Endovascular Treatment of Late Aortic Perforation due to Vena Cava Filter

Perforation of inferior vena cava (IVC) by filter struts ranges from 9% to 24%, and clinical sequelae and complications are unpredictable. The aim of this article was to report an unusual case of late complication of IVC filter that caused an IVC wall perforation and penetration of the filter's hooks in the aorta, which was treated by endovascular procedure. Molding strut tip by balloon angioplasty, its accommodation with a bare stent, and its coverage and protection with an endoprosthesis is probably the first technique reported so far in this situation.

Fatores envolvidos na migração das endopróteses em pacientes submetidos ao tratamento endovascular do aneurisma da aorta abdominal

A migração da endoprótese é complicação do tratamento endovascular definida como deslocamento da ancoragem inicial. Para avaliação da migração, verifica-se a posição da endoprótese em relação a determinada região anatômica. Considerando o aneurisma da aorta abdominal infrarrenal, a área proximal de referência consiste na origem da artéria renal mais baixa e, na região distal, situa-se nas artérias ilíacas internas. Os pacientes deverão ser monitorizados por longos períodos, a fim de serem identificadas migrações, visto que estas ocorrem normalmente após 2 anos de implante. Para evitar migrações, forças mecânicas que propiciam fixação, determinadas por características dos dispositivos e incorporação da endoprótese, devem predominar sobre forças gravitacionais e hemodinâmicas que tendem a arrastar a prótese no sentido caudal. Angulação, extensão e diâmetro do colo, além da medida transversa do saco aneurismático, são importantes aspectos morfológicos do aneurisma relacionados à migração. Com relação à técnica, não se recomenda implante de endopróteses com sobredimensionamento excessivo (> 30%), por provocar dilatação do colo do aneurisma, além de dobras e vazamentos proximais que também contribuem para a migração. Por outro lado, endopróteses com mecanismos adicionais de fixação (ganchos, farpas e fixação suprarrenal) parecem apresentar menos migrações. O processo de incorporação das endopróteses ocorre parcialmente e parece não ser suficiente para impedir migrações tardias. Nesse sentido, estudos experimentais com endopróteses de maior porosidade e uso de substâncias que permitam maior fibroplasia e aderência da prótese à artéria vêm sendo realizados e parecem ser promissores. Esses aspectos serão discutidos nesta revisão.

A total laparoscopic technique for endovascular thoracic stent graft deployment

Background: Limitations of endovascular thoracic aneurym treatment include small, tortuous, or severely calcified iliac Back, arteries. We present our experience with a total laparoscopic access to deploy thoracic endografts.Methods. A total laparoscopic left retrocolic approach was used in all cases. A Dacron conduit was laparoscopically sutured to either the iliac artery or to the aorta directly. The endograft was inserted through this conduit. After graft deployment, the Dacron prosthesis was tunneled to the groin and anastomosed with the femoral artery.Results. The laparoscopic procedure could successfully be performed in 11 patients. In six cases, the aorta was used as all access and in five patients, the iliac arteries were preferred. In one of these cases, the right iliac artery, was used for deployment of the endograft. After successful aorto- or ileo-femoral bypass grafting, all patients had an improvement of their ankle brachial index postoperatively. The mean operative time was almost four hours, including laparoscopy, laparoscopic anastomosis, endograft deployment, and femoral artery anastomosis or profundaplasty.Conclusion: Totally laparoscopic assisted graft implantation in aorta or iliac arteries provides a safe and effective access for the endovascular delivery system. However, further evaluation and long follow-up are necessary to ensure the potential advantages of this technique. It is a less invasive option to overcome access-related problems with thoracic endograft deployment, giving the patient the advantage of a totally minimal invasive procedure. (J Vasc Surg 2010;51:504-8.)

Internal carotid artery pseudoaneurysm after tonsillectomy treated by endovascular approach - A case report

Surgery on the head and neck region may be complicated by vascular trauma, caused by direct injury on the vascular wall. Lesions of the arteries are more dangerous than the venous one. The traumatic lesion may cause laceration of the artery wall, spasm, dissection, arteriovenous fistula, occlusion or pseudoaneurysm.We present a case of a child with a giant ICA pseudoaneurysm after tonsillectomy, manifested by pulsing mass and respiratory distress, which was treated by endovascular approach, occluding the lesion and the proximal artery with Histoacryl. We reinforce that the endovascular approach is the better way to treat most of the traumatic vascular lesions.

Surgical procedures used for post-traumatic neurogenic bladder in a cat: report case

Um gato de um ano de idade, macho, castrado, sem raça definida, foi encaminhado ao Hospital Veterinário Escola para avaliação de retenção urinária associada à subluxação nas vértebras T12-T13, que foi causada por um acidente automobilístico. Realizou-se a denervação do esfíncter uretral, por transecção dos nervos pudendo e hipogástrico, para permitir o esvaziamento da bexiga, porém três meses após a cirurgia inicial o animal apresentou recorrência da retenção urinária. Esfincterotomia endoscópica uretral foi então realizada, resultando em incontinência urinária por quatro meses.

Evaluating the knowledge of sports participants regarding dental emergency procedures

Dental trauma is a common consequence of sports practice to which emergency treatment is critical. The purpose of this study was to evaluate the knowledge of sports participants about dental trauma procedures, particularly tooth avulsion. A specific questionnaire concerning concepts, experiences and behaviors after dental trauma and the use of mouthguard was standardized and validated with 80 people. The validated questionnaire was then distributed to 310 sports participants. The results showed that 28.4% had experienced a kind of dental trauma; 42.6% would look for a dentist for treatment; 51.7% reimplanted or would reimplant the avulsed tooth; 6.5% would maintain the avulsed tooth in milk. Although 47.4% of the participants were aware of the possibility of accidents during sports practice, only 13.9% reported to use a mouthguard. This study showed an overall lack of knowledge of sportsmen and sportswomen with regards to tooth avulsion, thus reinforcing the need for educational campaigns to improve the immediate emergency treatment of tooth avulsion.

The effect of long-term disinfection procedures on hardness property of resin denture teeth

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

HARDNESS and SURFACE ROUGHNESS of RELINE and DENTURE BASE ACRYLIC RESINS AFTER REPEATED DISINFECTION PROCEDURES

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fracture resistance of bleached teeth restored with different procedures

This study evaluated the fracture resistance of teeth submitted to internal bleaching and restored with different non-metallic post. Eighty mandibular incisors were endodontically treated and randomly divided in 10 groups (n = 8): G1- restored with composite resin (CR), G2- CR + fiber-reinforced composite post (FRC, Everstick post, Sticktech) cemented with resin cement self-etch adhesive (RCS, Panavia F 2.0, Kuraray), G3- CR + FRC + self-adhesive resin cement (SRC, Breeze, Pentral Clinical), G4- CR+ glass fiber post (GF, Exacto Post, Angelus) + RCS, G5- CR + GF + SRC. The G6 to G10 were bleached with hydrogen peroxide (HP) and restored with the same restorative procedures used for G1 to G5, respectively. After 7 days storage in artificial saliva, the specimens were submitted to the compressive strength test (N) at 0.5 mm/min cross-head speed and the failure pattern was identified as either reparable (failure showed until 2 mm below the cement-enamel junction) or irreparable (the failure showed <2 mm or more below the cement-enamel). Data were analyzed by ANOVA and Tukey test (α = 0.05). No significant difference (p < 0.05) was found among G1 to G10. The results suggest that intracoronal bleaching did not significantly weaken the teeth and the failure patterns were predominately reparable for all groups. The non-metallic posts in these teeth did not improve fracture resistance.

Apical Sealing Quality of In Vitro Apicectomy Procedures After Using Both Er:YAG and Nd:YAG

The aim of this study was to evaluate the apical sealing of dentinal tubules after root-end surface cutting by using Er:YAG and Nd:YAG lasers. After root-canal instrumentation and filling, apices of 50 extracted maxillary canine human teeth were resected by Er: YAG with 400 mJ, 10 Hz, for 30 sec. The samples were randomly assigned to five groups (n = 10): (GI) treated without root-end cavity, but with Nd: YAG (1.0W, 10 Hz, 20 sec) for dentinal tubules sealing; (GII) treated with root-end cavity without the use of Nd: YAG; (GIII) treated with root-end cavity and Nd: YAG application; (GIV) treated with root-end cavity made by Er: YAG with no focus and without Nd: YAG application; and (GV) treated without root-end cavity and without Nd: YAG application. The root-end cavities were performed by using Er: YAG at 300 mJ, 10 Hz, for 20 sec. Subsequently, all teeth were waterproofed and immersed in 2% methylene blue for 48 h in a vacuum environment. The samples were longitudinally sectioned, and microleakage was measured. ANOVA and the Fisher LSD test showed that GIV was less susceptible to microleakage than were the other groups (p < 0.05). Interestingly, the use of the Er: YAG with no focus showed superior dentinal tubule sealing in comparison with the other groups, even with or without root-end cavity and Nd: YAG application.

An improved mouth-piece to prevent environmental contamination during radioaerosol inhalation procedures

The literature suggests that environmental contamination is common during labeled aerosol inhalation procedures in nuclear medicine. We have tested an adherent mask to prevent environmental contamination in 70 procedures. Two groups of patients were evaluated, Group 1 (60 inhalation cases in which the mask was used) presented no environmental contamination in 95% of the procedures (means of 553 dpm and 596 dpm before and after inhalation, p > 0.05, mean of the differences before/after inhalation 6.95, SD = 21.2 dpm) and the only 3 cases in which contamination did occur concerned bearded men; Group 2 (10 inhalation cases in which the mask was not used) showed large increases of environmental radioactive levels in 70% of the procedures (means of 601 dpm and 2,756 dpm before and after inhalation, p < 0.05, mean of the differences 3,066, SD = 2,98 dpm), We conclude that such a mask is very helpful in avoiding environmental contamination during radioaerosol inhalation procedures.

Evaluation of Lubricating Oil Preparation Procedures for the Determination of Al, Ba, Mo, Si and V by High-Resolution Continuum Source FAAS

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)