Use of 4 Immediately Loaded Zygomatic Fixtures for Retreatment of Atrophic Edentulous Maxilla After Complications of Maxillary Reconstruction

This article reports the 20-month clinical outcome of the use of 4 zygomatic implants with immediate occlusal loading and reverse planning for the retreatment of atrophic edentulous maxilla after failed rehabilitation with autogenous bone graft reconstruction and maxillary implants. The intraoral clinical examination revealed mispositioned and loosened implants underneath a maxillary complete denture. The panoramic radiograph showed 6 maxillary implants. One implant was displaced into the right maxillary sinus, and the implant anchored in the region of tooth 21 was fractured. The other implants presented peri-implant bone loss. The implants anchored in the regions of teeth 21 to 23 and 11 to 13 were first removed. After 2 months, the reverse planning started with placement of 4 zygomatic fixtures, removal of the implants migrated into the sinus cavity and anchored in the region of tooth 17, and installation of a fixed denture. After 20 months of follow-up, no painful symptoms, peri-implant inflammation or infection, implant instability, or bone resorption was observed. The outcomes of this case confirm that the zygoma can offer a predictable anchorage and support function for a fixed denture in severely resorbed maxillae.

Oral Piercing Complications Among Teenage Students

Purpose: The aim of this study was to assess the use of oral piercings and their possible associated complications among students aged 14 to 18 years.Materials and Methods: A total of 927 students from private and state schools were invited to participate in this study. The participants were subjected to clinical examination, and a questionnaire was provided for collecting the following data: gender, piercing location, oral complications or alterations, and cleaning frequency.Results: Among the students who were analysed, 33 had oral piercings (3.6%); 69.70% were from state schools and 30.30% were from private schools. There was a slight predominance of males (54.55%) compared with females (45.45%). The tongue was the most common location for piercing (66.6%). The complications and alterations associated with the use of piercing were observed in 74.3% of the cases.Conclusions: In the population that was studied, oral piercing was observed in a small percentage of teenage students (3.6%) and there were local complications associated with its use.

Genotypes of the mannan-binding lectin gene and susceptibility to visceral leishmaniasis and clinical complications

Background. Visceral leishmaniasis (VL) is almost always lethal if not treated, but most infections with the causative agents are clinically silent. Mannan-binding lectin (MBL), an opsonin, is a candidate molecule for modifying progression to VL because it may enhance infection with intracellular pathogens. Mutations in the MBL2 gene decrease levels of MBL and may protect against development of VL. This case-control study examines genotypes of MBL2 and levels of MBL in individuals presenting with different outcomes of infection with Leishmania chagasi.Methods. Genotypes for MBL2 and levels of serum MBL were determined in uninfected control subjects (n=76) and in individuals presenting with asymptomatic infection (n=90) or VL (n=69).Results. Genotypes resulting in high levels of MBL were more frequent (odds ratio [OR], 2.5 [95% confidence interval {CI}, 1.3-5.0]; P=.006) among individuals with VL than among those with asymptomatic infections and were even more frequent (OR, 3.97 [95% CI, 1.10-14.38];P=.043) among cases of VL presenting with clinical complications than among those with uneventful courses. Serum levels of MBL were higher (P=.011) in individuals with VL than in asymptomatic infections.Conclusions. Genotypes of the MBL2 gene predict the risk for developing VL and clinical complications in infections with L. chagasi.

Bone regeneration in cranioplasty and clinical complications in rabbits with alloxan-induced diabetes

This research evaluated the bone repair process in surgical defects created on the parietal bones of diabetic rabbits using the guided bone regeneration technique to observe the effects of alloxan in the induction of diabetes mellitus. Twenty-four adult rabbits were divided into three study groups: control (C), diabetic (D) and diabetic associated to polytetrafluoroethylene (PTFE) membrane (D-PTFE). For diabetes induction the animals received one dose of monohydrated alloxan (90 mg/kg) by intravenous administration in the auricular or femoral vein. In group D-PTFE the membrane covered both the floor and the surface of the bone defect. In groups D and C, the bone defect was filled up with blood clot. The specimens were fixed in 10% formol and prepared for histomorphometric analysis. The results showed that the 90 mg/kg dose of monohydrate alloxan was sufficient to promote diabetes mellitus when administered in the auricular vein. Bone regeneration was slower in the diabetic group when compared with the control and diabetic-PTFE groups, but there was no significant statistical difference between the two experimental groups (D and D-PTFE). The oral and general clinical complications among the diabetics were weight loss, polyuria, polyphagia and severe chronic gingivitis.

Gingival recession associated with noncarious cervical lesions: Combined periodontal-restorative approach and the treatment of long-term esthetic complications

The combined periodontalrestorative approach (that is, a connective tissue graft for root coverage and NCCL restoration with RMGI cement) has demonstrated significant root coverage and a good esthetic outcome. In some cases, though, the color of an RMGI restoration can change over time, compromising esthetics. In this situation, applying composite resin over an RMGI restoration can be a conservative approach to satisfy the patient's esthetic complaint. Long-term observation is necessary to evaluate the stability of the results and establish the success of this approach over time.

Time in the stair-climbing test as a predictor of thoracotomy postoperative complications

Objectives: The stair-climbing test as measured in meters or number of steps has been proposed to predict the risk of postoperative complications. The study objective was to determine whether the stair-climbing time can predict the risk of postoperative complications. Methods: Patients aged more than 18 years with a recommendation of thoracotomy for lung resection were included in the study. Spirometry was performed according to the criteria by the American Thoracic Society. The stair-climbing test was performed on shaded stairs with a total of 12.16 m in height, and the stair-climbing time in seconds elapsed during the climb of the total height was measured. The accuracy test was applied to obtain stair-climbing time predictive values, and the receiver operating characteristic curve was calculated. Variables were tested for association with postoperative cardiopulmonary complications using the Student t test for independent populations, the Mann-Whitney test, and the chi-square or Fisher exact test. Logistic regression analysis was performed. Results: Ninety-eight patients were evaluated. Of these, 27 showed postoperative complications. Differences were found between the groups for age and attributes obtained from the stair-climbing test. The cutoff point for stair-climbing time obtained from the receiver operating characteristic curve was 37.5 seconds. No differences were found between the groups for forced expiratory volume in 1 second. In the logistic regression, stair-climbing time was the only variable associated with postoperative complications, suggesting that the risk of postoperative complications increases with increased stair-climbing time. Conclusions: The only variable showing association with complications, according to multivariate analysis, was stair-climbing time. © 2013 by The American Association for Thoracic Surgery.

Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

Dialysis complications in AKI patients treated with extended daily dialysis: is the duration of therapy important?

This trial aimed to compare the dialysis complications occurring during different durations of extended daily dialysis (EDD) sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline dose ranging from 0.3 to 0.7 mu g/kg/min. Patients were divided into two groups randomly: in G1, 6 h sessions were performed and, in G2, 10 h sessions were performed. Seventy-five patients were treated with 195 EDD sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalaemia, and hypophosphataemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 and G2 were similar in male predominance and SOFA. There was no significant difference between the two groups in hypotension, filter clotting, hypokalaemia, and hypophosphataemia. However, the group treated with sessions of 10 hours showed higher refractory to clinical measures for hypotension and dialysis sessions were interrupted more often. Metabolic control and fluid balance were similar between G1 and G2. In conclusion, intradialysis hypotension was common in AKI patients treated with EDD. There was no difference in the prevalence of dialysis complications in patients undergoing different durations of EDD.

Cardiovascular Complications following Chronic Treatment with Cocaine and Testosterone in Adolescent Rats

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

Lactato sanguíneo em cães com insuficiência cardíaca congestiva decorrente de degeneração valvular mitral

Pós-graduação em Medicina Veterinária - FCAV

Treatment and complications of orbito-zygomatic fractures

The aim of the present study was to analyze the etiology, type and treatment employed in the orbito-zygomatic fractures (OZ). Also, postoperative complications are described and correlated with the type of treatment used. Fifty patients with OZ fractures were evaluated. Orbital fractures in which the zygomatic bone was not involved were excluded. Epidemiologic data and characteristics of treatment such as the type of material used for osteosynthesis, number of anatomical sites on which rigid internal fixation (RIF) was applied, surgical approaches and associated complications were recorded. The main causes of trauma were motorcycle and bicycle accidents, constituting 52% of the sample. The osteosynthesis system used was the 2.0 mm, except in four patients in whom the 1.5mm system was used for fixation at the infra-orbital rim. A total of 18% of the patients required reconstruction of the internal orbit and in all cases titanium mesh was used. 46% of the patients received RIF in three anatomical sites, most in the fronto-zygomatic suture, infra-orbital rim and zygomatic-maxillary buttress. The most frequent complication was paresthesia of the infra-orbital nerve (34 patients, 68%). Other findings were also discussed with the intent of better understanding the treatment of the OZ fractures.

Auditory brainstem response in term and preterm infants with neonatal complications: the importance of the sequential evaluation

Introduction Literature data are not conclusive as to the influence of neonatal complications in the maturational process of the auditory system observed by auditory brainstem response (ABR) in infants at term and preterm. Objectives Check the real influence of the neonatal complications in infants by the sequential auditory evaluation. Methods Historical cohort study in a tertiary referral center. A total of 114 neonates met inclusion criteria: treatment at the Universal Neonatal Hearing Screening Program of the local hospital; at least one risk indicator for hearing loss; presence in both evaluations (the first one after hospital discharge from the neonatal unit and the second one at 6 months old); all latencies in ABR and transient otoacoustic emissions present in both ears. Results The complications that most influenced the ABR findings were Apgar scores less than 6 at 5 minutes, gestational age, intensive care unit stay, peri-intraventricular hemorrhage, and mechanical ventilation. Conclusion Sequential auditory evaluation is necessary in premature and term newborns with risk indicators for hearing loss to correctly identify injuries in the auditory pathway.

Surgical time and complications of total transvaginal (total-NOTES), single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches

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