Tunnel technique with a surgical maneuver to increase the graft extension: Case report with a 3-year follow-up

Background: This article reports a clinical case with a 3-year follow-up in which a subepithelial connective tissue graft (SCTG) was used with the tunnel technique to treat multiple gingival recessions, and describes a technique used to enlarge the extension of the graft.Methods: A 41 -year-old female patient was referred for evaluation and treatment of maxillary multiple recessions. Following basic therapy, the plaque index was 23%, and the gingival index was 12%. Thus, SCTG with the tunnel technique was proposed to provide root coverage of Miller Class I recession on teeth #8 through #11 and a Miller Class III recession on tooth #12. After the donor area had been prepared, SCTG was removed and split cross-sectionally to lengthen it. The graft was placed through the tunnel and sutured.Results: Two weeks after the surgical procedure, the tissue color was nearly homogeneous with some reddish regions where the connective tissue was left uncovered, and there were no signs of incisions or suture marks. After 3 years of follow-up, the mean coverage of the recessions was 2.2 +/- 0.7 mm (74.2%), which corresponded to the gain of keratinized tissue. In addition, a gain in tissue thickness was observed.Conclusion: In a long-term evaluation, the tunnel technique with the elongated SCTG was used successfully for treatment of multiple gingival recessions with an increase of the soft tissue volume and gain of keratinized tissue.

Healing process after surgical treatment with scalpel, electrocautery and laser radiation: histomorphologic and histomorphometric analysis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Surgical treatment of earlobe keloid with CO2 laser radiation: Case report and clinical standpoints

Keloids are considered to be benign hyperproliferative growths of dense fibrous tissue and overabundant deposition of disorganized, thick, hyalinized collagen that result from an abnormal tissue response to cutaneous injury. Keloids do not have a specific cause, although genetic predisposition is heavily implicated. We present a case report of a patient with an earlobe keloid that was treated with carbon dioxide laser radiation (CO2) with an 0.8-mm focus, 7 W, a power density of 2.5 W/cm(2), in a continuous mode. The patient was seen for follow-up 6 months later. An intact hole for placement of an earring was observed with a very good esthetic and functional result.

Surgical treatment of squamous cell carcinoma of tongue with carbon dioxide laser radiation (CO2)

In this clinical study, we proposed to observe the efficacy of the treatment of squamous cell carcinoma of the tongue (SCCT) by carbon dioxide (CO2) laser surgery. Twelve patients with SCCT were treated with excisional surgery using the CO2 laser with a spot size of 0.8 mm, 10 W, power density of 2.5 W/cm(2) in continuous mode, and under constant vacuum removal of the plume. The post surgical clinical evaluations were done every day until the sutures were removed and then every 7 days up to 1 month postoperatively. Subjects were re-examined quarterly until the fifth year post surgery. After 5 yr of follow-up for all subjects, there was no recurrence of the SCCT at the involved sites. The functional and aesthetic results observed were excellent. It is concluded that CO2 laser ablation of SCCT is an extremely useful surgical technique that can provide a clean field and is capable of providing surgical results consistent with accepted principles of oncological surgery. (C) 2012 Laser Institute of America.

The effect of non-surgical periodontal therapy on peroxidase activity in diabetic patients: a case-control pilot study

Objective: To evaluate the effect of periodontal therapy on clinical parameters as well as on total salivary peroxidase (TSP) activity and myeloperoxidase (MPO) activity in the gingival crevicular fluid (GCF) of patients with type 2 diabetes mellitus (DM2) and of systemically healthy individuals.Material and Methods: Twenty DM2 subjects with inadequate metabolic control (test group) and 20 systemically healthy individuals (control group), both groups with chronic periodontitis, were enrolled. Periodontal clinical parameters, namely periodontal probing depth (PD), clinical attachment level (CAL), visible plaque index (VPI), bleeding on probing (BOP), gingival bleeding index (GBI) and presence of suppuration (SUP), as well as TSP activity and GCF MPO activity, were assessed before and 3 months after non-surgical periodontal therapy.Results: At baseline and 3 months post-treatment, the test group presented a higher percentage of sites with VPI and BOP (p < 0.01). MPO activity in the GCF presented lower values (p < 0.05) for the test group at both baseline and the post-treatment period. The periodontal treatment resulted in a significant improvement of most clinical and enzymatic parameters for both groups (p < 0.05).Conclusions: In both groups, the periodontal therapy was effective in improving most clinical parameters and in reducing salivary and GCF enzymatic activity. The diabetic individuals presented lower MPO activity in the GCF.

Surgical treatment of pulmonary aspergilloma

The objective of this study was to analyze the outcome of surgical treatment of pulmonary aspergilloma. To that end, we evaluated 14 adult patients so treated between 1981 and 2009 at the Botucatu School of Medicine University Hospital, in the city of Botucatu, Brazil. Data were collected from the medical records of the patients. Ten patients (71%) presented with simple pulmonary aspergilloma, and 4 (29%) presented with complex pulmonary aspergilloma. Hemoptysis was the most common symptom, and tuberculosis was the most prevalent preexisting lung disease. Two patients (14%) underwent surgery on more than one occasion. There were no intraoperative deaths. Half of the patients developed postoperative complications, prolonged air leak and empyema being the most common.

Oroantral communication closure using a pedicled buccal fat pad graft

OBJETIVO: O objetivo desde artigo foi relatar um caso clínico de fechamento de fístula buco-sinusal tardia utilizando rotação de enxerto de tecido adiposo pediculado do corpo adiposo da bochecha. DESCRIÇÃO do CASO: Paciente do sexo masculino, 66 anos, leucoderma, em boas condições de saúde geral, foi encaminhado para fechamento de extensa comunicação buco-sinusal. Ao exame clínico, observou-se uma fístula de aproximadamente 10 mm de diâmetro comunicando a cavidade oral com o seio maxilar. A cirurgia foi realizada em nível ambulatorial, sob anestesia local, para fechar a fístula buco-sinusal com um enxerto de tecido adiposo pediculado do corpo adiposo da bochecha. A reparação da ferida e o fechamento do defeito foram observados no pós-operatório de 30 dias, com completa epitelização. CONCLUSÃO: O enxerto pediculado de tecido do corpo adiposo da bochecha mostrou-se uma alternativa simples, eficaz e segura no fechamento mediato da fístula buco-sinusal apresentada neste caso clínico.

Three-dimensional magnetic resonance reconstruction images before and after surgical therapy of spontaneous canine brain tumors

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

Case-case-control study of risk factors for nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus in a medical-surgical intensive care unit

Nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus (MRSA) often precedes the development of nosocomial infections. In order to identify risk factors for MRSA colonization, we conducted a case-case-control study, enrolling 122 patients admitted to a medical-surgical intensive care unit (ICU). All patients had been screened for nasopharyngeal colonization with S. aureus upon admission and weekly thereafter. Two case-control studies were performed, using as cases patients who acquired colonization with MRSA and methicillin-susceptible S. aureus (MSSA), respectively. For both studies, patients in whom colonization was not detected during ICU stay were selected as control subjects. Several potential risk factors were assessed in univariate and multivariable (logistic regression) analysis. MRSA and MSSA were recovered from nasopharyngeal samples from 27 and 10 patients, respectively. Independent risk factors for MRSA colonization were: length-of-stay in the ICU (Odds Ratio [OR]=1.12, 95%Confidence Interval[CI]=1.06-1.19, p<0.001) and use of ciprofloxacin (OR=5.05, 95%CI=1.38-21.90, p=0.015). The use of levofloxacin had a protective effect (OR=0.08, 95%CI=0.01-0.55, p=0.01). Colonization with MSSA was positively associated with central nervous system disease (OR=7.45, 95%CI=1.33-41.74, p=0.02) and negatively associated with age (OR=0.94, 95%CI=0.90-0.99, p=0.01). In conclusion, our study suggests a role for both cross-transmission and selective pressure of antimicrobials in the spread of MRSA.

Surgical and chemical castration induce differential histological response in prostate lobes of Mongolian gerbil

The present study describes the short-term alterations in the prostate ventral and dorsal lobe of the adult Mongolian gerbil, in response to two different androgen suppression approaches. Groups (n = 6) of 16-week-old gerbils were maintained intact or subjected, either to the bilateral surgical castration I week previously or to daily subcutaneous injections of Flutamide (10 mg/kg body weight) for 7 days. The main microscopic features of both prostate lobes in these groups were compared using conventional paraffin tissue sections, measurements of acinar epithelial height and stereological data of main gland components (acini, collagen fibers and fibromuscular stroma). Marked alterations were observed in the basement membrane of the ventral lobe after both surgical and chemical castration, such as an increase in thickness and collagen staining. A low degree of epithelial atrophy was detected in the dorsal lobe following both androgen suppression approaches in comparison with that found in the ventral lobe, indicating that this lobe is not so responsive to testosterone ablation induced by castration or Flutamide treatment, at least insofar as secretory activity is concerned. However, the dorsal lobe exhibited marked stromal modification, such as an increase in collagen fibers following castration and an increase in fibromuscular stroma following Flutamide-treatment. Thus, the histological and quantitative data indicates a differential short-term response of the prostate dorsal lobe to surgical castration and Flutamide therapy, suggesting the existence of lobe-specific mechanisms for stromal remodeling. (c) 2006 Elsevier Ltd. All rights reserved.

Submucous myomas: A new presurgical classification to evaluate the viability of hysteroscopic surgical treatment - Preliminary report

STUDY OBJECTIVE: To develop a new preoperative classification of submucous myomas for evaluating the viability and the degree of difficulty of hysteroscopic myomectomy.DESIGN: Retrospective study (Canadian Task Force classification II-3)SETTING: University teaching hospitals.PATIENTS: Fifty-five patients who underwent hysteroscopic resection of submucous myomas.INTERVENTION: the possibility of total resection of the myoma, the operating time, the fluid deficit, and the frequency of any complications were considered. The myomas were classified according to the Classification of the European Society for Gynaecological Endoscopy (ESGE) and by our group's new classification (NC), which considers not only the degree of penetration of the myoma into the myometrium, but also adds in such parameters as the distance of the base of the myoma from the uterine wall, the size of the nodule (cm), and the topography of the uterine cavity. The Fisher's exact test, the Student's t test, and the analysis of variance test were used in the statistical analysis. A p value less than .05 in the two-tailed test was considered significant.MEASUREMENTS AND MAIN RESULTS: In 57 myomas, hysteroscopic surgery was considered complete. There was no significant difference among the three ESGE levels (0, 1, and 2). Using the NC, the difference between the numbers of complete surgeries was significant (p < .001) for the two levels (groups I and H). The difference between the operating times was significant for the two classifications. With respect to the fluid deficit, only the NC showed significant differences between the levels (p = .02).CONCLUSIONS: We believe that the NC gives more clues as to the difficulties of a hysteroscopic myomectomy than the standard ESGE classification. It should be stressed that the number of hysteroscopic myomectomies used in this analysis was low, and it would be interesting to evaluate the performance of the classification in a larger number of patients. (c) 2005 AAGL. All rights reserved.

Surgical treatment of erythroleukoplakia in lower lip with carbon dioxide laser radiation

Erythroplakia is considered to represent a premalignant condition and is felt to be at high risk to progress to oral cancer development. When the lesion presents with red and white mucosal alterations concomitantly, the term erythroleukoplakia is used. However, in erythroleukoplakia lesions, the red or erythroplakia areas have been shown to be most likely to demonstrate dysplastic changes compared to the white hyperkeratotic areas. We present a case of patient with erythroleukoplakia involving the lower lip that was treating with carbon dioxide laser radiation (CO2) with 0.8 mm focus, 5 W, power density of 2.5 W/cm(2) in continuous. After the surgery, the vaporized surface was protected with a fibrinolisine + chloramphenicol cream. To date, after 6 months, there has been no clinically evident recurrence on the vermilion area. The functional and esthetic results observed were judged to be excellent.

Surgical treatment of ranula with carbon dioxide laser radiation

Ranula is a mucous extravasation cyst which appears as a swelling in the submental and submandibular regions. Several surgical techniques to manage ranula have been described in the literature, these techniques include the CO2 laser radiation excision. Four patients were treated for intraoral ranula in the floor of the mouth by marsupialization with carbon dioxide laser radiation with defocused beam, continuous mode and 4 watts of power. There were no complications and no recurrences have occurred to date. The results showed that carbon dioxide laser radiation gives optimal results with no need for suture and good wound healing.

Effect of root canal filling material and level of surgical injury on periodontal healing in dogs

Some divergencies in the literature about periodontal healing after surgical injury stimulated the development of this experiment. The root canals of dogs' teeth were negotiated and filled by the lateral condensation technique with two kinds of sealers: Sealapex and zinc oxide-eugenol cement. In the second session, the bone tissue was exposed and one cavity was made at the apical third of the root and another at the border between the coronal and middle thirds, both penetrating into the root canal. Six months later the animals were sacrificed and the specimens prepared for histopathologic analysis. The results showed that the kind of filling material and the level of the periodontal wound exposing the root canal can influence the healing process (P<0.01).