Incisuroplastia troclear e estabilização articular após transecção do ligamento cruzado cranial: Estudo clínico e radiográfico em cães

Avaliaram-se as alterações clínicas e radiográficas em nove cães adultos, após a transecção do ligamento cruzado cranial (LCCr) seguida da substituição ligamentar por retalho de fáscia lata, associada ou não à incisuroplastia troclear (ITR). O joelho direito (GI) foi submetido à ITR e posterior estabilização articular, e o esquerdo somente à substituição ligamentar (GC). Os animais foram avaliados nos períodos pré-operatório, pós-operatório (po) imediato e aos 30, 90 e 180 dias de po, período coincidente com o momento de eutanásia de subgrupos de três cães. A instabilidade articular e o grau de claudicação diminuíram significativamente durante o período de avaliação, apesar da instabilidade persistir durante a flexão articular. Observou-se decréscimo significativo do perímetro muscular da coxa aos 30 e 90 dias p.o. em ambos os grupos. Não foram evidenciadas alterações nos graus de extensão e flexão articulares, na rotação interna da tíbia, na amplitude de movimento articular ou de doença articular degenerativa (DAD) durante o período de avaliação em ambos os grupos. Conclui-se que a ITR, associada à técnica de estabilização articular, não produz alterações em nenhuma das variáveis estudadas em cães, quando comparada à estabilização intra-articular, isoladamente.

Movimento de gaveta em joelhos de cães submetidos à estabilização extracapsular após secção do ligamento cruzado cranial in vitro

A técnica TightRope, que procura aperfeiçoar a estabilização extra-capsular com sutura lateral, por meio da realização de mínimas incisões e criação de túneis ósseos em pontos isométricos, que permitem a inserção de mecanismo que anula o movimento de gaveta, além de reduzir a ocorrência de complicações graves. Dessa forma, objetivou-se avaliar a modificação da técnica TightRope em joelhos de cadáveres caninos com a finalidade de disponibilizar um procedimento simples e de custo reduzido para tratamento da Ruptura do ligamento cruzado cranial (RLCCr). Experimentalmente, foram utilizados 20 membros pélvicos de dez cadáveres caninos, provenientes do setor de patologia da Universidade Norte do Paraná, os quais pesavam entre 6,3 e 24kg. Para estabilização do LCCr, rompido intencionalmente, foi adotada a técnica de TightRope modificada utilizando fio de poliamida, cavilha e emprego de um parafuso ortopédico para proporcionar a fixação óssea. Comparando os valores de deslocamento obtidos durante a realização do movimento de gaveta previamente à ruptura do LCCr e após a realização do procedimento cirúrgico, observou-se que a modificação da técnica TightRope promoveu estabilidade significativa para a maioria (12 de 20) dos joelhos testados (P=0,0033). Contudo, essa estabilidade foi inferior, quando comparada à estabilidade do ligamento intacto.

Elongamento do enxerto de tendões do músculo grácial e semitendinoso humanos: estudo realizado em cadáveres de adultos jovens

Na cirurgia de reconstrução do ligamento cruzado anterior do joelho, os enxertos de tendões autólogos são a principal opção como substitutos ligamentares. Entretanto, uma das razões da falha da reconstrução ligamentar com tecidos moles é o estiramento ou elongamento do enxerto com o tempo. Neste trabalho, foram ensaiados oito tendões do músculo grácil e oito do músculo semitendinoso humanos, obtidos de quatro cadáveres do sexo masculino, com idade média de 24,5 anos. Cada tendão foi submetido a uma deformação relativa constante de 2,5% durante 600 s, com registro contínuo do relaxamento de força. A seguir, o tendão retornava ao seu comprimento inicial e era mantido num período de repouso de 300 s. Após este intervalo, um segundo ensaio, semelhante ao primeiro, era realizado. A velocidade de carregamento empregada foi de 10% do comprimento inicial do corpo de prova por segundo. Foram obtidos valores de força inicial, com 300 s e 600 s nos dois ensaios. A análise estatística sugere um comportamento mecânico mais uniforme para o tendão do músculo semitendinoso quando comparado ao tendão do músculo grácil.

Reconstrução do L.C.P. do joelho: técnica de fixação no leito tibial (INLAY). Avaliação objetiva e subjetiva de 30 casos

A reconstrução cirúrgica do ligamento cruzado posterior (L.C.P.) do joelho ainda permanece como um grande desafio terapêutico. Neste trabalho avaliamos 30 pacientes submetidos à reconstrução cirúrgica do L.C.P. com a técnica de fixação do enxerto tendíneo no leito tibial por abordagem direta (INLAY). 28 pacientes eram do sexo masculino e 2 do feminino, com idade média de 31,10 anos. O tempo médio de lesão foi de 34,24 meses em 67% dos casos a lesão foi secundária a acidente motociclístico. As lesões condrais e do ligamento cruzado anterior (L.C.A.) do joelho estavam presentes em 67% e 33% dos casos, respectivamente. Os pacientes foram avaliados objetivamente (teste de gaveta posterior) e subjetivamente (Escala de Lysholm). O seguimento pós-operatório médio foi de 21,7 meses. Cerca de 66% dos casos foram classificados como bom e excelente na avaliação subjetiva e objetiva. A análise estatística apresentou comportamento semelhante para as duas avaliações.Os resultados clínicos pós-operatórios obtidos neste trabalho têm nos encorajado a seguir com esta técnica cirúrgica.

Tratamento cirúrgico da fratura-avulsão da inserção tibial do L.C.P. do joelho: experiência de 21 casos

Avaliamos 21 pacientes, sendo 16 pacientes do sexo masculino e 5 do feminino, com idade média de 30 anos, foram submetidos à tratamento cirúrgico da fratura-avulsão do LCP. em 57% dos casos a lesão foi secundária a acidente motociclístico e 19% a acidente automobilístico. em 72% dos casos foi identificada uma lesão na face anterior do joelho. O tratamento cirúrgico consistiu na abordagem posterior do joelho e fixação do fragmento ósseo com parafuso e arruela em 18 casos; e amarrilhas trans-ósseas em 3 casos, onde o fragmento ósseo era muito pequeno. em 91% dos casos, a cirurgia foi realizada dentro dos primeiros 15 dias apos a lesão. Os pacientes foram avaliados objetivamente (teste de gaveta posterior) e subjetivamente (Escala de Lysholm), apos um seguimento pós-operatório mínimo de 12 meses. A análise estatística não mostrou diferença significativa, ao nível de 5%, entre as avaliações objetiva e subjetiva. A ausência de lesão ligamentar periférica pode ter contribuído para que os resultados clínicos pós-operatórios tenham avaliação subjetiva satisfatória; entretanto, a presença de uma posteriorização tibial residual sugere que a fratura-avulsão do ligamento cruzado posterior deve ser abordada não como uma lesão óssea pura, mas sim, como uma lesão ósteo-ligamentar.

Estudo morfológico de tendões flexores de eqüinos

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

Neotropical Monogenoidea .25. Anacanthorus penilabiatus n sp (Dadylogyridae, Anacanthorinae) from Piaractus mesopotamicus (Osteichthyes, Serrasalmidae), cultivated in the State of São Paulo, Brazil

Anacanthorus penilabiatus n. sp. is described from the serrasalmid fish, Piaractus mesopotamicus (Holmberg, 1887), cultivated in the Centro de Aquicultura, Universidade Estadual Paulista. The new species is characterized by having a relatively straight copulatory organ with a long ''lip'' on the distal margin and a median longitudinal flap, and a copulatory ligament. The large size of the infrapopulations of this species of parasite indicates that it should be considered a potential agent causing losses in aquaculture of the fish host.

Ultrastructure of early mineral deposition during hyaline layer formation in rat molars

There is no consensus on whether the first mineralized layer, the hyaline layer, that is juxtaposed to root dentine is a variety of dentine or cementum or even a tissue of epithelial origin. Some suggest that there is no intermediate tissue between the acellular extrinsic fibre cementum (AEFC) and the root dentine. Here, to study hyaline layer formation and mineralization we examined by transmission electron microscopy the early stages of root development in upper molars from 10 to 13 day old Wistar rats. In addition to conventionally processed material, undemineralized and unstained sections were examined, which showed the deposition of fine mineral crystals in contact with the mineralized surface of root dentine. Early mineralization of the hyaline layer occurred in the region of the inner basement membrane, which persisted between the inner cellular layer of Hertwig's epithelial root sheath and the outer mineralized root dentine. When the root sheath began its fragment, collagen fibrils From the developing periodontal ligament began to insert into the mineralising hyaline layer, which was 0.5-0.8 mum wide. As the fragmentation of the root sheath HERS increased, more collagen fibrils appeared intermingled with the mineralising hyaline layer. In more advanced stages, when the hyaline layer had become fully mineralized and the formation of the AEFC began, the hyaline layer could no longer be identified. Thus, the hyaline layer is clearly discernible at early stages of periodontal development. Subsequently, it is masked by intermingling of cementum and dentine and therefore it is not possible to detect it in the formed roots of rat molars. (C) 2001 Elsevier B.V. Ltd. All rights reserved.

Effect of different irrigation solutions and calcium hydroxide on bacterial LPS

Aim To evaluate the effect of biomechanical preparation with different irrigating solutions and calcium hydroxide dressing in dog root canals containing bacterial endotoxin (lipopolysaccharides; LPS).Methodology One hundred and forty premolar roots from seven dogs were filled with Escherichia coli LPS for 10 days (three roots were lost during histological processing). The following irrigating solutions were used for biomechanical preparation: 1% (group I, n = 20), 2.5% (group II, n = 19) and 5% sodium hypochlorite (group III, n = 19), 2% chlorhexidine digluconate (group IV, n = 20) and physiological saline solution (group V, n = 19). In group VI (n = 20), the LPS solution was maintained in the root canal during the entire experiment and in group VII (n = 20), after biomechanical preparation with saline solution, the root canals were filled with a calcium hydroxide dressing (Calen; control). After 60 days, the animals were sacrificed and the following parameters of periapical disease were evaluated: (a) inflammatory infiltrate, (b) periodontal ligament thickness, (c) cementum resorption and (d) bone resorption. Scores were given and data were analysed statistically with the Kruskal-Wallis and Dunn tests (P < 0.05).Results Histopathological evaluation showed that groups I-VI had more inflammatory infiltrate, greater periodontal ligament thickening and greater cementum and bone resorption (P < 0.05) compared to group VII, which received the calcium hydroxide intracanal dressing.Conclusions Biomechanical preparation with the irrigating solutions did not inactivate the effects of the endotoxin but the calcium hydroxide intracanal dressing did appear to inactivate the effects induced by the endotoxin in vivo.

Influence of photodynamic therapy on the development of ligature-induced periodontitis in rats

Background: the purpose of this study was to evaluate, histologically and radiographically, the effect of photodynamic therapy on the progression of experimentally induced periodontal disease in rats.Methods: Ligatures were placed at the first mandibular molar in rats. The animals were divided into four groups: group 1 (C) received no treatment; group 2 was treated topically with methylene blue (MB; 100 mu g/ml); group 3 was treated with low-level laser therapy (LLLT); and group 4 was treated topically with methylene blue followed by LLLT (4.5 J/cm(2)) (photodynamic therapy; PDT). Rats were sacrificed 5, 15, or 30 days postoperatively. Standardized radiographs were taken to measure bone loss around the mesial root surface of the first molar. Data were analyzed statistically (analysis of variance and Tukey test; P < 0.05). A scoring system was used to evaluate the connective tissue, periodontal ligament, and alveolar bone histologically. Data were analyzed statistically (Kruskal-Wallis test; P < 0.05).Results: Radiographic examination showed that there was significantly less bone loss in Group PDT compared to Group C at 5 and 15 days postoperatively. There was no significant difference in bone loss at 30 days. At 15 days, the histologic results showed significant differences in the extent of inflammatory reaction in the gingival tissue, with a greater extent of chronic inflammatory reaction in Group LLLT.Conclusion: PDT transiently reduced the periodontal tissue destruction.

Prevalence of different types of accessory canals in the furcation area of third molars

Background: Although there are several studies that show the prevalence and diameter of accessory root canals in the furcation area, there is a scarceness of studies that observe the trajectory and different types of cavo-interradicular canals. The aim of this study was to verify the prevalence of the different morphologic types of accessory canals in the furcation region in an attempt to show their trajectories.Methods: Forty submerged mandibular third molars were used, which were extracted and decalcified so that the microtomy procedure in the mesio-distal axial plane could be performed, obtaining semiserial sections with thicknesses of 5 mu m. The sections were stained with hematoxylin and eosin and observed under optical microscopy.Results: All of the morphologic types were found, whereas the proper accessory canals, type-A canals, were present in 10% of the specimens. The most prevalent canals were the sealed ones (type D), with a prevalence of 87.5%, followed by the blind ones (type B), with a prevalence of 75%. The loop accessory canals (type C), observed in only 5% of the teeth, were the least prevalent ones.Conclusions: Different morphologic types of accessory canals were found in the furcation area of submerged mandibular molars. The histologic method was effective to show the canal trajectories.

Mast cells in the developing avian eye

Mast cells are present in the eye of Gallus domesticus, appearing in the anterior uvea in embryos at stage 39 HH (13th day). In hatching and adult birds, they are present in the sclera, uvea, pectinate Ligament, and conjunctiva. Mast cells are absent in the cornea, retina, and pecten oculi.Maturing mast cells in the anterior eye segment appear as round cells having eccentric nuclei and a few cytoplasmic metachromatic granules, whose fluorescence increases during development. Mature cells are more numerous in late development, and their cytoplasm is rich in metachromatic and intensely fluorescent granules. Ultrastructurally, maturing mast cells display progranules and a few electron dense and homogeneous granules on one side of the cell. Mast cells of adult birds possess homogeneous cytoplasmic granules, some of which display protuberances that penetrate hollows of adjoining granules. Heterogeneous granules exhibiting latticed and mottled patterns are also present. The existence of mast cells in the anterior eye segment indicates that these cells might perform a physiological role during development and in aqueous humor outflow. They might modulate exchanges between blood and aqueous humor through chemical mediators present in their granules. (C) 1996 Wiley-Liss, Inc.

Fracture strength of bovine incisors after intra-radicular treatment with MTA in an experimental immature tooth model

Aim To evaluate, using an experimental immature tooth model, the fracture resistance of bovine incisors submitted to different reinforcement treatments with mineral trioxide aggregate (MTA).Methodology An immature tooth model was created by sectioning the coronal and apical portions of 40 bovine incisors 8 mm above and 12 mm below the cementoenamel junction. The root canals were irrigated with 1.0% sodium hypochlorite. They were enlarged both coronally and apically using number 703 carbide burs (ISO: 500-104-168-007-021) and their internal diameter was standardized to 2.1 mm. The specimens were assigned to four groups (n = 10): GI-control (without filling); GII-apical MTA plug + filling with gutta-percha and endodontic sealer; GIII-filling with MTA; GIV-apical MTA plug + filling with MTA + metallic post (Reforpost I). A polyether impression material was used to simulate the periodontal ligament. The specimens were submitted to a compressive load at a crosshead speed of 0.5 mm min(-1) in a servo-hydraulic universal testing machine (MTS 810) applied at 45 degrees to the long axis of the tooth until failure. Data were submitted to statistical analysis by the Kruskal-Wallis test at 5% significance level.Results GIV presented the highest fracture resistance (32.7N) and differed significantly from the other groups (P < 0.05). No statistically difference was found between GII (16.6N) and GIII (23.4N) (P > 0.05). GIII had a significantly higher fracture resistance than GI (P < 0.05).Conclusions the use of MTA + metallic post as an intra-radicular reinforcement treatment increased the resistance to fracture of weakened bovine teeth in an experimental immature tooth model.

Apoptosis in the epithelial cells of the rests of Malassez of the periodontium of rat molars

Background and Objectives: Epithelial rests of Malassez are clusters of cells derived from Hertwig's root sheath that remain in the periodontal ligament throughout life. Although it is known that the cells of Malassez proliferate, there are no studies showing that they undergo programmed cell death, i.e. apoptosis. In most tissues, proliferation is balanced by apoptosis. Thus we examined regions of the periodontium of young and adult rat molars in the hope of detecting apoptosis.Methods: Wistar rats aged 29, 45 and 120 days were killed with chloral hydrate (600 mg/kg). Fragments containing maxillary molars were removed and fixed in formaldehyde, decalcified, and embedded in paraffin and glycol methacrylate. Sections were stained with hematoxylin/eosin and the Terminal deoxynucleotidyl transferase-mediated dUTP Nick End Labeling (TUNEL) method for detection of apoptosis. Specimens were also fixed in glutaraldehyde-formaldehyde, decalcified and processed for transmission electron microscopy.Results: Epithelial rests of Malassez containing round/ovoid basophilic dense bodies and TUNEL-positive structures were found in all specimens examined. Ultrastructural examination revealed that some cells of Malassez contained masses of condensed peripheral chromatin and a shrunken cytoplasm exhibiting intact organelles - images typical of apoptosis. Moreover, round/ovoid electron-opaque structures appeared to be in the process of being engulfed by neighboring epithelial cells of Malassez.Conclusions: Our results demonstrate that epithelial cells of Malassez's rests undergo apoptosis in the developing and adult periodontium. Apoptosis may, together with proliferation, be part of the mechanism of turnover/remodelling of the cells of Malassez.

Referring to judo's sports injuries in São Paulo State Championship

Objective. - In a pioneer way, we investigated the morbidity of sports injuries referred by judo athletes from São Paulo State Championship.Material and methods. - Data collection from 93 senior judokas in State of São Paulo Judo Championship, through Referred Morbidity Inquiry about last year.Results. - One hundred and ten events were registered with a distribution frequency gradient of sprain > contusion > strain > ligament injury > partial and total dislocation. The most injured body areas were: knee (26.3%), shoulder (21.8%), fingers (17.3%), and ankle (10.0%). The most risky situation was when the athlete was training (standing, applying a blow) and it can be explained by the frequent and unprepared exposition of the athletes. Yearly lesion rate was 1.18 injuries per athlete/year.Conclusion. - Sprains constitute the most common judo injury, and athletes are more susceptible when they apply blows; discussion about the direction that the prevention should be applied remains opened. (c) 2006 Elsevier Masson SAS. All rights reserved.