Autopsy: quality assurance in the ICU

Objective: To examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU). To determine the rate of agreement of the basic and terminal causes of death and the types of errors in order to improve quality control of future care,Design, Retrospective study.Setting: Adult ICU in a university hospital.Patients: 30 adult patients who died in the ICU. with the exclusion of medicolegal cases.Methods and main results: Anatomo-clinical meetings were held to analyze the pre- and postmortem correlations in 30 consecutive autopsies at the ICU of the University Hospital, School of Medicine of Botucatu/ UNESP, from January 1994 to January 1997. The rate of correct clinical diagnoses of the basic cause was 66.7 %; in 23.3 % of cases, if the correct diagnosis was made, management would have been different, as would have been the evolution of the patient's course (Class I error): in 10 % of the cases the error would not have led to a change in management (Class II error). The rate of correct clinical diagnoses of terminal cause was 80 %.Conclusions: the rate of recognition of the basic cause was 66.7 %, which is consistent with the literature, but the Class I error rate was higher than that reported in the literature.

Use of the connective tissue graft for the coverage of composite resin-restored root surfaces in maxillary central incisors

The purpose of this article is to report the use of the subepithelial connective tissue graft technique combined with the coronally positioned flap on a composite resin-restored root surface to treat Miller Class I gingival recessions associated with deep cervical abrasions in maxillary central incisors. Clinical measurements, including gingival recession height, probing depth, and bleeding on probing (BoP), were recorded during the preoperative clinical examination and at 2, 6, 12, and 24 months postoperatively. During the follow-up periods, no periodontal pockets or BoP were observed. The periodontal tissue of the teeth presented normal color, texture, and contouring. In addition, it was observed that creeping attachment had occurred on the restoration. This case report shows that this form of treatment can be highly effective and predictable in resolving gingival recession associated with a deep cervical abrasion. (Quintessence Int 2012;43:597-602)

Prevalence of removable partial dentures users treated at the Aracatuba Dental School - UNESP

Objectives: The aim of this study was to evaluate the frequency of removable partial dentures (RPD) at the Aracatuba Dental School.Methods: The study was conducted by analysing 412 clinical history of patients attended at the RPD clinics in the period from 2000 to 2007.Results: 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classification found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anterior-posterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps.Conclusion: The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedy's classification was Class I in mandible and Class III in maxilla; the most common major connector was anterior-posterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws.

Prevalence of Malocclusion and Related Oral Habits in 5-to 6-year-old Children

Purpose: To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5- and 6-year-old children enrolled in Brazilian public elementary schools during 2010.Materials and Methods: Exams were conducted in 1385 children from 56 Brazilian elementary schools using the method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information about the type of arch, social and economic data and harmful oral habits of the children were collected through a structured questionnaire.Results: In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found. Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior crossbite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of posterior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle and finger sucking was reported by 17.2%.Conclusion: There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition.

Características cefalométricas do padrão face longa

Este estudo determinou as características cefalométricas dos indivíduos portadores de Padrão Face Longa em comparação com indivíduos Padrão I. Um total de 73 telerradiografias em norma lateral, sendo 34 Padrão Face Longa e 39 Padrão I, foram selecionadas com base na morfologia facial, não considerando as relações oclusais e sagitais. Foram avaliados: padrão de crescimento facial, alturas faciais anteriores e posterior, relação maxilo-mandibular, além das relações dentárias com suas bases apicais. de uma forma geral, os indivíduos Padrão Face Longa apresentaram grandes desvios em relação aos indivíduos Padrão I, sendo a doença decorrente de um desequilíbrio entre os componentes verticais. Pôde-se observar que os valores das grandezas AFAT, AFAI, AFATperp, AFAIperp, 1-PP, 6-PP, 1-PM, SNB, ANB, ângulo goníaco, ângulo plano mandibular, além das proporções AFAI/AFAT e AFAIperp/AFATperp, estavam significantemente alterados para os indivíduos Padrão Face Longa. Com base nos resultados obtidos neste estudo, verificou-se que esses indivíduos caracterizavam-se pelo padrão de crescimento vertical e por um aumento da altura facial anterior inferior - conseqüentemente, da altura facial anterior total - estando a deformidade localizada abaixo do plano palatino. Foram observados ainda um retrognatismo maxilar e mandibular, além da presença de extrusão dentária anterior (superior e inferior) e póstero-superior, com os incisivos superiores bem posicionados em suas bases e os inferiores lingualizados.

Características cefalométricas do Padrão Face Longa: considerando o dimorfismo sexual

OBJETIVO: o presente estudo avaliou a hipótese de variação das características cefalométricas de acordo com o gênero para portadores de Padrão Face Longa. METODOLOGIA: foi analisado um total de 73 telerradiografias em norma lateral, sendo 34 Padrão Face Longa e 39 Padrão I (grupo controle), selecionadas com base na morfologia facial, sem considerar as relações oclusais. Foram avaliados: padrão de crescimento facial, alturas faciais anteriores e posterior, relação maxilomandibular, além das relações dentárias com suas bases apicais. RESULTADOS: o grupo controle (Padrão I) apresentou dimorfismo (p<0,001) no comprimento efetivo da maxila e da mandíbula, além das alturas faciais avaliadas. Foram significantes também (p<0,05) as proporções entre as alturas faciais e as distâncias entre os incisivos e molares em relação aos planos palatino e mandibular. Para os portadores de Padrão Face Longa, as mesmas variáveis cefalométricas não mostraram diferenças significantes entre os gêneros (p>0,05), exceto os comprimentos efetivos da maxila e da mandíbula, além da altura facial anterior inferior e posterior (p<0,05). CONCLUSÕES: concluiu-se que enquanto ocorreu dimorfismo nos indivíduos Padrão I, para as estruturas influenciadas pela diferença no tamanho esquelético entre os gêneros, isso não aconteceu nos portadores de Padrão Face Longa. Essa maior similaridade entre os gêneros provavelmente ocorreu porque a deformidade, mais grave no gênero feminino, foi suficiente para anular o menor tamanho esquelético esperado para estes indivíduos.

O efeito da retração dos dentes anteriores sobre o ponto A em pacientes submetidos ao tratamento ortodôntico corretivo

OBJETIVO: avaliar o efeito da retração anterior sobre o ponto A sagital e verticalmente, bem como a correlação e a previsibilidade do comportamento dessas estruturas. METODOLOGIA: sessenta telerradiografias em norma lateral foram usadas, tomadas no início e no final do tratamento ortodôntico corretivo, a partir de 30 pacientes (22 feminino e 8 masculino) com idade entre 10 e 17 anos antes do tratamento, com má oclusão de Classe II, divisão 1 ou Classe I, que foram submetidos às extrações dos quatro primeiros pré-molares ou somente dois primeiros pré-molares superiores. Além das variáveis .1NA,1-NA, 1.PP e 1-A, mensurações lineares horizontais e verticais foram feitas em relação a uma linha de referência construída a partir da linha SN menos 7º e uma linha perpendicular a ela. Todos os dados foram mensurados duas vezes, e as médias foram submetidas ao teste t emparelhado, de correlação linear e de regressão. RESULTADOS: em média, o ponto A retraiu 0,71mm e movimentou para baixo 2,38mm, seguindo 1,03mm e 4,13mm de retração, respectivamente, do ápice radicular e da borda incisal, e 2,35mm de extrusão dentária. A retração do ponto A apresentou correlação positiva em relação ao ápice radicular (r = 0,75; alfa < 0,0001) e em relação à retração da borda incisal (r = 0,70; alfa < 0,0001), mostrando um comportamento ântero-posterior previsível. CONCLUSÕES: concluiu-se que o ponto A retraiu-se e movimentou-se para baixo seguindo o dente, e a retração do ponto A em relação aos incisivos foi previsível.

Clinical assessment of postoperative sensitivity in posterior composite restorations

This incidence of postoperative sensitivity was evaluated in resin-based posterior restorations. Two hundred and ninety-two direct restorations were evaluated in premolars and molars. A total of 143 Class I and 149 Class 11 restorations (MO/OD and MOD) were placed in patients ranging in age from 30 to 50 years. After the cavity preparations were completed, a rubber dam was placed, and the preparations were restored using a total-etch system (Prime & Bond NT) and a resin-based restorative material (TPH Spectrum). The patients were contacted after 24 hours and 7, 30 and 90 days postoperatively and questioned regarding the presence of sensitivity and the stimuli that triggered that sensitivity. The Chi-square and Fisher's Exact Test were used for statistical analysis. Evaluation at 24 hours after restorative treatment revealed statistically significant differences among the types of cavity preparations restored and the occurrence of postoperative sensitivity (p=0.0003), with a higher frequency of sensitivity in Class H MOD restorations (26%), followed by Class II MO/DO (15%) and Class I restorations (5%). At 7, 30 and 90 days after restorative treatment, there was a decrease in the occurrence of sensitivity for all groups. The percentage of sensitivity among the groups was not significantly different. This study shows that the occurrence of sensitivity is correlated with the complexity of the restoration.

Biocompatibility of resin-based materials used as pulp-capping agents

Aim To evaluate and compare the response of pulps of rats capped with resin-modified glass-ionomer cement (RMGIC) or self-etching adhesive system.Methodology Class I cavities were prepared on the occlusal surface of 54 maxillary first molars of 27 rats. Pulp exposure was performed on the cavity floor. The following resin-based materials were applied as pulp-capping agents: G1, Clearfil Liner Bond 2V (CLB 2V; Kuraray Co., Japan); G2, Vitrebond (VIT; 3M/ESPE, USA). In group 3 (control group), a calcium hydroxide/saline paste (CH; Labsynth, Brazil) was used. The cavities were restored with amalgam. After 7, 30 and 60 days, the animals were sacrificed and the jaws were processed for microscopic evaluation.Results Despite the inflammatory response caused by the experimental and the control materials at 7 days, pulpal healing associated with calcified barrier formation was observed at 60 days following the pulp therapy. Both resin-based materials promoted a large zone of cell-rich fibrodentine matrix deposition on the pulp horn related to the pulp exposure site, which was larger to VIT than to CLB 2V specimens. Tertiary dentine underneath the fibrodentine matrix was deposited by a layer of elongated pulpal cells. The remaining pulpal tissue exhibited normal histological characteristics. In the control group, healing and dentine-bridge formation was observed at 30 days. Pulpal breakdown occurred only when bacterial infection occurred.Conclusion Both experimental pulp-capping agents allowed pulpal healing characterized by cell-rich fibrodentine and tertiary dentine deposition as well as calcified barrier formation.

A discrepância de tamanho dentário, de Bolton, na oclusão normal e nos diferentes tipos de más oclusões, bem como sua relação com a forma de arco e o posicionamento dentário

Esta pesquisa teve como objetivo geral avaliar a discrepância de tamanho dentário, na oclusão normal e nos diferentes tipos de más oclusões e a sua relação com as medidas que determinam a forma de arco e o posicionamento dentário na região anterior. Para tanto, foram estudados 185 pares de modelos de gesso, divididos em 4 grupos: Grupo 1 (composto por 41 pares com Oclusão Normal, sendo 20 do gênero masculino e 21 do gênero feminino); Grupo 2 (composto por 44 pares com má oclusão de Classe I, divisão 1, sendo 22 do gênero masculino e 22 do gênero feminino); Grupo 3 (composto por 54 pares com má oclusão de Classe II, sendo 28 do gênero masculino e 26 do gênero feminino) e Grupo 4 (composto por 46 pares com Classe III, sendo 23 do gênero masculino e 23 do gênero feminino). Observou-se que não ocorreu dimorfismo sexual entre as discrepâncias de tamanho dentário e os diferentes tipos de oclusão dentária; as proporções estabelecidas por Bolton não se aplicaram ao grupo com Oclusão Normal; na Oclusão Normal, Classe I, Classe II e Classe III, houve um predomínio de excesso dentário total (RAZ12) no arco inferior; na Classe I houve uma igualdade na distribuição de excesso dentário anterior (RAZ6) nos arcos superior e inferior; na Oclusão Normal, Classe II e Classe III, ocorreu um predomínio de excesso dentário anterior (RAZ6) no arco inferior, em relação ao arco superior; os excessos dentários não contribuíram na ocorrência das más oclusões e as discrepâncias total e anterior (RAZ12 e RAZ6) não interferiram diretamente nas larguras e comprimentos dos arcos, bem como no posicionamento dos dentes anteriores.

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.

Molecular Characterization and Physical Mapping of Two Classes of 5S rDNA in the Genomes of Gymnotus sylvius and G. inaequilabiatus (Gymnotiformes, Gymnotidae)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Molecular organization of 5S rDNA in sharks of the genus Rhizoprionodon: insights into the evolutionary dynamics of 5S rDNA in vertebrate genomes

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

Morphology of the sternal gland in workers of Coptotermes gestroi (Isoptera, Rhinotermitidae)

The sternal gland is considered the only source of trail pheromones in termites. The morphology of the sternal gland was investigated in workers of Coptotermes gestroi using transmission and scanning electron microscopy. The results showed a small bilobed gland at the anterior part of the fifth abdominal sternite. The cuticular surface of the sternal gland showed a V-shaped structure with two peg sensilla in elevated socket and various campaniform sensilla. Pores and cuticular scale-like protuberances also occur in the glandular area. The ultrastructure showed a gland composed of class I cells and two different types of class 3 cells distinguished by location, different size and electron-density of secretory vesicles. Small class 3 cells (type 1) of the anterior lobe are inserted among class I cells and have weakly electron-dense vesicles associated with mitochondria, glycogen and smooth endoplasmic reticulum. The class 3 cells (type 2) of posterior lobe showed many round electron-lucent vesicles of secretion, abundant free ribosomes and a well-developed Golgi apparatus. Each class 3 cell is connected to the cuticle by a cuticular duct constituted by the receiving canal and the conducting canal. The secretion of class I cells is stored in an inner subcuticular reservoir that is delimited by the microvilli of these cells. This inner reservoir is large and crossed by the campaniform sensilla and ducts of two types of class 3 cells that open outside of the insect body. An exterior reservoir also is present between the fourth and fifth sternite. The complex structure of the sternal gland suggests multicomponents for the trail pheromone in the worker of C gestroi. (c) 2005 Elsevier Ltd. All rights reserved.

Ocorrência e morfologia de glândulas tegumentares no abdome de algumas abelhas (Hymenoptera: Apidae): um estudo comparado

No presente trabalho foi estudada a ocorrência, distribuição e morfologia de glândulas tegumentares do abdome em Exomalopsis auropilosa Spinola, Centris fuscata Lepeletier, Epicharis flava Friese e Xylocopa (Neoxylocopa) suspecta Moure & Camargo. Os resultados mostraram a ocorrência de glândulas epiteliais (classe I) e unicelulares (classe III) com distribuição dorsal (tergais) e ventral (esternais) sem que se pudesse caracterizar um padrão relacionável com a posição filogenética ou grau de sociabilidade. No entanto, verificou-se uma tendência para maior número de glândulas em espécies com algum grau de sociabilidade como E. auropilosa e X. suspecta.