The Use of Etoricoxib and Celecoxib for Pain Prevention After Periodontal Surgery: A Double-Masked, Parallel-Group, Placebo-Controlled, Randomized Clinical Trial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Development, characterization and clinical use of a biodegradable composite scaffold for bone engineering in oro-maxillo-facial surgery

We have developed a biodegradable composite scaffold for bone tissue engineering applications with a pore size and interconnecting macroporosity similar to those of human trabecular bone. The scaffold is fabricated by a process of particle leaching and phase inversion from poly(lactide-co-glycolide) (PLGA) and two calcium phosphate (CaP) phases both of which are resorbable by osteoclasts; the first a particulate within the polymer structure and the second a thin ubiquitous coating. The 3-5 mu m thick osteoconductive surface CaP abrogates the putative foreign body giant cell response to the underlying polymer, while the internal CaP phase provides dimensional stability in an otherwise highly compliant structure. The scaffold may be used as a biomaterial alone, as a carrier for cells or a three-phase drug delivery device. Due to the highly interconnected macroporosity ranging from 81% to 91%, with macropores of 0.8 similar to 1.8 mm, and an ability to wick up blood, the scaffold acts as both a clot-retention device and an osteoconductive support for host bone growth. As a cell delivery vehicle, the scaffold can be first seeded with human mesenchymal cells which can then contribute to bone formation in orthotopic implantation sites, as we show in immune-compromised animal hosts. We have also employed this scaffold in both lithomorph and particulate forms in human patients to maintain alveolar bone height following tooth extraction, and augment alveolar bone height through standard sinus lift approaches. We provide a clinical case report of both of these applications; and we show that the scaffold served to regenerate sufficient bone tissue in the wound site to provide a sound foundation for dental implant placement. At the time of writing, such implants have been in occlusal function for periods of up to 3 years in sites regenerated through the use of the scaffold.

Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery

Study Objectives: To evaluate the effects of intraoperative skin-surface warming with and without 1 hour of preoperative warming, in preventing intraoperative hypothermia, and postoperative hypothermia, and shivering, and in offering good conditions to early tracheal extubation. Design: Prospective, randomized, blind study. Setting: Teaching hospital. Patients: 30 ASA physical status I and II female patients scheduled for elective abdominal surgery. Interventions: Patients received standard general anesthesia. In 10 patients, no special precautions were taken to avoid hypothermia. Ten patients were submitted to preoperative and intraoperative active warming. Ten patients were only warmed intraoperatively. Measurements and Main Results: Temperatures were recorded at 15-minute intervals. The patients who were warmed preoperatively and intraoperatively had core temperatures significantly more elevated than the other patients during the first two hours of anesthesia. All patients warmed intraoperatively were normothermic only at the end of the surgery. The majority of the patients warmed preoperatively and intraoperatively or intraoperatively only were extubated early, and none had shivering. In contrast, five unwarmed patients shivered. Conclusions: One hour of preoperative warning combined with intraoperative skin-surface warming, not simply intraoperative warming alone, avoided hypothermia caused by general anesthesia during the first two hours of surgery. Both methods prevented postoperative hypothermia and shivering and offered good conditions for early tracheal extubation. © 2003 by Elsevier B.V.

Comparison of hemodynamic, clinicopathologic, and gastrointestinal motility effects and recovery characteristics of anesthesia with isoflurane and halothane in horses undergoing arthroscopic surgery

Objective - To compare hemodynamic, clinicopathologic, and gastrointestinal motility effects and recovery characteristics of halothane and isoflurane in horses undergoing arthroscopic surgery. Animals - 8 healthy adult horses. Procedure - Anesthesia was maintained with isoflurane or halothane (crossover study). At 6 intervals during anesthesia and surgery, cardiopulmonary variables and related derived values were recorded. Recovery from anesthesia was assessed; gastrointestinal tract motility was subjectively monitored for 72 hours after anesthesia. Horses were administered chromium, and fecal chromium concentration was used to assess intestinal transit time. Venous blood samples were collected for clinicopathologic analyses before and 2, 24, and 48 hours after anesthesia. Results - Compared with halothane-anesthetized horses, cardiac index, oxygen delivery, and heart rate were higher and systemic vascular resistance was lower in isoflurane-anesthetized horses. Mean arterial blood pressure and the dobutamine dose required to maintain blood pressure were similar for both treatments. Duration and quality of recovery from anesthesia did not differ between treatments, although the recovery periods were somewhat shorter with isoflurane. After isoflurane anesthesia, gastrointestinal motility normalized earlier and intestinal transit time of chromium was shorter than that detected after halothane anesthesia. Compared with isoflurane, halothane was associated with increases in serum aspartate transaminase and glutamate dehydrogenase activities, but there were no other important differences in clinicopathologic variables between treatments. Conclusions and clinical relevance - Compared with halothane, isoflurane appears to be associated with better hemodynamic stability during anesthesia, less hepatic and muscle damage, and more rapid return of normal intestinal motility after anesthesia in horses undergoing arthroscopic procedures.

Molecular typing of bacterial strains isolated from the Clinics of Surgery and Face Traumatology at Ribeirão Preto University

The number of infectious illnesses and cross infection is spreading drastically among the professionals of the dentistry area. Controlling infections in dental offices is one of the greatest challenges for dentists and researchers of this area. In practice, contacts between professionals and infected patients are relatively common. The transmission of infectious illnesses from the health professionals to their patients is also possible, either by direct contact or due to lack of cares in relation to biosafety, increasing the cycle of cross infection. Molecular typing is necessary since these methods are an important tool to investigate the epidemiology of bacterial infections. Moreover, they are important for supplying information and precedents through the analysis of the infectious agents eletrophoretic profile. The aim of the present work was to analyze by molecular typing the genomic profile of aerobic bacteria isolated from the Clinics of Surgery and Face Traumatology, Ribeirão Preto University, through the technique of Random Amplified Polymorphic DNA (RAPD) and grouped based on similarity coefficients. Of two carried out collections, 55 strains were isolates belonging to the following groups: 12 Staphylococcus aureus; 13 Klebsiella oxytoca; 7 Klebsiella pneumoniae; 8 Pseudomonas aeruginosa; 5 Hafnia alvei; 5 Proteus vulgaris; 4 Escherichia coli; and 1 Proteus mirabilis. The adopted molecular typing strategy allowed the determination of the persistence of definitive strains at the collection environment, besides the identification of strains proceeding from the hands and gloves of the surgeon dentists, which could have been found in distant places as sinks and reflectors.

Preemptive dexamethasone and etoricoxib for pain and discomfort prevention after periodontal surgery: A double-masked, crossover, controlled clinical trial

Background: Several anti-inflammatory drugs have been used to reduce pain and discomfort after periodontal surgeries. This study evaluates the efficacy of using etoricoxib and dexamethasone for pain prevention after open-flap debridement surgery. Methods: For this prospective, double-masked, crossover, placebo-controlled, randomized clinical trial, open-flap debridement surgeries were performed on 15 patients (eight males and seven females, age range 20 to 56 years: mean age ± SD: 40 ± 9.7 years) who presented with chronic periodontitis after nonsurgical periodontal therapy at three quadrants. Each patient underwent three surgical procedures at intervals of 30 days and received one of the following premedication protocols 1-hour before surgery: group 1 = placebo, group 2 = 8 mg dexamethasone, and group 3 = 120 mg etoricoxib. Rescue medication (750 mg acetaminophen) was given to each patient who was instructed to take it when necessary. Pain intensity and discomfort were evaluated by a 101-point numeric rate scale and a four-point verbal rate scale, respectively, hourly for the first 8 hours after surgery and three times a day on the following 3 days. Results: The results demonstrate that groups 2 and 3 present reduced postoperative pain-intensity levels compared to group 1. There were statistically significant differences at the 4, 5, 6, 7, and 8 hour-periods after surgery (Friedman test; P<0.05). Furthermore, rescue-medication intake was significantly lower for groups 2 and 3 than for group 1 (analysis of variance; P<0.02). Conclusion: The adoption of a preemptive medication protocol using etoricoxib or dexamethasone may be considered effective for pain and discomfort prevention after open-flap debridement surgeries.

Deep venous thrombosis prophylaxis in oral and maxillofacial surgery: a Brazilian survey

Background : Deep venous thrombosis (DVP) is a frequent disease. Prophylaxis is the best means to reduce its incidence, for lowering morbidity and mortality rates and treatment costs caused by its complications. Objective : To evaluate the knowledge and use of any kind of DVT prophylaxis by Brazilian Oral and Maxillofacial surgeons. Materials and Methods : A questionnaire was sent to all Oral and Maxillofacial surgeons associated to the Brazilian College of Oral and Maxillofacial Surgeons that have a valid e-mail address. The data retrieved was evaluated and tabulated. Results : Of the 1100 questionnaires sent, only 4% were retrieved. The 42 retrieved were included in the study. Twenty six of the surgeons do not use any kind of deep venous thrombosis (DVT) prophylaxis, 11 use mechanical means as elastic compressive stockings or pneumatic compressive devices for prophylaxis, and 5 uses low-molecular weight heparins (LMWH) as the choice for prophylaxis. Conclusion : The data collected, despite the low rate of participation (4%) by the surgeons, shows that this subject still does not receive proper attention. Whereas other medical specialties make routine use of prophylactic means maybe the maxillofacial surgeons lack concern on that matter.

Mathematical analysis and simulations involving chemotherapy and surgery on large human tumours under a suitable cell-kill functional response

Dosage and frequency of treatment schedules are important for successful chemotherapy. However, in this work we argue that cell-kill response and tumoral growth should not be seen as separate and therefore are essential in a mathematical cancer model. This paper presents a mathematical model for sequencing of cancer chemotherapy and surgery. Our purpose is to investigate treatments for large human tumours considering a suitable cell-kill dynamics. We use some biological and pharmacological data in a numerical approach, where drug administration occurs in cycles (periodic infusion) and surgery is performed instantaneously. Moreover, we also present an analysis of stability for a chemotherapeutic model with continuous drug administration. According to Norton & Simon [22], our results indicate that chemotherapy is less eficient in treating tumours that have reached a plateau level of growing and that a combination with surgical treatment can provide better outcomes.

Use of cone-beam tomography and digital subtraction radiography for diagnosis and evaluation of traumatized teeth treated with endodontic surgery and MTA. A case report

The aim of this paper was to report the diagnosis and evaluation of periradicular bone repair by using computed tomography and digital subtraction radiography in an endodontic surgery case treated with mineral trioxide aggregate (MTA). The patient had local swelling and fistula 7years after trauma in the upper jaw. Periapical lesion on tooth #12 and root resorption of tooth #11 were detected radiographically. Endodontic therapy and placement of intracanal medication were carried out. After 3months, with no improvement in the clinical signs and symptoms, computed tomography was performed, showing extensive apical bone resorption on tooth #12 and dental resorption promoting communication of the root canal with the periodontium of tooth #11. The patient was referred to endodontic surgery. After surgery and postoperative periods of 15, 30, 60, 90, and 120days, standardized radiographs were taken, digitized, and subjected to digital subtraction of the images using Adobe Photoshop CS software. Four years later, a cone-beam computed tomography was performed, showing bone repair and absence of root resorption at tooth #11. In this clinical case, digital subtraction radiography was effective for early detection of new bone formation and evolution of repair. © 2011 John Wiley & Sons A/S.

Hypothermia prevention during surgery: comparison between thermal mattress and thermal blanket

This study aimed to compare the efficiency of the thermal blanket and thermal mattress in the prevention of hypothermia during surgery. Thirty-eight randomized patients were divided into two groups (G1 - thermal blanket and G2 - thermal mattress). The variables studied were: length of surgery, length of stay in the post-anesthetic care unit, period without using the device after thermal induction, transport time from the operating room to post-anesthetic care unit, intraoperative fluid infusion, surgery size, anesthetic technique, age, body mass index, esophageal, axillary and operating room temperature. In G2, length of surgery and starch infusion longer was higher (both p=0.03), but no hypothermia occurred. During the surgical anesthetic procedure, the axillary temperature was higher at 120 minutes (p=0.04), and esophageal temperature was higher at 120 (p=0.002) and 180 minutes (p=0.03) and at the end of the procedure (p=0.002). The thermal mattress was more effective in preventing hypothermia during surgery.

Short-term changes in handgrip strength, body composition, and lymphedema induced by breast cancer surgery

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

Use of surgery and carboplatin in feline malignant mammary gland neoplasms with advanced clinical staging

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

Ocular ultrasonography and ultrasound biomicroscopy: applicability in clinical and ophthalmic surgery

With the advent of high frequency transducers, the use of ocular ultrasound has become widely used because it provides definitions of major ocular structures. This diagnostic tool is useful in the evaluation of ophthalmic injuries, and also used for qualitative and quantitative evaluation of intraocular and orbital lesions. It is a noninvasive, safe and fast, easy to use and can be performed in an awake animal. The ocular ultrasonography is indicated in cases of ocular opacity, when the ophthalmic examination cannot be done, and in eyes with ocular trauma or suspected orbital disease. Ultrasound biomicroscopy (UBM) is a diagnostic tool with high cost and sedation or general anesthesia is necessary, but has the advantage of evaluating structures poorly defined or visualized in the anterior segment of the eye. Therefore, this paper aims to show the importance of ocular ultrasonography and UBM to veterinary practitioners, and to demonstrate its advantages and indications in ophthalmic routine.

Salivary and serum proteomics in head and neck carcinomas before and after surgery and radiotherapy

Several body fluids have been evaluated as new sources for cancer biomarker discovery. In this context, salivary and serum proteomics seem promising diagnostic and predictive tools for head and neck diseases. In the present study, we performed a proteomic analysis of saliva and serum from patients presenting head and neck squamous cell carcinoma (HNSCC) and compared the results before and after therapy. In saliva of cancer patients, we observed an altered protein profile, including over-expression of PLUNC and zinc-alpha-2-glycoprotein. Both proteins may contribute to control tumor growth and, therefore, represent targets for new analysis. We also detected serotransferrin and a modified transthyretin form with altered levels in serum from patients. Comparing preoperative and postreatment samples, the results showed that the protein profile after treatment reverted to a pattern closer to those observed for controls. These results add information on the role of secreted proteins in the cancer process and emphasize the potential of saliva and serum analysis for diagnosis and monitoring of HNSCC.