727 resultados para Hematoma Epidural Espinal
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The oral rehabilitation with osseointegrated implants is a well-documented treatment with high rate of success. Nevertheless, demands related to treatment time and surgical technique began to appear. In this context, the procedure of immediate loading in which the dental prosthesis is placed right after implant surgery has become a constant practice. Although immediate loading has been an important advance, minimally invasive procedures, such as implant placement without raising a mucoperiosteal flap (flapless) are increasingly being performed. Association of immediate loading with the flapless technique improves acceptance by patients and professionals, because no suturing is required. Moreover, it reduces swelling, bleeding during and after surgery, postoperative pain, surgery time, discomfort and hematoma, as well as the need for postoperative medication. These characteristics ease the stages of rehabilitation soon after implant placement, cooperating with prosthodontist's work. Thus, the proposal of this study is to present a clinical case of oral rehabilitation with osseointegrated implants and fixed prosthesis in both arches, in which the flapless technique was applied, followed by immediate loading. It will discuss the diagnosis, prosthetic planning, surgical/prosthodontic procedures and follow-up for 20 months.
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Pós-graduação em Cirurgia Veterinária - FCAV
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Pós-graduação em Cirurgia Veterinária - FCAV
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Cell therapy has frequently been reported as a possible treatment for spinal trauma in humans and animals; however, without pharmacologically curative action on damage from the primary lesion. In this study, we evaluated the effect of administering human adipose-derived stem cells (hADSC) in rats after spinal cord injury. The hADSC were used between the third and fifth passages and a proportion of cells were transduced for screening in vivo after transplantation. Spinal cord injury was induced with a Fogarty catheter no. 3 inserted into the epidural space with a cuff located at T8 and filled with 80 mu L saline for 5 min. The control group A (n = 12) received culture medium (50 mu L) and group B (n = 12) received hADSC (1.2 x 10(6)) at 7 and 14 days post-injury, in the tail vein. Emptying of the bladder by massage was performed daily for 3 months. Evaluation of functional motor activity was performed daily until 3 months post-injury using the Basso-Beattie-Bresnahan scale. Subsequently, the animals were euthanized and histological analysis of the urinary bladder and spinal cord was performed. Bioluminescence analysis revealed hADSC at the application site and lungs. There was improvement of urinary bladder function in 83.3% animals in group B and 16.66% animals in group A. The analysis of functional motor activity and histology of the spinal cord and urinary bladder demonstrated no significant difference between groups A and B. The results indicate that transplanted hADSC improved urinary function via a telecrine mechanism, namely action at a distance.
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The fatal outcome of a defensive attack by a giant anteater (Myrmecophaga tridactyla) is reported. The attack occurred while the victim was hunting, and his dogs cornered the adult anteater, which assumed an erect, threatening position. The hunter did not fire his rifle because of concern about accidentally shooting his dogs. He approached the animal armed with a knife, but was grabbed by its forelimbs. When his sons freed him, he had puncture wounds and severe bleeding in the left inguinal region; he died at the scene. Necroscopic examination showed femoral artery lesions and a large hematoma in the left thigh, with death caused by hypovolemic shock. A similar case is cited, and recommendations are made that boundaries between wildlife and humans be respected, especially when they coinhabit a given area.
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Objective: To evaluate the effect of early fetoscopictracheal occlusion (FETO) (22–24 weeks’ gestation) onpulmonary response and neonatal survival in cases ofextremely severe isolated congenital diaphragmatic hernia(CDH). Methods: This was a multicenter study involving fetuseswith extremely severe CDH (lung-to-head ratio < 0.70,liver herniation into the thoracic cavity and no otherdetectable anomalies). Between August 2010 and December 2011, eight fetuses underwent early FETO. Datawere compared with nine fetuses that underwent standard FETO and 10 without fetoscopic procedure fromJanuary 2006 to July 2010. FETO was performed undermaternal epidural anesthesia, supplemented with fetalintramuscular anesthesia. Fetal lung size and vascularitywere evaluated by ultrasound before and every 2 weeksafter FETO. Postnatal therapy was equivalent for bothtreated fetuses and controls. Primary outcome was infantsurvival to 180 days and secondary outcome was fetalpulmonary response. Results: Maternal and fetal demographic characteristicsand obstetric complications were similar in the threegroups (P > 0.05). Infant survival rate was significantlyhigher in the early FETO group (62.5%) comparedwith the standard group (11.1%) and with controls(0%) (P < 0.01). Early FETO resulted in a significantimprovement in fetal lung size and pulmonary vascularitywhen compared with standard FETO (P < 0.01). Conclusions: Early FETO may improve infant survival byfurther increases of lung size and pulmonary vascularityin cases with extremely severe pulmonary hypoplasia inisolated CDH. This study supports formal testing of thehypothesis with a randomized controlled trial.
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Twenty-four bitches which had been in labour for less than 12 hours were randomly divided into four groups of six. They all received 0(.)5 mg/kg of chlorpromazine intravenously as premedication, followed 15 minutes later by either 8 mg/kg of thiopentone intravenously (group 1), 2 mg/kg of ketamine and 0-5 mg/kg of midazolam intravenously (group 2), 5 mg/kg of propofol intravenously (group 3), or 2(.)5 mg/kg of 2 per cent lidocaine with adrenaline and 0(.)625 mg/kg of 0(.)5 per cent bupivacaine with adrenaline epidurally (group 4). Except for group 4, the bitches were intubated and anaesthesia was maintained with enflurane. The puppies' heart and respiratory rates and their pain, sucking, anogenital, magnum and flexion reflexes were measured as they were removed from the uterus. The puppies' respiratory rate was higher after epidural anaesthesia. in general the puppies' neurological reflexes were most depressed after midazolam/ketamine, followed by thiopentone, propofol and epidural anaesthesia.
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We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine). All patients received general anesthesia plus continuous epidural anesthesia and analgesia. Treatment was masked for all, except the provider anesthesiologist. We defined IRT as time since anesthetics discontinuation until tracheal extubation. Primary outcomes were IRT and PRCs incidence within 15 days after surgery. We also analyzed post-anesthesia care unit (PACU) and hospital length of stays; (ii) after the end of the RCT, we used the available data in an extension cohort study to investigate IRT > 20 min as exposure factor for PRCs. Control protocol (n = 152) resulted in longer IRT (30.4 ± 7.9 vs 18.2 ± 9.6 min; p < 0.0001), higher incidence of PRCs (6.58 vs 2.5 %; p = 0.048), and longer PACU and hospital stays than intervention protocol (n = 200); PRC relative risk (RR) = 2.6. Patients with IRT > 20 min (n = 190) presented higher incidence of PRCs (7.37 vs 0.62 %; p < 0.0001); RR = 12.06. Intervention protocol, with short-acting anesthetics, was more beneficial and safe compared to control protocol, with long-acting drugs, regarding the reduction of IRT, PRCs, and PACU and hospital stays for laparotomy in bariatric patients. We identified a 4.5-fold increase in the relative risk of PRCs when morbid obese patients are exposed to an IRT > 20 min.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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The aim of this study was to investigate the use of ropivacaine combined or not with different opioids, for epidural anesthesia in bitches submitted to elective ovariosalpingohisterectomy (OSH). Thirty two mixed-breed female dogs, adults were used with medium weigh of 10.5kg. The animals were premedicated with acepromazine (0.05mg.kg-1, IM) and midazolam (0.2mg.kg-1, IM) and allocated in four experimental groups: group 1(n=8): ropivacaine: 0.3 mL.kg-1; group 2(n=8): ropivacaine + morphine (0.1 mg.kg-1); group 3(n=8): ropivacaine + butorphanol (0.1 mg.kg-1); and group 4(n=8): ropivacaine + tramadol (0.5 mg.kg-1) administered epidurally. Heart and respiratory rate; systolic arterial pressure; rectal temperature; arterial blood gas partial pressures; blood pH; sedation and muscular relaxation degree were evaluated at different experimental moments. The data were submitted to ANOVA and compared by Kruskal Wallis, Friedman, Dunn, Tukey and Chi-square test (p≤0.05). Minimum cardiorespiratory alterations were observed and the group of the ropivacaíne combined with the butorphanol (G3) presented a more cranial blockage, what allowed the accomplishment of OSH without induction in six animals (75%) whereas most of the others needed anesthetic rescue. The results allow us to conclude that the use of ropivacaine sole or combinated with morphine, butorphanol or tramadol, for epidural anesthesia, didn't promote significant cardiorrespiratory depression and the ropivacaine associated to the butorphanol allowed the accomplishment of OSH in bitches.
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The aim of the present study was to evaluate the postoperative complications of bicoronal flaps used to treat facial fractures. One hundred and thirty two patients that received bicoronal flaps for the treatment of upper and middle third facial fractures were called for clinical and radiographic examination. Minimum follow-up was 1 year and all patients had charts with adequate information about their perioperative care pertinent to the study. Results showed as complications hypoesthesia (17%), partial unilateral frontal motor deficit (11%), infection (3%), hypertrophic scars (3%), varying degrees of alopecia (18%), seroma or hematoma in the immediate postoperative period (5%). The flap provided wide surgical access to the upper and middle facial thirds with very few serious complications, most frequently allowing good aesthetic results.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Pós-graduação em Zootecnia - FCAV
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)