Acupuntura e implante de fragmentos de ouro em pontos de acupuntura e pontos Acupuntura e implante de fragmentos de ouro em pontos de acupuntura e pontos gatilho para o tratamento de displasia coxo-femoral em Pastor Alemão

Background: Canine hip dysplasia (HD) is characterized by hip joint laxity and subluxation. It is the most common cause of osteoarthritis in dogs, especially in larger breeds. Its management includes nutritional supplements, nonsteroidal anti-inflammatory drugs, physical therapy, acupuncture or surgical procedures. Implantation of gold beads in acupuncture points and trigger points around a joint has been used in the treatment of osteoarthritis in dogs for at least 30 years. Gold bead implants(GBI) acts as continuous acupuncture stimulation and trigger point treatment in canine HD with long lasting results. Electrophysiological investigations of trigger points reveal dysfunctional muscle spindles which indicate that the electrical activity of active loci arises from extrafusal motor endplates.Case: This is a report on the use of acupuncture and GBI for bilateral HD in a nine year old female German Shepherd. The patient has a HD non-responsive to anti-inflammatory drugs and was unable to stand up or walk by its own. Radiographs showed marked dysplasia, significant subluxation with the femoral head partly out of a shallow acetabulum and massive secondary arthritic bone changes, mainly on the right side. The animal was submitted to eight acupuncture sessions with seven days interval. After the first acupuncture session the use of NSAID was interrupted. After eight weeks the dog was considered rehabilitated and underwent GBI in acupoints and trigger points as maintenance treatment. During the one-year follow-up period the improvement remained unchanged with no need of analgesics.Discussion: It has been suggested that acupuncture or GBI can treat the chronic pain resulting from osteoarthritis induced by HD. According to AP theory, GBI is permanent and long-lasting acupoint stimulation. Moreover, the method is inexpensive, quick and easy to perform, with no postoperative pain or need of exercise restriction. Although gold is extremely corrosion-resistant, the surface of the gold implants stimulates a reaction from the immune system causing an oxidative liberation of gold ions with anti-inflammatory actions. It is well known that gold ions are effective inhibitors of the respiratory burst of neutrophils and monocytes and the proliferation of lymphocytes. These findings suggest that gold implantation, on a local scale, mimics the anti-inflammatory and pain-relieving effect of drugs with chemically bound gold ions. The relatively slow speed of the process results in a limited liberation of gold ions securing that they are taken up almost exclusively by cells close to the implant. The nine year old female German shepherd had a positive response to acupuncture with pain relieve and locomotor rehabilitation. For the nine year old female German shepherd previous acupuncture sessions to GBI resulted in no post-implant worsening period. Indeed, the association acupuncture/GBI does not have the anti-inflammatory drugs undesirable effects and brings long lasting results. In conclusion, GBI therefore should be considered for canine HD when conservative or medical treatments fail to give the desired effect.

Tempo de latencia do rocuronio e da succinilcolina e condicoes de intubacao traqueal

Background and Objectives - Pulmonary aspiration of gastric content during induction of anesthesia for emergency surgical procedures is a serious complication; fast endotracheal intubation under these circumstances is of vital importance to secure the airways. Despite its numerous side effects, succinylcholine is used for this purpose. Rocuronium is the most recently introduced aminoesteroid neuromuscular blocking drug with short onset. The objective of this study was to compare the onset time and intubating conditions of rocuronium and succinylcholine. Methods - After informed consent, forty-five patients were randomly allocated into three groups of 15: Group I (GI) = succinylcholine 1 mg.kg-1; Group II (GII) = rocuronium 0.6 mg.kg-1; Group III (GIII) = rocuronium 0.9 mg.kg-1. Every patient was premedicated with midazolam 15 mg per os and induction of anesthesia was made with fentanyl 10 μg.kg-1 and etomidate 0.3 mg.kg-1. The neuromuscular block was monitored with the TOP-Guard neuromuscular transmission monitor. The TOP-Guard neuromuscular monitor uses an accelerometer to measure the response to nerve stimulation. The stimulating electrodes were placed close to the course of the ulnar nerve at the wrist. The onset time was considered as the time between the end of neuromuscular drug injection and the twitch height (T1) decrease to 10%. Heart rate and arterial blood pressure were registered at 6 moments before and after induction of anesthesia. Results - The onset time results were: Group I, 71 s; Group II, 120 s and Group III, 70 s or GI = GIII < GII (F = 8.862; p < 0.01). There were 43 patients exhibiting excellent intubating conditions and 2 with good intubating conditions. Heart rate and arterial blood pressure showed alterations due to induction of anesthesia and intubation. Conclusions - Rocuronium 0.9 mg.kg-1 can be used in rapid sequence induction because it has a short onset time which is similar to that of succnylcholine. It is likely that rocuronium would be a good indication in patients with high intracranial pressure, burns and neuromuscular diseases.

Peridural com ropivacaina a 1%: Experiencia com volume proporcional a estatura

Background and Objectives - Ropivacaine - a local amino amide anesthetic agent - is a plain S enantiomer which makes it a potent and low toxicity drug. The aim of our study was to evaluate 1% ropivacaine for epidural block in lower doses than those described in the literature. Methods - Thirty-eight patients, physical status ASA I and II, aged 15 to 70 years, weighing 50 to 100 kg were selected. Premedication consisted of 15 mg oral midazolam given 60 min before anesthesia induction. In the OR, after standard monitoring a catheter was inserted intravenously to administer 10 ml.kg-1 Ringers lactate solution. Epidural puncture was performed with the patient in the sitting position and 1% ropivacaine was administered in a volume corresponding to 10% of patient's height in centimeters. With the patient in the supine position, motor blockade intensity, temperature sensitivity and sensory block extension at 1, 3, 5, 7, 10, 15, 20, 30 minutes after drug injection were evaluated. Blood pressure, heart rate and adverse side effects during the course of anesthesia and in the post-anesthetic period were also observed. In the recovery room patients were followed-up until motor blockade intensity temperature sensitivity and sensory block had returned to level L2. Results - Mean values were 41.4 years of age, 68.8 kg of body weight and 165 cm height. Upper thermal blockade level was T4 and upper sensory block level was T6. Most patients showed motor block level 1 (Bromage scale) after 30 minutes of observation. Motor block mean duration was 254 minutes and temperature sensitivity 426 minutes. Only three patients had complications: two cases of hypotension and one of bradycardia. Conclusions - In the volumes used in this study, ropivacaine produced adequate analgesia and a less intense lower limb motor block which, however, was sufficient to allow for surgical procedures with low incidence of side-effects.

Inside-out vs. standard vein graft to repair a sensory nerve in rats

Nerve regeneration in a sensory nerve was obtained by the application of different techniques: inside-out vein graft (IOVG group) and standard vein graft (SVG group). These techniques provide a good microenvironment for axon regeneration in motor nerves, but their efficiency for regeneration of sensory nerves is controversial. The saphenous nerve was sectioned and repaired by the inside-out and standard vein graft techniques in rats. After 4, 12, and 20 weeks the graft and the distal stump were observed under electron microscopy. In each studied period, the pattern, diameters, and thickness of the myelin sheaths of the regenerated axons were measured in the graft and distal stump. A comparative study about the regenerated nerve fibers by these two different techniques was performed. Regenerated nerve fibers were prominent in both vein grafts 4 weeks after the surgical procedures. On the other hand, in the distal stump, regenerated nerve fibers were observed only from 12 weeks. In both inside-out vein graft and standard vein graft statistical difference was not observed about the diameters and thickness of the myelinated fibers after 20 weeks. On the other hand, the inside-out group had greater regenerated axon number when compared to the standard group. There is a capillary invasion in both graft and distal stump, especially in the IOVG group. The regenerated axons follow these capillaries all the time like satellite microfascicles. After 20 weeks, the diameters of regenerated fibers repaired by the standard vein graft technique were closer to the normal fibers compared to the inside-out vein graft. On the other hand, the pattern of these regenerated axons was better in the IOVG group.

Complicacoes respiratorias em criancas submetidas a anestesia geral

Background and Objectives - The decision to perform anesthetic and surgical procedures in children with upper airway infeccious disease, due to the possibility of intraoperative respiratory morbidity, has been a dilemma for anesthesiologists. This study aimed at evaluating the incidence of respiratory complications in children submitted to general anesthesia and correlate them to preoperative signs and symptoms related to the respiratory tract, thus determining anesthetic-surgical morbidity. Methods - Participated in this study 284 children, physical status ASA I or II, submitted to general anesthesia. During preoperative evaluation, respiratory signs and symptoms were recorded, as well as types of diseases and corresponding diagnoses. Respiratory complications during anesthesia and in the recovery room were also recorded and analyzed taking into account age, elective or urgent procedure, airway management and presence or absence of signs, symptoms or history of respiratory tract diseases. Results - We found 38% of patients with preoperative respiratory disease history. The most common respiratory disease was upper airway infection. Intraoperative respiratory complications were present in 26.4% of patients. Children under 12 months of age and those with preoperative respiratory disease history had more intraoperative and PACU complications. Conclusions - We concluded that children, specially younger, with respiratory system involvement, like upper airway infections, are at a higher risk of intra and postoperative respiratory complications, thus with an increased incidence of anesthetic-surgical morbidity.

Treatment of mucus retention phenomena in children by the micro-marsupialization technique: case reports

The purpose of the present study was to emphasize the technique of micro-marsupialization as an alternative for the treatment of mucus retention phenomena. Out of 41 patients, 14 were selected for treatment by the micro-marsupialization technique on the basis of clinical criteria. Patient age ranged from 5-9 years. The technique was performed as follows: the area was disinfected with 0.1% iodine; a topical anesthetic was applied to cover the entire lesion for approximately 3 min; a 4.0 silk suture was passed through the internal part of the lesion along its widest diameter; and a surgical knot was made. Of the original 14 patients treated by the micro-marsupialization technique, 12 presented full regression one week after treatment. Recurrence occurred in two cases. It was possible to conclude that the micro-marsupialization technique is an alternative to be considered, especially in pediatric dentistry.

Treatment of gingival recession: Comparative study between subepithelial connective tissue graft and guided tissue regeneration

Background: Various procedures have been proposed to treat gingival recession, but few studies compare these procedures to each other. The purpose of this study was to evaluate a clinical comparison of subepithelial connective tissue graft (SCTG) and guided tissue regeneration (GTR) with a collagen membrane in the treatment of gingival recessions in humans. Methods: Twenty-four defects were treated in 12 patients who presented canine or pre-molar Miller Class I and/or II bilateral gingival recessions. Both treatments were performed in all patients, and clinical measurements were obtained at baseline and 18 months after surgery. These clinical measurements included gingival recession height (GR), root coverage (RC), probing depth (PD), keratinized tissue width (KT), and final esthetic result. Results: Both SCTG and GTR with a bioabsorbable membrane and bone graft demonstrated significant clinical and esthetic improvement for gingival recession coverage. The SCTG group was statistically significantly better than GTR for height of GR (SCTG = 0.2 mm, GTR = 1.12 mm, P = 0.02) and KT (SCTG = 4.58 mm, GTR = 2.5 mm, P <0.0001). However, PD was statistically significantly better for GTR than SCTG treatment (GTR = 1.66 mm, SCTG = 1.00, P = 0.01). The 2 procedures were statistically similar in root coverage (SCTG = 95.6%, GTR = 84.2%, P = 0.073). The esthetic condition after both treatments was satisfactory (P = 0.024). Conclusions: It was concluded that the gingival recessions treated with the SCTG group were superior for GR, RC, and KT clinical parameters, while GTR demonstrated better PD reduction. The final esthetic results were similar using both techniques.

Reduction of diameter of the left ventricle of dogs by plication of the left ventricular free wall

Objective - To determine effects of reducing the diameter of the left ventricle of dogs by plication of the left ventricular free wall. Animals - 8 healthy adult mixed-breed dogs. Procedure - Left lateral thoracotomy and a T-shaped pericardiotomy were performed. The free wall of the left ventricle was imbricated with 3 interrupted transfixing sutures applied in a horizontal mattress pattern, using 3-0 polypropylene suture assembled on a straight cutting needle. Surgeons were careful to avoid the coronary vessels. Echocardiography was performed 24 hours before and 48 hours after surgery. Electrocardiography was performed before and 1, 2, 7, 15, 21, 30, and 60 days after surgery. Results - Echocardiographic measurements revealed that the diameter of the left ventricle was reduced by a mean of 23.5%. Electrocardiography revealed ventricular premature complexes 24 hours after surgery that regressed without treatment during the first week after surgery. Conclusions and Clinical Relevance - Plication of the left ventricular free wall of dogs can reduce end-diastolic and end-systolic dimensions of the left ventricle. The technique is simple and does not require cardiopulmonary bypass. According to Laplace's law, the reduction of cardiac diameter leads to reduction on free-wall tension and may improve left ventricular function in dilatated hearts. Thus, additional studies involving dogs with dilated cardiomyopathy should be conducted.

Prototipagem como forma alternativa para realização de cranioplastia com metilmetacrilato: Nota técnica

The prototyping is a method for reconstruction of human body segments by computer software. It has been used in neurosurgery for cranial reproduction in patients allowing the programming of surgical procedures and the production of prosthesis to reconstruct bone failures in the skull. We present two cases of cranioplasty performed with the use of acrylic prosthesis constructed by prototyping. After 10 months of follow-up, they donot present signs of infection and show good aesthetic result. The advantages pointed at the literature for this method (reduction of surgical time, easy technical handle, and good aesthetic result) were confirmed.

The frequency of pharmacological pain relief in university neonatal intensive care units

Objective: To evaluate the use of drugs to relieve the pain of invasive procedures newborn infants cared for at a university hospital NICU. Methods: A prospective cohort study of all newborn infants hospitalized in four NICU during October 2001. The following data were collected: demographic data of the hospitalized newborn infants; clinical morbidity; number of potentially painful procedures and frequency of analgesic administration. Factors associated with the use of analgesia in this cohort of patients were studied by multiple linear regression using SPSS 8.0. Results: Ninety-one newborn infants were admitted to the NICU during the study period (1,025 patient-days). Only 25% of the 1,025 patient-days received systemic analgesia. No specific drugs were administered to relieve acute pain during any of the following painful events: arterial punctures, venous, capillary and lumbar punctures or intubations. For chest tube insertion, 100% of newborn infants received specific analgesia. For the insertion of central catheters 8% of the newborn infants received painkillers. Only nine of the 17 newborn infants that underwent surgical procedures received any analgesic dosage during the postoperative period. For 93% of patients under analgesia the drug of choice was fentanyl. The presence of mechanical ventilation increased the chance of newborn infants receiving painkillers by 6.9 times and the presence of chest tube increased this chance by five times. Conclusion: It is necessary to train health professionals in order to bridge the gap between scientific knowledge regarding newborn infant pain and clinical practice. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Early healing pattern of autogenous bone grafts with and without e-PTFE membranes: A histomorphometric study in rats

Objective. The aim of this study was to perform quantitative and qualitative analyses of the initial repair pattern of an autogenous bone block graft when covered or not with e-PTFE membranes. Study design. Sixty male Wistar rats received a bone graft plus an e-PTFE membrane (MB) or just the graft (B). A block graft was harvested from the animal's calvarium and was laid and stabilized on the external cortical area near the angle of the mandible. Descriptive histology and histomorphometric analyses were carried out and the data were analyzed statistically by ANOVA and the Tukey test, with the level of significance set at 5%. Results. The results for group B showed that there was bone loss during the healing period (B0 = 1.38, B45 = 1.05, F = 7.91 > F C = 3.02), that is, the initial volume of the graft decreased in time. Bone tissue loss was about 24%. In contrast, the MB group showed bone tissue gain along the observation period (MB0 = 1.54, MB45 = 2.40, F = 7.91 > FC = 3.02), meaning that the total volume of newly formed bone was greater than the original graft area. Bone tissue gain was approximately 55%. MB showed significantly greater bone gain when compared to B (B45 = 1.05, MB45 = 2.40, F = 39.86 > FC = 1.90). These significant differences between B and MB could already be observed after 21 days. Conclusions. The bone block graft underwent resorption at an early healing stage, while additional new bone formation was observed when the bone graft was covered with an e-PTFE membrane. © 2005 Mosby, Inc. All rights reserved.

Analysis of susceptibility profile of Pseudomonas spp. and prevalence of bacterial samples from the surfaces of dental consulting-rooms

The aim of this research was to evaluate the susceptibility profile of Pseudomonas spp. and the prevalence of bacterial samples isolated from horizontal surfaces surrounding wash-basins used by dentists in several adjoined consulting-rooms, at points next to and at a distance from the basin, before and after surgical procedures. Our results showed a high percentage of Gram-positive cocci and Gram-negative bacilli; 34.66% were Staphylococcus spp. and 30.12% were non-fermentative Gram-negative bacilli among which Pseudomonas spp. (40.90%) was the commonest genus. Analysis of the susceptibility profile of Pseudomonas spp. isolates by determining the minimal inhibitory concentration (MIC) of 14 antibiotics showed a great variation among the strains and high rates of resistance to cefazolin, ceftazidime and aztreonan. Of the 14 antibiotics tested, 59.03% were found to be active against all the environmental isolates. Strains were resistant to aztreonan (62.82%), while susceptibility to third generation cephalosporins was variable.

A new device in immediately loaded implant treatment in the edentulous mandible

Purpose: This article reports preliminary clinical results of the Speed Master system, a method for immediate loading of implants for the treatment of mandibular edentulism. Materials and Methods: Fifteen patients with edentulous mandibles were consecutively included in the study. Each received 4 implants between the mental foramina placed using the system's surgical guides. Permanent fixed prostheses fabricated over premanufactured titanium bars were attached to the implants on the day of implant placement. The patients were followed for 15 to 27 months (mean, 19 months). Peri-implant tissues were periodically evaluated. Marginal bone loss was monitored with periapical radiographs using a computerized technique. Satisfaction was assessed by means of a questionnaire. Results: The overall implant and prosthetic survival rates were 100%. At the time of the final follow-up visit, mean marginal bone loss was 1.11 mm, and bleeding on probing was not observed. Only 6.7% of the patients reported any discomfort during treatment, and all patients would recommend the procedure to others. Discussion: The immediate loading of implants placed in the edentulous mandible with the Speed Master surgical and prosthetic protocol reduces treatment time and number of surgical procedures in comparison to classic delayed loading protocols. Conclusion: The rehabilitation of the mandible with an immediately delivered occlusally loaded hybrid prosthesis supported by 4 implants does not appear to jeopardize the success of the osseointegration and represents a viable treatment option.

Spontaneous resolution rates of vesicoureteral reflux in Brazilian children: A 30-year experience

Objective: We evaluated clinical characteristics of primary vesicoureteral reflux (VLJR) in infants in a 30-year period in Brazil with special reference to the relation of renal parenchymal damage to urinary tract infection and gender. Materials and Methods: From 1975 through 2005, 417 girls (81.6%) and 94 boys (18.4%) with all grades of reflux were retrospectively reviewed. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent yearly voiding cystourethrography until the reflux was resolved. VUR was considered resolved when a follow-up cystogram demonstrated no reflux. Surgical correction was recommended for those who fail medical therapy, severe renal scarring or persistent VUR. Results: Grades I to V VUR resolved in 87.5%, 77.6%, 52.8%, 12.2% and 4.3%, respectively. Renal scars were present at presentation in 98 patients (19.2%). Neither gender nor bilaterality versus unilaterality was a helpful predictor of resolution. The significant difference was found among the curves using the log rank (p < 0.001) or Wilcoxon (p < 0.001) test. Conclusion: Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection in our country. Scarring may be associated to any reflux grade and it may be initially diagnosed at any age but half of the scars are noted with higher grades of reflux (IV and V). The incidence of reflux related morbidity in children has significantly diminished over the last three decades.

Proposal of a new technique for bile duct reconstruction after iatrogenic injury. Study in dogs and review of the literature

Purpose: Interposition of a jejunal tube between the common bile duct and duodenum. Methods: Five adult mongrel dogs of both sexes, weighing on average 22.3 kg (18 to 26.5 kg), were used. Obstructive jaundice was induced by ligation of the distal common bile duct. After one week, a 2.5-cm long jejunal tube was fabricated from a segment of the loop removed 15 cm from the Treitz angle and interposed between the common bile duct and duodenum. Results: The animals presented good clinical evolution and no complications were observed. After 6 weeks, complete integration was noted between the bile duct mucosa, tube and duodenum and a significant reduction in total bilirubin and alkaline phosphatase was observed when compared to the values obtained one week after ligation of the common bile duct. Conclusion: The jejunal tube interposed between the dilated bile duct and duodenum showed good anatomic integration and reduced total bilirubin and alkaline phosphatase levels in the animals studied.