Complete atrioventricular block during renal transplantation in a patient with Alport's syndrome: case report

CONTEXTO: A síndrome de Alport é responsável por aproximadamente 5% dos pacientes com insuficiência renal crônica. Nessa doença, anormalidades no sistema de condução cardíaco são mais freqüentes que na população em geral. OBJETIVO: Relatar caso de síndrome de Alport que desenvolveu bloqueio atrioventricular total durante um transplante renal. RELATO DE CASO: Paciente masculino, 21 anos de idade, com insuficiência renal crônica secundária à síndrome de Alport, foi submetido a transplante renal sob anestesia peridural. Durante o procedimento anestésico-cirúrgico apresentou bloqueio atrioventricular total, que foi tratado rapidamente, e com sucesso, usando-se um marcapasso transcutâneo. O bloqueio simpático extenso pode contribuir para o desenvolvimento de distúrbios no sistema de condução cardíaco, particularmente em pacientes com insuficiência renal crônica em esquema de diálise. Mesmo em pacientes com eletrocardiograma pré-operatório normal e sem distúrbios de condução, graus variáveis de bloqueio atrioventricular, incluindo bloqueio atrioventricular total, podem ocorrer. Nesse caso, o uso de marcapasso transcutâneo é tratamento rápido e efetivo na sala de operação até o final da cirurgia, quando o tratamento definitivo pode ser planejado.

Evaluation of varying amounts of thermal cycling on bond strength and permanent deformation of two resilient denture liners

Statement of problem. Two problems found in prostheses with resilient liners are bond failure to the acrylic resin base and increased permanent deformation due to material aging.Purpose. This in vitro study evaluated the effect of varying amounts of thermal cycling on bond strength and permanent deformation of 2 resilient denture liners bonded to an acrylic resin base.Material and methods. Plasticized acrylic resin (PermaSoft) or silicone (Softliner) resilient lining materials were processed to a heat-polymerized acrylic resin (QC-20). One hundred rectangular specimens (10 X 10-mm(2) cross-sectional area) and 100 cylindrically-shaped specimens (12.7-mm diameter X 19.0-mm height) for each liner/resin combination were used for the tensile and deformation tests, respectively. Specimen shape and liner thickness were standardized. Specimens were divided into 9 test groups (n=10) and were thermal cycled for 200, 500, 1000, 1500, 2000, 2500, 3000, 3500, and 4000 cycles. Control specimens (n=10) were stored for 24 hours in water at 37degreesC. Mean bond strength, expressed as stress at failure (MPa), was determined with a tensile test using a universal testing machine at a crosshead speed of 5 mm/min. Analysis of failure mode, expressed as a percent (%), was recorded as either cohesive, adhesive, or both, after observation. Permanent deformation, expressed as a percent (%), was determined using ADA specification no. 18. Data from both tests were examined with a 2-way analysis of variance and a Tukey test (alpha=.05).Results. For the tensile test, Softliner specimens submitted to different thermal cycling regimens demonstrated no significantly different bond strength values from the control; however, there was a significant difference between the PermaSoft control group (0.47 +/- 0.09 MPa [mean +/- SD]) and the 500 cycle group (0.46 +/- 0.07 MPa) compared to the 4000 cycle group (0.70 +/- 0.20 MPa) (P<.05). With regard to failure type, the Softliner groups presented adhesive failure (100%) regardless of specimen treatment. PermaSoft groups presented adhesive (53%), cohesive (12%), or a combined mode of failure (35%). For the deformation test, there was no significant difference among the Softliner specimens. However, a significant difference was observed between control and PermaSoft specimens after 1500 or more cycles (1.88% +/- 0.24%) (P<.05).Conclusions. This in vitro study indicated that bond strength and permanent deformation of the 2 resilient denture liners tested varied according to their chemical composition.

Effect of thermocycling on bond strength and elasticity of 4 long-term soft denture liners

Statement of problem. Two problems found in prostheses with soft liners are bond failure to the acrylic resin base and loss of elasticity due to material aging.Purpose. This in vitro study evaluated the effect of thermocycling on the bond strength and elasticity of 4 long-term soft denture liners to acrylic resin bases.Material and methods. Four soft lining materials (Molloplast-B, Flexor, Permasoft, and Pro Tech) and 2 acrylic resins (Classico, and Lucitone 199) were processed for testing according to manufacturers' instructions. Twenty rectangular specimens (10 X 10-mm(2) cross-sectional area) and twenty cylinder specimens (12.7-mm diameter X 19.0-mm height) for each liner/resin combination were used for the tensile and deformation tests, respectively. Specimen shape and liner thickness were standardized. Samples were divided into a test group that was thermocycled 3000 times and a control group that was stored for 24 hours in water at 37degreesC. Mean bond strength, expressed in megapascals (Wa), was determined in the tensile test with the use of a universal testing machine at a crosshead speed of 5 mm/min. Elasticity, expressed as percent of permanent deformation, was calculated with an instrument for measuring permanent deformation described in ADA/ANSI specification 18. Data from both tests were examined with 1-way analysis of variance and a Tukey test, with calculation of a Scheffe interval at a 95% confidence level.Results. In the tensile test under control conditions, Molloplast-B (1.51 +/- 0.28 MPa [mean SD]) and Pro Tech (1.44 +/- 0.27 MPa) liners had higher bond strength values than the others (P < .05). With regard to the permanent deformation test, the lowest values were observed for Molloplast-B (0.48% +/- 0.19%) and Flexor (0.44% +/- 0.14%) (P < .05). Under thermocycling conditions, the highest bond strength occurred with Molloplast-B (1.37 +/- 0.24 MPa) (P < .05) With regard to the deformation test, Flexor (0.46% +/- 0.13%) and Molloplast-B (0.44% +/- 0.17%) liners had lower deformation values than the others (P < .05).Conclusion. The results of this in vitro study indicated that bond strength and permanent deformity values of the 4 soft denture liners tested varied according to their chemical composition. These tests are not completely valid for application to dental restorations because the forces they encounter are more closely related to shear and tear. However, the above protocol serves as a good method of investigation to evaluate differences between thermocycled and control groups.

Cytotoxicity of denture base acrylic resins: A literature review

Acrylic resins are widely used in the fabrication of denture bases and have been shown to be cytotoxic as a result of substances that leach from the resin. The primary eluate is residual monomer. Numerous reports suggest that residual monomer may be responsible for mucosal irritation and sensitization of tissues. This information is important, not only to assess the biologic effects of such materials, but also to enable a comparison among the different polymerization methods, thus assisting the clinician in selecting a material with minimal cytotoxicity. This article reviews the literature published from 1973 to 2000, selected by use of a Medline search, associated with cytotoxic effects usually ascribed to acrylic denture base materials.

The effect of polymerization cycles on porosity of microwave-processed denture base resin

Statement of problem. Although most of the physical properties of denture base resin polymerized by microwave energy have been shown to be similar to resins polymerized by the conventional heat polymerization method, the presence of porosity is a problem.Purpose. This study evaluated the effect of different microwave polymerization cycles on the porosity of a denture base resin designed for microwave polymerization.Material and methods. Thirty-two rectangular resin specimens (65 X 40 X 5 mm) were divided into 3 experimental groups (A, B, and C; Onda-Cryl, microwave-polymerized resin) and I control group (T; Classico, heat-polymerized resin), according to the following polymerization cycles: (A) 500 W for 3 minutes, (B) 90 W for 13 minutes + 500 W for 90 seconds, (C) 320 W for 3 minutes + 0 W for 4 minutes + 720 W for 3 minutes, and (T) 74degreesC for 9 hours. Porosity was calculated by measurement of the specimen volume before and after its immersion in water. Data were analyzed using 1-way analysis of variance (alpha = .05).Results. The mean values and SDs of the percent mean porosity were: A = 1.05% +/- 0.28%, B = 0.91% +/- 0.15%, C = 0.88% +/- 0.23%, T = 0.93% +/- 0.23%. No significant differences were found in mean porosity among the groups evaluated.Conclusion. Within the limitations of this study, a denture base resin specifically designed for microwave Polymerization tested was not affected by different polymerization cycles. Porosity was similar to the conventional heat-polymerized denture base resin tested.

Biocompatibility of denture base acrylic resins evaluated M culture of L929 cells. Effect of polymerisation cycle and postpoymerisation treatments

Objective: the purpose of this study was to evaluate the effect of two post-polymerisation treatments and different cycles of polymerisation on the cytotoxicity of two denture base resins.Materials and methods: the resins tested were Lucitone 550 and QC 20. Discs of resins were fabricated following the manufacturer's instructions. Lucitone 550 was processed by long cycle or short cycle. The resin QC 20 was processed by reverse cycle or normal cycle. The specimens were divided into groups: (i) post-polymerised in microwave for 3 min at 500 W; (ii) post-polymerised in water-bath at 55 degrees C for 60 min and (iii) without post-polymerisation. Eluates were prepared by placing three discs into a sterile glass vial with 9 ml of Eagle's medium and incubated at 37 degrees C for 24 hours. L929 cells were seeded into 96 3 well culture plates and DNA synthesis was assessed by H-thymidine incorporation assay.Results: the results were submitted to two-way ANOVA and Tukey HSD test. QC 20 specimens polymerised by the normal cycle and submitted to microwave post-polymerisation were graded as moderately cytotoxic. Similar results were observed for Lucitone 550 processed by long cycle without post-polymerisation. The other experimental groups were graded as not cytotoxic. After water-bath post-polymerisation, specimens of Lucitone 550 processed by long cycle produced significantly lower inhibition of DNA synthesis than the other groups.Conclusion: the long cycle increased the cytotoxicity of Lucitone 550 and water-bath post-polymerisation reduced the cytotoxicity of Lucitone 550 processed by long cycle.