Fechamento de fístula buco-sinusal usando tecido adiposo bucal

The Oro-antral Fistula is a common pathologic event, which occurs an opening or communication of the maxillary sinus with the oral cavity through dental extractions of upper posterior elements whose roots have close relationship with the maxillary sinus. This study aims to clarify the Surgeon Dentist about the possible etiological factors responsible for Oro-antral Communication, to identify its clinical and radiographic signs, to explain the Buccal Fat Pad’s anatomy and functioning and to describe the surgical technique adopted front of these cases. For this, the authors present a case of a patient who had a fistula in the region where there was a dental extraction of the upper posterior element. The treatment of Oro-antral Fistula using the buccal fat pad provides to be a safe and effective surgical method, because this element presents a rich blood supply and easy access. Many authors have found that this method have a broad application, large index of success, lower risk of infection, provides a comfortable post-operative for the patient. However, it needs to be done properly so that you have minimum incidence of failures, and this requires some caution on the part of professional.

Fechamento de diastemas utilizando restaurações diretas de resina composta

Os diastemas contribuem para a quebra de harmonia dos dentes, comprometendo a beleza do sorriso; os incisivos superiores são os dentes que mais se destacam no sorriso, sendo muito importante a simetria e harmonia entre eles. Para o fechamento dos diastemas, durante muito tempo, as alternativas clínicas foram o emprego da Ortodontia e das próteses fixas. Atualmente, com a evolução dos sistemas adesivos e das resinas compostas, é possível reproduzir as características dos dentes com uma técnica simples, previsível, sem desgaste da estrutura dentária, reversível, com menor custo, proporcionando um resultado satisfatório e imediato. O propósito do presente artigo é apresentar três casos clínicos de fechamento de diastemas generalizados associados ou não a outras alterações que comprometem o sorriso do paciente.

Emprego de técnica cirúrgica e materiais adesivos diretos no fechamento de diastema

The following is a clinical case report of a patient whose main complaint was the presence of a generalized spacing in the anterior maxillary segment. After meticulous clinical analysis and discussions of the clinical procedures to be adopted, a labial frenectomy was our first choice, so that we could reduce the diastemas directly using composite resin. It was observed that the association of clinical and restorative procedures was capable of giving back shape, function and dental aesthetics, allowing to the young patient the satisfaction of smiling without any fear.

Circunferência da cintura ou abdominal? uma revisão crítica dos referenciais metodológicos

Embora haja consenso sobre a validade e facilidade do uso da antropometria na classificação da obesidade abdominal, ainda não existe consenso sobre a nomenclatura da medida e os sítios anatômicos para sua obtenção. Desta forma, o objetivo deste estudo foi analisar de forma crítica o uso da circunferência da cintura ou abdominal em adultos para aferição da obesidade abdominal. Foi realizada uma revisão sistemática a partir de busca em bases de dados indexadas MEDLINE (PubMed) e Scientific Eletronic Library Online (SciELO). Foram revisados artigos publicados no período compreendido entre 2003 e 2009. Quanto à nomenclatura, apesar dos National Institutes Health tratarem circunferência da cintura e abdominal como sinônimos, os pesquisadores internacionais, tem preferido o uso do termo circunferência da cintura. Quanto ao sítio anatômico para a medida, falta ainda consenso entre os pesquisadores e orientação da International Diabetes Federation (IDF). Considerando que os atuais pontos de corte para as populações de origem européia foram elaborados a partir dos sítios anatômicos estabelecidos pela OMS 1989, torna-se razoável a adoção desta referência. Sobre os pontos de corte, a proposta da IDF representa resultado de um consenso internacional e avalizado pela Sociedade Brasileira de Cardiologia.

Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal

Pós-graduação em Anestesiologia - FMB

Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

Impacto de diferentes métodos de avaliação da obesidade abdominal após síndromes coronarianas agudas

Background: Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC) is a priority. Objective: To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS) as a predictor of cardiovascular complications during hospitalization. Methods: Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1), point of minimum circumference (2); immediately above the iliac crest (3), umbilicus (4), one inch above the umbilicus (5), one centimeter above the umbilicus (6), smallest rib and (7) the point of greatest circumference around the waist (8). Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. Results: A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67%) patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. Conclusion: The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes. Key words: Evaluation; Acute Coronary Syndrome; Abdominal Circumference

Avaliação ultrassonográfica abdominal modo-B em cães e gatos filhotes: revisão de literatura

In veterinary medicine, the same clinician usually follows an animal from birth to old age, whereas in human medicine different specialists are required. It is therefore essential that veterinarians know the normal imaging, biochemical, hematological and physical exam values for younglings, which differ significantly from those of adults of the same species. Abdominal radiographies of young animals are poorly defined due to differences in tissue constitution in relation to adults. These same factors, however, substantially improve sonographic images of the region. Nonetheless, the interpretation of B-mode sonographic findings in puppies is difficult due to the lack of information about the normal parameters in this phase of life. The objective of this study was to compile information about peculiarities of abdominal B-mode ultrasonography in puppies and kittens.

Fechamento de defeitos em padrão de figura geométrica associado ao emprego de anestesia por tumescência com lidocaína em coelhos (oryctolagus cuniculus)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fisioterapia respiratória, pressão intra-abdominal e função renal de pacientes de terapia intensiva

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A molecular linkage map for Drosophila mediopunctata confirms synteny with Drosophila melanogaster and suggests a region that controls the variation in the number of abdominal spots

The classic approach to gene discovery relies on the construction of linkage maps. We report the first molecular-based linkage map for Drosophila mediopunctata, a neotropical species of the tripunctata group. Eight hundred F2 individuals were genotyped at 49 microsatellite loci, resulting in a map that is approximate to 450 centimorgans long. Five linkage groups were detected, and the species' chromosomes were identified through cross-references to BLASTn searches and Muller elements. Strong synteny was observed when compared with the Drosophila melanogaster chromosome arms, but little conservation in the gene order was seen. The incorporation of morphological data corresponding to the number of central abdominal spots on the map was consistent with the expected location of a genomic region responsible for the phenotype on the second chromosome.

Nitric oxide modulates metalloproteinase-2, collagen deposition and adhesion rate after polypropylene mesh implantation in the intra-abdominal wall

Prosthetic meshes are commonly used to correct abdominal wall defects. However, the inflammatory reaction induced by these devices in the peritoneum is not completely understood. We hypothesized that nitric oxide (NO), produced by nitric oxide synthase 2 (NOS2) may modulate the response induced by mesh implants in the abdominal wall and, consequently, affect the outcome of the surgical procedure. Polypropylene meshes were implanted in the peritoneal side of the abdominal wall in wild-type and NOS2-deficient (NOS2(-/-)) mice. After 15 days tissues around the mesh implant were collected, and inflammatory markers (the cytokine interleukin 1 beta (IL-1 beta) and NO) and tissue remodeling (collagen and metalloproteinases (MMP) 2 and 9) were analyzed. The lack of NOS2-derived NO induced a higher incidence of visceral adhesions at the mesh implantation site compared with wild-type mice that underwent the same procedure (P < 0.05). Additionally, higher levels of IL-1 beta were present in the mesh-implanted NOS2(-/-) animals compared with control and wild-type mice. Mesh implantation induced collagen I and III deposition, but in smaller amounts in NOS2(-/-) mice. MMP-9 activity after the surgical procedure was similarly increased in both groups. Conversely, MMP-2 activity was unchanged in mesh-implanted wild-type mice, but was significantly increased in NOS2(-/-) mice (P < 0.01), due to decreased S-nitrosylation of the enzyme in these animals. We conclude that NOS2-derived NO is crucial for an adequate response to and integration of polypropylene mesh implants in the peritoneum. NO deficiency results in a prolonged inflammatory reaction to the mesh implant, and reduced collagen deposition may contribute to an increased incidence of visceral adhesions. (C) 2011 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Abdominal compression: A new intraoperative maneuver to detect chyle fistulas during left neck dissections that include level IV

Background Chyle fistulas may occur after left neck dissections that include level IV, due to injury of the thoracic duct or of 1 of its major branches. Despite being unusual, this complication carries substantial postoperative morbidity and even mortality. So far, no effective intraoperative maneuver has been reported to detect this fistula at the end of a neck dissection. In this cohort study, we sought to describe a simple new maneuver, intraoperative abdominal compression, which can effectively help to identify an open major lymphatic duct on level IV at the end of a neck dissection. Patients and Methods From March 1989 to September 2010, 206 patients underwent neck dissections involving left level IV, and underwent intraoperative abdominal compression. There were 119 men and 87 women, with ages ranging from 18 to 81 years (median, 52 years). One hundred forty-four patients had squamous cell carcinomas, 54 had thyroid carcinomas, 5 had malignant melanomas, and 3 had salivary cancers. Distribution by type of left neck dissection was: selective including levels II, III, and IV (73 cases; 35.4%), selective including levels II, III, IV, and V (55 cases; 26.6%), selective including levels I, II, III, and IV (12 cases; 5.8%), modified radical (47 cases; 22.8%), and radical (19 cases; 9.2%). In all cases, at the end of the procedure, the endotracheal tube was temporarily disconnected from the ventilator. Keeping the dissected level IV area under clear visualization, an abdominal compression was performed. At this moment, any detected lymphatic leak was carefully clamped and tied with nonabsorbable sutures. After ventilating the patient, the intraoperative abdominal compression was repeated to reassure complete occlusion of the lymphatic vessel. Results In 13 cases (6.3%), a chyle leak was detected after performing the intraoperative abdominal compression. All leaks except for 2 were successfully controlled after 1 attempt. In these 2 patients, a patch of muscle and fat tissue was applied with fibrin glue on the top. In 1 of these patients, another chyle leak in a different location was detected only at the second intraoperative abdominal compression, and was also effectively closed. Postoperatively, there were 2 (1%) chyle fistulas, both among these 13 cases, and all were successfully managed with clinical measures only. No fistulas occurred among the remaining 193 patients in whom intraoperative abdominal compression did not demonstrate lymphatic leak. Conclusion To our knowledge, this is the first description of a specific maneuver to actively detect a lymphatic fistula at the end of a left neck dissection involving level IV. In this study, intraoperative abdominal compression was able to detect an open lymphatic vessel in 6.3% of the cases, as well as to assure its effective sealing in the remaining 93.7% of the patients. Moreover, no life-threatening high-volume fistula was noted in this study. (C) 2012 Wiley Periodicals, Inc. Head Neck, 2012

Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery

Background and objective: Malnutrition is prevalent in hospitalized patients and causes systemic damage including effects on the respiratory and immune systems, as well as predisposing to infection and increasing postoperative complications and mortality. This study aimed to assess the impact of malnutrition on the rate of postoperative pulmonary complications, respiratory muscle strength and chest wall expansion in patients undergoing elective upper abdominal surgery. Methods: Seventy-five consecutive candidates for upper abdominal surgery (39 in the malnourished group (MNG) and 36 in the control group (CG)) were enrolled in this prospective controlled cohort study. All patients were evaluated for nutritional status, respiratory muscle strength, chest wall expansion and lung function before surgery. Postoperative pulmonary complications (pneumonia, tracheobronchitis, atelectasis and acute respiratory failure) before discharge from hospital were also evaluated. Results: The MNG showed expiratory muscle weakness (MNG 65 +/- 24 vs CG 82 +/- 22 cm H2O; P < 0.001) and decreased chest wall expansion (P < 0.001), whereas inspiratory muscle strength and lung function were preserved (P > 0.05). The MNG also had a higher incidence of postoperative pulmonary complications compared with the CG (31% and 11%, respectively; P = 0.05). In addition, expiratory muscle weakness was correlated with BMI in the MNG (r = 0.43; P < 0.01). The association between malnutrition and expiratory muscle weakness increased the likelihood of postoperative pulmonary complications after upper abdominal surgery (P = 0.02). Conclusions: These results show that malnutrition is associated with weakness of the expiratory muscles, decreased chest wall expansion and increased incidence of pulmonary complications in patients undergoing elective upper abdominal surgery.

Preoperative 6-min walking distance does not predict pulmonary complications in upper abdominal surgery

Background and objective: Field exercise tests have been increasingly used for pulmonary risk assessment. The 6-min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post-operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS). Methods: This prospective cohort study included 137 consecutive subjects undergoing elective UAS. Subjects performed the 6MWD on the day prior to surgery, and their performance were compared with predicted values of 6MWD (p6MWD) using a previously validated formula. PPCs (including pneumonia, tracheobronchitis, atelectasis with clinical repercussions, bronchospasm and acute respiratory failure) were assessed daily by a pulmonologist blinded to the 6MWD results. 6MWD and p6MWD were compared between subjects who developed PPC (PPC group) and those who did not (no PPC group) using Student's t-test. Results: Ten subjects experienced PPC (7.2%) and no significant difference was observed between the 6MWD obtained in the PPC group and no PPC group (466.0 +/- 97.0 m vs 485.3 +/- 107.1 m; P = 0.57, respectively). There was also no significant difference observed between groups for the p6MWD (100.7 +/- 29.1% vs 90.6 -/+ 20.9%; P > 0.05). Conclusions: The results of the present study suggest that the 6-min walking test is not a useful tool to identify subjects with increased risk of developing PPC following UAS.