Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies

Objectives: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA).Background: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes.Methods: A review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI) are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied.Results: Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05].Conclusion: This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.

Block Bone Graft Fixation ( Onlay): A Modification of the Surgical Technique

Several reconstructive methods of the alveolar ridge have been reported to make possible future rehabilitations with implants. Many of these methods come from studies done in animals, mainly rats. With this clinical practice based on scientific evidence, any experimental procedure that can be undertaken in real life is fundamental. Thus, any research that emulates as closely as possible those techniques used in humans are important. This study describes the modification of the technique for block bone graft fixation (onlay) in rats using the lag screw-type technique, normally used in clinical procedures for grafts in humans. The conclusion was that the execution of the described procedures minimizes interference of blood flow in the area because of the maintenance of the muscle insertion in the buckle aspect of the most anterior region of the mandible, providing better stability to the graft and better contact interface of the graft and receptor bed.

Assessment of postoperative pain after unilateral mastectomy using two different surgical techniques in dogs

Background: There are few studies reporting pain and postoperative analgesia associated with mastectomy in dogs. The aim of this study was to evaluate postoperative pain after unilateral mastectomy using two different surgical techniques in the dog.Findings: Twenty female dogs were assigned (n=10/group) to undergo unilateral mastectomy using either the combination of sharp and blunt dissection (SBD) or the modified SBD (mSBD) technique, in which the mammary chain is separated from the abdominal wall entirely by blunt (hand and finger) dissection except for a small area cranial to the first gland, in a prospective, randomized, clinical trial. All dogs were premedicated with intramuscular acepromazine (0.05 mg/kg) and morphine (0.3 mg/kg). Anesthesia was induced with intravenous ketamine (5 mg/kg) and diazepam (0.25 mg/kg), and maintained with isoflurane. Subcutaneous meloxicam (0.2 mg/kg) was administered before surgery. Postoperative pain was evaluated according to the University of Melbourne pain scale (UMPS) by an observer who was blinded to the surgical technique.. Rescue analgesia was provided by the administration of intramuscular morphine (0.5 mg/kg) if pain scores were > 14 according to the UMPS. Data were analyzed using t-tests and ANOVA (P>0.05). There were no significant differences between the groups for age, weight, extubation time, and duration of surgery and anesthesia (P>0.05). There were no significant differences for postoperative pain scores between groups. Rescue analgesia was required in one dog in each group.Conclusions: The two surgical techniques produced similar surgical times, incidence of perioperative complications and postoperative pain. Multimodal analgesia is recommended for treatment of postoperative pain in dogs undergoing unilateral mastectomy.

Adhesive bonding of resin composite to various titanium surfaces using diferente metal conditioners and a surface modification system

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

Influence of Adhesive Restorations on Diffusion of H2O2 Released from a Bleaching Agent and Its Toxic Effects on Pulp Cells

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

Evaluation of bond strength and thickness of adhesive layer according to the techniques of applying adhesives in composite resin restorations

Adhesive restorations have increasingly been used in dentistry, and the adhesive system application technique may determine the success of the restorative procedure. The aim of this study was to evaluate the influence of the application technique of two adhesive systems (Clearfil SE Bond and Adper Scotchbond MultiPurpose) on the bond strength and adhesive layer of composite resin restorations. Eight human third molars were selected and prepared with Class I occlusal cavities. The teeth were restored with composite using various application techniques for both adhesives, according to the following groups (n = 10): group 1 (control), systems were applied and adhesive was immediately light activated for 20 seconds without removing excesses; group 2, excess adhesive was removed with a gentle jet of air for 5 seconds; group 3, excess was removed with a dry microbrush-type device; and group 4, a gentle jet of air was applied after the microbrush and then light activation was performed. After this, the teeth were submitted to microtensile testing. For the two systems tested, no statistical differences were observed between groups 1 and 2. Groups 3 and 4 presented higher bond strength values compared with the other studied groups, allowing the conclusion that excess adhesive removal with a dry micro-brush could improve bond strength in composite restorations. Predominance of adhesive fracture and thicker adhesive layer were observed via scanning electron microscopy (SEM) in groups 1 and 2. For groups 3 and 4, a mixed failure pattern and thinner adhesive layer were verified. Clinicians should be aware that excess adhesive may negatively affect bond strength, whereas a thin, uniform adhesive layer appears to be favorable. (Quintessence Int 2013;44:9-15)

Bond strength of composite to dentin: effect of acid etching and laser irradiation through an uncured self-etch adhesive system

This study evaluated the effect on micro-tensile bond strength (mu-TBS) of laser irradiation of etched/unetched dentin through an uncured self-etching adhesive. Dentinal surfaces were treated with Clearfil SE Bond Adhesive (CSE) either according to the manufacturer's instructions (CSE) or without applying the primer (CSE/NP). The dentin was irradiated through the uncured adhesive, using an Nd: YAG laser at 0.75 or 1 W power settings. The adhesive was cured, composite crowns were built up, and the teeth were sectioned into beams (0.49 mm(2)) to be stressed under tension. Data were analyzed using one-way ANOVA and Tukey statistics (alpha = 5%). Dentin of the fractured specimens and the interfaces of untested beams were observed under scanning electron microscopy (SEM). The results showed that non-etched irradiated surfaces presented higher mu-TBS than etched and irradiated surfaces (p < 0.05). Laser irradiation alone did not lead to differences in mu-TBS (p > 0.05). SEM showed solidification globules on the surfaces of the specimens. The interfaces were similar on irradiated and non-irradiated surfaces. Laser irradiation of dentin through the uncured adhesive did not lead to higher mu-TBS when compared to the suggested manufacturer's technique. However, this treatment brought benefits when performed on unetched dentin, since bond strengths were higher when compared to etched dentin.

Adhesion of substrate-adherent combinations for early composite repairs: Effect of intermediate adhesive resin application

This study evaluated the effect of intermediate adhesive resin application (IAR) on tensile bond strength (TBS) for early composite repairs in situations where substrate and repair composite bonded together were once of the same kind with the substrate (similar) and once other than the substrate material (dissimilar). Specimens from three types of composites (TPH Spectrum (TPH), Charisma (CHA) and Filtek Z250 (Z250)) were fabricated. The specimens in each composite group (n=72) were randomly divided into six subgroups (n=12). In each composite group, the similar and two dissimilar composites were bonded onto the substrates once using an IAR (Adper Single Bond Plus) and once without. After water storage for I week at 37 degrees C, substrate-adherent combinations were submitted to tensile test. Data were analyzed with three-way ANOVA and Tukey's tests (alpha=0.05). The substrate-adherent combination (p=0.0001), adherent (repair) composite (p=0.0001), and application of IAR (p=0.0001) significantly affected the results. Utilization of IAR improved the repair bond strength for all composite combinations. (C) 2013 Elsevier Ltd. All rights reserved.

Two-year Clinical Performance of Self-etching Adhesive Systems in Composite Restorations of Anterior Teeth

Objective: The aim of this study was to evaluate the two-year clinical performance of Class III, IV, and V composite restorations using a two-step etch-and-rinse adhesive system (2-ERA) and three one-step self-etching adhesive systems (1-SEAs).Material and Methods: Two hundred Class III, IV, and V composite restorations were placed into 50 patients. Each patient received four composite restorations (Amaris, Voco), and these restorations were bonded with one of three 1-SEAs (Futurabond M, Voco; Clearfil S3 Bond, Kuraray; and Optibond All-in-One, Kerr) or one 2-ERA (Adper Single Bond 2/3M ESPE). The four adhesive systems were evaluated at baseline and after 24 months using the following criteria: restoration retention, marginal integrity, marginal discoloration, caries occurrence, postoperative sensitivity and preservation of tooth vitality. After two years, 162 restorations were evaluated in 41 patients. Data were analyzed using the chi(2) test (p<0.05).Results: There were no statistically significant differences between the 2-ERA and the 1-SEAs regarding the evaluated parameters (p>0.05).Conclusion: The 1-SEAs showed good clinical performance at the end of 24 months.

Influence of Nd:YAG Laser on the Bond Strength of Self-etching and Conventional Adhesive Systems to Dental Hard Tissues

Purpose: The aim of this study was to investigate the influence of Nd:YAG laser on the shear bond strength to enamel and dentin of total and self-etch adhesives when the laser was applied over the adhesives, before they were photopolymerized, in an attempt to create a new bonding layer by dentin-adhesive melting.Material and Methods: One-hundred twenty bovine incisors were ground to obtain flat surfaces. Specimens were divided into two substrate groups (n=60): substrate E (enamel) and substrate D (dentin). Each substrate group was subdivided into four groups (n=15), according to the surface treatment accomplished: X (Xeno III self-etching adhesive, control), XL (Xeno III + laser Nd:YAG irradiation at 140 mJ/10 Hz for 60 seconds + photopolymerization, experimental), S (acid etching + Single Bond conventional adhesive, Control), and SL (acid etching + Single Bond + laser Nd:YAG at 140 mJ/10 Hz for 60 seconds + photopolymerization, experimental). The bonding area was delimited with 3-mm-diameter adhesive tape for the bonding procedures. Cylinders of composite were fabricated on the bonding area using a Teflon matrix. The teeth were stored in water at 37 degrees C/48 h and submitted to shear testing at a crosshead speed of 0.5 mm/min in a universal testing machine. Results were analyzed with three-way analysis of variance (ANOVA; substrate, adhesive, and treatment) and Tukey tests (alpha=0.05). ANOVA revealed significant differences for the substrate, adhesive system, and type of treatment: lased or unlased (p<0.05). The mean shear bond strength values (MPa) for the enamel groups were X=20.2 +/- 5.61, XL=23.6 +/- 4.92, S=20.8 +/- 4.55, SL=22.1 +/- 5.14 and for the dentin groups were X=14.1 +/- 7.51, XL=22.2 +/- 6.45, S=11.2 +/- 5.77, SL=15.9 +/- 3.61. For dentin, Xeno III self-etch adhesive showed significantly higher shear bond strength compared with Single Bond total-etch adhesive; Nd:YAG laser irradiation showed significantly higher shear bond strength compared with control (unlased).Conclusion: Nd:YAG laser application prior to photopolymerization of adhesive systems significantly increased the bond strength to dentin.

Grander system: A new technology to reduce surface tension of adhesive systems in dentistry

Background. Reduced surface tension of liquids results in higher surface wetting ability and diffusivity by the substrate. Objectives. The objective of this study was to evaluate the influence of the Grander Technology in reducing the surface tension of adhesive systems. Methods. Two adhesive systems (self-etch and total-etch) were modified by physical contact with the Grander system Flexible unit to revitalize water, for 48 h. Surface tension of adhesive systems and water in normal and grander-modified conditions was measured with a goniometer. Results. The results showed a reduction of surface tension for all conditions grander-modified between 3-15%. Conclusions. Grander Technology was effective in reducing the surface tension of the Single Bond and Clearfil SE Bond adhesive systems. Clinical significance. Grander technology was employed to restructure the molecular structure of water-based adhesive systems, which can increase their wetness capacity and therefore ensure a greater diffusibility.

Ovarian blood vessel occlusion as a surgical sterilization method in rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação histológica do processo de reparação do tecido ósseo do rato frente à aplicação de um adesivo à base de cianoacrilato

This research objective was to verify the tissues reactions obtained, in surgical experimental bone defect, after the etil cyanoacrylate chemical adhesive application in rats parietal bones. 1t was investigated the acceptance or no acceptance of the tissues surround the bone defect in which was placed the etil cyanoacrylate and the control bone defect. The specimens were submitted to light microscopic analysis. 24 adults rats were used (Rattus norvergicus, albinus, Wistar) with the average weight to 300 gr. and were divided in two groups: treated and control. After the bone defects were realized, etil cyanoacrylate was placed over one of the defects at the parietal bone (treated group). On the other defect nothing was placed and it was used like control group. After 24 hours, 3,5,7,30 and sixty days after surgery, for animals of each group were sacrificed. The bone samples were removed and fixed in 10% formalin during 72 hours and analyzed using light microscopy. The results showed that the acute inflammatory responses was more observed at lhe treated group than the control group. The chemical adhesive was observed until 60 days follow the surgery and the tissues around it present normal appearance. The chemical adhesive, etil cyanaocrylate, did not impede at the bone repair process

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.