Fraturas do rádio distal : revisão bibliográfica

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Concordância de métodos de determinação da inclinação de caninos maxilares em radiografias panorâmicas

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Caracterização de defeitos ósseos maxilares: estudo imagiológico

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Petrologia das fraturas associadas a feições típicas de dissolução hipogênica na Formação Salitre, Bacia de Irecê, Bahia, Brasil

The recognition of karst reservoirs in carbonate rocks has become increasingly common. However, most karst features are small to be recognized in seismic sections or larger than expected to be investigated with borehole data. One way forward has been the study of analogue outcrops and caves. The present study investigates lithofacies and karst processes, which lead to the generation of the largest system of caves in South America. The study area is located in the Neoproterozoic Una Group in central-eastern Brazil. This province comprises several systems of carbonate caves (Karmann and Sanchéz, 1979), which include the Toca da Boa Vista and Barriguda caves, considered the largest caves in South America (Auler and Smart, 2003). These caves were formed mainly in dolomites of the Salitre Formation, which was deposited in a shallow marine environment in an epicontinental sea (Medeiros and Pereira, 1994). The Salitre Formation in the cave area comprises laminated mud/wakestones, intraclastic grainstones, oncolitic grainstones, oolitic grainstones, microbial laminites, colunar stromatolites, trombolites and fine siliciclastic rocks (marls, shales, and siltites). A thin layer and chert nodules also occur at the top of the carbonate unit. Phosphate deposits are also found. Our preliminary data indicate that folds and associated joints control the main karstification event at the end of the Brasiliano orogeny (740-540 Ma). We recognized five lithofacies in the cave system: (1) Bottom layers of grainstone with cross bedding comprise the main unit affected by speleogenesis, (2) thin grainstone layers with thin siltite layers, (3) microbial laminites layers, (4) layers of columnar stromatolites, and a (5) top layer of siltite. Levels (1) to (3) are affected by intense fracturing, whereas levels (4) and (5) seal the caves and have little fracturing. Chert, calcite and gipsite veins cut across the carbonate units and play a major role in diagenesis. Our preliminary study indicate that hypogenic spelogenesis is the main process of karst development and contributed significantly to the generation of secondary porosity and permeability in the carbonate units.

Criação de zonas de alta permeabilidade em fraturas: modelagem numérica do Lajedo de Soledade, Formação Jandaíra, Bacia Potiguar

The fracturing in carbonate rocks has been attracting increasingly attention due to new oil discoveries in carbonate reservoirs. This study investigates how the fractures (faults and joints) behave when subjected to different stress fields and how their behavior may be associated with the generation of karst and consequently to increased secondary porosity in these rocks. In this study I used satellite imagery and unmanned aerial vehicle UAV images and field data to identify and map faults and joints in a carbonate outcrop, which I consider a good analogue of carbonate reservoir. The outcrop comprises rocks of the Jandaíra Formation, Potiguar Basin. Field data were modeled using the TECTOS software, which uses finite element analysis for 2D fracture modeling. I identified three sets of fractures were identified: NS, EW and NW-SE. They correspond to faults that reactivate joint sets. The Ratio of Failure by Stress (RFS) represents stress concentration and how close the rock is to failure and reach the Mohr-Coulomb envelopment. The results indicate that the tectonic stresses are concentrated in preferred structural zones, which are ideal places for carbonate dissolution. Dissolution was observed along sedimentary bedding and fractures throughout the outcrop. However, I observed that the highest values of RFS occur in fracture intersections and terminations. These are site of karst concentration. I finally suggest that there is a relationship between stress concentration and location of karst dissolution in carbonate rocks.

Criação de zonas de alta permeabilidade em fraturas: modelagem numérica do Lajedo de Soledade, Formação Jandaíra, Bacia Potiguar

The fracturing in carbonate rocks has been attracting increasingly attention due to new oil discoveries in carbonate reservoirs. This study investigates how the fractures (faults and joints) behave when subjected to different stress fields and how their behavior may be associated with the generation of karst and consequently to increased secondary porosity in these rocks. In this study I used satellite imagery and unmanned aerial vehicle UAV images and field data to identify and map faults and joints in a carbonate outcrop, which I consider a good analogue of carbonate reservoir. The outcrop comprises rocks of the Jandaíra Formation, Potiguar Basin. Field data were modeled using the TECTOS software, which uses finite element analysis for 2D fracture modeling. I identified three sets of fractures were identified: NS, EW and NW-SE. They correspond to faults that reactivate joint sets. The Ratio of Failure by Stress (RFS) represents stress concentration and how close the rock is to failure and reach the Mohr-Coulomb envelopment. The results indicate that the tectonic stresses are concentrated in preferred structural zones, which are ideal places for carbonate dissolution. Dissolution was observed along sedimentary bedding and fractures throughout the outcrop. However, I observed that the highest values of RFS occur in fracture intersections and terminations. These are site of karst concentration. I finally suggest that there is a relationship between stress concentration and location of karst dissolution in carbonate rocks.

Imunoexpressão de receptores de calcitonina e corticosteroides em lesões centrais de células gigantes dos ossos maxilares

The aim of this study was to analyze the immunoexpression of calcitonin (CTR) and glucorticoid (GCR) receptors in aggressive and non-aggressive central giant cell lesions (CGCL). This is an immunohistochemistry study (immunoperoxidase technique) of 52 cases of CGCL of the jaws, in which 12 patients were treated with intralesional triamcinolone injections and one with calcitonin nasal spray. The mean of immunostaining was compared between the cell types and clinical subtype of the lesion. The correlations among means were analyzed by Mann-Whitney test. Of the 52 cases studied, 53.8% were females, with a mean of 25.69 years. Most lesions were located in the mandible. Thirty patients (57.7%) had aggressive lesions and 22 (42.3%) of the cases consisted of non-aggressive lesions. Surgery was the treatment of choice in 75% of the cases. In 56.7% of the aggressive CGCL surgery was performed, while 43.4% of patients were submitted to conservative treatment. Among cases submitted to conservative treatment, the majority (n = 8; 61.5%) responded well to treatment. CTR expression was observed in 67.3% and GCR in 96.15% of cases. There was no significant statistical difference between the expression of CTRs and GCRs in mononuclear and multinucleated CGCLscells, regarding aggressiveness, treatment performed for aggressive lesions and the response to conservative treatment (p>0.05). The results of our research suggest that the immunoreactivity of CTRs and GCRs did not influence the response to clinical treatment with calcitonin or triamcinolone in the sample studied and it exhibited a varied expression regardless of the aggressiveness of the lesion.

Imunoexpressão de receptores de calcitonina e corticosteroides em lesões centrais de células gigantes dos ossos maxilares

The aim of this study was to analyze the immunoexpression of calcitonin (CTR) and glucorticoid (GCR) receptors in aggressive and non-aggressive central giant cell lesions (CGCL). This is an immunohistochemistry study (immunoperoxidase technique) of 52 cases of CGCL of the jaws, in which 12 patients were treated with intralesional triamcinolone injections and one with calcitonin nasal spray. The mean of immunostaining was compared between the cell types and clinical subtype of the lesion. The correlations among means were analyzed by Mann-Whitney test. Of the 52 cases studied, 53.8% were females, with a mean of 25.69 years. Most lesions were located in the mandible. Thirty patients (57.7%) had aggressive lesions and 22 (42.3%) of the cases consisted of non-aggressive lesions. Surgery was the treatment of choice in 75% of the cases. In 56.7% of the aggressive CGCL surgery was performed, while 43.4% of patients were submitted to conservative treatment. Among cases submitted to conservative treatment, the majority (n = 8; 61.5%) responded well to treatment. CTR expression was observed in 67.3% and GCR in 96.15% of cases. There was no significant statistical difference between the expression of CTRs and GCRs in mononuclear and multinucleated CGCLscells, regarding aggressiveness, treatment performed for aggressive lesions and the response to conservative treatment (p>0.05). The results of our research suggest that the immunoreactivity of CTRs and GCRs did not influence the response to clinical treatment with calcitonin or triamcinolone in the sample studied and it exhibited a varied expression regardless of the aggressiveness of the lesion.

Cirurgia de fraturas ósseas na osteoporose: Fraturas da coluna vertebral

As fraturas que ocorrem no osso osteoporótico são por definição estrita fraturas patológicas. Podem estar relacionadas com quedas da própria altura ou de traumatismos de baixa energia cinética e envolvem habitualmente a anca, o punho, a coluna vertebral e o ombro. As fraturas osteoporóticas a que se associa a sarcopenia, representam um sério problema de saúde pública em todo o mundo, com uma proporção epidémica e um impacto devastador na morbilidade e mortalidade dos pacientes, assim como nos custos socioeconómicos. Apesar dos avanços registados na prevenção e no tratamento farmacológico da osteoporose bem como no tratamento cirúrgico das fraturas ósseas, continuam a ser desenvolvidos novos biomateriais metálicos e substitutos sintéticos do osso com a intenção de se conseguir alcançar melhores resultados clínicos. Dentro deste contexto incluem-se os cimentos hidráulicos, os parafusos expansivos, os parafusos dinâmicos, as malhas metálicas de titânio, as placas bloqueadas, entre outros, em conjugação com técnicas minimamente invasivas e com diferentes estratégias cirúrgicas. O objetivo central deste trabalho assenta nas modalidades cirúrgicas mais usadas para o tratamento das fraturas em osso osteoporótico, com especial destaque para as fraturas da coluna vertebral.

Avanço dos biomateriais e técnicas na correção dos defeitos ósseos maxilares

Introdução: Determinar as causas da perda óssea nos maxilares, compreender os mecanismos biológicos desencadeados após a perda dental e criar recursos técnicos no intúito de prevenir e/ou minimizar as sequélas decorrentes, tem sido ao longo dos anos uma das vertentes de maior pesquisa e desenvolvimento na medicina dental . Objetivo: Assim, o objetivo desta dissertação é realizar uma revisão da literatura sobre os avanços nos biomateriais e técnicas na correção dos defeitos ósseos maxilares, para que seja possível, futuramente, ampliar as suas aplicações em Medicina Dentária, ultrapassando as limitações das técnicas e materiais existentes atualmente. Metodologia: Para isso, foi realizada uma pesquisa de artigos na base de dados PubMed, Bireme, Lilacs, Medline, revistas e periódicos nos idiomas: português, inglês e espanhol; assim como livros consagrados na literatura médico-odontológica,com o recurso a limites e palavras-chave de forma a refinar essa pesquisa. Desenvolvimento: Os avanços nos biomateriais e técnicas na correção dos defeitos ósseos maxilares tem seguido, assim como os implantes dentais, dois principais eixos de pesquisa, primeiro no que diz respeito aos biomateriais empregados pós-exodontia, a prevenir a reabsorção osséa e aqueles utilizados à fim de corrigir defeitos já existentes; a aplicação destes materiais recai sobre fatores que são decisivos na escolha do cirurgião, tais como: disponibilidade, necessidade de procedimento cirúrgico adicional, compatibilidade, morbidade do enxerto, qualidade do osso resultante e tempo de neo-formação. Segundo, as técnicas e recursos desenvolvidos para garantir a eficáz correção do defeito, assim como proporcionar procedimentos menos traumaticos ao organismo e de maior simplicidade e previsibilidade na sua execução e reprodução pelos profissionais. Discussão: Os trabalhos desenvolvidos em volta dos biomateriais atualmente buscam não só o substituto ideal, mas sim a melhoria na interação entre o osso hospedeiro e o biomaterial enxertado perante os recursos já utilizados e consagrados pelas literaturas; assim como a utilização das técnicas já protocoladas de forma associada a estes novos materiais. Conclusão: As pesquisas sobre o aperfeiçoamento do processo de regeneração óssea nos defeitos maxilares avançam na questão de promover a rápida e eficaz interação entre organismo e biomaterial, a fim de trazer soluções para problemas como a anti-genicidade, previsibilidade dimensional, menor tempo entre a enxertia e a reabilitação protética e agrega-se a utilização de recursos técnicos práticos, uma vez que o planejamento da reabilitação inicia-se nas decisões pré-exodontias e pré-implantares.