Response of human pulps capped with a self-etching adhesive system

Objective: The aim of this study was to evaluate the human pulp response following direct pulp capping with a current self-etching bonding agent and calcium hydroxide (CH). Methods: Thirty-three sound human premolars had their pulp tissue mechanically exposed. Sterile distilled water was used to control the hemorrhage and exudation from the pulp exposure site. The pulps were capped with Clearfil Liner Bond 2 (CLB-2) or CH and the cavities were filled with a resin composite (Z-100) according to the manufacturer's instructions. After 5, 30 and 120-300 days, the teeth were extracted and processed for microscopic examination. Results: At short-term, CLB-2 elicited a mild to moderate inflammatory pulp response with dilated and congested blood vessels adjacent to pulp exposure site. With time, macrophages and giant cells engulfing globules and particulates of resinous material displaced into the pulp space were observed. This chronic inflammatory pulp response triggered by fragments of bonding agent displaced into the pulp space did not allow pulp repair interfering with the dentin bridging. On the other hand, pulps capped with CH exhibited an initial organization of elongated pulp cells underneath the coagulation necrosis. Pulp repair and complete dentin bridge formation was observed at long-term evaluation. Significance: The present study demonstrated that CH remains the pulp capping agent of choice for mechanically exposed human pulps. CLB-2 did not allow complete connective tissue repair adjacent to the pulp exposure site. Consequently, this bonding agent cannot be recommended for pulp therapy of sound human teeth. © 2001 Academy of Dental Materials. Published by Elsevier Science Ltd. All rights reserved.

Brazilian consensus on gastroesophageal reflux disease: Proposals for assessment, classification, and management

The Brazilian Consensus on Gastroesophageal Reflux Disease considers gastroesophageal reflux disease to be a chronic disorder related to the retrograde flow of gastroduodenal contents into the esophagus and/or adjacent organs, resulting in a variable spectrum of symptoms, with or without tissue damage. Considering the limitations of classifications currently in use, a new classification is proposed that combines three criteria - clinical, endoscopic, and pH-metric - providing a comprehensive and more complete characterization of the disease. The diagnosis begins with the presence of heartburn, acid regurgitation, and alarm manifestations (dysphagia, odynophagia, weight loss, GI bleeding, nausea and/or vomiting, and family history of cancer). Also, atypical esophageal, pulmonary, otorhinolaryngological, and oral symptoms may occur. Endoscopy is the first approach, particularly in patients over 40 yr of age and in those with alarm symptoms. Other exams are considered in particular cases, such as contrast radiological examination, scyntigraphy, manometry, and prolonged pH measurement. The clinical treatment encompasses behavioral modifications in lifestyle and pharmacological measures. Proton pump inhibitors in manufacturers' recommended doses are indicated, with doubling of the dose in more severe cases of esophagitis. The minimum time of administration is 6 wk. Patients who do not respond to medical treatment, including those with atypical manifestations, should be considered for surgical treatment. Of the complications of gastroesophageal reflux disease, Barrett's esophagus presents a potential development of adenocarcinoma; biopsies should be performed, independent of Barrett's esophagus extent or location. In this regard the designation short Barrett's is not important in terms of management and prognosis. © 2002 by Am. Coll. of Gastroenterology.

Hepatic bleeding induced by streptokinase and heparin in a patient with acute myocardial infarction

Although rare, major bleeding is the most important side effect of thrombolytic therapy in acute myocardial infarction (AMI) (Levine et al., 1995). Spontaneous hepatic bleeding in normal liver after thrombolytic administration has rarely been reported in literature. To our knowledge, there are only three cases of hepatic bleeding related to thrombolytic therapy in AMI. In these, the used drugs were anisolylated plasminogen streptokinase activator complex (APSAC) (Garcia-Jiménez et al., 1997; Fox et al., 1991) and rt-PA (Garcia-Jiménez et al., 1997). We report a case of hepatic bleeding after streptokinase followed by units over 60 minutes). The next day, the patient developed third-degree atrioventricular block and a temporary pacemaker was inserted. Twenty-seven hours after streptokinase infusion, the patient complained of refractory chest pain that was interpreted as post-myocardial infarction angina; clotting screen was normal and intravenous heparin was started (80 U/kg followed by 18 U/kg/hour). After four hours of heparin administration, the patient presented abdominal pain and distension, and his blood pressure and hematocrit level dropped. Abdominal ultrasonography revealed free fluid in the peritoneal cavity (about 3,000 mL). A laparotomy disclosed blood in the abdominal cavity with bleeding from the right lateral hepatic segment, which was removed. The remaining abdominal viscera were normal and there was no other evidence of hemorrhage. The partial liver resection presented subcapsular hemorrhage with small parenchymal hemorrhage. Histopathological examination also revealed focal areas of ischemic centrilobular necrosis. The patient died of multiple organ system failure 21 days after admission. Copyright © 2002 By PJD Publications Limited.

Diagnósticos e intervenções de enfermagem aos pacientes em terapia anticoagulante.

Patients under treatment with oral anticoagulants present specific needs for which nursing care plays an important role, especially to prevent complications. The present review was carried out aiming at discussing nursing diagnoses for these patients by using the system of the North American Nursing Diagnoses Association--NANDA. Diagnoses for such patients depict the risk of bleeding and rethrombosis almost always due to the ineffective control of the therapeutic regimen and the deficit in the volume of fluids during active bleeding. Also, nursing interventions and assessment criteria are proposed for such conditions. The authors see the team's preparation to deal with such therapy as relevant for successful assistance.

Surgical and clinical management of a patient with Glanzmann thrombasthenia: A case report

A 6-year-old girl with Glanzmann thrombasthenia presented with caries and periapical lesions in the primary mandibular second molars and moderate gingivitis of the maxillary and mandibular anterior teeth. Dental extraction was recommended, and before every surgical intervention, the patient underwent platelet-concentrate transfusion to prevent hemorrhage. Epsilon aminocaproic acid was administered 6 hours before, and 48 hours after every dental procedure to prevent bleeding. In this case, treatment was effective in the prevention of hemorrhagic complications, during the required dental procedures.

Injeção subaracnóidea inadvertida de corticoíde em tratamento de dor crônica da coluna lombar. Relato de caso

BACKGROUND AND OBJECTIVES: Before epídural steroids were used in chronic lumbar pain, subarachnoid injection of these agents was the treatment of choice. Although still preconized by some authors, this technique may lead to severe complications with neurological sequelae. This report aimed at describing a case of accidental subarachnoid injection of steroid associated to local anesthetics during epidural puncture to treat lumbar pain. CASE REPORT: Male patient, 46 years old, followed byneuro-surgery for presenting right sciatic pain for 9 month, refractory to clinical treatment due to L 4-L 5 disk protrusion confirmed by CT scan, without neurological deficit. Epidural puncture for pain treatment was performed in L 4-L 5 with 17G needle and 10 mL solution were injected containing 4 mL of 0.25% bupivacaine, 80 mg methylprednisolone and 4 mL of 0.9% saline. Although there has not been CSF reflux, 5 minutes after injection there were sensory block in T 4 and motor block in T 6, associated to blood pressure and heart rate decrease. CONCLUSIONS: Accidental subarachnoid injections with the association of steroids for pain relief may cause adverse effects. There are several risks, varying from mild transient symptoms to nervous injuries, including spinal cord injuries. Our patient had no sequelae from the accidental subarachnoid injection, probably because it has been a single injection.

A fatal attack caused by a lowland tapir (Tapirus terrestris) in Southeastern Brazil

A 55-year-old man was attacked by a Brazilian tapir (Tapirus terrestris) after surprising and stabbing the animal in his corn plantation. The victim received deep bites in the thighs, neck, and cervical areas, resulting in severe hemorrhage and death. This is the first report of a tapir incident resulting in death and is of interest because of the severity of the contusions and lacerations caused by the provoked animal.

Efeito alelopático de extratos de parte aérea de barbatimão [Stryphnodendron adstringens (Mart.) Coville] na germinação e desenvolvimento da plântula de pepino

Stryphnodendron adstringens (Mart.) Coville (barbatimão), belonging to Mimosaceae family; it is used as ornamental and the wood is used in civil buildings, edification in wet places, lathe and joinery jobs, being very used also in home-made medicine against hemorrhage, diarrhea, hemorrhoids, conjunctivitis, injury cleaning, uterus hemorrhage, ulcerous hurt and excessive oily skin. The objective of this research was to determine the allelopathic potential of an aqueous extract, boiled or not of S. adstringens (Mart.) Coville, in the Cucumis sativus germination and initial development. Thus, the aqueous vegetable extract was extracted from the shoot, which was triturated in 1L of distilled water to 100g of leaf, being the extract filtrated and separated in boiled and not boiled. The treatments used were distilled water (0%) and boiled and not boiled extracts, in the concentrations of 50 and 100%. The cucumber seeds were put to germinate in Gerbox, having filter paper as substrate, which was wet with 25mL from different treatments, in constant temperature of 25°C. The reading germination was accomplished in breaks of 24 hours, for a period of five consequently days after the beginning of the experiment, considering germinated the seeds that showed 2mm of root, approximately. To dry matter determination, the seedlings with five days after the germination were separated in shoot and root, dried during three days to a constant weight in a 60°C forced draft oven. Through results, it can be concluded that the extract of S. adstringens affected more the Cucumis sativus seedling development than the germination, and it didn't show difference if boiled or not.

Efeitos do parasitismo sobre a estrutura branquial de Leporinus macrocephalus Garavello e Britsk, 1988 (Anastomidae) e Piaractus mesopotamicus Holmberg, 1887 (Osteichthyes:Characidae).

This work described the lesions caused in different species of fish by gill parasites from fee-fishing at Guariba, State of São Paulo. The research was developed from april, 1997 to march to 1999, seeking to verified the kind tissues lesions from fish. Of these, forty and seven were Leporinus macrocephalus and fifty and five Piaractus mesopotamicus. About 87.2% of the L. macrocephalus, and 58.1% of the P. mesopotamicus were sponged by several species of parasites. The parasite most abundant in L. macrocephalus was Piscinoodinium pillulare, while monogenean, Trichodina sp and myxosporidian infected P. mesopotamicus. Severe gill lesions have been observed in L. macrocephalus and P. mesopotamicus caused by monogenean, P. pillulare e Trichodina sp. parasitism, such as intersticial hemorrhage, sub-epithelium edema, inflammation, epitelial hiperplasy in filaments and lamina, proliferation of mucosal cells and laminar fusion.

Arthrodesis tarsocrural or tarsometatarsal in 2 dogs using circular external skeletal fixator

An external fixation technique, using a circular fixator, to obtain arthrodesis was evaluated in 2 dogs with infected open lesions and soft tissue damage. In both cases, articular cartilage was curetted, and devitalized bone and necrotic soft tissue were removed. No bone graft was used. The wounds were maintained open and the dogs received postoperative antibiotic therapy. The arthrodesis site was compressed progressively as needed. Infection was eradicated and bony union was obtained in both dogs. It was concluded that the use of a circular fixator is an effective method to achieve arthrodesis.

Pneumoencéfalo intraventricular após perfuração acidental de dura-máter. Relato de caso

BACKGROUND AND OBJECTIVES: The loss of resistance to air to identify the epidural space is widely used. However, the accidental perforation of the dura mater is one of the possible complications of this procedure, with an estimated incidence between 1% and 2%. The objective of this report was to describe the case of a patient with intraventricular pneumocephalus after the accidental perforation of the dura mater using the loss of resistance with air technique. CASE REPORT: Female patient, 26 years old, 75 kg, 1.67 m, physical status ASA I, with a 38-week pregnancy, was referred to the obstetric service for a cesarean section. Venipuncture was performed after placement of the monitoring. The patient was placed in a sitting position for administration of the epidural anesthesia. During the identification of the epidural space with the loss of resistance with air technique, an accidental perforation of the dura mater was diagnosed by observing free flow of CSF through the needle. The technique was modified to epidural anesthesia and anesthetics were administered by the needle placed in the subarachnoid space. In the first 24 hours, the patient developed headache and she was treated with caffeine, dypirone, hydration, hydrocortisone, and bed rest; despite those measures, the patient's symptoms worsened and evolved to headache in decubitus. A CT scan of the head showed the presence of pneumocephalus. After evaluation by a specialist, the patient remained under observation, with progressive improvement of the symptoms and was discharged from the hospital in the fifth day, without complications. CONCLUSIONS: Pneumocephalus after accidental perforation of the dura mater presented headache with the characteristics of headache secondary to loss of CSF, but with spontaneous resolution after the air was absorbed. Invasive measures, such as epidural blood patch, were not necessary. © Sociedade Brasileira de Anestesiologia, 2006.

Biochemical and hematological study of goats envenomed with natural and 60Co-irradiated bothropic venom

Venoms from snakes of the Bothrops genus are proteolytic, coagulant, hemorrhagic and nephrotoxic, causing edema, necrosis, hemorrhage and intense pain at the bite site, besides systemic alterations. Many adjuvants have been added to the venom used in the sensitization of antiserum-producer animals to increase antigenic induction and reduce the envenomation pathological effects. Gamma radiation from 60Co has been used as an attenuating agent of the venoms toxic properties. The main objective was to study, comparatively, clinical and laboratory aspects of goats inoculated with bothropic (Bothrops jararaca) venom, natural and irradiated from a 60Co source. Twelve goats were divided into two groups of six animals: GINV, inoculated with 0.5mg/kg of natural venom; and GIIV, inoculated with 0.5mg/kg of irradiated venom. Blood samples were collected immediately before and one, two, seven, and thirty days after venom injection. Local lesions were daily evaluated. The following exams were carried out: blood tests; biochemical tests of urea, creatinine, creatine kinase (CK), aspartate amino-transferase (AST) and alanine amino-transferase (ALT); clotting time; platelets count; and total serum immunoglobulin measurement. In the conditions of the present experiment, irradiated venom was less aggressive and more immunogenic than natural venom.

Effects of hemostatic agents on the histomorphologic response of human dental pulp capped with calcium hydroxide

Objective: To evaluate the response of human pulps capped with a calcium hydroxide [Ca(OH)2] cement after bleeding control with 2 hemostatic agents. Method and Materials: Pulps were exposed on the occlusal floor, and the bleeding was controlled either with saline solution (SS) or 2.5% sodium hypochlorite (NaOCI) (SH). After that, the pulp was capped with Ca(OH) 2 cement and restored with resin composite. After 30 (groups SS30 and SH30) and 60 (groups SS60 and SH60) days, the teeth were extracted and processed with hematoxylin-eosin and categorized in a histologic score system. The data were subjected to Kruskal-Wallis and Mann-Whitney tests (α = .05). Results: Regarding dentin bridge formation, an inferior response of SH60 group was observed when compared to SS60 (P < .05). The response of the SH30 group generally was similar to that of the groups treated with saline solution. However, after 60 days, 2.5% NaOCl showed a trend toward having an inferior response. Conclusion: Using saline solution as a hemostatic agent before pulp capping with Ca(OH)2 resulted in a significantly better histomorphologic response than using 2.5% NaOCl as a hemostatic agent before capping with Ca(OH)2.

Effects of fibrin sealer and resorbable gelatin on the repair of osseous defects in rat tibia

Gelfoam® - a biologically resorbable gelatin sponge - has the function of restricting hemorrhage, providing platelet rupture, and supporting fibrin threads. Beriplast® - a fibrinogen-thrombin compound - is used to adhere tissues, to consolidate sutures and in hemostasis. The objective of this study was to perform a histological analysis of the effects of haemostatic agents on osseous repair. These materials were inserted into surgical sites in young rat right and left tibiae. After the observation periods of 7, 14, 30 and 45 days, according to the bioethic protocol, the animals were killed, the tibiae were removed and fixed in 10% formalin and decalcified in equal parts of formic acid and sodium citrate solutions. After routine processing, the specimens were embedded in paraffin for microtomy. Analysis of the results demonstrated that the haemostatic agents are effective in controlling hemorrhage; they stimulate osteogenesis, featuring a pattern of osseous tissue formation similar to the control pattern, although the amount of osseous trabeculae was superior, especially in the Gelfoam group in the periods of 7 and 14 days; 30 days after surgery, the delay in tissue healing in the control group in relation to the experimental groups started to decrease, and the control and experimental groups exhibited similar tissue repair after 45 days, when all the groups exhibited secondary osseous tissue.