Efeito do ácido tranexâmico associado à cola de fibrina sobre o reparo ósseo: estudo histológico em ratos

The bone repair process is controlled by complex molecular mechanisms that involve systemic and local factors. Fibrin glue is derived from human plasma and mimics the final pathway of coagulation network. Tranexamic acid inhibits fibrinolysis and prevents or decreases the formation of degradation products of fibrin and fibrinogen. The purpose of this study was to evaluate histologically in rats the effect of tranexamic acid associated with the fibrin glue on bone healing. The experiment used 60 (n = 5) male rats in: GI: Control, GII: fibrin glue, GIII tranexamic acid and GIV /fibrin glue/tranexamic acid. Bone defect (2.5mm diameter) was created in right tibia. The animals were euthanized at 7,14 and 30 days postoperatively, and the pieces were processed with hematoxylin and eosin. The results showed at 7 days post-operative surgical cavity filled with dense connective tissue rich in fibroblasts, permeated by delicate neoformed bone trabeculae in percentage of 70-80% for GI, GII and GIII and GIV to 94.8%. At 14 days post-operative newly formed bone was found between 75-85% for GI, GII and GIII and percentage above 95% for GIV. At 30 days postoperative GI and GIV showed 95-100% of mature bone tissue; GII and GIII in percentage close to 80-90%. Based on the results and methodology is concluded that fibrin / tranexamic acid glue association has positive action on bone repair.

Clinical and radiographic evaluation of surgical treatment of zygomatic fractures using 1.5 mm miniplates system

Fractures of the zygomaticomaxillary complex are among the most common face traumas. Based upon the complexity and great variety of reported diagnoses and treatments, the proposal of this study was to evaluate, clinically and radiographically, unilateral zygomatic fractures treated through internal rigid fixation with miniplates and screws of 1.5 mm. Material and Method: 15 patients with unilateral fractures of the zygomaticomaxillary complex were analyzed, and compared with 15 patients without fractures so that a comparative analysis of the area and the perimeter of the orbital cavities could be made, as well as the distance from the nasal point to the zygomatic prominence between both groups. Results: In the radiographic analysis, the both groups presented similarity in the perimeter and in the area of the orbital cavities. Concerning the distance from the nasal point to the zygomatic prominence, only the operated group showed a significant difference between the sides, even though clinically the observation of the asymmetry had been absent or discreet. Conclusions: The treatment of unilateral fractures of the zygomaticomaxillary complex with the use of plates and screws of the 1.5 mm system proved to be effective, showing good esthetic results and low complication rates.

Oral focal mucinosis: clinical case presentation with a focus on aesthetic and functional surgical resolution

Introduction: When planning excisional surgery, alterations in the oral mucosa, particularly in esthetically important areas, represent a challenge. For cases involving an exophytic lesion with a vegetative tumoral aspect, a clinician may prioritize obtaining a definitive diagnosis by histopathologic and histochemical examinations over the preservation of esthetics or maintenance of the involved tooth. Case Presentation: A painless, hard lesion with normal coloration was present in the maxillary left central incisor of a patient for at least 6 years. A biopsy was performed to preserve oral mucosa and a treatment plan was established that included endodontic retreatment and prosthetic restoration. The histopathologic diagnosis was oral focal mucinosis, an uncommon and poorly characterized type of lesion. Conclusion: A conservative biopsy of the lesion facilitated an accurate diagnosis, promoted the patient’s comfort, and achieved satisfactory esthetic results.

Verification of applicability of the polyurethane adhesive based on castor oil in the manufacture of glued laminated bamboo

The current concern with the environment promotes the development of new technologies for production with use of alternative materials, from renewable resources, and changes in production processes, having as main objective the reduction of environmental impact. One of the alternatives for cleaner production is the use of castor oil derivatives instead of non-renewable sources, such as adhesives based on PVA (polyvinyl acetate), applied in the manufacturing process of glued laminated bamboo. Based on the versatility of the bamboo laminate and the castor oil, and from the perspective of sustainability, this study aims to contribute to the application of new materials and processes, used in the manufacturing industry, by proposing the use of the polyurethane adhesive based on castor oil for glued laminated bamboo manufacturing, which can later be used in the manufacture of several products. To verify the applicability of the polyurethane adhesive based on castor oil in the glued laminated bamboo manufacture, mechanical tests of traction and shearing of the glue sheet were performed in specimens of the said material, and the results were compared with the Cascorez 2590 and Waterbond adhesives. The results showed that the polyurethane adhesive based on castor oil, in the traction test, has superior performance than the Waterbond adhesive and slightly below than the Cascorez 2590 adhesive, but in the shear test, the polyurethane adhesive based on castor oil presented a slightly inferior performance than the other two adhesives used in the comparison.

Physical and mechanical characteristic of particleboards produced with residues of sugarcane and stem leaves of bamboo bonded with castor oil adhesive

In this research the aim was produce a particleboard with alternative materials and evaluated its physical and mechanical characteristics. The raw materials used are residues from sucarcane bagasse (SC) (Saccharum officinarum) and stem leaves of bamboo (B) (Dendrocalamus giganteus), bonded with a bi component adhesive based on castor oil. It was produced particleboards with five different traces: 100% SC, 75% SC+25% B, 50% SC+50% B, 25% SC +75%B and 100 % B. Their physical and mechanical characteristics were evaluated accordingly to Brazilian standard NBR 14810-3. Regarding the results obtained, it can be detached that for physical and mechanical evaluation it is evident a negative relation among the amount the sugarcane bagasse and their physical and mechanical characteristics, that is particleboards with low concentrations of sugarcane bagasse had better results. However all particleboards could be recommended for use as sealing particleboards in the segment of civil construction.

Kasabach-Merritt syndrome: clinical vs. surgical treatment

Kassabach-Merritt syndrome is a combination of capillary hemangioma and thrombocytopenia that predisposes to bleeding with petechiae, ecchymosis and spontaneous bruising. Treatment is generally started with corticosteroids, interferon alpha or chemotherapy. We present the case of a child (aged 1 year and 9 months) with a giant hemangioma, from the root of the thigh to the knee, and thrombocytopenia. Treatment was started with corticosteroids, without improvement, and then intra-tumor and cutaneous bleeding appeared spontaneously. The patient’s clinical condition precluded prescription of vincristine and interferon and emergency tumor resection was conducted because of extreme thrombocytopenia and bleeding. The child then began to develop sepsis with hypotension and ischemia of remnant tissues. This case presented a therapeutic challenge, which is the subject of this article.

Surgical interventions for treating pectus excavatum

Pectus excavatum is characterized by a depression of the anterior chest wall (sternum and lower costal cartilages) and is the most frequently occurring chest wall deformity. The prevalence ranges from 6.28 to 12 cases per 1000 around the world. Generally pectus excavatum is present at birth or is identified after a few weeks or months; however, sometimes it becomes evident only at puberty. The consequence of the condition on a individual’s life is variable, some live a normal life and others have physical and psychological symptoms such as: precordial pain after exercises; impairments of pulmonary and cardiac function; shyness and social isolation. For many years, sub-perichondrial resection of the costal cartilages, with or without transverse cuneiform osteotomy of the sternum and placement of a substernal support, called conventional surgery, was the most accepted option for surgical repair of these patients. From 1997 a new surgical repair called, minimally invasive surgery, became available. This less invasive surgical option consists of the retrosternal placement of a curved metal bar, without resections of the costal cartilages or sternum osteotomy, and is performed by videothoracoscopy. However, many aspects that relate to the benefits and harms of both techniques have not been defined. Objectives To evaluate the effectiveness and safety of the conventional surgery compared with minimally invasive surgery for treating people with pectus excavatum. Search methods With the aim of increasing the sensitivity of the search strategy we used only terms related to the individual’s condition (pectus excavatum); terms related to the interventions, outcomes and types of studies were not included. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, LILACS, and ICTPR. Additionally we searched yet reference lists of articles and conference proceedings. All searches were done without language restriction.

Utilização de material alternativo para a obtenção e caracterização de biomodelos, por meio da técnica de impressão 3DPRINTER

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Surgical Performance During Laparoscopic Radical Nephrectomy Is Improved With Training in a Porcine Model

Background and Purpose: Becoming proficient in laparoscopic surgery is dependent on the acquisition of specialized skills that can only be obtained from specific training. This training could be achieved in various ways using inanimate models, animal models, or live patient surgery-each with its own pros and cons. Currently, there are substantial data that support the benefits of animal model training in the initial learning of laparoscopy. Nevertheless, whether these benefits extent themselves to moderately experienced surgeons is uncertain. The purpose of this study was to determine if training using a porcine model results in a quantifiable gain in laparoscopic skills for moderately experienced laparoscopic surgeons. Materials and Methods: Six urologists with some laparoscopic experience were asked to perform a radical nephrectomy weekly for 10 weeks in a porcine model. The procedures were recorded, and surgical performance was assessed by two experienced laparoscopic surgeons using a previously published surgical performance assessment tool. The obtained data were then submitted to statistical analysis. Results: With training, blood loss was reduced approximately 45% when comparing the averages of the first and last surgical procedures (P = 0.006). Depth perception showed an improvement close to 35% (P = 0.041), and dexterity showed an improvement close to 25% (P = 0.011). Total operative time showed trends of improvement, although it was not significant (P = 0.158). Autonomy, efficiency, and tissue handling were the only aspects that did not show any noteworthy change (P = 0.202, P = 0.677, and P = 0.456, respectively). Conclusions: These findings suggest that there are quantifiable gains in laparoscopic skills obtained from training in an animal model. Our results suggest that these benefits also extend to more advanced stages of the learning curve, but it is unclear how far along the learning curve training with animal models provides a clear benefit for the performance of laparoscopic procedures. Future studies are necessary to confirm these findings and better understand the impact of this learning tool on surgical practice.

Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment

Purpose: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. Methods: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of Sao Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. Results: Immunotherapy lasted from 8 to 12 weeks. All patients reported each cold-stored sachet with 5% imiquimod cream lasted 3 days. According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.40-1,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. Conclusions: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns. The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.

Particulate composite based on coconut fiber and castor oil polyurethane adhesive: An eco-efficient product

This paper presents a study on the potential use of coconut fiber as material to produce particleboards, with two different densities (0.8 g/cm(3) and 1.0 g/cm3), using castor oil-based polyurethane adhesive and urea-formaldehyde. The quality of the product that can be produced by industry was evaluated according to the normative NBR 14.810:2006, where density, thickness swell (TS), absorption, modulus of elasticity (MOE), modulus of rupture (MOR) in static bending and internal bond (IB) were determined. From the results, there was a decrease in TS and increase in MOR of coconut fiber panels with polyurethane resin panels compared with coconut fiber and resin urea-formaldehyde. Scanning microscopy electronic images (SEM) indicated that castor oil-based polyurethane adhesive occupies the gaps between the particles, a factor that contributes to improved physical and mechanical properties of the panels. The assessment of durability through accelerated aging tests shows that panels protected with waterproofing material can be used in environments that have contact with moisture. (C) 2012 Elsevier B.V. All rights reserved.

Eroded dentin does not jeopardize the bond strength of adhesive restorative materials

This in vitro study evaluated the bond strength of adhesive restorative materials to sound and eroded dentin. Thirty-six bovine incisors were embedded in acrylic resin and ground to obtain flat buccal dentin surfaces. Specimens were randomly allocated in 2 groups: sound dentin (immersion in artificial saliva) and eroded dentin (pH cycling model - 3x / cola drink for 7 days). Specimens were then reassigned according to restorative material: glass ionomer cement (Ketac (TM) Molar Easy Mix), resin-modified glass ionomer cement (Vitremer (TM)) or adhesive system with resin composite (Adper Single Bond 2 + Filtek Z250). Polyethylene tubes with an internal diameter of 0.76 mm were placed over the dentin and filled with the material. The microshear bond test was performed after 24 h of water storage at 37 degrees C. The failure mode was evaluated using a stereomicroscope (400x). Bond strength data were analyzed with two-way ANOVA and Tukey's post hoc tests (alpha = 0.05). Eroded dentin showed bond strength values similar to those for sound dentin for all materials. The adhesive system showed the highest bond strength values, regardless of the substrate (p < 0.0001). For all groups, the adhesive/mixed failure prevailed. In conclusion, adhesive materials may be used in eroded dentin without jeopardizing the bonding quality. It is preferable to use an etch-and-rinse adhesive system because it shows the highest bond strength values compared with the glass ionomer cements tested.

Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: microbiological profile

The aim of this trial was to investigate changes occurring in the subgingival microbiological composition of subjects with aggressive periodontitis, treated with antimicrobial photodynamic therapy (aPDT), in a single episode, or scaling and root planing (SRP), in a split-mouth design on -7, 0, and +90 days. Ten patients were randomly assigned to either aPDT using a laser source in conjunction with a photosensitizer or SRP with hand instruments. Subgingival plaque samples were collected and the counts of 40 subgingival species were determined using checkerboard DNA-DNA hybridization. The data were analyzed using the method of generalized estimating equations (GEE) to test the associations between treatments, evaluated parameters, and experimental times (alpha = .05). The results indicated that aPDT and SRP affects different bacterial species, with aPDT being effective in reducing numbers of A. actinomycetemcomitans than SRP. On the other hand, SRP was more efficient than aPDT in reducing the presence of periodontal pathogens of the Red Complex. Additionally, a recolonization in the sites treated by aPDT was observed, especially for T. forsythia and P. gingivalis. Under our experimental conditions, this trial demonstrates that aPDT and SRP affected different groups of bacteria, suggesting that their association may be beneficial for the non-surgical treatment of aggressive periodontitis.

Effect of surface area and air-drying distance on shear bond strength of etch-and-rinse adhesive

We evaluated the effects of air-drying distance and bond surface area on the shear bond strength of a 2-step etch-and-rinse adhesive. A total of 120 bovine anterior teeth were equally divided into 6 main groups based on bonding surface area. The main groups were divided into sub-groups (n = 5) according to air-drying distance. The shear strength was determined using a universal testing machine at a crosshead speed of 0.5 mm/min. The averaged results were subjected to two-way ANOVA and Tukey's test (alpha = 0.05). Two-way ANOVA testing identified no significant cross-product interactions (p > 0.05), but the main factors of area (p < 0.0001) and air-drying distance (p < 0.00001) significantly affected the mean bond strength. Shorter air-drying distances improved bond strength, and increased surface area decreased the bond strength.