Salud, equidad y capital humano en el Istmo Centroamericano

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Rehabilitacion oral sobre implantes instalados por medio de la tecnica sin colgajo (flapless) y carga inmediata

The oral rehabilitation with osseointegrated implants is a well-documented treatment with high rate of success. Nevertheless, demands related to treatment time and surgical technique began to appear. In this context, the procedure of immediate loading in which the dental prosthesis is placed right after implant surgery has become a constant practice. Although immediate loading has been an important advance, minimally invasive procedures, such as implant placement without raising a mucoperiosteal flap (flapless) are increasingly being performed. Association of immediate loading with the flapless technique improves acceptance by patients and professionals, because no suturing is required. Moreover, it reduces swelling, bleeding during and after surgery, postoperative pain, surgery time, discomfort and hematoma, as well as the need for postoperative medication. These characteristics ease the stages of rehabilitation soon after implant placement, cooperating with prosthodontist's work. Thus, the proposal of this study is to present a clinical case of oral rehabilitation with osseointegrated implants and fixed prosthesis in both arches, in which the flapless technique was applied, followed by immediate loading. It will discuss the diagnosis, prosthetic planning, surgical/prosthodontic procedures and follow-up for 20 months.

Conceptos actuales en la preparación de la cavidad apical para obturación retrógrada en cirugía perirradicular

The endodontic surgery is indicated in cases of failure and/or impossibility of conventional endodontic treatment. Among the existent modalities in the endodontic surgery, the retrograde filling consists on preparation of apical cavity and filling with a retrofilling material. The technical-scientific progress in Endodontics become possible the use of retrotips activated with ultrasonic for retrocavities preparation with appropriate extension and following the long axis of the root. The aim of the study was to present the current resources in the preparation of the retrograde cavity in endodontic surgery, detaching their advantages in comparison with the use of conventional preparation with burns. A review of the literature will be presented, considering the use of ultrasound and laser for retrograde preparation, seeking the current resources that provide better apical preparation, resulting in better prognostic of the endodontic surgery (AU)

Cirugía endodóntica con obturación simultánea del conducto radicular: caso atípico

The apical surgery with simultaneous root filling consists in the elimination of the local etiologic factors concomitant with the shaping and obturation of the root canal system. This technique is indicated when there is no possibility of obturating the root canal by conventional methods. Some adverse factors may difficult the clinical procedures, such as the radiographic interpretation. Periapical radiographs must not be used as the main diagnostic resource due to their inherent disadvantages, such as distortion and superimposition with other anatomical structures. The aim of this clinical case report is to show the limitations of radiographic examination in an apical surgery in which a root perforation was not visible in the radiographic image, as well as the gutta-percha was not related to its real clinical location.

Validez y confiabilidad de la versión en español de la escala multidimensional de la UNESP-Botucatu para evaluar el dolor postoperatorio en gatos

This study focused on the validation of the Spanish version of the UNESP-Botucatu multidimensional composite pain scale to assess postoperative pain in cats. The original scale in Portuguese was translated into Spanish by two independent translators, and summarised in one version by a third individual. The summarised version was back-translated and minor adjustments were made. The scale was reviewed by three anesthesiologists with Spanish as their first language, and the final version was submitted to psychometric testing. Thirty cats undergoing ovariohysterectomy were video recorded during the perioperative period. Six observers from different spanish speaking countries, who had Spanish as the first language watched the videos and determined the pain scores using the Spanish version of the scale, identifying the cats that should receive analgesics. Videos were reanalysed in a different order about 2 months after the first assessment. The sensitivity to change, content and construct validity were established by the significant change in pain scores in response to surgery and analgesics. The agreement between the evaluations of the 'gold standard'(researcher that developed the scale) and the other observers confirmed the criterion validity. Inter- and intra-rater reliability, evaluated by intra-class correlation coefficient, ranged from good to very good for all scale items. The cut-off point for rescue analgesia identified by Receiver Operating Characteristic curve was > 7 with 92% of sensitivity and 91% of specificity. The Spanish version of the UNESP-Botucatu multidimensional composite pain scale is interpretable (has an optimal analgesic intervention score), valid and reliable instrument for assessing acute pain in cats undergoing ovariohysterectomy.

Perfil clínico de crianças com indicação da cirurgia das tonsilas em um hospital terciário universitário

The indications for adenotonsillectomy in pediatric patients have changed considerably during the 90th decade. Local or systemic complications of the adenoid or tonsil hypertrophy itself have now been substituted by signs of obstructive ventilatory disturbances, including obstructive sleep apnea as the major indications for surgery. Objective: This study analyses the clinical profile of children submitted to adenotonsilectomy in their pre and postoperative state, at Botucatu Medical School-State University São Paulo, UNESP. Methods: 332 children of both genders, aged 1 to 12 years, who underwent adenotonsillectomy between 1999 and 2004, were studied, focused on epidemiological profile, pre and postoperative (1 month) symptoms, obtained from medical records. Height and weight were compared to brazilian normal age related values. Results: We found a predominance of the male gender, except in he group aged from 10 to 12 years. Considering wheight and height, we found important failure to thrive, mostly for height deficit. Among clinical aspects, we found a significant reduction in obstructive symptoms like snoring or apneia (p<0001) in the postoperative period. Conclusion: Our results were similar to the literature findings of patients clinical profile. The major indication for adenotonsillectomy in our service was clinical diagnosis of obstructive sleep apnea.

Avaliação dos dados obtidos em um programa de esterilização cirúrgica de gatos em Araçatuba, SP no período de 1996 a 2010

Cats are gradually occupying a more important position as pets and this preference is a result of how easy cat maintenance in an urban environment is, even though they are very prolific and need surgical sterilization. This paper aims at evaluating obtained data within 15 years of research in a university service program that offers free cats sterilization surgery. We carried out a statistical analysis of data shown in the records of animals treated by the program. Surgical sterilization was performed on 647 animals (409 females – 63% and 238 males – 37%). Unilateral cryptorchidism was observed in 9 (3.8%) male cats. Forty (10%) female cats were pregnant at the time of the surgery and the treatment with contraceptives was observed in 67 (16.4%) female cats. One death occurred during anesthesia recovery and 2 cats were euthanized because of wound infection, totalizing an amount of 0.5% of severe complications. From 1996 to 2004, 212 female cats were spayed (122 adults and 90 prepubertal) and during that time two different approaches for ovariohysterectomy were compared: flank laparotomy and ventral midline celiotomy. The flank laparotomy approach was used in only 46 female cats (21.7%) due to some disadvantages observed – the need of an incision on each flank in prepubertal or nulliparous animals and the difficulty or impossibility of total uterus removal. In the same period, 105 male cats underwent orchiectomy via an open technique in which the spermatic cord was linked with nylon thread. From 2005 to 2010, 197 females (106 adults and 91 prepubertal) were spayed. The minilaparotomy technique was used to perform ovariohysterectomy on 139 female cats (70.6%). In this procedure, ovaries and uterus were exteriorized in a blind fashion with a hook through a small midline incision. The traditional midline ovariohysterectomy, which incision length permits direct visualization of the ovaries and uterus, had to be performed in 58 (29.4%) female cats due to advanced pregnancy, full urinary bladder during surgery or obesity. Over the past 6 years, 133 male cats (48 adults and 85 prepubertal) were castrated by means of an open technique in which the spermatic cord was tied to itself. The demand for surgeries during the project demonstrated that people are becoming aware concerning the importance of sterilization when facing cat overpopulation and abandonment.

Periodontite ulcerativa necrosante: tratamento fisico da superficie radicular com Er YAG laser

Necrotizing ulcerative periodontitis is associated with bacteria and predisposing risk factors. The treatment is centered in elimination and/or control of the bacteria and predisposing risk factors. However the disease acute phase could induce sequelae as periodontal tissue destruction which may be treated by periodontal surgical procedures.

Selección del tratamiento farmacológico en el estado de mal epiléptico en niños

The status epilepticus (SE) is characterized by a series of crises which occur without recovery of consciousness or a single seizure lasting more than 30 minutes and can damage the central nervous system and systemic. The duration and frequency of attacks are directly related to patient prognosis. Whether seizures occur often and are longer, increase the risk of neurological and systemic complications. Child population has a higher frequency of seizures and it is associated with a lower threshold of immature brain to trigger these episodes. Aim: To determine the safest drugs prescribed for children in SE, their doses and schedules. A bibliographic survey was performed in electronic databases. Methods: The scientific health descriptors used for search was: “status epilecticus” and “anticonvulsivants” and “child”. Results: This strategy identified 396 manuscripts, of whom four were considered eligible for the study, after the assessment by floating reading and criteria. Of these, two were randomized trials and two descriptive. The studies address the use of oral midazolam, rectal diazepam and intravenous lorazepam. Conclusions: All investigated drugs were effective in treat in status epilepticus. Lorazepam is highlight, since it has fewer secondary effects and, as an alternative to the intravenous, oral midazolam. However, there is a need for further studies to demonstrate the efficacy and safety in the use of drugs in children.

Circulação extracorpórea e complicações no período pós-operatório imediato de cirurgias cardíacas

OBJETIVO: Comparar a frequência de complicações apresentadas pelos pacientes, durante o pós-operatório imediato (POI), de cirurgias cardíacas de acordo com o tempo de circulação extra-corpórea (CEC). MÉTODOS: Estudo de natureza quantitativa, descritivo e correlacional com 83 pacientes adultos divididos em dois grupos de acordo com o tempo de CEC. RESULTADOS: Do total de pacientes, 44 (53%) tiveram o tempo de duração da CEC de até 85 minutos e 39 (47 %) tiveram o tempo acima de 85 minutos. As complicações foram comuns para ambos os grupos, sendo as mais frequentes dor e oligúria. No entanto, hemotórax, pneumotórax e infarto agudo do miocárdio ocorreram apenas no grupo com maior tempo de CEC. CONCLUSÃO: A maioria das complicações ocorridas no POI apresentou frequencia semelhante para os pacientes, independente do tempo de CEC.

Valoración de los efectos terapeúticos y mecanismos de acción in vivo de los ultrasonidos pulsátiles sobre la consolidación de las fracturas costales

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Valoración del tratamiento con sellantes biológicos y terapia celular en la prevención de la fístula broncopleural en un modelo experimental in vivo

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