Preemptive dexamethasone and etoricoxib for pain and discomfort prevention after periodontal surgery: A double-masked, crossover, controlled clinical trial

Background: Several anti-inflammatory drugs have been used to reduce pain and discomfort after periodontal surgeries. This study evaluates the efficacy of using etoricoxib and dexamethasone for pain prevention after open-flap debridement surgery. Methods: For this prospective, double-masked, crossover, placebo-controlled, randomized clinical trial, open-flap debridement surgeries were performed on 15 patients (eight males and seven females, age range 20 to 56 years: mean age ± SD: 40 ± 9.7 years) who presented with chronic periodontitis after nonsurgical periodontal therapy at three quadrants. Each patient underwent three surgical procedures at intervals of 30 days and received one of the following premedication protocols 1-hour before surgery: group 1 = placebo, group 2 = 8 mg dexamethasone, and group 3 = 120 mg etoricoxib. Rescue medication (750 mg acetaminophen) was given to each patient who was instructed to take it when necessary. Pain intensity and discomfort were evaluated by a 101-point numeric rate scale and a four-point verbal rate scale, respectively, hourly for the first 8 hours after surgery and three times a day on the following 3 days. Results: The results demonstrate that groups 2 and 3 present reduced postoperative pain-intensity levels compared to group 1. There were statistically significant differences at the 4, 5, 6, 7, and 8 hour-periods after surgery (Friedman test; P<0.05). Furthermore, rescue-medication intake was significantly lower for groups 2 and 3 than for group 1 (analysis of variance; P<0.02). Conclusion: The adoption of a preemptive medication protocol using etoricoxib or dexamethasone may be considered effective for pain and discomfort prevention after open-flap debridement surgeries.

Lip cavernous hemangioma in a young child

Hemangiomas are benign tumors of infancy and childhood, characterized by a phase of fast growth with endothelial cell proliferation, occurring in 10-12% of children at 1 year of age. It is known that hemangiomas of infancy are most commonly located on the head and neck region (around 60% of cases) and occur more frequently in the lips, tongue, and palate. Approximately 50% of hemangiomas have complete resolution, and 90% of them are resolved up to the age of 9. Complications occur in only 20% of the cases, the most common problem being ulceration with or without infection. The treatment depends on lesion location, size and evolution stage, and the patient's age. Surgery is usually indicated when there is no response to systemic treatments, or even for esthetic reasons, being performed as a simple excision in combination or not with plastic surgery. This paper reports a case of lip cavernous hemangioma in a 4-year-old child, who was submitted to 3 sessions of vascular sclerosis due to the size of the lesion, before undergoing simple excision of the hemangioma. Two years of postoperative clinical follow-up shows treatment success with no recurrence of the lesion.

Results of open pararenal abdominal aortic aneurysm repair: Tabular review of the literature

Open surgical repair of complex abdominal aortic aneurysms requires more extensive dissection and aortic clamping above the renal or mesenteric arteries. Although results of open surgical series have shown variation, morbidity and mortality is higher compared with infrarenal aortic aneurysm repair. Potential complications include renal insufficiency, mesenteric ischemia, multisystem organ failure, and death. Although endovascular treatment with fenestrated and branched endografts might potentially decrease the risk of complications and mortality, its role is not yet defined and the technology is not widely available. Issues related to durability of the procedure and secondary interventions might limit its application to patients with higher risk or those with hostile anatomy. This article summarizes the clinical results of open surgical repair of pararenal abdominal aortic aneurysms to provide a benchmark for comparison with results of endovascular treatment, using fenestrated and branched techniques. © Annals of Vascular Surgery Inc.

Orbitoethmoidal impacted injury by kitchen knife causing abducens nerve palsy

Introduction: Impacted knife injuries in the maxillofacial region are rare and infrequently reported. In cases of injury involving orbit or eye, these reports are even rarer. Discussion: Damage to the orbital contents may result in a rupture of the globe, extraocular muscle injury, lacrimal gland damage, and others. Orbital foreign bodies are not only difficult to detect, and clinical features vary according to its size, characteristics, shape, penetrating method, and site. In this report, a case of abducens nerve palsy after orbitoethmoidal knife injury is presented. © 2010 Springer-Verlag.

Utilization of surgical trepan for the obtainment of calvarial autogenous bone graft in maxillary reconstructions

Maxillomandibular reconstructions are traditionally performed by means of autogenous bone grafts collected from intraoral donor areas and extraoral donor areas such as clavicle, iliac bone, rib, and tibia. The calvarial bone has been studied as an alternative donor area, with a low incidence of complications and minimal postoperative morbidity. Complications such as dural lacerations associated with cerebrospinal fluid leakage and extradural and subdural bleeding were minimized due to the use of surgical trepan, allowing the diploic layer delimitation before the osteotomy, preserving the internal calvarial cortical. The purpose of this article is to suggest a new technique for the obtainment of calvarial bone grafts with surgical trepan.

Partial external mitral annuloplasty in dogs with myxomatous mitral valve degeneration and congestive heart failure: Outcome in 9 cases

Objective: To report the outcome of partial external mitral annuloplasty in dogs with congestive heart failure (CHF) due to mitral regurgitation caused by myxomatous mitral valve degeneration (MMVD). Animals, materials and methods: Nine client-owned dogs with CHF due to mitral regurgitation caused by MMVD. Surgery consisted of a double row of pledget-butressed continuous suture lines placed into the left ventricle parallel and just ventral to the atrioventricular groove between the subsinuosal branch of the left circumflex coronary artery and the paraconal branch of the left coronary artery. Results: Two dogs died during surgery because of severe hemorrhage. Two dogs died 12 and 36 h after surgery because of acute myocardial infarction. Three dogs were euthanized 2 and 4 weeks after surgery because of progression of CHF, 1 was euthanized 30 days after surgery for non-cardiac disease, and 1 survived for 48 months. In the 5 dogs that survived to discharge there was no significant change in the left atrium to aortic ratio with surgery (3.6 ± 0.56 before surgery; 3.1 ± 0.4 after surgery; p = 0.182), and no significant change in mitral regurgitant fraction in 4 dogs in which this measurement was made (78.7 ± 2.0% before surgery; 68.7 ± 7.5% after surgery; p = 0.09). Conclusions: Partial external mitral annuloplasty in dogs with CHF due to MMVD was associated with high perioperative mortality and most dogs that survived to discharge failed to show clinically relevant palliation from this procedure. Consequently, partial external mitral annuloplasty is not a viable option for dogs with mitral regurgitation due to MMVD that has progressed to the stage of CHF. © 2011 Elsevier B.V. All rights reserved.

Unusually rapid growth of brown tumour in the mandible after parathyroidectomy associated with the presence of a supernumerary parathyroid gland

The aim of this study is to report the case of a quick growing brown tumour in the jaw after a parathyroidectomy due to the presence of a rare fifth parathyroid gland. The patient had chronic renal disease and the diagnosis was tertiary hyperparathyroidism. Thirty days after the parathyroidectomy, the patient returned with a significant increase in the tumour size. The suspicion of a supernumerary gland was confirmed by parathyroid scintigraphy. The treatment of brown tumour is dependent on the treatment of the hyperparathyroidism. However, curettage should be considered if a large lesion is disturbing mastication. In conclusion, this case should attract the attention of general practitioner dentists, since they may be the first professionals who have contact with the patient with a brown tumour in the jaws. Likewise, this case emphasises the importance of knowing the type of hyperparathyroidism involved to allow for effective treatment planning. © 2011 European Association for Cranio-Maxillo-Facial Surgery.

Estudio histológico comparativo de la reparación ósea entre hueso alveolar y extra-alveolar en los cerdos sometidos a osteotomía con alta y baja velocidad, con refrigeración líquida

Taking into account the bone repair process in pigs has shown a greater similarity among the histological variables studied compared to other biological models, the present study has as its aim to evaluate the histological bone repair process of osteotomy performed on alveolar and extra-alveolar bones, using drilling tools with liquid refrigeration. Material and method: Eighteen Large White pigs weighing between 20 and 25 Kg were divided into three groups of six animals in order to evaluate the osteotomy repairs with low and high speed in the alveolar bone and threes in the extra-alveolar area, study periods of 7, 14 and 28 days. Results: It was observed that in the alveolar bone at the postoperative times of 14 and 28 days, the best repair results were in the osteotomy performed with low speed, while in the 7 day postoperative period, the results with high speed were slightly better, in alveolar areas as well as extra-alveolar areas. There no statistically significant differences between the alveolar and extra-alveolar bone repair process. Conclusions: The repair process, by means of microscopic analysis in the alveolar and extra-alveolar areas, are similar with better results observed in osteotomies performed with low speed drills in the 14 and 28 day study periods, and at 7 days postoperative the results with high speed drills and refrigeration were slightly better. Research works using pigs as an animal model are perfectly viable. © 2011 SECOM.

Subluxation of the crystalline lens: A no-ring approach

Purpose: To report the surgical technique and outcomes of a no-ring approach to posterior chamber intraocular lens (IOL) implantation in children and young adults with subluxation of the crystalline lens. Methods: A three-piece 5.5-mm hydrophobic acrylic IOL was implanted in which the optic and one haptic were inside the capsular bag and the other haptic was in the ciliary sulcus. The implantations were done in 13 eyes of 10 patients with lens subluxation. One haptic was fixated in the ciliary sulcus by passing it through an operculum-shaped opening in the capsular bag edge, made between 2 and 3 clock hours, clockwise from the middle point of the subluxated area. Results: The mean age of the 10 patients was 12.61 ± 8.04 years and the mean follow-up was 21.38 ± 11.29 months. The mean preoperative and postoperative best-corrected visual acuity (BCVA) was 1.15 ± 0.58 and 0.37 ± 0.17 logarithm of the minimum angle of resolution, respectively, in 11 measured eyes. The postoperative BCVA was 20/40 or better in 4 eyes (36.36%), between 20/40 and 20/60 in 6 eyes (54.54%), and between 20/80 and 20/100 in 1 eye (9.09%). The BCVA improved in all eyes. Postoperative IOL decentration between 1.0 and 1.5 mm occurred in 3 of 13 eyes (23.08%). Conclusion: The results indicate that the no-ring technique allows centration of an IOL implanted into a subluxated capsular bag without using capsule tension rings. © SLACK Incorporated.

Biocompatibility analysis of Bioglass® 45S5 and Biosilicate® implants in the rabbit eviscerated socket

Purpose: Bioactive glass and bioactive glass-ceramic cone implants were placed in the rabbit eviscerated socket to assess their biocompatibility. Methods: Fifty-one Norfolk albino rabbits underwent evisceration of the right eye followed by implantation of cones made from Bioglass® 45S5 (control group) and two types of bioactive glass-ceramic (Biosilicate®), a single- and a two-phase bioactive glass-ceramic implants into the scleral cavity. Postoperative reactions, animal behavior and socket conditions were monitored daily. Clinical exam, biochemical evaluations, and orbit computed tomographic scan were done at 7, 90, and 180 days post-procedure. After that, the animals were euthanized, and the orbital content was removed and prepared to light microscopy with morphometric evaluation and scanning electron microscopy examination. Statistical analysis was done by parametric and non-parametric analysis of variance, complemented by Dunn's and Tukey's tests (p<0.05). Results: All animals did not develop systemic toxicity throughout the experimental period and also did not have orbit infection, implant migration or extrusion. Morphological analysis demonstrated pseudocapsule around all implants. Bioglass® and single-phase Biosilicate® implants induced less inflammation and pseudocapsule formation than two-phase Biosilicate® cones. Seven days post-procedure, the inflammatory reaction was intense and gradually decreased throughout the experiment. Tissue reaction was least intense in animals receiving Bioglass® implants. Conclusions: We observe discrete differences among the studied materials, with best responses obtained with use of Bioglass® 45S5 and single-phase Biosilicate®. The authors agree these implants might be useful in the management of the anophthalmic socket. © 2012 Informa Healthcare USA, Inc.

Necrotizing soft tissue infection of the breast: Case report and literature review

Background: Necrotizing soft tissue infection (NSTI) is characterized by progressive infectious gangrene of the skin and subcutaneous tissue. Its treatment involves intensive care, broad-spectrum antibiotic therapy, and full debridement. Methods: We present two cases of NSTI of the breast, adding these cases to the 14 described in the literature, reviewing the characteristics and evolution of all cases. Case Report: On the fourth day after mastectomy, a 59-year-old woman with ulcerated breast cancer developed Type I NSTI caused by Pseudomonas aeruginosa, which had a favorable evolution after debridement and broad-spectrum antibiotics. The second patient was a 57-year-old woman submitted to a mastectomy and axillary dissection, who had recurrent seromas. On the 32nd post-operative day, after a seroma puncture, she developed Type II NSTI caused by β-hemolytic streptococci. She developed sepsis and died on the tenth day after debridement, intensive care, and broad-spectrum antibiotics. The cases are the first description of breast NSTI after mammary seroma aspiration and the first report of this condition caused by P. aeruginosa. Conclusion: Necrotizing soft tissue infection is rare in breast tissue. It frequently is of Type II, occurring mainly after procedures in patients with breast cancer. The surgeon's participation in controlling the focus of the infection is of fundamental importance, and just as important are broad-spectrum antibiotic therapy and support measures, such as maintenance of volume, correction of electrolytic disorders, and treatment of sepsis and septic shock. Once the infection has been brought under control, skin grafting or soft tissue flaps can be considered. The mortality rate in breast NSTI is 18.7%, all deaths being in patients with the fulminant Type II form. Surgical oncologists need to be alert to the possibility of this rare condition. © 2012, Mary Ann Liebert, Inc.

Assessment of eyebrow position before and after upper eyelid blepharoplasty

Objective: Assess the occurrence of secondary brow ptosis after upper lid blepharoplasty. Methods: Forty-five individuals (n90 brows) submitted to upper lid blepharoplasty, were assessed by means of a comparative analysis using pre- and post-operatively digital photographs, in the primary position of the eye. The images were processed using ImageJ software, transferred to a computer, to an electronic Microsoft Excel 2002® worksheet. Angular measurements were used, taking the lateral canthal angle of the brow, the most medial point of the brow, the medial canthal angle and the lateral canthal angle of the lid as anatomical reference points. When the outer angles were reduced or the inner angles increased after surgery this was considered a brow ptosis. Individuals who had undergone lid surgery associated with the eyebrow, previous eyebrow surgery and those with eyelid ptosis were excluded. The difference between the pre-operative and post-operative measurements were analyzed statistically using the Student's t-test for paired samples and the angular variation was compared with their corresponding contralateral sample using Wilcoxon's non-parametric test. Results: The measurements obtained after the blepharoplasty show significant variations from those before the surgery, indicating that the correction of redundant tissues in the brow accentuates the tendency of the eyebrow to move down. The alterations are more important in the lateral portion of the eyebrow and they occur bilaterally. Conclusion: The assessment of angular measurements obtained pre- and post-operatively showed that there are secondary changes in the position of the eyebrow as a result of upper eyelid blepharoplasty. © 2012 Informa Healthcare USA, Inc.

One-year clinical evaluation of composite restorations in posterior teeth: Effect of adhesive systems

This clinical study assessed the performance of posterior composite resins applied with the Adper™ Single Bond Plus (SB) and Adper ™ Scotchbond SE (SE) adhesive systems and Filtek ™ Supreme Plus composite resin, using modified US Public Health Service criteria. A total of 97 restorations were placed in posterior teeth by two calibrated operators. Application of the materials followed manufacturers' instructions. The restorations were evaluated by two examiners at baseline and after one year. Statistical analyses were conducted using the proportion test at a significance level of 5% (p<0.05). All the restorations evaluated (ie, 100%) received an alpha rating for the criteria of marginal discoloration and marginal integrity at baseline. At one year, for marginal discoloration, 64.6% of SB and 61.2% of SE received an alpha rating. For marginal integrity, 72.9% of SB and 77.6% of SE received an alpha rating. The other restorations received bravo ratings for both criteria. None of the teeth that received the restorative systems presented caries lesions around the restorations. A total of eight teeth presented postoperative sensitivity one week after baseline, five with SB and three with SE; the symptom had disappeared one year later. One year later, composite resin restorations using either adhesive system showed satisfactory clinical performance.

Multiple brain abscess from dental origin: Case report and literature review

Background: Brain abscess of dental origin is a rare situation and deserves attention due to its high mortality rate even when adequate treatment is done. Few reports are available when dental origin is the main cause of this infection. Case report: We present the case of a 70-year-old man diagnosed with cerebral abscess caused by apical lesions located at superior and inferior teeth. The three lesions containing pus were drained from anterior and posterior brain region and the laboratory evaluation revealed the presence of Streptococcus viridians and Bacteroides. Postoperative period was uneventful with excellent recovery after 1 year of surgery. Final diagnosis was able to be done due to excellent image exams availability like computer tomography and magnetic resonance using diffusion and perfusion techniques. Discussion: The early detection of this pathology with the correct diagnosis essential to give the patient the best treatment including antimicrobial drugs and drainage is of extreme importance. © 2011 Springer-Verlag.

Appendiceal endometriosis as a rare cause of abdominal pain - a case report and literature review

Endometriosis is an estrogen-dependent inflammatory disease, common in young women, characterized by the presence of endometrial tissue outside the uterine cavity. This ectopic endometrial tissue is most commonly found in the ovaries, peritoneum, uterosacral ligaments and rectovaginal cul-de-sac, with extremely rare involvement of the appendix. The main symptom is chronic abdominal pain, and the diagnosis is often made later, after the result of the histopathological examination. This study reports a 34-year-old patient complaining of chronic pelvic pain refractory to medical treatment, having undergone diagnostic laparotomy. During the surgery, we observed the presence of endometrioma fixed to the uterine wall, and the appendix was enlarged, but without evidence of inflammation. Endometrioma resection and appendectomy were performed, with good postoperative recovery. The anatomopathological exam showed endometriosis in the cecal appendix.