Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies

PURPOSE: To evaluate the efficacy of surgical treatment for esophageal perforation. METHODS: A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series. RESULTS: Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05). CONCLUSION: Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.

Aneurysm of the Superior Labial Artery

This is a case report of a true and dissecting aneurysm of the superior labial artery in a 51-year-old patient without risk factors for vascular pathology. The patient complained of swelling of the upper lip, mostly on the left side. A Doppler ultrasonography was used in the diagnosis. The definitive treatment was surgical resection, and the histopathological analysis confirmed the diagnosis. The progress of the patient was satisfactory, leaving a slight change in sensitivity in the area. This seems to be the first reported case of true and dissecting aneurysm of the superior labial artery in the medical literature.

Modelo de risco controlado por resseguro e desigualdades para a probabilidade de ruína

In the work reported here we present theoretical and numerical results about a Risk Model with Interest Rate and Proportional Reinsurance based on the article Inequalities for the ruin probability in a controlled discrete-time risk process by Ros ario Romera and Maikol Diasparra (see [5]). Recursive and integral equations as well as upper bounds for the Ruin Probability are given considering three di erent approaches, namely, classical Lundberg inequality, Inductive approach and Martingale approach. Density estimation techniques (non-parametrics) are used to derive upper bounds for the Ruin Probability and the algorithms used in the simulation are presented

Sistematização da assistência de enfermagem a paciente com luxação de coluna cervical: estudo de caso

Trata-se de um estudo de caso de paciente portador de luxação de coluna cervical. Sem comprometimento medular, no qual as autoras operacionalizaram o processo de enfermagem, segundo Modelo Conceitual de Horta, adaptando a Taxonomia I dos Diagnósticos de Enfermagem proposta pela North American Nursing Diagnosis Association (NANDA). Os resultados demonstraram que as intervenções propostas ao caso contribuíram na sua reabilitação, prevenindo complicações, bem como ajudando-o a retomar ao seu ambiente social para reassumir a sua autonomia.

O papel da solidariedade desempenhado por familiares visitantes e acompanhantes de adultos e idosos hospitalizados

Este estudo objetivou compreender o papel da solidariedade desempenhado por familiares visitantes e acompanhantes de adultos e idosos internados. Utilizou-se como referencial teórico a teoria de enfermagem como cuidado solidário e como referencial metodológico a Grounded Theory. Foram entrevistados nove familiares de adultos e idosos hospitalizados no período de abril a setembro de 2002. Dos resultados identificou-se o fenômeno: assumindo o papel de familiar visitante ou de familiar acompanhante, que congrega os temas: querendo desempenhar um papel solidário e compreendendo o estar junto como uma interdependência emocional. Acredita-se que quando a enfermeira reconhece a singularidade da relação de solidariedade e de interdependência familiar, também exerce seu trabalho pautado na solidariedade, visto que colabora para o restabelecimento do doente, alivia seu sofrimento e de seus familiares e, portanto, promove a saúde do grupo familiar.

Natural killer activity in a medium-term multi-organ bioassay for carcinogenesis

Natural killer (NK) cell activity was evaluated after the initiation and promotion steps in a medium-term multi-organ bioassay for carcinogenesis. NK cell activity was assessed in vitro by Cr-51 release assay at the 4th and 30th weeks of the experiment. Male Wistar rats were sequentially initiated with N-diethylnitrosamine (DEN i.p.), N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN drinking water), N-methyl-N-nitrosourea (MNU i.p.), dihydroxy-di-N-propylnitrosamine (DHPN drinking water) and N,N'-dimethylhydrazine (DMH s.c.) at subcarcinogenic doses for 4 weeks (DMBDD initiation). One group was evaluated at the 4th week and the other was maintained without any further treatment until the 30th week. Two initiated groups were exposed through the diet to 2-acetylaminofluorene (2-AAF) or phenobarbital (PB), from the 6th until the 30th week, Five additional groups were studied to evaluate the effects of each initiator on NK activity. All groups submitted to initiation only, initiation plus promotion, or promotion only, developed significantly more preneoplastic lesions than the untreated control group. The main target organs for tumor development in the initiated animals n ere the liver and the colon, irrespective of treatment with 2-AAF or PB. NK cell activity was not affected bal exposure to genotoxic carcinogens after initiation, at the 4th week. Treatments only with PB or 2-AAF did not change NK cell activity, However, decreased NK cell activity was registered in the group only initiated with DMBDD and in the group given DMBDD+2-AAF. This late depression of NK cell activity at the 30th week could be related to the production of suppressing molecules by the tumor cells.

Histochemical and morphological characteristics of the levator ani muscle in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Functional Aesthetic Treatment of Patient With Phenytoin-Induced Gingival Overgrowth

Gingival overgrowth (GO) may be related to the frequent use of certain medications, such as cyclosporin, phenytoin (PHT), and nifedipine, and is therefore denominated drug-induced GO. This article reports a case of a patient who with chronic periodontitis made use of PHT and presented generalized GO. A 30-year-old man with GO was referred to the clinic of the Universidade Estadual Paulista, Brazil. The complaint was poor aesthetics because of the GO. The patient had a medical history of a controlled epileptic state, and PHT was administered as an anticonvulsant medication. The clinical examination showed generalized edematous gingival tissues and presence of bacterial plaque and calculus on the surfaces of the teeth. The diagnosis was GO associated with PHT because no other risk factors were identified. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation, prophylaxis, and daily chlorhexidine mouth rinses. After this stage, periodontal surgery was performed, and histopathologic evaluation was made. The patient has been under control for 3 years after the periodontal surgery, and up to the present time, there has been no recurrence. It can be concluded that PHT associated with the presence of irritants favored gingival growth and that the association of nonsurgical and surgical periodontal therapies was effective in the treatment of GO. Besides, motivating the patient to maintain oral hygiene is a prerequisite for the maintenance of periodontal health.

Occurrence of tooth injuries in patients treated in hospital environment in the region of Aracatuba, Brazil during a 6-year period

Dental trauma has been considered as a public health problem that affects mainly children and youngsters and due to its impact on the patient's quality of life. This study presents the results of a 6-year survey of the occurrence and characteristics of dental trauma in patients admitted to the Service of Surgery and Oral and Maxillofacial Traumatology of the School of Dentistry of Aracatuba (UNESP, Brazil) after emergency care in hospital facilities in the region of Aracatuba, SP, Brazil. For such purpose, the clinical files of patients treated at the Service between 1999 and 2005 were reviewed. Information regarding gender, age, number of traumatized teeth, etiology and diagnosis of the trauma was collected from the files of patients with tooth injuries and recorded in case report forms specifically designed for this purpose. The results showed that from a total of 4112 patients admitted to the Service within the surveyed period, 266 (6.5%) had tooth injuries (172 males - 64.7%; 94 females - 35.3%). The total number of traumatized teeth was 496. Most patients belonged to the 16-20 year-old age group (20.3%) and the most frequent causes of tooth injuries were bicycle accidents (28.6%), motorcycle accidents (19.2%) and falls (18.8%). Injuries to the periodontal tissues were the most frequent type of tooth injuries (408 teeth; 82.26%), occurring in 118 primary and 290 permanent teeth. Among the injuries to the periodontal tissues, avulsion was the most common (32.86%) (29.41% for primary and 34.0% for permanent teeth), followed by extrusive luxation (19.15%) (25.21% for primary and 17.24% for permanent teeth). In conclusion, in the surveyed population, cases of tooth injuries were more frequent in males aged 16-20 years old due to cyclist accidents with predominance of injuries to the periodontal tissues, in particular, avulsions.

Effect of Ultrasonic Excitation on the Porosity of Glass Ionomer Cement: A Scanning Electron Microscope Evaluation

Background: Ultrasonic excitation (US) was applied to glass ionomer cement (GIC) during early set time to increase the advantageous properties of this material. Purpose: The aim of this in vitro study was to assess the inner porosity of GIC after US. Study design: A total of 16 specimens, for each material, were prepared from high-viscosity GIC Fuji IX GP, Ketac Molar, and Ketac Molar Easymix. Half of these specimens (n = 8) received 30 s of US during the initial cement setting. After completion of the material setting, specimens were fractured and observed by scanning electronic microscopy to quantitatively assay porosity inside the material using Image J software. Results: Statistical data analysis revealed that US reduced the porosity for all tested materials (P <= 0.05). The following reductions (expressed in percentages) were achieved: Fuji IX-from 3.9% to 2.8%; Ketac Molar Easy Mix-from 4.4% to 2.6%, and Ketac Molar-from 2.4% to 1.6%. Conclusion: Under the tested conditions, US was an effective method for porosity reduction inside the material. Microsc. Res. Tech. 74:54-57, 2011. (C) 2010 Wiley-Liss, Inc.

EFFECT of ULTRASONIC EXCITATION on THE MICROTENSILE BOND STRENGTH of GLASS IONOMER CEMENTS TO DENTIN AFTER DIFFERENT WATER STORAGE TIMES

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Correlation between morphology and function of the upper lip: a longitudinal evaluation

In order to evaluate the relationship between the morphology of the upper lip and muscle activity in a sample of 38 subjects (17 males and 21 females) with Angle Class II division 1 malocclusions, cephalometric and electromyographic analyses were conducted. The sample was subdivided into either predominantly nose or mouth breathers. The individuals were evaluated at two different periods, with a 2 year interval. At the first observation, the subjects were 11 years to 14 years 11 months of age and at the second observation, 13 years 4 months to 16 years 6 months of age. Height and thickness of the upper lip were measured on lateral cephalograms with the aid of a digital pachymeter. For each individual, electromyographic records were obtained of the orbicularis oris superior muscle at rest and in a series of 12 movements. The electromyographic data were normalized as a function of amplitude, for achievement of the percentage value of each movement. Pearson and Spearman correlation tests were applied.The results showed some correlation between morphology and muscle function (at a confidence level of 95 per cent). However, as the values of the correlation coefficient (r) were too low to establish associations between variables, it was concluded that the dimensions of the upper lip are not correlated with muscle activity.

Utilização da distração osteogênica mediana sagital para tratamento da atresia mandibular

OBJETIVO: relatar o tratamento de uma paciente com apinhamento severo decorrente de uma atresia maxilomandibular, tratada por meio da Distração Osteogênica da Sínfise Mandibular (DOSM). RESULTADOS: neste caso, observamos bom engrenamento dentário, diminuição do corredor bucal escuro, correção do apinhamento, boa forma de arcos e boa estética facial, num período de tempo bastante satisfatório, sem trazer dano ao tecido periodontal adjacente. CONCLUSÃO: pacientes com arcos atrésicos e apinhamento dentário podem ser beneficiados com a DOSM que, quando bem indicada, surge como uma nova forma de tratamento para casos limítrofes de apinhamento dentário, nos quais as alternativas convencionais oferecem limitações, tais como o achatamento do perfil facial, o aumento do corredor bucal e a instabilidade.

Deposition of Lead and Cadmium Released by Cigarette Smoke in Dental Structures and Resin Composite

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)