Terapia de linguagem de irmãos com transtornos invasivos do desenvolvimento: estudo longitudinal

O objetivo deste trabalho foi descrever o processo de intervenção fonoaudiológica de dois irmãos com transtornos invasivos do desenvolvimento, por meio de um estudo longitudinal de caso clínico. Participaram dois irmãos, um de nove e outro de 11 anos de idade, ambos do gênero masculino, com autismo (Caso 1) e transtorno invasivo do desenvolvimento sem outra especificação (Caso 2). Como procedimento de coleta e análise de dados foi realizado um estudo longitudinal, por meio de acompanhamento dos casos ao longo de quatro anos de intervenção fonoaudiológica. Foram realizadas filmagens durante as sessões de terapia, análise documental de informações dos prontuários referentes à anamnese, avaliação e relatórios terapêuticos fonoaudiológicos, exames e avaliações multidisciplinares. em ambos os casos houve melhora no contato visual, na interação social, no vocabulário e na brincadeira simbólica. No Caso 1 ocorreu aumento de 2,0 para 6,2 atos comunicativos por minuto, no Caso 2 de 3,5 para 8,0 atos e ambos demonstraram predominância do meio verbal e maior variedade de funções comunicativas. Outros fatores influenciaram estes resultados, como a deficiência intelectual, a dinâmica familiar, os conflitos no relacionamento entre os irmãos e o ambiente escolar em que estavam inseridos. Confirmou-se a relevância do fonoaudiólogo em intervenções nos transtornos invasivos do desenvolvimento, junto a equipes multidisciplinares, para a discussão diagnóstica e de condutas mais adequadas. Estudos longitudinais podem contribuir para uma análise mais detalhada e fidedigna de intervenções terapêuticas nesses casos, para esclarecer lacunas existentes na literatura e subsidiar a atuação do fonoaudiólogo clínico.

Avaliação do efeito da expansão rápida da maxila na via aérea superior, por meio da nasofibroscopia: descrição da técnica e relato de caso

A finalidade deste artigo é avaliar o efeito da expansão rápida da maxila (ERM) na via aérea superior. Por intermédio de um caso clínico, será relatado como indivíduos com atresia da maxila e com comprometimento da função naso-respiratória podem beneficiar-se com a ERM. Para entender melhor as alterações morfológicas decorrentes do paciente com problemas respiratórios, deve-se conhecer a anatomia e a fisiologia do sistema respiratório. Entretanto, não se pode esquecer que o tratamento deste paciente é multidisciplinar, envolvendo o ortodontista, otorrinolaringologista e a fonoaudióloga.

Rolling technique for treatment of left displacement of the large colon in horses: 11 cases (2004-2009)

Durante o período de 2004 a 2009, 11 animais foram tratados para o deslocamento à esquerda do cólon maior, por meio da técnica de rolamento sob anestesia geral, com uma técnica distinta das demais previamente descritas. A seleção dos casos foi baseada nos achados da palpação retal e confirmada ultrassonograficamente. Nove animais foram tratados com sucesso e dois foram submetidos ao tratamento cirúrgico após três tentativas de rolamento. Não foram observadas complicações decorrentes do procedimento a curto e a longo prazos. Somente um animal apresentou recidiva do quadro clínico 10 meses após o tratamento e foi novamente submetido ao rolamento. Apesar da diferença com relação às outras técnicas, esta também se mostrou eficaz. O rolamento, mesmo quando realizado mais de uma vez, mostrou ser um procedimento seguro, porém enfatiza-se a necessidade de cuidados especiais aos animais após a sua realização, pois medidas emergenciais podem ser necessárias caso complicações decorrentes desta técnica ocorram.

Sobremordida exagerada: diagnóstico e estratégias de tratamento

A sobremordida exagerada é um tipo de má oclusão que apresenta etiologia multifatorial e necessita de um diagnóstico diferencial elaborado e específico. O objetivo desse artigo é descrever os principais elementos de diagnóstico facial, cefalométrico e dentário e as principais estratégias de tratamento, como a extrusão de dentes posteriores, a intrusão de dentes anteriores ou a combinação dessas. Serão apresentados seis casos clínicos, auxiliando o ortodontista no diagnóstico e na seleção da estratégia de tratamento individualizada para cada situação clínica.

Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease)

Background: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called Buruli ulcer'' (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of >= 10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC).Methods: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment.Findings: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%).Interpretation: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed.

Um caso de delirio de infestacao parasitaria tratado com clomipramina

The article describes a clinical case of primary delusional parasitosis responsive to clomipramine, that had not previously respond to neuroleptic treatment. Clinical similarities of this disorder with obsessive-compulsive disorder are discussed. In conclusion, the article suggests that serotonergic antidepressants may be usefull in the treatment of patients with somatic delusional disorder.

Tinea nigra: Relato de caso e revisao da literatura brasileira

The authors present a clinical case of palmar Tinea nigra in a 19-year-old young woman. The Brazilian literature concerning Tinea nigra is discussed as well as the reports presented in Brazilian Congresses from 1985 to 1995. The data show that 63.3% of the cases occurred in patients younger than 20-years-old, they were more frequent among females and 90.5% were localized on the palms; among the cases reported in the Brazilian Congresses those of atypical localization as the back and the genital area are worth noticing.

Osteopetrosis of the jaws

Osteopetrosis is a rare hereditary condition characterized by increased bone density. The jaws, bones, and teeth invariably are affected and the osteopetrosis is directly proportional with the severity of the disease. This article describes a clinical case of osteopetrosis and reviews the clinicopathologic, radiographic, and treatment features.

Periodontal plastic surgery associated with treatment for the removal of gingival overgrowth

Background: Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. Methods: Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. Results: Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. Conclusions: The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area.

Toxoplasma gondii genotyping in a dog co-infected with distemper virus and ehrlichiosis rickettsia

This paper reports a toxoplasmosis, erhlichiosis and distemper co-infection in a dog with an exuberant neuropathological clinical picture. Primary involvement was discussed based on information collected in the analysis of the clinical case, such as neurological impairment, epidemiological data, poor immunoprophylactic scheme of the dog affected and the role of these diseases on immunosuppression. Canine distemper and ehrlichiosis were diagnosed based on epidemiologic data, clinical signs, hematological and cytological evaluation. Toxoplasma gondii was isolated and genetically characterized as Type I using restriction analysis (RFLP) with SAG-2 genes. Immunosuppression features of both dogs and human beings are discussed, as well as implications on animal and public health. This is the first report on toxoplasmosis, ehrlichiosis and distemper co-infection in a dog in Brazil, associated with genotyping determination of the T. gondii strain involved.

Verruciform xanthoma located in anterior gingival

Verruciform xanthoma (VX) is a relatively rare benign lesion and oral predominantly, which occasionally affects skin and genital mucosa. It appears as a papule or single plaque showing a verrucous or papillomatous aspect, with variable color from reddish pink to gray. In majority of oral cases, it affects gingiva and alveolar mucosa such a solitary lesion. Histopathological findings are foamy histiocytes within elongated dermal papillae. Treatment consists of conservative excision surgery and recurrence is rare. A clinical case is reported, located in anterior gingiva, showing good prognosis, without recurrence. There was no concomitant oral lesion associated. Local trauma was the only possibility suggested to be related to etiology. No relevant alterations in laboratory exams (hemogram, total cholesterol, HDL, LDL, VLDL, glycose and glycolized hemoglobin) were found. The origin of the lesion remains unclear and investigation for possible associations with other lesions that could present greater risk of carcinogenesis is required. © Medicina Oral S.L.

Atitudes distintas de profssionais de diferentes especialidades médicas relacionadas à autonomia e aspectos jurídicos no cuidado de pacientes com demência

The evaluation of competence of Alzheimer's disease (AD) patients to assume personal or collective responsibilities and the resulting legal implications is a relevant issue. Objectives: The aim of this study was to evaluate the attitudes of different medical specialists towards the disability of patients with Alzheimer's disease and practitioners' competence to interfere with decision-making autonomy. Methods: Professionals from different areas (Neurology, Psychiatry, Geriatrics, and General Practice) were interviewed by one of the authors, after being presented a fictitious clinical case which raised several topics, namely: [1] Critical judgment and capacity of the patient to take decisions related to daily activities; [2] The role of family physicians in nominating trustees and caregivers. Results: Answers to the first question did not differ regarding degree of preservation of awareness but at least 25% stressed that the patient must be carefully listened to, independent of caregiver or legal representative opinion. There were significant knowledge gaps in responses to the second question. Half of the physicians interviewed did not have adequate information about the legal aspects of caring for patients with Alzheimer's disease. Conclusions: Legal aspects is a topic that must be incorporated into professional training in order to improve attitudes toward the long-term management of patients with dementia.

Functional and esthetic rehabilitation with In-Ceram alumina and zirconia system: A multidisciplinary approach

The development of all-ceramic systems following metalceramics restorations allowed simulation of natural dentition due to favorable esthetics and resistance. In-Ceram is an alternative when esthetics is primordial as well as resistance required in rehabilitation. However, an ideal smile is associated to not only shape, color, texture and translucency but also harmony with gingival tissue. So, the aim of this study is to report a clinical case based on periodontal and fixed partial dentures principles to perform periodontal plastic surgery followed by esthetic rehabilitation. A female patient, 40-year-old, presented complaint about dental esthetics. After clinical and radiographic exams, metal-ceramics crowns (teeth 11, 12, 13, 21, 22 and 23) were considered unsatisfactory due to marginal leakage, color change in gingival tissue associated to metallic margin, and gummy smile. So, a crown lengthening surgery of anterior teeth was performed followed by rehabilitation of superior teeth with In-Ceram single crowns. Clinical significance: The interaction between periodontics and fixed prosthodontic area is the key of an adequated treatment planning which involves gingival smile to provide function and an esthetic condition in association with an esthetic, resistant and predictable material.

Conservative reconstruction of the smile by orthodontic, bleaching, and restorative procedures

The following is a clinical case report of a patient whose chief complaint was the presence of generalized spacing in the maxillary anterior segment following orthodontic treatment. After meticulous clinical analyses and discussions of the clinical procedures to be adopted, dental bleaching was performed in both arches with 10% hydrogen peroxide (Opalescence Trèswhite Supreme 10% Hydrogen Peroxide - Ultradent Products, Inc., South Jordan, USA) after the conclusion and stabilization of orthodontic treatment. Then, the orthodontic appliance was removed and the diastemas in the maxillary anterior teeth were closed with Amelogen Plus (Ultradent Products, Inc., South Jordan, USA) resin composite. It was observed that the association of orthodontic, bleaching, and restorative procedures was capable of restoring dental shape, function, and esthetics, allowing the patient to smile without hesitation.

Association of fixed partial denture and gingival prosthesis as alternative approach to recover esthetics and function in anterior maxillary region

Tooth replacement in the maxillary anterior region is especially difficult when the loss includes significant amounts of the residual ridge and the soft tissue. Several techniques are available, such as dental implants or fixed partial denture, and bone and gingival grafts or gingival prostheses, respectively. This article showed a clinical case of an elderly who was treated with a collarless metal-ceramic fixed partial denture and acrylic removable gingival prosthesis to recover the esthetics in the maxillary anterior region. The association of a metal-ceramic fixed denture and gingival prosthesis was an excellent alternative in cases when surgical procedures are contraindicated. © 2012 Japan Prosthodontic Society.