Temporomandibular disorders: Guidelines and Self-Care for Patients During COVID-19 Pandemic / Desordem Temporomandibular: Orientações e Autocuidados para Pacientes Durante a Pandemia do COVID-19

Background: Temporomandibular disorder (TMD) belongs to a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, musculature and adjacent components. These conditions can generate signs and symptoms and be influenced by an altered biopsychosocial condition. Objective: This study aims to seek information to assist the patient in the presence of TMD signs and symptoms and Orofacial Pain, associated with the period of social isolation during the COVID-19 pandemic. Material and methods: For the preparation of this manual, a bibliographic search was performed in the databases PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science and The Cochrane Library, using the keywords: orofacial pain, temporomandibular disorders, bruxism, stress, anxiety, biopsychosocial, diagnosis, self-care with important information on how to reduce and control the signs and symptoms of TMD and Orofacial Pain in this moment of pandemic that we are experiencing a social detachment. Results: The results show that the pandemic of COVID-19 and the need for social isolation, generates psychological impact that raises the pattern of anxiety and can directly affect patients with bruxism and TMD. Conclusion: Psychological factors associated with the pandemic can lead to an increased risk of developing, worsening and perpetuating bruxism, especially waking bruxism and TMD, so dentists should be aware of the occurrence of signs and symptoms to manage the multifactorial aspects of this condition. At that time, individual self-management strategies are advised for the patient, which consist of self-massage techniques, body education, exercise practices, sleep hygiene, meditation also the use of mobile apps and online tools that facilitate this activity. (AU)

Introdução: A Desordem Temporomandibular (DTM) pertence a um grupo heterogêneo de condições musculoesqueléticas e neuromusculares envolvendo o complexo articular temporomandibular, a musculatura e os componentes adjacentes. Essas condições podem gerar sinais e sintomas e serem influenciadas por uma condição biopsicossocial alterada. Objetivo: Esse estudo teve como objetivo buscar informações que possam auxiliar ao paciente na presença de sinais e sintomas de DTM e Dor Orofacial associado ao período de isolamento social durante a pandemia do COVID -19. Material e Métodos: Para a elaboração deste manual, foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science e The Cochrane Library, utilizando as palavras-chaves: dor orofacial, desordem temporomandibular, bruxismo, estresse, ansiedade, biopsicossocial, diagnóstico e autocuidados, com informações importantes sobre como reduzir e controlar os sinais e sintomas de DTM e Dor Orofacial nesse momento de pandemia que estamos vivenciando um distanciamento social. Resultados: Os resultados mostram que a pandemia de COVID-19 e a necessidade de isolamento social, gera impacto psicológico que eleva o padrão de ansiedade e pode afetar diretamente pacientes com bruxismo e DTM. Conclusão: Fatores psicológicos associados à pandemia podem levar a um maior risco de desenvolver, piorar e perpetuar o bruxismo, principalmente bruxismo de vigília e DTM, por isso os cirurgiões-dentistas devem estar atentos a ocorrência de sinais e sintomas para gerenciar os aspectos multifatoriais dessa condição. Aconselha-se, nesse momento, estratégias individualizadas de autogerenciamento para o paciente que consistem em técnicas de automassagem, educação corporal, práticas de exercícios, higiene do sono e meditação. Além do uso de aplicativos digitais e ferramentas online facilitadores dessa atividade (AU)

First stages towards the establishment of Brazilian neurology faculties / Primeiros passos das escolas de neurologia do Brasil

ABSTRACT The establishment of modern medicine in Brazil was marked by the arrival of the Portuguese Court in 1808, when the Bahia and Rio de Janeiro Faculties of Medicine were founded. The French School of Medicine exerted a strong influence on Brazilian medicine and on the main pioneers of Brazilian neurology. The elite of "Parisian neurology" trained students and doctors from around the world, and were mentors to the pioneers of Brazilian neurology in the early 20th century. In this article, the authors review the origins of neurology faculties in Brazilian medicine and the main pioneers of Brazilian neurology. Neurology is certainly a continuously changing field and has always adapted to new advances and discoveries, and it is an honor for the authors to pay homage to their pioneers.

RESUMO O estabelecimento da medicina moderna no Brasil foi marcado pela chegada da corte portuguesa em 1808, quando foram fundadas as faculdades de medicina da Bahia e do Rio de Janeiro. A Escola Francesa de Medicina exerceu forte influência na Medicina Brasileira e nos principais pioneiros da Neurologia Brasileira. A elite da "Neurologia parisiense", treinou estudantes e médicos de todo o mundo e foram os mentores dos pioneiros da neurologia brasileira no início do século XX. Neste texto, os autores revisam as origens das faculdades de Neurologia na Medicina Brasileira e os principais pioneiros da Neurologia Brasileira. A neurologia é certamente um campo em constante mudança e sempre se adaptou a novos avanços e descobertas, e é uma honra para os autores homenagear seus pioneiros.

Intranasal inverted tooth: A rare cause of a persistent rhinosinusitis.

The aim of this study was to report a case of two supernumerary teeth in the nasal cavity in a 22‑year‑old woman who presented pain, rhinorrhea, and inflammation of the nasal mucosa (rhinosinusitis). The computed tomograph scan showed two radiopaque images that were diagnosed as supernumerary nasal teeth. One was unerupted in the floor and the other inverted, and erupted on the floor on the left side of the nasal cavity. They were removed under general anesthesia, one through the palatine approach, and the other directly through the nasal cavity. The patient was followed for a year and there was no sign of recurrence of rhinosinusitis.

Prevenção e ocorrência de acidentes com materiais perfurocortantes entre os profissionais da área odontológica da cidade de Vila Velha/ES / Prevention and occurrence of accidents with cutting and perforating materials among dental professionals in the City of Vila Velha/Espirito Santo

O objetivo deste trabalho foi a identificação da aplicação das normas de prevenção e o levantamento da ocorrência de acidentes entre 102 cirurgiões- -dentistas e 51 auxiliares de consultório odontológicos da cidade de Vila Velha, no Estado do Espírito Santo. A coleta de dados foi realizada por meio de aplicação de questionário estruturado aos profissionais randomicamente selecionados. Os resultados mostraram que 77 cirurgiões-dentistas e 27 auxiliares utilizavam todo o equipamento de proteção individual necessário. Por outro lado, respectivamente, 42 cirurgiões-dentistas e 18 auxiliares já sofreram um ou mais acidentes, ficando expostas a contaminação e contração de doenças infectocontagiosas.

The objective of this study was the standards application identification and the development of a survey about the prevention of accidents among 102 dentists and 51 dental office assistants at the city of Vila Velha, Espírito Santo. The data collection was conducted through a structured inquiry with randomly selected professionals. The results showed that 77 dentists and 27 assistants used all the personnal security equipment required. On the other hand, 42 dentists and 18 assistants already suffered one or more accidents, being exposed to contamination and infectious diseases.

Diagnóstico, clasificación y tratamiento de las infecciones en el pie diabético / Diagnosis, classification, and treatment of infections in the diabetic foot

Objetivo: Revisar la literatura para establecer lineamientos y recomendaciones para disminuir la amputación y muerte relacionadas con las infecciones del pie diabético. Sede: Centro de Prevención y Salvamento de Pie Diabético San Elian, Veracruz, Veracruz. Diseño: Revisión de la literatura. Material y Métodos: Se realizó una búsqueda en la literatura para la respuesta adecuada de los siguientes ejes de investigación: clasificación de la infección (cómo se determina la gravedad de la infección); importancia de clasificar (cómo se define una infección grave, qué puntaje tiene la osteomielitis en la gravedad de la infección), y tratamiento (momento óptimo, tratamiento no quirúrgico, uso de antibióticos, cultivos, manejo de osteomielitis y tiempo de tratamiento). Resultados: Las clasificaciones de PEDIS (Perfusión, extensión, profundidad, infección y sensibilidad), IDSA (Infectious Disease Society of America) y San Elian clasifican la gravedad de la infección en leve, moderada y grave. La desbridación quirúrgica de tejido infectado debe realizarse sin diferimiento en forma inicial y subsecuente tantas veces como sea necesario con ''destechamiento'' de trayectos fistulosos. En las infecciones de moderadas a graves se recomienda tratamiento empírico de amplia cobertura (Gram positivos, Gram negativos y anaerobios). El cultivo de la herida antes de iniciar o continuar el tratamiento empírico se hace en infecciones moderadas o graves y se ajusta con el resultado del cultivo si no mejora o empeora la infección. El Staphylococcus aureus se aísla en un 40 y 50 %, con resistencia a la meticilina en un 30 a 40 %. Los antibióticos de elección son la vancomicina, la tigeciclina o el linezolid. La osteomielitis es una infección moderada profunda, caracterizada por descarga purulenta, exposición del hueso, ''dedo en salchicha'', o prueba del estilete positivo. El diagnóstico definitivo se hace con biopsia o resonancia magnética nuclear. La hospitalización está indicada en casos graves en pacientes hemodinámicamente y metabólicamente inestables. Conclusiones: Las infecciones de pie diabético pueden ser de leves a graves y pueden culminar en amputación parcial del pie, de la extremidad o hasta causar la defunción del paciente. Se requiere de una atención sistemática e integral con base en la clasificación y puntaje de San Elian.

Objective: To review the literature to establish guidelines and recommendations to diminish amputation and deaths related to diabetic foot infections. Setting: Centro de Prevención y Salvamento de Pie Diabético San Elian, Veracruz, Veracruz, Mexico. Design: Review of the literature. Material and Methods: We performed a search in the literature to find an adequate answer to the following research questions: classification of the infection (how to determine the severity of the infection), relevance of classifying (how is a severe infection defined, what score can be given to osteomyelitis in the severity of the infection) and treatment (optimal time, non-surgical treatment, antibiotics use, handling of osteomyelitis, and time of treatment). Results: PEDIS (perfusion, extension, depth, infection, and sensitivity), IDSA (Infectious Disease Society of America) and San Elian classify the infection as mild, moderate and severe. Surgical debridement of the infected tissue must be performed without delay initially and subsequently as many times as required with ''unroofing'' of fistulous tracts. In moderate to severe infections an ample coverage (Gram positive and Gram negative and anaerobic bacteria) treatment is recommended. Culturing of the injury before or during empirical treatment is performed for moderate to severe infections and should be adjusted to the result of the culture if the infections does not improve or gets worse. Staphylococcus aureus is isolated 40 to 50%, with resistance to methicillin in 30 to 40%. Choice antibiotics are vancomycin, tigecycline and linezolid. Osteomyelitys is a deep moderate infection, characterized by purulent discharge, bone exposure, ''sausage toe'' or positive probe-to bone test. Definite diagnosis is reached with biopsy or magnetic nuclear resonance. Hospitalization is indicated in severe cases of hemodynamically and metabolically unstable patients. Conclusions: Diabetic foot infections can go from mild to severe and end in partial amputation of the feet, the extremity, or even cause death of the patient. Systematic and integral care based on the San Elian classification and score is required.

Estudo comparativo da osteossíntese utilizando parafuso com a osteossíntese utilizando fios de aço nos avanços do mento: um estudo retrospectivo da estabilidade esquelética / A comparative study of screw osteosynthesis to with wire osteosynthesis in advancement genioplasty: a retrospective study of skeletal stability

Objetivo: Avaliar dois métodos de fixação empregados durante o avanço do mento, através de: (1) fio de aço e (2) parafusos posicionais. Método: A amostra constou de 20 pacientes submetidos a mentoplastia para o avanço através da osteotomia basilar deslizante por abordagem intra-oral onde em 10 pacientes foi empregado a fixação com fio de aço 1 (0,018 polegadas)- grupo 1 e 10 pacientes a fixação com parafuso posicional do sistema 2.0 mm - grupo 2. A comparação de estabilidade foi obtida a partir de medidas realizadas sobre radiografias cefalométricas de perfil feitas no pré-operatório (T0), no pós-operatório imediato á intervenção (T1) e 6 meses após a intervenção(T2). Foi comparada a posição vertical e horizontal do segmento avançado, nos três tempos de estudo, a partir de um traçado cefalométrico específico. Resultados: Para os indivíduos do grupo 1, o avanço médio observado foi de 6.6mm, entre T1 - T0, onde T0 médio foi de 9,8mm e T1 médio foi de 16,5mm. No acompanhamento de 6 meses houve recidiva de 0,4mm, T2 - T1, sendo que foi observado um valor médio de T2 16,0mm. Verticalmente houve recidiva de 0,5mm no acompanhamento tardio, entre T2 - T1 onde foram observados valores médios de T1 43,5mm e T2 de 45,7mm. No grupo 2 o avanço médio observado foi de 5.6mm, T1 - T0 onde os valores médio de T0 e T1 foram respectivamente 8,5mm e 14,1mm. A recidiva foi de 0,4mm no acompanhamento,T2 - T1 ,com valor de T2 médio de 13,6mm. Verticalmente houve recidiva de 0,2mm, T2 - T1,com valores médios de T1 e T2 respectivamente de 45,2mm e 45,7mm. Conclusão: Os achados permitem concluir que não houve diferença de estabilidade esquelética entre os grupos avaliados, sendo ambos os métodos de fixação eficazes nas mentoplastias para o avanço.

Objective: To evaluate two fixation methods used for the advancement of the chin, through: (1) steel wire and (2) positional screws. Method: The sample consisted of 20 patients who underwent genioplasty to advance through the slide basilar osteotomy for intra-oral approach which was employed in 10 patients with fixing a steel wire (0.018 inches) - group 1 and 10 patients with screw fixation positional System 2.0 mm - group 2. The comparison of stability was obtained from measurements on cephalometric x-rays taken preoperatively (T0), postoperative immediate intervention (T1) and 6 months after intervention (T2). We compared the vertical and horizontal segment of the advanced study of the three times from a specific cephalometric tracing. Results: For individuals in group 1, the increase observed was 6.6mm between T1 - T0, where T0 average was 9.8 mm and mean T1 was 16.5 mm. At 6 months follow up there was recurrence of 0.4 mm, T2 - T1, and observed an average of 16.0 mm T2. Vertically there was recurrence of 0.5 mm at late follow-up between T2 - T1 where average values were observed in T1 and T2 43.5 mm by 45.7 mm. In group 2 progress observed was 5.6mm, T1 - T0 where the average values of T0 and T1 were respectively 8.5 mm and 14.1 mm. The relapse was 0.4 mm in monitoring, T2 - T1, T2 average value of 13.6 mm. Vertically there was recurrence of 0.2 mm, T2 - T1, with average values of T1 and T2 respectively 45.2 mm and 45.7 mm. Conclusion: The findings support the conclusion that there was no difference in skeletal stability between the groups, both methods are effective in fixing genioplasty to advance.

Restless legs syndrome in Parkinson's disease: clinical characteristics and biochemical correlations / Síndrome das pernas inquietas na doença de Parkinson: características clínicas e correlações bioquímicas

Restless legs syndrome (RLS) is a neurological disorder that responds to dopaminergic drugs, indicating a common pathophysiology with Parkinson's disease (PD). The prevalence of RLS was estimated in a group of PD patients and its clinical and biochemical characteristics were analysed. Forty-eight patients with PD were evaluated into two groups, with and without RLS. Clinical characteristics assessed in both groups were age, gender, duration of PD, Hoehn and Yahr, and Schwab and England scales. Laboratory variables such as hemoglobin, s-iron, s-ferritin and creatinine were obtained. The prevalence of RLS was 18.75 percent. No significant differences regarding clinical variables and biochemical parameters were observed. The high prevalence of RLS found in PD patients suggests the concept of a common etiological link and it seems that secondary causes did not play a central role in the pathophysiology of RLS in this group of parkinsonian patients.

A síndrome das pernas inquietas (SPI) é um distúrbio sensitivo-motor que responde aos agentes dopaminérgicos, demonstrando uma possível semelhança fisiopatológica com a doença de Parkinson (DP). Foi avaliada a prevalência da SPI em um grupo de pacientes com DP e suas características clínicas e laboratoriais. Quarenta e oito pacientes diagnosticados com DP foram divididos em dois grupos: com e sem SPI. Características clínicas como idade, sexo, duração da DP, escalas de Hoehn e Yahr, e Schwab e England e achados bioquímicos como hemoglobina, ferro sérico, ferritina sérica e creatinina foram obtidos. A freqüência da SPI foi de 18,75 por cento. Não se observaram diferenças estatisticamente significativas quanto às características clínicas e aos achados bioquímicos. A alta prevalência de SPI encontrada em pacientes com DP sugere associação entre essas duas doenças. É provável que causas secundárias não exerçam papel central na fisiopatologia da SPI nesse grupo de pacientes parkinsonianos.

Cisto dermoide lateral: relato de caso / Lateral dermoid cyst: a case report

O presente artigo relata o caso de um cisto dermóide lateral tratado cirurgicamente, acometendo o espaço submandibular esquerdo de uma criança com 9 anos de idade, com uma história de evolução de aproximadamente 1 ano e crescimento lento. A paciente foi admitida no serviço de ciurgia Bucomaxilofacial do Hospital Geral de Bonsucesso com queixa estética e sem sintomatologia dolorosa. O exame histopatológico evidenciou uma cavidade revestida por epitélio escamoso estratificado orto-ceratinizado com ceratina abundante no interior do lúmen cístico e anexos de glândulas sebáceas e folículos pilosos, compatível com o diagnóstico de cisto dermoide.

Ameloblastoma unicístico mural com componente intraluminal: revisão e relato de caso / Mural unicystic ameloblastoma with an intraluminal component: a review and case report

O ameloblastoma é, segundo a OMS, um tumor odontogênico de origem epitelial, benigno, que apresenta características de infiltração local e elevado índice de recidiva. Considerando a sua frequência, agressividade, diversidade histopatológica, capacidade de recidiva e controvérsia quanto às formas de tratamento, muitos têm sido os motivos para que esse tumor seja constantemente citado na literatura médica e odontológica. O ameloblastoma unicístico é uma variante do ameloblastoma que apresenta melhor prognóstico com baixo índice de recidiva, mesmo se tratado por cirurgias conservadoras, como enucleação e/ou curetagem da lesão. Clínica e radiograficamente pode se assemelhar a uma lesão cística, como um cisto folicular, sendo fundamental o diagnóstico preciso para que o tratamento adequado seja instituído com menor risco de recidiva da lesão. O caso clínico relatado é de uma paciente do gênero feminino, 20 anos, com aumento volumétrico na face, em região posterior de mandíbula. A punção aspirativa seguida de biópsia excisional e análise histopatológica confirmaram o diagnóstico de ameloblastoma unicístico...

According to the World Health Organization, ameloblastomas are benign odontogenic tumors of epithelial origin that present characteristics of local infiltration and a high rate of recurrence. Considering their frequency, aggressiveness, histopathological diversity, capacity of recurrence and the controversy regarding forms of treatment, there are many reasons why they have been frequently mentioned in dental and medical literature. Unicystic ameloblastoma is a variant form that presents a favorable prognosis and low rate of recurrence, even when treated by conservative procedures such as enucleation or curettage. Clinically and radiographically, it may resemble a cystic lesion, such as a follicular cyst, demanding a precise diagnosis in order to ensure the correct treatment and prevent recurrence. The case reported here is that of a 20-year-old female with an increase in facial volume in the posterior region of the jaw. A diagnosis of unicystic ameblastoma was confirmed by aspiratory puncture, followed by an excisional biopsy and histopathological analysis.

Bactibilia e infección del sitio quirúrgico posterior a colecistectomía abierta / Bactibilia and surgical site infection after open cholecystectomy

Introducción: La bactibilia es la presencia de bacterias en bilis vesicular y está relacionada con la aparición de complicaciones sépticas y con el desarrollo de infección en herida quirúrgica de la colecistectomía. En este estudio investigamos si la bactibilia se correlaciona con infección de herida posterior a colecistectomía abierta. Material y métodos: Estudio observacional, descriptivo, de pacientes sometidos, entre enero y diciembre de 2006, a colecistectomía abierta en forma electiva por colecistitis crónica litiásica, a quienes se les realizó cultivo de bilis en el transoperatorio. Se identificaron dos grupos: con cultivo biliar negativo (grupo 1) y con cultivo biliar positivo (grupo 2). Las variables estudiadas fueron edad, sexo, resultados del cultivo, absceso, celulitis, seroma y hematoma. El análisis estadístico incluyó c2 de Pearson o prueba exacta de Fisher y t de Student. Resultados: Se estudiaron 80 pacientes (n = 40 por grupo), 24 hombres (30%) y 56 mujeres (70%), en quienes se practicó colecistectomía abierta y que contaban con cultivo biliar para el análisis. La morbilidad general fue de 42.5%. La tasa de infección del sitio quirúrgico fue de 11.25%. En el grupo 1, dos pacientes presentaron abscesos y dos celulitis; en el grupo 2, cuatro abscesos y uno celulitis. No hubo diferencia significativa al comparar la infección del sitio quirúrgico entre ambos grupos. Conclusiones: La presencia de bacterias en los cultivos de bilis vesicular no se correlacionó con el desarrollo de infección en herida quirúrgica posterior a colecistectomía.

BACKGROUND: Bactibilia is the presence of bacteria in gall bladder bile and may play a role in the appearance of septic complications. It has been related to increased rates of surgical site infection after cholecystectomy. In this study we investigated whether bactibilia correlates with the presence of surgical site infection after cholecystectomy. METHODS: In this observational and descriptive study we investigated those patients operated by open cholecystectomy because of chronic cholecystitis. Patients had bile culture during surgery (January-December 2006). There were two study groups: patients with negative biliary culture (group 1) and patients with positive biliary culture (group 2). Variables were age, gender, biliary culture reports, abscess, cellulitis, seroma, and hematoma. Statistical analysis included Pearson chi(2) or Fisher's exact test. For independent variables, Student t-test was used. RESULTS: Eighty patients were included (n = 40 per group). There were 24 males (30%) and 56 females (70%) who had open cholecystectomy and had biliary culture. General morbidity was 42.50% and surgical site infection rate in general was 11.25%. There were two patients with abscesses and two patients with cellulitis in group 1. There were four patients with abscesses and one patient with cellulitis in group 2. There was no statistically significant difference when comparing surgical site infection in both groups. CONCLUSIONS: The presence of bacteria in gall bladder cultures does not correlate with the development of surgical site infection after open cholecystectomy.

Angiofibrolipoma de omento mayor: informe de un caso y revisión de la literatura / Angiofibrolipoma of the greater omentum: case report and literature review

Introducción: Los tumores sólidos primarios del omento son extremadamente raros. Como tumores benignos del omento se han descrito los lipomas, leiomiomas, fibromas, y neurofibromas, pero no el angiofibrolipoma. Caso clínico: Varón de 39 años de edad, con dolor abdominal de tres días de evolución localizado en cuadrante inferior derecho del abdomen, acompañado de náusea y vómito, así como dolor en fosa iliaca derecha, signo de McBurney, psoas, obturador y Markle positivos. El laboratorio documentó leucocitosis y bandemia; el ultrasonido abdominal, líquido libre en cavidad y masa no bien definida sugestiva de apendicitis aguda complicada; la laparotomía de urgencia, tumoración de omento mayor con zonas de isquemia, necrosis y hemorragia; el examen histológico, angiofibrolipoma de omento mayor. Conclusiones: El angiofibrolipoma del omento mayor se puede presentar como una urgencia quirúrgica debido a la torsión sobre su propio eje. Ante el hallazgo transoperatorio de una tumoración del omento, la escisión completa con omentectomía es el tratamiento de elección, en tanto se recibe el examen histológico definitivo.

BACKGROUND: Primary solid tumors of the greater omentum are extremely rare. Lipomas, leiomyomas, fibromas, and neurofibromas have been described as benign tumors of the greater omentum, but angiofibrolipomas have not. CLINICAL CASE: We present the case of a 39-year-old male with a 3-day evolution of right lower quadrant abdominal pain associated with nausea and vomiting. McBurney, Psoas, Obturator and Markle signs were all positive. Laboratory analysis revealed leukocytosis and bandemia. Abdominal ultrasound showed free fluid and an undefined mass suggestive of complicated acute appendicitis. Emergency midline laparotomy demonstrated a tumor of the greater omentum with areas of ischemia, necrosis and hemorrhage. Histological exam revealed angiofibrolipoma of the greater omentum. CONCLUSIONS: Angiofibrolipoma of the greater omentum may present as a surgical emergency due to torsion. When a tumor of the omentum is found during surgery, complete excision is the treatment of choice when a definitive histology result is received.

Cisto paradentário: relato de caso clínico / Paradental cyst: report of clinical case

O diagnóstico do cisto paradentário necessita, mais do que nunca, da associação dos achados clínicos, radiográficos e histológicos devido a suas características semelhantes com diversos parâmetros de outras patologias. Erros de diagnóstico e, consequentemente, de tratametno poderiam ser evitados se todo folículo dental fosse encaminhado para exame histopatológico juntamente com os achados clínicos e radiográficos. No presente artigo, é relatado um caso de cisto paradentário, bem como foram discutidos os aspectos clínicos, imaginológicos, histológicos, diagnóstico diferencial e tratamento.

Errores en cirugía: estrategias para mejorar la seguridad quirúrgica / Errors in surgery: strategies to improve surgical safety

Surgery is an extreme experience for both patient and surgeon. The patient has to be rescued from something so serious that it may justify the surgeon to violate his/her integrity in order to resolve the problem. Nevertheless, both physician and patient recognize that the procedure has some risks. Medical errors are the 8th cause of death in the U.S., and malpractice can be documented in >50% of the legal prosecutions in Mexico. Of special interest is the specialty of general surgery where legal responsibility can be confirmed in >80% of the cases. Interest in mortality attributed to medical errors has existed since the 19th century; clearly identifying the lack of knowledge, abilities, and poor surgical and diagnostic judgment as the cause of errors. Currently, poor organization, lack of team work, and physician/ patient-related factors are recognized as the cause of medical errors. Human error is unavoidable and health care systems and surgeons should adopt the culture of error analysis openly, inquisitively and permanently. Errors should be regarded as an opportunity to learn that health care should to be patient centered and not surgeon centered. In this review, we analyze the causes of complications and errors that can develop during routine surgery. Additionally, we propose measures that will allow improvements in the safety of surgical patients.

Donador exógeno de óxido nítrico en la respuesta inflamatoria hepática y hemodinámica después de choque hemorrágico / Exogenous nitric oxide donor in the liver inflammatory and hemodynamic response after hemorrhagic shock

BACKGROUND: Hemorrhagic shock (HS) results in oxidative stress to cells and in the induction of the inflammatory response, with an increased expression of a number of proinflammatory mediators and cytokines. We tested the ability of the nitric oxide (NO) donor sodium nitroprusside (NP) to reduce tissue injury in a rodent model of uncontrolled hemorrhagic shock. METHODS: Seventy two Sprague Dawley rats weighing 250-300 g were subjected to a model of uncontrolled hemorrhagic shock. Four groups of animals were included (n = 18 per group): sham/saline, sham/NP, shock/saline, shock/NP. Experimental design consisted of the development of hemorrhagic shock (3 ml/100 g) in a 15-min period, tail amputation (75%) and drug administration at 30 min, fluid resuscitation (FR) with Ringer's lactate (RL) solution to reach a mean arterial pressure (MAP) of 40 mmHg, a hospital phase of 60 min with hemostasis and FR with LR solution to reach a MAP of 70 mmHg, and a 3-day observation phase. Treatment at the beginning of resuscitation included either normal saline (groups 1, 3) or NP (0.5 mg/kg) (groups 2, 4). The following parameters were evaluated: fluid requirements for resuscitation, liver injury tests, liver tissue myeloperoxidase (MPO), liver histology, and 3-day survival. RESULTS: NP significantly reduced fluid requirements for resuscitation (p = 0.0001). We also observed an improved statistically significant difference in tests demonstrating hepatic injury (p = 0.0001), neutrophil infiltration as evidences by liver MPO (p <0.05), and histology studies (p = 0.001). Survival was also increased from 40% in controls to 60% with NP treatment. CONCLUSIONS: These data suggest that excess NO mediates hemorrhage-induced liver injury, and that the suppression of NO with NP may reduce the pathological consequences of severe hemorrhage, possibly by scavenging superoxide (O(2)(-)), thus limiting the production of more aggressive radicals.

Ensayos clínicos sin significado estadístico: la importancia del error tipo II / Clinical trials without statistical significance: importance of type II error

A randomized clinical trial is a prospective experiment to compare one or more interventions against a control group, in order to determine the effectiveness of the interventions. A clinical trial may compare the value of a drug vs. placebo. It may compare surgical with medical interventions. The principles apply to any situation in which the issue of who is exposed to which condition is under the control of the experimenter, and that the method of assignment is through randomization. A negative clinical trial is that in which no significant difference is found between the comparison groups. Results without statistical difference may be useful either to discard useless treatments or to demonstrate that one intervention is as effective as the one it was compared with. Eliminating useless treatments may be adequate. However, if this is the result of studies with methodological errors, new interventions that are actually useful may not be available for patients. In this review we present some of the possible methodological errors that may lead to false negative results in clinical trials.

Niveles séricos de Apo-AI y Apo-B como indicadores de estenosis de injerto sintético después de bypass arterial en enfermedad arterial periférica / Serum levels of Apo-AI and B as markers of synthetic graft stenosis after bypass for peripheral artery disease

BACKGROUND: Hyperlipidemias are the main risk factors for atherosclerosis and cardiovascular disease. Nevertheless, the protein fractions of these lipids such as apolipoprotein B (Apo-B) can lead to arterial obstruction. In this study we investigated levels of apolipoproteins AI and B in patients with chronic occlusive peripheral arterial disease (PAD) of the lower extremities and their association with either patency or stenosis of synthetic grafts. METHODS: This cohort study included 24 patients with chronic occlusive PAD who underwent infrainguinal revascularization with polytetrafluoroethylene (PTFE) synthetic graft. Patients were divided into two groups according to whether or not they were exposed to Apo-B, thus integrating two cohorts: the unexposed group (group 1, normal levels of Apo-B) and the exposed group (group 2, high levels of Apo-B). Variables investigated at 3, 6 and 12 months included arm/ankle index (AAI) and its association with levels of Apo-AI and Apo-B, and levels of cholesterol, triglycerides, and fibrinogen. RESULTS: The study was comprised of 67% men and 33% women. Average age was 65.2 +/- 8.4 years. There was a correlation between AAI and high levels of Apo-B (p <0.001). Apo-AI levels were not significantly different between groups. Fibrinogen remained elevated in both groups with no statistical difference. Triglycerides demonstrated a significant difference between groups in basal measurements (p <0.05). Cholesterol remained normal in both groups without statistical difference. CONCLUSIONS: This study demonstrates that patients exposed to high levels of Apo-B had synthetic graft failure (obstruction), as demonstrated by AAI <1.

Transcranial doppler in sickle cell anaemia: evaluation of brain blood flow parameters in children of Aracaju, Northeast - Brazil / Doppler transcraniano em portadores de anemia falciforme: estudo dos parâmetros de fluxo sangüíneo cerebral em crianças de Aracaju, Sergipe

BACKGROUND: Environmental factors interfere on sickle cell anaemia (SCA). Transcanial Doppler (TCD) is important to evaluate cerebrovascular disease. OBJECTIVE: To evaluate brain haemodynamic profile of children with SCA in Sergipe. METHODS: Cross sectional study (group1: SCA patients aged 3-18; group2: age and sex matched healthy individuals). Baseline brain flow was evaluated. RESULTS: Group1=34 patients; group 2=81 controls. SCA patients had mean velocity (MV)=125.69 cm/s±23.40; pulsatility index (PI)=0.66±0.10; middle cerebral artery ratio (MCAr)=14.53±15.23; right anterior cerebral artery/right middle cerebral artery=0.77±0.20; left anterior cerebral artery/left middle cerebral artery=0.78±0.20. Controls had MV=79.44±15.54; PI=0.82±0.11; MCAr=13.19±13.77; right anterior cerebral artery/right middle cerebral artery=0.80±0.16; left anterior cerebral artery/left middle cerebral artery=0.84±0.18. MV and PI differences were statistically significant between groups. MV was related to age but not to gender. CONCLUSION: MV evaluation using TCD was similar to international standards and possible to be used in our setting.

INTRODUÇÃO: Aspectos ambientais interferem na apresentação da anemia falciforme (AF). Doppler transcraniano (DTC) é útil na avaliação do risco para doença cerebrovascular em pacientes com AF. OBJETIVO: Avaliar o perfil hemodinâmico cerebral de crianças com AF em Sergipe. MÉTODO: Estudo transversal (grupo1: portadores de AF 3-18 anos; grupo2: indivíduos saudáveis, pareados por idade e gênero). Foram avaliadas medidas de fluxo sangüíneo cerebral basal. RESULTADOS: Grupo1 (n=34): velocidade média (Vm)=125,69 cm/s ±23,40; índice de pulsatilidade (Ip)=0,66±0,10; relação entre artéria cerebral média (ACMs)=14,53±15,23; artéria cerebral anterior (ACA)/ACM direita=0,77±0,20; ACA/ACM esquerda=0,78±0,20. Grupo 2 (n=81): Vm=79,44 cm/s ±15,54; Ip=0,82±0,11, relação entre ACMs=13,19±13,77, ACA/ACM direita=0,80±0,16; ACA/ACM esquerda=0,84± 0,18. Vm foi maior e Ip menor no grupo1. Vm se correlacionou com idade mas não com gênero. CONCLUSÃO: O perfil hemodinâmico cerebral de crianças com AF em Sergipe assemelha-se às referências internacionais. Não se observou interferência de fatores ambientais sobre os resultados.

Tratamento de fístula buco-sinusal: revisão de literatura e relato de caso clínico / Surgical treatment of oroantral fistula: review of the literature and report of case

A fístula buco-sinusal representa uma complicação frequente em extrações dentárias, que ocorre devido à íntima relação das raízes dos dentes superiores posteriores com o assoalho do seio maxilar. Este artigo tem como objetivo revisar os métodos cirúrgicos para o fechamento de fístula buco-sinusal usando diversos tipos de retalhos intrabucais e descrever em um relato de caso clínico a técnica que utiliza retalho rotatório palatino.

Synovial cyst of the thoracic spine: case report

Spinal cord compressing syndrome due to synovial cyst (SC) of the thoracic spine is a rare clinic condition. We report a case of SC located in the thoracic spine causing spastic paraparesis in a 14 year-old female patient. The SC was removed thoroughly by laminectomy. The patient had an excellent recovery. The etiological and therapeutic aspects are discussed.

Síndrome de compressão medular causada por cisto sinovial (CS) da coluna torácica é patologia rara e pouco descrita na literatura. Descrevemos um caso de CS da coluna torácica causando paraparesia espástica em uma paciente de 14 anos de idade. O cisto foi removido através de laminectomia e a paciente apresentou uma excelente recuperação. Discutimos os aspectos etiológicos e terapêuticos.

Fertilização in vitro com injeção intracitoplasmática de espermatozóide em ciclos naturais / In vitro fertilization with intracytoplasmic sperm injection in natural cycles

OBJETIVO: avaliar a eficácia da fertilização in vitro (FIV) com injeção intracitoplasmática de espermatozóide (ICSI) em ciclo natural (CN). MÉTODOS: estudo clínico retrospectivo que avaliou 70 ciclos de tratamento em 60 casais que se submeteram ao tratamento de FIV com auxílio da técnica de ICSI em CN em clínica privada de 1999 a 2003. Foi realizada monitorização ultra-sonográfica diária ou em dias alternados, e dosagem de LH urinário a partir de 16 mm de diâmetro folicular. Programada captação oocitária quando o folículo atingiu 18 mm de diâmetro e 36 horas após a administração de gonadotrofina coriônica humana (hCG - 5000UI) quando o teste de LH era negativo. A transferência embrionária foi realizada 48 a 52 horas depois do ICSI. RESULTADOS: foram realizados 70 ciclos de ICSI em 60 pacientes com as seguintes indicações: fator masculino (47,1 por cento), fator tubo-peritoneal (37,1 por cento), fatores associados (8,7 por cento) e infertilidade sem causa aparente (7,1 por cento). Do total de 70 ciclos, 18 foram cancelados (25,7 por cento de taxa cancelamento). Das 52 pacientes que se submeteram à punção ovariana, oócitos maduros foram encontrados em 77 por cento das vezes (40 ciclos). A taxa de fertilização foi de 70 por cento e as taxas de transferência embrionária por punção e por oócito maduro foram de 52 e 67,5 por cento, respectivamente. As taxas de gestação por ciclo iniciado, ciclo puncionado e transferência embrionária foram 11,4, 15,4 e 29,6 por cento, respectivamente. Das oito gestações, sete foram diagnosticadas em pacientes com idade inferior a 37 anos. A única gestação conseguida em pacientes com idade entre 37 e 43 anos evoluiu para abortamento. CONCLUSÕES: ICSI em ciclos naturais parece ser uma opção satisfatória de tratamento, com custos e índice de complicações (gestação múltipla e síndrome de hiperestímulo ovariano) reduzidos. Os resultados são melhores em pacientes mais jovens, com idade inferior a 37 anos.

PURPOSE: to evaluate the efficacy of in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) in natural cycle (NC). METHODS: retrospective clinical trial that evaluated 70 treatment cycles in 60 couples that were submitted to IVF treatment with ICSI in NC performed in private clinic from 1999 until 2003. It was performed daily ultrasound monitorization or on alternate days, and urinary LH dosage when the follicle reached 16 mm of diameter. It was scheduled egg retrieval when the follicle reached 18 mm of diameter and 36 hours after hCG administration when the LH test was negative. Embryo transfer was performed 48 to 52 hours after ICSI. RESULTS: 70 ICSI cycles in 60 patients were performed and the indications of treatment included: male factor (47.1 percent), tubal factor (37.1 percent), associated factors (8.7 percent), unknown infertility (7.1 percent). Out of 70 cycles, 18 cycles were cancelled (25.7 percent of cancellation rate). Out of 52 patients that were submitted to ovarian punction to oocyte retrieval we found mature oocytes in 77 percent of the cases (40 cycles), in four cases we collected immature oocytes and in eight cases we could not found it. We had 70 percent of fertilization rate and only one fertilized oocyte did not achieve the cleavage stage. So, the transfers rate per punction and per mature oocyte was 52 percent and 67.5 percent, respectively. We had 11.4 percent of pregnancy rate per cycle, 15.4 percent per punction and 29.6 percent per embryo transfer. CONCLUSIONS: FIV/ICSI in NC seem to be a satisfactory option of treatment, with low costs and complications (multiple gestation and Ovarian Hyperstimulation Syndrome), mainly in poor responder patients and in poor populations.