Surgical treatment of ankyloglossia using an ophthalmic topical anesthetic and a tentacannula for tongue elevation: a case report

Ankyloglossia is characterized by the presence of a short lingual frenum that can be inserted from the alveolar ridge to the lingual apex and, until promoting a true fusion of the tongue to the floor. A short lingual frenum can generate several problems such as phonetic disorders. Objective: To describe a surgical technique for the treatment of ankyloglossia using a topical ophthalmic anesthetic and a tentacannula for tongue elevation. Case report: A 15-year-old female was referred for lingual frenulum surgery due to speech impairment. Clinical examination revealed the presence of ankyloglossia which was both hindering the pronunciation of T, D, L phonemes and reducing tongue mobility. The surgical technique chosen was a lingual frenectomy. An ophthalmic topical anesthetic was initially applied to the lateral borders of the frenum with the patient in an upright position and in the presence of adequate aspiration. With the aid of a tentacannula the tongue was raised and the frenulum gradually released with a Goldman-Fox serrated scissor. The topical anesthetic was continuously trickled onto the surgical site during surgery. Results: No postoperative pain was reported by the patient, healing occurred normally and there was no recurrence of abnormal frenulum insertion. Conclusion: The advantages of this technique in comparison to conventional methods which use infiltrative anesthesia include less trauma and a more precise evaluation of tongue movements during surgery, because there will be better control of mobility for the patient when compared to infiltrative techniques.

Introdução: A anquiloglossia caracteriza-se pela presença de um freio lingual curto que pode inserir-se desde o rebordo alveolar até o ápice lingual e, até promover uma verdadeira fusão da língua ao assoalho. Um freio lingual curto poderá gerar vários problemas como distúrbios fonéticos. Objetivo: descrever uma técnica cirúrgica para tratamento da anquiloglossia utilizando um anestésico tópico oftálmico e uma tentacânula para elevação da língua. Relato do caso: Uma paciente com 15 anos de idade foi encaminhada para cirurgia do frênulo lingual devido ao comprometimento da fala. O exame clínico revelou a presença de anquiloglossia, dificultando a pronúncia dos fonemas T, D, L e, reduzindo a mobilidade da língua. A técnica cirúrgica escolhida foi a frenectomia lingual. Um anestésico tópico oftálmico foi aplicado inicialmente nas bordas laterais do freio com o paciente na posição vertical e na presença de aspiração adequada. Com o auxílio de uma tentacânula, a língua foi elevada e o frênulo foi gradualmente liberado com uma tesoura serrilhada Goldman-Fox. O anestésico tópico foi continuamente gotejado para o local cirúrgico durante a cirurgia. Resultados: Nenhuma dor pós-operatória foi relatada pelo paciente, a cicatrização ocorreu normalmente e não houve recorrência da inserção anormal do frênulo. Conclusão: As vantagens dessa técnica em comparação aos métodos convencionais que utilizam anestesia infiltrativa, incluem menor trauma e uma avaliação mais precisa dos movimentos da língua durante a cirurgia, pois haverá um melhor controle da mobilidade do paciente quando comparado às técnicas infiltrativas.

Transplantation of human immature dental pulp stem cell in dogs with chronic spinal cord injury

Abstract Purpose: To investigate the therapeutic potential of human immature dental pulp stem cells in the treatment of chronic spinal cord injury in dogs. Methods: Three dogs of different breeds with chronic SCI were presented as animal clinical cases. Human immature dental pulp stem cells were injected at three points into the spinal cord, and the animals were evaluated by limb function and magnetic resonance imaging (MRI) pre and post-operative. Results: There was significant improvement from the limb function evaluated by Olby Scale, though it was not supported by the imaging data provided by MRI and clinical sign and evaluation. Conclusion: Human dental pulp stem cell therapy presents promising clinical results in dogs with chronic spinal cord injuries, if used in association with physical therapy.

Cement-retained prostheses increase risk of peri-implantitis when compared to screw-retained prostheses

Peri-implantitis is a dental plaque-associated inflammatory process characterized by bone crest resorption and the formation of peri-implant pockets. Plaque accumulation around implants is influenced by the quality of adaptation between the implant and its prosthetic components, which, in turn, may be dependent on the type of prosthetic system used. The aim of this study was to investigate whether cement-retained implant prostheses are greater risk factors for peri-implantitis than screw-retained prostheses, due to cementation line, which is located in the subgingival portion, serving as a local secondary etiological factor. 107 implants of 25 patients (with 32 cement-retained and 75 screw-retained prostheses) in function for a minimum of 6 months were evaluated based on peri-implant probing depth, bleeding on probing and radiographic bone loss. Overall, peri-implantitis was diagnosed around 63 implants (58.88%) of which 81.2% with cement-retained prostheses and 49.3% with screw-retained prostheses. Chi-Square analysis revealed a significant ass ociation between the use of cement-retained prostheses and the presence of peri- implantitis (p=0.004). Moreover, radiographic bone loss was greater around implants with cement-retained prostheses than in those with screw-retained configurations (2.39 and 1.84mm respectively, p= 0.001, Student t test). These results suggest that cement-retained prostheses increase both radiographically detectable bone loss around implants and the risk of peri-implantitis.

Randomized clinical controlled trial on the effectiveness of conventional and orthodontic manual toothbrushes

The objective of this study was to compare the effectiveness of two manual toothbrushes (conventional and orthodontic). The following clinical parameters were used: VPI (visible plaque index) and GBI (gingival bleeding index). Patients, 64 total (30 males and 34 females), in the permanent dentition, with a mean age of 17.8 years, were randomly selected from a practice specializing in orthodontics. Each participant received audio-visual instructions on oral hygiene as well as a kit of materials containing two manual toothbrushes (orthodontic and conventional). Each toothbrush was randomly allocated to one side of the mouth (split-mouth design) and used for a period of approximately 4 weeks. The VPI and GBI were measured by a single calibrated examiner before (T0) and after (T1) the implementation of interventions. The Mann-Whitney test was used to compare the VPI values between the groups, and the Student t-test for independent samples was used to compare GBI values. The level of significance was set at 5%. No statistically significant difference was observed between the groups at T0 for both VPI and GBI, and at T1 for the GBI. The manual orthodontic toothbrush produced a statistically lower VPI (P < 0.05) at T1, but this did not seem to be of clinical importance.

Rins de Baleia Minke (Baleanoptera acutorostrata): arquitetura e estrutura / Kidney of Minke Whale (Baleanoptera acutorostrata): architecture and structure

Entre os mamíferos marinhos, a baleia é um dos animais que mais desperta atenção, especialmente no atinente ao seu sistema urinário. Este sistema segue o padrão entre os mamíferos quanto a sua constituição, entretanto, difere na morfologia renal, em número de lobos, que por sua vez, forma renículos completos, aglutinados às centenas. Esta estrutura é sustentada por tecido conjuntivo fibroso, mas altamente capaz de manter o equilíbrio hidroeletrolítico. Foram dissecados 6 pares de rins de baleia Minke (Balaenoptera acutorostrata), colhidos em 1982, Cabedelo, Estado da Paraíba, Brasil, na última pesca autorizada. Estes rins estavam conservados em formol 10% e apresentaram uma camada histológica de colágeno muito grande circundando a parede medular. O duto coletor urinário forma cálices papilares, desembocando num único centro coletor que desemboca no ureter. Verificou-se que o rim da baleia Minke apresenta característica lobulada possuindo em média 700 renículos, cada renículo possui características anatômicas e funcionais de um rim unipiramidal, com uma camada interna (medula), e uma camada externa (córtex), e irrigação independente, com formação das artérias arqueadas individualmente, como observadas em mamíferos terrestres unipiramidais. Entretanto, o conjunto destes renículos constitui ao final um rim multilobular e polipiramidal, contrariando a morfologia da maioria dos mamíferos terrestres. Não foi possível distinguir ao nível de microscopia de luz as estruturas do córtex renicular da baleia Minke. Na microscopia eletrônica de varredura foi possível visualizar uma camada cortical que fica localizada entre duas cápsulas fibrosas. Esta junção por sua vez é feita por tecido conjuntivo o qual juntamente com uma camada de colágeno e fibras elásticas, separa o córtex da medula , foram visualizados os glomérulos renais, completamente tomados pelos vasos glomerulares e dispostos em várias camadas. Percebe-se que a cavidade glomerular é praticamente um espaço virtual para onde o filtrado glomerular é drenado, não apresentando o formato globular. A vascularização intensifica-se ao chegar à região medular. A diferença entre rins de mamíferos terrestres e marinhos está na disposição dos componentes morfológicos, favorecendo a fisiologia do órgão.

Among marine mammals, whale is one of the most attention-arousing animals, especially concerning its urinary tract. This system follows the pattern of mammals with regard to its constitution, however, it differs in renal morphology and number of lobes, which, in turn, form complete reniculi, agglutinated in hundreds. This structure is supported by fibrous connective tissue, but highly capable of maintaining electrolyte balance. Six pairs of kidneys of Minke whale (Balaenoptera acutorostrata), collected in 1982, in Cabedelo, Paraiba, Brazil, in the last fishing allowed, were dissected. These kidneys were preserved in 10% formaldehyde and they presented a very large histologic layer of collagen surrounding the medullary wall. The urinary collecting duct form papillary glasses, that reach a single collecting center which discharges in the ureter. It was found that the kidney of Minke whale has a lobe characteristic, with, on average, 700 reniculi; each reniculus has anatomical and functional characteristics of a unipyramidal kidney, with an inner layer (medulla), and an outer layer (cortex), and independent irrigation, with formation of individually arcuate arteries, as observed in unipyramidal terrestrial mammals. However, the set gathering all these reniculi constitutes, in the end, a multilobular and polipyramidal kidney, contrary to the morphology of most terrestrial mammals. It was not possible to distinguish the renicular cortex structures of the Minke whale in the level of light microscopy. Through scanning electron microscopy, it was possible to visualize a cortical layer located between two fibrous capsules. This joint, in turn, consists of connective tissue, which, along with a layer of collagen and elastic fibers, separates the cortex from the medulla; the kidney glomeruli were visualized, completely taken by the glomerular vessels and arranged into several layers. One notices that the glomerular cavity is almost a virtual space into which the glomerular filtrate is drained, and it does not present a globular shape. Vascularization is increased in the medullary region. The difference between the kidneys of terrestrial and marine mammals consists in the arrangement of morphological components, favoring the organ's physiology.

Ultrasonic irrigation in the removal of smear layer and Enterococcus faecalis from root canals

Aim: This study evaluated both smear layer removal and reduction of Enterococcus faecalis after instrumentation with ultrasonic irrigation. Methods: Root canals were experimentally inoculated with E. faecalis for 20 days and microbiological samples were collected before and after chemomechanical preparation by using sterilized absorbent paper points. The irrigation solutions used were NaOCl 2.5% and EDTA 17%. In Group 1 (G1), conventional irrigation was used, whereas in Group 2 (G2) ultrasonic irrigation was performed. In group 3 (control), root canals were irrigated with distilled water. The samples were inoculated in BHI broth and turbidity was observed after 48 h to evaluate the reduction in the number of bacteria. Residual smear layer was examined by scanning electron microscopy (SEM). Results: The results showed no significant differences between ultrasonic and conventional irrigation. Conclusions: It was concluded that the level of disinfection and cleanliness of root canals achieved with ultrasonic irrigation is comparable to that obtained by conventional methods.

Influence of light-curing units and restorative materials on the micro hardness of resin cements.

Aim: The aim of this study was to evaluate the effect of indirect restorative materials (IRMs) and light-curing units (LCUs) on the micro hardness of dual-cured resin cement. Materials and Methods: A total of 36 cylindrical samples (2 mm thick) were prepared with dual-cured resin cement (Relyx ARC) photo-activated with either a QTH (Optilight Plus) for 40s or a LED (Radii) light-curing unit for 65s. Photo-activation was performed through the 2-mm- thick IRMs and the samples were divided into six groups (n=6) according to the combination of veneering materials (without, ceramic and indirect resin) and LCUs (QTH and LED). In the control group, the samples were light-cured with a QTH unit without the interposition of any restorative material. Vickers micro hardness test was performed on the top and bottom surfaces of each sample (load of 50 g for 15 secs). The data were statistically analyzed using a three-way ANOVA followed by Tukey x s post-hoc test ( P < 0.05). Results: There were no statistically significant differences on the top surface between the light curing-units ( P > 0.05); however, the LED provided greater hardness on the bottom surface when a ceramic material was used ( P < 0.05). The mean hardness in photo-activated samples, in which there was no interposition of indirect materials, was significantly greater ( P < 0.01). Conclusions: It may be concluded that the interposition of the restorative material decreased the micro hardness in the deeper cement layer. Such decrease, however, was lower when the ceramic was interposed and the cement light-cured with LED.

Morphological aspects of buffaloes (Bubalus bubalis) umbilical cord / Aspectos Morfológicos do cordão umbilical de búfalos (Bubalus bubalis)

Buffalo is an important livestock resource, with a great participation in agricultural systems, providing milk, meat, and work power. Umbilical cord is responsible for maternal-fetal nutrients exchange during pregnancy, and its alterations can compromise the fetal development. We investigated ten pregnant uteruses collected from cross-bread buffaloes in different stages of gestation. Pregnancy and fetal age was determined by measuring the apex sacral length and development period was calculated by previously published formula. Umbilical cords were measured for length determination. Umbilical cord vascular net and anastomosis were observed by injection of Neoprene latex. Histological sections of the umbilical cord were studied after stain with HE, picrossirius, toluidine blue, orceine, and PAS reaction. Buffaloes' umbilical cord was formed by two central arteries, an allantois duct and two peripheral veins. The artery wall was composed by large quantity of collagen, elastic fibers, fibroblasts and large number of vasa vasorum. The allantois duct was located between the arteries and presented a great number of small nourishing vessels. Small nourishing vessels should be carefully considered to avoid to be mistaken to the arterials and veins vasa vasorum. Medium length of umbilical cord from buffalos was 11.8cm (minimum of 6.8cm and maximum of 17.4cm).

Búfalo é uma importante fonte de recurso nos rebanhos animais, apresentando uma grande participação na agropecuária, provendo leite, carne e força de trabalho. O Cordão umbilical é responsável pela troca de nutrientes materno-fetais durante a gestação, e suas alterações podem comprometer o desenvolvimento fetal. Nós investigamos dez úteros gravídicos de búfalos de raças cruzadas em fases diferentes de gestação. O período de gestação e a idade fetal foram determinados pelo comprimento ápice sacral, aplicando fórmulas previamente estabelecidas. Posteriormente mediu-se o comprimento do cordão umbilical. A rede vascular do cordão umbilical e anastomoses foram observadas por injeção ou látex de neoprene. O cordão umbilical foi estudado a partir de cortes histológicos, corados por HE, picrossirius, azul de Toluidina, orceína e reação histoquímica de PAS. O cordão umbilical de búfalos é formado por duas artérias centrais, ducto alantóide e duas veias periféricas e apresentam forma de ampulheta. A parede da artéria umbilical é composta por grande quantidade de fibras colágenas e elásticas, fibroblastos e um grande número de vasa vasorum. O ducto alantóide fica alocado entre as artérias e apresenta um grande número de pequenos vasos nutritivos. Os vasos nutritivos devem ser cuidadosamente identificados para evitar-se confundi-los com vasa vasorum. O comprimento médio do cabo de cordão umbilical dos búfalos era 11.8cm (mínimo de 6.8cm e máximo de 17.4cm).

Chorion biopsy in mongrel dogs / Biopsia do cório fetal em cães

With the great development of the gestational studies in all of the species, we noticed the necessity of adaptations of these techniques for prenatal diagnosis in dogs. Based on this, we studied the feasibility of chorion biopsy guided by ultrasound. Our results demonstrated accuracy on the sex determination being 2 males and 12 females, as well as it would be possible to identify chromosome alteration due to the quality of samplings. Sex determination was accomplished with the identification of Y gene chromosomes in PCR technique. After the collection, fragments were prepared for light microscopy studies and revealed fetal chorion tissue, blood colloid and erythrocyte. In the whole material we found hemosiderin impregnations due to the hemolysis and to the residue of blood of the placental marginal hematomes. The submitted female dogs to this technique demonstrated normal puppy births without death.

Com o grande desenvolvimento dos estudos gestacionais em todas as espécies, percebemos a necessidade de adaptarmos técnicas para diagnóstico pré-natal para cães. Assim, buscamos bases nas técnicas já existentes empregadas em humanos, e através destas, conseguimos estabelecer um método para coleta em cães, utilizando PCR para garantirmos a integridade das amostras. O procedimento foi realizado através de punção da cinta placentária com agulha de biopsia guiada por ultra-som. De todas as 14 amostras coletadas, duas apresentaram-se positivas para o cromossomo Y, presente apenas em machos, confirmando assim a viabilidade das amostras demonstrando com isso que através desta técnica podemos coletar material fetal para diagnóstico de alterações gênicas ou cromossômicas presentes nos cães antes mesmo destes virem a termo. A microscopia de material revelou fragmentos de cório fetal, colóide sangüíneo e eritrócitos. Em todo o material encontramos impregnações de hemosiderina devido à hemólise e ao resíduo de sangue dos hematomas marginais placentários. As cadelas submetidas a esta técnica tiveram partos normais sem óbito de nenhum filhote.

De tenente civil a prefeito do povo: a trajetória política de Pedro Ernesto / From 'civil lieutenant' to mayor of the people: the political course of Pedro Ernesto

Analisa como a trajetória política de Pedro Ernesto, de tenente civil a prefeito do povo, explicita alguns dos aspectos fundamentais da cultura política carioca. Situando-se em um ponto de inflexäo entre uma determinada tradiçäo da política local e os experimentos que consolidariam as bases das futuras relaçöes políticas a serem estabelecidas com as crescentes massas urbanas, o itinerário percorrido pelo médico recifense no interior do campo político carioca torna-se um mapa deste mesmo campo.

Cirurgia Vascular: substitutos arteriais: passado, presente e futuro / Vascular surgery: arterial substitutes: past, present and future

O desenvolvimento histórico da substituiçäo arterial constitui um capítulo interessante e particularmente instrutivo da história da cirurgia das artérias. Desde o início do século até à actualidade, numerosos materiais foram empregues e avaliados na substituiçäo das artérias no homem, contando-se entre homosexuais cadáveres, autoenxertos (arteriais e venosos), heteroenxertos e próteses arteriais. Os substitutos protésicos têm sido, de longe, os materiais mais utilizados, sobretudo os enxertos de Dracon e PTFE. Recentes aquisiçöes tornaram-se mais eficazes e credores de melhor tolerância e adaptaçäo às suas funçöes bem como à interaçäo com o hospedeiro. Todavia, estäo ainda longe de se poderem assumir o substituto ideal das artérias. O seu comportamento biológico é insatisfatório e o índice de complicaçöes que registram é elevado e por vezes de consequências fatais. Neste trabalho é descrito o estado actual da substituiçäo arterial protésica e säo analisadas e discutidas as perspectivas de desenvolvimento, dando particular enfase à utilizaçäo dos homoenxertos arteriais criopreservados, aos heteroenxertos e à biosíntese laboratorial de artérias