Exodontia de terceiro molar ectópico no seio maxilar – relato de caso / Extraction of an ectopic third molar in the maxillary sinus – case report

Os dentes ectópicos não possuem etiologia definida e podem estar associados, ou não, a cistos dentígeros. Sua erupção ectópica ocorre de forma rara, em diferentes regiões da cavidade oral, tais como septo nasal, côndilo mandibular, processo coronoide, palato. Ocasionalmente, um dente pode erupcionar no seio maxilar e se apresentar com sintomas nasossinusais locais atribuídos à sinusite crônica. Diante do exposto, cabe ao cirurgião dentista ter conhecimento sobre a anatomia e técnicas cirúrgicas, a fim de realizar o planejamento cirúrgico seguro e efetivo, através do auxílio de exames radiográficos e de imagens evitando complicações e transtorno ao paciente. Este estudo tem como objetivo reportar um caso clínico raro, no qual foi realizada exodontia de um terceiro molar ectópico posicionado horizontalmente no interior do seio maxilar.

Ectopic teeth have no defined etiology, and may or may not be associated with dentigerous cysts. Its ectopic eruption occurs in rare form in different regions of the oral cavity, such as the nasal septum, mandibular condyle, coronoid process, palate. Occasionally, a tooth can erupt in the maxillary sinus and present local sinonasal symptoms attributed to chronic sinusitis. Given the above, it is up to the dentist to have knowledge about the anatomy and surgical techniques, in order to carry out a safe and effective surgical planning through the aid of radiographic images and avoiding complications and inconvenience to the patient. This study aimed to report a rare clinical case, in which was performed the extraction of an ectopic third molar horizontally positioned inside the maxillary sinus

Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis

Cardiopulmonary exercise testing (CPET) plays an important role in the assessment of functional capacity in patients with interstitial lung disease. The aim of this study was to identify CPET measures that might be helpful in predicting the vital capacity and diffusion capacity outcomes of patients with thoracic sarcoidosis. A longitudinal study was conducted on 42 nonsmoking patients with thoracic sarcoidosis (median age = 46.5 years, 22 females). At the first evaluation, spirometry, the measurement of single-breath carbon monoxide diffusing capacity (D LCOsb) and CPET were performed. Five years later, the patients underwent a second evaluation consisting of spirometry and D LCOsb measurement. After 5 years, forced vital capacity (FVC) percent and D LCOsb percent had decreased significantly [95.5 (82-105) vs 87.5 (58-103) and 93.5 (79-103) vs 84.5 (44-102), respectively; P < 0.0001 for both]. In CPET, the peak oxygen uptake, maximum respiratory rate, breathing reserve, alveolar-arterial oxygen pressure gradient at peak exercise (P(A-a)O2), and Δ SpO2 values showed a strong correlation with the relative differences for FVC percent and D LCOsb percent (P < 0.0001 for all). P(A-a)O2 ≥22 mmHg and breathing reserve ≤40 percent were identified as significant independent variables for the decline in pulmonary function. Patients with thoracic sarcoidosis showed a significant reduction in FVC percent and D LCOsb percent after 5 years of follow-up. These data show that the outcome measures of CPET are predictors of the decline of pulmonary function.

Inspirometria de incentivo e breath stacking: repercussões sobre a capacidade inspiratória em indivíduos submetidos à cirurgia abdominal / Incentive spirometry and breath stacking: effects on the inspiratory capacity of individuals submitted to abdominal surgery

CONTEXTUALIZAÇÃO: As complicações respiratórias são as principais causas de aumento da morbidade e da mortalidade em indivíduos submetidos à cirurgia de andar superior do abdômen. A eficácia dos procedimentos fisioterapêuticos precisa ser melhor definida, assim como é necessário o conhecimento da melhor estratégia terapêutica a ser implementada. OBJETIVO: Comparar o volume inspiratório mobilizado durante a técnica de breath stacking, com o volume na inspirometria de incentivo em pacientes submetidos à cirurgia abdominal. MATERIAIS E MÉTODOS: Doze pacientes, no primeiro dia de pós-operatório, foram orientados a inspirar profundamente por meio do inspirômetro de incentivo Voldyne® e a realizar esforços inspiratórios sucessivos pela máscara facial adaptada para realização da manobra de breath stacking. Cada técnica foi realizada cinco vezes de acordo com a randomização. No período pré-operatório, os pacientes realizaram prova espirométrica, foram avaliados e instruídos quanto à realização das técnicas. Um ventilômetro de Wright® permitiu o registro da capacidade inspiratória. RESULTADOS: A capacidade inspiratória foi significativamente maior durante o breath stacking do que durante a inspirometria de incentivo, tanto no pré quanto no pós-operatório. Houve redução significativa dos volumes após o procedimento cirúrgico, independentemente da técnica realizada. CONCLUSÕES: A técnica de breath stacking mostrou-se eficaz e superior à inspirometria de incentivo para a geração e sustentação de volumes inspiratórios. Por não haver descrição de efeitos adversos, essa técnica pode, provavelmente, ser utilizada de forma segura e eficaz, principalmente em pacientes pouco cooperativos.

BACKGROUND: Respiratory complications are the main causes of increased morbidity and mortality in individuals who undergo upper abdominal surgery. The efficacy of physical therapy procedures needs clarification, and it is necessary to know which therapeutic approaches are the best ones to implement. OBJECTIVE: To compare the inspiratory volume during the breath stacking maneuver with the volume during incentive spirometry, in abdominal surgery patients. METHODS: Twelve patients, on their first postoperative day, were instructed to take a deep breath through the VoldyneTM incentive spirometer and to make successive inspiratory efforts using a facemask that had been adapted for performing the breath stacking maneuver. Each technique was performed five times according to the randomization. Before the operation, the patients performed a spirometric test. They were also assessed and instructed about the procedures. A WrightTM ventilometer allowed inspiratory capacity to be recorded. RESULTS: The inspiratory capacity during breath stacking was significantly higher than during incentive spirometry, both before and after the operation. There was a significant reduction in volumes after the surgical procedure, independent of the technique performed. CONCLUSIONS: The breath stacking technique was shown to be effective. This technique was better than incentive spirometry for generating and sustaining inspiratory volumes. Since no adverse effects have been described, this technique can probably be used safely and effectively, particularly in uncooperative patients.

Avaliação da pressão inspiratória máxima em pacientes críticos não-cooperativos: comparação entre dois métodos / Maximal inspiratory pressure evaluation among non-cooperative critical patients: comparison between two methods

CONTEXTUALIZAÇÃO: A ventilação mecânica, embora necessária para o tratamento da insuficiência respiratória aguda, pode estar associada ao descondicionamento e à disfunção muscular respiratória. A avaliação da pressão inspiratória máxima (PiMáx) é utilizada para estimar a força muscular inspiratória de pacientes ventilados artificialmente, porém não há uma definição quanto à melhor forma de realizar esta medida. OBJETIVO: Comparar 2 métodos de avaliação da PiMáx, por meio de 4 protocolos diferentes, em pacientes não cooperativos ventilados artificialmente. MÉTODO: Foram avaliados 30 pacientes não cooperativos e em processo de desmame da ventilação mecânica. De acordo com a randomização em blocos, o Método de Oclusão Simples (MO) e o Método da Válvula Unidirecional (VU) foram aplicados com tempo de duração de 20 e 40 segundos para cada paciente. Adicionalmente, durante as medições em 40s, foi anotado o valor da PiMáx em 30s. RESULTADOS: Os valores de PiMáx foram maiores em 40s do que em 20s para MO (48,2 ± 21,7 vs 36 ± 18,7 cmH2O; p< 0,001) e VU (56,6 ± 23,3 vs 43,4 ± 24 cmH2O; p< 0,001). Os valores de PiMáx foram maiores no método VU em 40s (VU40) do que MO em 40s (MO40) (56,6 ± 23,3 vs 48,2 ± 21,7 cmH2O; p< 0,001). Houve diferença entre VU em 30 e 40s (51,5 ± 20,8 vs 56,6 ± 23,3 cmH2O; p< 0,001). CONCLUSÃO: Em pacientes não-cooperativos, valores maiores de PiMax são obtidos com o método da válvula unidirecional com oclusão durante 40 segundos em comparação com os outros protocolos avaliados.

BACKGROUND: Although mechanical ventilation is necessary for treating acute respiratory insufficiency, it may be associated with deconditioning and respiratory muscle dysfunction. Maximal inspiratory pressure (MIP) evaluation is used to estimate inspiratory muscle strength in artificially ventilated patients, but there is no definition as to the best way to make this measurement. OBJECTIVE: To compare two methods for MIP evaluation, using four different protocols, among non-cooperative artificially ventilated patients. METHOD: Thirty non-cooperative patients undergoing the process of weaning off mechanical ventilation were evaluated. In accordance with block randomization, the simple occlusion method (OM) or the unidirectional valve method (UV) was applied to each patient for time periods of 20 and 40 seconds. Additionally, during the 40s measurements, the MIP value at 30s was recorded. RESULTS: The MIP values were higher at 40s than at 20s, both from OM (48.2 ± 21.7 vs. 36 ± 18.7 cmH2O; p< 0.001) and from UV (56.6 ± 23.3 vs. 43.4 ± 24 cmH2O; p< 0.001). The MIP values were higher from UV at 40s (UV40) than from OM at 40s (OM40) (56.6 ± 23.3 vs. 48.2 ± 21.7 cmH2O; p< 0.001). There was a difference between UV at 30 and 40s (51.5 ± 20.8 vs. 56.6 ± 23.3 cmH2O; p< 0.001). CONCLUSION: Among non-cooperative patients, higher MIP values were obtained from the unidirectional valve method with 40s of occlusion than from the other protocols evaluated.

Damage induction by direct electric current in tumoural target cells.

Damage induction to tumour target cells (P815) by direct electric current (DC) was investigated. A 6 min treatment of P815 cells with DC generated decreased levels of cell viability and proliferation. The ultrastructural analysis of DC-treated cells revealed the presence of blebs, loss of cell surface filopodia, and ruptures in cell membrane. Mitochondrial alterations, swelling of cells, cytoplasmic matrix rarefaction, and cellular debri formation were also observed. The study shows that tumoural target cells can be damaged by direct electric current and this approach may provide means to understand the mechanism of tumour regression induced by electrochemical therapy.

Cell surface alterations induced by methylene blue and direct electric current in Escherichia coli.

Cell surface properties, including hydrophobicity, zeta potential, carbohydrate and fatty acid components, were altered on treatment of E. coli K12 with methylene blue (MB) and direct electric current (DC). The treatment of fimbriated E. coli cells with MB greatly increased the agglutination of yeast cells when compared to untreated bacteria. However, this increased agglutination was markedly reduced when the bacteria were treated with MB plus DC. These results suggest that MB modifies cell surface components in the absence of light and these alterations are more pronounced when cells are treated simultaneously with MB and DC.

Sister Mary Joseph's nodule--diagnosis of umbilical metastases by fine needle aspiration.

A 40 year old male patient presented with jaundice. The patient had a small periumbilical nodule. He was referred to the department of Pathology for FNAC of the nodule. A diagnosis of metastases from adenocarcinoma was made. Further investigations revealed carcinoma of stomach with metastatic deposits in liver. The present report highlights the utility of F N A C in diagnosis and to decide on further investigations to arrive at a final diagnosis in a given case. A brief review of historical aspect is also given.