Histological analysis of an alkaline based tissue clearing technique for fetal musculoskeletal tissue / Análisis histológico de una técnica de limpieza de tejido de base alcalina para tejido musculoesquelético fetal

SUMMARY: Tissue clearing techniques are frequently used in the observation and description of anatomical structures and pathways without altering the three-dimensional layout of the anatomical specimen. Tissue optical clearing promotes preservation of three-dimensional structures, which allows the study of the internal anatomy in its original position and original spatial interaction. Among these techniques, Potassium Hydroxide (KOH) maceration clearing is one of the most widely used. However, the histological changes of tissue after KOH maceration have yet to be fully understood. Our aim is to describe the microscopical differences between macerated and normal tissue. To better understand said changes, two human fetuses with a gestation period of 16 to 28 weeks were cleared and processed for histological analysis. Microtome slides of the fetuses' lower limbs were obtained and stained with Hematoxylin & Eosin, Periodic Acid Schiff (PAS), and Masson's trichrome with the purpose of observing the histological and macromolecule composition changes in cleared tissue. Remarkable differences at a histological level regarding the composition of the cellular structures, since diaphanized tissues showed a predominance of extracellular matrix composed of collagen fibers with the absence of most of the nucleated cellular tissue. Phospholipid's saponification, nucleic acids degradation and a change on proteins structural properties are the main factors inducing clearing. At the same time, molecular stability of collagen in alkaline conditions allows the specimen to maintain its shape after the process.

RESUMEN: Las técnicas de limpieza de tejido se utilizan con frecuencia en la observación y descripción de estructuras y vías anatómicas sin alterar el diseño tridimensional de la muestra anatómica. El aclaramiento óptico de tejidos promueve la preservación de estructuras tridimensionales, lo que permite el estudio de la anatomía interna en su posición original y la interacción espacial original. Entre estas técnicas, el aclarado por maceración con Hidróxido de Potasio (KOH) es una de las más utilizadas. Sin embargo, los cambios histológicos del tejido después de la maceración con KOH aún no se han entendido por completo. Nuestro objetivo es describir las diferencias microscópicas entre el tejido macerado y el normal. Para entender mejor dichos cambios, dos fetos humanos con un período de gestación de 16 a 28 semanas fueron aclarados y procesados para análisis histológicos. Se obtuvieron microtomos de las extremidades inferiores de los fetos y se tiñeron con hematoxilina y eosina, ácido peryódico de Schiff (PAS) y tricrómico de Masson con el fin de observar los cambios histológicos y de composición de macromoléculas en el tejido aclarado. Diferencias notables a nivel histológico en cuanto a la composición de las estructuras celulares, ya que los tejidos diafanizados mostraban un predominio de matriz extracelular compuesta por fibras de colágeno con ausencia de la mayor parte del tejido celular nucleado. La saponificación de los fosfolípidos, la degradación de los ácidos nucleicos y un cambio en las propiedades estructurales de las proteínas son los principales factores que inducen la depuración. Al mismo tiempo, la estabilidad molecular del colágeno en condiciones alcalinas permite que la muestra mantenga su forma después del proceso.

Capacidad de sellado de los conductos laterales con distintas técnicas de obturación del conducto radicular / Sealing capacity of lateral canals with different root canal obturation techniques

Objetivo: Estimar y comparar la eficacia de diferentes técnicas de obturación para impedir el flujo de colorante a través de los conductos laterales. Materiales y métodos: Se emplearon 50 premolares inferiores extraídos y conservados en formol neutro al 5% hasta el momento de su uso, a los cuales se les realizaron conductos laterales artificiales. Una vez instrumentados los conductos principales, los dientes fueron divididos al azar en 5 grupos (n=10) para ser obturados con cuatro técnicas distintas: A) System B + inyección de gutapercha termoplástica del sistema Elements, Extruder; B) obturadores de Thermafil, ProTaper Universal; C) técnica híbrida y D) obturación con inyección de gutapercha termoplástica del sistema Elements, Extruder. Inmersos en tinta china y diafanizadas las raíces, se evaluó la longitud de penetración de la tinta en los conductos laterales. Se empleó el análisis de la varianza para detectar diferencias significativas (P<0,05) entre los niveles medios de penetración del colorante según las técnicas de obturación y las zonas del diente, y se efectuaron pruebas de rango múltiple (HSD de Tukey) para realizar comparaciones dos a dos, manteniendo fija la tasa de error por familia. Resultados: A la técnica B le correspondió el valor medio más bajo (30,63%) de penetración de tinta china. Los valores medios más elevados (54,52% y 51,74%) correspondieron a las técnicas A y C, respectivamente. Conclusión: Ninguna de las técnicas de obturación del conducto radicular empleadas ha sido capaz de impedir la filtración del colorante en los conductos laterales (AU)

Aim: To estimate and compare the different obturation techniques to avoid the flow of colorant through lateral canals. Materials and methods: 50 extracted lower premolars preserved in 5% neutral formol until the moment of use, had artificial lateral canals made. Once canals were instrumented, the teeth were randomly divided into 5 groups (n=10) to be filled with four different techniques: A) System B + injection of thermoplastic gutta-percha, Elements system, Extruder; B) Thermafil, ProTaper Universal obturators; C) hybrid technique, and D) injection of thermoplastic gutta-percha, Elements system, Extruder. Having immersed the premolars in India ink and diaphanized the roots, the penetration length of the India ink inside the canals was assessed. Analysis of variance was used to detect significant differences (P<0.05) between the mean levels of dye penetration according to the filling techniques and tooth areas, and multiple range tests (Tukey's HSD) were performed for two-to-two comparisons, keeping the error rate per family fixed. Results: Technique B had the lowest mean value (30.63%) of penetration. The highest mean values (54.52% and 51.74%) corresponded to techniques A and C, respectively. Conclusion: No obturation technique of the root canal used was able to avoid filtration of colourant in the lateral canals (AU)

Influência de tecnologias para avaliação/visualização vascular no cateterismo intravenoso periférico: Revisão integrativa / Influencia de tecnologías para la evaluación/visualización vascular en el cateterismo intravenoso periférico: Revisión integrativa / Influence of vascular assessment/visualization in peripheral intravenous catheterization technologies: An integrative review

RESUMO Objetivo verificar a influência da ultrassonografia vascular, emissão de luz infravermelha e iluminação transdérmica no sucesso da cateterização intravenosa periférica; número de tentativas, tempo para a realização do procedimento, permanência do cateter in situ e ocorrência de complicações em crianças, quando comparadas ao método tradicional. Método trata-se de uma revisão integrativa da literatura realizada no período de 2018 a 2020 na Biblioteca Virtual em Saúde, PubMed, Science Direct, Scopus e Web of Science. Foram selecionados estudos originais, publicados entre 2007 e 2019, que comparassem o uso dessas tecnologias com o método tradicional da cateterização intravenosa periférica em crianças de 0 - 18 anos. Resultados de 52 estudos potenciais, 25 compuseram a amostra final, 10 relacionados ao uso da ultrassonografia vascular e 11 da luz infravermelha e 4 da iluminação transdérmica. Conclusão e implicações para a prática: o ultrassom parece ser a tecnologia mais eficaz para promover a obtenção bem sucedida da cateterização intravenosa periférica, porém há necessidade de realização de mais estudos que determinem melhor a eficácia das tecnologias estudadas na obtenção e manutenção da cateterização intravenosa periférica. Poderá propiciar práticas clínicas baseadas em evidências recentes, melhorando a qualidade da assistência à criança hospitalizada e sua família, através da promoção da segurança do paciente.

RESUMEN Objetivo verificar la influencia de la ecografía vascular, la emisión de luz infrarroja y la iluminación transdérmica en el éxito del cateterismo intravenoso periférico, el número de intentos, el tiempo para realizar el procedimiento, la permanencia del catéter in situ y la aparición de complicaciones en los niños, en comparación con el método tradicional. Método esta es una revisión de literatura integradora llevada a cabo desde 2018 hasta 2020 en la Biblioteca Virtual de Salud, PubMed, Science Direct, Scopus y Web of Science. Se seleccionaron estudios originales publicados entre 2007 y 2019 que compararon el uso de estas tecnologías con el método tradicional de cateterización intravenosa periférica en niños de 0 a 18 años. Resultados De 52 estudios potenciales, 25 constituyeron la muestra final, 10 relacionados con el uso de ultrasonido vascular y 11 con luz infrarroja y 4 con iluminación transdérmica. Conclusión e implicaciones para la práctica el ultrasonido parece ser la tecnología más efectiva para promover el logro exitoso del cateterismo intravenoso periférico, sin embargo, se necesitan más estudios para determinar mejor la efectividad de las tecnologías estudiadas para obtener y mantener el cateterismo intravenoso periférico. Puedese proporcionar prácticas clínicas basadas en evidencia reciente, mejorando la calidad de la atención para niños hospitalizados y sus familias, promoviendo la seguridad del paciente.

ABSTRACT Objective to verify the influence of vascular ultrasound, infrared light emission, and transdermal lighting on the success of peripheral intravenous catheterization, number of attempts, time to perform the procedure, catheter stay in situ and occurrence of complications in children, when compared to the traditional method. Method this is an integrative literature review carried out from 2018 to 2020 at the Virtual Health Library, PubMed, Science Direct, Scopus, and Web of Science. Original studies, published between 2007 and 2019, comparing the use of these technologies with the traditional method of peripheral intravenous catheterization in children aged 0 - 18 years, were selected. Results: of 52 potential studies, 25 made up the final sample. Ten were related to vascular ultrasound use, 11 to infrared light and 4 to transdermal lighting. Conclusion and implications for practice ultrasound seems to be the most effective technology to promote the successful achievement of peripheral intravenous catheterization. However, there is a need for further studies to better determine the effectiveness of the technologies studied in obtaining and maintaining peripheral intravenous catheterization. It may provide clinical practices based on recent evidence, improving the quality of care for hospitalized children and their families, by promoting patient safety.

An alternative method for the comparative study of coronary vessels: repletion and diaphanization experience in seven animal models / Repleción y diafanización como una alternativa para el estudio comparativo de los vasos coronarios: experiencia en siete modelos animales

Coronary arteries establish a complex blood vessel system, right and left coronary arteries commonly originate from the aortic sinuses and divide into multiple branches that supply the heart with several important variations between species. Diaphanization is a preservative technique which allows internal structures visualization, maintaining the three-dimensionality of the specimen. In this study, human (Homo sapiens), goat (Capra aegagrus hircus), bovine (Bos Taurus), equine (Equus caballus), porcine (Sus scrofa domesticus), canine (Canis lupus familiaris) and feline (Felis silvestris catus) coronary arteries were injected with selfcuring methyl-methacrylate and posteriorly diaphanized. The coronary vasculature was adequately observed in all models while keeping the three-dimensional relation with surrounding cardiac structures, except for septal arteries which were not visualized. As incidental findings, anatomical variations in canine and human hearts were observed. Repletion-diaphanization is a useful blended method to visualize the morphology of superficial coronary arteries. It could be a valuable tool in anatomical teaching and research, but further research needs to be done to prove its effectiveness in different vessel systems.

Las arterias coronarias son un complejo de vasos sanguíneos que usualmente se originan en los senos aórticos y que al dividirse en múltiples ramas suplen los requerimientos metabólicos del tejido cardiaco; cabe aclarar que la anatomía de estas estructuras posee variaciones importantes entre especies. La diafanización es una técnica de preservación que permite observar estructuras internas de un espécimen sin dañar su tridimensionalidad. En este estudio las arterias coronarias del corazón humano (Homo sapiens), caprino (Capra aegagrus hircus), bovino (Bos Taurus), equino (Equus caballus), porcino (Sus scrofa domesticus), canino (Canis lupus familiaris) y felino (Felis silvestris catus), fueron repletadas con metil-metacrilato y posteriormente diafanizados. Se observa la irrigación coronaria de cada uno de los corazones y su relación con las demás estructuras cardiacas, exceptuando las arterias septales. Como hallazgos incidentales se observaron variaciones anatómicas en los corazones canino y humano. Finalmente, esta técnica resultó de utilidad para evaluar la anatomía coronaria, lo que puede ser valioso para educación e investigación. Posteriores investigaciones deben ser realizadas para probar su utilidad en otros sistemas vasculares.

Tecnologia educacional para punção venosa periférica no adulto: o uso de localizador de veias / Educational technology for peripheral venipuncture in adults: use of the vein finder

Para o desenvolvimento de habilidades e competências relacionadas à punção e cateterização venosa periférica há vários tipos de tecnologias disponíveis que incluem os modelos anatômicos de braço convencional, modelos com veias em látex que podem ser presos com alças sobre um braço humano e simuladores de realidade virtual. Porém, em situação real, uma das maiores dificuldades relacionadas ao procedimento e relatadas não somente por estudantes mas também por profissionais consiste em realizar a punção utilizando-se a observação, palpação e conhecimentos de anatomia. Tais conhecimentos são essenciais para a prática clínica do enfermeiro, e apesar de escassa, a literatura tem recomendado a incorporação dos venoscópios/transiluminadores para a localização de veias. Dessa forma, o presente estudo teve como objetivo desenvolver e avaliar uma tecnologia educacional sobre o uso de venoscópio para punção venosa periférica na coleta de sangue à vácuo no paciente adulto. O estudo foi desenvolvido em duas etapas, sendo a primeira uma revisão integrativa da literatura e a identificação e caracterização dos venoscópios disponíveis no Brasil e, a segunda etapa, a elaboração de vídeo educativo sobre o uso de venoscópio para coleta de sangue a vácuo no paciente adulto. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Foram analisados 23 artigos acerca do uso de venoscópio para punção venosa periférica na prática clínica nos últimos dez anos, sendo que a maioria investigou seu uso junto aos pacientes pediátricos. De maneira geral os resultados dos artigos sintetizados apontam que os venoscópios/transiluminadores melhoram a visualização da rede venosa, inclusive nos pacientes com acesso venoso difícil, mas ainda não há concordância quanto a melhora nas taxas de sucesso na canulação e tempo de execução do procedimento. A busca pelos venoscópios disponíveis para comercialização no Brasil revelou que nenhum site dispõe de informações baseadas em evidências e que apenas uma pequena porcentagem dos equipamentos são registrados na Agência Nacional de Vigilância Sanitária. A elaboração do vídeo educativo sobre o uso de venoscópio para coleta de sangue a vácuo no paciente adulto foi conduzida em quatro fases que contemplaram o desenvolvimento do roteiro, a validação do roteiro, a gravação e produção do vídeo educativo e a validação do vídeo educativo. A validação do roteiro, bem como do vídeo educativo foi realizada por 8 enfermeiros peritos e 9 enfermeiros peritos e graduandos de enfermagem, respectivamente. Foram considerados válidos cada aspecto que obteve concordância mínima de 70% dos peritos. O vídeo educativo foi considerado validado, tendo elevada concordância nos diferentes itens avaliados, alcançando índices superiores a 90%. Espera-se que ele adicione conhecimento atualizado acerca do cuidado ao paciente adulto hospitalizado cujo acesso venoso seja difícil, uma vez que o manuseio desse recurso está previsto na prática clínica profissional e das equipes especialistas em acesso venoso

For the development of skills and competences related to peripheral venous catheterization and puncture, there are several types of technologies available that include conventional arm anatomical models, latex vein models that can be attached with loops on a human arm, and virtual reality simulators. However, in a real situation, one of the greatest difficulties related to the procedure and reported not only by students but also by professionals is to perform the puncture using observation, palpation and knowledge of anatomy. Such knowledge is essential for nurses' clinical practice, and although it is scarce, the literature has recommended the incorporation of venoscopes / transilluminators to locate veins. Thus, the present study had as objective to develop and evaluate an educational technology on the use of venoscope for peripheral venous puncture in the collection of blood to the vacuum in the adult patient. The study was developed in two stages, the first one being an integrative review of the literature and the identification and characterization of the venoscopes available in Brazil, and the second stage, the elaboration of an educational video about the use of venoscope for the collection of blood by vacuum in the patient adult. The study was approved by the Research Ethics Committee. We analyzed 23 articles about the use of venoscope for peripheral venipuncture in clinical practice in the last ten years, and the majority investigated its use among pediatric patients. In general, the results of the synthesized articles indicate that the venoscopes / transilluminators improve visualization of the venous network, even in patients with difficult venous access, but there is still no agreement as to the improvement in cannulation success rates and procedure execution time. The search for venoscopes available for commercialization in Brazil revealed that no site has evidence-based information and only a small percentage of the equipment is registered in the National Sanitary Surveillance Agency. The elaboration of the educational video about the use of venoscope for vacuum blood collection in the adult patient was conducted in four phases that included the development of the script, the validation of the script, the recording and production of the educational video and the validation of the educational video. The validation of the script as well as the educational video was performed by 8 expert nurses and 9 expert nurses and nursing undergraduates, respectively. Each aspect that obtained a minimum agreement of 70% of the experts was considered valid. The educational video was considered validated, having high agreement in the different evaluated items, reaching indexes above 90%. It is expected that he will add up-to-date knowledge about care to hospitalized adult patients whose venous access is difficult, since the handling of this feature is provided in professional clinical practice and venous access specialist teams

Nearinfrared light transillumination for detection of incipient proximal caries in primary molars / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the practical value of nearinfrared light transillumination (NILT, DIAGNOcam) on detection of incipient proximal caries in primary molars.@*METHODS@#In this study, 4-9-year-old children with suspicious proximal lesions in primary molars were recruited. The target teeth were examined with clinical examination, bitewing radiograph and DIAGNOcam. And the caries indexes were rated as 0 (no caries), 1 (caries reaching outer 1/2 enamel), 2 (caries reaching inner 1/2 enamel), and 3 (dentine caries). Those primary molars with at least one of the adjacent molars according with the criteria of invasive treatment, i.e. the teeth were diagnosed as caries reaching inner 1/2 enamel or dentine with at least two detection methods, were included. The target teeth with caries index ≥2 accepted the invasive treatment. And the caries status of the adjacent teeth was observed under direct vision and those teeth of caries index ≥2 would also accept the invasive treatment. The relationship of lesions to enamel-dentine junction (EDJ) were recorded and used as reference standard to compare the sensitivity, specificity and accuracy of those three methods in detecting the incipient proximal caries in primary molars.@*RESULTS@#In this study, 36 children with 104 suspicious proximal lesions in primary molars were recruited, of which 5 were diagnosed as no caries, 20 were diagnosed as superficial enamel caries, and 79 accepted invasive treatment, of which 22 were diagnosed as EDJ caries, and 57 as dentine caries. The sensitivity of clinical examination, bitewing radiograph, and DIAGNOcam were 68.69%, 81.82%, 78.79%, respectively. The specificity were 100.00%, 100.00%, 80.00%, and the accuracy were 75.96%, 85.65%, 78.85%, respectively. As for superficial enamel caries, the sensitivity of clinical examination was lowest, only 10%, while DIAGNOcam was 60%, higher than 40% of bitewing radiograph. As for EDJ caries, the sensitivity of bitewing radiograph was highest as 86.36%, followed by DIAGNOcam 72.73% and clinical examination 68.18%. As for dentine caries, the sensitivity of the three detection methods were higher than 85%, of which bitewing radiograph was the highest as 94.74%.@*CONCLUSION@#The accuracy of DIAGNOcam in detecting incipient proximal caries in primary molars was comparable to that of bitewing radiograph. It was safe, and convenient with no exposure to radiation, which was applicable to be used in pediatric dentistry.

Recursos actuales en el diagnóstico de caries / Current resources in caries diagnosis

Uno de los grandes problemas en la Odontología y en particular en aquellos asociados con el manejo de la caries dental es la detección y el diagnóstico preciso o acertado de las lesiones de caries, principalmente, de aquellas lesiones más incipientes. Actualmente, así como se ha ido presentando una mayor comprensión y entendimiento del desarrollo de las lesiones de la caries dental, también se han generado nuevas posibilidades de efectuar un mejor manejo de estas lesiones en forma individual y en general, a la disminución del riesgo de caries de cada paciente en forma más particular. Esto ha permitido la creación de lo que se puede considerar como un nuevo paradigma basado en los recursos actuales, no sólo en el diagnóstico de las lesiones de caries sino en especial, al manejo de la caries dental como enfermedad (AU)

One of the great problems in Dentistry and especially in those associated with the management of dental caries is the detection and the precise or accurate diagnosis of the caries lesions, particularly of the most incipient lesions. Actually, to our date, it has been shown a better comprehension and understanding on the development of the dental caries lesions that has generated also, the possibilities to perform a better management of these lesions individually, and in general, to decrease the caries risk in each patient in a particular form. All this has created what can be considered as: a new paradigm based in the current resources not only on the diagnosis of the caries lesions, but specially, on the management of dental caries as a disease (AU)

Enucleación esofágica de leiomioma asistida por robot: reporte de un caso y revisión de la literatura / Case report of robot-assisted esophageal enucleation of leiomyoma and literature review

Resumen Introducción: los leiomiomas esofágicos son tumores benignos, que son resecados por enucleación esofágica cuando son mayores de 5 cm o en lesiones de cualquier tamaño que sean sintomáticos o sospechosos de malignidad. Tradicionalmente, se ha realizado la resección por técnica de enucleación abierta; sin embargo, la cirugía mínimamente invasiva ha surgido como una técnica con grandes ventajas y, en especial, la tecnología robótica parece ofrecer ventajas. Caso clínico: se reporta un caso de leiomioma esofágico del esófago medio con enucleación mediante el uso de una técnica toracoscópica asistida por robot. La esofagoscopia intraoperatoria y la transiluminación fueron complementos útiles para identificar el esófago y desarrollar un plano de disección extramucosa seguro, que junto con la asistencia robótica parecen minimizar los riesgos intraoperatorios, entre ellos, potencialmente la probabilidad de lesión mucosa, y mejoran el tiempo de recuperación postoperatoria.

Abstract Introduction: Esophageal leiomyomas are benign tumors which are resected by esophageal enucleation when they are symptomatic, suspected of malignancy, or larger than 5 cm. Traditional resection uses the open enucleation technique, but minimally invasive surgery has emerged as a technique that has great advantages, especially when combined with robotic technology. Case report: We report a case of leiomyoma of the middle esophagus with treated with enucleation using a robotic-assisted thoracoscopic technique. Intraoperative esophagoscopy and transillumination were useful for identifying the esophagus and developing a plan of safe extra mucosal dissection. Together with robotic assistance this seems to minimize intraoperative risks including that of mucosal injury while also improving postoperative recovery time.

Secondary glaucoma induced by bilateral acute depigmentation of the iris / Glaucoma secundário à despigmentação bilateral aguda da íris

Abstract We report a case of a middle-aged woman who developed acute, bilateral, symmetrical, slightly transilluminating depigmentation of the iris and pigment discharge into the anterior chamber following the use of oral moxifloxacin for bacterial sinusitis. She had been misdiagnosed as having autoimmune uveitis, treated with steroids and tropicamide, and underwent severe ocular hypertension and glaucoma despite posterior correct diagnosis.

Resumo Relato de um caso de uma paciente do sexo feminino de meia idade que desenvolveu despigmentação bilateral simultânea aguda com dispersão de pigmentos na câmara anterior e discreta transiluminação após o uso de moxifloxacino oral para tratamento de sinusite bacteriana. Ela Havia sido diagnosticada com uveite autoimune e tratada com corticosteroide tópico e tropicamida e evoluiu com hipertensão ocular grave e glaucoma apesar de ,posteriormente, o diagnóstico ter sido correto.

Effect of Clinical Experience on Accuracy and Reliability of Radiographic Caries Detection / Efecto de la Experiencia Clínica en la Precisión y Concordancia de Detección de Caries en Radiografías

ABSTRACT: The purpose of this study was to investigate the accuracy and interobserver reliability of examiners with different levels of clinical experience, when diagnosing radiographic proximal caries lesions. Bitewing radiographs were selected from a patient attending Operative Dentistry Clinic, Universidad de Chile. Radiographic examination was performed by three different groups: A: third year dentistry students, B: fourth year dentistry students, and C: dentist recently graduated. Thirty-two proximal surfaces were scored as: 0, sound; 1: enamel caries; and 2: dentinal caries. The data were analysed and accuracy and interexaminer reliability were calculated. Accuracy values for enamel caries were: A (0.54), B (0.55) and C (0.58), and dentinal caries were: A (0.55), B (0.61) and C (0.63). Interexaminer reliability denoted marginal agreement for all groups, A (0.249), B (0.213) and C (0.282) for enamel caries and A (0.058), B (0.102), and C (0.344) for dentinal caries. The results of this study indicate that the accuracy and interexaminer reliability of bitewing radiographic examination were influenced by the clinical experience when detecting radiographic proximal caries, however low values of accuracy and interexaminer reliability were noted, reinforcing the necessity of improving education and training in radiographic caries detection.

RESUMEN:El objetivo de este trabajo fue evaluar la precisión y concordancia entre examinadores con distinto nivel de experiencia clínica, al diagnosticar lesiones de caries proximales en radiografías. Un set de radiografías bitewing fue seleccionado de un paciente que acudió a la Clínica de Operatoria de la Facultad de Odontología, Universidad de Chile. El examen radiográfico fue realizado por tres grupos distintos: A: estudiantes de Odontología de tercer año, B: estudiantes de Odontología de cuarto año, y C: dentistas recientemente graduados. Treinta y dos superficies proximales fueron analizadas y evaluadas como: 0, sana; 1: lesión de caries de esmalte, 2: lesión de caries dentinaria. Los datos obtenidos fueron analizados y la precisión y concordancia entre examinadores fueron calculadas. Los valores de precisión en lesiones de esmalte fueron: A (0,54), B (0,55) y C (0,58), y para lesiones dentinarias fueron: A (0,55), B (0,61) y C (0,63). La concordancia entre examinadores denotó ser marginal para todos los grupos, A (0,249), B (0,213) y C (0,282) en lesiones de esmalte y A (0,058), B (0,102), y C (0,344) en lesiones dentinarias. Los resultados de este estudio indican que la precisión y la concordancia entre examinadores está influenciada por la experiencia clínica, sin embargo los valores encontrados fueron bajos, lo que refuerza la necesidad de mejorar la educación y entrenamiento en detección de lesiones de caries en radiografías

Diaphanization: a standardized protocol for non-fetal tissue preservation / Diafanización: un protocolo estandarizado para la preservación de tejido adulto

In response to the arising difficulty of dissection use during anatomy courses, medical schools have been forced to research alternative teaching methods. These are meant to help students develop three dimensional mental images of the human body and increase spatial reasoning, thus improving the learning process of human morphology. One of those methods, used at the Universidad de los Andes is the Diaphanization process. This technique is a well-known method for specimen preservation, used as an anatomy research and teaching tool. Even though it is frequently used, finding a standardized protocol in indexed journals is not possible, which hinders the use of the technique. The standardization of an updated protocol is a need in order to continue exploiting the maximum educational capacity of the specimens used during classwork. The process used at the Universidad de los Andes for non-fetal tissue preservation by Diaphanization is described, with a detailed explanation of its five main stages: Injection, Fixation, Dehydration, Bleaching (or Maceration) and Final preservation. The final result should be an organ preserved in an acrylic box which allows clear three dimensional visualization of anatomical structures that can be used for the study and description of general anatomy and vascular structure. It also helps with spatial reasoning and represents little to no biological risk, leading to a new level of anatomical teaching and experimenting. Several specimens obtained at our laboratory through this technique are presented.

Como respuesta a la dificultad del uso de disección como una herramienta en el curso de anatomía, las escuelas de medicina se han visto forzadas a investigar y desarrollar métodos alternativos que la reemplacen. Estos pretenden estimular el desarrollo de la percepción tridimensional de los estudiantes, logrando mejor racionamiento espacial, y así, mejorando el proceso de aprendizaje de la morfología humana. Uno de estos métodos, en uso en la Universidad de los Andes, es el proceso de diafanización. Esta técnica es ampliamente conocida en el ámbito de preservación de tejidos, y empleada en investigación y educación. Aún con su uso frecuente, un protocolo estandarizado que la describa no está disponible en la literatura indexada, lo cual limita su uso. La estandarización de un protocolo actualizado es necesaria para permitir el continuo uso de esta técnica. Se describe el proceso de preservación de tejido adulto mediante la diafanización, con una explicación detallada de los 5 pasos que la componen: Inyección, Fijación, Deshidratación, Macerado y Preservación final. El resultado es un órgano inmerso en glicerina en un contenedor de acrílico que permite una visualización tridimensional de las estructuras anatómicas del espécimen, que puede ser empleado por los estudiantes para su estudio, y permite una descripción de la anatomía general del modelo y su estructura vascular. Adicionalmente incrementa el razonamiento espacial de los estudiantes, y no presenta ningún riesgo biológico. Se presentan una variedad de especímenes de características particulares obtenidos mediante la aplicación de esta técnica.

Light-emitting diode assessment of dentinal defects: the role of presumed extraction forces

OBJECTIVES: The evaluation of iatrogenic dentinal defects in extracted teeth may be influenced by extraction forces and prolonged dry times. The purpose of this study was to compare the presence of dentinal defects in freshly extracted, periodontally compromised teeth with those in a group of teeth with uncontrolled extraction forces and storage time. MATERIALS AND METHODS: The experimental group consisted of eighteen roots obtained from teeth extracted due to periodontal reasons with class II or III mobility. They were kept in saline and sectioned within 1 hour following extraction. The control group consisted of matched root types obtained from an anonymous tooth collection, consistent with previous dentinal defect studies. The slices were obtained at 3, 6, and 9 mm from the apex. The imaging process exposed all specimens to no more than 60 seconds of dry time. The × 12.8 magnification was used for the 9 mm slices and × 19.2 magnification for the 3 mm and 6 mm slices under light-emitting diode (LED) transillumination. The root canal spaces and periodontal tissues were masked to minimize extraneous factors that might influence the evaluators. Chi-square test was used for statistical analysis. RESULTS: Dentinal defects were detected in 17% of the experimental group teeth, compared to 61% of control teeth (p = 0.015). CONCLUSIONS: LED transillumination assessment of freshly extracted roots with class II or III mobility showed smaller number of dentinal defects than roots with uncontrolled storage time and extraction forces. The use of freshly extracted roots with mobility should be considered for future dental defect assessment studies.

Acute Scrotum in an Infant with Kawasaki Disease

Kawasaki disease (KD) is a systemic vasculitis that occurs predominantly in infants and young children. The etiology of KD is unknown and coronary heart disease is a major complication of KD. Acute scrotum is a rare complication of acute KD, and not as well recognized as other manifestations of the disease. We report a 2-month-old boy with acute scrotum in the acute phase of KD. He was treated with intravenous immunoglobulin (total 2 g/kg) and aspirin (50 mg/kg/day). The treatment was effective in resolving his fever and other clinical symptoms, but 2 days after starting treatment he experienced scrotal swelling. Scrotal ultrasound and transillumination were used in the diagnosis of acute scrotum. After 2 months, a follow-up testicular ultrasound revealed a remission of the acute scrotum. Subsequently, he has been followed up for KD.

Modelo BRAN-RS para la enseñanza de la conductometría electrónica sin verificación radiográfica a alumnos de licenciatura: estudio piloto / BRAN-RS model for teaching electronic root canal lenght measurement without X-ray confirmation by undergraduate students: a pilot study

Propósito: demostrar la ejecución de la conductometría electrónica sin verificación radiográfica con el modelo BRAN-RS, por dos alumnas de licenciatura en odontología Material y métodos: Se emplearon dos molares naturales, de los cuales se utilizaron seis conductos permeables (cuatro mesiales y dos distales); el localizador de foramen apical Raypex 6, tipodonto de acrílico y alginato. Los dientes se incluyeron en el espacio de los molares, que se abocardó y rellenó con alginato. Se insertó el clip labial por debajo del tipodonto. Una cavidad de acceso fue realizada en cada molar, se determinó la entrada de los conductos y se amplió con fresa Gates-Glidden número 4. Con el dispositivo Raypex conectado, se introdujo gentilmente en cada conducto una lima tipo K número 15 o 20, cerrándose el circuito con el sujetador de limas. La posición de la lima en el foramen se observó en la pantalla, que se indica por medio de la barra y punto rojos. La lima fue reajustada en las dos primeras barras amarillas y se fi jó con resina fotopolimerizable. Los molares fueron retirados del alginato, se diafanizaron y evaluaron con microscopio clínico a 16X para confi rmar la longitud de trabajo. Resultados: La posición de la lima respecto al foramen apical en los seis conductos fue precisa al 100 por ciento. Conclusión: El modelo BRAN-RS es fácil de realizar, preciso, y puede utilizarse por alumnos de la licenciatura en la práctica preclínica de conductometría.

To demonstrate how two undergraduate students perform electronic root canal measurement without X-ray confi rmation using the BRAN-RS model. Material and methods: Six permeable root canals (4 mesial and 2 distal) from two natural molars; Raypex 6 electronic apex locator; acrylic typodont; and alginate. The teeth were inserted in the molar space, which had been widened and fi lled with alginate. The lip clip was placed below the typodont. An access cavity was made in each molar and the entrance to the root canal located and widened using a number 4 Gates-Glidden drill. Once the Raypex device was connected, a number 15 or 20 K-fi le was gently introduced into each canal and the measurement circuit closed using the fi le clip. The posi-tion of the fi le within the foramen was shown on the screen in the form of a red bar and a red dot. The fi le was readjusted within the fi rst two yellow bars and secured using a light-cured resin. The molars were removed from the alginate, then diaphonized and evaluated under a clinical microscope at 16X magnifi cation to confi rm the working length. Results: In the six root canals, the position of the fi le relative to the apical foramen was 100% accurate. Conclusion: The BRAN-RS model is accurate, easy to perform, and can be used by undergraduate students in the preclinical practice of root canal measurement.

Características de los Canales Radiculares de Molares Temporales / Characteristics of Roots Canals of Deciduous Teeth

El objetivo de esta investigacion fue identificar en los canales radiculares de la dentición temporal las variantes anatómicas de la cavidad dentaria pulpar. Se realizó un estudio clínico, descriptivo, transversal ex vivo, que analizó una muestra de 60 dientes temporales pertenecientes a niños mexicanos aparentemente sanos, cuya extracción se indicó por motivos terapéuticos. Los dientes fueron almacenados en agua destilada y posteriormente diafanizados. La identificación de canales radiculares se realizó por un solo observador durante dos ocasiones (k= 0,7947). Los dientes unirradiculares presentaron 50% de canales simples y laterales, 25% secundarios y 25% deltas. Los molares maxilares presentaron un 8% de canales simples en cada raíz, mientras que los molares mandibulares un 29%. Canales secundarios, paralelos y recurrentes se observaron en el 33% de los molares. El 100% de las raíces distales de molares mandibulares presentaron canales reticulares. Las fusiones radiculares se presentan en el 88% de las molares mandibulares. La anatomía de los canales radiculares de la dentición temporal es altamente compleja.

The aim of this study was to identify in roots canals of deciduous teeth anatomical variants in pulpar cavity. In a clinical, descriptive, cross sectional ex vivo study was analyzed a sample of 60 deciduous teeth of healthy Mexican children. Each tooth was conserved in distillated water and were transparency with a technic modified for deciduous teeth. Identifications of root canals was made twice by a lonely observant (k= 0.7947). Simple root teeth show 50% simple and lateral root canal, 25% secondary, 25% delta. Upper molars show 8% simple canal in each root. Lower molars 29%. Secondary root canals, parallel and recurrent were identified in 33% of cases. 100% of distal roots of lower molars have reticular canals. Root fusions are presents in 88% of lower molars. In conclusion, root canals anatomy of deciduous teeth is high complex.

Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway / 대한마취과학회지

BACKGROUND: Although Lightwand and Glidescope have both shown high success rates for intubation, there has been no confirmation as to which device is most effective for difficult endotracheal intubation. We compared the Glidescope and Lightwand devices in terms of duration of intubation and success rate at the first attempt in a simulated difficult airway situation. METHODS: Fifty-eight patients were randomized to undergo tracheal intubation with either the Glidescope (Glidescope group, n = 29) or the Lightwand (Lightwand group, n = 29). All patients were fitted with a semi-hard cervical collar in order to simulate a difficult airway, and intubation was attempted with the assigned airway device. The data collected included the rate of successful endotracheal intubation, the number of attempts required, the duration of the intubation, as well as the interincisor distance, hemodynamic variables, and adverse effects. RESULTS: There was no difference between Glidescope group (92.6%) and Lightwand group (96.4%) in terms of success rate for the first attempt at intubation. The duration of successful intubation for the first tracheal intubation attempt was significantly longer in Glidescope group than in Lightwand group (46.9 sec vs 29.5 sec, P = 0.001). All intubations were completed successfully within two intubation attempts. The incidence of hypertension was significantly higher in Glidescope group than in Lightwand group (51.9% vs 17.9%, P = 0.008). CONCLUSIONS: In a simulated difficult airway situation, endotracheal intubation using Lightwand yielded a shorter duration of intubation and lower incidence of hypertension than when using Glidescope.

Endotracheal intubation using i-gel(R) and lightwand in a patient with difficult airway: a case report / 대한마취과학회지

This case report involves tracheal intubation using i-gel(R) in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel(R) was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel(R) and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel(R) and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.

Comparative morphometric study of the sigmoid sinus sulcus and the jugular foramen / Estudo morfométrico comparativo do sulco do seio sigmóideo e do forame jugular

Objective To compare the right and left sides of the same skulls as far as the described landmarks are concerned, and establish the craniometric differences between them. Method We carried out measurements in 50 adult dry human skulls comparing both sides. Results The sigmoid sinus width at the sinodural angle level was larger on the right side in 78% of the cases and at the level of the digastric notch in 72%. The jugular foramen width was also larger on the right side in 84% of the cases. The sigmoid sinus distance at the level of the digastric notch was larger on the right side in 64% of the cases, and the sigmoid sinus distance at the level of the digastric notch to the jugular foramen was larger on the right side in 70% of the cases. Conclusion Significant craniometric differences were found between both sides of the same skulls. .

Objetivo Comparar os lados direito e esquerdo no mesmo crânio nos pontos referenciais descritos e definir as diferenças craniométricas entre ambos. Método Realizamos mensurações em 50 crânios secos de humanos adultos comparando os lados direito e esquerdo. Resultados Como resultado, obtivemos as medidas da largura do seio sigmóideo na altura do ângulo sinodural maiores no lado direito em 78% dos casos e na altura do ponto digástrico em 72%. A largura do forame jugular foi também maior no lado direito em 84% dos casos. A distância do seio sigmóideo na altura do ângulo sinodural até a altura do ponto digástrico foi maior do lado direito em 64% dos casos, e a distância do seio sigmóideo na altura do ponto digástrico até o forame jugular foi maior do lado direito em 70% dos casos. Conclusão Diferenças craniométricas significativas foram encontradas entre os dois lados do crânio. .

Atrofia de íris após tratamento estético facial com luz intensa pulsada / Iris atrophy after aesthetic treatment with intense pulsed light

Relato de um caso de complicação ocular, em consequência do uso de luz intensa pulsada, para tratamento facial cosmético. A lesão consistiu em atrofia iriana no setor temporal, com grande área de transiluminação, sinéquias posteriores, deformidade e redução da dilatação pupilar. O objetivo é alertar para os riscos do procedimento para os olhos, caso não sejam tomadas as medidas adequadas de proteção ocular.

The authors report a case of ocular complication, following Intense Pulsed Light for cosmetic facial treatment.The lesion was iris atrophy with a large transilumination area, posterior synechiae, deformity and reduced dilation of the pupil, on the temporal side. The aim is to alert for the risk of ocular lesion related to this procedure, if adequate measures to protect the eyes are not taken.