Exploración del conducto en C con tomografía computada de haz cónico / Exploration of C-shaped canals with cone-beam computed tomography

El «conducto en C¼ es un tipo de anatomía dentaria compleja que debe ser evaluado previo a la realiza- ción de un tratamiento endodóntico. Esta variación anatómica es vista principalmente en segundos mola- res inferiores aunque también puede encontrarse en premolares y molares, tanto superior como inferior. Para su diagnóstico se solicitan distintos tipos de estudios imagenológicos. Debemos tener en cuenta que este tipo de anatomía no es observado fácilmen- te en imágenes bidimensionales por lo cual es muy importante considerar para estos casos complejos, la solicitud de un estudio de alta complejidad como lo es la tomografía computada de haz cónico, la cual nos permitirá explorar este tipo de anatomía para tenerlo en cuenta al momento de realizar un correcto aborda- je del conducto en C (AU)

The "C-canal" is a type of complex dental anatomy that must be evaluated prior to performing endodontic treatment. This anatomical variation is seen mainly in lower second molars although it can also be found in premolars and molars, both upper and lower. For its diagnosis we can use different types of imaging studies. We must keep in mind that this type of anatomy is not easily observed in two-dimensional images, which is why it is very important to consider, for these complex cases, the request for a highly complex study such as cone beam computed tomography, which will allow us to explore this type of anatomy to take it into account when performing a correct approach to the C-duct (AU)

Cribado de cáncer de páncreas en la práctica clínica: es el momento de la prevención

El cribado de cáncer de páncreas en población de alto riesgo puede mejorar la supervivencia. Sin embargo, hay pocas referencias sobre su aplicabilidad y hallazgos en la práctica clínica habitual. Nuestro objetivo es evaluar los hallazgos de las pruebas de cribado de cáncer de páncreas en individuos de alto riesgo en la práctica clínica y describir las variables asociadas a la presencia de lesiones relevantes. Este es un estudio observacional prospectivo en el que se seleccionaron pacientes con alto riesgo de cáncer de páncreas, según los criterios del Consorcio Internacional de Cribado de Cáncer de Páncreas. Se analizaron variables demográficas, presencia de factores de riesgo de cáncer páncreas y los hallazgos de las pruebas. Posteriormente se compararon pacientes que presentan lesiones relevantes con aquellos sin hallazgos. De 70 pacientes de alto riesgo, 25 cumplieron los criterios de cribado. El síndrome hereditario más frecuente fue el cáncer de mama y ovario hereditario (60%). En once individuos (44%) se identificaron hallazgos y en tres (12%) fueron relevantes: dos tumores papilares mucinosos intraductales y un tumor sólido localizado. La mutación en BRCA2 fue la más frecuente en lesiones significativas (66,7% vs 30%, p=0,376) sin encontrar asociación con diabetes ni tabaquismo (0 vs 18 %, p=0,578 y 0 vs 4,5%, p=0,880 respectivamente). En conclusión, las pruebas de cribado permiten detectar lesiones en estadio precoz o resecables en un importante porcentaje de población de alto riesgo seleccionada. Los hallazgos más relevantes fueron en los pacientes pertenecientes al síndrome de cáncer de mama y ovario hereditario.

Pancreatic cancer surveillance can improve outcomes in high-risk individuals. However, little is known about its applicability and findings in routine clinical practice. Our aim was to evaluate findings on screening tests in high-risk individuals in a clinical practice setting and to analyze factors associated with the presence of relevant pancreatic lesions. We developed a prospective observational study of pancreatic cancer high risk patients that meet criteria of surveillance from the International Cancer of the Pancreas Screening Consortium. The demographic variables, other risk factors and imaging findings are collected. Patients with significant findings are compared to those without noteworthy findings. Of 70 high-risk individuals, 25 fitted the criteria for pancreatic cancer surveillance. The most frequent condition was hereditary breast and ovarian cancer syndrome (60%). We identified eleven abnormal imaging findings (44%) and three of them (12%) were relevant: two intraductal papillary mucinous neoplasms and one localized pancreatic neoplasm. BRCA2 mutation was more frequent in patients with significant lesions (66.7% vs 30%, p=0.376) but smoking and diabetes were not associated with relevant findings (0 vs 18 %, p=0.578 and 0 vs 4.5%, p=0.880 respectively). Screening test could detect early-stage or resectable lesions in a significant in a significant percentage of the selected high-risk population. The most relevant findings were in patients belonging to hereditary breast and ovarian cancer syndrome.

Utilização do playground por crianças com paralisia cerebral tipo diparética espástica: preferências e dificuldades relatadas pelas mães / Utilization of playground by children suffering from cerebral palsy, spastic diparetic type: preferences and difficulties reported by mothers

Este estudo teve como objetivo investigar como ocorre a utilização do playground por um grupo de crianças com paralisia cerebral tipo diparética espástica segundo relato verbal de suas mães. Participaram da pesquisa dez mães de crianças entre quatro e oito anos, para as quais foi aplicado um questionário contendo perguntas sobre a utilização desse espaço pela criança. Posteriormente foram selecionadas cinco mães, que preenchiam os critérios estabelecidos para o estudo, que era freqüentar o playground regularmente com seu filho. Foi agendada uma entrevista semi-estruturada, realizada pela pesquisadora e gravada em fita cassete. As mães relataram freqüentar playgrounds de parques públicos com seus filhos, ressaltando que as crianças reagiam bem aos estímulos oferecidos pelos brinquedos, apresentando pouca dificuldade nos relacionamentos sociais. Referiram também ter sido pouco orientadas sobre os benefícios do playground por profissionais que atuam na área do desenvolvimento. O desempenho das crianças mostrou que este ambiente pode ser favorável ao desenvolvimento motor e social, proporcionando os estímulos vestibulares, proprioceptivos e táteis, semelhantes àqueles oferecidos na terapia de integração sensorial. Espera-se apontar uma nova alternativa de estimulação para a criança com paralisia cerebral no ambiente natural do playground, proporcionando melhor desenvolvimento motor, cognitivo e social.

The aim of this study was to investigate how does the use of the playground by a group of children with spastic diparetic cerebral palsy, according to their mothers' verbal report. Ten mothers of children between four and eight years participated of this research and answered a questionnaire with questions about the child performance in the playground space. Subsequently, five mothers were selected to participate in another phase of the study, which consisted in regularly attend the playground with their children. The data was collected in a semi-structured interview, conducted by the researcher and recorded on audiotape. Mothers reported frequenting public parks with playgrounds for their children, stating that the children reacted well to the stimuli offered by the toys, presenting little difficulty in social relationships and refer that they have been little counseling on the benefits of the playground by professionals who working in development. Children's performance showed that this environment may be conducive to the motor and social development, providing the vestibular, proprioceptive and tactile stimulus, like those offered on sensory integration therapy. It is hoped an alternative propose of stimulation for the child with cerebral palsy in the natural environment of the playground, providing a better motor development, cognitive and social development.

Lepra para a hanseníase: a visão do portador sobre a mudança de terminologia / Leprosy for Hansen´s Disease: the effect of this Terminology Change According to the Carriers modificar

A hanseníase, doença milenar, foi motivo de exclusão compulsória dos entrevistados ao convívio social. Atualmente sua cura é possível, a falta de informação existe e o preconceito ainda é um problema grave. Medidas foram tomadas na tentativa de diminuir o estigma,como a Lei nº 9.010/95, que oficializou a mudança no uso do termo lepra para hanseníase. Este trabalho objetivou investigar as mudanças sob o prisma das pessoas que têm ou tiveram hanseníase. Foi aplicado protocolo próprio contendo perguntas fechadas em 50entrevistados. A análise estatística foi descritiva, com cálculos percentuais simples e cruzamento de variáveis. Os resultados revelaram que houve predomínio de casados (56%), aposentados (30%) e assalariados(20%); com ensino fundamental incompleto (46%).Dos 64% que conheciam outra terminologia para hanseníase,93,8% citaram o termo lepra e 90% sabiam do preconceito histórico; 63% julgavam que a mudança do nome pode ter diminuído o preconceito e 76,7%achavam que as pessoas sabiam que a hanseníase era antiga lepra, tanto que ao comentar sobre a doença, a maioria (60%) logo referia o termo à lepra. O medo sob seus vários aspectos, atingiu 50% dos entrevistados. Salientamos a falta de informação em relação a formas de transmissão, instalação de deficiências e tratamento. O passado histórico ainda exerce influência apesar da mudança do nome, pacientes enfrentam preconceitos no meio social, pela associação com termo lepra. A dificuldade no entendimento dos conceitos pode ser uma das causas do estigma. Inferimos que a mudança do termo não foi capaz de eliminar preconceitos

Hansen´s disease, a very ancient disease, was the reason for patients´ compulsory exclusion into the social environment. Nowadays its cure is possible; there is lack of information and the prejudice is still a serious problem. Some measures were taken in the attempt of reducing the stigma, as the Law nº 9 010/95, which made official the change in the use of the term leprosy for Hansen´s disease. This study aimed at investigating the changes according to the people’s point of view who have or had Hansen´s disease. A particular protocol with closed questions was applied to 50 people. The statistical analysis was descriptive, with simple percentile calculations and crossed- variables. The results showed that there was married prevalence (56%), retired (30%) and salary earners (20%); with incomplete elementary education (46%). From the 64% that knew other name for Hansen´s disease, 93.8% mentioned the term leprosy and 90% knew about the historical prejudice; 63% claimed that the change of the name might have reduced the prejudice and 76.7% thought the people knew that leprosy´s disease was the old leprosy, as so much that when talking about the disease, most of them (60%) immediately referred the term to the leprosy. Fear under several aspects reached 50% of the interviewees. We pointed out the lack of information in relation to the transmission forms, disabilities onsets and treatment. The historical past still has influence in spite of the change of the term; patients face prejudices in the social environment due to the association with leprosy term. The difficulty in understanding the concepts can be one of the causes of the stigma. We could point out that the change of the term was not able to eliminate prejudice.