Coitus induced colpo evisceration in a 3-months post hysterectomy patient: an unusual tale in gynecology

Vaginal dehiscence after pelvic surgery is an extremely rare gynecological emergency world over. Without a high index of suspicion, it can easily be missed with grave consequences. We present an extremely rare case of this post abdominal hysterectomy case for which if immediate suspicion and timely intervention were not ensured, the patient would have suffered serious morbidity and/or death.

Observation on the effect of the treatment of lumbar disc herniation with lateral recess stenosis through the interlaminar approach under the technique of intervertebral foramen / 临床外科杂志

Objective This study explored the clinical effect of using transforaminal technique to treat patients with lumbar disc herniation and lateral recess stenosis.Methods 132 patients with lumbar disc herniation and lateral recess stenosis who were treated by orthopedic surgery in our hospital from July 2018 to December 2022 were selected for retrospective analysis.They were divided into the endoscopic group and the traditional group according to the surgical method.70 patients in the endoscopic group were treated by the inter-laminar approach under the technique of intervertebral foramen,and 62 patients in the traditional group were treated by the traditional open surgery.The operation process indexes of the two methods were compared The clinical symptoms of patients after operation were different.Results The average operation time[(76.1±7.5)min],surgical blood loss[(30.5±8.4)ml],incision length[(0.88±0.12)cm],post-operative drainage[(24.5±4.4)ml],bed time[(26.8±4.4)h],and length of stay[(5.6±1.8)d]in the endoscopic group were significantly lower than those in the traditional group[(88.0±9.3)min,(103.4±18.6)ml,(6.10±1.04)cm,(208.3±34.0)ml,(32.7±6.6)h and(9.4±2.0)d,respectively].The difference was statistically significant(P＜0.05).VAS scores of 3 months and 6 months after surgery were lower than those before surgery,and JO A scores were higher,the difference was statistically significant(P＜0.05).The lumbar function of the endoscopic group was excellent in 43 cases(61.43％)and good in 15 cases(21.43)％),29 cases of lumbar spine function were excellent(46.77％)and 17 cases(21.43％)were good in the traditional group.Overall,there was no statistically significant difference in the recovery of lumbar spine function between the endoscopic group and the traditional group(P＞0.05).2 patients(2.86％)in the endoscopy group had postoperative complications,and 7 patients(11.29％)in the traditional group had postoperative complications,but there was no significant statistical difference in the incidence of surgical complications between the two groups(P＞0.05).Conclusion For the treatment of lumbar disc herniation with lateral recess stenosis under intervertebral foraminal technique,the treatment of lumbar intervertebral disc herniation with lateral recess stenosis can achieve better functional recovery and effectively relieve the clinical symptoms of the patient,but its advantage lies in the operation time.Shorter,less traumatic impact on patients.

Stepwise treatment strategy for spontaneous osteonecrosis of the medial femoral condyle of the knee joint / 中国组织工程研究

BACKGROUND:Currently,there have been a variety of conservative and surgical treatment plans for spontaneous osteonecrosis of the knee,achieving excellent results.However,a broad consensus on indication and guide of surgical treatment has not been announced.In clinical practice,there is still a misunderstanding that unicondylar replacement or total knee arthroplasty should be performed upon the discovery of spontaneous osteonecrosis of the knee,while an urgent need for universal access to the concept of stepwise therapy. OBJECTIVE:To summarize and find the factors leading to the poor effect of conservative treatment in spontaneous osteonecrosis of the knee,which occurred on the medial femoral condyle,from the literature and clinical cases,at the same time,combined with the Koshino stage,to propose the strategy of stepwise spontaneous osteonecrosis of the knee treatment on the medial femoral condyle. METHODS:A systematic search of the literature database was conducted to summarize the factors leading to poor outcomes of conservative treatment in spontaneous osteonecrosis of the medial femoral condyle.Meanwhile,according to the Clinical&Health Records for analytics&Sharing system,the cases receiving conservative and surgical treatment in spontaneous osteonecrosis of the medial femoral condyle in the Department of Orthopedics of Guangdong Provincial Hospital of Chinese Medicine from January 2017 to January 2023 were analyzed retrospectively,then the causes of success and failure in typical cases were summarized and analyzed. RESULTS AND CONCLUSION:(1)Early diagnosis and treatment of spontaneous osteonecrosis of the knee were very important for prognosis.For sudden knee pain in some patients,if no obvious abnormality was found in the X-ray examination,and the symptoms persisted and could not be relieved for more than 1 week,an MRI examination was recommended to detect early spontaneous osteonecrosis of the knee.(2)The X-ray images of Koshino stage 1 and stage 2 of spontaneous osteonecrosis of the medial femoral condyle were difficult to be distinguished,which needed to be probed by MRI.MRI images of Koshino stage 1 were mainly characterized by bone marrow edema,and an osteonecrosis area with a clear boundary was not formed,while MR images of Koshino stage 2 showed a necrotic area with a clear boundary.(3)Five factors leading to the poor effect of conservative treatment on spontaneous osteonecrosis of the medial femoral condyle were summarized:a.The necrotic area was＞5 cm2;b.The necrotic area accounted for more than 40%of the condyle;c.relative compression percentage of medial meniscus≥33%(with or without medial meniscus injury and subchondral bone marrow edema);d.MRI depth of necrotic area(anterior-posterior diameter of sagittal necrotic area)＞20 mm;e.varus deformity of lower limb＞6°.(4)Conservative treatment of spontaneous osteonecrosis of the knee in Koshino stage 1 was good.For spontaneous osteonecrosis of the knee in Koshino stage 2,conservative treatment was preferred or combined with drilling decompression.If there was no relief or improvement of symptoms or in MRI after 3 months,while the patient had any of the previous five factors,then knee preservation surgery should be considered.For spontaneous osteonecrosis of the knee in Koshino stage 3 and stage 4,knee preservation surgery should be selected based on the previous five factors,including age,gender and activity level of the patient.Total knee arthroplasty was used for spontaneous osteonecrosis in Koshino stage 4,which was associated with symptomatic patellofemoral arthritis,valgus alignment,or necrotic area,which greatly affected the stability of unicondyle prosthesis.

A study of the effect of changes in nasal tip prominence on the sense of anterior prominence of the upper lip / 口腔疾病防治

Objective@#The aim of this study was to investigate the effect of changes in nasal tip protrusion on the sense of upper lip protrusion in different populations and to provide a reference for the improvement of soft tissue beauty.@*Methods @# Informed consent and portrait authorization were obtained from the model. A female model whose face met the criteria was selected, and a 3D model of her was obtained using a 3D stereo camera. Based on the original model, ZBRUSH2019 software was used to simulate changes in nose tip protrusion. Then, 9 segments of facial dynamic rotation videos were produced, and an electronic questionnaire was created through a questionnaire website to evaluate the effect of different nose tip protrusions on perceived upper lip protrusion. Randomly selected orthodontic patients, orthodontics professionals and general adults completed the electronic questionnaire. In the questionnaire, a Visual Analog Scale was used to evaluate the perceived degree of protrusion of the upper lip. The higher the score, the more prominent the upper lip of the model in the image. The questionnaire data were statistically analyzed using a generalized linear mixed model. @*Results @#As the nasal tip position became progressively more retracted, the subjects' upper lip protrusion scores increased. Among male subjects, the results showed that the general population thought that the upper lip protrusion was higher than the patients did when the nasal tip protrusion was +6 mm and +4.5 mm (P = 0.023, P = 0.047). When the nasal tip protrusion was +6 mm, the scores of the general population were higher than those of the orthodontics professionals (P = 0.023). However, when the nasal tip variable was -6 mm, their score was lower than that of the patients (P = 0.003), and there was no significant difference in other retest distances between groups (P>0.05).@*Conclusion @#When the protrusion of the nasal tip decreased, the three groups experienced a visual illusion of upper lip protrusion. When the nasal tip protrusion is too large, the general population perceived the visual illusion of the upper lip protrusion as being more obvious.

Reduction of Displaced Acetabular Fracture with Central Hip Dislocation using Vector Traction: A Case Report

@#Fracture-dislocations of the hip is the result of high-energy trauma which necessitates urgent reduction. Closed reduction is usually attempted first and if failed, open reduction is indicated and may require more than one surgical approach. However, there is also the option of managing it with vector traction. This case report details the treatment of a middle-aged gentleman who sustained a left hip central dislocation which was gradually reduced with vector traction prior to surgery and in doing so, diminished the risk of him developing several potentially debilitating complications known to be associated with surgical fixation of such injuries.

Influence of exophthalmos on design of double eyelid incision / 中华医学美学美容杂志

Objective:To compare the postoperative effects of double eyelid surgery with different exophthalmos to find its influence on the surgery and necessary changes in preoperative design and during operation.Methods:A total of 50 female patients with single eyelid seeking beauty from June 2021 to March 2022 were selected from the Department of Plastic Surgery, Affiliated Hospital of Qingdao University. The ocular protrusion was measured by HETEL ophthalmostatometer before surgery. Both eyes at 12-15 mm were taken as normal group ( n=26), both eyes at 16-18 mm as mild protrusion group ( n=14) and both eyes at 19-22 mm as severe protrusion group ( n=10). All the patients were treated with double-eyelid surgery by orbital septum and unified postoperative nursing. Results:After six months of follow-up, there was no difference in eyelid width with closed eyes (all P>0.05). The width of double eyelid with open eyes in normal group was smaller than that in mild protrusion group ( F=23.23, all P<0.05), and the width of double eyelid with open eyes in mild protrusion group was smaller than that in severe protrusion group ( F=47.70, all P<0.05). There was no difference in the improvement rate of facial aesthetics among the three groups ( P>0.05). The " feeling of meet" and scar formation in the normal group were less than those in the mild protrusion group ( F=16.92, F=33.45, all P<0.05), and the " feeling of meet" and scar formation in the mild protrusion group were less than those in the severe protrusion group ( F=27.93, F=28.53, all P<0.05). The improvement rate of normal group was higher than that of mild and severe protrusion group (χ 2=7.25, 7.89, all P<0.05). There was no difference in the improvement rate between the mild and severe protrusion groups ( P>0.05). Conclusions:In clinical practice, it is necessary to make corresponding changes in the preoperative design and operation of double eyelid surgery for patients with high eyeball protrusion.

Application of upright seated and head down tongue protrusion technique in the completely exposure of the epiglottic surface under electronic laryngoscopy / 局解手术学杂志

Objective To study the clinical application value of the upright seated + head down(30° to 45°)+ tongue protrusion technique for the completely exposure of the epiglottic surface under electronic laryngoscopy.Methods Based on the clinical examination process of electronic laryngoscopy in the laryngoscopy room,two methods were applied for the patients with difficulty in exposing the epiglottic surface:① upright seated + tongue protrusion;② upright seated + head down(30° to 45°)+ tongue protrusion.The proportions of patients exposed to the epiglottic surface by these two methods were compared.Results The electronic laryngoscopy examination used the upright seated + tongue protrusion technique allowed for the clear exposure of the epiglottic surface in approximately 73.91%of patients with exposure difficulty.By using the upright seated + head down(30° to 45°)+ tongue protrusion technique,combined with the operator's control over the free movement of the laryngoscope's front end lens into the epiglottic vallecula space for close-range exploration,a 100%clear exploration of the epiglottic surface was achieved.Conclusion The upright seated + head down(30° to 45°)+ tongue protrusion technique for electronic laryngoscopy examination in patients with difficulty in exposing the epiglottic surface can completely expose the epiglottic surface,with significantly clinical effect.It can be used as a supplementary examination method for patients with difficulty in exposing the epiglottic surface in the ordinary upright seated or upright seated + tongue protrusion technique,and has certain clinical application value.

Sonographic correlations between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic hyperplasia in Ibadan, Nigeria

Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p =0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP

Abdominal Wall Hernias: different types of classifications and complications / Hernias de la Pared abdominal: diferentes tipos de clasificaciones y complicaciones

Abdominal hernias are defects due to loss of continuity of the fasciae and/or muscles with the protrusion of abdominal structures. They are the third most prevalent and incident abdominal pathology worldwide and the second pathology of consultation in general surgery in patients of age limits. There are various factors that contribute to their formation, but within the scientific community there are various types of classifications, which differ according to the professional training school and their decision-making. This bibliographic review aims to expose the most used abdominal hernia classification systems such as the European one that has a morphological vision, the Ventral Hernia Working Group that proposes its aspect on recurrence together with the modified one that exposes comorbidity and the staging system of ventral hernia that provides a comprehensive approach to classification and management. In addition to the most common complications of the same.

Las hernias abdominales son defectos por pérdida de continuidad de las fascias y/o músculos con la protrusión de estructuras abdominales. Son la tercera patología abdominal más prevalente e incidente a nivel mundial y la segunda patología de consulta en cirugía general en pacientes en límites de edades. Existen diversos factores que contribuyen a su formación, pero dentro de la comunidad científica existe diversos tipos de clasificaciones, las cuales difieren de acuerdo a la escuela de formación de los profesionales y su toma de decisiones. La presente revisión bibliográfica pretende exponer los sistemas de clasificación de hernias abdominales más utilizados como la Europea que tiene una visión morfológica, el Grupo de Trabajo de Hernia Ventral que propone su aspecto sobre la recurrencia junto con el modificado que expone comorbilidad y el sistema de estadificación de hernia ventral que brinda un enfoque integral para clasificación y manejo. Además de las complicaciones más habituales de las mismas.

Correction of bimaxillary protrusion with four first premolar extractions and T-Loop mechanics: A case report

@#Bimaxillary protrusion is a condition characterized by proclined upper and lower incisors with an increased prominence of the lips. This is a case of a 18-year-old with bimaxillary protrusion, mild crowding on the maxilla and mandible, and mandibular dental midline shift to the left by 1 mm. The four first premolars were extracted using a pre-adjusted bracket. This bracket had in-built prescriptions of torque, tip, and in-out for orthodontic cases. There were three pre-adjusted orthodontic bracket systems: Andrews, Roth, and MBT. T-loop was also used to achieve controlled space closure. After 26 months of orthodontic treatment, the patient’s profile was straighter and a pleasant smile was achieved at the end of treatment.

Clinical aspects, food management, and clinical evolution of a cat with hypertrophic muscular dystrophy / Aspectos clínicos, manejo alimentar e evolução clínica de um gato com distrofia muscular hipertrófica

Hypertrophic feline muscular dystrophy (HFMD), rarely reported in the literature, is a disease caused by a hereditary recessive dystrophin deficiency linked to the X chromosome, mainly affecting young male cats. Here, we presented the clinical aspects, food management, and clinical evolution of a seven-year-old mixed-breed cat diagnosed with HFMD, having a primary history of progressive tongue protrusion.

A distrofia muscular hipertrófica felina é uma doença causada por uma deficiência da distrofina com caráter hereditário recessivo ligado ao cromossomo X, com poucos registros de ocorrência na literatura, que acomete principalmente gatos machos jovens. Neste trabalho, são relatados os aspectos clínicos, manejo alimentar e evolução clínica de um gato, sem raça definida, de sete anos com histórico principal de protrusão progressiva da língua e diagnosticado com distrofia muscular hipertrófica felina.

Frequency of enlarged external occipital protuberance and its association with age and sex: a cross-sectional CT scan study / Frecuencia de la protuberancia occipital externa agrandada y su asociación con la edad y el sexo: un estudio de tomografía computarizada transversal

SUMMARY: External occipital protuberance (EOP) is a midline bony protrusion in the occipital bone, the significance of which has gained recent attention in the medical community. Our present study aims to assess the average size of EOP in a Jordanian cohort and its relation to age and sex, while determining the frequency of enlarged EOP in this cohort. The present study was a cross-sectional study that was carried out in a referral hospital in Jordan. We reviewed thousands of CT scans taken with dedicated bone window imaging during the last two years, beginning January 2018. Measurements were taken by trained radiology residents and were then further reviewed by radiology specialists. An EOP was classified as enlarged (EEOP) if it exceeded 10 mm. A total of 4409 patients, 2265 (51.4 %) females and 2144 (48.6 %) males, met our inclusion criteria. Their mean age was 54.1 ? 22.2 years. The mean size of the EOP in these patients was 8.4 ? 4.2 mm (range: 0-56 mm). Out of the 4409-study population, 1210 (27.4 %) presented with EEOP. The prevalence of an EEOP was significantly higher in the male population (33.6 %) when compared with the female population (21.6 %) (P < 0.001). The size of the EOP was also significantly related to the age of the patient, with EEOP increasing with increasing age. The mean size of EOP in our Jordanian cohort was 8.4 ? 4.2 mm. The frequency of enlarged EOP was found to be 27.4 % in our cohort, and was significantly more common in males and in older patients.

RESUMEN: La protuberancia occipital externa (POE) es una protuberancia ósea localizada en el plano mediano del hueso occipital, cuya importancia recientemente ha ganado atención en la comunidad médica. Este estudio tuvo como objetivo evaluar el tamaño promedio de POE en una cohorte jordana y su relación con la edad y sexo, mientras se determina la frecuencia de POE aumentada en este grupo. Se llevó a cabo un estudio transversal en un hospital de referencia en Jordania. Revisamos miles de imagenes radiológicas en tomografía computarizada y visualización de ventanas durante los últimos dos años, a partir de enero de 2018. Las mediciones fueron tomadas por residentes de radiología, y luego revisadas por especialistas en radiología. Un POE se clasificó como aumentado (POEA) si superaba los 10 mm. Un total de 4409 pacientes, 2265 (51,4 %) mujeres y 2144 (48,6 %) hombres, cumplieron con nuestros criterios de inclusión. La edad media fue de 54,1 ? 22,2 años. El tamaño medio del POE en estos pacientes fue de 8,4 ? 4,2 mm (rango: 0-56 mm). De la población del estudio 4409, 1210 (27,4 %) presentaron POEA. La prevalencia de una POEA fue significativamente mayor en la población masculina (33,6 %) en comparación con la población femenina (21,6 %) (P <0,001). El tamaño del POE también se relacionó significativamente con la edad del paciente, aumentando el POEA con la edad. El tamaño medio de POE en nuestra cohorte jordana fue de 8,4 ? 4,2 mm. Se encontró que la frecuencia de aumento de POE en nuestra cohorte fue del 27,4 % y fue significativamente más común en hombres y en pacientes mayores.

Retrospective study on the merits of bone grafts and the influence of implant protrusion length after osteotome sinus elevation surgery / 华西口腔医学杂志

OBJECTIVES@#This study aims to evaluate the endo-sinus bone remodeling of dental implants placed via osteotome sinus floor elevation (OSFE) after 6 months and using different implant protrusion lengths and bone grafts through cone beam computed tomography (CBCT).@*METHODS@#Ninety-six patients with 124 implants were included and assigned into four groups. Group 1: implant protrusion length4 mm with bone graft; group 3: implant protrusion length4 mm without bone graft. Apical bone gain (ABG), cortical bone gain (CBG), bone density gain (BDG), and marginal bone loss (MBL) were observed and analyzed at baseline and 6 months after implant surgery.@*RESULTS@#The CBG in grafted groups 1 and 2 was higher than that in non-grafted groups. The ABG and BDG were higher in non-grafted groups 3 and 4 than in grafted groups, and the levels in group 3 were higher than those in group 4. The CBG in grafted group 2 was higher than that in group 1. No significant difference was observed in MBL analysis.@*CONCLUSIONS@#The BDG of IPL4 mm implant when bone grafts were not applied. No relevance was observed between IPL and CBG. Bone grafts can accelerate endo-sinus bone remodeling by increasing CBG and dissipating the influence of IPL on BDG.

Comparison of the impacts of two kinds of brackets on external apical root resorption in orthodontic treatment of bimaxillary protrusion patients / 中国组织工程研究

BACKGROUND: In orthodontic treatment, there will be different degrees of external apical resorption. Severe root resorption will reduce the root/shoot ratio, reduce the stability of teeth, and even cause teeth to loosen and fall out. OBJECTIVE: To compare the difference of external apical root resorption between high torque self-locking bracket and traditional straight wire bracket in orthodontic treatment of bimaxillary protrusion patients. METHODS: Forty-nine patients with bimaxillary protrusion, aged 13-16 years, who were treated in the Hospital of Stomatology of Southwest Medical University from January 2016 to December 2019, were enrolled in this study. The patients were divided into the high torque self-locking bracket group (n=24) and the traditional straight wire bracket group (n=25). Cone beam CT was taken before and after orthodontic treatment. The root morphology and length of maxillary central incisors and lateral incisors were observed by CS 3D Imaging Software. The amount of external apical root resorption between maxillary incisor and lateral incisor was calculated. This study was approved by the Medical Ethics Committee of Hospital of Stomatology of Southwest Medical University. RESULTS AND CONCLUSION: (1) The two groups after orthodontic treatment had achieved a good correction effect. The course of treatment was shorter in the high torque self-locking bracket group than that in the traditional straight wire bracket group (P 0.05). In the same appliance group, the amount of external apical root resorption of the maxillary central incisors was less than the lateral incisors (P < 0.05). (4) Results indicate that compared with the traditional straight wire bracket, the high torque self-locking bracket may have the advantages of short treatment course and low risk of apical absorption in the orthodontic treatment of bimaxillary protrusion.

Treatment result of skeletal class iii with combination of orthodontics and orthognatic surgery / Шинэ санаа Шинэ нээлт

Background@#Class III malocclusion is considered to be one of the most difficult and complex orthodontic problems to treat. For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left.@*Objective@#The treatment objectives were to: (1) level and align the dental arches; (2) obtain an ideal overbite and overjet, to establish correct anterior guidance; and (3) improve the facial profile.@*Results@#Excellent facial and occlusal results were achieved with this surgical-orthodontic management, post-treatment results showed a Class I relationship and ideal overjet and overbite. The facial profile became straight type.@*Conclusions@#This case report describes the treatment of a female with dental and skeletal class III relationships. Surgical-orthodontic treatment was the best option for achieving an acceptable occlusion and a good esthetic result in this case. An experienced multidisciplinary team approach ensures a satisfactory outcome.

Treatment of bimaxillary protrusion using intra- and extra-alveolar miniscrews associated to self-ligating brackets system

ABSTRACT Introduction: Moderate and severe bimaxillary protrusion impair the passive lip sealing and the facial and smile esthetics. The extraction of premolars can be avoided by the use of skeletal anchorage to retract both dental arches. This approach brings many advantages such as: prevents premolars extraction; simplifies orthodontic mechanics; there is no volume reduction of a premolar when smiling; control of overbite and gingival exposure. The utilization of this therapeutic approach, when associated with self-ligating brackets, can bring the possibility of spacing the appointments without damage to the treatment efficiency, and allows selection of the most appropriate torque prescriptions for each case. The intra-alveolar miniscrews are indicated for mild cases of bimaxillary protrusion, while extra-alveolar miniscrews may also be indicated for more severe cases. Objective: To report the treatment of three cases of mild, moderate and severe bimaxillary protrusion, in which intra- and extra-alveolar miniscrews were used, according to the retraction required. Conclusion: The retraction of both upper and lower dental arches using orthodontic intra- and extra-alveolar miniscrews, associated with self-ligating brackets, is an excellent tool to correct mild to severe bimaxillary protrusion, thus reducing the need of premolar extraction and simplifying the orthodontic management.

RESUMO Introdução: As biprotrusões moderadas e severas dificultam o selamento labial passivo, comprometem a estética facial e do sorriso. As extrações de pré-molares podem ser evitadas quando se utiliza a ancoragem esquelética como recurso para retrair ambas as arcadas. Essa abordagem traz as seguintes vantagens: evita que o paciente seja submetido ao processo da extração dos pré-molares; simplifica a mecânica ortodôntica; não reduz o volume de um pré-molar de cada lado no sorriso; e auxilia no controle da sobremordida e da exposição gengival. A utilização dessa terapêutica, quando associada aos aparelhos autoligáveis, possibilita maiores intervalos entre as consultas, sem comprometer a eficiência do tratamento, e permite a seleção dos torques mais adequados para essa mecânica. Os miniparafusos intra-alveolares podem ser utilizados na correção de biprotrusões mais suaves, enquanto os extra-alveolares podem ser indicados, também, nos casos mais severos. Objetivo: Relatar os tratamentos de três casos clínicos de biprotrusão leve, moderada e severa, respectivamente, efetuando a retração das arcadas em uma única fase, utilizando miniparafusos intra- e extra-alveolares, conforme a magnitude da retração necessária. Conclusão: A retração das arcadas superior e inferior com miniparafusos ortodônticos intra- e extra-alveolares associados aos aparelhos autoligáveis é um excelente recurso para a correção das biprotrusões de suave a severa, diminuindo a necessidade de extrações de pré-molares e simplificando a mecânica ortodôntica.

Evisceración vaginal post histerectomía abdominal. Presentación de un caso / Vaginal eviscerationafter abdominal hysterectomy. Filing a case / Evisceração vaginal após histerectomia abdominal. Arquivar um caso

RESUMEN Introducción: la evisceración vaginal después de una cirugía pélvica es una emergencia quirúrgica extremadamente rara. La dehiscencia laparotómica consiste en la desunión y separación precoz de los bordes de una herida quirúrgica suturada, con exteriorización o sin ella del contenido de la cavidad abdominal. Presentación de caso: el caso que aquí se reporta es el de unamujer de 36 años con antecedentes de hipertensión arterial. Intervenida hacia 3 meses de histerectomía abdominal por fibromiomas, sin prolapso uterino. Acude al cuerpo de guardia del hospital por dolor abdominal, sensación de ocupación vaginal y estreñimiento. Niega distensión abdominal y síntomas respiratorios. Ya en el cuerpo de guardia refiere deseos de defecar y al pujar ocurre una protrusión de intestino delgado de más o menos 3 cm, irreductible a través de orificio vaginal. Se realizó laparatomía, revisión por vía vaginal, reducción de las asas intestino delgado y ampliación del orificio por donde se produjo la evisceración. Discusión: se localizaron los bordes del peritoneo parietal, se sutura la cúpula vaginal con puntos continuos y se colocó una malla en el fondo de la pelvis recubierta por peritoneo. Se utilizaron los datos provenientes de la historia clínica hospitalaria. Exámenes complementarios, la entrevista y el examen físico de la paciente, a pesar las probables complicaciones no hubo pérdida de tiempo y la operación fue un éxito. Conclusiones: la evolución fue satisfactoria, gracias a la labor del personal médico que estuvo a cargo del caso.

ABSTRACT Introduction: vaginal evisceration after pelvic surgery is an extremely rare surgical emergency. Laparotomic dehiscence consists of disunity and early separation of the edges of a sutured surgical wound, with or without externalization of the contents of the abdominal cavity. Case presentation: the case reported here is that of a 36-year-old woman with a history of high blood pressure. She underwent 3 months of abdominal hysterectomy for fibromyomas, without uterine prolapse. She comes to the hospital guard corps for abdominal pain, a feeling of vaginal occupation and constipation. He denies abdominal bloating and respiratory symptoms. Already in the body of guard it refers desires to defecate and when pushing a protrusion of small intestine of more or less 3 cm occurs, irreducible through the vaginal opening. Laparatomy, vaginal revision, reduction of the small intestine loops and enlargement of the hole through which evisceration occurred were performed. Discussion: the edges of the parietal peritoneum were located, the vaginal dome was sutured with continuous stitches, and a mesh was placed at the bottom of the pelvis covered by peritoneum. The data from the hospital medical history were used. Complementary examinations, the interview and the physical examination of the patient, despite the probable complications, there was no loss of time and the operation was successful. Conclusions: the evolution was satisfactory, thanks to the work of the medical personnel who were in charge of the case.

RESUMO Introdução: a evisceração vaginal após cirurgia pélvica é uma emergência cirúrgica extremamente rara. A deiscência laparotômica consiste em desunião e separação precoce das bordas de uma ferida cirúrgica suturada, com ou sem externalização do conteúdo da cavidade abdominal. Apresentação do caso: o caso relatado aqui é o de uma mulher de 36 anos com histórico de pressão alta. Ela foi submetida a 3 meses de histerectomia abdominal por fibromiomas, sem prolapso uterino. Ele veio à guarita do hospital devido a dor abdominal, sensação de ocupação vaginal e constipação. Ele nega inchaço abdominal e sintomas respiratórios. Já no corpo de guarda refere desejos de defecar e ao empurrar uma protrusão do intestino delgado de mais ou menos 3 cm, ocorre irredutível através da abertura vaginal. Foram realizadas laparometria, revisão vaginal, redução das alças do intestino delgado e aumento do orifício através do qual a evisceração ocorreu. Discussão: as margens do peritônio parietal foram localizadas, a cúpula vaginal foi suturada com pontos contínuos e uma malha foi colocada na parte inferior da pelve coberta por peritônio. Foram utilizados os dados do histórico médico do hospital. Exames complementares, entrevista e exame físico do paciente, apesar das prováveis ​​complicações, não houve perda de tempo e a operação foi bem-sucedida. Conclusões: a evolução foi satisfatória, graças ao trabalho da equipe médica responsável pelo caso.

Clinical management of dogs with presumptive diagnosis of cervical intervertebral disc disease: 78 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral cervical: 78 casos (2006-2017)

This study aimed to identify dogs with a presumptive diagnosis of cervical intervertebral disc disease (IVDD; C1-C5 or C6-T2) submitted to clinical management and evaluate the outcome. This study also aimed to demonstrate the age, sex, and treatment response according to the neurological degree, and verify whether those factors could potentially influence the outcome. The data were obtained from patients with a neurological dysfunction, admitted at the Veterinary Hospital from January 2006 to March 2017. In addition to patient records, the tutors answered a questionnaire related to the success of therapy. A hundred and seventy-seven neurological records were evaluated, and 78 were included in the study according to the inclusion criteria. The most frequent breeds were Dachshunds, followed by mixed-breed dogs. Regarding the neurological dysfunction degree, 58.97% presented grade I (only neck pain), 25.64% were grade II (ambulatory tetraparesis), and 15.38% grade III (nonambulatory tetraparesis). Absolute and partial space rest were performed in 75.64% and 24.36% of the cases, respectively. The minimum rest time was one week and could come up to four weeks. Most dogs were small-sized (≤15kg). The recovery was satisfactory in 87.17% of dogs and unsatisfactory in 12.83%. Regarding recurrence, we observed that 10.3% of dogs presented satisfactory recovery. The clinical treatment for dogs with cervical IVDD can be indicated with adequate clinical response to dysfunction degrees ranging from I to III, either at rest or in restricted space and with a low rate of relapse.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de doença do disco intervertebral cervical (DDIV; C1-C5 ou C6-T2) submetidos ao tratamento clínico e avaliar a resposta a terapia instituída e o índice de recidiva. Esse estudo também visou demonstrar a idade, o gênero e a resposta ao tratamento de acordo com o grau neurológico, a fim de verificar se esses parâmetros podem ser utilizados como fatores prognósticos para a evolução clínica desses pacientes. Foram revisados os registros neurológicos do Hospital Veterinário Universitário de janeiro de 2006 a março de 2017. Realizaram coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Avaliaram 177 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 78 delas. As raças mais frequentes foram Dachshunds, seguido dos cães sem raça definida. Quanto ao grau de disfunção neurológica, 58,97% apresentavam grau I (somente dor), 25,64% estavam em grau II (tetraparesia ambulatória) e 15,38% em grau III (tetraparesia não ambulatória). O repouso absoluto e em espaço restrito foram realizados em 75,64% e 24,36% dos casos, respectivamente e com duração de no mínimo uma semana, podendo chegar a mais de quatro semanas. A maioria dos animais era de pequeno porte (≤15kg). A recuperação foi satisfatória em 87,17% dos cães e insatisfatória em 12,83%. Quanto à recidiva, esta foi observada em 10,3% dos pacientes com recuperação satisfatória. O tratamento clínico para cães com DDIV cervical pode ser indicado com adequada resposta clínica para graus de disfunção que variam de I a III, seja em repouso absoluto ou em espaço restrito e com baixo índice de recidiva.(AU)

Clinical management of dogs with presumptive diagnosis of thoracolumbar intervertebral disc disease: 164 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral toracolombar: 164 casos (2006-2017)

This study aimed to identify dogs with presumptive diagnosis of cervical intervertebral disc disease (IVDD) submitted to clinical management and to evaluate the outcomes. Data were obtained from the medical records of patients with neurological dysfunction assisted at a University Veterinary Hospital from 2006 to 2017. In addition to the patients' records, dog owners responded to a questionnaire on the success of therapy. Four hundred and thirteen neurological records were evaluated, and 164 met the inclusion criteria of the study. The most common breed was Dachshund, followed by mongrels. Classification of neurological dysfunction in the study sample was as follows: 15.9% with grade I, 25.6% with grade II, 26.8% with grade III, 8.5% with grade IV, and 23.2% with grade V. Outcome was satisfactory in 71.6% of the dogs and unsatisfactory in 28.4% of them. Recurrence was observed in 27.7% of those with satisfactory outcomes. The clinical treatment of dogs with thoracolumbar IVDD is satisfactory, particularly for animals with milder disease grades (I, II, and III). There is possibility of recurrence with conservative therapy and clinical signs may be more severe.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de DDIV toracolombar submetidos ao tratamento clínico, a fim de avaliar a resposta à terapia instituída. Foram revisados os registros neurológicos de cães atendidos pelo Serviço de Neurologia e Neurocirurgia Veterinária no período de 2006 a 2017 de um Hospital Veterinário Universitário. Foi realizada coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Foram avaliadas 413 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 164 delas. As raças mais frequentes foram dachshunds, seguido de cães sem raça definida. Quanto ao grau de disfunção neurológica foi definido como grau I para 15,9% dos cães, grau II para 25,6%, grau III para 26,8%, grau IV para 8,5% e grau V para 23,2%. A recuperação foi satisfatória em 71,6% dos cães e insatisfatória em 28,4%. Dos que se recuperaram satisfatoriamente, 27,7% tiveram recidivas. Com base nos resultados obtidos pode-se concluir que o tratamento clínico em repouso absoluto e administração de anti-inflamatórios e analgésicos opióides para cães com DDIV toracolombar é efetivo, principalmente para cães em graus mais leves da doença (grau I, II e III). Há possibilidade de recidiva com esse tipo de terapia cujos sinais clínicos poderão ser mais graves.(AU)

Impact of the degrees of intravesical prostatic protrusion on the recovery of urinary continence after radical prostatectomy / 中华男科学杂志

Objective@#To investigate the influence of the degrees of intravesical prostatic protrusion (IPP) on the recovery of urinary continence after radical prostatectomy.@*METHODS@#We retrospectively analyzed the clinical data on 212 patients diagnosed with prostate cancer by biopsy and treated by laparoscopic radical prostatectomy by the same surgeon. Based on the degrees of IPP measured by MRI, we divided the patients into an IPP ≤ 10 mm group (n = 146) and an IPP > 10 mm group (n = 66) and determined the factors influencing the recovery of urinary continence by univariate and multivariate logistic regression analyses.@*RESULTS@#At 1, 3, 6 and 12 months after surgery, the urinary continence rates of the patients were 32.5%, 50.5%, 82.1% and 91%, respectively. Univariate analysis indicated that the factors influencing the recovery of urinary continence included IPP, body mass index (BMI), bladder neck preservation (BNP), neurovascular bundle preservation (NVBP) and clinical tumor (T) stage at 3 months (P 10 mm (P 10 mm and BMI ≥ 25 kg/m2 are independent factors influencing the long-term recovery of urinary continence after radical prostatectomy.