Evaluación económica de las alternativas terapéuticas en pacientes con hiperestesia dentinaria / Economic evaluation of the therapeutic alternatives in patients with dentin hyperesthesia

Introducción: La hiperestesia dentinaria es una sensación dolorosa de intensidad variable, que va de leve a moderada y, al encontrarse la dentina expuesta, puede convertirse en una molestia constante. Objetivo: Determinar la alternativa menos costosa en el tratamiento de pacientes con hiperestesia dentinaria. Método: Se realizó una evaluación económica completa del tipo minimización de costo, en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde enero hasta mayo de 2019. Se revisaron 40 historias clínicas, escogidas a conveniencia, ya que contaban con los datos necesarios para la investigación. Se crearon 2 grupos de estudios, cuyos integrantes fueron tratados con laca flúor y láser, respectivamente. Se analizaron las variables de edad, sexo, efectividad de los tratamientos, costo directo e indirecto y costo unitario. Resultados: En la serie predominaron el grupo etario de 15-24 años (30,0 %), seguido por el de 25- 34 (25,0 %), así como el sexo femenino (70,0 %). El costo unitario del tratamiento con laca flúor fue de $7,77 y con láser de $5,74, para una diferencia de $2,03. Conclusión: La alternativa menos costosa en el tratamiento de pacientes con hiperestesia dentinaria resultó ser la aplicación de láser; mientras que la evaluación económica realizada demostró ser apropiada en materia de eficiencia económica.

Introduction: Dentin hyperesthesia is a painful sensation of variable intensity that goes from light to moderate and, as dentin is exposed, it can become a constant discomfort. Objective: To determine the less expensive alternative in the treatment of patients with dentin hyperesthesia. Method: A complete economic evaluation of the cost minimization type was carried out in Martires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba, from January to May, 2019. Forty medical records were reviewed, chosen of convenience, since they had the necessary data for the investigation. Two groups of studies were created whose members were treated with lacquer fluorine and laser, respectively. The age, sex, effectiveness of the treatments, direct and indirect cost and unitary cost variables were analyzed. Results: In the series there was a prevalence of the 15-24 age group (30.0 %), followed by that of 25-34 (25.0 %), as well as the female sex (70.0 %). The unitary cost of the treatment with lacquer fluorine was of $7.77 and with laser of $5.74, for a difference of $2.03. Conclusion: The less expensive alternative in the treatment of patients with dentin hyperesthesia was the laser application; while the economic evaluation carried out demonstrated to be appropriate as regards economic efficiency.

Hiperestesia dentinária: aspectos de interesse / Dentinal hyperesthesia: aspects of interest

A hiperestesia dentinária cervical se caracteriza como uma manifestação com sintomatologia dolorosa aguda, repentina, localizada e de curta duração, provocada por um estímulo tátil, químico, térmico ou osmótico. Cessa após a remoção e não é provocada em dentes saudáveis por estímulos considerados fisiológicos. Acomete geralmente o terço cervical dos elementos dentários como pré-molares e molares, com exposição da dentina e abertura dos túbulos dentinários após recessão gengival, perda de estrutura cementária ou adamantina, lesões não cariosas, hábitos deletérios, entre outros. Devido à alta prevalência dessa condição na população mundial e queixas frequentes no consultório odontológico, a hiperestesia tem sido exaustivamente estudada. O objetivo deste trabalho, por meio de revisão de literatura, é elucidar a etiologia, diagnóstico diferencial, terapias e efetividade no controle desse problema de saúde pública

The cervical dentinal hyperesthesia is characterized as a manifestation with sharp, sudden, located painful symptomatology and of short duration, provoked by a stimulus tactile, chemical, thermal or osmotic. It ceases after the removal and it isn´t provoked in healthy teeth by stimulus considered physiologic. It usually attacks the cervical third of the dental elements as premolar and molars, with exhibition of the dentine and opening of the dentinal tubules after gingival recession, loss of cementery or adamantine structures, non-carious lesions, harmful habits, among others. Due to the high prevalence of that condition in the world population and frequent complaints in the dentistry clinic, the hyperesthesia has been exhaustively studied. The aim of this paper, through review of literature, was to elucidate the aetiology, differential diagnosis,therapies and effectiveness in the control of that problem of public health

Long-term stability after multidisciplinary treatment involving maxillary distraction osteogenesis, and sagittal split ramus osteotomy for unilateral cleft lip and palate with severe occlusal collapse and gingival recession: A case report / 대한치과교정학회지

In this report, we describe a case involving a 34-year-old woman who showed good treatment outcomes with long-term stability after multidisciplinary treatment for unilateral cleft lip and palate (CLP), maxillary hypoplasia, severe maxillary arch constriction, severe occlusal collapse, and gingival recession. A comprehensive treatment approach was developed with maximum consideration of strong scar constriction and gingival recession; it included minimum maxillary arch expansion, maxillary advancement by distraction osteogenesis using an internal distraction device, and mandibular setback using sagittal split ramus osteotomy. Her post-treatment records demonstrated a balanced facial profile and occlusion with improved facial symmetry. The patient's profile was dramatically improved, with reduced upper lip retrusion and lower lip protrusion as a result of the maxillary advancement and mandibular setback, respectively. Although gingival recession showed a slight increase, tooth mobility was within the normal physiological range. No tooth hyperesthesia was observed after treatment. There was negligible osseous relapse, and the occlusion remained stable after 5 years of post-treatment retention. Our findings suggest that such multidisciplinary approaches for the treatment of CLP with gingival recession and occlusal collapse help in improving occlusion and facial esthetics without the need for prostheses such as dental implants or bridges; in addition, the results show long-term post-treatment stability.

Dental Management in a Patient with Congenital Insensitivity to Pain with Anhidrosis : A Case Report / 대한소아치과학회지

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare, autosomal recessive disorder; affected patients are characterized by inability to feel pain and to sweat over the entire body, as well as by mental retardation. Because, in the oral examination, no specific findings on soft or hard tissue may be found except possible lesions due to self-mutilation, early recognition and diagnosis are essential for these patients. Pediatric dentists must be aware of the clinical manifestations and treatment considerations related to uncontrolled body temperature, tactile hyperesthesia and lack of pain reflex. In this case report, dental management of CIPA was suggested by presenting a 6-year follow-up of young patient.

Sensory multiple mononeuropathy induced by pravastatin use: from a case report to literature's review / Mononeuropatia múltipla sensitiva induzida pelo uso de pravastatina: de um relato de caso à revisão de literatura

Statins are frequently prescribed in clinical practice for their proven efficacy in prevention of cardiovascular and cerebrovascular diseases. Despite the recognized beneficial effects of this class of drugs, in recent years, many studies published in medical literature have shown a wide range of adverse effects as a consequence of this therapy, including the risk of peripheral neuropathy. The purpose of this article is to report a case in which clinical features consistent with multiple mononeuropathy probably secondary to use of pravastatin were observed. The case report is followed by a review of the relevant literature.

As estatinas são frequentemente prescritas na prática clínica por sua comprovada eficácia na prevenção de doenças cardiovasculares e cérebrovasculares. Apesar dos reconhecidos efeitos benéficos dessa classe medicamentosa, nos últimos anos, diversos estudos publicados na literatura médica vem evidenciando uma ampla variedade de efeitos colaterais como consequência desta terapia, incluindo o risco de neuropatias periféricas. O objetivo deste artigo é relatar um caso no qual foram observadas manifestações clínicas compatíveis com o diagnóstico de mononeuropatia múltipla sensitiva, provavelmente secundária ao uso de pravastatina. O relato de caso é acompanhando de uma revisão de dados pertinentes da literatura.

Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold

BACKGROUND: Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements. METHODS: We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ≥3) and abnormal NCS results. RESULTS: A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia. CONCLUSION: NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.

Eficacia de un dentífrico con dióxido de silicio obliterante en pacientes con hiperestesia dentinaria / Efficacy of a toothpaste containing precipitated silica particles in patients with dentin hyperesthesia

Introducción: la hiperestesia dentinaria se caracteriza por un dolor intenso y breve asociado a la exposición de estímulos térmicos, táctiles, osmóticos o químicos. De prevalencia creciente, reduce la calidad de vida del paciente. Objetivo: evaluar la eficacia, aceptabilidad y tolerancia de un dentífrico con dióxido de silicio obliterante, nitrato potásico y monofluorofosfato sódico en pacientes con hiperestesia dentinaria. Métodos: estudio observacional y longitudinal (n= 22) en el que se aplicó el dentífrico 3 veces/día durante 28 días. Se realizó una evaluación clínica, antes y después de la aplicación, a las 48 horas, a las 96 horas y los días 7, 14, 21 y 28 del estudio. Se evaluó su eficacia en términos de reducción de la hipersensibilidad dental determinada mediante técnica táctil (escala de calificación verbal) y de chorro de aire (escala de Schiff). En cada visita se valoró la tolerancia del producto. Los pacientes valoraron el grado de hipersensibilidad y su percepción del producto mediante un cuestionario de evaluación subjetiva. El estudio se realizó bajo los principios de Buena Práctica Clínica. Resultados: la hipersensibilidad dental se redujo en todos los puntos temporales del estudio y fue significativa (p< 0,05) a partir del día 5. Esta mejoría fue sostenida y aumentó a medida que avanzó el tratamiento. El día 29 la hipersensibilidad media se redujo en un 85 por ciento respecto al valor basal en todos los pacientes. El 91 por ciento de los participantes opinó que el dentífrico había cumplido sus expectativas. No se observó ninguna reacción adversa derivada del uso del producto. Conclusiones: el dentífrico, administrado 3 veces/día, consiguió una reducción de la hipersensibilidad dental, significativa a partir del día 5, que fue aumentando con el tiempo. El producto presentó muy buena aceptabilidad y tolerancia(AU)

Introduction: dentin hypersensitivity is characterized by sharp pain of short duration associated with exposure to thermal, tactile, osmotic or chemical stimuli. Dentin hypersensitivity is a disorder of growing prevalence which reduces the quality of life of patients. Objective: evaluate the efficacy, acceptability and tolerance of a toothpaste with precipitated silica, potassium nitrate and sodium monofluorophosphate in patients with dentin hypersensitivity. Methods: an observational longitudinal study was conducted (n= 22) in which the toothpaste was applied 3 times a day for 28 days. Clinical assessment was performed before and after the application, at 48 hours, at 96 hours and on days 7, 14, 21 and 28 of the study. Efficacy was evaluated in terms of dental hypersensitivity reduction as determined by tactile (Verbal Rating Scale) and air jet (Schiff scale) techniques. Tolerance to the product was assessed in every visit. Patients ranked the degree of hypersensitivity and their perception of the product by means of a subjective assessment questionnaire. The study complied with Good Clinical Practice principles. Results: areduction was observed in dental hypersensitivity at all time points throughout the study, and it was significant (p< 0,05) as of day 5. This improvement was sustained and increased as treatment progressed. On day 29 mean hypersensitivity had reduced 85 percent with respect to baseline value in all patients. 91 percent of the patients stated that the toothpaste had met their expectations. No adverse reaction attributable to the product was observed. Conclusions: applied 3 times/day, the toothpaste obtained a reduction in dental hypersensitivity, which was significant as of day 5. This improvement increased over time. The product had very good acceptability and tolerance(AU)

Idiopathic Cervicosyringomyelia in 2 year-old Boy

Syringomyelia is a disorder in which a cavity has formed within the spinal cord. Idiopathic syringomyelia is not associated with identifiable causes such as Chari type 1 malformation, spinal cord tumor, vascular malformation, tethered cord, arachnoiditis, hydrocephalus, or previous spinal surgery. The main neurologic symptoms of idiopathic syringomyelia are toe-walking, constipation, incontinence, abnormal reflexes, and lower extremity weakness. Patients may present with various symptoms such as scoliosis, cutaneous markers, pain in the lower extremities or back, or may be asymptomatic. Herein, we report a young child with idiopathic syringomyelia presenting with subtle neck pain. A 23-month-old boy visited the neurologic clinic after 3 months of right occipital area neck pain. He had no history of trauma or central nervous system infection, and neurologic examination results were normal except for right posterior neck hyperesthesia. Brain and spinal magnetic resonance imaging showed an ovoid intramedullary cystic lesion (9.7×5.0×4.7 mm) at C6/7 of the spinal cord. There was no evidence of Chiari malformation or other lesions that can be primary pathologies of syringomyelia. Electromyogram/nerve conduction velocity results were normal. The subject was diagnosed as idiopathic syringomyelia. His symptoms and neurologic/radiologic indications showed no change at a 1-year follow-up. Idiopathic syringomyelia symptoms are varied and may be overlooked by physicians. Pediatricians may consider syringomyelia if patients complain about persistent sensory abnormality. All patients who present with syringomyelia should undergo detailed neuroimaging of the entire neuraxis to elucidate the proximate cause of the lesion.

Greater auricular nerve neuropraxia with beach chair positioning during open reduction and internal fixation with plate for clavicular fracture: A case report

Greater auricular nerve neuropathy is a reported as complication in some cases of shoulder arthroscopy in the beach chair position using a horse-shoe headrest. Due to this risk, intubation pad-type headrest is recommended for the beach chair position, to effectively prevent greater auricular nerve palsy. In this case report, we described a patient who experienced greater auricular nerve neuropraxia after open reduction and internal fixation with plate of clavicular fracture in beach chair position using an intubation pad-type headrest. A 49-year-old man was diagnosed with left clavicular fracture without accompanying injury or complication. He underwent an operation for open reduction and internal fixation with a plate. After surgery, the patient reported numbness, and a tingling sensation without pain or skin lesion in the auricular area and the lower margin of the left mandible. Based on the clinical symptoms, greater auricular nerve neuropraxia was diagnosed. The symptoms disappeared completely after four weeks of outpatient follow-up.

Occluding Effect of the Application of Fluoride Compounds and Desensitizers on Dentinal Tubules / 치위생과학회지

This study compared and analyzed the occluding effects of fluoride compounds and desensitizers, which are commonly used in dental clinics, on dentinal tubules. This study also evaluated the persistence of the active ingredients over time by performing toothbrushing with an electric toothbrush. Thirty-five molar teeth, which had been extracted within the past 3 months from healthy people without tooth decays, amalgam fillings, or dental crowns, were divided into 4 pieces each. Of these, 135 teeth pieces were used as study specimens. These specimens were divided into a control group, an untreated group, and 5 experimental groups (acidulated fluoride gel, fluoride varnish, Gluma, Super Seal, and SE-Bond). The specimens were then subjected to toothbrushing equivalent to 1 week (140 times), 2 weeks (280 times), and 4 weeks (560 times), and the occluding effects on dentinal tubules in 3 regions of each specimen were examined under a scanning electron microscope. The fluoride varnish treated group showed the highest degree of dentinal tubule occlusion effects during the first, second, and fourth weeks of toothbrushing, with the SE-Bond treated group showing the second highest degree and the Gluma treated group showing the lowest degree. After 4 weeks of toothbrushing, the Gluma treated group and the Super Seal treated group showed the lowest degrees of dentinal tubule occlusion effects. In summary, the fluoride varnish treated group and the SE-Bond treated group displayed higher occlusion effects even after 4 weeks of treatment than did the other experimental groups. Therefore, it is the authors' belief that fluoride varnish and SE-Bond are effective for treating dentinal hyperesthesia.

Recubrimiento radicular / Root Coverage

INTRODUCCIÓN: existen varias alternativas de tratamiento para el recubrimiento radicular provocado por la recesión periodontal, la cual se caracteriza por el desplazamiento en sentido apical del margen gingival, con ello queda expuesta la raíz dental al medio bucal, lo que puede provocar sensibilidad dentinaria, caries dental y afectación de la estética. OBJETIVO: presentar un caso clínico donde se empleó una técnica quirúrgica para el recubrimiento radicular. PRESENTACIÓN DEL CASO: paciente masculino de 32 años, acudió a la consulta por molestias a los cambios térmicos en el 23 y preocupado por su estética ya que presenta la raíz expuesta al medio bucal. Al examen físico se observó alteración de la morfología gingival caracterizado solamente por cambio de la posición gingival en sentido apical en el 23, que no alcanza a la línea mucogingival. Se decidió en el plan de tratamiento correctivo no quirúrgico, tratar la hiperestesia dentinaria aplicar el desensibilizante dentinario (laca fluorada: Profilac), y en el tratamiento correctivo quirúrgico realizar un colgajo deslizante lateral para cubrir la raíz expuesta y tratar la afectación estética. CONCLUSIÓN: el procedimiento empleado tuvo los resultados previsibles y constituye una alternativa terapéutica cuando exista compromiso estético del paciente.

INTRODUCTION: there are several treatment options for root coverage caused by periodontal recession, which is characterized by displacement toward apically gingival margin, thereby dental root is exposed to the oral environment, which may cause dentine sensitivity, dental cavities, and aesthetic affectation. OBJECTIVE: present a clinical case where a surgical technique was used to root coverage. CASE REPORT: a 32 year-old male patient came to consultation due to nuisance to thermal changes in tooth 23 and he was concerned about aesthetics since he had his root exposed to the oral environment. On physical examination, altered gingival morphology was observed. It was characterized only by changing the apical gingival position in tooth 23, which does not reach the mucogingival line. It was decided a corrective plan of nonsurgical treatment, treating dentin hyperesthesia by applying dentin desensitizing (fluoridated lacquer: Profilac), and corrective surgical treatment to make a lateral sliding flap to cover the exposed root, and treating aesthetic condition. CONCLUSION: the used procedure had the expected results and it represents an alternative therapy when there is patient aesthetic compromise.

Prevalência de lesões cervicais não cariosas e da hiperestesia dentinária em alunos de Odontologia / Prevalence of non-carious cervical lesions and dentin hypersensitivity in Odontology students

O objetivo deste estudo foi determinar a prevalência de lesões cervicais não cariosas (LCNCs) e de hiperestesia dentinária em estudantes do curso de Odontologia da Universidade Estadual de Maringá (UEM) e registrar as variáveis bucais, comportamentais e sistêmicas comuns aos pacientes portadores, Foram examinados 80 alunos, utilizando um questionário como instrumento de coleta de dados. O exame clínico foi utilizado para verificar a presença de lesões na face vestibular de pré-molares e primeiros molares de todos os quadrantes, além da hiperestesia dentinária. A análise estatística foi analisada através do teste qui-quadrado com nível de significância de 5%. 77,5% apresentaram LCNCs, com média de 2,5 ± 2,8. O dente mais acometido foi o 1° pré-molar seguido do 2° pré-molar e do 1° molar. Quanto à hiperestesia dentinária houve diferença estatisticamente significante em um único elemento dentário (p=0,00540). Idade, hábitos parafuncionais, tipo de escova dental e dieta ácida não apresentaram relação com a presença das LCNCs. Assim, a ocorrência das LCNCs não pode ser atribuida a um único fator etiológico.

The aim of this study was to determine the prevalence of non-carious cervicallesions (NC-CLs) and dentin hypersensitivity in Odontology students of the State University of Maringá (UEM) and correlate them to variables oral, behavioral and systemic. Data of 80 students were collected via a questionnaire and clinical examination. The clinical examination was used to verify the dentin hypersensitivity and the presence of lesions on the buccal surface of premolars and first molars. Statistical analysis was performed by chi-square test at 5% significance level. 77,5% had NCCLs, with mean of 2.5 ± 2.8. The teeth with most NCCLs were the first premolar, foliowed by second premolar and then first molar. The dentin hypersensitivity was statistical in a single tooth (p = 000540). No significant diference for age, parafunctional habits, type of toothbrush and acidic diet, between the groups with or without NCCLs. Thus, the occurrence of NCCLs cannot be attributed only to a single etiological factor.

Tratamento da dor neuropática crônica pós-trauma com o uso do bloqueio periférico: relato de caso / Treatment of post-traumatic chronic neuropathic pain with peripheral block: case report

JUSTIFICATIVA E OBJETIVOS: As dores neuropáticas podem apresentar sinais inequívocos, mas, podem ser de difícil diagnóstico e o tratamento é difícil. O objetivo deste estudo foi relatar o caso de um paciente com dor crônica pós-traumática, com baixa adesão ao tratamento farmacológico e que foi tratado com bloqueios periféricos e adjuvantes. RELATO DO CASO: Paciente do gênero masculino, 42 anos, sofreu acidente automobilístico com trauma no quadril e na região lombar direita. Foi submetido à laparotomia exploradora com nefrectomia direita, osteossíntese de fêmur direito e de semilunar direito. Evoluiu com dor na região lombar direita que não melhorava com as medicações prescritas e com baixa adesão ao esquema terapêutico proposto, devido a sua difícil situação socioeconômica. Optou-se pelos bloqueios de nervos periféricos, em cinco sessões, realizados em regime ambulatorial. CONCLUSÃO: O tratamento com os bloqueios de nervos periféricos na região lombar foi eficaz e reduziu as sintomatologias da dor neuropática em até 60%, permanecendo com intensidade entre 3 e 4 pela escala analógica visual e ausência de dor ao toque da cicatriz.

BACKGROUND AND OBJECTIVES: Neuropathic pain may have earmarks, but may be difficult to diagnose and treat. This study aimed at reporting a case of post-traumatic chronic pain, with poor adherence to pharmacological treatment, which was treated with peripheral blocks and adjuvants. CASE REPORT: Male patient, 42 years old, who suffered a car accident with hip and right lumbar region trauma. Patient was submitted to laparotomy with right nephrectomy, right femur and right lunate osteosynthesis. Patient evolved with right lumbar region pain not improving with prescribed drugs and with poor adherence to proposed therapeutic approach due to his difficult socio-economic status. We decided for peripheral nerve blocks in five sessions, in outpatient regimen. CONCLUSION: Treatment with peripheral nerve blocks in the lumbar region was effective and has decreased neuropathic pain symptoms in up to 60%, remaining with intensity between 3 and 4 by the visual analog scale and with no pain when the scar was touched.

Hipersensibilidade dentinária: considerações para o sucesso em seu manejo clínico / Dentin hypersensitivity: considerations for success in clinical management

A hipersensibilidade dentinária é caracterizada por uma dor aguda, de curta duração, bem localizada, que provém da dentina exposta a partir de estímulos químicos, voláteis, térmicos, tácteis ou osmóticos e que não pode ser atribuída a outra forma de defeito ou patologia dental. Atinge grande parte da população mundial, além disso, o aumento na expectativa de vida dos pacientes sugere uma tendência ao aumento da sua prevalência. Apesar de relatos que remontam o século XVI, do extenso número de estudos sobre este assunto e uma gama de propostas terapêuticas, o tratamento desta enfermidade ainda é considerado desafiador e os estudos frequentemente utilizam palavras como "controle", "alívio" ou "melhora" do quadro clínico. O objetivo deste trabalho é revisar a literatura a respeito da hipersensibilidade dentinária associada à recessão gengival, na busca de atualidades, no seu correto manejo clínico e na escolha da terapia adequada de acordo com cada caso.

A Case of Polyarteritis Nodosa Manifesting as a Neuropathy Following Influenza Infection

Polyarteritis nodosa (PAN) is a necrotizing vasculitis of the medium-sized arteries. The symptoms and signs of PAN include purpuric skin lesions, mononeuritis multiplex, symptoms of mesenteric ischemia, and renal involvement. We report the first case of PAN manifesting as a neuropathy after influenza infection in Korea. A 68-year-old woman had fever, myalgia, hyperesthesia of both hand and foot, and lower extremity weakness. EMG findings showed severe sensorimotor polyneuropathy, such as multiple mononeuritis. A sural nerve biopsy showed vasculitis and Influenza A (H1N1) were positive. Our patient was treated by glucocorticoid and oral cyclophosphamide, thereafter, symptoms and signs improved. No recurrence has been observed for five months.

Electroconvulsive Therapy for CRPS

Complex regional pain syndrome (CRPS) is a disease that causes chronic spontaneous pain and hyperesthesia of one or more parts of legs and arms, which is accompanied with problems of the automatic nervous system or the motor nervous system. However, up to date, it is unclear what causes the syndrome and how to diagnose and treat it. Although several treatments including medication and sympathetic nerve block are performed against CRPS, the therapeutic effect of the treatments is limited. The electroconvulsive therapy (ECT), of which the mechanism is not clarified, is a treatment used for treatment-resistant depression. ECT is also reported to be effective against pain. Therefore, we performed the ECT for a 24-year-old female patient who has been diagnosed as CRPS. Her pain had not been much improved by medications and interventional procedures. At admission to a psychiatric ward for ECT, she complained of over 8 points of pain on visual analogue scale and the constrained movement around the painful part. Eight ECTs-three times a week-were performed for three weeks in hospital and then the ECT once a week was performed after her leaving the hospital. During the ECTs, pain had been reduced and the range of movement in the constrained parts had increased. Further systematic research is needed to confirm the effect of electroconvulsive therapy against CRPS.

Congenital Cleft of Anterior Arch and Partial Aplasia of the Posterior Arch of the C1

Congenital anomalies in arches of the atlas are rare, and are usually discovered incidentally. However, a very rare subgroup of patients with unique radiographic features is predisposed to transient quadriparesis after minor cervical or head trauma. A 46-year-old male presented with a 2-month history of tremor and hyperesthesia of the lower extremities after experiencing a minor head trauma. He said that he had been quadriplegic for about 2 weeks after that trauma. Radiographs of his cervical spine revealed bilateral bony defects of the lateral aspects of the posterior arch of C1 and a midline cleft within the anterior arch of the atlas. A magnetic resonance imaging revealed an increased cord signal at the C2 level on the T2-weighted sagittal image. A posterior, suboccipital midline approach for excision of the remnant posterior tubercle was performed. The patient showed significant improvement of his motor and sensory functions. Since major neurologic deficits can be produced by a minor trauma, it is crucial to recognize this anomaly.

Tratamento de recessões gengivais múltiplas e lesões cervicais não cariosas através de técnica cirúrgica associada a restaurações com cimento de ionômero de vidro / Treatment of multiple gingival recessions and non-carious cervical lesions by surgical technique associated to restorations with glass ionomer cement

A integração entre diferentes especialidades é, hoje, uma tendência no consultório odontológico e tratamentos onde se associam a Periodontia e Dentística têm ganhado espaço. Em Odontologia, é um consenso que a estética não remete apenas à cor e forma dos elementos dentários. A chamada estética vermelha é também uma exigência colocada pelos pacientes quanto à sua expectativa do resultado do tratamento, principalmente quando são encontradas situações de recessão gengival. Esse trabalho visa ilustrar um tratamento integrado relacionando as possibilidades de recobrimento radicular na presença de lesões cervicais não cariosas, por meio de cirurgia periodontal associada a restaurações com cimento de ionômero de vidro.

Subluxação atlantoaxial em 14 cães (2003-2008) / Atlantoaxial subluxation in 14 dogs (2003-2008)

O objetivo deste trabalho foi realizar um estudo retrospectivo dos casos de subluxação atlantoaxial em cães, por meio de consulta dos registros neurológicos do Hospital Veterinário Universitário (HVU), entre os anos de 2003 e 2008. Foram identificados a raça, o sexo, a idade, a etiologia, os sinais neurológicos, a duração dos sinais clínicos, o tratamento empregado, a resposta ao tratamento, o tempo de recuperação, a recidiva e a relação entre a duração dos sinais clínicos e a recuperação pós-operatória. Foram feitos o diagnóstico de subluxação atlantoaxial em 14 cães, sendo as raças Poodle (35,7 por cento), Pinscher (21,4 por cento) e Yorkshire Terrier (21,4 por cento) as mais acometidas e a maioria (92,8 por cento) com idade inferior a 24 meses. A principal causa da instabilidade foi a agenesia do processo odontoide do áxis (71,4 por cento) e os sinais clínicos variaram desde hiperestesia cervical até tetraparesia não ambulatória. O tratamento predominante foi o cirúrgico, que demonstrou ser eficaz com recuperação satisfatória em 90 por cento dos casos e menor possibilidade de recidiva, quando comparado ao trata,mento clínico. O tempo de recuperação predominante foi de 30-60 dias após a cirurgia, não existindo relação deste com a duração dos sinais clínicos.

A retrospective study on atlantoaxial subluxation in dogs was done by reviewing the cases filed from 2003 to 2008 in the neurological records of the Veterinary Hospital of the Universidade Federal de Santa Maria, at Santa Maria, Rio Grande do Sul, Brazil. The following data were identified: Breed, sex, age, etiology, clinical signs, duration of clinical course, assessment of the therapy employed and its efficacy, response to treatment and relapse. Fourteen dogs were diagnosed as affected by atlantoaxial subluxation and the condition was more frequent in dogs under twenty-four month old years and of toy breeds, such as Poodle (35.7 percent), Pinscher (21.4 percent) and Yorkshire terrier (21.4 percent). The main cause found for the instability was agenesis of the odontoid process. Clinical signs ranged from cranial cervical pain to non-ambulatory tetraparesis. The predominant treatment employed was surgical which demonstrated to be efficacious in 90 percent of the cases with minor risks of relapse when compared with clinical treatment. The predominant time of recovery was 30-60 days after surgery. No correlation was found between the duration of clinical signs before surgery and the time of recovery.

Causalgia após trauma por projétil de arma de fogo: relato de caso / Post-traumatic causalgia due to firearm projectiles: case report

Causalgia é um tipo de doença neurológica crônica pertencente à Síndrome Dolorosa Regional Complexa, normalmente associada ao trauma. A sintomatologia é caracterizada por dor espontânea em queimação, hiperalgesia, edema, instabilidade vasomotora, alteração da função motora e anormalidades autonômicas. É rara, pouco conhecida e envolve várias teorias acerca de sua fisiopatologia. São descritas neste trabalho as manifestações de paciente masculino, de 20 anos, atendido no Pronto Socorro do Hospital Risoleta Tolentino Neves, vítima de múltiplas lesões por projéteis de arma de fogo, que evoluiu com manifestações compatíveis com causalgia.

Causalgia is a kind of chronic neurological disorder which is part of the Complex Regional Pain Syndrome, usually associated to trauma. Its symptoms are severe burning pain, hyperalgesia, edema, abnormal vasomotor activity, impairment of motor function and autonomic dysfunction. It is a rare, poorly known disease, which involves various theories in regard to its physiopathology. We report, in this article, a clinical case of a 20-year-old male patient, who was treated in the Emergency Room of Risoleta Tolentino Neves Hospital, victim of multiple lesions by firearm projectiles and evolved with symptoms compatible to the clinical features of Causalgia.