Maloclusión pseudoclase III en la dentición decidua resolución con aparato progénico / Pseudo Class III malocclusion treatment in primary dentition with progenic appliance

La maloclusión pseudoclase III es caracterizada par un desequilibrio funcional que, por lo general, resulta de contactos oclusales prematuros que causan un desplazamiento funcional anterior de la mandíbula. Estos casos, si no son tratados en una etapa inicial de desarrollo, pueden generar interferencias en el crecimiento normal de las bases óseas y resultar en una deformidad facial. Este papel conlleva a la selecci6n de un aparato apropiado, tomando cuenta opciones actuales, para una intervenci6n temprana en el desarrollo de maloclusiones de clase III. El uso del aparato progenico en este tipo de maloclusión, permite la correcci6n dental en pocos meses y una estabilidad terapéutica de la mandíbula mesio-posicionada fomentando un crecimiento esquelético favorable en una niña de 5,6 años de edad que acude a la clínica de postgrado del Instituto Latino Americano de Investigaci6n y Enseñanza Odontológica (ILAPEO) en Curitiba, Brasil...

Pseudo Class III malocclusion is a functional imbalance that generally results from premature occlusal contacts that causes a functional anterior displacement of the mandible. These cases, if not treated at an early stage of development, may interfere in normal growth of bone bases, resulting in facial deformity. This paper suggests the selection of an adequate appliance considering the available possibilities for early intervention of Class III malocclusion. The use of the progenic appliance in such dental malocclusion allows correction in a few months and therapeutic stability mesio-positioned mandible encouraging favorable skeletal growth in a child of 5.6 years of age who came to the Postgraduate Clinic of the Latin American Institute of Dental Research and Education (ILAPEO) in Curitiba, Brazil...

Proteins differentially expressed by Shiga toxin-producing Escherichia coli strain M03 due to the biliar salt sodium deoxycholate.

Shiga toxin-producing Escherichia coli (STEC) can cause conditions ranging from diarrhea to potentially fatal hemolytic uremic syndrome. Enteropathogen adaptation to the intestinal environment is necessary for the development of infection, and response to bile is an essential characteristic. We evaluated the response of STEC strain M03 to the bile salt sodium deoxycholate through proteomic analysis. Cell extracts of strain M03 grown with and without sodium deoxycholate were analyzed by two-dimensional electrophoresis; the differentially expressed proteins were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Three proteins were found to be differentially expressed due to sodium deoxycholate. Glycerol dehydrogenase and phosphate acetyltransferase, which are involved in carbon metabolism and have been associated with virulence in some bacteria, were downregulated. The elongation factor Tu (TufA) was upregulated. This protein participates in the translation process and also has chaperone activities. These findings help us understand strategies for bacterial survival under these conditions.

The effects of repetitive haemarthrosis on postural balance in children with haemophilia.

Sensory information from visual, vestibular and proprioceptive systems is necessary to control posture and balance. Impairment in proprioception due to repetitive joints bleeding may lead to a deficit in postural balance which, in turn, leads to high joint stress and risk of bleeding recurrence. Despite the increase in attention in this field during the past few years, the data concerning to how bleeds can affect postural control in children with haemophilia (CWH) remain scarce. This study aimed to evaluate the postural balance in CWH. Twenty CWH Haemophilia Group (HG) and 20 age-matched children Control Group (CG) were recruited to this study. A force plate was used to record centre of pressure (COP) displacement under four different postural conditions during quiet standing: eyes open on firm surface, eyes open on foam surface, eyes closed on firm surface and eyes closed on a foam surface. Variables of COP as sway area and mean velocity and in anterior-posterior (y) medio-lateral (x) direction were processed and for each variable sensory, quotients were calculated and compared between groups. No differences were found in visual and vestibular quotients variables between groups. A higher value was found in sway area variable on proprioception quotient in the HG when compared with CG (P = 0.042). CWH with repetitive joint bleed on lower limbs showed differences in postural balance when compared with non-haemophiliac children. The identification of early balance impairments in CWH can help us understand better the effects of bleeds inside joints on postural control and plan a more effective preventive and rehabilitative treatment.

Postural adjustment after an unexpected perturbation in children with haemophilia.

Children with haemophilia often bleed inside joints and muscles, which may impair postural adjustments. These postural adjustments are necessary to control postural balance during daily activities. The inability to quickly recover postural balance could elevate the risk of bleeding. To determine whether children with haemophilia have impaired postural adjustment after an unexpected perturbation compared with healthy children. Twenty children with haemophilia comprised the haemophilic group (HG), and 20 healthy, age-paired children comprised the control group (CG). Subjects stood on a force plate, and 4% of the subjects' body weight was applied via a pulley system to a belt around the subjects' trunks. The centre of pressure (COP) displacement was measured after the weight was unexpectedly released to produce a controlled postural perturbation followed by postural adjustment to recover balance. The subjects' postural adjustments in eight subsequent intervals of 1 s (t1-t8), beginning with the moment of weight removal, were compared among intervals and between groups. The applied perturbation magnitudes were the same for both groups, and no difference was observed between the groups in t1. However, the COP displacement in t2 in the HG was significantly higher than in the CG. No differences were observed between the groups in the other intervals. Within-group analysis showed that the COP was higher in t2 than in t4 (P = 0.016), t5 (P = 0.001) and t8 (P = 0.050) in the HG. No differences were observed among intervals in the CG. Children with haemophilia demonstrated differences in postural adjustment while undergoing unexpected balance perturbations when compared with healthily children.

Understanding contradictory data in contraction stress tests.

The literature shows contradictory results regarding the role of composite shrinkage and elastic modulus as determinants of polymerization stress. The present study aimed at a better understanding of the test mechanics that could explain such divergences among studies. The hypothesis was that the effects of composite shrinkage and elastic modulus on stress depend upon the compliance of the testing system. A commonly used test apparatus was simulated by finite element analysis, with different compliance levels defined by the bonding substrate (steel, glass, composite, or acrylic). Composites with moduli between 1 and 12 GPa and shrinkage values between 0.5% and 6% were modeled. Shrinkage was simulated by thermal analogy. The hypothesis was confirmed. When shrinkage and modulus increased simultaneously, stress increased regardless of the substrate. However, if shrinkage and modulus were inversely related, their magnitudes and interaction with rod material determined the stress response.

Can fiber posts increase root stresses and reduce fracture?

The clinical success of fiber posts has been attributed to their lower elastic modulus. The tested hypothesis was that fiber posts could lead to lower risk of post debonding and lower risk of root fracture, despite an increase in root stresses. Stress analyses were carried out with a 3D finite element model of a premolar restored with a metallic or a fiber post. Bonded and non-bonded post/cement interface conditions were simulated. We calculated risk-of-fracture indices by determining the highest principal stress values divided by the tensile strength. Shear stresses along the post/cement interface were analyzed for the bonded models. Compared with the premolar restored with a metallic post, the fiber post generated lower stresses along the interface and higher stresses in the root. However, with the fiber post, fracture was less likely to occur in the root, since its core and post fracture indices were higher.

Avaliação do alinhamento postural e do desempenho em atividades funcionais de crianças hemofílicas em idade inferior a sete anos, com e sem sinovite crônica: correlação com a incidência de hemartroses / Evaluation of postural alignment and performance in functional activities among hemophilic children under 7 years old with and without chronic synovitis: correlation with hemarthrosis incidence

INTRODUÇÃO: A sinovite na hemofilia pode induzir às alterações nos receptores sensitivos e proprioceptivos articulares. Tal efeito favorece a redução de estabilidade e um desalinhamento corporal, podendo comprometer a funcionalidade das crianças acometidas. OBJETIVO: Avaliar o alinhamento postural dos membros inferiores e o desempenho funcional de crianças hemofílicas, relacionando-os com a incidência de hemartroses. MÉTODO: Foi avaliado um grupo experimental (GE) de 28 crianças hemofílicas e um grupo controle (GC) de 20 crianças sem hemofilia. O GE foi dividido de acordo com o grau de comprometimento articular: 16 crianças no grupo sem sinovite crônica (GSS) e 12 no grupo com sinovite crônica (GCS). Cada grupo foi subdividido por faixa etária: 3-4 anos, 5-6 anos, 7 anos. A avaliação consistiu da análise do alinhamento dos ângulos do joelho e do tornozelo através do programa Geometer Sketchpad. O desempenho das atividades funcionais foi avaliado através de testes modificados a partir do Exame Neurológico Evolutivo de Lefévre. RESULTADOS: Foi constatado que a média dos sangramentos dos hemofílicos aumenta com a idade (p< 0,001) e parece ser relacionada com o grau de comprometimento articular (GCS>GSS), (p< 0,059); o ângulo do joelho do GCS tende a um menor valor (semiflexão) quando comparado aos outros grupos; e há diferença significativa no percentual de desempenho nos testes entre grupos na faixa etária de 7 anos (GSS>GC e GSS>GCS), (p< 0,087). DISCUSSÃO E CONCLUSÃO: Crianças hemofílicas de 7 anos apresentaram menor desempenho funcional quando comparadas aos outros grupos. Este resultado ressalta a importância da fisioterapia precoce associada à terapêutica médica para evitar comprometimentos articulares severos.

Use of Amifostine in the Therapy of Osteosarcomain Children and Adolescents

Amifostine protects normal tissue from the cytotoxic damage induced by radiation and chemotherapy. In this study, 39 consecutive newly diagnosed children with osteosarcoma were assessed; 20 received amifostine and 19 did not. The chemotherapy regimen included an induction phase of three cycles of cisplatin (100 mg/m2), carboplatin (500 mg/m2), and doxorubicin (60 mg/m2), followed by surgery. Alternating cycles of cisplatin/ifosfamide (9 mg/m2), ifosfamide/doxorubicin, carboplatin/doxorubicin, and ifosfamide/carboplatin were administered every 3 weeks to complete 26 weeks of treatment. Amifostine was administered 15 minutes before the infusions of cisplatin and carboplatin in a total of 193 infusions. Side effects during infusions and renal, hearing, and bone marrow toxicities were evaluated and compared between the two groups. Hypotension was observed in 28 (14.5%) infusions. No patient required discontinuation of therapy. Fewer than two episodes of vomiting occurred in 130 (71%) infusions and two to five episodes occurred in 51 (28%) infusions, and no patient had grade 4 toxicity. There was no difference between the two groups regarding renal toxicity (creatinine clearance). Neutropenia and leukopenia were significantly less frequent in the amifostine group. No difference was observed in platelet and hearing toxicities. Amifostine was well tolerated in doses of 740 mg/m2 in children and adolescents, and myelotoxicity was less severe in the amifostine group. This was a pilot study for further evaluation in a larger randomized trial.

Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial.

BACKGROUND: Infections are one of the major complications in children undergoing chemotherapy. Monotherapy with either ciprofloxacin or ceftriaxone is safe and efficient in low-risk patients (solid tumors and stage I/II lymphomas). The same drugs may be used in an outpatient setting, decreasing costs and the risk of nosocomial infections. PROCEDURE: Low-risk patients (N = 70) with episodes of fever and neutropenia (N = 116) were randomized to receive either oral ciprofloxacin or intravenous ceftriaxone as outpatients. Only one patient had a central venous catheter. RESULTS: Episodes of fever and neutropenia were classified as fever of unknown origin (41% vs. 32%) or clinically documented infection (56% vs. 63%) in the ciprofloxacin and ceftriaxone groups, respectively. Most of these infections were of upper respiratory tract, skin, or gastrointestinal origin. The mean duration of neutropenia was 5 vs. 6 days. Fever persisted for 1-9 days (mean 2 vs. 3 days). Therapy was successful with no modifications in 83% vs. 75% of the episodes. Patients were admitted in 7% vs. 4% of the episodes. No bone or joint side effects were seen in either group. All patients survived. CONCLUSIONS: Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients).

Activity of intraarterial carboplatin as a single agent in the treatment of newly diagnosed extremity osteosarcoma.

BACKGROUND: Chemotherapy has dramatically improved the rates of cure and survival of patients with localized and metastatic osteosarcoma. Nonetheless, the number of chemotherapeutic agents active against osteosarcoma is limited to doxorubicin, cisplatin, high-dose methotrexate, and ifosfamide. Carboplatin, a cisplatin analogue, has been tested as a single agent in patients with recurrent osteosarcoma or as part of multiagent chemotherapy in newly diagnosed patients. PROCEDURE: We tested the activity and toxicity of two cycles of intraarterial carboplatin as a "window therapy" (600 mg/m2 per cycle) in 33 consecutive patients with extremity osteosarcoma before the start of multiagent chemotherapy. Response was based on clinical (tumor diameter, local inflammatory signs, and range of motion) and radiological parameters (plain local films and arteriographic studies prior to drug administration). RESULTS: Patients' age ranged between 8 and 18 years (median age 13 years). Primary tumor originated from the femur (15 patients), tibia (10 patients), fibula (4 patients), humerus (3 patients), and calcaneus (1 patient). Only 7 patients (21%) had metastatic disease at diagnosis (5 in the lung and 2 in other bones). A favorable clinical and radiological response was documented in 81% and 73% of the patients, respectively. Clinical and radiological progression occurred in 12% and 9% of the patients, respectively. Seventeen of the patients remain alive and disease-free. Survival and event-free survival at 3 years for nonmetastatic patients are 71% (SE = 9%) and 65% (SE = 9%), respectively; for metastatic patients, the figures are 17% (SE = 15%) and 14% (SE = 13%), respectively. CONCLUSIONS: We conclude that carboplatin is an active agent in the treatment of newly diagnosed extremity osteosarcoma.

Study of the action of tamoxifen on the mammary gland epithelium of premenopausal patients by lysosome quantification.

Tamoxifen is an antiestrogen drug widely utilized for the adjuvant hormonal treatment of breast carcinoma. Its use in the primary prophylaxis of this disease is currently being proposed. Although the drug has few side effects, its precise action on breast tissue that has not undergone neoplastic transformation has not been fully elucidated. This prospective, randomized study assessed the estrogen activity of tamoxifen on the mammary gland epithelium of premenopausal patients using a quantitative analysis of mammary epithelium lysosome identified by the cytochemical technique of GOMORI for acid phosphatase and by light microscopy. Tamoxifen significantly increased the number of lysosomes only during the secretory phase of the menstrual cycle. We concluded that the early effect of the drug on normal mammary tissue is synergistic with the effect of estrogen during the premenopausal period.

Leiomyoma of the breast. A case report.

A rare case of leiomyoma of the breast is reported, with a discussion of the clinical aspects and of the differential diagnosis. Excluding tumors originating from the areolar-papillary complex and the skin, this neoplasm is extremely rare, with only 11 cases reported so far. The histogenesis of the lesion is still controversial.

Proximal humeral ossification center of the fetus: time of appearance and the sensitivity and specificity of this finding.

Ultrasonographic examinations were performed on 1,000 pregnant women between the 28th and 40th weeks of gestation who had been seen at a private clinic. For all women the date of last menstruation was known, and none had obstetrical or clinical-surgical complications. All were singleton pregnancies, and cases of fetal malformation were excluded from the study. The proximal humeral epiphyseal ossification center was visualized significantly frequently after the 38th week (P < 0.001). With respect to a gestational age of more than 38 weeks, its specificity was elevated (99%), as also were its positive (91%) and negative (93%) predictive values. Its sensitivity, however, was low (58%). Routine determination of the proximal humeral ossification center is a valuable aid for the estimation of gestational age in the third trimester.

Primary lymphoma of the breast.

We describe a case of primary lymphoma of the breast which clinically mimicked a phyllodes tumor. The diagnosis and treatment of this rare neoplasm are discussed. The lymphomas, neoplasias of the immune system, comprise a large group of proliferative diseases of the lymphoreticular tissue which are classified into two histological types, i.e., Hodgkin and non-Hodgkin. Primary lymphomas of the breast are quite rare, with an incidence ranging from 0.4 to 0.53% of all malignant breast tumors (2). They are characterized by uni- or bilateral involvement of the breast, with or without homolateral axillary lymphadenopathy, and by the absence of lymphatic disease at another site (7). We report here a case of primary non-Hodgkin lymphoma of the left breast and we discuss its clinical aspects and the treatment instituted.

Sex variation at the time of sonographic appearance of the proximal tibial epiphyseal ossification center.

The time of sonographic appearance of the proximal tibial epiphyseal ossification center and its sexual variation was assessed in 659 normal pregnancies. Proximal tibial center appears between 34-37 weeks gestation. In female fetuses, it appears between 34-35 weeks and in males, between 35-36 weeks (P < 0.001). There was a tendency of female proximal tibial center appearance to precede male appearance, by approximately one week. This difference, however, didn't show statistical significance.

[The connectivity between the greater occipital nerve and adjacent structures: anatomo-clinical considerations]. / Estudo da conectividade entre o nervo occipital maior e estruturas adjacentes: considerações anátomo-clínicas.

In order to offer anatomical basis that aid for clinical interpretation of headache of cervical origin a macro-mesoscopic study of greater occipital nerve and its subcutaneous rise out site was accomplished. The authors observed that in its course this nerve delineates angles and direction shifts that can stand for critical points in etiology of occipital pain, so that in its subcutaneous rise out region both occipital artery and vein shape the vasculo-nervous bundle wrapped by sheath of fibrous connective tissue which has continuity and contiguity relation with the adjoining epimysium and perimysium. From our results, anatomo-clinical aspects are discussed.

[Incentives that favor laboratory training in nursing: a review of the literature]. / Estímulos que favorecem o treinamento no laborató rio de enfermagem: revisão de literatura.

This article is a review of literature related to what motivates nursing graduates to attend freely a laboratory to better develop practical skills. It concluded that the literature indicates conditions that stimulate or discourage training of practical skills. These conditions are related to the professor, to techniques or procedures, to laboratory conditions, to evaluating systems and to the student himself.