Pleural appendages: Description, incidence and relations with body mass index

BACKGROUND AND AIMS: Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients. PATIENTS AND METHODS: Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI>30) and non-obese (BMI<30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant. RESULTS: Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured <5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458). CONCLUSIONS: Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages.

Apéndices pleurales: descripción, incidencia y relación con el índice de masa corporal / Pleural appendages: Description, incidence and relations with body mass index

Antecedentes y objetivo Los apéndices pleurales son grasa extrapleural que cuelga de la pared torácica. Han sido descritos mediante videotoracoscopia, pero no se conocen exactamente ni el aspecto ni la frecuencia con que se observan apéndices pleurales en tomografía computarizada (TC) ni tampoco si están relacionados con la cantidad de grasa del paciente. Pretendemos describir el aspecto y conocer la prevalencia de los apéndices pleurales observados en TC, así como saber si su presencia, tamaño y número es mayor en pacientes obesos que en no obesos. Pacientes y métodos Se han revisado retrospectivamente las imágenes axiales de tomografía computarizada de 226 pacientes con neumotórax. Fueron excluidos del estudio los pacientes con antecedentes de enfermedad pleural, cirugía torácica o neumotórax pequeños. Se dividió a los pacientes en dos grupos según el índice de masa corporal (IMC): obesos (IMC?≥?30) y no obesos (IMC<30). Se recogieron el número y tamaño de apéndices pleurales en cada paciente. Se emplearon una prueba de χ2 y el test exacto de Fisher para evaluar las diferencias entre los dos grupos. Un valor de p<0,05 se consideró significativo. Resultados 101 pacientes presentaron estudios de TC válidos. Se identificaron apéndices pleurales en 50 de los 101 pacientes (49,5%). La mayoría se presentan de forma solitaria (n=31), en el seno cardiofrénico (n=27) y tienen un tamaño inferior a 5cm (n=39). No hubo diferencia significativa entre los pacientes obesos y los no obesos en relación con la presencia o ausencia (p=0,315), número (p=0,458) y tamaño (p=0,458) de apéndices pleurales. Conclusiones Los apéndices pleurales se observan en el 49,5% de los pacientes con neumotórax estudiados con TC en este estudio. No hubo diferencia significativa entre los pacientes obesos y los no obesos respecto a la presencia, número y tamaño de apéndices pleurales (AU)

Background and aims Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients. Patients and methods Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI > 30) and non-obese (BMI < 30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant. Results Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured < 5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458). Conclusions Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages (AU)

Extrapleural fat: description, incidence, and relation with body mass index. / Apéndices pleurales: descripción, incidencia y relación con el índice de masa corporal.

BACKGROUND AND AIMS: Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients. PATIENTS AND METHODS: Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI > 30) and non-obese (BMI < 30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant. RESULTS: Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured < 5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458). CONCLUSIONS: Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages.

Effect of Pressure, Post-Pressing Time, and Polymerization Cycle on the Degree of Conversion of Thermoactivated Acrylic Resin.

Herein, the effect of different post-pressing times and pressure in two cycles of polymerization on the degree of conversion (DC) of thermally activated acrylic resin (TRRA) is analyzed to optimize the polymerization of this material. After post-pressing for 0, 6, or 12 h, polymerization was performed with or without a pressure of 60 psi (0.41 MPa) in a short (4 h) or a long (11 h) cycle, totaling 12 groups. To determine the DC, PMMA specimens were analyzed by Fourier transform infrared spectroscopy. The influence of each factor alone on the DC was studied by experimental planning. The statistical tests used were three-way ANOVA, t-test, Tukey's test, and Levene's test, with a margin of error of 5%. Two groups prepared with post-pressing times of 12 h had the lowest DC (p < 0.001). Post-pressing times of 0 and 6 h did not yield statistically different results. Pressure increased the DC in only one group (long cycle +12 h, p=0.001). The short cycle resulted in a higher DC than the long cycle in 2 groups (with pressure +0 h, p=0.002; without pressure +6 h, p=0.015), while the long cycle yielded a statistically higher DC in only one group (with pressure +12 h, p < 0.001). The polymerization showed satisfactory DC in all 12 groups. Small differences found among the specimens indicate that the pressure, post-pressing time, and polymerization cycles herein were not influential factors for the DC of PMMA.

Complications associated with radiofrequency ablation of pulmonary veins. / Complicaciones asociadas a la ablación mediante radiofrecuencia de venas pulmonares.

OBJECTIVE: Radiofrequency ablation is an efficacious alternative in patients with symptomatic atrial fibrillation who do not respond to or are intolerant to at least one class I or class III antiarrhythmic drug. Although radiofrequency ablation is a safe procedure, complications can occur. Depending on the location, these complications can be classified into those that affect the pulmonary veins themselves, cardiac complications, extracardiac intrathoracic complications, remote complications, and those that result from vascular access. The most common complications are hematomas, arteriovenous fistulas, and pseudoaneurysms at the puncture site. Some complications are benign and transient, such as gastroparesis or diaphragmatic elevation, whereas others are potentially fatal, such as cardiac tamponade. CONCLUSION: Radiologists must be familiar with the complications that can occur secondary to pulmonary vein ablation to ensure early diagnosis and treatment.

Clinical evaluation of nanofill and nanohybrid composite in Class I restorations: a 12-month randomized trial.

This randomized trial evaluated the 12-month clinical performance of nanofill, a nanohybrid, and a microhybrid composite in restorations in occlusal cavities of posterior teeth. This study utilized 41 patients, each of whom had three molars affected by primary caries or the need to replace restorations. All restorations were performed in accordance with the manufacturer's recommendations and evaluated in accordance with U.S. Public Health Service-modified criteria. Based on the results of the present study, the material investigated demonstrated acceptable clinical performance after 12 months of clinical service. Long-term re-evaluations are necessary for a more detailed analysis of these composites.

Degree of conversion of simplified contemporary adhesive systems as influenced by extended air-activated or passive solvent volatilization modes.

This study evaluated the effect of five methods of solvent volatilization on the degree of conversion (DC) of nine one-bottle adhesive systems using Fourier transform infrared/attenuated total reflectance (FTIR/ATR) analysis. Nine adhesives were tested: Adper Single Bond 2 (SB), Adper Easy One (EO), One Up Bond F Plus (OUP), One Coat Bond SL (OC), XP Bond (XP), Ambar (AM), Natural Bond (NB), GO, and Stae. The adhesive systems were applied to a zinc-selenide pellet and 1) cured without solvent volatilization, 2) left undisturbed for 10 seconds before curing, 3) left undisturbed for 60 seconds before curing, 4) air-dried with an air stream for 10 seconds before curing, and 5) air-dried with an air stream for 60 seconds before curing. FTIR/ATR spectra were obtained, and the DC was calculated by comparing the aliphatic bonds/reference peaks before and after light activation for 10 seconds (FlashLite 1401). The DC means of each material were analyzed by one-way analysis of variance and post hoc Tukey test (p<0.05). The DC of GO and Stae adhesive systems was not affected by the five evaporation conditions. Air-drying for 60 seconds before curing yielded the highest DC for SB, EO, and OC. Extended solvent volatilization time (60 seconds) either with or without air-drying before curing provided the highest DC for AM, NB, XP, and OUP. Thus, the monomer conversion of adhesive systems was material dependent. In general, the 60-second passive or active air-drying modes to volatilize solvents before curing enhanced the degree of conversion for the one-bottle simplified adhesive systems.

Marginal analysis of resin composite restorative systems using optical coherence tomography.

OBJECTIVES: To analyze marginal integrity of resin composites dental restorations using optical coherence tomography (OCT). METHODS: Thirty extracted human premolars had occlusal cavities prepared and were randomly divided according to the restorative systems evaluated: Filtek P90™/P90 Adhesive System™, Filtek Z350™, and Filtek Z250™/Single Bond™ (3M/ESPE). The teeth were then stored in the dark for 24h in 0.9% saline solution. Restorations were finished and polished and stored again for 24h before thermocycling (500 cycles, 5-55°C). A commercially available OCT system was used (SR-OCT: OCP930SR/Thorlabs) with 930nm central wavelength. Cross-sectional images were obtained every 250µm and evaluated using Image J. A-scans were analyzed using the Origin 8.0 program, after a filter treatment using Matlab. RESULTS: The qualitative analysis of the internal margins did not observe gaps even after A-scan examination, although distinctive patterns were found for each restorative system. Penetration of Single Bond and Filtek P90 self-etch primer into dentin was also observed. A thick adhesive layer was found for Filtek P90 bonding agent. SIGNIFICANCE: Considering the characteristics of the OCT system, the setup used in this study was capable of evaluating the marginal integrity of resin composite restorations and detecting some interaction between dental bonding agents and dental substrates. OCT can be considered a promising method for the evaluation of the internal margins of restorations in vivo.

Influence of antioxidants on stress of bonding agents in recently whitened teeth.

The aim of this study was to evaluate the influence of time of application of antioxidant agents on the bond strength to bovine enamel after bleaching by light emitting diode. Twenty two bovine incisors were used, on which the vestibular surfaces were flattened and divided into four experimental groups (n = 15) according to each antioxidant agent, with two groups each, varying the application time of 1 or 10 minutes, all submitted to the same whitening agent (Lase Peroxide) and the control group was only restored. The other groups were treated with antioxidant agents before the restorative procedure using the adhesive system All Bond 3 and resin Filtek Z-350. To obtain the dental fragments, teeth were placed in a precision cutter (Elquip), obtaining 0.8 mm 2 with sticks that were submitted to micro tensile testing at a test speed of 0.5 mm/min. The results, statistically analyzed by ANOVA and Tukey test (p < 0.05), indicated an increase in the value of bond strength of bleached groups treated with ascorbic acid, and a reduction when combined with sodium thiosulfate. No improvement in bond strength was found in the others.

Cytotoxicity of current adhesive systems: in vitro testing on cell cultures of primary murine macrophages.

OBJECTIVES: The aim of this study was to evaluate, in vitro, the potential cytotoxicity of dentinal adhesives on alveolar macrophages of Wistar rats, after diffusion through dentin. METHODS: The cytotoxicity of adhesives [single bond plus (SB), clearfil SE bond (CF) and Xeno V (XE)] applied to the occlusal surface of human dentin disks adapted to a dentin barrier test device were analyzed. The sets placed on a monolayer of cells were incubated for 24, 48 and 72h. Culture medium and Escherichia coli lipopolysaccharides (LPS) were used as negative and positive controls, respectively. Cellular cytotoxicity was evaluated by observing the cell survival rate (MTT assay) and nitric oxide production (NO). The data were analyzed by one-way factorial ANOVA and Tukey's and Tamhane's paired comparisons T2 (α=0.05). RESULTS: All the adhesive systems reduced the percentage of live cells by over 50%, compared with the control group. Within the same period of time, there was a statistically significant difference between the adhesives and LPS compared with the negative control group. SB presented a statistically significant difference between 24h and 72h, and XE between 48h and 72h. The quantity of NO produced in 24h did not differ statistically between the NC and adhesive groups. After 48h there was a significant difference between SB/CF and XE/NC. At 72h only CF showed a significant difference from each of the other groups. LPS differed statistically from all the other groups at all the evaluation times. SIGNIFICANCE: Components of the adhesives tested may permeate the dentin in sufficient concentrations to cause death and damage to cell metabolism in the alveolar macrophages of rats, which indicates potential cytotoxicity to pulpal cells.

Diagnosis and treatment of dentinal hypersensitivity.

This bibliographic review provides a general view of the etiology, characteristics and treatment of dentinal hypersensitivity, so that professionals can use this information in the therapeutic management of this clinical condition. For this purpose, the authors have analyzed whole texts of relevant articles on the subject. This study showed that the predisposing factors associated with the causes of dentinal hypersensitivity must be controlled or eliminated, by educating the patient regarding the excessive intake of acidic food, as well as providing guidance on the proper tooth brushing technique and analysis of occlusion. Effective treatment must be preceded by a proper diagnosis, established after the exclusion of any other possible causes of the pain. These cases must be managed efficiently, quickly and permanently. The availability of a wide variety of treatment could be an indicator that there is still no effective desensitizing agent to completely resolve the patient's discomfort, or that it is difficult to treat, irrespective of the available treatment options. Even with the large number of published studies, it has not been possible to reach a consensus about the product that represents the gold standard in the treatment of dentinal hypersensitivity.

Marginal adaptation and microtensile bond strength of composite indirect restorations bonded to dentin treated with adhesive and low-viscosity composite.

OBJECTIVES: This study evaluated the marginal adaptation of composite indirect restorations bonded with dual curing resin cement after different strategies to seal dentin. Different bonding techniques associated or not with a low-viscosity composite resin (LVCR) were utilized. In addition, the bond strength between composite resin and pre-sealed dentin was evaluated in the buccal and pulpal walls of class I cavities, prepared for indirect restorations. METHODS: Thirty-three freshly extracted human molars were used for this study, divided into three groups (n=11) representing different techniques to seal dentin-(Group 1) Conventional technique: the adhesive system was applied and polymerized just before the cementation of the indirect restoration; (Group 2) Dual bonding technique: a first layer of the adhesive system was applied and polymerized just after preparation, and a second layer just before the final cementation; (Group 3) Resin coating technique: a LVCR was applied and polymerized after the first layer of the adhesive system, and before the impression. A further application of the adhesive system was performed before the placement of the restoration. The restorations were polished and a solution of acid red propylene-glycol was dropped on each specimen's occlusal surface for 10 s. The dye penetrations were captured under stereoscopic lens and the images were transferred to a computer with a measurement program, in order to determine the extension of the dye penetration. The microtensile bond strength test (muTBS) was applied on pulpal (P) and buccal (B) walls of the restorations for Groups 1-3. The subgroups for muTBS were: Group 1P (n=13); Group 1B (n=7); Group 2P (n=6); Group 2B (n=14); Group 3P (n=14); Group 3B (n=15). All specimens were sectioned to obtain an area of 0.8 mm2. The specimens were mounted on a microtensile device and fractured using a universal testing machine at a cross-head speed of 1mm/min. Failure modes were analyzed by SEM. One-way ANOVA and multiple-comparison Tukey's test were used for statistical analysis of the marginal adaptation scores and muTBS test. Non-parametrical Kruskal-Wallis test was used for failure mode analysis. RESULTS: Group 3 showed a significantly higher mean value of marginal dye penetration (45.59) when compared to Groups 1 (8.44) and 2 (18.92). For pulpal walls, Group 1P showed significantly higher mean muTBS (25.93+/-2.27) when compared to Groups 2P (14.71+/-1.78) and 3P (16.07+/-2.81). There was no statistical difference between Groups 2P and 3P. For buccal walls, Group 2B presented significantly higher mean muTBS (23.29+/-1.42), and Group 1B the lowest mean values (11.37+/-1.14). The failure mode analysis presented a considerable variation, according to the treatment and to the wall. SIGNIFICANCE: The results of this study indicated that a previous sealing of dentin using the adhesive system, followed by a second application just before the cementation, is an effective alternative technique, since it maintains the marginal adaptation of indirect composite resin restorations, and improves the bond strength at the interface on buccal walls, which are the most critical regions for the long-term durability of these procedures.

Diseminación hemicorporal de un eccema de contacto / Hemicorporal dissemination in a case of contact dermatitis

El tratamiento del eccema de estasis con medicamentos tópicos puede determinar una sensibilización por contacto a alguno de ellos. Desde su lugar de aparición original, un eccema, alérgico o no, puede experimentar una diseminación, adoptando generalmente una distribución simétrica. Una mujer con una hemiparesia derecha debida a una intervención quirúrgica por tumor cerebral, y una úlcera crural por síndrome posflebítico para la que había seguido diversos tratamientos tópicos, desarrolló un eccema periulceroso que se diseminó en mayor medida por el hemicuerpo sano. Las pruebas epicutáneas revelaron una positividad a la mezcla de parabenes. En pacientes con accidente cerebrovascular se ha observado una mayor reactividad de la inmunidad celular en el hemicuerpo parésico, desconociéndose aún las causas. Se revisan las relaciones entre los sistemas nervioso e inmunológico (AU)