The Anaesthesiologist and Palliative Care in a Newborn with the Adam "Sequence".

Reports focusing on biomedical principlism and the role of anaesthesiologists in palliative care are rare. We present the case of a newborn with multiple craniofacial anomalies and a diagnosis of ADAM "sequence," in which surgical removal of placental adhesions to the dura mater and the correction of meningocele was not indicated due to the very short life expectancy. After 48 hours, the odor from the placenta indicted a necrotic process, which prevented the parents from being close to the child and increased his isolation. Urgent surgery was performed, after which the newborn was transported to the ICU and intubated under controlled mechanical ventilation. The patient died a week later. The principles of beneficence, nonmaleficence, justice, and respect for autonomy are simultaneously an inspiratory and regulatory framework for clinical practice. Although only necessary procedures are defended, which suggests a position contrary to invasive interventions at the end of life, sometimes they are the best palliative measures that can be taken in cases like the one described here.

Ischemic Postconditioning and Subanesthetic S(+)-Ketamine Infusion: Effects on Renal Function and Histology in Rats.

BACKGROUND: Ischemic postconditioning (IP) in renal Ischemia reperfusion injury (IRI) models improves renal function after IRI. Ketamine affords significant benefits against IRI-induced acute kidney injury (AKI). The present study investigated the effects of IP and IP associated with subanesthetic S(+)-ketamine in ischemia-reperfusion-induced AKI. METHODS: Forty-one Wistar rats were randomized into four groups: CG (10), control; KG (10), S(+)-ketamine infusion; IPG (10), IP; and KIPG (11), S(+)-ketamine infusion + IP. All rats underwent right nephrectomy. IRI and IP were induced only in IPG and KIPG by left kidney arterial occlusion for 30 min followed by reperfusion for 24 h. Complete reperfusion was preceded by three cycles of 2 min of reocclusion followed by 2 min of reperfusion. Renal function was assessed by measuring serum neutrophil gelatinase-associated lipocalin (NGAL), creatinine, and blood urea nitrogen (BUN). Tubular damage was evaluated by renal histology. RESULTS: Creatinine and BUN were significantly increased. Severe tubular injury was only observed in the groups with IRI (IPG and KIPG), whereas no injury was observed in CG or KG. No significant differences were detected between IPG and KIPG. CONCLUSIONS: No synergic effect of the use of subanesthetic S(+)-ketamine and IP on AKI was observed in this rat model.

CLIMATE CHANGE. Climate change impacts on bumblebees converge across continents.

For many species, geographical ranges are expanding toward the poles in response to climate change, while remaining stable along range edges nearest the equator. Using long-term observations across Europe and North America over 110 years, we tested for climate change-related range shifts in bumblebee species across the full extents of their latitudinal and thermal limits and movements along elevation gradients. We found cross-continentally consistent trends in failures to track warming through time at species' northern range limits, range losses from southern range limits, and shifts to higher elevations among southern species. These effects are independent of changing land uses or pesticide applications and underscore the need to test for climate impacts at both leading and trailing latitudinal and thermal limits for species.

Bumble Bees (Hymenoptera: Apidae: Bombus spp.) of Interior Alaska: Species Composition, Distribution, Seasonal Biology, and Parasites.

BACKGROUND: Despite the ecological and agricultural significance of bumble bees in Alaska, very little is known and published about this important group at the regional level. The objectives of this study were to provide baseline data on species composition, distribution, seasonal biology, and parasites of the genus Bombus at three major agricultural locations within Alaska: Fairbanks, Delta Junction, and Palmer, to lay the groundwork for future research on bumble bee pollination in Alaska. NEW INFORMATION: A total of 8,250 bumble bees representing 18 species was collected from agricultural settings near Delta Junction, Fairbanks, and Palmer, Alaska in 2009 and 2010. Of the 8,250 specimens, 51% were queens, 32.7% were workers, and 16.2% were males. The species composition and relative abundances varied among sites and years. Delta Junction had the highest relative abundance of bumble bees, representing 51.6% of the specimens collected; the other two locations, Fairbanks and Palmer represented 26.5% and 21.8% of the overall catch respectively. The species collected were: BombusbohemicusSeidl 1837 (= B.ashtoni (Cresson 1864)), B.balteatusDahlbom 1832, B.bifariusCresson 1878, B.centralisCresson 1864, B.cryptarum (Fabricius 1775) (=B.moderatusCresson 1863), B.distinguendusMorawitz 1869, B.flavidusEversmann 1852 (=B.fernaldaeFranklin 1911), B.flavifronsCresson 1863, B.frigidusSmith 1854, B.insularis (Smith 1861), B.jonellus (Kirby 1802), B.melanopygusNylander 1848, B.mixtusCresson 1878, B.neoboreusSladen 1919, B.occidentalisGreene 1858, B.perplexusCresson 1863, B.rufocinctusCresson 1863, and B.sylvicolaKirby 1837. Overall, the most common bumble bees near agricultural lands were B.centralis, B.frigidus, B.jonellus, B.melanopygus, B.mixtus, and B.occidentalis. Species' relative population densities and local diversity were highly variable from year to year. Bombusoccidentalis, believed to be in decline in the Pacific Northwest states, represented 10.4% of the overall specimens collected from the three sites studied. Bumble bees were found to be infected by Nosema and nematodes with infection rates up to 2.1% and 16.7% respectively. Of the eight species infected by parasites, B.occidentalis displayed the highest Nosema infection, while B.centralis was the species with the highest infection of nematodes. To our knowledge this represents the first multi-year study on bumble bees from the main agricultural areas of Alaska to provide baseline data on species composition, distribution, seasonal biology, and parasites of the genus Bombus.

Developmental effects on phenolic, flavonol, anthocyanin, and carotenoid metabolites and gene expression in potatoes.

Potato phytonutrients include phenolic acids, flavonols, anthocyanins, and carotenoids. Developmental effects on phytonutrient concentrations and gene expression were studied in white, yellow, and purple potatoes. Purple potatoes contained the most total phenolics, which decreased during development (from 14 to 10 mg g(-1)), as did the activity of phenylalanine ammonia-lyase. The major phenolic, 5-chlorogenic acid (5CGA), decreased during development in all cultivars. Products of later branches of the phenylpropanoid pathway also decreased, including quercetin 3-O rutinoside, kaempferol 3-O-rutinoside, and petunidin 3-O-(p-coumaroyl)rutinoside-3-glucoside (from 6.4 to 4.0 mg g(-1)). Violaxanthin and lutein were the two most abundant carotenoids and decreased 30-70% in the yellow and white potatoes. Sucrose, which can regulate phenylpropanoid metabolism, decreased with development in all cultivars and was highest in purple potatoes. Total protein decreased by 15-30% in two cultivars. Expression of most phenylpropanoid and carotenoid structural genes decreased during development. Immature potatoes like those used in this study are marketed as "baby potatoes", and the greater amounts of these dietarily desirable compounds may appeal to health-conscious consumers.

Rehabilitación mediante implantes de carga inmediata con regeneración ósea / Rehabilitation through Immediate Load Implant with Bone Regeneration

La disponibilidad ósea es uno de los principales elementos a tener en cuenta en la planificación del tratamiento implantológico. La posibilidad de optar por este se encuentra limitada en pacientes con déficit óseo, tanto en cantidad, como en calidad. La regeneración ósea guiada es una técnica quirúrgica, que permite estimular la formación de hueso en zonas específicas, permitiendo una disponibilidad adecuada del mismo, facilitando así esta terapéutica. Pueden realizarse previamente a la colocación de los implantes o durante la colocación de los mismos. Se presenta un caso de rehabilitación protésica por medio de implantes de carga inmediata utilizando una técnica de regeneración ósea, guiada en el momento de la implantación. Se realizó seguimiento por seis meses, constatándose la integración del implante, así como la adecuada adaptación de la rehabilitación protésica (AU)

Bone availability is one of the main elements to take into account when planning an implant treatment. The possibilities of selecting this treatment is limited in patients with lack of bone both, not only in quantity, but also in quality. Guided bone regeneration is a surgical technique that allows stimulating the development of bone in specific areas, permitting its adequate availability, thus facilitating this therapeutics. Bone regeneration can be done before or during the placing of the implants. A case of prosthetic rehabilitation by means of immediate load implant using guided bone regeneration during the surgery of implantation is reported. A six month follow up was done, observing the adequate integration of the implant and a proper adaptation of the prosthetic rehabilitation (AU)

Puente complejo de porcelana sobre implantes Mis- Seven / Complex Porcelain Bridge over Mis- Seven Implants

Durante años las prótesis convencionales han resuelto la difícil tarea de rehabilitar por medios artificiales los órganos dentarios perdidos, sin embargo, ellas no cumplen con la totalidad de las expectativas de los pacientes. El tratamiento implantológico constituye una alternativa eficaz, bien aceptada por pacientes y especialistas del ramo. Se presentó un paciente donde se utilizó una técnica restauradora compleja por medio de un puente fijo implantosoportado confeccionado con porcelana sobre implantes MIS- Seven, donde se modificó el diseño original de estas estructuras al suprimir el material estético en la cara palatina de los dientes, limitándolo solo a las superficies vestibulares y visibles durante las funciones básicas del aparato masticatorio; se logró de esta forma contrarrestar el espacio interoclusal reducido y ofrecer una mayor resistencia ante las fuerzas generadas durante la masticación(AU)...

Amount years conventional prosthetics treatment has solved the hard task of restitute dental loose, however this kind of prosthesis do not fulfill the totality of patients expectations. The implant treatment is an effective alternative well accepted by patients and specialists. The use of a complex restorative technique by a fixed implanted supported porcelain bridge over MIS Sven implants with a modification of its original design through the suppression of the esthetic material of the palatine surface, restricting it to the vestibular surfaces only, counteracting the limited interoclusal space and offering more resistance against forces generated during mastication is described(AU)...

Puente complejo de porcelana sobre implantes Mis- Seven / Complex Porcelain Bridge over MIS- Seven implants

Durante años las prótesis convencionales han resuelto la difícil tarea de rehabilitar por medios artificiales los órganos dentarios perdidos, sin embargo, ellas no cumplen con la totalidad de las expectativas de los pacientes. El tratamiento implantológico constituye una alternativa eficaz, bien aceptada por pacientes y especialistas del ramo. Se presentó un paciente donde se utilizó una técnica restauradora compleja por medio de un puente fijo implantosoportado confeccionado con porcelana sobre implantes MIS- Seven, donde se modificó el diseño original de estas estructuras al suprimir el material estético en la cara palatina de los dientes, limitándolo solo a las superficies vestibulares y visibles durante las funciones básicas del aparato masticatorio; se logró de esta forma contrarrestar el espacio interoclusal reducido y ofrecer una mayor resistencia ante las fuerzas generadas durante la masticación.

Amount years conventional prosthetics treatment has solved the hard task of restitute dental loose, however this kind of prosthesis do not fulfill the totality of patient’s expectations. The implant treatment is an effective alternative well accepted by patients and specialists. The use of a complex restorative technique by a fixed implanted supported porcelain bridge over MIS Sven implants with a modification of its original design through the suppression of the esthetic material of the palatine surface, restricting it to the vestibular surfaces only, counteracting the limited interoclusal space and offering more resistance against forces generated during mastication is described.

Puente complejo de porcelana sobre implantes Seven / Complex bridge of porcelain about Seven implants

Durante años las prótesis convencionales han resuelto la difícil tarea de rehabilitar por medios artificiales los órganos dentarios perdidos, sin embargo, las mismas no cumplen con la totalidad de las expectativas de los pacientes. El tratamiento implantológico constituye una alternativa eficaz, bien aceptada por pacientes y especialistas del ramo. Se presenta un caso donde se utiliza una técnica restauradora compleja por medio de un puente fijo implanto- soportado confeccionado con porcelana(AU)

During several years the conventional prostheses have solved the hard task of rehabilitating the loss of dental organs through artificial means; however these prostheses do not fulfill the whole expectations of the patients. The implant treatment constitutes an efficient alternative, well accepted by patients and specialists on the matter. It was presented a case where it was used a restoring technique through an implant supported fixed prostheses with porcelain(EU)

Sobredentadura Implantorretenida: un caso para reflexionar / Implant retained overdendenture: A case to think about

Las sobredentaduras son aquellas prótesis totales o parciales que descansan sobre uno o más dientes remanentes y o implantes. Una premisa fundamental en este tratamiento consiste en poder insertar y retirar la prótesis a voluntad, facilitando la higiene, así como un periodo de descanso para la mucosa, sobre todo en casos donde la misma participa en la trasmisión de cargas al hueso. El paso de cargar los implantes al incorporarle las cápsulas retentivas a las prótesis, constituye un momento crítico dentro de este tratamiento ya que se utilizan materiales como el acrílico autopolimerizable y de no tomarse las adecuadas precauciones pudieran crearse trabas que dificulten la adecuada inserción y remoción del aparato protésico, generando esto graves complicaciones en nuestros pacientes. Se presenta un caso, que por un proceder inadecuado, las prótesis quedaron unidas a los implantes por un lapso de dos años, sin posibilidad de remoción, afectando la salud del paciente(AU)

Overdentures are the total or parcial prostheses over one or more remanent teeth or implants. A main premise of this treatment is to insert and retire the prosthesis favouring the hygiene, as well as a resting period for the mucose, mainly in the cases where it participates in the transmission of the bone loading. The step of loading the implants when placing the retention capsules in the prosthesis constitutes a critical moment within this treatment, because there are used materials like autopolimerizable acrylic and if the adequate measures are not taken then some obstacles may difficult the proper insertion and removal of the prosthetic apparatus, generating severe complications in our patients. It was presented a case showing that for an inadequate behavior, the prosthesis were joint to the implants for a period of 2 years, with no possibilities of removal, affecting the patient´s health(EU)

Rehabilitación protésica sobre implantes y su interrelación con Ortodoncia / Prosthetic rehabilitation about implants and its interrelation with Orthodontics

Introducción: Uno de los grandes problemas al realizar la rehabilitación protésica es la no existencia de un adecuado espacio interoclusal, una de las variantes para resolver esta situación la brinda el tratamiento de ortodoncia. Objetivo: Mostrar una técnica de rehabilitación mediante implantes dentales cuyo éxito se garantizó gracias a un adecuado tratamiento ortodóncico. Métodos: Se presenta un caso de rehabilitación mediante implantes con espacio interoclusal recuperado con tratamiento de ortodoncia. Se utilizó técnica de arco recto para lograr los movimientos deseados. Se propuso aplanar la curva de Spee, para ello fueron utilizados arcos preformados superelásticos. Resultados: Se logró el movimiento dentario en un periodo de 6 meses. Se obtuvo el espacio para la restauración protésica, realizándose un puente fijo de porcelana. Conclusiones: El tratamiento de ortodoncia es una variante que ofrece un resultado seguro posibilitando la realización de una correcta rehabilitación(AU)

Introduction: One of the greatest problems at the time of performing a prosthetic rehabilitation is the non -existence of an adequate interductal space, one of the ways to solve this situation is offerred by the orthodontics treatment. Objective: To show a rehabilitation technique through dentary implants, succeeding thanks to an adequate orthodontics treatment. Methods: It was presented a rehabilitation case through implants with interductal space, recovered with the orthodontic treatment. It was used the rectal arc technique to obtain the desired movements. It was proposed to plain the Spee Curve and for that purpose there were used superelastic arcs. Results: It was obtained the dentary movement within a period of six months. It was created the space for the prosthetic restoration, making a fixed bridge of porcelain. Conclusions: The orthodontic treatment is a way that offers security, favouring the development of a proper rehabilitation(EU)

Anestesia em paciente com saturnismo: relato de caso / Anesthesia in patient with lead poisoning: case report / Anestesia en paciente con saturnismo: relato de caso

JUSTICATIVA E OBJETIVOS: O saturnismo decorre da intoxicação crônica pelo chumbo, comum após exposição ocupacional. Projéteis retidos no corpo podem resultar em elevados níveis plasmáticos de chumbo com inúmeras repercussões clínicas, principalmente neurológicas. Apresentamos um caso de paciente sintomático, sem diagnóstico, que foi detectado durante visita pré-anestésica. RELATO DO CASO: Paciente apresentado para retirada de projétil alojado em joelho esquerdo há 14 anos, com polineuropatia sem investigação. Durante visita pré-anestésica foi levantada a hipótese de saturnismo, confirmada pelos altos níveis plasmáticos de chumbo (129 µg.dL-1). A cirurgia foi realizada sob anestesia geral antes do início da quelação do chumbo. Durante indução anestésica, o paciente evoluiu com apneia, sem rigidez torácica após 50 µg de fentanil. CONCLUSÃO: A intoxicação por chumbo interfere com a função de diversos órgãos e sistemas, altera o metabolismo oxidativo e os mecanismos intracelulares de sinalização. O acometimento neurológico, com redução da condução neural merece especial atenção do anestesiologista.

BACKGROUND AND OBJECTIVES: Lead poisoning, also Saturnism, results from chronic lead poisoning, common after occupational exposure. Projectiles retained in the body may result in increased levels of plasma lead with numerous clinical implications, particularly neurological. We report a case of a symptomatic patient, undiagnosed, whose diagnosis was made during the preanesthesia evaluation. CASE REPORT: The patient was attended at our hospital to remove a bullet lodged in his left knee 14 years ago, presenting with polyneuropathy without investigation. During the preanesthetic visit, saturnism was hypothesized and confirmed by high plasma lead levels (129 µg.dL-1). Surgery was performed under general anesthesia before starting lead chelation. During anesthesia, the patient developed apnea, without chest-wall rigidity after administration of fentanyl (50 mg). CONCLUSION: Lead poisoning interferes with the function of various organs and systems, alters oxidative metabolism and intracellular signaling mechanisms. Neurological involvement, with reduced neural conduction, deserves special attention from anesthesiologists.

JUSTIFICATIVA Y OBJETIVOS: El saturnismo proviene de la intoxicación crónica por el plomo común después de la exposición ocupacional. Los proyectiles que el cuerpo retiene pueden traer como resultado elevados niveles plasmáticos de plomo con innumerables repercusiones clínicas, principalmente neurológicas. Presentamos aquí un caso de paciente sintomático, sin diagnóstico, y que fue detectado durante la visita preanestésica. RELATO DEL CASO: Paciente que se presentó para la retirada de una bala que se había alojado en la rodilla izquierda hacía 14 años, con polineuropatía sin investigación. Durante la visita preanestésica se pensó en saturnismo, lo que fue confirmado por los altos niveles plasmáticos de plomo (129 µg.dL-1). La cirugía fue realizada bajo anestesia general antes del inicio de la quelación del plomo. Durante la inducción anestésica, el paciente evolucionó con apnea sin rigidez torácica después de 50 µg de fentanilo. CONCLUSIONES: La intoxicación por plomo interfiere con la función de diversos órganos y sistemas, altera el metabolismo oxidativo y los mecanismos intracelulares de señalización. El compromiso neurológico, con la reducción de la conducción neural, merece una especial atención por parte del anestesiólogo.

Anesthesia in patient with lead poisoning: case report.

BACKGROUND AND OBJECTIVES: Lead poisoning, also Saturnism, results from chronic lead poisoning, common after occupational exposure. Projectiles retained in the body may result in increased levels of plasma lead with numerous clinical implications, particularly neurological. We report a case of a symptomatic patient, undiagnosed, whose diagnosis was made during the preanesthesia evaluation. CASE REPORT: The patient was attended at our hospital to remove a bullet lodged in his left knee 14 years ago, presenting with polyneuropathy without investigation. During the preanesthetic visit, saturnism was hypothesized and confirmed by high plasma lead levels (129 µg.dL(-1)). Surgery was performed under general anesthesia before starting lead chelation. During anesthesia, the patient developed apnea, without chest-wall rigidity after administration of fentanyl (50 µg). CONCLUSION: Lead poisoning interferes with the function of various organs and systems, alters oxidative metabolism and intracellular signaling mechanisms. Neurological involvement, with reduced neural conduction, deserves special attention from anesthesiologists.

Tratamiento de una fractura radicular mediante implante post extracción de carga inmediata / Treatment of a radicular fracture by means of a post extraction and immediate load implant

Los traumatismos dentales constituyen una de las principales causas de pérdida del órgano dentario, provocando desarmonías orgánicas, estéticas y psicológicas, viéndose los pacientes obligados a recurrir a diferentes variedades de tratamientos protésicos. El tratamiento implantológico constituye una opción de gran actualidad, lográndose cumplir con las principales expectativas de los pacientes. Se presenta un caso de fractura radicular en el 22, en el examen clínico se determinó la necesidad de realizar la exodoncia. Se decidió la colocación de un implante post extracción de carga inmediata, de 3,2mm de diámetro, por 16mm de largo. Se rehabilitó provisionalmente por medio de corona acrílica. Las principales demandas del paciente fueron alcanzadas. Con esta presentación se ha querido mostrar las ventajas asociadas a una técnica de rehabilitación, a través de un implante post extracción de carga inmediata (AU)

Dental traumas are one of the main causes of tooth loss, provoking organic, esthetic and psychological disorders, for this reasons patients are compelled to fall back on different varieties of prosthetic treatments. The implant treatment is an updated option to fulfill the main expectation of the patients. A case is presented to describe the treatment of a radicular fracture of a second upper left incisor. Oral examination disclosed that the affected tooth should be extracted. The placement of a post extraction and immediate load implant of 3.2 mm of diameter and 16 mm of length was decided. A provisional acrylic crown was made to restore the lost tooth. The main complaints of the patient were satisfied. By means of this presentation we put forward the advantages associated to this rehabilitation technique (AU)

Sobredentadura Implantoretenida: un caso para reflexionar / Implanto-retained overdenture: a case for reflection

Las sobredentaduras son aquellas prótesis totales o parciales que descansan sobre uno o más dientes remanentes y/o implantes. Una premisa fundamental en este tratamiento consiste en poder insertar y retirar la prótesis a voluntad, facilitando la higiene, así como un periodo de descanso para la mucosa, sobre todo en casos donde la misma participa en la trasmisión de cargas al hueso. El paso de cargar los implantes, al incorporarle las cápsulas retentivas a las prótesis, constituye un momento crítico dentro de este tratamiento, ya que se utilizan materiales como el acrílico autopolimerizable y, de no tomarse las adecuadas precauciones, pudieran crearse trabas que dificulten la adecuada inserción y remoción del aparato protésico; generando esto graves complicaciones en nuestros pacientes. Se presenta un caso, donde por un proceder inadecuado las prótesis quedaron unidas a los implantes por un lapso de dos años sin posibilidad de remoción, afectando la salud del paciente(AU)

Overdentures are the total or partial prostheses that rest on one or more remaining teeth and/or implants. A fundamental premise in this treatment consists on being able to insert and remove the prosthesis without medical assistance, facilitating hygiene as well as a rest period for the mucous membrane, especially in cases where it takes part in the transmission of charges to the bone. The step of charging the implants by incorporating the retentive capsules into the prosthesis, constitutes a critical moment in the treatment since materials like autopolymerizing acrylic are used and not following the proper precautions could lead to obstacles which difficult the suitable insertion and removal of the prosthetic device; generating serious complications in the patients. A case of an improperly treated patient presents with the prostheses joined to the implants for two years without possibility of removal, affecting the health of the patient(AU)

Differential effects of environment on potato phenylpropanoid and carotenoid expression.

BACKGROUND: Plant secondary metabolites, including phenylpropanoids and carotenoids, are stress inducible, have important roles in potato physiology and influence the nutritional value of potatoes. The type and magnitude of environmental effects on tuber phytonutrients is unclear, especially under modern agricultural management that minimizes stress. Understanding factors that influence tuber secondary metabolism could facilitate production of more nutritious crops. Metabolite pools of over forty tuber phenylpropanoids and carotenoids, along with the expression of twenty structural genes, were measured in high-phenylpropanoid purple potatoes grown in environmentally diverse locations in North America (Alaska, Texas and Florida). RESULTS: Phenylpropanoids, including chlorogenic acid (CGA), were higher in samples from the northern latitudes, as was the expression of phenylpropanoid genes including phenylalanine ammonia lyase (PAL), which had over a ten-fold difference in relative abundance. Phenylpropanoid gene expression appeared coordinately regulated and was well correlated with metabolite pools, except for hydroxycinnamoyl-CoA:quinatehydroxcinnamoyl transferase (HQT; r = -0.24). In silico promoter analysis identified two cis-acting elements in the HQT promoter not found in the other phenylpropanoid genes. Anthocyanins were more abundant in Alaskan samples and correlated with flavonoid genes including DFR (r = 0.91), UFGT (r = 0.94) and F3H (r = 0.77). The most abundant anthocyanin was petunidin-3-coum-rutinoside-5-glu, which ranged from 4.7 mg g-1 in Alaska to 2.3 mg g-1 in Texas. Positive correlations between tuber sucrose and anthocyanins (r = 0.85), suggested a stimulatory effect of sucrose. Smaller variation was observed in total carotenoids, but marked differences occurred in individual carotenoids, which had over a ten-fold range. Violaxanthin, lutein or zeaxanthin were the predominant carotenoids in tubers from Alaska, Texas and Florida respectively. Unlike in the phenylpropanoid pathway, poor correlations occurred between carotenoid transcripts and metabolites. CONCLUSION: Analysis of tuber secondary metabolism showed interesting relationships among different metabolites in response to collective environmental influences, even under conditions that minimize stress. The variation in metabolites shows the considerable phenotypical plasticity possible with tuber secondary metabolism and raises questions about to what extent these pathways can be stimulated by environmental cues in a manner that optimizes tuber phytonutrient content while protecting yields. The differences in secondary metabolites may be sufficient to affect nutritional quality.

Presentación de un paciente con sobredentadura implantoretenida / Presentation of a Patient with Retained Implant Overdenture

Las sobredentaduras son aquellas prótesis totales o parciales que descansan sobre uno o más dientes remanentes y o implantes. Una premisa fundamental en este tratamiento consiste en poder insertar y retirar la prótesis a voluntad para facilitar la higiene, así como un periodo de descanso para la mucosa, sobre todo en casos donde esta participa en la trasmisión de cargas al hueso. El paso de cargar los implantes al incorporarle las cápsulas retentivas a las prótesis, constituye un momento crítico en el tratamiento porque se utilizan materiales como el acrílico autopolimerizable y de no tomarse las adecuadas precauciones pudieran crearse trabas que dificulten la adecuada inserción y remoción del aparato protésico, que generan graves complicaciones a estos pacientes. Se presentó un caso donde a causa de un proceder inadecuado, las prótesis quedaron unidas a los implantes por un lapso de dos años, sin posibilidad de remoción, y la consiguiente afectación a la salud del paciente(AU)...

Overdentures are those partial or total prosthesis that are over one or more remaining tooth and or implants. A very important detail in this treatment is the possibility of inserting and removing the prosthesis making with a best oral hygiene and providing a rest time to the mucosa. The step of loading the implants by incorporate the retentive caps to the prosthesis is a critical moment because of the use of materials like the acrylic resin, if the proper measures are not take intoaccount it could generate locks that interfere with the proper insertion and removing of the dentures, causing serious complications in patients. A case was presented in this paper to describe and inadequate procedure that promote the fixing of a complete denture for two years without the possibility of removing it, affecting the patient´s health(AU)...

Tratamiento de fractura radicular mediante implante post extracción / Treatment of radicular fracture through a post extraction implant

Los traumatismos dentales, constituyen una de las principales causas de pérdida del órgano dentario, provocando desarmonías orgánicas, estéticas y psicológicas, viéndose los pacientes obligados a recurrir a diferentes variedades de tratamientos protésicos. El tratamiento implantológico constituye una opción de gran actualidad, lográndose cumplir con las principales expectativas de los pacientes. Se presenta un caso de fractura radicular en el 22, en el examen clínico se determinó la necesidad de realizar la exodoncia. Se decidió la colocación de un implante post extracción de carga inmediata de 3,2mm de diámetro por 16mm de largo. Se rehabilitó provisionalmente por medio de corona acrílica. Las principales demandas del paciente fueron alcanzadas. Mediante esta presentación nos proponemos mostrar las ventajas asociadas a una técnica de rehabilitación mediante un implante post extracción de carga inmediata(AU)

The dentary trauma constitutes one of the main causes of loss of the dentary organ, bringing about organic, aesthetic and psychologic disharmonies and the patients had to look for different varieties of prosthetic treatments. The implantologic treatment constitutes an updated option, fullfiling the main expectations of the patients. It was presented a case of radicular fracture in the 22, the clinical examination determined the need to perform the exodoncy. It was decided to apply an immediate post extraction implant of 3.2 mm diameter x 16 mm long. The rehabilitation was temporary through the acrylic crown. The main requirements of the patients were reached. Through this presentation we proposed to show the advantages associated to a rehabilitation technique through an immediate post extraction implant(EU)

Anesthesia in a patient with Job's syndrome (hyper IgE). Case report.

BACKGROUND AND OBJECTIVES: Job's syndrome (JS), one of the presentations of the Hyper IgE Syndrome, is a rare immunodeficiency. It includes cutaneous abscesses, recurring pneumonias, pneumatoceles, eosinophilia, hyperimmunoglobulinemia E (> 2,000 IU.mL(-1)), and craniofacial and bone growth changes. This report describes the disease and its anesthetic management. CASE REPORT: The patient is a 13 year old black male, 40 kg, ASA II, with Job's Syndrome diagnosed 6 months prior to this admission. The patient was admitted for elongation of the right femur. He denied use of drugs and prior surgeries; he presented good cervical mobility, interincisive distance greater than 3 cm, Mallampati II, without signs of infection. Preoperative exams were within normal limits. He was monitored with electrocardioscope, SpO(2), non-invasive blood pressure, and P(ET)CO(2). After pre-oxygenation, general anesthesia was induced and he was maintained with sevoflurane. At the end of the procedure, the patient was extubated after reversal of the neuromuscular blockade, and the patient was transferred to the PACU with Aldrete 9, He was discharged from the hospital 72 hours later, without complications. CONCLUSIONS: The choice of anesthetic technique is guided by rigorous observation among risks and benefits for each patient, according to respiratory sequelae, risk of infection, and surgical site. In the patient described here, we considered that neuroaxis anesthesia could be associated with an increased risk of severe infections due to the patient immunologic background. The procedure was safely performed with general anesthesia.