Analysis of bone stress and primary stability of a dental implant using strain and torque measurements.

Introduction: The consensus among researchers is that early failure of dental implants is due to the lack of primary stability and compressive stress on the peri-implant bone that exceeds the physiological tolerance. Objective: The objective of this work is to propose a new methodology to quantify bone stress during dental implant insertion and to correlate it with primary stability. Materials and Methods: Titanium dental implants with a diameter of 3.75 mm were inserted in a 3.35 mm hole of a synthetic bone of polyurethane (PU) foam with a density of 20 PCF (0.32 g/cm3). During insertion, the insertion torque was measured with a digital torque meter and the bone strain was measured with strain gages located at 2, 4, 6, 8, and 10 mm from the coronal region. Results: The tests showed that the compressive strain is maximum in the third coronal region and decreases in the apical direction. The data also showed that there is a relationship between strain, insertion torque, and the primary stability of dental implants. Conclusion: The stress and strain on the bone progressively decreased from the coronal to the apical third. The maximum compressive stress (0.42 MPa) during insertion of the implant did not exceed bone strength. Insertion of 3.75 mm implants in type D2 bone with a 3.35 mm hole provides adequate primary stability without excessive compression of the bone. Clinical Significance: For the implant-bone combination used in the present study, the compressive stress generated during implant insertion did not exceed the physiological limit of cortical and medullary bone to the point of impairing osseointegration.

Tratamento de ceratocistos na síndrome de Gorlin Goltz / Diagnosis and treatment of oral keratocysts in Gorlin Goltz Syndrome / Tratamento de ceratocistos na Síndrome de Gorlin Goltz

A Síndrome de Gorlin Goltz apresenta características com comprometimento craniofaciais que incluem carcinomas basocelulares, ceratocístos odontogênicos e fenda labial e/ou palatina. Ceratocísticos odontogênico aparecem durante as primeiras décadas de vida, mais comumente na mandíbula, associados a dentes impactados. O diagnóstico precoce possibilita a cura da lesão, minimiza as deformidades ósseas e pode ser concluído com exames como radiográfico e histopatológico. Relato de caso: Com o objetivo descrever o diagnóstico e analisar as possibilidades de tratamento das manifestações faciais da Síndrome de Gorlin Goltz será relatado um caso clínico de uma paciente infantil. A paciente tem um acompanhamento clínico multidisciplinar com geneticista, oncologista e cirurgião-dentista de 6 anos. Apresentou 5 ceratocisticos odontogênicos, carcinomas basocelulares na região do pescoço, calcificação da foice cerebral, ceratose palmo-plantar e macrocefalia. O tratamento para as lesões císticas foi a enucleação, seguida de osteotomia periférica. O defeito ósseo produzido pela enucleação de cisto mandibular foi enxertado com bloco de osso alógeno do banco de tecidos do INTO-RJ. Conclusão: Constata-se que o Cirurgião-dentista é capacitado para fazer o diagnóstico desta síndrome e encaminhar para o tratamento multidisciplinar. O enxerto alógeno é uma opção adequada de reconstrução de cavidades císticas, beneficiando pacientes do Sistema Único de Saúde... (AU)

Gorlin Goltz Syndrome has features with craniofacial involvement that include basal cell carcinomas, odontogenic keratocysts, and cleft lip and/or palate. Odontogenic keratocysts appear during the first decades of life, most commonly in the mandible, associated with impacted teeth. Early diagnosis enables healing of the lesion, minimizes bone deformities and can be completed with exams such as radiographic and histopathological exams. Case report: In order to describe the diagnosis and analyze the treatment possibilities of the facial manifestations of Gorlin Goltz Syndrome, a clinical case of a child patient will be reported.The patient has a multidisciplinary clinical follow-up with a 6-year geneticist, oncologist and dental surgeon. She had 5 odontogenic keratocystic keratocysts, basal cell carcinomas in the neck region, sickle cerebral calcification, palmoplantar keratosis and macrocephaly. The treatment for cystic lesions was enucleation, followed by peripheral osteotomy. The bone defect produced by the enucleation of a mandibular cyst was grafted with an allogeneic bone block from the tissue bank of INTO-RJ. Conclusion: It is concluded that the dentist is trained to make the diagnosis of this syndrome and refer to multidisciplinary treatment. Allogeneic graft is an appropriate option for the reconstruction of cystic cavities, benefiting patients from the Unified Health System... (AU)

El Síndrome de Gorlin Goltz tiene características con compromiso craneofacial que incluyen carcinomas de células basales, queratoquistes odontogénicos y labio leporino o paladar hendido. Los queratoquistes odontogénicos aparecen durante las primeras décadas de vida, más comúnmente en la mandíbula, asociados con dientes retenidos. El diagnóstico precoz permite la curación de la lesión, minimiza las deformidades óseas y se puede concluir con exámenes como exámenes radiográficos e histopatológicos. Reporte de caso: Con el fin de describir el diagnóstico y analizar las posibilidades de tratamiento de las manifestaciones faciales del Síndrome de Gorlin Goltz, se reportará un caso clínico de un paciente infantil. El paciente tiene un seguimiento clínico multidisciplinario con un genetista, oncólogo y cirujano dentista de 6 años. Presentó 5 queratocísticos odontogénicos, carcinomas basocelulares en la región del cuello, calcificación de la hoz cerebral, queratosis palmoplantar y macrocefalia. El tratamiento de las lesiones quísticas fue la enucleación, seguida de una osteotomía periférica. El defecto óseo producido por la enucleación de un quiste mandibular se injertó con un bloque óseo alogénico del banco de tejidos de INTO-RJ. Conclusión: Parece que el odontólogo está capacitado para realizar el diagnóstico de este síndrome y derivar al tratamiento multidisciplinario. El injerto alogénico es una opción adecuada para la reconstrucción de cavidades quísticas, beneficiando a los pacientes del Sistema Único de Salud... (AU)

Osteocondromatosis sinovial de hombro. Una enfermedad poco frecuente / Shoulder synovial osteocondromatosis. A rare disease

RESUMEN La osteocondromatosis sinovial es una condición poco común que se caracteriza por la formación de nódulos cartilaginosos u óseos comúnmente visto en las articulaciones sobretodo en la rodilla, sin embargo en el hombro esta condición es rara. Presentamos un caso clínico de una mujer de 35 años de edad con dolor en hombro izquierdo de larga evolución, tratado de manera conservadora antes de ser referido a un ortopedista. Luego de un diagnostico clínico y radiológico se sometió a tratamiento quirúrgico en la que se realizó un desbridamiento y escisión de los cuerpos condrales con éxito. Palabras claves: Condromatosis sinovial, tratamiento, adulto joven, mujer

ABSTRACTSynovial osteochondromatosis is a rare condition characterized by the formation of cartilage or bone nodules commonly seen in the joints, especially in the knee, however, this condition is rare in the shoulder. We present a clinical case of a 35-year-old woman with a long history of left shoulder pain, treated conservatively before being referred to an orthopedist. After a clinical and radiological diagnosis, she underwent surgical treatment in which a successful debridement and excision of the chondral bodies was performed

Cumulative incidence and spatial distribution of dogs exposed to Toxoplasma gondii.

Toxoplasma gondii is one of the most important protozoa parasites worldwide. Although many seroprevalence studies have been performed in domestic and wild species, data on the cumulative incidence and the spatial distribution of T. gondii in animals are extremely scarce. In the present study, dogs from Botucatu municipality, São Paulo state, were followed for one year and their blood samples were collected on three moments: days 1, 180, and 360. The sera were submitted to the immunofluorescence antibody test (IFAT) to detect IgG antibodies to T. gondii. Age and sex were compared with IFAT results through statistical tests. Spatial analysis was used to detect clusters of seropositive dogs. Among the 350 dogs that were seronegative on day 1, 53 became seropositive in subsequent samplings; thus, cumulative incidence was 15.1% exposed dogs/year. Age and sex were not associated with serological results. The spatial analysis revealed that seropositive dogs were distributed in all the studied areas, with a significant cluster in a zone with poor sanitary conditions and low socioeconomic status. T. gondii is frequent and widely distributed in the urban area of Botucatu, and impoverished areas are possibly associated with high levels of environmental contamination by this parasite.

Cumulative incidence and spatial distribution of dogs exposed to Toxoplasma gondii / Incidência cumulativa e distribuição espacial de cães expostos a Toxoplasma gondii

Abstract Toxoplasma gondii is one of the most important protozoa parasites worldwide. Although many seroprevalence studies have been performed in domestic and wild species, data on the cumulative incidence and the spatial distribution of T. gondii in animals are extremely scarce. In the present study, dogs from Botucatu municipality, São Paulo state, were followed for one year and their blood samples were collected on three moments: days 1, 180, and 360. The sera were submitted to the immunofluorescence antibody test (IFAT) to detect IgG antibodies to T. gondii. Age and sex were compared with IFAT results through statistical tests. Spatial analysis was used to detect clusters of seropositive dogs. Among the 350 dogs that were seronegative on day 1, 53 became seropositive in subsequent samplings; thus, cumulative incidence was 15.1% exposed dogs/year. Age and sex were not associated with serological results. The spatial analysis revealed that seropositive dogs were distributed in all the studied areas, with a significant cluster in a zone with poor sanitary conditions and low socioeconomic status. T. gondii is frequent and widely distributed in the urban area of Botucatu, and impoverished areas are possibly associated with high levels of environmental contamination by this parasite.

Resumo Toxoplasma gondii é um dos parasitas mais importantes mundialmente. Embora muitos estudos de soroprevalência tenham sido realizados em espécies domésticas e selvagens, dados sobre a incidência cumulativa e distribuição espacial de T. gondii em animais são extremamente escassos. No presente estudo, cães do município de Botucatu, estado de São Paulo, foram acompanhados por um ano, e suas amostras de sangue foram colhidas em três momentos: dias 1, 180 e 360. O soro foi submetido ao teste de imunofluorescência indireta (RIFI), para detectar anticorpos IgG para T. gondii. A idade e o sexo foram comparados com os resultados da RIFI por meio de testes estatísticos. Dos 350 cães soronegativos no dia, 1,53 se tornaram soropositivos nas amostragens subsequentes; portanto, a incidência cumulativa foi de 15,1% de cães expostos/ano. A idade e o sexo não tiveram associação com os resultados da sorologia. A análise espacial demonstrou que os cães soropositivos se distribuíram em todas as áreas compreendidas pelo estudo, com uma concentração significativa em uma região com condições sanitárias precárias e baixos níveis socioeconômicos. T. gondii é frequente e amplamente distribuído na área urbana de Botucatu, e regiões empobrecidas podem estar associadas a maiores níveis de contaminação ambiental por esse parasita.

Strongyloides stercoralis, the hidden worm. Epidemiological and clinical characteristics of 70 cases diagnosed in the North Metropolitan Area of Barcelona, Spain, 2003-2012.

BACKGROUND: The nematode Strongyloides stercoralis has a very particular autoinfection life-cycle which leads to chronic infections remaining undetected for decades. However, hyperinfection can occur in patients receiving immunotherapy resulting in high mortality rates. The main objective of this study was to assess the results of a 10-year multicenter surveillance program performed in an area with dense immigration in Barcelona, Spain. METHODS: From January 2003 to December 2012, all individuals with Strongyloides stercoralis infection attending the four centers with diagnostic capability in the North Metropolitan area of Barcelona were recorded. RESULTS: The annual detection rate was 0.2 new diagnosed cases x10 000 inhabitants/year and 1 case x10 000 immigrants/year. Many patients were immigrants (63; 90.0%), asymptomatic (45; 64.3%) and with a high eosinophil count (63; 90.0%). Immunosuppression was present in 11 (15.7%) patients, among whom two (2.8%) cases of disseminated hyperinfection were recorded. Ivermectin was prescribed in 45 (76.3%) and albendazole in 14 (23.7%). Following treatment seven patients (11.9%) receiving albendazole presented relapse, that is, albendazole failed to clear the parasite in 50% of these drug-treated patients (p < 0.001). CONCLUSIONS: During the study period, 90% of the cases of Strongyloides stercoralis diagnosed could be considered as imported by immigrants, most being asymptomatic and with eosinophilia. The infection is probably largely underestimated and population-based studies are needed to determine its true prevalence. Meanwhile, diagnosis must be based on active investigation of the helminth (serology and feces culture), especially in immunocompromised patients. The implementation of pre-immunosuppression protocols with the aim of identifying Strongyloides stercoralis is encouraged with empirical treatment with ivermectin being recommended in sites without diagnostic facilities.

Reabilitação do paciente com dente no traço de fratura mandibular / Treatment of teeth involved in mandible fracture line with dental implants: a case report

As fraturas mandibulares acometem aproximadamente dois terços de todas as fraturas faciais. A presença de dentes no traço de fratura, aparentemente, representa um aumento do risco para infecção quando comparada as fraturas onde os dentes não estão envolvidos. O cirurgião deve estar atento com relação a indicação de remover ou preservar o dente no traço de fratura. O tratamento das fraturas mandibulares com envolvimento de dentes é um assunto controverso. Neste estudo é relatado um caso clínico onde foi avaliada a efetividade e o benefício da instalação de implante após trauma dentoalveolar devido à fratura mandibular. Verificou-se que o procedimento é previsível, desde que bem realizado, visando obter resultado estético e funcional.

Fractures of mandible make up approximately two-thirds of all facial fractures. The presence of teeth in the fracture line apparently represents an increased risk for infection compared to a fracture where no teeth are involved. The surgeon should consider whether to remove or maintain the tooth. Treatment of jaw fractures with teeth in the fracture line is a controversial issue. In this study a clinical case is presented, where the effectiveness and benefits of the implant placement after dentoalveolar trauma due to a mandibular fracture were discussed. It was verified that the procedure is predictable, since well done, in order to obtain aesthetic and functional results.

Reconstrucción del ligamento colateral externo de la rodilla con mínimas incisiones: descripción de la técnica / Reconstruction of the lateral collateral ligament of the knee with minimal incisions: description of technique

El ligamento colateral externo de la rodilla es el estabilizador primario contra las fuerzas de estrés en varo de la rodilla. Las deficiencias de éste, ó de la esquina posterolateral de la rodilla ocasionan incremento en las fuerzas que actúan sobre el ligamento cruzado anterior durante la rotación interna de la rodilla e incrementan las fuerzas sobre el cruzado posterior durante la rotación externa. Las lesiones no diagnósticadas en combinación con lesiones del ligamento cruzado anterior (LCA) o ligamento cruzado posterior (LCP) pueden llevar a falla en la reconstrucción del LCA o LCP. El propósito de esta descripción de técnica quirúrgica es presentar una novedosa técnica de reconstrucción del ligamento colateral externo de la rodilla para el tratamiento de pacientes con estas lesiones, con mínimas incisiones. Esta técnica requiere el uso de un tomillo de interferencia y auto injerto semitendinoso para reconstruir el ligamento colateral lateral.

Ruptura del tendón rotuliano secundaria a tendolipomatosis: reparación con variante de técnica quirúrgica: reporte de un caso / Rupture of the tendon secondary to rotuliano tendolipomatosis: repair option of surgical technique: a case report

Presentamos el caso de un paciente masculino de 30 años con un cuadro de ruptura del tendón patelar secundaria a trauma deportivo (Fútbol), con antecedente de toma de injerto del mismo tendón para reconstrucción de ligamento cruzado anterior. El reporte histopatológico del tejido obtenido de los restos del tendón reveló tendolipomatosis del mismo. Resaltamos lo inusual de la patología y la técnica quirúrgica empleada para su reparación.

Manejo endoscópico de Bursitis trocantérica crónica calcificada: reporte de un caso / Endoscopic treatment of chronic calcified trocantérica Bursitis: a case report

Presentamos el caso de un paciente masculino de 60 años con un cuadro de un año de evolución de dolor de cadera derecha secundario a trauma por caída de propia altura, inicialmente manejado de forma conservadora sin mejoría de sintomatología, con evidencia radiográfica de calcificación en el área de la bursa trocantérica, quien fue sometido a bursoscopía y bursectomía endoscópica. Describimos los síntomas, hallazgos clínicos, técnica quirúrgica y resultados.

Tratamiento inicial de heridas por proyectil de arma de fuego. A propósito de un caso clínico / Initial treatment of gunshot wounds. A clinical case report

Los profesionales de salud en Rio de Janeiro tienen que perfeccionarseen un tema que cada vez más viene ganando espacio en loshospitales públicos de Río de Janeiro: la medicina de guerra.En el área de la cirugía bucomaxilofacial la preocupación de estos profesionalesestá dirigida a la devolución de la estética y función facial, teniendoen vistas que, estas heridas causan daños de grandes proporciones.En este sentido, el servicio inicial al paciente herido por arma de fuego enla cara será determinante para el éxito del tratamiento de este tipo de trauma.Este trabajo pretende, desde el relato de un caso clínico, promover discusionescon otros profesionales actuantes en el área de atención al pacientevíctima de PAF (proyectil de arma de fuego). El paciente objeto de esteestudio fue víctima de un asalto, siendo herido por un proyectil que penetrópor la región geniana y quedó alojado en la región cervical, presentandofractura fragmentada de rama ascendiente y proceso coronoide dela mandíbula. Debido a las controversias que hay en la literatura mundialsobre las conductas en esta atención precoz , proponemos este trabajo(AU)

Health care professionals in Rio de Janeiro have to gainexpertise in a specialty that is becoming increasingly important inthe public hospitals of Rio de Janeiro: military medicine.In the field of oromaxillofacial surgery, the concern of health careprofessionals is to restore facial aesthetics and function becausethese wounds cause major damage. In this sense, the initial care ofpatients with facial gunshot wounds determines the success oftreatment this type of trauma. The authors’ intention in this reportof a clinical case is to stimulate discussion among other professionalsinvolved in the care of patients who suffer gunshot wounds (GW).The patient studied here was an assault victim who was woundedby a bullet that entered the genial region and lodged in the cervicalregion. He had a fragmented fracture of the mandibular ascendantramus and coronoid process. Motivated by the controversy reigningin the world literature regarding the initial response in these cases,we proposed the current study(AU)

Longitudinal study on mitochondrial effects of didanosine-tenofovir combination.

Tenofovir disoproxil fumarate (TDF) has been reported to be free of adverse effects on mitochondria. We evaluate the effects of the introduction of TDF in a didanosine (ddI)-based highly active antiretroviral therapy (HAART) on mitochondrial DNA (mtDNA) content, mitochondrial mass (MM), and cytochrome c oxidase (COX) activity of the oxidative phosphorylation (OXPHOS) system over a 12-month period. Forty-four asymptomatic HIV patients with undetectable viral load receiving a ddI-based HAART were recruited and switched to ddI plus TDF (ddI + TDF) and nevirapine (n = 22) or maintained with the same baseline ddIbased HAART scheme (n = 22). Peripheral blood mononuclear cells were obtained at 0, 6, and 12 months. COX activity and MM were determined by spectrophotometry and the mtDNA content by quantitative realtime PCR. The mtDNA content showed a progressive decrease over the 12-month period of the study for the two groups with respect to baseline, with such a decrease statistically significant only in the ddI + TDF group (55% decrease, p < 0.001). In addition, the decrease of mtDNA content over time was statistically different between both groups (p < 0.001). Consistently, MM and COX activity decreased significantly at 12 months with respect to baseline only in the ddI < TDF group (28% decrease for MM, p < 0.05; 47% decrease for COX activity, p < 0.001). We conclude that switching to a HAART regimen containing ddI + TDF is associated with evolutive mitochondrial damage expressed as mtDNA depletion, loss of MM, and decrease in COX efficiency. The particular relevance of either ddI, TDF, or any interaction between them in such a mitochondrial dysfunction remains to be established.

Power relations and premature mortality in Spain's autonomous communities.

This trends ecological study analyzes, across 17 autonomous communities of Spain from 1989 to 1998, the relationship between mortality (total and by main causes of death) and power relations (type of government: social democratic (SDP), conservative (CDP), and others), labor market variables, welfare state variables, income inequality, absolute income, poverty, and number of civil associations. The authors conducted a descriptive analysis; a bivariate analysis (Pearson correlation coefficients) between mortality and each of the independent variables; and a multivariate analysis, adjusting multilevel linear regression models. All dimensions of the conceptual power relations model were related to premature mortality in the direction hypothesized. The cross-pooled multilevel regression models show that total premature mortality in males, male and female cerebrovascular mortality, male and female cirrhosis mortality, and male lung cancer mortality decreased somewhat more in communities where primary health care reform was implemented more quickly. Premature mortality decreased somewhat more in SDP than in CDP communities for male and female total premature mortality, cerebrovascular mortality, and cirrhosis mortality, and male lung cancer mortality. These results are in accord with earlier studies that found a relationship among health indicators and variables related to labor market, welfare state, income inequalities, civil associations, and power relations.

Neumonía eosinófila aguda como causa de insuficiencia respiratoria / Acute eosinophilic pneumonia as a cause of respiratory failure

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