Total occlusion of abdominal aorta: still a deadly event in the very elderly.

Total occlusion of the abdominal aorta is an uncommon but potentially devastating event. Clinical symptoms are usually sudden and may vary depending on the level of the aortic occlusion. Associated morbidity and mortality remain substantial with high rates of limb loss, acute renal failure, rhabdomyolysis, and death. We report a case of a bedridden 91-year-old woman with history of hypertension, hyperlipidemia, anemia and dementia, carried to the emergency department because of bilateral lower limb pallor. She had been at the same department the week before because of the same problems and high blood pressure (BP), but had been discharged after administration of hypotensive drugs and a short period of observation. No attention was paid to those perfusion alterations, or the global picture at all. The physical examination revealed cooling of the lower limbs and significant BP differential between upper and lower limbs (ankle-brachial index of 0.173), leading to the suspicion of bilateral acute limb ischemia. Abdominal, pelvic and lower limb CT was conducted, revealing calcification and important atheromatosis of the thoracic-abdominal aorta and a mural thrombus beginning above the origin of the celiac trunk, with complete occlusion below the origin of the renal arteries. After discussion with Vascular Surgery Department, given the advanced age, known co-morbidities and the timing of diagnosis, the patient was considered not eligible for revascularization surgery and comfort measures were honored. This case highlights the importance of stablishing a timely and correct diagnosis, even in the very elderly, emphasizing that they too benefit from secondary and tertiary prophylaxis, in order to prevent devastating outcomes as this.

Cumulative impact assessment for ecosystem-based marine spatial planning.

Claims for ocean space are growing while marine ecosystems suffer from centuries of insufficient care. Human pressures from runoff, atmospheric emissions, marine pollution, fishing, shipping, military operations and other activities wear on habitats and populations. Ecosystem-based marine spatial planning (MSP) has emerged worldwide as a strategic instrument for handling conflicting spatial claims among competing sectors and the environment. The twofold objective of both boosting the blue economy and protecting the environment is challenging in practice and marine planners need decision support. Cumulative Impact Assessment (CIA) was originally developed to provide an overview of the human imprint on the world's ocean ecosystems. We have now added a scenario component to the CIA model and used it within Swedish ecosystem-based MSP. This has allowed us to project environmental impacts for different planning alternatives throughout the planning process, strengthening the integration of environmental considerations into strategic decision-making. Every MSP decision may entail a local shift of environmental impact, causing positive or negative consequences for ecosystem components. The results from Swedish MSP in the North Sea and Baltic Sea illustrate that MSP certainly has the potential to lower net cumulative environmental impact, both locally and across sea basins, as long as environmental values are rated high and prevailing pressures derive from activities that are part of MSP. By synthesizing innumerous data into comprehensible decision support that informs marine planners of the likely environmental consequences of different options, CIA enables ecosystem-based MSP in practice.

Levantamento do seio maxilar usando substitutos ósseos autógeno e alógeno: relato de caso e análise histológica após sete meses / Sinus lifting with autogenous and allogenic bone substitutes: case report and histological analysis after seven months

A fim de satisfazer os objetivos ideais da Implantodontia, os tecidos duros e moles precisam apresentar volume e qualidade ideais. Enxertos ósseos autógenos são previsíveis e proporcionam a mais eficiente estrutura para os implantes osseointegrados, entretanto, a morbidade cirúrgica é grande. A utilização de osso fresco congelado torna-se uma alternativa em estudo para substituição dos enxertos autógenos em reconstruções de rebordos atróficos prevendo a instalação de implantes. O objetivo deste trabalho foi análise clínica e histológica de enxerto ósseo autógeno e osso alógeno utilizados na técnica de elevação do assoalho de seio maxilar, em um mesmo paciente, em sítios diferentes. Segundo a análise histológica, não houve diferença de neoformação entre as duas amostras.

To satisfy ideal objectives of the dental implants, hard and soft tissues need to present sufficient bone quantity and quality. Autogenous bone grafts are predictable and provide the most efficient structure for osseointegrated implants; however, significant surgical morbidity has been demonstrated. The use of fresh frozen bone becomes an alternative in the study for replacement of the autogenous grafts to reconstruct atrophic ridges for further implant placement. The objective of this case is to report clinical and histological examination of autogenous and allogenic bone grafts used in the technique of maxillary sinus lifting for the same patient at different sites. According to histological analysis after seven months, no differences in neoformati on were observed between both sites.

Avaliação do índice de sucesso dos enxertos autógenos e dos implantes instalados em região de seio maxilar / Success index evaluation of autogenous bone grafts and immediate/non-immediate dental implants at maxillary sinus area

A cirurgia de levantamento de seio maxilar é considerada uma excelente opção de tratamento reabilitador para pacientes que apresentam pneumatização de seio maxilar. Neste trabalho, foi efetuado estudo longitudinal em 41 pacientes do Ilapeo, com avaliação de 51 cirurgias de levantamento de seio maxilar e uso de enxerto ósseo autógeno de linha obliqua. Instalou-se 107 implantes, sendo 28 imediatos. Índice de sucesso alcançado com relação ao enxerto ósseo foi de 98,04%. Os implantes instalados de forma imediata ou com instalação posterior a enxertia obtiveram índice de sucesso com 92,86% e 94,59%, respectivamente, não havendo diferenças estatisticamente significantes entre eles. Cirurgias de enxerto ósseo e implantação imediata são consideradas uma alternativa confiável de tratamento, contanto que sejam respeitadas estruturas anatômicas, fisiologia dos tecidos, com indicação e técnica apropriada para a boa estabilidade dos implantes.

Maxillary sinus lifting surgery is considered an excellent option for patient rehabilitation in cases of maxillary sinus pneumatization. This longitudinal study was performed in 41 patients to evaluate 51 maxillary sinus lifting procedures concomitant to autogenous bone grafted from mandibular ramus. Of the 107 implants installed, 28 were immediate fixations. Success index achieved regarding to bone graft was of 98.04%. The implants installed immediately or after bone grafting resulted in success rates of 92.86% and 94.59% respectively, with no statistically significant differences between them. Surgeries for bone grafting and immediate installation are considered a reliable treatment alternative provided that both anatomical structures and tissue physiology are kept in good conditions, with appropriate indication and techniques for good implant stability.