Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada / Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis

Background: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. Aim: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. Material and Methods: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Results: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Conclusions: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

[Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis]. / Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada.

BACKGROUND: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. AIM: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. MATERIAL AND METHODS: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. RESULTS: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. CONCLUSIONS: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

Evaluación de un nuevo método de remoción quirúrgica de implantes oseointegrados considerados en fallo / Evaluation of a new surgical removal method of failed integrated implants

OBJETIVO El objetivo del presente estudio descriptivo es la valoración de un nuevo método de remoción de implantes oseointegrados bajo una técnica mínimamente invasiva. MATERIALES Y MÉTODOS El estudio fue desarrollado sobre un grupo de 66 implantes oseointegrados de conexión interna y externa diagnosticados en falla, a los cuales se les indicó su remoción quirúrgica por presentar un diagnóstico radiográfico de pérdida ósea periimplantaria, mal posicionamiento quirúrgico con imposibilidad de rehabilitación protésica o daño del elemento de retención protésico del implante. El procedimiento quirúrgico, el cual es de carácter ambulatorio, fue llevado a cabo en un pabellón bajo anestesia local. Como primera opción de remoción quirúrgica, el procedimiento consistió en la utilización de instrumental de remoción a contra-torque, sin la apertura de un colgajo de espesor total, y como segunda opción de remoción quirúrgica la utilización de una fresa trefina, para lo cual fue necesario realizar un colgajo de espesor total que expusiera el lecho implantario. RESULTADOS Se removieron un total de 66 implantes oseointegrados, todos bajo la primera modalidad de remoción a contra-torque con el nuevo instrumento, sin colgajo y sin la necesidad de usar fresa trefina. CONCLUSIONES Con las limitaciones de este estudio preliminar planteamos que la utilización del nuevo instrumento de remoción a contra-torque de implantes oseointegrados en fallo se vislumbra como una muy buena alternativa de remoción quirúrgica mínimamente invasiva, disminuyendo los riesgos quirúrgicos del uso de una fresa trefina, el daño a los tejidos aledaños.

OBJECTIVE The aim of this study is the evaluation of a new removal method of osseointegrated implants under a minimally invasive technique. MATERIALS AND METHODS The study was conducted on a group of 66 osseointegrated internal and external connection implants that were considered unsuccesful. The surgical removal was indicated after radiologically confirming peri-implant bone loss, and poor positioning which made the prosthetic rehabilitation impossible, or would damage the prosthetic implant retainer. The surgical procedure was developed in an operating room under local anesthesia. As first surgical removal option, the procedure consisted of the use of a removal instrument that works against torque and which does not need a full thickness flap to reach the surgical site; and as a second surgical removal option a trephine bur was used. For this option, a full thickness flap was performed in order to expose the surgical site. RESULTS A total of 66 osseointegrated implants were removed under the first mode, with no full thickness flaps or Trephine burs required. CONCLUSIONS Within the limitations of this preliminary study, we propose that the use of this new, against torque, removal instrument of osseointegrated implants in failure is seen as a very good alternative to invasive surgical removal techniques, reducing surgical risks.

Synthesis of new antibacterial composite coating for titanium based on highly ordered nanoporous silica and silver nanoparticles.

Infection is the most common factor that leads to dental titanium implant failure. Antibacterial implant surfaces based on nano-scale modifications of the titanium appear as an attractive strategy for control of peri-implantitis. In the present work, the preparation and antibacterial properties of a novel composite coating for titanium based on nanoporous silica and silver nanoparticles are presented. Starch-capped silver nanoparticles (AgNPs) were synthesized and then incorporated into sol-gel based solution system. The AgNP-doped nanoporous silica coatings were prepared on titanium surface using a combined sol-gel and evaporation-induced self-assembly (EISA) method. The coating nanostructure was characterized by XRD, SEM-EDX, and HR-TEM. Antibacterial activity was evaluated against Aggregatibacter actinomycetemcomitans, a representative pathogen of dental peri-implantitis. Colony-forming units (CFUs) were counted within the biofilm and at the planktonic state. Biofilm development was quantified using crystal violet staining and viability of adherent bacteria was confirmed with the Live/Dead fluorescence assay. Silica-based composite coating containing AgNPs (AgNP/NSC) was prepared on titanium surface by direct incorporation of AgNP suspension into the sol-gel system. The self-assembly technique enabled the spontaneous formation of a highly ordered nanoporosity in the coating structure, which is a desired property for osseointegration aspects of titanium implant surface. AgNP/NSC coating produces a strong antibacterial effect on titanium surface by not only killing the adherent bacteria but also reducing the extent of biofilm formation. Biofilm survival is reduced by more than 70% on the AgNP/NSC-modified titanium surface, compared to the control. This antibacterial effect was verified for up to 7 days of incubation. The long-term antibacterial activity exhibited by the nanostructured AgNP/NSC-titanium surface against A. actinomycetemcomitans suggests that this type of nano-scale surface modification is a promissory strategy to control infections associated with dental implant rehabilitation.

Synthesis of nanostructured porous silica coatings on titanium and their cell adhesive and osteogenic differentiation properties.

Nanostructured porous silica coatings were synthesized on titanium by the combined sol-gel and evaporation-induced self-assembly process. The silica-coating structures were characterized by X-ray diffraction, transmission electron microscopy, scanning electron microscopy, and nitrogen sorptometry. The effect of the nanoporous surface on apatite formation in simulated body fluid, protein adsorption, osteoblast cell adhesion behavior, and osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs) is reported. Silica coatings with highly ordered sub-10 nm porosity accelerate early osteoblast adhesive response, a favorable cell response that is attributed to an indirect effect due to the high protein adsorption observed on the large-specific surface area of the nanoporous coating but is also probably due to direct mechanical stimulus from the nanostructured topography. The nanoporous silica coatings, particularly those doped with calcium and phosphate, also promote the osteogenic differentiation of hBMSCs with spontaneous mineral nodule formation in basal conditions. The bioactive surface properties exhibited by the nanostructured porous silica coatings make these materials a promising alternative to improve the osseointegration properties of titanium dental implants and could have future impact on the nanoscale design of implant surfaces.

Características físico-químicas da dieta líquida cafeinada / Physicochemical characteristics of the caffeinated liquid diet

Objetivo: Estudar as características físico-químicas de bebidas líquidas cafeinadas comercializados na cidade de João Pessoa, PB.Método: Produtos utilizados: Nescafé®, Santa Clara®, São Brás®, Pilão® (cafés); Dr. Oetker®, Madrugada®, Leão® (chás pretos); Coca Cola® , Coca Cola light lemon®, Coca Cola zero®, Coca Cola light® (refrigerantes de cola). O preparo das soluções foi convencionado a uma proporção de 0,8g do pó, medido em balança digital, no caso do café, e um sachê para o chá, utilizando 50ml de água destilada fervida para ambos. Os refrigerantes foram analisados naturalmente, após sua abertura. Utilizando-se pHmetro digital foram feitas as aferições dos valores de pH, logo após o preparo das amostras, sendo obtida a média das três medições para cada produto analisado. Procedeu-se a medição da ATT utilizando 5ml de cada produto, adicionando-se 100ml de água destilada e deionizada acrescida de 5 gotas de indicador fenoftale??na a 1%. Adicionou-se NaOH a 0,01 N à solução até atingir o ponto de viragem. A medição do Brix foi feita com auxílio de um refratômetro com faixa de leitura de ºBrix de 0~32% e precisão de 0,2, utilizando-se aproximadamente 2 gotas de cada produto. Os dados foram analisados descritivamente.Resultados: Os valores de pH, acidez e sólidos solúveis, para os cafés: variaram, respectivamente de 4,69 a 4,78, 0,07% a 0,09%, 1,0 a 2,0 ºBrix; para os chás: foram respectivamente de 4,81 a 4,93, 0,06% a 0,07%, 0,0 ºBrix; e para os refrigerantes obteve-se os respectivos resultados: de 2,33 a 2,83, 0,23% a 0,49%, 0,0 a 0,7 ºBrix.Conclusão: O pH de algumas bebidas cafeinadas é baixo, confirmado pelo valor encontrado para acidez, além disso, o açúcar presente nestas amostras contribui para agravar o potencial cariogênico e erosivo das mesmas.

[Use of UroLume as an alternative to the treatment of recurrent stenosis of bulbar urethra and obstructive prostatic hyperplasia in patients with high surgical risk]. / Uso del "UroLume" como alternativa en el tratamiento de la estenosis de uretra bulbar recidivante y la hiperplasia prostática obstructiva en pacientes con alto riesgo quirúrgico.

This device consists of a woven in a form of a tubular mesh, made up for the use in the urethra. We report the clinical and uroflujometric results in 10 patients with urethral stricture and 4 with obstructive prostatic hyperplasia. The study includes a 7 year period since October of 1993 up until June 2000. All patients were evaluated pre and post stent insertion with periodic follow ups to assess the prostatic symptoms score, quality of life assessment, peak urinary flow rate, mean flow rate and post-void residual urine volume. The results were the following: For the group with urethral stricture the I-PSS decreased from 26.8 to 5.4 points, the peak flow rate increased from 8.24 to 16.12 mL/sec and the post-void residual urine volume decreased from 42.7 to 31.6 mL. By 12-month follow-up most endoprostheses were 90% covered with urothelium, only one of these patients required stent extraction with no sphincter lesion. For the prosthatic hyperplasia group the I-PSS decreased from 20.2 to 8 points. The peak flow rate increased from 6.95 to 14.5 mL/sec and the post-void residual urine volume decreased from 49 to 18.3 mL. By 12-month follow-up two patients were 95% covered with epithelium, and the other two were 70%. There have not been significant problems related to infections, migration, incontinence or erectile disfunction. An 80% of patients have shown some irritative symptoms (urgency, frequency or dysuria) at least during the first month after stent insertion. These 7 year results suggest that Urolume urethral endoprostheses can be a long-term effective treatment alternative to these patients.