Photodynamic therapy for root canals infected with Enterococcus faecalis.

OBJECTIVE: The aim of this study was to investigate the effects of photodynamic therapy (PDT) on endodontic pathogens by evaluating the decrease in numbers of Enterococcus faecalis colonies in the canals of extracted human teeth. BACKGROUND DATA: Failure in endodontics is usually related to inadequate cleaning and disinfection of the root canal system. This is due to the establishment of microorganisms in areas where the instruments and chemical agents used during root canal preparation cannot eliminate them. PDT is a complementary therapeutic method that could be used to eliminate these remaining bacteria. PDT is a process in which radiation acts on a dye that is applied to the target organism, resulting in bacterial death. MATERIALS AND METHODS: Forty-six uniradicular teeth had their canals contaminated with bacteria and were incubated for 48 h at 35 degrees C. After that, the teeth were divided into a control group (CG) and a test group (TG). The 23 CG teeth did not undergo any intervention, whereas in the TG the teeth received a solution of 0.0125% toluidine blue for 5 min followed by irradiation using a 50-mW diode laser (Ga-Al-As) at a wavelength of 660 nm. Bacterial samples were taken before and after irradiation. In each of the samples, the number of colony-forming units (CFU) was counted. RESULTS: The mean decrease in CFU was 99.9% in the TG, whereas in the CG an increase of 2.6% was observed. CONCLUSION: PDT was effective as a bactericidal agent in Enterococcus faecalis-contaminated root canals.

[Cyclosporine induced gingival hyperplasia in kidney transplants]. / Hipertrofia gengival em transplantados renais.

OBJECTIVE: Assess the influence of cyclosporine on the gingival growth of 60 patients with kidney transplant through a research carried out at the Hospital Cajuru in Curitiba, (April to October of 2002). METHODS: Regardless of age, gender, ethnic or social condition, all patients received cyclosporine daily and had, at least, one dental segment. They monthly returned to the Hospital for medical control and for several laboratory exams, among them the cyclosporine serum level. This permitted observation of these cases, especially with respect to the reaction of gingival growth. Clinical dental exams of the patients comprised filling out a form on their personal data, height and weight and number of dental segments. Also an observation of the degree of the gingival and bacterial plaque index was recorded. These data were treated statistically. RESULTS: Of the patients treated only with cyclosporine, 47.2% showed no alterations of the gingival structure while 52.8% presented gingival growth, of them 33.3% with a > 2 degree. Of the patients treated with both cyclosporine and nifedipine, 33.3% had a normal gingiva and 66.7% presented gingival growth. In 45.8% of them, the alteration was of > 2 degree, with no significant difference between results of the male and female patients. A positive correlation between excess fat and the corrected cyclosporine dose and serum concentration per unit of Body Mass Index was found, also between excess fat and the bacterial plaque index. A significant association between the extent of increased gingival growth and the bacterial plaque index was also observed. CONCLUSION: Use of cyclosporine when associated with nifedipine brings about an increase of gingival growth.

[Serum and salivary immunoglobulin A levels in patients with cancer of the mouth and oropharynx]. / Níveis sérico e salivar de imunoglobulina A em portadores de câncer da boca e orofaringe.

OBJECTIVE: Patients carriers of head and neck cancer (HNC) may show changes in concentrations of serum and salivary IgA owing to an inespecific immunologic disorder that follows the development of malignant lesions. PURPOSE: Evaluate the serum and salivary IgA levelS in Patients With Hnc. METHODS: A prospective study based on a sample of 34 patients with squamous cell carcinoma of the mouth and oropharynx and 34 normal control cases, matched by sex and age. Blood and saliva samples were collected at the same time and assayed for IgA by nephelometry and single radial immunodiffusion (RID). Statistical analysis included Student t Test, ANOVA and Pearson correlation index. RESULTS: The differences between nephelometry and RID could not be detected (p=0.039). The serum concentrations of IgA were 279.4 +/- 131.7 mg/dl and 310.9 +/- 194.1 mg/dl for control and study groups, respectively. Concerning salivary IgA, levels obtained by nephelometry were 17.0 +/- 10.4 mg/dl for control cases and 7.2 +/- 5.0 mg/dl for cancer cases and RID showed concentrations of 13.7 9.1 mg/dl and 5.6 +/- 4.2 mg/dl for control and study group, respectively. There were no significant correlations between serum or salivary IgA levels and age or disease stage. CONCLUSION: Patients carriers of HNC and control subjects showed similar serum concentrations of IgA but it was found that salivary IgA levels were reduced in cancer patients. Causes associated with decreased salivary IgA levels like malnutrition, stress and tobacco could be related to these findings.

Authorship for scientific papers: the new challenges.

The dissemination of the practice of collaborative authorship (coauthorship) in Brazil and in the international scientific community has been accompanied by an increasing occurrence of frauds, manipulations and other deviations in the assignment of responsibility for a scientific paper. This article discusses the criteria for authorship attribution, the reasons for the growing indices of coauthorship and the challenges to determine authorship in electronic journals. Through literature review and case study (bibliographic search in scientific database), it shows ways to avoid that "misbehaviors" related to the authorship attribution affect the credibility of science.

[Evaluation of palpebral subtarsal approach in surgical treatment of orbito-zigomatic fractures]. / Avaliação da abordagem palpebral subtarsal no tratamento cirúrgico das fraturas zigomático-orbitais.

OBJECTIVE: To evaluate the complications, advantages and disadvantages of the subtarsal approach when used to exposure the orbital rim and orbital floor in orbitozygomatic fractures. METHODS: Retrospective study of the 41 subtarsal incisions that were used in 39 patients with fractures of the zygomatic complex and/or orbital floor, of blowout type, between January 2002 and December 2006. RESULTS: The observed complications were conjunctivitis, epiphora and noticeable scar, in six (14,6%), five (12,2%) and two (4.9%) of the cases, respectively. There was no ectropion, entropion or scleral show in the patients reevaluated. CONCLUSIONS: The main advantages of this approach are the esthetic result together with the transoperative benefits.

Social integration and inclusion after pre-maxilla surgical repositioning in patients with bilateral cleft palate and lip.

UNLABELLED: Bilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration and interaction for these patients. AIM: (A) to assess motivations and expectations Treatment-wise and (B) to assess social inclusion and integration brought about by the surgery. MATERIALS AND METHODS: retrospective observational study involving 50 participants recruited among the patients submitted to the pre-maxilla repositioning procedure from January of 2003 to July of 2005 at the Centro de Atendimento Integral ao Fissurado Lábio-Palatal in Curitiba (CAIF), Paraná, and an assessment questionnaire was used. RESULTS: as far as the care protocol is concerned, results show a 90% success rate of surgeries. As to surgical and personal satisfaction rates are concerned, 76% sought treatment for personal satisfaction reasons and 86% reported having had more self-confidence after the surgery. CONCLUSIONS: Most of the patients submitted to the maxilla repositioning saw surgery as a continuation of the care previously given, with the expectation of better looks and self-confidence and, 96% of them were pleased with the results attained, which facilitated their social inclusion and re-integration.

[Epidemiologic study of mandible fractures in a public hospital of São Paulo]. / Estudo epidemiológico das fraturas mandibulares em hospital público da cidade de São Paulo.

OBJECTIVE: To analyze the frequency epidemiological description of mandibular fractures correlating gender, age, etiological factors, anatomic location, and types of fracture's traces. METHODS: A retrospective survey of the medical history of 883 patients with facial fractures, attended at the Buco-Maxilo-Facial Surgery and Traumatology Service of the Hospital Geral de Vila Penteado in São Paulo (São Paulo - Brazil), in a period of 3 years (from January 2004 to December 2006). RESULTS: From 883 patients evaluated, 270 presented mandibular fracture (30,5%). The male gender was the most affected (76,7%) in the age of 20 to 29 years (33,0%), the most frequent etiological factor was the car accident (35,2%), the body of the mandible was the most affected anatomic location (47,4%) and the single traces prevailed (76,7%). CONCLUSION: The majority of the fractures were simple, located in the body of the mandible, and higligted in males, aged from 20 t0 29 years, and caused by car accident.

[Risk factors for distant metastasis in head and neck cancer]. / Fatores de risco para metástases à distância no câncer de cabeça e pescoço.

OBJECTIVE: To identify risk factors for the development of distant metastasis (MD) among patients with head and neck squamous cell carcinoma (SCC) surgically treated. METHODS: A retrospective study of 253 patients from January, 1997 to December, 2002 was performed. Out of them, 10 patients presented DM during the follow up. The following aspects were analyzed: gender, age, tumor primary site, TNM classification, cervical lymph node status, and the presence of extracapsular spread - gross or microscopic. RESULTS: The survival average for the patients with DM, after finishing the oncological treatment, was 16 months (standard deviation = 2.256). The presence of both gross extracapsular spread (Odd ratio = 14.429) and the microscopic one (OR = 17.471) and the both the neck advanced pathological staging (OR = 4.409) and the primary tumor staging (RR = 2.929) presented statistical significance as risk fators for the occurrence of DM. CONCLUSION: The risk factors for DM were: microscopic and gross extracapsular spread, the pathological presence of positive neck lymph node and advanced primay tumor.

Predictive factors for temporary defunctioning stoma permanence in the treatment of rectal adenocarcinoma / Fatores preditivos da permanência do estoma derivativo temporário no tratamento do adenocarcinoma de reto

PURPOSE: determine the predictive factors for non-closure of defunctioning stoma in the low anterior resection for the treatment of rectal adenocarcinoma. METHODS: a retrospective cohort study of patients undergoing low anterior resection with defunctioning stoma for a period of nine years was performed. We compared, using univariate and multivariate analysis, the group that closed the defunctioning stoma (Group A) with the group that did not (Group B). RESULTS: eighty-one patients were analyzed; mean age was 61 ± 11 years, with a predominance of women (55.6%). Middle rectal tumors (66.6%), pT3 (59.2%) and pN0 (71.6%) were the most frequent. Stapled anastomosis (65.4%), and loop colostomy (80.2%) were the procedures most frequently performed. Sixty-five patients (80.2%) underwent stoma closure. The mean time for closure was 8.7 ± 4.4 months. The independent risk factors for non-closure of defunctioning stoma were complications of the anastomosis (p = 0.008) and follow-up complications (p = 0.007). CONCLUSION: complications with anastomosis and during the follow-up are factors that may justify a permanent stoma after low anterior resection for treatment of rectal adenocarcinoma. (AU)

OBJETIVO: determinar quais os fatores preditivos de não fechamento do estoma desfuncionalizante na retossigmoidectomia anterior para tratamento do adenocarcinoma de reto. MÉTODO: estudo de Coorte retrospectivo dos pacientes submetidos a retossigmoidectomia anterior e estoma derivativo em período de nove anos. Comparou-se o grupo que fechou o estoma derivativo (Grupo A) com o grupo que não fechou (Grupo B) através de análise uni e multivariada. RESULTADOS: foram estudados 81 pacientes, cuja média de idade foi de 61 ± 11 anos, com predomínio de mulheres (55,6%). Tumor de reto médio (66,6%), pT3 (59,2%) e pN0 (71,6%) foram os mais freqüentes. A anastomose mecânica foi a mais realizada (65,4%), assim como transversostomia em alça (80,2%). Sessenta e cinco pacientes (80,2%) fecharam o estoma. O tempo médio de fechamento foi 8,7 ± 4,4 meses. Os fatores de risco independentes de não fechamento do estoma foram complicações da anastomose (p = 0,008) e do seguimento (p = 0,007). CONCLUSÃO: complicações da anastomose e do seguimento são fatores que podem justificar a permanência do estoma pós-retossigmoidectomia para tratamento do adenocarcinoma retal. (AU)

Cephalometric deviations present in children and adolescents with temporomandibular joint disorders

INTRODUCTION: Temporomandibular disorders (TMD) have proved to be a risk factor for developing hyperdivergent facial growth patterns. OBJECTIVE: The aims of this study were: (1) Assess differences between the cephalometric measurements in children with articular TMD and a control group, before and after mandibular growth peak according to cervical vertebral maturation; and (2) Identify a predictive model capable of differentiating patients with TMD and control group patients based on early cephalometric characteristics. METHOD: The study included children and adolescents with maximum age of 17 years, divided into experimental group (n=30) diagnosed with articular TMD-according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for children and adolescents-subdivided according to growth stage, called pre-peak (n=17) and post-peak (n=13) and control group (n = 30), matched by gender, skeletal maturity stage of the cervical vertebrae and classification of malocclusion. Lateral cephalometric and craniofacial structures were traced and their relations divided into: Cranial base, maxilla, mandible, intermaxillary relations, vertical skeletal relations and dental relations. Differences between the means for each variable were evaluated by applying the statistical Student t test for independent samples. RESULTS: The means of the variables analyzed in the pre-peak showed no statistically significant differences. However, analysis of post-peak showed that the experimental group displayed decreased SNA and SNB and increased SN.Gn and 1.NB (p<0.05). CONCLUSION: It was possible to identify a predictive model able to differentiate patients with TMD and asymptomatic controls from early cephalometric characteristics.

Early cephalometric characteristics in Class III malocclusion

OBJECTIVE: Early identification of craniofacial morphological characteristics allows orthopedic segmented interventions to attenuate dentoskeletal discrepancies, which may be partially disguised by natural dental compensation. To investigate the morphological characteristics of Brazilian children with Class III malocclusion, in stages I and II of cervical vertebrae maturation and compare them with the characteristics of Class I control patients. METHODS: Pre-orthodontic treatment records of 20 patients with Class III malocclusion and 20 control Class I patients, matched by the same skeletal maturity index and sex, were selected. The craniofacial structures and their relationships were divided into different categories for analysis. Angular and linear measures were adopted from the analyses previously described by Downs, Jarabak, Jacobson and McNamara. The differences found between the groups of Class III patients and Class I control group, both subdivided according to the stage of cervical vertebrae maturation (I or II), were assessed by analysis of variance (ANOVA), complemented by Bonferroni's multiple mean comparisons test. RESULTS: The analysis of variance showed statistically significant differences in the different studied groups, between the mean values found for some angular (SNA, SNB, ANB) and linear variables (Co - Gn, N - Perp Pog, Go - Me, Wits, S - Go, Ar - Go). CONCLUSION: Assessed children displaying Class III malocclusion show normal anterior base of skull and maxilla, and anterior positioning of the mandible partially related to increased posterior facial height with consequent mandibular counterclockwise rotation.

Autoria em artigos científicos: os novos desafios / Authorship for scientific papers: the new challenges

A disseminação da prática de coautoria no Brasil e na comunidade internacional tem sido acompanhada pelo aumento no registro de fraudes, manipulações e outros desvios ao definir a responsabilidade por um trabalho científico. Este artigo discorre sobre os critérios utilizados para atribuição da autoria, as razões para o crescimento dos índices de coautoria e os desafios para estabelecer a autoria em periódicos eletrônicos. Por meio de revisão bibliográfica e estudo de caso (a partir de levantamento de base de dados), aponta caminhos para evitar que "desvios de comportamento" quanto à atribuição de autoria abalem a credibilidade da ciência.

The dissemination of the practice of collaborative authorship (coauthorship) in Brazil and in the international scientific community has been accompanied by an increasing occurrence of frauds, manipulations and other deviations in the assignment of responsibility for a scientific paper. This article discusses the criteria for authorship attribution, the reasons for the growing indices of coauthorship and the challenges to determine authorship in electronic journals. Through literature review and case study (bibliographic search in scientific database), it shows ways to avoid that "misbehaviors" related to the authorship attribution affect the credibility of science.

Fatores de risco para metástases à distância no câncer de cabeça e pescoço / Risk factors for distant metastasis in head and neck cancer

OBJETIVO: Identificar os fatores de risco para o desenvolvimento de metástase à distância (MD) entre pacientes com câncer de cabeça e pescoço cirurgicamente tratados. MÉTODOS: Realizou-se estudo retrospectivo de 253 pacientes entre janeiro de 1997 e dezembro de 2002. Deles, 10 desenvolveram MD durante o seguimento. Foram avaliados: gênero, idade, sítio primário, classificação TNM, nível de doença linfonodal e presença de invasão extracapsular macro ou microscópica. RESULTADOS: A média de sobrevida para pacientes com MD, a partir da finalização do tratamento oncológico, foi de 16 meses (com desvio-padrão de 2,256 meses). A presença de invasão extracapsular macro (risco relativo = 14,429) e microscópica (RR = 17,471) e os estadiamentos patológicos avançados cervical (RR = 4,409) e do tumor primário (RR = 2,929) apresentaram significado estatístico como fatores de risco para MD. CONCLUSÃO: Os fatores de risco para o surgimento de MD foram: invasão extracapsular macro e microscópica, presença de linfonodo positivo à avaliação histopatológica e tumor primário avançado.

OBJECTIVE: To identify risk factors for the development of distant metastasis (MD) among patients with head and neck squamous cell carcinoma (SCC) surgically treated. METHODS: A retrospective study of 253 patients from January, 1997 to December, 2002 was performed. Out of them, 10 patients presented DM during the follow up. The following aspects were analyzed: gender, age, tumor primary site, TNM classification, cervical lymph node status, and the presence of extracapsular spread - gross or microscopic. RESULTS: The survival average for the patients with DM, after finishing the oncological treatment, was 16 months (standard deviation = 2.256). The presence of both gross extracapsular spread (Odd ratio = 14.429) and the microscopic one (OR = 17.471) and the both the neck advanced pathological staging (OR = 4.409) and the primary tumor staging (RR = 2.929) presented statistical significance as risk fators for the occurrence of DM. CONCLUSION: The risk factors for DM were: microscopic and gross extracapsular spread, the pathological presence of positive neck lymph node and advanced primay tumor.

Avaliação da abordagem palpebral subtarsal no tratamento cirúrgico das fraturas zigomático-orbitais / Evaluation of palpebral subtarsal approach in surgical treatment of orbito-zigomatic fractures

OBJETIVO: avaliar as complicações, vantagens e desvantagens da abordagem subtarsal quando utilizada para exposição da borda infra-orbital e do assoalho da órbita em fraturas zigomático-orbitais. MÉTODOS: Estudo retrospectivo de 41 incisões subtarsais empregadas em 39 pacientes com fraturas do complexo zigomático e/ou do assoalho da órbita do tipo blow-out, no período de janeiro de 2002 a dezembro de 2006. RESULTADOS: As complicações observadas foram conjuntivite, epífora e cicatriz aparente em seis (14,6 por cento), cinco (12,2 por cento) e dois (4,9 por cento) dos casos, respectivamente. Não houve presença de ectrópio, entrópio ou esclera aparente nos pacientes reavaliados. CONCLUSÃO: As principais vantagens dessa abordagem são os resultados estéticos e funcionais associados aos benefícios trans-operatórios.

OBJECTIVE: To evaluate the complications, advantages and disadvantages of the subtarsal approach when used to exposure the orbital rim and orbital floor in orbitozygomatic fractures. METHODS: Retrospective study of the 41 subtarsal incisions that were used in 39 patients with fractures of the zygomatic complex and/or orbital floor, of blowout type, between January 2002 and December 2006. RESULTS: The observed complications were conjunctivitis, epiphora and noticeable scar, in six (14,6 percent), five (12,2 percent) and two (4.9 percent) of the cases, respectively. There was no ectropion, entropion or scleral show in the patients reevaluated. CONCLUSIONS: The main advantages of this approach are the esthetic result together with the transoperative benefits.

Social integration and inclusion after pre-maxilla surgical repositioning in patients with bilateral cleft palate and lip / A inclusão e a integração social pós-reposicionamento cirúrgico da pré-maxila em portadores de fissura lábio palatal bilateral

Bilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration and interaction for these patients. AIM: (A) to assess motivations and expectations Treatment-wise and (B) to assess social inclusion and integration brought about by the surgery. MATERIALS AND METHODS: retrospective observational study involving 50 participants recruited among the patients submitted to the pre-maxilla repositioning procedure from January of 2003 to July of 2005 at the Centro de Atendimento Integral ao Fissurado Lábio-Palatal in Curitiba (CAIF), Paraná, and an assessment questionnaire was used. RESULTS: as far as the care protocol is concerned, results show a 90 percent success rate of surgeries. As to surgical and personal satisfaction rates are concerned, 76 percent sought treatment for personal satisfaction reasons and 86 percent reported having had more self-confidence after the surgery. CONCLUSIONS: Most of the patients submitted to the maxilla repositioning saw surgery as a continuation of the care previously given, with the expectation of better looks and self-confidence and, 96 percent of them were pleased with the results attained, which facilitated their social inclusion and re-integration.

A fissura alveolar bilateral determina limitações funcionais e estéticas, determinando dificuldades de interação e integração no âmbito familiar e social. OBJETIVO: (A) avaliar as motivações e expectativas em relação ao tratamento e (b) avaliar a inclusão e integração social obtida pelo procedimento. MATERIAL E MÉTODO: Estudo observacional, retrospectivo em 50 participantes recrutados dentre os pacientes submetidos ao procedimento de reposicionamento de pré-maxila, no período de janeiro de 2003 a julho de 2005, no Centro de Atendimento Integral ao Fissurado Lábio-Palatal em Curitiba (CAIF), Paraná, sendo aplicado questionário de avaliação RESULTADOS: Com relação ao protocolo de atendimento, os resultados evidenciaram sucesso em 90 por cento das cirurgias. Quanto às expectativas cirúrgicas e de integração social, estas mostraram que 76 por cento procuraram tratamento em busca de satisfação pessoal e, 86 por cento relataram maior autoconfiança após a cirurgia. CONCLUSÕES: A maioria dos pacientes submetidos ao reposicionamento de maxila percebeu a avaliação pós-cirúrgica como continuidade dos cuidados dispensados previamente, com expectativa da aparência e melhora da autoconfiança e, 96 por cento deles manifestaram satisfação com os resultados obtidos, o que facilitou sua inclusão e reintegração social.

O impacto na qualidade de vida após o reposicionamento cirúrgico da pré-maxila em portadores de fissura lábio palatal bilateral - estudo de 50 casos / The life quality impact after surgical pre maxilla repositioning in patients with bilateral lip palatal cleft - study of 50 cases

OBJETIVO: Descrever o protocolo de tratamento no Centro de Atendimento Integral ao Fissurado Lábio-Palatal em Curitiba (CAIF); (b) avaliar as motivações e expectativas em relação ao tratamento e (c) avaliar a percepção de inclusão e integração social obtida pelo procedimento. MÉTODO: Estudo observacional, retrospectivo com todos os 50 participantes recrutados entre os pacientes submetidos ao procedimento de reposicionamento de pré-maxila, no período de janeiro de 2003 a julho de 2005, no Centro de Atendimento Integral ao Fissurado Lábio-Palatal em Curitiba (CAIF), Paraná. Foi aplicado questionário de avaliação RESULTADOS: Com relação ao protocolo de atendimento, os resultados evidenciaram sucesso em 90 por cento das cirurgias. Quanto às expectativas cirúrgicas e de integração social, estas mostraram que 76 por cento procuraram a cirurgia por motivos de insatisfação pessoal e, 86 por cento relataram maior confiança em si mesmo, após a cirurgia. CONCLUSÃO: O protocolo de reposicionamento cirúrgico da pré-maxila é uma técnica viável para o tratamento dos pacientes portadores de fissura bilateral do processo alveolar; a maioria dos pacientes submetidos ao tratamento de reposicionamento de pré-maxila percebeu o tratamento como continuidade dos cuidados dispensados, participou por indicação médica, com expectativa de melhora no aspecto pessoal e melhora da autoconfiança e, 96 por cento deles, manifestaram satisfação com os resultados obtidos, o que facilita a inclusão e integração social dos mesmos.

ABSTRACT BACKGROUND: To describe the assistance protocol, at the Center for Integral Assistance of Cleft Lip and Palate Patients (CAIF); to assess the expectations and motivations in respect to treatment; to evaluate the social integration and inclusion obtained through the procedure. METHODS: a retrospective study with all the 50 patients recruited among those submitted to the procedure of premaxilla repositioning, at the period from January 2003 to july 2005, at the Center for Integral Assistance of Cleft Lip and Palate Patients (CAIF), Paraná. A questionnaire was applied. RESULTS: regarding the assistance protocol, the results showed success in 90 percent of surgeries. Concerning surgical and social integration expectations, it was showed that 76 percent looked after surgery for personal satisfaction reasons and, 86 percent related better self trust after surgery. CONCLUSION: the surgical protocol of premaxilla repositioning is a viable technique for the treatment of patients with bilateral cleft of the alveolar process; the majority of patients submitted to premaxilla repositioning perceived the treatment as continuity of the care received, participated due to medical indication, expecting improvement at personal aspect and in self trust and, 96 percent of them, related satisfaction with results, which facilitates integration and social inclusion.

Tratamento cirúrgico das fraturas subcondilares: avaliação da abordagem retromandibular de hinds / Surgical treatment for sub-condylar fractures: analysis of hinds retromandibular approach

OBJETIVO: Avaliar retrospectivamente os resultados dos procedimentos terapêuticos cirúrgicos, através da abordagem retromandibular de Hinds, no tratamento das fraturas subcondilares. MÉTODO: o protocolo foi observacional, transversal, retrospectivo com inclusão de 31 casos divididos em quatro grupos, de acordo com a lateralidade, desvio da fratura e associação de fraturas em outros sítios. O sucesso terapêutico foi classificado de acordo com a necessidade de tratamento fisioterápico e bloqueio, permanência de desvios ou lateralidade de abertura bucal, amplitude reduzida de abertura bucal (menos de 40 mm), presença de dor moderada à intensa ou ausência de redução da fratura e instabilidade da osteossíntese. Para avaliação dos fatores determinantes de sucesso foram incluídas as variáveis: gênero, idade, causa da fratura, lateralidade, desvio, fraturas associadas e localização das fraturas. O método estatístico utilizou tabelas de associação cruzada com análise pelo teste não paramétrico do qui-quadrado. Em todas as situações foi arbitrado um valor de significância de 5 por cento (p< 0,05). RESULTADOS: Encontrou-se uma resposta de sucesso total em 19 casos (61 por cento) e sucesso parcial em 12 casos (39 por cento). Não foram encontradas associações entre a resposta cirúrgica e as variáveis gênero, idade, causa da lesão e presença de fratura associada. Os casos com desvios laterais e bilateralidade da lesão obtiveram maior freqüência de sucessos parciais. CONCLUSÃO: Na amostra estudada, a abordagem retromandibular de Hinds para o tratamento das fraturas subcondilares, na maioria dos casos, teve sucesso total após o procedimento.

BACKGROUND: The absence of definitive studies about more suitable surgical approach for sub-condylar fractures supports an analysis on Hinds retromandibular approach along the treatment response assessment. METHOD: It was an observational, transversal, retrospective protocol including 31 cases divided in four groups accordingly to the laterality, fracture dislocation, and the association of fractures in other sites. The therapeutic success has been classified according to the need of physiotherapeutic treatment and blockage; dislocation persistence or laterality of buccal opening; reduced amplitude of buccal opening (less than 40mm); presence of moderate to severe pain; or absence of fracture reduction and instability of osteosynthesis. To assess the determinant success factors, the variables gender, age, fracture cause, laterality, dislocation, associated fractures, and fractures sites have been included. The statistic method consisted of cross-association tables with analysis using the non-parametric test, chi-square. In each situation, a significant value of 5 percent (p< 0.05) was attributed. RESULTS: We obtained total response success in 19 cases (61 percent) and partial success in 12 cases (39 percent). We found no association between surgical response variables such as gender, age, fracture cause, and presence of an associated fracture. Lateral dislocations and injury bilateralism have shown a higher frequency of partial success cases. CONCLUSION: The Hinds retromandibular approach showed therapeutic success in most cases with a comprehensive access for reduction of sub-condylar fractures, stable fixation and with no postoperative complications.

Concomitância da tireoidite de Hashimoto e o carcinoma diferenciado da tireóide / Concomitance of Hashimoto's thyroiditis and differentiated thyroid cancer

OBJETIVO: Avaliar a associação da tireoidite auto-imune e o carcinoma diferenciado da tireóide na Santa Casa de Misericórdia de Goiânia-Goiás. MÉTODO: De 1395 tireoidectomias realizadas de 1994 a 2003, foram selecionadas 120 carcinomas diferenciados (27 foliculares e 93 papilíferos). Foram avaliadas as variáveis clínicas (idade e sexo) com apresentação de freqüências e de sumários de medidas-resumo na descrição estatística. Para aferir a associação de tireoidite auto-imune e carcinoma diferenciado da tireóide em função dos achados histopatológicos, utilizou-se tabelas de contingência e análise pelo teste não paramétrico do quiquadrado de Pearson. Em todos os testes estatísticos foi adotado um nível de significância de 5 por cento (p<0,05). RESULTADOS: 11,1 por cento dos carcinomas foliculares e 18,3 por cento dos carcinomas papilíferos estão associados à tireoidite auto-imune. Existe uma relação de freqüências quatro vezes maior da tireoidite auto-imune com o carcinoma diferenciado da tireóide em comparação com outras doenças tireoideanas (16,7 por cento X 3,6 por cento). CONCLUSÕES: Tais resultados permitem inferir que a associação entre a tireoidite auto-imune e o carcinoma diferenciado da tireóide é mais que casual, exigindo uma observação clínico-laboratorial cuidadosa nos portadores da doença auto-imune.

BACKGROUND: In spite of the controversial statistical relationship, the association of Hashimoto thyroiditis and differentiated carcinoma seems to be increasing. OBJECTIVE: To assess the association of Hashimoto thyroidites and differentiated carcinoma at Santa Casa de Misericórdia de Goiânia, Goiás. METHODS: From 1395 thyroidectomies performed from 1994 to 2003, 120 differentiated carcinoma (27 folicular and 93 papillary) were selected, analyzing clinical features (age and gender) with presentation of the frequency and a summary of measure resume in statistical description. For evaluation of auto-immune disease and differentiated carcinoma, contingence tables and analysis through non parametric test of Pearson K Square testwere employedc, with a level of significance of 5 percent (p less than 0.05 percent). RESULTS: We found a frequency of association of four times between Hashimoto thyroiditis and differentiated carcinoma of the thyroid in relation to others thyroid pathologies (16.7 percent versus 3.6 percent). CONCLUSION: These results allow us the conclusion that this association in not casual, suggesting a clinical and laboratorial follow up in patients with auto-immune diseases.

Hipertrofia gengival em transplantados renais / Cyclosporine induced gingival hyperplasia in kidney transplants

OBJETIVO: Avaliar os fatores associados ao crescimento gengival excessivo em transplantados renais. MÉTODOS: A pesquisa foi realizada no Hospital Cajuru de Curitiba, no período de abril a outubro de 2002, com a participacão de 60 transplantados renais, em uso diário de ciclosporina e com pelo menos um segmento dentário. O protocolo de ensaio foi observacional transversal. O exame odontológico dos indivíduos consistiu da avaliacão dos segmentos dentários com verificacão do grau de crescimento da gengiva e do índice de placa bacteriana. Todos os participantes preencheram questionário com dados relacionados ao transplante renal, realizaram coleta de material para controle do nível sérico de ciclosporina e foram avaliados quanto ao peso e altura. Na comparacão dos resultados de amostras categóricas, utilizou-se o teste do Qui-quadrado e a correlacão de classes de Spearman. O teste t foi aplicado na comparacão das variáveis contínuas. RESULTADOS: Em pacientes tratados somente com ciclosporina, 47,2 por cento não apresentavam alteracões da gengiva, enquanto 52,8 por cento cursaram com crescimento gengival, sendo 30,6 por cento com grau > 2. Nos pacientes tratados com ciclosporina e nifedipina, notou-se que 29,2 por cento tinham gengiva normal e 70,8 por cento apresentaram crescimento gengival, sendo que em 45,8 por cento o comprometimento foi grau > 2. Não foi observada diferenca significativa dos resultados entre os gêneros masculino e feminino. Foi encontrada correlacão positiva entre o índice de placa bacteriana e o volume gengival (r = 0,3295; p<0,01). CONCLUSAO: Em transplantados renais, a hipertrofia gengival está associada ao uso de ciclosporina, isoladamente ou em concomitância com bloqueadores de cálcio, e apresenta uma correlacão com o índice de placa bacteriana.

Edentulismo em mulheres idosas na pós-menopausa / Edentulism in post menopausal women

Introdução: A última metade do século XX caracterizou-se poruma melhoria nas condições de saúde bucal com reduções de30% na prevalência de cárie dentária e doenças periodontaisem vários países desenvolvidos e em desenvolvimento, assimcomo uma diminuição da perda dentária. Fatores sociaissão importantes determinantes de saúde e doença bucais ediferenças entre grupos sociais têm sido descritas em paísescom níveis socioeconômicos variados. Objetivo: Analisar osfatores associados com a perda dentária em mulheres idosas napós-menopausa segundo variáveis com nível socio econômico,escolaridade, etnia e doenças sistêmicas correlacionadas.Método: Participaram da pesquisa 116 mulheres na posmenopausa,acima de sessenta anos de idade as quais foram submetidas a um exame odontológico para avaliação do número de dentes presentes e responderam ao questionário com informações demográficas e de doenças sistêmicas. A análise estatística foi realizada por meio do teste não paramétrico do qui-quadrado. Resultados: 53,4% da população do estudo apresentava edentulismo e não foram observadas diferençassignificativas quanto à presença de perdas dentárias ou edentulismo em relação a etnia, escolaridade, renda familiar e doenças sistêmicas (p > 0,05). No grupo de mulheres mais velhas (+ 70 anos) foi observada uma prevalência maior de edentulismo (56,7%) em comparação com os outros grupos (60 a 65 anos - 21% e 66 a 70 anos - 22,6%). Conclusão: O edentulismo teve maior frequência na população mais idosa, com idade superior a 70 anos; não foi observada associação entre etnia, renda familiar ou escolaridade e a frequência de edentulismo; a presença de doenças sistêmicas não teve influência na distribuição de frequência do edentulismo.

Introduction: The last half of the 20th Century was poited by agreat improvement in oral health care. Reduction of 30% in theprevalence of dental caries and periodontal diseases can beobserved in several developed and underdeveloped countriesaround the world, as well as the improvement in the numberof teeth in elderly people. Social factor are important systemicand oral health determinants, and difference among socialgroups have been described in countries with the most variablesocioeconomic levels. Objective: To evaluate the risk factors thatcontribute to tooth loss in post menopause women, accordingto age, smoking, social and economic level, education, ethnicityand correlated systemic diseases. Method: 116 postmenopausalwomen, over the age of sixty, were submitted to odontologicexam, in which the number of teeth was counted and respondedto a sociodemographic and health questionnaire. Analyses ofcollected data were performed through non-parametric chi-squaretests. Results: Complete edentulousness was observed in 53.4%of population. There was not significant correlation between tooth loss or edentulism and sociodemographic factors or systemic illnesses (p > 0.05). Edentulism was more frequent (56.7%) in oldest subjects (+70 years) when compared to other groups (21% 60 to 65 years; 22.6% 66 to 70 years). Conclusion: Total edentulism was more frequent in aged people (+70 years), there were no evidence of an association between edentulous mouth and sociodemographic variables like educational level, ethnicity, familiar income or systemic illnesses.