Ex vivo evaluation of four final irrigation protocols on the removal of hard-tissue debris from the mesial root canal system of mandibular first molars.

AIM: To evaluate the efficacy of four final irrigation protocols on the reduction of hard-tissue debris accumulated within the mesial root canal system of mandibular first molars using micro-CT analysis. METHODOLOGY: Forty mesial roots of mandibular molars with a single and continuous isthmus connecting the mesiobuccal and mesiolingual canals (Vertucci's Type I configuration) were selected and scanned at a resolution of 8.6 µm. Canals were enlarged sequentially using WaveOne Small and Primary instruments activated in reciprocating motion without intracanal irrigation to allow debris to accumulate within the mesial root canal system. Then, specimens were anatomically matched and distributed into four groups (n = 10), according to the final irrigation protocol: apical positive pressure (APP), passive ultrasonic irrigation (PUI), Self-adjusting File (SAF) and XP-endo Finisher (XPF). The final irrigation procedures were performed over 2 min using a total of 5.5 mL of 2.5% NaOCl per canal. Reconstructed data sets were coregistered, and the mean percentage reduction of accumulated hard-tissue debris after the final irrigation procedures was compared statistically between groups using the anovapost hoc Tukey test with a significance level set at 5%. RESULTS: Reduction of accumulated hard-tissue debris was observed in all groups after the final irrigation protocol. Overall, PUI and XPF groups had higher mean percentage reductions of accumulated hard-tissue debris (94.1% and 89.7%, respectively) than APP and SAF groups (45.7% and 41.3%, respectively) (P < 0.05). No significant differences were found when comparing the results of PUI and XPF groups (P > 0.05) or APP and SAF groups (P > 0.05). CONCLUSIONS: The PUI technique and XP-endo Finisher instrument were associated with significantly lower levels of AHTD compared with conventional irrigation and the modified SAF system protocol in mesial root canals of mandibular molars.

Group cognitive behavior therapy for bipolar disorder can improve the quality of life

Bipolar disorder (BD) can have an impact on psychosocial functioning and quality of life (QoL). Several studies have shown that structured psychotherapy in conjunction with pharmacotherapy may modify the course of some disorders; however, few studies have investigated the results of group cognitive behavior therapy (G-CBT) for BD. Our objective was to evaluate the effectiveness of 14 sessions of G-CBT for BD patients, comparing this intervention plus pharmacotherapy to treatment as usual (TAU; only pharmacotherapy). Forty-one patients with BD I and II participated in this study and were randomly allocated to each group (G-CBT: N = 27; TAU: N = 14). Thirty-seven participants completed the treatment (women: N = 66.67%; mean age = 41.5 years). QoL and mood symptoms were assessed in all participants. Scores changed significantly by the end of treatment in favor of the G-CBT group. The G-CBT group presented significantly better QoL in seven of the eight sub-items assessed with the Medical Outcomes Survey SF-36 scale. At the end of treatment, the G-CBT group exhibited lower scores for mania (not statistically significant) and depression (statistically significant) as well as a reduction in the frequency and duration of mood episodes (P < 0.01). The group variable was significant for the reduction of depression scores over time. This clinical change may explain the improvement in six of the eight subscales of QoL (P < 0.05). The G-CBT group showed better QoL in absolute values in all aspects and significant improvements in nearly all subscales. These results were not observed in the TAU control group.

Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4 percent in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95 percent; P = 0.001). The most common adverse events were drowsiness/fatigue (57 percent), memory/concentration difficulties (24 percent), and sexual dysfunction (11 percent) in the clonazepam group and drowsiness/fatigue (81 percent), sexual dysfunction (70 percent), and nausea/vomiting (61 percent) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.

Mas deficiency in FVB/N mice produces marked changes in lipid and glycemic metabolism.

OBJECTIVE: Metabolic syndrome is characterized by the variable coexistence of obesity, hyperinsulinemia, insulin resistance, dyslipidemia, and hypertension. It is well known that angiotensin (Ang) II is importantly involved in the metabolic syndrome. However, the role of the vasodilator Ang-(1-7)/Mas axis is not known. The aim of this study was to evaluate the effect of genetic deletion of the G protein-coupled receptor, Mas, in the lipidic and glycemic metabolism in FVB/N mice. RESEARCH DESIGN AND METHODS: Plasma lipid, insulin, and cytokine concentrations were measured in FVB/N Mas-deficient and wild-type mice. A glucose tolerance test was performed by intraperitoneally injecting d-glucose into overnight-fasted mice. An insulin sensitivity test was performed by intraperitoneal injection of insulin. Uptake of 2-deoxy-[(3)H]glucose by adipocytes was used to determine the rate of glucose transport; adipose tissue GLUT4 was quantified by Western blot. Gene expression of transforming growth factor (TGF)-beta, type 1 Ang II receptor, and angiotensinogen (AGT) were measured by real-time PCR. RESULTS: Despite normal body weight, Mas-knockout (Mas-KO) mice presented dyslipidemia, increased levels of insulin and leptin, and an approximately 50% increase in abdominal fat mass. In addition, Mas gene-deleted mice presented glucose intolerance and reduced insulin sensitivity as well as a decrease in insulin-stimulated glucose uptake by adipocytes and decreased GLUT4 in adipose tissue. Mas(-/-) presented increased muscle triglycerides, while liver triglyceride levels were normal. Expression of TGF-beta and AGT genes was higher in Mas-KO animals in comparison with controls. CONCLUSIONS: These results show that Mas deficiency in FVB/N mice leads to dramatic changes in glucose and lipid metabolisms, inducing a metabolic syndrome-like state.

Unicystic ameloblastoma: a possible pitfall in periapical diagnosis.

AIM: To report a clinical case of unicystic ameloblastoma previously misdiagnosed as radicular cyst. SUMMARY: A 49-year-old white male was referred to a private practitioner complaining of an asymptomatic bony hard swelling of the left posterior mandible. The patient's dental history indicated that his left mandibular first molar had been extracted approximately 10 years previously. At that time, preoperative radiographic examination demonstrated a radiolucent area of 1.5 cm diameter with well-defined margins involving the distal root of tooth 36. The lesion was diagnosed as cystic and surgery for its removal was advised, but not performed. At presentation, radiography demonstrated a well-defined 3 cm diameter radiolucency extending from the second premolar to the second molar. The lesion was enucleated and histopathological examination confirmed a diagnosis of unicystic ameloblastoma. KEY LEARNING POINTS: *Despite a clinical diagnosis of periapical disease of endodontic origin, a nonendodontic lesion may be present. *Unicystic ameloblastoma located on the periapical area of a tooth can lead to a pulp-periapical misdiagnosis, and should be considered in differential diagnosis. *All tissue specimens recovered in apical surgery should be submitted to histopathological analysis.

A comparative histological evaluation of the biocompatibility of materials used in apical surgery.

AIM: To evaluate the biological properties of a variety of materials that could be used in apical surgery. METHODOLOGY: The intraosseous implant technique recommended by the FDI (1980) and ADA (1982) was used to test the following materials: zinc oxide-eugenol (ZOE), mineral trioxide aggregate (MTA), and Z-100 light-cured composite resin. Thirty guinea-pigs, 10 for each material, divided into experimental periods of 4 and 12 weeks, received one implant on each side of the lower jaw symphysis. The connective tissue response alongside the lateral wall outside the cup served as a negative control for the technique. At the end of the observation periods, the animals were killed and the specimens prepared for routine histological examination to evaluate their biocompatibility. RESULTS: The reaction of the tissue to the materials diminished with time. The ZOE cement was highly toxic during the 4-week experimental period, but this profile changed significantly after 12 weeks, when it showed biocompatible characteristics. MTA and Z-100 showed biocompatibility in this test model at both time periods. CONCLUSIONS: MTA and Z-100 composite were biocompatible at 4 and 12 weeks in this experimental model.

Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

The aim of the present study was to verify the sensitivity to the carbon dioxide (CO2) challenge test of panic disorder (PD) patients with respiratory and nonrespiratory subtypes of the disorder. Our hypothesis is that the respiratory subtype is more sensitive to 35 percent CO2. Twenty-seven PD subjects with or without agoraphobia were classified into respiratory and nonrespiratory subtypes on the basis of the presence of respiratory symptoms during their panic attacks. The tests were carried out in a double-blind manner using two mixtures: 1) 35 percent CO2 and 65 percent O2, and 2) 100 percent atmospheric compressed air, 20 min apart. The tests were repeated after 2 weeks during which the participants in the study did not receive any psychotropic drugs. At least 15 of 16 (93.7 percent) respiratory PD subtype patients and 5 of 11 (43.4 percent) nonrespiratory PD patients had a panic attack during one of two CO2 challenges (P = 0.009, Fisher exact test). Respiratory PD subtype patients were more sensitive to the CO2 challenge test. There was agreement between the severity of PD measured by the Clinical Global Impression (CGI) Scale and the subtype of PD. Higher CGI scores in the respiratory PD subtype could reflect a greater sensitivity to the CO2 challenge due to a greater severity of PD. Carbon dioxide challenges in PD may define PD subtypes and their underlying mechanisms

Sinais neurológicos menores no transtorno obsessivo compulsivo de inícios precoce e tardio: estudo piloto / Soft neurological signs in eorly and lite-onsel obsessive-compulsive disorder: pilot study

Investigamos a presenca de sinais neurologicos menores (SNM) em pacientes com transtorno obsessivo compulsivo (TOC), de "início precoce" e "início tardio" e sua correlaçao com características clínicas e terapêuticas. Vinte pacientes com TOC, sendo 10 de início precoce (idade média de início=11.10 anos) e 10 de início tardio (idade média de início de 41.70 anos) foram avaliados com as escalas Y-BOCS, CGI e uma escala elaborada pelos autores para avaliaçäo de SNM. Após a avaliaçäo neurológica, os pacientes foram tratados com inibidores da recaptaçäo da serotonima por 10 semanas. Dentre os 20 pacientes examinados,foram identificados um ou mais SNM em 12 (60 por cento), sendo seis pacientes pertencentes ao subgrupo de TOC de início precoce (n=10) e seis pacientes pertencentes ao subgrupo de TOC de início precoce (n=10) e seis pacientes pertencentes ao subgrupo de TOC de início tardio (n=10). Os sinais neurológicos mais comuns foram alteraçöes de fala/articulaçäo (em 36,4 por cento) e a impersistência de membros superiores (em 21,1 por cento). A presença de alteraçöes motoras as exame de SNM se correlacionou significativamente com maior gravidade das compulsöes (p=0,004). A presença de SNM näo se correlacionou com a resposta terapêutica. Concluímos que SNM säo frequentemente encontrados em pacientes com TOC, mas näo diferem em frequência entre o subgrupo de início precoce e de início tardio. A presença de SNM de motilidade se correlacionou com compulsöes mais graves

Dysthymia - Review - New Findings - Treatment Guindelines

Open trials with tricyclics, classical MAOIs or Lithium in dysthymia yielded a response rate in 45 per cent of subjects. A liong-term treatment of dysthymia with 276 patients treated during four years with eithermoclobemide,tranylcypromine or a combination of amitryptiline plus chlordiazepoxide is described. After discontinuation there was a relapse rate of 89.1 per cent. The controlled studies with tricycles, classical MAOIs, RIMAs, SSRs or benzamides showed that drugs well tolerated work better in dyathymia, due to the fact that the treatment has to be long-term. Sertraline was studied versus placebo or imipramine in primary dysthymia. Moclobemide, imipramine and polacebo were also studied in 315 patients. Mean doses were 650.0 mg-day of moclobemide, 203.2 mg-day of imipramine. Moclobemide and sertraline were both efficacious and well tolerated. In a long term treatment the clinician should assess the risk-benefit ratio. Dysthymic patients are very sensitive to unwanted effects and compliance is a serious issue

Avaliaçåo da eficácia, tolerabilidade e segurança da sertalina (50 mg a 200 mg) durante 8 semanas no tratamento de 150 pacientes ambulatoriais com depressåo maior / Evaluation of effectiveness, tolerance and safety of sertraline (50 mg to 200 mg) during 8 weeks in the treatment of 150 patients outpatients with major depression

Os resultados de um estudo multicêntrico, aberto e nåo comparativo, no qual foram avalaiados 150 pacientes com diagnóstico de depressåo maior de acordo com os critérios da DSM-III-R, såo relatados. Os pacientes selecionados foram inicialmente submetidos a um período simples-cego, durante 2 semanas. Após essa fase, aqueles que preenchiam os critérios de inclusåo e exclusåo iniciaram o tratamento com sertralina 50mg/dia que poderia ser aumentada gradualmente até 200mg/dia, incrementos de 50mg, e intervalos de no mínimo 2 semanas, caso a resposta ao tratamento fosse insatisfatória, segundo a avaliaçåo do investigador. O tratamento com sertalina mostrou-se altamente eficaz no alívio da depressåo. como também nos sintomas associados ao quadro depressivo como, ansiedade, transtornos do sono, agitaçåo ou inibiçåo psicomotora, trabalho e atividades, entre outros. Um total de 84,2 por cento dos pacientes responderam satisfatoriamente ao tratamento com sertralina em doses felíveis. Em relaçåo à tolerabilidade, um total de 54 por cento dos pacientes apresentaram algum efeito adverso ao longo do tratamento, porém estes efeitos foram geralmente de intensidade leve ou moderada e apenas 4,6 por cento dos pacientes interromperam o tratamento prematuramente devido à ocorrência de eventos adversos

Estudo retrospectivo de asmáticos crônicos em serviço de pneumologia / Retrospective study of chronic asthmatics in Pneumology Services

Foram analisados, retrospectivamente, dois grupos de asmáticos: grupo A (50 pacientes) e grupo B (17 pacientes) classificados de acordo com a utilizaçäo ou näo de corticóides, por tempo prolongado, durante o controle ambulatorial. Observou-se que os pacientes do grupo B (uso de corticóide) eram os mais gravemente acometidos, de acordo com a avaliaçäo dos seguintes parâmetros: internamentos mais freqüentes, acompanhamento ambulatorial por período mais longo e necessidade de maior número de medicamentos para controle adequado. O número relativamente alto (25 por cento) de pacientes, utilizando corticóide no controle ambulatorial, ressalta a necessidade de procedimentos mais objetivos, como monitorizaçäo de drogas e avaliaçäo periódica da funçäo pulmonar, dentre outros, como forma de diminuir este índice

Dados sobre 508 casos de doença do pânico e respostas ao tratamento com alprozolam, clomipramina, imipramina e tranilcipromina / Data about 508 cases of panic disorders and response of treatment with alprazolam, clomipramine, imipramine and tranylcypromine

Quinhentos e oito casos de Doenças do Pânico foram estudados. A evitaçäo fóbica está correlacionada freqüentemente aos ataques de pânico. Em apenas 23% dos pacientes, o diagnóstico de depressäo maior, no passado ou presente, foi dado. Em 238 casos, Alprazolam, Clomipramina, Imipramina e Tranilcipromina foram efetivos em doses mais baixas do que as citadas na literatura. Como cada uma das medicaçöes tem alguns inconvenientes específicos, nenhuma foi considerada superior às outras

Curso de psicofarmacoterapia:II - Antipsicoticos: indicacoes na esquizofrenia, escolha do medicamento, dose, associacao com outros medicamentos, tratamento de manutencao, forma "depot. / Psychopharmacotherapy course:II Antipsychotics: indications in schizophrenia, drug choice, dosage, combinations with others drugs, maintenance treatment, depot form

Os antipsicoticos agem preferencialmente nos sintomas produtivos da esquizofrenia.A escolha de um antipsicotico para um determinado caso deve ser feita a partir do perfil de acoes farmacologicas uma vez que sao equivalentes quanto a eficacia. A dose ideal varia muito de caso para caso e deve ser tateada procurando-se o maximo de efeitos terapeuticos com o minimo de efeitos indesejaveis. A dose unica diaria e pratica e pode ser empregada sempre que isto nao resultar em efeitos indesejados excessivos. A associacao com antiparkinsonianos nao deve ser uma rotina. O tratamento de manutencao evita novos surtos en 2/3 dos esquizofrenicos. A forma "depot" permite o tratamento de pacientes que nao tomam o medicamento. Tres casos clinicos sao apresentados

Curso de psicofarmacoterapia. IV - A doenca do panico. / Course of psychopharmacotherapy. IV - Panic disease

A doenca do panico, uma nova entidade clinica, caracteriza-se por ataques recorrentes de ansiedade, ricos em sintomas neurovegetativos. Sua independencia nosologica e justificada pela evolucao clinica, historia familiar, provas biologicas (injecao de lactato de sodio) e resposta terapeutica. No diagnostico diferencial, causas organicas e outras doencas psiquiatricas devem ser excluidas. Ha interessantes teorias biologicas e psicologicas para explica-la.O locus ceruleus "desregulado" pode explicar toda sintomatologia. Nos pacientes encontram-se varias manifestacoes de "ansiedade de separacao". A associacao com o prolapso da valvula mitral parece ser frequente. O tratamento com antidepressivos triciclicos ou inibidores da monoaminooxidase e altamente eficaz, bloqueando as crises em tres semanas. A psicoterapia tambem e importante para a melhora da evitacao fobica e para diminuir a vulnerabilidade a ansiedade de separacao

Avaliacao do emprego do cloxazolam em portadores de ansiedade moderada. / Evaluation of the use cloxazolam in patients with moderate anxiety

O cloxazolam, um novo ansiolitico benzodiazepinico, foi comparado com diazepam e com placebo no tratamento da ansiedade neurotica em 60 pacientes, de acordo com o metodo duplo-cego. A analise estatistica demonstrou que ambos os medicamentos sao eficientes e superiores no placebo. O cloxazolam foi muito bem tolerado.Como o cloxazolam revelou-se comparavel ao diazepam em termos de eficacia e tolerancia, ele passa a representar uma nova alternativa no tratamento da ansiedade