New online management software and DICOM viewer for dentistry.

The way we collect, store, and share dental records of our patients is rapidly becoming digital. Many programs have been designed to run on a single computer or local network to handle various tasks, so selecting a system can be complex; it can require high acquisition costs, update fees, and installation difficulties. The purpose of this article is to explain the architecture, characteristics, and advantages related to Web-based Management Software. In particular, this article describes the first Web-based Electronic Medical Record (DocSapiens.com), which is able to view and edit DICOM files directly online.

Radiofrequency ablation of hepatocellular carcinoma in patients with and without cirrhosis.

INTRODUCTION: Hepatocellular carcinoma (HCC) is a leading cause of death in patients with cirrhosis. Around 12% of all cases are associated with chronic liver disease without cirrhosis. The aim of our study was to compare primary tumor ablation rates, local tumor progression, safety, and long-term outcomes of radiofrequency ablation for single (less than 3.5 cm in diameter) or multiple HCC nodules (up to three nodules, each less than 3 cm) in both types of patients. METHODS: We treated 200 consecutive HCC patients recruited from a local sonographic screening program: 175 with cirrhosis and 25 with non-cirrhotic chronic liver disease. RESULTS: Complete ablation was achieved in 150 of the 175 patients (85.7%) (174 of the 206 nodules treated, 84.4%) in the cirrhotic group and in 24 of the 25 patients (96%) (27 of the 29 nodules treated; 93%) in the non-cirrhotic group. The two groups were not significantly different in terms of local tumor progression rates 1, 3, and 5 years after treatment (11%, 23%, and 24% among cirrhotics vs. 4%, 14%, and 14% among non-cirrhotic patients). Multifocal disease was more frequent among the cirrhotics. One-, three- and five-year survival rates were also similar in the cirrhotic (93%, 77%, and 61%) and non-cirrhotic groups (92%, 72%, and 64%). There were no treatment-related deaths. Severe complications occurred only in the cirrhotic group (2.2%). CONCLUSIONS: Radiofrequency ablation is safe and effective treatment for HCC in patients with or without cirrhosis. The latter group has a significantly lower rate of multifocal disease.

Immediate (overnight) switching from carbamazepine to oxcarbazepine monotherapy is equivalent to a progressive switch.

This study compared immediate (overnight) and progressive switching to oxcarbazepine monotherapy in patients with partial seizures unsatisfactorily treated with carbamazepine monotherapy. Patients were randomised to either an overnight (n = 140) or a progressive switch (n = 146) from carbamazepine to oxcarbazepine monotherapy at a dose ratio of 1:1.5. The difference between the two switch groups in the mean monthly seizure frequency supported the equivalence of overnight and progressive switching (difference of 0.02 excluding outliers; 95% confidence interval (CI) -0.74, 0.78). Following the switch from carbamazepine to oxcarbazepine, there was a reduction in median monthly seizure frequency in both the overnight group (from 1.5 to 0; P = 0.0005) and the progressive group (from 1.0 to 0.4; P = 0.003). The proportion of seizure-free patients increased from 38 to 51% (P = 0.002) and 39 to 49% (P = -0.01) in the overnight and progressive groups, respectively. In addition, the proportion of patients experiencing no clinically significant adverse events did not differ between the two switch methods (difference of 2.5; 95% CI -4.1, 9.0). For patients who are unsatisfactorily treated with carbamazepine monotherapy, overnight switch to oxcarbazepine monotherapy is as effective and well tolerated as a progressive switch, therefore allowing simple and flexible individualised treatment. Switching to oxcarbazepine monotherapy appears to be beneficial for patients who are unsatisfactorily treated with carbamazepine monotherapy, independently of the switch method used.

[The most frequent neurologic disturbances. A contribution to the definition of topics for the programmatic content to the program of neurology in medical graduation]. / Transtornos neurológicos mais frequentes: contribuição para a definição de temas do conteúdo programático do curso de neurologia, para a graduação médica.

INTRODUCTION: Knowledge accumulation is overfilling the thematic content of medical graduation. Medical Schools must be alert to define a minimal content related with the most frequent disturbs. We intent to suggest topics for the minimal content, to the program of Neurology in medical graduation. METHOD: 1. To identify the places where young doctors are working outside the School Hospital (SH): we analysed the answers of the letters sent to 6415 resident - doctors (RD) in São Paulo's State and we made personal interview with 201 RD. 2. To verify the most frequent neuropsychiatric disturbs (ND) in the population: we made the analysis of the patient's diagnostic records in emergency room of three institutions: Municipal of Taubaté-SP, Municipal of São José dos Campos-SP and Faculty of Medicine of São Paulo Santa Casa de Misericórdia. RESULTS: 1. The RD are young and, outside the SH, they work in other emergency services. 2. The most frequent diagnosis in institutions were listed: alcoholism, cerebrovascular disease, coma, cranial trauma, dementia, dizziness, epilepsy, facial paralysis, faint, headache, hemiplegia or paraplegia, meningitis, others paralysis, periferical neuropathy and psychiatric disorders. CONCLUSIONS: Those diagnostics most frequent are relevant topics of the programmatic content to the program of Neurology in medical graduation.

[Perception of nurses about risk factors for nosocomial infection]. / Percepção das enfermeiras sobre fatores de risco para a infecção hospitalar.

A study was undertaken in a pediatric teaching hospital to evaluate the nurses understanding about risk factors for nosocomial infections. The data were obtained in interviews with nurses of the emergency room, intensive and semi-intensive units. The analysis of the meaning of the conversation permitted the identification of the following risk factors: inadequacy of the hospital design and construction, deficiency of care equipment and supplies, understaffing, lack of education and training to the healthcare workers and orientation to the patients family.

Anticonvulsive efficacy of flumazenil in the electroinduced seizures in the rabbit.

The anticonvulsive efficacy of flumazenil, a specific antagonist of the ligands of the benzodiazepine receptor, was studied in the experimental seizures induced by electrical stimulation of corpus Amygdaloideum and Cornu Ammonis dorsale of the hippocampus in rabbits. In the amygdaloid seizure model flumazenil raised the threshold and/or reduced the afterdischarge duration. Results observed in the seizures induced by stimulation of hippocampus were less consistent. Possible explanations are discussed.

[Role of pelvic phlebography in the study of prostatic carcinoma]. / Ruolo della flebografia pelvica nello studio del carcinoma della prostata

On the basis of previous reports on a possible correlation between phlebographic patterns and diseases of the prostatic gland, indications of the pelvic phlebography in the staging of the prostatic cancer are discussed, in order to carry out informations according to TNM system.