Relações entre a judicialização de cobertura e a incorporação de tecnologia na saúde suplementar: o caso dos quimioterápicos / Relations between coverage litigation and technological incorporation in supplementary private health insurance: a case study on chemotherapy

A negativa de cobertura de tratamentos é o principal fator que leva beneficiários de planos de saúde a buscar a justiça, e o motivo central alegado pelas empresas do setor para essa recusa é o fato do tratamento pleiteado não ser contemplado no Rol de Procedimentos e Eventos em Saúde da Agência Nacional de Saúde Suplementar. Este artigo analisou a incorporação de tecnologias em saúde no Brasil, especialmente no setor de saúde suplementar, e a regulação da cobertura de tratamento para câncer pelos planos de saúde, identificando possíveis influências, bem como o sentido da atuação do Poder Judiciário na incorporação de quimioterápicos na saúde suplementar. Para tanto, utilizaram-se dois bancos de dados que, somados, contêm informações sobre todos os acórdãos (1.368), proferidos em segunda instância entre 2015 e 2019 pelo Tribunal de Justiça do Estado de São Paulo, em ações judiciais ajuizadas na Comarca da Capital que demandaram tratamentos quimioterápicos contra operadoras de planos de saúde. Foram explorados em maior detalhe os casos dos dez quimioterápicos mais demandados no escopo considerado. Os resultados do estudo mostraram que, apesar da regulação setorial da saúde suplementar determinar a cobertura de sete dos dez quimioterápicos mais demandados, isso não impediu que ela fosse, ainda assim, negada aos beneficiários. Há, portanto, indicativos de que a atuação do Poder Judiciário, que julgou favoravelmente 96,3% das demandas analisadas, cumpre uma função de enforcement da regulação setorial da incorporação de tecnologias, em contraposição à hipótese de que seria uma via ilegítima para o acesso a tecnologias não cobertas. Trata-se, a partir dessa perspectiva, de uma importante instância de garantia do direito à saúde dos beneficiários de planos privados de saúde.

Coverage denial of health treatment is the leading cause of litigations against insurers, whose main reason alleged for such refusals is the fact that the requested treatment is not included in the List of Procedures and Events in Health of the Brazilian Regulatory Agency for Private Health Insurance and Plans. This paper analyzed the incorporation of health Technologies in Brazil, especially in supplementary private health insurance, and the regulation of câncer treatment coverage by health plans, identifying possible influences and the meaning of judicial rulings over the incorporation of chemotherapy technologies in supplementary private health insurance. For this purpose, the analysis used two databases, which together contain information on all judgements (1.368) issued between 2015 and 2019 by the São Paulo State Court of Justice on lawsuits filed in the capital's judicial district that required private chemotherapy coverage. Cases of the ten most required chemotherapeutics were explored in greater detail. Results showed that, although sectorial regulation determines that seven out of the ten most required chemotherapeutics be covered by insurers, this did not prevent coverage denial from happening. This indicates that the judicial rulings, which judged favorably 96.3% of the claims, fulfil an enforcement function regarding sectorial regulation on technology incorporation, as opposed to the hypothesis that judicialization would be an illegitimate via to access non-covered health technologies. From this perspective, judicialization is an important instance of guaranteeing the right to health for private health insurance beneficiaries.

Previous blood pressure measurement and associated factors in student adolescents.

OBJECTIVE: To identify prevalence of previous blood pressure measurement and analyze some associated factors in adolescents. METHODS: This cross-sectional study included 6,077 adolescents aged 14 to 19 years. Demographic characteristics included (sex, age, period of study, region of residence, work, skin color, and economic) status, history of blood pressure measurement within last 12 months, local of blood pressure measurement, and reading obtained. To assess associations between previous blood pressure measurement with demographic characteristics and high blood pressure we used descriptive statistics and logistic regression analysis. RESULTS: Out of the adolescents, 56.8% reported no blood pressure measurement within the last 12 months. The health centers and the physician's office were most mentioned places for blood pressure measurement (28.3% and 36.9%, respectively). Boys (odds ratio of 1.64 95%CI: 1.46-1.84) aged 14 to 16 years (odds ratio of 1.12; 95%CI: 1.01-1.25), whose economic status was unfavorable (odds ratio of 1.48; 95%CI: 1.32-1.67) were significantly associated with no blood pressure measurement. Working was a protective factor for was not blood pressure measurement (odds ratio of 0.84; 95%CI: 0.73-0.97). CONCLUSION: Most of adolescents did not have their blood pressure measured within the last 12 months. Boys aged 14 to 16 years and those with unfavorable economic status had higher chance of not having their blood pressure measured.

Previous blood pressure measurement and associated factors in student adolescents / Medida prévia da pressão arterial e fatores associados em adolescentes estudantes

Objective To identify prevalence of previous blood pressure measurement and analyze some associated factors in adolescents.Methods This cross-sectional study included 6,077 adolescents aged 14 to 19 years. Demographic characteristics included (sex, age, period of study, region of residence, work, skin color, and economic) status, history of blood pressure measurement within last 12 months, local of blood pressure measurement, and reading obtained. To assess associations between previous blood pressure measurement with demographic characteristics and high blood pressure we used descriptive statistics and logistic regression analysis.Results Out of the adolescents, 56.8% reported no blood pressure measurement within the last 12 months. The health centers and the physician’s office were most mentioned places for blood pressure measurement (28.3% and 36.9%, respectively). Boys (odds ratio of 1.64 95%CI: 1.46-1.84) aged 14 to 16 years (odds ratio of 1.12; 95%CI: 1.01-1.25), whose economic status was unfavorable (odds ratio of 1.48; 95%CI: 1.32-1.67) were significantly associated with no blood pressure measurement. Working was a protective factor for was not blood pressure measurement (odds ratio of 0.84; 95%CI: 0.73-0.97).Conclusion Most of adolescents did not have their blood pressure measured within the last 12 months. Boys aged 14 to 16 years and those with unfavorable economic status had higher chance of not having their blood pressure measured.

Objetivo Identificar a prevalência de medida prévia da pressão arterial no último ano e analisar alguns fatores associados a essa medida em adolescentes estudantes.Métodos Estudo transversal realizado com 6.077 adolescentes entre 14 e 19 anos. Foram coletados os dados demográficos (sexo, faixa etária, turno de estudo, região de residência, trabalho, cor da pele e situação econômica) e históricos da medida da pressão arterial nos últimos 12 meses, além do local em que essa medida foi realizada e o valor de pressão arterial. Foi utilizada análise descritiva e de regressão logística para avaliar as associações entre a medida prévia da pressão arterial e os dados demográficos e a pressão arterial elevada.Resultados No presente estudo, 56,8% responderam não ter medido a pressão arterial nos últimos 12 meses. O posto de saúde e a consulta médica foram os lugares mais mencionados (28,3% e 36,9%, respectivamente) em que foi realizada a medida da pressão arterial. Ser do sexo masculino (odds ratio de 1,64; IC95%: 1,46-1,84), ter idade entre 14 e 16 anos (odds ratio de 1,12; IC95%:1,01-1,25) e apresentar situação econômica desfavorável (odds ratio de 1,48; IC95%: 1,32-1,67) foram associados positivamente a não medição da pressão arterial. Trabalhar foi fator de proteção para não medição da pressão arterial (odds ratio de 0,84; IC95%: 0,73-0,97).Conclusão Elevado número de adolescentes não mediu pressão arterial nos últimos 12 meses. Rapazes, adolescentes com idade entre 14 e 16 anos e com situação econômica desfavorável apresentaram maior chance de não medir a pressão arterial.

Evolution of Skin Temperature after the Application of Compressive Forces on Tendon, Muscle and Myofascial Trigger Point.

Some assessment and diagnosis methods require palpation or the application of certain forces on the skin, which affects the structures beneath, we highlight the importance of defining possible influences on skin temperature as a result of this physical contact. Thus, the aim of the present study is to determine the ideal time for performing thermographic examination after palpation based on the assessment of skin temperature evolution. Randomized and crossover study carried out with 15 computer-user volunteers of both genders, between 18 and 45 years of age, who were submitted to compressive forces of 0, 1, 2 and 3 kg/cm2 for 30 seconds with a washout period of 48 hours using a portable digital dynamometer. Compressive forces were applied on the following spots on the dominant upper limb: myofascial trigger point in the levator scapulae, biceps brachii muscle and palmaris longus tendon. Volunteers were examined by means of infrared thermography before and after the application of compressive forces (15, 30, 45 and 60 minutes). In most comparisons made over time, a significant decrease was observed 30, 45 and 60 minutes after the application of compressive forces (p < 0.05) on the palmaris longus tendon and biceps brachii muscle. However, no difference was observed when comparing the different compressive forces (p > 0.05). In conclusion, infrared thermography can be used after assessment or diagnosis methods focused on the application of forces on tendons and muscles, provided the procedure is performed 15 minutes after contact with the skin. Regarding to the myofascial trigger point, the thermographic examination can be performed within 60 minutes after the contact with the skin.

Ventilação não invasiva na Insuficiência Cardíaca Associada à Apneia do Sono / Noninvasive Ventilation in Heart Failure Associated With Sleep Apnea

Este estudo teve por objetivo revisar a literaturaacerca da utilização da Ventilação Não Invasiva (VNI) comoum tratamento não farmacológico no cuidado respiratório aopaciente com síndrome da apneia do sono em pacientesassociada à Insuficiência Cardíaca (IC) grave. Material eMétodos: Trata-se de uma revisão integrativa da literatura. Aamostra foi constituída por 19 artigos de periódicos da áreada Saúde, disponibilizados nas bases de dados ScientificEletronic Library Online (SciELO), PubMED e Science Direct,publicados entre os anos de 1999 a 2012. Foi utilizada acombinação dos descritores: heart failure, noninvasiveventilation e sleep apnea syndromes. Resultados: A análisedos resultados foi efetiva mediante à técnica de análise doconteúdo. Deste modo, os trabalhos mostram que a VNI diminuios batimentos ventriculares prematuros, melhora a fraçãode ejeção do Ventrículo Esquerdo (VE), a Saturação dooxigênio no sangue arterial (SO2) e a apneia central eobstrutiva do sono. Além disso, contribui para a melhora daqualidade de vida e redução da mortalidade desses pacientes.Conclusão: Como contribuição, os diversos estudos apontamque os efeitos da utilização da VNI em pacientes com ICparecem promissores no tratamento do cardiopata estável,principalmente se este apresentar distúrbio do sonoconcomitante...

This study aimed to review the literature on theuse of Noninvasive Ventilation (NIV) as a nonpharmacologicaltreatment in respiratory care to patients withsleep apnea syndrome in cases associated with severe heartfailure (HF). Material and Methods: This is an integrativeliterature review comprising a sample 19 articles from journalsin the field of health, available from the databases ScientificElectronic Library Online (SciELO), PubMED and ScienceDirect, published between 1999 and 2012. A combination ofthe following descriptors was used: heart failure,noninvasive ventilation and sleep apnea syndromes. Results:Data were analyzed through the technique of contentanalysis. Studies have shown that NIV reduces prematureventricular beats; improves the ejection fraction of the leftventricle (LV), saturation of oxygen in arterial blood (SO2), aswell as central and obstructive sleep apnea. Moreover, itcontributes to improved quality of life and reduced mortalityin these patients. Conclusion: Various studies indicate thatthe effects of NIV in patients with HF seem to be promising inthe treatment of stable cardiac disease, especially in caseswith concomitant sleep disturbance...

Prevalence of high blood pressure in Brazilian adolescents and quality of the employed methodological procedures: systematic review / Prevalencia de pressao arterial elevada em adolescentes brasileiros e qualidade dos procedimentos metodologicos empregados: revisao sistematica

OBJECTIVE: To review the literature on studies that estimated the prevalence of high blood pressure (HBP) or systemic arterial hypertension (SAH) in Brazilian adolescents, considering the employed methodological procedures. METHODS: Bibliographical research of prevalence studies of HBP/SAH in adolescents from 1995 to 2010. The search was conducted in the electronic databases PubMed/Medline, Lilacs, SciELO, and Isi Adolec. The descriptors "hypertension", "BP", "teen", "students", "cross-sectional", "prevalence" and "Brazil" were used in Portuguese and English. Furthermore, a score ranging from 0 to 18 based on Recommendations for Blood Pressure Measurement in Humans and Experimental Animals and the VI Brazilian Guidelines of Hypertension was elaborated, in order to analyze the procedures used to measure BP in studies. RESULTS: Twenty-one articles were identified, mostly published in the last 10 years, and 90.5% were performed in school-based and regions of the Southeast, Northeast and South. The prevalence of HBP/SAH ranged from 2.5 to 30.9%. The score of the studies ranged from 0 to 16. A significant negative correlation (rho = -0.504; p = 0.020) was observed between the prevalence of HBP/SAH and the score of BP measurement quality. CONCLUSION: The great variability of PAE/SAH estimates appears to be influenced by methodological procedures used in the studies. .

OBJETIVO: Revisar a literatura sobre estudos que estimaram a prevalência de pressão arterial elevada (PAE) ou hipertensão arterial sistêmica (HAS) em adolescentes brasileiros, considerando os procedimentos metodológicos empregados. MÉTODOS: Pesquisa bibliográfica de estudos de prevalência de PAE/HAS em adolescentes de 1995 a 2010. A busca foi realizada nas bases de dados eletrônicos PubMed/Medline, Lilacs, SciELO, Isi e Adolec. Foram utilizados os descritores: "hipertensão", "pressão arterial", "adolescente", "estudantes", "estudos transversais", "prevalência" e "Brasil", nas línguas portuguesa e inglesa. Além disso, foi elaborado um escore, baseado nas Recommendations for Blood Pressure Measurement in Humans and Experimental Animals e nas VI Diretrizes Brasileiras de Hipertensão, para a análise dos procedimentos utilizados para medida da PA nos estudos variando de 0 a 18. RESULTADOS: Foram identificados 21 artigos, a maioria publicada nos últimos 10 anos, sendo 90,5% realizados em base escolar e nas regiões sudeste, nordeste e sul do país. As prevalências de PAE/HAS variaram de 2,5 a 30,9%. A pontuação dos estudos variou de 0 a 16. Foi observada uma correlação negativa significante (rho = -0,504; p = 0,020) entre a prevalência de PAE/HAS e o escore da qualidade da medida da PA. CONCLUSÃO: A grande variabilidade das estimativas da PAE/HAS parece ser influenciada pelos procedimentos metodológicos utilizados nos estudos. .

Prevalence of high blood pressure in Brazilian adolescents and quality of the employed methodological procedures: systematic review.

OBJECTIVE: To review the literature on studies that estimated the prevalence of high blood pressure (HBP) or systemic arterial hypertension (SAH) in Brazilian adolescents, considering the employed methodological procedures. METHODS: Bibliographical research of prevalence studies of HBP/SAH in adolescents from 1995 to 2010. The search was conducted in the electronic databases PubMed/Medline, Lilacs, SciELO, and Isi Adolec. The descriptors "hypertension", "BP", "teen", "students", "cross-sectional", "prevalence" and "Brazil" were used in Portuguese and English. Furthermore, a score ranging from 0 to 18 based on Recommendations for Blood Pressure Measurement in Humans and Experimental Animals and the VI Brazilian Guidelines of Hypertension was elaborated, in order to analyze the procedures used to measure BP in studies. RESULTS: Twenty-one articles were identified, mostly published in the last 10 years, and 90.5% were performed in school-based and regions of the Southeast, Northeast and South. The prevalence of HBP/SAH ranged from 2.5 to 30.9%. The score of the studies ranged from 0 to 16. A significant negative correlation (rho = -0.504; p = 0.020) was observed between the prevalence of HBP/SAH and the score of BP measurement quality. CONCLUSION: The great variability of PAE/SAH estimates appears to be influenced by methodological procedures used in the studies.

Environmental influences on antibody-enhanced dengue disease outcomes

Because an enriched environment (EE) enhances T-cell activity and T-lymphocytes contribute to immunopathogenesis during heterologous dengue virus (DENV) infections, we hypothesised that an EE increases dengue severity. To compare single serotype (SS) and antibody-enhanced disease (AED) infections regimens, serial intraperitoneal were performed with DENV3 (genotype III) infected brain homogenate or anti-DENV2 hyperimmune serum followed 24 h later by DENV3 (genotype III) infected brain homogenate. Compared AED for which significant differences were detected between the EE and impoverished environmental (IE) groups (Kaplan-Meyer log-rank test, p = 0.0025), no significant differences were detected between the SS experimental groups (Kaplan-Meyer log-rank test, p = 0.089). Survival curves from EE and IE animals infected with the AED regimen were extended after corticoid injection and this effect was greater in the EE than in the IE group (Kaplan-Meyer log-rank test, p = 0.0162). Under the AED regimen the EE group showed more intense clinical signs than the IE group. Dyspnoea, tremor, hunched posture, ruffled fur, immobility, pre-terminal paralysis, shock and death were associated with dominant T-lymphocytic hyperplasia and presence of viral antigens in the liver and lungs. We propose that the increased expansion of these memory T-cells and serotype cross-reactive antibodies facilitates the infection of these cells by DENV and that these events correlate with disease severity in an EE.

[Post-operative mediastinitis in a heart hospital of Recife: contributions for nursing care]. / Mediastinite pós-cirúrgica em um Hospital Cardiológico de Recife: contribuições para a assistência de enfermagem.

The objective of this study was to determine the prevalence of post-operative mediastinitis with the purpose to contribute to nursing care knowledge. To do this, an analysis was performed on 896 medical records of patients who underwent heart surgery involving sternotomy at the Cardiology Emergency Room of Recife-PE, in the period between June 2007 and June 2009. The following variables were considered: gender, age, type of surgery, personal history, length of stay, use of antibiotics, and culture of the surgical wound. A high death rate from mediastinitis was observed (33.3%). Several risk factors were identified, including: systemic arterial hypertension (80.9%); smoking (61.9%); diabetes mellitus (42.8%); and obesity (33.3%), most of which (76.2%) were identified in patients who underwent surgery for myocardial revascularization. It is concluded that mediastinitis is a serious infection that needs continuous nursing supervision and preventive measures to assure an early diagnosis and, thus, reduce mortality.

Mediastinite pós-cirúrgica em um Hospital Cardiológico de Recife: contribuições para a assistência de enfermagem / Post-operative mediastinitis in a heart hospital of Recife: contributions for nursing care / Mediastinitis postoperatoria en un hospital cardiológico de Recife: contribuciones para la atención de enfermería

O objetivo deste estudo foi determinar a prevalência de mediastinite pós-cirúrgica com o intuito de contribuir para a assistência de enfermagem. Para tanto, foi realizada a análise de 896 prontuários de pacientes submetidos à operação cardíaca com esternotomia no Pronto Socorro Cardiológico de Recife-PE,no período de junho de 2007 a junho 2009. As variáveis consideradas foram: sexo, idade, tipo de operação, antecedentes pessoais, tempo de internamento hospitalar, uso de antibióticos e cultura de ferida operatória. Observou-se alta letalidade por mediastinite (33,3%). Vários fatores de risco foram identificados no estudo, tais como: hipertensão arterial sistêmica (80,9%); tabagismo (61,9%); diabetes mellitus (42,8%) e obesidade (33,3%), sendo a maioria (76,2%) em pacientes submetidos à cirurgia de revascularização do miocárdio. Conclui-se que a mediastinite é uma infecção grave que necessita de supervisão contínua da enfermagem e medidas preventivas para o diagnóstico precoce e a diminuição da mortalidade.

The objective of this study was to determine the prevalence of post-operative mediastinitis with the purpose to contribute to nursing care knowledge. To do this, an analysis was performed on 896 medical records of patients who underwent heart surgery involving sternotomy at the Cardiology Emergency Room of Recife-PE, in the period between June 2007 and June 2009. The following variables were considered: gender, age, type of surgery, personal history, length of stay, use of antibiotics, and culture of the surgical wound. A high death rate from mediastinitis was observed (33.3%). Several risk factors were identified, including: systemic arterial hypertension (80.9%); smoking (61.9%); diabetes mellitus (42.8%); and obesity (33.3%), most of which (76.2%) were identified in patients who underwent surgery for myocardial revascularization. It is concluded that mediastinitis is a serious infection that needs continuous nursing supervision and preventive measures to assure an early diagnosis and, thus, reduce mortality.

Este estudio objetivó determinar la prevalencia de mediastinitis postoperatoria con la intención de contribuir a la atención de enfermería. Fueron analizadas 896 historias clínicas de pacientes sometidos a operación cardíaca con esternotomía en Urgencia Cardiológica de Pernambuco, en el período de junio 2007 a junio 2009. Las variables consideradas fueron: sexo, edad, tipo de operación, antecedentes personales, tiempo de internación hospitalaria, uso de antibióticos y cultivo de la herida operatoria. Se observó alta mortalidad por mediastinitis (33,3%). Fueron identificados en el estudio algunos de los factores de riesgo, tales como: hipertensión arterial sistémica (80,9%), tabaquismo (61,9%), diabetes mellitus (42,8%) y obesidad (33,3%), ocurriendo la mayoría (76,2%) en pacientes sometidos a cirugía de revascularización del miocardio. La mediastinitis es una infección grave que necesita de supervisión continua de enfermería y medidas preventivas para el diagnóstico precoz y disminución de la mortalidad.

Environmental influences on antibody-enhanced dengue disease outcomes.

Because an enriched environment (EE) enhances T-cell activity and T-lymphocytes contribute to immunopathogenesis during heterologous dengue virus (DENV) infections, we hypothesised that an EE increases dengue severity. To compare single serotype (SS) and antibody-enhanced disease (AED) infections regimens, serial intraperitoneal were performed with DENV3 (genotype III) infected brain homogenate or anti-DENV2 hyperimmune serum followed 24 h later by DENV3 (genotype III) infected brain homogenate. Compared AED for which significant differences were detected between the EE and impoverished environmental (IE) groups (Kaplan-Meyer log-rank test, p = 0.0025), no significant differences were detected between the SS experimental groups (Kaplan-Meyer log-rank test, p = 0.089). Survival curves from EE and IE animals infected with the AED regimen were extended after corticoid injection and this effect was greater in the EE than in the IE group (Kaplan-Meyer log-rank test, p = 0.0162). Under the AED regimen the EE group showed more intense clinical signs than the IE group. Dyspnoea, tremor, hunched posture, ruffled fur, immobility, pre-terminal paralysis, shock and death were associated with dominant T-lymphocytic hyperplasia and presence of viral antigens in the liver and lungs. We propose that the increased expansion of these memory T-cells and serotype cross-reactive antibodies facilitates the infection of these cells by DENV and that these events correlate with disease severity in an EE.

Conhecendo o HTLV e suas implicações no atendimento odontológico / Getting to know HTLV and their implications during dental care

Os vírus T Linfotrópico humano representam um grupo de retrovírus que possuem tropismo por linfócitos T e são transmitidos pelas vias parenteral, vertical e sexual. Foram identificados os tipos 1, 2, 3 e 4 sendo que o vírus T Linfotrópico humano -1 tem sido o mais associado ao desenvolvimento de doenças nos pacientes infectados. A estimativa global é de que 15 a 20 milhões de pessoas estejam infectadas pelo vírus T Linfotrópico humano -1. No Brasil o vírus é endêmico, apresentando o maior número absoluto de casos no mundo e sendo incluído na triagem hematológica realizada nos hemocentros. As principais doenças associadas ao vírus T Linfotrópico humano -1 são a leucemia/linfoma de células T do adulto e a paraparesia espástica tropical. A única manifestação bucal associada ao vírus T Linfotrópico humano é o linfoma de células T do adulto, sendo que alguns autores apontam para a possibilidade de pacientes com paraparesia espástica tropical também apresentarem a síndrome de Sjõgren relacionada à infecção pelo vírus. O fato de o vírus T Linfotrópico humano ser um vírus contagioso e com capacidade oncogênica requer a atenção do cirurgião-dentista tanto no manejo odontológico quanto no diagnóstico de possíveis doenças associadas.

The human T-lymphotropic viruses represent a group of retroviruses that possess tropism for T lymphocytes and are transmitted parenterally, vertically and sexually. Four types have been identified, 1, 2, 3 and 4. Type 1 has been most frequently associated with disease in infected individuals. It is estimated that 15 to 20 million people are affected by human T-lymphotropic virus type 1. In Brazil, the virus is endemic, presenting the greatest absolute number of cases in the world and included in blood bank screening tests. The main diseases associated with human T-lymphotropic virus type 1 are adult T-cell leukemia/lymphoma and tropical spastic paraparesis. The only oral manifestation associated with human T-lymphotropic virus is adult T-cell lymphoma. Some authors believe it is possible for some patients with tropical spastic paraparesis to also present virus-related Sjõgren?s syndrome. Since human T-lymphotropic virus is contagious and potentially oncogenic, it demands attention from the dental surgeon not only for dental management but also for diagnosing associated diseases.

Use of laser phototherapy on a delayed wound healing of oral mucosa previously submitted to radiotherapy: case report.

Radiotherapy produces both acute and delayed effects on mucosal tissues, disturbing their healing. This report shows a successful treatment with laser phototherapy (LPT) on a delayed wound healing in oral mucosa previously submitted to radiotherapy with a follow up of 3 years. A 47-year-old patient treated 6 months earlier for tongue squamous cell carcinoma by surgery and radiotherapy presented with a mass in the operated area. Biopsy showed chronic inflammatory infiltrate around a residual polyglactin suture. After 2 months there was a painful mucosal dehiscence on the biopsy site. LPT was performed using a semiconductor laser with 660-nm wavelength (InGaAlP) and spot size of 0·04 cm(2) . The parameters applied were 40 mW, 4 Jcm(2) /point, 0·16 J/point, 2·4 J/session. The irradiation was performed punctually, through contact mode in 15 points (4 seconds/point), on top of and around the lesion, during ten sessions. The wound healed completely after ten sessions. This treatment proved to be conservative and effective, inducing healing of a chronic wound in a tissue previously submitted to radiotherapy.

Impact of oral care prior to HSCT on the severity and clinical outcomes of oral mucositis.

Patients who undergo hematopoietic stem cell transplantation (HSCT) frequently experience gastrointestinal toxicity as a result of their preparative regimen. The most frequent manifestation is oral mucositis (OM) and diarrhea. We studied the effects of oral care prior to HSCT on the severity of OM. Seventy patients suffering from hematologic malignancies who had undergone HSCT were divided into two groups (35 patients - Study Group [SG] and 35 - Control Group [CG]), and the severity of OM was evaluated by two calibrated dentists, using the WHO scale. The patients from the SG received oral care prior to HSCT and those from CG did not receive any dental care. The results showed no differences (p = 0.20) in the incidence or severity of OM among the groups. However, patients from the SG presented a shorter time elapsed (p < 0.001) when compared with the CG (median: 10 vs. 20 d). Our results show the importance of simple, inexpensive preventive intervention to control the time elapsed of OM, which reduces morbidity and, as a consequence, the cost of the treatment.

Oral and dental abnormalities in Barber-Say syndrome.

A previously unreported case of Barber-Say syndrome is described with special attention to dental manifestations. A 7-year-old female with multiple congenital anomalies such mammary gland hypoplasia, hypertrichosis, ectropion, and redundant skin was seen at the School of Dentistry of the University of São Paulo. Oral examination revealed macrostomia, broad alveolar ridges, gingival fibromatosis, taurodontism, delayed tooth eruption, and malocclusion. Dental treatment included gingivoplasty and orthodontic treatment.

Cowden syndrome.

Mucocutaneous papillomas can be manifestations of an autosomal dominant condition known as Cowden syndrome (CS). We report the case of a 22-year-old man with oral and cutaneous papules and a past history of thyroid malignancy. It is important to recognize oral manifestations of CS; they can lead to early diagnosis of the condition.

Recessive dystrophic epidermolysis bullosa--oral rehabilitation using stereolithography and immediate endosseous implants.

Dental management of patients with epi-dermolysis bullosa (EB) is challenging because of the severe soft tissue lesions associated with this disease. A case history is presented where two immediate endosseous implants were placed in the mandible of a patient with recessive dystrophic EB using computer-aided technology to plan the surgery and prosthetic rehabilitation. After a 24-month follow-up, the prosthesis was stable with healthy asymptomatic soft tissue around the implants. The stereolithographic model provides a precise and noninvasive copy of the mandibular and maxillary arches of patients with EB for rehabilitation of the dentition with immediate endosseous implants and a prosthesis.

Granulocytic sarcoma of the oral cavity in a chronic myeloid leukemia patient: an unusual presentation.

Intraoral granulocytic sarcoma is an unusual manifestation of chronic or acute leukemia. The oral manifestations often involve enlargements of the gingival and mucosal tissue from direct leukemic cell infiltration. Only 38 cases have been reported in scientific literature to date. We present the case of a 47 year-old female who was diagnosed with chronic myeloid leukemia (CML) in December 2006. She was referred to a dentist for further evaluation, revealing generalized gingival overgrowth as well as periodontal, apical disease, and bleeding of the gums. An oral biopsy was performed and histological features revealed immature blast-like cells.

Effect of laser phototherapy on recurring herpes labialis prevention: an in vivo study.

Alternative treatment for recurrent labial infection by herpes simplex virus (HSV) have been considered. The aim of this study was to evaluate the effectiveness of laser phototherapy in prevention and reduction of severity of labial manifestations of herpes labialis virus. Seventy-one patients, divided into experimental (n = 41) and control (n = 30) groups were followed up for 16 months. Patients in the control group were treated topically with aciclovir and patients in the experimental group were subjected to laser phototherapy (one session per week, 10 weeks): 780 nm, 60 mW, 3.0 J/cm(2) or 4.5 J/cm(2) on healthy (no HSV-1 infection) and affected (with HSV-1 infection) tissues. Patients in the experimental group presented a significant decrease in dimension of herpes labialis lesions (P = 0.013) and inflammatory edema (P = 0.031). The reduction in pain level (P = 0.051) and monthly recurrences (P = 0.076) did not reach statistical significance. This study represents an in vivo indication that this treatment should be further considered as an effective alternative to therapeutic regimens for herpes labialis lesions.