RESUMO
OBJECTIVE: Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection may yield a hypercoagulable state with fibrinolysis impairment. We conducted a single-center observational study with the aim of analyzing the coagulation patterns of intensive care unit (ICU) COVID-19 patients with both standard laboratory and viscoelastic tests. The presence of coagulopathy at the onset of the infection and after seven days of systemic anticoagulant therapy was investigated. PATIENTS AND METHODS: Forty consecutive SARS-CoV-2 patients, admitted to the ICU of a University hospital in Italy between 29th February and 30th March 2020 were enrolled in the study, providing they fulfilled the acute respiratory distress syndrome criteria. They received full-dose anticoagulation, including Enoxaparin 0.5 mg·kg-1 subcutaneously twice a day, unfractionated Heparin 7500 units subcutaneously three times daily, or low-intensity Heparin infusion. Thromboelastographic (TEG) and laboratory parameters were measured at admission and after seven days. RESULTS: At baseline, patients showed elevated fibrinogen activity [rTEG-Ang 80.5° (78.7 to 81.5); TEG-ACT 78.5 sec (69.2 to 87.9)] and an increase in the maximum amplitude of clot strength [FF-MA 42.2 mm (30.9 to 49.2)]. No alterations in time of the enzymatic phase of coagulation [CKH-K and CKH-R, 1.1 min (0.85 to 1.3) and 6.6 min (5.2 to 7.5), respectively] were observed. Absent lysis of the clot at 30 minutes (LY30) was observed in all the studied population. Standard coagulation parameters were within the physiological range: [INR 1.09 (1.01 to 1.20), aPTT 34.5 sec (29.7 to 42.2), antithrombin 97.5% (89.5 to 115)]. However, plasma fibrinogen [512.5 mg·dl-1 (303.5 to 605)], and D-dimer levels [1752.5 ng·ml-1 (698.5 to 4434.5)], were persistently increased above the reference range. After seven days of full-dose anticoagulation, average TEG parameters were not different from baseline (rTEG-Ang p = 0.13, TEG-ACT p = 0.58, FF-MA p = 0.24, CK-R p = 0.19, CKH-R p = 0.35), and a persistent increase in white blood cell count, platelet count and D-dimer was observed (white blood cell count p < 0.01, neutrophil count p = 0.02, lymphocyte count p < 0.01, platelet count p = 0.13 < 0.01, D-dimer levels p= 0.02). CONCLUSIONS: SARS-CoV-2 patients with acute respiratory distress syndrome show elevated fibrinogen activity, high D-dimer levels and maximum amplitude of clot strength. Platelet count, fibrinogen, and standard coagulation tests do not indicate a disseminated intravascular coagulation. At seven days, thromboelastographic abnormalities persist despite full-dose anticoagulation.
Assuntos
Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/sangue , COVID-19/sangue , Síndrome do Desconforto Respiratório/sangue , Tromboelastografia , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/sangue , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Testes de Coagulação Sanguínea , Enoxaparina/uso terapêutico , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Heparina/uso terapêutico , Humanos , Coeficiente Internacional Normatizado , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Estudos Prospectivos , SARS-CoV-2 , Resultado do Tratamento , Tratamento Farmacológico da COVID-19RESUMO
OBJECTIVE: The aim of this study is to collect the two years' data regarding the Integrated Trauma Management System (SIAT) by capturing the activity of its three Hubs in the Italian Lazio Region and test the performance of one of the Hubs' (Fondazione Policlinico Universitario A. Gemelli - IRCCS, FPG -IRCCS) Major Trauma Clinical Pathway's (MTCP) monitoring system, introducing the preliminary results through volume, process and outcome indicators. MATERIALS AND METHODS: A retrospective analysis on SIAT was conducted on years 2016 to 2018, by collecting outcome and timeliness indicators through the Lazio Informative System whereas the MTCP was monitored through set of indicators from the FPG - IRCCS Informative System belonging to randomly selected clinical records of the established period. RESULTS: Hubs managed 11.3% of the 998,240 patients admitted in SIAT. All patients eligible for MTCP were "Flagged", and 83% underwent a CT within 2 hours; intra-hospital mortality was 13% whereas readmission rates 16.9%. CONCLUSIONS: SIAT converges the most severe patients to its Hubs. The MTCP monitoring system was able to measure a total of 9 out of 13 indicators from the original panel. This research may serve as a departing point to conduct a pre-post analysis on the performance of the MTCP.
Assuntos
Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Planejamento Hospitalar/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Estudos Retrospectivos , Cidade de Roma , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do Tratamento , Triagem/organização & administração , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Adulto JovemRESUMO
BACKGROUND: Organ donation refusal from relatives of potential donors with brain death significantly reduces organ availability. The need for organ donation has increased over time, but the shortage of available donors is the major limiting factor in transplantation. We analyzed the impact of a new systematic communication approach between medical staff and patients' relatives on the rate of consent to organ donation. METHODS: The study was conducted as a single-center, non-randomized, controlled, before-and-after study at an 18-bed intensive care unit (ICU) of a university hospital. We compared the rate of consent for organ donation before and after the introduction of the new communication approach. RESULTS: A total of 291 brain-dead patients were studied. The consent rate increased from 71% in the pre-intervention period (2007-2012) to 78.4% in the post-intervention period (2013-2015), with an 82.75% increase in the 2014 to 2015 period. During these periods, no significant variation of consent to organ donation was recorded at the national and regional levels. CONCLUSIONS: The introduction of a new communication approach between medical staff and relatives of brain-dead patients was associated with a significant increase in the rate of consent to donation. Our results highlight the importance of empathy with relatives in the ICU.
Assuntos
Família , Relações Profissional-Família , Consentimento do Representante Legal , Obtenção de Tecidos e Órgãos , Morte Encefálica , Comunicação , Hospitais Universitários , Humanos , Consentimento Livre e Esclarecido , Unidades de Terapia Intensiva , Doadores de Tecidos/provisão & distribuiçãoRESUMO
Giant cell arteritis (GCA) is a vasculitis of large- vessels. A markedly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are characteristics of GCA, although temporal artery biopsy remains the gold standard for the diagnosis. We describe a case of biopsy-proven GCA showing a heavy infiltration of CD68 macrophages and CD3 T cells and with normal ESR and CRP levels at diagnosis. Key points (1) GCA may occur with normal ESR in a percentage of about 4 to 15 % (although the American College of Rheumatology classification criteria for giant cell arteritis include an ESR of 50 mm/h or more), while it can occur with normal ESR and normal CRP in a percentage of about 0.8 %. So, the clinical suspicion must be confirmed with a positive biopsy. (2) GCA patients with ESR >40 mm/h are characterized by higher incidence of headache and jaw claudication compared to patients with normal ESR. In our case, it occurred with normal ESR. (3) Color duplex ultrasonography is a noninvasive, easy, and inexpensive method for supporting a diagnosis of TA, with a high sensitivity and specificity. It can predict which patient will need TAB.
Assuntos
Biópsia/métodos , Proteína C-Reativa/biossíntese , Arterite de Células Gigantes/fisiopatologia , Antígenos CD/biossíntese , Antígenos de Diferenciação Mielomonocítica/biossíntese , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Complexo CD3/biossíntese , Feminino , Cefaleia/sangue , Humanos , Incidência , Arcada Osseodentária/fisiopatologia , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Linfócitos T/metabolismo , Ultrassonografia/métodosRESUMO
UNLABELLED: Introduction The early detection of systemic sclerosis (SSc) patients at high risk of developing digital ulcers could allow preventive treatment, with a reduction of morbidity and social costs. In 2009, a quantitative score, the capillaroscopic skin ulcer risk index (CSURI), calculated according to the formula 'D×M/N(2'), was proposed, which was highly predictive of the appearance of scleroderma digital ulcers within 3 months of capillaroscopic evaluation. OBJECTIVES: This multicentre study aims to validate the predictive value and reproducibility of CSURI in a large population of SSc patients. METHODS: CSURI was analysed in 229 unselected SSc patients by nailfold videocapillaroscopy (NVC). All patients were re-evaluated 3 months later with regard to the persistence and/or appearance of new digital ulcers. RESULTS: 57 of 229 patients presented with digital ulcers after 3 months. The receiver operating characteristic curve analysis showed an area under the curve of 0.884 (95% CI 0.835 to 0.922), with specificity and sensitivity of 81.4% (95% CI 74.8 to 86.89) and 92.98% (95% CI 83.0 to 98.0), respectively, at the cut-off value of 2.96. The reproducibility of CSURI was validated on a random sample of 81 patients, with a κ-statistic measure of interrater agreement of 0.8514. CONCLUSIONS: The role of CSURI was confirmed in detecting scleroderma patients with a significantly high risk of developing digital ulcers within the first 3 months from NVC evaluation. CSURI is the only method validated to predict the appearance of digital ulcers and its introduction into routine clinical practice might help optimise the therapeutic strategy of these harmful SSc complications.
Assuntos
Angioscopia Microscópica/métodos , Escleroderma Sistêmico/complicações , Úlcera Cutânea/etiologia , Adulto , Idoso , Algoritmos , Capilares/patologia , Diagnóstico Precoce , Métodos Epidemiológicos , Feminino , Dedos/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/irrigação sanguínea , Medição de Risco/métodos , Pele/irrigação sanguínea , Úlcera Cutânea/diagnósticoRESUMO
Infection of pancreatic necrosis, although present in less than 10% of acute pancreatitis, carries a high risk of mortality; debridment and drainage of necrosis is the treatment of choice, followed by 'open' or 'close' abdomen management. We recently introduced the use of intra-abdominal vacuum sealing after a classic necrosectomy and laparostomy. Two patients admitted to ICU for respiratory insufficiency and a diagnosis of severe acute pancreatitis developed pancreatic necrosis and were treated by necrosectomy, lesser sac marsupialisation and posterior lumbotomic opening. Both of the patients recovered from pancreatitis and a good healing of laparostomic wounds was obtained with the use of the VAC system. Most relevant advantages of this technique seem to be: the prevention of abdominal compartment syndrome, the simplified nursing of patients and the reduction of time to definitive abdominal closure.
Assuntos
Cavidade Abdominal , Tratamento de Ferimentos com Pressão Negativa/métodos , Pancreatite Necrosante Aguda/cirurgia , Cuidados Pós-Operatórios/métodos , Idoso , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/enfermagem , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Pancreatite Necrosante Aguda/diagnóstico , Cuidados Pós-Operatórios/enfermagem , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento , CicatrizaçãoRESUMO
The present study describes the specific content of ferritin iron, zinc and aluminium in four different groups: 1) hemodialysis hyperferritinemic patients; 2) septic patients; 3) iron overloaded patients with hematologic diseases; and 4) blood donors. In all four groups high levels of aluminium and zinc were found in addition to those of iron. However, the sum of the ferritin ions of the control group is significantly higher than that of the other three groups. Furthermore, while ferritin of hemodialysis patients has the same molecular ratio of metal ions as control group (high Al content vs. Fe and Zn), a lower Al/Fe ratio is found both in septic and hematological patients. The results of the present paper might help to explain the high percentage of hyperferritinemia found in hemodialysis patients also in presence of low transferrin saturation and in absence of inflammatory markers. Moreover, the high content of ions other than iron in the ferritin core leads us to believe that ferritin is not only an iron storage protein but rather a regulator of redox active ions.
Assuntos
Alumínio/sangue , Doadores de Sangue , Ferritinas/sangue , Ferro/sangue , Diálise Renal , Zinco/sangue , Estudos de Casos e Controles , HumanosRESUMO
The use of thrombolysis as an emergency treatment for cardiac arrest (CA) due to massive pulmonary embolism (MPE) has been described. However, there are no reports of successful treatment of MPE-associated CA in patients over 77 years of age. We report two cases of successful cardiopulmonary resuscitation for an MPE-associated CA in two very old women (87 and 86 years of age). In both cases, typical signs of MPE were documented using emergency echocardiography, which showed an acute right ventricle enlargement and a paradoxical movement of the interventricular septum. Emergency thrombolysis was administered during resuscitation, which lasted 45 and 21 min, respectively. Despite old age and prolonged resuscitation efforts, both patients had good neurological recovery and one of them was alive and neurologically intact 1 year later. Thrombolysis is a potentially useful therapy in MPE-associated CA. A good neurological outcome can be obtained even in very old patients and after prolonged resuscitation.
Assuntos
Reanimação Cardiopulmonar , Neurônios/efeitos dos fármacos , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/métodos , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Resultado do TratamentoRESUMO
OBJECTIVES: Hemodialysis (HD) population commonly show high plasma ferritin levels with a poor diagnostic value. The objective of this study is to elucidate the meaning of HD hyperferritinemia through the analysis of its ferritin iron content (FIC). DESIGN AND METHODS: FIC (iron atoms/ferritin molecule) was measured by atomic emission spectrometry. Ferritin and FIC values were correlated with iron storage and inflammation markers and the results of HD patients compared to those of septic and hemochromatosis patients. RESULTS: 1) In the whole HD population, high ferritin levels were associated to low FIC values; 2) the correlation of ferritin with iron indices and inflammation markers in HD patients was intermediate in between that of septic and hemochromatosis patients; 3) the FIC level of HD patients was lower than that of the other two groups. CONCLUSIONS: The high ferritin levels of HD patients are not synonymous with either inflammation or of high levels of iron storage. Their high levels and the low FIC values might be due to the presence inside the ferritin core of oligoelements other than iron.
Assuntos
Ferritinas/sangue , Hemocromatose/sangue , Nefropatias/sangue , Nefropatias/terapia , Diálise Renal , Sepse/sangue , Idoso , Humanos , Pessoa de Meia-Idade , Espectrofotometria AtômicaRESUMO
AIM: An ideal anesthetic regimen for kidney transplantation should be able to assure haemodynamic stability to obtain an optimal graft reperfusion. The aim of this study was to compare 2 regimens of anesthesia for patients submitted to kidney transplantation. METHODS: We studied 40 patients: 20 subjects (Group A) received balanced anesthesia with thiopental, fentanyl and isoflurane, to the others 20 (Group B), a total intravenous anesthesia (TIVA) with propofol and remifentanyl was given. In both groups muscle relaxation was obtained with a bolus of cisatracurium followed by a continuous infusion. We performed standard clinical, invasive blood pressure and central venous pressure monitoring. Hemodyna-mic data have been collected at standard times. During the postoperative period we evaluated the recovery (Aldrete Score) in the recovery room and the analgesia (VAS) at 1, 6, 24 h after the end of surgery. RESULTS: The trend of hemodynamic parameters did not show statistically significant differences between the 2 groups. We observed statistically significant differences concerning the quality of the recovery and the postoperative analgesia. The recovery in group B was faster than in group A, but in group A the pain control was better than in group B at least during the first postoperative hour. CONCLUSIONS: For their pharmacokinetic properties, propofol, remifentanyl and cisatracurium allow to obtain a good control of the hemodynamic parameters and a fast and safe recovery of consciousness. Total intravenous anesthesia regimen seems to be an alternative to the balanced anesthesia for patients undergoing kidney transplantation.
Assuntos
Anestesia Geral , Anestesia Intravenosa , Transplante de Rim , Adulto , Anestésicos Inalatórios , Anestésicos Intravenosos , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologiaRESUMO
BACKGROUND: Preterm infants often require surgery. As experimental evidence suggests that premature infants may experience pain and this could even result in fatal complications, the anaesthesiologist must face problems related to lowbirth weight, high risk of hypothermia, concomitant pulmonary disease and metabolic and receptor immaturity. Recently remifentanil has been considered an optimal analgesic drug in a preterm infant undergoing mechanical ventilation and frequent surgical manoeuvres, but no clinical studies have been reported in the literature. The aim of our study was to evaluate the efficacy of a continuous intravenous infusion of remifentanil in premature infants undergoing laser therapy for retinopathy of prematurity (ROP). METHODS: Six premature infants with ROP were scheduled for laser therapy. The procedure was performed in the neonatal intensive care unit. Transcutaneous carbon dioxide, pulse oximetry, respiratory rate, ECG and noninvasive blood pressure were continuously monitored. Infusion of remifentanil started with a dose of 0.75-1 microg x kg-1x min-1, 1 h before surgery. A midazolam bolus dose (0.20 mg x kg-1) was administered and the remifentanil infusion was increased to 3-5 microg x kg-1x min-1 taking into account haemodynamic and respiratory changes or spontaneous movements. RESULTS: Increased dosage was necessary only for 10 min during the procedure. No changes in temperature and ventilatory settings were observed and after 2 h from the surgical procedure the preterm infants were back to their preoperative status. CONCLUSIONS: A continuous infusion of remifentanil allowed optimal control of surgical stress and a return to preoperative status and ventilatory settings without side-effects.
Assuntos
Anestésicos Intravenosos/uso terapêutico , Recém-Nascido Prematuro/fisiologia , Terapia a Laser , Piperidinas/uso terapêutico , Retinopatia da Prematuridade/cirurgia , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Hemodinâmica/efeitos dos fármacos , Humanos , Recém-Nascido , Infusões Intravenosas , Piperidinas/administração & dosagem , Piperidinas/efeitos adversos , Remifentanil , Respiração/efeitos dos fármacos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Anesthetized morbidly obese patients often exhibit impaired pulmonary gas exchanges, mostly because of a reduction in functional residual capacity. At present, several approaches are suggested to ventilate these patients. METHODS: The efficiency of positive end-expiratory pressure (PEEP) and reverse Trendelenburg position (RTP) were compared in order to improve oxygenation in 20 morbidly obese patients undergoing bariatric surgery. RESULTS: Both PEEP and RTP determined a significant decrease in alveolar-arterial oxygen difference and an increase in total respiratory compliance (Ctot). RTP resulted in lower airway pressures than PEEP with similar improvements in Ctot and oxygenation. Concerning hemodynamic parameters, cardiac output (CO) significantly decreased with both PEEP and RTP. CONCLUSIONS: RTP and PEEP can be considered adequate ventilatory settings for morbidly obese patients, without any significant difference with regard to gas exchange improvement. However, the decrease in CO may partially counteract the beneficial effects on oxygenation of these ventilatory settings.
Assuntos
Desvio Biliopancreático , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Hemodinâmica/fisiologia , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/cirurgia , Respiração com Pressão Positiva , Troca Gasosa Pulmonar/fisiologia , Adulto , Anestesia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapiaRESUMO
The aim of this study was to assess the short-term effects of the administration of low doses of alfentanil on respiratory drive and respiratory pattern. We studied 17 ASA I patients scheduled for minor surgery or endoscopic procedures. During spontaneous ventilation, Respiratory Rate, Tidal Volume, Total Respiratory Cycle, Inspiratory and Expiratory Time, Mean Inspiratory Flow, P0.1, S(a)O(2) and EtCO(2) were all measured. The inspired oxygen concentration was 21% and measurements were made at baseline, 5 min (T1), 10 min (T2) and 15 min (T3) following an intravenous bolus injection 10 microg.kg(-1) alfentanil. The administration of alfentanil produced a significant (p < 0.05) reduction in S(a)O(2), minute volume and P0.1. In ASA I spontaneously breathing patients, the pre-operative administration of low doses of alfentanil can initially reduce the respiratory centre activity leading to a reduction in minute volume and S(a)O(2). We therefore recommend careful monitoring of cardio-respiratory function in ASA I patients, following the administration of alfentanil.
Assuntos
Alfentanil/efeitos adversos , Analgésicos Opioides/efeitos adversos , Sedação Consciente , Sistema Respiratório/efeitos dos fármacos , Alfentanil/administração & dosagem , Analgésicos Opioides/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Esquema de Medicação , Frequência Cardíaca/efeitos dos fármacos , Humanos , Injeções Intravenosas , Pessoa de Meia-Idade , Oxigênio/sangue , Troca Gasosa Pulmonar , Testes de Função RespiratóriaRESUMO
The genes AF10 and AF17 have been identified as the basis of the t(10;11) and t(11;17) translocations, events that result in their fusion to the MLL/HRX gene in acute myeloid leukaemias. AF10 and AF17 bear significant homology to each other within their putative zinc finger and leucine zipper domains, although they are diverged outside these regions. The BR140 gene encodes a 140 kDa protein of unknown function that contains a putative zinc finger domain, a leucine zipper region, and, in addition, a bromo domain. The zinc finger and leucine zipper domains of BR140 have significant homology to those of AF10 and AF17, suggesting that it belongs to this newly described gene family and, therefore, could be a target for chromosome translocation. To assess the potential involvement of BR140 in chromosome translocations in leukaemia, the chromosomal location of the BR140 gene has been determined by using several independent methods. A combination of Southern analysis, polymerase chain reactions (PCR) on monochromosomal cell hybrids, and fluorescence in situ hybridisation (FISH) has been used to show that the BR140 gene maps to chromosome band 3p25.
Assuntos
Bandeamento Cromossômico , Cromossomos Humanos Par 3 , Proteínas de Ligação a DNA , Zíper de Leucina , Proteínas de Neoplasias/genética , Fatores de Transcrição/genética , Dedos de Zinco , Southern Blotting , Eletroforese em Gel de Ágar , Humanos , Hibridização in Situ FluorescenteRESUMO
To evaluate the efficacy of Multiple Choice Questions (MCQ) as an evaluation tool in medical education, were analyzed the responses to 80 MCQ delivered by 300 physicians working in emergency departments and following a course on Basic and Advanced Life Support. Pre- and post-test were administered using a dedicated computer application running on PC. Students' scores were high and demonstrated both course and test validity. More than 95% of the students used the computer application without interface difficulties. However, some limits of MCQ were individuated: first, misinterpretation of some questions, especially when two or more similar answers were presented; from the other side, the student's personal experiences during the course practice could influence student's responses bringing him to different conclusions on respect to the instructor. These difficulties should be kept in mind in the development of a MCQ session, and students should have the possibility to give to the instructor a feedback of problems encountered during the course. This is especially important when MCQ are the sole evaluation technique.
Assuntos
Instrução por Computador/métodos , Educação Médica Continuada/métodos , Avaliação Educacional/métodos , Adulto , Reanimação Cardiopulmonar/educação , Instrução por Computador/estatística & dados numéricos , Educação Médica Continuada/estatística & dados numéricos , Avaliação Educacional/estatística & dados numéricos , Estudos de Avaliação como Assunto , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , SoftwareRESUMO
Purpose of the inquiry about dental replantation and transplantation and about principal operating methods is to explain to the practice dentist these technics as an extreme help when he is compelled to save a tooth. A logical utilisation of these therapeutic processes will allow, preserving some dental elements esteemed "lost", to postpone as much as possible in time the prosthesis construction and to maintain physiologically look and function of dental arches.