The Self-Assembling Peptide P11-4 Prevents Collagen Proteolysis in Dentin.

The major goal in restorative dentistry is to develop a true regenerative approach that fully recovers hydroxyapatite crystals within the caries lesion. Recently, a rationally designed self-assembling peptide P11-4 (Ace-QQRFEWEFEQQ-NH2) has been developed to enhance remineralization on initial caries lesions, yet its applicability on dentin tissues remains unclear. Thus, the present study investigated the interaction of P11-4 with the organic dentin components as well as the effect of P11-4 on the proteolytic activity, mechanical properties of the bonding interface, and nanoleakage evaluation to artificial caries-affected dentin. Surface plasmon resonance and atomic force microscopy indicated that P11-4 binds to collagen type I fibers, increasing their width from 214 ± 4 nm to 308 ± 5 nm ( P < 0.0001). P11-4 also increased the resistance of collagen type I fibers against the proteolytic activity of collagenases. The immediate treatment of artificial caries-affected dentin with P11-4 enhanced the microtensile bonding strength of the bonding interface ( P < 0.0001), reaching values close to sound dentin and decreasing the proteolytic activity at the hybrid layer; however, such effects decreased after 6 mo of water storage ( P < 0.05). In conclusion, P11-4 interacts with collagen type I, increasing the resistance of collagen fibers to proteolysis, and improves stability of the hybrid layer formed by artificial caries-affected dentin.

Bilateral carotid endarterectomy combined with myocardial revascularization during the same surgical act.

The best surgical approach for the treatment of patients with severe cerebral artery disease and simultaneous serious coronary artery disease still remains controversial. In this report we present a case of a 72-year-old female patient admitted to the hospital with unstable angina. Triple coronary artery obstructive disease and severe bilateral carotid artery stenosis were diagnosed. A combined, simultaneous surgical procedure was performed. After total circulatory by-pass with a membrane oxygenator, the patient's body temperature was lowered to 32 degrees C. During the cool-down period, three proximal anastomoses of segments of autologous saphenous veins were performed in the ascending aorta. Immediately afterwards, bilateral carotid endarterectomy was performed, followed by three distal anastomoses to coronary arteries. The patient showed a satisfactory post-operative outcome. It was concluded that the combination of moderate hypothermia, hemodilution with appropriate hemodynamic control, as used in this patient, was an effective method of cerebral protection. The simultaneous approach of carotid endarterectomy and coronary artery by-pass surgery should be seen as a safe option for the treatment of this type of patient.

Total inversion of the left lung circulation: morphologic and functional analyses.

BACKGROUND: An experimental model for total inversion of left lung circulation was developed. With this model, the authors demonstrate that it is possible to reverse the pulmonary circulation and preserve the normal function and morphology of the lung. METHODS: Eight dogs had their left pulmonary circulation reversed. The blood from the pulmonary artery trunk was diverted to the pulmonary veins, and returned from the pulmonary artery into the left atrium. In order to monitor the flow through the reversed system, color Doppler echocardiography was performed on the ninth postoperative day. The dogs were reoperated after 15 days for re-evaluation. Blood gas analyses from the aorta and the pulmonary artery were used to study the functional status of the lung in both operations. The morphology was studied by comparing biopsies of the lung performed before and after reversal of flow. RESULTS: Blood gas analysis showed no significant difference between the samples of from the aorta and pulmonary artery. Color Doppler echocardiography was a reliable method for the study of the inverted circulation. The histological study showed no differences in the morphology of the lung after the reversed circulation. CONCLUSIONS: Left pulmonary circulation was fully reversed. Pulmonary function and morphology remained normal.

[Partial median sternotomy in H. A new approach for cardiac surgery]. / Esternotomia parcial mediana em H. um novo acesso para a cirurgia cardíaca.

PURPOSE: To present our results with the minimally invasive thoracotomy (MIT) in patients with valve disease and to describe a new type of thoracotomy. METHODS: Twenty-five patients with valve disease as the major cardiac problem were operated during a five month period. Two types of incisions were used: one in an inverted-T fashion and another in a H fashion. Fourteen patients were submitted to an inverted-T incision and eleven to a H incision. In 24% of the patients reoperation was being performed. RESULTS: The incisions ranged from 7.5 to 11 cm (mean 9.1 cm), mean ICU stay was 31 h and hospital stay 4.8 days. In all but one patient the operation could be adequately in performed through the MIT, in only one patient total sternotomy had to be performed. CONCLUSION: The MIT may have some advantages such as, better aesthetic results, less pain and more sternal stability. These factors may improve early extubation and decrease hospital stay. The H type incision allows an adequate exposition of the most central part of the chest and all heart valves with adequate exposure. This technique led to no complications during reoperations and we believe it to be as safe as the total sternotomy.

Esternotomia parcial mediana em H. Um novo acesso para a cirurgia cardíaca / Partial sternotomy in H. A new approach for cardiac surgery

OBJETIVO - Apresentar a nossa experiência com a toracotomia minimamente invasiva (TMI) em pacientes com doença valvar e descrever um novo tipo de toracotomia. MÉTODOS - Vinte e cinco pacientes com doença, como maior problema cardíaco, foram submetidos a operaçäo em um período de 5 meses. A incisäo utilizada foi uma TMI em duas formas, uma em T invertido e outra em H. Nesta série, as reoperaçöes constituíram 24 por cento. RESULTADOS - O tamanho da incisäo de pele variou de 7,5 a 11,0cm (média=9,1cm). O tempo de permanência médio na UTI foi de 31h e hospitalar de 4,8 dias. Em todos os pacientes a cirurgia pôde ser realizada apropriadamente através desse acesso, sendo que em apenas um, foi necessária esternotomia total. CONCLUSÄO - A TMI apresenta algumas vantagens, como melhor resultado estético, menos dor e maior estabilidade torácica. Estes fatores possibilitam uma extubaçäo precoce, diminuindo o tempo de internaçäo hospitalar. A esternotomia em H apresenta como grande benefício a exposiçäo da parte mais central do tórax, permitindo um melhor acesso a todas as valvas cardíacas. Esta técnica apresentou complicaçöes nas reoperaçöes, o que nos faz acreditar que seria täo segura quanto a esternotomia total.

Squamous cell carcinoma of the cervix metastatic to the spleen--case report.

Squamous cell carcinoma of the cervix metastatic to the spleen is an uncommon occurrence which has only been reported in small numbers in autopsy series. We present a case of a 47-year-old patient with a Stage IIb carcinoma of the cervix, treated with radiotherapy in 1990. Four years after completion of primary treatment she presented with a voluminous left hypochondrium and epigastrium mass. An exploratory laparotomy was performed and a splenic cyst 19 cm in diameter was found. The pathological examination revealed metastatic squamous cell carcinoma of the cervix in the spleen. Peritoneal washings were positive for malignant cells, due to incidental rupture of the cyst capsule. The patient received six courses of chemotherapy with a palliative intent and is alive, without further evidence of disease, 15 months posttreatment. To our knowledge this is the only case reported in the literature of squamous cell carcinoma of the uterine cervix metastatic to the spleen, diagnosed clinically as the only site of distant spread.

About the arterial blood vessels pelvic opossum's (Didelphis albiventris) behaviour.

The work consists of the study of 20 opossums (Didelphis albiventris); 7 females and 13 males, adults, natives of Jaboticabal county proceeding to a cannulation and injection of the arterial system with neoprene latex-650 in the aorta artery (full-blooded). Right away the preparations were fixed by a 10% formaldehyde aqueous solution and afterwards dissected and formed a scheme. The analysis of the pieces showed that in the opossum, the end of the aorta always divides in the common iliac artery, right and left sides, both originating the external and internal iliac artery, on the right and left sides. The medium sacral artery results, medianly, from the aorta division's angle in 2 common iliac arteries in 8 cases (40%-6 males and 2 females); this vessel comes from the left common iliac artery in 7 animals (35%-5 males and 2 females) or comes from the right common iliac artery, in 5 preparations (25%-3 females and 2 males). The deep iliac circumflex artery is born by the common iliac artery from the right side in 10 preparations (50%-6 males and 4 females); can appear as well, concomitantly with the external and internal iliac artery, from the right side in 9 pieces (45%-6 males and 3 females) and further from the right this vessels can emerge from the external iliac artery, in 1 case only (5%-1 male).

Early surgical results in the treatment of endomyocardial fibrosis. A Brazilian cooperative study.

This report summarizes the surgical experience and early results obtained at four surgical centers in the northeast and south of Brazil. From December 1977 to September 1986, 95 operations were performed on 93 patients, ages 11-59. Bilateral lesions occurred in 42 patients, right lesions in 39, and left lesions in 12. Ventricular decortication and removal of thrombi were performed in all. In right-sided lesions, the tricuspid valve was substituted by a bioprosthesis in 34 cases, and substituted by a tilting disk valve in 1 case. In 4 patients, the valve could be preserved. The left-sided lesions led to valve substition by a bioprosthesis in 11 cases, and preservation of the valve in 1. The bilateral lesions needed bioprosthesis in the mitral position in 37 patients, and a disk valve in 2. In these 39 instances, the valvular procedure was insertion of a tricuspid bioprosthesis. Three tricuspid and three mitral plasties were performed. The overall mortality was 20% (26.2% for bilateral lesions, 14.6% for the right-sided lesions, and 20% for the left-sided lesions). The main cause of death was low cardiac output. Aside from a variable degree of right and left ventricular failure, many other non-fatal complications clouded the postoperative course. Complete AV blocks occurred in 10 cases, with the need for permanent pacing in 7 survivors. The mortality and morbidity in the present series is in keeping with the results reported in current literature. Regarding the advanced stage of their patients' disease, the authors agree with the recommendation for earlier surgical intervention.