Diagnosis and endodontic treatment in a mandibular first premolar with two canals: case report / Diagnóstico e tratamento endodôntico em primeiro pré-molar inferior com dois condutos radiculares: relato de caso

Objective: The objective of this article was to describe the diagnosis and the endodontic treatment of a mandibular first premolar with two root canals. Case report: A 67-year-old female patient presented to the dental clinic referring pain in the right mandibular first premolar. The patient reported induced pain and the sensation of "grown tooth". Clinical examination revealed a marked degree of dental abrasion associated with a slight swelling in the periapical region and positive percussion and cold tests. The radiographic examination revealed an apical radiolucency. A pulpal diagnosis of necrotic pulp and chronic perirradicular periodontitis were made. After access cavity, the canals were prepared using K-files, Gates-Glidden drills and 2.5% sodium hypochlorite. Gutta-percha cones and AH-Plus sealer were used during obturation with the lateral condensation technique. Conclusion: After a period of 23 months of follow-up, clinical and radiographic examinations revealed total regression of the lesion.

Objetivo: O objetivo deste artigo foi descrever o diagnóstico e tratamento endodôntico de um primeiro pré-molar inferior com dois canais radiculares. Relato de caso: Paciente de 67 anos de idade apresentou-se à clínica odontológica referindo dor no primeiro pré-molar inferior. A paciente relatava dor espontânea e sensação de "dente crescido". O exame clínico revelou um grau acentuado de abrasão dentária associada a ligeiro inchaço na região periapical e respostas positivas aos testes de percussão e frio. O exame radiográfico revelou a presença de uma radiolucência apical. Foi realizado o diagnóstico de polpa necrótica e periodontite perirradicular crônica. Após a realização da cavidade de acesso, os canais foram preparados utilizando limas tipo K, brocas Gates-Glidden e hipoclorito de sódio a 2,5%. Cones de guta-percha e cimento obturador AH-Plus foram utilizados na obturação com a técnica de condensação lateral. Conclusão: Após um período de 23 meses de acompanhamento, os exames clínicos e radiográficos revelaram regressão total da lesão.

Disability is associated with malnutrition in institutionalized elderly people. The I.R.A. Study. Istituto di Riposo per Anziani.

Several factors, such as disability, malnutrition, weight loss, and the interactive effect of diseases and aging have been associated with morbidity and mortality in the elderly population. Nevertheless, the relationship between disability and biological parameters has not been extensively investigated as a primary focus. In a cross sectional survey, 344 institutionalized elderly subjects were evaluated. Disability was measured according to the Katz index, and patients were divided into three groups: low (0-1 lost ADL), mild (2-4 lost ADL), and severe (5-6 lost ADL). Anthropometric, metabolic, and nutritional parameters were assessed; age, gender, number of pathologies, and number of drugs were also recorded. Data were analyzed by multiple comparison of means according to Scheffé, and by multivariate logistic regression analysis. An impairment in functional status was associated with several modifications in biological parameters. Logistic regression analysis showed that severe disability (5-6 lost ADL) was associated with low waist/hip ratio (< 0.9 vs > 0.9, OR: 1.56, CI 95%: 1.08-2.25), high body resistance (> 625 vs < 575 omega, OR: 1.39, CI 95%: 1.38-1.39), low plasma albumin levels (< 3.5 vs > 4.0 g/dL, OR: 6.02, CI 95%: 5.18-6.85), and low plasma transferrin levels (< 200 vs > 250 mg/dL, OR: 5.47, CI 95%: 4.56-4.58) independently of age, gender, comorbidity, and other confounding factors. Our results indicate that severe disability in ADL is strongly associated with anthropometric and biohumoral parameters suggesting the presence of malnutrition. A careful evaluation of the nutritional state appears to be of primary importance, and efforts to improve nutritional status are needed in approaching disabled elderly patients.

Prognostic value of early postoperative calcitonin level in medullary thyroid carcinoma.

AIMS: Serum calcitonin (CT) assay is commonly used in the diagnosis and follow-up of medullary thyroid carcinoma (MTC). The aim of this study was to ascertain whether serum CT levels, measured in the first few days after surgery, could be used to evaluate the efficacy of treatment. METHODS: A group of 33 patients was studied. In all patients the follow-up was more than 20 months. RESULTS: Preoperatively basal CT serum levels were high in all patients. Twenty-four hours after surgery CT serum levels dropped to within the normal range in 8 patients and 72 hours after operation in 7 others. In this group 1 patient was at stage I, 11 at stage II and 3 at stage III. Basal and pentagastrin stimulated CT levels continued to be in the normal range in these 15 patients 6 and 12 months after surgery and at the subsequent year by follow-up visits. No clinical or radiological evidence of disease was found during the follow-up in this group. In the other 18 patients CT was reduced but still high 72 hours after surgery; 6 months later basal serum CT levels continued to be elevated or responsive to pentagastrin stimulation. In this group restaging showed tumor relapse in the thyroid bed in 2 patients, cervical lymphadenopathy in 11, and distant metastases (bone, liver) in 3. CONCLUSIONS: Immediate postoperative CT serum levels seem to be the most useful index to evaluate the efficacy of surgical treatment and the presence of residual neoplastic tissue.

Acute and chronic effects of dextro-thyroxine on pituitary thyroid axis and on reverse triiodothyronine production in euthyroid subjects.

Serum levels of thyroxine (T4), triiodothyronine (T3), reverse triiodothyronine (rT3) and TSH were measured in euthyroid subjects after a single dose of 4 mg D-thyroxine (DT4) or of 0.25 mg L-thyroxine (LT4). The same parameters and TSH response to TRH were also evaluated in 7 dyslipidemic patients before and after one month of treatment with 6 mg DT4. T4 levels increased about 165% at h 4 after DT4 and only 47% after LT4; T3 levels remained unchanged until h 10 both after DT4 and after LT4; rT3 levels increased almost 179% after DT4 and only 32% after LT4. TSH levels decreased about 30% after both DT4 and LT4. In the long term study similar variations of the same parameters were observed: basal TSH levels decreased and TSH response to TRH was inhibited in all patients but one; T4 levels increased 62%, T3 levels increased 35%, while rT3 levels increased 545%. Our results show that: both acute and long-term treatment with DT4 suppress TSH secretion; DT4 both in acute and in long-term administration, is preferentially dealogenated in the alaninic ring with production of rDT3, instead of in the phenolic ring with production of DT3. This may contribute to explain its lower metabolic activity.