Retention systems for extraoral maxillofacial prosthetic implants: a critical review.

We describe the techniques available for retention of implant-supported prostheses: bar-clips, O-rings, and magnets. We present reported preferences and, although this is limited by the heterogeneity of methods used and patients studied, we hope we have identified the best retention systems for maxillofacial prosthetic implants. If practitioners know the advantages and disadvantages of each system, they can choose the most natural and comfortable prosthesis. We searched the PubMed and Scopus databases, and restricted our search to papers published 2001-13. MeSH terms used were Maxillofacial prosthesis and Craniofacial prosthesis OR Craniofacial prostheses. We found a total of 2630 papers, and after duplicates had been removed we analysed the rest and found 25 papers for review. Of these, 12 were excluded because they were case reports or non-systematic reviews. Of the remaining 13, 10 described group analyses and seemed appropriate to find practitioner's choices, as cited in the abstract (n=1611 prostheses). Three papers did not mention the type of prosthetic connection used, so were excluded. The most popular choices for different conditions were analysed, though the sites and retention systems were not specified in all 10 papers. The bar-clip system was the most used in auricular (6/10 papers) and nasal prostheses (4/10). For the orbital region, 6/10 favoured magnets. Non-osseointegrated mechanical or adhesive retention techniques are the least expensive and have no contraindications. When osseointegrated implants are possible, each facial region has a favoured system. The choice of system is influenced by two factors: standard practice and the abilities of the maxillofacial surgeon and maxillofacial prosthetist.

Morphometric analysis of the infraorbital foramen and acessories foraminas in brazilian skulls

El objetivo del estudio fue establecer morfométricamente la localización del agujero infraorbital (FIO) en los planos sagital y transversal del cráneo y analizar las variaciones, así como verificar la simetría con el FIO contralateral. Fueron analizados 210 cráneos de individuos adultos. Utilizamos un paquímetro digital para efectuar las dos mediciones: a) sagital: del borde infraorbital hasta el borde superior del FIO; b) transversal: del borde lateral de la abertura piriforme hasta el bordemedial del FIO, utilizando el plano transversal. Estas mediciones forman un ángulo de 90 entre sí. Los datos fueron analizados por Kolmogorov-Smirnov y prueba de Person para evaluar la correlación, considerando un p 0.05. La media y ± SD en la distancia sagital fueron en el lado derecho 6,71± 1.70 mm y en el lado izquierdo 6,83±1.83 mm (p0.0001). Las medidas transversales fueron: lado derecho 13.28±2.17 mm y lado izquierdo 13.31±2.19 mm (p0.0001). Fueron observadas foraminas supranumerarias del FIO, con la presencia del IOF doble en 50 casos, siendo bilaterales en 8 especímenes izquierdos y derechos de la cara, 21 para cada lado. El FIO no era absolutamente simétrico y podía presentar el par bilateral y la abertura unilateral. La presencia de foraminas supranumerarias, como diversas medidas de este estudio, pueden interferir con la anestesia. Así sugerimos considerar estos parámetros en la evaluación anestésica y recordar las variantes durante los procedimientos usados para la localización del agujero infraorbital.

[Multiple sclerosis, spinal cord ependymoma and intracranial meningioma: case report]. / Esclerose múltipla, ependimoma medular e meningioma intracraniano: relato de caso.

We report the association a multiple sclerosis (MS), spinal cord tumour and intracranial tumor in a 63 years-old female patient with a 10 years history of relapsing/remitting MS. Symptoms usually remitted in response to costicosteroid therapy. In 1997 the patient presented with paraparesis and paresis of right arm which did not respond to corticotherapy. A spinal RMI revealed in the cervical spinal an intra spinal cord tumour, further diagnosed as ependymoma, and a parietal region meningioma. We call attention to this rare association of central nervous system tumour and MS, enphasizing the need for investigation of new and uncommon symptoms during the evolution of MS.

[Intracranial tuberculomas developing during treatment of pulmonary tuberculosis: case report]. / Múltiplos tuberculomas intracerebrais na vigência de terapia específica para tuberculose pulmonar: a propósito de um caso.

The classical presentation of neurotuberculosis is meningitis. Intracranial tuberculomas are a rare manifestation of neurotuberculosis and are due to hematogenous dissemination of distant focuses of Mycobacterium tuberculosis infection. Around 1% of patients with central nervous system tuberculosis develop intracranial tuberculomas some weeks or months after the beginning of the specific treatment with tuberculostatic chemotherapy. The involution of the lesions is slow and does not mean drug resistance nor lack of adequate treatment. We describe the case, diagnosed and treated at the 25th Infirmary of Santa Casa da Misericórdia do Rio de Janeiro, of an immunocompetent male patient who developed meningitis and multiple intracranial tuberculomas during the specific treatment of miliary tuberculosis. The literature is revised and the diagnosis, treatment and possible immunological mechanisms are discussed.

Effects of oral nutritional supplementation on the intestinal mucosa of patients with AIDS.

Weight loss is a major component of the clinical syndrome in patients with acquired immunodeficiency syndrome (AIDS). The impact of malnutrition on the outcome of the disease has been unappreciated in many investigations. The authors evaluated the effects of oral nutritional supplementation on the morphology and immunology of the intestinal mucosa of patients with AIDS. Twelve patients with AIDS without diarrhea or opportunistic infections, with at least 10% of body weight loss over 1 year, were submitted to anthropometric measures, peripheral blood T-lymphocyte counts, and peroral jejunal biopsy before and after oral nutritional supplementation. An industrialized peptide-based formula containing omega-3 fatty acids was given for 6 weeks. Jejunal samples were analyzed by histomorphometry, including villous-to-crypt ratio, lamina propria, and intraepithelial lymphocyte count. Immunologic assessment of the intestinal mucosa was made by indirect immunoperoxidase using monoclonal antibodies against CD3, CD4, and CD8. Seven patients with irritable bowel syndrome and two healthy volunteers were selected as a control group for histologic and immunohistochemical comparisons. After 6 weeks the patient group maintained their body weight and increased their tricipital fold. The number of peripheral blood T cells, albumin, transferrin, and the number of CD3+, CD4+, and CD8+ cells in jejunal mucosa as well as the intestinal morphometry remained stable. Oral supplementation contributed to maintaining body weight and may constitute a reasonable adjuvant therapeutic tool against AIDS progression.

Small-bowel involvement in systemic lupus erythematosus: a morphometric and immunohistochemical study.

BACKGROUND: We have investigated the intestinal mononuclear cell subpopulations in patients with systemic lupus erythematosus (SLE) and correlated these with the disease activity. METHODS: Eighteen female outpatients were studied; in 10 of them lupus activity was measured with the Lupus Activity Criteria Count and the SLE Disease Activity Index. Eight patients were in lupus remission. The control group consisted of 10 healthy volunteers. Peroral jejunal biopsy was performed in all individuals, at the angle of Treitz, using a Watson capsule, under X-ray control. Histologic studies analysed the villous to crypt ratio, lamina propria cells, and intraepithelial lymphocyte count. Immunohistochemical evaluation was carried out with the indirect immunoperoxidase technique, using monoclonal antibodies against CD3, CD4, CD8, D1, D7, D9, and M1. RESULTS: Lamina propria CD3+, CD8+, D7+, and M1+ cells from patients with SLE did not differ significantly from those of controls. CD4+ cells were decreased in all patients with SLE, especially in the clinically inactive patients. D1+ and D9+ cells were also decreased in all patients. CONCLUSION: The finding of quantitative abnormalities in the cell-mediated immunity of the intestinal mucosa may reflect systemic defects of the immune system in SLE.

[Parinaud syndrome and Collier signal. Initial neurological manifestation in an HIV-1 positive patient]. / Síndrome de Parinaud e sinal de Collier. Manifestação neurológica inicial em paciente HIV-1 positivo.

We describe the third case in the literature of Parinaud's syndrome as the sole manifestation of brainstem toxoplasmosis, in a positive HIV-1 patient and review the literature concerning the possible etiologies of Parinaud's syndrome, enforcing that it is a rare manifestation of central nervous system toxoplasmosis. We refer to its occurrence without simultaneous obstructive hydrocephalus and increased intracranial pressure, pointing out the Collier signal which is not very well known, but has great semiotic value once it locates the lesion in the brainstem.

Clinical patterns of diarrhea in AIDS. A retrospective study at the Federal University Hospital, Rio de Janeiro.

Three hundred and fifty two medical records of AIDS inpatients were analysed in a retrospective study to establish the frequency, clinical patterns and etiology of AIDS-related diarrhea. Diarrhea was observed in 58.8% of the patients, being a chronic symptom in 65.7%, and the first complaint in 24.6%. The most common cause of diarrhea was coccidea and the etiology remained unknown in 56.1% of the patients. Routine stool examination was the most sensitive method in the diagnosis of diarrhea. In countries with limited resources, the use of stool examinations seems to provide appropriate clinical management. The implementation of an objective protocol could improve the etiologic diagnosis of AIDS-related diarrhea without the burden of more complex and invasive technologies.

[Tremor: adaptation of a clinical scale]. / Tremor: adaptação de uma escala clínica.

The Fahn, Tolosa e Marín's clinical rating scale for tremor was adapted to our country for evaluation of tremor. This scale was applied to 123 patients with this movement disorder, selected from the Ambulatory of General Medicine at Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro. These patients had been chosen no matter the etiology of their condition or their age. Although some variants may had influenced the scores of this particular scale, they did not seem to change its standardization and applicability.

Primary progressive freezing gait. Case report.

The clinical features of the primary progressive freezing gait, a rare and distinct neurological entity, have been described in some articles. This paper describes this gait disorder affecting one patient, whose condition's long course provoked no postural instability. As stated in the literature, the pathophysiology of the primary progressive freezing gait still remains unclear, although the lack of response to levodopa therapy suggests a possible involvement of nondopaminergic pathways. Alteration in the visual perception may be a potential cause for the condition.

[Cognitive disorders in Parkinson disease. Electroencephalographic correlations]. / Distúrbios cognitivos na doença de Parkinson. Correlações eletrencefalográficas.

Sixty-two patients with idiopathic Parkinson disease and 30 patients of a control group were clinically evaluated in the light of cognitive and/or psychic impairments according to DSM III-R, mini-mental state examination and Hamilton rating scale for depression. These patients were also submitted to electroencephalogram registration (EEG) with photic stimulation. From the parkinsonian group, 45.2% did not have mental manifestations as classified in the DSM III-R. Other 24.2% had depression, 14.5% had anxiety, 12.9% had dysthymic disorder and 3.2% had dementia. Considering the EEG, 58.1% of the parkinsonian patients had theta waves bilaterally, with predominance in frontal temporal or temporal areas, though more frequent on the left hemisphere than on the right one. Only 16.7% of the patients from the control group had these same findings in the EEG but neither of the two groups had their EEG modified by photic stimulation. The EEG findings were statistically significant when both groups were compared. However, these findings were not significant comparing parkinsonian patients with psychic impairment with the ones who did not have such impairments.

[Writing tremor: report of a case]. / Tremor da escrita. Relato de caso.

Primary writing tremor is induced by a specific motor activity, generally the handwriting. The case is analyzed under clinic and therapeutic points of view. The patient had a tremor elicited by handwriting without any other concurrent neurologic alteration. He neither presented familiar antecedents nor metabolic, endocrine, iatrogenic, toxic and traumatic ones. As to the therapeutic approach, the tremor did not respond satisfactorily neither to propranolol nor to primidone. But with anticholinergics improvement of the tremor was verified.

[Essential tremor. Clinical observations]. / Tremor essencial. Observações clínicas.

The authors have studied 53 patients with essential tremor, focusing its clinical and epidemiological aspects. There were familial history in 37.70% of all cases, prevailing in females (56.60%) and white people (69.80%); nevertheless this difference can not be assured from the statistical point of view due to lack of population data. We agreed that the main incidence of this syndrome occurred beyond the 5th decade, specially during the 6th and 7th decades. Topographically, we could observe that the hand tremor predominanted, with an incidence of 96.20% of the total number of cases, followed by head tremor (28.30%), voice tremor (16.99%), leg tremor (11.30%), tongue tremor (3.78%) and trunk tremor (1.88%). These focal tremors were seldom observed alone and we noted frequent association with hand tremor.