ECMO venovenoso durante procedimiento endoscópico de permeabilización de la vía aérea central en pacientes con riesgo vital: reporte de 2 casos / Use of venovenous extracorporeal membrane oxygenation (ECMO) during endoscopic treatment of central airway obstruction and vital risk: report of 2 cases

Resumen: La oxigenación por membrana extracorpórea (ECMO) es de gran utilidad al proveer soporte ventilatorio a pacientes con hipoxia, pero su utilidad en el manejo de pacientes con obstrucción central de la vía aérea y riesgo vital no ha sido frecuentemente usada. La broncoscopía intervencional como terapia bajo ventilación convencional es de alto riesgo en este tipo de pacientes, pero es posible lograr excelentes resultados al ser asociada a ECMO. Comunicamos el caso clínico de 2 pacientes que presentaban disnea en reposo y falla ven1ila1oria aguda ca1as1rófica debido a una obstrucción casi total del lumen traqueal, de causa tumoral. En ambos pacientes en forma urgente se inició soporte circulatorio mediante ECMO VV, mientras se efectuaba la resección tumoral broncoscópica. Luego de terminada la cirugía traqueal, en ambos pacientes se retiró el soporte, siendo decanulados sin eventos y con una buena evolución clínica posterior. Se discute el beneficio del soporte ECMO en este tipo de pacientes.

Abstract: In patients with severe central airway stenosis bronchoscopy-guided intervention therapy under conventional ventilation conveys a high risk. Extracorporeal membrane oxygenation (ECMO) provides very good cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy. We report 2 patients with resting dyspnea due to severe tumor tracheal obstruction and acute pulmonary failure with imminent vital risk. Both patients were cannulated and the ECMO circuit installed on a nearly emergency basis. Tumors were excised, and the patients weaned from cardiopulmonary bypass uneventfully. Subsequent clinical course was satisfactory in both cases. A brief discussion of this condition is included.

Adjunctive Lanicemine (AZD6765) in Patients with Major Depressive Disorder and History of Inadequate Response to Antidepressants: A Randomized, Placebo-Controlled Study.

The objective of this study was to investigate the efficacy and safety of adjunctive lanicemine (NMDA channel blocker) in the treatment of major depressive disorder (MDD) over 12 weeks. This phase IIb, randomized, parallel-arm, double-blind, placebo-controlled study was conducted at 49 centers in four countries between December 2011 and August 2013 in 302 patients aged 18-70 years, meeting criteria for single episode or recurrent MDD and with a history of inadequate treatment response. Patients were required to be taking an allowed antidepressant for at least four weeks prior to screening. Patients were randomized equally to receive 15 double-blind intravenous infusions of adjunctive lanicemine 50 mg, lanicemine 100 mg, or saline over a 12-week course, in addition to ongoing antidepressant. The primary efficacy end point was change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to week 6. Secondary efficacy outcome variables included change in MADRS score from baseline to week 12, response and remission rates, and changes in Clinical Global Impression scale, Quick Inventory of Depressive Symptomology Self-Report score, and Sheehan Disability Scale score. Of 302 randomized patients, 240 (79.5%) completed treatment. Although lanicemine was generally well tolerated, neither dose was superior to placebo in reducing depressive symptoms on the primary end point or any secondary measures. There was no significant difference between lanicemine and placebo treatment on any outcome measures related to MDD. Post hoc analyses were performed to explore the possible effects of trial design and patient characteristics in accounting for the contrasting results with a previously reported trial.

Finite element stress analysis of dental prostheses supported by straight and angled implants.

PURPOSE: A three-dimensional finite element analysis was conducted to evaluate and compare the stress distribution around two prosthesis-implant systems, in which implants were arranged in either a straight-line or an intrabone offset configuration. MATERIALS AND METHODS: The systems were modeled with three titanium implants placed in the posterior mandible following a straight line along the bone. The straight system was built with three straight implants (no offset). The angled system was built as follows: the first implant (mesial) was an angled implant inclined lingually, the second (median) was straight, and the third (distal) was another angled implant inclined buccally. This buccal incline created an intrabone implant offset owing to the inclination of the angled implants' bodies. Each system received a metal-ceramic prosthesis with crowns that mimicked premolar anatomy. In both systems, an axial load of 100 N and a horizontal load of 20 N were applied on the center of the crown of the middle implant. RESULTS: In both systems, the major von Mises stresses occurred with vertical loading on the mesial and the distal neck area of the first and third implants, respectively: 6.304 MPa on the first implant of the straight system and 6.173 MPa on the third implant in the angled system. The peak stress occurred for the minimum principal stress (S3) on the neck of the first implant for both systems at the level of -8.835 MPa for the straight system and -8.511 MPa for the angled system. There was no stress concentration on the inner or outer angles of the angled implants, on the notches along the implant body, or on any apex. CONCLUSIONS: In this analysis, the angled system did not induce a stress concentration in any point around the implants that was different from that of the straight system. The stress distribution was very similar in both systems.

Comparative 3D finite element stress analysis of straight and angled wedge-shaped implant designs.

PURPOSE: The goal of this work was to analyze the stress distribution in 2 wedge-shaped implant designs, straight and angled, by means of a 3-dimensional finite element method (FEM) stress analysis. MATERIALS AND METHODS: A model was generated from computerized tomography of a human edentulous mandible with the implants placed in the left first molar region. The model included boundary conditions representing the muscles of mastication and the temporomandibular joint. An axial load of 100 N and a horizontal load of 20 N were separately applied at the tops of the implant abutments, and system equilibrium equations were used to find each muscle intensity force based on its position and direction. The mandibular boundary conditions were modeled considering the anatomy of the supporting muscle system. Cortical and medullary bones were assumed to be homogeneous, isotropic, and linearly elastic. RESULTS: The stress analysis provided results in terms of normal maximum tensile (sigma1) and compressive (sigma3) stress fields. The stress distribution was quite similar for both designs, indicating a good performance of the angled design. CONCLUSIONS: Stresses in the angled implant were in general lower than in the straight implant, and the differences between the 2 designs studied were more relevant for the vertical load. No indication was found that angled implants of the type described generate stress-induced problems compared to straight implants.

Finite element stress analysis of cuneiform and cylindrical threaded implant geometries.

Statement of problem. Different implant geometries present different biomechanical behaviors and in this context, one arising question is how cuneiform implant geometry compares to clinical successful cylindrical threaded implant geometry. Purpose. The purpose of this work was to study stress distribution around cuneiform and cylindrical threaded implant geometries using three-dimensional finite element stress analysis taking the latter as a reference. Material and methods. A model was generated from a computerized tomography of a human edentulous mandible with implants placed in the left first premolar region. The model was supported by the mastication muscles and by temporomandibular joint. A vertical load of 100N was applied at the top of each implant in the direction of their long axes. The mandibular boundary conditions were modeled considering the actual muscle supporting system. Taking muscle forces intensities and directions, balance moment equations were employed to assess the system equilibrium. Cortical and medullary bones were assumed to be homogeneous, isotropic and linearly elastic. Results. The analysis provided results for maximum (S1) and minimum (S2) principal stress and Von Mises (SEQV) stress field. For both geometries, the results showed concentration on one side of the neck, smooth stress distribution along the body and no considerable concentration at the apical area. Conclusion. Results showed similar stress distribution pattern for cuneiform and cylindrical threaded geometries. The stresses profiles along the implants length reproduced their morphology. In both occurred stress concentration at one side of the neck and no body or apical stress concentration.

Hiperinfecção por Strongyloides stercoralis em paciente com Aids / Hiperinfection Strongyloides stercoralis in Aids patient

Os autores relatam um caso de paciente com Aids e hiperinfecção por Strongyloides stercoralis que evoluiu a óbito por septicemia e como encontro das larvas no pulmão, linfonodo e fígado. São discutidos os dados encontrados comparando com a literatura.

Three-dimensional finite element stress analysis of a cuneiform-geometry implant.

PURPOSE: The biomechanical behavior of an osseointegrated dental implant plays an important role in its functional longevity inside the bone. Studies of this aspect of dental implants by the finite element method are ongoing. In the present study, a cuneiform-geometry implant was considered with a 3-dimensional model that had a mesh that was finer than in the models commonly found in the literature. MATERIALS AND METHODS: A mechanical model of an edentulous mandible was generated from computerized tomography, with the implant placed in the left first premolar region. A 100-N axial load was applied at the implant abutment, and the mandibular boundary conditions were modeled considering the real geometry of its muscle supporting system. The cortical and trabecular bone was assumed to be homogeneous, isotropic, and linearly elastic. RESULTS: The stress analysis provided results that were used to plot global and detailed graphics of normal maximum (S1), minimum (S3), and von Mises stress fields. The results obtained were analyzed and compared qualitatively with the literature. DISCUSSION: Quantitative comparisons were not performed because of basic differences between the model adopted here and those used by other authors. The stress distribution pattern for the studied geometry was similar to those found in the current literature, but insignificant apical stress concentration occurred. The stress concentration occurred at the neck of the implant, ie, in the cortical bone, which was similar to results for other implant shapes reported in the literature. CONCLUSION: The studied geometry showed a smooth stress pattern, with stress concentrated in the cervical region. The values, however, were within the range of values found in the cortical layer far from the implant, caused by the muscular action. No significant stress concentration was found in the apical area.