Single-Tooth Rehabilitation Combining Root Displacement and Crown Lengthening Two-Year Follow-Up: A Case Report.

Rehabilitation of an extensively compromised single anterior tooth represents an intriguing challenge for dentists, particularly when the rehabilitation involves esthetic, psychosocial, and functional requirements. The success in rehabilitating a patient with a conservative approach depends on a critical evaluation of the remaining structures, precise treatment plan, systematic treatment strategies, and patient compliance. In this case, the patient's chief complaint was the undesirable appearance of the maxillary right lateral, caused by the displacement of the post and crown. Clinical examination revealed a remaining tooth with coronal fracture, severe loss of tissue due to caries, and absence of ferrule effect. Radiographic examination revealed that the fracture margin was located subgingival. This case report describes a single-tooth rehabilitation involving a combination of root displacement via orthodontic extrusion and crown lengthening. The rehabilitation was followed by post-and-core restoration using a prefabricated glass fiber post associated with a disilicate lithium crown. The clinical decision making and combined effect of both treatment strategies are explained in this report. The treatment required three months, including recovery times after surgery and the placement of the provisional crown. The patient was esthetically and functionally satisfied with the restoration. Patient follow-up examination was performed 24 months after the treatment. This clinical report contributes to the clinical practice and exemplifies the possibility of rehabilitating the natural tooth using combined techniques, which may offer particular advantages regarding prognosis and invested efforts.

Características das carcaças e carne de tourinhos Nelore alimentados com níveis de concentrado e farelo do mesocarpo de babaçu / Carcass and meat characteristics of cattle fed concentrate levels and babassu mesocarp bran

Avaliaram-se as características da carcaça e da carne de tourinhos Nelore alimentados com diferentes níveis de concentrado e farelo do mesocarpo do babaçu na dieta. Foram utilizados 28 tourinhos da raça Nelore, com idade inicial de 21 meses e 356,66±19,25kg de peso corporal inicial, distribuídos inteiramente ao acaso em dietas com dois níveis de concentrado (65 e 71%), associadas ou não à inclusão de 35% de farelo do mesocarpo do babaçu no concentrado. A elevação da fração concentrada na dieta de 65 para 71%, bem como a inclusão de 35% de farelo do mesocarpo do babaçu no concentrado, não alterou a quantidade de músculo, gordura e osso da carcaça, com valores médios de 63,91; 19,46 e 16,63% do peso de carcaça fria, respectivamente. O rendimento dos cortes comerciais secundários do traseiro especial não foi alterado pela inclusão de 35% de farelo do mesocarpo do babaçu no concentrado nem pelo teor de concentrado da dieta. A força ao cisalhamento das fibras musculares, a perda de líquido por descongelamento e cozimento não foram alteradas pelos fatores estudados, apresentando valores médios de 6,57kgf/cm3, 16,08% e 22,20%, respectivamente. O marmoreio aumentou (5,78 para 9,79 pontos) pelo avanço do nível de concentrado na dieta, mas não foi alterado pela inclusão do farelo do mesocarpo do babaçu. O farelo do mesocarpo do babaçu apresenta características nutricionais que possibilitam substituir parcialmente o milho em dietas com elevada proporção de concentrado, não alterando a composição física da carcaça e a qualidade da carne de tourinhos Nelore confinados.

Carcass characteristics and meat of young bulls fed different levels of concentrate and babassu mesocarp bran in the diet were evaluated. A total of 28 Nellore young bulls, initial age of 21 months and 356.66±19.25kg of initial body weight were randomized in diets containing two levels of concentrate (65% and 71) associated or not to the inclusion of 35% of babassu mesocarp bran in the concentrate. The elevation of the concentrate fraction of the diet from 65 to 71%, and the inclusion of 35% of babassu mesocarp bran in the concentrate did not alter the amount of muscle, fat and bone of the carcass, with average values of 63.91, 19.46 and 16.63% of cold carcass weight, respectively. The yields of retail cuts from the pistol cut were not altered by the concentrate level of the diet or by the inclusion of 35% babassu mesocarp bran in the concentrate. The shear force of muscle fibers and the losses of liquid during thawing and cooking were not altered by the factors studied, with average values of 6.57kgf/cm3, 16.06% and 22.20%, respectively. Marbling increased (5.78 to 9.79 points) to advance the level of concentrate in the diet, but was not altered by the inclusion of babassu mesocarp bran. Babassu mesocarp bran has nutritional characteristics that allow partial replacement of corn in diets with high concentrate, not changing physical carcass composition and meat quality of confined young Nellore bulls.

Shielding analysis of the Microtron MT-25 bunker using the MCNP-4C code and NCRP Report 51.

A cyclic electron accelerator Microtron MT-25 will be installed in Havana, Cuba. Electrons, neutrons and gamma radiation up to 25 MeV can be produced in the MT-25. A detailed shielding analysis for the bunker is carried out using two ways: the NCRP-51 Report and the Monte Carlo Method (MCNP-4C Code). The walls and ceiling thicknesses are estimated with dose constraints of 0.5 and 20 mSv y(-1), respectively, and an area occupancy factor of 1/16. Both results are compared and a preliminary bunker design is shown.

Avaliação físico-química de sementes de guaraná secas por diferentes métodos / Physico-chemical evaluation of guarana seeds dried by different methods

Amostras de sementes de guaraná provenientes da região amazônica e secas por diferentes métodos, foram analisadas por técnicas farmacopéicas e outras, e o extrato liofilizado foi analisado por cromatografia líquida de alta eficiência (CLAE). Realizou-se o doseamento de metilxantinas (MX) e dos taninos totais (TT), através de métodos espectrofotométricos, para a comparação das amostras. O maior teor de MX foi obtido com as sementes secas em tacho metálico por 4 h com adição de água, enquanto que o maior teor de TI foi obtido com a amostra torrada em tacho metálico por 4 h sem água. A análise cromatográfica por CLAE apresentou tempos de retenção para catequina, epicatequina e cafeína de 6,17; 8,85 e 11,91 min, respectivamente.

Contrai quality of the vegetable drug "guaraná", with samples of seeds obtained from Amazonian area, were carried out by pharmacopoeial assays, and the extract were analysed by HPLC. The determination of methylxantines (MX) and total tannins (TI) was performed by spectrophotometric methods. The most yield of MX were showed by the sample GTIB and for TI the best result were obtained by the sample GTIM4s. The analysis by HPLC showed retention times for catechin, epicatechin and cafteine of 6.17,8.85 and 11.91 min, respectively.

[Ebstein's anomaly associated with interventricular communication]. / Anomalia de Ebstein associada a comunicação interventricular.

Twelve-year-old patient, with congestive heart failure and mild, caused by Ebstein's anomaly with interventricular septal defect, was studied and submitted to surgical correction which consisted in covering the interventricular defect with a path of bovine pericardium and substituting for the tricuspid valve with a biological prosthesis (porcine). After surgical correction, the patient was submitted to strict clinical and laboratorial (echocardiogram and cardiac catheterization) evaluation which presented excellent adjustment of the cardiac antriums, with improvement of myocardial function index. The problems related to the diagnosis of the association of the Ebstein's anomaly with interventricular septal defect can be solved with a well done semiology, helped by accurate laboratorial procedures like echodopplercardiogram and cardiac catheterization. The total surgical correction can be achieved with results and, with this fact, change the natural development of the disease.

A unique inlet [the ascending aorta] for extra-anatomic bypass of infected arterial prostheses.

Infection is the most dreaded complication associated with implantation of a prosthetic arterial graft. The reported incidence of primary graft infection varies from 1.3% to 6.0%, with a mortality rate from this complication as high as 75%. Although remote bypass followed by complete removal of the infected prosthesis has proven to be a satisfactory method of treatment, in certain instances remote bypass alone is not feasible and other modes of surgical treatment must be employed. Such conservative methods of management of infected aorto-iliac-femoral prosthesis sometimes irradicate infection. The only certain cure, however, is obtained by totally removing the graft. And the success of extra-anatomic axillofemoral techniques has led to its extended use. The addition of a cross-limb on an axillo-unilateral femoral graft to form an axillobilateral femoral graft was described by Sauvage and Wood, reasoning that the higher flow rate in the axillary limb of the axillobilateral femoral graft would result in an improved patency rate compared with that of axillounilateral femoral grafts. Additionally, both medial (obturator foramen) and lateral extra-anatomic remote bypass of infected femoral prosthesis have been used, successfully. The current case illustrates the complexity of management, once sepsis occurs. It further focuses on groin, retroperitoneal and bilateral axillo-femoral tract infection with prolonged (apparently innocuous) graft exposure and finally points out the utility of the ascending aorta as an alternative extra-anatomic inlet to perfuse the lower extremities.

[The terminal patient and psychotherapeutic approach]. / A problemática do doente terminal e a atitude psicoterapêutica.

The end stage situation, namely AIDS and malignant diseases, patients are analysed by the authors from the psychiatric and psychologic standpoint. A multidisciplinary clinical approach is pointed out and psychotherapeutic attitude and action parameters are referred to achieve both the understanding of persons in those situations, and the correct clinical praxis towards them.

[Schizophreniform characteristics and schizophrenia illustrated with a Kafka story]. / Alguns aspectos sobre características esquizóides e esquizofrenia ilustrados com um conto de Kafka.

Kafka's literary work is the author's basis to illustrate the nature, function and evolution of schizophrenia related psychotic processes. Classical (Sobral Cid), psychoanalytic (Fairbain, Winnicott, Cortesão) among other author's contributions, are referred. The literary work analysis allows a link to be made between the symptoms (as referred in the APA'S D.S.M. III), and their understanding, and also elements for the therapeutic process.

[Pulmonary arteriovenous fistula. A case report and review of the literature]. / Fístula arteriovenosa pulmonar. Relato de caso e revisão da literatura.

The aim of this paper is to review clinical and laboratory features of this unusual pathology and its complications, indicating transcatheter embolization as a first choice for its management. Our case report is of a seven year-old child, with complex pulmonary arteriovenous fistula of the anterior segment of right superior lobe, which was diagnosed mainly by cintilography and pulmonary angiogram. Clinically she had cyanosis, fatigue with exertion, clubbing of the fingers and polycythemia with low partial pressure of oxygen (PAO2: 68.1 mmHg; Sat O2: 92.4%; Hct: 47.5%; Hb: 16 gr%). She did not have Rendu-Osler-Weber disease. The anatomic structure and localization of the complex fistula was showed by cineangiographic study. We preferred to manage this fistula with transcatheter embolization with a 02 gauge stainless steel coil occluding device (Gianturco-Wallace), as it was single and the patient was too young for sustain surgical trauma and the outcome would be positively satisfactory. After the embolization cyanosis was relieved and we could see normal pulmonary circulation following the point of the pre-existing fistula. We concluded that a judicious assessment by cineangiography could help select the transcatheter embolization procedure as an attractive therapeutic approach instead of surgery.

Infectious complications in four long-term recipients of the Jarvik-7 artificial heart.

This article describes the infectious complications that occurred among four of the longest-term recipients of the Jarvik-7 artificial heart. Infection arising from the drive lines, with spread to the mediastinal periprosthetic space, was the major limiting factor in long-term use of the device in these patients. Periprosthetic infections were due to coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas aeruginosa, and other Pseudomonas species. Other infectious complications incurred by some of the patients included pneumonia, empyema, urinary tract infection, and intravascular line sepsis with Candida. Intensive antimicrobial therapy for prolonged periods seemed to suppress but not to eradicate infection and was accompanied by the appearance of multiresistant bacterial strains. Complications of antimicrobial therapy included diarrhea secondary to overgrowth with Clostridium difficile in two patients. Use of the current device for more than 30 days should be considered extraordinary and should be reserved for patients for whom no other form of life support is available.

Splenic abscess due to Clostridium septicum in a patient with multiple myeloma.

Solitary abscesses of the spleen may occur as a consequence of septicemia from various septic foci, particularly intra-abdominal sites. A variety of causative organisms, including the clostridia, have been isolated. We have described a patient with multiple myeloma who had a solitary splenic abscess due to Clostridium septicum and who failed to survive despite seemingly appropriate treatment. Clinicians should be alert to this complication, which demands immediate splenectomy and appropriate antibiotic therapy.

Estenose mitral congênita: 2ª parte / Congenital mitral stenosis: 2ª part

Säo apresentados três casos de estenose mitral congênita isolada: dois classificados como tipo 1 (valvar) e outro como tipo 2 (valva mitral em paraquedas). Säo discutidos os dados eletrocardiográficos, ecocardiográficos, hemodinâmicos e de raio-X deste raro tipo de cardiopatia congênita. O caso 1 e 3 tiveram um curso clínico relativamente benigno e foram mantidos sob tratamento clínico. O caso 2 apresentou uma deteriorizaçäo rápida, desenvolvendo insuficiência cardíaca de difícil controle, vindo a falecer em choque cardiogênico. A autópsia mostrou uma estenose mitral do tipo paraquedas, associada a grau leve de fibroelastose endocárdica

Acute synovitis caused by an organism of the Rhodochrous taxon.

A 36-year-old man with systemic lupus erythematosus developed synovitis of the right wrist caused by an organism of the Rhodochrous taxon. The capacity of this pathogen to produce a granulomatous inflammatory reaction in human tissues is discussed. The isolate was sensitive to chloramphenicol, gentamicin, carbenicillin and colistin in in-vitro tests and the infection responded promptly to treatment with chloramphenicol.

Mycobacterium terrae tenosynovitis: chronic infection in a previously healthy individual.

We have described a case of Mycobacterium terrae tenosynovitis in an otherwise healthy individual. The chronic nature of this infection suggests that aggressive surgical and medical therapy is the most prudent course for physicians faced with this infection.

The protean manifestations of Legionnaires' disease.

The protean manifestations of Legionnaires' disease are described in an analysis of 12 sporadic cases. Two forms of the disease have been delineated. One variant (Group A) consisted of six patients who had a mild form of non-progressive pneumonia with minimum extra-pulmonary involvement. Six patients (Group B) were differentiated by rapidly progressive pulmonary infiltrates, severe hypoxia and respiratory failure, plus a higher frequency of band neutrophils and extra-pulmonary manifestations. Particularly notable were evidence of severe myositis (elevated creatinine phosphokinase and lactate dehydrogenase), anaemia, and neurological findings which included alterations in the sensorium, meningitis, and convulsions. Cerebrospinal fluid (CSF) abnormalities were seen frequently in patients with neurological manifestations, and necropsy findings in one patient suggested that the Legionnaires' bacillus was capable of producing a fatal leucoencephalitis. Renal findings included haematuria, proteinuria and oliguric renal failure. Hepatic transaminases (SGPT, SGOT) were elevated in six patients and serum bilirubin was abnormal in five. Alkaline phosphatase values were normal to minimally elevated. The gastrointestinal symptoms commonly considered to be a frequent initial manifestation of Legionnaires' disease were rare in this series. Recommendations for instituting empirical therapy, based upon recognition of a clinical syndrome which should suggest the diagnosis of Legionnaires' disease, are included.

Anaerobic osteomyelitis of long bones.

Nine cases of anaerobic osteomyelitis of long bones are reviewed, and data are tabulated for an additional 52 cases from the literature. Three major clinical presentations of this disease entity include an acute hematogenous form usually involving previously normal bones in younger patients; a chronic infection in which the anaerobic bacteria superinfect a fracture site already compromised by osteomyelitis due to aerobic organisms, usually Staphylococcus aureus; and an indolent infection at the site of indwelling prosthetic devices. This last form appears to be initiated at the time of surgery by the introduction of normal cutaneous anaerobic flora into the wound, but disease does not become apparent until months to years later. The responsible organisms, pathophysiology, and clinical presentations of these three forms are discussed; and the therapeutic necessity to remove all devitalized tissues, reestablish vascularity, graft bony defects, and combine this with long-term antibiotic therapy, preferably bactericidal against the causative organisms, is emphasized.