Perfil de utilização de anestésicos locais de uma cidade brasileira com ênfase em diabéticos / Profile of use of local anesthetics in a Brazilian city with emphasis on diabetics

Objetivo: avaliar o conhecimento de cirurgiões-dentistas que trabalham em consultórios particulares de Palmas, Tocantins, quanto à utilização de anestésicos locais em pacientes portadores de diabetes mellitus. Materiais e método: trata-se de um estudo descritivo qualitativo, aprovado pelo Comitê de Ética em Pesquisa da FAMERP de São José do Rio Preto, sob o protocolo 032/2007 e CAAE: 0065.0.000.140-07, respeitando-se a Resolução 466/12, do Conselho Nacional de Saúde. A coleta de dados foi realizada por meio da aplicação de um questionário, utilizando um formulário estruturado. Resultados: de 113 participantes, 47 (41,6%) eram do sexo masculino e 66 (58,4%) do sexo feminino, com idade média de 35 anos. O anestésico mais utilizado pelos cirurgiões-dentistas avaliados foi a lidocaína 2% + adrenalina 1:100.000 (53,1%), o qual também é o mais utilizado para pacientes diabéticos controlados (64,6%). Quanto à variedade de anestésicos, 47,8% dos avaliados relataram possuir somente 3 tipos de anestésicos no consultório e que 83,2% nunca presenciaram nenhum problema decorrente do uso de anestésico. Além disso, 65,5% relataram não participar de cursos para atualização de conhecimentos, sendo que 53,1% mostraram-se insatisfeitos com o ensino de anestesiologia que receberam na graduação. Conclusão: observou-se que os cirurgiões-dentistas do atendimento odontológico particular de Palmas precisam de uma reciclagem profissional, a fim de atualizarem conhecimentos adquiridos na graduação sobre indicação e utilização de anestésicos locais em tratamentos odontológicos de pacientes com necessidades especiais, com ênfase em pacientes portadores de diabetes mellitus.(AU)

Objective: to evaluate the knowledge of dentists who work in private offices in Palmas, Tocantins, regarding the use of local anesthetics in patients with diabetes mellitus. Materials and method: this research is a qualitative descriptive study, approved by the Research Ethics Committee of FAMERP from São José do Rio Preto, under protocol number 032/2007 and CAAE: 0065.0.000.140-07 in compliance with the Resolution 466/12 of the National Health Council. Data collection was performed through the application of a questionnaire, using a structured form. Results: 47 (41.6%) out of 113 participants were male and 66 (58.4%) female, with an average age of 35 years old. The anesthetic most used by the dentists evaluated was lidocaine 2% + adrenaline 1: 100,000 (53.1%) which is also the most used for controlled diabetic patients (64.6%). As for the variety of anesthetics, 47.8% of those evaluated reported having only 3 types of anesthetics in the office and that 83.2% never saw any problems resulting from the use of anesthetics. Furthermore, 65.5% reported not participating in courses to update knowledge and 53.1% were dissatisfied with the teaching of anesthesiology they received during graduation. Conclusion: it was observed that dentists who work in private dental offices in Palmas need a professional retraining in order to update knowledge acquired during graduation on the indication and use of local anesthetics in dental treatments for patients with special needs, with an emphasis on patients with diabetes mellitus.(AU)

Estudio histológico comparativo de la reparación ósea entre hueso alveolar y extra-alveolar en los cerdos sometidos a osteotomía con alta y baja velocidad, con refrigeración líquida / Comparative study of bone repair between alveolar and extra-alveolar bone in pigs subjected to osteotomy at low speed and high speed with liquid refrigeration

Introducción. Teniendo en cuenta que el proceso de reparación ósea en los cerdos se muestra en una mayor proximidad entre las variables histológicas estudiadas en comparación con otros modelos biológicos, el presente estudio tenía como objetivo evaluar el proceso histológico de la reparación ósea de osteotomías realizadas en huesos alveolares y extra-alveolar, utilizando instrumentos rotatorios con refrigeración líquida. Material y método. Dieciocho cerdos Large White con peso comprendido entre 20 y 25Kg fueron divididos en tres grupos de seis animales cada uno, con cada grupo formado por tres animales para evaluar la reparación de osteotomías con baja y alta velocidades en el hueso alveolar y tres en área extra-alveolar en los períodos de estudio de 7, 14 y 28 días. Resultados. Se observó que en el hueso alveolar en los tiempos post-operatorio de 14 y 28 días, los mejores resultados de reparación fueron en las osteotomías realizadas con baja velocidad, mientras que en el período post-operatorio de siete días, los resultados con alta velocidad fueron ligeramente mejores tanto en áreas alveolares como extra-alveolares. Para la metodología utilizada, no se encontraron diferencias estadísticamente significativas en el proceso de reparación ósea alveolar y extra-alveolar. Conclusiones. El proceso de reparación, por medio de análisis microscópico en la región alveolar y extra-alveolar, son similares con mejores resultados observados en osteotomías hechas con taladros en baja velocidad en los tiempos de catorce y veintiocho días y en el post-operatorio de siete días, los resultados con taladros de alta velocidad y la refrigeración fueron ligeramente mejores. Los trabajos de investigación utilizando cerdos como modelo animal son perfectamente viables(AU)

Introduction. Taking into account the bone repair process in pigs has shown a greater similarity among the histological variables studied compared to other biological models, the present study has as its aim to evaluate the histological bone repair process of osteotomy performed on alveolar and extra-alveolar bones, using drilling tools with liquid refrigeration. Material and method. Eighteen Large White pigs weighing between 20 and 25 Kg were divided into three groups of six animals in order to evaluate the osteotomy repairs with low and high speed in the alveolar bone and threes in the extra-alveolar area, study periods of 7, 14 and 28 days. Results. It was observed that in the alveolar bone at the postoperative times of 14 and 28 days, the best repair results were in the osteotomy performed with low speed, while in the 7 day postoperative period, the results with high speed were slightly better, in alveolar areas as well as extra-alveolar areas. There no statistically significant differences between the alveolar and extra-alveolar bone repair process. Conclusions. The repair process, by means of microscopic analysis in the alveolar and extra-alveolar areas, are similar with better results observed in osteotomies performed with low speed drills in the 14 and 28 day study periods, and at 7 days postoperative the results with high speed drills and refrigeration were slightly better. Research works using pigs as an animal model are perfectly viable(AU)

Estudio digital radiográfico y densitométrico en mandíbulas de cerdos sometidos a osteotomía con alta y baja velocidad, con refrigeración líquida / Digital and densitometric radiographic study in swine jaws subjected to osteotomy using high and low drilling speeds with liquid cooling

Se evaluó por medio de la radiografía digital y la densitometría, la influencia de un dispositivo de rotación para el corte en el proceso de curación del hueso después de osteotomías en mandíbulas de cerdos, a tiempos controlados. Se realizaron dos secciones transversales en la base de la mandíbula derecha, una con una alta velocidad de rotación y otra por la acción de baja velocidad, ambos con el líquido de irrigación. Tras los tiempos preestablecidos, los animales fueron sacrificados y sus mandíbulas retiradas para los estudios radiográficos y de densitometría radiológica con los sistemas digitales Cromox, Digora y ODR. En los períodos iniciales (7 y 28 días) el equivalente a la densitometría en milímetro de aluminio y la media de niveles de gris fueron más altos en la región de osteotomías hechas con alta rotación, y en los períodos finales (60 y 90 días) las mayores densitometrías fueron para osteotomías hechas con baja velocidad, lo que indica una mejor cicatrización final del hueso cuando se hace uso de la baja velocidad. El análisis cualitativo del proceso de reparación fue realizado por el ODR, lo que permitió la recopilación de imágenes digitales en color y en tres dimensiones, para la comparación del espesor del hueso con una cuña de aluminio, indicando que en los 28 días de curación del hueso, ya estaba evidente la completa reparación(AU)

The influence of the type of rotary cutting instrument on bone repair after osteotomy in swine jaw, was evaluated using digital and densitometric radiographic examinations, at controlled times. Two cross-sectional dissections were made through the base of the right jaw, one using a high speed rotary instrument and the other using low speed, both with liquid cooling. After established periods the animals were sacrificed and their jaws removed for direct and indirect digital radiographic and densitometric studies using the CROMOX, DIGORA and ODR systems. In the initial periods (7 and 28 days) the bone density was higher in osteotomy areas performed with high rotation speeds, and in the final periods (60 and 90 days) the bone density was higher in the osteotomies performed with low rotation, indicating a better final bone repair with the use of low rotation. The qualitative analysis of the repair process was made by the ODR system which obtained three-dimensional and coloured digital images, which enable the bone thickness to be measured using an aluminium wedge. This showed that by twenty-eight days the bone repair was already apparently complete(AU)

Estudio histológico del proceso de reparación alveolar después de la aplicación tópica de la solución anestésica prilocaína 3 por ciento con felipresina 003 UI/ML / Histological study of alveolar repair process after topical application of the anesthetic solution with 3 percent prilocaine Felypressin 0.03 IU / ML

El objetivo de este estudio fue evaluar la influencia de una solución anestésica, compuesta por Prilocaina 3% y felipresina 0,03 UI/ml, y el efecto que tiene sobre el proceso de reparación alveolar en ratones después de una exodoncia. Este estudio fue aprobado por el Comité de Etica en Investigación del Programa de Maestría de Cirugía y Traumatologia Bucomaxilofacial de la Universidad de Marilia (UNIMAR) Marília, São Paulo, Brasil. Este estudio fue de tipo experimental, aleatorio controlado, con análisis bifactorial (grupo control en relación al grupo experimental, en función de los tiempos operatorios (2X4)). Se utilizaron 32 ratones (Rattus norvegicus, albinus, Wistar), machos, adultos, pesando entre 280 y 320 gramos. Los animales fueron distribuidos de la siguiente forma: 16 especímenes fueron seleccionados para grupo control (Grupo I), no recibieron ningún tratamiento adicional después de la extracción del incisivo superior derecho; los otros 16 especímenes restantes, después de la exodoncia, un área de la herida quirúrgica fue tamponada con gasa embebida en la solución anestésica de Citocaína 3%® (Clorhidrato de Prilocaína 3% con Felipresina 0,03 UI/ml), y conformaron el grupo experimental (Grupo II). Los animales sufrieron eutanasia transcurridos los períodos de 3, 7, 15, 24 días post operatorios. Através del análisis histológico y con base en la metodología desarrollada, nos permitió concluir que la solución anestésica de Citocaína 3%® aplicada con compresas de gasa sobre la herida quirúrgica post-extracción dentaria, produjo eventos tisulares que comprometieron los principios básicos responsables por la regeneración del epitelio de la mucosa gingival y por el proceso de reparación alveolar. Se observó que en todos los períodos post operatorios estudiados y cuando se compararon los dos Grupos, se confirmó que el Grupo I presentó mejores resultados en relación al proceso de reparación alveolar

O objetivo deste estudo foi avaliar a influência da solução anestésica, composta por Prilocaína 3% com felipressina 0,03 UI/ml, sobre o processo de reparación alveolar em ratos, após a extração dental. O presente estudo foi previamente aprovado pelo comitê de ética em pesquisa do Programa de Mestrado em Cirurgia e Traumatologia Buço-maxilo-faciais da Universidade de Marília (UNIMAR), Marília, São Paulo, Brasil. Tratou-se de um estudo do tipo experimental, aleatório controlado, com análise bifatorial (grupo controle em relação ao grupo experimental, em função dos tempos operatórios (2x4)). Utilizou-se 32 ratos (Rattus norvegicus, albinus, Wistar), machos, adultos, pesando entre 280 e 320 gramas. Os animais foram distribuídos da seguinte forma: 16 espécimes foram selecionados para o grupo controle (Grupo I), não receberam nenhum tratamento adicional após a extração do incisivo superior direito; os outros 16 espécimes restantes, depois da exodontia, a área da ferida cirúrgica foi tamponada com gaze embebida em solução anestésica de Citocaína 3%® (Prilocaína 3% com Felipressina 0,03 UI/ml), e formaram o grupo experimental (Grupo II). Os animais sofreram eutanásia após decorrido os períodos de 3, 7, 15, 24 dias pós-operatórios. Através da análise histológica e com base na metodologia aplicada, permitiu-nos concluir que a solução de Citocaína 3%® aplicada com compressas de gaze sobre a ferida cirúrgica após extração dentária, produz eventos teciduais que comprometeram os princípios básicos responsáveis pela regeneração do epitélio da mucosa gengival e o processo de reparação alveolar em ratos. Observou-se que em todos os períodos pós-operatórios estudados e quando se compararam os dois Grupos, confirmou-se que o Grupo I apresentou melhores resultados em relação ao processo de reparo alveolar

The aim of this study was to evaluate the local anesthetic solution, composed by Prilocaine 3% and felipressin 0,03 UI/ml, influence on the alveolar repair process in rats after dental extraction. This research was previously approved by the Ethic Committee in Research of the Masters Degree Program in Oral and Maxillofacial Surgery of the Marília University (UNIMAR), Marília, São Paulo, Brazil. It was an experimental, randomly controlled study, with bifactorial analysis (group control versus experimental group, in function of the postoperative times (2 X 4)). For the accomplishment of this study 32 rats were used (Rattus norvegicus, albinus, Wistar), males, adults, weighing between 280 and 320 grams. The animals were selected and divided into Group I (control) and Group II (Citocain 3%® - Prilocaine 3% with felipressin 0,03UI/ml) with 16 rats each; being four animals of the Group I and four of the Group II, destined to the euthanasia in the postoperative periods of 3rd, 7th, 15th and 24th days. The histological analysis with base in the developed methodology, allowed us to conclude that the anesthetic solution of Citocain 3%® applied with gauze compress on the surgical dental wound, produced tissue events that committed the basic biological principles, that are responsible for the regeneration of the gingival epithelium and the alveolar process repair in rats. The Group I presented better results in the alveolar repair when compared to the Group II

Review article: pharmacological treatment of the hepatorenal syndrome in cirrhotic patients.

Renal failure is common in patients who are dying from end-stage cirrhosis, developing in 40-80% of all patients. Where there is no anatomical or pathological cause for the renal failure, it is termed the hepatorenal syndrome. When the hepatorenal syndrome develops, it will only recover when there is some degree of improvement in liver function. Thus for most patients this will occur only after liver transplantation, although the transplantation mortality is increased in this group. Hepatorenal syndrome is a common complication of alcoholic hepatitis, and this group is unusual in that with time and abstinence, significant recovery of liver function may occur. There is therefore a need for supportive therapy to allow time for some recovery of liver function in patients with alcoholic hepatitis and hepatorenal syndrome. Similarly, patients may need support whilst waiting for liver transplantation. This article reviews the pathophysiology and treatment of hepatorenal syndrome.

Utilizaçäo de cloridrato de prilocaína a 3 por cento com felipressina a 0, 03UI em pacientes hipertensos / The application of the prilocaine chloridrate at 3 per cent with felypressin at 0, 03UI in hypertensive patients

Este trabalho tem como propósito avaliar os efeitos da combinaçäo do cloridrato de prilocaína a 3 por cento a 0,03UI sobre a pressäo arterial de pacientes hipertensos submetidos a exodontias convencionais

The long-term morbidity and mortality rate in a cohort of patients with liver cirrhosis and oesophageal varices.

BACKGROUND/AIMS: A long-term study and follow-up of an uniform treatment strategy for esophageal varices was evaluated to plan future strategies more effectively. MATERIAL AND METHODS: Morbidity and mortality in 101 patients with liver cirrhosis followed up for 5 years in a single center after the first detection of oesophageal varices were studied. RESULTS: Definitive hemostasis of the first variceal bleeding episode could not be obtained in 31.5%, despite emergency endoscopic sclerotherapy in combination with vasopressin and/or balloon tamponade. Mortality related to this bleeding was 26% in this cohort of patients. Overall mortality from variceal bleeding during the 5 year period was 38%. Death occurred predominantly in patients with advanced liver disease, since the Child-Pugh score of patients who bled and survived was 8 +/- 2 as compared to 11 +/- 2 (p<0.01) in those who bled and died. If fundic varices were the origin of the hemorrhage, the mortality reached 78% within 6 months. Eighty-five percent of the fatalities were related to the liver disease. Besides variceal bleeding, infection was the predominant trigger leading to liver failure; occurring in 25%. The cause of non-liver related death was malignancy of esophagus, lung and pancreas. Only 13% of the patients with liver failure had undergone an orthotopic liver transplantation. CONCLUSION: Since variceal hemorrhage still carries a high mortality rate, primary prophylaxis for patients at high risk is indicated. The systematic, concomitant use of vasoactive drugs to sclerotherapy and the early performance of TIPS in case of failure of sclerotherapy have to be evaluated. Finally patients with an advanced liver disease and increased risk factors for variceal bleeding should be considered earlier for liver transplantation.

Avaliaçäo dos efeitos da associaçäo de adrenalina e felipressina à bupivacaína sobre a pressäo arterial de cäes / Effects on the epinephrine-fenylpressin association to bupivacaine upon the arterial pressure, in dogs

A combinaçäo de adrenalina e felipressina em uma soluçäo anestésica local tem sido estudada na tentativa de se melhorar a qualidade e duraçäo da anestesia, além de diminuir sua toxicidade. Este trabalho teve por objetivo avaliar, em cäes, os efeitos da associaçäo de adrenalina (1:2000.000) e felipressina (0,03 UI/ml) à bupivacaína a 0,25 por cento sobre a pressäo arterial. Os resultados demonstraram näo haver uma interferência significativa no parâmetro estudado, independentemente da via de administraçäo (intravenosa e intrabucal) da soluçäo anestésica, com exceçäo da PS no tempo de 1 minuto, pela via IV

The effects of two different local anaesthetic solutions administered for oral surgery on plasma potassium levels in patients taking kaliuretic diuretics.

The effects of two different dental local anaesthetic solutions, administered for oral surgery, on the plasma potassium levels of patients taking non-potassium sparing diuretics has been investigated. There was a significant reduction in plasma potassium concentration in eight subjects who received 4.4 ml of 2% lignocaine with 1:80,000 adrenaline; the mean reduction from baseline being 0.30 mmol.l-1 10 min following intraoral extravascular injection of the local anaesthetic. There was no significant difference from the pre-treatment plasma potassium concentration 10 min following similar injections of 3% prilocaine with 0.03 IU.ml-1 felypressin in 8 patients; the mean change in these subjects being -0.05 mmol.l-1. It is suggested that the use of adrenaline-free local anaesthetics would seem to be appropriate in patients receiving kaliuretic diuretics.

The effect of octapressin on renal and intrarenal blood flow in cirrhosis of the liver.

The effect of octapressin (2-phenylalanine-8-lysine vasopressin) on renal and intrarenal blood flow was studied in 11 normotensive cirrhotic patients with abnormal renal perfusion. Renal haemodynamic changes were assessed with the (133)Xenon washout technique. Of the six patients given suppressor doses of octapressin intravenously renal blood flow improved in one only. A further three patients responded to the drug in a dose which increased the mean arterial pressure by 5 or more mm Hg. The increase in mean renal blood flow was accompanied by an improvement in renal cortical perfusion. In two patients renal blood flow decreased after the administration of octapressin. These findings, in conjunction with previous reports, suggest that octapressin will only consistently improve renal perfusion in cirrhotic subjects who are hypotensive and in whom the mean arterial blood pressure is raised by the drug, but do not exclude the possibility that octapressin may have a direct renal circulatory effect in some patients.