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1.
Braz Dent J ; 31(1): 25-31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32159701

RESUMO

The purpose of this study was to evaluate the presence of residues after post space preparation (PSP) and establish whether the apical displacement of the gutta-percha was affected by the moments and methods of PSP in teeth filled by the single-cone technique. The root canals of 20 bovine incisor teeth were instrumented with Reciproc and filled with single-cone and AH Plus. The specimens were divided into 4 groups according to the moment and method of PSP (n=5): immediate with drill, immediate with thermoplasticizer, delayed with drill and delayed with thermoplasticizer. Micro-CT scans were performed before and after the PSP for residues of the root canal filling (1) and analysis of apical displacement (2). Data were analyzed by using 2-way repeated measurement ANOVA (1) and 2-way ANOVA (2) followed by the Tukey's test (a=0.05). Significance effect on the residues percentage remaining for methods (p=0.044), for moments (p=0.006), for thirds repetition (p<0.001), and for interaction between methods and thirds (p<0.001), and moments and thirds (p=0.044). Significance effect on the apical displacement of root canal filing was detected for methods (p=0.008), however no difference was found between moments (p=0.617). In general, PSP using drill resulted in more homogeneous root canal preparation, mainly when made immediately. For all other combinations between methods and moments for PSP, the middle and apical thirds presented significant higher residues remaining. Thermo method performed in both moments and the drill method performed immediately had displacement in the apical direction, representing extrusion of the root filling material.


Assuntos
Cavidade Pulpar , Materiais Restauradores do Canal Radicular , Animais , Bovinos , Guta-Percha , Retratamento , Obturação do Canal Radicular , Preparo de Canal Radicular , Microtomografia por Raio-X
2.
Medicine (Baltimore) ; 99(5): e18956, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000420

RESUMO

Intussusception is common emergency condition in children. Pneumatic or hydrostatic reduction (HR) is considered the first-choice management strategy in cases lacking indications for surgical intervention. Generally, sedatives are not used in children undergoing interventional radiology procedures. Surgical management is associated with long hospitalization durations and high costs, unlike nonsurgical reduction. To avoid surgery, reduction procedures are repeated despite initial treatment failure. However, in cases involving repeated failures, children should be referred for surgery.To ensure good response to reduction, we planned HR under sedation during the third reduction attempt. Sedative reduction (SR) was performed with the administration of ketamine, midazolam, and atropine. All patients with contraindications against HR underwent laparoscopic reduction (LR) without HR.During 3 years, SR was performed in 43 patients, and in 28 (65.1%), the treatment was successful. Among the 15 patients in whom the procedure failed, 14 underwent LR without intestinal resection. There was no significant risk factor contributing to failed reduction under sedation.During the second or third HR attempt, successful reduction may be ensured with the SR procedure with intravenous ketamine, midazolam, and atropine; this procedure may further reduce surgery rates in pediatric intussusception.


Assuntos
Hipnóticos e Sedativos/uso terapêutico , Intussuscepção/terapia , Administração Intravenosa , Atropina/uso terapêutico , Pré-Escolar , Feminino , Humanos , Lactente , Ketamina/uso terapêutico , Laparoscopia , Masculino , Midazolam/uso terapêutico , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
3.
Anticancer Res ; 40(2): 1141-1146, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014966

RESUMO

BACKGROUND/AIM: This study aimed to assess the efficacy and toxicity of second-line chemotherapy, especially combination chemotherapy, for advanced or metastatic urothelial cancer. PATIENTS AND METHODS: This retrospective analysis included patients who received second-line chemotherapy after disease progression during first-line chemotherapy between January 2009 to May 2018. Progression-free survival (PFS), overall survival (OS) and toxicity associated with second-line chemotherapy were assessed. RESULTS: In total 25 patients received second-line chemotherapy; 21 patients had combination chemotherapy and 4 had single-agent chemotherapy. Median PFS and OS were 3.6 months (range=0.2-23.5) and 11.9 months (range=0.5-29.0), respectively. Twenty patients (80%) exhibited grade 3 or more severe toxicities. CONCLUSION: PFS and OS benefits of second-line combination chemotherapy corresponded to those of the phase 3 study of pembrolizumab, but adverse events were more severe. Pembrolizumab is potentially a better second-line treatment than combination chemotherapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Uretrais/tratamento farmacológico , Neoplasias Uretrais/patologia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Retratamento , Resultado do Tratamento , Neoplasias Uretrais/diagnóstico por imagem
4.
World Neurosurg ; 135: 324-329, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31901498

RESUMO

BACKGROUND: Dissection of a vertebral artery (VA) fenestration is extremely rare. We herein present the first case of a patient who presented with the dissection of a VA fenestration limb accompanied by occlusion after rupture, who was treated with internal trapping of the dissected limb and the parent artery proximal to the fenestration. CASE DESCRIPTION: A 55-year-old man presented with sudden headache and altered consciousness. Computed tomography at admission showed subarachnoid hemorrhage. Angiography showed occlusion of the inner limb of the vertebrobasilar junction fenestration, and the occluded ends had a tapered shape, suggesting the occlusion of the dissection of the inner limb after rupture. Angiography immediately before embolization revealed inner limb recanalization with an irregular string sign; thus only the inner limb was embolized. Angiography after embolization showed near-complete suppression of the blood flow in the inner limb; however, a slight antegrade flow through the coil mass was observed in the late phase. The procedure was finished with the expectation of complete occlusion over time with natural heparin reversal. Angiography 8 days after embolization revealed a significant increase in antegrade blood flow through the coil mass within the inner limb. Therefore additional embolization of the parent artery proximal to the fenestration was performed, which achieved complete occlusion. CONCLUSIONS: The embolization length was limited and the antegrade blood flow through the other limb remained during internal trapping for the dissected VA fenestration limb; therefore careful observation of the blood flow to the dissected segment after embolization is necessary.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Dissecação da Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/anormalidades , Aneurisma Roto/terapia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/terapia , Angiografia Cerebral , Embolização Terapêutica , Procedimentos Endovasculares , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Retratamento , Ruptura Espontânea , Hemorragia Subaracnóidea/terapia , Dissecação da Artéria Vertebral/terapia
5.
Ann R Coll Surg Engl ; 102(2): 141-143, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31660754

RESUMO

INTRODUCTION: Colonic stent insertion has been shown to be an effective treatment for patients with acute large bowel obstruction, either as a bridge to surgery or as definitive treatment. However, little is known of the role of secondary stent insertion following primary stent failure in patients considered inappropriate or high risk for emergency surgery. METHODS: Fourteen patients presenting with acute large bowel obstruction who had previously been treated with colonic stent insertion were studied. All underwent attempted placement of a secondary stent. RESULTS: Technical deployment of the stent was accomplished in 12 patients (86%) but only 9 (64%) achieved clinical decompression. Successful deployment and clinical decompression of a secondary stent was associated with older age (p=0.038). Sex, pathology, site of obstruction, duration of efficacy of initial stent and cause of primary failure were unrelated to outcome. No procedure related morbidity or mortality was noted following repeated intervention. CONCLUSIONS: Secondary colonic stent insertion appears an effective, safe treatment in the majority of patients presenting with acute large bowel obstruction following failure of a primary stent.


Assuntos
Doenças do Colo/cirurgia , Descompressão Cirúrgica/instrumentação , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Stents , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Retratamento/instrumentação , Falha de Tratamento , Resultado do Tratamento
6.
J Endod ; 46(1): 44-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31740065

RESUMO

INTRODUCTION: The goal of regenerative endodontic treatment (RET) is to regenerate the pulp-dentin complex in immature teeth with pulp necrosis. There is no consensus in using RET in previously treated teeth. This article reports on long-term outcomes of RET in previously treated immature teeth. METHODS: Previously treated immature teeth with signs/symptoms of failure were included. After local anesthesia and rubber dam isolation, the root canal filling material was removed without the use of chemical solvents. The root canals were irrigated with 6% sodium hypochlorite using an EndoVac (Kerr Endodontics, Culver City, CA), and a creamy mix of metronidazole and ciprofloxacin was placed in the canals for 4 weeks. At the second visit, the antibiotic dressing was removed using 17% EDTA. Bleeding was induced into the root canal space, and SynOss Putty (Collagen Matrix Inc, Oakland, NJ) was placed. Bioceramic putty was placed over the SynOss Putty, and the teeth were restored at a subsequent visit. RESULTS: Five teeth in 4 patients were included. The patients' ages ranged from 14-46 years. Recall examinations were performed from 20 to 72 months with an average of 54.4 months. The apical openings of the teeth ranged from 1-3.7 mm. All teeth were functional and asymptomatic at the recall visits. All periapical lesions resolved with partial or complete mineralization of the root canals, and all teeth showed partial to complete apical closure at the follow-up visits. CONCLUSIONS: RET can be a viable option for nonsurgical retreatment of immature teeth. This article adds a new perspective to the field of regenerative endodontics.


Assuntos
Necrose da Polpa Dentária , Endodontia , Endodontia Regenerativa , Adolescente , Adulto , Necrose da Polpa Dentária/terapia , Humanos , Pessoa de Meia-Idade , Retratamento , Tratamento do Canal Radicular , Adulto Jovem
7.
Radiol Med ; 125(1): 98-106, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31583558

RESUMO

PURPOSE: To evaluate safety and efficacy of degradable starch microspheres (DSMs) TACE in a large clinical cohort of patients with unresectable HCC. MATERIALS AND METHODS: This is a single-center consecutive patients cohort study. The study was approved by local institutional ethics committee. Written informed consent was obtained. From December 2013 to March 2018, 137 cirrhotic patients with unresectable HCC were enrolled. For DSMs-TACE, a mixture of 4 mL of DSMs, 6 mL of non-ionic contrast and doxorubicin at a dose of 50 mg/m2 were used. Primary end point was long-term outcome, in terms of time to progression (TTP) and overall survival (OS). Secondary endpoints were: safety, liver toxicity, 1-month percentage of tumor necrosis according to the modified RECIST criteria. RESULTS: Two hundred and sixty-seven DSMs-TACE were performed in 137 HCC patients (33 patients in BCLC stage A, 84 patients in BCLC stage B, and 20 in stage C). Patients had a mean nodule number of 3.5 ± 1.2 (SD). Major complications were observed in 6.8% of cases. Post-embolization syndrome was common (101 patients 73.7%). According to mRecist criteria, a high objective response rate was obtained even after just one treatment (84.3% of patients showed complete response or partial response). The median TTP and OS after DSMs-TACE were 12 months and 36 months, respectively. OS at 6 months, 1 year, 2 and 3 years was 98%, 81.3%, 57.9%, 34.9%, respectively. CONCLUSION: DSMs-TACE is a safe and effective therapy for patients with HCC, allowing to obtain a good rate of OS with excellent local tumor control.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Amido/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antibióticos Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/mortalidade , Doxorrubicina/administração & dosagem , Feminino , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Critérios de Avaliação de Resposta em Tumores Sólidos , Retratamento/estatística & dados numéricos , Amido/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Int Endod J ; 53(3): 403-409, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31605377

RESUMO

AIM: To compare the weight of apically extruded debris produced during the removal of root canal filling material using various files in extracted teeth with simulated apical root resorption. METHODOLOGY: The root canals of one hundred and twenty extracted mandibular premolar teeth were prepared with Revo-S files and filled using a cold lateral compaction technique with gutta-percha and a resin-based sealer (AdSeal; Meta-Biomed, Cheongwon, Korea). Sixty teeth were randomly assigned to four control groups (hand file, ProTaper Universal retreatment file, D-RaCe retreatment file, and Reciproc file) for the removal of root canal filling material. The apical portion of the remaining 60 teeth was modified to simulate apical root resoption, and the teeth were then randomly divided into 4 experimental groups (using the same techniques as in the control groups) for the removal of root canal filling material. Apically extruded debris was collected into pre-weighed Eppendorf tubes and then dried. The mean weight of the apically extruded debris was assessed with an analytical balance to an accuracy of 10-4  g. Data were analysed using two-way analysis of variance and a Tukey's post hoc test. RESULTS: In the simulated apical root resorption groups, all file systems were associated with significantly more debris extrusion compared to the groups without simulated resorption (P < 0.05). The amount of apically extruded debris was greatest in the hand file groups compared with the other groups (P < 0.05). In the groups with simulated apical root resorption, the Reciproc system was associated with the least weight of apically extruded debris (P < 0.05), whereas there was no significant difference between the ProTaper Universal retreatment and D-RaCe files (P > 0.05). In the groups without simulated apical root resorption, there was no significant difference between Reciproc, ProTaper Universal retreatment and D-RaCe retreatment files (P> 0.05). The time required to remove the root canal filling material was as follows: hand file > ProTaper Universal retreatment = D-RaCe retreatment > Reciproc (P < 0.05). CONCLUSIONS: The weight of apically extruded debris was significantly greater in teeth with simulated apical root resorption than in those teeth without simulated apical root resorption. Hand files were associated with significantly more apically extruded debris in all groups during removal of root canal filling material.


Assuntos
Materiais Restauradores do Canal Radicular , Reabsorção da Raiz , Cavidade Pulpar , Guta-Percha , Humanos , Níquel , República da Coreia , Retratamento , Obturação do Canal Radicular , Preparo de Canal Radicular , Titânio
9.
Oncology ; 98(2): 98-101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31597138

RESUMO

BACKGROUND: Endometrial cancer currently represents the most frequent gynecologic malignancy in Western countries, and the seventh most common cancer in women. For advanced-stage disease, the recurrence risk is high, and the site of the relapse is heterogeneous with localized or spread peritoneal disease. There are few therapeutic strategies, and the quality of life is poor. CASES PRESENTATION: We present 3 cases of peritoneal-spread recurrences of endometrial cancer in patients with advanced stage at diagnosis. The patients had been subjected to multiple lines of chemotherapy including re-challenging with platinum regimens, pegylated liposomal doxorubicin, and taxane, with progression of disease. These patients came to us with abdominal distension, dyspnea, elevated CA 125, and presence of ascites. After paracentesis with a single administration of intraperitoneal chemotherapy based on carboplatin, all 3 patients showed improvement in their quality of life and breathing as well as reduction of fatigue and anorexia. No complications occurred. CONCLUSION: Although only 3 cases are reported, the exceptional results and the absence of side effects observed strongly warrant future trials to investigate the role intraperitoneal chemotherapy can have both as palliative treatment of refractory ascites and as salvage therapy in advanced endometrial cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ascite/patologia , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Biomarcadores Tumorais , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Infusões Parenterais , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Recidiva , Retratamento , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Oncology ; 98(1): 16-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31514200

RESUMO

PURPOSE: Preclinical studies indicated that imatinib may have single-agent activity in glioblastoma through inhibition of tyrosine kinase activity and also that it might enhance the efficacy of radiotherapy. We therefore sought to investigate clinical efficacy in patients with newly diagnosed and recurrent glioblastoma in combination with radiotherapy. METHODS: We conducted a nonrandomized, 2-arm, open-label phase II trial including patients aged 18 years or older with an ECOG performance status of 0-2 that were either newly diagnosed (arm A) with a measurable tumor (i.e., after incomplete resection or biopsy) or that were diagnosed with progression of a glioblastoma after initial therapy (arm B). Patients in arm A received 600 mg/day imatinib in combination with hypofractionated radiotherapy (2.5 Gy per fraction, 22 fractions). Patients in arm B received 600 mg/day imatinib alone or in combination with re-irradiation at various doses. In case tumor progression occurred, CCNU was added (2 cycles, 100 mg/m2) to imatinib. The primary end point was progression-free survival (PFS). The secondary end point was safety, defined as per Common Terminology Criteria for Adverse Events (version 2.0). Overall survival (OS) was analyzed as an exploratory end point. RESULTS: Fifty-one patients were enrolled, of which 19 were included in arm A and 32 in arm B. The median follow-up was 4 (0.5-30) months in arm A and 6.5 (0.3-51.5) months in arm B. The median PFS was 2.8 months (95% CI 0-8.7) in arm A and 2.1 months (95% CI 0-11.8) in arm B. The median OS was 5.0 (0.8-30) months (95% CI 0-24.1) in arm A and 6.5 (0.3-51.5) months (95% CI 0-32.5) in arm B. The major grade 3 events were seizure (present in 17 patients), pneumonia (11 patients), and vigilance decrease (7 patients). CONCLUSIONS: Imatinib showed no measurable activity in patients with newly diagnosed or recurrent glioblastoma.


Assuntos
Antineoplásicos/uso terapêutico , Glioblastoma/tratamento farmacológico , Glioblastoma/patologia , Mesilato de Imatinib/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Adulto , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Biópsia , Terapia Combinada , Progressão da Doença , Feminino , Seguimentos , Glioblastoma/mortalidade , Glioblastoma/cirurgia , Humanos , Mesilato de Imatinib/administração & dosagem , Mesilato de Imatinib/efeitos adversos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Cuidados Pós-Operatórios , Prognóstico , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos , Retratamento , Resultado do Tratamento
12.
Clin Oral Investig ; 24(1): 405-416, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31104115

RESUMO

OBJECTIVES: To compare the remaining root canal filling material, dentin removal, apical transportation, and apical extrusion of debris after the retreatment of canals filled with bioceramic or resin-based sealers using the Reciproc or Reciproc Blue instruments. MATERIALS AND METHODS: Sixty mandibular molars with severely curved mesial roots were selected. The samples were initially instrumented with Reciproc (R25) and then divided into four experimental groups according to the endodontic sealer and retreatment instrument (n = 15): BC Sealer/Reciproc (BCRC), BC Sealer/Reciproc Blue (BCRB), AH Plus/Reciproc (AHRC), and AH Plus/Reciproc Blue (AHRB). The procedure time was measured, and an Eppendorf tube was used in each root canal to store the debris extrusion. The samples were scanned by micro-CT before and after retreatment. The apical transportation, volume of dentin, and filling material were evaluated. RESULTS: There were no significant differences in the reduction of the volume of obturator material or dentin removal between groups (p > .05). There were also no differences in the amount of extruded material or apical transportation (p > .05). The retreatment time for the AHRC group was significantly lower than that for the other groups (p = .004). CONCLUSIONS: All tested instruments obtained similar efficacy in filling material removal procedures, although no system completely removed the filling material. Retreatment of canals filled with bioceramic BC Sealer may be more time consuming. CLINICAL RELEVANCE: This study reported that Reciproc and Reciproc Blue can be indicated in retreatment of severely curved root canals filled either with bioceramic or resin-based sealers.


Assuntos
Materiais Restauradores do Canal Radicular , Obturação do Canal Radicular , Preparo de Canal Radicular , Instrumentos Odontológicos , Cavidade Pulpar , Desenho de Equipamento , Guta-Percha , Humanos , Retratamento
13.
Tumori ; 106(1): 70-78, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31469058

RESUMO

BACKGROUND: Patients with intestinal cancer (colorectal, appendiceal, and small bowel) with peritoneal metastases (PM) have a poor prognosis. We assessed whether pressurized intraperitoneal aerosol chemotherapy (PIPAC) together with systemic chemotherapy is an effective treatment option for these entities in palliative intent. METHODS: Between November 2015 and February 2018, prospective data registry was performed (NCT03100708). Thirteen patients with intestinal cancer (median age 61 years [range 49-77]) underwent 26 PIPAC procedures with a median number of 2 interventions per patient (range 1-6). A chemoaerosol consisting of cisplatin/doxorubicin was administered during standard laparoscopy. RESULTS: The median peritoneal carcinomatosis index according to Sugarbaker before the first PIPAC was 14 (range 2-27), and the median ascites volume was 10 mL (range 0-6300 mL). Six patients who received 2 or more PIPAC procedures had decreased and stable ascites volumes, while only 1 patient displayed increased ascites. The median overall survival was 303 days (range 30-490) after the first PIPAC procedure. CONCLUSIONS: PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. TRIAL REGISTRATION: NCT03100708.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Intestinais/patologia , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Terapia Combinada , Feminino , Hospitalização , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/mortalidade , Prognóstico , Retratamento , Resultado do Tratamento
14.
Radiol Med ; 125(3): 288-295, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823294

RESUMO

PURPOSE: High-flow priapism is an incomplete and painless persistent erection caused by trauma. Its diagnosis is performed thanks to clinic and imaging evaluation with detection of fistula/pseudoaneurysm in the cavernous tissue. This paper aims to retrospectively assess the efficacy and safety of superselective arterial embolization in patients with high-flow priapism. MATERIALS AND METHODS: From January 2008 to March 2017, nine patients with high-flow priapism have been treated in a single center with embolization. The main etiology was trauma in eight subjects. The patients were evaluated with laboratory examinations and clinical and imaging findings (color Doppler ultrasonography and angiography). The mean follow-up time after embolization was 24 months. RESULTS: Eleven procedures were performed in nine patients: two of them required a second treatment session because of recurrence after 1-2 weeks. Embolic agents were microcoils, microparticles (300-500 µm) and Spongostan. Restoration of erectile function was monitored by clinical and color Doppler evaluation during follow-up. CONCLUSIONS: Superselective embolization should be the procedure of choice in patients affected by high-flow priapism; this technique appears to be successful in preserving erectile function. The choice of the embolic agent is crucial, and it should be tailored for each patient.


Assuntos
Embolização Terapêutica/métodos , Pênis/irrigação sanguínea , Priapismo/terapia , Adolescente , Adulto , Angiografia , Criança , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis/lesões , Priapismo/diagnóstico por imagem , Priapismo/etiologia , Recidiva , Fluxo Sanguíneo Regional , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
15.
Clin Oral Investig ; 24(1): 257-263, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31093742

RESUMO

OBJECTIVES: The aim of this randomized clinical trial was to assess the effect of solvent use during the removal of root canal filling on postoperative pain after retreatment. MATERIALS AND METHODS: Ninety patients scheduled for root canal retreatment were randomly assigned to one of the following two groups according to the root canal filling removal procedure used: ProTaper retreatment (Dentsply Maillefer, Ballaigues, Switzerland) instruments or ProTaper retreatment instruments in combination with gutta-percha solvent. A single operator performed the retreatments in a single visit. The incidence and intensity of the postoperative pain were rated on a numeric rating scale by patients at 24, 48, and 72 h after retreatment. The analgesic tablet intake number was also recorded. Data were analyzed using Mann­Whitney U, Wilcoxon, and chi-square tests. RESULTS: For the intensity of postoperative pain, the difference between the two groups was not statistically significant. Moreover, no statistically significant difference was found between the two groups in terms of analgesic medication intake (P > 0.05). CONCLUSIONS: The processes involving the use and non-use of a solvent in the removal of root canal fillings were found to be equivalent in terms of postoperative pain intensity and analgesic intake. CLINICAL RELEVANCE: Some in vitro studies claimed that the use of a gutta-percha solvent in the removal of root canal fillings tends to reduce postoperative pain since extrusion of debris was significantly less. This randomized clinical trial indicates that the removal of root canal fillings with or without the use of a solvent was associated with equivalent postoperative pain intensity and analgesic intake. This study is registered in the www.ClinicalTrials.gov database with the identifier number NCT03756363.


Assuntos
Dor Pós-Operatória , Materiais Restauradores do Canal Radicular , Obturação do Canal Radicular , Preparo de Canal Radicular , Solventes , Adulto , Cavidade Pulpar , Desenho de Equipamento , Feminino , Guta-Percha , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Retratamento , Solventes/uso terapêutico , Suíça
16.
J Prosthet Dent ; 123(1): 54-60, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31027959

RESUMO

STATEMENT OF PROBLEM: Despite an overall high survival rate for dental implants, the effectiveness of implant retreatment remains unclear. PURPOSE: The purpose of this systematic review was to examine the survival rate of implants placed at sites which had an implant failure and to investigate factors that might affect outcomes after retreatment. MATERIAL AND METHODS: A search of electronic databases limited to English language articles was conducted using the following MeSH terms: "dental implants," "dental implantation," or "dental restoration failure," combined with "retreatment," "replacement," or "reoperation." A hand search of selected journals was also performed. Of the retrieved 668 publications, 8 retrospective clinical studies met the inclusion criteria, providing the survival outcome for 673 implants in 557 patients after retreatment. Implant- and patient-related characteristics related to implant failures were assessed. RESULTS: The weighted mean survival rate for implants after retreatment was 86.3%, with follow-up ranging from less than 1 year to over 5 years. The survival rates of smooth-surfaced and rough-surfaced implants were compared in 217 retreated implants, revealing a significantly higher survival rate for rough-surfaced implants than for smooth-surfaced implants (90% versus 68.7%). Insufficient data were available to evaluate the effect of patient- or treatment-related characteristics on the survival of implants after retreatment. CONCLUSIONS: The survival rate of retreated implants is lower than that generally reported after initial implant placement. Higher survival rates were reported with rough-surfaced implants than with smooth-surfaced implants in retreatment. An overall implant survival rate of 86.3% after retreatment suggests that most initial implant failures are likely attributable to modifiable risk factors, such as implant architecture, anatomic site, infection, and occlusal overload.


Assuntos
Implantes Dentários , Implantação Dentária Endo-Óssea , Falha de Restauração Dentária , Humanos , Retratamento , Estudos Retrospectivos
17.
Eur J Ophthalmol ; 30(1): 26-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30421618

RESUMO

PURPOSE: To describe long-term outcomes with intravitreal Bevacizumab for choroidal neovascularization secondary to Sorsby fundus dystrophy. MATERIALS/METHODS: Observational case series. RESULTS: Two sisters of the same family formally diagnosed with Sorsby fundus dystrophy were followed-up for 12 years. The elder sister (S1) presented with significant decline in vision due to choroidal neovascularization in her right eye (OD). She developed choroidal neovascularization 3 years later in her left eye (OS). She was treated with Bevacizumab intravitreal injections on a on a pro-re-nata (PRN) until April 2015, when a treat-and-extend (T&E) approach was adopted. Best corrected visual acuities at the time of switch to T&E were 1.09 OD and 0.85 LogMar OS. Best corrected visual acuities at the last follow-up were LogMar 1.1 OD and 0.82 OS. Her younger sister (S2) presented with best corrected visual acuities of LogMar 0.1 OD and 0.0 OS. She developed choroidal neovascularization 5 years later in both eyes. OS developed choroidal neovascularization 18 months after her right eye. She received Bevacizumab on a pro re nata basis until April 2015 when a switch to a T&E was performed. Best corrected visual acuity in the left eye at the switch to T&E was 0.34 LogMar. At the last follow-up, best corrected visual acuities were LogMar 1.2 OD and 0.29 OS. CONCLUSION: Bevacizumab is an effective therapy for choroidal neovascularization secondary to Sorsby fundus dystrophy. A T&E protocol appears more effective compared to pro re nata protocol in minimizing recurrence of choroidal neovascularization with potential secondary scar formation or atrophy.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular/complicações , Adulto , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/etiologia , Protocolos Clínicos , Feminino , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Degeneração Macular/diagnóstico , Pessoa de Meia-Idade , Imagem Multimodal , Retratamento , Estudos Retrospectivos , Irmãos , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
18.
World Neurosurg ; 135: 141-145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843730

RESUMO

BACKGROUND: Rosai-Dorfman disease (RDD) is a rare, benign histiocytosis disorder with only approximately 100 reported central nervous system cases in the literature. Even less common is skull base involvement of RDD, with about 41 reported cases. Radiographically, RDD can appear similar to a meningioma; the true diagnosis is only found with histologic analysis. Although "benign," RDD can lead to significant neurologic morbidity from the disease or unnecessary surgical and nonsurgical treatment. While rare, intracranial RDD has been treated with chemotherapy or radiotherapy, with surgery playing a limited role to relieve mass effect. Surgical approaches to the skull base are invasive and pose risk, especially for a benign and self-limiting disease like RDD. CASE DESCRIPTION: Here we present the case of a 63-year-old woman with a presumed spheno-orbital meningioma for which the patient previously underwent radiation therapy. On presentation to our facility, the patient noted pressure headaches and blurry vision, and imaging demonstrated progression of her disease. For these reasons, surgical debulking and biopsy were undertaken. CONCLUSIONS: This report demonstrates the role of EEA for tissue biopsy and decompression of the affected cranial nerves and orbit. This paradigm seems to provide a safe and effective way to manage patients with compressive symptoms, while also allowing for tissue sampling.


Assuntos
Descompressão Cirúrgica , Histiocitose Sinusal/terapia , Cirurgia Endoscópica por Orifício Natural , Base do Crânio/cirurgia , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Feminino , Histiocitose Sinusal/diagnóstico , Humanos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Retratamento , Base do Crânio/diagnóstico por imagem
19.
Urology ; 137: 50-54, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31862326

RESUMO

OBJECTIVE: To determine if repeated treatment with Onabot/A in less injections points, provides similar clinical efficacy, duration, and adverse events compared with previous treatment. METHODS: Prospective data of neurogenic detrusor overactivity (NDO) and idiopathic detrusor overactivity (IDO) patients previously treated with Onabot/A according to standard technique. When patients requested for repeating procedure, they were treated with the same Onabot/A dose but with 3-4 injection sites. Onabot/A injection was performed under local or spinal anaesthesia. Pain was evaluated with VAS pain scale. Efficacy was evaluated by the Treatment Benefit Scale (TBS) and attainment of complete continence. Duration of effect was determined by patient reported return of symptoms, and requested for repeating procedure. Adverse events were also reported. RESULTS: We report the results of 21 patients. Nineteen patients (90%) were female, 10 patients (48%) neurogenic, 9 (43%) were under clean intermittent catheterization. Procedure was performed under local anaesthesia in 20 patients (95%). Doses of Onabot/A used were 100-300 units with 3-4 injections sites. According to TBS, 86% of patients improved. Seventeen patients (81%) were continent after the procedure. Five patients (24%) presented urinary tract infection as adverse event. The mean duration of effect was 34.9 weeks compared with 35.6 weeks of previous procedure with no significant differences. CONCLUSION: We consider that treatment of Onabot/A with 3-4 injections may have similar clinical efficacy and duration of effect, compared to standard technique, with limited adverse events.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Bexiga Urinária Hiperativa/tratamento farmacológico , Administração Intravesical , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Retratamento , Resultado do Tratamento
20.
J Endod ; 46(2): 149-157.e4, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31879031

RESUMO

INTRODUCTION: Healed rates of endodontic microsurgery (EMS) may decrease over time, but research on the long-term outcomes is scarce. The aims of this retrospective cohort study were to evaluate the 5- to 9-year healed and survival rates of EMS, to identify associations between prognostic factors and healing status, and to compare the short-term (1- to 2-year) with long-term (5- to 9-year) outcomes. METHODS: One hundred fifty-one eligible patients (166 teeth) who underwent EMS in 2007-2010 were invited for a follow-up examination. Eighty-three patients (94 teeth) participated in the study. Survival status and reasons for extraction of all teeth were determined, and survival rates were calculated by Kaplan-Meier analyses. Outcomes were determined on the basis of clinical and radiographic findings and associated with potential prognostic variables via multivariate Cox regression analyses. RESULTS: Thirty-two teeth were extracted: 6 because of endodontic failure, 20 for unrelated reasons, and 6 for unknown reasons. Outcomes were categorized as healed and not healed. Multivariate analysis revealed that adjusted hazard ratio for failure was 5.95 times higher (95% confidence interval, 1.54-22.91) for teeth treated with intermediate restorative material than with mineral trioxide aggregate and 3.38 times higher (95% confidence interval, 1.05-10.9) for teeth with no known history of nonsurgical retreatment. Teeth classified as healed in the 1- to 2-year review mostly remained healed at 5- to 9-year review (45/48 teeth); those with uncertain healing had varied outcomes at long-term review. CONCLUSIONS: EMS results in high long-term healed (78.3%, 72/92 teeth) and survival (95.2%) rates. Root-end filling material and nonsurgical retreatment before EMS may influence the long-term outcome.


Assuntos
Microcirurgia , Materiais Restauradores do Canal Radicular , Humanos , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
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