Streptococcus pneumoniae primary peritonitis mimicking acute appendicitis in an immunocompetent patient: a case report and review of the literature.

INTRODUCTION: Primary peritonitis without an identifiable intra-abdominal source is extremely rare in healthy individuals; it is commonly seen in cases of nephrotic syndrome, cirrhosis and end-stage liver disease, ascites, immunosuppression, and inflamed peritoneum due to pre-existing autoimmune and oncological conditions. CASE PRESENTATION: We present the case of a 68-year-old Caucasian woman operated on due to acute abdomen with a provisional diagnosis of acute appendicitis. During the operation a small amount of free intra-abdominal fluid was found. Her uterus, ovaries, and fallopian tubes were macroscopically normal. Therefore, with the suspicion of appendicitis, appendectomy was performed. Her blood cultures were negative while peritoneal fluid was positive for capsulated form of Streptococcus pneumoniae. A 30-day follow-up was performed and she was asymptomatic without any sign of infection. DISCUSSION: Streptococcus pneumoniae commonly causes upper respiratory tract infection and cutaneous infections. It very rarely causes gastrointestinal infection and it is very rarely responsible for primary peritonitis and septic shock syndrome. CONCLUSION: Pneumococcal peritonitis has a rare occurrence and represents a clinical challenge because of its subtle and non-specific clinical findings. The interest in our case lays in the relatively rare diagnosis of primary peritonitis mimicking acute appendicitis.

Challenging case of horseshoe kidney double fracture.

INTRODUCTION: Renal injuries occur in 10% of blunt abdominal traumas, 7% of these occur in kidneys with congenital or acquired disorders. Trauma of horseshoe kidney is an uncommon finding. PRESENTATION OF A CASE: We present the case of 31 year-old caucasian man with no remarkable personal records, who was brought to our Trauma Unit soon after being involved in a motorcycle collision. A Contrast Enhanced - Multi Detector Computed Tomography (ce-MDCT) revealed a double disconnection of a horseshoe kidney. The patient was not aware of bearing such abnormality. DISCUSSION: Trauma of horseshoe kidney is an uncommon finding. The abdominal ce-MDCT scan is the diagnostic tool of choice since the renal anatomy, injury grading and vascular or urinary tract abnormalities are well depicted and easily identified. The conservative management of these injuries is associated with a lower rate of nephrectomies and kidney failure while selective trans-catheter renal embolization is a challenging treatment option. However surgery can be a treatment of choice and should be aimed to preserve renal function. CONCLUSION: the interest in our case lies in the rarity and particular anatomical aspect of such injuries and the implication related to its management in an emergency setting.

Lateralization Technique and Inferior Alveolar Nerve Transposition.

Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics.

Mini-Implant Screws for Bone-Borne Anchorage: A Biomechanical In Vitro Study Comparing Three Diameters.

PURPOSE: To evaluate the maximum strength and the maximum aperture supported by mini-implant screws of three different diameters in an in vitro rapid maxillary expander model. MATERIALS AND METHODS: Fifteen appliances were mounted in artificial bone polyurethane blocks. In each appliance, a Hyrax expander anchored by four mini-implant screw sets of three different diameters were divided into: group 1 (n = 5), 1.8-mm-diameter screws; group 2 (n = 5), 2.0-mm-diameter screws; and group 3 (n = 5), 2.2-mm-diameter screws. All sets (bone blocks + expander + four mini-implants) were inserted into a customized and standardized device that simulated a mid-palate disjunction. The expanders were activated to mechanically test the insertion of the mini-implant into the devices until breakage or deflection of screws occurred. The number of activations, the maximum supported strength, and the maximum expander aperture values until failure were recorded for each group. Data were subjected to a Student t test at a significance level of 5%. RESULTS: There were no significant differences between the groups regarding the number of activations up to the maximum supported strength. The expander achieved aperture values where differences were slightly significant just between groups 1 and 2 (P = .048). There was a significant difference between groups 1 and 3 regarding the maximum supported load (P = .039). CONCLUSION: Regardless of the mini-implant screw diameters, the expander device used in this anchorage system model withstood strengths and aperture rates beyond those that may be required during clinical rapid maxillary expansion.

Manual reduction of articular disc after traumatic extraction of mandibular third molar: a case report.

INTRODUCTION: Disc displacement without reduction with limited opening is an intracapsular biomechanical disorder involving the condyle-disc complex. With the mouth closed, the disc is in an anterior position in relation to the condylar head and does not reduce with mouth opening. This disorder is associated with persistent limited mandibular opening. CASE REPORT: The patient presented severe limitation to fully open the mouth, interfering in her ability to eat. Clinical examination also revealed maximum assisted jaw opening (passive stretch) with less than 40 mm of maximum interincisal opening. Magnetic resonance imaging was the method of choice to identify the temporomandibular disorders. CONCLUSION: By means of reporting this rare case of anterior disc displacement without reduction with limited opening, after traumatic extraction of a mandibular third molar, in which manual reduction of temporomandibular joint articular disc was performed, it was possible to prove that this technique is effective in the prompt restoration of mandibular movements.

Photoelastic Analysis on Different Retention Methods of Implant-Supported Prosthesis.

The aim of this study was to evaluate the stress distribution of different retention systems (screwed, cemented, and mixed) in 5-unit implant-supported fixed partial dentures through the photoelasticity method. Twenty standardized titanium suprastructures were manufactured, of which 5 were screw retained, 5 were cement retained, and 10 were mixed (with an alternating sequence of abutments), each supported by 5 external hexagon (4.0 mm × 11.5 mm) implants. A circular polariscope was used, and an axial compressive load of 100 N was applied on a universal testing machine. The results were photographed and qualitatively analyzed. We observed the formation of isochromatic fringes as a result of the stresses generated around the implant after installation of the different suprastructures and after the application of a compressive axial load of 100 N. We conclude that a lack of passive adaptation was observed in all suprastructures with the formation of low-magnitude stress in some implants. When cemented and mixed suprastructures were subjected to a compressive load, they displayed lower levels of stress distribution and lower intensity fringes compared to the screwed prosthesis.

In vivo effectiveness of silicone gel sheets as barriers at the inner microgap between a prosthetic abutment and an external-hexagon implant platform.

PURPOSE: Bacterial penetration and colonization of the microgap at the implant-abutment interface have been reported in several studies. The aim of this study was to evaluate the effectiveness of placing a silicone membrane between the abutment and the implant platform in an attempt to seal the interface. MATERIALS AND METHODS: A total of 15 external-hex implants were placed in 10 patients with clinically healthy peri-implant tissues, and all of the patients had ceramic prosthetic crowns. Samples were collected from the microgaps before, 30 days after, and 90 days after insertion of a silicone membrane. Bacterial DNA was extracted and submitted in triplicate to polymerase chain reaction using primers specific for four peri-implant pathogens: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia. RESULTS: In the initial samples, a positivity of 52% was found, which was different from that found in samples collected after 30 days (32%) and 90 days (27%) after insertion of the membrane. CONCLUSION: It was evident that the silicone membrane reduced, but did not prevent, penetration of these species into external-hex implants.

Gastroduodenal major haemorrhages in critical patients: an original surgical technique.

AIM: Upper gastrointestinal bleeding represents today a serious pathology with two important problems: mortality and correct management. Our study is a review of recent and past licterature about causes, diagnosis and treatment of upper gastrointestinal bleeding. PERSONAL EXPERIENCE: The Authors describe an original surgical technique in treating patients with gastroduodenal haemorrhages and critical circulatory-coagulative conditions. Any surgical resective procedure could be absolutely inacceptable for the rates in morbility and mortality in these absolutely instable patients. We approached the problem with a control damage surgery by endoluminal packing of the stomach or the duodenum.

Manual reduction of articular disc after traumatic extraction of mandibular third molar: a case report

Introduction: Disc displacement without reduction with limited opening is an intracapsular biomechanical disorder involving the condyle-disc complex. With the mouth closed, the disc is in an anterior position in relation to the condylar head and does not reduce with mouth opening. This disorder is associated with persistent limited mandibular opening.Case report:The patient presented severe limitation to fully open the mouth, interfering in her ability to eat. Clinical examination also revealed maximum assisted jaw opening (passive stretch) with less than 40 mm of maximum interincisal opening. Magnetic resonance imaging was the method of choice to identify the temporomandibular disorders.Conclusion: By means of reporting this rare case of anterior disc displacement without reduction with limited opening, after traumatic extraction of a mandibular third molar, in which manual reduction of temporomandibular joint articular disc was performed, it was possible to prove that this technique is effective in the prompt restoration of mandibular movements.

Introdução: o deslocamento do disco articular sem redução com abertura limitada é uma desordem intracapsular que envolve o complexo côndilo-disco. Na posição de boca fechada, o disco articular se encontra numa posição anterior em relação à cabeça da mandíbula e não sofre redução com a abertura de boca. Essa desordem está associada à abertura mandibular limitada e persistente.Caso clínico:o paciente relatava travamento da mandíbula que não permitia uma abertura completa da boca, interferindo, assim, na capacidade de se alimentar. Também era possível observar-se uma abertura assistida (alongamento passivo) com uma distância vertical menor que 40 mm entre os incisivos. A ressonância magnética foi o método de escolha para o diagnóstico das desordens temporomandibulares.Conclusão:por meio da descrição de um caso raro de deslocamento anterior do disco articular sem redução e com abertura limitada, após exodontia traumática do terceiro molar inferior, em que foi realizada a redução manual do disco articular da articulação temporomandibular, provou-se ser essa uma técnica eficaz no rápido restabelecimento dos movimentos mandibulares.

A new interventional procedure in the treatment of iatrogenic pseudoaneurysm.

PURPOSE: The incidence of iatrogenic pseudoaneurysms as a complication of angiographic procedures is increasing. The purpose of this study was to test the validity and the efficacy of a new interventional procedure in the treatment of iatrogenic pseudoaneurysms. MATERIAL AND METHODS: Between April 1999 and June 2000, 14 patients suffering from a iatrogenic pseudoaneurysm were treated with the new technique which consists of the direct puncture of the aneurysmal cavity using the Seldinger technique and the introduction of a movable-core Teflon-coated guide wire into the hollow of the sac. Mild external compression with Femostop is then applied for no longer than 120 minutes. The puncture was also performed with colour-Doppler US guidance. RESULTS: We observed the complete healing of the pseudoaneurysms in all of the treated patients with no immediate complications or recurrence in the follow-up period. DISCUSSION AND CONCLUSIONS: The procedure applied to treat our group of patients proved valid, easy to perform and capable of producing satisfactory RESULTS: This new interventional method for treating iatrogenic pseudoaneurysms may be considered an effective alternative to surgery and US-guided compression and capable of achieving a quick recovery. The procedure is particularly suitable in those patients that may suffer discomfort or complications from the widely applied technique of sonographically-guided compression of pseudoaneurysms.

[Autonomic hyperreflexia in tetraplegic pregnant patient: case report]. / Hiperreflexia autonômica em gestante tetraplégica: relato de caso.

BACKGROUND AND OBJECTIVES: Complications of pregnant patients with medullary injury include urinary infection, renal stones, anemia, decubitus ulcers, muscle spasms, sepsis, uterine hyperactivity and autonomic hyperreflexia. Autonomic hyperreflexia is the most severe anesthetic complication and should, before all, be prevented. It is often developed in patients with medullary transection at the level of the 5th to 7th thoracic vertebra or above. This report aims at presenting a case of tetraplegic pregnant patient with injury at the level of the 6th cervical vertebra, submitted to Cesarean section under continuous epidural anesthesia with 0.25% bupivacaine without vasoconstrictor associated to fentanyl. CASE REPORT: Caucasian, tetraplegic primiparous term patient, 39 weeks of gestational age, 22 years old, 63 kg, 168 cm, physical status ASA II, admitted for elective Cesarean section. Patient reported spinomedullary trauma at C6, three years ago. After previous hydration with 1500 ml saline, epidural anesthesia was induced with medial puncture at L3-L4 interspace with the patient in the lateral position, disposable 17G Tuohy needle and without previous local infiltration anesthesia. Immediately after needle insertion, there was adjacent paravertebral muscles contraction, blood pressure increase (BP = 158 x 72 mmHg) and heart rate increase (HR = 90 bpm). Patient, however, did not refer pain. Needle was removed and local anesthesia was induced. Epidural block proceeded with 20 ml of 0.25% bupivacaine without vasoconstrictor associated to 100 microg spinal fentanyl and epidural catheter insertion in the cephalad direction (3 to 4 cm). Surgery went on without intercurrences with no need for blockade complementation. There were two arterial hypotension episodes in the first 24 postoperative hours, which were treated with lactated Ringers solution. Epidural catheter was maintained for 48 hours. Patient was discharged three days after. CONCLUSIONS: For paraplegic or tetraplegic pregnant patients, continuous epidural anesthesia with low local anesthetic concentration without vasoconstrictor and associated to fentanyl is a good indication for instrumented or not vaginal delivery, and Cesarean sections to prevent autonomic hyperreflexia. It is also important that the epidural catheter remains for at least 24 hours after delivery to block sympathetic afference in case a crisis is triggered.

Deflexão mandibular medial relacionada às falhas biomecânicas da prótese fixa implantossuportada com conexão rígida distal ao forame mentual / Medial mandibular flexure related to biomechanical failures of implant-supported fixed prosthesis with distal rigid connection to the mental foramen

Introdução: algumas falhas mecânicas e possíveis problemas biológicos foram relacionados à deflexão mandibular medial em indivíduos que possuíam próteses fixas implantossuportadas extensas, com conexão rígida bilateral em implantes posteriores ao forame mentual. Métodos: a pesquisa literária pertinente ao tema foi realizada a partir da consulta à base de dados MEDLINE, compreendendo os anos de 1954 até 2010. A proposta dessa revisão de literatura foi relacionar as possíveis falhas biomecânicas das próteses implantossuportadas com extensão distal ao forame mentual, tais como fratura de implantes, afrouxamento ou fratura de parafuso da prótese, falta de assentamento passivo da estrutura metálica, saucerização e, em alguns casos, dor muscular e limitação de abertura de boca, e propor o desenho dessas próteses. Conclusão: quando o planejamento protético necessitar elementos de apoio na parte posterior ao forame mentual, a prótese deverá ser segmentada, principalmente em região de sínfise. Dessa forma, os efeitos deletérios causados pela deflexão mandibular medial na prótese e região peri-implantar serão minimizados.

Fatores determinantes para formação e, ou manutenção da papila peri-implantar: revisão de literatura / Factors for formation and, or maintenance of peri implant papilla: literature review

Introdução: a papila interproximal, entre outros requisitos, é considerada fundamental para o sucesso estético nas próteses sobre implantes. Método: o presente artigo é uma revisão da literatura baseada em periódicos publicados de 1984 a 2011, disponíveis nos bancos de dados da LILACS e da MEDLINE. Foram selecionados 21 artigos com o objetivo de evidenciar os fatores determinantes para formação e/ou manutenção da papila peri-implantar, tais como distância ideal entre dente e implante, entre implantes, sua posição supra ou infraóssea e a distância necessária do ponto de contato à crista óssea. Conclusão: concluiu-se que a distância ideal entre dente e implante é de 2mm, e a entre implantes é de 3mm, haja vista que a altura da papila gengival é sustentada pela formação do espaço biológico. Quanto ao posicionamento do implante (supra ou infraósseo), não foram relatadas diferenças quanto à formação da papila. Por fim, a altura determinante para a formação da papila do ponto de contato da coroa à crista óssea deve ser de até 5mm.

The interproximal papilla, among other requirements, is considered essential for success in aesthetic prostheses on implants. This article is based on a review of literature in journals from 1984 to 2011 in Lilacs and Medline. 21 articles were selected in order to highlight the factors determining the formation and / or maintenance of peri-implant papilla, such as distance between tooth and implant, implants between his position and the bone above or below the required distance from the contact point to the crest marrow. Concluded that the distance between tooth implant is 2 mm, between the implant and the implant is 3 mm, whereas the height of the gingival papilla formation is sustained by biological space. Regarding the positioning of the implant, bone supra or infra, no differences were reported as the papilla formation. And the height of the papilla determining the formation of the contact point to the bone crest crown should be up to 5 mm.

Reabilitação de maxila atrófica com prótese implantossuportada empregando quatro fixações zigomáticas: relato de caso clínico / Rehabilitation of atrophic maxilla with implant-supported prosthesis using four zygomatic fixation: case report

A reabilitação de pacientes com maxila severamente atrófica é um dos maiores desafios na Implantodontia atual. A grande dificuldade inerente da reabilitação e a necessidade de extensas reconstruções ósseas (enxertos onlay, levantamento de seio maxilar) podem elevar o grau de morbidade cirúrgica e o tempo de tratamento. As fixações zigomáticas têm sido apresentadas na literatura como uma opção viável para o tratamento de pacientes com esse quadro clínico. Neste artigo será apresentado o relato de um caso clínico com reabilitação da maxila por meio da instalação de quatro implantes zigomáticos e uma prótese fixa parafusada sobre os implantes, instalada dois dias após a cirurgia, submetendo os implantes à carga imediata.

The rehabilitation of patients with severely atrophic maxilla is one of the greatest challenges in implant dentistry today. The difficulty inherent in this rehabilitation and the need for extensive bone reconstruction (onlay grafts, sinus Iifting) can raise the level of surgical morbidity and treatment time. The zygomatic fixations have been presented in literature as a viable option for the treatment of patients with this clinical scenario. This paper reports a clinical case of rehabilitation of the maxilla through the installation of four zygomatic implants and a fixed prosthesis screwed over the implants, installed two days after surgery, with the implants subjected to immediate loading.

Deflexão mandibular medial relacionada às falhas biomecânicas da prótese fixa implantossuportada / Midline mandibular deflection and possible biomechanical failures on implant-supported dental prostheses - literature review

Algumas falhas mecânicas e possíveis problemas biológicos foram relacionados à deflexão mandibular medial em indivíduos que possuíam próteses fixas implantossuportadas extensas, com conexão rígida bilateral em implantes posteriores ao forâmen mentual. A pesquisa literária pertinente ao tema foi realizada a partir da consulta à base de dados Medline, compreendendo de 1954 até 2010. A proposta desta revisão da literatura foi relacionar as possíveis falhas biomecânicas das próteses implantossuportadas com extensão distal ao forâmen mentual, tais como fratura de implantes, afrouxamento ou fratura de parafuso da prótese, falta de assentamento passivo da estrutura metálica, saucerização e, em alguns casos, dor muscular e limitação de abertura da boca e propor o desenho dessas próteses. Como conclusão, baseando-se na revisão da literatura selecionada, quando o planejamento protético necessitar de elementos de apoio na parte posterior ao forâmen mentual, a prótese deverá ser segmentada, principalmente em região de sínfise. Desta forma, os efeitos deletérios causados pela deflexão mandibular medial na prótese e região peri-implantar serão minimizados.

Some mechanical failures and possible biological problems were related to the mandibular midline deflection in individuals who had extensive fixed implant-supported dental prosthesis with bilateral rigid connection posterior to the mental foramina. A literature review relevant to the topic was performed in the Medline comprising the years from 1954 until 2010. The purpose was to relate the possible biomechanical failures of implant-supported dental prosthesis extending distal to the mental foramen such as implant fracture, prosthesis screw loosening or fracture, lack of passive fit of the metallic structure, bone saucerization, and in some cases, reports of muscle pain and limited mouth opening, to determine prosthesis design. In conclusion, when prosthetic reconstructions demand supporting elements distal to the mental foramen, the prosthesis should be segmented, especially in the symphyseal area. Thus, they neutralize the deleterious effects of midline mandibular flexion in the prosthesis and peri-implant regions.

Utilização de osso humano fresco congelado para aumento vertical na região posterior de mandíbula / Vertical augmentation at the posterior mandibular area with fresh-frozen human bone

A resolução do edentulismo posterior em mandíbula atrófica vem sendo um dos grandes desafios para o implantodontista. Neste sentido, a busca por diferentes biomateriais, entre eles o osso homógeno, tem sido estudada como potenciais substitutos ósseos em cirurgias reconstrutivas. O objetivo deste estudo foi demonstrar a possibilidade da utilização de osso humano fresco congelado, proveniente de tecido ósseo cortical de fêmur, em um procedimento de aumento vertical na região posterior de mandíbula e, através da análise estatística, avaliar o grau de ganho em altura óssea, o grau de reabsorção óssea e as complicações decorrentes da técnica empregada. Foram realizados 12 procedimentos de enxerto na área posterior da mandíbula. Os resultados do estudo foram avaliados clinicamente através de mensurações que foram comparadas com tomografias antes e após seis meses. Concluímos que a utilização do osso humano fresco congelado promoveu a formação óssea em altura de 4,75 ± 0,26 mm. A reabsorção dos enxertos foi considerada estatisticamente nula e, quanto ao quesito das complicações decorrentes da técnica empregada, existiu diferença estatisticamente significante entre os percentuais de fratura do bloco, mobilidade clínica e parestesia. Dos 12 enxertos colocados, quatro apresentaram deiscência de sutura, resultando em 66,7% de sucesso. Neste sentido, a reconstrução em altura da região posterior de mandíbula, com osso homógeno cortical, torna-se viável seguindo corretamente os passos e cuidados da técnica empregada.

Edentulous posterior mandibular atrophic areas have become a challenge for surgeons. For this, different biomaterials have being studied, being the fresh-frozen allograft bone applied in several works. The aim of this study was to demonstrate that the human fresh bone, proceeding from the cortical femoral area, can be used to reconstruct the lower jaw area. The new bone height level, bone resorption and the complications was analyzed statistically. Twelve lower jaw posterior bone graft procedures were performed, and the results evaluated clinically and measured with CT scans before and six months after surgery. We concluded that the allograft bone promoted a height bone formation of 4.75 ± 0.26 mm. Bone resorption was considered statistically non-significant. Statistically significant differences were seen for factors such as bone harvest fracture, clinical mobility, and paresthesia. Suture dehiscence was observed in 4 of 12 of these blocks, resulting in success rate of 66.7%. Vertical augmentation at posterior atrophic mandibular areas can be done with fresh-frozen bone using adequate surgical procedures.

Análise in vivo do silicone vedando à infiltração de bactérias na interface pilar/implante / In vivo effectiveness of silicone gel sheets as a barrier at the inner microgap between

Neste estudo foi avaliada a eficácia da colocação de uma placa de silicone para tentar vedar a interface entre o pilar protético e a base de 22 implantes de hexágono externo osseointegrados, em 14 pacientes com boa condição clínica dos tecidos peri-implantares e portadores de coroas protéticas, em intervalo de tempo que variava de dois a 36 meses. As amostras foram coletadas desses microespaços antes, 30 e 90 dias após da inserção da membrana de silicone. Os DNA bacterianos foram extraídos e submetidos, em triplicata, à reação em cadeia da polimerase (PCR) com o uso de iniciadores específicos para os patógenos peri-implantares Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia e Tannerella forsythensis. Nas amostras iniciais foi constatada uma positividade de 48%, valor estatisticamente diferente do encontrado nas amostras coletadas após 30 (33%; p = 0,0652) e 90 dias (27%; p = 0,0081); aos 90 dias apresentou-se p < 0,05 indicando diferença significativa após a inserção da membrana. Assim, ficou evidenciado que a placa de silicone apenas reduziu, mas não impediu a penetração de nenhuma destas espécies no interior dos implantes de hexágono externo.

In this study the efficiency of the placing of a silicone membrane in order to seal the interface between the prosthetic abutment and the foundation of 22 external hexagonal connection implants was evaluated in 14 patients with good clinical conditions of the peri-implant tissues and implant-suppored prostheses varying from 2 to 36 months. The samples were collected in these microgaps before the insertion of the silicone membrane, 30, and 90 days later. The bacterial DNA were extracted and triplicated following polymerase chain reactio (PCR) with the use of specific initiators for the pathogenic peri-implant Aggregatibacter actinomycetemcomitans, Porphyr omonas gingivalis, Prevotella intermedia and Tannerella forsythensis species. In the initial samples, 48% of positive results were presented, a number statistically different from those found in samples collected after 30 (33%; p = 0,0652) and 90 days (27%; p = 0,0081); at 90 days, p values of < 0,05 were found, showing a significant difference after the membrane insertion. It was concluded that the silicone membrane just reduced but did not prevent infiltration of all tested species inside the external hexagon connections.

Hiperreflexia autonômica em gestante tetraplégica: relato de caso / Autonomic hyperreflexia in tetraplegic pregnant patient: case report

JUSTIFICATIVA E OBJETIVOS: As complicações da gestante com lesäo medular incluem infecções urinárias, calculose renal, anemia, úlceras de decúbito, espasmos musculares, sepsis, hiperatividade uterina e a hiperreflexia autonômica. Durante a anestesia a hiperreflexia autonômica é a complicaçäo mais importante, que deve ser, antes de tudo, prevenida. Ela é freqüentemente desenvolvida em pacientes com transecçäo medular ao nível da quinta à sétima vértebra torácica, ou acima. Nosso relato tem com objetivo apresentar um caso de gestante tetraplégica, com lesäo ao nível da sexta vértebra cervical, que se submeteu à operaçäo cesariana sob anestesia peridural contínua com bupivacaína a 0,25 por cento sem vasoconstritor, associada ao fentanil. RELATO DO CASO: Paciente tetraplégica, primigesta à termo, idade gestacional de 39 semanas, branca, 22 anos, 63 kg, 168 cm de altura, estado físico ASA II, internada para ser submetida a cesariana eletiva. Relatava trauma raquimedular ao nível de C6 há 3 anos. Após hidrataçäo prévia com 1500 ml de soluçäo fisiológica, procedeu-se à anestesia peridural com punçäo mediana no espaço L3-L4 com a paciente em decúbito lateral, agulha Tuohy descartável calibre 17G e sem botäo anestésico prévio. Imediatamente após a introduçäo da agulha, observou-se contraçäo da musculatura paravertebral adjacente, aumento da pressäo arterial (PA = 158 x 72 mmHg) e aumento da freqüência cardíaca (FC = 90 bpm). No entanto, a paciente näo relatava dor. Retirou-se agulha e fez-se o botäo anestésico, dando-se seqüência ao bloqueio peridural, com injeçäo de 20 ml de bupivacaína a 0,25 por cento sem vasoconstritor associados a 100 æg de fentanil espinhal e passagem de cateter peridural em sentido cefálico (3 a 4 cm). A cirurgia transcorreu sem intercorrências, näo havendo necessidade de complementaçäo do bloqueio em nenhum momento. Houve dois episódios de hipotensäo arterial nas primeiras 24 horas do pós-operatório, tratados com infusäo de soluçäo de Ringer com lactato. O cateter peridural foi mantido por 48 horas. A alta hospitalar ocorreu após três dias de internaçäo. CONCLUSÕES: Para gestantes paraplégicas ou tetraplégicas a anestesia peridural contínua com baixa concentraçäo de anestésico local sem vasoconstritor associado ao fentanil é uma boa indicaçäo para conduçäo do parto normal instrumentado ou não,...

Análise fotoelástica das tensões induzidas em implantes por próteses parciais fixas cimentadas, parafusadas e mistas / Photoelastic analysis of implant-supported, screwed, cemented, and screwed/cemented frameworks

O uso de próteses implantossuportadas tornou-se uma modalidade terapêutica altamente difundida e confiável para a reabilitação de pacientes edêntulos. O sucesso dessa terapia está associado a um equilíbrio entre fatores biológicos e mecânicos. Em próteses sobreimplantes, a retenção se faz por meio de parafusos ou cimentos; entretanto, não existe um consenso na literatura sobre a melhor opção. Assim, testes de tensão programados foram utilizados para determinar a transferência de tensão de 20 infraestruturas, sendo cinco parafusadas, cinco cimentadas e dez mistas (alternando-se a sequência de pilares) aos implantes, com o objetivo dos resultados obtidos serem de interesse clínico. Através deste estudo observou-se a formação de franjas isocromáticas, resultado das tensões geradas ao redor dos implantes após a instalação das diferentes infraestruturas e, após a aplicação da carga axial compressiva de 100 N, podemos concluir a falta de adaptação passiva desta infraestrutura pela formação de tensões de baixa magnitude em alguns implantes. As infraestruturas cimentadas e mistas revelaram níveis mais baixos de distribuição de tensão quando submetidas à carga compressiva, comparadas às próteses parafusadas.