RESUMEN

AIM: To compare the effects of three instrumentation systems, and a supplementary approach with a finishing instrument, on filling material removal during retreatment of mandibular molar canals. METHODS: Sixty mesial canals from mandibular molars (Vertucci's type IV anatomy) were instrumented, filled and subjected to retreatment. After initial removal of the root canal filling material using the D-RaCe system, the canals were randomly distributed into three groups (n = 20) according to the instrument system used for preparation: the Self-Adjusting File (SAF), TRUShape or XP-endo Shaper. The filling material volume in the apical 5 mm of the canals was assessed by means of micro-computed tomography (micro-CT) before and after retreatment. All specimens with residual filling material were subjected to a supplementary approach with the XP-endo Finisher R instrument and another micro-CT scan was taken. Data on the volumes of filling material and incidence of total removal were compared between groups by the general linear model for paired data and the Fisher's exact test. The effects of the refinement step were evaluated by the Wilcoxon Signed Ranks test. RESULTS: The amount of removed material was 92.4%, 96.9% and 96.9% for the SAF, TRUShape and XP-endo Shaper, respectively. There were no significant differences between them (P > 0.05). Canals were completely cleaned of filling material in 70% of the specimens for XP-endo Shaper, 55% for SAF and 30% for TRUShape; the difference between XP-endo Shaper and TRUShape was significant (P = 0.03). The supplementary step with the XP-endo Finisher R instrument was associated with additional filling material removal of 38% (P < 0.001). Six more canals were rendered free of filling material after using this finishing instrument. CONCLUSIONS: The tested systems were equally effective in removing the mass of filling material from the apical 5 mm of molar canals. The supplementary step with the XP-endo Finisher R instrument enhanced filling material removal.

Asunto(s)

Materiales de Obturación del Conducto Radicular , Preparación del Conducto Radicular , Cavidad Pulpar , Diente Molar , Retratamiento , Microtomografía por Rayos X

RESUMEN

This chapter emphasizes some aspects of the Brazilian Guidelines for the Assessment of Head Injury Patients, written based on the experience of the Emergency Service, Neurosurgical Division of the University of São Paulo Medical School Hospital, and sponsored by the Brazilian Society of Neurosurgery. These guidelines approach the management of head-injury patients from their initial assessment in the Emergency Room until the final suggested clinical or surgical management. The Brazilian Guidelines represents our efforts to provide the basis for a common unified data collection system, which may allow cooperative studies in the future.

Asunto(s)

Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/cirugía , Procedimientos Neuroquirúrgicos/normas , Guías de Práctica Clínica como Asunto/normas , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/cirugía , Brasil , Humanos

RESUMEN

The cerebellum seems to be one of the structures responsible for early neurological improvement after cerebral hemispherectomy and its consequent deficits. Considered as an accessory brain, the cerebellum may constitute a neurobiological substrate for the recovery of such extensive cortical and subcortical lesions. It may compensate for the injury by structural remodeling and plasticity. The authors observed that, indeed, rats submitted to contralateral hemicerebellectomy before cerebral hemispherectomy do not recover as well as those submitted to hemicerebellectomy 2 weeks after cerebral hemispherectomy.

Asunto(s)

Cerebelo/fisiología , Cerebelo/cirugía , Destreza Motora/fisiología , Telencéfalo/fisiología , Telencéfalo/cirugía , Factores de Edad , Animales , Femenino , Lateralidad Funcional/fisiología , Masculino , Ratas , Ratas Wistar

RESUMEN

OBJECTIVE AND IMPORTANCE: Intravascular papillary endothelial hyperplasia (Masson's vegetant hemangioendothelioma) is a rare condition affecting the neuraxis. In the literature, only one case of this lesion involving the vertebral canal with spinal cord compression has been reported. We present a case of cauda equina compression due to this abnormality. CLINICAL PRESENTATION: A 17-year-old boy was admitted at our hospital with pain, numbness, paresis of the left lower extremity, and bladder dysfunction of approximately 1 month's duration. Computed tomography and magnetic resonance imaging of the spine revealed a tumor within the spinal canal at the T12-L1 level. INTERVENTION: The patient underwent a T12-L1 laminectomy. An epidural red nodular tumor was visualized and totally resected. The findings of the pathological examination were compatible with intravascular papillary endothelial hyperplasia. At follow-up examination 1 month after the operation, the patient had complete resolution of the pain, and the motor deficit and bladder dysfunction had improved significantly. CONCLUSION: This rare benign vascular lesion may be clinically and histopathologically mistaken for an angiosarcoma. Because the intravascular papillary endothelial hyperplasia can be cured by complete surgical resection, it is important to distinguish between these two lesions to avoid inappropriate aggressive treatment.

Asunto(s)

Cauda Equina/cirugía , Neoplasias Epidurales/cirugía , Hemangioendotelioma/cirugía , Síndromes de Compresión Nerviosa/cirugía , Adolescente , Cauda Equina/patología , Diagnóstico Diferencial , Endotelio Vascular/patología , Neoplasias Epidurales/diagnóstico , Neoplasias Epidurales/patología , Hemangioendotelioma/diagnóstico , Hemangioendotelioma/patología , Humanos , Hiperplasia , Laminectomía , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Masculino , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/patología , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos X

RESUMEN

The effectiveness of 4.0% sodium hypochlorite (NaOCl) used with three irrigation methods in the elimination of Enterococcus faecalis from the root canal was tested in vitro. Root canals contaminated with E. faecalis were treated as follows: (i) irrigation with 2 mL of NaOCl solution and agitation with hand files; (ii) irrigation with 2 mL of NaOCl solution and ultrasonic agitation; (iii) irrigation with NaOCl alternated with hydrogen peroxide. Contaminated canals irrigated with sterile saline solution served as the control. Paper points used to sample bacteria from the root canals were transferred to tubes containing 5 mL of brain heart infusion (BHI) broth. Tubes were incubated and the appearance of broth turbidity was indicative of bacteria remaining in the root canal. There were no statistically significant differences between the experimental groups. However, NaOCl applied by the three methods tested, was significantly more effective than the saline solution (control group) in disinfecting the root canal.

Asunto(s)

Desinfectantes Dentales/administración & dosificación , Cavidad Pulpar/microbiología , Enfermedades de la Pulpa Dental/tratamiento farmacológico , Enterococcus faecalis/efectos de los fármacos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Tratamiento del Conducto Radicular/métodos , Hipoclorito de Sodio/administración & dosificación , Distribución de Chi-Cuadrado , Diente Canino/microbiología , Cavidad Pulpar/efectos de los fármacos , Enfermedades de la Pulpa Dental/microbiología , Evaluación Preclínica de Medicamentos , Enterococcus faecalis/aislamiento & purificación , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Técnicas In Vitro , Irrigación Terapéutica/métodos

RESUMEN

Os autores apresentam tres casos de "subluxacao recorrente da articulacao interfalangena proximal do 5o. artelho". Todos foram vistos inicialmente em Servicos de Urgencia Especializados. Ainda nao encontramos mencao na literatura de patologia que descrevemos. O tratamento cirurgico instituido nos tres casos apresentou resultados uniformemente excelentes

Asunto(s)

Adulto , Humanos , Masculino , Femenino , Luxaciones Articulares , Articulación del Dedo del Pie , Procedimientos Quirúrgicos Operativos