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BACKGROUND: This study aimed to evaluate patients undergoing placement of zygomatic implants by Stella and Warner's technique, considering the survival rate of conventional and zygomatic implants, and assess the health of the maxillary sinuses and the level of patient satisfaction. METHODS: In this retrospective cohort study, 28 patients had received a combination of conventional and zygomatic implants (group I) and 14 were rehabilitated with only conventional implants (group II). RESULTS: The results showed that Stella and Warner's technique, thought to minimize the presence of the implant into the maxillary sinus, improving the emergence of the implant, proved to be effective, allowing a high survival rate of conventional and zygomatic implants (100 %). The follow-up period ranged from a minimum of 15 months to a maximum of 53 months after prosthetic rehabilitation (average of 34 months). No pathological changes were found on the periimplant tissues. Radiographs showed satisfactory bone levels in conventional implants of oral rehabilitation with zygomatic implants and a good positioning of the apex of the zygomatic implants in relation to the zygomatic bone. The tomographic findings revealed no characteristics of sinus disease. There were no cases of obstruction of the maxillary sinus ostium. CONCLUSIONS: The placement of zygomatic implants by Stella and Warner's technique proved to be a predictable technique with high implant survival rate in patients with atrophic maxilla and was not associated with sinus disease in the sample analyzed. However, a long-term follow-up is necessary to confirm the initial findings of this study.

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OBJECTIVE: Different instruments are available to measure functional status in juvenile rheumatoid arthritis (JRA); however, none is based on the evaluation of joint range of motion (ROM). We designed and evaluated a ROM scale to be used as a complementary instrument in daily practice with JRA as well as in trials. METHODS: The 10 joint movements of the Pediatric Escola Paulista de Medicina Range of Motion scale (Pediatric EPM-ROM) were derived from 25 initial movements. The selection was based on 2 criteria: (1) consensus among 3 pediatric rheumatologists, one physical therapist, and one occupational therapist; and (2) choice of movements that presented the highest scores in a pilot study involving patients with JRA. The score for each joint ranges from 0 (full movement) to 3 (severe limitation) and the cutoff degrees of motion are, in general, based on the lack of ability to perform some activities of daily living. The test-retest reliability was assessed by administering the scale twice by the same observer, 4 to 10 days apart, always in the morning. The interobserver reliability was evaluated on the same day by 2 independent observers. Cross sectional construct validity was also assessed by correlating the values of some clinical variables with the scores of the Pediatric EPM-ROM scale. RESULTS: The instrument was applied to 34 patients with JRA, 11 systemic, 11 polyarticular, and 12 pauciarticular. The mean EPM-ROM score was 0.57 (SD 0.54, min 0, max 2.05). The test-retest and interobserver correlation coefficients were 0.96 and 0.98, respectively. The Pearson correlation coefficients comparing scores of the Pediatric EPM-ROM scale and other variables were satisfactory: Childhood Health Assessment Questionnaire, r=0.55 (p<0.001); American College of Rheumatology global functional class, r=0.56 (p<0.001); and number of limited joints, r=0.65 (p<0.001). CONCLUSION: Our results provide evidence that the Pediatric EPM-ROM scale is a valid instrument to measure joint ROM in JRA.

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The authors report on two patients with large partial congenital defect of the left pericardium, as observed at post-mortem examination. In both cases, diagnosis was made during life thanks to the clinical syndrome described by Abbott, Sothworth and Stenvenson. In the first case diagnosis was confirmed by pneumothorax proposed by Ellis et al and the second case was recognized by the clinical-radiological syndrome. The first patient was followed until his death. Because of an abnormal echogram, he was submitted to exploratory cardiotomy and small ASD, aneurysmatic dilation of Valsalva sinus and mitral regurgitation by ruptured chordae tendineae were found. The autopsy, besides the findings at the operation, showed residual adhesive pericarditis with a cavity at the postero-superior region of the heart behind the left auricle and a redundant tricuspid cusp. The association of congenital pericardium defect to mitro-tricuspid redundant cusps and aneurysmatic dilatation of the sinus of Valsalva--suggesting myxomatous degeneration--plus atrial septal defect as in case 1, has not been found in the medical literature. In the second patient the defect was recognized in spite of congestive heart failure and severe tricuspid regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

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Os autores analisam a eletrofisiologia do nodulo sinusal de 31 portadores de cardiopatia chagasica cronica, com conducao AV 1:1 e varias formas de bloqueio de ramo ao ECG. Utilizam, como metodologia, a medida do tempo de recuperacao do nodulo simusal corrigido, determinado por estimulacao atrial continua e parada brusca da unidade geradora; a medida do tempo de conducao sino-atrial obtido por extra-estimulos pelas relacoes A1A2/A2A3 em seus percentuais sobre A1A1. Os resultados demonstram uma alta incidencia de transtornos do tecido perissinusal, sugerindo a existencia, nos casos de disfuncao sinusal em chagasicos, de um mecanismo misto de producao, envolvendo o automatismo celular e a condutividade tecidual. Sugerem que as lesoes do tecido perissinusal favorecem o aparecimento de mecanismos de reentrada, bem como representam fator de limitacao para a medida do tempo de recuperacao do nodulo sinusal. Descrevem, com os extra-extimulos um possivel novo tipo de fenomeno de "gap" ocorrendo entre o tecido atrial e a juncao sino-atrial

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