RESUMO

OBJECTIVE: To investigate the value of endoscopic duodenal papillary sphincterotomy combined with balloon dilatation in the treatment of duodenal papilloplasty with titanium clip after choledocholithiasis in post-operative complications. MATERIALS AND METHODS: One hundred and twenty-five patients (69 males and 56 females) with a median age of 65 (32-81) years were included. The treatment plan was randomly divided into Group A (n = 59) and Group B (n = 66) according to the random number table. Patients in Group A were treated with endoscopic sphincterotomy (EST) combined with endoscopic papillary large balloon dilation (EPLBD), followed by a titanium clip for duodenal papilloplasty and then indwelling nasobiliary drainage, whereas those in Group B were treated with EST combined EPLBD to remove stones and then indwelling nasobiliary drainage. RESULTS: In patients with choledocholithiasis or with anatomical changes that make stone extraction difficult, this prospective study attempted to perform duodenal papilloplasty with titanium clips after EST and EPLBD lithotripsy to compare and observe post-operative papillary healing, biliary reflux, and complication rates. CONCLUSIONS: The use of endoscopic duodenal papilloplasty with a titanium clip can improve biliary reflux after lithotripsy and reduce the incidence of post-operative cholangitis complications.

OBJETIVO: Investigar el valor de la esfinterotomía papilar duodenal endoscópica combinada con dilatación con balón en el tratamiento de la papiloplastia duodenal con clip de titanio después de coledocolitiasis en complicaciones postoperatorias. MATERIALES Y MÉTODOS: Se incluyeron un total de 125 pacientes (69 hombres y 56 mujeres) con una mediana de edad de 65 (32-81) años. Los pacientes del Grupo A se trataron con esfinterotomía endoscópica (EST) combinada con dilatación papilar endoscópica con balón grande (EPLBD), seguida de clip de titanio para papiloplastia duodenal y luego drenaje nasobiliar permanente, mientras que los del Grupo B se trataron con EPLBD combinado con EST para eliminar cálculos y luego drenaje nasobiliar permanente. RESULTADOS: En pacientes con coledocolitiasis o con cambios anatómicos que dificultan la extracción de cálculos, este estudio prospectivo intentó realizar papiloplastia duodenal con clips de titanio después de litotricia EST y EPLBD para comparar y observar la cicatrización papilar postoperatoria, el reflujo biliar y las tasas de complicaciones. CONCLUSIÓN: El uso de papiloplastia duodenal endoscópica con clips de titanio puede mejorar el reflujo biliar después de la litotricia y reducir la incidencia de complicaciones de colangitis postoperatorias.

Assuntos

RESUMO

Introducción: Se describen los signos clínicos de la anomalía de Morning Glory en una paciente femenina. Aunque esta anomalía es de baja prevalencia, la reportamos por la importancia del diagnóstico temprano debido a la asociación con alteraciones vasculares del sistema nervioso central que eventualmente son tratables. Objetivo: describir esta anomalía del disco óptico en una paciente atendida en el Hospital de San José, Bogotá. Métodos: búsqueda en la literatura de las manifestaciones clínicas, incidencia y patologías asociadas. Presentación del caso: mujer que consulta por pobre agudeza visual del ojo derecho cuya fundoscopia reveló una excavación cónica con disco óptico displásico y tejido glial alrededor de la pupila en 360 grados, pigmento retinocoroideo y aumento de los vasos retinianos que emergen del disco en distribución radial.

Introduction: We describe the clinical findings of morning glory optic disc anomaly, in a female patient. Despite the low prevalence of this optic disc malformation and although it has no specific treatment, we report this case, for timely diagnosis is important for associated vascular and central nervous system abnormalities may eventually be treated. Objective: to report this case of morning glory optic disc anomaly in a patient seen at Hospital de San José, Bogotá. Study design: case report. Methods: A search in the literature on the incidence, ophthalmological manifestations, clinical presentation and concomitant pathologies of morning glory optic disc anomaly, was conducted. Case report: female patient that consulted for decreased visual acuity in the right eye. Right eye fundus examination revealed a funnel-shaped excavation, dysplastic optic disc and glial tissue covering the peripapillary region circumferentially (360°), chorioretinal pigmentary changes, and increased number of retinal vessels emerging from the optical disc in a radial pattern.

Assuntos

RESUMO

Los procedimientos endodónticos regenerativos (REPs) representan una evolución significativa en el campo de la endodoncia, buscando no sólo tratar la infección o lesión presente en el diente, sino tam-bién promover la regeneración de los tejidos denta-rios afectados. El presente caso clínico muestra un incisivo lateral superior izquierdo con apexogénesis incompleta y diagnóstico de absceso alveolar crónico reagudizado en una paciente de 22 años, en el que se aplicó un procedimiento de endodoncia regenerativa (REPs). La estrategia terapéutica elegida se basó en los principios de ingeniería tisular, incorporando la novedosa aplicación de la membrana amniótica hu-mana liofilizada esterilizada como andamio bioactivo intraconducto. Las evaluaciones clínicas, radiográ-ficas y tomográficas a corto, mediano y largo plazo revelaron el éxito de la terapia. La resolución exitosa mostró en los controles a la pieza dentaria asintomá-tica, con una notable remisión de la patología apical, aumento de la longitud radicular y disminución del calibre apical. Se ha podido destacar la eficacia de los REPs, con una exitosa aplicabilidad de la membra-na amniótica como andamio innovador (AU)

Regenerative endodontic procedures (REPs) represent a significant evolution in the field of endodontics, aiming not only to address the infection or injury within the tooth, but also to promote the regeneration of the affected dental tissues. In this clinical case, an upper left lateral incisor with incomplete apexogenesis and diagnosis of acute exacerbation of a chronic periapical lesion in a 22-year-old patient is presented. A regenerative endodontic procedure (REPs) was applied. The chosen therapeutic strategy was based on tissue engineering principles, incorporating the innovative use of sterilized lyophilized human amniotic membrane as an intraconduct bioactive scaffold. Clinical, radiographic, and tomographic assessments at short, medium, and long-term follow-up revealed the success of the therapy. Successful resolution demonstrated an asymptomatic tooth in the follow-up, with a notable resolution of apical pathology, increased root length, and decreased apical caliber. The effectiveness of REPs has been highlighted, demonstrating the successful applicability of amniotic membrane as an innovative scaffold (AU)

Assuntos

RESUMO

INTRODUCTION AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure. Clinical guidelines assess competence in ERCP through a defined number of procedures, but multiple factors are involved. Our aim was to analyze the morphology of the papilla of Vater as an independent factor in selective common bile duct cannulation during resident training. MATERIAL AND METHODS: Patients that underwent ERCP were studied consecutively. All ERCPs were begun by a resident in training. The type of papilla was classified according to Haraldsson, including those with previous sphincterotomy. Cannulation difficulty and success and their relation to the type of papilla were documented. The analysis was divided into three 4-month periods. RESULTS: Of the 429 patients, cannulation was difficult in 101 (23.5%). The residents achieved selective cannulation of the common bile duct in 276 (64.3%) and the cannulation success rate at the end of their training was 81.7%. Cannulation was performed with the least difficulty in papillae with previous sphincterotomy (2.8%), unlike the type 4 papilla, which was difficult to cannulate in 50% of the cases. The lowest overall cannulation success was in the type 2 papilla (81.8%). CONCLUSION: Papilla type can influence cannulation success, but it is not the only related factor. Patients that underwent previous sphincterotomy appear to be the cases in whom ERCP training can be started.

RESUMO

ABSTRACT BACKGROUND: Duodenal papilla neuroendocrine tumors (DP-NET) are rare. Surgical therapy may be recommended for their treatment. However, they have high rates of morbidity and mortality. Endoscopic papillectomy (EP) is safe and effective for complete resection of tumors at this site. OBJECTIVE: This study aimed to describe a case series of DP-NETs resected by EP and perform a literature review. METHODS: A series of patients with DP-NETs underwent EP as primary treatment between Jan/2008 and Mar/2020 at a tertiary referral center. A comprehensive search was made on the MEDLINE primary electronic database. The search strategy was designed to find all articles related to DP-NETs published in the literature. RESULTS: Six patients underwent EP for presenting DP-NETs, four of whom were women (mean age, 63 years). The mean diameter of DP-NETs was 1.6±0.3 cm. Four of six patients were followed up, one of whom suffered relapse at the resection site after 3 months and was referred to surgery (pT3n1b) and the remaining three patients experienced no endoscopic or histological recurrence during follow-up periods of 10, 7, and 4 years, respectively. Eighteen articles were found in the literature search in MEDLINE. The articles included case reports of endoscopically treated DP-NETs. CONCLUSION: EP is safe and effective for DP-NETs that are ≤20 mm, confined to the submucosal layer, well-differentiated, and without local or remote metastasis. Adequate endoscopic follow-up and definitive surgical treatment in the presence of relapse are necessary.

RESUMO CONTEXTO: Tumores neuroendócrinos da papila duodenal (TNE-PD) são raros. A cirurgia deve ser recomendada para o tratamento. No entanto, apresentam altas taxas de morbimortalidade. A papilectomia endoscópica (PE) é segura e eficaz para a ressecção completa de tumores nesta região. OBJETIVO: Descrever uma série de casos de TNEs-PD ressecados por PE e realizar uma revisão da literatura. MÉTODOS: Pacientes com TNEs-PD submetidos a PE como tratamento primário com intenção curativa entre jan/2008 e mar/2020 em um centro de referência terciário foram estudados. Uma pesquisa abrangente foi feita no MEDLINE. A estratégia de busca foi desenhada para encontrar todos os artigos relacionados a TNEs-PD publicados na literatura, que haviam sido submetidos a PE. RESULTADOS: Seis pacientes foram submetidos a PE por apresentar TNEs-PD, sendo quatro mulheres, com média de idade de 66 anos (22-96). O diâmetro médio dos TNEs-PD foi de 1,8±0,4 cm. Quatro dos seis pacientes foram acompanhados, um dos quais sofreu recidiva no local da ressecção após 3 meses e foi encaminhado para cirurgia (pT3n1b), e os três pacientes restantes não apresentaram recorrência endoscópica ou histológica durante os períodos de acompanhamento de 10, 7 e 4 anos, respectivamente. Dezoito artigos foram encontrados no MEDLINE. Os artigos incluíram relatos de casos de TNEs-PD tratados pela PE. CONCLUSÃO: A PE é segura e eficaz para TNEs-PD ≤20 mm, confinados à camada submucosa, bem diferenciados e sem metástases locais ou remotas. Acompanhamento endoscópico adequado e tratamento cirúrgico definitivo na vigência de recidiva são necessários.

Assuntos

RESUMO

Resumen Existen numerosas publicaciones sobre resección endoscópica de lesiones de la papila mayor, pero solo se han presentado series de casos individuales de resección de lesiones de la papila menor. En el presente artículo se describe el éxito técnico y la seguridad de la resección endoscópica de dos lesiones adenomatosas de la papila menor.

Abstract There are various publications on endoscopic resection of major papilla lesions, but only individual case series of resection of minor papilla lesions have been reported. This article describes the technical success and safety of endoscopic resection of two adenomatous lesions of the minor papilla.

Assuntos

RESUMO

The present study aimed to morphometrically evaluate the ruminal mucosa and ruminal fluid characteristics of Santa Inês sheep fed different levels of spineless cactus as a replacement for Tifton grass hay. A total of 32 intact male Santa Inês sheep, approximately 180 days old and with a mean weight of 32.0±1.6kg, were studied in a completely randomized design with four treatments and eight replicates. The morphometric measurements evaluated in the ruminal epithelium (papilla height and surface area) were significantly affected (P< 0.05) by supplementation of the diet with spineless cactus, and these effects showed increasing linear trends. Evaluations of the ruminal fluid also showed a significant increasing linear effect (P< 0.05) for ammonia and a quadratic effect for microbial protein. The inclusion of spineless cactus in the sheep diet affects the ruminal epithelium morphology, including the papilla height and surface area, and favors the absorption process in the rumen. The diet containing higher levels of spineless cactus led to maximum microbial protein production. These results characterize spineless cactus as a feasible alternative for feeding sheep during periods of drought, when the typical food source is scarce.(AU)

O presente estudo teve como objetivo avaliar morfometricamente a mucosa ruminal e as características do líquido ruminal de ovinos Santa Inês alimentados com diferentes níveis de palma forrageira como substituta do feno de capim-Tifton. Um total de 32 ovinos, machos inteiros, da raça Santa Inês, com aproximadamente 180 dias de idade e peso médio de 32,0±1,6kg, foi estudado em delineamento inteiramente ao acaso, com quatro tratamentos e oito repetições. As medidas morfométricas avaliadas no epitélio ruminal (altura e área superficial da papila) foram significativamente afetadas (P<0,05) pela suplementação da dieta com palma forrageira, e esses efeitos mostraram tendências lineares crescentes. As avaliações do fluido ruminal também mostraram um efeito linear crescente significativo (P<0,05) para a amônia e um efeito quadrático para a proteína microbiana. A inclusão de palma forrageira na dieta de ovinos afeta a morfologia do epitélio ruminal, englobando a altura e a área da papila, e favorece o processo de absorção no rúmen. A dieta contendo níveis mais altos de palma forrageira levou à produção máxima de proteína microbiana. Esses resultados caracterizam a palma forrageira como uma alternativa viável para a alimentação de ovelhas durante períodos de seca, quando a fonte típica de alimento é escassa.(AU)

Assuntos

RESUMO

Uno de los problemas estéticos odontológicos más frecuentes es la presencia de triángulos negros por la pérdida de la papila interdental. Existen varias opciones de tratamiento quirúrgico y no quirúrgico para corregir esta anomalía, entre las más novedosas y menos invasivas, encontramos la utilización de un gel inyectable de ácido hialurónico para la reconstrucción de la papila interdental. El objetivo del estudio fue realizar una recopilación bibliográfica sobre la efectividad del ácido hialurónico como tratamiento para la reconstrucción de la papila interdental.

One of the most frequent cosmetic dental problems is the presence of black triangles due to the loss of the interdental papilla. There are several surgical and non-surgical treatment options to correct this anomaly, among the most innovative and less invasive we found the use of an injectable gel of hyaluronic acid for the reconstruction of the interdental papilla. The objective of the study was to carry out a bibliographic compilation on the effectiveness of hyaluronic acid as a treatment for the reconstruction of the interdental papilla.

Assuntos

RESUMO

INTRODUCCIÓN: Los drusen de papila son depósitos de material hialino calcificado a nivel de la cabeza del nervio óptico. Pueden ser difíciles de distinguir de la verdadera inflamación del nervio óptico y su identificación correcta es relevante debido a la morbilidad visual y sistémica que conlleva el diagnóstico de un verdadero edema de papila. OBJETIVO: Describir los hallazgos clínicos en un grupo de pacientes con drusen de papila. MATERIAL Y MÉTODO: Estudio descriptivo retrospectivo de 39 casos de pseudoedema de papila secundario a drusen de papila. Se recuperaron datos de la historia clínica y se analizaron características oftalmológicas y de los métodos complementarios (campo visual computarizado ­CVC-, tomografía de coherencia óptica ­OCT- , ecografía y neuroimágenes). RESULTADOS: Se estudiaron 39 ojos. La edad promedio al diagnóstico fue de 9 años. La mayoría no reporto antecedentes patológicos ni heredofamiliares. El principal motivo de consulta fue control de rutina y el segundo fue cefalea. El 56% tenían una excelente agudeza visual, 20% buena, 2.5% regular y 5% mala agudeza visual. El 36% de los ojos fueron emétropes, 41% hipermétropes y 23% miopes. Los hallazgos más representativos en el fondo de ojos fue la sobreelevación papilar (71,8% IC95% 57,9-86), papila de bordes borrados (43% IC95% 27,4-58,5) y tortuosidad vascular (43,6% IC95% 27,4-58,5). En todos los casos la ecografía fue diagnóstica, mostrando imágenes hiperecoicas dentro del nervio óptico. En el CVC no se encontraron hallazgos relevantes. CONCLUSIONES: Los drusen de papila son una alteración que puede encontrarse con frecuencia en un examen de fondo de ojo de rutina, y que un oftalmólogo debe conocer para evitar errores diagnósticos. (AU)

INTRODUCTION: Papillary drusen are deposits of calcified material at the level of the optic nerve head. It's can be difficult to distinguish from true optic nerve swelling. Its correct identification is relevant due to the visual and systemic implications of the diagnosis of true papilledema. OBJECTIVE: To characterize clinically a group of patients diagnosed with papillary drusen. MATERIAL AND METHODS: A retrospective descriptive study of 39 eyes with papillary pseudoedema secondary to optic nerve drusen was performed. Data from the medical history were retrieved and characteristics of the ophthalmological medical examination and complementary methods such as optical coherence tomography (OCT), computerized visual fields, and ocular ultrasound were analyzed. RESULTS: 39 eyes of 20 patients with papillary drusen were studied. The average age at diagnosis was 9 years. The majority did not report pathological or heredofamilial background. The main complain consultation was routine check out and the second was headache. The 56% had excellent visual acuity, 20% good, 2.5% regular and 5% had poor visual acuity. There were 36% emmetropic eyes, 41% hypermetropics and 23% myopia. The most representative findings in the fundus were swollen disks, appearing in (71,8% IC95% 57,9-86) of the cases, optic nerve with ill-defined and vascular tortuosity, appeating in 43,6% (IC95% 27,4-58,5) of the cases. In all cases the ultrasound was diagnostic, showing hyperechoic images withing the optic nerve. No relevant findings were found at CVC. CONCLUSIONS: Papillary drusen is a frequent disease that can be found in every day practice. Ophthalmologist should be aware of this to avoid misdiagnosis. (AU)

Assuntos

RESUMO

O objetivo desse trabalho foi avaliar parâmetros morfológicos do trato gastrointestinal de bubalinos submetidos a dietas de alto grão, pouco conhecida, e dieta convencional com adição de forragem. Dez bubalinos foram submetidos a 79 dias de confinamento, sendo 16 de adaptação e 63 de comparação. Avaliou-se dietas com 100% concentrado, utilizando milho grão inteiro e núcleo proteico e mineral, e dieta com 70% de concentrado, utilizando milho grão moído mais forragem e núcleo proteico e mineral. As dietas foram isoproteícas. O delineamento experimental foi em blocos casualizados e os animais blocados por peso. Os dados avaliados foram: peso dos animais ao abate, peso de ruminorreticulo, peso do intestino grosso e delgado, área e comprimento de papila ruminal, número de papilas ruminais por cm², área de superfície de absorção de ruminorreticulo. Os dados foram analisados pelo Proc GLM do SAS considerando efeitos de blocos e tratamento. Uma correlação de Pearson com todas as variáveis analisadas foi realizada. O peso médio dos animais, peso do ruminorreticulo, peso do intestino grosso e área do rúmen foram de 394,3 kg, 7,65 kg, 5,85 kg e 9,41 m respectivamente. O peso de intestino delgado foi maior para os animais que receberam dieta de grão total (4,9 vs 4,7 kg, P=0,04). Houve correlação positiva entre peso vivo dos animais e peso do ruminorreticulo; área de papila e comprimento de papila; e peso do intestino grosso e papilas por cm². Dietas com alto grão para bubalinos em confinamento apresentaram redução do trato gastrointestinal, porém com pouca diferença estatística.(AU)

The objective of this work was to evaluate morphological parameters of the gastrointestinal tract of buffaloes submitted to high-grain diets, little known and conventional diet with addition of forage. Ten buffaloes were submitted to 79 days of confinement, 16 days of which were adaptation and 63 days of comparison. Diets with 100% concentrate were evaluated, using whole grain corn and protein and mineral nuclei, and diets with 70% concentrate, using milled grain plus forage and protein and mineral cores. The diets were isoproteic. The experimental design was in randomized blocks and the animals were put into each block by weight. The data evaluated were weight of the animals at slaughter, weight of ruminoreticule, weight of the large and small intestine, area and ruminal papillae length, number of ruminal papillae per cm2 surface area of absorption of ruritreticulum. The data were analyzed by SAS's GLP Proc. considering block effects and treatment. A Pearson correlation with all analyzed variables was performed. The mean weight of the animals, weight of the ruminoreticule, weight of the large intestine and rumen area did not differ statistically and were 394.3kg, 7.65kg, 5.85kg and 9.41m, respectively. The small intestine weight was higher for the animals that received a total grain diet (4.9 vs.4.7 kg, P=0.04). There was a positive correlation between live weight of the animals and weight of the ruminoreticule; papillae and length of papila; and weight of the large intestine and papillae per cm2 . High grain diets for buffaloes in confinement presented reduction of the gastrointestinal tract, but with little statistical difference.(AU)

Assuntos

RESUMO

O objetivo desse trabalho foi avaliar parâmetros morfológicos do trato gastrointestinal de bubalinos submetidos a dietas de alto grão, pouco conhecida, e dieta convencional com adição de forragem. Dez bubalinos foram submetidos a 79 dias de confinamento, sendo 16 de adaptação e 63 de comparação. Avaliou-se dietas com 100% concentrado, utilizando milho grão inteiro e núcleo proteico e mineral, e dieta com 70% de concentrado, utilizando milho grão moído mais forragem e núcleo proteico e mineral. As dietas foram isoproteícas. O delineamento experimental foi em blocos casualizados e os animais blocados por peso. Os dados avaliados foram: peso dos animais ao abate, peso de ruminorreticulo, peso do intestino grosso e delgado, área e comprimento de papila ruminal, número de papilas ruminais por cm², área de superfície de absorção de ruminorreticulo. Os dados foram analisados pelo Proc GLM do SAS considerando efeitos de blocos e tratamento. Uma correlação de Pearson com todas as variáveis analisadas foi realizada. O peso médio dos animais, peso do ruminorreticulo, peso do intestino grosso e área do rúmen foram de 394,3 kg, 7,65 kg, 5,85 kg e 9,41 m respectivamente. O peso de intestino delgado foi maior para os animais que receberam dieta de grão total (4,9 vs 4,7 kg, P=0,04). Houve correlação positiva entre peso vivo dos animais e peso do ruminorreticulo; área de papila e comprimento de papila; e peso do intestino grosso e papilas por cm². Dietas com alto grão para bubalinos em confinamento apresentaram redução do trato gastrointestinal, porém com pouca diferença estatística.

The objective of this work was to evaluate morphological parameters of the gastrointestinal tract of buffaloes submitted to high-grain diets, little known and conventional diet with addition of forage. Ten buffaloes were submitted to 79 days of confinement, 16 days of which were adaptation and 63 days of comparison. Diets with 100% concentrate were evaluated, using whole grain corn and protein and mineral nuclei, and diets with 70% concentrate, using milled grain plus forage and protein and mineral cores. The diets were isoproteic. The experimental design was in randomized blocks and the animals were put into each block by weight. The data evaluated were weight of the animals at slaughter, weight of ruminoreticule, weight of the large and small intestine, area and ruminal papillae length, number of ruminal papillae per cm2 surface area of absorption of ruritreticulum. The data were analyzed by SAS's GLP Proc. considering block effects and treatment. A Pearson correlation with all analyzed variables was performed. The mean weight of the animals, weight of the ruminoreticule, weight of the large intestine and rumen area did not differ statistically and were 394.3kg, 7.65kg, 5.85kg and 9.41m, respectively. The small intestine weight was higher for the animals that received a total grain diet (4.9 vs.4.7 kg, P=0.04). There was a positive correlation between live weight of the animals and weight of the ruminoreticule; papillae and length of papila; and weight of the large intestine and papillae per cm2 . High grain diets for buffaloes in confinement presented reduction of the gastrointestinal tract, but with little statistical difference.

Assuntos

RESUMO

RESUMEN: El objetivo de este trabajo es evaluar el efecto de remodelación y relleno mediante aplicación de ácido hialurónico en papilas gingivales de sector estético con defectos de triángulo negro en un paciente tratado periodontalmente. Se inyectaron 0.15 ml de gel de ácido hialurónico dividido en 3 sesiones. Clínicamente se observó aumento de volumen y aumento de dimensiones verticales y horizontales en las papilas, mejorando así los parámetros estéticos. Como conclusión la aplicación de ácido hialurónico es efectiva en la remodelación y relleno en pérdidas de papila clase I de Nordland y Tarnow.

ABSTRACT: The objective of this work is to evaluate the effect of remodeling and filling through the application of hyaluronic acid in gingival papilla in the aesthetic sector with black triangle defects, in a periodontally- treated patient. In 3 portioned sessions, 0.15 ml of hyaluronic acid gel was injected. Clinically, an increase in volume was observed, and vertical and horizontal dimensions in the papilla increased too, thus improving aesthetic parameters. In conclusion, the application of hyaluronic acid is effective in the remodeling and filling in losses of class I papilla (Nordland and Tarnow classification).

Assuntos

RESUMO

Sexual dimorfism refers to morphological differences between males and females of a species. It may be a result of different selection pressures acting on either or both sexes and may occur in any sexually-reproducing dioecious species, including fishes. We analyzed 63 females and 63 adult males of Gymnorhamphichthys rondoni (Gymnotiformes) collected by us or deposited in museum collections. Sex was identified through abdominal dissection. We measured length from snout to posterior end of anal-fin, anal-fin length, distance from anus to anal-fin origin, distance from genital papilla to anal-fin origin, body width at beginning of anal-fin, and head length. Morphometric data submitted to a Principal Component Analysis (PCA) grouped males and females according to variables related to body size (along the first component) and to head length and body height along the second and third components. Females were larger than males, whereas males had proportionally larger heads and higher bodies than females. The urogenital papilla of males and females showed differences in shape, size and relative position on the body. The female papilla was elongated horizontally, larger than that of males, and was located on a vertical line below the eye, while the papilla of the males was vertically elongated and located on a vertical line below the operculum. To our knowledge, this is the first recorded case of sexual dimorphism in a species of Rhamphichthyidae, a condition that is now known in all the currently recognized families of Gymnotiformes.(AU)

Dimorfismo sexual é caracterizado por diferenças entre machos e fêmeas de uma espécie. Pode estar presente em qualquer ser vivo dioico que se reproduza sexualmente, inclusive peixes. Analisamos 63 fêmeas e 63 machos adultos de Gymnorhamphichthys rondoni (Gymnotiformes) coletados por nós ou obtidos em coleções. O sexo foi determinado por dissecção abdominal. Medimos o comprimento do focinho até o final da origem da nadadeira anal, comprimento da nadadeira anal, distância da papila genital até a origem da nadadeira anal, distância do ânus até a origem da nadadeira anal, altura do corpo e comprimento da cabeça. Dados morfométricos submetidos a uma Análise de Componentes Principais (PCA) agruparam machos e fêmeas de G. rondoni em função de variáveis relacionadas ao tamanho do corpo ao longo do primeiro componente, ao comprimento da cabeça e à altura do corpo ao longo do segundo e terceiro componentes. Fêmeas foram maiores que os machos, enquanto machos tiveram a cabeça proporcionalmente maior e o corpo mais alto que as fêmeas. A papila urogenital de machos e fêmeas diferiu no formato, tamanho e posição relativa no corpo. A papila das fêmeas foi alongada horizontalmente, maior que a dos machos e localizada na linha vertical abaixo do olho, enquanto que a papila dos machos foi alongada verticalmente e localizada na linha vertical abaixo do opérculo. Até onde sabemos, esse é o primeiro caso registrado de dimorfismo sexual em uma espécie de Rhamphichthyidae, uma condição que é agora conhecida para todas as famílias atualmente reconhecidas de Gymnotiformes.(AU)

Assuntos

RESUMO

RESUMEN: El objetivo de este artículo es evaluar el éxito clínico de una nueva alternativa para crear papilas en implantes de carga inmediata, que se realizó en una paciente de sexo femenino de 26 años de edad. Se inició el tratamiento con la confección de una guía quirúrgica, previo a la manipulación de los tejidos para crear las papilas peri-implantarias. En la cirugía se realizan 2 incisiones semilunares, unidas por una incisión perpendicular, las que al suturarlas sobre ellas mismas permitió crear las papilas; se instala un implante con buena estabilidad primaria y se toma la impresión para la rehabilitación. A las 24 horas se instala una corona atornillada, mostrando la presencia de las papilas de forma inmediata. Se realiza controles hasta los 20 meses de función, evidenciando buena estabilidad de las papilas mesial y distal sin presentar ningún tipo de complicación.

ABSTRACT: The aim of this paper is to evaluate the clinical success of a new alternative to create papillae in immediate load implants, which was performed in a 26-yearold female patient. The treatment was started with the preparation of a surgical guide, prior to the manipulation of tissues to create the peri-implant papillae. In the surgery, two semilunar incisions are made, joined by a perpendicular incision, which when sutured on them allowed to create the papillae. An implant with good primary stability is installed and the impression is taken for rehabilitation. At 24 h a screwed crown is installed, showing the presence of the papillae immediately. Controls are performed up to 20 months of function, demonstrating good stability of the mesial and distal papillae without presenting any type of complication.

Assuntos

RESUMO

RESUMEN: Introducción: El ácido hialurónico (AH) es un glucosaminoglicano esencial de la matriz extracelular de todos los tejidos, estando en una concentración media del 0.02%. Una persona de 60 kg de peso contiene aproximadamente 12 g de AH; las mayores concentraciones de este ácido se encuentran en los tejidos conectivos como la piel, la cual presenta hasta un 56% de éste. El AH tiene un papel importante en la migración celular, ya que está involucrado en procesos de crecimiento, inflamación y reparación, así como estimulación de diferentes células del tejido conectivo. Objetivo: Presentar un caso clínico de reconstrucción de la papila interdental infiltrando AH. Caso clínico: Paciente femenino de 24 años de edad que al interrogatorio refiere ser sistémicamente sana. Presenta pérdida de la papila interdental de la zona OD 11 y 21 a causa de una gingivitis y mala técnica de cepillado. Se valora de acuerdo con la clasificación de Nordland y Tarnow para saber el grado de predictibilidad del procedimiento y de acuerdo con la clasificación de Cardaropoli, con el fin de poder realizar comparaciones antes y después del tratamiento. La paciente presentaba 5 mm del punto de contacto a la cresta ósea, por lo que se realizó un infiltrado de AH en la papila durante cuatro semanas cada siete días. Conclusión: Existen muy pocas técnicas no quirúrgicas para la regeneración de la papila interdental, dentro de ellas encontramos el uso de AH. Las investigaciones sobre esta técnica no son nuevas, sin embargo, se deben continuar y ampliar los estudios considerando diversos factores: realizarlos en poblaciones mayores con personas de distintas razas, sexo y utilizando diferentes intervalos de infiltración.

ABSTRACT: Introduction: Hialuronic acid (HA) is an essential glucosaminoglycan of the extracellular matrix of all tissues; it is found at an average concentration of 0.02%. A subject weighing 60 kg contains approximately 12 g of HA. The greater concentrations of this acid are found in connective tissue such as the skin, which exhibits up to 56% percent of said acid. HA plays an important role in cell migration, since it is involved in processes of growth, inflammation and reparation as well as stimulation of different connective tissue cells. Objective: To present a clinical case involving interdental papilla reconstruction with HA infiltration. Clinical case: 24 year old female who reported being systemically healthy. The patient exhibited loss of interdental papilla in the area of tooth number 11 and 21 caused by presence of gingivitis and poor brushing techniques. The patient was assessed according to Nordland and Tarnow classification in order to ascertain the procedure's degree of predictability; she was additionally examined according to Cardaropoli classification in order to be able to establish pre- and post-treatment comparisons. The patient exhibited 5 mm of contact point to the bone crest, therefore, HA infiltration was undertaken into the papilla, every seven days for four weeks. Conclusion: There are very few non-surgical techniques to regenerate interdental papillae, one of them is HA use. Research conducted on this technique is not new, nevertheless, it would be suitable to further it taking into consideration different factors; conducting them in greater-sized populations with subjects of different ethnicities and gender, and using different infiltration intervals.

RESUMO

AIM: The gingival architecture is determined by the spatial orientation of the gingival zenith (GZ) and the inter-dental papillae (IP). Among the factors commonly associated with the presence and morphology of the IP, the contact point (CP) and the inter-dental distance relationships have been considered the most important. The objective of the present controlled clinical trial was to evaluate the role of the CP in determining the clinical and morphometric parameters of the inter-dental papilla. MATERIALS AND METHODS: The inter-dental papillae of sixty patients with unilateral diastemas were evaluated by means of periodontal probing, transgingival probing, the papilla presence index and morphometric measurement with a digital calliper and were analysed with a paired t-test, with significance set at alpha value of 0.05 or lower. RESULTS: All the papillae exhibited PPI score = 1. Papillary measurements were significantly increased in the experimental (diastema) group. CONCLUSIONS: In patients with gingival health, the dimensions of the IP are significantly increased in teeth without a contact point in comparison with their contra-lateral controls with a contact point. The contact point does not determine the presence and size of the inter-dental papilla, in patients with a healthy gingiva and without periodontal attachment loss.

Assuntos

RESUMO

This study aimed to reveal the morphometric differences between blind mole rats which live under ground and rats which live under laboratory conditions with regard to the length, base width, keratinization thickness and microscopic papilla depth. For this purpose, 7 adult blind mole rats and 7 adult Wistar albino rats were used in the study. All tongues were removed and fixed in 10 % neutral formalin. 4-5 micrometer of sections were obtained from paraffine sections which were obtained with routine histological follow ups and Crossman's modified triple staining was applied. While papilla length was found as 184.73±26.68 µm, base width 65.46±16.51 µm, keratinization thickness 11.60±1.37 µm, microscopic papilla depth 49.89±8.19 µm in blind rats; these values were found as 177.49±31.44 µm, 50.08±7.57 µm, 13.08±5.32 µm and 89.12±19.31 µm, respectively in rats. While a statistically significant difference was not detected between lengths (p>0.05), the difference between papilla width was found significant (p<0.05). While keratinization was found to be thicker on posterior side compared to anterior side in both species, a difference was not detected between keratinization thickness measurements (p>0.05). The difference between two species with regard to papilla depth was detected to be significant (p<0.001). The finding that papilla depth decreases as base width increases and the difference's being statistically significant suggested that living in different environments with different humidity could be effective on morphologic structures of the tongue in blind mole rats and rats.

Este estudio tuvo como objetivo revelar las diferencias morfométricas de las papilas linguales filiformes entre ratas topo ciegas que viven bajo tierra y ratas que viven en condiciones de laboratorio, con respecto a la longitud, ancho de la base, espesor de la queratinización y profundidad microscópica de las papilas. Para este propósito, se utilizaron 7 ratas topo ciegas adultas y 7 ratas albinas Wistar adultas. Se retiraron las lenguas y se fijaron en formalina neutra al 10 %. Se obtuvieron secciones de 4 a 5 µm a partir de técnicas histológicas de rutina, aplicándose la tinción triple modificada de Crossman. En las ratas topo ciegas se obtuvieron los siguientes datos morfométricos en relación a las papilas linguales filiformes: longitud 184,73 ± 26,68µm, ancho de la base 65,46 ± 16,51 µm, espesor de queratinización 11,60 ± 1,37 µm, profundidad microscópica de la papila 49,89 ± 8,19 µm, mientras que en las ratas control, los valores que se encontraron fueron 177,49 ± 31,44 µm, 50,08 ± 7,57 µm, 13,08 ± 5,32 µm y 89,12 ± 19,31 µm, respectivamente. Si bien no se detectó diferencia estadísticamente significativa entre las longitudes (p> 0,05), la diferencia del ancho de la papila fue significativa (p <0,05). Mientras que la queratinización fue más gruesa en la parte dorsal comparado con la parte ventral en ambas especies, no se detectó diferencia entre las mediciones de espesor de la queratinización (p> 0,05). Se detectó que la diferencia entre las dos especies con respecto a la profundidad de la papila era significativa (p <0,001). Se determinó que la profundidad de la papila disminuye a medida que aumenta el ancho de la base y la diferencia es estadísticamente significativa, lo que sugiere que vivir en diferentes ambientes con diferente humedad podría ser eficaz en las estructuras morfológicas de la lengua de ratas topo ciegas y de ratas de laboratorio.

Assuntos

RESUMO

La foseta papilar es una rara anomalía congénita que forma parte del espectro de las anormalidades congénitas del disco óptico. Se trata de invaginaciones intrapapilares que suelen localizarse en el margen del disco óptico. La mayoría se localiza a nivel temporal; en torno al 20 por ciento son de localización central seguidas por las fosetas superiores, inferiores o nasales. La bilateralidad se estima en un 10-15 por ciento y su incidencia se ha establecido en torno al 0,19 por ciento. Suelen ser asintomáticas, aunque en aproximadamente el 50 por ciento de los casos se produce afectación macular por el paso de fluido procedente desde la foseta papilar hacia las diferentes capas retinianas, lo que afecta secundariamente la agudeza visual y es, por tanto, el motivo de consulta. Hasta el momento se han descrito múltiples alternativas terapéuticas para el tratamiento de los desprendimientos de retina serosos asociados a foseta de papila, pero ninguna de estas alternativas se ha impuesto sobre el resto. El tratamiento de esta enfermedad consiste en cerrar la comunicación entre la foseta y el espacio subretiniano con diversas opciones terapéuticas como: la fotocoagulación láser, la neumoretinopexia, la indentación escleral posterior, la fenestración del nervio óptico, la vitrectomía o alguna combinación de las anteriores. La actual revisión bibliográfica se propone profundizar en el tema, sobre la base de pacientes en consulta con dicha afección retiniana(AU)

Papillary pit is a rare congenital anomaly that is part of the congenital optic disc anomaly spectrum. It deals with intrapapillary invaginations that may be located at the border of the optic disc. Most of them is located at temporal level, around 20 percent are located centrally followed by upper, lower and nasal pits. Bilateral pits are estimated to be 10-15 percent and their incidence has been set at 0.19 percent. They are asymptomatic although 50 percent of cases suffer macular damage due to the passing of fluid from the papillary pit to the different retinal layers, which affecgs in a secondary way the visual acuity and thus it is the reason to go to the ophthalmologist. Multiple therapeutic alternatives for the treatment of papillary pit-associated serous retinal detachments have been described but none of them has predominated over the others. The treatment of this disease consists of closing the communication between the pit and the subretinal space with several therapeutic options such as laser photocoagulation, pneumoretinopexia, posterior scleral indentation, optic nerve fenestration, vitrectomy or any combination of the above-mentioned methods(AU)

Assuntos

RESUMO

La denominada cirugía bariátrica “Bypass Gástrico” es una de las operaciones bariátricas mayormente efectuadas a nivel mundial y en aumento en años recientes. La exclusión del estómago y duodeno, después del procedimiento, deja con gran dificultad, la ejecución vía oral, de la Colangiopancreatografía endoscópica (CPRE) y el acceso al tracto biliar y pancreático. Debido a la incrementada incidencia de litiasis biliar en pacientes luego del procedimiento “bypass gástrico”, habrá más requerimiento de la Colangiopancreatografía endoscópica. En los últimos años se ha demostrado que los pacientes con bypass gástrico que ameriten evaluar el tracto biliopancreático pueden someterse exitosamente a Colangiopancreatografía endoscópica terapéutica transgástrica asistida por laparoscopia, en forma segura y confiada. Presentamos nuestra paciente con litiasis residual: cálculo impactado en la papila, efectuando la Colangiopancreatografía endoscópica transgástrica asistida por laparoscopia e Fistulotomía con bisturí - aguja por cálculo impactado en la papila, resuelto satisfactoriamente.

The “Gastric Bypass” is one of the most performed bariatric operatio ns worldwide, and in recent years the number of former bypass patients accrues. The gastric bypass excludes the stomach and duodenum, and it makes very difficult, by oral route, the access to the biliopancreatic tract, by means the endoscopic retrograde cholangiopancreatography (ERCP). Due to the increased evidence of gallstones after bariatric operations, the ERCP could be more often required. In recent years, it has been demostrated that gastric bypass patients can be successfully evaluated endoscopically by laparoscopic transgastric ERCP, as a safe and reliable method. We describe a patient with residual billiary impacted stone in the papilla, who underwent laparoscopic transgastric ERCP and a precut “fistulotomy” technique with needle - knife, was highly successful, without add significant morbidity to the procedure.

RESUMO

The objective of the present study was to conduct a systematic review of the treatment alternatives for the absence of interdental papilla (AIP), a clinical situation that can have aesthetic and phonetic impacts. A search for original articles, in humans, reporting more than one case, without language restrictions, dealing with therapeutic alternatives for AIP, was conducted in the databases of MEDLINE and EMBASE. The strategy included [("interdental papilla" OR "black triangles" OR "open gingival embrasure") AND ("treatment" OR "therapy" OR "reconstruction")] up to the year of 2010, resulting in seven studies being included. One study was found upon checking the reference lists and was added, bringing the total to 8 studies. The sample size ranged from two to 19 participants. Six of the eight studies used periodontal surgical techniques and fi ve associated the subepithelial connective tissue graft. Two studies treated AIP with reticulated hyaluronic acid gel. The follow-up time ranged from four to 24 months. The results, in relation to the interdental space area, ranged from 43% to 100% of fi lling and the reduction of the distance between the contact point and the tip of the papilla ranged from 0.73 to 2.8 mm. Two studies did not describe the results numerically. It was concluded that the therapeutic results presented by the authors were positive. However, it is necessary to take into consideration that the designs of the studies included here have a weak capacity for generating scientifi c evidence. As studies with a randomized clinical trial design are not conducted to respond to this clinical question, the results of the present study should be used with caution.

O objetivo deste estudo foi realizar uma revisão sistemática sobre as alternativas de tratamento da ausência da papila interdental (API), situação clínica que pode trazer impactos estéticos e fonéticos. Uma busca por artigos originais, em humanos, apresentando mais de 1 caso, sem restrição de idiomas, que tratassem sobre alternativas terapêuticas para a API foi realizada nas bases de dados Pubmed e Embase. A estratégia incluiu: [("interdental papilla" OR "black triangles" OR "open gingival embrasure") AND ("treatment" OR "therapy" OR "reconstruction")] a partir do ano de 2010, resultando em sete estudos incluídos. Um estudo foi encontrado na verifi cação das listas de referências e adicionado, totalizando 8 estudos. O tamanho amostral variou de dois a 19 participantes. Seis dos oito estudos utilizaram técnicas cirúrgicas periodontais e cinco associaram o enxerto conjuntivo subepitelial. Dois estudos trataram a API com gel de ácido hialurônico reticulado. O tempo de acompanhamento variou de quatro a 24 meses. Os resultados em relação ao espaço/área interdental variaram de 43 a 100% de preenchimento e a redução da distância entre o ponto de contato e a ponta da papila variou de 0,73 a 2,8 mm. Dois estudos não descreveram numericamente os resultados. Conclui-se que os resultados terapêuticos apresentados pelos autores foram positivos. Entretanto, é preciso levar em consideração que o delineamento dos estudos incluídos tem fraca capacidade de gerar evidência científi ca. Enquanto estudos com delineamento do tipo ensaio clínico randomizado não sejam realizados para responder essa pergunta clínica, os resultados do presente estudo devem ser utilizados com cautela.