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The widespread use of antibiotics created selective pressure for the emergence of strains that would persist despite antibiotic toxicity. The bacterial resistance mechanisms are several, with efflux pumps being one of the main ones. These pumps are membrane proteins with the function of removing antibiotics from the cell cytoplasm. Due to this importance, the aim of this work was to evaluate the inhibitory effect of tannic acid against efflux pumps expressed by the Staphylococcus aureus RN4220 and IS-58 strains. The efflux pump inhibition was assayed using a sub-inhibitory concentration of efflux pump standard inhibitors and tannic acid (MIC/8), observing their capacity to decrease the MIC of Ethidium bromide (EtBr) and antibiotics due the possible inhibitory effect of these substances. The MICs of EtBr and antibiotics were significantly different in the presence of tannic acid, indicating the inhibitory effect of this product against efflux pumps of both strains. These results indicate the possible usage of tannic acid asan inhibitor and an adjuvant in the antibiotic therapy against multidrug resistant bacteria (MDR).

Objective: a systematic review was performed to evaluate the natural head position (NHP) in children with maxillary constriction before and after rapid maxillary expansion (RME). Material and Methods: a comprehensive search was carried out in the MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE without restrictions. The annual conference of the IADR abstracts (1990–2017) and unpublished and ongoing trials registry were also searched. Dissertations and theses were searched using the ProQuest Dissertations and “Periódicos CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) Theses Databases”. The studies compared the natural head position in patients submitted rapid maxillary expansion (RME) and untreated patients both with maxillary constriction. Results: a total of 3023 studies were identified, three remained in qualitative study and all these studies were considered at “unclear” risk of bias in the key domains. Only two studies presented similar data to be included in the meta-analysis. Both studies evaluated the natural head position, through the angle between nasion-sella line and true vertical (SN-Ver). The meta-analyses demonstrated that after 12 months follow-up, the SN-Ver angle decreased by 3.39 degrees (95% confidence interval [CI]=0.57 to 6.21; p=0.02). Conclusion: the RME promoted increase in SN-VER angle in child after 12 months for intervention; however, there are few studies in the literature about this topic, and there is a need of further well-designed trials to investigate this alteration. Objetivo: uma revisão sistemática foi realizada para avaliar se a posição natural da cabeça (PNS) muda em crianças com constrição maxilar antes e após expansão rápida da maxila (ERM). Material e método: uma pesquisa foi realizada no MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO e Cochrane Library sem restrições. Também foram pesquisadas a conferência anual dos resumos da IADR (1990–2017) e o registro de ensaios não publicados e em andamento. As dissertações e teses foram pesquisadas usando os bancos de dados ProQuest Dissertations e “Periódicos CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) de Teses”. Os estudos compararam a posição natural da cabeça em pacientes submetidos a expansão rápida da maxila (ERM) e pacientes não tratados, ambos com constrição maxilar. Resultados: um total de 3023 estudos foram identificados, três permaneceram em estudo qualitativo e todos esses estudos foram considerados de risco "pouco claro" de viés nos principais domínios. Apenas dois estudos apresentaram dados semelhantes para serem incluídos na meta-análise. Ambos os estudos avaliaram a posição natural da cabeça, através do ângulo entre a linha násio-sela e a vertical verdadeira (SN-Ver). As meta-análises demonstraram que, após 12 meses de acompanhamento, o ângulo SN-Ver diminuiu 3,39 graus (intervalo de confiança de 95% [IC] = 0,57 a 6,21; p = 0,02). Conclusão: o ERM promoveu aumento do ângulo SN-VER na criança após 12 meses de intervenção; no entanto, existem poucos estudos na literatura sobre esse tópico, e há necessidade de mais estudos bem delineados para investigar essa alteração.

This study aimed to evaluate the environmental quality of the marine portion of Xixova-Japui State Park (XJSP), an urban marine protected area, which is influenced by multiple contamination sources, by using ecotoxicological and geochemical analyses. Sediments were predominantly sandy, with low CaCO3 and organic matter contents, and presented contamination by metals (Cd, Cu, Zn). Acute toxicity was detected in three tested samples, and copepod exposed to sediments from four stations exhibited lower fecundities, despite the absence of significant effects. Contamination and toxicity seemed to be associated, suggesting that the environment is degraded and presents risks to the biota. Whole sediment TIE indicated ammonia as a main responsible for toxicity, suggesting sewage is a main contributor to sediment degradation. As external contamination sources seem to be negatively influencing the sediment quality, the park conservation objectives are not being fully reached, demanding actions to mitigate impacts.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA - disseminated and implemented in over 70 countries globally - is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease. © 2016 The Author(s).

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:46Z No. of bitstreams: 1 S1679-87592010000700010.pdf: 362752 bytes, checksum: 24e450b065d804fe7f0149f73673e442 (MD5) Made available in DSpace on 2013-08-22T18:43:46Z (GMT). No. of bitstreams: 1 S1679-87592010000700010.pdf: 362752 bytes, checksum: 24e450b065d804fe7f0149f73673e442 (MD5) Previous issue date: 2010-06-01 Made available in DSpace on 2013-09-30T17:41:35Z (GMT). No. of bitstreams: 2 S1679-87592010000700010.pdf: 362752 bytes, checksum: 24e450b065d804fe7f0149f73673e442 (MD5) S1679-87592010000700010.pdf.txt: 38945 bytes, checksum: d87fdeddd30a65f7d66f116b5ae80be7 (MD5) Previous issue date: 2010-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:12:26Z No. of bitstreams: 2 S1679-87592010000700010.pdf: 362752 bytes, checksum: 24e450b065d804fe7f0149f73673e442 (MD5) S1679-87592010000700010.pdf.txt: 38945 bytes, checksum: d87fdeddd30a65f7d66f116b5ae80be7 (MD5) Made available in DSpace on 2014-05-20T13:12:26Z (GMT). No. of bitstreams: 2 S1679-87592010000700010.pdf: 362752 bytes, checksum: 24e450b065d804fe7f0149f73673e442 (MD5) S1679-87592010000700010.pdf.txt: 38945 bytes, checksum: d87fdeddd30a65f7d66f116b5ae80be7 (MD5) Previous issue date: 2010-06-01 A Baía de Guanabara é um ambiente marinho-estuarino de grande relevância ecológica e sócio-econômica, e sujeita a uma ampla gama de impactos ambientais. O sedimento é o principal destino para a maioria das substâncias introduzidas nos corpos d'água, podendo fornecer uma medida integrada da qualidade ambiental, a qual pode ser avaliada por várias abordagens. Neste projeto, a qualidade de sedimentos da Baía de Guanabara foi por uma abordagem ecotoxicológica, por meio de testes de toxicidade aguda de sedimento integral, utilizando Tiburonella viscana, e testes de toxicidade crônica de água intersticial, elutriato e interface sedimento-água, utilizando embriões de Lytechinus variegatus. Os sedimentos foram coletados em 14 estações de amostragem. Nos testes crônicos houve efeitos significativos na maioria das amostras, enquanto os sedimentos coletados nas estações 1, 2, 3, 6, 8, 10, 11, 12 e 15 apresentaram também toxicidade aguda. Houve grande concordância entre os resultados dos diferentes testes, e sua integração mostrou que os sedimentos analisados encontram-se inadequados à vida aquática, indicando degradação ambiental na baía da Guanabara. Nesse contexto, o controle das fontes poluidoras e o gerenciamento dos múltiplos usos da baía devem ser implementados, no sentido da melhora da qualidade ambiental. Guanabara Bay is a marine-estuarine environment of high ecological and socio-economic importance, subject to a variety of environmental impacts. Sediment is the eventual repository for most substances introduced into water bodies and may, therefore, provide an integrated measure of the environmental quality, which can be assessed by many different approaches. In this project, the quality of sediments from Guanabara Bay was evaluated by the ecotoxicological approach: whole-sediment toxicity tests, using Tiburonella viscana, and porewater, elutriate and sediment-water interface chronic toxicity tests, using embryos of Lytechinus variegatus, were applied. Sediments were collected at 14 sampling stations, distributed across the bay. Chronic tests showed significant toxicity in most of the sediment samples. Sediments from stations 1, 2, 3, 6, 8, 10, 11, 12 and 15 showed acute toxicity as well. The results of the different tests were well correlated, and their integration showed that the sediments analyzed were considered unsuitable for aquatic life, resulting in the environmental degradation of Guanabara Bay. In this context, the control of pollution sources and multi-purpose management are required to improve the environmental quality. Universidade Estadual Paulista Júlio de Mesquita Filho Campus do Litoral Paulista -São Vicente Universidade Federal Fluminense (UFF) Universidade Federal Fluminense (UFF) Instituto de Biologia Depto. de Biologia Marinha Universidade Federal do Ceará (UFC) Instituto de Ciências do Mar. Labomar Universidade Federal de Uberlândia (UFU) Laboratório de Biogeoquímica Marinha Centro de Estudos do Mar Universidade Estadual Paulista Júlio de Mesquita Filho Campus do Litoral Paulista -São Vicente

The tongue is a frequent cause of upper airway obstruction in obstructive sleep apnea syndrome. The genioglossi muscles are the front-most muscles of the tongue, attached to the geniotubercle on the inner cortical of the mandibular symphisis. The collapsibility of the tongue can be managed with genioglossus advancement. Piezo surgery can decrease the risk of apical dental lesion. The perfect depth control during osteotomy and absence of soft tissue lesion considerably limit the risks of oral floor lesion.

Purpose To assess radiology residency program directors' and chief rresidents' views regarding the Radiology Residency Review Committee's proposed revision of program requirements which would delay independent call until a resident has had 12 months of radiology training. Methods A Web-based survey was distributed electronically to the program directors and chief residents of 188 radiology residency programs. Survey responses were collected for two weeks in November-December 2006. Results The survey was completed by 91 Program Directors and 165 Chief Residents. There were no statistically significant differences between the two grooups of respondents on any of the 9 questions pertaining to the proposed call requirement change. Approximately 70% of the program directors and 80% of the chief residents disagreed or disagreed strongly that they were in favor of the proposed ACGME change. Strong opposition to the change was independent of both program size and current compliance with the proposed change. Over 70% in both groups disagree or strongly disagree that the proposed change would positively affect residency training. Conclusions The majority of survey respondents oppose changing the minimum required length of radiology residency training prior to residents' providing independent on-call radiology interpretations from 6 months to 12 months.

Antibiotic misuse is associated with emergence of resistance and high expenditures. Fluoroquinolones (FQ) and carbapenems (CP) are drugs with considerable potential of resistance development and its disseminated use is a concern. We undertook a prospective clinical audit to evaluate prescriptions of FQ and CP in a multistep process. Each prescription was unfolded in the following steps: indication for antimicrobial therapy; adequacy of initial prescription, dosage and route; previous cultures; and parenteral-oral transition. There was no antibiotics indication in 8.9% of FQ and 1.5% of CP group (p = 0.07). In CP 25.8% of initial schemes were inappropriate (21% in FQ). Lack of switch to oral therapy comprised 25% of monthly costs of FQ. Inadequacy in initial choice accounted for 13.6% of CP expenses. We concluded that, in spite of infection control restrictive policies, inappropriateness of antibiotic usage is worrisome. Clinical audit in a multistep approach may identify possible flaws in this process.

The EF1α genes were stable in the large majority of soybean tissues during development and in specific tissues/conditions under stress. Quantitative real-time PCR (qPCR) analysis strongly depends on transcript normalization using stable reference genes. Reference genes are generally encoded by multigene families and are used in qPCR normalization; however, little effort has been made to verify the stability of different gene members within a family. Here, the expression stability of members of the soybean EF1α gene family (named EF1α 1a1, 1a2, 1b, 2a, 2b and 3) was evaluated in different tissues during plant development and stress exposure (SA and PEG). Four genes (UKN1, SKIP 16, EF1β and MTP) already established as stably expressed were also used in the comparative analysis. GeNorm analyses revealed different combinations of reference genes as stable in soybean tissues during development. The EF1α genes were the most stable in cotyledons (EF1α 3 and EF1α 1b), epicotyls (EF1α 1a2, EF1α 2b and EF1α 1a1), hypocotyls (EF1α 1a1 and EF1β), pods (EF1α 2a and EF1α 2b) and roots (EF1α 2a and UKN1) and less stable in tissues such as trifoliate and unifoliate leaves and germinating seeds. Under stress conditions, no suitable combination including only EF1α genes was found; however, some genes were relatively stable in leaves (EF1α 1a2) and roots (EF1α 1a1) treated with SA as well as in roots treated with PEG (EF1α 2b). EF1α 2a was the most stably expressed EF1α gene in all soybean tissues under stress. Taken together, our data provide guidelines for the selection of EF1α genes for use as reference genes in qPCR expression analyses during plant development and under stress conditions.

This study focuses on the discussion of different lines of evidence (LoEs) applied to a sediment-quality assessment that considered the following: chemical concentrations of metals; polycyclic aromatic hydrocarbons (PAHs) in estuarine waters, sediments, and oysters (native and caged Crassostrea brasiliana); PAHs in semipermeable membrane devices (SPMDs); simultaneously extracted metals-acid volatile sulfides (SEM-AVS); benthic community assessment (the exploratory benthic index and the relative benthic index); chronic toxicity tests with the sea urchin Lytechinus variegatus; and bioaccumulation models. Significantly contaminated sediments from the Santos Estuarine System and the consequent toxicity of tested organisms were measured. Caged oysters presented bioaccumulation rates ≤2,500% of total PAH content and 200% of metal content when compared with control organisms from an uncontaminated area. SPMD results presented the same bioaccumulation pattern as caged oysters but at lower concentrations. Benthic communities presented some alterations, and there was a predominance of tolerant species in the inner part of the estuary. According to the SEM-AVS approach, metals should be assumed to be nonbioavailable, but experiments with transplanted C. brasiliana showed metal bioaccumulation, particularly in the cases of chromium, copper, mercury, and zinc. The weight-of-evidence approach was applied to compare and harmonize LoEs commonly used in sediment-quality assessments and to then classify estuary environments according to both their potential for having adverse effects on the biota and their possible ecological risks. All of the results of these approaches (except for SEM-AVS) were found to complement each other.

This study investigated the relationship of entertainment travelers’ past vacation behavior, vacation satisfaction, perceived vacation value, and intentions to revisit and repurchase. Subjects were inquirers for the purchase of an entertainment package that visited the destination and were systematically selected over a 12-month period. Results suggest that past behavior, satisfaction, and perceived value are good predictors of entertainment vacationers’ intentions to revisit the destination. It was further found that the variables of past behavior, satisfaction, and perceived value are poor predictors of intentions to visit and attend live theater entertainment or book an entertainment package during a visit. Given the relationships between past behavior, satisfaction, perceived value, and intentions to revisit, results of the present study provide important theoretical implications and direction for entertainment destination management.

Resumen La flebectasia yugular es una entidad muy poco frecuente, caracterizada por una dilatacion saculo-fusiforme de las venas del cuello durante las maniobras de Valsalva. Se presenta un caso de flebectasia de vena yugular interna en un varon de 7 anos de edad que consulta por tumoracion latero-cervical derecha que se manifiesta clinicamente con dichas maniobras. Tras el estudio ecografico inicial, se resalta la importancia del angio-TAC helicoidal como metodo complementario en el diagnostico de confirmacion, aportandose la reconstruccion tridimensional de las imagenes obtenidas para valorar la anormalia de vascularizacion yugular, asi como su extension y ausencia de complicaciones. Al tratarse de una alteracion benigna, sin tendencia a progresar y con minima repercusion estetica, se opta por evitar las tecnicas quirurgicas de reseccion o recubrimiento (drapping), incluyendolo en un protocolo de seguimiento con controles periodicos.

This study aimed to evaluate the sediment quality in the estuarine protected area known as Cananeia-Iguape-Peruibe (CIP-PA), located on the southeastern coast of Brazil. The study was designed considering possible negative effects induced by the city of Cananeia on the sediment quality of surrounding areas. This evaluation was performed using chemical and ecotoxicological analyses. Sediments were predominantly sandy, with low CaCO3 contents. Amounts of organic matter varied, but higher contents occurred closer to the city, as well as did Fe and Total Recoverable Oils and Greases (TROGs) concentrations. Contamination by Cd and Cu was revealed in some samples, while concentrations of Zn were considered low. Chronic toxicity was detected in all tested sediments and acute toxicity occurred only in sediments collected near the city. The principal component analysis (PCA) revealed an association among Cd, Cu, Fe, TROG, fines, organic matter, CaCO3, and chronic toxicity, whereas acute toxicity was found to be associated with Zn and mud. However, because Zn levels were low, acute toxicity was likely due to a contaminant that was not measured. Results show that there is a broad area within the CIP-PA that is under the influence of mining activities (chronic toxicity, moderate contamination by metals), whereas poorer conditions occur closer to Cananeia (acute toxicity); thus, the urban area seems to constitute a relevant source of contaminants for the estuarine complex. These results show that contamination is already capable of producing risks for the local aquatic biota, which suggests that the CIP-PA effectiveness in protecting estuarine biota may be threatened.

The media claims for the consumption of natural resource-based food have gradually increased in both developing and developed countries. The interest in the safety of these products is partially due to the possible presence of toxigenic fungi acting as mycotoxin producers, such as aflatoxins produced during the secondary metabolism of Aspergillus flavus, A. parasiticus and A. nomius. Aflatoxins, mainly aflatoxin B1, are directly associated with liver cancer in human beings. This paper is aimed at evaluating the presence of aflatoxin B1 in a few vegetable drugs, dried plant extracts and industrialized products traded in 2010 in the city of Belo Horizonte, State of Minas Gerais, Brazil. The method used for the quantification of aflatoxin B1 was based on extraction through acetone:water (85:15), immunoaffinity column purification followed by separation and detection in high efficiency liquid chromatography. Under the conditions of analysis, the Limits of Detection and Quantification were 0.6 µg kg(-1) and 1.0 µg kg(-1) respectively. The complete sets of analyses were carried out in duplicate. Aflatoxin B1 was noticed in a single sample (1.0 µg kg(-1)). The results revealed low aflatoxin B1 contamination in the products under analysis. However, it is required to establish a broad monitoring program in order to obtain additional data and check up on the actual extension of contamination.

This paper presents a harmonised framework of sediment quality assessment and dredging material characterisation for estuaries and port zones of North and South Atlantic. This framework, based on the weight-of-evidence approach, provides a structure and a process for conducting sediment/dredging material assessment that leads to a decision. The main structure consists of “step 1” (examination of available data); “step 2” (chemical characterisation and toxicity assessment); “decision 1” (any chemical level higher than reference values? are sediments toxic?); “step 3” (assessment of benthic community structure); “step 4” (integration of the results); “decision 2” (are sediments toxic or benthic community impaired?); “step 5” (construction of the decision matrix) and “decision 3” (is there environmental risk?). The sequence of assessments may be interrupted when the information obtained is judged to be sufficient for a correct characterisation of the risk posed by the sediments/dredging material. This framework brought novel features compared to other sediment/dredging material risk assessment frameworks: data integration through multivariate analysis allows the identification of which samples are toxic and/or related to impaired benthic communities; it also discriminates the chemicals responsible for negative biological effects; and the framework dispenses the use of a reference area. We demonstrated the successful application of this framework in different port and estuarine zones of the North (Gulf of Cadiz) and South Atlantic (Santos and Paranagua Estuarine Systems).

We aimed to develop site-specific sediment quality guidelines (SQGs) for two estuarine and port zones in Southeastern Brazil (Santos Estuarine System and Paranagua Estuarine System) and three in Southern Spain (Ria of Huelva, Bay of Cadiz, and Bay of Algeciras), and compare these values against national and traditionally used international benchmark values. Site-specific SQGs were derived based on sediment physical-chemical, toxicological, and benthic community data integrated through multivariate analysis. This technique allowed the identification of chemicals of concern and the establishment of effects range correlatively to individual concentrations of contaminants for each site of study. The results revealed that sediments from Santos channel, as well as inner portions of the SES, are considered highly polluted (exceeding SQGs-high) by metals, PAHs and PCBs. High pollution by PAHs and some metals was found in Sao Vicente channel. In PES, sediments from inner portions (proximities of the Ponta do Felix port's terminal and the Port of Paranagua) are highly polluted by metals and PAHs, including one zone inside the limits of an environmental protection area. In Gulf of Cadiz, SQGs exceedences were found in Ria of Huelva (all analysed metals and PAHs), in the surroundings of the Port of Cadiz (Bay of Cadiz) (metals), and in Bay of Algeciras (Ni and PAHs). The site-specific SQGs derived in this study are more restricted than national SQGs applied in Brazil and Spain, as well as international guidelines. This finding confirms the importance of the development of site-specific SQGs to support the characterisation of sediments and dredged material. The use of the same methodology to derive SQGs in Brazilian and Spanish port zones confirmed the applicability of this technique with an international scope and provided a harmonised methodology for site-specific SQGs derivation.

Producción Científica, Both transitory auditory otoemissions (TEOAE) and automated auditory brainstem responses (AABR) are considered adequate methods for universal hearing screening. The goal of this study was to compare the results obtained with each device, applying the same screening procedure. MATERIALS AND METHODS:From 2001 to 2003, all the newborns in our health area (2454 infants) were evaluated with TEOAE (ILO92, otodynamics) and all those born from 2004 to 2006 (3117) were evaluated with AABR (AccuScreen, Fischer-Zoth). The population studied included all well newborns and those admitted to neonatal intensive care units (NICU). The first screening was normally undertaken with well babies during the first 48h of life, before hospital discharge. Infants referred from this first step underwent a second screening after hospital discharge, before they were a month old. RESULTS:The results from each study group were compared and analyzed for significant differences. TEOAE screening yielded 10.2% fail results from the first screening step; AABR gave 2.6%. In the second screening step, 2% of the newborns screened with TEOAE were referred, whereas 0.32% of those screened with AABR were referred. These differences are statistically significant. CONCLUSIONS:Although AABR screening tests involve a slightly higher cost in time and money than TEOAE, the results obtained compensate this difference. AABR gives fewer false positives and a lower referral rate; the percent of infants lost during follow-up is consequently smaller. Therefore, in our environment, universal newborn auditory screening with AABR is more effective than that with TEOAE.

Sediment quality from Paranagua Estuarine System (PES), a highly important port and ecological zone, was evaluated by assessing three lines of evidence: (1) sediment physical-chemical characteristics; (2) sediment toxicity (elutriates, sediment-water interface, and whole sediment); and (3) benthic community structure. Results revealed a gradient of increasing degradation of sediments (i.e. higher concentrations of trace metals, higher toxicity, and impoverishment of benthic community structure) towards inner PES. Data integration by principal component analysis (PCA) showed positive correlation between some contaminants (mainly As, Cr, Ni, and Pb) and toxicity in samples collected from stations located in upper estuary and one station placed away from contamination sources. Benthic community structure seems to be affected by both pollution and natural fine characteristics of the sediments, which reinforces the importance of a weight-of-evidence approach to evaluate sediments of PES.

The tongue is a frequent cause of upper airway obstruction in obstructive sleep apnea syndrome. The genioglossi muscles are the front-most muscles of the tongue, attached to the geniotubercle on the inner cortical of the mandibular symphisis. The collapsibility of the tongue can be managed with genioglossus advancement. Piezo surgery can decrease the risk of apical dental lesion. The perfect depth control during osteotomy and absence of soft tissue lesion considerably limit the risks of oral floor lesion.

In order to evaluate possible trend changes in the epidemiological factors of adenotonsillar surgery, a total of 1,958 operations performed between 1992 and 2002 were reviewed.One third of the operations were to remove tonsils in comparison with the two thirds that were to remove adenoids. Three procedures were used: 59% adenoidectomies, 28% adenotonsillectomies and 13% tonsillectomies. During the study period, the percentage of adenotonsillectomies decreased, whereas the number of adenoidectomies increased. In general, this kind of surgery is mainly performed on males.Although we have not discovered variations regarding gender and average age for the operations, adenotonsillar surgery has increased over recent years and the percentage ratio of the various procedures has altered as a result of new indications.

Antibiotic misuse is associated with emergence of resistance and high expenditures. Fluoroquinolones (FQ) and carbapenems (CP) are drugs with considerable potential of resistance development and its disseminated use is a concern. We undertook a prospective clinical audit to evaluate prescriptions of FQ and CP in a multistep process. Each prescription was unfolded in the following steps: indication for antimicrobial therapy; adequacy of initial prescription, dosage and route; previous cultures; and parenteral-oral transition. There was no antibiotics indication in 8.9% of FQ and 1.5% of CP group (p = 0.07). In CP 25.8% of initial schemes were inappropriate (21% in FQ). Lack of switch to oral therapy comprised 25% of monthly costs of FQ. Inadequacy in initial choice accounted for 13.6% of CP expenses. We concluded that, in spite of infection control restrictive policies, inappropriateness of antibiotic usage is worrisome. Clinical audit in a multistep approach may identify possible flaws in this process.

Carcinomas arising from the Stensen's duct are extremely rare, and only 28 cases have been reported since 1927. Only two cases of the whole were adenoid cystic carcinoma like our case. A 83-year-old man with painless tumour of the left cheek is reported. The tumour was removed without facial nerve injury via extended parotidectomy incision and after superficial lobectomy.

In coordination with the Paediatrics Department, we drew up a protocol for the "Early Detection of Hearing Loss in High-Risk Neonates" based fundamentally on the sequential application of impedanciometry and the Auditory Brain Stem Response (ABR). These are the results obtained from October 1994 to March 2001. Of the 240 children examined, we found 36 cases (15%) of severe-to-profound bilateral sensorineural hearing loss (60 dBs HL). 55% was associated with risk factors. However, we diagnosed only 2 of these cases of hearing loss (5.5%) using the protocol (sent by the neonatology department due to the fact that they showed hearing loss risk factors), since the rest (94.5%) came as a result of suspected hearing loss, which resulted in an average age for diagnosis of 3 years. Although the procedure used is highly sensitive and is diagnostically specific, in the light of these results, we consider it necessary to extend hearing screening to all newborn infants in order to evaluate its effectiveness in the early detection of infant deafness.

These are the results of the first year of the application of a universal programme for the early detection of neonatal deafness. Our objective is making a diagnosis of all the unilateral or bilateral cases of hearing loss above 35 dB HL, before the age of 6 months. The detection strategy has 2 screening phases with transient evoked otoacoustic emissions (TEOAE) and one diagnostic phase with auditory brain stem response (ABR). The ABR were carried out both on those patients that failed the TEOAE screening and on the neonates with hearing loss risk factors. Of the 1,277 living newborn babies (NB), we evaluated 94%. 3.3% of the NB showed hearing loss risk factors. 90% of the NB passed the first TEOAE in both ears and, after the second TEOAE, only 2.5% of the NB reached the diagnostic phase. We provided early detection and treatment of 0.58% of cases of bilateral severe-deep hearing loss. Finally, the results obtained are examined together with the importance of planning universal hearing screening.

The osteomas of the mastoids are slow growing benign tumors, made predominantly of mature bone. Clinically these tumors are asymptomatic, except for cosmetic deformities, and they are usually casual radiological findings. Surgical treatment is indicated for symptomatic osteomas. In Spain only sixteen cases of extracanalicular osteoma have been described in the literature. Two new cases are reported and a review of the literature is presented.

In a previous report, we showed the efficacy of the submucous sclerosant therapy with Etoxiesclerol (Polidocanol) in two patients with Rendu-Osler-Weber disease. We confirm, in this present study, the advantages of Etoxiesclerol in the treatment of the epistaxis in the Rendu-Osler disease, in six patients, 3 males and 3 females and likewise in two patients with non-specific granuloma of nasal septum and another patient with cavernous hemangioma of soft palate.

The chemical composition of the essential oil of the aerial parts of Microlicia graveolens DC., Melastomataceae, growing wild in the mountains of Minas Gerais, Brazil, was investigated for the first time. A pale orange to colourless oil was obtained in a yield of 4.8%. The oil was analyzed by GC-MS. The main components were (+)-trans-pinocarvyl acetate (78.9%), (-)-trans-pinocarvyl acetate (5.5%) and β-pinene (3.8%).

Antrochoanal polyps are, basically, pathologies of children and young adults. The case here reported is really exceptional because its size and its appearance at so unusual age. Etio-pathogenesis, clinical course and differential diagnosis, face to other pathologies, are perused and also with several varieties of choanal polyps and the treatments proposed as well.

The appearance of mucoceles of paranasal sinuses during infancy is very rare. In relation with a patient, 11-year-old, enduring an ethmoidal mucocele treated in our Department we benefit it in order to realize a review of the published cases in medical literature. We also discuss on the etiopathogenesis, clinic and differential diagnostic aspects in pediatric age in comparison of those verified in grown-up.

Vascular malformations of the jaws can lead to disastrous complications, but there seems to be no consensus as to their treatment. The literature presents the pathophysiology and clinical aspects of these lesions, as well as the divergent views of the authors. Treatment by catheterization and embolization, with direct transosseous injection of cyanoacrylate, appears to be the least harmful and most permanent treatment in certain conditions, as evidenced by the case of this 9-year-old patient having a high-flow mandibular vascular malformation

Given the rareness of cervical schwannomas, they are often mistaken for other kinds of lesions. We present 2 clinical cases, make comments on the clinical-pathological features involved and point out the essential elements that ensure the differential diagnosis of these tumours.

The jugular phlebectasia is an infrequent anomaly in which a jugular dilatations of the jugular vein during the Valsalva manoeuvre is the main characteristic. We report a case of a 7 years old male with an internal jugular phlebectasia manifestating as a latero-cervical right mass expanding with Valsalva manoeuvre. After the first initial echographic study, we recommend angio-TAC helicoidal as an useful test to confirm the diagnosis, it is also useful to get a tridimensional reconstruction of the jugular anomaly as well as establish the extension and possible complication. Jugular phlebectasia is a benign entity, usually it doesn't progress and causes a minimal estatic defect, therefore it is recommended to avoid any surgical resection or drapping. Periodical follow up is the best choice.

Leiomyoma is a benign tumor of smooth muscle origin that is rarely found in oral cavity. We report a case of leiomyoblastoma of the tongue. The interest of this lesion is supported by its location and by the difficulty to determine its biological behavior. About 25% of the oral smooth muscle tumors are malignant, and have been reported "leiomyoma" locally invasive.

The unilateral abscess of the anterior portion of the tongue is an extremely rare occurrence. We report a case in which we have used the ultrasonography in the diagnosis, and discuss, as etiologic hypothesis the participation of Blandin-Nühn glands in the genesis of these abscess.

A case report of pilomatrixoma, benign neoplasy, originated of the skin annexes, which localisation force us to rule out a parotid tumor. Our intention is to include the pilomatrixoma among the possible differential diagnosis of calcified masses inside the growths of the parotid gland.

The protocol developed at our hospital for auditory assessment of children with risk factors for deafness is presented. The results obtained with tympanometry and auditory brainstem response (ABR) audiometry from October 1994 to March 1998 were analyzed. In 122 children, 17 cases (14%) of severe-to-profound bilateral deafness were found. Only 50% of these cases were associated with risk factors present at birth. The average age at time of diagnosis of deafness was over 3 years. In view of these results, we recommend auditory screening for all newborns as the only effective procedure for early detection of childhood deafness.

We report the cases of two women with Rendu-Osler-Weber disease and severe epistaxis. After several procedures failed (electrocoagulation, vascular clamping, dermoplasty, embolization), submucosal infiltration of a sclerosant was performed using the new product etoxysclerol. Epistaxis remained under control after two years of monitoring.

Pharyngeal tuberculosis is very rare and normally appears as an seemingly malignant process. As a result of which it is essential to perform a differential diagnosis before beginning anticancer treatment. We present a clinical case of lingual tonsil tuberculosis. A review is made of the pathogenic mechanisms, the clinical manifestations and the diagnosis of pharyngeal tuberculosis, whose response to treatment with antituberculous drugs proves to be excellent.

Cementifying fibroma is a benign fibro-osseous lesion with dental origin. We describe a case of cementifying fibroma of the maxillary sinus, an unusual location for this tumor.

The adenoid cystic carcinoma represents less than 1% of all the malignant tumours located in the larynx. Only about 80 cases have been described so far in world literature. In contrast with the epidermoid carcinoma of the larynx, the adenoid cystic carcinoma is not apparently related to common risk factors such as smoking. However the prognosis is much worse, with survival rates of less than 20% after 15-20 years. Treatment is surgical, although radiotherapy may be of help. In this paper a new case of adenoid cystic carcinoma located in the supraglottis of a 26-years-old woman is reported and the world literature is reviewed.

Two cases of pleomorphic adenoma of the parotid deep lobe are presented. Both of them were removed through back-submandibular approach. We favor this procedure as the best for tumors of the parapharyngeal space, whereas the mandibulotomies are indicated when dealing with strong adhesions, reoperations or malignancies.

Tumoral disease of the arteries is uncommon. It is possible that, in tumoral reoperations affecting cervical structures, periarterial fibrosis due to radiotherapy and previous surgery and metastatic adherences to the arterial wall makes radical surgery difficult. We present a case where the surgical treatment of a regional relapse from laryngeal neoplasm needed the removal of the common carotid artery and its reconstruction with autologous patent superficial femoral artery. Surgical technique included a PTFE graft interposition in the leg.