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Important changes have occurred over the last decades in the clinical application of the strategies for posterior restorations - from amalgam to composites in direct restorations and from traditional resistance form crowns to adhesive partial restorations such as onlays. Despite much evidence available for these advances, there are still very few established guidelines for common clinical questions: When does an indirect restoration present a clinical advantage over a direct one? When should one perform adhesive cusp coverage such as an onlay? When to implement resistance form designs in adhesive restorations? Which conditions create limitations for adhesion so that a resistance form preparation with a stiffer material such as a traditional crown might be more appropriate? In order to provide clinical guidelines, the present authors consider five parameters to support and clarify decisions - Coverage of cusps, Adhesion advantages and limitations, Resistance forms to be implemented, Esthetic concerns, and Subgingival management - the CARES concept. In Part I of this three-part review article, the focus is on clinical decisions for partial adhesive restorations regarding indications for direct versus indirect materials as well as the need for cusp coverage and/or resistance form preparations based on remaining tooth structure and esthetics.

The treatment or management of tooth wear with composite resins can be challenging because significant alterations in the patient's occlusion are usually required. Comprehensive approaches include the use of facebows, articulator-mounted casts, laboratory-made wax-ups, and silicone indexes to deliver the restorations. Even though this sequence of steps is recommended, in many cases it is not applied. The reason for this is related to the complexity and time required for these steps, which are normally applied in indirect restorations like ceramics but not properly used in direct composite resin rehabilitations. Moreover, a large portion of these patients, clinicians, and technicians in many countries may not have the resources and/or tools to undertake a full comprehensive approach. In order to aid clinicians to use an exclusively direct method to manage these patients for whatever reasons, the authors propose in this article a thought process applied to diagnosis and treatment planning that allows the restoration of extensively worn dentitions in a logical clinical sequence. The first goal is to provide a clear and organized vision of the functional, biologic, and esthetic principles of treatment planning based on the most current, evidence-based notions and clarified insights from experts. These are principles that should be applied universally in any comprehensive treatment plan. The second goal is to propose the application of these principles to direct restorations even when no individualized articulator mounting or appropriate laboratory wax-ups are available - the anatomically driven direct approach (ADA).

Aims: Peri-operative hyperglycemia is a risk factor for postoperative morbidity and mortality. However, the role of specific glycemic targets in reducing this risk has not been defined, particularly among patients with diabetes. Thus, our objective was to conduct a meta-analysis relating distinct peri-operative glycemic targets and postoperative outcomes in patients with diabetes., Methods: A systematic review was performed by two authors utilizing pre-specified terms: "diabetes mellitus" and "perioperative" and "mortality" and "blood glucose" or "strict glucose control" or "intensive insulin therapy" in PUBMED, CENTRAL and EMBASE. Glycemic control was considered strict when perioperative targets ranged between 100 and 150mg/dL (5.6-8.3mmol/l), moderate when the targets ranged between 150 and 200mg/dL 8.3-11.1mmol/l), and liberal when the target was >200mg/dL (11.1mmol/l). The data were combined utilizing the Dersimoan-Laird random-effects method. The primary endpoint was postoperative mortality with secondary endpoints of postoperative atrial fibrillation, wound infection, and stroke., Results: The literature search yielded 760 studies, of which only 6 met inclusion criteria. When compared with a liberal target, pooled data showed that a moderate glycemic target was associated with reduced postoperative mortality (OR=0.48, 95% CI 0.24-0.76) and stroke (OR=0.61, 95% CI 0.38-0.98), but no differences in atrial fibrillation or wound infection were found. There were no significant differences in postoperative outcomes between moderate versus strict perioperative glycemic target., Conclusions: Pooled results suggest that in patients with diabetes, a moderate peri-operative glycemic target (150-200mg/dl [5.6-8.3mmol/l]) is associated with reduction in postoperative mortality and stroke compared with a liberal target (>200mg/dl [11.1mmol/l]), whereas no significant additional benefit was found with more strict glycemic control (<150mg/dl [5.6mmol/l])., (Published by Elsevier Ireland Ltd.)

Introduction: The Appropriateness Evaluation Protocol (AEP) is an instrument to study the appropriate use of hospital beds based in objective criteria that classify a hospital admission as appropriate or inappropriate., Object: Evaluate the appropriateness of hospital admissions and stays of the patients of our Internal Medicine Department using the concurrent version of AEP., Method: Transversal study where was evaluated the clinical record of the patients admitted to our Department of Internal Medicine on March 13th of 2003, excluding all these who were admitted the day of the study. We analyzed demographic and clinic parameters and the appropriateness of hospital admission and stay using the AEP., Results: 22 patients fulfilled the inclusion criteria, 54.5% of male gender with a average age of 70.7 years. All the admissions were considered appropriate. The most common criteria was the need of intravenous therapy (100%), followed by the sudden lost of corporal mobility (12.3%). 27.3% of stays were considered inappropriate on the day of the study. The most common criteria of appropriateness was the need of intravenous therapy (93.7%). The most usual reason of inappropriate stay was the existence of planned discharge, but without the order written down in the clinical file (66.7%)., Conclusions: The AEP allows an efficient evaluation of the appropriateness of the hospital admissions and stays in a Health Unit, being used for a better utilization of resources. In our department all admissions were justified and about a quarter of stays were considered inappropriate using the AEP.

Authors present a case report of a 51 years old man, with a past history of peptic ulcer, arterial hypertension and dislipidemia. Three weeks before hospitalization he did a upper endoscopy that revealed a duodenal ulcer and oesophageal varices (grade II/III). During etiologic investigation, hepatic disease and portal hypertension were excluded. He had a goiter that invaded the anterior mediastinum. After thyroidectomy the oesophageal varices disappeared.