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Made available in DSpace on 2018-11-12T17:27:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-12-01. Added 1 bitstream(s) on 2018-11-12T17:35:42Z : No. of bitstreams: 1 S1981-86372015010500496.pdf: 1101809 bytes, checksum: bf61ef8d8cfad022ecb15b7aed51ba74 (MD5) A cirurgia de elevação da mucosa do seio maxilar para enxerto ósseo e posterior colocação de implantes osseointegráveis vem se tornando um procedimento de rotina na implantodontia moderna. Embora previsível, em alguns casos, tal procedimento, pode levar a complicações e sequelas consideráveis. Na maioria das vezes, essas complicações são ocasionadas por falhas técnicas, como a perfuração da membrana sinusal no momento transcirúrgico, o que pode acarretar perda do enxerto devido a um processo infeccioso no interior do seio maxilar, cuja via de drenagem acaba provocando a comunicação com a cavidade oral. A fístula bucossinusal é caracterizada pela persistência e epitelização desse pertuito. Neste relato é apresentado um caso de fechamento de fístula bucossinusal com o uso de um retalho palatino pediculado, em um paciente que havia desenvolvido um processo infeccioso, após ter sido submetido à realização de uma cirurgia para a elevação do seio maxilar. A cirurgia para o fechamento das comunicações bucossinusais apresenta técnicas variadas, que podem ser eleitas de acordo com as preferências do operador, além da localização e características da comunicação. Para o presente relato de caso, a técnica do retalho palatino pediculado foi eleita para o tratamento cirúrgico, proporcionando a cura do paciente. A técnica do retalho palatino pediculado mostrou-se uma opção adequada para o fechamento da fístula bucossinusal em um único ato cirúrgico, sem perda de mucosa ceratinizada ou diminuição do sulco vestibular na região da fístula Sinus lifting has become a routine procedure in modern implant dentistry. Despite its predictability, this type of surgery may eventually lead to serious complications and sequelae. Most of the time, such complications are due to technical failures, such as perforation of the sinus membrane during surgery, which may eventually lead to graft loss due to infection within the sinus, which finds its drainage path into the mouth and leads to an oroantral communication (OAC). Epithelization of such a draining duct characterizes an oroantral fistula (OAF). This report presents the use of a palatal pedicle flap to successfully close an OAF in a patient who had previously undergone a sinus lifting procedure. Several surgical techniques may be used in the closure of an OAF, and the choice of a particular technique is subject to the characteristics and location of the communication as well as to the preference of the surgeon. The palatal pedicle flap was successfully chosen in the present case report. The palatal pedicle flap was considered an adequate option for closure of an OAF in a single-stage surgical procedure, with no loss of either keratinized mucosa or buccal sulcus depth in the area of the fistula. Centro Universitário de Araraquara Universidade de São Paulo Faculdade de Odontologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Odontologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Odontologia

Background. The transplantation group of the National University of Colombia considers that education about transplants is important to raise the donation rate in this country.Objective. To find a statistical association between education about transplantation aimed at medical students and the number of students and their families bearing the organ donor card.Materials and methods. Cross-sectional analytical study. Two surveys were designed and sent to two different student populations. The first group had taken the course “Human Organ and Tissue Transplantation”, and the second group was composed of students from the fifth semester of medical education. The statistical test used was difference of proportions, sample size of 50 people, statistical power of 80%, difference in proportions 20%, alpha 0.05, p 0.05.Results. The surveys were answered by 29 students from first group and 74 students from second group. First question: “Do you carry the organ donor card?”, p-value of 0.03 found. Second question: “Do your family members carry the organ donor card?”, p-value of 0.732 found. Affirmative answer to the first question, p=0.10 and answer to second question, p=0.0005.Conclusion. An association was found between education about transplantation focused on medical students and bearing the organ donor card and communicating their wishes to their families. Likewise, an association between education and a positive attitude toward donation was found in the families of students that participated on the course “Human Organ and Tissue Transplantation”. Antecedentes. El grupo de trasplantes de la Universidad Nacional de Colombia considera que la educación en esta área es importante para mejorar la tasa de donación en el país.Objetivo. Encontrar una asociación entre la educación en trasplante dirigida a estudiantes de pregrado y el número de estudiantes y sus familias que portan el carné de donante de órganos.Materiales y métodos. Estudio de corte transversal analítico. Se realizaron dos encuestas dirigidas a dos grupos estudiantiles. El primer grupo cursó la asignatura “Trasplante de órganos y tejidos humanos” y el segundo grupo se encuentra cursando quinto semestre. La prueba estadística usada fue diferencia de proporciones, tamaño de muestra 50 personas, poder del 80%, diferencia de proporciones 20%, alfa 0,05, valor de p 0,05.Resultados. Encuestas evaluadas: 29 del primer grupo y 74 del segundo grupo. En la pregunta: “¿Porta el carné de donante de órganos?”, se encontró un valor de p de 0,03. En la pregunta: “¿Portan sus familiares el carné de donante de órganos?”, se halló un valor de p de 0,732. Respuesta afirmativa a primera pregunta p=0,10 y respuesta afirmativa a segunda pregunta p=0,0005.Conclusión. Existe una asociación entre educar en trasplantes a estudiantes de medicina en pregrado, el porte del carné de donante de órganos y la comunicación de su deseo de ser donante a su familia. Así mismo, se encontró una asociación entre la educación y una actitud positiva hacia la donación en las familias de los estudiantes que cursaron la asignatura de “Trasplante de órganos y tejidos humanos”.

Background/Aim. Introducing tyrosine kinase inhibitors (TKIs) has essentially changed curative approach, to be precise, clearly improved treatment efficacy for chronic myeloid leukemia (CML). Thus, the place and usage of allogeneic stem cell transplant (SCT) in CML treatment - as a former "nearly monopolistic" therapeutic manner - is nowadays controversial. The objective of this retrospective study was to evaluate the results obtained in the treatment of CML patients, with a particular attempt to define parameters critical for clinical benefit and superior overall outcome following allogeneic SCT. Methods. A total of 32 CML patients (27 in chronic phase and 5 with advanced disease), with female/male ratio 11/21, aged from 9 to 54 (32 in average) years, underwent allogeneic SCTs (1993 to 2009). The initial treatment for 25 patients was interferon alpha (IFN-α) with or without ARA-C, and additional 7 patients with no response to imatinib mesylat (IM). The time from diagnosis to SCT was approximately 12 (range 3- 37) months. The patient were categorized according to the risk for the disease, transplant-related mortality (TRM) scoring system, and stem cell (SC) source. The basic conditioning regimen was a combination of busulphan and cyclophosphamide (BuCy-2). Graft-versus-host disease (GvHD) was typically prevented with cyclosporine-A (CsA) and methotrexate (MTX). Results. Engraftment was observed in 26 (84.4%) patients, with polymorphonuclear (PMNs) and platelet (Plt) recovery on the 15th (range 10-22) and 19th (range 11-29) posttranspalnt days, respectively. Acute GvHD (aGvHD) had 13/26 (50%), and chronic GvHD (cGvHD) 10/21 (47.1%) patients. The incidence of overall TRM was 46.8% (15/32), while early death was noticed in 4 (12.5%) patients. A cause of death in 9 (28.1%) patients was cGvHD, in 2 (6.25%) patients infection, and in 3 (9.35%) cases disease-relapse was occurred. Fourteen (43.7%) of the patients are still alive, 9 from the low-risk group for TRM, with long-term survival from 1 to 16 years. Patients who received SCs from peripheral blood (PB) vs bone marrow (BM) had significantly faster engraftment (p < 0.05), lower oropharingeal mucositis rate (25% vs 70%; p < 0.05), but more frequent cGvHD (83.3% vs 30.3%; p < 0.05). A significantly improved (log-rank = 2.39; p < 0.01) overall survival (OS) was obtained in BM-setting. Conclusion. The results obtained in this study are in accordance with data from analogous clinical trials. Exactly, in the era of the new target therapy (TKI application), allogeneic SCT can be still a convenient therapeutic approach for well-selected CMLpatients, especially for those with initial high-risk disease and lower probability of TRM.

Clostridium difficile is the major etiological agent of pseudomembranous colitis and is found in up to 20% of adult inpatients. The recommended treatment is antibiotic therapy with metronidazole and/or vancomycin. However, the recurrence rate may reach up to 25% and it increases in each episode. The newest alternative to treat diarrhea due to recurrent Clostridium difficile is fecal microbiota transplantation. The procedure was performed in 12 patients, with a 6-month follow-up on 10 of them. Of the ten cases, bacterial recurrence was diagnosed in only one patient, after a course of antibiotic to treat urinary tract infection, without presenting with diarrhea. The particularity of our study, besides being an unprecedented event in South America, is the way to perform the infusion of fecal microbiota by enteroscopy.

INTRODUÇÃO: A utilização de enxerto alógeno é um tema que há décadas desperta interesse dos ortopedistas devido às supostas vantagens que apresenta, como diminuição do tempo cirúrgico, maior tamanho de enxerto, ausência de morbidade do sítio doador. OBJETIVO: O artigo a seguir faz análise retrospectiva da casuística do grupo de joelho do IOT-HC-FMUSP no uso de enxerto de banco de tecido próprio para reconstruções ligamentares. Serão apresentados as indicações de uso de enxerto alógeno e qual tipo de enxerto foi utilizado para cada tipo de reconstrução ligamentar. MÉTODOS: Foram revisados prontuários de 46 pacientes. RESULTADOS: Usados como enxerto 30 unidades de tendão patelar, 09 unidades de tendão tibial anterior, 08 unidades de tendão calcâneo, 06 unidades de tendão quadriceptal e 01 unidade de tendão fibular e foram usados principalmente para reconstruções multi-ligamentares e revisões de reconstrução do ligamento cruzado anterior. CONCLUSÃO: O uso de enxerto alógeno mostrou-se uma interessante opção para as recosntruções ligamentares. INTRODUCTION: The use of allograft is a matter of huge interest for orthopaedic surgeons, due to the supposed advantages with its use, like decreased surgical time, larger grafts and no donator site morbidity. OBJECTIVES: The aim of this article was to review our experience with the use of allografts on ligament reconstruction. We present the technique applied for graft harvest, preparation and storage, as well as the indications for allograft use and the type of procedure in which it was applied. METHODS: We revised the records of 46 patients. RESULTS: We used 09 patellar tendons, 09 anterior tibial tendons, 08 calcaneal tendons, 06 quadriceptal tendons and 01 fibular tendon, mainly for multiple ligamentar reconstructions and ACL reviews. CONCLUSION: The use of allograft seems to be an interesting option for ligamentar reconstruction.

Background The purpose of this study was to evaluate the outcome of 19 patients who underwent intestinal transplantation (ITx) for intestinal failure. Methods The 19 patients who underwent primary ITx between December 2000 and May 2003 were prescribed three different immunosuppressive protocols that included daclizumab, alemtuzumab, and antithymocyte globulin induction, respectively. A mucosal surveillance protocol for early detection of rejection consisted of zoom video endoscopy and serial biopsies associated with orthogonal polarization spectral imaging. Retrospective review of the clinical records was performed to assess the impact of new modalities of immunosuppression and intestinal mucosal monitoring on patient outcomes. Results All patients were adults (mean age 35.8 years). Etiology of intestinal failure included chronic intestinal pseudo-obstruction (n = 6), intestinal angiomatosis (n = 1), Gardner syndrome (n = 2), intestinal infarction (n = 8), radiation enteritis (n = 1), and intestinal atresia (n = 1). All patients experienced complications from total parenteral nutririon (TPN). Thirteen patients (68.4%) received isolated small bowel, whereas six (31.6%) received multivisceral grafts with or without the liver. Thirteen of 19 patients experienced at least one episode of rejection (68.4%). Most ACR episodes were treated with steroid boluses and resolved completely within 5 days. The overall 1-year patient survival was 82%. All living patients are in good health with functioning grafts having been weaned off TPN after a mean of 23.7 days post-ITx. Discussion Advances in immunosuppressive therapy with early detection and prompt treatment of rejection episodes make ITx a valuable treatment option for patients with intestinal failure and TPN-related life-threatening complications.