INTRODUÇÃO: Os desenluvamentos cutâneos são lesões graves e frequentemente há dificuldade para o cirurgião decidir qual o tratamento mais adequado a ser instituído, o reposicionamento e sutura do retalho ou o desengorduramento do retalho e enxertia da pele avulsionada. A conduta cirúrgica de reposicionamento e sutura do retalho é mais rápida e simples de ser realizada, mantém as características anatômicas e fisiológicas locais, mas frequentemente evolui com perda parcial ou total do retalho avulsionado. O tratamento cirúrgico de adelgaçamento do retalho desenluvado e enxertia da pele obtida tem a desvantagem de resultar em aspecto estético e protetivo inferiores, mas é o tratamento mais utilizado devido à maior taxa de integração do enxerto. Medicações com propriedades de aumentar a perfusão do retalho desenluvado podem permitir a conduta cirúrgica de reposicionamento e sutura do retalho ao seu leito original, mantendo as vantagens da cobertura cutânea original e preservando total ou parcialmente a viabilidade do retalho. Este estudo avaliou o efeito dos fármacos enoxaparina, pentoxifilina e alopurinol na diminuição da área de necrose de retalhos cutâneos avulsionados através da utilização de um modelo experimental de desenluvamento cutâneo em membros inferiores de ratos. MÉTODOS: Os animais foram divididos em 4 grupos com 25 ratos em cada um deles. Os quatro grupos foram submetidos ao modelo proposto de desenluvamento de todo membro inferior, resultando em um retalho de fluxo distal que foi reposicionado ao leito e suturado. O grupo 1 (avulsão / controle) recebeu 1ml de solução salina via intraperitoneal. O grupo 2 (avulsão / enoxaparina) recebeu 1 ml de enoxaparina (320 UI/kg) via subcutânea. O grupo 3 (avulsão / pentoxifilina) recebeu 1 ml de pentoxifilina (25 mg/kg) via intraperitoneal. O grupo 4 (avulsão / alopurinol) recebeu 1 ml de alopurinol (45 mg/kg) via intraperitoneal. As medicações foram infundidas em dose única imediatamente após o reposicionamento e sutura do retalho avulsionado. Os animais foram observados até o 7° dia pós-operatório, quando foram sacrificados e o retalho desenluvado foi retirado e analisado. A área total do retalho e a área de necrose do retalho foram quantificadas para todos os animais e análise estatística foi realizada entre os grupos. RESULTADOS: a mediana da área total do retalho desenluvado (cm2) foi de 5,633 para G1, 5,353 para G2, 5,505 para G3 e de 5,870 para G4 (p = 0,7460). A mediana da área de necrose do retalho desenluvado (cm2) foi de 3,368 para G1, 1,663 para G2, 2,297 para G3 e de 1,888 para G4 (p < 0,0001). Houve diferença estatística entre os pares G1 e G2, G1 e G3, G1 e G4 (p < 0,05). A relação entre a área de necrose e área total do retalho desenluvado para os quatro grupos foi de 63,34% (G1), 32,71% (G2), 41,7% (G3) e 34,85% (G4) (p < 0,0001). Houve diferença estatística entre os pares G1 e G2, G1 e G3, G1 e G4 (p < 0,05). CONCLUSÕES: Houve diminuição da área de necrose em retalhos cutâneos avulsionados em membros inferiores de ratos com a utilização das medicações enoxaparina (G2), pentoxifilina (G3) e alopurinol (G4) quando comparados ao grupo controle (G1). Não houve diferença estatística significativa entre os grupos terapêuticos com relação à área de necrose nos retalhos cutâneos avulsionados (G2 x G3; G2 x G4; G3 x G4) / INTRODUCTION: Degloving injuries may be a challenge when it comes to deciding the surgical approach to be used. Repositioning of the flap and suturing is faster and more straightforward, but often leads to total or partial loss of the avulsed flap. Skin flap deffating and grafting of the detached flap have the disadvantages of resulting in poor aesthetic appearance and being less protective, but they have been the most widely used due to the higher rate of graft take. Pharmacological agents with vascular properties that enhance the viability of the reattached flap could be beneficial to patients with degloving injuries. This study evaluated the effects of enoxaparin, pentoxifylline and allopurinol in reducing necrosis area of avulsed skin flaps through a degloving experimental model in the hind limb of rats. METHODS: Rats were grouped in four groups with 25 rats each. The four groups were subjected to the proposed degloving model of hind limb, resulting in a reverse flow flap. The flap was then repositioned and sutured. Group 1 (avulsion / control) received 1 ml saline solution intraperitoneally. Group 2 (avulsion / enoxaparin) received 1 ml of enoxaparin (320 IU/kg) subcutaneously. Group 3 (avulsion / pentoxifylline) received 1 ml of pentoxifylline (25 mg/kg) intraperitoneally. Group 4 (avulsion / allopurinol) received 1 ml of allopurinol (45 mg/kg) intraperitoneally. Saline solution and medications were infused in single dose after wound closure. The animals were observed until 7 days postoperatively, when they were sacrificed and the degloved flap was removed and analyzed by image processing software. The total area of the avulsed flap and the necrotic area were measured for all animals and statistical analysis was performed between groups. RESULTS: The median total flap area (cm2) was 5.633 for G1, 5.353 for G2, 5.505 for G3 and 5.870 for G4 (p = 0.7460). The median necrotic flap area (cm2) was 3.368 for G1, 1.663 for G2, 2.297 for G3 and 1.888 for G4 (p < 0.0001). There was statistical difference between pairs G1 and G2, G1 and G3, G1 and G4 (p < 0.05). The ratio between the necrotic flap area and total flap area was 63.34% (G1), 32.71% (G2), 41.7% (G3) and 34.85% (G4) (p < 0.0001). There was statistical difference between pairs G1 and G2, G1 and G3, G1 and G4 (p < 0.05). CONCLUSIONS: There was a decrease in necrosis of the avulsed skin flap in the hind limbs of rats with the use of medications enoxaparin (G2), pentoxifylline (G3) and allopurinol (G4) compared to the control group (G1). There was no statistically significant difference in the necrosis area of avulsed skin flaps between treatment groups (G2 x G3; G2 x G4; G3 x G4)

<p><i>Objectives.</i> To study the prevalence of musculoskeletal symptoms among farmers as compared to rural referents and to evaluate the effects of physical work exposures, psychosocial factors, lifestyle and comorbidity.</p><p><i>Material and methods.</i> A cross-sectional population-based survey of 1013 farmers and 769 matched referents was performed. Data on various symptoms, consultations and sick leave and information on primary health care and hospital admissions were obtained along with information on physical workload, psychosocial factors and lifestyle. </p><p><i>Results.</i> The farmers reported higher lifetime prevalence of symptoms from hands and forearms, low back and hips as compared to the referents. However, the farmers did not seek medical advice more often than the referents, and they reported significantly fewer sick leaves. After adjustment for the influence of physical work exposure, farmers still had a excess rate of low back pain (LBP) and hip symptoms as compared with the referents, while a lower rate of neck-shoulder symptoms was revealed. Several of the psychosocial variables were associated with LBP but the difference in LBP prevalence between farmers and referents could only be explained to some extent. LBP was associated with musculoskeletal symptoms other than LBP and with chest discomfort, dyspepsia, symptoms from mucous membranes, skin problems, work-related fever attacks, and primary care for digestive disorders. Presence of both respiratory and digestive disorders doubled the LBP prevalence.</p><p><i>Conclusions.</i> Symptoms from hips and low back were more frequent among farmers than among referents, but farmers did not seek more health care and reported fewer sick leaves than referents. Physical work exposure and psychosocial factors did not explain the differences in low back and hip symptoms between the two groups. Significant associations between LBP and digestive and respiratory disorders might indicate that these disorders may have etiological factors in common.</p>

The illicit use of prescription stimulants (IUPS) is a critical Public Health problem in the college population that represents a unique form of substance use. Namely, the primary motives for IUPS by college students are academic in nature (e.g., Teter, McCabe, LaGrange, Cranford, & Boyd, 2006), which may explain why usage rates as high as 43% have been reported on college campuses (Advokat, Guidry, & Martino, 2008). As the field of IUPS is in its infancy, the IUPS-literature lacks 1) a consistent definition of "illicit use of prescription stimulants", 2) an instrument designed to assess the multiple influences on IUPS behavior, and 3) a theoretical lens (Bavarian, 2010a). Accordingly, the goal of this study was to address these research gaps by examining IUPS at one university located in the Pacific Northwest using the theory of triadic influence (TTI; Flay & Petraitis, 1994; Flay, Snyder, & Petraitis, 2009), an integrated, ecological approach to explaining and predicting health behaviors. The study included five phases of research. The first phase began with a systematic approach to measurement development resulting in a 97-item preliminary instrument, the Behaviors, Expectancies, Attitudes and College Health Questionnaire (BEACH-Q). The measure was reviewed by the dissertation committee, leading to revisions in content and structure. During phase II, the BEACH-Q was evaluated by a convenience sample of five health and measurement professionals, and results suggested good content validity of the instrument (i.e. 35 of the 37 TTI-based covariates received a median rating between "agree" and "strongly agree", and 34 received a mean rating between "agree" and "strongly agree"). In phase III (instrument review by a convenience sample of six undergraduates), all 37 covariates received a median and mean rating between "agree" and "strongly agree", confirming good face validity. In phase IV, one undergraduate classroom was selected to participate in a pilot test of the BEACH-Q, using test-retest methodology. Results from the pilot (N = 39) showed that the instrument had moderate to high internal consistency reliability and modest to high stability reliability. In phase V, the final 96-item version of the BEACH-Q was administered throughout campus using one-stage cluster sampling, with classrooms as the sampling unit and students as the observation unit (N = 520 students in 20 classrooms, eligible student response rate = 96.30%). The prevalence of IUPS during college self-reported by the phase V sample was 25.58%, and the probability of engaging in IUPS did not differ between classrooms (Median Odds Ratio = 1.00). In crude logistic regressions, 24 out of 37 hypothesized theoretical covariates were significantly associated with IUPS in the expected direction, suggesting predictive validity of the BEACH-Q. Nested logistic regression analyses illustrated that, for the full multivariate model including ultimate, distal, and proximal covariates, the following measures in the intrapersonal stream were significantly associated with IUPS during college: race/ethnicity, year in school, academic concern, academic grades, diagnosis with Attention Deficit Disorder, and IUPS avoidance self-efficacy. Significant social situation/context stream covariates in the full model included: residence, varsity sports participation, perceptions of IUPS by friends, family, and faculty, endorsement of IUPS by friends, and perceived prevalence of IUPS among friends. With respect to the sociocultural environment stream, in the full multivariate model, the following covariates were found to be significantly associated with IUPS: financial-related stress, participation in religious activities, positive IUPS expectancies, prescription stimulant knowledge and perceived costs/benefits of IUPS. Lastly, intention to engage in IUPS (an immediate precursor) was positively associated with IUPS. Structural equation modeling was used to test models of IUPS for each of the three streams, as well as one integrated model that included covariates from each stream. The models all demonstrated good model fit, and provided insight into the factors that influence (and suggest the mechanisms of causation) intentions to engage in, and ultimately the behavior of, IUPS. In the intrapersonal stream model, inattention was positively associated with academic concern and inversely associated with avoidance self-efficacy, and avoidance self-efficacy was inversely associated with intentions to engage in IUPS. Moreover, intentions to engage in IUPS and avoidance self-efficacy were both significantly associated with IUPS. In the social situation/context stream model, living on-campus was negatively associated with friends' endorsement of IUPS which was positively associated with perceived prevalence of IUPS among friends, and perceived prevalence was positively associated with intentions to engage in IUPS; all of the direct paths to IUPS, excepting the path from perceived prevalence of IUPS among friends, were significant. In the sociocultural environment model, perception of course demand was significantly associated with both the perception that professors give the most attention to top academic students and attitudes about the impact of prescription stimulants on academics, and these attitudes had a positive association with intentions to engage in IUPS. Moreover, the direct paths from attitudes and intentions to IUPS were significant. The mixed model, including participation in religious activities (sociocultural environment stream), friends' endorsement of IUPS (social situation/context stream), and avoidance self-efficacy (intrapersonal stream), also had significant paths from ultimate to distal to proximal to immediate precursor, and significant direct paths to IUPS. This study successfully achieved its goals. First, the instrument developed was theory-driven, broadly defined IUPS, and was psychometrically strong. The cross-sectional study illustrated that IUPS was prevalent on the campus under investigation, as one in four students had engaged in the behavior during college. Associations of use with theoretical correlates were tested for, and structural equation modeling was used to support one premise of the TTI (i.e. that behavior is multifaceted, and covariates from different streams may interact to influence behavior). The findings also suggest that prevention and intervention plans should be multifaceted in nature. Given that this study's cross-sectional nature limited the ability to make causal inferences, future research involving the BEACH-Q should use longitudinal designs. / Graduation date: 2012

Objectives. To study the prevalence of musculoskeletal symptoms among farmers as compared to rural referents and to evaluate the effects of physical work exposures, psychosocial factors, lifestyle and comorbidity. Material and methods. A cross-sectional population-based survey of 1013 farmers and 769 matched referents was performed. Data on various symptoms, consultations and sick leave and information on primary health care and hospital admissions were obtained along with information on physical workload, psychosocial factors and lifestyle. Results. The farmers reported higher lifetime prevalence of symptoms from hands and forearms, low back and hips as compared to the referents. However, the farmers did not seek medical advice more often than the referents, and they reported significantly fewer sick leaves. After adjustment for the influence of physical work exposure, farmers still had a excess rate of low back pain (LBP) and hip symptoms as compared with the referents, while a lower rate of neck-shoulder symptoms was revealed. Several of the psychosocial variables were associated with LBP but the difference in LBP prevalence between farmers and referents could only be explained to some extent. LBP was associated with musculoskeletal symptoms other than LBP and with chest discomfort, dyspepsia, symptoms from mucous membranes, skin problems, work-related fever attacks, and primary care for digestive disorders. Presence of both respiratory and digestive disorders doubled the LBP prevalence. Conclusions. Symptoms from hips and low back were more frequent among farmers than among referents, but farmers did not seek more health care and reported fewer sick leaves than referents. Physical work exposure and psychosocial factors did not explain the differences in low back and hip symptoms between the two groups. Significant associations between LBP and digestive and respiratory disorders might indicate that these disorders may have etiological factors in common.

[Truncated abstract] The prinicipal aim of this thesis was to explore the relationship between 3rd generation cephalosporin antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea (CDAD). This antibiotic class has been implicated in the aetiology of CDAD; therefore restriction of these antibiotics via antibiotic policies represents a potential strategy for prevention and control of CDAD. Successful control of CDAD in hospitals translates to improved quality of care for patients, and a reduction of pressure on hospital resources. Therefore, the objectives of this study were to determine whether 3rd generation cephalosporins were related to CDAD, to evaluate the effect of changes to antibiotic policy on the incidence of CDAD, and to determine the impact of CDAD on patient length of stay and hospital costs. The study was conducted in Sir Charles Gairdner Hospital (SCGH), a public teaching hospital located in Perth, the capital city of the state of Western Australia. Evidence for an association between 3rd generation cephalosporins and CDAD was obtained from studies of ecologic- and individual-level data. A time series analysis of the relationship between monthly consumption of 3rd generation cephalosporins and the incidence of CDAD in SCGH was undertaken covering the period 1994 to 2000. The results demonstrated a positive relationship between the use of 3rd generation cephalosporins and CDAD. A matched case-control study that involved 193 adult inpatients diagnosed with CDAD and 386 adult inpatients without CDAD, selected from the period 1996 to 2000, was conducted. Information was collected on exposure to 3rd generation cephalosporin antibiotics during hospitalisation, as well as exposure to other antibiotics and medications, procedures, and comorbidities. Results from conditional logistic regression analyses found CDAD cases were six times more likely to be exposed to 3rd generation cephalosporins during their admission, prior to the onset of diarrhoea, than controls (adjusted odds ratio [OR] = 6.17, 95% confidence interval [CI] = 1.56-24.37). Approximately one third of CDAD in the study population could be attributed to 3rd generation cephalosporins. CDAD cases were also four times more likely to have been exposed to either amoxicillin-clavulanate or ticarcillin-clavulanate (adjusted OR=4.23, 95% CI=1.81-9.93). In October 1998, an antibiotic policy was introduced at SCGH that restricted the use of ceftriaxone, the 3rd generation cephalosporin most commonly used by the hospital. During 1999 and 2000, the incidence of CDAD halved as ceftriaxone consumption fell in response to this policy. The effect of this policy was demonstrated in the time series model; during the post-policy period the relationship between ceftriaxone and CDAD that was evident prior to the policy was cancelled out. From the individual-level data, obtained from the case-control study, a reduction in the prevalence of exposure to 3rd generation cephalosporins from 11% to 1% accounted for a 30% reduction in the incidence of CDAD. Data from the case-control study was also used to analyse the independent contribution of CDAD to length of stay and admission costs using multiple linear regression

[Truncated abstract] Early psychosocial stress is conjectured to place individuals on a developmental trajectory leading to earlier pubertal maturation, earlier initiation of sexual activity and earlier reproduction than those with less early psychosocial stress. This may have an adaptive function to minimise the chances of lineage extinction, which is more likely in environments of high risk and uncertainty. Previous studies have examined the relationship between early psychosocial stress and life history stages (e.g., age at puberty, age at first sex and age at first birth). However, these studies are limited in that they either examined only a few early psychosocial stressors, examined psychosocial stress relatively late in individuals' lives and/or were restricted to women. Thus, the first aim of the present thesis was to examine these findings in both genders using a measure of early psychosocial stress comprised of 24 categories of retrospectively assessed stressors (e.g., sexual abuse, physical abuse, parental divorce, rated quality of family life) during the first 7 years of life. It was hypothesised that individuals with high, as opposed to low, levels of early psychosocial stress would pass through life history stages earlier. The second aim was to examine how early psychosocial stress affects characteristics associated with life history traits, such as individuals? length, number and type of heterosexual relationships, number of sex partners, adult attachment styles, number of pregnancy terminations, and attitudes and behaviours towards contraceptive use. High levels of early psychosocial stress were predicted to be associated with characteristics reflecting a quantitative, as opposed to a qualitative, reproductive approach (e.g., more sex partners, more short-term relationships, insecure attachment styles). The third aim was to examine how early psychosocial stress is related to mate choice because numerous studies have identified what traits individuals' desire in a mate but not whether early psychosocial stress affects these choices. ... Early psychosocial stress generally had no effects on age at first sex, age at first birth, the number of pregnancy terminations, and mate choices. On the other hand, individuals with high, as opposed to low, levels of early psychosocial stress were more likely to be insecurely attached, had more short-term sexual relationships (men only), had more extra-pair copulations, were more likely to be divorced/separated, had a greater lifetime number of sex partners (men only), and had lower self-rated frequencies of contraception use. Overall, some of these findings are consistent with life history theory, which suggests that individuals with high levels of early psychosocial stress (i.e., those living in environments of high risk and uncertainty) should reach biological maturation earlier, engage in behaviours that facilitate earlier and more frequent reproduction to minimise the chances of lineage extinction. Implications for public health, limitations of the present study and future directions are also discussed.

Diss. (sammanfattning) Linköping : Univ. / Härtill 6 uppsatser.

Made available in DSpace on 2016-06-02T20:12:10Z (GMT). No. of bitstreams: 1 TeseJRBM.pdf: 1767918 bytes, checksum: 200ee529156f1dbfe98eeab387ba9dc6 (MD5) Previous issue date: 2006-12-15 / This doctoral thesis intends to analyze the main concepts of mental disease and the problematic relation between the organicism and the psychodinamism throughout the history of the psychopathologic ideas that came to constitute the scientific clinical psychiatry, from Philippe Pinel, in the beginning of XIX century, until the chaos of the no theoretical pretense descriptive of the official nosography of the end of XX century and beginning of XXI century (I.C.D.-10). The epistemologic conflict between the psychogenic and organogenic doctrines had resulted in many frustrated attempts of solution. The hermeneuticsynthetic psychopathology of Carl Gustav the Jung (1875-1961) and the phenomenonstructural psychopathology of Eugène Minkowski (1885-1972) stand out among the most promising proposals of XX century. The basic concepts of these authors keep an essential similarity, besides belonging to schools have different thoughts. However, their theorization go in parallel thinking about a psychopathologic formularization psychorganodinamic that is similar in its most essential principles. The antimechanist solution, anti-atomicist and antireductionist, of both, remind the current biological psychiatry that the desired and necessary consensual psychiatric theory will not do without a Metapsychopatology of the psychiatry that consider the irreducible biopsychosocial complexity of the normal or pathological human being. And, neither psychiatry will gain a satisfactory nosographic formularization while they don t reveal the mysteries of the complex etiology of mental disorders. / A presente tese de doutorado pretende analisar os principais conceitos de doença mental e a problemática relação entre o organicismo e o psicodinamismo ao longo da história das idéias psicopatológicas que vieram constituir a psiquiatria clínica científica, a partir de Philippe Pinel, no início do século XIX, até o caos da pretensa ateoricidade descritiva da nosografia oficial do final do século XX e início do século XXI (C.I.D.-10). O conflito epistemológico entre as doutrinas psicogênicas e organogênicas resultou em várias tentativas frustradas de solução. Dentre as mais promissoras propostas do século XX, destacam-se as da psicopatologia hermenêutico-sintética de Carl Gustav Jung (1875-1961) e da psicopatologia fenomeno-estrutural de Eugène Minkowski (1885-1972). Os conceitos fundamentais desses autores guardam uma semelhança essencial, apesar de pertencerem a escolas de pensamento diferentes; todavia, suas teorizações caminham paralelamente no sentido de uma formulação psicopatológica psicorganodinâmica muito parecida em seus princípios mais essenciais. A solução antimecanicista, anti-atomicista e anti-reducionista, de ambos, lembram à psiquiatria biológica atual que a tão desejada e necessária teoria psiquiátrica consensual não prescindirá de uma Metapsicopatologia da psiquiatria que considere a complexidade biopsicossocial irredutível do ser humano normal ou patológico. E, tampouco a psiquiatria chegará a uma formulação nosográfica satisfatória enquanto não desvendar os mistérios da etiologia complexa dos transtornos mentais.

As dissecções da artéria vertebral causam acidentes vasculares cerebrais isquêmicos e hemorrágicos. A dissecção arterial é a ruptura da sua parede com formação de hematoma intramural. Podem ser espontâneas, acometendo a artéria vertebral extra ou intracraniana. O tratamento em geral é clínico, porém em alguns casos está indicada intervenção. A via endovascular é uma importante alternativa, permitindo o tratamento específico da lesão em alguns casos, mas na maioria sacrificando a artéria vertebral, após teste de tolerância à oclusão. Com o objetivo de analisar os aspectos clínicos e técnicos do tratamento endovascular, estudamos de forma prospectiva 15 pacientes. Três apresentavam dissecções traumáticas (todas extracranianas) e 12 espontâneas, dos quais dois tiveram traumatismos menores como desencadeantes. Cinco pacientes apresentaram dissecções extracranianas, oito, intracranianas e dois, combinadas. No grupo das extracranianas, a principal indicação de tratamento foi a presença de fístula arteriovenosa, em três dos cinco pacientes. No grupo da intracranianas, foi a presença de hemorragia meníngea. Nos quatro pacientes com acidente vascular isquêmico, a indicação de tratamento deveu-se à presença de pseudoaneurismas que não involuíram com tratamento clínico. Nesse grupo, dois pacientes tinham dissecção extracraniana, um, intra e um, combinada. Um paciente apresentou intolerância à oclusão e foi encaminhado para tratamento conservador. Dos 14 pacientes tratados, um teve como estratégia a oclusão seletiva da lesão, 11 a oclusão da artéria vertebral proximal à lesão e dois oclusão acima e abaixo da lesão. Os materiais utilizados foram balões destacáveis em sete pacientes, molas de destaque livre em 6 e molas eletricamente destacáveis associadas a molas de destaque livre em 1 paciente. Dois pacientes apresentaram complicações do tratamento, e um paciente, recidiva de fístula arteriovenosa, todos resolvidos sem seqüelas. A angiografia controle revelou oclusão total do segmento dissecado ou do pseudoaneurisma em 9 pacientes, reversão do fluxo em quatro e preservação da artéria vertebral com oclusão da lesão em um. Num período de seguimento de 8,6 meses não se registraram recorrências. O tratamento foi eficiente na prevenção de ressangramentos e na trombose dos pseudoaneurismas e apresenta segurança em relação a complicações. / Vertebral artery dissections can cause brain ischemia and hemorrhage. Arterial dissection consist of mural tears with subsequent intramural hematoma formation. They may occur either spontaneously or as a consequence of traumatism, in the extracranial or intracranial vertebral artery. The treatment is usually clinical, but in some instances intervention is indicated. The endovascular approach is an important tool, allowing specific treatment of the lesion in some cases, but sacrificing the vertebral artery in most cases. With the aim of analyze the clinical and technical aspects of the endovascular treatment, we studied prospectively 15 patients treated by endovascular approach. Three presented traumatic dissections (all extracranial) and 12 spontaneous dissections, two of which after minor traumatic events. Five patients had extracranial dissections, eight, intracranial and two, combined. In the extracranial dissection group, the main indication for treatment was the presence of an arteriovenous fistula (three of five patients). In the intracranial group, it was subarachnoid hemorrhage. Four patients presenting with brain isquemia were treated because of pseudoaneurysms that did not resolve in clinical treatment. In this group 2 patients had extracranial dissections, one had intracranial and one had both. One patient did not tolerate occlusion and was treated clinically. Fourteen patients were treated by endovascular means, one with selective lesion occlusion, 12 with proximal vertebral artery occlusion and two with proximal and distal vertebral artery occlusion. The embolic material were detachable balloons in 7 patients, platinum microcoils in 6 patients and electrically detachable platinum microcoils and platinum microcoils in one patient. Two patients presented complications, and one presented recurrence of an arteriovenous fistula, all resolved without sequelae. Angiographic controls disclosed total occlusion of the segment with dissection or of the pseudoaneurysm in 9 patients, retrograde flow in 4 and vertebral artery preservation with selective lesion occlusion in 1. During a mean follow-up period of 8,6 months no recurrence was observed. The treatment was efficient in preventing recurrent hemorrhage and promoting pseudoaneurysms thrombosis, besides it was a safe treatment option.

Introdução: A periodontite é uma doença inflamatória caracterizada clinicamente pela destruição dos tecidos de suporte dental. Apresenta etiologia multifatorial, sendo a principal causa o acúmulo de bactérias patogênicas na superfície dentária. A periodontite tem sido associada ao avanço da aterosclerose. Os indivíduos portadores da hipercolesterolemia familiar apresentam o desenvolvimento precoce da doença aterosclerótica devido à exposição crônica a níveis altos de colesterol total e LDL-colesterol. Não existem estudos que analisem a associação entre a infecção periodontal e aterosclerose subclínica nessa população. Objetivo: Este trabalho analisou a relação entre a aterosclerose, coronariana, carotídea e/ou aórtica, e a doença periodontal em indivíduos com hipercolesterolemia familiar e em controles presumidamente sem a doença. Métodos: Foram incluídos 82 indivíduos com diagnóstico de hipercolesterolemia familiar pelo critério do U.S. MEDPED e 31 indivíduos saudáveis como grupo controle. A calcificação arterial coronariana foi avaliada por tomografia computadorizada e a medida realizada pelo método de Agatston. O espessamento médio-intimal carotídeo e o diâmetro da artéria carótida comum direita foram determinados por ultrassom pulsátil tipo echotracking. A rigidez arterial foi medida por meio da velocidade das ondas de pulso. Todos os indivíduos responderam a um questionário estruturado e foram submetidos à avaliação periodontal. A sondagem periodontal dos dentes foi realizada em seis sítios por dente em cada paciente. Dados sobre inflamação gengival, presença de placa bacteriana, profundidade de sondagem, recessão gengival e perda de inserção clínica foram coletados. As variáveis contínuas foram comparadas pelo do teste t de Student não pareado ou teste de Mann-Whitney. Para as variáveis categóricas, foram aplicados os testes de qui-quadrado ou teste exato de Fisher. Resultados: Dos indivíduos do grupo controle, 32,3% apresentam quadro de periodontite grave, enquanto que no grupo caso, 64,1% apresentou esse quadro (p = 0,001). Nos grupos controle e caso, 19,4% contra 43,4% apresentam respectivamente mais que 15% de sítios com profundidade de sondagem > 4mm (p=0,02). Na análise intragrupo os indivíduos com periodontite avançada apresentaram valores mais elevados de espessura médio-intimal (p=0,04), velocidade de onda de pulso (p=0,04), proteína Creativa (p=0,02) e leucócitos séricos (p=0,04). Periodontite grave não foi associada com calcificação arterial coronariana. Conclusões: Periodontite grave, aterosclerose subclínica e elevados marcadores inflamatórios foram mais comumente observados nos indivíduos com hipercolesterolemia familiar / Introduction: Periodontitis is an inflammatory disease with consequent destruction of teeth supporting tissues. It has multifactorial etiology, and its main cause is accumulation of periodontal pathogens on the dental surface. Periodontitis has been associated with the advance of atherosclerosis. Familial hypercholesterolemia patients display premature development of atherosclerosis due to chronic exposure to high levels of total cholesterol and LDL-c. The association between subclinical atherosclerosis and periodontitis in this population has not been previously studied. Objective: This study analyzed the relation between coronary and/or carotid atherosclerosis and the periodontitis in patients with familial hypercholesterolemia. Methods: 82 individuals with familial hypercholesterolemia according to the U.S. MEDPED criteria (case group) and 31 healthy individuals (control group) were enrolled. Subclinical atherosclerosis was evaluated by three methods: coronary artery calcification, common carotid-artery intima and media thickness and the diameter of right common carotid artery, and arterial stiffness measured by aortic pulse wave velocity. All individuals answered a structured questionnaire and were submitted to a complete periodontal evaluation. Gingival inflammation, the presence of bacterial biofilm, probing depth, gingival recession and clinical attachment level were examined in six sites per tooth in each individual. Continuous variables were compared by Student t test or Mann-Whitney test. For categorical variables, Chisquare or Fisher exact test were applied. Results: In the control group, 32.3% showed advanced periodontitis, whereas in the case group, 64.1 % showed advanced periodontitis (p=0,001). In control and case groups, 19.4% versus 43.4% respectively showed more than 15 % of sites with probing depth > 4mm (p=0,02). Intra-group analysis revealed that both FH and healthy individuals showed positive association between advanced periodontitis and higher values of intima-media thickness (p=0.04), pulse wave velocity (p=0.04), C-reactive protein (p=0.02) and serum leukocytes (p=0.04). Advanced periodontitis was not associated with coronary artery calcification. Conclusions: Advanced periodontitis, subclinical atherosclerosis and elevated inflammatory markers were more frequently observed in FH individuals