Orientador: Paulo Sérgio Cerri / Resumo: Biodentine é um cimento reparador à base de silicato tricálcico com indicações semelhantes ao MTA. O objetivo deste estudo foi avaliar a resposta do periodonto ao selamento de perfurações de furca em molares de ratos com Biodentine ou MTA e as possíveis alterações séricas em marcadores de atividade hepática e renal. As perfurações realizadas nos primeiros molares da maxila direita de 60 ratos foram preenchidas com Biodentine, MTA ou algodão (Sham). As maxilas contralaterais do grupo Sham foram utilizadas como grupo Controle. Após 7, 15, 30 e 60 dias, o sangue foi coletado e as maxilas foram fixadas e incluídas em parafina (n=5). A partir do soro foram mensurados ou níveis de transaminase glutâmico-oxalacética (TGO), transaminase glutâmico-pirúvica (TGP), ureia e creatinina. O sangue de 5 animais sem qualquer procedimento foi coletado para mensurar os padrões sorológicos de referência. O espaço periodontal (EP), densidade de volume de células inflamatórias (VvCI) e de fibroblastos (VvFb) e o número de osteoclastos TRAP-positivos foram obtidos. Interleucina-6 (IL-6) e osterix foram detectados por imuno-histoquímica. O conteúdo de colágeno birrefringente foi quantificado a partir de cortes corados com picrosirius. Os dados foram submetidos à ANOVA e ao teste Tukey (p≤0,05). Diferenças significantes nos níveis séricos de TGO (p≥0,1258) e TGP (p≥0,5827) não foram detectadas nos grupos Biodentine, MTA e Sham em comparação aos níveis de referência. Aos 7 dias, a concentração de urei... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Biodentine is a calcium silicate-based cement with similar indications of MTA. The aim of this study was to evaluate the periodontium response in the sealing of furcation perforations in rat molars with Biodentine and MTA, and its potential systemic effects in serum levels of hepatic and renal functions. The pulp chamber floor of right upper first molars of 60 rats were perforated and filled with Biodentine, MTA or sterile cotton pellet (Sham); the left first molars were used as control. After 7, 15, 30 and 60 days, the blood was collected and serum glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), creatinine and urea levels were measured. The blood of 5 rats without any treatment was collected to measure serum reference levels. The maxillary fragments were fixed and processed for paraffin-embedding. The periodontal space (PS), volume density of inflammatory cells (VvIC) and of fibroblasts (VvFb), and number of TRAP-positive osteoclasts were obtained. Interleukin-6 (IL-6), a pro-inflammatory cytokine, and osterix, an osteoblast marker, were detected by immunohistochemistry. The birefringent collagen content was quantified from picrosirius-stained sections. Data were submitted to ANOVA and Tukey test (p≤0.05). Significant differences in GOT (p≥0.1258) and GPT (p≥0.5827) serum levels were not observed in the Biodentine, MTA and Sham groups in comparison with reference levels. At 7 days, the concentration of serum urea increased significantly in the B... (Complete abstract click electronic access below) / Doutor

Le syndrome de fragilité est devenu le concept le plus étudié ces dix dernières années par les gériatres, de par le vieillissement rapide de la population Française et mondiale et pour l'intérêt en terme de prévention globale que ce syndrome pourrait représenter. L’ intérêt qu’ apporte ce nouveau concept de plus en plus consensuel est en effet sa capacité à définir une personne âgée comme étant une entité fonctionnelle et multidimensionnelle (cognitive, thymique et sociale) pouvant être réversible. A partir de la, l’élaboration d'une stratégie par les médecins, afin de dépister les patients les plus fragiles pourrait permettre d’éviter les stades irréversibles de la perte d’autonomie, l’institutionnalisation et la surmortalité. Cela aurait probablement des conséquence s possibles en matière de santé publique. Un des facteurs de risque possible de la fragilité est la douleur chronique qui a toujours été considérée à tord comme un simple symptôme prévalent chez les personnes âgées et non pas comme une maladie soit une entité clinico - pathologique complexe pouvant interagir avec la fragilité. Dans ce travail, nous avons étudié les mécanismes physiopathologiques communs qui lient le syndrome de fragilité à la douleur chronique , leur interaction et l’ intérêt que peut susciter l’optimisation du dépistage de la douleur chronique chez les personnes âgées dans l’évaluation des personnes les plus fragiles. Nous proposons à travers de nouveaux projets de recherche clinique prospectifs , de démontrer au - delà d e la relation possible entre la fragilité et la douleur persistante, le rôle que pourrait jouer les médicaments essentiellement analgésiques dans la réversibilité de ce syndrome / The frailty concept has become the most studied one over the past decade , by the rapid aging of French and the world population and for the interest in terms of overall prevention that this syndrome could represent. The advantage brought by this ne w concept increasingly consensual relies on its ability to define elderly as a m ultidimensional functional entity (cognitive, social and mood) being reversible. Caregivers have to start before to tailor a care plan by screening for the frailest patients in order to avoid irreversible stages of frailty, ( institutionalization and mortal ity ) . This probably would have possible consequences for public health. One of the possible risk factors for fragility is persistent pain which has always been wrongly considered as a mere prevalent symptom in o lder people and not as a clinical and patholo gical entity that can interact with the complex fragility syndrome. In this work, we studied the common pathophysiological mechanisms that link frailty to pain, their interaction and the interest that may lead to optimize screening of pain in older adults within frailty evaluation. We offer through new clinical research projects looking to demonstrate beyond the possible relationship between fragility and persistent pain, the potential role of analgesic drugs mainly in the reversibility of this syndrome

Alpacas kept in Central Europe are often deficient in vitamin D3, which is supplemented orally or by injection by the owners or veterinarians. Vitamin D3 can be specified in two different units (IU and µg), which differ by a factor of 40. By mixing up these units, an overdosage can be induced. In this study, three alpaca crias were examined after vitamin D3 intoxication, with particular reference to kidney function. All three animals developed non-specific clinical alterations 1–2 weeks after a vitamin D3 overdose of approximately 40 times. Plasma of the animals revealed several alterations. The main findings were severe azotemia, hypercalcemia and hyperphosphatemia, 15 days after treatment. Kidney function analysis (endogenous creatinine clearance) in two of the crias revealed severe glomerular damage. All crias died despite intensive treatment within 23 days after vitamin D3 treatment. Necropsy revealed calcification in different organs, mainly the kidneys, lungs and liver. Since nine other crias in the same group were treated with comparable doses of vitamin D3 and no clinical signs were observed in these animals, it is concluded that individual animals show different levels of sensitivity to vitamin D3.

Neste trabalho é feita a avaliação em bases empíricas das condições em que se aplicam os fundamentos da responsabilidade civil objetiva aos ilícitos civis do cirurgião plástico. Foram levantados 71 processos de litigância judicial cível por alegado erro médico no período de 1989 a 2005, dos arquivos do Instituto de Medicina Social e Criminologia do Estado de São Paulo. Elaborado um modelo de variáveis médicas, jurídicas, discursivas e geral pelas quais foi possível as implicações das posições doutrinárias do juiz sobre os resultados do processo. Foram abordadas as correlações entre posição doutrinária e decisão judicial e grau de comprometimento do patrimônio físico e estético e decisão judicial. Avaliada a importância relativa dos deveres de orientação, aconselhamento e obtenção de consentimento informado com relação ao tipo de sentença / In this paper an empirical analysis is accomplished about the aspects of application of the fundametals of objective doctrine of civil liability to the plastic surgeon tot. 71 records of judicial procedures of medical liability lawsuit from the archives of the Instituto de Medicina Social e Criminologia do Estado de São Paulo were examined. A system of medical, juridical, discursive and general variables was elaborated that allowed to accomplish the consequences of the doctrinaire position of the judge on the results of the process. Correlation were made between the doctrinaire position of the judge and the judicial decision, and the degree of health harming and he judicial decision. The relative importance of the obligation regarding informed consent was approached relative to the kind of sentence

Estudos recentes estimam que a maioria das estenoses benignas é de natureza iatrogênica podendo ser evitada. A incidência de lesões graves dos ductos biliares durante a colecistectomia é de aproximadamente 1/300 a 1/500 procedimentos (0,2 a 0,3%). Estas lesões podem resultar em coleperitôneo, fístula biliar, estenose de via biliar ou associação dessas complicações. O objetivo deste trabalho foi de relatar os casos de lesões de vias biliares tratados no Serviço de Cirurgia da Faculdade de Medicina da Universidade Federal de Goiás. Foram estudados retrospectivamente 31 pacientes, de 1990 a 2002, com diagnóstico de lesões de vias biliares pós colecistectomia. 29 pacientes (93,5%) eram do sexo feminino e 2 (6,5%) eram do sexo masculino. A idade variou de 21 a 80 anos com média de 46,6 anos. Pacientes provenientes da capital do Estado de Goiás eram em número de 12 (38,7%) enquanto 19 (61,2%) eram provenientes de outras regiões do país. A colecistectomia foi realizada eletivamente em 24 pacientes (77,4%) enquanto em 7 pacientes (22,5%) foi realizada cirurgia de urgência. A via de acesso através de incisão subcostal foi empregada em 70,9% dos pacientes e a via longitudinal (mediana e paramediana direita) em 29,1%. As principais manifestações clínicas foram icterícia em 87,9% dos pacientes, fístula biliocutânea em 29%, peritonite em 29,0%, colangite em 29% e sepse em 6,4% dos pacientes. A Colangiografia Retrógrada Endoscópica foi o exame mais empregado para o diagnóstico da lesão de via biliar. As lesões dos ductos biliares foram classificadas segundo a classificação proposta por Strasberg. Aproximadamente metade (54,8%) das lesões de vias biliares foram classificadas como Strasberg E3 e E4. A técnica cirúrgica mais utilizada para o tratamento das lesões de vias biliares foi a Hepaticojejunoanastomose, com alça jejunal exclusa em Y de Roux, em 20 (64,5%) pacientes. Os 4 óbitos foram em lesões totais proximais. As lesões parciais evoluíram melhor a longo prazo / Recent studies have estimated that most of the benign biliary stenosis are iatrogenic in nature, and can thus be prevent. The incidence of severe injury to the biliary ducts during a cholecystectomy is of approximately 1/300 to 1/500 procedures (0.2-0.3%). These lesions can result in choleperitoneum, biliary fistula, stenosis of the biliary tract or an association of these complications. The objective of this paper was to report on biliary tract injuries treated at the Surgical Unit of the School of Medicine of the Federal University of Goias. Thirty-one patients with a diagnosis of biliary tract lesions, post cholecistectomy, were studied, retrospectively, from 1990 to 2002. Twenty-nine individuals (93.5%) were female, and two (6.4%), males. Their age ranged from 21 to 80 years (average of 46.6 years).Twelve (38.7%) individuals came from the capital of State of Goias and 19 (61.2%), from other regions. Cholecystectomy was performed as an elective procedure in 24 (77.4%) patients, and 7 (22.5%) underwent emergency surgery. A subcostal incision was used in 70.9% of the cases, while the longitudinal approach was used in 29.1%. The main clinical manifestations were jaundice in 87.9%, cutaneous fistula in 29%, peritonitis in 29%, cholangitis in 29% and sepsis in 6.4% of the patients. The Endoscopic Retrograde Cholangiography was the diagnostic test most frequently ordered. Biliary duct injuries were classified according to the criteria proposed by Strasberg. Aproximately half (54.8%) of the injuries were classified as Strasberg E3 and E4. The most common surgical technique used in the treatment of this condition was a Roux-en-Y hepaticojejunostomy in twenty (64.5%). Four patients with proximal injuries died. Long term followup disclosed better results with partial injuries

Das Eingliedern festsitzender kieferorthopädischer Apparaturen macht das vorherige Anrauhen des Schmelzes notwendig. Das Ziel dieser Arbeit bestand darin zu ermitteln, ob ein zeit- und ausdehnungsbezogen überschüssiges kieferorthopädisches Ätzen des Schmelzes über die Fläche des zu befestigenden Brackets hinaus mit 30% Phosphorsäure zu einem erhöhten Risiko für White-Spot-Läsionen beitragen kann. Zusätzlich wurde getestet, inwieweit die Faktoren Zahnreinigung, Ätzdauer und Zeitdauer auf die mögliche Entstehung von White-Spot-Läsionen Einfluss nehmen. Für diese in-vitro-Studie wurden 90 extrahierte menschliche obere mittlere und seitliche Frontzähne verwendet. Die Zahnkronen mit einem Durchmesser von mindestens fünf mm wurden in Kunststoff eingebettet und mit Schleifpapier poliert. Es wurde jeweils eine Baseline-Messung mittels Quantitativer lichtinduzierter Fluoreszenz (QLF) durchgeführt, während der die Referenzbereiche für die nachfolgenden Messungen festgelegt wurden. Anschließend wurden die 90 Prüfkörper randomisiert in sechs Gruppen aufgeteilt. Drei Gruppen wurden täglich einer standardisierten Reinigung unterzogen und jeweils zu Versuchsbeginn 30 Sekunden, 15 Sekunden oder 0 Sekunden mit 30% Phosphorsäure angeätzt. Die Prüfkörper der anderen drei Gruppen wurden keiner Reinigung unterzogen und ebenfalls 30, 15 oder 0 Sekunden angeätzt. Während 42 aufeinanderfolgenden Tagen wurden alle Prüfkörper einem pH-Zyklus unterzogen: Die Demineralisation erfolgte für 60 Minuten. Hierauf folgte eine 120 minütige Remineralisation. Dieser Zyklus wurde drei Mal pro Tag durchgeführt. Nach dem letzten Zyklus wurden drei Gruppen mithilfe einer Zahnputzmaschine, die mit eingespannten Bürstenköpfen und einem Gemisch aus künstlichem Speichel und fluoridhaltiger Zahnpasta arbeitete, standardisiert gereinigt. Nach 2, 7, 14, 21 und 42 Tagen wurden die Fluoreszenzwerte der Schmelzoberflächen mittels QLF ermittelt. Bei der Auswertung der Messergebnisse zeigte sich ein signifikanter Einfluss  (p < 0,01) aller drei Faktoren (Reinigung, Ätzdauer, Versuchszeit) auf die Fluoreszenzwerte. Die Fläche der Demineralisation wurde nur durch die Ätzdauer signifikant beeinflusst. Der Einfluss der längeren Ätzdauer (30 Sekunden) verstärkte sich insbesondere bei den ungereinigten Prüfkörpern. Der DeltaQ-Wert wurde lediglich durch die verstrichene Versuchszeit in Kombination mit 30 sekündigem Ätzen signifikant beeinflusst (p < 0,02). Werden angeätzte Schmelzbereiche nicht von Bonding oder Bracket bedeckt, ist somit mit einer verstärkten Entstehung von White-Spot-Läsionen zu rechnen. Folglich ist bei der kieferorthopädischen Bracketbefestigung darauf zu achten, die Ätzfläche auf die Fläche des zu klebenden Brackets zu beschränken und Ätzzeiten von 15 Sekunden nicht zu überschreiten.

Estudos recentes estimam que a maioria das estenoses benignas é de natureza iatrogênica podendo ser evitada. A incidência de lesões graves dos ductos biliares durante a colecistectomia é de aproximadamente 1/300 a 1/500 procedimentos (0,2 a 0,3%). Estas lesões podem resultar em coleperitôneo, fístula biliar, estenose de via biliar ou associação dessas complicações. O objetivo deste trabalho foi de relatar os casos de lesões de vias biliares tratados no Serviço de Cirurgia da Faculdade de Medicina da Universidade Federal de Goiás. Foram estudados retrospectivamente 31 pacientes, de 1990 a 2002, com diagnóstico de lesões de vias biliares pós colecistectomia. 29 pacientes (93,5%) eram do sexo feminino e 2 (6,5%) eram do sexo masculino. A idade variou de 21 a 80 anos com média de 46,6 anos. Pacientes provenientes da capital do Estado de Goiás eram em número de 12 (38,7%) enquanto 19 (61,2%) eram provenientes de outras regiões do país. A colecistectomia foi realizada eletivamente em 24 pacientes (77,4%) enquanto em 7 pacientes (22,5%) foi realizada cirurgia de urgência. A via de acesso através de incisão subcostal foi empregada em 70,9% dos pacientes e a via longitudinal (mediana e paramediana direita) em 29,1%. As principais manifestações clínicas foram icterícia em 87,9% dos pacientes, fístula biliocutânea em 29%, peritonite em 29,0%, colangite em 29% e sepse em 6,4% dos pacientes. A Colangiografia Retrógrada Endoscópica foi o exame mais empregado para o diagnóstico da lesão de via biliar. As lesões dos ductos biliares foram classificadas segundo a classificação proposta por Strasberg. Aproximadamente metade (54,8%) das lesões de vias biliares foram classificadas como Strasberg E3 e E4. A técnica cirúrgica mais utilizada para o tratamento das lesões de vias biliares foi a Hepaticojejunoanastomose, com alça jejunal exclusa em Y de Roux, em 20 (64,5%) pacientes. Os 4 óbitos foram em lesões totais proximais. As lesões parciais evoluíram melhor a longo prazo / Recent studies have estimated that most of the benign biliary stenosis are iatrogenic in nature, and can thus be prevent. The incidence of severe injury to the biliary ducts during a cholecystectomy is of approximately 1/300 to 1/500 procedures (0.2-0.3%). These lesions can result in choleperitoneum, biliary fistula, stenosis of the biliary tract or an association of these complications. The objective of this paper was to report on biliary tract injuries treated at the Surgical Unit of the School of Medicine of the Federal University of Goias. Thirty-one patients with a diagnosis of biliary tract lesions, post cholecistectomy, were studied, retrospectively, from 1990 to 2002. Twenty-nine individuals (93.5%) were female, and two (6.4%), males. Their age ranged from 21 to 80 years (average of 46.6 years).Twelve (38.7%) individuals came from the capital of State of Goias and 19 (61.2%), from other regions. Cholecystectomy was performed as an elective procedure in 24 (77.4%) patients, and 7 (22.5%) underwent emergency surgery. A subcostal incision was used in 70.9% of the cases, while the longitudinal approach was used in 29.1%. The main clinical manifestations were jaundice in 87.9%, cutaneous fistula in 29%, peritonitis in 29%, cholangitis in 29% and sepsis in 6.4% of the patients. The Endoscopic Retrograde Cholangiography was the diagnostic test most frequently ordered. Biliary duct injuries were classified according to the criteria proposed by Strasberg. Aproximately half (54.8%) of the injuries were classified as Strasberg E3 and E4. The most common surgical technique used in the treatment of this condition was a Roux-en-Y hepaticojejunostomy in twenty (64.5%). Four patients with proximal injuries died. Long term followup disclosed better results with partial injuries

Neste trabalho é feita a avaliação em bases empíricas das condições em que se aplicam os fundamentos da responsabilidade civil objetiva aos ilícitos civis do cirurgião plástico. Foram levantados 71 processos de litigância judicial cível por alegado erro médico no período de 1989 a 2005, dos arquivos do Instituto de Medicina Social e Criminologia do Estado de São Paulo. Elaborado um modelo de variáveis médicas, jurídicas, discursivas e geral pelas quais foi possível as implicações das posições doutrinárias do juiz sobre os resultados do processo. Foram abordadas as correlações entre posição doutrinária e decisão judicial e grau de comprometimento do patrimônio físico e estético e decisão judicial. Avaliada a importância relativa dos deveres de orientação, aconselhamento e obtenção de consentimento informado com relação ao tipo de sentença / In this paper an empirical analysis is accomplished about the aspects of application of the fundametals of objective doctrine of civil liability to the plastic surgeon tot. 71 records of judicial procedures of medical liability lawsuit from the archives of the Instituto de Medicina Social e Criminologia do Estado de São Paulo were examined. A system of medical, juridical, discursive and general variables was elaborated that allowed to accomplish the consequences of the doctrinaire position of the judge on the results of the process. Correlation were made between the doctrinaire position of the judge and the judicial decision, and the degree of health harming and he judicial decision. The relative importance of the obligation regarding informed consent was approached relative to the kind of sentence

[pt] O aumento, nas últimas décadas, de diagnósticos psiquiátricos infantis como TDAH e outros, cuja etiologia vem sendo atribuída a fatores orgânicos, impulsionou o interesse da presente pesquisa. A partir do referencial psicanalítico freudiano, procuramos traçar um histórico da valorização do fator orgânico para o entendimento e tratamento das doenças físicas ou psíquicas na medicina. A especificidade da infância e a evolução do olhar sobre os tratamentos infantis foi abordada assim como o tema da medicina preventiva e os riscos da mesma se tornar uma predição com efeitos iatrogênicos. / [en] The increase, in the last few decades, in the number of ADHD and other psychiatric diagnoses in children, whose etiology is being attributed to organic factors, has propelled the interest for this research dissertation. Using the Freudian psychoanalytical framework, we sought to delineate a history of the valorization of the organic factor for the understanding and treatment of physical or psychological ailments in Medicine. The specificity of childhood and the evolution of the gaze on treatments of children has been approached, as well as the subject of preventive medicine and its risks of becoming a prediction with iatrogenic effects.

Iatrogenic injury resulting from psychiatric treatment represents a critical concern within the healthcare system and causes great harm to the afflicted individuals. This study delves into the multifaceted dimensions of iatrogenic harm attributed to psychiatric treatment, with a focus on the interplay between trust, accountability and recognition, and the social and relational experience of receiving treatment that ends up causing harm. The erosion of trust in psychiatric medicine on part of the individual, stemming from instances of iatrogenic injury where professional and systemic accountability was perceived as inadequate, challenges the foundation of the relationship between individual and treatment provider as well as the relationship between the individual and the psychiatric system. To mitigate this erosion, it is imperative to understand the factors that contribute to the individual’s lack of trust, in order to promote open communication and informed decision-making in psychiatric treatment. In that sense, being afflicted with iatrogenic injury is an inherently social experience. Furthermore, central to this study is the emphasis on recognizing the individual narratives of those who have experienced iatrogenic injury, as each individual’s unique circumstances and personal stories offer valuable insights into the human impact of medical maltreatment, and centering their experiences can contribute to a broader discourse on psychiatric care reform. This study underscores the need for a holistic re-evaluation of psychiatric treatment practices, where recognition of the individual’s experiences and open discussions on the limitations of psychiatric treatment are at the forefront. Ultimately, this study aims to contribute to the ongoing dialogue surrounding iatrogenic harm and the need for different pathways that improve the safety and quality of psychiatric care by focusing on the individual’s inherent right to control the process of undergoing psychiatric treatment and the right to not be harmed.