Reproduction de : Thèse d'exercice : Médecine : Nancy 1 : 2007. / Titre provenant de l'écran-titre.

O aumento da freqüência de cirurgias de sinus lift para reabilitação com implantes proporcionou uma maior preocupação com a fisiologia do seio maxilar. O objetivo deste estudo é avaliar a eficácia da radiografia panorâmica na detecção de sinusites maxilares. Para o estudo foram utilizados exames pareados (panorâmica + Tomografia Computadorizada) de pacientes encaminhados ao centro de radiologia para planejamento imaginologico para implantes. As 100 radiografias panorâmicas foram avaliadas por três examinadores distintos quanto a quatro padrões radiográficos: (A) padrão compatível com a normalidade, (B) presença de velamento parcial ou total opacificação do seio maxilar, (C) presença de fenômeno de retenção de muco e (D) presença de comunicação buco sinusal. Os diagnósticos obtidos pelos examinadores foram comparados com os achados radiográficos das TCs (padrão ouro). Os resultados obtidos foram submetidos à análise de concordânica de Kappa. Concluímos que a sensibilidade diagnóstica deste exame é diretamente proporcional à experência do examinador. Concluímos também que a radiografia panorâmica utilizada isoladamente não oferece recursos diagnósticos suficientes para a detecção de sinusites maxilares. / Due to the higher frequency of sinus lift surgeries for oral rehabilitation with implants, there is more concern to the physiology of the maxillary sinus. The purpose of the present study is to evaluate the panoramic x-ray efficacy at detecting maxillary sinusitis. For this study, one hundred paired exams (panoramic xray + Computed Tomography) from patients referred to a radiodiagnostic centre for dental implant placement planning were used. All panoramic x-rays were evaluated by three different observers and diagnosed for four radiographic findings: (A) healthy sinus, (B) mucosal swelling or total opacification of the maxillary sinus, (C) presence of mucosal cysts and (D) presence of buco antral communication. The diagnoses obtained by the three observers were compared to the CT findings (gold standard). We the used Kappa analysis to determine the agreement between the observers and the gold standard. We concluded that the more experience the observer has, the higher his agreement with the CT is. We also concluded that used by itself, the panoramic x-ray does not provide enough resources to detect maxillary sinusitis.

Objectif - Réaliser une étude en morphométrie géométrique pour définir la variabilité des sinus frontaux et maxillaires au sein d’une population adulte et pour l’établissement du profil biologique des individus à partir de la géométrie des sinus frontaux et maxillaires.- Valider un modèle de simulation numérique des écoulements pour l’étude de la ventilation nasosinusienne chez l’adulte et observer l’influence de la conformation sinusienne sur la ventilation nasosinusienne.Nous avons défini 20 landmarks fiables et reproductibles pour les sinus frontaux et maxillaires. Nous avons décrit la variabilité des sinus frontaux et maxillaires au sein d’un échantillon de population adulte. Enfin, nous avons mis en évidence l’existence d’allométries pour les sinus frontaux et maxillaires mais aussi l’existence d’un dimorphisme sexuel pour la conformation des sinus maxillairesNous proposons un modèle fiable de simulation numérique des écoulements à partir d’examen tomodensitométriques. Sur la base de ce modèle, nous n’avons pas mis en évidence d’influence de la conformation sinusienne sur la ventilation nasale et le conditionnement thermique de l’air inspiré et expiré. / Objectives - to conduct a morphometric geometric study in order to define the variability of the frontal and maxillary sinuses in an adult population and to determinate the sex of individuals - to validate a Computational fluid dynamic model of the nasal airflow and to describe the influence of the sinus conformation on the nasal airflow.We defined twenty reliable and reproducible landmarks for frontal and maxillary sinuses. We described the variability of the frontal and maxillary sinuses in an adult population sample. Finally, we highlighted the existence of allometries for frontal and maxillary sinuses but also the existence of a sexual dimorphism in the conformation of the maxillary sinusesComputational fluid dynamics:We offer a reliable model for numerical simulation of flows from CT examination. Based on this model, we have not shown any influence of the conformation on the nasal sinus ventilation and thermal conditioning of the inhaled and exhaled air. We showed no ventilation in the sinuses in the nasal respiratory cycle. Future studies will endeavor to define a humidity conditioning air model and a simulation model of production of NO and gas exchange between sinuses and nasal cavities.

The sinus node (SN) is the natural pacemaker of the heart. In the human, the SN is surrounded by the paranodal area (PNA), the function of which is currently unknown. The PNA may act as subsidiary atrial pacemakers (SAP) and become the dominant pacemaker during sinus node dysfunction (SND). Creation of an animal model of SND allows characterisation of SAP, which can be a target for novel treatment strategies other than the currently available electronic pacemakers. I developed a large animal model of SND by ablating the SN in the goat and validated it by mapping the location of the newly emergent SAP. Functional characterisation of the SAP revealed reduced atrioventricular (AV) conduction time consistent with a location of the SAP close to the AV junction. SAP recovery time showed an initially significant prolongation compared to the SN recovery time, followed by a gradual decrease over 4 weeks. SAP pauses, and temporary reliance on electronic pacemaker activity have also been demonstrated then disappeared over time, suggesting possible modulation, maturation of the SAP. Structural characterisation of the SN revealed an extensive pacemaking complex within the right atrium (RA); the SN was surrounded by the PNA, extending down to the inferior vena cava (IVC) and into the interatrial groove. The PNA had a histological appearance that is intermediate to the SN and the RA. 3D reconstruction demonstrated, for the first time in a large animal model, an extensive and almost complete circle of pacemaking tissue at the junction of the embryologically different sinus venosus and the muscular right atrium. The SAP emerged in a location close to the IVC along the crista terminalis. Expression of key ion channel proteins in the SAP showed abundance of the pacemaker channel (HCN4) and the sodium/calcium exchanger (NCX1) compared to RA, similar to the expression pattern of the SN. The expression of the main high conductance connexin (Cx43) was not significantly different between SAP and RA, and both expressed Cx43 more abundantly than the SN.Conclusion: Destruction of the sinus node in this experimental model resulted in the generation of chronic SAP activity in the majority of the animals. The SAP displayed maturation over time and located in the inferior part of the RA, in the same area where the PNA was found in controls, suggesting the role of PNA as the dominant pacemaker in sinus node dysfunction. The SAP in the goat constitutes a promising stable target for electrophysiological modification to construct a fully functioning biological pacemaker.

Symptomatic sinus bradycardia, due to either sick sinus syndrome or vagotonia, can be familial, affecting several members of a family. We report an 18-year-old male patient with palpitations and limited exercise capacity who was noted to have severe sinus bradycardia. His resting heart rate was 40/min, with normal PR and corrected QT intervals, and sinus pauses up to 6 seconds during sleep. Exercise treadmill test and pharmacologic autonomic blockade during electrophysiologic studies abolished the bradycardia, suggestive of vagotonia rather than intrinsic sinus node dysfunction. This patient's father and a female cousin had a similar clinical history but associated with syncope and severe sinus bradycardia. The mode of transmission appeared to be autosomal dominant. All three have permanent demand pacemakers implanted and are asymptomatic.

Objectives: The presence of sinus septa may cause complications in maxillary sinus elevation surgery such as perforations. CBCT is important for planning the size, shape, and position of the sinus septa, and help separation of the sinus membrane from the bony septum. The purpose of this study is to determine the prevalence, location and morphology of maxillary sinus septa in patients of Temple University Kornberg School of Dentistry.  Materials and Methods: Eight hundred and twenty one scans taken in Temple University Kornberg School of Dentistry between 2009 to July 31, 2013 were evaluated by use of the iCAT software. Age, gender, ethnicity, and dentition status were also evaluated to determine potential relationship of the presence of sinus septa. Results: This study included 680 patients subdivided by gender into 360 female and 320 male, and subdivided by ethnicity into 408 Caucasian, 61 Asian, 51 Hispanic, and 160 African Americans. Septa were present in 303 of 680 patients (44.56%) and 485 of 1360 sinuses (35.7%) evaluated. 26.76% of patients with one or multiple sinus septa were present on both sides of the sinus, and 17.79% of patients with one or multiple septa were present on either right or left side only. Septa height has a mean of 5.26 mm (range of 1.2 to 22.30 mm). Septa were located in premolar, molar, and retromolar regions in 43.4%, 42.03% and 14.6 % respectively. The most common location of the septa is the second premolar region. Orientation of septa was vertical in 67.8 %, transverse 31.68 %, and horizontal 0.005% of cases. Complete septa were found in only 0.01 % of patients evaluated.  Conclusions: Incidence of septa was found in 44.56% of the scans. The age, gender, and ethnicity factors are not statistically significant. However, according to the Wald test, the prevalence of septa in Caucasian and Hispanic groups are statistically significant (p< 0.05) from African Americans. Prior to sinus augmentation surgery, CBCT scans should be carefully evaluated for the septa location and height to prevent surgical complication such as perforations. / Oral Biology

In this study I examined the moderating effect of three profiles of respiratory sinus arrhythmia (RSA at baseline, in response to a stressor, and in recovery from a stressor) on the relationship between parental emotion socialization during an emotion-related discussion and parental report of child internalizing symptoms 6 months later. Parents were observed during an emotion discussion task and coded for their use of emotion encouragement and general positive involvement. A total of 65 families with children between the ages of eight and ten years old completed this task while RSA scores were obtained from children during baseline, task, and recovery phases. Regression analyses were conducted to test for main effects of parental emotion socialization and RSA, as well as two-way emotion socialization x RSA interactions, in the development of internalizing symptoms 6 months following the initial interview. Interactions were further examined for the degree they statistically conformed to either a diathesis-stress or biological sensitivity to context framework (BSC). Hypotheses were partially supported: main effects were found for RSA baseline and recovery, whereas RSA reactivity moderated the association between parental emotion encouragement and child internalizing symptoms, such that parents of children exhibiting RSA withdrawal reported greater internalizing symptoms in the context of low emotion encouragement and lesser internalizing symptoms in the context of high emotion encouragement. This study highlights the importance of considering child psychophysiology, particularly reactivity to stress, in the study of the effects of parental emotion socialization on the development of psychopathology during childhood.

Introdução: A evolução clínica da trombose venosa cerebral (TVC) pode variar desde a recuperação completa ao óbito. Séries européias e um estudo multicêntrico identificaram alguns fatores indicativos de prognóstico da TVC, dado importante na decisão da melhor terapêutica para os pacientes. Este estudo busca identificar, a partir do seguimento prospectivo de cento e onze pacientes com TVC, os fatores prognósticos envolvidos na evolução clínica durante o período de 2 anos. Pacientes Métodos: Foram acompanhados prospectivamente 111 pacientes com diagnóstico de TVC desde a fase aguda do diagnóstico, confirmado por meio de RM de encéfalo e/ou angiografia cerebral (ARM, ATC ou angiografia digital). Obtidos dados do quadro clínico e seguimento por um protocolo clínico. 96% dos pacientes foram anticoagulados na fase aguda com heparina e seguida de anticoagulação com warfarina. Submetidos a investigação para os fatores predisponentes para TVC. A evolução clínica foi quantificada por meio da escala modificada de Rankin (EMR) após 3, 6, 12 e 24 meses, definindo os pacientes de bom prognóstico EMR 1, e mau prognóstico EMR 2. Comparamos dados clínicos da fase aguda e resultados encontrados nos exames de imagem e laboratoriais como possíveis fatores prognósticos, através da análise univariada pelo teste 2 e os fatores de significância estatística (p<0,1), foram analisados com regressão logística ajustada e cálculo da razão de chances (RC), (intervalo de confiança IC=95%). Resultados: A média da idade dos pacientes foi de 35 anos, 72% mulheres, 40% afro-brasileiros. As principais manifestações clínicas foram: cefaléia 97%, déficit focal 47%, crise epiléptica 40%, alteração da consciência 28%, síndrome de HIC (SHIC) isolada 40%. Quanto aos fatores predisponentes; 75% das mulheres usavam anticoncepcional, 31% dos pacientes apresentavam trombofilia hereditária, 13% SAAF, 6% eram portadores de vasculites, 25% outros estados pro trombóticos, 7 % apresentavam fatores locais (infecciosos ou MAV); e 5% das mulheres estavam no puerpério ou gestação. Os dados de neuroimagem revelaram que 42% apresentaram trombose em mais de um sistema venoso, 33% tiveram infartos hemorrágicos e 18% infartos venosos isquêmicos, e 20% dos pacientes apresentaram trombose de veias e seios profundos. Após 24 meses 18 pacientes (17%) apresentaram EMR 2 e os fatores determinantes de pior prognóstico foram: a etnia afro-brasileira p=0,001; RC= 11,37 (95% IC 2.81- 46,08), alteração do nível de consciência p=0,007; RC=4.56 (95% IC 1.61-19.45), sexo masculino p=0,049 RC=3.55 (95% IC 1.00-12.55) e idade acima de 32 anos p=0,05 RC = 3.95 (95% IC 0,97-15.20). A presença isolada de ACO como fator predisponente está associado ao melhor prognóstico p = 0,016; RC=5,17(95% IC 1.37-19.57) e após 24 meses a mortalidade foi de 4,5%. Conclusão: A análise deste trabalho evidencia que a maioria dos pacientes portadores de TVC (83%) apresenta uma evolução benigna com o tratamento, estando após 24 meses assintomáticos ou com sintomas mínimos, e a presença de ACO como fator predisponente isolado a TVC está relacionado ao melhor prognóstico. Os pacientes com pior evolução clínica têm a raça afro-brasileira, a alteração do nível de consciência, sexo masculino e idade acima de 32 anos como fatores determinantes de pior prognóstico em vinte e quatro meses. A identificação destes fatores é importante por direcionar um melhor tratamento na fase aguda da TVC para casos selecionados / Introduction: The cerebral venous thrombosis (CVT) clinical evolution is quite variable from complete recovery to death. Some European series and a multicenter study had identified prognostic factors related to CVT prognosis. The identification of these factors is important for the best therapeutic decision to patients. This study aims to identify the prognostic factors enrolled in clinical evolution of 111 patients with CVT in a prospective outcome clinical trial during two years. Subjects and Methods: One hundred and eleven patients were prospective followed with the diagnosis of CVT since acute phase diagnosis, confirmed by brain MRI and/or brain angiography (MRA , CTA or digital angiography). Information about clinical features and follow-up were filled on a clinical form. 96% of the patients were anticoagulated on heparin followed by warfarin treatment. The patients were investigated to predisposing factors to CVT. The clinical evaluation was accessed by the modified Rakin scale (mRs) after 3, 6, 12 and 24 months, considering patients with good outcome when mRs 2. The acute phase clinical features, laboratory and imaging data were compared as possible prognosis factors beyond univariate 2 test and the factors with statistical significance (p<0,1) and then analyzed by logistic regression adjusted and Odds Ratio values (confidence interval CI=95%). Results: The mean age of the patients was 35 years, 72% were women, and 40% were African Brazilian. The main clinical features observed were: headache 97%, focal sign 47%, epileptic seizure 40%, isolated ICH syndrome 40% and altered mental status 28%. All the patients were investigated to predisposing factors; 75% of the women were on oral contraceptive, 31% of the patients presented hereditary thrombophilia, 13 % antiphospholipid syndrome, 6% presented vasculitis, 25% other protrhrombotic state, 7% presented some local feature (arterialvenous malformation or infection) and 5% of women were pregnant or on puerperium. The neuroimaging data showed that 42% of the patients presented thrombosis in more than one venous system, 33% had hemorrhage infarcts, 18% ischemic venous infarcts and 20% of the patients had thrombosis of the deep venous system. After two years 17% had a mRs > 2 and the features enrolled on poor prognosis were: African Brazilian patients p=0,001; OR= 11,37 (95% IC 2.81- 46,08), altered mental status p=0,007; OR=4.56 (95% IC 1.61-19.45), male gender p=0,049 OR=3.55 (95% IC 1.00-12.55) and age over 32 years p=0,05 OR = 3.95 (95% IC 0,97- 15.20). The presence of oral contraceptives as isolated predisposing factor was related to good outcome CVT p=0,016; OR=5,17(95% IC 1.37-19.57) and after two years the mortality rate was 4,5%. Conclusion: This study data show that most patients with the diagnosis of CVT (83%) has a good outcome with the treatment, after two years follow up they have no symptoms or minimal deficits, and the presence of oral contraceptives as isolated predisposing factor was related to better outcome CVT. The patients with poor prognosis have the African Brazilian ethnic group, altered mental status, male gender and age over 32 years as the factors enrolled on bad clinical evolution in two years. The identification of these factors can have future value on treatment better choice on acute phase to selected CVT patients

A técnica de levantamento de seio maxilar apresenta como uma possível complicação a perfuração da membrana sinusal. A utilização de dispositivos ultrassônicos apresenta-se como uma interessante ferramenta, particularmente segura e eficiente para realização das ostectomias de parede sinusal e divulsão de membrana sinusal. O presente trabalho teve por objetivo comparar duas técnicas que utilizam a cirurgia ultrassônica para realização de enxerto autógeno para levantamento de seio maxilar. Dez coelhos foram utilizados no estudo, sendo que um deles não foi submetido a procedimento cirúrgico. Os nove coelhos operados tiveram os seios maxilares preenchidos com enxertos autógenos coletados de díploe externa de calota craniana, nas formas particulado do lado direito e raspado do lado esquerdo, ambos com aparelho ultrassônico. Os dados de densidade óssea nos seios maxilares esquerdo e direito, obtidos por meio de tomografia computadorizada nos sentidos transversal e longitudinal, registrados 90 dias após a realização dos enxertos foram comparados estatisticamente. Cortes histológicos das áreas enxertadas foram realizados com finalidade descritiva. Não houve diferenças estatisticamente significantes entre as técnicas de enxerto que utilizaram osso raspado e particulado coletado por meio de dispositivo ultrassônico da calota craniana de coelhos. O aspecto histológico observado após 90 dias foi semelhante nos dois grupos, mostrando tecido ósseo maduro em meio a tecido conjuntivo frouxo. Os procedimentos transoperatórios nos levaram a concluir que o ultrassom piezoelétrico mostrou-se um instrumento seguro na abordagem cirúrgica do seio maxilar de coelhos, permitindo a manutenção da integridade da membrana sinusal durante as manobras cirúrgicas. / Maxillary sinus lifting is a technique which presents as a possible complication the sinus membrane perforation. The use of ultrasonic devices is presented as an interesting tool, particularly safe and efficient to perform ostectomies of sinus wall and dissection of sinus membrane. This study aimed to compare two techniques that used ultrasound surgery to perform autogenous graft for maxillary sinus lifting. Ten rabbits were used in the study, one of which did not undergo surgery. The other nine rabbits had their maxillary sinuses filled with autogenous bone grafts collected from the external skull diploe in particulate form on the right side and shaved on the left side, both with ultrasonic device. Data on bone density in left and right maxillary sinus, obtained by computed tomography in transverse and longitudinal sections, recorded 90 days after the grafts, were compared statistically. Histological sections of the grafted areas were performed with descriptive purposes. There were no statistically significant differences between the two techniques that used shaved and particulate bone collected by means of ultrasonic device of the skull of rabbits. Histological aspects after 90 days were similar in both groups, showing mature bone through a fibrous connective tissue. Operatory assessment procedures leads us to conclude that the piezoelectric ultrasound showed as a safe tool in the surgical approach of the maxillary sinus of rabbits, allowing the maintenance of sinus membrane integrity during surgical procedures.

O objetivo deste trabalho foi avaliar a neoformacão óssea induzida por um xenoenxerto bovino composto comparativamente ao ósseo autógeno, em cirurgias de levantamento de seio maxilar em coelhos. Nesse estudo utilizouse o seio maxilar de 18 coelhos machos, sendo que no seio maxilar esquerdo foi colocado 200mg de osso autógeno córtico-medular triturado e no seio maxilar direito, o biomaterial, de origem bovina, composto por matriz orgânica cortical e inorgânica medular, \'pool\' de BMPs e colágeno (Gen- Tech®). Realizou-se análise tomográfica por tomógrafo computadorizado (TC) para avaliar a densidade óptica comparativamente entre os grupos e períodos experimentais, a histológica descritiva para verificar a resposta tecidual frente aos materiais implantados e a histomorfométrica para obter os dados de densidade de volume de tecido ósseo neoformado, tecido conjuntivo e/ou granulação, material residual e tecido mielóide. Os resultados obtidos pela TC demonstraram densidade óptica cerca de 2 vezes maior no grupo teste. Na análise histológica observou-se infiltrado inflamatório apenas no período de 2 semanas do grupo teste e exclusivamente ao redor do componente orgânico do biomaterial. Quanto a neoformação óssea, não houve diferença estatisticamente significativa entre os dois grupos experimentais ou ao longo dos períodos, no entanto a área de tecido mielóide foi cerca de 2 vezes maior no grupo controle. Considerando-se os limites do modelo experimental e da técnica empregada podemos concluir que o biomaterial Gen-Tech® é potencialmente indicado como substituto ósseo em cirurgias de levantamento de seio maxilar, uma vez que promove uma neoformação óssea similar à do osso autógeno. / The purpose of this study was to evaluate new bone formation induced by a bovine xenograft compared to autogenous bone in maxillary sinus augmentation in rabbits. The maxillary sinus of 18 male rabbits were used, whereas the left sinus was filled with 200mg of a mixture of cortical and medullar autogenous bone and the right sinus was filled with a mix of organic and inorganic bovine matrix, plus \'pool\' of BMPs and collagen (Gen-Tech®). Computer tomography (CT) analysis was realized to evaluate and compare the optical density among the groups and experimental periods; descriptive histologic analysis was used to verify the tissue response to the materials implanted. In addition, histomorphometric analysis was realized to evaluate volume density of the newly formed bone, connective tissue and/or granulation tissue, residual material and myeloid tissue. The results obtained in the CT demonstrated an optical density approximately 2 times greater in the test groups. Histological analysis revealed an inflammatory infiltrate at 2 weeks in the test group and exclusively around the organic portion of the material. Regarding new bone formation, no statistical differences were observed among the two experimental groups or throughout the experimental periods. However the area of myeloid tissue was 2 times greater in the control group. Considering the limits of the experimental model and technique used in this study, it is possible to conclude that Gen-Tech® is a biomaterial with potential applications as a bone substitute in maxillary sinus augmentation once it is able to promote the formation of new bone similarly to autogenous bone.