Paulo Eduardo Capel Cardoso

Thoracoscopy talc poudrage : A 15-year experience

OBJECTIVES To review our experience with thoracoscopy and talc poudrage during the previous 15 years with regards to efficacy, side effects, morbidity, and mortality. METHODS Six hundred fourteen consecutive patients (58.6% female; mean age, 54.5 years) underwent thoracoscopy with talc poudrage from August 1983 to May 1999. Of these, 457 patients had malignant pleural effusions, 108 patients had benign pleural effusions, and 49 patients had spontaneous pneumothorax. RESULTS Sixty-four patients were excluded from evaluation for efficacy: 30 patients (4.9%) because the lung did not expand at the time of the procedure and 34 patients (5.5%) because they died within 30 days of the thoracoscopy. All exclusions were in the malignant group. The overall success rate of the 393 patients with malignant pleural effusions was 93.4%, while the overall success for the 108 patients with benign effusions was 97%, although 7 patients (7%) with benign effusions required a second thoracoscopy. The success rate with pneumothorax was 100%. Major morbidity included empyema in 4%, reexpansion pulmonary edema in 2.2%, and respiratory failure 1.3%. CONCLUSION Thoracoscopy with talc poudrage is effective in producing a pleurodesis in malignant and benign pleural effusion and in spontaneous pneumothorax. However, it should be noted that the insufflation of talc has a systemic distribution associated with a low rate of morbidity and perhaps does induce ARDS, which is sometimes fatal in a small percentage of patients. Because of these side effects, the search for a better agent should be continued.

Clinical InvestigationsThoracoscopy Talc Poudrage: A 15-Year Experience

OBJECTIVES To review our experience with thoracoscopy and talc poudrage during the previous 15 years with regards to efficacy, side effects, morbidity, and mortality. METHODS Six hundred fourteen consecutive patients (58.6% female; mean age, 54.5 years) underwent thoracoscopy with talc poudrage from August 1983 to May 1999. Of these, 457 patients had malignant pleural effusions, 108 patients had benign pleural effusions, and 49 patients had spontaneous pneumothorax. RESULTS Sixty-four patients were excluded from evaluation for efficacy: 30 patients (4.9%) because the lung did not expand at the time of the procedure and 34 patients (5.5%) because they died within 30 days of the thoracoscopy. All exclusions were in the malignant group. The overall success rate of the 393 patients with malignant pleural effusions was 93.4%, while the overall success for the 108 patients with benign effusions was 97%, although 7 patients (7%) with benign effusions required a second thoracoscopy. The success rate with pneumothorax was 100%. Major morbidity included empyema in 4%, reexpansion pulmonary edema in 2.2%, and respiratory failure 1.3%. CONCLUSION Thoracoscopy with talc poudrage is effective in producing a pleurodesis in malignant and benign pleural effusion and in spontaneous pneumothorax. However, it should be noted that the insufflation of talc has a systemic distribution associated with a low rate of morbidity and perhaps does induce ARDS, which is sometimes fatal in a small percentage of patients. Because of these side effects, the search for a better agent should be continued.

Clinical Performance and Wear Resistance of Two Compomers in Posterior Occlusal Restorations of Permanent Teeth: Six-Year Follow-up

This study evaluated the clinical performance and wear resistance of compomer restorations placed in the occlusal cavities of posterior permanent teeth after six years. In 1999, 72 Class I restorations were placed by a single operator in 33 patients. Eighty-two percent of these restorations were located in molars. Each patient received at least two restorations, one with F2000 (3M ESPE) and another with Dyract AP (Dentsply). The finished and polished restorations that were free of any failure were considered the baseline. The restorations were clinically evaluated at baseline and at one-, two- and six-year intervals using modified USPHS criteria for color mismatch, marginal discoloration, surface roughness, marginal adaptation, anatomic form and secondary caries. Polyvinylsiloxane impressions (Express, 3M ESPE) were also taken, and models were obtained for indirect wear assessment (Leinfelder scale) at the same intervals. After six years, 11 patients attended the recall. Twenty-seven compomer restorations (11 with Dyract and 16 with F2000) were reevaluated. Data were submitted to the Friedmans test, ANOVA with repetitive measures, Tukeys test (clinical data), Wilcoxon and Kruskal-Wallis tests and the Spearmans correlation test (wear evaluation), all at a significance level of p < 0.05. When comparing the materials, F2000 and Dyract presented similar clinical performance and occlusal wear at the end of the clinical trial. The two compomers showed a significant increase in wear at the six-year follow-up, and a positive correlation (r2 = 0.65) was detected between wear and evaluation time (p < 0.001). Despite the decrease in restoration quality and the increase in occlusal wear, nearly all restorations were considered acceptable after the six-year evaluation.

The effect of long-term storage on the microleakage of composite resin restorations: qualitative and quantitative evaluation

The aim of this study was to evaluate the influence of storage periods of 24 hours and 3 months on the microleakage of class II cavities. Two methods of assessing microleakage were also compared. Class II cavities were prepared in sound human molars. MO cavities were restored using ABF experimental (Kuraray Medical Inc.) + Z250 composite resin (3M ESPE), and DO cavities were restored using Single Bond (3M ESPE) + Z250. After different storage periods, specimens were thermocycled, immersed in a dye (0.5% methylene blue solution for 4 h) and longitudinally sectioned. Dye penetration was scored according to a 0-4 scale. The extent of microleakage was measured using the ImageLab 2000 program. A statistically significant correlation was verified between both evaluation methods (r = 0.978, p < 0.001). ANOVA revealed a statistically significant difference between the tested adhesive systems regarding microleakage (p < 0.001), although it was not influenced by the different storage periods.

Resistência de união entre liga de níquel-cromo e cimentos resinosos

The purpose of the investigation was to test tensile strength between Ni-Cr alloy and adhesive cements. Variables were: three cements (Comspan, Panavia Ex and All-Bond CB four surface treatments (smooth, sandblasted, electrolytic etching and silicoater); two types of storage (3 and 30 days in NaCl 0.9% solution at 37° C, performing in the latter 600 thermocycles at 5 and 55° C). Specimens were discs obtained through conventional casting procedures and cemented together two by two. Opposite sides of cementing discs were provided with a loop for fixing to the testing equipment. Conclusions were that: smooth surfaces presented very low retentivity and those with silicoater a very high one; Panavia Ex with sandblasting also led to very high retention; highest retention was obtained with the combination silicoater/All-Bond C&B.

Microtensile bond strength of current adhesive systems when compared to cohesive strength of sound dentin and a resin-based composite

Received: March 28, 2004; Revised: September 8, 2004Purpose: To evaluate the microtensile bond strength ( µTBS) to dentin of 4 adhesive systems,the micromorphology of the adhesive/dentin interface and to compare the results to the µTS (co-hesive strength) of sound dentin and resin composite. Occlusal surfaces of 24 extracted caries-freehuman molars were cut flat to expose the dentin surface. They were randomly assigned to 4 groups(n = 6): Adper Scotchbond Multi Purpose Plus (MP), Adper Single Bond (SB), Clearfil ProtectBond (CP) and Adper Prompt (AP). Adhesive systems were applied and “crowns” were builtusing Z100. Other 5 human molars were sectioned to obtain square-shaped dentin blocks and5 resin blocks were built using a composite resin, Z100. After storage in distilled water at 37 °Cfor 24 h, stick-shaped specimens were obtained for all groups (n = 5) with 0.8 mm

Falhas de grampos circunferenciais de próteses removíveis em função de ciclagens de flexão

The purpose of this research was to study the frequency of retention loss of removable partial denture clasps. Loss of retention was determined after several cycling periods (initially zero, and 1, 5, 15 and 25 thousand). Frequency was based on the number of vacant spaces when the clasp failed by rupture or retention loss under 120g. Thus, the number of vacant spaces depends on the number of clasps fractured and/or that lost retention. Other variables were: four base metal alloys, two types of clasps (standard and extra, which was thinner), and two teeth (premolar and molar). The conclusions were that: the number of vacant spaces depends on alloys with or without adjustment; with adjustment the extra clasp presented less failures; frequency of clasp failures is very high and almost half occurred up to 1,000 cycles.

Bronchial thermoplasty in a patient with difficult-to-control asthma.

1. Servico de Pneumologia, Pavilhao Pereira Filho, Santa Casa de Porto Alegre, Porto Alegre (RS) Brasil. 2. Disciplina de Pneumologia, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre (RS) Brasil. 3. Servico de Cirurgia Toracica, Pavilhao Pereira Filho, Santa Casa de Porto Alegre, Porto Alegre (RS) Brasil. 4. Disciplina de Cirurgia Toracica, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo (SP) Brasil. TO THE EDITOR:

Influência do tempo de armazenamento na resistência de união à dentina de dois

O objetivo da pesquisa foi estudar a influencia do tempo de armazenamento (24h e tres meses) na resistencia adesiva de dois tipos de adesivo dental, sendo um convencional, Single Bond (SB) e outro com primer autocondicionante, ABF experimental (ABF), e tambem a influencia das variacoes regionais do substrato dentinario. O esmalte oclusal de 16 terceiros molares foi removido, expondo uma superficie dentinaria plana. Nesta, foi criada uma camada de smear atraves de lixas de papel de granulacoes decrescentes. Apos a aplicacao dos sistemas adesivos, blocos de resina Z250 de 5 mm de altura foram construidos sobre a superficie dentinaria. Os dentes foram divididos em quatro grupos (n=4) de acordo com o material e o tempo de armazenagem em agua destilada a 37∞C: A)SB 24 h; B)SB tres meses; C)ABF 24 h; D)ABF tres meses. Apos o armazenamento, os dentes foram seccionados, longitudinalmente, em cortes perpendiculares entre si, a fim de se obterem corpos-de-prova (cp) em formato de palito de aproximadamente 0,8 mm2 de seccao transversal, constituidos por resina-adesivo-dentina. Esses cp foram mapeados, com esmaltes de diferentes cores, conforme suas localizacoes no dente: mais periferica ou interna, no sentido horizontal. Os especimes foram submetidos ao teste de microtracao. A analise de variância demonstrou nao haver diferenca significante entre os valores medios de resistencia dos dois adesivos com diferentes idades de armazenamento, nem entre as diferentes regioes do dente.