Inclusion of oral health services in the Family Health Program in the State of Paraná, Brazil

The aim of this study was to analyze the implementation of dental care in the Family Health Program (FHP) in the State of Paraná, Brazil, one year after Ministry of Health (MoH) Ruling 1,444 went into effect. A qualitative and quantitative study was designed, focusing on the 136 municipalities which had included oral health services in the program by early 2002. The dental care teams received previously tested questionnaires on administrative and operational issues. The mean population covered by each team is close to the minimum stipulated by the MoH in 2000. However, some teams experienced difficulties in developing all the activities under their responsibility. Referral of more complex cases was also reported as a critical point. Favorable reception by the population and participation by dentists in the training courses were identified as positive points. Finally, a large proportion of dentists were under temporary work contracts (37.7%); there were also reports of the need to train general dental practitioners with an adequate profile for the FHP.     

Dysphagia Lusoria Caused by Aberrant Right Subclavian Artery, Kommerell’s Diverticulum, Legamentum Ring, Right Descending Aorta, and Absent Left Pulmonary Artery: A Report of a Unique Vascular Congenital Disease Undetected until Adulthood and a Review of the Literature

An active otherwise healthy and middle-aged woman presented with left supraclavicular pulsation, right upper extremity claudication, and mild dysphagia. Evaluation revealed an aberrant right subclavian artery, Kommerell’s diverticulum with aneurysmal degeneration, legamentum arteriosum completing vascular ring, and absent left pulmonary artery with multiple collateral supply to the left lung. She underwent successful surgical repair via right thoracotomy, including division of the vascular ring, resection of the diverticulum and aneurysm, and finally reimplantation of the right subclavian artery to the aortic arch. Her symptoms resolved completely, and she was able to resume normal activities.     

Systemic lupus erythematosus presenting with a choreo-athetosic syndrome associated with antiphospholipid antibodies

INTRODUCTION: Chorea is a rare manifestation of systemic lupus erythematosus (1-4 percent), commonly affecting young woman. Chorea is revealing lupic disease in 50 percent, in the other cases it occurs early in the course of the disease. OBSERVATION: A 33-year-old woman was hospitalized for choreo-athetosic movements prevailing on the left leg and arm accompanied by behavioral and general state deterioration. The biological assessment consolidated the diagnosis of lupic disease associated antiphospholipides antibody (aPL). Cerebral magnetic resonance imaging (MRI) was normal except for cortical and subcortical atrophy. The patient was treated by corticosteroids (1mg/kg/day) and then was lost to follow-up. CONCLUSION: We review data in the literature on the pathophysiological mechanisms of lupic chorea focusing particularly on role of aPL.     

Sternal resection and reconstruction for primary malignant tumors

BACKGROUND: Primary malignant sternal tumors (PMST) are locally aggressive and their optimal surgical management still continues to evolve. METHODS: From 1986 to 2002, 38 patients (25 females/13 males) underwent radical resection of PMST. This series included 33 sarcomas, 17 of which had been radiation-induced, 3 hematologic tumors, and 2 carcinomas. Seventeen were high-grade tumors. Nine patients had received preoperative chemotherapy. Twelve patients required extensive skin excision. Eight total, seven subtotal, and 23 partial sternectomies were performed. Resection was extended to the anterior chest-wall in 4 patients, lung in 4, brachiocephalic vein in 3, superior vena cava in 2, and pericardium in 1. In 36 patients, chest wall stability was obtained by Marlex (n = 21) or Vicryl (n = 2) mesh and polytetrafluoroethylene patch (n = 13), with methylmethacrylate reinforcement in 12 patients. Soft tissue coverage was done by the pectoralis major muscles with skin advancement in 25 patients, a myocutaneous flap in 11, a breast transposition in 1, and a skin flap in 1. Omentoplasty was performed in 3 patients. RESULTS: One patient died from pneumonia. Two patients needed a tracheostomy after total sternectomy. No flap-related complication was observed. Four local septic complications required removal of the composite prosthesis with reoperations. Local recurrence occurred in 9 patients, 7 patients having a repeat resection. Metastases developed in eight. The 5-year overall and disease-free survival was 66% and 53%, respectively. The histologic grade of sarcomas was a survival predictor (high grade versus others p = 0.035). CONCLUSIONS: Wide resection of PMST is necessary to minimize local recurrence. Large sternal defects are safely reconstructed with a musculocutaneous flap. We suggest that the use of methylmethacrylate should be limited to reconstruction after total sternectomy.     

Identification of a novel brain-specific and Reelin-regulated gene that encodes a protein colocalized with synapsin

We carried out a screening of genes that are differentially expressed in normal mice and reeler mutants and are characterized by abnormal neuronal migration and neurite deployment due to defective Reelin signalling. A novel gene, provisionally named C61, was overexpressed in Reelin-deficient embryonic mouse brain RNA. C61 encodes a 3.7 kb mRNA that is brain specific and developmentally regulated, with predominant expression in differentiating neurons. The predicted protein is 664 amino acids long, and contains LAG1 and Ezrin/Radixin/Moesin-Myosin-Filament motifs, suggesting that it may function as an intracellular adaptor. From E14.5 to birth, C61 was highly expressed in all neuronal differentiation fields, with the highest signal in the telencephalic cortical plate and mitral cells in the olfactory bulb. When expressed as a GFP fusion protein in transfected non-neuronal cells and primary neurons, this protein localizes, respectively, to the nuclear membrane or axonal outgrowths, indicating a function in axonal traffic or signalling.     

Ilizarov external fixator for open fractures of the tibial shaft

Between December 1993 and 1999 we treated 34 open tibial diaphyseal fractures. Thirty patients were available for evaluation with a mean follow-up after fracture union of 40.5 (24–80) months. Patient average age was 33.1 (15–71) years. Two fractures were grade I, 16 grade II, six grade IIIA, five grade IIIB and one grade IIIC. The wound was debrided and the bone fixed with Ilizarov device. Soft-tissue healing was achieved through Z-plasty, delayed primary closure, split-thickness skin grafting, pedicle flaps and skin traction, and all fractures united with an average 5.6 (3–15.4) months. In 28 patients the results were excellent and good, in one fair and in one poor. Despite numerous complications the use of Ilizarov external fixator provides initial and definitive fracture stability.

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Résumé Entre décembre 1993 et 1999 nous avons traité 34 fractures diaphysaires tibiales ouvertes. Trente malades étaient disponibles pour l'évaluation avec un suivi moyen après consolidation de 40.5 (24–80) mois. L'âge moyen des malades était 33.1 (15–71) années. Deux fractures étaient de grade 1, 16 de grade II, 6 de grads IIIA, 5 de grade IIIB et 1 de grade IIIC. La blessure était débridée et l'os fixé avec l'appareil d'Ilizarov. La cicatrisation des parties molles a été obtenue avec des plasties en Z, des fermetures différées, des greffes de peau, des lambeaux pédiculés et des tractions cutanées. Toutes les fractures ont consolidé avec un délai moyen de 5.6 (3–15.4) mois. Pour 28 malades les résultats étaient excellents et bons, un était juste, et un mauvais. En dépit de nombreuses complications l'usage du fixateur externe d'Ilizarov fournit une stabilité initiale et définitive de la fracture.

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Sleeve lobectomy for bronchogenic cancers: factors affecting survival

BACKGROUND: Sleeve lobectomy is a parenchyma-sparing procedure that is particularly valuable in patients with cardiac or pulmonary contraindications to pneumonectomy. The purpose of this study is to report our experience with sleeve lobectomy for bronchogenic cancer and to investigate factors associated with long-term survival. METHODS: Between January 1981 and June 2001, 169 patients underwent sleeve lobectomy for non-small-cell lung cancer (n = 139) or carcinoid tumor (n = 30), including 61 with a preoperative contraindication to pneumonectomy. Mean age was 59 +/- 14 years (range, 19 to 82 years). Vascular sleeve resection was performed in 11 patients. The remaining bronchial stump contained microscopic disease in 7 patients. RESULTS: Major bronchial anastomotic complications occurred in 6 (3.6%) patients: one was fatal postoperatively, three required reoperation, and two were managed conservatively. In the non-small-cell lung cancer group, operative mortality was 2.9% (4 of 139), and overall 5-year and 10-year survival rates were 52% and 28%, respectively. Six patients experienced local recurrence after complete resection. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0 or N1 versus N2; p = 0.01) and microscopic invasion of the bronchial stump (p = 0.02). In the carcinoid tumor group, there were no operative deaths, and overall 5-year and 10-year survival rates were 100% and 92%, respectively. CONCLUSIONS: Sleeve lobectomy achieves local tumor control and is associated with low mortality and bronchial anastomotic complication rates. Long-term survival is excellent for carcinoid tumors. For patients with non-small-cell lung cancer, N2 disease or incomplete resection is associated with a worse prognosis; outcome is not affected by presence of a preoperative contraindication to pneumonectomy.