Rehabilitation with implant-supported overdentures in total edentulous patients: a review

Objectives: The main aim of this review article is to discuss implant-supported overdentures (ISOs) as treatment in edentulous patients. Besides, we will try to discuss among the different treatment options in such patients and to analyze their validity when ISOs are compared with other clinical modalities. At the same time, we will try to suggest clinical guidelines supported by current clinical studies. Material and methods: We performed a Medline search and review of pertinent articles on the mentioned subject from 1986 to 2011. As a searching strategy, we used the following words: implant-supported overdentures, attachment systems, Locator attachment, cantilever, fixed prosthesis. Results and conclusions: Implant-supported overdentures constitute an accurate and predictable treatment option and achieve a higher patient's satisfaction. This type of treatment constitutes a cheaper treatment than fixed prostheses and in some patients, with loss of lip support or with an interoclusal space larger than 15 mm, the choice of implant-supported overdentures seems to prevent future aesthetic or phonetic problems

PARACOCCIDIOIDOMYCOSIS IN A RENAL TRANSPLANT RECIPIENT

Paracoccidioidomycosis (PCM) is the most common endemic mycosis in Latin America. The etiological agents, which comprise two species, Paracoccidioides brasiliensis and P. lutzii, are thermodimorphic fungi that usually affect previously healthy adults. They primarily involve the lungs and then disseminate to other organs. Such mycosis is rare in organ transplant recipients; there have been only three cases reported in literature, until now. We report a case of PCM in a renal transplant recipient with an unusual dermatological presentation

Estudo do lavado broncoalveolar em pacientes com comprometimento pulmonar na leptospirose Study of bronchoalveolar lavage in leptospirosis patients with pulmonary involvement

INTRODUÇÃO: O comprometimento pulmonar é freqüente na leptospirose e caracteriza-se por hemoptise, dispnéia e infiltrados pulmonares bilaterais no radiograma de tórax. Esses achados podem ser compatíveis com hemorragia alveolar, previamente descrita por alguns autores em autópsias e em lavado broncoalveolar. OBJETIVO: Avaliar a presença de hemorragia alveolar, diagnosticada por meio do lavado broncoalveolar, em pacientes portadores de leptospirose com alterações pulmonares, enfatizando-se a importância do método para o diagnóstico precoce da complicação. MÉTODO: Sete pacientes com leptospirose foram submetidos à broncoscopia com lavado broncoalveolar. Todos apresentavam sinais e/ou sintomas respiratórios, e/ou infiltrados no radiograma de tórax, e/ou hipoxemia. A hemorragia alveolar foi definida pelos seguintes achados no lavado: porcentagem de siderófagos e"20%, escore de Golde > 100, e/ou presença de líquido hemorrágico. Foram realizados exame direto e cultura para Leptospiras, com o uso de meios específicos. O diagnóstico da doença foi confirmado por soroaglutinação microscópica para leptospirose. RESULTADOS: O aspecto da broncoscopia foi normal em 5 pacientes, mostrou sangramento na árvore brônquica em 1 caso e sinais inflamatórios em outro. O aspecto do lavado foi hemorrágico em todos os pacientes, configurando o quadro de hemorragia alveolar. A pesquisa direta e a cultura para Leptospiras foram negativas. CONCLUSÃO: A leptospirose deve ser considerada no diagnóstico diferencial das hemorragias alveolares.O lavado broncoalveolar mostrou-se um método eficaz para a detecção de hemorragia alveolar na leptospirose, servindo para orientar a terapêutica imediata, com a finalidade de prevenir sua evolução, caracterizada pela presença de hemoptises maciças e insuficiência respiratória.<br>BACKGROUND: Pulmonary involvement is common in leptospirosis and usually characterized by hemoptysis, dyspnea and diffuse bilateral infiltrates in chest X-rays. Such findings may be compatible with alveolar hemorrhage, already described by some authors both in autopsies and bronchoalveolar lavage (BAL). OBJECTIVE: To evaluate the presence of alveolar hemorrhage, diagnosed through BAL, in bearers of leptospirosis patients with pulmonary involvement emphasizing the methodís importance for early detection of this complication. METHOD: Seven patients with leptospirosis were submitted to BAL. All presented respiratory symptoms and/or infiltrates in the chest X-rays and/or hypoxemia.Alveolar hemorrhage was defined by the following findings in BAL: percentage of siderophages eî20% and/ or Golde score >100 and/or hemorrhagic fluid. Culture and direct tests for leptospirosis were performed in BAL. Diagnosis of disease was confirmed by microscopy serum agglutination. RESULTS: The aspect of the bronchoscopy was normal in five patients, showed blood in the bronchial tree in one case and inflammatory manifestations in another. The BAL aspect was hemorrhagic for all patients portraying alveolar hemorrhage. Culture and direct tests were negative for Leptospiras in the BAL. CONCLUSIONS: Leptospirosis must be taken into account in the differential diagnosis of alveolar hemorrhage. The BAL was confirmed as an efficient method for detection of alveolar hemorrhage in leptospirosis, to recommend immediate therapy for the purpose of preventing its evolution to massive hemoptysis and respiratory failure