Contribuções da imagem digitalizada na avaliação da qualidade da obturação endodôntica.

Recibido: Noviembre-2002 Aceptado: Diciembre-2002Todas as fases do tratamento endodôntico devem ser enfrentadas com a mesma atenção, outorgando igual importância para cada uma delas: correto diagnóstico, orientação do tratamento, realização de um preparo biomecánico pormenorizado e uma obturação suficientemente compactada para garantir um selamento impermeável do canal radicular a nível apical, lateral e coronário, reconstrução coronária e acompanhamento pós-operatório. Definida a obturação como a substituição do espaço obtido após o preparo cirúrgico do canal radicular por um material inerte ou antisséptico, estável, tridimensional e permanente, a principal função é atuar como obstáculo impenetrável para líquidos ou bactérias, e o material de obturação deverá estar suficientemente compactado como para ser radiograficamente aceitável. Existem muitos estudos demonstrando que o sucesso e o fracasso terapêutico está intimamente relacionado com a qualidade da obturação e sua compactação transversal. Tradicionalmente a avaliação da qualidade da obturação endodôntica se realiza através da observação radiográfica do: limite apical da obturação, grau de compactação e selamento coronário. (16). Porém, esta visão analógica é limitada, já que registra em um plano uma imagem tridimensional. Embora todas as técnicas sejam valiosas, nenhuma nos satisfaz totalmente para avaliar a qualidade da obturação. As imagens digitais são obtidas tanto por métodos diretos, através de Radiovisiógrafos ou programas Digoras, como por métodos indiretos, através da capturação de radiografias realizada por um scanner. As imagens digitais fornecem uma nova ferramenta que permite visualizar desde outra perspectiva as concentrações dos nuances do cinza. Os objetivos propostos para este trabalho foram: digitalizar radiografias periapicais, usando as ferramentas de um programa de processamento de imagens digitais e determinar se favorecem a avaliação da compactação das obturacões endodônticas. Foram selecionados 15 filmes radiográficos periapicais de pacientes dos alunos do curso de graduação da Disciplina de Endodontia da Faculdade de Odontologia de Rosario, com canais obturados, que foram classificados: alguns como aceitavelmente bem condensados e outros como pobremente condensados. Os filmes radiográficos foram capturados por um scanner Agfa e digitalizados. Para o processamento das imagens foi escolhido o programa ";IMAGE TOOL";(r), desenvolvido pela Faculdade de Odontologia do Centro de Saúde em San Antonio da Universidade de Texas (UTHSCSA). Foram utilizadas alguns ferramentas no tratamento das imagens. Os dados obtidos foram submetidos a uma avaliação estadística e resumidos em uma planilha

Aportes de la imagen digitalizada a la valorización de la calidad en la obturación endodóntica.

Todas las etapas del tratamiento endodóntico deben ser encaradas con la misma atención, otorgándosele igual importancia a cada una de ellas: correcto diagnóstico, orientación del tratamiento, realización de una limpieza y tallado minuciosos y una obturación lo suficientemente compactada, que garanticen el sellado impermeable del conducto radicular a nivel apical, lateral y coronario, reconstrucción coronaria y seguimiento a distancia. (1) Definida la obturación como el reemplazo del espacio logrado en la preparación quirúrgica del conducto radicular por un material inerte o antiséptico, estable, tridimensional y permanente, es su finalidad prioritaria funcionar como una barrera impenetrable para líquidos o bacterias, y el material de obturación deberá estar lo suficientemente compactado para ser radiográficamente aceptable. Numerosos son los estudios demostrando que los éxitos y fracasos terapéuticos están íntimamente relacionados con la calidad de la obturación y su compactación transversal. Tradicionalmente, la valoración de calidad de la obturación endodóntica se realiza mediante la observación radiográfica de: límite apical de la obturación, grado de compactación, y sellado coronario.(16). Sin embargo, esta visión analógica es limitada, ya que registra en un plano una imagen tridimensional. Si bien todas las técnicas son valiosas, ninguna nos satisface totalmente para estimar la calidad de la obturación. Las imágenes digitales son aquellas que se obtienen tanto por métodos directos, a través de Radiovisiógrafos o sistemas Digoras, e indirectos como las radiografías escaneadas. Las imágenes digitales aportan una nueva herramienta que permite visualizar desde otra perspectiva las concentraciones de matices de grises. Los objetivos propuestos para este trabajo fueron: digitalizar radiografías periapicales, aplicando herramientas de un programa de tratamiento de imágenes digitales, y determinar si las mismas favorecen la valoración de la compactación de las obturaciones endodónticas. Se seleccionaron 15 placas radiográficas periapicales de pacientes de los alumnos de grado de la Cátedra de Endodoncia de la Facultad de Odontología de Rosario. Correspondieron a piezas dentarias con conductos obturados, que fueron valorados unos como aceptablemente bien condensados y otros como pobremente condensados. Las placas radiográficas fueron ";escaneadas"; usando un Scanner Agfa , procediéndose a convertirlas en imágenes digitales. Para el procesamiento de las imágenes se escogió el programa ";IMAGE TOOL";®. Las imágenes se trataron con varias herramientas del programa. Los resultados se tabularon y los datos fueron procesados estadísticamente y resumidos en una planilla

Contribution of the digital image to the assessment of quality in endodontic obturation.

Every stage of the endodontic treatment should be equally approached, giving each one the same importance: correct diagnosis, treatment orientation, meticulous cleaning and instrumentation and a sufficiently compacted obturation that would guarantee the impermeable sealing of the root-canal in its apical, lateral and coronal levels, coronal reconstruction and distance control. Having defined obturation as the replacement of the space achieved in the surgical preparation of the root-canal by an inert or antiseptic, stable, three-dimensional and permanent material, its priority objective is to operate as an impregnable barrier to liquids and bacteria and the material for obturation must be sufficiently compacted to be radiographically acceptable. Several studies have shown that the therapeutic successes and failures are closely related to the quality of the obturation and its transverse compaction. Traditionally, the assessment of the endodontic obturation quality has been done by radiographic observations of: the apical limit of obturation, the degree of compaction and the coronal obturation. (16). Yet this analogical view is limited, since it records a three- dimensional image on a plane. Even though every technique is valuable, none of them meets totally our expectations to estimate the quality of obturation. The digital images are those obtained both by direct methods through radiopvisiograhs or Digoras systems and indirect ones through scanned x-rays. The digital images provide a new tool that enables us to visualize from another viewpoint the slight differences of gray concentrations. The aims suggested for this work were as follows: digitalizing of periapical X-rays, applying some tools of a program of digital image treatment, and determining if they themselves favor the assessment of the endodontic obturation compaction.. 15 periapical radiographic plates from patients of the undergraduates of the Chair of Endodontics of the School of Dentistry of Rosario were selected. These plates corresponded to teeth with sealed canals. Some were assessed as acceptably well condensed and others as poorly condensed.The radiographic plates were ";scanned"; using an Agfa Scanner, and transforming them into digital images. For the image processing the ";IMAGE TOOL";® program was chosen The images are treated through the different tools.. The data was statistically processed and summarized in a table

S(+)-ketamine for control of perioperative pain and prevention of Post Thoracotomy Pain Syndrome: A randomized, double blind study.

BACKGROUND: Post-thoracotomy pain syndrome (PTPS) often complicates the long term outcome of patients; its appearance has been related to perioperative acute pain. The main goal of this study was to evaluate a possible role of S(+)-ketamine in the prevention of PTPS up to 6 months and secondarily its efficacy in the control of perioperative pain when added to thoracic epidural analgesia (TEA) and adjuvants. METHODS: Sixty-six patients underwent thoracotomy under general anesthesia. A thoracic epidural catheter was placed for levobupivacaine and sufentanil administration. Thirty-three patients received an i.v. infusion of S(+)-ketamine (Group S(+)K) for 60 hours and 33 patients received i.v. placebo (Group PLAC). Pain was evaluated by Numeric Rating Scale (NRS) during the whole study. All patients had supplementary doses of analgesics, as needed, to have NRS targeted to a value of 643 in the 1st and <3 in the following days. Neuropathic Pain Symptom Inventory (NPSI) was evaluated at 1, 3 and 6 months. RESULTS: All patients had NRS 643 in the early postoperative period and NPSI was less or equal to 1 in the follow-up control for each group with no significant difference at three (P=0.67, OR 0.8 [IC95% 0.3-2.2]) and at six months (P=0.23, OR 1.9 [0.7-5.4]). Incidence of moderate PTPS was 24.6% at 3 and 21.1% at six months while severe PTPS was 6.6% at 3 and 1.8% at six months. No difference was detected in NRS and NPSI at 3 and 6 months between groups. CONCLUSION: S(+)-ketamine had no effects in respect to placebo in the prevention of PTPS at 3 and 6 months but had a significant role in maintaining a NRS 643 in the early postoperative period. A tight control of perioperative pain seems to be associated with a low incidence of moderate and severe PTPS

Triptan use in Italy: Insights from administrative databases.

In this drug utilization study, we aimed at assessing the pattern of triptan use in Italy by means of the drug prescription databases of two local health authorities, accounting for approximately 1 million citizens.The study population included all residents aged 18 to 84 years in the Vercelli province (about 175,000 inhabitants) and in the Umbria region (about 885,000 inhabitants), who had at least one dispensation for triptans in 2012. A frequent user, who might be at risk of medication-overuse headache (MOH), was defined as a patient being dispensed at least 10 defined daily doses (DDD) of triptans every month for at least three consecutive months.Triptans were used by 0.7\%-1\% of the population. While most patients were dispensed fewer than 60 DDDs per year, about 10\% of all triptan users were classified as frequent users. In both areas, patients below the age of 29 were less likely to be frequent users while the 40- to 49-year-old population was the most affected, with no sex difference. About two-thirds of frequent users persisted in this behavior for an additional three-month period in the following six months.Our data indicate that approximately 10\% of all triptan users in the Italian population are potentially at risk for MOH. An approach based on drug prescription databases could be useful to identify patients at risk for MOH

Correction to: Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial (Journal of Translational Medicine, (2020), 18, 1, (405), 10.1186/s12967-020-02573-9)

Following publication of the original article [1] the authors identified that the collaborators of the TOCIVID-19 investigators, Italy were only available in the supplementary file. The original article has been updated so that the collaborators are correctly acknowledged. For clarity, all collaborators are listed in this correction article

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)