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SUMMARY OBJECTIVE: This study aimed to evaluate the diagnostic efficiency of contrast-to-noise and signal-to-noise ratios created by the contrast medium in detecting lymph nodes. METHODS: In this study, 57 short-axis subcentimeter lymph nodes in 40 cardiac computed tomography patients with noncontrast- and contrast-enhanced phases were evaluated. The contrast-to-noise ratios and signal-to-noise ratios of noncontrast- and contrast-enhanced lymph node-mediastinal fat and aortic-mediastinal fat tissues were determined. In addition, lymph nodes in noncontrast- and contrast-enhanced series were evaluated subjectively. RESULTS: There was a significant difference in lymph node-mediastinal fat signal-to-noise values between the contrast and noncontrast phases (p=0.0002). In the contrast phase, aortic density values were found to be 322.04±18.51 HU, lymph node density values were 76.41±23.41 HU, and mediastinal adipose tissue density values were −65.73±22.96 HU. Aortic-mediastinal fat contrast-to-noise ratio value was 20.23±6.92 and the lymph node-mediastinal fat contrast-to-noise ratio value was 6.43±2.07. A significant and moderate correlation was observed between aortic-mediastinal fat and lymph node-mediastinal fat contrast-to-noise ratio values in the contrast phase (r=0.605; p<0.001). In the contrast-enhanced series, there was a significant increase in the subjective detection of lymph nodes (p=0.0001). CONCLUSION: In the detection of paratracheal lymph nodes, the contrast agent increases the detection of short-axis subcentimeter lymph nodes quantitatively and qualitatively. Contrast enhances and facilitates the detection of paratracheal lymph nodes.
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ABSTRACT Objective: To compare the clinical and functional outcomes of two different graft fixation methods, all-inside and anteromedial (AM), for single-bundle anterior cruciate ligament (ACL) reconstruction techniques. Methods: Comparing the mid-term results of two groups, the prospectively recorded data of patients diagnosed with isolated ACL rupture between 2015 and 2016 were reviewed retrospectively. Two groups of patients who underwent unilateral isolated ACL reconstruction via two different tibial fixation techniques (19 patients with all-inside [Group 1]; 20 patients with AM portal [Group 2]) from the same institution were enrolled as the study group. The patients were called for the final follow-up and evaluated for symptoms, knee stability (Lachman test, pivot shift test, and KT-1000 arthrometer analysis), and functional scores (Tegner and Lysholm knee scoring scale, International Knee Documentation Committee [IKDC] subjective knee score, and visual analog scale [VAS]). Results: The mean age and follow-up period were statistically equal between the two groups. The functional comparison of patients with Tegner and Lysholm knee and IKDC scores, showed no statistical difference at the mid-term follow-up period. In the clinical assessment of the operated knees, based on the Lachman test and KT-1000 arthrometer, the anterior translation results in group 1 were better than those in group 2, which was statistically significant. However, we obtained similar pivot shift test results in both groups. Conclusion: The study showed that ACL reconstruction via the all-inside had functionally better anterior translation and similar rotational stability results compared with the AM portal technique. Level of Evidence III, Case Control Study.
RESUMO Objetivo: Comparar desfechos clínicos e funcionais de dois métodos de fixação do enxerto, all-inside e anteromedial (AM), em técnicas de reconstrução do ligamento cruzado anterior (LCA). Métodos: Comparação dos resultados de médio prazo de dois grupos, os dados obtidos prospectivamente de pacientes diagnosticados com ruptura isolada do LCA entre 2015 e 2016 foram retrospectivamente analisados. Doisgrupos de pacientes submetidosà reconstrução unilateral isolada do LCA por duas diferentes técnicas de fixação tibial (19 pacientes por all-inside [Grupo 1]; 20 pacientes por portal AM [Grupo 2]) da mesma instituição foram registrados como grupo de estudo. Os pacientes foram convocados para o último acompanhamento e avaliados sobre sintomas, estabilidade do joelho (teste de Lachman, teste de pivot-shift, e análise com artrômetro KT-1000), e escores funcionais (escore de Tegner e Lysholm para joelho, escala subjetiva de joelho do International Knee Documentation Committee (IKDC), e escala visual analógica [EVA]). Resultados: A idade média e período de acompanhamento foram estatisticamente iguais entre osdoisgrupos. A comparação funcional de pacientespelosescore de Tegner and Lysholm para joelho e do IKDC, não revelou diferenças estatísticas no acompanhamento de médio prazo. Na avaliação clínica dos joelhos operados, baseada no teste de Lachman e no artrômetro KT-1000, os resultados de translação anterior no grupo 1 foram melhores do que os do grupo 2, o que foi estatisticamente significante. Entretanto, obtivemos resultados similares do teste de pivot-shift em ambos os grupos. Conclusão: O estudo mostro que a reconstrução do LCA pela técnica all-inside apresentou melhor translação anterior functional e resultados de estabilidade rotacional similares aos da técnica do portal AM. Nível de Evidência III, Estudo de Caso Controle.
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ABSTRACT Objective: The aim of this study was to evaluate the functional results, complications, and morbidity and mortality rates in patients with end-stage chronic renal failure (ESCRF) with collum femoris fractures who were treated with hemiarthroplasty. Methods: From 2005 to 2013, patients with ESCRF admitted to our hospital with collum femoris fracture and treated with hemiarthroplasty were retrospectively evaluated, and 44 hips in 42 patients were included in the study. Duration of hospital stay, bleeding, complications, morbidity and mortality were recorded for each patient. At the last control evaluation, patients were assessed via pelvis x-ray and functional status according to Harris Hip Score (HHS). Results: Patients required a mean 2.7 units of erythrocyte suspension. Mean hospital stay was 19.74 days. The most common complication was bleeding. The complication rate was 38.1%; mortality rate at first-year follow-up was 42.8%, and mean HHS was 74.5. Conclusion: Collum femoris fractures are more common in ESCRF patients due to metabolic bone disease, and these patients had many comorbidities which may exacerbate high complication and mortality rates. Orthopedic surgeons should consider these higher complication rates and inform patients about the consequences of this treatment. Level of Evidence IV, Case Series.
RESUMO Objetivo: O objetivo deste estudo foi avaliar os resultados funcionais, as complicações e as taxas de morbidade e mortalidade em pacientes com insuficiência renal crônica em estágio terminal (IRCT) com fraturas do colo do fêmur tratados com hemiartroplastia. Métodos: De 2005 a 2013, pacientes com IRCT internados em nosso hospital com fratura do colo do fêmur e tratados com hemiartroplastia foram avaliados retrospectivamente, e 44 quadris em 42 pacientes foram incluídos no estudo. Durante a estadia hospitalar, hemorragia, complicações, morbidade e mortalidade foram registradas para cada paciente. Na última avaliação de controle, os pacientes foram examinados com radiografias da pelve e quanto ao estado funcional, de acordo com o Harris Hip Score (HHS). Resultados: Os pacientes precisaram em média 2,7 unidades de suspensão de eritrócitos. A estadia hospitalar média foi 19,74 dias. A complicação mais comum foi hemorragia. A taxa de complicações foi 38,1%; a taxa de mortalidade no primeiro ano de acompanhamento foi 42,8% e o HHS médio foi 74,5. Conclusão: As fraturas de colo do fêmur são mais comuns em pacientes com IRCT, em decorrência da doença óssea metabólica, e esses pacientes apresentam muitas comorbidades que podem exacerbar as altas taxas de complicação e mortalidade. Os cirurgiões ortopédicos precisam considerar esses altos índices de complicações e informar os pacientes sobre as consequências desse tratamento. Nível de Evidência IV, Série de Casos.