Diagnóstico de anomalias dentárias em radiografias panorâmicas / Diagnosis of anomalies in dental panoramic

Introdução: As alterações que ocorrem no processo de odontogênese são denominadas anomalias dentárias e são classificadas quanto à forma, como geminação, fusão, concrescência, dilaceração, cúspide em garra, dens in dente, taurodontia, micro e macrodontia, quanto ao número: dentes ou raízes supranumerários e agenesias e quanto posição, como transmigrações ou ectopias. Objetivo: Determinar a prevalência das anomalias dentárias radiografias de prontuários de pacientes atendidos na clínica de uma Instituição de Ensino Particular. Material e Métodos: Análise de 300 radiografias panorâmicas em negatoscópio, iluminado por duas lâmpadas fluorescentes de 20 watts cada, recoberto com máscara preta, com uma abertura central medindo 15x30 cm onde o filme panorâmico foi fixado, realizadas em ambiente escuro e, com o auxílio de lupa (aumento 2X) e interpretadas conjuntamente por dois observadores calibrados. Os achados radiográficos foram registrados em tabela própria, constando número prontuário, gênero, presença de alterações e anomalias dentárias de forma, número e posição. A análise estatística descritiva foi realizada pelo cálculo da frequência e percentual de acometimento e relações entre gênero e alterações dentárias encontradas. Resultados: Ocorrência de dilacerações (3,32%), dentes cônicos (1%), taurodontia (0,66%), dens in dente (0,33%) e cúspide em garra (5,66%), em relação às anomalias de tamanho observaram-se microdontias (5,33%), nos distúrbios de posição ocorrência como erupção ectópica (0,33%) e em casos de alterações de número, dentes (4,32%) e raízes supranumerárias (0,66%), sem diferenças estatísticas entre os gêneros. Conclusão: A prevalência de variações anatômicas em dentes permanentes é baixa, porém não rara, sem distinção entre os gêneros, mas de significado clínico por induzir, em algumas situações, o comprometimento pulpar ou dificultar terapias odontológicas.

Introduction: The changes that occur in the process of odontogenesis are called dental anomalies and are classified according to form as twinning, fusion, concrescence, laceration, claw cusp, dens in dente, taurodontia, micro and macrodontia, the number: teeth or agenesis and supernumerary roots and the position as transmigration or ectopic. Objective: To determine the prevalence of dental anomalies radiographs records of patients seen at the clinic of a private education institution. Material and Methods: Analysis of 300 panoramic radiographs in light box illuminated by two fluorescent lamps of 20 watts each, coated with black mask, with a central opening where the measuring 15x30cm panoramic film was set, held in dark, with the aid of magnifying (2X increase) and interpreted jointly by two calibrated observers. The radiographic findings were recorded in the table itself, consisting chart number, gender, presence of dental anomalies and changes in shape, number and position. Descriptive statistical analysis was performed by calculating the frequency and percentage of involvement and relationships between gender and dental abnormalities found. Results: Occurrence of lacerations ( 3.32% ) , conical teeth (1%) , taurodontia ( 0.66% ) in tooth dens (0.33 %) and peak claw (5.66 %) in relation to size abnormalities were observed microdontia (5.33 %), the occurrence position disorders such as ectopic eruption (0.33%) and number of cases of changes teeth (4.32%) and roots supernumerary (0.66 % ), without statistical differences between genders. Conclusion: The prevalence of anatomical variations in permanent teeth is low, but not rare, without gender distinction, but to induce clinical significance, in some situations, the pulp involvement or hinder dental therapies.

First-trimester screening for fetal structural and chromosomal anomalies by detailed early anomaly scan / 中华围产医学杂志

Objectives To assess the performance of first trimester ultrasound screening for fetal structural and chromosomal anomalies based on a detailed anomaly and nuchal translucency (NT) scan at 11-13+6 weeks' gestation.Methods A prospective cohort study was conducted at Nanjing Drum Tower Hospital.Fetuses with a crown-rump length (CRL) between 45 mm and 84 mm scanned during December 2015 to March 2016 were enrolled in this study.After a detailed first-trimester anomaly scan followed the protocol of systematic standardized scan plans,fetuses with congenital abnormalities were screened out.Second trimester ultrasound screening and postnatal examination were performed for further examination of fetal anomalies.Cytogenetic analysis was performed on the fetuses with informed consent.Results (1) A total of 1 154 fetuses were enrolled in this study and among them,36 (3.1％) cases of fetal abnormalities were diagnosed through prenatal examination (35 cases) and postnatal examination (one case).(2) Twenty-one (58.3％) out of the 36 cases with structural and chromosomal anomalies were screened out by using the first-trimester scan,including eight cases of congenital cardiac defect (two cases of atrioventricular septal defect,one case of tricuspid atresia,one case of tetralogy of tetralogy,one case of right ventricle aneurysms and one cases of hypoplastic left heart syndrome combined with cystic hygroma with one case combined with polydactyly),four cases of central nervous system anomaly (three cases of exencephaly and one case of anencephaly combined with double outlet right ventricle),two cases of cleft palate/lip with one case combined with double outlet right ventricle,two cases of exomphalos,one case of amniotic band syndrome,one case of spinal bifida combined with megacystis,one case of umbilical cyst,one case of polydactyly and one case of cystic hygroma.One case of twin pregnancy chose selective fetocide to the fetus with exencephaly and 16 cases terminated pregnancy.The other four cases were confirmed by second trimester ultrasound screening and postnatal examination.Fourteen (38.9％,14/36) new cases of structural and chromosomal anomalies were detected by the second-trimester scan,six of which terminated the pregnancies and the rest were confirmed at term.One (2.8％,1/36) case of polydactyly was detected postnatally.(3) Chromosomal microarray analysis was performed on 28 cases,seven of which were identified as having chromosomal abnormalities including five cases detected in the first trimester and two cases detected in the second trimester.(4) Out of the 20 fetuses with abnormal NT in early trimester,which accounted for 1.7％ of all enrolled fetuses,nine were indentified with major structural or chromosomal abnormalies,a quarter of all abnormal fetus.Conclusions Detailed anomaly scan and NT scan in the first-trimester can increase the detection rate of fetal structural and chromosomal anomalies as compared with the traditional NT scan and provide earlier detection of severe fetal abnormalities as compared with second trimester anomaly scan.

Ectrodactilia del pie. Reporte de dos casos / Ectrodactyly of the foot

Antecedentes: La ectrodactilia es una malformación congénita caracterizada por la presencia de hendiduras en los pies acompañada de agenesia e hipoplasia de los metatarsianos y falanges. Es un desorden genético muy poco frecuente, con una incidencia de 1:90,000-100,000 nacimientos vivos y no está ligada al sexo. Su patrón genético es de tipo autosómico dominante con penetrancia genética variable. El diagnóstico es clínico al momento del nacimiento; sin embargo, puede ser prenatal mediante ultrasonografía desde el primer trimestre de gestación. El manejo de la ectrodactilia incluye tanto el tratamiento quirúrgico como el no quirúrgico. Métodos: Se revisó el archivo de historias médicas desde enero 2005 a enero 2010, se incluyeron todos los pacientes con diagnóstico de ectrodactilia. Se encontraron dos pacientes que fueron tratados quirúrgicamente a los cuales se les realizó un seguimiento mínimo de tres años. Resultados: La evolución a largo plazo fue favorable permitiendo el uso de calzado y la marcha. No se evidenciaron recidivas o complicaciones. Los resultados finales fueron buenos de acuerdo a la escala de Tani y colaboradores. Discusión: De acuerdo a nuestros resultados a mediano y largo plazo en el manejo de estos dos casos de ectrodactilia, recomendamos la combinación del tratamiento ortopédico conservador, como preparación para la cirugía, y la resolución definitiva mediante cierre de la hendidura. El tratamiento quirúrgico realizado y el adecuado manejo postoperatorio permitieron el uso de calzado, mejorar la función y apariencia en ambos casos.

Background: Ectrodactyly is a congenital malformation characterized by the presence of clefts in the feet accompanied by aplasia and hypoplasia of the phalanges and metatarsals. It is a rare genetic disorder with an incidence of 1:90,000-100,000 live births and it is not linked to sex. Its genetic pattern is autosomal dominant with a variable genetic penetrance. Clinical diagnosis is made at birth, however it can be prenatal through ultrasound during the first trimester. Management of ectrodactyly includes both surgical and non-surgical treatment. Methods: We reviewed the archive of medical histories from January 2005 to January 2010, we included all patients with an ectrodactyly diagnosis. We found two patients who were treated surgically and were followed-up for three years. Results: The long term evolution was favorable, allowing the patient to wear shoes and walk. There were no recurrences or complications observed. The final results were good according to the Tani et al scale. Discussion: According to our medium and long term results in the management of these two cases of ectrodactyly, we recommend the combination of conservative orthopedic treatment as preparation for surgery and the final resolution with closure of the cleft. The surgical treatment performed and appropriate postoperative management allowed the patient to wear shoes, to improve function and appearance in both cases.

Anestesia en embarazada para traqueostomía urgente por hemangioma sangrante en lengua / Anesthesia for emergency tracheostomy due to bleeding hemangioma of the tongue in a pregnant patient

Paciente embarazada de 20 años de edad con diagnóstico de hemangioma cavernoso en lengua, labios y cuello, con sangrado activo. Fue programada para traqueostomía de emergencia bajo anestesia general. La inducción anestésica fue planeada con intubación despierta con fibrobroncoscopio acorde a los algoritmos de vía aérea difícil de ASA, siendo la vía aérea manejada con tubo endotraqueal número 5,5 Fr bajo infusión de remifentanilo a 0,02-0,05 µg/kg/min para sedación y se aplicó anestesia local en la vía aérea superior para disminuir el dolor y el reflejo nauseoso, mientras respiraba espontáneamente. La intubación traqueal fue realizada exitosamente. Posterior a una hora de cirugía con 200 cc de pérdidas sanguíneas, la paciente fue trasladada a la sala de cuidados posoperatorios. Su vía aérea fue manejada con tubo número 7,5 Fr y se realizó traqueostomía sin lesionar el hemangioma en cuello. Posteriormente fue programada para embolectomía de los vasos del hemangioma y luego será programará para escisión quirúrgica. En este caso la intubación en paciente despierto con fibrobroncoscopia bajo infusión con remifentanilo fue segura y útil para el abordaje del paciente con hemangioma sangrante en vía aérea.

We present the case of a 20-year-old pregnant patient diagnosed with cavernous hemangioma in her tongue, lips and neck with active bleeding. An emergency tracheostomy under general anesthesia was scheduled. Anesthesia was planned for conscious intubation with a fibrobronchoscope suited for the difficult airway management ASA algorithms. The airway was managed with a number 5.5 Fr. endotracheal tube under 0.02-0.05µg/kg/min remifentanyl infusion. The patient was sedated and given local anesthesia in the upper airway to reduce pain and gag reflex during spontaneous breathing. Intubation was successful. Having a total blood loss of 200 cc, the patient was taken to the postoperative care room hour after surgery. The airway was managed with a tracheostomy procedure using a number 7.5 Fr tube and without damaging the hemangioma. She was then scheduled for a vessel embolectomy and surgical removal. In this case, conscious intubation with remifentanyl was safe and adequate for the approach of the patient with bleeding airway hemagioma.