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Introducción. La resonancia magnética nuclear es un estudio ampliamente usado, que se ha convertido actualmente en una herramienta imprescindible para la toma de decisiones terapéuticas en los pacientes con cáncer de recto. El objetivo de este estudio fue esclarecer si los informes actuales cumplen con las recomendaciones internacionales respecto a los ítems que deben incluir para tomar mejores decisiones en el manejo y el seguimiento de los pacientes. Métodos. Estudio observacional, retrospectivo, de una cohorte de seguimiento de pacientes con cáncer de recto a quienes se les realizó resonancia magnética nuclear para estadificación o re-estadificación posterior a una terapia neoadyuvante, entre julio de 2020 y julio del 2022, en 2 centros de referencia de la ciudad de Medellín, Colombia. Resultados. En total se evaluaron 205 informes de resonancia magnética nuclear tomadas en pacientes con cáncer de recto, de los cuales el 50,2 % fueron de diagnóstico inicial sin terapia neoadyuvante y el 49,7 % fueron informes de re-estadificación posterior a terapia neoadyuvante. Se evaluaron 13 ítems de los reportes de las resonancias. Se encontró que un 2 % de los reportes fueron de alta calidad, 14,6 % de moderada calidad y 83,4 % de baja calidad. Conclusiones. La mayoría de los reportes de resonancia magnética nuclear en pacientes con cáncer de recto son de baja calidad, por lo tanto, serán necesarias estrategias que mejoren la comunicación, la estandarización y la calidad de los estudios.

Introduction. Magnetic resonance imaging (MRI) is the widely used study, which today has become an essential tool for therapeutic decisions in patients with rectal cancer. The objective of this study was to clarify whether current reports comply with international recommendations regarding the items they should have to make better decisions in the patients management and follow-up. Methods. Observational, retrospective study of a follow-up cohort of patients with rectal cancer who underwent MRI for staging or re-staging after neoadjuvant therapy, between July 2020 and July 2022, in two reference centers in the city of Medellín, Colombia. Results. In total, 205 MRI reports in patients with rectal cancer were reviewed, of which 50.2% were initial diagnosis without neoadjuvant therapy and 49.7% were reports of restaging after neoadjuvant therapy; 13 items from the MRI reports were evaluated. It was found that 2% of the reports were of high quality, 14.6% of moderate quality and 83.4% of low quality. Conclusions. Most MRI reports in patients with rectal cancer are of low quality; therefore, strategies will be necessary to improve communication, standardization and quality of the studies.

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ABSTRACT Purpose: This study aimed to characterize retinitis pigmentosa associated with the eyes shut homolog gene, which causes hereditary retinal degeneration. Methods: The anatomical and functional findings of retinitis pigmentosa in patients with variants of the eyes shut homolog gene were characterized and compared using multimodal imaging and genetic analysis of the variants. Clinical data such as visual acuity, lens status, and refraction were obtained from medical records. Patients underwent an ophthalmic examination, including static visual field, microperimetry, optical coherence tomography, fundus autofluorescence, and fundus photography. Results: Twenty-two patients were included in the study. Several anatomical and functional characteristics of retinitis pigmentosa-eyes shut homolog were identified, including the presence of cataracts, cystoid macular edema, epiretinal membrane, and a tubular visual field. Genetic results revealed 26 distinct variants in the cohort, with 7 novel variants not previously documented or reported in the scientific literature or databases. Conclusion: The findings demonstrate that eyes shut homolog-retinitis pigmentosa manifests in specific patterns, starting in adolescence with mild progression and advancing with age. The integration of multimodal imaging and genetic analysis has provided a detailed understanding of the anatomical and functional features of retinitis pigmentosa-eyes shut homolog. Seven novel variants of the eyes shut homolog gene have been identified. These findings enhance the understanding of eyes shut homolog-related retinitis pigmentosa characteristics of by detailing the spectrum of mutations in this gene within the Brazilian population.

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El estridor es un síntoma de obstrucción de la vía aérea superior y puede ser resultado de causas congénitas o adquiridas. El diagnóstico suele ser clínico. Si es necesaria una investigación adicional para el diagnóstico diferencial, la endoscopia es el método de elección en la mayoría de los casos. Los estudios por imágenes son complementarios a la endoscopia. Permiten evaluar la patología laríngea y traqueobronquial, las compresiones extrínsecas de la vía aérea por tumores o malformaciones vasculares y definir la localización, extensión y características de una lesión. Son útiles en casos de duda diagnóstica y cuando la endoscopia no está disponible. Es fundamental comprender la anatomía y fisiopatología del tracto respiratorio, y ser conscientes de las indicaciones y limitaciones de los exámenes complementarios para el diagnóstico adecuado. Se describen las diferentes modalidades de imágenes disponibles para evaluar el estridor en pediatría y se discuten sus ventajas.

Stridor is a symptom of upper airway obstruction and may result from congenital or acquired causes. The diagnosis is usually clinical. If further investigation is necessary for differential diagnosis, endoscopy is the method of choice in most cases. Imaging studies are complementary to endoscopy. They allow evaluation of laryngeal and tracheobronchial pathology and extrinsic airway compressions due to tumors or vascular malformations and define a lesion's location, extent, and characteristics. They are helpful in cases of diagnostic doubt and when endoscopy is unavailable. It is essential to understand the anatomy and pathophysiology of the respiratory tract and to be aware of the indications and limitations of complementary examinations for proper diagnosis. The different imaging modalities available to evaluate stridor in pediatrics are described, and their advantages are discussed.

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Objetivo: O objetivo deste estudo foi destacar a potencial viabilidade do exame digital dos olhos na triagem neonatal a ser realizado por uma enfermeira para detectar anormalidades até 3 meses após o nascimento. Método: Trinta e quatro neonatos foram examinados neste estudo transversal. Foi utilizada uma câmera oftalmológica portátil Pictor Plus®, modelo VP2RET (Volk®, Mentor, USA). Para reduzir o desconforto durante o exame, uma solução oral de glicose a 25% foi administrada. Resultados: Foram avaliados 34 pacientes, dos quais 19 apresentaram resultados normais e 15 neonatos apresentaram alterações uni ou bilaterais. Conclusão: A triagem digital do fundo de olho em neonatos pode ser realizada por uma enfermeira para detectar anormalidades até 3 meses após o nascimento. Uma vez que o desenvolvimento do sistema visual ocorre concomitantemente com o desenvolvimento neuro motor da criança, a triagem digital do fundo de olho pode ter um impacto profundo na melhora não apenas ocular, mas também na saúde geral de recém-nascidos e crianças.(AU)

Objective: The aim of this study was to highlight the potential viability to the Digital Eye Fundus Triage Neonates examination be performed by a nurse in order to detect abnormalities until 3 months after birth. Method: Thirty-four neonates were examined at this transversal study. A Pictor Plus® portable digital ophthalmic camera, model VP2RET (Volk®, Mentor, USA) was utilized. To reduce discomfort during examination, a 25% oral glucose solution was administered. Results: Thirty-four patients participated, and 19 presented with normal results and 15 neonates presented with unilateral or bilateral alterations. Conclusion: The digital eye fundus triage examination could be performed by a nurse in order to detect abnormalities until 3 months after birth. Since visual system development occurs concomitantly with child ́s neuromotor development, the digital eye fundus triage may have a profound impact on improving not only ocular but on overall health of newborns and children.(AU)

El objetivo de este estudio fue resaltar la posible viabilidad de que la exploración de los neonatos mediante la Triage Digital del Fondo de Ojo pudiera ser llevada a cabo por una enfermera con el fin de detectar anomalías hasta 3 meses después del nacimiento. Método: Treinta y cuatro neonatos fueron examinados en este estudio cuantitativo aleatorizado. Se utilizó una cámara oftálmica portátil Pictor Plus®, modelo VP2RET (Volk®, Mentor, USA). Para reducir la incomodidad durante el examen, se administró una solución oral de glucosa al 25%. Resultados: Diecinueve neonatos presentaron resultados normales y 15 neonatos presentaron alteraciones unilaterales o bilaterales. Conclusión: La exploración de los neonatos mediante la Triage Digital del Fondo de Ojo podría ser llevada a cabo por una enfermera con el fin de detectar anomalías hasta 3 meses después del nacimiento. Dado que el desarrollo del sistema visual ocurre simultáneamente con el desarrollo neuromotor del niño, la Triage del Fondo de Ojo podría tener un impacto profundo en la mejora no solo de la salud ocular, sino de la salud general de los recién nacidos y niños.(AU)

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Introducción. La hidatidosis biliar es la complicación más frecuente de la hidatidosis hepática. La colangiopancreatografía retrógrada endoscópica desempeña un papel clave en el tratamiento. Caso clínico. Femenina de 57 años acude por dolor abdominal, vómito, diarrea, leucocitosis, hiperbilirrubinemia, en colangioresonancia magnética presenta vía biliar dilatada, defecto de señal en tercio proximal y distal. La colangiopancreatografía retrógrada endoscópica evidencia presencia de cuerpo extraño de aspecto de membranas, vía biliar dilatada, se extrae quistes de aspecto parasitario. Conclusión. El tratamiento de elección es quirúrgico y farmacológico, la colangiopancreatografía retrógrada endoscópica antes de la cirugía, asegura la extracción del material hidatídico y trata la obstrucción biliar, identifica el trayecto fistuloso y facilita su cierre mediante colocación de prótesis y esfinterotomía, por lo que constituye un tratamiento no quirúrgico efectivo y con margen amplio de seguridad.

Introduction: Biliary hydatid disease is the most common complication of hepatic hydatid disease. Endoscopic retrograde cholangiopancreatography plays a key role in treatment. Clinical case: A 57-year-old female presented with abdominal pain, vomiting, diarrhea, leukocytosis, mixed hyperbilirubinemia, and magnetic resonance cholangiography showed a dilated bile duct and a signal defect in the proximal and distal third. Endoscopic retrograde cholangiopancreatography shows the presence of a foreign body with a membrane appearance, a dilated bile duct, and cysts with a parasitic appearance. Conclusion: The treatment of choice is surgical and pharmacological, endoscopic retrograde cholangiopancreatography before surgery ensures the extraction of hydatid material and treats biliary obstruction, identifies the fistulous tract and facilitates its closure by placing a prosthesis and sphincterotomy, which is why it constitutes a Effective non-surgical treatment with a wide margin of safety.

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O objetivo deste estudo foi avaliar o desempenho do estudante de Odontologia no diagnóstico radiográfico de cáries proximais. Sessenta e oito estudantes de Odontologia passaram pelas etapas de treinamento teórico e prático para o diagnóstico radiográfico de cárie. O material foi constituído de exames radiográficos convencionais e digitalizados de 40 dentes humanos, sendo 20 pré-molares e 20 molares com alterações clínicas não tratadas em uma das superfícies proximais. Para avaliar a semelhança entre as referências de escores de diagnóstico radiográfico da cárie e a avaliação histológica foi aplicado o Coeficiente de Correlação Intraclasse, que mediu a assertividade entre os escores dos estudantes e o verdadeiro diagnóstico, a qual foi classificada em níveis de reprodutibilidade. Na avaliação da reprodutibilidade utilizando o coeficiente de correlação intraclasse, os valores obtidos para as imagens digitalizadas dos dentes pré-molares foram considerados satisfatórios, onde os estudantes do sétimo semestre mais se aproximaram do diagnóstico correto. Conclui-se que os estudantes do sétimo semestre tiveram melhor desempenho no diagnóstico radiográfico de cáries proximais.

The objective of this study was to evaluate the performance of the dental student in the diagnosis of proximal caries. Sixty-eight students of Dentistry underwent the stages of theoretical and practical training for the radiographic diagnosis of caries. The sample consisted of conventional and digitized radiographic examinations of 40 human teeth, 20 premolars and 20 molars with untreated clinical alterations on one of the proximal surfaces. To evaluate the similarity between the references of the radiographic diagnosis scores of the caries and the histological evaluation, the Intraclass Correlation Coefficient was used, which measured the assertiveness between the students' scores and the true diagnosis, which was classified in levels of reproducibility. In the evaluation of reproducibility using the intraclass correlation coefficient, the values obtained for the digitized images of the premolar teeth were considered satisfactory, where the students of the seventh semester more approached the correct diagnosis. It was concluded that the seventh semester students had better performance in the radiographic diagnosis of proximal caries.

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Las enfermedades quísticas renales son condiciones frecuentes cuya etiología puede ser muy heterogénea, por lo que se requiere un adecuado abordaje para su diagnóstico y manejo. El objetivo de este trabajo fue ilustrar parte del espectro de la enfermedad renal quística por medio de casos clínicos manejados en la Fundación Valle del Lili. Se describen 11 casos clínicos que incluyen enfermedades como displasia multiquística renal, enfermedad poliquística renal autosómica dominante y autosómica recesiva, entre otras. Las enfermedades quísticas renales varían en su presentación clínica, historia natural, hallazgos imagenológicos, bases genéticas y fisiopatológicas, por consiguiente, el enfoque diagnóstico y el manejo integral se debe realizar de forma individualizada y con un abordaje multidisciplinario.

Renal cystic diseases are common conditions whose etiology can be highly heterogeneous. They require a correct approach for adequate diagnosis and management. We aimed to illustrate part of the spectrum of renal cystic diseases through some clinical cases managed in our service. We describe 11 clinical cases including clinical entities such as renal multicystic dysplasia, and autosomal dominant and autosomal recessive polycystic renal disease, among other pathologies. Renal cystic diseases are heterogeneous in their clinical presentation, natural history, radiological findings, and genetic and pathophysiological basis. An integral clinical approach is needed to get a clear etiological diagnosis and offer adequate individualized care and follow-up for patients.

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Introduction. Cine-MRI (cine-magnetic resonance imaging) sequences are a key diagnostic tool to visualize anatomical information, allowing experts to localize and determine suspicious pathologies. Nonetheless, such analysis remains subjective and prone to diagnosis errors. Objective. To develop a binary and multi-class classification considering various cardiac conditions using a spatiotemporal model that highlights kinematic movements to characterize each disease. Materials and methods. This research focuses on a 3D convolutional representation to characterize cardiac kinematic patterns during the cardiac cycle, which may be associated with pathologies. The kinematic maps are obtained from the apparent velocity maps computed from a dense optical flow strategy. Then, a 3D convolutional scheme learns to differentiate pathologies from kinematic maps. Results. The proposed strategy was validated with respect to the capability to discriminate among myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy, abnormal right ventricle, and normal cardiac sequences. The proposed method achieves an average accuracy of 78.00% and a F1 score of 75.55%. Likewise, the approach achieved 92.31% accuracy for binary classification between pathologies and control cases. Conclusion. The proposed method can support the identification of kinematically abnormal patterns associated with a pathological condition. The resultant descriptor, learned from the 3D convolutional net, preserves detailed spatiotemporal correlations and could emerge as possible digital biomarkers of cardiac diseases.

Introducción. Las secuencias del cine-resonancia magnética (cine-MRI, cine magnetic resonance imaging) son una herramienta diagnóstica clave para visualizar la información anatómica que les permite a los expertos localizar y determinar aquellas anomalías que resulten sospechosas. No obstante, este análisis sigue siendo subjetivo y propenso a errores de diagnóstico. Objetivo. Desarrollar una clasificación binaria y multiclase, considerando diferentes condiciones cardiacas, mediante un modelo espaciotemporal que permita resaltar los movimientos cinéticos para caracterizar cada enfermedad. Materiales y métodos. Este estudio se centra en el uso de una representación de convolución 3D para caracterizar los patrones cinéticos durante el ciclo cardiaco que puedan estar asociados con enfermedades. Para ello, se obtienen mapas cinéticos a partir de mapas de velocidad aparente, calculados mediante una estrategia de flujo óptico denso. A continuación, un esquema de convolución 3D "aprende" a diferenciar patologías a partir de mapas cinemáticos. Resultados. La estrategia propuesta se validó según la capacidad de discriminar entre infarto de miocardio, miocardiopatía dilatada, miocardiopatía hipertrófica, ventrículo derecho anormal y un examen normal. El método propuesto alcanza una precisión media del 78,0 % y una puntuación F1 score del 75,55 %. Asimismo, el enfoque alcanzó el 92,31 % de precisión para la clasificación binaria entre enfermedades y casos de control. Conclusiones. El método propuesto es capaz de apoyar la identificación de patrones cinéticos anormales asociados con una condición patológica. El descriptor resultante, aprendido de la red de convolución 3D, conserva correlaciones espaciotemporales detalladas y podría surgir como posible biomarcador digital de enfermedades cardiacas.

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Apesar do crescimento darealização de diagnósticos por imagem em domicílio,com o avanço da telemedicina, ainda faltam diretrizes e padrões de segurança bem definidos. Objetivo: Mapear e caracterizar empresas que realizam diagnósticos por imagem em domicílio, e as legislações que regulamentam esses serviços no mundo. Métodos: O estudo utiliza análise documental com abordagem quantitativa e qualitativa. Realizou-se uma pesquisa de mercado que incluiu empresas que ofereciam serviços de diagnóstico por imagem em domicílio e uma pesquisa documental que abrangeu leis e regulamentações nacionais sobre esses serviços. Ambas as pesquisas foram feitas via Google, baseadas na relevância. Os dados quantitativos foram analisados por frequência absoluta e relativa, e os qualitativos, pela análise de conteúdo de Bardin. Resultados: Doze países apresentavam empresas que realizavam esse tipo de serviço, sendo distribuídas em diversos contextos socioeconômicos e realizavam em grande maioria raio-x e ultrassom. Dezesseis documentos de regulamentações referentesa nove países foram incluídos. Os resultados apresentaram diferentes enfoques agrupandosnas categorias: segurança, privacidade, documentação clínica, critérios de aplicação, equipamentos e equipes de diagnóstico. Conclusão: Essas descobertas ressaltam a importância de desenvolver e regulamentar serviços de diagnóstico domiciliar para atenderàs necessidades específicas da população, garantindo maior qualidade de serviço.(AU)

The performance of diagnostic imaging at home has grown with the advancement of telemedicine. However, there is a lack of well-defined guidelines and safety standards. Objective: To map and characterize companies that perform diagnostic imaging at home, and the laws that regulate these services worldwide. Methods: The study uses documentary analysis with a quantitative and qualitative approach. A market survey was conducted that included companies that offered diagnostic imaging services at home and a documentary survey that covered national laws and regulations on these services. Both surveys were conducted via Google, based on relevance. Quantitative data were analyzed by absolute and relative frequency, and qualitative data were analyzed by Bardin's content analysis. Results: Twelve countries had companies that performed this type of service, distributed in different socioeconomic contexts and mostly performed x-rays and ultrasounds. Sixteen regulatory documents related to nine countries were included. The results presented different approaches grouped into the following categories: security, privacy, clinical documentation, application criteria, equipment and diagnostic teams. Conclusion: These findings highlight the importance of developing and regulating home diagnostic services to meet the specific needs of the population, ensuring higher quality of service.(AU)

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Resumo A doença veno-oclusiva pulmonar (DVOP) e a hemangiomatose capilar pulmonar são tipos raros de substratos histopatológicos dentro do espectro da hipertensão arterial pulmonar (HAP) com prognóstico muito ruim. Caracterizam-se por um processo fibroproliferativo generalizado das veias e/ou capilares de pequeno calibre com preservação das veias maiores, resultando em um fenótipo de hipertensão pulmonar pré-capilar. A apresentação clínica é inespecífica e semelhante a outras etiologias de HAP. O diagnóstico definitivo é obtido por meio de análise histológica, embora a biópsia pulmonar não seja aconselhada devido ao maior risco de complicações. No entanto, alguns achados adicionais podem permitir um diagnóstico clínico presuntivo de DVOP, especialmente história de tabagismo, uso de drogas quimioterápicas, exposição a solventes orgânicos (particularmente tricloroetileno), baixa capacidade de difusão do monóxido de carbono (DLCO), dessaturação ao esforço e evidências de doença venosa sem doença cardíaca esquerda no exame de imagem, manifestada por uma tríade clássica de opacidades em vidro fosco, linhas septais, e linfadenopatias. O transplante pulmonar é o único tratamento eficaz e os pacientes devem ser encaminhados no momento do diagnóstico, devido à rápida progressão da doença e ao prognóstico ruim. Apresentamos o caso de um homem de 58 anos com HAP com características de envolvimento venoso/capilar em que a suspeita clínica, o pronto diagnóstico e o encaminhamento precoce para transplante pulmonar foram determinantes para um bom desfecho.

Abstract Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis are rare types of histopathological substrates within the spectrum of pulmonary arterial hypertension (PAH) with a very poor prognosis. They are characterized by a widespread fibroproliferative process of the small caliber veins and/or capillaries with sparing of the larger veins, resulting in a pre-capillary pulmonary hypertension phenotype. Clinical presentation is unspecific and similar to other PAH etiologies. Definitive diagnosis is obtained through histological analysis, although lung biopsy is not advised due to a higher risk of complications. However, some additional findings may allow a presumptive clinical diagnosis of PVOD, particularly a history of smoking, chemotherapy drug use, exposure to organic solvents (particularly trichloroethylene), low diffusing capacity for carbon monoxide (DLCO), exercise induced desaturation, and evidence of venous congestion without left heart disease on imaging, manifested by a classical triad of ground glass opacities, septal lines, and lymphadenopathies. Lung transplant is the only effective treatment, and patients should be referred at the time of diagnosis due to the rapid progression of the disease and associated poor prognosis. We present a case of a 58-year-old man with PAH with features of venous/capillary involvement in which clinical suspicion, prompt diagnosis, and early referral for lung transplantation were determinant factors for the successful outcome.

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Resumo Neoplasias cardíacas são raras, tendo como principal representante o mixoma atrial (MA), que corresponde a cerca de metade de todos os casos. O MA tem incidência estimada entre 0.001% e 0.3% na população em geral, no entanto apenas aproximadamente 0,06% desses cursam com eventos embólicos coronarianos. Homem de 33 anos, tabagista, admitido com quadro de precordialgia intensa e irradiação para membro superior esquerdo com duração de uma hora. O eletrocardiograma evidenciou elevação de segmento ST nas derivações D2, D3 e aVF troponina sérica elevada, confirmando infarto com supra desnivelamento do segmento ST (IAMCSST). Foi realizada cineangiocoronariografia, a qual revelou oclusão em terço proximal de artéria coronária direita por trombo. Realizada tentativa de aspiração do trombo, sem sucesso, seguido por angioplastia primária com balão sem colocação de stent. Durante a investigação do quadro, paciente realizou ecocardiograma transtorácico o qual demonstrou massa homogênea de superfície regular, de 5.2 cm x 2.3 cm, aderida ao septo interatrial, com lobulações de características emboligênicas prolapsando para valva mitral e ventrículo esquerdo na diástole, compatível com MA. Foi realizada ressecção cirúrgica com paciente evoluindo assintomático, recebendo alta para seguimento ambulatorial. O caso relatado difere em idade e sexo do perfil epidemiológico típico sendo um dos poucos descritos com acometimento da parede inferior apresentando a artéria coronária direita como culpada. Este relato ratifica a importância do diagnóstico diferencial frente às apresentações de IAMCSST em jovens.

Abstract Cardiac tumors are rare entities, among which atrial myxoma (AM) stands as the most frequent, accounting for approximately half of all reported cases. The incidence of AM is estimated to range from 0.001% to 0.3% within the general population, yet only about 0.06% of these cases present with coronary embolic events. We report on a 33-year-old male smoker who experienced acute, severe precordial pain radiating to the left upper limb, lasting for one hour. The electrocardiographic evaluation demonstrated ST-segment elevation in leads D2, D3, and aVF, alongside significantly elevated serum troponin levels, confirming a diagnosis of ST-segment elevation myocardial infarction (STEMI). Subsequent coronary angiography revealed proximal occlusion of the right coronary artery due to thrombus. An initial attempt of thrombus aspiration was unsuccessful, followed by primary angioplasty with balloon inflation without stent placement. Further diagnostic exploration through transthoracic echocardiography identified a homogenous, smooth-surfaced mass measuring 5.2 cm x 2.3 cm attached to the interatrial septum. This mass, characterized by lobulations, prolapsed into the mitral valve and left ventricle during diastole, consistent with AM. Surgical resection of the mass was successfully performed, with the patient being discharged asymptomatic. In the reported case, the patient's profile, notably his age, and gender, diverges from the typical epidemiological characteristics associated with AM. This case adds to the limited number of reports where the inferior wall is affected by the right coronary artery being occluded. This report emphasizes the significance of differential diagnoses in younger patients presenting with STEMI.

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El mesiodens es el diente supernumerario que se origina en la premaxila, siendo considerado el más prevalente o el más diagnosticado debido a las numerosas alteraciones que producen y que incluyen malposición de los dientes permanentes, formación de diastemas, retraso en la erupción de los incisivos anteriores superiores, y formación de quistes. La etiología de los mesiodens no está completamente comprendida, aunque se piensa que pueda deberse a la proliferación de la lámina dental u otros factores genéticos. El diagnóstico generalmente es tardío debido a que la mayoría permanece sin erupcionar, pudiendo generar complicaciones dentomaxilares que finalmente son el motivo de consulta de los pacientes. El quiste dentígero es un quiste odontogénico del desarrollo asociado a la corona de un diente incluido, numerario o supernumerario y su tratamiento es quirúrgico. El diagnóstico temprano y la planificación del tratamiento debe considerar una anamnesis minuciosa, un examen clínico e imágenes 3D. La cirugía debe consistir en la desinclusión del diente causal, la exéresis y legrado de la lesión, con o sin regeneración ósea inmediata del lecho quirúrgico con injerto. Se presentan dos casos de quiste dentígero asociado a un mesiodens que se diagnosticaron como hallazgo radiográfico. El plan de tratamiento consistió en evaluación y tratamiento endodóntico de los dientes desvitalizados, enucleción y legrado del quiste, junto a la desinclu sión del diente supernumerario, y seguimiento clínico y radiográfico en el largo plazo.

Mesiodens is the supernumerary tooth that originates in the premaxilla, considered the most prevalent or, the most diagnosed due to the multiple alterations that produce and that include malposition of the permanent teeth, formation of gaps, delayed eruption of the upper anterior incisors and cyst formation. The etiology of mesiodens is not fully established, although it is thought that it may be due dental lamina alteration or other genetic factors. Diagnosis is usually late because most remain unerupted, and can generate dentomaxillary complications that are ultimately the reason for patient consultation. The dentigerous cyst is a developmental odontogenic cyst associated with the crown of an included, numerary or supernumerary tooth and its treatment is surgery. Early diagnosis and treatment planning should consider a careful history, clinical examination, and 3D imaging. The surgery must consist of the disinclusion of the offending tooth, the exeresis and curettage of the lesion, with or without immediate bone regeneration of the surgical bed with a graft. Two cases of a dentigerous cyst associated with a mesiodens that were diagnosed as a radiographic finding are presented. The treatment plan consisted in evaluation and endodontic treatment of devitalized teeth, enucleation and curettage of the cyst, together with the disinclusion of the supernumerary tooth, and long-term clinical and radiographic follow-up.

ABSTRACT

Objetivo: revisar a literatura acerca da presença de anomalias dentárias por meio de radiografias panorâmicas de pacientes com fissura labiopalatina. Métodos: a busca foi realizada utilizando-se os descritores DECs/MeSH "Radiography, panoramic", "Cleft palate" e "Tooth Abnormalities", submetidos às bases de dados LILACS, SciELO, PubMed e Portal de Periódicos da Capes. Foram aceitos artigos observacionais e de caso-controle, publicados entre 2018 e 2022, em português, inglês ou espanhol. Resultados: trinta e dois artigos foram encontrados a partir dos critérios de inclusão. Dentre eles, foram excluídos artigos de revisão, relatos de caso e livros, além daqueles que não se enquadraram nos objetivos do estudo ou que estivessem publicados exclusivamente em outras línguas. Por fim, 5 artigos compuseram esta revisão. Entre as anomalias dentárias identificadas, a agenesia foi a mais prevalente, acometendo, majoritariamente, o incisivo lateral superior. Outras anomalias encontradas também foram relatadas, como hiperdontia, impactações, dilacerações radiculares, giroversões, geminações e fusões, e distúrbios na erupção. Conclusão: é possível considerar a radiografia panorâmica como recurso auxiliar no diagnóstico dessas anomalias com maior precisão.

Objective: the aim of this study is to review the literature on the presence of dental anomalies identified through panoramic radiographs of patients with cleft lip and palate. Methods: the search was carried out using the DECs/MeSH descriptors "Radiography, panoramic", "Cleft palate", and "Tooth Abnormalities", which were submitted to the LILACS, SciELO, PubMed, and Portal de Periódicos da Capes databases. Observational and case-control articles published between 2018 and 2022 in English, Portuguese, and Spanish were accepted. Results: thirty-two (32) articles were accepted according to the inclusion criteria. Among them, review articles, case reports and books were excluded, as well as articles that did not fit the objectives of this study or that were published only in other languages. Finally, five (5) articles were considered to compose this review. Among the identified dental anomalies, dental agenesis was the most prevalent, especially affecting the upper lateral incisor. Other anomalies found were also reported, such as hyperdontia, impaction, root laceration, rotation, twinning, and fusion, in addition to eruption disorders. Conclusion: It's possible to consider panoramic radiography as an important resource in the diagnosis of these anomalies with more precision.

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RESUMEN Objetivo: Determinar la sensibilidad y la especificidad de la endosonografía biliopancreática (ESBP) para diagnóstico en pacientes con riesgo intermedio de coledocolitiasis, derivados a un centro especializado de Gastroenterología quirúrgica de Unión de Cirujano SAS - Oncólogos de Occidente grupo Zentria - Manizales - Colombia entre el 01 de marzo de 2020 al 31 de enero de 2022. Materiales y métodos: Estudio retrospectivo transversal en pacientes con riesgo intermedio para coledocolitiasis. Se calculó el rendimiento diagnóstico de la ESBP y se confirmó con CPRE. Se hizo seguimiento telefónico a los ESBP negativas. Resultados: Se analizaron 752 casos con ESBP de los cuales el 43,2% (n=325) fue positivo y el 56,8% (n=427) fue negativo. Se practicó CPRE en los casos positivos que aceptaron el procedimiento (n=317); el 73,5% (n=233) fueron positivos para coledocolitiasis, el 25,8% (n=82) tumores y el 0,6% (n=2) áscaris biliares. Pacientes con ESBP positiva fueron intervenidos con CPRE. Se obtuvo S= 98,3% (IC 95%: 95,7-99,5); E= 88,1% (IC 95%: 79,2-94,1); VPP = 95,8% (IC 95%: 92,4-98,0); VPN = 94,9% (IC 95%: 87,4-98,7). El AUC de ESBP fue de 0,9319 (IC 95% 0,8961-0,967). Conclusión: En pacientes con riesgo intermedio para coledocolitiasis, la ESBP es una opción diagnostica útil en el estudio de patologías pancreáticas, árbol biliar extrahepático, y la identificación de microlitiasis biliares; por lo que nos permite además poder complementarla con una intervención terapéutica como la CPRE en un solo tiempo.

ABSTRACT Objective: Determine the sensitivity and specificity of the ESBP for diagnosis in patients with intermediate risk of choledocholithiasis, referred to the specialized surgical Gastroenterology center of Unión de Cirujanos SAS - Oncologists of the West Zentria group - Manizales - Colombia between March 01, 2020 to January 31, 2022. Materials and methods: Retrospective cross-sectional study in patients with intermediate risk for choledocholithiasis. The diagnostic performance of ESBP was calculated and confirmed with ERCP. Negative ESBPs were followed up by telephone. Results: 752 cases with ESBP were analyzed, of which 43.2% (n=325) were positive and 56.8% (n=427) were negative. ERCP was performed in positive cases who accepted the procedure (n=317); 73.5% (n:233) were positive for choledocholithiasis, 25.8% (n=82) tumors and 0.6% (n=2) biliary roundworms. Patients with positive ESBP underwent ERCP. S= 98.3% (95% CI: 95.7-99.5) was obtained; E= 88.1% (95% CI: 79.2-94.1); PPV = 95.8% (95% CI: 92.4-98.0); NPV = 94.9% (95% CI: 87.4-98.7). The AUC of ESBP was 0.9319 (95% CI 0.8961-0.967). Conclusion: In patients with intermediate risk for choledocholithiasis, ESBP is a useful diagnostic option in the study of pancreatic pathologies, extrahepatic biliary tree, and the identification of biliary microlithiasis; Therefore, it also allows us to complement it with a therapeutic intervention such as ERCP in a single time.

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Presentación del caso. Se trata de una paciente femenina de 45 años con antecedentes de hipertensión arterial y múltiples cirugías por cáncer, entre ellas, cáncer de tiroides, carcinoma de parótida, cáncer de mama y cáncer endometrial. De manera incidental se identificó una lesión en el hemisferio cerebeloso derecho en una tomografía de senos paranasales, que fue confirmada a través de una resonancia magnética cerebral. La lesión presentaba una apariencia estriada, característica de gangliocitoma displásico del cerebelo o enfermedad de Lhermitte-Duclos. Considerando los antecedentes de diversos tipos de cáncer y los criterios de diagnóstico propuestos por el Consorcio Internacional Cowden y la Red Nacional Integral del Cáncer, se estableció el diagnóstico de síndrome de Cowden que había pasado desapercibido hasta el momento. Intervención terapéutica. Posteriormente, la paciente fue hospitalizada debido al crecimiento de una masa metastásica en el hemicuello derecho con afectación del plexo braquial, adenopatías cervicales, infraclaviculares y axilares derechas. Evolución clínica. En la actualidad, se encuentra recibiendo tratamiento paliativo con el objetivo de controlar los síntomas y mejorar su calidad de vida, ya que expresó su negativa a someterse a una intervención quirúrgica de resección tumoral

Case presentation. The report is of a 45-year-old female patient with a history of high blood pressure and multiple surgeries for cancer, including thyroid cancer, parotid carcinoma, breast cancer, and endometrial cancer. Incidentally, a lesion in the right cerebellar hemisphere was identified in a tomography of the paranasal sinuses, which was later confirmed in a brain magnetic resonance. The lesion had a striated appearance, characteristic of dysplastic gangliocytoma of the cerebellum or Lhermitte-Duclos disease. Considering the history of various types of cancer and the diagnostic criteria proposed by the International Cowden Consortium and the National Comprehensive Cancer Network, the diagnosis of Cowden syndrome, which had gone unnoticed until now, was established. Treatment. Subsequently, the patient was hospitalized due to the growth of a metastatic mass in the right hemicollar with involvement of the brachial plexus, cervical, infraclavicular, and right axillary lymph nodes. Outcome. She is receiving palliative treatment to control the symptoms and improve her quality of life, since she expressed her refusal to undergo tumor resection surgery

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Introducción. La evaluación de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides hace parte de la adecuada valoración integral. Aunque la laringoscopia directa es prueba de referencia, su uso real no es rutinario por lo que se propone la ecografía translaríngea como alternativa de evaluación. Métodos. Estudio prospectivo de evaluación de una prueba diagnóstica de la movilidad de las cuerdas vocales pre y posoperatoria, comparando la ecografía translaríngea con la video laringoscopia, en pacientes con cirugía de tiroides y paratiroides, de febrero 1° a noviembre 30 de 2022. Se describieron las variables usando frecuencias absolutas y relativas. En el análisis univariado se calcularon Chi cuadrado y T de Student y en el bivariado, regresión logística binaria. La agudeza diagnóstica se determinó con sensibilidad, especificidad y valores predictivos; se consideró la significancia estadística con p < 0,05. Resultados. Se incluyeron 267 pacientes, 219 mujeres y 48 hombres; 196 pacientes (73,4%) tenían malignidad. Se encontró en el preoperatorio, sensibilidad 100 %, especificidad 99,6 %, VPP 83,3 %, VPN 100 %, odds de probabilidad positiva 83 % y Odds de probabilidad negativa 0,004 %. En el posoperatorio, sensibilidad 82,8 %, especificidad 99,2 %, VPP 92,3 % VPN 97,9 %, odds de probabilidad positiva 92 % y odds de probabilidad negativa 0,2 %. Conclusiones. La ecografía translaríngea en nuestro medio tiene alta agudeza diagnóstica. Podría ser usada en el abordaje inicial de la evaluación de la movilidad de las cuerdas vocales y reemplazar la laringoscopia directa, dejando ésta para cuando la visualización ecográfica no sea adecuada, o en casos de afectación o sospecha de invasión, para su confirmación.

Introduction. The evaluation of the mobility of the vocal cords in thyroid and parathyroid surgery is part of the adequate comprehensive assessment. Altough, direct laryngoscopy is the gold standard, its real use is not routine, so translaryngeal ultrasound approach is proposed as an alternative. Methods. A prospective diagnostic test study was carried out to evaluate the translaryngeal ultrasound compared with video laryngoscopy in visualizing vocal mobility in patients with thyroid and parathyroid surgery from February 1 to November 30, 2022. Patients were described using absolute and relative frequencies. Univariate statistical analysis with Chi-square and Student's t tests. T. Bivariate analysis using binary logistic regression. Diagnostic acuity was calculated with sensitivity, specificity, PPV, NPV. Statistical significance with p< 0.05, 95% confidence interval. Results. 267 patients undergoing thyroid or parathyroid surgery were included, 219 women and 48 men. Malignant: thyroid neoplasm 196 patients (73.4%). The findings were for the preoperative period, 100% sensitivity, 99.6% specificity, PPV 83.33%, NPV 100%, 83% positive probability odds, and 0.004% negative probability odds. For the postoperative period, 82.8% sensitivity, 99.2% specificity, 92.3% PPV, 97.9% NPV, 92% positive probability odds, and 0.2% negative probability odds were found.Conclusions. Translaryngeal ultrasound in our series has high diagnostic acuity. It could be used as the initial approach to evaluate vocal mobility and might replace direct laryngoscopy, leaving it when its visualization is not adequate or in cases of involvement or suspected invasion for confirmation.

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Abstract Background: Currently, there is no uniform and official terminology in Portuguese for reflectance confocal microscopy analysis, despite the increasing number of Brazilian dermatologists using this new tool. Objective: To present the terminology in Brazilian Portuguese for the description of reflectance confocal microscopy and establish the first Brazilian consensus on terms related to normal skin and cutaneous tumors. Methods: 10 Brazilian specialists from different institutions and states of Brazil were selected to evaluate the best corresponding terms in Portuguese for normal skin, melanocytic and non-melanocytic tumors. The terms used were translated from international consensuses in the English language. The modified Delphi method was used to create the consensus in 3 steps. Results: The terms considered the most appropriate in the Portuguese language to describe the findings of normal skin, melanocytic and non-melanocytic lesions in the reflectance confocal microscopy analysis were presented. Study limitations: The limitations of the present study include the number of participants and limited regional representation (only two of the five Brazilian regions were represented). Conclusion: This Brazilian consensus represents an opportunity for dermatologists and physicians specializing in cutaneous oncology to become familiar with reflectance confocal microscopy, propagating the technique in clinical and research environments to stimulate national and international publications on this subject.