ABSTRACT
ABSTRACT Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.
RESUMO Introdução: Doenças pulmonares são comuns em pacientes com doença renal em estágio terminal (DRET), dificultando o diagnóstico diferencial com COVID-19. Este estudo descreve achados de tomografia computadorizada de tórax (TC) em pacientes com DRET em terapia renal substitutiva (TRS) hospitalizados com suspeita de COVID-19. Métodos: Indivíduos maiores de 18 anos com DRET, encaminhados ao pronto-socorro com suspeita de COVID-19 foram incluídos. Dados clínicos e epidemiológicos foram extraídos de registros eletrônicos de saúde. A TC foi classificada como típica, indeterminada, atípica, negativa. Comparamos achados tomográficos de pacientes com COVID-19 positivos e negativos. Resultados: Recrutamos 109 pacientes (62,3% COVID-19-positivos) entre março e dezembro de 2020, idade média de 60 ± 12,5 anos, 43% mulheres. A etiologia mais comum da DRET foi diabetes. Tempo médio em diálise foi 36 meses, intervalo interquartil = 12-84. A lesão pulmonar mais comum foi opacidades em vidro fosco. O padrão típico de TC foi mais comum em pacientes com COVID-19 (40 (61%) vs. 0 (0%) em pacientes sem COVID-19, p < 0,001). Sensibilidade 60,61% (40/66), especificidade 100% (40/40). Valores preditivos positivos e negativos foram 100% e 62,3%, respectivamente. Padrão atípico de TC foi mais frequente em pacientes COVID-19-negativos (9 (14%) vs. 24 (56%) em COVID-19-positivos, p < 0,001), enquanto padrão indeterminado foi semelhante em ambos os grupos (13 (20%) vs. 6 (14%), p = 0,606), e padrão negativo foi mais comum em pacientes COVID-19-negativos (4 (6%) vs. 12 (28%), p = 0,002). Conclusões: Em pacientes com DRET em TRS hospitalizados, um padrão atípico de TC de tórax não pode excluir adequadamente o diagnóstico de COVID-19.
ABSTRACT
O odontoma é o mais comum tumor odontogênico, definido como malformação benigna, geralmente descoberto na segunda década de vida, durante a investigação de erupção tardia de dentes adjacentes ou retenção prolongada de dentes decíduos. O odontoma é subdividido em composto e complexo. O Odontoma classificado como Composto é constituído por um conjunto de estruturas similares a dentes, de formas e tamanhos diversos, cercados por uma área delgada radiolúcida. Já o Odontoma Complexo se assemelha a uma massa calcificada que apresenta a mesma radiopacidade do tecido dentário, também cercado por uma área delgada radiolúcida. Ocasionalmente, esses dois aspectos podem ser vistos em uma mesma lesão. Frequentemente os odontomas podem provocar um aumento de volume ósseo local devido ao seu desenvolvimento. O diagnóstico é feito através de exames radiográficos de rotina e quando necessário pode-se também lançar mão de Radiografias Panorâmicas e Tomografia Computadorizada Cone Beam com o intuito de verificar sua extensão, as malformações e alterações de erupção causadas aos dentes adjacentes, assim como a classificação do tumor. Este relato de caso apresenta um Odontoma Composto-Complexo em um paciente de 13 anos, do sexo masculino, atendido em 2016 na Clínica de Diagnóstico Bucal II da Universidade Federal Fluminense, que apresentou elementos dentários 22 e 23 impactados, retenção prolongada do elemento 63 e aumento de volume na região anterior do lado esquerdo da maxila. Para obtenção do diagnóstico foram realizadas: Radiografias Periapicais, Radiografia Panorâmica e Tomografia Computadorizada Cone Beam. O objetivo deste trabalho foi elucidar as formas de diagnóstico por imagem que foram utilizadas neste caso clínico e quais as vantagens de cada exame.
Odontomas are the most common type of odontogenic tumors, defined as a benign malformation, usually diagnosed in the second decade of life, during the investigation of late adjacent teeth eruption or a delay in exfoliation of deciduous teeth. They are divided into two types: compound and complex. The odontoma classified as compound is composed of multiple small tooth-like structures, in several shapes and sizes, surrounded by a thin radiolucent rim. On the other hand, complex odontomas resemble a mass of calcified tissue that presents the same dental tissue radiopacity, also surrounded by a thin radiolucent rim. Occasionally, both aspects can be seen in the same lesion. Often, odontomas can cause a local increase in bone volume due to their development. The diagnosis is made through routine radiographic examination and, when it is necessary, it is possible to make use of panoramic radiographies and cone beam computed tomography with the purpose of verifying its extension, malformations and erupted alterations caused to the adjacent teeth, as well as the tumor classification. This case report presents a Compound-Complex Odontoma in a 13-year-old male patient, treated in 2016 at the Oral Diagnosis Clinic II of the Federal Fluminense University. He presented impacted teeth 22 and 23, delayed eruption of tooth 63 and volume increase in the left anterior maxilla site. Aiming the patient's diagnosis, the following exams were necessary: periapical radiographies, panoramic radiography, cone beam computed tomography. The aim of this paper is to explain the different image diagnostic tools which were used in this clinical study and what are the advantages of each exam.
Subject(s)
Humans , Male , Adolescent , Tooth, Impacted , X-Rays , Diagnostic Imaging , Radiography, Panoramic , Odontoma , Cone-Beam Computed TomographyABSTRACT
SUMMARY: The Synsacrum is constructed of pelvic bones, sacral, lumbar vertebrae and some thoracic vertebrae, and it takes the form of a thin sheet of bone which is curled downwards at the sides. This study is designed to assess the morphometric specialization of the lumbosacral portion of the vertebral section in flying and non-flying winged creatures. Several parameters (ratio of cranial/caudal parts and diameter/length) of the lumbosacral vertebral column were calculated in computed tomography (CT). The ratio of diameter/length of the synsacrum was the narrowest in ostrich while the widest was in pigeon. While the cranial/caudal ratio was the smallest in ostrich and the largest in pigeon. The parameters of penguin were closed to that of pigeon. It is supposed that this ratio is related to the bird locomotion, flying, swimming or/and strolling.
El sinsacro está formado por huesos pélvicos, sacros, vértebras lumbares y algunas vértebras torácicas, y toma la forma de una fina lámina de hueso curvada a los lados hacia abajo. Este estudio está diseñado para evaluar la especialización morfométrica de la porción lumbosacra de la sección vertebral en criaturas aladas voladoras y no voladoras. Se calcularon varios parámetros (relación de partes craneal/caudal y diámetro/longitud) de la columna vertebral lumbosacra en tomografía computarizada (TC). La relación diámetro/longitud del sinsacro fue la más estrecha en avestruz mientras que la más ancha fue en paloma. Mientras que la relación craneal/caudal fue la más pequeña en avestruz y la más grande en la paloma. Los parámetros del pingüino estaban cerrados en relación a los de la paloma. Se supone que esta relación está relacionada con la locomoción de las aves, volando, nadando y/o caminando.
Subject(s)
Animals , Spine/diagnostic imaging , Birds/anatomy & histology , Tomography, X-Ray ComputedABSTRACT
Los salmónidos, durante su desarrollo, pueden experimentar ocasionalmente deformaciones esqueléticas. Para su diagnóstico se emplean diversas metodologías, entre las que se incluyen radiografías, técnicas histológicas, diafanización con tinciones de alizarina y azul de alcián, así como el uso del microscopio electrónico de barrido (SEM), cada una con sus inherentes ventajas y desventajas. Este estudio tuvo como finalidad evaluar y comparar la eficacia de la tomografía microcomputarizada (Micro-CT) para el análisis anatómico, reconstruyendo tridimensionalmente las imágenes y contrastándolas con los resultados obtenidos mediante la técnica de diafanización. Se analizaron las aletas caudales de cinco ejemplares de salmón Oncorhynchus kisutch: dos sujetos a diafanización y tres procesados para análisis mediante Micro-CT utilizando el equipo BRUKER SkyScan 1272. La técnica de Micro-CT demostró superioridad en la resolución de las estructuras óseas, facilitando una exploración detallada de las variaciones morfológicas y la distribución de la densidad mineral. Este enfoque permitió identificar anomalías en la morfología y crecimiento de las últimas vértebras y lepidotriquias dorsales, así como una densidad incrementada en lepidotriquias dorsales malformadas. La mayor resolución proporcionada por la Micro-CT no solo potencia nuestra comprensión de la ontogenia piscícola y su adaptación a ambientes diversos, sino que además inaugura perspectivas innovadoras para el estudio de la evolución de las estrategias locomotoras y las respuestas adaptativas frente a cambios ambientales a través del tiempo.
SUMMARY: During their development, some species of salmonids may occasionally experience skeletal deformations. Several methodologies are currently being used for the diagnosis of such malformations, among which X-rays, histological techniques, diaphanization coupled either with Alizarin Red or Alcian Blue stains, as well as Scanning Electron Microscopy (SEM) can be mentioned. Each one of those methods presents inherent advantages and disadvantages. The purpose of this study was twofold: Firstly, to evaluate and compare the effectiveness of microcomputed tomography (Micro-CT) technology for anatomical analysis, three-dimensionally reconstructing the obtained images; and secondly, to contrast those images with the results obtained through the diaphanization technique. The caudal fins of five specimens of the Oncorhynchus kisutch salmon were analyzed: Two specimens were subjected to diaphanization and three were processed for Micro-CT analysis, using the BRUKER SkyScan 1272 equipment. The Micro-CT technology demonstrated superiority in the resolution of bone structures, facilitating a detailed exploration of morphological variations, as well as the distribution of mineral density. This experimental approach allowed us to identify anomalies in the morphology and growth of the last vertebrae and dorsal lepidotrichiae, as well as an increased mineral density in the malformed dorsal lepidotrichiae. The higher resolution provided by Micro-CT not only enhances our understanding of the fish ontogeny and its adaptation to diverse environments, but also opens innovative perspectives for the study of the evolution of locomotor strategies and adaptive responses to environmental changes.
Subject(s)
Animals , Oncorhynchus kisutch/anatomy & histology , X-Ray Microtomography/methods , Salmonidae/anatomy & histology , Bone and Bones/diagnostic imaging , Bone Density , Imaging, Three-Dimensional , Animal Fins/diagnostic imagingABSTRACT
El foramen mental, una abertura en la parte inferior de la mandíbula, es la salida de un ramo del nervio alveolar inferior, proporcionando sensibilidad a la mandíbula y la piel del mentón. Su variabilidad anatómica es importante en procedimientos dentales y quirúrgicos. Nuestro estudio en San Luis Potosí, México, examinó la posición y características morfológicas del foramen mental en una muestra de tomografías computarizadas de la mandíbula. En mujeres, la zona entre el primer y segundo premolar fue la más común, mientras que en hombres, fue la misma zona pero con mayor prevalencia en el lado izquierdo. Se observaron diferencias en la dirección del foramen mental entre sexos y lados de la mandíbula, con la dirección posterior predominante en ambos sexos. Estos hallazgos concuerdan con estudios previos en diferentes poblaciones, aunque se identifican variaciones significativas en la prevalencia y ubicación específica del foramen. La comparación con otros estudios resalta la importancia de considerar factores étnicos y geográficos en la interpretación de los resultados. Las diferencias anatómicas observadas tienen implicaciones clínicas importantes para procedimientos dentales y quirúrgicos, subrayando la necesidad de enfoques adaptados a la población específica para mejorar la precisión y seguridad de las intervenciones en el área del mentón.
SUMMARY: The mental foramen, an opening at the bottom of the jaw, is the exit of the inferior alveolar nerve branch, providing sensation to the jawbone and skin of the chin. Its anatomical variability is important in dental and surgical procedures. Our study was carried out in San Luis Potosí, Mexico and examined the position and morphological characteristics of the mental foramen in a sample of lower jaw CT scans. In women, the area between the first and second premolar was the most common, while in men, it was the same area but with a greater prevalence on the left side. Differences in the direction of the mental foramen were observed between sexes and sides of the mandible, with the posterior direction predominating in both sexes. These findings are consistent with previous studies in different populations, although significant variations in the prevalence and specific location of the foramen are identified. The comparison with other studies highlights the importance of considering ethnic and geographic factors in the interpretation of results. The anatomical differences observed have important clinical implications for dental and surgical procedures, underscoring the need for approaches tailored to the specific population to improve precision and safety of interventions in the mental foramen area.
Subject(s)
Humans , Male , Female , Cone-Beam Computed Tomography , Mental Foramen/diagnostic imaging , Cross-Sectional Studies , Retrospective Studies , Mandible/diagnostic imagingABSTRACT
SUMMARY: In this study, we aim to share the volumes of the carpal bone and the ratio of these volumes to the total volume of wrist bones from Computed Tomography (CT) images obtained from individuals of different ages and sex using 3D Slicer. Right wrist CT images of 0.625 mm slice thickness of 42 healthy individuals (21 female, 21 male) of both sexes were included in our study. Volume calculations were made by loading the images into 3D Slicer, an open-source software package. In this study, mean capitate volume was the largest in both sexes (male 3479.9±679.2; female 2207.1±272.1 mm3), while pisiform had the smallest mean volume (male 810.0±141.2; female 566.6±97.7 mm3). This order was ordered from largest to smallest as hamate, scaphoid, trapezium, lunate, triquetrum, trapezoid, and pisiform. According to this study, carpal bone volumes were larger in males than in females (p0.05). In this study, it was seen that carpal bone volume differed according to sex. However, it was observed that the bone volumes of both sexes took up the same amount in the total bone volume. This information will be very useful in sex determination, 3D anatomical material creation, implant applications and reconstructive surgery.
Nuestro objetivo fue determinar los volúmenes de los huesos del carpo y la relación entre estos volúmenes y el volumen total de estos huesos a partir de imágenes de TC obtenidas de individuos de diferentes edades y sexos utilizando 3D Slicer. En el estudio se incluyeron imágenes de TC del carpo de la mano derecha de los participantes en el estudio, con un grosor de corte de 0,625 mm, en 42 individuos sanos (21 mujeres, 21 hombres) de ambos sexos. Los cálculos de volumen se realizaron cargando las imágenes en 3D Slicer, un paquete de software de código abierto. El volumen medio del hueso capitado fue el mayor en ambos sexos (hombre 3479,9 ± 679,2; mujer 2207,1 ± 272,1 mm3), mientras que el hueso pisiforme tuvo el volumen medio más pequeño (hombre 810,0 ± 141,2; mujer 566,6 ± 97,7 mm3). De mayor a menor el volumen de los otros huesos fue: hamato, escafoides, trapecio, lunato, piramidal, trapezoide y pisiforme. Según este estudio, los volúmenes óseos del carpo eran mayores en hombres que en mujeres (p0,05). En este estudio se observó que el volumen de los huesos del carpo difería según el sexo. Sin embargo, se observó que los volúmenes óseos de ambos sexos ocuparon la misma cantidad del volumen óseo total. Esta información será de gran utilidad en la determinación del sexo, creación de material anatómico 3D, aplicaciones de implantes y cirugía reconstructiva.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Carpal Bones/diagnostic imaging , Tomography, X-Ray Computed/methods , Sex Characteristics , Imaging, Three-Dimensional , Sex Factors , TitrimetryABSTRACT
SUMMARY: Since machine learning algorithms give more reliable results, they have been used in the field of health in recent years. The orbital variables give very successful results in classifying sex correctly. This research has focused on sex determination using certain variables obtained from the orbital images of the computerized tomography (CT) by using machine learning algorithms (ML). In this study 12 variables determined on 600 orbital images of 300 individuals (150 men and 150 women) were tested with different ML. Decision tree (DT), K-Nearest Neighbour (KNN), Logistic Regression (LR), Random Forest (RF), Linear Discriminant Analysis (LDA), and Naive Bayes (NB) algorithms of ML were used for unsupervised learning. Statistical analyses of the variables were conducted with Minitab® 21.2 (64-bit) program. ACC rate of NB, DT, KNN, and LR algorithms was found as % 83 while the ACC rate of LDA and RFC algorithms was determined as % 85. According to Shap analysis, the variable with the highest degree of effect was found as BOW. The study has determined the sex with high accuracy at the ratios of 0.83 and 0.85 through using the variables of the orbital CT images, and the related morphometric data of the population under question was acquired, emphasizing the racial variation.
Dado que los algoritmos de aprendizaje automático dan resultados más fiables, en los últimos años han sido utilizados en el campo de la salud. Las variables orbitales dan resultados muy exitosos a la hora de clasificar correctamente el sexo. Esta investigación se ha centrado en la determinación del sexo utilizando determinadas variables obtenidas a partir de las imágenes orbitales de la tomografía computarizada (TC) mediante el uso de algoritmos de aprendizaje automático (AA). En este estudio se probaron 12 variables determinadas en 600 imágenes orbitales de 300 individuos (150 hombres y 150 mujeres) con diferentes AA. Se utilizaron algoritmos de AA de árbol de decisión (DT), K-Nearest Neighbour, regresión logística (RL), Random Forest (RF), análisis discriminante lineal (ADL) y Naive Bayes (NB) para el aprendizaje no supervisado. Los análisis estadísticos de las variables se realizaron con el programa Minitab® 21.2 (64 bits). La tasa de ACC de los algoritmos NB, DT, KNN y RL se encontró en % 83, mientras que la tasa de ACC de los algoritmos ADL y RFC se determinó en % 85. Según el análisis de Sharp, la variable con el mayor grado de efecto se encontró como BOW. El estudio determinó el sexo con alta precisión en las proporciones de 0,83 y 0,85 mediante el uso de las variables de las imágenes de TC orbitales, y se adquirieron los datos morfométricos relacionados de la población en cuestión, enfatizando la variación racial.
Subject(s)
Humans , Male , Female , Orbit/diagnostic imaging , Tomography, X-Ray Computed , Sex Determination by Skeleton , Machine Learning , Orbit/anatomy & histology , Algorithms , Logistic Models , Forensic Anthropology , Imaging, Three-DimensionalABSTRACT
Objetivo: El cóndilo mandibular bífido es una alteración morfológica de la articulación temporomandibular en la que el cóndilo presenta un surco en la superficie superior que genera dos cabezas condilares. Esta alteración puede ser unilateral o bilateral. La mayoría de los cóndilos mandibulares bífidos se detectan mediante radiografías panorámicas, sin embargo, la tomografía computarizada Cone Beam de articulación temporomandibular es considerado el examen de elección para el diagnóstico de esta alteración. El propósito de este trabajo es presentar un caso de cóndilo mandibular bífido bilateral detectado incidentalmente mediante una tomografía computarizada Cone Beam solicitada por un diagnóstico presuntivo de osteoartritis. Caso clínico: Una paciente de 22 años sin antecedentes de traumatismos cráneo faciales solicita una tomografía computarizada Cone Beam de articulaciones temporomandibulares por diagnóstico presuntivo de osteoartritis. En la exploración del volumen se encontraron cóndilos mandibulares bífidos con dos cabezas condilares, medial y lateral de forma bilateral, siendo más acentuado en el cóndilo derecho.(AU)
Aim: The bifid mandibular condyle is a morphological alteration of the temporomandibular joint in which the condyle has a groove on its upper surface that generates two condylar heads. This alteration can be unilateral or bilateral. Most bifid mandibular condyles are detected by panoramic radiographs, however, Cone Beam computed tomography of the temporomandibular joint is considered the test of choice for the diagnosis of this alteration. The purpose of this work is to present a case of bilateral bifid mandibular condyle, incidentally detected by Cone Beam computed tomography requested for a presumptive diagnosis of osteoarthritis. Clinical case: A 22-year old female patient with no history of craniofacial trauma requests a Cone Beam computed tomography of the temporomandibular joints due to a presumptive diagnosis of osteoarthritis. In the volume exploration, bifid mandibular condyles were found with two condylar heads, medial and lateral bilaterally, being more accentuated in the right condyle.(AU)
ABSTRACT
El «conducto en C¼ es un tipo de anatomía dentaria compleja que debe ser evaluado previo a la realiza- ción de un tratamiento endodóntico. Esta variación anatómica es vista principalmente en segundos mola- res inferiores aunque también puede encontrarse en premolares y molares, tanto superior como inferior. Para su diagnóstico se solicitan distintos tipos de estudios imagenológicos. Debemos tener en cuenta que este tipo de anatomía no es observado fácilmen- te en imágenes bidimensionales por lo cual es muy importante considerar para estos casos complejos, la solicitud de un estudio de alta complejidad como lo es la tomografía computada de haz cónico, la cual nos permitirá explorar este tipo de anatomía para tenerlo en cuenta al momento de realizar un correcto aborda- je del conducto en C (AU)
The "C-canal" is a type of complex dental anatomy that must be evaluated prior to performing endodontic treatment. This anatomical variation is seen mainly in lower second molars although it can also be found in premolars and molars, both upper and lower. For its diagnosis we can use different types of imaging studies. We must keep in mind that this type of anatomy is not easily observed in two-dimensional images, which is why it is very important to consider, for these complex cases, the request for a highly complex study such as cone beam computed tomography, which will allow us to explore this type of anatomy to take it into account when performing a correct approach to the C-duct (AU)
Subject(s)
Dental Pulp Cavity/anatomy & histology , Cone-Beam Computed Tomography , Image Interpretation, Computer-Assisted , Molar/anatomy & histologySubject(s)
Humans , Bezoars , Intestinal Volvulus , Intestinal Obstruction , Tomography, X-Ray Computed , LaparotomyABSTRACT
ABSTRACT Introduction: Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM. Objective: To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM. Methods: Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses. Results: The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function. Conclusion: The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.
RESUMO Introdução: Lesão renal aguda associada ao contraste (LRA-AC) é uma deterioração da função renal que ocorre após a administração de meio de contraste iodado (MCI). A maioria dos estudos que definiram esse fenômeno utilizaram MCI mais antigos, mais propensos a causar LRA-AC. Na última década, diversos artigos questionaram a verdadeira incidência de LRA-AC. Entretanto, ainda há escassez de dados sobre a segurança dos MCI mais novos. Objetivo: Avaliar a incidência de LRA-AC em pacientes hospitalizados expostos à tomografia computadorizada (TC) com e sem MCI. Métodos: Estudo de coorte prospectivo com 1.003 pacientes submetidos a TC em hospital terciário, de dezembro/2020 a março/2021. Todos os pacientes internados com idade ≥ 18 anos que realizaram TC nesse período foram selecionados. A LRA-AC foi definida como aumento relativo de creatinina sérica de ≥ 50% em relação ao valor basal ou aumento absoluto de ≥ 0,3 mg/dL dentro de 18 a 48 horas após a TC. Utilizamos o teste qui-quadrado, teste de Kruskal-Wallis e modelo de regressão linear com splines cúbicos restritos para análises estatísticas. Resultados: A incidência de LRA-AC foi 10,1% no grupo exposto ao MCI e 12,4% no grupo controle ao usar o critério de aumento absoluto. A variação da creatinina em relação ao valor basal não foi significativamente diferente entre os grupos. Após ajuste para fatores basais, o uso de contraste não se correlacionou com pior função renal. Conclusão: A taxa de LRA-AC é muito baixa, caso exista, com MCIs mais novos, e a cautela excessiva quanto ao uso de contraste provavelmente não se justifica.
ABSTRACT
Há muito, os conhecimentos odontológicos têm se apresentado como uma ferramenta primordial na determinação da identidade de vítimas de morte violenta, especialmente quando estas se apresentam carbonizadas, putrefeitas, mutiladas ou esqueletizadas, mas também em casos atípicos, como em cadáveres "frescos". Nesse contexto, o presente trabalho tem o objetivo de relatar o primeiro caso de identificação odontológica utilizando-se o equipamento de tomografia computadorizada do Instituto Médico Legal (IML) de Goiânia-GO para obtenção das informações post-mortem (PM) de um cadáver íntegro, que foram confrontadas com os dados da radiografia panorâmica antemortem (AM). Relato de Caso: Um indivíduo vítima de projéteis de arma de fogo foi removido para o IML de Goiânia para os exames de praxe depois de vir a óbito em unidade hospitalar. Apesar de o corpo se apresentar "fresco", a coleta (tomada) de impressões digitais revelou um registro cuja qualidade não permitia a demarcação dos pontos necessários para um confronto papiloscópico. Os supostos familiares, então, apresentaram radiografia panorâmica AM, fato que motivou a equipe pericial a utilizar o recém instalado equipamento de tomografia computadorizada para a obtenção de imagem PM, possibilitando o devido processo de reconciliação (AM x PM), onde foram identificadas diversas similaridades de natureza anatômica e terapêutica que remeteram a uma identificação positiva da vítima. Conclusão: A adoção de abordagens tecnológicas e a alocação de recursos humanos especializados para a identificação humana devem ser prioridades nos serviços de Medicina e Odontologia Legal, visando aumentar a eficiência e precisão no processamento das demandas usuais, bem como para solucionar eventuais desafios técnicos
For a long time, dental knowledge has proven to be a fundamental tool in determining the identity of victims of violent death, especially when they are charred, putrefied, mutilated or skeletonized, but also in atypical cases, such as fresh corpses. In this context, the present work aims to report the first case of odontological identification using the computerized tomography equipment of the Forensic Medical Institute (IML) of Goiânia-GO to obtain post-mortem (PM) information from an intact corpse, which was compared with antemortem (AM) panoramic radiograph data. Case Report: An individual victim of gunshot wounds was taken to the IML of Goiânia for routine examinations after dying in a hospital unit. Although the body was "fresh," fingerprint collection revealed a record whose quality did not allow the necessary points for a papilloscopic confrontation to be marked. The supposed relatives then presented antemortem panoramic radiography, which motivated the forensic team to use the newly installed computerized tomography equipment to obtain PM images, enabling the proper reconciliation process (AM x PM), where several anatomical and therapeutic similarities were identified leading to a positive identification of the victim. Conclusion: The adoption of technological approaches and the allocation of specialized human resources for human identification should be priorities in Forensic Medicine and Odontology services, aiming to increase efficiency and accuracy in processing usual demands, as well as to solve any technical challenges that may arise
ABSTRACT
Reconhecido pela Organização Mundial de Saúde em 2016, o linfoma anaplásico de grandes células associado ao implante mamário (BIA-ALCL) é um subtipo incomum de linfoma não Hodgkin de células T, que se desenvolve após a inserção de próteses mamárias. A doença é uma afecção rara que afeta cerca de uma a cada 30.000 pessoas com implante mamário texturizado. As principais manifestações clínicas são o seroma tardio, assimetria mamária, massa e contratura capsular, com frequência mais elevada do primeiro. O explante da prótese com capsulectomia total pode ser suficiente para tratar o ALCL, com ressecções estendidas a locais adjacentes, quando necessário. Entretanto, em alguns casos, é realizada a radioterapia e/ou quimioterapia adjuvante. Conclui-se que, para um diagnóstico precoce e um tratamento efetivo, mulheres com seroma de aparecimento súbito e tardio deverão realizar exames complementares para a exclusão dessa afecção, mesmo com tempo inferior à média de desenvolvimento, que é de cerca de 10,6 anos.
Recognized by the World Health Organization in 2016, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon subtype of T-cell non-Hodgkin lymphoma that develops after the insertion of breast implants. The disease is a rare condition that affects approximately one in every 30,000 people with textured breast implants. The main clinical manifestations are late seroma, breast asymmetry, mass, and capsular contracture, with a higher frequency of the former. Explantation of the prosthesis with total capsulectomy may be sufficient to treat ALCL, with resections extended to adjacent sites when necessary. However, in some cases, adjuvant radiotherapy and/or chemotherapy is performed. It is concluded that, for an early diagnosis and effective treatment, women with sudden and late-onset seroma should undergo additional tests to exclude this condition, even with a shorter development time than the average, which is around 10.6 years.
ABSTRACT
Abstract The apnea test, employed for brain death assessment, aims to demonstrate the absence of respiratory drive due to hypercapnia. The tracheal oxygen insufflation apnea test mode (I-AT) involves disconnecting the pa tient from invasive mechanical ventilation (iMV) for ap proximately 8 minutes while maintaining oxygenation. This test supports the diagnosis of brain death based on a specified increase in PaCO2. Common complications include hypoxemia and hemodynamic instability, and lung collapse-induced reduction in end-expiratory lung volume (EELV). In our case series utilizing electrical impedance to mography (EIT), we observed that continuous positive airway pressure during the apnea test (CPAP-AT) effec tively mitigated lung collapse. This resulted in improved pulmonary strain compared to the disconnection of iMV. These findings suggest the potential benefits of routine CPAP-AT, particularly for potential lung donors, emphasizing the relevance of our study in providing quantitative insights into EELV loss and its association with pulmonary strain and potential lung injury.
Resumen La prueba de apnea es una técnica diagnóstica am pliamente utilizada para la evaluación de la muerte cerebral, con el objetivo de demostrar la ausencia de impulso respiratorio debido a la hipercapnia. La variante de la prueba de apnea con insuflación de oxígeno traqueal (I-AT) implica desconectar al pacien te de la ventilación mecánica invasiva (iVM) durante aproximadamente 8 minutos, manteniendo la oxigena ción mediante un catéter de insuflación. Esta prueba respalda el diagnóstico de muerte cerebral cuando se determina un aumento de la PaCO2 superior a 20 mmHg en comparación con el valor inicial o un nivel de PaCO2 superior a 60 mmHg al final de la prueba. En nuestra serie de casos, la implementación de la tomografía de impedancia eléctrica (EIT) reveló que la prueba de apnea con presión positiva continua (CPAP-AT) mitiga eficazmente el colapso pulmonar. Este enfo que resulta en una mejora en la tensión pulmonar en comparación con la desconexión de iMV, demostrando su relevancia en el contexto de potenciales donantes de pulmones.
ABSTRACT
RESUMEN Antecedentes: las cirugías abdominales mayores pueden presentar complicaciones posoperatorias graves cuya detección temprana resulta importante para su tratamiento. Objetivo: determinar la utilidad del uso de la tomografía computarizada (TC) para el diagnóstico temprano de las complicaciones de cirugía abdominal mayor. Materiales y métodos: estudio retrospectivo observacional descriptivo, mediante revisión de historias clínicas de pacientes operados de cirugía abdominal mayor en un Hospital Privado. Se agruparon los pacientes según presentaban o no síntomas sospechosos de complicación posoperatoria. Los primeros se clasificaron en 3 grupos: sin TC, con TC con hallazgos positivos y con TC sin hallazgos patológicos. Resultados: se analizaron 154 pacientes, con un promedio de edad de 61,3 ± 12,5 años; 83 (54%) fueron varones. Sobre 48 pacientes (31%) con síntomas sospechosos de complicaciones, fueron reoperados 6 sin TC, pero con síntomas muy evidentes, 7 con signos tomográficos positivos y 14/41 del grupo con TC negativa. Todos tuvieron hallazgos que justificaron la intervención. Hubo 27 casos (17,5%) con complicaciones IIIb según Clavien-Dindo y 3 pacientes (2%) fallecieron. Conclusión: la tomografía computarizada tuvo valor para confirmar una complicación, pero no para descartarla. Los parámetros clínicos cobran especial importancia en los pacientes sintomáticos sin hallazgos patológicos en la TC posoperatoria.
ABSTRACT Background: Major abdominal surgeries may present serious postoperative complications that require early diagnosis. Objective: The aim of this study was to determine the usefulness of computed tomography (CT) for the early diagnosis of major abdominal surgery complications. Material and methods: We conducted a retrospective, observational and descriptive study using data obtained from the medical records of patients undergoing major abdominal surgery in a private hospital. Patients were divided into two groups according to the presence or absence of symptoms suggesting a postoperative complication. Patients with symptoms were classified into 3 groups: without CT, with CT with positive findings and with CT without abnormal findings. Results: A total of 154 patients were analyzed; mean age was 61.3 ± 12.5 years and 83 (54%) were male. Of 48 patients (31%) with symptoms suggestive of complications, 6 had very evident symptoms and were re-operated without CT, 7 had positive findings on CT and CT was negative in 14/41. All the patients had findings that supported the decision to re-operate. There were 27 cases (17.5%) with grade 3b complications of the Clavien-Dindo classification and 3 patients (2%) died. Conclusion: Computed tomography was useful to confirm a complication, but not to rule it out. Clinical parameters remain of utmost importance in patients with symptoms and absence of abnormal findings in post-operative CT.
ABSTRACT
SUMMARY: The mandibular foramen and its canal are one of the most important structures in the skull, as they solely supply the mandible through their associated nerves and vessels. Many anatomical variations have been reported in the literature until now, and this case report represents a clear-cut appearance of its shape in a panoramic radiograph, which is not mostly seen in normal panoramic radiographs. These factors are of utmost importance when it comes to performing various surgeries and preventing complications due to their varied anatomy, which will allow dentists to create a better treatment plan and provide better treatments without any complications.
El foramen mandibular y su canal son algunas de las estructuras más importantes del cráneo y cara, ya que a través de ellos la mandíbula es inervada por nervios e irrigada por vasos. Hasta ahora, en la literatura consultada, se han informado de numerosas variaciones anatómicas. En este trabajo reportamos la forma y trayecto del foramen y canal mandibular, obtenidos en una radiografía panorámica, que no es observada normalmente en este tipo de radiografía. Los factores anatómicos son de importancia a la hora de realizar las cirugías para prevenir complicaciones debido a su variada anatomía, permitiendo a los odontólogos crear un mejor plan de tratamiento sin ningún tipo de complicaciones.
Subject(s)
Humans , Male , Adult , Radiography, Panoramic , Anatomic Variation , Mandible/diagnostic imaging , Incidental Findings , Cone-Beam Computed TomographyABSTRACT
SUMMARY: The average volumes of normal heart chambers in computed tomography (CT) are used not only as clinical criterions for heart disease diagnosis, but also as references in cardiology. With the development of artificial intelligence (AI), numerous CT data can be analyzed and segmented automatically. This study aimed to determine the average volumes of the four chambers in healthy adult hearts and present surface models with the average volume. Coronary CT angiographs of 508 Korean individuals (330 men and 178 women, 20 - 39 years old) were obtained. An automatic segmentation module for 3D Slicer was developed using machine learning in Anatomage KoreaTM. Using the module, the four chambers and heart valves in the CT were segmented and reconstructed into surface models. Surface models of the four chambers of identical hearts in the CT were produced using SimplewareTM. The volumes of structures were measured using Sim4life Light and statistically analyzed. After determining the average volumes of the four chambers, surface models of the average volumes were constructed. In both software measurements, the atrial volumes of females increased with age, and the ventricular volumes of males decreased significantly with age. The atrial and ventricular volumes of Simpleware were larger and smaller than those of Anatomage, respectively, because of errors in the Simpleware. Regarding the volume measurement, our module developed in this study was more accurate than the Simpleware. The average volume and three-dimensional models used in this study can be used not only for clinical purposes, but also for educational or industrial purposes.
Los volúmenes medios de las cámaras cardíacas normales en la tomografía computarizada (TC) se utilizan no sólo como criterios clínicos para el diagnóstico de enfermedades cardíacas, sino también como referencia en cardiología. Con el desarrollo de la inteligencia artificial (IA), numerosos datos de TC se pueden analizar y segmentar automáticamente. Este estudio tuvo como objetivo determinar los volúmenes promedio de las cuatro cámaras en corazones adultos sanos y presentar modelos de superficie con el volumen promedio. Se obtuvieron angiografías coronarias por TC de 508 individuos coreanos (330 hombres y 178 mujeres, de 20 a 39 años). Se desarrolló un módulo de segmentación automática para 3D Slicer utilizando aprendizaje automático en Anatomage KoreaTM. Utilizando el módulo, las cuatro cámaras y valvas cardíacas de la TC se segmentaron y reconstruyeron en modelos de superficie. Se produjeron modelos de superficie de las cuatro cámaras de corazones idénticos en la TC utilizando SimplewareTM. Los volúmenes de las estructuras se midieron utilizando Sim4life Light y se analizaron estadísticamente. Después de determinar los volúmenes promedio de las cuatro cámaras, se construyeron modelos de superficie de los volúmenes promedio. En ambas mediciones de software, los volúmenes atriales de las mujeres aumentaron con la edad y los volúmenes ventriculares de los hombres disminuyeron significativamente con la edad. Los volúmenes atrial y ventricular de Simpleware eran mayores y menores que los de Anatomage, respectivamente, debido a errores en Simpleware. En cuanto a la medición de volumen, nuestro módulo desarrollado en este estudio fue más preciso que el Simpleware. Los modelos tridimensionales y de volumen medio utilizados en este estudio se pueden utilizar no solo con fines clínicos, sino también con fines educativos o industriales.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Artificial Intelligence , Cardiac Volume , Computed Tomography Angiography , Heart/diagnostic imaging , Imaging, Three-DimensionalABSTRACT
SUMMARY: Anterior loop in the mental foramen region is a critical region in the mandible. The non detection of anterior loop leads to inadvertent complications during the surgical procedures in this region. This study aimed to evaluate the morphological assessment of the mental foramen's anterior loop (AL) using (CBCT) cone-beam computed tomography. CBCT data was retrieved from January 2018 to December 2022 and screened for eligibility. Images were viewed using panoramic reconstructed views for initial screening. Further multiplanar reformatted view in axial, coronal and sagittal planes were examined. When anterior loop was detected, the path of inferior alveolar canal was traced and the anterior loop was analyzed. Statistical analysis was carried out on the data. Cross-tabulation was done to associate gender and age with the achieved findings (heights and diameters) using the Chi-square test. In this analysis 519 cases were included and examined for presence of anterior loop. 22 cases were included in the study, out of which 10(45.5%) males and 12(54.5%) females. The prevalence of AL is high among females. AL was found higher on the right side in 14 (68.2%) cases compared to the left side with 7 (31.8%) cases. The mean diameter of AL on the right side was 2.5 mm, and on the left side diameter was 1.96 mm. The prevalence of anterior loop in the region of mental foramen in Saudi Population was found to be 4.24%. Careful evaluation for the anterior loop can prevent hemorrhagic episodes during surgical intervention or implant procedures in the mandibular premolar region.
El asa anterior en la región del foramen mentoniano es una región crítica en la mandíbula. La no detección del asa anterior conduce a complicaciones inadvertidas durante los procedimientos quirúrgicos en esta región. Este estudio tuvo como objetivo evaluar la evaluación morfológica del asa anterior (AL) del foramen mental mediante tomografía computarizada de haz cónico (CBCT). Los datos CBCT se recuperaron desde enero de 2018 hasta diciembre de 2022 y se examinaron para determinar su elegibilidad. Las imágenes se visualizaron utilizando vistas panorámicas reconstruidas para la evaluación inicial. Se examinaron además, vistas reformateadas multiplanares en los planos axial, coronal y sagital. Cuando se detectó el asa anterior, se trazó el trayecto del canal mandibular y se analizó el asa anterior. Se realizó un análisis estadístico de los datos. Mediante la prueba de Chi-cuadrado se realizó una tabulación cruzada para asociar el sexo y la edad con los hallazgos obtenidos (alturas y diámetros). En este análisis se incluyeron y examinaron 519 casos para detectar la presencia de asa anterior. Se incluyeron en el estudio 22 casos, de los cuales 10 (45,5 %) eran hombres y 12 (54,5 %) mujeres. La prevalencia de AL es alta entre las mujeres. Se observó que AL fue mayor en el lado derecho en 14 (68,2 %) de los casos en comparación con el lado izquierdo con 7 (31,8 %) casos. El diámetro medio de AL en el lado derecho fue de 2,5 mm y en el lado izquierdo fue de 1,96 mm. La prevalencia del asa anterior en la región del foramen mental en la población saudí fue de 4,24 %. Una evaluación rigurosa del asa anterior puede prevenir episodios hemorrágicos durante una intervención quirúrgica o procedimientos de implante en la región de los premolares mandibulares.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Cone-Beam Computed Tomography , Mental Foramen/anatomy & histology , Mental Foramen/diagnostic imaging , Cross-Sectional Studies , Retrospective Studies , Sex Characteristics , Mandible/anatomy & histology , Mandible/diagnostic imagingABSTRACT
SUMMARY: Conducting morphometric studies including many parameters and establishing certain standards for the anatomy of the lumbar spine will facilitate clinical applications. The Turkish example of lumbar vertebrae and disc morphometry has not yet been presented comprehensively. In our study, abdominal computed tomography images of 700 adults were evaluated retrospectively. It was observed that the anterior height of the vertebral bodies increased from L1 to L4 in males, and from L1 to L5 in females. The posterior height of the vertebral bodies was lowest at L5 in both sexes, while it was highest at L3 in males and L4 in females. In all age groups, the values for males were greater (p0.05). In all age groups and both sexes, an increase in anterior disc heights towards disc 5 was observed. The values for males were greater than those for females (p<0.05). The posterior disc height at disc 5 was higher in females, and in other discs, it was higher in males (p<0.05). In conclusion, it was found that the measurement values of the parameters examined varied according to lumbar level and sex, but were independent of age. The morphometric data we obtained are important in terms of providing a reference for the people of our region and contributing to the literature.
La realización de estudios morfométricos que incluyan diversos parámetros anatómicos y el establecimiento de ciertos estándares para la anatomía de la columna lumbar facilitarán los procedimientos clínicos. Como ejemplo, aún no se ha presentado de manera detallada la morfometría de las vértebras lumbares y del disco intervertebral en individuos turcos. En nuestro estudio evaluamos retrospectivamente imágenes de tomografía computarizada abdominal en 700 individuos adultos de ambos sexos. Observamos que la altura anterior de los cuerpos vertebrales aumentaba de L1 a L4 en los hombres y de L1 a L5 en las mujeres. La altura posterior de los cuerpos vertebrales fue más baja en L5 en ambos sexos, mientras que fue más alta en L3 en hombres y L4 en mujeres. En todos los grupos etarios los valores para los hombres fueron mayores (p0,05). En todos los grupos de edad y en ambos sexos se observó un aumento en la altura anterior del disco intervertebral hacia el disco 5. Los valores de los hombres fueron mayores que los de las mujeres (p<0,05). La altura posterior del disco intervertebral en el disco 5 fue mayor en las mujeres y en otros discos fue mayor en los hombres (p<0,05). En conclusión, se encontró que los valores de medición de los parámetros examinados variaron según el nivel lumbar y el sexo, pero fueron independientes de la edad. Los datos morfométricos que obtuvimos son importantes en términos de proporcionar una referencia para la población de nuestra región y contribuir a la literatura.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Tomography, X-Ray Computed , Intervertebral Disc/diagnostic imaging , Lumbar Vertebrae/diagnostic imaging , Sex Characteristics , Intervertebral Disc/anatomy & histology , Lumbar Vertebrae/anatomy & histologyABSTRACT
Aim: This study aimed to collect evidence on the validity and reliability of measurements obtained from digital impression techniques. Materials and Methods: This comparative study was conducted on 31 patients. Intraoral scanner was applied to all patients. For each patient, an alginate impression of the upper maxilla was taken and later the 3D digital model was extracted by dental cone-beam computed tomography (CBCT). For preparation of plaster models, alginate impressions were taken and immediately poured with dental stone. In the next stage, a comparison was performed among the intraoral scanner, CBCT, and plaster models in terms of tooth size, dental width, and intra-arch dimensions. Results: Measuring tooth size and intra-arch dimensions in digital images obtained from intraoral scanner and CBCT were in most cases lower than the results obtained in the plaster models but the differences between digital techniques and plaster models are not clinically noticeable. Conclusions: Digital systems including intraoral scanner and CBCT are acceptable for clinical use in terms of accuracy.
Objetivo: Este estudio tuvo como objetivo recopilar evidencia sobre la validez y confiabilidad de las mediciones obtenidas a partir de técnicas de impresión digital. Materiales y Métodos: Este estudio comparativo se realizó en 31 pacientes. A todos los pacientes se les aplicó escáner intraoral. Para cada paciente, se tomó una impresión de alginato del maxilar superior y posteriormente se extrajo el modelo digital 3D mediante Tomografía computarizada de haz cónico (CBCT) dental. Para la preparación de los modelos de yeso se tomaron impresiones de alginato y se vertieron inmediatamente con yeso dental. En la siguiente etapa, se realizó una comparación entre el escáner intraoral, CBCT y los modelos de yeso en términos de tamaño de diente, ancho dental y dimensiones intraarcada. Discusión: Se encontró que la apariencia microscópica de las células fusiformes era comparable en ambos grupos. Los resultados de la citometría de flujo demostraron expresiones comparables en ambos grupos, siendo las muestras positivas para CD90, CD73, CD105, HLA ABC y negativas para CD34, CD45 y HLA DR. Hubo variaciones en la expresión de los marcadores cuando se evaluaron los potenciales de diferenciación. Conclusión: Los sistemas digitales como el escáner intraoral y el CBCT son aceptables para uso clínico en términos de precisión.