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1.
Braz. j. oral sci ; 21jan.-dez. 2022. ilus
Article in English | LILACS, BBO | ID: biblio-1354779

ABSTRACT

Aim: To describe cone-beam computed tomography (CBCT) features in patients with temporomandibular disorders (TMDs), in terms of degenerative changes, condylar excursions and positioning as well as their possible correlations with signs and symptoms. Methods: Clinical records of patients diagnosed with TMD who were seen between January 2018 and December 2019 were retrospectively evaluated. These patients were divided into the following groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): arthralgia, myalgia, and arthralgia and myalgia groups. The CBCT examination findings of the patients were evaluated in relation to degenerative changes, estimates of condylar excursion, and condylar positioning. The likelihood ratio test was used to verify the possible differences among the three groups, whereas the chi-square test was used to verify the possible differences among the signs and symptoms for the tomographic findings (p ≤ 0.050). Results: In this study, 65 patients with TMD were included. These patients were predominantly female (84.6%) with a mean age of 40.6 years. Tomographic findings of flattening, hyperexcursion and posterior condylar positioning were frequent. A significant correlation was noted between osteophyte and lateral capsule pain (p = 0.027), erosion and posterior capsule pain (p = 0.026), and flattening, pseudocysts (p < 0.050) and condylar excursion (p < 0.001) with mouth opening. Conclusion: Few correlations were noted between degenerative changes and signs of joint pain as well as degenerative changes and condylar hypoexcursion with mouth opening. These correlations were likely associated with division by diagnosis, whereas condylar positioning did not correlate with signs and symptoms


Subject(s)
Signs and Symptoms , Temporomandibular Joint Disorders , Cone-Beam Computed Tomography , Mandibular Condyle
2.
Braz. j. oral sci ; 21: e226611, jan.-dez. 2022. ilus
Article in English | LILACS, BBO | ID: biblio-1393384

ABSTRACT

Aim: This study aimed to evaluate the relationship between clinical findings and some factors such as age, gender, and remaining teeth on the anatomy of the temporomandibular joint in order to diagnose normal variations from abnormal cases. Methods: In this cross-sectional study, cone-beam computed tomography (CBCT) images of 144 patients referring to Tabriz Dental School for various reasons were selected and evaluated. The different aspects of the clinical parameters and the morphology of the condyle were evaluated on coronal, axial, and sagittal views. The CBCT prepared using the axial cross-sections had been 0.5 mm in thickness. The sagittal cross-sections had been evaluated perpendicular to the lengthy axis of the condyle at a thickness of 1 mm and the coronal cross-sections had been evaluated parallel to the lengthy axis of the condyle at a thickness of 1 mm. Data were analyzed with descriptive statistical methods and t-test, chi-squared test, using SPSS 20. The significance level of the study was p < 0.05. Results: There was a significant relationship between the condyle morphology, number of the teeth, and mastication side (p = 0.040). There were significant relationships between the condyle morphology, age between 20-40, and occlusion class I on the all the three views (coronal, axial, sagittal) (p = 0.04), (p = 0.006), (p = 0.006). Also, significant relationships were found in the condyle morphology and location of pain according to age, the number of remaining teeth, and gender. (p = 0.046) (p = 0.027) (p = 0.035). Conclusion:There are significant relationships between the clinical symptoms and condyle morphology based on age, gender, and the number of remaining teeth. The clinical finding that has the most significant relationship between the condyle morphology, remaining teeth (9-16 teeth), all of the age range (20-80 year), and gender was mastication side


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Temporomandibular Joint/anatomy & histology , Cone-Beam Computed Tomography , Mandibular Condyle/anatomy & histology
3.
Arch. cardiol. Méx ; 92(3): 405-408, jul.-sep. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1393838

ABSTRACT

Resumen Se presenta el caso de un varón de 77 años que acude a urgencias tras un episodio sincopal en el contexto de una taquicardia ventricular monomorfa sostenida, por lo que se realizó cardioversión eléctrica. Para filiar la etiología del evento arrítmico ventricular se realizó un estudio de la anatomía coronaria mediante coronariografía invasiva, en el que se objetivaron las arterias coronarias sin lesiones significativas, pero como hallazgo casual se describió una anomalía coronaria, con ausencia de tronco coronario y salida independiente de las arterias circunfleja (Cx) y descendente anterior (DA) del seno coronario derecho, originándose la DA y la coronaria derecha del mismo ostium coronario. Dichos hallazgos se confirmaron mediante tomografía computarizada con reconstrucción tridimensional. Además, se objetivó un trayecto interarterial de la DA (entre las arterias aorta y pulmonar) y un trayecto intramuscular de la DA, así como un trayecto retroaórtico de la Cx. Debido a estos hallazgos, se procedió al implante de un desfibrilador automático implantable como prevención secundaria. El paciente tuvo una buena evolución posterior y fue dado de alta a su domicilio sin incidencias. Se presenta el caso para ayudar a comprender mejor estos trastornos, dado que actualmente constituyen un reto diagnóstico, ya que en muchas ocasiones se trata de un hallazgo casual en pruebas complementarias o incluso en autopsias. Además, es una causa relativamente frecuente de parada cardiorrespiratoria en pacientes jóvenes. De las muchas variables anatómicas que constituyen las anomalías coronarias, existe poca literatura sobre esta anomalía presentada y no hay imágenes similares a las de este caso.


Abstract We present the case of a 77-year-old man who came to the emergency room after a syncopal episode in the context of sustained monomorphic ventricular tachycardia for which electrical cardioversion was performed. In order to determine the etiology of the ventricular arrhythmic event, a study of the coronary anatomy was carried out using invasive coronary angiography, observing coronary arteries without significant lesions, although, as a chance finding, a coronary anomaly was described, with absence of the main coronary artery, with independent exit of circumflex (Cx) and anterior descending (AD) arteries of the right coronary sinus, originating the AD and right coronary artery from the same coronary ostium. These findings were later confirmed by computed tomography with 3D reconstruction. In addition, an interarterial path of AD (between aorta and pulmonary artery) and an intramuscular path of AD were observed, as well as a retro-aortic path of Cx. Given these findings, an implantable cardioverter defibrillator was implanted as secondary prevention. Good subsequent evolution with home discharge without incident. We present this case to help better understand these disorders, since they currently constitute a diagnostic challenge, since in many cases it is a chance finding in complementary tests or even in autopsies. It is also a relatively frequent cause of cardiorespiratory arrest in young patients. Of the many anatomical variables that make up the group of coronary anomalies, there is little bibliographic information on this anomaly presented, without finding images similar to those reported in this case.

4.
Rev. colomb. cir ; 37(4): 640-652, 20220906. tab
Article in Spanish | LILACS | ID: biblio-1396404

ABSTRACT

Introducción. La población mundial crece y con ello los accidentes de tránsito, incrementando la morbimortalidad. La combinación de factores clínicos y paraclínicos mediante las escalas de trauma impacta en los desenlaces al permitir tomar acciones oportunas. Métodos. Estudio de corte transversal en el que se incluyeron pacientes con lesiones por colisión en accidentes de tránsito, atendidos entre 2017 y 2018, en urgencias del Hospital Universitario San José de Popayán, Colombia, un hospital de alta complejidad. Se recolectaron variables sociodemográficas y biológicas y se aplicaron tres escalas de trauma, Revised Trauma Score, Injury SeverityScore y New Injury Severity Score. Posteriormente, se evaluó su rendimiento para predecir mortalidad. Resultados. Se atendieron en el servicio de urgencias 650 pacientes con lesiones en accidentes de tránsito y se presentaron 16 muertes. Al evaluar el rendimiento de las escalas de trauma se encontró que la sensibilidad para mortalidad varía entre el 75 % para Revised Trauma Score y el 93,8 % para Injury Severity Score y New Injury Severity Score, con una especificidad que varía entre 89,1 % y 96,8 %. Se identificó que la mejor razón de verosimilitud positiva fue para Revised Trauma Score, mientras que la mejor razón de verosimilitud negativa fue para Injury Severity Scorey New Injury Severity Score. Conclusiones. Los resultados evidencian un adecuado rendimiento de las escalas de trauma evaluadas para predecir mortalidad. La escala que presentó mejor rendimiento fue Injury Severity Score por su sensibilidad, especificidad y razón de verosimilitud positiva.


Background. The global population is on the rise and with such motor vehicle collisions, increasing the morbidity and mortality of individuals implicated in traffic accidents. The combination of clinical and paraclinical factors, as done by the different trauma scales, have an impact upon morbidity and mortality by allowing timely actions.Methods. Cross-sectional study that included patients with collision injuries in traffic accidents, treated at an emergency department from 2017 to 2018 at Hospital Universitario San José in Popayán, Colombia, a high-complexity hospital. The study defined the universe, collected sociodemographic and biological variables, and applied three trauma scales: Revised Trauma Score, Injury Severity Score, and New Injury Severity Score. Subsequently, its performance in predicting mortality was evaluated. Results. Six-hundred-fifty patients with collision injuries were treated in the emergency department with lesions due to collisions in traffic accidents; 16 deaths were reported. We found that the sensitivity varies between 75% for the Revised Trauma Score to 93.8% for the Injury Severity Score and the New Injury Severity Score. Likewise, an adequate specificity varying from 89,1% for the Injury Severity Score to 96,8% for the Revised Trauma Score. The best positive likelihood ratio was for the Revised Trauma Score. The negative likelihood ratios for the Injury Severity Score and the New Injury Severity Score were adequate.Conclusion. The results show an adequate performance of the trauma scales evaluated to predict mortality. The scale that presented the best performance was Injury Severity Score due to its sensitivity, specificity and positive likelihood ratio.


Subject(s)
Humans , Tomography, X-Ray Computed , Trauma Severity Indices , Emergencies , Wounds and Injuries , Accidents, Traffic , Mortality
5.
Odovtos (En línea) ; 24(2)ago. 2022.
Article in English | LILACS-Express | LILACS, SaludCR | ID: biblio-1386597

ABSTRACT

Abstract This study aimed to investigate the possibility of age and sex determination using bimastoid diameter with cone-beam computed tomography (CBCT). This retrospective study investigated 100 female and 100 male patients aged 18-83 years (mean age: 45.55±16.28 years). To measure bimastoid diameter, the appropriate image was chosen from sagittal, coronal, and axial images of CBCT in which the measurement points could be best detected. The distance between the points of the mastoid process was measured using three-dimensional coronal reconstruction. The mean bimastoid breadth was 106.12±6.22mm. The bimastoid diameter in male cases was higher than that in female cases (110.69±4.53mm vs. 101.65±4.00mm). There was no significant difference in bimastoid breadth with advancing age. For sex determination, morphometric measurements of bimastoid diameter ensured a high rate of dimorphism in the Turkish subpopulation. CBCT morphometric analysis may be reliable and convenient for evaluating sex and may be recommended to compare population data.


Resumen Este estudio tuvo como objetivo investigar la posibilidad de determinar la edad y el sexo utilizando el diámetro bimastoideo con tomografía computarizada de haz cónico (CBCT). Este estudio retrospectivo investigó a 100 mujeres y 100 hombres de entre 18 y 83 años (edad media: 45,55±16,28 años). Para medir el diámetro bimastoideo, se eligió la imagen adecuada de las imágenes sagital, coronal y axial de CBCT en las que los puntos de medición se podían detectar mejor. La distancia entre los puntos del proceso mastoideo se midió mediante reconstrucción coronal tridimensional. La amplitud media del bimastoide fue de 106,12± 6,22mm. El diámetro del bimastoide en los casos masculinos fue mayor que en los casos femeninos (110,69±4,53 mm frente a 101,65±4,00mm). No hubo diferencias significativas en la amplitud del bimastoide con la edad. Para la determinación del sexo, las mediciones morfométricas del diámetro bimastoide aseguraron una alta tasa de dimorfismo en la subpoblación turca. El análisis morfométrico CBCT puede ser confiable y conveniente para evaluar el sexo y puede recomendarse para comparar datos poblacionales.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cone-Beam Computed Tomography , Mastoid/anatomy & histology , Age Determination by Skeleton , Sex Determination by Skeleton
6.
Braz. dent. j ; 33(4): 31-39, July-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1394088

ABSTRACT

Abstract This study evaluated the centralization of the region of interest (ROI) in acquisition of the CBCT images, when the freely positionable scout-view (SV) function is applied. Additionally, the dosimetry of the acquired images was assessed in the SV function alone as well as in complete tomographic image in two different fields of view (FOV) (50x50 and 78x150mm). A three-location device was created to accommodate the dosimeters and the specimens, in the right, middle and left location during image acquisition. For dose assessment, thermoluminescent dosimeters were irradiated within the FOV and analyzed in a portable reader. For ROI evaluation, three specimens of gutta-percha stick were placed on the same device and the CT scans were acquired (CBCT OP 300 Maxio device, 90kV, 13mA, 85 µm voxel size, FOV of 50X50mm), with and without the SV, in three positions (3-9, 1-7 and 5-11 o'clock), simulating different regions of the mouth. Two image evaluations were performed, an objective and subjective. There was a slight percentage increase (1.36% to 1.40%) of the radiation dose with the use of SV. The distances were significantly greater in the images acquired without SV (p < 0.05). Every image obtained with SV was classified as being at the FOV's center. In conclusion, the results demonstrated that SVs function is effective to centralize the ROI in the FOV, increasing the scan precision and avoiding repetitions due to positioning errors.


Resumo Este estudo avaliou a centralização da região de interesse (ROI) na aquisição das imagens de TCFC, quando a função scout-view (SV) posicionável livremente é aplicada. Adicionalmente, a dosimetria das imagens adquiridas foi avaliada isoladamente na presença da função SV, bem como após aquisição de imagem tomográfica completa em dois diferentes campos de visão (FOV) (50x50 e 78x150mm). Um dispositivo de três localizações foi criado para acomodar os dosímetros e os espécimes, na localização direita, central e esquerda, durante a aquisição das imagens. Para avaliação da dose, dosímetros termoluminescentes foram irradiados dentro dos campos de visão e analisados em leitor portátil. Para avaliação da ROI, três espécimes de guta percha foram colocados no mesmo aparelho e as tomografias foram adquiridas (CBCT OP 300 Maxio, 90kV, 13mA, 85 μm tamanho de voxel, FOV de 50X50mm), com e sem a SV, em três posições (3-9, 1-7 e 5-11 horas), simulando diferentes regiões da boca. Foram realizadas duas avaliações de imagem, uma objetiva e outra subjetiva. Houve um leve aumento percentual (1,36% para 1,40%) da dose de radiação com o uso de SV. As distâncias foram significativamente maiores nas imagens adquiridas sem SV (p < 0,05). Todas as imagens obtidas com SV foram classificadas como sendo do centro do FOV. Em conclusão, os resultados do presente estudo demonstraram que a função scout view é eficaz para centralizar a ROI no FOV, aumentando a precisão do escaneamento e evitando repetições devido a erros de posicionamento.

7.
Braz. dent. j ; 33(4): 21-30, July-Aug. 2022. graf
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1394092

ABSTRACT

Abstract A contemporary technological revolution has started a new era in the metaverse of Endodontics, a world of virtual operational possibilities that use an exact replica of the natural structures of the maxillofacial complex. This study describes a modeling method for root canal endoscopy using modern cone-beam CT (CBCT) software in a series of clinical cases. The method consists in acquiring thin CBCT slices (0.10mm) in the coronal, sagittal, and axial planes. A specific 3D volume filter, the pulp cavity filter of the e-Vol DX CBCT software, was used to navigate anatomical root canal microstructures, and to scan them using root canal endoscopy. The pulp cavity filter should be set to synchronize CBCT scans from 2D mode - multiplanar reformations (MPR) - to 3D mode - volumetric reconstruction. This filter, when adopting the option of volumetric reconstruction, the developed algorithm leaves the dentin density in transparent mode so that the pulp cavity may be visualized. The algorithm applied performs the suppression (visual) of areas with dentin density. This ensures 3D visualization of the slices and the microanatomy of the root canal, as well as a dynamic navigation throughout the pulp cavity. This computational modeling method adds new resources to Endodontics, which may impact the predictability of root canal treatments positively. The virtual visualization of the internal anatomy of an exact replica of the canal ensures better communications, reliability, and clinical operationalization. Root canal endoscopy using this novel CBCT filter may be used for clinical applications together with innovative digital and virtual-reality resources that will be naturally incorporated into the principles of Endodontics.


Resumo Uma revolução tecnológica contemporânea deu início a uma nova era no metaverso da Endodontia, um mundo de possibilidades operacionais virtuais que utilizam uma réplica exata das estruturas naturais do complexo dentomaxilofacial. Este estudo descreve um método de modelagem computacional para a endoscopia do canal radicular, usando um moderno software de tomografia computadorizada de feixe cônico (TCFC), em uma série de casos clínicos. O método consiste na aquisição de finos slices de TCFC (0,10mm) nos planos coronal, sagital e axial. Um filtro específico de TCFC (filtro cavidade pulpar do software e-Vol DX) foi usado para navegar nas microestruturas anatômicas do canal radicular, e escanear para a aplicação da endoscopia do canal radicular. Este filtro foi configurado para sincronizar as imagens de TCFC em modo 2D - reformações multiplanares (MPR) para o modo 3D - reconstrução volumétrica. O filtro Pulp Cavity ao adotar a opção de reconstrução volumétrica, um algoritmo desenvolvido deixa a densidade dentinária em modo transparente, para que a cavidade pulpar possa ser melhor visualizada. O algoritmo aplicado realiza a supressão (visual) das áreas com densidade dentinária. Este modo de aplicação garante a visualização 3D da microanatomia do canal radicular, bem como permite uma navegação dinâmica por toda a cavidade pulpar. O método de modelagem computacional agrega novos recursos à Endodontia, o que pode impactar positivamente na previsibilidade dos tratamentos endodônticos. A visualização virtual da anatomia interna de uma réplica exata do canal radicular garante melhor comunicação, confiabilidade e operacionalização clínica. O exame de endoscopia do canal radicular com este novo filtro (Pulp cavity) pode ser usada para aplicações clínicas juntamente com recursos digitais e de realidade virtual inovadores que serão naturalmente incorporados aos princípios da Endodontia.

8.
J. pediatr. (Rio J.) ; 98(4): 413-418, July-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1386107

ABSTRACT

Abstract Objective: Suspicion of early anterior fontanel (AF) closure is a common reason for referral to a pediatric neurosurgeon because of the suspected increased risk of developing craniosynostosis (CS) in spite of the absence of evidence in the literature. The aim of this study was to analyze the association between AF closure and the diagnosis of non-syndromic CS in Brazilian children. Methods: An observational and case-cohort study was conducted to compare the incidence of closed AF between healthy children (group 1) and children diagnosed with non-syndromic CS (group 2) at a pediatric neurosurgery referral center. The accuracies of completely closed AF and diagnosis of CS were assessed. Results: High-resolution three-dimensional reconstruction computed tomography scans were obtained for 140 children aged < 13 months, of whom 62.9% were boys and 37.1% were girls (p < 0.001). The most common types of non-syndromic CS were trigonocephaly (34, 48%) and scaphocephaly (25, 35.7%). Closed fontanel (27, 38.6%) was observed in both groups, and a sensitivity of 36.1%, specificity of 72%, the positive predictive value of 59%, and negative predictive value of 51% were observed in the patients diagnosed with CS when AF closure occurred before the age of 6 months. Conclusion: The results of this comparative study of AF closure and CS diagnosis suggest that early AF closure does not imply a diagnosis of CS. Pediatricians should be aware of the risk of misdiagnosis of CS in cases with a widely open AF in spite of the presence of CS.

9.
Rev. Assoc. Med. Bras. (1992) ; 68(6): 780-784, June 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1387178

ABSTRACT

SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy's Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy's Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy's Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy's Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy's Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.

10.
Rev. argent. radiol ; 86(2): 83-92, jun. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1387606

ABSTRACT

Resumen Objetivo: Dar a conocer la experiencia en nuestro departamento de imágenes y presentar los hallazgos de radiografía (Rx) y tomografía computada (TC) que hemos observado en nuestra serie de casos con diagnóstico confirmado de COVID-19. Método: Estudio retrospectivo analítico de los hallazgos de Rx y TC en una serie de pacientes que asistieron al servicio de urgencias por sospecha de COVID-19 en los hospitales universitarios dependientes de nuestra institución en el periodo comprendido entre el 1 de marzo y el 31 de mayo de 2020. Resultados: En el período de estudio se detectaron 127 casos de COVID-19 positivos en nuestra institución. A 57 (45%) de ellos se les realizó Rx. En 46 (80%) de ellas no mostraron hallazgos patológicos. En 8 (14%) pacientes se observaron opacidades parcheadas en vidrio esmerilado y en 3 (5%) en asociación con consolidaciones. La distribución fue predominantemente bilateral y en los lóbulos inferiores. A 11 pacientes se les realizó TC de tórax y 9 (81%) manifestaron infiltrados en vidrio esmerilado, mostrando preferencia por las áreas periféricas y los lóbulos superiores, asociándose a consolidaciones en 4 (36%) casos. Un paciente (9%) presentó patrón en empedrado y otros 2 mostraron opacidades (18%) redondeadas en vidrio esmerilado. Dos pacientes (18%) no tuvieron hallazgos patológicos. Como hallazgos atípicos, se evidenció derrame pleural en 2 pacientes (18%) y neumotórax en uno (9%) en uno de ellos. Conclusiones: Nuestra experiencia demostró como características frecuentes la presencia de opacidades parcheadas en vidrio esmerilado y consolidaciones parcheados de distribución predominantemente en los lóbulos inferiores.


Abstract Objective: To show the experience in our radiology department at X-ray and computed tomography (CT) imaging findings in patients with confirmed COVID-19. Method: Retrospective analytical study of the radiological findings on X-ray and CT on a series of patients who attended the emergency department on suspicion of COVID-19 at university hospitals dependent of our institution in the period between March 1 and May 31, 2020. Results: During the study period, 127 cases of COVID-19 were detected in our institution. X-rays were performed in 57 (45%) of them, 46 (80%) of which did not show pathological findings. In total, 8 (14%)manifested as patchy ground glass opacities, and 3 (5%), in association with consolidations. The distribution was predominantly bilateral and in the lower lobes. Eleven patients underwent chest CT, 9 (81%) of these showed ground glass opacities, showing a preference for peripheral areas and upper lobes, associated with consolidations in 4 (36%) of them. One patient (9%) presented crazy paving and 2 rounded (18%) ground glass opacities. Two patients (18%) showed no pathological findings. As atypical findings, pleural effusion was evident in two (18%) patients, and pneumothorax, in one (9%). Conclusions: Our experience demonstrated the presence of patchy ground glass opacities and patchy consolidative opacities predominantly in the lower lobes as frequent features.

11.
Rev. argent. radiol ; 86(2): 102-114, jun. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1387608

ABSTRACT

Resumen Dentro del amplio espectro de los tumores pancreáticos, el adenocarcinoma es el que presenta mayor frecuencia. A pesar de los avances de los métodos imagenológicos y de las técnicas quirúrgicas, el carcinoma de páncreas sigue siendo uno de los tumores más agresivos. Su diagnóstico oportuno, y sobre todo la determinación de su resecabilidad, sirven para sectorizar aquellos pacientes candidatos a cirugía de aquellos en quienes esta no resultaría beneficiosa, sumando además los riesgos adicionales que dicho tratamiento implica. En el presente trabajo queremos mencionar los aspectos clínico-epidemiológicos fundamentales del carcinoma de páncreas y describir sus características imagenológicas y criterios de resecabilidad utilizando la tomografía computada multidetector (TCMD) con protocolo específico para glándula pancreática.


Abstract Within the wide spectrum of pancreatic tumors, adenocarcinoma is the one with the highest frequency. Despite advances in imaging methods and surgical techniques, pancreatic carcinoma continues to be one of the most aggressive tumors. Its timely diagnosis and especially the determination of its resectability serve to sectorize those patients who are candidates for surgery, those in whom it would not be beneficial, also adding the additional risks that said therapy implies. In the present work we want to mention the fundamental clinical-epidemiological aspects of pancreatic carcinoma, describe its imaging characteristics and resectability criteria using multidetector computed tomography with a specific protocol for the pancreatic gland.

12.
Rev. argent. radiol ; 86(2): 115-123, jun. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1387609

ABSTRACT

Resumen Para la reconstrucción y el tratamiento de anomalías que comprometen la aorta torácica pueden emplearse diversas técnicas quirúrgicas abiertas, las cuales estarán determinadas por la patología que presente el paciente. La angiotomografía computada multicorte (ATCMC) es el método de elección para su control y seguimiento. El médico radiólogo debe estar familiarizado con las técnicas quirúrgicas empleadas (Wheat, Bentall de Bono, Cabrol, entre otras), con las reparaciones estructurales que se realizan y con los materiales protésicos utilizados con el fin de evitar una interpretación errónea de las imágenes. El fieltro espontáneamente hiperdenso, los conductos protésicos y sus anastomosis, tanto con la aorta como con los grandes vasos, puede generar errores en el informe final y en el diagnóstico.


Abstract Multiple surgical techniques can be used for the reconstruction and treatment of abnormalities that compromise the thoracic aorta, which will be determined by the patient’s pathology. Multislice computed tomography angiography is the method of choice for their control and monitoring. The radiologist should be familiar with the surgical techniques used (Wheat, Bentall de Bono, and Cabrol, among others), as well as with the structural repairs that are performed and the prosthetic materials used in order to avoid an erroneous interpretation of the images. Spontaneously hyperdense felt, the prosthetic ducts and their anastomosis, both with the aorta and the large vessels, can generate pitfalls in the final report and error in the diagnosis.

13.
Rev. argent. radiol ; 86(2): 124-134, jun. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1387610

ABSTRACT

Resumen Las biopsias percutáneas a nivel de la pelvis plantean un desafío dada la compleja anatomía regional. El conocimiento de las estructuras afectadas y el tipo de lesión a intervenir son algunos de los aspectos que van a influenciar la técnica que se utilice. Se han propuesto distintas vías de abordaje, pero aún carecen de sistematización. El objetivo de este artículo es destacar accesos seguros ejemplificando con casos ilustrativos de nuestra institución. Además, agregamos comentarios basados en nuestra experiencia.


Abstract Pelvic percutaneous biopsies are challenging due to complex regional anatomy. Knowledge of affected structures and lesion type are some of the aspects that will condition the technique applied. Different approaches to pelvic percutaneous biopsies have been proposed, but still lack systematization. The aim of this article is to highlight safe approaches supported with illustrative cases. Furthermore, we provide opinion based on our experience.

14.
Säo Paulo med. j ; 140(3): 454-462, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377387

ABSTRACT

ABSTRACT BACKGROUND: Clinical assessment of head and neck cancers is highly challenging owing to the complexity of regional anatomy and wide range of lesions. The diagnostic evaluation includes detailed physical examination, biopsy and imaging modalities for disease extent and staging. Appropriate imaging is done to enable determination of precise tumor extent and involvement of lymph nodes, and detection of distant metastases and second primary tumors. OBJECTIVE: To evaluate the initial staging discrepancy between conventional contrasted computed tomography (CT) and 18F-fluorodeoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and its impact on management plans for head and neck malignancies. DESIGN AND SETTING: Prospective cross-sectional study in two tertiary-level hospitals. METHODS: This study included 30 patients with primary head and neck malignant tumors who underwent contrasted computed tomography and whole-body 18F-FDG PET/CT assessments. The staging and treatment plans were compared with the incremental information obtained after 18F-FDG PET/CT. RESULTS: 18F-FDG PET/CT was found to raise the stage in 33.3% of the cases and the treatment intent was altered in 43.3% of them, while there was no management change in the remaining 56.7%. 18F-FDG PET/CT had higher sensitivity (96% versus 89.2%) and accuracy (93% versus 86.7%) than conventional contrast-enhanced computed tomography. CONCLUSION: Our study demonstrated that 18F-FDG PET/CT had higher sensitivity and accuracy for detecting head and neck malignancy, in comparison with conventional contrast-enhanced computed tomography. 18F-FDG PET/CT improved the initial staging and substantially impacted the management strategy for head and neck malignancies.


Subject(s)
Humans , Positron Emission Tomography Computed Tomography/methods , Head and Neck Neoplasms/therapy , Head and Neck Neoplasms/diagnostic imaging , Cross-Sectional Studies , Prospective Studies , Sensitivity and Specificity , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Positron-Emission Tomography , Neoplasm Staging
15.
Arq. gastroenterol ; 59(2): 296-303, Apr.-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1383839

ABSTRACT

ABSTRACT Background: The nutritional status of patients with colorectal cancer (CRC) impacts on treatment response and morbidity. An effective evaluation of the body composition includes the measurements of fat and visceral fat-free mass and is currently being used in the diagnosis of the nutritional status. The better understanding regarding nutritional tools for body composition evaluation in CRC patients may impact on the outcome. Methods: Systematic review conducted according to Preferred Items of Reports for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A literature search was performed using the BVS (LILACS), PubMed, Embase, Cochrane, Scopus, and Web of Science databases. Results: For the initial search, 97 studies were selected and 51 duplicate manuscripts were excluded. Thus, 46 were reviewed and seven studies included with a total of 4,549 patients. Among them were one clinical trial, one prospective study (cohort), two retrospective cohort and two cross-sectional studies. All studies included body composition evaluated by computed tomography, one with bioelectrical impedance, one with handgrip strength, and two employed mid-arm muscle circumference and body mass index. Conclusion: Current evidence suggests that computed tomography has better accuracy in the diagnosis of sarcopenia, visceral fat, and myopenia among individuals with CRC. Further studies are needed to identify cutoff points for these changes aggravated by CRC.


RESUMO Contexto: O estado nutricional de pacientes com câncer colorretal (CCR) tem impacto na resposta ao tratamento e na morbidade. Uma avaliação eficaz da composição corporal inclui as medidas de gordura visceral e massa livre de gordura e está sendo usada atualmente no diagnóstico do estado nutricional. O melhor entendimento das ferramentas nutricionais para avaliação da composição corporal em pacientes com CCR pode impactar no desfecho. Métodos: Revisão sistemática conduzida de acordo com as diretrizes itens preferidos de relatórios para revisões sistemáticas e meta-análise (PRISMA). Foi realizada uma pesquisa bibliográfica nas bases de dados BVS (LILACS), PubMed, Embase, Cochrane, Scopus e Web of Science. Resultados: Para a busca inicial, 97 estudos foram selecionados e 51 manuscritos duplicados foram excluídos. Assim, 46 foram revisados e sete estudos incluídos, com um total de 4.549 pacientes. Entre eles estavam um ensaio clínico, um estudo prospectivo (coorte), dois estudos retrospectivos de coorte e dois estudos transversais. Todos os estudos incluíram composição corporal avaliada por tomografia computadorizada (TC), um com impedância bioelétrica, um com força de preensão manual e dois empregaram a circunferência muscular do braço e o índice de massa corporal. Conclusão: As evidências atuais sugerem que a TC tem melhor acurácia no diagnóstico de sarcopenia, gordura visceral e miopenia em indivíduos com CCR. Mais estudos são necessários para identificar pontos de corte para essas alterações agravadas pelo CCR.

16.
Dement. neuropsychol ; 16(2): 249-252, Apr.-June 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1384675

ABSTRACT

ABSTRACT. Rapidly progressive dementia (RPD) is a rare neurological disorder. Drug toxicity is among the differential diagnoses, including the use of lithium, in which an overdosage might cause cognitive dysfunction. Clinical suspicion, laboratory confirmation, and drug interruption are key points in the management of lithium intoxication. We described a 66-year-old female patient under treatment with lithium who developed an RPD associated with parkinsonian symptoms. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed an "Alzheimer-like" pattern, while cerebrospinal fluid biomarkers for the disease were negative. There was a significant clinical and radiological improvement after lithium interruption. Lithium intoxication is a potentially reversible cause of RPD, as demonstrated in this case report. Drug discontinuation should be considered even in patients with normal levels of this metal, if cognitive impairment is detected. 18F-FDG PET/CT images may show an "Alzheimer-like" image pattern in acute intoxication and are useful for monitoring these patients.


RESUMO. Demência rapidamente progressiva é uma condição rara, cujos diagnósticos diferenciais incluem intoxicação por drogas como lítio, podendo causar importante disfunção cognitiva. A suspeita clínica, a confirmação laboratorial e a interrupção do uso medicamentoso são elementos fundamentais em seu diagnóstico e manejo. Trata-se de paciente feminina, de 66 anos de idade, que apresentou quadro demencial após intoxicação por lítio. Tal quadro foi acompanhado de sintomas parkinsonianos, além de Tomografia por Emissão de Pósitrons com 18F-Fluodeoxiglicose (18F-FDG PET/CT) compatível com padrão "Alzheimer-like". Houve melhora objetiva de parâmetros clínicos e imaginológicos após a interrupção do uso medicamentoso. A intoxicação por lítio é uma causa potencialmente reversível de demência rapidamente progressiva. A descontinuação da droga deve ser considerada também em pacientes com níveis normais do metal no sangue se alterações cognitivas forem encontradas. Imagens 18F-FDG PET/CT podem demonstrar achados sugestivos de doença de Alzheimer na intoxicação aguda e parecem ser um método útil no seguimento.

17.
Rev. colomb. cir ; 37(3): 455-468, junio 14, 2022. fig
Article in Spanish | LILACS | ID: biblio-1378744

ABSTRACT

Introducción. Debido a la rareza de la hernia obturatriz y la imposibilidad para desarrollar estudios controlados de alto grado de evidencia, la mayoría de la literatura al respecto proviene de reportes de casos. Lo anterior, aunado al poco conocimiento del área anatómica de presentación y el cuadro clínico, la convierte en la hernia con mayor mortalidad. Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos, ilustrado con pacientes manejados en el Servicio de Cirugía general de la Clínica Santa María de Sincelejo, Colombia. Discusión. La hernia obturatriz se puede descubrir en mujeres ancianas con antecedentes de cirugía abdominal o multiparidad. El signo de Howship­Romberg, que se presenta en la mitad de los pacientes, puede acompañarse de dolor abdominal en hipogastrio, vómitos y distensión progresiva. La radiografía de abdomen simple muestra tardíamente niveles hidroaéreos con ausencia de gas en ampolla rectal, pero como es poco específica para demostrar el sitio de obstrucción, es preferible la Tomografía computarizada. Conclusión. La hernia obturatriz requiere alto índice de sospecha, que ayude a la detección temprana e intervención quirúrgica inmediata, para evitar las complicaciones.


Introduction. Due to the rarity of the obturator hernia and the impossibility to develop controlled studies with a high degree of evidence, most of the reference in the literature comes from case reports. This, coupled with little knowledge of the anatomical area of presentation and clinical picture, makes it the hernia with the highest mortality. Methods. A literature search was carried out in the main databases, illustrated with patients managed in the General Surgery Service of the Clínica Santa María de Sincelejo. Discussion. Obturator hernia can be discovered in elderly women with a history of abdominal surgery or multiparity. The Howship ­ Romberg sign occurs in half of the patients, it can be associated with lower abdominal pain, vomiting, and progressive distension. Plain abdominal X-ray shows delayed air-fluid levels with absence of gas in the rectal ampulla, but since it is not very specific to demonstrate the site of obstruction, computed axial tomography is preferable. Conclusion. Obturator hernia requires a high index of suspicion, which helps early detection and immediate surgical intervention, to avoid complications.


Subject(s)
Humans , Hernia, Obturator , Intestinal Obstruction , Tomography, X-Ray Computed , Abdominal Pain , Pelvic Pain , Diagnosis
18.
Rev. colomb. cir ; 37(3): 469-479, junio 14, 2022. fig
Article in Spanish | LILACS | ID: biblio-1378760

ABSTRACT

Introducción. En la actualidad, el trauma de recto continúa siendo una situación clínica compleja y temida por ser potencialmente mortal. Su detección y manejo temprano es la piedra angular para impactar tanto en la mortalidad como en la morbilidad de los pacientes. Hoy en día, aún existe debate sobre la aproximación quirúrgica ideal en el trauma de recto y las decisiones de manejo intraoperatorias se ven enormemente afectadas por la experiencia y preferencias del cirujano. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Clinical Key, Google Scholar y SciELO utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes publicados en los últimos 20 años; se tuvieron en cuenta los artículos escritos en inglés y español. Discusión. El recto es el órgano menos frecuentemente lesionado en trauma, sin embargo, las implicaciones clínicas que conlleva pasar por alto este tipo de lesiones pueden ser devastadoras para el paciente. Las opciones para el diagnóstico incluyen el tacto rectal, la tomografía computarizada y la rectosigmoidoscopía. El manejo quirúrgico va a depender de la localización, el grado de la lesión y las lesiones asociadas. Conclusión. El conocimiento de la anatomía, el mecanismo de trauma y las lesiones asociadas permitirán al cirujano realizar una aproximación clínico-quirúrgica adecuada que lleve a desenlaces clínicos óptimos de los pacientes que se presentan con trauma de recto.


Introduction. Currently, rectal trauma continues to be a complex clinical and potentially fatal situation. Its early detection and management is the cornerstone to avoid both mortality and morbidity of patients. Today there is still debate about the ideal surgical approach in rectal trauma, and intraoperative management decisions are greatly affected by the experience and preferences of the surgeon. Methods. A literature search was performed in the PubMed, Clinical Key, Google Scholar and SciELO databases using the keywords described. The most relevant articles published in the last 20 years were selected. Articles written in English and Spanish were considered.Discussion. The rectum is the organ less frequently injured in trauma; however, the clinical implications of overlooking this injury can be devastating for the patient. Options for diagnosis include digital rectal examination, computed tomography and rectosigmoidoscopy. Surgical management will depend on the location, degree of the injury and the associated injuries. Conclusion. Knowledge of the anatomy, the mechanism of trauma and the associated injuries will allow the surgeon to make an adequate clinical-surgical approach that leads to optimal clinical outcomes in patients presenting with rectal trauma.


Subject(s)
Humans , Rectum , Multiple Trauma , Sigmoidoscopy , Wounds and Injuries , Tomography, X-Ray Computed , Colorectal Surgery , Diagnosis
19.
Int. j. morphol ; 40(3): 774-780, jun. 2022. ilus, tab
Article in English | LILACS-Express | LILACS | ID: biblio-1385678

ABSTRACT

SUMMARY: The aim of this study is to contribute to sex determination studies from the scapula in the Turkish population and compare with previous studies. This study was performed with 200 scapulae (100 males and 100 females). The age range of the patients was between 18-93 years old. Computed tomography scans were used and length of glenoid cavity (LGC), breadth of glenoid cavity (BGC), depth of glenoid cavity (DGC), perimeter (PM) and volume (VL) were measured. Randomly selected 20 scapulae were measured three times for examine the intra-rater reliability from those measurements. Gender logistic regression analysis was conducted to find the significant variables at sex determination from the scapula. The most effective parameter in determining sex from scapula was found to be VL (88.5%). The effects of LGC, PM, BGC and DGC at sex determination from scapula were found to be 83%, 82.5%, 79.5%, 66%, respectively. The combination of VL and PM (89.5%) was found to be the most effective combination at sex determination from the scapula. The intraclass correlation values of all measurements were found to be at high reliability. According to the literature, PM and DGC along with the VL in Turkish population, were not used previously for sex determination from the scapula. A combination of the VL and PM was found to be the most effective parameters at sex determination from scapula in the Turkish population. There are few studies on the sex determination from scapula in the Turkish population. This study will guide anthropologists, forensic scientists and anatomists at sex determination studies from scapula and surgeons by morphometrically in clinical situations related to the scapula.


RESUMEN: El objetivo de este estudio fue contribuir a la determinación del sexo a partir de la escápula en la población turca y comparar con estudios previos. Esta investigación se realizó con 200 escápulas (100 hombres y 100 mujeres). El rango de edad de los pacientes estaba entre de 18 años y 93 años. Escaner de tomografía computada se usó para medir en la cavidad glenoidea los siguientes parámetros: longitud (LCG), ancho (ACG), profundidad (PCG), perímetro (PG) y volumen (VCG). Se midieron 20 escápulas seleccionadas tres veces al azar para examinar la confiabilidad intraevaluador de estas mediciones. Se realizó un análisis de regresión logística de género para encontrar las variables significativas en la determinación del sexo a partir de la escápula. El parámetro más eficaz para determinar el sexo a partir de la escápula resultó ser VCG (88,5%). Los efectos de LCG, PG, ACG y PCG en la determinación del sexo a partir de la escápula fueron del 83 %, 82,5 %, 79,5 % y 66 %, respectivamente. La combinación de VCG y PG (89,5%) resultó ser la combinación más efectiva en la determinación del sexo a partir de la escápula. Se encontró que los valores de correlación intraclase de todas las mediciones tenían una alta confiabilidad. De acuerdo con la literatura, PG y PCG junto con el VCG en la población turca, no se han utilizado previamente para la determinación del sexo a partir de la escápula. Se determinó que una combinación de VCG y PG son los parámetros más efectivos en la determinación del sexo a partir de la escápula. Existe escasa información sobre la determinación del sexo a partir de la escápula en la población turca. Este estudio guiará a los antropólogos, forenses y anatomistas en los estudios de determinación del sexo de la escápula y sera útil para los cirujanos en situaciones clínicas relacionadas con la escápula.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Tomography, X-Ray Computed , Sex Determination by Skeleton , Glenoid Cavity/anatomy & histology , Glenoid Cavity/diagnostic imaging , Scapula/anatomy & histology , Scapula/diagnostic imaging , Turkey , Logistic Models
20.
J. oral res. (Impresa) ; 11(1): 1-13, may. 11, 2022. ilus, tab
Article in English | LILACS | ID: biblio-1399621

ABSTRACT

Objective: To determine the impact of CBCT on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning. Material and Methods: Diagnostic evaluation and treatment plan for the maxillary sinus were evaluated by eight specialists experienced in dental implant placement. Eight panoramic radiographs (PAN) and CBCT examinations were obtained from five adult patients with a specific clinical need for dental implants. Evaluation was performed first on PAN then, at least 2 weeks later, on CBCT. Residual alveolar ridge height, mucosal thickening, radiographic findings and treatment plan were recorded. The confidence level was evaluated for both diagnostic evaluation and treatment plan. The kappa statistic for intra-observer reproducibility and McNemar test were performed. Results: In the diagnostic evaluation, CBCT showed significant impact on the diagnosis of radiographic findings. Availability of CBCT significantly changed the treatment plan, for less invasive treatment, or no treatment need. Observers had significantly greater confidence when using CBCT than PAN, when indicating presence of mucosal thickening and radiographic findings in the maxillary sinus. In addition, CBCT increased confidence in the treatment plan. Conclusion: The present study suggests that CBCT has an impact on the diagnostic evaluation of radiographic findings in the maxillary sinus and on the decision to place implants, owing to misdiagnosis of pathology and planning of more invasive treatments when using PAN. Availability of CBCT also improves clinician confidence. Further studies at higher levels of diagnostic efficacy should be performed, to justify the use of CBCT, by evaluating the actual treatment performed and its outcome.


Objetivo: Determinar el impacto de la tomografía computarizada de haz cónico (CBCT) en la evaluación diagnóstica y el plan de tratamiento del seno maxilar en la planificación de implantes dentales. Material y Métodos: La evaluación diagnóstica y el plan de tratamiento del seno maxilar fueron evaluados por ocho especialistas con experiencia en la colocación de implantes dentales. Se obtuvieron ocho radiografías panorámicas (PAN) y exámenes CBCT de cinco pacientes adultos con una necesidad clínica específica de implantes dentales. La evaluación se realizó primero en PAN y luego, al menos dos semanas después, en CBCT. Se registraron la altura del reborde alveolar residual, el engrosamiento de la mucosa, los hallazgos radiográficos y el plan de tratamiento. Se evaluó el nivel de confianza tanto para la evaluación diagnóstica como para el plan de tratamiento. Se realizó el estadístico kappa para la reproducibilidad intraobservador y la prueba de McNemar. Resultados: En la evaluación diagnóstica, CBCT mostró un impacto significativo en el diagnóstico de los hallazgos radiográficos. La disponibilidad de CBCT cambió significativamente el plan de tratamiento, para un tratamiento menos invasivo o sin necesidad de tratamiento. Los observadores tuvieron una confianza significativamente mayor al usar CBCT que PAN, al indicar la presencia de engrosamiento de la mucosa y hallazgos radiográficos en el seno maxilar. Además, CBCT aumentó la confianza en el plan de tratamiento. Conclusión: El presente estudio sugiere que la CBCT tiene un impacto en la evaluación diagnóstica de los hallazgos radiográficos en el seno maxilar y en la decisión de colocar implantes, debido al diagnóstico erróneo de la patología y la planificación de tratamientos más invasivos al usar PAN. La disponibilidad de CBCT también mejora la confianza del clínico. Se deben realizar más estudios a niveles más altos de eficacia diagnóstica para justificar el uso de CBCT, evaluando el tratamiento real realizado y su resultado.


Subject(s)
Humans , Dental Implants , Cone-Beam Computed Tomography/methods , Maxillary Sinus/diagnostic imaging , Peru/epidemiology , Diagnostic Imaging/instrumentation , Planning , Alveolar Process
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