Moldes individualizados para alineación de la artroplastía primaria de rodilla / Individualized molds for alignment of primary knee arthroplasty

Introducción: Los sistemas de bloque de corte específicos (BCE) se han presentado como una interesante medida para obtener una correcta alineación en la artroplastía de rodilla, aunque se desconoce cuál de todos los métodos existentes para realizar la planificación es el adecuado. Material y métodos: Se ha diseñado un estudio prospectivo comparando dos sistemas de BCE con planificaciones diferentes (Signature con TAC + teleradiografia; Visionaire con RMN) con el sistema convencional de alineación. Se analizaron parámetros radiográficos, funcionales preoperatorios y postoperatorios, estancia hospitalaria, necesidad de transfusión, tiempo quirúrgico y complicaciones asociadas. Resultados: Un total de 10 pacientes fueron intervenidos por cada grupo. No se observaron diferencias estadísticamente significativas entre los dos sistemas de alineamiento específicos y el sistema convencional (p > 0.05), aunque se objetivó una mayor precisión con estos sistemas, siendo discretamente superior en el sistema Signature. También se observó un menor tiempo quirúrgico en los pacientes intervenidos con los BCE, ligeramente inferior en los intervenidos con el sistema Visionaire (p > 0.05). Conclusiones: Los nuevos sistemas BCE pueden ser útiles para mejorar la alineación en la artroplastía de rodilla así como disminuir el tiempo quirúrgico. A la espera de series mayores que corroboren estos datos, los autores recomiendan estos sistemas en aquellos casos en los que los sistemas convencionales no sean adecuados.

Introduction: Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. Material and methods: A prospective study was designed to compare two PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. Results: A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it was still slightly shorter in those in whom the Visionaire system was used (p > 0.05). Conclusions: The new PSCB systems may be useful to improve alignment in knee arthroplasty and reduce the operative time. While larger case series confirming these data become available, the authors recommend using these systems in cases in which the standard systems do not work properly.

Cephalometric evaluation of the airway space and hyoid bone in children with atypical deglutition: correlations study / Evaluación cefalométrica del espacio de las vías respiratorias y hueso hioides en niños con deglución atípica: estudio correlacional

Although there is a close relationship between swallowing and breathing are no studies that relate to atypical swallowing radiographic anatomy of the airway space and its possible correlation with the radiographic position of the hyoid bone. The aim was to evaluate the possible correlation with the radiographic position of the hyoid bone and airway space in lateral radiographs of children with atypical deglutition. Using cephalometric analysis on lateral teleradiographs, the distances of H-MP (hyoid to mandibular plane) and H-T (hyoid to tuber) were Spearman's correlation analysis was performed with PAS (airway space) in two groups: the experimental group with atypical deglutition and the control group normal deglutition. Both groups included subjects in mixed dentition stage. Thevariable T-H had statistically significant correlation with PAS (0.0286) and the variable MP-H had significant correlation with variable PAS (0.0053). Ourresults show that advanced positive correlation of the radiographic position of the hyoid bone to the airway space only in the group of normal swallowing. The lower airway in patients with atypical swallowing, causing changes in tongue posture which leads to change in the position of the hyoid bone.

Aunque existe una estrecha relación entre la deglución y la respiración, no se dispone de estudios que relacionen la anatomía radiográfica atípica de deglución del espacio de la vía aérea y su posible correlación con la posición radiológica del hueso hioides. El objetivo fue evaluar la posible correlación de la posición radiológica del hueso hioides y las vías aéreas en radiografías laterales de niños con deglución atípica. Utilizando el análisis cefalométrico sobre telerradiografías laterales, fueron analizadas las correlaciones entre las distancias H-MP (hueso hioides al plano mandibular) y HT (hioides al tubérculo) y el PAS (espacio de la vía aérea) en dos grupos: el grupo experimental con la deglución atípica y el grupo control con deglución normal. Ambos grupos estaban en etapa de dentición mixta. Las variables HT y MP-H tuvieron una correlación estadísticamente significativa con la variable PAS, 0,0286 y 0,0053 respectivamente. Nuestros resultados muestran que la correlación positiva de la situación radiológica avanzada del hueso hioides al espacio de las vías respiratorias sólo se observa en el grupo de deglución normal. La vía respiratoria inferior en los pacientes con deglución atípica provoca cambios en la postura de la lengua, lo que conduce a un cambio en la posición del hueso hioides.

Aplicabilidad de la telemedicina con énfasis en la teleradiología: una aproximación bioética / Applicability of telemedicine with emphasis on teleradiology: a bioethical approach

La presente investigación se propuso conocer las implicaciones Bioéticas y educativas derivadas de la aplicación de la Telemedicina en la actualidad, con énfasis en la Radiología a distancia o Teleradiología, para establecer algunas reflexiones acerca de la viabilidad de su aplicación no sólo desde el punto de vista tecnológico sino Bioético. Se realizó una investigación documental. La información fue ordenada, organizada y presentada para su análisis e interpretación lo que permitió concluir que la Telemedicina y por ende la teleradiología, a través de un proceso educativo médico, puede solucionar problemas de índole clínico en zonas alejadas, estableciendo comunicación entre institucionesy profesionales de la salud, teniendo una adecuada plataforma tecnológica, siempre y cuando se mantenga la relación médico-paciente con los elementos de responsabilidad profesional que conlleva, respetando los principios bioéticos de: dignidad de la persona, autonomía, privacidad, beneficencia, justicia y equidad.

The following investigation has the purpose to acknowledge the bioethical and educational implications derived from the application of the telemedicine in our current days, with emphasis in distance radiology or tele-radiology, to establish furthermore some reflections about the possibility of its application, not only from the technological standing point but also from the bioethical point. To achieve the goal an approach through a documentary investigation was made. The information was organized and presented for its analysis and interpretation, allowed us to conclude that telemediycine and also tele-radiology, through a medical educational process may solve clinical type of problems in distant zones making contact between institutions and health professional, likewise having an adequate technological platform, as long as the doctor-patient relation is kept with the elements of professional responsibility which are inside it, respecting the bioethical principles of the person´s dignity, autonomy, privacy, beneficence, justice and equity.

Pesquisa de calcificações em tecidos moles na região cervical por meio das técnicas radiográficas panorâmica e telerradiografia / Research on calcifications in soft tissues in the cervical region by means of panoramic radiographic and teleradiographic techniques

A literatura tem alertado para a presença de imagens radiopacas em radiografias panorâmicas, adjacentes à coluna cervical, indicativas de calcificações na bifurcação da artéria carótida, representando indícios da presença de ateromas. Diferentes imagens radiopacas podem ser observadas na região cervical (anatômicas e patológicas), cujas características devem ser conhecidas. Existem, no entanto, considerações a serem feitas em relação a diferentes constituições físicas entre sexos, raças, e mesmo relacionadas ao tipo físico do indivíduo, que podem produzir projeções diferenciadas nas radiografias panorâmicas. A interpretação dessas radiografias requer umacompreensão da formação das imagens, já que a radiografia panorâmica é um sistema rotacional que resulta na formação de uma zona de nitidez dentro da qual as estruturas aparecem em foco e as que estivem para fora aparecerão borradas. O objetivo dotrabalho foi avaliar a contribuição das telerradiografias, nas normas lateral e frontal, na identificação e localização de calcificações em tecidos moles, quando comparado comas observadas em radiografia panorâmica...

The literature has warned about the presence of radiopaque images in panoramic radiographs, adjacent to the spine, indicative of calcifications in the bifurcation of the carotid artery, representing signs of the presence of atheromas. Different radiopaque images can be observed in the cervical region (anatomic and pathologic), whose characteristics should be known. There are, however, considerations to be made with regard to the different physical constitutions between sexes, races, and even related tothe physical type of the individual, which may produce differentiated projections in panoramic radiographs. Interpretation of these radiographs requires an understanding of the formation of the images, since the panoramic radiograph is a rotational system that results in the formation of a zone of nitidity within which the structures appear in focus and those that are outside of it appear blurred. The aim of the study was to evaluate the contribution of lateral and frontal teleradiographs to the identification and location of calcifications in soft tissues, when compared with those observed in panoramic radiographs...

Bosquejo histórico de la Cefalometría Radiográfica / Historical sketch of radiographic cephalometry

La cefalometría es un elemento importante en la conformación de una documentación ortodóncica para elaborar un diagnóstico y un plan de tratamiento adecuado. Con el descubrimiento de los rayos X, el 8 de noviembre de 1895 por Wilhhelm Conrad Roentgen, y la existencia de técnicas que precedieron a los rayos X, como la craneometría y la antropología, es que los ortodoncistas pueden contar con esta herramienta diagnóstica de inestimable valor. En el perfeccionamiento de la técnica cefalométrica y de sus análisis contemporáneos ha sido importante el concurso de diversos autores entre los que se destacan Broadbent, Bolton, Hofrath, Korkhaus, Ubaldo Carrea, De Nevreze, Paul Simon y Dreyfus, Margolis, Weingart, Thurow, Bjork, Freeman-Rasmussen, Reboul, Steiner, Andrews, Ricketts, Holdaway, McNamara, Interlandi, entre otros. Este trabajo se propone hacer un recuento de los hechos más significativos que acompañaron la evolución y desarrollo de la cefalometría(AU)

Cephalometry is an important element to take into account at the time of preparing an orthodontic documentation in order to make a diagnosis and an adequate treatment plan. Thanks to the discovery of X-rays on November 8, 1895 by Wilhhelm Conrad Roentgen, and to the existence of techniques that preceded the X-rays, such as craniometry and anthropology, orthodontists may use this diagnostic tool of great value. In the improvement of the cephalometric technique and its contemporary analyses it has been important the collaboration of various authors, among whom Broadbent, Bolton, Hofrath, Korkhaus, Ubaldo Carrea, De Nevreze, Paul Simon and Dreyfus, Margolis, Weingart, Thurow, Bjork, Freeman-Rasmussen, Reboul, Steiner, Andrews, Ricketts, Holdaway, McNamara and Interlandi, stand out. This paper intends to make an account of the most significant events related to the evolution and development of cephalometry(AU)

Avaliação da distribuição dos grupos rotacionais de crescimento de Lavergne e Petrovic utilizando o ângulo ANB medido e o ângulo ANB individual em indivíduos jovens brasileiros, do tipo facial provertido / Evaluation of the distribution of the rotations growth groups of Lavergne and Petrovic using the angle measure ANB and the angle individual ANB in young Brazilian individuals with facial type provertion

Introdução - O objetivo deste estudo foi avaliar a distribuição dos grupos rotacionais de crescimento de Lavergne e Petrovic, utilizando o ângulo ANB medido e a individualização do ângulo ANB proposta por Goffi, em indivíduos jovens, brasileiros, portadores de Classe I Basal e Dentária com tipo facial provertido. Métodos - Foram selecionadas 20 telerradiografias em norma lateral. As referidas telarradiografias eram de indivíduos que apresentavam o tipo facial provertido, que não foram submetidos a tratamento ortodôntico-ortopédico prévio. Sendo 14 do gênero masculinos e 6 do gênero feminino. Resultados - Os resultados foram avaliados pelos testes estatísticos de média aritmética, desvio padrão, teste "t" de Student para amostra pareada. Conclusão - A individualização do ângulo ANB, estatisticamente não influenciou na distribuição dos grupos rotacionais de Lavergne e Petrovic em pacientes do tipo facial provertidos.

Comparison between cephalometrics measure using anatomic and metallicporion point%Comparação entre medidas cefalométricas usando ponto pório metálico e anatômico

The aim of this study was to compare the cephalometric measures involving FMA (Frankfurt Mandibular Plane Angle), FMIA (Frankfurt Mandibular Incisor Angle), and occlusal plane angles (Frankfurt horizontal plane - occlusal plane) for cephalometric tracing by using anatomic and metallic porion points. Cephalometric tracingwas performed in thirty head lateral teleradiographs divided into two groups. The anatomic porion point was marked in group 1, whereas metallic porion point was marked regarding the Frankfurt horizontal Plane (FHP). All measures were analysed. The mean values for FMA(32.33o) and occlusal plane angles (10.77o) in group 2 were statistically higher than those found in group 1 (FMA - 27.57o); occlusal plane angle - 6.23o). The mean value for FMIA angle (62.73o) in group 1 was statistically higher when compared to group 2 (57,80°). According to these results, one can conclude that cephalometric tracing of porion points (either anatomic or metallic) alter the values for FMA, FMIA, and occlusal plane angles, thus resulting in different treatment plans

Design of an emergency teleradiology system based on progressive transmission

In clinical surgery, there are frequent needs for communication between the house staff and the attending physician in an emergency situation. To overcome the limitation of voice communication through the telephone line, we have designed an 'emergency teleradiology system' which can be used for emergency surgical and medical decision making. This system can transmit the high quality images of CT, MRI, and other X-ray data using a PC attached to a modem through the conventional telephone line. It is based on the progressive transmission system which enables the successive update of a received image. The iterative residual coding/decoding algorithm efficiently compresses the image to maximally utilize the low bandwidth PSTN channels. This system also satisfies design requirements such as low-cost, ease of operation, fast transmission, and interactive image communication including voice. Test results using several CT, MR, and X-ray images evaluate the compression performance, image quality, transmission time and computational time of the coding and decoding processes, thus demonstrate the usefulness of this system in an emergency situation.