Papel de la ecografía en la sala de emergencia en el diagnóstico del trauma de tórax / The Role of Sonography in the Emergency Room for the Diagnosis of Thoracic Trauma

Introducción: Dentro de la atención al lesionado con trauma torácico se cuenta con varios medios diagnósticos, entre ellos la evaluación por ecografía focalizada en trauma extendido a tórax, el cual ha mostrado una alta sensibilidad, aun realizado por médicos no radiólogos como cirujanos generales, emergencistas e intensivistas. Objetivo: Determinar la utilidad de la ecografía torácica extendida realizada por cirujanos en lesionados con traumatismo torácico. Métodos: Se realizó un estudio observacional, descriptivo de evaluación de pruebas diagnósticas con un diseño transversal, en 1052 pacientes ingresados en la sala de emergencia. Se les realizó la evaluación por ecografía torácica extendida en el Hospital Universitario "General Calixto García", durante el período comprendido entre enero de 2020 y febrero de 2021. Resultados: Fueron realizados en un periodo de 1 año un total de 1052 ultrasonidos torácicos, 221 casos fueron positivos, de ellos 81 neumotórax (7,7 por ciento) y 62 hemoneumotórax (5,9 por ciento) todos confirmados por tomografía de tórax. La edad promedio fue de 45,27 (18-97), el sexo masculino prevaleció con 772 casos (73,4 por ciento). Los mecanismos productores de trauma más frecuentes fueron: caída de altura 273 casos (26 por ciento) y trauma contuso 181 casos (17,2 por ciento). La ecografía torácica extendida obtuvo una sensibilidad de un 95,24 por ciento y una especificidad de 99,88 por ciento en el diagnóstico lesiones torácicas. Conclusiones: La ecografía torácica extendida demostró que en manos de los cirujanos generales es una herramienta confiable, segura, no invasiva, poco costosa, repetible, que permite diagnosticar rápidamente lesiones torácicas y tratarlas(AU)

Introduction: Within care for the injured patient with thoracic trauma there are several diagnostic means. For example, extended focused assessment with sonography for thoracic trauma has shown high sensitivity, even when performed by non-radiologists such as general surgeons, emergency specialists and intensivists. Objective: To determine the usefulness of extended thoracic sonography performed by surgeons on injured patients with thoracic trauma. Methods: An observational, descriptive and cross-sectional study of diagnostic tests assessment was carried out in 1052 patients admitted to the emergency room. They were assessed by extended thoracic sonography at General Calixto García University Hospital, during the period between January 2020 and February 2021. Results: A total of 1052 thoracic ultrasounds were performed in a period of one year, of which 221 cases were positive. Of them, 81 were pneumothorax (7.7 percent) and 62 were hemopneumothorax (5.9 percent), all confirmed by chest tomography. The average age was 45.27 (18-97). The male sex prevailed, with 772 cases (73.4 percent). The most frequent trauma-producing mechanisms were altitude fall, accounting for 273 cases (26 percent), and blunt trauma, accounting for 181 cases (17.2 percent). Extended thoracic ultrasound showed a sensitivity of 95.24 percent and a specificity of 99.88 percent in the diagnosis of thoracic injuries. Conclusions: Extended thoracic ultrasound showed that, in the hands of general surgeons, it is a reliable, safe, noninvasive, inexpensive and repeatable tool that allows rapid diagnosis and treatment of thoracic injuries(AU)

Efeitos da remoção do disco e cartilagem articular no crescimento e microarquitetura óssea da mandíbula de ratos: análise por microtomografia / Effects of articular disc and cartilage removal on mandible of growing rats: a micro-computed tomography study

Alterações na articulação emporomandibular (ATM) comumente geram desequilíbrios musculares que estão associados à alterações no tecido ósseo. Esta articulação pode sofrer a influência de traumas, fatores congênitos ou desordens de crescimento. Estudos sobre alterações de crescimento do complexo maxilomandibular decorrentes de problemas da ATM são escassos. O objetivo deste trabalho foi avaliar por meio da microtomografia os efeitos da remoção do disco articular e a remoção conjugada do disco e cartilagem articular no crescimento e na microarquitetura óssea da mandíbula de ratos. Trinta ratos da raça Wistar com um mês de idade foram divididos em três grupos: CTR (controle operado); RD (remoção de disco articular) e RDC (remoção conjugada do disco e cartilagem articular). Apenas o lado direito foi operado; o lado esquerdo permaneceu intacto. Após dois meses de acompanhamento, os ratos foram sacrificados e as hemimandíbulas escaneadas em microtomógrafo A remoção do disco articular e a remoção conjugada do disco e cartilagem articular alteram o volume e microestrutura do osso trabecular da mandíbula de ratos jovens. Estas duas intervenções provocaram uma queda na qualidade de parâmetros da microestrutura do trabeculado do processo angular e diminuição do crescimento da hemimandíbula do lado operado.

Changes in the temporomandibular joint (TMJ) lead to muscle dysfunctions that are associated with bone changes. This joint region can be influenced by trauma, congenital factors or growth disorders. Studies linking TMJ problems and growth alterations are scarce. The aim of this study was to evaluate the effects of the articular disc removal or articular disc and cartilage removal on the bone microarchitecture and mandibular growth of young rats. Thirty Wistar rats (one month old) were divided into three groups: CTR (sham operated); RD (disc removal) and RDC (disc and cartilage removal). Only the right side was operated, keeping the left side intact. After two months, the rats were sacrificed and the mandibles scanned on micro-CT for quantitative analysis. Some microstructural parameters were altered by the disc removal or disc and cartilage removal. The right side presented lower growth than the left side.

Correlación tomográfica y clínica, pre y posquirúrgica en los tumores de la región selar / Pre- and postsurgical tomographic and clinical correlation in the tumors of the sellar region

La alta prevalencia de los macroadenomas hipofisarios en el mundo motivó la realización de esta investigación, cuyo objetivo fue demostrar el valor diagnóstico de la tomografía computadorizada y su utilidad para definir la técnica quirúrgica en estos casos. Para ello se estudiaron 124 pacientes operados con el diagnóstico clínico y tomográfico de macroadenomas hipofisarios y otros tumores de la región selar menos frecuentes. El 100 por ciento de los tumores con crecimiento C-E y C-D se abordaron por vía transcraneal y el 99 restante con crecimiento A, B ó C se utilizó la vía transesfenoidal. Las complicaciones tomográficas y clínicas fueron superiores en la primera vía y se destacaron los restos tumorales (40 por ciento), las recidivas (28 por ciento) y daño de los nervios craneales (28 por ciento). La mejoría clínica posoperatoria alcanzada fue ostensible al igual que el grado de control de los adenomas, lo cual demostró el alto valor diagnóstico de la tomografía computadorizada y su utilidad para trazar la estrategia quirúrgica correcta, esto muestra una alta sensibilidad en la detección de algunas complicaciones posoperatorias que se pueden valorar con este método.

The high prevalence of hypophyseal macroadenomas in the world motivated us to conduct this research aimed at demonstrating the value of computerized tomography and its usefulness to define the surgical technique in these cases. To this end, 124 patients operated on with the clinical tomographic diagnosis of hypophyseal macroadenomas and other tumors of the sellar region that were less common were studied. 100 percent of the tumors with C-E and C-D growth were approached by transcranial route, whereas in the other 99 with A, B or C growth, it was used the transsphenoidal route. The tomographic and clinical complications were higher in the first route, and the tumor debris (40 percent), the relapses (28 percent) and the damage of the cranial nerves (28 percent) stood out. The postoperative clinical improvement attained was significant the same as the degree of control of the adenomas, which showed the high diagnostic value of computerized tomography and its usefulness to establish the suitable surgical strategy. This shows a high sensitivity in the detection of some postoperative complications that may be assessed by using this method.

Tomografia computadorizada do tórax de cadelas portadoras de neoplasias malignas. II – Avaliação dos campos pulmonares / Computed tomography exam of the thorax of female dogs with malignant mammary gland tumors. II – Pulmonary parenchimal evaluation

Visto a importância das neoplasias mamárias na clínica médico-veterinária e as novas perspectivas do diagnóstico por imagem, o presente trabalho visou comparar o exame tomográfico contrastado com o exame radiográfico simples dos campos pulmonares de cadelas portadoras de tumores mamários malignos. Para tanto, foram realizados exames de tomografia computadorizada contrastada da cavidade torácica de vinte fêmeas da espécie canina, de diferentes raças e idades, portadoras de neoplasias mamárias malignas encaminhadas ao Serviço de Diagnóstico por Imagem do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo pelos Serviços de Obstetrícia e Ginecologia e de Cirurgia de Pequenos Animais da mesma instituição. Concluiu-se que, o exame tomográfico se mostrou um importante complemento do exame radiográfico na pesquisa de metástases de neoplasias mamárias em cadelas no que se refere à avaliação do interstício pulmonar.

Seen the importancy of the malignant mammary gland tumors in the veterinary medicine clinic, the new perspectives of the diagnostic imaging in order to evaluate pacients that have this neoplasia, and the few information of this subject in the literature this research proposed to compare contrast computed tomographic and survey radiographic techniques in the lung’s evaluation of female dogs with malignant mammary gland tumors. This research was performed at the Diagnostic Imaging Service of the Veterinary School Hospital of the Faculdade de Medicina Veterinária e Zootecnia at the University of São Paulo in twenty, from different breed and age, bitches with malignant mammary gland tumors that were examined at the Obstetric and Ginecology and Small Animal Surgery Services of the same hospital. The tomographic exam showed up as an important complement of the radiographic exam in searching for mammary gland tumor metastasis, concerning the evaluation of the pulmonary intersticium.

Las grandes desarticulaciones preservadoras / The extensive preservative desarticulation

Se ha revisado la experiencia del Hospital Universitario de Caracas en los últimos 11 años (1986-1996) en las grandes desarticulaciones encontrándose sólo 18 casos, la mayoría de ellos (16) son desarticulaciones de la cadera, una hemipelvectomía y una desarticulación interescápulo torácica. Se analizan también, más detalladamente, 2 casos de grandes desarticulaciones preservadoras: una operación de Tikhoff-Linberg y una hemipelvectomía interna por razones ortópedicas, operado exitosamente en el Hospital de Clínicas Caracas