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1.
Int. j. odontostomatol. (Print) ; 14(1): 124-130, mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1056511

ABSTRACT

RESUMEN: En la historia de la Endodoncia, se han utilizado distintos métodos para determinar la longitud de los canales radiculares, como sensación táctil y radiografías. Últimamente, han adquirido gran importancia los localizadores apicales electrónicos, por su gran precisión. Actualmente se ha incorporado el uso de imagenología con Cone Beam. Debido a que existen muchas formas de medir dicha longitud, es necesario ponerlos a prueba y ver si se asemejan a la técnica gold estándar definida en la literatura como el localizador electrónico de foramen apical. El propósito de esta investigación es determinar si existen diferencias estadísticamente significativas en la medida de la longitud de trabajo entre el localizador electrónico de foramen apical, y el uso de Cone Beam procesado con el software 3D endo de Dentsply Sirona. Para esto, se seleccionaron 30 premolares extraídos; se les tomó un Cone Beam para ser analizados con el software 3D endo y medir la longitud de trabajo. Una vez hecho esto, se realizó manualmente cavidad de acceso y se preparó el tercio cervical con fresas Gates Glidden 1 y 2; luego, los dientes fueron colocados en un modelo Pro Train, que asemejó las propiedades de los dientes en la cavidad oral, para permitir el uso del localizador electrónico de foramen y determinar la longitud de trabajo. Una vez obtenidos los datos, fueron comparados a través del Test de Proporciones (p=0.05 hipotético), dando como resultado p=0,2 lo que indica que no existen diferencias estadísticamente significativas en la medida de la longitud de trabajo entre ambos métodos.


ABSTRACT: Various methods have been used in the history of endodontics, to determine the length of the root canals (working length), such as tactile sensation and X-rays. Recently, apical locators have acquired importance, due to their precision. The use of Cone Beam has now also been incorporated. Because there are many ways to measure this length, it is necessary to test them and see if they resemble the standard gold measurement technique defined in the literature as the electronic apex locators. The purpose of this research is to determine whether there are statistically significant differences in the working length between the electronic apex locators, and the use of Cone Beam processed with the Software 3D Endo by Dentsply Sirona. For this, 30 extracted pre-molars were selected, for Cone Beam tomography and 3D endo Software analysis, to measure the working length. Once this was carried out, cavity preparation was performed manually, and the cervical third approached with gates glidden drills 1 and 2. Subsequently, the teeth were placed in a Pro Train model, which resembled the properties of the teeth in the oral cavity, to allow the use of the electronic apex locators to determine the working length.Once the data were obtained, they were compared through the proportions Test (p = 0.05 hypothetical), resulting in p = 0.2, indicating that there are no statistically significant differences in the working length between the two methods.


Subject(s)
Humans , Tooth/anatomy & histology , Software , Imaging, Three-Dimensional , Surgery, Computer-Assisted/methods , Endodontics/standards , Magnetic Resonance Imaging/methods , Chile , Cone-Beam Computed Tomography/methods , Odontometry
2.
Rev. cir. (Impr.) ; 72(1): 36-42, feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1092888

ABSTRACT

Resumen Introducción El uso del sistema de visión 3D en cirugía laparoscópica puede significar una mejor performance de los procedimientos quirúrgicos de mayor complejidad. Objetivo Reportar las indicaciones, los resultados y la valoración de un grupo de cirujanos de diferentes especialidades en el uso de visión 3D. Materiales y Método: Se analizan las indicaciones quirúrgicas y los resultados subjetivos y objetivos del uso del sistema óptico 3D (n = 155 pacientes) en cirugía laparoscópica compleja. Para evaluación subjetiva se aplicó a una encuesta de percepción cualitativa a los cirujanos participantes tipo Likert. Para la evaluación objetiva, se registran los tiempos quirúrgicos empleados en los diferentes procedimientos efectuados y las complicaciones postoperatorias y se comparan con los pacientes operados con sistema 2D (n = 783 pacientes) en el mismo periodo. Resultados el 70,6% concuerda tener mejor imagen con la técnica 3D, el 64,7% de los cirujanos refieren que se puede reducir el tiempo operatorio, el 58,8% considera que se puede reducir el error quirúrgico, el 92% y 100% respectivamente afirman que el confort del cirujano es mejor con el uso de óptica 3D y que esta técnica es recomendable para los procedimientos complejos. El tiempo operatorio se redujo en algunos procedimientos, especialmente urológicos. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a complicaciones postoperatorias. En la 3D no se encontró mortalidad postoperatoria, probablemente por el menor número de pacientes de ese grupo. Conclusión La laparoscopia 3D posee una buena valoración por los cirujanos que la emplearon, principalmente en calidad de imagen, reducción del tiempo operatorio y confort del cirujano en comparación con la laparoscopía 2D convencional. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a tiempo operatorio ni complicaciones postoperatorias.


Introduction The use of the 3D vision system in laparoscopic surgery can mean better performance in more complex surgical procedures. Aim Report the indications, results and assessment of a group of surgeons of different specialties in the use of 3D vision. Materials and Method Surgical indications and subjective and objective results of the use of 3D optical system in patients (n = 155) submitted to complex laparoscopic surgery are analyzed. Subjective evaluation based on a survey of qualitative perception (Likert) was applied to the participating surgeons. For objective evaluation, the operatory times and postoperative complications were recorded and compared with the results observed with the use of the 2D system (783 patients) in the same period. Results 70.6% agree to have a better image with the 3D technique, 64.7% of surgeons report that the operative time can be reduced, 58.8% consider that it can be reduced the surgical error, 92% and 100% respectively considered that the comfort of the surgeon is better with the use of 3D optics and that this technique is recommended for complex procedures. No substantial differences were found when comparing the results with the use of 3D versus 2D system by the same surgical teams in terms of operative times and postoperative complications. In 3D, postoperative mortality was probably not found due to the lower number of patients in this group. Conclusion 3D laparoscopy has a good evaluation by the surgeons who used it, mainly in image quality, reduction of operative time and comfort of the surgeon compared to conventional 2D laparoscopy. No substantial differences were found when comparing the results with the use of 3D versus 2D system in terms of operative times or postoperative complications.


Subject(s)
Humans , Laparoscopy/methods , Imaging, Three-Dimensional/methods , Chile , Surveys and Questionnaires , Laparoscopy/statistics & numerical data , Imaging, Three-Dimensional/instrumentation , Surgery, Computer-Assisted/methods , Comparative Effectiveness Research , Operative Time
3.
Dental press j. orthod. (Impr.) ; 23(6): 80-89, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975031

ABSTRACT

Abstract Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.


Resumo A assimetria facial é uma condição capaz de comprometer a função oclusal e as interações sociais e, consequentemente, a qualidade de vida dos indivíduos. Nessas condições, para se obter oclusão estável e melhora significativa na estética facial, o tratamento ortodôntico-cirúrgico pode estar indicado. A simulação virtual da cirurgia permite planejar de forma adequada, e antecipada, os movimentos cirúrgicos a serem efetuados na maxila, mandíbula e mento. Esses movimentos são, então, realizados com sucesso graças ao uso de guias prototipados obtidos a partir do planejamento virtual. Assim, os objetivos do presente artigo consistem em relatar o estado da arte no planejamento virtual do tratamento de um paciente com assimetria facial e protrusão do mento, e enfatizar a importância da abordagem multidisciplinar para se atingir resultados estéticos previsíveis e funcionalmente estáveis.


Subject(s)
Humans , Male , Esthetics , Facial Asymmetry/surgery , Facial Asymmetry/therapy , Orthognathic Surgical Procedures/methods , Orthognathic Surgery/methods , Orthodontics, Corrective , Osteotomy/methods , Patient Care Planning , Cephalometry , Chin/surgery , Osteotomy, Le Fort/methods , Surgery, Computer-Assisted/methods , Dental Occlusion , Facial Asymmetry/diagnostic imaging , Dentofacial Deformities/surgery , Dentofacial Deformities/therapy , Malocclusion/surgery , Malocclusion/therapy , Malocclusion/diagnostic imaging , Mandible/surgery , Mandible/diagnostic imaging , Maxilla/surgery , Maxilla/diagnostic imaging
4.
Acta cir. bras ; 33(9): 862-867, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973493

ABSTRACT

Abstract Technological advances such as optical instruments and surgical tools have enabled the considerable contributions of microsurgery to surgical therapies. Accordingly, surgical therapeutics has provided the latest information across a wide range of medical specialties, including immunology and pharmacology, despite specialization according to organs and organ systems. The International Society for Experimental Microsurgery, an academic organization, has utilized experimental microsurgery technology in the identification of curative concepts for diseases that remain difficult to treat. For this publication to mark the 32nd anniversary of the Brazilian Surgical Society, I introduced the following types of technology related to the further development of microsurgical technological innovations in the future: high-resolution three-dimensional (3D) video and touch-sensitive microsurgery robots.


Subject(s)
Humans , Translational Research, Biomedical/methods , Robotic Surgical Procedures/education , Microsurgery/methods , Brazil , Imaging, Three-Dimensional , Surgery, Computer-Assisted/education , Surgery, Computer-Assisted/methods , Translational Research, Biomedical/education , Translational Research, Biomedical/trends , Robotic Surgical Procedures/trends , Microsurgery/education , Microsurgery/instrumentation , Microsurgery/trends
5.
Rev. argent. radiol ; 82(1): 2-12, mar. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-958045

ABSTRACT

Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y complicaciones al realizar este procedimiento mediante guía por tomografía computada. Materiales y Métodos Estudio observacional descriptivo de una serie de 108 pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017. Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se valoró el dolor mediante la escala visual análoga. Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n = 95) se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n = 9) y 3,7% (n = 4) de los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94% (n = 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el rango de dolor varió entre 0a7dondeel 98% de la población reportó un valor menor o igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metil-metacrilato, extravasación al plexo de Batson y extravasación al espacio interdiscal, cada una en tres pacientes diferentes. Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos vertebrales, con una baja tasa de complicaciones.


Objetive Describe the technique, results in terms of pain improvement and complications to perform this procedure by computed tomography. Materials and Methods A descriptive observational study of a 108 cases series of percutaneous vertebroplasty guided by computed tomography performed in two university hospitals between May 2007 and May 2017. All procedures were performed with local anesthesia on an outpatient basis, pain was assessed by means of the Visual analogue scale (VAS). Results A total of 125vertebroplasties were performed. In 87.9% (n = 95) of the patients, the procedure was performed in one vertebral body, in 8.3% (n = 9) and 3.7% (n = 4) of the patientshad two or three vertebrae cemented respectively. The range of pain according to VAS prior to treatment varied between 5 and 10, where 94% (n = 102) of the patients manifested a 10/10 intensity; after treatment, the range of pain varied between 0 to 7 where 98% of the population reported a value less than or equal to 3. Three complications were reported, one pulmonary thromboembolism due to methylmethacrylate, one extravasation in to the Batson plexus and one extravasation of cement to the interdiscal space. Conclusion CT-guided percutaneous vertebroplasty offers an undeniable immediate improvement of pain in patients with fracture of one or more vertebral bodies, with a low rate of complications.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Spinal Injuries/diagnostic imaging , Surgery, Computer-Assisted/methods , Vertebroplasty/methods , Pain/diagnostic imaging , Spinal Injuries/complications , Tomography, X-Ray Computed/instrumentation , Epidemiology, Descriptive , Fracture Healing
6.
Rev. Círc. Argent. Odontol ; 75(225): 9-14, nov. 2017. ilus
Article in Spanish | LILACS | ID: biblio-973128

ABSTRACT

Se utilizaron métodos digitales de fabricación para guías quirúrgicas de restricción absoluta, para la colocación asistida de implantes dentales que facilitaron la predicción y planificación de la rehabilitación protética virtual a través de protocolos de CAD-CAM con impresoras 3D de escritorio, aditivas, de bajo costo-eficiencia, obteniendo exactitud controlada y alta precisión, lo que permitió reproducibilidad y predecibilidad implantológica. Con el fin de universalizar, promover y difundir el uso de la tecnología 3D como herramienta facilitadora que la práctica dental actual requiere, se investigó la desviación entre la posición planeada y la final encontrada de los implantes colocados bajo asistencia guiada, dando como resultado una discrepancia clínicamente insignificante que sugiere que la guía quirúrgica en impresoras 3D puede ser utilizada como herramienta clínica para posicionar adecuadamente los implantes dentales.


Subject(s)
Humans , Imaging, Three-Dimensional/methods , Printing, Three-Dimensional/instrumentation , Dental Implantation, Endosseous/methods , Surgery, Computer-Assisted/methods , Models, Dental , Diagnostic Imaging , Software , Mouth Rehabilitation , Dental Prosthesis, Implant-Supported/methods , Cone-Beam Computed Tomography
7.
ImplantNewsPerio ; 2(3): 441-449, mai.-jun. 2017. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-847256

ABSTRACT

A aplicação de um fluxo digital é um recurso cada vez mais utilizado na Implantodontia. A técnica de cirurgia guiada tem evoluído constantemente, acompanhando os avanços de hardwares e softwares aplicados na Odontologia, resultando no aumento da indicação e precisão dos guias cirúrgicos obtidos. O objetivo deste trabalho foi, através de um relato de caso clínico, demonstrar o fluxo de trabalho utilizado para aplicação da técnica de cirurgia guiada em reabilitação total de maxila, utilizando o software coDiagnostiX (Dental Wings, Chemnitz, Alemanha). Após as etapas de preparo pré-tomográfico, obtenção da digitalização de superfície, aquisições tomográficas e planejamento virtual, foram instalados seis implantes cone-morse (Neodent, Curitiba, Brasil), com a utilização de um guia cirúrgico obtido por impressão 3D. Após o período de osseointegração, foi instalada uma prótese fixa implantossuportada. O planejamento virtual em software específico, através da digitalização de superfície associada à tomografia computadorizada de feixe cônico (TCFC), propõe um diagnóstico previsível, seguro e a possibilidade de oferecer maior segurança e precisão nas reabilitações com implantes osseointegrados.


The application of a digital workflow is an increasingly used resource in Implantology. The guided implant surgery (GIS) has constantly evolved, following the advances of hardware and software applied in Dentistry, resulting in an increase in the indication and precision of the surgical guides. The objective of this article is, through a clinical case report, to demonstrate a workflow used to apply guided surgery technique in full-arch maxillary rehabilitation using the coDiagnostiX software (Dental Wings, Chemnitz, Germany). After the pre-tomographic preparation, surface scanning, tomographic acquisitions and virtual planning, six morse taper implants (Neodent, Curitiba, Brazil) were placed using a surgical guide obtained by 3D printing. After a period of osseointegration, a implant supported fixed prosthesis was placed. The virtual planning in specific software, through surface scanning associated with cone beam computed tomography (CBCT), proposes a predictable, safe diagnosis and the possibility of offering greater safety and precision in the rehabilitations with osseointegrated implants.


Subject(s)
Humans , Female , Aged , Computer-Aided Design , Dental Implantation , Dental Prosthesis, Implant-Supported , Surgery, Computer-Assisted/instrumentation , Surgery, Computer-Assisted/methods , Technology, Dental
8.
Einstein (Säo Paulo) ; 14(4): 577-579, Oct.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-1039718

ABSTRACT

ABSTRACT The intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe.


RESUMO A identificação intraoperatória de certas estruturas anatômicas, por seu tamanho ou por elas serem ocultas à visão, pode ser desafiadora. O desenvolvimento da cirurgia minimamente invasiva trouxe dificuldades adicionais, pela falta da sensibilidade tátil completa. Diversas formas de detecção intraoperatória destas estruturas têm sido tentadas. Recentemente, a tecnologia de fluorescência infravermelha com verde de indocianina foi associada às plataformas robóticas. Além disso, essa tecnologia tem sido testada em uma variedade de cirurgias, e suas vantagens parecem estar ligadas a baixo custo, segurança e bons resultados. As desvantagens estão associadas à má distribuição do contraste em determinados cenários. A imagem intraoperatória por fluorescência infravermelha é uma nova e promissora adição à cirurgia robótica. Diversas séries mostram a utilidade da tecnologia em diferentes procedimentos. Dose ideal, local e tempo da injeção do corante ainda não estão bem estabelecidos. Estudos comparativos de alta qualidade epidemiológica baseados em evidência ainda não estão disponíveis. No entanto, os resultados iniciais são bons e seguros.


Subject(s)
Humans , Diagnostic Imaging/methods , Monitoring, Intraoperative , Surgery, Computer-Assisted/methods , Robotic Surgical Procedures/methods , Infrared Rays , Biliary Tract/anatomy & histology , Diagnostic Imaging/instrumentation , Feasibility Studies , Indocyanine Green
9.
Int. j. med. surg. sci. (Print) ; 3(3): 927-932, sept. 2016. ilus
Article in Spanish | LILACS | ID: biblio-1087599

ABSTRACT

El linfangioma es un tumor benigno raro y predominante en la infancia, debido a su crecimiento puede comprometer al órgano donde se desarrolla, se han propuesto varias opciones de trata-miento, sin embargo, la cirugía continúa siendo la primera opción. La neuronavegación permite realizar exéresis con gran precisión y de utilidad en cirugía ocular, por lo que disminuye el riesgo de secuelas después de una exéresis de linfangioma orbitario.


Lymphangioma is a benign tumor predominantly in childhood, due to growth that can compromise the organ where it grows. Several treatment options, have been proposed however,surgery remains the first choice. Neuronavigation allows successful excision and use in eye surgery,which decreases the risk of sequels following excision of orbital lymphangioma.


Subject(s)
Humans , Female , Child, Preschool , Orbital Neoplasms/surgery , Surgery, Computer-Assisted/methods , Neuronavigation/methods , Lymphangioma/surgery , Orbital Neoplasms/diagnostic imaging , Imaging, Three-Dimensional/methods , Lymphangioma/diagnostic imaging
10.
Article in English | LILACS | ID: lil-794501

ABSTRACT

Dental implant fixation techniques are widely studied in order to reduce surgical morbidity. Computer-guided flapless surgery has been considered an efficient alternative that presents several advantages and some limitations. This technique allows the virtual planning and simulation of the prosthetic-surgical treatment that can help predict the difficulties and limitations in order to reduce possible errors. In addition to the prosthetic predictability, computer-guided surgery enhances accuracy and reduces surgical morbidity. Thus, the aim of this study was to report on a 7-year follow-up of immediately loaded implants inserted into an edentulous maxilla using virtual planning and flapless surgery.


Las técnicas de fijación del implante dental se estudian ampliamente para reducir la morbilidad quirúrgica. La cirugía sin flapless guiada por ordenador ha sido considerada como una alternativa eficiente con varias ventajas y algunas limitaciones. Esta técnica permite la planificación virtual y simulación del tratamiento protésico quirúrgico con la predicción de las dificultades y limitaciones para reducir posibles errores. Además de la previsibilidad de prótesis, la cirugía guiada por ordenador mejora la precisión y reduce la morbilidad quirúrgica. Por lo tanto, el objetivo de este estudio fue reportar a 5 años de seguimiento de los implantes de carga inmediata insertados en un maxilar desdentado utilizando la planificación virtual y la cirugía sin colgajo. El presente caso prospectivo informó el éxito del tratamiento y destacó la importancia de la planificación, lo que justifica el costo de esta tecnología.


Subject(s)
Humans , Female , Adult , Jaw, Edentulous/surgery , Surgery, Computer-Assisted/methods , Immediate Dental Implant Loading/methods , Surgical Flaps , Treatment Outcome , Immediate Dental Implant Loading/instrumentation
11.
Int. braz. j. urol ; 42(3): 456-463, tab, graf
Article in English | LILACS | ID: lil-785731

ABSTRACT

ABSTRACT Purpose To describe our initial experience with radiofrequency ablation (RFA) of Bosniak IV renal cysts. Materials and Methods From 2010 to 2014, 154 renal tumor cases were treated with percutaneous thermal ablation, of which 10 cases (6.4%) from nine patients were complex renal cysts and were treated with radiofrequency ablation. Results All complex cysts were classified as Bosniak IV (four women and five men; mean age: 63.6 yrs, range: 33–83 years). One patient had a single kidney. Lesion size ranged from 1.5 to 4.1cm (mean: 2.5cm) and biopsy was performed on four cysts immediately before the procedure, all of which were malignant (two clear cell and two papillary carcinoma). Mean volume reduction of complex cysts was 25% (range: 10–40%). No patients required retreatment with RFA and no immediate or late complications were observed. The follow-up of Bosniak IV cysts had a median of 27 months (interquartile range [IQR], 23 to 38) and no recurrence or significant loss of renal function were observed. Conclusions Mid-term follow-up of the cases in our database suggests that image-guided percutaneous RFA can treat Bosniak IV cysts with very low complication rates and satisfactorily maintain renal function.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Catheter Ablation/methods , Kidney Diseases, Cystic/surgery , Kidney Diseases, Cystic/pathology , Postoperative Complications , Biopsy , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Feasibility Studies , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Surgery, Computer-Assisted/methods , Kidney Diseases, Cystic/diagnostic imaging , Kidney Neoplasms/surgery , Middle Aged
13.
Rev. chil. ortop. traumatol ; 57(1): 20-25, ene.-abr.2016. ilus
Article in Spanish | LILACS | ID: lil-795859

ABSTRACT

La mayoría de los tumores óseos primarios pueden ser tratados mediante una resección amplia —muchas veces asociada a terapias adyuvantes— sin comprometer la sobrevida del paciente. La posibilidad de una resección conservadora depende de la localización y tamaño del tumor y de las partes blandas circundantes. Una cuidadosa evaluación de estudios imagenológicos permite al cirujano elaborar un plan quirúrgico que permita una resección con márgenes adecuados, al mismo tiempo que conservar la mayor cantidad de tejido sano, de modo de obtener una extremidad funcional. A veces, la ejecución quirúrgica de lo planeado se hace muy difícil, y la precisión de esta puede resultar afectada. La cirugía guiada por computador se ha constituido en una herramienta útil en estas situaciones. Está basada en la creación de un plan virtual en 3 dimensiones mediante el procesamiento de imágenes de tomografía computada (TC) y resonancia nuclear magnética (RNM). Este plan puede ser reproducido en el escenario quirúrgico mediante la correspondencia entre este escenario virtual y la anatomía real del paciente. Esta tecnología puede permitir una mayor precisión en la ejecución de osteotomías en zonas difíciles como la pelvis, minimizando la resección innecesaria de tejido sano, pero manteniendo un margen oncológico adecuado. Describiremos los principios y el razonamiento que fundamentan el uso de la cirugía guiada por computador en la cirugía de tumores óseos, la cual se ha constituido en una herramienta útil para el manejo de situaciones clínicas específicas...


The majority of primary bone tumours can be effectively treated with wide resection —frequently associated with adjuvant therapy— without compromising the outcome of the patient. The feasibility of limb-sparing surgery in a particular scenario is dependent on the location and size of the tumour, as well as the involvement of the host bone and surrounding soft tissues. Careful evaluation of imaging studies allows the surgeon to plan the resection with adequate margins, while preserving as much normal tissues as possible, in order to achieve a functional limb. At times, the surgical execution of what was planned as resection becomes very difficult, and precision may be less than optimal. Computer-guided surgery has become a useful tool in these situations. It is based on the creation of a three-dimensional virtual plan by means of image processing from computed tomography (CT) and magnetic resonance (MRI) of the clinical situation. This plan is reproduced in the surgical field by means of the interaction between this virtual scenario and the actual anatomy of the patient. This technology could allow better precision in the execution of osteotomies in difficult areas, such as the pelvis, minimising unnecessary resection of normal tissue, while maintaining wide margins. A description is presented of the principles and rationale of computer-guided surgery for bone tumours, which has become a useful tool for the management of selected clinical situations...


Subject(s)
Humans , Surgery, Computer-Assisted/methods , Bone Neoplasms/surgery , Orthopedics/methods , Magnetic Resonance Imaging , Bone Neoplasms/pathology , Bone Neoplasms , Preoperative Care , Tomography, X-Ray Computed
14.
Article in English | WPRIM | ID: wpr-101608

ABSTRACT

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.


Subject(s)
Acetabulum/diagnostic imaging , Adult , Female , Hip Dislocation/diagnostic imaging , Humans , Imaging, Three-Dimensional , Male , Osteotomy/methods , Surgery, Computer-Assisted/methods , Tomography, X-Ray Computed , Young Adult
15.
Mem. Inst. Oswaldo Cruz ; 110(2): 192-200, 04/2015. tab, graf
Article in English | LILACS | ID: lil-744467

ABSTRACT

This study estimates the factors of artificial environments (houses and peridomestic areas) associated with Triatoma sordida occurrence. Manual searches for triatomines were performed in 136 domiciliary units (DUs) in two rural localities of Central-West Brazil. For each DU, 32 structural, 23 biotic and 28 management variables were obtained. Multiple logistic regression analysis was performed in order to identify statistically significant variables associated with occurrence of T. sordida in the study areas. A total of 1,057 specimens (99% in peridomiciles, mainly chicken coops) of T. sordida were collected from 63 DUs (infestation: 47%; density: ~8 specimens/DU; crowding: ~17 specimens/infested DU; colonisation: 81%). Only six (0.6%) out of 945 specimens examined were infected with Trypanosoma cruzi. The final adjusted logistic regression model indicated that the probability of T. sordida occurrence was higher in DU with wooden chicken coops, presence of > 30 animals in wooden corrals, presence of wood piles and presence of food storeroom. The results show the persistence of T. sordida in peridomestic habitats in rural localities of Central-West Brazil. However, the observed low intradomestic colonisation and minimal triatomine infection rates indicate that T. sordida has low potential to sustain high rates of T. cruzi transmission to residents of these localities.


Subject(s)
Humans , Brain Diseases/surgery , Brain Diseases , Neurosurgical Procedures/methods , Surgery, Computer-Assisted/methods , Ultrasonic Surgical Procedures/methods , Magnetic Resonance Imaging , Neurosciences/methods , Neurosciences/trends , Ultrasonography, Interventional/methods
16.
Article in English | IMSEAR | ID: sea-162081

ABSTRACT

Introduction: Intra-operative ultrasound provides low cost real time imaging that is simple and rapid to use. In recent years there has been a signifi cant improvement in the quality of ultrasound imaging. Ultrasound integrated neuronavigation can be used to optimize the approach, and achieving safe maximal resection, thereby improving outcomes for patients with diff erent localization and histology of brain tumors, vascular patology, spontaneous intra-cerebral hemorrhage. Material and Methods: Since 2007 till 2010, in the Institute of Neurology and Neurosurgery, 130 operations with application of 2D iUS have been performed. Starting from March till May 2012, 17 patients went under surgical treatment using the intraoperative ultrasound integrated neuronavigation system. Results: We applied ultrasound neuronavigation system in 17 cases on patients with diverse pathologies, including brain tumors (craniopharyngeoma, corpus callosum and intracerebral glioblastoma, intraaxial glioma), vascular patology (arteriovenous malformations, aneurysms), spontaneous intracerebral hemorrhage. Application of ultrasound neuronavigation system aids in improving postoperative outcomes for these patients. Conclusions: Th e integration of 3D US with neuronavigation technology created an effi cient and inexpensive tool for intraoperative imaging in neurosurgery. Th e technology has been applied to optimize surgery of brain tumors, but it has also been found to be useful in other procedures such as operations for aneurysms or arteriovenous malformations. iUS is easy to use and has a rapid learning curve which makes it a useful tool to the neurosurgeons intraoperative armamentarium.


Subject(s)
Brain Neoplasms/surgery , Brain Neoplasms/diagnostic imaging , Humans , Imaging, Three-Dimensional/instrumentation , Neuronavigation/methods , Neurosurgery/methods , Neurosurgical Procedures/methods , Surgery, Computer-Assisted/instrumentation , Surgery, Computer-Assisted/methods , Surgery, Computer-Assisted/statistics & numerical data , Ultrasonography/instrumentation , Ultrasonography/methods , Ultrasonography/statistics & numerical data
17.
Yonsei Medical Journal ; : 388-396, 2015.
Article in English | WPRIM | ID: wpr-210026

ABSTRACT

PURPOSE: Although conventional neuro-navigation is a useful tool for image-guided glioma surgery, there are some limitations, such as brain shift. We introduced our methods using an identifiable marker, a "tailed bullet", to overcome the limitation of conventional neuro-navigation. A tailed bullet is an identifiable tumor location marker that determines the extent of a resection and we have introduced our technique and reviewed the clinical results. MATERIALS AND METHODS: We have developed and used "tailed bullets" for brain tumor surgery. They were inserted into the brain parenchyma or the tumor itself to help identify the margin of tumor. We retrospectively reviewed surgically resected glioma cases using "tailed bullet". Total 110 gliomas included in this study and it contains WHO grade 2, 3, and 4 glioma was 14, 36, and 60 cases, respectively. RESULTS: Gross total resection (GTR) was achieved in 71 patients (64.5%), subtotal resection in 36 patients (32.7%), and partial resection in 3 patients (2.7%). The overall survival (OS) duration of grade 3 and 4 gliomas were 20.9 (range, 1.2-82.4) and 13.6 months (range, 1.4-173.4), respectively. Extent of resection (GTR), younger age, and higher initial Karnofsky Performance Status (KPS) score were related to longer OS for grade-4 gliomas. There was no significant adverse event directly related to the use of tailed bullets. CONCLUSION: Considering the limitations of conventional neuro-navigation methods, the tailed bullets could be helpful during glioma resection. We believe this simple method is an easily accessible technique and overcomes the limitation of the brain shift from the conventional neuro-navigation. Further studies are needed to verify the clinical benefits of using tailed bullets.


Subject(s)
Adult , Aged , Brain/pathology , Brain Neoplasms/pathology , Female , Glioma/pathology , Humans , Karnofsky Performance Status , Magnetic Resonance Imaging, Interventional , Male , Middle Aged , Neuronavigation/methods , Retrospective Studies , Surgery, Computer-Assisted/methods , Survival Rate , Time Factors , Treatment Outcome
18.
Article in English | WPRIM | ID: wpr-22495

ABSTRACT

Ultrasonography (US)-guided procedures such as ethanol ablation, radiofrequency ablation, laser ablation, selective nerve block, and core needle biopsy have been widely applied in the diagnosis and management of thyroid and neck lesions. For a safe and effective US-guided procedure, knowledge of neck anatomy, particularly that of the nerves, vessels, and other critical structures, is essential. However, most previous reports evaluated neck anatomy based on cadavers, computed tomography, or magnetic resonance imaging rather than US. Therefore, the aim of this article was to elucidate US-based thyroidal and perithyroidal anatomy, as well as its clinical significance in the use of prevention techniques for complications during the US-guided procedures. Knowledge of these areas may be helpful for maximizing the efficacy and minimizing the complications of US-guided procedures for the thyroid and other neck lesions.


Subject(s)
Biopsy, Large-Core Needle/methods , Catheter Ablation/methods , Humans , Laser Therapy/methods , Neck/anatomy & histology , Surgery, Computer-Assisted/methods , Thyroid Gland/anatomy & histology
19.
Article in English | WPRIM | ID: wpr-22483

ABSTRACT

OBJECTIVE: To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage. MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study. RESULTS: The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal. CONCLUSION: Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity.


Subject(s)
Adult , Aged , Catheters , Cerebrospinal Fluid , Contrast Media , Drainage/methods , Female , Fluoroscopy/methods , Humans , Lumbosacral Region/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Spinal Puncture/methods , Surgery, Computer-Assisted/methods
20.
Rev. bras. cir. cardiovasc ; 29(3): 455-458, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-727171

ABSTRACT

We have shown how the analysis of the angiotomography reconstruction through OsiriX program has assisted in endovascular perioperative programming. We presented its application in situations when an unexpected existence of metallic overlapping artifact (orthopedic osteosynthesis) compromised the adequate visualization of the arterial lesion during the procedure. Through manipulation upon OsiriX software, with assistance of preview under virtual fluoroscopy, it was possible to obtain the angles that would avoid this juxtaposition. These angles were reproduced in the C-arm, allowing visualization of the occluded segment, reducing the need for repeated image acquisitions and contrast overload, allowing the continuation of the procedure.


Temos demonstrado como a análise da reconstrução da angiotomografia utilizando o programa OsiriX tem auxiliado na programação perioperatória endovascular. Apresentamos aqui sua aplicação em situação em que a existência de artefato metálico (osteossíntese ortopédica) comprometia a adequada visibilização de lesão arterial durante o procedimento. Pela manipulação da angiotomografia no software OsiriX e com o auxílio das imagens sob fluoroscopia virtual foi possível obter-se automaticamente uma angulação que evitasse esta justaposição. Os ângulos foram reproduzidos no arcoscópio, o que permitiu expor o segmento ocluído, reduzindo a sobrecarga de contraste e de repetidas tomadas, permitindo a continuação do procedimento.


Subject(s)
Female , Humans , Young Adult , Endovascular Procedures/instrumentation , Imaging, Three-Dimensional/methods , Software , Tomography, X-Ray Computed/methods , Angiography/methods , Endovascular Procedures/methods , Fluoroscopy/methods , Reproducibility of Results , Surgery, Computer-Assisted/methods
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