ABSTRACT
Introducción: La prevalencia de periodontitis apical en dientes con tratamiento endodóntico oscila entre el 35 y el 60%, se ha encontrado una fuerte asociación con respecto al grado de inflamación sistémica generada por la periodontitis apical, como por ejemplo altos niveles de citoquinas proinflamatorias, proteína C reactiva e interleuquina 6; estudios refieren que un tratamiento endodóntico adecuado puede reducir los niveles de proteína C reactiva en individuos sanos y con periodontitis apical. Objetivo: Evaluar la frecuencia de periodontitis apical en una población adulta colombiana seleccionada y su correlación con la calidad del tratamiento endodóntico. Materiales y métodos: Estudio observacional analítico de corte transversal, se determinó la frecuencia de periodontitis apical en 318 CBCT (Tomografía Computarizada de Haz Cónico), de pacientes de una subpoblación de Bucaramanga y Medellín y evaluó la asociación de la calidad del tratamiento endodóntico con el estado periapical. Resultados: Sólo el 37,66% de los dientes evaluados fueron considerados sanos; el 44,81% se clasificaron como tratamiento endodóntico adecuado. La calidad del tratamiento endodóntico influyó significativamente en la condición del periodonto apical. Conclusiones: Los tratamientos evaluados presentaron alta frecuencia de periodontitis apical, la cual se asoció en buena parte a la alta frecuencia de tratamientos endodónticos inadecuados.
Introduction: The prevalence of apical periodontitis in teeth with endodontic treatment ranges between 35% and 60%, and a strong association has been found with respect to high levels of systemic inflammation markers (pro-inflammatory cytokines, protein C-reactive and interleukin 6) caused by apical periodontitis. Studies have shown that an adequate endodontic treatment can reduce C-reactive protein levels in healthy individuals and those with apical periodontitis. Objective: To evaluate the frequency of apical periodontitis in a selected Colombian adult population and its correlation with the quality of endodontic treatment. Materials and methods: Observational, analytical, cross-sectional study. The frequency of apical periodontitis was determined in 318 CBCTs of patients from Bucaramanga and Medellin, and the association between quality of endodontic treatment and periapical status was analyzed. Results: Only 37.66% of the observed teeth were considered healthy, whereas 44.81% were classified as teeth with appropriate endodontic treatment. Quality of endodontic treatment significantly affected the condition of the apical periodontium. Conclusions: The analyzed treatments had a high apical periodontitis frequency, which was associated with a high frequency of inadequate endodontic treatments.
Introdução: A prevalência de periodontite apical em dentes com tratamento endodôntico varia entre 35 e 60 %, uma forte associação foi encontrada com relação ao grau de inflamação sistêmica gerada pela periodontite apical, como altos níveis de citocinas pró-inflamatórias, proteína C reativa e interleucina 6; estudos relatam que o tratamento endodôntico adequado pode reduzir os níveis de proteína C-reativa em indivíduos saudáveis e naqueles com periodontite apical. Objetivo: Avaliar a frequência da periodontite apical em uma população adulta colombiana selecionada e sua correlação com a qualidade do tratamento endodôntico. Materiais e métodos: Estudo transversal analítico observacional; a frequência de periodontite apical foi determinada em 318 CBCT de pacientes de uma subpopulação de Bucaramanga e Medellín, foi avaliada a associação da qualidade do tratamento endodôntico com o estado periapical. Resultados: Apenas 37,66% dos dentes avaliados foram considerados saudáveis, 44,81% dos dentes foram classificados como tratamento endodôntico adequado. A qualidade do tratamento endodôntico influenciou significativamente a condição do periodonto apical. Conclusões: Os tratamentos avaliados apresentaram alta frequência de periodontite apical, que foi amplamente associada à alta frequência de tratamentos endodônticos inadequados.
Subject(s)
Humans , Dentistry , Periapical Diseases , Periapical Periodontitis , Tomography, X-Ray Computed , EndodonticsABSTRACT
INTRODUÇÃO: As técnicas de detecção precoce no câncer de mama tem se desenvolvido nos últimos anos. A ressonância magnética (RM) das mamas é considerada o melhor método de imagem para estadiamento locorregional do câncer de mama atualmente, no entanto, por ser um exame extremamente sensível, aumenta o número de achados falso positivos, consequentemente aumentado o número de biópsias desnecessárias. Um exame pouco estudado, porém com resultados promissores, é a tomografia computadorizada (TC) de tórax com protocolo dedicado para avaliação da mama em decúbito ventral, com técnicas de subtração. Comparando-se à RM, as vantagens da TC incluem principalmente o menor tempo de exame e capacidade de identificar metástases à distância no mesmo exame de avaliação locorregional. OBJETIVO: O presente estudo tem como objetivo avaliar a possibilidade do uso de tomografia computadorizada para avaliação locorregional no estadiamento do câncer de mama, comparando-se à ressonância magnética mamas e com resultado anatomo- patologico final (padrão-ouro). METODOLOGIA: Estudo prospectivo unicêntrico, no qual foram analisadas as tomografias computadorizadas de estadiamento, comparando-se com à RM, nas pacientes que já iriam realizar tomografias para estadiamento à distância e ressonância magnética para avaliação locoregional. A amostra foi coletada por conveniência, em um hospital oncológico, coletados de pacientes que realizaram o exame tomogreafico entre setembro de 2019 e setembro de 2021. Os seguintes dados dos pacientes foram extraídos por entrevista e do sistema de informações radiológicas do hospital: altura, peso, idade, ciclo menstrual, imagens tomográficas e de ressonância magnética e o diagnóstico histopatológico da biópsia. Foram incluídas pacientes que realizaram tomografia computadorizada para estadiamento a distância no câncer de mama e ressonância magnética de mamas para avaliação locoregional, conforme protocolo da instituição. O coeficiente de Kappa (k) foi utilizado para avaliar a concordância entre os achados da RM e TC. Foram considerados estatisticamente significantes os resultados que tiverem probabilidade de erro tipo I menor ou igual a 5% (p≤0,05). Para avaliar associação entre as dimensões do tumor na TC, RM e patologia, foi utilizado o coeficiente de correlação de Pearson (r) ou de Spearman (rho), conforme indicação. RESULTADOS: Foram realizadas 111 tomografia com protocolo dedicado para o estadiamento do câncer de mama, com pacientes com idade média de 48,7 anos, cujo subtipo mais comum foi o carcinoma ductal do tipo não especial (82,9%), enquanto o subtipo molecular mais comum foi de Luminais (A, B e indeterminados) (71,7%). A TC e a RM demonstraram uma ótima concordância entre os achados de imagem, sendo a lesão principal caracterizada em 99,1% dos casos, e a extensão tumoral média foi de 4,2 cm na TC e 4,3 cm na RM, demonstrando inclusive uma boa concordância com a patologia em casos que foram para a cirurgia sem quimioterapia neoadjuvante (Kappa de 0,537 (0.106) para a TC com a patologia e de 0,618 (0.098) para a RM), porém sem diferença estatística entre os métodos. A TC apresentou uma melhor concordância com a patologia nos casos de linfonodos axilares, principalmente nos níveis II e III (Kappa de 0,482 (0,111) para a TC e 0,246 (0.115) para a RM), nesse caso com significância estatística. CONCLUSÃO: A tomografia com protocolo dedicado para estadiamento locoregional em pacientes com câncer de mama é viável e mostra concordância substancial com achados da RM das mamas e com resultado anatomo-patologico
INTRODUCTION: Techniques for early detection of breast cancer have been developed in recent years. Magnetic resonance imaging (MRI) of the breasts is currently considered the best imaging method for locoregional staging of breast cancer, however, as it is an extremely sensitive test, it increases the number of false positive findings, consequently increasing the number of unnecessary biopsies. A little-studied test, but with promising results, is chest computed tomography (CT) with a dedicated protocol for breast evaluation in the prone position, with subtraction techniques. Comparing to MRI, the advantages of CT mainly include the shorter examination time and the ability to identify distant metastases in the same locoregional evaluation examination. OBJECTIVE: This study aims to evaluate the possibility of using computed tomography for locoregional evaluation in the staging of breast cancer, comparing it to magnetic resonance imaging of the breasts and with the final anatomopathological result (gold standard). METHODOLOGY: Prospective single-center study, in which staging computed tomography scans were analyzed, comparing them with MRI, in patients who were already going to undergo tomographies for distant staging and magnetic resonance imaging for locoregional evaluation. The sample was collected for convenience, in an oncology hospital, collected from patients who underwent the CT scan between September 2019 and September 2021. The following patient data were extracted by interview and from the hospital's radiological information system: height, weight, age, menstrual cycle, tomographic and magnetic resonance images and the histopathological diagnosis of the biopsy. Patients who underwent computed tomography for distant staging of breast cancer and magnetic resonance imaging of the breasts for locoregional evaluation, according to the institution's protocol, were included. The Kappa coefficient (k) was used to assess the agreement between MRI and CT findings. Results with a probability of type I error less than or equal to 5% (p≤0.05) were considered statistically significant. To assess the association between tumor dimensions on CT, MRI and pathology, the Pearson (r) or Spearman (rho) correlation coefficient was used, as indicated. RESULTS: 111 CT scans were performed with a dedicated protocol for breast cancer staging, with patients with a mean age of 48.7 years, whose most common subtype was ductal carcinoma of the non-special type (82.9%), while the subtype The most common molecular type was Luminals (A, B and indeterminate) (71.7%). CT and MRI showed excellent agreement between imaging findings, with the main lesion being characterized in 99.1% of cases, and the mean tumor extension was 4.2 cm on CT and 4.3 cm on MRI, demonstrating including good concordance with pathology in cases that underwent surgery without neoadjuvant chemotherapy (Kappa of 0.537 (0.106) for CT with pathology and 0.618 (0.098) for MRI), but with no statistical difference between methods. CT showed better agreement with the pathology in cases of axillary lymph nodes, mainly at levels II and III (Kappa of 0.482 (0.111) for CT and 0.246 (0.115) for MRI), in this case with statistical significance. CONCLUSION: Tomography with a dedicated protocol for locoregional staging in patients with breast cancer is feasible and shows substantial agreement with MRI findings of the breasts and with the anatomopathological result.
Subject(s)
Breast Neoplasms , Tomography, X-Ray Computed , Neoplasm Staging , Magnetic Resonance ImagingABSTRACT
Introducción: La sarcopenia está revistiendo importancia en el estudio de diferentes enfermedades para predecir la morbimortalidad en el perioperatorio. Los objetivos de este estudio fueron evaluar la eficacia de la tomografía y la resonancia en la medición de la musculatura del psoas y los paraespinales, y comparar estos índices con la edad, el sexo y la enfermedad. materiales y métodos: Se utilizaron las tomografías computarizadas y las resonancias magnéticas de pacientes ambulatorios. La medición de los músculos se realizó en los pedículos de L3 y L4. Resultados: El estudio incluyó 18 tomografías y 34 resonancias. El rango de edad de los pacientes era de 15 a 80 años, divididos en grupos etarios. En los promedios globales, en ambos estudios, el sexo masculino estaba por encima del promedio global. Con respecto a los rangos etarios, se observó que el primer grupo (15-29 años) tenía un mayor volumen muscular y de unidades Hounsfield en el psoas comparado con el grupo >60 años. Los pacientes que consultaron por espondilolistesis tenían menos masa muscular que aquellos con discopatías. Conclusiones: No existe diferencia entre la resonancia magnética y la tomografía computarizada en cuanto a la medición de los músculos paraespinales y psoas. Queda en evidencia que la disminución del volumen muscular es común en pacientes de mayor edad y con enfermedades que afectan el balance espinal. Nivel de Evidencia: IV
background: Sarcopenia is becoming increasingly significant in the research of various diseases to predict morbidity and mortal-ity in the perioperative period. Objectives: The objectives of this study were to evaluate the efficacy of computed tomography and magnetic resonance imaging in measuring the psoas and paraspinal muscles and to compare these indexes with age, sex, and pathology. materials and methods: Computed tomography and magnetic resonance imaging of outpatients were used. Muscle measurements were taken at the L3 and L4 pedicles. Results: The study included 18 CT and 34 MRI scans. The patients were divided into groups based on their age range, which was 15 to 80 years. In the overall averages, males were above the global average in both studies. Regarding age ranges, it was observed that the first group (15-29 years) had a higher muscle volume and Hounsfield units in the psoas compared to the >60 age group. Patients consulting for spondylolisthesis had less muscle mass than those with discopathy. Conclusions: There is no difference between magnetic resonance imaging and computed tomography in measuring the paraspinal and psoas muscles. It is evident that the decrease in muscle volume is common in older patients and those with diseases that affect spinal balance. Level of Evidence: IV
Subject(s)
Adolescent , Adult , Middle Aged , Aged , Spinal Diseases , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Psoas Muscles , Sarcopenia , Perioperative Period , Paraspinal MusclesSubject(s)
Humans , Female , Aged, 80 and over , Cholelithiasis/diagnostic imaging , Gallstones/diagnostic imaging , Intestinal Obstruction/diagnostic imaging , Radiography, Abdominal , Cholelithiasis/complications , Gallstones/complications , Tomography, X-Ray Computed , Octogenarians , Intestinal Obstruction/etiologyABSTRACT
Etudier à la tomodensitométrie, les variations anatomiques du toit de l'os ethmoïde en déterminant la prévalence des variantes à haut risque. Matériels et méthodes: Etude transversale, avec une collecte rétrospective, descriptive et analytique menée sur une période de 06 mois dans deux services de radiologie et imagerie médicale à Lomé. Elle portait sur des examens de tomodensitométrie normaux des sinus de l'adulte. Résultats: L'âge moyen était de 50,69 ± 16,18 ans. La profondeur moyenne de la fosse olfactive dans le sexe masculin était de 4,03± 1,40 mm contre 4,45±1,59 mm dans le sexe féminin (p=0,0136). Le type III de Keros a été retrouvé dans 11 cas (3,5%). L'asymétrie de la profondeur de la fosse olfactive a été observée chez 107 (69%) patients. L'angle de Gera mesurait en moyenne 58,5±14,6 degrés et 60 (19,4%) toits de l'ethmoïde étaient classés dans le type III. On notait une asymétrie de l'angle de Gera chez 102 (65,8%) patients. La longueur moyenne de la lamelle latérale de la lame criblée était de 5,34 ± 1,4 mm. La longueur moyenne de la fovéa ethmoïdale chez les hommes était de 10 ± 2,5 mm contre 9,3 ± 2,2 chez les femmes (p=0,0078). Il existait une corrélation linéaire positive entre la profondeur de la fosse olfactive et l'angle de Gera (r=0,498; p=0,002). Conclusion: La fréquence élevée de l'asymétrie du toit ethmoïdal suggère que ces variations soient précisées par les radiologues dans les compte-rendu des examens de tomodensitométrie des sinus pour bilan préopératoire
Subject(s)
Humans , Tomography, X-Ray Computed , Radiologists , Classification , Ethmoid Bone , Facial Asymmetry , Four-Dimensional Computed TomographyABSTRACT
Complete agenesis of the dorsal pancreas (ADP) is an exceedingly rare congenital anomaly, compatible with life. It may be asymptomatic and usually incidentally diagnosed. In symptomatic cases, the clinical manifestations vary from abdominal pain, pancreatitis and diabetes mellitus to exocrine insufficiency with steatorrhea. We present a case report of a 28 year old female with ADP, diagnosed incidentally during radiological evaluation for hyperglycemias in SARS COV2 concomitant affection. Magnetic resonance cholangiopancreatography confirmed the absence of, neck, body and tail of the pancreas. Knowing the pancreatic embryogenesis, the clinical presentation of their malformations and the main radiological characteristics is important for the proper diagnosis of these anomalies.
Subject(s)
Humans , Female , Adult , Pancreas/abnormalities , Pancreas/diagnostic imaging , Congenital Abnormalities , Pancreatitis, Chronic/complications , Pancreas/surgery , Tomography, X-Ray Computed , Cholangiopancreatography, Endoscopic Retrograde , Pancreatitis, Chronic/diagnosisSubject(s)
Humans , Teratoma , Laparoscopy , Pathology , Magnetic Resonance Spectroscopy , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Child, Preschool , Sinusitis/complications , Sinusitis/diagnostic imaging , Cavernous Sinus/diagnostic imaging , Cavernous Sinus Thrombosis/diagnosis , Cavernous Sinus Thrombosis/etiology , Cavernous Sinus Thrombosis/therapy , Streptococcus constellatus/isolation & purification , Tomography, X-Ray Computed , Anti-Infective Agents/therapeutic use , Anticoagulants/therapeutic useABSTRACT
Abstract Objective The aim of this study was to assess the sacropelvic anthropometry in the Portuguese population, through the study of pelvic computed tomography (CT) scans. Methods Pelvic CT scans of 40 individuals were analyzed, and the length and angle measurements were performed according to predefined screw trajectories of S1 anterior (S1A), anterolateral (S1AL) and anteromedial (S1AM), S2 anterolateral (S2AL) and anteromedial (S2AM), S2 alar iliac (S2AI), iliac, and sacroiliac (SI) screws. Comparisons between genders were also performed. Results The S1A screw trajectory mean length was 30.80 mm. The S1AL mean length and lateral angle were 36.48 mm and 33.13°, respectively, and the S1AM's were 46.23 mm and 33.21°. The S2AL mean length was 28.66 mm and lateral angle was 26.52°, and the S2AM length and angle were 29.99 mm and 33.61°, respectively. The S2 alar-iliac screw trajectory mean length, lateral, and caudal angles were 125.84 mm, 36.78°, and 28.66°, respectively. The iliac screw trajectory mean length, lateral, and caudal angles were 136.73 mm, 23,86° and 24.01°, respectively. The sacroiliac screw trajectory length was 75.50 mm. The length of the screws was longer in men than in women, except for the S1A and SI screws, for which no difference was found between genders. Conclusion This study describes sacropelvic anatomical specifications. These defined morphometric details should be taken into consideration during surgical procedures.
Resumo Objetivo O objetivo deste estudo foi avaliar a antropometria sacropélvica da população portuguesa por meio de exames de tomografia computadorizada (TC). Métodos Quarenta TCs pélvicas foram analisadas para determinação do comprimento e ângulo das trajetórias definidas dos parafusos, como trajetória anterior (S1A), anterolateral (S1AL) e anteromedial (S1AM) do parafuso no pedículo de S1, trajetória anterolateral (S2AL) e anteromedial (S2AM) do parafuso no pedículo de S2 e trajetória ilíaca alar (S2AI), ilíaca e sacroilíaca (SI) do parafuso em S2. Comparações entre sexos também foram realizadas. Resultados O comprimento médio da trajetória S1A foi de 30,80 mm. O comprimento médio e o ângulo lateral de S1AL foram de 36,48 mm e 33,13°, respectivamente, e de S1AM, 46,23 mm e 33,21°. O comprimento médio e o ângulo lateral de S2AL foram de 28,66 mm e 26,52° e, de S2AM, 29,99 mm e 33,61°. O comprimento médio da trajetória ilíaca alar e os ângulos lateral e caudal do parafuso em S2 foram de 125,84 mm, 36,78° e 28,66°, respectivamente. O comprimento médio da trajetória ilíaca e os ângulos lateral e caudal foram 136,73 mm, 23,86° e 24,01°, respectivamente. O comprimento da trajetória sacroilíaca foi de 75,50 mm. O comprimento dos parafusos foi maior em homens do que em mulheres, à exceção dos parafusos S1A e SI, que não apresentaram diferenças entre os sexos. Conclusão Este estudo descreve as especificações anatômicas sacropélvicas. Esses detalhes morfométricos definidos devem ser considerados durante os procedimentos cirúrgicos.
Subject(s)
Humans , Male , Female , Sacrum , Spinal Fusion , Tomography, X-Ray Computed , Anthropometry , Retrospective Studies , Lumbar VertebraeABSTRACT
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 , MortalityABSTRACT
Resumen El plasmocitoma extramedular solitario (PES) es una neooplasia maligna infrecuente caracterizada por una proliferación aislada de células plasmáticas monoclonales en tejido extramedular. La localización más frecuente es en cabeza y cuello con predominio en el territorio rinosinusal, sin embargo, estas lesiones malignas representan menos del 1% de los tumores de esta región anatómica. El diagnostico requiere una alta sospecha clínica, análisis histopatológico acucioso, estudios serológicos y exámenes radiológicos sistémicos de acuerdo a los criterios diagnósticos establecidos en la literatura internacional. Se analiza el caso de un paciente masculino con un PES que se presentó como un tumor de fosa nasal derecha y obstrucción nasal de meses de evolución con hallazgos clínicos e imagenológicos inespecíficos. El diagnóstico definitivo se realizó mediante biopsia endoscópica nasal y estudio histopatológico. El tratamiento fue abordado de manera multidisciplinaria entre otorrinolaringología, hematología y radiooncología. De acuerdo a las guías internacionales, se decidió realizar radioterapia localizada con buen resultado clínico precoz. El PES requiere un abordaje multidisciplinario para lograr un diagnóstico y tratamiento oportuno, siendo imprescindible la exclusión del mieloma múltiple debido a las diferencias terapéuticas y en pronóstico clínico. El tratamiento puede realizarse con radioterapia y/o cirugía, siendo la radioterapia el pilar de tratamiento.
Abstract Solitary extramedullary plasmacytoma (SEP) is a rare malignant neoplasm characterized by isolated proliferation of monoclonal plasma cells in extramedullary tissue. The most frequent location is in the head and neck with a predominance in the rhinosinusal territory; however, these malignant lesions represent less than 1% of the tumors in this anatomical region. The diagnosis requires a high clinical suspicion, careful histopathological analysis, serological studies and systemic radiological examinations according to the diagnostic criteria established in the international literature. We analyze the case of a male patient with SEP that presented as a tumor of the right nostril and nasal obstruction of months of evolution with nonspecific clinical and imaging findings. The definitive diagnosis was made by nasal endoscopic biopsy and histopathological study. The treatment was approached by multidisciplinary teamwork. According to international guidelines, it was decided to perform localized radiotherapy with good early clinical results. SEP requires a multidisciplinary approach to achieve a timely diagnosis and treatment, being essential exclusion of multiple myeloma due to the therapeutic differences and prognosis. Treatment can be done with radiation therapy and/or surgery; radiation therapy is the mainstay of treatment.
Subject(s)
Humans , Male , Middle Aged , Plasmacytoma/surgery , Plasmacytoma/diagnosis , Brain Neoplasms/surgery , Brain Neoplasms/diagnosis , Paranasal Sinus Neoplasms/surgery , Paranasal Sinus Neoplasms/diagnosis , Nose Neoplasms/surgery , Nose Neoplasms/diagnosis , Plasmacytoma/radiotherapy , Biopsy , Brain Neoplasms/radiotherapy , Paranasal Sinus Neoplasms/radiotherapy , Tomography, X-Ray Computed , Nose Neoplasms/radiotherapy , Treatment OutcomeABSTRACT
O fibroma ossificante juvenil trabecular (FOJTr) é uma lesão fibro-óssea benigna rara de comportamento agressivo, alto potencial de recorrência, e acometimento no esqueleto craniofacial de crianças e adolescentes. Uma paciente do gênero feminino, 8 anos de idade, compareceu ao ambulatório de Patologia Oral e Maxilofacial da Universidade de Gurupi UNIRG para avaliação clínica de um aumento de volume na região de corpo da mandíbula do lado esquerdo. Não havia sintomatologia dolorosa e sequer desconforto. Nos exames de imagem (radiografia panorâmica e tomografia computadorizada) foram observados uma extensa área radiolúcida que se estendia desde o primeiro molar permanente com rizogênese incompleta até o incisivo central do lado oposto. Após a realização da biópsia incisional e laudos histopatológicos realizou-se a remoção completa da lesão incluindo os remanescentes decíduos sobrejacentes ao fibroma. Nas imagens de controle pós-operatório aos 90 dias (radiografia panorâmica e tomografia computadorizada), notou-se sinais de neoformação óssea com espessamento basilar e os germes dos dentes permanentes em franco desenvolvimento. Diante disso, ressalta-se a importância do conhecimento dos aspectos clínicos, radiográficos e histopatológicos para a realização de um correto diagnóstico e tratamento adequado afim de reduzir as altas taxas de recidivas... (AU)
Trabecular juvenile ossifying fibroma (TrJOF) is a rare benign fibro-osseous lesion, with aggressive behavior, high recurrence potential, which affects the craniofacial skeleton of children and adolescents. This paper aims to describe a clinical case in a female patient, 8 years old, who attended the Oral and Maxillofacial Pathology outpatient clinic Faculty of Dentistry University of Gurupi - UNIRG, city of Gurupi - TOCANTINS - BRAZIL for clinical evaluation of an increased in volume in the region of the mandible body, on the left side. There was no painful symptomatology or even discomfort. Imaging examinations (panoramic radiography and computed tomography (CT) showed an extensive radiolucent area that extended from the first permanent molar with incomplete root formation to the central incisor on the opposite side. After performing an incisional biopsy and histopathological examination, the lesion was completely removed included the remainder deciduous teeth overlying the tumor. In the postoperative control images at 90 days (panoramic radiography and CT), signs of bone neoformation with basilar thickening and the germs of the permanent teeth in full development were noted. In view, this importance of knowledge of clinical, radiographic and histopathological aspects is emphasized for the realization of a correct diagnosis and adequate treatment in order to reduce the high rates of relapses... (AU)
El fibroma osificante trabecular juvenil (TRFOJ) es una lesión fibroósea benigna rara con comportamiento agresivo, alto potencial de recurrencia y afectación del esqueleto craneofacial de niños y adolescentes. Paciente femenina de 8 años de edad que acude al ambulatorio de Patología Oral y Maxilofacial de la Universidad de Gurupi - UNIRG para evaluación clínica de aumento de volumen en la región del cuerpo mandibular del lado izquierdo. No presentaba sintomatología dolorosa ni molestias. Los exámenes de imagen (radiografía panorámica y tomografía computarizada) mostraron una extensa área radiolúcida que se extendía desde el primer molar permanente con formación radicular incompleta hasta el incisivo central del lado opuesto. Tras realizar la biopsia incisional y los informes histopatológicos, se procedió a la extirpación total de la lesión, incluidos los remanentes caducos que recubrían el fibroma. En las imágenes de control postoperatorio a los 90 días (radiografía panorámica y tomografía computarizada), se observaron signos de neoformación ósea con engrosamiento basilar y los gérmenes de los dientes permanentes en pleno desarrollo. Por tanto, es importante conocer los aspectos clínicos, radiográficos e histopatológicos para la realización de un diagnóstico correcto y un tratamiento adecuado con el fin de reducir las altas tasas de recaídas... (AU)
Subject(s)
Humans , Female , Child , Bone Neoplasms/diagnosis , Fibroma, Ossifying/diagnosis , Cancellous Bone/pathology , Biopsy , Radiography, Panoramic , Mandibular Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
RESUMEN La impresión de modelos tridimensionales (M3D) implica obtener una estructura sólida y formada a partir de un modelo digital. Para la reconstrucción 3D se utilizó tomografía computarizada contrastada, realizándose impresión de modelos sobre la base de las principales estructuras anatómicas hepáticas. Se utilizaron M3D en dos pacientes con indicación quirúrgica, una mujer con trombocitopenia familiar y metástasis hepática de adenocarcinoma rectal, sin respuesta a quimioterapia, y un hombre con hepatopatía infecciosa crónica y diagnóstico de carcinoma hepatocelular. La aplicación de M3D resultó de gran utilidad, pues permitió un mejor entendimiento de la relación espacial de las estructuras anatómicas en ambos casos. En nuestra experiencia, la aplicación de M3D fue muy útil para planificar la cirugía y dar una aproximación más certera de los reparos anatómicos. El modelo se obtuvo en 7 días y costó 380 dólares, un valor elevado para nuestro medio.
ABSTRACT Three-dimensional (3D) printing is the construction of a solid structure from a digital model. 3D reconstruction was performed using contrast-enhanced computed tomography scan, and 3D-printed models were built based on the main anatomic structures of the liver. 3D-printed models were used in two patients with indication of surgery; one woman with inherited thrombocytopenia and liver metastases from colorectal adenocarcinoma with no response to chemotherapy, and one man with chronic liver infection and hepatocellular carcinoma. The implementation of 3D printing technology was very useful, as it facilitated the understanding of the spatial relationships among the anatomical structures in both cases. In our experience, the use of 3D-printed models was very useful for preoperative planning and for understanding the anatomic landmarks. The model was built in 7 days, with a cost of 380 dollars which is elevated in our environment.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Printing, Three-Dimensional , Hepatectomy/methods , Liver Neoplasms/surgery , Image Processing, Computer-Assisted , Tomography, X-Ray Computed , Liver Neoplasms/diagnostic imaging , Neoplasm Metastasis/diagnostic imagingABSTRACT
Resumen La mononucleosis infecciosa (MI) es un cuadro clínico generalmente benigno y autolimitado en la infancia y adolescencia debido a la primoinfección del virus de Epstein-Barr caracterizado por la triada de faringitis, fiebre y adenopatías. El riesgo de complicaciones aumenta con la edad y la inmunosupresión, siendo las complicaciones letales más frecuentes las asociadas a rotura esplénica, alteraciones neurológicas y obstrucción de la vía aérea por el aumento del tamaño amigdalar. Los abscesos cervicales asociados a MI son poco frecuentes, siendo mayoritariamente periamigdalinos e intraamigdalares. Presentamos dos casos quirúrgicos de abscesos cervicales profundos de gran tamaño con afectación retrofaríngea y parafaríngea en adolescentes sanos de corta edad (14 y 15 años), sin ningún tipo de inmunosupresión o factores de riesgo, uno de ellos asociado además, a una relevante hemorragia amigdalar espontanea, condición no descrita previamente en la literatura en relación a MI en un paciente tan joven.
Abstract Infectious mononucleosis (MI) is a generally benign and self-limited condition in childhood and adolescence due to the primary EBV infection characterized by the triad of pharyngitis, fever, and lymphadenopathies. The risk of complications increases with age and immunosuppression. The most frequent fatal complications are those associated with splenic rupture, neurological alterations, and airway obstruction due to increased tonsillar size. Cervical abscesses associated with MI are rare, being mostly peritonsillar and intra-tonsil. We present two surgical cases of big deep cervical abscesses with retropharyngeal and parapharyngeal involvement in healthy very young adolescents (14 and 15 years old), without any type of immunosuppression or risk factors, one of them associated with a clinically relevant spontaneous tonsillar bleeding, which had not been described in the literature associated with MI in such young patient.
Subject(s)
Humans , Female , Adolescent , Peritonsillar Abscess/complications , Peritonsillar Abscess/therapy , Infectious Mononucleosis/complications , Infectious Mononucleosis/therapy , Pharyngitis/etiology , Tomography, X-Ray Computed , Peritonsillar Abscess/diagnostic imaging , Fever/etiology , Hemorrhage/etiology , Infectious Mononucleosis/diagnostic imagingABSTRACT
Resumen Objetivo: Reportar el caso de una paciente con intususcepción apendicular (IA), condición infrecuente, secundario a foco de endometriosis, patología que en los últimos años ha presentado un aumento en su incidencia. Material y Método: Historia clínica, imágenes preoperatorias e intraoperatorias obtenidas de la ficha clínica. Resultados: Mujer de 35 años con dolor abdominal crónico de 4 meses de evolución. Se realiza estudio colonoscópico evidenciando lesión de 15 x 8 mm en ostium apendicular intususceptada al lumen cecal, y enteroclisis por tomografía axial computarizada (TC) que confirma IA. Se realiza una resección ileocecal laparoscópica demostrando la invaginación del apéndice con biopsia que muestra un foco de endometrioma. Discusión: La IA es una condición infrecuente con una incidencia cercana al 0,01% en la población general. Las patologías benignas son la principal causa (77%), siendo la endometriosis la causa más frecuente. Conclusión: La IA por endometriosis es anecdótica, con sintomatología poco específica. Los estudios disponibles pueden orientar adecuadamente la presencia de IA, sin embargo, en algunas ocasiones puede confundirse con patologías neoplásicas, donde cobra importancia la cirugía para dilucidar la etiología.
Objective: To report the case of a patient with appendicular intussusception (AI), an infrequent condition secondary to a focus of endometriosis, a pathology that has increased incidence in recent years. Material and Method: Clinical case, history and images obtained from the clinical file and intraoperative records with the consent of the patient. Results: A 35-year-old woman with abdominal pain. Colonoscopy study showing a 15 × 8 mm lesion in the appendicular ostium intussuscepted to the cecal lumen, and a computerized tomography (CT) enteroclysis confirming AI. A laparoscopic ileocecal resection is performed, demonstrating invagination of the appendix secondary to an endometrioma focus. Discussion: AI is a rare condition, with an incidence close to 0.01% in the general population. Benign pathologies are the main cause (77%), endometriosis being the most frequent cause. Conclusion: AI due to endometriosis is anecdotal, with unspecific symptoms. The available studies can adequately guide the presence of AI, however, on some occasions it can be confused with neoplastic pathologies, where surgery is important to elucidate the etiology.
Subject(s)
Humans , Female , Adult , Appendix/pathology , Cecal Diseases/etiology , Endometriosis/complications , Intussusception/etiology , Tomography, X-Ray Computed , Cecal Diseases/diagnosis , Colonoscopy , Endometriosis/diagnosis , Intussusception/diagnosisABSTRACT
Introducción. El seno dérmico cefálico es un tractotubular formado por una separación incompleta entre el ectodermo neural y el ectodermo epitelial;puede tener complicaciones infecciosas. Existen reportes aislados de esta patología. Objetivo: describir una serie de pacientescon seno dérmico craneal, las formas depresentación, el diagnóstico, el tratamiento y las complicaciones. Población y métodos. Estudio observacionaldescriptivo de una serie de pacientes pediátricos con seno dérmico cefálico atendidos en unhospital pediátrico de nivel III entre 2014 y 2019. Resultados. se incluyeron 18 pacientes. La clínicade presentación fue, en 12 casos, una lesión puntual en el cuero cabelludo, hipertensiónendocraneana en 4 casos, ataxia en 1 caso y lesión puntual con fístula en 1 caso. La mitad presentó síntomas de infección. La localización fue en la línea media sobre el hueso occipital en 13 casos, en la línea media sobre el hueso frontal en 3 casos y en la línea media interparietal en 2 casos. En 5 casos se encontró asociada una imagen extracraneana y, en 11 casos, una complicación intracraneana. Ningún paciente presentó recidiva de la lesión y en todos se realizó un solo procedimiento quirúrgico. Conclusiones. Los senos dérmicos en esta serie se presentaron como lesiones puntuales en cuerocabelludo. La localización más frecuente fue a nivel occipital sobre línea media y, en más de la mitad, atravesaba el hueso. El tratamiento de elección fue la exéresis completa del seno dérmicoy las lesiones asociadas. Ante la presencia de senos dérmicos sintomáticos o asociados alesiones intracraneanas, la cirugía se realizó de urgencia.
Introduction. A cranial dermal sinus is a tubular tract resulting from the incomplete separation of the epithelial ectoderm from the neuroectoderm which may lead to infectious complicationsThere have been isolated reports of this condition. Objective. To describe a series of patients with cranial dermal sinus, its presentation, diagnosis, management, and complications. Population and methods. Observational,descriptive study of a series of pediatric patients with cranial dermal sinus treated at a tertiary care children's hospital between 2014 and 2019. Results. A total of 18 patients were included. Theclinical presentation was a specific lesion on the scalp in 12 cases, intracranial hypertension in 4, ataxia in 1, and a specific lesion with fistula tract in 1. Half of patients had symptoms of infection. The lesion was located in the midline of the occipital bone in 13 cases; in the midline of the frontal bone in 3 cases; and in the interparietal midline in 2 cases. The dermal sinus was associated with anextracranial image in 5 cases and an intracranial complication in 11 cases. No patient hadrecurrence and only one surgery was performed in all of them. Conclusions. In this series, dermal sinusespresented as specific lesions on the scalp. The most common site was the occipital midline, and more than 50% of these extended through the bone. The treatment of choice was complete resection of dermal sinus and associated lesions. An emergency surgery was performed when the dermal sinus was symptomatic or associated with intracranial lesions.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Spina Bifida Occulta/surgery , Spina Bifida Occulta/complications , Spina Bifida Occulta/diagnosis , Tertiary Healthcare , Tomography, X-Ray Computed , HospitalsABSTRACT
Presentamos el caso de una mujer de 86 años con una hernia espigeliana complicada por la oclusión intestinal, cuyo diagnóstico se basó en semiología y tomografía computarizada. En la anamnesis, informó dolor en la fosa ilíaca derecha asociada con los vómitos. El examen físico mostró una masa dura, sensible y móvil ubicada en la fosa ilíaca derecha. La tomografía computarizada abdominal mostró un saco hernial de 13 mm con un cuello en la fosa ilíaca derecha, frente a la aponeurosis del músculo oblicuo externo. Eso contenía grasa y un bucle de intestino delgado. El diagnóstico de hernia espigeliana atascada. La cirugía se realizó con un manejo postoperatorio simple.
We present the case of an 86-year-old woman with a Spigelian hernia complicated by intestinal occlusion, whose diagnosis was based on semiology and computed tomography. In the anamnesis, he reported pain in the right iliac fossa associated with vomiting. Physical examination showed a hard, sensitive, and mobile mass located in the right iliac fossa. abdominal computed tomography showed a 13-mm hernial sac with a neck in the right iliac fossa, in front of the aponeurosis of the external oblique muscle. That contained fat and a loop of small intestine. The diagnosis of stuck Spigelian hernia. The surgery was performed with simple postoperative management
Subject(s)
Humans , Female , Aged, 80 and over , Tomography, X-Ray Computed , Hernia, Abdominal/surgery , Hernia, Abdominal/diagnosis , Hernia, Abdominal/pathology , Intestinal Obstruction/pathologyABSTRACT
A tomografia computadorizada (TC) é exame de escolha para rastreamento de lesões no traumatismo cranioencefálico (TCE). Apesar disso, seu uso rotineiro no TCE leve é controverso O objetivo desta revisão foi avaliar o impacto da aplicação de diretrizes de manejo e conduta de TCE leve quanto à solicitação de TC de crânio. É busca realizada nas bases de dados LILACS, Medline, PubMed, SciELO, utilizando descritores do MeSH e DeCS. A busca inicial identificou 30.191 artigos. Após remoção de publicações duplicadas, seleção pelo título, seleção pelo resumo, restaram 25 publicações, que foram lidas na íntegra e cinco incluídas na presente revisão sistemática. Em conclusão, os artigos analisados apresentaram, em média, redução de 25,8% na solicitação de TC de crânio quando aplicadas as diretrizes, e orientam que protocolos para TCE leve são ferramentas eficientes para auxiliar a prática médica, impactando positivamente quando aplicados na população, devendo sempre ser levado em conta a avaliação clínica.
Computed tomography (CT) is the exam of choice for tracking injuries in traumatic brain injury (TBI). Despite this, its routine use in mild TBI is controversial. The objective of this review was to evaluate the impact of applying guidelines for the management and conduct of mild TBI on the request for CT of the head. A search was carried out in the LILACS, Medline, PubMed, SciELO databases, using MeSH and DeCS descriptors. The initial search identified 30,191 articles. After removal of duplicate publications, selection by title, selection by abstract, 25 publications remained, which were read in full and five were included in this systematic review. In conclusion, the articles analyzed showed, on average, a 25.8% reduction in the request for cranial CT when the guidelines were applied, and guide that protocols for mild TBI are efficient tools to assist medical practice, positively impacting when applied to the population. , and clinical evaluation should always be taken into account.