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1.
Arch. argent. pediatr ; 120(2): e85-e88, abril 2022. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1363977

ABSTRACT

Las fracturas con hundimiento de cráneo intrauterinas representan una entidad poco frecuente, generalmente secundaria a traumatismos (previos o durante el nacimiento) o de etiología desconocida. Suelen requerir evaluación y seguimiento por el servicio de Neurocirugía Pediátrica. A la fecha, es controversial la necesidad de tratamiento quirúrgico y el momento oportuno para concretarlo. Se presentan dos casos clínicos de pacientes de término, nacidas porcesárea,condiagnósticoposnatalinmediatodehundimiento de cráneo de tipo ping-pong no traumático. Ambas pacientes presentaron examen neurológico normal. Se confirmó el diagnóstico a través de radiografía y tomografía de cráneo, sin observarse lesiones asociadas. Fueron valoradas por el servicio de Neurocirugía, que indicó corrección quirúrgica de la lesión en ambos casos, con buena evolución posterior.


Spontaneous intrauterine depressed skull fractures are a rare entity. They can appear secondarily to head trauma (before or during birth) or due to unknown etiology. They usually require a complete evaluation from pediatric neurosurgery specialists. Their optimal management, including timely surgical treatment remains controversial. We describe two cases delivered by cesarean section, with postnatal diagnosis of spontaneous intrauterine depressed skull fracture. Both had a normal neurological exam. A skull radiography and head CT were performed, and no associated lesions were found. Both cases required surgical correction, with positive results.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Skull Fracture, Depressed/surgery , Skull Fracture, Depressed/diagnostic imaging , Radiography , Tomography, X-Ray Computed , Cesarean Section , Parturition
3.
Rev. bras. ortop ; 57(1): 47-54, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365749

ABSTRACT

Abstract Objective To study the parameters related to the insertion path of cortical screws and to describe this technique. Methods Computed tomography (CT) scans of 30 patients, as well as the measurements from the L1 to the L5 vertebrae, were studied. A second observer evaluated ten randomly-selected exams. The parameters studied included the lateral angle (LA) and the screw diameter (SD) as axial variables, and the cranial angle (CA) and screw length (SL) as sagittal variables. Results We studied 15 male patients (mean age: 31.33 years) and 15 female patients (mean age: 32.01 years). The LA varied between 13.8° and 20.89°, with a tendency to increase in the proximal to distal direction. The CA varied from 17.5° to 24.9°, with a tendency to decrease in the caudal direction. The SD ranged from 2.3 mm to 7.2 mm, with a tendency to increase as we progressed from proximal to distal. The SL varied from 19 mm to 45 mm, with a tendency to decrease as we proceeded from proximal (L1) to distal (L5). No statistical difference was observed between the genders or in the interobserver agreement regarding the values studied when comparing the sides. Conclusion The path of insertion of the cortical screw shows a variation in different populations. Therefore, we recommend a preoperative imaging study to reduce the surgical risks related to the technique.


Resumo Objetivo Estudar os parâmetros anatômicos do trajeto de inserção do parafuso cortical e descrever sua técnica. Métodos Analisaram-se exames de tomografia computadorizada de 30 pacientes, e as medidas nas vértebras de L1 a L5 bilateralmente. Um segundo observador avaliou dez exames aleatoriamente. Os parâmetros incluíram o ângulo lateral (AL) e o diâmetro do parafuso (DP) como variáveis axiais, e o ângulo cranial (AC) e o comprimento do parafuso (CP) como variáveis sagitais. Resultados No total, havia 15 pacientes do sexo masculino (média de idade de 31,33 anos) e 15 do sexo feminino (média de idade de 32,01 anos). O AL variou de 13,8° a 20,89°, com uma tendência de aumento no sentido de proximal a distal. O AC variou de 17,5° a 24,9°, com tendência de diminuição no sentido caudal. O DP variou de 2,3 mm a 7,2 mm, havendo uma tendência ao aumento conforme avançamos de proximal a distal. O CP variou de 19 mm a 45 mm, havendo uma tendência de diminuição conforme avançamos de proximal (L1) a distal (L5). Não houve diferença estatística entre os sexos, nem diferenças na confiabilidade interobservador, quanto aos valores estudados quando comparados os lados. Conclusão A trajetória do parafuso de trajeto cortical apresenta variações em diferentes populações. Assim, recomendamos o estudo pré-operatório de imagens para reduzir os riscos cirúrgicos relacionados à técnica.


Subject(s)
Humans , Male , Female , Adult , Spine/anatomy & histology , Spine/surgery , Bone Screws , Tomography, X-Ray Computed , Minimally Invasive Surgical Procedures
4.
Rev. bras. ortop ; 57(1): 61-68, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365744

ABSTRACT

Abstract Objective The approachability of the cervicothoracic region anteriorly based on age and gender, and the possibility of anatomic variances in different geographic populations have not been previously investigated. The aim of the present work was to perform a radiographic analysis of Brazilian patients to assess anterior approachability of the cervicothoracic junction based on age and gender. Methods Retrospective radiographic analysis of 300 computed tomography scans. Patients were separated based on age and gender. The radiographic parameters studied were: horizontal level above the sternum (HLS), vertebral body angle (VBA), intervertebral disc line (IDL), and intervertebral disc line angulation (IDLA). Results The most frequent HLS and IDL were T2 (34.3%) and C7-T1 (46%) respectively. Vertebral body angleand IDLA had average values of 18 ± 8.94 and 19 ± 7.9 degrees, respectively. Males had higher values in both IDLA (p= 0.003) and VBA (p= 0.02). Older groups had higher values in both IDLA (p= 0.01) and VBA (p= 0.001). No differences were observed in HLS between gender (p= 0.3) or age groups (p= 0.79). No differences were seen in IDL between gender groups (p= 0.3); however, the older group had a more caudal level than the younger groups (p= 0.12). ConclusionsCompared to other populations, our sample had a more cephalad IDL and HLS. Vertebral body angle and IDLA were higher in males and higher angles for VBA and IDLA were shown for older groups. Intervertebral disc line was more caudal with aging.


Resumo Objetivo A capacidade de acesso anterior à região cervicotorácica com base na idade e gênero do paciente e a possibilidade de variações anatômicas em diferentes populações geográficas ainda não foram investigadas. O objetivo deste trabalho foi realizar uma análise radiográfica de pacientes brasileiros para avaliar a acessibilidade anterior da junção cervicotorácica conforme idade e gênero. Métodos Análise radiográfica retrospectiva de 300 tomografias computadorizadas. Os pacientes foram separados por idade e gênero. Os parâmetros radiográficos estudados foram: nível horizontal acima do esterno (HLS, na sigla em inglês), angulação do corpo vertebral (VBA, na sigla em inglês), linha do disco intervertebral (IDL, na sigla em inglês) e angulação da linha do disco intervertebral (IDLA, na sigla em inglês). Resultados Os HLS e IDL mais frequentes foram T2 (34,3%) e C7-T1 (46%), respectivamente. Os valores médios de VBA e IDLA foram de 18 ± 8,94 e 19 ± 7,9 graus, respectivamente. Os homens apresentaram valores maiores de IDLA (p= 0,003) e VBA (p= 0,02). Os grupos de maior idade apresentaram valores maiores de IDLA (p= 0,01) e VBA (p= 0,001). Não houve diferenças de HLS entre os gêneros masculino e feminino (p= 0,3) ou faixas etárias (p= 0,79). Não foram observadas diferenças na IDL entre os gêneros masculino e feminino (p= 0,3); entretanto, o grupo mais velho apresentou nível mais caudal do que os grupos mais jovens (p= 0,12). ConclusõesEm comparação a outras populações, nossa amostra apresentou IDL e HLS mais cefálicos. AVBA e a IDLA foram maiores no gênero masculino, enquanto VBA e IDLA foram maiores em grupos mais velhos. A IDL era mais caudal em pacientes idosos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Spinal Diseases , Spinal Fusion , Thoracic Vertebrae , Tomography, X-Ray Computed , Retrospective Studies , Gender Identity , Intervertebral Disc
5.
Rev. bras. ortop ; 57(1): 82-88, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365738

ABSTRACT

Abstract Objective To compare magnetic resonance imaging (MRI) using a body coil with computed tomography (CT) in measuring the tibial tubercle-trochlear groove distance (TT-TG) and the patellar tendon-cartilaginous trochlear groove (PT-CTG) distances, and evaluate interrater reliability. Methods The study group consisted of 34 knees from 17 asymptomatic subjects with no history of knee pathology, trauma or surgery. A low-dose CT scan and an axial T1-weighted MRI sequence of the knees were performed with rigorous standardization of the positioning with full extension of the knees and parallel feet. Two musculoskeletal radiologists performed the measurements independently. The reliability of the TT-TG and PT-CTG distances on CT (17.1 ± 4.2 mm and 17.3 ± 4.2 mm) and of MRI (16.2 ± 3.7 mm and 16.5 ± 4.1 mm) was assessed by intraclass correlation coefficient (ICC [2,1]) and Bland-Altman graphs, as well as the interrater reliability for both methods. Results Good reliability and agreement was observed between CT and MRI measurements for TT-TG and PT-CTG, with an ICC of 0.774 (p< 0.001) and 0.743 (p< 0.001), respectively, and no systematic bias was observed. The interrater reliability was excellent for all measurements on both imaging methods. Conclusion This was the first study that compared MRI using a body coil with CT in measuring the TT-TG distance, with the potential clinical implication that the CT in this clinical setting could be avoided.


Resumo Objetivo Comparar a ressonância magnética (RM) usando uma bobina corporal e tomografia computadorizada (TC) na medição da distância tubérculo tibial-sulco troclear (TT-ST) e as distâncias tendão patelar-sulco troclear cartilaginoso (TP-STC), e avaliar a confiabilidade interavaliador. Métodos O grupo de estudo consistiu em 34 joelhos de 17 indivíduos assintomáticos sem história de patologia, trauma ou cirurgia no joelho. Uma tomografia computadorizada (TC) de baixa dose e uma sequência axial de RM ponderada em T1 dos joelhos foram realizadas com padronização rigorosa do posicionamento com extensão total dos joelhos e pés paralelos. Dois radiologistas musculoesqueléticos realizaram as medidas de forma independente. A confiabilidade das distâncias TT-ST e TP-STC na TC (17,1 ± 4,2 mm e 17,3 ± 4,2 mm) e RM (16,2 ± 3,7 mm e 16,5 ± 4,1 mm), foi avaliada pelo coeficiente de correlação intraclasse (CCI [2,1)]) e gráficos Bland-Altman, bem como a confiabilidade entre avaliadores para ambos os métodos. Resultados Boa confiabilidade e concordância foram observadas entre as medidas de TC e RM para TT-ST e TP-STC com um CCI de 0,774 (p< 0,001) e 0,743 (p< 0,001), respectivamente, e nenhum viés sistemático foi observado. A confiabilidade entre avaliadores foi excelente para todas as medições em ambos os métodos de imagem. Conclusão Este foi o primeiro estudo que comparou a RM usando bobina de corpo com a TC na medição da distância TT-ST, com a implicação clínica potencial de que a TC neste cenário clínico poderia ser evitada.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Patellar Ligament , Patellar Dislocation , Knee
6.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.788-792, tab.
Monography in Portuguese | LILACS | ID: biblio-1353341
9.
Autops. Case Rep ; 12: e2021361, 2022. tab, graf
Article in English | LILACS | ID: biblio-1360149

ABSTRACT

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.


Subject(s)
Humans , Male , Adolescent , Head and Neck Neoplasms/pathology , Mediastinal Cyst/pathology , Tomography, X-Ray Computed , Biopsy, Fine-Needle , Diagnosis, Differential
10.
Rev. Círc. Argent. Odontol ; 79(230): 17-20, dic. 2021. ilus, graf
Article in Spanish | LILACS | ID: biblio-1358178

ABSTRACT

Luego de una extracción dental ocurren inevitablemente procesos de reabsorción y remodelación ósea, donde la dimensión y morfología de la cresta alveolar se ve modificada, representando un problema para la rehabilitación de la zona. Estudios clínicos han documentado un promedio de 4,0 a 4,5 mm de reabsorción ósea horizontal luego de una exodoncia, como así también cambios dimensionales significativos en los alrededores del hueso alveolar. El propósito fue evaluar y comparar clínica y tomográficamente los procesos de reparación y conservación del reborde alveolar post-extracción de paredes intactas, con y sin la utilización de esponjas de colágeno intraalveolar como relleno y placa termoformada como barrera física, durante el proceso de cicatrización. Se seleccionaron pacientes con indicación de exodoncia de elementos dentarios normalmente implantados y clínicamente aceptables, aplicando los criterios de exclusión, se realiza toma de impresión del terreno para la confección de una placa de protección rígida 0,8 termoformada para ser colocada posterior a la extracción durante la masticación por un período de 30 días. Se indica tomografía cone-beam post operatoria inmediata y a los tres meses para analizar, medir y comparar alto y ancho de crestas alveolares residuales. En la evaluación clínica y tomográfica de los casos estudiados, el grupo control donde se usó únicamente placa de protección alveolar arrojó mejores resultados que el grupo donde se colocaron esponja de colágeno en el interior del alvéolo. Palabras clave: Regeneración ósea, esponja de colágeno, cicatrización ósea, alvéolo postextracción, placa de protección alveolar (AU)


After a tooth extraction, bone resorption and remodeling processes inevitably occurs, where size and morphology of the alveolar crest is modified, representing a problem for the rehabilitation of the area. Clinical studies have documented an average of 4.0 to 4.5 mm of horizontal bone resorption after an extraction, us well us substantial dimensional changes around the alveolar bone. The purpose was to evaluate and compare clinical and tomographically both repair and preservation of post extraction alveolar ridge of intact walls processes, with and without the use of intraalveolar collagen sponges as filler and a thermoformed protective plaque, us physica? barrier, during healing process. Patients with normally implanted and clinically acceptable tooth with extraction indication were selected, applying the exclusion criteria, impression of the field is taken to build a 0.8 rigid thermoformed protective plaque in order to be placed after extraction and used during chewing for a period of 30 days. Immediate and three months post-operative cone beam tomography are indicated to analyze, measure and compare height and width of residual alveolar crests. In the clinical and tomographic evaluation of the cases treated, control group where only alveolar protective plaque was used, showed better results than the group with intraalveolar collagen sponge (AU)


Subject(s)
Humans , Male , Female , Bone Regeneration , Alveolar Bone Loss , Collagen , Argentina , Schools, Dental , Tooth Extraction , Wound Healing , Tomography, X-Ray Computed , Statistical Analysis , Cone-Beam Computed Tomography
11.
Braz. j. oral sci ; 20: e219912, jan.-dez. 2021. ilus
Article in English | LILACS, BBO | ID: biblio-1254429

ABSTRACT

Aim: Evaluation of the reliability of 3D computed tomography (3D-CT) in the diagnosis of mandibular fractures. Methods: A cross-sectional, quantitative and qualitative study was carried out, through the application of a questionnaire for 70 professionals in the area of Oral and Maxillofacial Surgery and Radiology. 3D-CT images of mandibular fractures were delivered to the interviewees along with a questionnaire. Participants answered about the number of traces, the region and the type of fracture. The correct diagnosis, that is, the expected answer, was based on the reports of a specialist in oral and maxillofacial radiology after viewing the images in the axial, sagittal and coronal sections. The resulting data from the interviewees was compared with the expected answer and then, the data was analyzed statistically. Results: In the sample 56.9% were between 22 and 30 years old, 52.8% were oral and maxillofacial surgeons (OMF), 34.7% were residents in OMF surgery and 12.5% OMF radiologists. Each professional answered 15 questions (related to five patients) and 50.8% of the total of these was answered correctly. Specialists in Oral and Maxillofacial Surgery and Traumatology correctly answered 53.9%. Interviewees with experience between 6 and 10 years correctly answered 58.2%. In identifying fracture traces, 46.1% of the questions were answered correctly. In terms of location, 5.6% of interviewees answered wrongly while 14.2% answered wrongly regarding classification. Conclusion: 3D computed tomography did not prove to be a reliable image for diagnosing mandibular fractures when used alone. This made necessary an association with axial, sagittal and coronal tomographic sections


Subject(s)
Humans , Male , Female , Diagnostic Imaging , Tomography, X-Ray Computed , Surveys and Questionnaires , Imaging, Three-Dimensional , Mandibular Fractures
12.
Int. j. med. surg. sci. (Print) ; 8(4): 1-14, dic. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1348232

ABSTRACT

El síndrome de Forestier es una enfermedad reumatológica, de origen desconocido, que consiste en la calcificación de diferentes zonas del cuerpo, predominantemente a nivel del ligamento vertebral común anterior, donde se forman osteofitos capaces de producir sintomatología variada y de intensidad variable. Normalmente asintomática, aunque, cuando afecta la columna cervical, el síntoma más común es la disfagia. Se presenta un caso de Síndrome de Forestier que consultó por disfagia en la Unidad de Cirugía de Cabeza y Cuello del Servicio de Otorrinolaringología del Instituto de Previsión Social de Asunción, Paraguay. La semiología permitió observar un abombamiento submucoso en la pared posterior de la orofaringe de 1,5 cm de diámetro, que pudo ser evaluado y confirmado por tomografía. Debido a poca intensidad de la sintomatología y escasa repercusión en el estado general se decidió realizar un tratamiento conservador con buenos resultados, tras dos años de seguimiento clínico. En estos casos la cirugía ocupa un lugar secundario, ya sea ante el fracaso de esta conducta conservadora o ante la progresión de los síntomas


Forestier Syndrome is a rheumatological disease of unknown origin, which consist in calcification of different areas of the body, predominantly at the level of the anterior common vertebral ligament, where osteophytes capable of producing varied symptoms of variable intensity are formed. Normally asymptomatic, although, when it affects the cervical spine, the most common symptom is dysphagia.A case of Forestier syndrome is presented who consulted for dysphagia in the Head and Neck Surgery Unit of the Otolaryngology Service of the Institute of Social Prevision, Asuncion, Paraguay. The semiology allowed to observe a submucosal bulge in the posterior wall of the oropharynx of 1,5 cm in diameter, which could be evaluated and confirmed by tomography.Due to the low intensity of the symptoms and little impact on the general state, it was decided to carry out a conservative treatment with good results, after two years of clinical follow-up. In these cases, surgery occupies a secondary place, either before the failure of this conservative behavior or the progression of the symptoms.


Subject(s)
Humans , Female , Middle Aged , Hyperostosis, Diffuse Idiopathic Skeletal/diagnostic imaging , Paraguay , Tomography, X-Ray Computed
13.
Int. j. med. surg. sci. (Print) ; 8(4): 1-9, dic. 2021. ilus
Article in English | LILACS | ID: biblio-1348234

ABSTRACT

Renal cell carcinoma accounts for 2-3% of all malignant neoplasms. Metastatic disease of the spine is common and 50% of bone metastases are already present at the time of primary diagnosis. Bone metastases from renal cell carcinoma are difficult to manage, especially vertebral localization.A 48-year-old woman was diagnosed with renal cell carcinoma in the context of low back pain. The patient presented two skeleton metastases at diagnosis (T11 and 5th rib). The patient received neoadjuvant treatment with cabozantinib, followed by removal of the renal tumor. Radiotherapy was administered for the lumbar lesion. In spite of the radiotherapy treatment, increased low back pain limiting mobility and ambulation. MRI showed an occupation of the spinal canal, without neurological lesion. The SINS scale revealed a score of 14 (vertebral instability). The patient's prognosis was greater than 12 months according to the Tokuhashi score. Based on clinical and mechanical criteria, surgical treatment of the vertebral lesion was decided. T11 vertebrectomy was performed, the reconstruction was made with an expandable cage, and T8 a L2 posterior spinal arthrodesis. A partial resection of the fifth rib was performed in order to remove the whole macroscopic tumor. After 3 months, she was diagnosed with a local infection, treated by irrigation, debridement and antibiotherapy, with good evolution. At 1-year follow-up, she has no low back pain or functional limitation. Follow-up chest-abdomen-pelvis computed CT scan showed absence of disease progression, furthermore, the vertebral arthrodesis shows fusion signs. At the time of this report, there are no clinical or radiological data of infection


El carcinoma de células renales representa el 2-3% de todas las neoplasias malignas. La enfermedad metastásica de la columna vertebral es frecuente y el 50% de las metástasis óseas ya están presentes en el momento del diagnóstico. Las metástasis óseas del carcinoma de células renales son difíciles de manejar, especialmente en localización vertebral.Una mujer de 48 años fue diagnosticada de carcinoma de células renales en el contexto de un dolor lumbar. La paciente presentaba dos metástasis óseas en el momento del diagnóstico (T11 y 5ª costilla). Inicialmente recibió tratamiento neoadyuvante con cabozantinib, seguido de la extirpación quirúrgica del tumor renal. Se administró radioterapia para la lesión lumbar. A pesar del tratamiento radioterápico, aumentó el dolor lumbar con limitación para la movilidad y la deambulación. La RM mostró una ocupación del canal espinal, sin lesión neurológica. La escala SINS reveló una puntuación de 14 (inestabilidad vertebral). El pronóstico de la paciente era superior a 12 meses según la puntuación de Tokuhashi. Basándose en criterios clínicos y mecánicos, se decidió el tratamiento quirúrgico de la lesión vertebral. Se realizó una vertebrectomía de T11, para la reconstrucción se usó una caja extensible, junto con una artrodesis vertebral T8-L2. Se realizó una resección parcial de la quinta costilla para eliminar todo el tumor macroscópico. A los 3 meses de la cirugía la paciente fue diagnosticada de infección local, tratada mediante irrigación, desbridamiento y antibioterapia, con buena evolución. Al año de seguimiento, no presenta dolor lumbar ni limitación funcional. La tomografía computarizada de tórax-abdomen-pelvis de seguimiento mostró ausencia de progresión de la enfermedad, además, la artrodesis vertebral muestra signos de fusión. En el momento de este informe, no hay datos clínicos ni radiológicos de infección.


Subject(s)
Humans , Female , Middle Aged , Spinal Neoplasms/secondary , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Spinal Neoplasms/surgery , Spinal Neoplasms/diagnostic imaging , Carcinoma, Renal Cell/diagnostic imaging , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed
14.
Rev. bras. ortop ; 56(6): 733-740, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1357128

ABSTRACT

Abstract Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.


Resumo Objetivo Comparar a avaliação do método glenoid-track (GT) em exames de tomografia computadorizada com reconstrução 3-D (TC-3D) com a avaliação realizada em exames de ressonância magnética (RM) e/ou artro-ressonância magnética (ARM). Métodos Quarenta e quatro ombros com diagnóstico clínico e radiográfico de instabilidade anterior traumática foram avaliados por meio de exames de TC-3D, RM e/ou ARM. As variáveis GT, intervalo de Hill-Sachs (IHS) e a perda óssea da glenoide (POG) foram realizadas por um médico radiologista, utilizando imagens de TC-3D, e classificadas em on-track/off-track. Três cirurgiões cegos à avaliação do radiologista realizaram o mesmo método utilizando RM/ARM. O estudo realizou análise descritiva, de variância, de associação da discordância de resultados, de concordância e curva característica de operação do receptor. Resultados Os resultados dos 4 examinadores foram totalmente concordantes em 61,4%. A RM/ARM diagnosticou lesões off-track com a sensibilidade variando de 35 a 65%, e lesões on-track com a especificidade variando de 91,67 a 95,83%. A acurácia variou de 68,1 a 79,5%. A maior divergência de dados ocorreu para o diagnóstico por RM/ARM de lesões off-track. A maior variabilidade dos dados ocorreu para o cálculo do IHS. Valores maiores de IHS e de POG foram associados a maior discordância entre os examinadores. A RM/ARM apresentou menor medida de valores de IHS quando comparado com a TC-3D. Ocorreu apenas moderada concordância no método GT entre a TC e a RM/ARM (Kappa 0,325-0,579). Conclusão A RM/ARM apresentou baixa acurácia e moderada concordância para o método GT, devendo ser utilizada com cautela por cirurgiões.


Subject(s)
Humans , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Clinical Diagnosis , Glenoid Cavity , Shoulder Injuries
16.
Prensa méd. argent ; 107(7): 349-352, 20210000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1358886

ABSTRACT

La colecistitis enfisematosa es una rara forma de presentación de la colecistitis aguda. Es causada por isquemia vascular y se caracteriza por la presencia de gas en la pared, en la luz o en ambas, la cual puede evolucionar a un cuadro de extrema urgencia asociada a una alta tasa de morbilidad y mortalidad. Se presenta un caso de un paciente con un cuadro de dolor abdominal con síntomas gastrointestinales y signos de respuesta inflamatoria sistémica con diagnóstico presuntivo de colecistitis enfisematosa que se realizó una colecistectomía laparoscopia de urgencia, con una adecuada evolución postoperatoria


Emphysematous cholecystitis is an uncommon variant of acute cholecystitis. It is caused by a vascular ischemia and characterized by the presence of gas in the wall, in the lumen, or in both. It can evolve into a life-threatening condition associated with a high rate of morbidity and mortality. We present a case of a patient who presented with abdominal pain, gastrointestinal symptoms, and signs of a systemic inflammatory response with a presumptive diagnosis of emphysematous cholecystitis. An emergency laparoscopic cholecystectomy was performed, with an adequate postoperative evolution


Subject(s)
Humans , Male , Middle Aged , Tomography, X-Ray Computed , Laparoscopy , Emphysematous Cholecystitis/surgery , Emphysematous Cholecystitis/pathology , Early Diagnosis , Emergencies
17.
Int. j. med. surg. sci. (Print) ; 8(3): 1-7, sept. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1292574

ABSTRACT

La tuberculosis es una enfermedad granulomatosa, con espectro clínico variable. El objetivo es presentar un caso con tuberculosis miliar, una de las formas clínicas menos frecuente de la enfermedad y la utilización del método clínico proporcionó el diagnóstico certero. Se presenta un paciente masculino de 54 años, no fumador, alcohólico atendido en el Hospital Clínico Quirúrgico Hermanos Ameijeiras por referir historia de tos poco productiva, cefalea, fiebre, pérdida de apetito y de peso de dos meses de evolución. En la radiografía y tomografía de tórax se evidencia un patrón miliar y la baciloscopía directa confirma la presencia del Mycobacterium tuberculosis. La TB miliar es muy poco frecuente, pero se puede sospechar ante un patrón radiológico miliar y confirmar mediante análisis microbiológico.


Tuberculosis is a granulomatous disease with a variable clinical spectrum. The objective is to present a case with miliar tuberculosis, one of the least frequent clinical forms of the disease, and the use of the clinical method provided an accurate diagnosis. We present a 54-year-old male, non-smoker, alcoholic who attended in the Ameijeiras Brothers Surgical Clinical Hospital for referring to a history of unproductive cough, headache, fever, loss of appetite, and weight two months of evolution. Chest X-ray and CT showed a miliar pattern and direct bacilloscopy confirmed the presence of Mycobacterium tuberculosis. Miliar TB is very rare but can be suspected by a miliar radiological pattern and confirmed by microbiological analysis.


Subject(s)
Humans , Male , Middle Aged , Tuberculosis, Miliary/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods
18.
Arq. gastroenterol ; 58(3): 322-328, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345302

ABSTRACT

ABSTRACT BACKGROUND: Crohn's disease (CD) is an inflammatory bowel disease characterized by a chronic and recurrent inflammation of the gastrointestinal tract caused by an interaction of genetic and environmental factors. OBJECTIVE: To compare the quality and acceptance of two different oral contrast volumes for computed tomography enterography in Crohn's disease patients. METHODS: A cross-sectional study was conducted in 58 consecutive Crohn's disease patients who randomly received an oral contrast agent composed of 78.75 g polyethylene glycol diluted in either 1,000 mL or 2,000 mL of water. An examination was performed to evaluate the presence of inflammation or complications in the small bowel. The variables included the quality of intestinal segment filling and luminal distension, and oral contrast agent acceptance and tolerance in the patients. Statistical analysis included descriptive statistics and association tests. RESULTS: A total of 58 patients were assessed, in which 58.6% were female, 34.5% exhibited clinically-active disease, and 63.8% were receiving biologic therapy. As for comparative analysis between the two different volumes of oral contrast, no statistically significant difference was found regarding bowel loop filling (P=0.58) and adequate luminal distension (P=0.45). Patients who received a larger volume (2,000 mL) exhibited side-effects more frequently (51.7% vs 31.0%; P=0.06) and had greater difficulty ingesting the agent (65.5% vs 37.9%; P=0.07) compared with a volume of 1,000 mL. CONCLUSION: The quality of computed tomography enterography was not influenced by the contrast volume. However, acceptance and tolerance were better in the 1,000 mL group.


RESUMO CONTEXTO: A doença de Crohn (DC) é uma doença inflamatória intestinal caracterizada por uma inflamação crônica e recorrente do trato gastrointestinal causada por uma interação de fatores genéticos e ambientais. OBJETIVO: Comparar a qualidade e aceitação de dois volumes diferentes de contraste oral para enterografia por tomografia computadorizada em pacientes com doença de Crohn. MÉTODOS: Um estudo transversal foi conduzido em 58 pacientes com doença de Crohn que receberam aleatoriamente um agente de contraste oral composto por 78,75 g de polietilenoglicol diluído em 1.000 mL ou 2.000 mL de água. Um exame foi realizado para avaliar a presença de inflamação ou complicações no intestino delgado. As variáveis incluíram a qualidade do preenchimento do segmento intestinal e distensão luminal e aceitação e tolerância do contraste oral nos pacientes. A análise estatística incluiu estatística descritiva e testes de associação. RESULTADOS: Foram avaliados 58 pacientes, dos quais 58,6% eram mulheres, 34,5% apresentavam doença clinicamente ativa e 63,8% estavam recebendo terapia biológica. Quanto à análise comparativa entre os dois diferentes volumes de contraste oral, não foi encontrada diferença estatisticamente significativa em relação ao enchimento da alça intestinal (P=0,58) e distensão luminal adequada (P=0,45). Pacientes que receberam um volume maior (2.000 mL) exibiram efeitos colaterais com mais frequência (51,7% vs 31,0%; P=0,06) e tiveram maior dificuldade para ingerir o agente (65,5% vs 37,9%; P=0,07) em comparação com um volume de 1.000 mL. CONCLUSÃO: A qualidade da entero-tomografia computadorizada não foi influenciada pelo volume de contraste. No entanto, aceitação e tolerância foram melhores no grupo de 1.000 mL.


Subject(s)
Humans , Female , Crohn Disease/diagnostic imaging , Contrast Media , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Cross-Sectional Studies , Intestine, Small
19.
Rev. cuba. med ; 60(3): e2563, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347523

ABSTRACT

Este artículo se publicó solamente con imágenes.


Subject(s)
Humans , Splenic Neoplasms/diagnostic imaging , Endocarditis , Tomography, X-Ray Computed/methods
20.
Arq. bras. med. vet. zootec. (Online) ; 73(4): 861-867, Jul.-Aug. 2021. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1285260

ABSTRACT

The aim of this study was to evaluate the anatomical structures of the skulls of peccaries to establish the basis for their clinical study and future preclinical research. Ten skulls of adult peccaries were subjected to tomographic examination. The data obtained were processed via three-dimensional image reconstruction software (3D images). The reconstructions obtained from the neurocranium of the studied specimens allowed the identification and description of the following structures: nasal bone, frontal bone, parietal bones, incisor bone, maxillary bone, zygomatic bone, temporal bone, palatal bone, occipital bone, vomer bone, pterygoid bone, sphenoid bone, paranasal sinuses and orbit. Computed tomography proved to be an important diagnostic tool in the investigation of the skull of this species, allowing the acquisition of anatomical values not yet documented for the species in the literature.(AU)


O objetivo deste estudo foi avaliar as estruturas anatômicas dos crânios de catetos, a fim de se estabelecerem as bases para seu estudo clínico e futuras pesquisas pré-clínicas. Dez crânios de catetos adultos foram submetidos a exame tomográfico. Os dados obtidos foram introduzidos em um software de reconstrução de imagens tridimensionais (imagens em 3D). As reconstruções obtidas do neurocrânio dos espécimes estudados permitiram a identificação e a descrição das seguintes estruturas: osso nasal, osso frontal, ossos parietais, osso incisivo, osso maxilar, osso zigomático, osso temporal, osso palatino, osso occipital, osso vômer, osso pterigoide, osso esfenoide, seios paranasais e órbita. A tomografia computadorizada mostrou-se como uma ferramenta diagnóstica importante na investigação do crânio dessa espécie, permitindo a aquisição de valores anatômicos ainda não documentados para a espécie na literatura.(AU)


Subject(s)
Animals , Artiodactyla/anatomy & histology , Skull/anatomy & histology , Skull/diagnostic imaging , Tomography, X-Ray Computed/veterinary , Imaging, Three-Dimensional/veterinary , Printing, Three-Dimensional
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