Artroscopia diagnóstica en cirugía maxilofacial / Diagnostic arthroscopy in Maxillofacial Surgery

Introducción: los desarreglos internos de la articulación temporomandibular (ATM) son los más comunes. La artroscopia es de gran utilidad en cirugía maxilofacial como alternativa para el diagnóstico y el tratamiento de los desarreglos internos de la ATM. El objetivo de la presente revisión es describir la artroscopia diagnóstica de la ATM. Métodos: se realizó una revisión narrativa de la literatura y una búsqueda en las bases de datos PubMed, ProQuest, SciELO, Mendeley y Elsevier empleando los descriptores (artroscopia diagnóstica, articulación temporomandibular) en español e inglés. Se seleccionaron los artículos publicados en un período de 40 años (1980-2020), incluyendo en el estudio un total de 26 artículos y 6 libros de 702 documentos revisados. Discusión: en la artroscopia de la ATM se puede observar la posición, calidad y textura del cartílago articular, la vascularización y la redundancia de la membrana sinovial y se pueden realizar procedimientos como técnicas de artroscopia avanzada. Conclusiones: la artroscopia diagnóstica facilita el diagnóstico y manejo de las patologías intraarticulares, por lo que el conocimiento de esta técnica resulta imprescindible.

Introduction: Internal disorders of the TMJ are the most common. Arthroscopy is very useful in Maxillofacial Surgery as an alternative for the diagnosis and treatment of internal disorders of the Temporomandibular Joint. The aim of this review is to describe the diagnostic arthroscopy of the Temporomandibular Joint. Methods: A narrative literature review and search of PubMed, ProQuest, SciELO, Mendeley and Elsevier databases were performed in English and Spanish using the descriptors (Diagnostic arthroscopy, Temporomandibular Joint) in Spanish and English. Articles published over a period of 40 years (1980-2020) were selected, including a total of 26 articles and 6 books from 702 reviewed documents in the study. Discussion: In the arthroscopy of the Temporomandibular Joint the position, quality, texture of the articular cartilage, the vascularization, and the redundancy of the synovial membrane can be observed, and procedures such as advanced arthroscopic techniques can be performed. Conclusions: Diagnostic arthroscopy facilitates the diagnosis and management of intra-articular pathologies. Being necessary and essential knowledge of this technique.

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

A Academia Americana de Dor Orofacial (AAOP) define anquilose da Articulação Temporomandibular (ATM) como restrição dos movimentos devido à adesão fibrosa intracapsular, alterações fibrosas nos ligamentos capsulares (fibroanquilose) e formação de massa óssea resultando na fusão dos componentes articulares (anquilose óssea). As características clínicas da Fibroanquilose são: capacidade severamente limitada de abertura bucal geralmente sem dor e sem ruídos articulares, com marcada deflexão para o lado afetado e marcada limitação de movimentos para o lado contralateral. Uma variedade de fatores pode causar anquilose da ATM, como trauma, condições inflamatórias locais e/ou sistêmicas, neoplasias e infecção na ATM. A artrite reumatóide (AR) é uma dessas condições sistêmicas inflamatórias que pode afetar a ATM e causar anquilose. O objetivo desse estudo é apresentar um caso de uma paciente, diagnosticada com Fibroanquilose da ATM bilateral e assintomática associada à AR. Esse caso ilustra a importância de um exame clínico bem realizado com exames complementares pode levar a um diagnóstico correto de Fibroanquilose da ATM e da importância do diagnóstico diferencial em casos de abertura bucal restrita.

New quantitative variables to measure postoperative pericardial adhesions: useful tools in experimental research / Novas variáveis quantitativas para avaliação das aderências pericárdicas: ferramentas úteis na pesquisa experimental

PURPOSE: To improve the measurement system, during a research for the prevention of adhesions, we explored the feasibility of introducing three continuous numeric variables to quantify the intensity of pericardial adhesions. METHODS: To validate these three new numeric variables - time spent to dissect the adhesions (Δt), the amount of sharp dissection (ShpD) and the adhesion's collagen area (ACA) - as useful tools in measuring the severity of pericardial adhesions, data from a randomized study on adhesion prevention enrolling twenty-four swine, were analysed. A statistical Spearman's test and regressions models were applied to verify the correlation and the relationship between the results of a standard severity score (SS) and Δt, between SS and ShpD used in adhesiolysis and, also, between SS and ACA. RESULTS: There was a statistically significant correlation between SS and Δt, between SS and ShpD, as well as between SS and ACA, all measured by the Spearman's test (r=0.897, r=0.932, r=0.66; p<0.01, respectively). Through a non-linear regression, an exponential relation of SS with ShpD (R²=0.915) and SS with Δt (R²= 0.917) was found. CONCLUSION: The time spent to dissect the adhesions (Δt) and the amount of sharp dissection (ShpD) are new powerful measurement tools in evaluating outcomes of the methods used to prevent pericardial adhesions.

OBJETIVO: A fim de melhorar a metodologia de mensuração das aderências pericárdicas, avaliamos, durante um estudo de prevenção de aderências pericárdicas, a possibilidade da utilização de três de novas variáveis contínuas e numéricas. MÉTODOS: Para validar estas novas variáveis numéricas - tempo de dissecção (Δt), quantidade de dissecção cruenta (ShpD) e a área de colágeno na aderência (ACA) como instrumentos precisos na quantificação das aderências pericárdicas, foram analisados os dados de um estudo para prevenção de aderências que envolveu 24 porcos. Foram aplicados modelos de regressão e o teste de Spearman para avaliar a força e os tipos correlações entre os resultados do escore padrão de classificação de aderências (SS) e o Δt, entre o SS e o ShpD, e, também, entre o SS e a ACA. RESULTADOS: Foram evidenciadas correlações, estatisticamente significativas, entre o SS e o Δt, entre o SS e o ShpD, também como entre o SS e a ACA avaliadas através do teste de Spearman (r=0,897, r=0,932 , r=0,66; p<0,001, respectivamente). Identificou-se, através de regreção não-linear, uma relação exponencial do SS com o ShpD (R²=0,915) e com o Δt (R²= 0,917). CONCLUSÃO: Este estudo mostrou que o Δt e o ShpD são variáveis poderosas para avaliar os resultados dos métodos utilizados para prevenção das aderências pericárdicas.

Laparoscopic findings in patients with infertility

To evaluate laparosocpic findings in patients with infertility both primary and secondary. This prospective study was carried out on two hundred female subjects with primary and secondary infertility aged 20-45 years, attending the department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore during the period of 1997 to 1999. A detailed history taken and physical examination was done. All relevant investigations were done and then laparoscopy was performed and findings recorded. Both tubes were found to be patent in 83.5% of patients with primary infertility and 69% of patients with secondary infertility. Bilateral tubal blockage was present in 9% of patients with primary infertility and 20% of patients with secondary infertility. Bilateral pelvic adhesions were present in 10% of patients with primary infertility and 28% of patients with secondary infertility. Bilateral hydrosalpinx was found in 6.75% of patients with primary infertility and 12.5% of patients with secondary infertility. Laparasopy is useful in assessing tubal patency. In addition it provides information about presence of peritubal and ovarian adhesions, presence of polycystic ovaries and endometriosis as it allows direct visualization of pelvic cavity

Reproductive outcome following hysteroscopic lysis of intrauterine adhesions: a result of 65 cases at Ramathibodi Hospital.

We reported the reproductive outcome of 65 patients with varying degrees of IUAs who underwent hysteroscopic adhesiolysis between August 1994 and December 1996 at Ramathibodi Hospital. Of the 65 patients treated, 29 had mild adhesions, 26 had moderate adhesions, and 10 had severe adhesions. Adhesions were lysed with hysteroscopic scissors in 25, with biopsy forceps through hysteroscope in 10, with electrosurgery using a monopolar probe in 22 patients, and with resectoscope in 8 patients. The mean duration of the procedure was 15 +/- 2.1 minutes. The mean follow-up was 12 +/- 1.4 months. Of the 44 patients who originally presented with secondary amenorrhea, 40 (90.9%) have normal menses, 4 (9.1%) have hypomenorrhea. Of the 6 patients who had hypomenorrhea, 5 (83.3%) have normal menses. Cyclic abdominal pain disappeared after treatment in all patients. Of the 45 patients with IUAs and infertility, 16 (35.6%) conceived. Two (20%) of the infertile patients with initially severe adhesions conceived. Of the 5 patients with RPL treated, delivered a full term baby and the other delivered a premature baby at 29 weeks of gestation. All 18 patients who delivered, had live births. Adhesion reformation was absent in patients with initially mild and moderate adhesion but occurred in 2 out of 10 (20%) patients with severe adhesions. These two patients initially suffered from secondary amenorrhea but reported hypomenorrhea after surgery. Both of them had tuberculosis of the genital tract. There were no serious complications occurring in all 65 procedures. All 65 patients were discharged a few hours after the operation.

Histerosonografía: una visión del interior de la cavidad uterina y endometrio, estudio prospectivo con correlación histeroscópica / Hysterosonography: an inner vision of the uterine cavity and endometrium, prospective study with hysteroscopic correlation

Se presenta un trabajo prospectivo, según nuestro conocimiento, el primero en el país, que demuestra la experiencia de nuestro grupo en esta novedosa técnica: la histerosonografía. La histerosonografía consiste en la instilación de solución salina estéril en la cavidad uterina, como medio de contraste para evaluar dicha cavidad así como también el endometrio y la capa subendometrial. Se estudiaron 64 pacientes, 57 con éxito; de éstas últimas se realizó histeroscopia en 42. Sobre el análisis comparativo entre la histerosonografía y la histeroscopia se basó nuestra presentación y conclusiones

Achados laparoscópicos em dor pélvica crônica / Laparoscopy in diagnosis of chronic pelvic pain

O papel da laparoscopia no diagnóstico de dor pélvica crônica permanece controvertido. Avaliamos 105 laparoscopias realizadas no Centro de Atençäo Integral à Saúde da Mulher (CAISM) - UNICAMP, indicadas por dor pélvica crônica, e apenas 14,2 por cento apresentaram pélvis normal. Em 31,3 por cento dos casos foram observados sinais de endometriose e 57,1 por cento das pacientes apresentavam aderências. Em 47,8 por cento dos casos havia mais de uma alteraçäo. Concluímos que a laparoscopia é ferramenta importante na elucidaçäo diagnóstica da causa de dor pélvica crônica, mas näo é definitiva, nem prescinde de outras avaliaçöes clínicas e psicológicas.

Abdominal tuberculosis in children: experience over a decade.

This presentation deals with 110 surgically proven cases of abdominal tuberculosis in the pediatric age group. The protean clinical profiles and complications of the disease entity made the clinical diagnosis difficult; the investigations were also found non-pathognomonic. The most common type of pathology seen was adhesive variety followed by nodal type. Strictures of the small bowel were uncommon and hyperplastic variety was rarely seen in the present series. The pathogenesis relating to various varieties has been suggested based on the vast experience from a single institution.

Capsulite adesiva: ombro congelado / Adhesive capsulitis: frozen shoulder

Após serem feitas consideraçöes cobre o termo "ombro congelado", enfatiza-se a definiçäo de capsulite adesiva como entidade nosológica própria. De acordo com a literatura säo descritos o quadro clínico, o radiológico, o tratamento e a hiosstória natural desta doença. O autor relata a experiência pessoal de cinco casos, destacando a importância do diagnóstico diferencial, o tratamento instituído e a evoluçäo quase sempre favorável desses processos

Sinéquia intra-uterina: análise de 28 casos / Intrauterine adhesion: analysis of 28 cases

Säo estudados 28 casos de sinéquias intra-uterinas. Após sucinta revisäo da literatura, säo tecidos comentários referentes à incidência, localizaçäo, fisiopatologia, quadro clínico, diagnóstico, diagnóstico diferencial e terapêutica. Em 6 tabelas säo analisados os antecedentes menstruais, a etiologia, o quadro clínico, diagnóstico, os aspectos da histerossalpingografia, o achado histopatológico e os resultados. Säo referidos bons resultados no que concerne à normalizaçäo dos ciclos menstruais, registrado em 60,8% dos casos, porém, em relaçäo à gestaçäo, apenas três engravidaram, duas abortaram e em uma a gestaçäo evoluiu a termo