Característica de Euler-Poincaré aplicada para identificar baixa densidade óssea a partir de imagens tomográficas de vértebras / The Euler-Poincaré characteristic applied to identify low bone density from vertebral tomographic images

A densidade mineral óssea (DMO) é o exame padrão-ouro para o diagnóstico da osteoporose. No entanto, sabe-se que apenas essa medida não é suficiente para identificar completamente a fragilidade óssea e o conseqüente risco de fratura, tornando-se necessário a investigação da estrutura óssea. OBJETIVOS: Avaliar se a característica de Euler-Poincaré (CEP) para analisar a conectividade do osso trabecular poderia fornecer um suporte adicional na identificação da deterioração da estrutura óssea. MATERIAIS E MÉTODOS: Analisou-se um conjunto de imagens formando disectors, obtidas da tomografia computadorizada de vértebras lombares, a partir dos quais foi estimada a característica Euler-Poincarè.(CEP). Para lidar com o processamento de imagens dos disectors, foi desenvolvido um programa de computador usando o GTK+ para MS-Windows. Os resultados foram comparados com a DMO. RESULTADOS: Verificou-se que a medida da CEP está correlacionada com os resultados obtidos por meio da DMO para as vértebras lombares. Ficou demonstrado também que a área de conectividade das trabéculas que é propagada ao longo dos disectors corrobora para assegurar que os resultados da CEP sejam consistentes com a medida da DMO. CONCLUSÕES: A aplicação da CEP na análise das tomografias vertebrais poderá vir a se constituir num método para avaliar a estrutura óssea trabecular, e sua correlação com a resistência mecânica do osso, sendo necessários porém mais estudos para confirmar esses dados.

The bone mineral density (BMD) is the gold standard test for the diagnosis of osteoporosis. Nevertheless, it is known that only this measurement is not sufficient to completely identify bone fragility and the consequent risk of fracture, becoming necessary the investigation of the bone structure. OBJECTIVES: Evaluate if the Euler-Poincaré characteristic (EPC) for the analysis of the connectivity of the trabecular bone could supply an additional support in identifying the deterioration of the bone structure. MATERIALS AND METHODS: A group of images forming dissectors were analyzed, obtained from the computerized tomography of the lumbar vertebrae, from which the Euler-Poincarè characteristic (EPC) was estimated. To deal with the processing of images of the dissectors, a computer program was developed using the GTK+ for MS-Windows. The results were compared to the BMD. RESULTS: It was verified that the measurement of the EPC is correlated with the results obtained by means of the BMD for the lumbar vertebrae. It was also demonstrated that the area of connectivity of the trabecular that is propagated over the dissectors corroborates to ensure that the results of the EPC are consistent with the BMD measurement. CONCLUSIONS: The application of ECP in the analysis of the vertebral tomographies could constitute a method to evaluate the trabecular bone structure, and its correlation with the mechanical resistance of the bone, however being necessary more studies to confirm this data.

[Uterus didelphys with a blind hemi-vagina and homolateral renal agenesis]. / Utérus didelphe avec hémi-vagin borgne et agénésie rénale homolatérale.

The authors report a case of bicervical bicornuate uterus with a blind hemi-vagina associated with homolateral renal agenesis. A review of the embryology and the various etiopathogenic theories for this rare anomaly are presented and the therapeutic principles are discussed.

[Nonseminomatous testicular tumors. Diagnostic strategy. Apropos of 53 cases]. / Tumeurs testiculaires non séminomateuses. Stratégie diagnostique. A propos de cinquante-trois observations.

The authors define a diagnostic strategy designed to establish the most reliable clinical staging on the basis of a series of 53 cases non-seminomatous testicular tumours. The value of each complementary laboratory and radiological examination is analysed in terms of its performance and its morbidity and a selective staging procedure is proposed. Finally, the role of retroperitoneal lymphadenectomy is discussed, as it appears that, with the development of chemotherapeutic protocols, this procedure will gradually disappear from the staging of early tumours to become an essentially therapeutic procedure. However, lymphadenectomy is still part of the authors' current staging protocol for clinical stage I tumours as it remains the only way to define the extension of the tumour with certainty.