Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study.

Sagittal craniosynostosis (SC) is a congenital condition whereby the newborn skull develops abnormally owing to the premature ossification of the sagittal suture. Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique to treat SC, where metallic distractors are used to reshape the newborn's head. Although safe and effective, SAC outcomes remain uncertain owing to the limited understanding of skull-distractor interaction and the limited information provided by the analysis of single surgical cases. In this work, an SC population-averaged skull model was created and used to simulate spring insertion by means of the finite-element analysis using a previously developed modelling framework. Surgical parameters were varied to assess the effect of osteotomy and spring positioning, as well as distractor combinations, on the final skull dimensions. Simulation trends were compared with retrospective measurements from clinical imaging (X-ray and three-dimensional photogrammetry scans). It was found that the on-table post-implantation head shape change is more sensitive to spring stiffness than to the other surgical parameters. However, the overall end-of-treatment head shape is more sensitive to spring positioning and osteotomy size parameters. The results of this work suggest that SAC surgical planning should be performed in view of long-term results, rather than immediate on-table reshaping outcomes.

Niveles de vitamina D en sangre materna y su relación con el consumo de pescado y los parámetros antropométricos de los recién nacidos en una cohorte de parejas madre/hijos de Sevilla / Vitamin D levels in maternal blood and its relationship with fish consumption and anthropometric parameters of newborns in a cohort of mother/child couples from Seville

Introducción: Comparar los niveles de vitamina D maternos con la zona de residencia o el consumo de pescado, así como su relación con el peso, la longitud y el perímetro craneal de los bebés. Materiales y métodos: Cohorte de 100 parejas madre-hijo (n=100) de la provincia de Sevilla (Hospital Universitario Virgen del Rocío y Hospital Universitario de Valme). En muestras de sangre materna (edad gestacional≥40 semanas) se han medido los niveles de 25(OH)D mediante quimioluminiscencia. Las medidas antropométricas de los bebés se realizaron mediante métodos estándares. Resultados: Con relación a los niveles de vitamina D, 54% presentaban valores deficientes, 26% insuficientes y 20% valores suficientes. Tras un análisis de regresión múltiple, se observa que no hay diferencia significativa entre niveles de vitamina D maternos, la longitud y el perímetro cefálico de los bebés, sin embargo, sí con el peso al nacer (p<0,05). Al aplicarse la T-Student y el test Wilcoxon, no hay relación entre niveles de vitamina D y el área de residencia ni con el consumo de pescado materno (ambos p>0,05). Conclusiones: El 80% de madres presentan valores deficientes e insuficientes de vitamina D. No hay correlación entre este parámetro y la longitud y perímetro cefálico del bebé, observándose correlación negativa con el peso al nacer. Tampoco se observa correlación entre la zona de residencia o el consumo de pescado y niveles de vitamina D en madres. Sugerimos complementos en dieta de madres gestantes y seguimiento de los niveles de vitamina D en los bebés.(AU)

Introduction: To compare maternal vitamin D levels with the area of residence or the consumption of fish, as well as its relationship with the weight, length and cranial perimeter of babies. Materials and methods: Cohort of 100 mother–child pairs (n=100) from the province of Seville (Virgen del Rocío University Hospital and Valme University Hospital). In maternal blood samples (gestational age≥40 weeks) 25(OH)D levels have been measured by chemiluminescence. Anthropometric measurements of the babies were made using standard methods. Results: Regarding vitamin D levels, 54% had deficient values, 26% insufficient and 20% sufficient values. After a multiple regression analysis, it is observed that there is no significant difference between maternal vitamin D levels, the length and the cephalic perimeter of the babies, however, there is a difference with the birth weight (P<.05). When applying the t-Student and the Wilcoxon test, there is no relationship between vitamin D levels and the area of residence or with maternal fish consumption (both P>.05). Conclusions: Eighty percent of mothers present deficient and insufficient values of vitamin D. There is no correlation between this parameter and the length and cephalic perimeter of the baby, observing a negative correlation with birth weight. No correlation was observed between the area of residence or the consumption of fish and vitamin D levels in mothers. We suggest dietary supplements for pregnant mothers and monitoring of vitamin D levels in babies.(AU)

The Esthetic Perception of Morphological Severity in Scaphocephalic Patients is Correlated With Specific Head Geometrical Features.

OBJECTIVE: To investigate the relationship between perception of craniofacial deformity, geometric head features, and 3D head shape analyzed by statistical shape modeling (SSM). PATIENTS: A total of 18 unoperated patients with scaphocephaly (age = 5.2 ± 1.1m)-6 were followed-up after spring-assisted cranioplasty (SAC) (age = 9.6 ± 1.5m)-and 6 controls (age = 6.7 ± 2.5m). MAIN OUTCOME MEASURES: 3D head shapes were retrieved from 3D scans or computed tomography (CTs). Various geometrical features were measured: anterior and posterior prominence, take-off angle, average anterior and posterior lateral and horizontal curvatures, cranial index (CI) (cranial width over length), and turricephaly index (TI) (cranial height over length). SSM and principal component analysis (PCA) described shape variability. All models were 3D printed; the perception of deformity was blindly scored by 9 surgeons and 1 radiologist in terms of frontal bossing (FB), occipital bulleting (OB), biparietal narrowing (BN), low posterior vertex (LPV), and overall head shape (OHS). RESULTS: A moderate correlation was found between FB and anterior prominence (r = 0.56, P < .01) and take-off angle (r = - 0.57, P < .01). OB correlated with average posterior lateral curvature (r = 0.43, P < 0.01) similarly to BPN (r = 0.55, P < .01) and LPV (r = 0.43, P < .01). OHS showed strong correlation with CI (r = - 0.68, P < .01) and TI (r = 0.63, P< .01). SSM Mode 1 correlated with OHS (r = 0.66, p < .01) while Mode 3 correlated with FB (r = - 0.58, P < .01). CONCLUSIONS: Esthetic cranial appearance in craniofacial patients is correlated to specific geometric parameters and could be estimated using automated methods such as SSM.

Avascular osteonecrosis of the hip: The vision of the radiologist (radiology, MRI, CT and scintigraphy).

Hip osteonecrosis is a localization at the hip of aseptic osteonecrosis, a disease characterized by bone infarction. Face to a painful hip, the first examination to carry out should be a standard radiograph examination. At an early stage, the radiographs remain strictly normal MRI remains the reference examination with a sensitivity of 71-100% and specificity of 94-100%. On T2 weighting-imaging, a hyperintense line between the normal and ischemic marrow is sometimes visible; this sign is pathognomonic of bone necrosis and is known as the "double line sign". This article reviews imaging features of standard radiographs, computed tomography and MRI and addresses the role of imaging in this pathology.

Estudio cuantitativo del flujo de líquido cefalorraquídeo mediante resonancia magnética en contraste de fase: método para identificar a los pacientes con hidrocefalia a presión normal / Quantitative phase-contrast MRI study of cerebrospinal fluid flow: A method for identifying patients with normal-pressure hydrocephalus

Objetivos: El objetivo de este estudio es valorar si la RM en contraste de fase es una herramienta útil en el diagnóstico de la hidrocefalia a presión normal (HPN), así como su diferenciación con otras afecciones neurológicas muy similares clínicamente. Métodos: Se incluyó a un total de 108 sujetos, de los cuales 61 eran sujetos sanos control, y 47 pacientes; 19 de ellos fueron clasificados en el grupo de pacientes con enfermedad cerebrovascular isquémica (ECI) y 28 pacientes dentro del grupo de HPN. A todos los pacientes se les realizó una RM en contraste de fase con cuantificación de parámetros de flujo y velocidad de LCR en el acueducto de Silvio. Se evaluó la capacidad de clasificación de los parámetros individualmente y combinándolos mediante análisis discriminantes. Resultados: Los parámetros de velocidad máxima diastólica, flujo promedio y volumen por ciclo mostraron diferencias estadísticamente significativas para separar a los pacientes con HPN y con ECI (p < 0,001). El volumen por ciclo y el flujo promedio no presentaron falsos positivos, con tasas de acierto del 86% y 79%, respectivamente. El resto de parámetros y la combinación de todos ellos no mejoraron los resultados. Conclusiones: La RM en contraste de fase es una herramienta muy útil para el diagnóstico precoz de los pacientes con HPN. La cuantificación de parámetros de flujo de LCR junto con la valoración del estudio morfológico de la RM convencional permite diferenciar a los pacientes con HPN de los pacientes con ECI

Objectives: The aim of this study is to evaluate the use of phase-contrast MR imaging to diagnose normal pressure hydrocephalus (NPH) and differentiate it from other neurological disorders with similar clinical symptoms. Methods: The study included 108 subjects, of whom 61 were healthy controls and 47, patients; in the patient group, 19 had cerebrovascular disease (CVD) and 28 had NPH. All patients underwent a phase-contrast MRI study and several CSF flow and velocity parameters were measured at the aqueduct of Sylvius. Discriminant analyses were performed to evaluate the classification capacity of both individual parameters and the combination of different parameters. Results: Maximum diastolic velocity, mean flow, and stroke volume showed statistically significant differences that could be used to distinguish between NPH and CVD patients (P<.001). Stroke volume and mean flow showed no false positive results and successful classification rates of 86% and 79%, respectively. No other parameters or combination produced better results. Conclusions: Phase-contrast MR imaging is a useful tool for the early diagnosis of patients with NPH. CSF flow quantitative parameters, along with morphological features in a conventional MR study, enable us to differentiate between NPH and CVD patients

Quantitative phase-contrast MRI study of cerebrospinal fluid flow: a method for identifying patients with normal-pressure hydrocephalus.

OBJECTIVES: The aim of this study is to evaluate the use of phase-contrast MR imaging to diagnose normal pressure hydrocephalus (NPH) and differentiate it from other neurological disorders with similar clinical symptoms. METHODS: The study included 108 subjects, of whom 61 were healthy controls and 47, patients; in the patient group, 19 had cerebrovascular disease (CVD) and 28 had NPH. All patients underwent a phase-contrast MRI study and several CSF flow and velocity parameters were measured at the aqueduct of Sylvius. Discriminant analyses were performed to evaluate the classification capacity of both individual parameters and the combination of different parameters. RESULTS: Maximum diastolic velocity, mean flow, and stroke volume showed statistically significant differences that could be used to distinguish between NPH and CVD patients (P<.001). Stroke volume and mean flow showed no false positive results and successful classification rates of 86% and 79%, respectively. No other parameters or combination produced better results. CONCLUSIONS: Phase-contrast MR imaging is a useful tool for the early diagnosis of patients with NPH. CSF flow quantitative parameters, along with morphological features in a conventional MR study, enable us to differentiate between NPH and CVD patients.

Segmentación deiimágenes de resonancia magnétic en contraste de fase para el eestudio de la dinámica del líquido cefalorraquídeo perimedular / Segmentation of Phase Contrast Magnetic Resonance Imaging to Study the Dynamic of Perimedullary Cerebrospinal Fluid

La imagen de resonancia magnética en contraste de fase permite estudiar la dinámica del líquido cefalorraquídeo (LCR) perimedular de manera cuantitativa. Sin embargo la anatomía propia del espacio subaracnoideo dificulta la segmentación del LCR debido a la presencia de estructuras vasculares y nervios raquídeos. El objetivo de este trabajo es describir un método de segmentación semiautomático para el estudio de la dinámica del LCR perimedular. El proceso se inicializa con un punto semilla dentro de la región a analizar. El algoritmo crea un mapa de correlación, calcula un valor de umbral y clasifica píxeles de LCR combinando diversas características temporales del comportamiento del flujo como atributos de entrada a un algoritmo k-medias. Un observador llevó a cabo diez veces la segmentación en cinco sujetos sanos y se calculó el volumen por ciclo y el área en el espacio perimedular C2C3. Las variaciones de las medidas fueron evaluadas como una estimación de la reproducibilidad del método. Para esto se calculó el coeficiente de variación. La variabilidad de las medidas fue menor del 5%. El método facilita la cuantificación del LCR perimedular. En 16 sujetos sanos se cuantificó el volumen por ciclo de LCR y el área en el espacio C2C3 y cisterna prepontina.

Phase contrast magnetic resonance imaging allows studying quantitatively the perimedullary cerebrospinal fluid (CSF) dynamics. However, the anatomy of the subarachnoid space difficults the segmentation of CSF due to the presence of vascular structures and spinal nerves. The aim of this paper is to describe a semiautomatic segmentation method for the study of the perimedullary CSF dynamics. The process is started with a seed point within the region to analyze. The algorithm creates a correlation map, calculates a threshold value and classifies pixels of CSF combining different temporal characteristics of flow behavior as input attributes to a k-means algorithm. One observer carried out ten times the segmentation of the cervical images in 5 healthy subjects; stroke volume and area were calculated. The variability of the obtained measurements was evaluated as an estimation of the reproducibility of the method. For this the coefficient of variation was calculated. The variability of the measurements was less than 5%. The method facilitates the quantification of perimedullary CSF. Stroke volume and the area at C2C3 space and prepontine cistern were measured in 16 healthy subjects.

Estimación de la dinámica de líquidos intracraneales mediante análisis cuantitativo de imágenes de resonancia magnética de contraste de fase / Estimating intracranial fluid dynamics using quantitative analyses of phase contrast magnetic resonance images

ObjetivoEstimar las relaciones dinámicas entre los fluidos craneoespinales (líquido cefalorraquídeo [LCR] y sangre) en el espacio ventricular, subaracnoideo cerebral y subaracnoideo espinal mediante la cuantificación de imágenes de resonancia magnética (RM) en contraste de fase.Material y métodosSe analizaron 15 sujetos voluntarios sanos en la misma franja horaria y bajo la misma intensidad de campo (3T). Para cada estudio se realizaron 4 exploraciones en contraste de fase: 2 secuencias para el cálculo de LCR (acueducto de Silvio y espacio perimedular C2-C3) y 2 para el cálculo del flujo sanguíneo (arterias carótidas internas y vertebrales, seno sagital superior y recto). En todos los sujetos se calcularon los parámetros de amplitud (volumen sistólico, flujo promedio, índices de pulsatibilidad y distensibilidad, amplitud del gradiente de presión absoluta y relación de volumen de fluido de LCR por ciclo) y temporales (retrasos frente a la entrada de flujo arterial).ResultadosRespecto a la entrada de sangre arterial, el desplazamiento de sangre venosa (al 22 y 38% del ciclo cardíaco en los senos recto y sagital superior, respectivamente) y del LCR (al 12 y 25% de ciclo cardíaco en el espacio perimedular C2-C3 y el acueducto de Silvio, respectivamente) describen la distribución de la pulsatibilidad de los fluidos intracraneales. Se obtienen índices de distensibilidad para los compartimientos encefálico y medular en una población normal.ConclusionesMediante los mapas de velocidad de flujo obtenidos con RM es posible describir de manera cuantitativa las relaciones dinámicas de los fluidos intracraneales e inferir el comportamiento elástico encefálico y medular (AU)

ObjectiveTo estimate the dynamic relations between cerebrospinal fluid (CSF) and blood in the cerebral and spinal subarachnoid spaces and in the ventricles by quantifying phase contrast magnetic resonance imaging (MRI).Material and methodsWe analyzed 15 healthy volunteers during the same time of day and using the same magnetic field strength (3T). Each study consisted of four phase contrast sequences: two to calculate the CSF (aqueduct of Sylvius and the C2-C3 perimedullary space) and two to calculate the blood flow (internal carotid and vertebral arteries, superior sagittal sinus, and straight sinus). We calculated the amplitude parameters (systolic volume, mean flow, pulsatility and compliance indexes, absolute pressure gradient, and ratio of CSF volume per cycle) and temporal parameters (delays respect to arterial flow).ResultsWith respect to the input of arterial blood, the displacement of venous blood (22% and 38% of the cardiac cycle in the straight sinus and superior sagittal sinus, respectively) and of CSF (12% and 25% of the cardiac cycle in the C2-C3 perimedullary space and in the aqueduct of Sylvius, respectively) show the distribution of the pulsatility of the intracranial fluids. We calculated the indexes of compliance of the encephalic and medullary compartments in normal subjects.ConclusionsIt is possible to quantitatively describe the dynamic relations between intracranial fluids and infer the elastic behavior of the brain and spinal canal by using flow velocity maps obtained with phase contrast MRI (AU)

[Estimating intracranial fluid dynamics using quantitative analyses of phase contrast magnetic resonance images]. / Estimación de la dinámica de líquidos intracraneales mediante análisis cuantitativo de imágenes de resonancia magnética de contraste de fase.

OBJECTIVE: To estimate the dynamic relations between cerebrospinal fluid (CSF) and blood in the cerebral and spinal subarachnoid spaces and in the ventricles by quantifying phase contrast magnetic resonance imaging (MRI). MATERIAL AND METHODS: We analyzed 15 healthy volunteers during the same time of day and using the same magnetic field strength (3T). Each study consisted of four phase contrast sequences: two to calculate the CSF (aqueduct of Sylvius and the C2-C3 perimedullary space) and two to calculate the blood flow (internal carotid and vertebral arteries, superior sagittal sinus, and straight sinus). We calculated the amplitude parameters (systolic volume, mean flow, pulsatility and compliance indexes, absolute pressure gradient, and ratio of CSF volume per cycle) and temporal parameters (delays respect to arterial flow). RESULTS: With respect to the input of arterial blood, the displacement of venous blood (22% and 38% of the cardiac cycle in the straight sinus and superior sagittal sinus, respectively) and of CSF (12% and 25% of the cardiac cycle in the C2-C3 perimedullary space and in the aqueduct of Sylvius, respectively) show the distribution of the pulsatility of the intracranial fluids. We calculated the indexes of compliance of the encephalic and medullary compartments in normal subjects. CONCLUSIONS: It is possible to quantitatively describe the dynamic relations between intracranial fluids and infer the elastic behavior of the brain and spinal canal by using flow velocity maps obtained with phase contrast MRI.

[Normal values for cerebrospinal fluid flow dynamics in the aqueduct of Sylvius through optimized analysis of phase-contrast MR images]. / Valores de normalidad de la dinámica del flujo de líquido cefalorraquídeo en el acueducto de Silvio mediante análisis optimizado de imágenes de contraste de fase en resonancia magnética.

OBJECTIVE: To establish normal values for the different parameters that characterize the cerebrospinal fluid (CSF) flow dynamics in the aqueduct of Sylvius (velocity, flow, volume per cycle, and CSF production) obtained from phase-contrast MR images using a reliable and reproducible post-processing method. The optimized semiautomatic method eliminates interobserver variability and corrects errors due to low amplitude movements, aliasing, and the partial volume effect. MATERIAL AND METHODS: We studied 42 healthy subjects without neurological or cerebrovascular disease or disturbances in CSF dynamics. Images were acquired on a 1.5 T MR scanner using a phase-contrast sequence. All images were acquired during the same time frame (14:00 to 18:00) to avoid circadian influences. RESULTS: we obtained normal values for each of the parameters that characterize CSF dynamics in the aqueduct (maximum diastolic and systolic velocity, mean velocity, maximum diastolic and systolic flow, mean flow, production rate, and stroke volume). Although trends were noted, neither sex nor age (< 25, 26-50, >51 years old) had a statistically significant effect on any parameter (p> or =0.05). DISCUSSION: Although measurements of CSF flow dynamics parameter are sensitive to various factors (temporal and spatial resolutions of the MR sequence, circadian rhythms, age, sex, and MR equipment manufacturer), an optimized post-processing method enables reliable and reproducible values and ranges for normal subjects to be established.

Valores de normalidad de la dinámica del flujo de líquido cefalorraquídeo en el acueducto de Silvio mediante análisis optimizado de imágenes de contraste de fase en resonancia magnética / Normal values for cerebrospinal fluid flow dynamics in the aqueduct of Sylvius through optimized analysis of phase-contrast MR images

Objetivo: establecer valores de normalidad de los diferentes parámetros que caracterizan la dinámica del líquido cefalorraquídeo (LCR) en el acueducto de Silvio (velocidad, flujo, volumen por ciclo y producción), obtenidos de las imágenes de resonancia magnética (RM) por contraste de fase empleando un método de posproceso fiable y reproducible. El método semiautomático optimizado presenta una variabilidad nula de los resultados interobservador y corrige los errores debidos a los movimientos de baja amplitud, al submuestreo (aliasing) y al efecto del volumen parcial. Material y métodos: se analizó a 42 sujetos sanos sin alteraciones neurológicas, hidrocefalia ni enfermedades cerebrovasculares. Las imágenes se adquirieron en un equipo de RM de 1,5 T con una secuencia de contraste de fase. Todas las exploraciones se adquirieron en la misma franja horaria (de 14:00 a 18:00 h) para evitar influencias circadianas. Resultados: se obtuvieron valores de normalidad para cada uno de los parámetros que caracterizan la dinámica del LCR en el acueducto de Silvio (velocidades máximas diastólica y sistólica, velocidad promedio, flujos máximos diastólico y sistólico, flujo promedio, producción de LCR y volumen por ciclo). Aunque hubo una tendencia, ni el sexo ni la edad (< 25, 26-50 y > 51 años) influyeron estadísticamente en los parámetros calculados. Conclusiones: aunque las mediciones de los parámetros de la dinámica del flujo de LCR son sensibles a múltiples factores (resolución temporal y espacial de la secuencia RM, ritmo circadiano, edad y sexo, y fabricante del equipo de RM), un método optimizado de posproceso permite establecer valores y rangos de normalidad precisos y reproducibles (AU)

Objective: to establish normal values for the different parameters that characterize the cerebrospinal fluid (CSF) flow dynamics in the aqueduct of Sylvius (velocity, flow, volume per cycle, and CSF production) obtained from phase-contrast MR images using a reliable and reproducible post-processing method. The optimized semiautomatic method eliminates interobserver variability and corrects errors due to low amplitude movements, aliasing, and the partial volume effect. Material and methods: we studied 42 healthy subjects without neurological or cerebrovascular disease or disturbances in CSF dynamics. Images were acquired on a 1.5 T MR scanner using a phase-contrast sequence. All images were acquired during the same time frame (14:00 to 18:00) to avoid circadian influences. Results: we obtained normal values for each of the parameters that characterize CSF dynamics in the aqueduct (maximum diastolic and systolic velocity, mean velocity, maximum diastolic and systolic flow, mean flow, production rate, and stroke volume). Although trends were noted, neither sex nor age (< 25, 26-50, > 51 years old) had a statistically significant effect on any parameter (p ¡Ý 0.05). Discussion: although measurements of CSF flow dynamics parameter are sensitive to various factors (temporal and spatial resolutions of the MR sequence, circadian rhythms, age, sex, and MR equipment manufacturer), an optimized post-processing method enables reliable and reproducible values and ranges for normal subjects to be established (AU)

[Assessment of reliable quantification of the dynamics of cerebrospinal fluid by magnetic resonance imaging in idiopathic normal pressure hydrocephalus]. / Valoración de la cuantificación fiable de la dinámica del líquido cefalorraquídeo en el acueducto de Silvio mediante resonancia magnética en la hidrocefalia normopresiva idiopática.

INTRODUCTION: A combination of good clinical selection with reliable quantification of diverse parameters that characterize the dynamics of cerebrospinal fluid (CSF) flow from phase-contrast magnetic resonance imaging may identify patients with idiopathic normal pressure hydrocephalus (NPH). MATERIAL AND METHODS: We have carried out a quantitative analysis of 38 subjects (19 healthy subjects and 19 patients with suspected idiopathic NPH). The images were acquired using a 1.5 T MR unit with a phase-contrast sequence in an oblique-transversal plane perpendicular to the Sylvius aqueduct codified to 20 cm/s and with 27 observations per cardiac cycle by means of retrospective synchronization. The area was defined to half the height of the peak velocity, to maximize accuracy. Parameters quantified were mean flow, maximum systolic and diastolic flow, maximum systolic and diastolic velocity, mean velocity, CSF production and stroke volume. RESULTS: All the parameters measured showed a significant difference (ANOVA: p

Valoración de la cuantificación fiable de la dinámica del líquido cefalorraquídeo en el acueducto de Silvio mediante resonancia magnética en la hidrocefalia normopresiva idiopática / Assessment of reliable quantification of the dynamics of cerebrospinal fluid by magnetic resonance imaging in idiopathic normal pressure hydrocephalus

Introducción. Para identificar a pacientes con hidrocefalia normopresiva (HNP) idiopática es necesario combinar una buena selección clínica con la cuantificación fiable de diversos parámetros que caracterizan la dinámica del líquido cefalorraquídeo (LCR) en las imágenes por resonancia magnética (RM) obtenidas en contraste de fase. Material y métodos. Se realizó un análisis cuantitativo a 38 sujetos (19 pacientes con sospecha de HNP idiopática y 19 controles). Las imágenes se adquirieron usando un equipo de RM de 1,5 T con una secuencia contraste de fase perpendicular al acueducto de Silvio, codificada a 20 cm/s y con 27 lecturas por ciclo cardíaco mediante sincronización retrospectiva. Se definió el área del acueducto a mitad de la altura del pico de velocidad para maximizar la precisión. Los parámetros cuantificados fueron el flujo promedio, flujo máximo sistólico y diastólico, velocidad máxima sistólica y diastólica, velocidad promedio, producción de LCR y volumen por ciclo.Resultados. Todos los parámetros medidos presentaron una diferencia significativa (ANOVA: p <= 0,05) entre controles y pacientes, excepto la velocidad máxima sistólica (p=0,17). En el análisis discriminante se observó que los dos grupos (controles y pacientes) fueron clasificados correctamente en un 92,1% con el uso del flujo máximo sistólico y la producción de LCR.Conclusiones. La cuantificación semiautomática de la dinámica del LCR mediante RM diferencia a los pacientes con estado hiperdinámico de los sujetos control, con diferencias significativas que pueden usarse para clasificar las HNP idiopáticas

Introduction. A combination of good clinical selection with reliable quantification of diverse parameters that characterize the dynamics of cerebrospinal fluid (CSF) flow from phase-contrast magnetic resonance imaging may identify patients with idiopathic normal pressure hydrocephalus (NPH). Material and methods. We have carried out a quantitative analysis of 38 subjects (19 healthy subjects and 19 patients with suspected idiopathic NPH). The images were acquired using a 1.5 T MR unit with a phase-contrast sequence in an oblique-transversal plane perpendicular to the Sylvius aqueduct codified to 20 cm/s and with 27 observations per cardiac cycle by means of retrospective synchronization. The area was defined to half the height of the peak velocity, to maximize accuracy. Parameters quantified were mean flow, maximum systolic and diastolic flow, maximum systolic and diastolic velocity, mean velocity, CSF production and stroke volume. Results. All the parameters measured showed a significant difference (ANOVA: p<=0,05) between controls and patient except for the maximum systolic velocity (p=0.17). It was observed in the discriminant analysis that the two groups (controls and patients) were classified correctly in 92.1% with the use of the maximum systolic flow and CSF production. Conclusions. Semiautomatic quantification of the dynamics of CSF by means of MRI differentiates patients with hyperdynamic state from the control subjects, with significant differences that can be used to classify idiopathic HNP

Prevalence, detection and treatment of anxiety, depression, and delirium in the adult critical care unit.

This study assesses the levels of depression, anxiety, and delirium during admission to three adult critical care units (CCU) and the performance of CCU staff with respect to detection and treatment. During a 1-month period, 96 consecutive patients were evaluated on the first day of admission by an independent rater, using the Hospital Anxiety Depression Scale and the Confusional Assessment Method. Frequency of alcohol use and demographic data were recorded. CCU teams rarely made diagnoses of anxiety, depression, or delirium. On at least one screening test, 29.2% of patients were positive. Delirium was present in 7.3%, depression in 13.7%, anxiety in 24%, and possible problem drinking in 37.9%. Although some form of psychiatric treatment was offered to 58%, there was low agreement between psychiatric diagnoses made by the independent rater and the diagnoses made and treatments used by CCU staff. This suggests that the CCU staff are using psychotropic medications without any clear documentation and perhaps clear understanding of the psychiatric diagnoses they are treating. In summary, we found high rates of psychiatric disorders in adult CCU patients but low rates of detection and only moderate rates of treatment by CCU staff.

Lesiones laringotraqueales post-intubación prolongada / Prolonged postintubation laryngotracheal injuries

De los 503 pacientes que ingresaron a la Unidad de Cuidados Intensivos (U. C.I.) del Hospital Universitario de Cartagena durante el segundo semestre de 1992 y el año de 1993, se evaluaron 50, presentando 26 de ellos lesiones laringotraqueales secuelas de su intubación. La intubación endotraqueal entre cinco y doce dias deja secuelas superficiales y la solución de las mismas o su pronostico es mucho mejor que cuando la intubación ha sido por 20 dias o mas, pues las lesiones cicatriciales son de peor pronostico. La intubación durante cinco dias o menos no deja secuelas laringotraqueales y pacientes en quienes se sospecha tratamiento prolongado de su via aerea obstruida, deben someterse sin dilaciones a traqueostomia

Violencia sexual y embarazo no deseado en la adolescente: estudio exploratorio para la ciudad de Bogotá / Sex violence and unwanted pregnancy in the adolescent: exploratory study for Bogota city

La violencia sexual es una de las muchas manifestaciones que se ejerce contra la mujer y sobre la cual existe un gran desconocimiento en Colombia. Parte de este desconocimiento se debe a la escasa documentación disponible y a la falta de cifras confiables. Tan solo de vez en cuando cuando los medios de comunicación escritos registran hechos de esta naturaleza. De allí que una de las grandes dificultades con las cuales tropezó este estudio fue la escasez de estadísticas confiables, sistematizadas y accesibles para una revisión analítica del número de violaciones sexuales que ocurren anualmente en nuestro país. Se tuvo que partir de innumerables supuestos debido precisamente a las limitaciones de la disponibilidad de los datos y al alto grado de subregistro que presenta la denuncia de las violaciones sexuales. El propósito fundamental de la investigación fue desarrollar una metodología para medir la incidencia de la violación sexual en adolescentes y la probabilidad de un embarazo como resultante de la agresión dentro del grupo de mujeres de 15 a 19 años de la ciudad de Bogotá y la cual esperamos sirva de punto de partida para nuevos desarrollos metodológicos que permitan una medición más precisa de este problema. El estudio fue de tipo exploratorio y piloto para Bogotá, sobre la base de datos secundarios, es decir no se llevaron a cabo entrevistas con la población adolescente sino que se utilizaron las cifras reportadas en instituciones como la Policia Nacional, Promujer, etc