Asymmetry of the anterior ethmoidal artery in relation to the anterior skull base: a population-based study of 500 arteries.

OBJECTIVE: To analyze variability in the distance between the Anterior Ethmoidal Artery (AEA) and the anterior Skull Base (SB), as well as the frequency of lateral asymmetry in a Latin American population using computed tomography. METHODS: A total of 250 computed tomography scans of paranasal sinuses in coronal reconstruction (500 AEAs) were analyzed. After determining the image with the best anatomical view of the artery, the distance between its midpoint and the ethmoidal roof was measured, and the images were independently interpreted by 2 physicians. RESULTS: Of the 500 AEAs, 279 (55.8%) adhered to or passed through the SB at a distance of 0mm. A total of 221 AEAs (44.2%) were at some distance from the SB, of which 107 (48.4%) were on the right side, ranging from 1.18 to 6.75mm, and 114 (51.5%) were on the left side, ranging from 1.15 to 6.04mm. The overall mean distance between the AEA and SB was 1.22 (SD=1.57) mm, increasing to 2.77 (SD=1.14) when the arteries adhered to the SB were excluded. Seventy-six individuals (30.4%) had a lateral distance variation > 1mm. CONCLUSION: Our study includes the largest sample of AEA analyzed with computed tomography scans of paranasal sinuses. There was some distance between the AEA and SB in almost half the patients, and we found a high rate of lateral variability >1mm. LEVEL OF EVIDENCE: Level 3.

Comparison between endoscopic and microscopic butterfly cartilage graft inlay tympanoplasty: a systematic review and meta-analysis.

PURPOSE: The purpose of this study was to compare the effectiveness of endoscopic and microscopic approaches for butterfly cartilage graft inlay tympanoplasty regarding anatomical and hearing outcomes through a systematic review and meta-analysis. METHODS: A search of PubMed, Embase, MEDLINE, and Virtual Health Library was performed from inception to July 3rd, 2021, using keywords, such as tympanoplasty, cartilage graft, and inlay technique. Data from articles that met inclusion criteria were extracted by two authors independently. The PRISMA statement was followed. RoB-2 and ROBINS-I tools were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap. RESULTS: Five studies were included, one randomized clinical trial and four retrospective cohorts, in which a total of 318 patients were included. Graft take rate was 91.3% in the endoscopic group and 93.6% in the microscopic group (RR 0.98; 95% CI 0.93-1.03; I2 0%; P = 0.68). Four studies provided data about the secondary outcome, all showing significant reductions in air-bone gap, ranging from 5.7 to 11.0 in the endoscope group and from 5.8 to 11.6 in the microscope group, with a mean difference between groups of 0.85 (95% CI - 0.79 to 2.48). CONCLUSION: Although the overall evidence of the included studies was low, endoscopic and microscopic butterfly cartilage graft inlay tympanoplasties have similar results on anatomical and hearing outcomes, making the selection between such approaches an individual choice for the surgeon.

Mapeamento radiológico e autismo: uma revisão bibliográfica / Radiological mapping and autism: a literature review

RESUMO Introdução: o autismo é definido como um distúrbio do desenvolvimento neurológico caracterizado por déficits sociais e padrões repetitivos e restritos de comportamento. O advento da tecnologia de diagnóstico por imagem, permitiu a introdução de Ressonância Magnética (RM), Tomografia Computadorizada (TC) e Tomografia por emissão de pósitrons (PET) no campo da psiquiatria. Métodos: foi realizada uma revisão da literatura acerca do uso de técnicas de neuroimagem em pacientes diagnosticados com diagnóstico psiquiátrico prévio de autismo. Resultados: Foram encontrados 23 artigos que atenderam aos critérios de inclusão e exclusão; 21 foram escritos em língua inglesa, sendo os outros 2 escritos em português. 22 artigos utilizaram RM como método de imagem; 1 trabalho fez uso de SPECT (Single-Prothon Emission Computed Tomography) exclusivamente. RM: 1 artigo utilizou campo magné- tico de 1 Tesla, 8 utilizaram 1,5 Tesla e 4 utilizaram 3 Tesla (todos publicados após 2006); 3 estudos utilizaram tanto SPECT quanto PET. Os achados radiológicos mais importantes em pacientes portadores de autismo foram: volume do corpo caloso (8 de 12 artigos; achado predominante: diminuição volumétrica do corpo caloso), cerebelo (9 de 12 artigos; achado predominante: redução do volume do verme cerebelar em relação ao volume cerebelar total), substância cinzenta cortical (6 dentre 10; resultados heterogêneos) e volume cerebral total (5 dentre 8; resultados também heterogêneos). Conclusão: O uso de mapeamento radiológico no diagnóstico de autismo pode mostrar-se útil na detecção de alterações anatômicas sugestivas da doença, embora a heterogeneidade de achados radiológicos não permita dispensar a avaliação clínica para o estabelecimento do diagnóstico. PALAVRA-CHAVE: Transtorno do espectro autista, diagnóstico por imagem, neurologia

ABSTRACT Introduction: Autism is defined as a neurological development disorder characterized by social deficits and repetitive and restricted behavior patterns. The advent of diagnostic imaging technology has allowed the introduction of Magnetic Resonance (MRI), Computed Tomography (CT) and Positron Emission Tomography (PET) in the field of psychiatry. Methods: A literature review was carried out on the use of neuroimaging techniques in patients with a previous psychiatric diagnosis of autism. Results: 23 articles that met the inclusion and exclusion criteria were found; 21 were written in English, with the other 2 written in Portuguese. Twenty-two articles used MRI as an imaging method; 1 work used SPECT (Single-Prothon Emission Computed Tomography) exclusively. MRI: 1 article used a magnetic field of 1 Tesla, 8 used 1.5 Tesla and 4 used 3 Tesla (all published after 2006); 3 studies used both SPECT and PET. The most important radiological findings in patients with autism were: corpus callosum volume (8 of 12 articles; predominant finding: volumetric decrease of the corpus callosum), cerebellum (9 of 12 articles; predominant finding: reduction in cerebellar vermis volume in relation to total cerebellar volume), cortical gray matter (6 out of 10; heterogeneous results) and total brain volume (5 out of 8; also heterogeneous results). Conclusion: The use of radiological mapping in the diagnosis of autism may prove to be useful in the detection of anatomical alterations suggestive of the disease, although the heterogeneity of radiological findings does not allow for dismissing clinical assessment for establishing the diagnosis. KEYWORDS: Autism spectrum disorder, diagnostic imaging, neurology

Poliarterite nodosa e osteonecrose em paciente feminino como afecção rara em atenção primária à saúde / Nodosa polyarteritis and osteonecrosis in a female patient as a rare condition in primary health care

A poliartrite nodosa (PAN) faz parte de um grupo de patologias autoimunes caracterizadas pela vasculite. Quando associada à osteonecrose, tal comorbidade torna-se ainda mais rara, sendo mais comum em indivíduos do sexo masculino e com manifestações clínicas variadas. O presente estudo trata-se de um relato de caso de uma paciente de 40 anos do sexo feminino que apresentou PAN, a qual se agravou desenvolvendo osteonecrose na articulação coxofemoral bilateral. O tratamento por meio da terapia com corticoides associados a ciclofosfamida, apesar de necessitar monitorização frequente, tem se mostrado eficaz na redução do impacto da morbidade sobre o bem estar do paciente. O quadro apresenta um prognóstico complexo e de difícil reconhecimento visto sua raridade, sintomatologia variada e diagnóstico histopatológico.

Polyarteritis nodosa (PAN) is part of a group of autoimmune disorders characterized by vasculitis. When associated with osteonecrosis, such comorbidity becomes even rarer, being more common in males. Its clinical manifestations are varied. The present study is a case report of a 40-year-old female patient who presented with PAN, which was aggravated by developing osteonecrosis on the bilateral hip joint. Treatment with corticosteroid therapy associated with cyclophosphamide, despite requiring frequent monitoring, has been shown to be effective in reducing the impact of morbidity on patient's well-being. The condition has a complex prognosis and is difficult to recognize due to its rarity, varied symptoms, and histopathological diagnosis.