Use of digital panoramic radiography as an auxiliary means of low bone mineral density detection in post-menopausal women.

OBJECTIVES: To correlate the radiomorphometric indices obtained using digital panoramic radiography (DPR) with bone mineral densities, evaluated by the dual-energy X-ray absorptiometry test, in a population of post-menopausal females to identify patients with asymptomatic low bone mineral densities. METHODS: The morphology of the mandibular cortex was evaluated using the mandibular cortical index (MCI) and the inferior mandibular cortex width was evaluated using the mental index (MI) in 64 female patients who had undergone dual-energy X-ray absorptiometry assessment. Of these patients, 21 were diagnosed with osteopaenia and 20 with osteoporosis, and 23 were normal. Three new indices for evaluating the inferior mandibular cortex width were designed: the mental posterior index 1 (MPI1), MPI2 and MPI3. Statistical analyses were performed using the χ(2) and Kruskal-Wallis tests and the receiver operating characteristic curve. RESULTS: There were significant differences between the normal and lower bone mineral density groups (osteopaenia and osteoporosis) for MCI (p < 0.01). In the osteoporosis group, the MI, MPI1, MPI2 and MPI3 were significantly different from the normal and osteopaenia groups (p < 0.05). The MI, MPI1, MPI2 and MPI3 showed that there is an area in the mandibular cortex, located between the mental foramen and the antegonial region, which is valid for identifying females at high risk for osteoporosis. CONCLUSIONS: The MCI, MI, MPI1, MPI2, and MPI3 radiomorphometric indices evaluated using DPR can be used to identify post-menopausal females with low bone densities and to provide adequate medical treatment for them.

Giant distal anterior cerebral artery aneurysm not visualized on angiography: case report.

BACKGROUND: Giant distal anterior cerebral artery (ACA) aneurysms are rare lesions, with only 10 cases having been reported in the literature. Their diagnosis may be difficult on computed tomography (CT) scan, often simulating a callosal tumor or hematoma, with only magnetic resonance imaging (MRI) scan or angiography allowing a correct diagnosis. CASE REPORT: The authors present one case of a giant distal ACA aneurysm not visualized on angiography, and whose MRI scan was interpreted as a hemorrhage from a cavernoma or a glioma. The correct diagnosis was only made during surgery, and was confirmed by histopathologic examination. CONCLUSIONS: The authors conclude that distal ACA aneurysms must be considered in the presence of a callosal mass, even with negative angiography, especially if there has been evidence of bleeding from the lesion.

[Perimesencephalic hemorrhage]. / Hemorragia perimesencefálica.

Among 293 subarachnoid hemorrhages admitted to the Neurology and Neurosurgery departments of Sta Maria Hospital, 108 patients had a normal cerebral angiography. Twenty-three meet the radiological criteria for perimesencephalic hemorrhage (center of the hemorrhage located in front of the mesencephalon, without blood in the interhemispheric and lateral sylvian fissures, nor significant intraventricular hemorrhage). The clinical picture was one of sudden, severe headache with meningeal signs, without focal signs or decreased alertness. Evolution was benign: there was no intrahospital mortality, morbidity or rebleeds on follow-up (3.5 years). In this subgroup of subarachnoid hemorrhage there is no need for a repeated angiogram if the first angiography is considered normal.

Pre-medicacao em laparoscopia: grave e rara complicacao. / Premedication in laparoscopy: severe and rare complication

Apos o uso de meperidina e diazepam em veia do dorso da mao de paciente com cirrose e doenca pulmonar cronica obstrutiva com eritrocitose secundaria, sobreveio vasculopatia aguda com necrose de um tendao. Como o tratamento clinico instituido nao obteve resultados adequados, foi indicada a fasciotomia dorsal e palmar para descompressao com boa resposta. Na revisao da literatura, a meperidina nao parece ser a responsavel, assim como o diazepam; o mesmo nao se pode afirmar, porem, em relacao ao solvente usado no diazepam

[Microangiographical study of arterio-luminal vessels]. / Etude microangiographique des vaisseaux artério-luminaux.

Using Micropaque (crystallized barium sulphate) in a gelatinous medium of a certain viscosity, with a fluorescent pigment in the solution, we obtained a mixture with a fluidity adequate to a vascular injection; this injection is performed with a constant pressure, the values of which are kept between limits near the values of the physiological arterial pressure. We found several types of arterio-luminal vessels with different calibres: some of them with a calibre of 200 micrometer, some others of the intermediate type with a calibre between 100 and 200 micrometer, and others, which we call arterio-Thebesian vessels, originating in arteriolar branches opening in the Thebesian veins. At last, we have the arterio-sinusoido-cavity vessels opening in the ventricular cavities by several orifices.