RESUMO
It is often assumed that the pattern of injury in children mirrors that of the adult population, but children have different anatomical proportions and the relative elasticity of their tissues results in different injury patterns. The authors of this review are members of the British Society of Paediatric Radiologists subgroup and developed the recently published(47) paediatric trauma protocols for imaging children involved in major blunt trauma. The following article has been written to bring these guidelines to the attention of the wider community of UK radiologists, and explain the rationale behind the recommendations.
Assuntos
Diagnóstico por Imagem/métodos , Pediatria/normas , Guias de Prática Clínica como Assunto , Ferimentos não Penetrantes/diagnóstico , Criança , Pré-Escolar , Humanos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Reino UnidoRESUMO
OBJECTIVE: To describe the features of invasive Panton-Valentine Leucocidin positive Staphylococcus aureus (PVL-SA) in children at a London teaching hospital, from 2004 to 2008. METHODS: Retrospective case note review. RESULTS: Eleven previously healthy children, 7 male, median age 9 years (range 7 months-13 years), had invasive infections due to unrelated community-acquired meticillin-sensitive PVL-SA. Possible risk factors were identified in 10 cases. Eight patients had complicated musculoskeletal infections, 2 had pneumonia, and 1 had a massive retropharyngeal abscess. At admission neutropenia was present in 2 patients, deep vein thrombosis in 3, and initial blood cultures were positive in 8. Patients with musculoskeletal involvement had a median of 3 (range 1-6) sites of infection, and required median 5 (range 1-11) operative procedures. Eight patients were admitted to PICU, 7 had septic shock. Median duration of hospital stay was 51 (range 14-255) days. One child died and 5 have long-term morbidity. CONCLUSIONS: The clinical features of invasive PVL-SA in this series were similar to those reported from USA and Europe. Musculoskeletal infection was the most common manifestation, frequently progressing to multiple sites and severe sepsis. Most cases had risk factors and clinical features which might have allowed earlier diagnosis, and possibly improved outcome.
Assuntos
Toxinas Bacterianas/genética , Exotoxinas/genética , Leucocidinas/genética , Infecções Estafilocócicas/diagnóstico , Adolescente , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Londres/epidemiologia , Masculino , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade , Trombose Venosa/complicaçõesRESUMO
The aims of this study were to develop a noninvasive, erect, gravity-dependent method for assessing movements of the female pelvic floor, to describe the range of movements in pelvic floor ascent and descent in asymptomatic and symptomatic women, and to quantify any differences. A total of 102 women, 28-86 years of age, 35 symptomatic and 67 asymptomatic, were included in the study. They were scanned in a sitting position in an open scanner with good vertical access using fast-gradient echo sequences fast spoiled grass (FSPGR). Measurements of the bladder base, uterocervical junction, and anorectal junction were taken in the sagittal plane. The levator ani (LA) muscle insertion was assessed in the coronal plane with the patients at rest, during maximal strain, and during maximum contraction of the pelvic floor. Premenopausal multiparous women have a significantly lower bladder base (8/0 mm above the baseline; P value = 0.009) and uterocervical junction (15.5/3.5 mm; P value = 0.03) at rest than nulliparous women, and this becomes more apparent on straining. Parity confers a more significant effect on the position and function of the pelvic floor than menopausal status. All pelvic organs are lower at rest and on straining in women with defecation difficulties (0/-24 mm; P value = 0.001). These differences are also seen when comparing women with and without urinary incontinence. Dynamic seated magnetic resonance imaging (MRI) shows that all the pelvic organs are lower at rest and on straining in multiparous women and in those with urinary incontinence than in a group of asymptomatic nulliparous volunteers. This difference is also seen in the position of the bladder base and anorectal junction during pelvic floor contraction. These findings suggest general pelvic floor weakness in women who present with symptoms in one compartment and indicate the need for evaluation of the entire pelvic floor particularly prior to surgery. J. Magn. Reson. Imaging 2001;13:923-929.
Assuntos
Constipação Intestinal/diagnóstico , Incontinência Fecal/diagnóstico , Imageamento por Ressonância Magnética/instrumentação , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/diagnóstico , Urodinâmica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/fisiopatologia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Aumento da Imagem , Contração Isométrica/fisiologia , Menopausa/fisiologia , Pessoa de Meia-Idade , Diafragma da Pelve/patologia , Sensibilidade e Especificidade , Incontinência Urinária/fisiopatologiaRESUMO
OBJECTIVE: Proinflammatory cytokines are involved in the pathogenesis of periapical lesions. The purpose of this study was to evaluate the presence of the cytokines tumor necrosis factor-alpha (TNF-alpha) and transforming growth factor-beta(1) (TGF-beta(1)) in periapical pathosis and to determine their relationship to the size of the lesions. STUDY DESIGN: One tooth from each of 25 patients was root-end resected, and the periapical lesion was collected. The amounts of TNF-alpha and TGF-beta(1) were assessed by enzyme-linked immunosorbent assay. RESULTS: TGF-beta(1) was detected in 21 of 25 lesions. In samples with scar tissue, no TGF-beta(1) activity was detected. A statistically significant correlation was found between TGF-beta(1) per milligram of tissue and the diameter of the lesions. TNF-alpha was detected in only 2 samples. CONCLUSIONS: TGF-beta(1) was present in periapical granulomas and cysts but not in lesions with scar tissue. The correlation between the amount of TGF-beta(1) per milligram of tissue and the size of the lesion was significant.
Assuntos
Granuloma Periapical/imunologia , Granuloma Periapical/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Granuloma Periapical/microbiologia , Granuloma Periapical/patologia , Análise de Regressão , Obturação Retrógrada , Fator de Crescimento Transformador beta/análise , Fator de Necrose Tumoral alfa/análiseRESUMO
OBJECTIVE: Surgical management is intended to eliminate or block infection originating in the root canals. The root end is customarily sealed to prevent pathogenic products remaining in the root canal from reaching the periradicular tissues. The purpose of this study was to evaluate the microbiologic and radiographic outcomes of surgical treatment of periradicular pathosis associated with teeth with necrotic pulps. STUDY DESIGN: One tooth from each of 10 patients was root-end resected and root-end filled without prior root canal treatment. One year postoperatively, the outcomes were assessed radiographically and the root canals were sampled for bacteria. RESULTS: Radiographic examination showed complete or incomplete (scar tissue) healing in 5 teeth and uncertain healing in the other 5 teeth. Bacteriologic samples from the root canals were positive in 9 of the 10 cases. CONCLUSIONS: In teeth with necrotic pulps, treatment of periradicular pathosis by surgery and root-end filling may show radiographic evidence of satisfactory healing 1 year postoperatively. However, viable bacteria may persist in the canals, constituting a potential risk factor for recurrence of periradicular pathosis.
Assuntos
Cavidade Pulpar/microbiologia , Necrose da Polpa Dentária/complicações , Granuloma Periapical/complicações , Granuloma Periapical/cirurgia , Obturação Retrógrada , Adulto , Idoso , Apicectomia , Bactérias Anaeróbias/isolamento & purificação , Necrose da Polpa Dentária/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cisto Radicular/complicações , Cisto Radicular/cirurgia , Resultado do TratamentoRESUMO
Glomerulocystic disease (GCD) is a very rare condition. Only two previous reports have linked this condition with hepatoblastoma. We report a neonate with US evidence of grossly enlarged echogenic kidneys and features typical of hepatic fibrosis, complicated by the presence of a hepatoblastoma. The report discusses the differential diagnosis and highlights GCD as one cause of large, bright kidneys on US. It also adds further evidence to the suggested association between GCD and hepatoblastoma.
Assuntos
Hepatoblastoma/complicações , Neoplasias Hepáticas/complicações , Doenças Renais Policísticas/complicações , Diagnóstico Diferencial , Hepatoblastoma/congênito , Hepatoblastoma/diagnóstico por imagem , Humanos , Lactente , Glomérulos Renais/patologia , Neoplasias Hepáticas/congênito , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Doenças Renais Policísticas/congênito , Doenças Renais Policísticas/diagnóstico por imagem , UltrassonografiaRESUMO
OBJECTIVES: This prospective randomized study compared the outcome of retreatment and surgical intervention in root canal treated teeth with nonhealing periradicular pathosis. STUDY DESIGN: One such tooth from each of 38 patients was randomly allotted to retreatment or root-end resection and root-end filling. Treatment outcome after 1 year was evaluated and compared clinically and radiographically. RESULTS: The success rate for surgery was higher than for conventional retreatment, but the difference was not statistically significant. CONCLUSIONS: For management of nonhealing periradicular pathosis associated with root canal treated teeth, surgical intervention should be considered as an alternative to retreatment. In cases with a similar prognosis for both modes of treatment, the choice should be governed by consideration of intrinsic and extrinsic factors.
Assuntos
Doenças Periapicais/terapia , Obturação Retrógrada , Obturação do Canal Radicular , Adulto , Idoso , Idoso de 80 Anos ou mais , Apicectomia , Distribuição de Qui-Quadrado , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Periapicais/cirurgia , Estudos Prospectivos , Retratamento , Dente não Vital , Resultado do Tratamento , CicatrizaçãoRESUMO
The microleakage of four retrograde filling materials was compared in vitro. Fifty-three single rooted teeth were instrumentated and root filled with resin chloroform and gutta-percha. The gutta-percha cones were left extruding from the access opening. All teeth were apicected and retrograde fillings placed. The materials used were a non gamma 2 amalgam (Amalcap), a glass ionomer cement (ChemFil II), threaded titanium pins cemented with a glass ionomer cement (ChemFil II) and identical titanium pins cemented with a silicone material (Adheseal). After removal of the gutta-percha with tweezers, a radioactive isotope solution was placed in the teeth. Extraradicular samples were taken at 3, 7, 28, 77 and 104 days. All retrograde fillings showed some microleakage. The group with titanium pins cemented with silicone showed the least leakage: significantly less than the teeth with glass ionomer cement (P < 0.01) and with amalgam (P < 0.01). No significant differences were found between other groups.
Assuntos
Cimentos Dentários/química , Infiltração Dentária/prevenção & controle , Pinos Dentários , Obturação Retrógrada/métodos , Materiais Restauradores do Canal Radicular/química , Amálgama Dentário , Cimentos de Ionômeros de Vidro , Humanos , Cimento de Silicato , Elastômeros de Silicone , TitânioRESUMO
We present the case of a patient with the acquired immune deficiency syndrome (AIDS) who developed an ileo-ileal intussusception due to lymphoma of the small bowel. The clinical and radiographic findings are described.
Assuntos
Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Intussuscepção/etiologia , Linfoma Relacionado a AIDS/complicações , Adulto , Humanos , Doenças do Íleo/diagnóstico por imagem , Íleo/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Masculino , RadiografiaRESUMO
Sealing properties of four different retrograde filling materials were investigated in vitro. Radioactive isotopes were applied in the root canal, and leakage into an extraradicular fluid was measured at regular intervals. The method permitted repeated observation of the specimens over prolonged periods of time. Forty single-rooted human teeth were biomechanically instrumented and obturated using calcium-hydroxide paste. Following obturation, an apicectomy was performed and retrograde cavities were filled with four different materials: group 1, non gamma 2 amalgam (Amalcap); group 2, glass ionomer cement (Ketac Silver); group 3, calcium-hydroxide-based root canal sealer (Sealapex); group 4, composite resin (Palfique Light-S). After removal of the calcium hydroxide, the teeth were immersed in a fluid. An isotope solution was then placed in the root canals. Samples were taken from the fluid at 0, 3, 7, 28, 56, 105, 210, 285 and 376 days to determine the radioactivity. It was found that Sealapex and Palfique Light-S showed significantly less leakage than amalgam and glass ionomer cement, which had the highest apical leakage.