Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead.

We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.

A comparison between ultrasonography and single-phase computed tomography for preoperative assessment of solid abdominal tumors in children.

OBJECTIVE: This study aimed to estimate the performance of single-phase-enhanced computed tomography and ultrasonography examinations in the preoperative evaluation of solid abdominal tumors and their relationship with relevant adjacent structures in children. METHODS: This retrospective study included 50 pediatric patients with malignant solid abdominal tumors treated with surgical resection between 2009-2017. Preoperative computed tomography and ultrasonography were compared to operative findings (gold standard) in the diagnosis of invasion or encasement of adjacent structures. Accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated. RESULTS: Renal (20.4%) and neuroblastic (19.4%) tumors were the most common. Complete surgical resection with negative margins was achieved in 44 (88%) patients. The comparison between single-phase-enhanced computed tomography and ultrasonography findings showed the following results: sensitivity = 90.3% vs 86.6%, specificity = 86.8% vs 94.6%, negative predictive value = 95.3% vs 94.4%, positive predictive value = 75.3% vs 86.9%, and accuracy = 87.9% vs 92.2%. The correlation (kappa index) between computed tomography and ultrasonography examinations was 0.72 (p < 0.001). In 14% (7/50) of the patients, the invasion of adjacent structures was diagnosed by ultrasonography but not by computed tomography (1 patient had 2 invaded structures). CONCLUSION: Ultrasonography can be considered a complementary method to single-phase-enhanced computed tomography in the preoperative evaluation of children with an abdominal tumor. The present study showed that ultrasonography and single-phase-enhanced computed tomography each possess a high accuracy in the preoperative planning of resection of solid abdominal tumors in children. Thus, it seems that the combination of both imaging methods would be enough for the evaluation of most abdominal tumors in the pediatric population.

Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study.

PURPOSE: Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS: The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS: In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS: There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.

A comparison between ultrasonography and single-phase computed tomography for preoperative assessment of solid abdominal tumors in children

Abstract Objective: This study aimed to estimate the performance of single-phase-enhanced computed tomography and ultrasonography examinations in the preoperative evaluation of solid abdominal tumors and their relationship with relevant adjacent structures in children. Methods: This retrospective study included 50 pediatric patients with malignant solid abdominal tumors treated with surgical resection between 2009-2017. Preoperative computed tomography and ultrasonography were compared to operative findings (gold standard) in the diagnosis of invasion or encasement of adjacent structures. Accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated. Results: Renal (20.4%) and neuroblastic (19.4%) tumors were the most common. Complete surgical resection with negative margins was achieved in 44 (88%) patients. The comparison between single-phase-enhanced computed tomography and ultrasonography findings showed the following results: sensitivity = 90.3% vs 86.6%, specificity = 86.8% vs 94.6%, negative predictive value = 95.3% vs 94.4%, positive predictive value = 75.3% vs 86.9%, and accuracy = 87.9% vs 92.2%. The correlation (kappa index) between computed tomography and ultrasonography examinations was 0.72 (p < 0.001). In 14% (7/50) of the patients, the invasion of adjacent structures was diagnosed by ultrasonography but not by computed tomography (1 patient had 2 invaded structures).

Manutenção em implantes dentários / Maintenance in dental implants

A manutenção em implantes é um fator decisivo para a obtenção de sucesso quando se utiliza overdenture e próteses sobre implantes. Neste trabalho, apresenta-se um caso clínico de um paciente do gênero masculino, 70 anos, leucoderma, com rebordo inferior desdentado total, reabsorção óssea grave, com presença apenas de osso basal e ausência de vestíbulo. O tratamento consistiu em instalação de overdenture inferior, inicialmente sobre três implantes na região anterior interforames, sendo que o implante esquerdo transfixou no osso basal de 2 a 3 milímetros; onze anos mais tarde, foram instalados mais dois implantes e foi confeccionada uma carga imediata até os primeiros molares para a colocação de uma prótese fixa implanto-suportada. Durante todo o tratamento foi realizada uma manutenção meticulosa, com acompanhamento por 14 anos, interrompida pelo óbito do paciente. A partir do terceiro mês após a abertura dos três implantes inicialmente instalados, observou-se a presença de mucosa ceratinizada, definição do vestíbulo, maturação do rebordo e formação de osso na região mentual. Conclui-se que um bom planejamento, aliado ao domínio da técnica e uma manutenção adequada, foram pré-requisitos necessários à obtenção de resultados favoráveis, ao sucesso do caso e à obtenção de uma melhor qualidade de vida pelo paciente.

In implants, maintenance is a decisive factor for obtaining success when implant supported overdentures and dentures are used. The present stud presents, a clinical case of a patient, a 70 year-old white man, with a completely edentulous mandibular alveolar ridge, severe bone resorption with presence of basal bone only, and absence of vestibule. Initially, treatment consisted of the placement of a mandibular overdenture, supported on three implants in the anterior inter-foramen region, as the left implant was transfixed in the basal bone of 2 to 3 millimeters. Eleven years later, another two implants were placed in the anterior area and an immediate load was performed up to the first molars, for the placement of an implant supported fixed. Throughout the entire treatment, meticulous maintenance was carried out, with follow-up for fourteen years, interrupted by the patient's death. From the third month after the opening the three implants initially placed, the presence of keratinized mucosa, definition of the vestibule, maturation of the alveolar ridge and bone formation in the mento region were observed. It was concluded that good planning, allied to mastery of the technique and adequate maintenance were the prerequisites necessary for obtaining favorable results, success of the present case, and for the patient to have a better quality of life.

O uso de microondas para polimerização de prótese total implanto-suportada submetida à carga imediata / Use of microwave for polymerization of implant-supported total prostheses submitted to the immediate load

O presente trabalho demonstra a utilização do forno de microondas para polimerização de prótese total implanto-suportada submetida à carga imediata, reduzindo o período entre a instalação dos implantes e da prótese, com resultados bastante satisfatórios e maior comodidade para o paciente.

Acidos graxos omega III: uma revisao / Marine omega III fatty acids: a review

A baixa mortalidade de esquimos por coronariopatia, tem sido relacionada a alta quantidade de peixe que eles consomem. A adicao do acido eicosapentanoico, um oleo de peixe marinho, na dieta humana, mostra a producao de metabolitos que sao menos potentes que seus assemelhados derivados do acido araquidonico. Devido as diferentes atividades funcionais destes eicosanoides, muitas pesquisas estao sendo feitas com outras patologias. O objetivo desta revisao e mostrar alguns trabalhos e resultados com o uso destas substancias.