Volumetric differences in the temporomandibular joint in patients with condylar hyperplasia in active and passive state, SPECT/CT study.

AIM: Condylar hyperplasia (CH) is a progressive and deforming disease that modifies anatomy of the temporomandibular joint (TMJ) structures. This study aims to correlate the metabolic bone activity of the condyle measured by SPECT with the volumetry anatomic information from the condyle, fossa and joint space provided by CT images, in patients with CH in active and inactive forms. MATERIALS AND METHODS: A cross-sectional comparative study was performed with a set of 116 images from healthy and diagnosed CH patients to compare volumetric measures of the TMJ. Images were acquired through a bone tissue mask using a three-dimensional DICOM reconstruction for SPECT/CT and CBCT images and the Threshold option for segmentation with standardized values for each tissue on the HU scale. RESULTS: there are differences (p<0.01), with greater condylar volume on the affected side in patients with active CH compared to passive CH. The volume of the glenoid cavity shows no differences in either form of CH (p>0.05), however, there were differences for the volume of the joint space on the affected right side of hemimandibular elongation (HE) in the active form. The volume of the mandibular condyle on the affected side in CH cases were larger in HE cases in active and inactive form (p<0.01) compared to healthy patients. Similar results were presented for the glenoid cavity and joint space. CONCLUSIONS: Volumetric anatomical evaluation of TMJ structures, as well as information on condylar metabolic activity, can be obtained from SPECT/CT. The study shows a greater condylar volume on the affected side of the CH compared to the contralateral side, but there are more significant differences in the active than in the inactive form.

Reference values of mandibular condyles metabolic activity: A study using 99m Tc-MDP single-photon emission computed tomography.

OBJECTIVE: To assess the condylar bone metabolic activity in patients with temporomandibular joint health by measuring 99m Tc-MDP uptake using a single-photon emission computed tomography (SPECT) to establish reference values of the uptake difference between condyles and the ratio with respect to the clivus. SETTING AND SAMPLE POPULATION: Eighty consecutive patients of both sexes who were admitted to a Nuclear Medicine Centre between 2017 and 2019 were included in the study. METHOD: This was an observational cross-sectional study in patients with SPECT indications to evaluate pathologies other than those of the temporomandibular joint. The values of the total and normalized counts in a fixed region of interest of five trans-axial slides were obtained to assess the percentage difference between the sides and the uptake ratio. The reference values are expressed as median and 5th and 95th percentiles. RESULTS: The sample included 53 women (66.25%) and 27 men (33.75%) aged 15-55 years. The percentage of uptake difference between condyles was 5.04% (0.46-14.78) for men and 5.17% (0.27-13.21) for women (difference not significant, P = .9). The uptake difference was below 10% in 85% of the subjects (n = 68). The ratio values for total counts in women (0.87, 0.46-1.33) were significantly different (P = .0030) from those in men (1.08, 0.61-2.09). No significant correlation with age was found. CONCLUSIONS: These new reference ranges are applicable to the diagnosis of unilateral and bilateral condylar hyperplasia.

Are There Mandibular Morphological Differences in the Various Facial Asymmetry Etiologies? A Tomographic Three-Dimensional Reconstruction Study.

PURPOSE: Facial asymmetries (FAs) have been classified according to the mandibular morphological differences to obtain better diagnostic and treatment decisions. The purpose of the present study was to establish diagnostic differentiation among FAs using computed tomography (CT) and 3-dimensional (3D) reconstruction. MATERIALS AND METHODS: We performed a cross-sectional study of patients with a diagnosis of FA, who had been evaluated by CT and 3D reconstruction in the same clinical center from 2015 to 2018. The following mandibular anatomic characteristics were compared between the 2 sides (deviated side vs contralateral side) and type of FA: condylar length, mandibular ramus length and width, mandibular body length, and symphysis deviation. RESULTS: The 53 patients included 23 men and 30 women (age range, 16 to 25 years). Six categories of FA were identified: hemimandibular elongation (n = 25), hemimandibular hyperplasia (n = 2), hybrid hyperplasia (n = 3), asymmetric mandibular prognathism (n = 14), asymmetry of the glenoid fossa (n = 2), and functional laterognathism (n = 7). The condylar length and mandibular ramus width were greater in the displaced side than in the contralateral side, with differences of -2.0 ± 2.8 mm (P < .001) and -0.5 ± 1.7 mm (P = .009), respectively. The mandibular body length was greater on the contralateral side (mean difference, 2.1 ± 3.5 mm; P < .001). The symphysis deviation was 5.0 ± 3.4 mm, and those with a hybrid form presented with a greater deviation, with values greater than 10 mm, followed by those with hemimandibular elongation. CONCLUSIONS: The evaluation of the CT images and 3D reconstructions in patients with FA provided detailed information of the mandibular structure that is useful to compare the differences between sides and to classify the entities associated with FA.

Quality of life of patients with benign prostatic hyperplasia (BPH): endoscopic surgery versus laser therapy.

OBJECTIVE: To compare the results observed in the quality of life of patients after transurethral prostate resection (bipolar TUR) or laser therapy. METHODS: This is a retrospective observational cohort study: one cohort includes patients who underwent endoscopic surgery, and the other patients undergoing laser therapy (vaporization). A total of 106 patients were included, divided into two cohorts. Two questionnaires were prepared for those who fulfilled inclusion criteria, the International Prostate Symptom Score (IPSS), two months before and six months after the date of surgery, and Benign Prostate Hyperplasia Patient Impact Measure (BPH - PIM) six months after surgery. We consider a statistical significance level, p 〈 0.05% and a confidence interval (CI) of 95%. RESULTS: Mean prostate size was 55 cc in the endoscopic surgery cohort versus 40 cc in the laser therapy cohort (p = 0.02). 35.8% of patients treated with laser therapy had urinary irritative symptoms compared with 6.3% in the endoscopic surgery group (p = 0.01). Within the laser group, 26.4% of patients had urine leakage compared to 4.4% among those operated by bipolar TUR (p = 0,03). 86.7% of patients in the cohort of bipolar TUR were fully satisfied after surgery compared to 53.6% of the laser therapy cohort (p = 0.03). CONCLUSION: In this retrospective observational cohort study, the patients of LBO laser therapy cohort had a worse quality of life the following six months after surgery compared to those who underwent bipolar transurethral resection.

Anatomical factors of the maxillary tuberosity that influence molar distalization.

Objective: To examine the areas of the maxillary tuberosity (MT) (coronal, apical, width, and height) with respect to the presence or absence of the third molar to establish possible anatomical limitations for molar distalization. Methods: A total of 277 tuberosities were evaluated through sagittal computed tomography (CT) images, divided for measurement into coronal (free of bone), apical (area of influence of the maxillary sinus), and tuberosity (bony area) zones, and stratified by the presence or absence of the third molar, sex, and two age subgroups. Mann-Whitney U test was used to compare the groups considering the third molar. Results: The medians of the width and height of the tuberosity decreased significantly in the absence of the third molar (P < 0.001). The apical area also showed differences, with negative values in the absence of the third molar and positive values in the presence of the third molar (P < 0.001). However, no differences were observed for the coronal area (P > 0.05). Conclusions: In the absence of the third molar, the size of the MT, represented by its width and height, was smaller and negative values (decrease) were observed for the maxillary sinus. The sagittal CT provides useful information regarding the amount of bone tissue available for distalization and relationship of the second molar with respect to the maxillary sinus, which allows individualizing each case in relation to the amount and type of movement expected.

Positional Features of the Mandibular Condyle in Patients with Facial Asymmetry.

OBJECTIVE: To describe the position of the mandibular condyle, the size of the joint spaces and the condylar angulation in patients with facial asymmetry (FA), and to classify these results according to the type of FA and compare them with a reference group without FA. Materials and Methods/Patients: An observational, cross-sectional, descriptive study using computed tomography (CT) was conducted on a sample of 133 patients with a clinical diagnosis of FA derived from the following entities: hemimandibular elongation (HE) (n = 61), hemimandibular hyperplasia (HH) (n = 11), condylar hyperplasia in its hybrid form (HF) (n = 19), asymmetric mandibular prognathism (AMP) (n = 25), glenoid fossa asymmetry (GFA) (n = 9) and functional laterognathism (FL) (n = 8). Likewise, a group of 20 patients without clinical or tomographic characteristics of FA was taken and their complete cone beam tomography (CBCT) scans were analyzed. The quantified variables were joint spaces (anterior, middle and posterior), angle of the condylar axis and condylar position. All measurements were performed using the free, open-source Horos software. RESULTS: Most of the subjects without FA had a right middle condylar position (55%), while in the patients with FA the anterior condylar position predominated. On the left side, the most frequent condylar position was anterior, including the group without FA, except in the HH group. Considering the measurements of the anterior, middle and posterior joint space (mm) on the right side (anterior JS: 1.9 mm, middle JS: 2 mm and posterior JS: 2.8 mm) and on the left side (anterior JS: 2.7 mm, middle JS: 2.1 mm and posterior JS: 2.6 mm) of the subjects without FA, compared to those with FA, the latter presented smaller distances in all diagnoses and only for the right posterior JS (1.9 mm) in HH, was not significant. The condylar axis of the AF group showed significant differences with smaller angles for the left side in those diagnosed with HE (65.4°) and HH (56.5°) compared to those without AF (70.4°). CONCLUSIONS: The condylar position of patients with FA tends to be anterior, both on the right and left sides, while for cases without FA it is middle and anterior, respectively. Patients with FA have smaller joint spaces (mm) compared to patients without FA, with the exception of HH for the right posterior JS.

SPECT/CT Correlation in the Diagnosis of Unilateral Condilar Hyperplasia.

OBJECTIVE: To evaluate the correlation between metabolic bone activity measured by single photon emission computed tomography (SPECT) and the anatomic condylar characteristics acquired by computed tomography (CT), in patients with unilateral condylar hyperplasia (UCH). Method and Materials/Patients: Observational, descriptive study in a group of 71 patients with clinical diagnosis of UCH and indication of SPECT/CT. Bone SPECT images obtained in a gamma-camera GE Infina and processed in a station Xeleris 3 with the program Volumetrix MI Evolution for bone. CT images acquired in a PET/CT Biograph mcT20 equipment (Siemens) processed in a station Osirix V 7.5.1 (Pixmeo, Bomex, Switzerland). RESULTS: The sample included 24 men (33.8%) and 47 women (66.2%). Active state UCH was detected in 40 (56.3%) cases (over 55% uptake in the affected condyle) and 38 (53.5%) presented mandibular deviation to the right side. No significant differences related to sex, age, or mandibular deviation side were found. Mandibular deviation was the only morphologic feature related to active/inactive UCH (p = 0.003). The likelihood of active CH was significantly higher in patients with mandibular deviation higher than 6 mm compared with <6 mm (odds ratio (OR): 3.51, confidence interval (CI) 95%: 1.27-9.72). CONCLUSION: There is a significant correlation between the magnitude of mandibular deviation quantified on CT and metabolic findings obtained by SPECT in patients with UCH. The risk of active UCH is 3.5 times higher in patients with a mandibular deviation ≥6 mm.

Mandibular and temporomandibular morphologic characteristics of patients with suspected unilateral condylar hyperplasia: a CT study.

INTRODUCTION: Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a complicated clinical condition. OBJECTIVE: The objective of this study was to describe morphological characteristics of the mandible and the temporomandibular joint in patients with facial asymmetry, using computed tomography and 3D reconstruction. METHODS: A retrospective observational study was performed with patients displaying facial asymmetry evaluated by single photon emission computed tomography (SPECT)/CT analysis, for suspected UCH, between 2015 and 2018. The following variables were compared between the affected side (producing the asymmetry) and the contralateral side (side to where the jaw is deflected): condylar length, condylar medial and lateral pole length, mandibular ramus length, intra-articular spaces, articular eminence height and position of the posterior wall of the glenoid fossa. RESULTS: Forty-three patients (21 women, mean age: 20.7 ± 7.25 years) with facial asymmetry were included, 19 patients presented right side deviation and 24 patients had left side deviation. Condylar length, lateral pole length, the sum of maximum values and articular eminence height were greater in the affected side (p< 0.05). A positive correlation was found between the position of the posterior wall of the glenoid fossa and the articular eminence height in the affected side (r = 0.442). CONCLUSIONS: In patients with suspected UCH, evaluated through CT, craniofacial measurements showed significantly larger condylar length and the condylar sum of maximum values in the affected side. A positive correlation was found between the increased dimensions of the articular eminence and the more posterior position of the glenoid fossa in the affected side.

[Androgen deprivation therapy in advanced prostate cancer. Multicenter study.] / Terapia de deprivación androgénica en cáncer de próstata avanzado. Estudio multicéntrico.

OBJECTIVES: Advanced prostate cancer (PC) is a frequent entity. The objectives of this paper are the presentation of a sample of patients with PC undergoing treatment with androgen deprivation therapy (ADT) in usual clinical practice and the determination of parameters associated with the development of resistance to castration (CRPC). MATERIAL AND METHODS: Multicenter, observational, retrospective study that analyzes patients treated with ADT from January 2016 to January 2017. Descriptive analysis of the most relevant clinical variables and univariante analysis and progression times by Kaplan-Meier test. RESULTS: Sample of 952 patients. At PC diagnosis median age 74 years. Median PSA at PC diagnosis 23 ng/ml, when begining ADT 20.2 ng/ml. 80.2% of patients were biopsied at PC diagnosis: 28.2% Gleason score group 1, 38.7% groups 2 and 3 and 33.1% groups 4 and 5. Initial treatment of PC: 75.9% ADT, radical prostatectomy 8.4% and radiotherapy 15.1%. Of the 952 patients, 281 (29.6%) fulfilled CRPC criteria.In this group 21.7% achieved undetectable PSA (group in which it was 59.9%. Increased probability of progression to CRPC in: PSA >30ng/ml at PC diagnosis (p=0.000, OR 2.78), Gleason score group 4-5 (p=0.000, OR 2.33), and not to reach undetectable PSA after ADT (p <0.001, OR 3.32). The initial ADT group presents progression to metastatic CRPC more rapidly in unfavourable histology and when not reached undetectable PSA after ADT. CONCLUSIONS: We present a sample of patients with advanced PC in treatment with ADT that shows heterogeneity in usual clinical practice. In our sample, elevated PSA at PC diagnosis, unfavorable histology and failure to achieve a PSA<0.1 ng/ml after ADT is presented as an indicator of progression to the CRPC stage.

OBJETIVO: El cáncer de próstata (CP) avanzado es una entidad frecuente. Los objetivos de este trabajo son la presentación de una serie de pacientes con CP en tratamiento con Terapia de Deprivación Androgénica (TDA) en práctica clínica habitual y la determinación de parámetros asociados al desarrollo de resistencia a la castración (CPRC).MATERIAL Y MÉTODOS: Estudio multicéntrico,  observacional, retrospectivo que analiza pacientes tratados con TDA desde enero 2016 hasta enero 2017. Análisis descriptivo de las variables clínicas más relevantes, análisis univariante y supervivencia libre de progresión mediante test Kaplan-Meier. RESULTADOS: Muestra 952 pacientes. Al diagnóstico del CP edad mediana 74 años. Mediana de PSA al diagnóstico de CP 23 ng/ml, al inicio TDA 20,2 ng/ml. El 80,2% de pacientes tenían biopsia al diagnóstico del CP: 28,2% grado pronóstico Gleason grupo 1, 38,7% grados 2 y 3 y 33,1% grados 4 y 5. Tratamiento inicial del CP: 75,9% TDA, prostatectomía radical 8,4% y radioterapia 15,1%.De los 952 pacientes, 281 (29,6%) cumplían criterios de CPRC. En este grupo el 21,7% alcanzó PSA indetectable (<0,1 ng/ml) con la TDA 20,2  frente al grupo no CPRC en el que lo alcanzaron el 59,9%. Encontramos mayor probabilidad de progresión a CPRC en pacientes con PSA al diagnóstico de CP >30 ng/ml (p=0,000, OR 2,78), grado pronóstico Gleason grupos 4-5 (p=0,000, OR 2,33) y en aquellos que no alcanzan PSA indetectable tras TDA (p<0,01, OR 3,32) variables que se relacionan con los tiempos de progresión a CPRC y especialmente al estadio metastásico. CONCLUSIONES: Se presenta una serie de pacientes CP avanzado en tratamiento con TDA que muestra heterogeneidad de características y de manejo según práctica clínica habitual. En nuestra serie el PSA elevado al diagnóstico, histología desfavorable y no alcanzar un PSA<0,1 ng/ml tras la TDA se presentan como indicadores de progresión a estadio CPRC.

Condylectomy and "surgery first" approach: An expedited treatment for condylar hyperplasia in a patient with facial asymmetry.

Condylar Hyperplasia (CH) is a self-limiting pathology condition that produces severe facial deformity at the expense of mandibular asymmetry. In this case report a 15-year-old female patient was diagnosed with Unilateral Condylar Hiperplasia (UCH) by mean of single-photon emission computed tomography (SPECT) and histological study. A high condylectomy in the right condyle was performed to stop the active status of the hyperplasia. A month after condylectomy, orthognathic jaw impaction and asymmetric mandibular setback surgery was performed with the Surgery First Approach (SFA). After 10 days, orthodontic appointments were made every two weeks during 4 months. The active phase of treatment lasted 14 months. Excellent facial and occlusal outcomes were obtained and after 24 months in retention the results remained stable.

Vitamina D: una estrategia profiláctica en tiempos del SARS-CoV-2. Vitamina D, SARS-CoV-2 y odontología / Vitamin D: A prophylactic strategy in times of SARS-CoV-2. Vitamin D, SARS- CoV-2 and Dentistry

Objetivo: ofrecer a todo el personal de salud oral un resumen narrativo de la literatura sobre la relación entre el uso de la vitamina D y la COVID-19, a través de la presentación de los beneficios de este suplemento. Se espera aportar a ampliar el conocimiento sobre esta sustancia orgánica, en tanto herramienta profiláctica para la salud de todos. Método: La búsqueda bibliográfica se realizó en las bases de datos PubMed, Cochrane, Science Direct y Ebsco, observando los años 2010 a 2020. Se seleccionaron 65 referencias bibliográficas relacionadas con la vitamina D, sus funciones intra y extra esqueléticas y su posible relación con el SARS-CoV-2; además, se incluyeron estudios que evalúan la deficiencia de vitamina D en el personal de salud. Resultados: la revisión narrativa efectuada demuestra que la deficiencia de vitamina D es frecuente en el personal de salud y que esta deficiencia reduce la actividad defensiva inmunológica. Además, se demuestra que existe suficiente evidencia de la relación entre niveles deficientes de vitamina D en plasma y el riesgo de desarrollar formas severas de COVID-19, especialmente en población susceptible. Conclusiones: se recomienda, tanto al personal de la salud como a los pacientes, el consumo de un suplemento de vitamina D como medida profiláctica.

Objective: to provide the clinicians and dental health staff with relevant information about the role of Vitamin D in connection with COVID-19, presenting the needs, benefits and risks of Vit D supplementation in the doses suggested in literature, to indicate preventive actions and provide patients advice to reduce the consequences of COV ID -19. Method: The bibliographic search was carried out in the PubMed, Cochrane, Science Direct and Ebsco databases, observing the years 2010 to 2020. We selected 65 references related to vitamin D and its intra and extra-skeletal functions, its possible relationship to SARS-CoV-2, and also included studies assessing vitamin D deficiency in health care workers. Results: Vitamin D deficiency is frequent in dental staff and this deficiency reduces the efficiency of immunologic defenses. There is evidence regarding a relationship between vitamin D levels and risk of severe forms of COVID-19. Conclusion: It is recommended the prophylactic use of a Vitamin D supplement for both dentists and dental patients.

Mandibular and temporomandibular morphologic characteristics of patients with suspected unilateral condylar hyperplasia: a CT study

ABSTRACT Introduction: Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a complicated clinical condition. Objective: The objective of this study was to describe morphological characteristics of the mandible and the temporomandibular joint in patients with facial asymmetry, using computed tomography and 3D reconstruction. Methods: A retrospective observational study was performed with patients displaying facial asymmetry evaluated by single photon emission computed tomography (SPECT)/CT analysis, for suspected UCH, between 2015 and 2018. The following variables were compared between the affected side (producing the asymmetry) and the contralateral side (side to where the jaw is deflected): condylar length, condylar medial and lateral pole length, mandibular ramus length, intra-articular spaces, articular eminence height and position of the posterior wall of the glenoid fossa. Results: Forty-three patients (21 women, mean age: 20.7 ± 7.25 years) with facial asymmetry were included, 19 patients presented right side deviation and 24 patients had left side deviation. Condylar length, lateral pole length, the sum of maximum values and articular eminence height were greater in the affected side (p< 0.05). A positive correlation was found between the position of the posterior wall of the glenoid fossa and the articular eminence height in the affected side (r = 0.442). Conclusions: In patients with suspected UCH, evaluated through CT, craniofacial measurements showed significantly larger condylar length and the condylar sum of maximum values in the affected side. A positive correlation was found between the increased dimensions of the articular eminence and the more posterior position of the glenoid fossa in the affected side.

RESUMO Introdução: A assimetria facial associada à hiperplasia condilar unilateral (HCU) é uma condição clínica complexa. Objetivo: O objetivo desse estudo foi descrever as características morfológicas da mandíbula e da articulação temporomandibular de pacientes com assimetria facial, usando tomografia computadorizada e reconstruções tridimensionais. Métodos: Esse estudo observacional retrospectivo foi realizado em pacientes com assimetria facial e suspeita de HCU, avaliados por meio da análise de tomografia computadorizada de emissão de fóton único (SPECT)/TC, entre os anos de 2015 e 2018. As seguintes variáveis foram comparadas entre o lado afetado (responsável pela assimetria) e o lado contralateral (lado para onde a arcada estava desviada): comprimento condilar, comprimento dos polos medial e lateral do côndilo, comprimento do ramo mandibular, espaços intra-articulares, altura da eminência articular e posição da parede posterior da fossa glenoide. Resultados: A amostra constituiu-se de 43 pacientes (21 mulheres, idade média: 20,7 ? 7,25 anos) com assimetria facial, da qual 19 pacientes apresentavam desvio do lado direito e 24, do lado esquerdo. O comprimento condilar, o comprimento do polo lateral, a soma dos valores máximos e a altura da eminência articular foram maiores no lado afetado (p< 0,05). Foi encontrada uma correlação positiva entre a posição da parede posterior da fossa glenoide e a altura da eminência articular no lado afetado (r = 0,442). Conclusão: Em pacientes com suspeita de HCU, avaliados por meio de TC, as medidas craniofaciais mostraram um comprimento condilar e a soma dos valores condilares máximos significativamente maiores no lado afetado. Foi encontrada uma correlação positiva entre as dimensões aumentadas da eminência articular e a posição mais posterior da fossa glenoide no lado afetado.

Condylectomy and "surgery first" approach: An expedited treatment for condylar hyperplasia in a patient with facial asymmetry

ABSTRACT Condylar Hyperplasia (CH) is a self-limiting pathology condition that produces severe facial deformity at the expense of mandibular asymmetry. In this case report a 15-year-old female patient was diagnosed with Unilateral Condylar Hiperplasia (UCH) by mean of single-photon emission computed tomography (SPECT) and histological study. A high condylectomy in the right condyle was performed to stop the active status of the hyperplasia. A month after condylectomy, orthognathic jaw impaction and asymmetric mandibular setback surgery was performed with the Surgery First Approach (SFA). After 10 days, orthodontic appointments were made every two weeks during 4 months. The active phase of treatment lasted 14 months. Excellent facial and occlusal outcomes were obtained and after 24 months in retention the results remained stable.

RESUMO A hiperplasia condilar (HC) é uma condição patológica autolimitante que produz deformidades faciais severas devido à assimetria mandibular. Nesse estudo de caso, uma paciente de 15 anos de idade foi diagnosticada com hiperplasia condilar unilateral (HCU), por meio de uma tomografia computadorizada por emissão de fóton único (SPECT) e de um estudo histológico. Uma condilectomia alta no côndilo direito foi realizada para interromper o status ativo da hiperplasia. Um mês após o procedimento, foram realizadas a impacção ortognática de maxilar e a cirurgia de retroposicionamento assimétrico da mandíbula, por meio de abordagem do tipo benefício antecipado. Depois de 10 dias, consultas ortodônticas passaram a ser feitas a cada duas semanas, durante 4 meses. A fase ativa do tratamento durou 14 meses. Excelentes resultados oclusais e faciais foram obtidos e, após 24 meses de contenção, os resultados permaneceram estáveis.

Percutaneous discectomy: a current treatment for lumbar disc herniation / Discotomia percutânea: tratamento vigente para hérnia de disco lombar / Discectomía percutánea: un tratamiento vigente para la hernia discal lumbarresumen

ABSTRACT Objective: Describe the functional outcomes of patients with contained lumbar disc herniation (L4-L5, L5-S1) treated with manual percutaneous nucleotomy (MPN) and demonstrate that it remains a technique with good results. Methods: A prospective, longitudinal study with 110 patients contained with lumbar disc herniation (LDH) treated with (MPN). The evaluation was pre-surgical and 4, 30, 180 and 365 days after the surgery. We used Numeric Pain Scale (NPS), Oswestry Disability Index (ODI) and Macnab criteria. Descriptive and inferential statistics for differences. Results: N=110: 58 (52.72%) men, 52 (47.27%) women; average age 37.95 years (14-56) ± 10.60; most affected level: L4-L5 in 63 (57.14%) patients. NPS preoperative average: 7.75 (5-9) ± 1.12, and at 365 days: 2.14 (0-7) ± 2.37. The mean preoperative ODI was 37% (28%-40%) + 3.06, and at 365 days 9.52% (0%-40%) + 13.92. The prognosis (ODI) was good to 79 (71.81%) patients at 365 days, regular in 26 (23.63%) and poor in 5 (4.57%), corresponding respectively to patients with no, mild, moderate and severe disability. The Macnab criteria showed similar results (p = 0.00, 95% CI 0.00 to 0.13 - Student's t). Conclusions: The results were good at one-year follow-up (p = 0.00), demonstrating that the MPN is still a good option for lumbosciatic pain relief.

RESUMO Objetivos: Descrever os resultados funcionais dos pacientes com hérnia de disco lombar contida (L4-L5, L5-S1) tratada com nucleotomia percutânea manual (NPM) e demonstrar que continua sendo uma técnica com bons resultados. Métodos: Estudo prospectivo, longitudinal com 110 pacientes com hérnia de disco lombar (HDL) contida tratados com NPM. A avaliação foi pré-cirúrgica e 4, 30, 180 e 365 dias depois da operação; utilizamos Escala Numérica de Dor (END), Índice de Incapacidade Funcional de Oswestry (ODI) e critérios de Macnab. Estatística descritiva e inferencial para diferenças. Resultados: N = 110: 58 (52,72%) homens, 52 (47,27%) mulheres; média de idade 37,95 anos (14-56) ± 10,60; nível mais afetado: L4-L5 em 63 (57,14%) pacientes. END pré-operatório média: 7,75 (5-9) ± 1,12; aos 365 dias: 2,14 (0-7) 2,37. O ODI pré-operatório médio foi 37% (28%-40%) ± 3,06, e aos 365 dias 9,52% (0%-40%) ± 13,92. O prognóstico (ODI) foi bom em 79 (71,81%) pacientes aos 365 dias, regular em 26 (23,63%) e ruim em 5 (4,57%), correspondendo, respectivamente, a pacientes sem incapacidade ou leve, moderada e severa. Os critérios de Macnab mostraram resultados similares (p = 0,00, IC 95% 0,00-0,13 - t de Student). Conclusões: Os resultados foram bons em um ano de acompanhamento (p = 0,00), demonstrando que a NPM continua sendo uma boa opção para o alívio da dor lombociática por HDL.

RESUMEN Objetivos: Describir los resultados funcionales de los pacientes con hernia discal lumbar contenida (L4-L5, L5-S1) tratada con nucleotomía percutánea manual (NPM) y demostrar que continua siendo una técnica con buenos resultados. Métodos: Estudio prospectivo, longitudinal, con 110 pacientes con hernia discal lumbar (HDL) contenida tratados con NPM. La evaluación fue preoperatoria y a los 4, 30, 180 y 365 días después de operados; utilizamos la Escala Numérica del Dolor (END), Índice de Discapacidad Funcional de Oswestry (IDO) y criterios de Macnab. Estadística descriptiva e inferencial para diferencias. Resultados: N = 110: 58 (52,72%) hombres, 52 (47,27%) mujeres; edad promedio 37,95 años (14-56) + 10,60; nivel más afectado: L4-L5 en 63 (57,14%) pacientes. END preoperatorio promedio: 7,75 (5-9) + 1,12; a los 365 días: 2,14 (0-7) + 2,37. El IDO preoperatorio promedio fue 37% (28%-40%) + 3,06, y a los 365 días 9,52% (0%-40%) + 13,92. El pronóstico (IDO) fue bueno en 79 (71,81%) pacientes a los 365 días, regular en 26 (23,63%) y malo en 5 (4,57%), correspondientes a pacientes sin incapacidad o leve, moderada y severa respectivamente. Los criterios de Macnab mostraron resultados similares, (p = 0,00, IC 95% 0,00-0,13 - t de Student). Conclusiones: Los resultados fueron buenos al año de seguimiento (p = 0,00), demostrando que la NPM continua siendo una buena opción para el alivio del dolor lumbociático por HDL.

Corrección de maloclusión dental clase II unilateral con dispositivo de anclaje temporal infracigomático / Unilateral class II malocclusion correction with infrazygomatic temporary anchorage device

La maloclusión dental clase II unilateral ha tenido varios enfoques de tratamiento a lo largo de la historia de la ortodoncia. Dichos enfoques han estado influenciados por tendencias, de acuerdo a las innovaciones en la tecnología y la eficacia del tratamiento instaurado. Actualmente el manejo ortodóncico para corregir las maloclusiones dentales unilaterales procura evitar en gran medida la extracción dental y que los aditamentos requieran de un mínimo de colaboración por parte del paciente. El siguiente reporte de caso tiene como objetivo ilustrar al lector acerca del manejo que se ha tenido hasta la fecha de la maloclusión dental de clase II unilateral y propone un manejo contemporáneo con el uso de Dispositivos de Anclaje Temporal (DAT), basado en evidencia científica, en un paciente masculino de 18 años de edad con diagnóstico de maloclusión dental clase II subdivisión derecha de 5 mm, logrando objetivos estéticos y funcionales.

Unilateral class II malocclusion has been treated along the history of orthodontics by multiple approaches. The treatment tendencies reflect the development of technology and treatment efficiency. Temporary Anchorage Devices (TADs) are now considered the best way to treat unilateral malocclusion without extractions, because is not dependent of patient cooperation. The following case report of a male, 18 year old, patient, presenting a class II malocclusion of 5 mm in the right hand side, suggest a treatment approach based on the use of TADs and explains previous approaches to treat unilateral class II malocclusions. The treatment outcome was both aesthetic and functional.

Representación de problemas matemáticos asociados al uso del algoritmo de signación en población sorda / Representation of Mathematical Problems with the Use of the Assignment Algorithm Form Used with Deaf People / Representação de problemas matemáticos associados ao uso do algoritmo de signação em população surda

Objetivo. La presente investigación pretende describir el cambio en los desempeños (logro y tipos de representación utilizados) de estudiantes de una escuela para población sorda de la ciudad de Cali después de recibir instrucción en el uso del algoritmo de signación, propuesto por Nunes y Moreno (1998b). Método. Para ello, se realizó un estudio con diseño descriptivo, en el que se empleó el formato de pretest y postest, así como comparación descriptiva con grupo control. Ocho estudiantes participaron para conformar dos grupos de cuatro integrantes. Como instrumento de evaluación se aplicó una batería de problemas aritméticos en formato arábigo y en lengua de señas colombiana (LSC) tanto en el pre como en el postest. La intervención consistió de cinco sesiones, donde se explicó a los estudiantes el uso del algoritmo al resolver problemas aditivos. Resultados. Se realizaron análisis de estadística descriptiva para variables categóricas, los cuales mostraron diferencias en los porcentajes de logro, formas de representación del problema y uso de estrategias en el grupo intervenido en el postest. Conclusión. Los resultados permiten concluir que una estrategia educativa pensada para la población sorda puede contribuir a mejorar los aprendizajes de conceptos matemáticos básicos.

Objective. The purpose of this research was to describe the change in performance (achievement and types of representation employed) of students attending a school for deaf people in the city of Cali, after receiving instructions in the use of the assignment algorithm proposed by Nunes and Moreno (1998b). Method. For this purpose, a descriptive study was carried out, in which a pre-test and post-test formula were used, as well as a descriptive comparison with control group. Eight students took part, to form two groups of four members each. As an instrument of evaluation, a battery of arithmetical problems was applied in arabic format, and in Colombian sign language (CSL), in the pre as well as the post test. The intervention consisted of five sessions in which an explanation was given to students on the use of the algorithm for solving problems of addition. Results. A descriptive statistical analysis was carried out for categorized variables, which showed differences in percentages of achievement, ways of problem representation and the use of strategies in the post test group. Conclusion. The conclusion drawn from the results was that an educational strategy designed for deaf people could help to improve learning of basic mathematical concepts.

Escopo. A presente pesquisa pretende descrever a mudança nos desempenhos (logro e tipo de representação utilizados) de estudantes de uma escola para população surda da cidade de Cali depois de receber instrução no uso do algoritmo de signação proposto por Nuñez e Moreno (1998b). Metodologia. Para isto, foi feito um estudo com desenho descritivo, no que empregou-se o formato de pretest e postest, assim como comparação descritiva com grupo de controle. Oito estudantes participaram para conformar dois grupos de quatro integrantes. Como instrumento de avaliação foi aplicado uma bateria de problemas aritméticos em formato arábigo e em língua de senhas colombianas (LSC) tanto no pre quanto no postest. A intervenção consistiu de cinco sessões onde foi explicado aos estudantes o uso do algoritmo ao resolver problemas auditivos. Resultados. Foram realizadas análises de estadística descritiva para variáveis categóricas, os quais mostraram diferenças nos porcentagem de logro, formas de representação do problema e uso de estratégias no grupo da intervenção no postest. Conclusão. Os resultados permitem concluir que uma estratégia educativa pensada para a população surda pode contribuir a melhorar as aprendizagens de conceitos matemáticos básicos.

La altitud como factor de riesgo para defectos deL tubo neuraL (DTN) / Altitude as a risk factor for neural tube defects (NTD)

Objetivo: determinar si la altura es un factor de riesgo para defectos del tubo neural (DTN) al comparar las prevalencias de defectos del tubo neural entre hospitales que utilizan la metodología del Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC) en las ciudades de Cali y Bogotá.Metodología: se realizó un estudio transversal haciendo uso de la base de datos del ECLAMC del Hospital Universitario del Valle (HUV) de la ciudad de Cali; Hospital Simón Bolívar, Clínica Emmanuel, Hospital Universitario San Ignacio y Clínica David Restrepo de la ciudad de Bogotá. La población en estudio fue la de los recién nacidos en dichas instituciones entre febrero del 2004 y marzo del 2005. Se estimó la razón de prevalencias entre las ciudades.Resultados: en el HUV de Cali se registraron 7.201 nacimientos entre febrero 2004 y marzo del 2005, dentro de los cuales se identificaron 21 casos de recién nacidos con DTN, para una prevalencia de 29,2 por cada 10.000 nacidos. En Bogotá la suma total de nacimientos registrados en las cuatro instituciones, fue de 15.239, y se identificaron nueve recién nacidos con DTN, para una prevalencia de seis por cada 10.000 nacidos. Se observó una diferencia estadísticamente significativa en general, para todos los DTN (RP: 4,94; 95 por ciento IC: 2,26 - 10,78), siendo marcada para anencefalia (RP: 8,46; 95 por ciento IC: 1,80 - 39,85) y para espina bífida (RP: 3,81; 95 por ciento IC: 1,28 - 11,36).Conclusiones: la prevalencia de los DTN es mayor en ciudades con altitud menor de 2.000 m sobre el nivel del mar, hallazgo acorde con lo reportado en la literatura.