Temporal evolution of postsurgical bone repair in a rabbit model: A [99mTc]Tc-MDP scintigraphic study

Abstract Bone regeneration is crucial for repairing bone tissue following various injuries. Research techniques that enable the study of metabolic changes in bone tissue under different conditions are important for understanding bone repair and remodeling. This study used bone scintigraphy to evaluate osteogenesis secondary to osteotomy in a preclinical model of New Zealand rabbits. For this purpose, we conducted a longitudinal, prospective, case-control study in which scintigraphic variables were measured in both the right forearm (case-operated) and the left forearm (control - non-operated). The study sample consisted of 10 rabbits subjected to osteotomy, followed by a 12-week postoperative evaluation period, divided into six imaging stages at 1, 2, 3, 4, 8, and 12 weeks. We observed that the operated forearm showed significantly higher external radiation than the control side, using the pinhole collimator, denoting an increase in the biodistribution and tropism of the radiopharmaceutical to the operated forearm. Among the three evaluated time points, osteoblastic activity was highest in the second week and presented a significant decline in the 8th and 12th weeks, denoting regeneration and resolution of the surgical injury; the control forearm was also influenced by the inactivity imposed by the operated forearm. This fact was notably evidenced by the reduction in the metabolic activity of osteoblasts in the left forearm. Our study suggested that bone scintigraphy was sensitive enough to semi-quantitatively differentiate the metabolic activity of osteoblasts in the operated forearm in the three temporal landmarks evaluated in the study.

Estudio de concordancia de radiografía-tomografía computarizada de las fracturas de radio distal / Radiography-computed tomography concordance study of distal radius fractures

Introducción: La fractura de radio distal resulta común en la extremidad superior y representa un reto terapéutico. Objetivo: Determinar la concordancia entre radiografía simple y tomografía computarizada con respecto a las clasificaciones AO Foundation y de Fernández, y la elección del tratamiento. Métodos: Se realizó un estudio de concordancia diagnóstica entre radiografía simple y tomografía computarizada. Ortopedistas y cirujanos de mano analizaron 19 imágenes de fracturas de radio distal de acuerdo con las clasificaciones AO Foundation y de Fernández, y las distintas opciones de tratamiento. Para el grado de concordancia se usó el coeficiente Kappa de Fleiss. La prueba de t-Student y Chi cuadrado diferenciaron los grupos para variables cuantitativas y cualitativas, respectivamente. Hubo una significancia estadística de p= 0,05. Resultados: La clasificación de Fernández coincidió mejor que la clasificación AO Foundation entre radiografía y tomografía computarizada. En la elección del tratamiento y la técnica de osteosíntesis la concordancia fue mayor al 90 por ciento, mientras que el abordaje quirúrgico solo alcanzó el 50 por ciento. La clasificación AO Foundation radiográfica se correspondió con fracturas complejas, mientras la de Fernández con las menos complicadas. Las fracturas se subestimaron cuando se clasificaron con radiografía. Conclusiones: La relación de las clasificaciones entre radiografía y tomografía computarizada para fracturas de radio distal no resulta satisfactoria. La tomografía computarizada ofrece información que modifica las decisiones en el tratamiento(AU)

Introduction: Distal radius fracture is common in the upper extremity and represents a therapeutic challenge. Objective: To determine the agreement between simple radiography and computed tomography with respect to AO Foundation and Fernández classifications, and the choice of treatment. Methods: A diagnostic agreement study was carried out between simple radiography and computed tomography. Orthopedists and hand surgeons analyzed 19 images of distal radius fractures according to AO Foundation and Fernández classifications, and the different treatment options. Fleiss Kappa coefficient was used for the degree of agreement. The Student's t-test and chi-square differentiated the groups for quantitative and qualitative variables, respectively. There was a statistical significance of p = 0.05. Results: Fernández classification coincided better than AO Foundation between radiography and computed tomography. In the choice of treatment and osteosynthesis technique, agreement was greater than 90 percent, while the surgical approach only reached 50 percent. The radiographic AO Foundation classification corresponded to complex fractures while Fernández classification corresponded to less complicated ones. Fractures were underestimated when classified with radiography. Conclusions: The relationship of classifications between radiography and computed tomography for distal radius fractures is not satisfactory. Computed tomography provides information that modifies treatment decisions(AU)

Hemimelia tibial: Presentación de un caso / Tibial Hemimelia

Introducción: La hemimelia tibial o hemimelia paraxial longitudinal tibial, es una deficiencia congénita de la tibia. Esta deficiencia de los miembros inferiores longitudinal tibial, es muy rara y su frecuencia está en el orden de 1: 1 000 000 de niños nacidos vivos. Objetivo: Presentar un caso de hemimelia tibial diagnosticado por medio del cuadro clínico y radiografías y tratado quirúrgicamente. Presentación del caso: Paciente masculino de dos horas de nacido, atendido por presentar malformación congénita a nivel de la pierna derecha que se presentaba acortada con una prominencia dura a nivel proximal y el pie con deformidad marcada en supinación, aducción y rotación interna. Se realizó examen físico exhaustivo de la extremidad afecta y se constató el acortamiento evidente de la misma. Se indicó radiografía anteroposterior y lateral de la pierna y se observó que el segmento proximal de la tibia y el peroné estaban bien, pero con implantación alta, por lo que se diagnosticó una hemimelia tibial tipo II de Jones. Luego del alta el niño recibió seguimiento por consulta de Genética y el servicio de Ortopedia donde se decidió someterlo a un primer tiempo quirúrgico a los 6 meses de edad, mediante tibialización del peroné. A los 10 meses se realizó un segundo tiempo quirúrgico para centrar el astrágalo al peroné. Conclusiones: La hemimelia tibial se considera un diagnóstico poco frecuente en nuestro medio. No existe prevención conocida. El tratamiento es complejo y altamente especializado, y en algunos casos requiere la amputación temprana del miembro afectado para adaptar al paciente al uso de prótesis(AU)

Introduction: Tibial hemimelia or tibial longitudinal paraxial hemimelia is a congenital deficiency of the tibia. This tibial longitudinal lower limb deficiency is very rare and its frequency is in the order of 1: 1,000,000 live births. Objective: To report a case of tibial hemimelia diagnosed through the clinical condition and radiographs and treated surgically. Case report: We report the case of a two-hour-old male patient, treated for a congenital malformation at the level of the right leg that was shortened with a hard prominence at the proximal level and the foot with marked deformity in supination, adduction and internal rotation. An exhaustive physical examination of the affected limb was carried out and its evident shortening was confirmed. Anteroposterior and lateral X-rays of the leg were indicated and it revealed that the proximal segment of the tibia and fibula were fine, but with high implantation, for which a Jones type II tibial hemimelia was diagnosed. After discharge, the child was followed up by the Genetics consultation and the Orthopedics service, where it was decided to undergo a first stage surgery at 6 months of age, by means of tibialization of the fibula. At 10 months, a second surgical time was performed to center the talus to the fibula. Conclusions: Tibial hemimelia is considered a rare diagnosis in our setting. There is no known prevention. Treatment is complex and highly specialized, and in some cases requires early amputation of the affected limb to adapt the patient to the use of a prosthesis(AU)

Evaluación radiológica pre y posoperatoria de la osteotomía de Austin y uso de AutoCAD® / Preoperative and Postoperative Radiological Evaluation of Austin Osteotomy and Use of Autocad®

Introducción: Se han descrito más de 300 técnicas quirúrgicas para la corrección del hallux valgus. Una de ellas es la técnica de Austin, la cual constituye una osteotomía capital en V con una angulación de 60º utilizada en el tratamiento quirúrgico del hallux valgus leve-moderado. Objetivos: Analizar el grado de corrección que tiene la osteotomía de Austin sobre diferentes parámetros radiológicos y describir la frecuencia con la que se utilizan técnicas complementarias sobre la falange proximal. Métodos: Se realizó un estudio descriptivo, transversal, observacional y retrospectivo. Se seleccionó una muestra de 29 pies intervenidos mediante la técnica de Austin, a los que se les realizaron varias mediciones sobre sus radiografías pre y posoperatorias con AutoCAD®. Resultados: Se obtuvieron diferencias estadísticamente significativas en todos los parámetros evaluados. Conclusiones: Esta técnica corrige significativamente todos los parámetros analizados. Se demuestra que el uso de técnicas quirúrgicas complementarias sobre la falange proximal es bastante frecuente al realizar esta osteotomía(AU)

Introduction: More than 300 surgical techniques have been described for the correction of hallux valgus. One of them is the Austin technique, which constitutes a capital V osteotomy with an angulation of 60º used in the surgical treatment of mild-moderate hallux valgus. Objectives: To analyze the degree of correction that Austin osteotomy has on different radiological parameters and to describe the frequency with which complementary techniques are used on the proximal phalanx. Methods: A descriptive, cross-sectional, observational and retrospective study was carried out in a sample of 29 feet operated on using the Austin technique. Several measurements were made on their pre- and postoperative radiographs with AutoCAD®. Results: Statistically significant differences were obtained in all the parameters evaluated. Conclusions: This technique significantly corrects all the parameters analyzed. It is shown that the use of complementary surgical techniques on the proximal phalanx is quite frequent when performing this osteotomy(AU)

Single-center, retrospective study on changes in pain-relieving therapy after bone metastasis detection by bone scintigraphy in prostate cancer patients

Abstract Whole-body bone scintigraphy (WB-BS) is used for detecting and monitoring metastatic spread of prostate cancer (PCa) and to investigate bone pain episodes. To investigate the impact of a positive WB-BS on pain-relieving medicine prescription in PCa patients, a single-center, retrospective cohort study with PCa patients classified as positive for bone metastases (BM) by WB-BS was conducted. Demographic, clinical, and ambulatory pain-relieving medicine prescription data were evaluated. Pain-relieving medicines were categorized according to the WHO 'Analgesic Ladder'. Regimens adopted before and after WB-BS were compared. Differences were considered significant at p<0.05. A total of 180 PCa patients were diagnosed with BM, 64.4% of whom were ≥65 years of age. Thirty-three patients were prescribed analgesics only after WB-BS, mostly including NSAIDs and weak opioids. Pain-relieving prescription changed after WB-BS in patients with prescriptions before and after WB-BS, with a reduction in NSAIDs and adjuvants and an increase in weak and strong opioids. In addition, 40% of patients with WHO analgesic step 1 drugs and 21.7% of patients with WHO step 2 drugs before WB-BS changed to other WHO steps after WB-BS. Pain-relieving prescriptions changed after a positive WB-BS, providing evidence that it could contribute to clinical management of painful metastatic PCa patients.

Actualidad sobre el consenso de los sistemas de clasificación en la fractura distal del radio

RESUMEN Introducción: Una clasificación es necesaria para la correcta orientación del cirujano ortopédico en cuanto a diferenciar los tipos de fracturas del extremo distal del radio, su pronóstico en base a su complejidad, la importancia de la radiografía, las variables demográficas de cada caso y qué tipo de proceder será el más indicado para el paciente. Objetivo: Actualizar las clasificaciones para fracturas del extremo distal del radio. Desarrollo: Se procedió a la búsqueda en las bases de datos Pubmed/ Medline, SciELO, BVS, Scopus, Ebsco y Cochrane, se emplearon los descriptores "fractura distal del radio", clasificación de fractura del extremo distal del radio, fractura de la muñeca, consenso sobre fractura del extremo distal del radio, radiología en la fractura de muñeca, guías terapéuticas actuales para el tratamiento de las fracturas distales del radio, solo y con las siguientes cadenas "clasificación", "radiología". Fueron incluidos 19 artículos originales, 10 de revisión, 4 guías terapéuticas, 2 de investigación y 2 libros de la especialidad. Se examinaron los sistemas de clasificación de las fracturas del extremo distal del radio. Conclusiones: No existe consenso en el sistema de clasificación. Se comprueba el pobre aporte al ortopédico de la clasificación de Frykman y que el sistema AO demuestra ser más fácil de interpretar. Se evidencia la utilidad de la radiografía con tracción esquelética para un diagnóstico útil y de ayuda al cirujano en la toma de decisiones para el tratamiento del paciente.

ABSTRACT Introduction: A classification is necessary for the correct orientation of the orthopedic surgeon in terms of differentiating the types of fractures at the distal end of the radius, their prognosis based on their complexity, the importance of radiography, the demographic variables of each case and what type of procedure will be the most suitable for the patient. Objective: To evaluate the current classifications for fractures of the distal end of the radius and to propose on the existing evidence which classification systems have better reliability and reproducibility. Development: The Pubmed / MEDLINE, SciELO, BVS, Scopus, Ebsco and Cochrane databases were searched; the descriptors "distal radius fracture", distal radius fracture classification, wrist fracture were used. , consensus on fracture of the distal end of the radius, radiology in the fracture of the wrist, current therapeutic guidelines for the treatment of distal fractures of the radius, alone and with the following chains "classification", "radiology". 19 original articles, 10 review articles, 4 therapeutic guidelines, 2 research guides, and 2 specialty books were included. Classification systems for distal radius fractures were examined. Conclusions: There is no consensus on the classification system. The poor contribution to the orthopedic of the Frykman classification is verified and that the AO system proves to be easier to interpret. The usefulness of skeletal traction radiography is evidenced for a useful diagnosis and to help the surgeon in making decisions for the treatment of the patient.

Determination of early bone metastasis on Bone Scans Using the Gray Levels Histogram / Búsqueda de metástasis ósea temprana en gammagramas óseos usando el histograma de tonos de gris

ABSTRACT The aim of this paper is to show a technique to speed up the interpretation of bone scans in order to determine the presence of early bone metastasis. This is done using the gray levels histogram of the region of interest. The technique is intended to assist in the bone scans interpretation in order to provide a successful diagnosis. During the analysis, three types of histograms were observed on the regions of interest. If the histogram is narrow and shifted toward the origin, the bone scan is free of metastasis. If it is shifted to the right and slightly broadened, indicates the presence of a bone anomaly different from a metastasis. On the other hand, if the histogram is more broadened and shifted to the right, is suggests the presence of metastasis. This histogram is characterized by displaying small curls on the right side providing information about the metastatic disease stage, which could be low-amplitude peaks and have a short length, if the metastasis is in early stage, or high-amplitude peaks and a long length, if is advanced. Finally, the analyzed region is displayed in false color considering the minimum gray levels observed in the histogram.

Diffuse pleural metastases of osteosarcoma detected by bone scan.

Osteosarcoma (OS) is a fast-growing tumor, with a high risk of local recurrence and distant metastases, with the lung and bone being the most common sites of dissemination occurring in approximately 80% of cases. Pleural metastases rarely occurs and the appearance of diffuse pleural thickening with ossification is not usual, with few such cases reported due to the current state-of-art treatment protocols. A 29-year-old woman, diagnosed with a proximal left tibial OS underwent planar and single-photon emission computed tomography/computed tomography bone scan scintigraphy with 99mtechnetium methylene diphosphonate showing bilateral pleural uptake, corresponding to multiple calcified foci of thickening and nodules.

Whole-body MRI: a powerful alternative to bone scan for bone marrow staging without radiation and gadolinium enhancer.

PURPOSE: Whole-body magnetic resonance imaging (WB-MRI) is a radiation-free alternative to the 99mTc-HDP bone scan (BS) for the detection of bone metastasis. The major drawback is the long examination time and application of gadolinium enhancer. The aim of this study is to analyze (i) the performance of WB-MRI versus the BS and (ii) the diagnostic benefit of gadolinium (WB-MRI + Gd) compared to a non-enhanced protocol (NE WB-MRI). METHODS AND MATERIALS: 1256 eligible WB-MRI scans were analyzed retrospectively with a single inclusion criterion, a clinical 12-month follow-up or a biopsy as ground truth. N = 285 patients received both a WB-MRI and a BS within 12 months. All the patients were imaged with a coronal T1w and a STIR, and n = 528 (42%) received an additional T1w-mDixon with gadoteridol (0.1 mmol Gd-DTPA/kg). RESULTS: From 1256 eligible patients, n = 884 (70%) had breast cancer as a primary disease, n = 101(8%) prostate cancer, and n = 77(6%) lung cancer. The sensitivity (Se) and negative predictive value (NPV) of the WB-MRI was 98/99%, significantly higher compared to BS with 82/89%, P < 0.001 Mc Nemar's test. The specificity (Spe) and positive predictive value (PPV) of the WB-MRI and BS was 85/82% and 91/86%, respectively. The interobserver agreement between WB-MRI and BS was 71%, Cohen's kappa 0.42. Analysis of the added diagnostic value of gadolinium revealed Se/Spe/PPV/NPV of 98/93/92/98% for the NE WB-MRI and 99/93/85/100% for the WM-MRI + Gd, P > 0.05 binary logistic regression with Fischer's exact test. CONCLUSION: WB-MRI exceeds the sensitivity of BS without compromising the specificity, even after omitting the gadolinium enhancer.

Enfermedad de Pott. Caso clínico radiológico / Pott's disease Radiological clinical case

RESUMEN Introducción: la tuberculosis es una infección causada por el micobacterium tuberculae, la cual afecta principalmente a la vía respiratoria, aunque se le puede ver afectando el sistema musculo esquelético, de este es la columna vertebral la mas afecta, donde provoca una colección fría y caseosa conocida como enfermedad de Pott, que en dependencia de la localización puede debilitar la vértebra y provocar fracturas patológicas con la consiguiente repercusión y limitación en la vida y salud del paciente. Presentación de caso: paciente masculino de 33 años de edad, que acude a nosotros por una fractura de la vértebra D12 producto de una caída sentado de sus propios pies, visualizada en Rx simple de columna total en proyección lateral. Discusión: se evidencia desplazamiento posterior de fragmento óseo y esclerosis subcondral, en el estudio de TAC se corrobora fractura aplastamiento del cuerpo vertebral D12, con desplazamiento posterior de un segmento vertebral que estrecha el canal medular, y en las imágenes de resonancia se confirma fractura aplastamiento de la vértebra D12 con desplazamiento de fragmento óseo y estenosis del canal medular, provocando severa mielitis compresiva con fibrosis a nivel del segmento medular D12. Conclusiones: se mostró la utilidad de los medios diagnósticos convencionales y de alta tecnología en el diagnostico de esta entidad, identificar las lesiones asociadas y complicaciones que puede sufrir el paciente.

ABSTRACT Introduction: tuberculosis is an infection caused by mycobacterium tuberculae, which mainly affects the respiratory tract, although it can be seen affecting the musculoskeletal system, this is the spine the most affected, where it causes a cold and caseous collection known as Pott's disease, which depending on the location can weaken the vertebra and cause pathological fractures with the consequent impact and limitation on the life and health of the patient. Case presentation: a 33-year-old male patient who came to us for a fracture of the vertebra D12 due to a fall sitting on his own feet, visualized in simple Rx of total spine in lateral projection. Discussion: posterior displacement of bone fragment and subchondral sclerosis is evidenced, in the CT study it is corroborated fracture crushing of vertebral body D12, with posterior displacement of a vertebral segment that narrows the medullary canal, and in the resonance images it is confirmed crush fracture of vertebra D12 with displacement of bone fragment and stenosis of the medullary canal, causing severe compressive myelitis with fibrosis at the level of the medullar segment D12. Conclusions: the usefulness of conventional and high-tech diagnostic means in the diagnosis of this entity was shown, identifying the associated injuries and complications that the patient may suffer.

Visualizando Gammagramas Óseos en Colores / Displaying Bone Scans in Color

Resumen En este trabajo se describe el uso de un software para detectar metástasis óseas en gammagramas cuyo funcionamiento está basado en un método cuantitativo. En la investigación se incluyeron cuarenta y tres gammagramas óseos de pacientes con cáncer de próstata, los cuales fueron previamente analizados visualmente por tres especialistas y su diagnóstico se tomó como referencia. Debido a que no todos los huesos de un paciente muestran los mismos tonos de gris, cada uno de los gammagramas se segmentó para su análisis en cuatro regiones: cráneo, hombros, tórax y pelvis. La segmentación se hizo con el fin de obtener intervalos de tonos de gris en cada una de las regiones empleando un proceso estadístico. Para ello se calcularon la media y la desviación estándar de cuatro muestras que contenían cada una cuarenta y tres regiones. Tomando en consideración los intervalos, siete colores fueron asignados a cada región. Mediante los colores fue posible diferenciar los casos sanos e infiltrados en cada región, lo que facilita el diagnóstico. Se muestran ejemplos de los resultados en cada una de las regiones.

Abstract The use of software based on a quantitative method for detecting skeletal metastasis in bone scans is presented. Forty-three bone scans of patients with prostate cancer were previously analyzed visually by three specialists and their diagnosis were taken as a reference. Later, these scans were analyzed by segmenting them into four regions: skull, shoulders, chest, and pelvis. The segmentation was made to obtain intervals of gray levels for each of the regions using a statistical process. Tríese values were found by calculating the mean and standard deviation of four samples containing each forty-three regions. Using these intervals, seven colors were assigned to each region. By means of the colors it is possible to differentiate healthy and infiltrated cases in each region, which may facilitate the diagnosis. Examples of results in each region are shown.

Case Report of Frostbite with Delay in Evacuation: Field Use of Iloprost Might Have Improved the Outcome.

Frostbite is a common injury in high altitude medicine. Intravenous vasodilators have a proven efficacy and, recently, have been proposed as a safe outpatient treatment. Nevertheless, the lack of availability and consequently delayed application of this treatment option can result in poor clinical outcomes for patients. We present the case of a 60-year-old Chilean man with severe frostbite injuries suffered while climbing Mount Everest. The patient was initially given field treatment to the extent permitted by conditions and consensus guidelines. Unfortunately, advanced management was delayed, with iloprost administered 75 hours after the initial injury. The patient also underwent 5 days of hyperbaric and analgesic/antibiotic therapies. An early bone scan predicted a poor clinical outcome, and five of the patient's fingers, between both hands, were incompletely amputated. We present this case to exemplify the importance of advanced in-field management of frostbite injuries.

Hallazgos gammagráficos en manos de población adulta, sin patología osteoarticular, bajo un análisis semicuantitativo / Semi-quantitative analysis of scintigraphic findings in the hands of adults without osteoarticular disease

RESUMEN Introducción: La gammagrafia ósea es uno de los estudios más frecuentemente utilizados para el abordaje diagnóstico de la patología osteoarticular, sin embargo, no se conocen patrones claros de normalidad para algunos sitios anatómicos, llevando a tasas altas de variabilidad interobservador, como es el caso de la evaluación de las manos. No se encuentra en la literatura una descripción del patrón gammagráfico normal sobre manos, por lo cual pretendemos describir el patrón de captación más frecuente en una población adulta sin enfermedad osteoarticular. Materiales y métodos: Se hizo un análisis prospectivo de 156 gammagrafías óseas sobre manos que cumplieron el criterio de inclusión. Se delinearon regiones de interés en el carpo, metacarpo, articulaciones interfalángicas proximales y distales de los dedos índice y medio de ambas manos; se tomaron las cuentas totales, se analizaron promedios y desviación estándar, y se hizo análisis semicuantitativo de la imagen. Resultados: Se incluyeron 36 hombres (23%) y 119 mujeres (77%), la edad media fue de 44,9 ± 13,9. Los promedios de las cuentas totales disminuyeron progresivamente deproximal a distal en todos los grupos de edad y en ambos géneros, siguiendo la siguiente proporción: carpo 4,4 veces más que metacarpo; metacarpo 1,7 veces más que interfalángica proximal; interfalángica proximal 1,4 veces más que distal. Conclusiones: En manos de pacientes adultos, sin enfermedad osteoarticular, sin distinción de género y edad, encontramos un patrón gammagráfico en «degradé¼ con mayor concentración isotópica en carpo, seguida del metacarpo y de las articulaciones interfalángicas proximales y distales.

ABSTRACT Introduction: Bone and joint disease has a high incidence and impact on the population. The bone scan is a diagnostic tool that provides important metabolic and clinical information; therefore the interpretation of the images by the nuclear medicine physician must be very precise. The isotopic distribution pattern in hands has not yet been described. For this reason a description is presented of common scintigraphic findings in adults without osteoarticular disease. Materials and methods: A prospective analysis was conducted on 156 hands of patients whose bone scans met inclusion criteria. There were delineated regions of interest in the carpal, metacarpal, proximal, and distal interphalangeal joints of the second and third fingers of both hands. An analysis was made, including the total counts, means, and standard deviations. The cut-offs were selected using the normal distribution, which was defined as the cut at the 99th percentile of each variable. A semi-quantitative analysis was made of the images. Results: The study included 36 men (23%) and 119 women (77%), and the mean age was 44.9 ± 13.9. The mean total counts gradually decreased from proximal to distal in all age groups and in both genders in the following proportions: the activity in carpus was 4.4 fold more than the metacarpus; the metacarpus was 1.7 fold more than proximal interphalangeal joint; proximal interphalangeal joint was 1.4 fold more than distal one. Conclusions: A scintigraphic pattern consisting of a gradual decrease from proximal to dis-tal joints (degradation) was found in the hands of adults without bone and joint disease, regardless of gender and age.

Quiste óseo aneurismático mandibular / Aneurysmal mandibular bone cyst

El quiste óseo aneurismático es definido como una lesión osteolítica expansiva que consiste en espacios llenos de sangre y canales divididos por tabiques de tejido conectivo, los cuales contienen tejido osteoide y células gigantes multinucleadas. El objetivo es presentar un caso clínico poco común de un quiste óseo aneurismático de la región del cuerpo mandibular. Se trata de una paciente femenina de 39 años de edad que acudió a consulta externa del Servicio de Cirugía Maxilofacial del Hospital Universitario General Calixto García por aumento de volumen en región mandibular derecha y dolor intenso de 1 mes de evolución. Radiográficamente se detectó un área radiolúcida unilocular de bordes bien definidos; se realizó curetaje de la cavidad, y estudio histopatológico de la lesión que informó la presencia de un quiste óseo aneurismático. Se concluye que el quiste óseo aneurismático es más común en los huesos largos y en la región del ángulo mandibular en el esqueleto facial, por lo que la presentación de este en el cuerpo mandibular resulta de interás(AU)

The aneurysmal bone cyst is defined as an expansive osteolytic lesion consisting of blood-filled spaces and divided by partitions of connective tissue, which contain bone tissue and giant cells channels. The objective is to present a rare case of an aneurysmal bone cyst in the region of the mandibular body. This is a case of a 39-year-old female who attended the outpatient Maxillofacial Surgery Service of General Calixto Garcia University Hospital due to an increased volume in right mandibular region and intense pain of a month, both in evolution. Radiographically, a unilocular radiolucent area with well-defined edges was detected; curettage of the cavity and histopathological examination of the lesion were performed, which reported the presence of an aneurysmal bone cyst. It is concluded that the aneurysmal bone cyst is most commonly presented in the long bones and in the region of the mandibular angle in the facial skeleton, so the presentation of this in the mandibular body is of interest(AU)

Quiste óseo aneurismático mandibular / Aneurysmal mandibular bone cyst

El quiste óseo aneurismático es definido como una lesión osteolítica expansiva que consiste en espacios llenos de sangre y canales divididos por tabiques de tejido conectivo, los cuales contienen tejido osteoide y células gigantes multinucleadas. El objetivo es presentar un caso clínico poco común de un quiste óseo aneurismático de la región del cuerpo mandibular. Se trata de una paciente femenina de 39 años de edad que acudió a consulta externa del Servicio de Cirugía Maxilofacial del Hospital Universitario General Calixto García por aumento de volumen en región mandibular derecha y dolor intenso de 1 mes de evolución. Radiográficamente se detectó un área radiolúcida unilocular de bordes bien definidos; se realizó curetaje de la cavidad, y estudio histopatológico de la lesión que informó la presencia de un quiste óseo aneurismático. Se concluye que el quiste óseo aneurismático es más común en los huesos largos y en la región del ángulo mandibular en el esqueleto facial, por lo que la presentación de este en el cuerpo mandibular resulta de interés(AU)

The aneurysmal bone cyst is defined as an expansive osteolytic lesion consisting of blood-filled spaces and divided by partitions of connective tissue, which contain bone tissue and giant cells channels. The objective is to present a rare case of an aneurysmal bone cyst in the region of the mandibular body. This is a case of a 39-year-old female who attended the outpatient Maxillofacial Surgery Service of General Calixto Garcia University Hospital due to an increased volume in right mandibular region and intense pain of a month, both in evolution. Radiographically, a unilocular radiolucent area with well-defined edges was detected; curettage of the cavity and histopathological examination of the lesion were performed, which reported the presence of an aneurysmal bone cyst. It is concluded that the aneurysmal bone cyst is most commonly presented in the long bones and in the region of the mandibular angle in the facial skeleton, so the presentation of this in the mandibular body is of interest(AU)

[Amputation level after frostbite: role of bone scan. A case report]. / Nivel de amputación tras lesiones por congelación: papel de la gammagrafía ósea. Reporte de un caso.

BACKGROUND: frostbite is defined as the damage sustained by tissues while subject to temperatures below their freezing point. The severity of tissue damage is variable, but frequently can result in amputation. Early surgical debridement is contraindicated in almost all patients because it can take weeks for definitive demarcation of non-viable tissues to occur. Bone scan is indicted in the evaluation of frostbite injuries and helps to establish the prognosis early. CLINICAL CASE: a 42 year old man suffered frostbite injury in the fingers and toes after more than 24 hours at 8,000 meters of altitude. The patient was treated with anticoagulant therapy and topical cures for six weeks. During this period, we performed two consecutive bone scan studies showing no changes in the level of vascularization. However, clinical improvement was important, devitalized tissues delimited to the level marked by the bone scan study, so amputation was performed. CONCLUSION: Because the bone scan remained invariable, we believe that could help us to determine the amputation level early without delaying surgery.

Antecedentes: la congelación es el daño sufrido por los tejidos cuando se someten a temperaturas inferiores a su punto de congelación. La gravedad de las lesiones es variable, pero con frecuencia termina en amputación. El desbridamiento quirúrgico temprano está contraindicado en la mayoría de los casos porque la demarcación de los tejidos viables tarda en producirse. La gammagrafía ósea está indicada para la evaluación de las lesiones por congelación y ayuda a establecer el pronóstico temprano. Caso clínico: paciente varón de 42 años, con lesiones por congelación en los dedos de las manos y los pies, tras permanecer más de 24 horas a 8,000 metros de altitud. Durante seis semanas se administró tratamiento anticoagulante y se realizaron curas tópicas. En este periodo se practicaron dos estudios gammagráficos consecutivos, sin apreciarse cambios en la vascularización. Sin embargo, la mejoría clínica fue importante, delimitándose el tejido desvitalizado hasta el nivel marcado por el estudio gammagráfico, por lo que se realizó la amputación. Conclusión: puesto que la gammagrafía ósea permaneció invariable, consideramos que puede ayudar a determinar de forma temprana el nivel de amputación, sin tener que demorar la cirugía.

Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? A retrospective study

PURPOSE: Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. MATERIALS AND METHODS: From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results. RESULTS: Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p = 0.02). Bone metastasis was detected in 39 cases (39.7 percent). In all patients with clinical T1-2 stage, a Gleason score of < 8 and PSA = 20 ng/mL, the bone isotope scans were negative. In univariate analysis, PSA (> 20 ng/mL) and Gleason score (> 7) were independently predictive of positive bone scan, while clinical stage was not. CONCLUSION: Staging bone scans can be omitted in patients with a PSA level of = 20 ng/mL, and Gleason score < 8. Our results suggest that by considering the Gleason score and PSA, a larger proportion of patients with prostate cancer could avoid a staging bone scan.

Medicina nuclear: aplicación en patología osteoarticular / Nuclear medicine: application in osteoarticular pathology

Bone scan, planar or Spect (single photon emission computed tomography) technique is the most frequently nuclear medicine procedures used in the osteoarticular applications. Other procedure, especially Galium 67, is also used. Bone scan is a safe, painless and cost-effective procedure to get information in a wide variety of diseases: malignancies, sports injuries, fractures, infections, inflammations, etc. Very early in the course of these diseases, it is possible to obtain a positive bone scan that reflects both: osteoblastic activity and skeletal vascular abnormalities. However the specificity is much less than the sensitivity of the bone scan procedure, but frequently the final diagnosis can be made by correlating the bone image with clinical data and radiographic findings.

La mayor parte del área osteoarticular en medicina nuclear, tiene como principal examen la cintigrafía ósea, ya sea planar o con técnica SPECT (single photon emision computed tomography). Existen algunos otros exámenes usados como el estudio con Galio-67, en el área de prótesis e infecciones. La sensibilidad, facilidad y seguridad en su realización, lo han hecho un examen altamente solicitado. Una amplia variedad de patologías (tumorales, inflamatorias, infecciosas, traumáticas, etc) producen alteraciones cintigráficas, ya sea por alteración osteoblástica o alteraciones de flujo, y aunque esto hace disminuir su especificidad, existen algunos patrones que claramente orientan a una patología u otra. Por otro lado, la interpretación del examen en el contexto clínico y en conjunto con los exámenes anatómicos del paciente, permite un excelente rendimiento diagnóstico.