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3.
Swiss Dent J ; 130(2): 126-138, 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32024348

RESUMEN

This second article about extraoral anatomy as seen in cone beam computed tomography (CBCT) images presents a literature review of the zygomatico-orbital region. The latter bounds the maxillary sinus superiorly and laterally. Since pathologic changes of the maxillary sinus are a frequent indication for three-dimensional radiography, the contiguous orbital cavity and the zygomatic bone may become visible on CBCT scans. The zygomatic bone forms the cheek prominence and has large contact areas with the maxilla through the zygomaticomaxillary suture in the infraorbital region as well as with the sphenoid bone along the lateral orbital wall. Each of the three surfaces of the zygomatic bone displays foramina that transmit neurovascular structures. The orbital cavity is located immediately above the maxillary sinus from which it is separated only by a thin bony plate simultaneously serving as the orbital floor and the roof of the maxillary sinus. Several openings, such as the superior and inferior orbital fissures, the ethmoidal and cranio-orbital foramina, and the optic and infraorbital canals, connect the orbit to the anterior and middle cranial fossae as well as to the infratemporal and pterygopalatine fossae.


Asunto(s)
Tomografía Computarizada de Haz Cónico , Tomografía Computarizada de Haz Cónico Espiral , Maxilar/diagnóstico por imagen , Seno Maxilar/diagnóstico por imagen , Cigoma
4.
Am J Orthod Dentofacial Orthop ; 157(2): 205-211, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32005472

RESUMEN

INTRODUCTION: This study aimed to determine the volumetric effects on the upper airways of growing patients with Class II malocclusion treated with the Herbst appliance (HA). METHODS: Volumetric measurements of the upper airways of 42 skeletal Class II malocclusion patients (mean age: 13.8 ± 1.2 years; ranging from 12.0 to 16.9 years) were assessed using cone-beam computed tomography scans acquired before treatment (T0) and approximately 1 year later (T1). The sample comprised a Herbst appliance group (HA group [HAG]; n = 24), and a comparison group (comparison group [CG]; n = 18) of orthodontic patients who had received dental treatments other than mandibular advancement with dentofacial orthopedics. RESULTS: In CG, nasopharynx and oropharynx volumes decreased slightly during the observation period (9% and 3%, respectively), whereas the nasal cavity volume increased significantly (12%; P = 0.046). In HAG, there was an increase in the volume of all regions (nasal cavity, 5.5%; nasopharynx, 11.7%; and oropharynx, 29.7%). However, only the oropharynx showed a statistically significant increase (P = 0.003), presenting significant volumetric changes along the time (T1-T0) in HAG. CONCLUSION: Mandibular advancement with the HA significantly increased the volume of the oropharynx, but no significant volumetric modifications were observed in the nasal cavity and nasopharynx.


Asunto(s)
Tomografía Computarizada de Haz Cónico , Maloclusión de Angle Clase II , Aparatos Ortodóncicos Funcionales , Adolescente , Cefalometría , Niño , Humanos , Maloclusión de Angle Clase II/diagnóstico por imagen , Maloclusión de Angle Clase II/terapia , Mandíbula , Avance Mandibular , Orofaringe
5.
Am J Orthod Dentofacial Orthop ; 157(2): 212-217, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32005473

RESUMEN

INTRODUCTION: This study aimed to investigate the association between root morphology of maxillary incisors and nonsyndromic tooth agenesis in patients compared with a control group without agenesis. METHODS: This controlled cross-sectional pilot study (1:4) was performed with a random sample of 335 records from Brazilian applicants for orthodontic treatment, paired by sex and age. Panoramic and periapical radiographs were analyzed to diagnose tooth agenesis and to assess root morphology. The agenesis group (n = 67) included patients with nonsyndromic tooth agenesis, and the control group (n = 268) included patients without tooth agenesis. The statistical analysis included the Student t test and z test, conditional logistic regression, and odds ratio estimates. RESULTS: Occurrence of root morphological changes was significantly higher among patients with agenesis (P <0.05). Significant morphological changes (short, blunt, apically bent, and pipette-shaped roots) were found in the roots of remaining teeth when comparing agenesis and control groups (P <0.05). Patients with agenesis were more likely to show root morphological changes (odds ratio, 74.23; 95% confidence interval, 16.93-325.46; P <0.001). CONCLUSION: Patients with agenesis are more likely to present root morphological changes, which should be considered to minimize problems during orthodontic treatments.


Asunto(s)
Anodoncia , Incisivo , Raíz del Diente , Anodoncia/diagnóstico por imagen , Brasil , Estudios Transversales , Humanos , Incisivo/diagnóstico por imagen , Maxilar , Proyectos Piloto , Radiografía Panorámica , Raíz del Diente/diagnóstico por imagen
6.
Am J Orthod Dentofacial Orthop ; 157(2): 228-239, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32005475

RESUMEN

INTRODUCTION: The objective of this study was to assess the reproducibility of cervical vertebral maturation (CVM) method based on the type of radiographic image and the level of experience and level of training of the evaluator. METHODS: Ten evaluators (5 orthodontic residents and 5 faculty members) were randomly divided into 2 groups: trained and untrained. All participants evaluated 80 radiographic images previously acquired in 4 different formats: (1) 2-dimensional (2D) digital (2D-digital), (2) 2D digitized hard copy from the Iowa Facial Growth Study (American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection), (3) 2D digital reconstructed from a 3-dimensional (3D) radiograph (2D-from 3D), and (4) 3D cone-beam computerized tomographic (3D-CBCT) images. Agreement among evaluators on the morphology of the cervical vertebrae (CV) and the CVM stage of each radiographic image was assessed using Randolph's kappa statistic and Kendall's W coefficient of concordance. RESULTS: Interobserver agreement on the determination of a curvature on the inferior border of the CV was substantial to perfect, whereas agreement on shape was fair to moderate. Overall, the level training in all image types, except 3D-CBCTs, but not the level of experience affected the agreement for shape and curvature of the CVs. Interobserver agreement on CVM staging for all combined images was substantial at 0.72. Faculty had a higher level of agreement than residents except for 2D-digital and 3D-CBCT images, whereas trained evaluators had an overall higher level of agreement than untrained evaluators except for 3D-CBCT images. CONCLUSIONS: Interobserver agreement in determining CVM stage was substantial for all images evaluated; experience and training resulted in higher level of agreement for some image types. The 3D-CBCT images did not provide increased interobserver agreement over current 2D-digital lateral cephalograms in determining CVM staging or shape of the CV. The highest agreement in CVM staging was obtained on 2D-digital lateral cephalograms with training.


Asunto(s)
Cefalometría , Vértebras Cervicales , Tomografía Computarizada de Haz Cónico , Ortodoncia/educación , Vértebras Cervicales/diagnóstico por imagen , Competencia Clínica , Humanos , Imagen Tridimensional , Iowa , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados
8.
Int J Radiat Oncol Biol Phys ; 106(3): 604-611, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-32014151

RESUMEN

PURPOSE: Steep dose falloff outside of tumors is a hallmark of stereotactic radiosurgery (SRS) and radiation therapy (SRT). Dose gradient index (DGI) quantifies the dose drop off. Tables of DGIs versus target volumes have been published for body sites, but none is available for brain. This study recommends guidelines for DGIs for brain SRS/SRT treatments based on clinical CyberKnife (CK) cases. METHODS AND MATERIALS: Four hundred ninety-five plans for patients with central nervous system tumors treated with CK at our institution between March 2015 and May 2018 were analyzed. The CK treatment planning system MultiPlan was used for planning. SRS/SRT plans were stratified into 6 groups by tumor size (Group I [0-1 cm3], II [1.0-3.0 cm3], III [3.0-5.0 cm3], IV [5.0-10.0 cm3], V [10.0-15.0 cm3], and VI [15.0-40.0 cm3]). Ideal and minimally acceptable DGIs were determined for each size group. To evaluate the effect of target shape on DGI criteria, the plans were divided into 4 target shape groups: (1) homogeneous shape (circular), (2) adjacent to radiosensitive organs at risk (adjacent), (3) irregularly shaped (irregular), and (4) multiple target plans (multilesion). The mean for each target size group was defined as the ideal DGI. Minimally acceptable DGI criteria are specified to reject the lowest 10% of cases. RESULTS: The minimal acceptable DGIs were 83 (Group I), 72 (II), 65 (III), 58 (IV), 52 (V), and 35 (VI). The ideal DGI is designated to evaluate SRS/SRT plans for homogeneous circular lesions, whereas minimal DGI is chosen to assess the plans for irregular, adjacent to organs at risk, and multilesions. SRS/SRT plans with higher DGI values are correlated with lower irradiated normal tissue volumes. CONCLUSIONS: This study provides a table of DGIs for brain SRS/SRT treatments as a tool for assessing the quality of intracranial SRS/SRT plans. DGI guidelines support SRS/SRT planning that results in lower risk of radionecrosis.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Órganos en Riesgo/efectos de la radiación , Radiocirugia/métodos , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia Conformacional/métodos , Neoplasias Encefálicas/diagnóstico por imagen , Guías como Asunto , Humanos , Órganos en Riesgo/diagnóstico por imagen , Tolerancia a Radiación , Radiocirugia/efectos adversos , Dosificación Radioterapéutica , Radioterapia Conformacional/efectos adversos , Dispersión de Radiación
9.
Anaesthesia ; 75(3): 359-365, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32022912

RESUMEN

Anaesthesia and positive pressure ventilation cause ventral redistribution of regional ventilation, potentially caused by the tracheal tube. We used electrical impedance tomography to map regional ventilation during anaesthesia in 10 patients with and without a tracheal tube. We recorded impedance data in subjects who were awake, during bag-mask ventilation, with the tracheal tube positioned normally, rotated 90° to each side and advanced until in an endobronchial position. We recorded the following measurements: ventilation of the right lung (proportion, %); centre of ventilation (100% = entirely ventral); global inhomogeneity (0% = homogenous); and regional ventilation delay, an index of temporal heterogeneity. We compared the results using Student's t-tests. Relative to subjects who were awake, anaesthesia with bag-mask ventilation reduced right-sided ventilation by 5.6% (p = 0.002), reduced regional ventilation delay by 1.6% (p = 0.025), and moved the centre of ventilation ventrally from 51.4% to 58.2% (p = 0.0001). Tracheal tube ventilation caused a further centre of ventilation increase of 1.3% (p = 0.009). With the tube near the carina, right-sided ventilation increased by 3.2% (p = 0.031) and regional ventilation delay by 2.8% (p = 0.049). Tube rotation caused a 1.6% increase in right-sided ventilation compared with normal position (p = 0.043 left and p = 0.031 right). Global inhomogeneity remained mostly unchanged. Ventral ventilation with positive pressure ventilation occurred with bag-mask ventilation, but was exacerbated by a tracheal tube. Tube position influenced ventilation of the right and left lungs, while ventilation overall remained homogenous. Tube rotation in either direction resulted in ventilation patterns being closer to when awake than either bag-mask ventilation or a normally positioned tube. These results suggest that even ideal tube positioning cannot avoid the ventral shift in ventilation.


Asunto(s)
Intubación Intratraqueal/métodos , Ventilación Pulmonar , Adulto , Anciano , Anestesia/métodos , Impedancia Eléctrica , Femenino , Humanos , Intubación Intratraqueal/efectos adversos , Máscaras Laríngeas , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva , Respiración Artificial , Tomografía , Adulto Joven
10.
Instr Course Lect ; 69: 625-640, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017756

RESUMEN

It is important to review the physics of current MRI developments in nontraumatic spinal imaging and their specific applications for assessing the bone marrow. Techniques include chemical shift imaging and its use in differentiating aggressive from benign lesions and in confirming the presence of diffuse red marrow conversion, which may mimic diffuse marrow infiltration in metastatic disease. The principles of dynamic contrast MRI and its uses in multiple myeloma and discriminating between postoperative change/scarring versus recurrence in soft-tissue tumors warrant discussion. The basic physics of diffusion-weighted imaging (DWI) in bone marrow pathologies are distinguished from the principles of DWI as applied to solid organs, and DWI is used in the staging of multiple myeloma and in differentiating between benign versus malignant compressive vertebral fractures. The orthopaedic surgeon should be knowledgeable about whole-body MRI principles and its uses in staging multiple myeloma and sarcoma. Knowledge about PET-MRI principles and its limitations as well as its potential use in assessing the subchondral bone plate and bony remodeling is also important. This technique may play a role in the future for predicting progression to osteoarthritis.


Asunto(s)
Médula Ósea/anomalías , Anomalías Musculoesqueléticas/diagnóstico por imagen , Columna Vertebral , Humanos , Imagen por Resonancia Magnética , Mieloma Múltiple , Recurrencia Local de Neoplasia , Fracturas de la Columna Vertebral
11.
Medicine (Baltimore) ; 99(6): e18978, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028407

RESUMEN

RATIONALE: AA amyloidosis (AA) is caused by a wide variety of inflammatory states, but is infrequently associated with Castleman disease (CD). CD describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. CD can present with a solitary enlarged lymph node (unicentric CD, UCD) or with multicentric lymphadenopathy (MCD), constitutional symptoms, cytopenias, and multiple organ dysfunction due to an interleukin-6 driven cytokine storm. PATIENT CONCERNS: We are reporting a case of a 26-year-old woman with no significant past medical history who presented with a 3-month history of fatigue and an unintentional 20-pound weight loss. DIAGNOSIS: A CT-scan of the abdomen and pelvis revealed hepatosplenomegaly and a mesenteric mass. Congo Red staining from a liver biopsy showed apple-green birefringence and serum markers were suggestive of an inflammatory process. Post-excision examination of the resected mass revealed a reactive lymph node with follicular hyperplasia with kappa and lambda stains showing polyclonal plasmacytosis consistent with CD. INTERVENTIONS: The patient underwent surgery to remove the affected lymph node. OUTCOMES: IL-6, anemia, leukocytosis, and thrombocytosis resolved or normalized 2 weeks after resection; creatinine normalized 9 months postsurgery. Twenty two months post-surgery her IFN-γ normalized, her fatigue resolved, her proteinuria was reduced by >90% and she had returned to her baseline weight. LESSONS: Our case and literature review suggest that patients presenting with UCD or MCD along with organ failure should prompt consideration of concurrent AA amyloidosis.


Asunto(s)
Amiloidosis/etiología , Enfermedad de Castleman/complicaciones , Enfermedades Peritoneales/etiología , Adulto , Amiloidosis/sangre , Amiloidosis/diagnóstico , Amiloidosis/diagnóstico por imagen , Enfermedad de Castleman/sangre , Enfermedad de Castleman/diagnóstico , Fatiga/etiología , Femenino , Humanos , Enfermedades Peritoneales/sangre , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/diagnóstico por imagen , Proteína Amiloide A Sérica/análisis , Tomografía Computarizada por Rayos X , Pérdida de Peso
12.
Medicine (Baltimore) ; 99(6): e18996, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028410

RESUMEN

Upper extremity vein thrombosis (UE-VT) are more and more frequent pathologies and yet little studied. The aim is to describe the clinical and ultrasound features, UE-VT-related diseases, and the prevalence of pulmonary embolism (PE) and associated deaths.All UE-VT patients diagnosed by Doppler-ultrasound in Nantes University Hospital, from January 2015 to December 2017, were included retrospectively. UE-VT suspicion patterns, clinical features, UE-VT topography, and prevalence of PE and death were analyzed.Seven hundred and fifty-five UE-VT were analyzed, including 427 deep thrombosis (UE-DVT) and 328 superficial thrombosis (UE-SVT). In 86.2% (n = 651) UE-VT were related to endovascular devices. Among these thrombosis, one third is in connection with a PICC LINE and one quarter with a peripheral venous line. Forty nine percent (n = 370) of the patients had solid neoplasia or hematological malignancies. An inflammatory or systemic infectious context was found in 40.8% (n = 308) of the cases. The most frequently observed clinical sign at the UE-VT diagnosis was edema (28.6%). Among the UE-SVT it was the presence of an indurated cord (33.2%) and among the UE-DVT the indication of the Doppler-ultrasound was mainly a suspicion of infection on endovascular device (35.1%). In 10.6% (n = 80) of the cases the UE-VT were asymptomatic. The most frequently thrombosed veins were brachial basilic veins (16.7% of all thrombosed segments) followed by jugular (13%) and subclavian (12.3%) veins; 61.3% (n = 463) of UE-VT were in the right upper extremity; 63.3% (n = 478) UE-VT were occlusive. The occurrence of PE is 4% and the death rate is 10.2%, mainly related to the severe comorbidities of patients with UE-VT.UE-VT occurs in particular clinical contexts (hematological malignancies, solid cancers, systemic infections) and in the majority of endovascular devices (86.2%). The occurrence of PE is low.


Asunto(s)
Brazo/irrigación sanguínea , Trombosis/diagnóstico , Trombosis de la Vena/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/etiología , Embolia Pulmonar/mortalidad , Estudios Retrospectivos , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Trombosis/mortalidad , Ultrasonografía , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/mortalidad
13.
Medicine (Baltimore) ; 99(6): e19035, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028418

RESUMEN

RATIONALE: Nabothian cysts are mucus-filled cervical cysts that are usually asymptomatic unless they become very large. Chronic urinary retention is the persistent inability to empty the bladder despite maintaining an ability to urinate. Chronic urinary retention caused by a large, deep nabothian cyst has not been reported previously. PATIENT CONCERNS: A 46-year-old woman presented with chronic urinary retention and a cervical cyst that gradually increased in size. DIAGNOSIS: Based on histopathological evidence, our patient was diagnosed with a nabothian cyst. INTERVENTIONS: A hysterectomy was performed. OUTCOMES: The urinary symptoms of the patient resolved after she performed clean, intermittent self-catheterizations for 5 days after the operation. She was discharged on postoperative day 6. LESSONS: Large nabothian cysts are rare but may account for some unusual symptoms including unexplained urinary difficulties in women. We recommend treating symptomatic nabothian cysts with local cystectomies or hysterectomies.


Asunto(s)
Quistes/complicaciones , Retención Urinaria/etiología , Enfermedades del Cuello del Útero/complicaciones , Quistes/diagnóstico por imagen , Quistes/cirugía , Femenino , Humanos , Histerectomía , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Enfermedades del Cuello del Útero/diagnóstico por imagen , Enfermedades del Cuello del Útero/cirugía
14.
Medicine (Baltimore) ; 99(6): e19053, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028424

RESUMEN

RATIONALE: Traditionally, transpedicular approach was used in the treatment of osteoporotic lumbar compression fracture. In order to avoid the risks of pedicle disruption and spinal canal intrusion, extrapedicular approache has been attempted. The aim of the article is to present the modified extrapedicular kyphoplasty technique for the treatment of osteoporotic lumbar compression fracture. PATIENT CONCERNS: A 62-year-old woman suffered from severe low back pain after an accidental fall 10 days ago. Low back pain was obvious when turning over and getting out of bed. It was not relieved after bed rest and conservative treatment. Visual analog scale (VAS) of low back pain was 8 points and Oswestry disability index score was 80%. DIAGNOSIS: Magnetic resonance imaging showed osteoporotic vertebral compression fracture of L2 and L3. INTERVENTIONS: We performed modified extrapedicular kyphoplasty for the patient. The technique has a standardized operating procedure. The puncture point of skin is determined according to preoperative computer tomography and X-ray. The puncture point of vertebral body is located at the outer upper edge of the pedicle. The puncture direction is from the upper edge of the pedicle to the lower edge of the contralateral pedicle. OUTCOMES: The operation time was 20 minutes. The intraoperative blood loss was 5 mL. The amount of bone cement was 4 mL in L2 and 5 mL in L3. VAS of low back pain was 2 points in 1 day after surgery. Preoperative symptoms were significantly improved. LESSONS: Modified extrapedicular kyphoplasty is a safe and effective technique for the treatment of osteoporotic lumbar compression fracture, which should be promoted and applied.


Asunto(s)
Fracturas por Compresión/cirugía , Cifoplastia/métodos , Vértebras Lumbares/lesiones , Fracturas de la Columna Vertebral/cirugía , Pérdida de Sangre Quirúrgica , Femenino , Fracturas por Compresión/diagnóstico por imagen , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Persona de Mediana Edad , Tempo Operativo , Radiografía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X
15.
Medicine (Baltimore) ; 99(6): e19068, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028429

RESUMEN

The impact between acetabulum and femoral neck is another possible mechanism of femoral neck fracture.Direct trauma of the greater trochanter may not be able to fully explain the mechanism underlying femoral neck fracture. In this study, we sought to investigate whether anterior femoroacetabular impingement are associated with femoral neck fractures.A total of 36 patients with femoral neck fracture who had undergone total hip arthroplasty or hemiarthroplasty were included in this study. These patients were divided into 2 groups: labrum tear group and normal labrum group. Patients' age, gender, body mass index, muscle injury, injury pattern, trauma severity, femoral head-neck offset, femoral head-neck ratio, Cam deformity alpha angle, acetabular anteversion, femoral head diameter, acetabular index, cortical index, hip axis length, and neck stem angle were recorded and analyzed. SPSS 18.0 software was used for statistical analyses.According to intraoperative findings, 22 patients exhibited a labrum tear. Magnetic resonance imaging examination revealed bone contusion on the anterolateral margin of the acetabulum with muscle damage surrounding the hip. Among 14 cases without a labrum tear, no bone contusion and obvious muscle injury were found on the anterolateral margin of the acetabulum. Notably, muscle injury, injury pattern, trauma severity and femoral head-neck offset differed significantly (P < .05) between labrum tear and normal labrum groups.Previous studies have focused more on direct lateral trauma. In this study, the impact between acetabulum and femoral neck is another possible mechanism besides lateral impact. Specifically, the abnormal anatomy of the hip, such as femoral head-neck offset, may promote the fracturing process.


Asunto(s)
Pinzamiento Femoroacetabular/complicaciones , Fracturas del Cuello Femoral/etiología , Anciano , Anciano de 80 o más Años , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/patología , Fracturas del Cuello Femoral/diagnóstico por imagen , Fracturas del Cuello Femoral/patología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Factores de Riesgo
16.
Medicine (Baltimore) ; 99(6): e19069, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028430

RESUMEN

Nutritional assessment is feasible with computed tomography anthropometry. The abdominal muscle at the L3 vertebra is a well-known nutritional biomarker for predicting the prognosis of various diseases, especially sarcopenia. However, studies on nutritional assessment of the brain using computed tomography are still scarce. This study aimed to investigate the applicability of the masseter muscle as a nutritional biomarker.Patients who underwent simultaneous brain and abdominopelvic computed tomography in the emergency department was retrospectively analyzed. We assessed their masseter muscle 2 cm below the zygomatic arch and abdominal muscle at L3 via computed tomography anthropometry. The skeletal muscle index, prognostic nutritional index, and other nutritional biomarkers were assessed for sarcopenia using the receiver operating characteristic curve analysis.A total of 314 patients (240 men and 72 women) were analyzed (mean age, 50.24 years; mean areas of the masseter and abdominal muscles, 1039.6 and 13478.3 mm, respectively). Masseter muscle areas significantly differed in sarcopenic, obese, and geriatric patients (P < .001). The areas under the curve of the masseter muscle in sarcopenic, geriatric, and obese patients were 0.663, 0.686, and 0.602, respectively. Multivariable linear regression analysis showed a correlation with the abdominal muscle area, weight, and age.The masseter muscle, analyzed via computed tomography anthropometry, showed a statistically significant association with systemic nutritional biomarkers, and its use as a nutritional biomarker would be feasible.


Asunto(s)
Músculo Masetero/diagnóstico por imagen , Estado Nutricional , Biomarcadores , Composición Corporal , Femenino , Humanos , Masculino , Músculo Masetero/anatomía & histología , Persona de Mediana Edad , Evaluación Nutricional , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
17.
Bone Joint J ; 102-B(2): 205-211, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009424

RESUMEN

AIMS: To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer. METHODS: A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls. RESULTS: Among the patients, the mean pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Karlsson-Peterson score were 98.7 (SD 2.5; p = 0.480) and 98.5 (SD 2.4; p = 0.480), and 98.3 (SD 2.4; p = 0.162) and 97.9 (SD 2.5; p = 0.162), respectively. There was no significant difference between square hop test bilaterally (p = 0.109) and plantar flexion peak force bilaterally (p = 0.371). The harvested limb had significantly less eversion peak force compared to the contralateral limb (p < 0.001). Evidence of probable tendon regeneration was observed in all the patients by MRI and the total bilateral peroneal tendon index (mean ratio of harvested side cross-sectional area of peroneal tendon compared with the contralateral side) was 82.9% (SD 17.4). In 12 healthy controls, peroneal tendons (mean 99.4% (SD 4.3) were found to be morphologically symmetrical between the two sides. CONCLUSION: The current study showed satisfactory clinical foot and ankle outcomes after full-thickness PLT harvesting and indicated the regenerative potential of PLT after its removal. Level of Evidence: Level IV, therapeutic retrospective case series. Cite this article: Bone Joint J 2020;102-B(2):205-211.


Asunto(s)
Articulación del Tobillo/fisiopatología , Tobillo/fisiopatología , Pie/fisiopatología , Ligamentos Articulares/fisiopatología , Tendones/trasplante , Sitio Donante de Trasplante/fisiopatología , Adulto , Tobillo/diagnóstico por imagen , Articulación del Tobillo/diagnóstico por imagen , Femenino , Pie/diagnóstico por imagen , Humanos , Ligamentos Articulares/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos , Recuperación de la Función , Regeneración , Estudios Retrospectivos , Transferencia Tendinosa , Tendones/diagnóstico por imagen , Tendones/fisiología , Recolección de Tejidos y Órganos/métodos , Recolección de Tejidos y Órganos/rehabilitación , Sitio Donante de Trasplante/diagnóstico por imagen , Trasplante Autólogo , Resultado del Tratamiento , Adulto Joven
18.
Bone Joint J ; 102-B(2): 232-238, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009429

RESUMEN

AIMS: Accurate measurement of the glenoid version is important in performing total shoulder arthroplasty (TSA). Our aim was to evaluate the Ellipse method, which involves formally defining the vertical mid-point of the glenoid prior to measuring the glenoid version and comparing it with the 'classic' Friedman method. METHODS: This was a retrospective study which evaluated 100 CT scans for patients who underwent a primary TSA. The glenoid version was measured using the Friedman and Ellipse methods by two senior observers. Statistical analyses were performed using the paired t-test for significance and the Bland-Altman plot for agreement. RESULTS: The mean glenoid version was -3.11° (-23.8° to 17.9°) using the Friedman method and -1.95° (-29.8° to 24.6°) using the Ellipse method (p = 0.002). In 16 patients the difference between methods was greater than 5°, which we considered to be clinically significant. There was poor agreement between methods with relatively large 95% limits of agreement. There was excellent inter-rater agreement between the observers for the Ellipse method and similarly, the intrarater agreement was excellent with a repeatability coefficient of 0.94. CONCLUSION: We recommend the use of the Ellipse modification to define the mid glenoid point prior to measuring the glenoid version in patients undergoing TSA. Cite this article: Bone Joint J 2020;102-B(2):232-238.


Asunto(s)
Desviación Ósea/diagnóstico por imagen , Escápula/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Pesos y Medidas Corporales , Apófisis Coracoides/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven
19.
Bone Joint J ; 102-B(2): 227-231, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009431

RESUMEN

AIMS: The purpose of this study was to evaluate the relationships between the degree of injury to the medial and lateral collateral ligaments (MCL and LCL) and associated fractures in patients with a posterolateral dislocation of the elbow, using CT and MRI. METHODS: We retrospectively reviewed 64 patients who presented between March 2009 and March 2018 with a posterolateral dislocation of the elbow and who underwent CT and MRI. CT revealed fractures of the radial head, coronoid process, and medial and lateral humeral epicondyles. MRI was used to identify contusion of the bone and collateral ligament injuries by tear, partial or complete tear. RESULTS: A total of 54 patients had a fracture; some had more than one. Radial head fractures were found in 25 patients and coronoid fractures in 42. Lateral and medial humeral epicondylar fractures were found in eight and six patients, respectively. Contusion of the capitellum was found in 43 patients and rupture of the LCL was seen in all patients (partial in eight and complete in 56), there was complete rupture of the MCL in 37 patients, partial rupture in 19 and eight had no evidence of rupture. The LCL tear did not significantly correlate with the presence of fracture, but the MCL rupture was complete in patients with a radial head fracture (p = 0.047) and there was significantly increased association in those without a coronoid fracture (p = 0.015). CONCLUSION: In posterolateral dislocation of the elbow, LCL ruptures are mostly complete, while the MCL exhibits various degrees of injury, which are significantly associated with the associated fractures. Cite this article: Bone Joint J 2020;102-B(2):227-231.


Asunto(s)
Ligamentos Colaterales/diagnóstico por imagen , Articulación del Codo/diagnóstico por imagen , Fracturas del Húmero/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Fracturas del Radio/diagnóstico por imagen , Fracturas del Cúbito/diagnóstico por imagen , Adulto , Anciano , Ligamentos Colaterales/lesiones , Articulación del Codo/lesiones , Femenino , Humanos , Fracturas del Húmero/complicaciones , Luxaciones Articulares/complicaciones , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fracturas del Radio/complicaciones , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Cúbito/diagnóstico por imagen , Cúbito/lesiones , Fracturas del Cúbito/complicaciones , Adulto Joven
20.
Bone Joint J ; 102-B(2): 212-219, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009435

RESUMEN

AIMS: In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. METHODS: A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years. RESULTS: The SB group had higher median AOFAS score (100 (interquartile range (IQR) 92 to 100) vs 90 (IQR 85 to 100); p = 0.006) and higher median OMA score (100 (IQR 95 to 100) vs 95 (IQR 75 to 100); p = 0.006). The SS group had a higher incidence of ankle osteoarthritis (OA) (24 (65%) vs 14 (35%), odds ratio (OR) 3.4 (95% confidence interval (CI) 1.3 to 8.8); p = 0.009). On axial CT we measured a significantly smaller mean difference in the anterior tibiofibular distance between injured and non-injured ankles in the SB group (-0.1 mm vs 1.2 mm; p = 0.016). CONCLUSION: Five years after syndesmotic injury treated with either SB or SS, we found better AOFAS and OMA scores, and lower incidence of ankle OA, in the SB group. These long-term results favour the use of SB when treating an acute syndesmotic injury. Cite this article: Bone Joint J 2020;102-B(2):212-219.


Asunto(s)
Fracturas de Tobillo/cirugía , Traumatismos del Tobillo/cirugía , Tornillos Óseos , Fijación Interna de Fracturas/instrumentación , Anclas para Sutura , Fracturas de Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Resultado del Tratamiento
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