Extra-articular Olecranon Osteotomy for Reconstruction of Distal Humerus Fractures: Technique and Clinical Results.

Articular fractures of the distal humerus in adults are challenging fractures requiring adequate surgical exposure for optimum reconstruction. Most commonly, an articular osteotomy of the olecranon is performed, but complications have been reported related to both creating and repairing the articular osteotomy. We describe the use of an extra-articular olecranon osteotomy for approaching articular fractures of the distal humerus. We highlight the surgical steps required to obtain adequate exposure facilitating anatomical reduction, stable fixation, and early range of motion of the elbow joint. This technique can be added to the surgeon's armamentarium for the management of these complex injuries. [Orthopedics. 2022;45(4):e220-e225.].

2D and 3D imaging for morphological assessment of maxillofacial cyst and tumors: a case series / Imagen 3D para la evaluación morfológica de quistes y tumores maxilofaciales: serie de casos

SUMMARY: The use and importance of cone beam computed tomography (CBCT) in the diagnostic, treatment and long term follow up of odontogenic tumours, as well as one reconstruction and dental implants rehabilitation is reported. This clinical series shows diagnosis of odontogenic tumors using selected and used CBCT for initial diagnosis, morphological characterization, and follow up for 5 to 10 years. The CBCTs showed the size and form of the tumor and the follow up showed a satisfactory remodelling of bone and the success in the rehabilition with dental implants. No signs of recurrence were observed. The conventional radiographies, Fan Beam CT, Cone Beam CT and Magnetic Resonance Imaging (MRI) are discussed in the use for follow up of odontogenic tumors. It is concluded that CBCT is an efficient tool for diagnosis, follow up and assessment of the morphology and size of the tumor in order to achieve the best treatment plan, returning the functional conditions to the patients.

RESUMEN: Se reporta el uso y la importancia de la tomografía computarizada de haz cónico (CBCT) en el diagnóstico, tratamiento y seguimiento a largo plazo de tumores odontogénicos, tal como en una reconstrucción y rehabilitación de implantes dentales. Esta serie clínica muestra el diagnóstico de tumores odontogénicos utilizando CBCT seleccionados y usados para el diagnóstico inicial, caracterización morfológica y seguimiento durante 5 a 10 años. Los CBCT mostraron el tamaño y la forma del tumor y el seguimiento mostró un remodelamiento óseo satisfactorio y el éxito de la rehabilitación con implantes dentales. No se observaron signos de recurrencia. Las radiografías convencionales, el uso de TAC, TAC de haz cónico y resonancia magnética nuclear (RMN) se consideran para el seguimiento de tumores odontogénicos. Se concluye que CBCT es una herramienta eficaz en el diagnóstico y seguimiento a largo plazo para evaluar la morfología del tumor y de su tamaño, y además, para obtener los mejores resultados en el tratamiento y eventuales condiciones funcionales de los pacientes.

Nailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm.

PURPOSE: Despite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing lateral malleolus fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all patterns of distal fibula fracture can be safely fixed with an IM device, with the potential benefit of providing biomechanical efficiency, but using a soft-tissue friendly implant. Here, we present a multicenter case series based on a proposed algorithm. PATIENTS AND METHODS: Sixty-nine consecutive patients were managed with fibular IM fixation for closed malleolar fractures. Twenty patients were managed by IM screw fixation and 49 by fibular nailing. Outcome was measured both according to the American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle and hindfoot, and the time to bone union. RESULTS: The mean AOFAS for Group I was 99.35 ± 1.95 points and that for Group II was 89.30 ± 16.98 points. There were no significant differences between the fracture pattern, according to the Lauge-Hansen classification, and post-operative levels of pain and functional activity among patients in both groups (p > 0.05). All fractures healed uneventfully in both groups. The mean time to union for Group I was 8.15 weeks and for Group II was 8.25 weeks (p > 0.05). CONCLUSION: In this multicenter case series, intramedullary fixation for the lateral malleolus fracture presented itself as a viable and safe option for the treatment of almost all patterns of fibula fracture in adults. Overall, we were able to demonstrate the potential indications of the proposed algorithm for the choice of IM implant for the lateral malleolus fracture in terms of the Lauge-Hansen staged classification.

Non-locked and locked small fragment straight plates have a similar behavior in buttressing the posteromedial shear tibial plateau fragment: a biomechanical analysis of three different fixations.

PURPOSE: The aim of this study is to compare the biomechanical behavior of three different fixation constructions currently used for buttressing the posteromedial shearing tibial plateau fragment. Our hypothesis is that non-locked implants provide sufficient comparable stability in posteromedial tibial plateau fractures as locked implants. METHODS: Fifteen left synthetic tibiae from a single manufacturing batch were used to create a posteromedial shear tibial plateau fracture. The fracture was buttressed with three different posteriorly placed five-hole straight small-fragment plate. Five models were fixed with a one-third tubular plate (TTP), five models with a dynamic compression plate (DCP), and five models with a locking compression plate (LCP). All groups were tested to vertical subsidence (Stage 1). In the same experiment (Stage 2), TTP and DCP groups were tested until catastrophic failure. Force versus displacement curves were obtained in the two stages of the experiment. RESULTS: Stage 1 - There was no significant difference in stiffness (p = 0.89), subsidence up to 2 mm (p = 0.38), and energy (p = 0.36) among the three fixation constructions. Stage 2 - Yield load revealed significantly less yield strength for the TTP group as compared with the DCP group (p = 0.048). However, there was no significant difference in maximum load to failure among the TTP and DCP fixation constructions (p = 0.16). CONCLUSION: Placement of either a locked or non-locked small fragment straight plate to buttress the posteromedial shear tibial plateau fragment has a similar biomechanical behavior. When the implant is positioned to buttress the shearing fragment it maximizes biomechanical stiffness.

Biomechanical behavior of three types of fixation in the two-part proximal humerus fracture without medial cortical support.

BACKGROUND: The purpose of this study was to evaluate the role of a non-locking plate applied to the anteromedial surface of the proximal humerus on loads at the implant-bone interface of non-locking and locking lateral plate fixation of proximal humeral fractures with a medial gap. METHODS: Twenty synthetic humeri models were used. In fifteen, the proximal portion of the humerus was osteotomized to create a two-part surgical neck fracture, with a 10-mm medial gap and a 5-mm lateral gap; five models were controls. In the osteotomized humeri, five models were stabilized with a locking lateral plate (group L), five with a locking lateral plate and an anteromedial non-locking plate (group L+T), and five with a non-locking lateral plate and a non-locking anteromedial plate (group T+T). All humeri were tested under axial loading until catastrophic failure, which was characterized as complete closure of the medial gap. Stiffness was calculated using force vs. displacement curves. The data were analyzed via descriptive and inferential studies, at a 5% significance level. RESULTS: Statistically significant differences were seen among all the constructions. The combination of a lateral locking plate with an anteromedial non-locking plate (group L+T) was the stiffest construction, while the combination of a non-locking lateral plate with a non-locking anteromedial plate (group T+T) was the least stiff, even in comparison with a single locking lateral plate (p = 0.01). When the two groups which utilized a lateral locking plate (groups L+T and L) were compared, the group with additional anteromedial support demonstrated greater stiffness (p = 0.03), and stiffness values for the control group comprised of intact humeri models were even higher (p = 0.01). CONCLUSION: Combining a lateral locking plate with a non-locking anteromedial plate provides a stiffer construction for fixation of unstable two-part proximal humerus fractures with a medial gap. Mechanical benefits of medial support with a second non-locking antero-medial plate seems to be related with better construct stability in terms of strength and fatigue, potentially reducing the risk of varus collapse of the humerus head and fracture healing disturbances.

The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws.

BACKGROUND: The biomechanical behavior of Pauwels type III fractures should be taken into consideration when performing internal fixation, since this repair should resist the shear force inherent in the vertical fracture line to the greatest extent possible. Recently, the use of a small fragment plate on the medial face of the femoral neck has been proposed by some authors, with satisfactory initial results. In the current study we analyze the mechanical role a medial plate used as a buttress plate for Pauwels type III femoral neck fractures, comparing the resistance of two fixation configurations using three cannulated screws. METHODS: Pauwels type III fractures were simulated in synthetic bones models and two groups were created, one of those using two parallel screws at the bottom of the femoral neck and the third screw crossing the fracture horizontally (G1), and the other fixed in the same arrangement as G1, but with the addition of a medial side plate at the apex of the fracture (G2). The constructs were subjected to axial loading until catastrophic failure. RESULTS: The addition of a medial plate buttressing the femoral neck increased significantly the resistance to maximum loading (p = 0.003). CONCLUSION: Use of a medial buttress plate results in a mechanically superior construction for Pauwels type III fractures fixed with multiple cannulated screws. LEBEL OF EVIDENCE: Level IV. Biomechanical comparative study.

Expanding the Indications for Mini Plates in the Orthopedic Trauma Scenario: A Useful Alternative Technique for Maintaining Provisional Reduction and Improving Stability for Complex Periarticular Fracture Fixation of the Upper Limbs.

INTRODUCTION: The use of mini plates as a reduction tool is an elegant technique for temporary stabilization of multifragmentary fractures. For some complex periarticular fractures with severe comminution close to the articular surface, mini plates seem to be a better option than K-wires for provisional as well as definitive fixation, because of the presence of small fragments and proximity to the joint increases the risk of additional fragmentation and articular penetration, respectively. CASE REPORT: Five cases of complex periarticular fractures of the upper limb are presented. We used 2.3 mm mini plates as reduction plates for different situations, including one scapula fracture, one clavicle fracture, one distal humerus fracture, one proximal ulna fracture, and one distal radius fracture. In all cases, an excellent clinical outcome with a full return to pain-free activity was achieved after a minimum follow-up of 12 months. CONCLUSION: We feel that these mini extra-articular implants are particularly helpful as temporary reduction tools before the application of the definitive implant to a reduced and stabilized the fracture. Because they have longer screws allowing better cortical purchase and low-profile allowing plate overlap, the procedure seems to be faster and easier when compared to the use of temporary K-wires and clamps.

A Survey of Current Practices and Preferences for Internal Fixation of Trochanteric Fractures of the Femur in Brazil.

Objective The primary aim of this study was to survey current practices and preferences behind internal fixation of trochanteric femoral fractures among Brazilian orthopedic surgeons. The secondary aim was to identify the main reason for these preferences. Methods A survey containing 20 images of trochanteric fractures of the femur was presented to a group of 62 orthopedists, all members of the Brazilian Society of Orthopedics and Traumatology (SBOT). The first part of the questionnaire was created to identify the surgeons' degree of professional experience, type of practice, and areas of greatest interest and performance within the specialty. The second part of the questionnaire contained options for fixating different trochanteric fracture patterns in the femur for participants to choose, along with the main reason for their decision. Statistical analysis was descriptive and profiled the surgeons' major area of interest, treatment option, and the main reason for their therapeutic decision. Results Of the 62 orthopedists who participated in the study, 10 (16.0%) stated that their area of greatest interest was orthopedic trauma and 52 (83.9%) reported greater interest in another area of the specialty; these two groups were classified as the Trauma Group and Orthopedics Group, respectively. To treat AO 31A1 type fractures, the trauma group selected the sliding hip screw (SHS) in 66.7% of cases, while the orthopedics group chose the SHS in 65.8% of cases. For 31A2 type fractures, the trauma group chose the intramedullary (IM) nail in 64.0% of the cases, while the orthopedics group chose the IM nail in 76.7% of the cases. For 31A3 type fractures, the trauma group opted for the IM nail in 70.0% of the cases, while the orthopedics group selected the IM nail in 88.0% of the cases. The two most important factors in implant selection for the three types of fracture were fracture pattern and implant availability. Conclusion The sliding hip screw is preferred by most Brazilian orthopedic surgeons for fixation of 31A1 type trochanteric femoral fractures. For 31A2 and 31A3 type fractures, the IM nail is preferred.

Stability of L-shaped and inverted triangle fixation assemblies in treating Pauwels type II femoral neck fracture: a comparative mechanical study.

PURPOSE: The aim of our study is to compare the mechanical resistance of two screw configurations in fixating type II Pauwels femoral neck fractures. METHODS: Fifteen synthetic models of femur bones in young adults were divided into three equal groups: intact (G1), models with fixation of a 5.0-mm failure zone created in the posterior cortex of the femoral neck using an L-shaped screw arrangement (G2, n = 5), and models with an identical failure zone fixated using an inverted triangle assembly (G3, n = 5). Model strength (axial loading) and rotational deviation of the fragments were load-tested until a 5.0-mm displacement was reached (step 1) and then until failure, here considered as 10.0 mm displacement in G2 and G3 or femoral neck fracture in G1 (step 2). RESULTS: In step 1, the mean resistance in G1 was 1593 N (standard deviation [SD] of 62 N); this value in G2 was 1261 N (SD 49 N) and in G3 was 1074 N (SD 153 N). During step 2, the value for G1 was 2247 N (SD 84 N), for G2 was 1895 N (SD 69 N), and for G3 was 1523 N (SD 280 N). G3 (the inverted triangle assembly) showed a significantly lower maximum load than the group using the L-shaped assembly (G2) and the control group (G1), which was significant using Kruskal-Wallis analysis of variance (p = 0.002). CONCLUSION: Under test conditions in synthetic bone, fixation using a L-shaped screw assembly provides greater mechanical resistance than an inverted triangle assembly.

Outcome evaluation of staged treatment for bicondylar tibial plateau fractures.

BACKGROUND: The universal accepted strategy for treating high-energy tibial plateau fractures remains a topic of ongoing debate. The challenge for the practicing orthopaedic trauma surgeon is to provide anatomical articular fracture reduction, with successfully managing the complex soft-tissue injury that is commonly present at patient admission. The primary aim of the actual study was to evaluate the results of a staged protocol for the treatment of high-energy bicondylar tibial plateau fractures. The secondary aim was to describe the technique used for the definitive fixation of this complex fracture pattern. METHODS: Thirty patients with unstable high-energy closed bicondylar tibial plateau fractures (17 Schatzker V and 13 Schatzker VI) were managed. There were 24 men (80%) and six women (20%). All of them were skeletally mature with their age ranging from 19 to 67 years (mean of 33.1±3.4 years). Treatment involved a two-stage procedure with appropriate emergency care, preoperative planning, and definitive fixation. Initial treatment, named 'damage control on complex articular fracture elements', consisted on temporary bridging external fixation. Definitive treatment was delayed in a mean of 10 days (ranging from seven to 13 days) and was performed when the soft-tissue conditioning demonstrated either complete or almost complete remission of the inflammatory reaction due to the 'first hit'. Conventional implants were used in the 30 patients. All patients were evaluated clinically and radiographically. RESULTS: Twenty-six (86.7%) patients had a moderate level of activity, three (10%) patients had a very light level of activity, and one (3.3%) patient was unable to have any kind of work activity and is currently supported by the Brazilian Welfare. Using the visual analog scale mean pain score was 30 (ranging from 10 to 60); even the patient with the workers' compensation had no severe pain. All patients except three have no difficulty with stairs, giving way, locking, swelling, and squatting, but were unable to run. Three (10%) patients had problems with stairs and could not bend the operated knee more than 90°. One of them had a varus knee but no instability. Ninety percent of the patients were either very satisfied or somewhat satisfied with their outcome. The three dissatisfied patients suffered postoperative complications, most commonly wound infections. Four (13.4%) patients with former anatomical reduction had a residual articular step-off or diastasis of less than 3mm after fracture healing. All patients had no or mild arthrosis at the time of the last outpatient consultation. CONCLUSIONS: The two-staged procedure presented herein showed to be an effective strategy for managing bycondilar tibial plateau fractures. The protocol used for these complex traumatic injuries follows very well defined steps, which means acute stabilization with a linear bridging external fixation, adequate soft tissue handling, preoperative planning, and definitive surgical fixation after seven to 14 days. The model presents a more biological approach to optimizing functional outcome with an acceptable complication rate and minimal risk of loss of reduction in these high-energy tibial plateau fractures.

Expectativas e realidade dos sintomas e comorbidades em mulheres submetidas à quimioterapia para câncer de mama / Facts and expectations in women on chemotherapy for breast cancer

Objetivo: este trabalho visa colaborar para o aprimoramento da qualidade de vida das pacientes em quimioterapia para câncer de mama, avaliando: o conhecimento prévio sobre os efeitos secundários da quimioterapia e após sua vivência; as repercussões em nível emocional; as informações prestadas pelo médico-assistente; a influência nas atividades laborais. Métodos: foi realizado questionário com 32 mulheres em quimioterapia no Serviço de Oncologia da Universidade Federal do Rio de Janeiro ou em clínica particular no período entre outubro de 2007 e setembro de 2008. A entrevista foi estratificada nos seguintes aspectos: domínio psicológico (sentimentos relacionados ao tratamento), social (familiar e preconceito), ambiental (fonte das informações prévias à quimioterapia) e físico (mediações em uso, atenção dado pelo médico-assistente e efeitos colaterais). Resultados: a idade média das entrevistadas foi de 46,7 anos. Do preconceito quanto aos sintomas relacionados à quimioterapia, temos que a alopecia é o fator mais conhecido e que distúrbios de humor são praticamente desconhecidos. As medicações para alívio sintomático são eficazes em 56,25% dos casos (18 pacientes). O apoio familiar, a ausência de discriminação e o afastamento das atividades laborais são constantes. A alopecia e as náuseas foram consideradas itens bem informados pelo oncologista ao início da terapia. Quando comparada à vivência da quimioterapia com a expectativa prévia, o único fator visto como pior do que o imaginado foi a alopecia. Conclusão: a qualidade de vida parece consolidar-se como uma variável clínica importante. Seu desenvolvimento poderá resultar em mudanças na prática assistencial e na consolidação de novos paradigmas do processo saúde-doença.

Avaliação dos laudos mamográficos: padronização prática de recomendação de conduta para um programa de detecção precoce do câncer de mama por meio da mamografia / Evaluation of mammographic awards: practical standardization recommending behaviour for a program of precocious detection of breast cancer by means of mammography

Em abril de 1998, durante a Jornada Paulista de Radiologia, o Colégio Brasileiro de Radiologia realizou uma reunião de consenso com a Federação Brasileira das Sociedades de Ginecologia e Obstetrícia e a Sociedade Brasileira de Mastologia para definir um padrão para o diagnóstico mamográfico no Brasil. Aprovou-se a classificação breast imaging reporting and data system (BI-Rads), e o CBR, a SBM e a Febrasgo divulgaram, em seus órgãos oficiais, a classificação referendada, que teve ampla divulgação nos eventos das três sociedades. Entretanto havia a necessidade de investigar como os médicos interpretadores, em diversos serviços de mamografia, faziam seus relatórios depois da divulgação da reunião de consenso. O material deste trabalho consiste em 115 questionários com perguntas sobre o laudo mamográfico, dando ênfase à parte descritiva, à impressão diagnóstica e à recomendação de conduta. Na metodologia estatística utilizam-se os cálculos de percentagem de adesão. Na recomendação de conduta, por exemplo, no nódulo benigno, o resultado da amostra (50,44%) deu-se no acompanhamento após um ano. No nódulo suspeito (amostra = 58,29%) e no nódulo maligno (amostra = 55,66%), em ambos, poder-se-iam ter obtido melhores valores. Nas microcalcificações benignas (amostra = 55,64%), nas intermediárias (amostra = 57,4%) e nas malignas (amostra = 61,4%) notam-se cálculos de percentagem não-condizentes com o serviço de mamografia. Na densidade assimétrica (amostra = 62,6%), na distorção arquitetural (amostra = 48,7%) e na dilatação ductal isolada (amostra = 49,57%), os médicos interpretadores poderiam ter obtido melhores índices de percentagem. Notamos que todas as respostas do laudo mamográfico permaneceram com valores percentuais não-aceitos num serviço de mamografia que apresente uma boa qualidade tanto técnica como científica. É importante realizar uma padronização prática de recomendação de conduta nos achados mamográficos...

In April of 1998 during the Paulista Radiology Meeting, The Brazilian College of Radiology held a meeting about consensus with The Brazilian Federation and Societies of Gynecology and Obstetrics and the Brazilian Society of Mastology to define a pattern using "Breast Imaging Reporting and Data System" classification (BI-Rads), SBM and Febrasgo spread out at their official offices the referred classification, with had a broad distribution at the meetings of the three societies. However, there was a need to investigate how the physicians, who interpret in diversified fields of mastectomy, do their reports after the diffusion of the consensus meeting. The material of this work is composed by 115 questionnaires with questions about breast image report with high emphasis on the written part, the printed diagnosis and the recommended actions. Adhesion percentage evaluations were used in the statistical methodology. The recommended procedure was for example: at the benign tissue, the sample result (50.44%) happened after one year of accompaniment. At the suspect breast tissue (sample = 58.29%) and the malignant breast tissue (sample = 55.66%); in both the results could have been better. At the benign microcalcifications (sample = 55.64%), intermediaries (sample = 57.4%), malignant (sample = 61.4%); in all of them the perceived percentage numbers didn't match the Breast Service. At the asymmetric density (sample = 62.6%), architectural distortion (sample = 48.7%), and isolated duct dilatation (sample = 49.57%); at all these breast numbers, the physicians, who interpret could have found better percentage indexes. It is noticeable that all answers at the report remained with percentage numbers not accepted in a Breast Service, which shows a high quality either in technique or in scientific. It is important to make a pratical standard recommended conduct at the breast cancer detection program in Brazil.

Produção de material instrucional para o ensino da radiologia por meio da digitalização de imagens / Development of educational material for radiology teaching using image digitalization

Criou-se um banco de dados usando a digitalização de imagens radiográficas para salvá-las da deterioração do tempo e, também, tornar mais ágil sua manipulação pelos profissionais que as utilizam. Foi criado um banco de dados que torna possível o armazenamento dos dados clínicos de cada paciente e, vinculadas a esses dados, suas respectivas imagens digitalizadas, com o propósito de ensino e pesquisa. Os elementos que compõem o banco de dados foram determinados por meio de pesquisa feita com os professores do Departamento de Radiologia da Universidade Federal do Rio de Janeiro. Conseguiu-se elaborar um sistema que contém dados e imagens, de baixo custo e de fácil manipulação por parte dos usuários.

Avaliaçäo dos resultados de exames mamográficos para detecçäo precoce de câncer de mama em mulheres assintomáticas, no Distrito Federal / Evalution of mamography results for early breast cancer detection in asymptomatic women in Dsitrito Federal, Brazil

Objetivo: Avaliar resultados mamográficos realizados em mulheres assintomáticas, segundo indicadores de qualidade para detecçäo precoce do câncer. Material e método: Foi feito estudo transversal, de dezembro 1993/ a junho/1996, em serviço privado de mamografia, no Distrito Federal, com 5684 mulheres atendidas consecutivamente, que preencheram um questionário padräo e submeteram-se a exames clínico e mamográfico. Foram excluídas 2745 mulheres com sintomas ou sinais de doença mamária . As 3209 restantes, assintomáticas, constituíram a amostra. 87 mulheres tiveram indicaçäo para biópsia, sendo 53 biopsiadas. Critérios para elegibilidade, seleçäo das mulheres, detalhes do instrumento e procedimentos técnicos estäo de acordo com padrões recomendados internacionalmente. Resultados: Os valores encontram-se na faixa de variaçäo dos indicadores. Taxa tumores intraductais: 21,4 por cento; tumores mínimos : 42 por cento ( até 0,5 cm) e 53 por cento (até 1,0cm); tumores estadiamento 0 a 1: 85,6 por cento; positividade nos gânglios axilares; 7,1 por cento prevalência de câncer subclínico: 8,7 por cento; valor preditivo positivo das biópsias recomendadas, realizadas: 52 por cento.

Videofluoroscopia como método de avaliaçäo do esvaziamento gástrico / Evaluation of gastric emptying using videofluoroscopy

Por intermédio do método videofluoroscópico, usando dieta contrastada, examinamos qualitativamente a dinâmica e o esvaziamento gástrico de 21 voluntários sadios. Oito exames foram selecionados para análise quantitativa do esvaziamento, através de método computacional desenvolvido para este fim. O esvaziamento foi definido pelas variaçöes do produto da área contrastada por sua densidade. Análise in vitro para a definiçäo da concentraçäo ideal de soluçäo de sulfato de bário para quantificaçäo computacional foi procedida. Concluímos que: 1) o método videofluoroscópico permite adequada análise da dinâmica gástrica, abrindo formidável perspectiva ao estudo da fisiologia do órgäo; 2) a estratégia de quantificaçäo computacional do esvaziamento gástrico a partir da digitalizaçäo das imagens videofluoroscópicas é factível; 3) mensurar a terceira dimensäo para o estudo do esvaziamento gástrico é meta desejável e passível de ser alcançada pela variaçäo da concentraçäo do meio de contraste a ser utilizado; 4) in vitro, a concentraçäo de soluçäo de sulfato de bário ideal para a correta percepçäo computacional das variaçöes de densidade, no modelo testado, encontram-se nas faixas de 25 por cento a 12,5 por cento.

Mamografias de alta resoluçäo: uma avaliaçäo do risco e do benefício / High resolution mammography: a simple risk and benefit evaluation

O presente estudo foi realizado com o objetivo de avaliar o risco da técnica de mamografia de alta resoluçäo para mulheres submetidas a este exame radiológico da mama. Para uma amostra de 407 mulheres, residentes em diferentes regiöes do País, foram avaliadas as doses de radiaçäo na superfície da pele e as doses médias no tecido glandular para a projeçäo crânio-caudal. A partir dessas medidas e adotando-se as orientaçöes da Publicaçäo n§ 60 da Comissäo Internacional de Proteçäo Radiológica (ICRP), aplicou-se o modelo aditivo de risco para estimar a incidência de câncer radioinduzido e os valores médios de anos perdidos de vida para a populaçäo feminina presente nos grupos de idade entre 30 e 70 anos. Como resultado, ficou demonstrado que, para uma eficiência de rastreamento superior a 40 por cento, os benefícios da mamografia de alta resoluçäo superam os riscos, mostrando-se plenamente justificados para mulheres na faixa etária acima de 40 anos