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2.
J Am Podiatr Med Assoc ; 111(4)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478529

RESUMO

BACKGROUND: Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach. METHODS: Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed. RESULTS: Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient. CONCLUSIONS: Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months.


Assuntos
Fraturas Ósseas , Ossos do Tarso , Adulto , Diagnóstico Tardio , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Ossos do Tarso/diagnóstico por imagem
3.
J Am Podiatr Med Assoc ; 111(4)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478535

RESUMO

BACKGROUND: We sought first to determine the efficacy of lateral ankle fixation alone in maintenance of medial clear space and talar valgus in bimalleolar equivalent ankle fractures not receiving primary deltoid repair, and second to assess perceived outcomes via the Foot and Ankle Outcome Score. To our knowledge, no study has quantified the reduction of medial clear space and talar valgus in bimalleolar equivalent ankle fractures receiving lateral ankle fixation alone. METHODS: We compared preoperative, initial postoperative, and greater than 1-year follow-up radiographs of medial clear space and talar valgus in individuals who received lateral ankle fixation alone in bimalleolar equivalent ankle fractures. Subjective outcomes were measured via the Foot and Ankle Outcome Score. RESULTS: Thirty-seven patients participated in the study and showed a statistically significant reduction of medial clear space and restoration of talar position, and maintenance with this fixation method during follow-up in patients with bimalleolar equivalent ankle fractures. Adjunctively, patients perceived their outcomes to be satisfactory, as demonstrated by the results of the Foot and Ankle Outcome Score. CONCLUSIONS: We aimed to assess the efficacy of lateral ankle fixation in the maintenance of medial clear space and talar valgus reduction at midterm follow-up. Although some authors contend that primary deltoid repair in bimalleolar equivalent ankle fractures is warranted, these midterm study results suggest that isolated lateral ankle fixation is adequate for medial ankle stabilization in bimalleolar equivalent fractures, and thus primary deltoid repair is not indicated.


Assuntos
Fraturas do Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo , Seguimentos , Fixação Interna de Fraturas , Humanos , Radiografia , Resultado do Tratamento
4.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479889

RESUMO

A 55-year-old man with mental retardation and calcaneal tendon thickening was referred for a suspected genetic disease. His serum cholestanol was elevated and genetic analysis of his blood cells for CYP27A1 revealed a homozygous missense mutation. We diagnosed him with cerebrotendinous xanthomatosis (CTX). Chest radiography revealed diffuse micronodular and reticular opacities. Histological findings obtained from the transbronchial lung biopsy revealed foamy macrophages and multinucleate giant cells with marked lipid crystal clefts. Although there are few reports of pulmonary lesions in CTX, we concluded from the radiological and histopathological findings that the pulmonary lesions were indeed caused by the CTX. The patient was treated with chenodeoxycholic acid. His neurological findings and calcaneal tendon thickening were unchanged; however, his serum cholestanol and radiological abnormalities of the chest decreased.


Assuntos
Xantomatose Cerebrotendinosa , Ácido Quenodesoxicólico/uso terapêutico , Colestanotriol 26-Mono-Oxigenase , Colestanol , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Xantomatose Cerebrotendinosa/diagnóstico por imagem , Xantomatose Cerebrotendinosa/tratamento farmacológico
5.
Acta Biomed ; 92(4): e2021219, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34487077

RESUMO

BACKGROUND AND AIM: The purpose of the study was to compare the data obtained by two independent observers and statistically analyze the results using Cohen's K to highlight the concordance or discordance in the diagnosis of normality, pathology and, in particular, the type of femoro-acetabular impingement (FAI) on plain films. METHODS: the study was conducted retrospectively. The only inclusion criterium was the minimum age of 20 years. All patients underwent a radiographic examination of the pelvis in standard anteroposterior projection in orthostasis. RESULTS: A good concordance between the two operators in the examination of normal hip joint (k= 0.68 right/ 0,74 left) was found; a similar grade of agreement was found for the analysis of "pincer" type FAI (k = 0.73 right, 0,67 left). The best results in concordance were achieved in the examination of "cam" type FAI (k= 0.82 right, 0,88 left), "mixed" type FAI (k = 0.85 right, 0,86 left), and in findings of "coxa profunda" (k = 0.92 right, 0,88 left). CONCLUSION: We found a good concordance between the two readers; a few cases of disagreement were found in the diagnosis of "pincer" type FAI and absence of disease. This discrepancy may be due to the different weight given by the single observer to the clinical indication that leads the patient to examination, but also by the difficulty of a not dedicated radiologist to show some subtle signs indicative of early FAI.


Assuntos
Impacto Femoroacetabular , Articulação do Quadril , Adulto , Impacto Femoroacetabular/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Humanos , Radiografia , Radiologistas , Estudos Retrospectivos , Adulto Jovem
6.
Acta Biomed ; 92(S5): e2021404, 2021 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-34505843

RESUMO

BACKGROUND AND AIM: Considering the high rate of mortality and permanent disability related to vertebral traumas, an early and detailed diagnosis of the trauma and subsequently an immediate and effective intervention are crucial. Cervical vertebral injury classifications guide treatment choice through a severity grade based on radiological information. The purpose of the present study was to define which imaging classification system could provide the best morphological and clinical-surgical correlations for cervical spine traumas. METHODS: We retrospectively analyzed patients evaluated for cervical spine trauma at our Institution in the period 2015-2020. Information regarding the morphological examination (using CT and MRI), the neurological evaluation, and the therapeutic management were collected. C3-C7 fractures were classified according to the SLIC and AOSpine criteria; axial lesions were classified according to the modified AOSpine for the C1-C2 compartment and through the Roy-Camille and the Anderson D'Alonzo system for the odontoid process of the axis. RESULTS: 29 patients were included in the final study population. Nine patients with axial spine trauma and 21 with subaxial cervical spine trauma. A conservative approach was applied in 16 patients while nine patients underwent neurosurgery. Considering the therapeutical indications provided by the SLIC system, a 76.9% accordance was found for patients with a <4 score, while a 100% concordance was calculated for patients with a >4 score undergoing neurosurgery. Regarding the AOSspine classification, a 28.6% concordance was observed for patients classified group B being treated with a posterior neurosurgical approach, while for patients belonging to subgroup C, considered for anterior neurosurgical approach, a 66.7% accordance was calculated. CONCLUSIONS: The study demonstrated a better morphological correlation for the AOSpine classification in subaxial trauma and the AOSpine and Anderson D'Alonzo in axial trauma. The therapeutic indication found a better correlation in the SLIC classification for subaxial trauma and the Anderson D'Alonzo for axial ones.


Assuntos
Processo Odontoide , Traumatismos da Coluna Vertebral , Tomada de Decisão Clínica , Humanos , Processo Odontoide/lesões , Radiografia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/terapia
7.
Dental Press J Orthod ; 26(4): e2119347, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524379

RESUMO

OBJECTIVES: This study aimed to (I) assess the morphology of the symphysis and soft tissue chin associated with sex, age and sagittal/vertical skeletal patterns, and (II) identify the individual and combined contributions of these variables to different portions of the symphysis. METHODS: This cross-sectional study included 195 lateral cephalometric radiographs from untreated adults. Alveolar, basal, and soft tissue of the symphysis were measured by an X/Y cranial base coordinate system, and divided in accordance to four predictor variables: sex, age, and sagittal/vertical skeletal patterns. Parametric tests were conducted for comparison and correlation purposes, while multiple regression analysis was performed to explore combined interactions. RESULTS: Alveolar inclination is related to sagittal and vertical patterns, and both explained 71.4% of the variations. Alveolar thickness is weakly predicted and poorly influenced by age. Symphysis height was 10% higher in males, and associated with a vertical skeletal pattern and sex, and both explained 43.6% of variations. Basal symphyseal shows an individual thickness, is larger in males, and vertically short-positioned with age. Soft tissue chin is not necessarily related to the size of the underling skeletal pattern, and enlarges with age, even in adulthood. CONCLUSIONS: The symphysis and surrounding tissues are influenced by sex, age, and sagittal and vertical patterns, acting differently on the alveolar, basal and soft tissue portions. Sagittal and vertical skeletal patterns are the strongest association on alveolar symphysis inclination, whereas sex and age acts on the vertical symphysis position and soft tissues thickness.


Assuntos
Mandíbula , Adulto , Cefalometria , Queixo/anatomia & histologia , Queixo/diagnóstico por imagem , Estudos Transversais , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Radiografia
8.
Stomatologija ; 23(1): 9-15, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34528902

RESUMO

OBJECTIVE: To determine prevalence of pulp stones in molars of patients at the Institute of Dentistry Faculty of Medicine Vilnius University and to evaluate the association of pulp stones and gender, patient age, tooth condition. MATERIAL AND METHODS: Intraoral radiographs were reviewed using the Romexis program and pulp stones were assessed in molars.  Teeth were distributed into intact and non-intact. Information about patients' gender and age was collected. Data were processed using SPSS IBM (Statistical Package for the Social Sciences 22.0) program. Pearson's Chi-square test (χ2) was used. Results were considered to be statistically significant when the significance level of p<0.05. RESULTS: A total of 531 patients' bitewing and periapical radiographs of molars were evaluated. 2361 molars in total were assessed. Prevalence of pulp stones was 58.8% when pulp stones were found in at least one molar. Pulp stones were detected in 832 molars (35.24%). Patients from 18 to 93 years old were assessed. The highest pulp stones' occurrence was found in the age group from 38 years and older (71.07%). Non-intact maxillary right first molars and maxillary right and left second molars demonstrated a statistically significantly more frequent occurrence of pulp stones than intact molars (p<0.05). CONCLUSION: More than half of the participants had pulp stones in molars. Higher prevalence of pulp stones was associated with older age and decayed/filled teeth. There was no statistically significant difference between genders with regards to prevalence of pulp stones.


Assuntos
Calcificações da Polpa Dentária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/epidemiologia , Feminino , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Dente Molar/diagnóstico por imagem , Prevalência , Radiografia , Adulto Jovem
9.
Croat Med J ; 62(4): 347-352, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34472737

RESUMO

AIM: To report on the outcomes of spinal dural arteriovenous fistulas (sDAVFs) treatment in a single-center retrospective cohort. METHODS: Data were retrieved on sDAVF cases treated surgically and endovascularly between January 2009 and January 2020. Sociodemographic, clinical, imaging data, and outcomes were analyzed. RESULTS: Thirty-four patients were identified: 11 female, mean age 64.1 ± 11.5 years; mean time of symptom duration 12 (range 1-149) months. The sDAVF locations were the following: 18 (62.1%) thoracic, 4 (13.8%) lumbar, 4 (13.8%) sacral, and 3 (10%) with multiple location feeders. All patients had a motor deficit and affected walking, and the majority had a sensory deficit, bowel, and bladder dysfunction. Fifteen (44.1%) patients underwent surgical treatment, 7 (20.6%) underwent endovascular treatment, and 12 (35.3%) underwent both (crossover). Radiological myelopathy showed regression in 19 (55.9%) patients. Overall, clinical improvement (decrease in modified Rankin score) following treatment was observed in 14 patients (41.2%), worsening in 1 (2.9%), while other had unchanged status. The proportion of patients with initial treatment failure markedly differed between the before-2014 and after-2014 period. Patients who failed to improve had more extensive myelopathy. CONCLUSION: Patients who underwent surgery or endovascular treatment had on average significant clinical recovery, while those who underwent treatment crossover had negligible improvement. The extent of myelopathy seems to be associated with clinical improvement.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
10.
J Assoc Physicians India ; 69(6): 11-12, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34472791

Assuntos
Raios X , Humanos , Radiografia
11.
JNMA J Nepal Med Assoc ; 59(237): 482-485, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34508422

RESUMO

INTRODUCTION: The Gonial angle is an important parameter of the craniofacial complex for growth Patterns prediction. The gonial angle on lateral cephalometric radiograph represents the mandibular morphology concerning mandibular body and ramus. The objective of this study was to find out the mean value of gonial angle in lateral cephalometric radiographs of patients of orthodontic department in a tertiary care center. METHODS: The descriptive cross-sectional study was conducted among patients from the Department of Orthodontics at People's Dental College and Hospital between 8th December 2020 to 8th February 2021 at People's Dental College and Hospital, Kathmandu, Nepal after obtaining Ethical approval (Reference Number. 01, CH100 09,2077/2078) by the Institutional Review Committee. A convenience sampling technique was used to collect 166 pre-treatment lateral cephalograms radiographs of patients between 17-30 years. Data were collected and entered using Statistical Package of Social Science 16. RESULTS: The mean value of gonial angle on lateral cephalogram radiographs was 132.84±3.70 in hyperdivergent, 119.94±5.57 in hypodivergent and 124.06±3.88 in normodivergent vertical skeletal patterns and between male and female were 132.52±4.32, 133.07±3.28 in hyperdivergent, 121.46±3.78, 119.14±6.42 in hypodivergent and 123.74±5.14, 123.94±3.90 in normodivergent vertical skeletal patterns of Orthodontic Patients. CONCLUSIONS: The gonial angle value on lateral cephalometric radiographs was greater in hyperdivergent than hypodivergent and normodivergent vertical skeletal patterns. The hyperdivergent vertical skeletal pattern of female was greater than of male patient's lateral cephalometric radiographs while hypodivergent and normodivergent vertical skeletal patterns of males were greater than female lateral cephalogram radiographs of Nepalese orthodontic patients.


Assuntos
Mandíbula , Cefalometria , Estudos Transversais , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Radiografia , Centros de Atenção Terciária
13.
Medicine (Baltimore) ; 100(36): e26855, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516488

RESUMO

ABSTRACT: Coronavirus disease (COVID-19) has spread worldwide. X-ray and computed tomography (CT) are 2 technologies widely used in image acquisition, segmentation, diagnosis, and evaluation. Artificial intelligence can accurately segment infected parts in X-ray and CT images, assist doctors in improving diagnosis efficiency, and facilitate the subsequent assessment of the severity of the patient infection. The medical assistant platform based on machine learning can help radiologists make clinical decisions and helper in screening, diagnosis, and treatment. By providing scientific methods for image recognition, segmentation, and evaluation, we summarized the latest developments in the application of artificial intelligence in COVID-19 lung imaging, and provided guidance and inspiration to researchers and doctors who are fighting the COVID-19 virus.


Assuntos
COVID-19/diagnóstico por imagem , Aprendizado de Máquina , Pneumonia Viral/diagnóstico por imagem , SARS-CoV-2 , Humanos , Radiografia , Tomografia Computadorizada por Raios X
14.
Sultan Qaboos Univ Med J ; 21(3): 477-480, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34522416

RESUMO

Schwannomas are typically benign tumours of the peripheral nerves. However, they seldom arise from the obturator nerve. We report a case of an uncommon swelling (2.5 × 3.5 cm) in a 65-year-old male cadaver, found during a routine dissection session for first Bachelor of Medicine and Surgery students in the Department of Anatomy, Kasturba Medical College, Manipal, India, in 2019. It was seen originating from the left obturator nerve in the pelvis at the level of the sacral promontory. Histopathological investigation revealed a schwannoma. The hypocellular tumour was arranged in a sweeping fascicle pattern with patches of myxoid degeneration. Obturator schwannomas, though rare, can exist in cadavers, as seen in the present case. Hence, it should be considered as a differential diagnosis for clinical cases of pelvic masses and eliminated only after thorough radiological examination. Knowledge about the existence of such schwannomas is therefore essential.


Assuntos
Neurilemoma , Nervo Obturador , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Pelve , Radiografia
15.
Vestn Otorinolaringol ; 86(4): 46-49, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34499447

RESUMO

OBJECTIVE: Of this study is to determine the optimal algorithm for active verification and treatment of children with foreign bodies of the esophagus, analysis of the causes and development of related complications. PATIENTS AND METHOD: The results of examination and treatment of 320 children with foreign bodies of the esophagus for the period from 2011 to 2017 were analyzed. The vast majority of patients (79.4%) were between 1 and 5 years old. The period from the moment of accidental ingestion of a foreign body to hospitalization ranged from 3 hours to 2 months. It was found that the x-ray method made it possible to confirm the presence of a foreign body in the esophagus in 89.1% of cases, to identify the nature of the radiopaque foreign body and associated complications in 100% of cases. RESULTS: In order to remove a foreign body, 314 emergency endoscopic interventions were performed. In 79.6% of cases, a foreign body was localized in the upper third of the esophagus. Coins were the most frequently found foreign bodies of the esophagus (80.1%), the second place was taken by disk-type batteries (8.7%), and the third - by bones of various origin (4.5%). Among all foreign bodies, the most dangerous were disk batteries, causing serious complications in 72% of cases, the treatment of which requires the joint efforts of doctors of various specialties. The occurrence and severity of complications was directly dependent on the nature, size, location of fixation and the length of stay of a foreign body in the esophagus. CONCLUSION: Main conclusion of this study is that children with suspected foreign body of the esophagus need emergency examination and treatment exclusively in a multidisciplinary medical institution.


Assuntos
Esôfago , Corpos Estranhos , Criança , Pré-Escolar , Endoscopia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Lactente , Radiografia , Estudos Retrospectivos
16.
Sensors (Basel) ; 21(17)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34502591

RESUMO

The global COVID-19 pandemic that started in 2019 and created major disruptions around the world demonstrated the imperative need for quick, inexpensive, accessible and reliable diagnostic methods that would allow the detection of infected individuals with minimal resources. Radiography, and more specifically, chest radiography, is a relatively inexpensive medical imaging modality that can potentially offer a solution for the diagnosis of COVID-19 cases. In this work, we examined eleven deep convolutional neural network architectures for the task of classifying chest X-ray images as belonging to healthy individuals, individuals with COVID-19 or individuals with viral pneumonia. All the examined networks are established architectures that have been proven to be efficient in image classification tasks, and we evaluated three different adjustments to modify the architectures for the task at hand by expanding them with additional layers. The proposed approaches were evaluated for all the examined architectures on a dataset with real chest X-ray images, reaching the highest classification accuracy of 98.04% and the highest F1-score of 98.22% for the best-performing setting.


Assuntos
COVID-19 , Aprendizado Profundo , Algoritmos , Humanos , Pandemias , Radiografia , Radiografia Torácica , SARS-CoV-2 , Raios X
17.
BMC Health Serv Res ; 21(1): 954, 2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34511105

RESUMO

BACKGROUND: There is emerging interest in person-centred care within a short-lived yet complex medical imaging encounter. This study explored this event from the viewpoint of patients referred for an imaging examination, with a focus on the person and their person-al space. METHODS: We used convenience sampling to conduct semi-structured interviews with 21 patients in a private medical imaging practice in Australia. The first phase of data analysis was conducted deductively, using the six elements of the person-centred, patient-journey framework of the Australian Commission on Safety and Quality in Healthcare: transition in; engagement; decisions; well-being; experience; and transition out. This was followed by inductive content analysis to identify overarching themes that span a patient's journey into, through and out of an imaging encounter. RESULTS: The transition-in phase began with an appointment and the first point of contact with the imaging department at reception. Engagement focused on patient-radiographer interactions and explanations to the patient on what was going to happen. Decisions related primarily to radiographers' decisions on how to conduct a particular examination and how to get patient cooperation. Participants' well-being related to their appreciation of gentle treatment; they also referred to past negative experiences that had made a lasting impression. Transitioning out of the imaging encounter included the sending of the results to the referring medical practitioner. Person-al vulnerabilities emerged as a cross-cutting theme. Patients' vulnerability, for which they needed reassurance, pertained to uncertainties about the investigation and the possible results. Healthcare professionals were vulnerable because of patient expectations of a certain demeanour and of pressure to perform optimal quality investigations. Lastly, patients' personal lives, concerns and pressures - their person-al 'baggage' - shaped their experience of the imaging encounter. CONCLUSION: To add value to the quality of the service they deliver, radiography practitioners should endeavour to create a person-al space for clients. Creating these spaces is complex as patients are not in a position to judge the procedures required by technical imaging protocols and the quality control of equipment. A reflective tool is proposed for radiographers to use in discussions with their team and its leaders on improving person-centred care and the quality of services in their practice.


Assuntos
Pessoal Técnico de Saúde , Pessoal de Saúde , Austrália , Humanos , Pesquisa Qualitativa , Radiografia
18.
Rev Med Suisse ; 17(750): 1576-1581, 2021 Sep 15.
Artigo em Francês | MEDLINE | ID: mdl-34528422

RESUMO

Sprains and dislocations of the proximal interphalangeal joint (PIP) are very common but are, nevertheless, often missed. They require an appropriate treatment to prevent stiffness and deformities. Initial assessment should include anteroposterior and true lateral radiographs. Intra-articular fractures are referred to the specialist. Clinical examination to detect laxity is essential and will guide the treatment. The treatment is based on the restoration of joint congruency and achieving early mobilization. Surgical indication is rare. The evolution is slow, pain and joint swelling can persist up to one year and definitive complications are not excluded.


Assuntos
Traumatismos dos Dedos , Fraturas Ósseas , Luxações Articulares , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/terapia , Articulações dos Dedos/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/terapia , Radiografia , Amplitude de Movimento Articular
19.
Pan Afr Med J ; 38: 408, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381552

RESUMO

Hydroxyapatite crystal deposition disease (HADD) of the hand and wrist is rare but can cause acute inflammatory syndromes that mimic infectious arthritis. These symptoms, which rapidly resolve with systemic anti-inflammatory drugs, are a source of diagnostic errors and inappropriate treatment. It is of crucial importance to make the diagnosis in order to avoid iatrogenic surgical management. The aim of this study was to determine the clinical and radiographic signs and the key features on which diagnosis depends. Treatment effectiveness and the course of the disease were also examined. Between 1992 and 2008, 12 patients consulted for an isolated acute local inflammatory syndrome of the hand or wrist, which was accompanied by a unique radiographic picture of calcific density. All patients were reassessed clinically and radiographically with a minimum follow-up of 2 years. All patients had presented with acute local inflammatory syndromes. Nine patients had edema and 8 had swelling and erythema. No patient had fever. The course was favorable in 11 patients and one patient required surgery. No patient had a recurrence at the mean final follow-up of 90 ± 64 months. The symptoms associated with hydroxyapatite crystal deposits suggest septic arthritis with acute joint inflammation. The radiological appearance is characteristic and corrects the diagnosis. Oral anti-inflammatory treatment gives more rapid spontaneous improvement, with complete and long-lasting resolution.


Assuntos
Calcinose/diagnóstico por imagem , Durapatita/metabolismo , Mãos/diagnóstico por imagem , Punho/diagnóstico por imagem , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Artrite Infecciosa/diagnóstico , Calcinose/patologia , Calcinose/terapia , Edema/etiologia , Feminino , Seguimentos , Mãos/patologia , Humanos , Inflamação/diagnóstico por imagem , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Punho/patologia
20.
J Pediatr Orthop ; 41(9): e706-e711, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34354030

RESUMO

INTRODUCTION: Preoperative radiographic assessment of curve flexibility in patients with idiopathic scoliosis is important to determine Lenke classification, operative levels, and potential postoperative correction. However, no consensus exists regarding the optimal technique. We compared measurements from supine side bending (SB) and intraoperative traction radiographs under general anesthesia (TUGA) with actual postoperative correction followed for 1 year. METHODS: We identified 235 patients with idiopathic scoliosis who underwent posterior spinal fusion with pedicle screw instrumentation between 2010 and 2018 who had preoperative and postoperative radiographs including standing posterior-anterior (PA) and lateral radiographs, preoperative SB radiographs, and TUGA radiographs. Curves were categorized into proximal thoracic, main thoracic/thoracolumbar (MT), and distal thoracolumbar/lumbar (TL/L) curves. Flexibility was calculated from SB and TUGA radiographs. Correction rates were calculated from 1 month and 1 year radiographs postoperatively. Bending radiographs that correlated significantly with postoperative correction with P<0.10 were eligible for inclusion. Preoperative demographics, etiology, deformity details, and surgical details were included in the multivariate models. RESULTS: On univariate analysis, TUGA radiographs correlated with postoperative correction at 1 month and 1 year on MT curves (r=0.214, P=0.001; r=0.209, P=0.001) and TL/L curves (r=0.280, P<0.001; r=0.181, P=0.006). Supine SB radiographs did not correlate with postoperative correction on either MT or T/TL curves. On multivariate analysis, major curve TUGA radiographs were independently associated with postoperative MT curve correction at 1 month (beta: 0.158, 95% confidence interval: 0.035-0.280, P=0.012) and 1 year (beta: 0.195, 95% confidence interval: 0.049-0.340, P=0.009). MT curve SB radiographs were not associated with postoperative major curve correction at 1 month (P=0.088). CONCLUSIONS: TUGA radiographs independently correlated with postoperative main thoracic and distal thoracolumbar/lumbar curve correction at 1 month and 1 year postoperatively. SB radiographs independently correlated only with TL/L curve correction at 1 year postoperatively. However, this correlation was not as strong as TUGA correction (beta of 0.280 vs. beta of 0.092). TUGA radiographs appear superior to SB radiographs at predicting curve correction after surgery. LEVEL OF EVIDENCE: Level III.


Assuntos
Escoliose , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tração , Resultado do Tratamento
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