RESUMO
Entre las causas de dolor torácico, la costilla deslizante presenta baja prevalencia, antecedentes traumáticos y manejo controvertido. Este síndrome merece ser incluido en el diagnóstico diferencial de causas de dolor torácico en niños. Al no asociarse a traumatismos previos y la deformidad de cartílagos, nos induce a pensar en una alteración en el desarrollo costal, al margen de la etiología traumática típica en adultos. Se presenta una serie de pacientes pediátricos intervenidos por costilla deslizante en un centro de referencia entre 2001 y 2022. Se incluyeron nueve pacientes, con un rango de edades de 11 a 16 años. Solo dos casos describen traumatismo previo. Todos presentan un inicio súbito de dolor toracoabdominal intenso. Los pacientes fueron intervenidos mediante resección abierta de cartílagos costales afectos, con resolución del dolor.
Among the causes of chest pain, slipping rib has a low prevalence, usually with a history of trauma, and its management is controversial. Slipping rib syndrome should be included in the differential diagnosis of causes of chest pain in children. When not associated with previous trauma and cartilage deformity, it is necessary to consider an alteration in rib development, regardless of the typical traumatic etiology in adults. Here we describe a series of pediatric patients with slipping rib seen at a referral hospital between 2001 and 2022. Nine patients aged 11 to 16 years were included. Only 2 had a history of trauma. All patients described a sudden onset of severe thoracic abdominal pain. The patients underwent open resection of the affected costal cartilages, with resolution of pain.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Costelas/anormalidades , SíndromeRESUMO
BACKGROUND: Myelolipoma is an uncommon benign tumor composed of mature adipose tissue and hematopoietic elements. These tumors generally affect the adrenal glands, with anomalous presentations being rare and with few cases described in the literature. Most myelolipomas are asymptomatic and discovered incidentally, either through imaging tests or at autopsies. However, depending on the location and size of the lesion, myelolipomas can cause symptoms of mass effect. This article aims to report a very rare presentation of a symptomatic primary myelolipoma affecting the ribs. CASE PRESENTATION: A 21-year-old white female patient presented with a complaint of burning chest pain over 3 months, with gradual worsening in intensity, accompanied by a progressively growing bulge in the right thoracic wall. The patient underwent thoracotomy of the fifth and sixth ribs with complete excision of the lesion with a safety margin. Thoracic wall reconstruction was performed using a polypropylene mesh. The patient had a good postoperative course and was discharged on postoperative day 3. Histopathological examination revealed a histological image consistent with myelolipoma. CONCLUSIONS: This report underscores the importance of considering a myelolipoma diagnosis for tumor masses in the ribs.
Assuntos
Mielolipoma , Costelas , Humanos , Mielolipoma/cirurgia , Mielolipoma/patologia , Mielolipoma/diagnóstico , Mielolipoma/diagnóstico por imagem , Feminino , Costelas/patologia , Costelas/cirurgia , Costelas/diagnóstico por imagem , Adulto Jovem , Toracotomia , Dor no Peito/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/diagnósticoRESUMO
OBJECTIVES: To analyze the differences in cusp height on radiographs, establishing proportional relationships between cusp and alveolar bone crest (ABC) measurements. The goal of this study was to develop a correction coefficient by considering this proportion. MATERIALS AND METHODS: Twenty-one artificial teeth, molars and premolars, and bovine ribs were used. Interproximal radiographs were taken with the aid of a positioner. The vertical angles used were: 0°, + 5°, and + 10°, and processed using three spatial resolutions measured in line pairs per mm (lp/mm): 20, 25 and 40. The Perio filter was applied to each image, in addition to the original one. Combinations of angle, resolution, and filter were made. Eighteen images were analyzed by three specialists, resulting in 252 measurements for each evaluator, totaling 756 measurements. RESULTS: The overall variability of the measurements can be explained mainly by the variation in tooth anatomy. The 0° 25 lp/mm Perio filter method was the closest one to the actual clinical scenario for both cusps and ABC. The correction factor managed to explain 71.45% of the errors. CONCLUSIONS: The variation in vertical angulation interferes with cusp and ABC measurements, and the angulation at 0º and spatial resolution of 25 lp/mm showed better results. The use of correction coefficients allowed approaching actual measurement values. CLINICAL RELEVANCE: More accurate ABC height measurements are essential even in radiographic exams that do not meet the standard of excellence because the need to repeat radiographic exams is then eliminated.
Assuntos
Processo Alveolar , Projetos Piloto , Animais , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/anatomia & histologia , Bovinos , Radiografia Dentária , Costelas/diagnóstico por imagem , Costelas/anatomia & histologia , Humanos , Técnicas In Vitro , Coroa do Dente/diagnóstico por imagem , Coroa do Dente/anatomia & histologiaRESUMO
BACKGROUND: We evaluated the impact of completion intraoperative venography on clinical outcomes for axillosubclavian vein (AxSCV) thrombosis owing to venous thoracic outlet syndrome (vTOS). METHODS: We performed a retrospective, single-center review of all patients with vTOS treated with first rib resection (FRR) and intraoperative venography from 2011 to 2023. We reviewed intraoperative venographic films to classify findings and collected demographics, clinical and perioperative variables, and clinical outcomes. Primary end points were symptomatic relief and primary patency at 3 months and 1 year. Secondary end points were time free from symptoms, reintervention rate, perioperative complications, and mortality. RESULTS: Fifty-one AxSCVs (49 patients; mean age, 31.3 ± 12.6 years; 52.9% female) were treated for vTOS with FRR and external venolysis followed by completion intraoperative venography with a mean follow up of 15.5 ± 13.5 months. Before FRR, 32 underwent catheter-directed thrombolysis (62.7%). Completion intraoperative venography identified 16 patients with no stenosis (group 1, 31.3%), 17 with no stenosis after angioplasty (group 2, 33.3%), 10 with residual stenosis after angioplasty (group 3, 19.7%), and 8 with complete occlusion (group 4, 15.7%). The overall symptomatic relief was 44 of 51 (86.3%) and did not differ between venographic classifications (group 1, 14 of 16; group 2, 13 of 17; group 3, 10 of 10; and group 4, 7 of 8; log-rank test, P = .5). The overall 3-month and 1-year primary patency was 42 of 43 (97.7%) and 32 of 33 (97.0%), respectively (group 1, 16 of 16 and 9 of 9; group 2, 16 of 17 and 12 of 13; group 3, 10 of 10, 5 of 5; group 4, primary patency not obtained). There was one asymptomatic rethrombosis that resolved with anticoagulation, and three patients underwent reintervention with venous angioplasty for significant symptom recurrence an average 2.89 ± 1.7 months after FRR. CONCLUSIONS: Our single-center retrospective study demonstrates that FRR with completion intraoperative venography has excellent symptomatic relief and short- and mid-term patency despite residual venous stenosis and complete occlusion. Although completion intraoperative venographic classification did not correlate with adverse outcomes, this protocol yielded excellent results and provides important clinical data for postoperative management. Our results also support a conservative approach to AxSCV occlusion identified after FRR.
Assuntos
Flebografia , Costelas , Síndrome do Desfiladeiro Torácico , Grau de Desobstrução Vascular , Humanos , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/cirurgia , Síndrome do Desfiladeiro Torácico/fisiopatologia , Feminino , Masculino , Estudos Retrospectivos , Adulto , Costelas/cirurgia , Costelas/diagnóstico por imagem , Adulto Jovem , Resultado do Tratamento , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Fatores de Tempo , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/cirurgia , Veia Axilar/diagnóstico por imagem , Veia Axilar/cirurgia , Cuidados Intraoperatórios , Valor Preditivo dos Testes , Terapia Trombolítica/efeitos adversosRESUMO
The use of less lethal weapons aims to mitigate civilian casualties caused by firearm use. However, due to numerous cases in which these weapons caused serious injuries, even lethal injuries, both legislation and the forensic field are interested in characterizing and regulating them better. In the forensic field, there is a lack of strong research about injury patterns of these weapons which makes it difficult to identify the type of weapon employed. In this study, the main objective was to characterize the injury pattern produced by the impact of the 9 mm P.A.K. projectile. A porcine model was used. Four different distances were studied: firm contact, 10 cm, 60 cm and 110 cm, using 3 of the more representative anatomical sites: the head, the hind leg and the ribs. The average measurement of the entrance orifice varied according to the anatomical site, being 6.67 mm wide and 6.25 mm long in the thorax, 7.3 mm wide and 8.8 mm long in the hind legs, and 7.62 mm wide and 7.54 mm long in the head. The variation in width and length measurements was not found to be directly related to the shot distance. The gunshot residues had similar characteristics to those of conventional lead projectiles, however there was more unburned powder deposit near the wounds, with a less dense soot and more dense powder tattoo. Depth varied widely regardless of tissue and firing distance, although loss of penetrating power and injury is observed as one moves away from the target.
Assuntos
Balística Forense , Modelos Animais , Ferimentos por Arma de Fogo , Animais , Suínos , Balística Forense/métodos , Ferimentos por Arma de Fogo/patologia , Costelas/lesões , Costelas/patologia , Armas de FogoRESUMO
OBJECTIVE: To assess the efficacy of the metal artifact reduction algorithm (MARA) of the Cranex 3D cone beam computed tomography (CBCT) device in the detection of peri-implant dehiscence and fenestration around zirconia implants. STUDY DESIGN: In total, 60 implants were placed in bovine ribs. Dehiscence and fenestration defects were created around the implants, after which 60 CBCT images were obtained with and 60 without activation of MARA. Three radiologists examined the images for the presence of defects. The area under the curve (AUC) from receiver operating characteristic analysis, sensitivity, and specificity were calculated to assess the ability to discriminate the presence vs absence of bone defects. One-way analysis of variance was employed to analyze outcome measures. The significance level was established at 5% (α = 0.05). RESULTS: AUC values indicated excellent discrimination of dehiscence on images with MARA activation and an excellent to outstanding range of discrimination with MARA deactivation. For fenestration, MARA activation and deactivation both led to outstanding discrimination. Sensitivity and specificity values revealed that activation of MARA was helpful in distinguishing the presence vs. absence of dehiscence, while both MARA conditions were helpful for fenestration. However, there were no statistically significant differences between MARA activation and deactivation for any outcome measure (P >.05). CONCLUSION: CBCT is suitable for detecting peri-implant defects, but MARA application does not significantly affect peri-implant dehiscence and fenestration detection.
Assuntos
Algoritmos , Artefatos , Tomografia Computadorizada de Feixe Cônico , Implantes Dentários , Zircônio , Tomografia Computadorizada de Feixe Cônico/métodos , Animais , Bovinos , Deiscência da Ferida Operatória/diagnóstico por imagem , Metais , Sensibilidade e Especificidade , Costelas/diagnóstico por imagem , Costelas/cirurgia , Imageamento Tridimensional , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
Among the causes of chest pain, slipping rib has a low prevalence, usually with a history of trauma, and its management is controversial. Slipping rib syndrome should be included in the differential diagnosis of causes of chest pain in children. When not associated with previous trauma and cartilage deformity, it is necessary to consider an alteration in rib development, regardless of the typical traumatic etiology in adults. Here we describe a series of pediatric patients with slipping rib seen at a referral hospital between 2001 and 2022. Nine patients aged 11 to 16 years were included. Only 2 had a history of trauma. All patients described a sudden onset of severe thoracic abdominal pain. The patients underwent open resection of the affected costal cartilages, with resolution of pain.
Entre las causas de dolor torácico, la costilla deslizante presenta baja prevalencia, antecedentes traumáticos y manejo controvertido. Este síndrome merece ser incluido en el diagnóstico diferencial de causas de dolor torácico en niños. Al no asociarse a traumatismos previos y la deformidad de cartílagos, nos induce a pensar en una alteración en el desarrollo costal, al margen de la etiología traumática típica en adultos. Se presenta una serie de pacientes pediátricos intervenidos por costilla deslizante en un centro de referencia entre 2001 y 2022. Se incluyeron nueve pacientes, con un rango de edades de 11 a 16 años. Solo dos casos describen traumatismo previo. Todos presentan un inicio súbito de dolor toracoabdominal intenso. Los pacientes fueron intervenidos mediante resección abierta de cartílagos costales afectos, con resolución del dolor.
Assuntos
Dor no Peito , Costelas , Humanos , Adolescente , Costelas/anormalidades , Criança , Masculino , Feminino , Dor no Peito/etiologia , Dor no Peito/diagnóstico , SíndromeRESUMO
Our knowledge of the diversity and evolution of South American Triassic pseudosuchians has greatly improved in the past 15 years, due to new discoveries, but also to the revision of several historically important specimens. One of the earliest descriptions of pseudosuchians from the Triassic of Brazil stems from the classic work of Huene from the first half of the 20th century, who described several species, including such influential taxa as Rauisuchus tiradentes or Prestosuchus chiniquensis, which have recently been reviewed. The more poorly known proposed second species of Prestosuchus, P. loricatus, is the focus of the present work. The original material included some elements of the axial skeleton (cervical and caudal vertebrae, ribs, osteoderms) and the hindlimb (ischia, calcaneum, metatarsus), collected from the Dinodontosaurus Assemblage Zone of the Chiniquá area, west of São Pedro do Sul. "Prestosuchus" loricatus shows numerous differences to P. chiniquensis, including the shape of cervical neural spines, presence of epipophyses on the cervical vertebrae, presence of a pit in the iliac articulation of the ischium, lack of longitudinal furrows in the dorsolateral surface of the ischial shafts, the more slender calcaneal tuber and a less pronounced ventral pit in the calcaneum, and is thus referred to a new genus, Schultzsuchus gen. nov. Phylogenetic analysis indicates an early branching position within Poposauroidea for Schultzsuchus, making it the oldest known member of this clade in South America.
Assuntos
Fósseis , Vertebrados , Animais , Brasil , Filogenia , CostelasRESUMO
En la actualidad es cada vez más frecuente la consulta de pacientes que siendo sometidos en edades tempranas a cirugías de extirpación tumoral y posterior reconstrucción con injertos presentan problemas tanto funcionales como estéticos, el uso de prótesis implantosoportadas mejora la calidad de vida, pero al mismo tiempo representan un desafío por la baja disponibilidad ósea. Se presenta un caso clínico de rehabilitación protésica implantosoportada en una paciente con gran déficit óseo mandibular como consecuencia de le extirpación de una neoplasia y posterior injerto de costilla. Se colocaron 2 implantes osteointegrados en hueso remanente y rehabilitación con prótesis removible sostenida a una barra colada. Por ser un tratamiento poco invasivo y conservador fue aceptado fácilmente por la paciente y la mejora tanto en la estética como en la función fue notoria.
Nowadays, it is becoming more and more frequent to see patients who underwent surgery for tumor removal and subsequent reconstruction with grafts at an early age, presenting both functional and esthetic problems. The use of implant-supported prostheses improves the quality of life, but at the same time represents a challenge due to the low availability of bone. A clinical case of implant-supported prosthetic rehabilitation is presented in a patient with a great mandibular bone deficit as a consequence of the removal of a neoplasm and subsequent rib graft. Two osseointegrated implants were placed in the remaining bone and rehabilitation with a removable prosthesis supported by a cast bar. Being a minimally invasive and conservative treatment, it was easily accepted by the patient and the improvement in both esthetics and function was notorious.
Atualmente, são cada vez mais frequentes os pacientes submetidos à cirurgia de remoção de tumores e posterior reconstrução com enxertos em idade precoce que apresentam problemas funcionais e estéticos. O uso de próteses implanto-suportadas melhora a qualidade de vida, mas, ao mesmo tempo, representa um desafio devido à baixa disponibilidade de osso. Apresentamos um caso clínico de reabilitação protética implanto-suportada em um paciente com grande déficit ósseo mandibular em consequência da remoção de uma neoplasia e posterior enxerto de costela. Dois implantes osseointegrados foram colocados no osso remanescente e a reabilitação foi feita com uma prótese removível suportada por uma barra de gesso. Por se tratar de um tratamento minimamente invasivo e conservador, foi facilmente aceito pelo paciente e a melhora na estética e na função foi perceptível.