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Introducción: El hipofraccionamiento moderado (hRt) en cáncer de próstata, consisten en disminuir el tiempo total de tratamiento con radioterapia, lo que mejora la adherencia terapéutica y optimiza recursos tecnológicos. En cáncer de próstata, existe evidencia robusta con datos maduros a 5 años de seguimiento, donde se evidenció que hRtno es inferior al tratamiento con fraccionamiento estándar en control oncológico, con menor o igual toxicidad aguda y tardía. Se hace una revisión de la evidencia, dosis de tolerancia, contorneo de volúmenes objetivo (GTV-CTV-PTV) / órganos de riesgo, planificación y reproducibilidad del hRt en cáncer de próstata localizado. Discusión: Se realizan recomendaciones técnicas para el hRT en cáncer de próstata: Tomografía axial de simulación, definición de volúmenes, objetivos en isodosis, dosis limitantes y definición de volúmenes para órganos de riesgo, planificación del tratamiento de radioterapia, reglas a seguir si no se cumplen las restricciones de dosis, entrega de tratamiento, verificación y precisión. Conclusión: En la actualidad existe evidencia convincente que permite disminuir el número de fracciones de radioterapia para cáncer de próstata localizado. La radioterapia de intensidad modulada guiada por imagen (marcadores fiduciales intraprostáticos, TAC de haz cónico) permite entregar un tratamiento más preciso y posiciona al hipofraccionamiento como un nuevo estándar de tratamiento con radioterapia para el cáncer de próstata localizado. Además, reducir el tiempo de radioterapia a 4 semanas disminuirá el costo de tratamiento y acortará las listas de espera en los departamentos de radioterapia.

El tumor fibroso pleural es una entidad médica poco frecuente, considerado una tumoración benigna. Representa entre el 5-8 % de los tumores primarios de pleural. Reportamos el caso de un paciente de sexo masculino de 59 años, no fumador con historia de 3 meses de deposiciones líquidas, asociadas a astenia, pérdida de peso y dolor en parrilla costal. Fue ingresado en el servicio de Gastroenterología del Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba. Se le realizó una radiografía de tórax, observándose como hallazgo accidental una masa tumoral en región para cardiaca, por lo que decide interconsultar con el servicio de Neumología. La tomografía de tórax evidenció una masa tumoral en el tercio inferior del hemitórax izquierdo, el estudio histológico e inmunohistoquímico fue compatible con un tumor fibroso solitario pleural. Conclusiones de este trabajo apuntan a que para el diagnóstico preciso de este tipo de tumor es necesario realizar una tomografía axial de tórax y un análisis histopatológico detallado.

Objective To evaluate the pulmonary alterations in workers from a dental prosthesis laboratory and explore dust and bacterial dissemination generated in the laboratory. Methods Spirometry and computerized axial tomography were performed on 67 workers. Dust in workplace air was determined using the filtration-gravimetric method, and bacterial detection was explored using 16S rDNA gene sequencing. Results Pulmonary alterations were detected in 37% of the workers. Airborne dust concentrations were determined to be higher than the maximum permissible exposure limit, and bacterial detection analysis revealed 23 bacterial genera. The most frequently detected bacterial genus was Sphingomonas sp., which has been described as microbiota associated with disease of the oral cavity. Conclusions The results of this study highlight the importance of the implementation of biosecurity measures, improvement of ventilation systems and routine disinfection of dental impressions.

espanolSe presenta el caso de una mujer en el segundo trimestre de gestacion, con enfermedad por coronavirus, que manifesto sintomatologia florida y variada con afectacion tanto gastrointestinal como respiratoria. Durante los 45 dias de seguimiento preciso de atencion multidisciplinaria por distintos niveles asistenciales (medicina de familia y matrona), que realizaron un seguimiento diario de la enferma desde el centro de salud y a traves de consulta no presencial, como por parte de los Servicios hospitalarios de Urgencias y Ginecologia en momentos concretos. En todo momento, se actuo asegurando el bienestar materno-fetal y analizando el riesgo-beneficio de las diferentes pruebas diagnosticas y medidas terapeuticas. A proposito del caso, se exponen los ultimos consensos sobre el diagnostico y tratamiento farmacologico de la embarazada con infeccion por SARS-CoV-2. Asi mismo se enuncian las ultimas teorias sobre la trasmisibilidad de la enfermedad desde la madre al neonato: se descarta la trasmision vertical, a pesar de que recientes estudios afirman la presencia de anticuerpos IgM en algunos de los neonatos de madres enfermas. La definicion de caso, el diagnostico, el pronostico y el abordaje de la mujer embarazada no difieren de los de la poblacion general; sin embargo, conlleva ciertos matices centrados en la situacion de hipercoagulabilidad propia del embarazo; de la yatrogenia derivada de la radiacion de pruebas complementarias como la radiografia de torax o la tomografia axial computerizada; o la debida a ciertos farmacos utilizados para el tratamiento de la covid-19, como los antivirales, que han sido administrados en uso compasivo en algunas pacientes, o la hidroxicloroquina (no ha demostrado beneficios y en estudios con animales se ha descrito acumulo en el tejido ocular fetal). EnglishThe case is presented of a woman in the second quarter of pregnancy, with coronavirus disease, who manifested abundant and varied symptoms with both gastrointestinal and respiratory involvement. During the 45 days of follow-up, she required multidisciplinary care by different care levels (family medicine and midwife), who conducted daily follow-up of the patient from the health care center and by remote consultation, and by the Hospital Emergency and gynecology Service at specific times. At all times, action was taken assuring the maternal-fetal well-being and analyzing the risk-benefit of the different diagnostic tests and therapeutic measures. Based on the case, the latest consensuses on the diagnostic and pharmacological treatment of the pregnant woman with SARS-CoV-2 infection are presented. Furthermore, the latest theories on the transmissibility of the disease from the mother to the newborn are set forth: vertical transmission is ruled out, in spite of the fact that recent studies state the presence of IgM antibodies in some of the newborns of ill mothers. The definition of the case, the diagnosis, prognosis and approach to the pregnant woman does not differ from that of the general population. However, it has certain nuances focused on the situation of hypercoagulability characteristic of the pregnant person; from the iatrogenic disease derived from the radiation of complementary tests such a chest x-ray or computerized axial tomography; or that due to certain drugs used for the treatment of the COVID-19, such as antiviral, which have been administered in compassionate use in some patients, or the hydroxychloroquine (it has not been demonstrated as beneficial and in studies with animals, accumulation in the fetal ocular tissue has been described).

Methods, experimental setups and perspectives of three-dimensional deep view imaging microscopy of cell or tissue samples are reported. Preliminary biophysical and clinically relevant examples are presented.

Aim Colorectal two week wait pathway investigations have been majorly affected due to Covid 19 especially with regards to endoscopy as well as virtual colonoscopy procedures in comparison to CT scan. We aimed to analyze the CT scan findings of colorectal rapid access patients. Method A total of 1900 patients was referred via the straight to test pathway in the year 2020.A retrospective analysis of CT scan investigation performed in these patients was analyzed. Results A total of 90 (4.74%) patients had a CT Scan as part of the work.20 patients (22%) of the CT scan revealed malignancy. 10 patients (50%) had metastatic disease on the scan. Among them, 6 (60%) were due to colorectal primary and another 2 (20%) was due to thoracic cancers. The remaining were diagnosed with widespread metastatic disease of unknown origin. Among the remaining 10 patients, Curative surgery was offered to 5 patients with colorectal primary and one patient with hepatocellular carcinoma. The remaining patients were diagnosed with High grade B cell lymphoma, Neuroendocrine tumor, pancreatic mass and primary renal cell carcinoma. One patient had high grade small bowel obstruction due to a band adhesion resulting in emergency surgery and 5% of the patient needed a vascular referral for Abdominal aneurysm. Conclusion CT scan in two week colorectal referral patients play a significant role in diagnosis of advanced disease. The ease of the procedure makes it more attractive during the pandemic in contrast to endoscopy and virtual-colonoscopy which has been significantly impacted by COVID 19.

Lumbar hernias of the lateroposterior abdominal wall have a low prevalence, being described in the scientific literature as sporadic cases or short series. Initially, they manifest as a painless tumor that can be confused with other more frequent pathologies such as soft-tissue tumors, lipomas, hematomas, or abscesses. We present the case of a 72-year-old female patient who, after removal of a lumbar lipoma by dermatology, was referred to our clinic for recurrence of tumor. An ultrasound scan showed a recurrence of the lipoma. The anamnesis and physical examination suggested lumbar hernia. Computerized axial tomography scan confirmed the clinical diagnosis, and surgery was indicated.

Background Low-grade fibromyxoid sarcoma is a very rare tumor that tends to develop in deep soft tissues of young adults and has the potential for local recurrence and distant metastasis. Clinical case We present the case of a 36-year-old man with a low-grade fibromyxoid sarcoma in the right shoulder, which was initially reported as a 4-year-old tumor, undergoing extensive resection with a histopathological report of low-grade fibromyxoid sarcoma, whose deep surgical edge was in bony contact. A simple and contrasted axial tomography was performed where an 8 mm left lung lesion was observed in the upper lobe lower lingular segment of heterogeneous content, hyperdense with contrast medium reinforcement. Left lateral thoracotomy is performed for metastasectomy and pathology corroborates the diagnosis of metastasis from fibromyxoid sarcoma. Conclusion Low histological fibromyxoid sarcoma is a very rare tumor that must be differentiated from other soft tissue tumors. Recurrences and metastases are reported, despite short or prolonged disease-free periods of up to 50 years, so patients with a history of this tumor should be followed up.

espanolEl insulinoma es un tumor formado por celulas especializadas beta de los islotes de Langerhans pancreaticos, que segregan constantemente insulina, lo que causa hipoglucemia. El diagnostico del insulinoma se realiza mediante la clinica (sintomas neuroglucopenicos y adrenergicos), la analitica (glucemia, peptido C e insulina) y la prueba de imagen complementaria (normalmente tomografia axial computerizada) que objetiva el insulinoma. El tratamiento consiste en la intervencion quirurgica mediante enucleacion del insulinoma, pancreatectomia parcial o total o cirugia con la tecnica de Whipple. Aunque es cierto que el insulinoma es una patologia rara, en atencion primaria hay que sospechar su presencia en pacientes con clinica sugestiva y solicitar analitica para completar estudio. EnglishInsulinoma is a tumor formed by specialized beta cells of the islets that are constantly secreting insulin, which causes hypoglycemia. The diagnosis of insulinoma is made through the clinic (neuroglycopenic and adrenergic symptoms), the analytical (glycemia, C-peptide and insulin) and the complementary image test (usually computerized axial tomography) that targets the insulinoma. The treatment consists of surgical intervention by enucleation of the insulinoma, partial or total pancreatectomy or surgery with the Whipple technique. At the Primary Care level, although it is true that insulinoma is a rare pathology, it is necessary to suspect it in patients with suggestive symptoms and order lab tests (or blood tests) to complete the study.

Resumen Introducción. El drenaje percutáneo de las colecciones intraabdominales, guiado por ultrasonografía o por tomografía computadorizada, ha sido el tratamiento de elección para los abscesos abdominales o pélvicos, entre otros. Objetivo. Describir la experiencia en el manejo percutáneo de colecciones abdominales en pacientes del Hospital Universitario San José de Popayán entre octubre de 2014 y abril de 2016. Materiales y métodos. Se trata de una serie de casos de 79 pacientes a quienes se les hizo manejo intervencionista de colecciones abdominales por medio de cirugía percutánea guiada por imágenes, los cuales cumplieron con los criterios de inclusión y exclusión. El análisis estadístico se hizo con el programa SPSS Statistics™. Resultados. Se realizaron 106 procedimientos percutáneos para drenar diferentes colecciones intraabdominales. La intervención más frecuente fue el drenaje de colecciones hepáticas (32,1 %), en su mayoría, abscesos hepáticos, seguida del drenaje de abscesos posquirúrgicos de cirugías abiertas o laparoscópicas. Conclusiones. Las técnicas intervencionistas en manos de un cirujano entrenado son un tratamiento eficaz y seguro para las diferentes colecciones intraabdominales. El procedimiento fue exitoso en el 99 % de los pacientes de la presente serie. Abstract Introduction: Percutaneous drainage of intraabdominal collections guided by ultrasonography or computerized axial tomography has been the treatment of choice for the management of abdominal or pelvic abscesses. Objective: To describe the experience with the percutaneous ultrasonography-guided drainage of abdominal collections in patients at the San José University Hospital in Popayán, Colombia, in the period October 2014 and April 2016. Materials and methods: This is a case series of 79 patients who underwent interventional management of abdominal collections by a percutaneous procedure guided by images; all patients met the inclusion and exclusion criteria. The statistical analysis was carried out with the SPSS Statistics program. Results: 106 percutaneous procedures were performed for drainage of different intra-abdominal collections. The most frequent intervention was the drainage of hepatic collections (32.1%), mostly hepatic abscesses, followed by drainage of postoperative abscesses following open or laparoscopic surgery. Conclusions: The management of interventional techniques in the hands of the trained surgeon is an effective and safe method for the treatment of different intra-abdominal collections. The procedure was successful in 99% of the patients.

We reviewed computerized axial tomography of 28 patients with hamate hook fractures who had surgical resection of the hook. We analysed the relationship between the fragment height ratio, fragment gap, and intraoperative findings of the tendons. We determined whether parameters in the images can predict complication of tear or disruption of the flexor tendons to the ring or little fingers. Of 28 patients, 16 had fragment height ratios between 50–74; ten among them had worn (eight patients) or ruptured (two patients) flexor tendons. Nine of the ten patients had fragment gaps greater than 2 mm. The remaining 12 patients had fragment height ratios between 75–100 and had intact tendons. We conclude that a fragment height ratio greater than 75 and fragment gap less than 2 mm in computer tomography may rule out tear or disruption of the flexor tendons of the ring and little fingers after hamate hook fractures, and a fragment height ratio between 50–74 with fragment gap greater than 2 mm indicates a high risk of flexor tendon tear or disruption.Level of evidence: IV

For probing small distances in living cells, methods of super-resolution microscopy and molecular sensing are reported. A main requirement is low light exposure to maintain cell viability and to avoid photobleaching of relevant fluorophores. From this point of view, Structured Illumination Microscopy (SIM), Axial Tomography, Total Internal Reflection Fluorescence Microscopy (TIRFM) and often a combination of these methods are used. To show the high potential of these techniques, measurements on cell-substrate topology as well as on intracellular translocation of the glucose transporter GLUT4 are described. In addition, molecular parameters can be deduced from spectral data, fluorescence lifetimes or non-radiative energy transfer (FRET) between a donor and an acceptor molecule. As an example, FRET between the epidermal growth factor receptor (EGFR) and the growth factor receptor-bound protein 2 (Grb2) is described. Since this interaction, as well as further processes of cellular signaling (e.g., translocation of GLUT4) are sensitive to stimulation by pharmaceutical agents, methods (e.g., TIRFM) are transferred from a fluorescence microscope to a multi-well reader system for simultaneous detection of large cell populations.

Our understanding of the management of ankle fractures has significantly improved in recent years. Computerized axial tomography and better biomechanical insights have renewed the underlying concepts for both diagnosis and treatment. Notwithstanding, some aspects of the management of malleolar fractures still lack consensus. This review aims to update concepts on the study and management of ankle fractures. Stability, radiological studies, computerized axial tomography, management of associated ligament injuries (deltoid ligament and syndesmosis), and posterior malleolus fractures are covered in the article. The authors opinions and the evidence are discussed for each question.El conocimiento acerca del manejo de las fracturas de tobillo ha tenido un gran crecimiento los últimos años. La tomografía axial computarizada y el mejor entendimiento biomecánico han renovado conceptos tanto del diagnóstico como del tratamiento. Pese a ello, actualmente existen consideraciones sobre el manejo de fracturas maleolares sin consenso. Esta revisión pretende actualizar conceptos sobre el estudio y manejo de las fracturas de tobillo. Serán discutidos los conceptos de estabilidad, estudios radiológicos, uso de tomografía axial computarizada, manejo de lesiones ligamentarias asociadas (ligamento deltoideo y sindesmosis) y manejo de fracturas del maléolo posterior. Se planteará la opinión de los autores y la evidencia en la literatura para cada pregunta propuesta.

Sinus of Valsalva aneurysms are unusual complications of endocarditis that can be fatal if not detected and treated. As the incidence of endocarditis continues to increase, and in patients not subjected to early surgery, our case suggests long term follow up should include imaging (echocardiography and computerized axial tomography), especially in patients with ongoing and unusual symptoms, despite negative blood cultures. This can also aid in planning of the surgical approach and treatment.

Alice in Wonderland syndrome (AIWS) is a rare disorder that refers to episodic body image distortions, sometimes associated with altered perception of external space and time. AIWS is mainly associated with viral disease in children as well as migraines and epileptic seizures in adults. Its pathogenesis is still very much unknown and there are not many reported drug-associated cases in medical literature. We describe a case of a 67-year-old woman, with a relevant history of depressive disorder, nontoxic goiter, and dyslipidemia that presented short episodes of altered body perception associated with altered external space perception for a period of one week. Her physical examination was unremarkable and her cerebral computerized axial tomography (cerebral CAT) and blood tests showed no alterations. She had been medicated with sertraline till the previous year and had restarted it in the previous month. She reported similar episodes of body image distortions in the first weeks of initiating sertraline for the first time. The current episode lasted for two weeks and in one year follow-up she reported no recurrence. The patient was diagnosed with AIWS probably induced by sertraline, being the first reported case of the kind.

In a future scenario in which all the concrete is recycled concrete, it will be necessary to recycle the recycled concrete. However, it is known that the recycling of concrete implies a loss of properties. This paper shows an innovative technique, the computerized microtomograph, used to evaluate closed porosity, volume of limestone aggregate fraction and volume of mortar of the multi-recycled aggregate concrete, in order to answer the question: how many times it is possible to recycle concrete? First, the source concrete mix using limestone coarse and fine aggregates was characterized. This mix was crushed to obtain a recycled aggregate that was used to manufacture the 1st generation or current recycled aggregate concrete. After the characterization of this 1st generation concrete, and in the same way, a 2nd and a 3rd generation concrete were obtained and characterized, using recycled aggregates from the 1st and 2nd concrete generations respectively. The evaluation by computerized axial tomography allows to know how the successive recycled affect the properties of the concrete. The results show that it is possible to observe the distribution and quantify the aggregate, cement paste and closed porosity contents of the recycled aggregate concrete showing that 3rd generation recycled concrete shows almost twice as much mortar as 1st generation one and demonstrates that it is only possible to recycle the concrete a finite number of times.

Software tools based on finite element analysis are widely used for structural mechanical analysis and even in other areas such as medicine. This research analyzes the efforts that occur in the two most important bones that are part of the knee joint from computerized axial tomography (CT) and proposes a methodology based on finite element meshes to obtain these efforts. From the simulation of the geometry of a real knee, stress-strain curves have been developed. The results obtained from the simulation showed that the stress pattern is at a value of 10.97 Mpa in the area between the intercondylar eminence and the intercondylar notch and a unit strain of 1.05 \(\times \) 10 − 2 mm for the femur and 8, 5 \(\times \) 10 − 4 mm in warm.

The editorial published in this same journal entitled "Sombras del tratamiento actual del hepatocarcinoma en España: una verdad incómoda" has awakened the need to review the available scientific literature on the precise diagnosis of hepatocarcinoma based on a clinical case. A 58-year-old male patient has a radiological finding in the left hepatic lobe of a new lesion of 3.5 cm in size. Nuclear magnetic resonance imaging and computerized axial tomography confirmed the typical radiological behavior of hepatocarcinoma. However, the definitive pathological anatomy (A-P) after surgery was compatible with intrahepatic cholangiocarcinoma. The main national and international clinical guides offer the use of imaging tests for diagnosis, especially in high-risk patients. However, diagnostic biopsy is not included as mandatory in the hepatocarcinoma diagnostic process, although it may be recommended in some cases. The interest of the clinical case we present establishes the relevance of reaching a histological diagnosis of certainty, since imaging tests can objectify findings that are confusing with other tumor histologies, with future therapeutic and prognostic implications.

Objetivo: esta investigación evaluó la reproducibilidad en el diagnóstico imagenológico de PA en dientes del maxilar superior a partir de 60 CBCT tomadas en una institución clínica en una ciudad intermedia en Colombia. Métodos: el estudio fue realizado por dos observadores previamente calibrados de CBCT del maxilar superior que contenían dientes permanentes con ápice cerrado, correspondientes a adultos mayores de 18 años de edad. La presencia o ausencia de periodontitis apical se analizó utilizando el índice CBCT PAI. La información registrada fue relacionada con variables de interés. Resultados: la reproducibilidad entre los evaluadores fue sustancial o perfecta. La prevalencia de periodontitis apical encontrada fue del 21,6%, en los dientes con tratamiento de endodoncia 12,4% y en los dientes sin tratamiento endodóntico 9,2%. Conclusiones: la tomografía CBCT proporciona al clínico información que permite una mayor claridad en la fase de diagnóstico. Los dientes con la mayor prevalencia de PA fueron el primer molar y el primer premolar superior izquierdo respectivamente.

The fatigue behavior of lightweight polyurethane foam waste cement mortars was analyzed, in which the sand is replaced by polyurethane waste in volumetric proportions of 50%, 60% and 75%. For this purpose, having calculated the static modulus of elasticity of the mortars, successive loading and unloading cycles under compression are performed. These tests confirm the fatigue capacity and structural properties of the mortars, aspects that are indicative of their long-term durability and suitability for use in masonry works. Two test phases were performed with increasing and variable loads of 20% and 90% of the breaking strain, reaching 300,000 cycles in the first phase and 525,000 in the second one. Both phases showed that the cement mortars with substitutions of up to 60% of sand by polyurethane foam waste were capable of withstanding loading and unloading cycles similar to the conditions of typical masonry mortars in construction works. The results underlined the long-term durability of these lightweight recycled materials. Their good fatigue behavior could be corroborated through the images taken by computerized axial tomography. No significant fractures were observed when comparing the sections before and after the loading cycles, which indicates that no structural collapse took place.

This paper analyzes hospital characteristics that are associated with higher average costs and charges for venipuncture, computed tomography procedures (computerized axial tomography [CAT] scans), and electrocardiograms (EKG). Using data from a Medicare database, our results indicate that higher wages, larger hospital sizes, and greater service quality are associated with higher procedure costs, whereas system membership is generally associated with lower procedure costs. Blinder‐type decompositions, which are the main focus of this study, suggest (a) that venipuncture costs are about 17% to 19% lower at proprietary hospitals than at nonprofit or government hospitals, (b) CAT scan costs are about 6% to 12% lower at nonprofit hospitals than at proprietary and government hospitals, and (c) that EKG costs are about 3% lower at proprietary hospitals than at nonprofit or government hospitals. Lastly, large portions of each of these differences are found to be due to both differences in mean values of the hospitals' characteristics by ownership type and differences in the mechanism by which the hospitals' characteristics are transmitted to procedure costs.

espanolEl sindrome de De Morsier o displasia septo-optica (DSO), fue descrito por De Morsier en 1956, quien reconocio la asociacion entre la agenesia o hipoplasia del septum pellucidum e hipoplasia del nervio optico, quiasma y tractos opticos. Se puede asociar a disfuncion hipotalamo-hipofisaria. La forma de presentacion es esporadica y los casos familiares son raros, aunque se ha postulado la posibilidad de herencia autosomica recesiva. El cuadro neurologico asociado al sindrome es variable. Se presenta en algunos pacientes con inteligencia normal y sin deficit neurologico. Los trastornos del aprendizaje y el retraso mental estan relacionados con las anomalias del septum pellucidum. Las convulsiones son las manifestaciones descritas con frecuencia. Como objetivo tenemos el de identificar sintomas y signos del sindrome de De Morsier en nina guatemalteca de seis anos. La paciente es una nina mestiza, de seis anos, antecedentes de distrofia muscular progresiva paterna, acude a consulta por nistagmo, estrabismo, torticolis compensadora y retardo del neurodesarrollo, con un incremento ponderal correcto, en el examen fisico encontramos telangiectasias palpebrales, nistagmo vertical-horizontal, desviacion de la cabeza al lado izquierdo. Fondo de ojo: Palidez temporal acentuada de ambos discos, atrofia macular, sin brillo foveal, tortuosidad venosa generalizada. Hipoplasia del nervio optico. En tomografia axial computadorizada se observa ausencia de septum pellucidum. La distrofia muscular progresiva y el Sindrome de De Morsier tienen una baja incidencia en la poblacion, por lo que la presencia de las mismas en padre e hija debe ser senalada, no se tiene explicacion para justificar el hallazgo, no se han encontrado reportes previos en la literatura que lo senalen. EnglishDe Morsier syndrome dysplasia septo-optic (DSO), was described by De Morsier in 1956, who recognized the association between Agenesis or hypoplasia of the septum pellucidum and hypoplasia of the optic nerve and CHIASM and optic tracts. You may be associated with dysfunction hypothalamic-pituitary. The form of presentation is sporadic and familial cases are rare, although it has been postulated the possibility of autosomal recessive inheritance. The neurological picture associated with the syndrome is variable. It occurs in some patients with normal intelligence and no neurologic deficit. Disorders of learning and mental retardation are related to abnormalities of the septum pellucidum. Seizures are frequently described demonstrations. Objectives. Identify signs and symptoms of De Morsier syndrome in 6-year-old Guatemalan girl. Patient mestizo, of six years, a history of progressive muscular dystrophy his father, goes to consultation by nystagmus, strabismus, torticollis buffer and delay of neurodevelopmental, with a correct weight increase. Physical examination palpebral telangiectasias, vertical nystagmus, deviation from the head to the left side. Fundus: pronounced temporal pallor of both discs, atrophy macular foveal, venous tortuous generalized dull. Optic nerve hypoplasia. Computerized axial tomography shows absence of septum pellucidum. Discussion. Progressive muscular dystrophy and De Morsier syndrome have a low incidence in the population, so the presence of the same father and daughter should be designated, there is no explanation to justify the finding, not found, previous reports in the lit erature pointing it.

Ameloblastoma is a benign but locally invasive odontogenic tumor that causes significant morbidity. The aim is to study an ameloblastoma treatment with reconstruction using titanium plates adapted using stereolithographic models. A 48-year-old female patient referred due to asymptomatic osteolytic lesion between teeth 47 and 48 discovered during routine radiographic study. The pathoanatomical study described a desmoplastic ameloblastoma. Due to the possibility of it being a malignant lesion, a computerized axial tomography scan was performed, which showed that the tumor was not malignant. A stereolithographic model was prepared to make the cutting guides and facilitate fitting of reconstruction plates. Three-dimensional printing technology enables fast, accurate mandibular reconstruction, helping to shorten operation time.

Purpose This paper aims to propose a functional methodology to produce cranial prostheses in polymeric sheet. Within the scope of rapid prototyping technologies, the single-point incremental forming (SPIF) process is used to demonstrate its capabilities to perform customized medical parts. Design/methodology/approach The methodology starts processing a patient’s computerized axial tomography (CAT) and follows with a computer-aided design and manufacture (CAD/CAM) procedure, which finally permits the successful manufacturing of a customized prosthesis for a specific cranial area. Findings The formability of a series of polymeric sheets is determined and the most restrictive material among them is selected for the fabrication of a specific partial cranial prosthesis following the required geometry. The final strain state at the outer surface of the prosthesis is analysed, showing the high potential of SPIF in manufacturing individualized cranial prostheses from polymeric sheet. Originality/value This paper proposes a complete methodology to design and manufacture polymer customized cranial prostheses from patients’ CATs using the novel SPIF technology. This is an application of a new class of materials to the manufacturing of medical prostheses by SPIF, which to this purpose has been mainly making use of metallic materials so far. Despite the use of polymers to this application is still to be validated from a medical point of view, transparent prostheses can already be of great interest in medical or engineering schools for teaching and research purposes.

Obesity and its possible association with diseases including diabetes and cardiovascular diseases have been studied for decades for its impact on healthcare. Recent studies clearly indicate the need for developing accurate and reproducible methodologies for assessing body fat content and distribution. Body fat distribution plays a significant role in developing an insight in the underlying mechanisms in which adipose tissue is linked with various diseases. Among imaging technologies including computerized axial tomography (CAT or CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS), MRI and MRS seem to be the best emerging techniques and together are being considered as the gold standard for body fat content and distribution. This paper reviews studies up to the present time involving different methodologies of these two emerging technologies and presents the basic concepts of MRI and MRS with required novel image analysis techniques in accurate, quantitative, and direct assessment of body fat content and distribution. This article is part of a Special Issue entitled: Oxidative Stress and Mitochondrial Quality in Diabetes/Obesity and Critical Illness Spectrum of Diseases - edited by P. Hemachandra Reddy.

This article presents the processes performed to obtain a medical image in three dimensions (3D), reconstructed from a stack of 2D medical images, acquired through a computerized axial tomography (CAT). Additionally, it is described the integration of a haptic tool within the developed system for the interaction and manipulation of the 3D virtual solid, generated in the application developed in this work, by a user who operates this tool (Phantom Omni).

In this work, the design and numerical evaluation of a personalized hip prosthesis for a 31-year-old male patient, who suffered of unilateral coxarthrosis, was performed. Based on the information obtained of the patient’s computerized axial tomography and the employment of specialized design platforms such as Solidworks®, a numerical analysis was performed for the prosthetic model in conjunction with the anthropometric data of the patient following the finite element mathematical method. Furthermore, the natural posture of the patient was taken into consideration every time the patient balanced the total weight on one leg. Furthermore, the structural mechanical evaluation of the prostheses was set under evaluation, considering the osseous integration of the femoral bone and the acetabulum before and after surgery.

Osteogenesis Imperfecta (OI) is a congenital and incurable disease known as the “Crystal Bones” disease. In most cases, people with OI suffer bone fractures due to minimal causes, although in drastic cases, a bone deformation is presented, consequently causing some physical disability. In open literature, there is no information concerning models for patients belonging to the Mexican phenotype. Hence, this paper is devoted to report advances in the development of finite element models for long bones of OI patients; the model was carried out from a computerized axial tomography. As well, stress analysis is shown by taking into account specific properties of the affected bone tissue. Our results obtained will be used for manufacturing orthopaedic implants and the construction of virtual dummies for crash test.

Background: It is not easy to suspect whether newly born infants diagnosed as hypoxic ischemic encephalopathy (HIE) will develop impairment of renal function, so there is an urge to scientifically research about correlations of severity of HIE, which is represented by Sarnat scoring and brain computerized axial tomography (CAT) and serum creatinine level in these newly born infants. Aim: To evaluate renal function in the form of serum creatinine levels in full-term neonates with HIE and their correlation with severity degree of HIE, which is represented by Sarnat scoring and CAT. Aim: To evaluate renal function in the form of serum creatinine levels in full-term neonates with HIE and their correlation with severity degree of HIE, which is represented by Sarnat scoring and CAT. Subjects and Methods: This study was a case–control type. It was conducted on 72 full-term neonates who were classified into group 1, which included 36 full-term neonates who were diagnosed as HIE according to the definition of the World Health Organization and group 2, which included 36 full-term neonates who were matched for age and sex and who served as the control group. Serum creatinine levels were measured at days 1 and 7 postnatally. CAT scans were carried out for cases only. Results: Serum creatinine levels were elevated in group 1 when compared to the control group at days 1 and 7 postnatally. They were significantly correlated to the Sarnat scoring system of HIE, meaning that serum creatinine levels gradually increased with the increase in severity of HIE according to Sarnat and Sarnat staging. A statistically significant difference was observed between serum creatinine levels in patients with different findings of brain CAT, meaning that more elevation in serum creatinine levels were reported with more severe cases represented by marked changes in brain CAT. Conclusion: Serum creatinine levels correlate with the severity of HIE of neonates according to Sarnat scoring and brain CAT.

A 25 years old Saudi single female school teacher presented 9 years ago to the haematologist with iron deficiency anaemia (Haemoglobin was 8.3 gr/l.

Hypothesis The hypothesis of this work is that infrared thermography could become a valid tool for the diagnosis and follow-up of the Emery-Dreifuss disease due to putative temperature changes produced by a constant degenerative evolution of this muscular dystrophy. Testing the hypothesis To justify this hypothesis we proposed a pilot study with 2 brothers affected of Emery-Dreifuss who present a very different age, with the principal objective to evidence a possible evolution of this pathology. Acquisition and comparison of images of computerized axial tomography (CT) and thermography (IRT) of the distal limbs in 2 affected brothers. Data and discussion Important image correlations in the region of the thighs and the posterior region of the legs have been highlighted. The comparison between the CT and the thermography showed how the first results are encouraged and promising and open a possible new line of research on the evaluation and follow-up of this disease. Despite this, a larger number of studies are needed to validate the thermography as a diagnostic technique and follow-up of this pathology.

The damage caused by the environment to exposed glazed terracotta objects is usually not externally visible. For instance, the detachment of the glaze owing to subsurface crack formation or whole cavities in the area of the terracotta cannot be located visually. In this article, we demonstrate that terahertz time-of-flight spectroscopy is suitable to locate and measure the air gaps under the glaze detachments which could only be done by X-ray axial tomography before. This tool will be very useful to guide the restoration process, particularly for pieces that are still attached to buildings or other structures that cannot be transported to a tomography facility.

In this paper, we have experimentally studied the impact of particle size distribution (PSD) on the fracture sealing capability of lost circulation material (LCM) blends. Our primary aim was to determine the PSD which maximizes the Wellbore Strengthening (WBS) benefits obtained from fracture sealing. High-pressure borehole fracturing experiments were conducted on Berea sandstone samples under atmospheric pore pressure and various confining pressures to investigate the WBS effects of several LCM blends. Post-fracturing methods such as Computerized Axial Tomography (CAT) scan and thin-section imaging were used to investigate the geometry of induced fractures and formed seals within them. Based on the conducted experiments and post-fracturing analyses, we have evaluated and re-assessed well-known theories applicable to the design of LCM blends, such as the one-third rule, the ideal packing theory, and the Vickers criteria. Our experiments indicate that for any rock with a given set of rock strength and failure parameters, there exists an optimum PSD to maximize WBS benefits. Optimum PSD appears to be of primary importance, almost independent of LCM type. In addition, we have shown that the optimum PSD should have a bimodal structure, with sufficient concentrations of properly sized fine and coarse particles. Although the one-third rule, the ideal packing theory, and the Vickers criteria may provide some basic PSD guidelines, these theories are mainly empirical relationships based on conventional particle plugging experiments. As shown here, they do not properly represent the physics of fracture sealing. To remedy this situation, we are introducing a new family of design curves for optimum PSD, based on the underlying physics of fracture sealing observed in the WBS experiments.

In this paper we present a new method for the monitoring of super-paramagnetic nanoparticles (SPANs) in the body. Nowadays, reliable and inexpensive device and method for monitoring the spatial distribution of SPANs in the body are not present in the market of clinical imaging equipments. Importantly, since SPANs can be conjugated to a huge variety of organic (antibodies, proteins, synthetic polymers) and inorganic molecules they can be used to selectively detect targets (e.g. cancer cells) with striking specificity. The existing imaging methods used for clinical diagnostic purposes are the nuclear magnetic resonance (NMR) and computerized axial tomography scan (CAT or CT scan). Detection of SPANs with these methods is still controversial and most import they used strong magnetic field and harmful X-ray radiation, respectively, and the cost for a single analysis is high as well. Herein we describe an innovative magnetic method promises the measurement of the distribution of SPANs with sensitivity quite better than 1 μm3. The method (patented device by our group) is based on magnetic excitation and consequent detection of nanoparticles using super-conducting or magnetic sensors (magnetometers). The device is innovative and novel, and could be considered as a universal breakthrough in tumor diagnosis. Possible other applications could be simultaneous killing of the cancer cells applying inductive heating techniques.

Thoracic aortic aneurysms (TAs) occur in reproducible patterns, but etiologic factors determining the anatomic distribution of these aneurysms are not well understood. This study sought to gain insight into etiologic differences and clinical outcomes associated with repetitive anatomic distributions of TAs. From 3,247 patients registered in an institutional Thoracic Aortic Center database from July 1992 to August 2013, we identified 844 patients with full aortic dimensional imaging by computerized axial tomography or magnetic resonance imaging scan (mean age 62.8 ± 14 years, 37% women, median follow-up 40 months) with TA diameter4.0 cm and without evidence of previous aortic dissection. Patient demographic and imaging data were analyzed in 3 groups: isolated ascending thoracic aortic aneurysms (AAs; n = 628), isolated descending TAs (DTAs; n = 130), and combined AA and DTA (mixed thoracic aortic aneurysm, MTA; n = 86). Patients with DTA had more hypertension (82% vs 59%, p0.001) and a higher burden of atherosclerosis (88% vs 9%, p0.001) than AA. Conversely, patients with isolated AA were younger (59.5 ± 13.5 vs 71.0 ± 11.8 years, p0.001) and contained almost every case of overt, genetically triggered TA. Patients with isolated DTA were demographically indistinguishable from patients with MTA. In follow-up, patients with DTA/MTA experienced more aortic events (aortic dissection/rupture) and had higher mortality than patients with isolated AA. In multivariate analysis, aneurysm size (odds ratio 1.1, 95% CI 1.07 to 1.16, p0.001) and the presence of atherosclerosis (odds ratio 5.7, 95% CI 2.02 to 16.15, p0.001) independently predicted adverse aortic events. We find that DTA with or without associated AA appears to be a disease more highly associated with atherosclerosis, hypertension, and advanced age. In contrast, isolated AA appears to be a clinically distinct entity with a greater burden of genetically triggered disease.

La arteria ácigos cerebral anterior (AACA) es un vaso formado por la fusión de ambas arterias pericallosas. Su presencia en series anatómicas es inferior al 5% de los casos. El objetivo de los autores es presentar dos casos de AACA asociados a un aneurisma intra-craneano y una malformación arteriovenosa (MAV). Casos clínicos: el caso 1 es una paciente de 52 años con un cuadro de hemorragia subaracnoidea. Una tomografía de cráneo (TC) confirmó el diagnóstico. Se hizo areriografía que evidenció un aneurisma de la AACA. El mismo fue clipado sin incidentes. El caso 2 se trata de un hombre que presentó un hematoma intraparenquimatoso y tenía antecedentes de haber sido operado por una malformación arteriovenosa (MAV). Una nueva arteriografía evidenció un remanente de MAV nutrido por ramos de una AACA. Se intervino sin complicaciones intraoperatorias, pero falleció en la evolución por una sepsis. La AACA es un vaso que se ve de forma transicional en embriones humanos y que se encuentra de forma reglada en mamiferos inferiors. Su presencia en cerebros adultos humanos e poco frecuente. Se destaca su asociación con aneurismas intracraneanos y alteraciones del desarrollo de la línea media cerebral. The azygos anterior cerebral artery (AACA) is a vessel formed by the fusion of both pericallosal arteries. Its presence in anatomical series is less than 5%. We present two cases of AACA, one associated with an aneurysm and other associated to an arteriovenous malformation (AVM). Clinical cases: Case 1 is a 52-year-old woman who was admitted to a hospital with sudden onset of sensory depression and headache. A cranial axial tomography (CT) demonstrated a sub-arachnoid hemorrhage. Cerebral angiography showed an aneurysm of an azygous anterior cerebral artery bifurcation. Surgical clipping was carried out with an excellent outcome. The second case is a 71-year-old man that had been operated 20 years before, of a right frontal AVM. He was admitted to a medical center with an acute severe left hemiparesis. The CT showed a right sided frontal haematoma and the cerebral angiography showed an AVM, partly fed by an AACA. The malformation was surgically treated, but the patient died at a later time as a consequence of sepsis. The AACA is seen as a transitional vessel in the human brain embryologic development, and is found in some inferior mammals and monkeys. This artery is seen in early stages related to the development of the corpus callosum. However, it disappears later on in most of the cases. Its existence in adults is infrequent, but has been reported in isolated cases sometimes associated with vascular malformations as those presented.

Background and Aim: After successful medical management of a patient with a clinical picture suggestive of post-sphincterotomy duodenal perforation, in which a computerized axial tomography (CAT) scan of the abdomen revealed the presence of subcutaneous emphysema and retroperitoneal air, concern arose as to the frequency of pneumoretroperitoneum following endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (ES) and if any procedure dependent factors were associated with this problem. Aim: To assess the frequency and clinical significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy. Methods: Fifty consecutive patients, who had undergone ERCP with sphincterotomy, were submitted to abdominal CT examinations within 24 hours after completion of the procedure. One patient was with a large precut, but a failed ERCP was also included. The ERCP findings were unknown to the radiologist. Results: Seven (14%) of 50 patients showed CT findings of retroperitoneal air. All of them had uneventful post-procedural recovery. No clinical or laboratory abnormality was found in this group of patients. The presence of retroperitoneal air was not associated to the variables: precut, biliopancreatic disease type, endoscopic sphincterotomy length, additional endoscopic procedure (balloon exploration, gallstone extraction, stent insertion) or procedure duration. Conclusion: After ERCP with ES, retroperitoneal air is frequently found. In the absence of physical symptoms, retroperitoneal air is not clinically relevant and does not require specific treatment.

Objectives The relationship between the presence of bone defects (fenestrations and dehiscences) observed in lateral slices in computerized axial tomography (CAT) images and maxillomandibular transverse discrepancies was determined. Methods The sample was composed of 160 CAT scan files, corresponding to 9–25-year-old patients, which had been taken prior to orthodontic treatment at a radiology center in Guadalajara, México, from 2009 to 2012. They were grouped by age, and we identified bone defects in maxillary teeth (first and second premolars and first molars). The maxillary (JL-JR) and mandibular (GA-AG) widths were measured, and the maxillomandibular discrepancy ([GA-AG]-[JL-JR]) was calculated. Chi-square and t-tests were performed. Results The values of maxillomandibular discrepancies increased with the age of the patient. There was no association between the magnitude of the maxillomandibular discrepancy and the presence of bone defects. The gender of the individual was not a decisive factor in whether bone defects were present. Conclusion Bone defects occur in the vast majority of patients pretreatment regardless of the magnitude of the maxillomandibular discrepancy.

Liver disease is a disease that can reduce liver function and affect the production process of protein, hormone and nutrients in the human body. One way of knowing liver disease by doing abdominal CT scan. CT Scan (Computerized Axial Tomography scan) can produce images of organs that cannot be seen by the standard x-ray photo equipment and the resulting image has good and accurate resolution. However, the problems found in Abdominal CT Scan are not able to ensure the image of the heart properly. This is because Abdominal CT Scan has a weakness that there are images that should not participate recorded, so the results cannot be used as a reference. From the problem, an idea came up to detect liver disease using Abdominal CT Scan automatically. Watershed transform algorithm used in the segmentation process to produces liver locations that can distinguish objects by background. Then the image will be segmented again using binary threshold method to separate the liver image as the observed object. The final step is done by doing a calculation to determine the affected area percentage. The output of this paper is a wide percentage of the area of liver disease that can be useful as a radiology doctor's analysis. From the result, the wide segmentation of the liver has an average accuracy of 81.15% and segmentation of disease has an average accuracy of 98.28%. So it can be concluded that the watershed method can be used for segmentation process on CT scan abdominal image.