INTRODUÇÃO: A redução cirúrgica e fixação rígida por meio do acesso retromandibular transparotídeo vem se difundindo como uma das opções para o controverso tratamento das fraturas de côndilo mandibular. OBJETIVOS: Avaliar o tratamento cirúrgico pela via retromandibular transparotídea das fraturas extracapsulares de côndilo mandibular em adultos. MÉTODOS: Foram avaliados retrospectivamente dez pacientes consecutivos operados pelo autor no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Todos eram adultos com fraturas extracapsulares de côndilo mandibular causando encurtamento maior que 2 mm ou desvio maior que 10 graus. Os pacientes foram operados por meio do acesso retromandibular transparotídeo e tiveram suas tomografias pré e pós-operatórias avaliadas por meio de reconstrução tridimensional. A qualidade da redução quanto ao posicionamento no foco de fratura foi classificada como ideal, satisfatória ou pobre. Em sete pacientes com fraturas unilaterais, os lados não fraturados serviram como controles em uma avaliação quantitativa do posicionamento da cabeça condilar. As variáveis altura condilar e inclinações sagital, coronal e axial foram medidas nas tomografias pré e pós-operatórias para os lados fraturados e não fraturados. As diferentes medidas foram comparadas entre si. Quanto à morbidade do acesso, foram avaliadas: assimetrias na mímica facial, incidência de fístulas salivares ou infecções e qualidade das cicatriz. Com pelo menos 18 meses após a cirurgia, os pacientes foram convocados para uma avaliação do pós-operatório tardio. Foram questionados quanto a presença de estalidos articulares, limitação da abertura oral, dor facial e mastigação insatisfatória. A situação referida no pós-operatório tardio foi comparada referida para o período anterior ao trauma. Os pacientes foram examinados em busca de estalidos ou dor à palpação facial, intercuspidação não corrigida, desvio à abertura oral, limitação à protrusão ou à lateralidade. A abertura oral máxima foi quantificada. RESULTADOS: No foco de fratura, a redução foi classificada como satisfatória ou ideal em nove pacientes. Quanto ao posicionamento da cabeça condilar, para as variáveis altura condilar e inclinação coronal, no pré-operatório, houve diferença estatística entre os lados fraturados e os lados normais. No pós-operatório, não houve diferença para nenhuma das variáveis na comparação entre os lados fraturados e os não fraturados. Não foram observadas assimetrias na motricidade da mímica, fístulas salivares ou infecção desde o pós-operatório imediato. Uma paciente apresentou cicatriz hipertrófica. No pós-operatório tardio, encontraram-se abertura oral máxima entre 39 e 55 mm, desvio à abertura oral em um paciente e surgimento de estalidos em dois, o que não se mostrou estatisticamente diferente do período anterior ao trauma. CONCLUSÕES: O tratamento aberto por via retromandibular com redução e fixação rígida de fraturas extracapsulares de côndilo mandibular com desvio ou encurtamento em adultos é capaz de prover correção da anatomia condilar com baixa morbidade relacionada ao acesso e com evolução funcional satisfatória. / INTRODUCTION: Open reduction and rigid internal fixation through retromandibular transparotid approach has been increasingly accepted as one of the options for treatment of fractures of the mandibular condyle, which is still a controversial subject. OBJECTIVES: To evaluate surgical treatment through retromandibular transparotid approach for extracapsular fractures of mandibular condyle in adults. METHODS: Ten consecutive patients operated on by the author at University of São Paulo Medical School Hospital were retrospectively evaluated. All of them were adults with extracapsular fractures of mandibular condyle causing shortening greater than 2 mm or deviation greater than 10 degrees. Patients were operated through retromandibular transparotid approach and had their pre and postoperative CT scans assessed with tridimensional reconstruction. Quality of reduction at fracture site was classified as optimal, satisfactory or poor. In seven patients with unilateral fractures, non-fractured sides served as controls in quantitative assessment condylar head positioning. Variables condylar height and sagittal, axial and coronal inclinations were measured in preoperative and postoperative CT scans, on fractured and not fractured sides. The different measures were compared. On morbidity of the approach, were evaluated: facial animation asymmetry, incidence of salivary fistula or infection and quality of scar. At least 18 months after surgery, patients were called for an assessment of postoperative period. They were asked about the presence of clicking joints, limitation on mouth opening, facial pain and poor mastication. Situation at postoperative period was compared with the one previous to trauma. Patients were examined for clicking or pain on palpation, uncorrected intercuspation, chin deviation on mouth opening and limitation on protrusion or laterality. The maximum mouth opening was measured. RESULTS: At the fracture site, reduction was rated as satisfactory or ideal in nine patients. As for the positioning of the condylar head, for the variables height and coronal condylar inclination, preoperatively, there was statistical difference between fractured and normal sides. Postoperatively, there was no difference for any variable when comparing fractured and normal sides. There were no asymmetries in facial animation, salivary fistula or infection since immediate postoperative period. One patient had hypertrophic scar. In the late postoperative period, were found: maximum mouth opening between 39 and 55 mm, chin deviation at oral opening in one patient and the emergence of clicking in two, data that was not statistically different from the period before the trauma. CONCLUSIONS: Treatment of shortened or deviated extracapsular fractures of the mandibular condyle in adults by open reduction and rigid internal fixation through retromandibular transparotid approach can provide correction of condylar anatomy with low morbidity and satisfactory functional outcome

<p>Karcinom pluća predstavlja vodeći uzrok smrtnosti među svim malignim obolenjima, a uprkos dostignućima u dijagnostici i terapiji u poslednjih 30 godina nije do&scaron;lo do bitnog pobolj&scaron;anja izuzetno niske ukupne stope petogodi&scaron;njeg preživljavanja kod ovih pacijenata. U momentu otkrivanja bolesti preko trećine svih novootkrivenih slučajeva nalazi se u IV stadijumu bolesti. Precizno i adekvatno praćenje odgovora tumora na terapijski tretman kod obolelih od karcinoma pluća u IV stadijumu kao i &scaron;to ranije utvrđivanje progresije bolesti, odnosno neefikasnosti terapijskog tretmana kod ove grupe bolesnika od velikog je značaja, jer za ove pacijente hemioterapija predstavlja jedinu terapijsku opciju. Postojeće konvencionalne metode jednodimenzionalnih merenja i procena tumorskog odgovora na terapijski tretman prema RECIST kriterijumima ne koriste sve prednosti CT dijagnostike i oslanjaju se na subjektivnost manuelnih merenja. Primena naprednih radiolo&scaron;kih tehnika, poput volumetrije, mogu doprineti razvoju imidžing praćenja terapijskog odgovora tumora kod pacijenata sa karcinomom pluća. Cilj istraživanja je evaluacija primene jednodimenzionalnog i volumetrijskog merenja u proceni terapijskog odgovora karcinoma pluća vi&scaron;eslojnom kompjuterizovanom tomografijom. Metodologija: Istraživanjem po tipu prospektivne studije obuhvaćeno je 100 pacijenata obolelih od karcinoma pluća u IV stadijumu bolesti u vreme otkrivanja, koji su ispitivani u periodu od 2013. do 2016. godine u Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici i koji su ispunili kriterijume za ulazak u studiju. Kod svih pacijenata obuhvaćenih istraživanjem, dva radiologa nezavisno su evaluirali sve CT preglede grudnog ko&scaron;a, izvr&scaron;ili jednodimenzionalna manuelna i volumetrijska merenja odabranih target lezija &scaron;to je omogućilo utvrđivanje unutarčitačke i međučitačke varijabilnosti i slaganja rezultata merenja target lezija primenom ispitivanih metoda. Na osnovu rezutata izvr&scaron;enih merenja urađena je kategorizacija terapijskog odgovora tumora primenom konvencionalnih RECIST kriterijuma kao i primenom modifikovanog sistema kategorizacije za volumetrijsku evaluaciju terapijskog odgovora sa modifikovanim optimalnim graničnim vrednostima za klasifikovanje progresije bolesti i pozitivnog odgovora na terapiju, izračunatim na osnovu ispitivanog uzorka (model 3Dindividual). Urađeno je poređenje manuelne i volumetrijske procene terapijskog odgovora primenom razičitih ispitivanih sistema klasifikacije uz utvrđivanje stepena različite klasifikacije i analizu preživljavanja pacijenata do pojave progresije bolesti. Uticaj morfolo&scaron;kih karakteristika &ldquo;target&rdquo; lezija na rezultate volumetrijskog merenja određen je analizom odstupanja izmerenog volumena tumora u odnosu na aritmetičku sredinu između grupa lezija ispitivanih morfoo&scaron;kih karakteristika. Rezultati: Primena volumetrijskog merenja, na ispitivanom uzorku, dovodi do niže stope varijabilnosti rezultata merenja dimenzija target lezija u odnosu na konvencionalnu manuelnu metodu merenja i u slučaju međučitačke varijabilnosti (0,9% vs 6,5%) i u pogledu unutarčitačke varijabilnosti (4,9% vs 0,9%). Volumetrijskom evaluacijom terapijskog odgovora tumora uz primenu modifikovanih graničnih vrednosti kategorizacije (model 3D-individual) postiže se značajno različita klasifikacija terapijskog odgovora u odnosu na primenu konvencionalnih RECIST kriterijuma. U slučaju volumetrijske evaluacije terapijskog odgovora, klasifikovanje pacijenata primenom novog sistema kategorizacije &rdquo;3D-individual&rdquo; dovodi do različite klasifikacije u 22,2 % slučajeva u poređenju sa RECIST ekvivalent kriterijumima za volumetriju, uz održavanje jednako dobre predikcije PFS ova dva sistema. Rezultati istraživanja pokazali su da izgled ivica lezija i odnos lezije prema okolnim anatomskim strukturama imaju srednji uticaj na varijabilnost rezultata volumetrijskih merenja. Zaključak: Primena volumetrijskog merenja kao novog aspekta morfolo&scaron;ke procene odgovora karcinoma pluća na primenjenu terapiju može unaprediti dono&scaron;enje terapijskih odluka kako u lečenju individualnih bolesnika tako i u vođenju kliničkih istraživanja.</p> / <p>Lung cancer is the leading cause of mortality among all malignancies, and despite advances in diagnostics and therapy over the past 30 years, there has been no significant improvement in the extremely low overall rate of a five-year survival with these patients. At the time of the diagnosis, more than a third of all newly discovered cases are at the IV stage of the disease. Precise and adequate monitoring of the response of the tumor to therapeutic treatment with lung cancer patients in IV stage, as well as the early detection of progression of the disease or inefficiency of therapy in this group of patients is of great importance as chemotherapy is the only therapeutic option for these patients. The existing conventional methods of one-dimensional measurement and assessment of tumor response to therapeutic treatment according to RECIST criteria do not use all the advantages of CT diagnostics and rely on the subjectivity of manual measurements. Advanced radiological techniques, such as volumetry, can contribute to the development of the image monitoring of the therapeutic response of tumors in patients with lung cancer. The aim of this study is to evaluate the application of one-dimensional and volumetric measurement in the assessment of the therapeutic response to lung cancer with multslice computerized tomography. Methodology: A study per type of prospective study included 100 patients with lung cancer at the IV stage of the disease at the time of detection, which were tested in the period between 2013 and 2016 at the Institute of Pulmonary Diseases of Vojvodina in Sremska Kamenica and met the criteria for entering the study. With all patients involved in the study, two radiologists independently assessed all CT chest exams, performed one-dimensional manual and volumetric measurements of selected target lesions, which enabled the determination of intraobserver and interobserver variability and the agreement of the target lesion measurement results using the test method. Based on the results of the performed measurements, the categorization of the therapeutic response of the tumor with conventional RECIST criteria, as well as the application of a modified categorization system for volumetric assessment of the therapeutic response with modified optimal limit values for classification (progression of the disease and positive response to the therapy) was performed, calculated on the basis of the tested sample. Comparison of manual and volumetric estimates of the therapeutic response was made using various classification systems with the determination of the degree of difference in classification and analysis of survival of patients until the progression of the disease. The influence of morphological characteristics of target lesions on the results of volumetric measurement was determined by the analysis of the deviation of the measured tumor volume relative to the arithmetic mean between the groups of lesions of the examined morphological characteristics. Results: The application of volumetric measurements on the test sample leads to a lower rate of variability in the results of measuring the dimensions of the target lesions compared to the conventional manual measurement method, and in the case of interobserver variability (0.9% versus 6.5%) and in terms of intraobserver variability (4.9% to 0.9%). The volumetric assessment of the therapeutic response of the tumor using modified boundary categorization values (3Dindividual model) results in a significantly different classification of the therapeutic response in relation to the use of conventional RECIST criteria. In the case of volumetric assessment of the therapeutic response, the classification of patients using the new &ldquo;3D-individual&rdquo; categorization system leads to a misclassification in 22.2% of cases compared to RECIST equivalent to volumetric criteria, reflecting the equally good predictability of PFS in these two systems. The results of the study showed that the appearance of the lesion margins and relation to the surrounding anatomical structures influenced the variability of the results of volumetric measurements. Conclusion: The application of volumetric measurements as a new aspect of the morphological evaluation of lung cancer response to applied therapies can help in making therapeutic decisions both in the treatment of individual patients and in the conduct of clinical trials.</p>

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: During root canal treatment (RCT), an opening is made through the crown of the tooth to access and to disinfect the root canal system (RCS). Traditional endodontic access (TEA) may sacrifice tooth structure and weaken the tooth. Cone beam computed tomography (CBCT) provides information about the exact location of the root canals. This information can be used for the design of a canal-directed endodontic access (CDEA). It may also be used for the 3D printing of an acrylic endodontic stent that could help to create a conservative CDEA. Objective: 1) Evaluate the ability of the Dolphin 3D imaging software to assist in creating a CDEA; 2) Compare tooth structure loss in a CDEA to that in a TEA by measuring the volume of remaining tooth structure, surface area of the access opening at the occlusal, and remaining dentin thickness at the CEJ. Materials and Methods: Thirty extracted human mandibular premolars were used. Teeth with large, wide canals were excluded. CBCT images will be taken for all teeth using Kodak 9000. Fifteen teeth were randomly assigned to the TEA group and 15 teeth were assigned to the CDEA group. The CDEA path was mapped using Dolphin 3D imaging software. Acrylic access stents were designed using Rhino 3D software and printed using a 3D printer. The teeth were accessed through the corresponding stents. The 15 teeth that are part of the traditional access group were accessed without a stent. A CBCT scan was taken post-access for all 30 teeth. Wilcoxon Rank Sum Tests were performed to compare the following outcomes for the two groups: the volume of remaining tooth structure, the surface area of the access opening at the occlusal, and remaining dentin thickness at the CEJ. Results: The remaining dentin thickness (percent loss) was not significantly larger for TEA than for CDEA. The surface area (post-treatment) was significantly larger for TEA than for CDEA, and volume (percent loss) was significantly larger for TEA than for CDEA. Conclusion: The use of the CBCT and Dolphin 3D imaging provided an accurate and more conservative CDEA with the guide of an acrylic stent.

Background: Research in heart disease can be aided by modelling myocardial hemodynamics with knowledge of coronary pressure and vascular resistance measured from the geometry and morphometry of coronary vasculature. This study presents methods to automatically reconstruct accurate detailed coronary vascular anatomical models from high-resolution three-dimensional optical fluorescence cryomicrotomography image volumes for simulating blood flow in coronary arterial trees. Methods: Images of fluorescent cast and bead particles perfused into the same heart comprise the vasculature and microsphere datasets, employed in a novel combined approach to measure vasculature and simulate a flow model on the extracted coronary vascular tree for estimating regional myocardial perfusion. The microspheres are used in two capacities - as fiducial biomarker point sources for measuring the image formation in order to accurately measure the vasculature dataset and as flowing particles for measuring regional myocardial perfusion through the reconstructed vasculature. A new model-based template-matching method of vascular radius estimation is proposed that incorporates a model of the optical fluorescent image formation measured from the microspheres and a template of the vessels’ tubular geometry. Results: The new method reduced the error in vessel radius estimation from 42.9% to 0.6% in a 170 micrometer vessel as compared to the Full-Width Half Maximum method. Whole-organ porcine coronary vascular trees, automatically reconstructed with the proposed method, contained on the order of 92,000+ vessel segments in the range 0.03 – 1.9 mm radius. Discrepancy between the microsphere perfusion measurements and regional flow estimated with a 1-D steady state linear static blood flow simulation on the reconstructed vasculature was modelled with daughter-to-parent area ratio and branching angle as the parameters. Correcting the flow simulation by incorporating this model of disproportionate distribution of microspheres reduced the error from 24% to 7.4% in the estimation of fractional microsphere distribution in oblique branches with angles of 100°-120°.