Congenital Malformation of The Great Toe in Children. Did You Exclude Fibrodysplasia Ossificans Progressiva – FOP.

Background: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare and severely disabling genetic disorder. The worldwide prevalence is approximately 1 per 2 million. Heterozygous mutations in ACVR1/ALK2 gene exist in all sporadic and familial cases of FOP. The primary aim of this study is to describe the clinical course of three children suffering from FOP and followed for fifteen, twenty-two and forty years, respectively Secondary aim is to provide clinical advice on how to diagnose the condition with special reference to the great toes malformation and give current best therapeutic approaches.Results: All three cases characterized with malformed great toes initially followed by progressive loss of mobility for a period from fifteen to forty years. Conventional radiology indicates the diagnosis and RNA/DNA test confirm it.Conclusion: Congenital malformation of the great toes in early childhood may be the first clinical sign of FOP. A devastating disease due to its progressive formation of heterotopic ossifications in soft tissue even after minor injuries. Leading to progressive immobility, skeletal deformities, chronic pain, growth defects and disabling joint stiffness. No curative treatment exists today. Management is symptomatic combined with a prophylactic lifestyle avoiding blunt and pointed trauma including surgery.

Lumbar lordosis in patients undergoing non-instrumented spinal stenosis

Objective: To study the behaviour of Lumbar Lordosis (LL) after non-instrumented decompression surgery in patients diagnosed with Lumbar Spinal Stenosis (LSS). Methods and materials: Retrospective analysis of patients undergoing non-lumbar instrumented decompression surgery for lumbar spine stenosis, operated on between January 2011 and December 2017. The variables collected were age, sex, affected segment, and presence or not of degenerative spondylolisthesis (ELS). The Lumbar Lordosis (LL) parameter was analysed using conventional radiology in standing position pre and postoperatively. Results: 64 patients were selected, 17 women and 47 men, with an average age of 68 (35-83). 65% stenosis was located in a single level, and 39.1% had degenerative ELS grade I. The average follow-up was 26 months (6m-104m). A preoperative LL angle of 43.2º (9.8º-70.8º) and 47º (8º-76º) were found at the postoperative follow-up, with an average difference of 3.8º (-15.7º-20.2º). 9.4% (6 patients) of degenerative ELS evolved to grade II, and 8 patients needed reoperation for different reasons. In patients with ELS, we found a greater increase in postoperative LL (5.59º) than in patients without ELS (2.61º) (p = 0.08). No statistically significant relationship was found between the behaviour of the LL with the number of decompressed levels (p = 0.43) and the need for reoperation (p = 0.26). Conclusions: According to our study, the technique of posterior decompression without instrumentation of the lumbar spine stenosis is not associated with a decrease of lumbar lordosis parameter. Conversely, there is a slight tendency for LL to increase in cases where a degenerative ELS is present.

Imaging in the Assessment of Musculoskeletal Manifestations Associated with Inflammatory Bowel Disease

Extraintestinal manifestations are the cause of morbidity and affect the quality of life of patients with inflammatory bowel diseases (IBDs). Musculoskeletal manifestations, in particular, spondyloarthritis and osteoporosis, are the most frequent extraintestinal manifestation of IBDs. The diagnosis and management of the musculoskeletal manifestation of IBDs relies on imaging. Conventional radiography, magnetic resonance imaging, computed tomography, and ultrasound can help to detect pathological signs of spondyloarthritis, both peripheral and with axial involvement. Dual-energy X-ray absorptiometry is the gold standard for identifying the presence of osteoporosis, whereas conventional radiology and computed tomography can reveal occult vertebral fractures. The aim of this narrative review is to describe the imaging of musculoskeletal manifestations of IBDs.

Knowledge and ability assessment of endodontists to prescribe and analyze cone beam computed tomography

Objective: To determine the prevalence of knowledge about cone-beam computed tomography (CBCT) by endodontists from the Metropolitan Area of Belém, Pará, Brazil. Material and methods: 151 questionnaires were spread containing 32 questions, 15 closed questions, 4 open and 13 mixed. Questions 1 to17 dealt with questions such as age; gender; geographic location where endodontists' office operates; year of graduation degree and of specialization in endodontics; owned equipment and questions about the conventional radiology practice at dental office. Questions 18 to 32 were related to knowledge about the CBCT and only those who reported having knowledge answered the questions 19 onwards. Results: 81 questionnaires were analyzed. 48 endodontists (59%) had some knowledge about CBCT, but among them, 5 never requested until that occasion. Regarding the radiation level, 76.75% have not any information about. The treatment plan of 36 (83.72%) those who requested CBCT changed. Conclusion: The CBCT imaging is slowly becoming an essential modality of imaging in the clinical practice of endodontists from the Metropolitan Area of Belém, Para, Brazil.

Non-traumatic lesions of clavicle – A pictorial essay

The aim of this paper is to illustrate the various pathological lesions encountered in clavicle other than traumatic. Clavicle is not a common structure for investigation, except when trauma is suspected. However, whenever a pathological lesion is to be studied, conventional radiology is the first modality to adopt. There are no standard radiographic techniques to study the clavicle. Often it is seen on a conventional chest radiograph. Many systemic disorders reflect on clavicles. Cross sectional imaging helps very little except in neoplastic conditions. The imaging appearances are described in most of the lesions that are found in clavicle.

Sofrimento moral dos profissionais das técnicas radiológica em serviço de radiologia convencional de Santa Catarina / Moral distressof radiological technologistsin conventional radiology service in Santa Catarina

Introdução: o uso da radiação ionizante na prática médica pode ocasionar eventos nocivos à saúde do indivíduo exposto. Diante disso, o emprego ético da radiação ionizante deve contemplar o que preconiza a legislação nacional e internacional, assim como os princípios de proteção radiológica e da bioética. O sofrimento moral relaciona-se à dimensão ética na prática da saúde, podendo afetar os profissionais das técnicas radiológicas. Objetivo: identificar as situações desencadeadoras de sofrimento moral nos profissionais das técnicas radiológicas em um serviço de radiologia convencional. Metodologia: trata-se de uma pesquisa qualitativa, descritiva e exploratória. Usou-se como técnicas de coleta de dados a observação participante, a entrevista semiestruturada e a validação consensual. Os dados foram analisados por meio da análise temática. Resultados e discussão: observou-se situações de sofrimento moral quando o profissional da técnica radiológica se deparava com pacientes em condições clínicas de se dirigir a unidade de diagnóstico e imagem, diante da não indicação clínica do exame radiológico, ante ao desrespeito dos princípios de proteção radiológica e perante a falta de autonomia para fazer cumprir os preceitos éticos do emprego da radiação ionizante. Conclusão: o desrespeito dos princípios legais, assim como dos princípios de proteção radiológica e bioéticos levam o profissional das técnicas radiológicas ao sofrimento moral.

Imaging of arthritis in the foot and ankle

This chapter discusses imaging of the foot and ankle in rheumatological disease, including the advantages and disadvantages of specific techniques by disease. Conventional radiology remains the mainstay for radiological investigation, and a systematic approach to viewing the plain film radiographs is covered. Findings by imaging technique and disease are described. Computerized tomography, nuclear medicine, magnetic resonance imaging, and ultrasound are all analysed.