Gilberto Szarf

Accuracy and Complications of Computer‐Designed Selective Laser Sintering Surgical Guides for Flapless Dental Implant Placement and Immediate Definitive Prosthesis Installation

BACKGROUND Computer-aided dental implant placement seems to be useful for placing implants by using a flapless approach. However, evidence supporting such applications is scarce. The aim of this study is to evaluate the accuracy of and complications that arise from the use of selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation. METHODS Sixty implants and 12 prostheses were installed in 12 patients (four males and eight females; age range: 41 to 71 years). Lateral (coronal and apical) and angular deviations between virtually planned and placed implants were measured. The patients were followed up for 30 months, and surgical and prosthetic complications were documented. RESULTS The mean ± SD angular, coronal, and apical deviations were 6.53° ± 4.31°, 1.35 ± 0.65 mm, and 1.79 ± 1.01 mm, respectively. Coronal and apical deviations of <2 mm were observed in 82.67% and 58.33% of the implants, respectively. The total complication rate was 34.41%; this rate pertained to complications such as pulling of the soft tissue from the lingual surface during drilling, insertion of an implant that was wider than planned, implant instability, prolonged pain, midline deviation of the prosthesis, and prosthesis fracture. The cumulative survival rates for implants and prostheses were 98.33% and 91.66%, respectively. CONCLUSIONS The mean lateral deviation was <1.8 mm, and the mean angular deviation was 6.53°. However, 41.67% of the implants had apical deviation >2 mm. The complication rate was 34.4%. Hence, computer-aided dental implant surgery still requires improvement and should be considered as in the developmental stage.

Forty-Year-Old Intrathoracic Gossypiboma After Cardiac Valve Surgery

A 59-year-old asymptomatic man, who had undergone cardiac valve surgery 40 years earlier, demonstrated a paracardiac mass on routine chest x-ray (Figure 1). Subsequently, a chest computed tomography scan was performed, which showed a 14.0×9.5 cm heterogeneous lesion, with lobulated contours, along the inferior aspect of the left and right ventricles (Figure 2). It was possible to identify areas of low density as well as high-density areas. Peripheral calcification was also present. There was mild peripheral enhancement after iodinated intravenous contrast injection. It was not possible to exclude cardiac invasion because this lesion had extensive contact with the cardiac ventricles. Figure 1. A, Posteroanterior chest radiograph showing an ill-defined opacity at the left pericardic region. B, This is better identified in the lateral projection (white arrows). Figure 2. …

Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients.

Aims We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. Methods and results Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient. Conclusion In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.

Ablation of Ventricular Tachycardia in Chronic Chagasic Cardiomyopathy With Giant Basal Aneurysm Carto Sound, CT, and MRI Merge

Chronic chagasic cardiomyopathy (CCC) is a parasitic disease that presents with life-threatening ventricular arrhythmias, dilated cardiomyopathy, or sudden death. Basal and posterior wall motion abnormalities and left apical aneurysms are common. We present a report of a patient with CCC, sustained ventricular tachycardia (Vt) refractory to amiodarone 400 mg/day and carvedilol 25 mg/day BID with a giant left basal aneurysm as visualized by CT scan and intracardiac echocardiogram 3D reconstruction(Carto Sound). The patient underwent preprocedural CT scan data acquisition with 64-slice MDCT scanner Aquilion (Toshiba, Tochigi, Japan), and the images were used for 3D reconstruction with Cartomerge (Biosense Webster, Inc., Diamond Bar, CA). Images acquired using cardiac MRI confirmed the size and shape of …

I Diretriz de Ressonância e Tomografia Cardiovascular da Sociedade Brasileira de Cardiologia Sumário Executivo

Cesar Augusto Mastrofrancisco Cattani, Dany Jasinowodolinsk, Fabiano Lucchesi, Fabio Berezowsky Rocha, Fatima Cristina Pedroti, Gilberto Szarf, Guilherme Urpia Monte, Iugiro Roberto Kuroki , Joalbo Andrade, Jose Rodrigues Parga Filho, Luis Claudio Correia, Luiz Francisco Avila, Marcelo Hadlich, Marcelo Zapparoli, Marcia Barbosa, Marcia Lima Mugnaini, Maria Helena Albernaz Siqueira, Marly Maria Uellendhal, Miguel Abraao Rosario Neto, Paulo R. Schwarzman, Raul Dias dos Santos Filho, Ricardo Loureiro, Roberto Kalil Filho, Robson de Macedo Vieira

Reduction of poor contrast enhancement of the pulmonary artery in computed tomography angiography using an alternative respiratory maneuver.

Purpose: The aim of the study was to compare the effects of different respiratory maneuvers in computed tomography pulmonary angiography for the diagnosis of pulmonary embolism (PE) on the contrast enhancement of pulmonary circulation and on the quality of lung window images. Materials and Methods: A retrospective analysis of 520 examinations, half obtained after deep inspiration followed by breath-holding and half solely during breath-holding. Subjective quality analyses and objective measurements of pulmonary arterial enhancement and lung parenchyma attenuation were performed. Results: Elimination of deep inspiration reduced suboptimal opacification of the pulmonary artery (PA), from 7.3% to 2.7%, with 2.7% of the deep inspiration scans having attenuation values <150 Hounsfield units (HU). The prevalence of PE was similar between the groups (19% vs. 23%, respectively), with excellent interobserver diagnostic agreement (&kgr;=0.89 to 0.91). Lung windows were compromised in 6.9% of the studies with respiratory pause, and these examinations had a higher attenuation of the lung parenchyma (median: −709.8 HU) compared with deep inspiration (−794.8 HU). A positive correlation between attenuation of the PA and the ascending aorta was observed (r=0.40 to 0.56). Conclusions: Eliminating deep inspiration before image acquisition had opposite effects with the same magnitude: it caused a reduction in inadequate PA enhancement at the cost of an increased number of nondiagnostic lung images and did not compromise diagnostic consistency for PE.

Diagnóstico auxiliado por computador na detecção de nódulos pulmonares pela tomografia computadorizada com múltiplos detectores: estudo preliminar de 24 casos

OBJECTIVES To evaluate the performance of a computer program designed to facilitate the detection of pulmonary nodules using multidetector computed tomography (MDCT) scans of the chest. METHODS We evaluated 24 consecutive MDCT scans of the chest at the Fleury Diagnostic Imaging Center during the period from October 7 to October 19 of 2006, using a 64-channel CT scanner. The study comprised 12 females and 12 males, ranging from 35 to 77 years of age (mean, 57.9 years). Double reading and a computer-aided diagnosis (CAD) system were used in order to perform two independent analyses of the data. The nodules found using both methods were recorded, and the data were compared. RESULTS The total sensitivity of CAD for the detection of nodules was 16.5%, increasing to 55% when nodules <4 mm in diameter were excluded. Sensitivity by diameter was 6.5% for nodules <4 mm, 45% for nodules of 4-6 mm, 100% for nodules of 6 mm-10 cm, and 0% for nodules >1 cm. More than 99% of true nodules detected by CAD were registered in the image double reading process. CONCLUSIONS In this preliminary 24-case study, the sensitivity of computer program tested was not significantly greater than that of the double-reading process that is routinely performed in this facility.

Freqüência dos sinais de pielonefrite aguda em pacientes submetidos a tomografia computadorizada

OBJECTIVE: The present study was aimed at establishing the frequency of renal/perirenal and extrarenal computed tomography findings in patients with acute pyelonephritis, and evaluating the interobserver agreement. MATERIALS AND METHODS: Retrospective study based on the analysis of computed tomography images of 47 patients with clinical and laboratory findings of acute pyelonephritis. Two independent observers evaluated the main renal/perirenal and extrarenal alterations. The frequency of tomographic findings and interobserver agreement were analyzed by the kappa (k) test. RESULTS: The frequency of tomographic findings for the several parameters was the following: striated nephrogram, 100%; renal enlargement, 65%; perirenal fat heterogeneity, 62.5%; renal calculi, 16.6%; abscesses, 21%; pleural effusion, 36%; thickened gallbladder wall, 32.5%; periportal edema, 32.5%. The k test for interobserver agreement demonstrated reproducibility ranging between moderate (k = 0.511 for renal enlargement) to almost perfect (k = 0.87 for striated nephrogram) for all of the parameters analyzed, except for perirenal fat heterogeneity (k = 0.268). CONCLUSION: The frequency of findings of acute pyelonephritis on computed tomography is high. Overall, striated nephrogram was the most frequent finding. Peri- and extra-renal alterations were found in about 2/3 of the cases. Computed tomography demonstrated a good interobserver agreement.

Noncompaction of the myocardium, Chagas' disease and dysfunction: a case report.

Relatamos la asociacion entre la cardiopatia asociada al miocardio no compactado del ventriculo izquierdo (MNCVI) con la cardiopatia chagasica cronica (CCC) en paciente con clinica de insuficiencia cardiaca, accidente vascular cerebral isquemico y arritmia cardiaca. Las imagenes tipicas de MNCVI y CCC fueron documentadas por resonancia magnetica cardiaca (RMC).Miocardio ventricular no compactado, enfermedad de Chagas, disfunción ventricular izquierda. Relatamos la asociación entre la cardiopatía asociada al miocardio no compactado del ventrículo izquierdo (MNCVI) con la cardiopatía chagásica crónica (CCC) en paciente con clínica de insuficiencia cardíaca, accidente vascular cerebral isquémico y arritmia cardíaca. Las imágenes típicas de MNCVI y CCC fueron documentadas por resonancia magnética cardíaca (RMC). Miocardio no Compactado, Enfermedad de Chagas y Disfunción Caso Clínico

Middle lobe pulmonary torsion after recurrent pleural effusions in a cirrhotic patient

A 57-year-old man was admitted with acute chest pain and shortness of breath. He had cirrhosis secondary to hepatitis C infection and had undergone multiple thoracocentesis in the last months for recurrent pleural effusions. Chest X-ray showed increased density in the right lung base and chest CT showed a right pleural effusion, partial atelectasis of the right lower lobe, middle lobe bronchovascular structures twisted on themselves with a swirling appearance, obliteration of the proximal middle lobe artery, narrowing of the accompanying bronchus and ground-glass opacities in this same lobe (figure 1). Symptoms persisted over the next week and …