Osteocondrite dissecante em côndilo femural lateral bilateral nos joelhos

The osteochondritis dissecans (OCD) is a disease of unknown cause that classically affects the knee lateral border of the medial femoral condyle. We present a rare case of OCD in bilateral lateral femoral condyle.A osteocondrite dissecante (OCD) é uma patologia de causa desconhecida, que classicamente acomete no joelho a borda lateral do côndilo femural medial. Apresentamos um raro caso de OCD no côndilo femural lateral bilateral.Tatuape Orthopedics ClinicUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Orthopedics and TraumatologyUNIFESP, EPM, Department of Orthopedics and TraumatologySciEL

Minerais do grupo da crichtonita em veios de quartzo da Serra do Espinhaço (Minas Gerais e Bahia)

O trabalho descreve quatro minerais do grupo da crichtonita encontrados em veios hidrotermais de quartzo, que cortam diversas formações geológicas da Serra do Espinhaço (Supergrupo Espinhaço). Esses minerais – senaíta, crichtonita, almeidaíta e gramaccioliíta-(Y) – foram coletados em duas regiões: Presidente Kubitschek, ao sul de Diamantina (MG), e Novo Horizonte, na Chapada Diamantina Ocidental (BA). A idade de tais veios é relacionada ao final do Ciclo Brasiliano, em ca. 490 Ma. A senaíta é um mineral descoberto no Brasil e classicamente identificado nos aluviões diamantíferos da região de Diamantina; sua primeira ocorrência primária é aqui descrita. A crichtonita, apesar de conhecida desde longa data, teve seu primeiro depósito no país reportado nessa mesma região. A almeidaíta é o 61º e um dos mais recentes dos “minerais brasileiros”, sendo encontrada na região de Novo Horizonte. A gramaccioliíta-(Y), uma espécie descoberta na última década (Itália), tem sua primeira ocorrência brasileira descrita também nessa região. Os depósitos e as composições químicas desses minerais são caracterizados, bem como as problemáticas envolvidas até suas definições finais.Four minerals of the crichtonite group found in hydrothermal quartz veins that cross several units of the Espinhaço Supergroup in the Espinhaço Mountain Range are described in this paper. These minerals, senaite, crichtonite, almeidaite and gramaccioliite-(Y), were collected in two regions: Presidente Kubitschek, south from Diamantina (State of Minas Gerais), and Novo Horizonte, in the Western Diamantina Tableland (State of Bahia). The age of these veins are related with the end of Brasiliano Cycle, at ca. 490 Ma. Senaite is a mineral discovered in Brazil and is usually recognized in diamond‑bearing alluvial deposits of the Diamantina region. Its occurrence as a primary mineral in situ is for the first time described here. Although crichtonite has been known for quite a long time, its first occurrence in Brazil has been reported in the same region in Minas Gerais. Almeidaite is the 61th “newest Brazilian mineral” and has been found in the region of Novo Horizonte. Gramaccioliite-(Y), a species discovered in the last decade in Italy, has also been described for the first time in Novo Horizonte, Bahia. The deposits and the chemical compositions of these rare minerals are characterized in this paper, as well as the problems involved until their final recognition

What Factors are Associated with Health-Related Quality of Life in Mixed Dentition Children?

Objective: To associate the OHRQoL and HRQoL in mixed dentition children with the influence on age range, socioeconomic and clinical variables. Material and Methods: A cross-sectional study was carried out with 1,240 children between 6 and 12 years of age. HRQoL was assessed by the Quality of Life Assessment Scale, considered an outcome variable. OHRQoL was determined using specific questionnaires related to the age group: Oral Health Impact Scale in Early Childhood, Child Perceptions Questionnaire for 8 to 10 years, and 11 to 12 years. Dental caries and malocclusion were diagnosed. The socioeconomic class was evaluated. A multiple negative binomial regression analysis was used to test the relationship between HRQoL, OHRQoL scores and socioeconomic and clinical variables. Correlation analyses were performed between the total HRQoL and OHRQoL, with a significance level of 5%. Results: The HRQoL is inversely related to the impact of OHRQoL (p<0.05), modulated by the age group. There was a significant weak negative correlation between the HRQoL scores and the impact of OHRQoL (p<0.05). Conclusion:The OHRQoL impacts the HRQoL, modulated by the age group and with minor influence from socioeconomic and clinical variables

A Multivariate Analysis of the Psychosocial Impact of Malocclusion and Self-Esteem in Adolescents

Objective: To evaluate the psychosocial impact of malocclusion and self-esteem in adolescents in the Amazon region. Material and Methods: A cross-sectional study was carried out with 212 adolescents with 12-year-old enrolled in all public schools in the Boca do Acre (Amazonas, Brazil). Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) assessed the psychosocial impact of malocclusion. The self-perception of the need for orthodontic treatment was evaluated by the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) and Global Negative Self-evaluation (GSE), the adolescent's self-esteem. The malocclusion was clinically evaluated by the Dental Aesthetic Index (DAI). The variables with p<0.20 in the individual analyses were tested in multiple logistic regression models, and those with p<0.10 remained in the model. The adjusted odds ratio (OR) was estimated with a 95% confidence interval (CI). Results: Adolescents with low self-esteem were 2.20 (95% CI: 1.23-3.93) times more likely to have a more significant impact on dental aesthetics (p<0.05). When verified by domains, the adolescents with low self-esteem had 2.33 (95% CI: 1.31-4.17) and 1.93 (95% CI: 1.09-3.42) times more likely to impact the psychological and social domains of the PIDAQ, respectively. Conclusion: Self-esteem influenced adolescents' perception of dental aesthetics in the domains related to psychological and social impact

Chondromalacia patellae: comparison of high-field strength versus low-field strength magnetic resonance imaging findings

OBJECTIVE: To compare the performance of low-field-strength and high-field-strength magnetic resonance imaging equipments for evaluation of the patella articular cartilage. MATERIALS AND METHODS: The study was developed using GRE 2D, GRE 3D, FSE T2, STIR sequences (low-field) and TSE T2 SPIR sequence. Each sequence has been separately analyzed for evaluation of the cartilage without knowledge of other sequences results or any patients data; the lesion was assigned a grade from 0 to 3 and had its location defined. Agreement and disagreement results were analyzed by Kappa and McNemar tests. RESULTS: Medial facet has presented low agreement index and disagreements showed to be significantly overestimated. Lateral facet has presented a reasonable agreement index and disagreement index was not significant. Medial ridge has presented a reasonable agreement index and disagreement index has showed to be underestimated. CONCLUSION: The STIR sequence versus TSE T2 SPIR sequence has presented the higher agreement index. High grade lesions are better characterized by low-field-strength magnetic resonance imaging equipment sequences. Areas of increased signal intensity make difficult the study of the patella medial facet cartilage in low-field-strength equipment.OBJETIVO: Comparar os aparelhos de ressonância magnética de baixo campo e de alto campo para estudo da cartilagem articular da patela. MATERIAIS E MÉTODOS: Foi realizado estudo usando as seqüências GRE 2D, GRE 3D, FSE T2 e STIR (baixo campo) e TSE T2 SPIR. Cada seqüência foi analisada separadamente para o estudo da cartilagem, sem o conhecimento dos dados do paciente e do resultado das outras seqüências, sendo atribuído grau de lesão de 0 a 3 e descrita a sua localização. Os resultados de concordância e discordância foram analisados pelos testes de Kappa e McNemar. RESULTADOS: Na faceta medial houve baixas concordâncias e as discordâncias mostraram significativa superestimação. Na faceta lateral houve boas concordâncias e as discordâncias não foram significativas. No ápice houve boas concordâncias e as discordâncias mostraram significativa subestimação. CONCLUSÃO: A seqüência STIR teve a melhor concordância com a seqüência TSE T2 SPIR. Lesões de alto grau são mais bem caracterizadas pelas seqüências do aparelho de baixo campo. Áreas de aumento de sinal dificultam o estudo da cartilagem da faceta medial da patela no aparelho de baixo campo.Universidade Federal de São Paulo (UNIFESP) Departamento de Diagnóstico por ImagemUniversidade Santo Amaro Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUniversidade Federal de SergipeUniversidade Santo AmaroUNIFESP, Depto. de Diagnóstico por ImagemUNIFESP, Depto. de Ortopedia e TraumatologiaSciEL

Randomized prospective study comparing transverse and extracortical fixation in anterior cruciate ligament reconstruction

OBJECTIVE: This study had the objective of prospectively comparing transverse fixation (Cross-PinTM) with extracortical fixation (EZLocTM) for the femur, in surgical reconstruction of the anterior cruciate ligament, from a clinical, biomechanical and functional point of view. METHODS: Between April 2007 and November 2009, 50 patients with acute or chronic anterior cruciate ligament injuries underwent arthroscopic reconstruction using the homologous flexor tendons (gracilis and semitendinosus). Randomization of the femoral fixation method was done by means of a draw at the time of the procedure. Patients were excluded if they presented multiple ligament lesions, fractures, previous surgery, autoimmune disease and impairment of the contralateral knee. The Lysholm scale, SF36 quality-of-life questionnaire and KT1000TM arthrometer were used. RESULTS: After a mean follow-up of 18.1 months, there were no statistically significant differences between the groups regarding the Lysholm scale and KT1000TM measurements. However, the SF36 questionnaire showed a statistical difference such that transverse fixation was superior regarding pain and vitality. CONCLUSION: Both techniques were shown to be efficient for transfemoral fixation, but with almost no statistically significant difference between them. We believe that new studies will be necessary for better understanding of these differences.OBJETIVO: Comparar prospectivamente as fixações transversas (Cross-PinTM) com as extracorticais (EZLocTM) no fêmur nas reconstruções cirúrgicas do ligamento cruzado anterior sob o ponto de vista clínico, biomecânico e funcional. MÉTODOS: Entre abril de 2007 e novembro de 2009, 50 pacientes com lesões do ligamento cruzado anterior, agudas e crônicas, foram submetidos à reconstrução por abordagem artroscópica utilizando os tendões flexores homólogos (grácil e semitendíneo). A randomização do método de fixação femoral ocorreu por meio de sorteio no momento da cirurgia. Excluímos os pacientes portadores de lesões ligamentares múltiplas, fraturas, cirurgias prévias, doenças autoimunes e comprometimento do membro contralateral. Foram utilizadas as escalas de Lysholm, o questionário qualidade de vida SF-36 e o artrômetro KT-1000TM. RESULTADOS: Após 18,1 meses, em média, não foram observadas diferenças estatisticamente significantes entre os grupos quanto utilizadas as escalas de Lysholm e as medidas do KT-1000TM. Quanto aos resultados do SF-36, observamos diferença significante com superioridade da fixação transversa considerando a dor e a vitalidade. CONCLUSÃO: As duas técnicas mostraram ser eficientes na fixação transfemoral com tendões flexores, porém quase sem nenhuma diferença estatística significante. Entendemos que novos estudos serão necessários para melhor entendimento dessas diferenças.Hospital IFORUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Grupo do JoelhoFaculdade de Medicina do ABC Grupo de Traumatologia EsportivaUNIFESP, Depto. de Ortopedia e Traumatologia Grupo do JoelhoSciEL

Surgical treatment of osteochondral lesions of the knee with mosaicplasty

OBJECTIVE: To evaluate the functional results of mosaicplasty in knees of patients with osteochondral lesion. METHODS: Between August 1999 and March 2005, twenty-seven patients were submitted to mosaicplasty on the knee. Twenty-one were male and six female. The patients' ages ranged from 16 to 64 years (average 38.1 years). Seventeen lesions were located on the right knee and ten on the left one. The lesion was located on the lateral condyle in 4 patients (15%), on the medial condyle in 18 patients (66.5%) and on the patella in 5 patients (18.5%). The lesion sizes varied from 1 to 8 cm² (average 2.7 cm²). The patients operated on were evaluated before and after surgery by the functional Lysholm scale, with an average follow-up of 2.5 years. RESULTS: In the preoperative evaluation, the average was 62.7 points, evolving to 95.4 points in the postoperative evaluation. The patients submitted to mosaicplasty in the lateral condyle presented an average of 51.5 points before surgery, evolving to 100 points after surgery. The patients submitted to mosaicplasty in the medial condyle had presented average of 64.1 points before surgery, evolving to 95.4 points after surgery. The patients submitted to mosaicplasty on the patella presented average of 66.4 points before surgery, evolving to 92 points in the postoperative evaluation. CONCLUSION: Mosaicplasty proved to be a good alternative for the treatment of chondral and osteochondral lesions of the knee, showing better evolution in lesions located on the femoral condyles than in lesions located on the patella.OBJETIVO: Avaliação dos resultados funcionais da técnica de mosaicoplastia em joelhos de pacientes com lesão osteocondral. MÉTODOS: No período de agosto de 1999 a março de 2005, 27 pacientes foram submetidos à mosaicoplastia do joelho. Vinte e um eram do sexo masculino e seis, do feminino. A idade variou de 16 a 64 anos (média de 38,1 anos). Dezessete lesões eram do lado direito e 10, do esquerdo. Em relação à localização da lesão, quatro (15%) situaram-se no côndilo femoral lateral, 18 (66,5%) no côndilo femoral medial e 5 (18,5%) na patela. O tamanho das lesões variou de 1 a 8cm² (média de 2,7cm²). Os pacientes operados foram avaliados no pré e pós-operatórios pela escala funcional de Lysholm, com seguimento médio de 2,5 anos. RESULTADOS: O pré-operatório teve uma média de 62,7 pontos e o pós-operatório uma média de 95,4 pontos. Os pacientes submetidos à mosaicoplastia no côndilo femoral lateral apresentaram, no pré-operatório, a média de pontos de 51,5 pontos e, no pós-operatório, média de 100 pontos. No côndilo femoral medial a média no pré-operatório foi de 64,1 pontos e, no pós-operatório, de 95,4 pontos. Com relação à patela, a média do pré-operatório foi de 66,4 pontos e, do pós-operatório, de 92 pontos. CONCLUSÃO: A mosaicoplastia mostrou-se uma boa alternativa no tratamento das lesões osteocondrais do joelho. Entretanto, apresentou melhor evolução nas lesões dos côndilos femorais em relação às localizadas na patela.UNIFESPUNIFESPUNIFESPSciEL

Mechanical evaluation of tibial fixation of the hamstring tendon in anterior cruciate ligament double-bundle reconstruction with and without interference screws

OBJECTIVE: The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS: A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2 ) were objectively determined in each group. RESULTS: Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2 ; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2 ; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION: The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws

U-Pb (LA-ICPMS) ages in zircons from the Santa Maria de Itabira and São José da Safira pegmatite districts (Minas Gerais): contrasting populations in the Eastern Brazilian Pegmatite Province?

Os distritos pegmatíticos de Santa Maria de Itabira (DPSM) e de São José da Safira (DPSJ) são classicamente integrantes da Província Pegmatítica Oriental do Brasil (PPOB), embora até então com carência de dados geocronológicos em termos regionais. Neste  estudo apresentam-se novas datações U-Pb (LA-ICPMS) de zircões extraídos de três pegmatitos desses distritos (Ponte da Raiz, Jaguaraçu e Ipê). Os zircões do Pegmatito Ponte da Raiz (DPSM), considerados magmáticos, fornecem uma robusta idade-concórdia em 1675 ± 5 Ma, indicando sua cristalização compatível com o magmatismo anorogênico da Suíte Granítica Borrachudos (~1,7 Ga). Os zircões do Pegmatito Jaguaraçu, do mesmo distrito, são metamícticos, fornecendo uma média de idades mais jovens de 508 ± 19 Ma que podem representar manifestações hidrotermais pós-colisionais no Orógeno Araçuaí. Os zircões do Pegmatito Ipê (DPSJ) apresentam idade-concórdia em 467 ± 5 Ma, interpretada como a da cristalização do corpo, valor similar à larga maioria das outras datações de pegmatitos do orógeno. Estes dados, aliados aos atributos mineralógicos dos pegmatitos/distritos estudados, evidenciam que o DPSM se caracteriza por pegmatitos berilíferos ricos em fluorita, amazonita e topázio, pertencendo à família NYF (nióbio-ítrio-flúor); possuem idade estateriana e representam magmas residuais de granitos da Suíte Borrachudos. Em contraste, o DPSJ constitui um distrito pegmatítico da família LCT (lítio-césio-tântalo), cujos pegmatitos são provenientes de magmas residuais de granitos tardi-orogênicos (pós-colisionais) do Orógeno Araçuaí. Em sentido mais amplo, a serem confirmados tais dados, o DPSM deve ser separado da PPOB, embora os depósitos quartzo-feldspáticos hidrotermais ricos em esmeralda/alexandrita que ocorrem em sua área geográfica estejam relacionados a um episódio hidrotermal tardio do Brasiliano.The Santa Maria de Itabira (DPSM) and São José da Safira (DPSJ) pegmatite districts are classically part of the Eastern Brazil Pegmatitic Province (PPOB), although lacking geochronological data in regional terms. This study presents new U-Pb dating (LA-ICPMS) of zircons extracted in three pegmatites from these districts (Ponte da Raiz, Jaguaraçu, Ipê). Zircons from the Ponte da Raiz  Pegmatite (DPSM), considered magmatic, provide a robust concordia-age at 1675 ± 5 Ma, indicating crystallization compatible with the anorogenic magmatism of the Borrachudos Granitic Suite (~1.7 Ga). Zircons from the Jaguaraçu Pegmatite in the same district, are metamictic, providing a younger age at 508 ± 19 Ma, which may represent post-collisional hydrothermal manifestations in the Araçuaí Orogen. Zircons of the Ipê Pegmatite (DPSJ) show a concordia-age at 467 ± 5 Ma, interpreted as the age of the body, a similar age to the large majority of other pegmatites from the orogen. These data, combined with the mineralogical atributes of the studied pegmatites/districts, show that the DPSM is characterized by berylliferous pegmatites rich in fluorite, amazonite and topaz, belonging to the NYF (niobium-yttrium-fluorine) family; they are of Statherian-age and represent residual magmas from granites of the Borrachudos Suite. In contrast, the DPSJ constitutes a pegmatite district of the LCT (lithium-cesium-tantalum) family, whose pegmatites come from residual magmas of late-orogenic (post-collisional) granites of the orogen. In a broader sense, such data to be confirmed, the DPSM should be separated from the PPOB, although the quartz-feldspathic hydrothermal deposits rich in emerald/alexandrite that occur in its geographic area are related to a late-hydrothermal episode of Brasiliano age