Magyarországon végzett infrarenalis aortaaneurysma-műtétek eredményei az Érsebészeti Regiszter adatai alapján (2010–2014)

Absztrakt Bevezetés: A Magyar Angiológiai és Érsebészeti Társaság az Érsebészeti Regiszter létrehozása után elhatározta, hogy az egyes beavatkozások eredményeiről rendszeresen beszámol. Célkitűzés: A szerzők 5 év alatt végzett infrarenalis aortaaneurysma-műtétek eredményeinek bemutatását tűzték ki célul. Módszer: A prospektíven rögzített multicentrikus adatokat retrospektíve dolgozták fel. Az Érsebészeti Regiszter 2010. január 1. és 2014. december 31. közötti adatainak statisztikai elemzéséhez Fischer-féle egzakt próbát és esélyhányadost használtak. Eredmények: Az 1435 beavatkozás 16,72%-ára aneurysmaruptura miatt került sor. A műtétek 78,4%-át 5 nagy betegforgalmú intézet végezte. A rupturált aortaaneurysma csoportba tartozó betegek életkora 71,77±9,82 (átlag±SD) év, a perioperatív mortalitás 33,75%, a nem rupturált aortaaneurysma csoport átlagéletkora 69,50±8,46 év, a perioperatív mortalitás 3,51% volt. Endovascularis beavatkozásoknál mindkét csoportban szignifikánsan kisebb volt a halálozás (rupturált: p<0,05, OR = 0,11; nem rupturált: p<0,05, OR = 0,26), illetve az ápolási időszak (rupturált: p<0,05, OR = 4,55; nem rupturált: p<0,001, OR = 4,27) a nyitott műtétekhez képest. Nagy betegforgalmú intézetekben mindkét csoportban szignifikánsan kisebb volt a halálozás (rupturált: p<0,0001, OR = 0,32; nem rupturált: p<0,0001, OR = 0,23) és az ápolási időszak (rupturált: p<0,05, OR = 3,16; nem rupturált: p<0,001, OR = 3,84) a kis betegforgalmú intézetekhez képest. Következtetések: Stentgraft-implantáció és nagy betegforgalmú intézetek esetében szignifikánsan alacsonyabb a perioperatív mortalitás és a posztoperatív ápolási napok száma. Orv. Hetil., 2015, 156(49), 1991–2002

Arcrekonstrukciós és orthognath műtétek tervezési lehetőségei háromdimenziós képalkotói módszerekkel

We summarize up-to-date planning technics of orthognathic and reconstructive surgery operation which appeared with three-dimensional imaging, using literature data and some clinical examples. In many cases, orthognathic and reconstructive operations mean the only treatment of facial deformity caused by tumour, traumatic injury or congenital anomaly. In this field, radiology plays an important role not only in the diagnosis but also in the planning of the treatment. With the appearance of cone-beam computed tomography (CBCT), the previously used two-dimensional cephalometric analysis on lateral cephalogram was changed for three-dimensional cephalometric measurements. The first step of the adaptation was the lateral and frontal x-ray images generated from the CBCT database and later the volume rendered surface and segmentation technics provided the moving of the facial bones in three dimensions which meant virtual surgical planning. With the development of CAD/CAM technic and the three-dimensional printing, many opportunities became available, such as preoperative bending splints and plates and printed surgical model for the tangible planning. The progress of imaging facilitated the individual, accurate, and reliable planning which significantly determines the success of the treatment

Cone-Beam Computed Tomography in Dentomaxillofacial Radiology

The daily application of cone-beam computed tomography (CBCT) has been increasing. Not only the number of referrals has been raising, but also the variety of the anatomical regions requested for imaging is also growing in the dentomaxillofacial area. Even though computed tomography (CT) has been widely used in the head and neck region, by the invention of CBCT, some of the drawbacks of CT were overcome and turned into the advantages of the CBCT appliances, such as lower patient dose. In this chapter, we provide a comprehensive picture of the everyday use of CBCT as a modality in the dentomaxillofacial region and its current limitations and expected improvements

Landmark-based midsagittal plane analysis in patients with facial symmetry and asymmetry based on CBCT analysis tomography

Purpose Reconstruction of the facial midplane is relevant in anthropometry, orthodontics, maxillofacial surgery, and the accurate measurement of symmetry deviation is relevant in many fields of medicine especially when planning surgical treatment. In the literature, three different means of midplane generation have been published; however, there is currently no consensus regarding the approach to use. Morphometric methods are used to determine the true midsagittal plane (MSP), but its use in clinical practice is difficult. Aregression plane based on N-ANS-PNS landmarks reportedly approximates the morphometric MSP. As these points are vulnerable, we investigated which combination of landmarks can be substituted in symmetric and asymmetric faces. Patients and methods Thirty symmetric and 30asymmetric faces were analyzed on cone-beam computed tomography scans. A total of 50 regression planes were generated based on three unpaired landmarks and 35 regression planes were generated based the midpoints of paired landmarks. The Na-ANS-PNS plane was used as reference plane, and the mean angle between it and each generated MSP was calculated. The differences from the reference plane were compared by t-test between the groups. Results In the symmetric group, 86% of angles deviated by <5 degrees using unpaired points, whereby 74% of angles deviated by <5 degrees for paired points. Between the two groups 50% of planes from midline points, and 77% of planes from paired points were significantly different. All planes deviated more in the asymmetric group. Conclusions The N-ANS-PNS reference plane can be substituted with the following combinations: ANS-G-Ba, ANS-G-S, ANS-S-De, PNS-G-Ba, PNS-S-Ba, PNS-ANS-G, and PNS-N-Ba

MRI compatibility of orthodontic brackets and wires: systematic review article

Abstract Background Before the magnetic resonance imaging (MRI) examination fixed orthodontic devices, such as brackets and wires, cause challenges not only for the orthodontist but also for the radiologist. Essentially, the MRI-safe scan of the fixed orthodontic tools requires a proper guideline in clinical practice. Therefore, this systematic review aimed to examine all aspects of MRI-safe scan, including artifact, thermal, and debonding effects, to identify any existing gaps in knowledge in this regard and develop an evidence-based protocol. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was used in this study. The clinical question in “PIO” format was: “Does MRI examination influence the temperature of the orthodontic devices, the size of artifacts, and the debonding force in patients who have fixed orthodontic bracket and/or wire?” The search process was carried out in PubMed, PubMed Central, Scopus, and Google Scholar databases. The search resulted in 1310 articles. After selection according to the eligibility criteria, 18 studies were analyzed by two reviewers. The risk of bias was determined using the Quality In Prognosis Studies tool. Results Out of the eligible 18 studies, 10 articles examined the heating effect, 6 were about the debonding effect, and 11 measured the size of artifact regarding brackets and wires. Considering the quality assessment, the overall levels of evidence were high and medium. The published studies showed that heating and debonding effects during MRI exposure were not hazardous for patients. As some wires revealed higher temperature changes, it is suggested to remove the wire or insert a spacer between the appliances and the oral mucosa. Based on the material, ceramic and plastic brackets caused no relevant artifact and were MRI-safe. Stainless steel brackets and wires resulted in susceptibility artifacts in the orofacial region and could cause distortion in the frontal lobe, orbits, and pituitary gland. The retainer wires showed no relevant artifact. Conclusions In conclusion, the thermal and debonding effects of the fixed orthodontic brackets and wires were irrelevant or resoluble; however, the size of the artifacts was clinically relevant and determined most significantly the feasibility of fixed brackets and wires in MRI examination