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First signs are itching homocysteine purchase arava 20 mg without prescription treatment uti, which can be measured in the blood buy arava 20mg mastercard treatment lyme disease, http://www cheap arava 10mg with mastercard medications for ocd. The infection can be fatal purchase arava 20 mg mastercard treatment for uti, partic- ularly for infants, pregnant women, and persons hormone therapy Treatment of disease or who are malnourished. The term is most commonly used to describe use of medications containing both estro- horizontal Parallel to the floor. A person lying on gen and progestogen to reduce or stop short-term a bed is considered to be in a horizontal position. In the See also Appendix B, “Anatomic Orientation more general sense, hormone therapy may be used Terms. It may also be used for thyroid disorders, and body that controls and regulates the activity of cer- illnesses associated with hormone production or tain cells or organs. Hormone therapy may include giving hor- special glands, such as thyroid hormone produced mones to the patient or using medications that by the thyroid gland. Many hormones, such as neuro- transmitters, are active in more than one physical Horner syndrome A condition resulting from process. Testosterone is an androgenic sweating (anhidosis) and flushing of the affected hormone. Also known as Horner-Bernard syn- drome, Bernard syndrome, Bernard-Horner syn- hormone, follicle-stimulating See follicle- drome, and Horner ptosis. For that regulates the balance of water and electrolytes those with severe reactions, injectable epinephrine (ions such as sodium and potassium) in the body. In selected cases, The mineralocorticoid hormones act specifically on allergy injection therapy is highly effective. The two most important thyroid cial care for people who are near the end of life and hormones are thyroxine (T4) and triiodothyronine for their families. Thyroid hormones are critical for regulation home, in a hospice or other freestanding facility, or of the body’s metabolism. Hospitalists assume the care of hospitalized patients hormone replacement therapy The use of in the place of patients’ primary care physicians. An usually acquired in childhood, and is associated immunization against commonly found types of with roseola. Its goals a cause of cancer of the cervix and other cancers of included the identification and sequencing (order- the ano-genital region. Humidified air makes it easier to breathe for disorder of the brain cells characterized by pro- persons with certain conditions, such as cystic gressive mental and physical deterioration that fibrosis, Sjogren’s syndrome, and others. Mood disturbance is normally present in the anterior chamber of the eye, usually the first symptom seen, with bipolar disor- between the cornea and the iris. Other symptoms include chorea duced by the ciliary body, that is normally present in (restless, wiggling, turning movements), muscle the anterior chamber of the eye, between the cornea stiffness and slowness of movement, and difficulties and the iris. The Hurler syndrome An inherited error of metabo- humors were phlegm (water), blood, gall (black lism characterized by deficiency of the enzyme bile, thought to be secreted by the kidneys and alpha-L-iduronidase, which normally breaks down spleen), and choler (yellow bile secreted by the molecules called mucopolysaccharides. The humoral theory was devised well before activity of this enzyme, mucopolysaccharides accu- Hippocrates, and it was not definitively demolished mulate abnormally in the tissues of the body. The word humor lives on as a medical are two clinical subtypes of disease due to defi- term for liquid or semiliquid substances in the body ciency of alpha-L-iduronidase: Hurler syndrome and as a euphemism for mood (such as being “in and Scheie syndrome. Hurler syndrome is inherited sulfatase, resulting in tissue deposits of molecules in an autosomal recessive manner. The charac- Enzyme replacement therapy helps the body make teristic features of Hunter syndrome include alpha-L-iduronidase and can alleviate many of the dwarfism, bone deformities, a thickened, coarse symptoms, but enzyme replacement therapy has not face, hepatosplenomegaly (enlargement of the liver been shown to affect the mental damage. Bone mar- and spleen) from mucopolysaccharide deposits, row transplantation may slow the progression of cardiovascular disorders from mucopolysaccharide Hurler syndrome and may prevent mental retarda- deposits, and deafness. Also known as Hunter syndrome: a severe form that causes pro- mucopolysaccharidosis type I. In older chil- respiratory distress syndrome and respiratory dis- dren and adults, there is no head enlargement from tress syndrome. See acute respiratory distress syn- hydrocephalus, but symptoms may include drome; respiratory distress syndrome. Patients may have problems with balance, hybrid The result of a cross between genetically delayed development in walking or talking, and unlike parents. Irritability, fatigue, seizures, and parents who differ in regard to the particular gene personality changes (such as an inability to concen- in question. Drowsiness and double vision are common symp- hybridoma A hybrid cell used as the basis for the toms as hydrocephalus progresses. Treatment production of antibodies in large amounts for diag- involves insertion of a shunt to let the excess fluid nostic or therapeutic use. Hybridomas are pro- exit and be reabsorbed into the bloodstream, duced by injecting a specific antigen into a mouse, thereby relieving the pressure on the brain. The out- collecting an antibody-producing cell from the look with hydrocephalus depends on the cause and mouse’s spleen, and fusing it with a tumor cell on the timing of the diagnosis and treatment. See indefinitely in the laboratory and can be used to also hydrocephalus, acquired; hydrocephalus, produce a specific antibody indefinitely. Hydatidiform moles occur during the child- bearing years, and they do not spread outside the hydrocephalus, communicating Hydrocephalus uterus. However, a malignancy called choriocarci- in which there is no obstruction to the flow of the noma may start from a hydatidiform mole. Specifically, there is no early stages, a hydatidiform mole may look like a obstruction within the ventricular system of the normal pregnancy. The fluid often increases intracranial pressure, which can com- hydrocephalus ex-vacuo Hydrocephalus that press and damage the brain. Hydrocephalus can occurs when there is damage to the brain caused by arise before birth or at any time afterward. Causes stroke or injury, in which there may be an actual can include birth defects (particularly spina bifida), shrinkage of brain substance. In infants, the most obvious sign is usually an abnormally large head; other symptoms hydrocephaly See hydrocephalus. An organ can be described as hyperactive if it is sorbed food to reach the colon, or when the colonic more active than is usual. See also attention deficit Hydrogen produced by the bacteria is absorbed into hyperactivity disorder. Hydronephrosis is caused by obstruction of chamber in which a patient receives pure oxygen, urine outflow (for example, by a stone blocking the either directly or through a mask, tent, or tube. See also hydrops fetalis A serious and potentially fatal hyperbaric oxygen therapy. Immune-related ber of conditions, notably carbon monoxide hydrops fetalis can be due to hemolytic disease such poisoning, decompression sickness (“the bends”), as Rh blood group incompatibility, in which antibod- smoke inhalation, and gas gangrene. Non-immune-related and it is sometimes used in cases of antibiotic- hydrops fetalis can have many causes but is most resistant or severe infection. The patient is enclosed commonly a result of cardiac abnormalities in the in the chamber and receives appropriately pressur- fetus. Treatment of hyper- hydroxyapatite crystal disease Inflammation bilirubinemia in the newborn involves exposure of caused by hydroxyapatite crystals. Hydroxyapatite the skin to special lights and removal of serum from molecules can group together (crystallize) to form the blood and replacing with solutions free of biliru- microscopic clumps. Hypercalcemia can be a result of malignancy, elevated parathyroid gland activity hygiene The science of preventive medicine and (hyperparathyroidism), or other conditions.

Testing the Pearson r As usual purchase 20 mg arava overnight delivery treatment junctional rhythm, the first step is to make sure that a study meets the assumptions of the statis- tical procedure discount 10 mg arava visa medicine 911. We have a random sample of pairs of X and Y scores buy generic arava 10 mg on-line medicine 319, and each variable is an inter- val or ratio variable discount arava 10 mg with amex symptoms parkinsons disease. This means that the Y scores at each X form a nor- mal distribution and the X scores at each Y form a normal distribution. For example, let’s say that we are unsure whether men produce higher or lower scores as they age. This is a two-tailed test because we’re predicting either a positive or a neg- ative correlation. For our alternative hypothesis, if the correlation in the population is either positive or negative, then does not equal zero. Thus, H0: 5 0 This implies that if r does not equal zero, it’s because of sampling error. It shows the scatterplot in the population that H0 says we would find: There is no relationship here, so equals 0. Recall, however, that a slanting elliptical scatterplot reflects an r that is not equal to zero. Thus, H0 implies that, by chance, we selected an elliptical sample scatterplot from this population plot. Therefore, it says, although age and housekeeping scores are not really related, the scores in our sample happen to pair up so that it looks like they’re related. Conversely, Ha implies that the population’s scatterplot would not look like Figure 11. Age Significance Tests for Correlation Coefficients 249 The Sampling Distribution of r We test H0 by determining the likelihood of obtaining our sample r from the population where is zero. By now, however, you could create the sampling distri- bution yourself: Using the same N as in our study, you would select an infinite number of samples of X2Y pairs from the population where 5 0 (as if you pulled each sam- ple from the scatterplot in Figure 11. If you then plotted the frequency of the various values of r, you would have the sampling distribu- tion of r. The sampling distribution of r is a frequency distribution showing all possi- ble values of r that occur by chance when samples are drawn from a population in which is zero. When 5 0, the most frequent sample r is also 0, so the mean of the sampling distribution— the average r—is 0. Because of sampling error, however, sometimes we’ll obtain a pos- itive r and sometimes a negative r. But, less frequently, we’ll obtain a larger r that falls into a tail of the distribution. Thus, the larger the r (whether positive or negative), the less likely it is to occur when the sample actually represents a population in which 5 0. To do so, we could per- form a variation of the t-test, but luckily that is not necessary. The mean of the sampling distribution is always zero, so, for example, our r of 2. As with the t-distribution, the shape of the sampling distribution of r is slightly dif- ferent for each df, so there is a different value of rcrit for each df. But, here’s a new one: With the Pearson correlation coefficient, the degrees of freedom equals N 2 2, where N is the number of pairs of scores in the sample. Table 3 in Appendix C gives the critical values of the Pearson correlation coefficient. Use these “r-tables” in the same way that you’ve used the t-tables: Find rcrit for either a one- or a two-tailed test at the appropriate and df. For the housekeeping correlation, N was 25, so df 5 23, and, for a two-tailed test with 5. As usual, this means that the results are significant: This r is so unlikely to occur if we had been representing the population where is 0, that we reject the H0 that we were representing this population. In particular, this was a correlational study, so we have not proven that changes in age cause test scores to change. In fact, we have not even proven that the relationship exists because we may have made a Type I error. Here, a Type I error is rejecting the H0 that there is zero cor- relation in the population, when in fact there is zero correlation in the population. Report the Pearson correlation coefficient using the same format as with previous statistics. However, recognizing that the sample may contain sampling error, we expect that is probably around 2. However, this is computed using a very different procedure from the one discussed previously. Thus, for the housekeeping study, we would now compute the linear regres- sion equation for predicting test scores if we know a man’s age. Recall, this is the proportion of variance in Y scores that is accounted for by the relationship with X. Remember that it is r2 and not “significance” that determines how important a relationship is. Significant indicates only that the sample relationship is unlikely to be a fluke of chance. The r2 indicates the importance of a relationship because it indi- cates the extent to which knowing participants’ X scores improves our accuracy in predicting and understanding differences in their Y scores. Thus, a relationship must be significant to be even potentially important (because it must first be believable). After describing the relationship, as usual the final step is to interpret it in terms of behaviors. For example, perhaps our correlation coefficient reflects socialization processes, with older men scoring lower on the housekeeping test because they come from generations in which wives typically did the housekeeping, while men were the “breadwinners. In this case, make no claims about the relationship that may or may not exist, and do not compute the regression equation or r2. One-Tailed Tests of r If we had predicted only a positive correlation or only a neg- ative correlation, then we would have performed a one-tailed test. When we predict a positive relationship, we are predicting a positive (a number greater than 0) so our alternative hypothesis is Ha: 7 0. On the other hand, when we predict a negative relationship, we are predicting a negative (a number less than 0) so we have Ha: 6 0. We test each H0 by again testing whether the sample represents a population in which there is zero relationship—so again we examine the sampling distribution for 5 0. When predicting a positive correlation, use the left-hand distribution: robt is significant if it is positive and falls beyond the positive rcrit. When predicting a negative correlation, use the right-hand distribution: robt is significant if it is negative and falls beyond the negative rcrit. Recall that rS describes the linear relationship in a sample when X and Y are both ordinal (ranked) scores. Again our ultimate goal is to use the sample coefficient to estimate the correlation coefficient we would see if we could measure everyone in the population. However, before we can use rS to estimate S, we must first deal with the usual prob- lem: That’s right, maybe our rS merely reflects sampling error. Therefore, before we can conclude that the corre- lation reflects a relationship in nature, we must perform hypothesis testing. Consider the assumptions of the test: The rS requires a random sample of pairs of ranked (ordinal) scores. Create the statistical hypotheses: You can test the one- or two-tailed hypotheses that we saw previously with , except now use the symbol S. The sampling distri- bution of rS is a frequency distribution showing all possible values of rS that occur when samples are drawn from a population in which S is zero.

Recently discount 20 mg arava with amex symptoms 16 weeks pregnant, we invented a new device to measure the fnger tap- ping movement with using magnetic sensor buy arava 10mg low price symptoms endometriosis. Conclusion: It was dependent on the parameter of fnger Introduction/Background: Patients with colon cancer are at risk for tapping whether we could detect the difference between patients developing functional impairment buy cheap arava 10 mg line medicine park ok. The aim of this study was to parameters to defne the difference of hand dexterity for the extent evaluate functional status and to determine its associations with of cognitive disorder and also to monitor the deterioration of hand demographic/disease-related characteristics and perceived family function in the course of progression of dementia quality 10 mg arava medications 142. Ros- major psychiatric disorder, the presence of substantial physical dis- 3 1 ability and unstable clinical status. Descriptive University of Medical Sciences, Tehran, Iran, 2Nuclear Medicine statistics, the Mann-Whitney U test and Spearman’s correlation co- and Molecular Imaging - Massachusetts General Hospital, Har- effcient were used for the analysis of data. Results: The mean age of the - Shariati hospital, Tehran University of Medical Sciences, Tehran, patients was 60. Better understand- engine another search was performed using various permutations ing of factors associated with functional status may provide more of the following keywords: ultrasonography, ultrasound imaging, effective interventions to improve health and well-being in patients low back pain, back muscles, paraspinal muscles, multifdus, trans- with colon cancer. The key to predicting successful lymphedema treatment is the lymphedema severity and patient’s compliance to bandaging. Current cancer care delivery capabilities far outweigh the needs of a growing population of patients. Among the most press- ing needs is a better approach to identify and manage functional impairments and disability. Rehabilitation providers diagnose and treat physical, psychological and cognitive impairments to main- tain or restore function, reduce symptom burden, and reduce dis- ability in this medically complex population. I Oujda, Physical and Rehabilitation Medicine, Oujda, Morocco Introduction/Background: Cancer is now considered a chronic dis- 25 ease which may result in disability and affect the patients’ quality of life. Self-assessment of the quality of life and provide care for many in military run hospitals. Impaired quality of life Methods: The Armed Forces Medical Institute of Pakistan and the was correlated with the presence of upper limb disability (p<0. Conclusion: Thus, improving the quality of pindi and Peshawar (12th–22nd Nov 2015). There Introduction/Background: Recent ongoing development of a spe- are however, challenges which can be overcome through planning, cialty called “Disaster Rehabilitation” has increased awareness of organization and recognition of specifc mission outcomes relevant the importance of rehabilitation intervention as part of post-dis- to each partner (humanitarian versus medical assistance). Natural disasters can cause signifcant presentation will provide an overview of these issues in the Hin- numbers of severe, disabling injuries, resulting in a public health dukush context. Conclusion: The present review of recent orthopedic literature reveals that de- Introduction/Background: Natural disasters may result in signif- spite of satisfactory results regarding impairment measurement af- cant loss of life and long-term disability from severe injuries. These results are comparable to tion is integral to comprehensive disaster management. The aim previous reviews and should lead to further research in terms of of this systematic review is to present an evidence-based overview contextual factors such as co-injuries, individualized rehabilitation of the effectiveness of medical rehabilitation intervention in natu- programs and psychological aspects affecting the rehabilitation pe- ral disaster survivors and outcomes that are affected. Results: A meta-analysis was not possible due to heteroge- 2 neity amongst included trials, therefore a narrative analysis was cak Alam, Malaysia, Baghdad University, College of physical Education and Sports Science, Bahdad, Iraq, 3Baghdad University, performed for best evidence synthesis. Ten studies (2 randomised controlled trials, 8 observational studies) investigated a variety of College of Physical Education and Sports Science, Baghdad, Iraq medical rehabilitation interventions for natural disaster survivors Introduction/Background: The incidence rates of hamstring muscle to evaluate “best” evidence to date. The interventions ranged from injuries in several sports is high, particularly that involve stretch comprehensive multidisciplinary rehabilitation to community edu- shortening cycle activities, such as sprinting, high- intensity run- cational programs. Studies scored low on quality assessment due to ning, stopping, starting, quick changes of direction, and kick- methodological limitations. A prevention exercise program de- disaster management for future natural catastrophes. Access to re- signed exclusively for adolescent male soccer players was includ- habilitation and investment in sustainable infrastructure and educa- ing jumping, eccentric strength, agility, balance, dynamic stretch- tion is crucial. Over 1 year all injuries were documented monthly build evidence for rehabilitation programs, cost-effectiveness and by physiotherapist. Marsh1 1Sunway University, Psychology, Bandar Sunway, Malaysia Introduction/Background: A patient’s lack of insight into their defcits following traumatic brain injury can negatively impact on their long-term adaptation and limit their successful reintegration into the community. Material and Methods: The neuropsychologi- cal functioning of a group of 71 adults was assessed at approxi- mately fve years (mean =65 months) following signifcant (i. Neuropsychological assessment included the cognitive domains of attention, verbal memory, and executive functions. In addition to the psychometric measures the patients completed a comprehensive self-report measure which included items on the perceived presence and severity of cognitive and emotional diff- culties. Results: Overall outcome as rated on the Glasgow Outcome Scale was 13 (18%) with severe disability, 22 (31%) with moder- ate disability; and 36 (51%) had made a good recovery. The cor- respondence between the objective and self-report assessment of cognitive functioning was high for prevalence of problems but the patients underestimated the severity of their defcits. For emotional problems patients self-reported a higher prevalence than that found on the psychometric measures of depression and anxiety. Conclu- sion: In general patients are aware of continuing problems with both their cognitive and emotional functioning. However there is a tendency for them to underestimate the severity of their cognitive defcits. The difference between results on the psychometric meas- ures and self-reports for anxiety and depression may illustrate a possible difference between the presence of a clinical disorder and the subjective daily experience of the patients. The type of injuries sus- tained included: subarachnoid haemorrhage, cerebral contusions, skull fractures, intracranial haemorrhage, extradural haematoma J Rehabil Med Suppl 55 Oral Abstracts 13 and diffuse axonal injuries. If not, can we improve it by using simple and inexpensive clinical interventions namely light, melatonin and caffeine? Intervention was consist of melatonin treatment at night and blue light therapy and caffeine treatment in the morning for fve weeks. Detailed visual inspection and micro-structure assessment of sleep recording were performed in order to score sleep stages. With intervention, improvement of sleep stages and/or sleep-wake patterns were detected in 8/10 patients. Cosinor analysis of saliva melatonin results revealed that averaged base- line % rhythmicity was low. Increase in %Melatonin Rhythm following intervention was statistically signifcant (p=0. One of the main limitations to caudal epidural injec- tions is the fairly high failure rate when no imaging guidance is used. Fluoroscopy and ultrasound may help identifying the sacral hiatus and may allow caudal epidural injections to be performed more accurately and safely. Material and Methods: Our purpose was to determine if there are any differences in effcacy and safety of caudal epidural corticoanesthetic injections guided by ultrasound or fuoroscopy in outpatient with subacute or chronic low back pain, refractory to conservative treatment. We conducted a retro- spective study where we evaluated 16 patients in our outpatient clinic, with low back pain related to disk herniation or associated with lumbar spine stenosis, refractory to conservative treatment. A caudal epidural injection (Lidocaine + Depo-medrol) guided by ultrasound or fuoroscopy was performed. We considered injection as successful when: with ultrasound guidance fuid was observed in the sacral canal; with fuoroscopic guidance radio-opaque contrast was observed in the sacral canal. Conclusion: The results showed similar improve- ments in short-term pain relief, function, patient satisfaction and safety with both, ultrasound and fuoroscopic guidance. Con- J Rehabil Med Suppl 55 Oral Abstracts 15 clusion: In Japan, which has a high population aging rate, vertebral low back pain. As part of addressing these matters, the research- body fractures rank high as a cause of interference with a healthy ers came up with the cost-effective lumbar brace and utilizing this life expectancy. The study used the independent 1 t-test to determine the signifcant difference on the functional dis- Marmara University Medical School, Department of Physical ability scores of patients before and after using the cost-effective Medicine and Rehabilitation- Pain Management, Istanbul, Turkey, lumbar brace. The computed t value Introduction/Background: Even though non-surgical treatments of 7. Patients who chose to have surgery and those who chose to have nonsurgical treatments were similar in age, Introduction/Background: A harmonious sagittal spinopelvic align- comorbidity scores and follow-up duration (69. Spinopelvic alignment needs to be included in surgi- culoskeletal symptom that may be either acute or chronic.

With the progression of pathol­ ogy both articular cartilages and bones disintegrate order arava 10 mg fast delivery treatment cervical cancer, resulting in concentric joint narrowing order arava 20mg online treatment hypothyroidism. Anterior pin­ hole scan ofthe left knee shows uniform tracer uptake spread diffusely in the synovia and sub­ chondral bones of the entire knee joint (arrowheads) discount 10mg arava fast delivery treatment goals for anxiety. Tomographic images in this group detected two additional foci not suspected in planar images generic 20 mg arava with amex treatment jellyfish sting. The great sensitiv­ ity of bone scans in detecting lesions with augmented osteoblastic activity is known. Important for specific diagnosis is the ability to accurately localize lesions to a particular anatomic structure, such as the vertebral centrum, pedicles, facet join, or pars interarticularis [3]. Tomographic slices through a structure show the localization characteristics of radio­ pharmaceuticals at various depths within the vertebra [2]. Acquisition was in a 64 x 64 x 16 matrix, following uniformity correction, and transaxial images were generated with back projection and a Hamming filter with a 1. The scintigraphic images were analysed in relation to the number of lesions and their localization. Mandell and Harcke [7] reviewed the use of scintigraphy in spinal disorders in adolescents. They concluded that scintigraphy is useful in helping to differentiate between a variety of developmental, infectious, neoplasic and traumatic lesions of the spine. A group of patients was selected comprising 12 adults with chronic knee pain and 11 children with disorders which might affect growth cartilage. These results are important in that they may directly influence the decision whether or not to proceed with orthopaedic treatment or surgery, the aim being to prevent or predict dysmetrias and secondary deformities caused by various pathologies. Se selecciona un grupo de pacientes compuesto por 12 adultos con dolor crónico de rodillas y 11 niños con trastornos susceptibles de afectar los cartílagos de crecimiento. Se destaca la importancia de estas indicaciones por la posibilidad de incidencia directa en la indicación ortopédica, quirúrgica o no, con la finalidad de impedir o pronosticar dosimetrías y deformaciones secundarias a patologías variadas. Estas carac­ terísticas especiales son: 1) Predominio de huesos largos, que en el centelleograma óseo del adulto presentan una concentración relativamente baja del metildifosfonato mar­ cado con "Tcm y en los que las lesiones hiperradiactivas muestran una marcada diferencia de captación con el hueso normal. En el primer análisis surge una diferencia significativa entre adultos (N = 12) y niños (N = 11) a consecuencia del órgano especial del esqueleto del niño que es el cartílago de crecimiento (fisis). Las patologías que inciden sobre este órgano determinarán estímulos o inhibiciones totales o parciales que provocarán dismetrías y/o deformaciones y su consecuente repercusión funcional. El centelleograma óseo permite valorar el cartílago de crecimiento, ya que su captación es proporcional a su actividad, lo que permite extraer conclusiones de valor para la conducta terapéutica. Todos presentaban dolor crónico en rodillas, uni o bilateral, que en tres casos se había agudizado en las últimas semanas. La paraclínica (velocidad de eritrosedimentación, proteinograma y factor reumatoideo) era normal en todos menos en dos casos, que mostraron alteraciones coincidentes con el diagnóstico de poliartritis reumatoidea. Otros dos casos presenta­ ron en su evolución derrame intra-articular de líquido citrino, de rápida reaparición, injertado en un cuadro clínico compatible con el diagnóstico de artrosis. La radiología mostró rodillas normales o con alteraciones típicas de trastornos degenerativos inespecíficos. El origen de estos trastornos fue en tres casos traumático, en dos infeccioso, en uno post-operatorio, en otro congénito y en cuatro idiopático o no aclarado. Las alteraciones radiológicas observadas fueron múltiples y estuvieron en razón con las diferentes patologías y alteraciones mencionadas. La selección de pacientes se efectuó en el Servicio de Ortopedia Pediátrica y fue orientada por la clínica y la radiología. En todos estos pacientes se partió de una dosis intravenosa de metildifosfonato marcado con "Tcm, calculada en base a 350 /¿Ci por kilo de peso. En estos casos, los niños fueron premedicados 30 min antes de comenzar la tomografía con 2 mg/kg de pentobarbital sódico por vía oral. Adquisición de imágenes Se utilizaron en todos los casos gammacámaras de detector único rectangular, y 96 fotomultiplicadores con matriz de corrección de uniformidad para el "Tcm. Para tibiotarsianas se utilizaron órbitas de 360° con 64 pasos y de 180° con 32 pasos con fines comparativos, ambas ajustadas al contorno corporal (Cuadro I). En tibiotarsianas se utilizó zoom en la adquisición dado el pequeño tamaño de las fisis, a fin de evitar utilizar demasiado factor de zoom durante el procesamiento, lo que puede introducir artefactos. Se utilizó un colimador universal para baja energía, con la finalidad de aumen­ tar el número de cuentas. En dos casos se repitió el estudio con el colimador de muy alta resolución para bajas energías con fines comparativos. Se procesaron los estudios mediante algoritmo de retroproyección filtrada usando un filtro Butterworth de orden 4 con una frecuencia de corte de 0,25. No se efectuó corrección por atenuación, usando zoom y sustracción de fondo para adecuación de las imágenes obtenidas. Como post-procesa- miento especial, en el estudio de las fisis en niños se utilizó el procesamiento en tres dimensiones, sacando ventaja de la diferencia de captación entre la fisis y el hueso maduro. Esta forma de demostración de imágenes facilita la visualización de las zonas de cartílago de crecimiento desde cualquier dirección. Los 12 adultos seleccionados mostraron todos áreas hipercaptantes anormales en varias localizaciones, en la rodilla afectada, coincidiendo con lo hallado por radiología normal o con signos de afección degenerativa similares a los de la rodilla contralateral (Cuadro П). Los pacientes afectados de poliartritis reumatoidea agregaron signos radio­ lógicos de desmineralización regional. En este grupo de pacientes, dada la diferencia de captación ósea observada, probablemente vinculada a la edad y metabolismo óseo, fue necesario introducir variaciones en el procesamiento a fin de lograr mejores imágenes y evitar artefactos. Estas variaciones consistieron en cambios de filtro de reconstrucción o, en algunos casos, en pasaje de matrices de 128 x 128 a 64 x 64, lo que introduce un efecto filtrador moderado. Uno de estos últimos casos, por encontrarse hipocaptación central y simétrica en ambas fisis tibiales proximales en una niña de 16 años, fue interpretado como resultado del cierre normal fisario sin relación con la patología (Fig. Secuela de fractura metafiso- epifisaria que muestra puentes óseos en fisis derecha. La comparación con la radio­ logía permitió diferenciar entre modificaciones degenerativas radiológicas sin sufri­ miento actual y lesiones activas. Se observa también que aparecen zonas de actividad lesional en regiones sin elementos patológicos radiológicos. De uno de estos últimos casos resultó una osteonecrosis aséptica de cóndilo femoral interno en una rodilla radiológicamente indemne. Este área hipercaptante aparece como redondeada y no toma la disposición subcondral frecuente en las lesiones activas correspondientes a sufrimiento óseo degenerativo. A esto se agrega la característica de monopolar, en tanto que en el sufrimiento de tipo artrósico la regla es la hipercaptación subcondral bipolar siguiendo la inter­ línea articular que a veces es difícil de definir en forma exacta. En estos casos el tejido óseo normal aparece hiporradiactivo, en relación a la intensa captación fisaria, lo que favorece el procesamiento post­ reconstrucción en tres dimensiones (Fig. Por esta razón y por ser el cartílago una estructura de potencial, los efectos de las alteraciones se manifestarán en esqueletos jóvenes y en el futuro. De tal manera, este procedimiento más exacto aporta información con la cual el ortopedista podrá actuar quirúrgicamente para evitar angulaciones progresivas o diferencias en longitud de los miembros (Fig. Tanto el estudio anormal como el normal pueden incidir sobre la conducta quirúrgica o expectante. Se realizó una epifisiodesis (cureteado de la fisis) tibial proximal y femoral distal contralateral para equiparar las longitudes al final del crecimiento. Radiológicamente no se evidencia el puente óseo hasta transcurridos aproximadamente 6 meses desde la operación. También su forma y localización permiten extraer conclusiones de valor diagnóstico. However, in the analysis of neurological disorders, it is important to know not only the structural abnormality of the brain but also regional changes in brain functions.

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