Simple X-ray Research Articles

X-ray fluorescent determination of an element in the multi-component samples

A method for determining the content of one element in the multi-component samples is proposed. In the known methods of X-ray fluorescent analysis, the standard composition samples are used, or the fundamental parameters method is applied to determine the intensity of the analytical line of the defined element from the content in order to account for the inter-nutrient influences. A distinctive feature of the method in determining the content of one element in the material proposed by the current study does not require the use of standard samples and does not require the measurements of other elements that are part of the sample being analyzed to account for the inter-nutrient influences. This approach is most convenient and economical when it comes to determining the content of one or more elements in the multi-component materials on the simple single-channel X-ray spectrometers and analyzers. The possibility of implementing such solution is based on using the measured intensity of the analytical line of the defined element in the single-element sample and in the material under study and calculating the content of the defined element with the record absorption factor of the - the relationship of absorbent properties of filler to the absorption properties of the defined element. The calculation of the absorption factor is carried out using a program to compute the theoretical intensity considering all the influencing factors. Experimental testing of the proposed method was performed using the standard samples of steel and brass composition. A theoretical assessment of the effectiveness of the method in determining niobium in zirconium as well as harmful impurities in organic materials has been conducted. Keywords : X-ray fluorescent analysis, definition of one element, multi-component samples, steel and alloys, organic materials, absorption factor (Russian) DOI: http://dx.doi.org/10.15826/analitika.2019.23.4.006 B.D. Kalinin “Pretsizion Tekhnologies” Co. Lt, u l. Altai, 12, St. Petersburg, 196066, Russian Federation

Comparison between EGSnrc and MCNPX for X-ray target in 6 MV photon beam

The Monte Carlo codes, EGSnrc and MCNPX, have been specifically developed to study the particles transport in linear accelerator used in radiotherapy. A simple X-ray target 6 MV photon beam geometry was chosen to highlight similarities and differences of particles transport algorithms implemented in these Monte Carlo codes. The purpose of this study was to compare the particles transport in X-ray target 6 MV photon beam using EGSnrc and MCNPX codes. This target has 0.2484 cm thickness consisting of 0.0899 cm Tungsten and 0.1575 Copper. The global cut-off energies used in the simulations for electron and photon were 500 KeV and 10 KeV, respectively. Monte Carlo simulations were performed for 6.4 MeV monoenergetic beam. The parameters used in this simulation were using the DEFAULT setting. The particles fluence, spectral distribution after target and simulation time were analysed in this simulation. The results showed that the spectrum from EGSnrc and MCNPX was not well-matched. There was under 5% difference, especially in the build-up region. Meanwhile, the EGSnrc was 2 to 3 times more efficient than MCNPX code to achieve certain statistical precision. This happened because the differences of transport algorithm and approximation in these MC codes. EGSnrc just follow photons and electrons during simulation, while MCNPX can simulate transport 34 types of particles, including neutrons. It also causes the simulation time difference between these two codes. MCNPX simulation took longer than the EGSnrc. However, in some cases, differences in results as well as simulation time between 2 codes can be ignored.

Extreme lateral and interlaminar approach for intra-canal and foraminal double disc herniation at lumbosacral level.

There are several approaches for double disc herniation consisting of an intracanal and foraminal lesion. Of several approaches, we introduced extreme lateral and interlaminar approach (ELIA). And we aimed to compare the approach with the conventional combined interlaminar and paraisthmic approach (CIPA). The authors reviewed the medical charts of patients who underwent a procedure for a double disc herniation at the lumbosacral level between March 2012 and February 2016 and patients who underwent CIPA or ELIA were selected. For preoperative testing, simple X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) scans were performed. For postoperative outcomes, the Korean version of the Oswestry Disability Index (K-ODI) and Numeric Rating Scale (NRS) at one, two, and three months post-operation were checked. Eleven patients were given ELIA and twenty-four patients were involved in CIPA. The mean pre K-ODI was 34.1 (±13.9) and 32.4 (±4.0) at each group. 1st, 2nd and 3rd month post-operative K-ODI was 8.2 (±4.1), 6.4 (±2.1) and 5.3 (±2.4) in ELIA and 8.1 (±3.2), 7.1 (±3.5) and 8.4 (±6.4) in CIPA. Post-operative 3rd month K-ODI showed significant difference between two groups (p: 0.005). The mean pre NRS was 8 (±0.9) and 8.6 (±1.0). 1st, 2nd and 3rd month post-operative NRS was 2.4 (±1.5), 2.2 (±1.5) and 2.0 (±0.9) in ELIA and 3.3 (±1.4), 3.3 (±1.6) and 3.7 (±1.9). Post-operative 3rd month NRS showed significant difference between two groups as well (p: 0.001). There were four (19.0%) recurrence cases in CIPA patients group, otherwise there was no recurrence case in ELIA group. In the treatment of L5-S1 double disc herniation, the ELIA surgical approach showed better outcomes than the CIPA surgical approach did with respect to pain and K-ODI during a mid-term follow-up examination conducted three months post-operation.

Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country

BackgroundTuberculosis (TB), especially extrapulmonary tuberculosis (EPTB), is an important cause of fever of unknown origin (FUO) in TB-burdened areas. Little information is known about patients with EPTB with clinical features presenting as FUO and about the factor of delaying the diagnosis.MethodsWe retrospectively analyzed EPTB patients who were referred with FUO at 3 university-affiliated hospitals over 8 years (2010–2017). The subjects were assigned to groups of early diagnosis and delayed diagnosis within 3 days of an initial comprehensive evaluation from the referral. Clinical and laboratory variables were compared between the groups.ResultsA total of 95 patients with febrile EPTB were included. Localizing symptoms and/or signs suggestive of anatomy were identified in 62.1% of the patients. Concurrent lung involvement by TB was presented by 49.5% (47/95) of the patients, and only 23.4% of them showed typical findings of pulmonary TB on simple chest X-ray. Most of the patients showed abnormal lesions on cross-sectional CT (98.9%) and MRI (100%). The clinical variables and blood test results of patients were not significantly different between the two groups. The less typical imaging finding of EPTB on CT (38.5% vs. 79.0%) and MRI (37.5% vs. 79.0%) in the delayed diagnosis group was a risk factor for delayed diagnosis.ConclusionFebrile EPTB referred as FUO showed nonspecific clinical manifestations. The active application of cross-sectional imaging tests according to clinical clues or randomly in the absence of local manifestations, combined with invasive diagnostic approaches even for atypical presentations may lead to an earlier diagnosis of febrile EPTB.

The effect of C-arm fluoroscope on unicompartmental knee replacement arthroplasty

PurposeThe aim of this study was to identify the effectiveness of C-arm fluoroscope in unicompartmental knee replacement arthroplasty through the clinical and radiologic results. Materials and methodsWe investigated the 33 cases of unicompartmental knee replacement arthroplasty in 31 patients who diagnosed degenerative arthritis of knee between February 2011 and March 2014. We divided 2 groups, one is 15 cases using C-arm fluoroscope during operation (group A), the other is 18 cases not using that (group B). We measured femoro-tibial angle (FTA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), femoral component coronal rotation angle (FCRA) by simple X-ray. We evaluated femur and tibia varus/valgus mismatch and posterior slope mismatch by above parameters after operation. And also we evaluated clinically by knee and functional score. ResultsIn group A, FTA average changes from −0.6° to 6.1°, MPTA changes from 84.5° to 87.6°, PTSA changes from 6.2° to 5.2° through operation. In group B, FTA changes from −0.4° to 5.8°, MPTA changes from 84.7° to 87.1°, PTSA changes from 6.3° to 5.5°, and FCRA is 0.6° in A group, 0.4° in B group after operation. The tibial varus/valgus mismatch cases after operation (nl.:87 ± 3°) was 1 in group A, 5 in group B. Post. slope mismatch cases after operation (nl.:7 ± 3°) was 1 in group A, 1 in group 31 B. All cases in both A and B group were not included in femoral varus/valgus mismatch (nl.:0 ± 3°) after operation. In group A, Knee score improved from 56.3 to 90.7, Functional score from 54.3 to 86.9 through operation. In group B, Knee score improved from 54.9 to 89.8, Functional score from 52.8 to 84.6. ConclusionThere was no statistically significant difference in radiologic and clinical results between group A and B, but the number of tibial varus/valgus mismatch case were fewer in fluoroscope guided group. Sowe consider that thefluoroscope is helpful for tibial cuttingin unicompartmental knee replacement arthroplasty.

Intervención De Enfermería En La Redirección De Catéteres Tenkhoff Disfuncionales

Renal Diseases (RD) today represent a high social and economic cost that affects the quality of life of people. This is irrespective of the fact that there are Substitutive Therapies of Renal Function (STRF) in some complications such as migration, elbowing or plug of fibrin in Peritoneal Dialysis. Objective: To know the effectiveness of the nursing intervention in the redirection of dysfunctional Tenckhoff catheters installed in the General Subzone Hospital No. 4 of the IMSS of the municipality of Tenosique, Tabasco, Mexico. Methodology: This uses a quantitative-qualitative approach with the quasi-experimental longitudinal cut design, with n = 9 people with CKD in TSFR under the DPCA and DPA modality. Results: The data that predominated indicate that 5 (55.6%) were men and 4 (44.4%) women. In terms of occupation, 3 were housewives (33.3%), followed by employees. 8 (88.9%) were married people and 4 (44.4%) have completed their basic primary education. 7 (77.8%) people have been diagnosed of Diabetes. At the pre-intervention stage, they found signs of edema, uremic syndrome, elevated creatinine, hyperglycemia and fluid control with a positive balance sheet. That is to say that the peritoneal cavity was presenting retention of peritoneal fluid, which is confirmed by the simple X-ray photography of abdomen. At the post-intervention stage, they found changes that result to decrease of the edema, urea, and creatinine due to the exit of the liquid preserved in the peritoneum. Conclusion: The redirection of the catheters Tenckhoff through the employment of the nursing intervention with metallic guide is effective to recover the functionality of the same one.

Formation of transparent glass-ceramics including thermodynamically metastable cubic phase in Na<sub>2</sub>Mn<sub>0.5</sub>Fe<sub>0.5</sub>SiO<sub>4</sub> glass

Optically transparent and electrically conductive glass-ceramics have been successfully prepared from 1Na2O–0.5MnO–0.5FeO–1SiO2 (Na2Mn0.5Fe0.5SiO4) glass by heat-treatment. Crystallization tendency was sensitive to the valence state of transition metal oxide. The as-quenched glass melted at 1400°C for 15 min, exhibited two exothermic peaks in the differential thermal analysis. Optically transparent glass-ceramics obtained at 493°C for 3 h showed simple X-ray diffraction pattern, which could be assigned to a cubic phase with a lattice constant of 0.74511 nm. A monoclinic Na2MSiO4 (M = Mn, Fe) phase appeared with the heat treatment above 610°C, suggesting that the crystal phase precipitated in the low temperature region was thermodynamically metastable. The transparent glass-ceramics showed an order of magnitude higher electrical conductivity than that of glass and the monoclinic phase.

2D imaging X-ray diagnostic for measuring the current density distribution in a wide-area electron beam produced in a multiaperture diode with plasma cathode

A simple and inexpensive X-ray diagnostic tool was designed for measuring the cross-sectional current density distribution in a low-relativistic pulsed electron beam produced in a source based on an arc-discharge plasma cathode and multiaperture diode-type electron optical system. The beam parameters were as follows: Uacc = 50–110 kV, Ibeam = 20–100 A, τbeam = 0.1–0.3 ms. The beam effective diameter was ca. 7 cm. Based on a pinhole camera, the diagnostic allows one to obtain a 2D profile of electron beam flux distribution on a flat metal target in a single shot. The linearity of the diagnostic system response to the electron flux density was established experimentally. Spatial resolution of the diagnostic was also estimated in special test experiments. The optimal choice of the main components of the diagnostic technique is discussed.

Three-Dimensional Analysis of Hemimetameric Segmental Shift in Congenital Scoliosis

This is a retrospective cohort study. Hemimetameric segmental shift (HMMS) is defined as a hemivertebral deformation in which 2 or more hemivertebrae exist on both sides of the spine and are separated by at least 1 normal vertebra. Reports of HMMS are rare and based on simple anterior x-ray images. No reports have used 3-dimensional computed tomography (3D-CT) to analyze both the anterior and posterior elements. The objective of this study was to analyze the morphology and clinical features of HMMS 3 dimensionally. HMMS was confirmed in 32 (6.6%, 16 males and 16 females) of 483 patients diagnosed with congenital scoliosis at the study institution between 1998 and 2013. The average age at the first visit was 6 years and 3 months. 3D-CT imaging was performed for 30 patients older than 2 years (average age: 9 y and 8 mo) and used to classify cases according to posterior elements. With regard to the number of hemivertebrae present, 21 patients had 2 hemivertebrae, 7 patients had 3 hemivertebrae, and 2 patients had 4 hemivertebrae. Patients with 2 hemivertebrae predominantly had hemivertebrae in the thoracolumbar spine. Patients were classified into 2 categories: malformation existing at an equal level in anterior and posterior sides (unison HMMS) and malformation existing at nonequal levels (discordant HMMS). Nine patients had unison HMMS and all of them had 2 hemivertebrae (average: 4.6 vertebrae). Twenty-one patients had discordant HMMS, with 12 having 2 hemivertebrae, 7 having 3 hemivertebrae, and 2 having 4 hemivertebrae. Through 3D-CT analysis, HMMS was categorized as unison or discordant. Discordant HMMS was observed in 21 of 30 (70%) patients and in all patients with >3 hemivertebrae. Diagnosing HMMS, whether unison or discordant, is clinically important and should be done with careful analysis of bone models and/or radiologic images to determine the correct spinal levels. Level IV-diagnostic study.

Tabletop x-ray ghost imaging with ultra-low radiation

Computational ghost imaging, in which an image is retrieved from a known patterned field that illuminates an object and the total transmitted intensity therefrom, has seen great advances on account of its advantages and potential applications at all wavelengths. However, even though lensless x-ray ghost imaging was anticipated more than a decade ago, its development has been hampered due to the lack of suitable optics. The image quality is proportional to the total flux in conventional projection x-ray imaging, but high photon energy could severely damage the object being imaged, so decreasing the radiation dose while maintaining image quality is a fundamental problem. Using a simple tabletop x-ray source, we have successfully realized ghost imaging of planar and natural objects with a much higher contrast-to-noise ratio compared to projection x-ray imaging at the same low-radiation dose. Ultra-low-flux imaging has been achieved, and thus radiation damage of biological specimens could be greatly reduced with this new technique.

Estimation of the effects of medical diagnostic radiation exposure based on DNA damage

X-rays are widely applied in the medical field for the diagnosis and treatment of diseases. Among the uses of X-rays in diagnosis, computed tomography (CT) has been established as one of the most informative diagnostic radiology examinations. Moreover, recent advances in CT scan technology have made this examination much easier and more informative and increased its application, especially in Japan. However, the radiation dose of CT scans is higher than that of simple X-ray examinations. Therefore, the health risk of a CT scan has been discussed in various studies, but is still controversial. Consequently, the biological and cytogenetic effects of CT scans are being analyzed. Here, we summarize the recent findings concerning the biological and cytogenetic effects of ionizing radiation from a CT scan, by focusing on DNA damage and chromosome aberrations.

Front Cover: From a Metastable Layer to a Stable Ring: A Kinetic Study for Transformation Reactions of Li2Mo3TeO12 to Polyoxometalates (Chem. Eur. J. 26/2018)

A metastable layered tellurite (Li2Mo3TeO12) in an extremely strained environment has been synthesized. Li+-exchange-driven transformation reactions of Li2Mo3TeO12 to polyoxometalates have been successfully monitored by simple lab-source X-ray diffraction. Through the obtained kinetic data, a plausible mechanism for the solid-state transformation reactions has been suggested. This new finding could be utilized in discovering novel metastable materials and their phase transitions. More information can be found in the Communication by K. M. Ok et al. on page 6712. A metastable layered tellurite (Li2Mo3TeO12) in an extremely strained environment has been synthesized. Li+-exchange-driven transformation reactions of Li2Mo3TeO12 to polyoxometalates have been successfully monitored by simple lab-source X-ray diffraction. Through the obtained kinetic data, a plausible mechanism for the solid-state transformation reactions has been suggested. This new finding could be utilized in discovering novel metastable materials and their phase transitions. More information can be found in the Communication by K. M. Ok et al. on page 6712.

A simple X-ray source of two orthogonal beams for small samples imaging

A simple method for simultaneous imaging of small samples by two orthogonal beams is proposed. The method is based on one channel-cut crystal which is oriented such that the beam is diffracted on two crystallographic planes simultaneously. These planes are symmetrically inclined to the crystal surface. The beams are three times diffracted. After the first diffraction the beam is split. After the second diffraction the split beams become parallel. Finally, after the third diffraction the beams become convergent and may be used for imaging. The corresponding angular relations to obtain orthogonal beams are derived.

Intraosseous Lipoma: 18 Years of Experience at a Single Institution.

BackgroundIntraosseous lipoma is a very rare lesion that constitutes no more than 0.1% of all bone tumors. We analyzed 21 cases of intraosseous lipoma at a single institution for clinical and radiographic characteristics.MethodsA retrospective study was performed on 21 pathologically confirmed intraosseous lipomas treated in our hospital from 2000 to 2017. Simple X-ray and magnetic resonance imaging findings and medical records were reviewed. Patients' age, sex, and clinical symptoms were investigated. From the radiographic images, the site of the lesion, calcification, bony expansion, and stage of the lesion were evaluated. Correlations between the degree of involution and clinical symptoms were analyzed.ResultsThe mean age of patients was 50 years (range, 20 to 67 years), and there were 13 males and eight females. The mean lesion size was 6.1 cm (range, 2.5 to 13.6 cm). The most common anatomical site of the lesion was the femur (seven cases), and three cases occurred in flat bones such as the ilium and scapula. Visual analogue scale score for pain was 3 to 6 in 15 patients. There were no complaints of functional limitation. There was no correlation between the degree of degeneration and clinical symptoms (p = 1.000). Curettage was performed as a surgical treatment in 20 patients, and bone graft was performed using a bone chip. Excision was performed in one patient. Pain was resolved in seven of 11 patients with a complaint of preoperative pain; intermittent pain remained in four cases. There was no local recurrence or malignant change during the follow-up.ConclusionsThere was no correlation between the degree of degeneration and clinical symptoms. Pain was the most common clinical symptom, but it was rarely accompanied by functional limitation. However, it is important to distinguish it from other pain-inducing disorders. The incidence of intraosseous lipomas is low, and detection based on various imaging findings can be difficult. Clear understanding of the radiographic findings and symptoms of intraosseous lipoma is helpful for diagnosis and differentiation.

Can acromiohumeral distance difference predict rotator cuff lesion? A study among unilateral shoulder pain in Makassar

Background: Magnetic resonance imaging (MRI) is the gold standard for detecting rotator cuff injury. Simple X-ray measurement such as acromiohumeral distance (AHD) could be helpful in places where MRI is not available, in determining the possibility of rotator cuff injury. AHD is mainly genetically determined, rather than adaptively. Objective: The objective of the study was to prove the correlation of AHD difference between symptomatic and asymptomatic shoulder with rotator cuff lesion in MRI among unilateral shoulder pain in Makassar and to measure sensitivity and specificity of AHD difference in diagnosing rotator cuff tear. Materials and Methods: This is a cross-sectional controlled study. 30 patients with unilateral shoulder pain, motion range deficit, age 45–65 year old, were included in this study. Chest anteroposterior (AP) X-ray was taken, AHD difference was measured. MRI of the symptomatic shoulder was taken to confirm rotator cuff lesion. Chest AP X-ray also was taken from healthy subject for significance comparison. Statistical analysis was conducted using Spearman’s test, independent sample t-test and receiver operating characteristic curve. Result: AHD difference correlates positively with the presence of rotator cuff lesion in MRI among unilateral shoulder pain (coefficient 0.749 [P < 0.05]). AHD difference 1.05 mm detects at least partial supraspinatus tear with sensitivity 85.7 % and specificity 88.9%. AHD difference 1.75 mm detects a total supraspinatus tear with sensitivity 80% and specificity 90%. Conclusion: AHD difference on X-ray correlates with rotator cuff tear seen in MRI, and be considered as a diagnostic aid in places where MRI is not available.

From a Metastable Layer to a Stable Ring: A Kinetic Study for Transformation Reactions of Li2 Mo3 TeO12 to Polyoxometalates.

A metastable tellurite, Li2 Mo3 TeO12 , revealing a corrugated layered structure in an extremely strained coordination environment was hydrothermally synthesized in high yield. Li2 Mo3 TeO12 undergoes Li+ -exchange-driven facile structural transformation reactions to polyoxometalates. The kinetic data for the transformation reactions at various conditions were successfully obtained by simple lab-source powder X-ray diffraction. The investigation suggests that the solid-state transformation reactions may occur through a series of steps; substitution, decomposition, recombination, and precipitation. This new finding could be utilized in discovering functional metastable materials as well as understanding their phase transition mechanisms.

Protocolo de diagnóstico y tratamiento de la valvulopatía aórtica

Aortic stenosis. Diagnostic evaluationClinical evaluation, baseline ECG, and chest x-ray (Rx) are mandatory in the initial diagnostic evaluation. Transthoracic echocardiography (TTE) is the main tool for diagnosis and follow-up. Other diagnostic techniques are also useful. Therapeutic managementPatients with severe symptomatic aortic stenosis should be involved, especially with aortic valve replacement surgery, and if the surgical risk is high, transcatheter aortic valve implantation (TAVI) may be an adequate alternative. Asymptomatic individuals will only be involved according to several factors predictive of onset of symptoms and adverse events. Aortic insufficiency. Diagnostic assessmentclinical evaluation, baseline ECG, and simple chest x-ray are also mandatory in the initial diagnostic evaluation. The ETT is the main diagnostic and monitoring tool. Therapeutic managementAcute severe aortic insufficiency (AI) should undergo urgent surgery. In chronic severe AI, when symptoms and/or systolic dysfunction of the left ventricle appear, aortic valve surgery must be performed; The asymptomatic patients will be operated according to several factors regarding left ventricular systolic size and function. Sometimes aortic root and ascending aorta surgery must be performed irrespective of the severity of the AI.

Determination of trace elements in calcium rich carbonate rocks by Wavelength Dispersive X-ray Fluorescence Spectrometry for environmental and geological studies

A simple, rapid and non destructive Wavelength Dispersive X-ray Fluorescence Spectrometry (WDXRFS) was developed for the determination of trace elements such as V, Cr, Co, Ni, Cu, Zn, Pb, Ba, La, Ce, Nd, Rb, Sr, Y, Zr, and Nb in carbonate rocks with high calcium content. Samples of marble, limestone, fluorite ore and carbonatite-like rocks were chosen as objects under investigation. These samples have wide ranges of major and trace element contents, and high concentration of calcite (70–98%) in calcium rich carbonates. The sample mass required for infinite thickness was calculated for each element. In order to determine V, Cr, Co, Ni, Cu, Zn, Ba, La, Nd, Ce, sample weighting 1g was pressed with a pressure of 100kN. For the determination of Rb, Sr, Y, Zr, Nb, Pb, the sample mass was increased up to 5g. The calibration curves were constructed by employing the International Certified reference materials (ICRMs) and in-house standard reference materials (HSRMs) of various types of rocks and sediments, and the matrix effects were taken into account using the influence coefficients (α-correction equations). Analytical figures of merit have also been assessed. The calculated values of the instrumental limit of the detection were within the interval from 0.5 to 4.0mgkg−1. The repeatability and reproducibility were found to be satisfactory with the relative standard deviations lower than 5%. The accuracy was evaluated by the analysis of two reference materials and the comparison with the ICP-MS results. A good agreement was achieved between the reference and measured values with recoveries ranging from 85% to 115%. The relative disagreements between the XRF and ICP-MS results were less than 10%.

Value of Ultrasound for Stability Assessment of Isolated Lateral Malleolar Fractures Compared to Stress Radiography and Arthroscopy

Category: Ankle, Trauma Introduction/Purpose: Isolated Lateral malleolus fracture, like any other fractures can be treated by operative or conservative treatment. Stability of ankle joint is the most important factor in deciding the type of treatment. Unstable ankle joints present superior clinical outcomes with surgical management. There are many methods to assess the stability of ankle joint such as plain x- ray films, stress radiographies and physical examination. Many studies have suggested the usage of ultrasound for diagnosis of ankle ligament injury. But, there are no reports about its use for stability assessment of isolated lateral malleolar ankle fracture. Therefore, the purpose of this study is to evaluate the value of ultrasound for stability assessment of isolated lateral malleolar fractures, compared to simple x-ray, stress radiography and arthroscopy. Methods: We have conducted a prospective study which included 13 consecutive patients who underwent arthroscopic exam and subsequent open reduction and internal fixation for isolated lateral malleolar ankle fracture. Before operation simple x-ray, external rotation stress radiographs were done. Stress ultrasound was performed to assess the anterior inferior tibiofibular ligament (AITFL) and medial deltoid ligament prior to operation. The arthroscopic findings were used as the reference standard. A standardized physical examination (tenderness and ecchymosis, external rotation stress test), simple radiography, stress radiography and ultrasound images were compared to assess the stability. Results: Deltoid ligament injury and or syndesmosis injury were verified arthroscopically in 12 cases with a clinical diagnosis (92.3%). There were 9 cases who showed unstable ankle fracture on the simple radiography. (69.2%). There were all cases who showed unstable ankle fracture on the external rotation stress radiography. (100%) In addition, for 12/13, there were acute tear of the deltoid ligament or AITFL injury on the ultrasound (92.3%). Conclusion: The results suggest that ultrasound could be used for the assessment of the instability of isolated lateral malleolar fracture.

Liposarcoma pleomórfico, reporte de caso

Introducción: El liposarcoma pleomórfico es el subtipo con mayor malignidad, presenta recurrencia local de 37% y metástasis en 10 años de 41%, porcentaje que aumenta directamente con el tamaño de la lesión; además, presenta una supervivencia a los 10 años de 39%. Objetivo: Presentar un caso de esta enfermedad en un hombre sin antecedentes de importancia quien presentó metástasis a pulmón posterior al diagnóstico y tratamiento de un liposarcoma pleomórfico. Discusión: En el grupo de los liposarcomas se encuentran 4 tipos diferentes: El liposarcoma bien diferenciado, desdiferenciado, pleomórfico y mixoide. A pesar de tener poca vascularización el porcentaje de metástasis, su pronóstico y dificultad para extirpación quirúrgica varía según el tipo histológico. En cuanto el diagnóstico: la radiografía simple, la ecografía, la Tomografía computarizada (TC) y la resonancia magnética (RM) son herramientas diagnósticas válidas para el estudio del liposarcoma. El tratamiento es controvertido debido a la tasa de recurrencia después de la resección quirúrgica, la cual oscila entre 0-69%.Conclusión: En pacientes con cuadros clínicos característicos de lesiones tumorales es importante hacer un diagnóstico oportuno por medio de herramientas imagenológicas y quirúrgicas como el caso de biopsias intraoperatoria para así clasificarlo según el subtipo de liposarcoma, evaluar el tratamiento de elección y evaluar pronóstico y sobrevida del paciente.