Monitorización avanzada durante la desvinculación de la ventilación mecánica invasiva en el trasplante unipulmonar / Advanced monitoring during weaning of invasive me chanical ventilation in single-lung transplantation

Resumen El trasplante de pulmón bilateral es el tratamiento de las enfermedades pulmonares en su etapa terminal. Sin embargo, a veces se realiza el trasplante de un solo pulmón. La técnica no está exenta de complicaciones como la hiperinsuflación aguda del pulmón nativo y cambios en el diafragma, predisponiendo a atelectasias e insuficiencia respiratoria que pueden derivar en resul tados negativos. Por lo tanto, las pruebas de respiración espontánea pueden fallar y retrasar el proceso de des vinculación de la ventilación mecánica. La combinación de herramientas de monitorización avanzadas, como la tomografía por impedancia eléctrica y la ecografía, para diagnosticar la causa de este fallo, reconociendo y cuantificando la distribución del volumen pulmonar y su comportamiento dinámico, podría ser crucial para mejorar los resultados. Presentamos el caso de un paciente con trasplante unipulmonar y ventilación prolongada que falla en repetidas ocasiones durante la desvinculación de la ventilación mecánica, donde utilizamos herramientas de monitoreo avanzado para detectar la causa de la falla.

Abstract Bilateral lung transplantation is the treatment of end-stage lung diseases. However, sometimes a single lung transplant is performed. The technique is not exempt from complications such as acute hyperinfla tion of the native lung and changes in the diaphragm, predisposing to atelectasis and respiratory failure that can lead to negative results. Therefore, spontaneous breathing trials may fail and delay the weaning process. The combination of advanced monitoring tools, such as electrical impedance tomography and ultrasonography, to diagnose the cause of this failure, recognizing and quantifying the distribution of lung volume and its dynamic behavior could be crucial to improve outcomes. We present the case of a patient with a one-lung transplant and prolonged mechanical ventilation who, after presenting successive failures in the weaning pro cess, underwent advanced monitoring in order to find the causes of the failure.

Importance of carotid intimal medial thickness measurement in patients with coronary artery disease

Background: Prevalence of CAD in urban India is about double that of rural India and about 4-fold higher than in United States. Mortality related to CAD is high in Indian Population. Early diagnosis can prevent the CAD related morbidity and mortality. Aims and objectives is to study and compare the CIMT among the patients with CAD and asymptomatic control group.Methods: Hundred patients with CAD were studied for the CIMT and compared with age and sex matched asymptomatic control subjects in Department of Medicine of G. R. Medical College, Gwalior for one year from 2012 to 2013. Details on history, risk factors and presenting symptoms were recorded for all. High resolution B mode ultrasonography was performed to assess CIMT of carotid arteries.Results: CAD was more prevalent among males (78%) having mean age of 56.82±8.91 years. Majority of CAD patients had dyslipidemia (42%) followed by hypertension (21%), diabetes (13%) and smoking (17%). Majority of the CAD patients had chest pain (98%) followed by breathlessness (54%) and sweating (12%) as the most common presenting symptom. Mean CIMT was significantly more among the CAD patients (0.76±0.34) as compared to those without it (0.63±0.22) (p<0.001).Conclusions: CIMT was found to be more in CAD as compared to asymptomatic control subjects. CIMT can be an important tool for assessing CAD and atherosclerosis.

INTRAPAPILLARY DUCT DILATION: A NEW ULTRASONOGRAPHY SIGN / Dilatação ductal intrapapilar: um novo sinal ultrassonográfico

Objective: To evaluate a not yet described ultrasound finding, the dilation of the intra-papillary portion of the lactiferous duct in patients with or without abnormal nipple discharge Methods: 24 patients with pathological nipple discharge and intrapapillary duct dilation and 1,255 asymptomatic patients (control group) were studied. Results: Just one asymptomatic patient had intrapapillary duct dilation. Among the symptomatic patients, 19 were biopsied: ten with exclusively percutaneous approach, six with exclusively surgical approach, and three with an initial percutaneous and then a surgical approach. There was one invasive carcinoma and two carcinomas in situ (15.8% of the biopsied patients). In 11 patients, a papilloma was found, three of them with atypia. In one patient, ultrasonography identified intrapapillary extension of microcalcifications, and another patient a changed duct diametrically opposite to the duct which had a trigger point. In these two patients, the examination changed the treatment strategy. In two other patients, an extra-papillary finding was identified only after the intrapapillary duct dilation has been encountered. Conclusion: The intrapapillary duct dilation is a new ultrasonography sign that adds sensitivity to the evaluation of the patient with pathological nipple discharge, besides helping to find the lesion and to guide the treatment. Further research is needed to determine its prevalence and its positive and negative predictive values for cancer, atypia and papilloma

Objetivo: Avaliar um achado de ultrassonografia inédito (dilatação intrapapilar do duto lactífero) em pacientes portadoras de fluxo papilar patológico e em pacientes assintomáticas. Métodos: Foram estudadas 24 portadoras de fluxo papilar patológico e dilatação ductal intrapapilar e 1.255 pacientes assintomáticas (grupo controle). Resultados: Apenas uma paciente assintomática apresentou dilatação ductal intrapapilar. Entre as pacientes sintomáticas, 19 foram biopsiadas, 10 com abordagem exclusivamente percutânea, 6 com abordagem exclusivamente cirúrgica e 3 com abordagem inicialmente percutânea e depois cirúrgica. Houve um carcinoma invasor e dois carcinomas in situ (15,8% das pacientes biopsiadas). Em 11 pacientes foi encontrado papiloma, 3 deles com atipias. Em uma paciente a ultrassonografia identificou extensão intrapapilar de microcalcificações e em outra, um duto alterado diametralmente oposto ao duto com sinal do gatilho clínico. Nessas duas pacientes o exame mudou a estratégia de tratamento. Em duas pacientes, um achado extrapapilar só foi identificado após o encontro da dilatação ductal intrapapilar. Conclusão: A dilatação ductal intrapapilar é novo sinal ultrassonográfico que agrega sensibilidade à avaliação da paciente com fluxo papilar patológico, além de ajudar a encontrar a lesão e a orientar o tratamento. São necessárias pesquisas adicionais para determinar sua prevalência e seus valores preditivos positivo e negativo para câncer, atipias e papilomas.

Evaluación de la adiponectina y su correlación con la íntima media carotidea en mujeres peri y post menopáusicas hospital de engativá, bogotá

El riesgo cardiovascular (RCV), se incrementa en las mujeres después de la menopausia. La adiponectina, se postula como un biomarcador de riesgo cardiovascular. La presente investigación buscó conocer si los niveles de adiponectina y la evaluación de a Intima Media Carotidea (IMT) se modifican durante el climaterio. Se evaluó el riesgo cardiovascular a diez años, en la escala de Framingham (FRS). Se tomaron 80 pacientes, entre 45 y 65 años, de la consulta de Climaterio en el Hospital de Engativá, Bogotá, entre el 15 de enero y 15 de diciembre de 2015. Las pacientes, se dividieron en dos grupos: 46 perimenopáusicas y 34 posmenopáusicas, todas las participantes firmaron el consentimiento informado. En formulario precodificado, se consignaron las variables sociodemográficas, examen físico, valores química sanguínea y resultados de ecografía doppler de carótida. La edad media entre los dos grupos fue: 50,95 años y 60,59 años. Se evidenció diferencia significativa en la presión arterial media. No hubo diferencia estadística en el perímetro abdominal ni en el Índice de Masa Corporal (IMC). La adiponectina presentó diferencia significativa intra grupos. No hubo diferencia en el perfil lipídico, el riesgo cardiovascular aumentó significativamente entre las mujeres pre y postmenopáusicas. La evaluación de la Íntima Media Carotidea (IMT) evidenció diferencias significativas en la placa anterior y posterior, tanto de carótida derecha como de carótida izquierda. El índice de pulsatilidad (IP) fue significativo en la carótida derecha y no en la izquierda. Se postula que la adiponectina es un marcador de riesgo cardiovascular y la IMT útil en la evaluación de arterioesclerosis.

The cardiovascular risk (CVR) increases in women after menopause. Adiponectin is postulated as a biomarker of cardiovascular risk. This study sought to determine whether adiponectin levels and assessment of Carotid Intima Media (IMT) are modified during the climacteric. cardiovascular risk ten years in the Framingham (FRS) was evaluated. 80 patients between 45 and 65 years of consulting Climaterio at the Hospital of Engativá, Bogota, between January 15 and December 15, 2015. The patients were divided into two groups, 46 perimenopausal and 34 postmenopausal, all participants signed informed consent. In pre-encoded form sociodemographic variables, physical examination, blood chemistry values and results of carotid doppler ultrasound were recorded. The average age between the two groups was: 50.95 years and 60.59 years. Significant difference was evidenced in mean arterial pressure. There was no statistical difference in waist circumference or the Body Mass Index (BMI). Adiponectin showed a significant difference intra groups. There was no difference in lipid profile, cardiovascular risk increased significantly between preand postmenopausal women. Evaluation of Carotid Intima Media showed significant differences in the anterior and posterior plates both right and left carotid carotid. The pulsatility index (PI) was significant in the right carotid artery and not in the left. We hypothesize that adiponectin is a marker of cardiovascular risk and IMT useful in assessing atherosclerosis.

Comprehensive Study of Neural Tube Defects in 1000 Foetuses with Clinical Spectrum.

Introduction: A variety of malformations are included under the description of Neural tube defects (NTDs). These are abnormalities of the embryonic neuralization process. The congenital malformations of human structure and are of great interest to anatomists, obstetricians, pediatricians and radiologists. NTDs are among the commonest and most severe disorders, affecting 0.5-2 per 1000 established pregnancies, and are second commonest group of birth defects, after congenital heart defects. A valuable contribution of this study, the neural tube defects aimed at clinical methods and refined for the prenatal diagnosis in utero. Materials and Methods: This comprehensive study was undertaken to know the incidence of detail knowledge of neural tube defects in KIMS Narketpally and KAMS & RC Hyderabad, among 1000 births during the period of two years. We found seven fetuses with neural tube defects involving brain and spinal cord. A detailed study was done emphasizing on embryology and genetic and non-genetic concepts. Results & Conclusion: The seven fetuses were stillbirths and aborted babies between 20 to 40 weeks, presented with neural tube defects (0.7%). Five fetuses were females and two fetuses were males. The spinal defects were 0.4%, cranial defects 0.2% and complete neural tube defects is 0.1%. This review article discusses the classification, clinical research and epidemiological understanding of NTDs and correlated with the available literatures.

Placental laterality and uterine artery resistance as predictor of preeclampsia: a prospective study at GMERS Medical College, Dharpur-Patan, North Gujarat, India.

Background: Placental abnormality is one of the initial events seen in patients who are destined to develop preeclampsia. The objective was to study whether ultrasonically identified; placental laterality and uterine artery resistance can be used as a predictor for development of preeclampsia. Methods: This prospective observational study was conducted at GMERS Medical College, Dharpur-Patan tertiary care teaching institute in North Gujarat from January 2013 to December 2014. A total 400 non high risk primigravida with singleton pregnancy were included, all patients with diabetes, hypertension, renal disease, and history of smoking were excluded. In all these patients, location of placenta was determined by ultrasonography at 18 to 22 weeks of gestation. Patients who had lateral placenta were subjected for colour Doppler study for determining uterine artery resistance index. All 400 patients were followed till delivery for occurrence of preeclampsia as per ACOG guidelines. All data was analyzed and statistical significance was determined by x2 test and value of p<0.05 is considered significant. Results: Out of 400 cases, 80 (20%) cases had laterally located placenta on ultra sound examination done at 18-24 weeks of gestation. Out of the 80 women with laterally located placenta, 28 (35%) developed preeclampsia. This relationship was statistically significant. All 80 patients who had lateral placenta, 26 patients had raised uterine artery resistance and out of those 26 patients, 22 developed preeclampsia and 54 had no change in uterine artery resistance. Out of those 54 only 6 had preeclampsia (p<0. 001). The sensitivity of determining uterine artery resistance as a predictive test was 84.6%, the specificity 88.8 %, positive predictive value 78.5 % and negative predictive value 92.3%. Conclusion: A chance of preeclampsia is more in patients with lateral placenta but its sensitivity and specificity increases significantly when it is combined with uterine artery velocimetric waveform study, and we can predict preeclampsia in patient who is having lateral placenta and raised uterine artery resistance.

Correlation between ultrasonic appearance and pathology of phyllodes tumors of the breast / 中国肿瘤临床

Objective:This study aims to evaluate the sonographic features of phyllodes tumors of the breast (PTBs) and the cor-relation between sonographic and pathologic findings to improve the understanding of the disease. Methods:Sonographic findings of 85 PTBs from 83 patients were reviewed. The sonographic findings included the results of two-dimensional ultrasound and color Dop-pler flow imaging, elastographic features, and pathologic data. Results:Of the 85 lesions, 33 were the benign tumors, 28 were border-line, and 24 were malignant according to the pathologic diagnosis. Tumor morphology revealed that most masses were lobulated, with a clear-cut boundary, smooth verge, and inhomogeneous internal echo. Clear boundary was more common in the benign phyllodes tumors (χ2=12.721, P=0.002), and a cystic echo-free area was more commonly observed in these malignant tumors (χ2=9.677, P=0.046). LevelⅡandⅢsignals of the blood flow were observed in 75.3%of PTB cases. Of all lesions, only 26 were subjected to elasticity imaging, and the elastographic scores ranged from 2 to 3 in 88.5%of the cases (23/26). Conclusion:Conventional ultrasound and elastographic findings on PTBs exhibited definite characteristics. The border and cystic areas in the tumors can be used to differentiate between be-nign and malignant PTBs.

Ultrasound-guided one supracostal upper-calyx percutaneous access nephrolithotomy for staghorn stone / 第二军医大学学报

Objective To evaluate the safety and efficacy of ultrasound-guided one supracostal upper-calyx percutaneous access nephrolithotomy for staghorn stone. Methods A total of 581 patients with staghorn stone were treated with one supracostal upper-calyx access percutaneous nephrolithotomy from October 2004 to October 2011. The maximal diameters of stone measured by plain abdominal radiography were 3. 6-6. 5 cm, with a mean of (5. 10 + 0. 82) cm. Target calyx was posterior upper-calyx,puncture point was selected in tenth or eleventh intercostal space as guided by ultrasound, and the F22-24 upper-calyx percutaneous access was established. 17F nephroscope and 70 W holmium laser were employed to crush the stones. The operation time, perioperative complications, and stone-free rate were recorded. Results The upper-calyx percutaneous access was established successfully in all patients. The mean operation time was (82. 07 + 16. 25) min (range 54 to 140 min). The stone-free rate was 85. 4% (496/581) after first-stage procedure. Fourteen patients (2. 4%) had postoperative high fever, and 3 of them (0. 5%) had infectious shock. Four patients received blood transfusion, and 2 of them underwent digital subtraction angiography to control bleeding. Four patients (0. 7%) underwent thoracic drainage. There were no injuries to the lung, spleen, colon, or liver. The overall postoperative complication rate was 3. 8%. The mean postoperative hospital stay was (5. 55 + 1. 35) days (ranging 4-15 days). Conclusion One supracostal upper-calyx percutaneous access can achieve high stone-free rate in treating staghorn stone, but with relatively high risk of complications. Ultrasound-guided technique can greatly reduce complication, making the procedure safer.

Application of two-dimensional echocardiography with spatio-temporal image correlation in fetal congenital heart disease / 安徽医科大学学报

Objective To explore the application value of two-dimensional echocardiography with spatio-temporal im-age correlation (STIC) in fetal congenital heart disease (CHD) prenatal ultrasonography. Methods 11 036 hearts of fetus were inspected by severalviews order scanning method and for STIC volume database acquisition and off-line a-nalysis congenital heart disease fetus for autopsy after induced labor or contrast the follow-up results after birth. Re-sults 97 cases with spatio-temp-oral image correlation in 176 cases congenital heart and great vessels exception (dysrhythmias not including) with simple two-dimensional echocardiography,92 cases were accordant (one case with incorporative intracardiac malformation missed diagnosis);in screened congenital heart disease fetus,STIC (n=79) and routine ultrasonography (n=87) took (7.76±2.42) min and (9.68±2.13) min per case,respectively;in dif-ferent gestational weeks,the quality of the images derived from volume datasets were comparable to that directly ob-tained from 2D echocardiography. Conclusion STIC technology can be used as effective supplementary means of 2D echocardiography, and the combination can further improve the prenatal diagnosis of fetal congenital heart disease.

Clinical analysis of hydrometra in the elderly women / 中华老年医学杂志

Objective To investigate ultrasonographic features,clinical and histopathologic characteristics of hydrometra in the elderly women.Methods Hysteroscopy endometrial biopsy,dilation and curettage (D&C) and Tao Brush were selectively performed for the endometrial cytologic and histopathologic diagnosis according to the depth of the hydrometra investigated by transvaginal sonography,endometrial thickness and high-risk factors of carcinoma of endometrium in 72 elderly women with hydrometra.Results Among 72 elderly women with hydrometra,9 cases (12.5％) were examined by hysteroscopy,51 cases (70.8％) by D&C and 12 cases (16.7％) by endometrial cytology along with D&C.Histopathologic examination revealed that there were 7 (9.72％) cases with endometrial carcinoma,2 cases (2.8％) with atypical endometrial hyperplasia,6 cases (5.6％) with endometrial benign lesion,14 cases(19.4％)with pyometra and the other 43 cases (59.7％) with normal and simple hydrometra.Conclusions Transvaginal sonography in combination with endometrial cytology are beneficial for screening of endometrial disorders or for drainage of hydrometra in elderly women,decreasing invasive examinations such as D&C.

Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of thoracic diseases / 中华胸心血管外科杂志

Objective To review the experience d EBUS-TBNA for staging of lung cancer and the value in diagnosing thoracic diseases in our single center.Methods The data of 343 patients who underwent EBUS-TBNA from September 2009 to August 2011 in our institution were retrospectively reviewed.There were 219 males and 124 females with an average age of (59.4 ± 13.6 ) years.Based on their primary indication,patyients were divided into three categories:group A:with known or strongly suspected lung cancer and enlarged mediastinal lymph nodes on chest radiographic examination ( short axis ≥ 1.0cm) ; group B:with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin; and group C:with pulmonary parenchymal mass located close to the central airways.Results The average short axis diameter of the thoracic lesions was ( 1.94 ± 1.01 ) cm ( range from 0.5 to 8.0cm),and 2.66 punctures were performed per lesion.In group A ( n =208 ),151 patients were confirmed to have mediestinal lymph nodes metastasis while 51 showed negative results.Four patients were diagnosed as tuberculosis and two were confirmed to be stage Ⅱ sarcoidosis.37 in the 51 patients with negative EBUS-TBNA underwent thoracoscopic or thoracotomy for pulmonary resection and mediastinal lymph node dissection.Postoperative pathology confirmed that 32 patients did not have lymph nodes metastases.The diagnostic sensitivity,specificity,accuracy,positive predictive and negative predictive of EBUS-TBNA for the mediastiral staging of lung cancer were 96.8％ (151/156),100.0％ (32/32),97.3％ ( 183/188 ),100％ ( 151/151 ) and 86.5％ (32/37),respectively.In group B ( n =94),22 patients had malignancy and 72 had benign diseases.Thirteen patients received operative validation in the 23 cases which were diagnosed as proliferative lymph nodes by EBUS-TBNA,and by further operation two and three patients were confirmed as malignancy and other benign diseases respectively.The sensitivity,negative predictive value ( NPV ) and accuracy of EBUS-TBNA in distinguishing malignant mediastinal diseases was 88.0％ (22/25)、100％ (73/73) 、95.9％ (70/73)and 97.9％ (92/94),respectively.In group C( n =41 ),malignant diagnosis was achieved in 33 patients,while 4 patients confirmed as malignancy by further operations in the other 8 negative cases.The diagnostic sensitivity and accuracy of EBUS-TBNA for the diagnosis of unknown pulmonary parenchymal mass were 89.2％ (33/37) and 90.2％ (37/41),respectively.All the procedures were uneventful and no complication occurred.Conclusion EBUS-TBNA is a highly effective and safe procedure in the diagnosis of thoracic diseases and staging.of lung cancer.

A Compared Study on Mammography, Ultrasound and Pathology of Breast Phyllodes Tumor / 中国医学影像学杂志

Purpose To investigate the imaging features of breast phyllodes tumor on mammography(MG),ultrasound(US) and pathology, correlated with its clinical manifestation.Materials and Methods Twelve cases of pathologically confirmed breast phyllodes tumors were examined by US and MG. The imaging findings were retrospectively analyzed. Results Of the 12 cases of breast phyllodes tumors, 6 were benign, 3 were malignant and 3 were borderline. MG predicted 3 breast phyllodes tumors, 3 breast carcinomas and 6 adenomas. US predicted 2 phyllodes tumors, 8 breast masses and 2 adenomas. Conclusion The imaging findings of phyllodes tumors on MG and US are characteristic but not specific. Combined application of both US and MG are helpful for early detection but can not differentiate its malignancy which is determined by pathology.

Pregnancy diagnosis, fetal quantification and gender estimation by ultra-sonography in ewes / Diagnóstico de gestação, quantificação e sexagem fetal por ultra-sonografia em ovelhas

The objective of this experiment was to evaluate the accuracy of gestation, fetal sexing and quantification diagnoses in ewes. Pregnancy and fetal quantification were diagnosed in 105 ewes at 35 days of pregnancy. For the fetal gender diagnosis sexing diagnose 55 ewes between 49 and 59 days of pregnancy were used. All exams were recorded on DVD for posterior analysis. After birth, lamb sex was recorded to determine fetal sexing precision. Data were analyzed by chisquare ( 2) or Fisher’s test, with a significance of 0.05. One hundred percent of pregnancy ultrasound diagnoses were correct. As for the fetal quantification diagnoses, there was an error of 12%. It was possible to diagnose the fetal sex in 87% of the 69 examined fetuses, and 90% of these were estimated correctly. The realtime ultrasound diagnoses were not different from the recorded DVD image diagnoses. Therefore, pregnancy diagnosis accuracy may reach 100%, differing from fetal gender estimation and quantification, which are dependent upon other variables such as fetal genderand examiner experience.

O objetivo deste experimento foi avaliar a acurácia do diagnóstico de gestação, quantificação e sexagem fetal em ovelhas. Foram realizados o diagnóstico de gestação e a quantificação fetal em 105 ovelhas aos 35 dias de gestação. Para o diagnóstico da sexagem fetal foram utilizadas 55 ovelhas com período de gestação entre 49 e 59 dias. As imagens de todos os exames foram gravadas em DVD para permitir posterior análise. Após o nascimento dos cordeiros, os respectivos sexos foram observados para determinar a precisão do exame de sexagem fetal. Os dados foram analisados pelo teste Qui- quadrado ( 2) ou Teste de Fisher, com nível de significância de 5%. Observou-se 100% de acerto no diagnóstico de gestação pela ultra-sonografia. Quanto ao diagnóstico de quantificação fetal, houve 12% de erro. Foi possível diagnosticar o sexo fetal em 87% dos fetos e destes, 90% estavam corretos. Os diagnósticos em tempo real não foram significativamente diferentes dos diagnósticos feitos após a observação de imagens gravadas em DVD. Portanto, a acurácia do diagnóstico de gestação pode alcançar 100%, diferente da quantificação e sexagem fetal, que dependem de outras variáveis como tipo de gestação e experiência do operador.

Thri-operators and the blood-oxygen functional image technology in diagnosing breast cancer / 中华内分泌外科杂志

Objective To evaluate thri-operators and the blood-oxygen functional image technology in di-agnosing breast cancer. Methods One hundred and forty-six patients were admitted to hospital for operation due to one hundred and fifty-three suspicious lesions detected in their breasts. These lesions were detected by physical examination, thri-operators and the blood-oxygen functional image, mammography uhrasonography. The sensitivity and specificity of each diagnostic method were obtained and the radiolagie-pathologic correlation was meanwhile calculated. Results Sixty one(41.8%)breast lesions were diagnosed as malignancy. The sensitivity, specificity, accuracy,positive prognostic value and negative prognostic value of ultras onography were 80. 33% ,89. 41%,85.61% ,84.48% and 86.36%. Such data of mammography were 57.89% ,80. 36% ,69.03% ,75.00% and 65. 22%. And those of thri-operators and the blood-oxygen functional image technology were 91.80% ,83.53%, 86.99% ,80.00% and 94.67%. Conclusions Thri-operators and the blood-oxygen functional image technology is superior to uhrasonography and mammography in diagnosing breast lesions with its sensitivity accuracy and neg-ative prognostic value, while specificity and positive prognostic value were between them, have greater value in screeninging and the diagnosing breast cancer.

Correlação dos dados clínicos e métodos não invasivos na detecção da aterosclerose humana / Effect of hypertonic saline solution (NaCl 7.5%) on oxidative stress, apoptosis and hepatic tissue remodeling during acute pancreatitis

A doença cardiovascular aterosclerótica é a principal causa de morte no hemisfério ocidental, portanto também no Brasil. A detecção não invasiva da aterosclerose é fundamental para prevenção. Objetivos: Correlacionar os fatores de risco (escore de Framingham), o perfil lipídico, a PCR-us, a espessura da íntima-média da carótida, a função endotelial, o índice tornozelo-braquial e o escore de cálcio pela tomografia computadorizada, com a extensão da doença coronariana determinada pelo índice de Friesinger, na cinecoronariografia. Casuística e métodos: Foram estudados 100 pacientes de ambos os sexos, com idade de 55,1±10,7 sendo 55% homens e 45% mulheres. Não foram incluídos pacientes com síndrome coronariana aguda, insuficiência renal dialítica, doença do colágeno e câncer. Todos se submeteram a avaliação clínica, laboratorial (glicemia, perfil lipídico e PCR-us), função endotelial da artéria braquial e ultrassonografia da artéria carótida por ultra-som de alta resolução, índice tornozelo-braquial e tomografia computadorizada coronária para determinação do escore de cálcio. Foram calculados o colesterol não HDL-c e a relação TG/HDL-c. Todos os pacientes foram submetidos à cinecoronariografia por indicação do médico assistente. Foram considerados normais pacientes sem lesão obstrutiva na cinecoronariografia. Resultados: Pela análise univariada, escore de cálcio (529,5 ± 930,9) um HDL-c (45,9±15,5), relação TG/HDL (5,5±9,2) e IMT (0,77±0,22) mostraram correlação significativa com o índice de Friesinger. Já por análise multivariada somente o escore de cálcio, relação TG/HDL-c aumentada e HDL-c baixo correlacionaram-se significativamente com a extensão da DAC. A PCR-s (3,4±3,5), LDL-c (122,8±51,5) e DMF (4,8±5,7) não se correlacionaram com o índice de Friensinger. Conclusão: Assim, é possível ter uma idéia aproximada da presença/extensão da DAC usando métodos não invasivos, especialmente escore de cálcio, relação TG/HDL-c e HDL-c baixo.

Background: Atherosclerotic cardiovascular disease is the leading cause of death in the western hemisphere including Brazil. Non-invasive detection of atherosclerosis is critical to prevention. Objectives: We correlated the risk factors (score of Framingham), lipid profile, PCR-us, carotid intima-media thickness, endothelial function, ankle-brachial index and calcium score by computed tomography with the extent of coronary disease determined by the Friesinger index, by coronary angiography. Methods: We studied 100 patients of both sexes, aged from 55.1 ± 10.7, 55% men and 45% women. Patients with acute coronary syndrome, renal dialitic, collagen disease and cancer were not included. All were submitted to clinical evaluation, laboratory (blood glucose, lipid profile and hs-CRP), endothelial function of brachial artery and ultra-sonography of carotid artery by high-resolution ultra-sound, ankle-brachial index and computed tomography for coronary determination of calcium score. We calculated the cholesterol not HDL-c and TG/HDL-c ratio. All patients were submitted to coronary angiography for indication by attending physician. We considered normal patients without obstructive lesion in coronary angiography. Results: By univariate analysis, calcium score, HDL-c, TG/HDL ratio and IMT showed significant correlation with Friesinger index. However, multivariate analysis only calcium score, increased TG/HDL-c and low HDL-c correlated significantly with the extension of the CAD. The hs-CRP, LDL-c and FMD, did not correlate Friensinger index. Conclusion: Thus, it is possible to have an approximate idea of the presence/extension of CAD by non-invasive methods, especially calcium score, TG/HDL-C ratio and HDL-c.

Diagnóstico por imagem de corpos estranhos da face e retirada cirúrgica guiada por ultra-sonografia / Imaging of foreign bodies in the face and ultrasound guided surgical removal

A identificação e remoção cirúrgica de corpos estranhos é um procedimento complexo, principalmente quando o material envolvido é radiolucente. O advento tecnológico dos aparelhos de ultrasonografia vem ampliando cada vez mais o campo de aplicação deste método de diagnóstico na prática médica. Os autores descrevem um caso de remoção cirúrgica de fragmentos de vidro naface de um paciente, por acesso intra-oral, guiada por ultra-sonografia. Os corpos estranhos foram previamente diagnosticados por ultra-som e por tomografia computadorizada. A técnica guiada mostrou-se segura, pouco invasiva e eficaz, permitindo a retirada de todos os fragmentos.

The identification and surgical removal of foreign bodies is a complex procedure in medical practice, principally when the involved material is radiolucent. The technological advent of the ultrasonography equipments comes enlarging the field of application of thismethod more and more, in medical practice. The authors describe a case of an ultrasound guided surgical removal of glass fragments from the face of a patient. The foreign bodies were previously diagnosed by ultrasound and computed tomography. The guidedtechnic showed secure, less invasive and efficient, allowing the retreat of all the fragments.

Correlação da classificação Bi-Rads em mamografia e ecografia com o resultado anatomopatológico na avaliação das lesões mamárias impalpáveis sob a forma de localizações pré-operatórias / Correlation of Bi-Radas classification with mammography, ecography and histopathology of impalpable breast lesion

Foram analisados 100 lesões mamárias, as quais foram submetidas à marcação préoperatória, por serem impalpáveis, e foi utilizado o critério Bi-rads (Breast Imaging and Data System), caracterizando as lesões e sua indicação para a exérese. Foi avaliada a correlação entre a indicação da retirada da lesão e seus achados anatomopatológicos, calculando o seu valor preditivo positivo de 52,2%, sendo que os dados da literatura falam deste valor dentro de 20% a 40%. Nos casos Bi-rads 5, todos os resultados anatomopatológicos foram malignos, dentro do Bi-rads 4, 17 casos apresentaram resultado histológico benigno, cinco casos pré-malignos e 17 casos malignos, no Bi-rads 3, dos 31 casos encontrados, 29 apresentaram resultados benignos e dois casos malignos, no Bi-rads 2, todos os 13 casos foram histologicamente benignos.

A hundred breast impalpable lesions were analyzed after the pre surgery labeling. The BI RADS (Breast Imaging and Data System) criteria was used. Lesions were identified and indicated to exeresis. The correlation between the indication to lesion's removal and the histopathology findings were evaluated. The predictive positive value was 52,2% while literature data is 20-40%. All histopathology results for BI RADS 5 were malignant. In BI RADS 4 17 cases were benign, 5 cases were pre malignant and 17 were malignant. Of the 31 cases BI RADS 3, 29 were benign e 2 malignant. All 13 BI RADS 2 cases were benign.

A Clinical Study of Pediatric Inguinal Hernia Before and After Using Ultrasonography for Diagnosis

The purpose of this retrospective study was to evaluate the effects of diagnostic sonography in pediatric patients with inguinal hernias. The patients were classified into two groups. Group A included the patients who had been operated upon for inguinal hernia in 1980's, when diagnostic sonography was not available. Group B included the patients, operated upon for inguinal hernia from 2001 to 2002, when inguinal sonography was employed to detect potential bilateral hernias. The age distribution, sex ratio, laterality, bilaterality, and concomitant symptoms were compared between group A and group B. There were 296 cases in group A and 377 cases in group B. The prevalent age group was from 1 to 5 years. There was no difference in age group distribution between both groups. The male to female ratio was 5.3:1 in group A and 3.5:1 in group B. The ratio of unilateral to bilateral hernia was 5:1 in group A and 3:1 in group B. In cases with a unilateral hernia, the ratio of right to left was 1.5:1 in group A and 1.8:1 in group B. In cases with bilateral hernia, the simultaneous bilateral hernia was 33 cases (67.4 %) in group A and 75 cases (80.6 %) in group B. The sequential bilateral hernia was 16 cases (32.7 %) in group A and 18 cases (19.4 %) in group B. Although the ratio of bilateral hernia was increased in group B, the portion of the sequential bilateral hernia was significantly decreased in group B. In conclusion, there were no differences in the age distribution and the laterality between group A and B. The ratio of female patients and the incidence of bilateral hernia were increased in group B even though the portion of the sequential bilateral hernia was decreased. This result shows that the preoperative inguinal sonography in unilateral hernia with potential bilateral hernia is useful in early detection of the sequential contralateral hernia.

Application of high resolution sonography in evaluating vascular endothelial function in patients with early-stage diabetic patients / 中华老年医学杂志

Objective To evaluate the endothelial function in diabetic patients by high resolution sonography. Methods The intima-media thicknesses (IMT) of the bilateral carotid artery, femoral artery and the iliac artery of 22 elderly patients and 142 non-elderly patients with diabetes mellitus (DM) and 20 elderly and 20 non-elderly healthy persons were measured. The changes of the diameter of brachial artery were determined by measuring the diameter of brachial artery during reactive hyperemia and after sublingual nitroglycerin. Results The increased percentage of the brachial artery diameter under reactive hyperemia was significantly lower in elderly patients with DM (10. 03?6. 39)% than that in the elderly healthy control (15. 87?4. 79)% (P 0. 05). The IMT in elderly patients with early-stage DM incrassated significantly(P