Polyorquidism: case report comparing ultrasonography and magnetic resonance imaging / Poliorquidismo: relato de caso comparando a ultrassonografia e a ressonância magnética

Abstract Introduction: polyorchidism is an unusual pathology, about 200 cases in the world literature. Case report: we reported a case of polyorchidism in a 16-year-old male patient diagnosed by ultrasound and confirmed by magnetic resonance imaging. Discussion: most of the cases presented, there is a supernumerary testis, but there are reports on more than three, up to five testicles with supranumerical gonads on both sides of the scrotum. The diagnosis is usually performed in late puberty, incidentally, with a painless scrotal mass or at the emergency room, presenting a testicular torsion of the whole hemiscrotum or supernumerary testisalone, and the differential diagnosis should be made with epididymal cyst and spermatocele, besides other extra-testicular masses (hydroceles, varicoceles, lipomas, tumors.) and para-testicular masses (hernias, scrotal calculi). After the initial clinical evaluation, ultrasound is the first line subsidiary exam. Magnetic Resonance Imaging is very helpful, just in case the ultrasound diagnosis is uncertain. The supernumerary testishave the same Magnetic Resonance Imaging characteristics as the normal testes (intermediate signal intensity on T1- weighted images and high signal intensity on T2-weighted images).

Resumo Introdução: o poliorquidismo é uma patologia incomum, contando cerca de 200 casos na literatura mundial. Relato de caso: relatamos um caso de poliorquidismo em um paciente do sexo masculino de 16 anos, diagnosticado por ultrassom e confirmado por ressonância magnética. Discussão: na maioria dos casos apresentados, há um testículo supranumérico, mas há relatos de mais de três, até cinco testículos, com gônadas supranuméricas em ambos os lados do escroto. O diagnóstico geralmente é feito no final da puberdade, aliás, com massa escrotal indolor ou no pronto-socorro, apresentando torção de todo o hemiscroto ou somente do testículo supranumerário, e o diagnóstico diferencial deve ser feito com cisto epididimário e espermatocele, além de outros massas extratesticulares (hidroceles, varicoceles, lipomas, tumores) e massas paratesticulares (hérnias, cálculos escrotais). Após a avaliação clínica inicial, o ultrassom é a primeira linha do exame subsidiário. A ressonância magnética é muito útil se o diagnóstico por ultrassom não for certo. Os testículos supranumerários têm as mesmas características de ressonância magnética que os testículos normais (intensidade do sinal intermediário nas imagens ponderadas em T1 e alta intensidade do sinal nas imagens ponderadas em T2).

Uso de software na imagem ultrassonográfica para diferenciação de edema de origem venosa e de origem linfática em membros inferiores / Use of ultrasound imaging software to differentiate venous and lymphatic edema in lower limbs

Resumo Contexto O edema de membros inferiores (MMII) possui causas de origem sistêmicas e locais. Uma inovação é a utilização de um software de caracterização tecidual para diferenciação da origem do edema em imagens de ultrassom. Objetivos Determinar os parâmetros do uso de software na imagem ultrassonográfica para diferenciação de edema de origem venosa e/ou linfática em MMII. Métodos Trata-se de um estudo transversal do tipo quantitativo analítico com amostragem não probabilística por conveniência. Os instrumentos de coleta foram: anamnese, exame físico, exame de ultrassom e análise do software de caracterização tecidual por imagem ultrassonográfica por meio da quantificação da ecogenicidade e da mediana da escala de cinza (GSM). Resultados A amostra foi composta por 42 MMII de edema venoso, 35 de edema linfático, 14 de edema misto e 11 controle. Quanto à distribuição dos pixels nos intervalos de ecogenicidade, o grupo com edema venoso apresentou 88,31% entre o intervalo hipoecogênico IV ao ecogênico III; o grupo com edema linfático, 71,73% entre o intervalo hipoecogênico II ao ecogênico I; grupo com edema misto, 76,17% entre o intervalo hipoecogênico III ao ecogênico II; e o grupo controle, 84,87% entre o intervalo ecogênico II ao hiperecogênico I. A média e o desvio-padrão da GSM apresentaram diferença estatística entre os grupos. Conclusão O software CATUS permitiu a diferenciação do tipo de edema de MMII, facilitando o diagnóstico do tipo de edema e, consequentemente, a escolha da melhor opção terapêutica.

Abstract Background Lower limb edema has both systemic and local causes. Using software to differentiate the origin of edema in ultrasound images is an innovation. Objective To determine the parameters for using software to differentiate edema of venous and/or lymphatic origin in ultrasound images of the lower limbs. Method This is a cross-sectional, quantitative, analytical study with non-probabilistic sampling by convenience. Data were collected by patient interview, physical examination, ultrasound examination, and analysis of software for tissue characterization in ultrasound image by means of quantification of echogenicity and Gray Scale Median (GSM). Results The sample comprised 42 lower limbs with venous edema, 35 with lymphatic edema, 14 with mixed edema, and 11 control limbs. The distributions of pixels in echogenicity intervals by group was as follows. In the venous edema group, 88.31% were distributed from hypoechogenic interval IV to echogenic interval III; in the lymphatic edema group 71.73% were from hypoechogenic interval II to echogenic interval I; in the mixed edema group 76.17% were from hypoechogenic interval III to echogenic interval II; and in the control group 84.87% were distributed from echogenic interval II to hyperechogenic interval I. Mean and standard deviation of GSM values showed statistical differences between groups. Conclusion The CATUS software enabled differentiation of the type of lower limb edema, facilitating diagnosis of edema type and, consequently, choice of the best therapeutic option.

Hand strenght and dexterity in interphalangeal hand osteoarthritis and effects of osteophyte formations

Abstract Background: Hand osteoarthritis (HOA) is a complex disorder with various subtypes characterized with predominance of different features. It is challenging to estimate the severity of hand disability in HOA, since contribution of different disease components to clinical burden is yet to be clarified. The aim of the study is to investigate hand functions in nonerosive interphalangeal hand osteoarthritis (HOA) without inflammatory features, and search for effects of osteophyte formations detected by radiography and ultrasound on functionality. Methods: Thirty one HOA patients and 20 healthy subjects with similar age, gender, body mass index were included. Hand functions were evaluated by self-reported questionnaires and objective strength and dexterity measurements. A total of 459 interphalangeal joints were evaluated and scored by radiography and ultrasound for ostephyte formations. Results: Strength and dexterity measurements were similar between groups. Self-reported functionality was hampered in HOA group but not statistically significant. Osteophyte scores obtained by ultrasound and radiography were significantly higher in HOA group. Osteophyte scores obtained by ultrasound were higher than the scores obtained by radiography. Ultrasound scores showed no correlation with any of the parameters while osteophytes scores obtained by radiography partially showed a significant negative correlation with assembly part of dexterity testing. Conclusions: No significant difference observed in hand strength and dexterity in nonerosive interphalangeal HOA patients withouth signs of inflammation when compared to healthy subjects. Osteophyte formations prominent enough to be deteceted by radiography may have a negative effect on hand dexterity.(AU)

Correlación clínica y ultrasonográfica con los hallazgos intra-operatorios de pacientes con diagnóstico de ruptura de manguito rotador en el servicio de traumatología del Hospital Obrero Nº 1, durante el periodo 2010 ­ 2014 / Clinical and ultrasonographic correlation with the intra-operative findings of patients with diagnosis of division of muff rotador in the service of traumatology of the Hospital Obrero Nº 1, during period 2010 ­ 2014

INTRODUCCIÓN: una gran parte de la población adulta padece dolor de hombro en algún momento de su vida. Dejando aparte las enfermedades neoplásicas, sistémicas y traumáticas directas, una de las causas de dolor de hombro es la patología inflamatoria o degenerativa del manguito rotador, que puede ser responsable de una limitación funcional importante adulto. OBJETIVO: determinar el grado de correlación clínica y ultrasonográfica con los hallazgos intra-operatorios en pacientes con diagnóstico de ruptura de manguito rotador en el servicio de Traumatología del Hospital Obrero Nº 1, durante el periodo 2010 ­ 2014. MATERIAL Y MÉTODOS: estudio descriptivo transversal y analítico. Se estudiaron 56 pacientes de ambos sexos, internados en el servicio de Traumatología y Ortopedia del Hospital Obrero Nº1, durante el periodo del 1° de enero del 2010 al 31 de diciembre del año 2014. Se realizó la valoración clínica (maniobra de Jobe y manobra de Yocum) y ultrasonográfica y se compararon los resultados con los hallazgos intra-operatorios, para determinar la validez y la seguridad de la clínica y la ecografía. RESULTADOS: se determina que el test diagnóstico clínico tiene mayor validez (Sensibilidad: 92,7-87,8% y Especificidad: 73,3-60%) y seguridad (Valor Predictivo Positivo: 90,5-85,7% y Valor Predictivo Negativo: 78,6-64,3%) que el test diagnóstico ultrasonográfico (Sensibilidad: 85,4%, Especificidad: 66,7%, Valor Predictivo Positivo: 87,5% y Valor Predictivo Negativo: 62,5%). CONCLUSIÓN: se determina que existe una correlación clínica y ultrasonográfica con los hallazgos intra-operatorios en pacientes con diagnóstico de ruptura de manguito rotador en el servicio de Traumatología del Hospital Obrero Nº 1

INTRODUCTION: a great part of the adult population suffers shoulder pain at some moment of life. Leaving aside direct neoplastic systems and traumatic diseases, one of the causes of pain of shoulder is the inflammatory or degenerative pathology of the muff rotator, which can result in an important functional limitation. OBJECTIVE: determining the degree of clinical and ultrasonographic correlation with the intra-operative findings in patients with yielding-point diagnosis of muff rotator in the service of Traumatology of the Hospital Obrero Nº 1, during the period 2010 ­ 2014. MATERIAL AND METHODS: cross-sectional descriptive and analytical study. 56 patients of both sexes were surveyed, inpatients in the service of Traumatology y Orthopedic of the Hospital Obrero Nº 1, during the period January 1 of 2010 to December 31 of 2014. The clinical assessment was carried out (maneuver of Jobe and maneuver of Yocum) and ultrasonographic and the results were compared with the intra operative findings, in order to determine the value and security of the clinic and the echography. RESULTS: it is determined that the diagnostic test has higher validity (Sensitivity: 92,7-87,8% and specificity: 73,3-60%) and certainty (Positive Predictive Value: 90,5-85,7% and Negative Predictive Value: 78,6-64,3%) than the diagnostic ultrasonographic test (Sensitivity: 85.4%, Specificity: 66.7%, Positive Predictive Value: 87.5% and Negative Predictive Value: 62.5%). CONCLUSIONS: it is determined that there is a clinical and ultrasonographic correlation with the intra operative findings in patients with yielding-point diagnosis of muff rotator at the service of Traumatology of the Hospital Obrero Nº 1

Diagnostic Accuracy of Ultrasonography in the Assessment of Facial Fractures

Abstract Objective: To assess the diagnostic accuracy of Ultrasonography (USG) in diagnosing superficial facial fractures. Material and Methods: Patients visiting our facility with facial trauma and suspected fracture of the facial skeleton, those who had undergone CT scans, and conventional radiographic examinations and those who were conscious and cooperative were included in the study. All conventional radiographs, CT scans and ultrasound examinations were done during 0-20 days after trauma in all the patients Results: A total of 20 patients participated in our study, out of which 18 were male (90%) with a mean age of 34.4 years (range of 19-75 years). Eleven sites of the face were examined bilaterally in each patient, i.e., a total of 440 sites. Of these, 84 sites were found to be fractured according to the CT scan examination whereas conventional radiographs detected 59 and ultrasonography detected 74 fractures (of which 70 were true fractures, while 4 were false-positive results). The sensitivity and specificity of USG in all fracture sites were 83.33% and 98.88% respectively. The positive and negative predictive values were 94.59% and 96.17% respectively Conclusion: Ultrasound examination had a better sensitivity when compared to conventional radiography in detecting superficial facial fractures.

Correlación clínica, imagenológica e histológica en patología endometrial: experiencia en el hospital Dr. Francisco Antonio Rísquez (2006-2016) / Clinical, imaging and histological correlation in endometrial pathology: experience in the hospital Dr. Francisco Antonio Rísquez (2006-2016)

Para el estudio y diagnóstico de la patología endometrial se cuenta con el ultrasonido transvaginal y la biopsia de endometrio. Objetivo: Determinar la correlación clínica, ultrasonográfica e histológica en patología endometrial, en pacientes tratadas en el Servicio de Cirugía del Hospital Dr. Francisco Antonio Rísquez, entre 2006 y 2016. Métodos: Estudio retrospectivo, transversal. Se incluyeron las pacientes intervenidas quirúrgicamente por patologías uterinas, que contaron con información completa en la historia clínica. Se utilizó estadística descriptiva, sensibilidad, especificidad y coeficiente de correlación. Resultados: El grupo etario más afectado fue el de 41 a 50 años, con 62,73 %, el motivo de consulta más frecuente fue sangrado genital con 52 casos (47,3 %), 52 pacientes (47,3 %) presentaron sangrado menstrual abundante y 40 (36,4 %) refirieron sangrado abundante y prolongado. Ecográficamente, el diagnóstico más frecuente fue leiomiomatosis uterina (87 casos, 79,1 %). La línea endometrial estuvo entre 1,3 y 11,3 mm en 80,9 %; en 54 casos (49,1 %) la biopsia de endometrio reportó secretor sin atipia. No se observó correlación estadística entre la clínica y la biopsia de endometrio (p=0,478 Kappa=0,00). La correlación estadística entre el ultrasonido y la biopsia de endometrio fue casi perfecta (p=0,000 Kappa=0,947) y entre la biopsia preoperatoria y la definitiva fue moderada (p=0,000 Kappa 0,542). La sensibilidad del ultrasonido es de 100 % y especificidad de 90,91 %. Conclusiones: La sensibilidad y especificidad del ultrasonido respecto a la biopsia de endometrio fue elevada. La frecuencia de patología endometrial en la biopsia endometrial fue baja(AU)

For the study and diagnosis of endometrial pathology it has with transvaginal ultrasound and endometrial biopsy. Objective: To determine the correlation of clinical, ultrasound and histological endometrial pathology in patients treated in the service of surgery of the Hospital Dr. Francisco Antonio Rísquez, between 2006 and 2016. Methods: Retrospective, cross-sectional study. Included patients surgically treated by uterine pathologies, which counted with complete information in the medical record. We used descriptive statistics, sensitivity, specificity, and correlation coefficient. Results: The most affected age group was that of 41 to 50 years, in 62,73%, the reason for more frequent consultation was bleeding genital with 52 cases (47.3%), 52 patients (47.3%) they had heavy menstrual bleeding and 40 (36.4%) abundant and prolonged bleeding was referred. Ecograficamente, the most frequent diagnosis was uterine leiomyomatosis (87 cases, 794.1%). The endometrial line was between 1.3 and 11.3 mm 80.9%; in 54 cases (49.1%) the endometrial biopsy reported secretory without atypia. No statistical correlation between the clinic and the endometrial biopsy was observed (p = 0, 478 Kappa = 0, 00). The statistical correlation between ultrasound and endometrial biopsy was almost perfect (p = 0, 000 Kappa = 0, 947) and between preoperative biopsy and the final was moderate (p = 0, 0000,542 Kappa). The sensitivity of ultrasound is 100% and specificity of 90.91%. Conclusions: The sensitivity and specificity of ultrasound for endometrial biopsy was high. The frequency of endometrial pathology in endometrial biopsy was low(AU)

Methotrexate use, not interleukin 33, is associated with lower carotid intima-media thickness in patients with rheumatoid arthritis

Abstract Background: Rheumatoid arthritis is a risk factor for early mortality due to cardiovascular disease. Interleukin-33 appears to protect against the development of atherosclerosis. The purpose of this study was to investigate the relationship between serum levels of interleukin-33 and its soluble receptor with the presence of subclinical carotid atherosclerosis in rheumatoid arthritis patients. Methods: Rheumatoid arthritis patients without atherosclerotic disease were subjected to clinical and laboratory assessments, including carotid ultrasound. Interleukin-33 and its soluble receptor serum levels were measured by ELISA. Results: 102 patients were included. The prevalence of carotid plaques was 23.5% and the median intima-media thickness was 0.7 mm. The median interleukin-33 and its soluble receptor concentration was 69.1 and 469.8 pg/ml. No association was found between serum interleukin-33 or its soluble receptor and intima-media thickness or plaque occurrence. Each 0.1 mm increase of intima-media thickness raised the odds of plaque occurrence by 5.3-fold, and each additional year of rheumatoid arthritis duration increased the odds of plaque occurrence by 6%. Each additional year in patients age and each one-point increase in the Framingham Risk Score were associated with a 0.004 mm and 0.012 mm increase in intima-media thickness. Methotrexate use was associated with a 0.07 mm reduction in intima-media thickness. Conclusions: Interleukin-33 and its soluble receptor were not associated with subclinical atherosclerosis. Traditional risk factors for atherosclerosis and rheumatoid arthritis duration were associated with intima-media thickness and plaque occurrence; methotrexate use was associated with a lower intima-media thickness.

Comparison of central corneal thickness estimated by an ultrasonic pachymeter and non-contact specular microscopy / Comparação da espessura central de córnea estimada por um paquímetro ultrassônico e por um microscópio especular sem contato

ABSTRACT Purpose: To compare central corneal thickness (CCT) measurements of healthy individuals obtained with ultrasonic pachymetry (UP) and non-contact specular microscopy (NCSM). Method: In total, 148 eyes of 74 subjects with no ocular or systemic diseases were included in the study. Central corneal thickness measurements of all patients performed with UP and NCCM were compared. Results: A total of 74 subjects (38 females) were included in this study. The mean age was 45.2 ± 18.4 (range 12-85) years. The mean central corneal thickness of all 148 eyes was 546.9 ± 40 μm with UP and 510.8 ± 42 μm with NCSM. The mean central corneal thickness measured with NCSM was 35 μm thinner than that measured with UP (p<0.001). A high degree of agreement was found between the two methods (r=0.942, p<0.001). Conclusions: Our results suggest that NCSM measures thinner corneas than UP and that the correction formula we identified should be applied when comparing between these two devices.

RESUMO Objetivo: Comparar as medidas de espessura central corneana (CCT) de indivíduos saudáveis obtidos pela paquimetria ultrassônica (UP) e microscopia especular sem contato (NCSM). Método: Cento e quarenta e oito olhos de 74 indivíduos que não tinham doenças oculares ou sistêmicas foram incluídos no estudo. Medidas da espessura central corneana de todos os pacientes foram comparadas entre UP (SP 100, Tomey, Nagoya, Japão) e do NCSM (NSP-9900, Konan Medical, Inc., Hyogo, Japão). Resultados: Um total de 74 indivíduos (38 mulheres) foram incluídos neste estudo. A idade média foi de 45,2 ± 18,4 (variação 12-85) anos. A medida média da espessura central corneana de todos os 148 olhos foi 546,9 ± 40 μm com UP e 510,8 ± 42 μm com NCSM. A espessura central corneana média avaliada pelo NCSM foi de 35 μm mais fina do que a UP (p<0,001). Foi encontrado um elevado grau de concordância entre os dois métodos (r=0,942, p<0,001). Conclusões: Nossos resultados sugerem que a microscopia especular sem contato mede córneas mais finas em comparação com a UP e que o fator de correção identificado deve ser aplicado ao fazer comparações entre esses dois aparelhos.

Aplicação do método ultrassonográfico na avaliação da biomecânica da deglutição ­ revisão de literatura / Application of ultrasound method in the evaluation of biomechanical swallowing ­ literature review / Aplicación del método de ultrasonido en la evaluación de la biomecánica de la deglución ­ revisión de literatura

Objetivo: analisar aspectos biomecânicos da deglutição pelo método ultrassonográfico por meio de revisão de literatura. Método: Foi realizada pesquisa bibliográfica nas bases SCOPUS, ScienceDirect e PubMed, adotando-se como descritores em inglês: deglutition, healthy subjects, ultrasonography e ultrasonic. Foram selecionados artigos sem limitação de ano escritos em Português ou Inglês que abordassem a ultrassonografia como método de avaliação da deglutição em adultos. Apenas estudos disponíveis na íntegra foram incluídos. Cada artigo passou pela análise de títulos e resumos, sendo posteriormente submetido à avaliação na íntegra. Os seguintes dados foram extraídos: autores, país, objetivo do estudo, amostra, procedimento de avaliação e principais resultados. Dez artigos preencheram os critérios de inclusão. Resultados: os estudos apresentam boa aplicabilidade do método na avaliação da língua, osso hióide, laringe, músculo gênio-hióide e do esfíncter esofágico superior. Conclusão: O método ultrassonográfico apresenta boa aplicabilidade na avaliação da deglutição, fornecendo dados quantitativos e evitando exposição à radiação e uso de bário.

Objective: to verify the application of the ultrasound method in the evaluation of swallowing biomechanics. Method: A literature search was conducted on bases Scopus, Science Direct and PubMed, adopting the descriptors, in English: deglutition, healthy subjects, ultrasonography and ultrasonic. The papers were selected without limitation of year, written in Portuguese or English and that focused ultrasound as swallowing assessment method in adults. Only available studies in full text were included. Each paper went through the analysis of titles and abstracts. The following data were extracted: author, country, goal, study sample, evaluation procedure and main results. Ten papers met the inclusion criteria. Results: Studies show good applicability of the method in the evaluation of the tongue, hyoid bone, larynx, genius-hyoid muscle and upper esophageal sphincter. Conclusion: The ultrasound method has good applicability in the evaluation of swallowing, providing quantitative data and minimizes risk to the patient, avoiding the exposure radiation and use of barium.

Objetivo: analizar aspectos biomecánicos de la degluticion usando el método de ultrasonido por medio de una revisión de literatura. Metodos: La búsqueda bibliográfica se realizó en las bases Scopus, ScienceDirect y PubMed, adoptando como descritores los términos en Inglés: deglutition, healthy subjects, ultrasonography y ultrasonic. Fueron seleccionados artículos sin limitación de año, escritos en Portugués o Inglés en que el método ultrasonografico fue enfocado como un método de evaluación de la deglución en los adultos. Sólo se incluyeron los estudios disponibles en su totalidad. Cada artículo pasó por análisis de los títulos y de los resúmenes, y posteriormente fue sometido a la evaluación en su totalidad. Los siguientes datos fueron extraídos: autor, país, objetivo del estudio, muestra, procedimiento de evaluación y resultados principales. Diez artículos cumplieron los criterios de inclusión. Resultados: Los estudios muestran buena aplicabilidad del método en la evaluación de la lengua, huesso hioide, laringe, músculo-genio hioide y esfínter esofágico superior. Conclusión: El método de ultrasonido tiene una buena aplicación en la evaluación de la deglución, proporcionando datos cuantitativos y evitando la exposición a la radiación y uso del bario.

Cecoureterocele, reporte de un caso / Cecoureterocele, a case report

El cecoureterocele es un ureterocele ectópico, malformación congénita del uréter distal en su desembocadura a la vejiga, que da lugar a un saco membranoso ciego que protruye por la uretra hasta el exterior. Presentamos a una niña de cinco meses y 6 kg de peso que acude para evaluación y manejo de una masa de color violáceo que protruye por el introito vaginal. Al examen físico, buen estado general. FC 134 lpm, TA 93/56 mmHg, FR 38 x´, T 36o C, Sat 02 96 %. Ecografía renal: Riñón izquierdo con una imagen líquida parahiliar compatible con doble sistema colector incompleto con dilatación del segmento proximal. Ecografía vesical: imagen con contenido líquido denso relacionada con el sistema urinario y compatible con ureterocele. Gammagrafía renal DMSA: área hipocaptante en polo superior del riñón izquierdo. Renograma isotópico DTPA: Retención del trazador en pelvis renal izquierda. Corrección quirúrgica consistente en nefrectomía parcial con escisión del polo superior del riñon izquierdo, separación y sección distal del uréter dilatado y resección del ureterocele. Evolución postoperatoria satisfactoria con alta a los dos días de la intervención. El cecoureterocele es una rara malformación de la vía urinaria habitualmente asociada a otras malformaciones corregibles quirúrgicamente. Recomendamos considerar esta posibilidad, en el diagnóstico diferencial de toda masa que protruye por la vagina.

A cecoureterocele is an ectopic ureterocele, congenital anomaly of the distal ureter at the uretero-vesical junction, consisting in a closed membranous pouch which protrudes through the urethra into the vagina. We present a five months old, 6 kg girl, admitted for assessment and management of a dark red mass protruding through the vagina. On examination, good general health. BP 93/56, HR 134 bpm, RR 38x´, T 36o, O2 Sat 96 %. Renal ultrasound: parahiliar liquid shadow in the left kidney sugesting a duplicated incomplete collecting system with a dilated proximal segment. Bladder ultrasound: dense liquid shadow related to the urinary tract sugesting a ureterocele. DMSA renal gamma scan: poor captation in the upper pole of the left kidney. DTPA isotopic renogram: Retention of the tracer in the left renal pelvis. Surgical correction consisting in a left upper pole partial nephrectomy, separation and distal section of the dilated ureter and resection of the ureterocele. Good postoperative course, discharged two days later. A cecoureterocele is an uncommon congenital malformation of the urinary tract commonly associated with other surgically correctable malformations. We recomend to consider this posibility in the differential diagnosis of any mass protruding through the vagina.

La ultrasonografía en el diagnóstico de apendicitis aguda, sensibilidad y especificidad experiencia en el Hospital General del ISSS / Ultrasonography in the diagnosis of acute appendicitis, sensitivity and specificity experience in the General Hospital of the ISSS

La Apendicitis Aguda es la patología quirúrgica aguda abdominal más frecuente, en el Instituto Salvadoreño del Seguro Social, en el año 2005 fue la 6a causa de ingreso hospitalario y su diagnóstico constituye uno de los problemas más habituales en los servicios de urgencias. En el departamento de radiología del ISSS desde hace muchos años se realizan ultrasonografías para ayudar al diagnóstico de apendicitis aguda; sin embargo a la fecha no se cuenta con estudios que determinen la sensibilidad y especificidad de este método diagnóstico, por lo cual se realizó el presente estudio titulado: "Ultrasonografía para el diagnóstico de apendicitis aguda. Sensibilidad y especificidad. Experiencia en el Hospital General del ISSS". Para tal fin, se revisaron los expedientes de los pacientes que fueron intervenidos quirúrgicamente por sospecha de apendicitis aguda en el año 2014; en total y según datos del censo obtenido en sala de operaciones, se realizaron 504 apendicetomías en el Hospital General; de los cuales a 84 pacientes se les realizó ultrasonografía abdominal antes de pasar a cirugía. Esto refleja que a un 16.6 % de los pacientes que pasaron a sala de operaciones por sospecha de apendicitis aguda, se les había realizado ultrasonido abdominal, aunque éste no siempre fue precisamente enfocado hacia el diagnóstico de apendicitis aguda. De éstos 84 pacientes, el 90% (72 pacientes) de los reportes histopatológicos fueron compatibles con apendicitis aguda y el 10% (12 pacientes) se reportaron como apéndices sanas. El 60% (50 pacientes) era del sexo femenino y el 80% (68 pacientes) tenían edades entre 15 a 45 años de edad. En la población en estudio se obtuvo una sensibilidad del ultrasonido abdominal para apendicitis aguda del 33% y una especificidad del 50%, sin embargo, varios de los ultrasonidos solicitados por los clínicos no eran enfocados a sospecha de apendicitis aguda, lo que llevó a la baja sensibilidad. El valor predictivo positivo (VPP) fue de 80%, lo que significa que aquellos pacientes con resultado positivo a apendicitis aguda por ultrasonido tiene un 80% de probabilidades de padecer dicha enfermedad. El valor predictivo negativo (VPN) obtenido en este estudio fue de 11%, lo que significa que aquellos pacientes que tienen un resultado negativo apendicitis por ultrasonido tiene apenas el 11% de probabilidades de no padecer apendicitis aguda

Doenças císticas das vias biliares / Cystic diseases of the bile ducts

JUSTIFICATIVA E OBJETIVOS: Os ductos biliares podemapresentar dilatações congênitas ou adquiridas. As lesões congênitaspodem ser hipoplásticas (atresias) e císticas. O primeiroestudo descrito na literatura foi realizado por Vater and Ezler in1723. Os cistos biliares são isolados ou múltiplos, e aparecemem qualquer idade, mas 75% deles são antes dos 20 anos. Elespodem ocorrer em toda árvore biliar, sendo, as intra-hepáticasrestritas, conhecida como doença de Caroli. O objetivo desseestudo foi fazer uma revisão sobre as Doenças císticas das viasbiliares. CONTEÚDO: As dilatações císticas extra-hepáticaatingem diversos tamanhos e são classificadas segundo sua formae localização. São elas: fusiforme, divertículos e dilataçõessaculares. Háuma incidência variada dessas lesões com câncer,entre 2,5% e 17,5%. O quadro clínico mais comum éa colestaseneonatal, correspondendo a 80% dos pacientes. Na idadeadulta, podem ser assintomáticos ou apresentar apenas sintomasinespecíficos como náuseas,vômitos. A dificuldade de drenagemda colestase obstrutiva pode lavar a cirrose biliar secundária.CONCLUSÃO: O ultrassom de abdome pode confirmar odiagnóstico. No tocante ao laboratório, observa-se uma hiperbilirrubinemiae elevação de enzimas canaliculares. A terapêuticaempregada na maioria dos casos écirúrgica, com excisão do cistoe reconstrução da drenagem biliar, devendo-se evitar a drenagemisolada, pois tais pacientes tendem a evoluir com complicaçõescomo fístulas, estenose, colangite e carcinoma.(AU)

BACKGROUND AND OBJECTIVES: The bile duct dilatationmay have congenital or acquired. Congenital lesions can behipoplásticas (atresia) and cystic. The first study described in theliterature was performed by Vater and Ezler in 1723. Biliary cystsare isolated or multiple and appear at any age, but 75% of themare before age 20. They can occur throughout the biliary tree,and the intrahepatic restricted, known as Caroli disease. Theaim of this study was to review about the cystic biliary diseases.CONTENTS: Dilated cystic extrahepatic reach various sizesand are classified according to their shape and location. Theyare: fusiform, saccular dilatation and diverticula. There is anincidence of these lesions with cancer varied between 2.5% and17.5%. The most common symptom is a neonatal cholestasis,corresponding to 80% of patients. In adulthood, may beasymptomatic or show only nonspecific symptoms such as nausea,vomiting. The difficulty of draining obstructive cholestasis canwash the secondary biliary cirrhosis. CONCLUSION: Theabdominal ultrasound can confirm the diagnosis. Regarding thelaboratory, there is a hyperbilirubinemia and elevated GGT. Thetherapy used in most cases is surgical excision of the cyst andreconstruction of biliary drainage, should be avoided drainagealone because these patients tend to develop complications suchas fistula, stricture, cholangitis and carcinoma.(AU)

Reliability of new software in measuring cervical multifidus diameters and shoulder muscle strength in a synchronized way; an ultrasonographic study

OBJECTIVES: This study was conducted with the purpose of evaluating the inter-session reliability of new software to measure the diameters of the cervical multifidus muscle (CMM), both at rest and during isometric contractions of the shoulder abductors in subjects with neck pain and in healthy individuals.METHOD: In the present study, the reliability of measuring the diameters of the CMM with the Sonosynch software was evaluated by using 24 participants, including 12 subjects with chronic neck pain and 12 healthy individuals. The anterior-posterior diameter (APD) and the lateral diameter (LD) of the CMM were measured in a resting state and then repeated during isometric contraction of the shoulder abductors. Measurements were taken on separate occasions 3 to 7 days apart in order to determine inter-session reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD) were used to evaluate the relative and absolute reliability, respectively.RESULTS: The Sonosynch software has shown to be highly reliable in measuring the diameters of the CMM both in healthy subjects and in those with neck pain. The ICCs 95% CI for APD ranged from 0.84 to 0.94 in subjects with neck pain and from 0.86 to 0.94 in healthy subjects. For LD, the ICC 95% CI ranged from 0.64 to 0.95 in subjects with neck pain and from 0.82 to 0.92 in healthy subjects.CONCLUSIONS: Ultrasonographic measurement of the diameters of the CMM using Sonosynch has proved to be reliable especially for APD in healthy subjects as well as subjects with neck pain.

Utilidad de la ecografía endo anal mediante el uso de videoecoendoscopio con transductor rotatorio de 360 / Usefulness of endo-anal ultrasound through the use of videoechoendoscope with 360 rotary transducer

Introducción: La aparición de la ecografía endoanal 360º significó un cambio importante en la Coloproctología de los últimos 20 años.1 Ha ganado popularidad por ser mínimamente invasivo, indoloro y costo/efectivo si se compara con otros estudios por imágenes. Además, es habitualmente realizada por un Coloproctólogo y puede formar parte del examen en la consulta. Objetivo: Comunicar la experiencia de nuestro grupo en el diagnóstico de diferentes patologías anorrectales mediante la utilización del método. Población y métodos: Entre noviembre de 2010 y abril de 2014 realizamos 978 ecografías endoanales de 360º. Las variables analizadas fueron: estudios realizados según diagnósticos de sospecha; variación en la cantidad de estudios solicitados y realizados durante el periodo establecido; especialidad del médico que solicita el estudio. Resultados: En cuanto al diagnóstico sospechado por el médico derivante, de los 978 estudios, 422 (43,1%) correspondieron a fístulas perianales, 311 (31,79%) ecografías fueron realizadas por diagnóstico de incontinencia anal, 93 (9,5%) como evaluación esfinteriana preoperatoria, 48 (4,9%) por proctalgia crónica, 7 (0,71%) fístulas ano-recto-vaginales, y 20 (2,04%) por otras sospechas diagnósticas (disinergias del piso pelviano, control postoperatorio, etc.). En cuanto a la variación de la cantidad de estudios en el tiempo, se realizaron 8 procedimientos en 2010, 146 durante 2011, 254 en 2012, 402 ecografías en 2013 y 168 durante los primeros meses de 2014. En cuanto a la especialidad acreditada por los médicos que prescribieron el estudio, el 84,1% (823) correspondía a cirujanos colorrectales, el 6,64% (65) a cirujanos generales, el 3,6% (36) a gastroenterólogos, el 2,4% (24) a ginecólogos y el 2,04% (20) a otros. Fueron excluidas del presente trabajo las ecografías realizadas para estadificar o reestadificar los tumores del recto inferior y el ano (22 estudios)...

Background: The appeareance of the 360º endoanal ultrasonography as a diagnostic method an improvement for coloproctology in the last 20 years.(1) It has been gaining popularity in virtue of being minimally invasive, painless and cost/effective, especially when compared to other methods. Furthermore, it is mainly realized by coloproctologists, making it almost part of the physical exam at the consult. Objective: To communicate our experience at the diagnostic of different anorectal pathologies. Population and methods: Between November 2010 and April 2014, we performed 978 studies with the 360º endoanal ultrasound. All of the studies were done with the same equipment and by the same operator. We analyzed the followings variables: Studies performed according to different initials diagnostics; variation in the number of studies requested and performed during the 4 years period; specialty of the primary physician who requested the study. Results: From 978 studies performed, 422 (43,1%) correspond to fistula in ano, 311 (31,79%) to anal incontinence, 93 (9,5%) were done for preoperative evaluation of the anal sphincter, 48 (4,9%) for chronic anal pain, 7 (0,71%) for recto vaginal fistula, and 20 (2,04%) for other presumed diagnostics (pelvic floor dyssynergia, post operatory control). As regards to the variation of the number of studies requested during this 4 years period we found that during 2010 we performed 8 procedures, 146 during 2011, 254 in 2012, 402 in 2013 and 168 during the firsts months of 2014. In relation to the specialty of the primary physician who requested the study, 84,1% (823) were solicited by coloproctologists, 6,64% (65) by general surgeons, 3,6% (36) by gastroenterologists, 2,4% (24) by gynecologists, and 2,04% (20) by other specialists. Studies performed for rectal and anal tumors staging (22 studies...

Efeito da fotobiomodulação no músculo masseter de criança com paralisia cerebral: relato de caso / Photobiomodulation effect on the masseter muscle in children with cerebral palsy: a case report

A espasticidade acarreta hipertonia nos músculos mastigatórios dos indivíduos com paralisia cerebral (PC), interferindo na amplitude de abertura bucal, dificultando a realização da higiene oral predispondo estes indivíduos a condições consideradas de risco para o desenvolvimento de doenças bucais. Objetivo: Avaliar o efeito da fotobiomodulação com laser de diodo, de baixa intensidade na espessura do músculo masseter em uma criança com PC do tipo espástico. Método: O relato do cuidador era que a criança apresentava grande dificuldade na realização da higiene bucal e com movimentos de fuga da cabeça quando a escova dental tocava a região de molares superiores. Com relação ao desconforto da criança, a mãe referiu como extremo. A 1ª avaliação ultrassonográfica foi realizada na avaliação inicial, e a 2ª avaliação após 6 sessões de aplicação de fobioestimulação. Foi empregado o Laser infravermelho, de Diodo, de baixa intensidade, As-Ga-Al, (? = 808 ± 3 nm, 120 mW; Twin Flex Evolution Laser MMOptics São Paulo, Brazil), usando 5,0 J/cm2 energia dose/local, com 20 segundos de exposição/local. A área do músculo masseter irradiado bilateralmente foi o ponto médio no sentido da sua extensão e largura. Foram realizadas seis sessões, com intervalo de 7 dias entre elas. Resultados: Ao final da sexta sessão da fotobioestimulação, a responsável relatou que a criança dormia melhor, apresentava redução no número de movimentos involuntários realizados pela mandíbula e a realização da higiene bucal era possível sem expressão dolorosa da criança. Durante a palpação observou-se menor hipertonia em masseter bilateral, ganho em espessura, e aumento na distância inter-incisal de 7 mm. Conclusão: A fotobioestimulação com laser de diodo parece ser efetiva na redução da espasticidade no músculo masseter de crianças com PC do tipo espástico

Spasticity causes stiffness in the masticatory muscles of individuals with cerebral palsy (CP), affecting the amplitude of mouth opening, making oral hygiene conditions difficult and predisposing these individuals to the risk of developing oral diseases. Objective: To evaluate the effect of a low-intensity photobiomodulation diode laser on the thick part of the masseter muscle in a child with spastic type CP. Method: The caregiver reported that the child had great difficulty in performing the oral hygiene, making avoidance movements of the head when the toothbrush touched the mucosa of the upper molar region in the mouth. The mother described the child's discomfort as extreme. The first ultrasound evaluation was performed at the first appointment, and the second evaluation after 6 sessions of photobiostimulation. The low-intensity Infrared Laser Diode, Ga-As-Al, was employed (? = 808 ± 3 nm, 120 mW; Twin Flex Evolution Laser MMOptics São Paulo, Brazil), using 5.0 J/cm2 dose energy/location, with 20 seconds exposure/site. The area of the masseter muscle was bilaterally irradiated towards the midpoint of its length and width. Six sessions were performed, with an interval of 7 days between them. Results: At the end of the sixth session of photobiostimulation, the mother reported that the child slept better, had reduction in involuntary movements performed by the jaw, and oral hygiene was possible now with no painful expression of the child. During palpation there was less stiffness in the bilateral masseter and an increased masseter thickness and increase in the amplitude of the mouth opening of 7 mm. Conclusion: The diode laser photobiostimulation appears to be effective in reducing spasticity in the masseter muscle of children with spastic type CP

Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study / Bloqueio contínuo do nervo femoral guiado por ultrassom e estimulador de nervo para analgesia após artroplastia total de joelho: estudo multicêntrico, randomizado e controlado / Bloqueo continuo del nervio femoral guiado por ultrasonido y estimulador de nervio para analgesia posterior a la artroplastia total de rodilla: estudio multicéntrico, aleatorizado y controlado

BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group); in 24 patients, epidural analgesia was done (PCEA group). The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score) during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition. .

JUSTIFICATIVA E OBJETIVOS: Analgesia pós-operatória é fundamental para o exercício funcional precoce logo após a artroplastia total de joelho. O objetivo foi investigar a eficácia clínica do bloqueio contínuo do nervo femoral guiado por ultrassom e estimulador de nervo em analgesia após artroplastia total do joelho. MÉTODOS: Receberam analgesia pós-operatória, de outubro de 2012 a janeiro de 2013, 46 pacientes, estado físico ASA I-III, submetidos à artroplastia total de joelho. Em 22 pacientes, o bloqueio femoral contínuo foi guiado por ultrassom e estimulador de nervo para analgesia (grupo BFC); em 24 pacientes, analgesia foi administrada por via epidural (grupo ACP). Os efeitos analgésicos, efeitos colaterais, a recuperação articular e as complicações foram comparados entre os dois grupos. RESULTADOS: Às seis e 12 horas após a cirurgia, os escores de dor no joelho (escore EVA) durante os testes funcionais após exercício ativo e passivo foram significativamente menores no grupo BFC do que no grupo ACP. A quantidade usada de parecoxib nos pacientes do grupo BFC foi significativamente menor em comparação com o grupo ACP. Quarenta e oito horas após a cirurgia, o grau de força muscular no grupo BFC foi significativamente maior e o tempo de atividade ambulatória foi menor do que no grupo ACP. A incidência de náusea e vômito em pacientes do grupo BFC foi significativamente menor em comparação com o grupo ACP. CONCLUSÃO: O bloqueio femoral contínuo guiado por ultrassom e estimulador do nervo proporcionou melhor analgesia às seis e 12 horas, demonstrada por EVA-R e EVA-P. A quantidade de parecoxib também foi menor, a incidência de náusea e vômito diminuiu, a influência sobre a força muscular é comprometida e os pacientes podem fazer atividade ambulatorial sob essa condição. .

JUSTIFICACIÓN Y OBJETIVOS: La analgesia postoperatoria es fundamental para el ejercicio funcional precoz posteriormente a la artroplastia total de rodilla. El objetivo fue investigar la eficacia clínica del bloqueo continuo del nervio femoral guiado por ultrasonido y estimulador de nervio en analgesia después de la artroplastia total de la rodilla. MÉTODOS: Cuarenta y seis pacientes, con estado físico ASA I-III, sometidos a artroplastia total de rodilla recibieron analgesia postoperatoria de octubre de 2012 a enero de 2013. En 22 pacientes, el bloqueo femoral continuo fue guiado por ultrasonido y estimulador de nervio para analgesia (grupo BFC); en 24 pacientes, la analgesia fue administrada por vía epidural (grupo ACP). Los efectos analgésicos, efectos colaterales, recuperación articular y las complicaciones fueron comparados entre los 2 grupos. RESULTADOS: A las 6 y 12 h después de la operación, las puntuaciones de dolor en la rodilla (puntuación EVA) durante los test funcionales después del ejercicio activo y pasivo fueron significativamente menores en el grupo BFC que en el grupo ACP. La cantidad usada de parecoxib en los pacientes del grupo BFC fue significativamente menor en comparación con el grupo ACP. Cuarenta y ocho horas después de la operación, el grado de fuerza muscular en el grupo BFC fue significativamente mayor y el tiempo de actividad ambulatoria fue menor que en el grupo ACP. La incidencia de náuseas y vómitos en pacientes del grupo BFC fue significativamente menor en comparación con el grupo ACP. CONCLUSIÓN: El bloqueo femoral continuo guiado por ultrasonido y estimulador del nervio proporcionaron una mejor analgesia a las 6 y 12 horas, lo que quedó demostrado por EVA-R y EVA-P. La cantidad de parecoxib también fue menor, la incidencia de náuseas y vómito disminuyó, la influencia sobre la fuerza muscular está comprometida y los pacientes pueden realizar una actividad ambulatoria bajo esa condición. .

Image Guided Neurosurgery by Using Neuronavigation Integrated with Intraoperative Three-Dimensional Ultrasound.

Introduction: Intra-operative ultrasound provides low cost real time imaging that is simple and rapid to use. In recent years there has been a signifi cant improvement in the quality of ultrasound imaging. Ultrasound integrated neuronavigation can be used to optimize the approach, and achieving safe maximal resection, thereby improving outcomes for patients with diff erent localization and histology of brain tumors, vascular patology, spontaneous intra-cerebral hemorrhage. Material and Methods: Since 2007 till 2010, in the Institute of Neurology and Neurosurgery, 130 operations with application of 2D iUS have been performed. Starting from March till May 2012, 17 patients went under surgical treatment using the intraoperative ultrasound integrated neuronavigation system. Results: We applied ultrasound neuronavigation system in 17 cases on patients with diverse pathologies, including brain tumors (craniopharyngeoma, corpus callosum and intracerebral glioblastoma, intraaxial glioma), vascular patology (arteriovenous malformations, aneurysms), spontaneous intracerebral hemorrhage. Application of ultrasound neuronavigation system aids in improving postoperative outcomes for these patients. Conclusions: Th e integration of 3D US with neuronavigation technology created an effi cient and inexpensive tool for intraoperative imaging in neurosurgery. Th e technology has been applied to optimize surgery of brain tumors, but it has also been found to be useful in other procedures such as operations for aneurysms or arteriovenous malformations. iUS is easy to use and has a rapid learning curve which makes it a useful tool to the neurosurgeons intraoperative armamentarium.

Perfil bociógeno en estudiantes de Camata Marka, mediante palpación semiológica y respaldo ultrasonográfico. Un estudio de corte / Transversal. Gestión 2014 goitrogenic profile of students from Camata Marka, through semiological palpation and backup ultrasound. A study of cross section. Management 2014

INTRODUCCIÓN: Los Desórdenes por Deficiencia de Yodo (DDI) tienen devastadoras repercusiones en mujeres embarazadas y niños, ocasionando secuelas como el cretinismo y retraso mental, vinculados con el desarrollo económico y social de los pueblos. Un indicador del grado de deficiencia de yodo de una población para el diagnóstico descriptivo de los DDI, son las pesquisas realizadas en niños, adolescentes y mujeres embarazadas. Estudios realizados por Peterson y col, demostraron que el Método Palpatorio de Pérez (MPP), adaptado por la OMS en 1960, continua siendo el método de elección para la clasificación de bocio en países en vías de desarrollo. Se pretende determinar el Perfil Bociógeno en estudiantes de Camata mediante palpación semiológica y Ultrasonografía, en un corte transversal. MÉTODO: Se realizó la pesquisa a 201 estudiantes niños y adolescentes, entre las edades de 5 a 17 años, mediante una Historia Clínica dirigida que permitió obtener datos generales y antropométricos, un examen físico teniendo como referencia el MPP y la Ultrasonografía. RESULTADOS: Los 2 casos de bocio encontrados muestran un valor estadístico de 1,4 %. Empero, este hallazgo en una población sensible para este tipo de estudio, revelan un indicador importante para este sector. DISCUSIÓN: El bocio existe en Bolivia desde los tiempos Precolombinos por un fenómeno geográfico montañoso deficiente de yodo que caracteriza a su territorio, entre ellos Camata Marka, es más, ningún estudio similar fue realizado en esa región. Con este estudio se demuestra que a la fecha existen DDI pese a políticas nacionales de lucha contra el Bocio vigentes.

INTRODUCTION: The Iodine Deficiency Disorders (IDD) have devastating effects on pregnant women and children, causing sequelae such as cretinism and mental retardation linked to economic and social development of peoples. An indicator of iodine deficiency in a population for descriptive diagnosis of IDD, are the investigations conducted in children, adolescents and pregnant women. Studies by Peterson et al, showed that the palpatory method Pérez (PMP), adapted by WHO in 1960, remains the method of choice for the classification of goiter in developing countries. It is intended to determine the profile goitrogenic in students Camata by palpation and ultrasonography semiológica, in cross section. METHOD: The research to 201 children and adolescents students was conducted between the ages of 5-17 years through a medical history that yielded demographic and anthropometric data, physical examination with reference MPP and ultrasonography. RESULTS: The 2 cases of goiter found show a statistical value of 1.4%. However, this finding sensitive to this type of study population, reveal an important indicator for this sector. DISCUSSION: Goiter exists in Bolivia since pre-Columbian times by poor mountainous geographical phenomenon of iodine that characterizes its territory, including Camata Marka also no similar study was conducted in that region. This study shows that to date there IDD despite national policies to combat goiter force.