Tumor pseudopapilar sólido de páncreas, una neoplasia inusual / Solid Pseudopapillary Tumor of the Pancreas, an Unusual Neoplasm

Presentación del caso. Se trata de una mujer de 26 años que presentó dolor en epigastrio e hipocondrio izquierdo, con aumento del perímetro abdominal y pérdida de 5 kg de peso corporal. En el examen físico se detectó una masa de gran tamaño en el epigastrio, con bordes regulares, ligeramente dolorosa al tacto y no móvil. Los estudios de imagen revelaron una neoplasia mixta en el cuerpo y cola pancreática. Intervención terapéutica. Se practicó una esplenopancreatectomía corpo-caudal, con extirpación completa del tumor. Evolución clínica. La paciente recibió cuidados especializados y vigilancia estrecha posquirúrgica en la unidad de cuidados intensivos, sin presentar complicaciones relevantes. Tras el alta hospitalaria, la paciente refirió un buen estado general en los controles de seguimiento, que incluyeron una tomografía realizada a los 12 meses, donde no se evidenciaron restos o recidivas tumorales

Case presentation. A 26-year-old woman who presented with pain in the epigastrium and left hypochondrium, with increased abdominal perimeter and loss of 5 kg of body weight. Physical examination revealed a large mass in the epigastrium, with regular borders, slightly painful to the touch and non-mobile. Imaging studies revealed a mixed neoplasm in the pancreatic body and tail. Treatment. A corpo-caudal splenopancreatectomy was performed, with complete removal of the tumor. Outcome. The patient received specialized care and close postoperative surveillance in the intensive care unit, with no relevant complications. After hospital discharge, the patient reported a good general condition in the follow-up controls, which included a computed tomography scan performed after 12 months, where no tumor remnants or recurrences were evidenced

MIPO con placa helicoidal en fractura de húmero

Introducción: Las fracturas humerales diafisarias multifragmentarias con extensión proximal son patrones infrecuentes de lesión causados principalmente por trauma de alta energía. La forma anatómica del húmero, la presencia de la tuberosidad deltoidea y la proximidad del nervio radial al surco radial representan retos a tratar, por ello se recomiendan incisiones mínimamente invasivas y la estabilización de la fractura con placa proximal humeral internal locking system. Objetivo: Demostrar la eficacia de la técnica minimally invasive plate osteosynthesis con el moldeamiento helicoidal de la placa proximal humeral internal locking system. Presentación del caso: Paciente de 29 años que sufrió accidente de tránsito y presentó fractura diafisaria multifragmentaria extendida al húmero proximal. Se trató con la técnica minimally invasive plate osteosynthesis y placa helicoidal proximal humeral internal locking system. Alcanzó la consolidación completa y rápida recuperación funcional. Conclusiones: La técnica minimally invasive plate osteosynthesis con placa helicoidal proximal humeral internal locking system es una opción quirúrgica eficaz y segura para las fracturas humerales diafisarias multifragmentarias con extensión proximal, ya que preserva la inserción muscular deltoidea, mejora el contacto placa hueso con riesgo mínimo de lesión neurológica axilar y radial, favorece la curación ósea y mejora el resultado funcional.

Introduction: Multifragmentary diaphyseal humeral fractures with proximal extension are infrequent patterns of injury caused mainly by high-energy trauma. The anatomical shape of the humerus, the presence of the deltoid tuberosity and the proximity of the radial nerve to the radial groove represent challenges to be treated, therefore minimally invasive incisions and fracture stabilization with the proximal humeral internal locking system plate are recommended. Objective: To establish the efficacy of the minimally invasive plate osteosynthesis technique with helical molding of the proximal humeral plate internal locking system. Case report: We report the case of a 29-year-old patient who suffered a traffic accident and had a multifragmentary diaphyseal fracture extended to the proximal humerus. He was treated with the minimally invasive plate osteosynthesis technique and the humeral proximal helical plate internal locking system. He achieved complete consolidation and rapid functional recovery. Conclusions: The minimally invasive plate osteosynthesis technique with the humeral proximal helical plate internal locking system is an effective and safe surgical option for multifragmentary diaphyseal humeral fractures with proximal extension, since it preserves the deltoid muscle insertion, improves bone-plate contact with minimal risk of fracture. Axillary and radial neurological injury, promotes bone healing and improves functional outcome.

Leak and Scattering Assessment by Optically Stimulated Luminescence Dosimetry in a Helical Linear Accelerator / Valoración de Fuga y Dispersión por medio de Dosimetría de Luminiscencia Estimulada Ópticamente (OSL) en un Acelerador Lineal Helicoidal

Radiation absorbed doses to organs outside the radiation therapy treatment beam can be significant and therefore of clinical interest. Two sets of out-of-beam measurements were performed measuring the leak dose and the scattered dose, at 5 points within the accelerator components (accelerator tube and collimator) and at 21 points on the equipment and surroundings based on a positioning scheme. For this purpose, 52 Optically Stimulated Luminescence (OSL) dosimeters were used in a latest generation helical linear accelerator. Of the 200 cGy fired at a cheese-like phantom, 0.332% of the out-of-beam dose contribution was found to come from the leak and 0.784% was transformed into scattering. For these dose values, estimates of the risk of second tumors in long-term survivors indicate a reduced probability of acquiring a second secondary radiation malignancy, based on information from the 1990 BEIR Committee report.

La dosis absorbida de radiación a órganos fuera del haz de tratamiento de radioterapia puede ser significativa y, por lo tanto, de interés clínico. Se realizaron dos sets de mediciones fuera del haz para determinar la dosis de fuga y la dosis dispersa, en 5 puntos dentro de los componentes del acelerador (tubo de aceleración y colimador) y 21 puntos en el equipo y alrededores basado en un esquema de posicionamiento. Para este fin se utilizaron 52 dosímetros de luminiscencia estimulada ópticamente (OSL, Optically Stimulated Luminescence), en un acelerador lineal helicoidal de última generación. De los 200 cGy disparados a un maniquí tipo queso, se encontró que el 0.332% de la contribución de dosis fuera del haz provenía de la fuga y 0.784% se transforma en dispersión. Para estos valores de dosis, las estimaciones del riesgo de segundos tumores en los supervivientes a largo plazo indican una reducida probabilidad de contraer una segunda malignidad por radiación secundaria, según la información del informe del Comité BEIR de 1990.

Aperfeiçoamento de modelo de estimativa da eficiência de remoção de turbidez da água em floculadores tubulares helicoidais / Model improvement for estimating of water turbidity removal efficiency in helical tubular flocculators

RESUMO Estudos científicos têm demonstrado que os floculadores tubulares helicoidais (FTHs) têm alta eficiência na formação de flocos e baixo tempo de retenção hidráulica, quando comparados aos floculadores comumente usados em tratamento de água e esgoto. No entanto, sua aplicação prática é limitada, pois ainda existe demanda significativa por avanços na compreensão da relação entre a hidrodinâmica da unidade e o processo de floculação, bem como critérios e metodologias para auxiliar em projeto racionais de FTH. Nesse contexto, este estudo teve por objetivo propor um aperfeiçoamento no modelo de estimativa de eficiência de remoção de turbidez apresentado por Oliveira (2014), o qual leva em conta um conjunto de parâmetros geométricos, hidráulicos e hidrodinâmicos relevantes ao processo de floculação nesse tipo de reator, pela incorporação de um dos parâmetros mais representativos de processos de floculação, o gradiente de pressão normal (GPp), como uma de suas variáveis independentes. O desenvolvimento do trabalho empregou dinâmica dos fluidos computacional (CFD) no estudo de 84 configurações de FTH, contemplando regimes de escoamento laminar e turbulento. Como resultado, chegou-se a uma nova versão de modelo de estimativa da eficiência de remoção de turbidez da água que, em relação à versão original: tem menor número de variáveis independentes; apresenta melhor ajuste aos dados experimentais; e é mais simples do ponto de vista operacional.

ABSTRACT Scientific studies have been demonstrating that helical tubular flocculators (HTFs) have high efficiency in floc formation and low hydraulic retention time when compared to flocculators commonly used in water and wastewater treatment. However, its practical application is still limited because there is still a significant demand for advances in the understanding of the relationship between the hydrodynamics of the unit and the flocculation process, as well as for criteria and methodologies in support to the rational design of HTF. In this context, the objective of this study was to propose an improvement in the model of turbidity removal efficiency developed by Oliveira (2014), which takes into account a set of geometric, hydraulic and hydrodynamic parameters relevant to the flocculation process in this type of reactor, by incorporating one of the most representative parameters of flocculation processes, the normal pressure gradient, as one of its independent variables. The development of the work employs computational fluid dynamics (CFD) in the study of 84 HTFs configurations, considering laminar and turbulent flow regimes. As a result, a new model version for estimating water turbidity removal's efficiency in helical tubular flocculators was obtained, which, in relation to the original version, has a smaller number of independent variables, presents better fit to the experimental data and is simpler from the operational point of view.

Estimation of type i collagen structure dissolved in inorganical acids from circular dichroism spectra / Estimativa da estrutura de colágeno tipo i dissolvida em ácidos inorgânicos a partir de espectros de dicroísmo circular

Usually, weak inorganic acids have been used to disperse collagen as green solvents for fabricating kinds of biomaterials all the time. However, it is an open question how much the dissolving process preserves or alters the native structure of collagen till now. Herein, we have examined the effect of three different solvents (HAc, HCl, H3PO4) on the secondary structures of collagen, based on circular dichroism (CD) spectra of collagen from 185 to 260 nm together with CDNN programs. We have found that collagen almost completely preserved its triple helical structure in the three inorganic acids at pH=3.0 or so, which demonstrated that it was the concentration of free H+ in the above three solutions whose pH was fixed at 3.0 that can maintain an proper amount of surface charge on the collagen colloidal particles and appropriately loose the three-helix structure, which can not only lead to a better dispersion behavior, but also maximize the preservation of the integrity of the collagen structure. Although the fractions of kinds of secondary structures in collagen were different from all the three solvents based on CDNN data, which gave very similar results for each other. These results was tested for the first time in this work to estimate the secondary structures for collagen in the different common inorganic acids, which provides a new avenue for green collagen solvents to prepare collagen-based composite with well triple-helical structure for tissue engineering.

Habitualmente, os ácidos inorgânicos fracos têm sido usados para dispersar colágeno como solventes verdes para fabricar tipos de biomateriais o tempo todo. No entanto, é uma questão aberta quanto o processo de dissolução preserva ou altera a estrutura nativa do colágeno até agora. Aqui, examinamos o efeito de três solventes diferentes (HAc, HCl, H3PO4) nas estruturas secundárias de colágeno, com base em espectros de dicroísmo circular (CD) de colágeno de 185 a 260 nm em conjunto com programas CDNN. Descobrimos que o colágeno preservou quase completamente sua estrutura helicoidal tripla nos três ácidos inorgânicos a pH = 3,0 ou mais, o que demonstrou que foi a concentração de H+ livre nas três soluções acima cujo pH foi fixado em 3,0 que pode manter uma boa quantidade de carga superficial sobre as partículas coloidais de colágeno e destrói adequadamente a estrutura de três hélices, o que não só pode levar a um melhor comportamento de dispersão, mas também maximizar a preservação da integridade da estrutura de colágeno. Embora as frações de tipos de estruturas secundárias em colágeno fossem diferentes de todos os três solventes com base em dados CDNN, que deram resultados muito semelhantes entre si. Estes resultados foram testados pela primeira vez neste trabalho para estimar as estruturas secundárias para o colágeno nos diferentes ácidos inorgânicos comuns, o que fornece uma nova alternativa para solventes de colágeno verdes para preparar compósitos à base de colágeno com a estrutura helicoidal tripla para engenharia de tecidos.

PET/CT: Técnica, consideraciones e indicaciones en el estudio oncológico de pacientes pediátricos / PET/CT: Technique, considerations and indications in the oncology study of pediatric patients

Resumen El cáncer en la población pediátrica representa la segunda causa de muerte en niños mayores de 5 años en nuestro país, después del trauma. La tomografia por emisión de positrones/tomograña computada (PET/CT) es una técnica hibrida que involucra radiación y que progresivamente se está implementando en niños. Esta técnica permite hacer evaluaciones morfológicas y funcionales del cuerpo con aplicaciones en patología neoplásica y no neoplásica. Su principal rol en la oncología se encuentra en la evaluación y control de linfomas, sarcomas y neuroblastomas, entre otros. La calidad de los resultados depende de la realización de procesos rigurosos para obtener las imágenes. En este artículo se revisan los pasos para la obtención de las imágenes, los aspectos técnicos involucrados, las fuentes de mala interpretación y las principales indicaciones que debe conocer el médico radiólogo y pediatra.

Abstract Pediatric cancer is the second cause of death in children older than 5 years in our country, after trauma. Positron emission tomography/computed tomography (PET/CT) is a hybrid technique that involves radiation, which has been used for some time in adults and is being progressively imple mented in children. This technique allows morphological and functional assessments of the body with applications in neoplastic and non-neoplastic pathology. Its main role in oncology is in the evaluation and control of lymphomas, sarcomas and neuroblastomas, among others. The quality of the results is determined by a number of rigorous processes to obtain the images. In this article we describe the steps in obtaining the images, the technicalities involved, sources of misinterpretation and what the main current indications that must be known by radiologists and pediatricians are.

Angiomiolipoma renal atípico versus carcinoma de células renales: dilema diagnóstico. Hallazgos útiles por tomografía computada para la discriminación de estos tumores / Atypical renal angiomyolipoma versus carcinoma renal cell: diagnosis dilemma. Findings by computed tomography for the discrimination of these tumors

Objetivo: Diferenciar el angiomiolipoma atípico del carcinoma de células renales del mismo tamaño mediante hallazgos tomográficos. Materiales y métodos: Se realizó un estudio retrospectivo con 68 pacientes (17 con angio-miolipomas atípicos y 51 con carcinoma de células renales) nefrectomizados por diagnóstico presuntivo preoperatorio, mediante tomografía computada trifásica (fases sin contraste, corticomedular y excretora temprana), de carcinoma de células renales menor de 45mm. Dos radiólogos que desconocían el diagnóstico definitivo evaluaron retrospectivamente las características generales del tumor, su atenuación en fase sin contraste y las características de su realce. Se realizó un análisis estadístico con software R, aplicándose el modelo logit para diferenciar el angiomiolipoma atípico del carcinoma de células renales a partir de los hallazgos tomográficos de masa renal, incluidos en el modelo final el contorno, la atenuación en fase sin contraste y el patrón de realce con el tiempo. Resultados: Los hallazgos de angiomiolipoma atípico que resultaron significativos fueron atenuación tumoral en fase sin contraste hiperdensa y patrón de realce con tiempo prolongado con chance de ocurrencia de 10,49 (p=0,0381) y 36,71 (p=0,0009), respectivamente. En los pacientes, según el valor de cada hallazgo incluido en el modelo, se calculó probabilidad, sensibilidad (0,2941) y especificidad (0,9804). La curva característica operativa del receptor (ROC) determinó un punto de corte óptimo (0,9694) para discriminar el angiomiolipoma atípico, por lo que se confirmó su presencia. Conclusión: La tomografía computada helicoidal trifásica es útil para diferenciar el angiomiolipoma atípico del carcinoma de células renales, siendo la atenuación hiperdensa sin contraste del tumor y su patrón de realce prolongado los hallazgos tomográficos más valiosos.

Objective: To compare various computed tomographic features of atypical angiomyolipoma with those of size-matched renal cell carcinoma. Materials and methods: Sixty-eight patients (17 with atypical angiomyolipomas and 51 with carcinoma renal cells) who had undergone nephrectomy by presumptive diagnosis of carcinoma renal cell<45mm on diameter by preoperative triphasic computed tomography (CT) (with unenhanced, corticomedullary, and early excretory phase scanning) were evaluated in a retrospective study. Two reviewers who were unaware of the diagnosis retrospectively recorded tumor attenuation on unenhanced scans, enhancement characteristics and general characteristics of the tumor. Statistical analysis was performed with R software, applying logit model to differentiate atypical angiomyolipoma from renal cell carcinoma from CT findings of renal mass, included in the final model the tumor margin, its attenuation on unenhanced scans and the enhancement pattern over time. Results: For atypical angiomyolipomas the most valuable CT findings were hyperdense attenuation tumour in unenhaced phase scan and prolonged enhancement pattern, with chance of occurrence of 10.49 (p=0.0381) and 36.71 (p=0.0009), respectively. In the patients, as each finding value in the model, probability, sensitivity (0.2941) and specificity (0.9804) was calculated ROC curve was constructed that determined optimal cutoff (0.9694) to discriminate atypical angiomyolipoma, confirming their presence. Conclusion: Triphasic helical CT may be useful in differentiating atypical angiomyolipoma from renal cell carcinoma, with hyperdense tumor attenuation on unenhanced scans and prolonged enhancement pattern being the most valuable CT findings.

Placa helicoidal en el tratamiento de fractura del húmero por cirugía mínimamente invasiva. Reporte de un caso / Helical plate in treating humerus fracture by minimally invasive surgery

Las fracturas del extremo proximal del húmero en pacientes osteoporóticos, pueden resultar en patrones complejos, como aquellos donde ocurre extensión a la diáfisis. El tratamiento de estas fracturas ha sido controversial durante largo tiempo, con distintos resultados. Las técnicas de osteosíntesis mínimamente invasiva con placa para el tratamiento de las fracturas del húmero han sido usadas para minimizar la disección de las partes blandas y lesión de estructuras neurovasculares. El principio helicoidal, es un concepto biomecánico aplicable al tratamiento de estas fracturas. Presentamos el caso de paciente femenino de 72 años de edad, quien sufrió fractura de húmero proximal con extensión a la diáfisis, tratado con placa larga helicoidal y técnica mínimamente invasiva. Mostramos el resultado del tratamiento y su evolución a largo plazo. Este caso muestra que con esta técnica innovadora se puede alcanzar la consolidación y la recuperación funcional satisfactoria, en pacientes con fracturas complejas(AU)

Humerus proximal fractures in osteoporotic patients may result in complex patterns such those which occur with shaft extension. The treatment of these fractures has been controversial for a long time with different results. The techniques of minimally invasive plate osteosynthesis for the treatment of theses fractures had been used to minimize soft tissue dissection and injury to neurovascular structures. The helical principle is a biomechanical concept can be applied for treatment of these fractures. We report the case of 72-year-old female who presented with proximal humerus fracture to the shaft extension that was treated with a long plate with minimally invasive plate osteosynthesis with helical principle, an innovative technique in the treatment of these fractures. We present the results of treatment and long-term evolution. This case shows that with this innovative technique can achieve consolidation and satisfactory functional recovery in patients with these complex fractures(AU)

Aspectos tomográficos da coluna cervical de equinos / Tomographic imaging of the cervical spine of horses

Descreveu-se a anatomia da região cervical de equinos adultos, com base em imagens obtidas no exame de tomografia computadorizada helicoidal realizado em peças anatômicas de equinos adultos. A tomografia computadorizada foi o método de imagem diagnóstica de escolha e possibilita as reconstruções de imagens tridimensionais e em outros planos anatômicos, como sagital e coronal. Todas as imagens foram adquiridas e avaliadas em filtro e janela para tecido ósseo. Observaram-se diferenças anatômicas e as particularidades normais das vértebras, principalmente da região occipitoatlantoaxial, a qual apresenta maior incidência de alterações.

The anatomy of the cervical spine of mature horses based on images obtained with a helical computed tomography examination performed on anatomic specimens was studied. Computed tomography was the diagnostic imaging method of choice and allowed three-dimensional reconstructions of images and other anatomical planes, such as coronal and sagittal. All images were acquired and evaluated in the filter and window to bone tissue. It was possible to demonstrate the anatomical differences and peculiarities of the normal vertebrae, particularly the occipito-atlantoaxial region, which has a higher incidence of changes to assist in the visualization of any change of the bone pattern on CT studies.

Morse potential in DNA molecule – An experiment proposal.

We rely on the helicoidal Peyrard-Bishop model for DNA dynamics. Interaction between nucleotides at a same site belonging to different strands is modelled by a Morse potential energy. This potential depends on two parameters that are different for AT and CG pairs, which is a possible source for inhomogeneity. It was shown recently (Zdravković and Satarić 2011) that certain values of these parameters bring about a negligible influence of inhomogeneity on the solitonic dynamics. We propose an experiment that should be carried out in order to determine the values of both of these parameters.

Densitometria óssea em gatos hígidos por tomografia computadorizada quantitativa / Bone densitometry in healthy cats by quantitative computed tomography

Estabeleceram-se valores de média radiodensidade do osso trabecular das vértebras lombares de 16 gatos adultos, hígidos, por meio da tomografia computadorizada quantitativa (TCQ). O valor médio de radiodensidade do osso trabecular da segunda vértebra lombar foi de 436,1±42,1 unidades Hounsfield, com distribuição não homogênea da radiodensidade no corpo vertebral.

The radiodensity of the trabecular bone of the lumbar vertebrae in 16 healthy adult cats was studied using quantitative computed tomography (QCT). The average radiodensity of the trabecular bone of the second lumbar vertebra was 436.1±42.1 Hounsfield units. However, there was a nonhomogeneous radiodensity distribution of the vertebral body.

Estudio de las venas de la fosa cubital a través de la tomografía computada helicoidal y su aplicación clínica / Study of the veins of the cubital fossa by helical computed tomography and its clinical application

Las venas superficiales de la fosa cubital, constituyen uno de los sitios más importantes de punción venosa. La disposición de estas venas presenta numerosas variaciones. Su anatomía no ha sido estudiada aplicando los avances tecnológicos en el campo de la medicina, como la tomografía computada helicoidal. Fueron analizadas mediante tomografía axial computada helicoidal, las formaciones venosas de la fosa cubital en 60 individuos chilenos de ambos sexos, de edades entre 10 y 86 años, de la IX Región de La Araucanía, Chile. El estudio fue realizado en un tomógrafo General Electric, modelo CT/e, perteneciente al Centro de Imagenología del Hospital del Trabajador, Temuco, Chile, en individuos ambulatorios. Basados en la clasificación de del Sol et al. (1988) para las formaciones venosas de la fosa cubital, se obtuvo los siguientes resultados: Tipo I (46,7 por ciento), la vena cefálica del antebrazo (VCA), se divide en vena mediana basílica (VMB) y vena mediana cefálica (VMC), las que se unen a la vena basílica del antebrazo (VBA) y vena cefálica del accesoria del antebrazo (VCAA), respectivamente. Tipo II (13,3 por ciento), la VCA originó la vena mediana del codo (VMCo), que se une a la VBA. Tipo III (20 por ciento), no existe comunicación entre la VBA y VCA a nivel de la fosa cubital. Tipo IV (8,3 por ciento), la VCA drenaba en la VBA. Tipo V (11,7 por ciento). Otras disposiciones, donde se incluye la "M" clásica, que resulta de la división de la vena mediana del antebrazo. La utilización de la VMC o de la VCA, se recomienda ya que previene los riesgos de punción de otras estructuras anatómicas importantes como el ramo anterior del nervio cutáneo antebraquial medial.

The superficial veins of the cubital fossa, is one of the most important sites of venipunctures. There are many variations in the arrangement of these veins. Their anatomy has not been studied using technology available in the field of medicine such, as helical computed tomography. The vein formation of the cubital fossa in 60 Chilean subjects of both sexes, between 10 and 86 years of age of the IX Region of Araucania, Chile, were analyzed by helical computed tomography. The study was realized on a General Electric scanner, model CT / e, belonging to the Imaging Center of the Hospital del Trabajador, Temuco, Chile, in ambulatory subjects. Based on the classification of del Sol et al. (1988) for the vein formation of the cubital fossa, we obtained the following results: Type I (46.7 percent), the cephalic vein of forearm (CVF), is divided into median basilic vein (MBV) and median cephalic vein (MCV), then anastomosis the basilic vein of forearm (BVF) and cephalic vein accessory (CVA), respectively. Type II (13.3 percent), the CVA originates at the median cubital vein (MCuV), which anastomoses to the BVF. Type III (20 percent), there is no communication between BVF and CVF at the cubital fossa. Type IV (8.3 percent), CVF drains into the BVF. Type V (11.7 percent) - Other disposition, which include the "M" classical, resulting from the division of the median antebrachial vein. Using the MCV or CVF, is recommended, since there are risks of puncture of other important anatomical structures such as the anterior branch of the medial antebrachial cutaneous nerve.

Tomografia computadorizada no diagnóstico de hepatopatia esteroidal em cão: relato de caso / Computed tomography in the diagnosis of steroidal hepatopathy in a dog: case report

It is reported a case of an eight-year-old Yorkshire Terrier dog, with a history of prolonged use of prednisone in a dosage of 1mg/kg of body weight each 24 hours during two years. The helical computed tomography revealed hepatomegaly associated to a hyperattenuation of the parenchyma, with a radiodensity value of 82.55 Hounsfield units (HU). The spleen presented a mean radiodensity of 57.17HU, and a radiodensity difference of 25.38HU was observed between the two organs. Based on the history and findings of imaging technique, it was determined the presumptive diagnosis of steroidal hepatopathy compatible with accumulation of hepatic glycogen. It was concluded that computed tomography enabled the characterization of hepatic injury and the presumed diagnosis of steroidal hepatopathy.

Relata-se o caso de um cão da raça Yorkshire, de oito anos de idade, com histórico de tratamento com prednisona na dose de 1mg/kg de peso, a cada 24 horas, por dois anos. A tomografia computadorizada helicoidal revelou hepatomegalia associada à hiperatenuação, com radiodensidade de 82,55 unidades Hounsfield (HU). O baço apresentava radiodensidade média de 57,17HU, sendo observada diferença de radiodensidade de 25,38HU entre os dois órgãos. Por meio do histórico e dos achados da técnica de imagem, foi possível determinar o diagnóstico presuntivo de hepatopatia esteroidal compatível com acúmulo de glicogênio hepático. Concluiu-se que a tomografia computadorizada possibilitou caracterizar a lesão hepática e presumir o diagnóstico de hepatopatia esteroidal.

Relaciones del origen del tronco celiaco, arterias mesentéricas y renales con la columna vertebral en individuos chilenos / Relationships between of the origin of celiac trunk, mesenteric and renal arteries with the vertebral column in chilean individuals

En la actualidad muchos procedimientos quirúrgicos invasivos, diagnósticos y terapéuticos requieren de un conocimiento preciso de la anatomía arterial del territorio abdominal. Entre estas intervenciones destaca la extracción de órganos en donantes vivos (renal y hepático) y las intervenciones oncológicas, entre otras. Tradicionalmente, el estudio de los vasos se ha hecho por medio de arteriografías que requieren de procedimientos invasivos con inyección de medio de contraste y largas exposiciones a rayos X, obteniendo imágenes bidimensionales en las cuales las relaciones entre los tejidos y órganos es difícil de analizar. El objetivo del presente trabajo fue determinar las características anatómicas del tronco celiaco, arterias mesentérica superior, renales y mesentérica inferior y la relación de origen con la columna vertebral. Se estudiaron las imágenes de 74 pacientes, 40 hombres y 34 mujeres, sometidos a una angiotomografía de la parte abdominal de la aorta, registrando las características y las relaciones de las arterias mencionadas. Las imágenes utilizadas se obtuvieron mediante tomografía computarizada helicoidal multidetectores. La división clásica del tronco celíaco en tres ramas se encontró en el 60,8 por ciento de los casos, el origen se relacionó con T12 en 50 por ciento de los hombres y en 52,9 por ciento de las mujeres, con L1 en 50 por ciento y 47,1 por ciento, respectivamente. La a. mesentérica superior se originó a nivel de T12, L1 y L2 en un 8,1 por ciento, 78,4 por ciento y 13,5 por ciento, respectivamente. Las aa. renales fueron dobles en el 18,9 por ciento de los casos. Con respecto a las descripciones clásicas encontramos diferencias que demuestran la variabilidad de la distribución vascular. El método se valida como una instancia útil de bajo riesgo para el paciente y reproducible por los investigadores y clínicos.

At present many surgical invasive, diagnostic and therapeutic procedures require a precise knowledge of the arterial anatomy of the abdominal territory. Among these interventions the extraction of organs stands out in alive donors (renal and hepatic) and the oncological interventions, among others. Traditionally, the study of the vascularization has been carried out by means of arteriographies which require invasive procedures with injection of contrast substances and long expossue to X-rays, obtaining two-dimensional images in which the relations between the tissues and organs is difficult to analyze. The aim of the present work was to determine the anatomical characteristics of the celiac trunk, superior mesenteric, renal and inferior mesenteric arteries and the relation of origin with the vertebral column. Images of 74 patients, 40 men and 34 women, submitted to an tomography of the abdominal part of the aorta, were studied as were the characteristics and the relations of the mentioned arteries. Images used were obtained by means of multidetector computed tomography. The classic division of the celiac trunk in three branches was observed in 60,8 percent of the cases, the origin related with T12 in 50 percent of the men and in 52,9 percent of the women, with L1 in 50 percent and 47,1 percent, respectively. The superior mesenteric artery originated to level of T12, L1 and L2 in 8,1 percent, 78,4 percent and 13,5 percent, respectively. The renal arteries were double in 18,9 percent of the cases. With regard to the classic descriptions we found differences that demonstrate the variability of the vascular distribution. The method is validated as a useful instance of low risk for the patient and reproducible for the researchers and clinical.

Anatomia arterial intracraniana: avaliação por angiotomografia computadorizada: [revisão] / Intracranial arterial anatomy: evaluation by computed tomography angiography: [review]

Durante muitos anos, o estudo arterial intracraniano foi realizado, exclusivamente, por meio daangiografia convencional, em que há cateterização seletiva das artérias. Hoje em dia, com a evoluçãotecnológica da tomografia computadorizada por meio de multidetectores permitindo aquisições com fatias de corte cada vez mais finas, maior velocidade e melhor resolução espacial, surgiucomo nova modalidade de investigação a angiotomografia, menos invasiva e com menor morbidade que a arteriografia convencional. Muitos estudos na literatura vêm analisando a sensibilidade deste novo método na detecção de aneurismas intracranianos e comparando seus resultados com aqueles obtidos pela arteriografia convencional. Para tal, percebe-se a necessidade doreconhecimento da anatomia arterial intracraniana normal e suas variações a partir de imagenscom reformações multiplanares, objetivando o fornecimento de importantes informações paradefinição de estratégias nas abordagens cirúrgicas, tais como calcificações parietais, posição docolo aneurismático e relações com estruturas anatômicas circundantes.

By many decades, the intracranial arteries study was realized exclusively by angiography through selective arterial catheterization.Nowadays, with the technologic evaluation of computerized tomography devices with multidetectors allowing acquisitions with even more thinner slices, higher speed and better resolution, it had appeared a new modality of investigation: the computed tomography angiography, less invasive and with minor morbidity than conventional arteriography. Many studies in the literature have been analyzing the sensibility of the new method for the detection ofintracranial aneurisms and comparing them with the conventional arteriography. There is a necessity to recognize the normal intracranial arterial anatomy and its variations using images obtainedfrom multiplanar reformations, in order to give important informationfor surgeries strategies, such as wall calcifications, aneurismatic neck position and relationships with surrounding anatomical structures.

O papel dos exames de imagem no diagnóstico de trombose das veias esplâncnicas: relato de dois casos / The role of imaging exams in the diagnosis of thrombosis of the splanchnic veins: Report of two cases

Objetivos: apresentar dois casos de trombose de veias esplâncnicas, que é considerada uma causa potencialmente fatal de isquemia intestinal, sendo as veias porta e mesentérica superior as mais acometidas. Discutir as possíveis etiologias e realçar a importância do uso de exames de imagem no diagnóstico dessa afecção.Descrição dos Casos: duas pacientes com trombose venosa esplâncnica apresentaram manifestações clínicas inespecíficas. No primeiro caso as principais manifestações foram dor abdominal, diarréia sanguinolenta, distensão abdominal e náuseas. No segundo caso, a paciente apresentava dor abdominal vaga, inapetência e hipotensão arterial. Nos dois casos o diagnóstico foi firmado por tomografia computadorizada.Conclusões: considerando as manifestações clínicas vagas da trombose de veias esplâncnicas, os exames de imagem, em especial a tomografia computadorizada, apresentam papel fundamental no seu diagnóstico.

Aims: To present two cases of thrombosis of the splanchnic veins, which is considered a possible fatal cause of intestinal ischemia, with the portal and superior mesenteric veins being the most affected. To discuss the etiological possibilities and emphasize the importance of using imaging exams for the definitive diagnosis.Case Description: Two women with splanchnic venous thrombosis showed nonspecific clinical manifestations. In the first case, the main symptoms were abdominal pain, bloody diarrhea, abdominal distension and nausea. In the second case, the patient presented with vague abdominal pain, anorexia and hypotension. In both cases the diagnosis was established by computed tomography. Conclusion: Considering the nonspecific clinical manifestations of splanchnic veins thrombosis, the imaging exams, especially the computed tomography, play a major role in its definitive diagnosis.

O valor dos critérios de indicação da angiotomografia no diagnóstico de lesões das artérias carótidas e vertebrais no trauma contuso / Value of the criteria for indication of angiography in the diagnosis of carotid and vertebral arterial injuries in blunt trauma

Introdução: As lesões contusas de artérias carótidas e vertebrais (LCCV) não são muito frequentes, porém podem apresentar repercussões graves. A incidência desse tipo de lesão é difícil de ser avaliada porque os doentes podem estar neurologicamente assintomáticos quando atendidos no pronto socorro ou podem apresentar sintomas que são atribuídos ao trauma de crânio ou a outras lesões associadas. Estatísticas recentes apontam uma incidência de 0,24% a 0,33% em doentes traumatizados portadores de algum sintoma neurológico. No Brasil não existem trabalhos de nosso conhecimento que tenham estudado a incidência das LCCV. Por outro lado, a real morbidade e mortalidade das LCCV não estão claramente determinadas, nem mesmo na literatura internacional. Os objetivos deste estudo foram: a) avaliar a incidência de LCCV em 100 doentes vítimas de trauma contuso submetidos à angiotomografia cervical, utilizando parâmetros obtidos da avaliação clínica inicial e das tomografias de crânio e da região cervical e b) verificar quais os critérios de indicação da angiotomografia cervical que mais se correlacionam com a presença de LCCV no serviço de trauma de hospital quaternário brasileiro. Material e Método: Durante o período de trinta meses a partir de julho de 2006, todos os doentes admitidos no Pronto-Socorro do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com trauma cervical fechado, com potencial risco de lesão dos vasos cervicais apresentando défice neurológico não justificado pela tomografia computadorizada de crânio, infarto cerebral, hematoma cervical estável, epistaxe volumosa, anisocoria/sinal de Horner, escore na escala de coma de Glasgow abaixo de 8 sem achados justificativos pela tomografia, fratura de coluna cervical, fratura de base de crânio, fratura de face (Le Forte II ou III), sinal do cinto de segurança acima da clavícula, frêmito ou sopro cervical, foram incluídos no estudo...

Background: Blunt trauma of the carotid and vertebral arteries (LCCV) are infrequent, but may have serious repercussions. The incidence of this type of injury is difficult to evaluate as many patients are neurologically asymptomatic when assisted in emergency rooms, or with symptoms attributed to cranium trauma or to other associated injuries. Recent statistical data show an incidence of 0.24% to 0.33% traumatized patients that carry some neurological symptom, we are not aware of any papers in Brazil that have studied the occurrence of LCCV. On the other hand, the real morbidity and mortality are not clearly determined, not even in the international literature. The objectives of the current study were: a) to evaluate the incidence of carotid and vertebral artery injuries in 100 patients with blunt trauma subjected to cervical angiography, using parameters obtained from the initial clinical evaluation and tomography of the patients and b) to verify which criteria for recommending cervical angiography are most related to the presence of LCCV in the trauma services section in a Brazilian quaternary care hospital. Method: During thirty months, starting in July 2006, all patients admitted in the emergency room of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, with blunt cervical trauma, with potential risk of injuries to cervical vessels that presented neurological deficit unexplained after cranial CT scan, cerebral infarction, stable cervical haematomas, severe epistaxis, anisocoria/sign of Horner`s syndrome, Glasgow coma scores bellow 8 that are not explained by CT scan, cervical spine fracture, basilar skull fracture, facial fracture (Le Forte II or III), seatbelt signals above the clavicle, cervical hum or bruit were included in the study. The patients were subjected to cervical angiography in order to diagnose LCCV. There were analyzed the mechanisms of injuries, gender, age, severity of LCCV, type of treatment and outcome...

Utilidad de la Tomografía Computada helicoidal en la diverticulitis aguda / Usefulness of helical computed tomography in the acute diverticulitis

Objetivo: Evaluar la utilidad de la tomografía computada helicoidal (TCH) en el diagnóstico y manejo terapéutico de la diverticulitis aguda. Materiales y métodos: Estudio de cohorte retrospectivo realizado sobre un periodo de 6 meses que incluyó a 100 pacientes con sospecha clínica de diverticulitis. Se efectuó TCH con contraste oral y endovenoso, salvo contraindicación. Los estudios se correlacionaron con la respuesta terapéutica y el seguimiento clínico y con cirugía e histopatología cuando fue necesario tratamiento quirúrgico. Resultados: De 100 pacientes estudiados, 62 tuvieron diagnóstico tomográfico de diverticulitis; de ellas, 41 fueron diverticulitis simples y 21, complicadas (absceso, flemón, plastrón, perforación libre, fístula vésicocolónica y obstrucción intestinal); en 24 pacientes se realizó diagnóstico alternativo (apendicitis, apendagitis, colitis inespecífica, colitis isquémica, pielonefritis, litiasis ureteral, pancreatitis, salpingitis, quiste de uraco complicado, obstrucción colónica mecánica y perforación colónica por cuerpo extraño) y en 14, diagnóstico de ausencia de diverticulitis aguda, sin diagnóstico alternativo, siendo dos de ellos falsos negativos por clínica y respuesta al tratamiento. La TCH para la diverticulitis demostró: sensibilidad: 96,87%; especificidad: 100%; valor predictivo positivo: 100%; valor predictivo negativo: 94,7%; certeza: 98%. De los 41 pacientes con diagnóstico tomográfico de diverticulitis no complicada, 37 recibieron tratamiento médico ambulatorio y 4, tratamiento médico con internación; de los 21 pacientes con diagnóstico de diverticulitis complicada, 18 realizaron un tratamiento médico con internación y en 3 se tomó una conducta quirúrgica; de los 14 pacientes con ausencia de hallazgos tomográficos de diverticulitis, en 12 se adoptó una conducta expectante ambulatoria y 2 recibieron tratamiento médico ambulatorio. Conclusión: La tomografía es muy útil y eficaz para el diagnóstico, evaluación y manejo de los pacientes con sospecha clínica de diverticulitis.

Objective: The evaluation of the usefulness of helical computed tomography (HCT) in the diagnosis and therapeutic management of the acute diverticulitis. Materials and methods: Six months retrospective cohort study of 100 patient population clinically suspected of diverticulitis was carried out. The exams were made with oral and intravenous contrast unless the patient presented contraindications. A correlation of these studies with the therapeutic response and clinical follow up was done with surgery and histopathology. Results: From a total of 100 patients studied, 62 presented tomographic diagnosis of diverticulitis, 41 were classified as simple diverticulitis and 21 were complicated cases (abscess, phlegmon, plastron, free perforation, vesicocolonic fistula and intestinal obstruction). In 24 patients an alternative diagnosis was made (appendicitis, appendagitis, uretheral litiasis, colitis, salpingitis, pancreatitis, uraco cyst complication, colonic mecanical obstruction, colonic perforation with foreign body): 14 patients did not present tomographic findings to support the clinical symptoms, two of them were false-negative by the clinic and by the response to treatment. These data represented a sensibility of 96,87%, specificity of 100%, PPV of 100% and NPV of 94,7% and a certainty of 98 for the tomography diagnosis of acute diverticulitis. Of the 41 patients with tomographic diagnostic of not complicated diverticulitis, 37 received medical outpatient treatment and only 4 medical treatment with placement; of the 21 patients diagnosed with complicated diverticulitis, 18 were hospitalised with medical treatment and the other 3 patients needed surgery; of the 14 patients without tomographic findings of diverticulitis, in 12 outpatients an expectant conduct was followed and the other 2 received medical outpatient treatment. Conclusion: HCT is very useful and effective in diagnosis, evaluation and management of patients with clinical suspicion of diverticulitis.

Utilidad de la tomografía computada en pacientes con dolor en fosa iliaca derecha: Apendicitis aguda y su diagnóstico diferencial / Usefulness of computed tomography in patients with right inferior abdominal quadrant pain: acute appendicitis and its alternative diagnosis

Propósito: Repasar los hallazgos de tomografía computada (TC) de la apendicitis aguda, sus complicaciones y diagnósticos diferenciales. Evaluar la utilidad de la tomografía computada helicoidal (TCH) en el diagnóstico de la apendicitis aguda y en el manejo de los pacientes con abdomen agudo de fosa iliaca derecha, tanto en la determinación de un diagnóstico, como de sus complicaciones, que permitan tomar una medida terapéutica. Materiales y métodos: Estudio de cohorte retrospectivo realizado durante 5 meses (mayo a septiembre del 2007), en el que la población de estudio incluyó a pacientes derivados del Servicio de Guardia de nuestra institución para la realización de una TCH por presentar dolor en fosa iliaca derecha como denominador común. Se efectuaron tomografías helicoidales con contraste oral y endovenoso, de no existir contraindicaciones. Los estudios fueron correlacionados con los hallazgos quirúrgicos e histopatológicos y, en aquellos casos de resolución no quirúrgica, por seguimiento clínico. Resultados: Sobre un total de 100 pacientes estudiados, 53 presentaron diagnóstico tomográfico de apendicitis, de las cuales, 22 fueron perforadas; 27 mostraron un diagnóstico alternativo (quistes o folículos anexiales, litiasis ureteral derecha, tiflitis, diverticulitis, colitis inespecífica, salpingitis y quiste anexial complicado); 18 no evidenciaron apendicitis ni alteraciones tomográficas que justificaran la clínica y hubo solo 2 pacientes con resultado indeterminado. El análisis de estos datos demostró una sensibilidad del 100%, especificidad del 95,7%, valor predictivo positivo del 96,2% y valor predictivo negativo del 100% para el diagnóstico tomográfico de apendicitis aguda y una sensibilidad del 100%, especificidad del 81,81%, valor predictivo positivo del 95,12% y un valor predictivo negativo del 100% para el diagnóstico tomográfico de las diferentes etiologías y manejo de los pacientes con abdomen agudo de fosa iliaca derecha. Conclusión: La TCH posee una elevada sensibilidad y especificidad para el diagnóstico de apendicitis aguda y para la evaluación y manejo de los pacientes con un cuadro de abdomen agudo de fosa iliaca derecha.

Purpose: To review the tomography findings of the acute appendicitis, their complications and alternative diagnosis. To value the use of helicoidal computed tomography (HCT) in the diagnosis of acute appendicitis and in the study of patients with right inferior abdominal quadrant (RIQ) pain and acute abdomen, for diagnosis and eventual complications, in order to decide treatment. Materials and method: For five months, the populations included in this retrospectively study were all patients delivered for presenting with RIQ pain for a HCT exam. These exams were made with oral and intravenous contrasts, when there were not contraindications. The HCT results were correlated with clinical follow up, surgery and histopathologic exams. Results: Over a total of 100 patients studied, 53 presented tomographic diagnosis of appendicitis, 22 of which presented perforation signs; 27 showed an alternative diagnosis (ovaries follicles, uretheral litiasis, tiphlitis, diverticulitis, colitis, salpingitis), 18 patients did not present tomographic findings to support the clinical symptoms and 2 presented indetermined results. These data represented a sensibility of 100%, specifity of 95,7%, positive predictiv value (PPV) of 96,2% and negative predictiv value (NPV) of 100% for the tomography diagnosis of acute appendicitis and a sensibility of 100%, specificity of 81,8%, PPV of 95,1% and NPV of 100% for the tomography diagnosis of the different etiology in patient with right inferior acute abdomen. Conclusion: HCT is extremely useful in the study of patients with acute abdomen with origin in the RIQ, not only to make a diagnosis, but also to evaluate the complications, so as to decide proper treatment.

Tomografia computadorizada de abdome normal: estudo retrospectivo das angulações dos hilos renais / Normal abdominal computed tomography: a retrospective study of renal hila angles

OBJETIVO: Obter valores da angulação média dos hilos renais em relação ao plano horizontal, traçado sobre músculos eretores da espinha direito e esquerdo, considerando como parâmetro de referência para as medidas das angulações o centro da coluna vertebral lombar. MATERIAIS E MÉTODOS: Foram analisados 250 exames de tomografia computadorizada de abdomes considerados normais de indivíduos de ambos os sexos, sendo 128 masculinos (idade média de 52,45 ± 17,42 anos) e 122 femininos (idade média de 54,39 ± 18,27 anos), totalizando 500 hilos renais estudados. A angulação média de cada hilo renal em relação ao plano horizontal foi obtida, sendo considerados sempre os ângulos agudos. RESULTADOS: O estudo comparativo entre os sexos mostrou que não houve diferença estatisticamente significante em relação aos ângulos agudos dos hilos renais. A análise estatística mostrou, com intervalo de confiança de 95 por cento, para média do ângulo direito os limites de 40,40° e 44,54° e para o hilo renal esquerdo os limites de 39,91° e 43,23°. CONCLUSÃO: Os hilos renais, independentemente do sexo, apresentam angulações semelhantes. Valores angulares maiores terão anomalia de hiper-rotação ou hiper-rotação exagerada e valores menores terão anomalia de rotação incompleta ou rotação invertida.

OBJECTIVE: To obtain mean angulation values for renal hila in relation to the horizontal plane traced over the right and left spinal erector muscles, considering the center of the lumbar vertebral spine as a parameter for measuring the renal hila angles. MATERIALS AND METHODS: The authors have analyzed 250 abdominal computed tomography studies of both male and female healthy individuals (128 men with mean age 52.45 ± 17.42 years, and 122 women with mean age 54.39 ± 18.27 years), corresponding to 500 renal hila evaluated. The mean angulation of each hilum in relation to the horizontal plane was obtained taking acute angles into consideration. RESULTS: The comparative study have not found any statistically significant difference in acute angles of renal hila between male and female individuals. The statistical analysis demonstrated limits of 40.40° and 44.54° for mean right hilum angulation and 39.91° and 43.23° for mean left hilum angulation, with a confidence interval of 95 percent. CONCLUSION: Renal hila present similar angulation independently of sex. Higher angulation values correspond to hyper-rotation or excessive rotation, and lower angulation values, to incomplete or reverse rotation.