Combined high-frequency and Doppler ultrasound in early diagnosis of atrophoderma of Pasini and Pierini

Abstract: Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.

Encefalopatía hiponatrémica / Hyponatremic encephalopathy

Introducción: la hiponatremia es la anomalía electrolítica más común en pacientes hospitalizados. Está relacionada con la administración de fluidos hipotónicos en pacientes con niveles elevados de hormona antidiurética. La complicación más grave de la hiponatremia es la encefalopatía hiponatrémica, que puede ser fatal, o provocar una lesión cerebral irreversible, si no se trata adecuadamente. Presentación del caso: lactante de 6 meses de edad, eutrófica, con antecedentes de salud y un desarrollo psicomotor acorde con su edad, que ingresa en el Hospital Pediátrico de Cienfuegos con el diagnóstico de una enfermedad diarreica aguda por rotavirus. Se decidió suspender la alimentación e iniciar hidratación de mantenimiento por intolerancia de la vía oral. Se empleó una solución en base a dextrosa al 5 por ciento con 0,18 por ciento de NaCl. Transcurridas 14 horas en la sala, la paciente se traslada a Cuidados Intensivos por convulsiones, que estuvieron relacionadas con hiponatremia severa. Inicialmente el valor del sodio fue normal. En la tomografía de cráneo realizada 13 días después presentaba signos de atrofia cortical. Al momento de realizar este trabajo la niña se seguía en consulta de Fisiatría y Neuropediatría por una cuadriparesia flácida. Conclusiones: los fluidos hipotónicos siguen siendo recomendados como líquidos de mantenimiento en pacientes agudamente enfermos, a pesar de la fuerte asociación entre su uso y el desarrollo de hiponatremia. Es hora de que se dejen de usar fluidos hipotónicos en estados de enfermedad asociados con exceso de hormona antidiurética, pues no existe razón para que esta práctica continúe(AU)

Introduction: hyponatremia is the most common electrolytic abnormality in hospitalized patients. It is related to the administration of hypotonic fluids in patients with high levels of antidiuretic hormone. The most serious complication of hyponatremia is hyponatremic encephalopathy which can be fatal, or cause irreversible brain damage if not treated properly. Case presentation: a 6-month-old, eutrophic infant with health history and psychomotor development according to her age that was admitted in the Pediatric Hospital of Cienfuegos with the diagnosis of an acute diarrheal disease by rotavirus. It was decided to suspend the feeding and initiate maintenance hydration due to intolerance in the oral route. A solution based on 5 percent dextrose with 0.18 percent of NaCl was used. After 14 hours in the ward, the patient was transferred to Intensive Care due to convulsions, which were related to severe hyponatremia. Initially the sodium value was normal. The cranial tomography performed 13 days later showed signs of cortical atrophy. At the time of doing this work the girl was being followed in consultation of Physiatry and Neuropediatrics by a flabby quadriparesia. Conclusions: hypotonic fluids are still recommended as maintenance fluids in acutely ill patients, despite the strong association among their use and the development of hyponatremia. It is time to stop using hypotonic fluids in disease states associated with excess of antidiuretic hormone, because there is no reason for this practice to continue(AU)

Volumetría hipocampal: análisis comparativo de los métodos de evaluación en enfermedad de Alzheimer / Hippocampal Volumetry: Comparative Analysis of Evaluation Methods in Alzheimer's Disease

Objetivo La atrofia hipocampal es uno de los biomarcadores radiológicos más sensibles de la enfermedad de Alzheimer (EA) y existen diferentes métodos para evaluarla: análisis subjetivo visual (ASV), análisis objetivo manual (AOM) y análisis objetivo automático (AOA). Nos proponemos comparar esos métodos, y evaluar si el AOA presenta una confiabilidad cercana al AOM (método de referencia) y superior al ASV. Materiales y Métodos Se seleccionaron retrospectivamente imágenes de resonancia magnética (RM) fast spoiled gradient-echo (FSPGR) de 28 sujetos (14 con deterioro cognitivo leve, 7 con EAy 7 controles). El ASV fue realizado por 10 radiólogos, clasificando la atrofia hipocampal en: nula, leve, moderada o severa. El AOM se basó en la segmentación manual de los hipocampos por dos operadores. El AOA fue realizada por medio del software FreeSurfer 5.3. Se calcularon coeficientes de correlación rho de Spearman para las variables discretas y coeficientes de correlación intraclase para las variables continuas. Resultados Los coeficientes de correlación entre los dos operadores que realizaron el AOM fueron de 0,88 (p < 0,0001) para los hipocampos izquierdos y de 0,86 (p < 0,0001) para los hipocampos derechos. El coeficiente de correlación entre todos los ASV (promediados) y AOM fue de-0,81 (IC 95%-0,96- -0,66). Los coeficientes de correlación entre el AOA y el AOM fue de 0,54 (p < 0,0001) para los hipocampos izquierdos y de 0,61 (p < 0,0001) para los hipocampos derechos. Conclusión Si bien el AOA tiene moderada correlación con el método de referencia, no es superior al ASV promedio y se deberían tomar recaudos antes de ser implementado en la práctica asistencial.

Objective Hippocampal atrophy is one of the most sensible radiological biomarkers of Alzheimer's disease. There are different methods to evaluate atrophy: visual subjective analysis (VSA), manual objective analysis (MOA) and automatic objective analysis (AOA). We will compare these methods and evaluate if AOA has a confidence similar to MOA (gold standard), and better than VSA. Materials and Methods We retrospectively selected 3D FSPGR MRI from 28 subjects of whom 14 had mild cognitive impairment, 7 Alzheimer's disease and 7 controls. VSA was performed by 10 radiologists who classified hippocampal atrophy in none, mild, moderate and severe. ForMOA, two operatorsmanually segmented both hippocampus from all subjects. AOA was performed by FreeSurfer 5.3. Spearman's rho correlation coefficient was calculated for discrete variables and intraclass correlation coefficient was calculated for continuous variables. Results Correlation coefficients between the operators that performed MOA was 0.88 (p < 0.0001) for left hippocampi and 0.86 (p < 0,0001) for right hippocampi. Correlation coefficients between mean VSA and MOA was-0,81 (95% CI-0,96- -0,66). Correlation coefficients between AOA and AOM was 0.54 (p < 0.0001) for left hippocampi and 0.61 (p < 0.0001) for right hippocampi. Conclusion Even though AOA has moderate correlation with the gold standard it is not superior to average VSA and should be implemented with care in clinical practice.

Age-related cerebral ventricular volume changes in healthy elderly humans / Alterações volumétricas dos ventrículos cerebrais relacionadas a idade em idosos saudáveis

Introduction: Normal aging is associated with morphological alte-rations in brain. Ventricular system is located deep inside brain and reflect the overall process of parenchymal atrophy. Once neurode-generative disorders course with more prominent dilatation of brain ventricles, to establish normative volumetric parameters from Brazi-lian healthy old individuals is necessary, and it may be an additional tool on differentiation from the normal to pathological. Objective: To investigate brain ventricular volume changes in Brazilian healthy el-derly people. Methods: Transversal study using magnetic resonance imaging (1.5T) of the brain from 21 elderly healthy volunteers (67±6 years old). Data were assessed with manual segmentation techni-que. Regions of interest were the brain ventricles and intracranial volumes. Old (60-69 years old, 15 women) and Older (>69 years old) groups were created for analysis. Results: Volume of all ventricular compartments significantly increased (p<.001) with age, with excep-tion of the fourth ventricle. The third and lateral ventricles increased between groups 2.1- and 2.8-fold, respectively. Mean total ventricular volume was 1.2±.4% of intracranial volume in Old and 3.2±1.8% in Ol-der group (p<.001), which represents 15±6ml and 40±24ml (p=.001), respectively. We observed a moderate to strong positive correlation between ventricular volume and age, with the best correlation in the third ventricle (r=.710). Total intracranial volume diminished with age, but without statistical significance. Conclusions: Brain ventricles vo-lume increased significantly with age in healthy old individuals, with exception of the fourth ventricle. (AU)

Introdução: O envelhecimento normal está associado a alterações morfológicas do cérebro. O sistema ventricular está localizado pro-fundamente no encéfalo e reflete o processo global de atrofia do pa-rênquima. Uma vez que doenças neurodegenerativas cursam com dilatação mais proeminente dos ventrículos cerebrais, estabelecer parâmetros volumétricos de normalidade em nossa população idosa saudável se faz necessário, podendo ser uma ferramenta a mais para diferenciar o normal do patológico. Objetivo: Investigar alterações volumétricas dos ventrículos cerebrais em brasileiros idosos sau-dáveis. Métodos: Estudo transversal com imagens de ressonância magnética (1,5T) do encéfalo de 21 idosos saudáveis (68±6 anos, 15 mulheres). Os dados foram examinados por técnicas de segmenta-ção manual. As regiões de interesse foram os ventrículos cerebrais e o volume intracraniano. Criamos os subgrupos Idosos (60-69 anos) e Mais idosos (>69 anos) para a análise. Resultados: O volume de todos os ventrículos aumentou com a idade (p<0,001), com exceção do quarto ventrículo. O terceiro e os ventrículos laterais aumentaram 2,1 e 2,8 vezes, respectivamente, entre os grupos. O volume ventri-cular médio foi de 1,2±0,4% do volume intracraniano nos Idosos e de 3,2±1,8% nos mais idosos, o que representa 15±6ml e 40±24ml, respectivamente. Observamos correlação positiva de moderada a forte entre volume ventricular e idade, com a melhor correlação no terceiro ventrículo (r=0,710). O volume intracraniano diminui com a idade, sem significância estatística. Conclusão: os ventrículos cere-brais aumentam significativamente com o envelhecimento em idosos saudáveis, exceto o quarto ventrículo. (AU)

Critical analysis on the present methods for brain volume measurements in multiple sclerosis / Análise crítica dos métodos atuais para medidas de volume cerebral em esclerose múltipla

ABSTRACT Objective The treatment of multiple sclerosis (MS) has quickly evolved from a time when controlling clinical relapses would suffice, to the present day, when complete disease control is expected. Measurement of brain volume is still at an early stage to be indicative of therapeutic decisions in MS. Methods This paper provides a critical review of potential biases and artifacts in brain measurement in the follow-up of patients with MS. Results Clinical conditions (such as hydration or ovulation), time of the day, type of magnetic resonance machine (manufacturer and potency), brain volume artifacts and different platforms for volumetric assessment of the brain can induce variations that exceed the acceptable physiological rate of annual loss of brain volume. Conclusion Although potentially extremely valuable, brain volume measurement still has to be regarded with caution in MS.

RESUMO Objetivo O tratamento da esclerose múltipla (EM) evoluiu rapidamente de um tempo onde o controle clínico dos surtos era suficiente para o momento atual, quando se almeja o completo controle da doença. Medidas de volume cerebral ainda estão em fases iniciais para utilização nas decisões terapêuticas na EM. Métodos Este artigo fornece uma revisão crítica de potenciais vieses e artefatos na volumetria cerebral utilizada no seguimento de pacientes com EM. Resultados Condições clínicas (como hidratação ou ovulação), hora do dia, tipo de máquina de ressonância magnética (fabricante e força do campo) artefatos de volume e diferentes plataformas de avaliação volumétrica cerebral podem induzir variações que excedem a taxa aceitável de perda anual fisiológica do volume cerebral. Conclusão Embora seja potencialmente de grande valor, a medida de volume cerebral ainda deve ser vista com cautela na EM.

Smoking enhances age related brain atrophy--a quantitative study with computed tomography.

This is a prospective study done on Bangladeshi people during the period from January 1999 to December 2002. Cases were collected from the department of Medicine in Sir Salimullah Medical College, Dhaka; Sher-e-Bangla Medical College, Barisal and Bangabandhu Sheikh Mujib Medical University, Dhaka. We examined the chronic effect of smoking on brain atrophy quantitatively with Computed Tomography (CT). Study was performed on 219 smokers and same numbers of non-smokers from 40 to 70 years old with neither neurological nor focal abnormality in brain CT. Brain atrophy index (BAI) which was a quantitative marker of brain atrophy reported previously, was calculated from each brain CT. Smokers showed a significant increase in BAI compared to non-smokers in groups 50-54 years (p<0.01), 55-59 years (p<0.01), 60-64 years (p<0.05) and 65-70 years (p<0.05). It was suggested that age-related brain atrophy was increased by chronic smoking through advanced atherosclerosis.