Plasma Campesterol Is Positively Associated with Carotid Plaques in Asymptomatic Subjects.

BACKGROUND: Increased cholesterol absorption and reduced synthesis are processes that have been associated with cardiovascular disease risk in a controversial way. However, most of the studies involving markers of cholesterol synthesis and absorption include conditions, such as obesity, diabetes, dyslipidemia, which can be confounding factors. The present study aimed at investigating the relationships of plasma cholesterol synthesis and absorption markers with cardiovascular disease (CVD) risk factors, cIMT (carotid intima-media thickness), and the presence of carotid plaques in asymptomatic subjects. METHODS: A cross-sectional study was carried out in 270 asymptomatic individuals and anthropometrical parameters, fasting plasma lipids, glucometabolic profiles, high-sensitivity C-reactive protein (hs-CRP), markers of cholesterol synthesis (desmosterol and lathosterol), absorption (campesterol and sitosterol), cIMT, and the presence of atherosclerotic plaques were analyzed. RESULTS: Among the selected subjects aged between 19 and 75 years, 51% were females. Age, body mass index, systolic and diastolic blood pressure, total cholesterol, non-HDL-C, triglycerides, glucose, and lathosterol/sitosterol ratios correlated positively with cIMT (p ≤ 0.05). Atherosclerotic plaques were present in 19% of the subjects. A direct association of carotid plaques with campesterol, OR = 1.71 (95% CI = 1.04-2.82, p ≤ 0.05) and inverse associations with both ratios lathosterol/campesterol, OR = 0.29 (CI = 0.11-0.80, p ≤ 0.05) and lathosterol/sitosterol, OR = 0.45 (CI = 0.22-0.95, p ≤ 0.05) were observed in univariate logistic regression analysis. CONCLUSIONS: The findings suggested that campesterol may be associated with atherosclerotic plaques and the lathosterol/campesterol or sitosterol ratios suggested an inverse association. Furthermore, synthesis and absorption of cholesterol are inverse processes, and the absorption marker, campesterol, may reflect changes in body cholesterol homeostasis with atherogenic potential.

Parameters of 2-Dimensional Perineal Ultrasonography Before and After Male Sling Procedure for Urinary Incontinence After Radical Prostatectomy.

OBJECTIVE: To compare ultrasonographic patterns of 2-dimensional perineal ultrasonography in men in the preoperative and postoperative periods after transobturator sling deployment for the treatment of urinary incontinence after radical prostatectomy. Radiotherapy and radical prostatectomy are the primary treatments for localized prostate cancer. Studies comparing anatomic changes in men before and after radical prostatectomy based on perineal ultrasonography are scarce in the literature. METHODS: Thirty-one patients from 2 centers were selected for examination and surgery. They were allocated into mild and/or moderate and severe incontinence groups who underwent the transobturator sling procedure between August 2014 and August 2018. Perineal ultrasonography was performed in the preoperative period for 21 of these patients and 3-6 months postoperatively after the transobturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest. RESULTS: Clinical improvements of >50% were significantly more frequent in the mild and/or moderate vs severe incontinence group after male sling surgery (P = .035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck during contraction than those with clinical improvement <50% (P = .024). CONCLUSION: The most important finding of this study was the significant difference in the posterior displacement of the bladder neck during contraction in patients who showed an improvement >50% compared with those with an improvement <50%. These data support the use of perineal ultrasonography in evaluating and selecting patients for the male sling procedure.

Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study.

OBJECTIVE: To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. MATERIALS AND METHODS: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. RESULTS: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. CONCLUSION: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation.

OBJETIVO: Comparar a ultrassonografia duplex e a angiotomografia computadorizada no diagnóstico dos endoleaks e na medida do diâmetro do saco aneurismático no acompanhamento pós-operatório da correção endovascular do aneurisma de aorta abdominal. MATERIAIS E MÉTODOS: Foram estudados, prospectivamente, 30 doentes submetidos a correção endovascular de aneurismas de aorta infrarrenal e ilíacas. No seguimento pós-operatório foram realizadas ultrassonografia duplex e angiotomografia no mesmo intervalo de tempo, por radiologistas independentes. Foram avaliadas as medidas do saco aneurismático e a presença ou ausência de endoleaks. RESULTADOS: O diâmetro médio do saco aneurismático encontrado foi 6,09 ± 1,95 cm para a ultrassonografia duplex e 6,27 ± 2,16 cm para a angiotomografia, existindo correlação estatisticamente significante, com R = 0,88 e p < 0,01 (Pearson). Considerando a detecção de endoleaks, o valor preditivo negativo da ultrassonografia duplex (comparada à angiotomografia) foi 92,59% e a especificidade foi 96,15%. CONCLUSÃO: Os resultados demonstram pequena variação entre os métodos empregados, não comprometendo o manejo clínico. A ultrassonografia duplex poderia substituir a angiotomografia no acompanhamento pós-operatório da correção endovascular do aneurisma de aorta infrarrenal, com baixo custo, evitando potenciais complicações clínicas relacionadas ao uso de contraste iodado e exposição à radiação ionizante.

Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study / Estudo comparativo entre ultrassonografia duplex e angiotomografia no acompanhamento pós-operatório da correção endovascular de aneurismas do eixo aortoilíaco

Abstract Objective: To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation.

Resumo Objetivo: Comparar a ultrassonografia duplex e a angiotomografia computadorizada no diagnóstico dos endoleaks e na medida do diâmetro do saco aneurismático no acompanhamento pós-operatório da correção endovascular do aneurisma de aorta abdominal. Materiais e Métodos: Foram estudados, prospectivamente, 30 doentes submetidos a correção endovascular de aneurismas de aorta infrarrenal e ilíacas. No seguimento pós-operatório foram realizadas ultrassonografia duplex e angiotomografia no mesmo intervalo de tempo, por radiologistas independentes. Foram avaliadas as medidas do saco aneurismático e a presença ou ausência de endoleaks . Resultados: O diâmetro médio do saco aneurismático encontrado foi 6,09 ± 1,95 cm para a ultrassonografia duplex e 6,27 ± 2,16 cm para a angiotomografia, existindo correlação estatisticamente significante, com R = 0,88 e p < 0,01 (Pearson). Considerando a detecção de endoleaks , o valor preditivo negativo da ultrassonografia duplex (comparada à angiotomografia) foi 92,59% e a especificidade foi 96,15%. Conclusão: Os resultados demonstram pequena variação entre os métodos empregados, não comprometendo o manejo clínico. A ultrassonografia duplex poderia substituir a angiotomografia no acompanhamento pós-operatório da correção endovascular do aneurisma de aorta infrarrenal, com baixo custo, evitando potenciais complicações clínicas relacionadas ao uso de contraste iodado e exposição à radiação ionizante.

Influence of Insulin Resistance Status on the Development of Gallstones Following Roux-En-Y Gastric Bypass: a Prospective Cohort Study.

BACKGROUND: The occurrence of gallstones following Roux-en-Y gastric bypass (RYGB) has been extensively reported. As RYGB promotes improvement in insulin resistance (IR), which is one of the factors enrolled in the pathophysiology of gallstones, this study aims to determine the influence of IR and its post-RYGB course on the development of gallstones. METHODS: This is a prospective cohort study that enrolled 108 morbidly obese subjects free of gallstones which underwent RYGB and were followed up for 24 months, through clinical, laboratory, and ultrasound examinations. IR was assessed through the surrogate marker homeostasis model assessment (HOMA). RESULTS: Of the individuals evaluated, 29 (26.8%) developed gallstones following RYGB. In the univariate analysis, postsurgical gallstones were associated with preoperative HOMA (p < 0.0001), preoperative fasting glucose (p = 0.0019), preoperative fasting insulin (p = 0.0001), and preoperative triglycerides (p = 0.0001). Multivariate analysis revealed that preoperative HOMA was the only factor independently associated with gallstones (p < 0.0001). The incidence of gallstones among individuals with IR was 46.8%; in the non-IR subjects, the incidence was 7.4% (p < 0.0001). Preoperative IR led to a relative risk of 6.02 (95% CI = 2.1-17.3; p = 0.0009) of gallstones. CONCLUSIONS: As gallstones often occur following RYGB, there is controversy regarding their management. Some authors propose systematic cholecystectomy along with RYGB, while others suggest that the aggregate risk of the concomitant approach is significantly higher. As IR was a significant risk factor in this study, an individualized approach for this population may be proposed. Further research is needed to confirm these findings.

p.Q192R SNP of PON1 seems not to be Associated with Carotid Atherosclerosis Risk Factors in an Asymptomatic and Normolipidemic Brazilian Population Sample / O SNP p.Q192R da PON1 não Parece Associar-se a Fatores de Risco para a Aterosclerose Carotídea em Amostra de População Brasileira Normolipidêmica e Assintomática

Evidences suggest that paraoxonase 1 (PON1) confers important antioxidant and anti-inflammatory properties when associated with high-density lipoprotein (HDL).

p.Q192R SNP of PON1 seems not to be Associated with Carotid Atherosclerosis Risk Factors in an Asymptomatic and Normolipidemic Brazilian Population Sample.

BACKGROUND: Evidences suggest that paraoxonase 1 (PON1) confers important antioxidant and anti-inflammatory properties when associated with high-density lipoprotein (HDL). OBJECTIVE: To investigate the relationships between p.Q192R SNP of PON1, biochemical parameters and carotid atherosclerosis in an asymptomatic, normolipidemic Brazilian population sample. METHODS: We studied 584 volunteers (females n = 326, males n = 258; 19-75 years of age). Total genomic DNA was extracted and SNP was detected in the TaqMan® SNP OpenArray® genotyping platform (Applied Biosystems, Foster City, CA). Plasma lipoproteins and apolipoproteins were determined and PON1 activity was measured using paraoxon as a substrate. High-resolution ß-mode ultrasonography was used to measure cIMT and the presence of carotid atherosclerotic plaques in a subgroup of individuals (n = 317). RESULTS: The presence of p.192Q was associated with a significant increase in PON1 activity (RR = 12.30 (11.38); RQ = 46.96 (22.35); QQ = 85.35 (24.83) µmol/min; p < 0.0001), HDL-C (RR= 45 (37); RQ = 62 (39); QQ = 69 (29) mg/dL; p < 0.001) and apo A-I (RR = 140.76 ± 36.39; RQ = 147.62 ± 36.92; QQ = 147.49 ± 36.65 mg/dL; p = 0.019). Stepwise regression analysis revealed that heterozygous and p.192Q carriers influenced by 58% PON1 activity towards paraoxon. The univariate linear regression analysis demonstrated that p.Q192R SNP was not associated with mean cIMT; as a result, in the multiple regression analysis, no variables were selected with 5% significance. In logistic regression analysis, the studied parameters were not associated with the presence of carotid plaques. CONCLUSION: In low-risk individuals, the presence of the p.192Q variant of PON1 is associated with a beneficial plasma lipid profile but not with carotid atherosclerosis.

Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy.

INTRODUCTION: Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. MATERIALS AND METHODS: This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP) for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D) perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil. RESULTS: Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002). We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008). CONCLUSIONS: We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared.

Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy

Introduction Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. Materials and Methods This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP) for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D) perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil. Results Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002). We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008). Conclusions We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared. .

Follicular thyroid carcinoma metastasis to the internal jugular vein demonstrated by 131I SPECT/CT.

Cervical uptake detected by 131I whole body scintigraphy (131I-WBS) may be due to thyroid remnants or loco-regional metastases. We describe a patient with follicular carcinoma submitted to total thyroidectomy. 131I-WBS showed left cervical linear uptake and focal areas of uptake in the abdomen and pelvis. SPECT/CT images demonstrated a potential thrombus in the left jugular vein (confirmed by doppler neck ultrasound and MRI) as well as bone metastases. The patient was submitted to thrombectomy and histopathology confirmed metastasis of follicular carcinoma.

Digital rectal examination standardization for inexperienced hands: teaching medical students.

Objectives. To standardize digital rectal examination (DRE) and set how it correlates with the comprehensive evaluation of lower urinary tract symptoms (LUTS). Methods. After scaled standardization of DRE based on fingertips graphical schema: 10 cubic centimeters-cc for each fingertip prostate surface area on DRE, four randomly selected senior medical students examined 48 male patients presenting with LUTS in an outpatient clinical setting, totaling 12 DRE each. Standardized DRE, international prostate symptom score (IPSS), serum PSA, transabdominal ultrasound (US), urodynamic evaluation, and postvoid residue were compared. Results. The mean and median PVs were US-45 and 34.7 cc (5.5 to 155) and DRE-39 and 37.5 cc (15 to 80). Comparing DRE and US by simple linear regression: US PV = 11.93 + 0.85 × (DRE PV); P = 0.0009. Among patients classified as nonobstructed, inconclusive, and obstructed, the US PVs were 29.8, 43.2, and 53.6 cc (P = 0.033), and DRE PVs were 20, 35, and 60 cc (P = 0.026), respectively. Conclusion. This is the first attempt to DRE standardization focusing on teaching-learning process, establishing a linear correlation of DRE and US PVs with only 12 examinations by inexperienced hands, satisfactorily validated in an outpatient clinical setting.

Visceral fat resection in humans: effect on insulin sensitivity, beta-cell function, adipokines, and inflammatory markers.

OBJECTIVE: The visceral fat is linked to insulin resistance, the metabolic syndrome, type 2 diabetes and an increased cardiovascular risk, but it is not clear whether it has a causative role. DESIGN AND METHODS: Surgical resection of this fat depot is a research model to address this issue. Twenty premenopausal women with metabolic syndrome and grade III obesity were randomized to undergo Roux-en-Y gastric bypass (RYGBP) either alone or combined with omentectomy. Insulin sensitivity (IS; euglycemic-hyperinsulinemic clamp), acute insulin response to glucose (AIR; intravenous glucose tolerance test), disposition index (DI = AIR × IS measured by clamp), lipid profile, adipokine profile (leptin, adiponectin, resistin, visfatin, interleukin-6, TNF-α, MCP-1), ultra-sensitive C-reactive protein (CRP), body composition, and abdominal fat echography were assessed prior to surgery and 1, 6, and 12 months post-surgery. RESULTS: Omentectomy was associated with greater weight loss at all time points. IS improved similarly in both groups. Omentectomy was associated to lower CRP after 12 months, but it did not influence adipokines and other metabolic parameters. Among non-diabetic subjects, omentectomy was associated with a preservation of baseline AIR after 12 months (as opposed to deterioration in the control group) and a greater DI after 6 and 12 months. CONCLUSION: Although omentectomy did not enhance the effect of RYGBP on insulin sensitivity and adipokines, it was associated with a preservation of insulin secretion, a greater weight loss, and lower CRP.

Development of a clinical laboratory data base of hyper and hypo alpha lipoproteins in Campinas-SP and neighboring region / Construção de um banco de dados clínico laboratorial de hiper e hipoalfalipoproteinêmicos em Campinas-SP e região

INTRODUCTION: The development of research for diagnosis, prevention and treatment of atherosclerotic cardiovascular disease is of utmost importance due to the fact that it is the main cause of morbidity and mortality in Brazil. OBJECTIVE: To demonstrate the phases of the selection process for candidates with the aim to develop a clinical-laboratorial database of hyper alpha lipoproteinemic patients (hyper A) - high density lipoprotein cholesterol (HDL-C) ≥ 68 mg/dl) and hypo alpha lipoproteinemic patients (hypo A) - HDL-C < 39 mg/dl. MATERIAL AND METHODS: The volunteers were contacted after selection of lipid profiles from individuals treated at the Sistema Único de Saúde (SUS), Campinas-SP and neighboring area. Afterwards, the selected patients went through blood collection, clinical examinations and answered questionnaires on dietary frequency and physical activity. After this preliminary evaluation, some individuals were convened to another blood collection and, subsequently, were submitted to an ultrasonographic exam of the carotid arteries. RESULTS: Only 0.6% and 0.3% from 598,288 lipid profiles were selected for hyper A and hypo A groups, respectively, including gender disparity. Lack of effective questionnaires (75%), missing calls (60%) and non-inclusion were the major hindrances in the construction of this database. DISCUSSION: The difficulties to obtain eligible candidates were also due to the low prevalence of both groups hypo A and hyper A and the high prevalence of pathologies that contribute to non-genetic variations of HDL-C. CONCLUSION: In spite of the obstacles in the development of this database, this study brought about several scientific publications. Furthermore, the development of molecular analyzes and functionality will shortly generate other findings, contributing to the diagnosis and follow-up of HDL dyslipidemias.

INTRODUÇÃO: O desenvolvimento de pesquisa para diagnóstico e prevenção da doença aterosclerótica cardiovascular no Brasil é de grande importância por esta ser a principal causa de morbimortalidade no país. OBJETIVO: Demonstrar as etapas do processo de seleção de voluntários para a construção de um banco de dados clínico-laboratorial de indivíduos hiperalfalipoproteinêmicos (hiper A) - colesterol da lipoproteína de alta densidade (HDL-C) ≥ 68 mg/dl - e hipoalfalipoproteinêmicos (hipo A) - HDL-C < 39 mg/dl. MATERIAL E MÉTODOS: Os voluntários são contatados a partir de resultados de perfis lipídicos de indivíduos atendidos pelo Sistema Único de Saúde (SUS) de Campinas-SP e região e, se selecionados, são convidados para coleta de sangue, exames clínicos e responder a questionários de atividade física e de frequência alimentar. Após essa avaliação, os indivíduos podem ser convocados para nova coleta de sangue e, posteriormente, para a ultrassonografia de carótidas. RESULTADOS: Entre 598.288 perfis lipídicos recebidos das redes públicas, apenas 0,6% e 0,3% compuseram os nossos grupos hiper A e hipo A, com disparidade entre os gêneros. A falta de questionários efetivos (75%), das chamadas não atendidas (60%) e a não inclusão foram os pontos mais difíceis na construção do banco de dados. DISCUSSÃO: A dificuldade de obtenção de voluntários elegíveis também se deve à baixa prevalência de hipo A e hiper A e à alta prevalência de patologias que contribuem para variações não genéticas do HDL-C. CONCLUSÃO: Apesar das dificuldades na criação da base de dados, este estudo gerou várias publicações e, com o desenvolvimento das análises moleculares e da funcionalidade, muitas outras seguirão em curto período, fatos contribuintes para o diagnóstico e o acompanhamento das dislipidemias envolvendo a HDL.

Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction.

OBJECTIVE: Pressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO). A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO. MATERIALS AND METHODS: Patients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOOI). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The IPP was classified into three stages: grade I under 5 mm; grade II, between 5 and 10 mm; and grade III over 10 mm. RESULTS: Forty-two patients, mean age 64.8 +/- 8.5 years were enrolled. Transabdominal ultrasound determined a mean prostatic volume of 45 +/- 3.2 mL. Achieved IPP's values were the following: grade I - 12 (28.5%), grade II - 5 - (12%) and grade III - 25 (59.5%). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0.016). For IPP, the area under ROC curve was 0.758 (95% confidence interval - 0.601 to 0.876), and the cutoff point to indicate BOO was 5 mm with 95 % sensitivity (75.1 - 99.2) and 50 % specificity (28.2 - 71.8). CONCLUSION: IPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.

Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction

OBJECTIVE: Pressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO). A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO. MATERIALS AND METHODS: Patients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOOI). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The IPP was classified into three stages: grade I under 5 mm; grade II, between 5 and 10 mm; and grade III over 10 mm. RESULTS: Forty-two patients, mean age 64.8 ± 8.5 years were enrolled. Transabdominal ultrasound determined a mean prostatic volume of 45 ± 3.2 mL. Achieved IPP's values were the following: grade I - 12 (28.5 percent), grade II - 5 - (12 percent) and grade III - 25 (59.5 percent). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0.016). For IPP, the area under ROC curve was 0.758 (95 percent confidence interval - 0.601 to 0.876), and the cutoff point to indicate BOO was 5 mm with 95 percent sensitivity (75.1 - 99.2) and 50 percent specificity (28.2 - 71.8). CONCLUSION: IPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.

Extent of prostatic atrophy in needle biopsies and serum PSA levels: is there an association?

OBJECTIVES: Prostatic atrophy is one of the most frequent benign mimics of prostate adenocarcinoma. Regardless of the cause, we hypothesized that damaged epithelial cells in the atrophic acini could be a source of the elevation of serum prostate-specific antigen (PSA). The aim of this study was to find any possible association between the extent of prostatic atrophy in needle biopsies and serum PSA level. METHODS: The study was based on 131 needle prostatic biopsies corresponding to 107 patients. The only diagnosis in all biopsies was focal prostatic atrophy without the presence of cancer, high-grade prostatic intraepithelial neoplasia, or areas suspicious for cancer. The extent of atrophy was measured in two ways: the linear extent in millimeters and the percentage of linear extent showing atrophy for each biopsy. Spearman's coefficient of rank correlation was used to evaluate the association of atrophy extent with total and free serum PSA levels. RESULTS: A positive and statistically significant correlation was found between the linear atrophy extent and the total serum PSA level (r = 0.25, P = <0.01) and free PSA level (r = 0.23, P = 0.01). A positive and statistically significant correlation was found between the percentage of the linear extent showing atrophy and the total serum PSA level (r = 0.23, P = 0.01) and free PSA level (r = 0.20, P = 0.02). CONCLUSIONS: A positive and significant association was found between the extent of atrophy and the total or free serum PSA elevation. The findings suggest that damaged epithelial cells in atrophic acini, regardless of cause, could be a source of serum PSA elevation.

Estudo de 50 casos por tomografia computadorizada de lesões hipodensas hepáticas fundamentais na infância / Computed tomographic study of 50 patients with hypodense hepatic injuries in childhood

OBJETIVO: Relatar os diferentes aspectos tomográficos das lesões hepáticas hipodensas na infância, orientando às diferentes possibilidades diagnósticas. MATERIAIS E MÉTODOS: Foram realizados estudos tomográficos de lesões hipodensas hepáticas previamente diagnosticadas à ultra-sonografia em 50 pacientes pediátricos (0-16 anos). As imagens foram obtidas antes e após a administração de contraste venoso. Os aspectos de imagem foram analisados e correlacionados posteriormente com o diagnóstico anatomopatológico. RESULTADOS: Dos 50 casos estudados, 47 foram confirmados, 30 destes por estudo anatomopatológico. A maioria das lesões era benigna, sendo o hemangioma o mais freqüente (20 por cento dos casos). Tais lesões apresentaram captação homogênea do meio de contraste, principalmente na fase tardia, diferenciando assim das malignas. As lesões malignas mais freqüentes foram as metástases (18 por cento). CONCLUSAO: O presente estudo constatou que o exame tomográfico, antes e após a administração do contraste venoso, dinâmico e/ou helicoidal, foi de grande valia para a complementação da hipótese diagnóstica nas lesões hipodensas hepáticas na infância, devendo ser rotina após diagnóstico ultra-sonográfico.

Aumento da transparência pulmonar na infância: ensaio iconográfico / Increased radiolucency of the lungs in infancy: iconographic essay

Assimetrias torácicas representadas pelo aumento da transparência pulmonar são causas importantes de morbidade na populacão pediátrica. A avaliacão dos pacientes afetados freqüentemente requer múltiplas modalidades de imagem para diagnosticar a anomalia e planejar a correcão cirúrgica. Os autores analisam e ilustram os aspectos de assimetrias torácicas comuns e raras, com ênfase nas manifestacões radiológicas. A aplicabilidade das diversas modalidades de imagem no diagnóstico e tratamento é avaliada. Diagnósticos diferenciais, assim como armadilhas e dificuldades diagnósticas, são incluídas.

Percutaneous cholecystostomy: a nonsurgical therapeutic option for acute cholecystitis in high-risk and critically ill patients.

Percutaneous cholecystostomy offers a potentially important type of therapy for critically ill patients with acute cholecystitis who present high risk when undergoing laparotomy or laparoscopy under general anesthesia. It offers a distinct advantage for these kinds of patients by avoiding the risks of the surgical intervention. Percutaneous cholecystostomy is a safe and effective minimally invasive procedure with a high success rate and low procedure-related complications. It should be considered not only in temporary management of calculous cholecystitis, but also in definitive treatment in cases of acalculous cholecystitis.

Percutaneous cholecystostomy: a nonsurgical therapeutic option for acute cholecystitis in high-risk and critically ill patients

A colecistostomia percutânea é uma modalidade terapêutica potencialmente importante a ser considerada em pacientes em estado grave com colecistite aguda, que estão sob alto risco ao serem submetidos a laparotomia ou a laparoscopia sob anestesia geral. A colecistostomia pecutânea oferece vantagens neste tipo de paciente por evitar os riscos cirúrgicos da colecistectomia. A colecistostomia percutânea é procedimento seguro, minimamente invasivo e efetivo, com alta taxa de sucesso e com pequeno número de complicações relacionadas ao procedimento. Deve ser considerada não apenas como tratamento temporário da colecistite calculosa, mas também como tratamento definitivo nos casos de colecistite acalculosa.