Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in colorectal liver metastasis: the radiologist's perspective.

PURPOSE: Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastasis (CRLM). Many multidisciplinary approaches, including the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, have been proposed to increase the resectability rate in these patients. ALPPS is the most recently described staged liver resection technique, representing an advantageous strategy to induce a rapid and marked increase in the future liver remnant (FLR) volume. The aim of this article is to describe the radiological evaluation of this procedure and its variation. METHODS: This retrospective study included 9 patients with CRLM who underwent the ALPPS procedure. Abdominal imaging studies were reviewed, with an emphasis on a rational radiological approach. The number of liver metastases, the FLR volume (pre- and postportal vein ligation), anatomical variations, potential pitfalls related to disease progression, and postoperative complications were evaluated. RESULTS: The types of hepatic resection included 4 classical ALPPS cases, 3 right ALPPS variations, and 2 left ALPPS variations. The mean FLR volume calculated in the initial evaluation was 453 mL (213-790 mL). Following the first surgery, the mean FLR volume increased to 634 mL (410-957 mL), which indicated a mean volume increase of 181.1 mL (95% CI 149.7-212.5 mL; p < 0.001) and a mean absolute volume increase of 48% (19%-88%). CONCLUSION: The ALPPS procedure is an emerging form of two-stage hepatectomy. In this context, radiologists should provide crucial preoperative and perioperative information that may change surgical planning and contribute to an improvement in the oncologic outcome.

The assessment of round lytic lesions in sternotomies.

OBJECTIVE: The aims of this study were to define imaging findings and to identify any predisposing factors for the development of the round lytic lesion across the margins of sternotomy during the process of bone healing. METHODS: We searched all chest CT scans performed between 2007 and 2012 and selected patients who had three studies performed in the recent, late and latest post-operative periods. Patients presenting any complications related to wound healing were excluded from the study. CT features of the sternotomy and possible instability factors were assessed. RESULTS: From 15689 chest CT images analysed, 68 patients fulfilled the criteria. The development of a round lytic lesion was observed in 35 and 39 patients in the late and latest post-operative periods, respectively, and there was an association between mild misalignment of margins in the recent post-operative period and the development of a round lesion in the follow-up periods (p=0.010 and p=0.002, respectively). CONCLUSION: Sternotomies exhibit a delayed and unusual pattern of bone healing, and minimal instability factors during bone closure could trigger the development of a lytic lesion that is part of the normal healing process. ADVANCES IN KNOWLEDGE: This lytic bone lesion is part of the bone healing, and its appearance should not be mistaken as infection or malignancy, even in a suggestive clinical setting.

The effect of paramagnetic contrast in choline peak in patients with glioblastoma multiforme might not be significant.

BACKGROUND AND PURPOSE: (1)H-MR spectroscopy is a useful tool in brain tumor evaluation. A critical point in obtaining representative spectra is the correct voxel positioning, which can be more accurate after Gd administration. Some experimental data suggested that Gd could cause Cho signal loss. Our aim was to evaluate the effect of Gd in the Cho peak area and width in patients with GBM. MATERIALS AND METHODS: We performed multivoxel (1)H-MR spectroscopy before and after Gd administration in 18 patients with GBM. Quantification of Cho peak area and width in each voxel was completed, and the Cho mean and maximum values before and after Gd injection were calculated in the tumor and contralateral hemisphere. Choline peak area and width values obtained before and after contrast were compared, considering as separate entities enhancing and nonenhancing tumoral voxels and the contralateral hemisphere. RESULTS: No statistically significant differences were found for the Cho peak area mean values in the tumoral voxels or contralaterally (P > .05). A tendency for an increase in the Cho peak width mean value was found in the tumoral enhancing voxels (P = .055). A statistically significant decrease was found for the mean value of the maximum Cho peak area in enhancing tumoral voxels (P = .020). No significant differences were found in the nonenhancing tumoral voxels or contralaterally (P > .05). CONCLUSIONS: The injection of Gd before performing (1)H-MR spectroscopy might not significantly affect the Cho peak area in patients with GBM. The paramagnetic contrast seems to cause a different effect, depending on Gd enhancement.

Transcranial duplex doppler ultrasonography in dogs with hydrocephalus / Ultrassonografia duplex Doppler transcraniana em cães com hidrocefalia

Transcranial duplex Doppler ultrasound was performed in 32 conscious dogs presenting ventriculomegaly detected in B-mode, obtaining measures of lateral ventricles and resistance parameters of main cerebral arteries before and after 30 days of clinical treatment. The animals were distributed divided in two groups: group 1, dogs that presented remission or decrease of the neurological signs of the disease after clinical therapy; and group 2, dogs that displayed worsening of the neurological signs or clinical stability. The data were all presented in tables and were submitted to paired t test and to logistic regression models to evaluate the influence of the RI reduction on both groups. There was no significant influence of the variables in the B-mode. After the treatment, the mean resistive index (RI) was significantly lower for the group that presented clinical improvement. There was no significant difference of the mean RI reduction for the same artery when the right and left sides were compared. It could be concluded that transcranial duplex Doppler ultrasound is a method of cerebral hemodynamic assessment able to monitor more precisely the treatment of hydrocephalus in dogs and verify the responses.

Foi realizada a ultrassonografia duplex Doppler transcraniana em 32 cães, conscientes, que apresentavam ventriculomegalia previamente detectada ao exame modo-B, para obter as medidas dos ventrículos laterais e os parâmetros de resistência das artérias cerebrais antes e depois de 30 dias de tratamento clínico. Os animais foram distribuídos em dois grupos: 1 - formado por cães que apresentaram remissão ou diminuição dos sinais clínicos após tratamento; 2 - por cães que apresentaram piora dos sinais neurológicos ou estabilidade do quadro clínico. Todos os dados foram dispostos em tabelas e submetidos ao teste t pareado e a modelos de regressão logística para avaliar a influência da redução do índice de resistividade (IR). Não foi observada influência das variáveis em modo-B. Após o tratamento, a média do IR foi significantemente menor para o grupo que apresentou melhora clínica; não houve diferença significativa da média de redução do IR para a mesma artéria quando comparados os lados direito e esquerdo. Concluiu-se que o duplex Doppler transcraniano é um métodos de avaliação hemodinâmica capaz de monitorar mais precisamente o tratamento da hidrocefalia em cães e verificar a resposta dos pacientes.

Ultra-sonografia transcraniana em cães com distúrbios neurológicos de origem central / Transcranial ultrasonography in dogs with central neurologycal disorders

Avaliaram-se 55 cães com distúrbios neurológicos e verificou-se a ocorrência de afecções neurológicas de origem central, detectadas pela ultra-sonografia transcraniana (USTC). Vinte e nove (52,9 por cento) animais apresentaram diagnóstico compatível com hidrocefalia, e destes, 16 (55,1 por cento) eram fêmeas e 15 (51,7 por cento) tinham menos de dois anos. Quinze (27,3 por cento) cães apresentaram lesões focais, quatro (7,2 por cento), alterações difusas e quatro (7,2 por cento) apresentavam imagens sugestivas de lissencefalia; em três (5,4 por cento) não foram detectadas alterações pela USTC. A hidrocefalia foi o distúrbio neurológico de origem central mais freqüente e a USTC é uma alternativa viável para auxiliar na rotina clínica veterinária como ferramenta diagnóstica na detecção de alterações morfológicas e estruturais do cérebro no cão

In this work, 55 dogs with neurologycal disorder were examined and central neurological affections were detected by transcranial ultrasonography (TCUS). They were classifyed in hydrocephaly, lissencephaly, focal and difuse parenchimal disorders, and none changes. From the examinated dogs, 52.9 percent presented diagnosis compatible with hydrocephaly, being 55.1 percent female and 51.7 percent younger than 2 year-old. Fifteen dogs (27.3 percent) presented focal lesions, 7.2 percent diffuse lesions, 7.2 percent images that suggested lissencephaly, and in 5.4 percent no changes were detected by TCUS. It was concluded that hydrocephaly was the most frequent central neurologycal disorder and TCUS is a valuable alternative to be used in clinical routine as a tool of diagnostic to detect morphological and structural cerebral disorders in dogs

Reference values for Doppler ultrasound parameters of the thyroid in a healthy iodine-non-deficient population.

The aim of this study was to describe normal Doppler parameter values in the thyroid arteries in an iodine-replete region. 165 individuals were randomly selected in a community located in the south-east of Brazil. We obtained a clinical history on each subject and determined serum thyrotropin, antiperoxidase antibodies, thyrotropin receptor antibody (TRAb) and thyroid volumes through ultrasound. Subjects with thyroid disease and those under 20 years of age were excluded. 84 representative subjects (30 men and 54 women) remained. The systolic peak velocity (SPV), resistive index (RI) and pulsatility index (PI) in the superior and inferior thyroid arteries were measured using a 5-12 MHz linear probe. Except for the RI, the distribution of all Doppler parameters was non-gaussian. The median and mean references for the SPV, RI and PI were 24.80 cm s(-1) and 25.85 cm s(-1), 0.60 and 0.62, and 0.98 and 1.04, respectively, for superior thyroid arteries; these reference values for the inferior thyroid artery were 20.92 cm s(-1) and 21.50 cm s(-1), 0.57 and 0.57, and 0.84 and 0.88, respectively (p<0.001). Women had greater SPV values (p<0.01). We have determined reference thyroid Doppler parameter values in our iodine-non-deficient population and prepared tables by sex and age.

Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament.

AIM: To evaluate the cross-sectional area of the median nerve using ultrasound in carpal tunnel syndrome patients before and after endoscopic intervention. MATERIAL AND METHODS: Twenty patients with carpal tunnel syndrome (15 women and five men; mean age 55 years) were prospectively evaluated. Informed consent was obtained from all participants. The study was approved by our Institutional Review Board (IRB). Median nerve cross-sectional area was evaluated at the proximal level before and at 4, 8, and 12 weeks after endoscopic release of the transverse ligament. In the present study, the median nerve cross-sectional area cut-off point was 10 mm(2). Repeated measures analysis of variance test (ANOVA) was applied to compare the reproducibility of ultrasound measurements before and after intervention. RESULTS: The mean cross-sectional area of the median nerve was 15 mm(2) (SD+/-2.1) before surgery; and 11.1 mm(2) (SD+/-3); 9.2 mm(2) (SD+/-2); and 8.6 mm(2) (SD+/-1.6) at 4, 8, and 12 weeks after surgery. Repeated measures analyses of variance were found to be statistically significant (p<0.001). CONCLUSION: The results of the present study demonstrated that there was a decrease in the cross-sectional area of the median nerve after the release of the transverse carpal ligament.

Differentiation between the two types of amiodarone-associated thyrotoxicosis using duplex and amplitude Doppler sonography.

PURPOSE: To evaluate the usefulness of Doppler parameters in the differentiation between the two types of amiodarone-associated thyrotoxicosis (AAT). MATERIAL AND METHODS: One hundred thirty-seven individuals were selected at our institution. They were divided into four groups: 84 normal subjects (N), 30 euthyroids taking amiodarone (A), 14 AAT type 1 patients (AAT1), and nine AAT type 2 patients (AAT2). Each AAT type was classified according to (131)I uptake and clinical outcome. Blindly, the resistance and pulsatility indexes (RI, PI), systolic peak velocity, and color pixel density (CPD) were calculated. RESULTS: AAT1 had greater CPD than AAT2 (P = 0.02). The latter group had similar vascularization to the N and A groups (P = 0.45). The area under the receiver operating characteristic (ROC) curve showed that systolic peak velocity in the inferior thyroid arteries and CPD were the best parameters in the differentiation between AAT type 1 and AAT type 2 (Az = 0.83 and 0.84, respectively). Impedance indexes were useless. CONCLUSION: Our results demonstrate that objective tests such as systolic peak velocities in the thyroid arteries and CPD are reliable parameters for differentiating between the two types of AAT.

The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis, paracoccidioidomycosis: a predominantly multifocal disease.

The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.

[MRI sequences in the detection of cavernous angiomas]. / Séquences de résonance magnétique dans la détection de cavernomes.

We prospectively evaluated 30 patients with CNS cavernous angioma with a high field (1.5T) magnetic resonance imager. In all patients the MRI protocol included: gradient echo T1*-weighted imaging, spin echo T2*-weighted imaging and gradient echo T2*-weighted imaging. We evaluated each case for the number of lesions detected on each sequence. Gradient echo T2*-weighted imaging with a long TE (TE: 35ms) was the most sensitive sequence for the detection of cavernous angiomas allowing detection of small lesions that were not identified on the other sequences.

Correlation between osteochondral changes depicted by magnetic resonance imaging and disease progression.

PURPOSE: To determine the consequences of the chronic use of systemic corticosteroids in children with juvenile rheumatoid arthritis by means of evaluating osteochondral effects depicted by magnetic resonance imaging. PATIENTS AND METHODS: We reviewed clinical and magnetic resonance imaging findings in 69 children (72 knees) with juvenile rheumatoid arthritis. Two groups were studied. Group I: 34 (49.3%) children had previous or current use of systemic corticotherapy (22 girls; 12 boys; mean age: 11.3 years; mean disease duration: 5.9 years; mean corticotherapy duration: 2.9 years; mean cumulative dose of previous corticosteroids: 5000 mg); Group II: 35 (50.7%) children had no previous use of corticosteroids (27 girls; 8 boys; mean age: 11.7 years; mean disease duration: 5.3 years). The groups were compared statistically. RESULTS: In the group that had received corticotherapy (Group I), osteochondral abnormalities were significantly correlated to long-standing disease (>3.5 years; p<0.001). This correlation was not found in the group that had no previous history of corticotherapy (Group II). No correlations were established between median dose of corticosteroids and magnetic resonance imaging findings. CONCLUSION: It is important to further investigate the long-term intra-articular effects of systemic corticotherapy to ensure that the side effects of the aggressive therapy will not be more harmful for the joints than the symptoms suffered over the natural course of the disease.

[Hepatosplenic schistosomiasis portal hypertension: effect of esophagogastric devascularization with splenectomy on the diameter and mean flow velocity in the portal system (ultra-sonographic Doppler]. / Hipertensão portal por esquistossomose mansônica hepatoesplênica: efeito da desconexão ázigo-portal com esplenectomia no diâmetro e na velocidade média de fluxo do sistema portal (estudo ultra-sonográfico com Doppler).

BACKGROUND: Esophagogastric devascularization with splenectomy has been used for the treatment of upper digestive bleeding due to esophagic varices in hepatoportal mansoni's schistosomic portal hypertension. Nevertheless, early portal thrombosis has hampered this surgical technique (13.3% and 53.2%), compromising the good results on the hemorrhagic side. Supposing that portal circulatory changes, due to the surgical treatment, may play an important role in this kind of complication, our objective was to identify the hemodynamic facilitating factors. Portal hemodynamic aspects, identified by ultra-sonographic Doppler study, from two groups of patients: non-operated upon and splenectomized with esophagogastric devascularization in late post-operatory phase (in excess of 6 moths), with portal hypertension due to mansoni hepatoesplenic portal hypertension and in similar clinical conditions, were compared. METHOD: Fifty eight ambulatorial patients were studied, all had portal hypertension caused by mansoni's hepatosplenic schistosomiasis and previous bouts of digestive bleeding. They were divided in two groups: A--29 followed clinically/endoscopically, and group B--29 previously submitted to esophagogastric devascularization with splenectomy. In all was measured the diameter and mean flow velocity in the portal vein and its right and left branches by ultra-sonographic Doppler study. The results were submitted to statistical analysis for inter- and intra-group comparison. RESULTS: Group A (non-operated): the portal vein diameter was greater than the right and left branches (10.6 +/- 2.9, 8.0 +/- 1.8, 9.1 +/- 2.6 cm), the mean flow velocities in the portal vein and its branches were similar (15.62 +/- 6.17, 14.92 +/- 5.33, 16.12 +/- 4.18 cm/seg). Group B (operated): the diameter and mean flow velocity in all vessels were reduced (8.8 +/- 1.7, 5.2 +/- 1.2, 7.5 +/- 2.2 cm/12.53 +/- 2.60, 8.86 +/- 1.75, 9.69 +/- 3.75 cm/seg). CONCLUSIONS: After esophagogastric devascularization with splenectomy, there was a reduction of the diameter and mean flow velocity in the portal vein, its right and left branches.

Juvenile rheumatoid arthritis of the knee: evaluation with contrast-enhanced color Doppler ultrasound.

BACKGROUND: Contrast-enhanced color Doppler ultrasonography is a non-radiation-bearing tool that can be of value for assessment of inflammatory and vascular synovial changes in juvenile rheumatoid arthritis (JRA). OBJECTIVES: To evaluate the effect of contrast-enhanced color Doppler ultrasound (US) in the evaluation of synovial changes in the knees of children with JRA. MATERIALS AND METHODS: Sagittal color Doppler sonograms of 31 knees in 22 patients with JRA and of 10 knees in 5 control subjects were obtained before (at baseline) and after (at peak contrast phase) intravenous injection of SHU 508. Images were assessed for overall mean pixel intensity within the synovial tissue and for peak enhancement ratios [[(mean pixel intensity values at maximum contrast enhancement-unenhanced mean pixel intensity values)/unenhanced mean pixel intensity values] x 100]. The joints were classified into three groups by clinical/laboratory criteria: group A (active disease in the knee), n = 9; group B (quiescent disease with serum chemistry levels of active disease), n = 12 and group C (remission disease), n = 10. RESULTS: Mean color pixel intensity values were markedly increased by the use of US contrast agents in groups A (P = 0.004) and B (P = 0.0001), did not reach statistical significance in group C (P = 0.06) and remained essentially unchanged in the control group (P = 0.25). Enhancement ratios for the three groups of JRA patients were not different (P = 0.38) (mean +/- SD, 720% +/- 402 for group A, 731% +/- 703 for group B and 314% +/- 263 for group C). CONCLUSION: Contrast-enhanced color Doppler imaging holds promise for the detection of active synovial inflammatory disease in subclinical cases of JRA, thereby allowing earlier treatment and improved clinical outcome.

Doppler mapping of direct carotid-cavernous fistulae (DCCF).

The aims of this study were to establish Doppler criteria for identifying direct carotid-cavernous fistulae (DCCF), as well as the level of agreement between results obtained by Doppler mapping vs. angiography. Doppler mapping and angiography were used to assess the direction of flow in the superior ophthalmic veins and the resistivity index in the internal carotid arteries of 30 patients with DCCF. Both methods independently demonstrated reverse flow in superior ophthalmic vein ipsilateral to the DCCF in 22 patients and normal flow in another four. The mean resistivity index for internal carotid arteries with ipsilateral DCCF was significantly reduced (p = 0.0001) compared with that for contralateral internal carotid arteries without DCCF. A resistivity index value of 0.495 offered a sensitivity and specificity of 86.6% in diagnosing ipsilateral DCCF. These findings suggest that a resistivity index < 0.495 in the ipsilateral internal carotid artery, with or without reverse flow in the superior ophthalmic vein, is associated with a reasonable probability of diagnosing DCCF.

Contribution of Doppler echocardiography to the evaluation of systolic and diastolic function of obese women versus a control group.

OBJECTIVE: To study by doppler echocardiography the cardiac systolic and diastolic functions of health, uncomplicated obese subjects. METHODS: Fifty-nine obese women with an average body mass index (BMI) of 35 kg/m2 were evaluated and compared with 19 subjects with an average BMI of 23 kg/m2 (control group). RESULTS: In the obese group, a clear tendency was observed toward higher systolic pressure, increased wall thickness and, consequently, myocardial mass, elevation on the circumference stress of the left ventricular wall, and an indisputable presence of diastolic abnormalities. Filling abnormalities were observed with impaired relaxation, with prolonged isovolumic relaxation time (IVRT) and augmented atrium contribution representing early indexes of cardiac dysfunction when systolic performance is still normal. CONCLUSION: Obesity is generally a chronic condition, and doppler echocardiography can be used as a noninvasive instrument for early evaluation of left ventricular diastolic indexes.

Cutaneous myiasis of the breast: mammographic and us features-report of five cases.

Five patients with breast myiasis underwent mammography, and three also underwent ultrasonography (US). Mammography revealed indistinct masses in all patients, with associated pairs of microcalcifications in three. US showed each larva as a fusiform hyperechoic mass surrounded by a hypoechoic halo, which included larval movement in one patient. These imaging features of breast myiasis facilitate correct diagnosis.

The value of teaching sectional anatomy to improve CT scan interpretation.

A specific course on sectional anatomy was developed to help medical students improve their knowledge of cross-sectional imaging. The educational methodology consists of identifying anatomical structures displayed in plastinated sections from human cadavers and corresponding anatomical structures in computed tomography (CT) sections from healthy patients. The course has a self-study format. To assess and verify the impact of learning sectional anatomy on radiological knowledge, students were asked to identify ten anatomical structures in CT images. This test was applied to two groups of students: Group I had been taught sectional anatomy with CT images 2 years before the test; Group II had not received instruction in sectional anatomy prior to the test. Analysis of the results revealed a significant difference in test scores (median percentages of correctly identified structures) between Group I and Group II, with scores of 100% and 63.4%, respectively. These results provide evidence that the inclusion of sectional anatomy training in medical school curricula has a great impact on subsequent CT interpretation.

[Doppler ultrasonography evaluation of paraumbilical vein and portal hypertension]. / Evaluation par échographie-Doppler de la veine para-ombilicale dans l'hypertension portale.

UNLABELLED: Portal hypertension is associated to the development of portosystemic collateral veins, particularly the paraumbilical vein. PURPOSE: To evaluate the biometric and hemodynamic characteristics of the portal vessels related to the presence of a patent paraumbilical vein, in the setting of portal hypertension secondary to hepatosplenic schistosomiasis. METHODS: 75 patients with portal hypertension secondary to hepatosplenic schistosomiasis were evaluated by Doppler US. The patients were studied based on the presence (group B) or not (Group A) of a patent paraumbilical vein. The diameter and blood flow velocity of the portal vessels and of the paraumbilical vein were recorded. RESULTS: The paraumbilical vein was detected in 17.33% of patients. The results showed an increase of the diameter of the main and left portal vessels whenever a patent paraumbilical vein was present (portal vein: A = 1.14 +/- 0.29 cm/B = 1.33 +/- 0.16 cm; left branch: A = 0.95 +/- 0.25 cm/B = 1.30 +/- 0.24 cm). The mean blood flow velocity was also increased in the portal trunk (A = 15.96 +/- 6.17 cm/sec/B = 19.82 +/- 6.26 cm/sec) and in the left portal branch (A = 14.77 +/- 4.29 cm/sec/B = 19.92 +/- 6.88 cm/sec). CONCLUSION: The presence of a patent paraumbilical vein is related to significant biometric and hemodynamic variations in the portal venous system, in the setting of portal hypertension secondary to hepatosplenic schistosomiasis.

[Patent paraumbilical vein: hemodynamic importance in Mansoni's hepatosplenic portal hypertension (Study with ultrasonography Doppler]. / Veia paraumbilical pérvia: importância hemodinâmica na hipertensão portal por esquistossomose mansônica hepatoesplênica. (Estudo com ultra-sonografia Doppler).

BACKGROUND: The hemodynamical effect of the collateral portosystemic circulation upon the portal system has not yet been fully understood. The US-Doppler made possible the non-invasive study of the portal system by evaluating the parameters: flow direction, diameter and flow velocity in it's vessels. AIMS: To study the paraumbilical vein as a collateral portosystemic pathway and identify patterns for appraising its hemodynamic importance to the portal system. METHOD: US-Doppler study of the portal system of 24 patients with Mansoni's hepatosplenic schistosomic portal hypertension, previous esophagic variceal bleeding and patent paraumbilical vein with hepatofugal flow. The diameter and the mean flow velocity were measured in the paraumbilical vein and so were the mean flow velocity in the portal vein, right and left portal branches. The Pearson test (linear correlation) was applied to the portal vein's mean flow velocity and the paraumbilical vein's diameter and mean flow velocity. The patients were divided in four groups: D1-paraumbilical vein with diameter < 0.68 cm (n = 14), D2-paraumbilical vein with diameter > or = 0.68 cm (n = 10), V1-paraumbilical vein with mean flow velocity < 18.41 cm/seg (n = 13) and V2-paraumbilical vein with mean flow velocity > or = 18.41 cm/seg (n = 11). The mean flow velocity in the portal vein, right and left portal branches of the four groups were compared. RESULTS: The paraumbilical vein diameter was 0.68 +/- 0.33 cm (range: 0.15-1.30 cm) and the mean flow velocity was 18.41 +/- 11.51 cm/seg (range: 5.73-38.20 cm/seg). The linear correlation between the portal vein's mean flow velocity/paraumbilical vein diameter and the paraumbilical vein's mean flow velocity showed r = 0.504 and r = 0.735, respectively. In the group D2 there was an increase in the mean flow velocity in the portal vein (17.80 +/- 3.42/22.30 +/- 7.67 cm/seg) and in the left portal branch (16.00 +/- 4.73/22.40 +/- 7.90 cm/seg). In the group V2 there was an increase in the mean flow velocity in the portal vein (16.31 +/- 3.49/21.96 +/- 5.89 cm/seg) and in the left portal branch (14.22 +/- 4.41/21.94 +/- 7.20 cm/seg). There was no change in the right portal branch (13.67 +/- 5.74/15.43 +/- 3.43 cm/seg). CONCLUSIONS: In portal hypertension due to hepatosplenic schistosomiasis, the patent paraumbilical vein, with hepatofugal flow, diameter > or = 0.68 cm and mean flow velocity > or = 18.41 cm/seg causes an increase of the mean flow velocity in the portal vein and left portal branch. The best US-Doppler parameter to appraise the paraumbilical vein influence upon the portal system is the mean flow velocity. The correlation between the increase in portal vein's mean flow velocity is stronger with the paraumbilical vein's mean flow velocity than with its diameter. The increase in the portal vein's and left portal branch's mean flow velocity may be understood as the paraumbilical vein's hemodynamic influence upon the portal system. An active portosystemic collateral pathway increases the mean flow velocity in the vein's segment proximal to its point of origin.

Correlations among prostatic biopsy results, transrectal ultrasound findings and PSA levels in diagnosing prostate adenocarcinoma.

OBJECTIVE: The objective of this study was to evaluate transrectal ultrasound (TRUS) findings and prostate-specific antigen (PSA) levels in relation to prostatic biopsy results and to analyze their individual and combined performances in diagnosing prostate adenocarcinoma (PAC). METHODS: Men (n=143) with PSA levels above 4 ng/ml underwent TRUS and randomized ultrasound-guided prostatic biopsy through the peripheral zone, including additional hypoechoic nodules biopsies, if they were noted on TRUS. Data related to TRUS, biopsy, and PSA level results were then correlated. RESULTS: A significant correlation between TRUS images suspicious for PAC and a biopsy-confirmed diagnosis of PAC, or between the lack of such images and a negative biopsy result, was not found. However, a significant correlation was found between positive biopsy results and PSA levels greater or equal to 10 ng/ml. The sensitivity of transrectal ultrasound in making a diagnosis of PAC was 63%, whereas its specificity was 73%. CONCLUSION: We conclude that while the separate performances of these examinations were not effective in diagnosing PAC, the integrated use of these methods was more adequate for making the diagnosis.