Coronary artery calcification and dietary intake in asymptomatic men.

Dietary factors may influence the process of atherosclerosis and coronary artery calcification (CAC). This study assessed CAC and its association with dietary intake in asymptomatic men. We evaluated 150 asymptomatic men with mean age of 58.2±5.3 years. The dietary intake was assessed by the Food Consumption Register method. CAC was measured through multidetector computed tomography (MDCT) and assessed in accordance with the Agatston score. Modified Poisson regression model was used to estimate the effects of intake of different nutrients that are prevalent in moderate/severe CAC, adjusted for calorie intake and CAC risk factors by means of prevalence ratios and 95% confidence intervals [95%CI]. An association was found between the intake of some nutrients and moderate/severe CAC. Lower carbohydrate intake (P=0.021) and higher lipid intake (P=0.006) were associated with moderate/severe CAC. After adjustment, the nutrients associated with the prevalence of moderate/severe CAC were carbohydrates (P=0.040), lipids (P=0.005), and saturated fatty acids (SFA) (P=0.013). A 1% increase in lipids and SFA intake caused an increase of 4% [95%CI: 1-7%] and 8% [95%CI: 2-14%] in the prevalence of moderate/severe CAC, respectively. A 1% increase of carbohydrate intake led to a 2% decrease in the likelihood of moderate/severe CAC [95%CI: 1-4%]. These conclusions showed that the higher intake of total lipids and SFA was associated with higher CAC scores, whereas higher carbohydrate intake was associated with lower CAC scores in asymptomatic men.

Coronary artery calcification and dietary intake in asymptomatic men

Dietary factors may influence the process of atherosclerosis and coronary artery calcification (CAC). This study assessed CAC and its association with dietary intake in asymptomatic men. We evaluated 150 asymptomatic men with mean age of 58.2±5.3 years. The dietary intake was assessed by the Food Consumption Register method. CAC was measured through multidetector computed tomography (MDCT) and assessed in accordance with the Agatston score. Modified Poisson regression model was used to estimate the effects of intake of different nutrients that are prevalent in moderate/severe CAC, adjusted for calorie intake and CAC risk factors by means of prevalence ratios and 95% confidence intervals [95%CI]. An association was found between the intake of some nutrients and moderate/severe CAC. Lower carbohydrate intake (P=0.021) and higher lipid intake (P=0.006) were associated with moderate/severe CAC. After adjustment, the nutrients associated with the prevalence of moderate/severe CAC were carbohydrates (P=0.040), lipids (P=0.005), and saturated fatty acids (SFA) (P=0.013). A 1% increase in lipids and SFA intake caused an increase of 4% [95%CI: 1-7%] and 8% [95%CI: 2-14%] in the prevalence of moderate/severe CAC, respectively. A 1% increase of carbohydrate intake led to a 2% decrease in the likelihood of moderate/severe CAC [95%CI: 1-4%]. These conclusions showed that the higher intake of total lipids and SFA was associated with higher CAC scores, whereas higher carbohydrate intake was associated with lower CAC scores in asymptomatic men.

Utilidad de la resonancia magnética en el diagnóstico de lesiones musculares de localización atípica / Usefulness of magnetic resonance imaging in the diagnosis of atypical location muscle lesions

En el presente los desgarros musculares son una causa muy frecuente de lesión en la práctica deportiva. Según los estudios actuales, un 30% de las lesiones en atletas afecta los músculos, siendo particularmente comunes a nivel de los isquiotibiales, el recto anterior de los cuádriceps, los gemelos y los aductores. El diagnóstico se realiza en forma sencilla mediante un estudio ecográfico. Sin embargo, existe un número importante de lesiones musculares de localización profunda e infrecuente, que pueden pasar inadvertidas en la ecografía y que causan largos períodos de inactividad para el deportista. La resonancia magnética (RM), por su resolución anatómica y capacidad multiplanar, es el método de elección para el estudio de este tipo de afecciones, ya que permite descartar otras patologías de similar presentación clínica y realizar un diagnóstico específico. En este artículo describimos los desgarros musculares de localización inusual, particularmente los de localización pelviana, evaluando también la pared torácica, abdominal y miembros superiores e inferiores. En todos los casos, se usaron equipos de alto campo 1.5 y 3 Tesla.

Muscle injuries are currently particularly frequent among people who participate in sports. Current studies show that 30% of injuries in athletes affect muscles, with hamstrings, quadriceps, gastrocnemius, and adductors being particularly prevalent. The diagnosis is easily made with an ultrasound study. However, there are a significant number of muscle injuries, considered uncommon, that may be not be detected by ultrasound, mainly because of their depth, and could be responsible for long periods of inactivity for the sportsman. Magnetic resonance imaging (MRI), with a better anatomical resolution and multiplanar capability, is the method of choice for detecting the precise location and severity of the injury and can establish their severity. The aim of this article is to review muscle tears of unusual location, particularly in the pelvic area, but also evaluating the chest wall, abdomen, and upper and lower limbs. All patients were evaluated by 3 and 1.5 Tesla MRI units.

Caracterización imagenológica de la sinovitis vellonodular pigmentada y el tumor de células gigantes de la vaina sinovial / Radiological features of pigmented villonodular synovitis and giant cell tumor of tendon sheath

OBJETIVO: Mostrar los hallazgos imagenológicos en la resonancia magnética (RM) de la sinovitis vellonodular pigmentada (SVP) y el tumor de células gigantes de la vaina sinovial (TCGVS), dado que son entidades que representan un diverso grupo de alteraciones en la proliferación de la sinovial. MATERIALES Y MÉTODOS: Entre mayo de 2011 y junio de 2013, se estudiaron en nuestra institución 25 casos con diagnóstico histológico de proliferación de la sinovial. Se destacaron los distintos tipos de presentación en imágenes a través de una RM 1.5 Tesla. Los resultados fueron analizados y comparados con la literatura. RESULTADOS: La RM mostró características similares para esta patología en todos los pacientes. No obstante, se distinguieron 4 patrones principales de presentación, dependiendo de la morfología, la localización de la lesión y las características radiológicas diferenciales. Estos fueron: como dominante, el tumor de células gigantes de la vaina sinovial (n = 10), todos de localización extraarticular; la sinovitis vellonodular pigmentada de localización bursal (n = 2); la sinovitis vellonodular pigmentada de forma intraarticular focal (n = 5); y la sinovitis vellonodular pigmentada difusa (n = 8). CONCLUSIÓN: La sinovitis vellonodular pigmentada y el tumor de células gigantes de la vaina sinovial se consideran entidades similares desde el punto de vista anatomopatológico. La RM fue de gran utilidad para objetivar tanto las características radiológicas comunes como las diferenciales. Estas últimas, junto con la localización, nos permitieron clasificar 4 patrones de presentación. Su reconocimiento posibilita un adecuado seguimiento de la patología y un óptimo manejo terapéutico.

PURPOSE: To show the resonance magnetic imaging (MRI) findings of pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (PVNTS), entities with similar histology but differences in clinical and some radiological manifestations. MATERIALS AND METHODS: We studied 25 cases with histologically benign synovial proliferation in intra and extraarticular location of the extremities. It highlighted with a 1.5T MRI unit the different types of images presentation. The results were analyzed and compared with the literature. RESULTS: MRI displayed very specific imaging features in all patients. However, we were able to distinguish 4 main patterns of presentation depending on the morphology, location of the lesion and radiological differential. These were: as dominant presentation, pigmented villonodular synovitis localized form (n=10); pigmented villonodular synovitis bursal form (n=2); pigmented villonodular synovitis focal (n =5); and pigmented villonodular synovitis diffuse (n = 8). CONCLUSION: Both pigmented villonodular synovitis as well as giant cell tumor of the tendon sheath are considered similar from the point of view of the histological findings. MRI was useful to objectify both radiological features in common, such as the differential, which along with the location, allow us to classify patterns into 4 individual presentations. This recognition involves adequate radiological evaluation and is important for optimal management.

Caracterización imagenológica de la sinovitis vellonodular pigmentada y el tumor de células gigantes de la vaina sinovial

Objetivo: Mostrar los hallazgos imagenológicos en la resonancia magnética (RM) de la sinovitis vellonodular pigmentada (SVP) y el tumor de células gigantes de la vaina sinovial (TCGVS), dado que son entidades que representan un diverso grupo de alteraciones en la proliferación de la sinovial. Materiales y métodos: Entre mayo de 2011 y junio de 2013, se estudiaron en nuestra institución 25 casos con diagnóstico histológico de proliferación de la sinovial. Se destacaron los distintos tipos de presentación en imágenes a través de una RM 1.5 Tesla. Los resultados fueron analizados y comparados con la literatura. Resultados: La RM mostró características similares para esta patología en todos los pacientes. No obstante, se distinguieron 4 patrones principales de presentación, dependiendo de la morfología, la localización de la lesión y las características radiológicas diferenciales. Estos fueron: como dominante, el tumor de células gigantes de la vaina sinovial (n = 10), todos de localización extraarticular; la sinovitis vellonodular pigmentada de localización bursal (n = 2); la sinovitis vellonodular pigmentada de forma intraarticular focal (n = 5); y la sinovitis vellonodular pigmentada difusa (n = 8). Conclusión: La sinovitis vellonodular pigmentada y el tumor de células gigantes de la vaina sinovial se consideran entidades similares desde el punto de vista anatomopatológico. La RM fue de gran utilidad para objetivar tanto las características radiológicas comunes como las diferenciales. Estas últimas, junto con la localización, nos permitieron clasificar 4 patrones de presentación. Su reconocimiento posibilita un adecuado seguimiento de la patología y un óptimo manejo terapéutico.(AU)

Purpose: To show the resonance magnetic imaging (MRI) findings of pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (PVNTS), entities with similar histology but differences in clinical and some radiological manifestations. Materials and methods: We studied 25 cases with histologically benign synovial proliferation in intra and extraarticular location of the extremities. It highlighted with a 1.5T MRI unit the different types of images presentation. The results were analyzed and compared with the literature. Results: MRI displayed very specific imaging features in all patients. However, we were able to distinguish 4 main patterns of presentation depending on the morphology, location of the lesion and radiological differential. These were: as dominant presentation, pigmented villonodular synovitis localized form (n=10); pigmented villonodular synovitis bursal form (n=2); pigmented villonodular synovitis focal (n =5); and pigmented villonodular synovitis diffuse (n = 8). Conclusion: Both pigmented villonodular synovitis as well as giant cell tumor of the tendon sheath are considered similar from the point of view of the histological findings. MRI was useful to objectify both radiological features in common, such as the differential, which along with the location, allow us to classify patterns into 4 individual presentations. This recognition involves adequate radiological evaluation and is important for optimal management.(AU)

Hypertension is the metabolic syndrome component most strongly associated with microvascular complications and coronary artery calcification in Type 1 diabetes.

AIM: To evaluate the association of metabolic syndrome (MetS) and its individual components with microvascular complications and coronary artery calcification (CAC) in patients with Type 1 diabetes. MATERIAL/SUBJECTS AND METHODS: Cross-sectional study included 261 patients with Type 1 diabetes. Patients were assessed regarding the presence of MetS according to National Cholesterol Education Program (NCEP) criteria. CAC score was measured in a subset of 100 patients without known cardiovascular disease. RESULTS: The prevalence of MetS was 13.4% according to the NCEP criteria. Microvascular complications and CAC were more frequent in patients with MetS. In a multiple logistic regression analysis, MetS remained associated with nephropathy [OR: 6.33 (95% CI 2.54-15.77), p<0.001], but not with retinopathy and CAC. Among the MetS components, hypertension was associated with presence of retinopathy [OR: 4.04 (95% CI 1.65- 9.90), p=0.002], nephropathy [OR: 5.92 (95% CI 2.42-14.4), p<0.001] and CAC [OR: 2.97 (95% CI 1.06-8.30), p=0.03]. CONCLUSIONS: Hypertension was the only MetS component associated with retinopathy, nephropathy and the presence of CAC. Hypertension was better associated with CAC than MetS itself.

Circuit weight training and cardiac morphology: a trial with magnetic resonance imaging.

BACKGROUND: Aerobic training (AT) and circuit weight training (CWT) improve peak oxygen uptake (VO(2)peak). During CWT the circulatory system is exposed to higher pressure, which could induce left ventricle morphological adaptations, possibly distinct from those derived from aerobic training. OBJECTIVE: To compare the effects of aerobic training and CWT upon morphological and functional cardiac adaptations detected by magnetic resonance imaging. METHODS: Twenty healthy sedentary individuals were randomly assigned to participate in a 12-week programme of aerobic training (n = 6), CWR (n = 7) or no intervention (n = 7, controls). Training programmes consisted of 36 sessions, 35 min each, 3 times per week, at 70% of maximal heart rate, and CWT included series of resistance exercises performed at 60% of 1 maximal repetition. Cardiopulmonary exercise testing and cardiac magnetic resonance imaging were performed before and after the intervention. RESULTS: There was a similar improvement in VO(2)peak following aerobic training (mean (SD) increment: 12 (4)%) and CWT (12 (4)%), while there was no change in the control group. Aerobic training (12 (6)%) and CWT (16 (5)%) improved strength in the lower limbs, and only CWT resulted in improvement of 13 (4)% in the strength of the upper limbs. However, there were no detectable changes in left ventricular mass, end-diastolic volume, stroke volume or ejection fraction. CONCLUSION: In previously sedentary individuals, short-term CWT and aerobic training induce similar improvement in functional capacity without any adaptation in cardiac morphology detectable by cardiac magnetic resonance imaging.

Clinical validation of an automated boundary tracking algorithm on cardiac MR images.

The goal of this research was to develop an automated algorithm for tracking the borders of the left ventricle (LV) in a cine-MRI gradient-echo temporal data set. The algorithm was validated on four patient populations: healthy volunteers and patients with dilated cardiomyopathy (DCM), left ventricular hypertrophy (LVH), or left ventricular aneurysm (LVA). A full tomographic set (approximately 11 slices/case) of short-axis images through systole was obtained for each patient. Initial endocardial and epicardial contours for the end-diastolic (ED) and end-systolic (ES) frames were manually traced on the computer by an experienced radiologist. The ED tracings were used as the starting point for the algorithm. The borders were tracked through each phase of the temporal data set, until the ES frame was reached (approximately 7 phases/slice). Peak gradients along equally spaced chords calculated perpendicular to a centerline determined midway between the endocardial and epicardial borders were used for border detection. This approach was tested by comparing the LV epicardial and endocardial volumes calculated at ES to those based on the manual tracings. The results of the algorithm compared favorably with both the endocardial (r2 = 0.72 - 0.98) and epicardial (r2 = 0.96 - 0.99) volumes of the tracer.

Imaging of cardiac and paracardiac masses.

Magnetic resonance imaging (MRI) and computed tomography (CT) are important imaging modalities for the noninvasive characterization of cardiac and paracardiac masses. They are, in general, superior to other modalities (e.g., echocardiography) in their ability to delineate the exact location and the extent of the lesion and to demonstrate the effects of the lesion on surrounding structures. MRI and CT may also be helpful in suggesting a specific diagnosis, because some tumors have rather characteristic locations and appearances. In addition, both modalities can be extremely helpful in both treatment planning and posttreatment follow-up because they are noninvasive, reproducible, and enable detection of residual or recurrent mass.

Normal values of echocardiographic measurements. A population-based study.

OBJECTIVE: To describe echocardiographic measurements and left ventricular mass in a population sample of healthy adults inhabitants of the urban region of Porto Alegre. METHODS: An analytical, observational, population-based, cross-sectional study was done. Through a multi-stage probability sample, 114 individuals were selected to be submitted to a M-mode and two-dimensional echocardiogram with color Doppler. The analyses were restricted to healthy participants. Echocardiographic measurements were described by mean, standard deviation, 95 percentile and 95% confidence limits. RESULTS: A total of 100 healthy participants, with several characteristics similar to those from the original population, had a complete and reliable echocardiographic examination. The measurements of aorta, left atrium, interventricular septum, left ventricle in systole and diastole, left posterior wall and left ventricular mass, adjusted or not for body surface area or height, were significantly higher in males. The right ventricle size was similar among the genders. Several echocardiographic measurements were within standard normal limits. Interventricular septum, left posterior wall and left ventricular mass, adjusted or not for anthropometric measurements, and aortic dimensions had lower mean and range than the reference limits. CONCLUSION: The means and estimates of distribution for the measurements of interventricular septum, left posterior wall and left ventricular mass found in this survey were lower than those indicated by the international literature and accepted as normal limits.

[Patients' opinions of the role of primary care physicians and the organization of health care services].

Patients' opinions of the role of the primary care physician were studied. The study population consisted of Hebrew-speaking members of the Clalit Sick Fund, aged 18+, who visited primary care and specialty clinics. Interviews took place during January-March 1995 in the Emek and Jerusalem, and during August-October 1995 in Beer Sheba. A total of 2,734 interviews were conducted, and the response rate was 88%. 64% of the respondents preferred the primary care physician as the first address for most problems occurring during the day. Multivariate analysis revealed that the variables predicting this reference were: being over age 45, having completed less than 12 years of schooling, being satisfied with the physician, and when a child's illness was involved. Whether the physician was a specialist had only a marginal effect. The findings also show that among those who did go directly to a specialist for the current visit, 49% would still prefer the primary care physician to be the first address for most problems. However, half of the respondents initiated the current visit to the specialty clinic themselves. The findings also showed that a preference for the primary care physician to be the first address had an independent and statistically significant effect on the following aspects of service consumption: taking the initiative to go to a specialist, the intention to return to the primary care physician or to the specialist for continuing care, and the patient's belief that referral to a specialist was needed. The findings of the study may be of assistance to policy-makers on the national level and to sick funds in planning the role of the primary care physician, so that it corresponds, on the one hand, to the needs of the sick funds and the economic constraints in the health system, and on the other, to the preferences of the patient.

An outbreak of Mycoplasma pneumoniae pneumonia in two kibbutzim: a clinical and epidemiologic study.

During a period a 9 months, 125 individuals with pneumonia due to infection with Mycoplasma pneumoniae were identified among 1,242 individuals in two Israeli kibbutzim. The monthly incidence of M. pneumoniae pneumonia (MPP) was 13.3/1,000 population. Of those infected, 93 (74.4%) were under the age of 18 years. The clinical course of MPP was mostly benign. The prominent signs and symptoms of disease were cough (100%), fine respiratory crepitations (77%), fever (37%), and diminished breathing sounds (25%) above affected lung areas. Leukocytosis was rare (9.6%); however, eosinophilia was observed in 23% of 53 tests performed. Exacerbations of bronchial asthma was observed among 36% of 11 patients with a previous history of asthma. The average duration of disease was 13.5 days, under treatment. A recurrence rate of 11.2% was noted among all MPP patients, with a very high (42.3%) rate among patients treated with cotrimoxazole. All patients with recurrent pneumonia were children under the age of 10 years.

Direct invasion of the central nervous system by Mycoplasma pneumoniae: a report of two cases.

We studied two patients with involvement of the central nervous system (CNS) associated with Mycoplasma pneumoniae. One patient had encephalitis and acute cerebellar ataxia, whereas the second had a mixed picture of encephalitic reaction superimposed on a disseminated malignancy of unknown origin. Specific IgM antibodies to M. pneumoniae were detected in the patients' sera but not in their cerebrospinal fluid. M. pneumoniae was repeatedly isolated by cultures from throat swabs and cerebrospinal fluid samples from both patients. Our patients add to previous reports suggesting that CNS involvement may result from direct invasion of the CNS by the pathogen.