FAST breast magnetic resonance imaging: a new approach for breast cancer screening?

OBJECTIVE: To develop an abbreviated breast magnetic resonance imaging protocol (FAST) and to compare it with the complete protocol (FULL) to determine its diagnostic accuracy for detecting malignant or suspicious lesions (BI-RADS 4, 5 and 6) and the time required for image interpretation using BI-RADS categorization. METHODS: Retrospective study with 100 consecutive women who underwent breast magnetic resonance imaging between January and February 2014. All patients were submitted to a complete breast magnetic resonance imaging protocol, which was then compared with an abbreviated protocol (pre-contrast sequence, second post-contrast sequence and subtraction of pre- from post-contrast images). RESULTS: Of 100 patients, 4 were classified as BI-RADS 5 or 6 and 16 as BI-RADS 4. In these 20 patients, there was full agreement among readers regarding the final BI-RADS categorization in both (FAST and FULL) protocols. CONCLUSION: The FAST protocol reduces interpretation time without compromising the accuracy of the method for detection of malignant or suspicious lesions.

New dimer and trimer of chalcone derivatives from anti-inflammatory and antinociceptive extracts of Schinopsis brasiliensis roots.

ETHNOPHARMACOLOGY RELEVANCE: Schinopsis brasiliensis Engl. is an endemic tree of the Brazilian semi-arid regions belonging to the Anacardiaceae family. It is the main representative of the genus Schinopsis, mostly native to Brazil and popularly known as "braúna" or "baraúna". Different parts of this plant are employed in Brazilian folk medicines to treat inflammation in general, sexual impotence, cough, and influenza. AIM OF THE STUDY: This work describes the antinociceptive (acetic acid-induced writhing and formalin-induced nociception) and anti-inflammatory (paw edema and neutrophil migration) activities of the extract of the root of S. brasiliensis. Besides, the evaluation of total phenolic compounds and antioxidant, antimicrobial (including MRSA bacteria), and acetylcholinesterase inhibition activities were also determined. MATERIAL AND METHODS: The pure compounds were isolated by different chromatographic techniques and their chemical structures have been unambiguously elucidated based on extensive spectroscopic methods, including 1D (1H, 13C, DEPT, and NOEdiff) and 2D (HSQC, HMBC, and NOESY) NMR experiments, MS data, and comparison with the literature data of similar compounds. The antinociceptive and anti-inflammatory activities were evaluated by acid acetic writhing test, formalin paw edema, and by the investigation of neutrophil migration to the peritoneal cavities of mice. For antimicrobial evaluation were determined MIC and MBC, antioxidant activities were obtained by TPC and DPPH tests, and AChE inhibition by Elmann's methodology. RESULTS: The extracts showed antinociceptive and anti-inflammatory activities and two unusual new compounds, a cyclobutanyl chalcone trimer (schinopsone A) and a cyclohexene-containing chalcone dimer (schinopsone B), with six known compounds were isolated from the active extracts. Additionally, the acetylcholinesterase inhibitory activity for isolated compounds was reported for the first time in this study. Molecular docking studies indicated that the isolated compounds are responsible for the interaction with anti-inflammatory targets (COX 1 and 2 and LOX) with variable binding affinities, indicating a possible mechanism of action of these compounds. CONCLUSIONS: These findings indicate for the first time the correlation between the anti-inflammatory activity different enriched polyphenol-organic soluble fractions of S. brasiliensis, and it contributes to the understanding of the anti-inflammatory potential of S. brasiliensis.

FAST breast magnetic resonance imaging: a new approach for breast cancer screening?

ABSTRACT Objective To develop an abbreviated breast magnetic resonance imaging protocol (FAST) and to compare it with the complete protocol (FULL) to determine its diagnostic accuracy for detecting malignant or suspicious lesions (BI-RADS 4, 5 and 6) and the time required for image interpretation using BI-RADS categorization. Methods Retrospective study with 100 consecutive women who underwent breast magnetic resonance imaging between January and February 2014. All patients were submitted to a complete breast magnetic resonance imaging protocol, which was then compared with an abbreviated protocol (pre-contrast sequence, second post-contrast sequence and subtraction of pre- from post-contrast images). Results Of 100 patients, 4 were classified as BI-RADS 5 or 6 and 16 as BI-RADS 4. In these 20 patients, there was full agreement among readers regarding the final BI-RADS categorization in both (FAST and FULL) protocols. Conclusion The FAST protocol reduces interpretation time without compromising the accuracy of the method for detection of malignant or suspicious lesions.

Fatores associados a reações transfusionais imediatas em um hemocentro universitário: estudo analítico retrospectivo / Factors associated with immediate transfusion reactions in a university blood center: an analytical, retrospective study

RESUMO: Estudo analítico, transversal, retrospectivo. Objetivos: Verificar a relação entre reações transfusionais imediatas, características demográficas e clínicas dos pacientes e características das hemotransfusões em um hemocentro universitário. Metodologia: O estudo foi realizado com dados de transfusões realizadas em 2016 no hemocentro da Universidade Federal de São Paulo. Foram coletados dados demográficos dos pacientes, características das hemotransfusões e ocorrência de reações transfusionais imediatas. Possíveis associações foram avaliadas usando os Testes de Fisher, Mann-Whitney, Qui-quadrado e t de Student. Associações com valores de p<0,05 foram consideradas significativas. Resultados: Foram analisados dados de 320 fichas de pacientes, totalizando 938 transfusões. Dos produtos sanguíneos transfundidos, 90,3% eram concentrados de hemácias, administrados por auxiliares de enfermagem em 43,8% das situações. As reações transfusionais ocorreram em 4,3% das situações (n=40). O sinal de reações mais frequente foi a febre (47,5%), seguido de prurido (22,5%). As reações foram mais prevalentes em pacientes com maior idade média (p= 0,0037), que receberam duas transfusões sanguíneas em comparação a uma (p<0,0001), consequentemente mais bolsas de transfusões (p=0,0002), maior volume total transfundido (p<0,0001) e maior tempo de administração (p=0,0017). Pacientes com anemia aplásica, leucemia mieloide aguda e neoplasias de órgãos sólidos tiveram reações transfusionais imediatas mais frequentemente do que pacientes com outros diagnósticos (p≤0,05). Conclusões: A ocorrência de reações transfusionais imediatas teve relação com a idade, diagnóstico médico, número de hemotransfusões, número de bolsas transfundidas, volume total transfundido e tempo de transfusão. O conhecimento desses fatores pode subsidiar treinamentos específicos voltados para a vigilância quanto às reações transfusionais imediatas. (AU)

ABSTRACT An analytical, cross-sectional, retrospective study. Objectives: To investigate the relationship among immediate transfusion reactions, patient's demographic and clinical characteristics, and transfusion-related characteristics in a university blood center. Methodology: The study was performed with data regarding blood transfusions of the blood center at Universidade Federal de São Paulo in 2016. Patient's demographic and clinical characteristics and the characteristics of the immediate trans-fusion reactions were collected. Possible associations were evaluated using Fisher's exact test, Mann-Whitney, Chi-square, and Student's t-test. Associations with p≤0.05 were considered statistically significant. Results: Data from 320 patient records were analyzed, totaling 938 blood transfusions. Of the blood products transfused, 90.3% were packed red blood cells administered by nursing assistants in 43.8% of the situations. Immediate transfusion reactions occurred in 4.3% of the situations (n=40). The most common transfusion reaction was fever (47.5%), followed by pruritus (22.5%). The transfusion reactions were more frequent in older patients (p=0.0037) who received two blood transfusions compared to one (p<0.0001), consequently more transfusion bags (p=0.0002), greater total transfused volume (p <0.0001), and longer length of administration (p=0.0017). Patients with aplastic anemia, acute myeloid leukemia, and solid organ neoplasms had immediate transfusion reactions more frequently than patients with other diagnoses (p <0.05). Conclusion: The occurrence of immediate transfusion reactions was related to age, medical diagnosis, number of blood transfusions, number of transfused bags, total transfused volume, and length of administration. Knowledge of these factors may support specific training for immediate transfusion reactions surveillance.

Radiological findings in megaesophagus secondary to Chagas disease: chest X-ray and esophagogram / Alterações radiológicas encontradas no megaesôfago chagásico em radiografias simples de tórax e esofagogramas

Abstract Objective: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. Materials and Methods: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. Results: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. Conclusion: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.

Resumo Objetivo: Identificar e classificar as alterações radiológicas no megaesôfago chagásico no esofagograma e na radiografia simples de tórax. Materiais e Métodos: Foram estudados 35 pacientes com diagnóstico de esofagopatia na manometria. As alterações encontradas no esofagograma foram estratificadas segundo a classificação de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatação e alteração da motilidade do esôfago. Também foi realizada correlação desta classificação com os achados na radiografia de tórax: presença ou ausência de bolha gástrica, nível líquido e alargamento do mediastino. Resultados: A distribuição encontrada, segundo a classificação de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alterações na radiografia simples. No grau II, o único achado foi a ausência da bolha gástrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Já no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. Conclusão: A classificação de Rezende é praticável, encontrando-se desde achados sutis caracterizando os graus iniciais até a completa acinesia do dolicomegaesôfago. Os achados na radiografia de tórax são mais frequentes em pacientes com estágios avançados da doença e podem fazer aventar o grau da esofagopatia chagásica.

Radiological findings in megaesophagus secondary to Chagas disease: chest X-ray and esophagogram.

OBJECTIVE: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. MATERIALS AND METHODS: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. RESULTS: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. CONCLUSION: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.

OBJETIVO: Identificar e classificar as alterações radiológicas no megaesôfago chagásico no esofagograma e na radiografia simples de tórax. MATERIAIS E MÉTODOS: Foram estudados 35 pacientes com diagnóstico de esofagopatia na manometria. As alterações encontradas no esofagograma foram estratificadas segundo a classificação de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatação e alteração da motilidade do esôfago. Também foi realizada correlação desta classificação com os achados na radiografia de tórax: presença ou ausência de bolha gástrica, nível líquido e alargamento do mediastino. RESULTADOS: A distribuição encontrada, segundo a classificação de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alterações na radiografia simples. No grau II, o único achado foi a ausência da bolha gástrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Já no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. CONCLUSÃO: A classificação de Rezende é praticável, encontrando-se desde achados sutis caracterizando os graus iniciais até a completa acinesia do dolicomegaesôfago. Os achados na radiografia de tórax são mais frequentes em pacientes com estágios avançados da doença e podem fazer aventar o grau da esofagopatia chagásica.

Radiofrequency ablation for breast cancer.

Although breast-conserving therapy or mastectomy remains the gold standard for breast cancer treatment, minimally invasive alternatives to surgery are becoming more attractive for select patient populations. Advances in technology, reduced morbidity, improved cosmesis, and the ability to provide treatment in an outpatient setting are some of the advantages of image-guided therapy. Radiofrequency ablation (RFA) has been investigated because of its relatively low cost, low morbidity, and favorable technical success rates (76%-100% in published series). Image guidance during ablation involves the use of real-time ultrasound or magnetic resonance imaging to target the tumor and monitor the adequacy of ablation. Tumor size, location, histologic type, and reliable visualization under ultrasound (or other imaging modalities) are important to determine patient eligibility and procedural planning. In patients with localized breast cancer who decline surgery or are not candidates for surgery, RFA alone, or in combination with hormonal therapy, or followed by conventional radiation therapy with or without chemotherapy may prove to be viable treatment options. In patients with locally advanced or metastatic disease, RFA may be suitable for palliation of larger symptomatic tumors. Additional studies with long-term patient follow-up are necessary to better understand response to RFA and to determine its future role in the treatment algorithm for breast cancer.

Analysis by MRI of residual tumor after radiofrequency ablation for early stage breast cancer.

OBJECTIVE: The objective of our study was to evaluate the effectiveness of MRI in the detection of possible residual lesions after radiofrequency ablation (RFA) in the treatment of breast cancer. SUBJECTS AND METHODS: We prospectively evaluated 14 patients who had undergone ultrasound-guided core biopsies diagnostic of invasive ductal carcinoma (IDC; range of diameters, 1.0-3.0 cm) and then ultrasound-guided percutaneous RFA with sentinel node biopsy as the primary treatment. Breast MRI was performed 1 week before RFA to evaluate tumor extension and again 3 weeks after RFA to verify the presence of possible residual lesions. Conventional surgical resection of the tumors was performed 1 week after RFA. The MRI findings were compared with histopathologic analyses to confirm the presence or absence of residual tumor. RESULTS: There was no residual enhancement in seven lesions on the postablation breast MRI scans. These findings were confirmed by negative histopathologic findings in the surgical specimens. The MRI scans of five patients showed small areas of irregular enhancement that corresponded to residual lesions. In the two remaining patients, we observed enhancement of almost the entire lesion, indicating that RFA had failed. CONCLUSION: Breast MRI is effective in detecting residual lesions after RFA in patients with IDC.

Evaluation of the accuracy of a computer-aided diagnosis (CAD) system in breast ultrasound according to the radiologist's experience.

RATIONALE AND OBJECTIVES: The aim of this study was to evaluate the performance of a computer-aided diagnosis (CAD) system for breast ultrasound to improve the characterization of breast lesions detected on ultrasound by junior and senior radiologists. MATERIALS AND METHODS: One hundred sixty ultrasound breast lesions were randomly reviewed blindly by four radiologists with different levels of expertise (from 20 years [radiologist A] to 4 months [radiologist D]), with and without the help of an ultrasound CAD system (B-CAD version 2). All lesions had been biopsied. Sensitivity and specificity with and without CAD were calculated for each radiologist for the following evaluation criteria: Breast Imaging Reporting and Data System category and the final diagnosis (benign or malignant). Intrinsic sensitivity, specificity, and predictive values of CAD alone were also calculated. RESULTS: CAD detected all cancers, and its use increased radiologists' sensitivity scores when this was possible (with vs without CAD: radiologist A, 99% vs 99%; radiologist B, 96% vs 87%; radiologist C, 95% vs 88%; radiologist D, 91% vs 88%). Seven additional cancers were diagnosed. However, the low specificity of CAD (48%) decreased the specificity of radiologists, especially of the more experienced among them (with vs without CAD: radiologist A, 46% vs 70%; radiologist B, 58% vs 80%; radiologist C, 57% vs 69%; radiologist D, 71% vs 71%). CONCLUSIONS: CAD for breast ultrasound appears to be a useful tool for improving the diagnosis of malignant lesions for junior radiologists. Nevertheless, its low specificity must be taken into account to limit biopsies of benign lesions.

Válvula da uretra posterior associada a urinoma perinefrético e ascite urinária / Posterior urethral valve associated to perinephric urinoma and urinary ascitis

A válvula de uretra posterior é a principal causa de obstrução do fluxo urinário na infância. Relatamos um caso de válvula de uretra posterior diagnosticada por uretrocistografia e ultra-sonografia, cuja função renal foi poupada devido a incomuns mecanismos redutores das pressões endovesicais.Seu diagnóstico e tratamento precoces foram decisivos no prognóstico do paciente.

The posterior urethral valve is the main cause of urinal flow obstructionin childhood. Here we report a case of a posterior urethral valve diagnosed by urethrocystography and ultrasonography,whose renal function was saved due to unusual reducing mechanisms of endovesical pressures. The diagnosis and early treatment were decisive in the prognosis of the patient.

Carcinoma em tecido mamário ectópica: aspectos de imagem (mamografia, ultra-sonografia e ressonância magnética) / Carcinoma in ectopic breast tissue: imaging aspects (mammography, ultrasonography and magnetic resonance imaging)

Nos últimos três anos foram realizadas 30.000 mamografias no Departamento de Diagnóstico por Imagem da Universidade Federal de São Paulo/Escola Paulista de Medicina, sendo que em 0,23% delas foi observado tecido mamário acessório. Relatamos um caso de paciente de 44 anos de idade, feminina, que apresentava nódulo endurecido, aderido ao subcutâneo, em topografia inframamária à direita. À ultra-sonografia observou-se imagem nodular sólida hipoecogênica, com contornos irregulares, medindo 1,4 cm. À ressonância magnética visualizou-se curva de realce tipo II (platô). Após biópsia, foi diagnosticado denocarcinoma mamário. O carcinoma nas mamas acessórias costuma apresentar aspecto histopatológico indiferenciado e disseminação mais precoce, determinando pior prognóstico. Por este motivo, é de fundamental importância sua detecção nos estágios iniciais, permitindo, dessa forma, a instituição precoce do tratamento e possibilitando maiores chances de cura.

Over the last three years 30,000 mammograms were performed in the Department of Diagnostic Imaging of Universidade Federal de São Paulo/Escola Paulista de Medicina. Accessory breast tissue was observed in 0.23% of the individuals. We report a case of a 44-year-old woman presenting a hard nodule adhered to the subcutaneous tissue in right inframammary topography. At ultrasonography, a hypoechogenic solid nodule with irregular contour measuring 1.4 cm was observed. Magnetic resonance imaging showed type II (plateau) dynamic curve. Breast adenocarcinoma was subsequently diagnosed by biopsy. Accessory breast carcinomas generally present with an ill-defined histopathological aspectand early dissemination. Early detection is essential to begin treatment in the initial stages, with better chances of cure.

Análise radiológica das alterações gastrintestinais após cirurgia de Fobi-Capella / Radiological evaluation of postoperative gastrointestinal alterations in patients submitted to Fobi-Capella surgery

OBJETIVO: Estudar os achados radiológicos encontrados na seriografia digestiva alta no pós-operatório tardio de cirurgia de Fobi-Capella. MATERIAIS E MÉTODOS: Estudo radiológico de 41 pacientes realizado seis a nove meses após a cirurgia de Fobi-Capella. RESULTADOS: As alterações encontradas foram hérnia hiatal (17 por cento), refluxo gastroesofágico (19,5 por cento) e deslizamento do anel (4,8 por cento). Os achados menos freqüentes foram fístula enterocutânea (2,4 por cento), estenose da anastomose gastrojejunal (2,4 por cento), bezoar (2,4 por cento) e não-visualização do anel em decorrência da sua retirada por intolerância (2,4 por cento). As alterações anatômicas da cirurgia foram claramente demonstradas. CONCLUSÃO: O estudo foi capaz de demonstrar as alterações anatômicas e as complicações da cirurgia de Fobi-Capella.

OBJECTIVE: The present study was aimed at evaluating radiological findings of delayed postoperative upper gastrointestinal series in patients submitted to Fobi-Capella surgery. MATERIALS AND METHODS: Radiological studies of 41 patients, six to nine months following the surgery. RESULTS: The following pathological alterations have been found: hiatal hernia (17 percent), gastroesophageal reflux disease (19.5 percent) and sliding of the silastic ring (4.8 percent). Least frequent findings have been the following: enterocutaneous fistula (2.4 percent), stenosis of the gastric pouch outlet (2.4 percent), bezoar (2.4 percent), and non-visualization of the silastic ring caused by its removal due to patient intolerance (2.4 percent). Anatomical alterations resulting from the surgery have been clearly demonstrated. CONCLUSION: The present study could demonstrate anatomical alterations and complications resulting from Fobi-Capella surgery.

Contribuicão da mamografia e da ultra-sonografia na avaliacão da mama reconstruída com retalho miocutâneo / Usefulness of mammography and ultrasound for the evaluation of myocutaneous flap-reconstructed breasts

A reconstrucão mamária com retalho miocutâneo tem sido amplamente utilizada em pacientes submetidas a mastectomia radical modificada por câncer de mama, com melhora significativa na auto-estima dessas pacientes, minimizando o sentimento de mutilacão e melhorando a estética, sem promover alteracão no prognóstico da doenca. Inicialmente acreditava-se não haver risco de recorrência do câncer na mama reconstruída devido à remocão completa do tecido mamário. Porém, exames histológicos têm demonstrado que pode restar pequena quantidade de tecido mamário local após a mastectomia, tendo este tecido remanescente alto potencial de malignidade. Tem-se preconizado o acompanhamento clínico dessas pacientes, uma vez que a maioria das lesões recidivantes se situa nos pontos de insercão do retalho e elas são passíveis de serem detectadas pela palpacão. No entanto, tem-se discutido a inclusão da mamografia e da ultra-sonografia no controle dessas pacientes, uma vez que estes métodos podem contribuir para o diagnóstico de lesão recorrente antes de esta tornar-se palpável.