Hand and finger, ultrasound-guided, percutaneous core needle biopsies: A safe procedure with high diagnostic accuracy.

Introduction/Purpose: To determine the diagnostic accuracy and complication rates of ultrasound-guided, percutaneous core needle biopsies of soft tissue masses in the hand and fingers. Methods: Reports from all ultrasound-guided procedures between 21 May 2014 and 17 March 2022 were queried for keywords including "hand", OR "finger", AND "biopsy". Patient demographics, lesion size and location, biopsy needle gauge and the number of cores obtained were recorded. The final pathology of the mass excision was then compared with the core needle biopsy (CNB) for each patient. Results: Sixty-six records were reviewed, and 37 patients met inclusion criteria. Maximum lesion diameter averaged 1.45 cm with a range between 0.4 and 4.3 cm. The frequency of needle gauges used was 14G (14%), 16G (24%), 18G (38%), 20G (11%) and 'not reported' (14%). The mean number of tissue cores obtained was 2.9 (SD 1.2; range 1 to 6), excluding nine cases that reported 'multiple'. The frequency of CNB diagnoses included tenosynovial giant cell tumour (TGCT) at 30%, ganglion cyst at 11% and epidermal inclusion cyst at 5%. CNB was 100% sensitive in detecting the three (8%) malignancies. Of the 37 tumours biopsied, 16 were surgically excised. One angiomyoma was originally diagnosed as a haemangioma on CNB, but all other histologic results were concordant for a diagnostic accuracy of 97%. Discussion: Small soft tissue masses in the hands and fingers, even those less than 1 cm, are often amenable to ultrasound-guided CNB. Performance under image guidance facilitates retrieval of core specimens adquate for histologic diagnosis with relatively few passes using higher gauge needles. Conclusion: Overall, ultrasound-guided CNB of the hand and fingers is safe and highly accurate in diagnosing soft tissue tumours. The accuracy is unrelated to the needle's gauge, the number of passes and the size of the lesions.

Unusual lipid poor spindle cell lipoma.

Spindle cell lipomas (SCLs) containing minimal fat are rare and can be diagnostically challenging due to their similar radiographic appearance to other benign and malignant tumours. SCLs are benign lipomatous tumours that typically occur in middle aged to elderly men as slow-growing, painless masses in the subcutaneous tissue of the posterior neck, shoulders or back. However, rarely these tumours can arise in unusual locations such as the lower extremities. We present an unusual case of a lipid poor SCL occurring in the lower extremity. Initial clinical and radiographic findings were suspicious for a malignancy. Two core biopsies demonstrated benign fibro collagenous tissue, so a marginal excision was performed. Final histopathological and immunohistochemical stains confirmed the diagnosis of an SCL. Radiologists, pathologists and oncologic surgeons should be aware of this lipomatous tumour's potential to present in unusual locations with minimal fatty components to increase confidence in radiologic-pathological concordance.

Effect of muscle contractions on cartilage: morphological and functional magnetic resonance imaging evaluation of the knee after spinal cord injury.

OBJECTIVE: To evaluate the effect of complete absence of muscle contractions on normal human cartilage in the presence of joint motion. METHODS: Patients with complete acute spinal cord injuries were enrolled. All patients underwent magnetic resonance imaging (MRI) on both knees as soon as their medical condition was stable and at six months after the primary lesion. All patients received rehabilitation treatment that included lower-limb passive motion exercises twice a day. The MRIs were analyzed by two radiologists with expertise in musculoskeletal disorders. A region of interest was established at the patellar facets and trochlea, and T2 relaxation times were calculated. The area under the cartilage T2 relaxation time curve was calculated and standardized. RESULTS: Fourteen patients with complete spinal cord injuries were enrolled, but only eight patients agreed to participate in the study and signed the informed consent statement. Two patients could not undergo knee MRI due to their clinical conditions. Initial knee MRIs were performed on six patients. After six months, only two patients underwent the second bilateral knee MRI. Both patients were neurologically classified as Frankel A. An increase in T2 values on the six-month MRI was observed for both knees, especially in the patellofemoral joint. CONCLUSION: The absence of muscle contractions seems to be deleterious to normal human knee cartilage even in the presence of a normal range of motion. Further studies with a larger number of patients, despite their high logistical complexity, must be performed to confirm this hypothesis.

OBJETIVO: Avaliar o efeito da completa ausência de contração muscular na cartilagem humana normal na presença de movimento articular. MÉTODOS: Pacientes com lesão completa da medula espinal foram incluídos. Todos os pacientes foram submetidos à ressonância magnética (RM) em ambos os joelhos assim que as condições clínicas foram estabilizadas e depois de seis meses da lesão inicial. Todos os pacientes receberam tratamento de reabilitação que incluía movimentos passivos para exercitar os membros inferiores duas vezes por dia. RM foram analisadas por dois radiologistas com experiência em doenças musculoesqueléticas. As regiões de interesse consideradas foram as da patela e na tróclea, e os tempos de relaxamento T2 foram calculados. A área da cartilagem abaixo dos valores de relaxamento em T2 foi calculada e padronizada. RESULTADOS: Catorze pacientes com lesão medular completa foram incluídos, porém apenas oito pacientes concordaram em participar do estudo e assinaram o termo de consentimento informado. Dois pacientes não puderam fazer RM dos joelhos devido às condições clínicas. RM inicial foi feita em seis pacientes. Após seis meses, apenas dois pacientes fizeram a segunda RM de ambos os joelhos. Ambos estavam em condição neurológica classificada como Frankel A. Um aumento dos valores em T2 no sexto mês foi observado em ambos os joelhos, especialmente na articulação patelofemoral. CONCLUSÃO: A ausência de contração muscular parece ser deletéria à cartilagem do joelho humano normal, mesmo na presença de movimentos articulares normais. Mais estudos com um número maior de pacientes devem ser feitos para confirmar esta hipótese.

Adesão ao tratamento farmacológico e controle dos níveis pressóricos de hipertensos acompanhados na Estratégia de Saúde da Família / Adherence to pharmacological treatment in hypertensive people followed in the Family Health Strategy

Introdução: A hipertensão arterial sistêmica é uma doença multifatorial com controle ainda difícil no Brasil, sendo a adesão ao tratamento um importante aspecto neste processo. Este estudo objetiva estimar a prevalência da adesão ao tratamento farmacológico anti-hipertensivo e sua associação com controle dos níveis pressóricos em indivíduos hipertensos acompanhados na Estratégia de Saúde da Família (ESF), em São Francisco do Conde, Bahia. Materiais e métodos: Trata-se de um estudo transversal, com 356 indivíduos hipertensos cadastrados no Programa de Acompanhamento de Hipertensos e Diabéticos (HIPERDIA). Osdados foram coletados através de visitas domiciliares, aplicação de questionário contendo o teste de Morisky-Green para avaliação da adesão farmacológica e realização da medida da pressão arterial. Resultados e discussão: Segundo o teste de Morisky-Green, 22,9% dos sujeitos foram considerados aderentes à terapia farmacológica, dado semelhante ao encontrado em outros estudos. O controle dos níveis pressóricos esteve associado com a adesão ao tratamento farmacológico. Os indivíduos aderentes à terapia farmacológica apresentaram maior média de idade e níveis pressóricos mais baixos. Conclusão: Nesse estudo a adesão ao tratamento farmacológico foi baixa entre os hipertensos, e esteve associada a melhores níveis pressóricos. Fazem-se necessárias diversas estratégias para melhor controle terapêutica desta doença

Introduction: Arterial systemic hypertension is a multifactorial disease hard to control in Brazil, and the adherence to treatment is a substantial aspect of this process. To estimate the prevalence of adherence to antihypertensive pharmacological treatment and its association with blood pressure level control in persons suffering from hypertension that were assisted by the Family Health Strategy (FHS), in São Francisco do Conde, Bahia, Brazil. Methods: It is a cross-sectional study, performed on 356 hypertense persons registered on the Hypertensive Diabetics Monitoring program (HIPERDIA). The data were collected through home visits, application of questionnaire containing the Morisky-Green test and two evaluations of blood pressure, both separated by at least 5 minutes within one another. Results: According to the Morisky-Green test, 22.6% of individuals did adhere to the pharmacological treatment, similar information were found in other studies. Blood pressure control was associated with medication adherence. Adherent individuals in this study possess higher average age and lower blood pressure levels. Conclusion: Medication adherence were low among hypertensive people and contributes to blood pressure level control. Various strategies are necessary for a better therapeutic control of this disease.