Intramuscular adipose tissue, muscle area, and power as predictors of performance in breast cancer survivors.

PURPOSE: The decline in physical performance, assessed by physical tests such as the timed up and go (TUG) test, is a consequence of reduced physiological reserves at higher levels of a hierarchical process. This occurs due to changes in muscle architecture, including atrophy and fat infiltration into the muscles, which in turn lead to changes in muscle function, resulting in reduced muscle strength and power and, consequently, affecting physical performance. This study investigated predictive factors for physical performance in breast cancer survivor (BCS), focusing on intramuscular adipose tissue (IMAT), quadríceps muscle area (QMA), and muscular power. METHODS: This observational, analytical, and cross-sectional study included 23 women without a history of cancer (age, 58.5 ± 8.3 years; BMI, 27.2 ± 5.1 kg/m2) and 56 BCS (age, 58.5 ± 8.3 years; BMI, 27.2 ± 5.1 kg/m2). QMA and IMAT were assessed using computed tomography images. Muscular power and physical performance were measured using the 5-repetition sit-to-stand and TUG tests, respectively. RESULTS: IMAT (r = 0.4, P < 0.01) and muscular power (r = - 0.4, P < 0.01) were associated with TUG performance in BCS, whereas QMA (r = - 0.22, P = 0.10) showed no significant association. QMA (r = 0.55, P < 0.01) was associated with muscular power, while no significant association was found between IMAT and muscular power (r = - 0.05, P = 0.73). Age explained 19% (P < 0.01) of TUG performance variability. Adding muscular power increased explanatory power by 12% (P < 0.01), and including IMAT further increased it by 7% (P = 0.02) for TUG performance. Collectively, age, muscular power, and IMAT accounted for 38% of the performance variance in the TUG test (age, B = 0.06, P = 0.043; muscular power, B = - 0.01, P = 0.002; IMAT, B = - 0.05, P = 0.020). CONCLUSIONS: Our findings suggest that IMAT and muscular power predict the physical performance of BCS, while QMA does not have the same predictive capability.

Ultrasound measurement of thyroid volume in euthyroid children under 3 years of age.

OBJECTIVE: To establish ultrasound reference values for thyroid volumes in children up to 3 years of age, given that ultrasound of the thyroid is an essential examination in the diagnosis of childhood thyroid disease. MATERIALS AND METHODS: This was a prospective study conducted in an iodine-sufficient city in southeastern Brazil. A total of 100 healthy children underwent clinical evaluation, anthropometric examination, and cervical ultrasound in accordance with conventional protocols. We evaluated characteristics such as echotexture, thyroid lobe volume, and total thyroid volume. The children were divided into five groups, by age: < 2 months; 2-12 months; 12-18 months; 18-24 months; and 24-36 months. RESULTS: The mean thyroid volume was lower in the < 2 month age group than in the other groups (0.4 mL vs. 0.18-0.70 mL; p < 0.001). For the subjects between 2 and 36 months of age, the mean volume was 1.0 mL (range, 0.30-2.0 mL). No other significant differences were observed between groups, thyroid lobes, or gender. However, body mass index correlated significantly with total thyroid volume (r = 0.347; p = 0.001). CONCLUSION: The mean thyroid dimensions were smallest in the < 2 month age group (0.35 ± 0.16 mL). For the subjects between 2 and 36 months of age, a reference value of 0.85 ± 0.42 mL can be used. Our data could guide the diagnostic investigation of thyroid disease, especially congenital hypothyroidism, in childhood.

OBJETIVO: Estabelecer valores de referência ultrassonográficos de volumes tireoidianos em crianças de até três anos de idade, por ser exame essencial no diagnóstico de doença tireoidiana infantil. MATERIAIS E MÉTODOS: Trata-se de estudo prospectivo conduzido em cidade do sudeste brasileiro suficiente em iodo. Participaram 100 crianças saudáveis, submetidas a exame clinicoantropométrico e ultrassonografia cervical seguindo protocolos convencionais. Características como ecotextura e volumes dos lobos e da tireoide total foram obtidos. Segundo a idade, as crianças foram distribuídas em cinco grupos: < 2 meses; 2-12 meses; 12-18 meses; 18-24 meses; e 24-36 meses. RESULTADOS: No grupo < 2 meses os volumes tireoidianos foram menores (p < 0,001) do que nos demais (0,4 mL; 0,18-0,70 mL). Além dessa idade, o volume total médio foi 1,0 mL (0,30-2,0 mL) e não diferiu entre os grupos. Não foram observadas diferenças entre lobos ou relacionadas a gênero. Houve correlação (r = 0,347; p = 0,001) entre índice de massa corporal e volume total. CONCLUSÃO: As dimensões tireoidianas foram menores até dois meses (0,35 ± 0,16 mL), e a partir dessa idade os mesmos valores de referência podem ser usados até 36 meses (0,85 ± 0,42 mL). Tais dados podem orientar a investigação diagnóstica, especialmente no hipotireoidismo congênito.

Radiology report: what is the opinion of the referring physician?

OBJECTIVE: To evaluate the opinion and perception of referring physicians regarding the radiology report, in order to develop tools that promote an improvement in its quality. MATERIALS AND METHODS: We prepared a questionnaire containing ten multiple choice questions about the radiology report, administering it to 70 physicians (35 specialists and 35 residents working in specialties other than radiology). RESULTS: Referring physicians (specialists and residents) showed a preference for structured reports, with a description explained in universal medical language and a complete conclusion listing the diagnostic possibilities with the degree of certainty. The examination technique should be described, and the final report is best presented when it contains the final chart, together with images, as hard copies and in digital format. The respondents also reported having confidence in the opinion of the radiologist and expressed the need for a direct channel of communication with the same. CONCLUSION: Referring physicians seek detailed reports (including a description of the examination technique), preferably structured, with objective language and relevant conclusions (the position of the radiologist on the case is important). It is necessary to discuss the differential diagnoses and provide a form of contact between the parties. Although referring physicians consider the radiologist opinion relevant, they also want to analyze the images on their own.

OBJETIVO: Avaliar a opinião e a percepção dos médicos solicitantes sobre o laudo radiológico e desenvolver ferramentas que promovam uma melhora de sua qualidade. MATERIAIS E MÉTODOS: Foi elaborado um questionário contendo dez questões de múltipla escolha acerca do laudo radiológico, o qual foi submetido a 35 médicos especialistas e 35 médicos residentes de outras especialidades. RESULTADOS: Médicos referentes (especialistas e residentes) mostraram preferência por laudos estruturados, com uma descrição explicada em linguagem médica universal e conclusão completa contendo as possibilidades diagnósticas indicadas com probabilidade de certeza. A técnica do exame deve ser descrita e o relatório final é mais bem apresentado quando contém o laudo final associado a imagens impressas e em formato digital. Também foram relatadas a confiança na opinião do radiologista e a necessidade de um canal direto de comunicação com ele. CONCLUSÃO: Os médicos solicitantes buscam relatórios detalhados (inclusive com a descrição da técnica do exame), preferencialmente estruturados, com linguagem objetiva e conclusões pertinentes (o posicionamento do radiologista sobre o caso é importante). É necessário discutir os diagnósticos diferenciais e fornecer uma forma de contato entre as partes. Apesar de considerarem relevante a opinião do radiologista, eles também querem analisar as imagens por conta própria.

Ultrasound evaluation of the penis.

Ultrasound is an excellent method for the study of penis. In this article, using a critical review of the literature and teaching files, we present examples of the major findings in the ultrasound routine, focusing on trauma, priapism, Peyronie's disease, and erectile dysfunction.

Sonographic evaluation of children with congenital hypothyroidism.

OBJECTIVE: To establish benchmarks and study some sonographic characteristics of the thyroid gland in a group of euthyroid children aged up to 5 years as compared with age-matched children with congenital hypothyroidism. MATERIALS AND METHODS: Thirty-six children (17 female and 19 male) aged between 2 months and 5 years were divided into two groups - 23 euthyroid children and 13 children with congenital hypothyroidism - and were called to undergo ultrasonography. RESULTS: In the group of euthyroid children (n = 23), mean total volume of the thyroid gland was 1.12 mL (minimum, 0.39 mL; maximum, 2.72 mL); a homogeneous gland was found in 17 children (73.91%) and 6 children (26.08%) had a heterogeneous gland. In the group of children with congenital hypothyroidism (n = 13), mean total volume of the thyroid gland was 2.73 mL (minimum, 0.20 mL; maximum, 11.00 mL). As regards thyroid location, 3 patients (23.07%) had ectopic thyroid, and 10 (69.23%) had topic thyroid, and out of the latter, 5 had a homogeneous gland (50%) and 5, a heterogeneous gland (50%). In the group with congenital hypothyroidism, 6 (46.15%) children had etiological diagnosis of dyshormoniogenesis, 3 (23.07%), of ectopic thyroid, and 4 (30.76%), of thyroid hypoplasia. CONCLUSION: Thyroid ultrasonography is a noninvasive imaging method, widely available, easy to perform and for these reasons could, and should, be performed at any time, including at birth, with no preparation or treatment discontinuation, to aid in the early etiological definition of congenital hypothyroidism.

OBJETIVO: Estabelecer padrões de referência e estudar algumas características ultrassonográficas tireoidianas em um grupo de crianças eutireoidianas até os 5 anos de idade, comparando-as a crianças portadoras de hipotireoidismo congênito de mesma faixa etária. OBJETIVO: Trinta e seis crianças foram divididas em dois grupos ­ 23 eutireoidianas e 13 portadoras de hipotireoidismo congênito ­ e convocadas para a realização de ultrassonografia de tireoide. Dessas crianças, 17 eram do sexo feminino e 19, do sexo masculino, com idades entre 2 meses e 5 anos. RESULTADOS: No grupo de crianças eutireoidianas (n = 23), o volume total médio da glândula tireoide foi 1,12 mL (mínimo: 0,39 mL; máximo: 2,72 mL), sendo observadas, também, glândula homogênea em 17 crianças (73,91%) e glândula heterogênea em 6 crianças (26,08%). No grupo de crianças com hipotireoidismo congênito (n = 13), o volume total médio da glândula tireoide foi 2,73 mL (mínimo: 0,20 mL; máximo: 11,00 mL). Quanto à localização da tireoide, foram encontradas 3 crianças (23,07%) com tireoide ectópica e 10 (69,23%) com tireoide tópica, sendo que, nessas últimas, 5 tinham glândula homogênea (50%) e 5, glândula heterogênea (50%). Das crianças com hipotireoidismo congênito, 6 (46,15%) apresentavam diagnóstico etiológico de disormoniogênese, 3 (23,07%) tinham diagnóstico etiológico de ectopia e 4 (30,76%) possuíam diagnóstico etiológico de hipoplasia tireoidiana. CONCLUSÃO: A ultrassonografia de tireoide, por se tratar de um método não invasivo, bastante disponível, de fácil realização, pode e deve ser realizada a qualquer momento, inclusive ao nascimento, sem preparação ou interrupção do tratamento, para auxiliar na definição etiológica precoce do hipotireoidismo congênito.

Low-load resistance training promotes muscular adaptation regardless of vascular occlusion, load, or volume.

PURPOSE: This study investigates the impact of two different intensities and different volumes of low-load resistance training (LLRT) with and without blood flow restriction on the adaptation of muscle strength and size. METHODS: The sample was divided into five groups: one set of 20 % of one repetition maximum (1RM), three sets of 20 % of 1RM, one set of 50 % of 1RM, three sets of 50 % of 1RM, or control. LLRT was performed with (OC) or without (NOC) vascular occlusion, which was selected randomly for each subject. The maximal muscle strength (leg extension; 1RM) and the cross-sectional area (quadriceps; CSA) were assessed at baseline and after 8 weeks of LLRT. RESULTS: 1RM performance was increased in both groups after 8 weeks of training: OC (1 × 50 % = 20.6 %; 3 × 50 % = 20.9 %; 1 × 20 % = 26.6 %; 3 × 20 % = 21.6 %) and NOC (1 × 50 % = 18.6 %; 3 × 50 % = 26.8 %; 1 × 20 % = 18.5 %; 3 × 20 % = 21.6 %; 3 × 20 % = 24.7 %) compared with the control group (-1.7 %). Additionally, the CSA was increased in both groups: OC (1 × 50 % = 2.4 %; 3 × 50 % = 3.8 %; 1 × 20 % = 4.6 %; 3 × 20 % = 4.8 %) and NOC (1 × 50 % = 2.4 %; 3 × 50 % = 1.5 %; 1 × 20 % = 4.3 %; 3 × 20 % = 3.8 %) compared with the control group (-0.7 %). There were no significant differences between the OC and NOC groups. CONCLUSION: We conclude that 8 weeks of LLRT until failure in novice young lifters, regardless of occlusion, load or volume, produces similar magnitudes of muscular hypertrophy and strength.

Laryngeal schwannoma: a case report with emphasis on sonographic findings.

Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings.

Schwannomas são tumores benignos derivados da bainha das células de Schwann de nervos motores, sensitivos e cranianos, sem conter elementos nervosos. Cerca de 25% a 45% dos casos ocorrem na região de cabeça e pescoço, mas a localização laríngea é rara. O objetivo do nosso estudo é descrever um caso clínico de schwannoma laríngeo, enfatizando-se os achados ultrassonográficos.

Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting.

CONTEXT AND OBJECTIVE: Recent studies have shown noncontrast computed tomography (NCT) to be more effective than ultrasound (US) for imaging acute ureterolithiasis. However, to our knowledge, there are few studies directly comparing these techniques in an emergency teaching hospital setting. The objectives of this study were to compare the diagnostic accuracy of US and NCT performed by senior radiology residents for diagnosing acute ureterolithiasis; and to assess interobserver agreement on tomography interpretations by residents and experienced abdominal radiologists. DESIGN AND SETTING: Prospective study of 52 consecutive patients, who underwent both US and NCT within an interval of eight hours, at Hospital São Paulo. METHODS: US scans were performed by senior residents and read by experienced radiologists. NCT scan images were read by senior residents, and subsequently by three abdominal radiologists. The interobserver variability was assessed using the kappa statistic. RESULTS: Ureteral calculi were found in 40 out of 52 patients (77%). US presented sensitivity of 22% and specificity of 100%. When collecting system dilatation was associated, US demonstrated 73% sensitivity, 82% specificity. The interobserver agreement in NCT analysis was very high with regard to identification of calculi, collecting system dilatation and stranding of perinephric fat. CONCLUSIONS: US has limited value for identifying ureteral calculi in comparison with NCT, even when collecting system dilatation is present. Residents and abdominal radiologists demonstrated excellent agreement rates for ureteral calculi, identification of collecting system dilatation and stranding of perinephric fat on NCT.