Cohorte descriptiva de pacientes adultos con hipertensión portal en una institución de tercer nivel en Colombia / Descriptive cohort of adult patients with portal hypertension at a tertiary care institution in Colombia

Introducción. La hipertensión portal (HTP) se define como una elevación anormal de la presión venosa en el sistema portal que lleva al desarrollo de vías colaterales para desviar el flujo sanguíneo de la zona. Dentro de su etiología están las relacionadas con la cirrosis hepática y otras causas denominadas no cirróticas. El objetivo de este estudio fue evaluar los principales hallazgos demográficos, clínicos y paraclínicos en un grupo de pacientes con HTP, y determinar el uso de ayudas invasivas y no invasivas, y su disponibilidad para el diagnóstico y seguimiento de los pacientes en los centros que no cuentan con laboratorio de hemodinamia hepática, reflejando la dinámica de múltiples escenarios en Colombia. Metodología. Se realizó un estudio descriptivo de corte transversal, retrospectivo, en pacientes atendidos en una institución de tercer nivel del sur de Colombia, entre enero del año 2015 y diciembre del año 2020. Resultados. Se obtuvo una muestra de 61 pacientes en donde la mayoría de casos correspondían a hombres en la séptima década de la vida, procedentes del área urbana. La principal causa de consulta fue el sangrado digestivo (39,3 %), asociado a la presencia de telangiectasias (arañas vasculares) en el 37,2 %, seguido de circulación colateral (31,3 %) e ictericia (19,7 %). En la ecografía abdominal (realizada en el 57,4 % de los pacientes) predominaron la cirrosis (68 %) y la presencia de esplenomegalia (14,2 %), y en lospacientes con Doppler portal (realizado en el 16,4 %) se encontró hígado cirrótico (80 %) y dilatación portal (40 %). Con respecto a los hallazgos en la esofagogastroduodenoscopia predominó la presencia de várices esofágicas y gastritis crónica. Conclusión. El principal motivo de consulta fue el sangrado digestivo, en tanto que la cirrosis fue el antecedente y el hallazgo imagenológico más frecuente, seguido de las várices esofágicas. Se encontró que el uso de paraclínicos, ecografía abdominal, ecografía con Doppler portal y esofagogastroduodenoscopia fueron los más utilizados en el contexto clínico de los pacientes con el diagnóstico de HTP.

Introduction. Portal hypertension (PHT) is defined as an abnormal elevation of venous pressure in the portal system that leads to the development of collateral pathways to divert blood flow from the area. Within its etiology are those related to liver cirrhosis and other so-called non cirrhotic causes. The aim of this study was to evaluate the main demographic, clinical and paraclinical findings in a group of patients with PHT, and to determine the use of invasive and non-invasive aids, and their availability for the diagnosis and follow-up of patients in centers that do not have a hepatic hemodynamics laboratory, reflecting the dynamics of multiple scenarios in Colombia. Methodology. A descriptive, retrospective, cross-sectional, retrospective study was conducted in patients attended in a third level institution in Southern Colombia, between January 2015 and December 2020. Results. A sample of 61 patients was obtained where the majority of cases corresponded to men in the seventh decade of life, from the urban area. The main cause of consultation was digestive bleeding (39.3%), associated with the presence of telangiectasias (spider veins) in 37.2%, followed by collateral circulation (31.3%) and jaundice (19.7%). In abdominal ultrasound (performed in 57.4% of the patients), cirrhosis (68%) and the presence of splenomegaly (14.2%) predominated, and in patients with portal Doppler (performed in 16.4%), cirrhotic liver (80%) and portal dilatation (40%) were found. With respect to the findings in the esophagogastroduodenoscopy, esophageal varices and chronic gastritis were predominant. Conclusion. The main reason for consultation was gastrointestinal bleeding, while cirrhosis was the most frequent history and imaging finding, followed by esophageal varices. It was found that the use of paraclinics, abdominal ultrasound, ultrasound with portal Doppler and esophagogastroduodenoscopy were the most used in the clinical context of patients diagnosed with PHT.

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

OBJECTIVE: This study aimed to identify the most useful ultrasound (US) features associated with definite neonatal necrotizing enterocolitis (NEC) and their prognostic values, particularly the calculated markers combined with important features. METHODS: A total of 213 suspected NEC cases were collected from the neonatal department of our hospital from January 2015 to August 2017. Each infant received both X-ray and US examinations. RESULTS: No differences were found in sex composition and delivery modes between groups. NEC-positive neonates had poorer prognosis compared to negative ones. The NEC group showed a higher frequency of abnormal signals. US showed higher NEC-related frequencies in different parameters. A variable (named predictor in US [PUS]) with five features was constructed. For NEC diagnosis, this variable provided a much higher area under the curve Q2 (AUC) (0.965) than other parameters. In this model, PUS had a cutoff value of 0.376 with a 0.900 sensitivity and 0.922 specificity. In prognosis, the closest factors were selected to draw a receiver operating characteristic curve, as well as a novel calculated variable US prognostic (USPro) marker. USPro had a much higher AUC (0.86) than other single features and showed a cutoff value of 0.18145, with 0.75 sensitivity and 0.84 specificity. This variable had a weaker power in prognosis when compared with PUS in diagnosis. CONCLUSIONS: The application of abdominal color Doppler US can provide high accuracy and sensitivity in NEC diagnosis and also contribute to its prognosis, without induction of radiation. Suspected neonates should be examined using this technique as early as possible.

Alteraciones bioquímicas y ecográficas a nivel hepático en pacientes que viven con VIH/Sida

Los pacientes con Virus de inmunodeficiencia humana (VIH) pueden presentar alteraciones del funcionalismo y estructura hepática como consecuencia de la terapia antirretroviral (TARV), de otras coinfecciones o de patologías metabólicas o neoplásicas que pueden presentarse en cualquier estadio de la enfermedad. La realización de las pruebas de laboratorio y el ultrasonido abdominal son herramientas fundamentales para la detección y seguimiento de estos casos. Objetivo: Describir las alteraciones bioquímicas y ecográficas a nivel hepático en pacientes que viven con condición de VIH/Sida que reciben TARV. Metodología: Investigación clínica, descriptiva, de campo, de corte transversal, donde se incluyeron pacientes con VIH mayores de 18 años que acudieron a la consulta de Infectología del Hospital Central de Maracay en el período marzo-junio de 2017. Se excluyeron pacientes con coinfecciones y patologías metabólicas. Se registraron datos epidemiológicos, clínicos y paraclínicos. Resultados: Se incluyeron 23 pacientes que recibían TARV, predominando el sexo masculino y el rango etario de 20-29 años. 60,87 % tenían entre 1 y 3 años en TARV regular. 21,73 % de los pacientes mostraron elevación de las transaminasas tanto glutámico-pirúvica (TGP) como glutámico-oxalacética (TGO), destacándose que todos los pacientes de este grupo recibían terapia con inhibidores de la transcriptasa reversa análogo de nucleósido más inhibidores de la transcriptasa reversa no análogo de nucleósido (ITRN/ ITRNN); en cuanto a los valores de bilirrubina se evidenció que quienes recibían la combinación ITRN/Inhibidores de la proteasa (IP) presentaron elevación de los niveles de bilirrubina a predominio de la indirecta (21,7 %). Para la GGT solo un paciente presentó alteración. El hallazgo ecográfico más frecuente fue la esteatosis hepática (69,56 %), predominando la esteatosis hepática grado II. Conclusión: Es necesario en los pacientes con condición VIH la evaluación regular e integral de parámetros hepáticos, en búsqueda de efectos adversos de la terapéutica, u otras condiciones médicas y nutricionales que puedan incrementar el riesgo de patología hepática

Patients with Human Immunodeficiency Virus (HIV) may have alterations in liver function and structure because of antiretroviral therapy (ART), other coinfections or metabolic or neoplastic diseases that can occur at any stage of the disease. The performance of laboratory tests and abdominal ultrasound are essential tools for the detection and monitoring of these cases. Objective: Describe the biochemical and ultrasound alterations at a hepatic level in patients living with HIV/ AIDS who receive ART. Methodology: Clinical research, descriptive, field, cross-sectional, which included patients with HIV over 18 years who attended the consultation of Infectious Diseases at the Central Hospital of Maracay in the period March-June 2017. Patients with coinfections and metabolic pathologies were excluded. Epidemiological, clinical and paraclinical data were recorded. Results: Twenty-three patients receiving ART were included, predominantly male and with an age range of 20-29 years. 60.87 % were between 1 and 3 years on regular ART. 21.73 % of the patients showed elevation of both glutamic-pyruvic transaminase (GPT) and glutamic-oxalacetic transaminase (GOT), highlighting that all patients in this group received therapy with nucleoside analogue reverse transcriptase inhibitors plus non-nucleoside analogue reverse transcriptase inhibitors (NRTIs/NNRTIs). In terms of bilirubin values, it was shown that those receiving the combination of NRTIs/Protease Inhibitors (PI) showed an increase in bilirubin levels with a predominance of hint (21.7 %). About GGT only one patient presented alteration. The most frequent ultrasound finding was Hepatic Steatosis (69.56 %), with predominance of hepatic steatosis grade II. Conclusion: It is necessary in patients with HIV condition regular and comprehensive assessment of liver parameters, in search of adverse effects of therapy, or other medical and nutritional conditions that may increase the risk of liver disease.

Contrast imaging techniques to diagnose hepatocellular carcinoma in cirrhotics outside regular surveillance.

INTRODUCTION AND AIM: The American Association for the Study of the Liver (AASLD) recommends contrast computerized tomography (CT-scan) and magnetic resonance (MRI) to diagnose hepatocellular carcinoma (HCC) arising in cirrhotic patients under semiannual surveillance with abdominal ultrasound (US). A US guided fine needle biopsy (FNB) serves the same purpose in radiologically undiagnosed tumors and incidentally detected nodules in cirrhotics outside surveillance. In this population, we evaluated the performance of radiological diagnosis of HCC according to 2010 AASLD recommendations. MATERIALS AND METHODS: All cirrhotic patients with a liver nodule incidentally detected by US were prospectively investigated with a sequential application of CT-scan/MRI examination and a FNB. RESULTS: Between 2011 and 2015, 94 patients (mean age 67 years) had a liver nodule (total 120) detected by US in the context of histologically confirmed cirrhosis. Mean nodules diameter was 40 (10-160) mm, 87 (73%) <5cm. At histology, 84 (70%) nodules were HCC, 8 (7%) intrahepatic cholangiocarcinoma, 6 (5%) metastases, 2 (2%) neuroendocrine tumors and 20 (16%) benign lesions. Hyperenhancement in arterial phase followed by wash-out in venous phases on at least one radiological technique was demonstrated in 62 nodules (61 HCC, 1 high grade dysplastic nodule), with a specificity of 97% (IC95%: 85-100%), sensitivity 73% (IC95%: 62-81%) and diagnostic accuracy 80%, being 64% for ≥5cm HCC. Sensitivity of AFP >200ng/mL was 12% (IC95%: 6-23%). CONCLUSION: A single contrast imaging technique showing a typical contrast pattern confidently identifies HCC also in cirrhotic patients with an incidental liver nodule, thereby reducing the need for FNB examinations.

Morbidity of schistosomiasis mansoni in a low endemic setting in Ouro Preto, Minas Gerais, Brazil

Abstract INTRODUCTION: Despite the advances of disease control programs, severe forms of schistosomiasis are prevalent. The prevalence of the disease in areas frequented by tourists urges for permanent prevention and control. The aim of this study was to describe the morbidity of schistosomiasis in the district of Antônio Pereira, Ouro Preto, Minas Gerais, Brazil. METHODS: The proportion of positives was defined by Kato-Katz coproscopy and urinary POC-CCA rapid test. Hepatosplenic form was diagnosed using abdominal ultrasound. RESULTS: Out of 180 participants,97 were examined by Kato-Katz, with 4 (4.1%) being positive. Thirty-four (22.1%) out of 154 were positive by POC-CCA. Five (2.8%) of 177 examined by ultrasound had hepatosplenic form. One of them had undergone splenectomy. One (0.6%)participant had myeloradiculopathy. CONCLUSIONS: Severe forms of schistosomiasis are still prevalent in low endemic areas and should be thoroughly investigated.

Frecuencia de hígado graso no alcohólico diagnosticado por ecografía abdominal en pacientes obesos / Frequency of fatty liver nonalcoholic diagnosed by abdominal ultrasound in patients obese

El hígado graso no alcohólico (HGNA) es una complicación asociada a la obesidad, debido a la acumulación excesiva de grasa en el hígado. Con el objetivo de determinar la frecuencia de hígado graso no alcohólico diagnosticado por ecografía abdominal en pacientes que asisten a la Unidad del Manejo Integral del Paciente Obeso del Hospital de Clínicas, FCM ­ UNA, se realizó un estudio observacional descriptivo retrospectivo que incluyó a 188 pacientes, de los cuales 146 fueron mujeres y 42 hombres, la edad media en los pacientes con diagnóstico de HGNA fue de 41,3±11,4 años con un rango de edad de 20 a 65 años. Los resultados señalan la frecuencia de HGNA con el 56,9% (n=107) por ecografía abdominal, siendo 39,9% (n=75) mujeres y 17% (n=32) hombres, mientras que 43,1% (n=81) presentó hígado de aspecto normal. El 43,9% (n=47) de los pacientes con HGNA exhibió obesidad grado III. Al comparar la circunferencia abdominal en los 107 pacientes con HGNA se obtuvo una media de 139,1±97,8 cm. Con respecto al grado de esteatosis el 43,1% (n=81) mostró grado 0, 31,9% (n=60) grado 1, 20,7% (n=39) grado 2 y 4,3% (n=8) grado 3. Se observaron en los datos de laboratorio elevación de las transaminasas GPT 35,5% (n=38), 25,2% (n=27) en la GOT y 24,3% (n=26) FA, se notó aumento en los valores de las bilirrubinas directa e indirecta, 65,4% (n=70) BD y 69,2% (n=74) BI, por otra parte el 47,7% (n=51) enseñó CT elevado, 49% (n=45,7) HDL disminuido, 36,4% (n=39) LDL elevado y 29% (n=31) con triglicéridos elevados. Se halló que el 69,1% (n=74) de los pacientes con HGNA tienen HTA. Al realizar la comparación de las variables mencionadas entre los pacientes con y sin HGNA, arrojó que las transaminasas GPT, GOT y triglicéridos estuvieron en niveles más altos en los pacientes con HGNA. Se evidenció que la obesidad es un factor determinante para el desarrollo de HGNA, la caracterización del perfil hepático y lipídico, asimismo la presión arterial constituyen puntos fundamentales para asociar el aumento de estos con la presencia de HGNA.

Nonalcoholic fatty liver disease (NAFLD) is a complication associated with obesity, due to excessive accumulation of fat in the liver. In order to determine the frequency of NAFLD diagnosed by abdominal ultrasound in patients attending the unit Comprehensive Patient Management Obese the Hospital of Clinics, FCM - UNA, a retrospective observational study involving performed in 188 patients, of which 146 were women and 42 men, average age in patients with NAFLD diagnosis was 41,3±11,4 years with an age range of 20 - 65 years. The results indicate the frequency of NAFLD with 56,9% (n=107) for abdominal ultrasound, being 39,9% (n=75) women and 17% (n=32) were men, while 43,1% (n=81) presented liver normal. 43.9% (n=47) of patients with NAFLD showed grade III obesity. By comparing the abdominal circumference in 107 patients with NAFLD an average of 139,1±97,8 cm was obtained. With respect to the degree of steatosis 43,1% (n=81) showed grade 0, 31,9% (n=60) grade 1, 20,7% (n=39) grade 2 and 4,3% (n=8) grade 3 were observed in laboratory data GPT transaminases elevation of 35,5% (n=38), 25.2% (n=27) in the GOT and 24,3% (n=26) FA, increased values of direct and indirect bilirubin, 65,4% (n = 70) BD and 69.2% (n=74) BI was noted, moreover 47,7% (n=51) CT taught high, 49% (n=45,7) decreased HDL, 36,4% (n=39) high LDL and 29% (n=31) with elevated triglycerides. It was found that 69,1% (n=74) of patients with NAFLD have hypertension. When comparing the variables mentioned among patients with and without NAFLD, he threw the GPT, GOT transaminases and triglycerides were at higher levels in patients with NAFLD. It was evident that obesity is a determining factor NAFLD development, characterization of liver and lipid profile, blood pressure also are key points to associate these increased with the presence of NAFLD.

Epipericardial Fat Necrosis: Sonographic Findings and Their Correlation With Computed Tomography.

Epipericardial fat necrosis is a rare cause of chest pain. It presents as pleuritic pain in an otherwise healthy patient. Computed tomography has proved to be the most effective diagnostic imaging technique because of its ability to reveal typical alterations in the cardiophrenic space. As far as we know, sonographic findings concerning this entity have not been reported in the literature. We report 4 cases admitted to our institutional emergency department with chest pain. Among other tests, chest wall sonography was requested in these patients and showed special findings that should be evaluated with chest computed tomography.

Medición de la longitud del cérvix por ecografía abdominal en gestantes normales entre 21 a 23 semanas

Objetivos: Evaluar la factibilidad técnica para medir la longitud del cérvix por ecografía abdominal en gestantes entre 20 y 23 semanas, y la correlación entre los valores obtenidos por ecografía abdominal versus ecografía vaginal. Diseño: Estudio observacional transversal. Lugar: Instituto Latinoamericano de Salud Reproductiva (ILSAR), Lima, Perú. Participantes: Gestantes. Métodos: En 67 gestantes normales sin factores de riesgo para parto pretérmino (PP), entre las 20 y 23 semanas de gestación, se midió la longitud cervical, en 30 de ellas tanto por ecografía abdominal utilizando transductor convexo de 3-5 MHZ como por ecografía vaginal con transductor endocavitario de 5-7 MHZ. Principales medidas de resultados: Correlación de la medida de la longitud del cérvix por ecografía abdominal y transvaginal. Resultados: En 65 gestantes se obtuvo una medida satisfactoria de la longitud del cérvix mediante ecografía abdominal (97% de casos). Se encontró correlación entre las mediciones por ecografía abdominal y vaginal (coeficiente Pearson 0,646, p<0,0001) y no existió diferencia significativa entre ambos valores (p:0,126) para IC del 95%. Conclusiones: En 97% de los casos estudiados se obtuvo una medida satisfactoria de la longitud del cérvix por ecografía abdominal. Hubo correlación, sin diferencia significativa, entre las mediciones obtenidas por vía abdominal y vaginal.

Objectives: To determine the feasibility of cervical length measurement by transabdominal ultrasound at 20-23 weeks of gestation and to correlate this measurements with those obtained by tansvaginal ultrasound. Design: Observational cross-sectional study. Setting: Instituto Latinoamericano de Salud Reproductiva (ILSAR), Lima, Peru. Participants: Pregnant women. Methods: In 67 pregnant women with no risk factors for preterm delivery (PTD) measurement of the uterine cervix at 20-23 weeks of gestation was performed. Thirty women (30) underwent both transabdominal and transvaginal ultrasound measurement. Main outcome measures: Correlation of uterine cervix measurement by abdominal and transvaginal ultrasound. Results: The cervix could be measured satisfactorily by transabdominal measurement in 65 women (97%). There was a good correlation between transabdominal and transvaginal measurement (r<.0.646, p<0.001) and there was no significant difference between both measurements (p:0.126). Conclusions: The uterine cervix could be measured by transabdominal ultrasound in 97% of pregnant women. There was correlation between measurements obtained by transabdominal and transvaginal ultrasound.

Ultrasonido abdominal en pacientes con infección por virus de inmunodeficiencia humana / Abdominal ultrasound in patients infected with human immunodeficiency virus

Introducción: La infección por el virus de inmunodeficiencia humana constituye un grave problema sanitario. En el 2011, el Ministerio del Poder Popular para la Salud señaló una prevalencia del 0,91%, calculando 111.324 casos en mayores de 15 años. Los reportes ecográficos en pacientes con VIH son escasos. Sin embargo, la ecografía es un método seguro, económico y accesible que permite el estudio de un gran número de condiciones. Pacientes y Métodos: Estudio prospectivo, descriptivo y de corte transversal, que incluye pacientes portadores de infección de VIH, que acudieron al servicio de Gastroenterología del Hospital General del Oeste, entre mayo de 2012 a mayo de 2013. A los cuales se les realizó eco abdominal. Resultados: 80 pacientes. 95% presentó alteraciones ecográficas, 52% cursaba con síntomas gastrointestinales, de ellos, el 100% presentaba alteraciones ecográficas. 42,5% pertenecían a la Categoría C de VIH, de los cuales el 100% tuvo alteraciones ecográficas. Se identificaron alteraciones hepáticas en el 85% de los casos, vesiculares en el 65%, retroperitoneales 51,25 %, renales 37,5%, esplénicas 25,25% y pancreáticas 3,75%. Conclusiones: La ecografía abdominal constituye una herramienta útil y accesible para el médico gastroenterólogo en la detección y/o diagnóstico de alteraciones intra-abdominales en pacientes VIH.

Introduction: Human Immunodeficiency Virus Infection (HIV) is a serious health problem.In 2011, the Ministry of People's Power for Health estimated a prevalence of 0.91% with 111,324 cases over 15 year’s population. Ultrasound reports in patients with HIV are scarce. However, ultrasound is safe, non-invasive, affordable and accessible to study a large number of conditions. Patients and methods: A Prospective, descriptive and cross-sectional study was performed. HIV infected patients who underwent the Gastroenterology Service ofWestern General Hospital, from May 2012 to May 2013, to an abdominal echo were included. Results: 80 patients. 95% had abnormal ultrasound, 52% had gastrointestinal symptoms and of these, 100% had ultrasound abnormalities. 42.5% were C category, of which 100% had ultrasound abnormalities. We identified lesions in the liver (85%), gallbladder (65%), retroperitoneum (51,25%), Kidneys (37,5%), spleen (26,25%) and pancreas (3,75%) of the patients. Conclusions: Abdominal ultrasound is a useful and accessible diagnostic tool for the gastroenterologist to detect abdominal abnormalities in HIV patients.

Medición de la longitud del cérvix por ecografía abdominal en gestantes normales entre 20 a 23 semanas

Objetivos: Evaluar la factibilidad técnica para medir la longitud del cérvix por ecografía abdominal en gestantes entre 20 y 23 semanas, y la correlación entre los valores obtenidos por ecografía abdominal vs. ecografía vaginal. Diseño: Estudio observacional transversal. Institución: Instituto Latinoamericano de Salud Reproductiva (ILSAR), Lima, Perú. Participantes: Gestantes normales de 20 a 23 semanas de gestación. Métodos: Se midió la longitud cervical por ecografía a 67 gestantes normales sin factores de riesgo para parto pretérmino, entre las 20 y 23 semanas de gestación, con la finalidad de medir la longitud cervical. En 30 de las embarazadas se midió la longitud cervical por ecografía abdominal utilizando transductor convexo de 3-5 MHZ y por ecografía vaginal con transductor endocavitario de 5-7 MHZ. Principales medidas de resultados: Medida de la longitud del cérvix. Resultados: En 65 gestantes se obtuvo una medida satisfactoria de la longitud del cérvix mediante ecografía abdominal (97% de los casos). Se encontró correlación entre las mediciones por ecografía abdominal y vaginal (coeficiente de Pearson 0,646, p<0,001) y no existió diferencia significativa entre ambas mediciones (p: 0,126). Conclusiones: En 97% de los casos estudiados se obtuvo una medida satisfactoria de la longitud del cérvix por ecografía abdominal. Hubo correlación entre las mediciones obtenidas por vía abdominal y vaginal.

Objectives: To assess the feasibility of measuring cervical by transabdominal ultrasound between 20 and 23 weeks of gestation and compare these measurements with those obtained by transvaginal ultrasound. Design: Crosssectional study. Setting: Instituto Latinoamericano de Salud Reproductiva (ILSAR), Lima, Peru. Participants: Normal pregnant women with no risk factors for preterm delivery (PTD). Methods: Cervical length was measured to 67 normal pregnant women 20-23 weeks by transabdominal ultrasound. In 30 women cervical length was measured by abdominal ultrasound using 3-5 MHZ convex transducer and by vaginal ultrasound with 5-7 MHZ endotransducer. Main outcome measures: Cervical length measurement. Results: The cervix was satisfactorily measured by transabdominal ultrasound in 65 women (97%). There was good correlation between transabdominal and transvaginal measurement (r<.0.646, p<0.001) with no significant difference between those measurements (p: 0.126). Conclusions: The cervix could be measured by transabdominal ultrasound in 97% of women. There was correlation between transabdominal and transvaginal ultrasound measurements.

Abdominal and pelvic ultrasound study of the maned wolf (Chrysocyon brachyurus) / Estudo ultrassonográfico abdominal e pélvico de lobo-guará (Chrysocyon brachyurus)

The aim of the present study was the ultrasound characterization of the abdominal and pelvic regions of five maned wolves kept in captivity at the Triage Center of Wild Animals of the Federal University of Viçosa (Centro de Triagem de Animais Silvestres, Universidade Federal de Viçosa). This characterization included descriptions of ultrasonographic aspects and measurements of various structures using B-mode ultrasound. Biometric data were collected to assess the existence of significant linear correlations between these measurements and the measurements obtained by ultrasound. Additionally, hematological and serum biochemistry evaluations of the animals were performed. The ultrasound findings were similar to those available in the literature on domestic dogs, which were used for comparison as a result of the lack of published data regarding maned wolves. The latter species showed characteristics closely resembling those of the former, differing in the spleen and left renal cortex echogenicities, in the appearance of the prostatic and testicular regions and in the hepatic portal vein morphology. In the current study, the biometric values were similar to those previously published; however, no data regarding thoracic perimeter, modified crown-rump length or thoracic depth were found in the literature for this Canidae species. Statistical analysis showed the existence of a strong negative correlation between the modified crown-rump length and left renal length, between the modified crown-rump length and the right renal volume, between the thoracic perimeter and the height at the cranial pole of the left adrenal gland and between the thoracic perimeter and the height at the caudal pole of the left adrenal gland. Laboratory findings, including segmented neutrophil, eosinophil, monocyte and lymphocyte counts and the serum levels of glucose, ALT, alkaline phosphatase, urea, total protein, globulin, creatine phosphokinase, triglyceride, sodium, phosphate, potassium and chloride, were inconsistent with values found by other authors. The ultrasound is a diagnostic imaging method that must be further explored in the medicine of wild animals; therefore, additional research in this area is required.

O presente trabalho objetivou a caracterização ultrassonográfica das regiões abdominal e pélvica de cinco lobos-guarás mantidos em cativeiro no Centro de Triagem de Animais Silvestres da Universidade Federal de Viçosa, com descrição dos aspectos ultrassonográficos e obtenção de medidas de suas diversas estruturas, por meio de ultrassonografia modo-B. Coletaram-se dados de biometria corporal com a finalidade de se verificar a existência de correlação linear significativa entre estas medidas e as mensurações obtidas ultrassonograficamente. Adicionalmente, efetuou-se avaliação hematológica e bioquímica sérica dos animais. Os achados ultrassonográficos foram equiparados aos existentes na literatura de cães domésticos devido à inexistência de dados publicados referentes a lobos-guarás. Esta espécie apresentou características muito semelhantes às do cão, diferindo nas ecogenicidades do baço e córtex renal esquerdo, no aspecto da região prostática, testicular e na morfologia da veia porta hepática. No presente estudo, os valores de biometria corporal foram semelhantes aos anteriormente publicados, porém não se encontraram dados na literatura referentes a perímetro torácico, comprimento vértice-caudal modificado e profundidade torácica para esta espécie de canídeo. A análise estatística revelou a existência de forte correlação negativa entre o comprimento vértice caudal modificado e o comprimento renal esquerdo, entre o comprimento vértice caudal modificado e o volume renal direito, entre o perímetro torácico e a altura do polo cranial da glândula adrenal esquerda e entre o perímetro torácico e a altura do polo caudal da glândula adrenal esquerda. Laboratorialmente, a contagem de neutrófilos segmentados, eosinófilos, monócitos e linfócitos e os níveis séricos de glicose, ALT, fosfatase alcalina, ureia, proteína total, globulina, creatina fosfoquinase, triglicérides, sódio, fosfato, potássio e cloreto foram discordantes de valores obtidos por outros autores. A ultrassonografia é um método de diagnóstico por imagem que necessita ser mais explorado na medicina de animais silvestres, sendo, portanto necessário o incremento de pesquisas nesta área.

Abdominal and pelvic ultrasound study of the maned wolf (Chrysocyon brachyurus) / Estudo ultrassonográfico abdominal e pélvico de lobo-guará (Chrysocyon brachyurus)

The aim of the present study was the ultrasound characterization of the abdominal and pelvic regions of five maned wolves kept in captivity at the Triage Center of Wild Animals of the Federal University of Viçosa (Centro de Triagem de Animais Silvestres, Universidade Federal de Viçosa). This characterization included descriptions of ultrasonographic aspects and measurements of various structures using B-mode ultrasound. Biometric data were collected to assess the existence of significant linear correlations between these measurements and the measurements obtained by ultrasound. Additionally, hematological and serum biochemistry evaluations of the animals were performed. The ultrasound findings were similar to those available in the literature on domestic dogs, which were used for comparison as a result of the lack of published data regarding maned wolves. The latter species showed characteristics closely resembling those of the former, differing in the spleen and left renal cortex echogenicities, in the appearance of the prostatic and testicular regions and in the hepatic portal vein morphology. In the current study, the biometric values were similar to those previously published; however, no data regarding thoracic perimeter, modified crown-rump length or thoracic depth were found in the literature for this Canidae species. Statistical analysis showed the existence of a strong negative correlation between the modified crown-rump length and left renal length, between the modified crown-rump length and the right renal volume, between the thoracic perimeter and the height at the cranial pole of the left adrenal gland and between the thoracic perimeter and the height at the caudal pole of the left adrenal gland. Laboratory findings, including segmented neutrophil, eosinophil, monocyte and lymphocyte counts and the serum levels of glucose, ALT, alkaline phosphatase, urea, total protein, globulin, creatine phosphokinase, triglyceride, sodium, phosphate, potassium and chloride, were inconsistent with values found by other authors. The ultrasound is a diagnostic imaging method that must be further explored in the medicine of wild animals; therefore, additional research in this area is required.(AU)

O presente trabalho objetivou a caracterização ultrassonográfica das regiões abdominal e pélvica de cinco lobos-guarás mantidos em cativeiro no Centro de Triagem de Animais Silvestres da Universidade Federal de Viçosa, com descrição dos aspectos ultrassonográficos e obtenção de medidas de suas diversas estruturas, por meio de ultrassonografia modo-B. Coletaram-se dados de biometria corporal com a finalidade de se verificar a existência de correlação linear significativa entre estas medidas e as mensurações obtidas ultrassonograficamente. Adicionalmente, efetuou-se avaliação hematológica e bioquímica sérica dos animais. Os achados ultrassonográficos foram equiparados aos existentes na literatura de cães domésticos devido à inexistência de dados publicados referentes a lobos-guarás. Esta espécie apresentou características muito semelhantes às do cão, diferindo nas ecogenicidades do baço e córtex renal esquerdo, no aspecto da região prostática, testicular e na morfologia da veia porta hepática. No presente estudo, os valores de biometria corporal foram semelhantes aos anteriormente publicados, porém não se encontraram dados na literatura referentes a perímetro torácico, comprimento vértice-caudal modificado e profundidade torácica para esta espécie de canídeo. A análise estatística revelou a existência de forte correlação negativa entre o comprimento vértice caudal modificado e o comprimento renal esquerdo, entre o comprimento vértice caudal modificado e o volume renal direito, entre o perímetro torácico e a altura do polo cranial da glândula adrenal esquerda e entre o perímetro torácico e a altura do polo caudal da glândula adrenal esquerda. Laboratorialmente, a contagem de neutrófilos segmentados, eosinófilos, monócitos e linfócitos e os níveis séricos de glicose, ALT, fosfatase alcalina, ureia, proteína total, globulina, creatina fosfoquinase, triglicérides, sódio, fosfato, potássio e cloreto foram discordantes de valores obtidos por outros autores. A ultrassonografia é um método de diagnóstico por imagem que necessita ser mais explorado na medicina de animais silvestres, sendo, portanto necessário o incremento de pesquisas nesta área.(AU)

Beneficio de la ecosonografía abdominal en la evaluación pediátrica de rutina / Routine abdominal ecosonografic scan in children

La ecografía abdominal es importante en el diagnóstico y tratamiento de un número elevado de patologías abdominales. El dolor abdominal es la principal indicación de ecografía. Se plan-tea la posibilidad de diagnosticar alteraciones y/o patologías asintomáticas, que pueden requerir intervención temprana. Determinar el beneficio de la ecosonografía abdominal en la evaluación pediátrica de rutina. Trabajo prospectivo y transversal. Se incluyen pacientes escogidos al azar, para realizarles ecografía abdominal. Distribuidos en grupo A, los niños con solicitud de evaluación gastrointestinal y grupo B, niños sin patología gastrointestinal. Se solicita consentimiento informado. Un total de 182 niños, promedio de edad 4,70 años (rango 1m-14 años), 92 varones y 90 hembras. De 131 niños, con enfermedad gastrointestinal, grupo A, 32(24,42%) presentaron alteraciones a la ecografía. De ellos 17/32(53,12%) con hallazgos ecográficos en relación a la enfermedad de base siendo lo más frecuentes hepatopatías (esteatosis, hepatomegalia, fibrosis periportal), litiasis vesicular, cambios en vísceras huecas y reflujo gastroesofágico; 15/32(46,88%) se detectaron alteraciones no relacionados con la enfermedad de base, como: enfermedad renal, tumoración abdominal, esplenomegalia. Grupo B: 16/51 (31,37%) se detectó alteraciones en órganos abdominales: barro biliar, esplenomegalia, hepatopatía, alteraciones renales y otras. Se encontró una diferencia significativa entre los grupos, en relación al hallazgo de alteraciones ecográficas no relacionadas con el motivo de consulta. Los resultados permiten inferir que la ecografía es una herramienta sensible que puede ser utilizada de rutina en la evaluación pediátrica para detectar alteraciones en órganos abdominales para una intervención temprana y tratamiento oportuno.

Abdominal ultrasound is important in the diagnosis and treatment of a large number of abdominal pathology. Abdominal pain is the main indication for ultrasound. It raises the possibility of diagnosing disorders and/or asymptomatic pathologies that may require early intervention. To determine the benefit of abdominal sonography in the routine pediatric evaluation. Prospective and cross. Includes patients are randomly selected for abdominal ultrasound and distributed in two groups: Group A, children with gastrointestinal application indication for assessment and group B, children without gastrointestinal pathology. Informed consent is requested. Results: A total of 182 children, mean age 4.70 years (range 1 m-14 years), 92 males and 90 females. Of 131 children with gastrointestinal disease, group A, 32 (24.42%) had alterations to the ultrasound. Of these 17/32 (53.12%) with ultrasound findings in relation to the underlying disease being the most common liver disease (steatosis, hepatomegaly, periportal fibrosis), gallstones, changes in hollow viscera and gastroesophageal reflux; 15/32 (46.88%) were detected abnormalities not related to underlying disease, such as kidney disease, abdominal tumor, splenomegaly. Group B: 16/51 (31.37%) resulted with detected abnormalities in abdominal organs, biliary sludge, spleen, liver, renal and others. We found a significant difference between groups in relation to the discovery of ultrasound abnormalities unrelated to the complaint. The results allow to conclude that ultrasound is a sensitive tool that can be used in routine pediatric evaluation to detect changes in abdominal organs for early intervention and treatment.

Comparison between clinical and ultrasonographic findings in cases of periportal fibrosis in an endemic area for schistosomiasis mansoni in Brazil / Comparação entre achados clínicos e ultrassonográficos no diagnóstico da fibrose periportal em uma área endêmica de esquistossomose no Brasil

INTRODUCTION: Abdominal palpation and ultrasound findings among patients from an endemic area for schistosomiasis in Brazil who had been followed up for 27 years were compared. METHODS: In 2004, 411 patients from Brejo do Espírito Santo, in the State of Bahia, were selected for the present investigation after giving their written informed consent. Based on clinical data, they were divided into three groups: 41 patients with evidence of liver fibrosis in 2004 (Group 1); 102 patients with evidence of liver fibrosis in the past (1976-1989) but not in 2004 (Group 2); and 268 patients without evidence of liver fibrosis at any time during the 27-year follow-up (Group 3). All of the patients underwent abdominal ultrasound in which the examiner did not know the result from the clinical examination. The data were stored in a database. RESULTS: The prevalence of periportal fibrosis on ultrasound was 82.9 percent, 56.9 percent and 13.4 percent in Groups 1, 2 and 3, respectively. In the presence of hard, nodular liver or prominent left lobe and a hard palpable spleen, ultrasound revealed periportal fibrosis in 70.9 percent. However, periportal fibrosis was diagnosed using ultrasound in 25.4 percent of the patients in the absence of clinical evidence of liver involvement. Thus, ultrasound diagnosed periportal fibrosis 3.1 times more frequently than clinical examination did. CONCLUSIONS: Although clinical examination is important in evaluating morbidity due to Manson's schistosomiasis in endemic areas, ultrasound is more accurate in diagnosing liver involvement and periportal fibrosis.

INTRODUÇÃO: Neste estudo, se comparou os achados da palpação abdominal e do ultrassom em pacientes de área endêmica de esquistossomose que foram acompanhados por 27 anos no Brasil. MÉTODOS: Em 2004, 411 pacientes de Brejo do Espírito Santo, no estado da Bahia, após consentimento informado e por escrito foram selecionados para o presente estudo. Baseando-se no exame clínico eles foram divididos em 3 grupos: 41 (Grupo 1) com evidência de fibrose hepática no ano de 2004; 102 (Grupo 2) com evidência de fibrose hepática no passado (1976-1989) mas não em 2004; e 268 (Grupo 3) sem evidência de fibrose hepática em 27 anos de seguimento. Todos foram submetidos a exame ultrassonográfico do abdome em que o examinador não sabia o resultado do exame clínico. Os dados foram armazenados em banco de dados. RESULTADOS: A prevalência de fibrose periportal ao ultrassom foi de 82,9 por cento, 56,9 por cento e 13,4 por cento nos Grupos 1, 2 e 3, respectivamente. Na presença de fígado duro, nodular ou lobo esquerdo proeminente e baço palpável duro, o ultra-som revelou fibrose periportal em 70,9 por cento. Porém, fibrose periportal foi diagnosticada através do ultrassom em 25,4 por cento dos pacientes, na ausência de evidência clínica de envolvimento hepático. Assim, o ultrassom diagnosticou fibrose periportal 3,1 vezes mais frequentemente que o exame clínico. CONCLUSÕES: O exame clínico tem importância na avaliação da morbidade da esquistossomose mansônica em áreas endêmicas, mas o ultrassom mostra-se mais preciso quando se pretende diagnosticar o envolvimento hepático e a fibrose periportal.

Grosor de la pared vesicular en pacientes con hipertensión portal: Utilidad clínica

Introducción: El engrosamiento de la pared vesicular se halla poco frecuente en el ultrasonido abdominal de pacientes con cirrosis hepática e hipertensión portal. En este trabajo se determinó cual es su importancia en relación con la presencia de varices esofágicas y otras variables. Pacientes y Métodos: Estudio prospectivo y comparativo con un grupo de pacientes con Cirrosis hepática e hipertensión portal y otro control sin Enfermedad hepática. Se realizaron pruebas hepáticas, ultrasonido abdominal, doppler de la vena porta y endoscopia digestiva superior. Resultados: Se evaluaron 25 pacientes: 14 casos y 11 controles, edad promedio 46,28 + 17,47 vs 38,27 +10,63. Las diferencias entre ellos fueron: Diámetro de vena porta 10,78 + 2,54 vs 8,63 + 1,80 mm, p=0,02; Albúmina sérica 3,16 + 0,83 vs 4,13 + 0,48 gms., p=0,003 y grosor de pared vesicular 3,51 + 1,45 vs 1,77 + 0,45mm, p=0,0009). La sensibilidad del engrosamiento de la pared vesicular para el diagnóstico de varices esofágicas resultó 80 %, especificidad 93,3 %, Valor predictivo positivo 89 % y valor predictivo negativo 88 %. Se encontró asociación entre grosor de la pared vesicular, albúmina (r=0,5347, p=0,005) y el diámetro de la porta (r=0,4105, p= 0,041). No hubo diferencias en cuanto a Velocidad sistólica máxima p=0,13; Velocidad diastólica final p=0,22; ¸ndice de resistencia p=0,15, Flujo sanguíneo portal: p=0,94. No se logró demostrar relación entre el Grosor de pared vesicular y el Child Pugh (r=0,25, p= 0,386). Conclusiones: Existe relación entre el grosor de la pared vesicular y la presencia de varices esofágicas en los pacientes con cirrosis hepática.

Objetive: The thickening of the gall bladder wall is little common in the abdominal ultrasound of patients with liver cirrhosis and portal hypertension. In this work it was determined its importance in relation with the presence of esophageal varices and other variables. Patients and Methods: A prospective and comparative study was made (cases and controls). A group of patients with liver Cirrhosis and portal hypertension and another control without liver Disease. Were made Liver tests, abdominal ultrasound, Doppler of the porta vein and upper endoscopy. Results: Evaluated 25 patients; 14 cases patients, and 11 patients controls, mean age 46.28 ± 17.47 vs 38.27 ± 10, 63. Differences between them were: Vein diameter porta 10.78 + 2.54 vs 8.63 + 1.80mm, p=0,02; Seric albumin 3.16 + 0.83 vs. 4.13 + 0.48 gm, p=0,003 and gall bladder wall thickness 3.51 + 1.45 versus 1.77 + 0,45mm, p=0,0009. The sensitivity of the thickening gall bladder wall for the diagnosis of esophageal varices was of 80%, specificity 93.3%, predictive value positive 89% and predictive value negative 88%. Association was found between thickness of the gall bladder wall and albumin (r=0,5347, p=0,005) and the diameter of the porta (r=0,4105, p= 0.041). There was not differences respect to speed systolic Maximum p=0,13; diastolic speed final p=0,22; resistance index p=0,15; blood Flow portal: p=0,94. No profit to demonstrate between the Thickness of gall bladder wall and the Child Pugh (r=0, 25, p= 0.386).Conclusions: Relationship betwen the gall bladder wall thickening and the presence of esophageal varices in patients with cirrhosis of the liver and portal hypertension.

Abscesos cerebelosos como complicación infrecuente de absceso hepático amebiano: Reporte de un caso

El absceso cerebral es una infrecuente y fatal complicación extraintestinal de la infección por E. histolytica. Presentamos el caso de un paciente que falleció por múltiples abscesos cerebelosos asociados con absceso hepático amebiano. Caso clínico: Se trata de paciente masculino, 62 años, proveniente del área metropolitana. Consulta por presentar dolor abdominal en hipocondrio derecho, nauseas, vómitos, fiebre y evacuaciones líquidas. Se diagnosticó absceso hepático de 12 x 8 cm de diámetro, por ultrasonido abdominal, correlacionado con la clínica y hallazgos de laboratorio (leucocitosis, elevación de transaminasas y fosfatasas alcalinas). Adicionalmente, el ELISA indirecto para determinar IgG para E. histolytica resultó positivo. La biopsia guiada por ultrasonido sugiere absceso hepático. Recibió tratamiento con metronidazol y ciprofloxacina por 10 días presentando mejoría clínica y de laboratorio. Sin embargo, consulta nuevamente con reaparición de los síntomas, pero se agrega cefalea occipital de fuerte intensidad. Al examen físico de reingreso se encuentran cifras tensiónales de 157/122 mmHg, refractarias al tratamiento, así como hallazgos de déficit neurológico sugestivos de síndrome cerebeloso. Se realizó tomografía de cráneo donde se evidencian múltiples imágenes hipodensas en probable relación con abscesos. Se planteó drenaje quirúrgico, sin embargo el paciente, falleció a las pocas horas.

Brain abscess are a rare and fatal complication of infection with extraintestinal E. histolytica. We present a patient who died of multiple cerebellar abscesses associated with amebic liver abscess. Clinical case: male, 62 years old, from the metropolitan area. Who came in 4 weeks before his death due to abdominal pain in the right hypochondrium, nausea, vomiting, fever and diarrhea. Liver abscess were diagnosed in 12 x 8 cm diameter, by abdominal ultrasound, correlated with clinical and laboratory findings (leukocytosis, high transaminases and alkaline phosphatases). Additionally, the indirect ELISA to determine IgG to E. histolytica was positive. Biopsy guided by ultrasound is concluded as abscess. The patient received treatment with metronidazole and ciprofloxacin for 10 days showing improvement. However, checked again with recurrence of symptoms, but adds strong occipital headache intensity. Initial physical examination re-found the blood pressure 157/122 mmHg, refractory to treatment, and findings of neurological deficits suggestive of cerebellar syndrome. Cranial tomography was performed which showed multiple hypodense images in connection with probable abscess. Surgical drainage was raised; however the patient evolved torpidly and died within hours.

Ultrassonografia e ressonância magnética: estudo comparativo no diagnóstico da esteatose em obesos grau III / Abdominal ultrasound and magnetic resonance imaging: a comparative study on the non-alcoholic fatty liver disease diagnosis in morbidly obese patients

OBJETIVOS: Avaliar a concordância entre a ressonância magnética (RM) e a ultrassonografia abdominal (USG) no diagnóstico da doença hepática gordurosa não-alcoólica (DHGNA), bem como a concordância entre cada método com o exame padrão-ouro histopatológico. MÉTODOS: A população estudada foi constituída por 145 pacientes com obesidade grau III (IMC > 40 Kg/m²), de ambos os sexos. O diagnóstico da DHGNA foi realizado por ultrassonografia e ressonância magnética. Em uma subamostra foi realizado o diagnóstico por biópsia hepática (n=40). Para avaliar a concordância entre os diagnósticos por USG e RM, utilizou-se o coeficiente Kappa. RESULTADOS: Observou-se uma concordância fraca entre os dois métodos (Kappa ajustado= 0,27; IC 95 por cento= 0,07-0,39). Foi encontrada uma concordância moderada entre o diagnóstico da doença por USG e biópsia hepática, com 83,3 por cento de resultados concordantes e Kappa ajustado de 0,67. Já a concordância entre o diagnóstico por RM e histopatológico foi ausente, com 53,6 por cento de resultados concordantes e Kappa ajustado de 0,07. CONCLUSÃO: A boa concordância encontrada entre o diagnóstico realizado pela USG e a biópsia hepática reforça a necessidade de condução de mais estudos como os que vêm recomendando uma padronização da avaliação diagnóstica por USG como forma de minimizar a necessidade da realização da biópsia hepática para diagnóstico de formas mais graves da doença.

OBJECTIVES: To evaluate the concordance between abdominal ultrasound and an MRI (Magnetic Resonance Imaging) in the diagnosis of non-alcoholic fatty liver disease (NAFLD), and concordance of these two methods with the histopathological exam. METHODS: The population studied was comprised of 145 patients with morbid obesity (BMI > 40 Kg/m²), of both genders. NAFLD diagnosis was performed by MRI and Ultrasound. Liver biopsy was performed in a sub-sample (n=40). To evaluate the concordance of these two methods, the kappa coefficient was used. RESULTS: Concordance between both methods (MRI and Ultrasound) was poor and not significant (Kappa adjusted= 0.27; CI 95 percent= 0.07-0.39.) Nevertheless a slight concordance was found between diagnosis of NAFLD by ultrasound and the hepatic biopsy, with 83.,3 percent of concordant results and Kappa adjusted= 0.67.Results of an MRI and the histopathological exam were compared and results showed 53.6 percent of concordant results and kappa adjusted= 0.07. CONCLUSION: The concordance found in the diagnosis performed using the ultrasound method and the hepatic biopsy, shows a need to implement and perform more research on the use of ultrasound to validate and reconsider these methods. This would minimize the need to perform biopsies to detect and diagnose such disease.

Tamizaje por hepatocarcinoma y estrategia de seguimiento en portadores del virus de hepatitis B / Tamizaje by hepatocarcinoma and strategy of pursuit in carriers of the virus of hepatitis B

La utilización del ultrasonido abdominal y la alfafetoproteína juntas se consideran las pruebas de tamizaje aceptadas como más útiles en él seguimiento de los portadores crónicos del virus B. Se debe separar los pacientes de alto riesgo (sexo masculino, cirróticos, historia familiar de hepatocarcinoma, mayores de 45 años) y los de bajo riesgo para determinar el tiempo de seguimiento, siendo cada 3 meses para los primeros y de cada 6 meses para los segundos. Cuando se detecte alguna imagen anormal, el uso de tomografía de 3 fases y resonancia magnética complementan la definición de las imágenes para definir una conducta terapéutica.

The use of both abdominal ultrasound and alphafetoprotein is considered as one of the most useful and accepted screening tests to follow up chronic HBV carriers. High risk patients (males, cirrhotic with hepatoma family history, older than 45 years of age) and those low-risks must be separated to establish follow up time wich shold be every 3 months for the former and every 6 months for the latter. If any abnormal image is detected, the use of three dimensional tomography and magnetic resonance complement image definition to establish a therapeutic conduct.