Adham do Amaral e Castro

Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers

Objective To describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations. Materials and Methods Two hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ) to evaluate the carpal tunnel syndrome severity. A median nerve area ≥ 9 mm2 was considered to be diagnostic of carpal tunnel syndrome. Results Carpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001), paresthesia (p < 0.0001), Tinel’s test (p < 0.0001), Phalen’s test (p < 0.0001), BCTQ score (p < 0.0001), and years of formal education (p < 0.0001). Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24). Conclusion The prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome.

ÁCIDO ÚRICO E REPARAÇÃO TECIDUAL

O acido urico, um produto metabolico das purinas, pode exercer um papel na cicatrizacao de tecidos. Nesta revisao, sera explorado o seu papel no alarme inicial do processo inflamatorio que e necessario para o reparo tissular, bem como a sua atuacao neutralizadora de radicais livres de oxigenio, mobilizadora de celulas endoteliais progenitoras e favorecedora da atuacao do sistema imunologico adaptativo.

URIC ACID AND TISSUE REPAIR.

Uric acid, a metabolic product of purines, may exert a role in tissue healing. In this review we will explore its role as an alarm initiating the inflammatory process that is necessary for tissue repair, as a scavenger of oxygen free radicals, as a mobilizer of progenitor endothelial cells and as supporter of adaptive immune system.

Ectopic ovary with torsion: uncommon diagnosis made by ultrasound

Ultrasound is an important diagnostic tool in inguinal hernia and in the evaluation of the contents of the hernia sac. This report presents a case in which ultrasound revealed a herniated ectopic ovary, complicated by torsion of its vascular pedicle, in the right labia majora. We also present a brief discussion of ovarian hernia, its potential complications, and the treatments available.

Obesidade, adiposopatia e biomarcadores de imagem quantitativa

Radiol Bras. 2017 Mai/Jun;50(3):VII–VIII Obesity is a metabolic disease with increasing incidence at a global level. The prevalence of obesity doubled between 1980 and 2014, now corresponding to more than half a billion obese people worldwide. The World Health Organization estimates that more than a third of adults over 18 years of age are now overweight. Obesity plays an important role in the development of several diseases, such as atherosclerosis, diabetes, musculoskeletal conditions (e.g., osteoarthritis, tendinopathy, and carpal tunnel syndrome), and chronic pain. Another important association is the increased risk of cancer. The development of these conditions is likely related to increased production of pro-inflammatory adipokines (e.g., interleukin 6 and tumor necrosis factor alpha) and decreased production of (or decreased tissue sensitivity to) anti-inflammatory adipokines (e.g., adiponectin). The final result is that those individuals are in an inflammatory state and show increased levels of acute phase reagents such as C-reactive protein. In the field of radiology, there is a trend toward more quantitative science that could increase the value of quantitative imaging biomarkers and reduce variability across devices, patients, and time. A quantitative imaging biomarker can be defined as “an objective characteristic derived from an in vivo image measured on a ratio or interval scale as indicators of normal biological processes, pathogenic processes, or a response to a therapeutic intervention”. It is extremely important that measurements can be reproduced by different observers on different equipment. In this context, the Radiological Society of North America has organized a Quantitative Imaging Biomarker Alliance. There is great interest in quantitative measurements of adipose tissue, to serve as imaging biomarkers. Total body adipose tissue can be better understood and quantified through sectional imaging methods such as computed tomography and magnetic

The draped aorta sign of impending aortic aneurysm rupture

aneurysm rupture Eduardo Kaiser Ururahy Nunes Fonseca , Adham do Amaral e Castro, Amanda de Vasconcelos Chambi Tames, Eduardo Matarolo Jayme, Omir Antunes Paiva, Luis Ricardo Sokolowski Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo 05652-901, Brazil Imaging Department, Hospital Municipal do M’boi Mirim Dr. Moysés Deutsch, Estrada do M’boi Mirim, 5203, São Paulo 05868-160, Brazil

TENDINOPATHY AND OBESITY

ABSTRACT Introduction: Tendinopathies and tendon tears account for over 30% of all musculoskeletal consultations. Obesity, which is becoming one of the world´s most prevalent public health issues, may be associated with this condition. Objective: To review the literature about tendinopathies and obesity association. Methods: This is a descriptive exploratory study using the portal Medline. Literature in English language from 2006 to 2014 were reviewed. Results: The pathogenesis of tendinopathies includes inflammatory, regenerative and degenerative processes that happen simultaneously from early to late phases of the disease. Mechanical stress upon tendons seems to be one of the most important factors to initiate the inflammatory response, but it´s not the only one that can deflagrate it: there are other extrinsic, genetic and metabolic factors that may be involved. Therefore, tendinopathies in obese patients can be due to tendon overload because of the excess of weight, but also because of increased production of pro-inflammatory mediators related to fat tissue such as adipokines. This pro-inflammatory state that obese people can suffer is known as adiposopathy, or sick fat syndrome. Weight loss is associated with decrease in adipokines and improvement of musculoskeletal symptoms. Conclusion: The relation of obesity and tendinopathies is supported by evidences of recent studies, exemplified in this review of literature.

Thickening of the greater auricular nerve in leprosy: clinical correlation by ultrasound

http://dx.doi.org/10.1590/0100-3984.2017.0001 Alinne Christina Alves Pires1, Diogo Costa Oliveira2, Marcelo Souto Nacif2, Marcelo Fontalvo Martin1, João Maurício Canavezi Indiani1 1. Unidade de Radiologia Clínica (URC), São José dos Campos, SP, Brazil. 2. Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil. Correspondence: Dra. Alinne Christina Alves Pires. Unidade de Radiologia Clínica. Rua Teopompo de Vasconcelos, 245, Vila Adyana. São José dos Campos, SP, Brazil, 12243-830. E-mail: alinnechrispires@gmail.com. which supply segments of the small bowel in the area of the hernia defect. In the case described here, MDCT revealed laterally insinuated loops clustered in the region of the mesocolic fossa, with no significant distension or injury of the jejunal loops. The addition of contrast could increase the diagnostic accuracy of the radiological examinations. Laparoscopic repair is a safe and effective method for the management of cases of Broesike hernia. However, because the patient described here was at prohibitive surgical risk, we opted for clinical monitoring. At this writing, the patient has been followed at our facility for over six months, without any worsening of her symptoms.

Overuse of the hip external rotators: greater trochanter apophysitis in the karate kid

Lucas Samuel Perinazzo Pauvels1, Felipe Welter Langer1, Daiane dos Santos1, Carlos Jesus Pereira Haygert1 1. Department of Radiology and Imaging Diagnosis, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil. Correspondence: Dr. Felipe Welter Langer. Universidade Federal de Santa Maria – Departamento de Radiologia e Diagnóstico por Imagem. Avenida Roraima, 1000, Camobi. Santa Maria, RS, Brazil, 97105-900. E-mail: felipewlanger@gmail.com. the presence of multiple accessory spleens and duplication of left-sided structures illustrate the polysplenia syndrome. Classical findings in HS include cardiac malpositioning, septal defects, bilateral bilobed or trilobed lungs, midline liver, intestinal malrotation, and abnormal spleen development. Intestinal malrotation can lead to gut volvulus and ischemia, whereas complete asplenia predisposes to bacterial infections and sepsis. Up to 75% of patients with polysplenia have significant cardiac malformations, namely endocardial cushion defects, double-outlet right ventricle, left heart obstruction, and anomalous venous return. The severity of congenital heart disease remains a main determinant of the long-term prognosis of HS patients—even after surgical repair of congenital heart disease, patients are prone to developing arrhythmias, thromboembolism due to right atrium enlargement, and progressive systolic dysfunction. In conclusion, HS is a complex syndrome that has remarkable phenotypic variability and is a challenge to manage. Patients with HS are prone to develop potentially life-threatening complications, which should be promptly diagnosed and managed. Therefore, imaging studies are critical in evaluating these patients, because they delineate the spectrum of possible cardiac and extracardiac involvement in HS and associated complications. REFERENCES

DIAGNOSTIC VALUE OF C-REACTIVE PROTEIN AND THE INFLUENCE OF VISCERAL FAT IN PATIENTS WITH OBESITY AND ACUTE APPENDICITIS

ABSTRACT Background: The C reactive protein (CRP) is one of the most accurate inflammatory markers in acute appendicitis (AA). Obesity leads to a pro-inflammatory state with increased CRP, which may interfere with the interpretation of this laboratory test in AA. Aim: To assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP in patients with AA and their correlation to body mass index (BMI) and body fat composition. Method: This is a retrospective study based on clinical records and imaging studies of 191 subjects with histopathologically confirmed AA compared to 249 controls who underwent abdominal computed tomography (CT). Clinical and epidemiological data, BMI, and CRP values were extracted from medical records. CT scans were assessed for AA findings and body composition measurements. Results: CRP values increased according to patients’ BMI, with varying sensitivity from 79.78% in subjects with normal or lean BMI, 87.87% in overweight, and 93.5% in individuals with obesity. A similar pattern was observed for NPV: an increase with increasing BMI, 69.3% in individuals with normal or lean BMI, 84.3% in overweight, and 91.3% in individuals with obesity. There was a positive correlation between CRP and visceral fat area in patients with AA. Conclusions: Variations exist for sensitivity, specificity, PPV, and NPV values of CRP in patients with AA, stratified by BMI. An increase in visceral fat area is associated with elevated CRP across the BMI spectrum.