Antonio Carlos Maciel

Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices

CONTEXT Upper gastrointestinal bleeding associated to esophageal varices is the most dramatic complication of cirrhosis. It is recommended screening every cirrhotic for esophageal varices with endoscopy. OBJECTIVES To evaluate the capacity of the platelet count/spleen diameter ratio in non-invasively predicting esophageal varices in a population of cirrhotics originated in an independent center from the one in which it was developed. METHODS The study included patients from the ambulatory care clinic of cirrhosis of a Brazilian hospital and studied platelet count, spleen diameter and presence of esophageal varices, as well as Child and MELD scores. It used a cutoff value of 909 for the platelet count/spleen diameter ratio, as previously published. A sample of 139 patients was needed to grant results a 95% confidence level. RESULTS The study included 164 cirrhotics, 56.7% male, with a mean age of 56.6 ± 11.6 years. In the univariate analysis, platelet count, spleen diameter, presence of ascites, Child and MELD scores and the platelet count/spleen diameter ratio were related to esophageal varices (P<0.05). The platelet count/spleen diameter ratio had sensitivity of 77.5% (95% CI = 0.700-0.850), specificity of 45.5% (95% CI = 0.307-0.602), positive predictive value of 79.5% (95% CI = 0.722-0.868), negative predictive value of 42.6% (95% CI = 0.284-0.567) and accuracy of 68.9% (95% CI = 0.618-0.760). In the multivariate analysis, platelet count was the only variable which related to esophageal varices (P<0.05). CONCLUSION Platelet count/ spleen diameter ratio is not adequate to predict esophageal varices in cirrhotics.

Acurácia dos achados ultrassonográficos do câncer de mama: correlação da classificação BI-RADS® e achados histológicos

OBJETIVO: A proposta deste estudo foi avaliar a acuracia da classificacao BI-RADS® na mamografia. Ospontos secundarios foram descrever a frequencia de apresentacao dos diferentes achados mamograficos eavaliar a concordância entre observadores. MATERIAIS E METODOS: Os exames de 115 pacientes, encami-nhados para core biopsy, foram reavaliados independentemente por dois medicos especialistas, cegados,utilizando a recomendacao do BI-RADS. Posteriormente, os exames foram comparados com a histologia. Aacuracia da classificacao BI-RADS na mamografia foi avaliada. A concordância entre os medicos foi calcu-lada pela estatistica kappa (κ) de Cohen e as diferencas nos grupos de comparacao foram analisadas comteste qui-quadrado. RESULTADOS: Esta pesquisa demonstrou que a acuracia mamografica oscilou de 75%a 62% na diferenciacao entre lesoes benignas de malignas com o uso do BI-RADS. Houve importante con-cordância na descricao das margens dos nodulos (κ = 0,66). Baixa concordância foi identificada na descri-cao dos contornos (formas) dos nodulos ( κ = 0,40) e na descricao das calcificacoes, tanto em relacao a suadistribuicao (κ = 0,24) como tambem em relacao a morfologia (κ = 0,36). CONCLUSAO: O presente estudodemonstrou que o metodo e acurado na diferenciacao de lesoes benignas de malignas. A concordância foifraca na analise das calcificacoes quanto a morfologia e distribuicao, no entanto, identificou-se elevacaoprogressiva dos valores preditivos positivos nas subcategorias 4.Unitermos: Neoplasia da mama; Mamografia; Histologia; Acuracia; BI-RADS; Ultrassonografia.OBJECTIVE: The present study was aimed at evaluating the BI-RADS® classification accuracy in mammography.Additionally, the frequency of different findings was described and the interobserver agreement was evaluated.MATERIALS AND METHODS: Mammographic images of 115 patients were independently and blindly reviewedby two specialists in compliance with BI-RADS recommendations, and later compared with histological data.The BI-RADS accuracy in mammography was evaluated. The interobserver agreement was analyzed withthe Cohen’s kappa (κ) test, and the differences between groups were evaluated with the chi-squared test.RESULTS: The present study demonstrated that the mammographic accuracy ranged from 75% to 62% inthe differentiation between benign and malignant lesions with the utilization of the BI-RADS classification.Statistically significant interobserver agreement was observed in the description of masses margins (κ =0.66). A low agreement rate was identified in the description of masses borders (shape) (κ = 0.40) andcalcifications, both in relation to their distribution (κ = 0.24) and morphology (κ = 0.36). CONCLUSION:The present study demonstrated the BI-RADS accuracy in the differentiation between benign and malignantlesions. The interobserver agreement was poor in the analysis of calcifications morphology and distribution,but a progressive increase in the positive predictive values was observed in the subcategory 4.Keywords: Breast cancer; Mammography; Histopathology; Accuracy; BI-RADS; Ultrasonography.

Accuracy of mammographic findings in breast cancer: correlation between BI-RADS classification and histological findings*

OBJECTIVE: The main purpose of the present study is to evaluate the accuracy of ultrasonography (BI-RADS) in the diagnosis of breast cancer whereas the additional specific objectives are to describe the frequency of different sonographic findings and evaluating interobserver agreement. MATERIALS AND METHODS: Images of 110 patients who had been referred for biopsy with previous diagnosis of breast nodules were independently reviewed by two specialists according to the BI-RADS classification. Histological findings were utilized as a gold-standard. The accuracy of findings was determined. The chi-squared test for categorical variables was utilized in the analysis of the differences resulting from the groups comparison, and the interobserver agreement was calculated with kappa () statistics. RESULTS: Among 110 breast masses evaluated by ultrasonography, 76 (69%) were benign and 34 (30.9%) were malignant. According to the radiologists, the sensitivity ranged from 70.5% to 82.3%, negative predictive value, from 81.1% to 87.5%, positive predictive value, from 42.1% to 45.1%, specificity from 56.58% to 55.2%, and accuracy from 60.9% to 63.6%. The global interobserver agreement was considered as moderate ( = 0.50). CONCLUSION: The fourth edition of BI-RADS provides radiologists with an accurate clinical decision support system for the diagnosis and management of breast disease.AbstractResumo * Study developed at Clinica de Radiodiagnostico ImagemLtda., Santo Ângelo, RS, Brazil.1. Master, MD, Radiologist, Director of the Clinica de Radio-diagnostico Imagem Ltda., Professor at Division of Imaging Diag-nosis, Instituto Cenecista de Ensino Superior Santo Ângelo, SantoÂngelo, RS, Brazil.2. PhD, Associate Professor, Pontificia Universidade Catolicado Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.3. PhD, MD, Radiologist at Hospital de Clinicas e Irmandadeda Santa Casa de Misericordia, Porto Alegre, RS, Brazil.Mailing address: Dr. Jose Hermes Ribas do Nascimento. RuaMarechal Floriano, 774, Meller Sul. Santo Ângelo, RS, Brazil,98801-650. E-mail: josehermesribas@hotmail.com duction of BI-RADS for ultrasonographyand magnetic resonance imaging, with theobjective of standardizing the assessmentand reporting of breast lesions, and provid-ing mastologists with guidance on theprobability of malignancy of a given lesionby helping to conduct the investigation (1,2) ,thus minimizing confusion in the imagesdescription and interpretation, and facilitat-ing the elaboration of the final reports of

Lesão de aorta simulando doença pulmonar: relato de caso

The authors report the case of an elderly woman assessed for dyspnea and right costal margin pain, whose chest radiography demonstrated opacity simulating pulmonary lesion, and computed tomography revealed the vascular origin of the condition. Acute aortic syndrome due to ruptured atheromatous plaque penetrating through the elastic lamina in association with aortic hematoma and aneurysm is a relevant differential diagnosis to be considered in these cases.The authors report the case of an elderly woman assessed for dyspnea and right costal margin pain, whose chest radiography demonstrated opacity simulating pulmonary lesion, and computed tomography revealed the vascular origin of the condition. Acute aortic syndrome due to ruptured atheromatous plaque penetrating through the elastic lamina in association with aortic hematoma and aneurysm is a relevant differential diagnosis to be considered in these cases.

Vocal Variability Post Swallowing in Individuals with and without Oropharyngeal Dysphagia

Introduction Voice modification after swallowing may indicate changes in the transit of the bolus. Objective The aim of this study is to verify the use of perceptual voice analysis to detect oropharyngeal dysphagia. Study Design Case series. Methods Twenty-seven patients with dysphagia as diagnosed by videofluoroscopy and 25 without were evaluated. The sustained vowel /a/ was recorded before this exam and after swallowing different consistencies (pasty, liquid and solid). For the voice evaluation, the GRBAS scale (grade, roughness, breathiness, asthenia and strain) and the parameter “wet voice” were used. Three judges blinded to study group and time of emission performed voice analysis. Results Individuals with dysphagia showed significant decrease in grade of voice and asthenia and increase in strain after swallowing pasty substances, differing from individuals without dysphagia who showed no modification of the parameters after swallowing. The wet voice parameter showed no difference after swallowing in both study groups. Conclusion The decrease in grade and asthenia and increased strain are indicative of a swallowing disorder, indicating increased vocal strain to clean the vocal tract of food. The modification of vocal production after swallowing proved to be a trusted resource for detection of swallowing disorders.

VIDEOFLUOROSCOPIC SWALLOWING STUDY: esophageal alterations in patients with dysphagia

CONTEXT Videofluoroscopic swallowing study is a dynamic exam and allows the evaluation of the complete swallowing process. However, most published studies have only reported alterations in the oropharynx and pharyngoesophageal transition, leaving the analysis of the esophagus as a secondary goal. OBJECTIVES The goal of this study was to investigate the prevalence of alterations in the esophageal phase thorough videofluoroscopic swallowing study in patients with dysphagia. METHODS Consecutive patients with dysphagia who underwent videofluoroscopic swallowing study including esophageal analysis between May 2010 and May 2012 had their exams retrospectively reviewed. Patients were classified into two groups: Group I - without a pre-established etiological diagnosis and Group II - with neurological disease. During the exam, the patients ingested three different consistencies of food (liquid, pasty and solid) contrasted with barium sulfate and 19 items were analyzed according to a protocol. The esophageal phase was considered abnormal when one of the evaluated items was compromised. RESULTS Three hundred and thirty-three (n = 333) consecutive patients were studied - 213 (64%) in Group I and 120 (36%) in Group II. Esophageal alterations were found in 104 (31%) patients, with a higher prevalence in Group I (36.2%), especially on the items esophageal clearance (16.9%) and tertiary contractions (16.4%). It was observed that 12% of individuals in Group I only presented alterations on the esophageal phase. CONCLUSION Evaluation of the esophageal phase of swallowing during videofluoroscopic swallowing study detects abnormalities in patients with cervical dysphagia, especially in the group without pre-established etiological diagnosis.

Transarterial Embolization and Percutaneous Ethanol Injection as an Effective Bridge Therapy before Liver Transplantation for Hepatitis C-Related Hepatocellular Carcinoma

Background. Transarterial chemoembolization alone or in association with radiofrequency ablation is an effective bridging strategy for patients with hepatocellular carcinoma awaiting for a liver transplant. However, cost of this therapy may limit its utilization. This study was designed to evaluate the outcomes of a protocol involving transarterial embolization, percutaneous ethanol injection, or both methods for bridging hepatocellular carcinomas prior to liver transplantation. Methods. Retrospective review of all consecutive adult patients who underwent a first liver transplant as a treatment to hepatitis C-related hepatocellular carcinoma at our institution between 2002 and 2012. Primary endpoint was patient survival. Secondary endpoint was complete tumor necrosis. Results. Forty patients were analyzed, age 58 ± 7 years. There were 23 males (57.5%). Thirty-six (90%) out of the total 40 patients were within Milan criteria. Complete necrosis was achieved in 19 patients (47.5%). One-, 3-, and 5-year patient survival were, respectively, 87.5%, 75%, and 69.4%. Univariate analysis did not reveal any variable to impact on overall patient survival. Conclusions. Transarterial embolization, ethanol injection, or the association of both methods followed by liver transplantation comprises effective treatment strategy for hepatitis C-related hepatocellular carcinoma. This strategy should be adopted whenever transarterial chemoembolization and/or radiofrequency ablation are not available options.

Colonografia por tomografia computadorizada: um método de rastreamento conhecido porém pouco utilizado

Radiol Bras. 2014 Mai/Jun;47(3):V–VI Malignant colon neoplasm is the third cause of death for cancer in the United States of America. Many of such deaths could be avoided with the introduction of an effective screening schedule. The ideal screening test is the one that allows for an early diagnosis and, consequently the management of the disease at its early stages. The effectiveness of a screening test depends on three factors, namely: 1) the disease must be common; 2) early detection of the disease; 3) acceptance of the test by the patient. Different factors predispose to large bowel neoplasia: 1) family history of disease or large adenomatous polyp (diagnosed before the age of 60); 2) inflammatory bowel disease; 3) family history of adenomatous polyposis or nonpolypoid hereditary colorectal cancer syndromes; 4) previous history of adenomatous colon polyps. Despite the existence of specific predisponent conditions, in approximately 75% of cases it is not possible to identify a specific risk factor. Before the introduction of computed tomography colonography (CTC), several screening tests were available to detect colon polyps or neoplasms, namely, fecal occult blood test, rectosigmoidoscopy, a combinations of the mentioned methods, double contrast barium enema and colonoscopy. In 2008, the American Cancer Society, in association with the US Multi-Society Task Force on Colorectal Cancer (representing the three major American gastroenterological societies – American Society of Gastroenterology, American College of Gastroenterology, and American Society of Endoscopy) and the American College of Radiology placed CTC as a screening test for colorectal carcinoma (CRC) in association with colonoscopy, as a modality for primary prevention and early detection. Virtual colonoscopy or CTC is a relatively recent investigation method, initially described in 1994 amongst the available options for screening CRC. It is a minimally invasive computed tomography (CT) modality utilizing low radiation doses,

Bilateral Killian-Jamieson diverticula demonstrated by videofluoroscopic swallowing study: case report

The authors report the case of a 56-year-old male patient complaining of dysphagia for solids and food impaction, submitted to videofluoroscopic swallowing study that demonstrated the presence of two esophageal diverticula. The videofluoroscopic swallowing study was critical in the identification and diagnosis of the diverticula, an esophageal cause of dysphagia.

Doença de Erdheim-Chester: relato de dois casos

Erdheim-Chester disease is a rare non-Langerhans cell histiocytosis of unknown etiology, affecting multiple organ system, involving bones, central nervous system, eyes, lungs, mediastinum, kidneys and retroperitoneum. The authors report two cases that progressed with the typical presentation of the disease. Radiological findings were in agreement with literature and guided the diagnosis, confirmed by immunohistochemistry.