Carlos Alberto de Barros Franco

Valor do FDG[18F]-PET/TC como preditor de câncer em nódulo pulmonar solitário

OBJETIVO: Determinar a acuracia diagnostica da positron emission tomography (tomografia por emissao de positrons)/tomografia computadorizada (PET/TC) com deoxiglicose marcada com fluor-18, conhecida como fluorodeoxiglicose (FDG[18F]), na avaliacao de nodulo pulmonar solitario (NPS). METODOS: Analise prospectiva de 53 pacientes consecutivos que realizaram PET/TC para avaliacao de NPS, entre marco de 2005 e maio de 2007. Destes 32 preencheram os criterios de inclusao. As lesoes foram avaliadas quanto a sua localizacao e tamanho, grau de captacao do radiofarmaco e o standardized uptake value (SUV, valor padronizado de captacao) maximo das lesoes. Os achados dos estudos de FDG-PET/TC foram correlacionados com outros preditores de malignidade (idade, sexo, tabagismo, tamanho e localizacao do nodulo). O diagnostico definitivo foi estabelecido por confirmacao histopatologica ou acompanhamento clinico-radiologico por um periodo minimo de um ano. RESULTADOS: Encontrados 14 NPS malignos. Apos analise da curva ROC, o SUV de 2,5 foi considerado o melhor ponto de corte que identificou corretamente 13 dos 14 NPS malignos. Os resultados abaixo deste ponto de corte mostraram um exame falso positivo para neoplasia num total de 14. O metodo semiquantitativo apresentou sensibilidade de 92,9%, especificidade de 72,2%, valor preditivo positivo de 72,2%, valor preditivo negativo de 92,9% e acuracia de 81,2%. Na analise multivariada, apenas a localizacao do nodulo nos lobos superiores (p = 0,048) e o SUV (p = 0,007) demonstraram significância estatistica para malignidade no NPS. CONCLUSOES: Os dados do estudo mostram que o SUV da FDG[18F] e um bom preditor de neoplasia em nodulos pulmonares e com alto valor preditivo negativo, o que oferece grande seguranca em afastar presenca de malignidade, indicando sua importância na abordagem diagnostica do nodulo pulmonar.OBJECTIVE To determine the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT) using fluorine-18-deoxyglucose ([18F]-FDG) for the evaluation of a solitary pulmonary nodule (SPN). METHODS Prospective analysis of 53 consecutive patients submitted to PET/CT between March 2005 and May 2007 for the evaluation of an SPN. Of those, 32 met the criteria for inclusion in the present study. The lesions were evaluated for location, size, radiotracer uptake and maximum standardized uptake value (SUV). The FDG-PET/TC results were correlated with other predictors of malignance (age, gender, smoking status, nodule size and nodule location). The definitive diagnosis was established through histopathology or through clinical/radiological follow-up for at least one year. RESULTS Fourteen malignant SPNs were found. Through analysis of the ROC curve, we established an SUV of 2.5 as the most appropriate cut-off point, since it correctly identified 13 of the 14 malignant SPNs. The results below that point revealed one false positive for neoplasia out of a total of 14. The semiquantitative method presented a sensitivity of 92.9%, specificity of 72.2%, positive predictive value of 72.2%, negative predictive value of 92.9% and accuracy of 81.2%. The multivariate analysis showed a statistically significant association with SPN malignancy only for nodule location in the upper lobes (p = 0.048) and SUV (p = 0.07). CONCLUSIONS The results obtained suggest that the SUV of [18F]-FDG is a useful predictor of neoplasia in SPN, with a high negative predictive value, which allows malignancy to be safely ruled out, showing its relevance in the diagnostic approach to pulmonary nodules.

Biópsia pulmonar a céu aberto em pacientes sob ventilação mecânica e com infiltrado pulmonar difuso

Background: Open lung biopsy is regarded as the gold standard for the diagnosis of diffuse pulmonary infiltrates. Objective: To determine the diagnostic yield, therapeutic changes, complications and mortality attributed to open lung biopsy in patients with diffuse pulmonary infiltrates and on mechanical ventilation. Method: We reviewed, retrospectively, the charts of 24 patients, ranging from 26 to 89 years of age, admitted to the intensive care units of two private hospitals and submitted to open lung biopsy. Results: Diagnostic positivity was found in 100% of patients, resulting in an alteration in the treatment regimen in 75%. Postoperative complications occurred in five patients (20.8%). There were no biopsy-related deaths, although global mortality was 45.8%. Conclusion: Open lung biopsy is a safe and high yield procedure for diagnosing diffuse pulmonary infiltrate in patients on mechanical ventilation. Despite the fact that no mortality impact factor has been assigned to such patients, data in the literature regarding prognosis must be taken into consideration.

Supermarket Game: An Adaptive Intelligent Computer Game for Attention Deficit/Hyperactivity Disorder Diagnosis

The This work reports the research and the application of an adaptive intelligent computer game with a fuzzy decision system developed specifically to help in the diagnosis process of the Attention Deficit/Hyperactivity Disorder (ADHD). ADHD is a neuropathology, its main signal is the severe performance impairment of activities that involves executive functions: planning, volition, problem resolution and aim oriented works. The specification, implementation and other relevant aspects of The Supermarket Game are here discussed.

The Consciousness Circuit - An Approach to the Hard Problem

This paper is the continuation of a study about Consciousness as a resulting function between attention and luminosity, presented at the Neuroscience International Congress, which was held in the city of Natal, in Brazil, in 2006. There it was described how visual Consciousness is generated by the interaction of the cortical area activity through FFS (Feedforward Sweep Processes), RP (Recurrent Processes) and WSRP (Wide Spread Recurrent Processes), and its relationship with the luminosity that hits the eyes. We have applied the reciprocal interaction model, which says that the eye reacts to luminosity through the regulation of sleep-awake states through EEG wave synchronization; this, in turn, is regulated by the thalamic cortical neural activity from the brainstem monoaminergic and cholinergic nuclei.Such an understanding has led us to construct a consciousness model which can be represented by an orthogonal graph. Through this model, we can represent all states of human consciousness (emotional consciousness, unconsciousness states, dreaming states, awareness states, pre-consciousness states and others) making it possible, in theory, to construct a Consciousness parameter which yields to the understanding of consciousness state observation without a subjective approach to experience.We have also applied on this orthogonal graph the Quantum Orch OR Model. According to it, subjective, phenomenal conscious vision depends on quantum computation in microtubules where the quantum is the smallest quantity of radiant energy, in a scale in which matter and energy interact. This model helps us to build the vertical axe of the consciousness orthogonal graph, a cholinergic-aminergic scale, in which activation triggers the quantum mechanism relevant to the consciousness phenomenon.

Pseudocisto pulmonar traumático

Traumatic pulmonary pseudocyst is a rare lesion and is typically seen after blunt chest trauma. Although secondary infection is an uncommon complication, it presents high morbidity and requires immediate treatment. A 28-year-old male motorcycle accident victim was admitted to the hospital with hemoptysis, chest pain, dyspnea and hypoxemia. Computed tomography of the chest revealed pulmonary infiltrate and pseudocysts in the lower lobe of the right lung. The patient developed fever, purulent expectoration and an air-fluid level within the pseudocysts. After culture collection, a course of broad-spectrum antibiotics was started. Clinical improvement was observed, and the patient was discharged 15 days after admission.

Toracoplastia traumática: relato de caso

Trauma primarily affects young people and is the leading cause of death in the first three decades of life. Flail chest is observed in approximately 10% of all patients with severe chest trauma, and the mortality rate among such patients is 10-15%. We report herein the case of a car accident victim with chest trauma causing hemopneumothorax and multiple rib fractures, intense pain and deformity of the chest wall. Surgical stabilization was performed, with good results. Therapeutic options are also discussed.

Bronquiolite obliterante com pneumonia em organização

Uma paciente 48 anos apresentou-se, assintomAEtica, mascom achado radiologico de condensacies alveolares, algumasconstituindo nodulos em lobo superior direito, lobo mOdioe lingula com predominio perihilar. Foi considerado odiagnostico diferencial de neoplasia, sarcoidose, doencasgranulomatosas e tuberculose, entre outras doencas. Odiagnostico de bronquiolite obliterante com pneumonia emorganizacao foi estabelecido atravOs de videotoracoscopia efoi iniciado o tratamento com esteroides. Houve boa evolucaocom resolucao radiologica.Uma paciente 48 anos apresentou-se, assintomatica, mas com achado radiologico de condensacoes alveolares, algumas constituindo nodulos em lobo superior direito, lobo medio e lingula com predominio perihilar. Foi considerado o diagnostico diferencial de neoplasia, sarcoidose, doencas granulomatosas e tuberculose, entre outras doencas. O diagnostico de bronquiolite obliterante com pneumonia em organizacao foi estabelecido atraves de videotoracoscopia e foi iniciado o tratamento com esteroides. Houve boa evolucao com resolucao radiologica.