Daniel Lahan Martins

Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma.

Objective To evaluate the role of multidetector computed tomography in the preoperative investigation of tumor invasion depth and lymph node and metastatic involvement according to the TNM classification, in patients with gastric adenocarcinoma. Materials and Methods Fifty-four patients with biopsy-confirmed gastric cancer underwent preoperative staging with 64-channel multidetector computed tomography. Two independent radiologists analyzed the images and classified the findings. Sensitivity, specificity, accuracy and overall accuracy were calculated for each observer. The interobserver agreement was also evaluated. Results The accuracy in the classification of categories T ranged from 74% to 96% for observer 1 and from 80% to 92% for observer 2. The overall accuracy was 70% for both observers. The weighted kappa index was 0.75, consistent with a significant interobserver agreement. The accuracy in the classification of lymph node involvement (category N) ranged from 55% to 79% for observer 1 and from 73% to 82% for observer 2. The evaluation of metastatic involvement showed an overall accuracy of 89.6% for both observers. Conclusion 64-channel multidetector computed tomography demonstrated clinically relevant accuracy in the preoperative staging of gastric adenocarcinoma as regards invasion depth (T category) and metastatic involvement (M category).

Comparative analysis of two-dimensional electrophoresis maps (2-DE) of Helicobacter pylori from Brazilian patients with chronic gastritis and duodenal ulcer: a preliminary report.

Helicobacter pylori is a bacterium recognized as the major cause of peptic ulcer and chronic gastritis. Recently, a proteome-based approach was developed to investigate pathogenic factors related to H. pylori. In this preliminary study, H. pylori strains were isolated from gastric biopsies of patients with chronic gastritis and duodenal ulcers. A partial proteomic analysis of H. pylori strains was performed by bacterial lyses and proteins were separated by two-dimensional gel electrophoresis (2-DE). A comparative analysis was performed to verify a differential protein expression between these two 2-DE maps. These data should be useful to clarify the role of different proteins related to bacterial pathogenesis. This study will be completed using a larger number of samples and protein identification of H. pylori by MALDI-TOF mass spectrometry.

Abdominal manifestations of extranodal lymphoma: pictorial essay

In the appropriate clinical setting, certain aspects of extranodal abdominal lymphoma, as revealed by current cross-sectional imaging techniques, should be considered potentially diagnostic and can hasten the diagnosis. In addition, diagnostic imaging in the context of biopsy-proven lymphoma can accurately stage the disease for its appropriate treatment. The purpose of this article was to illustrate the various imaging aspects of extranodal lymphoma in the abdomen.

Immunoglobulin G4-related disease: autoimmune pancreatitis and extrapancreatic manifestations.

We present a case of immunoglobulin G4 (IgG4)-related disease with pancreatic and extrapancreatic involvement, including the biliary and renal systems. Given the importance of imaging methods for the diagnosis of IgG4-related disease and its differentiation from pancreatic adenocarcinoma, we emphasize important abdominal computed tomography and magnetic resonance imaging findings related to this recently recognized systemic autoimmune disease.

Aspectos radiológicos relevantes no diagnóstico da enterocolite necrosante e suas complicações

Necrotizing enterocolitis is one of the most frequent and severe gastrointestinal emergencies occurring in the neonatal period. Once necrotizing enterocolitis is suspected a simple abdominal x-ray is a routine examination and this film will play an essential role in the diagnosis of the disease and the follow-up care of the patient, as well as in the detection of complications. In the present study we reviewed the pertinent literature and described the radiological findings, illustrated with cases from our institution. We concluded that the radiological diagnosis of necrotizing enterocolitis done at all stages contributes for an immediate therapeutic management, reducing the complications and improving the patients survival.

Estudo de 50 casos por tomografia computadorizada de lesões hipodensas hepáticas fundamentais na infância

OBJECTIVE: To describe the different tomographic findings in hypodense hepatic lesions in children and its differential diagnosis. MATERIALS AND METHODS: Computed tomographic studies were obtained from 50 patients (age range: 0-16 years) with low-density liver lesions previously diagnosed by ultrasound. Images were made before and after administration of intravenous contrast medium. Image findings were analyzed and afterwards correlated with anatomopathological diagnosis. RESULTS: Forty-seven of 50 cases were confirmed, 30 by anatomopathological diagnosis. Most of then were benign lesions, hemangioma in 20%. Such lesions presented a homogeneous contrast absorption, mainly at the delayed phase, differing from malignant lesions. Metastasis was the most frequently found malignant lesion (18%). CONCLUSION: Computed tomographic study is of great value in complementing the diagnosis of hypodense hepatic lesions in children, and must follow ultrasound diagnosis as a routine procedure.

Diverticulite jejunal: relato de caso

Jejunal diverticulitis is a rare disease that primarily affects the elderly. Clinical signs and symptoms are nonspecific, a fact that complicates and delays the diagnosis. Computed tomography is very valuable in defining the diagnosis. The present report describes a case of jejunal diverticulosis complicated with acute perforated obstructive diverticulitis, and presents a brief discussion on jejunal diverticulitis and its complications.

Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante

OBJECTIVE: To evaluate the prognostic value of bowel loops dilatation as a finding on radiographs in the development and mortality of neonates with necrotizing enterocolitis. MATERIALS AND METHODS: On abdominal radiographs of 53 patients for diagnostic suspicion of necrotizing enterocolitis, the major diameters of dilated bowel loops (AD) were measured, as well as the distance between the upper border of the first lumbar vertebra and the lower border of the second one (L1-L2), and the distance between the lateral borders of the first lumbar vertebra (L1) pedicles, and the subsequent association between AD/L1-L2, AD/L1. This measure was considered as a possible determining factor for potential complications, surgical intervention and mortality. RESULTS: The patients who needed surgical management and who had complications during progression and died of the disease had showed increased AD and AD/L1-L2 (p < 0.05). AD/L1 values and site of the most dilated bowel loop were not different in the groups with unfavorable progression. CONCLUSION: Bowel loop dilatation detected on initial supine abdominal radiographs suggests a worst prognosis in necrotizing enterocolitis. Furthermore, measurement of the most dilated bowel loop on these radiographs is a simple and reproducible method that adds diagnostic and prognostic information.

Aumento da transparência pulmonar na infância: ensaio iconográfico

Thoracic asymmetries characterized by increased radiolucency of the lungs are important causes of morbidity in infants and children. Evaluation of affected patients frequently requires multiple imaging methods to diagnose the abnormality and to plan the surgical correction. The authors review and illustrate the characteristics of both common and rare thoracic asymmetries with emphasis on the radiological findings. The usefulness of different imaging methods in the diagnosis and treatment of these conditions is evaluated. The differential diagnosis as well the pitfalls and diagnostic difficulties are also discussed.