Fernando Marum Mauad

Ressonância magnética do tórax: Aplicações tradicionais e novas, com ênfase em pneumologia

The objective of the present review study was to present the principal applications of magnetic resonance imaging (MRI) of the chest, including the description of new techniques. Over the past decade, this method has evolved considerably because of the development of new equipment, including the simultaneous interconnection of phased-array multiple radiofrequency receiver coils and remote control of the table movement, in addition to faster techniques of image acquisition, such as parallel imaging and partial Fourier acquisitions, as well as the introduction of new contrast agents. All of these advances have allowed MRI to gain ground in the study of various pathologies of the chest, including lung diseases. Currently, MRI is considered the modality of choice for the evaluation of lesions in the mediastinum and in the chest wall, as well as of superior sulcus tumors. However, it can also facilitate the diagnosis of lung, pleural, and cardiac diseases, as well as of those related to the pulmonary vasculature. Pulmonary MRI angiography can be used in order to evaluate various pulmonary vascular diseases, and it has played an ever greater role in the study of thromboembolism. Because cardiac MRI allows morphological and functional assessment in the same test, it has also become part of the clinical routine in the evaluation of various cardiac diseases. Finally, the role of MRI has been extended to the identification and characterization of pulmonary nodules, the evaluation of airway diseases, and the characterization of pleural effusion.

Reproducibility of first‐ and second‐trimester uterine artery pulsatility index measured by transvaginal and transabdominal ultrasound

To examine and compare the reproducibility of measurement of first‐ and second‐trimester uterine artery pulsatility index (UtA‐PI) using transabdominal (TAS) and transvaginal (TVS) ultrasound.

High-fat diet causes an imbalance in the colonic serotonergic system promoting adipose tissue enlargement and dysplasia in rats

A high-fat (HF) diet, the serotonergic system and stromal elements have all been implicated in colon carcinogenesis. We investigated whether the colonic serotonergic system could play a main role in the development of colonic dysplasia and stromal reactivity in carcinogen-treated rats under HF diet. For this, dimethylhydrazine-treated rats were fed with standard diet and a HF diet. Fat distribution was quantified by computerized tomography exam, serotonergic activity was analyzed by high-performance liquid chromatography, gene expression, and immunohistochemistry, which along with histopathological technique enabled us to enumerate dysplasia, microvessels density, cell proliferation and COX-2 expression. We found that the HF diet induced an increase in the amount of visceral adipose tissue, even without expressive changes in the average body weight. This was correlated with a loss of serotonergic balance in colon tissue. Moreover, the HF diet promoted dysplasia and microvessel density in association with increased proliferation and COX-2 expression within pericryptal colonic stroma. Our current findings suggest that a HF diet promotes the enlargement of adipose tissue via loss of control in colon serotonergic activity, which enhances colonic dysplasia by supporting microvessel development.

Intraoperative Ultrasonography to Guide Intramuscular Buttock Implants

Ultrasonography (US) is useful for a number of purposes. Intraoperative ultrasound (IOUS) provides better spatial and contrast resolution of the anatomical structures and organs than any other imaging method and is used mainly to identify nonpalpable lesions, guide surgical procedures, and stage local tumor disease.1 In plastic surgery, US is not commonly used as a transoperatory guide, although there are reports of IOUS having been used to guide the dissecting instrument for surgical treatment of fibrous tissue gynecomastia through mini-incisions.2 The objective of this letter is to describe the application of IOUS as a guide for intramuscular undermining during gluteal implant surgery. Over the past 12 months, we have performed nine intramuscular gluteal implant surgeries with this method. The primary goal of implementing IOUS during these procedures was to prove that the anatomic structures and points that act as a reference in our XYZ technique3-5 were reliable sites—that is, we sought to prove that by following the reference points, the surgeon is in fact on the right path to dissecting a plane within the muscle at the desired depth. We feel that this goal has been fully achieved. Although this forum is not appropriate for a full discussion of the data generated in this nine-patient series and we plan to address the reliability of the XYZ technique in a separate publication, the study led us to …

Breast imaging: is the sonographic descriptor of orientation valid for magnetic resonance imaging?

To evaluate if the Breast Imaging Reporting and Data System (BI‐RADS) ultrasound descriptor of orientation can be used in magnetic resonance imaging (MRI).

Intraoperative application of real-time tissue elastography for the diagnosis and staging of pancreatic tumours

The present study provides preliminary data of the usefulness of elastography applied in intraoperative pancreatic ultrasound for diagnosis and staging of pancreas tumors. We have studied six cases of pancreatic tumors, four adenocarcinomas and one insulinoma, which have been submitted to surgery. Tumor resection was considered based on preoperative evaluation and also in intraoperative findings. Only one patient had no surgical excision of the tumor. All tumors were presented as a “hard” mass in elastography. At least in one case, elastography imaging contributed significantly to demonstrate that there was no vascular invasion when compared to intraoperative gray scale ultrasound alone. There were no identified postoperative complications related to compression during the elastographic evaluation. We conclude that ultrasound elastography is a safe technique to evaluate pancreas intraoperatively and may be useful to diagnose and stage pancreatic tumors.

Reproducibility of abdominal fat assessment by ultrasound and computed tomography

Objective: To test the accuracy and reproducibility of ultrasound and computed tomography (CT) for the quantification of abdominal fat in correlation with the anthropometric, clinical, and biochemical assessments. Materials and Methods: Using ultrasound and CT, we determined the thickness of subcutaneous and intra-abdominal fat in 101 subjects-of whom 39 (38.6%) were men and 62 (61.4%) were women-with a mean age of 66.3 years (60-80 years). The ultrasound data were correlated with the anthropometric, clinical, and biochemical parameters, as well as with the areas measured by abdominal CT. Results: Intra-abdominal thickness was the variable for which the correlation with the areas of abdominal fat was strongest (i.e., the correlation coefficient was highest). We also tested the reproducibility of ultrasound and CT for the assessment of abdominal fat and found that CT measurements of abdominal fat showed greater reproducibility, having higher intraobserver and interobserver reliability than had the ultrasound measurements. There was a significant correlation between ultrasound and CT, with a correlation coefficient of 0.71. Conclusion: In the assessment of abdominal fat, the intraobserver and interobserver reliability were greater for CT than for ultrasound, although both methods showed high accuracy and good reproducibility.

Ultrasound scan as a potential source of nosocomial and cross-infection: a literature review

The authors review the main concepts regarding the importance of cleaning/disinfection of ultrasonography probes, aiming a better comprehension by practitioners and thus enabling strategies to establish a safe practice without compromising the quality of the examination and the operator productivity. In the context of biosafety, it is imperative to assume that contact with blood or body fluids represents a potential source of infection. Thus, in order to implement cleaning/disinfection practice, it is necessary to understand the principles of infection control, to consider the cost/benefit ratio of the measures to be implemented, and most importantly, to comprehend that such measures will not only benefit the health professional and the patient, but the society as a whole.

Avaliação por imagem dos gossipibomas abdominais

Gossypiboma is a term utilized to describe a mass developed from a matrix of cotton fibers surrounded by inflammatory granulomatous reaction. Its incidence is estimated at 0.15% to 0.2% of laparotomies. A foreign body within the abdominal cavity may provide a niche for proliferation of microorganisms, acting as primary focus for development of an abscess and peritonitis. Several studies have demonstrated the relevance of clinical correlation with the findings of different imaging methods (conventional radiography, ultrasonography, computed tomography and magnetic resonance imaging) in the diagnosis of gossypibomas. The present pictorial essay is aimed at demonstrating a series of typical cases of abdominal gossypibomas and illustrating the several presentations of such mass, with emphasis on the findings at different imaging methods in order to familiarize radiologists with this entity and with the main differential diagnosis.

Effects of Taurine Supplementation on Adipose Tissue of Obese Trained Rats

Physical exercise is related to the decrease in body fat mass, while taurine supplementation can increase energy expenditure and the function of lipolytic enzymes and may decrease adipocyte size, reflecting an improvement from obesity treatment. However, a possible additive effect of physical exercise and taurine supplementation on white adipose tissue has not been investigated. Thus, the aim of this study was to evaluate the effects of taurine supplementation on adipose tissue of trained obese rats. Male Wistar rats were fed with control or high-fat diet to induce obesity during 11 weeks and were divided into four groups: sedentary (SD); sedentary and taurine supplemented (SDTAU; supplemented with taurine after 3 weeks of high-fat diet diet); trained (TR; initiated the training program after 3 weeks of high-fat diet); trained and taurine supplemented (TRTAU; initiated the taurine supplementation and the training program after 3 weeks of high-fat diet). The animals were submitted to exercise training for 8 weeks and performance was analyzed at the beginning of week 4 and at the end of week 11. The epididymal tissue was extracted and weighed before and after taurine supplementation. Adipocyte sizes were analyzed and computed tomography was used to evaluate total body area and visceral fat area.