Helio K. Yamashita

Juvenile idiopathic inflammatory myopathies: the value of magnetic resonance imaging in the detection of muscle involvement

CONTEXT One of the major current challenges related to juvenile idiopathic inflammatory myopathy is the search for highly sensitive and specific non-invasive methods for diagnosis as well as for follow-up. OBJECTIVES The aim of our study was to describe typical magnetic resonance imaging findings and to investigate the usefulness of this method in detecting active muscle disease in juvenile dermatomyositis and juvenile systemic lupus erythematosus patients. DESIGN Transverse study, blinded assessment. SETTING University referral unit (Pediatric Rheumatology section, Department of Pediatrics, Universidade Federal de São Paulo / Escola Paulista de Medicina). SAMPLE Thirteen patients (9 girls) with dermatomyositis, as well as 13 patients (12 girls) with juvenile systemic lupus erythematosus and 10 normal children (5 girls), were enrolled in the study. MAIN MEASUREMENTS Qualitative and quantitative analyses of gluteus maximus, quadriceps, adductors and flexors were performed and evaluated by two radiologists, blinded to all clinical information. Spin-echo in T1, DP, T2 and IR was used in all MRI images. RESULTS The different muscle groups presented non-uniform involvement in the patients. The patients with dermatomyositis presented acute and chronic muscular alterations, while those with lupus presented only chronic myopathy, especially atrophy. In the dermatomyositis group, the major alterations were found in the gluteus and flexor regions (signal intensity and fat replacement). The signal intensity was increased in all acute myopathies. CONCLUSION The qualitative and quantitative resonance analyses are useful in detecting clinically active disease in patients with dermatomyositis.

Computed tomography in the diagnosis of otosclerosis

OBJECTIVES: To identify the main tomographic findings of otosclerosis and to evaluate the usefulness of high-resolution computed tomography as a diagnostic method for this osteodystrophy. STUDY DESIGN AND SETTING: A prospective and multi-center study consisting of computed tomography (CT) of the temporal bone was conducted on 54 patients with a clinical and surgical diagnosis of otosclerosis. Twenty-two patients were included in the control group. RESULTS: The CT scan was positive in 87% of the patients. The tomographic findings were mainly bilateral and fenestral foci were more prevalent. CONCLUSIONS: CT showed a high rate of positivity, mainly for fenestral lesions. Foci anterior to the oval window were the most prevalent in this population. SIGNIFICANCE: CT is useful as a diagnostic method and therapeutic indicator of otosclerosis.

Magnetic resonance imaging in sudden deafness.

Summary The etiology of sudden deafness can remain undetermined despite extensive investigation. This study addresses the value of magnetic resonance imaging in the analysis of sudden deafness patients. Study design: transversal cohort. Material and Method : In a prospective study, 49 patients attended at otolaryngology emergency room of Federal University of Sao Paulo - Escola Paulista de Medicina, from April 2001 to May 2003, were submitted to magnetic resonance imaging. Results : Magnetic Resonance abnormalities were seen in 23 (46.9%) patients and revealed two tumors suggestive of meningioma, three vestibular schwannomas, thirteen microangiopathic changes of the brain and five (21.7%) pathological conditions of the labyrinth. Conclusion : Sudden deafness should be approached as a symptom common to different diseases. The presence of cerebellopontine angle tumors in 10.2% of our cases, among other treatable causes, justifies the recommendation of gadolinium-enhanced magnetic resonance use, not only to study the auditory peripheral pathway, but to study the whole auditory pathway including the brain.

Variações anatômicas e sinusopatias: estudo por tomografia computadorizada

Introduction: Computed tomography has been increasingly used both to identify and to evaluate anatomy variations of nasal cavities that can lead to the development of sinusitis. Purpose: The purpose of the present study is to determine the incidence of mucosal abnormalities in paranasal sinuses found in CT scans of patients with symptons of sinusitis and analyze the correlation between sinusitis and presence of Hallers cell, concha bullosa and nasal septal deviation located in middle meatus. Study Design: Clinical retrospective. Material and Method: Paranasal sinus CT scans were obtained in 150 patients aged 13 years or more, from July 1999 to October 2001. The CT scans were performed in the Department of Radiology of Universidade Federal de Sao Paulo - Escola Paulista de Medicina. Patients with history of skull base or sinus surgery and tumor in these regions were excluded. Results: 70% of patients present mucosal abnormalities at least in one paranasal sinus. Maxillary sinusitis were observed in 52,7% of sinus, ethmoidal sinusitis in 28,0%, sphenoidal sinusitis in 13,0% and frontal sinusitis in 8,3%. Concha bullosa was observed in 33,3% of nasal cavities, nasal septal deviation (located in middle meatus) in 23,3% and Hallers cell in 9,3%. Conclusions: The most affected paranasal sinuses were: maxillary, ethmoid, sphenoid and frontal. Correlation between sinusitis and presence of Hallers cell, concha bullosa and nasal septal deviation (located in middle meatus) was not observed.

Mycetoma caused by Fusarium solani with osteolytic lesions on the hand: case report

Eumycetoma is a mycotic disease caused by saprophytic soil fungi that are usually inoculated through minor injuries. A case of mycetoma in a Brazilian farmer aged71 years is reported. This patient presented erythema and edema on the dorsal surface of the left hand with multiple crusted and cicatricial lesions. No macroscopic grains were observed. The histopathological findings showed grains consisted of numerous hyphae which stained well with Gomori-Grocott method. This material obtained by cutaneous biopsy was submitted to culture on Sabouraud’s medium and the colonies were identified as Fusarium solani. The radiological studies revealed bone osteolytic lesions and the ultrasound showed pseudocysts and fistulae at the site of this infection. The patient was treated with oral ketoconazole with a good clinical response.

Ressonância magnética em surdez súbita

The etiology of sudden deafness can remain undetermined despite extensive investigation. This study addresses the value of magnetic resonance imaging in the analysis of sudden deafness patients. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: In a prospective study, 49 patients attended at otolaryngology emergency room of Federal University of Sao Paulo - Escola Paulista de Medicina, from April 2001 to May 2003, were submitted to magnetic resonance imaging. RESULTS: Magnetic Resonance abnormalities were seen in 23 (46.9%) patients and revealed two tumors suggestive of meningioma, three vestibular schwannomas, thirteen microangiopathic changes of the brain and five (21.7%) pathological conditions of the labyrinth. CONCLUSION: Sudden deafness should be approached as a symptom common to different diseases. The presence of cerebellopontine angle tumors in 10.2% of our cases, among other treatable causes, justifies the recommendation of gadolinium-enhanced magnetic resonance use, not only to study the auditory peripheral pathway, but to study the whole auditory pathway including the brain.

Computed tomography evaluation of autogenous graft in sinus lift surgery

OBJECTIVE: To quantify bone formation within autogenous bone grafts and autogenous bone grafts in combination with platelet-rich plasma obtained either from aphaeresis or centrifugation using computed tomography. MATERIALS AND METHODS: This prospective, double-blind study was conducted in 34 male and female adult patients (mean age of 28 years and 8 months), with either unilateral or bilateral pneumatization of the maxillary sinuses, requiring bone graft for dental implant. All patients were submitted to computed tomography examinations prior and six months after sinus lift surgery. Fifty-three maxillary sinuses were operated and divided into three distinct groups: autogenous bone graft, autogenous bone graft in combination with platelet-rich plasma obtained by centrifugation, and autogenous bone graft in combination with platelet-rich plasma obtained by aphaeresis. RESULTS: Computed tomography demonstrated bone growth in height and width between the initial and the follow-up computed tomography scans in all three groups. However, no statistical difference was found either for bone height or width. CONCLUSION: Clinical evidence demonstrates the effectiveness of autogenous bone grafts, particularly when used in combination with bone growth factors such as platelet-rich plasma, which allow prosthetic and functional restoration of maxillofacial structures through fixation of dental implants.

Dentofacial characteristics of oral breathers in different ages: a retrospective case–control study

BackgroundThis study aimed to investigate the dental and skeletal variables associated with disturbances of craniofacial development in oral-breathing (OB) individuals and the probability that these variables are related to this condition.MethodsThis is an observational retrospective case–control study of 1596 patients divided into three groups of age n1 5–12, n2 13–18, and n3 19–57 years. Radiographic, clinical, and models data were analyzed. The control group was consisted of nasal breathing (NB) individuals. Statistical analyses of the qualitative data were performed with x2 test to identify associations, and odds ratio (OR) tests were performed for the variables that the chi-square test (x2) identified an association.ResultsIn the descriptive analysis of the data, we observed that the class II malocclusion was the most frequent in the total sample, but when divided by age group and mode of breathing, there is a random division of these variables. In n1 group, class II, (OR = 2.02) short and retruded mandible (SM and RM) (OR = 1.65 and1.89) were associated with OB and it was considered a risk factor. In n2 group, class II (OR = 1.73), SM (OR = 1.87) and increased lower anterior height (ILAFH) (OR = 1.84) seemed to be associated and to be risk factors for OB. In the n1 group, decreased lower anterior facial height (DLAFH) and brachycephalic facial pattern (BP) seemed to be associated with NB and a protective factor against oral breathing.ConclusionsThis study showed that dental and skeletal factors are associated with OB in children, and it seems that it becomes more severe until adolescence. But adults showed no associations between OB and skeletal factors, only in dental variables, indicating that there is no cause–effect relationship between the dental and skeletal factors and OB. The treatment of nose breathing patient should be multidisciplinary, since OB remains even when dental and skeletal factors slow down.

Effects of Herbst appliance treatment on temporomandibular joint disc position and morphology: A prospective magnetic resonance imaging study

INTRODUCTION The objective of this prospective study was to evaluate changes in the position and morphology of the disc in the temporomandibular joint (TMJ) with magnetic resonance imaging (MRI). METHODS The subjects were 32 consecutive adolescent patients with Class II Division 1 malocclusion treated with the Herbst appliance. The MRIs were obtained immediately before treatment (T1), 8 to 10 weeks after appliance placement (T2), and 12 months later (T3). RESULTS Qualitative evaluation of the MRIs showed that, in 42 (65.62%) of the 64 TMJs, the disc was positioned within normal limits at T1. Because of the advancements caused by the Herbst appliance, a tendency for disc retrusion was observed at T2, but at T3 the disc had returned to normal limits. In 22 TMJs (34.37%), the disc was displaced at T1, and no changes were observed at T3. In most subjects, comparison of the morphology of the disc at T1, T2, and, T3 showed no significant change. CONCLUSIONS Herbst therapy does not cause adverse effects on the morphology and position of the articular disc in the short term.

Classificação por ressonância magnética da degeneração do disco intervertebral

The authors suggest an analysis of the degeneration of intervertebral disks on human cadavers using magnetic resonance imaging. Nine lumbar spines were collected from fresh human cadavers and resonance images were captured. The images were analyzed and classified according to the degeneration grades, with the authors proposing a subdivision of type IV into IV-a and IV-b. Forty-four intervertebral disks were analyzed and authors found the following distribution: 4,5% type I; 40,9% type II; 32% type III and 18% type IV-a. However, the investigators disagreed with the conclusions in 4,5% of the disks. The authors found that the progressive signal lost in the T2-weighted images may be correlated to disk degeneration. Changes found in the magnetic resonance images must be standardized and classified for providing a better understanding.