João Paulo Kawaoka Matushita

Fadiga óssea: causa de dor em joelhos na osteoartrite

Knee pain is the most frequent symptom in osteoarthritis, a condition that is the leading cause of chronic disability in the elderly and one of the main sources of morbidity attributable to osteoarthritis in general. The causes of knee pain in individuals with osteoarthritis cannot be easily understood, and the knowledge of such causes is critical for determining future specific interventions. Bone attrition represents remodelling of the subchondral bone envelope in osteoarthritis, leading to a consequential change in bone shape and/or bone loss. However, bone attrition is not a feature that can be easily read, since it is hardly detected in the absence of clear defects of cortical bone integrity and because of overlap of bone structures at radiography. Bone attrition is associated not only with knee pain, but also with stiffness and disability. If attrition occurs prior to advanced osteoarthritis, this would suggest that changes in subchondral bone occur concurrently with cartilage loss and that treatments targeting cartilage loss alone are unlikely to be effective. Association with edema-like bone marrow lesions may be observed and constitute predictive factors for subchondral bone attrition. The present study was aimed at reviewing the literature, demonstrating the relevance of bone attrition and explaining how to diagnose this entity on imaging studies.

Riscos dos exames radiográficos em recém-nascidos internados em um hospital público de Belo Horizonte, MG

OBJECTIVE: The present study was aimed at: a) evaluating radiographic procedures and estimating entrance surface air kerma in preterm neonates submitted to chest and abdominal radiography at the unit of neonatology in a public hospital of Belo Horizonte, MG, Brazil; b) estimating the dose to organs and respective risks for cancer as a result from radiation exposure. MATERIALS AND METHODS: Records of patients admitted to the unit of neonatology of this hospital in the period between May and September 2004 were reviewed. Anthropometric data, admission/discharge dates and radiographic studies performed were recorded for each of the patients. The calculation of the entrance surface air kerma was based on the x-ray tube output and irradiation parameters adopted for examinations. Dose to organs was calculated with the aid of the software PCXMC, and the lifetime risk for cancer, with the software IREP. RESULTS: Mean entrance surface air kerma per examination was below the diagnostic reference levels recommended by the European Community. In the most severely irradiated patients, liver, breast and stomach were the organs at highest risk for cancer, with maximum excess relative risk of respectively 3.4%, 2.3%, and 1.7%. CONCLUSION: The present study demonstrated the need for optimization of radiographic procedures in order to reduce the risks for neonates that, in spite of being considered to be low as compared with the benefits, should be reduced to values as low as reasonably achievable.

Preparation and management of complications in prostate biopsies

Transrectal ultrasonography-guided biopsy plays a key role in prostate sampling for cancer detection. Among interventionalprocedures, it is one of the most frequent procedures performed by radiologists. Despite the safety and low morbidity ofsuch procedure, possible complications should be promptly assessed and treated. The standardization of protocols andof preprocedural preparation is aimed at minimizing complications as well as expediting their management. The authorshave made a literature review describing the possible complications related to transrectal ultrasonography-guided prostatebiopsy, and discuss their management and guidance to reduce the incidence of such complications.Keywords: Prostate; Needle biopsy; Interventional ultrasonography; Complications.A biopsia transretal da prostata guiada por ultrassonografia tem papel fundamental na coleta de amostra para odiagnostico do câncer prostatico. Dentro do contexto intervencionista, constitui um dos principais procedimentos rea-lizados pelo radiologista. Embora seja segura e com baixa morbimortalidade, complicacoes devem ser prontamenteavaliadas e tratadas. O uso da padronizacao das condutas e do preparo antes do procedimento tem a finalidade deminimizar as complicacoes, assim como agilizar o seu tratamento. Dessa forma, o objetivo deste trabalho foi fazer umarevisao da literatura sobre as complicacoes relacionadas a biopsia transretal de prostata guiada por ultrassonografia,discutir seu manejo e orientacoes para reduzir sua incidencia.Unitermos: Prostata; Biopsia por agulha; Ultrassonografia de intervencao; Complicacoes.AbstractResumo

Giant cell tumor of the frontal sinus: case report

The authors report the case of a giant cell tumor of the frontal sinus in a 54-year-old male patient. This tumor location is rare, and this is the third case reported in the literature with radiographic documentation and histopathological confirmation. The patient underwent surgery, with curettage of frontal sinus and placement of a prosthesis. He died because a voluntary abrupt discontinuation of corticosteroids.

Pulmão em ferradura: relato de caso

The authors report a case of a newborn term infant with horseshoe lung associated with supracardiac total anomalous pulmonary venous drainage; such association remains unreported in the Western literature.

Tumores primários da órbita incomuns diagnosticados por biópsia com agulha grossa guiada por tomografia computadorizada: relato de dois casos

Computed tomography-guided percutaneous biopsy is a safe and effective alternative method for evaluating selected intra-orbital lesions where the preoperative diagnosis is important for the therapeutic planning. The authors describe two cases of patients with uncommon primary orbital tumors whose diagnosis was obtained by means of computed tomography-guided core needle biopsy, with emphasis on the technical aspects of the procedure.Computed tomography-guided percutaneous biopsy is a safe and effective alternative method for evaluating selected intra-orbital lesions where the preoperative diagnosis is important for the therapeutic planning. The authors describe two cases of patients with uncommon primary orbital tumors whose diagnosis was obtained by means of computed tomography-guided core needle biopsy, with emphasis on the technical aspects of the procedure.

Salpingitis isthmica nodosa: review and hysterosalpingography diagnosis of 4 cases in a private radiology clinic

Objective: to identify the radiological findings of salpingitis isthmica nodosa (SIN) through hysterosalpingography and evaluate the site of involvement and its impact on infertility. Methods: 2,800 protocols were reviewed in a retrospective study between January of 1987 and January of 1997, in patients with a clinical history of female infertility; four of them with a radiological diagnosis of SIN. Ethnicity, age, marital status, current clinical complaints, medical history, location, and side of involvement were analyzed. Results: among the four patients with SIN, three were dark-skin, and one was Caucasian, with an average age of 35 years at diagnosis, two single, one married, and one divorcee. Three patients presented complaints of secondary infertility with previous tubal pregnancy history, and another with primary infertility without pregnancy history. In the four patients with SIN, the tubal portion affected was the cornual isthmian, bilateral tubal in three, and unilateral in one. Regarding peritonization, one showed positive bilateral Cotte proof, two with complete bilateral obstruction, and one with positive Cotte in one of the tubes. Conclusion: SIN is more common in dark-skin patients, in the mean age of 35 years, with a clinical history of infertility, with initial and recurrent tubal pregnancy, and subsequent tubal obstruction characterized by lesion in the Isthmian cornual portion of the fallopian tube, usually with bilateral involvement.

Isthmian nodosa salpingitis: histero-salpingography diagnosis of an infertility cause

RESUMO Objetivo: demonstrar os achados da salpingite istmica nodosa (SIN) por meio da histerossalpingografia e avaliar o local de comprometimento e sua repercussao na infertilidade feminina. Paciente e Metodos: em estudo retrospectivo foram revistas 2.800 histerossalpingografias realizadas entre janeiro de 1987 e janeiro de 2007 em pacientes com historia clinica de infertilidade feminina. Destas, quatro pacientes apresentavam diagnostico radiologico de SIN, sendo analisados seus principais aspectos radiograficos, como tambem os locais de comprometimento e suas repercussoes na infertilidade. Resultados: das quatro pacientes em que foi encontrada a doenca estudada a partir da investigacao histerossalpingografica da infertilidade, tres tinham antecedentes de gravidez tubaria, todas com comprometimento istmico cornual, sendo tres delas de comprometimento bilateral e uma unilateral. Uma delas apresentava prova de Cotte positiva bilateral, duas com prova de Cotte negativa bilateral e uma com tuba direita positiva e esquerda negativa. Conclusao: o diagnostico da SIN e feito com base na histerossalpingografia, caracterizada pelo acumulo do meio de contraste na parede tubaria, distribuida na porcao istmica cornual ou ampolar, uni ou bilateralmente, acompanhado de historia clinica de infertilidade, gravidez tubaria, abortamento espontâneo e obstrucao tubaria. Palavras-chave: Salpingite; Histerossalpingografia; Infertilidade; Gravidez Tubaria.

Percutaneous use of ePTFE/FEP-covered metallic stent for palliation of malignant biliary obstruction

Abstract Introduction: Placement of self-expanding metallic stents has been a standard palliative treatment for patients with inoperable biliary malignancy, aiming at improving quality of life via a minimally invasive procedure. This study aimed to evaluate the efficacy of percutaneous placement of expanded polytetrafluoroethylene/fluorinated ethylene propylene-covered metallic stents for palliation of inoperable biliary malignancy. Material and methods: Between February 2012 and April 2013, 11 patients with inoperable malignant biliary obstruction were treated with stent implantation. Serum bilirubin and liver enzyme levels were measured before/immediately after stent placement and at one, three, and six months. Patient survival and stent patency were calculated using Kaplan-Meier analysis. Results: No migration occurred. Patients showed clinical improvement immediately and one month after stent placement, with a significant reduction in mean serum bilirubin level (p < 0.05). At six months, bilirubin levels were <1.5 mg/dL in all cases. One patient developed acute liver failure four days after stent implantation, leading to death. Survival rates were 90% at three months and 70% at six months. Primary patency rates were 100%, 100%, and 90% at one, three, and six months, respectively. Conclusion: Percutaneous placement of expanded polytetrafluoroethylene/fluorinated ethylene propylene-covered metallic stents offered an effective palliative therapy for patients with inoperable biliary malignancy.

Idiopathic portal hypertension and related ultrasound findings

Objective: to characterize idiopathic portal hypertension clinically and by ultrasound (US). Patients and methods: 60 patients with clinical diagnosis of chronic liver disease and portal hypertension were retrospectively assessed by color Doppler US, from January 1996 to January 2006, in a privately owned clinic. Two cases of idiopathic portal hypertension were found. Comments: in young patients with splenomegaly, recurring hematemesis, anemia, ascites, normal liver function and portal hypertension without evidence of cirrhosis, US revealed livers of usual size, heterogeneous texture and flat surface, without deformities in the branches of the intra-hepatic portal veins. The portal vein walls were also thickened starting at 3 mm and marked by an abrupt narrowing of the secondary intra-hepatic portal veins, accompanied by splenomegaly.