Luciana Costa Silva

Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias

OBJECTIVE To investigate the prevalence and distribution of renal arteries and their branches in vivo, correlating the particularities found in them with sex and laterality. METHODS Two hundred renal pedicles were studied by CT angiography and its arteries analyzed according to number, position of origin, size, length and trajectory in relation to renal segments. Its frequency and laterality were surveyed regarding gender and age. RESULTS There were multiple arteries in 61.5% of the pedicles (56% in the right and 67% in the left), occurring in 65% of men and 58% of women. The aortic origin to the multiple arteries was more frequent on the right and, more often, the renal arteries originated between vertebrae L1 and L2 as pre-hilar division of the main artery. The average length of the main artery was higher in right kidneys with a single artery. There was no difference between the diameters of the main renal arteries. CONCLUSION There is a higher prevalence of multiple renal arteries than the one described in the literature, with no difference for gender or laterality. The renal arteries originated more frequently between vertebrae L1 and L2, with divisions of the pre-hilar route and main artery to the hilum of the kidney. The average length of the main artery is greater on the right and in kidneys with single artery. There was no difference in diameter between the main renal artery between kidneys with single and multiple arteries.

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.

Multiple symmetric lipomatosis.

Background: Multiple symmetric lipomatosis (MSL) is a relatively uncommon entity of unknown etiology characterized by symmetrically subcutaneous accumulation of nonencapsulated adipose tissue. Approximately 200 to 300 cases have been published. Objectives: The aims of this article are to report the case of a 58-year-old Brazilian patient with MSL and provide a comprehensive overview of the current concepts concerning this disease. Methods: Our search yielded 28 articles on MSL, including case reports and reviews of the literature. Results: MSL predominantly affects Mediterranean males with a history of chronic alcohol abuse. It is usually asymptomatic and may be associated with diabetes mellitus, hyperlipidemia, hyperuricemia, macrocytic anemia, and oral cancer. Surgical resection is the best treatment option. Conclusion: The case reported is a classic presentation of MSL; however, it is particularly uncommon owing to the association with immune thrombocytopenic purpura. This association has been described only once in the medical literature.

Evidências de hiperfluxo portal no pós-operatório de transplantes hepáticos

OBJECTIVE: A marked impact on the splanchnic circulation is seen in liver cirrhosis. Doppler ultrasonography (DUS) was performed in a group of patients with end-stage liver cirrhosis before, during and after orthotopic liver transplantation (OLT) in order to investigate the hemodynamic changes in portal vein flow velocity. MATERIALS AND METHODS: Fifty-four patients submitted to OLT and intraoperative DUS were prospectively studied from January 2002 to July 2003. Seventeen patients were excluded because of missing data due to either technical difficulties to obtain the measurements or early patient death. All 37 patients included in the analysis had liver cirrhosis mainly associated with hepatitis C virus infection and alcoholic disease. Patients were submitted to DUS just before OLT, intraoperatively after graft reperfusion, and in the postoperative period (1st and 7th postoperative days). Mean flow velocity was measured at main, right and left portal veins. Statistical analysis was performed using paired t test. Differences were significant when p < 0.05. RESULTS: The mean pre-OLT velocity in the portal vein was 16.0 cm/s. Intraoperative measurements obtained few minutes after graft reperfusion showed an increase in portal vein velocity to 84.09 cm/s. Portal flow velocity was 71.0 cm/s and 58.5 cm/s in the 1st and 7th postoperative days, respectively. Intraoperative and postoperative mean flow velocity in the portal vein was significantly higher than in pre-OLT period (p < 0.001). On the 7th postoperative day, the mean flow velocity in the portal vein decreased significantly compared to intraoperative values (p < 0.05). CONCLUSION: In liver transplantation, there is a significantly increase in mean flow velocity in the portal vein immediately after graft reperfusion when compared to pre-OLT data. Likewise, after this initial peak flow there is a significant and progressive decrease in mean flow velocity in the portal vein, which tends to normalize on the 7th postoperative day.

Avaliação dos métodos de imagem no diagnóstico da urolitíase: revisão da literatura

O objetivo deste trabalho foi comparar a tomografia computadorizada helicoidal com os metodos imaginologicos atualmente disponiveis para a abordagem dos pacientes com dor lombar aguda e revisar brevemente as caracteristicas fisiopatologicas da urolitiase e a evolucao da sua abordagem diagnostica. Foi revista a literatura publicada nos ultimos 30 anos, comparando os seguintes metodos: radiografia simples de abdome, urografia excretora, ultra-sonografia e tomografia computadorizada helicoidal. Esta ultima se mostrou metodo de alta sensibilidade e especificidade para o diagnostico de urolitiase, sendo que, virtualmente, todos os calculos sao identificados por este metodo, exceto em pacientes em uso de indinavir. A radiografia simples de abdome associada a ultra-sonografia tem acuracia semelhante a tomografia computadorizada helicoidal, contudo, esta foi superior como metodo de avaliacao isolado. A literatura sugere que a tomografia computadorizada helicoidal e util na avaliacao de pacientes com dor lombar aguda quando disponivel, possibilitando tambem o diagnostico diferencial entre as varias doencas que simulam os sintomas de urolitiase.

Evaluation of response to neoadjuvant treatment, by nuclear magnetic resonance, as a predictor of oncologic results and survival of patients with rectal cancer

INTRODUCAO: A radioquimioterapia neoadjuvante promove reducao do tamanho e do estadiamento dos tumores do reto antes da cirurgia, reduzindo o risco de acometimento de margem de resseccao circunferencial e da recorrencia local. Para pacientes que se submeteram a neoadjuvância, a realizacao de uma segunda ressonância magnetica (RNM) apos a radioquimioterapia, para avaliacao do resultado do tratamento, pode trazer dados relevantes para a programacao cirurgica e previsao do prognostico, porem sua utilizacao ainda e controversa. OBJETIVO: Avaliar a capacidade da RNM prever o grau de regressao tumoral e o downstaging obtidos e a correlacao entre o grau de regressao tumoral com o prognostico dos pacientes. Metodos: Foram incluidos 13 pacientes ate o momento; desses 69,23% eram do sexo masculino e a idade media foi de 52,3 anos. RESULTADOS: O anatomopatologico (AP) mostrou conformidade em relacao ao estadiamento T e N estimado pela RNM pos-neoadjuvância de 30,76%; nos demais pacientes, houve tendencia ao superestadiamento em 55,55%. No estadiamento T houve concordância de 53,84% e quanto ao status linfonodal, concordância 61,53%. A margem de resseccao circunferencial foi livre de neoplasia em 100%. A sobrevida foi de 92%, com 75% de sobrevida livre de doenca num seguimento medio de 1-2 anos. CONCLUSAO: Uma segunda ressonância apos neoadjuvância pode avaliar se houve regressao tumoral, porem com baixa conformidade em relacao ao anatomopatologico, com tendencia ao superestadiamento. Mais estudos sao necessarios para corroborar essas impressoes iniciais.