Luiz Roberto Fernandes Martins

Increased Hip Bone Mineral Density in a Woman with Gluteal Silicon Implant

Conditions and artifacts such as aortic calcification, osteophytes, hip prostheses, and metallic objects can mislead the results of dual energy X-ray absorptiometry (DXA) scanning of the spine and hip. Gluteal silicon implants increasingly are being used for aesthetic purposes by women in Brazil, some of whom are at an age of high risk for the development of postmenopausal osteoporosis. We herein report a case of a woman whose hip bone mineral density by DXA clearly increased after the placement of bilateral gluteal implants of silicon. This case demonstrates the importance of inquiring about the presence of this artifact to avoid unnecessary evaluation of hip bone densitometry in these situations.

Increased FDG uptake in the right cardiac chambers in a patient with pulmonary emphysema.

A solitary lung node was identified on a computed tomographic (CT) scan in a 62-year-old man with severe pulmonary hypertension and emphysema who was enrolled in a lung transplant program. Aspiration biopsy confirmed the presence of a pulmonary adenocarcinoma in the right middle lobe. A fluorodeoxyglucose (FDG) positron emission tomographic (PET) study was performed to stage the disease. In addition to the known lung cancer, significantly increased FDG uptake in the right atrium, right ventricle, and interventricular septum were noted.

Histometric study of age related changes in the thoracic aorta of Callus gallus (Linnaeus, 1758).

SummaryThe authors have studied the quantitative variations of elastic and collagenous fibers, muscle cells and cellular population in the mesarteria of the middle portion of the thoracic aorta of Gallus gallus from 1 day to 36 months of age. A histometric method has been employed, using an integrating eyepiece I (Zeiss Oberkochen) for the countings.The results obtained show that the concentration of elastic fibers increases from the first to the 30th day of age, decreasing from this point until 36 months while that of the collagenous fibers increases during the first and second period. The muscular tissue increases its concentration from the 30th day to 36th month, while the cellular population decreases from the 15th to 30th day, then remaining, stable until 36 months. From the variations pointed out here for the different elements studied between 30 days and 36 months of age, only those of the eollagenous fibers were linear with age.

Associação entre fatores de risco para doença arterial coronariana e coronariopatia em pacientes submetidos a cintilografia de perfusão do miocárdio

OBJECTIVES: To establish the degree of association between cardiovascular risk factors and the presence of coronary artery disease (CAD) in a group of patients undergoing myocardial perfusion scintigraphy (MPS). METHODS: The study included 7183 patients who had undergone MPS. Using logistic regression analysis the odds ratios for the following risk factors were evaluated: age, gender, family history, body mass index, smoking, dyslipidemia, diabetes mellitus (DM) and systemic hypertension. Indicators for the presence of CAD were defined as: myocardial infarction, revascularization, angioplasty or an altered MPS. Analysis was based on the whole the group as well as on male and female subgroups. The impact of the risk factors in relation to age was also analyzed. RESULTS: A statistically significant association was observed between patient age and gender and the presence of CAD. For females, it was demonstrated that DM is the main modifiable risk factor for CAD. For males various modifiable risk factors were associated with the presence of CAD, particularly DM and dyslipidemia. In the analysis by age groups some risk factors showed a more expressive association. CONCLUSION: The main risk factors for CAD were aging and male gender. In relation to modifiable risk factors and the presence of CAD, the greatest associations for males were DM and dyslipidemia and for females DM. The most relevant factors for specific age groups were smoking for young men and DM and smoking for women between the ages of 40 and 50.

Assessment of Hydroureteronephrosis by Renographic Evaluation under Diuretic Stimulus

42 dilated renal units, from 32 patients, were evaluated renographically with 131I, under diuretic stimulus, with the aim of differentiating between obstructed and atonic ureters. The results of this study are similar to the clinical follow-up and surgical findings in 88% of cases.

Relação dos níveis séricos de cálcio e paratormônio com a positividade da cintilografia das paratiróides

O hiperparatiroidismo primario (HPP) e caracterizado pelo aumento da secrecao de PTH, com consequente aumento da concentracao serica de calcio. O diagnostico e realizado pela dosagem de calcio e PTH. A cintilografia das paratiroides e solicitada, classicamente, em pacientes com recorrencia de HPP apos paratiroidectomia, na tentativa de detectar glândulas patologicas ectopicas ou remanescentes. Algumas vezes este exame tem sido solicitado antes do primeiro ato cirurgico, na tentativa de localizar as glândulas comprometidas e abreviar a duracao da cirurgia; na nossa casuistica, no entanto, a maioria dos exames solicitados com esta indicacao resulta negativa. Comparamos os niveis sericos de calcio e PTH nos pacientes com cintilografia das paratiroides positiva, com aqueles dos pacientes com cintilografia negativa, a fim de tentar definir niveis com indice maior de positividade na cintilografia. Foram estudados retrospectivamente 74 pacientes consecutivos submetidos a cintilografia das paratiroides. Avaliou-se a utilizacao dos valores mais baixos de PTH (79pg/mL) e calcio (10mg/dL) registrados no grupo com cintilografia positiva como referencia para a indicacao do exame. No grupo total de pacientes, 17 (23%) apresentaram cintilografia positiva. No subgrupo com valores de PTH ³ 79pg/mL e de calcio ³ 10 mg/dL a porcentagem de exames positivos foi de 49%. Concluimos que cintilografias das paratiroides realizadas antes da cirurgia de paratiroidectomia em pacientes com niveis de calcio serico abaixo do limite superior da normalidade ou niveis de PTH pouco aumentados sao, na maioria das vezes, negativas.

Fatores biológicos e superestimação da fração de ejeção do ventrículo esquerdo no gated SPECT

BACKGROUND Some patients present an overestimated left ventricular ejection fraction (LVEF) on electrocardiogram-gated myocardial scintigraphy (gated SPECT). OBJECTIVE To establish the relationship between biological factors and overestimated LVEF. METHODS We selected 3838 patients who underwent gated SPECT between May 20, 2000 and September 16, 2005 with normal perfusion images and LVEF > or =50%. The following variables were analyzed: gender (29.4% females and 70.6% males), age (from 20 to 94 years - mean: 56 years), weight (from 33.5 to 150 kg - mean: 79.6 kg), height (from 138 to 220 cm - mean: 171 cm) and BMI (from 13.9 to 54 - mean: 27.2). In a subgroup of 1002 patients who underwent echocardiogram, the diastolic diameter (from 36 to 68 mm - mean 47.5 mm) and systolic diameter (from 22 to 41 mm - mean 29.8 mm) variables were included. The patients were divided into two groups: normal LVEF (< or =80%) and overestimated LVEF (>80%). The odds ratio (OR) for presenting an overestimated LVEF was calculated for each variable using logistic regression. RESULTS The following odds ratios were found (p < 0.005): female gender OR = 3.585 (95%CI: 2.745 to 4.683), age in years OR = 1.020 (95%CI: 1.011 to 1.029) and height in cm OR = 0.893 (95%CI: 0.829 to 0.962). Weight and BMI were not significantly associated with LVEF (p>0.2). In the subgroup of 1002 patients, a statistically significant influence was found in overestimated LVEF values for the systolic diameter, gender and height variables. CONCLUSION Although systolic diameter influences the overestimation of LVEF, the gender and height variables have an independent influence on LVEF overestimation by gated SPECT.

Indication of myocardial perfusion scintigraphy for coronary artery disease detection based on clinical-epidemiological and treadmill test evidences.

OBJECTIVE To establish when the myocardial perfusion scintigraphy (MPS) should be performed based on well-defined information obtained from treadmill test results and clinical-epidemiological parameters for coronary artery disease (CAD). METHODS 2,100 patients who underwent MPS were classified according to the results of scintigraphy, the Duke score and a clinical-epidemiological score based on Framingham study. The patients with positive results on MPS were followed to define whether the results were true positives. Receiver operating characteristic (ROC) curves were used to establish the efficiency and the best Duke and clinical-epidemiological scores to define patients that should be submitted to scintigraphy. RESULTS It was observed that the MPS use restriction in patients with Duke score below 7.5 and/or clinical-epidemiological score above 4 could decrease the utilization of this method by 50% without exposing the patients to a significant misdiagnosis risk. CONCLUSION The utilization of the Duke score and a clinical-epidemiological score to classify the patients expressively decreased the number of unnecessarily requested scintigraphies.