Marina Celli Francisco

Análise radiológica das alterações gastrintestinais após cirurgia de Fobi-Capella

OBJECTIVE: The present study was aimed at evaluating radiological findings of delayed postoperative upper gastrointestinal series in patients submitted to Fobi-Capella surgery. MATERIALS AND METHODS: Radiological studies of 41 patients, six to nine months following the surgery. RESULTS: The following pathological alterations have been found: hiatal hernia (17%), gastroesophageal reflux disease (19.5%) and sliding of the silastic ring (4.8%). Least frequent findings have been the following: enterocutaneous fistula (2.4%), stenosis of the gastric pouch outlet (2.4%), bezoar (2.4%), and non-visualization of the silastic ring caused by its removal due to patient intolerance (2.4%). Anatomical alterations resulting from the surgery have been clearly demonstrated. CONCLUSION: The present study could demonstrate anatomical alterations and complications resulting from Fobi-Capella surgery.

Espondiloartropatias: critérios de ressonância magnética na detecção da sacroileíte

Diagnostic imaging is crucial to the diagnosis and monitoring of spondyloarthropathies. Magnetic resonance imaging is the most relevant tool for the early detection of sacroiliitis, allowing the institution of therapeutic strategies to impede the progression of the disease. This study illustrates the major criteria for a magnetic resonance imaging-based diagnosis of spondyloarthropathy. The cases selected here present images obtained from the medical records of patients diagnosed with sacroiliitis over a two-year period at our facility, depicting the active and chronic, irreversible forms of the disease. Although computed tomography and conventional radiography can also identify structural changes, such as subchondral sclerosis, erosions, fat deposits, and ankylosis, only magnetic resonance imaging can reveal active inflammatory lesions, such as bone edema, osteitis, synovitis, enthesitis, and capsulitis.

Estudo por imagem da síndrome do desfiladeiro torácico

O desfiladeiro toracico consiste em dois espacos anatomicos: 1. Espaco do triângulo interescaleno: compreende o espaco entre o musculo escaleno anterior (anteriormente), musculos escalenos medio e posterior (posteriormente) e pela primeira costela (inferiormente). O tronco superior do plexo braquial (raizes C5 e C6) e o tronco medio (raiz C7) ocupam a porcao superior deste espaco. O tronco inferior (raizes C8 e T1) ocupa a parte inferior, posteriormente a arteria subclavia. A arteria subclavia situa-se na margem inferior deste espaco. 2. Espaco costoclavicular: delimitado pela metade medial da clavicula (superiormente), pela face cranial da primeira costela (inferiormente), pelo ligamento costoclavicular ou romboide (anteriormente) e pelo musculo escaleno posterior (posteriormente). O plexo braquial e formado pela uniao dos ramos ventrais das raizes C5 a C8 e a maior parte do ramo ventral de T1. Os ramos ventrais de C5 e C6 se unem para formar o tronco superior. O ramo ventral de C7 continua como tronco medio, e os ramos ventrais de C8 e T1 juntam-se para formar o tronco inferior. Cada um dos tres troncos se divide em anterior e posterior. As divisoes posteriores unem-se para formar o fasciculo posterior. Ja as divisoes anteriores dos troncos superior e medio juntam-se para formar o fasciculo lateral, e a divisao anterior do tronco inferior prossegue como fasciculo medial. O termo sindrome do desfiladeiro toracico (SDT) foi utilizado pela primeira vez por Peet et al(1), em 1956, e descreve um quadro clinico atribuido a compressao do plexo braquial, arteria e veia subclavias na regiao designada desfiladeiro toracico. Sua incidencia varia de 3 a 80 casos/1.000 habitantes, predominando em mulheres entre 20 e 50 anos(2). A SDT e dividida em cinco apresentacoes clinicas(3): 1. Neurogenica com sinais clinicos classicos e achados compativeis a eletroneuromiografia; 2. Neurogenica com sinais clinicos inespecificos e sem os achados tipicos a eletroneuromiografia; 3. Vascular por compressao arterial; 4. Vascular por compressao venosa; 5. Pos-traumatica: apresenta sinais e sintomas de compressao neurogenica pos-traumatica. Muitas causas podem ser atribuidas a SDT, como compressao por anormalidades claviculares, costela cervical no segmento C7, alteracoes no primeiro arco costal, musculo subclavicular, membrana costoclavicular, ligamento costocoracoide e musculos escalenos anterior e medio(4).

Avaliação da via lacrimal pelos métodos radiológicos

The authors perform a revisional and iconographic study of the lacrimal system by means of radiological methods, namely, conventional radiography, linear tomography, computed tomography and magnetic resonance imaging. Image methods are essential to define diagnosis and therapy, considering that besides demonstrating alterations of the lacrimal system, they may indicate the patients with better prognosis associated with the surgical approach. Considering the lower cost, lower radiation dose, low rate of complications, and level of information that can be obtained dacryocystography by means of linear tomography is recommended as the initial investigation method.

Mastopatia diabética: um inusitado diagnóstico diferencial: relato de caso

Diabetic mastopathy affects premenopausal women with longstanding type 1 diabetes mellitus. The diagnosis is based on clinical findings (uni or bilateral hardened, palpable mass) associated with radiological (increase in breast density), sonographic (marked posterior acoustic shadowing), and histopathological (fibrosis and perivascular and periductal lymphocytic infiltration) findings. This disease may clinically simulate a breast carcinoma. The case of a patient with diabetic mastopathy is reported.

Mecanismo extensor da mão: desvendando a anatomia e avaliação por métodos de imagem

Medicos experientes apresentam grande dificuldade no exame fisico de pacientes com suspeita de lesao dos tendoes do antebraco e da mao. Estudos relatam ate 20% de atrasos no diagnostico, resultando em morbidade que poderia ser prevenida e evitada. Em atendimento de emergencia, o diagnostico clinico correto e realizado em apenas 64% dos casos(1). Pode ser dificil diferenciar ruptura tendinea de aderencia do tendao ou desordens neurologicas. O local e a dimensao da ruptura podem nao ser evidentes ao exame fisico, especialmente em casos de lesao degenerativa de tendao com disturbio motor incompleto, em que o edema local e a sensibilidade aumentada podem nao estar presentes(2). Desse modo, os metodos de imagem desempenham importante papel no auxilio diagnostico das lesoes dos musculos extensores da mao, ajudando a direcionar a terapeutica mais adequada em funcao da causa.

Desfecho da gravidez em portadoras de esclerodermia difusa e limitada

PURPOSE: to verify if there is any difference in the number of miscarriages and newborns with low weight in patients with scleroderma (SSc) when compared with women without the disease, between the two clinical variants of the disease and when the expression of SSc occurred before or after the gestation. METHODS: twenty-six patients were analyzed regarding the number of pregnancies, miscarriages, sex, and birth weight of the children, studying the clinical variant of the disease and the temporal relationship between diagnosis and gestation. The patients had not used either medications that could interfere in gestation or had any other disease that could do it. For control, twenty-six healthy women, without diseases that might alter the gestation, of the same ages and socioeconomic status were studied. For the statistical analysis study, tables of frequency, tables of contingency, and Fisher, c2 and Mann-Whitney tests were used. Statistical significance was considered when p<0.05. RESULTS: among the patients with SSc, there were 96 gestations with 13.5% (n=13) of miscarriages. In the control group, there were 94 gestations with 9.6% (n=9) of miscarriages. There were no differences in the number of newborns with low weight between the two groups (cases, n=8 and controls, n=6, with p=0.54), nor in the number of miscarriages (p=0.46). However, the number of newborn babies with low weight was significantly higher among the cases with the diffuse disease (diffuse form, n=4 and limited, n=4, with p=0.04) and among patients that became pregnant after the diagnosis of SSc (37.5% in women known to be sick and 6.7% in women who became pregnant before getting ill, with p=0.03). The number of male newborns was higher in the women with SSc (p=0.002). CONCLUSIONS: the women with SSc showed a higher number of low-weight newborns in the group with diffuse disease and when pregnancy occurred after the clinical diagnosis of the disease.