Osmar Saito

Minor sperm abnormalities in young male post-pubertal patients with juvenile dermatomyositis

The objective of the present study was to identify sperm abnormalities in young male patients with juvenile dermatomyositis (JDM). In 2005, 18 male JDM patients, diagnosed according to the criteria of Bohan and Peter, were followed at the Pediatric Rheumatology Unit and Rheumatology Division, of our Institution. Of the 18 males, 11 were pre-pubertal and 7 were post-pubertal. Two of 7 post-pubertal JDM male patients were excluded: one for orchidopexy for cryptorchidism and the other for testicular ectopia in the left testis. The remaining 5 post-pubertal JDM patients were prospectively evaluated on the basis of two semen analyses, according to the World Health Organization (WHO), urologic evaluation, testicular Doppler ultrasound hormone profile. The data of the JDM patients were compared with those of 5 age-matched healthy controls. The median age 18, was similar in JDM patients and controls. All JDM patients had teratozoospermia (abnormal sperm morphology), as did 4 (80%) of the controls. One of JDM patients had previous oligoasthenoteratozoospermia treated with intravenous cyclophosphamide with normalization of the number and concentration of the sperm after 5 years. All sperm parameters (sperm concentration, total sperm count and total motile sperm count by WHO, and sperm morphology by Kruger strict criteria), testicular volumes by Prader orchidometer and ultrasound, and hormones were similar in JDM patients compared with controls. The frequency of anti-sperm antibodies was similar in both groups. All JDM patients had minor sperm abnormalities in the head, midpiece, and/or tail of spermatozoids. Serial semen analyses in larger study populations are necessary to identify the extent and duration of sperm abnormalities in male patients with idiopathic inflammatory myopathies.

Gonadal function in male patients with ankylosing spondylitis

Objective: To assess reproductive function in male ankylosing spondylitis (AS) patients in comparison to healthy controls. Methods: Twenty AS patients were compared to 24 healthy male subjects with regard to demographic data, urological examination, testicular ultrasound (US), semen analysis, anti-sperm antibodies, and hormone profile. Exclusion criteria were present use of sulfasalazine or methotrexate, and ever use of biological/cytotoxic agents. Disease activity of AS was evaluated by clinical and laboratory assessments. Results: Demographic data were similar in AS and controls (p = 0.175). Varicocele was found significantly more frequently in AS patients than in controls (40% vs. 8%, p = 0.027). Semen analysis revealed no significant differences in sperm quality between AS patients and controls (p > 0.05). By contrast, the median of normal sperm forms was significantly lower in AS patients with vs. those without varicocele [13.5 (range 2–27) vs. 22 (range 10–32.5)%, p = 0.049] whereas no difference in sperm morphology was observed comparing AS patients and controls without varicocele (p = 0.670). Comparison of AS patients with and without varicocele showed that anti-sperm antibodies, hormones, inflammatory markers, and disease activity scores did not contribute to the impaired sperm morphology observed in AS patients with varicocele. Conclusions: An increased frequency of varicocele was found in AS patients associated with sperm abnormalities but independent of therapy, anti-sperm antibodies, hormonal alterations, or disease parameters. Investigation for varicocele should be routine in AS patients with fertility problems.

Primary antiphospholipid syndrome: morphofunctional penile abnormalities with normal sperm analysis

Objective: To perform a global gonadal and sexual functions assessment in primary antiphospholipid syndrome (PAPS) patients. Methods: A cross-sectional study was conducted in 12 male PAPS patients and 20 healthy controls. They were assessed by demographic data, clinical features, systematic urological examination, sexual function, testicular ultrasound, seminal parameters according to the World Health Organization (WHO), seminal sperm antibodies, and hormone profile, including follicle stimulating hormone (FSH), luteinizing hormone (LH), morning total testosterone, and thyroid hormones. Results: The median of current age and age of spermarche were similar in PAPS patients and controls (37.5 vs. 32.4 years, p = 0.270, and 13.1 vs. 12.85 years, p = 0.224, respectively), with a higher frequency of erectile dysfunction in the former group (25% vs. 0%, p = 0.044). Further analysis of PAPS patients with and without previous arterial thrombosis demonstrated that the median penis circumference was significantly lower in PAPS with arterial thrombosis than in PAPS without this complication (8.1 [6–10] vs. 10.2 [10–11] cm, p = 0.007). In addition, the median penis circumference was significantly lower in PAPS patients with erectile dysfunction than in patients without this complication (7.5 [6–9.5] vs. 9.5 [7.5–11] cm, p = 0.039). Regarding seminal analysis, the median sperm concentration, sperm motility, and normal sperm forms by WHO guidelines were comparable in PAPS patients and controls (141.5 [33–575] vs. 120.06 [34.5–329] × 106/ml, p = 0.65; 61.29 [25–80] vs. 65.42 [43–82]%, p = 0.4; 21.12 [10–42.5] vs. 23.95 [10–45]%, p = 0.45, respectively), and none of them had oligo/azoospermia. No differences were observed between PAPS patients and controls regarding the frequency of antisperm antibodies, testicular volume by ultrasound, or hormone profile (FSH, LH, morning total testosterone, and thyroid hormone) (p > 0.05). Conclusions: Normal testicular function has been identified in PAPS patients, in spite of morphofunctional penile abnormalities. Previous arterial thrombosis may underlie penile anthropometry alteration.

Reproductive health in male systemic lupus erythematosus

OBJECTIVE: To assess reproductive health in male systemic lupus erythematosus (SLE) patients and compare them with controls. METHODS: Twenty-five male SLE patients were evaluated for demographic data, urologic evaluation (including pubertal parameters, sexual/erectile function), testicular Doppler ultrasound, hormone profile, semen analysis, clinical features and treatment. The control group included 25 healthy men. RESULTS: The current median age was similar in SLE patients compared with controls (26 versus 27 years, P = 0.756). The frequencies of sexual/erectile disfunction were significantly higher (20% versus 0%, P = 0.0001) and the number of spontaneous pregnancies were lower in SLE patients than in controls (20% versus 60%, P = 0.0086). A trend to low contraceptive use was observed in SLE patients compared with controls (48% versus 76%, P = 0.079). Moreover, the frequencies of gonadal dysfunction parameters, such as testicular atrophies measured by ultrasound (36% versus 8%, P = 0.037), elevated FSH and/or LH levels (36% versus 0%, P = 0.002), and sperm abnormalities (48% versus 0%, P = 0.0001), were statistically higher in SLE patients versus controls. SLE patients with sexual/erectile disfunction had no sexual activity in the last month versus 95% of SLE patients without dysfunction (P = 0.0001). On the other hand, no differences were evidenced in SLE patients with or without sexual/erectile disfunction according to demographic data, disease activity, cumulative damage and treatment. CONCLUSION: This is the first study to identify sexual/erectile and gonadal disfunction in male SLE patients. A multidisciplinary approach is essential in order to offer preventive measures for these patients.

Avaliação ultrassonográfica dos distúrbios intracapsulares temporomandibulares

Objetivo: Avaliar a sensibilidade e a especificidade do exame ultrassonografico de alta resolucao para a avaliacao dosdisturbios intracapsulares temporomandibulares. Materiais e Metodos: Estudamos 38 pacientes (76 articulacoes)com queixas de disturbios temporomandibulares. Todos os pacientes realizaram exames de ultrassonografia e resso-nância magnetica (padrao ouro para a avaliacao) e os resultados obtidos foram comparados. Resultados: De 24 ar-ticulacoes evidenciando deslocamento discal com o paciente em repouso na ressonância magnetica, 7 foram confir-mados pela ultrassonografia, em 13 nao foram visualizados os discos e 4 estavam topicos na ultrassonografia. Em 48articulacoes, o disco articular nao foi visualizado na ultrassonografia com o paciente em repouso. Destes, 41 apresen-tavam posicionamento normal na ressonância magnetica e 7 apresentavam deslocamento anterior. Alteracoes morfo-logicas do condilo mandibular foram visualizadas pela ressonância magnetica em 13 articulacoes, identificadas pelaultrassonografia em 2 delas. Conclusao: Podemos concluir, no estudo, que o exame de ultrassonografia apresentaalta sensibilidade e especificidade para o diagnostico da localizacao do disco articular com o paciente em repouso,tanto para a analise de seu posicionamento anatomico como nos casos de deslocamentos, nao apresentando resul-tados significativos para a analise dos discos com o paciente com a boca aberta e para a analise de alteracoes mor-fologicas discais e condilares.Unitermos: Ultrassonografia; Articulacao temporomandibular; Imagem por ressonância magnetica.Objective: To evaluate the sensitivity and specificity of high-resolution ultrasonography in the assessment of intra-capsular temporomandibular disorders. Materials and Methods: The authors have studied 38 patients (76 joints)with complaint of temporomandibular disorder. All the patients underwent ultrasonography and magnetic resonanceimaging (gold standard for the evaluation) and the results were compared. Results: Among 24 joints demonstratingdisc displacement at magnetic resonance imaging of patients at rest, 7 were confirmed at ultrasonography; in 13, thediscs could not be visualized; and in 4, no sonographic abnormality was observed. In 48 joints, the articular discs couldnot be visualized at ultrasonography of patients at rest. Among them, 41 exhibited normal positioning at magneticresonance imaging, and 7 exhibited anterior disc displacement. Morphological changes of the mandibular condyle werevisualized in 13 joints at magnetic resonance imaging, and in 2 at ultrasonography. Conclusion: With the present study,the authors can conclude that ultrasonography offers high sensitivity and specificity in the diagnosis of the articulardisc location with the patient at rest, either to analyze anatomical position or to analyze disc displacement. On theother hand, it does not offer significant results to analyze articular discs in patients with open mouth as well as to analyzedisc/condyle morphological changes.Keywords: Ultrasonography; Temporomandibular joint; Magnetic resonance imaging.ResumoAbstract

Timo: caracterização ultra-sonográfica

O timo e uma pequena glândula responsavel pela producao de linfocitos T, importante na resposta imunitaria do organismo. E orgao relativamente grande no periodo perinatal e pode estender-se superiormente, atingindo o pescoco, com variantes anatomicas. E possivel identificar o timo normal, por meio da ultra-sonografia, pelo acesso supra-esternal, paraesternal e esternal e tambem na regiao cervical quando em localizacao atipica. A partir do inicio da puberdade, devido a sua involucao com diminuicao progressiva do seu tamanho e porque o pulmao aerado se interpoe entre o timo e o feixe sonoro, a sua visualizacao e mais dificil. O padrao da ecotextura normal timica e caracteristica: hipoecogenico em relacao ao parenquima normal da tireoide e apresenta multiplas estruturas ecogenicas lineares e focais, dispersas pelo parenquima, que correspondem aos septos e vasos sanguineos. O reconhecimento pela ultra-sonografia de tecido timico pode ser importante para evitar investigacoes desnecessarias ou cirurgias num timo normal que mimetiza massa patologica.

Avaliação clínica e da espessura cutânea um ano após preenchimento de ácido hialurônico

BACKGROUND: Few scientific studies evaluate the durability of existent fillers with objective parameters and non invasive methods. The objective of this study was to evaluate durability of a hyaluronic acid formula (Derma Hyal ®) in the nasolabial fold treatment, comparing the perception of clinical effect and soft tissue thickness measured by ultrasound. METHODS: Ten women were treated. Evaluation was made before, after 1, 3, 6, 9 and 12 months, clinically and by ultrasound. RESULTS: Median ultrasound thickness was 0.38 ± 0.14 pre, 0.69 ± 0.19 after 1 month, 0.65 ± 0.17 after 3 months, 0.61 ± 0.22 after 6 months, 0, 57 ± 0.23 after 9 months and 0.55 ± 0.14 after 12 months. Data analyzed by Friedmans test were not statistically significant. Regarding patient satisfaction after 6 months, 3 considered the results unsatisfactory, 5 fairly satisfactory and 2 satisfactory. Only one patient considered the treatment satisfactory at 9 months. By 12 months one considered it fairly satisfactory and nine unsatisfactory. All patients said they would do treatment again in another opportunity. CONCLUSIONS: Ultrasound evaluation of dermal thickness after filler treatment proved to be an objective and non invasive method, since when associated with clinical examination. Increase in soft tissue thickness was demonstrated until 12 months after nasolabial fold injection, with progressive decrease after this period. Despite the increase in soft tissue thickness at ultrasound, it was not statistically significant. Clinical effect was noticed by patients until nine months after treatment with this product.

Aspectos da saúde reprodutiva em homens com miopatia inflamatória idiopática: um estudo multicêntrico

OBJECTIVE: To evaluate reproductive health of males with idiopathic inflammatory myopathies (IIM), and comparing them with a control group. METHODS: Demographic data, urologic evaluation (including pubertal parameters and sexual/erectile function), testicular ultrasound, hormone profile, semen analysis, clinical features, and treatment of 25 IIM patients were evaluated. The control group was composed of 25 healthy males. RESULTS: Median age of IIM patients was similar to that of the control group (24 versus 27 years, P = 0.566). The frequency of sexual activity, number of partners with spontaneous pregnancies after the onset of the disease, and use of condom were significantly lower in IIM patients than in the control group (60% versus 96%, P = 0.004; 16% versus 60%, P = 0.0031; 40% versus 76%, P = 0.021, respectively). Moreover, the frequency of testicular atrophy (28% versus 4%, P = 0.049), elevated levels of FSH and/or LH (25% versus 0%, P = 0.05), and sperm abnormalities (40% versus 0%, P = 0.0006) were statistically higher in IIM patients than in the control group. Median age of onset of IIM and current age were significantly higher in IIM patients with sexual/erectile dysfunction than in patients without this dysfunction (41 versus 12.5 years, P = 0.014; 46 versus 21 years, P = 0.027, respectively). On the other hand, differences in the age of spermarche, parameters of gonadal function, disease activity, muscle enzymes, and treatment were not observed between IIM patients with or without sexual/erectile dysfunction. CONCLUSION: This is the first study to identify changes in reproductive health and gonadal dysfunction in male IIM patients. Rheumatologists should discuss sexual problems with their patients, counseling them on contraceptive methods.

Linfonodos cervicais: um dilema para o ultra-sonografista

Ultrasound assessment of neck lymphadenopathy can be difficult as sometimes the same pattern is seen both in inflammatory (specific or not) and neoplastic diseases (lymphoproliferative or metastatic). An adequate follow-up of these lymphadenopathies requires evaluation of some important ultrasound features, and relies on the ability of localizing these nodes. We reviewed the literature with the aim of establishing the most significant ultrasonographic features on gray-scale ultrasound and Doppler ultrasound that can help in the study of the lymph nodes of the neck. We also describe the localization of lymph nodes based on computed tomography anatomic landmarks. The aspects analyzed on B-mode were: number (isolated nodule or conglomeration), shape, echotexture/echogenicity, calcification, cystic necrosis and/or hemorrhagic necrosis, size, contours and extra nodal extension. Doppler aspects reviewed were color mapping and spectral analysis (pulsatility index and resistive index). Some patterns usually described for malignant nodes are round morphology, marked hypoechoic, peripheral vascularization and high pulsatility index and resistive index. We concluded that an accurate diagnosis requires the evaluation of multiple aspects seen on B-mode and Doppler ultrasound.A analise dos linfonodos cervicais e um assunto complexo, na medida em que obtemos, por vezes, padroes de imagens superponiveis para os processos benignos - reacionais (infecciosos especificos e inespecificos) - e para os malignos - doencas neoplasicas (linfoproliferativas e metastaticas). O seguimento adequado das linfadenopatias tambem requer do examinador detalhamento topografico e descricao dos aspectos ecograficos relevantes. Realizamos revisao literaria com os objetivos de ressaltar os criterios ultra-sonograficos mais significantes (modo-B e duplex-Doppler colorido) e fazer analogia aos reparos anatomicos utilizados na tomografia computadorizada, para uniformizar a descricao topografica dos niveis linfonodais por meio da ultra-sonografia. Os aspectos avaliados ao modo-B foram: numero (se agrupados ou isolado), forma, hilo ecogenico central, ecotextura/ecogenicidade, presenca de calcificacoes, necrose e/ou hemorragia interna, dimensoes, contornos (disseminacao extracapsular). Ao duplex-Doppler colorido os aspectos avaliados foram: padrao de vascularizacao e analise espectral - indice de resistividade e indice de pulsatilidade. Existem padroes ultra-sonograficos frequentemente descritos nos linfonodos malignos como morfologia globosa, hipoecogenicidade marcada, vascularizacao predominantemente periferica e indice de resistividade elevado, porem a analise deve ser multifatorial, levando-se em conta os parâmetros ao modo-B e ao duplex-Doppler colorido.

Blood flow velocity in monocular retinoblastoma assessed by color doppler

OBJECTIVE: To analyze the flow of retrobulbar vessels in retinoblastoma by color Doppler imaging. METHODS: A prospective study of monocular retinoblastoma treated by enucleation between 2010 and 2014. The examination comprised fundoscopy, magnetic resonance imaging, ultrasonography and color Doppler imaging. The peak blood velocities in the central retinal artery and central retinal vein of tumor-containing eyes (tuCRAv and tuCRVv, respectively) were assessed. The velocities were compared with those for normal eyes (nlCRAv and nlCRVv) and correlated with clinical and pathological findings. Tumor dimensions in the pathological sections were compared with those in magnetic resonance imaging and ultrasonography and were correlated with tuCRAv and tuCRVv. In tumor-containing eyes, the resistivity index in the central retinal artery and the pulse index in the central retinal vein were studied in relation to all variables. RESULTS: Eighteen patients were included. Comparisons between tuCRAv and nlCRAv and between tuCRVv and nlCRVv revealed higher velocities in tumor-containing eyes (p<0.001 for both), with a greater effect in the central retinal artery than in the central retinal vein (p=0.024). Magnetic resonance imaging and ultrasonography measurements were as reliable as pathology assessments (p=0.675 and p=0.375, respectively). A positive relationship was found between tuCRAv and the tumor volume (p=0.027). The pulse index in the central retinal vein was lower in male patients (p=0.017) and in eyes with optic nerve invasion (p=0.0088). CONCLUSIONS: TuCRAv and tuCRVv are higher in tumor-containing eyes than in normal eyes. Magnetic resonance imaging and ultrasonography measurements are reliable. The tumor volume is correlated with a higher tuCRAv and a reduced pulse in the central retinal vein is correlated with male sex and optic nerve invasion.