Renato A. Sernik

Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis

ObjectiveTo evaluate the inter- and intrareader variability for interpretation of a modified Larsens radiographic classification system for juvenile rheumatoid arthritis (JRA) focused on osteochondral lesions and a conventional Larsens classification system, compared to a reference MR scoring system of corresponding images.Materials and methodsSeventy-five radiographs of 60 children with JRA, performed within a short interval of time from the MR examinations, were independently evaluated by three experienced radiologists, three diagnostic imaging residents and three rheumatologists, in two separate sessions, according to the two different classification methods, blinded to the corresponding MR images.ResultsThe inter- and intrareader concordance rates between the two radiographic classification systems and the MR-related radiographs were respectively poor and poor/moderate. The interobserver range of weighted kappa values for the conventional and the modified Larsens system respectively was 0.25–0.37 vs 0.19–0.39 for radiologists, 0.25–0.37 vs 0.18–0.30 for residents and 0.19–0.51 vs 0.17–0.29 for rheumatologists. The intrareader rate ranged from 0.17–0.55 for radiologists, 0.2–0.56 for residents, and 0.14–0.59 for rheumatologists.ConclusionAlthough the proposal of a new radiographic classification system for JRA focused on osteochondral abnormalities sounds promising, the low inter- and intrareader concordance rates with an MR-related radiographic system makes the clinical applicability of such a radiographic system less suitable.

Avaliação eletromiográfica e ultrassonográfica do músculo masseter em indivíduos normais: estudo piloto

Abstract Background: recent studies have used ultrasonography with the purpose of measuring muscle cuts. Aim: tocharacterize the motor control and the morphology of the masseter muscle in normal individuals,verifying the compatibility between surface electromyography and ultrasonography. Method: five adultindividuals, with no alterations of the stomatognathic system. The adopted assessment procedures for allparticipants were: 1. Surface Electromyography; 2. Ultrasonography. Results: a high correlation wasobserved only when comparing both hemifaces in the ultrasonographic assessment (rest 0.95; biting0.86). Conclusion: the results indicate that there is no correlation between the tested methods, suggestingthat both methods are complementary and not mutually excludent. Key Words: Masseter Muscle; Electromyography; Ultrasonics. Resumo Tema: estudos recentes utilizaram a ultrassonografia com o objetivo de medir cortes musculares. Objetivo:caracterizar o controle motor e a morfologia do musculo masseter em individuos normais, verificando acompatibilidade entre a eletromiografia de superficie e a ultrassonografia. Metodo: cinco individuosadultos, sem alteracoes no sistema estomatognatico. Os procedimentos adotados para a avaliacao dosparticipantes foram: 1. Eletromiografia de Superficie; 2. Ultrassonografia. Resultados: houve alta correlacaoapenas para a comparacao entre hemifaces direita e esquerda no exame de ultrassonografia (repouso 0,95;maxima intercuspidacao dentaria 0,86). Conclusao: os resultados indicam nao haver correlacao entre osmetodos testados, sugerindo que os exames sao complementares e nao excludentes.

Caracterização eletromiográfica e ultrassonográfica da função mastigatória em indivíduos com oclusão normal

PURPOSE: To characterize the motor control of the masseter and temporal muscles and the morphology of the masseter muscles during mastication in individuals with normal occlusion and to verify the consistency between surface electromyography (sEMG) and ultrasound (USD). METHODS: Participants were 22 adults, of both genders, with no alterations of the oral myofuntional system. The procedures performed included sEMG of the masseter (MM) and temporal (TM) muscles and USD of the MM, each during three tasks: resting condition and maximum voluntary dental clench with and without cotton rolls. RESULTS: The following statistical tests were used: Kolmogorov-Smirnov, paired t-test and Spearman correlation (significance level of 5%). The sEMG data indicated a significant difference between the MM and TM during the maximum voluntary clench with and without cotton rolls, and the TM was more active than the TM in both clenching tasks. No significant difference was observed between the sides of the face when assessed with sEMG or USD. A significant positive correlation between the exams was observed for the left maximum voluntary dental clench with and without cotton rolls, and a trend toward significance was found for the right maximum dental clench without cotton rolls. CONCLUSION: The comparison of sEMG to USD for the investigation of muscle function reveals important information about the physiology of skeletal muscles. The results of the present study suggest a correlation between sEMG and USD, i.e., between increased electrical activity and the corresponding increase in muscle thickness.

Cross-Sectional Area of the Median Nerve Characterized by Ultrasound in Patients With Carpal Tunnel Syndrome Before and After the Release of the Transverse Carpal Ligament

The objective of this study was to evaluate the cross-sectional area of the median nerve by ultrasonography before and after release of the transverse carpal ligament in patients with carpal tunnel syndrome. An additional goal was to correlate the cross-sectional area following surgery with clinical symptoms. Eighteen patients and 22 wrists were evaluated. All patients underwent Paine’s surgical technique for release of the transverse ligament. Cross-sectional area was calculated from sonograms taken at the pisiform bone level pre- and postsurgery. Postsurgical measurements were made at 4, 8, 12, and 96 weeks. Before surgery, the mean cross-sectional area was 19.7 mm2. The results following surgery were as follows: 4 weeks, 20.1 mm2; 8 weeks, 17.4 mm2; 12 weeks, 15.5 mm2; and 96 weeks, 13.5 mm2. Three patients remained clinically symptomatic at the time of their last follow-up visit. Cross-sectional area of the median nerve tends to increase 4 weeks after surgery for carpal tunnel syndrome, compared with the measurements taken prior to surgery, and then progressively decreases. There was no evidence of postprocedure correlation between the cross-sectional area of the median nerve and clinical symptoms.

Síndrome do túnel do carpo com indicação de tratamento cirúrgico: avaliação ultra-sonográfica

Autora: Paula Gemignani Soriano.Orientador: Giovanni Guido Cerri.Tese de Doutorado. FMUSP, 2001.O câncer de mama e a forma mais co-mum de doenca maligna em mulheres,afetando uma em cada nove durante suavida. A enfase para sua deteccao preco-ce tem significativamente aumentado onumero de mamografias realizadas.O uso da ultra-sonografia de alta re-solucao como exame complementar asmamografias de mulheres com mamasdensas leva a deteccao de um significan-te numero de lesoes malignas ocultas.No entanto, varios estudos de ultra-so-nografia, tanto em lesoes mamarias pal-paveis como nao-palpaveis, mostram ina-ceitaveis taxas de falsos-negativos, atemaiores que 47%. Nodulos mamarios saoalteracoes comuns e em sua maioria saobenignos, porem o fato de o câncer ma-mario ser seu diagnostico diferencial tor-na necessario sua amostra tecidual. Me-todos minimamente invasivos e com bai-xos custos sao necessarios para se ob-ter o diagnostico histologico preciso delesoes mamarias. A reducao do numerode biopsias para lesoes benignas e dese-javel para se evitar cirurgias desnecessa-rias. A biopsia aspirativa por agulha fina ea biopsia por trocarte tem provado seremalternativas de minima invasividade, comacuracia e funcionalidade comparaveis.O presente estudo foi realizado paraavaliar a realizacao da biopsia aspirativapor agulha fina (BAAF) e da biopsia portrocarte (BT) em nodulos mamarios comsuspeita de malignidade, com os proce-dimentos realizados sob orientacao ultra-sonografica. Os resultados obtidos em164 nodulos foram analisados. A sensi-bilidade e a especificidade das biopsiasem nodulos mamarios suspeitos de ma-lignidade foram avaliadas. Dentre os 40nodulos benignos e 124 malignos, a sen-sibilidade foi de 100% e 91,6% e a especi-ficidade foi de 92,1% e 97,5%, altas para aBAAF e para a BT, respectivamente, mes-mo para as lesoes menores. Material ina-dequado foi encontrado em 16 casos naBT, em dez na BAAF e em quatro em am-bos os metodos. Concluiu-se que a BAAFe a BT sao metodos bastante sensiveisna deteccao de lesoes mamarias, inde-pendentemente do tamanho e tipo dotumor. Isto reforca o beneficio da BAAF eda BT na deteccao do câncer mamarioem estadios iniciais.