Silvia Maria Sucena da Rocha

Biometria do fígado e do baço em pacientes com lúpus eritematoso sistêmico de início pediátrico

OBJECTIVE To evaluate liver and spleen dimensions in childhood-onset systemic lupus erythematosus (c-SLE) patients and healthy controls. METHODS 30 c-SLE patients and 30 healthy control volunteers underwent abdominal ultrasound. The following two liver measurements were performed in left hepatic lobe: craniocaudal and anteroposterior and three in right hepatic lobe (RHL): posterior craniocaudal (PCC-RHL), anterior craniocaudal and anteroposterior. Three spleen dimension measurements were also evaluated: longitudinal, transverse and anteroposterior. Demographic, clinical and laboratorial data, SLEDAI-2K, ECLAM, SLAM and treatment were assessed. RESULTS Mean current age was similar in c-SLE and controls (170.31 ± 27.81 vs. 164.15 ± 39.25 months; p = 0.486). The mean of PCC-RHL dimension was significantly higher in c-SLE compared to controls (13.30 ± 1.85 vs. 12.52 ± 0.93, p = 0.044). There were no differences between the other hepatic biometrics and splenic parameters (p > 0.05). Further analysis in c-SLE patients according to PCC-RHL dimension ≥ 13.3cm versus < 13.3 cm showed that the median of SLEDAI-2K [8(0-18) vs. 2(0-8), p=0.004], ECLAM [4(0-9) vs. 2(0-5), p = 0.019] and SLAM [5(1-13) vs. 2(0-14), p = 0.016] were significantly higher in patients with higher PCC-RHL dimension, likewise the frequencie of nephritis (77% vs. 29%, p = 0.010). Liver enzymes were similar in both groups (p > 0.05). Positive correlation was observed between SLEDAI-2K and PCC-RHL (p = 0.001, r = +0.595). Negative correlation was evidenced between disease duration and longitudinal dimension of spleen (p = 0.031, r = -0.394). CONCLUSION Our data raises the possibility that disease activity could lead to a subclinical and localized hepatomegaly during the disease course. Long disease duration resulted to spleen atrophy in c-SLE patients.

Determinação do tamanho do fígado de crianças normais, entre 0 e 7 anos, por ultrassonografia

OBJECTIVE: The present study was aimed at sonographically determining the liver size in healthy newborns, infants and children under 7 years of age, correlating results with age, sex, height, body weight and body mass index. MATERIALS AND METHODS: A total of 584 healthy children subdivided into 11 age groups were evaluated with measurements of the left lobe craniocaudal diameter at the midsternal line, and the craniocaudal diameter of the right lobe posterior surface at the midclavicular line. The following tests were utilized for statistical analysis: a) Pearsons correlation coefficient (correlation study); b) non-paired Students t-test (comparison of measures between sexes); c) nonlinear regression models (nomograms). RESULTS: The liver size presented a progressive growth from the birth up to the age of 7, proportionally lower than the body growth, in correlation with age, height and body weight (r > 0.70). Correlation with the body mass index was not observed (r < 0.11). There was no significant difference in liver size between male and female individuals. CONCLUSION: Liver size was sonographically determined in healthy children under the age of 7 by means of a standardized method, demonstrating a strong correlation with age and anthropometric indicators. Nomograms demonstrate the typical variations of the liver size in the population evaluated with a different growth pattern for each hepatic lobe.

Ultrasound guided injection of botulinum toxin into the salivary glands of children with neurological disorders

Here, we report the case of a 2-year-old male patient with corpus callosum atrophy who was under investigation for genetic syndrome. The patient had a gastrostomy and a permanent tracheostomy. He had sialorrhea (drooling) that had not responded to clinical treatment with sublingual atropine and had been hospitalized for pneumonia on multiple occasions. He was referred for ultrasound-guided injection of botulinum toxin—recommended for therapeutic use since 1822—into the parotid and submandibular glands. Ultrasound studies of the parotid and submandibular glands, all conducted by the same physician (with 15 years of experience in ultrasound), revealed that the glands were normal in appearance. Prior to, 30 days after, and 60 days after injection of the botulinum toxin, the glands were measured and their volumes were calculated. Ultrasound guidance allowed the best site for injection of the botulinum toxin to be identified, which prevented the toxin affecting structures adjacent to the salivary glands, such as the muscles involved in swallowing and vascular structures (Figure 1). In follow-up visits, the mother reported that there was a significant decrease in the number of pads used for cleaning drool and a 50% reduction in the number of tracheal aspirations, without any complaints suggesting that the botulinum toxin had provoked an inflammatory process. The patient had no episodes of bronchopneumonia during the two-months observation period. The ultrasound studies of the parotid and submandibular glands showed no parenchymal changes subsequent to injection of the botulinum toxin. The use of ultrasound to guide botulinum toxin injections is important in pediatric patients, especially because the small size of the salivary glands makes them difficult to palpate in such patients. In neurologically impaired children, the use of the ultrasound guidance is even more relevant, because they can present with increased muscle tone and often have a tracheostomy in an Luiz de Abreu Junior, Henrique T. Martucci, Paulo Tarso Reck de Mendonça, Gustavo Garcia Marques, Célia Rodrigues

Polycystic Ovary Syndrome among Obese Adolescents

Abstract Background and aims: In adolescence and obesity, the pathophysiology of polycystic ovary syndrome (PCOS) is very difficult to distinguish. We aimed to assess the diagnosis of PCOS in the population of obese adolescent. Methods: Cross-sectional study. Setting: Pediatric Endocrinology Weight and Management Clinic from Childrens Institute, São Paulo, Brazil. Participants: Forty-nine post-menarcheal obese adolescents with mean age of 14.7 years. Interventions: Anthropometric assessment and review of medical records were done. Clinical and laboratory hyperandrogenism were quantified using Ferriman–Gallwey index and androgenic dosages, respectively. Ovarian morphology was evaluated through suprapubic ultrasonography. Results: By the 2015 Witchel et al. guideline for PCOS in adolescence, 18.4% were diagnosed as having PCOS. When assessed by Rotterdam, Androgen Excess and PCOS Society, and American National Institute of Health criterias, 26.4%, 22.4%, and 20.4% had PCOS, respectively. Irregular menstrual cycles were found in 65.3% of patients. Clinical hyperandrogenism was observed in 16.3% of girls and 18.4% had elevated serum androgen values. Suprapubic ultrasonography revealed enlarged ovaries in 18.4% of the adolescents. Conclusions: PCOS in all-comers obese adolescents from a Weight and Management Clinic in a quaternary hospital is more frequent when compared to adult women showed in the literature.

Ultra-sonografia intra-operatória na localização de insulinoma: relato de dois casos

The authors describe two cases of utilization of intraoperative ultrasound as an auxiliary method for surgical resection of pancreatic insulinomas. We emphasize the importance of this procedure, particularly in patients whose tumors could not be well delimited using other preoperative methods, thus avoiding unnecessary ample resections and reducing postoperative complications.

Liver and spleen biometrics in childhood-onset systemic lupus erythematosus patients

Involvement of the reticuloendothelial system occurs in 20-50% childhood-onset systemic lupus erythematosus (c-SLE) patients at disease onset, usually associated with disease activity. Hepatomegaly and/or splenomegaly may also be associated with abnormal liver function tests. Abdominal ultrasound can be used to assess liver and spleen measurements in children and adolescents without risk of radiation. However, a systematic evaluation of these visceral organ dimensions has not been performed in c-SLE population, particularly during the disease course.

PReS-FINAL-2298: Biometrics of spleen and liver in patients with childhood-onset systemic lupus erythematosus

Involvement of the reticuloendothelial system occurs in 20-50% of patients with childhood-onset systemic lupus erythematosus (C-SLE) at disease onset. However, a systematic evaluation of liver and spleen sizes has never been performed in a pediatric population with lupus.

O jejum como fator de influência na qualidade da ultrassonografia de abdome em crianças posto em questão

Sometimes, precepts of a practice seem to be so well established that one hardly sees them questioned. Such precepts end by becoming true “scientific dogmas” constituting a contradiction itself. In science, concepts (on which precepts are based) are coined on ideas requiring support from scientific experiments, and being reformulated by new ideas, new demands, technologies or realities. On the contrary, dogmas do not require scientific evidence and are based on faith. One of the most rooted precepts of diagnostic ultrasonography is the need for fasting as a condition to guarantee the quality of abdominal studies, reducing the amount of gas within the gastrointestinal tract and allowing a satisfactory distension of the gallbladder. In most clinical centers, the preparation recommended for abdominal ultrasonography includes instructions for fasting during periods ranging from four to six hours for children and from six to 12 hours for adults. The actual benefits from such procedure have rarely been questioned and have never been refuted. Thus, the article developed by Rabelo et al., published in the present issue of Radiologia Brasileira, is extremely refreshing for the field of ultrasonography: by means of comparing the quality of images of abdominal ultrasonography of children with and without previous fasting, their study tests the abdominal preparation paradigm and, as a conclusion, relativizes the advantages generated by this practice. Certainly, sonographers who perform ultrasonography in children have already been faced with the difficulty of getting minimally acceptable images because of the irritability condition of children after a long fasting period. A colleague, pediatric radiologist, defines a hungry child as “an adversary to be respected”... The word “adversary” defines the exact notion of the battle into which the procedure is transformed in such circumstances, and the winner almost never is the physician. Thus, frequently, we find ourselves compelled to yield and negotiating, preferring that the child be fed to allow us to take the control of the examination. Additionally, the child’s weep promotes a larger gaseous distension than that produced by the digestive process. Daily experiences in this field strengthen the conviction that, in children, the impairment of the abdominal