Wilson Campos Tavares Júnior

Autotransplantation for treatment of severe splenic lesions.

Abstract. The aim of the study was to evaluate clinical and laboratory variables in patients undergoing spleen autotransplantation. We studied 29 patients with severe trauma of the spleen and its pedicle. Of these, 20 underwent autotransplantation (group I) and 9 underwent total splenectomy without preservation of splenic tissue (group II). Twenty-two additional subjects with an intact spleen were used as controls (group III). Immediate and late postoperative complications were investigated. Laboratory counts were performed during the late postoperative period (red blood cells, hemoglobin, white blood cells, platelets, and Howell–Jolly bodies). To investigate the immunological profiles of patients we performed B- and T-lymphocyte counts and determined IgA, IgG, and IgM levels. All patients underwent splenic scintigraphy with technetium 99m sulfur colloid. Groups I and III did not present abnormal blood bodies, and their hematological and immunological patterns were normal. Group II showed increased numbers of Howell–Jolly bodies and low IgM levels. Splenic scintigraphy indicated the viability and filtering function of the splenic remnant in group I. Autotransplantation is a good option to maintain splenic function when total splenectomy is necessary.

Fadiga óssea: causa de dor em joelhos na osteoartrite

Knee pain is the most frequent symptom in osteoarthritis, a condition that is the leading cause of chronic disability in the elderly and one of the main sources of morbidity attributable to osteoarthritis in general. The causes of knee pain in individuals with osteoarthritis cannot be easily understood, and the knowledge of such causes is critical for determining future specific interventions. Bone attrition represents remodelling of the subchondral bone envelope in osteoarthritis, leading to a consequential change in bone shape and/or bone loss. However, bone attrition is not a feature that can be easily read, since it is hardly detected in the absence of clear defects of cortical bone integrity and because of overlap of bone structures at radiography. Bone attrition is associated not only with knee pain, but also with stiffness and disability. If attrition occurs prior to advanced osteoarthritis, this would suggest that changes in subchondral bone occur concurrently with cartilage loss and that treatments targeting cartilage loss alone are unlikely to be effective. Association with edema-like bone marrow lesions may be observed and constitute predictive factors for subchondral bone attrition. The present study was aimed at reviewing the literature, demonstrating the relevance of bone attrition and explaining how to diagnose this entity on imaging studies.

Avaliação da tomografia de alta resolução versus radiografia de tórax na doença intersticial pulmonar na esclerose sistêmica

OBJECTIVE: To compare the accuracy of high-resolution computed tomography (HRCT) with chest radiography in the diagnosis of interstitial lung disease in systemic sclerosis (SSc). MATERIALS AND METHODS: HRCT scans and chest radiographs in postero-anterior and lateral views were performed in 34 patients with systemic sclerosis, according to the American College of Rheumatology preliminary criteria for the diagnosis of SSc. The prevalence of radiological findings suggestive of interstitial lung disease in SSc seen on both imaging methods was compared. RESULTS: Interstitial disease was observed on HRCT images of 31 patients (91%) and in the chest radiographs of 16 patients (47%). The most frequent findings observed on HRCT were septal lines (74%), honeycombing (56%) and parenchymal bands (26%). Chest radiographs showed reticular areas of attenuation in 11 patients (32%) and parenchymal distortion in 12% of the patients. In 18 patients (53%) with normal chest radiographs HRCT showed septal lines in 55%, ground glass in 44%, honeycombing in 38.5% and cysts in 33%. CONCLUSION: HRCT is more sensitive than chest radiography in the evaluation of incipient interstitial lung involvement in patients with SSc and can provide a justification for immunosuppressive therapy in patients with early disease.

Apresentação da técnica de estudo do tempo de esvaziamento gástrico por meio da ultra-sonografia

OBJECTIVE: To describe a technique for measuring gastric emptying in children. MATERIALS AND METHODS: Gastric emptying time was measured in 14 healthy volunteer children aged between 2 to 11. The children were asked to drink modified milk in proportion of 200 ml/m² of body surface. The antral area was measured before the injection of contrast media and at 60, 90, 120 and 150 minutes after the injection. RESULTS: The diet was well tolerated by most patients. In the majority (85%) of the children total gastric emptying occurred 150 minutes after the ingestion of the solution. CONCLUSION: Ultrasound is a safe and low cost alternative for the assessment of gastric emptying.

Evidências de hiperfluxo portal no pós-operatório de transplantes hepáticos

OBJECTIVE: A marked impact on the splanchnic circulation is seen in liver cirrhosis. Doppler ultrasonography (DUS) was performed in a group of patients with end-stage liver cirrhosis before, during and after orthotopic liver transplantation (OLT) in order to investigate the hemodynamic changes in portal vein flow velocity. MATERIALS AND METHODS: Fifty-four patients submitted to OLT and intraoperative DUS were prospectively studied from January 2002 to July 2003. Seventeen patients were excluded because of missing data due to either technical difficulties to obtain the measurements or early patient death. All 37 patients included in the analysis had liver cirrhosis mainly associated with hepatitis C virus infection and alcoholic disease. Patients were submitted to DUS just before OLT, intraoperatively after graft reperfusion, and in the postoperative period (1st and 7th postoperative days). Mean flow velocity was measured at main, right and left portal veins. Statistical analysis was performed using paired t test. Differences were significant when p < 0.05. RESULTS: The mean pre-OLT velocity in the portal vein was 16.0 cm/s. Intraoperative measurements obtained few minutes after graft reperfusion showed an increase in portal vein velocity to 84.09 cm/s. Portal flow velocity was 71.0 cm/s and 58.5 cm/s in the 1st and 7th postoperative days, respectively. Intraoperative and postoperative mean flow velocity in the portal vein was significantly higher than in pre-OLT period (p < 0.001). On the 7th postoperative day, the mean flow velocity in the portal vein decreased significantly compared to intraoperative values (p < 0.05). CONCLUSION: In liver transplantation, there is a significantly increase in mean flow velocity in the portal vein immediately after graft reperfusion when compared to pre-OLT data. Likewise, after this initial peak flow there is a significant and progressive decrease in mean flow velocity in the portal vein, which tends to normalize on the 7th postoperative day.

Avaliação dos métodos de imagem no diagnóstico da urolitíase: revisão da literatura

O objetivo deste trabalho foi comparar a tomografia computadorizada helicoidal com os metodos imaginologicos atualmente disponiveis para a abordagem dos pacientes com dor lombar aguda e revisar brevemente as caracteristicas fisiopatologicas da urolitiase e a evolucao da sua abordagem diagnostica. Foi revista a literatura publicada nos ultimos 30 anos, comparando os seguintes metodos: radiografia simples de abdome, urografia excretora, ultra-sonografia e tomografia computadorizada helicoidal. Esta ultima se mostrou metodo de alta sensibilidade e especificidade para o diagnostico de urolitiase, sendo que, virtualmente, todos os calculos sao identificados por este metodo, exceto em pacientes em uso de indinavir. A radiografia simples de abdome associada a ultra-sonografia tem acuracia semelhante a tomografia computadorizada helicoidal, contudo, esta foi superior como metodo de avaliacao isolado. A literatura sugere que a tomografia computadorizada helicoidal e util na avaliacao de pacientes com dor lombar aguda quando disponivel, possibilitando tambem o diagnostico diferencial entre as varias doencas que simulam os sintomas de urolitiase.

Echocardiographic parameters associated with pulmonary congestion in Chagas cardiomyopathy

INTRODUCTION Discrepancy between the intensity of pulmonary congestion and the grade of cardiomegaly seems to be a common finding of Chagas cardiomyopathy, in spite of significant systolic dysfunction of the left ventricle. Its mechanism has not been established. The aim of this study was to investigate pulmonary congestion and to analyze if it correlated with Doppler echocardiographic parameters in patients with Chagas dilated cardiomyopathy. METHODS Fifty-five patients with positive serology tests for Trypanosoma cruzi and Chagas dilated cardiomyopathy were studied. Chest x-rays, Doppler echocardiogram and plasmatic brain natriuretic peptide levels were obtained in all patients. The degree of pulmonary venous vessels changes on chest x-ray was graded using a pulmonary congestion score, and then compared to Doppler echocardiographic parameters. RESULTS Mean age was 48.5 +/- 11.2 years and 29% were women. The majority (95%) of patients were in NYHA functional class I and II. Mild pulmonary congestion by chest x-ray was found in 80% of the patients. In a multivariate analysis, left ventricular ejection fraction, right ventricular TEI index and the color M-mode velocity correlated with the degree of pulmonary congestion. CONCLUSIONS Pulmonary venous changes on chest x-rays are frequent, but usually mild in patients with Chagas dilated cardiomyopathy. The degree of pulmonary congestion correlates with Doppler echocardiographic left and right ventricular dysfunction and with color M-mode velocity.

Pulmão em ferradura: relato de caso

The authors report a case of a newborn term infant with horseshoe lung associated with supracardiac total anomalous pulmonary venous drainage; such association remains unreported in the Western literature.

Anti-CCP antibodies are not a marker of severity in established rheumatoid arthritis: a magnetic resonance imaging study.

INTRODUCTION The presence of anti-CCP is an important prognostic tool of rheumatoid arthritis (RA). But research is still ongoing on its relationship with disease activity and functional capacity. OBJECTIVES To study the relationship between anti-CCP and disease activity, functional capacity and structural damage indexes, by means of conventional radiography (CR) and magnetic resonance imaging (MRI), in cases of established RA. METHODS Cross-sectional study with RA patients with 1-10 disease duration. Participants underwent clinical evaluation with anti-CCP. Disease activity was assessed using the Clinical Disease Activity Index (CDAI), and functional capacity through the Health Assessment Questionnaire (HAQ). CR analysis was carried out by the Sharp van der Heijde index (SvdH), and MRI analysis by RAMRIS (Rheumatoid Arthritis Magnetic Resonance Image Scoring). RESULTS We evaluated 56 patients, with a median (IqR) age of 55 (47.5-60) years; 50 (89.3%) participants were female and 37 (66.1%) were positive for anti-CCP. Medians (IqR) of CDAI, HAQ, SvdH and RAMRIS were 14.75 (5.42-24.97) 1.06 (0.28-1.75), 2 (0-8) and 15 (7-35), respectively. There was no association between anti-CCP and CDAI, HAQ and SvdH and RAMRIS scores. CONCLUSION Our results have not established an association of anti-CCP with the severity of disease. To date, we cannot corroborate anti-CCP as a prognostic tool in patients with established RA.

Effects of chronic consumption of green tea on weight and body fat distribution of Wistar rats evaluated by computed tomography

Purpose: To evaluate the effects of chronic consumption of green tea on body weight and distribution of visceral fat by Computed tomography in female Wistar rats. Methods: Wistar rats were divided into control group (n = 5), which received water and feed ad libitum, and green tea group (n = 8), in which water has been replaced by green tea. The animals were weighed weekly and Computed Tomography was used at the beginning (1st week) and end (18th week) of the experiment for evaluating the distribution of visceral fat. The animals were followed for 18 weeks. Results: There was no significant difference in body weight between the groups. However, there was significant difference in visceral fat area. The green tea group had less visceral fat area at the end of the experiment, 3.67 ± 1.2 cm2, while the control group showed an area of 6.25 ± 2.2 cm (p = 0.00). Conclusions: Chronic consumption of green tea leads to decreased visceral adipose tissue area.