Magnificación en la terapia endodóncica mediante el microscopio operatorio / Magnification in endodontic therapy through the operatory microscope

La microendodoncia involucra la visualización a través de un microscopio operatorio de todas las fases del tratamiento de conductos y procedimientos de cirugía apical y correctiva por parte del endodoncista. Existe sobrada evidencia acerca de las mejoras que puede aportar la magnificación al tratamiento; la literatura demuestra que la capacidad del operador mejora si su visión del campo gana claridad y precisión, ambos recursos pueden ser proporcionados por el microscopio operatorio, aunado a que posibilita diagnósticos más certeros junto con mejoras en el pronóstico, lo que permite evitar posibles complicaciones. La calidad de los tratamientos endodóncicos involucra infinidad de factores, cada uno relevante en sí mismo pero, en determinados casos, el microscopio puede significar la diferencia entre un tratamiento exitoso o un fracaso clínico. En la actualidad, se ha convertido en un tema de lo más relevante, por lo que el objetivo del presente trabajo es revisar la literatura con el fin de ayudar al entendimiento basado en evidencia científica de los criterios que determinan la relevancia del uso del microscopio en el ámbito endodóncico (AU)

Microendodontics involves the visualization through an operating microscope of all phases of root canal treatment and apical and corrective surgery procedures by the endodontist. There is plenty of evidence about the improvements that magnification can provide, the literature shows that the operator's ability improves if his vision of the field gains clarity and precision, both resources can be provided by the operating microscope, added to the fact that it enables more accurate diagnoses together with improvements in the prognosis allowing to avoid possible complications. The quality of endodontic treatments involves countless factors, each relevant in itself, but in certain cases the microscope can mean the difference between a successful treatment or a clinical failure. At present, it has become a very relevant topic, so the objective of this work is to review the literature in order to help understand the criteria that determine the relevance of the use of the microscope in the endodontic field based on scientific evidence (AU)

Serum iron and vitamin B 12 deficiency could indicate celiac disease by flexible spectral imaging color enhancement

SUMMARY INTRODUCTION Celiac disease (CeD) is an autoimmune disease that can be delayed in diagnosis due to the presence of atypical and asymptomatic cases in adulthood. Herein we aimed to study the frequency of CeD and evaluate whether magnified endoscopy and magnified/FICE (flexible spectral imaging color enhancement) techniques contribute to the diagnosis in patients with serum iron and vitamin B12 deficiency. METHODS We evaluated 50 adult patients (10 males and 40 females) who had serum iron and vitamin B12 deficiency, prospectively. All the patients had undergone upper gastrointestinal system endoscopy by the same endoscopist. The second part of the duodenum was evaluated with white light, magnified, and magnified/FICE endoscopy. Biopsy specimens were evaluated by the same pathologist. The specimens diagnosed as CeD were classified according to the Modified Marsh-Oberhuber criteria. RESULTS 10 of 50 patients (20%) were diagnosed as CeD. The average age was 41±11 years (20-67 years). Thirty percent of CeD diagnosed patients had typical CeD symptoms. Six of 10 patients (60%) who were diagnosed as CeD had typical endoscopic images under white lighted endoscopy. All of these 10 patients (100%) showed villous irregularity, partial villous atrophy, or total villous atrophy consistent with CeD with magnified and magnified/FICE endoscopy. CONCLUSION The practical use of magnified/FICE endoscopy allows us to differentiate mucosal abnormalities of the duodenum and minimize false-negative results that indicate normal mucosal findings with conventional endoscopy.

RESUMO INTRODUÇÃO A doença celíaca (DC) é uma doença autoimune que pode ter seu diagnóstico atrasado devido à presença de casos atípicos e assintomáticos na idade adulta. Neste trabalho, objetivamos estudar a frequência de DC e avaliar se as técnicas de endoscopia magnificada e magnificada/Fice (flexible spectral imaging color enhancement) contribuem para o diagnóstico em pacientes com deficiência sérica de ferro e vitamina B12. MÉTODO Foram avaliados prospectivamente 50 pacientes adultos (10 homens e 40 mulheres) com deficiência sérica de ferro e vitamina B12. Todos os pacientes foram submetidos a endoscopia digestiva alta pelo mesmo endoscopista. A segunda parte do duodeno foi avaliada com endoscopia com luz branca, magnificada e magnificada/Fice. As amostras de biópsia foram avaliadas pelo mesmo patologista. Os espécimes diagnosticados como DC foram classificados de acordo com os critérios de Marsh-Oberhuber modificado. RESULTADOS Dez dos 50 pacientes (% 20) foram diagnosticados como DC. A idade média foi de 41±11 anos (20-67 anos). Trinta por cento dos pacientes diagnosticados com DC apresentaram sintomas típicos de DC. Seis dos dez pacientes (60%) diagnosticados com DC tinham imagens endoscópicas típicas sob endoscopia de luz branca. Todos esses dez pacientes (% 100) apresentaram irregularidade das vilosidades, atrofia das vilosidades parciais ou atrofia das vilosidades totais consistentes com a DC com endoscopia magnificada e magnificada/Fice. CONCLUSÃO O uso prático da endoscopia magnificada/Fice permite diferenciar anormalidades mucosas do duodeno e minimizar os resultados falso-negativos que apresentam achados mucosais normais com a endoscopia convencional.

7. 0T ultrahigh-field MRI directly visualized the pedunculopontine nucleus in Parkinson's disease patients

OBJECTIVES: The pedunculopontine nucleus (PPN) is considered a promising new target for neurostimulation in Parkinson's disease (PD) patients with postural instability and gait disturbance that is refractory to other treatment modalities. However, the PPN is typically difficult to visualize with magnetic resonance imaging (MRI) at clinical field strengths, which greatly limits the PPN as a viable surgical target for deep brain stimulation (DBS). Thus, the aim of this study is to directly visualize the PPN based on 7.0T ultrahigh-field MRI. METHODS: Five PD patients were enrolled and scanned using the MP2RAGE sequence on a 7.0T ultrahigh-field MRI scanner. Then, the MP2RAGE sequences were imported into a commercially available navigation system. The coordinates of the directly localized PPN poles were recorded in the navigation system relative to the anterior commissure-posterior commissure plane. RESULTS: Our results indicated that the PPN presented intermediate signal intensity in the 7.0T ultrahigh-field MR images in comparison with the surrounding structure, such as the hypo-intensity of the periaqueductal gray and the hyperintensity of the neighboring white matter tracts, in PD patients. The mean coordinates for the rostral and caudal poles of PPN were 6.50 mm and 7.20 mm lateral, 1.58 mm and 2.21 mm posterior, and 8.89 mm and 13.83 mm relative to the posterior commissure. CONCLUSION: Our findings provide, for the first time, direct visualization of the PPN using the MP2RAGE sequence on a 7.0T ultrahigh-field MRI, which may improve the accuracy of stereotactic targeting of the PPN and improve the outcomes in patients undergoing DBS.

Recursos actuales en el diagnóstico de caries / Current resources in caries diagnosis

Uno de los grandes problemas en la Odontología y en particular en aquellos asociados con el manejo de la caries dental es la detección y el diagnóstico preciso o acertado de las lesiones de caries, principalmente, de aquellas lesiones más incipientes. Actualmente, así como se ha ido presentando una mayor comprensión y entendimiento del desarrollo de las lesiones de la caries dental, también se han generado nuevas posibilidades de efectuar un mejor manejo de estas lesiones en forma individual y en general, a la disminución del riesgo de caries de cada paciente en forma más particular. Esto ha permitido la creación de lo que se puede considerar como un nuevo paradigma basado en los recursos actuales, no sólo en el diagnóstico de las lesiones de caries sino en especial, al manejo de la caries dental como enfermedad (AU)

One of the great problems in Dentistry and especially in those associated with the management of dental caries is the detection and the precise or accurate diagnosis of the caries lesions, particularly of the most incipient lesions. Actually, to our date, it has been shown a better comprehension and understanding on the development of the dental caries lesions that has generated also, the possibilities to perform a better management of these lesions individually, and in general, to decrease the caries risk in each patient in a particular form. All this has created what can be considered as: a new paradigm based in the current resources not only on the diagnosis of the caries lesions, but specially, on the management of dental caries as a disease (AU)

Localización de la desembocadura del foramen apical en caninos superiores / Location of upper canine apical foramen opening

Objetivo: Evaluar radiográfica y macroscópicamente la desembocadura del foramen apical en caninos superiores. Materiales y métodos: Se seleccionaron 300 caninos superiores recientemente extraídos, siguiendo las normas del Comité de Ética de la Universidad Maimónides. Los dientes fueron conservados en una solución fisiológica y glicerina (ana/ana) hasta el momento de su utilización. Se tomaron radiografías preoperatorias en sentido ortorradial y próximo-proximal. Las aperturas fueron realizadas con piedra redonda de diamante #3, y la preparación de los tercios coronario y medio, con fresas de Gates Glidden #1, 2 y 3. Luego se introdujo una lima K #15 hasta que se constató visualmente su salida por el foramen apical mediante una lupa X6 (Ballon). Después se procedió a la toma radiográfica en sentido vestíbulo-palatino y próximo-proximal. Los criterios de valoración radiográfica fueron: incidencia radiográfica ortorradial: mesial (M), distal (D) y coincidencia (C); incidencia radiográfica próximo-proximal: vestibular (V), palatino (P) y coincidencia (C). Los criterios de valoración macroscópica fueron: vestibulodistal (DV), distopalatino (DP), mesiovestibular (MV), mesiopalatino (MP), mesial (M), palatino (P), vestibular (V), distal (D) y coincidencia (C). La desembocadura de los forámenes fue evaluada macroscópicamente con una lupa estereoscópica (ZTX-F2, Lancet) a 30X. Los datos de las evaluaciones fueron registrados en una planilla de Excel (Microsoft). Para efectuar el análisis estadístico, se empleó la prueba de frecuencia relativa en porcentaje, con intervalo de confianza de 95%. Resultados: Se encontraron diferencias estadísticas (P<0,0001) entre la incidencia radiográfica bucolingual y la vista macroscópica. No se encontraron diferencias estadísticas (P>0,5) entre la incidencia radiográfica mesiodistal y la vista macroscópica. Se encontraron diferencias estadísticas al comparar todas las vistas macroscópicas con todas las coincidencias radiográficas (P<0,0001). Conclusiones: En las condiciones en que se realizó este estudio, la terminación más frecuente del foramen apical en una incidencia radiográfica ortorradial fue hacia distal (43%), y en una vista próximo-proximal, hacia vestibular (47%). Macroscópicamente, la desembocadura más frecuente del foramen apical fue hacia distovestivular (27,7%), seguida de una coincidencia con el ápice anatómico (25,3%) (AU)

Aim: To evaluate the localization of the opening of the apical foramen of maxillary canines. Materials and methods: 300 recently extracted maxillary canines were selected and stored in a/a saline solution/glicerine. The teeth were radiographed in two directions: mesiodistal and buccolingual directions. The access cavity was prepared with a diamond round bur 3, and Gates Glidden burs 1, 2 and 3 were used to shape the coronal and middle third of the root canal. A K-file 15 was introduced in the root canal until its tip was seen at the opening of the apical foramen. Then, buccolingual and mesiodistal radiographs were taken. The evaluation followed these radiographic criteria: Buccolingual direction: mesial (M), distal (D), and coincidence (C). Mesiodistal direction: buccal (V), lingual (P), and coincidence (C). The macroscopic criteria: distobuccal (DV), distolingual (DP), mesiobuccal (MV), mesiolingual (MP), mesial (M), lingual (P), buccal (V), distal (D) and coincidence (C). The openings of the apical foramen were macroscopically evaluated using magnification (30X). Data were statistically analyzed using the relative frequency tests and 95% confidence intervals. Results: Statistical differences were found (P<0.0001) ortobetween buccolingual incidence and macroscopic view. No statistical differences were found (P>0.05) between mesiodistal and macroscopic view. Statistical differences were found comparing all macroscopic views with all radiographic coincidences (P<0.0001). Conclusions: The most frequent localization of the opening of the apical foramen was distal in a buccolingual radiographic direction (43%), and buccal in a mesiodistal view (47%). Macroscopically, the most frequent localization of the opening of the apical foramen was distobuccal (27.7%), followed by coincidence with the anatomic apex (25.3%) (AU)

Rendimiento de la mamografía espectral de energía dual con contraste en la detección de cáncer de mama: experiencia en un centro de referencia / Contrast-enhanced spectral mammography: experience in 465 examinations

Background: Contrast-enhanced spectral mammography or "contrast mammography" has a better cost effectiveness than breast magnetic resonance for confirmation of suspicious lesions detected on breast screening programs. Aim: To report the experience of a single center in Santiago. Material and Methods: All patients referred for contrast mammography between July 2015 and October 2017 were studied. We recorded the patient risk factors for breast cancer. In 85 patients with suspicious lesions, biopsy results were available. Results: We analyzed 465 contrast mammographies. The most common clinical indications were suspicion of cancer and previous inconclusive studies. Mass type lesions were detected in 33% of the studies. Non-mass-type lesions were observed in 10% of cases and findings compatible with papillomatosis in 2%. Fifty five percent of the studies had no visible lesions. In the 85 patients with a pathological study of the biopsy, the sensitivity of the contrast mammography was 100%, with a diagnostic accuracy of 85%, positive and negative predictive values of 82 and 100% respectively. Conclusions: Contrast mammography can be of great use for the assessment of patients with an altered conventional mammography, before indicating a magnetic resonance imaging or a percutaneous biopsy.

Repeatability of the "flash-replenishment" method in contrast-enhanced ultrasound for the quantitative assessment of hepatic microvascular perfusion

This study aimed to evaluate the feasibility and repeatability of the flash-replenishment method in contrast-enhanced ultrasound (CEUS) perfusion imaging and assess quantitatively microvascular perfusion in the liver. Twenty healthy New Zealand rabbits were submitted to CEUS perfusion imaging with continuous intravenous infusion. Using flash-replenishment kinetics, the dynamic process of depletion and refilling of microbubble contrast agent was recorded. The hepatic microvascular perfusion parameters were calculated, including region of interest, peak intensity (PI), area under the curve (AUC), and hepatic artery to vein transit time (HA-HVTT). A consistency test was performed for multiple measurements by the same operator and blind measurements by two different operators. The hepatic perfusion imaging of 3×108 bubbles/min had minimal error and the best imaging effect and repeatability. The variability of the perfusion parameter measured at 3 cm depth under the liver capsule was at a minimum with coefficient of variation of 3.9%. The interclass correlation coefficient (ICC) of measurements taken by the same operator was 0.985, (95% confidence interval, CI=0.927-0.998). Measurements taken by two operators had good consistency and reliability, with the ICC of 0.948 (95%CI=0.853-0.982). The PI and AUC of liver parenchyma after reperfusion were lower than before blocking; and HA-HVTT was significantly longer than before blocking (P<0.05). The flash-replenishment method in CEUS perfusion imaging showed good stability and repeatability, which provide a valuable experimental basis for the quantitative assessment of hepatic microvascular perfusion in clinical practice.

Ductal carcinoma in situ of the breast: Evaluation of main presentations on magnetic resonance imaging compared with findings on mammogram and histology / Carcinoma ductal in situ mamário: avaliação das principais apresentações à ressonância magnética em correlação com os achados da mamografia e histologia

SUMMARY Objective: The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS. Method: A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI. Results: The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases. Conclusion: DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.

RESUMO Objetivo: avaliar as várias morfologias e características cinéticas do carcinoma ductal in situ (CDIS) ao exame de ressonância magnética (RM) de mama, estabelecer as mais prevalentes e determinar a eficácia do método na detecção do CDIS. Método: estudo prospectivo e observacional, com início em 2011 e duração de 24 meses. Foram avaliadas 25 pacientes consecutivas que apresentaram microcalcificações suspeitas ou altamente suspeitas ao exame mamográfico de rastreamento, categorias 4 e 5 de BI-RADS, que realizaram RM mamária e, posteriormente, foram submetidas à cirurgia com resultado comprovado de CDIS puro. A cirurgia foi considerada padrão-ouro para correlação entre os resultados histológicos e os achados radiológicos obtidos à RM. Resultados: a característica morfológica do CDIS mais frequente à RM foi o realce não nodular (p<0,001), observada em 22/25 (88%) casos (IC 95% 72,5-100). Dentre estes, a distribuição segmentar foi a mais prevalente, representada por 9/22 (40,91%) casos (IC 95% 17,4-64,4), p=0,306, e o realce interno tipo clumped foi o padrão mais frequentemente caracterizado no CDIS, observado em 13/22 (50,09%) casos. Conclusão: o CDIS tem uma grande variedade de características imaginológicas à RM e é fundamental reconhecê-las. A apresentação morfológica mais comum é o realce não nodular, sendo a distribuição segmentar e o padrão interno de realce tipo clumped as apresentações mais frequentes. Diante da análise combinada desses achados, a biópsia percutânea por agulha grossa (core biopsy) ou assistida a vácuo (mamotomia) deve ser encorajada.

Cardiac Magnetic Resonance and Computed Tomography in Hypertrophic Cardiomyopathy: an Update / Ressonância Magnética e Tomografia Computadorizada Cardíaca na Cardiomiopatia Hipertrófica: Atualidades

Abstract Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease and represents the main cause of sudden death in young patients. Cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are noninvasive imaging methods with high sensitivity and specificity, useful for the establishment of diagnosis and prognosis of HCM, and for the screening of patients with subclinical phenotypes. The improvement of image analysis by CMR and CCT offers the potential to promote interventions aiming at stopping the natural course of the disease. This study aims to describe the role of RCM and CCT in the diagnosis and prognosis of HCM, and how these methods can be used in the management of these patients.

Resumo A cardiomiopatia hipertrófica (CMH) é a doença genética cardiovascular mais comum e representa a principal causa de morte súbita em pacientes jovens. A Ressonância Magnética Cardíaca (RMC) e a Tomografia Computadorizada Cardíaca (TCC) são métodos de imagem não invasivos de alta sensibilidade e especificidade, úteis no diagnóstico e no estabelecimento do prognóstico de CMH, e no rastreamento de indivíduos com fenótipos subclínicos. O aperfeiçoamento da análise da RMC e TCC tem grande potencial para promover intervenções com o objetivo de impedir o curso natural da doença. O presente estudo tem por objetivo descrever o papel da RMC e TCC no diagnóstico e prognóstico da CMH, e como essas ferramentas podem auxiliar no manejo clínico de pacientes portadores dessa doença.

Enhanced depth imaging optical coherence tomography of choroidal osteoma with secondary neovascular membranes: report of two cases / Tomografia de coerência óptica com imagem profunda aprimorada de osteoma de coroide com membrana neovascular secundária: relato de 2 casos

ABSTRACT We report enhanced depth imaging optical coherence tomography (EDI-OCT) features based on clinical and imaging data from two newly diagnosed cases of choroidal osteoma presenting with recent visual loss secondary to choroidal neovascular membranes. The features described in the two cases, compression of the choriocapillaris and disorganization of the medium and large vessel layers, are consistent with those of previous reports. We noticed a sponge-like pattern previously reported, but it was subtle. Both lesions had multiple intralesional layers and a typical intrinsic transparency with visibility of the sclerochoroidal junction.

RESUMO Relatamos as características na tomografia computadorizada óptica (EDI-OCT) de 2 pacientes recém diagnosticados com osteoma de coroide apresentando perda visual secundária à membranas neovasculares coroideanas. As características descritas em nossos 2 casos foram consistentes com trabalhos anteriores, exibindo a compressão da coriocapilar e desorganização das camadas médias e de grandes vasos. Notamos também o padrão em esponja anteriormente descrito, porém de forma discreta. Ambas as lesões tinham várias camadas intralesionais e uma transparência intrínseca típica com visibilidade da junção da esclero-coroideana.

Acute respiratory distress syndrome due to Clostridium difficile colitis: a case report and review of the literature / Síndrome de distress respiratorio agudo debido a colitis por Clostridium difficile: reporte de caso y revisión de la literatura

Clostridium difficile is a major cause of antibiotic-associated diarrhea. We report a patient with complicated Clostridium difficile infection (CDI) who developed rapidly progressive acute respiratory distress syndrome (ARDS), for which CDI was the only identifiable source. CDI should be considered in the differential diagnosis for anyone with diarrhea who presents ARDS, especially in high-risk groups such as the elderly, hospitalized patients, or those who have had a history of CDI.

El Clostridium difficile es una de las causas más frecuentes de diarreas asociadas a antibióticos. Reportamos un paciente con infección por Clostridium difficile complicada (CDI) que desarrolló rápida y progresivamente un síndrome de distress respiratorio agudo (ARDS), del cual el CDI fue la fuente única identificable. El CDI debe considerarse en el diagnóstico diferencial de cualquier persona con diarrea que presenta ARDS, especialmente en los grupos de alto riesgo como los ancianos, pacientes hospitalizados o aquellos que han tenido historia precia de DCI.

Liver-specific magnetic resonance contrast medium in the evaluation of chronic liver disease / Aplicações do contraste hepato-específico de ressonância magnética nas hepatopatias crônicas

ABSTRACT The hepatobiliary-specific contrast medium (gadoxetic acid – Primovist®) is primarily used to improve detection and characterization of focal hepatic lesions, such as in chronic liver disease patients with suspected hepatocellular carcinoma. Since the contrast medium is selectively taken up by functioning hepatocytes in the late hepatobiliary phase, it helps to detect typical hepatocellular carcinoma, which show low signal intensity on this phase. This imaging feature also assists in differentiating regenerative/dysplastic nodules from early hepatocellular carcinomas (with over 90% accuracy), as well as hypervascular hepatocellular carcinomas from arterial pseudo-enhancement foci. Future perspectives include its use in quantification of hepatic function and fibrosis.

RESUMO O contraste hepato-específico (ácido gadoxético – Primovist®) tem como utilidade principal melhorar a detecção e a caracterização de lesões hepáticas focais, por exemplo, em hepatopatas crônicos com suspeita de hepatocarcinoma. Por apresentar captação seletiva por hepatócitos funcionantes na fase hepatobiliar tardia, auxilia na detecção de hepatocarcinomas típicos – a maioria dos quais apresentando hipossinal nessa fase. Essa característica de imagem também auxilia na diferenciação entre nódulos regenerativos/ displásicos e hepatocarcinomas precoces (com mais de 90% de acurácia), e entre hepatocarcinomas hipervascularizados e focos de pseudorrealce arterial. Perspectivas futuras promissoras incluem sua utilização na quantificação de função e de fibrose hepáticas.

Heart rate turbulence analysis in female patients with fibromyalgia

OBJECTIVE: Fibromyalgia is characterized by diffuse musculoskeletal pain and discomfort. There are several reports regarding autonomic nervous system dysfunction in patients with fibromyalgia. Heart rate turbulence is expressed as ventriculophasic sinus arrhythmia and has been considered to reflect cardiac autonomic activity. Heart rate turbulence has been shown to be an independent and powerful predictor of sudden cardiac death in various cardiac abnormalities. The aim of this study is to determine whether heart rate turbulence is changed in female patients with fibromyalgia compared with healthy controls. METHODS: Thirty-seven female patients (mean age, 40±11 years) with fibromyalgia, and 35 age- and sex-matched healthy female control subjects (mean age, 42±9 years) were included. Twenty-four hours of ambulatory electrocardiography recordings were collected for all subjects, and turbulence onset and turbulence slope values were automatically calculated. RESULTS: The baseline clinical characteristics of the two groups were similar. There were no significant differences in turbulence onset and turbulence slope measures between patients and control subjects (turbulence onset: −1.648±1.568% vs. −1.582±1.436%, p ϝ 0.853; turbulence slope: 12.933±5.693 ms/RR vs. 13.639±2.505 ms/RR, p ϝ 0.508). Although body mass index was negatively correlated with turbulence slope (r ϝ −0.258, p ϝ 0.046), no significant correlation was found between body mass index and turbulence onset (r ϝ 0.228, p ϝ 0.054). CONCLUSION: To the best of our knowledge, this is the first study to evaluate heart rate turbulence in patients with fibromyalgia. It appears that heart rate turbulence parameters reflecting cardiac autonomic activity are not changed in female patients with fibromyalgia. .

Prevention of peritoneal adhesion using a bacterial cellulose hydrogel, in experimental study

PURPOSE: To analyze the effectiveness of bacterial cellulose hydrogel as a barrier in preventing postoperative peritoneal adhesion in rat model. METHODS: Experimental study with 45 Wistar rats (Rattus norvegicus) that were divided into three groups for the following treatments: A. Saline, B. Oxidized Regenerated Cellulose (ORC) barrier, and C Bacterial Cellulose Hydrogel (BCH) barrier. After 45 days of the surgery the adhesions were classified and graded according to the qualitative score. The histological parameters were evaluated using a modified semi-quantitative scale to rate the extent of fibrosis, inflammatory reaction and vascular proliferation. RESULTS: Compared with the saline group (A), the treatments with ORC barrier (B) and BHC barrier (C) resulted in a smaller number of adhesions (p=0.019 and p=0.003 on Fisher's exact test, respectively). Data from inflammation and neovascularization showed no statistically significant difference between the groups BHC and ORC (p=0.426 and 0.446 on chi-square test, respectively). CONCLUSION: Bacterial cellulose hydrogel is effective as a bio-re-absorbable barrier for preventing postoperative peritoneal adhesions. .

Imaging of adult leukodystrophies / Imagem nas leucodistrofias do adulto

Leukodystrophies are genetically determined white matter disorders. Even though leukodystrophies essentially affect children in early infancy and childhood, these disorders may affect adults. In adults, leukodystrophies may present a distinct clinical and imaging presentation other than those found in childhood. Clinical awareness of late-onset leukodystrophies should be increased as new therapies emerge. MRI is a useful tool to evaluate white matter disorders and some characteristics findings can help the diagnosis of leukodystrophies. This review article briefly describes the imaging characteristics of the most common adult leukodystrophies.

Leucodistrofias são doenças geneticamente determinadas. Apesar das leucodistrofias afetarem principalmente crianças lactentes e infantes, estas doenças podem acometer a faixa etária adulta. Nos adultos, as leucodistrofias podem ter uma apresentação clínica e de imagem distinta daquela da infância. Um aumento na suspeita clínica de leucodistrofias com início tardio deve ocorrer associado ao aparecimento de novas alternativas terapêuticas. Este artigo de revisão descreve sumariamente as características de imagem nas leucodistrofias no adulto.

Avaliação de realce tardio pela tomografia computadorizada em pacientes chagásicos crônicos com disfunção ventricular / Delayed enhanced computed tomography in chronic chagasic patients with ventricular dysfunction

A Doença de Chagas é uma infecção parasitária causada pelo Trypanosoma cruzi1, transmitida aos humanos principalmente pelas fezes contaminadas de insetos triatomídio. Esta patologia permanece endêmica na América Latina com grande impacto socioeconômico. O envolvimento cardíaco é a principal causa de morte, sendo que a fisiopatologia e a evolução clínica da doença não são completamente compreendidas e a estratificação de risco permanece desafiadora. A presença de disfunção miocárdica associada ou não à doença arterial aterosclerótica vem acompanhada de áreas de fibrose miocárdica e tem se mostrado como importante fator de pior prognóstico. Ressonância Magnética (RM) é um método já consagrado na detecção de fibrose miocárdica pela técnica de realce tardio (RT)...

Enhanced depth imaging optical coherence tomography and fundus autofluorescence findings in bilateral choroidal osteoma: a case report / Tomografia de coerência óptica com profundidade de imagem aprimorada e resultados autofluorescência de fundo em osteoma de coroide bilateral: relato de caso

The authors present enhanced depth imaging optical coherence tomography (EDI OCT) and fundus autofluorescence (FAF) characteristics of a patient with bilateral choroidal osteoma and try to make a correlation between two imaging techniques. Two eyes of a patient with choroidal osteoma underwent complete ophthalmic examination. Enhanced depth imaging optical coherence tomography revealed a cage-like pattern, which corresponded to the calcified region of the tumor. Fundus autofluorescence imaging of the same area showed slight hyperautofluorescence. Three different reflectivity patterns in the decalcified area were defined. In the areas of subretinal fluid, outer segment elongations similar to central serous chorioretinopathy were observed. Hyperautofluorescent spots were evident in fundus autofluorescence in the same area. Calcified and decalcified portions of choroidal osteoma as well as the atrophy of choriocapillaris demonstrated different patterns with enhanced depth imaging and fundus autofluorescence imaging. Both techniques were found to be beneficial in the diagnosis and follow-up of choroidal osteoma.

Os autores apresentam tomografia de coerência óptica com profundidade de imagem aprimorada (EDI OCT) e autofluorescência de fundo (FAF) características de um paciente com osteoma de coroide bilateral e tentam correlacionar as duas técnicas de imagem. Dois olhos de um paciente com osteoma de coroide foram submetidos a exame oftalmológico completo. Tomografia de coerência óptica com profundidade de imagem aprimorada revelou padrão em gaiola, correspondente à região de calcificação do tumor. Imagens de autofluorescência de fundo da mesma área mostraram ligeira autofluorescência positiva. Três padrões de refletividade diferentes foram definidos na área descalcificada. Nas áreas com fluido sub-retiniano, foram observados prolongamentos dos segmentos externos semelhantes aos da coroidorretinopatia serosa central. Manchas autofluorescentes positivas foram evidentes em autofluorescência de fundo na mesma área. Porções calcificadas e descalcificadas do osteoma de coroide, bem como a atrofia da camada coriocapilar, demonstraram diferentes padrões de tomografia de coerência óptica com profundidade de imagem aprimorada e de imagens de autofluorescência de fundo. Ambas as técnicas se mostraram úteis no diagnóstico e acompanhamento de osteoma de coroide.

Etapa maculotópica: una propuesta sobre el inicio de la señalización visual según nuestra teoría sobre la visión / Maculotopic stage: one proposal on the start of the visual signpost according to our theory on the vision

Estamos considerando que a nivel de la mácula, región de la retina de máxima agudeza visual por su alta densidad de conos, debe conformarse una representación o mapa maculotópico de aquella imagen del mundo exterior donde fijamos nuestra atención. La estimulación fotónica reflectante del mundo exterior excitaría a los conos de la mácula, y la distribución topográfica de estos conos absorbentes de luz o excitados, coincidiría exactamente con la topografía de la imagen exterior excitante. Uno o más fotorreceptores excitados conformarían un componente de la imagen o de información visual. La sumatoria de estos componentes de información visual conformaría la imagen total

We are considering that the level of the macula, the retinal region of maximum visual acuity due to its high density of cones, must conform maculotopic representation or map of that image of the outside world where we focus our attention. Reflecting photonic stimulation from the outside world excite the cones in the macula, and the topographic distribution of these linght- absorbing cones or excited, coindice exictly with the topography of the exciting exterior image. One or more photorececeptors excited would form a component of the image or visual information. The sum of these componets of visual information would form the total picture

Realce Tardio miocárdico por Ressonância Magnética Cardíaca pode identificar risco para Taquicardia Ventricular na Cardiopatia Chagásica Crônica / Delayed enhancement cardiac magnetic resonance Imaging can identify the risk for ventricular tachycardia in chronic Chagas' heart disease

FUNDAMENTO: Testes invasivos e não invasivos têm sido usados para identificar risco para Taquicardia Ventricular (TV) em pacientes com Cardiopatia Chagásica Crônica (CCC). Ressonância Magnética Cardíaca (RMC) pela técnica do Realce Tardio (RT) pode ser útil para selecionar pacientes com disfunção ventricular global ou segmentar, com alto grau de fibrose e maior risco para TV clínica. OBJETIVO: Melhorar a identificação de elementos preditivos de TV em pacientes com CCC. MÉTODO: Quarenta e um pacientes com CCC foram pesquisados, sendo 30 (72%) do sexo masculino, com média de idade de 55,1 ± 11,9 anos. Vinte e seis pacientes apresentavam histórico de TV (grupo TV), e 15 não apresentavam TV (grupo NTV). Todos os pacientes incluídos tinham RT e disfunção segmentar ventricular. Volume, porcentagem de comprometimento da espessura da parede ventricular em cada segmento, e distribuição de RT foi determinado em cada caso. RESULTADOS: Não houve diferença estatística em termos de volume de RT entre os dois grupos: grupo TV = 30,0 ± 16,2%; grupo NTV = 21,7 ± 15,7%; p = 0,118. A probabilidade de TV foi maior se duas ou mais áreas contíguas de fibrose transmural estivessem presentes, sendo um fator preditor de TV clínica (RR 4,1; p = 0,04). A concordância entre os observadores foi de 100% nesse critério (p < 0,001). CONCLUSÃO: A identificação de dois ou mais segmentos de RT transmural por RMC está associado com a ocorrência de TV clínica em pacientes com CCC. Portanto, a RMC melhora a estratificação de risco na população estudada. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: Invasive and non-invasive tests have been used to identify the risk of ventricular tachycardia (VT) in patients with chronic Chagas' heart disease (CCHD). Cardiac magnetic resonance imaging (CMRI) using the delayed enhancement (DE) technique can be useful to select patients with global or segmentary ventricular dysfunction, with high degree of fibrosis and at higher risk for clinical VT. OBJECTIVE: To improve the identification of predictors of VT in patients with CCHD. METHOD: This study assessed 41 patients with CCHD [30 (72%) males; mean age, 55.1 ± 11.9 years]. Twenty-six patients had history of VT (VT group), and 15 had no VT (NVT group). All patients enrolled had DE and segmentary ventricular dysfunction. In each case, the following variables were determined: left ventricular volume; percentage of ventricular wall thickness impairment in each segment; and DE distribution. RESULTS: No statistical difference regarding the DE volume between both groups was observed: VT group = 30.0 ± 16.2%; NVT group = 21.7 ± 15.7%; p = 0.118. The probability of VT was greater in the presence of two or more contiguous transmural fibrosis areas, and that was a predictive factor of clinical VT (RR 4.1; p = 0,04). Agreement between observers was 100% regarding that criterion (p < 0.001). CONCLUSION: The identification of two or more segments of transmural DE by use of CMRI is associated with the occurrence of clinical VT in patients with CCHD. Thus, CMRI improved risk stratification in the population studied. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).