A model to optimize public health care and downstage breast cancer in limited-resource populations in southern Brazil. (Porto Alegre Breast Health Intervention Cohort).

BACKGROUND: Breast cancer (BC) is a major public health problem, with rising incidence in many regions of the globe. Although mortality has recently dropped in developed countries, death rates are still increasing in some developing countries, as seen in Brazil. Among the reasons for this phenomenon are the lack of structured screening programs, a long waiting period between diagnosis and treatment, and lack of access to health services for a large proportion of the Brazilian population. METHODS AND DESIGN: Since 2004, an intervention study in a cohort of women in Southern Brazil, denominated Porto Alegre Breast Health Intervention Cohort, is being conducted in order to test the effectiveness and cost-effectiveness of a model for BC early detection and treatment. In this study, over 4,000 women from underserved communities aged 40 to 69 years are being screened annually with mammography and clinical breast examination performed by a multidisciplinary team, which also involves nutritional counseling and genetic cancer risk assessment. Risk factors for BC development are also being evaluated. Active search of participants by lay community health workers is one of the major features of our program. The accrual of new participants was concluded in 2006 and the study will last for 10 years. The main goal of the study is to demonstrate significant downstaging of BC in an underserved population through proper screening, attaining a higher rate of early-stage BC diagnoses than usually seen in women diagnosed in the Brazilian Public Health System. Preliminary results show a very high BC incidence in this population (117 cases per 100,000 women per year), despite a low prevalence of classical risk factors. DISCUSSION: This study will allow us to test a model of BC early diagnosis and treatment and evaluate its cost-effectiveness in a developing country where the mortality associated with this disease is very high. Also, it might contribute to the evaluation of risk factors in a population with a different ethnic background from that studied in developed countries. If our model is proven effective, it may be replicated in other parts of the globe where BC is also a major public health problem.

Lesões mamárias incomuns: ensaio iconográfico / Unusual breast lesions: iconographic essay

As lesões mamárias incomuns podem representar um desafio diagnóstico. Procuramos demonstrar alguns aspectos radiológicos destes tipos de lesões. Analisamos, retrospectivamente, casos incomuns, com e sem manifestações clínicas. Realizamos mamografia e, em alguns casos, ultra-sonografia, tomografia computadorizada, ressonância magnética e investigação histológica. Os métodos de imagem demonstraram ser úteis na detecção, caracterização e inclusive na elaboração diagnóstica.

Unusual breast lesions may represent a diagnostic challenge. We aimed to show some radiological features of these unusual breast lesions. Uncommon cases of symptomatic and asymptomatic patients with breast lesions were retrospectively analyzed. All patients were submitted to mammography and in some cases ultrasound, computed tomography, magnetic resonance imaging and histological investigation were also performed. Imaging methods proved to be useful in the detection, characterization and diagnosis of these lesions.

Quatro anos de experiência em artrografia de articulaçöes temporomandibulares (ATM) / Four years of experience with temporomandibular joint (TMJ) arthography

O diagnóstico por imagem das disfunçöes da articulaçäo temporomandibular (ATM) tem sido aprimorado com a utilizaçäo de novos métodos como a tomografia computadorizada e a ressonância magnética. Entretanto, os equipamentos usados para a realizaçäo desses exames säo dispendiosos e, além disso, algumas lesöes como a perfuraçäo do menisco näo säo demonstradas pela TC ou pela RM, mas o säo pela artrografia. Neste trabalho, säo apresentados os dados de 386 artrografias realizadas em 193 pacientes. Os resultados obtidos säo compatíveis com os da literatura

Detecção de microbolhas: comparação entre tomografia computadorizada e ultra-sonografia / Detection of micro bubbles: comparison between computed tomography and ultasonography

A detecção de gás e microbolhas é de grande importância na radiologia. No caso dos abcessos, por exemplo, vário autores descreveram que somente quando o gás está presente em uma coleção líquida anormal pode-se realizar esse diagnóstico com bastante segurança. Tanto a tomografia computadorizada (TC) quanto a ultrasonografia (US) podem demonstrar esses achados; mas, qual dos dois métodos é o mais sensível? Não é de nosso conheciemnto nenhum trabalho que responda a esta pergunta de forma direta. Utilizando-se de experimento simples, que consiste em uma luva cheia d'água, que foi submetida a exame tomográfico e ecográfico, antes e dpois de ser vigorosamente agitada, os autores observaram que a US é nitidamente mais sensível que a TC, nesta situação.