CO-RADS: aplicación móvil para la estandarización del informe radiológico en el contexto de la COVID 19 / CO-RADS: Mobile Application for Standardization of the Radiological Report in the Context of COVID 19

El nuevo coronavirus denominado SARS-COV2 causa diversas manifestaciones clínicas englobadas bajo el término COVID-19. El sistema de informe y datos conocidos por sus siglas en inglés como RADS, determinadas a partir del consenso de expertos producido por un grupo de trabajo multidisciplinario con el objetivo de mejorar la comunicación de los resultados, establece un enfoque estándar para la notificación de manifestaciones imagenológicas. El presente trabajo presenta el prototipo de aplicación CO-RADS que propone una herramienta digital sobre la base de una revisión actualizada del papel y la idoneidad de los estudios de imagenología para el diagnóstico y seguimiento de pacientes con sospecha o infección conocida de COVID-19, proporcionando terminología estandarizada de imágenes para lograr comunicar los resultados al médico de asistencia de manera clara y consistente. CO-RADS es una aplicación gratuita que se encuentra disponible en: htttps://www.aplikis.cu/es/application/cu.sld.hlucia.corads(AU)

The new coronavirus called SARS-COV2 causes various clinical manifestations encompassed under the term COVID-19. The data and reporting system known by its acronym in English as RADS, establishes a standard approach for the notification of imaging manifestations with the aim of improving the communication of results; was determined from the consensus of experts produced by a multidisciplinary working group. This paper presents the CO-RADS application prototype that proposes a digital tool based on an updated review of the role and suitability of imaging studies for the diagnosis and follow-up of patients with suspected or known COVID-19 infection, providing standardized imaging terminology to achieve clear and consistent communication of results to the attending physician. CO-RADS is a free application that is available at: htttps://www.aplikis.cu/es/application/cu.sld.hlucia.corads(AU)

Detección de tornillos prominentes en la articulación radiocarpiana mediante la proyección tangencial del escafoides dorsal / Detection of protruding screws in the radiocarpal joint using the "scaphoid skyline view"

INTRODUCCIÓN: Una de las complicaciones de la osteosíntesis retrógrada del escafoides es la protrusión del tornillo en la articulación radiocarpiana, dada la limitada visualización intraoperatoria del polo proximal del escafoides con las proyecciones tradicionales. OBJETIVO: Evaluar la capacidad de una nueva proyección radiológica, la proyección "tangencial del escafoides dorsal", o TED, para identificar tornillos prominentes radiocarpianos durante la osteosíntesis retrógrada del escafoides con tornillos canulados. MATERIALES Y MÉTODOS: Estudio cadavérico en muñecas frescas congeladas. Se introdujo en el escafoides un tornillo canulado con técnica retrógrada estándar. La proyección TED fue evaluada en 5 muñecas, con angulaciones del antebrazo de 15°, 30° y 45° para definir la mejor visualización del polo proximal del escafoides y del tornillo. Se comparó la capacidad para identificar la prominencia del tornillo en el polo proximal de la proyección TED de 30° con 5 proyecciones tradicionales de escafoides en 9 muñecas. El tornillo se posicionó a nivel de la superficie del escafoides, y luego se avanzó a intervalos de 0,5 mm bajo visualización directa por artrotomía dorsal. Tras cada intervalo, se repitieron todas las proyecciones para determinar su capacidad de detectar tornillos prominentes en el escafoides. RESULTADOS: La mejor visualización del polo proximal del escafoides se logró con la proyección TED de 30°. Al comparar la proyección TED de 30° y las tradicionales, con la TED se logró identificar tornillos prominentes a 0,8 mm promedio, seguida por la proyección posteroanterior con cubitalización y extensión a 1.3 mm (p » 0.014), con una alta precisión y correlación interobservador de estas proyecciones. CONCLUSIÓN: La proyección TED demostró ser la más sensible para detectar tornillos prominentes en la articulación radiocarpiana. Su uso rutinario podría evitar complicaciones durante la osteosíntesis.

INTRODUCTION: One of the complications of the retrograde percutaneous scaphoid fixation is the protrusion of the screw in the radiocarpal joint due to the limited intraoperative visualization of the proximal pole of the scaphoid with the traditional radiographic views. OBJETIVE: To evaluate the sensitivity of a novel radiographic view (the skyline scaphoid view, SSV) to detect screws protruding in the radiocarpal joint during the retrograde fixation of the scaphoid. MATERIALS AND METHODS: We studied nine cadaverous fresh frozen wrists. A retrograde cannulated screw was inserted in the scaphoid. To validate the SSV, 5 wrists were studied, comparing 3 forearm angulations (15°, 30° and 45°) to get the best visualization of the proximal pole and screw. We compared the ability to identify the protrusion of the screw in the proximal pole of the 30° SSV with that of 5 standard scaphoid radiographic views in 9 wrists. The screw was positioned at the level of the surface of the scaphoid, and was sequentially protruded in 0.5 mm increments, with direct visualization of its tip through a dorsal capsulotomy. After each increment, all views were repeated to determine if they were able to detect screws projecting from the scaphoid. RESULTS: The best visualization of the proximal pole of the scaphoid was found with the 30° SSV. In the comparison of the 30° SSV and the standard views, with the SSV we were able to identify the protrusion of the screws at an average of 0.8 mm, followed by the posterior-anterior view with ulnar deviation and extension at 1.3 mm (p » 0.014), with high precision and interobserver agreement regarding these views. CONCLUSION: The SSV was the most sensitive view to detect protruding screws in the proximal pole of the scaphoid. Its routine use could avoid complications during osteosynthesis.

Xpektrin, un simulador de espectros fácil de usar y ampliamente distribuible para radiología general / Xpektrin, an easy to use and highly distributable X-Ray spectra simulator in general radiography

Resumen: Se presenta una aplicación basada en Microsoft Excel llamada Xpektrin para el cálculo de dosis en radiología general. La aplicación permite simular espectros de rayos X en radiología general utilizando el modelo TASMICS a partir de mediciones del kerma en aire (Kair) y de la capa Hemirreductora (HVL). Tiene implementado el cálculo de magnitudes radiométricas y dosimétricas, como el kerma en aire en la superficie de entrada (Ke) y la dosis en piel (Dskin), en función de la elección arbitraria de los factores de exposición, el tipo y grosor de filtro, la distancia foco-piel y el tamaño de campo. Xpektrin fue validado con la herramienta computacional SPEKTR 3.0, utilizando mediciones de dosis y de HVL de tubos de rayos X de tres recintos hospitalarios. Se encontró buena correlación en ambas aplicaciones entre las mediciones experimentales y los valores calculados de HVL y con coeficientes de Pearson R² ≥ 0.99 en todos los casos. Sin embargo, se obtuvo mejor concordancia con los valores experimentales de HVL con Xpektrin (mediana de diferencias -0.43%, -0.04% y 0.01%) que con SPEKTR 3.0 (mediana de diferencias -3.31%, 0.10% y -7.85%), en particular para el tubo con mayor filtración. Xpektrin está optimizada para ser utilizada en los departamentos de radiología para la determinación de dosis de pacientes individuales en función de los parámetros utilizados durante la exposición, por lo que puede ser utilizada como parte de un sistema de registro dosimétrico o como apoyo para el establecimiento de niveles de referencia para diagnóstico (NRD), siendo particularmente útil en servicios con equipos sin registros automáticos de dosis. Además, debido a sus características de simulador, puede ser útil como herramienta pedagógica. El uso de Excel permite que sea altamente distribuible y fácil de usar, sin necesidad de conocimientos de programación.

Abstract: Xpektrin, an easy to use and highly distributable X-Ray Spectra Simulator in General Radiography. An application based on Microsoft Excel called Xpektrin is presented for dose calculation in general radiology. The application was developed to simulate X-ray spectra in general radiography using the TASMICS model. Using as inputs air kerma (Kair) and Half-value layer (HVL) measurements, Xpektrin allows the calculation of several radiometric and dosimetric quantities, such as the entrance surface air kerma (Ke) and the skin dose (Dskin), depending on the exposure factors, filter material type, filter thickness, focus-skin distance and field size. Xpektrin was validated against the Matlab toolkit SPEKTR 3.0, using dose and HVL measurements of X-ray tubes from three different hospitals. It was found good correlation in both applications between the experimental measurements and the calculated HVL and Kair values with Pearson coefficients R² ≥ 0.99 in all cases. However, experimental and calculated HVL have better agreement with Xpektrin (median percent difference -0.43%, -0.04% and 0.01%) than SPEKTR 3.0 (median percent difference -3.31%, 0.10% and -7.85%), particularly for the tube with greater filtration thickness. Xpektrin is optimized to be used in radiology departments for patient dose determination depending on the exposure parameters and may be used as part of a dosimetric record system or as a support for the determination of Diagnostic Reference Levels, which may be useful when no automatic dose records are available. In addition, due to its simulator characteristics, it can be useful as a pedagogical tool. Using Excel allows Xpektrin to be highly distributable and easy to use, without the need for programming skills.

An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity

Introduction: approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources.Methods: the equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data.Results: public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure.Conclusion: there exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data

Seguridad y Protección Radiológica en Procedimientos Imagenológicos Dentales / Safety and Radiological Protection in Dental Imaging Procedures

RESUMEN: Los procedimientos de imagenología dental son el tipo más frecuente de estudio radiológico y aportan información esencial para apoyar la evaluación, diagnóstico y tratamiento de patologías y/o alteraciones dentomaxilofaciales. La presente revisión narrativa, muestra los procedimientos de radiología dental, define conceptos asociados a la protección radiológica en éstos y entrega una guía con recomendaciones para mejorar la seguridad y protección radiológica del paciente y del operador, en esta clase de procedimientos imagenológicos. Comprender que bajo el actual sistema de protección radiológica, es el Odontólogo quién debe justificar la realización o no de un tipo de procedimiento radiológico, teniendo presente los costos económicos y sobre todo los costos en términos de dosis para el paciente.

ABSTRACT: Dental imaging procedures are the most frequent type of radiological study and provide essential information to support the evaluation, diagnosis and treatment of pathologies and / or dentomaxillofacial alterations. The present narrative review shows dental radiology procedures, defines concepts associated with radiological protection in these and provides a guide with recommendations to improve the safety and radiological protection of the patient and the operator in this kind of imaging procedures. Understanding that under the current system of radiological protection, it is the dentist who must confirm the realization or not, of a type of radiological procedure, keeping in mind the financial costs, and above all, consequences to the patient in terms of dose used in the procedure.

Birads 3: correlacion histopatologica de bajo potencial de malignidad, con conglomerados quisticos imagenologicos en pacientes de tegucigalpa / Birads 3: correlation of low histopathological potential for malignancy with breast clustered microcysts in patients from tegucigalpa

La categoría 3 del Breast Imaging Reporting and Data System (BIRADS) son hallazgos probablemente benignos y en menos del 2% de estos existe la posibilidad de carcinoma. El establecimiento de esta categoría precisa la realización de pruebas complementarias de imagen que incluye: proyecciones mamográficas adicionales, la ecografía, comparar las imágenes actuales con los estudios previos de la paciente y en casos especiales se recurre a la biopsia. Dentro de esta categoría se incluyen los conglomerados quísticos en los que se centró este estudio. Objetivo: Correlacionar hallazgos ecográficos y mamográficos, con estudio histopatológico de lesiones categorizadas como conglomerados quísticos (en imagenología). Población y Métodos: Pacientes que acuden al Hospital de Especialidades del Instituto Hondureño de Seguridad Social a quienes se les realizó mamografía y ecografía categorizadas como BIRADS 3 a las cuales se les confirmó diagnóstico mediante biopsia. Resultados: De las pacientes categorizadas BI-RADS 3, a 55(100%) se les realizó biopsia, el reporte histopatológico corroboró patología benigna en 55(100%) y no se encontró patología maligna. Discusión: Los conglomerados quísticos de mama son relativamente comunes, observados en ecografía en el 5,8% de los casos, ecográficamente, se observa un nódulo circunscrito, microlobulado u oval, compuesto de múltiples quistes pequeños adyacentes separados por tabiques delgados. Se encuentra generalmente como hallazgo incidental en mamografía, ecografía o en ambos.

Category 3 of the Breast Imaging Reporting and Data System (BIRADS) are probably benign findings and in less than 2% of these there is the possibility of carcinoma. The establishment of this category requires the performance of complementary imaging tests that include: additional mammographic projections, ultrasound, compare current images with previous studies of the patient and in special cases, biopsy is used. This category includes the cystic conglomerates that this study focused on. Objective: To correlate ultrasound and mammographic findings, with histopathological study of lesions categorized as cystic conglomerates (in imaging). Population and Methods: Patients who attend the Specialties Hospital of the Honduran Social Security Institute, who underwent mammography and ultrasound categorized as BIRADS 3, which were confirmed by biopsy. Results: Of the patients categorized BI-RADS 3, to 55 (100%) a biopsy was performed, the histopathological report corroborated benign pathology in 55 (100%) and no malignant pathology was found. Discussion: The breast cystic conglomerates are relatively common, observed in ultrasound in 5.8% of cases, ultrasound, we can observe a circumscribed, microlobulated or oval nodule, composed of multiple small adjacent cysts separated by thin septa. It is usually found as an incidental finding on mammography, ultrasound or both.

Utilização de imagens tridimensionais da cavidade sinusal frontal provenientes de tomografia computadorizada de feixe cônico para a identificação forense / Usage of tridimensional cone beam computed tomography imaging of the frontal sinus for human identifications in Forensic Scienses

A unicidade da cavidade sinusal frontal é um importante fator para a identidade humana. O uso de registros de imagens dessa cavidade para a identificação forense é amplamente difundido, sendo uma metodologia secundária segundo a INTERPOL. Recentes avanços nas tecnologias de imagem permitiram o registro de imagens tridimensionais dessa cavidade. Nosso objetivo foi validar a metodologia proposta por Beaini et al. (2015), padronizando critérios para a obtenção de imagens tridimensionais da cavidade sinusal frontal com tomografia computadorizada de feixe cônico e avaliando a capacidade desses dados para a identificação humana. Para tanto, utilizamos um banco de imagens tomográficas de 200 pacientes randomizados e analisados por três observadores. As imagens foram exportadas em formato DICOM e submetidas a dois processos de segmentação distintos e sobreposição tridimensional. Realizou-se a metodologia descrita para estabelecer a identificação entre pacientes randomizados. Os resultados mostraram que há uma diferença significativa entre os processos de segmentação, sendo mais indicada a técnica de segmentação manual. A metodologia proposta por Beaini et al. (2015) foi validada e um total de 166 pacientes foram identificados. O volume da cavidade sinusal possui um elevado potencial de identificação com uma probabilidade aproximada de 85% para determinar o gênero dos indivíduos.

The uniqueness of the frontal sinus cavity is an important factor for establishing human identity. The usage of imaging records of this cavity for human identity is a secondary methodology according to the INTERPOL protocols. Recent advances in imaging technologies have enabled the three-dimensional imaging records of this cavity. Our goal was to validate the methodology proposed by Beaini et al. (2015), by developing standardized criteria for the use of cone beam computed tomography three-dimensional images of the front sinus and evaluating the ability of these data for human identification. The aim of this study was to investigate a total of 200 imaging records from randomized patients that were analyzed by three observers. Images were exported in DICOM format and underwent two distinct segmentation processes and a three-dimensional overlap. The Beaini et al. (2015) technique was applied to establish identification of the randomized patients. My results showed a significant difference between both segmentation processes, with manual segmentation showing the best results. Beaini et al. (2015) technique was validated and a total of 166 patients were identified. The volume of the sinus cavity has a high identification probability with a rough probability of 85% to determine the sex of individuals.

Historia y evolución de la radiología en Centroamérica / History and evolution of radiology in Central America

En 1895, el físico alemán Wilhelm Conrad Röntgen descubrió una nueva forma de radiación que la llamó"radiación X" para denotar su naturaleza desconocida, un año después del descubrimiento; Guatemala yChile fueron los primeros países de América Latina que utilizaron la nueva tecnología. El propósito de esta revisión bibliográfica es ofrecer una síntesis delos principales hechos y fechas que dieron lugar a la historia de la radiología en Centroamérica, haciendo énfasis en la evolución histórica en Honduras, desde la aparición del primer aparato de rayos X hasta la adquisición de la última tecnología radiológica. Se presentan los primeros radiólogos del país formadosen prestigiosas universidades y centros hospitalarios extranjeros que contribuyeron a mejorar la calidaddiagnóstica y terapéutica de los centros asistenciales. Se realizó una revisión sistemática de la literatura existente en revistas científicas consultando las basesde datos; Medline, Lilacs, e Hinari y otros que incluían artículos relacionados con la historia de la radiología...(AU)

Coinfección tuberculosis pulmonar/VIH: asociación entre estado inmunológico y hallazgos radiológicos / Pulmonary Tuberculosis / HIV Infections: Association between Immune Status and Radiological Findings

Introducción: la infección por VIH afecta la inmunidad celular, por tanto aumenta la susceptibilidad del huésped a la infección por Mycobacterium tuberculosis. En la atención primaria de salud es imprescindible el papel desarrollado por el médico y la enfermera de la familia a fin de prevenir estas complicaciones en el paciente infectado. Objetivo: determinar la asociación entre el estado inmunológico y los hallazgos radiológicos en pacientes VIH/sida con TB pulmonar. Métodos: estudio descriptivo de casos clínicos. El universo estuvo constituido por 120 pacientes con VIH/sida y cultivo de esputo positivo de Mycobacterium tuberculosis, atendidos en el Hospital del Instituto de Medicina Tropical "Pedro Kourí", en el periodo comprendido entre enero de 2004 y diciembre del 2010. Resultados: los pacientes con conteo de linfocitos T CD4+ inferior a 200 cel/µL tuvieron 5,70 veces mayor oportunidad de presentar un patrón radiológico primario (OR: 5,70; IC 2,48- 13,09; p=0,00). No se encontró asociación estadísticamente significativa entre el patrón radiológico post primario y el conteo de linfocitos T CD4+. Los pacientes con conteos de linfocitos T CD4+ mayor a 200 cel/µL tuvieron 1,96 veces mayor oportunidad de presentar Rx de tórax normales, pero resultó no significativo estadísticamente. Conclusiones: el patrón radiológico de TB primaria se asoció al conteo de linfocitos T CD4+ inferior a 200 cel/µL y la ausencia de alteraciones radiológicas en pacientes con conteo de linfocitos T CD4+ superior a 200 cel/µL, no descartó la coinfección TB pulmonar/VIH(AU)

Introduction: HIV infection affects cellular immunity, thus increasing host susceptibility to infection by Mycobacterium tuberculosis. In primary health care the role played by the family physician and the family nurse is essential to prevent these complications in infected patients. Objective: Determine the association between immune status and radiological findings in HIV / AIDS patients with pulmonary TB. Methods: Descriptive study of clinical cases. A hundred twenty patients with HIV / AIDS and positive sputum culture for Mycobacterium tuberculosis were the universe of our study. These patients were treated at the Hospital of Pedro Kouri Institute of Tropical Medicine from January 2004 to December 2010. Results: Patients with T CD4+ counts below 200 cel/µL had 5.70 times higher chance of presenting a primary radiological pattern (OR: 5.70; CI 2, 48- 13,09; p = 0.00 ). No statistically significant association between the radiological post primary pattern and T CD4+ count was found. Patients with T CD4+ counts above 200 cel/µL had 1.96 times higher chance of presenting normal chest Rx, but it was not statistically significant. Conclusions: The radiographic pattern of primary TB is associated with T CD4+ count below 200 cells / uL and the absence of radiographic abnormalities in patients with counts of TCD4 + above 200 cells / uL, did not rule out pulmonary TB / HIV co- infection(AU)

Propensity Score Matching: A Conceptual Review for Radiology Researchers

The propensity score is defined as the probability of each individual study subject being assigned to a group of interest for comparison purposes. Propensity score adjustment is a method of ensuring an even distribution of confounders between groups, thereby increasing between group comparability. Propensity score analysis is therefore an increasingly applied statistical method in observational studies. The purpose of this article was to provide a step-by-step nonmathematical conceptual guide to propensity score analysis with particular emphasis on propensity score matching. A software program code used for propensity score matching was also presented.

Casuística dos exames de diagnóstico por imagem na medicina de animais selvagens - 2009 a 2010 / Casuistics of diagnostic imaging in wildlife medicine - from 2009 to 2010

The aim of this study was to retrospectively evaluate in the casuistry on class and systems frequently diagnosed in wild animals that were sent to the FMVZ-UNESP-Botucatu diagnostic imaging service. The class of birds was the most referred to the centers, followed by the mammals and reptiles. The majority of the requested tests were the radiographs and in a minor scale the tomography and ultrasound. Although the birds were the greatest number of animals sent to the service, mammals were the most radiographed for wound control. The most frequently observed system was the musculoskeletal caused by trauma, especially in birds. The radiograph was the most exam initially indicated, then the animal could be forwarded to other imaging modalities, which in wild animals medicine is still limited to research.

Cateterismo posterior do plexo braquial em cão: estudo radiológico e avaliação de três protocolos anestésicos na duração do bloqueio motor e sensitivo / Posterior catheterization of the brachial plexus: radiological study and evaluation of three anesthetic protocols in motor and sensory block duration

Avaliou-se a eficiência do cateterismo posterior do plexo braquial em cães para promover bloqueio motor e sensitivo, por meio de três protocolos anestésicos. Foram utilizados nove cães, machos e fêmeas, sem distinção de raça e idade, com peso variando de 6 a 15kg, distribuídos em três grupos de três animais por grupo. Após a confirmação do correto posicionamento do cateter pela via posterior do plexo braquial por meio do exame radiográfico, foram aplicadas as medicações de acordo com os grupos. No grupo 1, a solução anestésica de bupivacaína 0,5% sem vasoconstrictor, na dose de 2mg.kg-1, foi usada isoladamente. No grupo 2, a solução anestésica de bupivacaína foi associada ao butorfanol na dose de 0,25mg.kg-1 . No grupo 3, o fentanil, na dose de 0,005mg.kg¹, foi associado à solução anestésica de bupivacaína. Não houve diferença estatística significante entre os grupos. Observou-se que a duração dos bloqueios motor e sensitivo foi clinicamente maior no grupo 2. O cateterismo posterior do plexo braquial permite a aplicação de fármacos mais próximos do plexo nervoso, promovendo analgesia complementar nos membros anteriores.

We evaluated the efficiency of the posterior brachial plexus catheterization in dogs to promote motor and sensory block using three anesthetic protocols. We used nine dogs, males and females, without distinction of race and age, weighing 6 to 15kg which were divided into three groups of three animals per group. After confirming the correct positioning of the catheter through the posterior brachial plexus through radiographic examination, the medications were administered according to the groups. In group 1 the anesthetic bupivacaine 0.5% without a vasoconstrictor dose of 2mg.kg-1 was used alone. In group 2 the anesthetic bupivacaine was associated with butorphanol at a dose of 0.25mg.kg-1. In group 3, the fentanyl dose was associated with 0.005mg.kg-1 anesthetic bupivacaine. There was no statistically significant difference between groups. It was observed that the duration of sensory and motor block was clinically higher in group 2. The posterior brachial plexus catheterization allows the application of drugs closer to the nerve plexus promoting additional analgesia in the forelimbs.

Características morfo-citoquímicas del líquido pleural: estudio de 104 casos / Morph-cytochemical characteristics of the pleural effusion: study of 104 cases

El objetivo del trabajo es analizar las características morfo-citoquímicas de los líquidos pleurales, de pacientes con derrame pleurales, para proporcionar métodos útiles de diagnóstico etiológico. Se extrajeron entre 10 y 50 ml. de líquido pleural de 104 pacientes. Los líquidos pleurales se clasificaron en exudados y trasudados. Se practicó estudio morfo-citoquímico, citología, coloración de Ziehl-Neelsen y cultivo para bacilo de Koch, hongos y biopsia. La distribución de los derrames pleurales fue: tuberculosos (n=36-35,0%); neoplásicos (n=28-27,0%); indeterminados (n=18-17,3%) infecciones respiratorias (11,0%); insuficiencia renal (7,0%) y otros. El 84,0% de los derrames pleurales fue de tipo exudado. El 50,0% de los líquidos pleurales hemorrágicos fueron neoplásicos. En los derrames pleurales de tipo exudado hubo una predominancia de linfocitos/polimorfonucleares. La coloración de Ziehl-Neelsen resultó siempre negativa. Los cultivos fueron positivos para bacilo de koch (10,0%). En el 17,9% se diagnosticaron derrames pleurales neoplasicos. Concluimos, que las características morfo-citoquímicas del líquido pleural son importantes para hacer un diagnóstico etiológico del derrame pleural aun cuando se disponga de métodos más actualizados

The objective of the study is to analyze the characteristics of pleural fluid patients with pleural effusions to provide useful methods of etiological diagnosis. It was extracted between 10 and 50 ml pleural fluid 104 patients. The pleural fluids were classified in transudates and exudates. Was precticed morph-cytochemical, cytology, staib of Ziehl-Neelsen and cultivation for Koch's bacilli and fungi and biopsy. The distribution of the pleural effusions was: tuberculosis (n=36-35.0%); neoplastic (n=28-27.0%), indeterminate (n=18-7.3%) respiratory infections (n=18-17.3%); kidney failure (7,0%) and others. The 84.0% of the pleural fluids was exudates type. The 50.0% of bleeding pleural fluids were neoplastic. There was a predominance of lymphocytes/polymorphonuclears in the pleural effusions of exudates type; the stain of Ziehl-Neelsen was always negative. The cultures were positive for Koch's bacilli (10.0%). Neoplastic effusions were diagnosed at 17.0%. We conclude that the morph-cytochemical features of the pleural fluid are important making a diagnosis etiological effusion even when most up-to-date methods are available

Aspectos práticos da radiologia na avaliação do TEP / Practical aspects of radiology in the evaluation of pulmonary thromboembolism

O tromboembolismo pulmonar (TEP) é um tipo de tromboembolismo venoso que ocorre na circulação arterial pulmonar. É uma patologia que cursa com morbidade e mortalidade elevadas, uma vez que os pacientes costumam apresentar doenças graves subjacentes e que complicam também devido a instabilidade hemodinâmica secundária ao TEP. O diagnóstico desta condição depende da combinação de uma série de fatores clínicos, que definem a probabilidade pré-teste associados a exames de imagem, sendo a angiotomografia computadorizada (angioTC) o método de escolha.

Pulmonary embolism is a class of venous embolism that occurs in pulmonary arterial circulation. It curses with high morbity and mortality, since patients often have severe underlying diseases and may progress inadequately due to secondary hemodynamic instability. The diagnosis of this condition depends on the match of a series of clinical factors that defines probability plus image exams, being angioCT the main diagnostic tool.

Estudios por imágenes en reumatismo / Imaging studies in reumatology

En reumatología los estudios por imágenes juegan un papel fundamental en el diagnóstico y seguimiento de los pacientes. Si bien la radiografía convencional es el examen de primera línea en el estudio, el desarrollo de técnicas como el Ultrasonido (US), la Resonancia Magnética (RM) y la Densitometría ósea posibilitan realizar diagnósticos en etapas más precoces, lo que permite modificar el curso de la enfermedad a través de tratamientos más tempranos y controlar en forma más precisa la respuesta al tratamiento. Los grandes avances tecnológicos de la última década han mejorado la calidad y cantidad de información que las distintas técnicas aportan, especialmente la RM; esto hace vislumbrar un cambio significativo en el diagnóstico por imágenes, ya que en el futuro no solo estará basado en los cambios morfológicos en órganos y tejidos; las imágenes obtenidas aportarán información bioquímica, molecular y fisiológica de los procesos patológicos facilitando su diagnóstico aún más precoz.

Imaging studies in Rheumatology play fundamental role in the patients diagnosis and follow-up. While conventional radiography is the first line examination, development of other techniques such as US, MRI and bone densitometry make possible earlier diagnosis which can modify the disease course through earlier treatment and controlling more precisely the response to it. The great technological advances of the last decade have improved the quality and quantity of information that different techniques provide, especially MRI, this makes glimpse a significant change in diagnostic imaging, since in the future not only will be based on the morphological changes in organs and tissues, the obtained images will provide biochemical, molecular and physiological information of the pathological processes, allowing earlier diagnosis.

Condrosarcoma de pulmón: reporte de un caso / Lung chondrosarcoma: report of a case

El condrosarcoma primitivo de pulmón es una neoplasia maligna de crecimiento lento y escasos síntomas respiratorios al inicio de la enfermedad. El objetivo de este trabajo es dar a conocer un tumor de pulmón poco frecuente, la evolución del mismo y la revisión de la literatura. El caso descrito en particular presenta disimilitudes con la literatura en cuanto a las manifestaciones clínicas, particularmente en el carácter de la tos y su causa, así como por la ausencia de hemoptisis. Por otra parte, el derrame pleural, solo se ha descrito en algunos casos de este tipo de tumor y el mismo es más frecuente en los tumores de estirpe epitelial. El condrosarcoma primario de pulmón, es una neoplasia que se diferencia por la histología y los estudios de inmunotinción, que por su historia natural amerita el diagnóstico oportuno para emplear la terapéutica que rinda los mejores beneficios y mejore la supervivencia.

The primitive lung chondrosarcoma is a malignant tumor of slow growth and low respiratory symptoms at the beginning of the course of the disease. The aim of this paper is to present a rare lung tumor, its evolution and the literature review. The case described in particular presents dissimilarities with the world literature regarding in the clinical manifestations, particularly in the character of the cough and its cause, and by the absence of the hemoptysis. Moreover, the pleural effusion, only been described in some cases of patients with this tumor type and the same is more common describe in the epithelial tumors. The primary chondrosarcoma of the lung is aneoplasm that is well differentiated by the histology and the immunohistochemistry studies, which by its the natural history warrants of the early diagnosis for the type of therapeutic uses, will render the best benefits and improvesurvival in the patients.

Avaliação e seguimento de pacientes adultos com síndrome do intestino curto pelo exame contrastado de trânsito intestinal / Barium follow through in the assessment and follow-up of adult patients with short bowel syndrome

A síndrome do intestino curto é definida pela incapacidade da superfície do intestino delgado em manter as condições adequadas de absorção de nutrientes, ocasionando deficiências nutricionais. Em adultos, as principais causas de síndrome do intestino curto são as ressecções cirúrgicas amplas ou múltiplas, secundárias a infarto mesentérico, doença de Crohn e enterite actínica. Além de avaliar o tempo de trânsito até o intestino grosso, o exame contrastado de trânsito intestinal pode ser utilizado na medição da extensão do intestino remanescente e no acompanhamento dos fenômenos de adaptação estrutural das alças delgadas e colônicas. Em pacientes com síndrome do intestino curto, a adaptação estrutural do intestino delgado consiste na hiperplasia das vilosidades e das pregas mucosas, que se tornam mais numerosas, profundas e de maior diâmetro, assim como a dilatação do segmento remanescente. Esses achados morfológicos são mais pronunciados e bem estabelecidos nas alças ileais, evidenciando sua maior capacidade adaptativa. O conhecimento dos achados por imagem das características morfológicas e adaptativas do intestino delgado é de grande importância na abordagem multidisciplinar da síndrome do intestino curto.

Short bowel syndrome is defined as the small bowel functional absorptive surface inability to provide adequate nutrition, leading to intestinal failure and chronic malnutrition. In adult individuals the main etiologies for short bowel syndrome are related to extensive or multiple surgical bowel resections secondary to mesenteric ischemia, Crohn's disease and actinic enteritis. Besides evaluating the transit time through the large bowel, barium follow through may be utilized in the measurement of bowel remnants length as well as in the follow-up of structural adaptation phenomena of small bowel and colonic loops. In patients with short bowel syndrome, structural small bowel adaptation consists in hyperplasia of villi and mucosal folds, which become more numerous, deeper and larger in diameter, as well as remnant segment dilation. Such morphological findings are more prominent and best established in the ileal loops, whose remarkable adaptive capacity has been well documented. Therefore, the knowledge of imaging findings regarding morphological and adaptive characteristics of the small bowel is extremely relevant in the multidisciplinary approach to short bowel syndrome.