Categorización y revisión de reevaluaciones en tomografía computada en una unidad de telerradiología de urgencia / Categorization and review of reevaluations in computed tomography in an emergency teleradiology unit

INTRODUCCIÓN La telerradiología se basa en el despliegue de radiólogos a distancia para evaluar estudios de dicha especialidad. Actualmente hay evidencia limitada sobre las tasas de error de evaluaciones en telerradiología. Este estudio corresponde a una revisión de las discrepancias entre los informes preliminares y finales de tomografía computada (TC) de una unidad de urgencia telerradiológica. OBJETIVO Determinar las discrepancias de las reevaluaciones (addendum) en los informes radiológicos de TC en una unidad de telerradiología de urgencia. MATERIALES Y MÉTODOS La recolección de datos se planificó a modo de tabla de cotejo, en la cual se tabularon casos de reevaluaciones de urgencia desde el mes de enero hasta mayo del año 2021, en base a la categorización Agrawal. RESULTADOS De una total de 111.599, 836 informes presentaron addendum, que corresponden al 0,74% del total informado, La categoría Agrawal 0 agrupó la mayor cantidad de casos y los exámenes de TC especialidad de cuerpo se encuentran los segmentos con mayores requerimientos de reevaluación. Discusión: Los valores obtenidos permiten establecer una baja incidencia de reevaluaciones y de la gravedad de estas, apuntando a errores asociados a canales de comunicación, redacción y elaboración de informes con especial énfasis en estudios TC Tórax y Abdomen/Pelvis. CONCLUSIÓN El porcentaje de cumplimiento de un 99,26% de exactitud en los informes permite concluir la alta confiabilidad y la calidad del servicio de telerradiología de la empresa en cuestión durante el periodo evaluado y el empleo de medidas correctivas basadas en organización, gestión e instrumentalización tecnológica

A new species of Copionodon representing a relictual occurrence of the Copionodontinae (Siluriformes: Trichomycteridae), with a CT-scan imaging survey of key subfamilial features

A new species of the Copionodontinae genus Copionodon is described from the riacho do Mosquito, tributary to rio Santo Antônio, rio Paraguaçu basin in the Diamantina Plateau, Bahia State, northeastern Brazil. This species represents the northernmost occurrence of the subfamily yet known and is a relictual population, apparently restricted to an underground sector of the stream and its immediate downstream exit. The new species can be readily recognized by the combination of the presence of opercular odontodes, the mostly uniform coloration of the body, and the lack of a free orbital rim. Despite several troglomorphic traits shared between the new species and Glaphyropoma spinosum, the two species are not closest relatives and all such similarities are convergent adaptations to the subterranean habitat. A CT-Scan study of the holotype of the new species is presented and allows a view into the details of copionodontine anatomy with unprecedented clarity.(AU)

Uma nova espécie de Copionodon (Copionodontinae) é descrita do riacho do Mosquito, tributário do rio Santo Antônio, bacia do rio Paraguaçu, Chapada Diamantina, Bahia, Brasil. Essa espécie representa a ocorrência mais ao norte da subfamília até então conhecida como uma população relictual, aparentemente restrita a um setor subterrâneo do riacho e sua saída à jusante. A nova espécie pode ser reconhecida pela combinação de odontódeos presentes no opérculo, coloração uniforme do corpo e ausência de margem orbital livre. Apesar de alguns caracteres troglomórficos compartilhados entre a nova espécie e Glaphyropoma spinosum, as duas espécies não são proximamente relacionadas e todas essas similaridades são interpretadas como adaptações convergentes ao ambiente subterrâneo. É apresentado um estudo de tomografia computadorizada do holótipo da nova espécie que permite a visualização de detalhes da anatomia interna de copionodontinae com clareza sem precedentes.(AU)

Liposarcoma retroperitoneal: Reporte de caso / Retroperitoneal Liposarcoma: Case report

Los liposarcomas son tumores poco frecuentes, de comportamiento clínico silencioso y evolución variable dependiendo del tipo histológico, la recurrencia local y las metástasis a distancia. El tratamiento de elección es la resección quirúrgica total del tumor. Se presenta el caso de paciente femenina de 57 años de edad que consultó por tumor retroperitoneal cuyo diagnóstico por patología fue de liposarcoma bien diferenciado. Se reseca la totalidad el tumor, preservando el riñón derecho. Conclusión. La cirugía en caso de liposarcoma retroperitoneal es el tratamiento de elección donde la radioterapia y la quimioterapia juegan un papel controversial.

Liposarcomas are rare tumours, of silent clinical behavior and variable evoluton depending on histological type, local recurrence and distant metastases. Treatment of choice is tumors' complete surgical resecton. We hereby report the case of a 57-year-old female patent with a retroperitoneal tumor, whose fnal diagnosis was well-diferentated liposarcoma. The entre tumor was resected, preserving the right kidney. Conclusion. For Retroperitoneal Liposarcoma, surgery is the treatment of choice

Esclerose múltipla pseudotumoral: relato de caso e revisão de literatura / Pseudotumoral form of multiple sclerosis: case report and review of literature

A forma pseudotumoral de esclerose múltipla é extremamente rara e possui uma grande variedade de diagnósticos diferenciais, o que a torna um desafio na prática neurológica. Neste artigo, apresentamos um caso desta manifestação incomum de esclerose múltipla, que foi avaliado em uma clínica especializada no Rio de Janeiro. O caso é de um individuo do sexo masculino de 21 anos que apresentou apenas crises convulsivas. Apresentou curso benigno da doença.

Pseudotumoral forms of multiple sclerosis are very and have a great variety of differential diagnosis, which poses it as a great challenge in neurological practice. In this paper, we report one case of this uncommon manifestation of multiple sclerosis, which was assessed in a specialized clinic in Rio de Janeiro. The case is a 21 year old male patient that had only seizures. He presented a benign course of the disease.

Distribuição de tensões em um modelo tridimensional de canino e pré-molares superiores sob diferentes carregamentos oclusais: análise pelo método de elementos finitos / Stress distribution in a three-dimensional model of canine and premolars superiors under different occlusal loads: analysis by finite element method

O objetivo desse estudo foi analisar, por meio do Método de Elementos Finitos, a distribuição de tensões na estrutura dentária, no ligamento periodontal (LP) e no osso alveolar em um modelo tridimensional do canino (23), primeiro (24) e segundo pré-molares superiores (25) submetidos à ação de cargas axiais e oblíquas. Além disso, objetivou-se avaliar a influência do ponto de contato proximal na distribuição das tensões no modelo de três dentes (M1), comparado a um modelo unitário do 24 (M2). As propriedades mecânicas bem como as condições de contorno e carregamento foram determinadas no programa de elementos finitos Ansys®. Cargas axiais e oblíquas foram aplicadas nas seguintes simulações: C1) Carga axial nos contatos A e B no dente 24; C2) Contato excêntrico no dente 24; C3) Carga oblíqua de 45N, com inclinação de 45o no contato A do dente 24; C4) Carga oblíqua de 45N, com inclinação de 45o no contato B do dente 24; C5) Cargas axiais simultâneas, de 70N na ponta de cúspide do dente 23, 90N nos contatos A e B do dente 24 e de 105N nos contaos A e B do dente 25. Para estimar a possibilidade de falha no esmalte, as tensões máximas principais foram analisadas e deformações máximas e mínimas principais foram analisadas no LP e no osso alveolar, sendo que ambos foram comparados a valores encontrados em outros estudos com metodologia similar. Em C1, a distribuição de tensões foi mais favorável para as estruturas dente-LP-osso, com picos de tensões semelhantes em M1 e M2. Em C2, tensões deslocaramse para apical, devido ao contato entre os dentes 24 e 23 em M1; os picos de tensões foram maiores em M1 do que em M2 no esmalte e no osso e o inverso ocorreu na dentina e no LP. Em C3, tensões de tração concentraram-se na região cervical do esmalte e na furca do dente 24; os picos das tensões no esmalte, osso e LP foram menores em M1 comparado a M2, mas na dentina ocorreu o contrário (M1>M2). Em C4, ocorreu o maior pico de tensão de tração no esmalte, tensões de tração concentraram-se na furca do dente 24; esmalte e dentina comportaram-se de forma similar (M1>M2) e osso e LP também (M1˂M2). Em C5, tensões de tração se concentraram no osso alveolar do dente 23. Os contatos proximais em M1 permitiram a distribuição das tensões de forma mais homogênea para o LP e osso que em M2. Exceto em C1, a distribuição de tensões no esmalte cervical, na dentina, no LP e no osso alveolar diferiram em um modelo unitário comparado a um de três dentes, devido à presença dos contatos proximais.

The direction, type and magnitude of loads on the oclusal surface and also the characteristics of the support structures determines the stress distribution. The aim of this study was to analyze, by the finite element method, the stress distribution on the first superior premolar, in a tridimensional (3D) model subjected to various types of loadings considering the enamel anisotropic or isotropic. The geometric modeling was performed based on a computed tomography (CT) scan. The mechanical properties as well as the loading conditions determined by the Abaqus® finite element program. Axial and oblique loads were applied on the occlusal surface of the first superior premolar in the following conditions: I) 30N axial load applied simultaneously on the occlusal contacts A and B and in the mesial marginal ridge, totaling 90N; II) 90N axial load in the mesial longitudinal edge of the lingual cusp, simulating eccentric contact; III) 45N oblique load with a 45o inclination on theocclusal contact A; IV) 45N oblique load with a 45o inclination on the occlusal contact B. To estimate the possibility of failure in the simulated structures, the maximum principal stress were analyzed and compared to known tensile strength values of the tissues studied. The results showed compression stress on the side in which the load was applied and tensile stress on the opposite side. Tensile stress concentrates mainly in the cervical region of the tooth and in the alveolar insertion bone. Anisotropic models revealed areas of tensile stress concentration smaller than the isotropic models. It was concluded that the isotropic 3D models were suitable for analyzing the stress distribution in teeth, because they are less complex models to build and produced similar results compared to the anisotropic models. The cervical enamel seems to be more susceptible to fracture because of the largest stress concentration on this area, associated with its composition and anatomical characteristics

Uso do ácido hialurônico como uma estratégia terapêutica para o reparo ósseo de alvéolos dentais humanos: um ensaio clínico randomizado, triplo-cego, boca dividida / Use of hyaluronic acid as a therapeutic strategy for bone repair in human dental sockets: a split-mouth randomized triple-blind clinical trial

O ácido hialurônico (AH), nas últimas décadas, tem sido amplamente estudado como um potente biomaterial na engenharia de tecidos, devido a sua biocompatibilidade, biodegradabilidade e participação em diversos processos biológicos relacionados à morfogênese e regeneração tecidual. O objetivo do presente estudo foi avaliar os efeitos do AH no reparo ósseo de alvéolos dentais humanos. Trinta e dois primeiros pré-molares inferiores foram extraídos de 16 pacientes com média de 18,67 (DP = 7,95) anos de idade com indicação de exodontia bilateral. Imediatamente após as exodontias, um dos alvéolos foi preenchido aleatoriamente com gel contendo AH a 1%, enquanto o contralateral foi preenchido naturalmente com coágulo. Durante os intervalos pós-operatórios de 30 e 90 dias, os pacientes realizaram exames de tomografia computadorizada cone beam (TCCB). Foram capturadas imagens dos cinco cortes ortorradiais mais centrais de cada alvéolo. A intensidade de cinza foi mensurada para cada imagem e os resultados foram expressos como porcentagem média de formação de osso. A espessura vestíbulo-lingual do processo alveolar foi mensurada e comparada entre os intervalos pós-operatórios para avaliar possíveis alterações dimensionais do alvéolo. Também foi avaliado o padrão do trabeculado ósseo alveolar através da dimensão fractal. A análise estatística envolveu análise descritiva e Testes T pareado e Wilcoxon (p<0,05). Os alvéolos tratados apresentaram maior porcentagem de formação óssea e valores de dimensão fractal (58,17% e 1,098, respectivamente) em comparação com os controles (48,97% e 1,074, respectivamente) no período de 30 dias pós-operatório (p<0,05). Com relação ao período de 90 dias, não foi observada diferença significativa entre os grupos. Além disso, não foram observadas diferenças estatisticamente significativas nas dimensões dos alvéolos entre os grupos (p>0,05). Assim, estes dados indicam que o AH acelerou o reparo ósseo em alvéolos dentais humanos

Hyaluronic Acid (HA), in the last decades, has become widely studied as a powerful biomaterial for tissue engineering, since its biocompatibility, biodegradability, and participation in several biological processes related to morphogenesis and tissue healing. The aim of this study was to evaluate the effects of HA on bone repair in human dental sockets. Thirty-two premolars were extracted from 16 patients with a mean age of 18.67 (SD = 7.95) years old with indication of bilateral extraction of lower first premolars. Immediately after the extractions, one socket was randomly filled with 1% HA gel, while the other side was naturally filled with blood clot. During the postoperative intervals of 30 and 90 days, the patients underwent cone beam computed tomography (CBCT). Five central parasagittal scan images were captured from each socket. The gray intensity was measured in each image and the results were expressed as mean percentage of bone formation. The buccolingual alveolar ridge width was also measured and dimensional changes were compared between the postoperative intervals. The pattern of the alveolar trabecular bone was evaluated through the fractal dimension. Statistical analyses included descriptive analysis and Wilcoxon and paired-t tests (p<0.05). The treated sockets showed a higher percentage of bone formation and fractal dimension values (58.17% and 1.098, respectively) compared with controls (48.97% and 1.074, respectively) in the 30-day postoperative period (p<0.05). After 90 days, there were no significant differences between the groups. Additionally, no significant differences were found between the groups regarding the alveolar dimensions (p>0.05). Thus, these data indicate that HA accelerate the bone repair in human dental socket

Factores pronósticos de mortalidad por hemorragia intracerebral en el periodo agudo / Predictors of mortality due To intracerebral hemorrhage during the acute period

INTRODUCCIÓN: en Cuba la enfermedad cerebro vascular ocupa la tercera causa de muerte seguida por las cardiovasculares y por las neoplasias y constituye también la quinta causa de años de vida saludables perdidos. Dentro de la enfermedad cerebro vascular, la hemorragia intracerebral es la de mayores complicaciones. OBJETIVO: determinar los factores relacionados con la mortalidad a corto plazo de la hemorragia intracerebral. MÉTODO: estudio de cohorte, retrospectivo y analítico con los pacientes ingresados por hemorragia intracerebral en los servicios de urgencia y terapias del Hospital. Se utilizaron factores clínicos, demográficos e imagenológicos hipotéticamente pronósticos de muerte por hemorragia intracerebral. RESULTADOS: el grupo comprendido entre 70 - 79 años presentó mayor mortalidad con 76,2 % de defunciones y el mayor número de casos con hemorragia intracerebral (59 pacientes). El 60 % de los pacientes que consumieron anticoagulantes previo a la hemorragia intracerebral fallecieron, mientras que el 67 % de los noconsumidores sobrevivieron. La relación entre cardiopatía isquémica y hemorragia intracerebral se asocia de manera independiente al evento muerte (p=0,00), mientras que en los pacientes con infección respiratoria tuvieron la mayor proporción los fallecidos con un (73,1 %). Por otro lado los pacientes que llegaron inconscientes y con incontinencia urinaria se relacionaron directamente con la mortalidad con (77,5 %) y (69,1 %) respectivamente. Los que tuvieron extensión ventricular del hematoma y volumen mayor de 50 ml presentaron 8 y 13 veces más posibilidades de fallecer que los restantes, respectivamente. CONCLUSIONES: los factores pronósticos de mortalidad por hemorragia intracerebral fueron: el consumo de anticoagulantes orales, la cardiopatía isquémica, la presencia de infección respiratoria, el estado de inconsciencia al ingreso, la presencia de incontinencia urinaria, la extensión ventricular del hematoma y la hemorragia intracerebral con volumen mayor de 50 ml.

INTRODUCTION: in Cuba cerebrovascular disease occupies the third cause of death, followed by cardiovascular diseases and neoplasms and it is the fifth leading cause of years of healthy life lost. Inside the cerebrovascular disease, intracerebral hemorrhage is the major complication. OBJECTIVE: determine the factors associated with short-term mortality of intracerebral hemorrhage. METHOD: a cohort-retrospective and analytical study was conducted with intracerebral hemorrhage patients admitted in hospital emergency and therapies services. Clinical, demographic and imaging factors were considered for the hypothetical forecasts of death from intracerebral hemorrhage. RESULTS: the age group 70-79 has higher mortality (76.2%) and the highest number of cases of intracerebral hemorrhage (59 patients). 60% of patients taking anticoagulants prior to intracerebral hemorrhage, died; while 67% of non consumers survived. The relationship between intracerebral hemorrhage and ischemic heart disease is independently associated to death event (p = 0.00), while patients with respiratory infection had the highest proportion with deceased patients (73.1%). On the other hand, patients who arrived unconscious and urinary incontinence were directly related to mortality (77.5%) and (69.1%) respectively. Those who had ventricular hematoma extension and volume higher than 50 ml presented 8 and 13 times more probabilities to die than the others, respectively. CONCLUSIONS: the mortality predictors of intracerebral hemorrhage were: use of oral anticoagulants, ischemic heart disease, the presence of respiratory infection, unconscious on admission, the presence of urinary incontinence, ventricular extension of the hematoma and intracerebral hemorrhage with higher volume than 50 ml.

Paciente con tumor de cuerpo carotideo / Patient with carotid body tumor

Los tumores de cuerpo carotideo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotideo. Se presenta el caso de un paciente de 54 años, con aumento de volumen cervical derecho, asintomático, con estudio preoperatorio y angiografía realizados por tomografía axial computarizada, que resultan compatibles con tumor de cuerpo carotideo. Se realiza disección subadventicial, informando la biopsia paraganglioma. El tumor fue completamente resecado, sin evidencia de recurrencia y sin complicaciones(AU)

Carotid body tumors (paragangliomas) are highly vascularized, infrequent and generally benign neoplasms that emerge in the carotid body chemoreceptors. This is a male patient aged 54 years with increased right cervical volume, preoperative study and angiography by computerized tomography; the result was carotid body tumor. Subadventitial dissection was made for biopsy which yielded the diagnosis of paraganglioma. The tumor was completely excised, with no evidence of recurrence or complication(AU)

Traumatic arteriovenous fistula associated to pseudoaneurysm of the superficial temporal artery in a child: case report and literature review / Fístula arteriovenosa traumática associada a pseudoaneurisma da artéria temporal superficial em uma criança: relato de caso e revisão da literatura

As fístulas arteriovenosas (FAVs) e os pseudoaneurismas traumáticos extracranianos são malformações incomuns e, em sua maioria, estão associadas a traumatismo craniano fechado com lesão contusa de forte intensidade. O diagnóstico em geral é clínico, porém o exame de escolha para o diagnóstico definitivo é a angiografia. Nos casos em que a lesão é pequena, é possível abordá-la com embolização via endovascular com sucesso. A excisão cirúrgica, no entanto, ainda é o método de escolha para o tratamento. É relatado um caso de um paciente do sexo masculino, com 9 anos de idade, diagnosticado com FAV, acometendo o ramo frontal da artéria temporal superficial, secundária a trauma craniano contundente ocorrido três anos antes do diagnóstico.

The arteriovenous fistulae (AVFs) and the extracranial traumatic pseudoaneurysms are uncommon malformations and in the majority of the cases are associated to closed head trauma with high intensity blunt lesion. The diagnosis is generally clinical, though the exam of choice for definitive diagnosis is an angiography. In minor lesion cases it's possible to successfully approach it with endovas-cular embolization. The surgical excision though, is the method of choice for the treatment. Here is reported a case of a 9-year-old male patient, diagnosed with AVF involving the frontal branch of the superficial temporal artery, secondary to blunt head trauma occurred three years before diagnosis.

Effects of heterologous platelet-rich plasma gel on standardized dermal wound healing in rabbits

PURPOSE: To evaluate the potential of heterologous platelet-rich plasma (PRP) gel for surgical skin wound healing in rabbits METHODS: Blood from a single healthy dog was used for PRP production, with calcium gluconate added to the PRP to form the gel. Two surgical excisions, one to the right and the other to the left of the dorsal midline, were made in six rabbits. One side was randomly allocated to topical application of a physiological solution, and the other was allocated to treatment with heterologous PRP gel. Clinical assessments (weight, pain sensitivity, coloring, edema, hyperemia, exudation, crust, and granulation) and morphometric evaluations were performed 0, 3, 7, 10, 14, and 17 days postoperatively. Histological analysis was performed on the 17th day. RESULTS: With the exception of the presence of a crust at day 10, clinical variables did not differ significantly between the experimental groups. In both the control and PRP-treated groups, differences were identified when comparing time-points in terms of wound area reduction. Histological results indicated no significant differences between the control group and the PRP-treated group. CONCLUSION: Heterologous platelet-rich plasma gel promoted dermal wound healing in rabbits with no adverse effects. .

Clinical Features and Prognosis of Invasive Pulmonary Aspergillosis in Korean Children with Hematologic/Oncologic Diseases

Invasive pulmonary aspergillosis (IPA) is the most frequent form of invasive fungal diseases in immunocompromised patients. However, there are only a few studies on IPA in immunocompromised children in Korea. This study was designed to characterize IPA in Korean children with hematologic/oncologic diseases. Medical records of children with hematologic/oncologic diseases receiving antifungal therapy were reviewed. The enrolled children were divided into the IPA group (proven and probable IPA) and non-IPA group, and the clinical characteristics and prognosis were compared between the two groups. During the study period, 265 courses of antifungal therapy were administered to 166 children. Among them, two (0.8%) episodes of proven IPA, 35 (13.2%) of probable IPA, and 52 (19.6%) of possible IPA were diagnosed. More children in the IPA group suffered from neutropenia lasting for more than two weeks (51.4% vs. 21.9%, P<0.001) and showed halo signs on the chest computed tomography (78.4% vs. 40.7%, P<0.001) than in the non-IPA group. No other clinical factors showed significant differences between the two groups. Amphotericin B deoxycholate was administered as a first line antifungal agent in 33 (89.2%) IPA group episodes, and eventually voriconazole was administered in 27 (73.0%) episodes. Ten (27.0%) children in the IPA group died within 12 weeks of antifungal therapy. In conclusion, early use of chest computed tomography to identify halo signs in immunocompromised children who are expected to have prolonged neutropenia can be helpful for early diagnosis of IPA and improving prognosis of children with IPA.

Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant ( 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.

Role of CT in the Evaluation of Adult Brain Tumor.

Imaging plays an important role in the evaluation of patients with brain tumors. CT is an important and commonly used modality. They have a significant impact on patient modalities and care. The technical improvement of CT and the utility of contrast material in the imaging of brain tumors improved significantly the detection and the evaluation of brain neoplasms.Once a brain tumor is clinically suspected, radiologic evaluation is required to determine the location, the extent of the tumor and its relationship to the surrounding structures. This information is very important & critical in deciding among different forms of therapy such as surgery, radiation and chemotherapy. In this article we will give an overview of the role of CT in the diagnosis of brain tumors.

A neurologia no Brasil: considerações geodemográficas / Neurology in Brazil: geodemographic considerations

Este estudo destaca os recursos em neurologia, neurologistas eequipamentos de diagnóstico por meio de imagem, segundo os estadosbrasileiros e sua distribuição populacional. Há grandes desigualdadesentre as regiões. A informação apresentada pode ser útil para o planejamento em saúde e para os especialistas atuais ou futuros. Os resultados deste estudo sugerem a necessidade de aumento substancial dos serviços de neurologia em alguns locais do Brasil, mas de modo geral o atendimento neurológico parece ter indicadores satisfatórios. Entretanto, o material apresentado é apenas uma primeira abordagem da situação real, sendo necessário obter informações mais completas e precisas, em estudos futuros.

This study highlights neurological resources, mainly neurologists and diagnostic imaging equipment, according to the Brazilian states and their population distribution. There is great inequality between regions. The presented information may be useful for health planning and for current or future specialists. The results of this study suggest the need for substantial increase in neurology services in some locations of Brazil, but in general, neurological care seems to have satisfactory indicators. However, the presented material is only a first approach of the real situation, being necessary to acquire more complete and accurate information, in future studies.

Helminth parasitic infections of the central nervous system: a diagnostic approach

Helminth parasitic infections of the central nervous system [CNS] occur worldwide with high prevalence in tropical and subtropical countries. Clinical evaluation of patients is mandatory, and it is convenient to group the clinical manifestations into syndromes: for example space-occupying lesions, meningitis, and encephalitis. The history should focus on residence or travel to endemic areas, diet, activities, inter-current medical conditions, and associated clinical clues. Direct parasitological diagnosis can be reached by cerebrospinal fluid and cerebral tissue examination either by microscopy, culture, or immunological techniques. Immunodiagnosis by detection of parasite antibodies or antigens in serum could provide indirect evidence of parasitic infections. In addition, various imaging and radiological techniques e.g., computed tomography [CT] scan and magnetic resonance imaging [MRI] complement the diagnostic work-up of CNS diseases. Finally, the helminthic CNS infections of global impact, such as schistosomiasis, neurotoxocariasis, Strongyloides infection, neurotrichinosis, neurocysticercosis, and echinococcosis will be briefly discussed as regards the principal clinical and diagnostic features

Unusual localization and presentation of non-visceral hydatid cysts: review article

Echinococcosis is a major parasitic zoonosis of public health importance worldwide. This is particularly true in sheep-raising countries including Egypt. Therefore, it is very important to identify the significant risk factors of the diseases by reviewing studies done in the region in the past decade to help policy makers design appropriate control strategies

Effect of electron beam on prepared hap-gel composition

Polyvinyl alcohol liquid PVA1 was used as the organic carrier for Hydroxylapatite-gel [Hap-gel] composite. PVA1 has the ability to form a nano- hydroxylapatite polyvinyl alcohol composite gel which has a wide range of uses in different environmental and medical applications. Prepared Hap-gel is known to have a very similar composition to human bone and is used as a substitute for bones in compound fractures and artificial dentures. In this work prepared HAP- gel was exposed to a high ionizing radiation electron beam [5 kilo Gray] and an aqueous solution containing aluminum ions [Al[+]]. Some investigations were done to illustrate the effect of radiation exposure and aluminum contamination on prepared Hap-gel. Energy dispersive X-ray analysis [EDx] showed that the electron beam used caused an obvious increase in the calcium ions [Ca[++] content of the prepared Hap-gel from 60% to 65.69% with a prominent decrease in phosphorus ions [P[+] content from 40% to 34.31% in addition to an increase in the Ca/P ratio from 1.5 to 1.91. Exposure of the pre-irradiated Hap-gel samples to aluminium ions [Al[+] resulted in a noticeable decrease in Ca[+] content from 65.69 atomic% to 32.14% atomic% and a further noticeable decrease in P+content from 34.31% atomic% to 13 atomic% as well as an increase in the Ca/P ratio from 1.91 to 2.47. The levels for the original prepared Hap-gel were Ca[++]; 60 atomic% and P+; 40 atomic%. It was deduced that exposure of the Hap-gel to Al+had a further damaging effect on the pre-irradiated Hap-gel composition in addition to the damaging effect that the electron beam used induced on the samples. it could be concluded that electron beams and Al+ have an injurious effect on human bone tissue taking into consideration the similarity in composition between Hap-gel and bones. Therefore, this study could be beneficial in the field of osteoporosis research and assist the understanding of the effects of radiation such as that of electron beams and some pollutants such as aluminium present in running water on the health of human bone tissue

Value of TC-99M DMSA scintigraphy in urinary tract infection: comparative study with other imaging modalities

Urinary tract infection [UTI] is a common medical problem. It causes considerable morbidity specially if complicated, can cause severe renal damage. The aim of this study is to evaluate value of Tc-99m DMSA in UTI comparing with ultrasound and CT scan. We analyzed a random sample of 63 patients approved to have urinary tract infection. Abdominal ultrasound, CT, and [99m] Tc-DMSA scintigraphy of the kidneys were performed in all patients. Tc-99m DMSA scan showed scintigraphic changes consistent with pyelonephritis in all patients. The involvement was either unilateral in 53 patients [84%] or bilateral in 10 patients [16%]. The number of diseased kidneys were 73/126 [58%], 16/73 kidneys had abnormal unifocal defects [22%], 27/73 kidneys had multifocal defects [37%], while 30/73 kidneys had diffuse hypoactivity [41%]. The sensitivity of CT scan in detecting pyelonephritis was 82.8% while the sensitivity of ultrasound was poor [23.8%] and there was a statistically significant difference between the sensitivity of ultrasound and that of Tc-99m DMSA. Tc-99m DMSA is reliable diagnostic, cost-effective, simple, safe and noninvasive modality and may be taken as a routine procedure for the patients with clinical suspicion of upper UTI whenever the facilities are available

Rosai–Dorfman disease with exclusive intra-abdominal lymphadenopathy masquerading as Wilkie's syndrome

Rosai-Dorfman disease is a rare histiocytic proliferative disorder with a distinctive microscopic appearance. Patients usually present with nonspecific symptoms and massive cervical lymphadenopathy. Exclusive involvement of intra-abdominal lymph nodes is unusual and presentation mimicking Wilkie's syndrome due to compression of the third part of the duodenum by enlarged retroduodenal lymph nodes is rare. This entity should be included in the differential diagnosis with infectious, granulomatous and malignant causes of intra-abdominal lymphadenopathy. We highlight an uncommon presentation and discuss the challenges in the diagnosis and management of Rosai-Dorfman disease

Accident and emergency neuroimaging: is an optimization needed in ordered non-enhanced CT scans for brain imaging?

To determine and characterize ordering of computed tomography scans for neuroimaging and to identify the frequency of negative non-enhanced computed tomography [NECT] in a prospective series of patients presenting to medical, surgical and pediatric floors of Accident and Emergency Department, so as to manipulate ordering practice by the referring physicians. This study was conducted in Department of Radiology, Services Institute of Medical Sciences/ Services Hospital, Lahore, between January and June 2010. The study consecutively included all the cases from Accident and Emergency Department with neurological symptoms and signs undergoing CT head referred from medical, surgical and pediatric floors. The patients' medical records were reviewed. The study population consisted of 2570 patients, including 1611 men and 959 women, who were 1-75 years old [mean 42 years]. Interpretation of NECT heads was done for positive as well as negative cases. Of 2570 cases, 1155 cases [44.9%] were positive. The overall percentage of negative CT scans was high for medical emergencies, with only 481 cases [29.2%] out of 1647 revealing positive findings. The percentage of negative CT scans referred from surgical emergency was not as high as for medical emergencies, but the major head trauma was only productive for extra-axial bleed/ hematoma revealing 403 cases [44.6%]. Minor head trauma was more commonly scanned with most of the CT scans head remarkable only for skull vault non-depressed fractures. Pediatric referrals positive percentage was again low with only 6 [28.5%] out of 21 cases positive for any underlying pathology. Optimization in the neuroimaging should be encouraged for more thoughtful use of imaging modalities in Accidents and Emergency departments to ensure patients' benefit from continued imaging innovation. An urgent CT head scan is deemed appropriate if it leads to an immediate change in a patient's management. Unnecessary use of neuroimaging, in particular to CT scan, has long-term effects of accumulated diagnostic radiation. Appropriateness of the requests should be evaluated according to the various guidelines.