Acoustic radiation force impulse imaging in paediatric patients: normal liver values.

OBJECTIVES: The objective of this study was to obtain a normal value for liver shear wave velocities (SWVs) in healthy paediatric patients and to investigate variations concerning age, sex, and different approaches, depths, and lobes of measurements. METHODS: A total of 150 healthy children (2 months-17 years) were examined with acoustic radiation force impulse (ARFI) technology by an experienced paediatric radiologist, after receiving an informed consent. Measurements obtained were divided according to group age (n = 50, 0-5 years; n = 50, 6-11 years; n = 50, 12-17 years); sex (male-female); lobe (right-left lobe); approach (intercostal-subcostal), and depth of measurements (1-5 and 5-6 cm for the youngest group; 2-6 to 6-8 cm for the 2 other groups). Comparative analyses were performed with measurements obtained at right and left lobes, with different depths and approaches. Differences between age and sex were also analysed. RESULTS: Mean SWV in the right liver lobe was 1.07 ± 0.10 m/s. No significant differences were found according to sex or among different probe locations. SWVs were, however, significantly higher within left lobe in comparison with right liver lobe (1.07 ± 0.10 m/s, right; 1.21 ± 0.16 m/s, left). Depth of measurements also influenced SWV values obtained, being slightly lower at deeper locations. Regarding the age significant differences were found for children <6 years old compared with other age groups. CONCLUSIONS: ARFI analysis seems to be influenced by age, depth, and lobe of measurements. A mean SWV value of 1.07 ± 0.10 m/s for healthy paediatric population with the possibility of reaching 1.12 m/s in the case of younger children was found. ARFI values were more consistently obtained analysing right liver lobe and depths lower than 5 to 6 cm.

Comparison of acoustic radiation force impulse/serum noninvasive markers for fibrosis prediction in liver transplant.

OBJECTIVES: Fibrosis, related to several causes, can be diagnosed in children and adolescents' liver grafts that are >1 year old. At present, liver biopsy is the gold standard for assessing liver damage in the posttransplant setting. We aimed to evaluate the accuracy of noninvasive biomarkers of fibrosis, namely, acoustic radiation force impulse (ARFI), aspartate-to-platelet ratio index, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio index, either alone or in combination, for predicting fibrosis in pediatric patients submitted to liver transplantation. METHODS: We prospectively assessed liver fibrosis in 30 children/adolescents with liver transplant through biopsy (liver transplant follow-up during 12 months). ARFI with Virtual Touch Software (Acuson 2000) was performed, and blood samples were taken to determine liver function and platelet count. Two groups were analyzed according to the histopathologic stage of fibrosis, namely, none/mild (F0-F1) versus significant fibrosis (F2-4). RESULTS: The mean age of the 30 patients was 11 years (3-18 years), with a mean posttransplant period of assessment of 6.5 years. Twenty-four patients (80%) presented stage F0-F1 fibrosis and 6 patients (20%) presented stage F2-4. The area under the curve using receiver operating characteristic analysis for ARFI, aspartate-to-platelet ratio index, and AST/ALT ratio index for significant fibrosis was 0.76 (P = 0.052), 0.74 (P = 0.066), and 0.69 (P = 0.162), respectively. Through multivariate logistic regression analysis, the only independent predictor of significant fibrosis was ARFI (odds ratio 10.7, 95% confidence interval 1.2-95.7; P = 0.045). The combination of ARFI and AST/ALT ratio index presented a good diagnostic accuracy of fibrosis (area under the curve of 0.83; P = 0.013). CONCLUSIONS: ARFI may serve as a potential method for assessing significant fibrosis in pediatric patients with liver transplant, particularly in combination with AST/ALT ratio index.

Outcomes of choledochal cysts with or without intrahepatic involvement in children after extrahepatic cyst excision and Roux-en-Y hepaticojejunostomy.

BACKGROUND: Type I and type IV-A choledochal cysts (CC) in Todani's classification are the most frequent types of CC. Unlike type I cyst, in which the dilatation is confined to the extrahepatic bile duct, type IV-A affects both extra and intrahepatic ducts. AIM: To review our experience of complete cyst excision with Roux-en-Y hepaticojejunostomy for the treatment of type I and type IV-A CC in childhood, in order to better characterize these entities. MATERIAL AND METHODS: Data was collected retrospectively from a cohort of children who underwent cyst resection for CC from 1989 to 2011 in our institution. RESULTS: Twelve patients were submitted to surgical excision of extrahepatic cyst and hepaticojejunostomy for treatment of type I (n = 6) and type IV-A (n = 6) cysts, with a complication rate of 25% (n = 3) and no mortality. Long term follow-up was available in 92% of patients, with a median of 10 years (2-22 years). Morbidities consisted of bile leak (2 patients) and late-onset cholestasis (1 patient); two of these required anastomotic revision. The results did not reveal any significant differences between the groups regarding postoperative outcomes (P > 0.05). Preoperative intrahepatic dilatation was found to permanently vanish in 83% of patients diagnosed with type IV-A cyst after operative repair. CONCLUSIONS: Intrahepatic dilatation of type IV-A cyst in children did not adversely affect the postoperative outcome after conventional surgical repair. This operative approach was effective in the management of type I and type IV-A cysts.

Effectiveness and safety of ultrasound-guided percutaneous liver biopsy in children.

BACKGROUND: Percutaneous liver biopsy (PLB) is an important procedure in the diagnosis and follow-up of paediatric liver disease. Its purpose is to obtain tissue for histopathological observation, in our case, with ultrasound (US) guidance. OBJECTIVE: To evaluate the effectiveness and safety of US-guided PLB in children. MATERIAL AND METHODS: A retrospective study over a period of 12 years, from January 1999 until December 2010, with a selection of US-guided PLB performed in children with focal liver lesions or diffuse hepatic disease and liver transplant (LT). A 16-gauge automatic needle was used and a maximum of three fragments of liver were collected. Contraindications were: bile duct dilatation (>3 mm) INR > 1.5 (reference range, 0.9 -- 1.2) and platelet count <50,000 (reference range, 150,000 -- 450,000). Analysis focused on complications and final diagnosis. RESULTS: A total of 513 biopsies were performed, 379 (73.9%) in children who had undergone orthotopic LT, 117 (22.8%) in children with liver disease of unknown cause and 17 (3.3%) in children with focal hepatic lesions. Histological diagnosis was obtained in 509 of 513 (99.3%) biopsies performed. Minor complications were registered in 38 patients (7.4%) and major complications occurred in 5 patients (1%). None needed a surgical intervention. CONCLUSION: US-guided PLB in children is a safe and efficient method to achieve a specific diagnosis in liver disease.

Acoustic radiation force impulse-imaging in the assessment of liver fibrosis in children.

BACKGROUND: Acoustic radiation force impulse-imaging (ARFI) uses sound waves to interrogate the mechanical stiffness of a tissue. OBJECTIVE: To determine the usefulness of ARFI for estimating liver fibrosis in children. MATERIALS AND METHODS: A prospective masked study of children with chronic liver disease (CLD) and/or before liver transplant (LT) comparing ARFI with histopathological analysis. Children with no history of liver disease served as a control group. ARFI was performed with Virtual Touch software using ACUSON S2000. Share wave velocities (SWV) of several regions within the liver were measured. RESULTS: Fifty-two children were studied (mean age 8 years; range 1-16 years). The abnormal group included 10 children (31%) with CLD and 22 (69%) planned for LT. There were 20 normal controls. Mean SWV was 1.42 m/s in the abnormal group and 1.11 m/s [corrected] in the controls. For diagnosis of fibrosis stage ≥ F1, ≥F2 and F4, the areas under the receiver-operator characteristics curves were 0.834, 0.818 and 0.983, respectively. CONCLUSION: SWV is related to the degree of liver fibrosis in children, and may be a non-invasive alternative to biopsy.

Transit of radiopaque particles through the gastrointestinal tract: comparison between type 2 diabetes patients and healthy individuals.

BACKGROUND/AIMS: some studies have reported controversial results when comparing the gastrointestinal transit between diabetic and healthy individuals. Therefore, we compared the gastrointestinal transit of radiopaque particles between diabetic and non-diabetic healthy individuals. METHODS: abdominal radiographies were performed for 45 type 2 diabetes mellitus patients and 35 healthy individuals (gender and age similar for both groups) at 24 and 72 h after they ingested radiopaque particles. The mean number of particles in the colon was compared for both groups. The data were expressed as mean and standard deviation values. RESULTS: at 24 h, the total number of particles in the colon did not differ significantly for the diabetic and non-diabetic individuals. At 72 hours, the distribution in the diabetic and non-diabetic individuals was as follows: right colon, 0.44 ± 0.88 and 0.26 ± 0.7, respectively (p = 0.8); left colon, 2.6 ± 4.2 and 0.49 ± 1.3 (p < 0.003); and rectosigmoid colon, 2.65 ± 3.8 and 0.80 ± 1.5 (p < 0.005).The mean number of radiopaque particles in the entire colon was 5.7 ± 7.1 and 1.5 ± 2.7 for diabetic and non-diabetic individuals, respectively (p < 0.001). CONCLUSIONS: the number of radiopaque particles in the colon did not significantly differ for the diabetic and non-diabetic individuals at 24 h after ingestion but was significantly greater in diabetic individuals at 72 h after ingestion. At 72 h, the mean number of radiopaque particles in the left and rectosigmoid colon were significantly higher in the diabetics than in the non-diabetic individuals.

Primary Epiploic Appendagitis.

Primary epiploic appendagitis is an inflammation of the epiploic appendages occurring due to ischemic infarction as a result of appendage torsion or spontaneous thrombosis usually affecting patients from second to fifth decades, being more common in women and obese patients. It is a self-limiting entity with clinical features similar to other inflammatory abdominal processes and sometimes not remembered at clinical examinations. The awareness of this entity and its correct identification on imaging examinations could prevent unnecessary surgery. The authors present a clinical case complemented with ultrasound and CT images of this entity.

Adult abdominal Burkitt lymphoma with isolated peritoneal involvement.

Burkitt lymphoma is a fast-growing high grade B-cell neoplasm that rarely affects adults. Three clinical variants are described in the World Health Organization classification: endemic, sporadic, and immunodeficiency-associated. The non-endemic form typically presents as an abdominal mass in children. Symptoms usually occur due to mass effect or direct intestinal involvement. We describe a very unusual presentation of a sporadic Burkitt lymphoma case in a 61-year-old male with diffuse peritoneal and omental involvement, without lymphadenopathies, mimicking peritoneal carcinomatosis.

Individual spatial responses towards roads: implications for mortality risk.

BACKGROUND: Understanding the ecological consequences of roads and developing ways to mitigate their negative effects has become an important goal for many conservation biologists. Most mitigation measures are based on road mortality and barrier effects data. However, studying fine-scale individual spatial responses in roaded landscapes may help develop more cohesive road planning strategies for wildlife conservation. METHODOLOGY/PRINCIPAL FINDINGS: We investigated how individuals respond in their spatial behavior toward a highway and its traffic intensity by radio-tracking two common species particularly vulnerable to road mortality (barn owl Tyto alba and stone marten Martes foina). We addressed the following questions: 1) how highways affected home-range location and size in the immediate vicinity of these structures, 2) which road-related features influenced habitat selection, 3) what was the role of different road-related features on movement properties, and 4) which characteristics were associated with crossing events and road-kills. The main findings were: 1) if there was available habitat, barn owls and stone martens may not avoid highways and may even include highways within their home-ranges; 2) both species avoided using areas near the highway when traffic was high, but tended to move toward the highway when streams were in close proximity and where verges offered suitable habitat; and 3) barn owls tended to cross above-grade highway sections while stone martens tended to avoid crossing at leveled highway sections. CONCLUSIONS: Mortality may be the main road-mediated mechanism that affects barn owl and stone marten populations. Fine-scale movements strongly indicated that a decrease in road mortality risk can be realized by reducing sources of attraction, and by increasing road permeability through measures that promote safe crossings.

Assessing dam implementation impact on threatened carnivores: the case of Alqueva in SE Portugal.

Large dam construction in water deficient areas is a management decision often controversial. Besides providing water storage, economical benefits, and a source of renewable energy, the construction and flooding caused by large dams cause disruptions in natural systems. We monitored the pre- and post-Alqueva dam impacts on the threatened carnivore species (polecat, otter, wildcat and Iberian lynx) populations in SE Portugal, and assessed which factors mostly contribute to post-dam distribution. Major short term impacts of large dams are: (1) increase in accessibility and human presence; (2) movement of heavy machinery and dam-workers; (3) deforestation with habitat loss and fragmentation; (4) change from lotic to lentic system; (5) lower prey availability and harsher capture; and (6) changes in land use adjacent to the reservoir. Thus, the response to those impacts can be predicted as a decline of polecat, wildcat and lynx distribution ranges, and a recovery of the otter from the severe short term impacts. Our results corroborate this hypothesis for all the species, especially during deforestation/early flooding. Otter's distribution range increased in the phase of greater impact, with a subsequent decrease with flooding. Our results suggest carnivores used "escape" areas with favourable habitat and prey conditions, however, the areas with higher probability of species presence decreased by two fold showing a drastic range reduction. To ensure populations' survival of these charismatic threatened carnivore populations of Mediterranean landscapes of south-east Portugal, we propose continuing the monitoring program and the development of a conservation program for the subsisting areas of optimal and suboptimal habitats.

Transit of radiopaque particles through the gastrointestinal tract: comparison between type 2 diabetes patients and healthy individuals / Tránsito de partículas radiopacas a través del tracto gastrointestinal: comparación entre pacientes con diabetes tipo 2 y los individuos sanos

Background/aims: some studies have reported controversial results when comparing the gastrointestinal transit between diabetic and healthy individuals. Therefore, we compared the gastrointestinal transit of radiopaque particles between diabetic and non-diabetic healthy individuals. Methods: abdominal radiographies were performed for 45 type 2 diabetes mellitus patients and 35 healthy individuals (gender and age similar for both groups) at 24 and 72 h after they ingested radiopaque particles. The mean number of particles in the colon was compared for both groups. The data were expressed as mean and standard deviation values. Results: at 24 h, the total number of particles in the colon did not differ significantly for the diabetic and non-diabetic individuals. At 72 hours, the distribution in the diabetic and non-diabetic individuals was as follows: right colon, 0.44 ± 0.88 and 0.26 ± 0.7, respectively (p = 0.8); left colon, 2.6 ± 4.2 and 0.49 ± 1.3 (p < 0.003); and rectosigmoid colon, 2.65 ± 3.8 and 0.80 ± 1.5 (p < 0.005).The mean number of radiopaque particles in the entire colon was 5.7 ± 7.1 and 1.5 ± 2.7 for diabetic and non-diabetic individuals, respectively (p < 0.001). Conclusions: the number of radiopaque particles in the colon did not significantly differ for the diabetic and non-diabetic individuals at 24 h after ingestion but was significantly greater in diabetic individuals at 72 h after ingestion. At 72 h, the mean number of radiopaque particles in the left and rectosigmoid colon were significantly higher in the diabetics than in the non-diabetic individuals(AU)

Invasión cardiaca de tumor de esófago / Cardiac invasion of esophageal tumor

No disponible

Hiperintensidade de sinal em T1 dos núcleos da base: relato de caso na encefalopatia portal sistêmica esquissomótica / High intensity signal in basal ganglia on T1 weighted images: case report in Manson's Schistosomiasis with portal systemic encephalopathy

Relatamos o caso de uma paciente portadora de esquistossomose mansônica com encefalopatia portal sistêmica associada a elevada intensidade de sinal em TI ao nível dos núcleos da base, devido a deposição de manganês, decorrente da presença de colaterais porto-sistêmicos. Ressaltamos os achados radiológicos por ressonância magnética e fazemos revisão bibliográfica sobre o tema. Desconhecemos relato de tal associação na bibliografia.

Revisão de 28 casos de siringomielia - observação das alterações no exame de ressonância magnética e revisão da patogênese / Review of 28 cases of syringomyelia - magnetic resonance imaging findings and review of the pathogenesis

Foram estudados, retrospectivamente, por meio de ressonância magnética (RM), 28 pacientes com siringomielia (SM). Os pacientes foram separados em três grupos, que posteriormente, foram comparados: 17 pacientes (60,7 por cento) com SM comunicante (associada à malformação de chiari), seis pacientes (21,4 por cento) com SM pós-traumática e cinco pacientes (17,8 por cento) com SM idiopática. As características de cada SM, medula e tonsilas cerebelares foram analisadas com imagens de RM ponderadas em T1, T2 e em densidade de prótons. Relatamos característica específicas de cada grupo, como: existência de flow void (FV) ou ausência de sinal devido a fluxo rápido do liquido cefalorraquiano no interior da SM, forma da SM, aumento dos diâmetros ântero-posteriores do canal neural e da medula. As imagens em T1 foram as mais eficientes em demonstrar as relações anatômicas da SM e das tonsilas cerebelares. A maioria das SMs foi encontrada na transição cervicotorácica. A extensão média da SM foi de oito corpos vertebrais, variando de uma até 17 unidades vertebrais. As imagens em densidade de prótons foram úteis para detectar áreas de gliose presentes prevalentemente nas SMs de origem traumática, relacionadas com o maior grau de lesão parenquimatosa. A ausência de sinal devido ao fluxo estava presente em três casos (10,7 por cento), provavelmente decorrente da transmissão de pulsações para o interior da SM. Tem sido proposto que tais movimentos pulsáteis sejam responsáveis pelo crescimento da SM, o que altera o prognóstico. Nós observamos aumento das dimensões da SM nos três casos em que o FV estava presente, no espaço de tempo de 24 a 30 meses. As teorias de desenvolvimento da SM e sua evolução foram revisadas. As cavidades com morfologia em haustrações, semelhante às saculações do cólon, foram encontradas exclisivamente em pacientes com síndrome de chiari.

Exenfalia: relato de um caso e revisäo de literatura / Exencephaly: report of case and review of the literature

Os autores relatam um caso de recém-nascido com malformaçäo congênita do sistema nervoso central, enxefalia caracterizada pela ausência dos ossos da abóbada craniana e exteriorizaçäo do tecido nervoso cerebral mal formado, recoberto por uma membrana azul-acinzentada. Säo ressaltados, no trabalho, os achados radiológicos e tomográficos, e feita uma revisäo bibliográfica