Bilateral inguinal hernia repair and male fertility: a randomized clinical trial comparing Lichtenstein versus laparoscopic transabdominal preperitoneal (TAPP) technique.

BACKGROUND: The effects of hernia repair on testicular function remain uncertain, regardless of the technique used. Studies that analyze testicular volume and flow after hernia repair or hormonal measurements are scarce and show contradictory results. This study aimed to evaluate the impact of bilateral inguinal hernia repair on male fertility in surgical patients in whom the Lichtenstein and laparoscopic transabdominal preperitoneal (TAPP) techniques were used. METHODS: A randomized clinical trial comparing open (Lichtenstein) versus laparoscopic (TAPP) hernia repair using polypropylene mesh was performed in 48 adult patients (20 to 60 years old) with primary bilateral inguinal hernia. Patients were evaluated preoperatively and 90 and 180 postoperative (PO) days. Sex hormones (Testosterone, FSH, LH and SHGB) analysis, testicular ultrasonography, semen quality sexual activity changes and quality of life (QoL) were performed. Postoperative pain was evaluated using the visual analog scale (VAS). RESULTS: Thirty-seven patients with aged of 44 ± 11 years were included, 19 operated on Lichtenstein and 18 operated on TAPP. The surgical time was similar between techniques. The pain was greater in the Lichtenstein group on the 7th PO day. The biochemical and hormonal analyses, testicular ultrasonography (Doppler, testicular volume, and morphological findings) and sperm quality were similar between groups. However, the sperm morphology was better in the Lichtenstein group after 180 days (p < 0.05 vs. preoperative) and two patients who underwent Lichtenstein hernia repair had oligospermia after 180 days. The QoL evaluation showed a significant improvement after surgery in the following domains: physical function, role emotional, bodily pain and general health (p < 0.05). On comparison of Lichtenstein vs. TAPP none of the domains showed statistically significant differences. No patient reported sexual changes. CONCLUSION: Bilateral inguinal hernia repair with polypropylene mesh, whether using Lichtenstein or TAPP, does not impair male fertility in terms of long-term outcomes. TRIAL REGISTRATION: Approved by the Ethics Committee for the Analysis of Research Projects (CAPPesq) of the HC/FMUSP, Number 2.974.457, in June 2015, Registered on Plataforma Brasil in October 2015 under Protocol 45535015.4.0000.0068. Registered on Clinicaltrials.gov, NCT05799742. Enrollment of the first subject in January 2016.

Standardization of penile hemodynamic evaluation through color duplex-doppler ultrasound.

INTRODUCTION: The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process. Unfortunately, there is no standard procedure for CDDU conduction, a fact that results in high result-interpretation variability. OBJECTIVE: The aims of this review are to promote greater standardization during CDDU of the penis and discuss the fundamental principles for its accurate conduction. METHODS: CDDU is initially conducted with the penis in the flaccid state; the whole penis must be assessed (images at B mode) with a high-frequency linear transducer (7.5-18 MHz). Intracavernous injection of vasodilating agents (prostaglandin E1, papaverine, phentolamine) is performed to induce a rigid erection. Serial measurements at different times should be taken during the CDDU session and penile rigidity must be assessed in each evaluation. RESULTS: It is important to monitor the erection response after the vasoactive agent (hardness scale), and scanning during the best-quality erection should be contemplated. Manual self-stimulation, audiovisual sexual stimulation (AVSS), and vasoactive agent re-dosing protocols must be taken into account to reduce the influence of psychogenic factors and to help the patient to get the hardest erection possible. Such measurements contribute to the maximal relaxation of the erectile tissue, so the hemodynamic parameters are not underestimated. CONCLUSIONS: CDDU is a relevant specialized tool to assess patients with erectile dysfunction; therefore, this guideline will help to standardize and establish uniformity in its conduction and interpretation, taking into consideration the complexity and heterogeneity of CDDU evaluations of the penis.

Standardization of penile hemodynamic evaluation through color duplex-doppler ultrasound

SUMMARY INTRODUCTION: The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process. Unfortunately, there is no standard procedure for CDDU conduction, a fact that results in high result-interpretation variability. OBJECTIVE: The aims of this review are to promote greater standardization during CDDU of the penis and discuss the fundamental principles for its accurate conduction. METHODS: CDDU is initially conducted with the penis in the flaccid state; the whole penis must be assessed (images at B mode) with a high-frequency linear transducer (7.5-18 MHz). Intracavernous injection of vasodilating agents (prostaglandin E1, papaverine, phentolamine) is performed to induce a rigid erection. Serial measurements at different times should be taken during the CDDU session and penile rigidity must be assessed in each evaluation. RESULTS: It is important to monitor the erection response after the vasoactive agent (hardness scale), and scanning during the best-quality erection should be contemplated. Manual self-stimulation, audiovisual sexual stimulation (AVSS), and vasoactive agent re-dosing protocols must be taken into account to reduce the influence of psychogenic factors and to help the patient to get the hardest erection possible. Such measurements contribute to the maximal relaxation of the erectile tissue, so the hemodynamic parameters are not underestimated. CONCLUSIONS: CDDU is a relevant specialized tool to assess patients with erectile dysfunction; therefore, this guideline will help to standardize and establish uniformity in its conduction and interpretation, taking into consideration the complexity and heterogeneity of CDDU evaluations of the penis.

RESUMO INTRODUÇÃO: A avaliação vascular da função erétil por meio da ultrassonografia com Doppler colorido do pênis (UDCP) pode trazer benefícios na tomada de decisão. Infelizmente, a falta de padronização na condução de UDCP resulta em alta variabilidade do exame, além de poder comprometer a interpretação dos resultados. OBJETIVO: Os objetivos desta revisão são promover uma maior padronização durante o UDCP e discutir os princípios fundamentais para sua correta condução e interpretação. MÉTODOS: O UDCP é conduzido inicialmente com o pênis no estado flácido; todo o pênis deve ser avaliado (imagens no modo B) com um transdutor linear de alta frequência (7,5-18 MHz). A injeção intracavernosa de agentes vasodilatadores (prostaglandina E1, papaverina, fentolamina) é realizada para induzir uma ereção rígida. Medições seriais em momentos diferentes podem ser realizadas durante a sessão da UDCP e a rigidez peniana deve ser estimada em cada avaliação. RESULTADOS: É importante monitorar a resposta da ereção após o agente vasoativo (escala de rigidez), bem como realizar avaliação hemodinâmica durante a ereção de melhor qualidade. Os protocolos de estimulação sexual manual e audiovisual (AVSS) e redosagem de agente vasoativo devem ser levados em consideração para reduzir a influência de fatores psicogênicos e ajudar o paciente a obter a ereção mais rígida possível. Tais medidas contribuem para o relaxamento máximo do tecido erétil, de modo que os parâmetros hemodinâmicos não são subestimados. CONCLUSÕES: O UDCP é uma ferramenta especializada relevante para avaliar pacientes com disfunção erétil; portanto, esta diretriz ajudará a padronizar e estabelecer uniformidade em sua condução e interpretação, se considerarmos a complexidade e a heterogeneidade das avaliações do pênis por UDCP

Value of ultrasound in the anatomical evaluation of the brachial plexus: correlation with magnetic resonance imaging.

OBJECTIVE: To assess the accuracy of ultrasound in the visualization of the brachial plexus and to determine the value of the method in comparison with that of magnetic resonance imaging (MRI). MATERIALS AND METHODS: This was an anatomical study of the brachial plexuses of 20 asymptomatic adults (40 plexuses), comparing ultrasound and MRI in terms of their accuracy. In the ultrasound study, a high-frequency linear transducer was used, and a neurovascular coil was used in the MRI study. To estimate the frequency of visualization, the brachial plexus was divided into segments. RESULTS: The cervical nerve roots, the upper trunk, and the middle trunk were the segments that were best visualized on ultrasound. On MRI, the degree of visualization was excellent for most of the segments. In the comparison between ultrasound and MRI, the C6, C7, upper trunk, and middle trunk segments showed equivalent degrees of visualization, with a high level of agreement between the two methods. CONCLUSION: In the brachial plexus, ultrasound can be used in the assessment of the cervical nerve roots, as well as of the upper and middle trunks, although it provides limited visualization of the remaining segments. Ultrasound and MRI showed a high level of agreement for the visualization of the C6, C7, and middle trunk segments.

Value of ultrasound in the anatomical evaluation of the brachial plexus: correlation with magnetic resonance imaging / Valor da ultrassonografia na avaliação anatômica do plexo braquial por meio da correlação com estudo por ressonância magnética

Abstract Objective: To assess the accuracy of ultrasound in the visualization of the brachial plexus and to determine the value of the method in comparison with that of magnetic resonance imaging (MRI). Materials and Methods: This was an anatomical study of the brachial plexuses of 20 asymptomatic adults (40 plexuses), comparing ultrasound and MRI in terms of their accuracy. In the ultrasound study, a high-frequency linear transducer was used, and a neurovascular coil was used in the MRI study. To estimate the frequency of visualization, the brachial plexus was divided into segments. Results: The cervical nerve roots, the upper trunk, and the middle trunk were the segments that were best visualized on ultrasound. On MRI, the degree of visualization was excellent for most of the segments. In the comparison between ultrasound and MRI, the C6, C7, upper trunk, and middle trunk segments showed equivalent degrees of visualization, with a high level of agreement between the two methods. Conclusion: In the brachial plexus, ultrasound can be used in the assessment of the cervical nerve roots, as well as of the upper and middle trunks, although it provides limited visualization of the remaining segments. Ultrasound and MRI showed a high level of agreement for the visualization of the C6, C7, and middle trunk segments.

Resumo Objetivo: Avaliar a eficácia do exame de ultrassonografia (US) na visualização do plexo braquial e avaliar o método comparativamente à ressonância magnética (RM). Materiais e Métodos: Estudo da anatomia do plexo braquial pela US e RM (40 plexos braquiais) em 20 adultos assintomáticos. No estudo por US foi utilizado transdutor linear de alta frequência e na RM de alto campo magnético foi utilizada bobina neurovascular. O plexo braquial foi dividido em segmentos para estimar a frequência da visualização entre a US e a RM. Resultados: As raízes cervicais e os troncos superior e médio foram as estruturas que apresentaram maior grau de visualização pela US. Na RM, a maioria dos segmentos do plexo apresentou excelente grau de visualização. Na análise da equivalência entre a US e a RM, as raízes de C5, C6, tronco superior e médio apresentaram graus de visualização equivalentes, com alta concordância. Conclusão: O método de US consegue avaliar de forma eficaz o segmento proximal do plexo braquial que compreende as saídas das raízes cervicais de C5, C6 e C7, assim como os troncos superior e médio na região lateral do pescoço. O exame de US mostrou ter alta concordância com a RM nos ramos ventrais cervicais de C6, C7 e o tronco médio bilateral.

Blood Flow in Monocular Retinoblastoma Assessed by Color Doppler and Correlations With High-Risk Pathologic Features.

Purpose: To use color Doppler to analyze blood flow in the retrobulbar central retinal artery (CRA) and central retinal vein (CRV) in monocular retinoblastoma. Methods: This prospective study included patients with group D and E retinoblastomas managed with only enucleation. Peak blood velocities were assessed in the CRA and CRV of tumor-containing eyes (CRAv and CRVv, respectively). The resistivity index in the CRA (RIa) and pulse index in the CRV (PIv) were calculated and related to optic nerve invasion (ONi), choroid invasion (mCHi), and tumor volume. RIa and PIv were also calculated for healthy eyes. Results: In total, 25 patients with a mean age of 30.8-months old were included. The means (SD) for CRAv, CRVv, RIa, and PIv were 26.94 (12.32) cm/s, 16.2 (9.56) cm/s, 0.88 (0.12) and 0.79 (0.29), respectively. Tumor volume was significantly correlated with CRAv (P = 0.025) and RIa (P = 0.032). ONi was present in 19 eyes and correlated with a smaller PIv (P < 0.001). A PIv less than 0.935 had a sensitivity of 89.5% and specificity of 83.3% for predicting ONi. mCHi was not correlated with flow values. Healthy eyes had a significantly lower RIa (P < 0.001) and lower PIv than eyes with (P = 0.009) and without (P < 0.001) ONi. Conclusions: In advanced-stage monocular retinoblastoma, tumor volume was directly correlated with CRAv and RIa, and lower PIv was correlated with optic nerve invasion when a predictive cut-off value of less than 0.935 was applied. Comparisons with healthy eyes showed that tumor-containing eyes were associated with higher RIa and PIv values.

Clinical and Radiological Evaluation of Periocular Infantile Hemangioma Treated With Oral Propranolol: A Case Series.

PURPOSE: To evaluate the efficacy of propranolol (3 mg/kg/day) in the treatment of periocular infantile hemangioma (IH) based on clinical and radiological findings. DESIGN: Prospective interventional case series. METHODS: Study of previously untreated infants with IH conducted at the ophthalmology outpatient service of HC-FMUSP (Brazil). The patients were submitted to a complete ophthalmologic examination, gray-scale and Doppler ultrasonography, and nuclear magnetic resonance imaging. Lesion regression was evaluated clinically and radiologically during follow-up. The sample consisted of potentially amblyogenic and disfiguring lesions. The dose was increased at weekly intervals, from 0.5 mg to 3 mg/kg/day. The age at onset of treatment was 2-28 months. Follow-up lasted up to 48 months. RESULTS: Nine infants with periocular IH were treated with propranolol (oral) for 2-12 months (mean: 7.1 months). Clinical regression (attenuation of color and reduction in size) was observed in 88% during the first days of treatment. Partial recurrence was observed during follow-up in a patient treated for 6 months. On Doppler ultrasonography, during the first 6 months of treatment lesion volume and vascular density decreased while the arterial resistivity index (RI) increased, followed by a decline. CONCLUSION: Propranolol at 3 mg/kg/day was clinically and radiologically efficacious against deep IH in the proliferative stage, with no recurrence in patients treated for 12 months. RI might help determine when treatment can be safely interrupted.

Blood flow velocity in monocular retinoblastoma assessed by color doppler

OBJECTIVE: To analyze the flow of retrobulbar vessels in retinoblastoma by color Doppler imaging. METHODS: A prospective study of monocular retinoblastoma treated by enucleation between 2010 and 2014. The examination comprised fundoscopy, magnetic resonance imaging, ultrasonography and color Doppler imaging. The peak blood velocities in the central retinal artery and central retinal vein of tumor-containing eyes (tuCRAv and tuCRVv, respectively) were assessed. The velocities were compared with those for normal eyes (nlCRAv and nlCRVv) and correlated with clinical and pathological findings. Tumor dimensions in the pathological sections were compared with those in magnetic resonance imaging and ultrasonography and were correlated with tuCRAv and tuCRVv. In tumor-containing eyes, the resistivity index in the central retinal artery and the pulse index in the central retinal vein were studied in relation to all variables. RESULTS: Eighteen patients were included. Comparisons between tuCRAv and nlCRAv and between tuCRVv and nlCRVv revealed higher velocities in tumor-containing eyes (p <0.001 for both), with a greater effect in the central retinal artery than in the central retinal vein (p =0.024). Magnetic resonance imaging and ultrasonography measurements were as reliable as pathology assessments (p =0.675 and p =0.375, respectively). A positive relationship was found between tuCRAv and the tumor volume (p =0.027). The pulse index in the central retinal vein was lower in male patients (p =0.017) and in eyes with optic nerve invasion (p =0.0088). CONCLUSIONS: TuCRAv and tuCRVv are higher in tumor-containing eyes than in normal eyes. Magnetic resonance imaging and ultrasonography measurements are reliable. The tumor volume is correlated with a higher tuCRAv and a reduced pulse in the central retinal vein is correlated with male sex and optic nerve invasion.

Blood flow velocity in monocular retinoblastoma assessed by color Doppler.

OBJECTIVE: To analyze the flow of retrobulbar vessels in retinoblastoma by color Doppler imaging. METHODS: A prospective study of monocular retinoblastoma treated by enucleation between 2010 and 2014. The examination comprised fundoscopy, magnetic resonance imaging, ultrasonography and color Doppler imaging. The peak blood velocities in the central retinal artery and central retinal vein of tumor-containing eyes (tuCRAv and tuCRVv, respectively) were assessed. The velocities were compared with those for normal eyes (nlCRAv and nlCRVv) and correlated with clinical and pathological findings. Tumor dimensions in the pathological sections were compared with those in magnetic resonance imaging and ultrasonography and were correlated with tuCRAv and tuCRVv. In tumor-containing eyes, the resistivity index in the central retinal artery and the pulse index in the central retinal vein were studied in relation to all variables. RESULTS: Eighteen patients were included. Comparisons between tuCRAv and nlCRAv and between tuCRVv and nlCRVv revealed higher velocities in tumor-containing eyes (p < 0.001 for both), with a greater effect in the central retinal artery than in the central retinal vein (p = 0.024). Magnetic resonance imaging and ultrasonography measurements were as reliable as pathology assessments (p = 0.675 and p = 0.375, respectively). A positive relationship was found between tuCRAv and the tumor volume (p = 0.027). The pulse index in the central retinal vein was lower in male patients (p = 0.017) and in eyes with optic nerve invasion (p = 0.0088). CONCLUSIONS: TuCRAv and tuCRVv are higher in tumor-containing eyes than in normal eyes. Magnetic resonance imaging and ultrasonography measurements are reliable. The tumor volume is correlated with a higher tuCRAv and a reduced pulse in the central retinal vein is correlated with male sex and optic nerve invasion.

Penile alterations with severe sperm abnormalities in antiphospholipid syndrome associated with systemic lupus erythematosus.

This study aims to perform global gonadal and sexual function assessments in systemic lupus erythematosus-related antiphospholipid syndrome (SLE-APS) patients. A cross-sectional study was conducted in ten SLE-APS male patients and 20 healthy controls. They were assessed by demographic data, clinical features, urological examination, sexual function, testicular ultrasound, seminal parameters, sperm antibodies, and hormone profile. The median of current age was similar in SLE-APS patients and controls with a higher frequency of erectile dysfunction in the former group (30 vs. 0 %, p = 0.029). The median penis circumference was significantly reduced in SLE-APS patients with erectile dysfunction compared to patients without this complication (8.17 vs. 9.14 cm, p = 0.0397). SLE-APS patients with previous arterial thrombosis had a significantly reduced median penis circumference compared to those without this complication (7.5 vs. 9.18 cm, p = 0.039). Comparing SLE-APS patients and controls, the former had a significant lower median of sperm concentration (41.1 vs. 120.06 × 10(6)/mL, p = 0.003), percentages of sperm motility (47.25 vs. 65.42 %, p = 0.047), normal sperm forms by WHO guidelines (11 vs. 23.95 %, p = 0.002), and Kruger criteria (2.65 vs. 7.65 %, p = 0.02). Regarding seminal analysis, the medians of sperm concentration and total sperm count were significantly lower in SLE-APS patients treated with intravenous cyclophosphamide vs. those untreated with this drug (p < 0.05). Therefore, we have observed a novel association of reduced penile size with erectile dysfunction and previous arterial thrombosis in SLE-APS patients. Penis assessment should be routinely done in SLE-APS patients with fertility problems. We also identified that intravenous cyclophosphamide underlies severe sperm alterations in these patients.

Avaliação ultrassonográfica dos distúrbios intracapsulares temporomandibulares / Sonographic evaluation of temporomandibular joint internal disorders

OBJETIVO: Avaliar a sensibilidade e a especificidade do exame ultrassonográfico de alta resolução para a avaliação dos distúrbios intracapsulares temporomandibulares. MATERIAIS E MÉTODOS: Estudamos 38 pacientes (76 articulações) com queixas de distúrbios temporomandibulares. Todos os pacientes realizaram exames de ultrassonografia e ressonância magnética (padrão ouro para a avaliação) e os resultados obtidos foram comparados. RESULTADOS: De 24 articulações evidenciando deslocamento discal com o paciente em repouso na ressonância magnética, 7 foram confirmados pela ultrassonografia, em 13 não foram visualizados os discos e 4 estavam tópicos na ultrassonografia. Em 48 articulações, o disco articular não foi visualizado na ultrassonografia com o paciente em repouso. Destes, 41 apresentavam posicionamento normal na ressonância magnética e 7 apresentavam deslocamento anterior. Alterações morfológicas do côndilo mandibular foram visualizadas pela ressonância magnética em 13 articulações, identificadas pela ultrassonografia em 2 delas. CONCLUSÃO: Podemos concluir, no estudo, que o exame de ultrassonografia apresenta alta sensibilidade e especificidade para o diagnóstico da localização do disco articular com o paciente em repouso, tanto para a análise de seu posicionamento anatômico como nos casos de deslocamentos, não apresentando resultados significativos para a análise dos discos com o paciente com a boca aberta e para a análise de alterações morfológicas discais e condilares.

OBJECTIVE: To evaluate the sensitivity and specificity of high-resolution ultrasonography in the assessment of intracapsular temporomandibular disorders. MATERIALS AND METHODS: The authors have studied 38 patients (76 joints) with complaint of temporomandibular disorder. All the patients underwent ultrasonography and magnetic resonance imaging (gold standard for the evaluation) and the results were compared. RESULTS: Among 24 joints demonstrating disc displacement at magnetic resonance imaging of patients at rest, 7 were confirmed at ultrasonography; in 13, the discs could not be visualized; and in 4, no sonographic abnormality was observed. In 48 joints, the articular discs could not be visualized at ultrasonography of patients at rest. Among them, 41 exhibited normal positioning at magnetic resonance imaging, and 7 exhibited anterior disc displacement. Morphological changes of the mandibular condyle were visualized in 13 joints at magnetic resonance imaging, and in 2 at ultrasonography. CONCLUSION: With the present study, the authors can conclude that ultrasonography offers high sensitivity and specificity in the diagnosis of the articular disc location with the patient at rest, either to analyze anatomical position or to analyze disc displacement. On the other hand, it does not offer significant results to analyze articular discs in patients with open mouth as well as to analyze disc/condyle morphological changes.

Avaliação clínica e da espessura cutânea um ano após preenchimento de ácido hialurônico / Clinical and dermal thickness assessment one year after hyaluronic acid filler treatment

INTRODUÇÃO: Poucos estudos avaliam a durabilidade dos produtos de preenchimento facial de forma objetiva e não-invasiva. O objetivo deste estudo foi avaliar a durabilidade de formulação de ácido hialurônico (Derma Hyal ®) no preenchimento de sulco nasogeniano, comparando percepção do efeito clínico e espessura de partes moles medida por ultrassonografia. MÉTODO: Dez mulheres foram tratadas. Avaliação foi realizada após um, três, seis, nove e doze meses, clinicamente e por ultrassonografia. RESULTADOS: A média da espessura à ultrassonografia foi 0,38 ± 0,14 no pré, 0,69 ± 0,19 após 1 mês, 0,65 ± 0,17 após 3 meses, 0,61 ± 0,22 após 6 meses, 0,57 ± 0,23 após 9 meses e 0,55 ± 0,14 após 12 meses. Os dados analisados pelo teste Friedman não se mostraram estatisticamente significativos. Em relação à satisfação, aos 6 meses, 3 pacientes consideraram o resultado insatisfatório, 5, pouco satisfatório e 2, satisfatório. Apenas uma paciente considerou o resultado satisfatório aos 9 meses. Aos 12 meses, uma considerou pouco satisfatório e as demais, insatisfatório. Todas responderam que realizariam novamente o procedimento. CONCLUSÕES: A ultrassonografia demonstrou ser método objetivo e não-invasivo na avaliação da durabilidade de preenchimento, desde que avaliado com correlação clínica. Demonstrou-se aumento da espessura cutânea até 12 meses após injeção em sulco nasogeniano (SNG), com decréscimo progressivo. Embora exista diferença dos valores da ultrassonografia ao longo do tempo, essas não foram estatisticamente significantes. Clinicamente, o efeito percebido pelas pacientes se deu até o nono mês após aplicação do produto avaliado.

BACKGROUND: Few scientific studies evaluate the durability of existent fillers with objective parameters and non invasive methods. The objective of this study was to evaluate durability of a hyaluronic acid formula (Derma Hyal ®) in the nasolabial fold treatment, comparing the perception of clinical effect and soft tissue thickness measured by ultrasound. METHODS: Ten women were treated. Evaluation was made before, after 1, 3, 6, 9 and 12 months, clinically and by ultrasound. RESULTS: Median ultrasound thickness was 0.38 ± 0.14 pre, 0.69 ± 0.19 after 1 month, 0.65 ± 0.17 after 3 months, 0.61 ± 0.22 after 6 months, 0, 57 ± 0.23 after 9 months and 0.55 ± 0.14 after 12 months. Data analyzed by Friedman's test were not statistically significant. Regarding patient satisfaction after 6 months, 3 considered the results unsatisfactory, 5 fairly satisfactory and 2 satisfactory. Only one patient considered the treatment satisfactory at 9 months. By 12 months one considered it fairly satisfactory and nine unsatisfactory. All patients said they would do treatment again in another opportunity. CONCLUSIONS: Ultrasound evaluation of dermal thickness after filler treatment proved to be an objective and non invasive method, since when associated with clinical examination. Increase in soft tissue thickness was demonstrated until 12 months after nasolabial fold injection, with progressive decrease after this period. Despite the increase in soft tissue thickness at ultrasound, it was not statistically significant. Clinical effect was noticed by patients until nine months after treatment with this product.

Aspectos da saúde reprodutiva em homens com miopatia inflamatória idiopática: um estudo multicêntrico / Reproductive health aspects in men with idiopathic inflammatory myopathy: a multicenter study

OBJETIVO: Avaliar a saúde reprodutiva de homens com miopatia inflamatória idiopática (MII) e compará-la com controles saudáveis. MÉTODOS: Vinte e cinco pacientes com MII (dermatomiosite ou polimiosite) foram avaliados com relação aos dados demográficos, exame urológico (incluindo parâmetros pubertários e função sexual/erétil), ultrassonografia testicular, perfil hormonal, análise seminal, características clínicas e tratamento. O grupo controle incluiu 25 homens saudáveis. RESULTADOS: A mediana da idade atual foi similar nos pacientes com MII e controles (24 versus 27 anos, P = 0,566). As frequências de atividade sexual, número de parceiras com gestações espontâneas após início da doença e uso de preservativo masculino foram significativamente menores nos pacientes com MII versus controles (60 por cento versus 96 por cento, P = 0,004; 16 por cento versus 60 por cento, P = 0,0031; 40 por cento versus 76 por cento, P = 0,021; respectivamente). Além disso, as frequências de atrofia testicular (28 por cento versus 4 por cento, P = 0,049), níveis elevados de FSH e/ou LH (25 por cento versus 0 por cento, P = 0,05) e alterações dos espermatozoides (40 por cento versus 0 por cento, P = 0,0006) foram estatisticamente maiores nos pacientes com MII quando comparados aos controles. As medianas das idades de início da doença e atual foram estatisticamente maiores nos pacientes com MII que apresentaram disfunção sexual/erétil versus sem disfunção (41 versus 12,5 anos, P = 0,014; 46 versus 21 anos, P = 0,027; respectivamente). Entretanto, comparando-se, pacientes com disfunção sexual/erétil e sem disfunção, nenhuma diferença foi evidenciada em relação à idade da espermarca, parâmetros de função gonadal, atividade da doença, enzimas musculares e tratamento...

OBJECTIVE: To evaluate reproductive health of males with idiopathic inflammatory myopathies (IIM), and comparing them with a control group. METHODS: Demographic data, urologic evaluation (including pubertal parameters and sexual/erectile function), testicular ultrasound, hormone profile, semen analysis, clinical features, and treatment of 25 IIM patients were evaluated. The control group was composed of 25 healthy males. RESULTS: Median age of IIM patients was similar to that of the control group (24 versus 27 years, P = 0.566). The frequency of sexual activity, number of partners with spontaneous pregnancies after the onset of the disease, and use of condom were significantly lower in IIM patients than in the control group (60 percent versus 96 percent, P = 0.004; 16 percent versus 60 percent, P = 0.0031; 40 percent versus 76 percent, P = 0.021, respectively). Moreover, the frequency of testicular atrophy (28 percent versus 4 percent, P = 0.049), elevated levels of FSH and/or LH (25 percent versus 0 percent, P = 0.05), and sperm abnormalities (40 percent versus 0 percent, P = 0.0006) were statistically higher in IIM patients than in the control group. Median age of onset of IIM and current age were significantly higher in IIM patients with sexual/erectile dysfunction than in patients without this dysfunction (41 versus 12.5 years, P = 0.014; 46 versus 21 years, P = 0.027, respectively). On the other hand, differences in the age of spermarche, parameters of gonadal function, disease activity, muscle enzymes, and treatment were not observed between IIM patients with or without sexual/erectile dysfunction...

Reproductive health in male systemic lupus erythematosus / Saúde reprodutiva em homens com lúpus eritematoso sistêmico

OBJETIVO: Avaliar a saúde reprodutiva em homens com lúpus eritematoso sistêmico (LES) e compará-la com controles saudáveis. MÉTODOS: Vinte e cinco pacientes com LES do sexo masculino foram avaliados com dados demográficos, exame urológico (incluindo parâmetros pubertários e função sexual/erétil), ultrassonografia testicular com Doppler, perfil hormonal, análise seminal, características clínicas e tratamento. O grupo-controle incluiu 25 homens saudáveis. RESULTADOS: A mediana da idade atual foi similar nos pacientes com LES comparada aos controles (26 versus 27 anos, P = 0,756). As frequências de disfunções sexual/erétil foram significativamente maiores nos pacientes com LES em relação aos controles (20 por cento versus 0 por cento, P = 0,0001) e o número de gestações espontâneas foi menor (20 por cento versus 60 por cento, P = 0,0086). Uma tendência de uso infrequente de contraceptivos foi observada em pacientes com LES comparada aos controles (48 por cento versus 76 por cento, P = 0,079). Além disso, as frequências de parâmetros de disfunção gonadal: atrofia testicular avaliada pela ultrassonografia (36 por cento versus 8 por cento, P = 0,037), níveis elevados de FSH e/ou LH (36 por cento versus 0 por cento, P = 0,002) e alterações dos espermatozoides (48 por cento versus 0 por cento, P = 0,0001) foram estatisticamente maiores nos pacientes com LES versus controles. Os pacientes com LES e disfunção sexual/erétil não realizaram atividade sexual no último mês versus 95 por cento dos pacientes sem disfunção (P = 0,0001). Entretanto, nenhuma diferença foi evidenciada nos pacientes com LES com e sem disfunção sexual/erétil em relação a dados demográficos, atividade da doença, dano cumulativo e tratamento. CONCLUSÃO: Este é o primeiro estudo que identificou disfunção sexual/erétil e gonadal em homens lúpicos. Uma abordagem multidisciplinar é essencial para oferecer medidas preventivas para esses pacientes.

OBJECTIVE: To assess reproductive health in male systemic lupus erythematosus (SLE) patients and compare them with controls. METHODS: Twenty-five male SLE patients were evaluated for demographic data, urologic evaluation (including pubertal parameters, sexual/erectile function), testicular Doppler ultrasound, hormone profile, semen analysis, clinical features and treatment. The control group included 25 healthy men. RESULTS: The current median age was similar in SLE patients compared with controls (26 versus 27 years, P = 0.756). The frequencies of sexual/erectile disfunction were significantly higher (20 percent versus 0 percent, P = 0.0001) and the number of spontaneous pregnancies were lower in SLE patients than in controls (20 percent versus 60 percent, P = 0.0086). A trend to low contraceptive use was observed in SLE patients compared with controls (48 percent versus 76 percent, P = 0.079). Moreover, the frequencies of gonadal dysfunction parameters, such as testicular atrophies measured by ultrasound (36 percent versus 8 percent, P = 0.037), elevated FSH and/or LH levels (36 percent versus 0 percent, P = 0.002), and sperm abnormalities (48 percent versus 0 percent, P = 0.0001), were statistically higher in SLE patients versus controls. SLE patients with sexual/erectile disfunction had no sexual activity in the last month versus 95 percent of SLE patients without dysfunction (P = 0.0001). On the other hand, no differences were evidenced in SLE patients with or without sexual/erectile disfunction according to demographic data, disease activity, cumulative damage and treatment. CONCLUSION: This is the first study to identify sexual/erectile and gonadal disfunction in male SLE patients. A multidisciplinary approach is essential in order to offer preventive measures for these patients.

Achados ultra-sonográficos na tireoidite / Ultrasound findings in thyroiditis

OBJETIVO: Avaliar os aspectos ultra-sonográficos da glândula tireóide em pacientes portadores de tireoidites. MATERIAIS E MÉTODOS: Num período de nove meses, foram estudados 38 pacientes atendidos no Serviço de Ultra-sonografia do Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com diagnóstico prévio de tireoidite. Trinta e seis deles eram do sexo feminino, cujas idades variaram entre 17 e 78 anos. As variáveis observadas e estudadas foram: o volume glandular, a ecogenicidade e a ecotextura, e a presença de linfonodos na cadeia VI cervical (pré-traqueal, o sítio de drenagem linfática preferencial da tireóide) e suas dimensões. RESULTADOS: Treze pacientes apresentavam bócio. A análise ao ultra-som mostrou que 37 das 38 glândulas apresentavam ecotextura heterogênea com hipoecogenicidade difusa. Todos os pacientes apresentavam alterações nos exames laboratoriais compatíveis com tireoidites. Foram encontrados linfonodos na cadeia cervical VI (pré-traqueal) em 28 pacientes, todos de aspecto reacional. Destes, dez foram submetidos a punção aspirativa por agulha fina e o resultado citológico foi de reação inflamatória. Não foram encontrados casos de tireoidites focais que pudessem simular nódulos. CONCLUSÃO: Podemos inferir que para auxiliar no diagnóstico das tireoidites os achados ultra-sonográficos de heterogeneidade e hipoecogenicidade glandular, associados aos linfonodos na cadeia cervical VI, são de grande importância quando correlacionados aos exames clínicos e laboratoriais.

OBJECTIVE: The aim of this study was to evaluate sonographic features of thyroid gland in patients with thyroiditis. MATERIALS AND METHODS: During a nine-month period, 38 patients previously diagnosed with thyroiditis by the Ultrasound Unit of "Instituto de Radiologia da Faculdade de Medicina da Universidade de São Paulo", São Paulo, SP, Brazil, were studied. Thirteen-six of these patients were women in the age range between 17 and 78 years. The following variables were observed and studied: thyroid volume, echogenicity, echotexture, and the presence of level VI chain lymph nodes (pre-tracheal, the preferential site of thyroid drainage), besides the gland dimensions. RESULTS: Thirteen patients had goiter; 37 of 38 thyroid glands presented heterogeneous echotexture and diffuse hypoechogenicity. Thyroiditis was diagnosed by laboratory tests in all patients. Level VI chain (pre-tracheal) lymph nodes were observed in 28 cases, all of them with reactional features. Of these cases, ten patients were submitted to fine needle aspiration biopsy, and the cytological result indicated inflammatory reaction. No case of nodule-simulating focal thyroiditis was found. CONCLUSION: The thyroid gland sonographic hypoechogenicity and heterogeneity, in association with the presence of cervical chain lymph nodes, constitute findings of great importance in the diagnosis of thyroiditis when correlated with clinical and laboratory tests findings.

Parâmetros dopplervelocimétricos na avaliação da perviedade da anastomose portossistêmica intra-hepática transjugular (TIPS): estudo prospectivo / Doppler flowmeter parameters for evaluation of transjugular intrahepatic porto-systemic shunts (TIPS) patency: prospective study

OBJETIVO: Estudar as alterações hemodinâmicas consideradas normais após a realização da anastomose portossistêmica intra-hepática transjugular (TIPS) e a eficácia dos parâmetros sugestivos de estenose do TIPS com o ultra-som Doppler. MATERIAIS E MÉTODOS: Dezesseis pacientes foram avaliados de maneira prospectiva, no período de dezembro de 2001 a março de 2003. As avaliações foram realizadas 24-48 horas após o TIPS e a seguir em intervalos regulares de 30 dias, três meses, seis meses e um ano, com ultra-som modo B, Doppler pulsado, Doppler colorido e de amplitude em diferentes pontos da prótese relacionados ao TIPS. A angiografia foi realizada apenas para a confirmação dos resultados e terapêutica pertinente. RESULTADOS: Até o momento apenas os achados de fluxo contínuo no terço proximal da prótese e o gradiente de velocidade entre dois pontos da prótese apresentaram significância estatística para o diagnóstico de estenose do TIPS (p < 0,001), mas outros diferentes critérios também estiveram presentes, porém sem significância estatística. CONCLUSÃO: O ultra-som Doppler é uma ferramenta eficaz no diagnóstico da perviedade e das complicações secundárias à realização do TIPS, sobretudo da estenose. No entanto, é necessária casuística maior, a fim de determinar um conjunto de parâmetros que facilite o seguimento destes pacientes, reservando a angiografia apenas para o tratamento pertinente.

Ultrasound of tropical and infectious diseases that affect the scrotum.

Ultrasonography of the scrotum permits assessment of testicular and extratesticular masses with high sensitivity. It can differentiate a variety of conditions involving the scrotum, testicles, and epididymis with similar clinical manifestations, including infectious and tropical diseases. The authors performed conventional and color Doppler ultrasonographic examinations in 76 patients who presented with scrotal pain, swelling, and/or tenderness. Their diagnoses included sexually transmitted disease (eg, gonorrhea, syphilis, chlamydial infection), tuberculosis, mumps, and various tropical diseases (eg, filariasis, leishmaniasis, schistosomiasis, paracoccidioidomycosis). The most common imaging findings were enlarged hypoechoic testes, hypervascularity, small hydroceles, and cutaneous edema. This report reviews these and other possible presentations of tropical and infectious diseases affecting the scrotum, emphasizing ultrasound findings that facilitate diagnosis.

Linfonodos cervicais: um dilema para o ultra-sonografista / Neck lymph nodes: a challenge to ultrasonographists

A análise dos linfonodos cervicais é um assunto complexo, na medida em que obtemos, por vezes, padrões de imagens superponíveis para os processos benignos - reacionais (infecciosos específicos e inespecíficos) - e para os malignos - doenças neoplásicas (linfoproliferativas e metastáticas). O seguimento adequado das linfadenopatias também requer do examinador detalhamento topográfico e descrição dos aspectos ecográficos relevantes. Realizamos revisão literária com os objetivos de ressaltar os critérios ultra-sonográficos mais significantes (modo-B e dúplex-Doppler colorido) e fazer analogia aos reparos anatômicos utilizados na tomografia computadorizada, para uniformizar a descrição topográfica dos níveis linfonodais por meio da ultra-sonografia. Os aspectos avaliados ao modo-B foram: número (se agrupados ou isolado), forma, hilo ecogênico central, ecotextura/ecogenicidade, presença de calcificações, necrose e/ou hemorragia interna, dimensões, contornos (disseminação extracapsular). Ao dúplex-Doppler colorido os aspectos avaliados foram: padrão de vascularização e análise espectral - índice de resistividade e índice de pulsatilidade. Existem padrões ultra-sonográficos freqüentemente descritos nos linfonodos malignos como morfologia globosa, hipoecogenicidade marcada, vascularização predominantemente periférica e índice de resistividade elevado, porém a análise deve ser multifatorial, levando-se em conta os parâmetros ao modo-B e ao dúplex-Doppler colorido.