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2.
Pest Manag Sci ; 79(6): 2206-2219, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36750418

RESUMO

BACKGROUND: Spodoptera frugiperda (J. E. Smith) is a widespread agricultural pest with several records of resistance to different insecticides and Bt proteins, including the neurotoxic insecticides chlorpyrifos (organophosphate) and lambda-cyhalothrin (pyrethroid). Here, we (i) characterized and monitored the susceptibility of field populations of S. frugiperda to chlorpyrifos (194 populations) and lambda-cyhalothrin (197 populations) collected from major maize-growing regions of Brazil from 2003 to 2016, and (ii) compared gene expression levels of laboratory-selected, chlorpyrifos- and lambda-cyhalothrin-resistant strains to a susceptible reference strain (Sf-ss) of S. frugiperda. RESULTS: The susceptibility monitoring detected average survival ranging from 29.3% to 36.0% for chlorpyrifos, and 23.1% to 68.0% for lambda-cyhalothrin. The resistance ratio of the chlorpyrifos-resistant strain (Clo-rr) was 25.4-fold and of the lambda-cyhalothrin-resistant strain (Lam-rr) was 21.5-fold. We identified 1098 differentially expressed genes (DEGs) between Clo-rr and Sf-ss, and 303 DEGs between Lam-rr and Sf-ss. Functional analyses of the DEGs revealed the up-regulation of several detoxification enzymes, mainly cytochrome P450 belonging to CYP3 and CYP6 clans. Genes associated with regulatory processes, such as the forkhead box class O (FoxO) transcription factor were also up-regulated. Variant analysis of target-site mutations for both pesticides identified the A201S and F290V mutations in acetylcholinesterase-1, both occurring in heterozigosis in the Clo-rr S. frugiperda strain. CONCLUSION: Our data show that the overexpression of the enzymatic detoxification machinery is the main difference to explain the resistance of Clo-rr and Lam-rr strains of S. frugiperda to chlorpyrifos and lambda-cyhalothrin, although a target-site mutation also contributes to the Clo-rr resistance to chlorpyrifos. © 2023 Society of Chemical Industry.


Assuntos
Clorpirifos , Inseticidas , Piretrinas , Animais , Inseticidas/farmacologia , Clorpirifos/farmacologia , Spodoptera/genética , Acetilcolinesterase/genética , Resistência a Inseticidas/genética , Piretrinas/farmacologia , Expressão Gênica
3.
Insects ; 14(2)2023 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-36835698

RESUMO

Susceptibility monitoring to insecticides is a key component to implementing insecticide resistance management (IRM) programs. In this research, the susceptibility to teflubenzuron in Spodoptera frugiperda (J.E Smith) was monitored in more than 200 field-collected populations from major corn-growing regions of Brazil, from 2004 to 2020. Initially, we defined a diagnostic concentration of 10 µg mL-1 of teflubenzuron using a diet-overlay bioassay for monitoring the susceptibility. A variation in the susceptibility to teflubenzuron in S. frugiperda was detected among populations from different locations. We also detected a significant reduction in the susceptibility to teflubenzuron throughout time in all the populations of S. frugiperda evaluated, with larval survival at diagnostic concentration varying from values of <5% in 2004 to up 80% in 2020. Thus, this research provides evidence of field-evolved resistance of S. frugiperda to teflubenzuron and reinforces that IRM practices are urgently needed to be implemented in Brazil.

5.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;37(6): 937-941, Nov.-Dec. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1407329

RESUMO

ABSTRACT The anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital heart disease, generally diagnosed based on the clinical information and on echocardiographic and computed tomography angiography findings. Here we report two neonates successfully treated with surgery early in life.

6.
Braz J Cardiovasc Surg ; 37(6): 937-941, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36112742

RESUMO

The anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital heart disease, generally diagnosed based on the clinical information and on echocardiographic and computed tomography angiography findings. Here we report two neonates successfully treated with surgery early in life.


Assuntos
Cardiopatias Congênitas , Artéria Pulmonar , Recém-Nascido , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/anormalidades , Aorta/diagnóstico por imagem , Aorta/cirurgia , Cardiopatias Congênitas/cirurgia , Ecocardiografia/métodos , Angiografia/métodos
7.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;37(4): 534-545, Jul.-Aug. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1394728

RESUMO

ABSTRACT Introduction: Congenitally corrected transposition of the great arteries (CCTGA) is a rare anomaly. Current data available regarding adult cases is derived from small series, information simultaneously presented in pediatric publications, and one classical multicenter study. This review, not aimed to exhaust the subject, has the purpose to examine the literature addressing presentation, diagnostic methodology, and management of afflicted adult patients. Methods: A comprehensive search was undertaken in three major databases (PubMed, Cochrane, SciELO), using the keywords "congenitally corrected transposition of the great arteries" and "adults". Relevant articles in English, Spanish, and Portuguese were extracted and critically appraised in this review. Steps for study selection were: (1) identification of titles of records through databases searching, (2) removal of duplicates, (3) screening and selection of abstracts, (4) final inclusion in the study. Results: Four hundred sixty-five publications on CCTGA in adult patients were retrieved, and 166 were excluded; 299 studies were used for this review including 76 full-text articles, 70 studies related to general aspects of the subject, and, due to the small number of publications, 153 case reports. Sixty-one articles referring to combined experiences in pediatric and adult patients and judged to be relevant, but retrieved from another sources, were also included. Conclusion: Albeit clinical presentation and diagnostic criteria have been well stablished, there seems to be room for discussion related to clinical and surgical management of CCTGA in adults. Considering the rarity of the disease, well designed multicenter studies may provide answers.

8.
Braz J Cardiovasc Surg ; 37(4): 534-545, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35895985

RESUMO

INTRODUCTION: Congenitally corrected transposition of the great arteries (CCTGA) is a rare anomaly. Current data available regarding adult cases is derived from small series, information simultaneously presented in pediatric publications, and one classical multicenter study. This review, not aimed to exhaust the subject, has the purpose to examine the literature addressing presentation, diagnostic methodology, and management of afflicted adult patients. METHODS: A comprehensive search was undertaken in three major databases (PubMed, Cochrane, SciELO), using the keywords "congenitally corrected transposition of the great arteries" and "adults". Relevant articles in English, Spanish, and Portuguese were extracted and critically appraised in this review. Steps for study selection were: (1) identification of titles of records through databases searching, (2) removal of duplicates, (3) screening and selection of abstracts, (4) final inclusion in the study. RESULTS: Four hundred sixty-five publications on CCTGA in adult patients were retrieved, and 166 were excluded; 299 studies were used for this review including 76 full-text articles, 70 studies related to general aspects of the subject, and, due to the small number of publications, 153 case reports. Sixty-one articles referring to combined experiences in pediatric and adult patients and judged to be relevant, but retrieved from another sources, were also included. CONCLUSION: Albeit clinical presentation and diagnostic criteria have been well stablished, there seems to be room for discussion related to clinical and surgical management of CCTGA in adults. Considering the rarity of the disease, well designed multicenter studies may provide answers.


Assuntos
Transposição das Grandes Artérias Corrigida Congenitamente , Adulto , Humanos , Estudos Multicêntricos como Assunto
10.
Int. j. cardiovasc. sci. (Impr.) ; 35(1): 136-139, Jan.-Feb. 2022. graf
Artigo em Inglês | LILACS | ID: biblio-1356313

RESUMO

Abstract Isolated left ventricular apical hypoplasia is a rare cardiomyopathy, with a broad range of clinical presentations. Since this entity was already described in association with osteomuscular diseases, mutation in the Lamin A/C gene has been regarded as a possible cause of this disease. This study describes the case of an asymptomatic teenager with isolated left ventricular apical hypoplasia and arthrogriposis but with no mutations in the entire Lamin A/C gene.


Assuntos
Humanos , Masculino , Adolescente , Lamina Tipo A/genética , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Artrogripose , Lamina Tipo A/deficiência , Miocárdio Ventricular não Compactado Isolado/diagnóstico , Miocárdio Ventricular não Compactado Isolado/etiologia
12.
Endocr Pract ; 27(11): 1108-1113, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34153510

RESUMO

OBJECTIVE: To compare 2 ultrasound-based risk stratification systems in malignancy risk assessment of thyroid nodules and the clinical applicability of these guidelines in Brazil. METHODS: We retrospectively reviewed the ultrasound findings of 314 patients (473 thyroid nodules) who underwent fine-needle aspiration (FNA) biopsy and/or surgery between February 2018 and March 2019. All nodules were classified using 2 systems: the Thyroid Imaging, Reporting, and Data System (TIRADS) of the American College of Radiology (ACR-TIRADS) and the TIRADS of the European Thyroid Association (EU-TIRADS). Both risk stratification systems were analyzed. We identified the diagnostic predictive values that yielded optimal sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: Of the 473 nodules, all underwent FNA, and histopathology was performed for 332 nodules. The agreement between the ACR-TIRADS and EU-TIRADS results and that between cytology and histopathology findings was 92.6% (kappa = 0.84) and 86.7% (kappa = 0.73), respectively. The area under the curve for the ACR-TIRADS and EU-TIRADS was 0.871 and 0.828, respectively (P < .001). The EU-TIRADS had the best sensitivity and negative predictive value, whereas the ACR-TIRADS had the best specificity, positive predictive value, and accuracy. Of the 473 nodules studied, only 158 (33.4%) followed the FNA size criteria suggested by the ACR-TIRADS. CONCLUSION: ACR-TIRADS and EU-TIRADS had good diagnostic performances. However, most aspirated nodules did not follow the TIRADS indication; thus, the overuse of FNA as a diagnostic tool was observed.


Assuntos
Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Brasil , Sistemas de Dados , Humanos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Estados Unidos
13.
J Econ Entomol ; 114(2): 903-913, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33604658

RESUMO

Spodoptera frugiperda (J.E. Smith) is one of the key cross-crop pests in Brazilian agroecosystems. Field-evolved resistance of S. frugiperda to some conventional insecticides and Bt proteins has already been reported. Thus, the use of insecticides with new mode of action such as sodium channel blockers (indoxacarb and metaflumizone) could be an important tool in insecticide resistance management (IRM) programs. To implement a proactive IRM, we conducted baseline response and monitoring to indoxacarb and metaflumizone in 87 field populations of S. frugiperda collected from major maize-growing regions of Brazil from 2017 to 2020, estimated the frequency of resistance alleles to indoxacarb, and evaluated cross-resistance of indoxacarb and metaflumizone to some selected insecticides and Bt proteins. Low variation in susceptibility to indoxacarb (4.6-fold) and metaflumizone (2.6-fold) was detected in populations of S. frugiperda in 2017. The frequency of the resistance allele to indoxacarb was 0.0452 (0.0382-0.0527 CI 95%), by using F2 screen method. The mean survival at diagnostic concentration, based on CL99, varied from 0.2 to 12.2% for indoxacarb and from 0.0 to 12.7% for metaflumizone, confirming high susceptibility of S. frugiperda to these insecticides in Brazil. No cross-resistance was detected between sodium channel blocker insecticides and other insecticides (organophosphate, pyrethroid, benzoylurea, spinosyn, and diamide) and Bt proteins. These findings showed that sodium channel blocker insecticides are important candidates to be exploited in IRM strategies of S. frugiperda in Brazil.


Assuntos
Inseticidas , Bloqueadores dos Canais de Sódio , Spodoptera , Animais , Proteínas de Bactérias/farmacologia , Brasil , Resistência a Inseticidas , Inseticidas/farmacologia , Larva , Bloqueadores dos Canais de Sódio/farmacologia , Zea mays
14.
Braz J Cardiovasc Surg ; 35(3): 254-264, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32549096

RESUMO

OBJECTIVE: Description of adult congenital heart disease (CHD) outpatient characteristics has not been reported and several aspects regarding these patients require attention. We describe the 12-year experience of a Brazilian unit. METHODS: The main characteristics of 1168 patients were reviewed annotating for each patient age, gender, city of residence, main diagnosis, functional class at last examination, defect complexity and in-hospital referral pattern. RESULTS: Increasing workload was documented. Among the CHD patients, 663 (57%) were between 14 and 30 years old and 920 (79%) lived in the referral region. Referrals were made by hospital cardiologists for 611 (52%) patients, while 519 (45%) were referred by pediatric cardiologists. Regarding CHD severity, 637 (55%) had a defect of mild complexity. Of the patients analyzed, 616 (53%) had undergone an intervention, mainly atrial septal defect (ASD) closure, correction of tetralogy of Fallot, ventricular septal defect (VSD) closure and relief of coarctation of the aorta (CoAo). The main diagnosis of the 552 (47%) patients not submitted to an intervention were ASD, VSD, aortic stenosis, complex CHD and pulmonary stenosis. Regarding functional class, 1016 (87%) were in class I and 280 (24%) were lost to follow-up. Seventy-three patients had died, mainly due to cardiac death. CONCLUSION: In a unit were complex pediatric congenital heart surgery started twenty years ago, an increasing adult CHD workload was documented. Referral came predominantly from cities around the unit, most patients had low complexity defects and were in functional class I, a significant loss of follow-up was documented, and the death of patients was mainly due to the heart defect.


Assuntos
Cardiopatias Congênitas , Comunicação Interventricular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Brasil , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Adulto Jovem
15.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;35(3): 254-264, May-June 2020. tab, graf
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1137274

RESUMO

Abstract Objective: Description of adult congenital heart disease (CHD) outpatient characteristics has not been reported and several aspects regarding these patients require attention. We describe the 12-year experience of a Brazilian unit. Methods: The main characteristics of 1168 patients were reviewed annotating for each patient age, gender, city of residence, main diagnosis, functional class at last examination, defect complexity and in-hospital referral pattern. Results: Increasing workload was documented. Among the CHD patients, 663 (57%) were between 14 and 30 years old and 920 (79%) lived in the referral region. Referrals were made by hospital cardiologists for 611 (52%) patients, while 519 (45%) were referred by pediatric cardiologists. Regarding CHD severity, 637 (55%) had a defect of mild complexity. Of the patients analyzed, 616 (53%) had undergone an intervention, mainly atrial septal defect (ASD) closure, correction of tetralogy of Fallot, ventricular septal defect (VSD) closure and relief of coarctation of the aorta (CoAo). The main diagnosis of the 552 (47%) patients not submitted to an intervention were ASD, VSD, aortic stenosis, complex CHD and pulmonary stenosis. Regarding functional class, 1016 (87%) were in class I and 280 (24%) were lost to follow-up. Seventy-three patients had died, mainly due to cardiac death. Conclusion: In a unit were complex pediatric congenital heart surgery started twenty years ago, an increasing adult CHD workload was documented. Referral came predominantly from cities around the unit, most patients had low complexity defects and were in functional class I, a significant loss of follow-up was documented, and the death of patients was mainly due to the heart defect.


Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Cardiopatias Congênitas , Comunicação Interventricular , Pacientes Ambulatoriais , Brasil , Instituições de Assistência Ambulatorial
16.
Pest Manag Sci ; 76(8): 2674-2680, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32133753

RESUMO

BACKGROUND: The use of spinosyn insecticides is one of the major control strategies of the fall armyworm, Spodoptera frugiperda (J. E. Smith) in Brazil. In this study, we selected a spinetoram-resistant strain from a field-population of S. frugiperda to characterize the inheritance of the resistance and cross-resistance relationship between spinosyn insecticides. RESULTS: The values of LC50 (95% CI) obtained from concentration-response bioassays were 0.63 (0.55-0.73) µg spinetoram mL-1 for the susceptible strain (SUS), and 1170.96 (1041.61-1323.89) µg spinetoram mL-1 for the strain resistant to spinetoram (SPT-R). These values resulted in a resistance ratio of 1844-fold. The SPT-R strain showed cross-resistance with spinosad (resistance ratio = 1196-fold). The reciprocal crosses showed LC50 values of 3.91 (2.97-5.84) and 5.37 (4.52-6.52) µg spinetoram mL-1 , suggesting that the resistance of S. frugiperda to spinetoram is autosomal and incompletely recessive. The backcrosses of the F1 progeny with the SPT-R strain suggest a resistance with polygenic effect. Estimates of the effective number of loci with equal contributions to the resistance effect were from 1.18 to 1.76, suggesting that resistance to spinetoram is associated with a few genes. CONCLUSION: The inheritance pattern of resistance of S. frugiperda to spinetoram was characterized as autosomal, incompletely recessive and polygenic. Cross-resistance between spinosyns was confirmed in S. frugiperda. The importance of this information for implementing insect resistance management strategies is discussed in this paper. © 2020 Society of Chemical Industry.


Assuntos
Spodoptera , Animais , Proteínas de Bactérias , Brasil , Resistência a Inseticidas , Inseticidas , Macrolídeos
17.
Pest Manag Sci ; 76(1): 169-178, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31106516

RESUMO

BACKGROUND: The use of Bt plants has been the main strategy for controlling the fall armyworm Spodoptera frugiperda (J. E. Smith) in Brazil. However, many resistance cases were already registered. The resistance of S. frugiperda to the Vip3Aa20 protein was recently characterized under laboratory conditions but it is still efficient under field conditions. Here, resistance monitoring studies were conducted using phenotypic (purified protein and Bt maize leaves) and genotypic (F1 and F2 screen) methods to support insect resistance management (IRM) programs and preserve Vip3Aa20 technology on maize. RESULTS: Phenotypic monitoring with purified protein showed two populations significantly different from the susceptible strain on the second crop season in 2016. This number increased for the first and second crop seasons in 2017 in several regions. The genotypic monitoring estimated a mean frequency of the resistance allele of 0.0027 for the F1 screen and 0.0033 for the F2 screen. Three new resistant strains to Vip3Aa20 were selected from F2 screen assays. Complementation tests on these new resistant strains were positive with the previous resistant strain. CONCLUSION: Here we showed that the resistance allele of S. frugiperda to Vip3Aa20 protein is widely distributed in maize-producing regions in Brazil and its frequency increases throughout crop seasons. © 2019 Society of Chemical Industry.


Assuntos
Spodoptera/genética , Animais , Proteínas de Bactérias , Brasil , Endotoxinas , Frequência do Gene , Proteínas Hemolisinas , Proteínas de Insetos , Resistência a Inseticidas , Larva , Plantas Geneticamente Modificadas , Zea mays
18.
Pest Manag Sci ; 75(10): 2682-2689, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30761724

RESUMO

BACKGROUND: Understanding the genetic basis of insect resistance to insecticides can help to implement insecticide resistance management (IRM) strategies. In this study, we selected a strain of Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) resistant to chlorantraniliprole using the F2 screen method, characterized the inheritance of resistance and evaluated patterns of cross-resistance to other diamide insecticides. RESULTS: The chlorantraniliprole-resistant strain (Chlorant-R) was selected from a field-collected population with an estimated allele frequency of 0.1316. The estimated median lethal concentration (LC50 ) values were 0.011 and 2.610 µg a.i. cm-2 for the susceptible (Sus) and Chlorant-R strains, respectively, resulting in a resistance ratio (RR) of 237-fold. The LC50 values of the reciprocal crosses were 0.155 and 0.164 µg a.i. cm-2 , indicating that resistance is autosomally inherited. Resistance was characterized as incompletely recessive and monogenic at concentrations close to the recommended field rates of chlorantraniliprole. Survival of the resistant strain and heterozygous larvae in maize plants treated at the field rate was ∼ 60 (similar to the susceptible strain on untreated maize) and 15%, respectively. The Chlorant-R strain showed low cross-resistance to cyantraniliprole (RR ∼ 27-fold) and very high cross-resistance to flubendiamide (RR > 42 000-fold). CONCLUSIONS: The frequency of chlorantraniliprole resistance allele was moderately high in a field-collected population of S. frugiperda. The inheritance of chlorantraniliprole resistance was characterized as autosomal, incompletely recessive and monogenic. S. frugiperda showed cross-resistance to other diamide insecticides. These results provide essential information for the implementation of IRM programs to preserve the useful life of diamide insecticides for controlling S. frugiperda in Brazil. © 2019 Society of Chemical Industry.


Assuntos
Hereditariedade/genética , Resistência a Inseticidas/genética , Inseticidas/farmacologia , Larva/genética , Spodoptera/genética , ortoaminobenzoatos/farmacologia , Animais , Diamida/farmacologia , Larva/efeitos dos fármacos , Larva/crescimento & desenvolvimento , Spodoptera/efeitos dos fármacos , Spodoptera/crescimento & desenvolvimento
19.
J Invertebr Pathol ; 161: 1-6, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30582929

RESUMO

The resistance of fall armyworm, Spodoptera frugiperda, has been characterized to Cry and Vip3A proteins of Bacillus thuringiensis (Bt) expressed in maize in Brazil. Here, we investigate the cross-resistance to Bt-insecticide XenTari in selected fall armyworm strains resistant to Bt maize varieties. The LC50 of XenTari in neonates of resistant strains ranged from 0.28 to 0.68 µg a.i./cm2, while for the susceptible reference strain (Sus), LC50 was 0.21 µg a.i./cm2. This indicated a resistance ratio lower than 3.2-fold. A similar variation in susceptibility was detected in EC50 values, which ranged from 0.04 to 0.13 µg a.i./cm2, demonstrating a maximum resistance ratio of 4.3-fold relative to the Sus strain (EC50 = 0.03 µg a.i./cm2). In the F1 progeny from reciprocal crosses, the LC50 ranged from 0.28 to 0.64 µg a.i./cm2 and EC50 from 0.03 to 0.18 µg a.i./cm2, similar to the values verified in parental resistant strains and representing a maximum resistance ratio of 3.0 and 6.0-fold, respectively. We also determined that susceptibility of third instar larvae to XenTari decreased when compared to neonates, however the variation remained similar. For third instar larvae from resistant strains, LC50 of XenTari ranged from 10.79 to 39.85 µg a.i./cm2, while for the Sus strain, LC50 was 9.25 µg a.i./cm2 (resistance ratio inferior to 4.3-fold). At the same stage, in heterozygous strains the LC50 ranged from 14.75 to 58.47 µg a.i./cm2 (resistance ratio inferior to 6.3-fold). Our data demonstrate a lack of significant cross-resistance to Bt-based insecticide XenTari in fall armyworm strains with resistance to Bt maize varieties.


Assuntos
Resistência a Inseticidas/genética , Spodoptera/genética , Zea mays/genética , Animais , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Bioensaio/métodos , Inseticidas/farmacologia , Larva/efeitos dos fármacos , Larva/metabolismo , Plantas Geneticamente Modificadas
20.
Artigo em Inglês | MEDLINE | ID: mdl-29656552

RESUMO

INTRODUCTION: The multi-phase or four-dimensional computed tomography (4D CT) has emerged as a promising technique for preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism (PHPT), but little is known about its accuracy in patients with normocalcemic primary hyperparathyroidism (NPHPT). METHODS: A total of 18 patients diagnosed with PHPT underwent three methods of preoperative localization (4D CT, TC-99-Sestamibi scintigraphy and ultrasonography). After surgery, the results of imaging were compared with operative findings, pathological and biochemical data to evaluate the sensitivity and of each localization procedure. RESULTS: In NPHPT the sensitivity for identifying the parathyroid lesion, according to presentation of PHPT (hypercalcemic or normocalcemic), was better with 4DCT in comparison to USG and scintigraphy. In these patients, the sensitivity for lateralization was as follows: USG: 22% (95% CI 0-44.9), scintigraphy: 11.1% (95% CI 0-31.6), 4DCT: 55.6% (95% CI 23.1-88). In hypercalcemic patients the results were as follows: USG: 58.3% (95% CI 30.4-86.2), scintigraphy: 75% (95% CI 50.5-99.5), 4DCT: 75% (95% CI 50.5-99.5). There was a poor agreement between the three procedures in the identification of the parathyroid lesions, with Kappa coeficients of 0.292 and 0.01 for scintigraphy and 4DCT, respectively, in comparison to USG. CONCLUSION: Our data showed that 4DCT had a better performance as a preoperative localization procedure of the parathyroid lesion in patients with NPHPT.

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