Phantom development for radiographic image optimization of chest, skull and pelvis examination for nonstandard patient.

The construction of the adapted patient equivalent phantom (APEP) to simulate the X-ray scattering and absorption by chest, skull and pelvis of nonstandard patient in conventional radiographic equipment is presented. This APEP system is associated to the pre-existing realistic-analytic phantom (RAP) [Pina, D.R., Duarte, S.B., Ghilardi Netto, T., Trad, C. S., Brochi, M.A.C., Oliveira, S.C. de, 2004. Optimization of standard patient radiographic images for chest, skull and pelvis exams in conventional X-ray equipment. Phys. Med. Biol. 49, N215-N226] forming the coupled phantom (RAP-APEP), which is used to establish an optimization process of radiographic images of chest, skull and pelvis for nonstandard patients. A chart of the optimized radiographic technique is established covering a wide range of nonstandard patient thickness, and offering a dose reduction in comparison with those techniques currently used. Different validation processes were applied to confirm the improving of the radiographic image quality when techniques of the established chart are used.

Development of phantom for radiographic image optimization of standard patient in the lateral view of chest and skull examination.

We present the construction of a homogeneous phantom to be used in simulating the scattering and absorption of X-rays by a standard patient chest and skull when irradiated laterally. This phantom consisted of lucite and aluminium plates with their thickness determined by a tomographic exploratory method applied to the anthropomorphic phantom. Using this phantom, an optimized radiographic technique was established for chest and skull of standard sized patient in lateral view. Images generated with this optimized technique demonstrated improved image quality and reduced radiation doses.

Local edema and hemorrhage caused by Crotalus durissus terrificus envenoming evaluated by magnetic resonance imaging (MRI)

The objective of this study was to detect the presence of local edema and hemorrhage caused by Crotalus durissus terrificus envenoming using magnetic resonance imaging (MRI). Six patients bitten by Crotalus durissus terrificus snakes were treated at the Emergency Unit and Tropical Diseases Unit of Botucatu School of Medicine, UNESP, Säo Paulo State, Brazil. After receiving specific serotherapy, the patients were submitted to MR of the bite site. Post contrast T1 and T2 spin-echo MRI were obtained revealing the following lesions: edema associated with hemorrhage in subcutaneous and muscular tissue (n=3), edema in subcutaneous tissue (n=2), and perimuscular hemorrhage (n=1). In this study, MR demonstrated a local effect of Crotalus durissus terrificus envenoming in inducing edema and hemorrhage, mainly in muscular tissues and perimuscular areas. These results indicate that Crotalus durissus terrificus venom cause a local muscular tissue damage in human envenoming represented by edema and hemorrhage.

Tissue damage caused by Bothrops sp envenoming evaluated by magnetic resonance imaging (MRI)

The objective of this clinical study was to evaluate local tissue damage caused by Bothrops sp envenoming in relation to lesion type and damaged tissues using magnetic resonance imaging (MRI). Fifteen patients bitten by Bothrops snakes were treated at the Emergency Unit of the Tropical Diseases Unit at the University Hospital, Botucatu School of Medicine, UNESP, Säo Paulo State, Brazil. After receiving specific serotherapy, the patients were submitted to MR of the bite site. T1 spin-echo MRI were obtained revealing the following lesions: edema (n=9), edema associated with hemorrhage (n=5), and hemorrhage (n=1). Perimuscular areas (n=6) and subcutaneous tissues (n=5) were the most affected, followed by muscular tissues (n=4). It is important to mention that MRI did not show myonecrosis of the bite site, a widely reported finding in anatomical and histopathological experimental studies.

Sputum cytology in the diagnosis of pulmonary paracoccidioidomycosis.

The presence of Paracoccidioides brasiliensis was determined in sputum samples from 50 patients with paracoccidioidomycosis using four different techniques: (a) cell-block preparations stained with silver methenamine, (b) direct microbiologic examination, (c) smears stained with Shorr, and (d) smears stained with silver methenamine. Overall, cell-block preparations and smears stained with silver methenamine proved to be the most sensitive techniques, followed by smears stained with Shorr and direct microbiologic examination in decreasing order of sensitivity. Sputum cytology tended to be less positive in patients with interstitial pulmonary lesions as determined by chest X-ray than in patients with alveolar lesions. In addition to its high sensitivity, cell-block preparation technique allows storage of blocks and slides for further studies.

Mal de Pott em lactantes de 11 meses de idade / Pott's disease in an infant of 11 months old

Apresenta-se um paciente do sexo masculino, de 11 meses e 6 dias, que apresentava adenopatia cervical, axilar e inguinal há 1 semana e diminuiçäo de atividade, palidez, vômitos pós-alimentares e dificuldade respiratória há 3 dias. Antecedentes familiares: baixa condiçäo sócio-econômica e mäe com Tbc, e tratamento irregular durante esta gestaçäo. O paciente nasceu com desnutriçäo intra-uterina, apresentava retardo de desenvolvimento deformidade torácica. Pelo exame clínico e radiológico tratava-se de paciente com tuberculose pulmonar e vertebral. Foi iniciado esquema tríplice, imobilizaçäo no leito e posteriormente colete de gesso. Após 5 meses de tratamento a criança passou a sentar sozinha e trocar passos e com 2 anos estava andando e correndo, apesar do quadro radiológico de coluna ficar inalterado

Avaliacao do tratamento da paracoccidioidomicose com o ketoconazol. / Evaluation of the treatment of paracoccidioidomycosis with ketoconazole

Foram tratados 12 doentes atendidos na Disciplina de Molestias Infecciosas e Parasitarias da Faculdade de Medicina de Botucatu com diagnostico etiologico de paracoccidioidomicose que apresentavam lesoes organicas multiplas e evolucao prolongada.O tratamento foi realizado por 18 meses, com o Ketoconazol, pela via oral, nas doses diarias de 400 mg no primeiro mes e de 200 mg nos meses seguintes. Todos os doentes foram acompanhados durante o tratamento e, em media 4 meses e meio apos o mesmo, clinica, radiologica e sorologicamente pelas reacoes de imunofluorescencia indireta, precipitinas e imunodifusao em gel.A competencia imunitaria foi avaliada em todos os doentes antes do tratamento e repetida em quatro, no final do mesmo. Os resultados mostraram que houve recaida em 5 doentes. A droga foi bem tolerada e a imunodifusao em gel e a hemossedimentacao foram as provas que mostraram maior paralelismo com a evolucao clinica