ABSTRACT BACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.

Resumo Radiologistas devem estar familiarizados com as principais técnicas de reparo cirúrgico da cartilagem do joelho e os métodos de imagem disponíveis para sua avaliação, no intuito de otimizar o seguimento pós-operatório do paciente. O presente estudo tem por finalidade, por meio de uma coletânea de casos do nosso serviço, ilustrar as principais técnicas cirúrgicas aplicadas ao reparo da cartilagem do joelho, bem como as técnicas de ressonância magnética usualmente utilizadas na avaliação pós-operatória e os achados radiológicos relevantes.

Abstract Radiologists should be familiar with the main techniques of knee cartilage repair and the imaging methods available for its evaluation, in order to optimize the postoperative follow-up of patients. The objective of this study was to present a series of clinical cases seen at our facility, illustrating the main techniques necessary for the repair of knee cartilage, as well as the magnetic resonance imaging techniques used in the postoperative evaluation and the relevant radiological findings.

Two ruthenium complexes of the type [RuCl(dmso)(L)2]Cl {L = 4,4’-dimethyl-2,2’-bipyridine (dmbpy); 4,4’-dinonyl-2,2’-bipyridine (dnbpy)} have been synthesized and characterized by elemental analysis, 1H NMR, FTIR, electronic spectra, and molar conductivity. The IR spectral studies revealed that the DMSO molecule is S-bound ( νSO= 1100 cm-1; 1079 cm-1). For complexes, MLCT bands were observed around 390 nm and 440 nm. The measurements of conductivity revealed the presence of 1:1 electrolyte. Interactions of ruthenium complexes with human serum albumin were examined by fluorescence spectroscopy. The results revealed a combined quenching mechanism of HSA fluorescence by [RuCl(dmso)(dmbpy)2]Cl, with binding constant of 5.82 ± 0.08 x 105 mol-1 L (297 K), 5.29 ± 0.06 x 105 mol-1 L (303 K), and 4.68 ± 0.06 x 105 mol-1 L (313 K), whereas the [RuCl(dmso)(dnbpy)2]Cl caused static quenching predominantly, with binding constant of 9.87 ± 0.05 x 105 mol-1 L (297 K), 3.41 ± 0.04 x 105 mol-1 L (303 K), and 0.89 ± 0.05 x 105 mol-1 L (313 K). The binding process occurred spontaneously and was mainly driven by enthalpy, as evidenced by thermodynamic parameters. Site marker competitive experiment showed that ruthenium complexes bind to the warfarin binding site in subdomain IIA of HSA.

Resumo A artroplastia de quadril é um procedimento cirúrgico ortopédico amplamente utilizado e de grande sucesso para tratamento da doença articular, seja esta degenerativa, inflamatória ou traumática, promovendo importante melhora da dor, recuperação da função do membro, redução da incapacidade e melhora da qualidade de vida. Entretanto, existem complicações relacionadas, as quais possuem aspectos de imagem característicos. O presente estudo revisou a literatura e exemplificou essas complicações de forma ilustrativa com a experiência do nosso serviço, abordando os principais aspectos radiológicos das complicações da artroplastia de quadril, englobando ossificação heterotópica, fraturas periprotéticas, osteólise, infecção, desgaste e luxação.

Abstract Hip arthroplasty is a widely used and successful orthopedic procedure for the treatment of degenerative, inflammatory, or traumatic joint disease. The procedure promotes significant pain relief, as well as recovery of limb function, reduction of disability, and better quality of life. However, there are related complications, which have characteristic imaging aspects. In the present study, we review the literature and exemplify such complications using images obtained at our facility, illustrating the main radiological aspects of complications such as heterotopic ossification, periprosthetic fractures, osteolysis, infection, wear, and dislocation.

Resumo Necroses avasculares são um grupo de doenças ósseas que possuem como via comum a morte dos constituintes dos ossos por falta de suprimento vascular. Podem ocorrer nas mais diversas partes do esqueleto, recebendo não somente denominações distintas, como também apresentam epidemiologia única em cada uma dessas localizações. Seus achados nos métodos de imagem, no entanto, são similares, independente do seu sítio de acometimento, passando por fases radiológicas já bem descritas. Se não forem detectadas e manejadas de forma adequada, podem trazer grande morbidade aos pacientes, o que torna o papel do radiologista primordial. O presente estudo faz uma revisão sucinta acerca dos principais aspectos radiológicos das diversas formas de apresentação das necroses avasculares, ilustradas com base em uma coletânea de casos da nossa instituição.

Abstract The term avascular necrosis describes any one of a number of bone diseases that have a common mechanism: the death of bone components due to lack of blood supply. Avascular necrosis can occur in diverse parts of the skeleton, each location-specific form not only receiving a distinct designation but also presenting unique epidemiologic characteristics. However, the imaging findings are similar in all of the forms, which pass through well-described radiological phases, regardless of the site of involvement. Because avascular necrosis can cause considerable morbidity if not properly detected and managed, the radiologist plays a fundamental role. The present study provides a brief review of the main radiological aspects of the various forms of avascular necrosis, illustrated on the basis of a collection of cases from our institution.

Resumo Objetivo Avaliar os resultados anatômicos e funcionais da técnica laparoscópica modificada de Vecchietti para a criação de uma neovagina em pacientes com aplasia vaginal congênita. Métodos Estudo retrospectivo de nove pacientes com aplasia vaginal congênita submetidas à técnica laparoscópica modificada de Vecchietti, no nosso departamento, entre 2006 e 2013. Os resultados anatômicos foram aferidos através da avaliação do comprimento, largura e reepitelização da neovagina nas consultas pós-operatórias. Os resultados funcionais foram avaliados com recurso à versão em português do questionário Female Sexual Function Index de Rosen, comparando os resultados das pacientes aos de um grupo de controle de 20 mulheres saudáveis. A análise estatística foi realizada utilizando o programa SPSS Statistics versão 19.0), o teste t de Student, teste U de Mann-Whitney e teste exato de Fisher. Resultados A etiologia subjacente à aplasia vaginal foi a síndrome de Mayer-Roki-tansky-Küster-Hauser em oito casos, e a síndrome de insensibilidade aos andrógenos em um caso. O comprimento vaginal médio pré-operatório era de 2,9 cm. À data da cirurgia, a média de idade das pacientes era de 22,2 anos. A cirurgia foi realizada com sucesso em todos os casos, sem registo de complicações intra ou pós-operatórias. Na primeira avaliação pós-operatória (6 a 8 semanas após a cirurgia), o comprimento vaginal médio foi de 8,1 cm. Em todos os casos, a neovagina estava reepitelizada e com amplitude adequada. As pontuações médias, total e de cada domínio, obtidas no questionário de avaliação da função sexual não diferiram significativamente das do grupo controle: 27,5 vs 30,6 (total); 4.0 vs 4.2 (desejo); 4,4 vs 5,2 (excitação); 5,2 vs 5 , 3 (lubrificação); 4,2 vs 5,0 (orgasmo); 5,3 vs 5,5 (satisfação) e 4,4 vs 5,4 ( conforto ). Conclusões A técnica laparoscópica modificada de Vecchietti é um procedimento simples, seguro e eficaz, permitindo às pacientes com aplasia vaginal congênita uma atividade sexual satisfatória, comparável à dos controles normais.

Abstract Purpose To evaluate the anatomic and functional results of a laparoscopic modified Vecchietti technique for the creation of a neovagina in patients with congenital vaginal aplasia. Methods Retrospective study of nine patients with congenital vaginal aplasia submitted to the laparoscopic Vecchietti procedure, in our department, between 2006 and 2013. The anatomical results were evaluated by assessing the length, width and epithelialization of the neovagina at the postoperative visits. The functional outcome was evaluated using the Rosen Female Sexual Function Index (FSFI) questionnaire and comparing the patients' results to those of a control group of 20 healthy women. The statistical analysis was performed using SPSS Statistics version 19.0 (IBM, Armonk, NY, USA), Student t-test, Mann-Whitney U test and Fisher exact test. Results The condition underlying the vaginal aplasia was Mayer-Rokitansky-KüsterHauser syndrome in eight cases, and androgen insensitivity syndrome in one case. The average preoperative vaginal length was 2.9 cm. At surgery, the mean age of the patients was 22.2 years. The surgery was performed successfully in all patients and no intra or postoperative complications were recorded. At the first postoperative visit (6 to 8 weeks after surgery), the mean vaginal length was 8.1 cm. In all cases, the neovagina was epithelialized and had an appropriate width. The mean FSFI total and single domain scores did not differ significantly from those of the control group: 27.5 vs. 30.6 ( total); 4.0 vs. 4.2 (desire); 4.4 vs. 5.2 (arousal); 5.2 vs. 5.3 (lubrication); 4.2 vs. 5.0 ( orgasm); 5.3 vs. 5.5 (satisfaction) and 4.4 vs. 5.4 ( comfort ). Conclusions This modified laparoscopic Vecchietti technique is a simple, safe and effective procedure, which allows patients with congenital vaginal aplasia to have a satisfactory sexual activity, comparable to that of normal controls.

ABSTRACT Introduction: Capsular contracture is among the main complications of surgeries involving breast implants. The most commonly used classification to assess the degree of contracture is the Baker grading system, which divides contractures into grades I, II, III, and IV. Of these, grade III and IV contractures are considered significant. Although several causes have been postulated, the etiology of capsular contracture remains uncertain. Conventional treatment for contracture is based on a surgical approach, specifically capsulotomy or capsulectomy. These procedures, however, are not exempt from morbidity, and patients may develop complications such as dehiscence, hematoma, seroma, pneumothorax, asymmetry, and contracture recurrence. This study provides a review of alternatives to conventional surgery described in the literature. Methods: We researched the PubMed and Cochrane Library databases using the following keywords: “capsular contracture”, “capsular contracture treatment”, and “capsular contracture breast treatment”. We identified 991 articles from which we selected those discussing medication options for contracture treatment other than capsulectomy and capsulotomy. Results: We identified several studies in which drugs, most commonly zafirlukast, were used to reduce capsular contracture. Conclusion: Among the various reported drugs, zafirlukast exhibited good efficacy and a low rate of complication. Triamcinolone also appears to be a good option, although professional assistance would be needed for drug administration via infiltration. The other drugs described would require further investigation.

RESUMO Introdução: A contratura capsular é uma das principais complicações em cirurgias envolvendo implantes mamários. A classificação mais usada para avaliar o grau de contratura é a de Baker, que a divide em graus I, II, III e IV, sendo as de grau III e IV consideradas significativas. Apesar de existirem diversas teorias, a etiologia da contratura capsular permanece incerta. O tratamento convencional para os casos de contratura é a abordagem cirúrgica com realização de capsulotomia ou capsulectomia. Estes procedimentos, no entanto, não estão isentos de morbidades, com complicações como deiscências, hematomas, seromas, pneumotórax, assimetrias e recidiva da contratura. Este estudo faz uma revisão sobre as alternativas ao tratamento cirúrgico convencional, descritas na literatura. Métodos: Foi realizada pesquisa nas bibliotecas da Pubmed e da Cochrane, utilizando-se os termos: ‘capsular contracture’, ‘capsular contracture treatment’ e ‘capsular contracture breast treatment’. Foram identificados 991 artigos e selecionados os que discutiam opções medicamentosas para o tratamento de contratura, diferentes de capsulectomia e capsulotomia. Resultados: Foram encontrados vårios estudos utilizando drogas com o fim de reduzir a contratura capsular, das quais o Zafirlucaste é apresentado em maior número de trabalhos. Conclusão: Dentre as várias drogas utilizadas, o Zafirlucaste apresentou boa eficácia, com baixos índices de complicação; a Triancinolona parece ser também uma boa opção, no entanto precisa de profissional habilitado para realizar as infiltrações. As demais drogas necessitam de maiores estudos.

OBJECTIVES: To determine the safety of intramyocardial injection of autologous bone marrow cells in patients undergoing surgical myocardial revascularization (CABG) for severe coronary artery disease. INTRODUCTION: There is little data available regarding the safety profile of autologous bone marrow cells injected during surgical myocardial revascularization. Potential risks include arrythmias, fibrosis in the injected sites and growth of non-cardiac tissues. METHODS: Ten patients (eight men) were enrolled; they were 59±5 years old with limiting angina and were non-optimal candidates for complete CABG. Bone marrow cells (1.3±0.3x10(8)) were obtained prior to surgery, and the lymphomonocytic fraction (CD34+=1.8±0.3%) was separated by density gradient centrifugation. During surgery, bone marrow cells were injected in non-grafted areas of ischemic myocardium. During the first year after surgery, the patients underwent laboratory tests, cardiac imaging, and 24-hour ECG monitoring. RESULTS: Injected segments: inferior (n=7), anterior (n=2), septal (n=1), apical (n=1), and lateral (n=1) walls. Except for a transient elevation of C-reactive protein at one month post-surgery (P=0.01), laboratory tests results were within normal ranges; neither complex arrhythmias nor structural abnormalities were detected during follow-up. There was a reduction in functional class of angina from 3.6±0.8 (baseline) to 1.2±0.4 (one year) (P<0.0001). Also, patients had a significant decrease in the ischemic score assessed by magnetic resonance, not only globally from 0.65±0.14 (baseline) to 0.17±0.05 (one year) (P=0.002), but also in the injected areas from 1.11±0.20 (baseline) to 0.34±0.13 (one year) (P=0.0009). CONCLUSIONS: Intramyocardial injection of bone marrow cells combined with CABG appears to be safe. Theoretical concerns with arrhythmias and/or structural abnormalities after cell therapy were not confirmed in this safety trial.

OBJETIVOS: conhecer a prevalência de defeito de fechamento do tubo neural (DFTN) em crianças nascidas na maternidade do Centro de Atenção à Mulher do Instituto Materno Infantil Prof. Fernando Figueira (IMIP) no período de 2000 a 2004. MÉTODOS: estudo descritivo, do tipo corte transversal, cujos dados foram coletados de um banco de dados do Sistema de Informações sobre Nascidos Vivos do qual foram selecionados todos os registros de recém-nascidos com malformação fetal. A partir daí selecionaram-se os recém-nascidos com DFTN ocorridos no período considerado. RESULTADOS: entre os 24.964 nascimentos, foram registrados 709 recém-nascidos apresentando alguma malformação ao nascer. Ao se considerar apenas os recém nascidos com DFTN, observaram-se 124 registros, representando uma prevalência de 0,5% entre nascimentos naquele período. Os recém-nascidos com DFTN apresentaram características semelhantes aos recém-nascidos com malformações, de uma forma geral. A maioria (68,5%) desses recém-nascidos era de parto cesariano e 37,7% apresentaram baixo peso ao nascer. CONCLUSÕES: a prevalência de DFTN entre os nascimentos registrados no Centro de Atenção à Mulher do Instituto Materno Infantil Prof. Fernando Figueira foi elevada (5/1000 nascimentos) e isso, provavelmente é reflexo do fato de a maternidade ser referência para gestações de alto-risco.

OBJECTIVES: to determine neural tube closing defects in newborns delivered in the maternity ward of the Women Care Center of the Instituto Materno Infantil Prof. Fernando Figueira (IMIP). METHODS: a descriptive cross-sectional cohort study, with data collected from a Born Alive Information System from which all records of newborns with fetal malformation were selected. From these records the ones pertaining to newborns between 2000 and 2004 with the neural tube closing defect were considered. RESULTS: of 24.964 births, 709 newborns with some type of malformation were registered. When narrowing this to the newborns with the neural tube closing defect the number disclosed was 124, with a prevalence of 0.5% of the births within the period. Newborns with the neural tube closing defect, in general, had similar characteristics to newborns with other malformations. The majority (68.5%) of these newborns was delivered through C-Section and 37.7% had low birthweight. CONCLUSIONS: a high prevalence of neural tube closing defect was determined, but this could have resulted from the fact that the maternity ward of Instituto Materno Infantil Prof. Fernando Figueira (IMIP) is a referral facility for high-risk pregnancies.