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Interictal and postictal 18F-FDG PET/CT in epileptogenic zone localization
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Carvalho, Marcela Santos

; Alvim, Marina Koutsodontis Machado

; Etchebehere, Elba

; Santos, Allan de Oliveira

; Ramos, Celso Dario

; Argenton, Juliana Luz Passos

; Cendes, Fernando

; Amorim, Bárbara Juarez

Radiologia Brasileira

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oct 2022, Volume 55 N. 5 Pages 273 - 279

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Avaliar a capacidade da PET/CT FDG detectar a zona epileptogênica, com injeção da FDG realizada tanto no período interictal como perto de uma crise epiléptica. Materiais e Métodos: Foram avaliados pacientes com epilepsia de difícil controle que realizaram PET/CT FDG. A zona epileptogênica foi definida pelo follow up/anatomopatológico ou eletroencefalogramas (EEGs) seriados, telemetria e ressonância magnética. PET/CT FDG foi realizada independentemente se o paciente tinha crise epiléptica durante a monitoração com EEG ou no período interictal. Os resultados foram definidos como concordantes ou discordantes, comparando com a zona epileptogênica. Resultados: Foram incluídos no estudo 110 pacientes: 10 no grupo pós-ictal (injeção de FDG depois da crise) e 100 no grupo interictal. A PET/CT FDG foi concordante com a zona epileptogênica em nove pacientes do grupo pós-ictal (90%) e 60 pacientes do grupo interictal (60%). Entre os nove pacientes concordantes do grupo pós-ictal, quatro mostraram hipermetabolismo (44,4%) e cinco mostraram hipometabolismo na zona epileptogênica (55,6%). Conclusão: Nossos resultados confirmaram que a PET/CT FDG é uma ferramenta útil na localização da zona epileptogênica e a monitoração com EEG é muito importante para correlacionar os achados. Além disso, PET/CT FDG realizada no período pós-ictal é capaz de identificar a zona epileptogênica, mostrando tanto hipometabolismo como hipermetabolismo.

Abstract Objective: To evaluate the performance of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography ( 18F-FDG PET/CT) in localizing epileptogenic zones, comparing 18F-FDG injection performed in the traditional interictal period with that performed near the time of a seizure. Materials and Methods: We evaluated patients with refractory epilepsy who underwent 18F-FDG PET/CT. The reference standards for localization of the epileptogenic zone were histopathology and follow-up examinations (in patients who underwent surgery) or serial electroencephalography (EEG) recordings, long-term video EEG, and magnetic resonance imaging (in patients who did not). The 18F-FDG injection was performed whether the patient had an epileptic seizure during the EEG monitoring period or not. The 18F-FDG PET/CT results were categorized as concordant or discordant with the reference standards. Results: Of the 110 patients evaluated, 10 were in a postictal group (FDG injection after a seizure) and 100 were in the interictal group. The 18F-FDG PET/CT was concordant with the reference standards in nine (90%) of the postictal group patients and in 60 (60%) of the interictal group patients. Among the nine postictal group patients in whom the results were concordant, the 18F-FDG PET/CT showed hypermetabolism and hypometabolism in the epileptogenic zone in four (44.4%) and five (55.6%), respectively. Conclusion: Our data indicate that 18F-FDG PET/CT is a helpful tool for localization of the epileptogenic zone and that EEG monitoring is an important means of correlating the findings. In addition, postictal 18F-FDG PET/CT is able to identify the epileptogenic zone by showing either hypometabolism or hypermetabolism.

https://doi.org/10.1590/0100-3984.2021.0141

Lithium Intoxication as a cause of reversible dementia mimicking FDG PET features of Alzheimer’s disease
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Mecê, Alexandre Motta

; Abreu, Vitor Corsaletti

; Lamas, Gustavo Manginelli

; Tacla, Rafaella do Rosário

; Minekawa, Thais Benício

; Ramos, Celso Dario

; Balthazar, Marcio Luiz Figueiredo

Dementia & Neuropsychologia

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jun 2022, Volume 16 N. 2 Pages 249 - 252

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO. Demência rapidamente progressiva é uma condição rara, cujos diagnósticos diferenciais incluem intoxicação por drogas como lítio, podendo causar importante disfunção cognitiva. A suspeita clínica, a confirmação laboratorial e a interrupção do uso medicamentoso são elementos fundamentais em seu diagnóstico e manejo. Trata-se de paciente feminina, de 66 anos de idade, que apresentou quadro demencial após intoxicação por lítio. Tal quadro foi acompanhado de sintomas parkinsonianos, além de Tomografia por Emissão de Pósitrons com 18F-Fluodeoxiglicose (18F-FDG PET/CT) compatível com padrão “Alzheimer-like”. Houve melhora objetiva de parâmetros clínicos e imaginológicos após a interrupção do uso medicamentoso. A intoxicação por lítio é uma causa potencialmente reversível de demência rapidamente progressiva. A descontinuação da droga deve ser considerada também em pacientes com níveis normais do metal no sangue se alterações cognitivas forem encontradas. Imagens 18F-FDG PET/CT podem demonstrar achados sugestivos de doença de Alzheimer na intoxicação aguda e parecem ser um método útil no seguimento.

ABSTRACT. Rapidly progressive dementia (RPD) is a rare neurological disorder. Drug toxicity is among the differential diagnoses, including the use of lithium, in which an overdosage might cause cognitive dysfunction. Clinical suspicion, laboratory confirmation, and drug interruption are key points in the management of lithium intoxication. We described a 66-year-old female patient under treatment with lithium who developed an RPD associated with parkinsonian symptoms. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed an “Alzheimer-like” pattern, while cerebrospinal fluid biomarkers for the disease were negative. There was a significant clinical and radiological improvement after lithium interruption. Lithium intoxication is a potentially reversible cause of RPD, as demonstrated in this case report. Drug discontinuation should be considered even in patients with normal levels of this metal, if cognitive impairment is detected. 18F-FDG PET/CT images may show an “Alzheimer-like” image pattern in acute intoxication and are useful for monitoring these patients.

https://doi.org/10.1590/1980-5764-dn-2021-0105

Posicionamento sobre Diagnóstico e Tratamento da Amiloidose Cardíaca – 2021
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Simões, Marcus V.

; Fernandes, Fabio

; Marcondes-Braga, Fabiana G.

; Scheinberg, Philip

; Correia, Edileide de Barros

; Rohde, Luis Eduardo P.

; Bacal, Fernando

; Alves, Silvia Marinho Martins

; Mangini, Sandrigo

; Biolo, Andréia

; Beck-da-Silva, Luis

; Szor, Roberta Shcolnik

; Marques Junior, Wilson

; Oliveira, Acary Souza Bulle

; Cruz, Márcia Waddington

; Bueno, Bruno Vaz Kerges

; Hajjar, Ludhmila Abrahão

; Issa, Aurora Felice Castro

; Ramires, Felix José Alvarez

; Coelho Filho, Otavio Rizzi

; Schmidt, André

; Pinto, Ibraim Masciarelli Francisco

; Rochitte, Carlos Eduardo

; Valicelli, Flávio Henrique

; Vieira, Marcelo Luiz Campos

; Mesquita, Cláudio Tinoco

; Ramos, Celso Dario

; Soares-Junior, José

; Romano, Minna Moreira Dias

; Mathias Junior, Wilson

; Garcia Junior, Marcelo Iório

; Montera, Marcelo Westerlund

; Melo, Marcelo Dantas Tavares de

; Silva, Sandra Marques e

; Garibaldi, Pedro Manoel Marques

; Alencar Neto, Aristóteles Comte de

; Lopes, Renato Delascio

; Ávila, Diane Xavier de

; Viana, Denizar

; Saraiva, José Francisco Kerr

; Canesin, Manoel Fernandes

; Oliveira, Glaucia Maria Moraes de

; Mesquita, Evandro Tinoco

Arquivos Brasileiros de Cardiologia

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sep 2021, Volume 117 N. 3 Pages 561 - 598

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210718 330 downloads

Fluorodeoxyglucose-positron emission tomography staging can replace bone marrow biopsy in Hodgkin's lymphoma. Results from Brazilian Hodgkin's Lymphoma Study Group
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Cerci, Juliano Júlio

; Bogoni, Mateos

; Buccheri, Valeria

; Etchebehere, Elba Cristina Sá de Camargo

; Silveira, Talita Maira Bueno da

; Baiocchi, Otavio

; Pereira Neto, Carlos de Araujo Cunha

; Sapienza, Marcelo Tatit

; Marin, Jose Flavio Gomes

; Meneghetti, José Cláudio

; Novis, Yana

; Souza, Carmino Antonio de

; Chiattone, Carlos

; Torresan, Marcia

; Ramos, Celso Dario

Hematology, Transfusion and Cell Therapy

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sep 2018, Volume 40 N. 3 Pages 245 - 249

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: To investigate, in a large prospective multicenter study, whether 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography is sufficiently accurate to identify clinically important bone marrow involvement by Hodgkin's lymphoma to replace routine bone marrow biopsy in a developing tropical country. Methods: Patients newly diagnosed with Hodgkin's lymphoma were recruited from six cancer centers in Brazil. All were staged by the results of positron emission tomography/computed tomography that were centrally reviewed and by iliac crest bone marrow biopsy. Patients were classified as having marrow disease if they had lymphoma identified by marrow biopsy histology or had focal 2-[18F]-fluoro-2-deoxy-D-glucose marrow uptake that resolved following chemotherapy. Results: A total of 246 participants were recruited from six different centers and 62 (25.2%) were judged to have Hodgkin's lymphoma in the bone marrow. Positron emission tomography and biopsies were concordant in 206 patients (83%). Positron emission tomography correctly identified marrow disease in 59/62 patients (95.1%) and marrow biopsy in 25/62 patients (40.3%). In 22/62 (35.4%) patients, the two techniques were concordant in the diagnosis of marrow involvement. Of the forty discordant results, positron emission tomography found bone marrow involvement in 37 patients, upstaging 22 to stage IV and having an impact on therapeutic decision in nine cases given their reallocation from early to advanced stage. Three false negative positron emission tomography results were obtained with bone marrow biopsy giving positive findings. All three cases were classified as stage IV regardless of bone marrow findings implying no modification in the clinical management. The sensitivity, specificity and accuracy of positron emission tomography for detecting bone marrow disease were 95%, 100% and 98% and for bone marrow biopsy they were 40%, 100% and 84%, respectively. Conclusion: We conclude that positron emission tomography can replace marrow biopsy in Brazilian patients with Hodgkin's lymphoma without compromising clinical management.

https://doi.org/10.1016/j.htct.2018.03.002 603 downloads

SPECT/CT with radiolabeled somatostatin analogues in the evaluation of systemic granulomatous infections
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Monteiro, Paulo Henrique Silva

; Souza, Thiago Ferreira de

; Moretti, Maria Luiza

; Resende, Mariangela Ribeiro

; Mengatti, Jair

; Lima, Mariana da Cunha Lopes de

; Santos, Allan Oliveira

; Ramos, Celso Darío

Radiologia Brasileira

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dec 2017, Volume 50 N. 6 Pages 378 - 382

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Avaliar o estudo SPECT/CT com análogos de somatostatina radiomarcados (RSA) em infecções granulomatosas sistêmicas, em comparação com o estudo com gálio-67 (67Ga). Materiais e Métodos: Vinte e oito paciente com infecção granulomatosa sistêmica ativa foram estudados, incluindo tuberculose, paracoccidioidomicose, pneumocistose, criptococose, aspergilose, leishmaniose, vasculite infecciosa e uma infecção oportunista inespecífica. Vinte e três tinham iniciado o tratamento previamente ao estudo. Todos fizeram imagem de varredura e SPECT/CT, 7 deles pós-injeção de 99mTc-EDDA-HYNIC-TOC e os outros 21 pós-injeção de 111In-DTPA-octreotide. Todos os pacientes também fizeram cintilografia com 67Ga, exceto um, que fez biópsia guiada por 99mTc-EDDA-HYNIC-TOC. Resultados: Vinte e sete sítios de atividade foram detectados com 67Ga em 20 de 27 pacientes, também vistos nos estudos com RSA. Ambos foram negativos nos outros 7 pacientes. A captação de RSA foi visualmente menor que a de 67Ga em 11 de 20 pacientes positivos e similar nos outros 9. Um paciente que não pôde fazer cintilografia com 67Ga, fez biópsia guiada por 99mTc-EDDAHYNIC-TOC SPECT/CT em uma cavidade pulmonar com captação desse traçador, que foi positiva para aspergilose. Conclusão: SPECT/CT com 99mTc-EDDA-HYNIC-TOC ou 111In-DTPA-octreotide parece ser uma boa alternativa para o estudo com 67Ga na avaliação de pacientes com doença granulomatosa sistêmica.

Abstract Objective: To evaluate SPECT/CT with radiolabeled somatostatin analogues (RSAs) in systemic granulomatous infections in comparison with gallium-67 (67Ga) citrate scintigraphy. Materials and Methods: We studied 28 patients with active systemic granulomatous infections, including tuberculosis, paracoccidioidomycosis, pneumocystosis, cryptococcosis, aspergillosis, leishmaniasis, infectious vasculitis, and an unspecified opportunistic infection. Of the 28 patients, 23 had started specific treatment before the study outset. All patients underwent whole-body SPECT/CT imaging: 7 after injection of 99mTc-EDDA-HYNIC-TOC, and 21 after injection of 111In-DTPA-octreotide. All patients also underwent 67Ga citrate imaging, except for one patient who died before the 67Ga was available. Results: In 20 of the 27 patients who underwent imaging with both tracers, 27 sites of active disease were detected by 67Ga citrate imaging and by SPECT/CT with an RSA. Both tracers had negative results in the other 7 patients. RSA uptake was visually lower than 67Ga uptake in 11 of the 20 patients with positive images and similar to 67Ga uptake in the other 9 patients. The only patient who did not undergo 67Ga scintigraphy underwent 99mTc-EDDA-HYNIC-TOC SPECT/CT-guided biopsy of a lung cavity with focal RSA uptake, which turned to be positive for aspergillosis. Conclusion: SPECT/CT with 99mTc-EDDA-HYNIC-TOC or 111In-DTPA-octreotide seems to be a good alternative to 67Ga citrate imaging for the evaluation of patients with systemic granulomatous disease.

https://doi.org/10.1590/0100-3984.2016.0076 1005 downloads

Influence of bladder fullness on the detection of urinary tract obstruction by dynamic renal scintigraphy
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Cosenza, Nathalia Novaes

; Lau, Fábio

; Lima, Mariana Cunha Lopes

; Amorim, Barbara Juarez

; Mosci, Camila

; Lima, Marcelo Lopes

; Ramos, Celso Darío

Radiologia Brasileira

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aug 2017, Volume 50 N. 4 Pages 237 - 243

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Verificar a influência da repleção vesical no diagnóstico da obstrução do trato urinário durante a cintilografia renal dinâmica com estímulo de diurético. Materiais e métodos: Foram estudados, retrospectivamente, 82 rins de 82 pacientes submetidos a cintilografia renal dinâmica. Compararam-se as porcentagens de excreção do radiofármaco DTPA-99mTc pelos rins antes e após o esvaziamento vesical nas imagens pós-diurético, classificando-os como obstruídos, indeterminados ou não obstruídos. Resultados: A avaliação da excreção do radiofármaco pelos rins mostrou que houve aumento de 10,4% na taxa de excreção global quando a bexiga foi esvaziada. Dos 82 rins estudados, 40 foram considerados obstruídos, 16 indeterminados e 26 como não obstruídos, na análise com a bexiga repleta. Na análise das imagens após micção, dos 40 classificados como obstruídos, 11 passaram a ser classificados como indeterminados e 3 como não obstruídos. Além disso, dos 16 rins apontados como indeterminados nas imagens com a bexiga repleta, 13 passaram a ser considerados não obstruídos com a bexiga vazia. Conclusão: É fundamental uma imagem após a micção na cintilografia renal dinâmica para uma análise fidedigna da porcentagem de excreção do radiofármaco pelo rim, evitando-se possíveis falso-positivos para obstrução do trato urinário.

Abstract Objective: To investigate the influence of bladder fullness on the diagnosis of urinary tract obstruction during dynamic renal scintigraphy with a diuretic stimulator. Materials and methods: We studied 82 kidneys in 82 patients submitted to dynamic renal scintigraphy with a diuretic stimulator. We compared the proportional elimination of the radiopharmaceutical 99mTc-DTPA from the kidneys before and after bladder emptying in post-diuretic images, classifying each image as representing an obstructed, indeterminate, or unobstructed kidney. Results: The overall elimination of 99mTc-DTPA from the kidneys was 10.4% greater after bladder emptying than before. When the analysis was performed with a full bladder, we classified 40 kidneys as obstructed, 16 as indeterminate, and 26 as unobstructed. When the 40 kidneys classified as obstructed were analyzed after voiding, 11 were reclassified as indeterminate and 3 were reclassified as unobstructed. Of the 16 kidneys classified as indeterminate on the full-bladder images, 13 were reclassified as unobstructed after voiding. Conclusion: In dynamic renal scintigraphy with a diuretic stimulator, it is important to obtain images after voiding, in order to perform a reliable analysis of the proportional excretion of 99mTc-DTPA from the kidneys, avoiding possible false-positive results for urinary tract obstruction.

https://doi.org/10.1590/0100-3984.2016-0061 7078 downloads

Bilateral spontaneous chylothorax after severe vomiting in children
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Rodrigues, Antonio Lucas Lima

; Romaneli, Mariana Tresoldi das Neves

; Ramos, Celso Dario

; Fraga, Andrea de Melo Alexandre

; Pereira, Ricardo Mendes

; Appenzeller, Simone

; Marini, Roberto

; Tresoldi, Antonia Teresinha

Revista Paulista de Pediatria

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dec 2016, Volume 34 N. 4 Pages 518 - 521

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Relatar o caso de uma criança com quilotórax bilateral devido a etiologia pouco frequente: lesão do ducto torácico após quadro de vômitos excessivos. Descrição do caso: Menina, sete anos, apresentava edema facial crônico iniciado após quadro de hiperemese. À avaliação, também apresentava derrame pleural bilateral, com líquido quiloso obtido na toracocentese. Após extensa investigação clínica, laboratorial e radiológica da etiologia do quilotórax, foi definido ser secundário a lesão do ducto torácico por aumento da pressão intratorácica pela manifestação inicial de vômitos, corroborado por achados de linfocintilografia. Comentários: À exceção do período neonatal, o quilotórax é achado infrequente de efusão pleural em crianças. As causas são diversas, incluindo trauma, neoplasia, infecção e doenças inflamatórias; contudo, etiologia como a aqui descrita é pouco relatada na literatura.

Abstract Objective: To report the case of a child with bilateral chylothorax due to infrequent etiology: thoracic duct injury after severe vomiting. Case description: Girl, 7 years old, with chronic facial swelling started after hyperemesis. During examination, she also presented with bilateral pleural effusion, with chylous fluid obtained during thoracentesis. After extensive clinical, laboratory, and radiological investigation of the chylothorax etiology, it was found to be secondary to thoracic duct injury by the increased intrathoracic pressure caused by the initial manifestation of vomiting, supported by lymphoscintigraphy findings. Comments: Except for the neonatal period, chylothorax is an infrequent finding of pleural effusion in children. There are various causes, including trauma, malignancy, infection, and inflammatory diseases; however, the etiology described in this study is poorly reported in the literature.

https://doi.org/10.1016/j.rppede.2016.04.003 2068 downloads

18F-fluoride PET/CT in clinical practice
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Ramos, Celso Darío

Radiologia Brasileira

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aug 2015, Volume 48 N. 4 Pages VII - VIII

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/0100-3984.2015.48.4e2 7367 downloads

The use of spect/ct in the evaluation of heterotopic ossification in para/tetraplegics
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Lima, Maurício Coelho

; Passarelli, Marcus Ceregati

; Dario, Virgílio

; Lebani, Bruno Rodrigues

; Monteiro, Paulo Henrique Silva

; Ramos, Celso Darío

Acta Ortopédica Brasileira

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2014, Volume 22 N. 1 Pages 12 - 16

Abstract: En | Text: En | PDF: En

Objective: To evaluate the stage of maturation and the metabolism of neurogenic heterotopic ossification by using SPECT/CT. Methods: A total of 12 medical records of patients with spinal cord injury, all of them classified according to the ASIA protocol (disability scale from the American Spinal Injury Association) in complete lesion (A) and partial lesions (B, C and D) and registered at the Laboratory of Biomechanics and Rehabilitation of the Locomotor System, were submitted to SPECT/CT evaluation. Results: Sixteen hips with heterotopic ossification observed in X-ray were studied and only two (12.5%) had high osteoblastic activity. Five hips showed medium activity, three (18.75%) low activity and six (37.5%) did not present any activity detected by SPECT/CT. Conclusion: SPECT/CT helps to determinate which patients have a greater risk of relapse after surgical resection, proving to be a useful imaging study in preoperative evaluation that can be used to determinate the postoperative prognosis of these patients. Level of Evidence III, Investigating a Diagnostic Test.

https://doi.org/10.1590/S1413-78522014000100001 3366 downloads

10.

Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients
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Oki, Gláucia Celeste Rossatto

; Pavin, Elizabeth João

; Coelho, Otávio Rizzi

; Parisi, Maria Cândida R.

; Almeida, Raitany C.

; Etchebehere, Elba Cristina Sá de Camargo

; Camargo, Edwaldo Eduardo

; Ramos, Celso Dario

Radiologia Brasileira

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feb 2013, Volume 46 N. 1 Pages 7 - 14

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Este estudo teve por finalidade avaliar a perfusão miocárdica de pacientes com diabetes mellitus tipo 1 (DM1) e tipo 2 (DM2) assintomáticos, sem diagnóstico prévio de doença arterial coronariana (DAC) ou acidente vascular cerebral. MATERIAIS E MÉTODOS: Cinquenta e nove pacientes consecutivos (16 DM1, 43 DM2) foram submetidos a cintilografia de perfusão miocárdica com sestamibi-99mTc (CPM). Foram avaliados quanto ao índice de massa corpórea, controle metabólico do diabetes, dislipidemia, terapia para o diabetes, hipertensão arterial sistêmica, nefropatia, retinopatia, neuropatia periférica, tabagismo e história familiar de DAC. RESULTADOS: CPM foi anormal em 25,4%: 12 (20,3%) com alterações de perfusão e 3 com disfunção ventricular esquerda isolada. Os mais fortes preditores de perfusão miocárdica anormal foram: idade igual ou maior a 60 anos (p = 0,017, odds ratio [OR] = 6,0), neuropatia periférica (p = 0,028, OR = 6,1), nefropatia (p = 0,031, OR = 5,6) e ECG de esforço positivo para isquemia (p = 0,049, OR = 4,08). CONCLUSÃO: A isquemia miocárdica silenciosa ocorre em mais de um em cada cinco diabéticos assintomáticos. Os mais fortes preditores de isquemia foram: idade avançada, neuropatia periférica, nefropatia, retinopatia e ECG de esforço positivo para isquemia.

OBJECTIVE: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. MATERIALS AND METHODS: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. RESULTS: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). CONCLUSION: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia.

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11.

Animal model for training in sentinel lymph node biopsy of the stomach through combined methods
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Alves, José Roberto

; Lopes, Luiz Roberto

; Meirelles, Luciana Rodrigues de

; Ramos, Celso Darío

; Sasasaki, Tânia

; Andreollo, Nelson Adami

Acta Cirúrgica Brasileira

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dec 2012, Volume 27 N. 12 Pages 833 - 840

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Criar e validar uma proposta de modelo animal para o treinamento em pesquisa de linfonodos sentinelas no estômago. MÉTODOS: Em trinta e dois coelhos, mediante laparotomia, foi injetado na subserosa da parede anterior do corpo gástrico, 0,1 ml de fitato marcado com tecnécio-99m (0,2 mCi), seguido pelo mesmo orifício, de 0,2 ml de Azul Patente V® 2,5%. A cavidade abdominal foi avaliada, in vivo, por meio de inspeção para pesquisa de suspeitas de linfonodos azuis e com detector manual de radiação gamma aos cinco, dez e 20 minutos para pesquisa de suspeitas de linfonodos radioativas. Após 20 minutos, foi realizada a ressecção dessas para posterior avaliação da radioactividade (ex vivo) e estudo histológico. RESULTADOS: Foram identificados linfonodos em 30 coelhos (Média de 2,2 linfonodos por animal). Das 90 suspeitas de linfonodos ocorridas no estudo, em 70 casos (77,8%) obteve-se confirmação histológica para tecido linfóide. Destas, a maioria estava localizada na região periesofágica do fundo gástrico. A amostra apresentou taxa de mortalidade de 6,25% e nove intercorrências relacionadas ao método, que interferiram na identificação dos linfonodos. CONCLUSÃO: O modelo animal para pesquisa de linfonodos sentinelas em estômago de coelhos mostrou-se factível, pouco complexo e reproduziu as dificuldades encontradas para a pesquisa de linfonodos gástricos em humanos, sendo adequado para o treinamento cirúrgico.

PURPOSE: Create and validate a proposed animal model for training in sentinel lymph node biopsy of the stomach. METHODS: In thirty-two rabbits, through a laparotomy, they received a subserosal injection of 0.1 ml of phytate labeled with technetium-99m (0.2 mCi) in the anterior wall of the gastric corpus, followed by 0.2 ml of Blue Patent V® 2.5%, through the same puncture site. Suspicious lymph nodes were searched in vivo at five, ten and 20 minutes, both visually (Blue Patent stained lymph nodes) and with a manual gamma radiation detector (to detect suspected radioactive lymph nodes). After 20 minutes, was performed resection of these for further evaluation of radioactivity (ex vivo) and histological study. RESULTS: Lymph nodes were identified in 30 rabbits (Average of 2.2 lymph nodes per animal). Of the 90 suspected lymph nodes that occurred in the study, 70 cases (77.8%) were histologically confirmed for lymphoid tissue. Of these, the majority were located in the periesophageal region of the gastric fundus. The sample presented a mortality rate of 6.25% and nine complications related to the method, which interfered in the identification of the lymph nodes. CONCLUSION: The animal model for sentinel node biopsy in rabbit stomachs proved to be feasible, with low complexity and reproduced the difficulties encountered for gastric lymph node biopsy in humans, being adequate for surgical training.

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12.

Is liver transplantation associated with decreased bone mass in climacteric women?
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Baccaro, Luiz Francisco

; Boin, Ilka de Fátima

; Costa-Paiva, Lúcia

; Leal, Aline Garcia

; Ramos, Celso Dario

; Pinto-Neto, Aarão Mendes

Revista Brasileira de Ginecologia e Obstetrícia

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jul 2012, Volume 34 N. 7 Pages 335 - 342

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar se mulheres climatéricas submetidas a transplante de fígado tiveram maior prevalência de massa óssea diminuída do que aquelas sem antecedente de doença hepática. MÉTODOS: Estudo de corte transversal, com 48 mulheres em acompanhamento ambulatorial em um hospital universitário na região Sudeste do Brasil, no período de 04 de fevereiro de 2009 a 05 de janeiro de 2011. Foram incluídas 24 mulheres submetidas a transplante hepático há pelo menos um ano, com idades igual ou superior a 35 anos, e 24 sem antecedente de doença hepática, com idade (± três anos) e padrão menstrual semelhante ao das transplantadas. As mulheres foram submetidas a exames laboratoriais (hormônio folículo estimulante e estradiol) e densitometria óssea de coluna lombar e fêmur, com equipamento Hologic, Discovery WI. A análise estatística foi realizada por meio do teste exato de Fisher, por Odds Ratio (OR) simples e pela regressão logística múltipla. RESULTADOS: A média etária das mulheres incluídas no estudo foi de 52,8 (±10,7) anos, sendo que 27,1% estavam na pré-menopausa e 72,9%, na peri/pós-menopausa. Aproximadamente 14,6% dessas mulheres apresentaram osteoporose e 35,4%, baixa massa óssea. Os seguintes itens foram associados com massa óssea diminuída: estar na pós-menopausa (OR=71,4; IC95% 3,8 - 1.339,7; p<0,0001), idade atual maior que 49 anos (OR=11,4; IC95% 2,9 - 44,0; p=0,0002) e nível de estradiol sérico menor que 44,5 pg/mL (OR=18,3; IC95% 3,4 - 97,0; p<0,0001). Ter antecedente de transplante hepático não se associou massa óssea diminuída (OR=1,4; IC95% 0,4 - 4,3; p=0,5). CONCLUSÃO: O transplante hepático não se associou massa óssea diminuída nesse grupo de mulheres climatéricas.

PURPOSE: To evaluate whether climacteric women undergoing liver transplantation had higher prevalence of decreased bone mass than those without any liver disease. METHODS: A cross-sectional study with 48 women receiving follow-up care at a university hospital in Southeastern Brazil, from February 4th 2009 to January 5th 2011, was conducted. Of these women, 24 were 35 years or older and had undergone liver transplantation at least one year before study entry. The remaining 24 women had no liver disease and their ages and menstrual patterns were similar to those of transplanted patients. Laboratorial tests (follicle-stimulating hormone and estradiol) and bone density measurements of the lumbar spine and femur (equipment Hologic, Discovery WI) were performed. Statistical analysis was carried out by Fisher's exact test, simple Odds Ratio (OR), and multiple logistic regression. RESULTS: Mean age of the women included in the study was 52.8 (±10.7) years-old, 27.1% were premenopausal and 72.9% were peri/postmenopausal. Approximately 14.6% of these women exhibited osteoporosis and 35.4% had low bone mass. The following items were associated with decreased bone mass: being postmenopausal (OR=71.4; 95%CI 3.8 - 1,339.7; p<0.0001), current age over 49 years-old (OR=11.4; 95%CI 2.9 - 44.0; p=0.0002), and serum estradiol levels lower than 44.5 pg/mL (OR=18.3; 95%CI 3.4 - 97.0; p<0.0001). Having a history of liver transplantation was not associated with decreased bone mass (OR=1.4; 95%CI 0.4 - 4.3; p=0.56). CONCLUSION: Liver transplantation was not associated with decreased bone mass in this group of climacteric women.

1805 downloads Cited 1 time in SciELO

13.

Função linfática do membro superior no pré-operatório de câncer de mama
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Rezende, Laura Ferreira de

; Pedras, Felipe Vilela

; Ramos, Celso Dario

; Gurgel, Maria Salete Costa

Revista da Associação Médica Brasileira

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oct 2011, Volume 57 N. 5 Pages 540 - 544

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Descrever o padrão linfocintilográfico do membro superior em mulheres no pré-operatório de câncer de mama. MÉTODOS: Foram estudadas 37 pacientes que realizaram a linfocintilografia até 30 dias antes da cirurgia, sendo 37 estudos linfocintilográficos de membros superiores ipsilaterais à cirurgia e 32 contralaterais. O protocolo de exame consistiu na realização de imagens estáticas do membro superior em semiflexão após 10 minutos, 1 e 2 horas da injeção subcutânea de 1 mCi (37 MBq) de dextran-99mTc no dorso da mão. Foram feitas análises da velocidade de aparecimento dos linfonodos axilares (I, visíveis aos 10 minutos; II, 1 hora; III, 2 horas e IV, não visíveis) e do grau (intensidade) de captação dos mesmos (a, acentuada; b, moderada; c , discreta e d, ausente). RESULTADOS: Quatro (11%) pacientes apresentaram o padrão de estado da funcionalidade linfática considerado ideal (Ia) no membro superior ipsilateral, enquanto seis (19%) apresentaram no contralateral. Três (8%) apresentaram a pior classificação (IVd) no membro superior ipsilateral e duas (6%) no contralateral. As demais pacientes apresentaram estados intermediários de velocidade e intensidade de captação. CONCLUSÃO: Este estudo encontrou relevantes alterações na linfocintilografia pré-operatória, demonstrando a preexistência de diferenças funcionais do sistema linfático.

OBJECTIVE: To describe the preoperative upper limb lymphoscintigraphic pattern in women with breast cancer. METHODS: Thirty-seven patients undergoing lymphoscintigraphy within 30 days of surgery were investigated. Lymphoscintigraphic studies of 37 upper limbs ipsilateral to surgery and 32 contralateral upper limbs were performed. The examination protocol consisted in obtaining static images of the upper limb in semi-flexion after 10 minutes, and 1 and 2 hours after subcutaneous injection of 1 mCi (37 MBq) of Tc-99m-dextran in the dorsum of the hand. The velocity of axillary lymph node visualization (I, visible at 10 minutes; II, 1 hour; III, 2 hours; and IV, invisible) and degree (intensity) of nodal uptake (a, marked; b, moderate; c,mild; and d, absent) were analyzed. RESULTS: Optimal lymphatic functional pattern (Ia) was observed in four (11%) patients, in the ipsilateral upper limb, and six (19%), in the contralateral upper limb. Worse condition was observed in three (8%) patients (IVd) in the ipsilateral upper limb and two (6%) patients in the contralateral upper limb. The remaining patients showed intermediate states of velocity and uptake intensity. CONCLUSION: This study found relevant changes in preoperative lymphoscintigraphy, demonstrating preexisting functional differences in the lymphatic system.

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14.

Functional electrical stimulation improves brain perfusion in cranial trauma patients
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Amorim, Bárbara Juarez

; Santos, Allan de Oliveira

; Oberg, Telma Dagmar

; Romanato, Juliana

; Anjos, Dalton A.

; Lima, Mariana da Cunha Lopes de

; Ramos, Celso Darío

; Honorato, Donizete Cesar

; Camargo, Edwaldo Eduardo

; Etchebehere, Elba Cristina de Sá Camargo

Arquivos de Neuro-Psiquiatria

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aug 2011, Volume 69 N. 4 Pages 682 - 686

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Demonstrar mudanças na perfusão cerebral devido à ativação neuronal depois de estimulação elétrica funcional (EEF). MÉTODO: Foram estudados 14 pacientes com hemiplegia submetidos a quatorze semanas de um programa com EEF. O SPECT de perfusão cerebral foi realizado antes e depois da terapia com EEF. Estes pacientes foram separados em 2 grupos com relação à causa da hemiplegia: trauma craniano e acidente vascular cerebral (AVC). As imagens de SPECT foram analisadas usando SPM. RESULTADOS: Houve diferença estatisticamente significativa entre os dois grupos relacionada a idade dos pacientes e extensão da hipoperfusão. Os pacientes com trauma craniano tiveram redução na área de hipoperfusão e pacientes com AVC tiveram aumento na área de hipoperfusão após terapia com EEF. CONCLUSÃO: A terapia com EEF pode levar a melhora na perfusão cerebral em pacientes com lesões cerebrais secundárias a trauma craniano; entretanto, provavelmente não em pacientes com extensas áreas de infarto secundárias a AVC.

OBJECTIVE: Demonstrate brain perfusion changes due to neuronal activation after functional electrical stimulation (FES). METHOD: It was studied 14 patients with hemiplegia who were submitted to a program with FES during fourteen weeks. Brain perfusion SPECT was performed before and after FES therapy. These patients were further separated into 2 groups according to the hemiplegia cause: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. RESULTS: There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT. Patients with cranial trauma had a reduction in the hypoperfused area and patients with major vascular insult had an increase in the hypoperfused area after FES therapy. CONCLUSION: FES therapy can result in brain perfusion improvement in patients with brain lesions due to cranial trauma but probably not in patients with major vascular insults with large infarct area.

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15.

Low bone mass density is associated with hemolysis in brazilian patients with sickle cell disease
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Baldanzi, Gabriel

; Traina, Fabiola

; Marques Neto, João Francisco

; Santos, Allan Oliveira

; Ramos, Celso Dario

; Saad, Sara T Olalla

Clinics

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2011, Volume 66 N. 5 Pages 801 - 805

Abstract: En | Text: En | PDF: En

OBJECTIVES: To determine whether kidney disease and hemolysis are associated with bone mass density in a population of adult Brazilian patients with sickle cell disease. INTRODUCTION: Bone involvement is a frequent clinical manifestation of sickle cell disease, and it has multiple causes; however, there are few consistent clinical associations between bone involvement and sickle cell disease. METHODS: Patients over 20 years of age with sickle cell disease who were regularly followed at the Hematology and Hemotherapy Center of Campinas, Brazil, were sorted into three groups, including those with normal bone mass density, those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared using statistical analyses. RESULTS: In total, 65 patients were included in this study: 12 (18.5%) with normal bone mass density, 37 (57%) with osteopenia and 16 (24.5%) with osteoporosis. Overall, 53 patients (81.5%) had bone mass densities below normal standards. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p<0.05). Osteoporosis patients also had decreased hemoglobin levels (p<0.05). Hemolysis was significantly increased in patients with osteoporosis compared with patients with osteopenia, as indicated by increased lactate dehydrogenase levels and reticulocyte counts as well as decreased hemoglobin levels. Osteoporosis patients were older, with lower glomerular filtration rates than patients with osteopenia. There was no significant difference between the groups with regard to gender, body mass index, serum creatinine levels, estimated creatinine clearance, or microalbuminuria. CONCLUSION: A high prevalence of reduced bone mass density that was associated with hemolysis was found in this population, as indicated by the high lactate dehydrogenase levels, increased reticulocyte counts and low hemoglobin levels.

2845 downloads Cited 1 time in SciELO

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