OBJECTIVE: To evaluate endometrial alterations by means of transvaginal ultrasound and to correlate them with hysteroscopic and histological findings in patients under tamoxifen therapy. MATERIALS AND METHODS: The present study was developed in the period between January 2003 and December 2005, including patients under tamoxifen therapy for breast cancer, and presenting with endometrial thickening > 5 mm. The sonographic findings were correlated with hysteroscopic and anatomopathological results. RESULTS: Twenty-five patients, mean age 62.6 years, were selected. The mean time elapsed from the diagnosis of cancer was 4.3 years, and use of tamoxifen, three years. Twenty patients (80%) were asymptomatic, and five (20%) presented with bleeding. Ultrasound showed that 16% of patients had endometrial thickening ranging between 5 mm and 8 mm, 40% between 9 mm and 15 mm, and 44% above 15 mm. Hysteroscopy showed 40% of patients with atrophy, 16% with cystic atrophy, 28% with polyps and 16% with hyperplastic lesion. Anatomopathological study showed 35.2% of patients with normal results, 5.8% with atrophy, 29.4% with polyps and 11.7% with hyperplasia. One case of adenocarcinoma (5.8%) was observed. CONCLUSION: Combined ultrasound and hysteroscopy have proven to be important allies in the evaluation of patients under tamoxifen therapy. Ultrasonography presents low specificity for detecting endometrial thickening, while hysteroscopy is more accurate in the detection of polyps, hyperplasia and neoplastic alterations.

Keywords: Ultrasound, Hysteroscopy, Tamoxifen

OBJECTIVE: The aim of this study was to describe the role of transvulvar ultrasonography in the assessment of anatomical changes following fascia lata sling or tension-free vaginal tape procedures. MATERIALS AND METHODS: Forty women in the age range between 30 and 60 years had fascia lata sling (20 patients) or tension-free vaginal tape (20 patients) placement for treating stress urinary incontinence. Transvulvar ultrasonography was utilized, both pre- and post-operatively, as the main investigational tool in these cases for evaluating the urethrovesical junction vertical and horizontal distances, pubo-urethral distance and proximal urethra length. RESULTS: The urethrovesical junction vertical distance did not vary significantly after the fascia lata sling surgery (p > 0.10). Both the pubo-urethral distance and the proximal urethra length became shorter (p < 0.003), and the urethrovesical junction horizontal distance was reduced only at rest (p = 0.03). The tension-free vaginal tape procedure resulted in a reduction of the urethrovesical junction vertical distance (p = 0.0005) and of the proximal urethra length (p = 0.02). CONCLUSION: Transvulvar ultrasonography was of utmost importance in the demonstration that both the fascia lata sling and tension-free vaginal tape surgical procedures elongate the proximal urethra, even though the fascia lata sling technique does it more effectively. The fascia lata sling technique is more focused on shortening the pubo-urethral distance, and the tension-free vaginal tape, on the correction of the vertical displacement of the urethrovesical junction.

Keywords: Transvulvar ultrasound, Perineal ultrasound, Urethrovesical junction, Stress urinary incontinence, Tension-free vaginal tape, Sling procedure

OBJECTIVE: To determine the intra- and interobserver agreement in the classification of periportal fibrosis, according to the criteria defined at the Niamey Workshop of 1996. MATERIALS AND METHODS: A prospective, observational and transverse study was developed in the period between February, 2005 and March, 2006, in 30 schistosomal patients with no other hepatic findings associated, submitted to abdominal ultrasound. Ultrasonographic studies were independently performed and reviewed by two radiologists at three different moments: the dynamic examination itself (first moment), 30 and 90 days later (second and third moments), by means of the images review performed in a workstation. Intra- and interobserver agreement was evaluated by means of the kappa test. RESULTS: Intraobserver agreement was 0.43 for the first, and 0.57 for the second observer. Interobserver agreement as regards the dynamic examination and images review was respectively 0.46 and 0.71. CONCLUSION: Ultrasonography demonstrated moderate to substantial reproducibility in the classification of periportal fibrosis according to the Niamey criteria.

Keywords: Ultrasonography, Reproducibility of results, Fibrosis, Schistosomiasis

OBJECTIVE: To evaluate the reproducibility of unenhanced and contrast-enhanced computed tomography in the assessment of patients with acute pancreatitis. MATERIALS AND METHODS: Fifty-one unenhanced and contrast-enhanced abdominal computed tomography studies of patients with acute pancreatitis were blindly reviewed by two radiologists (observers 1 and 2). The morphological index was separately calculated for unenhanced and contrast-enhanced computed tomography and the disease severity index was established. Intraobserver and interobserver reproducibility of computed tomography was measured by means of the kappa index (kappa). RESULTS: Interobserver agreement was kappa = 0.666, 0.705, 0.648, 0.547 and 0.631, respectively for unenhanced and contrast-enhanced morphological index, presence of pancreatic necrosis, pancreatic necrosis extension, and disease severity index. Intraobserver agreement (observers 1 and 2, respectively) was kappa = 0.796 and 0.732 for unenhanced morphological index; kappa = 0.725 and 0.802 for contrast-enhanced morphological index; kappa = 0.674 and 0.849 for presence of pancreatic necrosis; kappa = 0.606 and 0.770 for pancreatic necrosis extension; and kappa = 0.801 and 0.687 for disease severity index at computed tomography. CONCLUSION: Computed tomography for determination of morphological index and disease severity index in the staging of acute pancreatitis is a quite reproducible method. The absence of contrast-enhancement does not affect the computed tomography morphological index reproducibility.

Keywords: Pancreatitis, X-ray computed tomography, Disease severity index, Prognosis, Contrast media, Necrosis

OBJECTIVE: Several methods are utilized for determining the radioiodine activity in the treatment of Graves' disease (hyperthyroidism). Some of this methods do not take into consideration the thyroid absorbed dose or the necessary parameters for this estimation. The association between absorbed dose and administered activity depends on effective half-life, iodine uptake and thyroid mass of each patient. The present study was aimed at developing a methodology for individualized 131I therapy for Graves' disease in patients with hyperthyroidism of the Graves' disease. MATERIALS AND METHODS: A neck-thyroid phantom developed at Instituto de Radioproteção e Dosimetria, containing a standard solution of 131I, was utilized for calibrating the scintillation gamma camera and uptake probe installed in the Department of Nuclear Medicine of the Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. RESULTS: The view angle of the collimator/detector assembly presented values compatible with the thyroid gland size for distances of 25 cm (uptake probe) and 45.8 cm (scintillation gamma camera). Calibration factors were 39.3 ± 0.78 and 4.3 ± 0.17 cpm/kBq, respectively. The 14-30-hour interval in the retention curve allows the estimation of activity between two points for determining the effective iodine half-life in the thyroid. CONCLUSION: The utilization of equipment usually available in nuclear medicine clinics is feasible, so this is a simple, effective and low cost methodology.

Keywords: Graves' disease, Hyperthyroidism, Iodine therapy, Iodine-131, Scintillation gamma camera, Uptake probe

OBJECTIVE: To compare the responses of plasmatic ACTH to CRH or combined CRH/desmopressin stimulation in patients with ACTH-dependent Cushing's syndrome submitted to simultaneous, bilateral inferior petrosal sinuses sampling. MATERIALS AND METHODS: The procedure was performed in 21 patients - 14 women and 7 men - diagnosed with ACTH-dependent Cushing's syndrome in the period between January 1998 and December 2003. Upon catheterization of both inferior petrosal sinuses, blood samples for ACTH test were simultaneously collected from the petrosal sinuses and peripheral vein, both in the basal state and three to five minutes after injection of human CRH (100 mg) (six patients), or combined CRH/desmopressin (100 mg + 10 mg) (15 patients). RESULTS: After three minutes, both groups presented increased ACTH levels: CRH (257.77 ± 240.36 in the right petrosal sinus, and 718.78 ± 1358.82 in the left petrosal sinus [mean ± standard error]); combined CRH/desmopressin (1263.35 ± 1842.91 in the right petrosal sinus [p = 0.06], and 583.93 ± 1020.03 in the left petrosal sinus [p = 0.83]). After five minutes, the ACTH levels decreased in the group with CRH (181.07 ± 217.39 in the right petrosal sinus, and 188.25 ± 270.15 in the left petrosal sinus), and presented a progressive increase in the group with combined CRH/desmopressin (1365.29 ± 1832.31 in the right petrosal sinus [p = 0.03], and 866.43 ± 1431.72 in the left petrosal sinus [p = 0.11]). Gradient was absent in the three patients with ectopic secretion. CONCLUSION: Combined CRH/desmopressin stimulation induced a higher production of ACTH in cases of corticotroph adenomas as compared with CRH stimulation, which can improve the diagnostic sensibility of this procedure.

Keywords: Cushing's syndrome, CRH, Desmopressin, Petrosal sinus sampling

OBJECTIVE: To evaluate the shoulders of symptomatic or asymptomatic competitive swimmers, quantifying the incidence of rotator cuff lesions in these athletes MATERIALS AND METHODS: Eleven (eight male and three female) symptomatic and asymptomatic, competitive swimmers (master category) in the age range between 28 and 52 years, had both shoulders prospectively evaluated by ultrasonography for determining the prevalence of injuries in correlation with clinical findings. The studies included at least two orthogonal planes of rotator cuff tendons, as well as non-tendinous components of the shoulder joint. Tendinous findings were classified into tendinosis, probable full-thickness tears and partial-thickness tears. Non-tendinous findings were classified into present or absent. Additionally to the sonographic studies results, the analysis has taken the presence or absence of symptoms and the patients' age into consideration. RESULTS: Overall, the prevalence of symptomatic patients was higher (63.6%; seven athletes), with 75% of patients with bursitis, and 100% of those with partial-thickness tendon tears. Among isolated tendinous findings, the supraspinatus tendon was the most frequently involved, showing echographic pattern alteration in 36.36% of cases. Tendinosis was the most prevalent finding, present in at least one tendon in 50% of the studied shoulders. The incidence of partial-thickness tendon tears was similar to the incidence reported for non-athlete individuals (13%), always present in individuals above 40 years of age. CONCLUSION: Swimmers do not seem to present a higher incidence of tendon tears or degeneration when compared with the general population. Individuals' age is the most relevant determining factor, as far as rotator cuff lesions are concerned, no matter these individuals practice or not activities involving an overload of the shoulder joint.

Keywords: Impingement syndrome, Rotator cuff, Swimmers, Ultrasonography

OBJECTIVE: The present study was aimed at evaluating the frequency of radiographic assessment of paranasal sinuses in pediatric patients in hospitals of Belo Horizonte, MG, Brazil. Additionally, aspects regarding radiation protection conditions and radiographic parameters were evaluated, and entrance air kerma and organ doses were estimated. MATERIALS AND METHODS: Patients' data and parameters of radiographic technique employed in the assessment of children in the age range between 1 and 16 years were collected in five examination rooms of four hospitals in Belo Horizonte, also taking into consideration the radiation protection aspects. Entrance air kerma calculation was based on the x-ray tubes output, and organ doses were estimated with the PCXMC software. RESULTS: Mean entrance air kerma values found in the five rooms were, respectively, 1398 µGy, 829 µGy, 877 µGy, 1168 µGy and 3886 µGy for patients with ages between 1 and 5 years. CONCLUSION: Most frequently, mento-naso and fronto-naso views are requested in conjunction in the majority of hospitals, which increases the radiation dose to the patients. It may be concluded that the risks for patients can be reduced by means of the utilization of an appropriate x-ray field, non-utilization of antiscattering grids, selection of high voltages and lower exposure times.

Keywords: Pediatric radiology, Patient dose, Organ dose

The increasing worldwide popularization of telemedicine activities has demanded a new approach to the professional practice by physicians and other health professionals. As far as teleradiology is concerned, a remarkable trend has been observed toward the transformation of clinical documents - like radiological studies results, that so far existed as printed films and paper-based reports - into electronic documents available in internal networks of medical clinics and hospitals or through the internet. As a result of this trend, it is necessary to divulge and explain concepts such as digital certification, internet data encryption, sites' reliability, reliability of electronic documents, and digital signature. Even though the baseline principles of these concepts may seem complex for health professionals, they can be effectively understood with no need to wander through labyrinths like the mathematics of asymmetric keys cryptography, or digital data communication protocols. Security and reliability aspects related to internet-based electronic clinical documents are described in the present study, in a straight and practical way, aiming at an informed, safe and soundly grounded interaction between medical users and telemedicine services.

Keywords: Teleradiology, Safety in information technology

This study is an interesting selection of esophageal dynamic images and respective activity/time curves to demonstrate motility ranging from normal to the opposite extreme (advancedstage achalasia). The technique employed was: 4-hour fast, with restriction of smoking, alcohol and caffeine products; anterior 0.5-second imaging during 2 minutes, covering the region from the mouth to the gastric fundus, followed by a planar 20-second image from the same region (normal transit time: < 10 seconds). The collection is based on a twenty-year experience employing a systematization including several parameters, which is able to discriminate patients with normal total esophageal transit time independently of symptoms.

Keywords: Esophageal scintigraphy, Transit time, Motility, Achalasia, Parameters

Prostatic rhabdomyosarcoma is an aggressive tumor predominantly found in children. The present paper reports a case of a 27-year-old-patient who had an extensive lesion invading periprostatic planes, with distant metastases found at the moment of the diagnosis. Imaging findings on ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography were evaluated and correlated with the ones already described in the literature.

Keywords: Rhabdomyosarcoma, Prostate, Adult

We present the preliminary results of testing and acceptance of a method for displaying medical images that employs simple computer freewares that can be run in unsophisticated computational platforms, which are commonly underutilized. This method allows easy and accessible visualization, printing, documenting, archiving, consulting and electronic transmission of a wide range of medical images without the need of expensive, complex and difficult to learn softwares.

Keywords: Medical images, Freeware, Ultrasound