OBJECTIVE: To evaluate the efficacy of double reading on routine screening mammography for the detection of breast cancer in a non-academic environment. MATERIALS AND METHODS: During one year, 22,024 screening mammograms of asymptomatic women were submitted to independent double reading by two radiologists specialized in breast imaginology. Data analyzed were the number of additional carcinomas found after a second reading and the absolute number of recalls on account of the second reading. RESULTS: Nine additional carcinomas were detected after the second reading: 55.5% were ductal carcinoma in situ and the remainder were ductal invasive carcinomas up to 1.5 cm. Our absolute recall rate generated by the double reading was only 1.8%, with a percentage of false-positive findings of 98%. CONCLUSION: Double reading increased cancer detection rate by 8.5% and all tumors detected were stage 0 or 1.

Keywords: Screening mammography, Breast cancer detection, Double reading

OBJECTIVE: To determine the influence of intraabdominal pressure in the ultrasonographic evaluation of the urethrovesical junction (UVJ) and proximal urethra (PU) in patients with stress urinary incontinence (SUI). MATERIALS AND METHODS: A prospective, cross-sectional study was conducted at the Urinary Incontinence Research Unit of "Universidade Federal de Pernambuco", Brazil, from January 2002 to January 2005. Perineal ultrasounds of the UVJ and PU were performed in thirty-six women complaining of SUI with the bladder virtually empty (< 50 ml); simultaneous measurement of the intraabdominal pressure was also performed. An ultrasound machine with a computer chip and a high-resolution photographic camera connected to a 7 MHz vaginal probe was used for the evaluation. In order to measure the intraabdominal pressure, an urodynamic equipment with a 10fr rectal catheter connected to a pressure sensitive balloon was used. RESULTS: The age of the patients ranged from 25 to 69 years (mean 46.4 ± 10.2 years). On Valsava maneuver, the intra-abdominal pressure ranged from 7 to 193 cmH2O (mean: 99.3 ± 51.8 cmH2O; median: 99.5 cmH2O). Eight out of 31 (25.8%) patients with UVJ hypermobility had an intraabdominal pressure lower than 60 cmH2O. There was no statistically significant association between intraabdominal pressure and the ultrasound parameters studied. CONCLUSION: There is a specific urethral pressure index for each woman with SUI. However, there is no significant association between increase in intraabdominal pressure and increase of UVJ and UP hypermobility in women with clinical SUI.

Keywords: Stress urinary incontinence, Abdominal pressure, Perineal ultrasound, Urethrovesical junction

OBJECTIVE: To estimate which is the best period to realize uterine artery Doppler for the prediction of pregnancy complications. MATERIALS AND METHODS: A prospective study was conducted with 45 women without a history of chronic diseases and in their first pregnancy. The uterine artery Doppler was performed between the pregnancy weeks 18-20, 24-26, 28-30 and 34-36, with determination of the resistance index, the pulsatility index, the A/B ratio and presence or absence of notch on the flow velocity waveform, as well as the result of the pregnancy. RESULTS: The Doppler index showed decrease in the course of the pregnancy, more pronounced in the normal pregnancies in comparison with the complicated pregnancies. This was most noticed in the examinations performed between the weeks 24-26. The best sensitivity/specificity relation for detecting pregnancy complications was achieved in the examination performed in this same period. CONCLUSION: The best period to perform uterine artery Doppler for prediction of pregnancy complications is between weeks 24-26 of gestation.

Keywords: Doppler, Uterine artery, Preeclampsia, Intrauterine growth restriction

OBJECTIVE: To describe the different tomographic findings in hypodense hepatic lesions in children and its differential diagnosis. MATERIALS AND METHODS: Computed tomographic studies were obtained from 50 patients (age range: 0-16 years) with low-density liver lesions previously diagnosed by ultrasound. Images were made before and after administration of intravenous contrast medium. Image findings were analyzed and afterwards correlated with anatomopathological diagnosis. RESULTS: Forty-seven of 50 cases were confirmed, 30 by anatomopathological diagnosis. Most of then were benign lesions, hemangioma in 20%. Such lesions presented a homogeneous contrast absorption, mainly at the delayed phase, differing from malignant lesions. Metastasis was the most frequently found malignant lesion (18%). CONCLUSION: Computed tomographic study is of great value in complementing the diagnosis of hypodense hepatic lesions in children, and must follow ultrasound diagnosis as a routine procedure.

Keywords: Hypodense hepatic injuries, Computed tomography, Childhood

OBJECTIVE: Retrospectively determining the coloileal reflux prevalence at the barium enema examination, characterizing its distribution by sex and age range and classifying it according to the intensity degree. MATERIALS AND METHODS: 715 barium enemas were reviewed, being 268 of male patients and 447 of female patients, with average age of 54 years. RESULTS: Of the 715 enemas performed, 46.5% showed coloileal reflux, classified as mild (45%), moderate (37.5%) and severe (17.5%). Coloileal reflux was present in 48.3% of female and in 43.6% of male patients. The coloileal reflux distribution by age range was 46.1% in individuals less than 21 years, 42.1% in individuals between 21-40, 49.8% in individuals between 41-60 and 44.7% in people more than 60 years old. CONCLUSION: Coloileal reflux was a common finding, with 25% of them being classified as moderate or severe. Apparently, there is not a clear relationship between its occurrence and gender or age. The etiopathogenesis and consequences of the coloileal reflux remain still poorly known. Some studies suggest that the compromising of ileocecal junction components, like ligaments, could favor the coloileal reflux occurrence. Among the probable consequences, we could mention contamination and ileal motility disorders resulting from the material refluxed from cecum into the ileum.

Keywords: Coloileal reflux, Ileocecal valve, Ileocecal junction, Small bowel bacterial overgrowth syndrome, Coloileal reflux at the barium enema

OBJECTIVE: To evaluate the main findings of chest high-resolution computed tomography in patients with amiodarone pulmonary toxicity. MATERIALS AND METHODS: Ten patients - six male and four female, average age of 73.5 years - with amiodarone-induced pneumonitis have undergone chest high-resolution computed tomography. RESULTS: The most relevant tomographic findings were linear or reticular opacities in six cases (60%), small high density nodules in six cases (60%), dense consolidations in three cases (30%) and increased density in the hepatic parenchyma in five of eight cases in which there was a superior abdomen CT scan (62.5%). CONCLUSION: The high-resolution computed tomography is a valuable non-invasive test for evaluating patients with amiodarone pulmonary toxicity and should always be performed when one suspects of the presence of this disease. The finding of interlobular septa thickening associated with increased density of lesions is highly suggestive of this diagnosis.

Keywords: Computed tomography, Amiodarone, Pulmonary toxicity

OBJECTIVE: To review clinical and radiographic findings in patients with histologically confirmed giant cell tumor of bone. MATERIALS AND METHODS: Clinical and radiological data of 115 patients with giant cell tumor of bone were analyzed. RESULTS: Of the evaluated cases, 57.4% (66) were female and 80% (92) were white. The patients were 30 years old in average and the most common site of the lesions was the distal femoral metaphysis, in 22.6% (26). The most common radiographic aspect was a purely lytic lesion, in 63.7% (51) of the cases. CONCLUSION: Giant cell tumor of bone is not an uncommon tumor, predominant in the white race, with radiological findings well established.

Keywords: Conventional radiology, Giant cell tumor of bone, Bone neoplasms

OBJECTIVE: This study aims to evaluate the effective ionizing radiation dose received by staff involved in interventional vascular procedures to establish parameters for comparison between the data obtained with an ionization chamber and with the dosimeters used for individual monitoring. MATERIALS AND METHODS: The evaluation was performed in a cardiac catheter laboratory and air kerma rate was measured in a real working environment, in the positions occupied by physicians and nurses, with and without the lead glass shield. The number of tests performed in the laboratory was taken into consideration and most common projections and radiographic parameters were selected. Conversion factors founded in the literature were applied for the effective dose estimation. RESULTS: The values found in the effective dose and in the dosimetry report were rather consistent. Additionally, it was observed that the use of the lead glass shield reduces in up to 97% the doses received by the professional and therefore it must be routinely used. CONCLUSION: The reported values are representative but cannot be assumed as a reproduction of individual monitoring conditions, although they are valid for comparison purposes and as a guidance for dosing optimization.

Keywords: Occupational exposure, Dosimetry, X-rays, Hemodynamics

OBJECTIVE: This study focuses on the biochemical response of the following variables: prostate volume, prostate-specific antigen (PSA) value, Gleason scores, staging, the risk of the disease, and hormonotherapy. MATERIALS AND METHODS: In the period between February of 1998 and July of 2001, 46 patients with prostate cancer were treated with radiotherapy, in a combination of teletherapy and high-dose rate brachytherapy (HDR). The age ranged from 51 to 79 years (averaging 66.4 years). T1c stage was the most frequent one: 30 (65%). The Gleason score was below 7 in 78% of the patients. PSA ranged from 3.4 to 33.3, being below 10 in 39% of the cases. The average prostatic volume was 32.3cc. Twenty-eight percent of the patients received hormonotherapy. Teletherapy dose ranged from 45 to 50.4 Gy, associated to four fractions of 4 Gy of HDR. RESULTS: The follow-up period varied from 6 to 43 months. Four patients missed the follow-up and four died (one due to the disease). Out of the 39 patients that were analyzed, 76% presented a less than 1.5 PSA. None of the analyzed variables were found to be of statistical significance (p>0.05) regarding biochemical control. CONCLUSION: The use of HDR brachytherapy was found to be effective in the treatment of prostate cancer and, in this study, the variables considered as prognostic factors did not interfere in the biochemical control.

Keywords: Prostate cancer, Brachytherapy, Interstitial radiotherapy

OBJECTIVE: To verify if the use of InGaAIP laser with 685 nm wave length can reduce the xerostomy incidence, the oral mucositis severity and the pain related to mucositis in patients with head and neck cancer submitted to radiotherapy. MATERIALS AND METHODS: Sixty patients presenting head and neck carcinoma were submitted to radiotherapy with daily doses of 1.8 to 2.0 Gy and a final dose of 45 to 72 Gy. The salivary volume was evaluated in the first and fifteenth days, at the end of the treatment and after 15 and 30 days. The oral mucositis was evaluated on a weekly basis. Twenty-nine patients were submitted to radiotherapy without laser and 31 were submitted to radiotherapy and laser with daily doses of 2 joules/cm² in predetermined areas of the oral mucosa and the parotid and submandibular glands. RESULTS: In the group submitted to radiotherapy and laser the incidence of mucositis (p < 0.001) and pain (p < 0.016) was significantly lower and the salivary volume (p < 0.001) was kept higher during and after the treatment. CONCLUSION: The group of patients submitted to radiotherapy and laser had lower incidence of xerostomy, oral mucositis and pain when compared to the group treated with radioteraphy without laser, producing statistically significant results.

Keywords: Low level laser, Xerostomy, Mucositis, Radiotherapy, Chemotherapy

In order to evaluate atypical aspects of hepatocellular carcinoma at computed tomography and magnetic resonance imaging, we have retrospectively evaluated 100 patients with diagnosed hepatocellular carcinoma, based on combined imaging studies, laboratory results, biopsy and surgery. We have selected those cases with atypical findings at computed tomography or magnetic resonance imaging, including cystic lesions, bleeding tumors, with calcifications, with spontaneous regression, pedunculated tumors, hypovascular lesions, giant hepatocellular carcinomas, and those with unusual local invasiveness. The hepatocellular carcinoma is the most usual primary malignant lesion of the liver and usually it has a typical aspect and is associated with hepatic cirrhosis. However, in a significant number of cases, some uncommon findings can be responsible for a delayed diagnosis.

Keywords: Hepatocellular carcinoma, Liver, Atypical findings, Ultrasound, Computed tomography, Magnetic resonance imaging

The pleural effusion, formerly called pleural spill, is an accumulation of fluid in the pleural space, as a consequence of an imbalance between the formation and reabsorption of such fluid, or due to an alteration in the drainage to lymph nodes. The purpose of this bibliographic review is to establish the importance of the use of ultrasound in pleural diffusion diagnosis. The authors discuss the use of ultrasonography in the diagnosis and therapeutic approach of this disease, and stress the importance of ultrasonography in chest diseases diagnosis, its advantages, limitations and disadvantages when compared to the common x-ray, computed tomography and physical examination. The authors also discuss the definition of pleural effusion, its physiopathology, morbidity, mortality, main causes and clinical presentation. The examination technique is systematically approached both by thoracic and abdominal pathways.

Keywords: Pleural effusion, Pleural spill, Ultrasound

Portal vein thrombosis may be associated with many alterations, such as the presence of tumors (for example, hepatocellular carcinoma, metastatic liver disease and carcinoma of the pancreas) as well as pancreatitis, hepatitis, septicemia, trauma, splenectomy, portacaval shunts, hypercoagulable conditions (for example, pregnancy), in neonates (for example, omphalitis and umbilical vein catheterization) and in acute dehydration. The authors discuss herein the sonographic features of portal vein thrombosis as well as some aspects of clinical relevance.

Keywords: Portal vein, Portal vein thrombosis, Ultrasound

Sarcoidosis is an inflammatory disease whose etiology remains unknown. It is characterized by the formation of non-caseating granulomas and adenopathy, mainly in the pulmonary interstice. This is a systemic disease that may affect any organ or system and should be included in the differential diagnosis of infectious, neoplastic or autoimmune diseases as a correct diagnosis avoids unnecessary surgeries or administration of drugs. The authors report a case of pulmonary sarcoidosis with hepatic involvement in which the patient has developed cirrhosis and portal vein thrombosis.

Keywords: Liver, Sarcoidosis, Ultrasonography