OBJECTIVE: To evaluate the efficacy of TIPS (transjugular intrahepatic portosystemic shunt) for resolving clinical complications in patients with portal hypertension. MATERIALS AND METHODS: Forty-four caucasian patients, 30 men and 14 women, with a mean age of 52 years have been evaluated. Indication for TIPS has been gastrointestinal hemorrhage in 28 patients, and refractory ascites in 16. There has been 7 Child-Pugh A patients, 24 Child-Pugh B, and 11 Child-Pugh C. RESULTS: TIPS was successfully performed in all the patients (100%), with a decrease in the mean portosystemic pressure gradient of about 49.69% (from 18.98 mmHg to 9.55 mmHg). A clinical improvement was observed in 35 patients (79.55%). The general postoperative mortality rate was 13.64%, with higher incidence in Child-Pugh C patients (45.45%). The most relevant factors associated with a poor prognosis were increase in bilirubin and creatinine seric levels. The mean survival time was 11.5 months for Child-Pugh A patients, 10.97 months for Child-Pugh B patients, and just 5.9 months for Child-Pugh C patients. Complications directly related to the procedure have been observed in nine cases (20.44%). CONCLUSION: TIPS is efficient to reduce portosystemic pressure. TIPS-related complications and morbidity-mortality may be considered as acceptable. In the present study, mortality has been directly influenced by some clinical factors such as Child-Pugh class C, and increased bilirubin and creatinin seric levels.

Keywords: Portal hypertension, Cirrhosis, TIPS, Esophageal varices bleeding, Ascites

OBJECTIVE: To evaluate the role, especially of computed tomography, in the staging of maxillary sinus carcinomas. MATERIALS AND METHODS: Ten cases of carcinoma treated in Hospital Heliópolis Department of Diagnostic Imaging and Head and Neck Surgery, São Paulo, SP, Brazil, in the period between 1988 and 2002, were evaluated. RESULTS: Nine patients presented with tumor extension to the cheek, eight to the masticator space, seven to the mouth floor and hard palate, five to the pterygoid fossa, five to the orbit, three to the ethmoid bone, and one to the skull base. Three of the patients were staged T3, and seven T4. Two patients had lymph nodes metastases at their initial presentation, and were staged T4. All of the cases were histopathologically confirmed. CONCLUSION: The accurate analysis of the tumor local extent and dissemination by means of computed tomography and magnetic resonance imaging plays a relevant role in the surgical planning, besides influencing the therapeutic conduct and prognosis.

Keywords: Squamous cell carcinoma, X-ray tomography, Cancer, Maxillary sinus

OBJECTIVE: The authors have established a methodological approach to evaluate head and neck squamous cell carcinoma aiming at identifying and distinguishing high metabolic activity inside the lesion, combining in a single examination, functional, metabolic and morphological data simultaneously acquired by means of different non-dedicated positron emission tomography (PET)-computed tomography (CT) device. MATERIALS AND METHODS: The study population included 17 patients with head and neck squamous cell carcinoma submitted to a non-dedicated 18F-FDG-PET imaging at Department of Diagnostic Imaging of Hospital do Câncer, São Paulo, SP, Brazil. CT and 18F-FDG-PET images were simultaneously acquired in a non-dedicated device. The original data were transferred to an independent workstation by means of the Entegra 2 NT software to generate PET-CT imaging fusion. RESULTS: The findings were defined as positive in the presence of a well defined focal area of increased radiopharmaceutical uptake in regions not related with the normal biodistribution of the tracer. CONCLUSION: The fusion of simultaneously acquired images in a single examination (18F-FDG-PET and CT) has allowed the topographic-metabolic mapping of the lesion as well as the localization of high metabolic activity areas inside the tumor, indicating recidivation or metastasis and widening the array of alternatives for radiotherapy or surgical planning.

Keywords: Squamous cell carcinoma, Computed tomography, Positron emission tomography, Face

OBJECTIVE: To assess radiographically the prevalence of morphological alterations of the styloid process in patients with temporomandibular joint disorders. MATERIALS AND METHODS: We have analyzed 1,500 panoramic x-ray films of temporomandibular joint from both male and female patients with no age limit, who were attended in the Service of Temporomandibular Joint Disorder of Faculty of Odontology at Universidade Federal de Juiz de Fora, MG, Brazil, in the period between 1997 and 2003. RESULTS: Eighty-three (5.53%) of the analyzed patients (74 female and 9 male), predominantly in the age range between 41 and 50 years (32.5%), presented with, at least, one of the joint sides with morphological alteration of the styloid process. As far as the type of styloid process in concerned, 113 elongated, 21 pseudoarticulated and 19 segmented were observed. Also, it was noticed that the morphological alterations of the styloid process develop in a symmetrical fashion. CONCLUSION: In individuals with temporomandibular joint disorder, styloid process alterations occur symmetrically and in a different way for each patient, independently from sex and age.

Keywords: Styloid process, Temporomandibular joint disorder, Radiography

OBJECTIVE: In the pediatric group, the radiological diagnosis of bone tumors of the hip is difficult and presents some peculiarities, but reviewed literature does not approach this specific problem. The objective of the present study was to investigate the existence of reliable radiological patterns for the differential diagnosis of these tumors. MATERIALS AND METHODS: Radiological findings of bone tumors of the hip in ten patients in the age range between 8 and 19 years have been reviewed. RESULTS: Bone reaction (sclerosis or lysis), periosteal reaction (lamellar with single or multiple layers, or radial), tumor extent in the bone and level of soft tissues invasion have presented low specificity. Soft tissue calcifications, when considered as a whole, were non-specific. However, when those calcifications with varied shapes and sizes, nearby the affected bone (pattern I) were separated from those, thin and amorphous, away from the bone (pattern II), we have observed that the pattern I was totally non-specific, and the pattern II was found in the three cases of osteosarcoma (100%) and in only one case of Ewing's sarcoma (16.6%). CONCLUSION: In the present study, pattern II calcifications have shown a 100% sensitivity and 90% specificity for osteosarcoma. However, their importance may be not limited to the radiological diagnosis. Pattern II calcifications indicate probably ideal sites for biopsy.

Keywords: Bone tumors, Ilium, Hip, Pelvis, Pediatrics, Computed tomography

OBJECTIVE: To define, by means of computed tomography, the level of ureteral implantation into de bladder. MATERIALS AND METHODS: We have measured the distances from the ureteral meatus to the acetabulum, and to the superior margin of the pubic symphysis, as well as the bladder volume, using contrast enhanced computed tomography of the pelvis in 46 patients (31 male and 15 female) in the age range between 18 and 45 years, with at least one of the ureteres filled with excreted contrast material. The Student t test has been applied to determine eventual statistically significant differences between groups. RESULTS: The level of ureteral implantation into the bladder was, on average, 10.6 ± 8.1 mm below the acetabular roof, and 29.7 ± 9.5 mm above the superior margin of the pubic symphysis. In patients with bladder repletion volume of < 200 ml and > 200 ml, the level of ureteral implantation into the bladder was, respectively, on average, 11.6 ± 7.3 mm and 10.2 ± 8.4 mm below the acetabular roof (p = 0.61), and 28.3 ± 7.3 mm and 30.3 ± 10.2 mm above the superior margin of the pubic symphysis (p = 0.52), and in male and female men patients, respectively, on average, 11.8 ± 8.0 mm and 8.3 ± 8.0 mm below the acetabular roof (p = 0.17), and 27.7 ± 9.2 mm and 33.9 ± 8.8 mm above the superior margin of the pubic symphysis (p = 0.34). CONCLUSION: Calcifications located < 3 cm below the acetabular roof and < 1.5 cm above the superior margin of the pubic symphysis probably do not represent ureteral calculi. Vesical repletion or sex have no significant influence on the ureteral meatus position.

Keywords: Calculus, Ureter, Ureteral obstruction, Lithiasis, X-ray computed tomography

OBJECTIVE: The present study had as its objective to compare the findings of voiding cystourethrography with those of duplex color Doppler in patients with suspected vesicoureteral reflux. MATERIALS AND METHODS: The research was developed through the study of ureterovesical jet angles, both in axial and longitudinal planes. Also, the distance (in cm) between ureteral meatuses was analyzed. RESULTS: From a total sample of 32 patients (mean age of five years and two months), 18 presented with vesicoureteral reflux (10 with unilateral reflux - 4 right-sided and 6 left-sided -, and 8 with bilateral reflux) and 14 patients did not presented with reflux. The angles of ureterovesical jet and distances between the ureteral meatuses were measured in all patients, and mean values, standard deviation and coefficient of variance were calculated. CONCLUSION: Data showed that a trend towards meatus lateralization is a sign of predisposition to vesicoureteral reflux. Non-parametric Mann-Whitney statistical analysis did not show significant differences (p > 0.05) between groups (inclination angles of ureterovesical jet and distance between urinary meatuses).

Keywords: Vesicoureteral reflux, Ureterovesical jet, Color Doppler ultrasound, Voiding cystourethrography

OBJECTIVE: The aim of the present study is to evaluate the performance of the Europrobe gamma probe spatial resolution in radioguided surgery. MATERIALS AND METHODS: In the radioguided surgery technique, after a radiotracer injection into the primary tumor, a gamma detector probe is utilized to determine the localization of the sentinel lymph node. In order to simulate the region of the radiotracer injection the sentinel lymph node, two Tc-99m sources, with 20.42 MBq and 0.70 MBq, were positioned in a water-filled tank. With a collimator cap attached to the probe, scans over the water surface were made. So, the count rate was measured by means of lateral displacement of the probe in relation to the both sources with distances ranging between 30 mm and 60 mm. RESULTS: Results showed that the use of the collimator contributes to improve the spatial resolution of the probe allowing the identification of a sentinel lymph node within a distance up to 30 mm from the radiotracer injection point. CONCLUSION: The utilization of a collimator cap with a 3.5 mm diameter central orifice on a Europrobe gamma probe, allows the identification of a sentinel lymph node within a distance up to 30 mm from the radiotracer injection point.

Keywords: Intraoperative probe, Radioguided surgery, Sentinel lymph node localization, Spatial resolution

The purpose of this study is to describe the normal findings of the newborn chest radiography, the criteria utilized for evaluating the quality radiographs and the correct catheter and tube positions, emphasizing the peculiarities inherent to the patient's age. In the neonatal period changes in the fetal circulation contribute to an increase in cardiac size, skin folds and variations in the thymic silhouette may simulate diseases, the evaluation of catheter and tube positions avoids iatrogenic complications, the abdominal gas pattern must be correlated with the patient's age and the presence of the secondary ossifications centers in the upper humerus and scapula is associated with the term newborn, providing a radiological sign for normal skeletal maturation. The knowledge of the peculiarities and normal radiological findings of the newborn chest radiography avoids ambiguous diagnosis, reduces iatrogenic complications and represents a valuable support in the diagnosis and clinical follow-up of these patients.

Keywords: Newborn, Normal findings, Chest radiography

Hemangiomas are the most common benign tumors of the liver, occurring in all age groups, and more frequently in adults. The vast majority of hemangiomas are small, asymptomatic, and are incidentally discovered. Larger lesions may eventually produce symptoms. The sonographic aspect of these tumors varies, the lesions being typically small, well defined and hyperechoic. In this study the authors review clinical and sonographic features of hemangiomas, highlighting the clinical significance of such features to be taken into consideration in the treatment of affected patients.

Keywords: Hemangioma, Liver, Ultrasound

Energy and angular dependences of different thermoluminescent materials were studied with the objective to verify which type of detector would be the most appropriate for beta monitoring of workers. Three types of CaSO4:Dy + teflon pellets were studied. The energy dependence was evaluated using standard beta radiation sources (147Pm, 204Tl and 90Sr+90Y). For the angular dependence study, the pellets were exposed to beta radiation of the 90Sr+90Y source, varying the incidence angle between 0° and 90°. In relation to the studied characteristics, the CaSO4:Dy + 10% C dosimeters were the most adequate for use in beta monitoring of workers.

Keywords: Thermoluminescent dosimetry, Beta radiation, Angular dependence, Energetic dependence

The authors report a case of chondrosarcoma in a 14-year-old female patient with multiple osteochondromatosis who has sought medical assistance complaining of a tumor on the left coxa. CT images of the affected limb have demonstrated osteodestructive lesion on the superior third of the left femur. The diagnosis has been made through a review of the biopsy slide from the service of origin of the patient, confirming the finding of a grade I chondrosarcoma in a chondromatous lesion. Disarticulation of the femoral neck was made because of the large extent of the lesion in muscular groups, subcutaneous cellular tissue and skin. The literature shows a wide variation in rates of malignant transformation of exostosis in patients with this disease, and this is a significant complication in patients affected by this disease.

Keywords: Chondrosarcoma, Multiple osteochondromatosis, Computed tomography, Femur