OBJECTIVE: To determine and compare the efficacy of image-guided percutaneous needle aspiration (PNA) versus percutaneous catheter drainage (PCD) in the treatment of intra-abdominal liquid collections. MATERIALS AND METHODS: A prospective study involving 52 patients referred to our service for percutaneous treatment of abdominal liquid collections was carried out. Sixteen of these patients had intra-abdominal liquid collections (six patients with simple localized collections and ten patients with complex, multiseptated or multiple, collections). The volume of the collections ranged from 40 to 1,200 ml (median, 200 ml). PCD was performed in ten (62.5%) collections and PNA in six (37.5%) collections. Successful treatment was defined as complete resolution of the collection with both clinical and laboratorial recovery. RESULTS: Success was achieved in 75% of cases. The success rate was 100% and 60% in the groups submitted to PNA and PCD, respectively. Successful treatment was observed in 50% of the patients submitted to PCD with collections £ 200 ml, and in 75% of the patients with larger collections. Complete resolution with PCD was obtained in 33.3% of complex, 42.9% of infected and 100% of simple or sterile collections. Only two minor complications (transient bacteremia and cutaneous infection) due to the procedures were observed. CONCLUSION: Our results showed that PCD and PNA are safe and effective in the treatment of intra-abdominal collections. In this study, needle aspiration was more effective than drainage, particularly for smaller collections.

Keywords: Intra-abdominal collections, Percutaneous needle aspiration, Percutaneous catheter drainage

OBJECTIVE: To evaluate ultrasonographic and clinical variables such as the presence or absence of bile sludge, thickness of the gallbladder wall, transverse measurement of the gallbladder, age, parity, and presence or absence of diabetes mellitus, and to determine the prevalence of asymptomatic gallstones in female patients submitted to ultrasonographic examination. MATERIALS AND METHODS: We conducted a prospective study involving 265 female patients attending at the "Escola de Ultra-sonografia e Reciclagem Médica de Ribeirão Preto", São Paulo, Brazil, during the period from January to September, 2001. RESULTS: There was a statistically significant difference in gallstones and gallbladder wall thickness, bile sludge, transverse gallbladder diameter, age, parity, with a 4.1% among nulliparous women and a 39.1% in multiparous women and diabetic women. The prevalence of gallstones in asymptomatic patients was 14.7%. CONCLUSION: Asymptomatic gallstones in women were mainly related to age and parity. The most frequently detected ultrasonographic findings were the presence of bile sludge and thickening of the gallbladder wall.

Keywords: Gallstones, Asymptomatic women, Ultrasonography

OBJECTIVE: The objective of this study was to evaluate the magnetic resonance imaging findings in patients with Parkinson's disease. MATERIALS AND METHODS: In the period from October 1999 to October 2002, 42 patients with parkinsonism were investigated using a 1.5 T MR equipment. Patients were divided into two groups: patients with Parkinson's disease (n = 26) and patients with atypical Parkinsonian syndrome (n = 16). The results were compared with a control group (n = 18). The following variables were evaluated: thickness of the mesencephalon compact pars, hypointense signal in the putamen, degree of brain atrophy, lesions in the mesencephalon, lesions in the white matter, and the presence of lesions in the posterior-lateral edge of the putamen. Statistical data analysis was carried out using the SPSS program. RESULTS: The mean age was 58.2 years for the Parkinson's disease and control groups, and 60.5 years for the atypical Parkinsonian syndrome group. Patients with Parkinson's disease and atypical Parkinsonian syndromes presented decreased thickness of the compact pars and a higher degree of signal hypointensity in the putamen. Cerebral atrophy was more prominent in the patients with atypical Parkinsonian syndrome. Lesions in mesencephalon and white matter were similar in both groups. The frequency of hyperintense signal in the posterior-lateral edge of the putamen was low within the studied population, although that could suggest multiple-system atrophy. CONCLUSION: Magnetic resonance imaging allows the detection of brain morphological changes that may help in the diagnosis of Parkinsonian syndromes.

Keywords: Parkinson's disease, Magnetic resonance imaging, Neuroradiology

OBJECTIVE: To identify the characteristics of physicians in the State of Goiás, Brazil, regarding patient management, beliefs, opinions and knowledge about breast cancer. MATERIALS END METHODS: A total of 592 questionnaires were mailed to gynecologists, mastologists and geriatricians. The survey covered the following main aspects: 1 - socio-demographic characteristics (sex, age, year of graduation, private or public practice); 2 - ability to recognize breast cancer risk factors; 3 - implementation of educational activities for the patients; 4 - perception of obstacles to breast cancer screening; 5 - generic questions. RESULTS: The total number of answered questionnaires was 105 (21.2%); 70.5% were male physicians; mean age was 43.9 years (26-70 years); 73.5% had 20 years or less of graduation; 88.6% were gynecologists, 4.8% gynecologists/mastologists, 3.8% mastologists and 2.8% geriatricians; 62.5% were practicing in private and public clinics. Only 13.3% of the physicians recognized the five breast cancer risk factors presented. Approximately 95% of the physicians attended continuing medical education courses in the last two years previous to the survey. CONCLUSION: Breast cancer screening guidelines seemed to be misleading for most physicians. The answers regarding educational activities were sometimes contradictory. The beliefs and opinions regarding breast cancer screening were strongly positive. Insufficient number of equipments and the high cost of the tests were pointed out as obstacles to breast cancer screening.

Keywords: Mammography, Screening, Breast cancer

The authors examine the financial costs for implementation of a small mammography service. The literature was reviewed and a survey based on questionnaires applied to various companies specialized in medical radiology in different States of Brazil was carried out. Questionnaires were used to collect data on the costs of goods and services of mammography services such as equipment, furniture and fixtures, consumable products and materials, personnel, social contracts, and income taxes. Considering the social role of these companies but also their enterprise activity, the questionnaires were also employed for the analysis of economic and financial viability. The analysis of the data allowed us to establish a relationship between the variables - income, cost and return - that could ensure financial viability and profit in the implementation of a mammography service.

Keywords: Costs, Costs analysis, Diagnosis service, Mammography, Radiology

OBJECTIVE: To assess the latent and active TGFbeta1 localization in the heart, to evaluate whether or not radiation induces latent TGFbeta1 activation, and to study the distribution of collagen fibers in the irradiated heart. MATERIALS AND METHODS: Thirty-two C57BL mice were randomly assigned in two groups: GI (non irradiated animals) and GII (irradiated animals). The mice from GII received a single whole-body radiation dose of 7Gy, using a 60Co source at a dose rate of 0.97 Gy/min. The animals were sacrificed by cervical dislocation at 1, 14, 30 and 90 days after irradiation. RESULTS: The irradiated hearts showed: 1) nuclear changes and muscle cells with decreased striations; 2) significant increase in the collagen deposition 90 days after irradiation; 3) latent TGFbeta1 activation in the cardiomyocytes and connective tissue cells after irradiation. CONCLUSION: Our results show the importance of TGFbeta1 protein in the process of radiation-induced heart fibrosis and suggest that cardiomyocytes and connective cells may play a role in this mechanism acting as cellular sources of active TGFbeta1.

Keywords: Ionizing radiation, Heart fibrosis, Transforming growth factor beta (TGFbeta)

The main objective of this study is to implement an impartial and efficient inspection method for a correct and secure use of ionizing radiation in nuclear medicine. The radiological protection model was tested in 113 nuclear medicine services (NMS) all over Brazil, following a biannual analysis schedule (1996, 1998, 2000 and 2002). In the analytical process, we adopted the methodology of assigning different importance levels to each of 82 features, based on the risk factors established by the "Comissão Nacional de Energia Nuclear" (CNEN) and on the International Atomic Energy Agency (IAEA) recommendations. A feature was considered a radioprotection fault when in nonconformity with the rules mentioned above, and was imparted a grade. The sum of those grades, classified the NMS in one of the three different ranges, as follows: operating without restriction - 100 points and below; operating with restriction - between 100 and 300 points; temporary shutdown - above 300 points. Permission for the second group to carry on operation should be attached to a defined and restricted period of time (6 to 12 months), considered enough for the NMS to solve the problems and submit to a new evaluation. The NMS's classified in the third group are supposed to go back into operation only after compliance with all the pending radioprotection requirements. Until the next regular evaluation, a multiplication factor 2n was applied to the recalcitrant NMS's, where n is the number of unwilling occurrences. The previous establishment of those items of radioprotection, with their respective grades, excluded subjective and personal values in the judgement and technical evaluation of the institutions.

Keywords: Nuclear medicine, Radiation protection, Rules, Inspection

Transjugular intrahepatic portosystemic shunts (TIPS) are the most recent and popular technique for the relief of symptomatic portal hypertension, particularly in patients with varices and gastrointestinal bleeding and less often in patients with refractory ascites. TIPS may be complicated by stenosis or occlusion of the stent. Sonography with Doppler provides a noninvasive method for monitoring patients with TIPS. The authors report the recent sonographic and Doppler findings in patients with normal functioning TIPS and patients with stenosis or occlusion of TIPS.

Keywords: Liver, Portal hypertension, Cirrhosis, Liver transplantation, Transjugular intrahepatic portosystemic shunt

Leukokoria is an abnormal pupillary reflex most commonly seen in children that usually results from an intra-ocular abnormality. The evaluation of a child with leukokoria should be performed particularly to rule out a retinoblastoma (the cause of leukokoria in half of the cases). The authors present the main clinical and imaging features for the diagnosis of the most common causes of leukokoria.

Keywords: Eye, Leukokoria, Childhood, Ultrasonography, Computed tomography, Magnetic resonance imaging

We report the case of a 38-year-old man with pulmonary malaria. High-resolution computed tomography showed thickening of the peribronchovascular interstitium and interlobular septa, areas of consolidation and ground glass attenuation and bilateral pleural effusion suggesting pulmonary edema. The patient recovered well after receiving specific treatment and was discharged after 11 days of hospitalization.

Keywords: Malaria, High-resolution computed tomography, Lungs, Radiology

The authors report a case of congenital hydrocolpos due to vaginal malformation (vaginal septae) associated with ectopic ureter and renal displasia. Several imaging diagnostic procedures (ultrasonography, nuclear medicine, intravenous urography and computed tomography) were performed. A review of the literature on hydrocolpos and its association with urinary malformations is also presented.

Keywords: Hydrocolpos, Vaginal malformation, Renal displasia

We report a case of two siblings with primary hypertrophic osteoarthropathy (pachydermoperiostosis). Pachydermoperiostosis represents only 3 to 5 per cent of all cases of hypertrophic osteoarthropathy. These patients presented long bone changes on conventional x-ray films including periosteal new bone formation and expansion of the diaphysis.

Keywords: Primary hypertrophic osteoarthropathy, Pachydermoperiostosis, Radiology