Breast ultrasound: evaluation of echographic criteria for differentiation of breast lesions

Made available in DSpace on 2010-08-23T16:00:26Z (GMT). No. of bitstreams: 1 license.txt: 1878 bytes, checksum: 4ab65ca798f15d32db061c8ec1b00ab1 (MD5) Previous issue date: 2007Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Centro de Estudos e Pesquisas da Mulher. Rio de Janeiro, RJ, Brasil.OBJETIVO: O câncer de mama é uma das causas mais importantes de mortalidade feminina. Na busca do diagnóstico cada vez mais precoce, a associação de métodos diagnósticos tem sido utilizada com êxito, tendo grande participação a ultra-sonografia mamária diagnóstica e intervencionista. Este trabalho tem como objetivos: identificar os critérios ecográficos mais relacionados com benignidade e malignidade e avaliar as propriedades das características ecográficas, verificando o seu poder de predição de malignidade. MATERIAIS E MÉTODOS: Os critérios morfológicos ecográficos utilizados nas descrições das imagens foram: forma, limites, contorno, ecogenicidade, ecotextura, ecotransmissão, orientação e sinais secundários. A validação foi buscada em 450 imagens ecográficas, comparadas aos resultados de seguimento ou de histopatologia de peça cirúrgica. RESULTADOS: Os principais critérios de benignidade foram: forma definida, contorno regular, limites precisos, lesões isoecóicas ao tecido adiposo, ecotextura homogênea e orientação horizontal. Os critérios mais característicos de malignidade foram: forma indefinida, contorno irregular, limites parcialmente precisos e lesões hipoecóicas. O contorno irregular apresentou a maior sensibilidade (92,7 por cento) e o maior valor preditivo negativo (98,2 por cento) para malignidade, a orientação vertical apresentou a maior especificidade (99,3 por cento), e a forma indefinida, o maior valor preditivo positivo (91,0 por cento). CONCLUSÃO: O método padronizado para a caracterização e descrição das imagens ultra-sonográficas mamárias apresentado resultou em uniformidade e otimização dos laudos, viabilizando as condutas mais adequadas

The predictive value of neonatal neurological assessment and neonatal cranial ultrasonography with respect to the development of very low birth weight premature infants

Submitted by Luis Guilherme Macena ([email protected]) on 2013-03-11T14:54:39Z No. of bitstreams: 1 Valores de predição da avaliação neurológica.pdf: 79270 bytes, checksum: 4c0a8648614ec3f345dea0ea99ac828d (MD5)Made available in DSpace on 2013-03-11T14:54:39Z (GMT). No. of bitstreams: 1 Valores de predição da avaliação neurológica.pdf: 79270 bytes, checksum: 4c0a8648614ec3f345dea0ea99ac828d (MD5) Previous issue date: 1998Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Neonatologia. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Pediatria. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Pediatria. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, BrasilVerifica os valores de prediçäo de dois exames (neurológico e ultra-sonográfico) realizados no período neonatal, em relaçäo ao desenvolvimento neuromotor e cognitivo de prematuros. Foram estudados 70 prematuros com peso de nascimento inferior a 1.500g. A média do peso de nascimento e idade gestacional foram, respectivamente, 1.185g (DP: 180) e 32,2 semanas (DP: 1,4). Foi realizada a avaliaçäo neurológica pelo método de Dubowitz e ultra-sonografia cerebral por volta de 40 semanas de idade corrigida. Após a alta do berçário, estas crianças foram acompanhadas no ambulatório de seguimento. Com idade média de 21 meses (DP: 4,9) corrigidos para a prematuridade, 25,7 por cento das crianças apresentaram comprometimento neuromotor, e 20,3 por cento, alteraçäo cognitiva. O exame neurológico neonatal foi mais sensível que específico em relaçäo à alteraçäo neuromotora (sensibilidade: 77,7 por cento, especificidade: 57,6 por cento) e cognitiva (sensibilidade: 78,5 por cento, especificidade: 56,4 por cento), e apresentou baixo valor de prediçäo tanto para alteraçäo neuromotora (38,9 por cento) quanto cognitiva (31,4 por cento). A ultra-sonografia apresentou elevada especificidade tanto para o desenvolvimento neuromotor (92,3 por cento) quanto cognitivo (89,1 por cento). O valor preditivo da ultra-sonografia foi satisfatório para anormalidades neuromotoras (69,2 por cento), porém baixo para as alteraçöes cognitivas (50,0 por cento). A associaçäo dos dois exames com resultados anormais apresentou valores de prediçäo mais elevada para as anormalidades nas duas áreas do desenvolvimentoTo verify the predictive value of two tests (neurological assessment and ultrasonography) performed at the time of discharge, with respect to the neuromotor and cognitive development of premature infants. Seventy very low birth weight premature infants (below 1,500g), admitted to the Neonatal Department between 1992 and 1994 were studied. The average birth weight and gestation age were, respectively, 1,185g (SD:180g) and 32.2 weeks (SD: 1.4). At the term correct age, neurological assessment by the Dubowitz & Dubowitz method and cerebral ultrasonography were carried out. After discharge, the development was monitored at the follow up clinic. At 21 months correct age (SD: 4.9), neuromotor and cognitive abnormalities were observed, respectively, in 25.7% and 20.3% of the infants evaluated. The neonatal neurological assessment was found to be more sensitive than those specific for neuromotor (sensibility:77.7%, specificity:57.6%) and cognitive (sensibility:78.5%, specificity:56.4%) abnormalities, and exhibited low predictive value for both neuromotor and cognitive abnormality. Ultrasonography exhibited high specificity with respect to both neuromotor and cognitive development. The cerebral ultrasonography has also a reasonable predictive value for neuromotor abnormality. The combination of both tests yielded higher predictive values

Efficacy in treatment of subclinical cervical HPV infection without intraepithelial neoplasia: systematic review

CONTEXT: The treatment of the subclinical Human papillomavirus (HPV) infection of the uterine cervix is controversial. OBJECTIVE: To assess the efficacy of any therapy for subclinical HPV infection of the cervix without intraepithelial neoplasia, via a search in the medical literature. METHOD: We performed a systematic review with a comprehensive reference search in Medline, LILACS, Excerpta Medica, AIDSLINE, Popline, Cochrane Library and other authors' reference lists to identify experimental studies of therapy for subclinical HPV infection without intraepithelial neoplasia of the uterine cervix. In order to identify unpublished studies, we also contacted experts in the area, clinical trial registries, pharmaceutical industries, government and research institutions. We also searched on the Internet and in the book-of-abstracts of some medical conferences. The studies identified were masked and selected by inclusion criteria to help ascertain their internal validity. The data about regression or progression of HPV infection were extracted from the studies included. RESULTS: We identified 67 studies related to the treatment of subclinical HPV infection without intraepithelial neoplasia of the uterine cervix. Only five clinical trials matched the inclusion criteria and none demonstrated significant differences between the experimental group and the control group concerning regression of HPV infection (with or without CIN I) or progression to higher grades of CIN. CONCLUSION: The evidence we found in the medical literature regarding the efficacy of any therapy for subclinical HPV infection without intraepithelial neoplasia of the uterine cervix was unsatisfactory

Lung mechanics and high-resolution computed tomography of the chest in very low birth weight premature infants

CONTEXT: Premature infant lung development may be affected by lung injuries during the first few weeks of life. Lung injuries have been associated with changes in lung mechanics. OBJECTIVE: To evaluate an association between lung mechanics and lung structural alterations in very low birth weight infants (birth weight less than 1500 g). DESIGN: A cross-sectional evaluation of pulmonary mechanics (lung compliance and lung resistance) and high resolution computed tomography of the chest at the time of discharge, in 86 very low birth weight infants born at Instituto Fernandes Figueira, a tertiary public healthcare institution in Rio de Janeiro, Brazil. Lung compliance and resistance were measured during quiet sleep. High resolution computed tomography was performed using Pro Speed-S equipment. MAIN MEASUREMENTS: Statistical analysis was performed by means of variance analysis (ANOVA/ Kruskal Wallis). The significance level was set at 0.05. RESULTS: Abnormal values for both lung compliance and lung resistance were found in 34 babies (43%), whereas 20 (23.3%) had normal values for both lung compliance and lung resistance. The mean lung compliance and lung resistance for the group were respectively 1.30 ml/cm H2O/kg and 63.7 cm H2O/l/s. Lung alterations were found via high-resolution computed tomography in 62 (72%) infants. Most infants showed more than one abnormality, and these were described as ground glass opacity, parenchymal bands, atelectasis and bubble/cyst. The mean compliance values for infants with normal (1.49 ml/cm H2O/kg) high resolution computed tomography, 1 or 2 abnormalities (1.31 ml/cm H2O/kg) and 3 or more abnormalities (1.16 ml/cm H2O/kg) were significantly different (p = 0.015). Our data were insufficient to find any association between lung resistance and the number of alterations via high-resolution computed tomography. CONCLUSION: The results show high prevalence of lung functional and tomographic abnormalities in asymptomatic very low birth weight infants at the time of discharge. They also show an association between lung morphological and functional abnormalities

Neonatal risk factors for respiratory morbidity during the first year of life among premature infants

CONTEXT AND OBJECTIVE: There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS: Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS: Ninety-seven newborn infants (mean birth weight: 1113g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS: Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors