Estudo Comparativo entre Dois Tipos de Eco-Contrastes: Echovist® e Levovist®, Avaliação da Permeabilidade Tubária em Infertilidade Feminina

Na propedêutica inicial do casal infértil, a realização da Sonossalpingografia (SoSG) contrastada através de dois tipos de ecocontrastes, Echovist® e Levovist®, durante a realização da ultra-sonografia ginecológica convencional pode, em casos seleccionados, substituir como exame de “screening” da permeabilidade tubária a Histerossalpingografia (HSG) e a Laparoscopia com cromotubação (LPC). Objectivos: Comparar os resultados da permeabilidade tubária através da SoSG contrastada com Echovist® ou com Levovist® e a HSG e determinar a sua acuidade em relação a LPC considerada “gold-standard”. Pacientes e métodos: Foram avaliadas prospectivamente 90 pacientes inférteis submetidas a SoSG em que se utilizou o contraste ecogénico Echovist® e 28 pacientes em que se utilizou o eco-realçador Levovist®. Para a HSG utilizou-se, em todas as pacientes, contraste iodado e hidrossolúvel Telebrix®. A observação da permeabilidade tubária teve sua avaliação final e sistemática pela LPC. Resultados: No estudo das trompas pelo Echovist® observamos permeabilidade em 67 pacientes (74,4%) e obstruções bilaterais em 23 das pacientes (25,6%) e pelo Levovist®, respectivamente, 22 (78,6%) e 6 pacientes (21,4%). Na comparação da avaliação da permeabilidade tubária entre a SoSG com Echovist® e LPC encontramos: especificidade € 91,3%, sensibilidade (S) 100%, falsos positivos (FP) 8,7%, falsos negativos (FN) 0%, valor preditivo positivo (VPP) 97,1%, valor preditivo negativo (VPN) 100% e Kappa de 96,5%, e entre a HSG e LPC, neste grupo Echovist® foram: E 100%, S 91,04%, FP 0%, FN 8,96%, VPP 100%, VPN 79,31% e Kappa de 88,6%. Na comparação da avaliação da permeabilidade tubária entre a SoSG com Levovist® e LPC encontramos: E 100%, S 100%, FP 0%, FN 0%, VPP 100%, VPN 100% e Kappa de 100%, e entre a HSG e LPC, no grupo Levovist® foram: E 100%, S 86,36%, FP 0%, FN 13,64%, VPP 100%, VPN 66,67% e Kappa de 82,2%. Conclusões: As Sonossalpingografias (SoSG) contrastadas utilizando-se como eco-realçadores o Echovist® ou o Levovist® podem ser consideradas exames complementares equivalentes na rotina da avaliação inicial do factor tubário por apresentarem, além do mesmo composto químico activo, alta sensibilidade, especificidade e concordância, ambos com acuidade superior à HSG quando comparados com a LPC

Aktive Übungen zur Reduzierung des Lymphoedems nach Brustkrebsbehandlung

The aim of this study was to evaluate the reduction in volume of arm lymphedema secondary to breast cancer therapy utilizing an exercise facilitating device. Twenty-one women with arm lymphedema resulting from the surgical and radiotherapeutic treatment of breast cancer were randomly selected. Evaluation was made by water-displacement volumetry before and after each session. The patients were submitted to a series of active exercises using a facilitating device for four 12-minute sessions with intervals of 3 minutes between sessions in the sitting position with alignment of the spinal column. The lymphedematous arm was maintained under compression using a cotton-polyester sleeve. The active exercising device used was a mobile flexion bar fixed on a metal base at a height of 30 cm from the tabletop and at a distance of 10 cm from the patient's body. The paired t-test was utilized for statist ica l analysis with an alpha error of 5% (p-value er Irrtumswahrscheinlichkeit von 5% (p 2.023,0 ml mit einer mittleren Flüssigkeitsverdrängung von 66,9 ml (p<=0,001).Die aktive Übung mit einem einfachen Gerät kann eine signifikante Reduktion des Lymphoedems der Arme bewirken

Teleultrasound: Historical Perspective and Clinical Application

The health care of patients in rural or isolated areas is challenged by the scarcity of local resources, limited patient access to doctors and hospitals, and the lack of specialized professionals. This has led to a new concept in telemedicine: teleultrasonography (or teleultrasound), which permits ultrasonographic diagnoses to be performed remotely. Telemedicine and teleultrasonography are effective in providing diagnostic imaging services to these populations and reduce health care costs by decreasing the number and duration of hospitalizations and reducing unnecessary surgical procedures. This is a narrative review to present the potential clinical applications of teleultrasonography in clinical practice. The results indicate that although barriers persist for implementing teleultrasonography in a more universal and routine way, advances in telecommunications, Internet bandwidth, and the high resolution currently available for portable ultrasonography suggest teleultrasonography applications will continue to expand. Teleultrasound appears to be a valuable addition to remote medical care for isolated populations with limited access to tertiary healthcare facilities and also a useful tool for education and training

Non-association between anti-Toxoplasma gondii antibodies and ABO blood group system

Toxoplasma gondii infects humans through the gastrointestinal tract (GIT), which elicits humoral immune response with specific antibodies. The expression of the ABO blood group glycoconjugates also occurs in this same system and may influence the human susceptibility of infection by T. gondii. The aim of the present study was to investigate the association between ABO blood group phenotypes and the presence of anti-T. gondii antibodies. Data - including age, results of serology tests for T. gondii infection and ABO blood group phenotypes - were assembled from the medical records of 1,006 pregnant women attended in the Base Hospital of the Medical School of São José do Rio Preto, Brazil, between 2001 and 2004. The chi-square test was used to compare the results with the level of significance set at 5%. Of the studied cases, 64.1% (645/1006) and 35.9% (391/1006) presented respectively positive and negative serology tests for anti-T. gondii antibodies. The mean age of those who tested positive was higher than those with negative serology tests (p = 0.0004). The frequencies of ABO blood group phenotypes were similar in those with and without anti-T. gondii antibodies (p = 0.35). In conclusion, the ABO blood group system is not associated with the presence or absence of anti-T. gondii antibodies