Editorial

Nowadays there is a standardization of opinion in our society. The implementation of the “streamline thought culture” is most likely related to current information dissemination systems, which being true for society in general, is also true for scientific dissemination.Opinion makers associated with mass information vehicles condition a common sense of what is socially acceptable, with little disclosure for the diversity of thoughts and even low tolerance for their acceptance.Hoje em dia existe uma uniformização da opinião na nossa sociedade. A implementação da “cultura do pensamento dominante” está muito provavelmente relacionada com os actuais sistemas de divulgação de informação, o que sendo verdade para a sociedade em geral, também o é na divulgação científica.Fazedores de opinião associados a veículos de informação massificados condicionam um sentido comum do que é socialmente aceite, existindo pouca divulgação para a diversidade de pensamentos e mesmo baixa tolerância para aceitação dos mesmos

Editorial

One year has now passed since the online submission and editing system was implemented, a further step was taken to index the main databases of medical journals. Starting with this issue, all articles published in Acta Radiológica Portuguesa will be available in English.Submission of the papers, as previously, may be done directly in English (without the Portuguese version), maintaining the possibility of submission in Portuguese. In this case, if the paper is accepted for publication, it will subsequently be translated into English by the Editorial Board of the Journal, according to the authors’ corrections. Thus, when submitting in English, the paper will be available only in that language and when submitting it in Portuguese, the two versions will be published, one in Portuguese and one in English.With this measure, we hope to maintain the national identity of the Journal and make international indexing easier.In view of the interest shown by a large number of Radiologists present at the last SPRMN Conference, the person responsible for the updating program in Mammary Imaging, Dr. José Carlos Marques, was invited for the authorship of the article of opinion in the present issue of the Journal

Caso Clínico ARP nº 19

A 4-year-old male child presented was referred to our department with a history of an incidental finding reported on an abdominal ultrasound which was performed during the diagnostic workup of an interauricular communication

Editorial

Muitas mudanças surgiram na divulgação científica desde a data do 1º número da Acta Radiológica Portuguesa até hoje.O primeiro número da revista foi editado em janeiro-março de 1989 e resultou de uma série de iniciativas tomadas após a organização do “VI Congresso Europeu de Radiologia, ECR 87” organizado pela SPRMN. Iniciativas que incluíram a instalação de meios audio-visuais (programas de vídeo e slides) e a criação de uma biblioteca. Destas, a criação da Acta foi, a nosso ver, a iniciativa que mais retorno teve na formação e divulgação da Radiologia. Quis a Direção de então criar “um jornal periódico com características duma revista internacional.(…) uma alternativa para a publicação dos jovens radiologistas europeus. (…) pretende-se estimular a participação sem fronteiras, por outro, pretende-se atingir um nível qualitativo que assegure o interesse da divulgação internacional dos trabalhos.” [retirado do editorial do 1º número da autoria da Dr.ª Maria Emília Silvestre

[Proposta de protocolo para redução dos riscos e otimização da sensibilidade nos exames de imagem em pessoas com diabetes]

Diabetes is a very common chronic disease in the Portuguese population, with an estimated prevalence of 13.6% in the adults. Doubts often arise regarding the best preparation and the risks associated with doing imaging tests in these patients. In this article we intend to review the main precautions in imaging tests in people with diabetes and to suggest a guideline to reduce the risks and optimize the sensitivity of these tests in this population. The main topics addressed in this article are the need to suspend metformin after the administration of endovascular iodinated contrast due to the risk of lactic acidosis, the precautions in insulin-treated patients or those taking medicines with a higher risk of hypoglycemia when performing imaging tests that require fasting, and the influence of hyperglycemia and of anti-diabetic therapy on the sensitivity of PET-FDG. With this review and the presentation of a guideline, we intend to demystify and simplify the management of individuals with diabetes who are undergoing imaging tests.authorsversionpublishe

HIPERTENSÃO RENOVASCULAR NUM RAPAZ COM 12 MESES: O QUE PODE O RADIOLOGISTA FAZER?

We report a clinical case of renovascular disease, probably linked to fibromuscular dysplasia, in a 12 months old boy with severe arterial hypertension with target-organ damage, highlighting the radiological approach. Initial investigation included renal ultrasound that showed normal sized kidneys, with normal cortical echogenicity on the right and focally increased echogenicity of the posterior aspect of the left kidney, forming a mass-like lesion. Magnetic resonance imaging excluded renal tumor, which was confirmed by ultrasound guided biopsy. A doppler ultrasonography was also performed suggesting a right renal artery stenosis and decreased flow to the posterior aspect of the left kidney. Angiography with diagnostic and therapeutic intention was performed: right renal artery stenosis was detected and transluminal ballon dilation was performed; the left renal artery bifurcated precociously and the branch that irrigated the posterior part of the kidney had a stenosis which was also successfully dilated. After the intervention good blood pressure control with antihypertensive drugs was achieved, which was not possible before the angiographic procedure. The authors underline various methods of imaging used to accurately diagnose renovascular disease and the usefulness of interventional radiology treatment for this disease in very young children

Hepatobiliary fascioliasis

Hepatobiliary fascioliasis is a parasitic disease caused by Fasciola hepatica, which is a trematode that primarily infects cattle and sheep, but may also affect humans in endemic areas.There are two phases of the disease: the acute one - where the parasites infect the liver parenchyma; and the subacute / chronic phase - when the parasites reach the biliary ducts and gallbladder, providing typical imaging findings.Because this disease may mimic several hepatobiliary disorders, misdiagnosis or late diagnosis is a concern. Therefore, knowledge of the typical and specific imaging findings is important in accomplishing a correct diagnosis.The authors describe a case of a 49-year-old male that presented with nonspecific liver symptoms. Liver ultrasound, computed tomography and magnetic resonance imaging showed several typical findings of the disease, which helped achieve the diagnosis

Kingdon’s multiple stream model used to analyze health policies : applicability, contribution and limits

O presente trabalho teve como objetivos identifcar as produções científcas sobre análise de políticas de saúde que utilizaram o modelo dos múltiplos fuxos de Kingdon e examinar as contribuições e os limites do modelo no estudo das políticas públicas de saúde, no contexto do SUS. Realizou-se uma revisão integrativa de publicações disponíveis nas bases de dados ProQuest, Portal de Periódicos e Banco de Teses e Dissertações da Capes e Scientifc Elec- tronic Library Online, com uso das palavras-chave Kingdon Model, multiple streams model (modelo dos múltiplos fuxos) e políticas públicas de saúde. Os critérios de inclusão foram: estudos completos em português e inglês, disponíveis on-line nas bases de dados; e análises de políticas públicas de saúde com uso do modelo Kingdon em experiências nacio- nais ou internacionais. Foram excluídos estudos de revisão e relatos de experiência. Foram levantados 4 teses de doutorado, 6 artigos e 2 dissertações de mestrado, publicados entre 1994 a 2009. O modelo de Kingdon mostrou-se aplicável a análises de políticas de saúde em diferentes sistemas políticos nacional e internacional, em períodos prolongados de tempo e na atuação dos governos. As contribuições desse modelo de análise para o SUS incluem: a) a incorpo- ração da ambiguidade nas decisões; b) a valorização da consistência das ideias contidas nas propostas; c) a análise das diferentes interpretações sobre os problemas complexos da saúde brasileira pelos tomadores de decisão. Dentre os limites, aponte-se a ênfase na atuação dos atores em detrimento do marco institucional que delimita suas decisões.This study aimed to identify the scientifc produc- tion on health policy analysis that use Kingdon’s model of multiple streams, and to examine the model’s contributions and limits in the study of public health policies, in the SUS context. An inte- grative review of publications using the keywords Model Kingdon, multiple streams model “modelo de múltiplos fuxos” and health public policy was made at the following databases: ProQuest, Portal de Periódicos and Banco de Teses e Dissertações (from CAPES) and Scientific Electronic Library Online. Inclusion criteria were: complete studies in Portuguese and English, available online in the databases; analysis of public health policies using the Kingdon model in national or international ex- periences. Review studies and experience reports were excluded. We identifed 4 doctoral thesis, 6 articles and 2 master dissertations published from 1994 to 2009. The Kingdon’s model proved to be ap- plicable for analysis of health policies in different national and international political systems, in long periods of time and in the practice of governments. The contributions of this model for SUS analysis include: a – the incorporation of ambiguity in the decisions; b –appreciation of the consistency of the ideas contained in the proposals; c – an analysis of di- fferent interpretations of decision makers about the complex problems of Brazilian health. Concerning its limits, we point out its emphasis in the action of actors at the expense of the institutional framework that delineates their decisions