BackgroundPulmonary arterial hypertension is a progressive disease that is characterized by dyspnea and exercise intolerance. Impairment in skeletal muscle has recently been described in PAH, although the degree to which this impairment is solely determined by the hemodynamic profile remains uncertain. The aim of this study was to verify the association of structural and functional skeletal muscle characteristics with maximum exercise in PAH.MethodsThe exercise capacity, body composition, CT area of limb muscle, quality of life, quadriceps biopsy and hemodynamics of 16 PAH patients were compared with those of 10 controls.ResultsPAH patients had a significantly poorer quality of life, reduced percentage of lean body mass, reduced respiratory muscle strength, reduced resistance and strength of quadriceps and increased functional limitation at 6MWT and CPET. VO2 max was correlated with muscular variables and cardiac output. Bivariate linear regression models showed that the association between muscular structural and functional variables remained significant even after correcting for cardiac output.ConclusionOur study showed the coexistence of ventilatory and quadriceps weakness in face of exercise intolerance in the same group of PAH patients. More interestingly, it is the first time that the independent association between muscular pattern and maximum exercise capacity is evidenced in PAH, independently of cardiac index highlighting the importance of considering rehabilitation in the treatment strategy for PAH.
Appendiceal diverticulitis is an uncommon condition, mimicking appendicitis, but with greater risk of perforation and complications. Preoperative diagnosis is rare, but can be achieved by ultrasonography as identification of the diverticulum and classical signs of appendicitis. We report a case of ultrasonographic diagnosis of a perforated appendiceal diverticulitis in an adult male and discuss this condition.Keywords: Appendix; Diverticulum; Diverticulitis/ultrasonography; Diverticulitis/diagnosis; Case reports RESUMO A diverticulite do apêndice é uma patologia incomum, eventualmente confundida com a apendicite cecal, tendo, porém, maior risco de perfuração e de outras complicações. Seu diagnóstico pré-cirúrgico é raramente realizado, mas pode ser obtido pela ultrassonografia com a demonstração de um divertículo associado a sinais clássicos de apendicite. Relatamos o caso de um homem adulto em que foi possível o diagnóstico ultrassonográfico de diverticulite do apêndice cecal e revisamos os principais aspectos relacionados a essa condição.
ObjectiveTo evaluate bone mineral density among patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy.MethodsThis was a descriptive prospective study in which both bone densitometric and anthropometric data were evaluated. The inclusion criteria used were that the patients should present quadriplegic cerebral palsy, be confined to a wheelchair, be between 10 and 20 years of age and present neuromuscular scoliosis.ResultsWe evaluated 31 patients (20 females) with a mean age of 14.2 years. Their mean biceps circumference, calf circumference and body mass index were 19.4 cm, 18.6 cm and 16.9 kg/m2, respectively. The mean standard deviation from bone densitometry was −3.2 (z-score), which characterizes osteoporosis.ConclusionThere is high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy.
Congenital anomalies of the inferior vena cava (IVC) can represent a difficult for abdominal surgeries, and the radiologist must be aware even of the less common of these anatomical variations. Preaortic iliac venous confluence, also known as marsupial vena cava, is a rare congenital anomaly of the development of the IVC in which the IVC or the left common iliac vein is located anterior to the aortic bifurcation or the right common iliac artery. We report 4 cases of marsupial vena cava detected on multidetector computed tomography examinations in asymptomatic patients and discuss that this congenital anomaly can be recognized more frequently with the use of this new technique based on thinner images.
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