US measurement of craniocaudal displacement of the left intrahepatic branches of the portal vein can be used for indirect assessment of right hemidiaphragmatic mobility.

Background: Obese subjects are at increased risk of developing obstructive sleep apnea syndrome (OSAS). However, the individual role of local (i.e., upper airway-related) and general (clinical and whole-body anthropometric) characteristics in determining OSAS in obese patients is still controversial. Objectives: To contrast the clinical, anthropometric and upper airway anatomical features of obese subjects presenting or not presenting with OSAS. Methods: Thirty-seven obese (BMI ≧30 kg/m²) males with OSAS and 14 age- and gender-matched obese controls underwent clinical and anthropometric (BMI, waist-to-hip ratio and neck circumference) evaluation. In a subgroup of subjects (18 and 11 subjects, respectively), magnetic resonance imaging (MRI) during wakefulness was used to study the upper airway anatomy. Results: OSAS patients showed significantly higher BMI, waist-to-hip ratio and neck circumference as compared to controls (p < 0.05). They also referred to nonrepairing sleep, impaired attention, and previous car accidents more frequently (p < 0.05). The transversal diameter of the airways (TDAW) at the retroglossal level by MRI was found to be an independent predictor of the presence and severity of OSAS (p < 0.05). Parapharyngeal fat increase, however, was not related to OSAS. A TDAW >12 mm was especially useful to rule out severe OSAS (apnea-hypopnea index >30, negative predictive value = 88.9%, likelihood ratio for a negative test result = 0.19). Conclusions: MRI of the upper airway can be used in association with clinical and anthropometric data to identify obese males at increased risk of OSAS.

Objectives: The aim of this study was to investigate bone changes in the condyle, articular eminence and glenoid fossa in relation to the position of the articular disc. Methods: 148 temporomandibular joints (TMJs) of 74 symptomatic patients who underwent MRI were evaluated. The position of the disc was classified as either normal (N), disc displacement with reduction (DDwR), disc displacement without reduction (DDwoR) and posterior displacement (PD). Bone changes were investigated in the condyle and temporal components of the TMJ and classified as osteophytosis, sclerosis or erosion. Results: There were no bone changes in the glenoid fossa of the temporal bone. Of the total number of TMJs studied, 94 (63.5%) were N, 34 (23%) presented DDwoR, 19 (12.8%) presented DDwR and 1 (0.7%) presented PD. The bone changes in the condyle and posterior aspect of the articular eminence were associated with the position of the disc. The bone changes in the anterior aspect of the articular eminence were not associated with the position of the disc. Conclusion: In cases of DDwoR, bone changes in the condyles were more common. The combination of erosion and osteophytosis in the condyle and the bone changes of the posterior aspect of the articular eminence were associated with disc position.

Using strict criteria (same patient, same drug, same dose) our results strongly suggest that the surgical reduction of tumour mass can improve the outcome of OCT-LAR treatment in acromegalic patients resistant to primary therapy with SA.

The results suggest that, during spontaneous ventilation, the dependent portion of the diaphragm presents greater mobility than does the nondependent portion, and that the technique used was sufficiently sensitive to detect variations in diaphragmatic mobility related to changes in posture.

SUMMARYPersistent trigeminal artery (PTA) is the most frequent embryonic communication between the carotid and vertebrobasilar systems. However, hormonal changes or the association of PTA with other sellar lesions, such as pituitary adenomas, are extremely rare. The aim of the present study was to report two patients with intrasellar PTA and simultaneous pituitary adenoma in order to emphasize the importance of differential diagnoses for sellar lesions. Case 1. A female patient, 41 years old, was admitted with a history of chronic headache (> 20 years). Pituitary magnetic resonance imaging (MRI) showed a rounded lesion in the left portion of the pituitary gland suggestive of adenoma (most likely clinically non-functioning adenoma). In addition to this lesion, the MRI demonstrated ecstasy of the right internal carotid artery and imaging suggestive of an intrasellar artery that was subsequently confirmed by an angio-MRI of the cerebral vessels as PTA. Case 2. A female patient, 42 years old, was admitted with a history of amenorrhea and galactorrhea in 1994. Laboratorial investigation revealed hyperprolactinemia. Pituitary MRI showed a small hyposignal area in the anterior portion of pituitary gland suggestive of a microadenoma initiated by a dopaminergic agonist. Upon follow-up, aside from the first lesion, the MRI showed a well delineated rounded lesion inside the pituitary gland, similar to a vessel. Angio-MRI confirmed a left primitive PTA. Failure to recognize these anomalous vessels within the sella might lead to serious complications during transsphenoidal surgery. Therefore, although their occurrence is uncommon, a working knowledge of vascular lesions in the sella turcica or pituitary gland is important for the differential diagnosis of pituitary lesions, especially pituitary adenomas. Arq Bras Endocrinol Metab. 2014;58(6):661-5 SUMÁRIO Persistência da artéria trigeminal (PAT) é a comunicação embrionária mais frequente entre os sistemas carotídeo e vertebrobasilar. No entanto, alterações hormonais ou associação de PAT com outras lesões selares, como adenomas hipofisários, são extremamente raros. O objetivo do presente estudo foi relatar dois pacientes com PAT intrasselar e concomitante adenoma hipofisário e enfatizar a importância para o diagnóstico diferencial de lesões selares. Caso 1. Paciente do sexo feminino, 41 anos, admitida com história de cefaleia crônica (> 20 anos). Ressonância magnética (RM) de hipófise mostrou imagem arredondada na porção esquerda da glândula sugestiva de adenoma (provavelmente adenoma clinicamente não funcionante). Adicionalmente, a RM demonstrou ectasia da artéria carótida interna direita e imagem sugestiva de artéria intrasselar, posteriormente confirmada por angio-RM dos vasos cerebrais como PAT. Caso 2. Paciente do sexo feminino, 42 anos, admitida com história de amenorreia e galactorreia em 1994. A investigação laboratorial revelou hiperprolactinemia. RM de hipófise mostrou pequena área de hipossinal na porção anterior da glândula sugestiva de microadenoma, sendo iniciad...

RESUMOO presente artigo -parte 2 de 3 -apresenta uma revisão sobre a abordagem diagnóstica do enfermo em estado de coma, destacando a investigação semiológica. Geralmente, a avaliação do indivíduo cujo nível de consciência encontra-se comprometido é uma tarefa complexa, tendo em vista as dificuldades para se analisar diretamente a consciência. Portanto, sua apreciação exige a observação atenta de um conjunto de sinais clínicos fundamentados em uma cuidadosa e sistemática avaliação neurológica a partir dos seguintes itens: (1) nível de consciência, (2) diâmetro e reflexo pupilar, (3) movimentação extrínseca do globo ocular, (4) padrão respiratório e (5) resposta motora esquelética aos diferentes estímulos. A adequada articulação entre estes itens, aliada aos dados coletados da anamnese -quando isto é possível -, permitirá a proposição de hipóteses diagnósticas, as quais guiarão a solicitação de exames complementares e a adoção de medidas terapêuticas.Unitermos. Transtornos da Consciência, Diagnóstico, Exame Físico. ABSTRACTThis article -part 2 of 3 -presents an overview of the diagnostic approach of the patient in a coma, highlighting the semiotic research. Generally, evaluating patients, whose level of consciousness is impaired, is a complex task, considering the difficulties to directly analyze the conscience status. Therefore, their evaluation requires a close observation of a set of clinical signs based on a careful and systematic neurological evaluation of the following aspects: (1) awareness, (2) diameter and pupillary reflex, (3) extrinsic movement of eyes, and (4) respiratory pattern, (5) skeletal motor response to different stimuli. The proper coordination between these items, together with data collected from the interview -when it is possible -will allow the proposal of diagnostic hypotheses, which will guide the requisition of additional tests and the therapeutic.

ObjectiveTo assess the accuracy of ultrasound in the visualization of the brachial plexus and to determine the value of the method in comparison with that of magnetic resonance imaging (MRI).Materials and MethodsThis was an anatomical study of the brachial plexuses of 20 asymptomatic adults (40 plexuses), comparing ultrasound and MRI in terms of their accuracy. In the ultrasound study, a high-frequency linear transducer was used, and a neurovascular coil was used in the MRI study. To estimate the frequency of visualization, the brachial plexus was divided into segments.ResultsThe cervical nerve roots, the upper trunk, and the middle trunk were the segments that were best visualized on ultrasound. On MRI, the degree of visualization was excellent for most of the segments. In the comparison between ultrasound and MRI, the C6, C7, upper trunk, and middle trunk segments showed equivalent degrees of visualization, with a high level of agreement between the two methods. ConclusionIn the brachial plexus, ultrasound can be used in the assessment of the cervical nerve roots, as well as of the upper and middle trunks, although it provides limited visualization of the remaining segments. Ultrasound and MRI showed a high level of agreement for the visualization of the C6, C7, and middle trunk segments.