Subchondral Cystlike Lesions Develop Longitudinally in Areas of Bone Marrow Edema-like Lesions in Patients with or at Risk for Knee Osteoarthritis: Detection with MR Imaging-The MOST Study

Purpose: To assess the association of prevalent bone marrow edema-like lesions (BMLs) and full-thickness cartilage loss with incident subchondral cyst-like lesions (SCs) in the knee to evaluate the bone contusion versus synovial fluid intrusion theories of SC formation. Materials and Methods: The Multicenter Osteoarthritis study is a longitudinal study of individuals who have or are at risk for knee osteoarthritis. The HIPAA-compliant protocol was approved by the institutional review boards of all participating centers, and written informed consent was obtained from all participants. Magnetic resonance images were acquired at baseline and 30-month follow-up and read semiquantitatively by using the Whole-Organ Magnetic Resonance Imaging Score system. The tibiofemoral and patellofemoral joints were subdivided into 14 subregions. BMLs and SCs were scored from 0 to 3. Cartilage morphology was scored from 0 to 6. The association of prevalent BMLs and full-thickness cartilage loss with incident SCs in the same subregion was assessed by using logistic regression with mutual adjustment for both predictors. Results: A total of 1283 knees were included. After adjustment for full-thickness cartilage loss, prevalent BMLs showed a strong and significant association with incident SCs in the same subregion, with an odds ratio of 12.9 (95% confidence interval [CI]: 8.9, 18.6). After adjustment for BMLs, prevalent full-thickness cartilage loss showed a significant but much less important association with incident SCs in the same subregion (odds ratio, 1.4; 95% CI: 1.0, 2.0). There was no apparent relationship between severity of full-thickness cartilage loss at baseline and incident SCs. Conclusion: Prevalent BMLs strongly predict incident SCs in the same subregion, even after adjustment for full-thickness cartilage loss, which supports the bone contusion theory of SC formation. (C) RSNA, 2010

Dual Effects of Hyperprolactinemia on Carrageenan-Induced Inflammatory Paw Edema in Rats

Objectives: The effects of short-term 5-day and long-term 30-day hyperprolactinemia induced by domperidone (1.7 mg/kg/day, s.c.) or ectopic pituitary graft on the acute inflammatory response induced by carrageenan were evaluated in male rats. Both models of hyperprolactinemia effectively increased serum prolactin (PRL) levels. Methods: The volume in milliliters of inflammatory edema was measured by plethysnnography 1, 2, 3, 4, 6, 8 and 24 h after carrageenan injection. The areas under the inflammatory time-response curves were compared. Additionally, the effects of hyperprolactinemia on body weight and serum corticosterone levels were evaluated. Results: In both domperidone-treated and pituitary graft-implanted animals, short-term 5-day hyperprolactinemia increased the inflammatory response, while long-term 30-day hyperprolactinemia had anti-inflammatory effects. Body weight was not affected by either short- or long-term hyperprolactinennia. Conclusion: These results show that PRL has biphasic effects on the carrageenan-induced inflammatory response. Copyright (C) 2011 S. Karger AG, Basel

Amitriptyline and Acute Inflammation: A Study Using Intravital Microscopy and the Carrageenan-Induced Paw Edema Model

Background/Aims: Antidepressants are reported to exhibit antiinflammatory effects. However, mechanisms involved in this action have not been elucidated. Thus, the objectives of the present study were (a) to evaluate the effects of amitriptyline on the acute inflammatory process, and (b) to investigate the participation of alpha(1)-adrenergic receptors and glucocorticoids as possible mechanisms implicated in the amitriptyline action on inflammation. Methods and Results: Single and multiple doses of amitriptyline were administered to rats submitted to the carrageenan-induced paw edema model. The results showed a significant antiedematous reaction to amitriptyline, mainly when administered at each elimination half-life. The next step was to evaluate its effects on leukocyte behavior, using intravital microscopy. Amitriptyline produced a significant effect on leukocyte behavior. To investigate possible mechanisms involved, a glucocorticoid receptor antagonist (RU-486) and an alpha(1)-adrenergic receptor antagonist (prazosin) were used. RU-486 administration lacked the ability to decrease the amitriptyline antiinflammatory effects in the carrageenan-induced paw edema model. Prazosin pretreatment potentiated the amitriptyline antiinflammatory effect without presenting an effect per se. Conclusion:The present study shows the ability of amitriptyline to decrease edema and affect leukocyte behavior in an acute inflammatory process; and, for the first time to our knowledge, we suggest the involvement of alpha(1)-adrenoceptors in the antiinflammatory effects of amitriptyline. Copyright (C) 2010 S. Karger AG, Basel

Noninvasive measurement of cerebral bioimpedance for detection of cerebral edema in the neonatal piglet

The association of sustained cerebral edema with poor neurological outcome following hypoxia-ischaemia in the neonate suggests that measurement of cerebral edema may allow early prediction of outcome in these infants. Direct measurements of cerebral impedance have been widely used in animal studies to monitor cerebral edema, but such invasive measurements are not possible in the human neonate. This study investigated the ability of noninvasive cerebral impedance measurements to detect cerebral edema following hypoxia-ischaemia. One-day-old piglets were anaesthetized, intubated and ventilated. Hypoxia was induced by reducing the inspired oxygen concentration to 4-6% O-2. Noninvasive cerebral bioimpedance was measured using gel electrodes attached to the scalp. Cerebral bioimpedance was also measured directly by insertion of two silver-silver chloride electrodes subdurally. Noninvasive and invasive measurements were made before, during and after hypoxia. Whole body impedance was measured to assess overall fluid movements. Intracranial pressure was measured continuously via a catheter inserted subdurally, as an index of cerebral edema. There was good agreement between noninvasive and invasive measurements of cerebral impedance although externally obtained responses were attenuated. Noninvasive measurements were also well correlated with intracranial pressure. Whole body impedance changes did not account for increases in noninvasively measured cerebral impedance. Results suggest that noninvasive cerebral impedance measurements do reflect intracranial events, and are able to detect cerebral edema following hypoxia-ischaemia in the neonate. (C) 2002 Elsevier Science B.V. All rights reserved.

A new technique for the quantification of peripheral edema with application in both unilateral and bilateral cases

Current noninvasive techniques for the routine and frequent quantification of peripheral lymphedema in patients are total limb volume measurement (by water immersion or by circumferential measurements) and bioelectrical impedance analysis (BIA). However both of these techniques require standardizing the measurement using a contralateral measurement from the unaffected limb, Hence these techniques are essentially restricted to unilateral lymphedema. This paper describes the results from a preliminary study to investigate an alternative approach to the analysis of the data from multiple frequency BIA to produce an index of lymphedema without the need for normalization to another body segment. Twenty patients receiving surgical treatment for breast cancer were monitored prior to surgery and again after diagnosis with unilateral lymphedema. The data recorded were total limb volume, by circumferential measurements; and BIA measurements of both limbs. From these measurements total limb volumes and extracellular fluid volumes were calculated and expressed as ratios of the affected limb to that of the unaffected limb. An index of the ratio of the extracellular fluid volume to the intracellular fluid volume was determined. This ECW/ICW index was calculated for both the affected and unaffected limbs at both measurement times. Results confirmed that the established techniques of total limb volume and extracellular fluid volume normalized to the unaffected contralateral limb were accurate in the detection of lymphedema (p < 10(-6)). Comparison of the ECW/ICW index from the affected limb after diagnosis with that from the pre-surgery measurement revealed a significant (p< 10(-6)) and considerable (75%) increase. The results of this pilot study suggest that by using multiple frequency bioelectrical impedance analysis, an index of the ECW/ICW ratio can be obtained and this index appears to have an equal, or better, sensitivity, than the other techniques in detecting lymphedema. More importantly, this index does not require normalization to another body segment and can be used to detect all types of peripheral edema including both unilateral and bilateral lymphedema.

Diferenciação histopatológica e imunoistoquímica das alterações epiteliais no nódulo vocal em relação aos pólipos e ao edema de laringe

OBJETIVO: Avaliar, por meio de técnicas histológicas e imunoistoquímicas, o epitélio nos nódulos vocais em relação aos pólipos, ao edema de laringe e às pregas vocais sem lesões macroscópicas. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Por meio de levantamento de prontuário, foram identificados vinte e seis pacientes com lesões laríngeas inflamatórias (nódulos, pólipos e edema de laringe), que haviam sido submetidos à cirurgia. Pregas vocais sem alterações macroscópicas foram obtidas a partir de autópsia de cadáveres. Para análise do epitélio, foram realizadas colorações pela técnica da hematoxilina-eosina e do ácido periódico de Schiff e técnicas de imunoistoquímica com anticorpos dirigidos contra laminina e colágeno IV. A leitura das lâminas foi realizada por meio de microscopia óptica. RESULTADOS: Houve maior imunoexpressão de laminina e colágeno IV nos nódulos quando comparados aos pólipos (p=0,034 e p=0, 036, respectivamente), assim como quando comparados às pregas vocais sem lesões macroscópicas (p=0,019 e p=0, 021, respectivamente). Nódulos tendem a apresentar maior espessura da membrana basal, quando utilizamos coloração pela técnica do PAS, em relação aos pólipos (p=0,102). O edema de laringe não se diferenciou das demais nas técnicas utilizadas (p> 0,10). CONCLUSÕES: O Nódulo Vocal diferencia-se dos pólipos, nas três técnicas utilizadas para detecção da membrana basal (PAS, laminina, colágeno IV), e das pregas vocais sem lesões macroscópicas em duas das técnicas utilizadas (laminina e colágeno IV). Edema de laringe não se diferencia das demais lesões, nem de pregas vocais sem lesões macroscópicas, quando utilizadas as técnicas anteriormente descritas, para estudo da membrana basal.

Perimetria de hiperacuidade preferencial no estudo do edema macular diabético

Introdução – A diabetes é uma das maiores epidemias do último século. Mais de 250 milhões de pessoas, em todo o mundo, sofrem de diabetes. Das complicações derivadas da diabetes são as principais causas de cegueira, de insuficiência renal e de amputação de membros inferiores, derivando estes, predominantemente, da disfunção vascular. Quando surge perda de pericitos na parede vascular ocorrem uma série de alterações da microcirculação que levam ao aparecimento de microaneurismas e outras alterações vasculares que possibilitam a passagem de componentes sanguíneos para o tecido retiniano adjacente que, em situação de normalidade, não ocorreriam, sendo esta uma das causas do edema macular exsudativo diabético. A perimetria de hiperacuidade preferencial (PHP) é um teste psicofísico que pretende detetar metamorfopsias na Degenerescência Macular ligada à Idade (DMI). Uma vez que o edema macular diabético (EMD) se destaca como uma das principais causas de deficiência visual e baixa visão, pretende-se verificar a eficácia do PHP no estudo do edema macular diabético, respondendo à seguinte questão: “Qual a capacidade do perímetro de hiperacuidade preferencial em detetar metamorfopsias em pacientes com edema macular diabético?“ Metodologia – Estudo quantitativo, do tipo descritivo e correlacional. Selecionou-se uma amostra de 33 pacientes, onde se analisou um total de 60 olhos. Resultados – A sensibilidade do PHP na deteção de metamorfopsias associadas ao EMD na tomografia de coerência ótica (OCT) foi de 70,6%, a especificidade foi de 11,5% e a eficiência global do teste de 45%. Comparando os resultados encontrados no PHP e no OCT, constatou-se a existência de uma correlação inversa fraca (Phi = -0,215). Conclusões – Este novo método de diagnóstico revela-se sensível, contudo pouco específico e eficaz na deteção de metamorfopsias consequentes da existência de EMD. - ABSTRACT - Introduction – Preferential hyperacuity perimeter (PHP) is a new psychophysical test, which principle is based on the detection of metamorphopsia in age-related macular degeneration (AMD). It is intended to verify its effectiveness in the study of diabetic macular edema (DME). When there is loss of pericytes in the vascular wall occur a number of microcirculatory changes that lead to the appearance of microaneurysms and other vascular changes that allow the passage of blood components to the surrounding retinal tissue than in normal situation does not occur, this being one of the causes exudative diabetic macular edema. Methodology – It was performed a quantitative study, using descriptive and correlational analysis. A sample of 33 patients was selected, and 60 eyes were analyzed. Results – The sensitivity of PHP on the detection of metamorphopsia associated to EMD was 70.6%, the specificity was 11.5% and the global efficiency of the test was 45%. It was found a weak negative correlation (Phi= -0.215) between the PHP and optical coherence tomography (OCT). Conclusions – This new method of diagnosis was sensitive, but not very specific and effective on the detection of metamorphopsia, due to the DME.

Caracterização do fibro edema gelóide e respectivos tratamentos nos estudantes de fisioterapia

Mestrado em Fisioterapia

Edema Agudo do Pulmão Pós-Extubação Traqueal. Caso Clínico

O edema agudo do pulmão pós-extubação traqueal é um acontecimento raro (≈ 0,1%)1. A etiologia é multifactorial, sendo a obstrução da via aérea superior o factor desencadeante principal. O esforço inspiratório contra a glote encerrada causa pressões intra torácicas muito negativas, que se transmitem ao interstício pulmonar, condicionando uma transudação de fluidos a partir dos vasos capilares pulmonares1-5. Relatamos um caso de edema agudo do pulmão pós-extubação num doente de quinze anos, operado no serviço de urgência por amputação traumática da perna esquerda. Revemos a fisiopatologia, o padrão radiológico, potenciais factores de risco e medidas preventivas desta complicação respiratória pós-anestésica.

Asymmetric pulmonary edema after scorpion sting: a case report

A 12-year-old boy was referred with acute asymmetric pulmonary edema (APE) four-hour after scorpion sting to Emergency department. On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. The patient was treated with oxygen, intravenous frusemide and digoxin and discharged on the sixth hospital day in a good condition. This case report emphasizes the occurrence of asymmetric pulmonary edema after severe scorpion envenomation within few hours immediately after the sting.

Edema Pulmonar de Pressão Negativa Após Extubação Traqueal

O edema pulmonar de pressão negativa (EPPN) também descrito na literatura como edema agudo do pulmão pós-obstrutivo ou pós-extubação traqueal, é uma entidade rara, com uma incidência de aproximadamente 0.1 % em doentes anestesiados. Os autores descrevem o caso, ocorrido após extubação traqueal, de um doente submetido a orquidectomia por via laparoscópica sob anestesia geral balanceada. Relatam a fisiopatologia, o padrão radiológico e broncoscópico e as medidas terapêuticas instituídas.

Edema na hanseníase: aspectos clínicos e terapêuticos

Durante o curso da hanseníase, o edema comumente descrito como um sintoma de estados reacionais, pode ocorrer. Tanto o diagnóstico como a terapêutica adequada são, freqüentemente, difíceis de conseguir e assim podem acarretar permanente dano aos membros inferiores. Em um ano de acompanhamento, pacientes hansenianos - 10 multibacilares e 1 paucibacilar -, que foram submetidos a um protocolo clínico para o diagnóstico e classificação histopatológica, apresentaram clinicamente edema, localizado ou sistêmico. Entre estes pacientes, cinco apresentaram simultaneamente outros sintomas de reação, 4 foram classificados como reação Tipo I e um como reação tipo II. Por outro lado, três pacientes não apresentaram reação no momento do diagnóstico, mas desenvolveram alguns aspectos de reação posteriormente (2 tiveram neurite e um teve reação tipo I). Os edemas observados precedendo ou associados a quadros reacionais apresentaram ótima resposta clínica às drogas de ação anti-inflamatória (corticóide, talidomida e pentoxifilina) utilizadas para o tratamento dos estados reacionais, na ausência de qualquer outro tratamento normalmente usado para edema. Embora necessitem ser confirmados por estudos controlados, estes dados sugerem fortemente que mecanismos imunológicos estejam envolvidos na fisiopatologia dos edemas na hanseníase.

Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2), continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69±7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at begining, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05). Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05). CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.