OBJETIVO: O objetivo deste estudo foi predizer o prognóstico perinatal em fetos com derrame pleural isolado por meio da medida do volume pulmonar estimado pela ultrassonografia tridimensional. MÉTODO: Estudo retrospectivo, entre julho de 2005 e julho de 2010, com 19 fetos com derrame pleural isolado (ausência de causas infecciosas, imunes, anomalias cromossômicas ou estruturais associadas) acompanhados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os volumes pulmonares foram obtidos pela ultrassonografia tridimensional (Voluson 730 Expert, GE Medical System, Kretzechnick, Áustria) em dois períodos, no momento do diagnóstico (20 26 semanas) e próximo ao parto (duas semanas antecedentes ao parto ou até 36 semanas), e mensurados pela técnica VOCAL (Virtual Organ Computer Aided Analysis) com rotação de 30º. Os volumes obtidos (observados) foram comparados com valores esperados para idade gestacional, e a razão entre o volume total fetal observado/esperado (VPTo/e) foi avaliada de acordo com a mortalidade perinatal e morbidade neonatal (necessidade de ventilação mecânica por mais que 48 horas). RESULTADOS: Dezenove fetos com derrame pleural isolado foram analisados no período do estudo. Doze (63,2%) crianças sobreviveram. Dos sobreviventes, sete (58,3%) apresentaram morbidade respiratória. O VPTo/e no primeiro exame ultrassonográfico não se associou significativamente com mortalidade (VPTo/e: 0,42±0,19 nos sobreviventes contra 0,30±0,08 nos não sobreviventes, p=0,11). No segundo exame, por outro lado, VPTo/e foi significativamente menor nos casos que faleceram (0,24±0,08) em relação aos sobrevivente (0,58±0,21; p<0,01) e nos que necessitaram de ventilação mecânica prolongada (0,35±0,08) comparados aos que não necessitaram (0,68±0,10; p<0.01). CONCLUSÃO: O volume pulmonar fetal medido pela ultrassonografia tridimensional pode ser utilizado para predizer o prognóstico de fetos com derrame pleural isolado. / OBJECTIVE The aim of the present study was to predict the perinatal outcome in isolated pleural effusion using fetal lung volumes assessed by three-dimensional ultrasonography. METHODS: A retrospective study conducted between July 2005 and July 2010, in which 19 fetuses with isolated pleural effusion (absence of infection, immunological causes, chromosomal anomalies and associated structural anomalies) at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Fetal lung volumes were assessed by three-dimensional ultrasonography (Voluson 730 Expert, GE Medical System, Kretzechnick, Áustria) in two periods: at diagnosis (20-26 weeks) and nears the delivery (2 weeks before delivery or at 36 weeks), by VOCAL technique (Virtual Organ Computer Aided Analysis) with rotation of 30o. The observed volumes were compared to expected values for determine gestational age, and the observed/expected total fetal lung volume ratio (o/e-TFLV) was evaluated according to perinatal death and neonatal morbidity (need for mechanical ventilation longer than 48 hours). RESULTS: A total of 19 fetuses with isolated pleural effusion were evaluated during the study period. Twelve (63.2%) infants survived. Among the survivors, seven (58.3%) had severe respiratory distress at birth. The o/e-TFLV at the first ultrasound examination was not associated statistically with mortality (o/e-TLFV: 0.42±0.19 in survivors x 0.30±0.08 among those that died, p=0.11). On the second ultrasound examination, on the other hand, the o/e-TFLV was significantly reduced in those cases that died (0.24±0.08) whilst in survivors (0.58±0.21; p<0.01) and in those that needed mechanical ventilation (0.35±0.08) when compared to those that did not need it (0.68±0.10; p<0.01). CONCLUSION: Fetal lung volumes measured by three-dimensional ultrasonography may be useful to predict perinatal outcome in fetuses with primary pleural effusion

Dans le cadre de l'installation GANIL / SPIRAL-1, un système innovant de source d'ions cible (TISS) a été conçu pour produire des nouveaux faisceaux d'ions radioactifs compétitifs et déterminer dans quelle mesure il est possible d'améliorer les performances de production par l’optimisation de l’ensemble cible-source (ECS) d’ions dédié à la production d'un faisceau d'ions radioactifs spécifique.L'isotope d'alcalin de courte durée de 74Rb ( demi-vie = 64.8 ms) a été choisi comme cas d’école.En étudiant et en améliorant les processus impliqués dans le fonctionnement de l’ECS, i.e. production dans la cible par réaction fusion-évaporation, implantation dans- et sortie du graphite, effusion et ionisation, une efficacité de transformation atome-ion de 75% est attendue, menant à un taux d'ions de l'ordre de 104 pps à la sortie de l’ECS.Les performances estimées permettraient à l'installation GANIL / SPIRAL-1 de délivrer des faisceaux de 74Rb et 114Cs avec des intensités compétitives, jamais atteintes dans d'autres installations.Le dispositif de production a été développé sur la base de mon travail, pour répondre aux objectifs de physique et aux conditions d'opération de SPIRAL-1. L'efficacité, la fiabilité et donc la simplicité étaient essentielles. Le système répond à ces exigences. / In the frame of GANIL/SPIRAL-1 facility, an innovative target ion source system (TISS) has been designed in order to produce new competitive radioactive ion beams, and to determine to which extent it is possible to improve the production performances by optimizing a target ion source system dedicated to the production of a specific radioactive ion beam.The short-lived alkali isotope of 74Rb (half-life = 64.8 ms) has been chosen as a challenging case study.By studying and improving the processes involved in the TISS designed, i.e. in-target production by fusion-evaporation, implantation in and release out of graphite, effusion, and ionization, an atom-to-ion transformation efficiency of 75% was predicted, leading to an ion rate of the order of 104 pps at the exit of the TISS.The estimated performances would allow the GANIL / SPIRAL-1 installation to deliver beams of 74Rb and 114Cs with competitive intensities never reached in other installations.The production device was developed based on my work, to cope with physics objectives and with the conditions of the SPIRAL-1 operation. Efficiency, reliability and thus simplicity were essential. The system meets these requirements.The instrumentation needed for tests existed or have been specifically designed. The TISS has been built, assembled and partly tested.In parallel, issues have been addressed to answer related questions about sticking times, resistivity, and emissivity, to get inputs for the design of the TISS.Expected results with alkali allow thinking that the transposition of the principle to the production of neutron-deficient short-lived isotopes of noble gases and eventually metals could be performing.

Children frequently experience fluctuating conductive hearing loss during and following episodes of otitis media with effusion. With the prevalence of the disease increasing in the non-Aboriginal population in Australia, many children may be at risk of long-term learning and behavioural problems. There are conflicting findings in the research literature regarding the effects of this type of hearing loss. Although it is expected that the insertion of tympanostomy tubes (grommets) will reduce the duration and prevalence of both the disease and the conductive hearing loss, this does not always happen. For some primary school aged children it appears that experience with otitis media with effusion with or without grommet insertion is associated with various education problems including poor academic achievement and inappropriate behaviour. A current concern is whether or not these possible effects would continue to influence the learning and behaviour of children as they continue into their high school years. A review of the literature suggests that multiple factors including interrelationships between experience of otitis media with effusion, family and childcare environments may be involved in explaining why some students do not achieve as expected at school (Roberts et al., 2000). The literature further suggests there may be a cumulative effect in these factors, which introduces both quantitative and qualitative aspects to the discussion. A study was undertaken to identify the impact of otitis media with effusion and its associated sequelae on the learning and behaviour of high school students. Information from parents of high school students in Years 8 and 9 was used to identify students for inclusion in the study and to provide information on their medical and educational history as well as the parents' perceptions of various aspects of the students' learning and behaviour (including social skills). Three groups were formed: a Non-OME/Non-Grommet Group (n = 28), an OME/Grommet Group (n = 17) and an OME/Non-Grommet Group (n = 32). The TORCH, WRAT 3 and the Test of Syntactic Abilities (Screening Test) were administered to the students who also provided their own perceptions of specific aspects of their own learning and behaviour on a survey form. Teachers' perceptions on these areas were also collected. School academic records as well as data from school behavioural records were used. Analysis of the results revealed a range of mild effects. These included poorer academic results particularly for girls with a history of grommets, who also exhibited a lack of confidence in their social skills. An increase in behaviour problems for boys with a history of the disease (with or without grommets) was also found. The study identifies a number of associated teaching and learning issues including noise levels in childcare environments and school classrooms, current teaching and learning methodology and the training of new teachers. It recommends a number of areas for future research including more in-depth questioning of parents regarding their awareness of hearing problems in their children, the use of more fine-grained measures to assess learning outcomes and the identification of possible gender differences associated with the disease and experiences with grommets.

Otitis media (OM), one of the commonest of childhood diseases, causes much suffering. OM exists in a variety of forms, two of which are acute otitis media (AOM) and otitis media with effusion (OME). The clinical courses of these conditions differ, AOM usually presenting with earache, fever and/or aural discharge, and the OME usually with hearing impairment. The tympanic membrane (TM) mirrors the events in the middle ear cavity, and pars flaccida (PF) is the initial site of inflammatory changes in the TM. PF is rich in mast cells (MCs), which by releasing various mediators, may trigger TM inflammation. The aims of the present studies were to investigate early inflammatory changes in the TM in rat models of OM; after mast cell degranulation, in response to AOM, and OME, after myringotomy in AOM and in normal ears. Furthermore, we developed a new rat AOM model, that excludes surgical trauma and resembles the natural route of infection in man. AOM and OME elicited the first inflammatory response in PF of the TM. The response to OME was discrete, but a slight increase in macrophages was found. During the first 48 hours of AOM, the inflammatory response was intense, following a bimodal pattern. This reaction is similar to that found after MC degranulation. In AOM, macrophages were the predominant cell in PF, while in pars tensa (PT), polymorphonuclear cells (mainly neutrophils) predominated. When myringotomy was performed in AOM ears, the healing time was shorter than that of myringotomy in normal ears. The highly inflamed lamina propria seemed to promote healing. During early AOM, as well as following myringotomy, fibrin extravasates into PF and PT. This fibrin deposition may be involved in regulating the inflammatory response. Repeated nasal challenge with the otitis media pathogen Streptococcus pneumoniae provoked AOM and concomitant TM stimulation reduced the number of AOM cases. This new rat AOM model has the advantage of avoiding trauma in the middle ear cavity, while eliciting an intense inflammatory response in the middle ear cavity (MEC).

This thesis details the development of expertise and tools required for the study of amino acids deposited on Au(111), with a primary focus on the design and testing of a Knudsen cell for controlled deposition of L-cysteine and L-methionine. An ultra-high vacuum preparation chamber designed by Dr. Katie Mitchell and built by Torrovap Industries Inc. was installed. This chamber is connected to the existing scanning tunneling microscopy chamber via a gate valve, and both chambers can operate independently. Various instruments such as a mass spectrometer, quartz crystal microbalance, ion source, and sample manipulator were installed on the preparation chamber. Scanning tunneling microscopy was performed on both homemade and commercial Au(111) thin films. High resolution images of "herringbone" reconstruction and individual atoms were obtained on the commercial thin films, and optimal tunneling conditions were determined. A Knudsen cell was designed to be mounted on the preparation chamber. The Knudsen cell operates over the temperature range 300-400K, with temperatures reproducible to ±0.5K, and stable to ±0.1K over a five minute period. Reproducible deposition rates of less than 0.2Ǻ/s were obtained for both L-cysteine and L-methionine. Electron impact mass spectrometry and heat of sublimation measurements were performed to characterize the effusion of L-cysteine and L-methionine from the Knudsen cell. The mass spectrometry results suggest that L-cysteine was decomposing at 403K while L-methionine was stable during effusion. Heats of sublimation of 168.3±33.2kJ/mol and 156.5±10.1kJ/mol were obtained for L-cysteine and L-methionine respectively.

This thesis details the development of expertise and tools required for the study of amino acids deposited on Au(111), with a primary focus on the design and testing of a Knudsen cell for controlled deposition of L-cysteine and L-methionine. An ultra-high vacuum preparation chamber designed by Dr. Katie Mitchell and built by Torrovap Industries Inc. was installed. This chamber is connected to the existing scanning tunneling microscopy chamber via a gate valve, and both chambers can operate independently. Various instruments such as a mass spectrometer, quartz crystal microbalance, ion source, and sample manipulator were installed on the preparation chamber. Scanning tunneling microscopy was performed on both homemade and commercial Au(111) thin films. High resolution images of "herringbone" reconstruction and individual atoms were obtained on the commercial thin films, and optimal tunneling conditions were determined. A Knudsen cell was designed to be mounted on the preparation chamber. The Knudsen cell operates over the temperature range 300-400K, with temperatures reproducible to ±0.5K, and stable to ±0.1K over a five minute period. Reproducible deposition rates of less than 0.2Ǻ/s were obtained for both L-cysteine and L-methionine. Electron impact mass spectrometry and heat of sublimation measurements were performed to characterize the effusion of L-cysteine and L-methionine from the Knudsen cell. The mass spectrometry results suggest that L-cysteine was decomposing at 403K while L-methionine was stable during effusion. Heats of sublimation of 168.3±33.2kJ/mol and 156.5±10.1kJ/mol were obtained for L-cysteine and L-methionine respectively.

Made available in DSpace on 2016-06-02T20:18:15Z (GMT). No. of bitstreams: 1 3957.pdf: 2895420 bytes, checksum: 6582876d42cf86a1b96fcbcd3db2a9c4 (MD5) Previous issue date: 2011-11-29 / Universidade Federal de Minas Gerais / The joint inflammation is a frequent cause of activity limitation in daily life of the population. Usually, this condition also affects the muscles that are functionally related to the inflamed joint. The possible relationship between joint inflammation and the expression of genes related to muscle atrophy, differentiation and growth and muscle mass control in muscles functionally related to the inflamed joint, has not been studied. The aim of this thesis was to evaluate the effect of the tibiotarsical joint inflammation, induced by carrageenan, on the expression of genes related to muscle atrophy (atrogin-1 and MuRF-1), growth and differentiation (MyoD), muscle mass regulation (myostatin), and proinflammatory factors (p38MAPK, NFkB and TNF-alpha); and the expression of TNF-alpha protein in the tibialis anterior (TA) and soleus rat muscle. Changes in the muscle fiber cross-sectional area (CSA) were also evaluated. Wistar rats were randomly divided into four periods (2 days, 7 days and 15 days) and were assigned into four groups within each experimental period: Control, Sham, Inflammation and Immobilization. Real-time polymerase chain reaction, Western blot, immunofluorescence and muscle fiber CSA analyses were performed. The joint inflammation altered the mRNA levels of genes related to muscle atrophy, growth and differentiation, muscle mass regulation and proinflammatory factors in TA and soleus rat muscle after 2, 7, and 15 day. The joint inflammation increased the TNF-alpha protein expression only in the TA muscle at 7 days. The muscle fiber CSA was reduced in the TA at 7 days and, in the soleus muscle at 7 and 15 days. In both muscles TA and soleus, acute joint inflammation was able to stimulate the molecular pathway related to muscle atrophy with no reduction in AST fibers. Conversely, the chronic joint inflammation led to a differential response according to the muscle studied. In the TA muscle, the muscle fiber CSA reduction was related to the proteolytic pathway, while in the soleus, the muscle atrophy occurred without overexpression of genes related to the classical proteolysis pathway. These results suggest that, in soleus muscle, the atrophy could be mediated by other pathway than the ubiquitin-proteasome; suggesting the importance of the decreased protein synthesis in the reduction of protein content in the skeletal muscle. In addition, joint effusion also induced changes in gene expression, although without changes in the muscle fiber CSA. The results of this thesis have clinical relevance and indicate the importance of therapeutic interventions with the attempt to reduce the deleterious effects on muscles related to an inflamed joint. / A inflamação articular é uma causa frequente de limitação nas atividades de vida diária da população. Geralmente essa afecção afeta também os músculos que estão funcionalmente relacionados à articulação inflamada. A possível relação entre a inflamação articular e a expressão de genes relacionados à atrofia muscular, diferenciação e crescimento muscular e com o controle da massa em músculos funcionalmente relacionados à articulação inflamada, ainda não foram estudadas. O objetivo desta tese foi avaliar o efeito da inflamação aguda e crônica da articulação tíbio-társica induzida por carragenina, sobre a expressão de genes musculares relacionados à atrofia (atrogina-1 e MuRF-1), diferenciação e crescimento (MyoD), regulação da massa muscular (miostatina), e fatores próinflamatórios (TNF-alfa, p38MAPK e NFkB) nos músculos TA e sóleo de rato. Foram também avaliadas a expressão da proteína TNF-alpha e a área de secção transversa (AST) das fibras musculares. Ratos Wistar foram distribuídos em três períodos experimentais 2, 7 e 15 dias. Em cada período experimental os animais foram distribuídos em 4 grupos: Controle, inflamação, sham, imobilização. Foram realizadas análises da AST nos músculos TA e sóleo, da reação em cadeia de polimerase (PCR) em tempo real para todos os genes, e análise da expressão da proteína TNF-alpha com as técnicas Western blot e immunofluorescência. A inflamação articular gerou mudanças nos níveis de RNAm dos genes relacionados com a atrofia muscular, diferenciação e crescimento, regulação da massa muscular e de fatores pró-inflamatórios no músculo TA e sóleo de ratos, nos dias 2, 7 e 15. A inflamação articular também aumentou a expressão da proteína TNF-alfa apenas no músculo TA no dia 7. A AST das fibras musculares foi reduzida no TA nos dia 7, e no músculo sóleo nos dias 7 e 15. Em conclusão, em ambos os músculos TA e sóleo, a inflamação articular aguda estimulou a via molecular envolvida na atrofia muscular, sem redução na AST das fibras. Contrariamente, a inflamação articular crônica levou a um padrão de resposta diferente segundo o músculo analisado. No músculo TA, a redução na AST das fibras esteve relacionando com a atividade da via proteolítica, enquanto no sóleo, a atrofia muscular acorreu sem aumento na expressão de genes relacionados com a clássica via de degradação de proteína. Estes resultados sugerem que no músculo sóleo a atrofia pode ter sido regulada por outra via diferente da ubiquitina-proteosoma; indicando a importância que possui a redução da síntese protéica no controle do conteúdo total de proteína no músculo esquelético. Os resultados desta tese têm relevância clinica e orientam sobre a importância de utilizar recursos terapêuticos visando diminuir o efeito deletério que se sucedem nos músculos relacionados com uma articulação inflamada.

Made available in DSpace on 2016-06-02T20:19:10Z (GMT). No. of bitstreams: 1 2169.pdf: 1164220 bytes, checksum: 1a022742edbedbb87cd4f0eb001d00a4 (MD5) Previous issue date: 2008-12-15 / Universidade Federal de Minas Gerais / Clinic evidences show that joint injuries affect muscles related to that joint making them more sensitive to atrophy and loss of force. However, muscle molecular responses in those conditions has not been investigated yet. Objective: To evaluate the effects of tibiotarsal acute joint inflammation on the expression of genes related to muscle atrophy (atrogin-1 and MuRF-1), differentiation and growing (MyoD) and mass regulation (myostatin) in soleus and tibialis anterior (TA) rat muscles. Changes in muscular crosssectional area (CSA) will also be identified. Methods: Fifteen Wistar rats were randomized and divided into three groups: 1) Control, 2) Inflammation, 3) Sham. A 0.03 ml of &#964;-carragenan or saline solution was injected into right tibiotarsal joint, in both Inflammation and Sham groups, respectively. The muscle fiber CSA analysis was performed in soleus and TA muscles. Real time polymerase chain reaction (PCR) was used to investigate gene expression in soleus and TA muscles, after 48 h of inflammation or effusion joint induction. Results: No significant changes were observed either in muscle and animal weights or in muscle fiber CSA among the groups (p>0.05). The Inflammation group enhanced atrogin-1, MuRF-1 and myostatin gene expressions; however, it decreased MyoD expression in TA muscle. On the other hand, the soleus muscle increased MuRF-1 and MyoD expressions. The Sham group presented an increase of atrogin-1 and myostatin in the TA, while soleus muscle decreased myostatin and enhanced MyoD expression. Conclusion: Both the tibiotarsal acute joint inflammation and the effusion regulate the expression of the genes related to atrophy, differentiation and mass control in rat muscles differently. In addition, this regulation between fast (TA) and slow (soleus) twitch muscles is done differently. / Evidências clínicas indicam que afecções articulares acometem músculos relacionados à articulação tornando-os mais suscetíveis à atrofia e perda de força. Entretanto, as respostas moleculares dos músculos esqueléticos nessas condições não foram ainda estudadas. Objetivo: Avaliar o efeito da inflamação aguda da articulação tíbio-társica sobre a expressão de genes musculares relacionados à atrofia (atrogina-1 e MuRF-1), diferenciação e crescimento (MyoD), e regulação da massa (miostatina) nos músculos Sóleo e Tibial anterior (TA) do rato. Possíveis alterações na área de secção transversa (AST) das fibras musculares foram também identificadas. Métodos: Ratos Wistar foram distribuídos em três grupos (n=5/cada): 1) Controle, 2) Inflamação, 3) Sham. Uma solução de 0,03 ml de carragenina ou salina foi injetada na articulação tíbio-társica direita dos animais nos grupos Inflamação e Sham, respectivamente. Quarenta e oito horas após foram realizadas análises da AST em ambos os músculos sóleo e TA, análise da reação em cadeia de polimerase (PCR) em tempo real para todos os genes. Resultados: Não houve diferença na AST das fibras musculares entre os diferentes grupos experimentais, tanto para os músculos sóleo como os TA (p>0,05). O TA do grupo Inflamação apresentou um aumento na expressão de atrogina-1, MuRF-1 e miostatina com diminuição de MyoD. No sóleo houve aumento na expressão de MuRF-1 e MyoD. O TA do grupo Sham apresentou aumento na expressão de atrogina-1 e miostatina, enquanto que o músculo sóleo apresentou diminuição na expressão de miostatina e aumento de MyoD. Conclusão: Tanto a inflamação como a efusão da articulação tíbio-tarsica regulam diferentemente a expressão de genes relacionados à atrofia, diferenciação e controle de massa muscular. Essa regulação é diferente entre músculos de contração lenta (sóleo) e rápida (TA).

Introdução: O tratamento para o derrame pleural maligno recidivado tem caráter paliativo, sendo a pleurodese o método mais utilizado. Contudo, nem todos os procedimentos são efetivos, em parte por um encarceramento do pulmão pela pleura visceral espessada que impede o contato entre os folhetos pleurais e subsequente pleurodese efetiva. A elastância pleural reflete o grau de encarceramento da pleura visceral, contudo sua correlação com a efetividade da pleurodese não é bem conhecido. Objetivo: Analisar a correlação entre a elastância pleural e a efetividade radiológica (quantificada por tomografia de tórax) da pleurodese realizada através de cateteres pleurais. Os objetivos secundários deste estudo são: correlacionar a elastância pleural com a qualidade de vida, graus de dispneia e dor após o procedimento, efetividade clínica, complicações e mortalidade. Correlacionar a posição da extremidade do cateter pleural com o sucesso radiológico e clínico da pleurodese. Métodos: Estudo prospectivo com 131 pacientes candidatos a pleurodese por instilação de nitrato de prata ou talco mineral por cateter pleural. As pressões pleurais foram aferidas através de manômetro hidrostático ou de transdutor eletrônico de pressão vascular durante o esvaziamento do líquido e usadas para calcular a elastância pleural, em cm H2O/L. A efetividade radiológica foi avaliada pelos volumes pleurais medidos por tomografias computadorizadas de tórax logo após a drenagem e 30 dias após a pleurodese. A efetividade clínica foi avaliada conforme a necessidade de procedimentos adicionais para controle de sintomas. A qualidade de vida foi avaliada através do questionário geral da OMS. A avaliação da dor foi feita pela quantificação na Escala Visual Analógica de Dor. A análise da dispneia foi realizada através da quantificação da funcionalidade na escala de dispneia do British Medical Research Council. Todos esses questionários foram aplicados antes da drenagem, 30 dias após pleurodese e, então, trimestralmente. Para a análise da segurança dos procedimentos foram considerados os tempos de internação e de drenagem e a ocorrência de complicações. Todos os pacientes foram seguidos até o óbito ou até o término do estudo, em novembro de 2014, registrando as complicações e as datas do óbito para a construção da curva de sobrevida. Resultados: Avaliamos 87 pacientes de um total de 131 recrutados. Não houve diferença entre os volumes pleurais nas duas tomografias realizadas. A efetividade clínica foi observada em 86,20% dos pacientes. Não houve diferença em nenhum dos domínios da qualidade de vida. Encontramos diferenças entre a dispneia e a dor aferidas 30 dias após a pleurodese e antes da drenagem. Complicações ocorreram em 14,94% dos casos. A mediana da sobrevida global foi de 16 meses. Não foram encontradas correlações entre as elastâncias pleurais em 400 ml, 800 ml e total com nenhum dos desfechos radiológicos, clínicos (efetividade clínica, qualidade de vida, dispneia, dor e complicações) ou com a sobrevida dos pacientes. A posição da ponta do cateter pleural não se correlacionou com o sucesso radiológico ou clínico da pleurodese. Conclusões: A elastância pleural não se mostrou, até o presente momento, capaz de predizer os defechos radiológicos, clínicos e a sobrevida em pacientes submetidos a pleurodese / Background: The treatment of recurrent malignant pleural effusion has a palliative purpose. Pleurodesis is the most used method. However, not all the procedures are effective, in part because of the lung entrapment by the visceral pleura, preventing the contact between the pleural surfaces and subsequente effective pleurodesis. The pleural elastance reflects the degree of entrapment of the visceral pleura, but its correlation with the effectiveness of pleurodesis is not well known. Objetive: To evaluate the correlation between pleural elastance and radiological effectiveness (measured by tomography) of bedside pleurodesis. The secondary objectives of this study are: correlating the pleural elastance with quality of life, degree of dyspnea and pain after the procedure, clinical effectiveness, complications and mortality. Evaluate the role of intrapleural position of the pleural catheter in early lung expansion and success of pleurodesis. Methods: Prospective study including 131 patients with recurrent malignant pleural effusion candidates for treatment with bedside pleurodesis with silver nitrate or mineral talc. Pleural pressures were measured through hydrostatic gauge or electronic pressure transducer during emptying of effusion and used to calculate the pleural elastance in cm H2O/L. Pleural volumes measured by CT scans of the chest after drainage and 30 days after pleurodesis were assess the radiological effectiveness. The clinical effectiveness was evaluated as the need for additional procedures to control symptoms. The quality of life was assessed using the WHO general questionnaire. Quantifying the Visual Analog Scale of Pain did pain assessment. Measuring the functionality in the British Medical Research Council dyspnea scale made the analysis of dyspnea. All these questionnaires were applied prior to drainage, 30 days after pleurodesis and then quarterly. Results: We evaluated 87 patients of a total of 131 recruited. There was no difference between the two pleural volumes CT scans performed. The clinical effectiveness was observed in 86.20% of patients. There was no difference in any of the domains of quality of life. We found differences between dyspnea and pain measured 30 days after pleurodesis and before draining. Complications occurred in 14.94% of cases. The median overall survival was 16 months. No correlations between pleural elastance in 400 ml, 800 ml and complete were found with all the imaging, clinical (clinical effectiveness, quality of life, dyspnea, pain and complications) or with patient survival outcomes. The tip of the pleural catheter was not correlated with the radiological or clinical success of pleurodesis. Conclusions: The pleural elastance was not, so far, able to predict the radiological outcomes, clinical outcomes and survival in patients undergoing bedside pleurodesis

Este estudo avaliou por meio da Ressonância Magnética a intensidade de sinal do tecido retrodiscal associando a anatomia da eminência articular, derrame articular e deslocamento do disco com e sem redução. Para isto, foram analisadas imagens por RM de 48 ATM de 24 indivíduos sintomáticos, sendo 19 (79,2%) do gênero feminino e 5 (20,8%) do gênero masculino. Considerando o posicionamento sagital, cerca de 5 (10,4%) das articulações eram normais, 23 (47,9%) das articulações eram DDCR e 20 (41,7%) eram DDSR. Para a forma da eminência articular, cerca de 15 (31,3%) das articulações foram classificadas como tendo formato de caixa, 12 (25,0%) foram classificadas como sigmoide, 10 (20,8%) como aplainada e 11 (22,9%) das articulações foram classificadas como deformada. A maioria das articulações apresentaram derrame cerca de 32 (66,7%). Das articulações com DDSR, 16 (51,6%) apresentaram derrame e as com DDCR 15 (48,4%). As articulações com DDCR apresentaram 9 (39,15) em forma de caixa, 6 (26,1%) como sigmóide, 3 (13,0%) estavam aplainada e 5 (21,7%) deformadas; as ATM com DDSR apresentaram 5 (25,5%) como caixa, 4 (20,0%) como sigmóide, 6 (30,0%) aplainadas e 5 (25,5%) deformadas. A forma da eminência articular não está relacionada ao posicionamento sagital (p=0,520). O posicionamento sagital do disco não está relacionado à presença de derrame (p=0,281). A intensidade de sinal do TR foi estatisticamente menor no posicionamento sagital DDCR, quando comparado ao posicionamento sagital DDSR (p=0,016). Houve uma tendência da intensidade do sinal do tecido retrodiscal ser maior nas articulações com derrame quando comparado às sem derrame (p=0,065). Não houve relação entre posicionamento sagital do disco e derrame. E por fim, o presente estudo não conseguiu estabelecer uma relação entre o sinal do tecido retrodiscal e eminência articular (p=0,159). / This study evaluated MR signal intensity of retrodiscal tissue associated with articular eminence morphology, joint effusion status, and disc displacement with and without reduction (DDwR and DDwoR, respectively). Forty-eight TMJ MR images of 24 symptomatic subjects (19 females and 5 males) were analyzed. For the sagittal position, 5 (10.4%) joints were normal, 23 (47.9%) showed DDwR and 20 (41.7%) DDwoR. Regarding articular eminence morphology, 15 (31.3%) joints were classified as box-shaped, 12 (25.0%) as sigmoid, 10 (20.8%) flattened and 11 (22.9%) deformed. The majority of TMJs (32 or 66.7%) showed effusion. Sixteen (51.6%) of the TMJs with DDwoR had effusion versus 15 (48.4%) of those with DDDwR. Of TMJs with DDwR, 9 (39.1%) were box-shaped, 6 (26.1%) sigmoid, 3 (13.0%) flattened and 5 (21.7%) deformed. Among joints with DDwoR, 5 (25.5%) were boxshaped, 4 (20.0%) sigmoid, 6 (30.0%) flattened and 5 (25.5%) deformed. As a conclusion, articular eminence shape was not related to sagittal position of the disk (p = 0.520). Sagittal position of the disk was not related to presence of effusion (p = 0.281). Signal intensity of retrodiscal tissue (RT) was statistically lower in the DDwR sagittal position than in DDwoR cases (p = 0.016). There was a tendency for higher RT signal intensity in joints with effusion versus those without effusion (p = 0.065). No relationship between sagittal position of the disc and effusion was observed. No relationship between signal intensity of retrodiscal tissue and shape of articular eminence was identified (p = 0.159).