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Bichectomy surgery has been increasingly widespread and performed as an aesthetic, functional, or aesthetic-functional treatment. This study aims to describe the surgical technique of bichectomy with the application of the Kinesio tape to verify its effectiveness in controlling edema formation, with the measurement in four postoperative periods. Through a split-mouth, double-blind, randomized study, 13 participants who had an indication for the surgery were selected and divided into two groups - Control Group: bichectomy surgery and cryotherapy for a period of 12 hours, without external application of the Kinesio tape (KT) and Experimental Group: bichectomy surgery, cryotherapy for a period of 12 hours, and application of KT in the outer cheek area of the face, for 2 days. A millimeter measuring tape was used to measure three reference points on the face before and after the surgical procedure (preoperative, 24 hours, 48 hours, and 7 days postoperatively). Quantitative data were subjected to statistical analysis using the Sigma Plot 12.0 program (Exakt graphs and data analysis, San Jose, USA). The comparisons were made according to the edema measurements for the two experimental groups (2 levels: Kinesio tape versus cryotherapy) and the periods of analysis (4 levels: Preoperative, 24 hours, 48 hours and 7 days postoperatively). After obtaining the data, and the statistical analysis, the application of Kinesio Tape proved to be more effective when compared to the use of cryotherapy alone, in the control of postoperative edema in patients who underwent bichectomy surgery. The study contributes to the literature regarding the applicability of the KT and expands the therapeutic possibilities in an aesthetic-functional procedure that is increasingly sought after by patients. La cirugía de bichectomía está cada vez más extendida y se realiza como tratamiento estético, funcional o estético-funcional. Este estudio tiene como objetivo describir la técnica quirúrgica de la bichectomía con la aplicación de la cinta Kinesio para verificar su efectividad en el control de la formación de edemas, con la medición en cuatro postoperatorios. A través de un estudio aleatorizado, doble ciego, de boca partida, se seleccionaron 13 participantes que tenían una indicación para la cirugía y se dividieron en dos grupos - Grupo Control: cirugía de bichectomía y crioterapia por un período de 12 horas, sin aplicación externa del Kinesio tape (KT) y Grupo Experimental: cirugía de bichectomía, crioterapia por un período de 12 horas y aplicación de KT en la zona externa de la mejilla del rostro, durante 2 días. Se utilizó una cinta métrica milimétrica para medir tres puntos de referencia en el rostro antes y después del procedimiento quirúrgico (preoperatorio, 24 horas, 48 horas y 7 días del postoperatorio). Los datos cuantitativos se sometieron a análisis estadístico utilizando el programa Sigma Plot 12.0 (gráficos y análisis de datos Exakt, San José, EE. UU.). Las comparaciones se realizaron según las medidas de edema para los dos grupos experimentales (2 niveles: Kinesio tape versus crioterapia) y los periodos de análisis (4 niveles: Preoperatorio, 24 horas, 48 horas y 7 días del postoperatorio). Tras la obtención de los datos, y el análisis estadístico, la aplicación de Kinesio Tape demostró ser más eficaz en comparación con el uso de crioterapia sola, en el control del edema postoperatorio en pacientes sometidos a cirugía de bichectomía. El estudio aporta a la literatura sobre la aplicabilidad del KT y amplía las posibilidades terapéuticas en un procedimiento estético-funcional cada vez más buscado por los pacientes. A cirurgia de bichectomia tem sido cada vez mais difundida e realizada como tratamento estético, funcional ou estético-funcional. Este estudo tem como objetivo descrever a técnica cirúrgica da bichectomia com a aplicação da fita Kinesio para verificar sua eficácia no controle da formação de edema, com a mensuração em quatro períodos pós-operatórios. Por meio de um estudo duplo-cego, randomizado e duplo-cego, foram selecionados 13 participantes que tinham indicação para a cirurgia e divididos em dois grupos - Grupo Controle: cirurgia de bichectomia e crioterapia por um período de 12 horas, sem aplicação externa do Kinesio fita adesiva (KT) e Grupo Experimental: cirurgia de bichectomia, crioterapia por um período de 12 horas e aplicação de KT na região externa da bochecha, por 2 dias. Uma fita métrica milimetrada foi utilizada para medir três pontos de referência na face antes e após o procedimento cirúrgico (pré-operatório, 24 horas, 48 horas e 7 dias de pós-operatório). Os dados quantitativos foram submetidos à análise estatística por meio do programa Sigma Plot 12.0 (gráficos Exakt e análise de dados, San Jose, EUA). As comparações foram feitas de acordo com as medidas de edema para os dois grupos experimentais (2 níveis: Kinesio tape versus crioterapia) e os períodos de análise (4 níveis: pré-operatório, 24 horas, 48 horas e 7 dias de pós-operatório). Após a obtenção dos dados e análise estatística, a aplicação do Kinesio Tape mostrou-se mais eficaz quando comparada ao uso da crioterapia isolada, no controle do edema pós-operatório em pacientes submetidos à cirurgia de bichectomia. O estudo contribui com a literatura a respeito da aplicabilidade do KT e amplia as possibilidades terapêuticas em um procedimento estético-funcional cada vez mais procurado pelos pacientes.

Depression is the most frequent psychiatric comorbidity in patients with mesial temporal lobe epilepsy (MTLE) and hippocampal sclerosis (HS). This study aimed to confirm whether patients with comorbid depression have different volumetric patterns on magnetic resonance imaging, analysing the influence of HS sides. Psychiatrists conducted semi-structured interviews with 75 patients, who were divided into non-depression group (NDG, n = 52) and depression group (DG, n = 23), and compared with 98 controls. The FreeSurfer software was used in the volumetric analysis of the estimated total intracranial volume (eTIV), bilateral cortical and subcortical regions of interest (ROIs), and for presence of left (L-, n = 41) or right (R-, n = 34) MTLE-HS. Twenty-three (30.7%) patients had depression, of whom 14 (34.1%) had l -MTLE-HS and 9 (26.5%) had R-MTLE-HS. No difference was observed between DG and NDG vs. controls in terms of eTIV and cortical ROIs, regardless of the severity of depression. In patients with l -MTLE-HS, the eTIV in the DG was reduced in comparison with that in the NDG and control group, with a small effect size. Hippocampal reduction occurred ipsilateral to HS in the l -MTLE-HS and R-MTLE-HS subgroups when DG and NDG were compared with controls, as expected according to Enhancing Neuro Imaging Genetics through Meta-Analysis (2018).

Objective The objectives of this study were to verify in a series of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) if those with low intellectual quotient (IQ) levels have more extended areas of atrophy compared with those with higher IQ levels and to analyze whether IQ could be a variable implicated on a surgical outcome. Material and methods Patients (n = 106) with refractory MTLE-HS submitted to corticoamygdalohippocampectomy (CAH) (57 left mesial temporal lobe epilepsy (MTLE); 45 males) were enrolled. To determine if the IQ was a predictor of seizure outcome, totally seizure-free (SF) versus nonseizure-free (NSF) patients were evaluated. FreeSurfer was used for cortical thickness and volume estimation, comparing groups with lower ( Results In the whole series, 42.45% of patients were SF (Engel Class 1a; n = 45), and 57.54% were NSF (n = 61). Total cortical volume was significantly reduced in the group with lower IQ (p = 0.01). Significant reductions in the left hemisphere included the following: rostral middle frontal (p = 0.001), insula (p = 0.002), superior temporal gyrus (p = 0.003), thalamus (p = 0.004), and precentral gyrus (p = 0.02); and those in the right hemisphere included the following: rostral middle frontal (p = 0.003), pars orbitalis (p = 0.01), and insula (p = 0.02). Cortical thickness analysis also showed reductions in the right superior parietal gyrus in patients with lower IQ. No significant relationship between IQ and seizure outcome was found. Conclusions This is the first study of a series of patients with pure MTLE-HS, including those with low IQ and their morphometric magnetic resonance imaging (MRI) features using FreeSurfer. Although patients with lower intellectual scores presented more areas of brain atrophy, IQ was not a predictor of surgical outcome. Therefore, when evaluating seizure follow-up, low IQ in patients with MTLE-HS might not contraindicate resective surgery.

We conducted a retrospective study in order to investigate the clinical significance of temporopolar grey/white matter abnormalities (GWMA) in patients with temporal lobe epilepsy (TLE) and unilateral hippocampal sclerosis (HS) with a long post-surgical follow-up.The study comprised 122 consecutive patients with medically refractory TLE and unilateral HS who underwent epilepsy surgery and had a minimum postoperative follow-up of 5 years. Patients were divided into two groups, based on findings of pre-surgical MRI: group 1 with GWMA and 2 with normal signal and grey/white matter definition in temporal pole. Demographic and clinical data were reviewed and compared between groups.GWMA were found in 52.5% of patients, always ipsilateral to HS. Compared with group 2, group 1 patients had earlier epilepsy onset (mean, 9.3 vs 14.4 years, P=0.001), a higher occurrence of first seizure ≤2 years of age (25.8% vs 10.5%, P=0.036; OR=2.96 [95% CI=1.07-8.19]), and greater prevalence of left HS (76.6% vs 43.1%, P0.001; OR=4.31 [95% CI=1.98-9.38]). No differences were found in gender, presence or type of initial precipitating injury, history of secondary generalized seizures, duration of epilepsy, seizure frequency before surgery, neuropsychological evaluation and presence or lateralization of pre-surgical interictal epileptiform discharges. Postoperative follow-up varied from 5 to 11.5 years (mean 7.4) and was similar in both groups (P=0.155). The proportion of patients classified as seizure-free (Engel class I) at last follow-up in groups 1 and 2 were 73.4% and 69%, respectively (P=0.689). Similarly, the percentages of seizure-free patients with no antiepileptic drugs at last evaluation were not different between groups (P=0.817). In logistic regression analysis, left HS (P=0.001; OR=4.166 [95% CI=1.86-9.34]) and age at epilepsy onset ≤2 years (P=0.047; OR=3.885 [95% CI=1.86-17.50]) were independently associated with risk of having GWMA.GWMA are frequent findings in patients with TLE and HS, and may help lateralize the epileptogenic zone. Our data support the hypothesis that GWMA are caused by seizure-related insults during the critical period of cerebral myelination. GWMA did not influence the postoperative seizure outcome of patients with TLE and HS, even after an extended duration of post-surgical follow-up.

Purpose To evaluate if the duration of epilepsy influences MRI volumes of the hippocampus, amygdala, parahippocampal gyrus, entorhinal cortex and temporal pole of both hemispheres and epileptogenic hippocampus neuronal cell density and dentate gyrus granular cells distribution in patients with refractory mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS). Methods Seventy-seven patients with refractory MTLE/HS submitted to surgery were included. Histopathological analysis included: (1) quantitative: hippocampal subfields and total estimated hippocampal cell density (HCD), thickness of the dentate gyrus – normal, thinning or dispersion; (2) qualitative: type of HS and granule cells pathology in the dentate gyrus (normal, neuronal cell loss, dispersion and bilamination). Automated MRI-derived measurements from bilateral temporal structures (hippocampus, amygdala, parahippocampal gyrus, temporal pole, entorhinal cortex) were obtained for 58 subjects. Histopathological and imaging findings were compared with data from specimens obtained in autopsies of age-matched individuals and living controls, respectively, and the data were adjusted for the age at epilepsy onset and the frequency of focal impaired awareness seizures/month. Results Forty-two (54.5%) patients presented right HS. The greater the duration of epilepsy, the smaller the total estimated HCD (p = 0.025; r = −0.259). Patients with a normal distribution of the granular cells had a shorter epilepsy duration than those with dispersion (p = 0.018) or thinning (p = 0.031). A reduced ipsilateral hippocampal volume (r = −0.551, p = 0.017) and a smaller hippocampal asymmetry index (r = −0.414, p = 0.002) were correlated to a longer epilepsy duration. The estimated HCD was correlated to the volume of the ipsilateral hippocampus (r = 0.420, p = 0.001). Conclusion Our study showed an increasing atrophy of the ipsilateral hippocampus in patients with a longer epilepsy duration. Our data suggest that this reduction in hippocampal volume is related to neuronal loss. Besides that, we also showed an increased probability of exhibiting an abnormal distribution of the granular cells in the dentate gyrus in patients with longer epilepsy duration.

Purpose Gender differences are recognized in the functional and anatomical organization of the human brain. Differences between genders are probably expressed early in life, when differential rates of cerebral maturation occur. Sexual dimorphism has been described in temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS). Several voxel-based morphometry (VBM) studies have shown that TLE-MTS extends beyond mesial temporal structures, and that there are differences in the extent of anatomical damage between hemispheres, although none have approached gender differences. Our aim was to investigate gender differences and anatomical abnormalities in TLE-MTS. Methods VBM5 was employed to analyze gender and hemispheric differences in 120 patients with TLE-MTS and 50 controls. Results VBM abnormalities were more widespread in left-TLE; while in women changes were mostly seen in temporal areas, frontal regions were more affected in men. Conclusions Our study confirmed that gender and laterality are important factors determining the nature and severity of brain damage in TLE-MTS. Differential rates of maturation between gender and hemispheres may explain the distinct areas of anatomical damage in men and women.

O cone medular é frequentemente acometido por lesões de etiologia inflamatória e infecciosa, muitas vezes de difícil diferenciação devido a história clínica e exame físico semelhantes entre as diversas entidades. A ressonância magnética apresenta alta sensibilidade na detecção de lesões no cone medular e tem importante papel no diagnóstico e controle evolutivo. Este ensaio iconográfico com casos selecionados dos arquivos do nosso serviço tem como objetivo demonstrar achados de imagem que possam auxiliar no diagnóstico de uma etiologia específica entre as doenças inflamatórias e infecciosas e na diferenciação com doenças de outras etiologias como neoplasias e causas vasculares. Características como padrão de realce, presença de cistos, edema, além do acometimento de outras regiões do sistema nervoso central são importantes para esta diferenciação, podendo definir uma etiologia específica quando associadas ao quadro clínico e laboratorial.The conus medullaris is frequently affected by inflammatory and infectious lesions which many times are hardly differentiated because of the similarity of their clinical history and physical examination among the different etiologies. Magnetic resonance imaging presents high sensitivity in the detection of these lesions and plays a relevant role in the diagnosis as well as in the evolutive control of the condition. The present pictorial essay with selected cases from the archives of the authors' institution is aimed at demonstrating imaging findings which might help in the diagnosis of a specific etiology amongst inflammatory an infectious conditions and in the differentiation with diseases of neoplastic and vascular etiologies, for example. Findings such as enhancement pattern, presence of cysts, edema and involvement of other regions of the central nervous system are important for this differentiation, and may define a specific etiology as associated with clinical and laboratory tests findings.

Purpose Corticoamygdalohippocampectomy (CAH) improves seizure control, quality of life, and decreases mortality for refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). One-third of patients continue having seizures, and it is pivotal to determine structural abnormalities that might influence the postoperative outcome. Studies indicate that nonhippocampal regions may play a role in the epileptogenic network in MTLE-HS and could generate seizures postoperatively. The aim of this study is to analyze areas of atrophy, not always detected on routine MRI, comparing patients who became seizure free (SF) with those non seizure free (NSF) after CAH, in an attempt to establish possible predictors of surgical outcome. Methods 105 patients with refractory MTLE-HS submitted to CAH (59 left MTLE; 46 males) and 47 controls were enrolled. FreeSurfer was performed for cortical thickness and volume estimation comparing patients to controls and SF versus NSF patients. The final sample after post processing procedures resulted in 99 patients. Results Cortical thickness analyses showed reductions in left insula in NSF patients compared to those SF. Significant volume reductions in SF patients were present in bilateral thalami, hippocampi and pars opercularis, left parahippocampal gyrus and right temporal pole. In NSF patients reductions were present bilaterally in thalami, hippocampi, entorhinal cortices, superior frontal and supramarginal gyri; on the left: superior and middle temporal gyri, temporal pole, parahippocampal gyrus, pars opercularis and middle frontal gyrus; and on the right: precentral, superior, middle and inferior temporal gyri. Comparison between SF and NSF patients showed ipsilateral gray matter reductions in the right entorhinal cortex (p = 0.003) and contralateral parahippocampal gyrus (p = 0.05) in right MTLE-HS. Patients NSF had a longer duration of epilepsy than those SF (p = 0.028). Conclusion NSF patients exhibited more extensive areas of atrophy than SF ones. As entorhinal cortex and parahippocampal gyrus are reduced in NSF patients compared to those SF these structures might be implicated in the network responsible for the maintenance of postoperative seizures. Duration of epilepsy is a predictor of seizure outcome.

To describe the different and lesser-known ultrasound features of tophi in chronic tophaceous gout. Ultrasound images of 138 affected areas were analyzed from 31 patients with gout, using high-quality broadband linear transducers (frequency range of 8–14 MHz). Tophi were classified relative to echogenicity, echotexture, contours, number and the presence or absence of hypoechoic halo. The duration of illness was correlated with the presence of calcifications in tophi. Hyperechoic tophi were seen in 133 areas (96.3%); these were most frequently hyperechoic and heterogeneous (37.6%) or hyperechoic and heterogeneous with calcification (32.6%). Contours were found to be poorly defined in 115 (83.3%) areas. Multiple grouped tophi were seen in 85 areas (61.6%) and 50 areas (36.2%) had individual tophi. In 77 examined areas (55.8%), there was a hypoechoic halo around the tophi. There was no correlation between illness duration and presence of calcifications on tophi. Tophi are generally hyperechoic, heterogeneous, with poorly defined contours, multiple grouped and surrounded by an anechoic halo. Individual tophus and the absence of association between illness duration and the presence of calcification are newly described features. This study of tophaceous gout by ultrasound may contribute to the diagnostic elucidation of patients with clinically atypical gout and show its diverse characteristic forms of presentation.

ObjectiveTo describe and classify the varied ultrasound features of tendinous involvement in relation to tophi in chronic tophaceous gout so that they are better recognised.MethodsUltrasound images of 138 affected areas from 31 patients with chronic tophaceous gout were analysed using high-quality broadband linear transducers. The relationship between tendon and tophi was classified, and the inter-observer agreement regarding classification was analysed.ResultsTophi envelopment in the tendon was the most frequent characteristic (45%) followed by no relationship between tophi and tendon (41%), tophi at the insertion site of the tendon (7%), extrinsic compression (6%) and tophi within the tendon (1%). The inter-observer concordance on classification of the relationship between tophi and tendon was measured using McNemar’s test withP χ2 = 30.0, degree of freedom = 9) and kappa test = 0.627 (P ConclusionTophi generally envelope the tendon or there is no relationship between them. Tophi can also be found at the insertion site of the tendon, cause extrinsic compression or be located inside the tendon. There is substantial inter-observer agreement for ultrasound classification of tendon involvement by tophi. This study contributes to diagnostic elucidation and shows the diverse characteristic forms of tendon involvement by tophi.

O cone medular é frequentemente acometido por lesões de etiologia inflamatória e infecciosa, muitas vezes de difícil diferenciação devido a história clínica e exame físico semelhantes entre as diversas entidades. A ressonância magnética apresenta alta sensibilidade na detecção de lesões no cone medular e tem importante papel no diagnóstico e controle evolutivo. Este ensaio iconográfico com casos selecionados dos arquivos do nosso serviço tem como objetivo demonstrar achados de imagem que possam auxiliar no diagnóstico de uma etiologia específica entre as doenças inflamatórias e infecciosas e na diferenciação com doenças de outras etiologias como neoplasias e causas vasculares. Características como padrão de realce, presença de cistos, edema, além do acometimento de outras regiões do sistema nervoso central são importantes para esta diferenciação, podendo definir uma etiologia específica quando associadas ao quadro clínico e laboratorial. The conus medullaris is frequently affected by inflammatory and infectious lesions which many times are hardly differentiated because of the similarity of their clinical history and physical examination among the different etiologies. Magnetic resonance imaging presents high sensitivity in the detection of these lesions and plays a relevant role in the diagnosis as well as in the evolutive control of the condition. The present pictorial essay with selected cases from the archives of the authors' institution is aimed at demonstrating imaging findings which might help in the diagnosis of a specific etiology amongst inflammatory an infectious conditions and in the differentiation with diseases of neoplastic and vascular etiologies, for example. Findings such as enhancement pattern, presence of cysts, edema and involvement of other regions of the central nervous system are important for this differentiation, and may define a specific etiology as associated with clinical and laboratory tests findings.