377 results on '"Isabela S. Silva"'
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2. Diagnóstico por imagem do tromboembolismo pulmonar agudo Imaging of acute pulmonary thromboembolism
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C. Isabela S. Silva and Nestor L. Müller
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Diagnóstico por imagem ,Emboliapulmonar ,Angiografia ,Pneumopatias ,Tomografia computadorizada de emissão de fóton único ,Diagnostic imaging ,Pulmonary embolism ,Angiography ,Lung diseases ,Tomography, emission-computed single-photon ,Diseases of the respiratory system ,RC705-779 - Abstract
O diagnóstico do tromboembolismo pulmonar agudo é baseado na probabilidade clínica, uso do dímero D (quando disponível) e na avaliação por imagem. Os principais métodos de imagem utilizados no diagnóstico são representados por cintilografia ventilação-perfusão, angiografia pulmonar e tomografia computadorizada (TC). Na última década vários estudos têm demonstrado que a TC espiral apresenta elevada sensibilidade e especificidade no diagnóstico de tromboembolismo pulmonar agudo. Uma melhor avaliação das artérias pulmonares tornou-se possível com a recente introdução dos equipamentos de TC espirais com multidetectores. Vários pesquisadores têm sugerido que a angiografia pulmonar por TC espiral deve substituir a cintilografia na avaliação de pacientes com suspeita clinica de tromboembolismo pulmonar agudo. Os autores discutem os principais métodos de imagem utilizados no diagnóstico de tromboembolismo pulmonar agudo enfatizando o papel da TC espiral.The diagnosis of acute pulmonary thromboembolism is based on the clinical probability, use of D-dimer (when available) and imaging. The main imaging modalities used in the diagnosis are ventilation-perfusion (V/Q), scintigraphy, angiography, and computed tomography (CT). In the last decade several studies have demonstrated that spiral CT has a high sensitivity and specificity in the diagnosis of acute pulmonary thromboembolism. The evaluation of the pulmonary arteries has further improved with the recent introduction of multidetector spiral CT scanners. Various investigators have suggested that spiral CT pulmonary angiography should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute pulmonary thromboembolism with emphasis on the role of spiral CT.
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- 2004
- Full Text
- View/download PDF
3. Sindrome de encefalopatia posterior reversível: relato de caso Reversible posterior encephalopathy syndrome: case report
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Francine Judith Freitas Fernandes, Marcos Alberto da Costa Machado Júnior, Adriana Vieira Pedreira, Cleonice Isabela S. Silva, Heleno Cabral Tavares, and Verônica Aline Barbosa
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encefalopatia posterior reversível ,encefalopatia hipertensiva ,neurorradiologia ,reversible posterior encephalopathy ,hypertensive encephalopathy ,neuroradiology ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
A encefalopatia posterior reversível é uma síndrome aguda / subaguda geralmente causada pela encefalopatia hipertensiva, eclâmpsia, neurotoxicidade a ciclosporina-A, encefalopatia urêmica e púrpura trombocitopênica trombótica.. A maioria dos pacientes apresenta elevação acentuada dos níveis tensionais outros, níveis moderados ou normais. Os sintomas são progressivos e compreendem cefaléia, diminuição do nível de consciência, crises epilépticas e distúrbios visuais. A sintomatologia regride completamente se corrigidas em tempo as causas determinantes, caso contrário, podem instalar-se danos irreversíveis como a cegueira cortical e morte. A tomografia computadorizada (TC) e, sobretudo, a ressonância magnética (RM) contribuem para o diagnóstico. Tais métodos evidenciam edema da substância branca e cinzenta, principalmente das regiões parieto-occipitais. Os achados podem apresentar dificuldade no diagnóstico, hoje superado em parte, com a técnica de difusão pela RM, capaz de diferenciar edema citotóxico de vasogênico. Apresentamos um caso de encefalopatia posterior reversível decorrente de encefalopatia hipertensiva estudada com TC e RM.The posterior reversible leukoencephalopathy syndrome (PRES) is a recently proposed cliniconeuroradiologic entity.The most common causes of PRES are hypertensive encephalopathy, eclampsia, cyclosporin A neurotoxicity and the uremic encephalopathies.Most patients are markedly hypertensive at presentation, although some have only middly elevated or even normal blood pressure. Symptoms may include headache, nausea , vomiting, altered mental status, seizures,stupor, and visual disturbances. On CT and MR studies, edema has been reported in a relatively symmetrical pattern, typically in the subcortical white matter and occasionally in the cortex of the occipital and parietal lobes. These often striking imaging findings usually are resolved on follow-up studies obtained after appropiate therarapy. Diffusion-weighted images would not show hyperintense signal because of the presence of interstitial rather than cytotoxic edema. We report a case of PRES due to hipertensive encephalopathy studied by CT and MRI.
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- 2002
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4. Reúso de água pluvial na faculdade de engenharia civil, arquitetura e urbanismo - estudo de caso
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Luana Mattos de Oliveira Cruz and Isabela S. Silva
- Abstract
Atualmente, ha necessidade de reduzir o consumo de agua potavel e e notavel que a agua de chuva no Brasil e um grande potencial de fornecimento, a qual atraves de supostos simples tratamentos pode ser utilizada para fins nao potaveis. Identifica-se a necessidade de estudar o perfil da agua precipitada e como trata-la em regioes em que se deseja estabelecer o projeto para o reuso. Logo, a presente pesquisa apresenta um estudo de caso sobre a agua da chuva na regiao da Faculdade de Engenharia Civil, Arquitetura e Urbanismo da Universidade Estadual de Campinas (FEC/UNICAMP), sob a hipotese de que a agua captada nao possui altos teores de substâncias indesejaveis.
- Published
- 2019
5. Polyploidy and nuclear phenotype characteristics of cardiomyocytes from diabetic adult and normoglycemic aged mice
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Flávia G. Ghiraldini, Maria Luiza S. Mello, Isabela S. Silva, and Giovana M. B. Veronezi
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0301 basic medicine ,medicine.medical_specialty ,Histology ,Nod ,Biology ,Polyploidy ,Mice ,03 medical and health sciences ,Polyploid ,Mice, Inbred NOD ,Diabetes mellitus ,Internal medicine ,Diabetes Mellitus ,medicine ,Animals ,Myocytes, Cardiac ,NOD mice ,Mice, Inbred BALB C ,Staining and Labeling ,Myocardium ,Cell Biology ,General Medicine ,Reference Standards ,medicine.disease ,Phenotype ,Chromatin ,030104 developmental biology ,Endocrinology ,Ploidy ,Cytometry - Abstract
The frequency of polyploid nuclei in the aging human heart is in sharp contrast with that in the human liver. An inverse pattern exists between the mouse heart and liver cells. Ploidy degrees in mouse hepatocytes under hyperglycemic conditions are elevated to higher levels than those in aged hepatocytes. In this study, image analysis cytometry was used to investigate the effect of diabetes and aging on Feulgen-DNA quantities, ploidy degrees, nuclear shapes and chromatin texture in mouse cardiomyocytes compared to previously reported data for mouse hepatocytes. Adult, non-obese diabetic (NOD) hyperglycemic and normoglycemic females and 56-week-old normoglycemic BALB/c females were used. A small percentage (∼7%) of the cardiomyocyte nuclei in severely hyperglycemic NOD adult mice possessed higher ploidy values than those in the 8-week-old normoglycemic mice. Surprisingly, the Feulgen-DNA values and the frequency of nuclei belonging to the 4C and 8C ploidy classes were even higher (∼6%) in normoglycemic NOD specimens than in age-matched hyperglycemic NOD specimens. Additionally, a pronounced elongated nuclear shape was observed especially in adult normoglycemic NOD mice. In conclusion, NOD mice, irrespective of their glycemic level, exhibit a moderate increase in ploidy degrees within cardiomyocyte nuclei during the adult lifetime. As expected, aging did not affect the Feulgen-DNA values and the ploidy degrees of cardiomyocytes in BALB/c mice. The differences in ploidy degrees and chromatin textures such as absorbance variability and entropy, between adult NOD and aged BALB/c mice are consistent with other reports, indicating dissimilarities in chromatin functions between diabetes and aging.
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- 2018
6. Perguntamos: Qual o diagnóstico? We ask: What is the diagnosis?
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Gustavo Sobreira Taberner, Eduardo Scortegagna Júnior, C. Isabela S. Silva, and Nestor L. Müller
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Diseases of the respiratory system ,RC705-779 - Published
- 2005
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- View/download PDF
7. COPD phenotypes in biomass smoke- versus tobacco smoke-exposed Mexican women
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Luis F Alva, Nestor L. Müller, Pat G. Camp, C. Isabela S. Silva, Alejandra Ramírez-Venegas, Jill E McDougall, Harvey O. Coxson, Peter D. Paré, Carlos E. Rojas, Raúl H Sansores, and Don D. Sin
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cross-sectional study ,Air trapping ,Gastroenterology ,Tobacco smoke ,Pulmonary function testing ,Pulmonary Disease, Chronic Obstructive ,Quality of life ,Air Pollution ,Forced Expiratory Volume ,Smoke ,Internal medicine ,Tobacco ,Humans ,Medicine ,Cooking ,Diagnosis, Computer-Assisted ,Expiration ,Mexico ,Aged ,Oxygen saturation (medicine) ,Emphysema ,COPD ,Exercise Tolerance ,business.industry ,Smoking ,Middle Aged ,medicine.disease ,Respiratory Function Tests ,respiratory tract diseases ,Surgery ,Cross-Sectional Studies ,Phenotype ,Multivariate Analysis ,Quality of Life ,Female ,Blood Gas Analysis ,medicine.symptom ,Tomography, X-Ray Computed ,business - Abstract
We hypothesised that biomass smoke exposure is associated with an airway-predominant chronic obstructive pulmonary disease (COPD) phenotype, while tobacco-related COPD is associated with an emphysema-predominant phenotype. In this cross-sectional study, female never-smokers with COPD and biomass exposure (n=21) and female ex-cigarette smokers with COPD without biomass exposure (n=22) completed computed tomography (CT) at inspiration and expiration, pulmonary function, blood gas, exercise tolerance, and quality of life measures. Two radiologists scored the extent of emphysema and air trapping on CT. Quantitative emphysema severity and distribution and airway wall thickness were calculated using specialised software. Women in the tobacco group had significantly more emphysema than the biomass group (radiologist score 2.3 versus 0.7, p=0.001; emphysema on CT 27% versus 19%, p=0.046; and a larger size of emphysematous spaces, p=0.006). Women in the biomass group had significantly more air trapping than the tobacco group (radiologist score 2.6 and 1.5, respectively; p=0.02) and also scored lower on the symptom, activities and confidence domains of the quality of life assessment and had lower oxygen saturation at rest and during exercise (p
- Published
- 2013
8. Polyploidy and chromatin remodeling in hepatocytes from insulin-dependent diabetic and normoglycemic aged mice
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Isabela S. Silva, Flávia G. Ghiraldini, and Maria Luiza S. Mello
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Blood Glucose ,Aging ,medicine.medical_specialty ,Histology ,Nod ,Chromatin remodeling ,Pathology and Forensic Medicine ,Polyploidy ,Mice ,Mice, Inbred NOD ,Internal medicine ,Diabetes mellitus ,Image Processing, Computer-Assisted ,Rosaniline Dyes ,medicine ,Animals ,Micrococcal Nuclease ,DNA Cleavage ,Coloring Agents ,Gene ,NOD mice ,Mice, Inbred BALB C ,biology ,DNA ,Cell Biology ,Chromatin Assembly and Disassembly ,medicine.disease ,Chromatin ,Diabetes Mellitus, Type 1 ,Endocrinology ,Immunology ,Hepatocytes ,biology.protein ,Female ,Ploidy ,Micrococcal nuclease - Abstract
Changes in polyploidization, chromatin supraorganization, and chromatin accessibility were investigated in hepatocytes collected from adult, nonobese diabetic (NOD) mice with increasing hyperglycemia and compared with adult normoglycemic controls and 56-week-old normoglycemic BALB/c mice. Our goal was to determine the changes in ploidy degrees and chromatin characteristics in mouse hepatocytes that are associated with insulin-dependent diabetes and to detect similarities in these aspects with those verified with aging, with greater accuracy than previous studies. Image analysis of Feulgen-stained nuclei revealed changes in ploidy degrees and chromatin supraorganization. Chromatin accessibility was assessed with micrococcal nuclease (MNase) digestion. Increased polyploidy was associated with increasing levels of glycemia, and this trend toward polyploidy was found even under normoglycemic conditions in NOD mice. Although high degrees of ploidy were also detected in aged BALB/c mice, the magnitude of polyploidy was not the same magnitude as that in the diabetic mice. While there was increased homogeneity of chromatin packaging with increasing polyploidy under conditions of severe hyperglycemia (and even under conditions of normoglycemia) in NOD mice, an inverse relationship was observed in aged BALB/c mice. Chromatin accessibility to MNase increased under severe hyperglycemia and advanced age, but it was much higher in the diabetic mice. In conclusion, although similarities in polyploidy were observed between the hepatocytes from increasingly hyperglycemic adult mice and those from normoglycemic aged mice, the relationship between chromatin remodeling and increases in ploidy degrees was not the same between the hepatocytes of these two groups. These findings demonstrate that strict similarities between diabetes and aging are not always true at the cellular level. This discordance is likely due to differences in the metabolic state of mouse hepatocytes during aging and diabetic conditions consequent to specificities in their gene regulatory programs.
- Published
- 2012
9. Lung diffusing capacity relates better to short-term progression on HRCT abnormalities than spirometry in mild asbestosis
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Nestor L. Müller, Lara Maris Nápolis, Reynaldo Tavares Rodrigues, Ericson Bagatin, J. Alberto Neder, C. Isabela S. Silva, Cristiano Rabelo Nogueira, Luiz Eduardo Nery, and Mario Terra-Filho
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Male ,Spirometry ,High-resolution computed tomography ,medicine.medical_specialty ,Pathology ,Time Factors ,Asbestos, Serpentine ,Asbestosis ,Severity of Illness Index ,Pulmonary function testing ,DLCO ,Occupational Exposure ,Internal medicine ,Diffusing capacity ,medicine ,Humans ,Lung volumes ,Prospective Studies ,medicine.diagnostic_test ,business.industry ,Pneumoconiosis ,Public Health, Environmental and Occupational Health ,Middle Aged ,respiratory system ,medicine.disease ,Respiratory Function Tests ,Occupational Diseases ,Disease Progression ,Cardiology ,Pulmonary Diffusing Capacity ,Female ,Tomography, X-Ray Computed ,business - Abstract
Pulmonary function tests (PFT), particularly spirometry and lung diffusing capacity for carbon monoxide (DL(CO) ), have been considered useful methods for the detection of the progression of interstitial asbestos abnormalities as indicated by high-resolution computed tomography (HRCT). However, it is currently unknown which of these two tests correlates best with anatomical changes over time.In this study, we contrasted longitudinal changes (3-9 years follow-up) in PFTs at rest and during exercise with interstitial abnormalities evaluated by HRCT in 63 ex-workers with mild-to-moderate asbestosis.At baseline, patients presented with low-grade asbestosis (Huuskonen classes I-II), and most PFT results were within the limits of normality. In the follow-up, most subjects had normal spirometry, static lung volumes and arterial blood gases. In contrast, frequency of DL(CO) abnormalities almost doubled (P 0.05). Twenty-three (36.5%) subjects increased the interstitial marks on HRCT. These had significantly larger declines in DL(CO) compared to patients who remained stable (0.88 vs. 0.31 ml/min/mm Hg/year and 3.5 vs. 1.2%/year, respectively; P 0.05). In contrast, no between-group differences were found for the other functional tests, including spirometry (P 0.05).These data demonstrate that the functional consequences of progression of HRCT abnormalities in mild-to-moderate asbestosis are better reflected by decrements in DL(CO) than by spirometric changes. These results might have important practical implications for medico-legal evaluation of this patient population.
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- 2010
10. Consenso brasileiro ilustrado sobre a terminologia dos descritores e padrões fundamentais da TC de tórax Illustrated Brazilian consensus of terms and fundamental patterns in chest CT scans
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C. Isabela S. Silva, Edson Marchiori, Arthur Soares Souza Júnior, and Nestor L. Müller
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lcsh:RC705-779 ,Consensus ,Consenso ,Pulmão ,Tomografia ,lcsh:Diseases of the respiratory system ,Lung ,Tomography - Abstract
O objetivo deste novo consenso brasileiro é atualizar e dar continuidade à padronização da terminologia dos principais descritores e padrões fundamentais da TC de tórax em língua portuguesa. Este consenso contém uma descrição sucinta dos principais termos utilizados na TC de tórax e ilustrações de exemplos clássicos. O grupo de autores é formado por médicos radiologistas membros do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, especializados em radiologia torácica, e por pneumologistas membros da Sociedade Brasileira de Pneumologia e Tisiologia, com particular interesse em diagnóstico por imagem.The objective of this new Brazilian consensus is to update and to continue the standardization of the principal terms and fundamental patterns in chest CT scans in Portuguese. There is a succinct definition of the principal terms used to describe chest CT findings, as well as illustrations of classic examples. The group of authors comprised radiologists specializing in chest radiology and holding membership in the Brazilian College of Radiology and Diagnostic Imaging, as well as pulmonologists having a special interest in diagnostic imaging and holding membership in the Brazilian Thoracic Association.
- Published
- 2010
11. Interstitial Lung Disease in the Setting of Collagen Vascular Disease
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C. Isabela S. Silva and Nestor L. Müller
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Vasculitis ,Pathology ,medicine.medical_specialty ,business.industry ,Radiography ,Collagen Diseases ,Interstitial lung disease ,medicine.disease ,Diagnosis, Differential ,Risk Factors ,X ray computed ,Collagen vascular disease ,Humans ,Medicine ,Radiography, Thoracic ,Radiology, Nuclear Medicine and imaging ,Lung Diseases, Interstitial ,Tomography, X-Ray Computed ,business - Published
- 2010
12. Misplaced pulmonary arteries in an adult patient with pulmonary hypertension
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Robert D. Levy, Cleonice Isabela S. Silva, Nestor L. Müller, J C English, and G B Marshall
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Alveolar capillary dysplasia ,medicine.medical_specialty ,Biopsy ,Hypertension, Pulmonary ,Case Report ,Lung biopsy ,Pulmonary Artery ,Vascular anomaly ,Young Adult ,Internal medicine ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography ,Hypertrophy, Right Ventricular ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Pulmonary hypertension ,Respiratory failure ,Angiography ,Pulmonary artery ,Cardiology ,Female ,Radiology ,business ,Tomography, Spiral Computed - Abstract
Misalignment of pulmonary vessels, with or without alveolar capillary dysplasia, is a rare cause of persistent pulmonary hypertension in the newborn. The prognosis is poor, with virtually all patients succumbing to unremitting hypoxaemic respiratory failure and death during the newborn period. We report the CT and histological findings of misplaced pulmonary arteries in a previously healthy young adult patient who presented with pulmonary arterial hypertension. Contiguous high-resolution spiral CT angiography showed small pulmonary arteries coursing within the interlobular septa and enlarged central pulmonary arteries. Surgical lung biopsy demonstrated anomalous muscularised pulmonary arteries in the interlobular septa. This is, to our knowledge, the first report of misplaced pulmonary arteries presenting in an adult patient and may represent a forme fruste of the neonatal vascular anomaly. A possible association with pulmonary arterial hypertension is also suggested in this case.
- Published
- 2010
13. Idiopathic Interstitial Pneumonias
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C. Isabela S. Silva and Nestor L. Müller
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pathology ,Lung ,business.industry ,Prognosis ,medicine.disease ,Sensitivity and Specificity ,respiratory tract diseases ,Idiopathic pulmonary fibrosis ,medicine.anatomical_structure ,Usual interstitial pneumonia ,Fibrosis ,Lymphatic Metastasis ,Acute Interstitial Pneumonia ,medicine ,Etiology ,Humans ,Radiology, Nuclear Medicine and imaging ,Idiopathic Interstitial Pneumonias ,Radiology ,Tomography, X-Ray Computed ,business ,Idiopathic interstitial pneumonia ,Cryptogenic Organizing Pneumonia - Abstract
The idiopathic interstitial pneumonias (IIPs) are a group of diffuse parenchymal lung diseases of unknown etiology characterized by the presence of various degrees of inflammation and fibrosis. Confident definitive diagnosis of the various IIPs requires dynamic interaction among clinicians, radiologists, and pathologists to arrive at a clinico-radiologic-pathologic diagnosis. The aims of this manuscript are to summarize the characteristic clinical and histologic manifestations, and to describe and illustrate the high-resolution computed tomography manifestations of the IIPs. The focus will be on idiopathic pulmonary fibrosis (idiopathic usual interstitial pneumonia), nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, and acute interstitial pneumonia. High-resolution computed tomography plays an important role in the initial diagnosis, the assessment of disease extent, the likelihood of response to treatment and prognosis, and the assessment of complications.
- Published
- 2009
14. Clinic and radiological improvement of lipoid pneumonia with multiple bronchoalveolar lavages
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Pedro Daltro, Cleonice Isabela S. Silva, Angela Santos Ferreira, Regina Caetano, Selma Maria de Azevedo Sias, José Cláudio Fonseca Moreira, Nestor L. Müller, Edson Marchiori, and Thereza Quirico-Santos
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,Respiratory distress ,business.industry ,Respiratory disease ,medicine.disease ,Gastroenterology ,Surgery ,Pneumonia ,Bronchoalveolar lavage ,Radiological weapon ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,business ,Prospective cohort study ,After treatment ,Oxygen saturation (medicine) - Abstract
Objective To assess the potential role of multiple bronchoalveolar lavages (BALs) in the treatment of children with lipoid pneumonia (LP). Materials and Methods This prospective study included 10 children (7 female, 3 male) with LP secondary to mineral oil aspiration. The age ranged from 3 months to 7 years and 1–60 days history of mineral oil intake, with a 6 months clinic follow-up. High-resolution computer tomography (CT) was performed 1–7 days prior to treatment and 2–20 days after the last therapeutic BAL, and reviewed by two experienced chest radiologists. Oxygen saturation was measured with digital oximetry. Therapeutic BAL was performed weekly until BAL fluid was nearly transparent and the cell count returned to normal range values. Results In all children, the initial CT scans showed multifocal bilateral consolidation involving mainly the dorsal and central regions. The areas of consolidation had foci of decreased attenuation in eight patients. Following a total of 4–10 therapeutic BALs, the CT scans returned to normal in 3 patients, improved considerably in 5, and showed only slight improvement in 2. Oxygen saturation increased from 88.8 ± 3.4% at presentation to 96.2 ± 0.8% after treatment (P
- Published
- 2009
15. Asbestos-related Disease
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J. Alberto Neder, Ericson Bagatin, Cristiano Rabelo Nogueira, C. Isabela S. Silva, Lara Maris Nápolis, Luiz Eduardo Nery, Nestor L. Müller, and Mario Terra-Filho
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,High resolution ,Computed tomography ,medicine.disease_cause ,Radiographic image interpretation ,Asbestos ,Occupational Exposure ,Parenchyma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,medicine.diagnostic_test ,business.industry ,Disease progression ,Middle Aged ,Occupational Diseases ,Asbestosis ,Disease Progression ,Radiographic Image Interpretation, Computer-Assisted ,Radiology ,Tomography ,Tomography, X-Ray Computed ,business - Abstract
To evaluate the changes over time in the pattern and extent of parenchymal abnormalities in asbestos-exposed workers after cessation of exposure and to compare 3 proposed semiquantitative methods with a careful side-by-side comparison of the initial and the follow-up computed tomography (CT) images.The study included 52 male asbestos workers (mean age+/-SD, 62.2 y+/-8.2) who had baseline high-resolution CT after cessation of exposure and follow-up CT 3 to 5 years later. Two independent thoracic radiologists quantified the findings according to the scoring systems proposed by Huuskonen, Gamsu, and Sette and then did a side-by-side comparison of the 2 sets of scans without awareness of the dates of the CT scans.There was no difference in the prevalence of the 2 most common parenchymal abnormalities (centrilobular small dotlike or branching opacities and interstitial lines) between the initial and follow-up CT scans. Honeycombing (20%) and traction bronchiectasis and bronchiolectasis (50%) were seen more commonly on the follow-up CT than on the initial examination (10% and 33%, respectively) (P=0.01). Increased extent of parenchymal abnormalities was evident on side-by-side comparison in 42 (81%) patients but resulted in an increase in score in at least 1 semiquantitative system in only 16 (31%) patients (all P0.01, signed test).The majority of patients with previous asbestos exposure show evidence of progression of disease on CT at 3 to 5 years follow-up but this progression is usually not detected by the 3 proposed semiquantitative scoring schemes.
- Published
- 2008
16. Manifestações intratorácicas das doenças do colágeno na tomografia computadorizada de alta resolução do tórax Intrathoracic manifestations of collagen vascular diseases on high-resolution chest computed tomography
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C. Isabela S. Silva and Nestor L. Müller
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Pneumonia intersticial ,Collagen vascular disease ,lcsh:Medical physics. Medical radiology. Nuclear medicine ,Hipertensão pulmonar ,Pulmão ,Tomografia computadorizada ,lcsh:R895-920 ,Lung ,Computed tomography ,respiratory tract diseases ,Doença do colágeno ,Interstitial pneumonia ,Pulmonary hypertension - Abstract
As manifestações intratorácicas das doenças do colágeno são bastante comuns. O padrão e a freqüência de comprometimento dependem do tipo específico de doença do colágeno, que pode envolver um ou vários compartimentos simultaneamente, tais como parênquima, vias aéreas, artérias pulmonares, pleura, e pericárdio. As manifestações mais importantes incluem as pneumonias intersticiais difusas e a hipertensão pulmonar, que em conjunto representam as principais causas de mortalidade e morbidade nesses pacientes. O acometimento pulmonar, pleural e de via aérea pode ser também secundário a terapêutica instituída ou ser decorrente de processos infecciosos bacterianos ou por germes oportunistas, por causa da imunossupressão. Nesta revisão os autores sumarizam as manifestações intratorácicas e o diagnóstico diferencial das principais doenças do colágeno na tomografia computadorizada de alta resolução do tórax.Intrathoracic manifestations of collagen vascular diseases are very common. The frequency of intrathoracic manifestations and the pattern of abnormality are variable depending on the type of collagen vascular disease and may simultaneously involve one or more of the following: lung parenchyma, airways, pulmonary vessels, pericardium, and pleura. Most significant manifestations include diffuse interstitial pneumonia and pulmonary hypertension which together represent the main causes of morbidity and mortality of these patients. Pulmonary, airway and pleural involvement may also be secondary to the therapy adopted for management of the disease, or result from bacterial pneumonia or opportunistic infection. In the present review, the authors summarize the main intrathoracic manifestations of collagen vascular diseases and the differential diagnosis on high-resolution chest computed tomography.
- Published
- 2008
17. Manifestações intratorácicas das doenças do colágeno na tomografia computadorizada de alta resolução do tórax
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Nestor L. Müller and C. Isabela S. Silva
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Pneumonia intersticial ,Hipertensão pulmonar ,Pulmão ,Tomografia computadorizada ,Radiology, Nuclear Medicine and imaging ,Doença do colágeno - Abstract
As manifestações intratorácicas das doenças do colágeno são bastante comuns. O padrão e a freqüência de comprometimento dependem do tipo específico de doença do colágeno, que pode envolver um ou vários compartimentos simultaneamente, tais como parênquima, vias aéreas, artérias pulmonares, pleura, e pericárdio. As manifestações mais importantes incluem as pneumonias intersticiais difusas e a hipertensão pulmonar, que em conjunto representam as principais causas de mortalidade e morbidade nesses pacientes. O acometimento pulmonar, pleural e de via aérea pode ser também secundário a terapêutica instituída ou ser decorrente de processos infecciosos bacterianos ou por germes oportunistas, por causa da imunossupressão. Nesta revisão os autores sumarizam as manifestações intratorácicas e o diagnóstico diferencial das principais doenças do colágeno na tomografia computadorizada de alta resolução do tórax.
- Published
- 2008
18. Nonspecific Interstitial Pneumonia and Idiopathic Pulmonary Fibrosis: Changes in Pattern and Distribution of Disease over Time
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David M. Hansell, Andrew G. Nicholson, C. Isabela S. Silva, Kyung Soo Lee, Athol U. Wells, and Nestor L. Müller
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Adult ,Male ,medicine.medical_specialty ,Pulmonary Fibrosis ,Disease ,Logistic regression ,Idiopathic pulmonary fibrosis ,Pulmonary fibrosis ,medicine ,Humans ,Distribution (pharmacology) ,Radiology, Nuclear Medicine and imaging ,Honeycombing ,Lung ,Aged ,business.industry ,Respiratory disease ,Middle Aged ,respiratory system ,medicine.disease ,respiratory tract diseases ,medicine.anatomical_structure ,Female ,Radiology ,Lung Diseases, Interstitial ,Tomography, X-Ray Computed ,business - Abstract
To retrospectively assess the change in disease pattern of nonspecific interstitial pneumonia (NSIP) and idiopathic pulmonary fibrosis (IPF) findings seen at thin-section computed tomography (CT) at long-term follow-up and to compare the same with initial findings at CT.The study included 48 patients (28 men, 20 women; mean age, 57.5 years) with biopsy-proved NSIP (n = 23) or IPF (n = 25) who underwent CT at initial diagnosis and at follow-up 34-155 months later. The CT scans were randomized and reviewed by two independent thoracic radiologists for pattern and distribution of ground-glass opacity (GGO), reticulation, traction bronchiectasis and bronchiolectasis, and honeycombing. Statistical analysis was performed by using nonparametric methods and univariate logistic regression.Follow-up CT in patients with NSIP showed marked decrease in the extent of GGO, increase in reticulation, and a greater likelihood of peripheral distribution (all P.05). At presentation, the CT findings were interpreted as suggestive of NSIP in 18 of 23 patients with NSIP and indeterminate or suggestive of IPF in five. In five (28%) of 18 patients with initial findings suggestive of NSIP, the follow-up CT scans were interpreted as more suggestive of IPF. No CT features seen at presentation allowed distinction between patients with NSIP that maintained an NSIP pattern at follow-up and those that progressed to an IPF pattern.At follow-up CT, 28% of patients with initial CT findings suggestive of NSIP progressed to findings suggestive of IPF. Similar initial CT findings for NSIP may have different imaging outcomes.
- Published
- 2008
19. Organizing Pneumonia as a Manifestation of Pneumocystis jiroveci Immune Reconstitution Syndrome in HIV-positive Patients
- Author
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Peter Phillips, Jennifer Ellis, Nestor L. Müller, Myrna C. B. Godoy, and C. Isabela S. Silva
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Biopsy ,Human immunodeficiency virus (HIV) ,HIV Infections ,Lung biopsy ,Lung injury ,Pneumocystis carinii ,medicine.disease_cause ,Immune system ,Immune Reconstitution Inflammatory Syndrome ,Antiretroviral Therapy, Highly Active ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Respiratory system ,Lung ,business.industry ,Pneumonia, Pneumocystis ,PNEUMOCYSTIS JIROVECI ,Middle Aged ,CD4 Lymphocyte Count ,Immunology ,Organizing pneumonia ,Tomography, X-Ray Computed ,business ,Viral load - Abstract
Organizing pneumonia (OP) is a nonspecific response to various forms of lung injury. Although patients with human immunodeficiency virus (HIV) infection tend to develop several respiratory disorders, especially infections and malignances, the association of HIV infection and OP is unusual. Pneumocystis jiroveci infection is also rarely associated with OP. We describe the radiologic findings in 2 HIV-positive patients who shortly after introduction of highly active antiretroviral therapy, presented with clinical and radiologic deterioration, despite elevation of the CD4 cell count and viral load decrease. In both patients, clinical and radiologic features were consistent with OP and lung biopsy revealed OP associated with P. jiroveci infection. These findings are consistent with immune reconstitution syndrome due to P. jiroveci.
- Published
- 2008
20. Pulmonary Complications of Illicit Drug Use
- Author
-
Nestor L. Müller, Carolina A. Souza, Elsie T. Nguyen, and C. Isabela S. Silva
- Subjects
Adult ,Lung Diseases ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Substance-Related Disorders ,Air trapping ,Diagnosis, Differential ,Bacterial endocarditis ,medicine ,Humans ,Illicit drug ,Radiology, Nuclear Medicine and imaging ,Ct findings ,Pneumomediastinum ,Lung ,business.industry ,Middle Aged ,medicine.disease ,Discitis ,Female ,Septic arthritis ,Radiology ,Differential diagnosis ,medicine.symptom ,Tomography, X-Ray Computed ,business - Abstract
Objective: The aim of this manuscript is to summarize an approach to the differential diagnosis of the pulmonary complications of illicit drug use based on the computed tomography findings. Conclusions: The various pulmonary complications of illicit drug use result in 5 main patterns of parenchymal abnormality: nodules, ground-glass opacities, consolidation, air trapping, and emphysema. Other thoracic manifestations of illicit drug use include pulmonary arterial hypertension, pneumomediastinum, bacterial endocarditis, discitis, and septic arthritis.
- Published
- 2007
21. Acute Exacerbation (Acute Lung Injury of Unknown Cause) in UIP and Other Forms of Fibrotic Interstitial Pneumonias
- Author
-
C. Isabela S. Silva, Andrew Churg, Nestor L. Müller, and Joanne L. Wright
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Exacerbation ,Biopsy ,Pulmonary Fibrosis ,Lung biopsy ,Lung injury ,Pathology and Forensic Medicine ,Usual interstitial pneumonia ,Azathioprine ,Humans ,Medicine ,Diffuse alveolar damage ,Cyclophosphamide ,Glucocorticoids ,Aged ,Respiratory Distress Syndrome ,business.industry ,Respiratory disease ,Interstitial lung disease ,Middle Aged ,respiratory system ,medicine.disease ,Pulmonary Alveoli ,Treatment Outcome ,Disease Progression ,Drug Therapy, Combination ,Female ,Radiography, Thoracic ,Surgery ,Anatomy ,Respiratory Insufficiency ,Tomography, X-Ray Computed ,business ,Immunosuppressive Agents ,Hypersensitivity pneumonitis ,Alveolitis, Extrinsic Allergic - Abstract
Acute exacerbation of usual interstitial pneumonia (UIP) is a condition in which patients with UIP, and occasionally other forms of fibrotic interstitial lung disease, develop rapid respiratory failure, accompanied by extensive radiologic infiltrates. The pathologic features of this condition are ill-defined in the literature and the outcome is unclear. We report 12 such patients, 9 with underlying UIP, 2 with underlying fibrotic nonspecific interstitial pneumonia, and 1 with underlying chronic hypersensitivity pneumonitis, who underwent surgical lung biopsy for diagnosis. High-resolution computed tomography data were available in 11 cases and showed the presence of extensive bilateral ground-glass opacities, sometimes accompanied by focal consolidation, superimposed on underlying fibrosis. Three microscopic patterns of acute lung injury were seen: diffuse alveolar damage (DAD), organizing pneumonia (OP), and a pattern of numerous very large fibroblast foci superimposed on underlying fibrosis. After the biopsy, all patients were treated with steroids, in some instances accompanied by cyclophosphamide or azathioprine. Ten patients survived the acute episode and were discharged with survival times of 1 to 11 months; of these cases, 6 showed a pattern of OP or OP plus extensive fibroblast foci; 2 a pattern of extensive fibroblast foci only; and 2 a pattern of DAD. Both patients who died had histologic DAD. We conclude that acute exacerbation of UIP and other fibrotic lung diseases produces a variety of pathologic patterns on biopsy, and that patients with OP or extensive fibroblast foci as the acute pattern seem to do better than those with DAD. Our data also imply that survival (of the acute episode) may be better than the literature suggests.
- Published
- 2007
22. Modelo de interpretação da tomografia computadorizada de alta resolução do diagnóstico diferencial das doenças intersticiais crônicas High-resolution computed tomography interpretation model for differential diagnosis of chronic interstitial lung diseases
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,Tomografia computadorizada de alta resolução ,Pulmão ,lcsh:R895-920 ,Interstitial lung disease ,Doença pulmonar intersticial ,Lungs ,Doenças pulmonares ,Lung diseases ,High-resolution computed tomography - Abstract
O reconhecimento e o diagnóstico diferencial dos diversos padrões da tomografia computadorizada de alta resolução (TCAR) são de fundamental importância na avaliação das doenças pulmonares difusas. Existem vários padrões de TCAR descritos na literatura, sendo alguns deles superponíveis. A interpretação desses padrões pode ser uma tarefa difícil, particularmente para residentes e radiologistas não especializados em tórax. Os autores ilustram os achados característicos da TCAR nas doenças pulmonares intersticiais crônicas e propõem um modelo simplificado de interpretação desses achados, baseado no padrão e na distribuição da doença. O algoritmo inclui os seis principais padrões de anormalidade identificados na TCAR: septal, reticular, cístico, nodular, de atenuação em vidro fosco e consolidação parenquimatosa.The recognition and differential diagnosis of the various patterns of abnormality seen on high-resolution computed tomography (HRCT) are important in the evaluation of patients with chronic insterstitial lung diseases. Various patterns of abnormality have been described in the literature, which sometimes are overlapped. Distinction between the various patterns can be difficult particularly for residents and radiologists who are not familiarized with these images. The authors illustrate the characteristic patterns of abnormality seen in chronic interstitial lung diseases and propose a simple interpretation algorithm based on the pattern and distribution of the findings. The algorithm includes the six main patterns of abnormality seen on HRCT: septal lines, reticular pattern, cystic pattern, nodular pattern, ground-glass opacities and consolidation.
- Published
- 2005
23. Diagnóstico por imagem do tromboembolismo pulmonar agudo
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
Tomografia computadorizada de emissão de fóton único/métodos ,Pulmonary and Respiratory Medicine ,business.industry ,Pulmonary embolism ,Angiography ,Diagnóstico por imagem ,Emboliapulmonar/diagnóstico ,Emboliapulmonar ,Pneumopatias ,Pneumopatias/cintilografia ,Diagnostic imaging ,Medicine ,Angiografia ,Tomography, emission-computed single-photon ,Nuclear medicine ,business ,Lung diseases ,Tomografia computadorizada de emissão de fóton único - Abstract
O diagnóstico do tromboembolismo pulmonar agudo é baseado na probabilidade clínica, uso do dímero D (quando disponível) e na avaliação por imagem. Os principais métodos de imagem utilizados no diagnóstico são representados por cintilografia ventilação-perfusão, angiografia pulmonar e tomografia computadorizada (TC). Na última década vários estudos têm demonstrado que a TC espiral apresenta elevada sensibilidade e especificidade no diagnóstico de tromboembolismo pulmonar agudo. Uma melhor avaliação das artérias pulmonares tornou-se possível com a recente introdução dos equipamentos de TC espirais com multidetectores. Vários pesquisadores têm sugerido que a angiografia pulmonar por TC espiral deve substituir a cintilografia na avaliação de pacientes com suspeita clinica de tromboembolismo pulmonar agudo. Os autores discutem os principais métodos de imagem utilizados no diagnóstico de tromboembolismo pulmonar agudo enfatizando o papel da TC espiral. The diagnosis of acute pulmonary thromboembolism is based on the clinical probability, use of D-dimer (when available) and imaging. The main imaging modalities used in the diagnosis are ventilation-perfusion (V/Q), scintigraphy, angiography, and computed tomography (CT). In the last decade several studies have demonstrated that spiral CT has a high sensitivity and specificity in the diagnosis of acute pulmonary thromboembolism. The evaluation of the pulmonary arteries has further improved with the recent introduction of multidetector spiral CT scanners. Various investigators have suggested that spiral CT pulmonary angiography should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute pulmonary thromboembolism with emphasis on the role of spiral CT.
- Published
- 2004
24. Chronic pulmonary microaspiration: high-resolution computed tomographic findings in 13 patients
- Author
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Thamine Lessa Andrade, Cleonice Isabela S. Silva, Jorge L. Pereira-Silva, Nestor L. Müller, and Cesar A. Araújo Neto
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,High resolution ,Computed tomography ,Pneumonia, Aspiration ,Computed tomographic ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung ,Subclinical infection ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Pneumonia ,Chronic disease ,Chronic Disease ,Female ,Radiology ,Tomography ,business ,Tomography, X-Ray Computed - Abstract
The aim of the study was to describe the high-resolution computed tomography (CT) manifestations of chronic pulmonary microaspiration, a condition characterized by recurrent subclinical aspiration of small droplets of gastric contents or foreign particles into the lungs.We reviewed the CT findings in 13 consecutive patients with clinical (n=13) and histologic (n=1) diagnosis of chronic pulmonary microaspiration. Twelve patients presented with persistent cough, but none had a clinical history of acute aspiration. One patient was asymptomatic. All patients had volumetric CT of the chest reconstructed using thin sections (1 to 1.3 mm) at the time of diagnosis. The CT scans were interpreted by 3 chest radiologists who reached a final decision by consensus.All 13 patients had centrilobular nodules and ground-glass opacities that involved mainly the dependent lung regions in 11 patients and had a random distribution in 2. Other common findings included branching opacities (n=10), small foci of consolidation (n=7), septal lines (n=5), and bronchiectasis (n=7). The 13 patients had at least 1 risk factor for aspiration including gastroesophageal reflux (n=9), hiatus hernia (n=6), esophageal dysfunction (n=3), oropharyngeal dysphagia (n=1), esophageal carcinoma (n=1), and use of sedatives (n=2).The high-resolution CT manifestations of chronic pulmonary microaspiration consist mainly of centrilobular nodules and ground-glass opacities that tend to involve predominately the dependent regions. Branching opacities and small foci of consolidation are seen in the majority of cases.
- Published
- 2014
25. Screening of miners and millers at decreasing levels of asbestos exposure: comparison of chest radiography and thin-section computed tomography
- Author
-
Gustavo de Souza Portes Meirelles, Lara Maris Nápolis, Nestor L. Müller, Luiz Eduardo Nery, Mario Terra-Filho, Ericson Bagatin, José Alberto Neder, and C. Isabela S. Silva
- Subjects
Thorax ,Spirometry ,Asbestos, Serpentine ,Radiography ,Asbestosis ,lcsh:Medicine ,medicine.disease_cause ,Asbestos ,Mining ,Occupational Exposure ,Chrysotile ,medicine ,Humans ,Mass Screening ,False Positive Reactions ,Longitudinal Studies ,lcsh:Science ,Mass screening ,Multidisciplinary ,medicine.diagnostic_test ,business.industry ,Asbestos, Amphibole ,lcsh:R ,Microtomy ,medicine.disease ,Cross-Sectional Studies ,Tremolite ,lcsh:Q ,Radiography, Thoracic ,business ,Nuclear medicine ,Tomography, X-Ray Computed ,Brazil ,Research Article - Abstract
Background Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases. Methods Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940–1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967–1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977–1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure). Results In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p
- Published
- 2014
26. Consenso brasileiro ilustrado sobre a terminologia dos descritores e padrões fundamentais da TC de tórax
- Author
-
Edson Marchiori, C. Isabela S. Silva, Nestor L. Müller, and Arthur Soares Souza Junior
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Consensus ,business.industry ,Pulmão ,Tomografia ,Chest ct ,Medical illustration ,Consenso ,X ray computed ,Medical imaging ,medicine ,Medical physics ,Tomography ,business ,Chest radiology ,Lung ,Pulmonologists - Abstract
O objetivo deste novo consenso brasileiro é atualizar e dar continuidade à padronização da terminologia dos principais descritores e padrões fundamentais da TC de tórax em língua portuguesa. Este consenso contém uma descrição sucinta dos principais termos utilizados na TC de tórax e ilustrações de exemplos clássicos. O grupo de autores é formado por médicos radiologistas membros do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, especializados em radiologia torácica, e por pneumologistas membros da Sociedade Brasileira de Pneumologia e Tisiologia, com particular interesse em diagnóstico por imagem. The objective of this new Brazilian consensus is to update and to continue the standardization of the principal terms and fundamental patterns in chest CT scans in Portuguese. There is a succinct definition of the principal terms used to describe chest CT findings, as well as illustrations of classic examples. The group of authors comprised radiologists specializing in chest radiology and holding membership in the Brazilian College of Radiology and Diagnostic Imaging, as well as pulmonologists having a special interest in diagnostic imaging and holding membership in the Brazilian Thoracic Association.
- Published
- 2010
27. Case 189
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Published
- 2010
28. Online Case 74
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
business.industry ,Medicine ,business - Published
- 2010
29. Online Case 100
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
World Wide Web ,Computer science ,Online research methods - Published
- 2010
30. Online Case 23
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Subjects
business.industry ,Medicine ,business - Published
- 2010
31. Online Case 36
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
business.industry ,Medicine ,business - Published
- 2010
32. Case 60
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Published
- 2010
33. Case 43
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Published
- 2010
34. Online Case 40
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
business.industry ,Medicine ,business - Published
- 2010
35. Online Case 51
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Subjects
business.industry ,Medicine ,business - Published
- 2010
36. Case 77
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Published
- 2010
37. Case 93
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Published
- 2010
38. Case 34
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Published
- 2010
39. Online Case 64
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
business.industry ,Medicine ,business - Published
- 2010
40. Online Case 38
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Subjects
business.industry ,Medicine ,business - Published
- 2010
41. Online Case 24
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
business.industry ,Medicine ,business - Published
- 2010
42. Online Case 89
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Subjects
business.industry ,Medicine ,business - Published
- 2010
43. Case 25
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Published
- 2010
44. Online Case 48
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Subjects
business.industry ,Medicine ,business - Published
- 2010
45. Case 50
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Published
- 2010
46. Preface
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Published
- 2010
47. Online Case 56
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
business.industry ,Medicine ,business - Published
- 2010
48. Online Case 82
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
business.industry ,Medicine ,business - Published
- 2010
49. Online Case 62
- Author
-
C. Isabela S. Silva and Nestor L. Müller
- Subjects
business.industry ,Medicine ,business - Published
- 2010
50. Online Case 99
- Author
-
Nestor L. Müller and C. Isabela S. Silva
- Subjects
business.industry ,Medicine ,business - Published
- 2010
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