OBJECTIVE: Comparative study of receptiveness (cooperation) and sensitivity of upper gastrointestinal series and intraabdominal esophagus ultrasonography in patients with suspicion of gastroesophageal reflux. MATERIALS AND METHODS: The present study included 42 pediatric patients (26 male, with mean age of 33.64 ± 34.33 months, and 16 female, with mean age of 31.02 ± 35.56 months) with suspicion of gastroesophageal reflux, who were initially submitted to upper gastrointestinal series and subsequently to intraabdominal esophagus ultrasonography. RESULTS: The statistical comparative analysis covering sexes and ages suggests no evidence of association with cooperation, both for the upper gastrointestinal series and the intraabdominal esophagus ultrasonography. However, in the classification of the patients' cooperation, the technique of upper gastrointestinal series presented less than 50% of cooperation, while 80.49% of patients cooperated in the intraabdominal esophagus ultrasonography examinations. As regards the methods sensitivity for the diagnosis of gastroesophageal reflux, the technique of intraabdominal esophagus ultrasonography was significantly superior (85.7%) to the upper gastrointestinal series (47.6%). CONCLUSION: The present study suggests that an intraabdominal esophagus ultrasonography should be performed even if gastroesophageal reflux even if it is not detected at the upper gastrointestinal series.

Keywords: Gastroesophageal reflux, Intraabdominal esophagus, Ultrasonography, Contrast-enhanced study

OBJECTIVE: Retrospectively determining the coloileal reflux prevalence at the barium enema examination, characterizing its distribution by sex and age range and classifying it according to the intensity degree. MATERIALS AND METHODS: 715 barium enemas were reviewed, being 268 of male patients and 447 of female patients, with average age of 54 years. RESULTS: Of the 715 enemas performed, 46.5% showed coloileal reflux, classified as mild (45%), moderate (37.5%) and severe (17.5%). Coloileal reflux was present in 48.3% of female and in 43.6% of male patients. The coloileal reflux distribution by age range was 46.1% in individuals less than 21 years, 42.1% in individuals between 21-40, 49.8% in individuals between 41-60 and 44.7% in people more than 60 years old. CONCLUSION: Coloileal reflux was a common finding, with 25% of them being classified as moderate or severe. Apparently, there is not a clear relationship between its occurrence and gender or age. The etiopathogenesis and consequences of the coloileal reflux remain still poorly known. Some studies suggest that the compromising of ileocecal junction components, like ligaments, could favor the coloileal reflux occurrence. Among the probable consequences, we could mention contamination and ileal motility disorders resulting from the material refluxed from cecum into the ileum.

Keywords: Coloileal reflux, Ileocecal valve, Ileocecal junction, Small bowel bacterial overgrowth syndrome, Coloileal reflux at the barium enema

OBJECTIVE: The present study had as its objective to compare the findings of voiding cystourethrography with those of duplex color Doppler in patients with suspected vesicoureteral reflux. MATERIALS AND METHODS: The research was developed through the study of ureterovesical jet angles, both in axial and longitudinal planes. Also, the distance (in cm) between ureteral meatuses was analyzed. RESULTS: From a total sample of 32 patients (mean age of five years and two months), 18 presented with vesicoureteral reflux (10 with unilateral reflux - 4 right-sided and 6 left-sided -, and 8 with bilateral reflux) and 14 patients did not presented with reflux. The angles of ureterovesical jet and distances between the ureteral meatuses were measured in all patients, and mean values, standard deviation and coefficient of variance were calculated. CONCLUSION: Data showed that a trend towards meatus lateralization is a sign of predisposition to vesicoureteral reflux. Non-parametric Mann-Whitney statistical analysis did not show significant differences (p > 0.05) between groups (inclination angles of ureterovesical jet and distance between urinary meatuses).

Keywords: Vesicoureteral reflux, Ureterovesical jet, Color Doppler ultrasound, Voiding cystourethrography

OBJECTIVE: The present study was aimed at analyzing the value of the early diagnosis of hemodynamic changes in hemorrhages and hypoxic-ischemic events in premature, very-low-birth-weight neonates through the evaluation of images and resistance index measurement by means of transcranial Doppler ultrasonography. MATERIALS AND METHODS: Fifty premature, very-low-birth-weight neonates were submitted to transcranial Doppler ultrasonography with sequential transfontanellar and transtemporal techniques. RESULTS: Cerebral abnormalities were detected in 32% of the neonates (22% with intracranial hemorrhage, 8% with periventricular leukomalacia, and 2% with toxoplasmosis). Among the 34 cases (68%) of neonates in whom no brain lesion was detected at transcranial Doppler ultrasonography, 18 (53%) presented changes in the resistance index. Such resistance index varied according to the time of the examination. CONCLUSION: There is a correlation between the presence of cerebral hemodynamic changes demonstrated by resistance index measurements and the subsequent development of hemorrhages and hypoxic-ischemic lesions. Although not being a death predictor, changes in the resistance index are associated with the severity of the clinical conditions in preterm, very-low-birth-weight neonates.

Keywords: Transcranial Doppler ultrasonography; Premature, very-low-birth-weight neonates; Ultrasonography; Resistance index.

Objective: To determine the sensitivity of upper gastrointestinal (UGI) series, adopting the 24-h esophageal pH monitoring as the gold standard in the diagnosis of gastroesophageal reflux disease (GERD) in preterm newborns, besides describing the presence of anatomical abnormalities in the digestive tube. Materials and Methods: The present study included 41 neonates with average birth weight of 1,243.9 g, presenting signs/symptoms of GERD and abnormal 24-h esophageal pH monitoring (reflux index > 10%). The UGI series was performed as soon as the infants’ clinical conditions were considered sufficiently stable. Results: The 24-h pH monitoring and UGI series were performed respectively at 49.8 and 66.8 days of life. The UGI series sensitivity was of 39.0 (CI 95%: 25.7–54.3%). The reflux index was significant in 41.4%, moderate in 44.8%, and mild in 13.8% of the cases. Only one case of hiatus hernia was identified by UGI series. Conclusion: Upper gastrointestinal series has demonstrated low sensitivity in the diagnosis of GERD in preterm newborns and was not associated with the reflux severity as compared with pH monitoring. However, it is useful in the detection of anatomical abnormalities in the upper gastrointestinal tract.

Keywords: Gastroesophageal reflux disease; Upper gastrointestinal series; 24-h esophageal pH monitoring; Preterm newborns.

OBJETIVO: Este estudo teve por finalidade avaliar a perfusão miocárdica de pacientes com diabetes mellitus tipo 1 (DM1) e tipo 2 (DM2) assintomáticos, sem diagnóstico prévio de doença arterial coronariana (DAC) ou acidente vascular cerebral. MATERIAIS E MÉTODOS: Cinquenta e nove pacientes consecutivos (16 DM1, 43 DM2) foram submetidos a cintilografia de perfusão miocárdica com sestamibi-^99mTc (CPM). Foram avaliados quanto ao índice de massa corpórea, controle metabólico do diabetes, dislipidemia, terapia para o diabetes, hipertensão arterial sistêmica, nefropatia, retinopatia, neuropatia periférica, tabagismo e história familiar de DAC. RESULTADOS: CPM foi anormal em 25,4%: 12 (20,3%) com alterações de perfusão e 3 com disfunção ventricular esquerda isolada. Os mais fortes preditores de perfusão miocárdica anormal foram: idade igual ou maior a 60 anos (p = 0,017, odds ratio [OR] = 6,0), neuropatia periférica (p = 0,028, OR = 6,1), nefropatia (p = 0,031, OR = 5,6) e ECG de esforço positivo para isquemia (p = 0,049, OR = 4,08). CONCLUSÃO: A isquemia miocárdica silenciosa ocorre em mais de um em cada cinco diabéticos assintomáticos. Os mais fortes preditores de isquemia foram: idade avançada, neuropatia periférica, nefropatia, retinopatia e ECG de esforço positivo para isquemia.

Keywords: Diabetes mellitus; Cintilografia de perfusão miocárdica; Isquemia miocárdica silenciosa; Doença arterial coronariana.

OBJECTIVE: To determine whether preterm infants diagnosed with intracranial hemorrhage (by transfontanellar ultrasound) at birth have cerebral lesions that are detectable by magnetic resonance imaging (MRI) upon reaching school age. MATERIALS AND METHODS: MRI scans of the brain were obtained in 22 school-age children. Fifteen had presented intracranial hemorrhage at birth, and seven had not. We calculated the odds ratio (OR) for the occurrence of brain alterations detectable by MRI and the kappa index for discrepancies among the radiological reports. RESULTS: The children without previous intracranial hemorrhage presented normal MRI findings. Of the 15 children with previous intracranial hemorrhage, 6 (40%) presented brain alterations on MRI: isolated ventricular alteration (dilation and asymmetry), in 2 (13.3%); and ventricular asymmetry accompanied by parenchymal lesion, in 4 (26.7%). The nine remaining children with previous intracranial hemorrhage (60%) presented normal MRI findings. The children with previous intracranial hemorrhage were more likely to present ventricular alteration (OR = 7.8) and parenchymal lesions (OR = 5.4). CONCLUSION: Ventricular and parenchymal brain alterations detected by MRI suggest isolated morphologic alterations that do not result in neurological impairment detectable on physical examination in school-age children.

Keywords: Newborn; Premature; Intra]cranial hemorrhage; Magnetic resonance imaging; Child.

OBJECTIVE: To analyze the radiological aspects of pulmonary atelectasis in newborns on mechanical ventilation and treated in an intensive care unit, associating the characteristics of atelectasis with the positioning of the head and endotracheal tube seen on the chest X-ray, as well as with the clinical variables. MATERIALS AND METHODS: This was a retrospective cross-sectional study of 60 newborns treated between 1985 and 2015. Data were collected from medical records and radiology reports. To identify associations between variables, we used Fisher’s exact test. The level of significance was set at p < 0.05. RESULTS: The clinical characteristics associated with improper positioning of the endotracheal tube were prematurity and a birth weight of less than 1000 g. Among the newborns evaluated, the most common comorbidity was hyaline membrane disease. Atelectasis was seen most frequently in the right upper lobe, although cases of total atelectasis were more common in the left lung. Malpositioning of the head showed a trend toward an association with atelectasis in the left upper lobe. CONCLUSION: Pulmonary atelectasis is a common complication in newborns on mechanical ventilation. Radiological evaluation of the endotracheal tube placement provides relevant information for the early correction of this condition.

Keywords: Pulmonary atelectasis/diagnostic imaging; Respiration, artificial; Infant, newborn; Premature birth; Infant, low birth weight.