ABSTRACT Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 – 10.0 ng/mL and its ability to reduce unnecessary biopsies. Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 – 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted. Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0.806) (P<0.001) and PSAD (0.806) (P<0.001). With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies. Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies.

OBJETIVO: Definir padrões de normalidade da função endotelial de adolescentes através de avaliação ultra-sonográfica da dilatação vascular dependente do endotélio. MÉTODOS: Estudo descritivo observacional de corte transversal, parte do projeto temático "Estudos Clínicos de Crescimento, Comportamento, Hipertensão Arterial, Obesidade e Saúde Bucal", de sigla ECCCHOS, desenvolvido na Disciplina de Nutrologia da Universidade Federal de São Paulo - Escola Paulista de Medicina. Foram selecionados 31 adolescentes, sendo oito do sexo masculino e 23 do feminino, sem fatores de risco conhecidos para hipertensão arterial sistêmica, entre 1.420 alunos de uma escola de ensino médio da cidade de São Paulo, capital do estado de São Paulo, situado no Sudeste do Brasil. Para apresentação de todos os resultados, utilizaram-se as médias, desvios padrão e percentis. RESULTADOS: A dilatação vascular dependente do endotélio 90 segundos pós-liberação do manguito foi de 20,9±6,7% [média mais ou menos 1 desvio padrão (DP)] e o 10° percentil ficou em 12,5% no sexo masculino e de 18,8±12,9% DP e o 10° percentil em 6,6% no sexo feminino. Os valores no grupo todo foram de 19,3±11,7% e 6,7%, respectivamente. CONCLUSÃO: O 10° percentil (6,7%) da curva de distribuição dos valores de dilatação vascular dependente do endotélio, em adolescentes do presente estudo, pode ser considerado como limite inferior da normalidade. O conhecimento desse limite é importante para o diagnóstico de disfunções endoteliais que aparecem antes das doenças cardiovasculares.

OBJECTIVE: To define standards for normal endothelial function in adolescents by high-resolution ultrasound measurement of endothelium-dependent vascular dilatation. METHODS: This was a cross-sectional, descriptive, observational study and part of the thematic project "Clinical Study of Growth, Behavior, Arterial Hypertension, Obesity and Oral Health" (ECCCHOS) that was developed by the Discipline of Nutrition at the Universidade Federal de São Paulo. Thirty-one adolescents, eight male and 23 female, with no risk factors for systemic arterial hypertension were selected from 1,420 high school students. The students were daytime pupils at a school in the southeastern district of the city of São Paulo, the capital of São Paulo state, located in the Southeast region of Brazil. All results are presented in the form of means with standard deviations and percentiles. RESULTS: For male students, endothelium-dependant dilation 90 seconds after the cuff was released was 20.9±6,7% [mean ±1 standard deviation] with a 10th percentile of 12.5 and for females these figures were 18.8±12.9% with a 10th percentile of 6.6%. Values for the whole group of subjects were 19.3±11.7% and 6.7%, respectively. CONCLUSION: Endothelium-dependant vascular dilation of 6.7%, after 90 seconds, which corresponds to the 10th percentile, can be considered the lower limit of normality for this age group. Knowledge of this limit is important for the diagnosis of endothelium dysfunction that appears before cardiovascular disease.

OBJETIVO: Determinar a freqüência de identificação das estruturas músculo-ligamentares do assoalho pélvico por meio de exames de ressonância magnética e avaliar o índice de concordância entre os observadores. MÉTODO: Estudo prospectivo em 20 voluntárias assintomáticas, idade de 20 a 80 anos (média de 50 anos). Realizados exames de ressonância magnética pélvica (1,5 T) nas seqüências turbo spin-eco ponderadas em T1 e T2 nos planos axial e sagital. Os exames foram avaliados por dois observadores independentes, que procuraram identificar os músculos levantador do ânus (músculos coccígeo, pubococcígeo, iliococcígeo e puborretal), obturador interno e compressor da uretra e os ligamentos pubovesical e pubouretral. Os resultados foram comparados com base na freqüência de identificação das estruturas anatômicas e na concordância entre os observadores (índice kappa -- kapa). RESULTADOS: A freqüência de identificação das estruturas variou de 50% a 100%, sendo pouco inferior para os ligamentos. A concordância interobservador na identificação das estruturas foi a seguinte: músculos levantador do ânus e obturador interno (kapa=1), pubococcígeo (kapa=0,62), iliococcígeo (kapa=0,86), puborretal (kapa=0,27), coccígeo (kapa=0) e compressor da uretra (kapa=1), e ligamentos pubovesical (kapa=0,50) e pubouretral (kapa=0,58). CONCLUSÃO: A ressonância magnética de pelve permite identificar as principais estruturas músculo-ligamentares do assoalho pélvico na grande maioria dos indivíduos, com boa concordância interobservador.

OBJECTIVE: To determine the frequency and to assess the interobserver agreement of identification of muscular and ligamentous pelvic floor structures using magnetic resonance imaging. METHOD: Twenty asymptomatic female volunteers (aged 20--80 years old; mean: 50) were submitted to magnetic resonance imaging (1.5 T) examinations of the pelvis. Turbo spin-echo sequences were employed to obtain T1 and T2 weighted images on axial and sagittal planes. Two independent observers evaluated the scans in order to identify the levator ani (coccygeal, pubococcygeal, iliococcygeal and puborectalis muscles), obturatorius internus and urethral sphincter muscles, and the pubovesical and pubourethral ligaments. The frequency and the interobserver agreement of the identification of the anatomical structures were assessed (kappa statistic -- kappa). RESULTS: The frequency of identification of the structures ranged from 50 to 100%, and was slightly lower for identification of the ligaments. Interobserver agreement was as follows: levator ani and obturatorius internus muscle (kappa=1), pubococcygeal (kappa=0.62), iliococcygeal (kappa=0.86), puborectalis (kappa= 0.27), coccygeal (kappa=0) and urethral sphincter muscles (kappa=1), pubovesical (kappa=0.50) and pubourethral (kappa=0.58) ligaments. CONCLUSION: Magnetic resonance imaging of the pelvis allowed precise identification of the main muscular and ligamentous pelvic floor structures in most individuals, whereas interobserver agreement was considered good.