Gout is an arthritis characterized by the deposition of sodium monoacid crystals in the synovial membrane, articular cartilage, and periarticular tissues that leads to an inflamatory process. In most cases, the diagnosis is established by clinical criteria and analysis of the synovial fluid for MSU crystals. However, gout may manifest in atypical ways and make diagnosis difficult. In these situations, imaging studies play a fundamental role in helping to confirm the diagnosis or even exclude other differential diagnoses. Conventional radiography is still the most commonly used method in the follow-up of these patients, but it is a very insensitive test, because it only detects late changes. In recent years, advances in imaging methods have emerged in relation to gout. Ultrasound has proven to be a highly accurate test in the diagnosis of gout, identifying MSU deposits in articular cartilage and periarticular tissues, and detecting and characterizing tophi, tendinopathies, and tophi enthesopathies. Computed tomography is an excellent exam for the detection of bone erosions and evaluation of spinal involvement. Dual-energy computed tomography, a new method that provides information on the chemical composition of tissues, allows identification of MSU deposits with high accuracy. MRI can be useful in the evaluation of deep tissues not accessible by ultrasound. In addition to diagnosis, with the emergence of drugs that aim to reduce the tophaceous burden, imaging examinations become a useful tool in the follow-up treatment of gout patients.

Introduction: Stenoses in the path of arteriovenous fistulas (AVF) for hemodialysis are a very prevalent problem and there is long experience in their treatment by percutaneous angioplasty (PTA). These procedures, however, involve non-negligible equipment requirements, exposure to radiation and intravenous contrast that are not beneficial for the patient and make their performance more complex. This study reviews our initial experience with Doppler ultrasound-guided angioplasty. Methods: Prospective cohort of patients with native AVF dysfunction due to significant venous stenosis treated by Doppler echo-guided PTA. AVF puncture, lesion catheterization, balloon localization and inflation, and outcome verification were performed under ultrasound guidance. Only one fistulography was performed before and another one after dilatation. As a control, the cases performed during the same period by the usual angiographic method were also collected. Results: Between February 2015 and September 2018, 51 PTAs were performed on native AVF, of which 27 were echogenic (mean age, 65.3 years; 63% male). The technical success rate was 96%. In 26% of cases, PTA was repeated due to residual stenosis after angiographic imaging. There were 7.3% periprocedural complications. 92% of the AVFs were punctured at 24 hours. Primary patency at 1 month, 6 months and 1 year was 100%, 64.8% and 43.6%, and assisted patency was 100%, 87.2% and 74.8%. There were no significant differences in immediate or late results with respect to angiographically guided AVF angioplasty. Conclusions: AVF-PTA can be performed safely and effectively guided by Doppler ultrasound, which simplifies the logistics required for its performance, although we still need to improve the capacity for early verification of the result with this imaging technique.

Imaging technology plays a key role in guiding endovascular treatment of aortic aneurysm, especially in the complex thoracoabdominal aorta. The combination of high quality images with a sterile and functional environment in the surgical suite can reduce contrast and radiation exposure for both patient and operator, in addition to better outcomes. This presentation aims to describe the current use of this technique, combining angiotomography and intraoperative cone beam computed tomography, image “fusion” and intravascular ultrasound, to guide procedures and thus improve the intraoperative success rate and reduce the need for reoperation. On the other hand, a procedure is described to create customized 3D templates with the high-definition images of the patient’s arterial anatomy, which serve as specific guides for making fenestrated stents in the operating room. These customized fenestration templates could expand the number of patients with complex aneurysms treated minimally invasively.

Introduction: Chest trauma has a high incidence and pneumothorax is the most frequent finding. The literature is scarce on what to do with asymptomatic patients with pneumothorax due to penetrating chest trauma. The aim of this study was to evaluate what are the findings of the control radiography of patients with penetrating chest trauma who are not initially taken to surgery, and their usefulness in determining the need for further treatment. Methods: A retrospective cohort study was performed, including patients older than 15 years who were admitted for penetrating chest trauma between January 2015 and December 2017 and who did not require initial surgical management. We analyzed the results of chest radiography, the time of its acquisition, and the behavior decided according to the findings in patients initially left under observation. Results: A total of 1,554 patients were included, whose average age was 30 years, 92.5% were male and 97% had a sharp weapon wound. Of these, 186 (51.5%) had no alterations in their initial X-ray, 142 had pneumothorax less than 30% and 33 had pneumothorax greater than 30 %, hemopneumothorax or hemothorax. Closed thoracostomy was required as the final procedure in 78 cases, sternotomy or thoracotomy in 2 cases and discharged in 281. Conclusion: In asymptomatic patients with small or moderate pneumothorax and no other significant lesions, longer observation times, radiographs and closed thoracostomy may be unnecessary.

Objective: To evaluate the clinical and radiographic results and complications of arthroscopic subcapital realignment osteotomy for the treatment of chronic and stable proximal femoral epiphysiolysis (PFE) in an initial series of patients. According to the literature review, the study presents the first description of an arthroscopic technique of this type of osteotomy. Methods: Between June 2012 and December 2014, seven patients underwent arthroscopic subcapital realignment osteotomy for the treatment of chronic, stable PFE. The mean age of the patients was 11 years and four months. Minimum follow-up ranged from 6 to 36 months (mean, 16.5 months). Patients were clinically evaluated according to the Harris Hip Score modified by Byrd and radiographically according to Southwick’s quantitative classification and the epiphyseal-diaphyseal angle. Postoperative complications were analyzed. Results: With regard to the evaluation of the Harris Hip Score Modified by Byrd clinical score, a preoperative mean of 35.8 points and a postoperative mean of 97.5 points were observed (p < 0.05). Radiographically, five patients were classified as Southwick grade II and two as grade III. A mean correction of the epiphyseal-diaphyseal angle of 40° was observed. There were no immediate postoperative complications. One patient developed avascular necrosis of the femoral head, without collapse or chondrolysis at the last follow-up (22 months). Conclusion: The arthroscopic technique presented by the authors for the treatment of chronic, stable PFE resulted in clinical and radiographic improvement of the patients in this initial series.

This study uses the opening of the new Mass Rapid Transit (MRT) in stages between 2010 and 2012 in Singapore as the exogenous event to empirically test the impact of the new Circle Line (CL) on housing wealth. Applying a "differences-in-differences" approach to the non-landed private housing transaction data covering the period from 2009 to 2013, we find that the average housing prices increase by 1.6% in the post-opening of the CL. We find significant capitalization of the new CL into housing prices, especially households living within a 400-meter radius (the treatment zone) from the closest MRT stations on the CL. The treatment effects that are measured by the "marginal willingness to pay" for houses located within the treatment zone is 13.2% relative to houses located outside the treatment zone. The new CL opening creates an estimated S$1.23 billion housing wealth effects for households living in close proximity to the CL MRT stations. However, we do not find significant "anticipative" effects on house prices in the six-month window prior to the opening of CL. The strongest treatment effect is found after the opening of the phase 1 of CL, and the treatment intensity declines in phases 2 and 3 of the CL opening.