RESUMO
BACKGROUND: A study was undertaken to evaluate the clinical impact of endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) in patients with mediastinal masses suspected of malignancy. METHODS: From April 1993 to December 1999, 84 patients were referred for EUS-FNA. In all patients CT scanning had shown a lesion of the mediastinum suspected of malignancy located adjacent to the oesophagus. In order to evaluate the clinical impact of EUS-FNA, the history of each patient up to referral for EUS-FNA was reviewed. A board of thoracic specialists was asked to decide the further course of the patient if EUS-FNA had not been available, and this diagnostic strategy was compared with the actual clinical course after EUS-FNA. RESULTS: For the 79 patients in whom sufficient verification was obtained, EUS-FNA had a sensitivity of 92%, specificity of 100%, PPV of 100%, NPV of 80%, and an accuracy of 94% for cancer of the mediastinum. In 18 of 37 patients (49%) a thoracotomy/thoracoscopy was avoided as a result of EUS-FNA, and in 28 of 41 patients (68%) a mediastinoscopy was avoided. The direct result of the cytological diagnosis obtained by EUS-FNA was that a final diagnosis of small cell lung cancer was made in eight patients resulting in referral for chemotherapy, and in another three patients with benign disease specific treatment could be initiated (sarcoidosis, mediastinal abscess, and leiomyoma of the oesophagus). CONCLUSIONS: EUS-FNA is a safe and sensitive minimally invasive method for evaluating patients with a solid lesion of the mediastinum suspected by CT scanning. EUS-FNA has a significant impact on patient management and should be considered for diagnosing the spread of cancer to the mediastinum in patients with lung cancer considered for surgery, as well as for the primary diagnosis of solid lesions located in the mediastinum adjacent to the oesophagus.
Assuntos
Biópsia por Agulha/métodos , Endossonografia/métodos , Neoplasias do Mediastino/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de IntervençãoRESUMO
A rare type of coronary arteriovenous fistula with multiple supplying vessels from both coronary arteries and draining into the pulmonary artery was found in a 52-year-old woman with angina pectoris. The fistula was successfully closed by division of the vessels draining into the pulmonary artery.
Assuntos
Fístula Arteriovenosa/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Artéria Pulmonar/anormalidades , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/fisiopatologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/fisiopatologia , Doença Crônica , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Diagnóstico Diferencial , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
To evaluate the influence of complete coronary revascularization after coronary artery bypass grafting (CABG) on long-term survival, we reviewed the records, including reports of coronary angiography, of 198 patients (25 women). Coronary artery bypass grafting was performed in the period 1973-1982, when the patients' mean age was 52.5 years. No significant (p < 0.05) difference in survival in the first 15 postoperative years was found between the patients judged to have complete revascularization at coronary angiography 6 months after CABG and the general Danish population. Complete revascularization by extensive grafting should improve survival of patients treated for angina. If the revascularization remains complete at coronary angiography assessment 6 months postoperatively, the 15-year survival rate can be expected to equal that in the general population.
Assuntos
Angina Pectoris/mortalidade , Angina Pectoris/cirurgia , Ponte de Artéria Coronária/mortalidade , Análise Atuarial , Angina Pectoris/diagnóstico por imagem , Estudos de Casos e Controles , Angiografia Coronária , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Taxa de Sobrevida , Fatores de TempoRESUMO
STUDY OBJECTIVE: The study details our preliminary experience with endoscopic ultrasonography (EUS) guided fine-needle aspiration biopsy (FNAB) of mediastinal masses suspected of malignancy. DESIGN: Prospective uncontrolled study. PATIENTS: Nine patients had lesions suspected of malignancy ranging from 1 to 9 cm in diameter in various locations of the mediastinum. INTERVENTIONS: The EUS examination was performed with a gastroscope (Hitachi/Pentax FG-32 UA) equipped with an adjustable 5- or 7.5-MHz curved array ultrasonic transducer. The scanning plane is in the long axis of the endoscope allowing endosonographically guided biopsy to be performed. A 21-gauge (0.8 mm), full-length steel needle housed in a biopsy handle (type: Hancke/Vilmann; GIP-Medizin Technik; Grassau, Germany) was used for the biopsies. RESULTS: Nine patients had biopsy specimens taken from 13 lesions. The total number of needle passes was 18 (range, 1 to 3; median, 1.4). The cytologic diagnosis was conclusive for cancer in ten lesions and consistent with a benign lesion in three lesions. All ten malignant diagnoses and two benign diagnoses were confirmed either by operation or follow-up. In the last patient with lung cancer, a final diagnosis of the EUS-guided biopsy of an enlarged lymph node could not be obtained. No false-positive or negative biopsy diagnoses were recorded. The biopsy procedure was well tolerated by all patients, and there were no complications. CONCLUSIONS: EUS-guided aspiration biopsy is a significant advance in the differentiation between malignant and benign lesions of the mediastinum carrying a high diagnostic potential.
Assuntos
Biópsia por Agulha , Endoscopia , Neoplasias do Mediastino/diagnóstico , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/instrumentação , Biópsia por Agulha/métodos , Endoscópios , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia de Intervenção/instrumentaçãoRESUMO
A method of endoscopic ultrasonography (EUS) with guided needle aspiration biopsy for conclusive diagnosis of a mediastinal mass lesions is described. The technique might prove useful for diagnosis of solid mass lesions in the mediastinum including diagnosis of lymph nodes for preoperative staging of lung cancer.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Biópsia por Agulha , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Ultrassonografia de Intervenção , Biópsia por Agulha/instrumentação , Desenho de Equipamento , Feminino , Gastroscópios , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Mediastinoscópios , Pessoa de Meia-Idade , Invasividade Neoplásica , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção/instrumentaçãoRESUMO
This study describes the influence of complete revascularization on the long term survival of patients following coronary artery bypass surgery. The patient population consists of 100 consecutive patients discharged from our department after undergoing a coronary bypass operation between November 1973 and July 1978. Patients who survived less than 30 days postoperatively are excluded from the study. The patient population consists of 87 males and 13 females. Mean age was 52.2 years at time of surgery. The rate of revascularization was estimated by coronary angiography, performed between one and 34 months postoperatively, in contrast to other similar studies found in the literature, where such estimation was performed peroperatively. Twenty-five of 86 patients were completely revascularized at postoperative angiographic estimation. Long term survival for the patient population and for the group of completely revascularized patients were compared to the expected survival of the Danish background population (comparable age and sex). Long term survival for the patient population as a whole was similar to that found in similar studies. There was an expected increased mortality compared to the Danish background population.
Assuntos
Ponte de Artéria Coronária/mortalidade , Adulto , Dinamarca , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Prognóstico , Qualidade de Vida , Reoperação , Estudos Retrospectivos , Fatores de TempoRESUMO
Lymphangioleiomyomatosis (LAM) is a rare disease, which only affects women of childbearing age. A case of LAM in a 36-year-old woman is presented. Patho-anatomical findings are smooth muscle hyperplasia leading to obstruction of lymphatics (possibly resulting in chylothorax), blood vessels (possibly resulting in haemoptysis) and bronchi (possibly resulting in emphysema and pneumothorax). High resolution computed tomography (HRCT) of the chest can show the typical multiple small cysts and bullous emphysema distributed diffusely throughout both lungs together with interstitial fibrosis. Treatment of the disease aims at an inhibition of the presumed growth-promoting effect of oestrogen on the smooth muscle cells. However, progression is often seen in spite of treatment.
Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Linfangioleiomiomatose/diagnóstico por imagem , Adulto , Feminino , Humanos , Neoplasias Pulmonares/patologia , Linfangioleiomiomatose/patologia , Tomografia Computadorizada por Raios XRESUMO
To evaluate the reliability of diagnosing type of bladder suspension defect in incontinent women by means of voiding colpo-cysto-urethrography (CCU), 93 CCU-series with exposures at rest, coughing, withholding and voiding were diagnosed. Three senior and one junior radiologists, a gynecologist and a urologist diagnosed the CCU-series twice with 3-6 months interval. The main diagnostic possibilities were anterior bladder suspension defects, posterior defects and normal, which were in accordance with general practice of choosing an abdominal suspension operation for the anterior suspension defects and a vaginal operation for the posterior defects. The intra-observer agreement varied between 99% and 72%, i.e. 1/5 to 1/4 of the patients changed from one main diagnostic group to another at the two examinations. The inter-observer agreement varied between 43% and 60%. Information of clinical patient data, given to the two clinicians, did not change their CCU-diagnoses significantly. We concluded, that CCU should not be recommended as a routine for evaluation of type of suspension defect since the intra-inter-observer variation was around 25% and 50% respectively. CCU might still be useful preoperatively in selected cases, since it gives an excellent visualisation of bladder base anatomy.
Assuntos
Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Incontinência Urinária por Estresse/diagnóstico por imagem , Feminino , Humanos , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos Testes , Vagina/diagnóstico por imagemRESUMO
We describe our experience from the first 30 patients treated with percutaneous transluminal coronary angioplasty (PTCA) in the Cardiologic Department P, Gentofte Hospital. The main purpose was to evaluate the value of thallium scintigraphy performed before and three months after PTCA. After PTCA, 23 (77%) had no angina and 22 (73%) had normal exercise-ECG. On the basis of the scintigraphies before PTCA, the patients were divided into two groups: In group 1, five had normal scintigraphy and 14 reversible perfusion defects only. In group 2, all 11 patients had both persistent and reversible defects. In patients without persistent defects, significantly more were free from angina. No difference was observed between group 1 and 2 in percentage stenosis of the vessel or in reduction of the diameter. Significant reduction in the extent of reversible perfusion defects after PTCA was observed in both groups and also in the extent of persistent defects in group 2. In about 1/3 of the patients, the changes in percentage stenosis after PTCA and in the perfusion as judged by the scintigraphies differed. Therefore, as the two methods supplement each other, the main conclusions are: 1) Evaluation of the revascularization procedure is more reliable if a scintigraphy is obtained both before and after PTCA than if only coronary arteriography is performed. 2) Scintigraphy alone suffices for the three-month follow-up examination, partly because it gives better information about the myocardial perfusion than does the arteriography, partly because scintigraphy is a noninvasive procedure.
Assuntos
Angioplastia Coronária com Balão , Coração/diagnóstico por imagem , Radioisótopos de Tálio , Adulto , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Revascularização Miocárdica , CintilografiaRESUMO
A statistical model based on the method of variance components was applied to obtain confidence statements for single and repeat determinations of left ventricular ejection fraction by radionuclide techniques. With this approach variance caused by individual factors in the measurement procedure is estimated to allow calculation of confidence intervals based on single measurements and the detection limits for changes. Six study groups made up of a total of 143 subjects were examined by both multigated equilibrium and first pass imaging. Under favourable conditions (with an updated gamma camera and experienced observer) the 95% confidence interval with a single measurement of left ventricular ejection fraction by equilibrium imaging was +/- 3 ejection fraction units, compared with +/- 6 units with the first pass technique (one ejection fraction unit = 1/100 of the possible values from 0.00 to 1.00). The minimal significant changes (at the 5% level) in measured equilibrium left ventricular ejection fraction at intervals of 15 min, 3 days, 1, 3, and 4 weeks were +/- 4, +/- 4, +/- 5, +/- 5, and +/- 6 units, respectively. The corresponding minimal detectable changes in a subject's "true" left ventricular ejection fraction for the same intervals were +/- 7, +/- 7, +/- 10, +/- 10, and +/- 12 units respectively. With first pass imaging, only average values for the variation at repeat determination could be calculated. The minimal significant change in measured first pass left ventricular ejection fraction was +/- 7 units, and the minimal detectable change in "true" left ventricular ejection fraction was +/- 14 units. Measurements of left ventricular ejection fraction by equilibrium technique were generally more reproducible than first pass determinations because the variability caused by study acquisition, observer analysis, and residual errors was smaller. The method of variance components appears to be well suited to the evaluation of quantitative biological measurements in clinical use. The popularity of established procedures may obscure the lack of basic information about method evaluation.
Assuntos
Cardiopatias/diagnóstico por imagem , Coração/diagnóstico por imagem , Volume Sistólico , Adulto , Idoso , Cardiopatias/fisiopatologia , Humanos , Métodos , Pessoa de Meia-Idade , Cintilografia , Valores de Referência , Estatística como Assunto , Fatores de TempoRESUMO
A new noninvasive procedure for quantitation of cardiac valve regurgitation was evaluated using a combination of first pass and gated equilibrium radionuclide cardiography in 38 subjects with and without cardiac valve disease. Left-sided cardiac catheterization was performed to determine the severity of mitral incompetence and aortic regurgitation semiquantitatively. In healthy subjects and in patients without valve disease, stroke volumes were nearly identical with the two methods and the correlation was high (r = 0.98 [p less than 0.001]). The mean regurgitation fraction was 13% in patients with mild mitral incompetence and 2+ aortic regurgitation, 37% in patients with moderate mitral incompetence and 3+ aortic regurgitation and 57% in patients with severe mitral incompetence and 4+ aortic regurgitation. These findings suggest that combined first pass and gated equilibrium radionuclide cardiography, being insensitive to intracardiac shunts and right-sided valve disorders, constitutes a valid noninvasive technique for quantitation of left-sided cardiac valve regurgitation.
Assuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Volume Sistólico , Adulto , Idoso , Angiocardiografia , Insuficiência da Valva Aórtica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Cateterismo Cardíaco , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , CintilografiaRESUMO
The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements, r = 0.93 (p less than 0.001). LVEF determined by multigated radionuclide cardiography was, however, significantly lower than when measured by cardioangiography, the mean difference being 6 per cent (p less than 0.001). These findings suggest that radionuclide determinations of SV and LVEF are reliable. The discrepancy between the non-invasive and invasive LVEF values raises the question, whether LVEF is overestimated by cardioangiography or underestimated by radionuclide cardiography.
Assuntos
Angiocardiografia , Coração/diagnóstico por imagem , Volume Sistólico , Adulto , Idoso , Cateterismo Cardíaco , Débito Cardíaco , Técnica de Diluição de Corante , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Cintilografia , TermodiluiçãoRESUMO
A 40-year old male patient with a mild, rather diffuse hypertrophic cardiomyopathy (HCM) developed a marked apical hypertrophy of the left ventricle during nine years of observation. The apical HCM showed a characteristic "ace of spades" diastolic configuration on the left ventriculogram. There was no change in the patient's symptoms or haemodynamics. The ECG showed constantly inverted T-waves whereas the precordial QRS amplitude and the corrected QT-interval increased during the observation period. Previous studies have proposed that abortive forms of the apical HCM exist that might become complete later. The present case demonstrates that such a morphological change can take place and that the clinical and haemodynamic picture can be unaffected by the progression of the left ventricular hypertrophy.
Assuntos
Cardiomiopatia Hipertrófica/etiologia , Adulto , Angiografia , Cateterismo Cardíaco , Cardiomegalia/complicações , Cardiomiopatia Hipertrófica/classificação , Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/fisiopatologia , Ecocardiografia , Eletrocardiografia , Humanos , MasculinoRESUMO
A case of didelphic uterus, unilateral atretic vagina with a small communication and a right-sided hypoplastic kidney is presented and illustrated by 'fistulography' and HSG. When a communication between the atretic and the normal vagina is present, the symptoms are often vague, clinically puzzling and can easily be misinterpreted. Because of the close relationship between the development of the urinary and the female genital tract, concomitant malformations are commonly found.
Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Adulto , Feminino , Humanos , Rim/anormalidades , Radiografia , Ureter/anormalidades , Útero/anormalidades , Vagina/anormalidadesRESUMO
In order to compare tolerability and radiographic properties of Omnipaque (iohexol) 350 mg I/ml and Urografin (sodium meglumine diatrizoate) 76% (370 mg I/ml) in left ventriculography and coronary arteriography, a randomised, double-blind parallel study was conducted. ECG, heart rate, blood pressure, cardiac output, oxygen saturation, CK-MB, adverse reactions and opacification were recorded. Twenty-five patients received Omnipaque and 24 Urografin and all patients were included in the final material. Omnipaque was found to have less influence on haemodynamics than Urografin. Few adverse reactions were encountered in the entire study, but fewer after injections of Omnipaque than after Urografin. Equally good opacification was demonstrated for both media. Omnipaque was found well suited for cardioangiography and superior to standard ionic media.
Assuntos
Angiografia Coronária , Diatrizoato de Meglumina , Diatrizoato , Ventrículos do Coração/diagnóstico por imagem , Iodobenzoatos , Ácidos Tri-Iodobenzoicos , Adulto , Pressão Sanguínea/efeitos dos fármacos , Ensaios Clínicos como Assunto , Diatrizoato/análogos & derivados , Diatrizoato de Meglumina/farmacologia , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Ventrículos do Coração/efeitos dos fármacos , Humanos , Iodobenzoatos/farmacologia , Iohexol , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Ácidos Tri-Iodobenzoicos/farmacologiaRESUMO
In a prospective study, forty-one patients underwent myocardial imaging using 201-thallium (201 Tl) scintigraphy before and 6 months after coronary artery bypass grafting (CABG). The results were compared with the findings at coronary arteriography performed at the same time. 201 Tl was injected at peak exercise level performing an exercise scintigram. A thallium image equivalent to a redistribution scan was obtained at rest approximately 4 h after the injection of 201 Tl. The overall angiographic patency rate was 0.77. Postoperative myocardial perfusion was improved in 26 patients (88%) having 72 of 83 grafts patent (patency rate 0.87). New perfusion defects or unchanged ischaemic patterns were found in 5 patients, who had 2 of 13 grafts patent (graft patency 0.15). Estimation of the graft-status by 201Tl-scintigraphy showed a sensitivity, specificity, and predictive value of a positive and negative result of 0.71, 0.94, 0.79 and 0.91, respectively, using angiographic findings as a reference. It is concluded, that comparison between preoperative and postoperative 201Tl imaging of the myocardium at exercise and rest provides useful information on graft patency after CABG. The procedure is superior at exercise and rest provides useful information on graft patency after CABG. The procedure is superior to graft patency estimation based on resting--or postoperative scintigrams only.