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INTRODUCTION: Venous thromboemboli and bleeding are the complications that threaten the graft and patient's life in the early postoperative period after cadaveric renal transplantation. For this reason, heparin administration after renal transplantation should be administered carefully. The aim of this study was to evaluate the necessity for heparinization after cadaveric renal transplantation. METHODS: Between March 2009 and October 2010, we formed 2 study groups among 50 recipients who underwent either cadaveric (n = 25) or living donor transplantations (n = 25). We did not observe any risk factors for thromboembolism while group 1 did not undergo heparinization, group 2 received a prophylactic dose of low-molecular weight heparin for 1 week. Doppler ultrasonography (USG) was performed between postoperative 24-48 hours to examine the transplanted kidney vessels, and in one group 1 case for a bilateral lower extremity venous system examination. We were also compared postoperative thromboembolic and hemorrhagic complications, lymphorrhagia, and serum creatinine levels. RESULTS: The female/male ratios in group 1 and 2 were 14/11 and 8/17 with mean ages of 36.7 (range, 17-51) and 35.9 (range, 17-59) years, respectively. The mean preoperative serum creatinine levels were 7.9 ± 2.9 mg/dL and 6.8 ± 2.4 mg/dL, and at postoperative week 1, they were 5.1 ± 4.3 mg/dL and 1.2 ± 0.5 mg/dL, respectively. We did not encounter any partial or total thrombus upon doppler USG studies for renal and lower extremity venous systems. No clinical symptoms of pulmonary emboli were detected in any patients. Only 1 subject group 2 experienced massive postoperative bleeding. CONCLUSION: Herein, we have reported that, except for the patients with risk factors for venous thromboemboli, heparinization was not necessary in the early postoperative period and did not add benefits to outcomes of cadaveric renal transplant recipients.
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Anticoagulantes/administração & dosagem , Enoxaparina/administração & dosagem , Transplante de Rim , Doadores de Tecidos , Tromboembolia Venosa/prevenção & controle , Adolescente , Adulto , Anticoagulantes/efeitos adversos , Cadáver , Enoxaparina/efeitos adversos , Feminino , Humanos , Transplante de Rim/efeitos adversos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Hemorragia Pós-Operatória/etiologia , Medição de Risco , Fatores de Risco , Meias de Compressão , Fatores de Tempo , Resultado do Tratamento , Turquia , Ultrassonografia Doppler , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/etiologia , Adulto JovemRESUMO
PURPOSE: This study was done to determine mammographic, sonographic and magnetic resonance imaging (MRI) appearances of idiopathic granulomatous mastitis, an entity clinically and radiographically resembling breast carcinoma. MATERIALS AND METHODS: A total of 36 women (mean age 37 years, range 21-51 years) with histopathological diagnosis of idiopathic granulomatous mastitis were enrolled in the study. The Breast Imaging Reporting and Data System (BI-RADS) was used to categorise the levels of suspicion of malignancy on mammography. Mammography findings were classified also according to density, margin, architectural distortion and number of lesions. Lesions were classified according to number, heterogeneity and echogenic features on sonography. Dynamic MRI findings were categorised as enhancing mass lesion, nonmass lesion or both mass lesions and nonmass lesions together. Subclassification criteria for MRI included lesion shape, margin, border and internal enhancement pattern. RESULTS: The most common mammographic finding was either focal or diffuse asymmetric density (n=15, 44%). The most common sonographic findings were solitary or multiple circumscribed heterogeneous hypoechoic masses (n=19, 52%). Among other sonographic findings were diffuse abscess formation with fistulae and massive parenchymal heterogeneity and hypoechogenicity in 12 (33%) and five (13%) women, respectively. On MRI, enhancing mass lesions were detected in 24 patients, whereas enhancing nonmass lesions were observed in 28. Sixteen patients had both enhancing mass lesions and nonmass lesions together. CONCLUSIONS: Although not characteristic for this entity, asymmetric density on mammography, solitary or multiple clustered heterogeneous hypoechogenicity with a tubular configuration on sonography and round, smooth-contoured masslike lesion with rim enhancement or segmental non-mass-like lesion on MRI are the most common features of the disease.
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Mastite Granulomatosa/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia MamáriaRESUMO
OBJECTIVES: This study investigated whether diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values provide specific information that allows the diagnosis of solid or predominantly solid gynaecological adnexial lesions, especially whether they can discriminate benign and malignant lesions. METHODS: DWI was performed in 37 patients with histologically proven solid or predominantly solid adnexial lesions (22 malignant and 15 benign neoplasms). The lesions in our data set were divided into two groups, all adnexial lesions or lesions of ovarian origin, for evaluation. The areas of the highest signal intensity on DWI (b = 800 s mm(-2)) and the lowest ADC values within the lesions were evaluated. RESULTS: On DWI, high signal intensity was observed more often in malignant than in benign lesions (p<0.0001). There was no significant difference between the ADC values of the malignant and benign lesions in either the adnexial (0.88±0.16 vs 0.84±0.42; p = 0.96) or the ovarian (0.85±0.14 vs 1.05±0.2; p = 0.133) lesions. When signal intensities on DWI were compared, however, malignant lesions had higher values than the benign lesions in both the adnexial (0.69±0.21 vs 0.29±0.13; p<0.0001) and the ovarian lesions (0.75±0.14 vs 0.37±0.24; p = 0.003). CONCLUSION: On DWI, high signal intensity was observed more frequently with the malignant lesions.
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Adenocarcinoma/diagnóstico , Doenças dos Anexos/diagnóstico , Imagem de Difusão por Ressonância Magnética/normas , Tumor de Células da Granulosa/diagnóstico , Neoplasias Ovarianas/diagnóstico , Adenocarcinoma/patologia , Doenças dos Anexos/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Tumor de Células da Granulosa/patologia , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/secundário , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Adulto JovemRESUMO
Adrenal carcinoma is a rare tumor and with metastasis usually in lungs, lymph nodes, liver, and bones. However, intracaval invasion extending into the right atrium is very rare. The surgical approach to adrenal tumor extending into the vena cava is challenging. The optimal surgical approach of tumor with inferior vena cava extension depends on the level of vena cava involvement. This article reports a case of malignant pheochromocytoma extending into the cavoatrial junction in a young man.
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Neoplasias das Glândulas Suprarrenais/patologia , Átrios do Coração , Neoplasias Cardíacas/secundário , Feocromocitoma/patologia , Veia Cava Inferior , Adolescente , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Ponte Cardiopulmonar/métodos , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Invasividade Neoplásica , Feocromocitoma/cirurgia , Resultado do Tratamento , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgiaAssuntos
Cistos/diagnóstico por imagem , Granuloma de Corpo Estranho/diagnóstico por imagem , Mediastino/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Tampões de Gaze Cirúrgicos/efeitos adversos , Adulto , Meios de Contraste , Cistos/cirurgia , Diagnóstico Diferencial , Granuloma de Corpo Estranho/cirurgia , Humanos , Masculino , Mediastino/cirurgia , Mielografia , Complicações Pós-Operatórias/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: We aimed to evaluate the accuracy of ultrasonography, radioactive iodine uptake and serum thyroid-stimulating hormone level in predicting the volume of remnant thyroid gland. METHODS: Sixty-six thyroidectomy patients were divided into two groups according to their functional status, i.e. those operated upon for nontoxic multinodular goitre (group one) and those operated upon for hyperthyroidism (group two). Ultrasonography, radioactive iodine uptake and thyroid-stimulating hormone assay were performed in all patients during the first post-operative month. The two groups were subdivided according to the amount of remnant thyroid volume detected on ultrasonography: <2 ml, 2-5 ml and >5 ml. RESULTS: The remnant thyroid volume was positively correlated with the radioactive iodine uptake (rs = 0.684, p = 0.0001). The increase in remnant thyroid tissue radioactive iodine uptake was significantly greater in the patients operated upon for hyperthyroidism compared with those operated upon for nontoxic multinodular goitre (p = 0.0001). There was a negative correlation between remnant thyroid volume and post-operative serum thyroid-stimulating hormone level (rs = -0.865, p = 0.0001) and between remnant thyroid tissue radioactive iodine uptake and post-operative serum thyroid-stimulating hormone level (rs = -0.682, p = 0.0001). CONCLUSION: Ultrasonography is a more accurate measure of remnant thyroid volume than radioactive iodine uptake in patients operated upon for hyperthyroidism, compared with those operated upon for nontoxic multinodular goitre.
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Radioisótopos do Iodo , Glândula Tireoide , Tireotropina/sangue , Adolescente , Adulto , Idoso , Feminino , Bócio Nodular/cirurgia , Humanos , Hipertireoidismo/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Estudos Prospectivos , Cintilografia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , UltrassonografiaRESUMO
BACKGROUND: We compared the diagnostic values of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and ultrasonography (USG)-guided fine-needle aspiration biopsy (FNAB) in the detection of thyroid carcinoma associated with multinodular goiter. METHODS: USG-guided FNAB and DCE-MRI were performed consecutively on 26 patients who had multinodular goiter with dominant nodules and clinical suspicion of malignancy. DCE-MRI findings, cytodiagnosis, and final histopathologic results were correlated. We compared the sensitivity, specificity, diagnostic accuracy, and positive (PPV) and negative predictive values (NPV) of DCE-MRI and USG-guided FNAB. RESULTS: Of 57 nodules in 26 patients, 16, 37, and 4 nodules showed delayed, plateau, and rapid washout patterns, respectively. Thyroid carcinoma was found in 8 patients (31%). Delayed washout pattern in a nodule was correlated with the histologic diagnosis of thyroid carcinoma (P < .001). None of the nodules with thyroid carcinoma had a plateau or rapid washout pattern. The sensitivity and NPV of DCE-MRI to diagnose thyroid carcinoma were greater when compared with those in USG-guided FNAB (100 vs 71.4%, and 100 vs 91.7%, respectively; P < .001). CONCLUSION: When other diagnostic methods are inconclusive, DCE-MRI is superior to USG-guided FNAB to exclude thyroid carcinoma in patients with multinodular goiter.
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Biópsia por Agulha Fina/métodos , Bócio Nodular/patologia , Imageamento por Ressonância Magnética , Neoplasias da Glândula Tireoide/patologia , Adulto , Biópsia por Agulha Fina/economia , Biópsia por Agulha Fina/normas , Custos e Análise de Custo , Diagnóstico Diferencial , Feminino , Bócio Nodular/diagnóstico por imagem , Bócio Nodular/cirurgia , Humanos , Imageamento por Ressonância Magnética/economia , Imageamento por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , UltrassonografiaRESUMO
BACKGROUND: Hypothyroidism is a risk factor for atherosclerotic cardiovascular disease. This study investigated the effects of L-thyroxine replacement therapy on lipid profile and endothelial function after thyroidectomy in patients with overt transient non-autoimmune hypothyroidism. METHODS: Twenty-two patients with non-toxic multinodular goitre treated by total or near-total thyroidectomy and 22 healthy individuals matched for age, sex and body mass index were studied. Lipid profile and endothelial function were determined in each patient at the euthyroid phase before thyroidectomy (stage 1), the hypothyroid phase 3 weeks after surgery (stage 2), and the euthyroid phase 3 months (stage 3) and 6 months (stage 4) after the start of thyroxine treatment. RESULTS: The lipid profile and endothelial function deteriorated between stage 1 and stages 2 and 3. Findings at stage 4 were similar to those at stage 1. There was a positive correlation between serum thyroid-stimulating hormone (TSH) and total cholesterol (r(s) = 0.588, P < 0.001), and a negative correlation between serum TSH and flow-mediated arterial dilatation (r(s) = 0.506, P < 0.001). Total cholesterol and TSH were independent determinants of endothelial function. CONCLUSION: A 3-week hypothyroid period after thyroidectomy led to a more atherogenic lipid profile and impaired endothelial function that persisted for at least 3 months.
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Colesterol/metabolismo , Bócio Nodular/tratamento farmacológico , Tireoidectomia/métodos , Tiroxina/uso terapêutico , Adulto , Endotélio Vascular/fisiopatologia , Feminino , Bócio Nodular/sangue , Bócio Nodular/fisiopatologia , Humanos , Hipocalcemia/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Tireotropina/metabolismoRESUMO
The aim of this study was to retrospectively evaluate 140 patients with severe (97 massive, 43 moderate) haemoptysis treated by bronchial artery embolisation. Between January 1997 and April 2005, 140 patients (120 males and 20 females, aged 23-71 years) with severe haemoptysis considered surgically inoperable because of limited pulmonary reserve were treated by embolisation. The cause of haemoptysis was tuberculosis in 136 patients and malignancy in four. Embolisation succeeded in controlling haemoptysis immediately after the intervention in 138 patients (98.5%) and at 1 month in 126 patients (90%). Severe haemoptysis recurred in 11 patients with prior massive haemoptysis and 3 patients with prior moderate haemoptysis in a mean time of 3.7 months (1-7 months) after the last intervention. The bleeding source was detected during angiography and embolised in 12 of these patients. Two patients with malignant tumour died because of abundant bleeding, following an asymptomatic period of 30 days. There were no procedure-related major complications. Bronchial artery embolisation is a safe and effective palliative treatment alternative in moderate and massive haemoptysis.
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Embolização Terapêutica/métodos , Hemoptise/terapia , Adulto , Idoso , Artérias Brônquicas/diagnóstico por imagem , Broncoscopia , Feminino , Hemoptise/diagnóstico por imagem , Hemoptise/etiologia , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose Pulmonar/complicaçõesRESUMO
OBJECTIVES: To evaluate the incidence and risk factors of recurrent laryngeal nerve palsy and hypoparathyroidism following thyroidectomy. DESIGN: Retrospective case-control study. SETTING: Tertiary clinic. PARTICIPANTS: From September 1990 to September 2005, 3250 consecutive patients who had a thyroidectomy for treatment of various thyroid diseases. MAIN OUTCOME MEASURES: The rates of nerve palsy and hypoparathyroidism were evaluated based on thyroid pathology, the choice of operative procedure, whether the nerve was identified, and the experience of the surgeon. RESULTS: Overall, the rate of nerve palsy was 1.8% and that of hypoparathyroidism was 6.6%. On univariate analysis the rates of complications were siginificantly higher in the patients who had an extended thyroidectomy, identification of the recurrent laryngeal nerve during surgery, repeat surgery and patients older than 50 years of age. Complications were no commoner in operations performed by trainees under supervision than experienced surgeons. On multivariate analysis extended thyroidectomy had a 12 fold (95% CI 1.7, 92) increased risk of nerve palsy. Repeat surgery had a 3 fold (95% CI 2.1, 4.7) increased risk of postoperative hypoparathyroidism. CONCLUSION: Extentended thyroidectomy and repeat surgery had a significant effect on the incidence of recurrent laryngeal nerve palsy and postoperative hyperparathyroidism respectively following thyroid surgery.
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Hipoparatireoidismo/etiologia , Tireoidectomia/efeitos adversos , Paralisia das Pregas Vocais/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Seguimentos , Humanos , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/epidemiologia , Incidência , Laringoscopia , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Doenças da Glândula Tireoide/cirurgia , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/epidemiologiaRESUMO
AIMS: We aimed to determine the risk factors for recurrence and to assess the complication rate associated with surgery for benign, recurrent goitre. METHODS: We studied 125 consecutive patients with recurrent goitre who underwent re-operative thyroid surgery (group one). Patients in the control group were randomly selected from those undergoing their first procedure during the same period (group two). Age, initial surgery, presence of multinodular goitre, presence of carcinoma in the resected thyroid tissue, interval between initial operation and re-operation, and complications were analysed and compared for the two groups. RESULTS: The mean age (+/- standard deviation) was found to be significantly greater in group one compared with group two. The mean age at the time of primary thyroid operation was found to be significantly less in group one compared with group two. The interval between the initial and the re-operative procedures was a mean of 15.8+/-eight years. Initial surgery was conservative. Papillary thyroid carcinoma was found in 14/125 (11 per cent) of group one patients. The incidence of complications was found to be significantly higher in group one compared with group two. CONCLUSION: The incidence of recurrent goitre has been directly related to conservative thyroid surgery and to the retention of large amounts of remnant tissue. To avoid recurrent goitre and possible re-operative complications, total or near-total thyroidectomy should be performed in all patients with bilateral, multinodular goitre, especially in endemic regions.