Inflammatory Modifications in Paranasal Sinuses and Ostiomeatal Complex Anatomical Variations in Jet Aircraft Pilots: A Computed Tomography Study.

Introduction Jet aircraft pilots are exposed to huge pressure variation during flight, which affect physiological functions as systems, such as the respiratory system. Objectives The objective of the present investigation was to evaluate inflammatory changes of paranasal sinuses of jet aircraft pilots before and after a jet aircraft training program, using multislice computed tomography (CT), in comparison with a group of nonairborne individuals with the same age, sex, and physical health conditions. A second objective of the present study was to assess the association between the ostiomeatal complex obstruction and its anatomical variations. Methods The study group consisted of 15 jet aircraft pilots participating in the training program. The control group consisted of 41 nonairborne young adults. The 15 fighter pilots were evaluated before initiating the training program and after their final approval for the presence of inflammatory paranasal sinus disease. The ostiomeatal complex anatomical variations and obstructions were analyzed in pilots after the training program. Results Jet aircraft pilots presented higher incidence of mucosal thickening in maxillary sinus and anterior ethmoid cells than controls. Prominent ethmoidal bulla showed significant association with obstruction of the osteomeatal complex. Conclusions Jet aircraft pilots present increased inflammatory disease when compared with nonairborne individuals. The presence of a prominent ethmoidal bulla is associated with ostiomeatal complex obstruction.

Maxillary sinus volumetric changes in jet aircraft pilots: A multislice computed tomography pilot study.

Purpose: This study evaluated maxillary sinus volume changes in military jet aircraft pilot candidates before and after the training program, in comparison with a control group, considering the effects of pressurization, altitude, and total flight hours, through multislice computed tomography. Materials and Methods: Fifteen fighter pilots were evaluated before initiating the training program and after the final approval. The control group consisted of 41 young adults who had not flown during their military career. The volumes of each maxillary sinus were measured individually before and at the end of the training program. Results: When comparing the initial and final volumes in the pilots, a statistically significant increase was observed both in the left and right maxillary sinuses. When evaluating the average total volume of the maxillary sinuses (i.e., the average volume of the right and left maxillary sinuses together), a significant increase in the volume of the maxillary sinuses was observed in the pilot group when compared to the control group. Conclusion: The maxillary sinus volumes in aircraft pilot candidates increased after the 8-month training program. This may be explained by changes in the gravitational force, the expansion of gas, and positive pressure from oxygen masks. This unprecedented investigation among pilots might lead to other investigations considering paranasal sinus alterations in this singular population.

Simplified PADUA Renal (SPARE) Nephrometry Scoring System: External Validation, Interobserver Variability, and Comparison with RENAL and PADUA in a Single-center Robotic Partial Nephrectomy Series.

BACKGROUND: The RENAL (radius [R], exophytic/endophytic [E], nearness to collecting system/sinus [N], anterior/posterior [A], and location relative to polar lines [L]) and the PADUA (preoperative aspects and dimensions used for an anatomical classification) scores help in quantifying tumor complexity. However, nephrometry scoring systems have low interobserver variability. To simplify and improve score reproducibility, a new Simplified PADUA Renal (SPARE) scoring system was introduced. OBJECTIVE: To externally validate the SPARE nephrometry scoring system and to determine its interobserver variability. DESIGN, SETTING, AND PARTICIPANTS: A total of 202 patients were included in the analysis. We performed a retrospective analysis of robot-assisted partial nephrectomy (RAPN) cases for a single renal mass performed at a single academic institution during the period 2008-2018. For each renal mass, PADUA, RENAL, and SPARE nephrometry scores were calculated. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Three urology residents (URs), two urology attendings (UAs), two radiology residents (RRs), and one radiology attending (RA) retrospectively reviewed computed tomography scans blinded to clinical outcomes. The accuracy of the SPARE nephrometry score in the prediction of any complication (Clavien grade ≥1) was compared with other scoring systems in a univariable and a multivariate fashion. The area under the curve (AUC) and kappa statistics were used to assess interobserver variability of the SPARE score. RESULTS AND LIMITATIONS: The SPARE score was not inferior to the PADUA and RENAL scores (AUC 0.61, 0.59, and 0.57, respectively, p = 0.43). Patients with intermediate to high SPARE scores had longer operative time (158 vs 135 min, p = 0.10) and a higher rate of complications (28% vs 14%, p = 0.012). Univariable analysis predicting overall complications showed that RRs performed slightly better than URs and UAs using the SPARE score. Interobserver agreement was 84% between an RA and an RR (kappa 0.42), 85% between an RA and a UA (kappa 0.39), and 85% between an RA and a UR (kappa 0.45). CONCLUSIONS: These findings confirm that the SPARE nephrometry scoring system is a reproducible and easy tool offering overall fair interobserver agreement regardless of years of training or type of practice, while maintaining the predictive capabilities of more established nephrometry scores. PATIENT SUMMARY: In this study, a novel and simple classification system was assessed using a sample of cases from our institution to define surgical complexity renal masses detected on radiological imaging. Our findings suggest that this tool can be useful in clinical practice to facilitate the characterization of renal masses and predict the complications of surgical treatment.

Impact of Perioperative Blood Transfusions on the Outcomes of Patients Undergoing Kidney Cancer Surgery: A Systematic Review and Pooled Analysis.

The aim of the present study is to systematically review current evidence regarding the association between perioperative blood transfusions (PBT) and oncological outcomes of patients with renal cell carcinoma undergoing nephrectomy procedures. A computerized bibliographic search was conducted to identify pertinent studies. The Population, Intervention, Comparator, Outcome (PICO) study design approach was used to define study eligibility according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. Only 7 studies were deemed fully eligible for analysis. Most series included both open and laparoscopic cases. The rate of PBT varied between 9.6% and 76.6%, and the median number of transfused units was 2 for most of the studies. At pooled analysis, a statistically significant association was found between PBT and disease recurrence (HR, 1.79; 95% CI, 1.32-2.41; P < .001), cancer-specific mortality (HR, 1.62; 95% CI, 1.29-2.05; P ≤ .001), and all-cause mortality (HR, 1.45; 95% CI, 1.25-1.69; P < .001). Current evidence suggests that indeed the use of PBT may be associated with worse oncologic outcomes in patients with renal cell carcinoma undergoing nephrectomy procedures. Although presents findings should be interpreted within the intrinsic limitations of this type of pooled analysis, they emphasize the need for evidence-based strategies to minimize the use of PBT during kidney cancer surgery.

Hemangioma mamário em mamografia de rastreamento: relato de caso / Breast hemangioma in screening mammography: case report

Hemangiomas são tumores vasculares benignos raros na mama. São de origem extraparenquimal e desenvolvem-se no tecido celular subcutâneo. O diagnóstico por exames de imagem pode ser difícil já que não apresentam características específicas, podendo ser confundidos com tumores malignos. Relatamos nesse artigo o caso de uma paciente portadora de hemangioma mamário em que a mamografia de rastreamento inicialmente demonstrou resultado inconclusivo, havendo necessidade de complementação diagnóstica com exame clínico e ultrassonografia para o laudo final de achados benignos (BI-RADS 2)

Hemangiomas are rare benign vascular tumors in the breast. They have extra parenchymal developing in the subcutaneous cellular tissue. Diagnosis by imaging exams can be difficult since this type of benign tumor does not have specific characteristics and can be confused with malignant tumors. We report in this article the case of a patient with breast hemangioma on screening mammography who initially had inconclusive result requiring clinical examination and ultrasound for the final report of benign findings (BI-RADS 2)

Rationale for Robotic-assisted Simple Prostatectomy for Benign Prostatic Obstruction.

Current evidence supports the role of robotic-assisted simple prostatectomy as safe and effective minimally invasive surgical treatment of benign prostatic obstruction.

Fratura de fêmur distal Salter-Harris tipo II por mecanismo de hiperextensão do membro inferior em atleta: relato de caso / Salter-Harris type II distal femur fracture by hyperextension mechanism of lower limb in athlete: case report

Apresentamos um caso de um adolescente de 14 anos, atleta da categoria sub-15 de um clube de futebol do Brasil, com diagnóstico de fratura de fêmur distal Salter-Harris tipo II por um mecanismo de hiperextensão do membro inferior. Foi optado por tratamento conservador com uso de órtese para imobilização e muletas para deambulação. O acompanhamento foi feito com 7, 21, 56 e 86 dias de evolução com o auxílio de tomografia computadorizada, ressonância magnética e radiografia simples de joelho. O atleta não apresentou nenhum sintoma ou incapacidade após os 90 dias de acompanhamento, mas foi verificada uma epifisiodese no exame de imagem. Apesar de ser uma fratura da placa de crescimento femoral distal comum em adolescentes entre 11 e 14 anos de idade por trauma direto ou por angulação do fêmur distal por um pé fixo ao solo que é golpeado pelo lado por outro individuo, não há relatos de fratura Salter-Harris tipo II por mecanismo de hiperextensão do membro inferior na literatura

We report a case of a 14-year-old athlete in the U-15 category of a soccer club in Brazil with a diagnosis of Salter-Harris type II distal femur fracture due to a hyperextension mechanism of the lower limb. Conservative treatment with bracing and crutches for ambulation was used. Follow-up was performed with 7, 21, 56 and 86 days of evolution with the aid of computed tomography, magnetic resonance and simple knee radiography. The athlete did not present any symptoms or disability after the 90 days of follow-up, but an epiphysiodesis was verified in the image exam. Despite being a common distal femoral growth plate fracture in adolescents between 11 and 14 years-old due to direct trauma or distal femur angulation by a foot fixed to the ground that is struck by the side by another individual, there are no reports of fracture Salter-Harris type II by mechanism of hyperextension of the lower limb in the literature