RESUMO
Aneurysm of the left sinus of Valsalva is an extremely rare entity. It may be asymptomatic and incidentally discovered, or may be symptomatic and manifest acutely with compression of adjacent cardiac structures. Encasement of the left main coronary artery by such an aneurysm is a recognized but infrequent complication that can lead to severe coronary insufficiency. Surgical decompression of the left main coronary artery is the standard treatment for such conditions. We describe a patient presenting with extrinsic compression of the left main coronary artery by a large unruptured aneurysm of the left sinus of Valsalva occurring 4 months after unsuccessful surgical repair. Since reoperation was considered high-risk for the patient, successful fractional flow reserve- and intravascular ultrasound-guided percutaneous treatment of the left main coronary artery was performed with implantation of one bare-metal stent.
Assuntos
Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Estenose Coronária/etiologia , Estenose Coronária/cirurgia , Seio Aórtico/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Radiografia , Seio Aórtico/diagnóstico por imagem , Resultado do TratamentoRESUMO
Abdominal fat accumulation is a major risk factor for cardiometabolic morbidity and mortality. The purpose of the study is to assess the possibility of developing accurate estimation equations based on body measurements to determine total abdominal (TFA), subcutaneous (SFA) and visceral fat area (VFA). Hungarian volunteers (n=198) aged between 20 and 81 years were enrolled in the study, which was conducted between July and November 2014. All persons underwent anthropometric measurements and computer tomographic (CT) scanning. Sex-specific multiple linear regression analyses were conducted in a subgroup of 98 participants to generate estimation models, then Bland-Altman's analyses were applied in the cross-validation group to compare their predictive efficiency. The variables best predicting VFA were hip circumference, calf circumference and waist-to-hip ratio (WHR) for males (R2=0.713; SEE=5602.1mm2) and sagittal abdominal diameter (SAD), WHR, thigh circumference and triceps skinfold for females (R2=0.845; SEE=3835.6mm2). The SFA prediction equation included SAD, thigh circumference and abdominal skinfold for males (R2=0.848; SEE=4124.1mm2), body mass index and thigh circumference for females (R2=0.861; SEE=5049.7mm2). Prediction accuracy was the highest in the case of TFA: hip circumference and WHR for males (R2=0.910; SEE=5637.2mm2), SAD, thigh circumference and abdominal skinfold for females (R2=0.915; SEE=6197.5mm2) were used in the equations. The results suggested that deviations in the predictions were independent of the amount of adipose tissue. Estimation of abdominal fat depots based on anthropometric traits could provide a cheap, reliable method in epidemiologic research and public health screening to evaluate the risk of cardiometabolic events.
Assuntos
Gordura Abdominal/anatomia & histologia , Adiposidade , Antropometria/métodos , Gordura Abdominal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Bioestatística , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/diagnóstico por imagem , Obesidade Abdominal/patologia , Fatores de Risco , Tomografia Computadorizada por Raios X , Relação Cintura-Quadril , Adulto JovemAssuntos
Eletrodos Implantados/efeitos adversos , Migração de Corpo Estranho/cirurgia , Mucosa Gástrica/lesões , Gastroscopia , Melena/etiologia , Marca-Passo Artificial , Idoso , Procedimentos Cirúrgicos Cardíacos , Remoção de Dispositivo/métodos , Humanos , Doença Iatrogênica , Masculino , Fatores de TempoRESUMO
The paleopathological analysis of a well-preserved young adult female skeleton from the AD 7-8th century (Avar Age) in Hungary revealed multiple lytic lesions in all of the thoracic and lumbar vertebral bodies. The lesions were characterized by smooth marginal zones and space-occupying mass appearance. The considerable loss of spongy bone in the thoracolumbar vertebrae resulted in angular deformity and fusion, characteristic of the healing stage of TB. Osteolytic lesions were also observed on the vertebral processes, ribs and sternum. On the endocranial surface, abnormal blood vessel impressions were revealed, indicating some kind of meningitis. The X-ray and CT analysis of the affected bones detected abnormal structures and cystic zones of destruction. The lesions were however not always bordered by areas of increased density, which is typical in cystic TB. Vertebral remains were also subjected to biomolecular analysis in two different laboratories, which attested the presence of Mycobacterium tuberculosis complex (MTBC) DNA and supported the paleopathological diagnosis of TB. Spoligotyping analysis confirmed the presence of MTBC DNA and more specifically an infection caused by bacteria belonging to the M. tuberculosis lineage. This case study provides new data for the paleoepidemiology of TB in this geographical area and historical period, and draws attention to the great variability of TB lesions in the human skeleton.
Assuntos
Tuberculose da Coluna Vertebral/patologia , Adulto , DNA Bacteriano/genética , Feminino , História Antiga , Humanos , Hungria , Mycobacterium tuberculosis/genética , Técnicas de Amplificação de Ácido Nucleico , Paleopatologia , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/genética , Tuberculose da Coluna Vertebral/história , Adulto JovemRESUMO
Authors analyse the value of intravenous pyelography, ultrasonography, computed tomography, angiography and fine needle aspiration biopsy in the detection, differentiation and staging of renal space-occupying lesions, on the basis of examinations performed in 158 patients, in comparison with results of surgery and/or clinical follow up. Their conclusion is that ultrasonography plays a major role in the detection and differentiation of these lesions, intravenous pyelography is only a complementary method, while computed tomography can provide diagnosis in cases with uncertain ultrasonographic findings. Staging has to be based on computed tomography. The role of angiography and fine needle aspiration biopsy is limited they need to be performed in a few selected cases only.
Assuntos
Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Adulto , Idoso , Angiografia , Biópsia por Agulha , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/patologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Hungria/epidemiologia , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia , UrografiaRESUMO
OBJECTIVE: To define whether volume of water, administered during water enema CT (WE-CT) for local staging of rectal cancer, may be reduced without compromising the diagnostic value of the examination. MATERIALS AND METHODS: 29 patients with rectum cancer underwent preoperative WE-CT. Contrast-enhanced CT (equilibrium phase) measurements were performed after i.v. injection of smooth muscle relaxant and rectal administration of 400-500 ml lukewarm tap water. Quality of the obtained scans was evaluated and the images were analyzed for depth of tumor invasion. Results of the CT examinations were compared to findings at surgery. RESULTS: Despite reduced dose of water enema, 19/29 examinations were of excellent quality, 6/29 good, and 4/29 poor, but still diagnostic. We achieved sensitivity (90.1), specificity (70.1) and accuracy (86.2) in differentiating tumors confined to the bowel wall from those extending beyond it. CONCLUSION: Large volume of water enema administered during CT examination of the rectum may cause complaints and increases the risk of complications. Our results prove that using lower amount of water does not impair the quality of examination and accuracy of local staging of rectum carcinomas.
Assuntos
Neoplasias Retais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Enema/efeitos adversos , Feminino , Humanos , Masculino , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/efeitos adversos , ÁguaRESUMO
This article demonstrates the usefulness of ultrasound (US)-guided core needle biopsy in the diagnosis of thoracic lesions. Between January 1997 and June 2000, 45 US-guided core needle biopsies were performed in the department of radiology. This method was chosen in every case when the lesion abutted the chest wall. Conventional histologic examinations supplemented by immunohistochemical methods were performed. The location and size of the mass, the number of samplings, the needle size, the histologic results, and any complications were recorded. Twenty-two lesions reached the anterior, six reached the lateral, and 14 reached the posterior chest wall. Biopsies were performed on three masses from the supraclavicular region. The mean diameter was 4.5 cm and the number of passes was 1.8; 18-G, 16-G, and 14-G needles were used in 41, two, and two cases, respectively. In 43 of the 45 cases (95.68%), an exact histologic diagnosis could be provided. In two cases, only necrotic tissue was seen in the biopsy sample. No major complications occurred. Minor complications, including pain and collaptiform weakness, were documented in four patients. Ultrasound-guided core needle biopsy of thoracic lesions is a safe, quick, and accurate method. For diagnosing thoracic lesions, a single sample with an 18-G biopsy needle is sufficient to achieve a final diagnosis when using appropriate histologic methods.
RESUMO
The authors review a case of a patient with spontaneous cervical hematoma without trauma. The similar cases of the international literature, the causes (local and systemic vascular disorders, inflammatory and neoplastic disease of the surrounding tissues) are summarized and the importance of the computerized tomography in connection with the described case is emphasized.
Assuntos
Hematoma/complicações , Insuficiência Respiratória/etiologia , Idoso , Feminino , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Pescoço/irrigação sanguínea , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Authors report about the role of contrast medium enhanced magnetic resonance imaging in diagnosis of breast diseases, and experiences with this method. The aim of the study was to determine the diagnostic accuracy of the method. The results was correlated with the histopathological findings, and compared to the diagnostic accuracy of the conventional X-ray mammography in breast lesions. X-ray and MR-mammography were evaluated in 220 patients (238 breasts) scheduled for breast surgery. The breasts were examined with T1-weighted transversal images using contrast medium enhanced semidynamic technique with 3D fast low angle shot (FLASH) sequence. Each breast was given a routine examination with 3 mammographic views. Contrast enhanced MR-mammography is a highly sensitive method for the detection of breast cancer, it has a higher diagnostic accuracy (84.5%), than conventional X-ray mammography (82.4%). When MRI and conventional X-ray mammography were used together, very high sensitivity but a lower diagnostic accuracy (81.5%) was achieved. MRI was effective in revealing mammographically equivocal or occult lesions and multifocal tumors even in dense breasts, but it was less reliable for some invasive lobular cancers, non-invasive ductal carcinomas, fibroadenomas and hyperplastic breast changes. Presently accepted indications for MRI of the breast are: (1) patients with breast implants--to demonstrate prothesis complications and tumor relapses; (2) postoperative imaging in patients after tumorectomy and radiation therapy--in these cases MRI allows differentiation between tumor relapses and extensive scars; (3) proven axillary lymph node metastasis from an unknown primary carcinoma; (4) preoperative MR imaging in cases suspected or verified carcinomas within dense breasts to exclude multicentricity/multifocality; (5) follow-up in chemotherapy of breast cancer; (6) patients with high-risk constellation.
Assuntos
Doenças Mamárias/diagnóstico , Mama/patologia , Imageamento por Ressonância Magnética , Mamografia/métodos , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Uterine leiomyoma, a benign, monoclonal tumor derived from a single myometrial cell, is one of the most frequent diseases in the female reproductive system. However, the factors involved in its initiation and growth remain poorly understood. Most commonly, it results in dysmenorrhea, menorrhagia, urinary tract and neurological symptoms, and abdominal distension. Additionally, it may cause infertility, late miscarriage or other severe complications in pregnancy. The conventional treatment for fibroids has been hysterectomy. However, many women do not like to lose their uterus and potential fertility. Myomectomy and medical treatment with GnRH analogue are accepted as alternative organ-conserving methods with limited efficacy. Selective embolization of uterine arteries might therefore have a significant role in the management of the disease. The purpose of this study was to determine the effectiveness of uterine embolization as primary therapy in the management of myomas. Uterine arterial embolization was performed in 3 patients with symptomatic leiomyomas. The uterus and fibroids were objectively evaluated with ultrasound and MRI. The efficacy and safety convinced the authors that this promising technique is at present the only reasonable alternative method in organ-conserving therapy. It is less invasive than surgery, it can restore fertility, it is well tolerated and the recovery time is shorter than that following surgical procedures. This preliminary experience is sufficient to encourage gynecologists to introduce the method in Hungary.
Assuntos
Quimioembolização Terapêutica , Leiomioma/terapia , Neoplasias Uterinas/terapia , Útero/irrigação sanguínea , Adulto , Feminino , Humanos , Infertilidade Feminina/etiologia , Leiomioma/complicações , Imageamento por Ressonância Magnética , Resultado do Tratamento , Neoplasias Uterinas/complicações , Útero/patologiaRESUMO
The authors report a total of 62 middle and low third rectal cancer cases operated on by total mesorectal excision by the method of Heald. The oncological basis of this procedure is the horizontal regional metastatization of rectal cancer. The total mesorectal excision facilitates, the low anterior resections and preservation of sphincter with an ultra-low colorectal, or coloanal anastomosis using the double stapling technique. In the authors' experience, the "UltraCision" cutting-coagulating device permits an atraumatic, bloodless and oncologically correct dissection. Using the double stapling technique, we succeeded in 60% of our middle- and low-third rectal cancer patients to perform a sphincter preserving low anterior resection. In 9 (28%) of the low third rectal cancer patients, preservation of the sphincter was possible with oncologically correct anterior resection and an ultra-low colo-anal anastomosis. Three anastomotic insufficiencies occurred, two of them healed on lotion-suction drainage, and one on the application of transient protective ileostomy. The literature data suggest a lower local recurrency rate after radical rectal cancer surgery, if total mesorectal excision is performed.
Assuntos
Neoplasias Retais/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/cirurgia , Anastomose Cirúrgica/métodos , Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Reto/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , UltrassonografiaRESUMO
A multidisciplinary program for the treatment of colorectal cancer is described. The main objective of the authors has been to define uniform up to date guidelines based on recent progress in the treatment of colorectal cancer. Preoperative diagnostic procedures are summarized which advance determination of clinical stage and prognosis. These information essentially determine care. Sequences of surgical methods, preoperative and postoperative radiotherapy and medical treatments are discussed according to tumor stages. Guidelines for surveillance following active treatment and recommendation for the screening of population at high risk for colorectal cancer are presented.
Assuntos
Neoplasias Colorretais/terapia , Terapia Combinada , Algoritmos , Quimioterapia Adjuvante , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/radioterapia , Neoplasias Colorretais/cirurgia , Árvores de Decisões , Diagnóstico Diferencial , Progressão da Doença , Humanos , Programas de Rastreamento/métodos , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Vigilância da População/métodos , Guias de Prática Clínica como Assunto , Radioterapia AdjuvanteRESUMO
The authors report on their experience with the treatment of renovascular hypertension by stent implantation. In the past 4 years different types of stents (Palmaz [9], Palmaz-Corinthian [4], Memotherm [1] and AVE [1]) were implanted into 15 renal arteries of 11 patients. The indication was primary in 8 cases, and secondary in 3 patients, because of restenosis of a previously dilated renal artery. 14 stents were implanted into narrowed renal arteries, and in the remaining one case a stent was placed in an occluded renal artery immediately after recanalization. The technical success was 100%. In all but the recanalized case in which the renal artery was occluded, stents are still open. On the basis of this experience and the literature, the authors suggest the more extensive usage of this less invasive method.
Assuntos
Hipertensão Renovascular/cirurgia , Obstrução da Artéria Renal/cirurgia , Stents , Idoso , Angiografia Digital , Feminino , Seguimentos , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/etiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico por imagem , Resultado do TratamentoRESUMO
CT-guided histological sampling is nowadays used routinely in the differential diagnosis of focal lung diseases with no characteristic morphology. The aim of this study was to determine the value of the method. CT-guided core biopsy was performed in 25 patients with pulmonary nodules. 16 patients underwent bronchoscopy where cytological sampling was also carried out, while 5 patients underwent fluoroscopically guided biopsy. The histological diagnosis resulting from CT-guided biopsy specimens was compared with the findings from the other diagnostic procedures (bronchoscopy or fluoroscopically guided biopsy), with the results of surgery and/or chemotherapy and with the follow-up data. The result of CT-guided biopsy was true in 20/25 and falls in 5/25 cases. Of the 16/25 patients undergoing bronchoscopy, 13/16 gave negative results. In 11/16 cases, the result of the CT-guided biopsy was positive. The fluoroscopically guided biopsy was negative in 4/5 cases, and in 3/5 of these cases the diagnostic CT-guided biopsies proved positive. Our results demonstrate the better diagnostic value of CT-guided core biopsy relative to fluoroscopically guided biopsy or bronchoscopic sampling in those cases where the size and localization of the nodule make it inaccessible with the latter two methods.
Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Adulto , Idoso , Biópsia por Agulha , Broncoscopia , Feminino , Fluoroscopia , Hamartoma/diagnóstico por imagem , Hamartoma/patologia , Humanos , Neoplasias Pulmonares/patologia , Linfoma/etiologia , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/patologiaRESUMO
Staging of malignant lymphomas, monitoring of response to therapy and regular follow-up of treated patients can properly be performed by new diagnostic imaging modalities. Diagnosis of subdiaphragmatic nodal involvement by ultrasonography and computed tomography is based on enlargement of lymph nodes. Lymphography is the only method which can depict pathologic internal architecture in normal sized lymph nodes. Of 82 patients there were 72 on admission without known subdiaphragmatic nodal disease. Of these 22 (30.5%) were found to have nodal involvement in this region. Suggested diagnostic algorhythm is shown on flow diagram.
Assuntos
Linfografia , Linfoma/diagnóstico , Imageamento por Ressonância Magnética , Doença de Hodgkin/diagnóstico , Humanos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
A case of the rare condition of renal and retroperitoneal actinomycosis is presented. The clinical and imaging (ultrasonography and computed tomography) findings are described and attention is drawn to the diagnostic difficulties in this rare disease.
Assuntos
Actinomicose/diagnóstico , Nefropatias/microbiologia , Actinomicose/diagnóstico por imagem , Adulto , Diabetes Mellitus Tipo 2/complicações , Diagnóstico Diferencial , Humanos , Nefropatias/diagnóstico por imagem , Masculino , Espaço Retroperitoneal , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
CT, performed in 66 patients with suspected renal tumors, showed renal cell carcinoma in 36. Tumor spreading was correctly established in 80.6%. Accurate diagnosis was made in 64 of 66 cases. The authors regard CT as an effective method for the recognition of sizable processes and differential diagnosis of solid tumors. Among the visual methods of investigation, used to define a tumor stage, CT turned out to be the most effective one.