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1.
Int J Colorectal Dis ; 31(2): 291-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26310797

RESUMO

PURPOSE: The treatment of high transsphincteric fistula is a complex procedure, which may be associated with the risk of recurrence and fecal incontinence. In this study, we used an animal model to compare different types of sphincter-preserving treatments for transsphincteric fistula. METHODS: Sixteen female New Zealand rabbits, weighing 2.8-4.8 kg underwent a surgical creation of high transsphincteric fistula. After 6 weeks, magnetic resonance imaging (MRI) was performed in order to confirm fistula formation and measure the fistula diameter. The rabbits were divided into three groups. Group 1 received no plug treatment (control). Autologous dermal graft and acellular dermal matrix were used as a plug in groups 2 and 3, respectively. Five weeks after treatment, fistula tract healing was determined by measuring the largest fistula diameter with MRI. All rabbits were euthanized and the anorectum excised en bloc for histopathological examination. RESULTS: According to the MRI findings, all groups showed significant healing after the treatment (p < 0.05). The healing rate of fistula diameters after treatment was 40, 66, and 29% in the control, dermal graft, and acellular dermal matrix groups, respectively. In terms of negative healing parameters such as neutrophil, eosinophil, lymphocyte, and plasmocyte accumulation, dermal graft and acellular dermal matrix groups showed significantly lower results than those in the control group (p < 0.05). CONCLUSION: According to MRI and histopathological results, fistula tract curettage and fistula orifice closure improved transsphincteric anal fistula healing. Additionally, in this study, plug treatment favoring autologous dermal graft resulted in better healing.


Assuntos
Derme Acelular , Curetagem/métodos , Modelos Animais de Doenças , Fissura Anal/cirurgia , Transplante de Pele , Cicatrização , Animais , Feminino , Fissura Anal/patologia , Fissura Anal/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Coelhos , Transplante Autólogo
2.
Hepatogastroenterology ; 62(139): 577-84, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-26897932

RESUMO

BACKGROUND/AIMS: Due to being a severe complication, iatrogenic bile duct injury is still a challenging issue for surgeons in gallbladder surgery. However, a commonly accepted classification describing the type of injury has not been available yet. This study aims to evaluate ability of six current classification systems to discriminate bile duct injury patterns. METHODOLOGY: Twelve patients, who were referred to our clinic because of iatrogenic bile duct injury after laparoscopic cholecystectomy were reviewed retrospectively. We described type of injury for each patient according to current six different classifications. RESULTS: 9 patients underwent definitive biliary reconstruction. Bismuth, Strasberg-Bismuth, Stewart-Way and Neuhaus classifications do not consider vascular involvement, Siewert system does, but only for the tangential lesions without structural loss of duct and lesion with a structural defect of hepatic or common bile duct. Siewert, Neuhaus and Stewart-Way systems do not discriminate between lesions at or above bifurcation of the hepatic duct. CONCLUSION: The Hannover classification may resolve the missing aspects of other systems by describing additional vascular involvement and location of the lesion at or above bifurcation.


Assuntos
Fístula Anastomótica/classificação , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colestase/classificação , Doença Iatrogênica , Terminologia como Assunto , Ferimentos e Lesões/classificação , Adulto , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Ductos Biliares/cirurgia , Colangiografia/métodos , Colangiopancreatografia por Ressonância Magnética , Colestase/diagnóstico , Colestase/etiologia , Colestase/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reoperação , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/cirurgia
3.
Eur Radiol ; 24(2): 434-40, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24220753

RESUMO

OBJECTIVES: To measure the median nerve (MN) stiffness by quantitative shear wave elastography (SWE) at the carpal tunnel inlet and to determine whether SWE can be used in the diagnosis of carpal tunnel syndrome (CTS). METHODS: The study included 37 consecutive patients (60 wrists) with a definitive diagnosis of CTS and 18 healthy volunteers (36 wrists). The MN cross-sectional area (CSA) by ultrasound and stiffness by SWE were studied. The difference between CTS patients and controls, and the difference among subgroups based on electrodiagnostic tests were studied by the Student's t test. Interobserver variability and ROC analysis were performed. RESULTS: The MN stiffness was significantly higher in the CTS group (66.7 kPa) when compared to controls (32.0 kPa) (P < 0.001), and higher in the severe or extreme severity group (101.4 kPa) than the mild or moderate severity group (55.1 kPa) (P < 0.001). A 40.4-kPa cut-off value on SWE revealed sensitivity, specificity, PPV, NPV and accuracy of 93.3%, 88.9%, 93.3%, 88.9% and 91.7%, respectively. Interobserver agreement was excellent for SWE measurements. CONCLUSIONS: Median nerve stiffness at the carpal tunnel inlet is significantly higher in patients with carpal tunnel syndrome, for whom shear wave elastography appears to be a highly reproducible diagnostic technique. KEY POINTS: • Clinical examination is important for diagnosis of carpal tunnel syndrome • Shear wave elastography (SWE) offers new clinical opportunities within diagnostic ultrasound • SWE is highly reproducible in evaluation of median nerve stiffness • Median nerve stiffness is significantly increased in carpal tunnel syndrome • Elastography could become useful in diagnosis of carpal tunnel syndrome.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Nervo Mediano/fisiopatologia , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Elasticidade , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes
4.
J Ultrasound Med ; 33(3): 503-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24567462

RESUMO

OBJECTIVES: The purpose of this study was to evaluate whether the relative proportions of stromal to cellular components of pleomorphic adenomas have an effect on the shear elastic modulus determined by shear wave elastography (SWE). METHODS: This study was approved by the Ethics Committee of our institution and performed between September 2011 and December 2012. Thirty-five patients who underwent surgery for a parotid mass were included in the study. The maximum shear elastic modulus of the mass was measured by SWE. Pleomorphic adenomas were histopathologically subdivided into stroma-poor, intermediate-stroma, and stroma-rich tumors based on the relative proportion of stromal to cellular components. RESULTS: The maximum shear elastic modulus values of the pleomorphic adenomas ranged from 12.6 to 291.9 kPa (mean ± SD, 120.9 ± 92.8 kPa). The Friedman test revealed a statistically significant relationship between the stromal amount and maximum shear elastic modulus (P < .001). Stroma-poor adenomas (mean, 32.3 ± 27.7 kPa; range, 12.6-81.1 kPa) were softer on SWE than stroma-rich adenomas (mean, 174.1 ± 48.4 kPa; range, 92.7-217.2 kPa; P = .009). No such significant difference was detected between stroma-poor and intermediate-stroma tumors (mean, 146.3 ± 106.1 kPa; range, 19.1-291.9 kPa; P = .062) or between intermediate-stroma and stroma-rich tumors (P = .465). CONCLUSIONS: Shear wave elastography depicts pleomorphic adenomas with a variable appearance, which is due to the relative proportions of stromal to cellular contents in the tumors.


Assuntos
Adenoma Pleomorfo/diagnóstico por imagem , Adenoma Pleomorfo/patologia , Técnicas de Imagem por Elasticidade/métodos , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Células Estromais/diagnóstico por imagem , Células Estromais/patologia , Adulto , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
5.
JOP ; 13(3): 289-91, 2012 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-22572134

RESUMO

CONTEXT: Cystic-cavernous lymphangioma is a rare cystic tumor especially for adults and pancreas. CASE REPORT: We reported a case of a 33-year-old woman who presented with a visible and palpable abdominal mass found to be a huge lymphangioma of the pancreas. An abdominal magnetic resonance imaging (MRI) showed a multiloculated, lobulated T1 hypo/hyper, T2 hyperintense cystic mass extending from right subhepatic space to the pelvis measuring 155x167x100 mm. A pancreaticoduodenectomy was performed encompassing the distal stomach and a segment of the transverse colon, because of their close, inseparable relationship to the mass. The cystic mass was histopathologically diagnosed as partly cavernous and partly cystic lymphangioma. CONCLUSION: To our knowledge this is the first case of pancreatic lymphangioma requiring additional organ resection besides a standard pancreaticoduodenectomy. To reduce recurrences, we recommend a complete resection for this pathology, even though its benign nature.


Assuntos
Colo/cirurgia , Linfangioma Cístico/cirurgia , Linfangioma/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Estômago/cirurgia , Adulto , Feminino , Humanos , Linfangioma/patologia , Linfangioma Cístico/patologia , Imageamento por Ressonância Magnética , Neoplasias Pancreáticas/patologia , Resultado do Tratamento
6.
J Clin Imaging Sci ; 7: 12, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28400998

RESUMO

OBJECTIVES: We aimed to prospectively assess the diagnostic value of apparent diffusion coefficient (ADC) measurement in the differentiation of benign and malignant mediastinal lymphadenopathies. MATERIALS AND METHODS: The study included 63 consecutive patients (28 women, 35 men; mean age 59.3 years) with 125 mediastinal lymphadenopathies. Echoplanar diffusion-weighted magnetic resonance imaging of the mediastinum was performed with b-factors of 0 and 600 mm2/s before mediastinoscopy and mediastinotomy, and ADC values were measured. The ADC values were compared with the histological results, and statistical analysis was done. P < 0.05 was considered statistically significant. RESULTS: The mean ADC value of malignant mediastinal lymphadenopathy (1.030 ± 0.245 × 10-3 mm2/s) was significantly lower (P < 0.05) when compared to benign lymphadenopathies (1.571 ± 0.559 × 10-3 mm2/s). For differentiating malignant from benign mediastinal lymphadenopathy, the best result was obtained when an ADC value of 1.334 × 10-3 mm2/s was used as a threshold value; area under the curve 0.848, accuracy 78.4%, sensitivity 66%, specificity of 86%, positive predictive value 76.7%, and negative predictive value of 79.2%. Interobserver agreement was excellent for ADC measurements. CONCLUSIONS: ADC measurements could be considered an important supportive method in differentiating benign from malignant mediastinal lymphadenopathies.

7.
Cardiorenal Med ; 7(4): 284-294, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29118767

RESUMO

AIMS: Compared to the general population, mortality is significantly increased in renal transplant recipients. In the general population, coronary artery calcification (CAC) and its evolution over time are associated with cardiovascular and all-cause mortality, and the study of this biomarker could provide useful information for describing the long-term progression of coronary heart disease in renal transplant recipients. METHODS: We followed up a cohort of 113 renal transplant patients by performing three multi-detector computed tomography studies over 83.6 ± 6.8 months. Data analysis was performed by logistic regression analysis and by mixed linear modelling. RESULTS: Progression was observed in 34.5% of patients. Baseline CAC and time-to-transplantation were the sole variables that predicted CAC evolution over time. Neither classical nor nontraditional risk factors, biomarkers of renal function (GFR) and kidney damage (albuminuria) or biomarkers of bone mineral disorder (BMD), such as serum phosphorus, calcium, and PTH, were associated with the long-term progression of coronary calcification. Serum triglycerides predicted CAC progression only in logistic regression analysis, while in addition to baseline CAC, time to transplantation was the sole variable predicting CAC progression when the data were analyzed by mixed linear modelling. These data suggested that, in addition to the background calcification burden, other unmeasured factors play major roles in promoting the evolution of coronary calcification in the transplant population. CONCLUSION: CAC progression continued over the long-term follow-up of renal transplant patients. This phenomenon was unaccounted for by classical and nontraditional risk factors, as well as by biomarkers of renal dysfunction and renal damage.

8.
Eurasian J Med ; 47(1): 72-4, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25745350

RESUMO

Computed tomography-guided percutaneous transthoracic fine-needle aspiration biopsy of lung lesions is a well known diagnostic technique. Nevertheless, it has some complications; such as pneumothorax, intraparenchymal hemorrhage and hemoptysis, which are not rare. Air embolism is one of the rare but potentially fetal complications of this procedure. Herein, we report the case of a 69-year-old male, in which case of systemic air embolism developed after the performance of lung biopsy. Early diagnosis and prompt oxygen therapy is crucial for patient's survival so careful reviewing of the obtained computed tomography images during the biopsy may prevent a missing systemic air embolism and provide an adequate therapy.

9.
Iran J Radiol ; 12(4): e29084, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26715982

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is highly accurate for the depiction of both the primary tract of fistula and abscesses, in patients with perianal disease. In addition, MRI can be used to evaluate the activity of fistulas, which is a significant factor for determining the therapeutic strategy. OBJECTIVES: This study aimed to determine the usefulness of diffusion-weighted (DW) MRI for assessing activity and visibility of perianal fistula. PATIENTS AND METHODS: Fifty-three patients with 56 perianal fistulas were included in the current retrospective study. The T2-weighted imaging (T2WI) and DWMRI were performed and apparent diffusion coefficient (ADC) values of fistulas were measured. Fistulas were classified into two groups: only perianal fistulas and fistulas accompanied by abscess. Fistulas were also classified into two groups, based on clinical findings: positive inflammatory activity (PIA) and negative inflammatory activity (NIA). RESULTS: Mean ADC value (mm(2)/s) of PIA group was significantly lower than that of NIA group, regarding lesions in patients with abscess-associated fistulas (1.371 × 10(-3) ± 0.168 × 10(-3) vs. 1.586 × 10(-3) ± 0.136 × 10(-3); P = 0.036). No statistically significant difference was found in mean ADC values between PIA and NIA groups, in patients with only perianal fistulas (P = 0.507). Perianal fistula visibility was greater with combined evaluation of T2WI and DWMRI than with T2WI, for two reviewers (P = 0.046 and P = 0.014). CONCLUSION: The DWMRI is a useful technique for evaluating activity of fistulas with abscess. Perianal fistula visibility is greater with combined T2WI and DWMRI than T2WI alone.

11.
Jpn J Radiol ; 32(2): 113-6, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24390476

RESUMO

A case of acute mesenteric ischemia due to thrombosis of superior mesenteric artery and vein in a 44-year-old woman following chemotherapy for invasive laryngeal carcinoma was diagnosed on a multi-detector CT scan. Although the link between malignancy and thromboembolism is widely recognized in patients with cancer, chemotherapy further elevates the risk of thrombosis. Acute mesenteric ischemia associated or not associated with chemotherapy rarely occurs in patients with cancer. Moreover, co-occurrence of superior mesenteric artery and superior mesenteric vein thrombosis is reported for the first time.


Assuntos
Antineoplásicos/efeitos adversos , Artéria Mesentérica Superior/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Trombose/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Carcinoma de Células Escamosas/tratamento farmacológico , Cisplatino/efeitos adversos , Docetaxel , Feminino , Fluoruracila/efeitos adversos , Humanos , Neoplasias Laríngeas/tratamento farmacológico , Taxoides/efeitos adversos
12.
Korean J Urol ; 53(3): 209-13, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22468219

RESUMO

Giant multilocular prostatic cystadenoma is a rare benign tumor that evolves from the prostate gland. Obstructive voiding symptoms occur in all reported cases. These lesions do not invade adjacent structures. Preoperative radiologic evaluation can define the benign nature of the lesion. Here we report a case of large cystic lesions identified by magnetic resonance imaging and sonographic findings that caused an extensive mass effect in the pelvis. When retrovesical, huge cystic lesions fill the pelvis completely in young men, with high levels of serum prostate-specific antigen, giant multilocular prostatic cystadenoma should be considered as a differential diagnosis. To our knowledge, this is the youngest case of prostatic cystadenoma reported in the literature.

14.
Respir Med ; 105(11): 1739-47, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21862304

RESUMO

OBJECTIVES: To determine the frequency of elevated systolic pulmonary artery pressure (sPAP) estimated by echocardiography in Behçet's syndrome (BS) patients with pulmonary artery involvement (PAI), in healthy controls and in diseased controls with systemic sclerosis (SSc), as well as in BS patients without PAI. METHODS: We studied 3 groups of patients with BS (patients with PAI: n = 30, with vascular disease but without PAI: n = 26 and without vascular disease: n = 21), patients with SSc (n = 23) and healthy controls (n = 22). Systolic pulmonary artery pressure (sPAP) was estimated by echocardiography. The upper limit for a normal sPAP was arbitrarily set at 35 mmHg. We also evaluated cardiac function by echocardiography. Pulmonary function tests, a six-minute walking test (six-MWT) and several serum biomarkers were also studied. RESULTS: The frequency of patients with an elevated sPAP was significantly higher only among BS patients with PAI (17%) and among patients with SSc (26%). In addition, DL(CO) was decreased and pro-BNP levels were increased in BS patients with PAI, which are similar to the results in patients with SSc. Furthermore, BS patients with PAI also had mild RV diastolic dysfunction. CONCLUSIONS: When BS involves the pulmonary arteries, it can cause mild elevations in the estimated sPAP, decrease in DL(CO), mild cardiac dysfunction and increase in pro-BNP levels. These findings suggest that BS can also affect the small/micro vessels of the heart and the lungs in addition to the well-recognized large vessel disease.


Assuntos
Síndrome de Behçet/fisiopatologia , Pressão Sanguínea , Dispneia/fisiopatologia , Eletrocardiografia , Artéria Pulmonar/fisiopatologia , Escleroderma Sistêmico/fisiopatologia , Adulto , Síndrome de Behçet/sangue , Síndrome de Behçet/complicações , Biomarcadores/sangue , Dispneia/sangue , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escleroderma Sistêmico/sangue , Turquia , Caminhada
15.
Cardiovasc Intervent Radiol ; 32(2): 206-12, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18810530

RESUMO

The purpose of this study was to evaluate the feasibility of multislice computed tomographic (MSCT) angiography as a noninvasive method for detecting ostial, proximal, and middle segment coronary stenosis or occlusion and anatomy in patients with transposition of the great arteries who had undergone arterial switch operation (ASO). Sixteen-detector-row MSCT angiography was performed in 16 patients treated with ASO for transposition of the great arteries. The median age was 10.3 years (range, 6.2-16.3 years). Sixteen-detector-row MSCT angiography was performed in 16 patients who had undergone ASO. CT imaging was performed in the craniocaudal direction from 2 cm above the carina up to the heart basis. Noninvasive assessment of coronary artery stenosis and anatomy were investigated by MSCT angiography. Two patients were excluded from the study because of artifacts. Of 14 evaluated patients, 1 patient had ostial stenosis (7.1%). A coronary artery anatomy variant was present in six patients: left main artery (LMA) and right coronary artery (RCA) originating from the right sinus as a single orifice (n = 2); left circumflex artery (LCX) originating from the RCA (n = 1); LMA and RCA, after branching to the LCX, originating separately from the right sinus (n = 1); and LMA (n = 1) and left anterior descending artery (LADA; n = 1) originating directly from the right sinus. Intramural bridging in the LAD (n = 2) was detected. Five patients were normal. In conclusion, MSCT angiography, as a noninvasive, feasible technique for assessing coronary stenosis or occlusion and anatomy, can be used in the follow-up of patients who have undergone ASO.


Assuntos
Angiografia Coronária/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/cirurgia , Adolescente , Criança , Meios de Contraste , Estenose Coronária/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Imageamento Tridimensional , Masculino , Interpretação de Imagem Radiográfica Assistida por Computador , Resultado do Tratamento
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