RESUMO
Extrapelvic endometriosis is a rare and usually misdiagnosed entity. Some extrapelvic endometriotic lesions are small and nonpalpable, which makes them difficult to locate and remove. Here, we report the use of radioactive seed localization to locate and guide the excision of a small, nonpalpable endometriotic lesion. A 32-year-old woman presented with disabling pain in the right inguinal area. Magnetic resonance imaging and abdominal ultrasound results showed an 11-mm nodule in the abdominal wall, in the vicinity of the groin, consistent with an endometriotic lesion. The radioactive seed was placed within the lesion with the help of ultrasonography, and excision was guided with a portable gamma camera. Complete excision of the endometriotic nodule was achieved. We propose radioactive seed localization as an accurate and feasible technique for the treatment of nonpalpable endometriotic lesions.
Assuntos
Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Endometriose/cirurgia , Radioisótopos do Iodo , Doenças Peritoneais/cirurgia , Cirurgia Assistida por Computador/métodos , Parede Abdominal/patologia , Adulto , Endometriose/diagnóstico por imagem , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Imageamento por Ressonância Magnética , Palpação , Doenças Peritoneais/diagnóstico por imagem , Traçadores Radioativos , UltrassonografiaRESUMO
The malignant transformation of endometriosis is very uncommon. Whereas 75% of tumors arising from endometriosis arise in the ovary, location in extra-genital organs is rare and mesenchymal neoplasms are exceptional. A 47 year-old woman who underwent hysterectomy with bilateral salpingo-ooforectomy due to endometriosis 13 years before presented with abdominal pain. The magnetic resonance imaging (MRI) showed a 9.7×7.5 cm solid-cystic supravesical mass and a recto-vaginal tumor, as well as endometriotic nodules in the sigma, right parametrium and peritoneum that had significantly increased in size over a six months period. The patient underwent surgical resection of the masses. The histological study showed a low-grade endometrial stromal sarcoma (ESS) arising from endometriosis located at recotovaginal septum and affecting colonic wall and multiple peritoneal and pelvic implants. The patient received radiotherapy and aromatase inhibitors and is free of disease after a follow up of 2 years. Only 15 cases of ESS arising in endometriosis of the bowel have been reported. Tumor dissemination at diagnosis is unusual but does not imply a poor prognosis, as only one patient has died due to progression of the tumor. ESS should be included in the differential diagnosis of mesenchymal neoplasms in the intestine.
Assuntos
Inibidores da Aromatase/uso terapêutico , Transformação Celular Neoplásica/patologia , Endometriose/complicações , Enteropatias/complicações , Sarcoma do Estroma Endometrial/etiologia , Diagnóstico Diferencial , Intervalo Livre de Doença , Endometriose/patologia , Feminino , Humanos , Histerectomia , Enteropatias/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Sarcoma do Estroma Endometrial/diagnóstico , Sarcoma do Estroma Endometrial/patologia , Sarcoma do Estroma Endometrial/terapiaRESUMO
OBJECTIVE: The objective of our study was to identify the most useful parameters to differentiate between renal cell carcinoma (RCC) and oncocytoma using four-phase CT. MATERIALS AND METHODS: Ninety-seven patients with solid renal lesions who underwent surgery with four-phase preoperative CT evaluation and with pathologic diagnosis of RCC or oncocytoma were included in the study. Features of tumors and the enhancement pattern in the four CT phases were evaluated and analyzed. Logistic regression models were used to assess independent predictors for malignancy. RESULTS: Histopathologically, 13 tumors were oncocytomas and 84 were RCCs. RCCs were larger (6.20 cm vs 3.21 cm, p = 0.0004) and more often enhanced heterogeneously (66 vs 6, p = 0.02). Lesions that were larger than 4 cm showed a significantly higher risk of malignancy (p = 0.0046). Significant differences were found in intensity of nodule enhancement between the nephrographic and the excretory phases with respect to the unenhanced phase (p = 0.003 and p = 0.0026). At multivariate analysis, parameters that were independent predictors of malignancy were enhancement pattern, with RCCs more often having heterogeneous enhancement than oncocytomas (odds ratio [OR], 0.18; 95% CI, 0.04-0.90), and nodule enhancement in the excretory phase in relation to the unenhanced phase, with RCCs showing lower enhancement (OR, 0.93; 95% CI, 0.88-0.97), and a size larger than 4 cm (OR, 4.01; 95% CI, 0.70-23.14). CONCLUSION: The combination of different CT parameters including lesion size larger than 4 cm, lesion enhancement in the excretory phase in relation to the unenhanced phase, and heterogeneous enhancement pattern helps distinguish RCC from oncocytoma.
Assuntos
Adenoma Oxífilo/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Idoso , Algoritmos , Meios de Contraste , Diagnóstico Diferencial , Diatrizoato de Meglumina , Feminino , Humanos , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos , SoftwareRESUMO
Precise radiologic evaluation of regional adenopathic involvement in pelvic gynecologic tumors is fundamental to clinical practice because of its prognostic and therapeutic significance. Likewise, the identification of metastatic adenopathies at posttreatment imaging is essential for assessing response and detecting recurrence. Similar to urologic neoplasms, gynecologic neoplasms most often spread regionally to the pelvic and retroperitoneal lymph nodes, following the normal drainage pathways of the pelvic organs. Familiarity with routes of dissemination, treatment options, and means of analyzing lymph node characteristics is crucial to determine the extent of disease. Two staging systems can be used in characterizing gynecologic malignancies: the FIGO (International Federation of Gynecology and Obstetrics) system, which is the most commonly and universally used, and the TNM (tumor, node, metastasis) system, which is based on clinical and/or pathologic classification. Anatomic assessment with multidetector computed tomography (CT) and magnetic resonance (MR) imaging is still the most commonly used technique for the detection of lymph node spread, which is mainly based on morphologic criteria, the most important of which is nodal size. However, size has limited diagnostic specificity. Consequently, functional imaging techniques such as diffusion-weighted MR imaging, positron emission tomography combined with CT, lymphoscintigraphy, and sentinel lymph node mapping, which are based on molecular and physiologic activity and allow more precise evaluation, are often incorporated into diagnostic imaging protocols for staging of gynecologic malignancies.
Assuntos
Diagnóstico por Imagem , Neoplasias dos Genitais Femininos/patologia , Metástase Linfática , Feminino , Humanos , Estadiamento de Neoplasias , Prognóstico , Biópsia de Linfonodo SentinelaRESUMO
OBJECTIVE: The aim of this study was to assess the accuracy of Ultrasound (US) and contrast-enhanced ultrasound (CEUS) in the characterization of renal nodules indeterminate on CT by identifying benign cystic lesions not requiring further examination. METHODS: 72 patients with 83 indeterminate renal nodules on CT underwent baseline US and CEUS that classified lesions as benign (Bosniak I, II or IIF cysts) or potentially malignant (Bosniak III or IV cysts, solid nodules). The accuracy of US and CEUS in the differentiation between benign cysts and potentially malignant nodules was analyzed and compared with the final diagnosis obtained by histology or follow-up of at least 23 months with CEUS ± a conclusive CT/MR study. RESULTS: Final diagnoses comprised 50 benign complex cysts, 1 focal nephritis, 1 multilocular cystic nephroma, 3 oncocytomas, 1 transitional cell carcinoma and 27 renal cell carcinomas. Unenhanced US correctly classified 18/50 (36%) benign cysts and 17/33 (51.5%) of the potentially malignant lesions obtaining a sensitivity of 36%, specificity of 51.5%, and overall accuracy of 42.2%. The addition of CEUS allowed a correct diagnosis of 48 /50 (96%) benign cysts and of 31/33 (93.9%) nodules as potentially malignant, with a sensitivity of 96%, specificity of 93.9%, and overall accuracy of 95.2%. CONCLUSION: CEUS is very useful in the differentiation between benign complex cysts and other lesions that require further investigation in non-conclusive renal nodules detected on CT, improving the accuracy of baseline US from 42.2 to 95.2%.
Assuntos
Cistos/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
OBJECTIVE: To develop a system for the culture of murine preantral ovarian follicles using Human Serum Albumin (HSA) and Human Platelet Lysate (PLTMax). METHODS: Mechanically isolated preantral follicles (N=146) were obtained from Swiss mice and cultured in DMEM:F12 medium for ten days in a 96-well plate with conical bottom. The medium was supplemented with penicillin, streptomycin, and equine chorionic gonadotropin. Additional proteins were tested in 4 test groups: G1: human serum albumin (HSA), G2: human platelet lysate (PLTM), and G3 and G4: HSA + PLTMax at lower and higher concentrations, respectively. Cellular vitality and oocyte morphology were evaluated on day 11 of culture. RESULTS: The highest follicular growth (3.4 fold) was achieved in HSA (G1), while a significantly lower (1.8 fold) growth was achieved in the presence of PLTM (G2, G4) and even further reduced (1.2 fold) when HSA and PLTM were combined (G3). Cellular vitality was close to 70-80% among the four groups, and the highest number of intact oocytes were found in G1. CONCLUSIONS: PLTM did not improve follicular development and oocyte maturation compared to HSA but preserved cell vitality.
RESUMO
Postpartum hemorrhage is one of the leading causes of maternal mortality worldwide. According to the time when postpartum hemorrhage develops, it is classified as (a) primary, or early, postpartum hemorrhage (within the first 24 hours after delivery) or (b) secondary, or late, postpartum hemorrhage (>24 hours to 6 weeks after delivery). Primary postpartum hemorrhage may be caused by uterine atony (75%-90% of cases), trauma of the lower portion of the genital tract, uterine rupture, uterine inversion, bladder flap hematoma, retention of blood clots or placental fragments, and coagulation disorders. Secondary postpartum hemorrhage may be caused by uterine subinvolution, coagulopathies, and abnormalities of the uterine vasculature. Extrauterine sources of bleeding include rectus sheath hematoma, direct arterial injuries, and the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Severe postpartum hemorrhage is a life-threatening condition that is diagnosed on the basis of the findings from clinical examination, with or without ultrasonography. Computed tomography (CT) and magnetic resonance imaging are useful in the characterization of postpartum hemorrhage when medical treatment fails. Multidetector CT has an important role when intraabdominal bleeding is suspected and can be considered in cases of recurrent bleeding after embolization, as well as for the evaluation of postsurgical complications. A proposed clinical and CT imaging algorithm for postpartum hemorrhage is presented. A multidisciplinary approach to postpartum hemorrhage is essential to optimize the role of diagnostic and interventional radiology in obstetric hemorrhage, to avoid hysterectomy and thus preserve fertility.
Assuntos
Hemorragia Pós-Parto/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
PURPOSE: To evaluate the diagnostic value of computed tomography (CT) performed immediately after excretory urography (EU) in patients with delayed renal opacification or dilated upper urinary system with nonconclusive diagnosis after EU. MATERIALS AND METHODS: CT was performed immediately after EU in 39 patients with delayed opacification or dilated upper urinary system of unknown cause, without additional intravenous contrast administration for the CT study. We classified EU + CT findings as benign or malignant causes and we compared our results with the final diagnosis. RESULTS: The combination of EU + CT correctly diagnosed 38 out of the 39 cases with a sensitivity of 97%. Correct diagnosis was established in all malignant cases (n = 17) but one benign case consistent with blood clots in the upper urinary tract was incorrectly diagnosed as a multicentric urothelial carcinoma. Sensitivity, specificity, and accuracy for the diagnosis of the underlying cause with EU + CT was 100%, 95%, and 97%, respectively. The final diagnoses were: urothelial carcinoma (n = 10), stone disease (n = 10), bladder tumor (n = 4), benign post-treatment ureteral stenosis (n = 4), ureteral invasion (n = 3), benign bladder disease (n = 2), urinary tract infections (n = 2), crossing vessels (n = 1), ureteropelvic junction obstruction (n = 1), retrocaval ureter (n = 1), and blood clots in the upper urinary tract due to bleeding renal metastasis from lung cancer (n = 1). CONCLUSION: Combined EU and CT study allowed correct diagnosis of the underlying cause of delayed excretion or upper urinary tract dilatation in 97% of cases. The combination of EU and CT provides diagnosis reducing time and radiation.
Assuntos
Tomografia Computadorizada por Raios X/métodos , Urografia/métodos , Doenças Urológicas/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Doenças Urológicas/patologiaRESUMO
Regional lymph node involvement in urogenital malignancies (category N in the TNM classification system) is a significant radiologic finding, with important implications for treatment and prognosis. Male urogenital pelvic cancers commonly spread to iliopelvic or retroperitoneal lymph nodes by following pathways of normal lymphatic drainage from the pelvic organs. The most likely pathway of nodal spread (superficial inguinal, pelvic, or paraaortic) depends on the tumor location in the prostate, penis, testis, or bladder and whether surgery or other therapy has disrupted normal lymphatic drainage from the tumor site; knowledge of both factors is needed for accurate disease staging. At present, lymph node status is most often assessed with standard anatomic imaging techniques such as multidetector computed tomography or magnetic resonance (MR) imaging. However, the detection of nodal disease with these techniques is reliant on lymph node size and morphologic characteristics, criteria that provide limited diagnostic specificity. Functional imaging techniques, such as diffusion-weighted MR imaging performed with or without a lymphotropic contrast agent and positron emission tomography, may allow a more accurate nodal assessment based on molecular or physiologic activity.
Assuntos
Neoplasias Urogenitais/diagnóstico por imagem , Neoplasias Urogenitais/patologia , Virilha , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática , Imageamento por Ressonância Magnética , Masculino , Pelve , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To assess the need of the dynamic contrast-enhanced (DCE) sequence in addition to T2-weighted imaging (T2-WI) and diffusion-weighted imaging (DWI) for the detection of clinically significant prostate cancer in the presence of artifacts associated with rectal gas (which compromise the diffusion assessment) and/or PIRADS 3 lesions. METHODS: This retrospective study was approved by the institutional review board; informed consent was not required. Patients referred consecutively over a period of 5 months for elevated PSA underwent multiparametric magnetic resonance imaging (mpMRI). mpMRI was performed using a 3T MRI system without an endorectal coil. The MRI findings were reviewed by two radiologists and were scored according to the Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2). Any discrepancies were resolved by consensus. For statistical purposes, lesions were classified as PIRADS 1-2, PIRADS 3, or PIRADS 4-5. First, all studies were reviewed using a biparametric assessment (T2-WI + DWI), and the presence or absence of susceptibility artifacts was assessed for each prostate. Subsequently, all images were analyzed using the standard multiparametric approach (T2-WI + DWI + DCE). RESULTS: The biparametric evaluation (T2-WI + DWI) showed artifacts (due to the presence of rectal gas or other) in 87 patients (43.5%) and no artifacts in 113 patients (56.5%). In the latter group, 15 patients had peripheral zone (PZ) PIRADS 3 lesions. Thus, a total of 102 patients (51%) had artifacts or PZ PIRADS 3 lesions and therefore required DCE. When evaluating the group of prostates without artifacts, 13.3% of prostates required DCE. A total of 17 (23.9%) PIRADS 4-5 prostate lesions would have not been detected without the use of DCE. CONCLUSION: Biparametric evaluation of the prostate revealed some limitation due to the presence of artifacts or PIRADS 3 PZ lesions. Artifacts were present in almost 44% of our patients, but when the DWI was correctly evaluated, only 13.3% of prostates required DCE.
Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata , Artefatos , Meios de Contraste , Imagem de Difusão por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética , Masculino , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate in vitro oocyte maturation rates in embryonic culture medium after induction by hyperosmotic shock caused by exposure to vitrification solutions. METHODS: Bilateral oophorectomy was performed on 20 prepubescent female mice (Swiss). Immature (Prophase I) oocytes (N = 400) were obtained by ovarian dissection, divided into 4 groups, and transferred to culture dishes containing fertilization medium (Sydney IVF Fertilization Medium, Cook® Medical). The control group (CG) did not receive treatment, the test groups (G1, G2, G3) were treated with vitrification solution - 2 (VI-2: 14 M sucrose + ethylene glycol and dimethyl sulfoxide) for 30 seconds and subsequently: G1: 30 seconds in devitrification solution - 2 (DV-2: 0.5M sucrose); G2: 60 seconds DV-2; G3: 60 seconds DV-1(1M sucrose) and 180 seconds DV-2. All groups were cultivated for 24 hours in an incubator at 37ºC and 5% CO2 (Thermo model 3110). After this period, we checked their maturation status. RESULTS: Oocytes exposed to VI-2, DV-1 and DV-2 (G3) showed the highest rate of competence in resuming meiosis and reaching the MII stage; however, there was no statistically significant difference (G3 = 50.5% - 49/97; CG = 27.8% - 10/30). CONCLUSIONS: Oocyte exposure to vitrification solutions, in order to cause osmotic shock, did not interfere with the resumption of meiosis in mice oocytes.
Assuntos
Criopreservação , Vitrificação , Animais , Dimetil Sulfóxido , Feminino , Técnicas de Maturação in Vitro de Oócitos , Camundongos , OócitosRESUMO
Malacoplakia is an uncommon chronic granulomatous inflammation that rarely affects the female genital tract. A case of a 78-year-old woman with malacoplakia involving the uterine cervix and the vagina is described. The patient complained of vaginal bleeding. Clinically, a 13-mm mass was detected in the cervix, which was confirmed by ultrasound scan and magnetic resonance imaging. Histological examination showed a dense histiocytic infiltrate with abundant Michaelis-Gutmann bodies involving the uterine cervix and the upper vagina. The presence of Escherichia coli was confirmed in the lesion by immunohistochemistry and polymerase chain reaction. Only 12 cases of cervical malacoplakia have been reported to date. This condition should be included in the differential diagnosis of cervical tumors.
RESUMO
Multidetector computed tomography (CT) is the choice technique for preoperative evaluation of living renal donors. Living donor transplantation, as opposed to cadaveric donation, is the best option for recipient and graft survival. The need for kidney transplantation has undergone exponential growth over the past 40 years, and cadaveric donations are inadequate to meet this ever-increasing demand. These factors have led to a continued increase in organ donation from living related donors. From January 2007 to October 2009, 199 potential renal donors were studied in one center with 64-row multidetector CT. Of these candidates, 94 were rejected for donation. The remaining 105 potential donors were evaluated by a multidisciplinary committee, and 101 donor-recipient couples were accepted for renal donation and transplantation. Laparoscopic nephrectomy is the preferred surgical procedure for harvesting kidneys from living donors. Radiologists are responsible for providing accurate anatomic information about the donor's renal parenchyma, arteries, veins, and collecting system. Accurate reporting depends on the radiologist's level of expertise, attention to detail, and commitment to careful image evaluation. Knowledge of the surgical techniques and the difficulties that surgeons face during laparoscopic nephrectomy and renal transplantation is essential for compiling accurate radiologic reports.
Assuntos
Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Transplante de Rim/diagnóstico por imagem , Doadores Vivos , Seleção de Pacientes , Tomografia Computadorizada por Raios X/métodos , HumanosRESUMO
Contrast-enhanced ultrasound imaging represents a new approach to imaging tumoral neovascularity. This review describes the application of contrast-enhanced ultrasound in the detection, differential diagnosis, and staging of bladder cancer.
Assuntos
Neoplasias da Bexiga Urinária/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Humanos , Ultrassonografia , Bexiga Urinária/diagnóstico por imagemRESUMO
OBJECTIVE: The purpose of this study is to validate a multivariable predictive model previously developed to differentiate between renal cell carcinoma (RCC) and oncocytoma using CT parameters. METHODS AND MATERIALS: We included 100 renal lesions with final diagnosis of RCC or oncocytoma studied before surgery with 4-phase multidetector CT (MDCT). We evaluated the characteristics of the tumors and the enhancement patterns at baseline, arterial, nephrographic and excretory MDCT phases. RESULTS: Histopathologically 15 tumors were oncocytomas and 85 RCCs. RCCs were significantly larger (median 4.4 cm vs 2.8 cm, p = 0.006). There were significant differences in nodule attenuation in the excretory phase compared to baseline (median: 31 vs 42, p = 0.015), with RCCs having lower values. Heterogeneous enhancement patterns were also more frequent in RCCs (85.9% vs 60%, p = 0.027).Multivariable analysis showed that the independent predictors of malignancy were the enhancement pattern, with oncocytomas being more homogeneous in the nephrographic phase [Odds Ratio (OR) 0.16 (95% CI 0.03 to 0.75, p = 0.02)], nodule enhancement in the excretory phase compared to baseline, with RCCs showing lower enhancement [OR 0.96 (95% CI 0.93 to 0.99, p = 0.005)], and a size > 4 cm, with RCCs being larger [OR 5.89 (95% CI 1.10 to 31.58), p = 0.038]. CONCLUSION: The multivariable predictive model previously developed which combines different MDCT parameters, including lesion size > 4 cm, lesion enhancement in the excretory phase compared to baseline and enhancement heterogeneity, can be successfully applied to distinguish RCC from oncocytoma. ADVANCES IN KNOWLEDGE: This study confirms that multiparametric assessment using MDCT (including parameters such as size, homogeneity and enhancement differences between the excretory and the baseline phases) can help distinguish between RCCs and oncocytomas. While it is true that this multiparametric predictive model may not always correctly classify renal tumors such as RCC or oncocytoma, it can be used to determine which patients would benefit from pre-surgical biopsy to confirm that the tumor is in fact an oncocytoma, and thereby avoid unnecessary surgical treatments.
Assuntos
Adenoma Oxífilo/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Adenoma Oxífilo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Carcinoma de Células Renais/patologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Estudos Retrospectivos , Carga TumoralRESUMO
INTRODUCTION: The AMR Direct Flow Chip assay allows the simultaneous detection of a large variety of antibiotic resistance genetic markers. To assess this kit's performance, we use isolated colonies as starting material. The assay has been approved by the European Economic Area as a suitable device for in vitro diagnosis (CE IVD) using clinical specimens. METHODS: A total of 210 bacterial isolates harbouring either one or more antimicrobial resistance genes including plasmid-encoded extended-spectrum ß-lactamases (SHV, CTX-M) and carbapenemases (GES, SME, KPC, NMC/IMI, SIM, GIM, SPM, NDM, VIM, IMP, and OXA), mecA, vanA and vanB, and 30 controls were included. RESULTS: The assay displayed a sensitivity and specificity of 100% for all target genes included in the array. CONCLUSION: The AMR Direct Flow Chip Kit is an accurate assay for detecting genes which commonly confer resistance to ß-lactams and vancomycin from isolated colonies in culture of Gram-positive and Gram-negative bacteria.
Assuntos
DNA Bacteriano/genética , Resistência Microbiana a Medicamentos/genética , Genes Bacterianos , Bactérias Gram-Negativas/genética , Bactérias Gram-Positivas/genética , Análise de Sequência com Séries de Oligonucleotídeos , Kit de Reagentes para Diagnóstico , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana Múltipla/genética , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/microbiologia , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Sensibilidade e Especificidade , Vancomicina/farmacologia , Resistência beta-Lactâmica/genética , beta-Lactamases/genéticaRESUMO
OBJECTIVE:: To evaluate the efficacy and learning curve of ultrasoundguided vacuum-assisted excision (US-VAE) of benign breast lesions, and to assess characteristics associated with residual lesion. METHODS:: This was a retrospective study with institutional review board-approval. Sonographic and clinical follow-up were performed 6 months after intervention. Effectiveness and safety of the technique were analyzed. The cumulative summation (CUSUM) graphs were used to evaluate learning curves concerning complete excision and hematoma. RESULTS:: 152 ultrasound-VAEs in 143 patients were included. Initial complete resection was achieved in 90.8 % (138 of 152). 6-month follow-up was completed for 143 (94%) of cases and complete resection was observed in 72 % (100 of 143). Mean maximum size without residual tumor was 16.9 mm, while with residual lesion it was 21.9 mm (p = < 0.001), with a volume of 1.53 and 3.39 cm3, respectively (p = < 0.001). Increase in lesion size and volume was associated with less effectiveness (p = 0.05), clinical control (p = 0.05), and higher risk of clinically significant hematoma (p = 0.05). Receiver operating characteristic analysis demonstrate a volume threshold of 2.6 cm3 (r = 0.71, specificity 84.5%) for leaving no residual lesion. Cumulative summation graphs demonstrate that, on average, 11 excisions were required to acquire skills to perform complete excision in more than 80% at the end of the ultrasound-VAE and 18 excisions at 6 months. CONCLUSION:: Ultrasound-VAE is an effective treatment for benign breast lesions. Breast lesion volume should be considered when assessing for percutaneous treatment. ADVANCES IN KNOWLEDGE:: A follow-up of the learning process of ultrasound-VAE will be a valuable tool to assess the efectiveness and safety of the technique i.
Assuntos
Doenças Mamárias/cirurgia , Mama/cirurgia , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Biópsia por Agulha , Mama/diagnóstico por imagem , Mama/patologia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Curva de Aprendizado , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia Mamária , Vácuo , Adulto JovemRESUMO
OBJECTIVE: To evaluate storage time effects in cryopreserved human semen samples, kept in the freezer at a controlled temperature of -80°C, on sperm viability after thawing. METHODS: We used 20 semen samples. Each sample was cryopreserved in 10 fingers, which were divided into five groups: one group was kept in cryogenic canisters throughout the experiment(control), and four groups were kept in a VIP Ultra Low MDF-U76V- PE freezer, with the temperature set at -80°C, for 24, 48, 72 and 96 hours, respectively. After the exposure time, the samples were stored in cryogenic canisters after being thawed. The analyzed parameters were: motility, vitality and mitochondrial activity. RESULTS: After thawing, we noticed decreased sperm motility, vitality and mitochondrial activity, when comparing the tested groups with the control group, as well as a progressive reduction in the analyzed parameters between the times evaluated. CONCLUSIONS: Cryopreservation of semen samples at -80°C is potentially harmful to sperm viability, causing damage when submitted to longer exposure times.
Assuntos
Criopreservação/métodos , Preservação do Sêmen/métodos , Manejo de Espécimes/métodos , Criopreservação/normas , Humanos , Masculino , Análise do Sêmen , Preservação do Sêmen/normas , Manejo de Espécimes/normasRESUMO
OBJECTIVE: To evaluate the efficiency of ovarian tissue heterotopic autografting after vitrification in prepubertal rats. METHODS: Fragments of excised ovaries from prepubertal rats were used after assessing post-warming cellular viability, to determine the best vitrification protocol prior to retroauricular autografting. Pre-pubertal females (N=24) were castrated and divided into three group: Group 1 - fresh ovarian tissue transplantation; Group 2 - vitrified/warmed tissue transplantation; Group 3 - bilateral oophorectomy without transplantation. The ovarian fragments were exposed to solutions from the Ingamed® commercial kit, allocated in bacteriological loops and immersed in liquid nitrogen. Sixty days after transplantation, a vaginal mucus sample was collected for cytology tests, followed by sacrificing the animal, performing a cardiac puncture for collecting a blood sample to determine luteinizing hormone and estradiol levels, and excision of the transplanted fragment for histology tests. RESULTS: Vaginal cytology revealed that 87.5% of females from groups 1 and 2 had estrus while all females in Group 3 remained in diestrus. The mean LH value in groups 1 (0.08 mIU/mL) and 2 (0.34 mIU/mL) were statistically different from that of Group 3 (2.27 mIU/mL). E2 values did not differ between the groups. The histological analysis of Group 1 excised grafts versus those from Group 2 showed a higher percentage of primary follicles (62.5% vs. 12.5%), developing follicles (75% vs. 25%), corpus luteum (37.5% vs. 12.5%) and stromal region (100% vs. 87.5%). CONCLUSION: This study indicated that pre-pubertal ovarian tissue vitrification can be used to preserve fertility and to restore endocrine function in castrated rats.
Assuntos
Preservação da Fertilidade/métodos , Ovário/patologia , Preservação de Tecido/métodos , Animais , Criopreservação , Feminino , Ratos Wistar , Maturidade Sexual , Transplante Autólogo/métodosRESUMO
OBJECTIVE: To evaluate the efficiency of two vitrification protocols for rat immature testicular tissue and heterotopic transplantation. METHODS: Twenty-four pre-pubertal Wistar rats were divided into three groups (n=8). After orchiectomy, testicular fragments (3mm) from Groups 1 and 2 were vitrified with different cryoprotectant concentration solutions, using sterile inoculation loops as support. After warming up, the fragments were submitted to cell viability assessment by Trypan blue and histological evaluation. Vitrified (Groups 1 and 2) and fresh (Group 3) fragments were grafted to the animals periauricular region. After 8 weeks of grafting, the implant site was histologically analyzed. RESULTS: The viability recovery rate from Group 1 (72.09%) was higher (p=0.02) than that from Group 2 (59.19%). Histological analysis showed similar tubular integrity between fresh fragments from Groups 1 and 3. Group 2 samples presented lower tubular integrity. We ran histological analyses in the grafts from the Groups. In all groups, it was possible to see the implant site, however, no fragment of testicular tissue or signs of inflammation were histologically found in most samples from Groups 1 and 3. In one sample from Group 2, we found degenerated seminiferous tubules with necrosis and signs of an inflammatory process. In another sample from Group 2, we found seminiferous tubules in the implant site. CONCLUSION: The vitrification of pre-pubertal testicular tissue of rats showed little damage to cell viability through histological analysis when we used cryoprotectants in a lower concentration. Heterotopic transplantation could not preserve the structural organization of the testicular tissue.