RESUMO
AIM: To evaluate the usefulness of computed tomography (CT) and chemical-shift magnetic resonance imaging (MRI) in patients with myasthenia gravis (MG) for differentiating thymoma (THY) from thymic lymphoid hyperplasia (TLH) and normal thymus (NT), and to determine which technique is more accurate. MATERIALS AND METHODS: Eighty-three patients with generalised MG who underwent surgery were divided into the TLH/NT group (A; 65 patients) and THY group (B; 24 patients). Differences in qualitative characteristics and quantitative data (CT: radiodensity in Hounsfield units; MRI: signal intensity index [SII]) between groups were tested using Fisher's exact test and Student's t-test. Logistic regression models were estimated for both qualitative and quantitative analyses. At quantitative analysis, discrimination abilities were determined according to the area under the receiver operating characteristic (ROC) curve (AUROC) with computation of optimal cut-off points. The diagnostic accuracies of CT and MRI were compared using McNemar's test. RESULTS: At qualitative assessment, MRI had higher accuracy than CT (96.4%, 80/83 and 86.7%, 72/83, respectively). At quantitative analysis, both the radiodensity and SII were significantly different between groups (p<0.0001). For CT, at quantitative assessment, the AUROC of the radiodensity in discriminating between groups was 0.904 (optimal cut-off point, 20 HU) with an accuracy of 77.1% (64/83). For MRI, the AUROC of the SII was 0.989 (optimal cut-off point, 7.766%) with an accuracy of 96.4% (80/83), which was significantly higher than CT (p<0.0001). By using optimal cut-off points for cases with an erroneous diagnosis at qualitative assessment, accuracy improved both for CT (89.2%, 74/83) and MRI (97.6%, 81/83). CONCLUSION: Quantitative analysis is useful in evaluating patients with MG and improves the diagnostic accuracy of CT and MRI based on qualitative assessment. Chemical-shift MRI is more reliable than CT in differentiating THYs from non-thymomatous conditions.
Assuntos
Imageamento por Ressonância Magnética/métodos , Miastenia Gravis/patologia , Timoma/diagnóstico , Neoplasias do Timo/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Meios de Contraste , Diagnóstico Diferencial , Humanos , Iohexol/análogos & derivados , Pessoa de Meia-Idade , Estudos Prospectivos , Timoma/diagnóstico por imagem , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgiaRESUMO
OBJECTIVE: Lymphoid proliferations of the salivary glands can be either reactive or malignant. Diagnosis based solely on fine needle aspiration (FNA) cytology may be troublesome in view of the difficulty in distinguishing low-grade B-cell and mucosa-associated lymphoid tissue (MALT) lymphomas from reactive lymphoid proliferations. We report our experience with FNA cytology combined with flow cytometry (FC) immunophenotyping for the diagnosis of lymphoproliferative processes affecting the salivary glands. METHODS: Sixty-one FNA specimens, obtained from salivary glands over a 10-year period, were analysed by cytology and FC. The results were correlated with histological follow-up if available. RESULTS: A diagnosis of lymphoma was given in 37 of 61 (61%) specimens; 22 of 61 (36%) specimens were considered as benign/reactive or non-lymphomatous processes; two of 61 (3%) specimens were considered as suspicious for lymphoma on cytological analysis and negative on FC. Histological control was available in 23 malignant, four non-lymphomatous and one cytologically suspicious case. Data obtained by the combination of cytology and FC were confirmed in all but one case: the case suspicious on cytology received a histological diagnosis of carcinoma. Four of seven cases with small populations of clonal cells (less than 15%) were histologically confirmed as lymphoma, whereas two remain under surveillance and one was reactive. Correlation with histological data showed a sensitivity of 100% and a specificity of 83% for the combination of cytology and FC. CONCLUSIONS: FC is fundamental for the diagnosis of lymphoproliferative lesions of the salivary glands. It may solve cytologically suspicious cases and detect the presence of neoplastic B or T cells. This combined approach reduces the time to therapy and may prevent unnecessary surgical biopsies.
Assuntos
Biópsia por Agulha Fina , Citodiagnóstico , Linfoma não Hodgkin/diagnóstico , Transtornos Linfoproliferativos/diagnóstico , Adulto , Idoso , Feminino , Citometria de Fluxo , Humanos , Linfoma não Hodgkin/patologia , Transtornos Linfoproliferativos/patologia , Masculino , Pessoa de Meia-Idade , Glândulas Salivares/patologiaRESUMO
PURPOSE: This retrospective analysis was carried out to assess the feasibility and results of transjugular intrahepatic portal systemic shunt (TIPS) performed with ultrasound (US)-guided percutaneous puncture of the hepatic veins. MATERIAL AND METHODS: Over a period of 3 years, 153 patients were treated with TIPS at our centre. In eight cases, a percutaneous puncture of the middle (n=7) or right (n=1) hepatic vein was required because the hepatic vein ostium was not accessible. Indications for TIPS were bleeding (n=1), Budd-Chiari syndrome (n=1), ascites (n=2), reduced portal flow (n=1) and incomplete portal thrombosis (n=3). A 0.018-in. guidewire was anterogradely introduced into the hepatic vein to the inferior vena cava (IVC) through a 21-gauge needle. In the meantime, a 25-mm snare-loop catheter was introduced through the jugular access to retrieve the guidewire, achieving through-andthrough access. Then, a Rosch-Uchida set was used to place the TIPS with the traditional technique. RESULTS: Technical success was achieved in all patients. There was one case of stent thrombosis. One patient died of pulmonary oedema. Three patients were eligible for liver transplantation, whereas the others were excluded due to shunt thrombosis (n=1) and previous nonhepatic neoplasms (n=3). CONCLUSIONS: The percutaneous approach to hepatic veins is rapid and safe and may be useful for avoiding traumatic liver injuries.
Assuntos
Veias Hepáticas/cirurgia , Hipertensão Portal/etiologia , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Ultrassonografia de Intervenção , Adulto , Idoso , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Punções , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: Microwave thermal ablation (MWA) opens up a new scenario in the field of image-guided tumour ablation thanks to its potential advantages over validated radiofrequency ablation (RFA). In this pilot study, we assessed the technical success, safety and efficacy of MWA in treating hepatic malignancies. MATERIALS AND METHODS: After obtaining informed consent, we enrolled 15 inoperable patients, for a total of 19 lesions (ten metastases, nine hepatocellular carcinoma) with a mean diameter of 47 mm (range 14-78 mm). Mean follow-up was 8 (range 1-14) months. RESULTS: Technical success reached 100%. Complications (one major and one minor) occurred in two cases. Complete ablation, obtained in 68.4% of cases, showed no significant correlation with either cancer histological type or with lesion diameter. At follow-up, treatment failures occurred in 60% of cases; lesion diameter was the only prognostic factor for maintaining complete ablation. CONCLUSIONS: Our preliminary results should encourage further trials of this technique. MWA proved to be feasible and safe in treating advanced-stage liver tumours and represented an additional therapeutic attempt to be validated in further and larger efficacy studies.
Assuntos
Ablação por Cateter/métodos , Neoplasias Hepáticas/cirurgia , Micro-Ondas/uso terapêutico , Carcinoma Hepatocelular/cirurgia , Seguimentos , Humanos , Neoplasias Hepáticas/secundário , Projetos Piloto , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study was to review some prognostic factors for survival after radiofrequency ablation (RFA) of metastases from colorectal cancer (CRC). MATERIALS AND METHODS: From 1996 to 2009, 262 patients with metastases from CRC were treated with RFA. Fourteen were lost to follow-up. The following predictors were analysed in the remaining 248: synchronous/metachronous metastases, single/multiple metastases, diameter of largest metastasis and absence/presence of extrahepatic metastases. Survival was measured from the date of metastasis diagnosis and from the date of RFA. RESULTS: Survival at 1, 2, 3 and 5 years was 93%, 78%, 62% and 35% from metastasis diagnosis, and 84%, 59%, 43% and 23% from the date of RFA. Median survival was 41 months in patients with largest metastasis ≤3 cm and 21.7 months for those with metastases >3 cm (p=0.0001); survival increased to 45.2 months in patients with largest metastasis ≤2.5 cm and fell to 18.5 months in those with metastasis >3.5 cm. Median survival of patients with extrahepatic metastases was significantly lower than that of patients without extrahepatic disease (23.3 vs. 32.6 months, p=0.018). CONCLUSIONS: In light of our long-term results obtained with commonly used equipment, small lesion size (diameter of largest lesion ≤3 or 2.5 cm) proved to be the most favourable prognostic factor for survival in patients with CRC metastases to the liver treated with RFA. This conclusion is probably related to the possibility of obtaining radical ablation and points to the usefulness of devices allowing ablation of larger volumes. In the presence of extrahepatic metastases, RFA has less impact on survival, even though it is potentially useful in patients at a higher risk of death due to hepatic rather than extrahepatic metastases.
Assuntos
Ablação por Cateter/métodos , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Distribuição de Qui-Quadrado , Neoplasias Colorretais/tratamento farmacológico , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida , Resultado do TratamentoRESUMO
This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.
Assuntos
COVID-19 , Medicina do Trabalho , Psiquiatria , Telemedicina , Feminino , Pessoal de Saúde , Humanos , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Quarentena , SARS-CoV-2RESUMO
OBJECTIVES: Although several findings have highlighted the prevalence of Axis I psychiatric disorders in fibromyalgia (FM) and rheumatoid arthritis (RA), very little information is available on the prevalence of subthreshold mood symptoms in these conditions. Therefore, we aimed at comparing the prevalence of subthreshold mood symptoms in rheumatic patients suffering from FM and RA. The hypothesis is that subthreshold mood symptoms are more represented in FM, given the evidence of higher rates of Axis I psychopathology in FM than in RA. METHODS: Sixty patients suffering from FM and 50 from RA, assessed according to the American College of Rheumatology (ACR) criteria, selected in a Rheumatology Department, were included in the study. The subthreshold affective symptoms were assessed by means of the Mood Spectrum-Self Report (MOODS-SR). RESULTS: The results showed that FM patients presented significantly higher scores than RA patients in 'mood depressive', 'cognition depressive' domains and in total depressive component. CONCLUSIONS: The present study demonstrates that subthreshold depressive symptoms are more represented in FM than in RA patients. This fact could play a role in the worse quality of life and in the major perception of pain which characterises FM.
Assuntos
Artrite Reumatoide/psicologia , Dor Crônica/psicologia , Fibromialgia/psicologia , Transtornos do Humor/psicologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Comorbidade , Feminino , Fibromialgia/diagnóstico , Fibromialgia/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Qualidade de Vida , SíndromeRESUMO
BACKGROUND: Prophylactic use of abdominal drain in gastrectomy has been questioned in the last 15 years, and a 2015 Cochrane meta-analysis on four RCTs concluded that there was no convincing evidence to the routine drain placement in gastrectomy. Nevertheless, the authors evidenced the moderate/low quality of the included studies and highlighted how 3 out of 4 came from Eastern countries. After 2015, only retrospective studies have been published, all with inconsistent results. METHODS: ADiGe (Abdominal Drain in Gastrectomy) Trial is a multicenter prospective randomized non-inferiority trial with a parallel design. It aimed to verify whether avoiding routine use of abdominal drain is burdened with complications, particularly an increase in postoperative invasive procedures. Patients with gastric cancer, scheduled for subtotal or total gastrectomy with curative intent, are eligible for inclusion, irrespective of previous oncological treatment. The primary composite endpoint is reoperation or percutaneous drainage procedures within 30 postoperative days. The primary analysis will verify whether the incidence of the primary composite endpoint is higher in the experimental arm, avoiding routine drain placement, than control arm, undergoing prophylactic drain placement, in order to falsify or support the null hypothesis of inferiority. Secondary endpoints assessed for superiority are overall morbidity and mortality, Comprehensive Complications Index, incidence and time for diagnosis of anastomotic and duodenal leaks, length of hospital stay, and readmission rate. Assuming one-sided alpha of 5%, and cumulative incidence of the primary composite endpoint of 6.4% in the control arm and 4.2% in the experimental one, 364 patients allow to achieve 80% power to detect a non-inferiority margin difference between the arm proportions of 3.6%. Considering a 10% drop-out rate, 404 patients are needed. In order to have a balanced percentage between total and subtotal gastrectomy, recruitment will end at 202 patients for each type of gastrectomy. The surgeon and the patient are blinded until the end of the operation, while postoperative course is not blinded to the patient and caregivers. DISCUSSION: ADiGe Trial could contribute to critically re-evaluate the role of prophylactic drain in gastrectomy, a still widely used procedure. TRIAL REGISTRATION: Prospectively registered (last updated on 29 October 2020) at ClinicalTrials.gov with the identifier NCT04227951 .
Assuntos
Gastrectomia , Complicações Pós-Operatórias , Drenagem , Gastrectomia/efeitos adversos , Humanos , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos RetrospectivosRESUMO
BACKGROUND: Boerhaave's syndrome (BS) is a rare life-threating condition with poor prognosis. Unfortunately, due to its very low incidence, no clear evidences or definitive guidelines are currently available: in detail, surgical strategy is still a matter of debate. Most of the case series reports thoracic approach as the most widely used; conversely, transhiatal abdominal management is just described in sporadic case reports. In our center, the laparoscopic approach has been adopted for years: in the present study, we aim to show his feasibility by reporting the outcomes of the largest clinical series available to date. METHODS: Clinical records of patients admitted for BS to the General and Upper GI Surgery Division of Verona from February 2014 to December 2019 were retrospectively collected. Clinico-pathological characteristics, preoperative workup, surgical management, and outcomes were analyzed. RESULTS: Seven patients were admitted; epigastric/thoracic pain and vomiting were the most frequent symptoms at diagnosis. Laboratory findings were not specific; conversely, radiological imaging always revealed abnormal findings: particularly, CT had excellent sensitivity in detecting signs of esophageal perforation. All but one case had diagnostic workup and received surgery within 24 h. Every patient had laparoscopic transhiatal direct suture and gastric valve; 2 patients (28.6%) also needed a thoracoscopic toilette. Postoperative complications occurred in 4 patients (57%), but in only two of them (29%), the complication was severe according to Clavien-Dindo classification (both received thoracentesis or thoracic drainage for pleural effusion). Of note, no cases of postoperative esophageal leak were recorded. Postoperative mortality was 14% due to one patient who died for cardiovascular complications. Most of the patients (71.4%) were admitted to ICU after surgery (average length, 8.8 days); mean hospital stay was 14.7 days. No patients had readmissions. CONCLUSIONS: To our knowledge, this is the largest case series reporting laparoscopic management of BS. We show that laparoscopy is a safe and feasible approach associated with a shorter length of hospital stay when compared with clinical series in which thoracic approach had been chosen. Of note, laparoscopic management would be easily adopted by surgical centers treating benign gastro-esophageal junction entailing a proper management more widely.
Assuntos
Perfuração Esofágica/cirurgia , Laparoscopia/métodos , Doenças do Mediastino/cirurgia , Técnicas de Sutura , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Itália , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
This review discusses the usefulness of bedside lung ultrasound in the diagnostic distinction between the various causes of acute dyspnoea in the emergency department, with special attention to the differential diagnosis of pulmonary oedema and exacerbation of chronic obstructive pulmonary disease (COPD). This is made possible by using mid- to low-end scanners and simple acquisition techniques accessible to both radiologists and clinicians. Major advantages include ready availability at the bedside, the absence of ionising radiation, high reproducibility and cost efficiency. The technique is based on the recognition and analysis of sonographic artefacts rather than direct visualisation of the pulmonary structures. These artefacts are caused by the interaction of water-rich structures and air, called comet tails or B-lines. When such artefacts are widely detected on anterolateral transthoracic lung scans, diffuse alveolar-interstitial syndrome can be diagnosed, which is often a sign of acute pulmonary oedema. This condition rules out exacerbation of COPD as the main cause of acute dyspnoea.
Assuntos
Artefatos , Dispneia/etiologia , Insuficiência Cardíaca/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Doença Aguda , Diagnóstico Diferencial , Dispneia/diagnóstico por imagem , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/complicações , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Edema Pulmonar/complicações , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Síndrome , UltrassonografiaRESUMO
Objective Many patients with adrenocortical carcinoma (ACC) suffer from tumor recurrence despite radical surgery. Evidence on the post-operative use of mitotane is controversial and no predictors of response are available. We aimed to assess whether adjuvant mitotane treatment may prolong survival in patients with non-metastatic ACC following complete resection and whether ACC patients at high risk of recurrence may benefit from treatment. Design and methods We retrospectively reviewed data from 152 non-metastatic ACC patients followed at the San Luigi Gonzaga Hospital: 100 patients were treated with adjuvant mitotane and 52 patients were left untreated following surgery. We assessed a number of potential predictive factors of recurrence and death. Mitotane effect was explored stratifying patients by staging (stage I-II vs stage III), hormone secretion (yes vs no) and Ki67 index. Results The non-treated group had a higher risk of recurrence (HR: 2.79, 95%CI: 1.58-4.91; P < 0.001) than mitotane-treated group, while overall survival was not significantly different between groups. Hormone secretion, elevated Weiss score and elevated Ki67 index confer a higher risk of both recurrence and death and stage III ACC of death. Adjuvant mitotane treatment reduced significantly the risk of death in patients with elevated Ki67 index (P = 0.005) and in patients with stage III ACC (P = 0.02). Conclusions Adjuvant mitotane may prolong recurrence-free survival in radically resected ACC patients with acceptable toxicity and may also prolong overall survival in a subgroup of ACC patients at high risk of recurrence.
Assuntos
Neoplasias do Córtex Suprarrenal/tratamento farmacológico , Carcinoma Adrenocortical/tratamento farmacológico , Antineoplásicos Hormonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Mitotano/administração & dosagem , Recidiva Local de Neoplasia/tratamento farmacológico , Adolescente , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/mortalidade , Carcinoma Adrenocortical/diagnóstico , Carcinoma Adrenocortical/mortalidade , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/mortalidade , Fatores de Risco , Taxa de Sobrevida , Adulto JovemRESUMO
We report on the electrically controlled optical phase modulator behavior of light sculptured periodic structures made of polymer slices alternated to films of well aligned Liquid Crystals (POLICRYPS). Arbitrarily polarized light normally incident on the structure experiences a birefringence that depends on the anisotropy of the composite liquid crystalline material and on the geometrical cell parameters. The sample behaves as a retardation plate in good agreement with the Jones matrices formalism. Birefringence tuning is obtained by applying a suitable voltage, while a negligible birefringence variation is detected by increasing the incidence power. This makes POLICRYPS structures suitable as switchable phase retarders for high power laser beams.
Assuntos
Desenho Assistido por Computador , Eletrônica/instrumentação , Lasers , Cristais Líquidos/química , Modelos Teóricos , Polímeros/química , Refratometria/instrumentação , Simulação por Computador , Desenho de Equipamento , Análise de Falha de Equipamento , Integração de SistemasRESUMO
Bartonella henselae is the causative agent of cat-scratch disease and other disorders, including hepatosplenic granulomatosis. This infection has only rarely been reported after solid organ transplantation, where it can mimic the more common post-transplant lymphoproliferative disease. Here we present a case of asymptomatic B. henselae hepatic and lymph nodal granulomatosis in a pediatric patient who had received orthotopic liver transplant 2 months before; we hypothesize that the causative agent was transmitted from the donor. This infection developed early in the post-transplant period; the disease involved only the graft liver and the regional lymph nodes, and the patient did not have a cat or any history of contact, scratches, or bites by a cat. In our patient this infection resolved successfully with a combination of 2 associated antibiotics and reduction of immunosuppressive therapy.
Assuntos
Bartonella henselae/isolamento & purificação , Doença da Arranhadura de Gato/diagnóstico , Neoplasias Hepáticas/diagnóstico , Transplante de Fígado/efeitos adversos , Granulomatose Linfomatoide/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Amicacina/uso terapêutico , Anti-Infecciosos/uso terapêutico , Anticorpos Antibacterianos/sangue , Azitromicina/uso terapêutico , Doença da Arranhadura de Gato/tratamento farmacológico , Doença da Arranhadura de Gato/etiologia , Doença da Arranhadura de Gato/transmissão , Criança , Humanos , Imunossupressores/administração & dosagem , Fígado/diagnóstico por imagem , Fígado/microbiologia , Fígado/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/microbiologia , Linfonodos/diagnóstico por imagem , Linfonodos/microbiologia , Linfonodos/patologia , Granulomatose Linfomatoide/tratamento farmacológico , Granulomatose Linfomatoide/etiologia , Granulomatose Linfomatoide/microbiologia , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/microbiologia , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , RNA Ribossômico 23S/análise , Tacrolimo/administração & dosagem , Doadores de Tecidos , Transplantes/microbiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , UltrassonografiaRESUMO
INTRODUCTION: Actually, thyroid volume >25 ml, obtained by preoperative ultrasound evaluation, is a very important exclusion criteria for minimally invasive thyroidectomy. So far, among different imaging techniques, two-dimensional ultrasonography has become the more accepted method for the assessment of thyroid volume (US-TV). The aims of this study were: (1) to estimate the preoperative thyroid volume in patients undergoing minimally invasive total thyroidectomy using a mathematical formula and (2) to verify its validity by comparing it with the postsurgical TV (PS-TV). MATERIALS AND METHOD: In 53 patients who underwent minimally invasive total thyroidectomy (from January 2003 to December 2007), US-TV, obtained by ellipsoid volume formula, was compared to PS-TV determined by the Archimedes' principle. A mathematical formula able to predict the TV from the US-TV was applied in 34 cases in the last 2 years. RESULTS: Mean US-TV (14.4 +/- 5.9 ml) was significantly lower than mean PS-TV (21.7 +/- 10.3 ml). This underestimation was related to gland multinodularity and/or nodular involvement of the isthmus. A mathematical formula to reduce US-TV underestimation and predict the real TV was developed using a linear model. Mean predicted TV (16.8 +/- 3.7 ml) perfectly matched mean PS-TV, underestimating PS-TV in 19% of cases. We verified the accuracy of this mathematical model in patients' eligibility for minimally invasive total thyroidectomy, and we demonstrated that a predicted TV <25 ml was confirmed post-surgery in 94% of cases. CONCLUSIONS: We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two-dimensional US can provide the accurate estimation of thyroid volume but that it can be improved by a mathematical model. This may contribute to a more appropriate surgical management of thyroid diseases.
Assuntos
Bócio Nodular/diagnóstico por imagem , Bócio Nodular/cirurgia , Hipertireoidismo/diagnóstico por imagem , Hipertireoidismo/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Cicatriz/etiologia , Estética , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Medição da Dor , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , UltrassonografiaRESUMO
We present a numerical approach to the nemato-elasticity differential equation in a nematic liquid crystal cell when irradiated with multiple gaussian beams. Solutions have been carried out on a configuration with two coplanar beams illuminating the sample in order to compare it with particular nonlinear phenomena experimentally studied in the past. A new set of experimental measures were realized confirming the validity of the numerical model. Solutions for an instable case showing nonlocal effects are also presented as an example of the broader class of systems this approach can describe.
RESUMO
BACKGROUND: Recently, in advanced non-small cell lung cancer (NSCLC), standard chemotherapy was flanked by biological agents directed against genomic abnormalities, including EGFR and ALK alterations, that significantly improved patient outcome. Despite these achievements, tumour progression almost always occurs and a reassessment of the tumour genetic profile may contribute to modulating the therapeutic regimen. Resampling may provide tissue for additional tests to detect acquired resistance and/or new genetic alterations, but the currently available information is limited. PATIENTS AND METHODS: Histological and genetic reassessments of biopsy or surgical tissue samples from 50 non-squamous NSCLC patients before and after at least one systemic treatment were performed. EGFR, KRAS, BRAF, PIK3CA and HER2 mutations were sequenced, p.T790M was identified with real-time PCR, and ALK and MET genomic alterations by fluorescence in situ hybridization. RESULTS: Overall in baseline biopsies, 37/50 (74 %) tumours had genetic alterations, either single (52 %) or multiple (22 %). Among them, 16 were EGFR mutations and 6 ALK rearrangements. In the second tissue sampling, 54 % of cases had additional genomic changes, including newly acquired alterations (81 %) or losses (18 %). The commonest changes were MET amplification and p.T790M mutation. One case had a histological shift from adenocarcinoma to small cell carcinoma. CONCLUSIONS: The remarkable number of molecular changes following systemic therapy and the genetic complexity of some cases underline the value of histological and molecular re-evaluation of lung cancer to tailor the most appropriate therapy during disease progression.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Adulto , Idoso , Biópsia , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante , Estudos RetrospectivosRESUMO
Malignant Pleural Mesothelioma (MPM) remains a relevant public health issue, and asbestos exposure is the most relevant risk factor. The incidence has considerably and constantly increased over the past two decades in the industrialized countries and is expected to peak in 2020-2025. In Italy, a standardized-rate incidence in 2011 among men was 3.5 and 1.25 per 100,000 in men and women, respectively, and wide differences are noted among different geographic areas. The disease remains challenging in terms of diagnosis, staging and treatment and an optimal strategy has not yet been clearly defined. The Third Italian Multidisciplinary Consensus Conference on Malignant Pleural Mesothelioma was held in Bari (Italy) in January 30-31, 2015. This Consensus has provided updated recommendations on the MPM management for health institutions, clinicians and patients.
Assuntos
Neoplasias Pulmonares , Mesotelioma , Neoplasias Pleurais , Animais , Humanos , Incidência , Itália/epidemiologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Mesotelioma/complicações , Mesotelioma/diagnóstico , Mesotelioma/epidemiologia , Mesotelioma/terapia , Mesotelioma Maligno , Derrame Pleural/etiologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/epidemiologia , Neoplasias Pleurais/terapia , Saúde Pública , Fatores de RiscoRESUMO
It has been suggested that occlusal interference may increase habitual activity in the jaw muscles and may lead to temporomandibular disorders (TMD). We tested these hypotheses by means of a double-blind randomized crossover experiment carried out on 11 young healthy females. Strips of gold foil were glued either on a selected occlusal contact area (active interference) or on the vestibular surface of the same tooth (dummy interference) and left for 8 days each. Electromyographic masseter activity was recorded in the natural environment by portable recorders under interference-free, dummy-interference, and active-interference conditions. The active occlusal interference caused a significant reduction in the number of activity periods per hour and in their mean amplitude. The EMG activity did not change significantly during the dummy-interference condition. None of the subjects developed signs and/or symptoms of TMD throughout the whole study, and most of them adapted fairly well to the occlusal disturbance.
Assuntos
Força de Mordida , Oclusão Dentária , Hábitos , Músculo Masseter/fisiologia , Adaptação Fisiológica/fisiologia , Adolescente , Adulto , Análise de Variância , Estudos Cross-Over , Método Duplo-Cego , Eletromiografia , Feminino , Humanos , Monitorização Ambulatorial , Contração Muscular , Valores de Referência , Estatísticas não ParamétricasRESUMO
Like most small mammals, Mongolian gerbils (Meriones unguiculatus) are born without the ability to maintain core body temperature (Tb). Breeding adults, juvenile alloparents, nest materials, and other litter mates probably contribute to the maintenance of core body temperature in neonates, but the relative role of each factor is unknown. We developed a procedure allowing biotransmitters to be implanted into 9-day-old pups for use with a radiotelemetry system. Experiment 1 demonstrated the development of thermoregulatory capacity over postpartum days 11, 15, and 19. Pups at 11 days of age lacked thermoregulatory capacity, and maintained Tb only slightly above the ambient temperature (15 degrees C) of the testing environment. The transition from poikilothermy to homeothermy was clearly accomplished by day 19, with pups maintaining Tb of 35.8 +/- 0.2 degrees C for at least 100 min. Experiment 2 measured Tb in 11- and 12-day-old pups during a thermal challenge (15 degrees C) in the presence of nest materials, litter mates, or both. Pups provided with either nest materials, litter mates, or both maintained higher Tb during a 40-min test than those without these resources. Our methodology minimizes disruptions and the thermal consequences associated with other invasive (rectal probe thermistors) and noninvasive (e.g., infrared thermography) procedures.