Beyond the revised atlanta classification: a comprehensive review of the imaging assessment of acute pancreatitis and its complications.

While the Revised Atlanta Classification outlines the primary complications of acute pancreatitis, it is crucial to recognize additional factors that contribute to morbidity and mortality associated with acute pancreatitis. In this review, we discuss the imaging-based classification and staging of acute pancreatitis as described by the Revised Atlanta Classification, but also provide a comprehensive understanding of the pancreatic anatomy and its relation to surrounding structures, which is essential for imaging-based assessment of both acute pancreatitis and its complications. We further extend the discussion beyond common complications such as pseudocysts and walled-off necrosis to include lesser-known but significant complications such as peripancreatic infection, disconnected ductal disconnection syndrome, thrombosis, hemorrhage, and gastrointestinal complications. Additionally, illustrative examples are presented to highlight relevant points pertaining to real-life imaging assessment of acute pancreatitis and its complications.

Cross-sectional imaging of pancreatic leak: a pictorial review.

Pancreatic leaks occur when a disruption in the pancreatic ductal system results in the leakage of pancreatic enzymes such as amylase, lipase, and proteases into the abdominal cavity. While often associated with pancreatic surgical procedures, trauma and necrotizing pancreatitis are also common culprits. Cross-sectional imaging, particularly computed tomography, plays a crucial role in assessing postoperative conditions and identifying both early and late complications, including pancreatic leaks. The presence of fluid accumulation or hemorrhage near an anastomotic site strongly indicates a pancreatic fistula, particularly if the fluid is connected to the pancreatic duct or anastomotic suture line. Pancreatic fistulas are a type of pancreatic leak that carries a high morbidity rate. Early diagnosis and assessment of pancreatic leaks require vigilance and an understanding of its imaging hallmarks to facilitate prompt treatment and improve patient outcomes. Radiologists must maintain vigilance and understand the imaging patterns of pancreatic leaks to enhance diagnostic accuracy. Ongoing improvements in surgical techniques and diagnostic approaches are promising for minimizing the prevalence and adverse effects of pancreatic fistulas. In this pictorial review, our aim is to facilitate for radiologists the comprehension of pancreatic leaks and their essential imaging patterns.

Vascular Spectrum of Imaging Findings in COVID-19: Ischemic, Hemorrhagic, and Thromboembolic Complications

Abstract Ischemic strokes secondary to occlusion of large vessels have been described in patients with COVID-19. Also, venous thrombosis and pulmonary thromboembolism have been related to the disease. Vascular occlusion may be associated with a prothrombotic state due to COVID-19-related coagulopathy and endotheliopathy. Intracranial hemorrhagic lesions can additionally be seen in these patients. The causative mechanism of hemorrhage could be associated with anticoagulant therapy or factors such as coagulopathy and endotheliopathy. We report on cases of ischemic, thrombotic, and hemorrhagic complications in six patients diagnosed with SARS-CoV-2 infection. Chest computed tomography (CT) showed typical SARS-CoV-2 pneumonia findings in all the cases, which were all confirmed by either serology or reverse transcription polymerase chain reaction (RT-PCR) tests.

Lung Ultrasound as a Triage Tool in an Emergency Setting during the Covid-19 Outbreak: comparison with CT Findings

Abstract Background Lung ultrasound (LUS) can detect interstitial alveolar changes confined to the subpleural region, like those described in Covid-19. Objetive To evaluate how LUS findings correlate with chest computed tomography (CT) in patients admitted to the emergency department (ED) with suspicion of Covid-19. Methods Cross-sectional study of 20 patients (median age 43 years; interquartile range, 37-63 years; 50% male). All patients underwent LUS and chest CT on the day of ED admission. Each hemithorax was divided into 6 segments with similar landmarks, and equivalent scores (sc) of lesion severity were defined for both methods. The number of affected segments on LUS (LUSseg) was divided into tertiles (0-1, 2-5, and ≥6), and compared with number of affected segments on CT (CTseg), LUSsc, CTsc, and percentage of affected lung parenchyma through visual analysis (CTvis). ANOVA or Kruskal-Wallis test for continuous variables, chi-square test for categorical variables, and receiver operating characteristic (ROC) curve analysis to define optimal cutoff points were performed. P<0.05 was considered statistically significant. Results Median LUSsc, CTsc, CTseg, and CTvis were significantly different between groups. A clear separation between groups was demonstrated; patients with <2 affected segments on LUS were defined as low risk. The ROC curve showed good discriminative power to predict ≥6 affected segments on CT, with an area under the curve (AUC) of 0.97 and 0.98 for >7 LUSsc and >3 LUSseg, respectively. Conclusion LUS findings correlate with chest CT, and can help identify patients with normal lung or minor pulmonary involvement secondary to Covid-19. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Plasmablastic lymphoma of the anal canal in an HIV-infected patient.

BACKGROUND: The advent of antiretroviral therapy increased the life expectancy of human immunodeficiency virus (HIV)-positive patients and, consequently, the morbidity and mortality due to neoplasms. Plasmablastic lymphoma is one such neoplasm that generally presents with involvement of the oral cavity; cases of extra-oral involvement are rare. CASE REPORT: We report a case of plasmablastic lymphoma in a 46-year-old woman for whom the initial clinical manifestation was a painless perineal tumor accompanied by fecal incontinence. CONCLUSIONS: The possibility of this neoplasm should be considered in patients with HIV/acquired immune deficiency syndrome (HIV/AIDS) because its early diagnosis is essential so that the start of the treatment is not delayed.

Síndrome de Mayer-Rokitansky-Kuster-Hauser: relato de caso e revisão da literatura / Mayer-Rokitansky-Kuster-Hauser syndrome: a case report and literature review

Os autores descrevem o caso de uma paciente jovem com amenorreia primária e caracteres sexuais secundários normais. A investigação diagnóstica constatou a ocorrência da síndrome de Mayer-Rokitansky-Kuster-Hauser.

The authors describe the case of a young female patient with primary amenorrhea and normal secondary sexual characteristics. The diagnostic investigation demonstrated the occurrence of Mayer-Rokitansky-Kuster-Hauser's syndrome.

Evaluation of a compartmental model to describe non-esterified fatty acid kinetics in Holstein dairy cows.

The dynamics of non-esterified fatty acid (NEFA) metabolism in lactating dairy cows requires quantification if we are to understand how dietary treatments and disease influence changes in body condition (adipose reserves) and the production of milk fat. Recently, Thomaseth & Pavan (2003) presented a compartmental model (Thomaseth model), which employs the pattern of plasma insulin concentrations in humans to predict the dynamic changes that occur in the plasma concentrations of glucose and NEFA during an intravenous glucose tolerance test (IVGTT). The Thomaseth model, or at least a similar model, could have potential application to the field of energy metabolism in ruminants because it would enable the estimation of parameters that describe the rates of whole body disposition of glucose, and the production and utilization of NEFA. In this study we investigated the suitability of the Thomaseth model to describe NEFA and glucose kinetics in 10 lactating Holstein-Friesian cows given a standard IVGTT in early lactation. The Thomaseth model described the general pattern of the NEFA response and, in particular, described the downward-slope and nadir in NEFA concentrations reasonably well. However, it failed to describe the initial latency period (the period before NEFA concentrations decline precipitously), and it could not describe terminal 'rebound' plateau in NEFA concentration. Because of these inherent problems, the parameters of the Thomaseth model cannot be considered to provide accurate estimates of rates of NEFA production or utilization. It is concluded that the Thomaseth model is not suitable for describing NEFA kinetics in lactating dairy cows.

Tratamento endodôntico em sessäo única nas faculdades de Odontologia brasileiras / One-visit endodontic therapy in Brazilian dentistry college

Tendo em vista a polêmica que ainda causa a realizaçäo do tratamento dos canais com necrose e lesäo apical em uma única sessäo, os coordenadores dos cursos de Endodontia das Faculdades Brasileiras receberam um questionário que objetivou verificar o percentual de tal procedimento em suas clínicas, possibilitando a realizaçäo de um panorama nacional da filosofia da obturaçäo imediata em dentes necróticos com lesäo. Pôde-se comprovar que a maioria dos cursos de graduaçäo de Endodontia näo realiza a obturaçäo imediata em dentes necróticos com lesäo periapical, mesmo após realizarem os passos essenciais que fundamentam cientificamente tal conduta

Tratamento endodôntico em sessäo única / Endodontic treatment in single section

O presente estudo avalia a situaçäo do tratamento endodôntico em sessäo única de dentes necrosados com lesäo apical nas Universidades dos Estados Unidos da América. Foi enviada a cada Universidade uma carta explicativa com um questionário contendo 8 perguntas objetivas e 1 pergunta subjetiva. Totlizaram 61 cartas enviadas e 47 respondidas. A partir dos resultados concluímos que o tema ainda gera certa polêmica, porém a maior parte das Universidades pratica o tratamento de dentes sem vitalidade pulpar e com lesäo periapical em sessäo única

Momento da ovulação em ovelhas corriedale após cio natural e induzido com progestágeno e eCG / Time of ovulation in corriedale ewes after natural and induced ovulation with progestagen and eCG

Durante a estação reprodutiva (março e abril), dois experimentos foram conduzidos com 116 ovelhas da raça Comedale, objetivando verificar o momento de ovulação nesta raça após estro natural ou induzido com ou sem o "efeito macho". As ovelhas foram submetidas a laparoscopia em intervalos de quatro horas entre 20 e 40 horas depois da identificação do início do cio natural e entre 48 e 120 horas em cada uma de duas repetições após a remoção dos pessários impregnados com 50mg de medroxiprogesterona e injeção de 500UI de eCG (gonadotrofina sérica equina)ou até a ovulação ser observada. Após o cio natural, 96 por cento de 56 ovelhas ovularam sendo a maioria (85 por cento) entre 24 e 32 horas do início do cio. No grupo de 60 ovelhas submetido a indução de cio foi constatado que na média as ovulações ocorreram as 65,1±2,2 horas e 73,8±3,2 horas após a remoção dos pessários, respectivamente, para os grupos submetidos ou não ao efeito macho (P < 0,05). As ovulações não foram afetadas pela idade das ovelhas e repetição dos tratamentos hormonais. O momento de ovulação após o cio natural apresenta pouca variação, já após cio induzido constatou-se antecipação nas ovulações com o efeito macho sem alteração na amplitude de variação, fato este, que pode ser responsável pela variabilidade nas taxas de concepção após inseminação com sêmen congelado.

The aim of the present study was to verify the time of ovulation after natural or induced estrus in the Comedale ewe. The ram effect was also evaluated in the presence of induced estrus. Both treatments were examined by laparoscopy every four hours, from 20h to 40h after beginning the natural estrus, and from 48h to 120h after withdrawing the sponges or until ovulation was observed. After natural estrus, 96 percent from 56 ewes had ovulated, and most of the ovulations (85 percent) had occurred from 24 to 32h after the onset of heat. The mean time of ovulation in 60 ewes treated with progestagen pessaries (50mg, MAP, 12 days) and eCG injection (500IU at sponge withdrawai) was 65.1 ± 2.2h and 73.8 ± 3.2h respectively for groups with and without the presence of rams. This trait was affected by the ram effect (P < 0.05); however, it was neither influenced by the age of the ewes nor the repeated hormonal treatments. The time of ovulation after natural estrus, due to its small variation, is not likely to affect the results of artificial insemination with frozen semen. On the contrary, the time of ovulation, but not the range of ovulation distribution, was significantly increased in ewes with induced estrus when in the presence of rams. These results probably play a role in the success rate of the artificial insemination with frozen semen.