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1.
ACG Case Rep J ; 11(9): e01492, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39238885

RESUMO

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition characterized by the presence of a collection of individual gas cysts in the submucosa and subserosa of the intestine. The etiology of PCI is still unclear. We experienced 3 cases with PCI during treatment for pulmonary Mycobacterium avium complex (MAC) infection. Each case was treated conservatively. We believe our case series will highlight the importance of examining the gastrointestinal tract of patients with MAC infection and hopefully elucidate the clinical characteristics of PCI which developed during MAC treatment.

2.
Clin Case Rep ; 12(3): e8652, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38464587

RESUMO

An elderly patient with upper back pain and hypertension was diagnosed as having spontaneous spinal epidural hematoma (SSEH) after excluding artery dissection. The initial symptoms of SSEH mimic those of artery dissection, and the symptoms of spinal damage frequently appear later. Physicians should, therefore, be mindful of SSEH.

3.
BMJ Open ; 14(1): e076678, 2024 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-38171629

RESUMO

OBJECTIVES: In older patients, the diagnosis of acute pyelonephritis (APN) is challenging. The aim was to evaluate the added value of CT to history, physical examination and urinalysis for the diagnosis of APN in older patients with suspected infection with an unknown focus. DESIGN: Retrospective diagnostic study. SETTING: Department of General Medicine in an acute care hospital in Japan. PARTICIPANTS: Patients aged ≥65 years who underwent blood cultures, a urine culture, and chest and abdominal CT to detect the focus of infection were included. PRIMARY OUTCOME MEASURES: Two radiologists independently reviewed four non-contrast CT signs: perirenal fat stranding, pelvicalyceal wall thickening, enlargement of the kidney and thickening of Gerota's fascia. Findings on contrast-enhanced CT could not be evaluated due to an insufficient number of patients in whom contrast-enhanced CT was performed. An expert panel was used as the reference standard for APN. The added value of CT findings was quantified by comparing the diagnostic performance between a model based on 10 predictors available before CT and an extended model including the CT findings. RESULTS: Of 473 patients, 61 (14.8%) were diagnosed with APN. When the laterality of the CT findings was taken into account, the model fit was not improved by adding them. In the laterality-insensitive analysis, the model performance was significantly improved by adding the CT signs (likelihood-ratio test p=0.03; c-index 0.89 vs 0.91, p=0.03). However, their clinical utility was only to improve the classification of 11.5% of patients with APN. CONCLUSIONS: The added value of non-contrast CT findings to history, physical examination and urinalysis was limited for the diagnosis of APN in older patients with a suspected infection with an unknown focus.


Assuntos
Pielonefrite , Tomografia Computadorizada por Raios X , Humanos , Idoso , Estudos Retrospectivos , Doença Aguda , Pielonefrite/diagnóstico por imagem , Rim
4.
BMC Pregnancy Childbirth ; 22(1): 323, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35428216

RESUMO

BACKGROUND: Ovarian vein thrombosis (OVT) may cause maternal mortality by inducing pulmonary thromboembolism (PTE). However, the prevalence, etiology, risk factors, prognosis, and optimal treatments for asymptomatic OVT during and after pregnancies are unclear, which therefore requires a high clinical index of suspicion for certain diagnoses due to its vague presentation. We herein present a case of asymptomatic postpartum OVT that extended toward the inferior vena cava (IVC), resulting in a potential risk of PTE. CASE PRESENTATION: A 30-year-old postpartum woman presented with slight dyspnea after an uneventful vaginal delivery at 40 weeks of gestation. We checked her laboratory data to exclude lethal thrombosis; D-dimer levels were 85.6 µg/mL. We performed computed tomography (CT) to search the presence of PTE and deep vein thrombosis (DVT); although no signs of PTE and DVT in her legs were detected, CT and trans-abdominal ultrasonography (TAUS) revealed a right OVT. Heparin was administered, and D-dimer levels decreased; warfarin at a dose of 2 mg/day was subsequently administered to control anti-coagulopathy. However, D-dimer was re-elevated despite adequate anticoagulation treatment, and extension of the right OVT to the IVC was detected by CT and TAUS. With warfarin administration, CT and TAUS showed the disappearance of right OVT. The patient was discharged from the hospital 17 days after delivery. CONCLUSIONS: Even asymptomatic postpartum OVT may lead to PTE. Universal screening guidelines and optimal treatment strategies for asymptomatic OVT in pregnant and postpartum women should be established through future studies.


Assuntos
Embolia Pulmonar , Trombose , Trombose Venosa , Adulto , Feminino , Humanos , Ovário/diagnóstico por imagem , Período Pós-Parto , Gravidez , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Varfarina/uso terapêutico
5.
Acta Radiol ; 63(2): 268-277, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33508952

RESUMO

BACKGROUND: In older adults, the diagnosis of acute pyelonephritis is challenging because of non-specific symptoms and false-positive urine test results. Few studies have investigated the diagnostic performance of computed tomography (CT) signs. PURPOSE: To evaluate the diagnostic performance of CT signs for acute pyelonephritis in older patients suspected of infection with unknown focus. MATERIAL AND METHODS: This cross-sectional study was conducted between 2015 and 2018. Patients aged ≥65 years who underwent blood cultures, urine culture, and non-contrast or contrast-enhanced CT on admission were included. Cases with clinically presumable infection focus before CT were excluded. Two radiologists blinded to clinical information independently reviewed five CT signs: perirenal fat stranding; pelvicalyceal wall thickening and enhancement; renal enlargement; thickening of Gerota's fascia; and area(s) of decreased attenuation. The final diagnoses were made by a clinical expert panel. RESULTS: Among 473 eligible patients, 61 were diagnosed with acute pyelonephritis. When the laterality of findings between the left and right kidneys were considered, the positive and negative likelihood ratios of perirenal fat stranding were 4.0 (95% confidence interval [CI] = 2.3-7.0) and 0.8 (95% CI = 0.7-0.9) in non-contrast CT, respectively. The other signs in non-contrast CT showed similar diagnostic performance with positive and negative likelihood ratios of 3.5-11.3 and 0.8-0.9, respectively. CONCLUSION: CT signs can help physicians diagnose acute pyelonephritis in older patients suspected of infection with unknown focus.


Assuntos
Pielonefrite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pielonefrite/etiologia , Sensibilidade e Especificidade
6.
J Comput Assist Tomogr ; 43(4): 664-670, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31259851

RESUMO

PURPOSE: To assess the diagnostic ability of whole-body magnetic resonance imaging (MRI) using integrated positron emission tomography/MRI(PET/MRI). METHODS: Axial T2-weighted image (T2WI), diffusion-weighted imaging (DWI), coronal T1-weighted image (T1WI), axial volumetric interpolated breath-hold examination in the lung field, and 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG-PET) were evaluated in combination with T2WI alone, T2WI + DWI, T2WI + DWI + T1WI, T2WI + DWI + T1WI + volumetric interpolated breath-hold examination (all MRI images), and all MRI + FDG-PET. RESULTS: A total of 370 lesions were observed in 90 (62.5%) of the 144 patients. The lesion-based sensitivities were 62%, 74%, 74%, 76%, and 94%, and the patient-based sensitivities were 70%, 77%, 77%, 77%, and 81% using T2WI, T2WI + DWI, T2WI + DWI + T1WI, all MRI, and all MRI + FDG-PET, respectively. There were significant differences in the lesion-based sensitivity between T2WI and other sequence combinations and between all MRI and all MRI + FDG-PET. No significant differences were observed between any combinations among the patient-based sensitivities. CONCLUSION: The sensitivity of whole-body MRI was lower when lesion based, but almost equivalent when patient based compared with PET/MRI.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Imagem Corporal Total/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fluordesoxiglucose F18/uso terapêutico , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
7.
Fukushima J Med Sci ; 63(2): 90-99, 2017 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-28680010

RESUMO

AIMS: To evaluate the relationship between the apparent diffusion coefficient (ADC) value for bladder cancer and the recurrence/progression risk of post-transurethral resection (TUR). METHODS: Forty-one patients with initial and non-muscle-invasive bladder cancer underwent MRI from 2009 to 2012. Two radiologists measured ADC values. A pathologist calculated the recurrence/progression scores, and risk was classified based on the scores. Pearson's correlation was used to analyze the correlations of ADC value with each score and with each risk group, and the optimal cut-off value was established based on receiver operating characteristic (ROC) curve analysis. Furthermore, the relationship between actual recurrence / progression of cases and ADC values was examined by Unpaird U test. RESULTS: There were significant correlations between ADC value and the recurrence score as well as the progression score (P<0.01, P<0.01, respectively). There were also significant correlations between ADC value and the recurrence risk group as well as progression risk group (P=0.042, P<0.01, respectively). The ADC cut-off value on ROC analysis was 1.365 (sensitivity 100%; specificity 97.4%) for the low and intermediate recurrence risk groups, 1.024 (sensitivity 47.4%; specificity 100%) for the intermediate and high recurrence risk groups, 1.252 (sensitivity 83.3%; specificity 81.3%) for the low and intermediate progression risk groups, and 0.955 (sensitivity 87.5%; specificity 63.2%) between the intermediate and high progression risk groups. The difference between the ADC values of the recurrence and nonrecurrence group in Unpaired t test was significant (P<0.05). CONCLUSION: ADC on MRI in bladder cancer could potentially be useful, non-invasive measurement for estimating the risks of recurrence and progression.


Assuntos
Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia/etiologia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Idoso , Difusão , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Neoplasias da Bexiga Urinária/cirurgia
8.
Can J Gastroenterol Hepatol ; 2017: 4385161, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28349044

RESUMO

Background. A new agent, potassium-competitive acid blocker vonoprazan (VPZ) has potent acid-inhibitory effects and may offer advantages over conventional H. pylori eradication therapies. We aimed to compare the eradication rate between VPZ-based treatment and PPI-based one. Methods. This randomized controlled trial was designed to assign 141 patients with H. pylori-positive gastritis to VPZ group (VPZ 20 mg, amoxicillin 750 mg, and clarithromycin 200 or 400 mg twice daily for 7 days) or PPI group (rabeprazole 20 mg or lansoprazole 30 mg, amoxicillin 750 mg, and clarithromycin 200 or 400 mg twice daily for 7 days). Primary endpoints were eradication rates and adverse events. Results. Seventy of 72 patients in VPZ group and 63 of 69 patients in PPI group completed the treatment after 7 days. The eradication rate was significantly higher in VPZ group than PPI group by intention-to-treat analysis (95.8% versus 69.6%, P = 0.00003, 95% confidence interval [CI] 88.3-99.1% versus 57.3-80.1%) and per-protocol analysis (95.7% versus 71.4%, P = 0.0002, 95% CI 88.0-99.1% versus 58.7-82.1%). The incidence of adverse events was not different between the groups (26.3% in VPZ group versus 37.7% in PPI group, P = 0.15). Conclusion. VPZ-based regimen is more useful than that PPI-based regimen as a first-line H. pylori eradication therapy.


Assuntos
Infecções por Helicobacter/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Pirróis/uso terapêutico , Sulfonamidas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Quimioterapia Combinada , Feminino , Helicobacter pylori/efeitos dos fármacos , Humanos , Japão , Lansoprazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Rabeprazol/uso terapêutico , Método Simples-Cego , Resultado do Tratamento
9.
J Nippon Med Sch ; 83(5): 188-195, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27890892

RESUMO

We performed a cross-sectional survey to investigate actual clinical practice concerning blood-pressure control among patients with hypertension in Kanagawa. The guidelines of the Japanese Society of Hypertension (JSH) for the management of patients with hypertension were revised in 2014. From October 1 to November 30, 2014, questionnaires on the care of patients with hypertension were sent via post to members of the Kanagawa Physicians Association in Kanagawa Prefecture, Japan. -Data on 1,105 patients (mean age: 68.4±12.3 years, 537 men and 568 women) were obtained. The overall mean systolic blood pressure (BP) of these patients was 128.7±12.1 mmHg for home monitoring and 132.9±12.6 mmHg for office monitoring; diastolic BP was 75.7±9.7 for home monitoring and 77.0±9.7 mmHg for office monitoring. According to the JSH 2014 guidelines, the target BP was achieved by 68.1% of all subjects; 89.2% of late-phase elderly patients (75 years or older); 69.1% of young, middle-aged, and early-phase elderly patients (younger than 75 years except in patients with diabetes mellitus [DM] or chronic kidney disease [CKD] with proteinuria); 9.3% of patients with DM except late-phase elderly patients; and 11.9% of CKD patients with proteinuria except DM. Cross-sectional analysis showed that the factors significantly associated with an increased likelihood of achieving the target BP were as follows: 1) good medication compliance even for a small number of antihypertensive agents at small amount of doses in patients 75 years and older; 2) good medication compliance in patients in younger than 75 years; 3) an older age, a larger proportion in the female-to-male ratio and a lower body mass index in patients with DM except late-phase elderly patients; and 4) usage of a large number of antihypertensive agents in CKD patients with proteinuria. Further follow-up surveys are necessary to investigate changes in clinical practice following the introduction of the revised guidelines.


Assuntos
Pressão Sanguínea , Pesquisas sobre Atenção à Saúde , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Padrões de Prática Médica , Idoso , Diabetes Mellitus/patologia , Feminino , Humanos , Hipertensão/complicações , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Insuficiência Renal Crônica/complicações
10.
Jpn J Radiol ; 34(11): 754-762, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27714486

RESUMO

Although PET/MRI has the advantages of a simultaneous acquisition of PET and MRI, high soft-tissue contrast of the MRI images, and reduction of radiation exposure, its low profitability and long acquisition time are significant problems in clinical settings. Thus, MRI protocols that meet oncological purposes need to be used in order to reduce examination time while securing detectability. Currently, half-Fourier acquisition single-shot turbo spin echo and 3D-T1 volumetric interpolated breath-hold examination may be the most commonly used sequences for whole-body imaging due to their shorter acquisition time and higher diagnostic accuracy. Although there have been several reports that adding diffusion weighted image (DWI) to PET/MRI protocol has had no effect on tumor detection to date, in cases of liver, kidney, bladder, and prostate cancer, the use of DWI may be beneficial in detecting lesions. Another possible option is to scan each region with different MRI sequences instead of scanning the whole body using one sequence continuously. We herein report a workflow and imaging protocols for whole-body oncologic PET/MRI using an integrated system in the clinical routine, designed for the detection, for example by cancer screening, of metastatic lesions, in order to help future users optimize their workflow and imaging protocols.


Assuntos
Imageamento por Ressonância Magnética , Imagem Multimodal/métodos , Neoplasias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Imagem Corporal Total/métodos , Fluxo de Trabalho , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade
11.
Ann Nucl Med ; 30(3): 225-33, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26676720

RESUMO

PURPOSE: To compare the diagnostic accuracy of whole-body PET/CT and integrated PET/MR in relation to the total scan time durations. METHODS: One hundred and twenty-three (123) patients (40 males and 83 females; mean age 59.6 years; range 20-83 years) with confirmed primary cancer and clinical suspicion of metastatic disease underwent whole-body 18F-FDG-PET/CT and 18F-FDG-PET/MR. Data acquisition was done after intravenous administration of 110-301 MBq radioactivity of 18F-FDG, and PET/MR data were acquired after the PET/CT data acquisition. The mean uptake times for PET/CT and PET/MR acquisition were 68.0 ± 8.0 and 98.0 ± 14 min, respectively. Total scan time was 20.0 and 25.0 min for whole-body PET/CT and PET/MR imaging. RESULTS: The reconstructed PET/CT and PET/MR data detected 333/355 (93.8 %) common lesions in 111/123 (90.2 %) patients. PET/CT and PET/MR alone detected 348/355 and 340/355 lesions, respectively. No significant (p = 0.08) difference was observed for the overall detection efficiency between the two techniques. On the other hand, a significant difference was observed between the two techniques for the detection of lung (p = 0.003) and cerebrospinal (p = 0.007) lesions. The 15 lesions identified by PET/CT only included 8 lung, 3 lymph nodes, 2 bone, and 1 each of peritoneal and adrenal gland lesions. On the other hand, 7 (6 brain metastatic lesions and 1 bone lesion) were identified by PET/MR only. CONCLUSION: Integrated PET/MR is a feasible whole-body imaging modality and may score better than PET/CT for the detection of brain metastases. To further prove diagnostic utility, this technique requires further clinical validation.


Assuntos
Imageamento por Ressonância Magnética , Oncologia/métodos , Imagem Multimodal/métodos , Neoplasias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Imagem Corporal Total , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Integração de Sistemas , Adulto Jovem
12.
Fukushima J Med Sci ; 61(1): 23-31, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25946906

RESUMO

PURPOSE: To validate the use of bone scintigraphy (BS) versus computed tomography (CT) for therapeutic monitoring in patients during treatment with zoledronic acid. MATERIALS AND METHODS: Eleven patients with bone-only metastatic disease and being treated with zoledronic acid were included. The effects of therapies including chemotherapy and hormone therapy were evaluated in 25 separate examinations in total as follows: complete response (CR), when no bone metastasis was visible; partial response (PR), when a decrease in the lesion area was detected; stable disease (SD), when no or slight change was observed; and progressive disease (PD), when new or enlarged lesion areas were observed. RESULTS: The accuracies of examination by Readers 1, 2, and 3 respectively were 76%, 80% and 76% for BS, 52%, 48%, and 40% for CT, and 64%, 52% and 60% for BS and CT combined with Readers 2 and 3 observing significant differences between CT and BS results. The rates of interobserver agreement between Readers 1 and 2, between Readers 1 and 3, and between Reader 2 and 3 respectively, were 84%, 80% and 88% (κ = 0.648, 0.561 and 0.766) for BS, 52%, 56%, and 60% (κ = 0.180, 0.278 and 0.282) for CT, and 52%, 60%, and 56% (κ = 0.215, 0.282 and 0.232) for CT and BS combined. CONCLUSION: BS is effective for assessing the response of bone metastasis to therapy in patients during zoledronic acid treatment.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Osso e Ossos/diagnóstico por imagem , Neoplasias da Mama/patologia , Difosfonatos/uso terapêutico , Imidazóis/uso terapêutico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Ácido Zoledrônico
13.
J Nippon Med Sch ; 81(4): 258-63, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25186579

RESUMO

We performed cross-sectional surveys to investigate changes in clinical practices regarding blood-pressure control in patients with hypertension from 2008 through 2011. Questionnaires regarding the care of patients with hypertension were mailed to members of the Kanagawa Physicians Association in Kanagawa Prefecture, Japan. Data were obtained on 675 patients in 2008, 332 in 2009, and 1,076 in 2011. The mean systolic blood pressure (BP) was significantly lower in 2011 than in 2008 (132.2±11.9 mm Hg versus 134.6±10.6 mm Hg). The office-measured target BP, according to the 2009 guidelines of the Japanese Society of Hypertension for the management of patients with hypertension, was achieved in 53.9% of patients in 2008, 55.1% in 2009, and 57.1% in 2011. In nonelderly patients (younger than 65 years), the achievement rate was significantly greater in 2011 (41.2%) than in 2008 (23.6%). This analysis showed that the factor most significantly associated with a decrease in office-measured BP was treatment with a larger number and higher doses of antihypertensive agents. To investigate changes in clinical practices according to the guidelines, further follow-up surveys are necessary.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Inquéritos Epidemiológicos/estatística & dados numéricos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Hipertensão/epidemiologia , Japão/epidemiologia , Masculino , Guias de Prática Clínica como Assunto
14.
Kaku Igaku ; 50(2): 55-9, 2013 May.
Artigo em Japonês | MEDLINE | ID: mdl-23855247

RESUMO

An eighty-one-year-old male patient with a feeling of chest pressure was admitted to our hospital for investigation of the heart. 201T1/123I-BMIPP dual scintigraphy was performed and multiple uptakes of 123I-BMIPP were detected in the lung, but not of 201T1. His chest X-ray and chest CT showed no abnormal lesions in the corresponding regions. There have been no reports that 123I-BMIPP accumulate in the lung. The possible cause of the lung uptake was embolism from aggregated 123I-BMIPP due to cold tempetatures.


Assuntos
Ácidos Graxos , Coração/diagnóstico por imagem , Radioisótopos do Iodo , Iodobenzenos , Pulmão/diagnóstico por imagem , Idoso de 80 Anos ou mais , Temperatura Baixa , Humanos , Pulmão/patologia , Masculino , Tomografia Computadorizada de Emissão de Fóton Único/métodos
15.
Nucl Med Commun ; 34(1): 13-8, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23044518

RESUMO

PURPOSE: The aim of this study was to compare uptake lesions in sarcoidosis and IgG4-related disease through gallium-67 ((67)Ga) scintigraphy to differentiate between the two diseases. MATERIALS AND METHODS: Whole-body (67)Ga scintigraphy findings of 27 patients with sarcoidosis and 16 with IgG4-related disease were reviewed between 2005 and 2011 at our hospital. RESULTS: In the case of patients with sarcoidosis, significant accumulation of (67)Ga was observed in the lacrimal gland in the case of 26 patients (96%), in mediastinal lymph nodes (LNs) in 23 (85%), in pulmonary hilar LNs in 21 (78%), in the parotid gland in 10 (38%), in supraclavicular LNs in eight (30%), in muscles in seven (26%), in the lung in five (18%), in inguinal LNs in four (15%), in submandibular LNs in two (7%), and in the heart, spleen, kidney and para-aorta in one patient (4%). In patients with IgG4-related disease, abnormal uptake was detected in the pulmonary hilar LNs in 12 patients (75%), in the lacrimal gland in 10 (62%), in the pancreas in 10 (62%), in the parotid gland in six (37%), in the submandibular gland in six (37%), in the para-aorta in three (19%), in the lung in three (19%), in mediastinal LNs in two (12%), and in the kidney in the case of two patients (12%). Asymmetrical accumulation in the submandibular gland was observed in three of six patients (50%) with IgG4-related disease and in none of the two patients (0%) with sarcoidosis. Significant differences were observed in the uptake ratio of the lacrimal gland, the submandibular gland, supraclavicular LNs, mediastinal LNs, pancreas, and muscle between the two groups (P<0.05). CONCLUSION: (67)Ga scintigraphy was useful in differentiating between the two diseases. Uptake in mediastinal LNs, in supraclavicular LNs, and in the muscle was specific to sarcoidosis, whereas uptake in the pancreas and in the submandibular gland indicated IgG4-related disease.


Assuntos
Imunoglobulina G/metabolismo , Sarcoidose/diagnóstico por imagem , Imagem Corporal Total , Idoso , Idoso de 80 Anos ou mais , Feminino , Radioisótopos de Gálio , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , Sarcoidose/imunologia , Sarcoidose/metabolismo
16.
Tohoku J Exp Med ; 228(3): 181-7, 2012 11.
Artigo em Inglês | MEDLINE | ID: mdl-23060199

RESUMO

Arteriovenous malformation (AVM) can arise in various organs, particularly the brain, but it is rare in the uterus. Uterine AVM is potentially lethal and is generally associated with uterine trauma, such as dilatation and curettage, therapeutic abortion or uterine surgery. On the other hand, uterine myoma is the most common benign gynecological tumor, but uterine cervical myoma is rare and grows in the extraperitoneal space, with development of complex capillary networks within the tumor. Cervical myoma surgery is therefore a difficult operation with a risk of massive bleeding. We report herein a patient with uterine AVM formed within a large cervical myoma in a postmenopausal woman. The patient was a 55-year-old Japanese woman who complained of lower abdominal distension. Ultrasonography, computed tomography and magnetic resonance imaging showed an 18 × 20-cm uterine cervical tumor with dilatation of numerous vessels. Pelvic angiography was scheduled to provide accurate diagnosis and to minimize intraoperative blood loss. In fact, preoperative pelvic angiography allowed us to identify the true feeding artery and drainage veins. Occlusion of the feeding artery with a balloon device is effective in decreasing intraoperative bleeding. Abdominal total hysterectomy was performed as the surgical management of this uterine AVM. Prophylactic endovascular balloon occlusion of the ipsilateral internal iliac artery reduced the amount of hemorrhage during surgery, although blood transfusion was needed in our patient. In conclusion, preoperative embolosclerotherapy should be considered as a treatment option in patients with AVM present in a large uterine cervical myoma.


Assuntos
Malformações Arteriovenosas/complicações , Mioma/complicações , Neoplasias do Colo do Útero/complicações , Útero/irrigação sanguínea , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Feminino , Humanos , Histerossalpingografia , Artéria Ilíaca/anormalidades , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Mioma/diagnóstico por imagem , Mioma/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgia
17.
Clin Nucl Med ; 37(6): 596-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22614196

RESUMO

An 123I metaiodobenzylguanidine (MIBG) planar image showed abnormal uptake in the left adrenal gland and thyroid in a 24-year-old woman with multiple endocrine neoplasia type 2A. 131I MIBG showed abnormal uptake in the thyroid but not in the adrenal gland. Abdominal CT with 2-mm thin slices demonstrated a normal adrenal gland. Postoperative pathologic findings were consistent with medullary carcinoma in both thyroid lobes and a small 1-mm pheochromocytoma in the left adrenal gland. 123I MIBG could clearly show the small pheochromocytoma, which was negative in thin-slice CT and equivocal in 131I MIBG.


Assuntos
3-Iodobenzilguanidina , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasia Endócrina Múltipla/complicações , Feocromocitoma/complicações , Feocromocitoma/diagnóstico , Tomografia Computadorizada por Raios X , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Feminino , Humanos , Feocromocitoma/diagnóstico por imagem , Cintilografia , Adulto Jovem
18.
J Nippon Med Sch ; 79(1): 69-78, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22398792

RESUMO

We performed a cross-sectional survey to investigate actual clinical practices regarding blood-pressure control in patients with hypertension. From October 16 to 31, 2008, postal questionnaires regarding the care of patients with hypertension were sent to members of the Kanagawa Physicians Association in Kanagawa, Japan. Data of 675 patients (mean age: 70.1 ± 10.6 years, 301 men and 374 women) were returned. The overall mean systolic blood pressure (BP) in these patients was 134.6 ± 10.6 mm Hg, and diastolic BP was 76.2 ± 8.3 mm Hg. According to the 2009 guidelines of the Japanese Society of Hypertension for the management of patients with hypertension, the target office BP was achieved by 53.9% of all subjects; 29.7% of patients with diabetes mellitus, chronic kidney disease, or a history of myocardial infarction; 72.0% of elderly patients; 23.6% of nonelderly patients (younger than 65 years); and 75.4% of patients with cerebrovascular disease. Cross-sectional analysis showed that factors significantly associated with an increased likelihood of achieving the target office BP were: 1) usage of a larger number of antihypertensive agents in nonelderly patienys and in patients with diabetes mellitus, chronic kidney disease, or a history of myocardial infarction and: 2) usage of a smaller number of antihypertensive agents in elderly patients and patients with cerebrovascular disease. Further follow-up surveys are necessary to provide a full assessment.


Assuntos
Pressão Sanguínea/fisiologia , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Feminino , Humanos , Hipertensão/tratamento farmacológico , Japão/epidemiologia , Masculino
19.
J Comput Assist Tomogr ; 36(2): 257-60, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22446370

RESUMO

OBJECTIVE: This study evaluated the incidence and course of a hematoma occurring after femoral arterial sampling. MATERIALS AND METHODS: We studied 270 patients who underwent computed tomography (CT) including the pelvis and blood gas sampling from femoral artery using a 22-gauge needle during 2010. This population comprised 176 men and 94 women with a mean (SD) age of 54.9 (24.3) years (range, 0-97 years). We evaluated whether hematoma was present at the femoral artery. Size and location of the hematoma, the short-axial luminal diameter of artery contact with the hematoma was also assessed. RESULTS: The CT images showed hematoma around the femoral artery in 128 patients (47.4%); this group comprised 84 men and 44 women with a mean (SD) age of 51.1 (24.1) years (range, 0-92 years). Hematoma was not observed in 142 patients (52.6%; 92 men and 50 women; mean [SD] age, 58.3 [24.2] years; range, 0-97 years). There was no significant difference in age, sex, altered hemostasis, or time between arterial puncture and CT between the 2 groups with or without hematoma. Arterial stenosis of 50% or greater was observed in 7 patients (mean [SD] age, 17.1 [8.97] years; range, 6-31 years; 4 males and 3 females). CONCLUSIONS: Our data revealed a high frequency of small hematoma around the femoral artery is following arterial blood sampling that was independent of bleeding diathesis. No patient progressed to a severe condition, although temporary arterial stenosis did occur.


Assuntos
Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Punções/efeitos adversos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Gasometria , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Meios de Contraste , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas
20.
Clin Nucl Med ; 36(7): e57-60, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21637043

RESUMO

Tc-99m MAA showed asymmetric uptake in the lung field in a 21-year-old man with dilated cardiomyopathy. CT revealed partial anomalous venous connections in the left upper lobe. Angiogram of the left pulmonary upper lobe showed all the contrast material drained into the left vertical vein. The possible cause of relative increase in the left upper lobe blood flow is that right pulmonary blood flow is slowed by the high pressure in the left atrium due to dilated cardiomyopathy, whereas the flow from the left upper lobe drains into the superior vena cava which has less pressure than left atrium.


Assuntos
Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Agregado de Albumina Marcado com Tecnécio Tc 99m , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Masculino , Perfusão , Artéria Pulmonar/diagnóstico por imagem , Cintilografia , Tomografia Computadorizada por Raios X , Adulto Jovem
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