RESUMO
CT angiography prior to endovascular aortic surgery is the standard non-invasive imaging method for evaluation of aortic dimensions and access sites. A detailed report is crucial to a proper planning. We assessed Artificial Intelligence (AI)-algorithm accuracy to measure vessels diameters at CT prior to transcatheter aortic valve implantation (TAVI). CT scans of 50 patients were included. Two Radiologists with experience in vascular imaging together manually assessed diameters at nine landmark positions according to the American Heart Association guidelines: 450 values were obtained. We implemented TOST (Two One-Sided Test) to determine whether the measurements were equivalent to the values obtained from the AI algorithm. When the equivalence bound was a range of ± 2 mm the test showed equivalence for every point; if the range was equal to ± 1 mm the two measurements were not equivalent in 6 points out of 9 (p-value > 0.05), close to the aortic valve. The time for automatic evaluation (average 1 min 47 s) was significantly lower compared with manual measurements (5 min 41 s) (p < 0.01). In conclusion, our results indicate that AI-algorithms can measure aortic diameters at CT prior to endovascular surgery with high accuracy. AI-assisted reporting promises high efficiency, reduced inter-reader variabilities and time saving. In order to perform optimal TAVI procedure planning aortic root analysis could be improved, including annulus dimensions.
Assuntos
Inteligência Artificial , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Humanos , Feminino , Masculino , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Substituição da Valva Aórtica Transcateter , Aorta/diagnóstico por imagem , Aorta/cirurgiaRESUMO
This report demonstrates the successful treatment of a carotid artery pseudoaneurysm using percutaneous thrombin injection. The patient, a 62-year-old woman with multiple comorbidities, experienced a pseudoaneurysm following an unintentional carotid artery puncture during a failed attempt to place a triple lumen catheter in the right jugular vein. Percutaneous thrombin injection was chosen as the treatment method, with Doppler ultrasound monitoring. Follow-up examinations showed no signs of recurrence, and the patient was discharged after nine days without complications.
Assuntos
Lesões das Artérias Carótidas , Doença Iatrogênica , Punções , Trombina , Lesões do Sistema Vascular , Humanos , Trombina/administração & dosagem , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/tratamento farmacológico , Lesões das Artérias Carótidas/etiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/tratamento farmacológico , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/etiologia , Hemostáticos/administração & dosagem , Hemostáticos/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Veias Jugulares/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Ultrassonografia DopplerRESUMO
Peripheral Nerve Sheath Tumors (PNSTs) are extremely uncommon and it is almost certain that no individual upper limb surgeon will gain great experience in a lifetime with these lesions. Benign and malignant PNSTs are separately analyzed in this descriptive review and discussed focusing the attention towards the most important features. A comprehensive and summarized overview of this topic is offered to the reader in order to improve the complex management of these tumors from diagnosis to treatment. A systematic search in PubMed was carried out using the keywords (and synonyms) written below in order to find relevant and most cited papers. Reckoning the rarity of the pathology, few selected case reports were taken into account. A compendium of each PNST was created to sum up the personal experience of the Authors who wrote the articles, critically inspected and analyzed. Every section of the paper is meant to provide useful tips to the reader.
Assuntos
Neoplasias de Bainha Neural , Humanos , Neoplasias de Bainha Neural/diagnóstico , Neoplasias de Bainha Neural/epidemiologia , Neoplasias de Bainha Neural/cirurgia , Extremidade SuperiorAssuntos
Adenoma/induzido quimicamente , Adenoma/patologia , Terapia de Reposição de Estrogênios/efeitos adversos , Neoplasias Hepáticas/induzido quimicamente , Neoplasias Hepáticas/patologia , Adenoma/diagnóstico por imagem , Síndrome de Aicardi , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Adulto JovemAssuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Terapia Combinada/métodos , Idoso , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Masculino , Ablação por Radiofrequência , Resultado do TratamentoRESUMO
A 78-year-old male patient was admitted to our hospital after abdominal trauma. Contrast-enhanced computed tomography (CT) scan demonstrated a horseshoe kidney with a perinephric hematoma and evidence of arterial hemorrhage. An anomalous renal arterial anatomy was noted as well, with a renal artery originating from the left common iliac artery. He was successfully treated via an endovascular approach. Varying forms of vascularization may complicate angiographic treatment of patients with abdominal trauma in a setting of kidney anomalies. Obtaining and evaluating contrast-enhanced CT angiography can identify anomalous vessels and can be invaluable when deciding on the most appropriate interventional approach.
Assuntos
Traumatismos Abdominais/terapia , Acidentes por Quedas , Embolização Terapêutica , Procedimentos Endovasculares , Rim Fundido/complicações , Rim/lesões , Lacerações/terapia , Artéria Renal/lesões , Lesões do Sistema Vascular/terapia , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Idoso , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Rim Fundido/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Lacerações/diagnóstico por imagem , Lacerações/etiologia , Masculino , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologiaRESUMO
OBJECTIVE: The biological heterogeneity of hepatocellular carcinoma (HCC) makes prognosis difficult. We translate the results of a genome-wide high-throughput analysis into a tool that accurately predicts at presentation tumour growth and survival of patients with HCC. DESIGN: Ultrasound surveillance identified HCC in 78 (training set) and 54 (validation set) consecutive patients with cirrhosis. Patients underwent two CT scans 6â weeks apart (no treatment in-between) to determine tumour volumes (V0 and V1) and calculate HCC doubling time. Baseline-paired HCC and surrounding tissue biopsies for microarray study (Agilent Whole Human Genome Oligo Microarrays) were also obtained. Predictors of survival were assessed by multivariate Cox model. RESULTS: Calculated tumour doubling times ranged from 30 to 621â days (mean, 107±91â days; median, 83â days) and were divided into quartiles: ≤53â days (n=19), 54-82â days (n=20), 83-110â days (n=20) and ≥111â days (n=19). Median survival according to doubling time was significantly lower for the first quartile versus the others (11 vs 41â months, 42, and 47â months, respectively) (p<0.0001). A five-gene transcriptomic hepatic signature including angiopoietin-2 (ANGPT2), delta-like ligand 4 (DLL4), neuropilin (NRP)/tolloid (TLL)-like 2 (NETO2), endothelial cell-specific molecule-1 (ESM1), and nuclear receptor subfamily 4, group A, member 1 (NR4A1) was found to accurately identify rapidly growing HCCs of the first quartile (ROC AUC: 0.961; 95% CI 0.919 to 1.000; p<0.0001) and to be an independent factor for mortality (HR: 3.987; 95% CI 1.941 to 8.193, p<0.0001). CONCLUSIONS: The hepatic five-gene signature was able to predict HCC growth in individual patient and the consequent risk of death. This implies a role of this molecular tool in the future therapeutic management of patients with HCC. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01657695.
Assuntos
Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/mortalidade , Progressão da Doença , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/genética , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo , Carga TumoralRESUMO
BACKGROUND: Schwannomas are the most common benign tumours developing in peripheral nerves. They usually present as a slow-growing mass, sometimes associated with pain and paraesthesia. The aim of this study is to define the correct preoperative diagnosis, to review the surgical treatment employed and to evaluate short- and long-term neurological deficits. METHODS: Thirty-four patients affected by schwannoma in the upper limbs were treated in the period 1995-2011. In 15 patients the tumour was located on the ulnar nerve, in 8 on the median nerve, in 2 on the radial nerve, in 1 on the anterior interosseous nerve, in 1 on the muscle-cutaneous nerve, and in the remaining 7 on the digital nerves. All patients were surgically treated using a microsurgical approach. RESULTS: The enucleation of the mass was possible without fascicle lesion in 12 cases. In 22 cases resection of the indissociable fascicles was performed. Postoperative paraesthesia was present in 28 out of 34 treated patients; this clinical sign regressed in a mean period of 12 months in 27 patients. CONCLUSIONS: When approaching a palpable mass in the upper limbs, the possibility of a peripheral nerve tumour should always be considered. It is important to look for typical signs of schwannomas, such as a positive Tinel sign and peripheral paraesthesia. Imaging assessment with magnetic resonance imaging (MRI) and ultrasonography enables the determination of where the tumour takes its origin and from which nerve. Microsurgical techniques and know-how are recommended in approaching the resection in order to respect as many nerve fibres as possible.
Assuntos
Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Microcirurgia , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Nervo Ulnar/cirurgia , Extremidade Superior/cirurgiaRESUMO
BACKGROUND & AIMS: We performed a randomized controlled trial to evaluate the safety and efficacy of enoxaparin, a low-molecular-weight heparin, in preventing portal vein thrombosis (PVT) in patients with advanced cirrhosis. METHODS: In a nonblinded, single-center study, 70 outpatients with cirrhosis (Child-Pugh classes B7-C10) with demonstrated patent portal veins and without hepatocellular carcinoma were assigned randomly to groups that were given enoxaparin (4000 IU/day, subcutaneously for 48 weeks; n = 34) or no treatment (controls, n = 36). Ultrasonography (every 3 months) and computed tomography (every 6 months) were performed to check the portal vein axis. The primary outcome was prevention of PVT. Radiologists and hepatologists that assessed outcomes were blinded to group assignments. Analysis was by intention to treat. RESULTS: At 48 weeks, none of the patients in the enoxaparin group had developed PVT, compared with 6 of 36 (16.6%) controls (P = .025). At 96 weeks, no patient developed PVT in the enoxaparin group, compared with 10 of 36 (27.7%) controls (P = .001). At the end of the follow-up period, 8.8% of patients in the enoxaparin group and 27.7% of controls developed PVT (P = .048). The actuarial probability of PVT was lower in the enoxaparin group (P = .006). Liver decompensation was less frequent among patients given enoxaparin (11.7%) than controls (59.4%) (P < .0001); overall values were 38.2% vs 83.0%, respectively (P < .0001). The actuarial probability of liver decompensation was lower in the enoxaparin group (P < .0001). Eight patients in the enoxaparin group and 13 controls died. The actuarial probability of survival was higher in the enoxaparin group (P = .020). No relevant side effects or hemorrhagic events were reported. CONCLUSIONS: In a small randomized controlled trial, a 12-month course of enoxaparin was safe and effective in preventing PVT in patients with cirrhosis and a Child-Pugh score of 7-10. Enoxaparin appeared to delay the occurrence of hepatic decompensation and to improve survival.