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OBJECTIVES: To assess whether the combination of biparametric magnetic resonance imaging with prostate-specific antigen density can properly stratify the risk of significant prostate cancer in patients undergoing prostate biopsies and how this approach affects the detection of prostate cancer during follow-up in patients who do not undergo prostate biopsy. METHODS: In total, 411 biopsy-naïve patients who had elevated prostate-specific antigen levels and then underwent biparametric magnetic resonance imaging for suspicious prostate cancer were analyzed: 203 patients underwent prostate biopsies, whereas 208 patients did not. Significant prostate cancer detection rates stratified by the combination of Prostate Imaging Reporting and Data System score and prostate-specific antigen density were assessed in patients who underwent prostate biopsies. The cumulative incidence of prostate cancer detection during the follow-up was assessed in patients who omitted biopsy. RESULTS: The negative predictive value for significant prostate cancer was 89% for Prostate Imaging Reporting and Data System scores 1-3, which increased to 97% when prostate-specific antigen density <0.15 ng/ml/cm3 was combined. Among patients who did not undergo biopsy, patients with Prostate Imaging Reporting and Data System scores 1-3 plus prostate-specific antigen density <0.15 ng/ml/cm3 included significantly less cases in which significant prostate cancer was detected during the follow-up, compared with the others (3.2% versus 17% at 36 months). CONCLUSIONS: Restriction of prostate biopsies to patients with Prostate Imaging Reporting and Data System scores 4-5 or prostate-specific antigen density ≥0.15 ng/ml/cm3 proved to be the good biopsy strategy, effectively balancing risks and benefits.
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Antígeno Prostático Específico , Neoplasias da Próstata , Biópsia , Seguimentos , Humanos , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Neoplasias da Próstata/patologiaRESUMO
Background: Vanin-1 is a novel acute kidney injury (AKI) biomarker that has not been clinically investigated as a biomarker for obstructive nephropathy. This study investigated the diagnostic value of vanin-1 as a biomarker for adult obstructive nephropathy by comparing it to existing AKI biomarkers. Methods: A total of 49 patients, 21 controls, and 28 hydronephrosis (HN) cases were assessed. AKI biomarkers in bladder (BL) urine and renal pelvic (RP) urine in the HN group were compared to each BL marker in the control group. In a subgroup of cases receiving interventions for obstructive nephropathy, the BL values of each biomarker were assessed after the intervention. Results: RP vanin-1 levels were significantly higher while BL vanin-1 levels were marginally higher in the HN group than in the control group. The area under the receiver operating characteristics curve values for RP and BL vanin-1 were 0.9778 and 0.6386, respectively. In multivariate analyses, BL vanin-1 and N-acetyl-ß-D-glucosaminidase (NAG), but not kidney injury molecule-1 (KIM-1) or neutrophil gelatinase-associated lipocalin (NGAL), were independent factors for predicting the presence of HN. In cases receiving interventions, vanin-1 decreased significantly from 1 week after the intervention in cases of moderate to severe obstructive nephropathy compared to RP values at baseline. Conclusion: Urinary vanin-1 is a useful biomarker to detect and monitor the clinical course of obstructive nephropathy.
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Injúria Renal Aguda/etiologia , Injúria Renal Aguda/metabolismo , Amidoidrolases/metabolismo , Biomarcadores , Injúria Renal Aguda/diagnóstico , Adulto , Idoso , Amidoidrolases/urina , Estudos de Casos e Controles , Feminino , Proteínas Ligadas por GPI/metabolismo , Proteínas Ligadas por GPI/urina , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Estudos Prospectivos , Curva ROC , Obstrução Uretral/complicaçõesRESUMO
BACKGROUND: To determine whether prebiopsy multiparametric magnetic resonance imaging (mpMRI) with subsequent systematic plus targeted biopsies for suspicious lesions improve prostate cancer detection compared with standard non-targeting systematic biopsies without mpMRI in biopsy-naïve patients. METHODS: Patients who underwent their first prostate biopsy due to suspicion of prostate cancer were analyzed retrospectively to compare the biopsy outcomes between patients who received prebiopsy mpMRI (215 patients) and those who did not (281 patients). mpMRI was performed to determine pre-biopsy likelihood of the presence of prostate cancer using a three-point scale (1 = low level of suspicion, 2 = equivocal, and 3 = high level of suspicion). Systematic biopsies were performed in both groups. Targeted biopsies were added for a high level of suspicious lesions on mpMRI. All biopsies were performed by transperineal biopsy technique. After biopsy, Prostate Imaging Reporting and Data System ver. 2 (PIRADS-2) scoring was performed to describe the mpMRI findings and predictive value of PIRADS-2 was evaluated. RESULTS: The detection rate of total and clinically significant prostate cancer was significantly higher in patients who received prebiopsy mpMRI than in those who did not (55.3 and 46.0% vs. 42.0 and 35.2%, respectively; p = 0.004 and p = 0.016). The clinically insignificant prostate cancer detection rate was similar between the two groups (9.3% vs. 6.8%; p = 0.32). Of 86 patients who underwent systematic plus targeted biopsy in the MRI cohort and were diagnosed with prostate cancer, seven patients were detected by addition of targeted biopsy whereas 29 patients were missed by targeted biopsy but detected by systematic biopsy. There was a correlation between the PIRADS-2 and prostate cancer detection rate, and a receiver-operator curve analysis yielded an area under the curve of 0.801 (p < 0.0001). CONCLUSIONS: Prebiopsy mpMRI with subsequent systematic plus targeted biopsies for suspicious lesions can yield a higher cancer detection rate than non-targeting systematic biopsies. PIRADS-2 scoring is useful for predicting the biopsy outcome.
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Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/tendências , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/tendências , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/cirurgia , Estudos RetrospectivosRESUMO
A 32-year-old man with a history of bronchial asthma was referred for low back pain and bilateral femur pain. Vascular sonography revealed bilateral deep vein thrombosis (DVT) from the femoral veins to the popliteal veins. Computed tomography revealed hypoplasia of the inferior vena cava (IVC) and dilated lumbar veins, ascending lumbar veins, and azygos vein as collaterals. There was no evidence of malignant neoplasm. The results of the thrombophilia tests were within normal limits. Hypoplasia of the IVC is a rare cause of DVT. This anomaly should be considered as a cause of bilateral and proximal DVT, in particular, in young patients without major risk factors.
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Trombose Venosa/diagnóstico , Adulto , Humanos , Masculino , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/etiologia , Trombose Venosa/terapiaRESUMO
OBJECTIVE: To assess the value of the Prostate Imaging Reporting and Data System (PI-RADS) scoring system, for prostate multi-parametric magnetic resonance imaging (mpMRI) to detect prostate cancer, and classical parameters, such as prostate-specific antigen (PSA) level, prostate volume and PSA density, for predicting biopsy outcome in biopsy naïve patients who have suspected prostate cancer. PATIENTS AND METHODS: Patients who underwent mpMRI at our hospital, and who had their first prostate biopsy between July 2010 and April 2014, were analysed retrospectively. The prostate biopsies were taken transperineally under transrectal ultrasonography guidance. In all, 14 cores were biopsied as a systematic biopsy in all patients. Two cognitive fusion-targeted biopsy cores were added for each lesion in patients who had suspicious or equivocal lesions on mpMRI. The PI-RADS scoring system version 2.0 (PI-RADS v2) was used to describe the MRI findings. Univariate and multivariate analyses were performed to determine significant predictors of prostate cancer and clinically significant prostate cancer. RESULTS: In all, 288 patients were analysed. The median patient age, PSA level, prostate volume and PSA density were 69 years, 7.5 ng/mL, 28.7 mL, and 0.26 ng/mL/mL, respectively. The biopsy results were benign, clinically insignificant, and clinically significant prostate cancer in 129 (45%), 18 (6%) and 141 (49%) patients, respectively. The multivariate analysis revealed that PI-RADS v2 score and PSA density were independent predictors for prostate cancer and clinically significant prostate cancer. When PI-RADS v2 score and PSA density were combined, a PI-RADS v2 score of ≥4 and PSA density ≥0.15 ng/mL/mL, or PI-RADS v2 score of 3 and PSA density of ≥0.30 ng/mL/mL, was associated with the highest clinically significant prostate cancer detection rates (76-97%) on the first biopsy. Of the patients in this group with negative biopsy results, 22% were subsequently diagnosed as prostate cancer. In contrast, a PI-RADS v2 score of ≤3 and PSA density of <0.15 ng/mL/mL yielded no clinically significant prostate cancer and no additional detection of prostate cancer on further biopsies. CONCLUSIONS: A combination of PI-RADS v2 score and PSA density can help in the decision-making process before prostate biopsy and in the follow-up strategy in biopsy naïve patients. Patients with a PI-RADS v2 score of ≤3 and PSA density of <0.15 ng/mL/mL may avoid unnecessary biopsies.
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Imageamento por Ressonância Magnética , Antígeno Prostático Específico/sangue , Próstata/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Biópsia por Agulha , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valor Preditivo dos Testes , Neoplasias da Próstata/patologia , Estudos RetrospectivosRESUMO
The scrotum hematoma following femoral artery puncture is a rare complication. The bleeding from the puncture site drained through the inguinal canal into the scrotum. The present case may indicate the importance of quick observation of the scrotum, when the puncture of femoral artery was performed.
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OBJECTIVE: We evaluated radiological findings and clinical significance of right aortic arch with mirror-image branching (RAMI) in adults using data from computed tomography (CT) examinations. MATERIAL AND METHODS: We reviewed recorded reports and CT images obtained from university and branch hospitals for RAMI in adults. The RAMI incidence in adults found on CT was assessed. Associated congenital and acquired cardiovascular diseases were evaluated. RESULTS: A total of 27 cases (14 men, 13 women; mean age, 59.4 ± 18.3 years) of RAMI were found. Among 107,014 cases in three hospitals, the RAMI incidence in the first, second, and third Tokai University hospitals were 0.018%, 0.012%, and 0.012%, respectively. Eight cases had high aortic arches and four cases had aortic diverticulum (AD) in proximal descending aorta. Three cases had a history of tetralogy of Fallot. One case with an absent left pulmonary artery and three cases with an aberrant left brachiocephalic vein were found incidentally. Two cases were associated with AD aneurysm and vascular ring formation. One case had stenosis of the left subclavian artery due to injury. CONCLUSION: Cases of RAMI found in CT examinations in adults were extremely rare. Some cases were associated with congenital anomalies and/or acquired cardiovascular disease.
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Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Veias Braquiocefálicas/anormalidades , Veias Braquiocefálicas/diagnóstico por imagem , Doenças Cardiovasculares/congênito , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/etiologia , Divertículo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagemRESUMO
Pulmonary varix is a rare entity that presents as a focal aneurysmal dilatation of the pulmonary vein and is frequently mistaken for a pulmonary arteriovenous malformation (PAVM). It is important to distinguish between pulmonary varix and PAVM because the former does not usually require treatment. We present the findings of non-contrast-enhanced magnetic resonance angiography with the time-spatial labeling inversion pulse technique in case of pulmonary varix and PAVM and the utility of this method for differentiating between these diseases.
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A pulmonary arteriovenous malformation (PAVM) is a direct connection between the pulmonary arteries and veins for which metallic coil transcatheter embolization is the standard of care. Detecting recanalization after PAVM treatment is crucial, but direct visualization with computed tomography or magnetic resonance imaging (MRI) is generally difficult. Here, we report a case of a recanalized PAVM that was directly detected with ultra-short echo time MRI. The detection of these signals in the coils was confirmed in a phantom study.
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OBJECTIVE: A puerperal vulvovaginal hematoma may continue to grow after a surgical procedure and may require blood transfusion. Thus, we selected arterial embolization for hemostasis as the first-line management in two cases of large vulvovaginal hematoma. MATERIALS AND METHODS: Case 1 was a 32-year-old pregnant woman. After delivery, a 10-cm vulvar hematoma developed. An enhanced computed tomography (CT) scan revealed active bleeding. Arterial embolization was performed and complete hemostasis was obtained. Case 2 was a 34-year-old woman with a recurring hematoma after delivery. An enhanced CT scan revealed extravasation in the hematoma. Gelatin sponges were applied and complete hemostasis was obtained. In both cases, arterial embolization was successful without requiring blood transfusions. RESULTS AND CONCLUSION: We successfully managed two cases of puerperal vulvovaginal hematoma by arterial embolization based on the evaluation of an enhanced CT scan. In conclusion, we suggest arterial embolization to be a viable option for first-line treatment in the management of vulvovaginal hematomas.
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Embolização Terapêutica , Hematoma/terapia , Hemorragia Pós-Parto/terapia , Doenças Vaginais/terapia , Doenças da Vulva/terapia , Adulto , Feminino , Humanos , GravidezRESUMO
INTRODUCTION: Nonocclusive mesenteric ischemia (NOMI) after surgery has an extremely poor prognosis with a mortality rate of 30-100%. We report a patient with NOMI following aortic valve replacement who failed to improve despite continuous intra-arterial infusion of papaverine, but was successfully treated with alprostadil (prostaglandin E1 [PGE1]) infusion. PRESENTATION OF CASE: The patient is a 77-year-old man who underwent aortic valve replacement. Due to elevated serum lactate levels five hours after intensive care unit admission, superior mesenteric arteriography was performed, establishing the diagnosis of NOMI. Although continuous intra-arterial infusion of papaverine was begun, lactate levels remained elevated. Repeat angiography and laparotomy revealed extensive ischemic changes of the intestine. The vasodilator was changed to PGE1, which improved arterial spasm. The patient ultimately needed an ileocecal resection, but the extent of the resection was limited with concomitant PGE1 administration. DISCUSSION: In the present patient, although NOMI was unresponsive to appropriate treatment including intra-arterial infusion of papaverine, continuous intra-arterial infusion of PGE1 salvaged most of the intestine. CONCLUSIONS: In a patient with recurrent NOMI despite appropriate treatment including intra-arterial infusion of papaverine, continuous intra-arterial infusion of PGE1 may limit the extent of intestinal resection needed. Continuous intra-arterial infusion of PGE1 may be a useful treatment for patients with refractory NOMI.
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BACKGROUND: Near-infrared spectroscopy revealed that the regional saturation of oxygen (rSO2) in cerebral tissue is lower in hemodialysis (HD) patients than in healthy subjects. However, no study has examined the changes in cerebral oxygenation by aortic arch calcification (AAC) progression in HD patients. METHODS: A total of 104 HD patients were divided into four groups by AAC grade determined using chest radiography: 23 patients at grade 0, 24 at grade 1, 30 at grade 2, and 27 at grade 3. Differences in clinical parameters, including cerebral rSO2, among AAC grades were investigated and atherosclerotic parameters affecting cerebral rSO2 values were identified. RESULTS: Cerebral rSO2 significantly decreased as AAC progressed (AAC grade 3 versus grade 0, p < 0.01 versus grade 1, p < 0.05). Multivariate logistic regression analysis was performed using parameters with p values < 0.20 in univariate analysis between cerebral rSO2 values less than the mean and atherosclerotic parameters. AAC grades 2 and 3, serum phosphate level, and history of smoking were factors associated with the cerebral rSO2 decrease. CONCLUSIONS: Cerebral rSO2 significantly decreased as AAC progressed and was independently associated with higher AAC grade, serum phosphate level, and history of smoking.
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Aorta Torácica/fisiopatologia , Aterosclerose/fisiopatologia , Calcinose/fisiopatologia , Falência Renal Crônica/fisiopatologia , Idoso , Aorta Torácica/metabolismo , Aterosclerose/sangue , Calcinose/metabolismo , Circulação Cerebrovascular/fisiologia , Progressão da Doença , Feminino , Humanos , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Fosfatos/sangue , Diálise Renal/efeitos adversos , Espectroscopia de Luz Próxima ao Infravermelho , Calcificação Vascular/fisiopatologiaRESUMO
PURPOSE: The purpose of this study was to evaluate the diagnostic performance of non-contrast-enhanced magnetic resonance angiography with time-spatial labeling inversion pulse (time-SLIP MRA) in the assessment of pulmonary arteriovenous malformation (PAVM). METHODS: Eleven consecutive patients with 38 documented PAVMs underwent time-SLIP MRA with a 3-tesla unit. Eight patients with 25 lesions were examined twice, once before and once after embolotherapy. The lesions were divided into two groups-initial diagnosis (n = 35) and follow-up (n = 28)-corresponding to untreated and treated lesions, respectively, and were evaluated separately. To evaluate the initial diagnosis group, two reviewers assessed image quality for visualization of PAVMs by using a qualitative 4-point scale (1 = not assessable to 4 = excellent). The location and classification of PAVMs were also evaluated. The results were compared with those from digital subtraction angiography. For evaluation of the follow-up group, the reviewers assessed the status of treated PAVMs. Reperfusion and occlusion were defined respectively as visualization or disappearance of the aneurysmal sac. The diagnostic accuracy of time-SLIP MRA was assessed and compared with standard reference images. Interobserver agreement was evaluated with the κ statistic. RESULTS: In the initial diagnosis group, time-SLIP MRA correctly determined the PAVMs in all but one patient with one lesion who had image degradation due to irregular breath. Image quality was considered excellent (median = 4) and the κ coefficient was 0.85. Additionally, both readers could correctly localize and classify the PAVMs on time-SLIP MRA images with both κ coefficient of 1.00. In the follow-up group, the sensitivity and specificity of time-SLIP MRA for reperfusion of PAVMs were both 100%, and the κ coefficient was 1.00. CONCLUSION: Time-SLIP MRA is technically and clinically feasible and represents a promising technique for noninvasive pre- and post-treatment assessment of PAVMs.
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Angiografia Digital/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Sensibilidade e Especificidade , Adulto JovemRESUMO
PURPOSE: To evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access. SUBJECTS AND METHODS: Twenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients' pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient's motor/sensory paralysis after PTA was also examined. RESULTS: The mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min. CONCLUSION: US-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites. LEVEL OF EVIDENCE: Level 4 (case series).
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Analgesia/métodos , Angioplastia/métodos , Fístula Arteriovenosa/terapia , Bloqueio do Plexo Braquial/métodos , Diálise Renal , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Plexo Braquial , Feminino , Antebraço , Humanos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Estudos Prospectivos , Resultado do TratamentoRESUMO
UNLABELLED: Objection: To evaluate of Kommerell diverticulum (KD) in adults during routine CT examinations. MATERIAL AND METHODS: Eighty-seven cases of left aortic arch with aberrant right subclavian artery (LAARS) and 28 cases of right aortic arch with aberrant left subclavian artery (RAALS) were found on routine CT examinations using 64-128 multidetector CT. We assessed the incidence of KD and measured the size of KD, and compared the results between both groups. We evaluated associated congenital and acquired cardiovascular diseases on both groups. RESULTS: The incidence of KD in each group was as follows: RAALS 100 % and LAARS 48.3 % and incidence of KD in RAALS group was significant higher than in LAARS group. The mean KD size was as follows: RAALS 32.8 mm and LAARS 17.8 mm and, the size of KD in RAALS group was larger than that in LAARS group. Two cases were associated with congenital heart disease. Several cases were associated with acquired aortic diseases including aortic aneurysm, dissection, severe atherosclerosis and aortitis. CONCLUSION: KD was common among adults with an ASA and some adults were associated with aortic diseases.
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Aneurisma/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Anormalidades Cardiovasculares/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico por imagem , Divertículo/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Artéria Subclávia/anormalidades , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/epidemiologia , Divertículo/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Artéria Subclávia/diagnóstico por imagemRESUMO
An autopsy of a 70-year-old man with multiple bone metastases from a malignancy of unknown origin (MUO) and renovascular hypertension revealed an aortic intimal sarcoma (AIS) in the right renal artery accompanied by atherosclerotic changes. AIS appeared as aggregated mutton fat-like translucent particles arising from the intima of the branching portion of the right renal artery and was composed of undifferentiated, fine spindle cells with thicket-like proliferation. AIS was confirmed by immunohistopathology, showing the loss of the lumen lined by CD31-positive endothelium and the expression of CD31, keratin, and vimentin in the viable part of the tumor. In patients with MUO presenting with both bone metastases and an acute or sub-acute onset of renovascular hypertension, AIS in the renal artery may be responsible.
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Aorta Torácica/patologia , Arteriopatias Oclusivas/patologia , Arteriosclerose/complicações , Neoplasias Ósseas/secundário , Hipertensão Renovascular/patologia , Sarcoma/patologia , Túnica Íntima/patologia , Neoplasias Vasculares/patologia , Idoso , Autopsia , Dispneia/etiologia , Evolução Fatal , Humanos , Hipertensão Renovascular/etiologia , Masculino , Sarcoma/complicações , Neoplasias Vasculares/complicaçõesRESUMO
OBJECTIVE: Uterine artery embolization (UAE) is a standard method for treating postpartum hemorrhage (PPH), although uterine artery vasospasm during UAE may lead to failure of hemostasis. Here, we report our experience with a case of PPH in which the bleeding was successfully controlled by intra-arterial administration of nitroglycerin during the second UAE. CASE REPORT: A 30-year-old woman experienced PPH following a successful cesarean section, and a UAE was performed. However, 6 hours later, vaginal bleeding restarted; the reason for unsuccessful embolization during the first UAE was vasoconstriction due to hypovolemic shock. We performed a second UAE, but uterine bleeding continued. After intra-arterial administration of nitroglycerin, hemostasis was confirmed, and there was no reperfusion of the uterine artery. After these two UAE procedures, no recurrence of bleeding was observed. CONCLUSION: Thus, use of intra-arterial nitroglycerin was effective for controlling uterine artery vasospasm during UAE. However, larger studies are required to confirm these findings.
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Nitroglicerina/uso terapêutico , Hemorragia Pós-Parto/terapia , Embolização da Artéria Uterina , Artéria Uterina/fisiopatologia , Vasodilatadores/uso terapêutico , Adulto , Cesárea , Terapia Combinada , Constrição Patológica , Feminino , Humanos , Hemorragia Pós-Parto/fisiopatologia , Gravidez , RecidivaRESUMO
PURPOSE: To evaluate the incidence of supernumerary renal arteries in horseshoe kidney (HSK) patients, focusing on number and diameters using computed tomographic angiography (CTA). MATERIAL AND METHODS: Thirty-nine patients with HSK and 103 patients with normal kidney (NK) underwent 64 or 128 multidetector CT. Based on 2-dimensional CT, including multiplanar reconstruction, maximum intensity projection, and volume-rendered images with a 0.5-mm reconstruction interval on CTA, we assessed the incidence of supernumerary renal arteries, and large ( > 3 mm in diameter) supernumerary renal arteries, and compared the results between the HSK and NK patients using a chi-square test. RESULT: The mean number of renal arteries was 3.87 in HSK patients and 2.41 in the NK patients. The incidence rates of supernumerary arteries and supernumerary arteries greater than 3 mm were 92.3 %, 69.2 % in HSK patients and 33%, 8.7% in NK patients. Supernumerary and large supernumerary renal arteries had significantly higher incidence rates in the HSK patients than in the NK patients on CTA (p = 0.003, < 0.001). CONCLUSION: Supernumerary and large supernumerary renal arteries were frequently found among the HSK patients on CTA.
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Angiografia/métodos , Rim Fundido/diagnóstico por imagem , Rim Fundido/patologia , Tomografia Computadorizada Multidetectores/métodos , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Adulto , Idoso , Feminino , Rim Fundido/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: The purpose of this study was to review the high-resolution computed tomography (CT) findings in patients with pulmonary complications after allogeneic hematopoietic stem cell transplantation (HSCT), and to evaluate the relationship between CT findings and clinical outcomes. PATIENTS AND METHODS: We collected the clinical data in 96 consecutive patients who underwent CT scan for pulmonary complications after allogeneic HSCT and analyzed the relationships among these clinical characteristics, CT findings and clinical responses. Radiologists who were blinded to clinical information evaluated the CT findings. RESULTS: In multivariate analyses, the presence of chronic graft-versus-host disease (GVHD) and non-segmental multiple consolidations were significantly associated with a poor response to antimicrobial therapies, and the disease risk was significantly associated with a poor corticosteroid response. In addition, the existence of cavity formation and pleural effusion were significantly associated with a fatal prognosis. Twenty-five patients underwent bronchoscopic examination and 4 of them also underwent transbronchial lung biopsy (TBLB), but diagnostic information was not obtained in 15 patients. There was no significant association between specific CT findings and the diagnosis based on bronchoscopic examination. CONCLUSIONS: No specific CT finding was identified as a predictor for either an antimicrobial response or for a corticosteroid response in this study. The presence of cavity formation and pleural effusion may predict a poor prognosis.
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Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pneumopatias/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Biópsia , Feminino , Doença Enxerto-Hospedeiro , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Pseudoaneurysms (PsA) and arteriovenous fistulae (AVF) of the thyrocervical trunk and its branches are rare complications of traumatic or iatrogenic arterial injuries. Most such injuries are iatrogenic and are associated with central venous catheterization. Historically, thyrocervical trunk PsA and AVF have been managed with open surgical repair; however, multiple treatment modalities are now available, including ultrasound-guided compression repair, ultrasound-guided thrombin injection, and endovascular repair with covered stent placement. We report a case of a 65-year-old woman with an iatrogenic thyrocervical trunk PsA with concomitant AVF that developed after attempted internal jugular vein cannulation for hemodialysis access. The PsA was successfully treated by transcatheter coil embolization using 0.010-inch detachable microcoils. Our case is the first published instance of a thyrocervical trunk PsA with concomitant AVF that was successfully treated by endovascular procedure.