ABSTRACT
Fundamento: la estratificación del riesgo de rotura de los aneurismas intracraneales es importante para decidir la conducta ante aquellos pacientes con aneurismas que son incidentales o asintomáticos. No existe consenso para determinar la realización de intervención quirúrgica o seguimiento médico de estos pacientes. Objetivo: elaborar un instrumento predictivo de rotura de aneurismas intracraneales incidentales. Métodos: se incluyó una muestra de 152 pacientes con diagnóstico, mediante angiografía por tomografía axial computarizada, de aneurismas intracraneales saculares rotos (n=138) y no rotos(n=22). Se trabajó con 160 imágenes de aneurismas intracraneales. Los 152 pacientes fueron divididos, al azar, en un grupo de desarrollo que corrrespondió a 95 pacientes, 100 imágenes de aneurismas y un grupo de validación que incluyó 57 pacientes con 60 imágenes de aneurismas. Se realizaron mediciones y segmentaciones de los aneurismas; se obtuvieron nueve factores morfológicos. Se realizó una combinación multivariante, mediante regresión logística múltiple, que expresó seis factores demográficos, clínicos y mofológicos predictivos obtenidos de los expedientes clínicos de los pacientes. La selección para inclusión de los factores fue realizada a partir de un consenso de 15 expertos con más de 15 años de experiencia en el tema. Se confeccionó un nomograma representativo del modelo con los predictores significativos. Se evaluó la calibración y la precisión del instrumento predictivo representado por un modelo y su nomograma. Resultados: el instrumento quedó conformado por cinco predictores que resultaron estadísticamente significativos asociados con la rotura en el análisis multivariado: el sexo femenino, la razón de aspecto, el mayor ancho del domo, el volumen, y el índice de no esfericidad. El nomograma mostró una buena calibración y discriminación (grupo de entrenamiento: área bajo la curva = 99 %; grupo de validación área bajo la curva=99 % ). Conclusiones: el instrumento predictivo, validado y representado por el nomograma es un modelo útil para estratificar el riesgo de rotura de aneurismas. Puede emplearse para el seguimiento de aneurismas considerados de menor riesgo.
Background: the stratification of the intracranial aneurysms rupture risk is important to decide the strategy before those patients with aneurysms that are incidental or asymptomatic. There is no consensus to determine the performance of surgical intervention or medical follow-up of these patients. Objective: to develop a predictive instrument for incidental intracranial aneurysm rupture. Methods: a sample of 152 patients diagnosed by computed tomography angiography of ruptured (n=138) and unruptured (n=22) saccular intracranial aneurysms was included. The 160 images of intracranial aneurysms were studied. The 152 patients were randomly divided into a development group consisting of 95 patients, 100 aneurysm images, and a validation group consisting of 57 patients, 60 aneurysm images. Measurements and segmentations of the aneurysms were performed; nine morphological factors were obtained. A multivariate combination was performed, using multiple logistic regression, which expressed six predictive demographic, clinical and morphological factors obtained from the clinical records of the patients. The selection for inclusion of the factors was made from a consensus of 15 experts with more than 15 years of experience in the subject. A representative nomogram of the model with the significant predictors was made. Calibration and accuracy of the predictive instrument represented by a model and its nomogram were evaluated. Results: the instrument was made up of five predictors that were statistically significant associated with breakage in the multivariate analysis: female sex, aspect ratio, the greatest width of the dome, volume, and non-sphericity index. The nomogram showed good calibration and discrimination (training group: area under the curve = 99%; validation group area under the curve = 99% ). Conclusions: the predictive instrument, validated and represented by the nomogram, is a useful model to stratify the risk of aneurysm rupture. It can be used to monitor aneurysms considered to be of lower risk.
ABSTRACT
Abstract Introduction The treatment of papillary thyroid microcarcinoma remains controversial. Central lymph node metastasis is common in papillary thyroid microcarcinoma and it is an important consideration in treatment strategy selection. Objective The aim of this study was to investigate clinicopathologic risk factors and thyroid nodule sonographic characteristics for central lymph node metastasis in papillary thyroid microcarcinoma. Methods We retrospectively reviewed the data of 599 papillary thyroid microcarcinoma patients who underwent surgery from 2005 to 2017 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic factors and preoperative sonographic features of central lymph node metastasis. A receiver-operating characteristic, ROC curve analysis, was performed to identify the efficacy of ultrasonographic features in predicting central lymph node metastasis. A nomogram based on the risk factors was established to predict central lymph node metastasis. Results The incidence of central lymph node metastasis was 22.4%. The univariate and multivariate analyses suggested that gender, age, multifocality, extrathyroidal invasion, and lateral lymph node metastasis were independent risk factors for central lymph node metastasis. The univariate and multivariate analyses revealed that nodular shape, margin, and calcification were independently associated with central lymph node metastasis. The ROC curve analysis revealed that the combination of shape, margin and calcification had excellent accuracy in predicting central lymph node metastasis. The nomogram was developed based on the identified risk factors for predicting central lymph node metastasis, and the calibration plot analysis indicated the good performance and clinical utility of the nomogram. Conclusions Central lymph node metastasis is associated with male gender, younger age (<5 years), extrathyroidal invasion, multifocality and lateral lymph node metastasis in papillary thyroid microcarcinoma patients. The ultrasongraphic features, such as irregular shape, ill-defined margin and calcification, may improve the efficacy of predicting central lymph node metastasis. Surgeons and radiologists should pay close attention to the patients who have these risk factors. The nomogram may help guide surgical decision making in papillary thyroid microcarcinoma.
Resumo Introdução O tratamento do microcarcinoma papilífero de tireoide permanece controverso. A metástase em linfonodos centrais é comum e é uma consideração importante na seleção da estratégia de tratamento. Objetivo Investigar os fatores de risco clínico-patológicos e as características ultrassonográficas de nódulos tireoidianos para metástase em linfonodos centrais em microcarcinoma papilífero de tireoide. Método Foram analisados retrospectivamente os dados de 599 pacientes com microcarcinoma papilífero de tireoide submetidos à cirurgia de 2005 a 2017 em uma única instituição. Análises univariadas e multivariadas foram usadas para identificar os fatores clínico-patológicos e as características ultrassonográficas pré-operatórias das metástases em linfonodos centrais. Uma análise de curva ROC (receiver-operating characteristic) foi feita para identificar a eficácia das características ultrassonográficas na previsão dessas metástases. Um nomograma baseado nos fatores de risco foi estabelecido para prever a metástase em linfonodos centrais. Resultados A incidência de metástase em linfonodos centrais foi de 22,4%. As análises univariadas e multivariadas sugeriram que sexo, idade, multifocalidade, invasão extratireoidiana e metástase em linfonodos laterais eram fatores de risco independentes para a metástase em linfonodos centrais. As análises univariadas e multivariadas revelaram que o formato nodular, a margem e a calcificação estavam independentemente associadas à metástase em linfonodos centrais. A análise da curva ROC mostrou que a combinação do formato, margem e calcificação apresentou excelente precisão na previsão dessas metástases. O nomograma foi desenvolvido com base nos fatores de risco identificados para predizer a metástase em linfonodos centrais e a análise do gráfico de calibração indicou o bom desempenho e a utilidade clínica do nomograma. Conclusões Em pacientes com microcarcinoma papilífero de tireoide, metástase em linfonodos centrais está associado ao sexo masculino, menor idade ( < 45 anos), invasão extratireoidiana, multifocalidade e presença de metástase em linfonodos laterais. As características ultrassonográficas, como formato irregular, margem mal definida e calcificação, podem melhorar a eficácia da previsão de metástase em linfonodos centrais. Cirurgiões e radiologistas devem ficar mais atentos aos pacientes que apresentam esses fatores de risco. O nomograma pode ajudar a orientar a tomada de decisão cirúrgica para o microcarcinoma papilífero de tireoide.
Subject(s)
Humans , Appendiceal Neoplasms , Neuroendocrine Tumors , Prognosis , Nomograms , Survivorship , HistologyABSTRACT
El acetaminofén se ha convertido en el analgésico más ampliamente disponible alrededor del mundo. Aunque se considera muy seguro a dosis terapéuticas, la sobredosis puede conducir a necrosis hepática y es una de las causas principales de insuficiencia hepática aguda. La hepatitis inducida por acetaminofén es de inicio agudo, rápidamente progresiva y se caracteriza por una marcada elevación de las transaminasas. Las manifestaciones iniciales pueden ser leves e inespecíficas, por lo tanto, la medición de la concentración sérica del fármaco es crítica cuando existe sospecha de sobredosis. El nivel debe ser evaluado de acuerdo según el nomogramamodificado de Rumack-Matthew para determinar el uso de la N-acetilcisteína (NAC), un antídoto eficaz si se utiliza con prontitud.Este artículo proporciona una visión general de la fisiopatología, la presentación, el diagnóstico y presenta las opciones terapéuticas actuales disponibles para tratar esta condición.
Acetaminophen has become the most widely available analgesic around the world. Although it's considered remarkably safe at therapeutic doses, its overdose can lead to hepatic necrosis and its one of the principal causes of acute liver failure. Acetaminophen-induced hepatitis is acute in onset, progresses rapidly and is characterized by a marked elevation in aminotransferases. Initial manifestations may be mild and nonspecific, thus, measurement of serum acetaminophen concentration is critical when an overdose is suspected. The level should be evaluated according to the modified Rumack-Matthew nomogram to determine the use of N-acetylcystein (NAC), an effective antidote if used promptly.This article provides an overview of the pathophysiology, presentation, diagnosis of acetaminophen poisoning and presents the actual therapeutic options available to treat this condition.
Subject(s)
Humans , Acetaminophen , Hepatitis , PoisoningABSTRACT
OBJETIVO: Determinar uma curva de referência baseada em múltiplos da mediana para o pico de velocidadesistólica da artéria cerebral média fetal. MATERIAIS E MÉTODOS: Realizou-se estudo de corte transversal com 143 gestantes normais entre 23 e 35 semanas. Realizou-se varredura bidimensional em corte axial docrânio fetal, incluindo os tálamos e o septo pelúcido, e em seguida acionou-se o modo color Doppler, visualizando-se a artéria cerebral média. O Doppler pulsátil foi disposto próximo à origem deste vaso, utilizando-se ângulo de insonação de menos de 20º. Para avaliar a correlação do pico de velocidade sistólica da artéria cerebral média com a idade gestacional, utilizou-se o coeficiente de correlação de Person (r). Por meio de modelos de regressão, construiu-se uma tabela de múltiplos da mediana para o pico de velocidade sistólica da artéria cerebral média em cada idade gestacional avaliada, e adicionalmente determinaram-se valores de referência para essa variável. RESULTADOS: Observou-se forte correlação entre o pico de velocidade sistólica da artéria cerebral média e a idade gestacional (r = 0,70; p = 0,001). Determinaram-se valores do pico de velocidade sistólica da artéria cerebral média para os seguintes múltiplos da mediana: 1,0; 1,29; 1,5;1,55. Determinaram-se os percentis 2,5 e 97,5 para o pico de velocidade sistólica da artéria cerebral média,variando de 24,33 cm²/s a 78,36 cm²/s. CONCLUSÃO: Um nomograma do pico de velocidade sistólica da artéria cerebral média fetal foi determinado.
OBJECTIVE: To determine a reference curve for the peak systolic velocity of fetal middle cerebral artery. MATERIALS AND METHODS: The authors developed a cross-sectional study with 143 healthy pregnant women between the 23rd and 35th gestational weeks. A bidimensional axial scan of the fetal skull wasperformed, including the thalami and pellucid septum. Subsequently, the middle cerebral artery was visualizedwith the color Doppler mode. The pulsed-wave Doppler transducer was positioned over the origin of this vessel, at < 20º insonation angle. The correlation between the peak systolic velocity of the middle cerebral artery and gestational age was evaluated by means of the Pearson's correlation coefficient (r). Regression models were utilized in the construction of a table with multiples of the medians of the middle cerebral artery peak systolic velocity for each gestational age. Additionally, reference values for this variable were determined. RESULTS: A strong correlation was observed between the middle cerebral artery peak systolic velocity and gestational age (r = 0.70; p < 0.001). Values of middle cerebral artery peak systolic velocity were calculated for the following multiples of the medians: 1.0, 1.29, 1.5, 1.55. The 2.5th and 97.5th percentiles were determined for the middle cerebral artery peak systolic velocity ranging between 24.33 cm²/s and 78.36 cm²/s. CONCLUSION: A nomogram for the fetal middle cerebral artery peak systolic velocity during the second half of pregnancy was generated.
Subject(s)
Humans , Female , Pregnancy , Middle Cerebral Artery/growth & development , Fetal Development , Gestational Age , Nomograms , Cross-Sectional Studies , Models, Statistical , Ultrasonography, DopplerABSTRACT
Pregunta de investigación. ¿Cual sera la validez del índice de masa corporal en embarazadas con relación al nomograma de Rosso y Mardones en los hospitales materno infantil, de la mujer y boliviano holandés de la ciudad de La Paz de enero a febrero gestión 2002?. Objetivo general. Determinar la sensibilidad, especificidad, valores predictivos positivos y negativo, además de los likelihood ratio del índice de masa corporal en embarazadas con relación al nomograma de Pedro Rosso y Mardones en los hospitales materno infantil, de la mujer y boliviano holandés de enero a febrero gestíon 2002. Diseño de estudio en la investigación. Test diagnóstico. Lugar. Hospital Materno Infantil, Hospital de la Mujer de la ciudad de La Paz y Hospital Boliviano Holandés de la Ciudad de El Alto. Población. Embarazadas, desde la décima semana a la semana 40 de gestación que asistieron al control prenatal de rutina de los hospitales señalados anteriormente. Métodos. Se evaluó el estado nutricional de la embarazada utilizando el Indice de Masa Corporal IMC (prueba a validarse) y el Nomograma de Rosso y Mardones (Gold Estandar). Para los cálculos de sensibilidad, especificidad, valores predictivos positivos y valores predictivos negativos se utilizó el paquete estadístico EPIDATA y para los cálculos estadísticos el paquete estadístico STATA 6.0. Se realizó el análisis descriptivo utilizando medidas de tendencia central y de dispersión como Promedio, Desviación Estandar, verificando a través del cálculo del intervalo de confianza 95 por ciento, porcentajes y frecuencia para las variables cualitativas. Resultados. El presente estudio se realizó en 479 embarazadas que asistieron al control prenatal de rutina en los meses de enero y febrero del 2002...
What is the validity of the Body Mass Index in pregnant women in relation to the Normogram of Rosso and Mardones in the Hospitals "Materno Infantil" " de la Mujer", and "Boliviano Holandés" in La Paz, from January to February 2002 ? General Objective o determine sensibility, specificity, positive and negative predictive values, in addition to likelihood ratio and Body Mass Index in pregnant women in relation to the Normogram of Pedro Rosso and Mardones in the Hospitals "Materno Infantil", "de la Mujer", and Boliviano Holandés" from January to February 2002. Research Design Diagnostic test SITE"Hospital Materno Infantil", "Hospital de la Mujer", "Hospital Boliviano Holandés" in La Paz. SAMPLE The sample consisted of 479 pregnant women, from the 10th week of gestation to 40 weeks of gestational age who came for routine prenatal control to the above mentioned hospitals. Methods We assessed the nutritional status of the pregnant woman using the Body Mass Index (the test to be validated), and the Normogram of Rosso and Mardones (Gold Standard).For the calculation of sensibility, specificity, negative and positive predictive values, we used the statistic package EPIDATA, and for the statistic calculus the statistic package STATA 6.0.For the descriptive analysis we used measures of central tendency and of dispersion like Mean, Standard Deviation, verifying by means of calculating the Confidence Interval 95%, percentages and frequency for the qualitative values. In order to establish the relationship between both tests we used the tests of Correlation and Chi2 .Result The present study was carried out in 479 pregnant women who came to the routine prenatal control in January and February 2002 in the Hospitals "Materno Infantil", "Boliviano Holandés", and "Hospital de la Mujer".The nutritional diagnose of the preThe results of the...