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1.
Arq. bras. oftalmol ; Arq. bras. oftalmol;88(1): e2023, 2025. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1568845

ABSTRACT

ABSTRACT Purpose: To characterize the extracellular vesicle protein cargo in the aqueous humor and plasma of patients with ocular toxoplasmosis. Methods: Aqueous humor and plasma were collected from six patients with active ocular toxoplasmosis and six patients with cataract. Extracellular vesicles were isolated, and western blotting and mass spectrometry were performed for protein analysis. Results: All plasma samples from patients with ocular toxoplasmosis and cataract were positive for the tetraspanins CD63 and TSG101. However, the aqueous humor from patients with ocular toxoplasmosis was positive only for CD63. Sixty-seven new unreported proteins were identified in the aqueous humor and plasma of patients with the ocular toxoplasmosis and cataract. Of the 67 proteins, 10 and 7 were found only in the cataract and ocular toxoplasmosis groups, respectively. In general, these proteins were involved in immune system activation and retina homeostasis and were related to infections and retina-associated diseases. Conclusion: The distinct protein signatures between ocular toxoplasmosis and cataract may be helpful in the differential diagnosis of ocular toxoplasmosis. However, more studies are needed to better understand the role of these proteins in the pathogenesis of ocular toxoplasmosis.

2.
Cambios rev. méd ; 23(2): e977, 30/11/2024.
Article in Spanish | LILACS | ID: biblio-1579229

ABSTRACT

INTRODUCCION: El rechazo se define como un aumento en el nivel de creatinina sérica des-pués de la exclusión de otras causas de disfunción del injerto, asociado a cambios patológicos específicos en el injerto y puede ocurrir en cualquier momento después del trasplante.OBJETIVO: Determinar el tiempo de sobrevida del injerto renal en pacientes trasplantados renales con Rechazo Activo.MATERIALES Y MÉTODOS: Estudio observacional, descriptivo, transversal, se realizó en el Hospital de Especialidades Carlos Andrade Marín en el periodo 2013-2022, el universo se con-formó por una base de datos anonimizada de 460 pacientes trasplantados, de los cuales 92 pacientes (20 %) presentaron diagnóstico de rechazo activo. Se utilizó el programa estadístico SPSS v26®.RESULTADOS: El 60,8% fueron pacientes de sexo masculino, con una edad media de 43,7 años, la supervivencia del aloinjerto en pacientes con rechazo fue del 85% a los 5 años de seguimiento, y de los que no tuvieron rechazo fue del 97,1 % a los 5 años con una (p =0,001). El rechazo mediado por células T presentó una mayor sobrevida del injerto renal del 97% y la menor tasa de sobrevida se evidenció en el rechazo mediado por anticuerpos.DISCUSIÓN. La incidencia del rechazo del injerto renal a nivel global se estima del 5% al 10%, aunque puede ser mayor hasta el 35%, en el grupo de alto riesgo inmunológico. La sobrevida del aloinjerto empeora con cada episodio de rechazo comparado con pacientes que no experi-mentan rechazo del injerto.CONCLUSIÓN: La tasa más alta de sobrevida se evidenció en pacientes sin rechazo durante 5 años de seguimiento, corroborando lo hallado en el estado del arte. En este estudio la super-vivencia del rechazo mediado por células T fue superior en relación con el rechazo mediado por anticuerpos.


Rejection is defined as an increase in serum creatinine level after exclusion of other causes of injectable dysfunction, associated with specific pathological changes in the injectable and may occur at any time after transplantation.OBJECTIVE: Determine the survival time of the kidney graft in kidney transplant patients with Active Rejection.MATERIALS AND METHODS: Observational, descriptive, cross-sectional study was carried out at the Carlos Andrade Marín Specialty Hospital in the period 2013-2022, the universe was made up of an anonymized database of 460 transplant patients, of which 92 patients (20 %) presented a diagnosis of active rejection. The SPSS v26® statistical program was used. RESULTS: 60.8% were male patients, with a mean age of 43.7 years, allograft survival in pa-tients with rejection was 85% at 5 years of follow-up, and of those who did not have rejection it was 97.1% at 5 years with one (p =0.001). Rejection mediated by T cells presented a greater survival rate of the kidney graft of 97% and the lowest survival rate was evident in rejection mediated by antibodies.DISCUSSION. The incidence of kidney graft rejection globally is estimated at 5% to 10%, al-though it can be higher, up to 35%, in the high immunological risk group, with increasing preva-lence. Allograft survival worsens with each episode of rejection compared to patients who do not experience graft rejection.CONCLUSION: The highest survival rate was evident in patients without rejection during 5 years of follow-up, corroborating what was found in the state of the art in this study, the survival of rejection mediated by T cells was superior in relation to rejection mediated by antibodies.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Biopsy , Kidney Transplantation , Creatinine , Graft Rejection , Graft Survival , Immunosuppressive Agents , T-Lymphocytes , Survival Analysis , Ecuador , Transplant Recipients
3.
An. bras. dermatol ; An. bras. dermatol;99(5): 696-705, Sept.-Oct. 2024. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1573828

ABSTRACT

Abstract Background Histopathology can be crucial for diagnosis of inflammatory nail diseases. Longitudinal excision and punch biopsies are the most used techniques to obtain the tissue sample. However, there is a low clinical-histopathological correlation, besides the risk of nail dystrophy. Tangential excision biopsy (TB) is a well-established technique for the investigation of longitudinal melanonychia. TB could also be used to evaluate diseases in which histopathological changes are superficial, as in psoriasis. Objective To study the value of TB in the histopathological diagnosis of nail psoriasis. Methods This is a prospective and descriptive study of the clinical-histopathological findings of samples from the nail bed or matrix and nail plate of 13 patients with clinical suspicion of nail psoriasis. Biopsies were obtained through partial nail avulsion and TB. Results In nine patients, the hypothesis of psoriasis was confirmed by histopathology; in one, the criteria for diagnosing nail lichen planus were fulfilled. The tissue sample of only one patient did not reach the dermal papillae, and, in four of 13 patients, the adventitial dermis was not sampled. No patient developed onychodystrophy after the procedure. Study limitations In three patients, the clinical and, consequently, histopathological nail changes were subtle. Also, in one patient's TB didn't sample the dermal papillae. Conclusions TB is a good option to assist in the histopathological diagnosis of nail psoriasis, especially when appropriate clinical elements are combined. Using this technique, larger and thinner samples, short postoperative recovery time, and low risk of onychodystrophy are obtained.

4.
Medwave ; 24(9): e2801, 30-10-2024.
Article in English, Spanish | LILACS-Express | LILACS | ID: biblio-1585361

ABSTRACT

Introducción La progresión del cáncer de mama involucra mecanismos fisiológicos como metástasis. Los retrasos en diagnóstico y tratamiento aumentan el riesgo de mortalidad y se asocian a barreras de acceso a la salud. En Chile, el cáncer de mama es altamente prevalente y su diagnóstico temprano ha mejorado, aunque persisten disparidades en el proceso de enfermedad. Este estudio caracterizó exámenes de diagnóstico y etapificación, tiempos de espera y perfiles sociodemográficos para identificar demoras e inequidades en la atención. Métodos Estudio de encuesta. Utilizando una muestra no probabilística, se aplicó un cuestionario en plataforma encriptada previo consentimiento informado. En el instrumento se recogieron datos de exámenes solicitados, tiempos asociados, etapificación y características sociodemográficas. Estas variables fueron analizadas utilizando estadística descriptiva, test de asociación, intervalos de confianza y test de comparación utilizando . Resultados Se logró una muestra de 263 personas. Los exámenes más solicitados fueron biopsia (99,62%) y exámenes de sangre (80,23%). La mediana de exámenes solicitados fue de 6 (Q1:4, Q3:8), con media 5,87 (desviación estándar: 2,24). No se observaron diferencias significativas en el porcentaje de personas a quienes se solicitó la totalidad de exámenes según variables estudiadas. Los intervalos día-hora-resultado oscilaron entre 1 y 365 días. La mediana día-hora-resultado de la biopsia fue de 15 días (Q1:10, Q3:30). Las personas entre 40 y 49 años, no residentes de la capital, pertenecientes al quintil I de ingreso, con educación media, del sistema público de salud, con diagnóstico en etapa tardía presentaron mayores medianas de día-hora-resultado en biopsia. No hubo diferencia significativa en la cantidad de exámenes solicitados según etapificación (I a II y III a IV). Conclusiones La biopsia en Chile es el examen de elección para la confirmación diagnóstica en cáncer de mama. Otros exámenes son solicitados independientemente de la etapa del diagnóstico, existiendo una discordancia con las recomendaciones de la guía clínica. El pronóstico del cáncer es crucial, especialmente en países con mayores inequidades.


Introduction Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Methods Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. Results A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Conclusions Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.

5.
Article | IMSEAR | ID: sea-242307

ABSTRACT

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a breakthrough in diagnosing mediastinal diseases. However, it is less sensitive in diagnosing some mediastinal diseases, where diagnosis largely depends on a larger tissue sample with preserved tissue architecture, such as lymphoproliferative diseases of the mediastinum. Another newer approach, endobronchial ultrasound-guided transbronchial mediastinal cryonodal biopsy (EBUS-TBCNB), can overcome the limitations of EBUS-TBNA and provide larger samples with preserved tissue architecture. Here we present a case of an elderly female with multiple mediastinal lymphadenopathy who underwent EBUS-TBNA two times, despite adequate sampling, the diagnosis remains inconclusive. We were only able to make a diagnosis of mediastinal lymphoma after EBUS-TBCNB under conscious sedation. Endobronchial ultrasound-guided transbronchial mediastinal cryonodal biopsy is a safe and effective procedure that can be used in the successful diagnosis of mediastinal pathologies where EBUS-TBNA remained inconclusive, or it may be used as a combined procedure with EBUS-TBNA in cases of diagnostic uncertainty.

6.
J. bras. nefrol ; 46(3): e20230143, July-Sept. 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1558250

ABSTRACT

Introduction: Percutaneous kidney biopsy (KB) is crucial to the diagnosis and management of several renal pathologies. National data on native KB in pediatric patients are scarce. We aimed to review the demographic and clinical characteristics and histopathological patterns in children who underwent native percutaneous KB over 24 years. Methods: Retrospective observational study of patients undergoing native percutaneous KB in a pediatric nephrology unit between 1998 and 2021, comparing 3 periods: period 1 (1998-2005), period 2 (2006-2013), and period 3 (2014-2021). Results: We found that 228 KB were performed, 78 (34.2%) in period 1, 91 (39.9%) in period 2, and 59 (25.9%) in period 3. The median age at KB was 11 (7-14) years. The main indications for KB were nephrotic syndrome (NS) (42.9%), hematuria and/or non-nephrotic proteinuria (35.5%), and acute kidney injury (13.2%). Primary glomerulopathies were more frequent (67.1%), particularly minimal change disease (MCD) (25.4%), IgA nephropathy (12.7%), and mesangioproliferative glomerulonephritis (GN) (8.8%). Of the secondary glomerulopathies, lupus nephritis (LN) was the most prevalent (11.8%). In group 1, hematuria and/or non-nephrotic proteinuria were the main reasons for KB, as opposed to NS in groups 2 and 3 (p < 0.01). LN showed an increasing trend (period 1-3: 2.6%-5.3%) and focal segmental glomerular sclerosis (FSGS) showed a slight decreasing trend (period 1-3: 3.1%-1.8%), without statistical significance. Conclusions: The main indication for KB was NS, which increased over time, justifying the finding of MCD as main histological diagnosis. LN showed an increase in incidence over time, while FSGS cases did not increase.


RESUMO Introdução: A biópsia renal (BR) percutânea é fundamental para diagnóstico e manejo de diversas patologias renais. Dados nacionais sobre BR nativa em pacientes pediátricos são escassos. Nosso objetivo foi revisar características demográficas, clínicas e padrões histopatológicos em crianças submetidas a BR percutânea nativa ao longo de 24 anos. Métodos: Estudo observacional retrospectivo de pacientes submetidos a BR percutâneas nativas em unidade de nefrologia pediátrica entre 1998 e 2021, comparando três períodos: período 1 (1998-2005), período 2 (2006-2013), período 3 (2014-2021). Resultados: Constatamos que foram realizadas 228 BR, 78 (34,2%) no período 1, 91 (39,9%) no período 2, 59 (25,9%) no período 3. A idade mediana na BR foi 11 (7-14) anos. As principais indicações para BR foram síndrome nefrótica (SN) (42,9%), hematúria e/ou proteinúria não nefrótica (35,5%), lesão renal aguda (13,2%). Glomerulopatias primárias foram mais frequentes (67,1%), principalmente doença de lesão mínima (DLM) (25,4%), nefropatia por IgA (12,7%), glomerulonefrite mesangioproliferativa (GN) (8,8%). Das glomerulopatias secundárias, nefrite lúpica (NL) foi a mais prevalente (11,8%). No grupo 1, hematúria e/ou a proteinúria não nefrótica foram os principais motivos para BR, ao contrário da SN nos grupos 2 e 3 (p < 0,01). A NL apresentou tendência crescente (período 1-3: 2,6%-5,3%) e a glomeruloesclerose segmentar focal (GESF) apresentou leve tendência decrescente (período 1-3: 3,1%-1,8%), sem significância estatística. Conclusões: A principal indicação para BR foi SN, que aumentou ao longo do tempo, justificando o achado de DLM como principal diagnóstico histológico. A NL apresentou aumento na incidência ao longo do tempo, enquanto os casos de GESF não aumentaram.

7.
Rev. argent. radiol ; 88(4): 152-158, set. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1583341

ABSTRACT

Resumen Introducción: La biopsia transtorácica guiada por tomografía computada es uno de los métodos más utilizados por la obtención de una muestra redituable para el estudio histopatológico de nódulos pulmonares. Se destaca el neumotórax como una de las complicaciones más frecuentes. Objetivo: Analizar la incidencia de neumotórax en biopsias pulmonares y su relación con el enfisema. Evaluar si existe mayor frecuencia de esta complicación en alguno de los pasos del proceso. Método: Estudio retrospectivo que incluyó procedimientos de biopsia pulmonar percutánea realizados entre mayo de 2021 y abril de 2023. Se establecieron como variables la presencia de enfisema, la relación de la lesión a la pleura y el neumotórax como complicación. Se evaluó el RR (IC95%) de neumotórax según la presencia de enfisema y el contacto con la pleura. Resultados: Entre 70 casos, 27 (39%) mostraron signos de enfisema. Entre los casos con neumotórax, el 71% fueron al retirar la aguja. Entre los pacientes con neumotórax, 10 (71%) presentaban enfisema (RR: 4,0; IC95%: 1,4-11,4; p = 0,01) y nueve de ellos (90%) fueron al retirar la aguja. De las lesiones en contacto pleural, 2/34 desarrollaron neumotórax (RR; 0,17; IC95%: 0,04-0,69; p = 0,01). Conclusiones: Identificamos una relación significativa entre el enfisema y el riesgo de neumotórax. Esto se observó con mayor frecuencia al retirar la aguja y en punciones de lesiones sin contacto pleural, lo que sugiere que el daño parenquimatoso del enfisema impide al tejido pulmonar poder colapsar de forma habitual el orificio de entrada.


Abstract Introduction: CT-guiaded transthoracic biopsy is one of he most commonly used methods for obtaining a reliable sample for the histopathological study of pulmonary nodules. Pneumothorax is highlighted as one of the most frequent complications. Objective: To analyze the incidence of pneumothorax in lung biopsies and its relationship with emphysema. To assess whether there is a higher frequency of this complication in any of the steps of the process. Method: A retrospective that includes percutaneous lung biopsy procedures performed between May 2021 and April 2023. The presence of emphysema and the relation of the lesion to the pleura were established as variables and so was the pneumothorax as a complication. The RR (95%CI) of pneumothorax was assessed according to the presence of emphysema and pleural contact. Results: Among 70 cases, 27 (39%) showed signs of emphysema. Among cases with pneumothorax, 71% were on needle removal. Among patients with pneumothorax, 10 (71%) had emphysema (RR: 4.0; 95% CI: 1.4-11.4; p = 0.01) and nine of them (90%) were on needle removal. Of the pleural contact lesions, 2/34 developed pneumothorax (RR: 0.17; 95% CI: 0.04-0.69; p = 0.01). Conclusions: We identified a significant relationship between emphysema and risk of pneumothorax. This was most frequently observed at needle removal and in punctures of lesions without pleural contact, which suggests that the parenchymal damage of emphysema prevents the entry orifice of the lung tissue from closing.

8.
Odontol. sanmarquina (Impr.) ; 27(3): e27687, jul-set. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1572452

ABSTRACT

Introducción: El lipoma es una neoplasia benigna común en tejidos blandos, pero poco frecuente en cavidad bucal. El mixolipoma es un subtipo histológico raro, caracterizado por adipocitos maduros y abundantes sustancias mucoides. Suele presentarse como nódulos submucosos blandos, móviles, recubiertos por mucosa intacta, crecimiento lento y asintomáticos hasta que crecen causando incomodidad. Reporte de caso: Hombre de 74 años habitante de la calle que presentó en fondo de surco en mucosa labial inferior lesión nodular de 2 cm de diámetro, que se desarrolló durante dos años, causando molestias al comer y fue eliminada quirúrgicamente. El estudio histopatológico mostró tejido adiposo maduro y zonas de aspecto mixoide, sin evidencia de atipia, red vascular plexiforme o lipoblastos, en la inmunohistoquímica los adipocitos maduros exhibieron marcada positividad para la proteína S-100 y negatividad para CD34, las células endoteliales mostraron positividad para CD34, confirmando el diagnóstico de mixolipoma. Conclusión: Es esencial que los proveedores de atención médica estén familiarizados con las manifestaciones clínicas del mixolipoma e incluirlo en los posibles diagnósticos ante la presencia de nódulos en la cavidad oral. Asimismo, no se debe subestimar la importancia de educar y concienciar sobre la salud bucal de los habitantes de la calle.


Introduction: Lipoma is a common benign neoplasm in soft tissues, but rare in the oral cavity. Myxolipoma is a rare histological subtype, characterized by mature adipocytes and abundant mucoid substances. It usually presents as soft, mobile submucosal nodules, covered by intact mucosa, slow growing and asymptomatic until they grow causing discomfort. Case report: This is the case of a 74-year-old street dweller who presented with a nodular lesion, 2 cm in diameter, at the bottom of the groove in the lower labial mucosa. The lesion developed over two years and caused discomfort when eating. It was surgically removed. The histopathological study showed mature adipose tissue and areas with a myxoid appearance, without evidence of atypia, plexiform vascular network or lipoblasts, in immunohistochemistry the mature adipocytes exhibited marked positivity for the S-100 protein and negativity for CD34, the endothelial cells showed positivity for CD34, confirming the diagnosis of myxolipoma. Conclusion: It is essential that healthcare providers are familiar with the clinical manifestations of myxolipoma and include it in the possible diagnoses in the presence of nodules in the oral cavity. Likewise, the importance of educating and raising awareness about the oral health of street dwellers should not be underestimated.

9.
Medicina (B.Aires) ; Medicina (B.Aires);84(3): 459-467, ago. 2024. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1575223

ABSTRACT

Resumen Introducción : Objetivo: comparar sensibilidad diag nóstica de videocolposcopia con inteligencia artificial (IA) auxiliar, con la videocolposcopia común realizada por colposcopistas. Métodos : Estudio descriptivo de corte transversal retrospectivo, en 782 historias clínicas anonimizadas del Sistema Informático para el Tamizaje (SITAM), de mujeres a las cuales se les efectuaron videocolposcopia con IA y colposcopías con videocolposcopio común rea lizadas por especialistas, con sus biopsias (gold standard). Se evaluó la relación entre los resultados de videocol poscopia con IA y videocolposcopia común con resulta dos de las biopsias. Se calculó precisión global de cada procedimiento diagnóstico. Se determinó sensibilidad y concordancia de los resultados de la videocolposcopia con IA, con el gold standard. Resultados : Se analizaron 395 historias clínicas de pacientes con videocolposcopia con IA y 387 con vi deocolposcopia común. La precisión diagnóstica de resultados fue 80% (IC 95%: 75-83%) en videocolposco pias con IA y 65% (IC 95%: 60-69%) en videocolposcopia común (p<0.001). Los resultados de videocolposcopia con IA y colposcopia común se correlacionaron signifi cativamente con los resultados de las biopsias, rs=0.75 vs. rs=0.57 respectivamente (p<0.001). La sensibilidad de videocolposcopia con IA fue 96% (IC 95%: 94-98%), y 93% (IC 95%: 89-95%) en colposcopías comunes. La concordancia general de las impresiones colposcópicas clasificadas por videocolposcopia con IA y enfermedad fue mayor que la de la interpretación colposcópica de los colposcopistas (90% frente a 83%, Kappa 0.59 frente a 0.47, p<0.001). Conclusión : La alta precisión diagnóstica de video colposcopia con IA permite aumentar la sensibilidad del estudio y mejorar la detección precoz de lesiones precursoras de neoplasias cervicouterinas.


Abstract Introduction : To compare the diagnostic sensitivity of artificial intelligence (AI) assisted videocolposcopy with standard videocolposcopy performed by specialist colposcopists. Methods : A descriptive retrospective cross-sectional study, 782 anonymized medical records from the Com puterized System for Screening (SITAM) of women who underwent videocolposcopy with AI and colposcopy with common videocolposcopy performed by specialists, with their corresponding biopsies (gold standard) were analyzed. The relationship between the results of IA videocolposcopy and regular videocolposcopy and the results of biopsies was evaluated. The overall accuracy of each diagnostic procedure was calculated. The sensitiv ity and concordance of the results of AI videocolposcopy with the gold standard (biopsy) were determined. Results : A total of 395 patient records of patients with IA videocolposcopy and 387 with regular vi-deocolposcopy were analyzed. The accuracy of results was 80% (IC 95%: 75-83%) in IA videocolposcopy and 65% (IC 95%: 60-69%) in regular videocolposcopy (p<0.001). Videocolposcopy results with IA and com mon colposcopy were significantly correlated with bi opsy results, rs=0.75 vs. rs=0.57 respectively (p<0.001). The sensitivity of videocolposcopy with AI was 96% (95% CI: 94-98%), and 93% (95% CI: 89-95%) for regu lar colposcopy. The overall agreement of colposcopic impressions classified by videocolposcopy with AI and disease was higher than that of colposcopic interpretation by colposcopists (90% vs. 83%, Kappa 0.59 vs. 0.47, p<0.001). Conclusion : The high diagnostic accuracy of AI vi-deocolposcopy allows obtaining highly sensitive studies that help in the early detection of precursor lesions of cervical neoplasia.

10.
Article | IMSEAR | ID: sea-234208

ABSTRACT

Background: Breast carcinoma is one of the most researched cancers across the world. FNAC is often used as a first priority investigation in patients with breast lump. Tru-cut biopsy is useful in preoperative knowledge of prognostic parameters with the help of IHC markers ER, PR, Her2 neu. The technique is reliable, simple and reproducible which can be used even in resource poor countries like India. To analyze the sensitivity, specificity, positive predictive values and negative predictive values and the diagnostic accuracy (efficacy) of fine needle aspiration cytology and trucut biopsy. Methods: The study included 82 patients presenting with palpable breast lesions. All patients underwent FNAC followed by Tru-cut biopsy under ultrasound guidance. ER, PR, HER2 Neu, cytokeratin immunostaining was done in malignant cases. The data collected analysed statistically. Results: The sensitivity, specificity, PPV, NPV of FNAC were 96.61 %, 95.65 %, 98.28%, 90.91% respectively and that of trucut biopsy were 100%, 100%, 100%, and 100 % respectively. Conclusions: Out of total 82 patients, maximum no of cases (57) were duct carcinoma accounting 69.50% on FNAC and Tru-cut biopsy. IHC was done in all carcinomas. Maximum (46 cases) were luminal type. The present study emphasizes that tru-cut biopsy can serve as confirmative diagnostic tool over FNAC and provides information regarding prognostic factors and treatment modalities based on IHC markers.

11.
Article | IMSEAR | ID: sea-240365

ABSTRACT

There are two forms of myeloma: Solitary plasmacytoma and multiple myeloma. Both are malignant tumors and develop from bone marrow plasma cells, which secrete immunoglobulins. Pleural effusion secondary to myeloma is extremely rare, with an incidence of 1–2%. A 58-year-old man presented to the emergency department with a chief complaint of swelling and pain over the left side of his chest, breathlessness, generalized weakness, abdominal pain, and blood in his stool for 15 days. The chest X-ray posteroanterior view showed well-defined homogenous opacity in the left hemithorax. The patient underwent ultrasound-guided left-sided thoracocentesis. Pleural fluid was exudative, and cytology showed the presence of malignant cells. Contrast-enhanced computed tomography of the thorax and abdomen showed a well- defined soft-tissue density lesion involving the left posteriolateral chest wall with underlying rib erosion. For confirmation of malignant etiology, a USG-guided transthoracic needle biopsy was performed. A biopsy revealed a malignant round cell tumor in a histopathological review. For confirmation, a tissue sample was sent for immunohistochemistry markers, which had positivity for CD 138 and MUM 1, consistent with myeloma. Rarely, MM can present as chest wall swelling. Ultrasound is an easily available diagnostic modality that can be used for chest wall biopsy with a minimal incidence of complications.

12.
Article | IMSEAR | ID: sea-240319

ABSTRACT

Background: Leprosy usually remains underdiagnosed or over-diagnosed due to a high dependency on clinical expertise. Leprosy requires a simple easy-to-perform laboratory test that guides clinicians to come to a conclusion with clinical correlation. Punch biopsy is the gold standard but it requires a biopsy facility in a hospital setting. Molecular diagnosis is out of reach even in resource-rich setups due to the non-availability of commercial kits. In this context slit-skin smear (SSS) might be an easier alternative to guide clinicians for a quality diagnosis, especially in peripheral hospitals. Aims and Objectives: To determine diagnostic sensitivity and specificity of SSS with respect to punch biopsy. Materials and Methods: The present study is an observational cross-sectional study conducted in a teaching institute in peripheral West Bengal. Two samples from clinically suspected patients of leprosy were collected for SSS and punch biopsy. Tests were performed as per standard laboratory protocol. Positive cases were informed to the clinician and treated as per World Health Organization treatment guidelines. SSS was compared to a punch biopsy with respect to sensitivity, specificity, positive predictive value, and negative predictive value. Results: Twenty-five among 59 clinically suspected cases were positive by either two tests or only one test. Twenty-one were males and four were female. Thirty-six was the median age distribution in positive cases 19 cases were positive by both SSS and punch biopsy, five by punch biopsy only, and one by SSS only. Sensitivity and specificity were 79.17% and 97.14%, respectively. Conclusion: SSS is not inferior to punch biopsy even in paucibacillary cases. It is a simple easy-to-perform test but requires training and awareness in medical personnel to make it a front-line weapon to combat continuous leprosy transmission in the community.

13.
An. Fac. Med. (Perú) ; 85(3): 324-328, jul.-set. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1581620

ABSTRACT

RESUMEN La criobiopsia transbronquial se ha descrito como un nuevo método para obtener tejido pulmonar, demostrando buena correlación con las biopsias quirúrgicas, menos complicaciones, costos y estancia hospitalaria. Describimos la primera experiencia con éxito en un hospital nacional de Perú. Paciente mujer de 53 años, con tiempo de enfermedad de cinco años, caracterizado por disnea progresiva. La tomografía mostró patrón no usual de neumonía intersticial (UIP). Estudio reumatológico: anticuerpos antinucleares (ANA) positivo mixto, nuclear moteado 1/2560 y nucleolar 1/5120. El anti - anticuerpos nucleares extraíbles (ENA) fue positivo y los anticuerpos frente al citoplasma de los neutrófilos (ANCA) negativo. La espirometría con capacidad vital forzada (CVF) 1,83 (69%) y prueba de difusión 10,39 (67%). Tras la evaluación del comité multidisciplinario se solicitó biopsia pulmonar. Previa evaluación clínica y funcional, se realizó la criobiopsia con el uso de anestesia general, bloqueador endobronquial profiláctico, guía fluoroscópica y criosonda.


ABSTRACT Transbronchial cryobiopsy has been described as a new method to obtain lung tissue, demonstrating good correlation with surgical lung biopsies, fewer complications, costs and hospital stay. We describe our first experience carried out successfully in a national hospital. This is a 53-year-old female patient, with a disease duration of five years, characterized by progressive dyspnea. Non-UIP standard tomography. Rheumatological study: mixed positive ANA, speckled nuclear 1/2560 and nucleolar 1/5120. Anti-ENA positive, ANCA negative. Spirometry with FVC 1.83 (69%) and diffusion test 10.39 (67%). After the evaluation of the multidisciplinary committee, a lung biopsy was indicated. After clinical and functional evaluation, cryobiopsy was performed with the use of general anesthesia, prophylactic endobronchial blocker, fluoroscopic guidance and cryoprobe.

14.
Int. braz. j. urol ; 50(3): 319-334, May-June 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1558077

ABSTRACT

ABSTRACT Purpose: To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx). Materials and Methods: We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination. Discrimination was evaluated with area under the receiver operating characteristic (AUROC). Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC. Results: Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75. Conclusions: Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI

15.
Rev. cuba. med. mil ; 53(2)jun. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1583706

ABSTRACT

Introducción: El estudio citológico por punción ecoguiada es rápido, confiable, mínimamente invasivo y beneficioso. Permite reducir procedimientos quirúrgicos innecesarios y clasifica a los pacientes con nódulos benignos o malignos para una intervención quirúrgica oportuna. Objetivo: Evaluar la utilidad diagnóstica, para enfermedad nodular, de la punción con aguja fina. Métodos: Estudio observacional, analítico y de corte transversal, basado en el análisis de los resultados de punción aspiración con aguja fina preoperatoria de pacientes sometidos a cirugía tiroidea en el Hospital Hipólito Unánue entre enero 2016 - diciembre 2019. Resultados: 105 pacientes cumplieron con los criterios de inclusión, de los cuales el 95 % (n= 100) fueron de sexo femenino. El rango de edad estuvo entre 13 y 82 años. Del total de pacientes en 64 la citología fue informada como benigna y en 19 como maligna. El diagnóstico citológico mostró una sensibilidad de un 60 %, especificidad de un 98,1 %, y valores predictivos positivo del 94,7 % y negativo del 81,3 %. La precisión de la prueba diagnóstica de citología fue de un 84,3 % (intervalo de confianza de 95 %: 74,7-91,4). Conclusión: La punción aspiración con aguja fina permite un diagnóstico simple, mínimamente invasivo, seguro y rentable, para lesiones tiroideas, con una alta especificidad y precisión. Sin embargo, debido a las posibilidades de resultados falsos negativos encontrados en este estudio, se recomienda que incluso los pacientes con hallazgos citológicos benignos sean sometidos a seguimiento clínico regular.


Background: Ultrasound-guided fine-needle aspiration cytology is fast, reliable, minimally invasive, and beneficial. It reduces unnecessary surgical procedures and classifies patients with benign or malignant nodules for timely surgical intervention. Objective: To evaluate the diagnostic utility, for nodular disease, of the ultrasound-guided fine-needle aspiration cytology. Methods: An observational, analytical and cross-sectional study was carried out based on the analysis of the results of preoperative fine-needle aspiration cytology of patients who underwent thyroid surgery between January 2016 and December 2019. Results: 105 patients fulfilled the inclusion criteria, of which 95% (n= 100) were women, and 5% (n= 5) were men. The age range was between 13 and 82 years. Of the total stitches, 64 were reported as benign and 19 as malignant. A sensitivity of 60% and a specificity of 98.1%, positive predictive value of 94.7%, and negative predictive value of 81.3% were calculated. The diagnostic accuracy of fine-needle aspiration cytology is 0.8434, with a 95% confidence interval of (74.7%-91.4%). Conclusion: Fine-needle aspiration cytology allows a simple, minimally invasive, safe, and cost-effective diagnosis of thyroid lesions with high specificity and precision. However, due to the possibility of false-negative results, it is recommended that even patients with benign cytological findings be maintained in regular clinical follow-up.

16.
Rev. cuba. med. mil ; 53(2)jun. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1583718

ABSTRACT

Introducción: El quiste óseo aneurismático fue descrito como una lesión hemorrágica que contiene cavidades quísticas, de paredes delgadas, llenas de sangre, localmente destructivo y no se considerada una neoplasia verdadera. Objetivos: Presentar a un paciente masculino, con quiste óseo aneurismático en la cadera. Caso Clínico: Se presenta el caso de un varón de 18 años de edad, con dolor en la cadera derecha, de meses de evolución, que se irradia a la rodilla derecha, que fue incrementando sin mejorar y se asoció aumento de volumen de la rodilla ipsilateral. En la radiografía se evidenció una lesión lítica localizada en el macizo trocantérico derecho, de aproximadamente 8 cm de diámetro, multiloculada, con cavidades en su interior y adelgazamiento de las corticales; se realizó biopsia incisional abierta, curetaje y relleno con injerto heterólogo de esponjosa y se envió el tejido a anatomía patológica. Conclusiones: El quiste óseo aneurismático constituye una lesión poco frecuente, que el ortopedista debe sospechar ante imágenes radiológicas óseas de lesiones líticas y multiloculadas de carácter expansivo.


Introduction: The aneurysmal bone cyst was described as a hemorrhagic lesion that contains cystic cavities, with thin walls, filled with blood, locally destructive and was not considered a true neoplasm. Objectives: To present a male patient with aneurysmal bone cyst in the hip. Clinical Case: The case of an 18-year-old male is presented, with pain in the right hip, lasting for months, which radiated to the right knee, which increased without improving and was associated with an increase in the volume of the knee. ipsilateral. The radiograph revealed a lytic lesion located in the right trochanteric mass, approximately 8 cm in diameter, multiloculated, with cavities inside and thinning of the cortices; Open incisional biopsy, curettage and filling with heterologous cancellous graft were performed and the tissue was sent to pathology. Conclusions: The aneurysmal bone cyst constitutes a low frequent lesion, which the orthopedist should suspect in the presence of radiological bone images of lytic and multiloculated lesions of an expansive nature.

17.
Rev. argent. mastología ; 42(154): 28-40, jun. 2024. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1568358

ABSTRACT

Introducción: En la actualidad entre un 25 y 30% de los cánceres de mama se representan por lesiones no palpables. Es por eso que ha aumentado y se nos exige cada vez más en la detección de estas lesiones y posterior tratamiento de las mismas. Presentamos en este trabajo nuestra experiencia desde 2014 a 2020 de la realización de Biopsia radio quirúrgica guiada por radioscopia intraoperatoria. Objetivo: El objetivo de nuestro trabajo es evaluar si la BRQ asistida por radioscopia permitió mejorar ciertos parámetros, como la evaluación de márgenes quirúrgicos, tasas de retumorectomias, volumen de tejido resecado y tiempo quirúrgico empleado. Material y método: Se realizó un estudio observacional retrospectivo de tipo corte transversal, incluyendo las pacientes con lesiones mamarias no palpables a las cuales se les realizó punción biopsia y colocación de clip metálico, y que luego fueron sometidas a BRQ en el Centro Mamario del Hospital Universitario Austral entre noviembre de 2014 a noviembre de 2020. Resultados: Se incluyeron un total de 128 pacientes. En el 100% de las cirugías se logró la extracción del clip, colocado preoperatoriamente. No encontramos diferencias estadísticamente significativas, entre ambos grupos con respecto a la edad de las pacientes, tipo de cirugía, piezas obtenidas, márgenes quirúrgicos y necesidad de re operación. Sí se constató una diferencia estadísticamente significativa en cuanto al volumen total resecado, siendo esta menor en la técnica de BRQ con radioscopia, infiriendo un mejor resultado cosmético. Conclusiones: La biopsia radioquirúrgica asistida por radioscopia es un procedimiento sencillo que permite extirpar las lesiones no palpables de la mama, minimizando la probabilidad de fallo del procedimiento, y con menor volumen de tejido mamario resecado. Con la sistematización de la técnica, se podrían mejorar otros parámetros, inclusive los costos del procedimiento, lo cual creemos que da un gran beneficio en la práctica diaria para la resección de estas lesiones(AU)


Introduction: Currently, between 25 and 30% of breast cancers are represented by non-palpable lesions. That is why it has increased and we are increasingly required to detect these lesions and later treat them. In this study we present our experience from 2014 to 2020 of performing intraoperative fluoroscopy-guided radio-surgical biopsy. Objetive: The objective of our workis to evaluate whether radioscopy-assisted BRQ allowed to improve certain parameters, such as the evaluation of surgical margins, re-lumpectomy rates, volume of resected tissue, and surgical time used. Material and method: A retrospective cross-sectional observational study was carried out, including patients with non-palpable breast lesions who underwent a biopsy puncture and metal clip placement, and who then underwent BRQ at the Breast Center of the Austral University Hospital between November from 2014 to November 2020. Results: A total of 128 patients were included. In 100% of the surgeries, the clip was extracted, placed preoperatively. We did not find statistically significant differences between both groups with respect to the age of the patients, type of surgery, pieces obtained, surgical margins and need for reoperation. A statistically significant difference was found in terms of the total volume resected, this being less in the BRQ technique with fluoroscopy, inferring a better cosmetic result. The aesthetic result is very good. Conclusions: Radioscopy -assisted radio surgical biopsy is a simple procedure that allows the removal of non-palpable breast lesions, minimizing the probability of procedural failure, and with a smaller volume of resected breast tissue. With the systematization of the technique, other parameters could be improved, including the costs of the procedure, which we believe is of great benefit in daily practice for the resection of these lesions(AU)

18.
Article | IMSEAR | ID: sea-228567

ABSTRACT

Background: Celiac disease or gluten enteropathy is an immune-mediated systemic disorder elicited by gluten and related prolamines in genetically susceptible individuals and is characterized by the presence of gluten enteropathy, celiac disease-specific antibodies, HLA-DQ2/DQ8 haplotypes. IgG4-related diseases is an increasingly recognized immune-mediated condition in autoimmune disorders such as primary sclerosing cholangitis, autoimmune hepatitis, and autoimmune thyroiditis, characterized by tissue fibrosclerosis and infiltration by IgG4-positive plasma cells and increased serum IgG4 concentrations.Methods: A total of 33 children with newly diagnosed celiac disease and 31 control subjects were included in this study. All suspected celiac disease children underwent duodenal biopsy and were diagnosed based on Marsh grading. Serum IgG4 level estimations were performed using an enzyme-linked immune sorbet assay method with a cut-off of 135 mg/dl for diagnosis.Results: A significant positive association between serum IgG4 levels and Marsh classification was found, the higher the levels of IgG4 in serum, the higher the grade on Marsh staging. Mean serum IgG4 levels in Marsh 3a was 126.32 mg/dl, in 3b was 171.35 mg/dl and in 3c was 209.24 mg/dl (p value=0.004)Conclusions: With increasing serum IgG4 levels, increased severity of damage was seen on biopsy specimens based on higher Marsh grade. To the best of found knowledge, this is the first study to establish the relation between IgG4 and mucosal damage in children with celiac disease.

19.
Hepatología ; 5(2)mayo-ago. 2024. fig, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1556417

ABSTRACT

La enfermedad vascular porto-sinusoidal es una causa infrecuente de hipertensión portal no cirrótica, fue descrita recientemente y es poco diagnosticada por el desconocimiento entre los médicos. Se considera en casos de hipertensión portal clínicamente significativa, en ausencia de cirrosis. El diagnóstico se basa en los hallazgos de la biopsia. El pronóstico de la enfermedad es mejor que el de los pacientes cirróticos, y el tratamiento es similar al de la hipertensión portal y al de las complicaciones que presentan los pacientes con cirrosis. Se presenta el caso de una paciente con várices esofágicas con estudios de imágenes no compatibles con cirrosis y hallazgos específicos en la biopsia de enfermedad vascular porto-sinusoidal. Este caso muestra el ejercicio diagnóstico en un caso de enfermedad vascular porto-sinusoidal de una paciente de Colombia, así como el resultado de las intervenciones terapéuticas y la evolución en el tiempo.


Porto-sinusoidal vascular disease is an uncommon cause of non-cirrhotic portal hypertension. It was recently described and is rarely diagnosed due to lack of knowledge among doctors. It is considered in cases of clinically significant portal hypertension in the absence of cirrhosis, and the diagnosis is based on biopsy findings. The prognosis of the disease is better than that of cirrhotic patients, and the treatment is similar to that of portal hypertension, including the management of complications associated with cirrhosis. We present the case of a patient with esophageal varices, whose imaging studies were not compatible with cirrhosis, alongside specific biopsy findings of porto-sinusoidal vascular disease. This case illustrates the diagnostic process in a patient from Colombia with portosinusoidal vascular disease, as well as the outcomes of therapeutic interventions and the patient´s evolution over time.

20.
Article | IMSEAR | ID: sea-233880

ABSTRACT

Acute kidney injury (AKI) with evidence of hemolysis is associated with tropical infections. However, pigment-induced AKI can happen with relatively uncommon genetic causes of hemolytic anemia, i.e., glucose 6-phosphate deficiency (G6PD). We share our experience of one such patients whose clinical presentation was rapidly progressive glomerulonephritis. On evaluation, she had a history of usage of some drugs and with G6PD estimation revealing deficient status even during the episode while other tests such as Coomb's test and bone marrow biopsy was normal. The kidney biopsy revealed diffuse tubular injury with presence of several coarse granular/pigmented casts in tubular lamina. She was managed with hemodialysis and showed complete recovery. Thus, in tropical countries G6PD deficiency although is not common, should be considered among patients who presented as rapidly progressive renal failure (RPRF) and having history of precipitating factors for G6PD deficiency and a detailed hemolytic work-up needs to be carried out as an important cause of preventable recurrent AKI in tropical countries.

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