Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 155
Article in Chinese | WPRIM | ID: wpr-931683


Objective:To investigate the effects of ultrasound-guided adductor block with chloroprocaine combined with fentanyl on analgesia and early rehabilitation after total knee arthroplasty.Methods:Eighty-eight patients who underwent total knee arthroplasty in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between June 2018 and June 2020 were included in this study. They were randomly divided into control and study groups, with 44 patients per group. The control group was subjected to distal adductor block with ropivacaine. The study group received distal adductor block with ropivacaine combined with fentanyl. Before and after distal adductor block, resting pain response was evaluated using the Visual Analogue Scale. The success rate, onset time of block, and duration of block effect were recorded. The quadriceps femoris muscle strength, knee joint range of motion, and Hospital for Special Surgery knee score before and after block were measured. The time spent in stand-to-walk test and 10-meter walking test, and incidence of falls during rehabilitation training as well as drug-related adverse reactions were recorded.Results:There were no significant differences in resting-state and task-state Visual Analogue Scale scores post-block between the two groups ( t = 0.43, 0.46, P = 0.689, 0.644). The onset time of block and duration of block effect in the study group were (5.02 ± 0.94) minutes and (2.64 ± 0.39) minutes, respectively, which were significantly shorter than those in the control group [(7.49 ± 1.12) minutes, (7.08 ± 0.92) minutes, t = 5.73, 13.02, both P < 0.001]. There was no significant difference in block success rate between study and control groups (100.0% vs. 100.0%, χ 2 = 0.00, P = 1.000). The quadriceps femoris muscle strength, knee range of motion, and Hospital for Special Surgery knee score in the study group were (4.68 ± 0.44), (112.57 ± 9.96) o and (70.56 ± 6.84) points, which were superior to those in the control group [(4.19 ± 0.42), (101.30 ± 9.67) o,(62.47 ± 6.16) points, t = 3.42, 4.64, 6.58, all P < 0.001). The time spent in stand-to-walk test and 10-meter walking test were (7.95 ± 1.48) minutes and (4.67 ± 0.63) minutes, respectively, which were significantly shorter than those in the control group [(13.41 ± 2.05) minutes, (6.24 ± 0.77) minutes, t = 8.23, 6.74, both P < 0.001). The incidence of falls in the study group was significantly lower than that in the control group (11.3% vs. 29.5%, χ 2 = 4.47, P = 0.034). There was no significant difference in total incidence of drug-related adverse reactions between the two groups (9.1% vs. 13.6%, χ 2 = 0.45, P = 0.502). Conclusion:Distal adductor block with cloprocaine combined with fentanyl meets the requirement of short-term intensive analgesia after total knee arthroplasty, and achieves sufficient analgesia, maximum retention of motor function, rapid onset, and repaid recovery.

Radiol. bras ; 54(5): 311-317, Sept.-Oct. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1340585


Abstract Objective: To evaluate the success and complication rates of ultrasound-guided renal biopsy at a tertiary care hospital. Materials and Methods: This was a retrospective analysis of 97 ultrasound-guided renal biopsies, all performed by the same radiologist, between 1 March, 2017 and 31 October, 2019. Results: Of the 97 biopsies evaluated, 87 had a definitive pathological diagnosis. In five cases (5.4%), the biopsy results were inconclusive and a second procedure was required. In seven procedures (7.6%), there were complications, all of which were properly resolved. Conclusion: Ultrasound-guided renal biopsy has proven to be a safe, effective method for the diagnosis of nephropathies, with high success rates.

Resumo Objetivo: Avaliar taxas de sucesso e de complicações de biópsias renais guiadas por ultrassonografia em um hospital terciário. Materiais e Métodos: Análise retrospectiva de 97 biópsias renais realizadas entre 1º de março de 2017 e 31 de outubro de 2019, guiadas por ultrassonografia e executadas por um único médico radiologista. Resultados: Oitenta e sete biópsias apresentaram diagnóstico anatomopatológico definitivo. Cinco biópsias foram inconclusivas (5,4%) e precisaram de um segundo procedimento. Houve complicações em sete procedimentos (7,6%), todas devidamente solucionadas. Conclusão: A biópsia renal guiada por ultrassonografia demonstrou ser um método efetivo e seguro para o diagnóstico de nefropatias, com elevada taxa de sucesso em sua execução.

Arq. bras. cardiol ; 116(6): 1101-1108, Jun. 2021. tab
Article in English | LILACS | ID: biblio-1278338


Resumo Fundamento O advento dos stents farmacológicos permitiu que a intervenção coronariana percutânea apresentasse resultados seguros nas lesões de tronco da artéria coronária esquerda. Objetivos Analisar os resultados do tratamento percutâneo da lesão não protegida de tronco da artéria coronária com a utilização de ultrassom intravascular. Métodos Estudo de série de casos consecutivos realizado no período de janeiro de 2010 a dezembro de 2018. Coletaram-se dados clínicos dos pacientes, assim como escores prognósticos e dados da lesão coronariana. Considerou-se de sucesso a lesão residual menor que 50% à angiografia e a área mínima da luz maior que 6 mm 2 ao ultrassom intravascular. O nível de significância adotado foi de 5%. Resultados Analisaram-se 107 casos. A lesão multiarterial foi predominante, sendo com maior frequência (39,25%) encontradas lesões em três vasos além do tronco coronariano. O escore SYNTAX apresentou média de 46,80 (DP: 22,95), e 70 (65,42%) pacientes tiveram escore SYNTAX acima de 32 pontos. Considerou-se sucesso angiográfico da intervenção percutânea em 106 (99,06%) pacientes. A taxa geral de evento maior cardíaco e cerebrovascular no desfecho hospitalar foi 6,54%, sendo semelhante nos pacientes com escore SYNTAX ≤ 32 (8,10%) e ≥ 33 (5,71%; p = 0,68) . Conclusões A intervenção percutânea em casos de lesão não protegida de tronco coronariano foi realizada com segurança e apresentou ótimos resultados. Atingiu-se alto sucesso angiográfico de tratamento guiado pelo ultrassom intravascular. A taxa de eventos cardíacos e cerebrovasculares maiores foi semelhante entre os pacientes de menor e de maior risco.

Abstract Background The advent of drug-eluting stents allowed the percutaneous coronary intervention to present safe results in lesions in the left main coronary artery. Objectives To analyze the results of the percutaneous treatment of unprotected left main coronary artery lesion with the use of intravascular ultrasound. Methods Study of consecutive case series carried out from January 2010 to December 2018. Clinical data were collected from patients as well as prognostic scores and data on coronary lesion. Low-grade residual lesion (less than 50%) on angiography and minimum luminal area greater than 6 mm2on intravascular ultrasound were considered successful. The adopted significance level was 5%. Results 107 cases were analyzed. The multivessel lesion was predominant, with most (39.25%) of the lesions being found in three vessels in addition to the left main coronary artery. The SYNTAX score had a mean of 46.80 (SD: 22.95), and 70 (65.42%) patients had a SYNTAX score above 32 points. Angiographic success of percutaneous intervention was considered in 106 (99.06%) patients. The overall rate of major cardiac and cerebrovascular events in the hospital outcome was 6.54%, being similar in patients with SYNTAX score ≤ 32 (8.10%) and ≥ 33 (5.71%; p = 0.68). Conclusions Percutaneous intervention in cases of unprotected left main coronary artery lesion was safely performed and presented excellent results. Considerable angiographic success of treatment guided by intravascular ultrasound was achieved. The rate of major cardiac and cerebrovascular events was similar between patients at low and high risks.

Humans , Coronary Artery Disease , Percutaneous Coronary Intervention , Time Factors , Risk Factors , Treatment Outcome , Coronary Angiography
Radiol. bras ; 54(1): 27-32, Jan.-Feb. 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1155222


Abstract Objective: To compare ultrasound images of the kidney obtained, randomly or in a controlled manner (standardizing the physical aspects of the ultrasound system), by various professionals and with different devices. Materials and Methods: We evaluated a total of 919 images of kidneys, obtained by five professionals using two types of ultrasound systems, in 24 patients. The images were categorized into four types, by how they were acquired and processed. We compared the gray-scale median and different gray-scale ranges representative of virtual histological tissues. Results: There were statistically significant differences among the five professionals, regardless of the type of ultrasound system employed, in terms of the gray-scale medians for the images obtained (p < 2.2e-16). Analyzing the four categories of images-a totally random image (without any standardization); a standardized image (with fixed values for gain, time gain control, and dynamic range); a normalized version of the random image; and a normalized version of the standardized image-we determined that the random image, even after normalization, differed quite significantly among the professionals (p = 0.006098). The analysis of the normalized version of the standardized image did not differ significantly among the professionals (p = 0.7319). Conclusion: Our findings indicate that a gray-scale analysis of ultrasound images of the kidney performs better when the image acquisition process is standardized and the images undergo a process of normalization.

Resumo Objetivo: Comparar imagens renais ultrassonográficas obtidas de maneira aleatória e controlada (padronizando fatores físicos do aparelho de ultrassom) por diferentes profissionais e aparelhos. Materiais e Métodos: Foram obtidos quatro tipos de imagens, de acordo com sua aquisição e processamento por cinco profissionais e dois tipos de aparelhos de ultrassonografia, em 24 pacientes, totalizando 919 imagens. Comparamos a mediana de escala de cinza e diferentes intervalos de tons de cinza representantes de tecidos histológicos virtuais. Resultados: As medianas de escala de cinza de imagens renais obtidas por dois tipos de aparelhos foram estatisticamente diferentes (p < 2.2e-16). Analisando os quatro tipos de imagens, partindo de uma totalmente aleatória (sem qualquer padronização), uma padronizada (fixado o ganho, time gain control e dynamic range), e essas duas passando por um processo de normatização, obteve-se que a imagem aleatória é totalmente diversa entre os profissionais (p = 0,006098), mesmo passando pelo processo de normatização. A imagem padronizada, após passar pelo processo de normatização, apresentou resultados equivalentes, não possuindo diferença estatística (p = 0,7319). Conclusão: Constatou-se que na análise de tons de cinza deve-se usar um mesmo tipo de máquina e uma imagem em que sejam padronizados aspectos físicos, passando por um processo de normatização/padronização.

Rev. méd. Minas Gerais ; 31: 31408, 2021.
Article in Portuguese | LILACS | ID: biblio-1291383


A mastite é uma patologia relativamente frequente na mulher que amamenta. Surge maioritariamente nas primeiras seis semanas após o parto (prevalência entre 75-95% antes do bebé completar os três meses de vida), podendo, contudo, ocorrer ao longo de todo o período da amamentação. Apresenta-se clinicamente com mastalgia, eritema e edema mamário, linfonodomegalia axilar, febre, calafrios, mal-estar e prostração. Entretanto, o quadro clínico completo pode não estar presente em todos os casos. A técnica incorreta de amamentação provoca as microlesões mamáriasque são fatores associados à mastite, inicialmente, e esta quando não recebe tratamento adequado pode evoluirpara os abscessos mamários, que são caracterizados clinicamente por nodulação palpável ou não, flutuante, parcialmente circunscrita, geralmente no quadrante superior lateral da mama afetada. O microrganismo mais envolvido é o Staphylococcus aureus. O diagnóstico diferencial envolve principalmente outras causas não infecciosas de mastite, por exemplo a granulomatosa com reação a corpo estranho (piercing, implantes de silicone) e também malignidade. A ultrassonografia é um método bastante útil na investigação inicial daqueles quadros com suspeita de desenvolvimento de tal complicação e possibilita de maneira segura o tratamento minimamente invasivo e a obtenção de amostra para analise laboratorial. Isto permite a escolha de antibioticoterapia direcionada para os microorganismos causadores.

Mastitis is a relatively common condition in breastfeeding women. It appears mostly in the first six weeks after delivery (prevalence between 75-95% before the baby is three months old), however, it can occur throughout the entire period of breastfeeding. It may present clinically with mastalgia, erythema and breast edema, axillary lymph node enlargement, fever, chills, malaise and prostration. However, the complete clinical picture may not be present in all cases. The incorrect breastfeeding technique causes breast microlesions which are factors associated with mastitis, initially, and when it does not receive adequate treatment it can evolve for breast abscesses, which are characterized clinically by palpable or not, floating, partially circumscribed nodulation, usually in the upper lateral quadrant of the affected breast. The most involved microorganism is Staphylococcus aureus. The differential diagnosis mainly involves other non-infectious causes of mastitis, for example granulomatous with a foreign body reaction (piercing, silicone implants) and also malignancy. Ultrasonography is a very useful method in the initial investigation of those conditions suspected of developing such a complication, and it safely allows minimally invasive treatment and obtaining a sample for laboratory analysis. This allows the choice of antibiotic therapy directed at the causative microorganisms.

Humans , Female , Adult , Silicones , Breast Implants , Mastitis , Staphylococcus aureus , Wounds and Injuries , Breast Feeding , Diagnostic Imaging , Ultrasonography, Mammary , Infections , Inflammation , Anti-Bacterial Agents/therapeutic use
Journal of Chinese Physician ; (12): 1457-1460, 2021.
Article in Chinese | WPRIM | ID: wpr-909724


Objective:To explore the clinical features of ultrasound intervention combined with antibiotics in the treatment of Klebsiella pneumoniae liver abscess, and to provide a reference for clinical treatment.Methods:The clinical data of 100 patients with Klebsiella pneumoniae liver abscess treated in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to November 2020 were analyzed retrospectively. The patient's gender, age, abscess diameter, number of abscesses, abscess separation, air cavity formation and length of hospital stay were recorded. The blood white blood cell (WBC), neutrophil percentage (GR%), platelet count (PLT), C-reactive protein (CRP), procalcitonin (PCT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), prothrombin activity (PTA) before and after treatment were analyzed.Results:After treatment, the infection indexes (WBC, GR%, PLT, CRP, PCT) were significantly decreased, and the liver function indexes (ALT, AST, TBIL, PTA) were significantly improved ( P<0.05). Patients were divided into two groups according to diabetes. The results showed that the diabetic group was prone to air cavity formation (χ 2=8.632, P=0.003), and there was no significant difference between other clinical indicators among the groups ( P>0.05). Diabetes mellitus group was divided into two groups based on hemoglobin A1c (HbA1c) 9%. The results showed that the HbA1c>9% group was younger ( t=2.861, P=0.006), more male (χ 2=6.81, P=0.013), and more prone to form multiple abscesses (χ 2=10.304, P=0.001), while the other clinical indicators were not statistically significant. Conclusions:Ultrasound intervention combined with antibiotics can effectively treat liver abscess. Patients with diabetes are prone to air cavity formation, which should be paid more attention in clinic.

Article in Chinese | WPRIM | ID: wpr-909170


Objective:To investigate the success rate, operation time and complications of ultrasound combined with X-ray-guided precise implantation of totally implantable access port (TIAP) in the chest wall.Methods:A total of 623 patients who underwent implantation of totally implantable venous access ports in the chest wall in Meizhou People's Hospital, China between January 2015 and August 2018 were included in this study. In group A ( n = 320), jugular or subclavian access ports were precisely implanted in the chest wall under the guidance of ultrasound combined with X-ray. During the surgery, color Doppler ultrasound was used to guide the puncture and a C-arm machine was used to locate the position of catheter tip. In group B ( n = 303), venous access ports were implanted using the conventional method. Subclavian vein puncture was performed using anatomic landmarks and the depth of catheterization was estimated by experience. The success rate of the first implantation, operation time, and complications (pneumothorax, hemothorax, catheter displacement, poor position of catheter tip, skin infection, and thrombosis) were compared between the two groups. Results:There were no statistical differences in baseline data between the two groups ( P > 0.05). The success rate of the first implantation in the group A was significantly higher than that in the group B [100% (320/320) vs. 93.06% (282/303), χ2 = 22.95, P < 0.01]. The operation time in the group A was significantly shorter than that in the group B [(26.48 ± 5.49) minutes vs. (35.51 ± 14.37) minutes, t = -10.25, P < 0.01]. In group A, 2 patients developed pneumothorax and healed after conservative treatment, 6 patients had thrombosis, and the incidence of complications was 2.5% (8/320). In group B, complications occurred in 67 patients, including pneumothorax in 9 patients, poor catheter tip position in 17 patients, thrombosis in 36 patients, and skin infection in 1 patient, and the incidence of complications was 22.11% (67/303). There was significant difference in the incidence of complications between the two groups ( χ2 = 56.53, P < 0.01). In group B, 6 out of 9 patients developing pneumothorax were healed after closed thoracic drainage, and 4 patients underwent a secondary surgery because of catheter displacement into the internal jugular vein. Conclusion:Precise implantation of venous access ports in the chest wall guided by ultrasound combined with X-ray has the advantages including 100% success rate of first precise implantation, few complications, short operation time, high comfort, safety and efficacy.

Journal of Clinical Hepatology ; (12): 2632-2635, 2021.
Article in Chinese | WPRIM | ID: wpr-905006


Objective To investigate the endoscopic ultrasound (EUS) features of distal biliary stricture (DBS), and to provide a clinical basis for the evaluation of DBS by EUS. Methods Related clinical data were collected from 175 patients with DBS who underwent EUS examination in The First Affiliated Hospital of Anhui Medical University from April 2016 to March 2020 to analyze their clinical manifestation, laboratory examination results, imaging findings, and EUS findings, and the patients were followed up to summarize the EUS features of DBS. The chi-square test was used for comparison of categorical data between groups, and the t -test was used for comparison of continuous data between groups. Results Among the 175 patients with DBS, 85(48.57%) had benign DBS and 90(51.43%) had malignant DBS. Compared with the patients with benign DBS, the patients with malignant DBS had a significantly longer length of stricture on EUS (14.1±3.0 mm vs 7.9±3.0 mm, t =13.358, P < 0.001) and significantly higher incidence rates of the characteristic changes on EUS such as hypoechoic space-occupying lesions in lumen (57.8% vs 34.1%, χ 2 =9.843, P =0.002), peripheral lymph node enlargement (26.7% vs 12.9%, χ 2 =5.147, P =0.023), and pancreatic duct dilatation (51.1% vs 28.2%, χ 2 =9.532, P =0.002). EUS combined with magnetic resonance cholangiopancreatography had a sensitivity of 70.6% in the diagnosis of benign DBS and a sensitivity of 92.2% in the diagnosis of malignant DBS. Conclusion The characteristic EUS features of DBS, such as long length of stricture, hypoechoic lesion, peripheral lymph node enlargement, and pancreatic duct dilatation, may help with the differential diagnosis of DBS in clinical practice.

Article in Chinese | WPRIM | ID: wpr-912170


To evaluate the efficacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for patients with metastases to the pancreas.Data on patients with pancreatic lesions who underwent EUS-FNA and confirmed as having metastases to the pancreas at the Endoscopy Center of Zhongshan Hospital, Fudan University from January 2015 to November 2020 were retrospectively analyzed.Characteristics of patients, EUS performance, pathological results, and follow-up were reviewed and analyzed. A total of 11 patients were diagnosed of metastasis to pancreas by EUS-FNA.The primary tumor mainly came from kidney (4/11) and lung (4/11), and the rest from colon (1/11), breast (1/11) and bladder (1/11), respectively. EUS performance of metastases to the pancreas mostly presented homogeneous hypoecho (10/11)with unclear margin (6/11). Enlarged lymphnodes were noticed in nearly half of the patients (5/11). The time span from detection of primary tumor to metastases ranged from 6 days to 27 years. EUS-FNA is effective in the diagnosis of metastases to the pancreas.

Rev. enferm. UERJ ; 28: e50366, jan.-dez. 2020. graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1139121


RESUMO Objetivo discutir as evidências disponíveis sobre uso de ultrassonografia na implantação/manutenção de cateter venoso central de inserção periférica no neonato crítico. Método scoping review, baseada nas recomendações de especialistas do Joanna Briggs Institute. Para identificar a questão de investigação foi seguida a versão PCC - Population, Concept and Context. As buscas foram realizadas entre janeiro e março de 2020, em três bases dados e no Google Scholar. Resultados das 354 publicações encontradas resultou uma amostra de 15 artigos, publicados em diversos países, entre 2016 e 2020, em inglês e português. A maioria evidenciava uso da ultrasound point of care (POCUS) para escolha do sítio venoso ou localização da ponta do cateter. Conclusão são necessários mais estudos, investigando a efetividade da POCUS na inserção/manutenção de cateter epicutâneo em neonatos críticos, para basear sua adoção como padrão ouro nesta clientela. O manejo por enfermeiros ainda é incipiente.

RESUMEN Objetivo discutir la evidencia disponible sobre el uso de el ultrasonido en la inserción y mantenimiento de catéteres venosos centrales de inserción periférica en neonatos críticos. Método esta revisión de alcance se basó en recomendaciones de expertos del Instituto Joanna Briggs. Se utilizó el enfoque de población, concepto y contexto (PCC) para identificar la pregunta de investigación. El estudio se realizó entre enero y marzo de 2020 en tres bases de datos y Google Scholar. Resultados en las 354 publicaciones encontradas se obtuvo una muestra de 15 artículos publicados en varios países entre 2016 y 2020, en inglés y portugués. La mayoría mostró que se usaba el punto de atención de ultrasonido (POCUS) para elegir el sitio venoso o ubicar la punta del catéter. Conclusión se necesitan más estudios para investigar la efectividad de POCUS en la inserción y mantenimiento de catéteres epicutáneos en neonatos críticos, para respaldar su adopción como el estándar de oro en esta clientela. El manejo por parte de enfermeras es aún incipiente.

ABSTRACT Objective to discuss the available evidence on the use of ultrasound in insertion and maintenance of peripherally inserted central venous catheters in critical neonates. Method this scoping review was based on recommendations by experts from the Joanna Briggs Institute. The population, concept and context (PCC) approach was used to identify the research question. The study was carried out between January and March 2020 in three databases and Google Scholar. Results a sample of 15 articles published in several countries between 2016 and 2020, in English and Portuguese, was obtained in the 354 publications found. Most showed ultrasound point of care (POCUS) being used to choose the venous site or locate the catheter tip. Conclusion further studies are needed to investigate the effectiveness of POCUS in insertion and maintenance of epicutaneous catheters in critical neonates, to support its adoption as the gold standard in this clientele. Handling by nurses is still incipient.

Humans , Infant, Newborn , Catheterization, Central Venous/instrumentation , Intensive Care Units, Neonatal , Intensive Care, Neonatal , Ultrasonography, Interventional/standards , Critical Care/methods , Point-of-Care Testing
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1521-1525, Nov. 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1143633


SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.

RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.

Humans , Gastroenterostomy , Endosonography , Brazil , Stents , Gastric Outlet Obstruction/surgery , Gastric Outlet Obstruction/etiology , Gastric Outlet Obstruction/diagnostic imaging , Tertiary Care Centers
Rev. méd. Chile ; 148(8)ago. 2020.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389306


Background: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. Aim: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. Material and Methods: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. Results: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. Conclusions: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.

International Journal of Surgery ; (12): 28-31,封4, 2020.
Article in Chinese | WPRIM | ID: wpr-863265


Objective To explore the application effect of fine needle aspiration cytology and sentinel lymph nodes stain assisted by contrast-enhanced ultrasound in early breast cancer.Methods A patient with early breast cancer enrolled in Beijing Friendship Hospital,Capital Medical University received fine needle aspiration cytology assisted by contrast-enhanced ultrasonography and the sentinel lymph nodes were stained with blue dye before a standard sentinel lymph nodes biopsy traced with indocyanine green.The axillary status accessed by these two methods were compared.Results Three sentinel lymph nodes were found and aspirated assisted by contrast-enhanced ultrasonography.Seven sentinel lymph nodes were obtained in sentinel lymph nodes biopsy surgery.All of these sentinel lymph nodes were negative.The stained sentinel lymph nodes could be recognized and dissected in open lymph nodes biopsy surgery.Conclusions Fine needle aspiration cytology assisted by contrast-enhanced ultrasonography could be a substitute for open sentinel lymph nodes biopsy.More related researches should be carry out to further compare these two methods.

Article in Chinese | WPRIM | ID: wpr-861908


Objective: To observe the efficacy of percutaneous microwave ablation on low-risk papillary thyroid microcarcinoma (PTMC) and impact on patient's life quality. Methods: Totally 75 pathologically confirmed patients with single low risk PTMC (T1N0M0) were treated with ultrasound-guided percutaneous microwave ablation and followed up at 1, 3, 6, 12 and 24 months respectively after operation. The therapeutic effect and complications were observed, and score the physical component summary (PCS), mental component summary (MCS) and 36-item short form health survey (SF-36) scores were counted. Results: The operation was successfully completed in all 75 patients. Four patients experienced temporary hoarseness during the ablation process and recovered within 2 h, while 15 patients complained of radiation-induced ear root pain, neck pain and other symptoms which immediately relieved after ablation. Twenty-four months after operation, the effective rate of treatment was 100% (75/75), the lesion disappearance rate was 93.33% (70/75), while no local recurrence occurred. The maximum diameter and volume of lesions increased 1 and 3 months after operation but decreased 6, 12 and 24 months after operation (all P0.05). PCS scores at different time points before and after operation showed no statistical significant difference (all P>0.05). MCS scores and SF-36 scores of all time points after operation were higher than those before operation (all P<0.05). Conclusion: Percutaneous ablation is safe and effective for treating low risk PTMC, which can improve the patient's life quality.

Article in Chinese | WPRIM | ID: wpr-861109


Objective: To investigate the value of contrast-enhanced ultrasound (CEUS) and BRAF mutation in pre-operative diagnosis of extracapsular extension in papillary thyroid carcinoma (PTC). Methods: A total of 129 PTC in 119 patients were enrolled, including 25 PTC with extracapsular extension (A group) and 104 PTC without extracapsular extension (B group). Both the range of contact between PTC and thyroid capsule and the presence of discontinued capsule in ultrasound (US) and CEUS, as well as BRAF mutation examination result were recorded. The diagnostic performance of the above features in diagnosis of extracapsular extension in PTC, and the overall diagnostic performance of their combination were calculated. Results: Significant differences were found in BRAF mutation, range of capsule contact and the presence of discontinued capsule between US and CEUS (all P<0.05). In different ranges of contact, the threshold of ≥25% demonstrated the highest diagnostic accuracy in both US and CEUS. CEUS had higher accuracy than US in diagnosis of extracapsular extension in PTC based on single ultrasonic feature as well as the combination of ultrasonic features and BRAF mutation. The accuracy of CEUS combined with BRAF was 88.37% (114/129). Conclusion: The characteristics of extracapsular extension in PTC include BRAF mutation, ≥25% range of contact between PTC and thyroid capsule and the presence of discontinued capsule in US and CEUS. CEUS has higher accuracy than US. Combination of BRAF mutation and CEUS has important clinical significance in preoperative diagnosis of PTC extracapsular extension.

Article in Chinese | WPRIM | ID: wpr-861078


Objective: Contrast-enhanced ultrasound (CEUS) was used to investigate the feasibility of CEUS for evaluation on renal cortex blood perfusion changes in rat models of different degrees hemorrhagic shock (HS). Methods: Twenty-four healthy male SD rats were randomly and equally divided into sham operation group (Sham group), mild hemorrhagic shock group (T1 group), moderate hemorrhagic shock group (T2 group) and severe hemorrhagic shock group (T3 group, each n=6). CEUS was performed after establishment of models to observe renal cortex blood perfusion, and analysis was performed on the time-intensity curve (TIC). Comparative parameters, including peak, time to peak (TTP), AUC and mean transition time (MTT) were analyzed. Venous blood was taken for renal biochemical examination after CEUS, and renal tissue was taken for pathological examination after the rats were killed. Results: TTP, AUC, MTT and urea nitrogen (Urea) in T1 group increased compared with those in Sham group (all P<0.05), but pathological changes were not obvious. TTP, MTT and creatinine (Crea) in T2 group increased than those in Sham group and T1 group (all P<0.05), AUC in T2 group increased than that in Sham group (P<0.05), and pathological changes in T2 group were more damaging compare with T1 group. TTP, AUC, MTT and Crea in T3 group increased than that in the other groups (all P<0.05), and peak in T3 group increased than that in Sham group and T1 group (both P<0.05). Urea in T3 group increased than that in Sham group (P<0.05), and pathological changes were significant. Significant positive correlations were found between TTP, AUC, MTT and Crea (r=0.789, 0.790, 0.800, all P<0.001). Conclusion: CEUS can quantitatively analyze renal cortex blood perfusion changes of rat models caused by hemorrhagic shock. TIC is useful for quantitative analysis, of which TTP, AUC and MTT can be used as sensitivity indexes.

Article in Chinese | WPRIM | ID: wpr-860929


Objective: To observe the value of targeted contrast enhanced ultrasound (CEUS) using anti-Mullerian canal hormone (AMH) targeted nanobubbles (AMH-NB) for in vivo quantitative evaluation on ovarian neovascular density after ovarian auto-transplantation in SD rats. Methods: The nanobubbles carrying anti-AMH antibody were prepared, and their basic physical properties were examined. Then ovarian auto-transplantation rat models were established. The targeted (AMH-NB), non-targeted (N-NB) contrast agents and SonoVue were administered on the 7th day after transplantation to obtain peak intensity (PI) and time to peak (TTP). The microvascular density (MVD) was measured using immunohistochemistry, and the correlation of PI, TTP and MVD were analyzed. Results: The particle size of AMH-NB uniformly distributed, ranged (622.67±33.65)nm, and the concentration of AMH-NB was (2.90±0.26)×108/ml. PI of ovarian angiography with AMH-NB was (7.93±0.65)dB and TTP was (42.53±1.74)s, with N-NB was (6.14±0.44)dB and (54.35±1.73)s, with Sonovue was (4.15±0.83)dB and (28.71±1.18)s, respectively (all P<0.05).Immunohistochemical analysis showed that the microvascular density was (61.20±6.84)/HP, histological analysis indicated that AMH-NB were able to penetrate blood vessels to the interstitial space and combine with AMH. PI, TTP of AMH-NB were highly both correlated with MVD (r=0.84, r=-0.84, both P<0.05). Conclusion: AMH-NB can be used to qualitatively and quantitatively evaluate the angiogenesis in transplanted ovarian of rats in vivo with CEUS.

Article in Chinese | WPRIM | ID: wpr-860874


Objective:To explore the correlation between contrast-enhanced ultrasound (CEUS) and 18F-FDG PET/CT for judging activity of Takayasu arteritis (TA). Methods: A total of 36 TA patients who underwent CEUS and 18F-FDG PET/CT were enrolled, the related laboratory indexes and imaging parameters were compared. The correlation between CEUS and 18F-FDG PET/CT for judging TA activity was analyzed. Results: There were significant differences of disease duration, Indian Takayasu arteritis clinical activity score (ITAS 2010), carotid occlusion ratio, CEUS peak intensity, PET/CT uptake and the maximal standardized uptake value (SUVmax) between CEUS significantly enhanced group and non-enhanced or little enhanced group (all P<0.05). CEUS was moderately correlated with PET/CT visual score (r=0.697, P<0.001) and slightly correlated with NIH criteria of clinical activity and SUVmax (r=0.385, P=0.018; r=0.477, P=0.014). Taken 18F-FDG PET/CT visual score as the criterion of TA activity, the sensitivity and specificity of NIH criteria of clinical activity was 0.783 and 0.769, of CEUS was 1.000 and 0.846, and AUC was 0.776 and 0.923, respectively. Conclusion: Significant positive correlation existed between CEUS and 18F-FDG PET/CT for judging TA activity. Taken18F-FDG PET/CT visual scoring as the standard, CEUS had higher sensitivity and specificity than clinical disease activity criteria, and might be used as an effective method for judging TA activity.

Journal of Clinical Hepatology ; (12): 1710-1713, 2020.
Article in Chinese | WPRIM | ID: wpr-825034


Pancreatic cancer is a gastrointestinal tumor with a high degree of malignancy. It is difficult to treat and often has poor prognosis, and therefore, it has always been a clinical challenge. Endoscopic ultrasound-guided interstitial implantation of radioactive seeds and gold fiducial markers are both innovative techniques which combine interventional ultrasonography and radiotherapy and are used for the treatment of pancreatic cancer to realize the concentrated radioactive treatment of pancreatic tumors. This article reviews the advances in the application and research of these two techniques, hoping that more studies can be conducted in the future to help it play a greater role in the treatment of pancreatic cancer.

International Journal of Surgery ; (12): 28-31,f4, 2020.
Article in Chinese | WPRIM | ID: wpr-799272


Objective@#To explore the application effect of fine needle aspiration cytology and sentinel lymph nodes stain assisted by contrast-enhanced ultrasound in early breast cancer.@*Methods@#A patient with early breast cancer enrolled in Beijing Friendship Hospital, Capital Medical University received fine needle aspiration cytology assisted by contrast-enhanced ultrasonography and the sentinel lymph nodes were stained with blue dye before a standard sentinel lymph nodes biopsy traced with indocyanine green. The axillary status accessed by these two methods were compared.@*Results@#Three sentinel lymph nodes were found and aspirated assisted by contrast-enhanced ultrasonography. Seven sentinel lymph nodes were obtained in sentinel lymph nodes biopsy surgery. All of these sentinel lymph nodes were negative. The stained sentinel lymph nodes could be recognized and dissected in open lymph nodes biopsy surgery.@*Conclusions@#Fine needle aspiration cytology assisted by contrast-enhanced ultrasonography could be a substitute for open sentinel lymph nodes biopsy. More related researches should be carry out to further compare these two methods.