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1.
Arch. argent. pediatr ; 120(4): 248-256, Agosto 2022. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1371822

ABSTRACT

Introducción. El seno dérmico cefálico es un tractotubular formado por una separación incompleta entre el ectodermo neural y el ectodermo epitelial;puede tener complicaciones infecciosas. Existen reportes aislados de esta patología. Objetivo: describir una serie de pacientescon seno dérmico craneal, las formas depresentación, el diagnóstico, el tratamiento y las complicaciones. Población y métodos. Estudio observacionaldescriptivo de una serie de pacientes pediátricos con seno dérmico cefálico atendidos en unhospital pediátrico de nivel III entre 2014 y 2019. Resultados. se incluyeron 18 pacientes. La clínicade presentación fue, en 12 casos, una lesión puntual en el cuero cabelludo, hipertensiónendocraneana en 4 casos, ataxia en 1 caso y lesión puntual con fístula en 1 caso. La mitad presentó síntomas de infección. La localización fue en la línea media sobre el hueso occipital en 13 casos, en la línea media sobre el hueso frontal en 3 casos y en la línea media interparietal en 2 casos. En 5 casos se encontró asociada una imagen extracraneana y, en 11 casos, una complicación intracraneana. Ningún paciente presentó recidiva de la lesión y en todos se realizó un solo procedimiento quirúrgico. Conclusiones. Los senos dérmicos en esta serie se presentaron como lesiones puntuales en cuerocabelludo. La localización más frecuente fue a nivel occipital sobre línea media y, en más de la mitad, atravesaba el hueso. El tratamiento de elección fue la exéresis completa del seno dérmicoy las lesiones asociadas. Ante la presencia de senos dérmicos sintomáticos o asociados alesiones intracraneanas, la cirugía se realizó de urgencia.


Introduction. A cranial dermal sinus is a tubular tract resulting from the incomplete separation of the epithelial ectoderm from the neuroectoderm which may lead to infectious complicationsThere have been isolated reports of this condition. Objective. To describe a series of patients with cranial dermal sinus, its presentation, diagnosis, management, and complications. Population and methods. Observational,descriptive study of a series of pediatric patients with cranial dermal sinus treated at a tertiary care children's hospital between 2014 and 2019. Results. A total of 18 patients were included. Theclinical presentation was a specific lesion on the scalp in 12 cases, intracranial hypertension in 4, ataxia in 1, and a specific lesion with fistula tract in 1. Half of patients had symptoms of infection. The lesion was located in the midline of the occipital bone in 13 cases; in the midline of the frontal bone in 3 cases; and in the interparietal midline in 2 cases. The dermal sinus was associated with anextracranial image in 5 cases and an intracranial complication in 11 cases. No patient hadrecurrence and only one surgery was performed in all of them. Conclusions. In this series, dermal sinusespresented as specific lesions on the scalp. The most common site was the occipital midline, and more than 50% of these extended through the bone. The treatment of choice was complete resection of dermal sinus and associated lesions. An emergency surgery was performed when the dermal sinus was symptomatic or associated with intracranial lesions.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Spina Bifida Occulta/surgery , Spina Bifida Occulta/complications , Spina Bifida Occulta/diagnosis , Tertiary Healthcare , Tomography, X-Ray Computed , Hospitals
2.
Rev. colomb. cir ; 37(3): 455-468, junio 14, 2022. fig
Article in Spanish | LILACS | ID: biblio-1378744

ABSTRACT

Introducción. Debido a la rareza de la hernia obturatriz y la imposibilidad para desarrollar estudios controlados de alto grado de evidencia, la mayoría de la literatura al respecto proviene de reportes de casos. Lo anterior, aunado al poco conocimiento del área anatómica de presentación y el cuadro clínico, la convierte en la hernia con mayor mortalidad. Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos, ilustrado con pacientes manejados en el Servicio de Cirugía general de la Clínica Santa María de Sincelejo, Colombia. Discusión. La hernia obturatriz se puede descubrir en mujeres ancianas con antecedentes de cirugía abdominal o multiparidad. El signo de Howship­Romberg, que se presenta en la mitad de los pacientes, puede acompañarse de dolor abdominal en hipogastrio, vómitos y distensión progresiva. La radiografía de abdomen simple muestra tardíamente niveles hidroaéreos con ausencia de gas en ampolla rectal, pero como es poco específica para demostrar el sitio de obstrucción, es preferible la Tomografía computarizada. Conclusión. La hernia obturatriz requiere alto índice de sospecha, que ayude a la detección temprana e intervención quirúrgica inmediata, para evitar las complicaciones.


Introduction. Due to the rarity of the obturator hernia and the impossibility to develop controlled studies with a high degree of evidence, most of the reference in the literature comes from case reports. This, coupled with little knowledge of the anatomical area of presentation and clinical picture, makes it the hernia with the highest mortality. Methods. A literature search was carried out in the main databases, illustrated with patients managed in the General Surgery Service of the Clínica Santa María de Sincelejo. Discussion. Obturator hernia can be discovered in elderly women with a history of abdominal surgery or multiparity. The Howship ­ Romberg sign occurs in half of the patients, it can be associated with lower abdominal pain, vomiting, and progressive distension. Plain abdominal X-ray shows delayed air-fluid levels with absence of gas in the rectal ampulla, but since it is not very specific to demonstrate the site of obstruction, computed axial tomography is preferable. Conclusion. Obturator hernia requires a high index of suspicion, which helps early detection and immediate surgical intervention, to avoid complications.


Subject(s)
Humans , Hernia, Obturator , Intestinal Obstruction , Tomography, X-Ray Computed , Abdominal Pain , Pelvic Pain , Diagnosis
3.
Rev. colomb. cir ; 37(3): 469-479, junio 14, 2022. fig
Article in Spanish | LILACS | ID: biblio-1378760

ABSTRACT

Introducción. En la actualidad, el trauma de recto continúa siendo una situación clínica compleja y temida por ser potencialmente mortal. Su detección y manejo temprano es la piedra angular para impactar tanto en la mortalidad como en la morbilidad de los pacientes. Hoy en día, aún existe debate sobre la aproximación quirúrgica ideal en el trauma de recto y las decisiones de manejo intraoperatorias se ven enormemente afectadas por la experiencia y preferencias del cirujano. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Clinical Key, Google Scholar y SciELO utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes publicados en los últimos 20 años; se tuvieron en cuenta los artículos escritos en inglés y español. Discusión. El recto es el órgano menos frecuentemente lesionado en trauma, sin embargo, las implicaciones clínicas que conlleva pasar por alto este tipo de lesiones pueden ser devastadoras para el paciente. Las opciones para el diagnóstico incluyen el tacto rectal, la tomografía computarizada y la rectosigmoidoscopía. El manejo quirúrgico va a depender de la localización, el grado de la lesión y las lesiones asociadas. Conclusión. El conocimiento de la anatomía, el mecanismo de trauma y las lesiones asociadas permitirán al cirujano realizar una aproximación clínico-quirúrgica adecuada que lleve a desenlaces clínicos óptimos de los pacientes que se presentan con trauma de recto.


Introduction. Currently, rectal trauma continues to be a complex clinical and potentially fatal situation. Its early detection and management is the cornerstone to avoid both mortality and morbidity of patients. Today there is still debate about the ideal surgical approach in rectal trauma, and intraoperative management decisions are greatly affected by the experience and preferences of the surgeon. Methods. A literature search was performed in the PubMed, Clinical Key, Google Scholar and SciELO databases using the keywords described. The most relevant articles published in the last 20 years were selected. Articles written in English and Spanish were considered.Discussion. The rectum is the organ less frequently injured in trauma; however, the clinical implications of overlooking this injury can be devastating for the patient. Options for diagnosis include digital rectal examination, computed tomography and rectosigmoidoscopy. Surgical management will depend on the location, degree of the injury and the associated injuries. Conclusion. Knowledge of the anatomy, the mechanism of trauma and the associated injuries will allow the surgeon to make an adequate clinical-surgical approach that leads to optimal clinical outcomes in patients presenting with rectal trauma.


Subject(s)
Humans , Rectum , Multiple Trauma , Sigmoidoscopy , Wounds and Injuries , Tomography, X-Ray Computed , Colorectal Surgery , Diagnosis
4.
MedUNAB ; 25(1): 79-82, 202205.
Article in Spanish | LILACS | ID: biblio-1372495

ABSTRACT

Figura 1. Tomografía Computarizada de tórax (corte coronal). Se observan ambos campos pulmonares y las cavidades cardiacas. La flecha roja señala el área hipodensa ovalada correspondiente al aire dentro de un asa de colon interpuesta entre el hemidiafragma derecho (línea hiperdensa arriba) y el borde superior del hígado (abajo), causando una depresión del borde superior del hígado. Fuente: tomada de la historia clínica, previa autorización del paciente.


Figure 1. Chest Computed Tomography Scan (coronal plane) Both lung fields and cardiac chambers are observed. The red arrow indicates the oval hypodense area corresponding to the air inside the loop of colon interposed between the right hemidiaphragm (hyperdense line up) and superior border of the liver (down), causing a depression of the superior border of the liver. Source: taken with authorization from the patient's medical record.


Figura 1. Tomografia Computadorizada de tórax (corte coronal). Observam-se ambos os campos pulmonares e as cavidades cardíacas. A seta vermelha aponta para a área hipodensa oval correspondente ao ar dentro de uma alça do cólon interposta entre o hemidiafragma direito (linha hiperdensa acima) e a borda superior do fígado (abaixo), causando uma depressão da borda superior do fígado. Fonte: obtida com permissão do histórico clínico do paciente.


Subject(s)
Chilaiditi Syndrome , Pneumoperitoneum , Diagnostic Imaging , Tomography, X-Ray Computed , Abdominal Pain
5.
Arch. argent. pediatr ; 120(2): e85-e88, abril 2022. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1363977

ABSTRACT

Las fracturas con hundimiento de cráneo intrauterinas representan una entidad poco frecuente, generalmente secundaria a traumatismos (previos o durante el nacimiento) o de etiología desconocida. Suelen requerir evaluación y seguimiento por el servicio de Neurocirugía Pediátrica. A la fecha, es controversial la necesidad de tratamiento quirúrgico y el momento oportuno para concretarlo. Se presentan dos casos clínicos de pacientes de término, nacidas porcesárea,condiagnósticoposnatalinmediatodehundimiento de cráneo de tipo ping-pong no traumático. Ambas pacientes presentaron examen neurológico normal. Se confirmó el diagnóstico a través de radiografía y tomografía de cráneo, sin observarse lesiones asociadas. Fueron valoradas por el servicio de Neurocirugía, que indicó corrección quirúrgica de la lesión en ambos casos, con buena evolución posterior.


Spontaneous intrauterine depressed skull fractures are a rare entity. They can appear secondarily to head trauma (before or during birth) or due to unknown etiology. They usually require a complete evaluation from pediatric neurosurgery specialists. Their optimal management, including timely surgical treatment remains controversial. We describe two cases delivered by cesarean section, with postnatal diagnosis of spontaneous intrauterine depressed skull fracture. Both had a normal neurological exam. A skull radiography and head CT were performed, and no associated lesions were found. Both cases required surgical correction, with positive results.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Skull Fracture, Depressed/surgery , Skull Fracture, Depressed/diagnostic imaging , Radiography , Tomography, X-Ray Computed , Cesarean Section , Parturition
6.
Int. braz. j. urol ; 48(2): 294-302, March-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364942

ABSTRACT

ABSTRACT Objective: To compare enhancement patterns of typical adrenal adenomas, lipid-poor adenomas, and non-adenomas on magnetic resonance imaging (MRI). Materials and Methods: Evaluation of adrenal nodules larger than 1.0 cm, with at least 2-year follow-up, evaluated on MRI in January 2007 and December 2016. Two different protocols were included - upper abdomen MRI (delayed phase after 3 minutes) and abdomen and pelvis MRI (delayed phase after 7 minutes) - and nodules were divided in typical adenomas (characterized on out-of-phase MRI sequence), lipid-poor adenomas (based on follow-up imaging stability) and non-adenomas (based on pathological finding or follow-up imaging). T2-weighted and enhancement features were analyzed (absolute and relative washout and enhancement curve pattern), similarly to classic computed tomography equations. Results: Final cohort was composed of 123 nodules in 116 patients (mean diameter of 1.8 cm and mean follow up time of 4 years and 3 months). Of them, 98 (79%) nodules had features of typical adenomas by quantitative chemical shift imaging, and demonstrated type 3 curve pattern in 77%, mean absolute and relative washout of 29% and 16%, respectively. Size, oncologic history and T2-weighted features showed statistically significant differences among groups. Also, a threshold greater than 11.75% for absolute washout on MRI achieved sensitivity of 71.4% and specificity of 70.0%, in differentiating typical adenomas from non-adenomas. Conclusion: Calculating absolute washout of adrenal nodules on MRI may help identifying proportion of non-adenomas.


Subject(s)
Humans , Adrenal Gland Neoplasms/pathology , Adrenal Gland Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Retrospective Studies , Sensitivity and Specificity , Contrast Media , Diagnosis, Differential
8.
J. coloproctol. (Rio J., Impr.) ; 42(1): 99-101, Jan.-Mar. 2022. tab, ilus
Article in English | LILACS | ID: biblio-1375762

ABSTRACT

Background: Multiple small-bowel diverticulosis comprises a rare entity with probable underestimated incidence, and that may be the reason why it is sometimes overlooked when managing cases with peritonitis. Case report: In the present paper, we report the case of a 76-year-old male presenting abdominal pain and fever in an acute setting. Computed tomography (CT) scans revealed jejunal thickening and numerous images of saccular addition that were interpreted as jejunoileal diverticulitis. After an initial period of clinical treatment, surgical management was indicated based on a worsening clinical picture and the presence of an extraluminal focus of gas detected in a subsequent CT scan. Through a laparoscopic approach, multiple small-bowel diverticula and a tamponade perforation were found. A segmental intestinal resection was performed, and the patient was discharged after a ten days. Conclusions: Multiple jejunal diverticulosis is a rare condition that should be remembered in the setting of an acute abdomen. As it prevails among older patients, early diagnosis with radiological aid is crucial to establish the most adequate management, including intestinal resection, if necessary. (AU)


Subject(s)
Humans , Male , Aged , Diverticulum/complications , Jejunum , Tomography, X-Ray Computed , Laparoscopy , Intestinal Perforation/etiology
9.
Rev. bras. ortop ; 57(1): 47-54, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365749

ABSTRACT

Abstract Objective To study the parameters related to the insertion path of cortical screws and to describe this technique. Methods Computed tomography (CT) scans of 30 patients, as well as the measurements from the L1 to the L5 vertebrae, were studied. A second observer evaluated ten randomly-selected exams. The parameters studied included the lateral angle (LA) and the screw diameter (SD) as axial variables, and the cranial angle (CA) and screw length (SL) as sagittal variables. Results We studied 15 male patients (mean age: 31.33 years) and 15 female patients (mean age: 32.01 years). The LA varied between 13.8° and 20.89°, with a tendency to increase in the proximal to distal direction. The CA varied from 17.5° to 24.9°, with a tendency to decrease in the caudal direction. The SD ranged from 2.3 mm to 7.2 mm, with a tendency to increase as we progressed from proximal to distal. The SL varied from 19 mm to 45 mm, with a tendency to decrease as we proceeded from proximal (L1) to distal (L5). No statistical difference was observed between the genders or in the interobserver agreement regarding the values studied when comparing the sides. Conclusion The path of insertion of the cortical screw shows a variation in different populations. Therefore, we recommend a preoperative imaging study to reduce the surgical risks related to the technique.


Resumo Objetivo Estudar os parâmetros anatômicos do trajeto de inserção do parafuso cortical e descrever sua técnica. Métodos Analisaram-se exames de tomografia computadorizada de 30 pacientes, e as medidas nas vértebras de L1 a L5 bilateralmente. Um segundo observador avaliou dez exames aleatoriamente. Os parâmetros incluíram o ângulo lateral (AL) e o diâmetro do parafuso (DP) como variáveis axiais, e o ângulo cranial (AC) e o comprimento do parafuso (CP) como variáveis sagitais. Resultados No total, havia 15 pacientes do sexo masculino (média de idade de 31,33 anos) e 15 do sexo feminino (média de idade de 32,01 anos). O AL variou de 13,8° a 20,89°, com uma tendência de aumento no sentido de proximal a distal. O AC variou de 17,5° a 24,9°, com tendência de diminuição no sentido caudal. O DP variou de 2,3 mm a 7,2 mm, havendo uma tendência ao aumento conforme avançamos de proximal a distal. O CP variou de 19 mm a 45 mm, havendo uma tendência de diminuição conforme avançamos de proximal (L1) a distal (L5). Não houve diferença estatística entre os sexos, nem diferenças na confiabilidade interobservador, quanto aos valores estudados quando comparados os lados. Conclusão A trajetória do parafuso de trajeto cortical apresenta variações em diferentes populações. Assim, recomendamos o estudo pré-operatório de imagens para reduzir os riscos cirúrgicos relacionados à técnica.


Subject(s)
Humans , Male , Female , Adult , Spine/anatomy & histology , Spine/surgery , Bone Screws , Tomography, X-Ray Computed , Minimally Invasive Surgical Procedures
10.
Rev. bras. ortop ; 57(1): 61-68, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365744

ABSTRACT

Abstract Objective The approachability of the cervicothoracic region anteriorly based on age and gender, and the possibility of anatomic variances in different geographic populations have not been previously investigated. The aim of the present work was to perform a radiographic analysis of Brazilian patients to assess anterior approachability of the cervicothoracic junction based on age and gender. Methods Retrospective radiographic analysis of 300 computed tomography scans. Patients were separated based on age and gender. The radiographic parameters studied were: horizontal level above the sternum (HLS), vertebral body angle (VBA), intervertebral disc line (IDL), and intervertebral disc line angulation (IDLA). Results The most frequent HLS and IDL were T2 (34.3%) and C7-T1 (46%) respectively. Vertebral body angleand IDLA had average values of 18 ± 8.94 and 19 ± 7.9 degrees, respectively. Males had higher values in both IDLA (p= 0.003) and VBA (p= 0.02). Older groups had higher values in both IDLA (p= 0.01) and VBA (p= 0.001). No differences were observed in HLS between gender (p= 0.3) or age groups (p= 0.79). No differences were seen in IDL between gender groups (p= 0.3); however, the older group had a more caudal level than the younger groups (p= 0.12). ConclusionsCompared to other populations, our sample had a more cephalad IDL and HLS. Vertebral body angle and IDLA were higher in males and higher angles for VBA and IDLA were shown for older groups. Intervertebral disc line was more caudal with aging.


Resumo Objetivo A capacidade de acesso anterior à região cervicotorácica com base na idade e gênero do paciente e a possibilidade de variações anatômicas em diferentes populações geográficas ainda não foram investigadas. O objetivo deste trabalho foi realizar uma análise radiográfica de pacientes brasileiros para avaliar a acessibilidade anterior da junção cervicotorácica conforme idade e gênero. Métodos Análise radiográfica retrospectiva de 300 tomografias computadorizadas. Os pacientes foram separados por idade e gênero. Os parâmetros radiográficos estudados foram: nível horizontal acima do esterno (HLS, na sigla em inglês), angulação do corpo vertebral (VBA, na sigla em inglês), linha do disco intervertebral (IDL, na sigla em inglês) e angulação da linha do disco intervertebral (IDLA, na sigla em inglês). Resultados Os HLS e IDL mais frequentes foram T2 (34,3%) e C7-T1 (46%), respectivamente. Os valores médios de VBA e IDLA foram de 18 ± 8,94 e 19 ± 7,9 graus, respectivamente. Os homens apresentaram valores maiores de IDLA (p= 0,003) e VBA (p= 0,02). Os grupos de maior idade apresentaram valores maiores de IDLA (p= 0,01) e VBA (p= 0,001). Não houve diferenças de HLS entre os gêneros masculino e feminino (p= 0,3) ou faixas etárias (p= 0,79). Não foram observadas diferenças na IDL entre os gêneros masculino e feminino (p= 0,3); entretanto, o grupo mais velho apresentou nível mais caudal do que os grupos mais jovens (p= 0,12). ConclusõesEm comparação a outras populações, nossa amostra apresentou IDL e HLS mais cefálicos. AVBA e a IDLA foram maiores no gênero masculino, enquanto VBA e IDLA foram maiores em grupos mais velhos. A IDL era mais caudal em pacientes idosos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Spinal Diseases , Spinal Fusion , Thoracic Vertebrae , Tomography, X-Ray Computed , Retrospective Studies , Gender Identity , Intervertebral Disc
11.
Rev. bras. ortop ; 57(1): 82-88, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365738

ABSTRACT

Abstract Objective To compare magnetic resonance imaging (MRI) using a body coil with computed tomography (CT) in measuring the tibial tubercle-trochlear groove distance (TT-TG) and the patellar tendon-cartilaginous trochlear groove (PT-CTG) distances, and evaluate interrater reliability. Methods The study group consisted of 34 knees from 17 asymptomatic subjects with no history of knee pathology, trauma or surgery. A low-dose CT scan and an axial T1-weighted MRI sequence of the knees were performed with rigorous standardization of the positioning with full extension of the knees and parallel feet. Two musculoskeletal radiologists performed the measurements independently. The reliability of the TT-TG and PT-CTG distances on CT (17.1 ± 4.2 mm and 17.3 ± 4.2 mm) and of MRI (16.2 ± 3.7 mm and 16.5 ± 4.1 mm) was assessed by intraclass correlation coefficient (ICC [2,1]) and Bland-Altman graphs, as well as the interrater reliability for both methods. Results Good reliability and agreement was observed between CT and MRI measurements for TT-TG and PT-CTG, with an ICC of 0.774 (p< 0.001) and 0.743 (p< 0.001), respectively, and no systematic bias was observed. The interrater reliability was excellent for all measurements on both imaging methods. Conclusion This was the first study that compared MRI using a body coil with CT in measuring the TT-TG distance, with the potential clinical implication that the CT in this clinical setting could be avoided.


Resumo Objetivo Comparar a ressonância magnética (RM) usando uma bobina corporal e tomografia computadorizada (TC) na medição da distância tubérculo tibial-sulco troclear (TT-ST) e as distâncias tendão patelar-sulco troclear cartilaginoso (TP-STC), e avaliar a confiabilidade interavaliador. Métodos O grupo de estudo consistiu em 34 joelhos de 17 indivíduos assintomáticos sem história de patologia, trauma ou cirurgia no joelho. Uma tomografia computadorizada (TC) de baixa dose e uma sequência axial de RM ponderada em T1 dos joelhos foram realizadas com padronização rigorosa do posicionamento com extensão total dos joelhos e pés paralelos. Dois radiologistas musculoesqueléticos realizaram as medidas de forma independente. A confiabilidade das distâncias TT-ST e TP-STC na TC (17,1 ± 4,2 mm e 17,3 ± 4,2 mm) e RM (16,2 ± 3,7 mm e 16,5 ± 4,1 mm), foi avaliada pelo coeficiente de correlação intraclasse (CCI [2,1)]) e gráficos Bland-Altman, bem como a confiabilidade entre avaliadores para ambos os métodos. Resultados Boa confiabilidade e concordância foram observadas entre as medidas de TC e RM para TT-ST e TP-STC com um CCI de 0,774 (p< 0,001) e 0,743 (p< 0,001), respectivamente, e nenhum viés sistemático foi observado. A confiabilidade entre avaliadores foi excelente para todas as medições em ambos os métodos de imagem. Conclusão Este foi o primeiro estudo que comparou a RM usando bobina de corpo com a TC na medição da distância TT-ST, com a implicação clínica potencial de que a TC neste cenário clínico poderia ser evitada.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Patellar Ligament , Patellar Dislocation , Knee
12.
Int. braz. j. urol ; 48(1): 89-98, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356281

ABSTRACT

ABSTRACT Purpose: Contrast-enhanced CT scan is the standard staging modality for patients with bladder cancer undergoing radical cystectomy (RC). Involvement of lymph nodes (LN) determines prognosis of patients with bladder cancer. The detection of LN metastasis by CT scan is still insufficient. Therefore, we investigated various CT scan characteristics to predict lymph node ratio (LNR) and its impact on survival. Also, pre-operative CT scan characteristics might hold potential to risk stratify cN+ patients. Materials and Methods: We analyzed preoperative CT scans of patients undergoing RC in a tertiary high volume center. Retrospectively, local tumor stage and LN characteristics such as size, morphology (MLN) and number of loco-regional LN (NLN) were investigated and correlation to LNR and survival was analyzed. CT scan characteristics were used to develop a risk stratification using Kaplan-Maier and multivariate analysis. Results: 764 cN0 and 166 cN+ patients with complete follow-up and imaging data were included in the study. Accuracy to detect LN metastasis and locally advanced tumor stage in CT scan was 72% and 62%. LN larger than 15mm in diameter were significantly associated with higher LNR (p=0.002). Increased NLN correlated with decreased CSS and OS (p=0.001: p=0.002). Furthermore, CT scan based scoring system precisely differentiates low-risk and high-risk profiles to predict oncological outcome (p <0.001). Conclusion: In our study, solely LN size >15mm significantly correlated with higher LNR. Identification of increased loco-regional LN was associated with worse survival. For the first time, precise risk stratification based on computed-tomography findings was developed to predict oncological outcome for clinical lymph node-positive patients undergoing RC.


Subject(s)
Humans , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/diagnostic imaging , Cystectomy , Prognosis , Tomography, X-Ray Computed , Retrospective Studies , Lymph Node Excision , Lymph Nodes/surgery , Lymph Nodes/pathology , Lymph Nodes/diagnostic imaging , Neoplasm Staging
13.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.788-792, tab.
Monography in Portuguese | LILACS | ID: biblio-1353341
16.
Autops. Case Rep ; 12: e2021361, 2022. tab, graf
Article in English | LILACS | ID: biblio-1360149

ABSTRACT

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.


Subject(s)
Humans , Male , Adolescent , Head and Neck Neoplasms/pathology , Mediastinal Cyst/pathology , Tomography, X-Ray Computed , Biopsy, Fine-Needle , Diagnosis, Differential
19.
Article in English | WPRIM | ID: wpr-929028

ABSTRACT

OBJECTIVES@#Low dose computed tomography (LDCT) is the best method for early diagnosis of lung cancer. Even though it has been widely used in clinic, the selection of screening objects and the management scheme of pulmonary nodules are still not unified among research institutions. This study aims to evaluate the effect of LDCT in detection effect and follow-up process for pulmonary nodules in asymptomatic participants.@*METHODS@#A total of 1 600 asymptomatic participants (37 to 82 years old), who came from Yantian District People's Hospital, Southern University of Science and Technology, received LDCT. The lung nodules were categorized into positive nodules and semi-positive nodules, and according to the density of positive nodules they were categorized into 4 types: solid nodules (SN), partial solid nodules (pSN), pure ground glass nodules (pGGN), and pleural nodules (PN). The number, detection rate, imaging findings, follow-up change of lung nodules, and the postoperative pathological results of positive nodules were recorded and analyzed.@*RESULTS@#Lung nodules were found in 221 cases by LDCT. The total detection rate of lung nodule was 13.8% (221/1 600), and the detection rate in positive nodules was 4.9% (79/1 600). The detected nodules were mainly single (173 cases), solid (133 cases) and semi-positive nodules (142 cases). Most of nodules (177 cases) had no change in the follow-up process. The enlargement and/or increased density of nodules (5 cases) were lung cancer. Pathological results were obtained in 10 cases, 8 cases were malignant (1 small cell lung cancer and 7 adenocarcinomas), 2 cases were benign (cryptococcal infection and alveolar epithelial dysplasia). The detection rate of lung cancer was 0.5% (8/1 600), and the proportion of early lung cancer was 75% (6/8).@*CONCLUSIONS@#LDCT screening can identify and increase the detection rate in the early lung cancer, which is an effective screening method. It is safe and feasible to take regular follow-up and re-examination for nodules with diameter less than 5 mm. When the size and or density of nodule increases, it indicates the malignant prognosis of the nodule and timely clinical intervention is needed.


Subject(s)
Adenocarcinoma , Adult , Aged , Aged, 80 and over , Early Detection of Cancer/methods , Humans , Lung Neoplasms/pathology , Mass Screening/methods , Middle Aged , Tomography, X-Ray Computed/methods
20.
Article in Chinese | WPRIM | ID: wpr-928892

ABSTRACT

Objective The study aims to investigate the effects of different adaptive statistical iterative reconstruction-V( ASiR-V) and convolution kernel parameters on stability of CT auto-segmentation which is based on deep learning. Method Twenty patients who have received pelvic radiotherapy were selected and different reconstruction parameters were used to establish CT images dataset. Then structures including three soft tissue organs (bladder, bowelbag, small intestine) and five bone organs (left and right femoral head, left and right femur, pelvic) were segmented automatically by deep learning neural network. Performance was evaluated by dice similarity coefficient( DSC) and Hausdorff distance, using filter back projection(FBP) as the reference. Results Auto-segmentation of deep learning is greatly affected by ASIR-V, but less affected by convolution kernel, especially in soft tissues. Conclusion The stability of auto-segmentation is affected by parameter selection of reconstruction algorithm. In practical application, it is necessary to find a balance between image quality and segmentation quality, or improve segmentation network to enhance the stability of auto-segmentation.


Subject(s)
Algorithms , Humans , Image Processing, Computer-Assisted , Neural Networks, Computer , Radiation Dosage , Tomography, X-Ray Computed
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