The role of multiparametric MRI in differentiating uterine leiomyosarcoma from benign degenerative leiomyoma and leiomyoma variants: a retrospective analysis.

AIM: To assess qualitative and quantitative magnetic resonance imaging (MRI) factors that can help distinguish leiomyosarcoma (LMS) from benign degenerative leiomyoma (BDL) and leiomyoma variants (LV) and assess the interobserver agreement for the proposed quantitative factors. MATERIALS AND METHODS: Retrospective analysis of all histopathology proven cases of LV, BDL, and LMS with a preoperative MRI was performed. Twenty-seven cases were included (five LMS, three LV, and 19 BDL) with each case independently read by a pair of radiologists. Lesion size, margins, presence or absence of degeneration, necrosis, and haemorrhage were assessed on MRI along with quantitative factors such as mean T2-weighted (W) and T1W signal intensity, T1W signal heterogeneity, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) ratios as well as dynamic contrast enhancement (DCE) characteristics along with the presence or absence of lymphadenopathy and extra-uterine and peritoneal spread. Mean and standard deviation for quantitative variables and frequency with percentages for qualitative variables were assessed. RESULTS: Infiltrative margins were seen exclusively in the LMS group (n=1), with the remaining LMS cases showing lobulate or rounded smooth margins similar to BDL or LV. A high T2W signal <25% was seen exclusively in the BDL group (n=8). The presence of concomitant necrosis and haemorrhage was seen exclusively in the LMS group (n=2). Quantitative MRI had good inter-reader correlation but was not significantly different between the LMS, BDL, and LV groups. CONCLUSION: LMS, BDL, and LV may have overlapping features on multiparametric MRI making differentiation difficult.

[Death in the hospital--cardiac resuscitation teams]. / A morte no contexto hospitalar--as equipes de reanimação cardíaca.

The author investigated the meaning of the daily work with the death on the perspective of the professionals that integrate a team of heart and lung revival from a university hospital. To belong to this team implies somehow, to live together with the death with an explicit objective of reverting it. The literature evidences the concern of several authors with these professionals, considering their tendency of weariness. The study was developed according to the methodology of phenomenological investigation and was carried out through recorded interviews with all members of the referred team. The analyzed data allowed authors to evidence that the professionals perceive the work on a functionalist perspective, where the time is revealed as a decisive factor against death; it is a work permeated by the success/failure and difficulties; it generates a posture of omnipotence/impotence and requires a confrontation. They also evidenced waste, feelings of impotence and of failure when the reanimation is not possible. They still reinforce the concern about daily exhausting work and the advise for schools and institutions of health to develop channels for the evaluation of weariness and for the new valuation of the health professionals role.