Asunto(s)
Anastomosis Quirúrgica/efectos adversos , Malformaciones Vasculares del Sistema Nervioso Central/patología , Diálisis Renal/efectos adversos , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/etiología , Anciano , Constricción Patológica , Diagnóstico Diferencial , Reacciones Falso Positivas , Femenino , Humanos , Imagen por Resonancia Magnética , Radiografía , Diálisis Renal/instrumentaciónRESUMEN
The availability of genetically manipulated mice offers a golden opportunity for the study of the contribution of the genome to diseases. Because of the technical difficulty in performing spinal subarachnoid catheterization in mice, this opportunity has hitherto been less harnessed in investigations on the role of the spinal cord in the physiological or pathological processes. Even less explored are spinal mechanisms that underlie cardiovascular regulation since subarachnoid catheterization of the mouse thoracic spinal cord, where preganglionic sympathetic neurons governing vasomotor tone are located posts the highest challenge because of the restricted operating area. We report a procedure for subarachnoid catheterization of the thoracic spinal cord in mice that did not require laminectomy or drilling of the lamina proper, and compared the suitability of two candidate catheters, polyethylene PE-5 catheter (0.51mm, OD) and polyurethane PU-10 catheter (0.25mm, OD). Whereas all implanted mice resumed normal feeding one day after surgery and were devoid of bladder dysfunction or self-mutilation, the smaller and softer PU-10 catheter compared favorably because of lower post-operative mortality rate and no unilateral lower limb paresis.
Asunto(s)
Cateterismo/métodos , Bombas de Infusión Implantables/normas , Procedimientos Neuroquirúrgicos/métodos , Espacio Subaracnoideo/cirugía , Vértebras Torácicas/cirugía , Animales , Cateterismo/instrumentación , Catéteres de Permanencia/normas , Masculino , Ratones , Ratones Endogámicos ICR , Microcirugia/instrumentación , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/instrumentación , Vértebras Torácicas/inervaciónRESUMEN
AIMS: Vascular calcification is a common complication among dialysis patients and its pathogenesis involves a variety of factors. The roles of pro-inflammatory cytokines and residual kidney function (RKF) in peritoneal dialysis (PD) patients with vascular calcification have not been investigated. MATERIALS AND METHODS: 157 stable PD patients were enrolled. All patients had plain X-ray film examination including chest (posterior-anterior view, CXR) and pelvis. Vascular calcification was interpreted as calcified deposit over aortic arch and linear calcification of pelvic arteries. Relevant biochemical data, pro-inflammatory markers, and PD-related factors were measured and collected. RESULTS: Vascular calcification prevalence in CXRs was higher than that in pelvis films (38.2% vs. 22.3%, p < 0.05). Patients with vascular calcification in CXR had higher incidence of calcification in pelvis films (p < 0.05). Only a minor portion (14.6%) had two calcification sites. Regression analysis revealed that age, PD duration, body mass index, and RKF were independent factors associated with vascular calcification in CXR. Age, diabetes, IL-10 and RKF were factors associated in pelvis films. Factors independently related to vascular calcification in both films were age, duration, diabetes, IL-10, and RKF. CONCLUSIONS: Besides traditional risk factors, IL-10 and RKF were important factors associated with vascular calcification in PD patients.
Asunto(s)
Calcinosis/etiología , Interleucina-10/fisiología , Riñón/fisiopatología , Diálisis Peritoneal/efectos adversos , Enfermedades Vasculares/etiología , Adulto , Anciano , Femenino , Humanos , Interleucina-10/sangre , Masculino , Persona de Mediana Edad , Radiografía Torácica , Factores de RiesgoRESUMEN
Ectopic pancreas is relatively uncommon and usually occurs in the stomach or duodenum. Retroperitoneal ectopic pancreas has not previously been documented. We report the case of a 48-year-old man with retroperitoneal ectopic pancreas that imitated bilateral adrenal tumours on ultrasound and MRI. Subsequent CT-guided biopsies confirmed an ectopic pancreas. The lesions remained stable during follow-up for 7 years. In retrospect, the similarity in signal intensities and enhancement pattern between the retroperitoneal masses and the pancreas may have been a clue to the diagnosis of this rare entity.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Coristoma/diagnóstico , Páncreas , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Espacio Retroperitoneal , Tomografía Computarizada por Rayos XAsunto(s)
Hemorragia Cerebral/diagnóstico , Complicaciones del Embarazo/diagnóstico , Rotura Uterina/diagnóstico , Dolor Abdominal/etiología , Aborto Inducido/efectos adversos , Adulto , Presión Sanguínea , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/cirugía , Cesárea , Coma/etiología , Resultado Fatal , Femenino , Cefalea/etiología , Frecuencia Cardíaca , Hematoma/complicaciones , Hematoma/diagnóstico , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiología , Hidrocefalia/cirugía , Embarazo , Complicaciones del Embarazo/cirugía , Rotura Uterina/etiología , Rotura Uterina/cirugía , Vómitos/etiologíaRESUMEN
This study was designed to assess the clinical usefulness of imaging for predicting the prognosis of patients with combined hepatocellular cholangiocarcinoma (cHCC-CC). Between 1999 and 2004, 30 patients with histopathologically proven cHCC-CC underwent computed tomography (CT) or magnetic resonance imaging (MRI). The imaging data and survival were analysed. Univariate log-rank analysis of imaging findings revealed that tumour necrosis, bile duct invasion, major vascular branch invasion, multiplicity, bilobar distribution, regional lymph node involvement, regional organ invasion, distant metastasis and ascites had adverse influences on overall survival. Multivariate Cox proportional hazard analysis demonstrated that major vascular branch invasion, regional organ invasion, nodal and distant metastases were independent prognostic factors that adversely affected overall survival rates. Overall cumulative survival rates at 1, 3 and 5 years were 53%, 26% and 12%, respectively. Analysing the survival of our patients by using clinical stages of the newly updated American Joint Committee on Cancer (AJCC) classification for liver neoplasm based on the imaging findings, we found significant differences between stages I/II and III (p < 0.001) and between stages III and IV (p = 0.040). We conclude CT or MRI can be used to identify the prognostic factors and to estimate the outcomes of patients with cHCC-CC.
Asunto(s)
Neoplasias de los Conductos Biliares/patología , Conductos Biliares Intrahepáticos/patología , Carcinoma Hepatocelular/patología , Colangiocarcinoma/patología , Neoplasias Hepáticas/patología , Imagen por Resonancia Magnética/normas , Neoplasias Primarias Múltiples/patología , Tomografía Computarizada por Rayos X/normas , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Conductos Biliares/mortalidad , Carcinoma Hepatocelular/mortalidad , Colangiocarcinoma/mortalidad , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/mortalidad , Pronóstico , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
Renal vein thrombosis (RV Thromb) is a serious complication ofnephrotic syndrome. Anticoagulation is usually recommended as the treatment of choice. This study reports 3 nephrotic patients diagnosed to have RVThromb combined with thromboembolic events. Low-molecular weight heparin (LMWHep) was given subcutaneously every 12 hours following the diagnosis of RVTromb, which continued at the outpatient clinic after an average of 11 in-hospital days. The patients visited the nephrology outpatient clinic every other week and underwent magnetic resonance image (MRI) studies at 6-week intervals for follow-up of patency of the involved renal vein. LMWHep was discontinued when MRI showed this patency. The average outpatient treatment period was 74 days. There was no recurrent RVThromb in the follow-up course of 6 months after discontinuation of LMWHep. Kidney function was preserved, as indicated by image studies and serial renal function tests. LMWHep produced a more predictable anti-coagulant effect, a superior bioavailability, a longer half-life and a dose-independent effect than unfractionated heparin and coumadin. These benefits made the outpatient treatment of RVThromb possible. Our report recommends outpatient treatment of RVThromb by LMWHep because it is feasible, effective and safe.
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Heparina de Bajo-Peso-Molecular/uso terapéutico , Síndrome Nefrótico/complicaciones , Síndrome Nefrótico/tratamiento farmacológico , Pacientes Ambulatorios , Venas Renales/efectos de los fármacos , Trombosis de la Vena/tratamiento farmacológico , Adulto , Anciano , Creatinina/sangre , Femenino , Humanos , Masculino , Proteinuria/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagenRESUMEN
Catheterization of the subarachnoid space provides a convenient means to deliver drugs to, or collect cerebrospinal fluid from, the spinal cord in animal experiments, and has been instrumental to our understanding of spinal mechanisms that underlie anesthesia, analgesia, or cardiovascular regulation. Experience gained over the years has revealed several shortcomings of this technique. We report a procedure that encompasses the benefits of direct subarachnoid catheterization of the rat thoracic spinal cord but circumvents the known shortcomings. An intrathecal catheter was fabricated with a small silicon bead at one end of a PE-10 catheter, which was cannulated with a 4/0 suture that served as a guide. Using the L-shape hook of the suture guide as an anchorage, the catheter was advanced into the subarachnoid space until the silicon bead was lodged on a drilled hole (2 x 2 mm) over the lamina proper on the T13 vertebrae. With less surgical trauma, greater precision of placement and firmer anchorage of the catheter, less leakage of cerebrospinal fluid, and minimal mortality or morbidity, our modified procedure for catheterization of the thoracic spinal subarachnoid space in the rat compared favorably to previously reported methods.
Asunto(s)
Anestesia Raquidea , Cateterismo/métodos , Espacio Subaracnoideo , 6-Ciano 7-nitroquinoxalina 2,3-diona/farmacología , Animales , Maleato de Dizocilpina/farmacología , Antagonistas de Aminoácidos Excitadores/farmacología , Masculino , Músculo Liso Vascular/fisiología , Paraplejía/etiología , Pentobarbital , Radiografía , Ratas , Ratas Sprague-Dawley , Espacio Subaracnoideo/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagenRESUMEN
The management of pediatric patients with coronary artery fistula (CAF) remains controversial because the clinical course of CAF may vary greatly from spontaneous closure to severe complications. The purpose of our study was to report the outcome of CAF in pediatric patients by using echocardiography as an evaluation tool. Between January 1997 and July 2003, 17 patients (age range, 5 months to 14 years; mean, 3.8 years) with coronary angiographically proven CAF were recruited. We divided patients into two groups. Group 1 (n = 4) included patients with symptoms related to CAF (n = 3), persistent coronary artery dilatation for 6 months (n = 4), and/or a continuous waveform of the fistula detected by Doppler (n = 3). Group 2 (n = 13) included patients who were asymptomatic, with normal coronary artery size or coronary artery dilatation less than 6 months, and/or a noncontinuous waveform of the fistula detected by Doppler. Group 1 patients received interventional therapy, whereas group 2 patients were managed conservatively. There were 6 male and 11 female patients. The correlation coefficient of coronary artery diameter measured on echocardiography and angiography was 0.935 and 0.834 in groups 1 and 2, respectively. The diameter of the involved coronary artery was 5.8-9.2 mm (mean, 7.50 +/- 1.85) and 1.7-3.8 mm (mean, 2.72 +/- 0.59) in group 1 and group 2, respectively. After transcatheter coil embolization, group 1 patients became asymptomatic with no residual fistula and had decrement of the coronary artery diameter (p = 0.035). All group 2 patients remained asymptomatic with no significant change in coronary artery size (p = 0.846) and 3 of them showed spontaneous closure of CAF. Persistent dilatation of the diameter of proximal coronary artery may be a useful parameter for determining subsequent application of interventional therapy. In patients with nonsignificant CAF, conservative follow-up is strongly suggested and intervention procedures may be unnecessary.
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Fístula Arterio-Arterial/diagnóstico , Enfermedad Coronaria/diagnóstico , Ecocardiografía Doppler , Adolescente , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/terapia , Niño , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Vasos Coronarios/diagnóstico por imagen , Femenino , Atrios Cardíacos , Soplos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos , Humanos , Lactante , Masculino , Arteria Pulmonar/diagnóstico por imagenRESUMEN
Extraskeletal Ewing's sarcoma (EES) is rarely found in the head and neck region. We report here a case of EES of the parapharyngeal space in a 53-year-old man who presented with blurred vision, dysphagia, hoarseness and right facial numbness. CT examination showed a large, seemingly well-defined soft tissue mass in the right parapharyngeal space with skull base destruction and intracranial extension. The patient showed poor response to chemotherapy and radiotherapy and died 6 months after initial presentation. A review of the literature revealed no previous reports of EES occurring in the parapharyngeal space.
Asunto(s)
Neoplasias Faríngeas/diagnóstico por imagen , Sarcoma de Ewing/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Faríngeas/tratamiento farmacológico , Neoplasias Faríngeas/radioterapia , Sarcoma de Ewing/tratamiento farmacológico , Sarcoma de Ewing/radioterapiaRESUMEN
A 66-year-old woman with previous hysterectomy had dysuria and vaginal spotting for 1 month. Computed tomography showed a heterogeneous presacral mass with eccentric calcification. Biopsies of the bladder and vagina and transrectal biopsy of the pelvic mass yielded only inflammation. T2-weighted magnetic resonance images revealed a heterogeneous mass with wavy hypointensities. Computed tomographically guided biopsy targeting at the calcified area disclosed thread-like materials, thus confirming the diagnosis of gossypiboma.
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Cuerpos Extraños/patología , Tapones Quirúrgicos de Gaza , Anciano , Biopsia con Aguja , Calcinosis/diagnóstico por imagen , Femenino , Reacción a Cuerpo Extraño/patología , Humanos , Histerectomía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To report on fluoroscopically guided percutaneous gastrostomy (FPG) using a modified gastropexy technique with the insertion of a large-bore balloon-retained gastrostomy catheter in patients with head and neck tumors. MATERIAL AND METHODS: Thirty-four patients with head and neck tumors underwent a modified gastropexy with two T-fasteners followed by the insertion of a 14-F ballooon-retained catheter through a peel-away introducer. The success rate and the complications of the procedures were evaluated at 14 days, 30 days, and 60 days. The complications were classified as: major complications that necessitated intensive and/or surgical treatment; minor complications that could be treated conservatively; and tube-related complications manageable by tube exchange. RESULTS: FPG was technically successful in all cases. There were no major complications, two minor complications where superficial stoma infection was controlled by antibiotics, three minor tube-related complications, all three easily managed by catheter replacement via the original tract. CONCLUSION: FPG with insertion of a large-bore balloon-retained catheter using a modified gastropexy technique is a safe and effective method that creates a feeding access for patients with head and neck tumors and esophageal obstruction. Minor complications can be managed conservatively. FPG may be a good alternative to surgical or percutaneous endoscopic gastrostomy.
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Catéteres de Permanencia , Gastrostomía/métodos , Neoplasias de Cabeza y Cuello/terapia , Radiografía Intervencional/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fluoroscopía , Gastrostomía/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Castleman disease is a rare benign lymphoid tumour of uncertain aetiology that usually appears as a solitary mediastinal mass. We report a rare case of Castleman disease in the right paracardiac pleural space, occurring in a young woman with non-specific chest discomfort. MRI showed a well-defined, oval mass that was slightly hyperintense on T(1) weighted images, inhomogeneously hyperintense on T(2) and enhanced T(1) weighted images. The patient underwent radical tumour resection and has remained well for 8 years.
Asunto(s)
Enfermedad de Castleman/diagnóstico , Enfermedades Pleurales/diagnóstico , Adulto , Enfermedad de Castleman/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Enfermedades Pleurales/diagnóstico por imagen , RadiografíaRESUMEN
We report an unusual case of Müllerian duct cyst in an 8-month-old infant who presented with frequent vomiting and recurrent urinary tract infections. Computed tomography showed a midline giant cyst in the pelvic floor. Delayed enhanced computed tomography demonstrated contrast filling of the cyst, indicating a communication with the urotract. Subsequent cystourethrogram and surgery confirmed a giant Müllerian duct cyst.
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Quistes/diagnóstico , Conductos Paramesonéfricos/diagnóstico por imagen , Sistema Urinario/anomalías , Abdomen/diagnóstico por imagen , Quistes/cirugía , Humanos , Lactante , Masculino , Conductos Paramesonéfricos/cirugía , Radiografía Abdominal/métodos , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía , Infecciones Urinarias/complicaciones , Urografía , Vómitos/complicacionesRESUMEN
We present a surgically proven case of infradiaphragmatic pulmonary sequestration combined with cystic adenomatoid malformation. Prenatal magnetic resonance imaging revealed a well-defined hyperintense mass with a hypointense septum in the left infradiaphragmatic region. Postdelivery computed tomography (CT) and 3-month follow-up CT showed replacement of intralesional cystic areas by solid content. Such unusual postnatal CT changes, to our knowledge, have not been previously documented.
Asunto(s)
Secuestro Broncopulmonar/complicaciones , Secuestro Broncopulmonar/diagnóstico por imagen , Malformación Adenomatoide Quística Congénita del Pulmón/complicaciones , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/cirugía , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico , Malformación Adenomatoide Quística Congénita del Pulmón/cirugía , Diagnóstico Diferencial , Femenino , Enfermedades Fetales/diagnóstico , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética/métodos , Masculino , Embarazo , Diagnóstico Prenatal/métodos , Radiografía Abdominal/métodosRESUMEN
We report a case of traumatic false aneurysm developed in the right glabella in a 5-year-old boy 3 weeks after an innocuous fall. Ultrasound, CT and facial arteriography did not reveal the feeding artery. After direct puncture of the glabellar bulge and rapid aspiration of blood, percutaneous contrast agent infusion revealed that the false aneurysm was supplied by the contralateral angular artery. Intralesional obliteration with cyanoacrylate was subsequently performed smoothly. Succeeding excision was easy and the cosmetic outcome was excellent.
Asunto(s)
Aneurisma Falso/terapia , Traumatismos Craneocerebrales/complicaciones , Cianoacrilatos/uso terapéutico , Embolización Terapéutica/métodos , Adhesivos Tisulares/uso terapéutico , Heridas no Penetrantes/complicaciones , Accidentes por Caídas , Aneurisma Falso/diagnóstico por imagen , Preescolar , Humanos , Masculino , Cuidados Preoperatorios/métodos , Tomografía Computarizada por Rayos X/métodos , UltrasonografíaRESUMEN
We report a rare case of malignant peripheral nerve-sheath tumour of the diaphragm in a 12-year-old boy with neurofibromatosis presented clinically and radiographically as recurrent lung infection. Ultrasound revealed a pedunculated diaphragmatic tumour invading the posterior chest wall. This case highlights that this unusual tumour may limit diaphragmatic excursion leading to, and even being masked by, superimposed lung infection. In patients with neurofibromatosis, ultrasound is recommended when chest radiography shows a basal lung opacity.
Asunto(s)
Diafragma/inervación , Enfermedades Pulmonares/diagnóstico por imagen , Neoplasias de la Vaina del Nervio/diagnóstico por imagen , Neoplasias del Sistema Nervioso Periférico/diagnóstico por imagen , Infecciones del Sistema Respiratorio/diagnóstico por imagen , Niño , Diagnóstico Diferencial , Humanos , Enfermedades Pulmonares/etiología , Masculino , Neurofibromatosis/complicaciones , Neoplasias del Sistema Nervioso Periférico/etiología , Radiografía , Recurrencia , Infecciones del Sistema Respiratorio/etiología , UltrasonografíaRESUMEN
SETTING: A 2500-bed medical centre in southern Taiwan. OBJECTIVE: To study the clinical value of high-resolution computed tomography (HRCT) in predicting the activity of pulmonary tuberculosis (TB). DESIGN: HRCTs were performed prospectively in 148 patients whose chest radiographs (CXRs) showed highly suspicious signs of pulmonary TB, predominantly upper lung field infiltration. The HRCT findings, interpreted independently by a pulmonologist and a radiologist, were used to predict the activity of pulmonary TB. RESULTS: Pulmonologist-interpreted and radiologist-interpreted HRCTs showed high sensitivity (both 93%), specificity (83 vs. 88%), accuracy (86 vs. 90%), positive predictive values (76 vs. 83%) and negative predictive values (both 95%). Kappa statistic indicates good inter-reader agreement. CONCLUSION: HRCT has a high value in predicting the activity of pulmonary TB. It is a useful tool in this regard when a patient with suspected pulmonary TB lacks microbiologic proof, when clinical condition makes invasive diagnosis impossible or when a patient has completed anti-tuberculosis treatment with no compatible unequivocal CXR.
Asunto(s)
Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Esputo/microbiología , Tuberculosis Pulmonar/microbiologíaRESUMEN
Although mesenteric vasculitis due to Henoch-Schönlein purpura (HSP) is relatively uncommon, it is the most life-threatening manifestation associated with high mortality. We describe a 15-year-old boy with HSP who had massive gastrointestinal bleeding and ileus but delayed onset of the purpuric rash. Abdominal ultrasonography revealed thickening of both small and large intestinal walls, and CT found prominent mesenteric vessels with comb sign and double wall of the bowel. These findings were consistent with mesenteric vasculitis and bowel ischaemia. The ischaemic intestine recovered after methylprednisolone pulse therapy and surgical intervention was avoided. Our report suggests that corticosteroid pulse therapy may help controlling HSP with massive gastrointestinal haemorrhage and ischaemic bowel due to widespread mesenteric vasculitis.