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1.
J Cancer Res Clin Oncol ; 146(9): 2311-2317, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32583236

RESUMO

PURPOSE: We herein present the results of the first Italian Association of Radiotherapy and Clinical Oncology (AIRO) survey regarding salvage external beam re-irradiation of local prostate cancer relapse named PROLAPSE. METHODS: A questionnaire with 12 items was administered to the 775 Italian radiation oncologist members of the AIRO. RESULTS: One hundred of the members completed the survey. The survey highlighted that 59% of the participants are currently performing prostate re-EBRT, while nearly two-thirds (65%) affirmed that they are taking into consideration the procedure in case of intraprostatic relapse. Regarding the clinical target volume (CTV), only a minority (16%) declared to always prefer the partial prostate re-irradiation, while a consistent portion (nearly two-thirds) relied on clinical considerations of the choice towards partial or whole gland irradiation. The main techniques used for re-irradiation resulted to be intensity-modulated RT (IMRT)/volumetric modulated arc therapy (VMAT) and SBRT, having received approximately 40% of responses each. Regarding the criteria for patients' selection, more than 75% of responders agreed on the use of positron emission tomography (PET)/computed tomography (CT)-choline to exclude distant metastases and of multiparametric magnetic resonance imaging (mp-MRI) to detect intraprostatic recurrence. A sufficient timeframe (> 3 years) between primary RT and reirradiation was indicated by more than half of participants as an important driver in decision-making, while histological confirmation of the relapse was considered not essential by more than two-thirds. For the use of concomitant androgen deprivation therapy (ADT), most AIRO members (79%) agreed that the prescription should be based on a case-by-case analysis. Extreme hypofractionation (> 5 Gy/fraction) was preferred by the majority (52%) of the AIRO members. In most centers (more than 74%), the planning dose-volume constraints were generally extrapolated from the published data. In half of the cases, the interviewed responders affirmed that no major gastrointestinal (GI) and genitourinary (GU) toxicities were registered in the follow-up of their re-EBRT patients. Bladder complications represented the most commonly observed form of toxicity, with an incidence of 67%. CONCLUSION: This first AIRO survey about salvage prostate re-EBRT provides an interesting snapshot and suggests increasing interest in re-EBRT patients in Italy. Consensus about some aspects of patients' selection, the necessity of biopsy, fractionation, and highly selective techniques seems feasible, but other key points such as irradiated volume, dosimetry parameters, and hormonal treatment association need to be clarified.


Assuntos
Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Próstata/patologia , Próstata/efeitos da radiação , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Idoso , Biópsia/métodos , Fracionamento da Dose de Radiação , Humanos , Itália , Masculino , Oncologia/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Prolapso , Radiocirurgia/métodos , Radioterapia de Intensidade Modulada/métodos , Reirradiação/métodos , Recidiva , Terapia de Salvação/métodos , Inquéritos e Questionários
3.
Niger J Clin Pract ; 23(4): 498-502, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32246656

RESUMO

Background: Prolapsed lumbar intervertebral disc is one of the most prevalent causes of low back pain and traction is one of the most common physical therapy treatments offered to affected patients. Advancements in traction equipment are needed to ensure their effectiveness in clinical situations. Aims: The objective of the study was to find out the effect of patient-specific three-dimensional lumbar traction on pain and functional disability in individuals with lumbar intervertebral disc prolapse. Subjects and Methods: Original article and Experimental design. Twenty-five participants (age range: 34-67 years) diagnosed with lumbar intervertebral disc prolapse were included in this study. Patient-specific three-dimensional lumbar traction was given as three sessions per week for the duration of one month. All participants completed a 10-cm visual analog pain scale and pain pressure threshold to assess pain and the Oswestry disability index to assess the functional disability. Results: On pre to post interventions, a significant change in mean values were found for visual analog scale pain score, pain pressure threshold, and Oswestry disability index (P < 0.001). The pain intensity was reduced from 8.5 to 3.2, pain pressure threshold increased from 0.7 to 1.6 kg/cm2, and functional disability was reduced from 53.5% to 31.3%. Conclusion: Twelve sessions of patient-specific three-dimensional lumbar traction promoted a reduction in pain and improvement in functional disability among subjects with lumbar intervertebral disc prolapse.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Dor Lombar/terapia , Tração/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Prolapso , Resultado do Tratamento , Escala Visual Analógica
4.
Zhonghua Yan Ke Za Zhi ; 56(3): 205-210, 2020 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-32187949

RESUMO

Objective: To analyze the clinical histopathologic characteristics of lacrimal glands and possible mechanisms of lacrimal gland prolapse in blepharochalasis (BC). Methods: A case-controlled study of 23 consecutive patients with prolapse of lacrimal glands in BC was performed. All samples were obtained during surgery from the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University between January 2009 and December 2016. The lacrimal tissue included prolapsed lacrimal glands (30 samples) and controls from the donors in the eye bank of Beijing Tongren Hospital, Capital Medical University (8 samples). Hematoxylin-eosin staining, special staining, immunohistochemistry and colloidal gold-labeled pre-embedded indirect immunogold electron microscopy (Gold-IIEM) were performed to analyze the histopathologic characteristics of the samples. The nonparametric Wilcoxon signed-ranks test was carried out for statistical analysis. Results: Among the 23 patients with lacrimal gland prolapse in BC, there were 3 males and 20 females. The mean age of morbidity was 11 years old (7-16 years). In the 8 normal control cases, 3 males and 5 females were included. The mean age was 15 years (10-20 years). In the 30 prolapsed lacrimal gland samples, hematoxylin-eosin staining showed enlargement of glandular lumina accompanied by inflammatory infiltrates of interstitial tissue in 2 samples. Marked loosening of collagen fibers of the obtainable lacrimal fascia was observed. The results on immunohistochemical staining demonstrated an increased level of immunocytes in the 30 prolapsed lacrimal gland samples, including IgA (+++, ++, +, -; 12, 11, 4, 3 vs. 0, 0, 1, 7; Z=-3.892), CD3(+)T cells (+++, ++, +, -; 2, 19, 7, 2 vs. 0, 0, 1, 7; Z=-4.168), matrix metalloproteinase (MMP)-3 (+++, ++, +, -; 0, 0, 11, 19 vs. 0, 0, 0, 8; Z=-2.005) and MMP-9 (+++, ++, +, -; 14, 14, 0, 2 vs. 0, 0, 0, 8; Z=-4.552) (all P<0.05). IgG, IgM, CD20 and C1-inhibitor were either absent or expressed at background level in the 30 prolapsed lacrimal gland samples (all P>0.05). Gold-IIEM showed zymogon granules in lacrimal glands were out of shape. MMP-3 and MMP-9 colloidal gold particles existed on the zymogon granules, and MMP-3 colloidal gold particles also existed on the surface of lacrimal gland epithelial cells. Conclusions: The histopathological changes in the lacrimal glands of lacrimal gland prolapse with BC include inflammatory infiltration, elastic fiber degeneration, marked loosening of the supporting fascia tissue, and an increased level of immunocytes, including IgA, CD3(+)T cells, MMP-3 and MMP-9. The results suggest that lacrimal gland prolapse with BC may result in the immuno-pathogenetic mechanisms with the involvement of cell-mediated immune responses. (Chin J Ophthalmol, 2020, 56: 205-210).


Assuntos
Blefaroptose/patologia , Doenças do Aparelho Lacrimal/patologia , Aparelho Lacrimal/patologia , Adolescente , Criança , Feminino , Humanos , Masculino , Prolapso , Linfócitos T
5.
Clinics (Sao Paulo) ; 75: e1353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939559

RESUMO

OBJECTIVE: Stoma prolapse is an intussusception of the bowel through a mature stoma. It can be caused by increased intra-abdominal pressure, excessively mobile bowel mesentery and/or a large opening in the abdominal wall at the time of stoma formation. It occurs predominantly in loop stomas, and correction methods include conservative modalities, such as local reduction to the prolapsed bowel, or surgical treatment. The purpose of this study was to describe our experience with the treatment of colostomy prolapse using a novel mesh strip technique. METHODS: Between February 2009 and March 2018, ten consecutive male patients underwent correction of colostomy prolapse under local anesthesia by peristomal placement of a polypropylene mesh strip. Operation time, short- and long-term complications, and recurrence rates were recorded and analyzed. RESULTS: No postoperative complications, morbidity or mortality were observed. The median length of the prolapse ranged from 6-20 cm, and the median operative time was 30 minutes. The median duration of follow-up was 25 months (range, 12-89 months). No relapse, mesh strip extrusion, local infection or granuloma formation were found. CONCLUSION: A simple, fast, and low-cost operation under local anesthesia using a mesh strip is a valuable option to treat colostomy prolapse.


Assuntos
Doenças do Colo/cirurgia , Colostomia/reabilitação , Complicações Pós-Operatórias/cirurgia , Telas Cirúrgicas , Estomas Cirúrgicos/efeitos adversos , Parede Abdominal , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso , Resultado do Tratamento
7.
Kyobu Geka ; 73(1): 28-33, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956247

RESUMO

BACKGROUND: Carpentier's techniques for degenerative posterior mitral leaflet (PML) prolapse have been established with excellent long-term results reported. However, residual mitral regurgitation( MR) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a PML repair. METHODS AND RESULTS: We retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated PML prolapse including a preoperative three-dimensional ransesophageal echocardiography( 3D-TEE) examination. Eleven had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet (AML) tethering angle as a significant predictor for residual MR [odds ratio (OR) 6.82, 95% confidence interval (CI) 1.8~33.8, p=0.0049]. Receiver operator characteristics curve analysis revealed a cut-off value of 24.3°( area under the curve 0.77), indicating that AML angle predicts residual MR. In multivariate regression analysis, smaller anteroposterior mitral annular diameter( p<0.001) and lower left ventricular ejection fraction( p=0.002) were significantly associated with higher AML angle, while left ventricular and left atrial dimension had no significant correlation. CONCLUSIONS: AML tethering in cases of PML prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3D-TEE are important for consideration of a careful surgical strategy.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Humanos , Valva Mitral , Prolapso , Estudos Retrospectivos , Resultado do Tratamento
8.
J Urol ; 203(3): 603, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31769711
9.
Int J Surg ; 74: 53-60, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31887419

RESUMO

BACKGROUND: Hemorrhoids are one of the most common conditions in the world, and grade III and IV internal hemorrhoids are mainly treated with surgery. However, there are many different surgical methods, and many postoperative complications occur. Therefore, we aimed to update and expand our previous work to compare the safety and efficacy of the procedure for prolapse and hemorrhoids (PPH), Milligan-Morgan hemorrhoidectomy (MMH) and tissue-selecting therapy stapler (TST) in the treatment of grade III and IV internal hemorrhoids. METHODS: We performed a network meta-analysis. We searched the Cochrane library, Embase, PubMed, Medline, Web of Science, CNKI, Wangfang, and VIP databases up to May 20, 2019. All randomized controlled trials (RCTs) comparing PPH, MMH and TST in the treatment of grade III and IV internal hemorrhoids were included. We performed a Bayesian network meta-analysis to integrate the adverse events of all treatments. This work is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. This study was registered with PROSPERO, number CRD42019137270. RESULT: Twenty-two RCTs that recruited 3511 patients were identified. Among these patients, 1379 patients underwent PPH, 805 patients underwent TST, and 1327 patients underwent MMH. In terms of adverse events, TST presented the lowest urinary retention rates and fecal incontinence rates. TST exhibited fewer incidences of anal stenosis than PPH and MMH. Importantly, PPH showed the weakest effects on reducing recurrence rates in hemorrhoid patients. CONCLUSIONS: The current study indicated that TST showed optimal potential superior clinical effects for grade III and IV hemorrhoids compared to PPH and MMH. However, high-quality large sample RCTs are still expected.


Assuntos
Hemorroidectomia/métodos , Hemorroidas/cirurgia , Metanálise em Rede , Grampeamento Cirúrgico/métodos , Incontinência Fecal/epidemiologia , Hemorroidectomia/efeitos adversos , Humanos , Prolapso , Ensaios Clínicos Controlados Aleatórios como Assunto , Grampeamento Cirúrgico/efeitos adversos
11.
Rev Prat ; 69(4): 381-384, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626486

RESUMO

The clinical evaluation of a prolapse has several components: a precise interrogation, a careful clinical examination, the evaluation of its maintenance on the quality of life. It must take into account the urinary, genital and anorectal spheres. From this clinical evaluation will depend the choice and interpretation of paraclinical investigations that may be requested. But the complementary examinations must never replace the interrogation and the clinical examination. Only symptomatic genital prolapses should be treated.


Assuntos
Genitália , Qualidade de Vida , Prolapso Retal , Prolapso Uterino , Feminino , Genitália/patologia , Humanos , Masculino , Prolapso , Prolapso Retal/diagnóstico , Prolapso Uterino/diagnóstico
12.
J Laparoendosc Adv Surg Tech A ; 29(10): 1368-1371, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31483193

RESUMO

Background: Prolapse can occur in up to 20% of newborn end colostomies and may be associated with significant morbidities that require operative intervention. Prolapse repair is traditionally performed through an open parastomal or laparotomy incision. We report on 2 cases that utilized a novel laparoscopic transabdominal colopexy technique, which offered a minimally invasive solution uniquely suited to neonates and infants while obviating the morbidity of open reoperative surgery. Materials and Methods: Retrospective review of 2 patients at a single center undergoing a laparoscopic transabdominal colopexy for end colostomy prolapse. The primary outcome measure was prolapse recurrence. Secondary outcomes included intraoperative or immediate postoperative complications. Results: Both patients who underwent the laparoscopic transabdominal colopexy procedure had prolapsed end colostomies. There were no intraoperative or immediate postoperative complications. Both patients had no additional episodes of recurrence during the follow-up period. One patient has since had their colostomy reversed without complications. Conclusion: We present our initial results in the utilization of a novel technique for repair of a newborn end colostomy prolapse-laparoscopic transabdominal colopexy. Our technique thus far has demonstrated success in preventing recurrent prolapse through a minimally invasive technique with no significant morbidity.


Assuntos
Colostomia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Abdome/cirurgia , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias , Prolapso , Estudos Retrospectivos
13.
BMC Gastroenterol ; 19(1): 157, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462228

RESUMO

BACKGROUND: An intestinal stoma, though a life-saving procedure on the care of many gastrointestinal conditions, carries significant number of complications. This study describes the common indications, complications, and management of stomas and identifies the factors that are associated with these complications in a tertiary care hospital in Tanzania. METHODS: A cross-sectional study of patients with intestinal stomas was conducted at Bugando Medical Centre (BMC) between July 2016 and June 2017. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study. RESULTS: A total of 167 patients (M: F = 1.2:1) were enrolled in the study. The mean age at diagnosis was 0.6 ± 1.4 years for children and mean age for adults was 36.7 ± 15.8 years. Anorectal malformation (110, 89.4%) was the most common indication for intestinal stoma formation in children, while bowel perforation (14, 31.8%) was the main indications in adults. The sigmoid colon (137, 82.0%) was the most common anatomical site for stoma formation followed by the ileum (18, 10.8%). Stoma prolapse (18, 41.9%) was the most frequent complication of a stoma, whereas, surgical site infection (9, 34.6%) was the most frequent complication after stoma closure. Thirty five (26.7.%) of the children developed stomal complications, while only 8 (22.2%) of the adults developed complications. The level of training of operating surgeon and timing of surgery were the main predictors of stoma-related complications (p < 0.034 and 0.013), whereas the level of training of the operating surgeon and the type of stoma closure were significantly associated with the complications related to stoma closure (p < 0.001). CONCLUSION: The intestinal stomas performed at BMC are associated with various complications, which in turn, become a burden to the patients. The insights observed in the current study may apply to other tertiary hospitals in Tanzania and Africa at large. We suggest that the keystones for improvement and control in the formation and complications of intestinal stomas are the following; colostomy formation should rarely be done in transverse colon, the procedure should be carried out by senior doctors (specialist) or junior doctors under close and direct supervision of the specialists, using proper meticulous techniques, and the need to determine and/or improve techniques for early detection of complications.


Assuntos
Malformações Anorretais/cirurgia , Enterostomia , Perfuração Intestinal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Colostomia , Estudos Transversais , Feminino , Humanos , Ileostomia , Lactente , Enteropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Prolapso , Estomas Cirúrgicos , Infecção da Ferida Cirúrgica/epidemiologia , Tanzânia/epidemiologia , Atenção Terciária à Saúde , Técnicas de Fechamento de Ferimentos , Adulto Jovem
15.
Mymensingh Med J ; 28(3): 586-594, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391431

RESUMO

Open lumbar discectomy is the gold standard surgical procedure for intervertebral disc herniation but still controversy exit whether limited or aggressive open discectomy provides better outcomes. Retrospectively we evaluate 2380 patients to compare the clinical outcomes, complications and recurrence rate between limited (LD) and aggressive open discectomy (AD). Records of 745 men and 255 women aged 19 to 55 (mean, 38.03±9.1) years for LD and 995 men and 385 women aged 21 to 60 (mean, 43.7±9.3) years for AD were reviewed. Demographic data, surgical data, complications and re-herniation rate were collected and assessment done by Visual analogue score (VAS), Oswestry Disability Index (ODI) and modified Mcnab criteria. The mean follow-up period was 24.5 and 28.8 months respectively. In compare to aggressive discectomy, limited discectomy required significantly less operative time (95 vs. 55 minutes, p<0.001, unpaired 't' test), less used of post-operative analgesic (p<0.05) and better patients' satisfaction (p<0.05). But low back pain, leg pain, recurrence rate, infection, per-operative blood loss and periods of hospitalization were without significant difference. Both groups achieved satisfactory clinical outcomes 85%, 78.62 % respectively. Complications were foot drop (n=2, 5), dural tear (n=7, 14), superficial wound infection (n=7, 17) and discitis (n=19, 37) and reherniation (55, 64) respectively. Limited discectomy is an alternative to the aggressive discectomy. Both groups showed satisfactory outcome but in limited discectomy group shown better satisfaction in relation to aggressive discectomy.


Assuntos
Discotomia , Deslocamento do Disco Intervertebral , Disco Intervertebral , Adulto , Discotomia/métodos , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Prolapso , Estudos Retrospectivos , Resultado do Tratamento
17.
J Craniofac Surg ; 30(8): e790-e793, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343590

RESUMO

Conjunctival prolapse may occur following ocular, eyelid, and orbital surgeries. Conjunctival prolapse usually results as a complication of maximal levator resection or cosmetic lower eyelid blepharoplasty. Here, we describe conjunctival prolapse as an unexpected complication of frontalis muscle flap transfer for severe ptosis. On postoperative day 5, the patient experienced upper eyelid swelling after closing his eyes suddenly and standing up abruptly. The conjunctiva was reddish and ballooned up, and they protruded over the eyelids. Conjunctival prolapse persisted until postoperative day 8. The patient and surgeon were concerned that this complication would affect ptosis correction and surgical outcome. U-shaped fixations were placed to suture and force the prolapsed conjunctiva back to their normal anatomical positions. At postoperative 6 months, the patient had not experienced additional issues, and he was satisfied with the appearance of his eyes. This report describes a rare clinical case of conjunctival prolapse and provides a reference for surgeons treating similar complications.


Assuntos
Túnica Conjuntiva/cirurgia , Blefaroplastia , Blefaroptose/cirurgia , Humanos , Masculino , Procedimentos Neurocirúrgicos , Satisfação Pessoal , Período Pós-Operatório , Prolapso , Suturas , Adulto Jovem
18.
World Neurosurg ; 131: e108-e115, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31323410

RESUMO

OBJECTIVE: To investigate correlations between radiologic measurements and clinical outcomes in patients with basilar invagination (BI). METHODS: The medical records and radiologic data of 46 patients (27 women) who had undergone posterior atlantoaxial fusion or occipitocervical fusion for BI from January 2010 to June 2018 were retrospectively analyzed. Patients under 15 years old or with a polytraumatic, tumorous, or infectious pathology were excluded. The modified Ranawat method (MRM) and the Redlund-Johnell method (RJM) were used to obtain radiographic measurements of basilar invagination preoperatively, subacute postoperatively, and at 3-month and last follow-up. Visual analogue scale, Neck Disability Index, and Japanese Orthopedic Association (JOA) scores were also assessed. Correlations between MRM and RJM measurements and clinical outcomes were evaluated. RESULTS: Mean age of patients was 59.9 ± 16.5 years, mean body mass index was 23.5 ± 4.6 kg/m2, and mean follow-up was 37.9 ± 23.8 months. Postoperative radiologic measurements increased about 36% of preoperative radiologic measurements. Subsidence at the C1-2 joint occurred in most patients at 3 months postoperatively, but clinical outcomes did not deteriorate. JOA scores were linearly correlated with percentage increases in both radiologic measurements subacute postoperatively (P < 0.05), but this significance was not maintained until the last follow-up. Occipital numbness and neuralgia were most common postoperative complications. One case of neurovascular injury and 3 cases of postoperative dysphagia occurred postoperatively. CONCLUSIONS: The subacute postoperative neurological outcomes of BI patients are significantly related to the amount of vertical reduction.


Assuntos
Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoccipital/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral , Adulto , Idoso , Artrite Reumatoide/cirurgia , Articulação Atlantoaxial/cirurgia , Articulação Atlantoccipital/cirurgia , Feminino , Forame Magno , Humanos , Masculino , Pessoa de Meia-Idade , Anormalidades Musculoesqueléticas/cirurgia , Processo Odontoide , Prolapso , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/anormalidades , Espondilose/cirurgia , Resultado do Tratamento
19.
AJNR Am J Neuroradiol ; 40(8): 1388-1391, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31248866

RESUMO

BACKGROUND AND PURPOSE: A few patterns of orbital fat prolapse have been described. Some are associated with disease, and others may mimic a neoplasm. We have observed prolapse of orbital fat into the infratemporal fossa via the inferior orbital fissure on MR imaging. The clinical relevance of this finding, if any, is unknown. The purposes of this study were to describe the MR imaging appearance of orbital fat prolapse through the inferior orbital fissure, to estimate the prevalence of this finding, and to assess possible pathologic associations. MATERIALS AND METHODS: For this retrospective study of 228 orbital MR imaging examinations, 3 neuroradiologists independently assessed the presence of prolapse on high-resolution T1-weighted images. Discrepancies were resolved by consensus, and interobserver agreement was calculated. Patient demographics, indications for imaging, and pertinent clinical history were recorded. One-way analysis of variance and the Fisher exact test were used to assess possible associations between prolapse and specific patient characteristics. RESULTS: Orbital fat prolapse through the inferior orbital fissure was observed in 20/228 patients (9%). This finding was unilateral in 11 patients (55%) and bilateral in 9 patients (45%). There was no significant association with age, sex, obesity, Graves disease, hypercortisolism, prior orbital trauma, proptosis, or enophthalmos. Interobserver agreement was 90%. CONCLUSIONS: Prolapse of orbital fat into the infratemporal fossa via the inferior orbital fissure is a relatively common finding on orbital MR imaging that has no identified pathologic association. Neuroradiologists should recognize this finding so as not to report it as pathologic.


Assuntos
Órbita/patologia , Doenças Orbitárias/patologia , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Adulto , Idoso , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Órbita/diagnóstico por imagem , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/epidemiologia , Prevalência , Prolapso , Reprodutibilidade dos Testes , Estudos Retrospectivos
20.
Heart Surg Forum ; 22(3): E241-E246, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31237551

RESUMO

BACKGROUND: In aortic root replacement, "preexisting" or "induced" aortic leaflet prolapse is related to advanced aortic root pathology and can indicate valve repair. Efforts should be made to perform root replacement before leaflet prolapse is in its maximum extent. MATERIALS AND METHODS: Thirty-nine patients with chronic aortic root dilatation and aortic valve regurgitation (AR) underwent a reimplantation procedure. Contrary to 32 of the 39 patients (group A), 7 of the 39 patients (group B) underwent cusp plication for prolapse. For both groups, data related to the diameter at the level of maximal tubular extension, sinotubular junction, sinus of Valsalva, aorto-ventricular junction (AVJ), and aortic annulus were obtained from preoperative computed tomography scans and analyzed comparatively. RESULTS: Group B showed a higher mean AR grade (P = .007), a higher mean diameter at the level of the aortic annulus (P = .038), AVJ (P = .037), and aortic sinus (P <.001) and a higher sinus dilatation index (existing-to-predicted diameter ratio) (P <.001) than group A. The sinus of Valsalva displayed the best predictive value regarding a plicature-indicating prolapse (P <.001; 95% confidence interval [CI]: 0.809-1.013). A diameter >40 mm was accompanied by an odds ratio (OR) of 24.6 (95% CI: 1.29-496.02). During the follow-up period of 29.0 ± 18.4 months (range: 6-62 months), 1 patient (group A) required reoperation 5 years postoperatively for progressive AR. CONCLUSION: The sinus of Valsalva diameter seems to have the greatest prognostic value for the development of prolapse. Our data suggest that root repair should be considered earlier in time before leaflet prolapse is complete, which most likely occurs when root dilatation becomes an aneurysm.


Assuntos
Insuficiência da Valva Aórtica/patologia , Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Seleção de Pacientes , Idoso , Estudos de Coortes , Dilatação Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso , Reoperação , Fatores de Risco , Resultado do Tratamento
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