Substernal goiter is a rare presentation of goiter but relatively frequent cause of anterior mediastinal mass. Symptomatic patients should be treated surgically with a total or partial thyroidectomy via a cervical or thoracic approach. This case report of a woman with a large symptomatic substernal goiter illustrates how the option to perform a partial median sternotomy may be useful when attempting a cervical approach. This allows for better visualization and resection of large masses and minimizes the risk of complications such as recurrent laryngeal nerve injury. Furthermore, it reinforces that cases of substernal goiter should be treated at specialized centers in order to minimize complications and reach better patient outcomes.
This comprehensive review compares clinical protocols of important entities regarding the management of fetal growth restriction (FGR), published since 2015. Five protocols were chosen for data extraction. There were no relevant differences regarding the diagnosis and classification of FGR between the protocols. In general, all protocols suggest that the assessment of fetal vitality must be performed in a multimodally, associating biophysical parameters (such as cardiotocography and fetal biophysical profile) with the Doppler velocimetry parameters of the umbilical artery, middle cerebral artery, and ductus venosus. All protocols reinforce that the more severe the fetal condition, the more frequent this assessment should be made. The timely gestational age and mode of delivery to terminate the pregnancy in these cases can vary much between the protocols. Therefore, this paper presents, in a didactic way, the particularities of different protocols for monitoring FGR, in order to help obstetricians to better manage the cases.
Esta revisão compreensiva compara protocolos clínicos de entidades importantes em relação ao manejo da restrição de crescimento fetal (RCF), publicados desde 2015. Cinco protocolos foram escolhidos para a extração de dados. Não houve diferenças relevantes quanto ao diagnóstico e classificação da RCF entre os protocolos. Em geral, todos os protocolos sugerem que a avaliação da vitalidade fetal deve ser realizada de forma multimodal, associando parâmetros biofísicos (como cardiotocografia e perfil biofísico fetal) aos parâmetros dopplervelocimétricos da artéria umbilical, artéria cerebral média e ducto venoso. Todos os protocolos reforçam que quanto mais grave a condição fetal, mais frequente essa avaliação deve ser feita. A idade gestacional oportuna e o modo de parto para interromper a gravidez nesses casos podem variar muito entre os protocolos. Portanto, este trabalho apresenta, de forma didática, as particularidades de diferentes protocolos de acompanhamento de RCF, a fim de auxiliar os obstetras no melhor manejo dos casos.
Fetal Growth Retardation , Ultrasonography, Prenatal , Female , Humans , Pregnancy , Cardiotocography , Fetal Growth Retardation/diagnostic imaging , Fetal Growth Retardation/therapy , Fetus/blood supply , Gestational Age , Ultrasonography , Ultrasonography, Doppler , Umbilical Arteries/diagnostic imaging
Abstract This comprehensive review compares clinical protocols of important entities regarding the management of fetal growth restriction (FGR), published since 2015. Five protocols were chosen for data extraction. There were no relevant differences regarding the diagnosis and classification of FGR between the protocols. In general, all protocols suggest that the assessment of fetal vitality must be performed in a multimodally, associating biophysical parameters (such as cardiotocography and fetal biophysical profile) with the Doppler velocimetry parameters of the umbilical artery, middle cerebral artery, and ductus venosus. All protocols reinforce that the more severe the fetal condition, the more frequent this assessment should be made. The timely gestational age and mode of delivery to terminate the pregnancy in these cases can vary much between the protocols. Therefore, this paper presents, in a didactic way, the particularities of different protocols for monitoring FGR, in order to help obstetricians to better manage the cases.
Resumo Esta revisão compreensiva compara protocolos clínicos de entidades importantes em relação ao manejo da restrição de crescimento fetal (RCF), publicados desde 2015. Cinco protocolos foram escolhidos para a extração de dados. Não houve diferenças relevantes quanto ao diagnóstico e classificação da RCF entre os protocolos. Em geral, todos os protocolos sugerem que a avaliação da vitalidade fetal deve ser realizada de forma multimodal, associando parâmetros biofísicos (como cardiotocografia e perfil biofísico fetal) aos parâmetros dopplervelocimétricos da artéria umbilical, artéria cerebral média e ducto venoso. Todos os protocolos reforçam que quanto mais grave a condição fetal, mais frequente essa avaliação deve ser feita. A idade gestacional oportuna e o modo de parto para interromper a gravidez nesses casos podem variar muito entre os protocolos. Portanto, este trabalho apresenta, de forma didática, as particularidades de diferentes protocolos de acompanhamento de RCF, a fim de auxiliar os obstetras no melhor manejo dos casos.
Humans , Infant, Newborn , Infant, Premature , Cardiotocography , Laser-Doppler Flowmetry , Guidelines as Topic , Fetal Growth Retardation
OBJECTIVES: To evaluate MRI with gadoxetic acid to quantify liver function in cirrhotic patients using the relative enhancement index (REI) compared with Child-Pugh score (CPS), MELD score, and indocyanine green plasma disappearance rate (ICG-PDR) and to establish cutoffs for REI to stratify cirrhotic patients into good and poor liver function groups. METHODS: We prospectively evaluated 60 cirrhotic patients and calculated CPS, MELD score, ICG-PDR, and REI for each patient. Spearman's correlation coefficient was used to assess correlation between REI, CPS, MELD, and ICG-PDR. Good and poor liver function groups were created by k-means clustering algorithm using CPS, MELD, and ICG-PDR. ROC curve analysis was performed and optimal cutoff was identified for group differentiation. RESULTS: Good correlations were found between REI and other liver function biomarkers: REI and CPS (rho = - 0.816; p < 0.001); REI and MELD score (rho = - 0.755; p < 0.001); REI and ICG-PDR (rho = 0.745; p < 0.001)]. REI correlation was stronger for patients with Child-Pugh A (rho = 0.642, p = 0.002) and B (rho = 0.798, p < 0.001) than for those with Child-Pugh C (rho = 0.336, p = 0.148). REI is significantly lower in patients with poor liver function (p < 0.001). ROC curve showed an AUC 0.94 to discriminate patients with poor liver function (REI cutoff < 100; 100% sensitivity; 76% specificity). CONCLUSIONS: REI is a valuable non-invasive index for liver function quantification that has good correlations with other liver function biomarkers. REI can be easily calculated and can be used to estimate liver function in clinical practice in the routine evaluation of cirrhotic patients that undergo MR imaging with gadoxetic acid contrast. KEY POINTS: ⢠REI is a valuable non-invasive index for liver function quantification that has good correlations with other liver function biomarkers. ⢠REI can be easily calculated in the routine evaluation of cirrhotic patients that undergo gadoxetic acid-enhanced MRI. ⢠The REI enables stratification of cirrhotic patients into good and poor liver function groups and can be used as additional information, together with morphological and focal liver lesion evaluation.
Contrast Media , Gadolinium DTPA , Humans , Contrast Media/pharmacology , Liver/diagnostic imaging , Liver Cirrhosis/complications , Liver Cirrhosis/diagnostic imaging , Indocyanine Green/pharmacology , Biomarkers , Magnetic Resonance Imaging/methods , Retrospective Studies
OBJECTIVES: Rapid on-site evaluation (ROSE) by cytopathologists during endoscopic ultrasound-fine-needle aspiration (EUS-FNA) of solid pancreatic lesions (SPLs) improves adequacy and diagnostic accuracy while reducing the number of needle passes. We evaluated the usefulness of ROSE performed by the endosonographer. METHODS: Patients with an SPL were randomly assigned to EUS-FNA with ROSE or non-ROSE. Procedure duration, number of needle passes, specimen adequacy, and adverse event rates were compared. RESULTS: Sixty-five patients were enrolled (33 in the ROSE vs 32 in the non-ROSE group). Both groups were similar in terms of age, sex, size, and location of the lesion. Specimen adequacy rates were high and similar between groups. Mean (standard deviation) procedure duration was shorter in the ROSE versus non-ROSE group (30.0 [11.3] vs 37.0 [7.2] minutes, P < 0.005), as well as the mean (standard deviation) number of needle passes (2.6 [0.8] vs 3.5 [0.8], P < 0.005). Accuracy parameters as sensitivity and accuracy of ROSE by the endosonographer for malignancy were 93% and 88%, respectively. CONCLUSIONS: After specific training, the endosonographer can accurately evaluate samples during EUS-FNA of SPL, allowing for a shorter procedure duration and a lower number of needle passes.
Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Endosonography/methods , Pancreas/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Rapid On-site Evaluation , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pancreas/pathology , Pancreatic Neoplasms/pathology , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Young Adult
RESUMO O objetivo deste trabalho foi avaliar o potencial do Venturi para a síntese de biodiesel a partir de óleo comestível residual em rota metílica. Para tanto, foi construído em escala de laboratório um aparato experimental constituído de um tanque de 5,2 L e um dispositivo Venturi projetado para produzir o fenômeno de cavitação. A produção de biodiesel foi avaliada em três diferentes pressões de entrada do Venturi: 4,4; 2,9; e 1,4 bar. Os teores de ésteres metílicos foram determinados por cromatografia gasosa. O tempo de síntese de 5,2 L de biodiesel, com o Venturi, foi de 23,2 segundos (ou 4,5 segundos por litro de biodiesel produzido), o que equivale a um único ciclo de passagem pelo sistema a pressão máxima (4,4 bar). Nessa condição, o rendimento dos teores de ésteres foi superior a 98%. Não há na literatura outro caso de síntese tão rápida como a encontrada neste trabalho. A caracterização do biodiesel mostrou que os parâmetros viscosidade cinemática, índice de acidez, ponto de entupimento a frio e massa específica estão dentro dos limites estabelecidos pela Agência Nacional de Petróleo. A comparação com outros estudos da literatura mostrou que o Venturi é superior às placas de orifício na síntese de biodiesel.
Abstract The objective of this work was to evaluate the potential of Venturi in the synthesis of biodiesel from residual edible oil in a methyl route. For this purpose, an experimental apparatus consisting of a 5.2 L tank and a Venturi device designed to produce the cavitation phenomenon was constructed in laboratory scale. Biodiesel production was evaluated at three different Venturi inlet pressures: 4.4; 2.9; and 1.4 bar. Methyl esters contents were determined by gas chromatography. Biodiesel synthesis time with the Venturi device was 23.2 seconds (or 4.5 seconds per liter of biodiesel produced), which is equivalent to a single cycle of the system at maximum pressure (4.4 bar). In this condition, the yield of the ester contents was greater than 98%. There is no other case of synthesis as fast as that found in this work. The biodiesel characterization showed that the parameters kinematic viscosity, acidity index, cold clogging point, and specific mass are within the limits established by National Agency of Petroleum Natural Gas and Biofuels (Agência Nacional de Petróleo). The use of Venturi, as a cavitation device, was shown to be more efficient in biodiesel synthesis than other devices, such as orifice plates.
Humans , Female , Pregnancy , Ultrasonography, Prenatal/methods , Ultrasonography, Prenatal/standards , Diagnostic Techniques, Obstetrical and Gynecological/instrumentation , Diagnostic Techniques, Obstetrical and Gynecological/standards , COVID-19/prevention & control , COVID-19/epidemiology , Brazil/epidemiology , Occupational Health/standards , Pandemics , Public Health Surveillance/methods
Embora a maioria das famílias monoparentais seja feminina, vê-se um incremento significativo de homens que vêm ocupando o lugar de genitor exclusivo junto aos filhos. Assim, esse estudo objetivou investigar a experiência de homens de famílias monoparentais masculinas. Para tanto, quatro pais foram entrevistados individualmente, sendo que, após a realização de cada entrevista, foi redigida uma narrativa transferencial, pelo entrevistador, sobre aquele encontro, incluindo suas impressões contratransferenciais. O conjunto das quatro narrativas foi analisado psicanaliticamente, à luz da Teoria dos Campos de Herrmann, sendo identificados os campos "Na tradição", "Segunda chance" e "No improviso". Observou-se que os participantes apresentavam manifestações ancoradas no imaginário patriarcal, mas experienciavam, de modo improvisadamente organizado, a possibilidade de serem pais melhores do que já haviam sido ou do que já haviam tido. Vê-se que a configuração familiar do tipo monoparental revela-se, por excelência, como um campo de investigação que viabiliza reflexões sobre a parentalidade na contemporaneidade.
Although the majority of single-parent families is female, there is an increase in men who have been taking the place of exclusive parent. Thus, this study aimed to investigate the experience of men from male single parent families. Therefore, four parents were interviewed individually. After each interview, a transferential narrative was written by the interviewer, about that meeting, including his countertransference feelings. The set of the four narratives was analyzed psychoanalytically, with the Theory of the Fields of Herrmann. It was identified the fields "In tradition", "Second chance" and "In improvisation". It was observed that the participants had manifestations anchored in the patriarchal imaginary, but they experienced, in an improvised organized way, the possibility of being better parents than they had been or had ever had. In conclusion, the family configuration of the single parent type reveals itself, by excellence, as a field of investigation for the development of reflections on parenting in contemporary times.
Three-dimensional (3D) visualization involves feature extraction and 3D reconstruction of CT images using a computer processing technology. It is a tool for displaying, describing, and interpreting 3D anatomy and morphological features of organs, thus providing intuitive, stereoscopic, and accurate methods for clinical decision-making. It has played an increasingly significant role in the diagnosis and management of liver diseases. Over the last decade, it has been proven safe and effective to use 3D simulation software for pre-hepatectomy assessment, virtual hepatectomy, and measurement of liver volumes in blood flow areas of the portal vein; meanwhile, the use of 3D models in combination with hydrodynamic analysis has become a novel non-invasive method for diagnosis and detection of portal hypertension. We herein describe the progress of research on 3D visualization, its workflow, current situation, challenges, opportunities, and its capacity to improve clinical decision-making, emphasizing its utility for patients with liver diseases. Current advances in modern imaging technologies have promised a further increase in diagnostic efficacy of liver diseases. For example, complex internal anatomy of the liver and detailed morphological features of liver lesions can be reflected from CT-based 3D models. A meta-analysis reported that the application of 3D visualization technology in the diagnosis and management of primary hepatocellular carcinoma has significant or extremely significant differences over the control group in terms of intraoperative blood loss, postoperative complications, recovery of postoperative liver function, operation time, hospitalization time, and tumor recurrence on short-term follow-up. However, the acquisition of high-quality CT images and the use of these images for 3D visualization processing lack a unified standard, quality control system, and homogeneity, which might hinder the evaluation of application efficacy in different clinical centers, causing enormous inconvenience to clinical practice and scientific research. Therefore, rigorous operating guidelines and quality control systems need to be established for 3D visualization of liver to develop it to become a mature technology. Herein, we provide recommendations for the research on diagnosis and management of 3D visualization in liver diseases to meet this urgent need in this research field.
Imaging, Three-Dimensional , Liver Diseases/diagnostic imaging , Tomography, X-Ray Computed , Humans , Liver Diseases/surgery
OBJECTIVE: To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. METHODS: This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. RESULTS: 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years. CONCLUSIONS: If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.
OBJECTIVES: Recently, controlled attenuation parameter (CAP) was incorporated for XL probe. However, its performance through M and XL probes has been scarcely evaluated in nonalcoholic fatty liver disease (NAFLD). The performance of probes regarding transient elastography by Fibroscan is still under debate. AIM: Compare the performance of CAP and transient elastography in NAFLD patients obtained through XL with M probes using histological analysis as gold standard. METHODS: NAFLD patients underwent liver biopsy and FibroScan/CAP with M and XL probes the same day. C-statistic evaluated CAP performance in the identification of moderate/severe (≥33%) and severe (≥66%) steatosis by both probes and transient elastography performance for identification of significant fibrosis (≥F2). RESULTS: Eighty-one patients (74% female; age 54.2 ± 9.9 years; BMI 32.8 ± 5.2/ BMI ≥ 25 92.6%; 96% metabolic syndrome; 60% diabetes mellitus) were included. Mean CAP with M and XL probes was 314 ± 39 and 325 ± 47 dB/m, respectively. The areas under receiver operating characteristic curves (AUROCs) of the M and XL probes for steatosis detection ≥33% were 0.75 (0.64-0.84) and 0.76 (0.65-0.84) (P = 0.95) and for steatosis ≥66% 0.83 (0.73-0.90) and 0.82 (0.71-0.89) (P = 0.73), respectively, with similar performances for both degrees of steatosis. Regarding transient elastography, AUROCs of M and XL probes for ≥F2 were 0.82 (0.71-0.93) and 0.80 (0.69-0.92) (P = 0.66). CONCLUSION: Performance of M and XL probes is similar for the diagnosis of moderate and severe steatosis and significant fibrosis even on a overweight population with NAFLD.
Elasticity Imaging Techniques , Non-alcoholic Fatty Liver Disease , Biopsy , Brazil , Female , Humans , Liver/diagnostic imaging , Liver/pathology , Liver Cirrhosis/diagnostic imaging , Liver Cirrhosis/pathology , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/diagnostic imaging , Non-alcoholic Fatty Liver Disease/pathology , Prospective Studies
