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1.
Emerg Radiol ; 28(1): 23-29, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32577933

RESUMEN

PURPOSE: Emergency departments (EDs) worldwide face crowding, which negatively affects patient care. Diagnostic imaging plays a major role in management of ED patients and contributes to patients' length of stay at the ED. In this study, the impact of Lean-driven interventions on the imaging process at the ED was assessed. METHODS: During a 6-month multimodal intervention period, Lean-driven interventions and a dedicated radiologist present at the ED were implemented during peak hours (12 a.m.-8 p.m.). Data concerning patient population, radiology department turnaround time (RDTT), radiology report time (RRT), and examination time (ET) for ED patients were compared with a control period of 6 months 1 year earlier. RESULTS: RDTT, RRT, and ET were significantly shorter in the intervention period compared with those in the control period. Median RDTT was respectively 36 min (interquartile range (IQR) 24-56) and 70 min (IQR 39-127), RRT 11 min (IQR 6-21) and 37 min (IQR 15-88), and ET 22 min (IQR 14-35) and 23 min (14-38). CONCLUSION: Lean-driven interventions on the imaging process at the ED significantly reduced RDTT, RRT, and ET.


Asunto(s)
Aglomeración , Servicio de Urgencia en Hospital/organización & administración , Radiólogos/estadística & datos numéricos , Tomografía Computarizada por Rayos X , Gestión de la Calidad Total , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo
2.
Radiology ; 298(2): E98-E106, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33201791

RESUMEN

Background Clinicians need to rapidly and reliably diagnose coronavirus disease 2019 (COVID-19) for proper risk stratification, isolation strategies, and treatment decisions. Purpose To assess the real-life performance of radiologist emergency department chest CT interpretation for diagnosing COVID-19 during the acute phase of the pandemic, using the COVID-19 Reporting and Data System (CO-RADS). Materials and Methods This retrospective multicenter study included consecutive patients who presented to emergency departments in six medical centers between March and April 2020 with moderate to severe upper respiratory symptoms suspicious for COVID-19. As part of clinical practice, chest CT scans were obtained for primary work-up and scored using the five-point CO-RADS scheme for suspicion of COVID-19. CT was compared with severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction (RT-PCR) assay and a clinical reference standard established by a multidisciplinary group of clinicians based on RT-PCR, COVID-19 contact history, oxygen therapy, timing of RT-PCR testing, and likely alternative diagnosis. Performance of CT was estimated using area under the receiver operating characteristic curve (AUC) analysis and diagnostic odds ratios against both reference standards. Subgroup analysis was performed on the basis of symptom duration grouped presentations of less than 48 hours, 48 hours through 7 days, and more than 7 days. Results A total of 1070 patients (median age, 66 years; interquartile range, 54-75 years; 626 men) were included, of whom 536 (50%) had a positive RT-PCR result and 137 (13%) of whom were considered to have a possible or probable COVID-19 diagnosis based on the clinical reference standard. Chest CT yielded an AUC of 0.87 (95% CI: 0.84, 0.89) compared with RT-PCR and 0.87 (95% CI: 0.85, 0.89) compared with the clinical reference standard. A CO-RADS score of 4 or greater yielded an odds ratio of 25.9 (95% CI: 18.7, 35.9) for a COVID-19 diagnosis with RT-PCR and an odds ratio of 30.6 (95% CI: 21.1, 44.4) with the clinical reference standard. For symptom duration of less than 48 hours, the AUC fell to 0.71 (95% CI: 0.62, 0.80; P < .001). Conclusion Chest CT analysis using the coronavirus disease 2019 (COVID-19) Reporting and Data System enables rapid and reliable diagnosis of COVID-19, particularly when symptom duration is greater than 48 hours. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Elicker in this issue.


Asunto(s)
COVID-19/diagnóstico por imagen , Servicio de Urgencia en Hospital , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Estudios Retrospectivos , SARS-CoV-2 , Sensibilidad y Especificidad
3.
Crit Care Explor ; 2(10): e0266, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33134952

RESUMEN

OBJECTIVES: There is accumulating evidence of a distinct coagulopathy in severe acute respiratory syndrome coronavirus 2 infection which is associated with poor prognosis in coronavirus disease 2019. Coagulation abnormalities in blood samples resemble systemic coagulopathies in other severe infections but demonstrate specific features such as a very high d-dimer. These clinical observations are consistent with histopathologic findings of locally disturbed pulmonary microvascular thrombosis and angiopathy in end-stage coronavirus disease 2019. However, exact underlying processes and the sequence of events are not fully understood. DATA SOURCES: CT perfusion may provide insight in the dynamic aspect of the vascularity in pulmonary lesions in coronavirus disease 2019 infection as, in contrast to dual energy CT, a multiphase perfusion pattern is displayed. STUDY SELECTION: In six patients with coronavirus disease 2019 pneumonia, findings on additional CT perfusion series were correlated with known histopathologic vascular patterns upon pulmonary autopsy of patients who had died of coronavirus disease 2019. DATA EXTRACTION: In this case series, we were able to show perfusion changes on CT scans in typical pulmonary lesions illustrating diverse patterns. DATA SYNTHESIS: We demonstrated hyperperfusion in areas with ground glass and a severely decreased perfusion pattern in more consolidated areas often seen later in the course of disease. A combination was also observed, illustrating temporal heterogeneity. CONCLUSIONS: These findings provide new insights into the pathophysiology of coronavirus disease 2019 pneumonia and further understanding of the mechanisms that lead to respiratory failure in these patients.

4.
Radiology ; 296(2): E97-E104, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32339082

RESUMEN

Background A categorical CT assessment scheme for suspicion of pulmonary involvement of coronavirus disease 2019 (COVID-19 provides a basis for gathering scientific evidence and improved communication with referring physicians. Purpose To introduce the COVID-19 Reporting and Data System (CO-RADS) for use in the standardized assessment of pulmonary involvement of COVID-19 on unenhanced chest CT images and to report its initial interobserver agreement and performance. Materials and Methods The Dutch Radiological Society developed CO-RADS based on other efforts for standardization, such as the Lung Imaging Reporting and Data System or Breast Imaging Reporting and Data System. CO-RADS assesses the suspicion for pulmonary involvement of COVID-19 on a scale from 1 (very low) to 5 (very high). The system is meant to be used in patients with moderate to severe symptoms of COVID-19. The system was evaluated by using 105 chest CT scans of patients admitted to the hospital with clinical suspicion of COVID-19 and in whom reverse transcription-polymerase chain reaction (RT-PCR) was performed (mean, 62 years ± 16 [standard deviation]; 61 men, 53 with positive RT-PCR results). Eight observers used CO-RADS to assess the scans. Fleiss κ value was calculated, and scores of individual observers were compared with the median of the remaining seven observers. The resulting area under the receiver operating characteristics curve (AUC) was compared with results from RT-PCR and clinical diagnosis of COVID-19. Results There was absolute agreement among observers in 573 (68.2%) of 840 observations. Fleiss κ value was 0.47 (95% confidence interval [CI]: 0.45, 0.47), with the highest κ value for CO-RADS categories 1 (0.58, 95% CI: 0.54, 0.62) and 5 (0.68, 95% CI: 0.65, 0.72). The average AUC was 0.91 (95% CI: 0.85, 0.97) for predicting RT-PCR outcome and 0.95 (95% CI: 0.91, 0.99) for clinical diagnosis. The false-negative rate for CO-RADS 1 was nine of 161 cases (5.6%; 95% CI: 1.0%, 10%), and the false-positive rate for CO-RADS category 5 was one of 286 (0.3%; 95% CI: 0%, 1.0%). Conclusion The coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) is a categorical assessment scheme for pulmonary involvement of COVID-19 at unenhanced chest CT that performs very well in predicting COVID-19 in patients with moderate to severe symptoms and has substantial interobserver agreement, especially for categories 1 and 5. © RSNA, 2020 Online supplemental material is available for this article.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/normas , Adulto , Anciano , COVID-19 , Comunicación , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Países Bajos , Variaciones Dependientes del Observador , Pandemias , Sistemas de Información Radiológica , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , SARS-CoV-2 , Tomografía Computarizada por Rayos X/métodos
5.
Clin Case Rep ; 8(1): 221-223, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31998524

RESUMEN

Cystic or cavitating lung nodules may reflect an additional diagnostic challenge in benign metastasizing leiomyoma. Our case underlines the importance of combining clinical and radiological findings with specific pulmonary pathology consultation.

6.
J Bone Joint Surg Am ; 98(6): 441-8, 2016 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-26984911

RESUMEN

BACKGROUND: Spinal fusion with the use of autograft is a commonly performed procedure. However, harvesting of bone from the iliac crest is associated with complications. Bone morphogenetic proteins (BMPs) are extensively used as alternatives, often without sufficient evidence of safety and efficacy. The purpose of this study was to investigate non-inferiority of osteogenic protein-1 (OP-1, also known as BMP-7) in comparison with iliac crest bone graft in posterolateral fusions. METHODS: This study was a randomized, controlled multicenter trial. Patients who underwent a single-level instrumented posterolateral fusion of the lumbar spine for degenerative or isthmic spondylolisthesis with symptoms of neurological compression were randomized to receive OP-1 combined with local bone (OP-1 group) or autologous bone graft from the iliac crest combined with local bone (autograft group). The primary outcome was overall success, defined as a combination of clinical success and evidence of fusion on computed tomography (CT) scans, at one year postoperatively. RESULTS: One hundred and nineteen patients were included in the study, and analysis of the overall outcome was performed for 113. Non-inferiority of OP-1 compared with iliac crest autograft was not found at one year, with a success rate of 40% in the OP-1 group versus 54% in the autograft group (risk difference = -13.3%, 90% confidence interval [CI] = -28.6% to +2.10%). This was due to the lower rate of fusion (the primary aim of OP-1 application) seen on the CT scans in the OP-1 group (54% versus 74% in the autograft group, p = 0.03). There were no adverse events that could be directly related to the use of OP-1. CONCLUSIONS: OP-1 with a collagen carrier was not as effective as autologous iliac crest bone for achieving fusion and cannot be recommended in instrumented posterolateral lumbar fusion procedures. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Proteína Morfogenética Ósea 7/uso terapéutico , Ilion/trasplante , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Espondilolistesis/cirugía , Descompresión Quirúrgica , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Fusión Vertebral/instrumentación , Espondilolistesis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Trasplante Autólogo , Resultado del Tratamiento
7.
J Comput Assist Tomogr ; 40(2): 261-5, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26599962

RESUMEN

OBJECTIVE: To determine pretreatment computed tomography observer agreement in patients with newly diagnosed lymphoma. METHODS: Forty-nine computed tomography scans were reviewed by 3 experienced radiologists, with each scan assessed twice by 1 observer. Predefined nodal and extranodal regions were assessed, and Ann Arbor stages were assigned. K-statistics were defined as poor (κ < 0.2), fair (κ > 0.2 to κ ≤ 0.4), moderate (κ > 0.4 to κ ≤ 0.6), substantial (κ > 0.6 to κ ≤ 0.8), and almost perfect (κ > 0.8 to κ ≤ 1). RESULTS: Nodal interobserver agreement varied from 0.09 for infraclavicular involvement to 0.95 for para-iliac involvement; intraobserver agreement was substantial to almost perfect, except for infraclavicular nodes. Extranodal interobserver agreement varied from 0.56 to 0.88; intraobserver agreement was substantial to almost perfect. Ann Arbor stage interobserver agreement varied from 0.57 to 0.69; intraobserver agreement was substantial. CONCLUSION: Computed tomography observer agreement in staging malignant lymphoma appears to be suboptimal.


Asunto(s)
Linfoma/diagnóstico por imagen , Linfoma/patología , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios de Cohortes , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los Resultados , Adulto Joven
8.
J Magn Reson Imaging ; 40(1): 26-36, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24307538

RESUMEN

PURPOSE: To compare whole-body magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), to computed tomography (CT) for staging newly diagnosed lymphoma. MATERIALS AND METHODS: In all, 108 patients with newly diagnosed lymphoma prospectively underwent whole-body MRI (T1-weighted and T2-weighted short inversion time inversion recovery [n = 108], and DWI [n = 104]) and CT. Ann Arbor stages were assigned according to whole-body MRI and CT findings. Staging disagreements were resolved using bone marrow biopsy, FDG-PET, and follow-up studies. The results were descriptively analyzed. RESULTS: Staging results of whole-body MRI without DWI were equal to those of CT in 66.6%, higher in 24.1%, and lower in 9.3%, with correct/incorrect/unresolved higher staging and incorrect/unresolved lower staging relative to CT in 15/7/4 and 9/1 patient(s), respectively. Staging results of whole-body MRI with DWI were equal to those of CT in 65.4%, higher in 27.9%, and lower in 6.7%, with correct/incorrect/unresolved higher staging and incorrect/unresolved lower staging relative to CT in 18/6/5 and 6/1 patient(s), respectively. CONCLUSION: The results of this study suggest that whole-body MRI staging equals CT staging in the majority of patients with newly diagnosed lymphoma. No advantage of additional DWI was demonstrated. Whole-body MRI can be a good alternative to CT if radiation exposure should be avoided.


Asunto(s)
Imagen de Difusión por Resonancia Magnética/métodos , Aumento de la Imagen/métodos , Linfoma/patología , Estadificación de Neoplasias/métodos , Tomografía Computarizada por Rayos X/métodos , Imagen de Cuerpo Entero/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto Joven
9.
Clin Nucl Med ; 37(9): e231-3, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22889800

RESUMEN

A 55-year-old man with no relevant history was analyzed for weight loss, night sweats, and left upper quadrant pain. An abdominal ultrasound and CT scan were performed, revealing a lobulated rim-enhancing mass in the left adrenal gland. Further analysis by an F-FDG PET/CT scan demonstrated high uptake in the periphery of the adrenal lesion with central photopenia. Because a primary malignancy was suspected, an adrenalectomy was performed. Histopathology, however, revealed a necrotizing granulomatous infection. Serum was tested positive for syphilis and Treponema pallidum infection. Results of additional HIV tests were negative. The adrenal tumor proved to be an expression of gummatous syphilis.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Neurosífilis/complicaciones , Fluorodesoxiglucosa F18 , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal , Neurosífilis/diagnóstico por imagen , Neurosífilis/patología , Neurosífilis/fisiopatología , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X
10.
J Nucl Med ; 51(10): 1507-16, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20847179

RESUMEN

UNLABELLED: The purpose of this study was to test the hypothesis that the level of baseline (18)F-FDG uptake in the primary tumor adds value to its relative change in (18)F-FDG uptake in serial PET scans in predicting the histopathologic response to systemic cytotoxic neoadjuvant treatment of patients with solid extracerebral tumors. METHODS: We performed a literature search from January 1995 through November 2008 using PubMed and Embase. Two reviewers independently selected eligible studies for possible inclusion in the meta-analysis by reviewing titles and abstracts. Inclusion criteria were at least 10 patients, (18)F-FDG PET before and after therapy, (18)F-FDG PET performed with the intention of monitoring the response of solid extracerebral tumors in humans to cytotoxic neoadjuvant systemic therapy, attenuation-corrected (18)F-FDG PET studies, and studies presenting individual patient data (PET results and histopathologic reference test after treatment). Multilevel logistic regression was used to assess the effect of relative change of (18)F-FDG uptake ([baseline - end]/baseline) and baseline (18)F-FDG uptake value with type of tumor and type of treatment as level 1 covariates. RESULTS: Nineteen studies (all observational; a total of 438 patients [median, 23 patients per study; range, 10-40]) were included, aiming at the accuracy of PET versus histopathology. To quantify PET, maximum standardized uptake value (SUV) was used in 6 studies, mean SUV in 7, SUV (subtype unclear) in 1, tumor-to-background ratio in 3, and dose uptake ratio in 1. The average overall histopathologic response rate was 0.47 (median, 0.50), ranging from 0.17 to 0.88. The relative change in (18)F-FDG uptake was the strongest indicator (P < 0.0001) for tumor response. Baseline (18)F-FDG was not significantly associated as a main factor; however, a significant interaction of baseline uptake and relative change after therapy was observed (P < 0.001). CONCLUSION: Relative change in (18)F-FDG uptake was the strongest indicator for tumor response, but the level of baseline (18)F-FDG uptake in the primary tumor provided additional information about prediction of response to therapy. These data corroborate and extend the need for standardization, quality assurance, and control of PET studies quantifying (18)F-FDG in oncologic treatment monitoring.


Asunto(s)
Antineoplásicos/uso terapéutico , Fluorodesoxiglucosa F18 , Neoplasias/diagnóstico por imagen , Neoplasias/tratamiento farmacológico , Tomografía de Emisión de Positrones/estadística & datos numéricos , Fluorodesoxiglucosa F18/farmacocinética , Humanos , Terapia Neoadyuvante , Neoplasias/metabolismo , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del Tratamiento
12.
Mol Imaging Biol ; 12(2): 225-32, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19809855

RESUMEN

PURPOSE: The added value of baseline positron emission tomography (PET) scans in therapy evaluation in malignant lymphoma is unclear. In guidelines, baseline PET is recommended but not mandatory except in lymphoma types with variable fluoro-D-glucose uptake. The aim of the present study was to test the hypothesis that adding baseline PET information decreases false positive readings with posttreatment PET and improves observer agreement. METHODS: Forty-four patients (mean age 56 years, standard deviation 14) with malignant lymphoma were included. Two nuclear medicine physicians retrospectively and independently evaluated the posttreatment PET, 3 weeks later followed by paired reading of baseline and posttreatment PET. For each PET, 22 regions were classified as positive, negative, or equivocal, resulting in an overall PET score of positive, unclear, or negative. In case of discrepancies, consensus was reached. RESULTS: Addition of baseline to posttreatment PET evaluation affected the classification of metabolic response in 34% of malignant lymphoma patients treated with first-line chemotherapy. In one out of seven patients, addition of the baseline PET lead to opposite conclusions (95% confidence interval 4-14). False positivity was reduced by adding the baseline scan information, but the effect on false negativity was similar. In addition, the amount of unclear classifications halved after paired reading. Observer agreement did not improve upon adding the baseline PET data. CONCLUSION: Without any other clinical information, pretreatment PET facilitates changes the interpretation of a posttreatment PET in a third of the patients, resulting in both upgrading and downgrading of the posttreatment situation of a malignant lymphoma patient. If these results are confirmed for PET-computed tomography systems, they favor the addition of baseline PET to the current work-up of patients with malignant lymphoma.


Asunto(s)
Fluorodesoxiglucosa F18 , Enfermedad de Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Tomografía de Emisión de Positrones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Enfermedad de Hodgkin/patología , Humanos , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Imagen de Cuerpo Entero , Adulto Joven
14.
Hell J Nucl Med ; 10(2): 105-8, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17684586

RESUMEN

The aim of our study was to analyze how many oncology patients might benefit from a) integrated positron emission tomography - multidetector computed tomography (PET/MDCT) and additionally b) clinically relevant information provided by either the CT scan or PET scan. A total of 285 consecutive patients 164 male and 121 female, age range 17-84 years, 153 lung cancer, 112 lymphoma, 20 miscellaneous, referred for PET and separate CT scan, were included. The CT scan was performed after the intravenous injection of a soluble contrast media. Patients were retrospectively classified into six Groups: Group I: No pathological uptake on the PET scan, Group II: Suspected lesions were correctly identified by the PET scan alone, Group III: Side-by-side evaluation of PET and CT appeared sufficient to assess the localization of lesions, Group IV: Side-by-side reading was not sufficient and integrated PET/CT was considered beneficial. Additionally all patients with a CT scan with additional clinical relevant information (not visualized by the PET scan) were classified in Group V. Group VI was set for lesions detected by PET alone (not visualized by the CT scan). The CT scan was used as the gold standard to confirm or disprove PET lesion localization. Our results showed: A number of 77 patients, (Group I: 77/285, 27%) had no pathologic fluorine-18-fluorodeoxyglucose (18F-FDG)-uptake. Lesions were correctly localized by either conventional PET alone (Group II: 76/285, 27%) or side-by-side evaluation of PET and CT scans (Group III: 44/285, 15%). Integrated PET/CT or software fusion, was considered beneficial in 31% (88/285) of the patients with pathological 18F-FDG-uptake (Group IV). Additionally to the above, in 15% of all patients clinically relevant information, referring to disseminated small pulmonary lesions, abdominal aortic aneurysms >5 cm, thrombi or pulmonary emboli, was also provided by the CT scan (Group V). Also, in 7% of all patients, unsuspected pathological lesions, mainly bone metastases, were correctly detected by PET alone (Group VI). In conclusion, in 54% of all oncologic patients, PET alone was diagnostic. In 46% of all patients side-by-side reading (15%) or integrated PET/CT images (31%) were considered beneficial for more accurate anatomical localization of the lesions. Additionally, the CT scan added clinically relevant information in 15% of all patients and the PET scan showed unsuspected metastases in 7% of all studied patients. Therefore, integrated reading of PET and MDCT images by nuclear physicians and radiologists may gain quality in the staging of oncology patients.


Asunto(s)
Neoplasias/diagnóstico por imagen , Neoplasias/diagnóstico , Neoplasias/radioterapia , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Medicina Nuclear/métodos , Radiología/métodos , Reproducibilidad de los Resultados
15.
Clin Nucl Med ; 30(8): 582-3, 2005 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16024964

RESUMEN

A 71-year-old woman with a history of stage III melanoma was hospitalized for evaluating fever of unknown origin and severe left upper quadrant abdominal pain. A computed tomography scan of the abdomen revealed a solitary lesion in the spleen, 10.5 x 10.4 x 10.1-cm, causing splenomegaly. Fused F-18 FDG PET/CT images revealed a solitary splenic metastasis and a focus of increased uptake in the region of the previously removed melanoma at the right scapula. Based on the clinical findings and CT and PET scans, malignant melanoma (stage IV) was diagnosed. Splenectomy was performed subsequently. The histopathologic finding was consistent with a metastasis of a melanoma.


Asunto(s)
Fluorodesoxiglucosa F18 , Melanoma/secundario , Tomografía de Emisión de Positrones , Radiofármacos , Neoplasias del Bazo/secundario , Anciano , Femenino , Humanos , Melanoma/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Estadificación de Neoplasias , Escápula/diagnóstico por imagen , Neoplasias del Bazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Recuento Corporal Total
16.
Planta Med ; 69(2): 174-6, 2003 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12624828

RESUMEN

Clionasterol (1a), clionasterol monoacetate (1b) and 5alpha,8alpha-epidioxy-24alpha-ethylcholest-6-en-3-ol (2), isolated from the marine sponge Xestospongia exigua, and beta-sitosterol (3) were tested for their influence on the classical (CP) and alternative (AP) pathways of activation of the human complement system in vitro. All the sterols inhibited the CP in a dose-dependent manner but no detectable effect was observed in the AP even at concentrations of 400 microM. Clionasterol was found to be a potent inhibitor of CP (IC50 = 4.1 microM) being ten-fold more active than beta-sitosterol. The presence of the epidioxy group on C-5 and C-8 of compound 2 caused a pronounced decrease of the inhibitory effect. Mechanistic studies on the anticomplementary effect of clionasterol revealed that it interferes with the complement component C1.


Asunto(s)
Proteínas Inactivadoras de Complemento/farmacología , Poríferos , Sitoesteroles/farmacología , Animales , Proteínas Inactivadoras de Complemento/administración & dosificación , Proteínas Inactivadoras de Complemento/uso terapéutico , Vía Alternativa del Complemento/efectos de los fármacos , Vía Clásica del Complemento/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Hemólisis/efectos de los fármacos , Humanos , Concentración 50 Inhibidora , Sitoesteroles/administración & dosificación , Sitoesteroles/uso terapéutico
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