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2.
World J Surg Oncol ; 17(1): 208, 2019 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-31801564

RESUMEN

BACKGROUND: Ultrasound, along with ultrasound-guided fine needle aspiration, is currently used for the axillary evaluation of breast cancer patients in order to identify candidates for axillary lymph node dissection. The aim of this study is to evaluate the accuracy of this tool in correctly identifying patients who may or may not benefit from axillary clearance in light of the ACOSOG Z0011 trial recommendations. METHODS: One hundred one patients (65 with positive US-FNA with corresponding axillary lymph node dissection (ALND), and 36 with negative US-FNA with corresponding ALND/sentinel lymph node biopsy) were studied for the number of involved axillary lymph nodes, tumor clinicopathologic features, and axillary radiologic findings. RESULTS: From the positive US-FNA group, 43% of patients had two or fewer positive lymph nodes upon ALND pathologic examination. In the US-FNA negative group, the negative predictive value for detecting axillary disease was 72.7%. With both groups combined, the sensitivity, specificity, PPV, and NPV of US-FNA for selecting patients based on axillary disease burden were 86%, 51.7%, 57%, and 83.3%, respectively. CONCLUSION: Based on Z0011 guidelines, US-FNA is not a reliable tool in triaging patients in need for ALND and leads to overtreatment of 43% patients when positive, while depriving a small but significant percentage of patients from necessary therapy, when negative.

3.
Radiol Res Pract ; 2019: 1406291, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31354994

RESUMEN

Ovarian/adnexal torsion is a rather frequent occurrence in women of reproductive age group worldwide. Etiologies are quite diverse with ovarian lesions and corpus luteal cysts being the most two common. Pelvic or intravaginal ultrasound remains the first-line imaging modality used for diagnosis and evaluation of suspected ovarian/adnexal torsion. In this study, we have adopted a case-based statistical analysis to identify important sonographic markers and further evaluated their contribution in identifying ovarian torsion. Our study successfully determined the important sonographic markers. Our observation and analysis suggest that ovarian enlargement is the most sensitive marker. Ovarian edema was found to be the most specific marker to identify the ovarian torsion with higher level of accuracy and confidence. This pioneer study will provide valuable information and direction to the medical practitioners and radiologists for better diagnosis. Further studies with large sample size will help in establishing our findings universally.

4.
J Magn Reson Imaging ; 50(6): 1702-1717, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31102327

RESUMEN

Even though the placenta has been known for millennia, it is still considered one of the most complex and least understood human organs. Imaging of the placenta is gaining attention due to its impact on fetal and maternal outcomes. MRI plays a vital role in evaluation of inconclusive cases by ultrasonography. It enables precise mapping of placental abnormalities for proper multidisciplinary planning and management. In this article we provide a comprehensive in-depth review of the role of antenatal MR in evaluating "The Placenta." We will describe the protocols and techniques used for MRI of the placenta, review anatomy of the placenta, describe MRI features of major placental abnormalities including those related to position, depth of implantation, hemorrhage, gestational trophoblastic neoplasia, and retained products of conception and discuss the added value of MRI in the management and preoperative planning of such abnormalities. Level of Evidence: 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:1702-1717.

5.
Radiol Res Pract ; 2019: 5045908, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30886748

RESUMEN

Objectives: The aim of this study is to demonstrate the various imaging appearances of stromal fibrosis on mammography, ultrasound, and magnetic resonance imaging (MRI). Material and Methods: This study included 75 female patients who presented to the American University of Beirut Medical Center between January 2010 and October 2015 for breast imaging. 66 (88%) patients obtained a mammogram, 71 (95%) had an ultrasound, and 6 (8%) had an MRI. Patients included had stromal fibrosis proven on biopsy. Results: The most common finding on mammogram was calcifications which was present in 14 (21%) patients, while on ultrasound it was a mass which was present in 61 (86%) patients. A mass was detected on MRI in 2 (33.5%) patients. Most lesions detected had benign findings such as masses with circumscribed margins. We had a follow-up for 53 (71%) patients with an average follow-up interval of 28.5 months (range: 5 - 70). Increase in size of the index lesion was noted in only 2 patients; upon rebiopsy, pathology results read stromal fibrosis for one lesion and fibroadenoma for the other. The remaining lesions were either stable or decreased in size. The higher detection rate of a mass on ultrasound was statistically significant (p<0.001) in comparison to that of mammography. Conclusion: Stromal fibrosis can have various presentations on imaging from benign to suspicious for malignancy features. In the case of accurate targeted biopsy, when stromal fibrosis is diagnosed, the result can be considered concordant. Therefore, such lesions can be followed up by imaging to document stability and confirm benignity.

6.
Nucl Med Commun ; 39(11): 1039-1044, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30198973

RESUMEN

OBJECTIVE: To determine whether breast cancer staging differs between high-resolution (HR) and standard-resolution (SR) PET/computed tomography acquisition. PATIENTS AND METHODS: This retrospective study included 39 women with breast cancer referred for staging. Images were assessed for the number of primary breast lesions with the corresponding size and the average maximum standardized uptake value (SUVmax), the anatomical site of fluorine-18-fluorodeoxyglucose-avid lymph nodes (LNs) with their SUVmax, and the number and type (lytic/blastic) of metastatic bone lesions. RESULTS: On HR, 42 breast tumor lesions with a size range of 0.30 cm up to 12.00 cm were detected versus 34 breast tumor lesions on SR. One hundred and forty-one versus 90 axillary LNs were detected on HR versus SR, respectively. Pathology reports were available for 60 axillary LNs out of the total 141 identified on HR. Rates for HR versus SR sensitivity, true positivity, false positivity, and false negativity are as follows: 92 versus 75%, 92 versus 75%, 2 versus 0%, and 7 versus 25%. The higher detection rate of axillary LN on HR was significant (P<0.001), but not the number of nodes detected (P=0.091). SUVmax for breast tumor lesions (P=0.225) and axillary LNs (P=0.134) were not significant. Three (8%) patients had a change in staging and management. CONCLUSION: HR detected primary breast lesions and metastatic LNs missed on SR, which led to change in staging and management. In addition, HR images provided higher SUVmax, which enabled a more comfortable localization, especially when SR presented borderline values. Finally, HR images decreased the number of gray zone lesions, especially in axillary LN detection.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adulto , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Femenino , Humanos , Procesamiento de Imagen Asistida por Computador , Estadificación de Neoplasias , Pronóstico , Sensibilidad y Especificidad
7.
Clin Imaging ; 50: 43-50, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29262377

RESUMEN

In this pictorial essay, the authors discuss etiologies, imaging findings with focus on fluoroscopy and management of the short esophagus in children and adults.


Asunto(s)
Anomalías del Sistema Digestivo/diagnóstico por imagen , Esófago/anomalías , Esófago/diagnóstico por imagen , Adulto , Niño , Fluoroscopía , Humanos
8.
J Glob Oncol ; 3(3): 242-249, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28717766

RESUMEN

PURPOSE: Multidisciplinary tumor boards (MTBs) have become commonplace. The use, attendance, and function of MTBs need continued assessment and improvement. METHODS: We prospectively recorded and assessed all cases presented at MTBs between October 2013 and December 2014. Data were collected before and during each MTB. Data were analyzed using SPSS for Windows version 23 (SPSS, Chicago, IL). RESULTS: Five hundred three cases were presented: 234 cases (46%) at GI cancer MTBs, 149 cases (29.6%) at breast cancer MTBs, 69 cases (13.7%) at thoracic/head and neck cancer MTBs, and 51 cases (10.7%) at neuro-oncology MTBs. A total of 86.7% of MTB cases were presented to make plans for management. Plans for upfront management were made in 67% of the breast cancer cases, 63% of GI cases, 59% of thoracic/head and neck cases, and 49% of neuro-oncology cases. Three hundred ninety-four cases (78.3%) were presented by medical oncologists, whereas only 74 cases (14.7%) were presented by surgeons, and 10 cases (2%) were presented by radiation oncologists. The majority of MTBs, with the exception of the neurosurgery MTBs, were led by medical oncologists. Surgeons presented the least number of cases but attended the most, and their contributions to discussions and decision making were essential. CONCLUSION: MTBs enhance the multidisciplinary management of patients with cancer. Upfront multidisciplinary decision making should be considered as an indicator of benefit from MTBs, in addition to changes in management plans made at MTBs. Increasing the contributions of surgeons to MTBs should include bringing more of their own cases for discussion.

9.
J Ultrasound Med ; 35(4): 783-90, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26969597

RESUMEN

OBJECTIVES: Hyperechogenicity has been strongly associated with benign breast lesions. Although it is correct in most cases, hyperechogenicity must not always be considered synonymous with benignancy, as hyperechoic breast cancers do occur. The purpose of this study was to review clinical and imaging characteristics of hyperechoic breast lesions, looking for features associated with malignancy. METHODS: Institutional Review Board approval was granted for this research. A total of 19,417 sonographic examinations were performed between January 2009 and June 2013. Among these, hyperechoic lesions with histologic diagnoses, stability on long-term followup, or characteristic imaging appearances were included in the study. The patients' clinical charts, mammograms, and sonograms were reviewed. The clinical and imaging features were recorded, and the data was analyzed by the χ(2) test, Fisher exact test, and independent-samples t test, looking for statistically significant predictors of malignancy. RESULTS: Among the 19,417 scans, 42 patients (0.2%) with 44 hyperechoic lesions were identified. Twenty-six lesions fulfilling the inclusion criteria were included in the study: 5 malignancies (3 invasive ductal carcinomas, 1 invasive lobular carcinoma, and 1 invasive mucinous cancer) and 21 benign lesions. An irregular shape, a nonparallel orientation, and noncircumscribed margins were significantly associated with the risk of malignancy (P = .002, .02, and .01, respectively). CONCLUSIONS: A hyperechoic breast lesion must not always be assumed to be benign. Instead, a full sonographic assessment according to the American College of Radiology Breast Imaging Reporting and Data System descriptors is needed for correct characterization and avoidance of misdiagnosis.


Asunto(s)
Algoritmos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/epidemiología , Interpretación de Imagen Asistida por Computador/métodos , Ultrasonografía Mamaria/métodos , Ultrasonografía Mamaria/estadística & datos numéricos , Adulto , Anciano , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Humanos , Aumento de la Imagen/métodos , Líbano/epidemiología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Prevalencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto Joven
10.
J Burn Care Res ; 32(1): 160-5, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21099436

RESUMEN

Burn injuries involving the joints around the lower extremity often lead to debilitating postburn contractures that frequently compromise extremity functions. Treatment of such injuries, especially involving the ankle and foot area, is very challenging. Conservative management has limited efficiency in correcting the deformities, whereas open surgical treatment is often coupled with high complication rates because of poor soft-tissue coverage and poor vascularity around the burnt areas. The use of the Ilizarov fixator has the advantage of tackling these deformities without the need for extensive open surgical procedures, which will minimize complications and recurrences. The authors present a series of three patients, two adults and one pediatric patient, who were treated successfully with minimally invasive surgery and soft-tissue distraction with the Ilizarov apparatus.


Asunto(s)
Traumatismos del Tobillo/cirugía , Quemaduras/complicaciones , Contractura/cirugía , Deformidades Adquiridas del Pie/cirugía , Técnica de Ilizarov , Traumatismos del Tobillo/etiología , Niño , Contractura/etiología , Femenino , Deformidades Adquiridas del Pie/etiología , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Adulto Joven
11.
Breast Cancer Res Treat ; 124(1): 13-26, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20809361

RESUMEN

The risk of breast cancer has been associated with reproductive history. The purpose of this study was to determine the relationship between fertility drugs used in assisted reproductive procedures and the risk of breast cancer. We performed a literature search using the MEDLINE, the COCHRANE Library, and Scopus to identify studies linking breast cancer to fertility drugs. We excluded case series, case reports, and review articles from our analysis. The study populations included women who were treated for infertility with clomiphene, gonadotropins, gonadotropin-releasing hormones, or other unspecified fertility agents. We extracted information on study design, sample size, type of fertility drugs and number of treatment cycles, breast cancer incidence, and follow-up time from these studies. Eight case-control studies and fifteen cohort studies were included in the quantitative analyses. The Newcastle-Ottawa Quality Assessment Scales were used. Two investigators independently extracted study methods, sources of bias, and outcomes. We found that the risk of breast cancer was not significantly associated with fertility drug treatment. The follow-up periods were short in some of the studies analyzed in our study; however, we proceeded to test the trend in risk estimates across different durations of follow-up and found a trend for association using the nonparametric test; this was interpreted with caution in view of the lack of adjustment with other confounding factors. The current published data do not suggest higher risk of breast cancer in women who receive fertility treatment, but the lack of long-term follow up and the inherent weaknesses in some of the published studies have to be cautiously taken into account.


Asunto(s)
Neoplasias de la Mama/inducido químicamente , Fármacos para la Fertilidad Femenina/efectos adversos , Técnicas Reproductivas Asistidas/efectos adversos , Adulto , Anciano , Medicina Basada en la Evidencia , Femenino , Humanos , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
12.
Cancer ; 116(16): 3825-9, 2010 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-20564093

RESUMEN

BACKGROUND: Most Hodgkin lymphoma (HL) patients present with disease in nodal regions. However, in a small subset, disease develops in unique anatomic sites such as the head and neck area. This study aims to identify the characteristics and outcomes of patients who develop HL involving extranodal and nodal head and neck sites. METHODS: The authors searched The University of Texas M. D. Anderson Cancer Center's database for HL patients treated between 1967 and 2007 and included those with HL at head and neck sites. They reviewed the records for site of involvement, pathology, treatment, and survival. RESULTS: The authors identified 39 patients with extranodal and nodal HL of the head and neck. Five patients with lymphocyte predominant HL were excluded. Specifically, 10 of 34 patients had disease in the tonsils, 9 in the nasopharynx, 8 in the thyroid, 3 in the parotid, 2 in the adenoids, and 1 each in Waldeyer's ring and nasal antrum. Median age at diagnosis was 31.5 years, average age at diagnosis was 38 years, and 22 of 34 were male; 23 had stage I or II disease. Pathologically, 14 of 34 had the nodular sclerosis subtype, whereas 15 had mixed cellularity. Twenty-nine of 34 had nodal neck disease at presentation. Five of 34 received chemotherapy alone, 5 received radiation alone, and 24 received combination therapy. Twenty-one of 34 received 39.6 gray of external beam radiation. The most commonly used chemotherapy regimens were ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and MOPP (mechlorethamine, vincristine, procarbazine, and prednisone). At last follow-up, 85% were disease-free. CONCLUSIONS: HL of the head and neck is primarily diagnosed as early stage disease of men and of young to middle-aged individuals. Chemotherapy and primary/adjuvant radiotherapy offer excellent local and systemic control. The extent to which nodal disease is present in the neck does not alter outcomes when combined modality therapy is offered. Despite the unique anatomic location of these lesions, standard HL protocols work effectively to promote disease-free survival.


Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico , Enfermedad de Hodgkin/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Terapia Combinada , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Enfermedad de Hodgkin/mortalidad , Enfermedad de Hodgkin/patología , Enfermedad de Hodgkin/terapia , Humanos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
13.
J Voice ; 24(6): 732-7, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20335001

RESUMEN

The objective of this study was to assess structural and functional abnormalities of the cricothyroid joint (CTJ) in patients with advanced rheumatoid arthritis (RA). A total of 19 subjects--11 patients with advanced RA and eight normal controls--were considered. All subjects underwent laryngeal endoscopy, acoustic analysis, and high-resolution computerized tomography (HRCT). Vocal symptoms, such as hoarseness, loss of range, vocal fatigue, and dyspnea were inquired and acoustic parameters, mainly pitch range, fundamental frequency, habitual pitch, perturbation parameters, and noise-to-harmonic ratio (NHR) and voice turbulence index were measured. Frequencies and means were calculated for categorical and continuous variables. Cases and controls were compared with respect to acoustic analysis, HRCT findings and laryngeal symptoms using nonparametric tests, Mann-Whitney U test for continuous variables and Fishers exact test for categorical variables. Almost half of the patients with RA had loss range and two-thirds had vocal fatigue. Thirty-six percent experienced hoarseness compared with 25% in the control group. 9.1% had decrease in vocal fold mobility and 27% had moderate/severe edema of the vocal folds/arytenoids compared with none in the control group. HRCT showed narrowing in the CTJ in 81.8% and ankylosis in 9.1% compared with none in the control group. 45.5% had an increase in the CTJ density compared with 12.5% in the control group. Acoustic analysis revealed significant decrease in pitch range and maximum phonation time (MPT) and significant increase in perturbation parameters. CTJ is commonly affected in patients with RA. Functional disabilities are crucial especially in professional voice users. Proper awareness is important for early detection and intervention.


Asunto(s)
Artritis Reumatoide/patología , Cartílago Cricoides/patología , Articulaciones/patología , Cartílago Tiroides/patología , Adulto , Anciano , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/fisiopatología , Artrografía , Estudios de Casos y Controles , Cartílago Cricoides/diagnóstico por imagen , Disnea/etiología , Femenino , Ronquera/etiología , Humanos , Laringoscopía , Líbano , Masculino , Persona de Mediana Edad , Fonación , Acústica del Lenguaje , Cartílago Tiroides/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos X , Pliegues Vocales/patología , Pliegues Vocales/fisiopatología , Calidad de la Voz , Adulto Joven
14.
Strategies Trauma Limb Reconstr ; 5(3): 127-35, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21286357

RESUMEN

Correction of a relapsed clubfoot deformity by distraction with an external fixator is a recognized alternative to open surgery. Most published series report a good outcome but none are prospective observational studies using the scoring system of the International Clubfoot Study Group (ICFSG). We present a series of 9 relapsed club feet treated with closed gradual distraction using this scoring method.

15.
World J Gastroenterol ; 14(20): 3224-30, 2008 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-18506930

RESUMEN

AIM: To study the factors that may affect survival of cholangiocarcinoma in Lebanon. METHODS: A retrospective review of the medical records of 55 patients diagnosed with cholangio-carcinoma at the American University of Beirut between 1990 and 2005 was conducted. Univariate and multivariate analyses were performed to determine the impact of surgery, chemotherapy, body mass index, bilirubin level and other factors on survival. RESULTS: The median survival of all patients was 8.57 mo (0.03-105.2). Univariate analysis showed that low bilirubin level (< 10 mg/dL), radical surgery and chemotherapy administration were significantly associated with better survival (P = 0.012, 0.038 and 0.038, respectively). In subgroup analysis on patients who had no surgery, chemotherapy administration prolonged median survival significantly (17.0 mo vs 3.5 mo, P = 0.001). Multivariate analysis identified only low bilirubin level < 10 mg/dL and chemotherapy administration as independent predictors associated with better survival (P < 0.05). CONCLUSION: Our data show that palliative and postoperative chemotherapy as well as a bilirubin level < 10 mg/dL are independent predictors of a significant increase in survival in patients with cholangiocarcinoma.


Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de los Conductos Biliares/terapia , Conductos Biliares Intrahepáticos/efectos de los fármacos , Conductos Biliares Intrahepáticos/cirugía , Procedimientos Quirúrgicos del Sistema Biliar , Índice de Masa Corporal , Colangiocarcinoma/terapia , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Conductos Biliares/tratamiento farmacológico , Neoplasias de los Conductos Biliares/mortalidad , Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos/metabolismo , Conductos Biliares Intrahepáticos/patología , Bilirrubina/metabolismo , Quimioterapia Adyuvante , Colangiocarcinoma/tratamiento farmacológico , Colangiocarcinoma/mortalidad , Colangiocarcinoma/patología , Colangiocarcinoma/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Líbano/epidemiología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
16.
Fertil Steril ; 85(5): 1510.e5-8, 2006 May.
Artículo en Inglés | MEDLINE | ID: mdl-16647381

RESUMEN

OBJECTIVE: To report on a patient with Müllerian agenesis (MA) and inguinal ovaries and to review the pertinent literature. DESIGN: Case report and literature review. SETTING: Clinical. PATIENT(S): A 12-year-old girl. INTERVENTION(S): Magnetic resonance imaging, review of prior ovarian biopsies, karyotyping. MAIN OUTCOME MEASURE(S): Accuracy of diagnosis and preservation of ovarian function. RESULT(S): A 12-year-old girl with MA and bilateral inguinal ovaries is reported. An exhaustive review of the English literature on this rare association revealed only seven other well-documented such cases. Management of this condition involves reduction of the ovaries into the pelvis. CONCLUSION(S): The association of MA and bilateral inguinal ovaries is rare and possibly underreported. Ideal management consists of surgical reduction of the gonads into the pelvic cavity as soon as they are discovered, to decrease the risk of ovarian torsion and loss of ovarian function.


Asunto(s)
Coristoma/diagnóstico , Coristoma/cirugía , Conducto Inguinal/cirugía , Conductos Paramesonéfricos/anomalías , Conductos Paramesonéfricos/cirugía , Ovario , Niño , Femenino , Humanos
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