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1.
J Med Case Rep ; 15(1): 166, 2021 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-33771229

RESUMEN

BACKGROUND: Traditional coronary artery disease risk factors are well established and help risk stratify most patients presenting with chest pain syndromes. Young patients (under age 30 years) without other risk factors are thought to be at very low risk of coronary artery disease and acute coronary syndromes. CASE PRESENTATION: We highlight the case of a 27-year-old Afro-Caribbean male who presented to hospital with chest pain and was discharged from the emergency room because he was thought to be low risk for ischemic heart disease. Laboratory investigations subsequently confirmed acute coronary syndrome. He was found to have an anomalous right coronary artery with a malignant origin running between the aorta and pulmonary artery eventually requiring surgical correction. Anomalous origins of the coronary arteries are rare causes of acute coronary syndromes, chest pain, and sudden cardiac death. CONCLUSION: Our patient could have easily had an adverse outcome as his diagnosis was missed by the initial treating physician. It is important to consider anomalous coronary artery origin in the evaluation of young symptomatic patients who may be otherwise low risk and not have traditional risk factors for ischemic heart disease.


Asunto(s)
Síndrome Coronario Agudo , Anomalías de los Vasos Coronarios , Infarto del Miocardio , Síndrome Coronario Agudo/etiología , Adulto , Dolor en el Pecho/etiología , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Humanos , Masculino
2.
J Investig Med High Impact Case Rep ; 8: 2324709620933425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32525425

RESUMEN

In isolated partial anomalous pulmonary venous connections (PAPVCs), an abnormal vein connects venous blood from the pulmonary circulation to the systemic circulation, resulting in an extracardiac shunt. A single aberrant pulmonary vein (PV) is usually hemodynamically insignificant, and affected patients are generally asymptomatic. We describe a young Caribbean-Black woman with an isolated, singular PAPVC from the left inferior PV to the left innominate (brachiocephalic) vein that was hemodynamically significant, obfuscated by recurrent pleural effusions from catamenial pleural endometriosis.


Asunto(s)
Venas Braquiocefálicas/anomalías , Cardiopatías Congénitas/diagnóstico por imagen , Venas Pulmonares/anomalías , Síndrome de Cimitarra/diagnóstico por imagen , Adulto , Angiografía por Tomografía Computarizada , Ecocardiografía Transesofágica , Electrocardiografía , Femenino , Cardiopatías Congénitas/cirugía , Hemodinámica , Humanos , Imagen por Resonancia Magnética , Radiografía Torácica , Síndrome de Cimitarra/cirugía
3.
J Investig Med High Impact Case Rep ; 8: 2324709620921626, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32389028

RESUMEN

The quadricuspid aortic valve is an exceedingly rare congenital valvular anomaly, characterized by a tetrad of leaflets that typically presents with aortic regurgitation. Almost one third of cases are associated with coexisting cardiac defects with one fifth warranting surgical intervention. In this article, we describe the first documented-in-Caribbean case and present a brief clinical review of its pathophysiology, diagnosis, and management.


Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Válvula Aórtica/anomalías , Válvula Aórtica Cuadricúspide/diagnóstico , Adulto , Válvula Aórtica/cirugía , Ecocardiografía , Electrocardiografía , Humanos , Masculino , Válvula Aórtica Cuadricúspide/cirugía , Tomografía Computarizada por Rayos X , Trinidad y Tobago
4.
Ecancermedicalscience ; 14: 1159, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33574904

RESUMEN

Usually late in the course of advanced prostate carcinoma, atypical nodal and distant metastases may be encountered. Accurate characterisation of disease spread and assessment of disease response have significant treatment and prognostic implications. Surveillance imaging, therefore, along with clinical and biochemical parameters, is a key factor in directing appropriate management. Atypical metastases may also require histological re-evaluation, as they may indicate differentiation into aggressive histologic subtypes, which can lead to management alteration. We present a pictorial review of the less common patterns of metastatic prostate carcinoma, to aid in timely recognition and diagnosis.

5.
Br J Radiol ; 92(1095): 20180658, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30412423

RESUMEN

This article highlights the range of osseous findings that can be encountered as well as the imaging features of extramedullary haematopoiesis. As iron overload remains a major cause of morbidity and mortality in these disorders, we also discuss the MRI evaluation of hepatic and cardiac hemosiderosis, to aid in the optimization of iron chelation therapy. Future imaging use will be dictated by evolving clinical needs, such as in screening for emerging morbidities, including hepatic fibrosis and hepatocellular carcinoma.


Asunto(s)
Enfermedades Óseas/diagnóstico por imagen , Hemosiderosis/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Talasemia/diagnóstico por imagen , Enfermedades Óseas/etiología , Corazón/diagnóstico por imagen , Hematopoyesis Extramedular , Hemosiderosis/etiología , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Talasemia/complicaciones
6.
AJR Am J Roentgenol ; 209(6): 1197-1208, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28981355

RESUMEN

OBJECTIVE: Neurocutaneous syndromes are a heterogeneous group of multisystemic disorders. We review the multimodality imaging findings in the disorders with a propensity for intraabdominal disease. We highlight more recently recognized disease patterns and discuss imaging surveillance optimization. CONCLUSION: Knowledge of varied intraabdominal phenotypic expressions can increase diagnostic rates. Limitation of radiation dose must be considered in screening this tumor-prone population. Early detection of neoplastic findings is critical for morbidity and mortality reduction.


Asunto(s)
Abdomen , Imagen Multimodal , Síndromes Neurocutáneos/diagnóstico por imagen , Humanos
7.
BMC Res Notes ; 9: 388, 2016 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-27488391

RESUMEN

BACKGROUND: Cowden syndrome is an autosomal dominant disorder with a predisposition to multiple benign and malignant tumors. In our patient, in addition to breast and endometrial malignancies as well as facial trichilemmomas, she was noted to have multiple meningiomas, pancreatic lipomas and lung cysts. These latter lesions have been noted in previous Cowden syndrome case reports, but are not included in the diagnostic criteria at this time. To our knowledge, this is the first case of multiple meningiomas in this syndrome. Further studies are therefore warranted to assess the significance of these findings in Cowden syndrome. CASE PRESENTATION: A middle-aged Afro-Caribbean known endometrial carcinoma patient (post surgery and adjuvant radiotherapy), presented with a locally advanced breast carcinoma. She received neoadjuvant chemotherapy followed by a modified radical mastectomy and axillary lymph node clearance. Her past medical history included a sphenoid wing meningioma for which she received definitive external beam radiotherapy. She was also known to have a multinodular goiter, anal polyp and longstanding mucocutaneous lesions. Further workup revealed additional smaller meningiomas, a parotid arteriovenous malformation, a lung cyst and pancreatic lipomas. Overall, consortium criteria were met for the diagnosis of Cowden syndrome. Furthermore, genetic testing identified a pathogenic mutation in the PTEN gene. She will be closely followed with annual clinical examination, dermatologic assessment and screening colonoscopies. She will perform interval whole body contrast enhanced CT for continued surveillance for metastatic disease. CONCLUSION: Cowden syndrome is likely to be an under diagnosed condition, but critically important to identify due to its cancer predisposition. When encountering multi-organ tumors, diagnostic criteria for Cowden syndrome should be sought in order to increase the diagnostic rates. Cancer surveillance for carcinoma detection in the early and curative stages remains the most critical aspect of management.


Asunto(s)
Síndrome de Hamartoma Múltiple/diagnóstico , Neoplasias/diagnóstico , Femenino , Síndrome de Hamartoma Múltiple/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Neoplasias/diagnóstico por imagen , Especificidad de Órganos , Fosfohidrolasa PTEN/genética , Tomografía Computarizada por Rayos X
8.
Int J Surg Case Rep ; 24: 37-42, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27179335

RESUMEN

INTRODUCTION: Unlike left sided accessory spleen that are seen in 10-30% of cases at autopsy, cases of right accessory spleens are extremely rare. This congenital body of healthy splenic tissue simulates tumors from neighboring organs and presents a challenge in formulating a differential diagnosis. PRESENTATION OF CASE: We present the case of a patient whose CT scan of the abdomen showed a large mass, 11×8cm, arising retro-duodenal and lying just anterior to the right kidney. To the best of our knowledge, this is the only case where the accessory spleen was found retro-duodenal, directly anterior to the kidney and completely separate from the supra-renal gland. The chief complaint of the patient was right upper quadrant pain, radiating to the back, and colicky in nature. The patient was diagnosed with duodenal gastro-intestinal stromal tumor and a retro-peritoneal sarcoma. The mass was removed via a Kocher's incision and immunohistological examination showed that it was a right sided accessory spleen. The patient's left sided spleen appeared normal. DISCUSSION: Efforts to distinguish an accessory spleen from a retroperitoneal tumor with available scans, percutaneous biopsy or biochemical tests are inconclusive. Differential diagnosis between a retroperitoneal tumor and an accessory spleen can only be made after surgical exploration. CONCLUSION: This case highlights the fact that surgeons should consider the possibility of an accessory spleen when making a differential diagnosis of retroperitoneal tumors.

9.
J Ultrasound Med ; 21(9): 977-81, 2002 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12216763

RESUMEN

OBJECTIVE: To determine whether same-day sonographic evaluation of the gallbladder is possible after the use of oral or intravenous iodinated contrast agents during intravenous urography or computed tomography. METHODS: One hundred fifty-three patients involved in this prospective study received low-osmolar or conventional contrast material. Each preparation contained 300 mg/mL iodine. Sixty-six patients received contrast agents intravenously, and 87 received them orally. Gallbladder volume was estimated sonographically, and the precontrast volume was used to calculate the volume after contraction at 30-minute intervals up to 2 hours after contrast agent administration. RESULTS: Gallbladder volume returned to precontrast values at 2 hours irrespective of the type of contrast agent or route of administration. The mean volume after contraction at 0.5 hour was 71% after intravenous contrast agent administration and 76% after oral contrast agent administration. Both changes were statistically significantly different from precontrast values (P < .01, null hypothesis) and were unaffected by the osmolarity of the contrast agent. CONCLUSIONS: Gallbladder volume was restored to precontrast values 2 hours after contrast agent administration. Thus any strategy involving simultaneous same-day sonographic or computed tomographic assessment of the gallbladder after contrast agent administration can be confidently undertaken after this period. This finding may have cost-saving implications.


Asunto(s)
Medios de Contraste , Diatrizoato de Meglumina , Vesícula Biliar/diagnóstico por imagen , Yohexol/análogos & derivados , Intensificación de Imagen Radiográfica , Tomografía Computarizada por Rayos X , Urografía , Adulto , Estudios de Factibilidad , Femenino , Vaciamiento Vesicular , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Ultrasonografía
10.
West Indian Med. J ; 49(4): 298-301, Dec. 2000. ilus, tab
Artículo en Inglés | MedCarib | ID: med-458

RESUMEN

This paper describes the experience with 99m Technetium labelled red blood cell (99mTc RBC) scintigraphy in twenty-two patients presenting with acute gastrointestinal (GI) tract bleeding. Studies were postitive in thirteen cases - eight from the lower GI tract and five from the upper. The data from surgical intervention were available in ten cases. Scintigraphy cannot diagnose the cause of GI bleeding, as it is a nonspecific study. Its usefulness lies in its ability to accurately diagnose the bleeding site, as was shown in this study where there was good surgical correlation. The simplicity, reproducibility and reliability of the technique, particularly when bleeding rates are low and intermittent, make it, in our view, the first line of investigation in any patient with suspected bleeding from the colon or upper GI tract if endoscopic evaluation is not possible in the latter. Its current under-utilisation in the Caribbean may be a reflection of the lack of nuclear imaging facilities.(Au)


Asunto(s)
Adulto , Niño , Persona de Mediana Edad , Anciano , Femenino , Humanos , Masculino , Adolescente , Preescolar , Eritrocitos/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico por imagen , Cintigrafía/métodos , Hemorragia Gastrointestinal/sangre , Enfermedad Aguda , Sensibilidad y Especificidad , Tecnecio/diagnóstico
11.
The New England journal of medicine ; 342(25): 1924-1924, June 2000.
Artículo en Inglés | MedCarib | ID: med-17384

RESUMEN

Malaria often presents as an acute febrile illness with fever, headache, rigors, anemia, and splenomegaly. The only malaria parasite associated with cerebral complications, Plasmodium falciparum usually blocks cerebral capillaries because of its endothelial adhesiveness. Infections with P. marlariae can persist for decades and are associated with splenomegaly and the nephrotic syndrome but not with cerebral complications. We describe P. malariae infection that was reactivated after neurosurgery after decades of latency. Infections with P. malariae may be asymptomatic and can be reactivated decades after the initial infection. The epidemiologic significance of asymptomatic cases of P. malariae infection has been well documented during outbreaks in Trinidad and Tobago and Grenada. Most of the symptomatic cases were detected by microscopial analysis, whereas the asymptomatic cases were diagnosed with the use of immunofluorescence antibody assays. Subclinical infections in humans may serve as the source of the protozoa in mosquitoes. Consequently, it is recommended that a sensitive technique that is based on the polymerase chain reaction be used to screen persons for persistent malaria infections, especially those who live in regions where the disease was once common but has since been eradicated


Asunto(s)
Humanos , Masculino , Malaria/diagnóstico , Malaria/cirugía , Región del Caribe , Trinidad y Tobago
12.
West Indian med. j ; 46(4): 128-9, Dec. 1997.
Artículo en Inglés | MedCarib | ID: med-1937

RESUMEN

A 6 month old infant presenting initially with clinical signs of bronchiolitis developed acute symptoms of large airway obstruction and respiratory failure despite treatment of bronchiolitis. Endotracheal intubation and oxygen therapy resulted in immediate and dramatic improvement of respiratory failure. Plain chest radiograph, computerized tomography and surgical biopsy with subsequent histological examination established that the respiratory failure was due to a mediastinal cystic hygroma.(AU)


Asunto(s)
Informes de Casos , Humanos , Lactante , Masculino , Linfangioma Quístico/complicaciones , Linfangioma Quístico/cirugía , Neoplasias del Mediastino/complicaciones , Insuficiencia Respiratoria/etiología , Bronquiolitis/terapia , Linfangioma Quístico/diagnóstico por imagen
13.
West Indian med. j ; 45(Suppl 2): 37, Apr. 1996.
Artículo en Inglés | MedCarib | ID: med-4595

RESUMEN

Comparison between coronary angiography (CA) and SPECT myocardial perfusion scintigraphy (MPS) using Tc-99m labeled compounds in 30 patients (23 males, 7 females) yielded a sensitivity of 97 percent and a specificity of 76 percent for lesion detectability (p<0.01) using CA as the reference standard. Angiographic analysis initially ascribed the scintigraphic defects in 8 patients (5 males, 3 females) as falsely positive. Eleven coronary artery territories were involved: eight within the LAD and three within the RCA. Patient symptomatology however, prompted angiographic review which revealed myocardial bridging of the LAD in one male patient and differential perfusion of the LAD in two male patients. A review of the patients' history revealed associated risk factors such as diabetes, hyperlipidaemia, hypertension and smoking. Based on these findings, critical re-evaluation of other pathophysiolocial abnormalities in the absence of vascular stenosis should thus be sought in patients with positives MPD and associated risk factors to avoid unsuspected patient morbidity (AU)


Asunto(s)
Femenino , Humanos , Masculino , Cintigrafía , Enfermedad Coronaria/diagnóstico , Angiografía Coronaria
14.
West Indian med. j ; 44(Suppl. 2): 32-3, Apr. 1995.
Artículo en Inglés | MedCarib | ID: med-5757

RESUMEN

The assessment of myocardial perfusion has for many years been performed with thallous chloride (T1-201). This imaging agent suffers, however, from a number of well-recognized limitations, which has prompted a global search for better radiopharmaceuticals. Within the last two years, Technetium labelled myocardial perfusion imaging agents, namely, Sestamibi (Du Pont Pharma) and Tetrofosmin (Amersham) became available, and prompted us to evaluate the efficacy with respect to coronary angiography (CA) recently introduced at our institution. The data for both imaging agents were analyzed in fifty consecutive patients (ages 30 to 70 years), referred over the past eighteen months for myocardial perfusion scintigraphy (MPS). Twenty-five patients had combined MPS and CA studies. Comparative analysis for individual coronary artery territories yielded a sensitivity of 97 percent, specificity of 80 percent and an overall accuracy of 80 percent for MPS. Angiographic review of initially ascribed false positive MPS in eight patients revealed pathophysiological abnormalities other than coronary artery stenosis which accounted for the observed perfusion deficits. These included differential blood flow in two patients and myocardial bridging in one. The remaining false positives were attributed to diaphragmatic or breast attenuation (AU)


Asunto(s)
Humanos , Masculino , Femenino , Angiografía Coronaria , Diagnóstico por Imagen/métodos , Cintigrafía/métodos , Talio , Tecnecio
18.
Artículo en Inglés | MedCarib | ID: med-2503

RESUMEN

Wilms'tumor (nephroblastoma) is a common childhood tumour, with a reported annual incidence in the United States of 7.8 cases per million of population aged one to 14 years. Horseshoe-shaped kidney is a congenital malformation with a recognized risk of complications, yet an associated nephroblastic is exceeding rare. A case of this simultaneous but unsuspected occurrence of a Wilms' tumour co-existing within a horseshoe kidney, and diagnostic dilemma encountered is presented. (Au)


Asunto(s)
Humanos , Preescolar , Femenino , Tumor de Wilms/diagnóstico , Riñón/anomalías
19.
West Indian med. j ; 35(Suppl): 55, April 1986.
Artículo en Inglés | MedCarib | ID: med-5909

RESUMEN

Hospital admission figures, cirrhosis death rates, per capita alcohol consumption rates and other indices have for many years indicated a high prevalence of alcoholism in Trinidad and Tobago. A six-month survey of the Medical wards, Port-of-SPain General Hospital by Prasad in 1979 showed that 47 percent of male admissions and 5 percent of female admissions were alcohol-related. Beaubrun (1978)) demonstrated a close inverse relationship (r = -0.978) between total motor vehicle and the real price of rum, i.e. the price relative to average personal income. Trinidad and Tobago has one of the highest per capita motor vehicle accident rates anywhere, even higher than the United States and very much higher than Europe. It is well established that alcohol is the single most important factor yet identified in traffic accidents wherever this has been studied. Nevertheless, there has been some reluctance to enact B.A.C. laws and to introduce the Breathalyser and other controls until more specific local research has been done to establish clearly the relationship between alcohol and such accidents. For these reasons a survey was carried out in December 1984 to determine the blood alcohol concentrations of all persons seen at the Casualty Department of the Port-of-Spain General Hospital as a result of traffic accidents. PROCEDURE: A pilot study was carried out first to refine the schedule for use in the study and to test its feasibility. A one-month survey was then carried out. Blood specimens were taken of all victims and a schedule filled out. Venous blood specimens were taken in Fluoride Oxalate and analyzed by a staff member of the Department of Pathology. Thirty-eight (38) accident victims were seen. More than 68 percent had blood alcohol concentrations higher than 0.05 percent (50mg. per 100 ml) and 55 percent had concentrations higher than 0.08 percent (80 mg per 100 ml) which is the legal limit in the United Kingdom. Blood specimens from three (3) controls, i.e. not involved in accidents, showed levels of between .002 percent (2mg percent) and .011 percent (11 mg percent). Many of the accident victims had B.A.Cs well over 0.1 percent (100 mg/100ml), and some were over 0.2 percent (200mg/100ml), levels of 0.2 percent could only be tolerated by habitual excessive drinkers who have developed considerable tolerance. The findings of this preliminary study point to an urgent need for B.A.C. legislation and the introduction of the breathalyser and other preventive strategies aimed at reducing the drinking/driving hazard (AU)


Asunto(s)
Humanos , Masculino , Femenino , Consumo de Bebidas Alcohólicas/sangre , Accidentes de Tránsito , Trinidad y Tobago , Alcoholismo
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