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1.
BMC Health Serv Res ; 21(1): 909, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34479565

RESUMEN

BACKGROUND: To evaluate the cost-effectiveness of six diagnostic strategies involving magnetic resonance imaging (MRI) targeted biopsy for diagnosing prostate cancer in initial and repeat biopsy settings from the Singapore healthcare system perspective. METHODS: A combined decision tree and Markov model was developed. The starting model population was men with mean age of 65 years referred for a first prostate biopsy due to clinical suspicion of prostate cancer. The six diagnostic strategies were selected for their relevance to local clinical practice. They comprised MRI targeted biopsy following a positive pre-biopsy multiparametric MRI (mpMRI) [Prostate Imaging - Reporting and Data System (PI-RADS) score ≥ 3], systematic biopsy, or saturation biopsy employed in different testing combinations and sequences. Deterministic base case analyses with sensitivity analyses were performed using costs from the healthcare system perspective and quality-adjusted life years (QALY) gained as the outcome measure to yield incremental cost-effectiveness ratios (ICERs). RESULTS: Deterministic base case analyses showed that Strategy 1 (MRI targeted biopsy alone), Strategy 2 (MRI targeted biopsy ➔ systematic biopsy), and Strategy 4 (MRI targeted biopsy ➔ systematic biopsy ➔ saturation biopsy) were cost-effective options at a willingness-to-pay (WTP) threshold of US$20,000, with ICERs ranging from US$18,975 to US$19,458. Strategies involving MRI targeted biopsy in the repeat biopsy setting were dominated. Sensitivity analyses found the ICERs were affected mostly by changes to the annual discounting rate and prevalence of prostate cancer in men referred for first biopsy, ranging between US$15,755 to US$23,022. Probabilistic sensitivity analyses confirmed Strategy 1 to be the least costly, and Strategies 2 and 4 being the preferred strategies when WTP thresholds were US$20,000 and US$30,000, respectively. LIMITATIONS AND CONCLUSIONS: This study found MRI targeted biopsy to be cost-effective in diagnosing prostate cancer in the biopsy-naïve setting in Singapore.


Asunto(s)
Imagen por Resonancia Magnética , Neoplasias de la Próstata , Anciano , Biopsia , Análisis Costo-Beneficio , Humanos , Masculino , Neoplasias de la Próstata/diagnóstico por imagen , Singapur/epidemiología
2.
Curr Urol Rep ; 22(9): 46, 2021 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-34487255

RESUMEN

PURPOSE OF REVIEW: The use of renal tumor biopsy (RTB) for small renal masses (SRMs) in daily practice, although safe and accurate, is unusual. Considering the large number of benign tumors in patients with renal masses < 4 cm, some patients with benign tumors are directly referred for surgery instead. This study aimed to report the diagnostic rates of RTB, determine the concordance with surgical pathology, and assess the number of procedures that could have been avoided. We retrospectively studied 255 patients who underwent RTB at our institution in 2010-2019. Of them, 73 were excluded from the analysis (exclusion criteria: > 4 cm, cystic lesion, missing data). The remaining 182 with undetermined SRMs ≤ 4 cm underwent RTB under computed tomography guidance. RECENT FINDINGS: Biopsies were diagnostic in 154/182 (84.6%) cases. Of the non-diagnostic biopsies, 11 were diagnostic when repeated. When RTB was performed of all undetermined SRMs, active treatment (surgery or cryotherapy) was avoided in 50/182 patients (27.5%) because of a benign diagnosis, while 9/182 patients (4.9%) underwent surveillance after a shared multidisciplinary decision. The overall diagnostic rate was 90.6%. All adverse events (approximately 4%) were Clavien-Dindo grade I and did not require active treatment. RTB histology results and nuclear grade were highly concordant with the final pathology (96% and 86.6%, respectively). On univariate logistic regression analysis, male sex was the only contributing factor of diagnostic biopsy. RTB of SRMs should be performed more frequently as part of a multidisciplinary decision-making process since it avoided unnecessary surgical treatment in 1 of 3 patients in our institution.


Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Biopsia , Carcinoma de Células Renales/cirugía , Humanos , Neoplasias Renales/cirugía , Masculino , Nefrectomía , Estudios Retrospectivos
3.
Clin Plast Surg ; 48(4): 577-585, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34503718

RESUMEN

Early detection of melanoma is important in improving patient survival. The treatment of melanoma is multidisciplinary and begins by obtaining an accurate diagnosis. The mainstays of melanoma diagnosis include examination of the lesion and surrounding areas and an excisional biopsy so that a pathologic diagnosis can be obtained. The pathology results will help guide treatment recommendations, and some information can be used for prognosis. Further workup of the patient may include laboratory studies and imaging for staging and surveillance.


Asunto(s)
Melanoma , Neoplasias Cutáneas , Biopsia , Humanos , Melanoma/diagnóstico por imagen , Melanoma/patología , Estadificación de Neoplasias , Pronóstico , Neoplasias Cutáneas/diagnóstico por imagen
4.
Croat Med J ; 62(4): 318-327, 2021 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-34472734

RESUMEN

AIMS: To report the outcomes of robot-assisted brain biopsies performed using a novel RONNA G4 system. The system was developed by a research group from the Faculty of Mechanical Engineering and Naval Architecture and a team of neurosurgeons from Dubrava University Hospital, University of Zagreb School of Medicine. METHODS: This prospective study included 49 biopsies analyzed during one year: 23 robotic frameless and 26 frame-based Leksell stereotactic biopsies. We analyzed the presenting symptoms, tumor range and location, postoperative complications, pathohistological diagnosis, diagnostic yield, as well as operation and hospitalization duration. The target point error was calculated to assess the accuracy of the RONNA system. RESULTS: No postoperative mortality, morbidity, or infections were observed. In the frameless robotic biopsy group, only one pathohistological diagnosis was inconclusive. Therefore, the diagnostic yield was 95.6% (22/23), similar to that of the framebased Leksell stereotactic biopsy group (95.1% or 25/26). The average target point error in the frameless robotic biopsy group was 2.15±1.22 mm (range 0.39-5.85). CONCLUSION: The RONNA G4 robotic system is a safe and accurate tool for brain biopsy, although further research warrants a larger patient sample, comparison with other robotic systems, and a systematic analysis of the entry and target point errors.


Asunto(s)
Neoplasias Encefálicas , Procedimientos Quirúrgicos Robotizados , Robótica , Biopsia , Encéfalo/diagnóstico por imagen , Humanos , Neuronavegación , Estudios Prospectivos , Técnicas Estereotáxicas
5.
Anticancer Res ; 41(9): 4401-4405, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34475060

RESUMEN

BACKGROUND/AIM: We previously found in Swedish patients with inflammatory bowel disease (IBD), crypts in symmetric fission (CSF) and in asymmetric fission (CAF). This study aimed to examine CSF and CAF in a cohort of German patients with IBD. PATIENTS AND METHODS: H&E-sections from 106 IBD-patients [59 ulcerative colitis (UC) and 47 Crohn colitis (CCs)] were analysed. RESULTS: A total of 588 crypts in fission (CF) were found; 342 (58.2%) in UC and 246 (41.8%) in CCs. Out of the 505 CAFs found, 304 (60.2%) were recorded in UC, and 201(39.8%) in CCs (p=0.15272). CONCLUSION: Despite that German and Swedish populations reside in disparate geographical regions with different ecological milieus, the proportions of CAF and CSF were similar, thereby suggesting that CAF and CSF develop in IBD independently of the local environmental conditions in the two regions.


Asunto(s)
Colitis Ulcerosa/patología , Colitis/patología , Enfermedad de Crohn/patología , Biopsia , Estudios de Cohortes , Colitis/epidemiología , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Alemania/epidemiología , Humanos , Factores de Riesgo , Suecia/epidemiología
7.
Harefuah ; 160(9): 576-581, 2021 Sep.
Artículo en Hebreo | MEDLINE | ID: mdl-34482669

RESUMEN

INTRODUCTION: Transrectal ultrasound is utilized as an auxiliary tool when performing a prostate biopsy, but its sensitivity and specificity are low. Performing prostate multiparametric magnetic resonance imaging (mp-MRI) before prostate biopsy can increase the probability to detect aggressive prostate cancer while decreasing the probability to detect indolent prostate cancer, thereby assisting in the selection of patients before the biopsy. The Israel Basket of Health Services does not include prostate mpMRI prior to the first prostate biopsy. Our objective was to examine the significance of performing mpMRI before prostate biopsy. METHODS: We retrospectively evaluated the demographic, clinical, and pathological data from men who underwent transrectal biopsy of the prostate in the last 30 months in our institute. In all men with suspicious findings on mpMRI, targeted biopsies were taken in addition to systematic biopsies. We considered cancer as clinically significant if the Gleason sum was 7 or above. Fisher's Exact test was performed for categorical variables and student t-test for continuous variables. RESULTS: Five hundred and sixteen men underwent prostate biopsy; 163(32%) performed prostate mpMRI before the biopsy; 101(25%) performed mpMRI before the first prostate biopsy and 62(59%) before the second or more prostate biopsies. Prostate cancer was detected in 46% of all men (61% in men after mpMRI versus 38% in men without, p<0.0001). In men for whom this was the first prostate biopsy, prostate cancer was detected in 47% (73% in men after mpMRI versus 39% in men without, p<0.0001); and after second or more biopsies 38% (42% in men after mpMRI versus 33% in men without, p=0.4147). Also, there was a statistically significant difference in the detection of clinically significant prostate cancer with mpMRI versus without. CONCLUSIONS: Performing prostate mpMRI before prostate biopsy significantly increases the detection rate of prostate cancer and clinically significant prostate cancer. It should be recommended to perform mpMRI before any prostate biopsy in accordance with the European and American Urology Association, and NCCN guidelines.


Asunto(s)
Imágenes de Resonancia Magnética Multiparamétrica , Neoplasias de la Próstata , Biopsia , Humanos , Biopsia Guiada por Imagen , Israel , Imagen por Resonancia Magnética , Masculino , Próstata/diagnóstico por imagen , Neoplasias de la Próstata/diagnóstico , Estudios Retrospectivos
8.
Nihon Ronen Igakkai Zasshi ; 58(3): 453-458, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-34483173

RESUMEN

AIM: We herein report the safety and usefulness of a kidney biopsy in older elderly patients (≥75 years old). METHODS: A retrospective observational study was conducted in older elderly patients who had received a renal biopsy at the Department of Nephrology, Shimane University Hospital, from January 1, 2008, to December 31, 2018. The native renal biopsy results of 52 later-stage elderly patients were analyzed (29 men and 23 women). RESULTS: The most common indication for a renal biopsy was nephrotic syndrome (n = 22), followed by rapidly progressive glomerulonephritis (n = 12) and asymptomatic urinary abnormalities (n = 12). The most common pathological diagnosis was membranous nephropathy (n = 12), followed by ANCA-associated nephritis (n= 8), minimal change nephrotic syndrome (6 case), membranoproliferative glomerulonephritis (n = 5), IgA nephropathy (n = 4), and diabetic nephropathy (n = 3). The concordance rate between the clinical and pathological diagnoses was 53.8%. The only complication of the renal biopsy was hemorrhaging requiring blood transfusion (1 patient; 1.9%). The hemoglobin level decreased by 0.5±0.05 d/dL after the biopsy. CONCLUSION: The rate of serious complications associated with a renal biopsy was comparable to that in previous reports in younger patient. Renal biopsies can therefore be safely performed even in older elderly patients. The concordance rate of the clinical and pathological diagnoses was about 50%. Therefore, renal biopsies should be performed in older elderly patients when necessary.


Asunto(s)
Glomerulonefritis Membranosa , Enfermedades Renales , Síndrome Nefrótico , Anciano , Biopsia , Femenino , Humanos , Riñón , Masculino , Estudios Retrospectivos
9.
Chest ; 160(3): e279-e283, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34488968

RESUMEN

CASE PRESENTATION: A 24-year-old previously healthy woman was brought to the hospital for acute altered mental status. One week prior to presentation, she had developed a sore throat, nausea, and vomiting. At that time, SARS-CoV-2 polymerase chain reaction and rapid streptococcal pharyngitis test results were both negative. On the day prior to presentation, the patient had developed an erythematous painful rash on her left arm. The following day she was noted to be agitated, combative, and having trouble communicating, prompting ED evaluation. In the ED, the patient was tachycardic to 108 beats/min and tachypneic to 30 breaths/min but normotensive and afebrile. Her initial workup was notable for leukocytosis with bandemia, acute liver injury with coagulopathy, and acute renal failure. She was intubated, transferred to our hospital, and admitted to the MICU. The patient's medical history was notable for obesity and oral contraceptive use. She had no family history of autoimmune, rheumatologic, or hematologic disorders. She was a student and worked part time in retail. She had no recent travel or outdoor exposure. The patient's family was unaware of any tobacco or drug use but did report that she drank socially.


Asunto(s)
Trastornos Mentales/diagnóstico , Salud Mental , Enfermedad Aguda , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Trastornos Mentales/complicaciones , Insuficiencia Multiorgánica/complicaciones , Insuficiencia Multiorgánica/diagnóstico , Adulto Joven
10.
Ned Tijdschr Tandheelkd ; 128(9): 429-433, 2021 Sep.
Artículo en Holandés | MEDLINE | ID: mdl-34490767

RESUMEN

A 41-year-old woman, who was referred with a reddish purple like lesion on the left side of the tongue, appeared to have an angiokeratoma after histopathological examination. Because of the benign character of this lesion and the absence of any complaints, no adjuvant treatment after excisional biopsy was indicated. Angiokeratomas rarely appear as solitary oral lesions. More often they are seen as part of an underlying systemic disease, mostly Fabry disease. Due to widespread skin involvement of angiokeratomas with Fabry disease, referral to a dermatologist is indicated when oral lesions are encountered. Esthetically unpleasing or painful angiokeratomas can be locally excised or treated by laser- or cryotherapy.


Asunto(s)
Angioqueratoma , Neoplasias Cutáneas , Adulto , Angioqueratoma/diagnóstico , Biopsia , Femenino , Humanos , Neoplasias Cutáneas/diagnóstico , Lengua
11.
J Coll Physicians Surg Pak ; 31(9): 1024-1029, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34500515

RESUMEN

OBJECTIVE: To compare the effect of different quantification methods of ADC values in the evaluation of breast lesions and compare contralateral normal breast tissue ADC value by calculating ADC ratios. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Sisli Etfal Training and Research Hospital, Turkey, between February 2019 and December 2020. METHODOLOGY: Two hundred and forty-six breast MRI scans with DWI of the patients with biopsy proven unilateral breast lesions were studied. ADC measurements were done by placing ROI. Two ADC values and two ADC ratios were obtained by different methods. The diagnostic accuracies of these four techniques were compared. RESULTS: Mean ADC values and ratios of benign and malignant lesions were statistically significant in all of four methods to quantify ADC (p< 0.001). Highest positive value and negative predictive value, and diagnostic accuracy rates were achieved when the most restricted part ADC value was calculated. However; highest sensitivity rate and negative predictive value were achieved by calculating the ratio of darkest point ADC to contralateral breast tissue. Positive predictive value, negative predictive value, and diagnostic accuracy rate of calculated ADC values and ratios were higher when lesions were larger than the mean size (3.15 mm2). CONCLUSION: Highest diagnostic accuracy rate was obtained with most restricted part ADC value. Obtained ratios by calculating contralateral breast tissue ADC value did not improve the diagnostic accuracy rate. Positive and negative predictive values and diagnostic accuracy rates of ADC values and ratios increased as the lesion size increased. Key Words: Breast mass, Diffusion weighted imaging, ADC value, ADC ratio, Normalised ADC.


Asunto(s)
Neoplasias de la Mama , Imagen de Difusión por Resonancia Magnética , Biopsia , Mama/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad
12.
Pathologe ; 42(5): 509-523, 2021 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-34415383

RESUMEN

BACKGROUND: In Germany pancreas transplants are performed in only a few selected and specialized centres, usually combined with a kidney transplant. Knowlegde of the indications for and techniques of transplantation as well as of the histopathological assessment for rejection in pancreas and duodenal biopsies is not very widespread. AIM: To give an overview of the development and status quo in pancreas-kidney-transplantation in Germany summarizing the experience of the largest German pancreas transplant centre and to give a résumé of the results of histological diagnoses of biopsy specimens submitted between 06/2017 and 12/2020. Moreover, a detailed description and illustration of histological findings is included. MATERIAL AND METHODS: A thorough literature search for aspects of the history, technique and indication for pancreas transplantation was performed and discussed in the context of the local experience and technical particularities specific for the transplant centre in Bochum. The occurrence of complications was compared with international reports. Results of pancreas and duodenal biopsies submitted to Erlangen between 06/2017 and 12/2020 for histological evaluation, which were evaluated according to the Banff classification, were summarized. For a better understanding key histological findings of pancreas rejection and differential diagnoses were illustrated and discussed. RESULTS: A total of 93 pancreas transplant specimens and 3 duodenal biopsies were included. 34.4% of pancreas specimens did not contain representative material for a diagnosis. In the remaining 61 biopsies 24.6% showed no rejection, 62.3% were diagnosed with acute T-cell mediated rejection (TCMR) and 8.2% with signs suspicious of antibody-mediated rejection (ABMR). Acute acinary epithelial injury was seen in 59%, pancreatitis in 8.2% and allograft fibrosis was reported in as many as 54.1%. Calcineurin-inhibitor toxicity was discussed in only 4.9%. CONCLUSION: Pancreas-kidney-transplantation and standardized histological assessment of the transplanted pancreas or rarely duodenum with reporting according to the updated Banff classification of pancreas transplants or previous reports of duodenal rejection are important mainstays in the management of patients with diabetes.


Asunto(s)
Trasplante de Riñón , Trasplante de Páncreas , Biopsia , Rechazo de Injerto , Humanos , Riñón
13.
Microb Pathog ; 159: 105125, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34371109

RESUMEN

The clinical diagnosis of Acute Invasive Fungal Rhinosinusitis (AIFRS) is technically difficult because it presents with non-exclusive and nonspecific clinical symptoms. Laboratory confirmation (usually via histopathologic techniques such as formalin-fixed paraffin-embedded (FFPE)) is necessary but it is time-consuming, despite the urgent need for timely diagnosis of AIFRS for effective management. This study aimed to investigate the sensitivity and specificity of the GMS frozen-section biopsy in the diagnosis of AIFRS and compare the same with that of different tissue staining methods to provide valid decision-grounds that may guide clinicians in prompt diagnosis of acute fungal invasive rhinosinusitis. A cross-sectional study was conducted in the Medical Mycology Laboratory, Faculty of Medicine, Iran University of Medical Sciences between 2018 and 2020 on 200 patients with suspected AIFRS referred to Baqiyatallah and Imam Khomeini Hospital, Tehran. All patients were subjected to diagnostic nasal endoscopy and computed tomography (CT) scan of paranasal sinuses. Magnetic resonance imaging (MRI) was done in cases of suspected intracranial extension. After screening by routine mycological examination, the diagnosis was confirmed using complementary molecular methods. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the frozen-section biopsy were also compared with FFPE. Of the 200 suspect patients, 47 cases (23.5%) met the criteria for AIFRS. Species of the genus Aspergillus were the predominant 27 (57.4%) followed by Mucorales species 10 (21.3%), and Fusarium spp 3 (6.4%). Also, 3 cases (6.4%) of co-infection due to Aspergillus/Rhizopus were reported. The accuracy, sensitivity, specificity, PPV, and NPV of frozen section assessments were 99.5%, 97.9%, 100%, 100% and 99.3%, respectively. For GMS frozen-section alone, sensitivity, specificity, NPV, and PPV was 100%. Overall, the calculated accuracy of FFPE was 98.5%, sensitivity was 94%, specificity was 100%, PPV was 100%, and NPV was 98.1%. Examination of the frozen-section biopsy is a highly predictive tool for a rapid and effective diagnosis of patients with suspected AIFRS. We observed that GMS frozen-section is a fast and reliable exam to confirm the diagnosis of fungal invasion, with good accuracy, sensitivity, and specificity compared to the gold-standard FFPE biopsy.


Asunto(s)
Secciones por Congelación , Sinusitis , Biopsia , Estudios Transversales , Humanos , Irán , Sensibilidad y Especificidad , Sinusitis/diagnóstico
14.
Curr Urol Rep ; 22(9): 43, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34357476

RESUMEN

PURPOSE OF REVIEW: The goal of this paper is to evaluate the use of an office-based renal mass biopsy (RMB), whose feasibility could represent a paradigm shift in clinical practice. RECENT FINDINGS: Despite the earlier diagnosis of patients with renal masses, the lack of evidence showing a reduction in cancer-specific mortality warrants an examination in treatment practices. RMB is underutilized when compared to biopsy practice for all other neoplasms in every other solid organ (except testis), and the majority of RMB performed are outsourced to interventional radiologists. Performing an ultrasound-guided, office-based RMB is safe, reproducible, and has a meaningful impact on management decisions. The use of percutaneous RMB in clinical practice is growing, and the use of RMB has meaningful impact on management decisions for renal masses. Incorporating ultrasound-guided biopsy of a renal mass into clinical practice is feasible, and in contemporary practice, the urologist has the skill set to perform the procedure reliably, with low morbidity, and with minimal patient discomfort.


Asunto(s)
Neoplasias Renales , Riñón , Biopsia , Humanos , Biopsia Guiada por Imagen , Neoplasias Renales/cirugía , Masculino , Nefrectomía
15.
BMC Nephrol ; 22(1): 278, 2021 08 10.
Artículo en Inglés | MEDLINE | ID: mdl-34376184

RESUMEN

BACKGROUND: The recent COVID-19 pandemic has raised concerns about patient diagnosis and follow-up of chronically ill patients. Patients suffering from chronic illnesses, concomitantly infected by SARS-CoV-2, globally tend to have a worse prognosis and poor outcomes. Renal tropism and acute kidney injury following SARS-CoV-2 infection has recently been described in the literature, with elevated mortality rates. Furthermore, patients with pre-existing chronic kidney disease, infected by SARS-CoV-2, should be monitored carefully. Here, we report the case of a 69-year-old patient with splenic marginal zone lymphoma, suffering from longstanding chronic kidney disease following SARS-CoV-2 infection. CASE PRESENTATION: A 69-year-old male patient previously diagnosed with pulmonary embolism and splenic marginal zone lymphoma (Splenomegaly, Matutes 2/5, CD5 negative and CD23 positive), was admitted to the hospital with shortness of breath, fever and asthenia. A nasopharyngeal swab test was performed in addition to a CT-scan, which confirmed SARS-CoV-2 infection. Blood creatinine increased following SARS-CoV-2 infection at 130 µmol/l, with usual values at 95 µmol/l. The patient was discharged at home with rest and symptomatic medical treatment (paracetamol and hydration), then readmitted to the hospital in August 2020. A kidney biopsy was therefore conducted as blood creatinine levels were abnormally elevated. Immunodetection performed in a renal biopsy specimen confirmed co-localization of SARS-CoV2 nucleocapsid and protease 3C proteins with ACE2, Lewis x and sialyl-Lewis x antigens in proximal convoluted tubules and podocytes. Co-localization of structural and non-structural viral proteins clearly demonstrated viral replication in proximal convoluted tubules in this chronically ill patient. Additionally, we observed the co-localization of sialyl-Lewis x and ACE2 receptors in the same proximal convoluted tubules. Reverse Transcriptase-Polymerase Chain Reaction test performed on the kidney biopsy was negative, with very low Ct levels (above 40). The patient was finally readmitted to the haematology department for initiation of chemotherapy, including CHOP protocol and Rituximab. CONCLUSIONS: Our case emphasizes on the importance of monitoring kidney function in immunosuppressed patients and patients suffering from cancer following SARS-CoV-2 infection, through histological screening. Further studies will be required to decipher the mechanisms underlying chronic kidney disease and the putative role of sialyl-Lewis x and HBGA during SARS-CoV-2 infection.


Asunto(s)
COVID-19/complicaciones , Túbulos Renales/virología , Insuficiencia Renal Crónica/virología , SARS-CoV-2/fisiología , Replicación Viral , Anciano , Enzima Convertidora de Angiotensina 2/análisis , Biopsia , COVID-19/sangre , COVID-19/diagnóstico , Proteínas de la Nucleocápside de Coronavirus/análisis , Creatinina/sangre , Humanos , Riñón/química , Riñón/patología , Riñón/virología , Túbulos Renales/química , Túbulos Renales/patología , Antígeno Lewis X/análisis , Linfoma de Células B de la Zona Marginal/complicaciones , Masculino , Insuficiencia Renal Crónica/patología , Antígeno Sialil Lewis X/análisis , Neoplasias del Bazo/complicaciones
16.
BMJ Case Rep ; 14(8)2021 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-34389586

RESUMEN

Solitary fibrous tumours (SFTs) are rare neoplasms derived from mesenchymal cell lines. They are often asymptomatic, follow an indolent growth pattern and are more often benign than malignant. Here, we present a case of a very large, asymptomatic mediastinal SFT in an otherwise healthy man. A 67-year-old Irish man was referred for workup of an asymptomatic murmur. Auscultation of the lung fields revealed diminished breath sounds on the right side. Chest X-ray identified a 20 cm mass localised within the thorax. CT of the thorax confirmed a pleural based, solid lesion with no local invasion. CT-guided core biopsies were reported as consistent with SFT. Primary excision of the lesion was undertaken via median sternotomy. Histological examination confirmed a diagnosis of SFT. The patient remains well at this time. Primary excisive surgery is a safe and effective treatment modality for SFTs.


Asunto(s)
Mediastino , Tumores Fibrosos Solitarios , Anciano , Biopsia , Humanos , Masculino , Radiografía , Tumores Fibrosos Solitarios/diagnóstico por imagen , Tumores Fibrosos Solitarios/cirugía
18.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-34413040

RESUMEN

Management of an uncorrected broncho-oesophageal fistula in the perioperative period is a challenge for the anaesthesiologist. Positive pressure ventilation which is inevitable during surgery will lead to gastric insufflation and there is a high risk of aspiration of gastric contents. In this case report, we discuss how we used a double lumen tube to occlude a pericarinal broncho-oesophageal fistula. This method was quite effective as it obviated the need for isolating the lung as well as ensured smooth delivery of positive pressure ventilation during the surgery.


Asunto(s)
Anestésicos , Fístula Bronquial , Fístula Esofágica , Biopsia , Fístula Bronquial/cirugía , Fístula Esofágica/cirugía , Humanos
19.
Zhonghua Zhong Liu Za Zhi ; 43(8): 817-820, 2021 Aug 23.
Artículo en Chino | MEDLINE | ID: mdl-34407584

RESUMEN

Breast-conserving surgery (BCS) has now become one of the optimal surgical choices for early invasive breast cancer. The pathological diagnosis of margin in breast-conserving specimen is very important. There is no acknowledge on the approaches of pathological biopsy and safety margin diagnosis of breast conserving surgery. This paper will compare the biopsy and diagnosis methods of breast-conserving surgery specimens between Tianjin Medical University Cancer Institute and Hospital in China and MD Anderson Cancer Center in the United States. We summarize our biopsy method and diagnostic criteria to explore how to accurately evaluate the margin of breast-conserving surgery specimen from a pathological point of view, and to escort a successful breast-conserving surgery.


Asunto(s)
Neoplasias de la Mama , Biopsia , Mama/cirugía , Neoplasias de la Mama/cirugía , Femenino , Humanos , Márgenes de Escisión , Mastectomía Segmentaria
20.
Adv Gerontol ; 34(3): 404-408, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-34409819

RESUMEN

At this moment differential diagnostic of the prostate cancer (PC) needs the new, more effective ways with regard of multifactor analysis. One of this factor is patient's age. Men older than 45 years old have expressed involution changes of prostate tissues. This fact must be take into account in valuation morphologic and laboratory criteria's in PC. The goal of the investigation is to take into account age-related changes of the prostate volume and laboratory criteria of blood analysis in PC. 632 patients in age from 42 to 88 years old were exanimated by trans rectal ultrasound examination (TRUS) method (volume parameters of the prostate) and by levels of prostate-specific antigen (PSA) and (-2) pro-PSA in blood. The increase of patient's age correlated with increase of the density of transient, peripheral and central zones of prostate. It correlates with the probability of the frequency of PC verification. Levels of PSA and 2-pro-PSA in blood of PC patients increase during the transition from middle to elderly age in 1,4-2,8 times. Thus the information, which was obtained during the examination of volume prostate characteristics by TRUS method and laboratory diagnostic of PC, must take to account patient's age.


Asunto(s)
Antígeno Prostático Específico , Neoplasias de la Próstata , Anciano , Anciano de 80 o más Años , Biopsia , Humanos , Masculino , Neoplasias de la Próstata/diagnóstico , Ultrasonografía
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