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1.
Radiographics ; 40(6): 1574-1599, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33001783

RESUMEN

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. The infection has been reported in most countries around the world. As of August 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. It has become apparent that although COVID-19 predominantly affects the respiratory system, many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease, as well as its related complications, and proper utilization and interpretation of imaging examinations is crucial. With the growing global COVID-19 outbreak, a comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystemic involvement, and evolution of imaging findings is essential for effective patient management and treatment. To date, only a few articles have been published that comprehensively describe the multisystemic imaging manifestations of COVID-19. The authors provide an inclusive system-by-system image-based review of this life-threatening and rapidly spreading infection. In part 1 of this article, the authors discuss general aspects of the disease, with an emphasis on virology, the pathophysiology of the virus, and clinical presentation of the disease. The key imaging features of the varied pathologic manifestations of this infection that involve the pulmonary and peripheral and central vascular systems are also described. Part 2 will focus on key imaging features of COVID-19 that involve the cardiac, neurologic, abdominal, dermatologic and ocular, and musculoskeletal systems, as well as pediatric and pregnancy-related manifestations of the virus. Vascular complications pertinent to each system will be also be discussed in part 2. Online supplemental material is available for this article. ©RSNA, 2020.


Asunto(s)
Betacoronavirus/fisiología , Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Tromboembolia/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Angiografía/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Síndrome de Liberación de Citoquinas/etiología , Síndrome de Liberación de Citoquinas/fisiopatología , Progresión de la Enfermedad , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Inflamación , Peptidil-Dipeptidasa A/fisiología , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/virología , Arteria Pulmonar/diagnóstico por imagen , Receptores Virales/fisiología , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico por imagen , Síndrome de Dificultad Respiratoria del Adulto/etiología , Evaluación de Síntomas , Tromboembolia/sangre , Tromboembolia/etiología , Trombosis/sangre , Trombosis/etiología , Microangiopatías Trombóticas/diagnóstico por imagen , Microangiopatías Trombóticas/etiología , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos
2.
J Med Imaging Radiat Oncol ; 64(5): 649-659, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33000560

RESUMEN

To describe the chest CT features reported in children with confirmed COVID-19 infection, published in English literature. A systematic review was completed on PubMed, Embase and Scopus databases on the 1st of June 2020 using the PICO strategy. The NIH Quality Assessment Tool was used to assess the quality of the selected articles. The systematic review was evaluated by Case Series Studies and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA). The extracted data were assessed and compared with those reported in the adult population. Seventy-two articles were retrieved from the database search and screened by the title, abstract and keywords. Eleven articles were deemed eligible for full-text assessment. Nine articles were included for the data extraction and in the final analysis. Chest CT features in children with COVID-19 differ from those in adults. 'Ground-grass opacities' (GGOs) are the most commonly described abnormalities, but closely followed by a combination of GGO and consolidation, not usual in adults. Children tend to have a more variable involvement than the subpleural and posterior and basal topography described in adults. Interlobular thickening and air bronchogram found in adults with COVID-19 are not frequent in children. Pulmonary embolism reported in up to 30% of adults has not been yet reported in children. Original articles describing chest CT features in children with COVID-19 in the English literature are limited to small populations of Chinese children. Chest CT imaging features are very diverse across the selected studies and globally different from those reported in adults. Data from children of different countries would provide a more comprehensive description of chest CT features in children with COVID-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/virología , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Betacoronavirus , Niño , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Humanos , Pandemias , Neumonía Viral/diagnóstico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa
3.
Eur J Med Res ; 25(1): 49, 2020 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-33046116

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) has brought a global disaster. Quantitative lesions may provide the radiological evidence of the severity of pneumonia and further to assess the effect of comorbidity on patients with COVID-19. METHODS: 294 patients with COVID-19 were enrolled from February, 24, 2020 to June, 1, 2020 from six centers. Multi-task Unet network was used to segment the whole lung and lesions from chest CT images. This deep learning method was pre-trained in 650 CT images (550 in primary dataset and 100 in test dataset) with COVID-19 or community-acquired pneumonia and Dice coefficients in test dataset were calculated. 50 CT scans of 50 patients (15 with comorbidity and 35 without comorbidity) were random selected to mark lesions manually. The results will be compared with the automatic segmentation model. Eight quantitative parameters were calculated based on the segmentation results to evaluate the effect of comorbidity on patients with COVID-19. RESULTS: Quantitative segmentation model was proved to be effective and accurate with all Dice coefficients more than 0.85 and all accuracies more than 0.95. Of the 294 patients, 52 (17.7%) patients were reported having at least one comorbidity; 14 (4.8%) having more than one comorbidity. Patients with any comorbidity were older (P < 0.001), had longer incubation period (P < 0.001), were more likely to have abnormal laboratory findings (P < 0.05), and be in severity status (P < 0.001). More lesions (including larger volume of lesion, consolidation, and ground-glass opacity) were shown in patients with any comorbidity than patients without comorbidity (all P < 0.001). More lesions were found on CT images in patients with more comorbidities. The median volumes of lesion, consolidation, and ground-glass opacity in diabetes mellitus group were largest among the groups with single comorbidity that had the incidence rate of top three. CONCLUSIONS: Multi-task Unet network can make quantitative CT analysis of lesions to assess the effect of comorbidity on patients with COVID-19, further to provide the radiological evidence of the severity of pneumonia. More lesions (including GGO and consolidation) were found in CT images of cases with comorbidity. The more comorbidities patients have, the more lesions CT images show.


Asunto(s)
Algoritmos , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Procesamiento de Imagen Asistido por Computador/métodos , Pulmón/diagnóstico por imagen , Neumonía Viral/epidemiología , Neumonía/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía/epidemiología , Neumonía Viral/diagnóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos
5.
Urol Clin North Am ; 47(4): 457-467, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33008496

RESUMEN

Biochemically recurrent prostate cancer represents a stage of prostate cancer where conventional (continued on next page) computed tomography and technetium Tc 99m bone scan imaging are unable to detect disease after curative intervention despite rising prostate-specific antigen. There is no clear standard of care and no systemic therapy has been shown to improve survival. Immunotherapy-based treatments potentially are attractive options relative to androgen deprivation therapy due to the generally more favorable side-effect profile. Biochemically recurrent prostate cancer patients have a low tumor burden and likely lymph node-based disease, which may make them more likely to respond to immunotherapy.


Asunto(s)
Antagonistas de Andrógenos/uso terapéutico , Inmunoterapia/métodos , Recurrencia Local de Neoplasia/terapia , Neoplasias de la Próstata/patología , Anciano , Terapia Combinada , Supervivencia sin Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Selección de Paciente , Pronóstico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/terapia , Medición de Riesgo , Rol , Análisis de Supervivencia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
6.
BMC Pregnancy Childbirth ; 20(1): 587, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023500

RESUMEN

BACKGROUND: There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and Severe Acute Respiratory Syndrome (SARS) Coronavirus (COV) 2 (SARS-COV-2) infection. We do not just face new and unknown manifestations, but also how different patient groups are affected by SARS-COV-2 infection, such as pregnant women. Coronavirus Disease 2019 (COVID-19), preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. CASE PRESENTATION: A 35-year-old pregnant woman was admitted for tonic-clonic seizures and SARS-COV-2 infection. She had a normal pregnancy control and no other symptoms before tonic-clonic seizures development. After a Caesarean section (C-section) she developed high blood pressure, and we initiated antihypertensive treatment with labetalol, amlodipine and captopril. Few hours later she developed symptoms of cortical blindness that resolved in 72 h with normal brain computed tomography (CT) angiography. CONCLUSION: The authors conclude that SARS COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.


Asunto(s)
Antihipertensivos/administración & dosificación , Betacoronavirus/aislamiento & purificación , Ceguera Cortical , Cesárea/métodos , Infecciones por Coronavirus , Eclampsia , Fibrinolíticos/administración & dosificación , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Convulsiones , Adulto , Ceguera Cortical/diagnóstico , Ceguera Cortical/virología , Encéfalo/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Eclampsia/diagnóstico , Eclampsia/terapia , Eclampsia/virología , Femenino , Humanos , Examen Neurológico/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/etiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Resultado del Embarazo , Convulsiones/diagnóstico , Convulsiones/etiología , Convulsiones/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
7.
J Med Case Rep ; 14(1): 191, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028403

RESUMEN

BACKGROUND: Determining the infectiousness of patients with coronavirus disease 2019 is crucial for patient management. Medical staff usually refer to the results of reverse transcription polymerase chain reaction tests in conjunction with clinical symptoms and computed tomographic images. CASE PRESENTATION: We report a case of a 62-year-old Japanese man who twice had positive and negative test results by polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 over 48 days of hospitalization, including in intensive care. His respiratory symptoms and computed tomographic imaging findings consistent with coronavirus disease 2019 improved following initial intensive care, and the result of his polymerase chain reaction test became negative 3 days before discharge from the intensive care unit. However, 4 days after this first negative result, his polymerase chain reaction test result was positive again, and another 4 days later, he had a negative result once more. Eight days after the second polymerase chain reaction negative test result, the patient's test result again became positive. Finally, his polymerase chain reaction results were negative 43 days after his first hospitalization. CONCLUSIONS: This case emphasizes the importance of repeat polymerase chain reaction testing and diagnosis based on multiple criteria, including clinical symptoms and computed tomographic imaging findings. Clinical staff should consider that a negative result by polymerase chain reaction does not necessarily certify complete coronavirus disease 2019 recovery.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral , Evaluación de Síntomas/métodos , Toma de Decisiones Clínicas , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Reacciones Falso Negativas , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
8.
Sci Rep ; 10(1): 16942, 2020 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-33037291

RESUMEN

The use of imaging data has been reported to be useful for rapid diagnosis of COVID-19. Although computed tomography (CT) scans show a variety of signs caused by the viral infection, given a large amount of images, these visual features are difficult and can take a long time to be recognized by radiologists. Artificial intelligence methods for automated classification of COVID-19 on CT scans have been found to be very promising. However, current investigation of pretrained convolutional neural networks (CNNs) for COVID-19 diagnosis using CT data is limited. This study presents an investigation on 16 pretrained CNNs for classification of COVID-19 using a large public database of CT scans collected from COVID-19 patients and non-COVID-19 subjects. The results show that, using only 6 epochs for training, the CNNs achieved very high performance on the classification task. Among the 16 CNNs, DenseNet-201, which is the deepest net, is the best in terms of accuracy, balance between sensitivity and specificity, [Formula: see text] score, and area under curve. Furthermore, the implementation of transfer learning with the direct input of whole image slices and without the use of data augmentation provided better classification rates than the use of data augmentation. Such a finding alleviates the task of data augmentation and manual extraction of regions of interest on CT images, which are adopted by current implementation of deep-learning models for COVID-19 classification.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico , Redes Neurales de la Computación , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Inteligencia Artificial , Betacoronavirus , Manejo de Datos , Bases de Datos Factuales , Humanos , Procesamiento de Imagen Asistido por Computador , Pulmón/diagnóstico por imagen , Pulmón/patología , Pandemias
9.
Crit Care ; 24(1): 619, 2020 10 21.
Artículo en Inglés | MEDLINE | ID: mdl-33087155

RESUMEN

BACKGROUND: Subtraction CT angiography (sCTA) is a technique used to evaluate pulmonary perfusion based on iodine distribution maps. The aim of this study is to assess lung perfusion changes with sCTA seen in patients with COVID-19 pneumonia and correlate them with clinical outcomes. MATERIAL AND METHODS: A prospective cohort study was carried out with 45 RT-PCR-confirmed COVID-19 patients that required hospitalization at three different hospitals, between April and May 2020. In all cases, a basic clinical and demographic profile was obtained. Lung perfusion was assessed using sCTA. Evaluated imaging features included: Pattern predominance of injured lung parenchyma in both lungs (ground-glass opacities, consolidation and mixed pattern) and anatomical extension; predominant type of perfusion abnormality (increased perfusion or hypoperfusion), perfusion abnormality distribution (focal or diffuse), extension of perfusion abnormalities (mild, moderate and severe involvement); presence of vascular dilatation and vascular tortuosity. All participants were followed-up until hospital discharge searching for the development of any of the study endpoints. These endpoints included intensive-care unit (ICU) admission, initiation of invasive mechanical ventilation (IMV) and death. RESULTS: Forty-one patients (55.2 ± 16.5 years, 22 men) with RT-PCR-confirmed SARS-CoV-2 infection and an interpretable iodine map were included. Patients with perfusion anomalies on sCTA in morphologically normal lung parenchyma showed lower Pa/Fi values (294 ± 111.3 vs. 397 ± 37.7, p = 0.035), and higher D-dimer levels (1156 ± 1018 vs. 378 ± 60.2, p < 0.01). The main common patterns seen in lung CT scans were ground-glass opacities, mixed pattern with predominant ground-glass opacities and mixed pattern with predominant consolidation in 56.1%, 24.4% and 19.5% respectively. Perfusion abnormalities were common (36 patients, 87.8%), mainly hypoperfusion in areas of apparently healthy lung. Patients with severe hypoperfusion in areas of apparently healthy lung parenchyma had an increased probability of being admitted to ICU and to initiate IMV (HR of 11.9 (95% CI 1.55-91.9) and HR 7.8 (95% CI 1.05-61.1), respectively). CONCLUSION: Perfusion abnormalities evidenced in iodine maps obtained by sCTA are associated with increased admission to ICU and initiation of IMV in COVID-19 patients.


Asunto(s)
Medios de Contraste , Infecciones por Coronavirus/diagnóstico por imagen , Yodo , Imagen de Perfusión/métodos , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos
10.
Artículo en Inglés | MEDLINE | ID: mdl-33053145

RESUMEN

Coronavirus Disease 2019 (COVID-19) has rapidly spread worldwide. Numerous studies have shown its typical and atypical CT findings. We report one COVID-19 patient who presented with a transient pneumothorax, spontaneous pneumomediastinum (SP), as well as subcutaneous emphysema during hospitalization. Chest CT andclinical findings were discussed, and a literature review is presented. The probable cause of SP in COVID-19 was alveolar damage. Once pneumothorax and SP were present, the patient should be carefully monitored to prevent respiratory deterioration, especially when lung lesions are severe.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Enfisema Mediastínico/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico , Neumotórax/diagnóstico por imagen , Enfisema Subcutáneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Betacoronavirus , Humanos
11.
Nat Commun ; 11(1): 4968, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33009413

RESUMEN

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread to become a worldwide emergency. Early identification of patients at risk of progression may facilitate more individually aligned treatment plans and optimized utilization of medical resource. Here we conducted a multicenter retrospective study involving patients with moderate COVID-19 pneumonia to investigate the utility of chest computed tomography (CT) and clinical characteristics to risk-stratify the patients. Our results show that CT severity score is associated with inflammatory levels and that older age, higher neutrophil-to-lymphocyte ratio (NLR), and CT severity score on admission are independent risk factors for short-term progression. The nomogram based on these risk factors shows good calibration and discrimination in the derivation and validation cohorts. These findings have implications for predicting the progression risk of COVID-19 pneumonia patients at the time of admission. CT examination may help risk-stratification and guide the timing of admission.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Progresión de la Enfermedad , Neumonía Viral/diagnóstico , Neumonía , Tomografía Computarizada por Rayos X/métodos , Adulto , Betacoronavirus , China , Técnicas de Laboratorio Clínico , Coinfección , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/fisiopatología , Femenino , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Linfocitos , Masculino , Persona de Mediana Edad , Neutrófilos , Pandemias , Neumonía Viral/patología , Neumonía Viral/fisiopatología , Análisis de Regresión , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
12.
Medicine (Baltimore) ; 99(40): e22534, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019459

RESUMEN

RATIONALE: Foreign bodies are frequently ingested, but only approximately 1% of them cause perforation. Perforations in the lesser curvature of the stomach are exceedingly rare. Here, we report a case of gastric perforation in the lesser curvature caused by a foreign body. The patient presented to the clinic complaining of abdominal skin swelling and reddening with upper abdominal discomfort as the initial symptoms. PATIENT CONCERNS: An 83-year-old female presented with a mass in the middle of the epigastrium for 10 days. Physical examination found an apparent local tenderness and inflammatory mass in the upper abdominal wall. Her body temperature was normal (37.5°C) and the white blood cell count was elevated (8.12 × 10/L [reference value 3.5-9.5 × 10/L]). DIAGNOSES: The ultrasound examination of the abdomen revealed a 4 cm strip-like hyperechoic object entangled in the muscles of the abdominal wall. The computed tomography scan revealed a thin strip of bone-like hyperdense shadow. Intraoperative findings showed a sharp fishbone protruding from the lesser curvature of the stomach into the abdominal cavity, part of which remained in the gastric cavity. The postoperative pathological report revealed chronic suppurative inflammation with abscess and sinus canal formation. INTERVENTIONS & OUTCOMES: The patient underwent a gastric foreign body removal with partial gastrectomy. Anti-inflammatory treatment post-surgery rapidly relieved the patient's symptoms of discomfort in the upper abdomen. At the 1-month follow-up, the patient showed no discomfort in the upper abdomen and the inflammatory mass was no longer present. LESSONS: A foreign body had penetrated through the lesser curvature of the stomach, an area with a flat gastric wall, which occurs infrequently. In such cases, computed tomography is the gold standard for diagnosis of foreign bodies in the digestive tract. Ultrasound can also be used as a supplemental diagnostic technique. It is recommended that people who wear dentures should exercise caution while eating, especially when the food contains bones.


Asunto(s)
Pared Abdominal/patología , Cuerpos Extraños/cirugía , Inflamación/etiología , Piel/patología , Estómago/cirugía , Cuidados Posteriores , Anciano de 80 o más Años , Huesos , Ingestión de Alimentos , Femenino , Cuerpos Extraños/diagnóstico por imagen , Humanos , Alimentos Marinos , Perforación Espontánea , Estómago/microbiología , Estómago/patología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Ultrasonografía/métodos
13.
Medicine (Baltimore) ; 99(40): e22535, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019460

RESUMEN

RATIONALE: Adolescent wrist trauma can cause epiphyseal dysplasia and even distal radius deformity malunion. At present, there is no uniform treatment standard for the malunion of the distal radius of adolescents. Osteotomy and autologous bone grafting are currently one of the effective ways to treat the disease. We treated an adolescent patient with distal radius deformity malunion, and used this surgical method to treat the patient and achieved satisfactory results. PATIENT CONCERNS: A 16-year-old boy suffered from a serious distal radius deformity after trauma of the left wrist 8 years ago. DIAGNOSES: Physical examination, X-rays examination, high-resolution computed tomography scan, and 3-dimensional reconstruction images of the affected limb helped us diagnose the distal radius fracture malunion. INTERVENTIONS: The fracture malunion was treated by osteotomy and autologous iliac bone grafting. OUTCOMES: At the 2-year follow-up, wrist flexion returned to 68°, wrist dorsiflexion to 55°, radial deviation to 14°, ulnar deviation to 12°, forearm pronation to 75°, supination to 67°. Grip strength increased to 35.1 kg after 2 years of operation, recovered to 87% of the uninjured side. Quick DASH score at 2-year follow-up was 9. No complication, such as nonunion or infection, was observed. LESSONS: This rare case provides valuable insights for hand surgeons. High-resolution computed tomography scan and 3-dimensional reconstruction can help us effectively diagnose wrist diseases. Small lesions on the articular surface of the distal radius will change the position and function of the wrist joint, and cause traumatic arthritis of the wrist joint. Therefore, it is very important to reconstruct the normal structure of the distal radius articular surface. Osteotomy and autologous iliac bone grafting are effective treatments for serious distal radius fracture malunion in the adolescent patient. During the operation, care should be taken to protect the osteoepiphysis to avoid bone dysplasia.


Asunto(s)
Fracturas Mal Unidas/cirugía , Osteotomía/métodos , Fracturas del Radio/complicaciones , Trasplante Autólogo/métodos , Adolescente , Cuidados Posteriores , Trasplante Óseo/métodos , Fracturas Mal Unidas/diagnóstico por imagen , Humanos , Ilion/trasplante , Procesamiento de Imagen Asistido por Computador/instrumentación , Masculino , Radiografía/métodos , Rango del Movimiento Articular , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Articulación de la Muñeca/fisiología
14.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028572

RESUMEN

A 13-year-old boy presented to hospital with 3-day self-limited fever, followed by dry cough, persistent asthenia and impaired general condition of 2 weeks' duration. Blood analyses showed a severe inflammatory status and chest X-ray images were consistent with bilateral COVID-19 pneumonia. He developed an acute respiratory failure that required paediatric intensive care admission and non-invasive ventilation. A targeted COVID-19 treatment was initiated with hydroxicloroquine, corticosteroids, enoxaparine and a single dose of tocilizumab. Repeated serological tests and real-time reverse transcription PCR for SARS-CoV-2 were negative. Other infectious pathogens were also ruled out. Thoracic high resolution CT showed an intense bilateral pulmonary dissemination with lytic vertebral bone lesions. After diagnostic investigations, Ewing's sarcoma with metastatic pulmonary dissemination was diagnosed. Nowadays, in the context of SARS-CoV-2 community pandemic, we cannot forget that COVID-19 clinical presentation is not specific and other entities can mimic its clinical features.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Neumonía Viral/diagnóstico , Sarcoma de Ewing , Tomografía Computarizada por Rayos X/métodos , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica , Examen de la Médula Ósea/métodos , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/fisiopatología , Neoplasias Pulmonares/secundario , Masculino , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/fisiopatología , Tomografía Computarizada de Emisión de Fotón Único/métodos
15.
BMJ Case Rep ; 13(10)2020 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-33040042

RESUMEN

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.


Asunto(s)
Absceso Encefálico , Infecciones por Coronavirus , Cuidados Críticos/métodos , Diagnóstico Tardío , Fusobacterium necrophorum , Absceso Piógeno Hepático , Nódulos Pulmonares Múltiples , Pandemias , Neumonía Viral , Cuarentena , Enfermedades Dentales , Antibacterianos/administración & dosificación , Anticoagulantes/administración & dosificación , Betacoronavirus , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/etiología , Deterioro Clínico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Diagnóstico Diferencial , Fusobacterium necrophorum/aislamiento & purificación , Fusobacterium necrophorum/patogenicidad , Humanos , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/etiología , Síndrome de Lemierre/fisiopatología , Absceso Piógeno Hepático/diagnóstico por imagen , Absceso Piógeno Hepático/etiología , Absceso Piógeno Hepático/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/etiología , Pandemias/prevención & control , Aceptación de la Atención de Salud , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Cuarentena/métodos , Cuarentena/psicología , Tomografía Computarizada por Rayos X/métodos , Enfermedades Dentales/complicaciones , Enfermedades Dentales/diagnóstico , Enfermedades Dentales/microbiología , Resultado del Tratamiento , Adulto Joven
16.
Pan Afr Med J ; 36: 257, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33014253

RESUMEN

Since asymptomatic infections as "covert transmitter", and some patients can progress rapidly in the short term, it is essential to pay attention to the diagnosis and surveillance of asymptomatic patients with SARS-COV2 infection. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspected or probable asymptomatic cases with negative RT-PCR for SARS-COV2. This study aimed to detect incidentally COVID-19 pneumonia on medical imaging for patients consulting for other reasons.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Dolor Abdominal/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas , Lesiones Encefálicas/complicaciones , Dolor en el Pecho/complicaciones , Niño , Preescolar , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Hallazgos Incidentales , Linfadenopatía/diagnóstico por imagen , Linfadenopatía/etiología , Masculino , Persona de Mediana Edad , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Neumonía Viral/complicaciones , Estudios Prospectivos , Tomografía Computarizada por Rayos X/métodos , Túnez/epidemiología , Adulto Joven
17.
Eur J Gastroenterol Hepatol ; 32(11): 1475-1478, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32925503

RESUMEN

An oligosymptomatic patient with initially exclusively gastrointestinal symptoms (massive nausea and mild pancreatitis) turned out to suffer from COVID-19 during the hospital stay. The patient did not exhibit the typical COVID-symptoms cough or fever despite lung involvement. The gastroenterological diagnostic investigations comprised abdominal ultrasound, gastroscopy and endoscopic ultrasound and first revealed no clear cause of these symptoms. In an abdominal computed tomography (CT) scan, patchy ground-glass opacities in both lungs were discovered and the following chest CT scan and a virus PCR test revealed the right and surprising diagnosis. This case report depicts the clinical course of this atypical case and discusses gastrointestinal COVID-manifestations and clinical consequences as well as consequences of this atypical presentation for disease control.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Enfermedades Gastrointestinales/etiología , Neumonía Viral/complicaciones , Anciano , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Endosonografía , Enfermedades Gastrointestinales/diagnóstico , Gastroscopía , Humanos , Masculino , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Tomografía Computarizada por Rayos X/métodos
18.
Medicine (Baltimore) ; 99(39): e22341, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32991448

RESUMEN

RATIONALE: The Goodpasture syndrome is an extremely rare disease, with renal and pulmonary manifestations, and is mediated by anti-glomerular basement membrane (anti-GBM) antibodies. Renal pathological changes are mainly characterized by glomerular crescent formation and linear immunofluorescent staining for immunoglobulin G on the GBM. There are few reports on the atypical course of the syndrome involving serum-negative anti-GBM antibodies. Therefore, we present a case of Goodpasture syndrome that presented with nephrotic-range proteinuria and was seronegative for anti-GBM antibodies. PATIENT CONCERNS: A 38-year-old Chinese man presented with a lung lesion that was discovered by physical examination a month prior to presentation. The chief concern was occasional hemoptysis without fever, cough, chest pain, and edema. DIAGNOSES: Laboratory testing revealed that the urinary protein level and urine erythrocyte count were 7.4 g/24 hours and 144/high-power field (HPF), respectively. Serological testing for anti-GBM antibodies was negative. Chest computed tomography revealed multiple exudative lesions in both lungs, indicating alveolar infiltration and hemorrhage. Electronic bronchoscopy and pathological examination of the alveolar lavage fluid indicated no abnormalities. However, kidney biopsy suggested cellular crescent formation and segmental necrosis of the globuli, with linear IgG and complement C3 deposition on the GBM. These findings were consistent with the diagnosis of anti-GBM antibody nephritis. INTERVENTIONS: The patient underwent 7 sessions of double filtration plasmapheresis. He was also administered with intravenous methylprednisolone and cyclophosphamide. After renal function stabilization, he was discharged under an immunosuppressive regimen comprising of glucocorticoids and cyclophosphamides. OUTCOMES: Three months later, follow-up examination revealed that the 24-hour urine protein had increased to 13 g. Furthermore, the urine erythrocyte count was 243/HPF. After a 6-month follow-up, the patient achieved partial remission, with a proteinuria level of 3.9 g/24 hours and a urine erythrocyte count of 187/HPF. LESSONS: This extremely rare case of Goodpasture syndrome manifested with seronegativity for anti-GBM antibodies and nephrotic-range proteinuria. Our findings emphasize the importance of renal biopsy for the clinical diagnosis of atypical cases. Furthermore, because renal involvement achieved only partial remission despite therapy, early detection and active treatment of the Goodpasture syndrome is necessary to improve the prognosis of patients.


Asunto(s)
Enfermedad por Anticuerpos Antimembrana Basal Glomerular/complicaciones , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/inmunología , Autoanticuerpos/sangre , Proteinuria/etiología , Administración Intravenosa , Adulto , Cuidados Posteriores , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/terapia , Grupo de Ascendencia Continental Asiática/etnología , Complemento C3/metabolismo , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Quimioterapia Combinada , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Hemoptisis/diagnóstico , Hemorragia/etiología , Hemorragia/patología , Humanos , Inmunoglobulina G/metabolismo , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Riñón/patología , Glomérulos Renales/metabolismo , Glomérulos Renales/patología , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Nefritis/diagnóstico , Nefritis/inmunología , Plasmaféresis/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
19.
Medicine (Baltimore) ; 99(36): e22038, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32899061

RESUMEN

The effectiveness of diethylenetriamine pentaacetic acid scan is regularly monitored for the assessment of any potential modifications in treatment responses or kidney functions in the pediatric population.This study attempts to compare the usefulness of diethylenetriamine pentaacetic acid and ultrasound imaging of renal disorders among paediatric patients.A retrospective observational study was conducted by enrolling 106 children. The demographic details such as: participant's age, gender, and the history of renal disease of each patient were recorded. Patients were administered radiopharmaceuticals in a fixed dose and were later subjected to computed tomography (CT) scan. The obtained data was analysed using descriptive statistics.Findings indicated increased sensitivity for CT (61.20%); whereas, a major decrease in specificity (23.68%) was observed. Comparison of Single-photon emission CT (SPECT) and CT findings revealed the increased sensitivity (90.90%) for ultrasound; whereas, there was a slight decrease in the specificity (40%) for SPECT. However, SPECT findings show 91% sensitivity among patients with 71.42% positive predictive value. Moreover, an increase in sensitivity for CT (61.20%), followed by a major decrease in specificity (23.68%) was observed.Ultrasonography has been proved to be the safest and the most effective method for the diagnosis and the treatment of most renal disorders, due to the higher predictive value of SPECT scans. It is thus suggested that patients with ureteral calculi should be diagnosed with renal scintigraphy and unenhanced helical computerized tomography.


Asunto(s)
Enfermedades Renales/diagnóstico por imagen , Ácido Pentético/administración & dosificación , Cintigrafía/métodos , Ultrasonografía/métodos , Cálculos Ureterales/diagnóstico por imagen , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Enfermedades Renales/fisiopatología , Masculino , Medicina Nuclear/métodos , Valor Predictivo de las Pruebas , Radiofármacos/administración & dosificación , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos X/métodos
20.
Medicine (Baltimore) ; 99(36): e22060, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32899071

RESUMEN

The phase III West Japan Oncology Group (WJOG) 4407G study showed noninferiority of folinic acid, bolus/continuous fluorouracil, and irinotecan plus bevacizumab to modified folinic acid, bolus/continuous fluorouracil, and oxaliplatin 6 plus bevacizumab in progression-free survival (PFS) as first-line chemotherapy for patients with metastatic colorectal cancer. The aim of this study was to evaluate the predictive and prognostic value of morphologic response in patients with colorectal liver metastases (CLM) as a post hoc analysis of the WJOG4407G study.Morphologic response was assessed by comparing contrast-enhanced computed tomography (CT) images at baseline and week 8. Three blinded radiologists evaluated CT images and classified their response as optimal, incomplete, or no response according to the morphologic criteria. Response evaluation criteria in solid tumors (RECIST) response, early tumor shrinkage (ETS), and depth of response (DpR) were also evaluated.Among 395 patients who were eligible for efficacy analysis in the WJOG4407G study, 70 patients had liver-limited disease. We finally evaluated 55 of these patients. Optimal morphologic response was identified in 19 of 55 patients (34.5%). The median PFS was 10.7 months for patients with optimal response and 10.1 months in those with incomplete/no response (log-rank, P = .96). The median overall survival (OS) was 26.2 and 35.5 months, respectively (log-rank, P = .062). According to univariate analysis, morphologic response was not associated with PFS or OS, whereas RECIST response was significantly associated with both PFS and OS, with ETS and DpR being associated with significantly longer PFS.Morphologic response might be neither a predictive nor a prognostic factor in patients with CLM undergoing chemotherapy containing bevacizumab, whereas RECIST response was significantly associated with both PFS and OS.


Asunto(s)
Antineoplásicos Inmunológicos/uso terapéutico , Bevacizumab/uso terapéutico , Neoplasias Colorrectales/patología , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Adulto , Anciano , Antimetabolitos Antineoplásicos , Antineoplásicos Inmunológicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/administración & dosificación , Femenino , Fluorouracilo/uso terapéutico , Humanos , Infusiones Intravenosas/métodos , Irinotecán/uso terapéutico , Japón/epidemiología , Leucovorina/administración & dosificación , Leucovorina/uso terapéutico , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/tratamiento farmacológico , Metástasis de la Neoplasia/patología , Oxaliplatino/uso terapéutico , Valor Predictivo de las Pruebas , Pronóstico , Supervivencia sin Progresión , Criterios de Evaluación de Respuesta en Tumores Sólidos , Tomografía Computarizada por Rayos X/métodos , Inhibidores de Topoisomerasa I/uso terapéutico , Resultado del Tratamiento , Complejo Vitamínico B/administración & dosificación , Complejo Vitamínico B/uso terapéutico
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