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1.
Medicine (Baltimore) ; 100(35): e26774, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34477116

RESUMEN

ABSTRACT: Umbilical Vein Recanalization (UVR) may occur in patients with long-standing portal hypertension and liver cirrhosis. This study aimed to investigate the clinical significance of UVR.Medical records of a cohort of patients with cirrhosis (n = 247) who were hospitalized at the Digestive Medicine Center of the Second Affiliated Hospital of Nanchang University from January 2012 to October 2015 were accessed. The UVR diagnosis was made by ultrasound examination and was confirmed by computerized tomography scan.The UVR incidence was 20.2% (50/247) in the cohort. The size of UVR was 9.9 ±â€Š4.7 mm (range: 5-26.5 mm) in diameter. The UVR and non-UVR groups showed no difference in grades of hepatic encephalopathy (P = .496), Child-Pugh classification (P = .401), the incidence of moderately severe ascites (26% vs 26%, P = 1), the esophageal variceal bleeding rate (32% vs 39%, P = .402), or portal vein thrombosis (8% vs 12%, P = .580). However, the incidence of cavernous transformation of the portal vein was statistically different, that there was 0 case in the UVR group and 8 cases in the non-UVR group (P < .05).Our results suggested that UVR had little impact on the clinical manifestations of patients with liver cirrhosis, the significance of UVR as an intervention method requires further studies.


Asunto(s)
Cateterismo/estadística & datos numéricos , Fibrosis/fisiopatología , Venas Umbilicales , Adulto , Cateterismo/métodos , Femenino , Fibrosis/clasificación , Fibrosis/terapia , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos
2.
Medicine (Baltimore) ; 100(35): e27040, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34477134

RESUMEN

ABSTRACT: To investigate the clinical and pathological characteristics in patients with pulmonary inflammatory pseudotumors (PIP).This retrospective study included 31 patients with PIP from 2001 to 2019. Preoperative computed tomography scan was performed in all patients. Clinical and pathological characteristics were collected and analyzed.Thirty-one patients (16 female and 15 male) were recruited, with a median age of 57 years (range, 11-72 years). Eight (25.8%) patients were asymptomatic, and the others had symptoms characterized by cough with sputum, chest and back pain, dry cough, fever and blood in sputum, or hemoptysis. All cases were single lesions, including 23 cases in the right lung, and 8 cases in the left lung. Computed tomography scan demonstrated irregular lobulated nodules or masses in 14 patients, and regular round or oval nodules or masses in 11 cases. The blurred edge of tumors and spiculation was found in 12 cases. Microscopic results were characterized by the collection of inflammatory mesenchymal cells. Immunohistochemical examination showed vimentin, smooth muscle actin, and anaplastic lymphoma kinase positive. Complete tumor resection was obtained in all cases. No recurrence or metastasis was observed during the follow-up period.PIP has a variety of manifestations. Preoperative diagnosis is difficult to reach. The final diagnosis still depends on the pathological and immunohistochemical examination. Complete surgical resection is the main treatment at present, and the overall prognosis is good.


Asunto(s)
Granuloma de Células Plasmáticas/patología , Adolescente , Adulto , Anciano , Niño , Femenino , Granuloma de Células Plasmáticas/epidemiología , Granuloma de Células Plasmáticas/fisiopatología , Humanos , Pulmón/patología , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Síndrome , Tomografía Computarizada por Rayos X/métodos
3.
Medicine (Baltimore) ; 100(35): e27058, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34477137

RESUMEN

ABSTRACT: The treatment for squamous cell lung cancer (SqCLC) is limited, and the prognosis of SqCLC is poor. In this article, we aimed to analyze and identify immune-related cells and competition endogenous RNA (ceRNA) that influence the prognosis of SqCLC. SqCLC and lung adenocarcinoma data were downloaded from TCGA-GDC. A total of 22 types of immune cell fractions were estimated using CIBERSORT. R software was used to identify any significantly different transcriptome data, including mRNA, LncRNA, and miRNA. The univariate cox regression method was applied to screen for prognosis-related lncRNA, miRNA, mRNA and tumor-infiltrating immune cells. There were 504 patients included in this study. There was a higher proportion of memory activated CD4+ T cells and CD8+ T cells in younger women. Follicular helper T (Tfh) cells were predictive of a good prognosis and reflected immune activation in SqCLC. The SFTA1P/NKX2-1-AS1, hsa-mir-503, GREM2 ceRNA axes and NKX2-1-AS1, hsa-mir-96, PROK2 ceRNA axes were found to be important for the immune function, pathogenesis, and prognosis of SqCLC. Collectively, the immune-related ceRNA and tumor-infiltrating immune cells in SqCLC are likely important determinants of SqCLC pathogenesis, prognosis, and immune status.


Asunto(s)
Neoplasias Pulmonares/inmunología , Neoplasias de Células Escamosas/inmunología , Adolescente , Anciano , Niño , Células Epiteliales/patología , Femenino , Ontología de Genes , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Neoplasias de Células Escamosas/patología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos
4.
Isr Med Assoc J ; 23(9): 550-555, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34472229

RESUMEN

BACKGROUND: Medical imaging and the resultant ionizing radiation exposure is a public concern due to the possible risk of cancer induction. OBJECTIVES: To assess the accuracy of ultra-low-dose (ULD) chest computed tomography (CT) with denoising versus normal dose (ND) chest CT using the Lung CT Screening Reporting and Data System (Lung-RADS). METHODS: This prospective single-arm study comprised 52 patients who underwent both ND and ULD scans. Subsequently AI-based denoising methods were applied to produce a denoised ULD scan. Two chest radiologists independently and blindly assessed all scans. Each scan was assigned a Lung-RADS score and grouped as 1 + 2 and 3 + 4. RESULTS: The study included 30 men (58%) and 22 women (42%); mean age 69.9 ± 9 years (range 54-88). ULD scan radiation exposure was comparable on average to 3.6-4.8% of the radiation depending on patient BMI. Denoising increased signal-to-noise ratio by 27.7%. We found substantial inter-observer agreement in all scans for Lung-RADS grouping. Denoised scans performed better than ULD scans when negative likelihood ratio (LR-) was calculated (0.04--0.08 vs. 0.08-0.12). Other than radiation changes, diameter measurement differences and part-solid nodules misclassification as a ground-glass nodule caused most Lung-RADS miscategorization. CONCLUSIONS: When assessing asymptomatic patients for pulmonary nodules, finding a negative screen using ULD CT with denoising makes it highly unlikely for a patient to have a pulmonary nodule that requires aggressive investigation. Future studies of this technique should include larger cohorts and be considered for lung cancer screening as radiation exposure is radically reduced.


Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Dosis de Radiación , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Exposición a la Radiación
5.
Bone Joint J ; 103-B(9): 1497-1504, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34465153

RESUMEN

AIMS: Type 2 diabetes mellitus (T2DM) impairs bone strength and is a significant risk factor for hip fracture, yet currently there is no reliable tool to assess this risk. Most risk stratification methods rely on bone mineral density, which is not impaired by diabetes, rendering current tests ineffective. CT-based finite element analysis (CTFEA) calculates the mechanical response of bone to load and uses the yield strain, which is reduced in T2DM patients, to measure bone strength. The purpose of this feasibility study was to examine whether CTFEA could be used to assess the hip fracture risk for T2DM patients. METHODS: A retrospective cohort study was undertaken using autonomous CTFEA performed on existing abdominal or pelvic CT data comparing two groups of T2DM patients: a study group of 27 patients who had sustained a hip fracture within the year following the CT scan and a control group of 24 patients who did not have a hip fracture within one year. The main outcome of the CTFEA is a novel measure of hip bone strength termed the Hip Strength Score (HSS). RESULTS: The HSS was significantly lower in the study group (1.76 (SD 0.46)) than in the control group (2.31 (SD 0.74); p = 0.002). A multivariate model showed the odds of having a hip fracture were 17 times greater in patients who had an HSS ≤ 2.2. The CTFEA has a sensitivity of 89%, a specificity of 76%, and an area under the curve of 0.90. CONCLUSION: This preliminary study demonstrates the feasibility of using a CTFEA-based bone strength parameter to assess hip fracture risk in a population of T2DM patients. Cite this article: Bone Joint J 2021;103-B(9):1497-1504.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/etiología , Tomografía Computarizada por Rayos X/métodos , Anciano , Estudios de Casos y Controles , Estudios de Factibilidad , Femenino , Análisis de Elementos Finitos , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad
9.
BMC Infect Dis ; 21(1): 836, 2021 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-34412614

RESUMEN

BACKGROUND: Corona Virus Disease 2019 (COVID-19) is currently a worldwide pandemic and has a huge impact on public health and socio-economic development. The purpose of this study is to explore the diagnostic value of the quantitative computed tomography (CT) method by using different threshold segmentation techniques to distinguish between patients with or without COVID-19 pneumonia. METHODS: A total of 47 patients with suspected COVID-19 were retrospectively analyzed, including nine patients with positive real-time fluorescence reverse transcription polymerase chain reaction (RT-PCR) test (confirmed case group) and 38 patients with negative RT-PCR test (excluded case group). An improved 3D convolutional neural network (VB-Net) was used to automatically extract lung lesions. Eight different threshold segmentation methods were used to define the ground glass opacity (GGO) and consolidation. The receiver operating characteristic (ROC) curves were used to compare the performance of various parameters with different thresholds for diagnosing COVID-19 pneumonia. RESULTS: The volume of GGO (VOGGO) and GGO percentage in the whole lung (GGOPITWL) were the most effective values for diagnosing COVID-19 at a threshold of - 300 HU, with areas under the curve (AUCs) of 0.769 and 0.769, sensitivity of 66.67 and 66.67%, specificity of 94.74 and 86.84%. Compared with VOGGO or GGOPITWL at a threshold of - 300 Hounsfield units (HU), the consolidation percentage in the whole lung (CPITWL) with thresholds at - 400 HU, - 350 HU, and - 250 HU were statistically different. There were statistical differences in the infection volume and percentage of the whole lung, right lung, and lobes between the two groups. VOGGO, GGOPITWL, and volume of consolidation (VOC) were also statistically different at the threshold of - 300 HU. CONCLUSIONS: Quantitative CT provides an image quantification method for the auxiliary diagnosis of COVID-19 and is expected to assist in confirming patients with COVID-19 pneumonia in suspected cases.


Asunto(s)
COVID-19 , Neumonía/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Inteligencia Artificial , Humanos , Estudios Retrospectivos , SARS-CoV-2
10.
Br J Radiol ; 94(1125): 20201380, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34415201

RESUMEN

OBJECTIVE: There is limited and contradictory information about pulmonary perfusion changes detected with dual energy computed tomography (DECT) in COVID-19 cases. The purpose of this study was to define lung perfusion changes in COVID-19 cases with DECT, as well as to reveal any possible links between perfusion changes and laboratory findings. METHODS: Patients who had a positive RT-PCR for SARS-CoV-2 and a contrast-enhanced chest DECT examination were included in the study. The pattern and severity of perfusion deficits were evaluated, as well as the relationships between perfusion deficit severity and laboratory results and CT severity ratings. The paired t-test, Wilcoxon test, and Student's t-test were used to examine the changes in variables and perfusion deficits. p < 0.05 was regarded as statistically significant. RESULTS: Study population consisted of 40 patients. Mean age was 60.73 ± 14.73 years. All of the patients had perfusion deficits at DECT images. Mean perfusion deficit severity score of the population was 8.45 ± 4.66 (min.-max, 1-19). In 24 patients (60%), perfusion deficits and parenchymal lesions matched completely. In 15 patients (37.5%), there was partial match. D dimer, CRP levels, CT severity score, and perfusion deficit severity score all had a positive correlation. CONCLUSIONS: Perfusion deficits are seen not only in opacification areas but also in parenchyma of normal appearance. The CT severity score, CRP, D-dimer, and SpO2 levels of the patients were determined to be related with perfusion deficit severity. ADVANCES IN KNOWLEDGE: Findings of the current study may confirm the presence of micro-thrombosis in COVID-19 pneumonia.


Asunto(s)
COVID-19/fisiopatología , Pulmón/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen Radiográfica por Emisión de Doble Fotón/métodos , Estudios Retrospectivos , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Adulto Joven
11.
Br J Radiol ; 94(1125): 20210117, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34415198

RESUMEN

New treatment developments in ovarian cancer have led to a renewed interest in staging advanced ovarian cancer. The treatment of females with ovarian cancer patients has a strong multidisciplinary character with an essential role for the radiologist. This review aims to provide an overview of the current position of CT, positron emission tomography-CT, and MRI in ovarian cancer and how imaging can be used to guide multidisciplinary team discussions.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Neoplasias Ováricas/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Femenino , Humanos , Ovario/diagnóstico por imagen
12.
Sci Prog ; 104(3): 368504211016204, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34424791

RESUMEN

As the coronavirus disease 2019 (COVID-19) epidemic spreads around the world, the demand for imaging examinations increases accordingly. The value of conventional chest radiography (CCR) remains unclear. In this study, we aimed to investigate the diagnostic value of CCR in the detection of COVID-19 through a comparative analysis of CCR and CT. This study included 49 patients with 52 CT images and chest radiographs of pathogen-confirmed COVID-19 cases and COVID-19-suspected cases that were found to be negative (non-COVID-19). The performance of CCR in detecting COVID-19 was compared to CT imaging. The major signatures that allowed for differentiation between COVID-19 and non-COVID-19 cases were also evaluated. Approximately 75% (39/52) of images had positive findings on the chest x-ray examinations, while 80.7% (42/52) had positive chest CT scans. The COVID-19 group accounted for 88.4% (23/26) of positive chest X-ray examinations and 96.1% (25/26) of positive chest CT scans. The sensitivity, specificity, and accuracy of CCR for abnormal shadows were 88%, 80%, and 87%, respectively, for all patients. For the COVID-19 group, the accuracy of CCR was 92%. The primary signature on CCR was flocculent shadows in both groups. The shadows were primarily in the bi-pulmonary, which was significantly different from non-COVID-19 patients (p = 0.008). The major CT finding of COVID-19 patients was ground-glass opacities in both lungs, while in non-COVID-19 patients, consolidations combined with ground-glass opacities were more common in one lung than both lungs (p = 0.0001). CCR showed excellent performance in detecting abnormal shadows in patients with confirmed COVID-19. However, it has limited value in differentiating COVID-19 patients from non-COVID-19 patients. Through the typical epidemiological history, laboratory examinations, and clinical symptoms, combined with the distributive characteristics of shadows, CCR may be useful to identify patients with possible COVID-19. This will allow for the rapid identification and quarantine of patients.


Asunto(s)
COVID-19/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Radiografía Torácica/normas , Tomografía Computarizada por Rayos X/normas
13.
Medicine (Baltimore) ; 100(31): e26692, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397803

RESUMEN

ABSTRACT: To investigate computed tomography (CT) diagnostic reference levels for coronavirus disease 2019 (COVID-19) pneumonia by collecting radiation exposure parameters of the most performed chest CT examinations and emphasize the necessity of low-dose CT in COVID-19 and its significance in radioprotection.The survey collected RIS data from 2119 chest CT examinations for 550 COVID-19 patients performed in 92 hospitals from January 23, 2020 to May 1, 2020. Dose data such as volume computed tomography dose index, dose-length product, and effective dose (ED) were recorded and analyzed. The radiation dose levels in different hospitals have been compared, and average ED and cumulative ED have been studied.The median dose-length product, volume computed tomography dose index, and ED measurements were 325.2 mGy cm with a range of 6.79 to 1098 mGy cm, 9.68 mGy with a range of 0.62 to 33.80 mGy, and 4.55 mSv with a range of 0.11 to 15.37 mSv for COVID-19 CT scanning protocols in Chongqing, China. The distribution of all observed EDs of radiation received by per patient undergoing CT protocols during hospitalization yielded a median cumulative ED of 17.34 mSv (range, 2.05-53.39 mSv) in the detection and management of COVID-19 patients. The average number of CT scan times for each patient was 4.0 ±â€Š2.0, and the average time interval between 2 CT scans was 7.0 ±â€Š5.0 days. The average cumulative ED of chest CT examinations for COVID-19 patients in Chongqing, China greatly exceeded public limit and the annual dose limit of occupational exposure in a short period.For patients with known or suspected COVID-19, a chest CT should be performed on the principle of rapid-scan, low-dose, single-phase protocol instead of routine chest CT protocol to minimize radiation doses and motion artifacts.


Asunto(s)
COVID-19/diagnóstico por imagen , Neumonía/diagnóstico por imagen , Dosis de Radiación , Tomografía Computarizada por Rayos X/clasificación , Adulto , COVID-19/complicaciones , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía/etiología , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricos
14.
Medicine (Baltimore) ; 100(31): e26790, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397831

RESUMEN

ABSTRACT: Hypertrophy of the uncinate process (UP) can cause radiculopathy. Minimal UP resection is considered to remove the lesion while minimizing the risk of complications. This study aimed to elucidate the surgical results of minimal oblique resection of the UP. This study is a retrospective review of about sixty segments in 34 patients who underwent anterior cervical discectomy and fusion (ACDF) with minimal oblique uncinectomy between 2016 and 2018. The cross-sectional area of the UP was measured pre- and postoperatively. The interspinous distance, segmental Cobb angle, subsidence, fusion rate, surgical time, estimated blood loss, and postoperative complications were evaluated. The mean resected areas of the UP were 17.4 ±â€Š8.7 mm2 (25.9%) on the right and 17.3 ±â€Š11.2 mm2 (26.2%) on the left. The difference in interspinous distance in flexion-extension was 7.1 ±â€Š3.2 and 1.6 ±â€Š0.6 mm pre- and postoperatively, respectively (P = .000). The fusion rate after ACDF was 91.7% when measured according to segment (55/60) and 91.2% when measured according to patients (31/34). The difference in the segmental Cobb angle in flexion-extension was 8.3 ±â€Š6.2° and 1.9 ±â€Š0.3° pre and postoperatively, respectively (P = .000). Subsidence occurred in 4 (11.8%) patients and 5 (8.3%) segments. The average surgical time per segment was 68.8 ±â€Š9.3 minute, and the estimated blood loss was 48.5 ±â€Š25.0 mL. Postoperative complications comprised 1 case each of neck swelling, wound infection, pneumonia, and gastrointestinal bleeding. Our findings therefore revealed that minimal oblique uncinectomy during an ACDF can maintain the stability of the uncovertebral joint while sufficiently decompressing the neural foramen.


Asunto(s)
Vértebras Cervicales , Discectomía , Complicaciones Posoperatorias , Radiculopatía , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Descompresión Quirúrgica/métodos , Discectomía/efectos adversos , Discectomía/métodos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Radiculopatía/etiología , Radiculopatía/prevención & control , República de Corea/epidemiología , Estudios Retrospectivos , Ajuste de Riesgo/métodos , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 100(31): e26801, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397833

RESUMEN

RATIONALE: At present, the prognosis of patients with giant lung squamous cell carcinoma (LSCC) is poor, and there is no safe and effective treatment for elderly patients with large LSCC. PATIENT CONCERNS: Here, we reported a 77-year-old man admitted to the hospital with cough for 3 months and significant chest pain. Computed tomography (CT) imaging showed a large mass in the left lung with pleural effusion. DIAGNOSES: Chest CT scan revealed a 12.5 cm × 7.3 cm mass in the left upper lobe adjacent to the pulmonary vein, with left pleural effusion. Pulmonary tumor markers were significantly elevated, and CT-guided percutaneous lung mass biopsy specimens showed LSCC. INTERVENTIONS: After diagnosis, the patient was treated with sintilimab combined with endostar and nab-paclitaxel. After 2 cycles of treatment, the lung mass in the patient shrank rapidly and the clinical symptoms were relieved. OUTCOMES: The patient's tumor dramatically shrank, and the pleural effusion was decreased after 4 cycles of treatment without any adverse effects. Meanwhile, the high-level tumor marker resumed normal. LESSONS: Sintilimab combined with endostar and nab-paclitaxel may be a good treatment option for lung squamous cell cancer, especially for that in elderly patients.


Asunto(s)
Albúminas/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Carcinoma de Células Escamosas , Endostatinas/administración & dosificación , Neoplasias Pulmonares , Paclitaxel/administración & dosificación , Derrame Pleural , Proteínas Recombinantes/administración & dosificación , Anciano , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Biopsia/métodos , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/fisiopatología , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/fisiopatología , Masculino , Estadificación de Neoplasias , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Carga Tumoral
16.
Medicine (Baltimore) ; 100(31): e26802, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397834

RESUMEN

RATIONALE: Listeria monocytogenes (L. monocytogenes) is a compatible intracellular bacterial pathogen that can invade different mammalian cells and reach the central nervous system (CNS), leading to meningoencephalitis and brain abscesses. In the diagnosis of L. monocytogenes meningoencephalitis (LMM), conventional tests are often reported as negative due to antibiotic therapy or low bacterial content in cerebrospinal fluid. To date, prompt diagnosis and accurate treatment remain a challenge for patients with Listeria infections. PATIENT CONCERNS: Here, we report a case of a 64-year-old male diagnosed with LMM by using metagenomics next-generation sequencing (mNGS). DIAGNOSIS: LMM was confirmed by mNGS analysis of cerebrospinal fluid. INTERVENTIONS: The patient was treated with piperacillin and sensitive antibiotics. OUTCOMES: The patient could walk independently about 1 month after admission and was discharged from the hospital. LESSONS: This case highlights the value of mNGS in the diagnosis of LMM and emphasizes the inadequate sensitivity of conventional diagnostic methods for Listeria infection.


Asunto(s)
Encéfalo/diagnóstico por imagen , Líquido Cefalorraquídeo , Hemorragias Intracraneales , Accidente Cerebrovascular Isquémico , Listeria monocytogenes/aislamiento & purificación , Meningitis por Listeria , Piperacilina/administración & dosificación , Antibacterianos/administración & dosificación , Líquido Cefalorraquídeo/citología , Líquido Cefalorraquídeo/microbiología , Angiografía por Tomografía Computarizada/métodos , Diagnóstico Diferencial , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/etiología , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/etiología , Imagen por Resonancia Magnética/métodos , Masculino , Meningitis por Listeria/diagnóstico , Meningitis por Listeria/tratamiento farmacológico , Meningitis por Listeria/fisiopatología , Metagenómica/métodos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
17.
Medicine (Baltimore) ; 100(31): e26807, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397837

RESUMEN

ABSTRACT: Several studies have demonstrated that the dynamic factor at the mobile segment affects the severity of myelopathy in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL), and posterior decompression supplemented with posterior instrumented fusion at the mobile segment provides good neurological improvement. However, there have been few reports of changes in range of motion at the mobile segment (segmental ROM) after laminoplasty (LP). The aim of this study was thus to retrospectively investigate changes in segmental ROM after LP and the impacts of these changes on neurological improvement in patients with C-OPLL.A total of 51 consecutive patients who underwent LP for C-OPLL since May 2010 and were followed for at least 2 years after surgery were included in this study. Neurological status was assessed using the Japanese Orthopaedic Association (JOA) score before surgery and at 2-year follow-up. Segmental ROM at the responsible level for myelopathy was measured preoperatively and at 2-year follow-up using lateral flexion-extension radiographs of the cervical spine.The mean JOA score improved significantly from 10.7 points preoperatively to 13.5 points at 2 years after surgery (mean recovery rate, 45.0%). The mean segmental ROM decreased significantly from 6.5 degrees before surgery to 3.2 degrees at 2 years after surgery. In the good clinical outcome group (recovery rate of the JOA score ≥50%; n = 22), the mean segmental ROM decreased significantly from 5.8 degrees preoperatively to 3.0 degrees postoperatively. It also decreased significantly from 7.1 degrees to 3.4 degrees in the poor clinical outcome group (recovery rate of the JOA score <50%; n = 29).This study showed that segmental ROM was stabilized after LP in most patients with C-OPLL. Neither preoperative nor postoperative segmental ROM showed significant differences between the good and poor clinical outcome groups and neither a postoperative increase nor decrease of segmental ROM significantly affected the recovery rate of the JOA score.


Asunto(s)
Vértebras Cervicales , Laminoplastia , Examen Neurológico , Osificación del Ligamento Longitudinal Posterior , Rango del Movimiento Articular , Fusión Vertebral , Anciano , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/fisiopatología , Vértebras Cervicales/cirugía , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/métodos , Femenino , Humanos , Japón/epidemiología , Laminoplastia/efectos adversos , Laminoplastia/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Examen Neurológico/métodos , Examen Neurológico/estadística & datos numéricos , Osificación del Ligamento Longitudinal Posterior/diagnóstico , Osificación del Ligamento Longitudinal Posterior/fisiopatología , Osificación del Ligamento Longitudinal Posterior/cirugía , Evaluación de Resultado en la Atención de Salud/métodos , Periodo Perioperatorio/métodos , Periodo Perioperatorio/estadística & datos numéricos , Estudios Retrospectivos , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
18.
Medicine (Baltimore) ; 100(31): e26837, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397851

RESUMEN

INTRODUCTION: Moyamoya disease (MMD) and posterior reversible encephalopathy syndrome (PRES) share similar pathophysiological characteristics of endothelial dysfunction and impaired cerebral autoregulation. However, there have never been any published studies to demonstrate the relationship between these 2 rare diseases. PATIENT CONCERNS: A 26-year-old Asian man presented with a throbbing headache, blurred vision, and extremely high blood pressure. We initially suspected acute cerebral infarction based on the cerebral computed tomography, underlying MMD, and prior ischemic stroke. However, the neurological symptoms deteriorated progressively. DIAGNOSIS: Cerebral magnetic resonance imaging indicated the presence of vasogenic edema rather than cerebral infarction. INTERVENTIONS AND OUTCOMES: An appropriate blood pressure management prevents the patient from disastrous outcomes successfully. Cerebral magnetic resonance imaging at 2 months post treatment disclosed the complete resolution of cerebral edema. The patient's recovery from clinical symptoms and the neuroimaging changes supported the PRES diagnosis. CONCLUSION: This report suggests that patients with MMD may be susceptible to PRES. It highlights the importance of considering PRES as a differential diagnosis while providing care to MMD patients with concurrent acute neurological symptoms and a prompt intervention contributes to a favorable clinical prognosis.


Asunto(s)
Edema Encefálico , Hipertensión , Enfermedad de Moyamoya , Nicardipino/administración & dosificación , Síndrome de Leucoencefalopatía Posterior , Adulto , Antihipertensivos/administración & dosificación , Encéfalo/diagnóstico por imagen , Edema Encefálico/diagnóstico por imagen , Edema Encefálico/etiología , Edema Encefálico/terapia , Diagnóstico Diferencial , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología , Hipertensión/terapia , Imagen por Resonancia Magnética/métodos , Masculino , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/diagnóstico , Enfermedad de Moyamoya/fisiopatología , Enfermedad de Moyamoya/terapia , Examen Neurológico/métodos , Síndrome de Leucoencefalopatía Posterior/complicaciones , Síndrome de Leucoencefalopatía Posterior/diagnóstico , Síndrome de Leucoencefalopatía Posterior/fisiopatología , Síndrome de Leucoencefalopatía Posterior/terapia , Pronóstico , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
19.
Medicine (Baltimore) ; 100(31): e26838, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397852

RESUMEN

RATIONALE: Renal cell carcinoma (RCC) almost metastasizes to every organ, the possibility of adrenal metastasis is relatively low in patients that have undergone radical nephrectomy, only a few cases of bilateral adrenal metastasis are reported on literature. Although surgical treatment of metastases from RCC is preferred and contributes to the rate of survival, it is considered challenging to manage such cases due to the rarity of bilateral metastasis to the adrenal glands. PATIENT CONCERNS: A 64-year-old Manchus female presented with an incidental ultrasonic finding of a left adrenal mass 4 years after radical nephrectomy for left renal cell carcinoma. DIAGNOSIS: Abdominal contrast enhanced CT scan revealed bilateral adrenal masses, suggesting metastatic lesion. Examinations indicated neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography/Computed Tomography (PET/CT) scan except high radioactive uptake in bilateral adrenal glands. INTERVENTIONS: Metachronous bilateral adrenalectomy was taken and laparoscopic right adrenalectomy was first performed. She was discharged home on third postoperative day. Pathological examination revealed metastatic renal cell carcinoma. Two months later she was performed laparoscopic left adrenalectomy. OUTCOMES: The patient healed without obvious complications and no tumor recurrence. LESSONS: Bilateral metastatic adrenal recurrence from RCC is very rare. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally. Surgical intervention is a wise option for these patients that may improve survival, and metachronous bilateral adrenalectomy is proved to be safe and effective.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales , Adrenalectomía/métodos , Carcinoma de Células Renales , Neoplasias Renales , Metástasis de la Neoplasia , Nefrectomía/métodos , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/patología , Glándulas Suprarrenales/cirugía , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Femenino , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Persona de Mediana Edad , Metástasis de la Neoplasia/diagnóstico por imagen , Metástasis de la Neoplasia/patología , Metástasis de la Neoplasia/terapia , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Imagen de Cuerpo Entero/métodos
20.
Medicine (Baltimore) ; 100(31): e26897, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397866

RESUMEN

ABSTRACT: Although complication with non-mycobacterial pneumonia among patients with pulmonary tuberculosis (TB) may lead to poor prognosis, discrimination between TB complicated with and without non-mycobacterial pneumonia using radiological imaging has not been fully elucidated. We aimed to clarify the differences in chest computed tomography (CT) features between pulmonary TB patients with culture-positive and culture-negative sputum for non-mycobacteria.We retrospectively included consecutive patients admitted to our hospital from January 2013 to December 2015 for bacteriologically-confirmed pulmonary TB, who were tested by sputum culture for non-mycobacteria, and who underwent chest CT within 2 weeks before or after admission. Chest CT features were compared between pulmonary TB patients who had positive non-mycobacterial cultures and in those who had not.Of 202 patients with pulmonary TB, 186 (92%) were tested by sputum culture for non-mycobacteria and underwent chest CT. Among these, non-mycobacteria were isolated in 118 patients (63%), while 68 patients (37%) had negative cultures. Patients with a positive culture for non-mycobacteria were significantly older and had lower levels of physical activity and albumin, higher levels of C-reactive protein, and a greater number of respiratory failures. By CT, emphysematous lesions, ground-glass opacities, airspace consolidation, air-bronchogram, interlobular septal thickening, bronchiectasis, pleural effusion, pleural thickening, and lymph node enlargement were more frequently in patients with a positive culture for non-mycobacteria. These chest CT features could be helpful for detecting complication with non-mycobacterial pneumonia in patients with pulmonary TB.


Asunto(s)
Antibacterianos/uso terapéutico , Pulmón/diagnóstico por imagen , Neumonía Bacteriana , Esputo/microbiología , Tomografía Computarizada por Rayos X/métodos , Tuberculosis Pulmonar , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/epidemiología , Diagnóstico Diferencial , Errores Diagnósticos/prevención & control , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/epidemiología , Pronóstico , Estudios Retrospectivos , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología
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