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1.
Abdom Radiol (NY) ; 48(7): 2349-2360, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37071122

RESUMO

PURPOSE: This study aimed to evaluate the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI) in the differentiation of renal cell carcinoma (RCC) subtypes. METHODS: This is a retrospective diagnostic performance study, in which the diagnostic performances of mpMRI features were evaluated to differentiate clear cell RCC (ccRCC) from non-clear cell RCC (non-ccRCC). Adult patients who were evaluated using a 3-Tesla dynamic contrast-enhanced mpMRI before undergoing partial or radical nephrectomy for possible malignant renal tumors were included in the study. Signal intensity change percentages (SICP) between contrast-enhanced phases and pre-administration period for both the tumor and normal renal cortex, and tumor-to-cortex enhancement index (TCEI); tumor apparent diffusion coefficient (ADC) values; tumor-to-cortex ADC ratio; and a scale which was developed according to the tumor signal intensities on the axial fat-suppressed T2-weighted Half-Fourier Acquisition Single-shot Turbo spin Echo (HASTE) images were used in ROC analysis to estimate the presence of ccRCC in the patients. The reference test positivity was the histopathologic examination of the surgical specimens. RESULTS: Ninety-eight tumors from 91 patients were included in the study, and 59 of them were ccRCC, 29 were pRCC, and 10 were chRCC. The mpMRI features that had the three highest sensitivity rates were excretory phase SICP, T2-weighted HASTE scale score, and corticomedullary phase TCEI (93.2%, 91.5%, and 86.4%, respectively). However, those with the three highest specificity rates were nephrographic phase TCEI, excretory phase TCEI, and tumor ADC value (94.9%, 94.9%, and 89.7%, respectively). CONCLUSION: Several parameters on mpMRI showed an acceptable performance to differentiate ccRCC from non-ccRCC.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Imageamento por Ressonância Magnética Multiparamétrica , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Diagnóstico Diferencial
2.
J Surg Res ; 274: 196-206, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35183030

RESUMO

BACKGROUND: The relationship between sarcopenia and postoperative outcomes in patients with gastric cancer remains controversial. This study aimed to investigate the impact of sarcopenia on short-term outcomes after surgery for gastric cancer. METHODS: Patients who underwent surgical treatment for gastric cancer were evaluated in this prospective observational study. Muscle strength, muscle mass, and physical performance were measured before surgery. Diagnosis of sarcopenia was based on the revised European Working Group on Sarcopenia criteria. Postoperative 30-day outcomes, including complications, reoperation, readmission, and operative mortality, were recorded. RESULTS: Sarcopenia was observed in 31 out of 146 patients (21.2%). The overall complication incidence was 31.5%. The postoperative complication rate was higher in the sarcopenic patients compared to the nonsarcopenic patients (54.8% versus 25.2%, P = 0.003). There was no statistically significant difference in terms of surgical complication rates (25.8% versus 14.8%, P = 0.239), although the sarcopenic group had a significantly higher systemic complication rate (38.7% versus 13%, P = 0.003). No statistically significant difference was observed in terms of major complications (3.2% versus 5.2%, P = 1.000). Muscle strength, muscle mass, and physical performance were not identified as independent factors when tested alone at adjusted multivariable analysis. Sarcopenia (Odds ratio: 2.73, 95% CI 1.02-7.52, P = 0.047) and severe sarcopenia (Odds ratio: 4.44, 95% CI 1.57-13.34, P = 0.006) were identified as independent prognostic factors for postoperative complications. CONCLUSIONS: Sarcopenia was associated with postoperative complications after gastrectomy for gastric cancer. Severe sarcopenia may serve as a more robust prognostic indicator. The variation in the complication rates between sarcopenic and nonsarcopenic patients was mainly due to difference in systemic complications rather than surgical complications.


Assuntos
Sarcopenia , Neoplasias Gástricas , Gastrectomia/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/epidemiologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgia
3.
Turk J Med Sci ; 51(5): 2396-2402, 2021 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33992039

RESUMO

Background/aim: The presented study aimed to evaluate the utility of magnetic resonance angiography (MRA) in the pediatric population with nutcracker syndrome. Materials and methods: Patients with suggestive clinical symptoms and laboratory findings and got the diagnosis of nutcracker syndrome with Doppler ultrasonography between January 2011­2019 were included in the study. In addition, children who had renal MRA due to hypertension were evaluated as the control group. MRA images of all patients were examined retrospectively by three radiologists at different levels of experience, and the superior mesenteric artery angle, aorta-mesenteric distance, left renal vein diameter both in the regions of aorta-mesenteric, and renal hilum were recorded. Results: Forty-five patients diagnosed with nutcracker syndrome were included in the study. The mean age of patients was 12 (4­16) and 30 (67%) were female. As the control group, 25 patients with hypertension who had MRA were included and they had a mean age of 12 (1­18) and 19 (76%) were male. The mean superior mesenteric artery angle was 26.5 ° (16­73 ± 12) in the patient group and 57.8 ° (25­139, ± 33) in the control group (p < 0.001); the mean aorta-mesenteric distance was 3.3 mm (1.7­6.5, ± 1.1) in the patient group and 8 mm (3.4­32, ± 5.9) in the control group (p < 0.001). MRA measurements of three radiologists were consistent with each other. Conclusion: MRA imaging can be applied as an alternative diagnostic method for Doppler ultrasonography and multidetector CT examinations by radiologists with different experience levels in pediatric patients with nutcracker syndrome.


Assuntos
Angiografia por Ressonância Magnética/estatística & dados numéricos , Síndrome do Quebra-Nozes/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão , Angiografia por Ressonância Magnética/métodos , Masculino , Veias Renais/diagnóstico por imagem , Estudos Retrospectivos
4.
Sisli Etfal Hastan Tip Bul ; 54(2): 227-230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32617064

RESUMO

OBJECTIVES: In this study, records of the children who underwent Computed Tomography of the Brain (CTB) were reviewed to increase the awareness of pediatricians to protect patients from radiation, whether CTB was used with right indications or if it was determinative for diagnosis. METHODS: In total, in this study, 342 cases applied to our Pediatric Emergency Polyclinic between January 2005-December 2010 were retrospectively evaluated regarding complaints at admission, neurological examination and CTB results. The sensitivity and specificity of the neurological examination in detecting the CTB pathology was determined. RESULTS: The results were normal in 319 of the 342 cases with CBT and abnormal in 23, out of which abnormal CTB results were only in three (0.99%) of the 301 patients with normal neurological examination results and in 20 (48.8%) of 41 patients with abnormal neurological examination results. The difference between the two groups was statistically significant (p=0.001). The sensitivity and specificity of the neurological examination in detecting CTB pathology were 87% and 94%, respectively. CONCLUSION: Detailed neurological examination of the patients in the pediatric emergency department has a key role in determining the indications for CTB. Clinical follow-up should guide neuroradiological imaging in children with normal results of the neurological examination.

5.
Medicine (Baltimore) ; 99(8): e19202, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080107

RESUMO

The present study aimed to investigate the potential use of T2-weighted sequences with diffusion weighted imaging (DWI) in magnetic resonance (MR) enterography instead of conventional contrast-enhanced MR imaging (MRI) sequences for the evaluation of active inflammation in Crohn disease.Two-hundred thirteen intestinal segments of 43 patients, who underwent colonoscopy within 2 weeks before or after MR enterography were evaluated in this retrospective study. DWI sequences, T2-weighted sequences, and contrast-enhanced T1-weighted sequences were acquired in the MR enterography scan after cleaning of the bowel and using an oral contrast agent. First, the intestinal segments that had active inflammation in MR enterography were qualitatively evaluated in T2-weighted and contrast-enhanced T1-weighted sequences and then MR activity index (MRAI 1) and MRAI 2 were formed with and without contrast-enhanced sequences in 2 separate sessions.The correlation coefficient between contrast enhanced and DWI MR enterography scores (MRAI 1 and MRAI 2) of intestinal inflammation was 0.97 for all segments. In addition, separate correlation coefficients were calculated for terminal ileum, right colon, transverse colon, left colon, and rectum, and there was a strong correlation between the MRAI 1 and MRAI 2 scores of each segment (r = 0.86-0.97, P < .001). On the other hand, MR enterography had 88.7% sensitivity, 97.9% specificity, 95.5% positive predictive value, 94.6% negative predictive value, and 94.8% accuracy for detection of active inflammation in all intestinal segments in Crohn disease.DWI and T2-weighted sequences acquired with cleaning of the bowel can be used instead of contrast-enhanced MRI sequences for the evaluation of active inflammation in Crohn disease.


Assuntos
Doença de Crohn/diagnóstico por imagem , Doença de Crohn/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
6.
Turk J Med Sci ; 50(1): 110-116, 2020 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-31731334

RESUMO

Background/aim: This study aimed to evaluate the diagnostic efficacy of vertebral Hounsfield unit (HU) values on routine contrast- enhanced abdominal computed tomography (CT) scans for the assessment of osteoporosis using dual-energy X-ray absorptiometry (DXA) T-scores as a reference standard. Materials and methods: A total of 111 consecutive patients who underwent contrast-enhanced abdominal CT examination for any indication and DXA within a 6-month period were retrospectively analyzed. The CT attenuation values of trabecular bone in HUs were measured in axial and sagittal planes from lumbar vertebrae 1­4 (L1­L4). The correlation between the DXA T-scores and HU values measured on the CT scans was evaluated by Pearson's correlation test. Areas under the curves (AUCs) were calculated by receiver operating characteristic analysis for diagnostic proficiency, and threshold values were determined. Paired t-test and Bland­Altman plot test were used to evaluate the correlation between axial and sagittal HU values. Results: There was a strong correlation between the DXA T-scores and HU values of all the lumbar vertebrae (P < 0.001). The highest correlation was for the L3 vertebra; L3 was thus chosen for additional analyses. The mean axial and sagittal L3 attenuations were 133.7 HU and 131.9 HU, respectively. The axial measurements were not significantly different from the sagittal measurements, with a mean difference of 1.8 HU (P > 0.05). The L3 axial CT attenuation threshold for 90% sensitivity was 170 HU and that for 90% specificity was 102 HU for distinguishing osteoporosis from osteopenia and normal bone mineral density (BMD). To distinguish the low BMD group from the normal group, the L3 axial CT attenuation threshold for approximately 90% sensitivity was 102 HU and for 90% specificity was 165 HU. Conclusion: The HUs derived from routine contrast-enhanced abdominal CT scans can be used for the evaluation of osteoporosis, without additional radiation exposure and cost.


Assuntos
Abdome/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X/métodos , Absorciometria de Fóton , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
J Comput Assist Tomogr ; 43(4): 619-622, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268877

RESUMO

OBJECTIVE: This study aimed to evaluate the diagnostic efficacy of T2 dark spot, T2 dark rim, and T2 shading signs on magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts. METHODS: Seventy-two hemorrhagic lesions were included in this retrospective study. The presence of T2 dark spot, T2 dark rim, and T2 shading signs in the lesions and the presence of complete or incomplete rim in lesions exhibiting T2 dark rim signs were evaluated. RESULTS: Of 72 lesions, 50 were diagnosed with endometrioma and 22 were diagnosed with hemorrhagic cyst. Twenty-six of 50 endometriomas and none of the hemorrhagic cysts showed T2 dark spot sign. T2 shading was observed in 90% of endometriomas and 18% of hemorrhagic cysts. Incomplete T2 dark rim was detected in 67% of endometriomas and 21% of hemorrhagic cysts. CONCLUSIONS: T2 dark spot and T2 dark rim signs could be useful for distinguishing endometriomas from hemorrhagic cysts.


Assuntos
Endometriose/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Cistos Ovarianos/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Adolescente , Adulto , Diagnóstico Diferencial , Feminino , Hemorragia/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Adulto Jovem
8.
Turk J Med Sci ; 49(3): 723-729, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31203590

RESUMO

Background/aim: This study aimed to evaluate the diagnostic value of vascular indices obtained using 3D power Doppler ultrasound (3D PDUS) in differentiation of benign and malignant thyroid nodules. Materials and methods: Sixty-seven patients (56 female, 11 male, mean age 44.6) with 81 thyroid nodules exhibiting mixed (peripheral and central) vascularization patterns, with the largest diameter between 10 and 30 mm, were prospectively evaluated using 3D PDUS. Nodule volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated using the Virtual Organ Computer-aided Analysis (VOCAL) software, and these indices were then compared with regard to the cytohistopathology-based diagnosis. The optimum cutoff values for the differentiation of benign and malignant nodules were identified, and diagnostic efficacy was calculated using receiver operating characteristic (ROC) analysis. Results: Fifty-six of the 81 nodules included in this study were diagnosed as benign and 25 as malignant. Vascular indices in malignant nodules were significantly higher than those in benign nodules (P < 0.05). In benign nodules, the mean VI was 11.61 ± 6.88, mean FI was 39.75 ± 3.93, and mean VFI was 4.82 ± 2.94, compared to 18.64 ± 12.81, 41.82 ± 4.43, and 8.17 ± 6.37, respectively, in malignant nodules. The area under the curves (AUCs) was calculated as 0.68, 0.61, and 0.67 for VI, FI, and VFI, respectively. At optimal cutoff values of 10.2 for VI, 40.8 for FI, and 5.5 for VFI, the sensitivity and specificity were 72%/55.4%, 68%/57.1%, and 68%/67.9%, respectively. Conclusion: 3D PDUS can be useful in the characterization of thyroid nodules.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Glândula Tireoide/irrigação sanguínea , Nódulo da Glândula Tireoide/irrigação sanguínea
9.
Turk J Med Sci ; 49(3): 782-788, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31062940

RESUMO

Background/aim: This study aimed to investigate the relationship between the iodine concentration (IC) of perigastric fat tissue as assessed by dual-energy computed tomography (DECT) and serosal invasion of gastric cancer. Materials and methods: A total of 41 patients underwent preoperative staging evaluation for gastric cancer using DECT between July 2015 and March 2018. Patients were divided into 2 groups based on pathology results: serosal invasion (stage T4a) and intact serosa (stages T1­T3). Cutoff values, the diagnostic efficacy of IC in the perigastric fat tissue, and the perigastric fat tissue/tumor (P/T) ratio were determined. Results: Among the 41 patients, 22 had stage T4a gastric cancer and 19 patients had gastric cancer with a stage lower than T4a. The mean IC of perigastric fat tissue and the P/T ratio were significantly higher in patients with serosal invasion than in those with intact serosa (P < 0.001). During the arterial phase, the area under the curve (AUC) was 0.915 and 0.854 for the IC of perigastric fat tissue and the P/T ratio, respectively. During the venous phase, the AUC was 0.890 and 0.876 for the IC of perigastric fat tissue and the P/T ratio, respectively. Conclusion: The IC in the perigastric fat tissue seems to be a reliable indicator for serosal invasion of gastric cancer.


Assuntos
Membrana Serosa/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Gordura Intra-Abdominal/química , Gordura Intra-Abdominal/diagnóstico por imagem , Iodo/análise , Iodo/química , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Membrana Serosa/patologia , Neoplasias Gástricas/patologia
10.
Pediatr Gastroenterol Hepatol Nutr ; 21(4): 361-364, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30345253

RESUMO

Accessory hepatic lobe is noted as and considered a rare disease in children. It can manifest with various symptoms and complications depending on the location, volume, type and position of the disease as presented on a child. The patient presented as a 14-month-old girl who was seen with a notable hepatosplenomegaly and portal hypertension. A diagnosis was made after taking an extensive medical history, observation and radiological examinations. The formal diagnosis was a prehepatic portal hypertension associated with accessory hepatic lobe.

11.
Turk J Med Sci ; 48(3): 569-575, 2018 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-29914254

RESUMO

Background/aim: This study aimed to investigate the prevalence and association of mesenteric panniculitis (MP) with other diseases and the clinicoradiological features of MP, and to examine computed tomography findings to estimate the presence of malignancy in patients with MP. Materials and methods: Between September 2012 and August 2016, we used a keyword search to identify patients diagnosed with MP. Associated diseases and malignancies of patients were recorded. Cut-off values and diagnostic efficiencies of total MP scores and short and long diameters of the greatest lymph nodes were determined. Results: Out of 22,033 patients, 309 were determined to have MP (prevalence 1.40%); 57.9% of these patients had a malignancy and 42.1% did not have a malignancy. The mean total MP scores and diameters of the greatest lymph nodes were significantly higher in the patients with a malignancy (P < 0.001). AUCs were 0.728, 0.879, and 0.767 for the short diameter, long diameter, and total score, respectively. The diagnostic efficiencies of the long diameter of the greatest lymph nodes were significantly higher than the total MP scores and the short diameter of the greatest nodes. Conclusion: MP is thought to be associated with abdominal and other system malignancies so MP may be a paraneoplastic syndrome in some patients.

12.
Turk J Med Sci ; 47(4): 1144-1151, 2017 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-29156854

RESUMO

Background/aim: Endovascular embolization is widely used instead of surgery in the treatment of traumatic and postoperative abdominopelvic bleeding. The objective of this study is to evaluate the efficiency of computed tomography in the determination of active bleeding and the efficiency of endovascular embolization in traumatic and postoperative abdominopelvic bleeding. Materials and methods: Thirty-one patients admitted to our hospital with traumatic and postoperative abdominopelvic bleeding between January 2006 and September 2012 and treated with endovascular embolization were retrospectively enrolled in the study. In 15 hemodynamically stable patients, abdominal computed tomography was performed to detect the presence and/or localization of the hemorrhage. All 31 patients underwent digital subtraction angiography (DSA) and endovascular embolization. Results: Active hemorrhage was detected in all patients evaluated by computed tomography. Thirty-two embolization procedures were performed in 31 patients. Embolization was successful in all procedures. Two patients needed retreatment because of recurrent bleeding. One patient died 2 days after embolization as a result of concomitant multiorgan injury. Conclusion: Computed tomography is able to detect active bleeding, allowing it to take the place of diagnostic DSA. If careful patient selection is carried out, endovascular embolization may be the final treatment, despite high-grade visceral organ injury.

13.
J Pediatr Hematol Oncol ; 38(8): e307-e309, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27403774

RESUMO

Adenomyomatosis of the gallbladder (ADMG) is characterized by proliferation of the mucosal epithelium and hypertrophy of the muscularis. ADMG is predominantly diagnosed by using ultrasonography. Although ADMG is benign in nature, lithiasis, and chronic inflammation secondary to it may lead to dysplastic changes and cancer. Mucosal invagination through the hypertrophied muscularis results in large intramural diverticula or sinus tracts which are visible at radiology, known as Rokitansky-Aschoff sinuses. Histologically, ADMG manifests with hyperplasia of the muscular layer and proliferation of mucosal glandular tissues. We describe a case of ADMG in an 8-year-old girl presenting with recurrent abdominal pain. Diagnosis was made using ultrasound, and the condition was successfully treated with open cholecystectomy. Ultrasound scanning in children presenting with recurrent abdominal pain may lead to more accurate diagnosis of ADMG during childhood.


Assuntos
Adenomioma/patologia , Neoplasias da Vesícula Biliar/patologia , Adenomioma/diagnóstico por imagem , Adenomioma/cirurgia , Criança , Colecistectomia , Feminino , Vesícula Biliar/anormalidades , Doenças da Vesícula Biliar , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Hiperplasia/patologia , Hipertrofia , Mucosa , Ultrassonografia
14.
Am J Emerg Med ; 34(11): 2074-2078, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27450389

RESUMO

INTRODUCTION: The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma. METHODS: This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture. RESULTS: A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%. CONCLUSION: With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.


Assuntos
Tomada de Decisão Clínica/métodos , Técnicas de Apoio para a Decisão , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Ulna/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Palpação , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Radiografia , Amplitude de Movimento Articular , Traumatismos do Punho/complicações , Adulto Jovem
15.
Spine J ; 16(4): e251, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26523964
16.
Am J Emerg Med ; 33(9): 1269-72, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26113244

RESUMO

OBJECTIVES: The purpose of this study was to evaluate predetermined physical examination and function tests recommended to identify severe injury among patients presenting with wrist injury to the emergency department and to establish a reliable clinical decision rule capable of determining the need for radiography in wrist injuries. MATERIALS AND METHODS: This was a multicenter prospective derivation study of wrist injuries. All patients were assessed in terms of mechanism of trauma, inspection findings, heart rate, sensitivity at palpation, presence of pain with active movement, grasp strength, and functional tests using an examination form under main headings. Sensitivity, specificity, and positive and negative predictive values were expressed for each sign and each examination finding. RESULTS: One hundred nineteen adult patients were enrolled during the 6-month study period. Fracture was identified in 24.3% (n = 29). Presence of pain on the radial deviation, dorsal flexion, distal radioulnar drawer, and axial compression tests exhibited high sensitivity (82.8%, 89.7%, 82.8%, and 86.2%, respectively) and high negative predictive values (88.6%, 81.3%, 87.5%, and 93.6%, respectively) for wrist fracture. Sensitivity of 96.6% was observed when these 4 tests were evaluated together. CONCLUSIONS: The presence of one of these examination findings increases the likelihood of fracture and is adequate to recommend wrist radiography. In addition, there is a strong possibility of radiography being unnecessary if all 4 test results are negative in patients presenting with wrist injury, potentially preventing many nonessential radiographs being performed.


Assuntos
Serviço Hospitalar de Emergência , Avaliação das Necessidades , Exame Físico , Traumatismos do Punho/diagnóstico por imagem , Adolescente , Adulto , Idoso , Técnicas de Apoio para a Decisão , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Traumatismos do Punho/etiologia , Traumatismos do Punho/fisiopatologia , Adulto Jovem
17.
Can Urol Assoc J ; 8(11-12): E867-71, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25485018

RESUMO

Eosinophilic cystitis is a rare inflammatory disease of the bladder; it rarely occurs in children. Patients typically show irritative urination symptoms frequently, with a possible need for urgency, alongside dysuria, gross haematuria, suprapubic pain and painful urination. Sometimes bladder mass accumulation with the possibility of malignancy is also observed. We present an 8-year-old male patient who gained admission for terminal hematuria and discuss the management of eosinophilic cystitis.

18.
J Magn Reson Imaging ; 40(5): 1158-64, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24923252

RESUMO

PURPOSE: To evaluate the diagnostic efficacy of quantitative Diffusion-weighted imaging (DWI) in the characterization of breast lesions of mass and non-mass enhancement (NME) types. MATERIALS AND METHODS: After the institutional review board gave approval, DWI exams of 267 women with 212 suspicious masses, 73 NMEs were retrospectively analyzed. Apparent diffusion coefficients (ADCs) of benign and malignant lesions were compared. Cutoff values were obtained by receiver operating characteristics analysis. Diagnostic accuracies of DWI for masses and NMEs were compared with the use of Chi-square test. The effect of the lesions histologic subtypes and size on diagnostic accuracies was evaluated. RESULTS: ADCs were significantly lower in malignants than in benigns for both masses (0.75 versus 1.21 × 10(-3) mm(2) /s,) and NMEs (0.79 versus 1.06 × 10(-3) mm(2) /s)(P < 0.001). Cutoff value was 0.90 × 10(-3) mm(2) /s for both lesion types. The accuracy of DWI was lower in NMEs (76.7%) than masses (89.2%) (P = 0.008) unrelated to lesion size. There was more overlap in ADCs of the benign and malignant NMEs due to the lower ADCs of the benign histologies of this group. CONCLUSION: Despite the lower diagnostic accuracy of DWI in NMEs, it could be helpful in the characterization of suspicious breast lesions of both mass and NME types.


Assuntos
Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Imagem de Difusão por Ressonância Magnética/métodos , Adulto , Idoso , Mama/patologia , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Sensibilidade e Especificidade , Carga Tumoral , Adulto Jovem
19.
Eur J Radiol ; 83(7): 1080-1085, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24801262

RESUMO

PURPOSE: To investigate the relationship between renal function and total renal volume-vascular indices using 3D power Doppler ultrasound (3DPDUS). MATERIALS AND METHODS: One hundred six patients with hypertensive proteinuric nephropathy (HPN) (49 male, 57 female) and 65 healthy controls (32 male, 33 female) were evaluated prospectively using 3DPDUS. Total renal volume (RV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using Virtual Organ Computer-aided Analysis (VOCAL). The estimated glomerular filtration rates (GFRs) of the patients with HPN and the control group were calculated. The patients with HPN were divided into two groups on the basis of GFR, normal (≥90) or reduced (<90). Differences between groups were compared using ANOVA. Correlations between GFR, renal volume and vascular indices were analyzed using Pearson's correlation analysis. Significance was set at p<0.05. RESULTS: The mean total RV, VI, FI and VFI values in the reduced GFR, normal GFR and control groups were RV (ml): 234.7, 280.7 and 294.6; VI: 17.6, 27.6 and 46.8; FI: 79.1, 88.7 and 93.9 and VFI: 7.1, 12.7 and 23.8. There were statistically significant differences between the groups (p<0.001). Total RVs and vascular indices exhibited significant correlations with estimated GFR (r=0.53-0.59, p<0.001) CONCLUSION: Three-dimensional power Doppler ultrasound is a reliable predictive technique in renal function analysis.


Assuntos
Taxa de Filtração Glomerular , Hipertensão Renal/diagnóstico , Imageamento Tridimensional/métodos , Nefroesclerose/diagnóstico , Proteinúria/diagnóstico , Ultrassonografia Doppler/métodos , Adulto , Humanos , Hipertensão Renal/complicações , Masculino , Pessoa de Meia-Idade , Nefroesclerose/etiologia , Variações Dependentes do Observador , Tamanho do Órgão , Proteinúria/etiologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Int J Clin Exp Med ; 7(2): 421-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24600499

RESUMO

BACKGROUND: Abdominal aortic aneurysm (AAA) is a severe disease that can prove fatal. Factors such as advanced age, male gender, family history and cigarette use increase the risk of AAA. These factors associated with AAA development also increase arterial stiffness. Aortic pulse-wave velocity (PWV) was measured as an index of aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Elevated arterial stiffness increases the risk of development of cardiovascular events and impairs cardiovascular functions. In this study we investigated whether arterial stiffness rises in patients with AAA by measuring aortic PWV and AIx@75 parameters. METHODS: Eighteen patients with AAA (age 69 ± 4 years) and 20 patients with no aneurysm (age 66 ± 6) were included. AAA was diagnosed using computerized tomography. Arterial stiffness was measured non-invasively in all patients using a SphygmoCor device. Aortic PWV and AIx@75 were used as arterial stiffness parameters. RESULTS: There was no significant difference between the two groups in terms of demographic characteristics. AIx@75 (33.2 ± 8.9 vs 25.1 ± 7.8, p=0.008) and aortic PWV (14.8 ± 4.9 vs 10.0 ± 1.7, p=0.002) were significantly elevated in the AAA group compared to the control group. CONCLUSION: Elevated AIx@75 and aortic PWV shows that arterial stiffness increases in patients with AAA.

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