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PURPOSE: To analyze the referral patterns and the clinical and therapeutic features of patients diagnosed with uveitis in an Italian tertiary referral center to provide a comparison with previously published series from the same center. METHODS: Retrospective retrieval of data on all new referrals to the Ocular Immunology Unit in Reggio Emilia (Italy) between November 2015 and April 2022 and comparison with previously published series from the same center. RESULTS: Among the 1557 patients, the male-to-female ratio was 1:1.27. Anterior uveitis was the most common diagnosis (53.7%), followed by posterior (21.6%), pan- (18.5%), and intermediate (6.2%) uveitis. The most identifiable specific diagnoses were anterior herpetic uveitis (18.4%), Fuchs uveitis (12.8%), and tuberculosis (6.1%). Infectious etiologies were the most frequent (34.1%) and were more diffuse among non-Caucasian patients (p < 0.001), followed by systemic disease-associated uveitis (26.5%), and ocular-specific conditions (20%). Idiopathic uveitis accounted for 19.4% of cases. Fuchs uveitis presented the longest median diagnostic delay (21 months). Immunosuppressants were administered to 25.2% of patients. Antimetabolites, calcineurin inhibitors, and biologicals were prescribed to 18.4%, 3%, and 11.4% of cases, respectively. Compared to our previous reports, we observed a significant increase in foreign-born patients and in infectious uveitis, a decrease in idiopathic conditions, and an increasing use of non-biological and biological steroid-sparing drugs. CONCLUSIONS: The patterns of uveitis in Italy have been changing over the last 20 years, very likely due to migration flows. Diagnostic improvements and a more widespread interdisciplinary approach could reduce the incidence of idiopathic uveitis as well as diagnostic delay.
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Introducción: La piel es fundamental en la transición de la vida intrauterina a la extrauterina. El recién nacido presenta cambios fisiológicos, siendo frecuente observar hallazgos cutáneos benignos y transitorios que varían según las características maternas, neonatales y de la gestación. Objetivos: Estimar la frecuencia de distintos hallazgos dermatológicos en neonatos en las primeras 72h de vida e identificar la existencia de diferencias de proporciones estadísticamente significativas con factores neonatales, maternos y de la gestación. Métodos Se realizó un estudio descriptivo, observacional de corte transversal entre abril-julio 2015 y julio-noviembre de 2017 en la maternidad del Centro Hospitalario Pereira Rossell. Se incluyeron neonatos de hasta 72h de vida, a los que se les practicó un examen dermatológico completo. Se presenta la proporción de cada uno de los hallazgos con el intervalo de confianza (IC) correspondiente. Se analiza la relación entre los hallazgos y determinados factores asociados. Resultado Se incluyeron 2811 neonatos. El 100% presentó al menos un hallazgo a nivel de la piel. La mediana fue de 8 lesiones por paciente (rango intercuartílico: 6-9/mínimo-máximo: 1-16). De los 46 hallazgos explorados clínicamente se encontraron 42. Las lesiones benignas y transitorias correspondieron al 99,9%. Entre ellas se observó: lanugo 98% (IC: 97,7-98,7), descamación fisiológica 79,7% (IC: 78,2-81,1) e hiperplasia sebácea 73,3% (IC: 71,6-74,9). El lanugo (p=0,001), la descamación fisiológica (p<0,001) y el eritema tóxico neonatal (p=0,001) se observaron con más frecuencia en los neonatos de término y postérmino. La hiperplasia sebácea (p=0,001) y la hiperpigmentación transitoria neonatal (p<0,001) se encontraron con mayor frecuencia en varones (AU)
Background: The skin is a fundamental organ in the transition from intrauterine to extrauterine life. The newborn infant experiences physiological changes and often presents benign, transient skin characteristics that vary according to maternal, gestational, and neonatal factors. Objectives: To estimate the frequency of various dermatologic findings during the first 72hours of life and to identify their association with maternal, gestational, or neonatal factors. Methods Descriptive, observational, cross-sectional study from April to July 2015 and July to November 2017 in the maternity ward of Centro Hospitalario Pereira Rossell. We examined the skin of neonates within 72hours of birth. Proportions and 95% CI were calculated for all findings. Associations between findings and factors were analyzed. Results A total of 2811 neonates were included. We observed at least one neonatal skin finding in all of the neonates and found a median (interquartile range) of 8 (6-9) findings (minimummaximum, 1-16). We observed 42 of the 46 possible characteristics we looked for; 99.9% of the findings were benign and transient. Among the findings were lanugo (98%; 95% CI, 97.7%-98.7%), physiological scaling (79.7%; 95% CI: 78.2%-81.1%), and sebaceous hyperplasia (73.3%; 95% CI: 71.6%-74.9%). Lanugo (P=.001), physiological scaling (P<.001), and erythema toxicum (P=.001) were observed significantly more often in full- and late-term neonates. Sebaceous hyperplasia (P=.001) and transient hyperpigmentation (P<.001) were found more often in newborn males. Erythema toxicum was more common after vaginal births (P=.008). Transient hyperpigmentation (P<.001) and dermal melanocytosis (P<.001) were seen more often in neonates of African descent (AU)
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Humanos , Feminino , Recém-Nascido , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Doenças do Recém-Nascido/epidemiologia , Dermatopatias/epidemiologia , Estudos Transversais , Uruguai/epidemiologia , Fatores de Risco , PrevalênciaRESUMO
BACKGROUND: The skin is a fundamental organ in the transition from intrauterine to extrauterine life. The newborn infant experiences physiological changes and often presents benign, transient skin characteristics that vary according to maternal, gestational, and neonatal factors. OBJECTIVES: To estimate the frequency of various dermatologic findings during the first 72hours of life and to identify their association with maternal, gestational, or neonatal factors. METHODS: Descriptive, observational, cross-sectional study from April to July 2015 and July to November 2017 in the maternity ward of Centro Hospitalario Pereira Rossell. We examined the skin of neonates within 72hours of birth. Proportions and 95% CI were calculated for all findings. Associations between findings and factors were analyzed. RESULTS: A total of 2811 neonates were included. We observed at least one neonatal skin finding in all of the neonates and found a median (interquartile range) of 8 (6-9) findings (minimum-maximum, 1-16). We observed 42 of the 46 possible characteristics we looked for; 99.9% of the findings were benign and transient. Among the findings were lanugo (98%; 95% CI, 97.7%-98.7%), physiological scaling (79.7%; 95% CI: 78.2%-81.1%), and sebaceous hyperplasia (73.3%; 95% CI: 71.6%-74.9%). Lanugo (P=.001), physiological scaling (P<.001), and erythema toxicum (P=.001) were observed significantly more often in full- and late-term neonates. Sebaceous hyperplasia (P=.001) and transient hyperpigmentation (P<.001) were found more often in newborn males. Erythema toxicum was more common after vaginal births (P=.008). Transient hyperpigmentation (P<.001) and dermal melanocytosis (P<.001) were seen more often in neonates of African descent. CONCLUSIONS: All neonates have skin characteristics that are part of their adaptation to extrauterine life. Most are benign and transient. Maternal age, type of delivery, and certain neonatal factors such as gestational age, birth weight, sex, and ethnicity are associated with specific findings.
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Eritema , Causalidade , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Prevalência , Uruguai/epidemiologiaRESUMO
Several invasive bark beetle species have caused major economic and ecological losses in South America. Accurate predictions of beetle emergence times will make control efforts more efficient and effective. To determine whether bark beetle emergence can be predicted by season, temperature, or precipitation, we analyzed trapping records for three introduced pest species of bark beetles in Uruguay. We used trigonometric functions as seasonal predictors in generalized linear models to account for purely seasonal effects, while testing for effects of temperature and precipitation. Results show that all three beetle species had strong but unique seasonal emergence patterns and responded differently to temperature and precipitation. Cyrtogenius luteus (Blandford) emerged in summer and increased with precipitation but was not affected by temperature. Hylurgus ligniperda (Fabricius) emerged in winter and increased with temperature but was not affected by precipitation. Orthotomicus erosus (Wollaston) had a primary emergence in spring, and a smaller emergence in early summer, but showed no significant relationship with temperature or precipitation. This study shows that the emergence of these bark beetle species in Uruguay is influenced by seasonality more than by temperature and precipitation fluctuations. It also shows how seasonality can be easily incorporated into models to make more accurate predictions about pest population dynamics.
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Estações do Ano , Temperatura , Gorgulhos , Animais , Espécies Introduzidas , Pinus taeda , Casca de Planta , Dinâmica Populacional , Chuva , UruguaiRESUMO
PURPOSE: The aim of this study was to assess the role of contrast-enhanced ultrasonography (CEUS) in the characterisation of focal liver lesions in comparison with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) with liver-specific contrast agent. MATERIALS AND METHODS: One hundred and eighty-seven focal liver lesions, 91 malignant and 96 benign (mean size 3.2 cm) - proved by biopsy (n=12), histology (n=4), MDCT (n=108), MRI (n=44) MDCT/MRI (n=19) - in 159 patients were studied by CEUS. Two expert radiologists consensually evaluated the contrast-enhancement patterns at CEUS. For each lesion, they assessed: (a) nature (benign, malignant, not assessable), (b) specific diagnosis and (c) need for further radiological evaluation. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were calculated. RESULTS: A total of 167/187 (89.3%) lesions were correctly assessed as benign or malignant at CEUS, whereas 14/187 (7.5%) lesions remained undetermined and 6/187 (3.2%) were incorrectly assessed. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were, respectively, 89%, 89.6%, 89%, 89.6% and 89.3%. The need for further radiological evaluation decreased to 46/187 (24.6%) lesions after CEUS (p<0.001). CONCLUSIONS: In selected cases, CEUS can be considered an effective alternative to MDCT and MRI and reduce the need for further radiological workup.
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Hepatopatias/diagnóstico , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Biópsia por Agulha Fina , Meios de Contraste , Feminino , Humanos , Hepatopatias/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , UltrassonografiaRESUMO
LyeTx I, an antimicrobial peptide isolated from the venom of Lycosa erythrognatha, known as wolf spider, has been synthesised and its structural profile studied by using the CD and NMR techniques. LyeTx I has shown to be active against bacteria (Escherichia coli and Staphylococcus aureus) and fungi (Candida krusei and Cryptococcus neoformans) and able to alter the permeabilisation of L: -alpha-phosphatidylcholine-liposomes (POPC) in a dose-dependent manner. In POPC containing cholesterol or ergosterol, permeabilisation has either decreased about five times or remained unchanged, respectively. These results, along with the observed low haemolytic activity, indicated that antimicrobial membranes, rather than vertebrate membranes seem to be the preferential targets. However, the complexity of biological membranes compared to liposomes must be taken in account. Besides, other membrane components, such as proteins and even specific lipids, cannot be discarded to be important to the preferential action of the LyeTx I to the tested microorganisms. The secondary structure of LyeTx I shows a small random-coil region at the N-terminus followed by an alpha-helix that reached the amidated C-terminus, which might favour the peptide-membrane interaction. The high activity against bacteria together with the moderate activity against fungi and the low haemolytic activity have indicated LyeTx I as a good prototype for developing new antibiotic peptides.
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Antibacterianos/farmacologia , Antifúngicos/farmacologia , Peptídeos Catiônicos Antimicrobianos/farmacologia , Venenos de Aranha/química , Animais , Antibacterianos/química , Antibacterianos/isolamento & purificação , Antifúngicos/química , Antifúngicos/isolamento & purificação , Peptídeos Catiônicos Antimicrobianos/química , Peptídeos Catiônicos Antimicrobianos/isolamento & purificação , Candida/efeitos dos fármacos , Cryptococcus neoformans/efeitos dos fármacos , Relação Dose-Resposta a Droga , Escherichia coli/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Modelos Moleculares , Fosfatidilcolinas/antagonistas & inibidores , Estrutura Secundária de Proteína , Aranhas , Staphylococcus aureus/efeitos dos fármacosRESUMO
PURPOSE: This study aimed to assess the prevalence and characteristics of myocardial bridging in patients who underwent multislice computed tomography coronary angiography (MSCT-CA) and to evaluate the correlation between bridged coronary segments and atherosclerosis. MATERIALS AND METHODS: A total of 277 patients (mean age 60+/-11 years) we consecutively examined with 64-slice MSCT-CA for suspected or known coronary atherosclerosis were retrospectively reviewed for myocardial bridging. Segments proximal and distal to the bridging were evaluated for atherosclerotic plaque, as were the remaining coronary segments. RESULTS: Myocardial bridging was present in 82 patients (30%, mean age 59+/-12). Bridges were of variable length (<1 cm 58%; 1-2 cm 32%; >2 cm 10%) and depth (superficial 69%, intramyocardial 31%) and frequently localised in the mid-distal segment of the left anterior descending artery (95%). Myocardial bridging cannot be considered a significant risk factor for coronary atherosclerosis (odds ratio 0.49) compared with traditional cardiovascular risk factors. Coronary segments proximal to the bridge showed no atherosclerotic disease (33%), positive remodelling (27%), <50% stenosis (20%) or >50% stenosis (20%). We identified 12 noncalcified, 32 mixed and 17 calcified plaques. The distal segments were significantly less affected (p<0.0001). CONCLUSIONS: MSCT-CA is a reliable, noninvasive method that is able to depict myocardial bridging and associated atherosclerotic plaque in the proximal segments.
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Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Ponte Miocárdica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte Miocárdica/epidemiologia , Prevalência , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Sicília/epidemiologiaRESUMO
One fundamental question about pulsars concerns the mechanism of their pulsed electromagnetic emission. Measuring the high-end region of a pulsar's spectrum would shed light on this question. By developing a new electronic trigger, we lowered the threshold of the Major Atmospheric gamma-ray Imaging Cherenkov (MAGIC) telescope to 25 giga-electron volts. In this configuration, we detected pulsed gamma-rays from the Crab pulsar that were greater than 25 giga-electron volts, revealing a relatively high cutoff energy in the phase-averaged spectrum. This indicates that the emission occurs far out in the magnetosphere, hence excluding the polar-cap scenario as a possible explanation of our measurement. The high cutoff energy also challenges the slot-gap scenario.
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PURPOSE: The aim of our study was to assess the influence of heart rate on the selection of the optimal reconstruction window with 40-slice multidetector-row computed tomography (40-MDCT) coronary angiography. MATERIALS AND METHODS: We studied 170 patients (114 men, age 60+/-11.3 years) with suspected or known coronary artery disease with 40-MDCT coronary angiography. Patients [mean heart rate (HR) 62.9+/-9.3 bpm, range 42-94 bpm] were clustered in two groups (group A: HR
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Angiografia Coronária , Frequência Cardíaca , Processamento de Imagem Assistida por Computador , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Angiografia Coronária/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The atmospheric Cherenkov gamma-ray telescope MAGIC, designed for a low-energy threshold, has detected very-high-energy gamma rays from a giant flare of the distant Quasi-Stellar Radio Source (in short: radio quasar) 3C 279, at a distance of more than 5 billion light-years (a redshift of 0.536). No quasar has been observed previously in very-high-energy gamma radiation, and this is also the most distant object detected emitting gamma rays above 50 gigaelectron volts. Because high-energy gamma rays may be stopped by interacting with the diffuse background light in the universe, the observations by MAGIC imply a low amount for such light, consistent with that known from galaxy counts.
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AIMS/HYPOTHESIS: The aim of our study was to compare prescription drug costs in diabetic and non-diabetic individuals in a large population-based Italian cohort covered by the National Health System. METHODS: We identified diabetic residents in Turin on 31 July 2003 through multiple independent data sources (diabetes registry, hospital discharges and prescriptions data sources). All prescriptions registered in the 12 month period 1 August 2003 to 31 July 2004 were examined to compare prevalence of treatment and costs in diabetic (n = 33,797) and non-diabetic individuals (n = 863,876). A log-linear model was employed to estimate age- and sex-adjusted ratios of costs. RESULTS: Costs per person per year were 830.90euros in diabetic patients and 182.80euros in non-diabetic individuals (age- and sex-adjusted rate ratio 2.8, 95% CI 2.7-2.9). Diabetes treatment accounted for 18.5% of the total cost. Compared with non-diabetic individuals, the excess of expenditure was particularly high in diabetic patients aged <45 years (rate ratio 9.3), in those with type 1 diabetes (rate ratio 7.7) and in insulin users (rate ratio 4.8). The cost of diet-treated patients was similar to those treated with oral drugs. Diabetes was associated with an increased prevalence of treatment for most drug categories; one-third of the diabetic cohort received ACE inhibitors, anti-thrombotic drugs and statins. CONCLUSIONS/INTERPRETATION: This population-based study shows that diabetes has a great impact on prescription drug costs, independently of main confounders, particularly in insulin-treated patients, suggesting that a wide range of comorbidities affect their health. Costs are expected to further increase if the transferability of knowledge provided by evidence-based guidelines on diabetic patients is completed over the coming years.
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Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/economia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/economia , Prescrições de Medicamentos/economia , Adulto , Idoso , Custos e Análise de Custo , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Sistema de Registros , População Urbana/estatística & dados numéricosRESUMO
PURPOSE: This study was performed to evaluate the usefulness of digital cineradiography in detecting swallowing disorders in dysphagic patients affected by amyotrophic lateral sclerosis (ALS) with a view to planning an adequate therapeutic approach. MATERIAL AND METHODS: From January 2005 to September 2006, 23 patients (10 men and 13 women; mean age 41.3+/-8.6 years) affected by ALS were evaluated with digital cineradiography to assess the grade of dysphagia. All patients were classified using the Hillel ALS Severity Scale (ALSSS). All examinations were performed with radiocontrolled equipment provided with a digital C-arm. RESULTS: The cineradiographic technique enabled us to differentiate patients with disorders of the oral (17/23) and/or pharyngeal (19/23) swallowing phase from those without swallowing dysfunction (4/23). In 14/23 patients, passage of contrast medium into the upper airways was observed during swallowing, whereas in 5/23 cases, aspiration of contrast medium into the lower airways was recorded. CONCLUSIONS: The videofluoroscopic swallowing study has high diagnostic capabilities in the evaluation of swallowing disorders, as it is able to identify the degree and causes of impairment. In addition, the study proved useful for planning speech therapy and for follow-up in patients with ALS.
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Esclerose Lateral Amiotrófica/complicações , Cinerradiografia , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Adulto , Esclerose Lateral Amiotrófica/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The aim of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) enteroclysis after oral hyperhydration with isotonic solution in detecting bowel wall alterations in patients with Crohn's disease. MATERIALS AND METHODS: Twenty-eight patients with a diagnosis of Crohn's disease established by ileocolonoscopy and histology were enrolled in the study; 15 patients with negative ileocolonoscopy served as controls. In all cases, MDCT enteroclysis was performed after oral administration of 2,000 ml of isotonic solution and intravenous administration of N-butylscopolamine. Axial, isotropic multiplanar and volume-rendered reconstructions were used to evaluate bowel wall thickness, ulceration, contrast enhancement, extraparietal involvement and possible complications. RESULTS: MDCT enteroclysis identified the typical signs of Crohn's disease in 26 patients (92.8%), with sensitivity of 92.8%, specificity of 100%, positive predictive value 100% and negative predictive value 75%. CONCLUSIONS: MDCT enteroclysis after oral hyperhydration with isotonic solution showed a high level of accuracy in detecting small bowel changes in patients with Crohn's disease. It can be considered a safe and effective alternative to conventional radiography and small-bowel spiral computed tomography enema, especially in patients who refuse nasojejunal intubation.
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Doença de Crohn/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Polietilenoglicóis/administração & dosagem , Tomografia Computadorizada por Raios X , Administração Oral , Adulto , Catárticos/administração & dosagem , Meios de Contraste , Feminino , Humanos , Iopamidol/análogos & derivados , Soluções Isotônicas/administração & dosagem , Masculino , Sensibilidade e EspecificidadeRESUMO
Ninety-six patients with chronic bacterial prostatitis (CBP) and evidence of infection were randomized to receive a 4-week oral course of either prulifloxacin (a new fluoroquinolone) 600 mg or levofloxacin 500 mg once daily. They were evaluated with the Meares-Stamey test and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) at baseline and one week after therapy completion. Patients with microbiological eradication were evaluated again with the Meares-Stamey test 6 months after therapy completion. The microbiological eradication rate was 72.73% for prulifloxacin and 71.11% for levofloxacin (p=0.86) and the reduction in the NIH-CPSI was 10.75 and 10.73, respectively (p=0.98). Safety was comparable, with 18.18% adverse events for prulifloxacin and 22.22% for levofloxacin (p=0.79). Thus, a 4-week course of prulifloxacin 600 mg once daily is at least as effective and safe as levofloxacin 500 mg once daily in the treatment of CBP.
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Antibacterianos/uso terapêutico , Dioxolanos/uso terapêutico , Fluoroquinolonas/uso terapêutico , Levofloxacino , Ofloxacino/uso terapêutico , Piperazinas/uso terapêutico , Prostatite/tratamento farmacológico , Quinolonas/uso terapêutico , Adulto , Antibacterianos/efeitos adversos , Doença Crônica , Dioxolanos/efeitos adversos , Método Duplo-Cego , Fluoroquinolonas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Ofloxacino/efeitos adversos , Piperazinas/efeitos adversos , Estudos Prospectivos , Prostatite/microbiologia , Quinolonas/efeitos adversosRESUMO
PURPOSE: We assessed the value of image fusion in the staging of prostatic cancer in a series of 32 patients who underwent preoperative evaluation with transrectal colour-Doppler ultrasonography (TRUS) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Colour-Doppler TRUS exams were performed using a 7.5-MHz biplanar probe. MRI exams were done with a scanner operating at 1.5 Tesla (T) using an endorectal coil. All patients underwent radical prostatectomy within 2 weeks from the imaging assessment. Whole-mount sections were prepared from the surgical specimens and were subsequently digitised by using a high-resolution scanner. The Digital Imaging and Communications in Medicine (DICOM) TRUS and MR images as well as the digitised pathological images were transferred to a graphic workstation to perform image fusion. RESULTS: Image fusion was technically possible in 25/32 cases in which axial TRUS images were available. The following fusion images were obtained: TRUS + pathological sections; MRI + pathological sections; TRUS + MRI + pathological sections. The final pathological staging concerning the T status was: four pT2b, fourteen pT2c, three pT3a and four pT3b. The three types of image fusion led to the following results: TRUS + pathological sections, correct staging in 20/25 cases (accuracy 80%); MRI + pathological sections, correct staging in 22/25 cases (accuracy 88%); TRUS + MRI + pathological sections, correct staging in 23/25 cases (accuracy 92%). CONCLUSIONS: Our study suggests that by using image fusion between colour-Doppler TRUS and endorectal MRI, it is possible to improve the accuracy of pathological staging in patients who are candidates for radical prostatectomy.
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Carcinoma/patologia , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/patologia , Ultrassonografia Doppler em Cores/métodos , Idoso , Carcinoma/diagnóstico por imagem , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Inclusão em Parafina , Valor Preditivo dos Testes , Antígeno Prostático Específico/análise , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico por imagem , Glândulas Seminais/patologia , Sensibilidade e Especificidade , Fixação de TecidosRESUMO
Prostate cancer synchronously or metachronously metastasizing to the testis is a rare finding. We herein report on the first case of a solitary testicular metastasis from an organ-confined prostate cancer, diagnosed 6 months after a radical prostatectomy, without evidence of previous or concomitant biochemical and local recurrence.
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Adenocarcinoma/secundário , Neoplasias da Próstata/cirurgia , Neoplasias Testiculares/secundário , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Humanos , Masculino , Antígeno Prostático Específico/análise , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata/diagnóstico , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patologia , UltrassonografiaRESUMO
Accidents caused by brown spiders (Loxosceles genus) are frequent in Brazil and are associated with dermonecrotic lesions and, eventually, systemic reactions that may be lethal. The major species implicated with human envenoming have been: L. intermedia, L. gaucho and L. laeta. In this study we characterized the venom from Loxosceles similis, a species of spider normally found inside caves. L. similis venom was characterized by two-dimensional gel electrophoresis and enzymatic activity (dermonecrosis and haemolysis). The lethal dose to mice and the capacity of commercial anti-serum to neutralize this venom were also analysed. The cross-reactivity with anti-venoms against L. intermedia, L. laeta and L. gaucho were studied. Our results showed that this venom was able to induce severe dermonecrotic lesions and showed the presence of the bacteria Clostridium septicum in association with the fangs. In addition, we have cloned the DNA coding for a dermonecrotic protein (LsD1), using the genomic DNA of L. similis. The deduced amino acid sequence showed a toxin of approximately 31.2 kDa with an estimated pI of 7.37 and sequence similar to LiD1, a protein from the dermonecrotic family of Loxosceles intermedia spider venom, a synanthropic species of medical importance.
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Diester Fosfórico Hidrolases/isolamento & purificação , Diester Fosfórico Hidrolases/toxicidade , Pele/patologia , Venenos de Aranha/isolamento & purificação , Venenos de Aranha/toxicidade , Aranhas/química , Animais , Sequência de Bases , Western Blotting , Brasil , Clostridium/isolamento & purificação , Reações Cruzadas/imunologia , Primers do DNA , Eletroforese em Gel Bidimensional , Eletroforese em Gel de Poliacrilamida , Ensaio de Imunoadsorção Enzimática , Hemólise/efeitos dos fármacos , Soros Imunes/farmacologia , Dose Letal Mediana , Camundongos , Dados de Sequência Molecular , Necrose , Diester Fosfórico Hidrolases/genética , Análise de Sequência de DNA , Especificidade da Espécie , Venenos de Aranha/antagonistas & inibidores , Venenos de Aranha/genética , Aranhas/microbiologiaRESUMO
PURPOSE: This paper describes the role of MR imaging in the identification of the different macroscopic patterns of lipoma arborescens. MATERIALS AND METHODS: Between June 1995 and January 2004, a total of 6387 MR examinations of the knee were retrospectively assessed for the presence of lipoma arborescens. The MR examinations were performed using a superconductive 0.5 T MR unit with a transmitting/ receiving coil dedicated for the extremities. The MR images were acquired with SE T1-weighted, GE T2-weighted and STIR sequences in sagittal, coronal and axial planes with 3-mm thickness and 1-mm gap. RESULTS: Lipoma arborescens was identified in 9 patients (mean age: 36 years). In 2/9 cases a localized lipoma arborescens was detected as a well-marginated single nodule on the suprapatellar bursa without irregularity or synovial hyperplasia. In the remaining 7 cases diffuse lipoma arborescens was identified on the wall of the suprapatellar bursa. In one case of diffuse lipoma arborescens there was involvement of both knees. In all cases the MR findings were verified at surgery and the final diagnosis was made by histological examination. CONCLUSIONS: MR imaging shows a high accuracy in the identification and characterization of lipoma arborescens, due to its multiplanar capabilities and high contrast resolution. MRI allows correct evaluation of size and grade, accurate treatment planning and effective follow-up, avoiding the need for synovial biopsy.
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We assessed the accuracy of voiding color Doppler ultrasonography (US) with echo enhancement for diagnosis or exclusion of vesicoureteral reflux (VUR) versus voiding cystourethrography (VCUG) and evaluated patient tolerance of the echo-enhancing agent. One hundred twenty-two patients (ages range, 1 month to 17 years) with 244 ureterorenal units underwent voiding color Doppler US with echo enhancement, which was followed by VCUG on the same day. After US of the urinary tract, the bladder was filled with saline solution via catheter. Then an echo-enhancing agent was instilled, and color Doppler US was performed. Reflux was diagnosed when microbubbles appeared in the ureter or the pelvicaliceal system. VUR was detected in 98 units. All grades of reflux were identified. In 13 units (13.3%), grade I reflux diagnosed at voiding color Doppler US was not observed at VCUG. No reflux was detected in 146 units by either method. In 231 (94.2%) of the 244 ureterorenal units, there was concordance between the two methods. The echo-enhancing agent was well tolerated by all patients. Voiding color Doppler US with echo enhancement is useful for the diagnosis or exclusion of VUR, being as good as VCUG. Therefore, it may reduce the number of patients exposed to ionizing radiation.