RESUMO
Imaging of the submandibular glands can provide vital information about malignant neoplastic processes. One of these modalities, fluorine-18 fluorodeoxyglucose-positron-emission tomography/computed tomography (FDG-PET/CT), has become very important in the detection of malignancies because it provides functional and metabolic information as well as anatomic localization. However, there are several pitfalls associated with FDG-PET/CT in terms of salivary gland imaging. For example, a normal increase in the uptake of radiotracer might be mistaken for a neoplastic process. Other routine findings may include normal physiologic uptake in some structures, benign tumors and medical conditions, and iatrogenic abnormalities. We review a case in which compensatory hypertrophy of a submandibular gland was suspected to be a possible malignancy.
Assuntos
Erros de Diagnóstico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Glândula Submandibular/diagnóstico por imagem , Glândula Submandibular/diagnóstico por imagem , Adulto , Feminino , Fluordesoxiglucose F18/farmacocinética , Humanos , Compostos Radiofarmacêuticos/farmacocinéticaRESUMO
OBJECTIVE: Native Hawaiians (NH) represent a unique population where socioeconomic factors have contributed to higher incidence rates of obesity and related comorbidities than in the general population resulting in substantial prescription medication costs. Studies demonstrate that laparoscopic Roux-en-y gastric bypass (LRYGB) surgery results in significant weight loss, improvement of comorbidities, and decreased costs for prescription medications in Caucasians. This study aimed to analyze the effects of LRYGB surgery on Native Hawaiians and their prescription drug costs. METHODS: Demographics, baseline body mass index (BMI), comorbidities, preoperative, and postoperative data were analyzed for NH patients who underwent LRYGB between January 2004 and April 2009. Medication costs were determined using the online pharmacy
Assuntos
Redução de Custos/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Derivação Gástrica , Havaiano Nativo ou Outro Ilhéu do Pacífico , Obesidade Mórbida/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Derivação Gástrica/métodos , Havaí/epidemiologia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/economia , Obesidade Mórbida/etnologia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Redução de PesoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Fibrossarcoma/tratamento farmacológico , Neoplasias do Seio Maxilar/tratamento farmacológico , Pré-Escolar , Doxorrubicina/administração & dosagem , Feminino , Fibrossarcoma/diagnóstico , Humanos , Ifosfamida/administração & dosagem , Neoplasias do Seio Maxilar/diagnóstico , Razoxano/administração & dosagemRESUMO
INTRODUCTION: Since receiving Food and Drug Administration approval in 2000, surgery utilizing a robot has been successfully performed in numerous procedures including gastric bypass. However, despite the proven safety profile, reported lower complication rates, and technical benefits of robotic surgery, only a few centers in the USA have consistently applied this technology to bariatric surgery. In addition, there are limited studies with relatively small sample sizes comparing robotic-assisted Roux-en-Y gastric bypass (RRYGB) with laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: Through a retrospective analysis of our database, we compared outcomes of RRYGB versus LRYGB in the treatment of morbid obesity. All patients who underwent RRYGB and LRYGB through the Comprehensive Weight Management Program of the Queen's Medical Center (Honolulu, HI) from January 2007 to December 2009 were included. Outcomes data included weight loss, operative times, and hospital length of stay. All complications were reported. RESULTS: 105 patients who underwent RRYGB were compared with 195 patients who received LRYGB. Excess weight loss, estimated blood loss, and length of hospital stay were similar in both groups. There were no mortalities in either group. The RRYGB group experienced a 9.5% complication rate versus 9.7% in LRYGB patients. Operative time was the only statistically significant difference, being approximately 17 min in favor of LRYGB. However, there was a steady decrease in RRYGB operative time with increasing experience. CONCLUSION: Our study demonstrates a favorable safety profile with nearly equivalent outcomes and some previously unidentified qualitative benefits of the RRYGB approach to bariatric surgery in a community setting. These results are despite our early experience with the robotic surgery platform and confirm noninferiority of RRYGB versus LRYGB. While the RRYGB operative time was longer than LRYGB, the demonstrated decrease in operative time commensurate with increase in operative experience holds tremendous promise for the future.