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1.
J Clin Med ; 11(21)2022 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-36362510

RESUMO

Pulmonary arteriovenous malformations (PAVMs) are uncommon, predominantly congenital direct fistulous connections between the pulmonary arteries and pulmonary veins, resulting in a right to left shunt. Patients with PAVMs are usually asymptomatic with lesions detected incidentally when radiological imaging is performed for other indications. In this review, we discuss the classification and radiological features of PAVMs as well as their treatment and follow-up options, with a particular focus on percutaneous endovascular techniques and the evolution of the available equipment for treatment.

2.
Australas J Ultrasound Med ; 25(3): 142-153, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35978727

RESUMO

Focal liver lesions are commonly encountered. Grey-scale and Doppler sonographic characteristics of focal liver lesions are often non-specific and insufficient to conclusively characterise lesions as benign or malignant. Contrast-enhanced ultrasound is useful for the characterisation of FLLs in patients who are unable to undergo contrast-enhanced computed tomography or magnetic resonance imaging. It is also easily available and relatively cheap. However, interpretation of contrast-enhanced ultrasound can be challenging without a systematic approach. In this pictorial essay, we highlight an algorithm-based approach to FLLs and discuss the characteristic contrast-enhanced ultrasound features of commonly encountered and clinically significant focal liver lesions.

3.
Medicine (Baltimore) ; 101(17): e29143, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35512070

RESUMO

BACKGROUND: Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP. METHODS: MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated. RESULTS: Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688-1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434-6.121; P = .003). There was substantial heterogeneity in this group. CONCLUSION: This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.


Assuntos
Neoplasias , Paniculite Peritoneal , Bases de Dados Factuais , Humanos , Mesentério , Paniculite Peritoneal/complicações , Paniculite Peritoneal/epidemiologia , Tomografia Computadorizada por Raios X
4.
Ann Acad Med Singap ; 51(12): 766-773, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36592145

RESUMO

INTRODUCTION: Sarcopenia, defined as low skeletal muscle mass and poor muscle function, has been associated with worse postoperative recovery. This study aims to evaluate the significance of low muscle mass in the elderly who require emergency surgeries and the postoperative outcomes. METHOD: Data from the emergency laparotomy database were retrieved from Khoo Teck Puat Hospital, Singapore, between 2016 and 2019. A retrospective analysis was performed on patients aged 65 years and above. Data collected included skeletal muscle index (SMI) on computed tomography scan, length of stay, complications and mortality. Low muscle mass was determined based on 25th percentile values and correlation with previous population studies. RESULTS: A total of 289 patients were included for analysis. Low muscle mass was defined as L3 SMI of <22.09cm2/m2 for females and <33.4cm2/m2 for males, respectively. Seventeen percent of our patients were considered to have significantly low muscle mass. In this group, the length of stay (20.8 versus 16.2 P=0.041), rate of Clavien-Dindo IV complications (18.4% vs 7.5% P=0.035) and 1-year mortality (28.6% vs 14.6%, P=0.03) were higher. Further multivariate analysis showed that patients with low muscle mass had increased mortality within a year (odds ratio 2.16, 95% confidence interval 1.02-4.55, P=0.04). Kaplan-Meier analysis also shows that the 1-year overall survival was significantly lower in patients with low muscle mass. CONCLUSION: Patients with low muscle mass have significantly higher post-surgical complication rates and increased mortality.


Assuntos
Laparotomia , Sarcopenia , Idoso , Masculino , Feminino , Humanos , Estudos Retrospectivos , Prognóstico , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Sarcopenia/complicações , Músculo Esquelético/diagnóstico por imagem
5.
J Gastroenterol Hepatol ; 37(3): 455-463, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34665473

RESUMO

BACKGROUND AND AIM: A preemptive transjugular intrahepatic portosystemic shunt (p-TIPSS) after acute variceal bleeding (AVB) is advocated. However, when compared with the current standard of care, the survival benefit of p-TIPSS is questionable. We performed a systematic review, meta-analysis, and trial sequential analysis of randomized control trials (RCTs) to assess the survival benefit of p-TIPSS in patients with cirrhosis and AVB. METHODS: Comprehensive literature search of three bibliographic databases (MEDLINE, Embase, and Cochrane) was conducted from inception till May 2021. All study types evaluating the survival benefit of p-TIPSS in AVB were considered for inclusion. The relative risk (RR) of mortality and rebleeding at 6 weeks and mortality at 1 year with a random-effects model was computed. Trial sequential analysis was performed for the primary outcome of 6-week mortality. RESULTS: A total of nine studies (four RCTs and five cohort studies) comprising 2861 patients with AVB were included. The overall pooled risks of mortality at 6 weeks and 1 year were 17.9% (95% confidence interval [CI]: 16.5-19.3%) and 26.7% (95% CI: 25.0-28.3%), respectively. Although p-TIPSS was associated with lower 6-week rebleeding risk (RR = 0.20; 95% CI = 0.13-0.29, I2  = 0%), data from pooled RCTs showed no significant difference in mortality at 6 weeks (RR = 0.33; 95% CI = 0.08-1.36, I2  = 63%) or at 1 year (RR = 0.76; 95% CI = 0.51-1.14, I2  = 30%). Using trial sequential analysis, required sample size to detect a 20% relative risk reduction in mortality at 6 weeks with p-TIPSS was estimated to be 6317, which is beyond the total number of patients available for analysis. CONCLUSIONS: This meta-analysis found that the available data from RCTs are insufficient to confer 6-week mortality benefit with p-TIPSS compared with standard of care; thus, adequately powered RCTs are required.


Assuntos
Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Cirrose Hepática , Derivação Portossistêmica Transjugular Intra-Hepática , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/cirurgia , Humanos , Cirrose Hepática/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco
6.
J Emerg Trauma Shock ; 14(2): 111-116, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34321811

RESUMO

Intercostal artery bleeding from trauma can result in potentially fatal massive hemothorax. Traumatic hemothorax has traditionally been treated with tube thoracostomy, video-assisted thoracoscopic surgery, or thoracotomy. Transcatheter arterial embolization (TAE), a well-established treatment option for a variety of acute hemorrhage is not widely practiced for the management of traumatic hemothorax. We present 2 cases of delayed massive hemothorax following chest trauma which were successfully managed by transarterial embolization of intercostal arteries. The published studies are reviewed and a systematic approach to the selection of patients for TAE versus emergency thoracotomy is proposed.

9.
Travel Med Infect Dis ; 35: 101636, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32205267

RESUMO

BACKGROUND: The current 2019 novel coronavirus outbreak is rapidly evolving. YouTube has been recognized as a popular source of information in previous disease outbreaks. We analyzed the content on YouTube about n-CoV in English and Mandarin languages. METHODS: YouTube was searched using the terms '2019 novel coronavirus', 'Wuhan virus' and '' (Mandarin for Wuhan virus) on 1st and 2nd February 2020. First 50 videos in each group were analyzed. Videos in other languages, duplicate videos, those without an audio and duration >15 min were excluded .72 videos in English and 42 in Mandarin were reviewed. 2 reviewers classified the videos as useful, misleading or news based on pre specified criterion. Inter-observer agreement was evaluated with kappa coefficient. Modified DISCERN index for reliability and medical information and content index (MICI) score were used for content analysis. RESULTS: These videos attracted cumulative 21,288,856 views. 67% of English and 50% Mandarin videos had useful information. The viewership of misleading Mandarin videos was higher than the useful ones. WHO accounted for only 4% of useful videos. Mean DISCERN score for reliability was 3.12/5 and 3.25/5 for English and Mandarin videos respectively. Mean cumulative MICI score of useful videos was low (6.71/25 for English and 6.28/25 for Mandarin). CONCLUSIONS: YouTube viewership during 2019 n-CoV outbreak is higher than previous outbreaks. The medical content of videos is suboptimal International health agencies are underrepresented. Given its popularity, YouTube should be considered as important platform for information dissemination.


Assuntos
Betacoronavirus , Informação de Saúde ao Consumidor/métodos , Infecções por Coronavirus/epidemiologia , Disseminação de Informação/métodos , Pneumonia Viral/epidemiologia , Mídias Sociais , COVID-19 , Infecções por Coronavirus/virologia , Estudos Transversais , Humanos , Idioma , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2
10.
J Med Imaging Radiat Oncol ; 64(2): 211-214, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32037715

RESUMO

INTRODUCTION: In the present study, we aimed to assess whether normal saline injection for sealing the biopsy track is useful in reducing the incidence of pneumothorax after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB). METHODS: We retrospectively compared the incidence of pneumothorax in 100 consecutive biopsies (n = 100, group A) that had injection of saline along the track, with historical cohort of same number of consecutive patients who underwent PTLB without injection of saline along the needle track (n = 100, group B). CT-guided biopsies were performed by coaxial technique and 1-3 ml of saline was injected along the tract. Patient chjmirocteristics, lesion size, location and other baseline pjmirometers were compared. Incidence of pneumothorax and number of patients who underwent catheter drainage of pneumothorax was compared in both groups. RESULTS: Baseline chjmirocteristics were compjmiroble in both groups. Track sealing with saline was successful in all patients. Pneumothorax rate was 46% for patients in group B and 32% in group A (P < 0.05). Seven patients (7%) had insertion of chest drain for pneumothorax in the group B and only 1% in the group A (P < 0.05). No mortality was observed in both groups. No complications were observed in any of the patients due to saline injection. CONCLUSION: Track sealing with saline is a simple and safe technique which significantly reduces the incidence of pneumothorax and chest tube insertion after PTLB.


Assuntos
Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumotórax/prevenção & controle , Radiografia Intervencionista/métodos , Solução Salina/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Idoso , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Estudos Retrospectivos , Solução Salina/administração & dosagem
12.
AJR Am J Roentgenol ; 213(6): 1291-1296, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31573848

RESUMO

OBJECTIVE. This study aims to compare the diagnostic accuracy of virtual unenhanced CT images derived from dual-source dual-energy contrast-enhanced CT with that of standard unenhanced CT images for evaluation of sialolithiasis. MATERIALS AND METHODS. All dual-energy CT studies of the neck performed during the preceding 5 years were reviewed for submandibular gland calculi. Only patients who had unenhanced CT and contrast-enhanced CT performed as part of the same evaluation were included in this study. This review yielded 30 patients. Virtual unenhanced CT images were derived from the dual-energy dataset and compared with the true unenhanced CT images by two separate radiologists who assessed the total number of calculi encountered, their location, the largest dimension, and the attenuation of the calculi. The radiation burden incurred for true unenhanced CT and virtual unenhanced CT and the total radiation burden were calculated. RESULTS. Our analysis revealed that measurements of stone size showed good interobserver agreement. The mean stone size was 7.9 ± 5.9 (SD) mm on virtual unenhanced CT and 8.4 ± 5.9 mm on true unenhanced CT (range, 2.0-31.8 mm); the difference was statistically insignificant. The mean stone attenuation differed considerably (p < 0.01) between the virtual and true unenhanced CT images (494.8 ± 187.5 HU and 924.4 ± 374.9 HU, respectively), but correlated well. The mean radiation dose for a dual-phase IV contrast-enhanced CT study was 23.13 mGy (volume CT dose index). The mean dose was 10.93 mGy for the true unenhanced CT phase, thereby suggesting a 47.25% reduction in administered radiation dose when a single-phase contrast-enhanced CT study with virtual unenhanced image reconstructions is performed. CONCLUSION. Virtual unenhanced CT images derived from dual-source dual-energy CT scans of the neck provide accurate assessment of sialolithiasis akin to that provided by conventional CT protocols but at only a fraction of the radiation dosage.


Assuntos
Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Cálculos das Glândulas Salivares/diagnóstico por imagem , Glândula Submandibular/diagnóstico por imagem , Adolescente , Adulto , Meios de Contraste , Feminino , Humanos , Iohexol , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
13.
Ann Hepatobiliary Pancreat Surg ; 22(3): 282-286, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30215051

RESUMO

Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past. She was deemed to be a high operative risk and declined hepatic resection. She had undergone multiple endoscopic and percutaneous biliary interventions to control sepsis and stone burden. A bilateral PTBD catheter was left in situ with plans for 3-monthly change. However, she defaulted follow-up and presented 11 months later with complaints of pain over the drain site and inability to flush the right catheter. Abdominal X-ray and computed tomography scans detected right catheter fracture at two places, making three fragments. She underwent percutaneous removal of the proximal fragment by an interventional radiology team. A temporary 4 Fr catheter was inserted to maintain biliary access. Endoscopic removal of the intra-biliary fragments was done the next day. Complete removal was confirmed on fluoroscopy. Finally, the 4 Fr catheter was replaced by a new 12 Fr catheter. The patient was discharged well.

14.
BMJ Case Rep ; 20182018 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-29735509
15.
Asian J Neurosurg ; 13(2): 458-461, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29682060

RESUMO

Subdural empyema (SDE) is collection of pus in the potential space between the dura and arachnoid layers of the meninges. Leading causes of SDE are sinonasal and otomastoid infections. Commonly affecting patients in the second and third decades, SDE could have a fulminant course with immediate complications and delayed morbidities including hydrocephalus, focal deficits, and epilepsy.

16.
J Clin Ultrasound ; 46(8): 558-561, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29457228

RESUMO

Pseudoaneurysms of the scalp are rare. Most common etiology is trauma. The patients usually present clinically with persistent painful swelling in the scalp few days after the trauma. The lesion may or may not be pulsatile clinically. Ultrasonography (US) is the best modality to assess these pseudoaneurysms. It not only helps in the diagnosis, but also to trace the offending arterial branch and helps in treatment. We present two cases of post-traumatic scalp pseudoaneurysms which were diagnosed with US and were managed by US-guided thrombin injection. Follow up US showed complete resolution. We highlight the importance of US scan in diagnosis, management, and follow up of scalp pseudoaneurysms.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Hemostáticos/administração & dosagem , Couro Cabeludo/lesões , Artérias Temporais/diagnóstico por imagem , Trombina/administração & dosagem , Ultrassonografia de Intervenção , Assistência ao Convalescente/métodos , Idoso de 80 Anos ou mais , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/etiologia , Hemostáticos/uso terapêutico , Humanos , Injeções , Masculino , Couro Cabeludo/irrigação sanguínea , Couro Cabeludo/diagnóstico por imagem , Trombina/uso terapêutico
17.
Clin Imaging ; 37(3): 564-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23265981

RESUMO

Epstein-Barr virus-related smooth muscle cell tumors (EBV-SMTs) are rare albeit increasingly recognized tumors in immunocompromised patients. We report on the imaging features of EBV-SMTs occurring in the central nervous system (CNS) in two patients. Central areas of T2 prolongation, surrounding vasogenic edema, mass effect on adjacent neuroparenchyma, dural tails, and underlying bone erosions were the notable imaging findings. Besides the usual differentials of extraaxial tumors like meningioma, hemangiopericytoma, and lymphoma, CNS EBV-SMTs should be considered in immunocompromised patients.


Assuntos
Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/patologia , Infecções por Vírus Epstein-Barr/patologia , Neoplasias Musculares/patologia , Músculo Liso/patologia , Neoplasias da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/patologia , Adulto , Infecções por Vírus Epstein-Barr/complicações , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/virologia , Músculo Liso/virologia
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