Assuntos
Síndrome de Ehlers-Danlos/diagnóstico , Doença de von Willebrand Tipo 1/diagnóstico , Adulto , Alelos , Colágeno Tipo V/genética , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/genética , Síndrome de Ehlers-Danlos/patologia , Fator VIII/análise , Feminino , Fibroblastos/citologia , Fibroblastos/patologia , Humanos , Metrorragia/diagnóstico , Metrorragia/etiologia , Tempo de Tromboplastina Parcial , Doença de von Willebrand Tipo 1/complicaçõesRESUMO
Wernicke encephalopathy is a neurological disorder, often caused by a lack of thiamine. Immediate diagnosis and therapy are important to prevent significant morbidity and mortality. Based on a clinical case radiologic imaging features on MRI are demonstrated.
Assuntos
Encefalopatia de Wernicke , Idoso , Alcoolismo/complicações , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Desnutrição/complicações , Tiamina/administração & dosagem , Tiamina/uso terapêutico , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologiaRESUMO
BACKGROUND: The reduction of treatment-related toxic effects is the main goal in the current trials of the German Hodgkin Study Group (GHSG). In this regard, the protection of the ovarian reserve in young women is very important. Therefore, the GHSG investigated the use of gonadotropin-releasing hormone-analogues (GnRH-a) and oral contraceptives (OC) in young women with advanced-stage Hodgkin lymphoma (HL). PATIENTS AND METHODS: Women (18-40 years) were randomly assigned either to receive daily OC or monthly GnRH-a during escalated combination therapy with bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc). Hormonal levels were determined at baseline, during therapy, and at follow-up. RESULTS: The study was closed prematurely after an interim analysis of 12 patients in arm A (OC) and 11 in arm B (GnRH-a), 9 and 10 are assessable for the primary end point. Women's median age was 25 years in both arms. The anti-Mullerian hormone level after at least 12 months was reduced in all patients. For the entire study cohort, the respective ovarian follicle preservation rate was 0% (95% confidence interval 0% to 12%). CONCLUSION: We observed no protection of the ovarian reserve with hormonal co-treatment during BEACOPPesc. This result supports efforts of ongoing trials to reduce chemotherapy intensity and toxicity. Alternative strategies for the protection of fertility must be offered to young female HL patients before the start of BEACOPPesc therapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Anticoncepcionais Orais/uso terapêutico , Fertilidade/efeitos dos fármacos , Hormônio Liberador de Gonadotropina/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Folículo Ovariano/efeitos dos fármacos , Adolescente , Adulto , Hormônio Antimülleriano/metabolismo , Bleomicina/uso terapêutico , Estudos de Coortes , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Alemanha , Doença de Hodgkin/patologia , Humanos , Estadiamento de Neoplasias , Prednisona/uso terapêutico , Procarbazina/uso terapêutico , Taxa de Sobrevida , Resultado do Tratamento , Vincristina/uso terapêutico , Adulto JovemRESUMO
The central pontine and extrapontine myelinolysis is an important entity in the neurology disorders in the context with alcohol abuse. Though often first based on clinical characteristics, the diagnosis can be often supported with radiologic imaging.
Assuntos
Alcoolismo/complicações , Mielinólise Central da Ponte/etiologia , Desequilíbrio Hidroeletrolítico/complicações , Alcoolismo/sangue , Encéfalo/patologia , Evolução Fatal , Humanos , Hipopotassemia/sangue , Hipopotassemia/complicações , Hipopotassemia/terapia , Hiponatremia/sangue , Hiponatremia/complicações , Hiponatremia/terapia , Infusões Intravenosas , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielinólise Central da Ponte/sangue , Mielinólise Central da Ponte/diagnóstico , Potássio/administração & dosagem , Potássio/efeitos adversos , Solução Salina Hipertônica/administração & dosagem , Solução Salina Hipertônica/efeitos adversos , Sódio/sangue , Tomografia Computadorizada por Raios X , Desequilíbrio Hidroeletrolítico/sangueAssuntos
Edema Encefálico/etiologia , Hipertensão Intracraniana/etiologia , Doença da Urina de Xarope de Bordo/complicações , Papiledema/etiologia , Idade de Início , Encéfalo/patologia , Edema Encefálico/patologia , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Doença da Urina de Xarope de Bordo/patologia , Papiledema/patologia , Adulto JovemRESUMO
OBJECTIVE: Spermatozoa transport into uterus and fallopian tubes is directed to the side of the dominant follicle and seems to be controlled by the ipsilateral ovary. The objective of this study was to evaluate the temperature in the fallopian tubes as well as the concentrations of estradiol and progesterone in the utero-ovarian veins draining the ipsilateral ovary and compare these to the contralateral side of the uterus. STUDY DESIGN: A prospective clinical study. SETTING: Academic-assisted reproductive technology program. SUBJECTS: Temperature was measured in both oviducts of 10 patients each in the early phase as well as during the late follicular phase during the course of examination of tubal patency and function. Blood samples of the ovarian veins were obtained during hysterectomy in 10 premenopausal patients with regular menstrual cycles. Five of the women were in the early follicular phase and 5 were in the late follicular phase. RESULTS: Late follicular phase temperature as well as concentrations of estradiol and progesterone were significantly higher in the ipsilateral tube and the utero-ovarian veins draining the ipsilateral ovary as compared to the contralateral side. No such differences were found during the early follicular phase of the cycle. CONCLUSIONS: These data support our view that the uterus and fallopian tubes during the late follicular phase immediately before ovulation are composed of two functional units with different functional properties acting as a peristaltic pump resulting in increased transport of spermatozoa into the oviduct ipsilateral to the ovary bearing the dominant follicle and that this effect is mediated in part by the utero-ovarian countercurrent system.
Assuntos
Tubas Uterinas/fisiopatologia , Ovário/fisiologia , Transporte Espermático/fisiologia , Útero/fisiologia , Estradiol/sangue , Feminino , Fase Folicular/fisiologia , Humanos , Ovário/irrigação sanguínea , Gravidez , Progesterona/sangue , Estudos Prospectivos , Temperatura , Útero/irrigação sanguíneaAssuntos
Neoplasias Encefálicas/patologia , Glioblastoma/patologia , Metástase Neoplásica/patologia , Idoso , Terapia Combinada , Proteína Glial Fibrilar Ácida/análise , Glioblastoma/radioterapia , Glioblastoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Metástase Neoplásica/radioterapiaRESUMO
The uterus and fallopian tubes represent a functionally united peristaltic pump under the endocrine control of ipsilateral ovary. We have examined this function by using hysterosalpingoscintigraphy (HSS), recording of intrauterine pressure, electrohysterography, and Doppler sonography of the fallopian tubes. An uptake of labeled particles into the uterus was observed during the follicular and luteal phases of the cycle after application into the vagina. Transport into the oviducts, however, could only be demonstrated during the follicular phase. Furthermore, the predominant transport was into the tube ipsilateral to the ovary containing the dominant follicle. The pregnancy rate following spontaneous intercourse or insemination was higher in those women in whom ipsilateral transport could be demonstrated. The amount of material transported to the ipsilateral tube was increased after oxytocin administration, as demonstrated by radionuclide imaging and by Doppler sonography following instillation of ultrasound contrast medium. An increase in the basal tone and amplitude of contractions was observed after oxytocin administration. These results support the idea that the uterus and fallopian tubes act as a peristaltic pump, which increases transport of sperm into the oviduct ipsilateral to the ovary bearing the dominant follicle. Oxytocin appears to play a critical role in this peristaltic pump. A failure of the peristaltic mechanism is possibly responsible for infertility. We propose the term tubal transport disorder (TTD) as a nosological entity. Results from HSS could be a useful adjunct for choosing treatment modalities in patients with patent fallopian tubes suffering from infertility. These patients may be better served with in vitro fertilization (IVF).
Assuntos
Tubas Uterinas/fisiologia , Transporte Espermático/fisiologia , Espermatozoides/fisiologia , Útero/fisiologia , Adulto , Feminino , Humanos , Histerossalpingografia , Masculino , Microesferas , Pessoa de Meia-Idade , Estudos Retrospectivos , Contração Uterina/fisiologia , Útero/anatomia & histologiaAssuntos
Dor Abdominal/etiologia , Veia Porta , Trombose Venosa/diagnóstico , Adulto , Calcinose/diagnóstico , Doença Crônica , Diagnóstico Diferencial , Humanos , Masculino , Veia Porta/patologia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Dupla , Veia Cava Inferior/patologiaRESUMO
OBJECTIVE: Eight women, aged 25-58 years, with hereditary angioneurotic oedema (HANE) were treated with tibolone, a synthetic steroid exhibiting oestrogenic, androgenic and progestational activity. DESIGN: Pilot study. RESULTS: Tibolone at a dose of 2.5-7.5 mg/day significantly reduced the number and severity of attacks and the number of ampoules of C1-esterase inhibitor (C1-INH) needed for symptomatic therapy. The efficacy of tibolone was comparable to that of danazol, while the androgenic side-effects were considerably reduced. CONCLUSIONS: Tibolone may represent an alternative to danazol administration for the prophylaxis of HANE in women.
Assuntos
Angioedema/tratamento farmacológico , Angioedema/genética , Norpregnenos/uso terapêutico , Adulto , Proteínas Inativadoras do Complemento 1/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Resultado do TratamentoAssuntos
Sepse , Tuberculose , Adulto , Autopsia , Broncoscopia , Feminino , Humanos , Radiografia Torácica , Sepse/diagnóstico , Sepse/mortalidade , Sepse/patologia , Choque Séptico/diagnóstico , Choque Séptico/mortalidade , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico , Tuberculose/mortalidade , Tuberculose/patologia , Tuberculose Gastrointestinal/mortalidade , Tuberculose Gastrointestinal/patologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/mortalidade , Tuberculose Pulmonar/patologia , Tuberculose Renal/diagnóstico , Tuberculose Renal/mortalidade , Tuberculose Renal/patologia , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/mortalidade , Tuberculose da Coluna Vertebral/patologiaAssuntos
Estenose da Valva Aórtica/diagnóstico , Dispneia/etiologia , Endocardite/diagnóstico , Auscultação Cardíaca , Neoplasias do Mediastino/diagnóstico , Insuficiência da Valva Mitral/diagnóstico , Teratoma/diagnóstico , Adulto , Biópsia , Gonadotropina Coriônica/análise , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias do Mediastino/patologia , Valores de Referência , Teratoma/patologia , Tomografia Computadorizada por Raios X , alfa-Fetoproteínas/análise , Microglobulina beta-2/análiseAssuntos
Emergências , Hematoma Epidural Espinal/diagnóstico , Hemiplegia/etiologia , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Vértebras Cervicais/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Canal Medular/patologia , Compressão da Medula Espinal/diagnósticoRESUMO
INTRODUCTION: This investigation is a retrospective analysis to evaluate the influence of second-look surgery on the relapse-free and overall survival of patients with ovarian and tubal carcinomas. METHOD: For 208 patients with and without second-look operation out of 469 of the total collective, a matched analysis and a Cox regression model were established in the framework of a multivariate analysis. RESULTS: Second-look surgery in patients with ovarian cancer had no significant influence on the relapse-free and overall survival. The 10-year survival was equal in both groups: CONCLUSION: Second-look surgery cannot be justified on the basis of clinically noninvasive methods such as radiological findings with additional use of tumor markers. It should only be done in control clinical trials to evaluate new means of treatment.
Assuntos
Neoplasias das Tubas Uterinas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia , Idoso , Intervalo Livre de Doença , Neoplasias das Tubas Uterinas/mortalidade , Neoplasias das Tubas Uterinas/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Modelos de Riscos Proporcionais , Taxa de SobrevidaRESUMO
The introduction of fast gradient systems allows a reliable visualization of the extracranial carotid vessels by the magnetic resonance angiography (MRA) which meanwhile is implemented into clinical routine. By the mainly applied time-of-flight (TOF) technique, vessels can be imaged without contrast agent (CA). Due to the application of ultra-fast gradient-echo-sequences, the first-pass evaluation of an intravenous bolus-injection of Gadolinium in the carotids from the aortic arch up to the skull base can be performed in less than 30 s. In this study. Advantages and disadvantages of both techniques are discussed. For a qualitatively optimal contrast enhanced MRA (CE-MRA) timing parameters like injection delay, flow rate and the adjustment of sequence parameters have to be considered in relation to the fast venous return from the sinus to the jugular veins. First, the optimal time point of the data acquisition have been determined at a model and with a computer simulation in reference to the presence of CA in the arteries. As a result, 90% of the contrast contribution is defined by 16% of the symmetrically acquired central k-space lines. A measuring protocol for clinical use was obtained by a gradual variation of spacial resolution, measuring time and CA-injection parameters and was proved in normal volunteers and patients. An exact determination of the bolus-arrival-time by means of a test-bolus injection was acquired. The best qualitative results were achieved by a double-dose- injection at 2 ml/s injection rate. The temporal reserves of ultra-fast sequences should be invested in the improvement of the spatial resolution. To date, further investigations related to the problem of optimal CA-application may improve the potentials of CE-MRA procedures.