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1.
Eur J Radiol ; 119: 108634, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31473463

RESUMO

PURPOSE: Glioblastomas (GBM) and metastases are the most frequent malignant brain tumors in the adult population. Their presentation on conventional MRI is quite similar, but treatment strategy and prognosis are substantially different. Even with advanced MR techniques, in some cases diagnostic uncertainty remains. The main objective of this study was to determine whether fractal, texture, or both MR image analyses could aid in differentiating glioblastoma from solitary brain metastasis. METHOD: In a retrospective study of 55 patients (30 glioblastomas and 25 solitary metastases) who underwent T2W/SWI/CET1 MRI, quantitative parameters of fractal and texture analysis were estimated, using box-counting and gray level co-occurrence matrix (GLCM) methods. RESULTS: All five GLCM parameters obtained from T2W images showed significant difference between glioblastomas and solitary metastases, as well as on CET1 images except correlation (SCOR), contrary to SWI images which showed different values of two parameters (angular second moment-SASM and contrast-SCON). Only three fractal features (binary box dimension-Dbin, normalized box dimension-Dnorm and lacunarity-λ) measured on T2W and Dnorm measured on CET1 images significantly differed GBMs from solitary metastases. The highest sensitivity and specificity were obtained from inverse difference moment (SIDM) on T2W and SIDM on CET1 images, respectively. Combination of several GLCM parameters yielded better results. The processing of T2W images provided the most significantly different parameters between the groups, followed by CET1 and SWI images. CONCLUSIONS: Computational-aided quantitative image analysis may potentially improve diagnostic accuracy. According to our results texture features are more significant than fractal-based features in differentiation glioblastoma from solitary metastasis.

2.
Eur J Heart Fail ; 21(5): 553-576, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30989768

RESUMO

Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies. In DCM, HF with reduced ejection fraction (HFrEF) has high incidence and prevalence and represents the most frequent cause of death, despite improvements in treatment. In addition, advanced HF in DCM is one of the leading indications for heart transplantation. In HCM, HF with preserved ejection (HFpEF) affects most patients with obstructive, and ∼10% of patients with non-obstructive HCM. A timely treatment is important, since development of advanced HF, although rare in HCM, portends a poor prognosis. In RCM, HFpEF is common, while HFrEF occurs later and more frequently in amyloidosis or iron overload/haemochromatosis. Irrespective of RCM aetiology, HF is a harbinger of a poor outcome. Recent advances in our understanding of the mechanisms underlying the development of HF in cardiomyopathies have significant implications for therapeutic decision-making. In addition, new aetiology-specific treatment options (e.g. enzyme replacement therapy, transthyretin stabilizers, immunoadsorption, immunotherapy, etc.) have shown a potential to improve outcomes. Still, causative therapies of many cardiomyopathies are lacking, highlighting the need for the development of effective strategies to prevent and treat HF in cardiomyopathies.

3.
J BUON ; 23(6): 1867-1873, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30610815

RESUMO

PURPOSE: Bone and soft tissue tumors are rare. There is a variety of types and each one has its own particular behavior, treatment and patient outcome. The assessment of treatment response following the 3rd cycle of chemotherapy is one of the most important aspects of patient care, as therapeutic options and the timing of surgery may vary depending on the achievement of response. Hence, we focused on the advanced imaging technique, proton magnetic resonance spectroscopy (1H MRS), aiming at improving the diagnostic accuracy and the tumor response to therapy, based on the absolute concentration of choline (Cho) as biomarker of malignancy. METHODS: Twenty patients were studied. All of them had a pathological diagnosis after biopsy. MRI examinations were performed using a 1.5 T MR scanner (Avanto; Siemens, Erlangen, Germany). Single-voxel 1H MR spectroscopy was performed by using a PRESS with TR/TE 1530/100 ms, before chemotherapy and after the 3rd cycle. 1H MRS was processed in LCmodel. RESULTS: Of 20 patients, 7 responded to neoadjuvant chemotherapy and 13 did not. In responders, the mean concentration of tCho before therapy was 4.7±2.5 mmol/kg, which showed statistically significant reduction after therapy. In non-responders, the mean tCho concentration before therapy was 2.9±0.9 mmol/kg which remained the same or increased after the 3rd cycle of neoadjuvant chemotherapy (2.7±2.5 mmol/kg; range from 2.05 to 5.79 with no statistical significance). Compared to reference healthy group, tCho concentrations were increased in all cases. CONCLUSIONS: 1H MRS appears to be valuable technique for evaluation of response to neoadjuvant chemotherapy of patients with musculoskeletal tumors (MSK).


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Doenças Musculoesqueléticas/patologia , Terapia Neoadjuvante/métodos , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/tratamento farmacológico , Prognóstico , Curva ROC , Adulto Jovem
4.
J BUON ; 22(4): 1061-1067, 2017 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28952228

RESUMO

PURPOSE: To compare arterial spin labeling (ASL) perfusion technique with the clinically established dynamic susceptibility contrast-enhanced (DSC) perfusion weighted-imaging (PWI), and to determine its value in routine MRI evaluation of disease progression in patients with glioblastoma multiforme (GBM). METHODS: A prospective intraindividual study was performed in 31 patients with histologically proven GBM who had clinical and/or radiological deterioration after treatment, including surgery, radiotherapy and therapy with temozolomide. Conventional brain protocol with ASL and DSC techniques was performed on 3T MRI unit. Cerebral blood flow (CBF) and cerebral blood volume (CBV) maps were analyzed by means of regions of interest (ROI). Each ROI average value was normalized to the contralateral normal brain parenchyma ROI value. Neuroradiologists analyzed CBF and CBV maps separately, and classified patients into progression or pseudoprogression group. Radiological diagnosis was confirmed by clinical-radiological follow-up for at least three months after patient deterioration. RESULTS: High linear correlation existed between DSC-PWI and ASL in the tumor ROI (r=0.733; p<0.001). 92% of ASL CBF maps were informative. ASL detected all lesions as well as DSC MRI. Both techniques provided perfusion values closely correlated. CONCLUSION: ASL allows distinction between GBM progression and pseudoprogression, and it can be used as reliable alternative to DSC-PWI.

5.
J Neurol ; 264(9): 1899-1908, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28756605

RESUMO

Magnetic resonance imaging (MRI) of muscles has recently become a significant diagnostic procedure in neuromuscular disorders. There is a lack of muscle MRI studies in patients with myotonic dystrophy type 1 (DM1), especially type 2 (DM2). To analyze fatty infiltration of leg muscles, using 3.0 T MRI in patients with genetically confirmed DM1 and DM2 with different disease durations. The study comprised 21 DM1 and 10 DM2 adult patients. Muscle MRI was performed in axial plane of the lower limbs using T1-weighted (T1w) sequence. Six-point scale by Mercuri et al. was used. Fatty infiltration registered in at least one muscle of lower extremities was found in 71% of DM1 and 40% of DM2 patients. In DM1 patients, early involvement of the medial head of gastrocnemius and tibialis anterior muscles was observed with later involvement of other lower leg muscles and of anterior and posterior thigh compartments with relative sparing of the rectus femoris. In DM2, majority of patients had normal MRI findings. Early involvement of lower legs and posterior thighs was found in some patients. Less severe involvement of the medial head of the gastrocnemius compared to other lower leg muscles was also observed, while involvement of proximal muscles was rather diffuse than selective. It seems that both in DM1 and DM2 some muscles may be affected before weakness is clinically noted and vice versa. We described characteristic pattern and way of progression of muscle involvement in DM1 and DM2.


Assuntos
Perna (Membro)/patologia , Imagem por Ressonância Magnética , Músculo Esquelético/diagnóstico por imagem , Distrofia Miotônica/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Distrofia Miotônica/classificação , Estatísticas não Paramétricas
6.
Eur J Hum Genet ; 25(5): 572-581, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28295036

RESUMO

Variants in the TTN gene have been associated with distal myopathies and other distinctive phenotypes involving skeletal and cardiac muscle. Through whole-exome sequencing we identified a novel stop-gain variant (c.107635C>T, p.(Gln35879Ter)) in the TTN gene, coding a part of the M-line of titin, in 14 patients with autosomal recessive distal myopathy and Serbian ancestry. All patients share a common 1 Mb core haplotype associated with c.107635C>T, suggesting a founder variant. In compound heterozygotes, nine other TTN variants were identified: four stop-gain, three frameshift, one missense and one splice donor variant. Patients homozygous for the common variant did not show significant clinical differences to the compound heterozygous patients. The clinical presentation of all patients was an adult onset distal myopathy with predominant lower limb involvement. In addition, most patients had normal to mildly elevated serum creatine kinase levels, myopathic electromyograms, normal cardiologic and respiratory tests and muscle pathology consistent with a dystrophic process. In this study, we describe a distinct phenotype for patients with distal myopathy associated with novel recessive TTN variants including a Serbian founder variant. Our results expand the phenotypic and genetic spectrum of titinopathies and will facilitate the diagnosis of this condition in patients of Serbian origin.


Assuntos
Conectina/genética , Miopatias Distais/genética , Efeito Fundador , Distrofias Musculares/genética , Mutação de Sentido Incorreto , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Creatina Quinase/sangue , Miopatias Distais/diagnóstico , Feminino , Frequência do Gene , Genes Recessivos , Haplótipos , Humanos , Masculino , Pessoa de Meia-Idade , Distrofias Musculares/diagnóstico , Fenótipo , Sérvia , Síndrome
7.
AJR Am J Roentgenol ; 208(3): W71-W78, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28095024

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the utility of ampullary MDCT in the noninvasive, preoperative differentiation of pancreatobiliary and intestinal subtypes of ampullary adenocarcinoma. MATERIALS AND METHODS: This retrospective study included 32 patients (20 men, 12 women; age range, 41-81 years) with resected ampullary adenocarcinoma who underwent preoperative contrast-enhanced ampullary MDCT. Two radiologists, blinded to pathologic diagnosis of adenocarcinoma subtype, evaluated the presence of seven MDCT features independently. MDCT findings and ampullary adenocarcinoma subtypes were correlated using chi-square and Fisher exact tests. Interobserver agreement was evaluated using the Cohen kappa statistic. RESULTS: When evaluated with ampullary MDCT, the intestinal and pancreatobiliary subtypes were significantly different in terms of lesion morphology (p < 0.0001), papillary shape (p < 0.0001), common bile duct (CBD) infiltration and dilatation (p = 0.003 and p = 0.0004, respectively), duodenopancreatic groove infiltration (p = 0.0009), and pancreaticoduodenal artery involvement (p = 0.004). Pancreatobiliary subtype tumors were more often infiltrative in morphology (18/18) and showed retracted papilla (14/18), CBD (18/18) and main pancreatic duct (MPD) infiltration (12/18), dilated CBD (18/18) and MPD (13/18), fixed duodenopancreatic groove appearance (15/18), and pancreaticoduodenal artery involvement (12/18). Intestinal subtype carcinomas were more frequently nodular (14/14) and had a bulging papilla (13/14), a free duodenopancreatic groove appearance (11/14), and no pancreaticoduodenal artery involvement (2/14). When all features were taken into account, MDCT showed sensitivity of 85.7% and specificity of 83.3% in differentiating intestinal and pancreatobiliary subtype tumors. Accuracy, positive predictive value, and negative predictive value of MDCT were 84.4%, 80%, and 88.2%, respectively. Interobserver agreement was almost perfect for the presence of each imaging feature (κ > 0.8). CONCLUSION: Ampullary MDCT can be useful to differentiate pancreatobiliary and intestinal subtypes of ampullary adenocarcinoma preoperatively, provided the duodenum is optimally distended at imaging.


Assuntos
Ampola Hepatopancreática/diagnóstico por imagem , Ampola Hepatopancreática/patologia , Neoplasias do Ducto Colédoco/diagnóstico por imagem , Neoplasias do Ducto Colédoco/patologia , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Variações Dependentes do Observador , Cuidados Pré-Operatórios , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
8.
Acta Radiol ; 57(6): 758-66, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26307063

RESUMO

BACKGROUND: Preoperative differentiation of ovarian malignant tumors still remains a challenge. Diffusion-weighted imaging (DWI) provides information about cellularity of the lesion and might facilitate discrimination between different malignant ovarian lesions. PURPOSE: To evaluate magnetic resonance imaging (MRI) findings of endometrioid adenocarcinoma of the ovary and to determine the value of DWI in the differential diagnosis of malignant and benign adnexal tumors. MATERIAL AND METHODS: The following MRI findings were reviewed in 162 patients (21 endometrioid adenocarcinoma, 103 other malignant tumors, 38 benign tumors): lesion size, morphological appearance, T2-weighted (T2W) signal intensity, T1-weighted (T1W) signal intensity, contrast-enhancement pattern, DWI signals with apparent diffusion coefficient (ADC) calculated for b = 800 s/mm(2) in solid tumor components. RESULTS: The most common morphological appearance was predominantly cystic lesion, found in 90.3% of patients with endometriod adenocarcinoma. The solid parts were slightly hyperintense on T2W images in 19 patients with marked enhancement after contrast administration. No significant difference (P = 0.13) in conventional MRI features was found between endometrioid adenocarcinoma and other malignant ovarian tumors. Hyperintensity on DWI was more frequently observed in malignant tumors than in benign lesions (P < 0.001). ADC values were significantly lower in endometrioid adenocarcinoma than other malignant tumors (0.79 ± 0.21 vs. 0.90 ± 0.19; P = 0.04) and in all malignant lesions compared with benign tumors (0.88 ± 0.31 vs. 1.33 ± 0.17; P < 0.001). CONCLUSION: DWI with ADC measurement could indicate the presence of endometrioid adenocarcinomas due to a slightly but significantly lower ADC values compared to other malignant ovarian lesions. Thus, DWI is beneficial and should be part of a standard protocol for the evaluation of indeterminate adnexal lesions.


Assuntos
Carcinoma Endometrioide/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Idoso , Meios de Contraste , Diagnóstico Diferencial , Feminino , Gadolínio DTPA , Humanos , Aumento da Imagem/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
9.
Vojnosanit Pregl ; 72(10): 942-4, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26665563

RESUMO

INTRODUCTION: Bronchobiliary fistula (BBF) is a pathological communication between the bronchial system and the biliary tree that presents with bilioptysis. Many conditions can cause its development. There is still no optimal therapy for BBF. Conservative treatment is rarely indicated, as was published before in a few cases. CASE REPORT: We presented a 71-year-old Caucasian Serbin woman with BBF secondary to previous laparotomy due to multiple echinococcus liver cysts. The diagnosis was established by the presence of bilirubin and bile acids in sputum and magnetic resonance cholangiopancreatography (MRCP). A repeat MRCP performed after conservative procedure, did not reveal fistulous communication. CONCLUSION: We suggest that in small and less severe fistulas between the biliary and the bronchial tract, conservative treatment may be used successfully, and invasive treatment methods are not needed in all patients.


Assuntos
Fístula Biliar/diagnóstico , Fístula Brônquica/diagnóstico , Colangiopancreatografia por Ressonância Magnética , Idoso , Antibacterianos/uso terapêutico , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/patologia , Fístula Biliar/terapia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/patologia , Fístula Brônquica/terapia , Terapia Combinada , Feminino , Hidratação , Humanos , Infusões Intravenosas , Valor Preditivo dos Testes , Radiografia , Índice de Gravidade de Doença , Cloreto de Sódio/administração & dosagem , Resultado do Tratamento
10.
Croat Med J ; 56(5): 460-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26526883

RESUMO

AIM: To determine the impact of two apparent diffusion coefficient (ADC) measurement techniques on diffusion-weighted magnetic resonance images (DW MRI) on the assessment of rectal cancer response to neoadjuvant chemoradiotherapy (CRT). METHODS: ADC values were measured prospectively with two different techniques - the first, which measures ADCs in the most cellular tumor parts, and the second, which measures the entire tumor area, in 58 patients with locally advanced rectal cancer on pre-CRT and post-CRT image sets. Areas under the receiver operating characteristic curves (AUCs) and parameters of diagnostic accuracy were calculated for pre- and post-CRT ADC values and numeric and percent ADC change for each technique to determine their performance in tumor response evaluation using histopathological tumor-regression grade as the reference standard. RESULTS: The second technique yielded higher AUCs (0.935 vs 0.704, P<.001), percent-change (0.828 vs 0.636, P<0.001), and numeric-change (0.866 vs 0.653, P<0.001) than the first technique for post-CRT ADC. Accuracies for post-CRT ADC assessment were 62% for the first and 88% for the second technique (cut-off values: 0.98 and 1.29×10(-3) mm2/s, respectively) and for ADC change assessment, both numeric and percent, 59% and 74%, respectively (cut-off values: increase of 0.18 and 0.28×10(-3) mm(2)/s; increase of 24% and 37%, respectively). CONCLUSIONS: The type of measurement technique significantly affected ADC results. ADC measurements covering a larger area better predicted tumor response to therapy. Post-CRT ADCs, regardless of the measurement technique, and numeric ADC change measured in the whole tumor volume accurately identified non-complete responders. Post-CRT ADCs measured in the entire tumor area yielded the highest accuracy level in tumor response evaluation.


Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia , Imagem de Difusão por Ressonância Magnética/métodos , Terapia Neoadjuvante , Neoplasias Retais/terapia , Adenocarcinoma/diagnóstico , Adulto , Idoso , Área Sob a Curva , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Neoplasias Retais/diagnóstico , Reprodutibilidade dos Testes , Resultado do Tratamento
11.
Hellenic J Cardiol ; 56(5): 394-401, 2015 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26429367

RESUMO

INTRODUCTION: The aim of this study was to evaluate oxidative stress markers (OSM) and catecholamine levels in patients with dilated cardiomyopathy (DCM) before and after cardiopulmonary exercise testing, and to investigate the association between changes in these markers and the New York Heart Association classification (NYHA) and left ventricular ejection fraction (LVEF) in these patients. METHODS: We evaluated 74 patients with DCM and 80 control subjects without DCM. Patients were grouped according to NYHA stages I/II or III/IV. Eligible participants were considered to be those with LVEF values <45%. The OSM analysed included superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), and glutathione peroxidase (GPX). The catecholamines analysed included adrenaline, noradrenaline, and dopamine. Vitamin C was also evaluated. All values were obtained before and after cardiopulmonary exercise testing. RESULTS: There was a significant increase in GR, adrenaline, and noradrenaline after testing in the DCM patients. A significant difference between controls and patients in CAT and evaluated catecholamines was observed after testing. A significant increase in GR, GPX, adrenaline, and noradrenaline for patients in NYHA I/ II, and in CAT, GR, adrenaline, noradrenaline, and dopamine for patients in NYHA III/IV, was found between the different times of observation. LVEF before testing showed a significant positive correlation with GPX, and a negative correlation with noradrenaline and adrenaline. After testing a significant negative correlation was found with SOD and GR. CONCLUSIONS: The results of our study demonstrate the complexity of the neurohumoral mechanisms and physiological alterations in the failing heart in DCM patients. Further studies are needed, including other biomarkers and larger samples of patients, in order to improve our understanding of the aetiopathogenesis of DCM development and progression.


Assuntos
Cardiomiopatia Dilatada/metabolismo , Catecolaminas/metabolismo , Teste de Esforço/métodos , Estresse Oxidativo/fisiologia , Adulto , Cardiomiopatia Dilatada/fisiopatologia , Catalase/metabolismo , Glutationa Peroxidase/metabolismo , Glutationa Redutase/metabolismo , Insuficiência Cardíaca/fisiopatologia , Humanos , Pessoa de Meia-Idade , Superóxido Dismutase/metabolismo , Função Ventricular Esquerda/fisiologia
12.
Eur J Radiol ; 83(8): 1363-7, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24894697

RESUMO

OBJECTIVES: The aim of this study was to contribute to the standardization of the numeric positive enhancement integral (PEI) values in breast parenchyma, ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) and to evaluate the significance of the difference in PEI values between IDC and parenchyma, DCIS and parenchyma and IDC and DCIS. MATERIALS AND METHODS: In the prospective trial, we analyzed the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of 60 consecutive patients with histologically confirmed unilateral DCIS (n=30) and IDC (n=30) and defined the PEI values (range; mean ± SD) for the lesions and the breast parenchyma. Tumor-to-non-tumor (T/NT) ratios were calculated for DCIS and IDC and compared. PEI color maps (PEICM) were created. The differences in PEI values between IDC and parenchyma and between DCIS and parenchyma were tested according to t-test. Analysis of variance (ANOVA) was used to test the differences between the mean PEI values of parenchyma, DCIS and IDC. RESULTS: IDC showed highly statistically different PEI numeric values compared to breast parenchyma (748.7 ± 32.2 vs. 74.6 ± 17.0; p<0.0001). The same applied to the differences in the group of patients with DCIS (428.0 ± 25.0 vs. 66.0 ± 10.6; p<0.0001). The difference between IDC, DCIS and parenchyma were also considered highly statistically significant (p<0.0001) and so were the T/NT ratios for IDC and DCIS (10.1 ± 2.4 vs. 6.6 ± 1.4; p<0.0001). CONCLUSIONS: PEI numeric values may contribute to differentiation between invasive and in situ breast carcinoma.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Imagem por Ressonância Magnética/métodos , Meios de Contraste , Feminino , Gadolínio DTPA , Humanos , Aumento da Imagem/métodos , Mamografia , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Srp Arh Celok Lek ; 142(3-4): 184-8, 2014 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24839773

RESUMO

INTRODUCTION: Parenteral nutrition-associated cholestasis is well recognized phenomenon in the term and preterm infant receiving long-term parenteral nutrition. OBJECTIVES: The aim of this study was to evaluate the effect of ursodeoxycholic acid (UDCA) use on cholestasis in newborns on prolonged TPN. METHODS: A total of 56 infants were enrolled in this retrospective study: control group consisted of lower (1500 g) birth weight infants (n = 30), as well as the group of pediatric (n = 11) and surgical patients (n = 15) treated with UDCA. Blood chemistries were obtained two times weekly. RESULTS: All of 56 newborns developed cholestasis but duration of parenteral nutrition (PN) before onset of cholestasis was significantly longer in UDCA treated patients. Average duration of PN before the onset of cholestasis in control group of patients was 25 days in distinction from treated pediatric and surgical patients (39 and 34 days, respectively).The peak serum conjugated bilirubin (CB), AST, ALT and alkaline phosphatase (AP) levels were significantly lower in the treated groups.There was no significant difference among treated pediatric and surgical patients and between lower and higher birth weight infants considering the CB, ALT, AST and AP peak. Duration of cholestasis was significantly decreased in all treated groups.There was a significant difference in time needed to achieve complete enteral intake between pediatric and surgical patient group. CONCLUSION: Cholestasis developed significantly later in treated groups than in the controls. UDCA appears to be very successful in reducing the symptoms of cholestasis. The difference in efficacy of UDCA treatment between lower and higher birth weight infants could not be proven.


Assuntos
Colestase/etiologia , Colestase/prevenção & controle , Nutrição Parenteral/efeitos adversos , Ácido Ursodesoxicólico/uso terapêutico , Peso ao Nascer/efeitos dos fármacos , Estudos de Casos e Controles , Colestase/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Nascimento a Termo
14.
Auris Nasus Larynx ; 41(5): 471-4, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24636450

RESUMO

OBJECTIVE: The purpose of this study was to evaluate whether magnetic resonance (MR) imaging can accurately predict invasion of the preepiglottic and paraglottic space in patients with laryngeal carcinoma. Identification of these fat filling spaces is important for surgical treatment and prognosis. MATERIALS AND METHODS: The study was based on the prospective analysis of MRI images in a series of 40 patients (90% males), overall average age 60.1 ± 7.3 years, (49-70 years), with histopathologically diagnosed laryngeal squamous cell carcinoma. Unenhanced T2w, T2w FS, T1w, and contrast-enhanced T1w FS scans were analyzed for the presence of preepiglottic and paraglottic neoplastic invasion and were compared to postoperative histopathologic analysis. RESULTS: In 28 patients (70%) the tumor was glottic and in 12 patients (30%) supraglottic. No statistical difference was found in the number of patients with positive MRI findings in comparison to postsurgical patohistology for infiltration of the preepiglottic space (23% vs 20%, respectively). Sensitivity for infiltration of preepiglottic space was 89% and specificity was 97%. However, infiltration of the paraglottic spaces was observed more frequently on MRI than on postsurgical patohistology analysis (60% vs 40%, respectively; p<0.05), with a sensitivity of 67% and a specificity 50%. According to MRI findings, 26 (65%) patients were classified as T3, 14 (35%) patients as T2 while according to histopathologic analysis of specimens after surgery, 19 patients were classified as T3 (48%) and 21 as T2 (52%). CONCLUSION: MRI has been shown to be a reliable method for assessment of preepiglottic space while the diagnostic accuracy in patients with infiltration of the paraglottic space is limited.


Assuntos
Carcinoma de Células Escamosas/patologia , Epiglote/patologia , Glote/patologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Laríngeas/patologia , Idoso , Estudos de Coortes , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Prospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço
15.
Diagn Interv Radiol ; 19(6): 463-70, 2013 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24047722

RESUMO

PURPOSE: We aimed to prospectively assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the evaluation of predictive factors for breast conservative surgery during neoadjuvant chemotherapy. MATERIALS AND METHODS: Sixty-six patients were evaluated before the first treatment cycle, after the second cycle, and upon the completion of neoadjuvant chemotherapy according to largest tumor diameter, tumor volume, postcontrast enhancement, and tumor regression pattern. The patients were divided into responders (pathologic complete and near complete response) and nonresponders. Each subgroup was re-evaluated according to morphokinetic criteria for identification of candidates for breast conservative surgery. RESULTS: In responders (n=27), the lesion size upon the completion of neoadjuvant chemotherapy was significantly smaller compared to nonresponders (1.5 ± 0.6 vs. 3.2 ± 0.9 cm; P < 0.001), as was the volume (1.2 vs. 11.0 cm(3); P < 0.001). The measured lesion size did not differ from the histologic size (1.5 ± 0.6 vs. 1.2 ± 0.6 cm; P = 0.09) and had a high correlation (r=0.93). In responders, the following parameters were significantly different before and after neoadjuvant chemotherapy: size (3.6 ± 1.4 to 1.5 ± 0.6 cm; P < 0.001), volume (17.6 to 1.2 cm(3); P < 0.001), predominant concentric regression, plateau and continuous time-intensity curves (P < 0.001). DCE-MRI has the sensitivity of 87% and the accuracy of 77% to identify candidates for breast conservative surgery. CONCLUSION: Selected morphokinetic DCE-MRI parameters may contribute to the multidisciplinary decision when considering the selection of candidates for breast conservative surgery.


Assuntos
Neoplasias da Mama/patologia , Imagem por Ressonância Magnética , Mastectomia Segmentar , Seleção de Pacientes , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/tratamento farmacológico , Carcinoma Lobular/patologia , Carcinoma Lobular/cirurgia , Meios de Contraste , Feminino , Seguimentos , Humanos , Imagem Tridimensional , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estudos Prospectivos
16.
Acta Radiol ; 54(3): 242-8, 2013 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-23386736

RESUMO

BACKGROUND: Primary sclerosing cholangitis (PSC) is a cholestatic liver disease with chronic inflammation and progressive destruction of biliary tree. Magnetic resonance (MR) examination with diffusion-weighted imaging (DWI) allows analysis of morphological liver parenchymal changes and non-invasive assessment of liver fibrosis. Moreover, MR cholangiopancreatography (MRCP), as a part of standard MR protocol, provides insight into bile duct irregularities. PURPOSE: To evaluate MR and MRCP findings in patients with primary sclerosing cholangitis and to determine the value of DWI in the assessment of liver fibrosis. MATERIAL AND METHODS: The following MR findings were reviewed in 38 patients: abnormalities in liver parenchyma signal intensity, changes in liver morphology, lymphadenopathy, signs of portal hypertension, and irregularities of intra- and extrahepatic bile ducts. Apparent diffusion coefficient (ADC) was calculated for six locations in the liver for b = 800 s/mm(2). RESULTS: T2-weighted hyperintensity was seen as peripheral wedge-shaped areas in 42.1% and as periportal edema in 28.9% of patients. Increased enhancement of liver parenchyma on arterial-phase imaging was observed in six (15.8%) patients. Caudate lobe hypertrophy was present in 10 (26.3%), while spherical liver shape was noted in 7.9% of patients. Liver cirrhosis was seen in 34.2% of patients; the most common pattern was micronodular cirrhosis (61.5%). Other findings included lymphadenopathy (28.9%), signs of portal hypertension (36.7%), and bile duct irregularities (78.9%). The mean ADCs (x10(-3)mm(2)/s) were significantly different at stage I vs. stages III and IV, and stage II vs. stage IV. No significant difference was found between stages II and III. For prediction of stage ≥II and stage ≥III, areas under receiver-operating characteristic curves were 0.891 and 0.887, respectively. CONCLUSION: MR with MRCP is a necessary diagnostic procedure for diagnosis of PSC and evaluation of disease severity. Moreover, DWI could be used in continuation with standard MR sequences for the evaluation of liver fibrosis stage and distribution.


Assuntos
Colangite Esclerosante/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Adulto , Análise de Variância , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
17.
Heart Fail Rev ; 18(3): 255-66, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22855353

RESUMO

Despite a myriad of causes, pericardial diseases present in few clinical syndromes. Acute pericarditis should be differentiated from aortic dissection, myocardial infarction, pneumonia/pleuritis, pulmonary embolism, pneumothorax, costochondritis, gastroesophageal reflux/neoplasm, and herpes zoster. High-risk features indicating hospitalization are: fever >38 °C, subacute onset, large effusion/tamponade, failure of non-steroidal anti-inflammatory drugs (NSAIDs), previous immunosuppression, trauma, anticoagulation, neoplasm, and myopericarditis. Treatment comprises 10-14-days NSAID plus 3 months colchicine (2 × 0.5 mg; 1 × 0.5 mg in patients <70 kg). Corticosteroids are avoided, except for autoimmunity, as they facilitate the recurrences. Echo-guided pericardiocentesis (±fluoroscopy) is indicated for tamponade and effusions >2 cm. Smaller effusions are drained if neoplastic, purulent or tuberculous etiology is suspected. In recurrent pericarditis, repeated testing for autoimmune and thyroid disease is appropriate. Pericardioscopy and pericardial/epicardial biopsy may clarify the etiology. Familial clustering was recently associated with tumor necrosis factor receptor-associated periodic syndrome (TNFRSF1A gene mutation). Treatment includes 10-14 days NSAIDs with colchicine 0.5 mg bid for up to 6 months. In non-responders, low-dose steroids, intrapericardial steroids, azathioprine, and cyclophosphamide can be tried. Successful management with interleukin-1 receptor antagonist (anakinra) was recently reported. Pericardiectomy remains the last option in >2 years severely symptomatic patients. In constriction, expansion of the heart is impaired by the rigid, chronically inflamed/thickened pericardium (no thickening ~20 %). Chest radiography, echocardiography, computerized tomography, magnetic resonance imaging, hemodynamics, and endomyocardial biopsy indicate the diagnosis. Pericardiectomy is the only treatment for permanent constriction. Predictors of poor survival are prior radiation, renal dysfunction, high pulmonary artery pressures, poor left ventricular function, hyponatremia, age, and simultaneous HIV and tuberculous infection.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Tamponamento Cardíaco , Colchicina/administração & dosagem , Derrame Pericárdico , Pericardite , Pericárdio/patologia , Doença Aguda , Biópsia , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Diagnóstico Diferencial , Humanos , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/terapia , Pericardiectomia/métodos , Pericardiocentese/métodos , Pericardite/complicações , Pericardite/diagnóstico , Pericardite/fisiopatologia , Pericardite/terapia , Prognóstico , Recidiva , Fatores de Risco , Síndrome , Moduladores de Tubulina
18.
Heart Fail Rev ; 18(3): 345-53, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22850905

RESUMO

Pericardial cytokine patterns in various diseases are not well established. We have analyzed pericardial proinflammatory (interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha) and immunoregulatory cytokines (transforming growth factor (TGF)-beta1 and interferon (IFN)-gamma) in patients with pericarditis, myocarditis, and ischemic heart disease. Pericardial fluid was obtained in 30 subsequent patients undergoing pericardiocentesis (Group 1: 60 % males, 52.4 ± 14.2 years) and in 21 patients during aortocoronary bypass surgery (Group 2: 42.9 % males, age 67.2 ± 7.4 years). After clinical, laboratory, echocardiography examination, fiberoptic pericardioscopy (Storz-AF1101Bl, Germany) and pericardial/epicardial biopsy Group 1 was subdivided to 40 % neoplastic, 36.6 % autoreactive, 10 % iatrogenic, and 13.3 % viral pericarditis. Samples were promptly aliquoted, frozen, and stored at -70 °C. The cytokines were estimated using quantikine enzyme amplified-sensitivity immuno-assays (R&D Systems, USA) and the results compared between neoplastic, viral, iatrogenic, and autoreactive pericarditis and surgical groups. IL-6 was significantly increased in PE versus serum in all forms of pericarditis (except in autoreactive) and increased in comparison with pericardial fluid of surgical patients. TNF-alpha was increased only in PE of patients with viral pericarditis in comparison with Group 2. TGF-beta1 was strikingly lower in the PE than in the serum of all pericarditis patients. However, TGF-beta1 levels in PE were significantly higher in Group 1 than in Group 2, except in viral pericarditis. IFN-gamma levels did not significantly differ between PE and serum or in comparison with Group 2. The cytokine pattern "high TNF-alpha/low TGF-beta1" was found in viral pericarditis and low IL-6 in autoreactive PE. Different etiologies of pericardial inflammation did not influence the IFN-gamma levels. IL-6 pericardial to serum ratio was significantly higher in autoreactive PE than in viral and neoplastic forms. However, TNF-alpha and IFN-gamma pericardial to serum ratios were significantly higher in viral than in autoreactive and neoplastic PE.


Assuntos
Doenças Autoimunes/complicações , Interferon gama , Interleucina-6 , Neoplasias/complicações , Pericardite , Fator de Crescimento Transformador beta1 , Fator de Necrose Tumoral alfa , Viroses/complicações , Adulto , Idoso , Exsudatos e Transudatos/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Inflamação/metabolismo , Interferon gama/análise , Interferon gama/metabolismo , Interleucina-6/análise , Interleucina-6/metabolismo , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/metabolismo , Pericardiocentese/métodos , Pericardite/diagnóstico , Pericardite/etiologia , Pericardite/metabolismo , Estatística como Assunto , Fator de Crescimento Transformador beta1/análise , Fator de Crescimento Transformador beta1/metabolismo , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/metabolismo
19.
Heart Fail Rev ; 18(3): 307-16, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22648151

RESUMO

The epicardial halo delineates the heart shadow in fluoroscopy. To establish whether the sign is applicable to pericardiocentesis guidance, three investigators evaluated its intensity as absent = grade 0, indistinct = 0.5, clear = 1, intensive = 2 in posterior-anterior (PA) and lateral fluoroscopies recorded before pericardiocentesis or cardiac catheterization (Philips Integris-II BH3000). Three populations were studied: (a) 32 patients with pericardial effusion (PE group), 53.1 % males, aged 53.9 ± 13.9 years; (b) 14 patients with perimyocarditis (PM group), 64.3 % males, aged 51.6 ± 14.4 years; and (c) 46 coronary patients (CAD group), no PE, 95.6 % males, aged 67.3 ± 11.8 years. The intensity of the halo phenomenon was highest in patients with PE, lowest in patients with CAD, and intermediate in patients with PM (median sum of grades in PA/lateral view: 4/5 vs. 2/2.5 vs. 3/3, respectively) (p < 0.01). The halo phenomenon correlated well with HR and echocardiographic PE size in both angiographic views. The correlation with body mass index (BMI) and age was significant only in the lateral view and with PE volume only in the PA view. The sensitivity of the halo sign for PE was 84.1 % in PA and 92.0 % in lateral views. In 10/32 PE patients, the evaluation of the sign was repeated after PE drainage, revealing lower grades both in PA and in lateral views (p < 0.01). In conclusion, the epicardial halo sign is highly sensitive for the detection of a PE; it correlates well in at least one angiographic projection with the PE volume, HR, age, BMI, and the PE size in echocardiography and could be therefore applied as a safety guide for pericardiocentesis.


Assuntos
Doença da Artéria Coronariana , Fluoroscopia , Derrame Pericárdico , Pericardiocentese/métodos , Pericardite , Pericárdio/diagnóstico por imagem , Tecido Adiposo/patologia , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Cateterismo Cardíaco/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia/métodos , Feminino , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/fisiopatologia , Pericardite/etiologia , Pericardite/fisiopatologia , Pericárdio/patologia , Sensibilidade e Especificidade , Resultado do Tratamento
20.
Radiat Prot Dosimetry ; 155(1): 88-95, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23185070

RESUMO

The purpose of this paper is to evaluate the image quality and dose to patients in the radiography of sacroiliac joints and to perform a clinical comparative study of digital and conventional screen-film radiography. Routine radiography of sacroiliac joint was performed in 60 patients using digital and screen-film radiography. The visibility of five anatomical regions and the overall image quality were rated by experienced radiologists. Patient dose assessment in terms of entrance surface air kerma (ESAK) was performed. The digital system showed slightly improved visualisation of specific anatomical structures. Overall image quality was significantly better in the digital when compared with the screen-film imaging system. The average ESAK was 2.4 mGy in screen-film and 3.6 mGy in digital radiography. The digital radiography provided equal or better visibility of anatomical details and overall image quality, but on higher dose levels. Therefore, the practice on digital systems must be optimised.


Assuntos
Intensificação de Imagem Radiográfica/instrumentação , Articulação Sacroilíaca/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Ecrans Intensificadores para Raios X , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Doses de Radiação
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