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1.
Vaccine ; 39(39): 5563-5570, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34454782

RESUMO

BACKGROUND: With rapid approval of SARS-CoV-2 vaccines, the ability of clinical laboratories to detect vaccine-induced antibodies with available high-throughput commercial assays is unknown. We aimed to determine if commercial serology assays can detect vaccine-induced antibodies (VIAs) and understand the vaccination response. METHODS: This cohort study recruited healthcare workers and residents of long-term care facilities (receiving the BNT162b2 and mRNA-1273 products, respectively) who underwent serum collection pre-vaccination (BNT162b2 group), 2-weeks post vaccination (both groups), and pre-2nd dose (both groups). Sera were tested for the presence of SARS-CoV-2 IgG using four commercial assays (Abbott SARS-CoV-2 IgG, Abbott SARS-CoV-2 IgG II Quant, DiaSorin Trimeric S IgG, and GenScript cPASS) to detect VIAs. Secondary outcomes included description of post-vaccination antibody response and correlation with neutralizing titers. RESULTS: 225 participants (177 receiving BNT162b2 and 48 receiving mRNA-1273) were included (median age 41 years; 66-78% female). Nucleocapsid IgG was found in 4.1% and 21.9% of the BNT162b2 (baseline) and mRNA-1273 (2-weeks post first dose). All anti-spike assays detected antibodies post-vaccination, with an average increase of 87.2% (range 73.8-94.3%; BNT162b2), and 25.2% (range 23.8-26.7%; mRNA-1273) between the first and last sampling time points (all p < 0.05). Neutralizing antibodies were detected at all post-vaccine timepoints for both vaccine arms, with increasing titers over time (all p < 0.05). CONCLUSIONS: Anti-spike vaccine-induced SARS-CoV-2 IgG are detectable by commercially available high-throughput assays and increases over time. Prior to second dose of vaccination, neutralizing antibodies are detectable in 73-89% of individuals, suggesting most individuals would have some degree of protection from subsequent infection.


Assuntos
COVID-19 , SARS-CoV-2 , Adulto , Vacinas contra COVID-19 , Estudos de Coortes , Feminino , Humanos , Masculino , RNA Mensageiro
2.
PLoS One ; 16(8): e0256352, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34403456

RESUMO

Rapid tests for SARS-COV-2 infection are important tools for pandemic control, but current rapid tests are based on proprietary designs and reagents. We report clinical validation results of an open-access lateral flow assay (OA-LFA) design using commercially available materials and reagents, along with RT-qPCR and commercially available comparators (BinaxNOW® and Sofia®). Adult patients with suspected COVID-19 based on clinical signs and symptoms, and with symptoms ≤7 days duration, underwent anterior nares (AN) sampling for the OA-LFA, Sofia®, BinaxNOW ™, and RT-qPCR, along with nasopharyngeal (NP) RT-qPCR. Results indicate a positive predictive agreement with NP sampling as 69% (60% -78%) OA-LFA, 74% (64% - 82%) Sofia®, and 82% (73% - 88%) BinaxNOW™. The implication for these results is that we provide an open-access LFA design that meets the minimum WHO target product profile for a rapid test, that virtually any diagnostic manufacturer could produce.


Assuntos
Antígenos Virais/análise , COVID-19/diagnóstico , Imunoensaio , SARS-CoV-2/metabolismo , Área Sob a Curva , COVID-19/virologia , Humanos , Nasofaringe/virologia , Sistemas Automatizados de Assistência Junto ao Leito , RNA Viral/análise , RNA Viral/metabolismo , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real , SARS-CoV-2/isolamento & purificação , Sensibilidade e Especificidade
3.
Patient Educ Couns ; 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33896685

RESUMO

OBJECTIVE: To validate an approach to measuring professional identity formation (PIF), we explore if the Professional Identity Essay (PIE), a stage score measure of medical professional identity (PI), predicts clinical communication skills. METHODS: Students completed the PIE during medical school orientation and a 3-case Objective Structured Clinical Exam (OSCE) where standardized patients reliably assessed communication skills in 5 domains. Using mediation analyses, relationships between PIE stage scores and communication skills were explored. RESULTS: For the 351 (89%) consenting students, controlling for individual characteristics, there were increases in patient counseling (6.5%, p<0.01), information gathering (4.3%, p = 0.01), organization and management (4.1%, p = 0.02), patient assessment (3.6%, p = 0.04), and relationship development (3.5%, p = 0.03) skills for every half stage increase in PIE score. The communication skills of lower socio-economic status (SES) students are indirectly impacted by their slightly higher PIE stage scores. CONCLUSION: Higher PIE stage scores are associated with higher communication skills and lower SES. PRACTICE IMPLICATIONS: PIE predicts critical clinical skills and identifies how SES and other characteristics indirectly impact future clinical performance, providing validity evidence for using PIE as a tool in longitudinal formative academic coaching, program and curriculum evaluation, and research.

4.
Anal Chem ; 93(9): 4160-4165, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33631932

RESUMO

The rapid onset of the global COVID-19 pandemic has led to challenges for accurately diagnosing the disease, including supply shortages for sample collection, preservation, and purification. Currently, most diagnostic tests require RNA extraction and detection by RT-PCR; however, extraction is expensive and time-consuming and requires technical expertise. With these challenges in mind, we report extraction-free, multiplexed amplification of SARS-CoV-2 RNA from 246 clinical samples, resulting in 86% sensitivity and 100% specificity. The multiplex RT-PCR uses the CDC singleplex targets and has an LoD of 2 c/µL. We also report on amplification using a range of master mixes in different transport media. This work can help guide which combinations of reagents will enable accurate results when availability of supplies changes throughout the pandemic. Implementing these methods can reduce complexity and cost, minimize reagent usage, expedite time to results, and increase testing capacity.


Assuntos
Teste para COVID-19/métodos , COVID-19/diagnóstico , COVID-19/virologia , Reação em Cadeia da Polimerase Multiplex/métodos , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Humanos , RNA Viral/genética , Sensibilidade e Especificidade
5.
Acad Med ; 96(4): 518-521, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33464738

RESUMO

PROBLEM: Physician-scientists are individuals trained in both clinical practice and scientific research. Often, the goal of physician-scientist training is to address pressing questions in biomedical research. The established pathways to formally train such individuals are mainly MD-PhD programs and physician-scientist track residencies. Although graduates of these pathways are well equipped to be physician-scientists, numerous factors, including funding and length of training, discourage application to such programs and impede success rates. APPROACH: To address some of the pressing challenges in training and retaining burgeoning physician-scientists, New York University Grossman School of Medicine formed the Accelerated MD-PhD-Residency Pathway in 2016. This pathway builds on the previously established accelerated 3-year MD pathway to residency at the same institution. The Accelerated MD-PhD-Residency Pathway conditionally accepts MD-PhD trainees to a residency position at the same institution through the National Resident Matching Program. OUTCOMES: Since its inception, 2 students have joined the Accelerated MD-PhD-Residency Pathway, which provides protected research time in their chosen residency. The pathway reduces the time to earn an MD and PhD by 1 year and reduces the MD training phase to 3 years, reducing the cost and lowering socioeconomic barriers. Remaining at the same institution for residency allows for the growth of strong research collaborations and mentoring opportunities, which foster success. NEXT STEPS: The authors and institutional leaders plan to increase the number of trainees who are accepted into the Accelerated MD-PhD-Residency Pathway and track the success of these students through residency and into practice to determine if the pathway is meeting its goal of increasing the number of practicing physician-scientists. The authors hope this model can serve as an example to leaders at other institutions who may wish to adopt this pathway for the training of their MD-PhD students.


Assuntos
Pesquisa Biomédica/educação , Pesquisa Biomédica/tendências , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Guias como Assunto , Internato e Residência/normas , Internato e Residência/tendências , Adulto , Pesquisa Biomédica/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Feminino , Previsões , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , New York , Adulto Jovem
6.
PLoS One ; 15(1): e0227108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940377

RESUMO

The acceptance of students to a medical school places a considerable emphasis on performance in standardized tests and undergraduate grade point average (uGPA). Traditionally, applicants may be judged as a homogeneous population according to simple quantitative thresholds that implicitly assume a linear relationship between scores and academic success. This 'one-size-fits-all' approach ignores the notion that individuals may show distinct patterns of achievement and follow diverse paths to success. In this study, we examined a dataset composed of 53 variables extracted from the admissions application records of 1,088 students matriculating to NYU School of Medicine between the years 2006-2014. We defined training and test groups and applied K-means clustering to search for distinct groups of applicants. Building an optimized logistic regression model, we then tested the predictive value of this clustering for estimating the success of applicants in medical school, aggregating eight performance measures during the subsequent medical school training as a success factor. We found evidence for four distinct clusters of students-we termed 'signatures'-which differ most substantially according to the absolute level of the applicant's uGPA and its trajectory over the course of undergraduate education. The 'risers' signature showed a relatively higher uGPA and also steeper trajectory; the other signatures showed each remaining combination of these two main factors: 'improvers' relatively lower uGPA, steeper trajectory; 'solids' higher uGPA, flatter trajectory; 'statics' both lower uGPA and flatter trajectory. Examining the success index across signatures, we found that the risers and the statics have significantly higher and lower likelihood of quantifiable success in medical school, respectively. We also found that each signature has a unique set of features that correlate with its success in medical school. The big data approach presented here can more sensitively uncover success potential since it takes into account the inherent heterogeneity within the student population.


Assuntos
Sucesso Acadêmico , Faculdades de Medicina , Estudantes de Medicina , Teste de Admissão Acadêmica , Modelos Logísticos , Cidade de Nova Iorque , Critérios de Admissão Escolar
7.
Acad Med ; 95(4): 534-539, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31577593

RESUMO

The revision of the curriculum at New York University Grossman School of Medicine in 2010, with a reduction of the preclerkship curriculum to 18 months, made it possible to offer an accelerated 3-year pathway in 2013 for students who know their career path. The goals of the program include individualizing education, reducing student debt, and integrating undergraduate and graduate medical education. This accelerated 3-year doctor of medicine (3YMD) pathway is the first program of its kind in the United States to offer conditional acceptance to residency programs in all specialties through the National Resident Matching Program. Since inception of the pathway 6 years ago, 81 students have graduated. Critical components to successfully launch and implement the program are described.Unwavering commitment to the program as a high institutional priority by the dean and vice dean for education facilitated the support required by department chairs and residency program directors and the flexibility needed for success. Alignment between the 3- and 4-year pathways has made it possible to add points of entry into the 3-year pathway during the second and third years and to shift back into the 4-year pathway, as warranted. Modifications to how 3YMD students are mentored included changing the role of the departmental advisor and adding a dedicated 3YMD pathway advisor who serves as an advocate for both the students and the program. Having a relatively large number of 3YMD students has contributed to the success of the program and facilitated acceptance by the residencies.


Assuntos
Escolha da Profissão , Currículo , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Graduação em Medicina/organização & administração , Faculdades de Medicina , Educação de Graduação em Medicina/métodos , Humanos , Tutoria , Cidade de Nova Iorque , Fatores de Tempo , Apoio ao Desenvolvimento de Recursos Humanos
8.
Sensors (Basel) ; 19(21)2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31653093

RESUMO

The high importance of green urban planning to ensure access to green areas requires modern and multi-source decision-support tools. The integration of remote sensing data and sensor developments can contribute to the improvement of decision-making in urban forestry. This study proposes a novel big data-based methodology that combines real-time information from soil sensors and climate data to monitor the establishment of a new urban forest in semi-arid conditions. Water-soil dynamics and their implication in tree survival were analyzed considering the application of different treatment restoration techniques oriented to facilitate the recovery of tree and shrub vegetation in the degraded area. The synchronized data-capturing scheme made it possible to evaluate hourly, daily, and seasonal changes in soil-water dynamics. The spatial variation of soil-water dynamics was captured by the sensors and it highly contributed to the explanation of the observed ground measurements on tree survival. The methodology showed how the efficiency of treatments varied depending on species selection and across the experimental design. The use of retainers for improving soil moisture content and adjusting tree-watering needs was, on average, the most successful restoration technique. The results and the applied calibration of the sensor technology highlighted the random behavior of water-soil dynamics despite the small-scale scope of the experiment. The results showed the potential of this methodology to assess watering needs and adjust watering resources to the vegetation status using real-time atmospheric and soil data.

9.
Phys Rev Lett ; 114(18): 188101, 2015 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-26001019

RESUMO

A mechanistic theory is developed to describe segregation in confined multicomponent suspensions such as blood. It incorporates the two key phenomena arising in these systems at low Reynolds number: hydrodynamic pair collisions and wall-induced migration. In simple shear flow, several regimes of segregation arise, depending on the value of a "margination parameter" M. Most importantly, there is a critical value of M below which a sharp "drainage transition" occurs: one component is completely depleted from the bulk flow to the vicinity of the walls. Direct simulations also exhibit this transition as the size or flexibility ratio of the components changes.


Assuntos
Análise Química do Sangue , Modelos Biológicos , Modelos Químicos , Suspensões/química , Sangue , Hidrodinâmica
12.
Pediatr Radiol ; 39(11): 1179-87, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19727697

RESUMO

BACKGROUND: In accordance with ALARA, minimizing radiation exposure associated with voiding cystourethrograms (VCUG) is of critical importance. Advances in fluoroscopic technology might help achieve this goal. OBJECTIVE: To determine the efficacy of fluoroscopic image capture compared to conventional digital radiographic spot (DRS) images in voiding cystourethrograms (VCUG) for the evaluation of vesicoureteral reflux (VUR) in children. MATERIALS AND METHODS: The study was a retrospective review of 65 VCUG examinations (130 kidney/ureter units). Each examination consisted of fluoroscopically captured spot (FCS) images and the corresponding DRS images. Each set of images was evaluated by three pediatric radiologists for the diagnosis of VUR for a total of 390 kidney/ureter units reviewed. Using the DRS image set as the reference standard, the efficacy of the FCS images for diagnosing reflux was determined. RESULTS: The diagnostic accuracy of the FCS images in terms of the binary characterization of reflux as negative or positive was 97.2% (379/390). The sensitivity of the FCS images was 92.6% (88/95); the specificity of the FCS images was 98.6% (291/295). CONCLUSION: Fluoroscopically captured images are adequate in documenting absence of VUR on VCUG examinations, obviating the need for radiographic spot images and resulting in reduction in radiation exposure.


Assuntos
Fluoroscopia/métodos , Proteção Radiológica/métodos , Intensificação de Imagem Radiográfica/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Masculino , Doses de Radiação , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
13.
J Magn Reson Imaging ; 28(5): 1293-8, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18972340

RESUMO

PURPOSE: To determine the feasibility of time-resolved dynamic contrast-enhanced magnetic resonance urography (MRU) for the evaluation of ureteral peristalsis using a data-sharing 3D gradient echo sequence with spiral k-space filling. MATERIALS AND METHODS: Eight patients (M=3, F=5, mean 48.1 years) were referred for MRU for the evaluation for renal mass (n=3), hematuria (n=2), urinary tract tuberculosis (n=1), postoperative bladder cancer (n=1), and postoperative ureteric reimplantation (n=1). Dynamic MRU was performed for 120 seconds at 1.5T after intravenous furosemide and gadolinium administration using an oblique sagittal, time-resolved T1 3D gradient echo sequence with 1 second effective temporal resolution. Study quality was assessed based on artifacts and extent of ureteric visualization. Frequency of peristalsis from the renal pelvis to urinary bladder was evaluated for each subject. RESULTS: A total of 16 ureters were examined. Image quality was good in four ureters, satisfactory in 11 ureters, and poor in one ureter. Mean peristaltic frequency was 3.5 waves per minute (range, 2.5-6.5 waves/minute) in normal ureters (n=11). Five ureters were considered abnormal (one urinary tract tuberculosis and four postsurgical ureters), and all had decreased or no peristalsis (0-1.5 waves per minute). CONCLUSION: MRU using a time-resolved, data-sharing 3D contrast-enhanced technique is able to demonstrate ureteral peristalsis and permits quantification of ureteral peristaltic frequency.


Assuntos
Gadolínio , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Ureter/patologia , Doenças Ureterais/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Pré-Escolar , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peristaltismo , Projetos Piloto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
14.
Bol Asoc Med P R ; 100(4): 25-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19400526

RESUMO

Ever since the last American Heart Association (AHA) publication on prevention of infective endocarditis (IE) many medical societies and physicians have questioned the efficacy of prophylaxis in patients that undergo a dental, genitourinary (GU) or gastrointestinal (GI) procedures. In 1997 AHA recognize that most cases of IE were not related to invasive procedures but as a result of arbitrarily occurring bacteremia from routine daily activities as well as recognition of the possibility of IE prophylaxis failure. This assumptions as well as review of numerous published studies over the past two decades caused that AHA to revise the guidelines of 1997. Based on published series this new guidelines identify the following underlying cardiac conditions with an increase risk of IE and are the ones in which prophylaxis is recommended. They include (1) prosthetic cardiac valve or prosthetic material used for cardiac valve repair, (2) previous IE, (3) Congenital Heart Disease (CHD) including unrepaired cyanotic as well as palliative shunts and conduits, completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure, repaired CHD with residual defects and (4) cardiac transplantation recipients who develop cardiac valvulopathy. All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa will require IE prophylaxis. Patients that undergo respiratory tract procedure that involves incision or biopsy of the respiratory mucosa will also required IE prophylaxis. In contrast to previous AHA guidelines, antibiotic prophylaxis to prevent IE is not recommended for GU or GI procedures. First line therapy recommended includes amoxicillin or ampicillin and if allergic to penicillin, clindamycin 600 mg or azithromycin 500 mg. Antibiotics should be administered in a single dose before the procedure, but the dosage may be administered up to two hours after procedure. This new AHA recommendation are more clear for healthcare providers regarding to which patient should undergo prophylaxis in comparison with previous ones and are expected to reduce antibiotic resistance that increased during the past years as a result of previous antibiotic prophylaxis for IE.


Assuntos
Antibioticoprofilaxia , Endocardite/prevenção & controle , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Cardiologia , Endocardite/etiologia , Endocardite/mortalidade , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Higiene Bucal , Procedimentos Cirúrgicos Bucais/efeitos adversos , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Sociedades Médicas , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Doenças Dentárias/complicações , Estados Unidos
15.
Bol Asoc Med P R ; 100(4): 60-70, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19400531

RESUMO

Amyloidosis has been defined as an infiltrative disorder primarily caused by extracellular tissue deposition of amyloid fibrils. There are at least twenty five different human and eight different animal proteins precursors of amyloid fibrils. Subtypes are differentiated by means of immunohistochemical and genetic testing, with prognosis and therapeutic strategies different from each other. There are a total of five types of amyloidosis: (1) Primary systemic amyloidosis, (2) secondary systemic amyloidosis, (3) Senile amyloidosis, (4) Hereditary amyloidosis, and (5) Hemodialysis-related. Cardiovascular manifestations can be fourfold and include congestive heart failure due to restrictive cardiomyopathy, vascular abnormalities, autonomic dysfunction, and conduction abnormalities. Tissue diagnosis remains the goal standard for diagnosis ofamyloidosis. Non invasive evaluation includes echocardiogram, cardiac MRI and Serum amyloid P component scintigraphy. These studies will be helpful in the diagnosis as well as follow up of patients with cardiac amyloidosis. Cardiac amyloidosis management will vary depending on the subtype but consist of supportive treatment of cardiac related symptoms and reducing the amyloid fibrils formation attacking the underlying disease.


Assuntos
Amiloidose , Cardiomiopatias , Fatores Etários , Idoso , Amiloidose/classificação , Amiloidose/diagnóstico , Amiloidose/diagnóstico por imagem , Amiloidose/epidemiologia , Amiloidose/patologia , Amiloidose/terapia , Biópsia , Cateterismo Cardíaco , Cardiomiopatias/diagnóstico , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Cardiomiopatias/cirurgia , Cardiomiopatias/terapia , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Feminino , Transplante de Coração , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Prognóstico , Fatores de Risco , Fatores Sexuais , Volume Sistólico
16.
Radiographics ; 28(1): e28, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-17967936

RESUMO

Unlike peripheral lower extremity vascular disease, upper extremity vascular disease is relatively uncommon. While atherosclerosis and embolic disease are the most common causes of upper extremity ischemia, a wide variety of systemic diseases and anatomic abnormalities can affect the upper extremity. Upper extremity ischemia poses a significant diagnostic and therapeutic challenge for both clinicians and radiologists. Although history and physical examination remain the mainstays of diagnosis, imaging can be vital in confirming suspected disease and guiding treatment planning. Digital subtraction angiography is often the preferred method for detection of upper extremity vascular disease, particularly for characterization of complex arteriovenous anatomy such as in vascular malformations and for evaluation of dialysis fistulas and grafts. However, this modality is invasive, requires iodinated contrast agents and radiation, and may fail to demonstrate significant extraluminal disease. More recently, magnetic resonance (MR) angiography techniques have made important advances, permitting higher temporal and spatial resolution that is preferable for diagnosing upper extremity vascular disorders. In this review, the authors present an overview of upper extremity MR angiography techniques and protocols, revisit the often variable vascular anatomy of the arm and hand, and offer examples of various pathologic entities diagnosed with MR angiography. Finally, several imaging pitfalls that one must be aware of for accurate diagnosis are illustrated and reviewed.


Assuntos
Aumento da Imagem/métodos , Isquemia/diagnóstico , Angiografia por Ressonância Magnética/métodos , Doenças Vasculares Periféricas/diagnóstico , Extremidade Superior/irrigação sanguínea , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Extremidade Superior/patologia
17.
Pediatr Surg Int ; 23(9): 927-30, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17394003

RESUMO

Calcified catheter "cast" found on radiologic studies after central venous catheter removal is a rare complication that has been reported twice. Both cases were associated with thrombus. In this case report, we present a 15-year-old boy with acute lymphoblastic leukemia who demonstrated on CT scan a radiopacity in his left brachiocephalic vein after removal of an implanted venous access device. This was initially thought to be a retained catheter fragment. Diagnostic studies, including venogram, excluded the presence of a retained catheter fragment. Additional procedures to retrieve a nonexistent catheter fragment were thus avoided. Therefore, a catheter "cast" should be considered as part of the differential diagnosis when calcification is found on an imaging study after removal of an implantable venous access device to prevent an unwarranted surgical exploration.


Assuntos
Calcinose/diagnóstico , Cateterismo Venoso Central/efeitos adversos , Remoção de Dispositivo/efeitos adversos , Migração de Corpo Estranho/diagnóstico , Adolescente , Veias Braquiocefálicas/diagnóstico por imagem , Calcinose/etiologia , Cateteres de Demora/efeitos adversos , Diagnóstico Diferencial , Humanos , Masculino , Flebografia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Tomografia Computadorizada por Raios X
18.
J Pediatr Surg ; 41(10): E19-22, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17011253

RESUMO

Uterus didelphys is a rare congenital anomaly with a well-documented association with obstructed hemivagina and ipsilateral renal agenesis. Treatment of this anomaly includes drainage of hematocolopos and excision of the vaginal septum, which has traditionally used a scalpel or scissors, often with hymenotomy. Recently, a less invasive approach using hysteroscopic resection has been reported, allowing improved visualization with preservation of the hymenal ring. In this article, we present an alternative minimally invasive approach using a combination of laparoscopy and vaginoscopy in the case of a 10-year-old girl. This approach allows for treatment in cases wherein vaginoscopy provides inadequate visualization with the advantage of enabling full evaluation for associated complications affecting future fertility including endometriosis, pelvic infection, and pelvic adhesions.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Estruturas Criadas Cirurgicamente , Útero/anormalidades , Útero/cirurgia , Vagina/anormalidades , Vagina/cirurgia , Anormalidades Múltiplas/cirurgia , Criança , Feminino , Humanos , Laparoscopia , Imageamento por Ressonância Magnética , Procedimentos Cirúrgicos Minimamente Invasivos , Ultrassonografia , Útero/diagnóstico por imagem
19.
Pediatr Surg Int ; 22(10): 865-8, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16944181

RESUMO

Children with acquired immunodeficiency syndrome (AIDS) are at an increased risk for lymphoproliferative and neoplastic disorders. Included among these are smooth muscle neoplasms such as leiomyomas and leiomyosarcomas. There have been at least 15 reported cases of smooth muscle tumors in the approximately 8,000 children with AIDS, however the incidence in immunocompetent children is only two per ten million. The lesions in children with human immunodeficiency virus infection are usually found in the lung, liver, and gastrointestinal tract. Here, we present an unusual case of a 12-year-old African American girl with vertically acquired AIDS who presented to the pediatric emergency department with severe diffuse abdominal pain. She was ultimately found to have an appendiceal leiomyoma on abdominal exploration, the first reported case. Our report suggests that smooth muscle tumors of the appendix be included in the differential diagnosis of abdominal masses in children with AIDS.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Neoplasias do Apêndice/complicações , Leiomioma/complicações , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/cirurgia , Criança , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Laparoscopia , Laparotomia , Leiomioma/diagnóstico , Leiomioma/cirurgia , Tomografia Computadorizada por Raios X
20.
Pediatr Radiol ; 36(8): 841-4, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16688445

RESUMO

BACKGROUND: The arterial vascularity of the hip has been investigated in normal infants using duplex Doppler sonography. This study addressed the differences in hip vascularity in infants with respect to gender and acetabular morphology. OBJECTIVE: To determine whether there is a relationship between the resistive index of the vessels of the femoral chondroepiphysis and the alpha angle in normal infant hips and in those with developmental dysplasia of the hip. MATERIALS AND METHODS: We studied 76 hips (38 patients) with gray-scale and power Doppler US. The patients were referred because of a possible abnormal clinical hip examination or had risk factors for developmental dysplasia of the hip. The infants ranged in age from 1 day to 6 weeks. There were 13 boys and 25 girls. Gray-scale images were initially performed in the coronal and transverse planes to evaluate acetabular morphology, alpha angle and position of the femoral chondroepiphysis relative to the acetabulum. The hips were then examined with power Doppler US, in both sagittal and transverse planes, to identify arterial vessels within the femoral epiphysis. Resistive indices were then recorded from the spectral analysis in each vessel identified. Each examination was performed by one of five pediatric radiologists. Mixed model regression was used to assess the relationship between resistive index and alpha angle, age and gender. RESULTS: Of the 76 hips, 34 had an alpha angle of 60 degrees or greater and were classified as normal, 26 had an alpha angle between 50 degrees and 59 degrees and were classified as immature, and 13 had an alpha angle of less than 50 degrees and were either subluxed or dislocated at the time of examination. At least two vessels were documented in each femoral epiphysis except in three hips, in which no vessels could be documented because of technical factors. There was a statistically significant linear relationship between the alpha angle and resistive index, such that the resistive index tended to rise with increasing alpha angle (P=0.0022). In addition, female infants had a significantly higher average resistive index than the average resistive index in male infants with the same alpha angle (P=0.0005). CONCLUSION: There is a direct linear relationship between alpha angle and resistive index in the infant hip. Female infants have a higher average resistive index than male infants. We believe that these results might serve as a model for predicting an infant hip at risk of ischemia. In addition, the fact that lower resistive indices of the femoral epiphysis are associated with acetabular dysplasia might help explain the documented low incidence of avascular necrosis in untreated hip dysplasia.


Assuntos
Acetábulo/diagnóstico por imagem , Fêmur/anatomia & histologia , Fêmur/irrigação sanguínea , Luxação Congênita de Quadril/patologia , Resistência Vascular , Epífises/anatomia & histologia , Epífises/irrigação sanguínea , Epífises/diagnóstico por imagem , Feminino , Fêmur/diagnóstico por imagem , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Masculino , Valores de Referência , Análise de Regressão , Fatores Sexuais , Ultrassonografia Doppler
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