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1.
J Infect Chemother ; 27(2): 336-341, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33402303

RESUMO

INTRODUCTION: In patients with severe coronavirus disease 2019 (COVID-19), respiratory failure is a major complication and its symptoms occur around one week after onset. The CURB-65, A-DROP and expanded CURB-65 tools are known to predict the risk of mortality in patients with community-acquired pneumonia. In this retrospective single-center retrospective study, we aimed to assess the correlations of the A-DROP, CURB-65, and expanded CURB-65 scores on admission with an increase in oxygen requirement in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. METHODS: We retrospectively analyzed 207 patients who were hospitalized with SARS-CoV-2 pneumonia at the Self-Defense Forces Central Hospital in Tokyo, Japan. Performance of A-DROP, CURB-65, and the expanded CURB-65 scores were validated. In addition, we assessed whether there were any associations between an increase in oxygen requirement and known risk factors for critical illness in COVID-19, including elevation of liver enzymes and C-reactive protein (CRP), lymphocytopenia, high D-dimer levels and the chest computed tomography (CT) score. RESULTS: The areas under the curve for the ability of CURB-65, A-DROP, and the expanded CURB-65 scores to predict an increase in oxygen requirement were 0.6961, 0.6980 and 0.8327, respectively, and the differences between the three groups were statistically significant (p < 0.001). Comorbid cardiovascular disease, lymphocytopenia, elevated CRP, liver enzyme and D-dimer levels, and higher chest CT score were significantly associated with an increase in oxygen requirement CONCLUSIONS: The expanded CURB-65 score can be a better predictor of an increase in oxygen requirement in patients with SARS-CoV-2 pneumonia.


Assuntos
/terapia , Oxigenoterapia/métodos , Índice de Gravidade de Doença , Adulto , Idoso , Proteína C-Reativa/análise , /mortalidade , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Linfopenia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Prognóstico , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tóquio , Tomografia Computadorizada por Raios X
2.
J Infect Chemother ; 27(1): 70-75, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32950393

RESUMO

OBJECTIVES: The symptoms of Coronavirus disease 2019 (COVID-19) vary among patients. The aim of this study was to investigate the clinical manifestation and disease duration in young versus elderly patients. METHODS: We retrospectively analyzed 187 patients (87 elderly and 100 young patients) with confirmed COVID-19. The clinical characteristics and chest computed tomography (CT) extent as defined by a score were compared between the two groups. RESULTS: The numbers of asymptomatic cases and severe cases were significantly higher in the elderly group (elderly group vs. young group; asymptomatic cases, 31 [35.6%] vs. 10 [10%], p < 0.0001; severe cases, 25 [28.7%] vs. 8 [8.0%], p = 0.0002). The proportion of asymptomatic patients and severe patients increased across the 10-year age groups. There was no significant difference in the total CT score and number of abnormal cases. A significant positive correlation between the disease duration and patient age was observed in asymptomatic patients (ρ = 0.4570, 95% CI 0.1198-0.6491, p = 0.0034). CONCLUSIONS: Although the extent of lung involvement did not have a significant difference between the young and elderly patients, elderly patients were more likely to have severe clinical manifestations. Elderly patients were also more likely to be asymptomatic and a source of COVID-19 viral shedding.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Eliminação de Partículas Virais , Adulto , Fatores Etários , Idoso , Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
4.
Am J Case Rep ; 21: e926630, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33075039

RESUMO

BACKGROUND Acquired cystic disease-associated renal cell carcinoma (ACD-associated RCC), which was added to the 2016 World Health Organization classification, is the most common subtype of RCC in patients undergoing long-term dialysis. ACD-associated RCC is underrecognized and reports of computed tomography (CT) and magnetic resonance imaging findings for the lesion are sparse. Similar to urothelial carcinoma, ACD-associated RCC is poorly to slightly enhanced on dynamic CT. Here, we report 2 cases of ACD-associated RCC filling the renal pelvis and mimicking urothelial carcinoma. CASE REPORT We describe 2 cases of ACD-associated RCC filling the left renal pelvis in patients undergoing dialysis for more than 10 years. In both cases, the patient's chief complaint was hematuria, and a left renal pelvic mass with poor enhancement was seen on dynamic CT. In both cases, the preoperative diagnosis was urothelial carcinoma of the left renal pelvis. Total nephroureterectomy was performed, and the final diagnosis was ACD-associated RCC. CONCLUSIONS ACD-associated RCC is a common tumor in patients undergoing long-term dialysis. When ACD-associated RCC is located in the renal pelvis, the imaging findings are similar to those of urothelial carcinoma. Therefore, it is important for radiologists to include ACD-associated RCC in the differential diagnosis.

5.
Radiol Case Rep ; 15(4): 371-374, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32055262

RESUMO

Lymphorrhea is a rare complication of rectal surgery. Although percutaneous embolization of thoracic or lymphatic ducts is now increasingly being reported for various types of lymphatic leakage, there are only sparse data on lymphatic interventions for lymphorrhea following rectal surgery. A novel balloon-occluded retrograde lymphatic embolization (BRLE) technique can be a simple and effective option for intractable lymphorrhea. We report a case of a man with infected lymphorrhea after rectal resection. Transperineal drainage was performed; however, lymphatic leakage persisted after 1 month of conservative treatment. Lymphangiography revealed multifocal leaks from bilateral iliac lymphatics. The proposed BRLE technique was performed via a balloon catheter inserted through the transperineal drainage. The balloon allowed occlusion of lymphatic outflow and forceful retrograde injection to achieve denser accumulation of n-butyl cyanoacrylate. Tight embolization of bilateral iliac lymphatics and drastic improvement of the leakage was achieved. To the best of our knowledge, this is the first report of percutaneous embolization for lymphorrhea after rectal surgery. This case supports the efficacy of the BRLE as a simple and effective therapeutic option for such persistent multifocal lymphatic leaks.

7.
Magn Reson Med Sci ; 19(1): 40-47, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-30918223

RESUMO

PURPOSE: Prostate cancer management includes identification of clinically significant cancers that may require curative treatment. Statistical models based on gamma distribution can describe diffusion signal decay curves of prostate cancer. The purpose of this study was to evaluate the ability of parameters obtained with the gamma model in differentiating prostate cancers with different Gleason score values. METHODS: This study included 155 patients with prostate cancer who underwent multiparametric magnetic resonance imaging prior to prostate biopsy (127 patients) or radical prostatectomy (28 patients) between January 2015 and June 2017; 159 foci of prostate cancer were included in our study. We compared cases scored as Gleason score (GS) 3 + 3 and GS ≥ 3 + 4, and analyzed cases scored as GS ≤ 3+ 4 and GS ≥ 4 + 3 based on the gamma model (Frac < 1.0, Frac < 0.8, Frac < 0.5, Frac < 0.3, and Frac > 3.0), and apparent diffusion coefficient (ADC). RESULTS: Among 159 cancerous lesions in 155 patients, 13 (8.2%) were GS 3 + 3 prostate cancers, 51 (32.0%) were GS 3 + 4 prostate cancers, 30 (18.2%) were GS 4 + 3 cancers, and 65 (40.9%) were GS ≥ 4 + 4 cancers. Frac < 0.3, Frac < 0.5, Frac < 0.8, and Frac < 1.0 were significantly higher and ADC values were significantly lower in GS ≥ 4 + 3 cancers than in GS ≤ 3 + 4 cancers (P < 0.01, P < 0.01, P < 0.01, P = 0.01, and P < 0.01, respectively). With receiver operating characteristic (ROC) analysis, Frac < 0.3 and Frac < 0.5 had significantly greater area under the ROC curve for discriminating GS ≥ 4 + 3 cancers from GS ≤ 3 + 4 cancers than ADC (P = 0.03, P < 0.01, respectively). CONCLUSION: Frac < 0.3 and Frac < 0.5 showed higher diagnostic performance than ADC for differentiating GS ≥ 4 + 3 from GS ≤ 3 + 4 cancers. The gamma model may add additional value in discrimination of tumor grades.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Gradação de Tumores/métodos , Neoplasias da Próstata/diagnóstico por imagem , Humanos , Masculino , Próstata/diagnóstico por imagem
8.
Cardiovasc Intervent Radiol ; 42(9): 1358-1362, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31076841

RESUMO

INTRODUCTION: A postoperative clinically relevant pancreatic fistula can cause severe sequelae. We aimed to describe our minimally invasive procedure (rendezvous technique) for the treatment of a pancreatic fistula resulting from pancreaticojejunal anastomosis dehiscence involving a dislodged main pancreatic duct tube. METHODS: In our rendezvous technique, a guidewire is advanced into the jejunal lumen from the access site of the drainage tube and is caught by a snare catheter, which is used to replace the dislodged main pancreatic duct tube. Then, the guidewire is passed from the access site of the drainage tube to the site of the dislodged main pancreatic duct tube. A sheath is inserted along the route of the dislodged main pancreatic duct tube and is placed across the pancreaticojejunal anastomosis over the guidewire. Another guidewire is advanced into the main pancreatic duct via the sheath, and a new main pancreatic duct tube is inserted into the main pancreatic duct over the second wire. This technique was performed in two patients with a pancreatic fistula. RESULTS: Our rendezvous technique was successfully performed in a 73-year-old man with an intractable clinically relevant pancreatic fistula and large discharge from the drain and a 74-year-old woman with a pancreatic fistula and fluid collection between the elevated jejunum and remnant pancreas. Discharge from the drain and fluid collection decreased after the procedure. CONCLUSION: Our rendezvous technique is an effective minimally invasive approach for a pancreatic fistula resulting from pancreaticojejunal anastomosis dehiscence.


Assuntos
Drenagem/instrumentação , Drenagem/métodos , Fístula Pancreática/terapia , Pancreaticojejunostomia , Complicações Pós-Operatórias/terapia , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Masculino , Ductos Pancreáticos/diagnóstico por imagem , Fístula Pancreática/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Retratamento , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Urology ; 121: e3-e4, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30142403

RESUMO

Bosniak category III renal cystic masses are often treated with surgical resection because of high risk of malignancy. Crizotinib is an anaplastic lymphoma kinase (ALK) inhibitor used to treat ALK gene-rearranged non-small cell lung cancer and reported to be associated with complex renal cyst formation. We herein report a case of Bosniak category III renal cysts occurred in a crizotinib-treated ALK gene-rearranged non-small cell lung cancer patients. The cysts regressed spontaneously after cessation of crizotinib and we could thus avoid unnecessary surgical resection.

10.
Jpn J Radiol ; 36(11): 661-668, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30109553

RESUMO

PURPOSE: Inferior vena cava filter fracture (FF) may cause life-threatening complications, including cardiac tamponade, although the actual prevalence remains unclear. Therefore, we investigated the incidence of FF. MATERIALS AND METHODS: Data on fracture incidence with filter brands, filter positions [suprarenal (SR) vs. infrarenal (IR)], and follow-up durations were collected from the databases of eight hospitals. RESULTS: Of 532 patients, Günther Tulip (GT), Trap/OptEase (TE/OE), ALN and VenaTech (VT) were implanted in 345, 147, 38 and 2 patients, respectively. Of these, filter retrieval was attempted in 110 (21.7%) patients and was successful in 106 (96.4%). Of the remaining 426 patients, FFs were observed in two (0.7%) of 270 GT filters and 19 (14.1%) of 135 TE/OE filters. Fragment embolization occurred in one patient with a GT filter (50.0%) and three with a TE/OE filter (15.8%) with a total follow-up interval of 718.0 ± 1019.4 days. FF occurred more frequently in TE/OE than in GT filters (p < 0.001). Kaplan-Meier estimates showed significantly higher fracture-free rates for GT than TE/OE (p < 0.001) and IR-TE/OE than SR-TE/OE (p < 0.05). CONCLUSIONS: TE/OE filters are not suitable for permanent implantation due to the relatively early and high fracture rates.


Assuntos
Falha de Prótese , Embolia Pulmonar/terapia , Filtros de Veia Cava , Adulto , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/cirurgia , Adulto Jovem
11.
Br J Radiol ; 91(1087): 20180115, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29630390

RESUMO

OBJECTIVE: The diagnostic performance of endoscopic retrograde cholangiography (ERC) with radiography is imperfect. We assessed the value of adding tomosynthesis to ERC with radiography for the detection of choledocholithiasis. METHODS: This study included 102 consecutive patients (choledocholithiasis/non-choledocholithiasis, n = 57/45), who underwent both radiography and tomosynthesis for ERC in the same examination and were not diagnosed with malignancy. The reference standard for the existence of choledocholithiasis was confirmed by endoscopic stone extraction during ERC, intraoperative cholangiography, or follow up with magnetic resonance cholangiopancreatography (n = 78, 11, and 13, respectively). A gastroenterologist and a radiologist independently evaluated the radiographs and the combination of tomosynthesis and radiographic images in a blinded and randomised manner. Receiver operating characteristic analysis was used for statistical analysis. RESULTS: The areas under the receiver operating characteristic curve for combined tomosynthesis and radiography were significantly higher than those for radiography alone for both readers: Reader 1/Reader 2, 0.929/0.956 [95% confidence interval (CI), 0.861-0.965/0.890-0.983) vs 0.803/0.769 (95% confidence interval, 0.707-0.873/0.668-0.846), respectively (p = 0.0047/< 0.0001). CONCLUSION: Adding tomosynthesis to radiography improved the diagnostic performance of ERC for detection of choledocholithiasis. Advances in knowledge: Adding tomosynthesis to radiography improves detection of choledocholithiasis and tomosynthesis images can be obtained easily after radiographs and repeated immediately.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Idoso , Colangiopancreatografia por Ressonância Magnética , Coledocolitíase/cirurgia , Meios de Contraste , Feminino , Humanos , Masculino , Estudos Retrospectivos
12.
Radiographics ; 36(7): 2199-2211, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27831840

RESUMO

Traumatic lymphorrhea is a rare but potentially life-threatening complication. Postoperative lymphorrhea is the leading cause of traumatic lymphorrhea and can arise anywhere within the lymphatic system. Leaks arising from the aortoiliac region to the thoracic duct (TD) and from hepatic lymphatics can be identified with intranodal lymphangiography and transhepatic lymphangiography, respectively. Therefore, an appropriate lymphangiography technique is essential for identifying the sources of leaks. Chylothorax resulting from damage to the TD can be serious because the TD transports large amounts of lymphatic fluid from the gastrointestinal, hepatic, and aortoiliac regions. Percutaneous TD embolization-comprising access to the TD followed by embolization-has recently become a minimally invasive alternative to surgical TD ligation for high-output chylothorax. The selection of access routes to the TD depends on its anatomy. If the TD cannot be approached by such means, other options include TD needle interruption or drainage of lymphatic fluid adjacent to the leakage point followed by sclerotherapy. Most cases of abdominal lymphorrhea arise from the aorta-iliac lymphatic system, and lymphangiography alone or computed tomography-guided sclerotherapy might be useful. Rarely, leakage may arise from hepatic lymphatics due to a damaged gastroduodenal ligament and can be visualized and embolized transhepatically. This article comprehensively reviews clinically relevant anatomic TD variations, lymphangiography techniques and criteria for their selection, and treatment strategies for lymphorrhea. ©RSNA, 2016.


Assuntos
Excisão de Linfonodo/métodos , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/terapia , Linfografia/métodos , Cirurgia Assistida por Computador/métodos , Terapia Combinada/métodos , Diagnóstico Diferencial , Drenagem/métodos , Embolização Terapêutica/métodos , Medicina Baseada em Evidências , Humanos , Escleroterapia/métodos , Resultado do Tratamento
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