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1.
Ann Ital Chir ; 90: 52-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30862770

RESUMO

OBJECTIVES: The objective of our study was to determine the predictive factors of their occurrence during conservative surgical treatment of the hepatic hydatid cyst (HHC). PATIENTS AND METHODS: We carried out a retrospective review of patients who had undergone conservative surgical treatment of the HHC during 6 years. Univariate analyzes were used to determine the predictive factors of an occult cystobiliary fistula (CBF). RESULTS: This current study included 105 patients. Concerning the predictive factors of an CBF regardless of its pattern of evolution, we noted that the presence of fistula was statistically correlated with the a cyst size (bigger than 8.65 cm ; p = 0.003) and with advanced age (p=0.035). Interestingly enough, the correlation to a degenerated cyst (p=0.069) were of little significance. CONCLUSION: The size of the cyst greater than 8.65 cm and the advanced age are the risk factors of CBF according to our study. KEY WORDS: Biliary Fistula, Diagnosis, Echinococcosis, Hepatic, Prevention and control.


Assuntos
Fístula Biliar/diagnóstico , Fístula Biliar/etiologia , Equinococose Hepática/complicações , Equinococose Hepática/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Ann Ital Chir ; 89: 309-314, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30337501

RESUMO

OBJECTIVES: The liver is the most frequent anatomic location of hydatid disease. Imaging modality nowadays are numerous and increasingly efficient. The objective of our study is to precise the correlation between Ultrasonography, computed tomography and intraoperative findings on the different characteristics of hepatic hydatid cyst. PATIENTS AND METHODS: We conducted a prospective study including all hepatic hydatid cyst operated in 2015. We evaluated statistically, by calculating the coefficient K or the intraclass correlation coefficient, the concordance between Ultrasonography, computed tomography (CT) and intraoperative findings on the different characteristics of hepatic hydatid cyst. RESULTS: In our study, we included 48 patients with 79 hepatic hydatid cysts. It was concluded that Ultrasonography performs better than CT in the study of type of cyst, pericyst, relationships with portal vein and main bile duct. While CT is better than echography in terms of number, localizations of cyst, relationship with the vena cava inferior, other localizations and the remaining liver, both examinations remain limited in the determination of pericyst characteristics and the identification of biliary fistula. CONCLUSION: Ultrasonography and CT cannot provide accurate data for the study of pericyst and biliary fistula, hence requiring prospective studies of the place of MRI and intraoperative echography in this domain. KEY WORDS: Diagnostic, Imaging, Echinococcosis, Hepatic, Intraoperative Care.


Assuntos
Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/cirurgia , Correlação de Dados , Humanos , Cuidados Intraoperatórios , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia
6.
Presse Med ; 47(11-12 Pt 1): 950-960, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30224216

RESUMO

Magnetic resonance cholangiopancreatography is a non-invasive imaging, highly performant in detecting and locating biliary stenosis and in predicting its malignancy. The combination of two and three-dimensional MRI sequences is recommended to assess a biliary obstacle. Cholangiopathies are the main differential diagnosis of cholangiocarcinomas. In addition to bile duct abnormalities beyond the stenosis, the predictive signs of malignancy are: asymmetric irregular luminal narrowing (longer than 3mm and thicker than 13mm), abrupt discontinuation of stenosis, and enhancement superior to that of the adjacent hepatic parenchyma during arterial and portal acquisitions. Diffusion sequences improve the sensitivity of biliary stenosis detection. Moreover, restriction of diffusion is useful for distinguishing malignant from benign stenosis. Combining Magnetic resonance cholangiopancreatography, late LAVA and diffusion sequences improves the sensitivity of detection of a possible biliary extension without significant specificity. MRI with gadolinium chelate injection is efficient in assessing vascular extension of cholangiocarcinomas. However its accuracy remains lower than that of Ct-scan. To assess hepatic, lymphatic and peritoneal extensions of cholangiocarcinomas, it is fundamental to combine diffusion and dynamic MRI sequences.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/cirurgia , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/cirurgia , Imagem por Ressonância Magnética , Diagnóstico Diferencial , Humanos , Período Pré-Operatório
8.
Arch Iran Med ; 21(4): 180-182, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29693409

RESUMO

Isolated macro-nodular liver tuberculosis is a very rare condition. It may mimic primitive or secondary tumors of the liver. This could delay or mislead the therapeutic management. An immunocompetent 48-year-old man with a history of non-metastatic seminoma was treated with right orchidectomy followed by 20 Gy radiotherapy. The discovery, 8 months later, of a 2 cm nodule of the hepatic dome evoked a liver metastasis. Percutaneous biopsy was not feasible. Wedge resection was performed whereas medical treatment would have sufficed, as pathologic examination of the resected specimen showed a macro-nodular hepatic tuberculosis. The patient received anti-tuberculosis drugs for 9 months. The diagnosis of isolated macro-nodular liver tuberculosis is frequently misleading, particularly in immunocompetent and paucisymptomatic patients. Thus percutaneous biopsy is mandatory for diagnosis and also prior to any major surgeries.


Assuntos
Fígado/patologia , Seminoma/patologia , Neoplasias Testiculares/patologia , Tuberculose Hepática/diagnóstico , Antituberculosos/uso terapêutico , Biópsia , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas , Masculino , Pessoa de Meia-Idade , Seminoma/terapia , Neoplasias Testiculares/terapia , Tomografia Computadorizada por Raios X , Tuberculose Hepática/tratamento farmacológico
11.
Presse Med ; 46(12 Pt 1): 1139-1143, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29133083

RESUMO

Diverticulitis is much less common in the jejunum than in colonic diverticula probably because of diverticulum larger size, better intra-luminal flow and relatively sterile jejunal content. Complications of jejunal diverticulitis are acute intestinal obstruction, diverticular bleeding and mainly perforation with mesenteric abscess, localized or generalized peritonitis. The Multi-detector row computed tomography is now the best diagnostic imaging for small bowel diverticulitis as well as its complications. Magnetic resonance enterography is also quite useful but it is still impractical to resort to such an imaging in an abdominal emergency. Non-surgical treatment is usually sufficient for jejunal diverticulitis without peritonitis but it does not prevent recurrence of diverticulitis. Surgery is mandatory in case of generalized peritonitis or voluminous local abscess complicating small bowel diverticulitis. In case of extensive small bowel diverticulosis, resection should be limited to the intestinal loop with complicated diverticulum (local abscess, peritonitis or bleeding) to avoid short bowel syndrome. Poor prognostic factors are advanced age, associated comorbidities, delayed diagnosis and mainly the time interval between perforation and surgery.


Assuntos
Algoritmos , Diverticulite/terapia , Doenças do Jejuno/terapia , Diverticulite/diagnóstico , Humanos , Doenças do Jejuno/diagnóstico
12.
Am J Emerg Med ; 33(6): 858.e1-3, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25572647

RESUMO

Neurogenic pulmonary edema (NPE) is a possible complication of severe central nervous system insult. Its physiopathology is still debated. We report a fatal case of a 55-year-old man who was admitted because of severe head injury. The diagnosis of NPE was considered according to clinical and radiologic findings. Transpulmonary thermodilution study showed decreased stroke volume index and cardiac function index. Indexed extravascular lung water was increased as well as pulmonary vascular permeability index. The impairment of the left ventricular function was confirmed by the echocardiographic study. Our case suggests that NPE imply both cardiac dysfunction and lung injury. Thus, transpulmonary thermodilution can be helpful in managing fluid balance and the choice of vasopressors in patients with life-threatening NPE.


Assuntos
Traumatismos Craniocerebrais/complicações , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Traumatismos Craniocerebrais/cirurgia , Diagnóstico por Imagem , Água Extravascular Pulmonar , Evolução Fatal , Escala de Coma de Glasgow , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Termodiluição
14.
Neurosciences (Riyadh) ; 16(2): 137-45, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21427663

RESUMO

OBJECTIVE: To illustrate through 10 pediatric cases, the clinical features, course, and importance of neuroimaging (especially MRI) in guiding the diagnosis of acute disseminated encephalomyelitis (ADEM) and controlling patients after treatment. METHODS: A retrospective review of 10 pediatric cases of ADEM, with special regard to the MRI features, presenting to the Pediatric Departments, Hedi Chaker Hospital, Sfax, Tunisia between January 2002 and December 2008. RESULTS: Children with ADEM presented with variable and multiple neurological signs most often occurring after an infectious episode, especially after upper respiratory tract infection. The MRI permitted confirmation of the diagnosis by showing demyelinating lesions either in the brainstem, the cerebellum, the cerebral white and grey matter, or in the spine of all patients. CONCLUSION: Acute disseminated encephalomyelitis is characterized by multifocal demyelinating lesions resulting in varied neurological signs. The MRI is the technique of choice to show these lesions.


Assuntos
Encefalomielite Aguda Disseminada/diagnóstico , Imagem por Ressonância Magnética/métodos , Aciclovir/uso terapêutico , Adolescente , Corticosteroides/uso terapêutico , Antivirais/uso terapêutico , Criança , Pré-Escolar , Encefalomielite Aguda Disseminada/terapia , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
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