RESUMO
This review focuses on the initial imaging in the reproductive age adult population with acute pelvic pain, including patients with positive and negative beta-human chorionic gonadotropin (ß-hCG) levels with suspected gynecological and nongynecological etiology. For all patients, a combination of transabdominal and transvaginal pelvic ultrasound with Doppler is usually appropriate as an initial imaging study. If nongynecological etiology in patients with negative ß-hCG is suspected, then CT of the abdomen and pelvis with or without contrast is also usually appropriate. In patients with positive ß-hCG and suspected nongynecological etiology, CT of the abdomen and pelvis with contrast and MRI of the abdomen and pelvis without contrast may be appropriate. In patients with negative ß-hCG and suspected gynecological etiology, CT of the abdomen and pelvis with contrast, MRI of pelvis without contrast, or MRI of pelvis with and without contrast may be appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Assuntos
Dor Pélvica , Adulto , Feminino , Humanos , Gravidez , Dor Aguda/diagnóstico por imagem , Dor Aguda/etiologia , Medicina Baseada em Evidências , Dor Pélvica/diagnóstico por imagem , Sociedades Médicas , Estados UnidosRESUMO
Current understanding of the physiological underpinnings of normative pain processing is incomplete. Enhanced knowledge of these systems is necessary to advance our understanding of pain processes as well as to develop effective therapeutic interventions. Previous neuroimaging research suggests a network of interrelated brain regions that seem to be implicated in the processing and experience of pain. Among these, the dorsal anterior cingulate cortex (dACC) plays an important role in the affective aspects of pain signals. The current study leveraged functional MRS to investigate the underlying dynamic shifts in the neurometabolic signature of the human dACC at rest and during acute pain. Results provide support for increased glutamate levels following acute pain administration. Specifically, a 4.6% increase in glutamate was observed during moderate pressure pain compared with baseline. Exploratory analysis also revealed meaningful changes in dACC gamma aminobutyric acid in response to pain stimulation. These data contribute toward the characterization of neurometabolic shifts, which lend insight into the role of the dACC in the pain network. Further research in this area with larger sample sizes could contribute to the development of novel therapeutics or other advances in pain-related outcomes.
Assuntos
Dor Aguda , Humanos , Feminino , Dor Aguda/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Giro do Cíngulo/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Ácido GlutâmicoRESUMO
Introduction: Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it. Methods: A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients. Results: Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery. Conclusion: There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.
Assuntos
Dor Aguda , Torção do Cordão Espermático , Masculino , Criança , Humanos , Feminino , Escroto/diagnóstico por imagem , Escroto/cirurgia , Torção do Cordão Espermático/diagnóstico por imagem , Torção do Cordão Espermático/cirurgia , Dor Aguda/diagnóstico por imagem , Ultrassonografia , Estudos RetrospectivosRESUMO
ABSTRACT: Mild traumatic brain injury (mTBI), is a leading cause of disability worldwide, with acute pain manifesting as one of its most debilitating symptoms. Understanding acute postinjury pain is important because it is a strong predictor of long-term outcomes. In this study, we imaged the brains of 157 patients with mTBI, following a motorized vehicle collision. We extracted white matter structural connectivity networks and used a machine learning approach to predict acute pain. Stronger white matter tracts within the sensorimotor, thalamiccortical, and default-mode systems predicted 20% of the variance in pain severity within 72 hours of the injury. This result generalized in 2 independent groups: 39 mTBI patients and 13 mTBI patients without whiplash symptoms. White matter measures collected at 6 months after the collision still predicted mTBI pain at that timepoint (n = 36). These white matter connections were associated with 2 nociceptive psychophysical outcomes tested at a remote body site-namely, conditioned pain modulation and magnitude of suprathreshold pain-and with pain sensitivity questionnaire scores. Our findings demonstrate a stable white matter network, the properties of which determine an important amount of pain experienced after acute injury, pinpointing a circuitry engaged in the transformation and amplification of nociceptive inputs to pain perception.
Assuntos
Dor Aguda , Concussão Encefálica , Substância Branca , Humanos , Dor Aguda/diagnóstico por imagem , Dor Aguda/etiologia , Encéfalo/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Percepção da DorRESUMO
INTRODUCTION@#Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it.@*METHODS@#A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients.@*RESULTS@#Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery.@*CONCLUSION@#There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.
Assuntos
Masculino , Criança , Humanos , Feminino , Escroto/cirurgia , Torção do Cordão Espermático/cirurgia , Dor Aguda/diagnóstico por imagem , Ultrassonografia , Estudos RetrospectivosRESUMO
Our objective was to investigate the feasibility of deep learning-based synthetic contrast-enhanced CT (DL-SCE-CT) from nonenhanced CT (NECT) in patients who visited the emergency department (ED) with acute abdominal pain (AAP). We trained an algorithm generating DL-SCE-CT using NECT with paired precontrast/postcontrast images. For clinical application, 353 patients from three institutions who visited the ED with AAP were included. Six reviewers (experienced radiologists, ER1-3; training radiologists, TR1-3) made diagnostic and disposition decisions using NECT alone and then with NECT and DL-SCE-CT together. The radiologists' confidence in decisions was graded using a 5-point scale. The diagnostic accuracy using DL-SCE-CT improved in three radiologists (50%, P = 0.023, 0.012, < 0.001, especially in 2/3 of TRs). The confidence of diagnosis and disposition improved significantly in five radiologists (83.3%, P < 0.001). Particularly, in subgroups with underlying malignancy and miscellaneous medical conditions (MMCs) and in CT-negative cases, more radiologists reported increased confidence in diagnosis (83.3% [5/6], 100.0% [6/6], and 83.3% [5/6], respectively) and disposition (66.7% [4/6], 83.3% [5/6] and 100% [6/6], respectively). In conclusion, DL-SCE-CT enhances the accuracy and confidence of diagnosis and disposition regarding patients with AAP in the ED, especially for less experienced radiologists, in CT-negative cases, and in certain disease subgroups with underlying malignancy and MMCs.
Assuntos
Dor Abdominal/diagnóstico por imagem , Aprendizado Profundo , Serviço Hospitalar de Emergência , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Aguda/diagnóstico , Dor Aguda/diagnóstico por imagem , Dor Aguda/etiologia , Adulto , Idoso , Algoritmos , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP. Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care. Design, Setting, and Participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020. Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral). Main Outcomes and Measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records. Results: Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98; P < .001). Patient and clinical characteristics associated with transition to chronic LBP included obesity (aOR, 1.52; 95% CI, 1.28-1.80; P < .001); smoking (aOR, 1.56; 95% CI, 1.29-1.89; P < .001); severe and very severe baseline disability (aOR, 1.82; 95% CI, 1.48-2.24; P < .001 and aOR, 2.08; 95% CI, 1.60-2.68; P < .001, respectively) and diagnosed depression/anxiety (aOR, 1.66; 95% CI, 1.28-2.15; P < .001). After controlling for all other variables, patients exposed to 1, 2, or 3 nonconcordant processes of care within the first 21 days were 1.39 (95% CI, 1.21-2.32), 1.88 (95% CI, 1.53-2.32), and 2.16 (95% CI, 1.10-4.25) times more likely to develop chronic LBP compared with those with no exposure (P < .001). Conclusions and Relevance: In this cohort study, the transition rate to chronic LBP was substantial and increased correspondingly with SBT stratum and early exposure to guideline nonconcordant care.
Assuntos
Dor Aguda/fisiopatologia , Dor Crônica/fisiopatologia , Dor Lombar/fisiopatologia , Atenção Primária à Saúde , Dor Aguda/diagnóstico por imagem , Dor Aguda/epidemiologia , Dor Aguda/terapia , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Dor Crônica/epidemiologia , Transtorno Depressivo/epidemiologia , Diagnóstico por Imagem/estatística & dados numéricos , Progressão da Doença , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Razão de Chances , Guias de Prática Clínica como Assunto , Prognóstico , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Fumar/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Acute scrotal pain is one of the most frequent symptoms in pediatric patients visited in the Emergency Department. Ultrasonography with color and power Doppler represents the first-line method that clinicians use to carry out the differential diagnosis between spermatic cord torsion and inflammation, but sensitivity and specificity are 63-100% and 97-100%, respectively; this variability may be related to operator's experience and testis vascular hemodynamics and also to machine performance and patient age. Recent technological innovations have made possible to create a new Doppler mode called ultrasound microvascular imaging. This technique exploits algorithms capable of separating low frequencies of static tissue artifacts from ones of very weak flows. It is known as MicroV (from Esaote) and Superb microvascular imaging (from Toshiba). It provides both macrocirculation vascular maps, as a typical Doppler feature, and microcirculation vascular maps. Furthermore, the use of background subtraction could improve the visibility of small vascular structures. We report a case of a pediatric patient suffering from acute scrotal pain assessed ultrasonographically with this innovative Doppler technique (MicroV) that may give more confidence in detecting testicular vascular signals if compared with traditional Doppler techniques.
Assuntos
Dor Aguda/diagnóstico por imagem , Torção do Cordão Espermático/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Adolescente , Diagnóstico Diferencial , Humanos , Masculino , Torção do Cordão Espermático/cirurgiaAssuntos
Dor Aguda/terapia , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Esportes , Terminologia como Assunto , Dor Aguda/diagnóstico por imagem , Dor Aguda/etiologia , Dor Aguda/psicologia , Atletas/psicologia , Traumatismos em Atletas , Comunicação , Tomada de Decisão Compartilhada , Humanos , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/psicologia , Encaminhamento e Consulta , Autoeficácia , Esportes/psicologiaRESUMO
No disponible
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Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Dor de Ombro/diagnóstico por imagem , Dor Aguda/diagnóstico por imagem , Ultrassonografia/métodos , Tendinopatia/diagnóstico por imagem , Neurite do Plexo Braquial/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem , Pneumotórax/diagnóstico por imagemRESUMO
Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.
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Dor Aguda/terapia , Analgesia/métodos , Crioterapia/métodos , Terapia por Estimulação Elétrica/métodos , Manejo da Dor/métodos , Nervos Periféricos/fisiologia , Dor Aguda/diagnóstico por imagem , Humanos , Nervos Periféricos/diagnóstico por imagemRESUMO
BACKGROUND: Although percutaneous vertebroplasty (PVP) can effectively relieve the pain for patients with acute osteoporotic vertebral compression fractures (OVCFs), many patients still complain of mild back pain in the early postoperative period. OBJECTIVES: The aim of this study was to assess the effect of early limited activity (LA) on prognosis after bipedicular small-cement-volume (i.e., PVP) to treat single-segment acute OVCFs. STUDY DESIGN: A prospective study and retrospective observations were performed on 125 patients with a minimum of 1 year of follow-up. SETTING: A university hospital orthopedics and pathology departments. METHODS: All patients were allocated into an LA group (n = 64) and an unlimited activity group (ULA group, n = 61). Patients in the LA group were suggested to keep time of off-bed activity < 4 hours per day in the first 3 weeks postoperatively. Patients in the ULA group did not limit activity. The demographic, clinical, and radiologic outcomes were assessed, such as pain intensity Numeric Rating Scale (NRS-11) and vertebral height ratio (i.e., fractured vertebral height/adjacent nonfractured vertebral height). Based on outcomes following surgery, all patients were classified as responders (NRS-11 score 1-day postoperation < 50% of preoperative NRS-11 score) or low responders (NRS-11 score 1-day postoperation >= 50% of preoperative NRS-11 score). RESULTS: The demographic results and complications were similar. In the LA group, NRS-11 scores at 1 and 3 months postoperation respectively were 2.23 ± 0.42 and 1.46 ± 0.40, and corresponding scores respectively were 2.85 ± 0.80 and 1.73 ± 0.77 in the ULA group, and there was a difference in the 2 groups in both time points (P < 0.05). At 12 months postoperation, anterior and middle vertebral height ratio respectively were 78.42% ± 3.52% and 82.37% ± 3.49% in the LA group, which were higher than 76.87% ± 3.68% and 81.10% ± 3.31% in the ULA group (P < 0.05). Thirty-two cases were low responders. Among those, NRS-11 scores at 1 and 3 months postoperation respectively were 2.29 ± 0.45 and 1.53 ± 0.46 in the LA group, which were lower than 3.67 ± 0.80 and 2.56 ± 0.79 in the ULA group (P < 0.05), and at 12 months postoperation, anterior vertebral height ratio was 79.81% ± 3.25% in the LA group and 75.60% ± 3.50% in the ULA group (P < 0.05). LIMITATIONS: First, some patients lacked the results of bone mineral density during follow-up; second, the limited time in our study was chosen from our previous working experience, which may lack an objective basis; third, NRS-11 is solely used as an indicator of clinical outcomes in our study; finally, our next studies can increase the sample size to improve the clinically difference. CONCLUSIONS: LA in the early period after PVP can help patients achieve more pain relief postoperatively and maintain better vertebral shape, especially for low responders. KEY WORDS: Osteoporotic vertebral compression fractures, percutaneous vertebroplasty, Numeric Rating Scale, vertebral height, responders, low responders, limited activity, complications.
Assuntos
Dor Aguda/cirurgia , Fraturas por Compressão/cirurgia , Limitação da Mobilidade , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/tendências , Dor Aguda/diagnóstico por imagem , Idoso , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Medição da Dor/métodos , Medição da Dor/tendências , Estudos Prospectivos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Vertebroplastia/métodosRESUMO
PURPOSE: The purpose of this study was to evaluate the utilization of invasive and noninvasive tests and compare cost in patients presenting with chest pain to the emergency department (ED) who underwent either triple-rule-out computed tomography angiography (TRO-CTA) or standard of care. MATERIALS AND METHODS: We performed a retrospective single-center analysis of 2156 ED patients who presented with acute chest pain with a negative initial troponin and electrocardiogram for myocardial injury. Patient cohorts matched by patient characteristics who had undergone TRO-CTA as a primary imaging test (n=1139) or standard of care without initial CTA imaging (n=1017) were included in the study. ED visits, utilization of tests, and costs during the initial episode of hospital care were compared. RESULTS: No significant differences in the diagnosis of coronary artery disease, pulmonary embolism, or aortic dissection were observed. Median ED waiting time (4.5 vs. 7.0 h, P<0.001), median total length of hospital stay (5.0 vs. 32.0 h, P<0.001), hospital admission rate (12.6% vs. 54.2%, P<0.001), and ED return rate to our hospital within 30 days (3.5% vs. 14.6%, P<0.001) were significantly lower in the TRO-CTA group. Moreover, reduced rates of additional testing and invasive coronary angiography (4.9% vs. 22.7%, P<0.001), and ultimately lower total cost per patient (11,783$ vs. 19,073$, P<0.001) were observed in the TRO-CTA group. CONCLUSIONS: TRO-CTA as an initial imaging test in ED patients presenting with acute chest pain was associated with shorter ED and hospital length of stay, fewer return visits within 30 days, and ultimately lower ED and hospitalization costs.
Assuntos
Dor no Peito/economia , Angiografia por Tomografia Computadorizada/economia , Angiografia Coronária/economia , Doença da Artéria Coronariana/complicações , Custos e Análise de Custo/métodos , Padrão de Cuidado/economia , Dor Aguda/líquido cefalorraquidiano , Dor Aguda/diagnóstico por imagem , Dor Aguda/economia , Dor Aguda/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/diagnóstico por imagem , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Angiografia Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/economia , Custos e Análise de Custo/economia , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Padrão de Cuidado/estatística & dados numéricos , Adulto JovemRESUMO
Acute pelvic pain in the nonpregnant woman is one of the most common conditions requiring emergent medical evaluation in routine clinical practice. Although clinical evaluation and laboratory testing are essential, imaging plays a central role. Although various adnexal and uterine disorders may result in acute pelvic pain of gynecologic origin, other nongynecologic disorders of the gastrointestinal and genitourinary systems may likewise result in acute pelvic pain. Ultrasound is first choice for initial evaluation of acute pelvic pain of gynecologic origin. Computed tomography is performed if pelvic sonography is inconclusive, or if a suspected disorder is nongynecologic in origin.
Assuntos
Dor Aguda/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Dor Pélvica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Feminino , Humanos , Pelve/diagnóstico por imagemRESUMO
Pelvic pain in the first trimester is nonspecific, with causes including pregnancy complications, pregnancy loss, and abnormal implantation, and symptom severity ranges from mild to catastrophic. Ultrasonography is the imaging modality of choice and essential to evaluate for the location of pregnancy, either intrauterine or not. If there is an intrauterine pregnancy, ultrasonography helps assess viability. If there is not an intrauterine pregnancy, ultrasonography helps assess for abnormal implantation, which accounts for a high percentage of maternal morbidity and mortality.
Assuntos
Dor Aguda/diagnóstico por imagem , Dor Pélvica/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Diagnóstico Diferencial , Feminino , Humanos , GravidezRESUMO
Abdominal pain is a common occurrence in pregnant women and may have a variety of causes, including those that are specific to pregnancy (eg, round ligament pain in the first trimester) and the wide range of causes of abdominal pain that affect men and women who are not pregnant (eg, appendicitis, acute cholecystitis). Noncontrast magnetic resonance (MR) imaging is increasingly performed to evaluate pregnant women with abdominal pain, either as the first-line test or as a second test following ultrasonography. The imaging appearance of causes of abdominal pain in pregnant women are reviewed with an emphasis on noncontrast MR imaging.
Assuntos
Abdome Agudo/diagnóstico por imagem , Dor Aguda/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Pelve/diagnóstico por imagem , GravidezRESUMO
Characterizing a reliable, pain-related neural signature is critical for translational applications. Many prior fMRI studies have examined acute nociceptive pain-related brain activation in healthy participants. However, synthesizing these data to identify convergent patterns of activation can be challenging due to the heterogeneity of experimental designs and samples. To address this challenge, we conducted a comprehensive meta-analysis of fMRI studies of stimulus-induced pain in healthy participants. Following pre-registration, two independent reviewers evaluated 4,927 abstracts returned from a search of 8 databases, with 222 fMRI experiments meeting inclusion criteria. We analyzed these experiments using Activation Likelihood Estimation with rigorous type I error control (voxel height p < 0.001, cluster p < 0.05 FWE-corrected) and found a convergent, largely bilateral pattern of pain-related activation in the secondary somatosensory cortex, insula, midcingulate cortex, and thalamus. Notably, these regions were consistently recruited regardless of stimulation technique, location of induction, and participant sex. These findings suggest a highly-conserved core set of pain-related brain areas, encouraging applications as a biomarker for novel therapeutics targeting acute nociceptive pain.
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Dor Aguda/fisiopatologia , Mapeamento Encefálico , Giro do Cíngulo/fisiopatologia , Imageamento por Ressonância Magnética , Nociceptividade/fisiologia , Córtex Somatossensorial/fisiopatologia , Tálamo/fisiopatologia , Dor Aguda/diagnóstico por imagem , Giro do Cíngulo/diagnóstico por imagem , Humanos , Córtex Somatossensorial/diagnóstico por imagem , Tálamo/diagnóstico por imagemAssuntos
Dor Aguda/diagnóstico por imagem , Artralgia/diagnóstico por imagem , Diagnóstico por Imagem/normas , Fraturas do Quadril/diagnóstico por imagem , Acidentes por Quedas , Dor Aguda/etiologia , Artralgia/etiologia , Humanos , Ortopedia/normas , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
For the purpose of assessing the impact of ultrasound in patients with acute shoulder pain, we conducted an analysis of quality health care indicators: need for reevaluation of the pain, rate of referral to specialized medicine and length of time in the emergency department. We reviewed the 1,433 records of patients attended to between 2015 and 2016. Thirty days after the first examination, 90 patients (10.1%) had returned to the control group (56 through the emergency department and 34 because of the), whereas, in the ultrasound (US) group, 14 (2.5%) had returned at least once (12 through the emergency department and 2 because of the PCC) (P<.001). The rate of referral to specialized medicine in the control group was 36.5%, whereas in the US group it was 6.21% (P<.0001). The average length of stay was 94.5 (standard deviation [SD] 34.3) minutes in the control group and 105.4 (SD 40.1) minutes in the US group (P<.0001). Our results suggest that the practice of shoulder ultrasound improves health care quality in these patients, at the cost of a slight increase in health care time.