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1.
BMJ Case Rep ; 14(5)2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33958366

RESUMO

A 49-year-old man presented with new onset headache and diplopia, with right ptosis and limitation of extraocular movements consistent with a third nerve palsy. He had a known diagnosis of a non-functioning pituitary adenoma, and his presentation and neuroimaging were consistent with ischaemic pituitary apoplexy. The patient was otherwise stable with no signs of optic neuropathy or endocrine abnormality. He was observed with close interval follow-up and reported resolution of symptoms within 4 days after onset. Pituitary apoplexy is a potentially life-threatening condition often managed with initial medical stabilisation followed by neurosurgical decompression. The guidelines regarding the utility of surgery in patients with isolated ocular motility disorders are unclear, and recent retrospective studies suggested that outcomes may be similar in patients managed conservatively. This case demonstrates that rapid resolution of an isolated third nerve palsy may occur in this setting, and that observation is a reasonable initial management strategy.


Assuntos
Adenoma , Doenças do Nervo Oculomotor , Apoplexia Hipofisária , Neoplasias Hipofisárias , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/etiologia , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem , Estudos Retrospectivos
2.
Eur J Endocrinol ; 185(1): 109-120, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-33886494

RESUMO

Background: Primary hyperparathyroidism is characterized by an autonomous hypersecretion of parathyroid hormone by one or more parathyroid glands. Preoperative localization of the affected gland(s) is of key importance in order to allow minimally invasive surgery. At the moment, 11C-Methionine and 18F-Fluorocholine PET studies appear to be among the most promising second-line localization techniques; their comparative diagnostic performance, however, is still unknown. Methods: PubMed/Medline and Embase databases were searched up to October 2020 for studies estimating the diagnostic accuracy of 11C-Methionine PET or 18F-Fluorocholine PET for parathyroid localization in patients with primary hyperparathyroidism. Pooled sensitivity and positive predictive value were calculated for each tracer on a 'per-lesion' basis and compared using a random-effect model subgroup analysis. Results: In total, 22Twenty-two studies were finally considered in the meta-analysis. Of these, 8 evaluated the diagnostic accuracy of 11C-Methionine and 14 that of 18F-Fluorocholine. No study directly comparing the two tracers was found. The pooled sensitivity of 18F-Fluorocholine was higher than that of 11C-Methionine (92% vs 80%, P < 0.01), while the positive predictive value was similar (94% vs 95%, P = 0.99). These findings were confirmed in multivariable meta-regression models, demonstrating their apparent independence from other possible predictors or confounders at a study level. Conclusion: This was the first meta-analysis that specifically compared the diagnostic accuracy of 11C-Methionine and 18F-Fluorocholine PET for parathyroid localization in patients with primary hyperparathyroidism. Our results suggested a superior performance of 18F-Fluorocholine in terms of sensitivity, while the two tracers had comparable accuracy in terms of positive predictive value.


Assuntos
Adenoma/diagnóstico por imagem , Colina/análogos & derivados , Hiperparatireoidismo Primário/diagnóstico por imagem , Metionina , Neoplasias das Paratireoides/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Adenoma/cirurgia , Radioisótopos de Carbono , Radioisótopos de Flúor , Humanos , Hiperparatireoidismo Primário/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Cuidados Pré-Operatórios
3.
Clin Nucl Med ; 46(6): 497-498, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33826572

RESUMO

ABSTRACT: Hyperparathyroidism-jaw-tumor syndrome (HPT-JTS) is a rare autosomal dominant disorder. A typical manifestation of HPT-JTS is the association of jaw-ossifying fibroma with primary hyperparathyroidism. Due to its rarity and diversity in its manifestations, it is a challenging diagnosis. A 33-year-old woman was referred due to painful swelling of the right maxilla suggestive of malignancy. The clinical presentations were not conclusive until she underwent F18-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT). F18-FDG PET/CT proved to be a useful tool to assist the clinicians in visualizing the "bigger picture" and, therefore all manifestation as pieces of "one puzzle."


Assuntos
Adenoma/diagnóstico por imagem , Fibroma/diagnóstico por imagem , Fluordesoxiglucose F18 , Hiperparatireoidismo/diagnóstico por imagem , Neoplasias Maxilomandibulares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adenoma/patologia , Adulto , Feminino , Fibroma/patologia , Humanos , Hiperparatireoidismo/patologia , Neoplasias Maxilomandibulares/patologia
4.
BMJ Case Rep ; 14(4)2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33837034

RESUMO

Giant parathyroid adenomas are rare and underreported benign tumours of parathyroid gland. Preoperative differentiation between giant parathyroid adenoma (GPA) and parathyroid carcinoma can be challenging, as they both may present as a large parathyroid tumour with hyperparathyroidism. Very few GPAs had been described in the literature, with only 60 cases including our present case. We report a case of GPA and the preoperative diagnostic challenges we faced in differential diagnosis of a potential parathyroid malignancy. As a parathyroid malignancy could not be excluded preoperatively the parathyroid tumour was excised en bloc with surrounding thyroid lobe. The histology was contributory to exclude parathyroid malignancy confirming a benign GPA.


Assuntos
Adenoma , Hiperparatireoidismo , Neoplasias das Paratireoides , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Humanos , Hiperparatireoidismo/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia
7.
Clin Nucl Med ; 46(6): 505-506, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33782291

RESUMO

ABSTRACT: In addition to gastroenteropancreatic neuroendocrine neoplasms, a wide variety of tumors express somatostatin receptors. Somatostatin receptor imaging, heavily utilized in neuroendocrine oncology, may also have utility in the diagnosis of other neoplasms and raises the possibility of potential therapeutic options. We describe the case of a 60-year-old man who underwent 68Ga-DOTATATE PET/CT, demonstrating an avid invasive pituitary macroadenoma. This mass was persistent and refractory despite traditional treatment options. Because of the avidity, 177Lu-DOTATATE therapy was offered, although not ultimately performed, demonstrating a potential treatment for challenging cases utilizing the principles of theranostics.


Assuntos
Adenoma/diagnóstico por imagem , Adenoma/patologia , Órbita/diagnóstico por imagem , Compostos Organometálicos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adenoma/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/análogos & derivados , Octreotida/uso terapêutico , Compostos Organometálicos/uso terapêutico , Neoplasias Hipofisárias/radioterapia , Falha de Tratamento
8.
South Med J ; 114(4): 199-206, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33787931

RESUMO

OBJECTIVES: Endoscopic mucosal resection (EMR) is an alternative to surgery for the treatment of large laterally spreading lesions. Residual or recurrent adenoma is a major limitation. This study aimed to quantify early and late recurrences and to assess its associated risk factors. METHODS: The study was a single-center, multiendoscopist, longitudinal study conducted between January 1, 2013 and April 26, 2017. A total of 480 patients with 500 polyps who underwent an endoscopic resection were included. Surveillance colonoscopy (SC) was performed at 4 to 6 months (SC1) and 16 to 18 months (SC2). RESULTS: At SC1, early recurrence was noted in 77 of 354 (21.8%) lesions; 76 (98.7%) were treated endoscopically. The remaining 277 of 354 (78.2%) lesions had no recurrence at SC1; only 41 lesions (15%) were followed up at SC2. Recurrence at SC2 was found in 4 lesions (9.8%), all of which were treated endoscopically. Lesion size >40 mm was associated with recurrence. Recurrence at both SC1 and SC2 was successfully treated endoscopically in 78 of 81 lesions (96.3%). CONCLUSIONS: EMR is an effective, minimally invasive technique for the treatment of large laterally spreading lesions. Although recurrence is a concern, its risk is low (21.8% on SC1 and 9.8% on SC2) and was managed endoscopically in 96.3% cases on follow-up endoscopy.


Assuntos
Adenoma/cirurgia , Neoplasias do Colo/cirurgia , Pólipos do Colo/cirurgia , Ressecção Endoscópica de Mucosa , Recidiva Local de Neoplasia/epidemiologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/patologia , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/patologia , Colonoscopia , Ressecção Endoscópica de Mucosa/métodos , Feminino , Seguimentos , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/etiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
BMJ Case Rep ; 14(3)2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692064

RESUMO

A 68-year-old Chinese man was found to have a lobular mass in the sphenoid sinus which extended to the clivus and the roof of the nasopharynx on a staging MRI scan performed for his high-grade parotid salivary duct carcinoma. Further positron emission tomography scan showed that this lesion was fluorodeoxyglucose (FDG) avid. This proved to be a diagnostic dilemma. The patient underwent a total parotidectomy, left selective neck dissection and a transphenoidal biopsy of his nasal lesion. Final histology revealed that this lesion was a synchronous ectopic sphenoid sinus pituitary adenoma (ESSPA). Initial differential diagnoses that were considered included a chordoma, metastatic carcinoma and nasopharyngeal carcinoma. However, an important differential with a neoplastic appearance and a tendency for positive FDG uptake is an ESSPA. It requires dedicated immunohistochemical staining to diagnose, and its mainstay of treatment is surgical excision.


Assuntos
Adenoma , Neoplasias dos Seios Paranasais , Neoplasias Hipofisárias , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/cirurgia , Seio Esfenoidal/diagnóstico por imagem
10.
Am J Case Rep ; 22: e929788, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33654049

RESUMO

BACKGROUND The World Health Organization classification of premalignant gallbladder lesions includes adenomas, intraductal papillary neoplasms, biliary intraepithelial neoplasia, and intracystic papillary neoplasms. Noninvasive neoplastic lesions >1 cm that originate from the pancreatobiliary system are defined as intraductal papillary neoplasia when they occur in the biliary ducts. The clinical and pathological features of preinvasive lesions arising in the gallbladder are not yet well defined. However, the most widely accepted classification is that of intracholecystic papillary neoplasm (ICPN). CASE REPORT We present the case of a 71-year-old woman referred to a General Surgery outpatient clinic for suspicious findings on imaging of the gallbladder, namely irregular infundibular parietal thickening. The patient underwent a laparoscopic cholecystectomy and histological examination revealed a thickened gallbladder with mucosa partially surrounded by ICPN with an intestinal pattern and some foci of low-grade dysplasia but no foci of high-grade dysplasia or invasive neoplasia. At follow-up at 30 months, the patient remains clinically well, with no changes visible on computed tomography scan. CONCLUSIONS ICPN of the gallbladder appears to be part of a spectrum of alterations encompassing bile duct or pancreatic lesions. Although it is uncommon, more than half of the lesions are known to have foci of invasive neoplasia at the time of diagnosis. Despite that, the prognosis for these neoplasms is more favorable than for gallbladder neoplasia that originates from another type of lesion. Pathological study of ICPN is essential to define the main characteristics that impact prognosis and survival in these patients.


Assuntos
Adenoma , Neoplasias dos Ductos Biliares , Carcinoma in Situ , Neoplasias da Vesícula Biliar , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/cirurgia , Humanos
11.
J Clin Neurosci ; 86: 252-259, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33775337

RESUMO

Significant restoration of visual function can occur following pituitary tumor resection, although the time course of visual recovery remains poorly understood. This single-centre, two-year, prospective cohort study investigated the temporal patterns of visual recovery in consecutive patients undergoing pituitary tumor resection, between 2009 and 2018. Eyes were stratified based on pre-operative optical coherence tomography (OCT) retinal nerve fibre layer (RNFL) thickness measurements, with thin RNFL being defined as those within the fifth-percentile of age-matched normative values, and normal RNFL as those above the fifth-percentile. Visual function and OCT parameters were assessed pre-operatively, and at 6 weeks, 6 months, and 2 years post-operatively. 456 eyes of 228 patients (mean ± SD age, 53 ± 15 years) were included, of which 114 (25%) eyes had thin RNFL pre-operatively. Visual field recovery was observed in both groups during the first 6 weeks post-operatively (all Q ≤ 0.02), although improvements in visual field parameters between 6 weeks to 6 months were limited to eyes with thin RNFL (both Q < 0.05). No further improvements in visual function were detected beyond 6 months in both groups (both Q > 0.50). Similar trends were observed in linear regression analysis according to baseline visual function in both groups. In summary, eyes with normal RNFL thickness at baseline experienced most of their recovery within the first six weeks following surgery, while eyes with thin RNFL exhibited gradual improvements during the first six months. These findings have important implications when providing patient counselling and prognostication in the pre-operative setting.


Assuntos
Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Recuperação de Função Fisiológica/fisiologia , Campos Visuais/fisiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Quiasma Óptico/diagnóstico por imagem , Quiasma Óptico/cirurgia , Estudos Prospectivos , Retina/diagnóstico por imagem , Fatores de Tempo , Tomografia de Coerência Óptica/métodos , Tomografia de Coerência Óptica/tendências
13.
Turk Neurosurg ; 31(2): 238-246, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33624276

RESUMO

AIM: To analyze the effectiveness of fat and fibrin glue to prevent postoperative cerebrospinal fluid (CSF) leak in pituitary surgery. MATERIAL AND METHODS: Two hundred and eleven patients affected by pituitary adenoma entered this study. Patients that underwent a microscopic transsphenoidal approach between January 2013 and April 2019 were included. All the patients that developed intraoperative CSF leak were treated with fat and fibrin glue. The presence or absence of postoperative CSF leak was considered as a parameter to test the effectiveness of the intraoperative reconstruction technique used. RESULTS: Postoperative CSF leak was observed in 5 patients (2.4%). Among patients with an intraoperative low- grade CSF leak (1 or 2), 97.9% did not develop a postoperative CSF leak. In contrast, those who presented an intraoperative CSF leak of grade 3, had a worse prognosis. CONCLUSION: Fat and fibrin glue is currently an effective method in the treatment of low-grade intraoperative CSF leak. In case of intraoperative CSF leak of grade 3, it should be used combined with the nasoseptal flap technique to obtain a safer reconstruction.


Assuntos
Adenoma/cirurgia , Tecido Adiposo/transplante , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Adesivo Tecidual de Fibrina/administração & dosagem , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adenoma/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Adulto , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Retalhos Cirúrgicos/transplante , Transplantes/diagnóstico por imagem , Transplantes/transplante
14.
Medicina (B Aires) ; 81(1): 99-102, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33611251

RESUMO

Endoscopic fullthickness resection is a technique that allows in block resection of colonic lesions in patients in whom conventional endoscopic methods such as endoscopic mucosal resection or endoscopic submucosal dissection have failed. We present a case of a 75-year-old man with history of a difficult-to-resect colon adenoma. He had undergone two previous failed attempts of endoscopic mucosal resection due to non-lifting sign in another center. We successfully performed an endoscopic full-thickness resection procedure, avoiding unnecessary surgery.


Assuntos
Adenoma , Neoplasias do Colo , Ressecção Endoscópica de Mucosa , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Neoplasias do Colo/cirurgia , Fibrose , Humanos , Masculino , Resultado do Tratamento
15.
BMC Surg ; 21(1): 58, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485359

RESUMO

BACKGROUND: Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. METHODS: The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. RESULTS: The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). CONCLUSIONS: Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.


Assuntos
Adenoma , Hipófise , Neoplasias Hipofisárias , Base do Crânio , Cirurgia Assistida por Computador , Cirurgia Endoscópica Transanal , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Idoso , Feminino , Humanos , Imageamento Tridimensional , Período Intraoperatório , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuronavegação/métodos , Projetos Piloto , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Cirurgia Endoscópica Transanal/métodos
16.
PLoS One ; 16(1): e0245211, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33481809

RESUMO

Risk stratification by index colonoscopy is well established for first surveillance endoscopy, but whether the previous two colonoscopies affect the subsequent advanced neoplasias has not been established. Therefore, the subsequent risk based on the findings of the index and first surveillance colonoscopies were investigated. This retrospective, cohort study was conducted in two clinics and included participants who had undergone two or more colonoscopies after index colonoscopy. High-risk was defined as advanced adenoma (≥ 1 cm, or tubulovillous or villous histology, or high-grade dysplasia). Based on the findings of the index and first surveillance colonoscopies, patients were classified into four categories: category A (both colonoscopy findings were normal), category B (no high-risk findings both times), category C (one time high-risk finding), and category D (high-risk findings both times). The incidence of subsequent advanced neoplasia was examined in each category. A total of 13,426 subjects were included and surveyed during the study periods. The subjects in category D had the highest risk of advanced neoplasia (27.4%, n = 32/117). The subjects in category A had the lowest risk (4.0%, n = 225/5,583). The hazard ratio for advanced neoplasia of category D compared to category A was 9.90 (95% Confidence interval 6.82-14.35, P<0.001). Classification based on the findings of index and first surveillance colonoscopies more effectively stratifies the risk of subsequent advanced neoplasia, resulting in more proper allocation of colonoscopy resources after two consecutive colonoscopies.


Assuntos
Adenoma/diagnóstico por imagem , Colonoscopia , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Adenoma/epidemiologia , Idoso , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco
17.
Medicina (Kaunas) ; 57(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33435540

RESUMO

The detection of a renal mass is a relatively frequent occurrence in the daily practice of any Radiology Department. The diagnostic approaches depend on whether the lesion is cystic or solid. Cystic lesions can be managed using the Bosniak classification, while management of solid lesions depends on whether the lesion is well-defined or infiltrative. The approach to well-defined lesions focuses mainly on the differentiation between renal cancer and benign tumors such as angiomyolipoma (AML) and oncocytoma. Differential diagnosis of infiltrative lesions is wider, including primary and secondary malignancies and inflammatory disease, and knowledge of the patient history is essential. Radiologists may establish a possible differential diagnosis based on the imaging features of the renal masses and the clinical history. The aim of this review is to present the contribution of the different imaging techniques and image guided biopsies in the diagnostic management of cystic and solid renal lesions.


Assuntos
Nefropatias/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Adenoma Oxífilo/diagnóstico por imagem , Angiomiolipoma/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células de Transição/diagnóstico por imagem , Meios de Contraste , Cistos/classificação , Cistos/diagnóstico por imagem , Humanos , Leiomioma/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Imageamento por Ressonância Magnética , Plasmocitoma/diagnóstico por imagem , Pielonefrite/diagnóstico por imagem , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Ultrassonografia Doppler em Cores
18.
Dis Colon Rectum ; 64(2): 241-247, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394769

RESUMO

BACKGROUND: Colorectal endoscopic submucosal dissection is typically performed by specialized knife, such as a dual knife. However, it is not covered by Taiwan's National Health Insurance. In the literature review, using a traditional snare tip for endoscopic submucosal dissection has been reported for stomach lesions only. OBJECTIVE: The purpose of this study was to evaluate the outcomes of colorectal endoscopic submucosal dissection using a snare tip. DESIGN: We retrospectively reviewed the clinical using of a snare tip compared with a dual knife for colorectal endoscopic submucosal dissection. Postoperative short- and long-term outcomes were investigated after the procedure. SETTINGS: This study was conducted at a single tertiary care institution. PATIENTS: Patients who could not afford the expense of a specialized knife were included. MAIN OUTCOME MEASURES: Dissection time, dissection speed, and perioperative complications were used for short-term outcome measurement. Recurrence-free rate was used for long-term outcome measurement. RESULTS: Twenty-one lesions were in the snare tip group and 57 lesions in the dual knife group. The outcomes, including rate of en bloc resection, complication, local recurrence, and recurrence-free interval, between the 2 groups were similar. The mean resected specimen diameter in the dual knife group is larger than the snare tip group (p = 0.041). The dissection time of the snare tip group was shorter than the dual knife group (p = 0.025). However, the dissection speed was significantly slower in the snare tip group than in the dual knife group (p = 0.008). LIMITATIONS: This study was a retrospective and single doctor chart review in nature with a limited patient number. CONCLUSIONS: The snare tip is an alternative tool for colorectal endoscopic submucosal dissection in a selected population without the support of specialized knives, such as the dual knife. Although the dissection speed is slower using a snare tip, it is still a recommended technique for developing country or low-income patients.


Assuntos
Adenocarcinoma/cirurgia , Adenoma/cirurgia , Pólipos do Colo/cirurgia , Colonoscopia/instrumentação , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/instrumentação , Adenocarcinoma/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Adulto , Idoso , Pólipos do Colo/diagnóstico por imagem , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico por imagem , Intervalo Livre de Doença , Ressecção Endoscópica de Mucosa/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
Ter Arkh ; 92(10): 78-82, 2020 Nov 24.
Artigo em Russo | MEDLINE | ID: mdl-33346483

RESUMO

Clinical observation of a young woman with chronic kidney disease IV stage and hyperparathyroidism is presented. Ultrasound and99mTc-sestamibi scintigraphy of the anterior surface of the neck visualized a tumor of the left upper parathyroid gland. In a histological examination of distant education was diagnosed a solid parathyroid adenoma. The difficulty of differential diagnosis between primary and secondary/tertiary hyperparathyroidism in chronic kidney disease is discussed.


Assuntos
Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Insuficiência Renal Crônica , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico por imagem , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/diagnóstico por imagem , Cintilografia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico
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