Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.438
Filtrar
1.
Urol Clin North Am ; 48(1): 25-33, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218591

RESUMO

"Approximately 1 million prostate biopsies are performed each year in the United States. This procedure has traditionally been performed using a transrectal approach, which is associated with a significant risk of infectious complications including sepsis. In recent years, transperineal prostate biopsy has been increasingly adopted due to its lower associated infectious risk. In this review, we explore the benefits of the transperineal approach for performing prostate biopsy and detail technical advancements that have allowed for this procedure to now be routinely performed in the outpatient settings under local anesthesia."


Assuntos
Biópsia/métodos , Biópsia Guiada por Imagem/métodos , Próstata/patologia , Neoplasias da Próstata/patologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Biópsia/efeitos adversos , Biópsia/tendências , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/tendências , Imagem por Ressonância Magnética , Masculino , Períneo/cirurgia , Próstata/cirurgia , Neoplasias da Próstata/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Ultrassonografia
2.
J Vasc Interv Radiol ; 31(12): 2106-2112, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33023806

RESUMO

This study aimed to better define the safety and efficacy of transjugular renal biopsy (TJRB) based on published studies. Seventeen published articles were included (1,321 biopsies). Complications were classified as major if they resulted in blood transfusion or additional invasive procedures. All other bleeding complications were considered minor. Diagnostic tissue was obtained in 1,193 procedures (90.3%). The total incidence of bleeding complications among 15 articles with complete data was 202 of 892 procedures (22.6%): 162 (18.2%) minor and 40 (4.5 %) major. These results show that TJRB is a feasible procedure for obtaining renal tissue for diagnosis and that most complications are self-limiting.


Assuntos
Biópsia , Nefropatias/patologia , Rim/patologia , Biópsia/efeitos adversos , Feminino , Hemorragia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco
3.
Rev Mal Respir ; 37(8): 662-665, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32863066

RESUMO

INTRODUCTION: Cerebral air embolism is a rare complication of flexible fiberoptic bronchoscopy. It is a serious, life-threatening complication. The treatment consists of hyperbaric oxygen therapy. CASE REPORT: We report the case of cerebral air embolism that occurred in an 80-year-old woman after a flexible bronchial fibroscopy with bronchial spur biopsies. The patient showed neurological signs after the procedure. The brain CT-scan found disseminated air emboli. The progress was fatal in the absence of specific treatment, taking account of the context, the patient's comorbidities and the wishes of the family. CONCLUSIONS: Cerebral air embolism is a serious complication that can occur during a bronchial biopsy even though this complication is rare.


Assuntos
Broncoscopia/efeitos adversos , Transtornos Cerebrovasculares/etiologia , Embolia Aérea/etiologia , Idoso de 80 Anos ou mais , Biópsia/efeitos adversos , Biópsia/instrumentação , Biópsia/métodos , Brônquios/patologia , Broncoscópios/efeitos adversos , Broncoscopia/instrumentação , Broncoscopia/métodos , Transtornos Cerebrovasculares/diagnóstico , Embolia Aérea/diagnóstico , Desenho de Equipamento , Evolução Fatal , Feminino , Humanos
4.
PLoS One ; 15(9): e0239114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956379

RESUMO

BACKGROUND: In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES: We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD: Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS: Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS: Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02464592.


Assuntos
Broncoscopia/instrumentação , Criocirurgia/instrumentação , Fluoroscopia/instrumentação , Doenças Pulmonares Intersticiais/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Idoso , Biópsia/efeitos adversos , Biópsia/instrumentação , Biópsia/métodos , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos
5.
Int J Clin Oncol ; 25(12): 2107-2114, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32770439

RESUMO

BACKGROUND: Patients with favorable-risk prostate cancer on active surveillance (AS) are strictly followed for safer execution. Repeat protocol biopsy is essential for evaluating cancer aggressiveness. However, the acceptance rate of repeat biopsy is not high enough because of the burdens of biopsy. We assessed the impact of complications after the initial biopsy on repeat protocol biopsy at 1 year using data from the Prostate Cancer Research International: Active Surveillance (PRIAS)-JAPAN study. METHODS: We performed a retrospective analysis using a prospective cohort in the PRIAS-JAPAN study. Patients with favorable-risk prostate cancer (n = 856) who consented to participate in the PRIAS-JAPAN study from 2010 to 2018 were enrolled. Follow-up evaluations included regular prostate-specific antigen, digital rectal examination and biopsy. Rates of complications after biopsies and repeat protocol biopsy non-acceptance rate at 1 year were reported. Logistic regression analysis explored the association between the complications after the initial biopsy and repeat protocol biopsy non-acceptance. RESULTS: Altogether, 759 patients (88.7%) actually proceeded to protocol at 1 year. Repeat protocol biopsy non-acceptance rate at 1 year was 14.9%. Regarding complications after the initial biopsy, hematuria (p = 0.028) and pain (p < 0.001) rates were significantly higher in the repeat biopsy non-acceptance group, but infection (p = 0.056) and hematospermia (p = 0.337) rates were not different. On multivariate logistic regression analysis, pain was a significant predictor for repeat protocol biopsy non-acceptance (odds ratio 4.68, 95% confidence interval 1.864-11.75; p = 0.001). CONCLUSIONS: Pain at the initial biopsy negatively impacts patients' compliance with further protocol biopsies during AS.


Assuntos
Biópsia/efeitos adversos , Biópsia/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias da Próstata/patologia , Idoso , Antibioticoprofilaxia , Humanos , Japão , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Estudos Retrospectivos , Conduta Expectante/métodos
6.
World Neurosurg ; 141: 157-161, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32526365

RESUMO

BACKGROUND: When Belgium's coronavirus disease 2019 (COVID-19) outbreak began in March 2020, our neurosurgical department followed the protocol of most surgical departments in the world and postponed elective surgery. However, patients with tumor-like brain lesions requiring urgent surgery still received treatment as usual, in order to ensure ongoing neurooncologic care. From a series of 31 patients admitted for brain surgery, 3 were confirmed as infected by the novel severe acute respiratory syndrome coronavirus 2. CASE DESCRIPTION: We present the clinical outcomes of these 3 COVID-19 patients, who underwent an intracerebral biopsy in our department during April 2020. All suffered from a diffuse intraparenchymal hemorrhage postoperatively. Unfortunately, we were not able to identify a clear etiology of these postoperative complications. It could be hypothesized that an active COVID-19 infection status may be related to a higher bleeding risk. The remaining 28 neurooncologic non-COVID-19 patients underwent uneventful surgery during the same period. CONCLUSIONS: This case series reports the previously unreported and unexpected outcomes of COVID-19 patients suffering from acute hemorrhage after intracerebral biopsy procedures. Although no direct relation can yet be established, we recommend the neurosurgical community be cautious in such cases.


Assuntos
Biópsia/efeitos adversos , Infecções por Coronavirus/complicações , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/terapia , Pneumonia Viral/complicações , Idoso , Neoplasias Encefálicas/cirurgia , Epilepsia/cirurgia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pandemias , Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/terapia , Resultado do Tratamento
8.
Ann Thorac Surg ; 110(5): 1726-1729, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32504602

RESUMO

BACKGROUND: Most mediastinal biopsy patients are managed with an overnight inpatient stay and chest drainage. We sought to determine the safety, accuracy, and cost of outpatient thoracoscopic mediastinal biopsy by reviewing operative techniques, perioperative outcomes, and admission charges for this procedure. METHODS: This single-institution retrospective study reviewed all patients who underwent elective thoracoscopic mediastinal biopsy between 2012 and 2017. Patients were assigned to outpatient or inpatient management preoperatively based on surgeon judgment and preference. The procedures were performed in the supine or lateral decubitus position using ports only. Patients discharged on postoperative day 0 (outpatient) were compared with those discharged on postoperative day 1 or greater (inpatient). RESULTS: A total of 46 patients were included. Thirty-one patients were outpatients, and 15 were admitted. The outpatient cohort was younger than the inpatient group (48 years of age vs 66 years of age; P = .001). There was no statistically significant difference in other baseline characteristics. The operative time was longer (P = .001) and the total charges were higher (P = .003) in the inpatient cohort. One patient in each group had a nondiagnostic procedure. One patient in the outpatient group returned to the emergency department for pain but was discharged. There were no complications. CONCLUSIONS: Outpatient thoracoscopic mediastinal biopsy is a safe and effective procedure that has lower charges compared with inpatient management and should be considered for patients undergoing this procedure.


Assuntos
Biópsia , Mediastino/patologia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/efeitos adversos , Biópsia/economia , Análise Custo-Benefício , Secções Congeladas , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Retrospectivos
9.
Clin Imaging ; 67: 62-67, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32526659

RESUMO

PURPOSE: Skull base osteomyelitis (SBO) is difficult to diagnose due to a wide array of clinical presentations. It can be life threatening if not treated promptly. The objective of this study is to identify the various neck spaces involved in skull base osteomyelitis, correlate them with the possible source of infection and identify the related complications. METHODS: Eighty nine consecutive either culture proven cases of skull base osteomyelitis, or culture negative cases with inflammation on histopathology responding to antibiotic therapy, presenting at a single non-government hospital in south India between January 2016 and December 2018 were included in this study. Images were reviewed by two radiologists and imaging findings were documented by consensus. RESULTS: Involvement of the parotid space, retromastoid space and (temporomandibular) TM joint was associated with otogenic source of infection (p value < 0.05); while, retropharyngeal/prevertebral involvement was associated with sphenoid and nasopharyngeal sources (p value < 0.05). Complications such as cavernous sinus thrombosis (p value = 0.023) and ICA involvement (p value = 0.014) were more commonly seen with central skull base osteomyelitis. Abscess formation was seen in all three groups of patients without a significant difference between the groups. CONCLUSION: Imaging plays an important role in determining the possible source of infection by identifying the involved neck spaces and this in turn can guide the clinician to a site for biopsy. Complications related to SBO can also be identified on imaging and can guide appropriate management.


Assuntos
Osteomielite/diagnóstico por imagem , Base do Crânio/diagnóstico por imagem , Antibacterianos/uso terapêutico , Biópsia/efeitos adversos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nasofaringe , Osteomielite/diagnóstico , Base do Crânio/patologia
10.
Diagn Interv Imaging ; 101(6): 347-353, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32360351

RESUMO

The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.


Assuntos
Betacoronavirus , Institutos de Câncer/organização & administração , Infecções por Coronavirus/epidemiologia , Neoplasias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Aerossóis , Fatores Etários , Anestesia Geral , Anestesiologia/estatística & dados numéricos , Biópsia/efeitos adversos , Biópsia/métodos , Carcinoma Hepatocelular/terapia , Carcinoma de Células Renais/terapia , Quimioembolização Terapêutica/métodos , Técnicas de Laboratório Clínico/métodos , Neoplasias do Colo/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Bases de Dados Factuais , Pessoal de Saúde/estatística & dados numéricos , Recursos em Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Número de Leitos em Hospital/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Hipertermia Induzida/métodos , Neoplasias Renais/terapia , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Neoplasias/complicações , Cuidados Paliativos/métodos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Triagem
11.
Sci Rep ; 10(1): 8029, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32415191

RESUMO

Endomyocardial biopsy is a valuable tool in cardiac diagnostics but is limited by low diagnostic yield and significant complication risks. Meanwhile, recent developments in transcriptomic and proteomic technologies promise a wealth of biological data from minimal tissue samples. To take advantage of the minimal tissue amount needed for molecular analyses, we have developed a sub-millimeter endovascular biopsy device, considerably smaller than current clinical equipment, and devised a low-input RNA-sequencing protocol for analyzing small tissue samples. In in vivo evaluation in swine, 81% of biopsy attempts (n = 157) were successful. High quality RNA-sequencing data was generated from 91% of the sequenced cardiac micro-biopsy samples (n = 32). Gene expression signatures of samples taken with the novel device were comparable with a conventional device. No major complications were detected either during procedures or during 7 days' follow-up, despite acquiring a relatively large number of biopsies (median 30) in each animal. In conclusion, the novel device coupled with RNA-sequencing provides a feasible method to obtain molecular data from the myocardium. The method is less traumatic and has a higher flexibility compared to conventional methods, enabling safer and more targeted sampling from different parts of the myocardium.


Assuntos
Biópsia/métodos , Miocárdio/metabolismo , Miocárdio/patologia , Animais , Biópsia/efeitos adversos , Biópsia/instrumentação , Biópsia/normas , Cateterismo Cardíaco , Biologia Computacional/métodos , Modelos Animais de Doenças , Imunofluorescência , Perfilação da Expressão Gênica , Ontologia Genética , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/prevenção & controle , Imuno-Histoquímica , Anotação de Sequência Molecular , Suínos
12.
J Pediatr ; 223: 87-92.e1, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32381465

RESUMO

OBJECTIVE: To study the optimal cut-off value for anti-tissue transglutaminase type 2 IgA antibodies (TG2A) in serum to select for diagnostic small bowel biopsies for celiac disease in children with type 1 diabetes mellitus. STUDY DESIGN: Children with type 1 diabetes mellitus with elevated TG2A titers and duodenal biopsies performed during the course of their diabetes treatment were included. Anti-endomysial antibodies were recorded if present. The optimal TG2A cut-off value, expressed as the ratio between obtained value and upper limit of normal (ULN), was determined using receiver operating characteristic curve analysis and compared with the cut-off value used in the European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in terms of sensitivity, specificity, positive and negative predictive value. RESULTS: We included 63 children. The optimal cut-off value for performing biopsies is demonstrated to be 11 times the ULN. Raising the cut-off value from 3 times the ULN to 11 times the ULN changed sensitivity from 96% to 87% and increased specificity from 36% to 73%, increased the positive predictive value from 88% to 94% and lowered negative predictive value from 67% to 53%. The percentage of normal histology was decreased from 12% to 6%. CONCLUSIONS: Increasing the TG2A cut-off value for performing duodenal biopsies in children with type 1 diabetes mellitus and suspected celiac disease leads to a substantial reduction of unnecessary biopsies. We advocate to adapt the European Society for Pediatric Gastroenterology, Hepatology and Nutrition 2012 guidelines for this group of children, including monitoring patients with TG2A levels of less than 11 times the ULN over time.


Assuntos
Doença Celíaca/diagnóstico , Diabetes Mellitus Tipo 1/complicações , Proteínas de Ligação ao GTP/sangue , Transglutaminases/sangue , Adolescente , Anticorpos , Biópsia/efeitos adversos , Doença Celíaca/sangue , Doença Celíaca/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Intestino Delgado/imunologia , Masculino , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Procedimentos Desnecessários
13.
Respir Med ; 165: 105934, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308202

RESUMO

Transbronchial lung cryobiopsy (TBLC) is an emerging technique for the diagnosis of interstitial lung disease (ILD), but its risk benefit ratio has been questioned. The objectives of this research were to describe any adverse events that occur within 90 days following TBLC and to identify clinical predictors that could help to detect the population at risk. METHODS: We conducted an ambispective study including all patients with suspected ILD who underwent TBLC. Data were collected concerning the safety profile of this procedure and compared to various clinical variables. RESULTS: Overall, 257 TBLCs were analysed. Complications were observed in 15.2% of patients; nonetheless, only 5.4% of all patients required hospital admission on the day of the procedure. In the 30 and 90 days following the TBLC, rates of readmission were 1.3% and 3.5% and of mortality were 0.38%, and 0.78% respectively. Two models were built to predict early admission (AUC 0.72; 95% CI 0.59-0.84) and overall admission (AUC 0.76; 95% CI 0.67-0.85). CONCLUSIONS: Within 90 days after TBLC, 8.9% of patients suffered a complication serious enough to warrant hospital admission. Modified MRC dyspnoea score ≥2, FVC<50%, and a Charlson Comorbidity Index score ≥2 were factors that predicted early and overall admission.


Assuntos
Biópsia/efeitos adversos , Biópsia/métodos , Congelamento/efeitos adversos , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/patologia , Pulmão/patologia , Idoso , Biópsia/mortalidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Fatores de Tempo
14.
Transplant Proc ; 52(5): 1601-1604, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32224013

RESUMO

Transbronchial biopsy (TBB) using standard forceps is the main procedure to establish the presence of lung allograft rejection (AR) after lung transplantation. Few studies report the use of the transbronchial cryobiopsy (TCB) as a scheduled procedure for surveillance purposes in lung allograft, despite this the technique yields larger biopsies. We aimed to analyze the diagnostic yield and potential complications of TCB compared with conventional forceps biopsy for acute rejection surveillance in lung transplantation. In our center, TCBs are performed to monitor lung allografts at 3, 6, and 12 months after transplantation. From March 2018 to September 2019 TCBs were performed in 54 lung transplanted patients for surveillance purposes. Clinical and functional data, complications, and histologic results were collected. We analyzed through a retrospective study our first 75 cases of cryobiopsies for surveillance purposes in lung allograft recipients. The diagnostic rate of AR using TCB was 100% compared with 83% using conventional TBB. Also, diagnostic rate of airway inflammation and chronic rejection was 17% and 21% higher, respectively, for TCB compared with TBB. The overall major complication rate was 9%: 1 pneumothorax case required chest tube drainage and 6 moderate bleedings. Bleeding rate in the scheduled TCB group (8%) seems to be higher if compared with scheduled TBB group (1%). TCB seems to be safe and effective for diagnosis of lung AR compared with transbronchial conventional forceps biopsy.


Assuntos
Biópsia/efeitos adversos , Rejeição de Enxerto/patologia , Transplante de Pulmão , Complicações Pós-Operatórias/epidemiologia , Adulto , Aloenxertos , Biópsia/métodos , Feminino , Rejeição de Enxerto/epidemiologia , Hemorragia/patologia , Humanos , Inflamação/patologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Estudos Retrospectivos
15.
J Minim Invasive Gynecol ; 27(5): 1127-1132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240839

RESUMO

STUDY OBJECTIVE: To develop a new hysteroscopic morphologic scoring system to diagnose chronic endometritis (CE). DESIGN: Prospective study. SETTING: Medical hysteroscopy office. PATIENTS: In total, 320 patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies from February 2017 to June 2018 with the intention of undergoing assisted reproductive technology treatment because of infertility or recurrent miscarriage. INTERVENTIONS: All patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies for histologic examination and were classified according to the new hysteroscopic morphologic scoring system. MEASUREMENTS AND MAIN RESULTS: Of the 320 patients, 164 received a diagnosis of CE by histology (group A), whereas 156 patients were found not to have CE (group B). A total of 116 patients were diagnosed by our hysteroscopy scoring system to have CE, and 204 patients did not have CE. The scoring system showed a sensitivity and specificity of 62.8% and 91.7%, respectively. The positive predictive values and negative predictive values were 88.8% and 70.1%, respectively. Receiver operating characteristic analysis showed a cutoff value of >2 and an area under the curve of 0.823. Hysteroscopic and histologic grading showed moderate agreement (κ index = 0.529). CONCLUSION: Our hysteroscopic scoring system has a high sensitivity and specificity for CE; it is hoped that its use can reduce interobserver variability. Future clinical studies are warranted to confirm the validity and clinical applicability of the proposed hysteroscopic morphologic scoring system for CE.


Assuntos
Endometrite/diagnóstico , Histeroscopia/métodos , Aborto Habitual/diagnóstico , Aborto Habitual/epidemiologia , Aborto Habitual/etiologia , Aborto Habitual/patologia , Adulto , Biópsia/efeitos adversos , Doença Crônica , Endometrite/complicações , Endometrite/epidemiologia , Endometrite/patologia , Endométrio/metabolismo , Endométrio/patologia , Feminino , Humanos , Imuno-Histoquímica , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Infertilidade Feminina/patologia , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Projetos de Pesquisa , Sensibilidade e Especificidade , Sindecana-1/análise , Sindecana-1/metabolismo , Adulto Jovem
17.
Acta Radiol ; 61(12): 1717-1723, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32212828

RESUMO

BACKGROUND: Renal transplant biopsies are essential in nephrology; however, they are invasive and complications can occur. PURPOSE: To explore the risk of transplant kidney biopsy (TxB) complications in relation to possible preventive effects of desmopressin prophylaxis. MATERIAL AND METHODS: A total of 515 consecutive TxB (375 patients, median age 53 years) were analyzed. In 252 TxB, the Resistive Index (RI) was measured right before the biopsy. A total of 282 patients had serum creatinine >150 µmol/L. In one of the six hospitals 39/282 patients consecutively received desmopressin (dose 0.3 µg/kg subcutaneously) as prophylaxis within 1 h before the biopsy. Fisher's exact and χ2 test were used (odds ratio [OR], 95% confidence interval [CI]). Univariate and multiple binary logistic regression analyses were performed. A two-sided P value <0.05 was considered significant. RESULTS: RI ≥ 0.8 was a risk factor for major TxB complications (OR 4.2, 95% CI 1.13-15.76). The risk for minor complications decreased with mean arterial blood pressure (MAP) (97.9 vs. 89.5 mmHg, OR 0.97, 95% CI 0.95-0.997). In a multiple regression analysis for overall biopsy complications, the risk remained increased for patients with RI ≥ 0.8 (OR 4.45, 95% CI 1.32-15.04). No patients (0/39) with desmopressin prophylaxis had a major complication versus 8/243 in the other group. In patients with serum creatinine >150 µmol/L, those with a higher MAP had more overall TxB complications (104.5 vs. 98.2 mmHg, OR 1.05, 95% CI 1.004-1.1). CONCLUSION: RI ≥ 0.8 was a risk factor for major and overall complications and a lower MAP for minor biopsy complications. Desmopressin prophylaxis showed yet no verified benefit as prophylaxis in TxB.


Assuntos
Biópsia/efeitos adversos , Desamino Arginina Vasopressina/uso terapêutico , Hemostáticos/uso terapêutico , Transplante de Rim , Hemorragia Pós-Operatória/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Fatores de Risco
18.
BJU Int ; 126(1): 97-103, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32124525

RESUMO

OBJECTIVES: To assess the complications of transrectal (TR) compared to transperineal prostate (TP) biopsies. PATIENTS AND METHODS: Men diagnosed with prostate cancer between 1 April 2014 and 31 March 2017 in England were identified in the National Prostate Cancer Audit. Administrative hospital data were then used to categorize the type of prostate biopsy and subsequent complications requiring hospital admission. Administrative hospital data were used to identify patients staying overnight immediately after biopsy and those readmitted separately for hospital admissions because of sepsis, urinary retention or haematuria. Procedure-related mortality and total length of hospital stay within 30 days were also recorded. Generalized linear models were used to calculate adjusted risk differences (aRDs). RESULTS: A total of 73 630 patients undergoing prostate biopsy were identified. Those undergoing TP biopsy (n = 13 723) were more likely to have an overnight hospital stay (12.3% vs 2.4%; aRD 9.7%, 95% confidence interval [CI] 7.1-12.3), were less likely to be readmitted because of sepsis (1.0% vs 1.4%; aRD -0.4%, CI -0.6 to -0.2), and were more likely to be readmitted with urinary retention (1.9% vs 1.0%; aRD 1.1%, CI 0.7-1.4) than those undergoing a TR biopsy (n = 59 907). There were no significant differences in the risk of haematuria or mortality. CONCLUSIONS: Our results showed that TP biopsy had a lower risk of readmission for sepsis but a higher risk of readmission for urinary retention than TR biopsy. Use of the TP route would prevent one readmission for sepsis in 278 patients at the cost of three additional patients readmitted for urinary retention.


Assuntos
Biópsia/efeitos adversos , Próstata/patologia , Neoplasias da Próstata/patologia , Sepse/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Inglaterra/epidemiologia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Períneo , Reto , Estudos Retrospectivos , Sepse/etiologia
19.
Skinmed ; 18(1): 54-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32167459

RESUMO

A 79-year-old woman presented to the emergency room with a chief complaint of headache of 1 month's duration. Her medical history consisted of hypertension, congestive heart failure, anemia, chronic kidney disease, and hyperlipidemia. She reported the headache as waxing and waning, and occurring bilaterally in the frontal and occipital regions. On examination, she was found to have mild right-sided ptosis and possible early right-sided papilledema. She was also found to have bilateral shoulder tenderness and scalp tenderness. She denied double vision, vision changes, or jaw claudication.


Assuntos
Biópsia/efeitos adversos , Traumatismos do Nervo Facial/etiologia , Paralisia Facial/etiologia , Idoso , Feminino , Cefaleia/diagnóstico , Humanos , Artérias Temporais/patologia
20.
Asian Pac J Cancer Prev ; 21(3): 771-775, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32212806

RESUMO

INTRODUCTION: Bone marrow biopsy is a common procedure for the diagnosis and treatment of hematologic diseases and tumors, which are associated with anxiety. The purpose of this study was to examine the effect of lavender aroma on anxiety of patients having bone marrow biopsy. MATERIALS AND METHODS: This study was performed on 80 patients referred to Vali-e-Asr Hospital for bone marrow biopsy. Samples were selected by convenience method and were assigned into intervention and control groups using randomized blocks of 4. Random sequence was generated by RAS software. Several drops of distilled water on a cotton ball was used in the control group and same amount of lavender essential oil on a cotton ball was used in the intervention group. Then, participants in both groups were asked to smell the cotton ball for 15 minutes and then, their anxiety level was measured immediately. The results were analyzed by SPSS software version 25 using covariance analysis and rank regression. RESULTS: The results showed that, the mean scores of anxiety in the control and intervention groups were 6.3 ± 1.92 and 3.75 ± 1.05, respectively. There was a significant difference (p <0.05) between the two groups in terms of anxiety score.The results showed that there was a significant difference in anxiety score between two groups in terms of variables such as age, gender, physician experience, biopsy history and biopsy site (P <0.05). The results also showed no significant difference between the (p >0.05). CONCLUSION: The results of this study showed that bone marrow biopsy is associated with anxiety, and smelling of lavender aroma is effective in reducing anxiety in patients undergoing this procedure. This fragrance can be used by treatment team in hematology and oncology clinics to reduce anxiety caused by bone marrow biopsy.
.


Assuntos
Ansiedade/prevenção & controle , Biópsia , Medula Óssea , Lavandula/química , Óleos Voláteis/uso terapêutico , Óleos Vegetais/uso terapêutico , Adulto , Ansiedade/etiologia , Aromaterapia , Biópsia/efeitos adversos , Medula Óssea/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Odorantes
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA