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1.
Isr Med Assoc J ; 21(8): 532-537, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474015

RESUMO

BACKGROUND: Implant-related spinal infections are a surgical complication associated with high morbidity. Due to infection, hardware removal may be necessary, which could lead to pseudarthrosis and the loss of stability and alignment. OBJECTIVES: To evaluate the accuracy and diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in the workup of patients with suspected implant-related infections of the spine and to assess the clinical impact of PET/CT results on the management of these infections. METHODS: The study included nine consecutive patients with a history of spinal surgery who underwent PET/CT for evaluation of suspected spinal implant related infection. All imaging studies were performed between January 2011 and December 2013. All 18F-FDG PET/CT scans were performed on an 8 slice PET/CT following an 18F-FDG injection. Images were scored both visually and semi-quantitatively by a radiology expert. Results were compared to additional imaging studies when available, which were correlated to clinical and bacteriological findings allowing calculation of sensitivity, specificity and accuracy. RESULTS: Among the patients, five experienced hardware-related spinal infection. 18F-FDG PET/CT sensitivity was 80%, specificity 100%, and accuracy 88.9%. One scan produced a false negative; however, a second PET/CT scan revealed an infection. CONCLUSIONS: PET/CT was found to be valuable for the diagnosis of postoperative hardware-related spinal infection, especially when other imaging modalities were uninformative or inconclusive. As such, PET/CT could be useful for management of infection treatment.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Infecções Relacionadas à Prótese/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Coluna Vertebral/patologia
2.
Pan Afr Med J ; 33: 154, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558951

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a radioclinical entity associating a reversible central nervous system involvement with a common brain imaging feature. There is a great variability in the clinical presentation of this syndrome and in the features of its sometimes atypical imaging appearance. PRES is an unusual neurological complication occurring during pregnancy or in the post-partum period, other than any pre-existing pathology occurred during pregnancy. Vasogenic edema due to the rupture of the blood-brain barrier seems to be its main cause. We here report the case of a primiparous patient with generalized tonic-clonic seizures associated with hypertensive peak occurred during the third trimester of pregnancy. Magnetic resonance imaging (MRI) of the brain showed posterior reversible encephalopathy. PRES should be suspected in patients with any sign of neurological disorder. It has a favorable outcome without sequelae under early and fast treatment.


Assuntos
Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Convulsões/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Gravidez , Terceiro Trimestre da Gravidez
3.
Vasc Endovascular Surg ; 53(7): 572-582, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31382837

RESUMO

BACKGROUND-AIM: Limited data exist concerning the fluid dynamic changes induced by endovascular aortic repair with fenestrated and chimney graft modalities in pararenal aneurysms. We aimed to investigate and compare the wall shear stress (WSS) and flow dynamics for the branch vessels before and after endovascular aortic repair with fenestrated and chimney techniques. METHODS: Modeling was done for patient specific pararenal aortic aneurysms employing fenestrated and chimney grafts (Materialise Mimics 10.0) before and after the endovascular procedure, using computed tomography scans of patients. Surface and spatial grids were created using the ANSYS CFD meshing software 2019 R2. Assessment of blood flow, streamlines, and WSS before and after aneurysm repair was performed. RESULTS: The endovascular repair with chimney grafts leaded to a 43% to 53% reduction in perfusion in renal arteries. In fenestrated reconstruction, we observed a 15% reduced perfusion in both renal arteries. In both cases, we observed a decrease in the recirculation phenomena of the aorta after endovascular repair. Concerning the grafts of the renal arteries, we observed in both the transverse and longitudinal axes low WSS regions with simultaneous recirculation of the flow 1 cm distal to the ostium sites in both aortic graft models. High WSS regions appeared in the sites of ostium. CONCLUSIONS: We observed reduced renal perfusion in chimney grafts compared to fenestrated grafts, probably caused by the long and kinked characteristics of these devices.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Tomada de Decisão Clínica , Procedimentos Endovasculares/instrumentação , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Hemodinâmica , Humanos , Hidrodinâmica , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Desenho de Prótese , Interpretação de Imagem Radiográfica Assistida por Computador , Circulação Renal , Estresse Mecânico , Resultado do Tratamento
4.
Braz J Cardiovasc Surg ; 34(3): 361-365, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310476

RESUMO

Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is an issue that has been overlooked (not to say neglected). Cardiac surgeons must bear in mind that this is a real problem that we must tackle. The purpose of this paper is to be a wake-up call to the surgical community by giving a brief overview of what PPM is, its incidence and impact on the outcomes. We also discuss the increasing role played by imaging for predicting and assessing PPM after SAVR (with which surgeons must become more acquainted) and, finally, we present some options to avoid PPM after the surgical procedure.


Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/mortalidade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/mortalidade , Falha de Tratamento
5.
Radiol Clin North Am ; 57(5): 977-1000, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351545

RESUMO

Imaging has a paramount role in postsurgical assessment. Radiologists need to be familiar with the different surgical procedures to be able to identify expected postsurgical appearances and also detect potential complications. This article reviews the indications, normal expected postsurgical appearances, and complications of the most frequently used surgical procedures in the shoulder, elbow, and wrist. The emphasis is on points that should not be overlooked in the surgical planning.


Assuntos
Diagnóstico por Imagem/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/lesões , Articulação do Ombro/cirurgia , Extremidade Superior/lesões , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
6.
Medicine (Baltimore) ; 98(28): e14847, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305388

RESUMO

RATIONALE: Atlantoaxial transarticular screw fixation has been an effective and appealing method for inducing fusion of the C1-C2 complex. This technique is usually performed with Gallie fusion. In performing Gallie fusion using sublaminar wiring, a major concern is the risk of dural tear associated with passing sublaminar wires through the epidural space. We present the first report on symptomatic symptomatic subdural hygroma (SDH) due to transarticular screw fixation with posterior wiring. PATIENTS CONCERNS: A 50-year-old man had sustained dens fracture 20 years ago and presented with severe neck pain following a recent traffic accident. The images showed atlantoaxial instability due to nonunion of the dens fracture and the patient underwent transarticular screw fixation with posterior sublaminar wiring using Gallie technique. When the U-shaped wire was passed under the arch of C1 from inferior to superior, a dural tear and cerebrospinal fluid (CSF) leak occurred. The site of dural tear was repaired by direct application of sutures. The patient was discharged in good condition. Fifteen day after surgery, the patient was readmitted with a history of a progressive headache associated with vomiting and vertigo. DIAGNONSIS: Brain CT and MRI showed bilateral posterior fossa and a right-sided supratentorial SDH. INTERVENTIONS: The patient underwent right occipital burr hole and evacuation of posterior fossa SDH due to deteriorating neurological status. OUTCOMES: The patient's condition gradually improved after the operation and became asymptomatic at 3-year follow-up. LESSONS: Posterior fossa and supratentorial SDH could occur resulting from any intraoperative dural tear and CSF leakage during posterior cervical spinal surgery. Symptomatic SDH after posterior cervical spinal surgery should be cautiously assessed and treated. LEVEL OF EVIDENCE: 5.


Assuntos
Articulação Atlantoaxial/cirurgia , Instabilidade Articular/cirurgia , Complicações Pós-Operatórias , Fusão Vertebral , Derrame Subdural/etiologia , Articulação Atlantoaxial/diagnóstico por imagem , Parafusos Ósseos , Fios Ortopédicos , Diagnóstico Diferencial , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/cirurgia
7.
Medicine (Baltimore) ; 98(29): e16503, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335720

RESUMO

RATIONALE: Total knee arthroplasty (TKA) is a globally well-accepted surgery because of its good outcome and safety. Although TKA-associated arterial injuries occur, postoperative anterior tibial artery (ATA) occlusion has not been reported yet. Herein, we present a case of ATA occlusion after TKA. PATIENT CONCERNS: A 42-year-old man with a 6-year history of right knee pain after right patella fracture treated with open reduction was referred to our clinic. Valgus and contracture deformities were detected in the right knee. Severe osteoarthritis (OA) in the right knee and multiple osteochondromas were observed on radiography. DIAGNOSIS: On the basis of clinical and imaging findings, the patient was diagnosed with OA and multiple osteochondromas. INTERVENTIONS: TKA was performed in the right knee and the osteochondromas were resected. ATA occlusion was found postoperatively and was treated conservatively. OUTCOMES: Although the right ATA occlusion did not resolve, the patient recovered well postoperatively, with pain relief and recovery of right knee range of motion. LESSONS: The clinical outcome in a case of ATA occlusion after TKA demonstrates that conservative treatment could be appropriate in this context.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Artroplastia do Joelho/efeitos adversos , Artérias da Tíbia/diagnóstico por imagem , Adulto , Anticoagulantes/uso terapêutico , Arteriopatias Oclusivas/tratamento farmacológico , Humanos , Masculino , Osteoartrite do Joelho/cirurgia , Osteocondrose/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem
8.
Medicine (Baltimore) ; 98(26): e16081, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261520

RESUMO

The purpose of the present study was to investigate the characteristics of growth disturbances in patients with remaining growth after transphyseal anterior cruciate ligament (ACL) reconstruction who were confirmed to have no definite postoperative physeal abnormalities on magnetic resonance imaging (MRI).Forty adolescents (mean age 15.6 ±â€Š1.0 years [range 12.2-16.8], mean follow-up 2.7 ±â€Š0.7 years [range 2.0-5.5 years]), who underwent transphyseal ACL reconstruction and were confirmed to have no focal physeal disruptions on follow-up MRIs 6 to 12 months after the operation, were retrospectively evaluated. The patients were grouped according to the leg-length growth of the uninjured side, measured on scanograms, obtained before surgery, and at the final follow-up.Leg-length discrepancies (LLD) at the last follow-up were greater in patients with leg growth ≥4 cm than in those with leg growth <4 cm (5.3 ±â€Š9.0 mm vs -0.3 ±â€Š4.2 mm, P = .033); however, no significant difference was observed between subgroup patients with leg growth of 4 to 6 cm or ≥6 cm (5.6 ±â€Š10.4 mm vs 4.8 ±â€Š7.0 mm, P = .958). On multivariate analysis, leg growth was a significant predictive factor for the final LLD (P = .030).Adolescents with additional leg-length growth after transphyseal ACL reconstructions presented with greater LLDs (as shown in the <4 cm vs ≥4 cm groups), but they also presented a ceiling effect (as shown in the 4-6 cm vs ≥6 cm subgroups). Transphyseal ACL reconstructions appeared to cause temporary growth arrest/disturbances in patients with substantial remaining growth which then resumed resulting in clinically insignificant LLDs.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Desigualdade de Membros Inferiores/etiologia , Complicações Pós-Operatórias , Adolescente , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Criança , Feminino , Seguimentos , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/crescimento & desenvolvimento , Perna (Membro)/cirurgia , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/patologia , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 98(26): e16121, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261529

RESUMO

BACKGROUND: To identify whether the aperture or the midportion of the femoral tunnel had a larger tunnel widening in patients who undergo ACL reconstruction. METHODS: PubMed, EMBASE and Cochrane Library were searched for relative studies that evaluated tunnel widening in patients underwent arthroscopic ACL reconstruction. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening. Random-effects meta-analyses were performed to pool the outcomes of tunnel widening by estimating the standardized mean differences in tunnel widening and their 95% confidence intervals (CIs), Publication bias was assessed using funnel plots and Egger test when the number of included studies was >10. RESULTS: Eleven included studies compared tunnel widening between the aperture and the midportion. In these studies, 372 and 92 patients underwent single- and double-bundle ACL reconstructions, respectively. Subgroup analyses in terms of evaluation imaging tool for tunnel widening showed no significant differences in tunnel widening between the aperture and the midportion of the femoral tunnel regardless of plain radiograph (mean difference, 0.02 mm; P = .97), computed tomography (mean difference 0.08 mm; P = .55), and magnetic resonance imaging (mean difference, 0.13 mm; P = .78). Likewise, no significant difference in femoral tunnel widening was found between the aperture and the midportion, irrespective of transtibial (mean difference, 0.18 mm; P = .57), anteromedial (mean difference, 0.02 mm; P = .90), and outside-in techniques (mean difference, 0.01 mm; P = .98). CONCLUSION: No significant difference in femoral tunnel widening was found between the aperture and the midportion in the patients who underwent ACL reconstruction.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Fêmur/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Humanos
11.
J Comput Assist Tomogr ; 43(4): 592-598, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162231

RESUMO

OBJECTIVES: The objective of this study was to determine the effect of a lobectomy to the location and orientation of nonresected lung nodule and its corresponding airway. METHODS: We reviewed preoperative and postoperative computed tomography of patients who underwent lobectomies and have a separate nonresected nodule in the ipsilateral lung. Displacement of the nonresected nodule and angulation of its corresponding segmental bronchus were measured. RESULTS: Fifty nodules from 40 patients (30 females, 10 male; mean ± SD age, 67 ± 7 years) were assessed. Nodules are displaced clockwise after right upper, right middle, and left lower lobectomies and counterclockwise after right lower and left upper lobectomies. Displacement of the remaining nodules was greater in the craniocaudal plane, followed by anteroposterior and transverses planes (mean, 3.7, 2.5, and 1.9 cm, respectively). CONCLUSIONS: Remaining ipsilateral nodules and their associated segmental airways are displaced in a predictable fashion after lobectomy. This may help in the assessment of follow-up imaging.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos
12.
Vasc Endovascular Surg ; 53(6): 458-463, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31185832

RESUMO

BACKGROUND: Few long-time follow-up studies describe all complications, treatment outcome of complications, and mortality in relation to endovascular aneurysm repair (EVAR). The purpose of this study was to evaluate the incidence and treatment outcome including mortality of radiological visible complications related to the EVAR procedure at a single center with up to 10 years' surveillance. MATERIALS AND METHODS: Patients treated with EVAR from March 2006 to March 2016 at a Danish university hospital, 421 in total, were included. Patient and aneurysm characteristics, follow-up, and secondary intervention data were collected from a national database and medical records. Follow-up computed tomography angiography and plain abdominal X-ray reports were reviewed for complications. Scans and X-rays with suspected complications were evaluated by an interventional radiologist. RESULTS: A total of 172 complications in 147 patients, mainly in the beginning of the follow-up period, were found; 35% had a least one complication. The main part of complications (62%) was type II endoleaks, followed by stent graft stenosis (11%), type I endoleaks (9%), and stent graft occlusion (7%). A total of 66 (38%) complications, observed in 55 patients, were treated with reintervention, of which 77% were treated with endovascular procedures and 23% with surgical treatment, that is, 13% of all studied patients had a complication that required a reintervention. The remaining 2 of the 3 complications were treated conservatively. We found no increased all-cause mortality in connection with having a complication including those requiring reintervention. CONCLUSION: We presented a 10-year single-center study of EVAR. Many patients treated with EVAR had a radiological visible complication, mainly in the beginning of the follow-up period. Only a smaller fraction required reintervention and having a reintervention-requiring complication was not connected to increased mortality.


Assuntos
Aneurisma/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/epidemiologia , Aneurisma/mortalidade , Implante de Prótese Vascular/mortalidade , Dinamarca/epidemiologia , Procedimentos Endovasculares/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Bone Joint J ; 101-B(5): 540-546, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31039002

RESUMO

AIMS: Cardiac magnetic resonance (CMR) was used to assess whether cardiac function or tissue composition was affected in patients with well-functioning metal-on-metal hip resurfacing arthroplasties (MoMHRA) when compared with a group of controls, and to assess if metal ion levels correlated with any of the functional or structural parameters studied. PATIENTS AND METHODS: In all, 30 participants with no significant cardiac history were enrolled: 20 patients with well-functioning MoMHRA at mean follow-up of 8.3 years post-procedure (ten unilateral, ten bilateral; 17 men, three women) and a case-matched control group of ten non-MoM total hip arthroplasty patients (six men, four women). The mean age of the whole cohort (study group and controls) at the time of surgery was 50.6 years (41.0 to 64.0). Serum levels of cobalt and chromium were measured, and all patients underwent CMR imaging, including cine, T2* measurements, T1 and T2 mapping, late gadolinium enhancement, and strain measurements. RESULTS: None of the MoMHRA patients showed clinically significant cardiac functional abnormality. The MoMHRA patients had larger indexed right and left end diastolic volumes (left ventricular (LV): 74 ml/m2 vs 67 ml/m2, p = 0.045; right ventricular: 80 ml/m2 vs 71 ml/m2, p = 0.02). There was a small decrease in T2 time in the MoMHRA patients (median 49 ms vs 54 ms; p = 0.0003). Higher metal ion levels were associated with larger LV volumes and with shorter T2 time. CONCLUSION: Although cardiac function is not clinically adversely affected in patients with well-functioning MoMHRA, modern imaging is able to demonstrate subtle changes in structure and function of the heart. As these changes correlate with systemic ion measurements, they may be consequences of wear debris deposition. Longer, longitudinal studies are necessary to determine whether cardiac function will become affected. Cite this article: Bone Joint J 2019;101-B:540-546.


Assuntos
Artroplastia de Quadril/efeitos adversos , Coração/diagnóstico por imagem , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Imagem Cinética por Ressonância Magnética/métodos , Próteses Articulares Metal-Metal/efeitos adversos , Adulto , Idoso , Estudos de Casos e Controles , Cromo/sangue , Cobalto/sangue , Feminino , Coração/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia
14.
BMC Cancer ; 19(1): 404, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035949

RESUMO

BACKGROUND: Preoperative chemoradiotherapy (pre-CRT) followed by total mesorectal excision (TME) is currently a standard therapy for locally advanced mid-to-low rectal cancer. Less aggressive, organ-preserving option such as local excision (LE) or watchful wait can alternatively be used for patients who respond well to pre-CRT. High-resolution rectal magnetic resonance imaging (MRI) is one of the most useful methods to assess pre-CRT response, and the MERCURY group has shown that the MR tumor regression grade (mrTRG) correlated with the pathologic TRG. The aim of this study is to compare postoperative complication and oncologic outcomes between LE and TME in mid-to-low rectal cancer patients whose tumors are mrTRG grade 1 (radiological complete remission) or 2 (predominant fibrosis; near-complete remission) after pre-CRT. METHODS: A prospective, double-arm, randomized, open-labeled, single center, clinical trial will be conducted in patients with mid-to-low rectal cancer whose tumors are mrTRG 1/2 after pre-CRT at the Asan Medical Center, Seoul, Korea, after approval from the Institution Review Board. Patient medical records will be de-identified using a serial number to protect personal information. Inclusion criteria will include rectal adenocarcinoma with an inferior border < 8 cm from the anal verge, mrTRG 1/2, age > 20, and provision of informed consent. Postoperative complications will be assessed by Clavien-Dindo Classification Grade. Oncologic and functional outcomes will be collected and risk factors related to these outcomes will be investigated. DISCUSSION: We believed that the rate of postoperative complication of LE will be comparable to that of TME in mid-to-low advanced rectal cancer patients with a favorable response after pre-CRT. TRIAL REGISTRATION: KCT0002579 ( https://cris.nih.go.kr ) Dec-2017.


Assuntos
Adenocarcinoma/terapia , Neoplasias Retais/terapia , Adenocarcinoma/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde)/métodos , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico por imagem , Período Pré-Operatório , Estudos Prospectivos , Neoplasias Retais/diagnóstico por imagem
15.
Medicine (Baltimore) ; 98(19): e15550, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083214

RESUMO

RATIONALE: Transradial access (TRA) is a widely used technique during percutaneous coronary intervention (PCI). However, mediastinal and cervical hematomas, the rare and severe complications of transradial approach, have extremely high mortality rates. To the best of our knowledge, there were no medical literatures about the successful anticoagulation reversal procedure of mediastinal hematoma in PCI till now. PATIENT CONCERNS: We here present a 54-year-old male Han patient who underwent PCI. Immediately after PCI, he reported an episode of neck and chest discomfort, dyspnea, cough recurrence, and cold sweats. Emergency chest computed tomography (CT) revealed a perforation of the subclavian artery resulting in a large mediastinal hematoma with potentially lethal tracheal compression. DIAGNOSIS: A diagnosis of the large mediastinal hematoma was made based on the enhanced computed tomography. INTERVENTIONS: The patient was successfully managed with palliative therapy of anticoagulation reversal instead of a covered stent graft and surgical operation. OUTCOMES: Angiography confirmed the absence of leakage after anticoagulation reversal. The patient had an apparent remission of clinical dyspnea. Follow-up CT confirmed an almost entire absorption of the mediastinal hematoma 35 days postdischarge. LESSONS: The current case highlights the importance of anticoagulation reversal as well as careful guidewire and guide catheter manipulation by the radial approach. Early evaluation, prompt identification, appropriate treatment, and close monitoring are all essential for invasive cardiology.


Assuntos
Hematoma/terapia , Doenças do Mediastino/terapia , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/terapia , Terapia de Salvação , Artéria Subclávia/lesões , Diagnóstico Diferencial , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/etiologia , Pessoa de Meia-Idade , Cuidados Paliativos , Complicações Pós-Operatórias/diagnóstico por imagem
16.
Clin Nucl Med ; 44(7): e433-e434, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31058690

RESUMO

We report a case of a 43-year-old man who underwent a radical prostatectomy 3 years before the procedure (June 2015) for a locally advanced Gleason 7(4 + 3) prostate adenocarcinoma (pT3aN0), with negative surgical margins, followed by salvage radiotherapy. He also underwent antiandrogen therapy for biochemical relapse (bicalutamide) from October 2016 through May 2017, but prostate-specific antigen continued to rise (2.5 ng/mL [December 2017] and 3.3 ng/mL [February 2018]). At this point, he underwent a Ga-prostate-specific membrane antigen PET/CT, and after multidisciplinary discussion, the therapeutic option chosen was image-guided salvage cryoablation.


Assuntos
Criocirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/diagnóstico por imagem , Prostatectomia , Neoplasias da Próstata/diagnóstico por imagem , Adulto , Ácido Edético/análogos & derivados , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Oligopeptídeos , Complicações Pós-Operatórias/cirurgia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Compostos Radiofarmacêuticos
17.
Br J Radiol ; 92(1100): 20190054, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31116575

RESUMO

OBJECTIVE: This study aimed to assess the imaging features and natural course of clavicle fracture following neck dissection (ND). METHODS AND MATERIALS: Eight patients with clavicle fracture following ND were included. Because bilateral clavicle fractures occurred in one patient, a total of nine clavicle fractures following ND were assessed using CT images. Pathological fracture due to bone metastasis or local recurrence was carefully ruled out. RESULTS: The time interval from ND to clavicle fracture ranged from 2 to 8 months (median, 4 months). On CT images, all the nine fractures occurred in the proximal clavicles and displayed increased bone marrow density with extraosseous soft-tissue mass formation. Osteolysis of the clavicle was not observed. Intra articular fractures were observed in three (33%), displaced fractures in two (22%), and free bone fragments in three (33%) cases. Further follow-up using CT showed that six (67%) fractures resulted in pseudoarthrosis. For the remaining three (33%) fractures with bone union during follow-up, the time interval between clavicle fracture and bone union ranged from 4 to 16 months (median, 6 months). CONCLUSION: Proximal clavicle fractures, which are rarely observed following ND, always display extraosseous soft-tissue mass formation without osteolysis. They frequently result in pseudoarthrosis; however, occasionally, they also result in bone union within 24 weeks. ADVANCES IN KNOWLEDGE: The location of proximal clavicle, the lack of osteolysis, and the presence of free bone fragments may be the key to diagnosis of clavicle fracture following ND.


Assuntos
Clavícula/diagnóstico por imagem , Clavícula/lesões , Fraturas Ósseas/diagnóstico por imagem , Esvaziamento Cervical , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Medicine (Baltimore) ; 98(14): e15042, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946346

RESUMO

RATIONALE: The application of post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) is becoming increasingly common in forensic investigations. One of the most frequently applied techniques today is PMCTA. However, few studies have focused on the application of contrast-enhanced PMCT of hollow organs such as the gastrointestinal tract. The intestine is a special digestive organ with a complicated anatomical structure; it is difficult to separate in medicolegal investigations, during which new rupture may occur, affecting the examiner's judgment. Moreover, the formalin-fixed intestine is more difficult to separate because of its increased brittleness. In the present case, the authors applied contrast-enhanced PMCT to the diagnosis of intestinal perforation caused by a medical accident. PATIENT CONCERNS: A 67-year-old woman with cholecystitis underwent laparoscopic cholecystectomy in the hospital. The gallbladder was successfully removed, but the doctor was suspected to have accidentally perforated her intestinal tract with the laparoscopic machinery. The patient developed severe peritonitis and died after the operation. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: Contrast-enhanced PMCT with isolation of the intestinal tract was performed after dissection of the body. The results suggested that the contrast agent flowed out through the rupture. The autopsy and histological examination revealed a perforated crevasse, confirming the cause of peritonitis while excluding other probabilities despite the doctor's denial. LESSONS: Contrast-enhanced PMCT was an effective technique with which to interpret this gastrointestinal tract rupture and served as a non-invasive tool for identifying the injury.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Perfuração Intestinal/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Colecistite/cirurgia , Meios de Contraste , Diagnóstico , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/etiologia , Imperícia , Peritonite/etiologia , Complicações Pós-Operatórias/etiologia
20.
Isr Med Assoc J ; 21(4): 246-250, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31032565

RESUMO

BACKGROUND: Kidney transplantation is associated with early improvement in cardiac function and structure; however, data on cardiac adaptation and its relation to kidney allograft function remain sparse. OBJECTIVES: To investigate the relationship between post-transplant kidney function and echocardiographic measures in patients with normal/preserved pre-transplant cardiac structure and function. METHODS: The study included 113 patients who underwent kidney transplantation at a single tertiary medical center from 2000 to 2012. The patients were evaluated by echocardiography before and after transplantation, and the relation between allograft function and echocardiographic changes was evaluated. Echocardiography was performed at a median of 510 days after transplantation. RESULTS: The post-transplantation estimated glomerular filtration rate (eGFR) was directly correlated with left ventricular (LV) systolic function and inversely correlated with LV dimensions, LV wall thickness, left atrial diameter, and estimated systolic pulmonary arterial pressure. In patients with significant allograft dysfunction (eGFR ≤ 45 ml/min), LV hypertrophy worsened, with no improvement in LV dimensions. In contrast, in patients with preserved kidney function, there was a significant reduction in both LV diameter and arterial pulmonary systolic pressure. CONCLUSIONS: Our results show that in kidney transplant recipients, allograft function significantly affects cardiac structure and function. Periodic echocardiographic follow-up is advisable, especially in patients with kidney graft dysfunction.


Assuntos
Aloenxertos/fisiologia , Ecocardiografia/métodos , Transplante de Rim , Complicações Pós-Operatórias/diagnóstico por imagem , Pressão Arterial/fisiologia , Estudos de Coortes , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/fisiologia , Estudos Retrospectivos , Função Ventricular Esquerda/fisiologia
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