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3.
Respir Physiol Neurobiol ; 284: 103585, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33197604

RESUMO

BACKGROUND: In a variable number of Covid-19 patients with acute respiratory failure, non-invasive breathing support strategies cannot provide adequate oxygenation, thus making invasive mechanical ventilation necessary. Factors predicting this unfavorable outcome are unknown, but we hypothesized that diaphragmatic weakness may contribute. METHODS: We prospectively analyzed the data of 27 consecutive patients admitted to the general Intensive Care Unit (ICU) from March 19, 2020, to April 20, 2020 and submitted to continuous positive airway pressure (CPAP) before considering invasive ventilation. Diaphragmatic thickening fraction (DTF) inferred by ultrasound was determined before applying CPAP. RESULTS: Eighteen patients recovered with CPAP, whereas nine required invasive mechanical ventilation with longer stay in ICU (p < 0.001) and hospital (p = 0.003). At univariate logistic regression analysis, CPAP failure was significantly associated with low DTF [ß: -0.396; OR: 0.673; p < 0.001] and high respiratory rate [ß: 0.452; OR: 1.572; p < 0.001] but only DTF reached statistical significance at multivariate analysis [ß: -0.384; OR: 0.681; p < 0.001]. The DTF best threshold predicting CPAP failure was 21.4 % (AUC: 0.944; sensitivity: 94.4 %, specificity: 88.9 %). CONCLUSIONS: In critically ill patients with Covid-19 respiratory failure admitted to ICU, a reduced DTF could be a potential predictor of CPAP failure and requirement of invasive ventilation.


Assuntos
/patologia , Pressão Positiva Contínua nas Vias Aéreas , Diafragma/patologia , Resultado do Tratamento , Idoso , Diafragma/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , Ultrassonografia
4.
Medicine (Baltimore) ; 99(49): e23383, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285723

RESUMO

Over one-third of infants with congenital diaphragmatic hernia (CDH) eventually require a Nissen fundoplication (NF). We examined pre- and intraoperative predictors for need of a NF in children undergoing CDH repair to elucidate, which patients will need a later NF.A retrospective analysis of all consecutive patients undergoing CDH repair at our institution from 2008 to 2018 was performed. Patients who underwent a NF were compared to those who did not (noNissen). Logistic regression analysis was performed to find independent predictors for NF in patients undergoing CDH repair. Severe Defect Grade was defined as defect >50% of the hemidiaphragm and intrathoracic liver.One hundred twenty-six patients were included, 42 (33%) underwent NF at a median of 61 days after CDH repair. Intrathoracic liver was more frequent in the NF (71%) versus noNissen (45%) group (P = .008). Absence of >50% of the hemidiaphragm was more frequent in the NF group (76% vs 31%, P < .001). Severe Defect Grade emerged as independent predictor for NF (odds ratio 7, 95% confidence interval 3-16, P < .001).Severe Defect Grade emerged as independent predictor for NF after CDH repair.


Assuntos
Fundoplicatura/métodos , Hérnias Diafragmáticas Congênitas/fisiopatologia , Hérnias Diafragmáticas Congênitas/cirurgia , Diafragma/patologia , Feminino , Humanos , Recém-Nascido , Fígado/patologia , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
5.
BMJ Case Rep ; 13(12)2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328208

RESUMO

We describe a case of a 61-year-old man with a background of rheumatoid arthritis who presented to the emergency department with a single-reported episode of haemoptysis on the background of an upper respiratory tract infection. A CT scan revealed an incidental 40 mm mass in upper right lobe of the liver abutting the diaphragmatic surface. A subsequent positron emission tomography scan confirmed the mass and raised the possibility of another lesion in the liver raising the suspicion of malignancy. The case was complicated by the inability to perform a fine needle aspiration biopsy due to the mass' proximity to the diaphragm. After discussion with the patient, it was decided to resect the affected liver segment. Histological analysis of the mass revealed localised necrotising granulomatous inflammation suggestive of a rheumatoid nodule, which is seldom reported in the literature.


Assuntos
Hepatopatias/diagnóstico , Nódulo Reumatoide/diagnóstico , Diagnóstico Diferencial , Diafragma/patologia , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
6.
Kyobu Geka ; 73(13): 1076-1079, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33271575

RESUMO

Solitary diaphragmatic metastasis from early endometrial cancer is quite rare. We present a case of a 58-year-old woman who had been performed radical surgery for stageⅠA, G1 endometrial cancer 3 years before. The patient was referred to our hospital for chest abnormal shadow. Computed tomography (CT) and Magnetic resonance imaging (MRI) showed a mass in the right diaphragm, without the finding of liver invasion. We performed partial resection of diaphragm through video-assisted thoracoscopic surgery (VATS). After surgery, there were no serious complications and was discharged from the hospital on day 6 from surgery. Nine months later, the patient is alive without recurrence.


Assuntos
Diafragma , Neoplasias do Endométrio , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
8.
J Bras Pneumol ; 46(6): e20200064, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33237154

RESUMO

The diaphragm is the main muscle of respiration, acting continuously and uninterruptedly to sustain the task of breathing. Diaphragmatic dysfunction can occur secondary to numerous pathological conditions and is usually underdiagnosed in clinical practice because of its nonspecific presentation. Although several techniques have been used in evaluating diaphragmatic function, the diagnosis of diaphragmatic dysfunction is still problematic. Diaphragmatic ultrasound has gained importance because of its many advantages, including the fact that it is noninvasive, does not expose patients to radiation, is widely available, provides immediate results, is highly accurate, and is repeatable at the bedside. Various authors have described ultrasound techniques to assess diaphragmatic excursion and diaphragm thickening in the zone of apposition. Recent studies have proposed standardization of the methods. This article reviews the usefulness of ultrasound for the evaluation of diaphragmatic function, addressing the details of the technique, the main findings, and the clinical applications.


Assuntos
Diafragma/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Doenças Neuromusculares , Músculos Respiratórios , Doenças Respiratórias
9.
BMC Surg ; 20(1): 270, 2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148241

RESUMO

BACKGROUND: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. METHODS: We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99-28.5 kg, median body weight: 7.87 ± 4.40 kg) admitted to our hospital in the previous 10 years, and we statistically analyzed their clinical manifestations and surgical methods. RESULTS: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). CONCLUSIONS: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.


Assuntos
Eventração Diafragmática , Toracoscopia , Toracotomia , Criança , Pré-Escolar , Diafragma/anormalidades , Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
10.
BMC Surg ; 20(1): 289, 2020 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-33213428

RESUMO

BACKGROUND: Schwannomas are nerve sheath tumors that commonly originate from the stomach and small intestine. A primary schwannoma of the diaphragm is rare and does not show any symptoms until it grows to a certain size. Hence, it is extremely rare that it was found at a size that allowed resection under videoscopic surgery. CASE PRESENTATION: A 77-year-old woman was referred to our department for surgical treatment of a tumor located near the gastric fornix. She underwent a routine esophagogastroduodenoscopy 2 years and 7 months prior to the referral. It was suspected that she had a submucosal tumor measuring 10 mm, located in the fornix, and was then referred to her previous physician. During her follow-up, endoscopic ultrasonography (EUS) revealed that the cystic structure had continued to grow toward the gastric wall, and she was then referred to the endoscopy division of our hospital. She continued to be followed-up, and it was noted that the tumor was gradually increasing in size. Therefore, she requested surgical resection, and was finally referred to our division. Since the tumor was rather small, we planned a laparoscopic surgery. An initial examination during the operation revealed that the tumor was located on the left diaphragm. Since the tumor was relatively small and visibility was good, we decided to continue with the laparoscopic surgery. Partial diaphragmectomy with complete inclusion of the tumor was performed, and the defect of the diaphragm was directly closed by a running suture. Pathological examination revealed a benign schwannoma that had originated from the diaphragm. To support our findings, we also reviewed the scientific literature on diaphragmatic schwannoma cases reported up to April 2020. CONCLUSIONS: In this extremely rare case, we successfully resected the diaphragmatic schwannoma using laparoscopic surgery.


Assuntos
Diafragma/cirurgia , Endoscopia do Sistema Digestório , Laparoscopia , Neurilemoma/cirurgia , Idoso , Diafragma/diagnóstico por imagem , Feminino , Humanos , Masculino , Neurilemoma/diagnóstico por imagem , Resultado do Tratamento
11.
Yonsei Med J ; 61(12): 1024-1033, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33251776

RESUMO

PURPOSE: Patients with respiratory failure associated with neurological dysfunction often require mechanical ventilator support, which poses increased economic burden and ventilator-associated complications. A diaphragm pacing system (DPS) is an implanted device that provides respiratory support for such patients. In this systematic review, we reviewed the literature to assess the safety and efficacy of DPS for patients with respiratory failure resulting from amyotrophic lateral sclerosis (ALS) or cervical spinal cord injuries. MATERIALS AND METHODS: The following databases were searched from July 10 to July 30, 2018: MEDLINE, EMBASE, Cochran library, KoreaMed, Research Information Sharing Service, Korean studies Information Service System, Korea Institute of Science and Technology Information, and Korean Medical database. The abstracts and full texts of the searched articles were reviewed by two reviewers. RESULTS: The search keywords generated 197 articles: two randomized controlled trials, two case-control studies, and one case report involving patients with ALS; one cohort study, one case-control study, and two case reports involving patients with cervical spine injury; and one case report involving patients with both conditions were included. The primary outcome was safety profile (complications and adverse event) and efficacy (overall survival and sleep improvement). Complications and adverse events were more common in patients with ALS and spinal cord injury receiving DPS than in controls. Efficacy outcomes were inconsistent across ALS studies. CONCLUSION: Based on safety and efficacy results, we do not support using DPS to manage respiratory failure in patients with ALS or cervical spine injury.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Esclerose Amiotrófica Lateral/terapia , Diafragma/patologia , Respiração Artificial/métodos , Respiração , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Esclerose Amiotrófica Lateral/diagnóstico , Humanos , Próteses e Implantes/efeitos adversos , Insuficiência Respiratória/diagnóstico , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento
12.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1213-1216, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198866

RESUMO

OBJECTIVE: To understand the function of diaphragm and analyze the clinical factors affecting the function of diaphragm by measuring twitch tracheal pressure (TwPtr) in patients with mechanical ventilation and in the weaning phase. METHODS: Patients with more than 48 hours of invasive mechanical ventilation admitted to the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2015 to March 2017 were enrolled. After the patient entered the weaning stage, TwPtr of patients was monitored by two-way non repetitive automatic respiratory trigger device, the effects of duration of mechanical ventilation, severe pulmonary infection, sedative application and chronic obstructive pulmonary disease (COPD) on weaning were analyzed. RESULTS: A total of 62 patients were included, of which 45 were male and 17 were female. The average age was (66.8±11.7) years old. Twenty-three cases had severe pneumonia. The absolute value of TwPtr in severe pneumonia group was lower than that in non-severe pneumonia group [cmH2O (1 cmH2O = 0.098 kPa): 10.40±5.81 vs. 14.35±5.22, P = 0.021]. However, there was no significant difference in the duration of mechanical ventilation between the severe pneumonia group and non-severe pneumonia group [days: 26 (17, 43) vs. 15 (11, 36), P = 0.091]. In 62 patients with mechanical ventilation, there was a negative correlation between TwPtr and duration of mechanical ventilation (r = 0.414, P = 0.002), there was also a negative correlation between the duration of mechanical ventilation and TwPtr after the assessment of diaphragm function (r = 0.277, P = 0.039). There was a linear relationship between TwPtr and sedatives (r = 0.220, P = 0.040), but there was no correlation between TwPtr and COPD (r = -0.178, P = 0.166). CONCLUSIONS: For patients in the weaning stage of mechanical ventilation, severe pulmonary infection is one of the factors that affect the diaphragm dysfunction. There is a certain correlation between the diaphragm dysfunction and the use of sedatives.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Respiração Artificial , Idoso , Diafragma , Feminino , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Pressão , Respiração Artificial/efeitos adversos , Traqueia , Desmame do Respirador
14.
Am J Emerg Med ; 38(10): 2081-2087, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33142179

RESUMO

INTRODUCTION: Ultrasound is a feasible and reproducible method for measuring right diaphragmatic excursion (RDE) in ED patients with acute dyspnea (AD). In AD patients, the correlation between the RDE value and the need for mechanical ventilation (MV) is not known. MATERIALS: This was a bicentric, observational prospective study. The RDE measurement was done at admission. The need for MV was defined by the use of MV within 4 h of AD management. An optimal threshold for RDE was determined as the value that minimized the incorrect predictions of the use of MV in the first 4 h as the highest Youden index. RESULTS: We analyzed 102 patients (79 [70; 86] years), 38 (37%) of whom had been ventilated. The RDE value was 1.7 cm [1.4; 2.0] and 2.2 cm [1.8; 2.6] in the ventilated and non-ventilated groups, respectively (p = 0.06). The AUC was 0.68 95% CI [0.57; 0.80]. With a threshold of 2 cm, the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 76% [60%; 89%], 59% [46%; 71%], 81% [67%; 91%], and 53% [39%; 66%], respectively. In the non-COPD patients, the RDE values were 1.5 cm [1.2; 1.9] and 2.2 cm [1.8; 2.6] (p < 0.01) in the ventilated and not-ventilated groups, respectively. The AUC was 0.77 95% CI [0.64; 0.90]. With a threshold of 2.18 cm, the sensitivity, specificity, NPV, and PPV were 91% [71%; 99%], 51% [36%; 66%], 92% [75%; 99%], and 54% [38%; 69%], respectively. CONCLUSION: The RDE values at ED admission were unable to define a prognostic threshold value associated with subsequent MV need in the AD patients. In non-COPD patients, the NPV was 92%.


Assuntos
Diafragma/anormalidades , Dispneia/complicações , Respiração Artificial/métodos , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Dispneia/fisiopatologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Estudos Prospectivos , Curva ROC , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos
15.
Neurol Sci ; 41(12): 3471-3474, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33090303

RESUMO

A wide range of neurological signs and symptoms have been associated with SARS-CoV-2 infection. In the present report, we described two Italian patients diagnosed with diaphragmatic myoclonus after COVID-19. In both cases, mild lymphocytosis at cerebrospinal fluid analysis and no structural brain changes were reported. The pathophysiological origin of the myoclonus in the two cases was different. In case 1, electroencephalogram did not reveal any cortical correlates and brain imaging of the spine was unremarkable, while in case 2, cortical origin of myoclonus was demonstrated. With the present two cases, we confirm and extend the neurological manifestations of SARS-CoV-2 infection.


Assuntos
Infecções por Coronavirus/complicações , Diafragma/fisiopatologia , Mioclonia/virologia , Pneumonia Viral/complicações , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
16.
Medicine (Baltimore) ; 99(44): e22763, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126314

RESUMO

Ultrasound guided percutaneous thermal ablation has been well acknowledged in treating hepatic malignancy. Although thermal ablation is safe for the treatment, it may induce some lethal complications such as diaphragmatic injury, bile-stained pleural fistula, and bilious pleuritis.We presented 2 cancer patients in hepatic diaphragmatic dome showed diaphragmatic injury, bile-stained pleural fistula, and bilious pleuritis after microwave ablation (MVA). The symptoms were attenuated after chest drainage and anti-infection therapy. In the literature review, 17 articles published in the recent 10 years on diaphragmatic injury after MVA for treating hepatic cancer were available. Twenty-three cases were obtained, among which 2 showed bilious pleuritis after radiofrequency treatment. Most of the lesions were adjacent to the diaphragma. Among the articles reporting the localization of lesions, most of the cases showed lesions in S8, 2 in S7, 3 in S4, and 3 in S5, respectively. Surgical recovery was required for the patients with massive diaphragmatic injury. Only 2 cases underwent thorascopic surgery. After chest drainage and anti-infection, their symptoms were attenuated to some extent.Radiofrequency or MVA may induce pleural effusion, and special attention should be paid to the diaphragmatic injury induced by thermal ablation.


Assuntos
Diafragma/lesões , Neoplasias Hepáticas/radioterapia , Micro-Ondas/efeitos adversos , Pleurisia/etiologia , Lesões por Radiação/etiologia , Ablação por Radiofrequência/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/etiologia , Fístula do Sistema Respiratório/etiologia
17.
Rev Esp Enferm Dig ; 112(11): 891-892, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33054278

RESUMO

We read the interesting case study of interposition of the colon between the liver and the right diaphragm (Chilaiditi's sign) that was recently reported by Ruiz Pardo et al. in a 73-year-old male with epigastric pain, ectopic cholecystitis and segmental hepatic hypoplasia. The condition was managed by laparoscopic cholecystectomy with an uneventful outcome. This sign was first described in 1910 by the Greek radiologist Demetrius Chilaiditi. The incidence of Chilaiditi's sign in plain imaging studies is from 0.025 % to 0.28 % and may be reported by abdominal computed tomography in between 1.18 % and 2.40 % of cases.


Assuntos
Síndrome de Chilaiditi , Fígado , Idoso , Síndrome de Chilaiditi/diagnóstico por imagem , Síndrome de Chilaiditi/cirurgia , Colo , Diafragma , Humanos , Masculino
18.
Vestn Oftalmol ; 136(6): 26-31, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33084276

RESUMO

All methods of laser radiation therapy currently used in clinical practice are positioned as safe in terms of possible negative effects on the eye and surrounding tissues. PURPOSE: To assess possible changes in the macular region of the retina and thickness of the peripapillary retinal nerve fiber layer (RNFL) according to the results of a dynamic study of OCT parameters after laser operations in the iris-lens diaphragm area. MATERIAL AND METHODS: Optical coherence tomography (OCT) was performed on 34 pseudophakic patients (43 eyes) with clinical signs of secondary cataract with best corrected visual acuity (BCVA) of at least 0.3, and on 28 patients (38 eyes) with relative papillary block before laser intervention and 1 hour, 1 day, 3 days, 7 days, 1 and 6 months after surgery. The changes in the thickness of the retina in 9 standard ETDRS areas, and the thickness of the ganglion cells layer and peripapillary RNFL were analyzed. RESULTS: In both groups of patients during the entire observation period, there was no fundamental change in the thickness of the peripapillary RNFL and the ganglion cell complex (all p>0.05). According to OCT, retinal thickness in both groups significantly increased an hour after laser irradiation in 5 out of 9 ETDRS areas. The retinal thickness returned to preoperative values in the group of patients with Nd:YAG laser posterior capsulotomy on the 3rd day after surgery, and after 1 week in the group with Nd:YAG laser iridectomy. Retinal thickness in the macular area did not change significantly during the follow-up. CONCLUSION: Laser operations in the iris-lens diaphragm area have a negligible effect on the thickness of the retina, as measured by the OCT method, do not affect the thickness of the ganglion cells layer or peripapillary RNFL, and is safe for the central zone of the retina.


Assuntos
Diafragma , Cristalino , Humanos , Iris/diagnóstico por imagem , Iris/cirurgia , Fibras Nervosas , Células Ganglionares da Retina
19.
Minerva Med ; 111(4): 354-361, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33032395

RESUMO

INTRODUCTION: According to the Staging System of Barcelona Clinic Liver Cancer (BCLC), diaphragmatic invasion (DI) is generally considered to be a manifestation of advanced hepatocellular carcinoma (HCC) with nearly no cure. However, some studies have indicated that combined liver and diaphragmatic resection may be a reasonably safe treatment option for HCC patients with diaphragmatic invasion. In this article, we conduct a systematic review to compare the short- and long-term surgical outcomes between HCC patients without diaphragmatic involvement who underwent hepatectomy alone and HCC patients with diaphragmatic involvement who underwent combined liver and diaphragmatic resection. EVIDENCE ACQUISITION: PubMed, Web of Science, Embase and Cochrane library databases were searched. All related studies were checked. Hazard ratios (HR) with 95% confidence intervals were calculated for the comparison of cumulative overall survival (OS) and recurrence free survival (RFS). Odds ratios (OR) with 95% CI were calculated for the comparison of overall postoperative morbidity and mortality. EVIDENCE SYNTHESIS: Seven studies met the inclusion criteria were included. There was no significant difference between the single hepatectomy group and combined liver and diaphragmatic resection group in the overall survival and recurrence free survival. Subgroup analysis showed a statistically significantly higher overall survival in HCC patients with diaphragmatic fibrous adhesion (DFA) compared with the DI group. However, there was no statistically significant difference in OS between the DI group and the single hepatectomy group. CONCLUSIONS: For HCC patients with diaphragmatic involvement, combined liver and diaphragmatic resection might be considered no matter whether its diaphragmatic invasion or not.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Diafragma , Hepatectomia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Neoplasias Musculares/patologia , Neoplasias Musculares/cirurgia , Humanos , Invasividade Neoplásica
20.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 76(10): 1017-1024, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33087647

RESUMO

Dynamic pulmonary computed tomography (CT) enables morphological analyses of tumor adhesion and infiltration and functional analyses of the lungs based on four-dimensional data. However, the functional analysis requires visualization of the respiratory cycle. The aim of the present study was to investigate the utility of spectral analysis as part of the functional analysis of the lungs based on dynamic pulmonary CT. In this study, the reference curves for the respiratory cycle were obtained using measurements of all phases of respiration based on the movement of the diaphragm. The reference curves and fields of the unaffected lung were divided into three sections: upper, middle, and lower. The central position within each lung field in the axial section was used as the fixed location, and the lung field concentrations (CT values within each lung field) were measured. Using the maximum entropy (ME) method, the spectral analysis was performed for the lung field concentration curves obtained in this manner. The investigated items were the peak frequency in the power spectrum based on the ME analysis of the reference curve and the time difference from this peak frequency in the upper, middle, and lower lung field concentration curves. The time differences (median±standard deviation) from the reference values were 0.18±0.20, 0.34±0.33, and 0.34±0.35 s in the upper, middle, and lower lung fields, respectively, indicating the smallest time difference in the upper lung field. Performing spectral analysis using the ME method on lung field concentration curves enables assessment of the respiratory cycle based on dynamic pulmonary CT, and this approach is consistent with the visual assessment of the respiratory cycle.


Assuntos
Pulmão , Tomografia Computadorizada por Raios X , Diafragma , Pulmão/diagnóstico por imagem , Respiração
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