Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 14.368
Filtrar
2.
Pan Afr Med J ; 38: 311, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285734

RESUMO

Introduction: contrast media are increasingly used in diagnostic and interventional procedures but are also known causes of acute kidney injury - a condition known as contrast induced nephropathy (CIN). We aimed to determine the magnitude and associated factors of CIN among patients undergoing coronary angiography and percutaneous coronary intervention at a cardiac referral hospital in Tanzania. Methods: all adult patients undergoing elective coronary angiography and percutaneous coronary intervention at Jakaya Kikwete Cardiac Institute were consecutively enrolled between August 2017 and January 2018, if they fulfilled the inclusion criteria. Pre-procedure, 24- and 72-hours' post procedure serum creatinine was measured. CIN was defined as increase of ≥25% or absolute increase of ≥44µmol/L of serum creatinine within 72 hours following exposure to contrast media. Data analysis were done using SPSS Version 20. P-value of <0.05 was considered statistically significant. Results: in total, 210 (94.6%) out of 222 patients seen during the study period fulfilled the inclusion criteria and were enrolled. Their mean (SD) age was 61.3 (10.9) years and 64.3% were men. Hypertension, diabetes, smoking and alcohol consumption was present in 86.7%, 37.7%, 12.4% and 37.6% respectively. The incidence of CIN was 19% within 72 hours post procedure. On multivariate logistic regression analysis, independent factors for developing CIN were history of heart failure (aOR=7.34), central obesity (aOR=3.12), triple vessel disease (aOR=10.14) and post procedure stay of ≥3 days (aOR=4.1), all p<0.05. Conclusion: the incidence of CIN found in this population is high (19%) and is associated with heart failure, obesity, multi-vessel disease and longer post-procedure hospital stay.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Angiografia Coronária/métodos , Injúria Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Estudos Prospectivos , Fatores de Risco , Tanzânia
3.
West J Emerg Med ; 22(3): 614-622, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-34125036

RESUMO

INTRODUCTION: Acute kidney injury (AKI) after intravenous contrast administration for computed tomography (CT) occurs infrequently, but certain patients may be susceptible. This study evaluated AKI incidence among emergency department (ED) patients with pre-existing chronic kidney disease (CKD) undergoing CT exams. METHODS: This retrospective cohort study in an integrated healthcare system included ED patients previously diagnosed with CKD stages 3-5 (estimated glomerular filtration rate <60 milliliters per minute per 1.73 meters squared over at least three months), undergoing CT exams with or without intravenous contrast, from January 1, 2013-December 31, 2017. We excluded patients with CT prior to (30 days) or following (14 days) index CT and missing serum creatinine (sCr) measurements. We applied propensity score matching, and then multivariable regression adjustment for post-CT ED disposition and ED diagnosis, to calculate adjusted risk of AKI. Secondary patient-centered outcomes included 30-day mortality, end-stage renal disease (ESRD) diagnosis, and dialysis initiation. RESULTS: Among 103,573 eligible ED patients undergoing CT, propensity score matching yielded 5,589 pairs. Adjusted risk ratio (ARR) for AKI was higher overall for contrast-enhanced CT (1.60; 95% confidence interval [CI], 1.43-1.79). However, secondary outcomes were infrequent: 19/5,589 non-contrast vs 40/5,589 contrast patients with new dialysis initiation at 30 days (adjusted risk 0.3% vs 0.7%; adjusted risk reduction 0.4%; 95% CI, 0.1%-0.7%). CONCLUSION: In ED patients with chronic kidney disease undergoing CT, intravenous contrast was associated with higher overall adjusted risk of AKI, but patient-centered secondary outcomes were rare. The clinical significance of transient kidney injury after CT is unclear, although patients with advanced chronic kidney disease appear to have elevated risk.


Assuntos
Meios de Contraste/efeitos adversos , Insuficiência Renal Crônica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/efeitos adversos , Injúria Renal Aguda/epidemiologia , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Meios de Contraste/administração & dosagem , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
4.
Medicine (Baltimore) ; 100(22): e26213, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087898

RESUMO

ABSTRACT: Pulmonary embolism (PE) is a common medical problem. Its diagnostic criteria must be reviewed to determine the need for confirmatory testing. Computed tomography pulmonary angiography (CTPA) is the current standard of care, which provides accurate diagnosis with rapid turnaround. This study aimed to estimate the diagnostic yield of CTPA in clinically suspected PE patients in a tertiary care hospital in Saudi Arabia.Radiology records of all patients with clinically suspected PE who underwent CTPA between January 1, 2012 and September 30, 2018 were reviewed retrospectively. A radiologist with 10 years of professional experience interpreted and reported all cases. The Wells score with 2 tiers (likely and unlikely) was used to raise the clinical suspicion of PE.Positive results for PE were reported in 177 out of 534 clinically suspected cases (33%). Among the positive PE cases, 143 were acute (81%) and 34 (19%) were chronic. Bilateral, right-sided, and left-sided PE were found in 115 (65%), 37 (21%), and 25 (14%) cases, respectively. Involvement of the segmental branches, subsegmental branches, and the pulmonary trunk were noted in 152 (86%), 70 (40%), and 9 cases (5%), respectively. Saddle PE was found in (4%) of the cases. The lower lobe branches (right 55%, left 53%) and the upper lobe branches (right 47%, left 41%) were the most common sites of involvement.CTPA had a higher positive detection rate for PE among clinically suspected cases than its published diagnostic yield. Adequate clinical evaluation when selecting patients for CTPA is emphasized to minimize unjustified exposure of the patients to radiation and intravenous contrast administration. It is crucial for radiologists to provide detailed reports commenting on all relevant findings, including pertinent negatives. A template for reporting radiological findings for CTPA can be recommended for this purpose.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/efeitos adversos , Pulmão/irrigação sanguínea , Embolia Pulmonar/diagnóstico , Exposição à Radiação/efeitos adversos , Administração Intravenosa , Adulto , Idoso , Angiografia por Tomografia Computadorizada/normas , Meios de Contraste/administração & dosagem , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Exposição à Radiação/prevenção & controle , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Centros de Atenção Terciária
5.
Medicine (Baltimore) ; 100(26): e26414, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190159

RESUMO

ABSTRACT: Transcatheter arterial chemoembolization (TACE) is a standard treatment modality for intermediate stage hepatocellular carcinoma (HCC). The aim of this study was to determine the tumor radiological characteristics associated with prognosis of patients with early-staged HCC receiving TACE.Patients with BCLC stage A HCC were enrolled at Taichung Veterans General Hospital from January 2005 to December 2009. According to mRECIST criteria, patients with or without complete response (CR) were assigned to either the CR group or the non-CR group. Clinical and radiological characteristics were compared between the two groups.In 40 enrolled patients, 24 (60%) were in the CR group, and 16 (40%) in the non-CR group. Clinical parameters were similar between the 2 groups. Radiological characteristics including complete lipidol retention and the absence of residual tumor blush were significantly correlated with achievement of CR in the patients with small-sized HCC. Patients with CR after TACE had a significantly longer overall survival than those without (31.29 vs 22.63 months, P = .021).Complete lipidol retention and the absence of residual tumor blush were correlated with the radiological complete tumor response of these patients with small-sized early-stage HCC receiving TACE.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Idoso , Carcinoma Hepatocelular/patologia , Meios de Contraste/administração & dosagem , Feminino , Humanos , Óleo Iodado/administração & dosagem , Neoplasias Hepáticas/patologia , Masculino , Estadiamento de Neoplasias , Radiologia , Resultado do Tratamento
6.
J Zoo Wildl Med ; 52(2): 460-469, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34130388

RESUMO

IV iodinated contrast is undocumented in koi (Cyprinus carpio). IV contrast-enhanced computed tomography (CT) provides detailed imaging of the vascular structures and parenchymal organs. The goals of this study were to (1) document feasibility of IV contrast into the caudal vein, (2) determine distribution of contrast media and conspicuity of organs, (3) evaluate for differences in contrast uptake with two different doses of IV contrast, and (4) evaluate for contraindications of IV iodinated contrast in a small cohort of fish. Thirty adult koi were split into three groups (n = 10) in a prospective interrupted time series design with nonequivalent groups, receiving 480 mg iodine per kg (mg I/kg), 800 mg I/kg, and saline. Contrast doses were selected based on the range of doses used in other species. Half of the fish given IV contrast (n = 10) were imaged with CT. Physical exams, blood smears, and biochemistries were performed on all fish. Half of the fish in each group were euthanized 24 h after injection and the other half two weeks later. Necropsies and histopathology were performed to evaluate pathology associated with contrast. For the CT examinations, precontrast, immediate postcontrast, and 5-m delayed postcontrast CT scans were obtained. Contrast in coelomic organs and circulatory system was measured using Hounsfield units. The caudal kidney was the most contrast-enhancing organ. Both doses produced good vascular enhancement and similar distribution. The delayed postcontrast scans showed repeatable parenchymal enhancement of organs. No mortality was encountered. No abnormalities were detected on blood smears, necropsies, or histopathology. Results suggest IV contrast administration is feasible, both contrast doses provided valuable anatomical information in the study with CT of coelomic organs, and no contraindications of contrast administration were detected.


Assuntos
Carpas , Meios de Contraste/administração & dosagem , Doenças dos Peixes/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Animais , Tomografia Computadorizada por Raios X/métodos
7.
Plast Reconstr Surg ; 148(1): 19e-27e, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34003805

RESUMO

BACKGROUND: Anatomical knowledge of the zygomatico-orbital artery and its most relevant clinical applications is essential for ensuring the safety of filler injection into the temporal region. The purpose of this study was to provide the precise position, detailed course, and relationship with surrounding structures of the zygomatico-orbital artery. METHODS: Fifty-eight patients who underwent head contrast-enhanced three-dimensional computed tomography and 10 fresh frozen cadavers were investigated. RESULTS: The zygomatico-orbital artery was identified in 93 percent of the samples in this work. Ninety-four percent of the zygomatico-orbital arteries derived directly from the superficial temporal artery, and the remaining arteries started from the frontal branch of the superficial temporal artery. According to the origin of the zygomatico-orbital artery, it was classified into type I and type II. Type I arteries were then classified into three subtypes. The trunk of the zygomatico-orbital artery was located between the deep temporal fascia and the superficial temporal fascia. Deep branches of the zygomatico-orbital artery pierced the superficial layer of the deep temporal fascia. The zygomatico-orbital artery originated from 11.3 mm in front of the midpoint of the apex of the tragus, and most of its trunks were located less than 20.0 mm above the zygomatic arch. The mean diameter of the zygomatico-orbital artery was 1.2 ± 0.2 mm. There were extensive anastomoses between the zygomatico-orbital artery and various periorbital arteries at the lateral orbital rim. CONCLUSION: The precise anatomical knowledge of the zygomatico-orbital artery described in this study could be helpful for cosmetic physicians for improving the safety of temporal augmentation.


Assuntos
Variação Anatômica , Técnicas Cosméticas/efeitos adversos , Testa/irrigação sanguínea , Artérias Temporais/anormalidades , Lesões do Sistema Vascular/prevenção & controle , Adulto , Idoso , Cadáver , Meios de Contraste/administração & dosagem , Preenchedores Dérmicos/administração & dosagem , Feminino , Humanos , Imageamento Tridimensional , Injeções Subcutâneas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Órbita/irrigação sanguínea , Artérias Temporais/diagnóstico por imagem , Artérias Temporais/lesões , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/etiologia , Zigoma/irrigação sanguínea
8.
Medicine (Baltimore) ; 100(20): e25804, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011043

RESUMO

ABSTRACT: The aim of the study was to assess the potential role of preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic enhanced MR imaging for diagnosing microvascular invasion (MVI) and pathological grade of hepatocellular carcinoma (HCC).A total of 113 consecutive HCC patients confirmed by histopathology underwent preoperative Gd-EOB-DTPA dynamic enhanced MRI were included. Signal intensity (SI) of peritumoral, normal liver tissue and tumor parenchyma during arterial phase and hepatobiliary phase (HBP) were analyzed. The receiver operating characteristic (ROC) curves were performed to assess the potential diagnostic capability for MVI and pathological grade of HCC. Kaplan-Meier method was performed to estimate the recurrence-free survival rate and compared using the log rank test.SI ratio of peritumoral tissue to normal liver in arterial phase (SIAp/Al) was independently associated with MVI [odds ratio (OR) = 3.115, 95% confidence interval (CI): 1.867-5.198] and pathological grades (OR = 1.437, 95% CI: 1.042-1.981). The area under the curve (AUC) of SIAp/Al was equivalent to the SI of tumor parenchyma on arterial phase (SIAt) in distinguishing low and high pathological grades. However, the AUC of SIAp/Al (0.851) was larger than peritumoral hypointensity on HBP (0.668) for distinguishing MVI. The recurrence-free survival rate of HCC patients with SIAp/Al<1.1 was higher than HCC with SIAp/Al≥1.1(P = .025).The SIAp/Al in preoperative Gd-EOB-DTPA dynamic enhanced MR imaging is a potential diagnosis marker for MVI and pathological grade of HCC noninvasively. The higher SIAp/Al may predict the poor prognosis of HCC after surgery.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Recidiva Local de Neoplasia/epidemiologia , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Meios de Contraste/administração & dosagem , Intervalo Livre de Doença , Feminino , Seguimentos , Gadolínio DTPA/administração & dosagem , Hepatectomia , Humanos , Fígado/irrigação sanguínea , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Microvasos/diagnóstico por imagem , Microvasos/patologia , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Curva ROC , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 100(20): e25928, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011065

RESUMO

ABSTRACT: Bilateral kidney damage in hypertensive patients is not parallel. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), as a commonly used antihypertensive drug, could protect kidney function and delay its deterioration. Most studies focused on overall renal function, but the researches on split renal function (SRF) are rare. We investigated the effects of ACEI/ARB on the SRF in patients with primary hypertension.Patients with primary hypertension (n = 429; male: 213; female: 216) admitted to our department between January 2014 and December 2016 were included in this study. The glomerular filtration rate (GFR) of split and total renal function were determined using diethylenetriaminepentaacetic acid tagged with 99mTc renal dynamic imaging method. For the same patient, the side with high GFR was considered as higher GFR kidney, whereas that with a low GFR was considered as lower GFR kidney. The split function score (Q value) was utilized to evaluate the differences of bilateral renal function. The patients were divided into 3 groups based on the Q values (Group 1, Q value <5%; Group 2, Q value of 5%-10%; Group 3, Q value ≥10%). All the patients received antihypertensive therapy based on ACEI/ARB. The renal dynamic imaging was performed in the 1-year follow-up to investigate the changes of the SRF.Compared with the baseline level, significant decline was noticed in the serum creatinine (Scr) in Group 2 and Group 3 (P < .05). The cystatin C in Group 3 showed significant decline (P < .05). Compared with the baseline, there was significant decline in the Q value in Group 2, whereas the GFR of lower GFR kidney showed significant increase (P < .05). No statistical differences were noticed in the Q value and split GFR in Group 1 and Group 3 (P > .05).In primary hypertension patients, ACEI/ARB therapy could improve the SRF of lower GFR kidney in the presence of certain differences between the SRF. As a result, the SRF difference was reduced. In case of Q value in a range of 5% to 10%, ACEI/ARB could improve the renal function effectively. It may be significant for the design of antihypertensive drugs.


Assuntos
Antagonistas de Receptores de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Hipertensão/tratamento farmacológico , Rim/efeitos dos fármacos , Insuficiência Renal/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Creatinina/sangue , Cistatina C/sangue , Feminino , Seguimentos , Taxa de Filtração Glomerular/efeitos dos fármacos , Taxa de Filtração Glomerular/fisiologia , Humanos , Hipertensão/sangue , Hipertensão/complicações , Rim/diagnóstico por imagem , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Insuficiência Renal/etiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Resultado do Tratamento
10.
Anticancer Res ; 41(5): 2477-2484, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952474

RESUMO

BACKGROUND/AIM: Positron emission tomography/computed tomography (PET/CT) plays an important role in cancer localization in ectopic Cushing's syndrome (ECS). However, the choice of the optimal tracer for investigation of this disease is still unclear. We aimed to evaluate the diagnostic feasibility of [18F]fluoro-2-deoxyglucose ([18F]FDG), [18F]fluoro-L-dihydroxyphenylalanine ([18F] FDOPA), and [68Ga]-DOTA-1-Nal3-octreotide ([68Ga]-DOTANOC) in ECS. PATIENTS AND METHODS: All PET/CT scans of patients admitted to our department for suspected ECS between 2010 and 2020 were retrospectively analysed. RESULTS: Collectively, 30 PET/CT examinations, 11 with [18F]FDOPA, 11 with [18F]FDG and 8 with [68Ga]GaDOTANOC were conducted for 18 patients eligible for analysis. [18F]FDG detected the tumour in 3/6 of the cases, [18F]FDOPA in 3/4, and [68Ga]GaDOTANOC in 3/3. [18F]FDOPA was the only tracer without false positive results. CONCLUSION: [68Ga]GaDOTANOC and [18F]FDOPA showed superior results compared to [18F]FDG, although the sensitivity of the tracers might be influenced by the aetiology of the tumour underlying the ECS.


Assuntos
Meios de Contraste/administração & dosagem , Síndrome de Cushing/diagnóstico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Idoso , Síndrome de Cushing/diagnóstico por imagem , Síndrome de Cushing/patologia , Feminino , Gadolínio/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade
11.
Cancer Med ; 10(9): 3077-3084, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33797861

RESUMO

PURPOSE: The aim of this study was to explore the feasibility of 3D printing of kidney and perinephric fat based on low-dose CT technology. PATIENTS AND METHODS: A total of 184 patients with stage T1 complex renal tumors who underwent laparoscopic nephrectomy were prospectively enrolled and divided into three groups: group A (conventional dose kidney and perinephric fat 3D printing group, n = 62), group B (low-dose kidney and perinephric fat 3D printing, n = 64), and group C (conventional dose merely kidney 3D printing group, n = 58). The effective dose (ED), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were determined. The 3D printing quality was evaluated using a 4-point scale, and interobserver agreement was assessed using the intraclass correlation coefficient (ICC). RESULTS: The ED of group B was lower than that of group A, with a decrease of 55.1%. The subjective scores of 3D printing quality in all groups were 3 or 4 points. The interobserver agreement among the three observers in 3D printing quality was good (ICC = 0.84-0.92). The perioperative indexes showed that operation time (OT), warm ischemia time (WIT), estimated blood loss (EBL), and laparoscopic partial nephrectomy (LPN) conversion to laparoscopic radical nephrectomy (LRN) in groups A or B were significantly less than those in group C. LPN was more frequent in group A and group B than in group C (all p < 0.017). There were no significant differences in perioperative indexes between group A and group B (all p > 0.017). CONCLUSION: Low-dose CT technology can be effectively applied to 3D printing of kidney and perinephric fat and reduce the patient's radiation dose without compromising 3D printing quality. 3D printing of kidney and perinephric fat can significantly increase the success rate of LPN and decrease OT, WIT, and EBL.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Rim/diagnóstico por imagem , Nefrectomia/métodos , Impressão Tridimensional/normas , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Meios de Contraste/administração & dosagem , Estudos de Viabilidade , Feminino , Humanos , Isquemia , Rim/irrigação sanguínea , Rim/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrectomia/estatística & dados numéricos , Duração da Cirurgia , Doses de Radiação , Razão Sinal-Ruído
12.
Biochem Med (Zagreb) ; 31(2): 021001, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-33927559

RESUMO

The detection of monoclonal immunoglobulins is a key element in the diagnosis of monoclonal gammopathy. In clinical practice, screening and measurement of monoclonal proteins are commonly performed using capillary zone electrophoresis (CZE). Some exogenous substances, such as iodinated contrast agents, absorb incident UV light at the same wavelengths as the peptide bonds and may therefore interfere with the detection of proteins in CZE. We herein use the description of a case to illustrate that iodinated contrast agents can mask the presence of monoclonal immunoglobulins in CZE and we discuss the strategy needed to confirm this interference. Performing immunofixation, immunosubtraction, or a second CZE at a distance from the first blood sample is not only necessary to confirm the presence of an iodinated contrast media interference but also to ensure the absence of monoclonal proteins.


Assuntos
Meios de Contraste/efeitos adversos , Eletroforese Capilar , Imunoglobulinas/sangue , Paraproteinemias/sangue , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Feminino , Humanos
13.
J Med Ultrason (2001) ; 48(2): 137-144, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33837866

RESUMO

PURPOSE: We previously reported that acoustic radiation force impulse (ARFI) with concomitant administration of perfluorobutane as an ultrasound contrast agent (UCA)-induced arrhythmias at a mechanical index (MI) of 1.8 or 4.0 in a rabbit model. The present study identified the location of arrhythmias with a MI < 1.8 using a new system that can transmit ARFI with B-mode imaging. METHODS: Under general anesthesia, six male Japanese white rabbits were placed in a supine position. Using this system, we targeted ARFI to the exact site of the heart. ARFI exposure with MI 0.9-1.2 was performed to the right or left ventricle of the heart 2 min after UCA injection. RESULTS: ARFI with a MI lower than previously reported to rabbit heart evoked extrasystolic waves with single UCA infusion. Arrhythmias were not observed using ARFI without UCA. Extrasystolic waves were observed significantly more frequently in the right ventricle group than in the left ventricle group, with arrhythmias showing reversed shapes. No fatal arrhythmias were observed. CONCLUSION: ARFI applied to simulate clinical conditions in rabbit heart evoked extrasystolic waves with single UCA infusion. The right ventricle group was significantly more sensitive to ARFI exposure, resulting in arrhythmias, than the left ventricle group. The shapes of PVCs that occurred in the right ventricle group and the left ventricle group were reversed. Ultrasound practitioners who use ARFI should be aware of this adverse reaction, even if the MI is below the previously determined value of 1.9.


Assuntos
Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/diagnóstico por imagem , Meios de Contraste/efeitos adversos , Técnicas de Imagem por Elasticidade/métodos , Fluorcarbonetos/efeitos adversos , Aumento da Imagem/métodos , Animais , Arritmias Cardíacas/fisiopatologia , Meios de Contraste/administração & dosagem , Modelos Animais de Doenças , Fluorcarbonetos/administração & dosagem , Coração/diagnóstico por imagem , Coração/fisiopatologia , Masculino , Coelhos
14.
Surgery ; 170(2): 596-602, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33836900

RESUMO

BACKGROUND: Gastrografin challenge is increasingly used as a diagnostic tool to predict patients who may benefit from nonoperative management in adhesive small bowel obstruction. This study explores the optimal timing of Gastrografin in the management of adhesive small bowel obstruction by comparing early versus late Gastrografin challenge. METHODS: A retrospective chart review from January 2016 to January 2018 identified patients with adhesive small bowel obstruction who underwent Gastrografin challenge. A receiver operating characteristic curve, to predict a duration of stay less than 5 days, calculated a 12-hour limit which separated early and late groups. Nonoperative and operative patients were compared separately. Our primary outcome was duration of stay. Secondary outcomes included operative requirement, time to the operating room, complication rate, and 1-year mortality. In a separate analysis, multivariable logistic regression identified independent risk factors for 1-year mortality. RESULTS: One hundred thirty-four patients were identified (58 early, 76 late). In nonoperative patients, the early group had a shorter duration of stay (3.2 days vs 5.4 days), fewer complications, and a lower complication and 1-year mortality rate (P < .05). In operative patients, the early group had a shorter preoperative duration of stay (1.8 days vs 3.9 days) (P < .05). On multivariable regression, congestive heart failure, any postoperative complication, and operative requirement were the best predictors of 1-year mortality (R2 = 0.321; P < .05). CONCLUSION: Gastrografin administration within 12 hours of adhesive small bowel obstruction diagnosis had favorable outcomes in terms of duration of stay, complications, and mortality in nonoperative patients. Moreover, in operative patients, preoperative duration of stay was shortened. Our findings suggest protocolizing early Gastrografin challenge may be an important principle in adhesive small bowel obstruction management.


Assuntos
Meios de Contraste/administração & dosagem , Diatrizoato de Meglumina/administração & dosagem , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intestino Delgado , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Obstrução Intestinal/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Aderências Teciduais , Tomografia Computadorizada por Raios X
15.
J Urol ; 206(3): 655-661, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33904760

RESUMO

PURPOSE: Previous studies have elucidated the unique macroscopic and histological properties of buccal mucosa that make it a viable and durable graft for urethral augmentation. However, no prior literature has directly investigated the impact of preoperative oral health on these features. MATERIALS AND METHODS: We analyzed all consenting patients who underwent buccal mucosal graft (BMG) urethroplasty at our institution from 2018 to 2020. Validated oral health surveys, the Oral Health Impact Profile (OHIP-14) and the Kayser-Jones Brief Oral Health Status Examination (BOHSE) were completed preoperatively. A staff pathologist analyzed BMG histology and quantified oral mucositis using a modified Oral Mucosa Rating Scale. RESULTS: We analyzed 51 patients with a median age of 40 years (IQR 31-58). Mean BOHSE score was 1.1 and OHIP-14 score was 1.4. Median epithelial thickness was 530 µm and lamina propria thickness was 150 µm. On age-adjusted analysis, increasing BOHSE and OHIP-14 were associated with decreasing epithelial thickness (p values <0.05). Higher BOHSE scores also correlated with thinner lamina proprias (p=0.05) and increased graft stretch (p=0.03). The 2 patients with postoperative urine leaks and available graft histology had lamina propria thicknesses well below the cohort median, at 50 µm and 60 µm. CONCLUSIONS: This is the first study to demonstrate that oral health conditions impact graft histology and stretch. Although much remains to be learned, our findings shed light on the potential importance of optimizing oral health prior to BMG urethroplasty, and raise the question of if preoperative mucosal biopsy could help inform surgical decision making and discussions regarding surgical success.


Assuntos
Mucosa Bucal/transplante , Saúde Bucal/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estreitamento Uretral/cirurgia , Adulto , Autoenxertos/diagnóstico por imagem , Autoenxertos/patologia , Autoenxertos/transplante , Biópsia , Tomada de Decisão Clínica , Meios de Contraste/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Inquéritos e Questionários/estatística & dados numéricos , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/estatística & dados numéricos , Resultado do Tratamento , Uretra/anormalidades , Uretra/diagnóstico por imagem , Uretra/patologia , Uretra/cirurgia , Urografia/métodos
16.
Medicine (Baltimore) ; 100(16): e25517, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879689

RESUMO

RATIONALE: Primary schwannoma of the thyroid gland is very rare, and its preoperative diagnosis is difficult. PATIENT CONCERNS: We report the case of a thyroid nodule in an 18-year-old woman, who presented with a mass in her left neck with stiffness and normal thyroid function. However, the patient complained of numbness in her left upper extremity, and ultrasound (US) features were suspicious of malignancy. DIAGNOSES: Multimodal US imaging was performed using B-mode, color doppler, ultrasonic elastography (UE), and contrast-enhanced ultrasound (CEUS). CEUS revealed heterogeneous enhancement and "target sign" within the tumor. The nodule was suspicious for malignancy and classified as TI-RADS 4b, while the elasticity values measured by UE indicated a benign lesion. Fine needle aspiration (FNA) was subsequently performed in the markedly contrast-enhanced area for biopsy. Cytological results revealed a benign schwannoma. INTERVENTION: The patient underwent left lobe resection. Postoperative pathology confirmed it to be a primary benign schwannoma of the thyroid. OUTCOMES: After thyroidectomy, the patient was followed-up with US. At present, all laboratory tests and thyroid imaging are normal, and the numbness of the left upper limb has disappeared. LESSONS: The combination of different US modalities is useful for the diagnosis of thyroid lesions. FNA performed under CEUS guidance improves the accuracy of biopsy sampling.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Neurilemoma/diagnóstico , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico , Ultrassonografia Doppler em Cores/métodos , Adolescente , Biópsia por Agulha Fina , Meios de Contraste/administração & dosagem , Feminino , Humanos , Imagem Multimodal/métodos , Neurilemoma/patologia , Neurilemoma/cirurgia , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Resultado do Tratamento
18.
Pan Afr Med J ; 38: 123, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33912293

RESUMO

This study reports the case of a 45-year-old female patient who underwent brain CT scan which fortuitously revealed de novo lesion. She was diagnosed with left isodense intradiploid lesion in the pterional region with bone lysis uniformly enhancing after injection of contrast medium. Magnetic resonance imaging showed T1-weighted hypointense lesion, spontaneously hyperintense signal on T2-weighted images and FLAIR images, strongly enhancing after gadolinium injection. Total tumor excision was performed. Histological examination showed chordoid meningioma.


Assuntos
Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Feminino , Gadolínio/administração & dosagem , Humanos , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/patologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Int J Radiat Oncol Biol Phys ; 109(5): 1472-1482, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33714528

RESUMO

PURPOSE: Chemoradiation therapy is the standard of care in muscle-invasive bladder cancer (MIBC). Although agents such as gemcitabine can enhance tumor radiosensitivity, their side effects can limit patient eligibility and treatment efficacy. This study investigates ultrasound and microbubbles for targeting gemcitabine delivery to reduce normal-tissue toxicity in a murine orthotopic MIBC model. MATERIALS AND METHODS: CD1-nude mice were injected orthotopically with RT112 bladder tumor cells. Conventional chemoradiation involved injecting gemcitabine (10 mg/kg) before 6 Gy targeted irradiation of the bladder area using the Small Animal Radiation Research Platform (SARRP). Ultrasound-mediated gemcitabine delivery (10 mg/kg gemcitabine) involved either coadministration of microbubbles with gemcitabine or conjugating gemcitabine onto microbubbles followed by exposure to ultrasound (1.1 MHz center frequency, 1 MPa peak negative pressure, 1% duty cycle, and 0.5 Hz pulse repetition frequency) before SARRP irradiation. The effect of ultrasound and microbubbles alone was also tested. Tumor volumes were measured by 3D ultrasound imaging. Acute normal-tissue toxicity from 12 Gy to the lower bowel area was assessed using an intestinal crypt assay in mice culled 3.75 days posttreatment. RESULTS: A significant delay in tumor growth was observed with conventional chemoradiation therapy and both microbubble groups (P < .05 compared with the radiation-only group). Transient weight loss was seen in the microbubble groups, which resolved within 10 days posttreatment. A positive correlation was found between weight loss on day 3 posttreatment and tumor growth delay (P < .05; R2 = 0.76). In contrast with conventional chemoradiation therapy, ultrasound-mediated drug delivery methods did not exacerbate the acute intestinal toxicity using the crypt assay. CONCLUSIONS: Ultrasound and microbubbles offer a promising new approach for improving chemoradiation therapy for muscle-invasive bladder cancer, maintaining a delay in tumor growth but with reduced acute intestinal toxicity compared with conventional chemoradiation therapy.


Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Quimiorradioterapia/efeitos adversos , Desoxicitidina/análogos & derivados , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/prevenção & controle , Neoplasias da Bexiga Urinária/terapia , Animais , Antimetabólitos Antineoplásicos/efeitos adversos , Biotinilação , Linhagem Celular Tumoral , Quimiorradioterapia/métodos , Meios de Contraste/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/síntese química , Feminino , Humanos , Intestinos/efeitos da radiação , Camundongos , Camundongos Nus , Microbolhas , Invasividade Neoplásica , Carga Tumoral , Ultrassonografia , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologia
20.
Am J Emerg Med ; 47: 70-73, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33774453

RESUMO

PURPOSE: The aim of this study was to determine if contrast-enhanced CT can safely exclude obstructive urolithiasis in patients with flank plain. We performed a retrospective cohort analysis to compare the negative predictive values of contrast-enhanced and non-contrast CTs for the detection of obstructing urolithiasis. METHODS: Through report analysis, we identified all non-contrast and contrast-enhanced CT examinations of the abdomen and pelvis performed on adult patients in the emergency department at a single, multi-site academic medical institution in 2017 with an indication of flank pain. The prevalence of obstructive urolithiasis in each group was calculated. We subsequently analyzed 200 consecutive studies from each of these groups (reported negative for obstructive urolithiasis) for negative predictive value calculation. Follow up abdominal imaging within 7 days from original presentation was used as a reference standard for analysis. RESULTS: In the noncontrast group, 1 study out of 200 was false negative (negative predictive value = 99.5%). In the contrast-enhanced group, there were no false negatives (negative predictive value = 100%). The prevalence of obstructive urolithiasis was 44.0% (351/797) in the noncontrast group and 18.7% (86/459) in the contrast-enhanced group. CONCLUSION: Our results suggest that contrast-enhanced CT can safely exclude obstructing ureteral calculi in the setting of acute flank pain. This finding is of clinical relevance given the inherent benefit of IV contrast in diagnosing abdominopelvic pathology.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , Urolitíase/diagnóstico , Adulto , Idoso , Meios de Contraste/administração & dosagem , Feminino , Dor no Flanco/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...