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1.
Surg Clin North Am ; 100(6): 1049-1067, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128879

RESUMO

Polyps in the upper and lower gastrointestinal tract can be premalignant or malignant lesions that can be treated endoscopically in early stages to prevent morbidity and more invasive procedures. This article critically reviews the techniques available and provides recommendations for endoscopic polypectomy.


Assuntos
Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/normas , Neoplasias Gastrointestinais/cirurgia , Pólipos/cirurgia , Endoscopia Gastrointestinal/instrumentação , Neoplasias Gastrointestinais/diagnóstico , Trato Gastrointestinal/anatomia & histologia , Trato Gastrointestinal/cirurgia , Humanos , Assistência Perioperatória/normas , Pólipos/diagnóstico , Guias de Prática Clínica como Assunto/normas
2.
Hinyokika Kiyo ; 66(9): 303-306, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988167

RESUMO

A 56-year-old woman presented with left flank pain. Computed tomography revealed hydronephrosis and a 35 mm mass in the left renal pelvis. Ureteroscopy revealed a white elevated lesion in the left renal pelvis. Tissue biopsy was performed and the histological findings showed no evidence of malignancy. Urine cytology was class III. Based on these results, we could not completely rule out malignancy. Left retroperitoneoscopic nephroureterectomy was performed and a pedunculated white mass was found in the renal pelvis. The pathological diagnosis was a fibroepithelial polyp of the renal pelvis. Fibroepithelial polyps in the urinary tract are relatively rare, and those in the renal pelvis even more so. When the preoperative diagnosis shows no malignant findings, fibroepithelial polyps should be considered as a differential diagnosis.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Pólipos/diagnóstico por imagem , Pólipos/diagnóstico , Pólipos/cirurgia , Neoplasias Cutâneas , Feminino , Humanos , Pelve Renal/diagnóstico por imagem , Pelve Renal/cirurgia , Pessoa de Meia-Idade , Ureteroscopia
3.
Khirurgiia (Mosk) ; (6): 49-52, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573532

RESUMO

OBJECTIVE: To study the incidence of gallbladder polyps and the possibilities of modern methods of diagnosis and surgical treatment of this disease. MATERIAL AND METHODS: There were 42 laparoscopic cholecystectomies in patients with diagnosed gallbladder polyps. The polyps were diagnosed preoperatively. Intraoperative diagnosis during surgery for gallstone disease was observed in 3 cases. A comparative analysis of preoperative examination did not reveal any advantages of certain diagnostic approach. RESULTS: Hyperplastic polyp was the most common type (n=20, 47.6%), adenomatous polyps occurred in 19 (45.3%) cases, cholesteric polyps - in 3 (7.1%) patients. All patients had signs of chronic inflammation of the gallbladder wall with its infiltration by lymphocytes and histiocytes. CONCLUSION: Further studies with clear criteria for the diagnosis of gallbladder polyps including ones for determining true polyps, precancerous and malignant polyps are required.


Assuntos
Doenças da Vesícula Biliar/cirurgia , Pólipos/cirurgia , Colecistectomia Laparoscópica , Colecistite/cirurgia , Doença Crônica , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Pólipos/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/cirurgia
4.
Am J Ophthalmol ; 217: 240-251, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32445699

RESUMO

PURPOSE: Indocyanine green angiography (ICGA) was compared with swept-source optical coherence tomography angiography (SS-OCTA) for the detection of polypoidal choroidal vasculopathy (PCV). DESIGN: Retrospective, cross-sectional. METHODS: Patients with treatment-naïve PCV based on ICGA imaging underwent same-day SS-OCTA imaging at Kyung Hee University Medical Center between April 2017 and November 2018. ICGA and SS-OCTA images were graded independently. SS-OCTA images were graded using both flow and structural information. Images were graded for the number of polypoidal lesions and the total lesion area, which included both the polypoidal lesions and the branching vascular networks (BVNs). RESULTS: A total of 31 eyes from 30 patients were enrolled. Polypoidal lesions were identified in all eyes using both modalities, and there was agreement on the number of polypoidal lesions in 17 eyes (55%). In 12 eyes (39%), SS-OCTA graders identified a greater number of polypoidal lesions, and in 2 eyes (6%) ICGA graders identified more lesions. There was no significant difference in the lesion area measurements (standard deviation = 1.09, P = .08). The lesion with the largest difference in area measurements resulted from focal areas of atrophy, misdiagnosed as polypoidal lesions on ICGA, and a low-lying serous retinal pigment epithelial detachment erroneously identified as part of the BVN by ICGA graders. SS-OCTA imaging correctly diagnosed the focal areas of atrophy and the serous retinal pigment epitheial detachment. CONCLUSIONS: SS-OCTA imaging was comparable to ICGA for the diagnosis of treatment-naïve PCV. However, SS-OCTA might be better than ICGA in correctly identifying both polypoidal lesions and BVNs in treatment-naïve PCV.


Assuntos
Doenças da Coroide/diagnóstico , Corioide/irrigação sanguínea , Angiofluoresceinografia/métodos , Verde de Indocianina/farmacologia , Pólipos/diagnóstico , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Idoso , Corioide/diagnóstico por imagem , Corantes/farmacologia , Estudos Transversais , Feminino , Fundo de Olho , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
5.
BMC Med Genet ; 21(1): 52, 2020 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171268

RESUMO

BACKGROUND: Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant genodermatosis characterized by benign growth of the hair follicles, the presence of pulmonary cysts, spontaneous pneumothorax, and bilateral renal tumors that are usually hybrid oncocytic or multifocal chromophobe renal cell carcinoma. The diagnosis is confirmed by the presence of a pathogenic variant in the tumor suppressor folliculin (FLCN) gene mapped at 17p11.2. Although the dermatological lesions typical of BHDS are benign and only cause aesthetic concerns, and the pulmonary manifestations are controllable, the greater tendency of patients with this syndrome to present benign or malignant renal tumors, often bilateral and multifocal, makes the diagnosis of this syndrome important for the prognosis of the patients. The objective was to report the case of a patient with BHDS, without pulmonary manifestations and with hyperplastic polyposis of the gastrointestinal tract, and to perform a literature review. CASE PRESENTATION: A 60-year-old man complained of abdominal pain and diarrhoea for 2 months. Physical examination was normal except for the presence of normochromic papules in the frontal region of the face associated with hyperkeratotic and hyperchromic papules in the dorsal region. The excisional biopsies of the skin lesions indicated trichodiscomas. Esophagogastroduodenoscopy, enteroscopy, and colonoscopy showed the presence of hyperplastic polyps in the stomach, duodenum, jejunum, colon, and rectum. Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed multiple expansive solid lesions in both kidneys, with necrotic and calcified areas. Renal magnetic resonance angiography also showed a solid lesion in the right kidney measuring 5 cm in diameter and another solid lesion in the left kidney measuring 8 cm in diameter, both suggestive of renal angiomyolipoma. CT scans of the skull, chest, and temporal bones were normal. The genetic study revealed the presence of a variant of FLCN in the intron 13. CONCLUSIONS: To the best of our knowledge, this is the first reported case of BHDS with the simultaneous finding of gastrointestinal hyperplastic polyposis, which may represent a possible phenotypic expression of this syndrome that has not yet been described.


Assuntos
Síndrome de Birt-Hogg-Dubé/complicações , Neoplasias Gastrointestinais/complicações , Trato Gastrointestinal/patologia , Pólipos/complicações , Síndrome de Birt-Hogg-Dubé/diagnóstico , Síndrome de Birt-Hogg-Dubé/genética , Diagnóstico Diferencial , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/genética , Humanos , Hiperplasia/complicações , Hiperplasia/diagnóstico , Hiperplasia/genética , Pólipos Intestinais/complicações , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/genética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/genética , Pólipos/diagnóstico , Pólipos/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Supressoras de Tumor/genética
6.
J Surg Res ; 250: 226-231, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32106001

RESUMO

BACKGROUND: Gallbladder cancer is rare but associated with significant morbidity and mortality necessitating the early identification of premalignant and malignant lesions to improve overall prognosis. Despite limited evidence regarding the effectiveness of transabdominal ultrasound (US) in the detection of gallbladder polyps, it plays a key role in current European guidelines. The aim of this study was to investigate gallbladder polyp prevalence in a western European population and assess the diagnostic accuracy of transabdominal US. METHODS: Data from patients who underwent cholecystectomy for US detected gallbladder polypoid lesions at four hospitals in Ireland and the United Kingdom between 2010 and 2018 were retrospectively collected. Patient demographics, ultrasonographic, and histopathologic findings were analyzed. RESULTS: A total of 134 patients underwent cholecystectomy for US-detected gallbladder polyps. After histopathologic examination, pseudopolyps were found in 75 (56%) specimens with dysplastic or malignant polyps seen in only six (4.5%) specimens. Mean size for neoplastic polyps was 33 mm. The positive predictive value for US in detecting neoplastic polyps in this study was 4.5%, which is significantly lower than the 10%-15% reported previously. CONCLUSIONS: Although the prevalence of neoplastic polyps in this study is higher than in the previous literature, the distribution of pseudopolyps and true polyps is as expected. With all malignant polyps being >10 mm in diameter, these findings support the current size thresholds stated in European guidelines. The poor diagnostic accuracy of US demonstrated may have led to significant number of patients undergoing unnecessary surgical intervention, further supporting the argument for improved strategies for the investigation of gallbladder polyps.


Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Vesícula Biliar/diagnóstico por imagem , Pólipos/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Colecistectomia/estatística & dados numéricos , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/cirurgia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Ultrassonografia/estatística & dados numéricos , Reino Unido/epidemiologia , Adulto Jovem
7.
Taiwan J Obstet Gynecol ; 59(1): 85-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039807

RESUMO

OBJECTIVE: To evaluate differences in hysteroscopic findings between benign endometrial polyps and endometrial cancer. MATERIALS AND METHODS: From January 2012 to December 2016, we extracted 179 cases with endometrial polyps from 3066 women who underwent hysteroscopy followed by dilatation and curettage or transcervical resection, with 154 and 25 cases of benign and malignant endometrial polyps, respectively. Clinical characteristics, histopathological and hysteroscopic findings of the women were evaluated retrospectively. RESULTS: The hysteroscopic findings of malignant polyps were hyper-vascular (72%, 18/25), ulcerative (64%, 16/25) and polyps with irregular surfaces (24%, 6/25). In contrast, pedunculate small growths with smooth surfaces were usually seen in the benign endometrial polyps (38.3%, 59/154). Hyper-vascular (OR: 142.6, 95% CI: 25.98-783.4) and polyps with irregular surfaces (OR: 12.02, 95% CI: 1.765-81.83) in hysteroscopic findings were significant strong predictors of endometrial polyps with endometrial cancer. Hysteroscopic findings of ulcerative changes were most strongly associated with a diagnosis of malignant polyps, with sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of 64.0%, 100%, 94.5%, and 100%, respectively. CONCLUSION: Women with hysteroscopic findings of endometrial polyps with hyper-vascular, ulcerative, and polyps with irregular surfaces had a high likelihood of endometrial cancer. A target biopsy of the polyps with these specific appearances should be performed to exclude malignant lesions.


Assuntos
Neoplasias do Endométrio/diagnóstico , Histeroscopia/estatística & dados numéricos , Pólipos/diagnóstico , Doenças Uterinas/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Dilatação e Curetagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Gastroenterol. hepatol. (Ed. impr.) ; 43(2): 73-78, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188297

RESUMO

Introducción: La calprotectina en heces es una técnica útil para detectar actividad en pacientes con colitis ulcerosa. No obstante, puede haber valores elevados debido a otros factores distintos de la actividad de la colitis ulcerosa. Nuestro objetivo fue analizar posibles resultados falsos positivos de calprotectina para la actividad de la colitis ulcerosa debidos a la presencia de pólipos inflamatorios. Pacientes y métodos: Estudio retrospectivo, descriptivo y observacional. Se recogieron los datos de pacientes seguidos durante 2 años en los que se realizó una colonoscopia dentro de los 3 meses posteriores a detectarse valores de calprotectina elevados (>150μg/g) antes de modificar el tratamiento. Resultados: Se revisaron 39 pacientes y en 5 de ellos, previamente diagnosticados de colitis ulcerosa extensa, se detectaron pólipos inflamatorios. Tres pacientes tomaban mesalazina, uno azatioprina y otro estaba en tratamiento con infliximab. Todos ellos se encontraban asintomáticos y la endoscopia no presentaba actividad macroscópica (Mayo endoscópico=0) ni histológica. La mediana de los valores de calprotectina fue de 422μg/g (RIC: 298-2.408) y permanecieron elevados en una segunda determinación. En 4 de los pacientes los pólipos inflamatorios eran múltiples y de pequeño tamaño. Otro paciente presentaba un pólipo de 4cm. Discusión: En la práctica clínica podemos encontrar valores de calprotectina fecal elevados no debidos a la presencia de actividad de la colitis ulcerosa, sino a otras lesiones, como pólipos inflamatorios. Este hecho debe ser tenido en cuenta antes de llevar a cabo cambios relevantes como la subida de escalón terapéutico a inmunosupresores o biológicos en pacientes con elevación de calprotectina confirmada


Introduction: Faecal calprotectin is a useful technique for detecting activity in patients with ulcerative colitis. However, there may be high levels due to factors other than the activity of ulcerative colitis. Our aim was to analyse possible false positive results of calprotectin for the activity of ulcerative colitis owing to the presence of inflammatory polyps. Patients and methods: Retrospective, observational, descriptive study. Data was collected from patients monitored for 2 years in whom a colonoscopy had been requested within 3 months after detecting high calprotectin values (>150μg/g) and before modifying the treatment. Results: We reviewed 39 patients and in 5 of them, with previous diagnosis of extensive ulcerative colitis, inflammatory polyps were detected. Three patients were on treatment with mesalazine, one with azathioprine and other with infliximab. All of them were asymptomatic and the endoscopy did not show macroscopic activity (endoscopic Mayo score=0) or histological activity. The median values of calprotectin were 422μg/g (IQR: 298-2,408) and they remained elevated in a second measurement. In 4 of the patients the inflammatory polyps were multiple and small in size. The other patient had a polyp measuring 4cm. Discussion: In clinical practice we can find high faecal calprotectin levels not due to the presence of ulcerative colitis activity, but due to other lesions such as inflammatory polyps. This fact must be taken into account before carrying out relevant changes such as step-up therapy to immunosuppressive drugs or biological drugs in patients with confirmed high calprotectin levels


Assuntos
Humanos , Colite Ulcerativa/diagnóstico , Pólipos/diagnóstico , Biomarcadores/análise , Pólipos/complicações , Fezes/química , Estudos Retrospectivos , Colonoscopia/métodos , Doenças Inflamatórias Intestinais/diagnóstico
9.
Ann R Coll Surg Engl ; 102(4): e89-e90, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31964152

RESUMO

A fibrovascular polyp is a rare benign pseudotumour of the oesophagus and hypopharynx. Although patients usually present with dysphagia, aspiration related mortality may occur. If the tumour is too large and/or located in the proximal oesophagus, it may protrude from the mouth. The general approach to treatment is complete reconstruction with cervicotomy. We present our experience of a giant oesophageal fibrovascular polyp that was protruding from the mouth and treated with endoscopic resection. A 55-year-old man was admitted to our outpatient clinic complaining of a mass protruding from his mouth when he coughed. Endoscopy and bronchoscopy both revealed a 15-18cm long polypoid mass originating from the proximal oesophagus (at the level of the hypopharynx). Complete resection was performed via endoscopy.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagoscopia/métodos , Pólipos/cirurgia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Esôfago/patologia , Esôfago/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/patologia , Resultado do Tratamento , Carga Tumoral
10.
BMC Ophthalmol ; 20(1): 15, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914968

RESUMO

BACKGROUND: The concentrations of cytokines in the aqueous humor from neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) may vary. The study was conducted to compare various cytokine levels in the aqueous humor of eyes with PCV, nAMD and control. METHODS: The present case control study included 49 treatment-naïve eyes from 49 patients (PCV 24, nAMD 11, and cataract 14 eyes). Totally 34 angiogenic and inflammatory cytokines in the aqueous humor were measured by Luminex bead-based multiplex array. RESULTS: After adjusting for gender and age by multivariate logistic analysis, concentrations of IL-31, LIF, SDF1-α, VEGF-A, VEGF-D were significantly higher in eyes with nAMD or PCV compared with control eyes (all P < 0.05, times in nAMD: 59.5, 6.0, 7.0, 4.5, 5.6, respectively, times in PCV: 51.9, 5.21, 6.6, 4.0, 5.1, respectively), and concentrations of HGF, IP-10, MCP-1, IL-13 were significantly lower in eyes with nAMD or PCV than in control eyes (all P < 0.05, times in nAMD: 2.6, 2.0, 4.5, 4.7, respectively, times in PCV: 1.9, 3.0, 3.0, 2.8, respectively), but none of the 34 cytokines, including VEGF and IL-8, showed significantly different between eyes with nAMD and PCV. CONCLUSIONS: Various cytokines involved in inflammation and angiogenesis including elevated IL-31, LIF, SDF1-α, VEGF-A, VEGF-D might be involved in the pathogenesis of nAMD or PCV. None of the 34 cytokines may help to differentiate nAMD and PCV.


Assuntos
Humor Aquoso/metabolismo , Neovascularização de Coroide/metabolismo , Citocinas/metabolismo , Pólipos/metabolismo , Degeneração Macular Exsudativa/metabolismo , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neovascularização de Coroide/diagnóstico , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Pólipos/diagnóstico , Degeneração Macular Exsudativa/diagnóstico
12.
Indian J Ophthalmol ; 68(1): 134-140, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31856491

RESUMO

Purpose: To explore novel Optical Coherence Tomography (OCT) biomarkers and precursor lesions in Polypoidal Choroidal Vasculopathy (PCV). Methods: This retrospective cohort study included 76 treatment naïve fellow eyes of PCV. Focus was given to analyse the various morphological changes in the clinically unaffected fellow retina during the follow-up period. Results: 11 fellow eyes (14.47%) developed disease activity in the form of Sub Retinal Fluid (SRF) or Intra Retinal Fluid (IRF) within a mean follow-up of 17 months. All 11 eyes (100%) showed the presence of flat irregular pigment epithelial detachment (FIPED) and a peculiar property of lateral elongation of FIPED during disease activity. A positive correlation with the disease progression was found for the same (P < 0.0001). The mean horizontal dimension of the flat irregular PED at the enrolment was 1984 ± 376u and the mean expansion of FIPED at SRF formation was 461 ± 152u. ICG taken at the time of disease activity in the fellow eye revealed branching vascular network (BVN) in 9 (81.8%) eyes, polyps in 7 (63.6%) eyes, a combination of both in 5 (45.4%) eyes. Type one BVN with interconnecting channels showed faster disease progression than type two BVN. Eye tracking ICG illustrated that BVN corresponded to the FIPED in OCT and polypoidal lesions developed at the end of expanding FIPED. Conclusion: Flat irregular pigment epithelial detachment with its characteristic property of lateral elongation may be considered as a precursor lesion for PCV and as a novel OCT biomarker for the disease activity. Fellow eyes with FIPED need close monitoring to identify development of disease activity at the earliest.


Assuntos
Biomarcadores , Corioide/irrigação sanguínea , Neovascularização de Coroide/diagnóstico , Pólipos/diagnóstico , Descolamento Retiniano/diagnóstico por imagem , Epitélio Pigmentado da Retina/diagnóstico por imagem , Idoso , Corantes/administração & dosagem , Progressão da Doença , Feminino , Angiofluoresceinografia , Humanos , Verde de Indocianina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Líquido Sub-Retiniano , Tomografia de Coerência Óptica
13.
Comput Math Methods Med ; 2019: 4393124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31885680

RESUMO

Endoscopic diagnosis is an important means for gastric polyp detection. In this paper, a panoramic image of gastroscopy is developed, which can display the inner surface of the stomach intuitively and comprehensively. Moreover, the proposed automatic detection solution can help doctors locate the polyps automatically and reduce missed diagnosis. The main contributions of this paper are firstly, a gastroscopic panorama reconstruction method is developed. The reconstruction does not require additional hardware devices and can solve the problem of texture dislocation and illumination imbalance properly; secondly, an end-to-end multiobject detection for gastroscopic panorama is trained based on a deep learning framework. Compared with traditional solutions, the automatic polyp detection system can locate all polyps in the inner wall of the stomach in real time and assist doctors to find the lesions. Thirdly, the system was evaluated in the Affiliated Hospital of Zhejiang University. The results show that the average error of the panorama is less than 2 mm, the accuracy of the polyp detection is 95%, and the recall rate is 99%. In addition, the research roadmap of this paper has guiding significance for endoscopy-assisted detection of other human soft cavities.


Assuntos
Diagnóstico por Computador/métodos , Gastroscopia/métodos , Pólipos/diagnóstico , Gastropatias/diagnóstico , Algoritmos , Biologia Computacional , Diagnóstico por Computador/estatística & dados numéricos , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Pólipos/diagnóstico por imagem , Gastropatias/diagnóstico por imagem
14.
Prog. obstet. ginecol. (Ed. impr.) ; 62(6): 559-566, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-192143

RESUMO

La prevalencia de los pólipos endometriales se estima entre el 7,8 y el 35% de las mujeres, siendo mayor en el estado posmenopáusico. Los pólipos endometriales se asocian con hiperplasia endometrial y carcinogénesis, con una prevalencia informada de lesiones malignas y premalignas que puede llegar al 13%. La detección de pólipos endometriales en edad peri o posmenopáusica, en pacientes sintomáticas o asintomáticas, requiere un examen histeroscópico meticuloso. No está claro si la polipectomía debe realizarse de forma rutinaria en pacientes asintomáticas. El manejo expectante de pólipos pequeños y asintomáticos es razonable en muchos casos. Se necesitan estudios adicionales para dilucidar si los pólipos endometriales son precursores de cáncer, o simplemente marcadores de una enfermedad endometrial. Los biomarcadores capaces de detectar cambios a nivel molecular en los pólipos y el tejido endometrial nos ayudan a un mejor conocimiento y clasificación de los procesos malignos. Este conocimiento permite pasar de una medicina intervencionista a una medicina más conservadora, basada en la confianza de un conocimiento más preciso de los procesos biomoleculares. GynEC®-DX se basa en determinar la expresión de genes que se combinan en un algoritmo matemático diagnóstico para llegar a un diagnóstico negativo o positivo de cáncer de endometrio. La prueba molecular tiene un valor predictivo negativo del 99,6%, con una alta especificidad y sensibilidad. Esta prueba podría usarse para el diagnóstico diferencial del cáncer de endometrio en mujeres con pólipos endometriales sin requerir la exéresis de pólipos, limitando el riesgo iatrogénico y evitando intervenciones innecesarias


The prevalence of endometrial polyps is estimated between 7.8 and 35% of women, being more prevalent in postmenopausal women. Endometrial polyps are associated with endometrial hyperplasia and carcinogenesis, with an informed prevalence of malignant and premalignant lesions that may reach 13%. The detection of endometrial polyps in peri- or postmenopausal (status) age, in symptomatic or asymptomatic patients, requires a meticulous hysteroscopic examination. It is unclear if routine polypectomy should be performed in asymptomatic patients. The expectant management of small and asymptomatic polyps is reasonable in many cases. Additional studies are needed to elucidate whether endometrial polyps are precursors of cancer, or simply markers of an endometrial disease. Biomarkers capable of detecting changes at the molecular level in polyps and endometrial tissue help us to better understand and classify malignant processes. This knowledge allows to move from an interventional medicine to a more conservative medicine, based on the confidence of a more precise knowledge of the biomolecular processes. GynEC®-DX is based on determining the expression of genes that are combined in a diagnostic mathematical algorithm to arrive at a negative or positive diagnosis of endometrial cancer. The molecular test has a negative predictive value of 99.6%, with high specificity and sensitivity. This test could be used for the differential diagnosis of endometrial cancer in women with EPs and prevent the resection of polyps, limiting the iatrogenic risk and avoiding unnecessary interventions


Assuntos
Humanos , Feminino , Doenças Uterinas/diagnóstico , Biomarcadores , Pólipos/diagnóstico , Neoplasias do Endométrio/diagnóstico , Prevalência
15.
Pan Afr Med J ; 33: 211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693718

RESUMO

Introduction: Different diagnostic tools are available to evaluate endometrial focal lesion such as hysteroscopy, sonohystrography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with Abnormal Uterine Bleeding (AUB). Methods: This cross-sectional study recruited 100 married women with chief complain of AUB referred to gynecologic clinics at the Amir Al-Momenin hospital, Semnan, Iran from March 2014 to February 2016. All participants were in the reproductive age and post-menopausal period that showed abnormal endometrial thickness or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus focal lesion resection and endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist. Results: Mean±SD age of women was 41.2±11.3 years. To diagnose the overall focal lesions, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SIS were 79.6, 89.1, 89.6, and 78.8% respectively. These figures were 75.0, 87.5, 82.5 and 81.7%, respectively to diagnose polyps. The SIS sensitivity, specificity, PPV and NPV values to diagnose the myomas were 60.0, 97.8, 75.0, and 95.7% respectively. Conclusion: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.


Assuntos
Histeroscopia/métodos , Solução Salina/administração & dosagem , Doenças Uterinas/diagnóstico , Hemorragia Uterina/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/patologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Ultrassonografia/métodos , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
16.
Am J Case Rep ; 20: 1664-1668, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31712548

RESUMO

BACKGROUND Intravascular papillary endothelial hyperplasia (IPEH), is a vascular tumor characterized by the proliferation of endothelial cells with papillary formations. It is a rare benign disease; therefore, it is important to exclude malignant vascular neoplasm in order to prevent misdiagnosis and inappropriate overtreatment. CASE REPORT Herein, we describe the case of a 51-year-old male who reported changes in his voice, and who was preoperatively diagnosed with vocal cord polyp and hemorrhagic change based on laryngoscopy. He underwent laryngomicrosurgery and the lesion was completely excised via the microflap surgical method. Histopathology analysis was consistent with IPEH. CONCLUSIONS Herein, we report an extremely rare case of IPEH arising from the true vocal cord, and we provide a brief review of the relevant literature and a detailed discussion of this rare clinical entity.


Assuntos
Endotélio Vascular/patologia , Pólipos/diagnóstico , Neoplasias Vasculares/diagnóstico , Prega Vocal/patologia , Diagnóstico Diferencial , Humanos , Hiperplasia/diagnóstico , Masculino , Pessoa de Meia-Idade , Pólipos/cirurgia , Neoplasias Vasculares/cirurgia
17.
Acta Gastroenterol Belg ; 82(3): 437-439, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566334

RESUMO

Giant fibrovascular polyps of the esophagus are rare benign tumors that originate at the hypopharynx or the upper third of the esophagus. Because of the indolent and benign nature they are mostly discovered when very large with symptoms like dysphagia or regurgitation of the polyp into the mouth which can cause asphyxia and dead. The removal of these polyps is obligatory. Although more than 100 cases of giant fibrovascular esophageal polyps have been described in literature so far, the approach for removal is not yet standard and needs a customized use of medical technology from different disciplines. We present the case of a 42 year old man in whom a giant polyp was removed transorally by a combination of instruments and materials from different disciplines (gastroenterological, surgical and laryngological).


Assuntos
Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/cirurgia , Pólipos/cirurgia , Adulto , Neoplasias Esofágicas/patologia , Humanos , Masculino , Boca , Pólipos/diagnóstico , Resultado do Tratamento
18.
Optom Vis Sci ; 96(9): 686-694, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31479024

RESUMO

SIGNIFICANCE: In patients initially diagnosed as having unilateral polypoidal choroidal vasculopathy, the visual prognosis of the better-seeing eye is highly favorable. If patients are overly pessimistic regarding their vision in the future, physicians can encourage patients by informing them of the small possibility for visual deterioration in the better-seeing eye. PURPOSE: The purpose of this study was to investigate the long-term changes in the visual acuity of the better-seeing eyes in patients with unilateral polypoidal choroidal vasculopathy. METHODS: This retrospective, single-institution study was performed with 221 patients who were diagnosed as having unilateral polypoidal choroidal vasculopathy and who were treated with intravitreal anti-vascular endothelial growth factor. Only patients with an initially uninvolved eye best-corrected visual acuity (BCVA) of 20/40 or better and who were followed up for at least 24 months were included. The changes in the BCVAs of the initially involved and uninvolved eyes as well as the better-seeing eyes were measured. For patients with three or more lines of uninvolved eye visual deterioration, the cause for the visual deterioration was identified. RESULTS: Patients were followed up for a mean of 43.1 ± 11.8 months after diagnosis. During the follow-up period, three or more lines of deterioration in the BCVA were noted in 61 initially involved eyes (27.6%) and 11 uninvolved eyes (4.9%). The reasons for uninvolved eye visual deterioration were neovascularization (n = 8), retinal vein occlusion (n = 2), and posterior capsule opacification (n = 1). At diagnosis, the BCVA of the better-seeing eye was 0.05 ± 0.08 (Snellen equivalents, 20/22). During the follow-up period, three or more lines of deterioration in the BCVA for the better-seeing eye were noted in eight patients (3.6%). CONCLUSIONS: Visual acuity of the better-seeing eye over time remained stable in most patients who were initially diagnosed as having unilateral polypoidal choroidal vasculopathy. As a result, the visual prognosis of the better-seeing eye is highly favorable in this condition.


Assuntos
Corioide/irrigação sanguínea , Neovascularização de Coroide/fisiopatologia , Pólipos/fisiopatologia , Acuidade Visual/fisiologia , Idoso , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/tratamento farmacológico , Prognóstico , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
19.
Indian J Ophthalmol ; 67(10): 1756-1758, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31546555

RESUMO

Full-thickness macular hole (FTMH) formation in Polypoidal choroidal vasculopathy (PCV) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment is a rare complication. Spontaneous closure of FTMH following anti-VEGF therapy has not been described in PCV till date. We present a case of Asian woman with PCV who developed a FTMH following treatment with intra-vitreal anti-VEGF injections which subsequently closed spontaneously on further course of treatment.


Assuntos
Bevacizumab/administração & dosagem , Doenças da Coroide/tratamento farmacológico , Corioide/irrigação sanguínea , Pólipos/tratamento farmacológico , Perfurações Retinianas/diagnóstico , Inibidores da Angiogênese/administração & dosagem , Doenças da Coroide/complicações , Doenças da Coroide/diagnóstico , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Pólipos/complicações , Pólipos/diagnóstico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Remissão Espontânea , Perfurações Retinianas/etiologia , Tomografia de Coerência Óptica
20.
Gastric Cancer ; 22(6): 1294-1300, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31529234

RESUMO

A 37-year-old male with tarry stool presented to our hospital. Esophagogastroduodenoscopy revealed advanced gastric cancer, fundic gland polyposis (FGPsis), and negativity for Helicobacter pylori (HP) infection. Computed tomography exhibited multiple liver tumors. Total colonoscopy (TCS) demonstrated 139 tubular adenomas. He was diagnosed as having unresectable gastric cancer and received systemic chemotherapy. His sister and mother had colorectal adenomatous polyposis as revealed by TCS. His sister had FGPsis and was negative for HP infection, whereas his mother had early gastric cancer with HP infection but not FGPsis. Genetic analysis revealed a novel mutation in exon 15 of the APC gene (NM_000038.5: c.7647_7648_delTG) for the patient, his mother, and his sister, whereas no mutation was found for his father who had no gastrointestinal polyps. Therefore, the pedigree was diagnosed as an FAP family with a novel APC germline mutation which had different gastric phenotypes depending on the status of HP infection.


Assuntos
Polipose Adenomatosa do Colo/diagnóstico , Infecções por Helicobacter/diagnóstico , Pólipos/diagnóstico , Neoplasias Gástricas/diagnóstico , Polipose Adenomatosa do Colo/genética , Polipose Adenomatosa do Colo/patologia , Proteína da Polipose Adenomatosa do Colo/genética , Adulto , Colonoscopia , Endoscopia do Sistema Digestório , Mutação em Linhagem Germinativa , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Fenótipo , Pólipos/genética , Pólipos/patologia , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X
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