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Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32994178


BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method. METHODS: Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher's exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]). RESULTS: We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1-2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25-27.0) for the blind method (P = .001). CONCLUSIONS: Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.

Intubação Gastrointestinal/métodos , Imãs , Piloro , Adolescente , Adulto , Criança , Pré-Escolar , Estado Terminal , Campos Eletromagnéticos , Nutrição Enteral/métodos , Feminino , Humanos , Análise de Intenção de Tratamento , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Piloro/diagnóstico por imagem , Exposição à Radiação/prevenção & controle , Radiografia Abdominal/estatística & dados numéricos , Estatísticas não Paramétricas , Fatores de Tempo , Adulto Jovem
AJR Am J Roentgenol ; 215(3): 679-684, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755183


OBJECTIVE. The purpose of this study was to determine dose-area product-to-effective dose (DAP/E) conversion coefficients for a five-view pelvic radiograph series. DAP/E conversion coefficients may be used for radiation dose optimization when designing institutional protocols for pelvic trauma evaluation. MATERIALS AND METHODS. We conducted a retrospective record review of 25 patients at a level 1 trauma center who had sustained pelvic fractures and required a five-view pelvic radiograph series during workup. E values given in International Commission on Radiological Protection Publication 103 were simulated with a PC-based Monte Carlo program in conjunction with anthropomorphic phantoms adjusted on the basis of patient height and weight. Inputs included tube voltage (in kV), tube filtration (in millimeters of aluminum), anode angle, x-ray beam collimation, geometric distances, and angle of projection for each radiograph in the series. An incident polychromatic x-ray spectrum was generated and matched to the corresponding DAP values of each radiograph, and regression analysis was performed for the DAP/E conversion coefficients. RESULTS. E was strongly correlated with DAP independent from body mass index, with a mean global DAP/E conversion coefficient of 0.0125 mSv/dGy · cm2 for all radiographs (R2 = 0.95). Mean DAP/E conversion coefficients were 0.0133, 0.0110, 0.0143, 0.0113, and 0.0101 mSv/dGy · cm2 for anteroposterior, inlet, outlet, Judet left, and Judet right views, respectively (all R2 ≥ 0.94). CONCLUSION. DAP/E conversion coefficients are provided for a five-view pelvic radiograph series to allow reliable estimation of E. Measurement of cumulative E may affirm protocol design changes for the management of pelvic trauma.

Fraturas Ósseas/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/lesões , Doses de Radiação , Radiografia Abdominal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método de Monte Carlo , Imagens de Fantasmas , Estudos Retrospectivos , Centros de Traumatologia
AJR Am J Roentgenol ; 215(4): 885-895, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32755185


OBJECTIVE. Multiple endocrine neoplasia (MEN) syndromes are autosomal-dominant genetic disorders that predispose two or more organs of the endocrine system to tumor development. Although the diagnosis relies on clinical and serologic findings, imaging provides critical information for surgical management with the ultimate goal of complete tumor resection. CONCLUSION. This article reviews abdominal neoplasms associated with the various subtypes of MEN syndromes, with a focus on clinical presentation and characteristic imaging features.

Neoplasias Abdominais/diagnóstico por imagem , Neoplasia Endócrina Múltipla/diagnóstico por imagem , Neoplasias Abdominais/patologia , Humanos , Neoplasia Endócrina Múltipla/patologia , Radiografia Abdominal
AJR Am J Roentgenol ; 215(3): 685-694, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755203


OBJECTIVE. The purpose of this study was to evaluate radiation dose, effective dose, and image quality of different low-dose abdominal CT protocols in a swine model and an anthropomorphic phantom using a third-generation dual-source CT scanner. MATERIALS AND METHODS. Four different abdominal low-dose protocols were established using a swine model and were regarded as diagnostic by two experienced radiologists on the basis of clarity and sharpness of anatomic structures. General image conditions such as noise and spatial resolution as well as diagnostic acceptability and artifacts were evaluated. Objective image quality was determined by measuring signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in different anatomic locations. To evaluate the effective dose, thermoluminescent dosimeter (TLD) measurements were repeated in a phantom. RESULTS. Diagnostic acceptability, spatial resolution, and noise were rated as optimal in all four protocols, which were therefore regarded as diagnostic. We found no statistically significant differences in SNR or CNR for the four low-dose protocols. Effective dose determined from the phantom measurements did not exceed 0.33 mSv for any protocol. Overall evaluation of the 86 TLD measurements for the four low-dose protocols revealed a statistically significant difference in radiation dose (p < 0.0001), showing that the dual-source protocol had the lowest radiation dose. CONCLUSION. Submillisievert abdominal CT is feasible with good image quality and doses even lower than conventional abdominal radiography. Our dual-source protocol achieved the lowest dose, which further shows that dual-source imaging is possible in the submillisievert range without additional dose.

Doses de Radiação , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Animais , Imagens de Fantasmas , Suínos
Abdom Radiol (NY) ; 45(9): 2613-2623, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32761402


PURPOSE: Some patients with novel coronavirus disease 2019 (COVID-2019) present with abdominal symptoms. Abdominal manifestations of COVID on imaging are not yet established. The goal of this study was to quantify the frequency of positive findings on abdominopelvic CT in COVID-positive patients, and to identify clinical factors associated with positive findings to assist with imaging triage. MATERIALS AND METHODS: This retrospective study included adult COVID-positive patients with abdominopelvic CT performed within 14 days of their COVID PCR nasal swab assay from 3/1/2020 to 5/1/2020. Clinical CT reports were reviewed for the provided indication and any positive abdominopelvic findings. Demographic and laboratory data closest to the CT date were recorded. Multivariate logistic regression model with binary outcome of having no reported positive abdominopelvic findings was constructed. RESULTS: Of 141 COVID-positive patients having abdominopelvic CT (average age 64 years [± 16], 91 [64%] women), 80 (57%) had positive abdominopelvic findings. Abdominal pain was the most common indication, provided in 54% (43/80) and 74% (45/61) of patients with and without reported positive abdominopelvic findings, respectively (p = 0.015). 70% (98/141) of patients overall had reported findings in the lung bases. Findings either typical or intermediate for COVID were reported in 50% (40/80) and 64% (39/61) of patients with and without positive abdominopelvic findings, respectively (p = 0.099). Of 80 patients with positive abdominopelvic findings, 25 (31%) had an abnormality of gastrointestinal tract, and 14 (18%) had solid organ infarctions or vascular thromboses. In multivariate analysis, age (OR 0.85, p = 0.023), hemoglobin (OR 0.83, p = 0.029) and male gender (OR 2.58, p = 0.032) were independent predictors of positive abdominopelvic findings, adjusted for race and Charlson comorbidity index. CONCLUSION: Abdominopelvic CT performed on COVID-positive patients yielded a positive finding in 57% of patients. Younger age, male gender, and lower hemoglobin were associated with higher odds of having reportable positive abdominopelvic CT findings.

Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Radiografia Abdominal/métodos , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Fatores Sexuais , Tomografia Computadorizada por Raios X/métodos
Cir. pediátr ; 33(3): 146-148, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193558


INTRODUCCIÓN: La bolsa colónica congénita (BCC) es una malformación poco común en la que se produce una dilatación variable del colon asociada a malformación anorrectal (MAR); generalmente presenta una fístula hacia el tracto genitourinario. CASO CLÍNICO: Paciente femenino de 2 días de vida, sin antecedentes médicos de relevancia, presenta distensión abdominal y ano imperforado. Es sometida a colostomía, presenta evolución irregular con débitos altos a través de la colostomía, se realizan estudios contrastados de imagen donde se observa exteriorización errónea de asa de yeyuno, se somete a laparotomía exploratoria donde se comprueba lo descrito y además se reporta como hallazgo incidental agenesia colónica con desembocadura del íleon en una bolsa de 6 cm de diámetro que se conecta con la vejiga. DISCUSIÓN: La BCC es una patología común en ciertos países orientales y extremadamente rara en países occidentales; en Ecuador no se encontraron registros de casos reportados. Se debe realizar un correcto análisis prequirúrgico de los pacientes con MAR para conseguir una adecuada planificación y abordaje quirúrgico, disminuyendo con ello la morbimortalidad en el paciente

INTRODUCTION: Congenital pouch colon (CPC) is a rare malformation. It causes variable dilatation of the colon associated with anorectal malformation (ARM), usually presenting a fistula towards the genitourinary tract. CLINICAL CASE: 2-day-old female patient, with no relevant medical history. She had abdominal distension and imperforate anus. She underwent colostomy. She had an irregular evolution with high colostomy debits. Contrast imaging studies were performed, which demonstrated an erroneous exteriorization of the jejunal loop. She underwent an exploratory open surgery, which confirmed the previous diagnosis and incidentally found colonic agenesis, with ileum entering in a pouch of 6 cm of diameter that connects with the bladder. DISCUSSION: CPC is a common pathology in certain eastern countries and extremely rare in western countries. In Ecuador, no records of reported cases were found. A correct pre-surgical analysis of ARM patients should be carried out to achieve an adequate planning and surgical approach, thus reducing morbidity and mortality

Humanos , Feminino , Recém-Nascido , Colo/anormalidades , Colo/cirurgia , Parede Abdominal/cirurgia , Colostomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Intestinal/cirurgia , Radiografia Abdominal
Cir. pediátr ; 33(3): 149-152, jul. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193559


INTRODUCCIÓN: La ceftriaxona es un antibiótico de amplio espectro frecuentemente utilizado en pediatría. La pseudolitiasis vesicular es un efecto adverso bien conocido que se presenta en un 15 a 57% de los casos. En cambio, la litiasis renal es extremadamente infrecuente, con muy pocas publicaciones al respecto. CASO CLÍNICO: Se presenta el caso de un paciente de 9 años que, durante tratamiento con ceftriaxona por una apendicitis aguda complicada, desarrolla pseudolitiasis vesicular y urinaria. Durante la misma internación el paciente presenta una pancreatitis leve y una ureterohidro-nefrosis bilateral, con insuficiencia renal aguda, como complicaciones de las pseudolitiasis. COMENTARIOS: La sospecha de la formación de litiasis renal y/o vesicular asociada al uso de ceftriaxona es fundamental para un diagnóstico temprano y prevención de complicaciones como las reportadas en este paciente, siendo fundamental la suspensión precoz del fármaco como inicio del tratamiento

INTRODUCTION: Ceftriaxone is a wide-spectrum antibiotic frequently used in pediatrics. Biliary pseudolithiasis is a well-known side-effect occurring in 15-57% of cases. However, nephrolithiasis is extremely infrequent, with very few related publications. CASE REPORT: We present the case of a 9-year-old patient with ceftriaxone-treated complicated acute appendicitis who developed biliary pseudolithiasis and nephrolithiasis. During hospitalization, the patient presented with pseudolithiasis complications such as mild pancreatitis and bilateral ureterohydronephrosis with acute renal failure. REMARKS: Suspecting ceftriaxone-associated biliary pseudolithiasis and/or nephrolithiasis is key to achieve an early diagnosis and prevent complications such as those reported in this patient. Early discontinuation is essential as an initial treatment measure

Humanos , Masculino , Criança , Nefrolitíase/induzido quimicamente , Ceftriaxona/efeitos adversos , Antibacterianos/efeitos adversos , Cálculos Renais/induzido quimicamente , Cálculos Biliares/induzido quimicamente , Nefrolitíase/prevenção & controle , Ceftriaxona/uso terapêutico , Nefrolitíase/diagnóstico por imagem , Radiografia Abdominal
PLoS One ; 15(7): e0236827, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730362


BACKGROUND: Heart failure (HF) is a major cause of morbidity and mortality. However, much of the clinical data is unstructured in the form of radiology reports, while the process of data collection and curation is arduous and time-consuming. PURPOSE: We utilized a machine learning (ML)-based natural language processing (NLP) approach to extract clinical terms from unstructured radiology reports. Additionally, we investigate the prognostic value of the extracted data in predicting all-cause mortality (ACM) in HF patients. MATERIALS AND METHODS: This observational cohort study utilized 122,025 thoracoabdominal computed tomography (CT) reports from 11,808 HF patients obtained between 2008 and 2018. 1,560 CT reports were manually annotated for the presence or absence of 14 radiographic findings, in addition to age and gender. Thereafter, a Convolutional Neural Network (CNN) was trained, validated and tested to determine the presence or absence of these features. Further, the ability of CNN to predict ACM was evaluated using Cox regression analysis on the extracted features. RESULTS: 11,808 CT reports were analyzed from 11,808 patients (mean age 72.8 ± 14.8 years; 52.7% (6,217/11,808) male) from whom 3,107 died during the 10.6-year follow-up. The CNN demonstrated excellent accuracy for retrieval of the 14 radiographic findings with area-under-the-curve (AUC) ranging between 0.83-1.00 (F1 score 0.84-0.97). Cox model showed the time-dependent AUC for predicting ACM was 0.747 (95% confidence interval [CI] of 0.704-0.790) at 30 days. CONCLUSION: An ML-based NLP approach to unstructured CT reports demonstrates excellent accuracy for the extraction of predetermined radiographic findings, and provides prognostic value in HF patients.

Insuficiência Cardíaca/mortalidade , Processamento de Imagem Assistida por Computador/métodos , Processamento de Linguagem Natural , Redes Neurais de Computação , Radiografia Abdominal/métodos , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/patologia , Humanos , Aprendizado de Máquina , Masculino , Prognóstico , Taxa de Sobrevida
Rev. cuba. cir ; 59(2): e933, abr.-jun. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126421


RESUMEN Introducción: La migración de una prótesis en la vía biliar es una complicación muy poco frecuente que normalmente se expulsa de forma natural, pero en raras ocasiones puede cursar con complicaciones severas. Objetivo: Describir una complicación rara por migración de una prótesis biliar. Caso clínico: Se presenta un paciente de sexo masculino de 75 años, portador de stent biliar que presenta una perforación de sigma secundaria a migración de la prótesis. Conclusiones: Las migraciones protésicas deben vigilarse y si no se eliminan de manera espontánea o el paciente presenta síntomas, se debe proceder a su retirada endoscópica o quirúrgica(AU)

ABSTRACT Introduction: Migration of a prosthesis in the bile duct is a very rare complication normally expelled in a natural way, but on rare occasions it can lead to severe complications. Objective: To describe a rare complication due to migration of biliary prosthesis. Clinical case: A case is presented of a 75-year-old male patient with a biliary stent who presented a sigmoid perforation secondary to migration of the prosthesis. Conclusions: Prosthetic migrations should be monitored and, if they are not eliminated spontaneously or the patient presents with symptoms, they should be removed endoscopically or surgically(AU)

Humanos , Masculino , Idoso , Próteses e Implantes/efeitos adversos , Colo Sigmoide/cirurgia , Ductos Biliares/diagnóstico por imagem , Radiografia Abdominal/métodos , Stents Metálicos Autoexpansíveis
J Zoo Wildl Med ; 51(2): 371-378, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32549567


The anatomy of the avian gastrointestinal (GI) tract is uniquely suited to each species' dietary requirements. African penguins (Spheniscus demersus) are charismatic and popular exhibit animals. As their prevalence grows, there is a need to understand their unique digestive tract to diagnose abnormalities. Reference material specific to the digestive tract of piscivores is scant, and knowledge of the GI tract of a healthy penguin is based on information from other birds. The purpose of this study is to determine the normal gross anatomy, transit time, and histopathologic structures of the penguin GI tract. Twelve clinically healthy penguins were selected for this study from the colony at the Maryland Zoo in Baltimore, which, at the time of this study, consisted of 55 birds. All penguins underwent a barium contrast study, and radiographic images were obtained until the entire GI tract was empty. Approximately 2 wk later, each penguin was anesthetized, and an endoscopic evaluation of the anterior GI tract was performed. Time from barium administration to defecation ranged from 17 to 70 min, and on average, barium clearance was 17.6 hr (range, 5-36 hr). Fluid from the ventriculus had an average pH of 2.75 and contained a mixed bacterial population. Koilin presence and thickness appreciated on endoscopy did not correspond with the thickness determined on histopathology. The results of this study provide a comparative baseline to use during diagnostic workups and help guide treatment decisions.

Endoscopia do Sistema Digestório/veterinária , Trato Gastrointestinal/anatomia & histologia , Radiografia Abdominal/veterinária , Spheniscidae/anatomia & histologia , Animais , Animais de Zoológico/anatomia & histologia , Baltimore , Digestão , Feminino , Trato Gastrointestinal/diagnóstico por imagem , Masculino
Ann R Coll Surg Engl ; 102(9): e1-e3, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32508109


Splenosis is the autotransplantation of splenic tissue into abnormal locations due to trauma or iatrogenically. Usually, this causes no symptoms, but in rare cases the mass effect of the transplanted nodules can cause small bowel obstruction. Resection of the culprit splenic tissue is recommended, but not more extensive dissection of non-involved nodules. Our patient presented at 43 years of age with abdominal pain, distention and bilious vomiting. He had undergone a splenectomy at the age of 13 years due to splenic rupture after a motor vehicle collision. Computed tomography demonstrated a small bowel obstruction with multiple nodules suspicious of splenosis. The obstructing mass and compromised bowels. were resected. Final pathology confirmed the diagnosis. Splenosis is an uncommon aetiology of small bowel obstruction and must be considered in patients who had previous splenic trauma or surgery.

Obstrução Intestinal/etiologia , Esplenectomia/efeitos adversos , Esplenose/complicações , Adulto , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Valva Ileocecal/diagnóstico por imagem , Valva Ileocecal/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Radiografia Abdominal , Esplenose/etiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X