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1.
Eur. j. anat ; 23(6): 465-468, nov. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-185090

RESUMO

Anatomical variation of pulmonary fissures and lobes is common, and may be a source of confusion in the interpretation of signs seen on chest imaging. We report a very rare case of three pulmonary fissures in a plastinated specimen of a left lung, producing a unique lobar pattern consisting of four lobes. To our knowledge, this is the first report of three complete fissures dividing the left lung into four distinct lobes. A left minor fissure courses obliquely across the upper lobe, distinguishing the lingula from the rest of the upper lobe while an inferior accessory fissure demarcates the anteromedial basal segment from the other bronchopulmonary segments of the lower lobe . Recognising the existence of such rare variants is crucial for surgeons performing lobectomies or surgical resection of the lungs. It is also of great clinical significance to radiologists interpreting chest radio-graphs and computerised tomography (CT) scans to identify and diagnose lung lesions


No disponible


Assuntos
Humanos , Pulmão/anatomia & histologia , Variação Anatômica , Lesão Pulmonar/diagnóstico por imagem , Pulmão/anormalidades , Pneumonectomia , Radiografia Torácica , Tomografia Computadorizada de Emissão
2.
Nutr. hosp ; 36(5): 1101-1108, sept.-oct. 2019. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-184633

RESUMO

Purpose: the main purpose of this study was to diagnose pre-sarcopenia in cancer patients who had lack of computed tomography (CT) abdominal images, with a newly discovered method based on cervical images. Material and methods: a sample of 37 patients with either lung cancer or a cancer that affected the upper digestive system underwent radiotherapy computed simulation which included measurements at C3 and L3 regions. Skeletal muscle mass (SMM) and skeletal muscle index (SMI) were determined by Hounsfield units and compared in both regions. Pre-sarcopenia was identified according to the cut-points currently established: ≤ 41 cm2/m2 in females, ≤ 43 cm2/m2 in males with a BMI ≤ 25 kg/m2, and ≤ 53 cm2/m2 in males with a BMI > 25 kg/m2. Results: the correlation of SMM and SMI between the C3 and L3 regions was R2 = 0.876 and R2 = 0.805, respectively. Moreover, there was a positive association (86.49%) in terms of the diagnosis of pre-sarcopenia according to both regions. In total, eleven pre-sarcopenic patients (29.37%) were identified; three of them being overweight (27.27%) and two of them being obese (18.18%). Conclusion: a single sectional cross at the level of C3 can be used for the diagnosis of pre-sarcopenia. This new method avoids unnecessary irradiation, saves hospital costs and detects malnutrition before starting radiotherapy treatment in cancer patients who have lack of CT abdominal imaging


Propósito: el propósito de este estudio fue diagnosticar la presarcopenia en pacientes con cáncer que no disponen de imágenes por tomografía computarizada (TC) a nivel abdominal mediante un método novedoso basado en cortes a nivel cervical. Material y métodos: se analizaron y se compararon mediante unidades la masa muscular y la masa muscular esquelética en 37 pacientes con cáncer de pulmón y neoplasias del aparato digestivo superior que incluían cortes en la TC de planificación a nivel de C3 y L3. La presarcopenia se identificó de acuerdo con los puntos de corte establecidos actualmente: ≤ 41 cm2/m2 para mujeres, ≤ 43 cm2/m2 en hombres con un IMC ≤ 25 kg/m2 y ≤ 53 cm2/m2 en hombres con IMC > 25 kg/m2. Resultados: la correlación de la masa muscular y el índice musculoesquelético entre las regiones C3 y L3 fue R2 = 0.876 y R2 = 0.805, respectivamente. Además, hubo una asociación positiva (86,49%) en términos del diagnóstico de presarcopenia según ambas regiones. En total, se identificaron once pacientes con presarcopenia (29,37%); tres de ellos con sobrepeso (27,27%) y dos con obesidad (18,18%). Conclusión: un solo corte transversal a nivel de la vértebra C3 puede diagnosticar la presarcopenia. Este nuevo método evita la irradiación innecesaria, ahorra costos hospitalarios y detecta la desnutrición antes de iniciar el tratamiento de radioterapia en pacientes con cáncer que no disponen de imágenes a nivel abdominal


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Sarcopenia/diagnóstico por imagem , Sarcopenia/radioterapia , Estudos de Coortes , Projetos Piloto , Tomografia Computadorizada de Emissão , Estudos Retrospectivos , Força Muscular/fisiologia , Composição Corporal , Neoplasias Pulmonares/complicações
3.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 254-258, sept.-oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183881

RESUMO

Objetivo: Presentar un caso de histiocitoma fibroso maligno vertebral a nivel de la cuarta vértebra lumbar que recibió tratamiento por una espondilectomía L4 y colocación de expansor intervertebral y fijación posterior. Caso clínico: Paciente masculino de 47 años de edad sin antecedentes de importancia, que presenta dolor lumbar de 2 meses de evolución. Se trata de forma conservadora, con una leve mejoría del dolor; sin embargo, persiste con dolor lumbar con irradiación a miembros pélvicos de predominio izquierdo, acompañado de debilidad y claudicación. Clínicamente presenta paraparesia 3/5 e hipoestesia L4, L5 y S1 de predominio izquierdo. La tomografía axial computarizada de la región lumbosacra evidencia una lesión osteolítica en cuerpo de L4 de predominio izquierdo con invasión a canal lumbar con márgenes poco delimitados. En el estudio de resonancia magnética de columna lumbosacra se observa lesión hiperintensa en T2, heterogénea, de bordes irregulares, que involucra más del 60% del cuerpo vertebral de L4 con invasión al canal raquídeo que ocasiona compresión a raíces. Se manejó con una espondilectomía L4 y la colocación de un expansor intervertebral y fijación posterior. Conclusión: La espondilectomía es una opción viable y efectiva para el tratamiento del histiocitoma fibroso maligno. La localización lumbar baja conlleva abordajes combinados; sin embargo, el desafío es mayor, ya que requiere de un conocimiento de los grandes vasos abdominales y de una intervención multidisciplinaria


Objective: To present a case of spinal malignant fibrous histiocytoma in the fourth lumbar vertebra that received treatment by an L4 spondylectomy and placement of intervertebral expander and posterior fixation. Case report: A 47-year-old male patient with no relevant history presented with lumbar pain of 2 months' evolution. Treated conservatively, with slight improvement in pain, the patient persisted with low back pain irradiation to pelvic members, predominantly left-sided, accompanied by weakness and claudication. Clinically, he presented with paresthesias 3/5, hypoaesthesia L4, L5 and S1, predominantly left-sided. Lumbosacral computerized axial tomography evidence of an osteolytic lesion in the L4 body, predominantly left-sided, with invasion of the lumbar canal with poorly delimited margins; lumbosacral spine MRI showed hyperintense lesion in T2, heterogeneous, with irregular borders involving more than 60% of the vertebral body of L4 with invasion of the spinal canal causing compression to the roots. He was treated with an L4 spondylectomy and placement of intervertebral expander and posterior fixation. Conclusion: Spondylectomy is an effective option for the treatment of spinal malignant fibrous histiocytoma that involves combined approaches. However the challenge is greater since it requires a knowledge of the great abdominal vessels and multidisciplinary intervention


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Histiocitoma Fibroso Maligno/cirurgia , Dor Lombar/etiologia , Paraparesia/complicações , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Tomografia Computadorizada de Emissão , Imuno-Histoquímica
4.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 341-345, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184124

RESUMO

Objetivo. Conocer la epidemiología de las consultas en urgencias por amnesia global transitoria (AGT), ya sea pura, asociada al consumo de tóxicos o en el contexto de una agresión sexual. Método. Estudio retrospectivo de enero a diciembre de 2018. Se revisaron las AGT atendidas en intoxicados (AGTtox), en víctimas de agresiones sexuales (AGTsex) y las amnesias puras (AGTpur), evaluando la presencia de tóxicos. Resultados. Se identificaron 287 AGT: 169 AGTsex (58,9%), 62 AGTpur (21,6%) y 56 AGTtox (19,5%). De ellas, 218 (76%) fueron mujeres y la edad osciló entre 16 y 90 años (60,6% menores de 30 años). Reconocieron consumo de alcohol 201 casos (72,8%), con etanolemia positiva en 105 (49,1%) (media de 0,74 g/l y máxima de 3,9 g/l). Admitieron consumo de cannabis 20 pacientes (7,1%), con analítica positiva en 39 casos (17,3%); cocaína 14 (4,9%), con analítica positiva en 28 (12,4%), y anfetaminas 5 (1,7%), con analítica positiva en 20 (8,8%). Presentaron sínto-mas de intoxicación 58 casos (20,1%). Cuatro pacientes ingresaron en coma. Se realizó una tomografía computariza-da (TC) craneal a 66 pacientes (23%), se hospitalizaron 7 y no hubo ningún fallecimiento. Conclusiones. La prevalencia de AGT es mayor si se incluyen los intoxicados y las agresiones sexuales, modificando la determinación de tóxicos la epidemiología de la AGT en urgencias


Objectives. To study the epidemiology of emergency department visits for transient global amnesia (TGA) by itself or associated with substance abuse or sexual assault. Methods. Retrospective study of cases treated from January to December 2018. Data for all patients with TGA were extracted, and cases were classified as associated with substance abuse (TGASUB), sexual assault (TGASEX), or neither (TGAONLY). Results. A total of 287 TGA cases were found: 169 (58.9%) were TGASEX, 62 (21.6%) TGAONLY, and 56 (19.5%) TGASUB. Two hundred eighteen (76%) were female and 69 (24%) were male. Ages ranged from 16 to 90 years; 174 (60.6%) were under the age of 30 years. Two hundred one patients (72.8%) reported consuming alcohol; and 105 (49.1%) were positive on testing (mean blood alcohol concentration, 0.74 g/L; maximum, 3.9 g/L. Twenty patients (7.1%) reported using cannabis, and 39 (17.3%) had positive test results; 14 reported using cocaine (4.9%) and 28 (12.4%) tested positive; 5 (1.7%) reported using amphetamines and 20 (8.8%) tested positive. Fifty-eight (20.1%) had symptoms of intoxication. Four were admitted in coma. A computed tomography scan was ordered for 66 patients (23%), 7 patients were hospitalized, and none died. Conclusions. The prevalence of TGA is higher if cases of substance abuse and sexual assault are counted. Toxicolgy testing changes the epidemiology of TGA in emergencies


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Amnésia Global Transitória/complicações , Amnésia Global Transitória/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Serviços Médicos de Emergência/métodos , Delitos Sexuais , Sintomas Toxicológicos/efeitos adversos , Estudos Retrospectivos , Coma/complicações , Coma/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Etanol/toxicidade , Cocaína/toxicidade , Cannabis/toxicidade , Anfetaminas/toxicidade , Análise de Variância
7.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 159-166, jul.-ago. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183581

RESUMO

Objective: Although meningiomas are the most common primary non-glial intracranial tumors, cystic meningiomas are quite rare. This study presents six cases in order to discuss the radiological and pathological features of cystic meningiomas. Patients and methods: Six patients with cystic meningiomas were included in the study. All patients underwent a cranial computed tomography scan and magnetic resonance imaging (MRI) evaluation, pre- and postoperatively. Results: All patients presented with long standing headache dating back at least two years. There was no gender predominance in our series. Radiological evaluation revealed two parasagittal and two convexity meningiomas located at the frontal region. Two lesions were located at the tuberculum sellae and the foramen magnum. All of the tumors were totally excised (Simpson Grade I or II). Pathology results included meningothelial meningioma in three patients, angiomatous meningioma in two patients, and metaplastic meningioma in one patient. In two patients, the cystic meningiomas were resected with the use of sodium fluorescein (Na-Fl) under a YELLOW 560nm microscope filter. Na-Fl was found to be very useful in demonstrating the brain-tumor interface, and it was especially effective in resecting the cyst wall of the peritumoural cystic meningiomas. None of the patients had any complications, and no recurrences were noted in any of the patients within the mean follow-up period of 51 months (range: 16-102 months). Conclusion: It is important to note MRI changes specific to cystic meningioma and include meningiomas in the differential diagnosis of intracranial cystic lesions. The use of sodium fluorescein (Na-Fl) under a YELLOW 560nm microscope filter is a useful tool to differentiate the brain-tumor interface, as well as to identify the cyst wall in order to fully resect the tumor with the cystic component to avoid recurrence and achieve better clinical results


Objetivo: Aunque los meningiomas son los tumores intracraneales primarios no gliales más frecuentes, los meningiomas quísticos son bastante raros. Este estudio presenta 6 casos para discutir las características radiológicas y patológicas de los meningiomas quísticos. Pacientes y métodos: Se incluyeron 6 pacientes con meningiomas quísticos en el estudio. Todos los pacientes se sometieron a una tomografía computarizada craneal y a una evaluación por resonancia magnética, antes y después de la operación. Resultados: Todos los pacientes presentaron dolor de cabeza de larga duración de al menos 2 años. No hubo predominio de género. La evaluación radiológica reveló 2 meningiomas parasagitales y 2 de la convexidad ubicados en la región frontal. En los otros 2 pacientes las lesiones se ubicaron en el tubérculo selar y en el foramen magno respectivamente. Todos los tumores fueron totalmente extirpados (grado de Simpson I o II). En 2 pacientes, los meningiomas quísticos se resecaron con el uso de fluoresceína de sodio bajo un filtro de microscopio AMARILLO de 560nm. Se encontró que la fluoresceína de sodio era muy útil para demostrar la interfaz entre el cerebro y el tumor, y fue especialmente eficaz para resecar la pared de los quistes peritumorales. Los resultados de histopatología incluyeron meningioma meningotelial en 3 pacientes, meningioma angiomatoso en 2 y meningioma metaplásico en uno. Ninguno de los pacientes presentó ninguna complicación, y no se observaron recurrencias en ningún paciente dentro del período de seguimiento medio de 51 meses (rango: 16-102 meses). Conclusión: Es importante tener en cuenta los cambios en la resonancia magnética específicos de los meningiomas quísticos e incluir estos tumores en el diagnóstico diferencial de las lesiones quísticas intracraneales. El uso de fluoresceína de sodio bajo un filtro de microscopio AMARILLO de 560nm es una herramienta útil para diferenciar la interfaz cerebro-tumor, así como para identificar la pared del quiste y resecar completamente el tumor con el componente quístico para evitar la recidiva y conseguir mejores resultados clínicos


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Cistos/diagnóstico por imagem , Meningioma/diagnóstico , Neoplasias Meníngeas/diagnóstico por imagem , Craniotomia/métodos , Cistos/patologia , Meningioma/patologia , Neoplasias Meníngeas/patologia , Cefaleia/etiologia , Tomografia Computadorizada de Emissão/métodos , Fluoresceína , Estudos Retrospectivos , Procedimentos Neurocirúrgicos/métodos
8.
Int J Cardiovasc Imaging ; 35(11): 2085-2093, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31197526

RESUMO

Little is known about the comparison of multiple-gated acquisition (MUGA) scanning with cardiovascular magnetic resonance (CMR) for serial monitoring of HER2+ breast cancer patients receiving trastuzumab. The association of cardiac biomarkers with CMR left ventricular (LV) function and volume is also not well studied. Our objectives were to compare CMR and MUGA for left ventricular ejection fraction (LVEF) assessment, and to examine the association between changes in brain natriuretic peptide (NT-BNP) and troponin-I and changes in CMR LV function and volume. This prospective longitudinal two-centre cohort study recruited HER2+ breast cancer patients between January 2010 and December 2013. MUGA, CMR, NT-BNP and troponin-I were performed at baseline, 6, 12, and 18 months after trastuzumab initiation. In total, 41 patients (age 51.7 ± 10.8 years) were enrolled. LVEF comparison between MUGA and CMR demonstrated weak agreement (Lin's correlation coefficient r = 0.46, baseline; r = 0.29, 6 months; r = 0.42, 12 months; r = 0.39, 18 months; all p < 0.05). Bland-Altman plots demonstrated wide LVEF agreement limits (pooled agreement limits 3.0 ± 6.2). Both modalities demonstrated significant LVEF decline at 6 and 12 months from baseline, concomitant with increased LV volumes on CMR. Changes in NT-BNP correlated with changes in LV diastolic volume at 12 and 18 months (p < 0.05), and LV systolic volume at 18 months (p < 0.05). Changes in troponin-I did not correlate with changes in LV function or volume at any timepoint. In conclusion, CMR and MUGA LVEF are not interchangeable, warranting selection and utility of one modality for serial monitoring. CMR is useful due to less radiation exposure and accuracy of LV volume measurements. Changes in NT-BNP correlated with changes in LV volumes.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Imagem por Ressonância Magnética , Compostos Radiofarmacêuticos/administração & dosagem , Pertecnetato Tc 99m de Sódio/administração & dosagem , Volume Sistólico/efeitos dos fármacos , Tomografia Computadorizada de Emissão , Trastuzumab/efeitos adversos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda/efeitos dos fármacos , Adulto , Biomarcadores/sangue , Técnicas de Imagem de Sincronização Cardíaca , Cardiotoxicidade , Feminino , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangue , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/fisiopatologia
9.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(3): 115-123, mayo-jun. 2019. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-183574

RESUMO

Introduction: Intracranial volume (ICV) is an important tool in the management of patients undergoing decompressive craniectomy (DC) surgery. The aim of this study was to validate ICV measurement applying the shape-based interpolation (SBI) method using open source software on computed tomography (CT) images. Methods: The pre- and post-operative CT images of 55 patients undergoing DC surgery were analyzed. The ICV was measured by segmenting every slice of the CT images, and compared with estimated ICV calculated using the 1-in-10 sampling strategy and processed using the SBI method. An independent t test was conducted to compare the ICV measurements between the two different methods. The calculation using this method was repeated three times for reliability analysis using the intraclass correlations coefficient (ICC). The Bland-Altman plot was used to measure agreement between the methods for both pre- and post-operative ICV measurements. Results: The mean ICV (±SD) were 1341.1±122.1ml (manual) and 1344.11±122.6ml (SBI) for the preoperative CT data. The mean ICV (±SD) were 1396.4±132.4ml (manual) and 1400.53±132.1ml (SBI) for the post-operative CT data. No significant difference was found in ICV measurements using the manual and the SBI methods (p=.983 for pre-op, and p=.960 for post-op). The intrarater ICC showed a significant correlation; ICC=1.00. The Bland-Altman plot showed good agreement between the manual and the SBI method. Conclusion: The shape-based interpolation method with 1-in-10 sampling strategy gave comparable results in estimating ICV compared to manual segmentation. Thus, this method could be used in clinical settings for rapid, reliable and repeatable ICV estimations


Introducción: El volumen intracraneal (ICV) constituye una importante herramienta para el tratamiento de los pacientes sometidos a craneotomía descompresiva (CD). El objetivo de este estudio fue validar la medición del ICV aplicando el método de interpolación basado en formas (SBI), utilizando software de código abierto en las imágenes de tomografía computarizada (TC). Métodos: Se analizaron las imágenes pre- y postoperatorias de TC de 55 pacientes sometidos a CD. Se midió el ICV segmentando cada corte de las imágenes de TC, comparándose con el ICV estimado calculado utilizando la estrategia de muestreo 1 de 10, y procesándose mediante el método SBI. Se realizó una prueba t independiente para comparar las mediciones de ICV entre los 2 métodos. Se repitió 3 veces el cálculo con este método, para realizar el análisis de fiabilidad, utilizando el coeficiente de correlación intra-clase (ICC). Se utilizó el gráfico de Bland-Altman para medir el acuerdo entre ambos métodos, para las mediciones de ICV pre- y postoperatorias. Resultados: El ICV medio (±DE) fue de 1.341,1ml±122,1 (manual) y 1.344,11ml±122,6 (SBI) para los datos de la TC preoperatoria. El ICV medio (±DE) fue de 1.396,4ml±132,4 (manual) y 1.400,53ml±132,1 (SBI) para los datos de la TC postoperatoria. No se encontró diferencia significativa en cuanto a las mediciones de ICV utilizando los métodos manual y SBI (p=0,983 para preoperatoria, p=0,960 para postoperatoria). El ICC intra-evaluador reflejó una correlación significativa; ICC=1. El gráfico de Bland-Altman reflejó un buen acuerdo entre el método manual y el método SBI. Conclusión: El método de interpolación basado en formas con estrategia de muestreo 1 de 10 proporcionó resultados comparables a la hora de calcular el ICV, en comparación con la segmentación manual. Por tanto, este método podría utilizarse en el entorno clínico para realizar estimaciones del ICV rápidas, fidedignas y repetibles


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Crânio/diagnóstico por imagem , Cefalometria , Processamento de Imagem Assistida por Computador/métodos , Craniectomia Descompressiva/métodos , Crânio/anatomia & histologia , Tomografia Computadorizada de Emissão , Análise Estatística
10.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(3): 144-148, mayo-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183577

RESUMO

El tumor glioneuronal papilar (TGNP) es una neoplasia del sistema nervioso central de reciente descripción. En el año 2007, la Organización Mundial de la Salud clasificó este tumor como una neoplasia neuronal-glial de grado i. Los pacientes suelen ser niños o adultos jóvenes que presentan clínica de cefalea o crisis comiciales. Describimos el caso de un paciente varón de 13 años de edad que fue remitido a nuestro centro tras presentar un traumatismo craneal leve a consecuencia de un accidente de circulación. La tomografía computarizada realizada en urgencias mostraba una lesión temporo-occipital derecha hipointensa. La imagen de resonancia magnética confirmó la presencia de una lesión indicativa de un tumor cerebral primario. Se realizó una exéresis quirúrgica completa de la lesión, con adecuada recuperación postoperatoria. El estudio de anatomía patológica de la lesión demostró una estructura seudopapilar con astrocitos y neuronas, compatible con TGNP. Discutimos los hallazgos clínicos, radiológicos e histológicos de este tipo de tumores poco frecuentes


Papillary glioneuronal tumor (PGNT) is a recently described central nervous system neoplasm. In 2007, the World Health Organization classified this tumor as a grade I neuronal-glial neoplasm. Patients are usually juvenile and young adults who commonly present with headache or seizures. We report a case of a 13-year-old boy that was related to our hospital after suffering a mild head injury result of an automobile accident. Emergent CT scan showed a right hypointense temporo-occipital lesion. MRI confirmed the presence of a lesion suggestive of a primary brain tumor. The patient underwent total resection of the tumor, followed by an uneventful recovery. Pathological analysis of the lesion revealed characteristic pseudopapillary structure with astrocytes and neurons, compatible with PGNT. We discuss the clinical, Radiological and histological features of this infrequent type of tumors


Assuntos
Humanos , Masculino , Adolescente , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Neuroglia/patologia , Neurônios/patologia , Neoplasias Neuroepiteliomatosas/patologia , Sistema Nervoso Central/patologia , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Diagnóstico Diferencial
12.
J Med Case Rep ; 13(1): 95, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31003598

RESUMO

BACKGROUND: Papillary thyroid carcinoma is the most common endocrine malignancy. Distant metastasis from differentiated thyroid carcinoma is infrequent and the metastasis rate of papillary thyroid carcinoma is lower than that of follicular thyroid carcinoma. Distant metastases from differentiated thyroid carcinoma are usually seen in the lungs and bones; however, renal metastasis is very rare. CASE PRESENTATION: Here we describe an 85-year-old Caucasian woman who presented with right flank pain 10 years ago. We describe a case of papillary thyroid carcinoma presenting as a primary renal tumor with extensive pulmonary and bone metastases. Abdominal screening with computed tomography revealed a mass on her right kidney, which was considered a primary renal cell carcinoma and she underwent a right nephrectomy. Unexpectedly, papillary thyroid carcinoma metastasis was diagnosed from demonstrative histopathological findings, such as positive immunoperoxidase staining for thyroglobulin. A total thyroidectomy was performed. Unenhanced thoracic computed tomography and skeletal scintigraphy revealed bilateral multiple nodules in her lungs and bone metastasis on T10 vertebra and right sacroiliac joint. Initially, 30 Gy radiotherapy was implemented to her T9-10 vertebrae and then she was treated with a total of 800 mCi radioactive iodine for ablation. A radioactive iodine whole body scan was performed after each 200 mCi and continuous progression was shown in each scan. After she was lost to follow-up for 3 years, she referred to our clinic again with a draining mass on her neck and we planned radiotherapy to this giant mass. CONCLUSION: Our patient was surprisingly still alive after metastatic disease was diagnosed 10 years ago and she had no major complaint other than a draining mass on her neck. Our primary aim by sharing this case is to underline potential renal metastasis from papillary thyroid carcinoma. In other words, when approaching primary renal tumors, possible distant metastases of other organs need to be kept in mind for differential diagnosis. In addition, it should be noted that if managed appropriately, the long-term survival in patients with papillary thyroid carcinoma with multiple organ metastases could be encouraging.


Assuntos
Neoplasias Renais/secundário , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Nefrectomia , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Tomografia Computadorizada de Emissão , Imagem Corporal Total
13.
J Med Case Rep ; 13(1): 99, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31003599

RESUMO

BACKGROUND: Adefovir dipivoxil is a nucleotide analogue that is approved for treatment of chronic hepatitis B. Adefovir dipivoxil is associated with proximal tubular dysfunction, resulting in Fanconi syndrome, which can cause secondary hypophosphatemic osteomalacia. We describe a case of a patient with hypophosphatemic osteomalacia secondary to Fanconi syndrome induced by adefovir dipivoxil concomitantly with osteoporosis in whom clinical symptoms were improved by adding denosumab (a human monoclonal antibody targeting the receptor activator of nuclear factor-κB ligand) to preceding administration of vitamin D3. CASE PRESENTATION: A 60-year-old Japanese man had been receiving low-dose adefovir dipivoxil (10 mg/day) to treat chronic hepatitis B for approximately 5 years. He presented to an orthopedic surgeon with severe pain of the right hip and no trauma history, and fracture of the neck of the right femur was identified. In addition, 99mTc-hydroxymethylene diphosphate scintigraphy revealed significantly abnormal uptake in the bilateral ribs, hips, and knees, and he was therefore referred to our university hospital for evaluation of multiple pathological fractures. We diagnosed hypophosphatemic osteomalacia due to Fanconi syndrome induced by adefovir dipivoxil therapy. Although we reduced the patient's adefovir dipivoxil dose and added calcitriol (active vitamin D3), he did not respond and continued to complain of bone pain. Several bone resorption markers and bone-specific alkaline phosphatase were also persistently elevated. Therefore, we added denosumab to vitamin D3 supplementation for treatment of excessive bone resorption. Two months after initiation of denosumab, his hip and knee pain was relieved, along with a decrease in serum alkaline phosphatase and some bone resorption markers. CONCLUSIONS: Although denosumab is not generally an appropriate treatment for acquired Fanconi syndrome, it may be useful for patients who have hypophosphatemic osteomalacia due to adefovir dipivoxil-induced Fanconi syndrome associated with excessive bone resorption. However, clinicians should keep in mind that if denosumab is administered to patients with hypophosphatemic osteomalacia accompanied by excessive bone resorption, adequate vitamin D and/or phosphate supplementation should be done before administration of denosumab.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Denosumab/administração & dosagem , Síndrome de Fanconi/induzido quimicamente , Hipofosfatemia , Osteomalacia , Adenina/efeitos adversos , Adenina/análogos & derivados , Adulto , Antivirais/efeitos adversos , Síndrome de Fanconi/tratamento farmacológico , Hepatite B/tratamento farmacológico , Humanos , Hipofosfatemia/induzido quimicamente , Hipofosfatemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Organofosfonatos/efeitos adversos , Osteomalacia/induzido quimicamente , Osteomalacia/tratamento farmacológico , Tomografia Computadorizada de Emissão , Resultado do Tratamento
15.
Acta otorrinolaringol. esp ; 70(2): 112-118, mar.-abr. 2019.
Artigo em Espanhol | IBECS | ID: ibc-178522

RESUMO

Los implantes activos de oído medio son prótesis implantadas quirúrgicamente, que estimulan la cadena osicular o los fluidos del oído interno a través de la ventana oval o redonda. Estos implantes pueden ser útiles para el tratamiento de determinados pacientes con pérdida auditiva neurosensorial, así como para pérdida auditiva conductiva o mixta. Esta guía clínica pretende resumir los conocimientos actuales sobre las características básicas y las indicaciones de los implantes de oído medio más utilizados, como Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia) y CodacsTM. (Cochlear, Australia)


Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and CodacsTM. (Cochlear, Australia)


Assuntos
Humanos , Criança , Adolescente , Adulto , Implantes Cocleares , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/cirurgia , Implantes Cocleares/classificação , Auxiliares de Audição/tendências , Processo Mastoide/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Audiometria/métodos
17.
J Med Case Rep ; 13(1): 88, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30909965

RESUMO

INTRODUCTION: Immune checkpoint inhibitors are a promising class of anticancer drugs. The clinical benefits afforded by immune checkpoint inhibitors can be accompanied by immune-related adverse events that affect multiple organs, and endocrine immune-related adverse events include thyroiditis and hypophysitis. Hypophysitis is less frequent and has a less severe clinical presentation in patients treated with other immune checkpoint inhibitors, such as nivolumab, pembrolizumab, and atezolizumab, than in those treated with ipilimumab. However, studies have described isolated adrenocorticotropic hormone deficiency cases associated with nivolumab, pembrolizumab, and atezolizumab therapy, most of which occurred during the course of immune checkpoint inhibitor therapy. We report a rare case of patient with isolated adrenocorticotropic hormone deficiency that occurred after nivolumab therapy. CASE PRESENTATION: A 69-year-old Japanese woman with advanced lung adenocarcinoma developed painless thyroiditis with transient elevations of serum thyroid hormones during 3 months of cancer treatment with nivolumab and began thyroid hormone replacement therapy for subsequent primary hypothyroidism. Four months after nivolumab therapy was discontinued, she developed isolated adrenocorticotropic hormone deficiency; corticosteroid replacement therapy relieved her secondary adrenal insufficiency symptoms, such as anorexia and fatigue. Human leukocyte antigen typing revealed the presence of DRB1*04:05-DQB1*04:01-DQA1*03:03 and DRB1*09:01-DQB1*03:03-DQA1*03:02 haplotypes, which increase susceptibility to autoimmune polyendocrine syndrome associated with thyroid and pituitary disorders in the Japanese population. CONCLUSIONS: Our patient developed thyroiditis during cancer treatment with nivolumab and subsequently exhibited isolated adrenocorticotropic hormone deficiency 4 months after discontinuing the drug. Administration of nivolumab in combination with a genetic predisposition to polyglandular autoimmunity probably caused both the thyroiditis and hypophysitis, resulting in primary hypothyroidism and isolated adrenocorticotropic hormone deficiency, respectively, in our patient. The present case highlights the need for physicians to be aware that endocrine immune-related adverse events, including hypophysitis, can occur more than several months after discontinuing a drug.


Assuntos
Adenocarcinoma de Pulmão/tratamento farmacológico , Hormônio Adrenocorticotrópico/deficiência , Antineoplásicos Imunológicos/efeitos adversos , Neoplasias Encefálicas , Doenças do Sistema Endócrino/induzido quimicamente , Doenças Genéticas Inatas/induzido quimicamente , Hipoglicemia/induzido quimicamente , Nivolumabe/efeitos adversos , Tireoidite/induzido quimicamente , Adenocarcinoma de Pulmão/diagnóstico por imagem , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Biópsia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/secundário , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Imagem por Ressonância Magnética , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios X , Imagem Corporal Total
18.
Rev Assoc Med Bras (1992) ; 65(2): 100-104, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30892428

RESUMO

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Assuntos
Biópsia/métodos , Nefropatias/patologia , Rim/patologia , Laparoscopia/métodos , Feminino , Humanos , Nefropatias/diagnóstico por imagem , Masculino , Guias de Prática Clínica como Assunto , Espaço Retroperitoneal , Tomografia Computadorizada de Emissão
20.
PLoS One ; 14(2): e0212679, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30802258

RESUMO

OBJECTIVES: To evaluate the accuracy of Spectral Photon-Counting Computed Tomography (SPCCT) in the quantification of iodine concentrations and its potential for the differentiation between blood and iodine. METHODS: Tubes with blood and a concentration series of iodine were scanned with a preclinical SPCCT system (both in vitro and in an ex vivo bovine brain tissue sample). Iodine density maps (IDM) and virtual non-contrast (VNC) images were generated using the multi-bin spectral information to perform material decomposition. Region-of-interest (ROI) analysis was performed within the tubes to quantitatively determine the absolute content of iodine (mg/ml). RESULTS: In conventional CT images, ROI analysis showed similar Hounsfield Unit (HU) values for the tubes with blood and iodine (59.9 ± 1.8 versus 59.2 ± 1.5). Iodine density maps enabled clear differentiation between blood and iodine in vitro, as well as in the bovine brain model. Quantitative measurements of the different iodine concentrations matched well with those of actual known concentrations even for very small iodine concentrations with values below 1mg/ml (RMSE = 0.19). CONCLUSIONS: SPCCT providing iodine maps and virtual non-contrast images allows material decomposition, differentiation between blood and iodine in vitro and ex vivo in a bovine brain model and reliably quantifies the iodine concentration.


Assuntos
Sangue/metabolismo , Encéfalo/diagnóstico por imagem , Meios de Contraste/farmacocinética , Iodo/farmacocinética , Fótons , Tomografia Computadorizada de Emissão , Animais , Encéfalo/metabolismo , Bovinos , Meios de Contraste/farmacologia , Iodo/farmacologia
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