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2.
Clin Nucl Med ; 45(8): 626-627, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32433167

RESUMO

We report a case of a 50-year-old man diagnosed with cholecystocolonic fistula (CCF), confirmed by scintigraphy. After negative initial radiologic workup, a colonoscopy revealed findings of right-sided ischemic colitis. Soon after, a febrile episode prompted a repeat abdominal CT scan demonstrating a possible CCF, later confirmed with a nuclear medicine hepatobiliary scintigraphy and treated surgically. Less than 10% of CCFs are diagnosed preoperatively.


Assuntos
Fístula Intestinal/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Humanos , Masculino , Pessoa de Meia-Idade
4.
An. sist. sanit. Navar ; 43(1): 103-106, ene.-abr. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193684

RESUMO

Everolimus es un inhibidor de mTOR, empleado en oncología y como inmunosupresor en el trasplante de órgano sólido. Sus efectos adversos a nivel metabólico son muy frecuentes, especialmente los más severos. Puede ocasionar hiperglucemia, hipercolesterolemia e hipertrigliceridemia, por lo que la monitorización de los parámetros metabólicos en las sucesivas visitas es vital para detectar e iniciar tratamientos que puedan prevenir las complicaciones. Se presenta el caso de una mujer con diagnóstico de tumor neuroendocrino intestinal que desarrolló dos pancreatitis agudas secundarias a hipertrigliceridemia severa por everolimus. Tras inicio de tratamiento con fibratos y omega-3, se normalizó la cifra de triglicéridos sin presentar nuevas complicaciones metabólicas ni digestivas secundarias al fármaco. La recomendación en pacientes con cáncer en tratamiento activo con everolimus es mantener los triglicéridos por debajo de 500 o 300 mg/dL, dependiendo de si la esperanza de vida es inferior o superior a un año, respectivamente


Everolimus is an mTOR inhibitor, approved as a treatment for cancer and as an immunosuppressant agent in solid organ transplantation; it frequently produces toxic metabolic effects, particularly of the most severe kind. Its use can cause hyperglycemia, hypercholesterolemia and hypertriglyceridemia; thus, metabolic values should be monitored regularly to prevent these adverse events. We present the case of a woman with an intestinal neuroendocrine tumor who developed two episodes of acute pancreatitis, secondary to severe hypertriglyceridemia caused by everolimus. After treatment with fibrates and omega-3, triglyceride levels returned to baseline, without developing new metabolic or digestive complications. Targeted levels of triglyceride for cancer patients treated with everolimus, should be below 500 or 300 mg/dL, depending on whether life expectancy is less or longer than one year, respectively


Assuntos
Humanos , Feminino , Adulto , Hipolipemiantes/administração & dosagem , Pancreatite Necrosante Aguda/tratamento farmacológico , Hipertrigliceridemia/induzido quimicamente , Everolimo/administração & dosagem , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/tratamento farmacológico , Imunossupressores/administração & dosagem , Everolimo/efeitos adversos , Tomografia Computadorizada de Emissão , Íleo/diagnóstico por imagem , Proteína Regulatória Associada a mTOR/antagonistas & inibidores
7.
Int J Cardiovasc Imaging ; 36(5): 947-969, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32048125

RESUMO

Pericardial abnormalities are common cardiovascular disease entity, which are encountered in various clinical settings. Imaging plays an integral role in evaluation of pericardial abnormalities. The appropriate use of multiple imaging modalities is crucial to initiate the diagnosis and guide the referring providers to establish a management plan. Echocardiography (echo) is the initial imaging modality of choice. Computed tomography (CT) and magnetic resonance imaging (MRI) are complementary imaging tools with better tissue characterization. Pericardial abnormalities include pericardial effusion, pericarditis, pericardial constriction, tamponade, pneumopericardium, pericardial rupture, fistulas, congenital abnormalities, and pericardial tumors. Pericardial effusion is a common clinical entity, where there is accumulation of fluid in the pericardial sac. Pericarditis can be acute, incessant, chronic, or recurrent. Pericardial thickening or enhancement are the main CT findings in acute pericarditis. Pericardial constriction results into diastolic heart failure. Differentiating constrictive pericarditis from restrictive cardiomyopathy is important, since these conditions can present with similar clinical and hemodynamic findings and both have different management. Right atrial or right ventricular compression by the pericardial sac contents should raise the suspicion for tamponade. Immediate pericardiocentesis to release the elevated intra-pericardial pressure can be lifesaving. Pericardial rupture is a serious condition that can occur after trauma and can lead to cardiac herniation. The main purpose of this article is to do a comprehensive review of the imaging appearance of pericardial diseases on different imaging modalities and establish a structured diagnostic approach for pericardial diseases to appropriately guide management.


Assuntos
Tamponamento Cardíaco/diagnóstico por imagem , Imagem Multimodal , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Pneumopericárdio/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pericardite Constritiva/diagnóstico por imagem , Valor Preditivo dos Testes , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Cir. pediátr ; 33(1): 51-54, ene. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-186139

RESUMO

Introducción: El tratamiento de la tiroides lingual es controvertido y debe individualizarse. Las opciones incluyen el reemplazo hormonal, cirugía en presencia de hemorragia y obstrucción de la vía aérea o digestiva, y la terapia con radioisótopos. Caso clínico: Niña de 8 años de edad, con molestias a la deglución. Se observa masa rosada, muy vascularizada, no dolorosa ni ulcerada, que protruye desde la base de la lengua y cierra prácticamente toda la orofaringe. Ecografía informa ausencia de tejido tiroideo en su posición normal. Tomografía axial computarizada cervical comprueba el diagnóstico y la obstrucción faríngea. Se indicó tratamiento sustitutivo de las hormonas tiroideas. Ante la progresión de los síntomas de disfagia, se indicó cirugía. Se describe la exéresis tiroidea por vía cervical, suprahioidea, con reimplante de láminas de tejido tiroideo. Evolucionó sin complicaciones y se mantiene tratamiento sustitutivo, con excelente estado clínico después de cuatro años


Introduction: The treatment of lingual thyroid is controversial and should be individualized. Options include hormonal replacement, surgery in the presence of bleeding and obstruction of the airway and the digestive tract, and radioisotope therapy. Clinical case: 8-year-old girl presenting with discomfort when swallowing. A pink, well-vascularized mass, not painful or ulcerated, protruding from the base of the tongue and virtually closing the whole oropharynx, was observed. Absence of thyroid tissue in its normal posi-tion was reported by the ultrasound department. Cervical computed axial tomography confirmed the diagnosis and the presence of pharyngeal ob-struction. Thyroid hormone replacement was established. As a result of dysphagia symptom progression, surgery was indicated. Thyroid removal was performed by means of a cervicotomy, with re-implantation of thyroid tissue laminas. The postoperative course was uneventful and replacement treatment was maintained, with an excellent clinical status four years later


Assuntos
Humanos , Feminino , Criança , Tireoide Lingual/diagnóstico por imagem , Tireoide Lingual/cirurgia , Obstrução das Vias Respiratórias/complicações , Radioisótopos/uso terapêutico , Tireoide Lingual/tratamento farmacológico , Transtornos de Deglutição/complicações , Tomografia Computadorizada de Emissão , Laringe/diagnóstico por imagem , Laringe/patologia , Cintilografia
17.
PLoS One ; 15(1): e0227969, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945112

RESUMO

PURPOSE: Although rotation of the distal portion of the tibia below the osteotomy site is considered an inevitable change in the axial plane in open wedge high tibial osteotomy (HTO), several studies on this issue have shown contradictory results. The purpose of this study was, therefore, to determine the direction and amount of distal tibial rotation following open wedge HTO using a three-dimensional reconstructed model. METHODS: This study involved 41 patients (42 knees) undergoing open wedge HTO for primary medial osteoarthritis. Distal tibial rotation was measured on the overlaid tibial plateau of a preoperative and postoperative 3-dimensional reconstructed model based on computed tomography. RESULTS: The mean distal tibial external rotation was 2.7° ± 2.3° (range, -0.9° to 9.9°), and the opening gap was larger in the group with > 3° distal tibial rotation than in the group with ≤ 3° distal tibial rotation (11.4 mm vs. 9.6 mm, P = 0.027). Multiple regression analysis showed that the opening gap was the only predictor of distal tibial rotation. On receiver operating characteristics analysis, an opening gap of 10 mm was found to be the optimal cutoff value for achieving greater than 3° of distal tibial rotation. CONCLUSIONS: Following medial opening wedge HTO, the distal tibial portion below the osteotomy site rotated approximately 3° externally. The magnitude of the external rotation of the distal tibia was affected by the opening gap width.


Assuntos
Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Osteotomia , Tíbia/cirurgia , Adulto , Idoso , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Período Pós-Operatório , Cirurgiões , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologia , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios X
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