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1.
BMC Musculoskelet Disord ; 22(1): 517, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090409

RESUMO

BACKGROUND: Osteoarthritis (OA) of the hip rarely develops in the early second decade. As the incidence of this disease is low, no treatment method has been established. We report two patients with unilateral OA in their early teens in whom the anteversion angle of the femoral neck on the affected side was greater than that on the unaffected side. CASE PRESENTATION: Case 1 was an 11-year-old girl with left coxalgia and limited range of motion. There was no history of femoroacetabular impingement (FAI) or developmental dysplasia of the hip (DDH). Plain X-rays revealed the disappearance of the Y cartilage, joint space narrowing of the left hip, and acetabular/femoral head osteosclerosis. In CT images, the anteversion angle of the femoral neck (lt/rt) was 45/35 degrees. As osteoarthritis was severe, proximal femoral flexional derotational varus osteotomy (PFFDVO) and triple pelvic osteotomy (TPO) were performed. Case 2 was a 13-year-old girl with left coxalgia and limited range of motion. There was no history of FAI or DDH. Plain X-ray revealed irregularity of the left anterolateral femoral head, and a subcartilaginous cyst. In CT images, the anteversion angle of the femoral neck (lt/rt) was 30/20 degrees. As osteoarthritis was severe, PFFDVO was performed. In addition, we resected bone spurs on the femoral head because flexion was limited owing to the presence of osteophytes. In both patients, coxalgia and claudication/gait disorder resolved postoperatively, and joint space narrowing and osteosclerosis improved. However, in Case 1, there was a 3-cm difference in the leg length, and in Case 2, range-of-motion limits remained. CONCLUSIONS: We present the findings in two patients with unilateral OA in their early second decade in whom the femoral anteversion angle on the affected side was greater than that on the unaffected side. PFFDVO + TPO was performed in Case 1, and PFFDVO + bone spur resection on the femoral head was performed in Case 2. Coxalgia resolved, and plain X-ray demonstrated improvements in OA; however, a difference in the leg length and range-of-motion limits remained.


Assuntos
Colo do Fêmur , Osteoartrite do Quadril , Acetábulo , Adolescente , Criança , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/cirurgia , Humanos , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X
2.
Am J Case Rep ; 22: e930727, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34088888

RESUMO

BACKGROUND Whipple's triad is a rare condition that prompts urgent investigation. A rare cause of such a clinical presentation is excess production of insulin-like growth factor 2 (IGF-2) from a solitary fibrous tumor. CASE REPORT A 94-year-old man presented to the hospital following episodes of confusion, gait disturbance, and multiple falls secondary to hypoglycemia. His initial blood glucose was 45 mg/dL, with normalization to 144 mg/dL after administration of 1 ampule of glucose in the field. By the time the patient arrived at our facility, his blood glucose had fallen to 75 mg/dL, and then fell further to 38 mg/dL. He had no preceding history of hypoglycemia and led an active lifestyle. His medical history was relatively unremarkable with the exception of a large but asymptomatic solitary fibrous tumor previously diagnosed, being managed conservatively. A physical examination demonstrated a large, left-sided, nontender abdominal tumor. Computed tomography demonstrated a very large well-defined, complex mass in the left upper quadrant of the abdomen. Hypoglycemic episodes occurred frequently, and reliably ensued with fasting. Hypoglycemia proved refractory to conservative strategies, and surgical intervention was recommended. Despite challenges due to the tumor's characteristics, the mass was successfully resected and normoglycemia was achieved within 24 hours. CONCLUSIONS Solitary fibrous tumors may rarely present with hypoglycemia refractory to medical therapy. We present the first reported case of a nonagenarian patient with hypoglycemia secondary to ectopic production of IGF-2 from a solitary fibrous tumor managed with surgical resection.


Assuntos
Neoplasias Abdominais , Hipoglicemia , Tumores Fibrosos Solitários , Idoso de 80 Anos ou mais , Glicemia , Humanos , Hipoglicemia/etiologia , Masculino , Tomografia Computadorizada por Raios X
3.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(3): 256-260, 2021 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-34096231

RESUMO

In this study, through the analysis of the composition of domestic large radioactive medical equipment PET/CT and the characteristics of each subsystem, combing the vulnerable spots, according to the standard requirements of PET/CT for 10 years in its service life, we research the PET/CT service life's effectiveness. Firstly, this study introduces the concept of service life, the relationship between service life and risk analysis, the pivotal system composition of PET/CT, the importance of reliability of each component, the traditional test method to verify its reliability is researched. This study suggests a test procedure and method to prove the reliability of various components of PET/CT equipment during the service life. This method is described in detail, and the specific test process in practical engineering application is discussed, which proves that it is beneficial to ensure the effectiveness of PET/CT during the service life.


Assuntos
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X
4.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(3): 261-265, 2021 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-34096232

RESUMO

Based on the clinical application data of medical X-ray computed tomography (CT) in the Shanghai Sixth People's Hospital, this study transformed it into the product reliability index requirements, and took the mechanical representative component-examination table (hereinafter referred to as "patient table") and the electronic representative component-DCB (data control board) as examples. Based on the relationship between failure characteristics and clinical application data, a complete set of closed-loop implementation methods from reliability index requirements to reliability design and verification are discussed.


Assuntos
Tomografia Computadorizada por Raios X , China , Humanos , Reprodutibilidade dos Testes
5.
Infez Med ; 29(2): 259-262, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061792

RESUMO

COVID-19 patients may experience a hypercoagulable condition, leading to thrombotic events. We describe a patient with COVID-19, carrying a rare homozygous mutation of the prothrombin gene, who developed a severe systemic vein thrombosis. In COVID-19 patients with hypercoagulability disorders the most common inherited and acquired risk factors should be investigated.


Assuntos
COVID-19/complicações , Homozigoto , Protrombina/genética , Trombofilia/genética , Trombose Venosa/genética , Adulto , COVID-19/sangue , COVID-19/diagnóstico por imagem , Humanos , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
Am J Case Rep ; 22: e930948, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115743

RESUMO

BACKGROUND Castleman's disease is defined as a benign lymphoproliferative disorder of uncertain origin. It is most commonly found in the area of mediastinum. Castleman's disease is classified based on pathological features into hyaline-vascular, plasma cell, and mixed variants, which the hyaline-vascular variant is the commonest in association with Myasthenia Gravis. Castleman's Disease have been very rarely reported in Myasthenia Gravis, as it is associated with various clinical abnormalities. The enlarged localized lymph node is mainly diagnosed by incidental radiological findings due to the enlargement of thymus gland or by compression symptoms. CASE REPORT Here we report a case revolves around a 31-year-old Saudi woman who presented with a 2 years history of exertional dyspnea associated with mouth and eye ulcers. There were no other associated symptoms such as muscular weakness, rapid fatigue or drooping of the eyelids. She was referred to our institution for further investigations and management. She was diagnosed with a mediastinal thymoma that was detected based on a positive serology of antibody anti-acetylcholine receptor (AChR) testing and a computed tomography (CT) scan findings, she eventually underwent a bilateral thoracoscopic thymectomy. CONCLUSIONS The aim of this case report is to add more to the literature by reporting a rare case of an asymptomatic subclinical Myasthenia Gravis associated with Castleman's disease. It highlights the importance of considering a Castleman's Disease in an asymptomatic case who presented with a mediastinal mass and in order to avoid an unusual intraoperative finding such as massive bleeding by performing a biopsy and an angiography preoperatively.


Assuntos
Hiperplasia do Linfonodo Gigante , Doenças do Mediastino , Miastenia Gravis , Adulto , Hiperplasia do Linfonodo Gigante/complicações , Hiperplasia do Linfonodo Gigante/diagnóstico , Feminino , Humanos , Mediastino , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Tomografia Computadorizada por Raios X
7.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116999

RESUMO

We report a case of a 30-year-old man who presented with altered mental status, fever, headache and vomiting for 3 days. An initial CT scan of the brain revealed the presence of pneumocephalus with a bony defect in the anterior cranial fossa. The pneumocephalus was not explained initially and the patient was re-examined for any signs of trauma to the face, and a review of the history revealed a series of three traumatic events months prior to this illness. Further laboratory studies revealed Streptococcus pneumoniae in the blood and bacterial meningitis. He was treated with antibiotics and was later taken up for endoscopic repair of the skull base defect. This case highlights the importance of recognising post-traumatic pneumocephalus with superimposed meningitis and sepsis months after a traumatic event to the skull base.


Assuntos
Meningites Bacterianas , Pneumocefalia , Adulto , Fossa Craniana Anterior , Humanos , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Orv Hetil ; 162(24): 952-959, 2021 06 13.
Artigo em Húngaro | MEDLINE | ID: mdl-34120101

RESUMO

Összefoglaló. Bevezetés: Korábbi vizsgálatunk szerint a kis dózisú komputertomográfiával évente végzett tüdorákszurés 50-74 éves dohányzók körében költséghatékony, és az 55-74 évesek körében költségmegtakarító. Célkituzés: Ennek a vizsgálatnak a célja a korábbi hosszú távú költséghatékonysági elemzés kiegészítése egy finanszírozó szempontú, rövid és középtávú költségvetési hatásvizsgálattal. Módszer: Egészség-gazdaságtani modellünk az 50-74 éves, naponta dohányzó lakosság tüdorákszurésének költségét hasonlítja össze a szervezett szurésben nem részesülo, naponta dohányzó lakosság költségével. Ehhez megvizsgáljuk a célpopuláció létszámának alakulását, az eredményes elérés és felfedezés valószínuségét, továbbá a szurés nyomán felmerülo terápiás költségeket és megtakarításokat. A szurés és a kivizsgálások után diagnosztizált betegek útját az érvényben lévo hazai ellátási protokollnak megfeleloen követjük. A kezelések eredményességét a HUNCHEST-felmérés adatai alapján, a kezelésekhez tartozó beavatkozások költségét közfinanszírozási adatok alapján számoljuk. Eredmények: A kis dózisú komputertomográfiával történo tüdorákszurés az érintett lakosság 10%-ának várható részvétele mellett a kezdeti évben mintegy 3,3 milliárd, az 5. évben 1,9 milliárd Ft éves többletkiadással jár. A 3. évig szuréssel felfedezett betegek terápiája többe kerül, mint a szurés nélkülieké, ugyanakkor a 4. és 5. évben a szurés nélküli csoportban a késobbi stádiumban felismert betegek kezelési költsége már meghaladja a szurt betegek terápiás költségét. A 3. évtol folyamatosan növekvo terápiás megtakarítás a teljes szurés költségét a 10. évre az 1. év kiadásának 20%-ára csökkenti. Következtetések: A kis dózisú komputertomográfiával történo tüdorákszurés bevezetése évi 2,6 milliárd Ft többletforrást igényelne, és folyamatos kiadáscsökkenés mellett hosszú távon akár nettó megtakarítást is eredményezhet a nem szervezett szuréshez képest. A kockázati csoportok pontosítása, például kiemelt földrajzi területeken végzett célzott szurés tovább javíthatja az eredményeket. Orv Hetil. 2021; 162(24): 952-959. INTRODUCTION: Our earlier analysis indicated that screening lung cancer patients with low-dose computed tomography amongst smokers between age of 50-74 and between age of 55-74 is cost-effective and cost-saving, respectively. OBJECTIVE: This study aims to extend the long-term cost-effectiveness analysis with short- and mid-term budget impact analysis. METHOD: The health economic model compares the cost of nationwide screening amongst smokers between 50-74 years to the current occasional screening policy. The analysis determines the size of the target population, recruitment rates and market uptake. Health care finance costs associated with the patient pathways are determined by national guidelines and clinical practice. Screening and treatment effectiveness are based on the HUNCHEST survey and international scientific literature, while the cost of health states and events are determined using national tariffs. RESULTS: Assuming 10% uptake of low-dose computed tomography screening for the target population will cost an additional 3.3 billion HUF and 1.9 billion HUF in the 1st and 5th years, respectively. Until the 3rd year, new patients' treatment costs exceed costs due to late discovery and delay in treatment. This pattern is changing from the 4th year on. Due to timely care savings by the 10th year in the screened population will reduce total costs to the 20% of the first year costs. CONCLUSIONS: Introduction of national screening for lung cancer patients with low-dose computed tomography is estimated to cost around additional 2.6 billion HUF/year and could end up in net savings in the long run. Identification of risk groups according to regional or other strata could increase the effectiveness and efficiency of the program. Orv Hetil. 2021; 162(24): 952-959.


Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares , Custos de Cuidados de Saúde , Humanos , Hungria , Neoplasias Pulmonares/diagnóstico por imagem , Programas de Rastreamento , Tomografia Computadorizada por Raios X
9.
Sci Rep ; 11(1): 11591, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078950

RESUMO

Making timely assessments of disease progression in patients with COVID-19 could help offer the best personalized treatment. The purpose of this study was to explore an effective model to predict the outcome of patients with COVID-19. We retrospectively included 188 patients (124 in the training set and 64 in the test set) diagnosed with COVID-19. Patients were divided into aggravation and improvement groups according to the disease progression. Three kinds of models were established, including the radiomics, clinical, and combined model. Receiver operating characteristic curves, decision curves, and Delong's test were used to evaluate and compare the models. Our analysis showed that all the established prediction models had good predictive performance in predicting the progress and outcome of COVID-19.


Assuntos
COVID-19/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , COVID-19/etiologia , Diagnóstico por Computador/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Prognóstico , Curva ROC
10.
Sci Rep ; 11(1): 11636, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34079027

RESUMO

The elevated level of D-dimer and its relationship with poor outcomes in SARS-COV-2 pneumonia patients have been demonstrated. In addition to a hypercoagulable state, D-dimer is also a biomarker of inflammation. We investigated the relationship between D-dimer level and chest computed tomography (CT) severity score, which could reflect the severity of inflammation in SARS-COV-2 pneumonia patients. We retrospectively enrolled 86 consecutive SARS-COV-2 pneumonia patients. CT severity scores were computed to quantify the overall lung involvement. The D-dimer level among CT score tertiles and the association of the D-dimer level with CT score were analyzed. Our results showed that the median D-dimer level was 0.70 mg/L (IQR 0.35-1.76). 42 patients (48.8%) had D-dimer levels above the median level. The D-dimer levels were significantly different across CT score tertiles (0.37 mg/l [IQR 0.31-0.87], 0.66 mg/l [IQR 0.39-1.43], 1.83 mg/l [IQR 0.85-4.41], P < 0.001). The natural logarithm of the D-dimer level was significantly associated with the CT score (rs = 0.586, P < 0.001). In conclusion, the D-dimer level may be associated with the severity of inflammation of SARS-COV-2 pneumonia prior to coagulopathy/thrombosis. This could be an additional explanation for the mechanism of the relationship between elevated D-dimer level and higher mortality.


Assuntos
COVID-19/diagnóstico por imagem , COVID-19/etiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Adulto , Idoso , COVID-19/sangue , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/virologia , Respiração Artificial , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
11.
Front Public Health ; 9: 671070, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34095073

RESUMO

Malignant pulmonary nodules are one of the main manifestations of lung cancer in early CT image screening. Since lung cancer may have no early obvious symptoms, it is important to develop a computer-aided detection (CAD) system to assist doctors to detect the malignant pulmonary nodules in the early stage of lung cancer CT diagnosis. Due to the recent successful applications of deep learning in image processing, more and more researchers have been trying to apply it to the diagnosis of pulmonary nodules. However, due to the ratio of nodules and non-nodules samples used in the training and testing datasets usually being different from the practical ratio of lung cancer, the CAD classification systems may easily produce higher false-positives while using this imbalanced dataset. This work introduces a filtering step to remove the irrelevant images from the dataset, and the results show that the false-positives can be reduced and the accuracy can be above 98%. There are two steps in nodule detection. Firstly, the images with pulmonary nodules are screened from the whole lung CT images of the patients. Secondly, the exact locations of pulmonary nodules will be detected using Faster R-CNN. Final results show that this method can effectively detect the pulmonary nodules in the CT images and hence potentially assist doctors in the early diagnosis of lung cancer.


Assuntos
Nódulos Pulmonares Múltiplos , Nódulo Pulmonar Solitário , Humanos , Pulmão/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Redes Neurais de Computação , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X
12.
PLoS One ; 16(6): e0252478, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34101734

RESUMO

BACKGROUND: Gas exchange in COVID-19 pneumonia is impaired and vessel obstruction has been suspected to cause ventilation-perfusion mismatch. Dual-energy CT (DECT) can depict pulmonary perfusion by regional assessment of iodine uptake. OBJECTIVE: The purpose of this study was the analysis of pulmonary perfusion using dual-energy CT in a cohort of 27 consecutive patients with severe COVID-19 pneumonia. METHOD: We retrospectively analyzed pulmonary perfusion with DECT in 27 consecutive patients (mean age 57 years, range 21-73; 19 men and 8 women) with severe COVID-19 pneumonia. Iodine uptake (IU) in regions-of-interest placed into normally aerated lung, ground-glass opacifications (GGO) and consolidations was measured using a dedicated postprocessing software. Vessel enlargement (VE) within opacifications and presence of pulmonary embolism (PE) was assessed by subjective analysis. Linear mixed models were used for statistical analyses. RESULTS: Compared to normally aerated lung 106/151 (70.2%) opacifications without upstream PE demonstrated an increased IU, 9/151 (6.0%) an equal IU and 36/151 (23.8%) a decreased IU. The estimated mean iodine uptake (EMIU) in opacifications without upstream PE (GGO 1.77 mg/mL; 95%-CI: 1.52-2.02; p = 0.011, consolidations 1.82 mg/mL; 95%-CI: 1.56-2.08, p = 0.006) was significantly higher compared to normal lung (1.22 mg/mL; 95%-CI: 0.95-1.49). In case of upstream PE, EMIU of opacifications (combined GGO and consolidations) was significantly decreased compared to normal lung (0.52 mg/mL; 95%-CI: -0.07-1.12; p = 0.043). The presence of VE in opacifications correlated significantly with iodine uptake (p<0.001). CONCLUSIONS: DECT revealed the opacifications in a subset of patients with severe COVID-19 pneumonia to be perfused non-uniformly with some being hypo- and others being hyperperfused. Mean iodine uptake in opacifications (both ground-glass and consolidation) was higher compared to normally aerated lung except for areas with upstream pulmonary embolism. Vessel enlargement correlated with iodine uptake: In summary, in a cohort of 27 consecutive patients with severe COVID-19 pneumonia, dual-energy CT demonstrated a wide range of iodine uptake in pulmonary ground-glass opacifications and consolidations as a surrogate marker for hypo- and hyperperfusion compared to normally aerated lung. Applying DECT to determine which pathophysiology is predominant might help to tailor therapy to the individual patient´s needs.


Assuntos
COVID-19/diagnóstico por imagem , Pulmão , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Meios de Contraste/química , Feminino , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
13.
PLoS One ; 16(6): e0252573, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34101762

RESUMO

The current COVID-19 pandemic threatens human life, health, and productivity. AI plays an essential role in COVID-19 case classification as we can apply machine learning models on COVID-19 case data to predict infectious cases and recovery rates using chest x-ray. Accessing patient's private data violates patient privacy and traditional machine learning model requires accessing or transferring whole data to train the model. In recent years, there has been increasing interest in federated machine learning, as it provides an effective solution for data privacy, centralized computation, and high computation power. In this paper, we studied the efficacy of federated learning versus traditional learning by developing two machine learning models (a federated learning model and a traditional machine learning model)using Keras and TensorFlow federated, we used a descriptive dataset and chest x-ray (CXR) images from COVID-19 patients. During the model training stage, we tried to identify which factors affect model prediction accuracy and loss like activation function, model optimizer, learning rate, number of rounds, and data Size, we kept recording and plotting the model loss and prediction accuracy per each training round, to identify which factors affect the model performance, and we found that softmax activation function and SGD optimizer give better prediction accuracy and loss, changing the number of rounds and learning rate has slightly effect on model prediction accuracy and prediction loss but increasing the data size did not have any effect on model prediction accuracy and prediction loss. finally, we build a comparison between the proposed models' loss, accuracy, and performance speed, the results demonstrate that the federated machine learning model has a better prediction accuracy and loss but higher performance time than the traditional machine learning model.


Assuntos
COVID-19/diagnóstico por imagem , Aprendizado de Máquina , Tórax , Simulação por Computador , Conjuntos de Dados como Assunto , Humanos , Processamento de Imagem Assistida por Computador , Tórax/diagnóstico por imagem , Tórax/patologia , Tomografia Computadorizada por Raios X
15.
Cell Transplant ; 30: 9636897211021008, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34074163

RESUMO

The coronavirus pandemic is one of the most significant public health events in recent history. Currently, no specific treatment is available. Some drugs and cell-based therapy have been tested as alternatives to decrease the disease's symptoms, length of hospital stay, and mortality. We reported the case of a patient with a severe manifestation of COVID-19 in critical condition who did not respond to the standard procedures used, including six liters of O2 supplementation under a nasal catheter and treatment with dexamethasone and enoxaparin in prophylactic dose. The patient was treated with tocilizumab and an advanced therapy product based on umbilical cord-derived mesenchymal stromal cells (UC-MSC). The combination of tocilizumab and UC-MSC proved to be safe, with no adverse effects, and the results of this case report prove to be a promising alternative in the treatment of patients with severe acute respiratory syndrome due to SARS-CoV-2.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , COVID-19/terapia , Transplante de Células-Tronco Mesenquimais , COVID-19/tratamento farmacológico , COVID-19/virologia , Terapia Combinada , Humanos , Imunofenotipagem , Cariotipagem , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Pessoa de Meia-Idade , RNA Viral/análise , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Cordão Umbilical/citologia , Carga Viral
16.
Medicine (Baltimore) ; 100(22): e26161, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087874

RESUMO

ABSTRACT: The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs 1037.0 minutes, P < .001).Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.


Assuntos
COVID-19/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Triagem/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Comorbidade , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais , Adulto Jovem
17.
BMJ Open ; 11(6): e047305, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108167

RESUMO

INTRODUCTION: Severe traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI. Having a definitive assessment tool would help predict early in-hospital mortality in this population. CT perfusion (CTP) has shown promise diagnosing early in-hospital mortality in patients with severe TBI and other populations. The purpose of this study is to validate admission CTP features of brain death relative to the clinical examination outcome for characterizing early in-hospital mortality in patients with severe TBI. METHODS AND ANALYSIS: The Early Diagnosis of Mortality using Admission CT Perfusion in Severe Traumatic Brain Injury Patients study, is a prospective cohort study in patients with severe TBI funded by a grant from the Canadian Institute of Health Research. Adults aged 18 or older, with evidence of a severe TBI (Glasgow Coma Scale score ≤8 before initial resuscitation) and, on mechanical ventilation at the time of imaging are eligible. Patients will undergo CTP at the time of first imaging on their hospital admission. Admission CTP compares with the reference standard of an accepted bedside clinical assessment for brainstem function. Deferred consent will be used. The primary outcome is a binary outcome of mortality (dead) or survival (not dead) in the first 48 hours of admission. The planned sample size for achieving a sensitivity of 75% and a specificity of 95% with a CI of ±5% is 200 patients. ETHICS AND DISSEMINATION: This study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed through forums at the end of the study. TRIAL REGISTRATION NUMBER: NCT04318665.


Assuntos
Lesões Encefálicas Traumáticas , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Canadá , Diagnóstico Precoce , Escala de Coma de Glasgow , Humanos , Perfusão , Estudos Prospectivos , Tomografia Computadorizada por Raios X
18.
Am J Case Rep ; 22: e929198, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061818

RESUMO

BACKGROUND With a prevalence of about 2% to 3%, duplication is the most common anomaly associated with the inferior vena cava (IVC). In general, systemic venous anomalies are being more frequently diagnosed in asymptomatic patients. We report the case of a young man with an incidental finding of an asymptomatic duplicated IVC, along with a literature review. CASE REPORT A 36-year-old man was brought to our Emergency Department (ED) following a high-speed motor vehicle collision (MVC), reporting right flank and hip pain. Upon examination, the "seatbelt sign" was noticed, along with abrasions over his right side. He sustained a small-bowel mesenteric injury, for which he was admitted and was treated conservatively. A CT scan incidentally revealed a duplicate IVC (DIVC). He later underwent a laparotomy with limited right hemi-colectomy and was discharged home in good condition. CONCLUSIONS Undiscovered and asymptomatic DIVCs pose a potential risk to patients during clinical interventions. Advancements in diagnostic imaging contribute greatly to the incidental discoveries of inferior vena cava duplication.


Assuntos
Achados Incidentais , Veia Cava Inferior , Adulto , Humanos , Masculino , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagem
19.
Medicina (Kaunas) ; 57(6)2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34070410

RESUMO

Background and objectives: Occipital condyle fractures (OCF) occur rarely in children. The choice of treatment is based on the Anderson-Montesano and Tuli classification systems. We evaluated the outcome of unstable OCF in children and adolescents after halo-vest therapy. Materials and Methods: We treated 6 pediatric patients for OCF, including 3 patients (2 girls, 1 boy) with unstable OCF. Among the 3 patients with unstable OCF, 2 patients presented with an Anderson-Montesano type III and Tuli type IIB injury, while 1 patient had an Anderson-Montesano type I fracture (Tuli type IIB) accompanied by a C1 fracture. On admission, the children underwent computed tomography (CT) of the head and cervical spine as well as magnetic resonance imaging (MRI) of the cervical spine. We treated the children diagnosed with unstable OCF with halo-vest immobilization. Before removing the halo vest at the end of therapy, we applied the CT and MRI to confirm OCF consolidation. At follow-up, we rated functionality of the craniocervical junction (CCJ) based on the Neck Disability Index (NDI) and Questionnaire Short Form 36 Health Survey (SF-36). Results: All children achieved OCF consolidation after halo-vest therapy for a median of 13.0 weeks (range: 12.5-14.0 weeks). CT and MRI at the end of halo-vest therapy showed no signs of C0/C1 subluxation and confirmed the correct consolidation of OCF. The only complication associated with halo-vest therapy was a superficial infection caused by a halo-vest pin. At follow-up, all children exhibited favorable functionality of the CCJ as documented by the NDI score (median: 3 points; range: 3-11 points) and SF-36 score (median: 91 points; range: 64-96 points). Conclusions: In our small case series, halo-vest therapy resulted in good mid-term outcome in terms of OCF consolidation and CCJ functionality. In pediatric patients with suspected cervical spine injuries, we recommend CT and MRI of the CCJ to establish the diagnosis of OCF and confirm stable fracture consolidation before removing the halo vest.


Assuntos
Fraturas Ósseas , Fraturas da Coluna Vertebral , Adolescente , Vértebras Cervicais/lesões , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X
20.
Kyobu Geka ; 74(6): 429-433, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34059585

RESUMO

Case 1 was a 79-year-old man. Computed tomography (CT) showed a nodule in the left upper lobe. Surgery was planned, but the regression of the nodule was noted and the surgery was postponed. Six months later, the nodule shadow increased again, and was surgically resected. Pathological diagnosis was adenocarcinoma. Case 2 was an 82-year-old man. CT showed a nodule in the right lower lobe and surgery was planned, but the nodule regressed. Three months later, it increased and was resected. It was pathological diagnosed as squamous cell carcinoma. Although spontaneous regression of lung cancer is rare, careful follow up of the regressed nodules shadow is required because of possible regrowth after the regression.


Assuntos
Adenocarcinoma , Carcinoma de Células Escamosas , Neoplasias Pulmonares , Idoso , Idoso de 80 Anos ou mais , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Tomografia Computadorizada por Raios X
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