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1.
Bone Joint J ; 101-B(10): 1218-1229, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564157

RESUMO

AIMS: Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT. PATIENTS AND METHODS: A retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed. RESULTS: We found a specificity of 99%, positive predictive value (PPV) of 93%, and sensitivity of 23% for in-toeing (FPA < 0°) to detect increased FT > 25°. Most of the hips with normal or decreased FT had no in-toeing (false-positive rate of 1%). Patients with increased FT had significantly (p < 0.001) more in-toeing than patients with decreased FT. The majority of the patients (77%) with increased FT walk with a normal foot position. The correlation between FPA and FT was significant (r = 0.404, p < 0.001). Five cluster groups were identified. CONCLUSION: In-toeing has a high specificity and high PPV to detect increased FT, but increased FT can be missed because of the low sensitivity and high false-negative rate. These results can be used for diagnosis of abnormal FT in patients with FAI or hip dysplasia undergoing hip arthroscopy or femoral derotation osteotomy. However, most of the patients with increased FT walk with a normal foot position. This can lead to underestimation or misdiagnosis of abnormal FT. We recommend measuring FT with CT/MRI scans in all patients with FAI. Cite this article: Bone Joint J 2019;101-B:1218-1229.


Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Imagem Tridimensional , Metatarso Valgo/diagnóstico por imagem , Metatarso Varo/diagnóstico por imagem , Osteotomia/efeitos adversos , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Fêmur/fisiopatologia , Seguimentos , Humanos , Modelos Lineares , Imagem por Ressonância Magnética/métodos , Masculino , Metatarso Valgo/epidemiologia , Metatarso Varo/epidemiologia , Pessoa de Meia-Idade , Osteotomia/métodos , Prevalência , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Anormalidade Torcional/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 98(38): e17033, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567939

RESUMO

RATIONALE: Compared with most malignant tumors, papillary thyroid carcinoma (PTC) is usually associated with favorable survival and low recurrence rate. The prognostic factors of PTC include age, sex, tumor size, enlarged lymph nodes, and extrathyroidal extension. Among the extrathyroidal extension, upper aerodigestive tract (ADT) invasion by PTC is a marker of more aggressive tumor behavior, defining a subpopulation of patients at a greater risk of recurrence and death. PATIENT CONCERNS: A 61-year-old woman had a cervical mass that was slowly growing for three years. Additionally, she had haemoptysis of 1-year duration. During the month prior to her visit, she had difficulty breathing. DIAGNOSIS: Neck ultrasonography (US) and thyroid computed tomography (CT) images both showed a well-defined calcified mass on the left lobe of the thyroid gland. Additionally, the thyroid CT revealed that part of the mass protruded into the lumen which resulted in the thickening on the left side of the trachea. Accordingly, her diagnoses were as follows: firstly, a solid mass on the left lobe of the thyroid gland with tracheal compression; and finally, the space-occupying airway lesion. INTERVENTIONS: She underwent a bronchoscopic examination, which revealed a mass blocking most of the upper endoluminal trachea. Thus, the mass was resected at the upper tracheal segment, followed by electrotome and argon plasma coagulation treatment. She was then transferred to the Thyroid Surgery Department. Thyroid surgeons took the surgical type of bilateral subtotal thyroidectomy + exploration of bilateral recurrent laryngeal nerve + dissection of the lymph node in neck central area + circumferential sleeve resection + end-to-end anastomosis + tracheotomy in the patient. OUTCOMES: After surgery, she recovered well without any local recurrence or distant metastasis. LESSONS: When patients with PTC have haemoptysis, hoarseness, dyspnea, or any other symptoms, and the imaging examinations reveal a space-occupying lesion in the thyroid and airway, clinicians should focus on PTC with tracheal invasion, a bronchoscopic examination must be immediately performed because the subsequent surgical management depends on the degree of tracheal invasion.


Assuntos
Câncer Papilífero da Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Traqueia/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Hemoptise/etiologia , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Câncer Papilífero da Tireoide/complicações , Câncer Papilífero da Tireoide/secundário , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/secundário , Neoplasias da Traqueia/cirurgia , Ultrassonografia
3.
Medicine (Baltimore) ; 98(38): e17034, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567940

RESUMO

BACKGROUND: Pericardial infection caused by Acinetobacter baumannii is rare, particularly that of carbapenem-resistant A baumannii (CRAB). CASE PRESENTATION: We describe a rare case of purulent pericarditis due to CRAB in a 76-year-old man with acute myocardial infarction and acute kidney injury. The man was admitted to the intensive care unit for a catheter-related bloodstream infection. Pericardial effusion was detected via the bedside X-ray and ultrasound, and pericardiocentesis was performed. Cultures of the pericardial fluid, catheter tip, and blood independently revealed the presence of CRAB. These findings confirmed a diagnosis of purulent pericarditis. CONCLUSIONS: Clinicians should be reminded that CRAB infection can lead to purulent pericarditis, particularly in patients with congestive heart failure or renal insufficiency.


Assuntos
Infecções por Acinetobacter/diagnóstico , Acinetobacter baumannii/isolamento & purificação , Lesão Renal Aguda/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Pericardite/diagnóstico , Infecções por Acinetobacter/complicações , Acinetobacter baumannii/efeitos dos fármacos , Lesão Renal Aguda/complicações , Idoso , Carbapenêmicos/farmacologia , Diagnóstico Diferencial , Farmacorresistência Bacteriana , Evolução Fatal , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Pericardiocentese , Pericardite/complicações , Pericardite/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
Medicine (Baltimore) ; 98(38): e17037, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567941

RESUMO

RATIONALE: Glucagonoma is a rare type of functional pancreatic neuroendocrine tumor that is characterized by distinctive clinical manifestations; among these, necrolytic migratory erythema represents the hallmark clinical sign of glucagonoma syndrome and is usually presented as the initial complaint of patients. PATIENT CONCERNS: A 30-year-old male patient was admitted to our hospital with a complaint of diffuse erythematous ulcerating skin rash for more than 10 months. He also complained of hyperglycemia and a weight loss of 15 kg in those months. DIAGNOSIS: This patient underwent a contrast-enhanced computed tomography scan which showed a pancreatic body mass measuring approximately 6 cm with low density accompanied by partial calcification in plain scanning images and uneven enhancement in strengthening periods. In addition, laboratory tests indicated elevated fasting blood glucagon (1109 pg/mL, normal range: 50-150 pg/mL) levels. Glucagonoma syndrome was ultimately diagnosed in clinical. INTERVENTION: Spleen-preserving distal pancreatectomy was conducted and postoperative pathology revealed the presence of glucagonoma. OUTCOMES: The patient recovered uneventfully with the glucagonoma syndrome disappeared soon after surgery, and the postoperative plasma glucagon decreased to a normal level. Follow-up showed no recurrence for 5 years since the surgery. LESSONS: The treatment of glucagonoma should be directed according to the stage at which the disease is diagnosed. Surgery is currently the only method available to cure the tumor, although medications are given to patients who present with advanced glucagonoma and who are not candidates for operation. Multidisciplinary therapy and multimodality treatment are advised, although these have been systematically evaluated to a lesser degree.


Assuntos
Glucagonoma/diagnóstico , Eritema Migratório Necrolítico/etiologia , Neoplasias Pancreáticas/diagnóstico , Adulto , Diagnóstico Diferencial , Glucagonoma/complicações , Glucagonoma/diagnóstico por imagem , Glucagonoma/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Pancreatectomia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Baço , Síndrome , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 98(38): e17088, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567944

RESUMO

An international consensus for rheumatoid arthritis (RA) patients at risk of developing interstitial lung disease (ILD) is still lacking. The aims of study were to evaluate: the prevalence of ILD involvement in RA over high-resolution computed tomography (HRCT); the relationships between pulmonary function tests (PFTs), patient-centered measurements, and ILD; and the potential risk factors contributing to RA-ILD patients.Data regarding the clinical characteristics (age, sex, age at onset of RA), laboratory findings (rheumatoid factor [RF] and anti-citrullinated protein antibodies [ACPA]), respiratory functional assessment (forced vital capacity [FVC] and carbon monoxide diffusion capacity [DLCO]), patient-centred measures of dyspnea (PCMD), Health Assessment Questionnaire-Disability Index (HAQ-DI), and HRCT have collected retrospectively. HRCT abnormalities were evaluated using a conventional visual reader-based score (CoVR) and a computer-aided method (CaM). The relationships between the 2 HRCT scores-PFTs and PCMD-were calculated using Pearson correlation. The area under the receiving-operating characteristic (AUC-ROC) curve was calculated to determine the discriminatory performance of measurements between patients with and without ILD. The multivariate regression model was used to evaluate the association force between ILD and RA characteristics.In all, 151 patients (45 males and 106 females, mean age 53.4 ±â€Š7.6 years) were included. ILD had been detected in 29 patients out of 151 (19.2%). Usual interstitial pneumonia was the most common HRCT. RA-ILD patients were older, and older at RA onset (both P < .01), with a higher HAQ-DI (P < .05) than patients without ILD. ACPA positivity and titer were higher in the RA-ILD group (P = .02). Extent and severity of ILD, and total CoVR and CaM score closely related to DLCO and PCMD (both P < .0001). A reduced DLCO was the most sensitive test for predicting the presence of ILD on HRCT (AUC-ROC 0.811 ±â€Š0.037). Advanced age (P < .0001), age at RA onset (P = .025), ACPA titer (P = .004), and smoking (P = .008) were independent explanatory variables of HRCT damage in multivariate analysis.The RA-ILD is associated with age and older age of RA onset, smoking, and ACPA titer. DLCO seems to be the most sensitive parameter to predict ILD on HRCT, followed by PCMD.


Assuntos
Artrite Reumatoide , Doenças Pulmonares Intersticiais/epidemiologia , Fatores Etários , Idoso , Feminino , Humanos , Itália/epidemiologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Curva ROC , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
6.
Medicine (Baltimore) ; 98(38): e17211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567974

RESUMO

This study aims to evaluate the feasibility and effectiveness of minimally invasive puncture treatment by positioning the simple bedside for spontaneous cerebellar hemorrhage.From January 2017 to March 2018, the investigators applied simple bedside positioning to perform the intracranial hematoma minimally invasive surgery for 21 patients with cerebellar hemorrhage.For these 21 patients, the bleeding amount and Glasgow Coma Scale (GCS) score before the operation were 18.5 ±â€Š5.0 cc and 9.5 ±â€Š3.3, respectively; 24 hours after the operation, the GCS score was 11.0 ±â€Š4.6. Five patients died within 7 days of the operation and the head computed tomography (CT) was re-examined. It was found that the average bleeding amount was 3.4 ±â€Š0.9 cc, the operation success rate was 76.2%, and the accurate puncture rate was 100%. Six months later, the Modified Rankin Scale (MRS) score was 2.5 ±â€Š2.0. The postoperative recovery was good. The situation shows that patients with favorable outcomes (MRS score 0-2) accounted for 38.1% (8/21), and the fatality rate was 33.3% (7/21).The efficacy of the intracranial hematoma minimally invasive surgery by positioning the simple bedside for spontaneous cerebellar hemorrhage with severe brainstem dysfunction is good.


Assuntos
Tronco Encefálico/fisiopatologia , Doenças Cerebelares/cirurgia , Hemorragia Cerebral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paracentese/métodos , Posicionamento do Paciente , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Feminino , Humanos , Masculino , Neuroimagem , Posicionamento do Paciente/métodos , Tomografia Computadorizada por Raios X
7.
Medicine (Baltimore) ; 98(38): e17219, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567979

RESUMO

RATIONALE: Retained placenta accreta is an increasing obstetric problem in recent years, and pulmonary embolism (PE) during pregnancy and the postpartum period is a vital condition, but lack of standard therapy guidelines. This report describes a case of postpartum PE combined with retained placenta accreta. PATIENT CONCERNS: A 27-year-old woman presenting with fever and dyspnea after delivery was admitted to our hospital with retained placenta accreta. DIAGNOSES: The patient was diagnosed with the infection, postpartum PE, and residual placenta. INTERVENTIONS: The antibiotics and low molecular weight heparin were initially started to cure the infection and control PE. Mifepristone was then used to promote the necrosis of residual placenta while long-term use of warfarin was served as continuous anticoagulant therapy. Hysteroscopic resection of retained placenta was not performed until thrombi had been almost disappeared after more than 2 months of anticoagulation therapy. OUTCOMES: The patient's menstruation returned to normal within several weeks after hysteroscopic resection and she completely recovered from PE after 3 months of anticoagulant therapy. LESSONS: Treatment of retained placenta accreta can be postponed when encountering complicated cases, such as postpartum PE. PE in perinatal stage can be managed referring to nonmaternal PE.


Assuntos
Placenta Acreta/terapia , Placenta Retida/terapia , Período Pós-Parto , Embolia Pulmonar/terapia , Adulto , Feminino , Humanos , Placenta Acreta/diagnóstico , Placenta Retida/diagnóstico , Gravidez , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Tomografia Computadorizada por Raios X
10.
Braz J Med Biol Res ; 52(9): e8446, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482999

RESUMO

Left atrial diameter (LAD) has been considered an independent risk factor for atrial fibrillation (AF) relapse after pulmonary vein isolation (PVI). However, whether LAD or other factors are more predictive of late recurrence in patients with paroxysmal AF remains unclear. We aimed to evaluate the value of pulmonary vein (PV) parameters for predicting AF relapse 1 year after patients underwent cryoablation for paroxysmal AF. Ninety-seven patients with paroxysmal AF who underwent PVI successfully were included. PV parameters were measured through computed tomography scans prior to PVI. A total of 28 patients had recurrence of AF at one-year follow-up. The impact of several variables on recurrence was evaluated in multivariate analyses. LAD and the time from first diagnosis of AF to ablation maintained its significance in predicting the relapse of AF after relevant adjustments in multivariate analysis. When major diameter of right inferior pulmonary vein (RIPV) (net reclassification improvement (NRI) 0.179, CI=0.031-0.326, P<0.05) and cross-sectional area (CSA) of RIPV (NRI: 0.122, CI=0.004-0.240, P<0.05) entered the AF risk model separately, the added predictive capacity was large. The accuracy of the two parameters in predicting recurrence of AF were not inferior (AUC: 0.665 and 0.659, respectively) to echocardiographic LAD (AUC: 0.663). The inclusion of either RIPV major diameter or CSA of RIPV in the model increased the C-index (0.766 and 0.758, respectively). We concluded that major diameter of RIPV had predictive capacity similar to or even better than that of LAD for predicting AF relapse after cryoablation PVI.


Assuntos
Fibrilação Atrial/etiologia , Átrios do Coração/anatomia & histologia , Veias Pulmonares/anatomia & histologia , Idoso , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/diagnóstico por imagem , Recidiva , Fatores de Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Pan Afr Med J ; 33: 92, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489070

RESUMO

Isolated involvement of the hypothalamic-pituitary axis in patients with sarcoidosis is rare. Only a few cases have been reported in the literature. We report the clinical case of a 50-years old female patient who had undergone total thyroidectomy followed by replacement therapy because of goitre 4 years before. She complained of chronic headaches persisting for 6 months and resistant to all appropriate therapies, with concomitant decrease in visual acuity. Clinical examination showed optochiasmatic syndrome with extensive visual field defect and common oculomotor nerve palsy in the right eye with ptosis. Brain MRI objectified pathological process to the sellar region with heterogeneous tissue signal intensity extending to the pituitary stalk with thickening in the latter. Preoperative hormonal assessment showed mild thyrotropic deficiency. The patient underwent wide transnasal endoscopic transsphenoidal resection of fibrous and little bleeding tumor. Postoperative outcome was marked by the occurrence of diabetes insipidus and CSF fistula two days after surgery. Patient's outcome was good under medical treatment with spinal drainage. Thoracoabdominal CT scan and cardiac ultrasound were performed which showed no other site of occurrence of sarcoidosis. Dose of converting enzyme was normal. The patient received corticosteroid therapy for the treatment of systemic disease. Neurosarcoidosis is a criterion of poor prognosis in a patient with sarcoidosis. Hypothalamopituitary involvement is rare resulting in complications which are more frequent than those of other neurological and systemic disorders. This requires multidisciplinary long term management.


Assuntos
Adenoma/diagnóstico , Doenças da Hipófise/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Sarcoidose/diagnóstico , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Doenças da Hipófise/patologia , Prognóstico , Sarcoidose/patologia , Tomografia Computadorizada por Raios X
12.
Niger J Clin Pract ; 22(9): 1196-1200, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489853

RESUMO

Background: Septoplasty is one of the frequently applied nasal surgical procedures. There is still no gold standart objective method to evaluate the patients whom suffers from nasal blockage. To evaluate the septoplasty candidate with a Paranasal Computerised Tomography (PNCT) is one of the most discussed topic in the otorhinolaryngology surgical philosophy. Objectives: In this study, we aim to interpret the value of nasal valve areas measured by PNCT for both septoplasty candidates and the control population. We believe that this information could be useful for the evaluation of patients before undergoing a septoplasty procedure. Material and Methods: 600 coronal and axial tomography sections performed between May 2014 and February 2018 at the University Of Gaziantep Radiology Dept. were assessed. These tomography sections were divided into two groups called the septoplasty and the control. The septoplasty group was made up of three hundred paranasal sinus tomography images scanned before patients' septoplasty operations. The control group was created by screening 300 maxillofacial tomography's which were taken due to the suspicion of trauma at the University Of Gaziantep Emergency Clinic between May 2014 and January 2018. Results: There were 192 (64%) patients with left nasal septal deviation and 108 (36%) patients with right nasal septal deviation. The Independent Sample T-Test revealed that the mean internal nasal valve angle in the left septoplasty group was significantly lower than that of the control group (P < 0.005). A comparison of the right side nasal values revealed a significant statistical change according to the Independent Sample T-Test between the value of the right septoplasty and the control groups (P < 0.005). Conclusion: The sectional areas of nasal tomography images may show different values. However, it is still difficult to say that the clinical application of tomography images could be used as one of the indication criteria for the septoplasty procedure.


Assuntos
Septo Nasal/anormalidades , Seios Paranasais/diagnóstico por imagem , Rinoplastia/métodos , Tomografia Computadorizada por Raios X/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico por imagem , Obstrução Nasal/cirurgia , Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Seios Paranasais/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
13.
Bull Cancer ; 106(10): 903-914, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31495441

RESUMO

Germ-cell tumors are the most common solid tumors in young men. The follow-up of these patients is very important in their management. In stage I testicular cancer, surveillance is the standard for low-risk disease. In addition to the early detection of relapse, follow-up should be directed towards prevention, detection and treatment of late toxicity, and secondary malignancies. Follow up consists in physical examination, laboratory analysis and radiological imaging. Recently, guidelines recommend risk-adapted surveillance strategy, with a reduction of CT scans numbers, due to the recognition of the risk of ionizing radiation exposure. However, efforts to maintain adequate compliance with follow up are required.


Assuntos
Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Embrionárias de Células Germinativas/prevenção & controle , Segunda Neoplasia Primária/diagnóstico , Neoplasias Testiculares/prevenção & controle , Adulto , Humanos , Masculino , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Induzidas por Radiação/diagnóstico , Neoplasias Induzidas por Radiação/prevenção & controle , Cooperação do Paciente , Exposição à Radiação/prevenção & controle , Prevenção Secundária , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Am Surg ; 85(8): 861-864, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560304

RESUMO

Traumatic brain injuries in patients on antithrombotic agents carry significant morbidity. Initial therapy is centered around reversal of these agents. The thromboelastogram (TEG) maps the clotting cascade to guide reversal. A retrospective chart review was conducted for 118 patients presenting with a traumatic brain injury while on antithrombotics. Patients were divided between those who received a TEG on arrival and those who did not. The primary endpoint was overall mortality. Secondary endpoints included blood product utilization, and outcomes associated with specific novel anticoagulants. Mortality in the control group was 20.3 per cent compared with 18.5 per cent in the TEG group (P = 0.81). For less severe injuries, the control group mortality was 3.8 per cent and the TEG group mortality was 8.7 per cent (P = 0.64). For more severe injuries, mortality in the control versus TEG groups were 31.6 per cent and 25.8 per cent, respectively (P = 0.73). Blood product utilization was significantly lower in the TEG group (P = 0.002). Overall mortality was not significantly different between the groups. However, when stratified by severity of injury, mortality was reduced in the TEG-guided group in severely injured patients. Blood product utilization was significantly reduced with TEG-guided reversal. Trauma centers can improve the utilization of blood products in reversal of antithrombotics with the use of TEG.


Assuntos
Anticoagulantes/administração & dosagem , Lesões Encefálicas Traumáticas/sangue , Hemorragias Intracranianas/sangue , Ressuscitação/métodos , Tromboelastografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Emerg Med Clin North Am ; 37(4): 785-809, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563208

RESUMO

Emergency physicians rely on a multitude of different imaging modalities in the diagnosis of genitourinary emergencies. There are many considerations to be taken into account when deciding which imaging modality should be used first, as oftentimes several diagnostic tools can be used for the same pathologic condition. These factors include radiation exposure, sensitivity, specificity, age of patient, availability of resources, cost, and timeliness of completion. In this review, the strengths and weaknesses of different imaging tools in the evaluation of genitourinary emergencies are discussed.


Assuntos
Serviço Hospitalar de Emergência , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Emergências , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Radiografia , Tomografia Computadorizada por Raios X , Ultrassonografia
17.
Artigo em Japonês | MEDLINE | ID: mdl-31548466

RESUMO

PURPOSE: Computed tomography (CT) attenuation correction of myocardial perfusion in single-photon emission computed tomography (SPECT) /CT systems is possibility of misregistration between emission and transmission scans. This study aimed to evaluate the influence of misregistration using a polar map of 17 segments model. METHODS: Using the fusion software, we assessed the magnitude and direction of misregistration in 200 consecutive myocardial perfusion SPECT images with 99mTechnetium (99mTc) tetrofosmin. After registration, CT data was shifted by ±1, ±2, and ±3 pixels along the cephalad/caudal, dorsal/ventral, and left/right axes, respectively. The registered image was compared with the shifted image. RESULTS: Misregistration between the SPECT and CT images occurred by 1-2 pixels in 127 cases (63.5%) and by 2 or more pixels in four cases (2%); the maximum misregistration was 1.2±0.4 pixels on average. The polar map scoring was most significantly affected by 3 pixel ventral shift. A ventral shift of 1 pixel affected the scores for the anterolateral and inferolateral segments, whereas a caudal shift of 1 pixel affected the scores for the anterior segment. CONCLUSION: Since the 17 segments model can evaluate the position more precisely than the five segments model, it is possible to evaluate up to 1 pixel misregistration.


Assuntos
Artefatos , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Sensibilidade e Especificidade , Tecnécio , Tomografia Computadorizada de Emissão de Fóton Único/normas , Tomografia Computadorizada por Raios X/normas
18.
Pan Afr Med J ; 33: 153, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558950

RESUMO

Acute intestinal intussusception occurs primarily in infants and young children. It uncommonly occurs in adults. It can have various causes. In the vast majority of cases, it is secondary to a benign or malignant tumor. Intestinal T-cell lymphoma revealed by intestinal intussusception is very rare. We report the case of a 43-year old patient admitted with intestinal occlusion to the Emergency Department at the University Hospital Hassan II, Fes, Morocco. Abdominal CT scan showed acute intestinal intussusception associated with incarcerated bowel loop with bowel wall thickening. Treatment was based on open carcinological resection. Anatomopathological and immunohistochemical examination of the surgical specimen showed large T-cell anaplastic lymphoma. After surgery, chemotherapy was indicated to improve prognosis and to avoid a potential relapse. Intestinal intussusception rarely occurs in adults. It most often leads to the detection of an organic cause such as a tumor. This study and literature review aim to highlight the clinical and diagnostic features as well as the therapeutic approaches for this rare disease.


Assuntos
Obstrução Intestinal/etiologia , Intussuscepção/etiologia , Linfoma Anaplásico de Células Grandes/diagnóstico , Doença Aguda , Adulto , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Linfoma Anaplásico de Células Grandes/complicações , Linfoma Anaplásico de Células Grandes/terapia , Masculino , Marrocos , Prognóstico , Tomografia Computadorizada por Raios X
19.
Medicine (Baltimore) ; 98(36): e16826, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490369

RESUMO

The purpose of this study was to present the computed tomographic (CT) findings of lung abnormalities in macrolide-resistant Mycobacterium massiliense pulmonary disease and its changes in follow-up CT after antibiotic treatment.Chest CT scans of patients with macrolide-resistant M massiliense pulmonary disease (n = 19) were retrospectively reviewed. Patients were treated with multidrug therapy, and sputum examinations were performed. Follow-up CT scans obtained during antibiotic treatment after detection of macrolide resistance were also reviewed, if available (n = 13). The CT scores at detection of macrolide resistance and at the last follow-up periods were also compared.Of all patients with macrolide-resistant M massiliense pulmonary disease, 2 (11%) patients achieved sputum culture conversion during the follow-up period. The most common CT findings of M massiliense pulmonary disease at detection of macrolide resistance were bronchiectasis and bronchiolitis (n = 19, 100%), followed by consolidation (n = 16, 84%), cavities (n = 11, 58%), and nodules (n = 6, 32%). On the last follow-up CT, overall CT scores were increased in 8 (62%) of 13 patients, and total mean CT score was significantly increased (P = .021). For each CT pattern, the cavity showed the greatest increase in CT score (P = .027), followed by bronchiectasis (P = .038).Common CT findings of macrolide-resistant M massiliense pulmonary disease were similar to those of pulmonary disease caused by other species of nontuberculous mycobacteria at presentation. However, in macrolide-resistant M massiliense pulmonary disease, serial CT scans showed deterioration with cavitary and bronchiectatic change in most patients despite multidrug antibiotic therapy.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Macrolídeos/farmacologia , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Doenças Respiratórias/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Macrolídeos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/diagnóstico por imagem , Infecções por Micobactéria não Tuberculosa/microbiologia , Infecções por Micobactéria não Tuberculosa/patologia , Mycobacterium abscessus , Doenças Respiratórias/diagnóstico por imagem , Doenças Respiratórias/microbiologia , Doenças Respiratórias/patologia , Estudos Retrospectivos , Escarro/microbiologia , Tomografia Computadorizada por Raios X
20.
Medicine (Baltimore) ; 98(36): e16910, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490375

RESUMO

RATIONALE: Conventional computerized tomography (CT) examination can differentiate renal cortical tumor from urothelial carcinoma on the basis of the highly contrast-enhanced vessels in renal cortical tumors. However, the capillary distribution of renal cell carcinoma (RCC) has been under-investigated. Here, we present a micro-CT image of tumor tissue in a patient with RCC. PATIENT CONCERNS: The patient was a 72-year-old woman with a past history of diabetes mellitus and hypertension. She did not have tumor-related symptoms. DIAGNOSIS AND INTERVENTIONS: The tumor was diagnosed using abdominal CT during her yearly routine health check. After radical nephrectomy, the tumor was subjected to pathological examination and micro-CT imaging. Pathological analysis confirmed a clear cell renal carcinoma. The capillary distribution of the tumor was significantly lesser than that of the normal cortex on micro-CT image. LESSONS: Microvessels of RCC can be detected by micro-CT. We also found that the distribution of microvessels was uneven and lower than that in the normal cortex in this case. For a more general diagnosis, more micro-CT images of RCC tumors are needed.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Idoso , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Nefrectomia , Tomografia Computadorizada por Raios X
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