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1.
Medicine (Baltimore) ; 99(5): e18582, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000365

RESUMO

The aim of this study was to explore the efficacy, repeatability, and efficiency of a new intraoperative contactless device (INTEGRA Optomed, Chorzów, Poland) for determining the axis for toric intraocular lens implantation and then to compare this with that determined using a manual method.This study was conducted at the Ophthalmological Center for Children and Adults Optomed, Chorzów, Poland.This nonrandomized, retrospective, observational study included 20 eyes of 12 patients (5 males and 7 females) who had toric intraocular lens implanted. A video recording of each surgery using the INTEGRA system was made showing the analysis. The surgeon and one of the researchers then independently assessed the location of the implant axes determined with both digital and manual slit-lamp methods, and compared them.The implantation axes suggested for both the manual and INTEGRA methods were similar. The median axis disparities were 0.0 degree and 0.5 degree, and standard deviations were 0.61 and 0.81 for researcher 1 and 2, respectively. The dominant value was 0.0 in both groups. The INTEGRA axis designation was not statistically different from the manual method (level of significance: α < 0.01).The INTEGRA system is a digital ink-free device for image tracking scleral vessels. It was helpful for determining the implantation axis in a precise and repeatable manner, and measurements were comparable with a manual technique.


Assuntos
Implante de Lente Intraocular/instrumentação , Adulto , Idoso , Feminino , Humanos , Implante de Lente Intraocular/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclera/irrigação sanguínea , Esclera/diagnóstico por imagem , Adulto Jovem
2.
Medicine (Baltimore) ; 99(5): e18643, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000368

RESUMO

INTRODUCTION: Metastatic mesenchymal chondrosarcoma of the spine is a highly unusual disease without standard curative managements yet. The objective of this case report is to present a very rare case of metastatic chondrosarcoma to the spine successfully operated by surgical treatment. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS: A 34-year-old woman presented with a 4-month history of continuous and progressive back pain and a 1-month history of radiating pain of bilateral lower extremities. The patient, who had been diagnosed of mesenchymal chondrosarcoma of maxillary sinus for 3 years, received surgical treatment of palliative endoscopic-assisted total left maxillary resection via mini Caldwell-Luc approach, and palliative enlarged resection due to the progress of residual lesions, followed by no adjuvant therapy. Multiple lytic, expanding lesions of the spine and paraspinal region with severe epidural spinal cord compression was identified. DIAGNOSIS: CT, MRI and bone scan of spine showed spinal cord compression secondary to the epidural component of the metastatic lesions. Post-operative pathology confirmed the diagnosis of metastatic spinal mesenchymal chondrosarcomas. INTERVENTIONS: The patient underwent posterior spinal canal decompression, resection of T12 and L3 lesions, internal fixation of T11-L5 pedicles, and cement augmentation of T12 and L3. OUTCOMES: The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 1-year follow-up visit. There were no complications associated with the spinal surgery during the follow-up period. CONCLUSION: Metastatic spinal mesenchymal chondrosarcoma, although rare, should be part of the differential diagnosis when the patient presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression and total resection of the metastatic chondrosarcoma when the tumor has caused neurological deficits or other severe symptoms. Osteoplasty by cement augmentation is also a good choice for surgical treatment in some patients.


Assuntos
Condrossarcoma Mesenquimal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Condrossarcoma Mesenquimal/diagnóstico por imagem , Condrossarcoma Mesenquimal/secundário , Feminino , Humanos , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário
3.
Medicine (Baltimore) ; 99(5): e18646, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000369

RESUMO

INTRODUCTION: Clear cell adenocarcinoma of the cervix (CCAC), a rare and more severe type of gynecological cancer, is especially rare in pediatric patients. Traditionally, surgery following chemotherapy (CT) and radiation therapy is the preferred treatment for CCAC; however, patients have poor 5-year survival rates than other types of cervical cancers. PATIENT CONCERNS: A 6-year-old girl with a history of vaginal discharge for 18 months was diagnosed with CCAC by histological examination. Her parents refused the traditional treatment of radical hysterectomy and lymph node dissection because of her young age. DIAGNOSIS: The patient's tests revealed negative human papilloma virus and negative methylated paired box 1 gene results. The tumor mass histopathology revealed stage IIA1 CCAC that originated from the cervix. INTERVENTIONS: Tumor mass excision with preservation of the cervix by electrosurgical biopsy under hysteroscopy was performed. Four cycles of docetaxel and oxaliplatin CT were administered every 3 weeks. OUTCOMES: No signs of recurrence were observed in the 28 months after final treatment and diagnosis on magnetic resonance imaging, color ultrasonic imaging, and gynecological examination. Serologic tumor biomarkers were also within normal ranges. CONCLUSIONS: This is the first reported CCAC case in which the primary treatment included electrosurgical biopsy of the polypoid mass under hysteroscopy, followed by CT without traditional treatment: radical surgery with pelvic and/or lymphadenectomy for fertility preservation. This is a new treatment approach for young CCAC patients without the use of surgery.


Assuntos
Adenocarcinoma/cirurgia , Histeroscopia , Tratamentos com Preservação do Órgão , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Antineoplásicos/uso terapêutico , Colo do Útero/patologia , Criança , Docetaxel/uso terapêutico , Feminino , Humanos , Oxaliplatina/uso terapêutico , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/patologia
4.
Medicine (Baltimore) ; 99(5): e18654, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000370

RESUMO

INTRODUCTION: Acute hydrocephalus is a common complication of spontaneous or traumatic intracranial bleeding with extensive subarachnoid hemorrhage (SAH) or ventricular extension. However, it has never been reported to be secondary to pneumocephalus. PATIENT CONCERNS: A 32-year-old man was admitted following a motorcycle accident. Head computed tomography (CT) performed right after the accident revealed a skull base fracture and mild perimesencephalic SAH. Three days later, repeated CT revealed delayed perimesencephalic pneumocephalus and an evident enlargement of the ventricular system. DIAGNOSIS: The patient was diagnosed with acute obstructive hydrocephalus, which was secondary to pneumocephalus and traumatic SAH. INTERVENTIONS: The patient was treated with temporary external ventricular drainage (EVD). OUTCOMES: The patient experienced an unremarkable recovery process. At follow-up 3 months later, he showed no recurrence of the hydrocephalus and the score of Glasgow Outcome Scale was 5. CONCLUSION: Transient mechanical obstruction of CSF circulation and disturbance of CSF physiology might conjointly lead to the acute obstructive hydrocephalus.


Assuntos
Hidrocefalia/etiologia , Pneumocefalia/complicações , Fratura da Base do Crânio/complicações , Hemorragia Subaracnóidea/complicações , Acidentes de Trânsito , Adulto , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Fratura da Base do Crânio/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(5): e18884, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000391

RESUMO

INTRODUCTION: Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a secondary infection occurs. The symptoms of an infected urachal cyst are nonspecific and may be similar to acute appendicitis or other acute abdominal conditions. However, complications attributable to a delayed diagnosis can endanger the life of a patient. PATIENT CONCERNS: A 5-year-old boy presented with a 3-day history of severe intermittent lower abdominal pain. DIAGNOSIS: Infected urachal cyst. INTERVENTIONS: The patient was treated with surgical resection of the urachus, followed by intravenous antibiotics during the hospitalization. OUTCOMES: The patient was discharged without incident 7 days after the operation. With his follow-up in our out-patient department, he recovered well without any sequelae in the 6 months post-surgery. CONCLUSION: We suggested using the abdominal echo scan to differentiate the urachal cyst because of its high sensitivity and nonradioactive characteristic, and computed tomography is a typical diagnostic tool for urachal cysts. The mainstream management of an infected urachal cyst remains surgical excision. Complete excision of urachal cysts is relatively easy in a pediatric patient and the risk of subsequent infection is low; however, patients tend to have a low, although possible, risk of potential malignant transformation over their lifetimes.


Assuntos
Abdome Agudo/etiologia , Cisto do Úraco/diagnóstico por imagem , Abdome Agudo/diagnóstico por imagem , Pré-Escolar , Humanos , Masculino , Cisto do Úraco/complicações , Cisto do Úraco/patologia , Cisto do Úraco/cirurgia , Úraco/patologia
6.
Int J Oral Sci ; 12(1): 5, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32024813

RESUMO

Rheumatoid arthritis (RA) is an autoimmune disease affecting 1% of the world population and is characterized by chronic inflammation of the joints sometimes accompanied by extra-articular manifestations. K/BxN mice, originally described in 1996 as a model of polyarthritis, exhibit knee joint alterations. The aim of this study was to describe temporomandibular joint (TMJ) inflammation and damage in these mice. We used relevant imaging modalities, such as micro-magnetic resonance imaging (µMRI) and micro-computed tomography (µCT), as well as histology and immunofluorescence techniques to detect TMJ alterations in this mouse model. Histology and immunofluorescence for Col-I, Col-II, and aggrecan showed cartilage damage in the TMJ of K/BxN animals, which was also evidenced by µCT but was less pronounced than that seen in the knee joints. µMRI observations suggested an increased volume of the upper articular cavity, an indicator of an inflammatory process. Fibroblast-like synoviocytes (FLSs) isolated from the TMJ of K/BxN mice secreted inflammatory cytokines (IL-6 and IL-1ß) and expressed degradative mediators such as matrix metalloproteinases (MMPs). K/BxN mice represent an attractive model for describing and investigating spontaneous damage to the TMJ, a painful disorder in humans with an etiology that is still poorly understood.


Assuntos
Artrite Experimental/patologia , Artrite Reumatoide/patologia , Osso e Ossos/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/lesões , Microtomografia por Raio-X/métodos , Animais , Artrite Experimental/imunologia , Artrite Reumatoide/imunologia , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Modelos Animais de Doenças , Humanos , Imagem por Ressonância Magnética , Metaloproteinase 8 da Matriz/imunologia , Camundongos , Camundongos Transgênicos , Articulação Temporomandibular/metabolismo , Tomografia Computadorizada por Raios X
7.
Adv Exp Med Biol ; 1213: 47-58, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030662

RESUMO

Image-based computer-aided diagnosis (CAD) algorithms by the use of convolutional neural network (CNN) which do not require the image-feature extractor are powerful compared with conventional feature-based CAD algorithms which require the image-feature extractor for classification of lung abnormalities. Moreover, computer-aided detection and segmentation algorithms by the use of CNN are useful for analysis of lung abnormalities. Deep learning will improve the performance of CAD systems dramatically. Therefore, they will change the roles of radiologists in the near future. In this article, we introduce development and evaluation of such image-based CAD algorithms for various kinds of lung abnormalities such as lung nodules and diffuse lung diseases.


Assuntos
Aprendizado Profundo , Diagnóstico por Computador , Interpretação de Imagem Assistida por Computador , Pneumopatias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Humanos
8.
Adv Exp Med Biol ; 1213: 59-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030663

RESUMO

For computer-aided diagnosis (CAD), detection, segmentation, and classification from medical imagery are three key components to efficiently assist physicians for accurate diagnosis. In this chapter, a completely integrated CAD system based on deep learning is presented to diagnose breast lesions from digital X-ray mammograms involving detection, segmentation, and classification. To automatically detect breast lesions from mammograms, a regional deep learning approach called You-Only-Look-Once (YOLO) is used. To segment breast lesions, full resolution convolutional network (FrCN), a novel segmentation model of deep network, is implemented and used. Finally, three conventional deep learning models including regular feedforward CNN, ResNet-50, and InceptionResNet-V2 are separately adopted and used to classify or recognize the detected and segmented breast lesion as either benign or malignant. To evaluate the integrated CAD system for detection, segmentation, and classification, the publicly available and annotated INbreast database is used over fivefold cross-validation tests. The evaluation results of the YOLO-based detection achieved detection accuracy of 97.27%, Matthews's correlation coefficient (MCC) of 93.93%, and F1-score of 98.02%. Moreover, the results of the breast lesion segmentation via FrCN achieved an overall accuracy of 92.97%, MCC of 85.93%, Dice (F1-score) of 92.69%, and Jaccard similarity coefficient of 86.37%. The detected and segmented breast lesions are classified via CNN, ResNet-50, and InceptionResNet-V2 achieving an average overall accuracies of 88.74%, 92.56%, and 95.32%, respectively. The performance evaluation results through all stages of detection, segmentation, and classification show that the integrated CAD system outperforms the latest conventional deep learning methodologies. We conclude that our CAD system could be used to assist radiologists over all stages of detection, segmentation, and classification for diagnosis of breast lesions.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Aprendizado Profundo , Diagnóstico por Computador , Interpretação de Imagem Assistida por Computador , Mamografia/métodos , Humanos
9.
Adv Exp Med Biol ; 1213: 73-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030664

RESUMO

Lung cancer is the most common cancer among men and the third most common among women in the world. Many diagnostic techniques have been introduced to diagnose lung cancer. Positron emission tomography (PET)/computed tomography (CT) examination is an image diagnostic method that performs automatic detection and distinction of lung lesions. In addition, pathological examination by biopsy is performed for lesions that are suspected of being malignant, and appropriate treatment methods are applied according to the diagnosis results. Currently, lung cancer diagnosis is performed through coordination between respiratory, radiation, and pathological diagnosis experts, but there are some tasks, such as image diagnosis, that require a large amount of time and effort to complete. Therefore, we developed a decision support system using PET/CT and microscopic images at the time of image diagnosis, which leads to appropriate treatment. In this chapter, we introduce the proposed system using deep learning and radiomic techniques.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Aprendizado Profundo , Humanos
10.
Adv Exp Med Biol ; 1213: 95-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030665

RESUMO

This chapter proposes a method to detect metastatic liver cancer from X-ray CT images using a convolutional neural network (CNN). The proposed method generates various lesion images by the combination of three kinds of generation methods: (1) synthesis using Poisson Blending, (2) generation based on CT value distributions, and (3) generation using deep convolutional generative adversarial networks (DCGANs). The proposed method constructs two kinds of detectors by using synthetic (fake) lesion images generated by the methods as well as real ones. One of the detectors is a 2D CNN for detecting candidate regions in a CT image, and the other is a 3D CNN for validating the candidate regions. Experimental results showed that the proposed method gave 0.30 improvement from 0.65 to 0.95 in terms of the detection rate, and 0.70 improvement from 0.90 to 0.20 in terms of the number of false detections per case. From the results, we confirmed the effectiveness of the proposed method.


Assuntos
Aprendizado Profundo , Processamento de Imagem Assistida por Computador , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Tomografia Computadorizada por Raios X , Humanos
11.
Adv Exp Med Biol ; 1213: 107-120, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030666

RESUMO

At medical checkups or mass screenings, the fundus examination is effective for early detection of systemic hypertension, arteriosclerosis, diabetic retinopathy, etc. In most cases, ophthalmologists and physicians grade retinal images by the condition of the blood vessels, lesions. However, human observation does not provide quantitative results, thus blood vessel analysis is an important process in determining hypertension and arteriosclerosis, quantitatively. This chapter describes the latest automated blood vessel extraction using the deep convolution neural network (DCNN). Diabetic retinopathy is a common cardiovascular disease and a major factor in blindness. Therefore, early detection of diabetic retinopathy is very important to preventing blindness. A microaneurysm is an initial sign of diabetic retinopathy, and much research has been conducted for microaneurysm detection. This chapter also describes diabetic retinopathy detection and automated microaneurysm detection using the DCNN.


Assuntos
Aprendizado Profundo , Retinopatia Diabética/diagnóstico por imagem , Retinopatia Diabética/complicações , Diagnóstico Precoce , Fundo de Olho , Humanos , Microaneurisma/complicações , Microaneurisma/diagnóstico por imagem
12.
Adv Exp Med Biol ; 1213: 121-132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030667

RESUMO

Early detection of glaucoma is important to slow down progression of the disease and to prevent total vision loss. Retinal fundus photography is frequently obtained for various eye disease diagnosis and record and is a suitable screening exam for its simplicity and low cost. However, the number of ophthalmologists who are specialized in glaucoma diagnosis is limited. We have been studying automated schemes for detection of nerve fiber layer defects and analysis of optic disc deformation, two major signs of glaucoma, in assisting ophthalmologists' accurate and efficient diagnosis. In this chapter, our recent progress in computerized methods is discussed.


Assuntos
Aprendizado Profundo , Fundo de Olho , Glaucoma/diagnóstico por imagem , Glaucoma/patologia , Humanos , Fibras Nervosas/patologia , Disco Óptico/diagnóstico por imagem , Disco Óptico/patologia
13.
Adv Exp Med Biol ; 1213: 149-163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030669

RESUMO

The skin is the largest organ of our body. Skin disease abnormalities which occur within the skin layers are difficult to examine visually and often require biopsies to make a confirmation on a suspected condition. Such invasive methods are not well-accepted by children and women due to the possibility of scarring. Optical coherence tomography (OCT) is a non-invasive technique enabling in vivo examination of sub-surface skin tissue without the need for excision of tissue. However, one of the challenges in OCT imaging is the interpretation and analysis of OCT images. In this review, we discuss the various methodologies in skin layer segmentation and how it could potentially improve the management of skin diseases. We also present a review of works which use advanced machine learning techniques to achieve layers segmentation and detection of skin diseases. Lastly, current challenges in analysis and applications are also discussed.


Assuntos
Processamento de Imagem Assistida por Computador , Aprendizado de Máquina , Dermatopatias/diagnóstico por imagem , Pele/diagnóstico por imagem , Tomografia de Coerência Óptica , Humanos
14.
Adv Exp Med Biol ; 1213: 165-176, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030670

RESUMO

Advancements in musculoskeletal analysis have been achieved by adopting deep learning technology in image recognition and analysis. Unlike musculoskeletal modeling based on computational anatomy, deep learning-based methods can obtain muscle information automatically. Through analysis of image features, both approaches can obtain muscle characteristics such as shape, volume, and area, and derive additional information by analyzing other image textures. In this chapter, we first discuss the necessity of musculoskeletal analysis and the required image processing technology. Then, the limitations of skeletal muscle recognition based on conventional handcrafted features are discussed, and developments in skeletal muscle recognition using machine learning and deep learning technology are described. Next, a technique for analyzing musculoskeletal systems using whole-body computed tomography (CT) images is shown. This study aims to achieve automatic recognition of skeletal muscles throughout the body and automatic classification of atrophic muscular disease using only image features, to demonstrate an application of whole-body musculoskeletal analysis driven by deep learning. Finally, we discuss future development of musculoskeletal analysis that effectively combines deep learning with handcrafted feature-based modeling techniques.


Assuntos
Osso e Ossos/diagnóstico por imagem , Aprendizado Profundo , Interpretação de Imagem Assistida por Computador , Músculo Esquelético/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos
15.
Medicine (Baltimore) ; 99(5): e18920, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000402

RESUMO

The aim of this study was to compare the diagnostic yield of conventional cytology (CC) with ethanol-based fixation, a cytological analysis using an ethanol based fixative system including a cell block procedure (EBF) to evaluate indeterminate biliary strictures (IBStr). We also compared additionally taken fluorescence-guided forceps biopsies (FB) with EBF concerning a potential additive diagnostic benefit.Early detection and accurate diagnosis are crucial for patients with suspected carcinoma within the biliary tree to preserve curative treatment options but diagnostics and patient care in the evaluation of IBStr are still challenging. ERC-guided brush cytology is the gold standard of nonsurgical evaluation of IBStr. However, accuracy is generally low. New specimen processing's are needed to higher the diagnostic yield in the evaluation of IBStr.We performed a retrospective evaluation in 404 patients referred for further diagnosis of IBStr. Gold standard was defined as surgically obtained histology or patient follow-up of at least 1 year to diagnose or exclude malignancy.Three hundred thirty-four patients were included into the final analysis. One hundred seventy-two strictures were malignant, 162 strictures benign. One hundred seventeen specimens were evaluated by CC, 217 processed by EBF. EBF performed significantly better in terms of sensitivity (24.6% vs 60%, P < .001) and accuracy (59.0% vs 75.1%, P = .006). Fifty-eight FB were additionally taken and showed a numerically improved sensitivity compared to EBF alone (80% vs 62.9%, P = .19).EBF is a simple and inexpensive technique that substantially improved sensitivity and accuracy in the evaluation of IBStr. FB specimen did not significantly improve diagnostic yield.


Assuntos
Ductos Biliares/diagnóstico por imagem , Ductos Biliares/patologia , Colangiografia , Endoscopia do Sistema Digestório , Etanol , Fixadores , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/patologia , Biópsia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Óptica , Estudos Retrospectivos , Sensibilidade e Especificidade , Fixação de Tecidos
16.
Medicine (Baltimore) ; 99(5): e18923, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000404

RESUMO

To evaluate the risk of first upper gastrointestinal bleeding by computerized tomoscanning (CT) for esophageal varices patients with cirrhotic portal hypertension.One hundred thirty two esophageal varices patients with cirrhotic portal hypertension who are also complicated with gastrointestinal bleeding were recruited as bleeding group, while another 132 patients without bleeding as non-bleeding group. The diameter of esophageal varices, number of vascular sections, and total area of blood vessels were measured by CT scanning. The sensitivity and specificity of these indicators were calculated, and Youden index was adjusted with the critical point.The diameter of esophageal varices was 7.83 ±â€Š2.76 mm in bleeding group, and 6.57 ±â€Š3.42 mm in non-bleeding group. The Youden index was 0.32 with the critical point 5.55 mm. The area under the receiver operating characteristics (AUROC) was 0.72. The number of venous vessels was 4.5 ±â€Š2 in bleeding group, whereas being 4 ±â€Š2 in non-bleeding group. The Youden index was 0.35 with a critical point 4, and the area under the curve (AUC) was 0.68. The blood vessel area was 1.73 ±â€Š1.15 cm in bleeding group, and 1.12 ±â€Š0.89 cm in non-bleeding group. The Youden index was 0.48 with the critical point being 1.03 cm, and corresponding AUC was 0.82.Among all 3 indicators of the total area, diameter, and number of sections of the esophageal varices, the total area of esophageal varices showed more accuracy as a potential and novel indicator for bleeding prediction.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Tomografia Computadorizada por Raios X , Adulto , Idoso , Varizes Esofágicas e Gástricas/epidemiologia , Esôfago/diagnóstico por imagem , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/epidemiologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Sensibilidade e Especificidade
17.
Medicine (Baltimore) ; 99(5): e18927, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000406

RESUMO

Cytomegalovirus (CMV) gastritis is a rare opportunistic infection with diverse clinical manifestations. Our study aimed to investigate the clinical features of Chinese patients with CMV gastritis.Six inpatients diagnosed with CMV gastritis were retrospectively enrolled, based on the finding of inclusion bodies in routine hematoxylin and eosin staining or positive anti-CMV monoclonal antibodies under immunohistochemistry in the gastric biopsy. Data, including demographics, diagnostic measurements, and medications, were collected.Abdominal pain was the most frequently reported symptom, occurring in 4 patients. Five patients were immunocompromised with associated underlying diseases, and 3 patients had decreased leukocyte differentiation antigen 4 positive (CD4) T lymphocyte counts. Only 3 patients had either positive cytomegalovirus (CMV)-immunoglobulin (Ig) M or increased copies of CMV-DNA peripherally. All patients had gastric lesions in the antrum of the stomach, including ulcers or erosions observed by gastroscopy. All patients received ganciclovir by intravenous injection (IV) as the first line anti-CMV therapy, and attained complete (4) or partial remission (2) during the follow-up.CMV gastritis should be taken into consideration in patients with immunocompromised status who have abdominal pain, nausea, or vomiting. Gastroscopy and necessary biopsy are the major diagnostic methods for CMV gastritis. Early diagnosis leads to a better prognosis for these patients.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Gastrite/diagnóstico , Gastrite/epidemiologia , Dor Abdominal/diagnóstico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Idoso , Biomarcadores/sangue , Biópsia , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Feminino , Gastrite/tratamento farmacológico , Gastrite/patologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/tratamento farmacológico , Náusea/epidemiologia , Náusea/etiologia , Prognóstico , Estudos Retrospectivos , Estômago/diagnóstico por imagem , Estômago/patologia , Centros de Atenção Terciária , Vômito/diagnóstico , Vômito/tratamento farmacológico , Vômito/epidemiologia , Vômito/etiologia
18.
Medicine (Baltimore) ; 99(5): e18939, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000411

RESUMO

RATIONALE: Diagnosing and treating refractory cancer pain have become standardized and effective procedures with guidance from the Expert Consensus on Refractory Cancer Pain released in 2017 by the Committee of Rehabilitation and Palliative Care of China. Doxorubicin has been used for perineural injection in the treatment of chronic non-cancer pain owing to its retrograde sensory ganglion resection effect. Our study reports a new fourth-ladder treatment for cancer pain: CT-guided paravertebral doxorubicin injection for patients with refractory cancer pain caused by paraspinal metastasis. PATIENT CONCERNS: A 48-year-old female and a 47-year-old male patients suffered from refractory cancer pain over the past months. They had both undergone surgical tumor resection, chemotherapy, and precision radiotherapy but result in limited analgesic effect. The daily oral morphine dosage was around 60 to 100 mg and rescue analgesic methods had been used at the time. DIAGNOSES: Refractory cancer pain in 2 patients with renal cancer and hepatobiliary adenocarcinoma. INTERVENTIONS: The patients both received computed tomography (CT)-guided 1 mL of 0.5% doxorubicin paravertebral injection at each affected nerve root segments. OUTCOMES: The Visual Analog Scale and Douleur Neuropathique four Questions were used for 6-month follow-up, and the analgesic requirement was also recorded. The patients enjoyed satisfactory analgesia for up to 6 months without adverse reaction. In addition, the oral opioid analgesic doses were significantly reduced after the neurolytic block. LESSONS: The CT-guided paravertebral doxorubicin injection was an effective fourth-step analgesic interventional technology that allowed our 2 patients with refractory cancer pain to maintain satisfactory analgesia. This analgesia method taken at an appropriate stage, according to the latest analgesic concept, results in good analgesia and opioid use reduction. Also, with the imaging guidance, only a small amount of neurolytic agent is needed to achieve analgesia in a precise and safe way.


Assuntos
Analgésicos/administração & dosagem , Dor do Câncer/tratamento farmacológico , Doxorrubicina/administração & dosagem , Dor Intratável/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário , Tomografia Computadorizada por Raios X , Dor do Câncer/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Intratável/diagnóstico por imagem , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/tratamento farmacológico
19.
Medicine (Baltimore) ; 99(5): e18940, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000412

RESUMO

Soluble suppression of tumorigenicity 2 (sST2) is a free form of membrane-bound ST2, which is a member of the interleukin-1 receptor family. Previous research has shown that sST2 is associated with diabetes, but cardiovascular risk factors have not been established.To analyze the relationship between sST2 and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM).After screening, a total of 118 subjects with T2DM were divided into 2 groups according to the measurement of CIMT (normal CIMT (NCIMT), n = 58; abnormal CIMT (ACIMT), n = 60), and 60 healthy subjects (normal control (NC), n = 60) were recruited in this study. CIMT was measured by a color Doppler ultrasound, and sST2 and other metabolic parameters were measured as well.The median concentration of sST2 was elevated in the ACIMT group (31.30 ng/ml) compared with the NCIMT group (28.29 ng/ml, P < .01) and the NC group (20.15 ng/ml, P < .01). After adjustment for age and sex, log sST2 was strongly associated with smoking history (ß = 0.197, 95% CI, 0.084-0.311, P < .01), FPG level (ß = 0.302, 95% CI, 0.162-0.442, P < .01) and HbA1c level (ß = 0.296, 95% CI, 0.165-0.426, P < .01) and negatively correlated with HDL level (ß = -0.153, 95% CI, -0.259 to -0.046, P < .01). Furthermore, sST2 level was a risk factor for increased CIMT in patients with T2DM.Increased sST2 level not only was associated with indicators of glucose and lipid metabolism but also was a risk factor for increased CIMT in patients with T2DM. Thus, sST2 may be a potential novel marker to assess the progression of diabetic macrovascular complications.


Assuntos
Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
20.
Medicine (Baltimore) ; 99(5): e18952, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000418

RESUMO

RATIONALE: Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue neoplasm with controversial histogenesis. ASPS accounts for 0.5% to 1% of all soft tissue sarcomas. Because of its rarity, ASPS is easily misdiagnosed, increasing the risk of incorrect treatment. PATIENT CONCERNS: A 6-year-old female patient presented with a history of a 2.0 × 2.5 × 3.0-cm mass in the deep soft tissues of her right lower extremity. DIAGNOSES: Histopathological features indicated the diagnosis of ASPS. Microscopically, a diffuse arrangement of tumor cells or pseudoalveolar architectures separated by thin and well-vascularized fibrous septa were observed. Immunohistochemical staining of the tumor cells indicated positivity for transcription factor E3, myogenic determination factor 1, and periodic acid-Schiff-diastase (PAS-D) and showed a Ki-67 proliferating index of approximately 20%. INTERVENTIONS: The patient underwent enlarged resection of the tumor and was treated with radiotherapy. OUTCOMES: During the 3-year follow-up, the patient has remained in good condition, with no symptom recurrence, distant metastatic spread, or significant toxicity during or after treatment. The patient remains under regular surveillance. LESSONS: Its low incidence, lack of characteristic clinical manifestations, and atypical location often lead to ASPS misdiagnosis and subsequent incorrect treatment. Nuclear expression of transcription factor E3 is of diagnostic value for ASPS. At present, there is no consensus on the treatment for ASPS. In-depth pathological analysis is needed to better understand the characteristics of this tumor.


Assuntos
Sarcoma Alveolar de Partes Moles/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/patologia , Sarcoma Alveolar de Partes Moles/patologia , Sarcoma Alveolar de Partes Moles/radioterapia , Sarcoma Alveolar de Partes Moles/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/radioterapia , Neoplasias de Tecidos Moles/cirurgia
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