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2.
Pan Afr Med J ; 33: 264, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31693722

RESUMO

Introduction: The purpose of our study was to describe the epidemioclinical and ultrasonographic features of hydatidiform moles (HM) in Abidjan. Methods: We conducted a cross-sectional study in the Department of Radiology, University Teaching Hospital of Yopougon over a 6-year period (January 2011-December 2016). In this study we describe the epidemioclinical and ultrasonographic profile of patients with HM. Ultrasonographic exams were performed using a mixed-methods approach (intravaginal and subpubic) based on B-mode and Color Doppler by senior radiologists. Anatomopathological examination of uterine content was performed. Results: Out of 12190 obstetric ultrasound performed, twenty-five cases of HM were diagnosed reflecting a radiological referral rate of 0.2%. The average age of patients was 33.4 years, ranging from 22 to 50 years. There was no dominant age class. The main clinical signs associated with amenorrhea (100%) included abdominal mass 36% and vaginal bleeding 28%. Ultrasound showed hypertrophic uterus in 100% of cases, homogeneous uterus in 96% of cases and myomatous uterus in 4% of cases. MH had an average thickness of 42.7 mm with vesicular appearance in 68% of cases, "honeycomb" appearance in 16%, multicystic appearance in 12% and snowstorm appearance in 4%. MHs were classified as partial in 4% of cases, complete in 92% of cases and invasive in 4% of cases. Hypertrophic ovaries were found in 44% of cases with macrofollicles in 32% of cases and cysts in 8% of cases. Ultrasonographic diagnosis of HM was confirmed by anatomopathological examination in 100% of cases. Conclusion: HMs are rare in Abidjan and are dominated by the complete hydatidiform mole. Its occurrence at the extreme ages wasn't found.


Assuntos
Mola Hidatiforme/epidemiologia , Ultrassonografia Doppler em Cores/métodos , Neoplasias Uterinas/epidemiologia , Útero/diagnóstico por imagem , Adulto , Costa do Marfim , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Mola Hidatiforme/diagnóstico por imagem , Hipertrofia , Pessoa de Meia-Idade , Gravidez , Neoplasias Uterinas/diagnóstico por imagem , Adulto Jovem
4.
An Bras Dermatol ; 94(4): 473-475, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644625

RESUMO

Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.


Assuntos
Derme/diagnóstico por imagem , Derme/patologia , Dermatopatias/diagnóstico por imagem , Dermatopatias/patologia , Ultrassonografia Doppler em Cores/métodos , Adulto , Atrofia/diagnóstico por imagem , Atrofia/patologia , Biópsia , Diagnóstico Precoce , Feminino , Humanos
5.
Medicine (Baltimore) ; 98(35): e16757, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464905

RESUMO

RATIONALE: Parotid gland adenolymphoma is one of the most common benign tumors in parotid gland, and mainly treated by surgery. Despite the widespread of ultrasound-guided percutaneous microwave ablation, there is no report concerning its application in parotid gland adenolymphoma. Herein, we reported a 2-year follow-up result of a male patient underwent ultrasound-guided percutaneous microwave ablation for parotid gland adenolymphoma. PATIENT CONCERNS: A 73-year-old man was admitted due to a hypoechoic nodule measuring 2.67 × 1.42 × 1.35 cm in posterior-inferior area of parotid gland with a high flow velocity in color Doppler flow imaging. DIAGNOSE: The lesion was pathologically diagnosed as parotid gland adenolymphoma. INTERVENTIONS: Ultrasound-guided percutaneous microwave ablation was performed to the tumor due to the fact that the patient refused to receive an open surgery in consideration of older age. OUTCOMES: The ablation procedure lasted about 2 minutes and 15 seconds, without significant adverse effect. The reduction ratios of tumor at postoperative 1 and 3-month were 53% and 82%, respectively. The tumor was fully absent at postoperative 8-month evaluation. Finally, there was no evident recurrence at postoperative 24-month evaluation. LESSONS: Ultrasound-guided percutaneous microwave ablation is a safe and effective treatment for parotid gland adenolymphoma, which may serve as a novel alternative approach for patients unsuitable for open surgery.


Assuntos
Adenolinfoma/terapia , Micro-Ondas/uso terapêutico , Neoplasias Parotídeas/terapia , Ultrassonografia de Intervenção/métodos , Adenolinfoma/diagnóstico por imagem , Idoso , Humanos , Masculino , Neoplasias Parotídeas/diagnóstico por imagem , Ablação por Radiofrequência , Terapia por Radiofrequência , Resultado do Tratamento , Carga Tumoral , Ultrassonografia Doppler em Cores/métodos
7.
J Clin Ultrasound ; 47(8): 453-460, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31343081

RESUMO

PURPOSE: The aim is to investigate whether baseline contrast-enhanced ultrasound (CEUS) correlates with indices of activity in Crohn's disease (CD) and can predict response to medical treatment. METHODS: In this prospective study, symptomatic CD patients underwent baseline CEUS performed with Definity using both bolus and infusion methods. Time-intensity curves (TIC), peak intensity (PI), and area under curve (AUC) from a region of interest over the diseased bowel were calculated for both bolus and infusion acquisitions. We used Mann-Whitney U test for continuous and chi-square/two-tailed Fisher's exact test for categorical variable comparison and Spearman's correlation coefficient to correlate clinical score and CEUS kinetic parameters. RESULTS: Twenty-one patients (9 men, 12 women, median age 32 years) were accrued. Fifteen patients had clinically active disease defined as Harvey-Bradshaw Index (HBI) score ≥5. Median values of baseline CEUS parameters PI (bolus: 26 vs 8.86; P = .023 and perfusion: 7.6 vs 3.2; P = .009) and AUC (bolus: 769 vs 248.8; P = .036 and perfusion: 188.9 vs 73.9; P = .012) differed significantly in patients with active vs inactive disease. Nine patients with active disease underwent escalated or new treatment. Five were nonresponders. Responders had higher median values of baseline parameters (PI, bolus: 35 vs 18.8; P = .556, and perfusion: 7.6 vs 3.9; P = 190), (AUC, bolus: 1473.9 vs 314; P = .111, and perfusion: 154.7 vs 74.4, P = .286). CONCLUSIONS: CEUS kinetic parameters correlate with clinical and laboratory indices and are significantly higher in patients with active disease. The responders had higher CEUS kinetic parameters than nonresponders that did not reach statistical significance in our small cohort.


Assuntos
Colo/irrigação sanguínea , Meios de Contraste/farmacologia , Doença de Crohn/diagnóstico , Fluxo Sanguíneo Regional/fisiologia , Ultrassonografia Doppler em Cores/métodos , Adulto , Colo/diagnóstico por imagem , Doença de Crohn/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
8.
Medicine (Baltimore) ; 98(29): e16458, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335703

RESUMO

We evaluated the clinical value of the cerebroplacental ratio (CPR) in predicting neonatal acidosis according to the gestational weeks in late pregnancy.From July 2016 to June 2017, 1018 neonates without acidosis and 218 neonates with acidosis (confirmed postpartum) underwent a prenatal examination and hospital delivery at 28 to 41 weeks in our hospital. The CPR was calculated as the ratio of the prenatal middle cerebral artery-pulsation index (MCA-PI) to the umbilical artery-pulsation index (UA-PI).In neonates without acidosis, the fetal UA-PI decreased with increased gestational age during late pregnancy. Similarly, the MCA-PI decreased with increased gestational age, and decreased significantly during the full pregnancy term. Additionally, the CPR peaked in the middle of the late pregnancy period and then decreased. In contrast, in neonates with acidosis, the prenatal UA-PI increased significantly, MCA-PI declined significantly, and CPR declined significantly in relation to normal values (P < .05). For the prediction of neonatal acidosis, the UA-PI was suitable after 32 weeks and the MCA-PI was suitable before 37 weeks. The cutoff values of the CPR for the prediction of neonatal acidosis at 28 to 31 weeks, 32 to 36 weeks, and 37 to 41 weeks were 1.29, 1.36, and 1.22, respectively. Unlike the UA-PI and MCA-PI, the CPR was suitable as an independent predictor of neonatal acidosis at all late pregnancy weeks. In neonates with acidosis, the z score of the UA-PI increased significantly, whereas the z scores of the MCA-PI and CPR decreased significantly, in relation to normal values (P < .05).The CPR can be used to evaluate the adverse status of fetuses during late pregnancy, providing an early prediction of neonatal acidosis.


Assuntos
Acidose/diagnóstico , Doenças do Recém-Nascido/diagnóstico , Artéria Cerebral Média/diagnóstico por imagem , Fluxo Pulsátil , Artérias Umbilicais/diagnóstico por imagem , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Feto/metabolismo , Feto/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/metabolismo , Doenças do Recém-Nascido/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Diagnóstico Pré-Natal/métodos , Prognóstico , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodos
9.
Am J Case Rep ; 20: 800-805, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31171763

RESUMO

BACKGROUND Chest wall recurrences of carcinoma after mastectomy usually involve subcutaneous tissue or the deep muscular layer. Recurrences arising in the skin are rare, and there are few reports of the associated radiologic features. This report presents an unusual case of cutaneous recurrence in the mastectomy bed and demonstrates its radiologic features using sonography and magnetic resonance imaging (MRI). CASE REPORT A 44-year-old woman presented with a palpable lump in the inferomedial area of the right chest wall. Six years ago, she had undergone total mastectomy for ductal carcinoma in situ in her right breast. Sonography showed an indistinct, oval, heterogeneous echoic mass measuring 0.9 cm, confined within the skin layer, corresponding to the palpable lump. A color Doppler sonogram showed minimal, spotted vascularity in and around the mass. Sonography-guided fine-needle aspiration biopsy was performed, revealing multiple clusters of atypical cells, suggestive of ductal carcinoma. On subsequent breast MRI, the mass, measuring 1.3 cm, was again localized to the skin; dynamic contrast-enhanced scans showed a circumscribed margin, oval shape, and rim enhancement (morphology) and slow initial enhancement and persistent delayed enhancement (kinetics). The mass was surgically excised and the pathological examination confirmed the diagnosis as recurrent invasive ductal carcinoma in the dermis. CONCLUSIONS Cutaneous recurrence in the mastectomy bed can manifest as a mass with suspicious radiologic features: indistinct margin on the sonogram and rim enhancement on the MRI. Awareness of such radiologic features may aid in differentiating between the various cutaneous manifestations encountered after mastectomy.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Mastectomia/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Cutâneas/secundário , Adulto , Biópsia por Agulha , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Recidiva Local de Neoplasia/cirurgia , Doenças Raras , Medição de Risco , Neoplasias Cutâneas/cirurgia , Ultrassonografia Doppler em Cores/métodos
10.
Zhonghua Shao Shang Za Zhi ; 35(5): 388-391, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154739

RESUMO

Objective: To explore the application value of color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns complicated with upper respiratory tract obstruction. Methods: From July 2013 to June 2018, 17 patients with head and neck burns complicated with upper respiratory tract obstruction, including 15 males and 2 females, aged 19-63 years, were hospitalized in our unit and treated with color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps. Before operation, the trachea was examined by color Doppler ultrasonography to specify condition of trachea and peribronchial tissues and organs for comprehensive assessment, so as to confirm optimal incision site of puncture and pathways as well as specify distance from anterior cervical skin to intima of anterior tracheal wall. Then, under real-time guidance of color Doppler ultrasound, percutaneous dilational tracheostomy with dilatation forceps was performed. The position, shape, inner diameter, and intraluminal abnormalities of trachea of patients before operation, abnormal location of peribronchial vessels and thyroid, distance from anterior cervical skin to intima of anterior tracheal wall, success rate of puncture, surgical time (from skin disinfection to successful catheterization), success rate of catheterization, intraoperative blood loss, heart rate, blood pressure, respiration, percutaneous oxygen saturation, and presence or absence of complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative hemorrhea, wound infection after operation were observed and detected. Results: (1)Preoperative color Doppler ultrasonography showed that the trachea of one patient deviated from the anterior median line of neck 13 mm to the right; 17 patients had edema of different degrees in the cervical soft tissue and more secretions in the trachea; 3 patients had the trachea changed from round to oval with reduced anteroposterior diameter; 1 patient had a small artery obstruction at the conventional puncture point; 2 patients had the trachea covered by the congestive and swollen isthmus of the thyroid between the first and the third tracheal cartilage rings; 16 patients had a distance from anterior cervical skin to anterior tracheal wall intima of 17-33 mm, and 1 patient had a distance from anterior cervical skin to anterior tracheal wall intima of 47 mm. (2) Puncture for 17 patients was successful at one time, and success rate of puncture was 100%. The operation time was 5-11 min, with an average of 7 min, and the success rate of catheterization was 100%. (3) Intraoperative blood loss of patients was less, all not exceeding 8 mL. Intraoperative percutaneous oxygen saturation was maintained between 0.90 and 0.99. The heart rate, blood pressure, and respiration were stable. (4) No complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative massive hemorrhage, or wound infection occurred in any patient. Conclusions: Applying color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns combined with upper respiratory tract obstruction can not only open up the airway quickly and effectively, but also reduce the complications related to the operation. It is expected to improve the success rate of rescue and improve the prognosis, making it of good application value.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Queimaduras/complicações , Dilatação/instrumentação , Traqueostomia/métodos , Ultrassonografia Doppler em Cores/métodos , Adulto , Cuidados Críticos , Feminino , Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço , Estudos Prospectivos , Instrumentos Cirúrgicos , Traqueostomia/efeitos adversos , Adulto Jovem
11.
Diagn Interv Radiol ; 25(4): 320-327, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31231068

RESUMO

PURPOSE: We aimed to assess the technical success of the combined percutaneous direct puncture of occluded artery - antegrade intervention technique, as well as the clinical effectiveness of treatment, on the basis of changes in the Rutherford classification. METHODS: Between June 2015 and July 2018, 441 patients underwent endovascular recanalization due to lower limb peripheral arterial disease at our center. Of these, 18 patients (4%; 15 males, 3 females; mean age, 63.2 years) had failed antegrade recanalization and percutaneous retrograde access because of long segment occlusion, arterial rupture or dissection. Combined percutaneous direct puncture of occluded artery and antegrade approach was applied to these patients. Clinical follow-up examinations were performed at 1 month, 3 months, 6 months, and annually thereafter. RESULTS: The mean follow-up period was 22.8±10.9 months. The mean procedure time was 93.6±28.2 min. Technical success was achieved in 14 patients (78%). Complete restoration of arterial flow in the punctured vessel could not be achieved in 4 patients (22%). Minor complications occurred in 4 of 18 procedures (22%). Amputation-free survival and limb salvage rates (83.3% and 100%, respectively) were the same for 12 and 24 months. CONCLUSION: Technical success in lower limb peripheral arterial disease may be improved with the use of a combined percutaneous direct puncture of occluded artery - antegrade intervention, particularly for patients in whom other techniques are not a viable option.


Assuntos
Procedimentos Endovasculares/métodos , Doença Arterial Periférica/terapia , Punções/instrumentação , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/terapia , Terapia Combinada/métodos , Feminino , Fluoroscopia/métodos , Seguimentos , Humanos , Salvamento de Membro/estatística & dados numéricos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Punções/tendências , Estudos Retrospectivos , Artérias da Tíbia/patologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodos , Grau de Desobstrução Vascular
12.
Med. clín (Ed. impr.) ; 152(12): 495-501, jun. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183321

RESUMO

Las técnicas de imagen se han convertido en una herramienta esencial en la valoración de los pacientes con arteritis de células gigantes. La detección del compromiso del territorio craneal con la ecografía Doppler tiene una utilidad diagnóstica indudable. La afectación de la aorta y sus ramas detectada mediante la tomografía por emisión de positrones, la tomografía computarizada con angiografía o la resonancia magnética con angiografía puede ayudar también en el diagnóstico y en la valoración de la actividad de la enfermedad y la respuesta al tratamiento, pero es necesaria la estandarización y validación de su uso. El desarrollo de daño vascular aórtico puede influir en la supervivencia de los pacientes con arteritis de células gigantes por lo que se recomienda su cribado periódico


Imaging has become an essential tool in the management of patients with giant cell arteritis. Cranial involvement detected by Doppler ultrasonography is an unquestionable diagnostic finding. Imaging of the aorta and its branches with positron emission tomography, computed tomography angiography or magnetic resonance imaging may also have a role in diagnosis and in the assessment of disease activity and response to treatment, but standardisation and validation are still needed before their widespread use as an outcome measure. Aortic structural damage is associated with increased mortality in giant cell arteritis; therefore, periodic screening is recommended


Assuntos
Humanos , Arterite de Células Gigantes/diagnóstico por imagem , Angiografia/métodos , Aneurisma Aórtico/diagnóstico por imagem , Angiografia/instrumentação , Inflamação/diagnóstico por imagem , Ultrassonografia Doppler em Cores/instrumentação , Ultrassonografia Doppler em Cores/métodos
13.
World Neurosurg ; 128: 547-555, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31132498

RESUMO

BACKGROUND: Preoperative embolization is often considered mandatory in highly vascularized brain tumors to contain blood loss. However, not all lesions are amenable to endovascular preoperative embolization. In the literature, cases of preoperative and intraoperative embolization are described only by arterial catheterization, whereas experiences of tumor embolization through direct puncture of the lesion are anecdotal; furthermore these cases lack an intraoperative control method to assess the effects of the embolizing procedure itself. METHODS: We describe the association of contrast enhanced ultrasonography (CEUS) and color Doppler ultrasonography (CDUS) to perform intraoperative embolization in an illustrative case of a posterior cranial fossa hemangioblastoma not amenable to a preoperative endovascular procedure. The combination of CEUS and CDUS was tested as an option for the intraoperative devascularization of tumors in which preoperative embolization is considered risky or not possible. RESULTS: The association of CEUS and CDUS provided real-time intraoperative data that directly guided the intraoperative embolization and provided reliable data about the hemodynamic effects produced after the direct injection of an embolizing agent. The technique offered a true real-time definition of the anatomic characteristics of the lesion and its relationships with the adjacent structures while distinguishing feeding from draining vessels. CONCLUSIONS: This technique has been proved to be a valuable tool in the surgical resection of highly vascularized tumors and in the treatment of intracranial and spinal vascular lesions and can be considered an option in those cases in which preoperative embolization is not possible. It is a feasible, modern, and cost-effective intraoperative imaging technique that allows identification of unexposed anatomic structures, hence minimizing surgical exposition and surgical manipulation.


Assuntos
Neoplasias Encefálicas/cirurgia , Embolização Terapêutica/métodos , Hemangioblastoma/cirurgia , Cuidados Intraoperatórios/métodos , Procedimentos Neurocirúrgicos/métodos , Ultrassonografia Doppler em Cores/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Meios de Contraste , Fossa Craniana Posterior , Feminino , Hemangioblastoma/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Cirurgia Assistida por Computador , Ultrassonografia/métodos
14.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036731

RESUMO

Thyrotoxicosis factitia, a disorder frequently seen in young or middle-aged women with psychological disorders, most commonly results from surreptitious ingestion of excess thyroid hormones. In most patients, diagnosis is relatively straightforward and depends on the demonstration of biochemical thyrotoxicosis, suppressed endogenous thyroid function and absence of clinical features of underlying thyroid disease. However, at times, confounding factors can make the diagnosis particularly challenging and necessitate the investigating physician to don the detective's cap to get to the root of the problem. We discuss a patient whose diagnosis was reached with ingenuity after considerable effort from four endocrinologists having a total experience of 37 years in their field.


Assuntos
Síndrome de Munchausen/diagnóstico , Glândula Tireoide/fisiopatologia , Tireotoxicose/induzido quimicamente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Síndrome de Munchausen/psicologia , Ovário/diagnóstico por imagem , Ovário/patologia , Glândula Tireoide/diagnóstico por imagem , Tireotoxicose/diagnóstico , Tireotoxicose/fisiopatologia , Resultado do Tratamento , Ultrassonografia , Ultrassonografia Doppler em Cores/métodos
15.
Ultrasound Obstet Gynecol ; 54(1): 79-86, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31100188

RESUMO

OBJECTIVE: To investigate the potential value of uterine artery pulsatility index (UtA-PI) and serum levels of the angiogenic placental growth factor (PlGF) and the antiangiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) in the prediction of adverse perinatal outcome in small-for-gestational-age (SGA) and non-SGA neonates at 35-37 weeks' gestation. METHODS: This was a prospective observational study of 19 209 singleton pregnancies attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, sonographic estimation of fetal weight, color Doppler ultrasound for measurement of mean UtA-PI, and measurement of serum concentrations of PlGF and sFlt-1. Multivariable logistic regression analysis was carried out to determine which of the factors from maternal or pregnancy characteristics and measurements of UtA-PI, PlGF and sFlt-1 provided a significant contribution in the prediction of each of four adverse outcome measures: first, stillbirth; second, Cesarean delivery for suspected fetal compromise in labor; third, neonatal death or hypoxic ischemic encephalopathy Grade 2 or 3; and, fourth, admission to the neonatal unit (NNU) for ≥ 48 h. Predicted probabilities from logistic regression analysis were used to construct receiver-operating characteristics curves to assess the performance of screening for these adverse outcomes. RESULTS: First, 83% of stillbirths, 82% of Cesarean sections for presumed fetal compromise in labor, 91% of cases of neonatal death or hypoxic ischemic encephalopathy and 86% of NNU admissions for ≥ 48 h occurred in pregnancies with a non-SGA neonate. Second, UtA-PI > 95th percentile, sFlt-1 > 95th percentile and PlGF < 5th percentile were associated with increased risk of Cesarean delivery for suspected fetal compromise in labor and NNU admission for ≥ 48 h; the number of stillbirths and cases of neonatal death or hypoxic ischemic encephalopathy was too small to demonstrate significance in the observed differences from cases without these adverse outcomes. Third, multivariable logistic regression analysis demonstrated that, in the prediction of Cesarean delivery for suspected fetal compromise in labor, there was no significant contribution from biomarkers; the prediction of NNU admission for ≥ 48 h by maternal demographic characteristics and medical history was only marginally improved by the addition of sFlt-1 or PlGF. Fourth, for each biomarker, the detection rate of adverse outcome was higher in SGA than in non-SGA neonates, but this increase was accompanied by an increase in false-positive rate. Fifth, the relative risk of UtA-PI > 95th , sFlt-1 > 95th and PlGF < 5th percentiles for most adverse outcomes was < 2.5 in both SGA and non-SGA neonates. CONCLUSIONS: In pregnancies undergoing routine antenatal assessment at 35-37 weeks' gestation, measurements of UtA-PI, sFlt-1 or PlGF provide poor prediction of adverse perinatal outcome in both SGA and non-SGA fetuses. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Biomarcadores/sangue , Resultado da Gravidez/epidemiologia , Gravidez/metabolismo , Fluxo Pulsátil/fisiologia , Adulto , Cesárea , Feminino , Humanos , Hipóxia-Isquemia Encefálica/epidemiologia , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/metabolismo , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Morte Perinatal , Fator de Crescimento Placentário/metabolismo , Placentação , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Natimorto/epidemiologia , Ultrassonografia Doppler em Cores/métodos , Artéria Uterina/diagnóstico por imagem , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo
16.
Obstet Gynecol Surv ; 74(5): 298-302, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31098643

RESUMO

Importance: Bilateral renal agenesis is a rare congenital anomaly associated with poor prognosis. Objective: The aims of this article are to review and summarize evidence on prenatal diagnosis and outcomes of bilateral renal agenesis. Evidence Acquisition: A search was undertaken using PubMed and ClinicalTrials.gov databases from January 1, 1998, to September 1, 2018. Search terms include "prenatal diagnosis" OR "outcomes" AND "bilateral renal agenesis." Search was limited to English language. Results: Fetal ultrasonography is the primary imaging modality for prenatal diagnosis of fetal urogenital tract abnormalities. However, ultrasonography is limited by several factors; it is operator dependent and associated with small field of view, has limited soft-tissue acoustic contrast, and is also influenced by patient habitus and fetal position. Color Doppler ultrasonography can be used as an adjunct to exclude bilateral renal agenesis by visualizing renal arteries. In the literature, prenatal magnetic resonance imaging has been reported to be equal to or superior to prenatal ultrasonography. Bilateral renal agenesis with oligohydramnios/anhydramnios is associated with a poor prognosis; perinatal death occurs secondary to pulmonary hypoplasia in the majority of cases. Conclusions: Ultrasonography in combination with color Doppler ultrasonography permits the fetal urinary tract to be assessed in the first and early second trimester of gestation. The magnetic resonance imaging can be used as a complementary adjunctive modality in equivocal or inconclusive ultrasonographic findings.


Assuntos
Anormalidades Congênitas/diagnóstico por imagem , Nefropatias/congênito , Rim/anormalidades , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodos , Anormalidades Congênitas/mortalidade , Feminino , Humanos , Rim/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Nefropatias/mortalidade , Oligo-Hidrâmnio/diagnóstico por imagem , Gravidez
17.
Bull Cancer ; 106(10): 875-886, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31088679

RESUMO

OBJECTIVES: Reviewing the characterization and the follow-up imaging of testicular tumors. MATERIAL AND METHODS: Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: Testicular tumors; Color Doppler ultrasound; US elastography; Magnetic resonance imaging; Contrast enhanced sonography. RESULTS: Ultrasound remains the basic exam for the tumor characterization. Among the other techniques, MRI, elastography, contrast enhanced ultrasound, although still in evaluation, will be increasingly used in the future. The frequency of benign Leydig cell tumors justifies a testicular preservation approach, through improvement of characterization, monitoring or tumorectomy. The follow-up of testicular lesions must be indicated on precise indications: follow-up of the contralateral testicle in the case of germi cell tumor, follow-up by of a supposed benign lesion, such as a small Leydig cell tumor in an infertile patient, follow-up when ultra-sound findings are not sufficiently worrying to require immediate diagnosis but which include pejorative criteria. The tumor markers and the extension screening remain systematic. CONCLUSION: The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on clinical biological data and suspected nature of the tumor at imaging.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias Testiculares/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Tumor Carcinoide/diagnóstico por imagem , Meios de Contraste , Humanos , Litíase/diagnóstico por imagem , Metástase Linfática , Linfoma/diagnóstico por imagem , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos
18.
Eur Radiol ; 29(11): 5991-5998, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31028448

RESUMO

OBJECTIVES: To evaluate the accuracy of US in calculating renal volumes and renal resistive index (RRI) that was obtained using a new method in patients with autosomal dominant polycystic kidney disease (ADPKD). METHODS: In this prospective study, US and MRI were performed in 57 patients with ADPKD (31 female and 26 male; age range, 19-79 years) between August 2017 and May 2018. The volumes determined using US and MRI were compared. The ellipsoid formula was re-evaluated using different multipliers. RRI was obtained 1.5-2 cm distal to the outlet of main renal arteries. The relationship between mean RRI, renal function tests, and kidney volumes and difference between mean RRI of ADPKD patients with and without renal failure were investigated using a two-sided independent samples t test and Pearson correlation test. Interobserver agreements for volume assessments and RRI measurements were determined. RESULTS: By changing the ellipsoid formula, a very good agreement was found (ICC 0.970 for the right kidney and ICC 0.973 for the left kidney). The mean RRI in the right renal artery was 0.61 ± 0.07 and in the left renal artery 0.63 ± 0.06. The mean RRI of ADPKD patients with renal failure was significantly higher than that of patients without renal failure (p = 0.005). There was a significant correlation between mean RRI and renal function tests. CONCLUSION: The accuracy of the US in calculating renal volumes increases by adapting the ellipsoid formula. RRI may be used for the management of ADPKD independently of volumes. KEY POINTS: •The accuracy of ultrasonography for renal volume measurement increases by changing the classical ellipsoid formula. •Renal resistive index measured by color Doppler ultrasonography is helpful for the management of autosomal dominant polycystic kidney disease. •The role of Doppler US in autosomal dominant polycystic kidney disease should increase as a result of our findings.


Assuntos
Rim Policístico Autossômico Dominante/diagnóstico por imagem , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Rim/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Renal/diagnóstico por imagem , Insuficiência Renal/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Adulto Jovem
19.
Zhonghua Fu Chan Ke Za Zhi ; 54(4): 245-248, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31006190

RESUMO

Objective: To measure the uterine volume by ultrasonic imaging in nullipara patients with endometriosis and analyze its clinical significance. Methods: From July 1st, 2016 to August 1st, 2017, 107 cases of nullipara patients with endometriosis hospitalized in Peking University First Hospital were selected as endometriosis group. Among 107 cases, 59 cases were in proliferative phase of menstrual cycle, 48 cases were in secretory phase; and 10 cases had an abortion history.Totally 101 cases of patients without endometriosis operated for other benign disease during the same period were chosen as the control group. All patients underwent laparoscopic surgery, and the diagnosis was confirmed by pathology. The uterine size was measured by transvaginal or transrectal color Doppler ultrasound, and the uterine volume was calculated according to the known formula. Results: The uterine volume of the endometriosis group [(69±26) cm(3)] was larger than that of the control group [(54±18) cm(3), P<0.01]. In the endometriosis group, the uterine volume of patients with pregnant history [(78±34) cm(3)] was larger than that of patients without pregnant history [(68±25) cm(3)]. The endometrial thickness in endometriosis group was higher than that of the control group [(9.1±3.5) versus (7.8±2.9) mm, P<0.05], and positively correlated with the uterine volume (r=0.39, P<0.05). The hemoglobin in endometriosis group was lower than that in the control group [(124±12) versus (131±10) g/L, P<0.01], and was negatively correlated with the uterine volume in the two groups (r(endometriosis)=-0.12, r(control)=-0.21; both P<0.05).The uterine volume of dysmenorrhea patients in the endometriosis group [(73±28) cm(3)] was greater than that of patients without dysmenorrhea [(62±19) cm(3), P<0.01]; both uterine volumes of patients with and without dysmenorrhea in endometriosis group were larger than those of patients with or without dysmenorrhea in the control group (P<0.05). The degree of dysmenorrhea in endometriosis group was positively correlated with the uterine volume (r=0.20, P=0.042). The uterine volume of stage Ⅳendometriosis patients [(79±30) cm(3)] was greater than that of stage Ⅲ patients in endometriosis group [(58±14) cm(3), P<0.01]. Conclusion: Patients with endometriosis are of increased uterine volume, which may be related to dysmenorrhea, menorrhagia and infertility.


Assuntos
Endometriose/cirurgia , Laparoscopia , Ultrassonografia Doppler em Cores/métodos , Útero/diagnóstico por imagem , Estudos de Casos e Controles , Dismenorreia/patologia , Endometriose/patologia , Feminino , Humanos , Menorragia/patologia , Gravidez , Útero/irrigação sanguínea
20.
Altern Ther Health Med ; 25(2): 46-48, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30990793

RESUMO

Morel-Lavallée lesions are posttraumatic hemolymphatic collections related to shearing injury of variable mechanism (severe trauma or low-velocity crush injury), resulting in disruption of interfacial planes between subcutaneous soft tissue and muscle and perforating lymphatics and blood vessels. A 69-y-old woman, without medical history, was admitted to the emergency ward for important pain located from her behind to the anterior face of the thighs. Physical examination revealed large semirecent hematoma with a large soft fluctuant area with hypermobility of the skin and cutaneous hyperesthesia, spreading from her behind to the anterior face of her thigs. Her symptoms were typical of a Morel-Lavallée lesion. The ultrasound examination revealed hypoechoic heterogeneous compressible fluid containing fat debris with irregular margins and lobular shape, localized between subcutaneous fat and deep fascia, without flow on color Doppler, confirming the acute Morel-Lavallée lesion. After evacuation by needle puncture, the collection reappearance was probably due to hemolymphatic fluid corresponding to type 1 of the Mellado and Bencardino classification of Morel-Lavallée lesions. Patients and Physicians should be aware of the worsening effects of balneotherapy on skin hematoma to prevent dramatic extension of Morel-Lavallée lesions.


Assuntos
Hematoma/cirurgia , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/diagnóstico por imagem , Idoso , Feminino , Hematoma/diagnóstico por imagem , Humanos , Lesões dos Tecidos Moles/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos
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