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1.
Medicine (Baltimore) ; 98(38): e17192, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567964

RESUMO

BACKGROUND: Previous clinical studies have reported that ultrasound-guided fine needle aspiration cytology (UGFNAC) can be used for the diagnosis of thyroid nodules (TN) effectively. However, no study has systematically explored its diagnosis accuracy in patients with TN. Thus, this study will assess its diagnosis accuracy for TN. METHODS: We will perform a comprehensive literature search from the following databases from their inceptions to the present without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will consider all case-controlled studies investigating the impacts of UGFNAC diagnosis for patients with TN for inclusion. Two authors will independently carry out study selection, data collection, and methodological quality assessment. Quality Assessment of Diagnostic Accuracy Studies tool will be used for methodological quality evaluation. We will use RevMan V.5.3 and Stata V.12.0 software to perform statistical analysis. RESULTS: We will apply sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio to judge the diagnostic accuracy of UGFNAC for TN. CONCLUSION: The results of this study will provide latest evidence for the diagnostic accuracy of UGFNAC for TN. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138805.


Assuntos
Biópsia por Agulha Fina , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia de Intervenção , Biópsia por Agulha Fina/métodos , Humanos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Ultrassonografia de Intervenção/métodos
2.
Semin Vasc Surg ; 32(1-2): 33-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540655

RESUMO

Vascular ultrasound has proven to be a cornerstone for the management of patients with vascular disease, and is utilized by vascular surgeons in the outpatient clinic, the operating room, and for follow-up after revascularisation. Today vascular surgeons are among the most frequent users of ultrasound apart from radiologists. Mastering the skills of vascular ultrasound and interpretation is best acquired under supervision and is more easily learned as part of the daily practice of vascular surgery. Separating vascular ultrasound into basic and advanced procedures is useful, and basic vascular ultrasound skills should be a part of a vascular surgical training program curriculum. In Europe, certification of vascular surgeons in basic vascular ultrasound via a pass-fail test is in its infancy, preceded by local and national initiatives. In the area of clinical vascular research, duplex ultrasound is superior to most other diagnostic modalities due to its availability and noninvasive nature and ultrasound-based research will in addition to improving patient care generate physicians highly experienced in vascular ultrasound.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Aprendizagem , Cirurgiões/educação , Ultrassonografia de Intervenção , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Currículo , Humanos
3.
N Engl J Med ; 381(10): 912-922, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31483962

RESUMO

BACKGROUND: Endovenous laser ablation and ultrasound-guided foam sclerotherapy are recommended alternatives to surgery for the treatment of primary varicose veins, but their long-term comparative effectiveness remains uncertain. METHODS: In a randomized, controlled trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of laser ablation, foam sclerotherapy, and surgery. Primary outcomes at 5 years were disease-specific quality of life and generic quality of life, as well as cost-effectiveness based on models of expected costs and quality-adjusted life-years (QALYs) gained that used data on participants' treatment costs and scores on the EuroQol EQ-5D questionnaire. RESULTS: Quality-of-life questionnaires were completed by 595 (75%) of the 798 trial participants. After adjustment for baseline scores and other covariates, scores on the Aberdeen Varicose Vein Questionnaire (on which scores range from 0 to 100, with lower scores indicating a better quality of life) were lower among patients who underwent laser ablation or surgery than among those who underwent foam sclerotherapy (effect size [adjusted differences between groups] for laser ablation vs. foam sclerotherapy, -2.86; 95% confidence interval [CI], -4.49 to -1.22; P<0.001; and for surgery vs. foam sclerotherapy, -2.60; 95% CI, -3.99 to -1.22; P<0.001). Generic quality-of-life measures did not differ among treatment groups. At a threshold willingness-to-pay ratio of £20,000 ($28,433 in U.S. dollars) per QALY, 77.2% of the cost-effectiveness model iterations favored laser ablation. In a two-way comparison between foam sclerotherapy and surgery, 54.5% of the model iterations favored surgery. CONCLUSIONS: In a randomized trial of treatments for varicose veins, disease-specific quality of life 5 years after treatment was better after laser ablation or surgery than after foam sclerotherapy. The majority of the probabilistic cost-effectiveness model iterations favored laser ablation at a willingness-to-pay ratio of £20,000 ($28,433) per QALY. (Funded by the National Institute for Health Research; CLASS Current Controlled Trials number, ISRCTN51995477.).


Assuntos
Procedimentos Endovasculares , Terapia a Laser , Qualidade de Vida , Escleroterapia , Varizes/terapia , Adulto , Análise Custo-Benefício , Procedimentos Endovasculares/economia , Feminino , Seguimentos , Humanos , Análise de Intenção de Tratamento , Terapia a Laser/economia , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Escleroterapia/economia , Escleroterapia/métodos , Inquéritos e Questionários , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/cirurgia
4.
Vasc Health Risk Manag ; 15: 283-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496717

RESUMO

Angiography remains a widely utilized imaging modality during vascular procedures. Angiography, however, has its limitations by underestimating the true vessel size, plaque morphology, presence of calcium and thrombus, plaque vulnerability, true lesion length, stent expansion and apposition, residual narrowing post intervention and the presence or absence of dissections. Intravascular ultrasound (IVUS) has emerged as an important adjunctive modality to angiography. IVUS offers precise imaging of the vessel size, plaque morphology and the presence of dissections and guides interventional procedures including stent sizing, assessing residual narrowing and stent apposition and expansion. IVUS-guided treatment has shown to yield superior outcomes when compared to angiography-only guided therapy. The cost-effectiveness of the routine use of IVUS during vascular procedures needs to be further studied.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Ultrassonografia de Intervenção , Doença da Artéria Coronariana/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Stents , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(33): e16714, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415364

RESUMO

To investigate the efficiency and clinical safety of intra-articular triamcinolone acetonide (TA) injection under the guide of ultrasonography combined with standard treatment for treating refractory small joints arthritis in rheumatoid arthritis (RA) patients.TA was injected upon confirmation of the needle inserting into the articular cavity. The dose was 40 mg for the wrist, 20 mg for the metacarpophalangeal (MCP) joint and 20 mg for the proximal interphalangeal (PIP) joint, respectively. Visual analogue scale (VAS) for joint pain, swelling, tenderness, synovial hyperplasia and power Doppler signal scores were evaluated at pretreatment, and post-treatment 24 hours, 1 week, 4 weeks as well as 12 weeks.The VAS for pain and tenderness scores showed gradual improvement at 24 hours, 1 week, 4 weeks and 12 weeks after treatment compared with the baseline levels (P' < .005). The swelling showed no changes at 24 hours after treatment compared with the baseline, and showed gradual improvement at 1 week, 4 weeks and 12 weeks after treatment (P' < .005). Significant decrease was noticed in the synovial hyperplasia score at 4 weeks and 12 weeks compared with the baseline level. Power Doppler signal score showed significant decrease at post-treatment 24 hours, which showed further decrease at 1 week and 4 weeks.Ultrasound-guided intra-articular TA injection is effective for treating RA patients with refractory small joints arthritis without changing the original treatment plan.


Assuntos
Anti-Inflamatórios/administração & dosagem , Artrite Reumatoide/complicações , Sinovite/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Feminino , Articulações dos Dedos/efeitos dos fármacos , Humanos , Injeções Intra-Articulares , Masculino , Articulação Metacarpofalângica/efeitos dos fármacos , Pessoa de Meia-Idade , Estudos Prospectivos , Sinovite/etiologia , Sinovite/patologia , Resultado do Tratamento , Articulação do Punho/efeitos dos fármacos , Adulto Jovem
6.
Rev Assoc Med Bras (1992) ; 65(7): 982-987, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389509

RESUMO

OBJECTIVE: A clinical, placebo-controlled, randomized, double-blind trial with two parallel groups. OBJECTIVE: to evaluate the efficacy of ropivacaine injection in each belly of the anterior and middle scalene muscles, guided by ultrasonography, in the treatment of Nonspecific Thoracic Outlet Syndrome (TOS) compared to cutaneous pressure. METHODS: 38 patients, 19 in the control group (skin pressure in each belly of the anterior and middle scalene muscles) and 19 in the intervention group (ropivacaine). Subjects with a diagnosis of Nonspecific Thoracic Outlet Syndrome, pain in upper limbs and/or neck, with no radiculopathy or neurological involvement of the limb affected due to compressive or encephalic root causes were included. The primary endpoint was functionality, evaluated by the Disabilities of the Arm, Shoulder, and Hand - DASH scale validated for use in Brasil. The time of the evaluations were T0 = before the intervention; T1 = immediately after; T2 = 1 week; T3 = 4 weeks; T4 = 12 weeks; for T1, the DASH scale was not applied. RESULTS: Concerning the DASH scale, it is possible to affirm with statistical significance (p> 0.05) that the intervention group presented an improvement of functionality at four weeks, which was maintained by the 12th week. CONCLUSION: In practical terms, we concluded that a 0.375% injection of ropivacaine at doses of 2.5 ml in each belly of the anterior and middle scalene muscles, guided by ultrasonography, in the treatment of Nonspecific Thoracic Outlet Syndrome helps to improve function.


Assuntos
Anestésicos Locais/administração & dosagem , Injeções Intramusculares/métodos , Músculos do Pescoço/efeitos dos fármacos , Ropivacaina/administração & dosagem , Síndrome do Desfiladeiro Torácico/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(35): e16612, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464896

RESUMO

RATIONALE: Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, and nowadays poorly understood. The overall incidence of SCAD ranges from 0.28% to 1.1% in angiographic studies. Therefore, the true incidence of SCAD is most likely underestimated due to asymptomatic or sudden cardiac death before diagnosis. Stent fracture (SF) is a multifactorial issue. Longer vessel remodeled by 2 stents can be more prone to have SF due to higher radial force. PATIENT CONCERNS: In this paper we report a 48-year-old man with chest pain for 2 years. DIAGNOSES: Elective coronary angiography revealed a linear dissection in obtuse marginal branch (OM). INTERVENTIONS: He underwent percutaneous coronary intervention (PCI) with the guidance of intravascular ultrasound (IVUS). OUTCOMES: Then SF was revealed 9 months later. LESSONS: This is the first case report of SF after coronary intervention therapy in SCAD patients.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Stents/efeitos adversos , Doenças Vasculares/congênito , Dor no Peito/etiologia , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Resultado do Tratamento , Ultrassonografia de Intervenção , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
9.
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
10.
Medicine (Baltimore) ; 98(31): e16694, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374058

RESUMO

RATIONALE: Although most complications of herpes zoster (HZ) are associated with the spread of varicella-zoster virus from the initially involved sensory ganglion, motor nerve impairment, such as limb weakness, is a rare but severe complication that is difficult to treat. PATIENT CONCERN: A 73-year-old female presented with sudden left upper limb pain and weakness after HZ. DIAGNOSIS: Brachial plexopathy following HZ (postherpetic brachial plexopathy). INTERVENTION: Despite alleviation of the vesicles with antiviral treatments, the left upper limb weakness and neuropathic pain did not improve. After obtaining patient's consent, ultrasound-guided polydeoxyribonucleotide (PDRN) injection was performed around the left brachial plexus. OUTCOMES: The patient showed marked improvement in left arm pain from numerical rating scale (NRS) 9 to 4, 1 day after PDRN injection. Subsequently, the pain improved to NRS 3, and motor weakness improved to Medical Research Council grade 2 to 4. LESSONS: PDRN can be considered a viable substitute for corticosteroid injection in treatment of motor weakness and neuropathic pain after HZ.


Assuntos
Neuropatias do Plexo Braquial/tratamento farmacológico , Neuropatias do Plexo Braquial/etiologia , Herpes Zoster/complicações , Polidesoxirribonucleotídeos/administração & dosagem , Idoso , Feminino , Humanos , Medição da Dor , Resultado do Tratamento , Ultrassonografia de Intervenção
11.
Medicine (Baltimore) ; 98(26): e16126, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261532

RESUMO

Ultrasound-guided central venous catheterization may cause lethal mechanical complications intraoperatively. We developed a novel device to prevent such complications. It works as a needle guide to supplement the operator's skill. We evaluated the utility of this device in terms of the success rate and visualization of the needle tip while penetrating the target vessel using a simulator.This study was approved by the local ethics committee. The new device - an optical skill-assist device - has a slit and a mirror in the center. The operator can see the needle's reflection in the mirror through the slit and can thus ensure that the needle is directed in line with the ultrasound beam. Participants were recruited by placing an advertisement for a hands-on seminar on ultrasound-guided vascular access. They received hands-on training on the in-plane approach for 2 hours. Pre-test and post-test without the device and an additional test using the device were performed to evaluate the proficiency of ultrasound-guided vascular access. An endoscope inserted into the simulated vessel was used to detect the precise location of the needle tip in the vessel.The primary outcomes were the success rate of the procedure. The secondary outcome was visualization of the needle tip while penetrating the simulated vessel. The chi-squared test was used for comparing the success rate and needle tip visualization between the different tests. P < .05 was considered to indicate significant differences.Forty-two participants were enrolled in this study. The success rate did not increase after the simulation training (P = .1). Using the optical skill-assist device, the rate improved to 100%. There was a significant difference in success rate between the pre-test and additional test using the optical skill-assist device (P = .003). Needle tip visualization significantly improved with the use of the optical skill-assist device compared to the pre-test (P < .001) and post-test (P = .001).Simulation training improved participants' skill for ultrasound-guided vascular access, but the improvement depended on each participant. However, further, improvement was achieved with the use of the optical skill-assist device.The optical skill-assist device is useful for supplementing the operator's skill for ultrasound-guided central venous catheterization.


Assuntos
Cateterismo Venoso Central/instrumentação , Ultrassonografia de Intervenção/instrumentação , Cateterismo Venoso Central/métodos , Competência Clínica , Educação Médica , Humanos , Complicações Intraoperatórias/prevenção & controle , Aprendizagem , Imagem Óptica/instrumentação , Médicos , Complicações Pós-Operatórias/prevenção & controle , Dados Preliminares , Treinamento por Simulação , Ultrassonografia de Intervenção/métodos
12.
Br J Anaesth ; 123(3): 368-377, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31255289

RESUMO

BACKGROUND: Our goal is to develop metrics that quantify the translation of performance from cadavers to patients. Our primary objective was to develop steps and error checklists from a Delphi questionnaire. Our second objective was to show that our test scores were valid and reliable. METHODS: Sixteen UK experts identified 15 steps conducive to good performance and 15 errors to be avoided during interscalene block on the soft-embalmed cadaver and patients. Thereafter, six experts and six novices were trained, and then tested. Training consisted of psychometric assessment, an anatomy tutorial, volunteer scanning, and ultrasound-guided needle insertion on a pork phantom and on a soft-embalmed cadaver. For testing, participants conducted a single interscalene block on a dedicated soft-embalmed cadaver whilst wearing eye tracking glasses. RESULTS: We developed a 15-step checklist and a 15-error checklist. The internal consistency of our steps measures were 0.83 (95% confidence interval [CI]: 0.78-0.89) and 0.90 (95% CI: 0.87-0.93) for our error measures. The experts completed more steps (mean difference: 3.2 [95% CI: 1.5-4.8]; P<0.001), had less errors (mean difference: 4.9 [95% CI: 3.5-6.3]; P<0.001), had better global rating scores (mean difference: 6.8 [95% CI: 3.6-10.0]; P<0.001), and more eye-gaze fixations (median of differences: 128 [95% CI: 0-288]; P=0.048). Fixation count correlated negatively with steps (r=-0.60; P=0.04) and with errors (r=0.64; P=0.03). CONCLUSIONS: Our tests to quantify ultrasound-guided interscalene nerve block training and performance were valid and reliable.


Assuntos
Anestesiologia/educação , Educação de Pós-Graduação em Medicina/métodos , Bloqueio Nervoso/normas , Pesquisa Médica Translacional/normas , Cadáver , Lista de Checagem , Técnica Delfos , Educação de Pós-Graduação em Medicina/normas , Humanos , Simulação de Paciente , Psicometria , Reprodutibilidade dos Testes , Escócia , Pesquisa Médica Translacional/métodos , Ultrassonografia de Intervenção/métodos
13.
Medicine (Baltimore) ; 98(28): e16343, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305422

RESUMO

To estimate the BRAFV600E mutation frequency in Chinese patients with papillary thyroid carcinoma (PTC), and the diagnostic value of BRAFV600E mutation status in thyroid nodules with indeterminate TBSRTC categories.A total of 4875 consecutive samples for thyroid ultrasound-guided fine-needle aspiration cytology (FNAC) and BRAF mutation analysis were collected from patients at Jiangsu Province Hospital on Integration of Chinese and Western Medicine. Among all the cases, 314 underwent thyroidectomy. According to TBSRTC categories, FNAC was performed for a preoperative diagnosis. ROC of the subject was constructed to evaluate the diagnostic value of these 2 methods and their combination.BRAF mutation in FNAC of thyroid nodules occurred in 2796 samples (57.35%). Of 353 nodule samples from 314 patients with thyroid operation, 333 were pathologically diagnosed as PTC. Of these PTC patients, 292 (87.69%) were found to have BRAF mutation in their preoperative FNAC. In 175 cytologically indeterminate thyroid nodules, BRAF mutation identified 88% of PTC. According to ROC data, BRAF mutation testing had an obviously higher sensitivity (87.69%) and specificity (100.00%) than TBSRTC. Combining BRAF mutation testing and TBSRTC achieved the largest AUC (0.954). For 41 PTC with a negative BRAF mutation in preoperative evaluation, the repeated BRAF mutation testing found out 12 samples with BRAF mutation. The true BRAF mutation rate of Chinese PTC patients was 91.29%.Chinese patients with PTC have a higher frequency of BRAF mutation. The BRAF mutation testing affords a high diagnostic value in thyroid nodules with indeterminate cytology.


Assuntos
Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/metabolismo , Nódulo da Glândula Tireoide/patologia , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Biópsia por Agulha Fina , Criança , China , Análise Mutacional de DNA , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas B-raf/metabolismo , Sensibilidade e Especificidade , Câncer Papilífero da Tireoide/genética , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Ultrassonografia de Intervenção , Adulto Jovem
14.
EuroIntervention ; 15(5): 434-451, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31258132

RESUMO

This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/cirurgia , Consenso , Angiografia Coronária , Vasos Coronários , Humanos , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção
15.
Radiol Clin North Am ; 57(5): 1073-1082, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351537

RESUMO

Ultrasound has been reported to be a quick, cheap, and effective imaging modality to guide the interventional procedures in the musculoskeletal system. The use of ultrasound results in increased accuracy of needle placement associated with a reduction of complications. In the upper limb, ultrasound-guided procedures are applied to joints and soft tissues around the shoulder, elbow, wrist, and hand. This article reviews the clinical and technical aspects of the most common procedures performed in this anatomic area.


Assuntos
Tendinopatia/diagnóstico por imagem , Tendinopatia/terapia , Ultrassonografia de Intervenção/métodos , Extremidade Superior/diagnóstico por imagem , Humanos , Extremidade Superior/lesões
16.
Rev Med Chil ; 147(4): 458-464, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344207

RESUMO

BACKGROUND: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. AIM: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. MATERIAL AND METHODS: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. RESULTS: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. CONCLUSIONS: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Chile/epidemiologia , Estudos Transversais , Feminino , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Prevalência , Diálise Renal/instrumentação , Diálise Renal/métodos , Distribuição por Sexo , Ultrassonografia de Intervenção/métodos
17.
Cancer Radiother ; 23(5): 426-431, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31255579

RESUMO

The purpose of this article was to report the treatment effect of image-guided high-dose-rate interstitial brachytherapy boost in the radical radiotherapy for a huge metastatic carcinoma of cervical lymph nodes from an unknown primary site. The patient was a 75-year-old male. A diagnostic biopsy showed metastatic squamous cell carcinoma and the tumour size was 7.5×6.5×11.5cm3 before treatment (N3; AJCC 7th). After external beam radiotherapy with a dose of 60Gy in 30 fractions, the residual tumour (6.2×4.7×6.0cm3) was treated with image-guided high-dose-rate interstitial brachytherapy boost under ultrasound guidance. The brachytherapy dose was 16Gy in four fractions of 4Gy each. Removal of the huge metastatic tumour was securely achieved by high dose rate interstitial brachytherapy guided with ultrasound scanning. The refractory tumour in the patients healed uneventfully after image-guided high-dose-rate interstitial brachytherapy without recurrence during the 24 months of follow-up. The image-guided high-dose-rate interstitial brachytherapy boost may be a proposed treatment strategy for metastatic carcinoma of cervical lymph nodes from an unknown primary site with radical radiotherapy, especially for huge residual tumour.


Assuntos
Braquiterapia/métodos , Carcinoma de Células Escamosas/secundário , Irradiação Linfática/métodos , Metástase Linfática/radioterapia , Neoplasias Primárias Desconhecidas , Radioterapia Guiada por Imagem/métodos , Ultrassonografia de Intervenção/métodos , Idoso , Carcinoma de Células Escamosas/radioterapia , Fracionamento da Dose de Radiação , Humanos , Imagem por Ressonância Magnética , Masculino , Pescoço , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Órgãos em Risco , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radioterapia de Intensidade Modulada
18.
Medicine (Baltimore) ; 98(29): e16262, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335674

RESUMO

RATIONALE: The thoracic epidural block and thoracic paravertebral block are widely used techniques for multimodal analgesia after thoracic surgery. However, they have several adverse effects, and are not technically easy. Recently, the erector spinae plane block (ESPB), an injected local anesthetic deep to the erector spinae muscle, is a relatively simple and safe technique. PATIENT CONCERNS: Three patients were scheduled for video assisted thoracoscopic lobectomy with mediastinal lymph node dissection. All the patients denied any past medical history to be noted. DIAGNOSES: They were diagnosed with primary adenocarcinoma requiring lobectomy of lung. INTERVENTIONS: The continuous ESPB was performed at the level of the T5 transverse process. The patient was received the multimodal analgesia consisted of oral celecoxib 200 mg twice daily, intravenous patient-controlled analgesia (Fentanyl 700 mcg, ketorolac 180 mg, total volume 100 ml), and local anesthetic (0.375% ropivacaine 30 ml with epinephrine 1:200000) injection via indwelling catheter every 12 hours for 5 days. Additionally, we injected a mixture of ropivacaine and contrast through the indwelling catheter for verifying effect of ESPB and performed Computed tomography 30 minutes later. OUTCOMES: The pain score was maintained below 3 points for postoperative 5 days, and no additional rescue analgesics were administered during this period. In the computed tomography, the contrast spread laterally from T2-T12 deep to the erector spinae muscle. On coronal view, the contrast spread to the costotransverse ligament connecting the rib and the transverse process. In the 3D reconstruction, the contrast spread from T6-T10 to the costotransverse foramen. LESSONS: Our contrast imaging data provides valuable information about mechanism of ESPB from a living patient, and our report shows that ESPB can be a good option as a multimodal analgesia after lung lobectomy.


Assuntos
Adenocarcinoma de Pulmão , Adjuvantes Anestésicos , Neoplasias Pulmonares , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Músculos Paraespinais/fisiopatologia , Pneumonectomia , Ropivacaina/administração & dosagem , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/classificação , Idoso , Analgesia Controlada pelo Paciente/métodos , Anestésicos Locais/administração & dosagem , Terapia Combinada/métodos , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Toracoscopia/efeitos adversos , Toracoscopia/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
19.
Urologiia ; (1): 73-77, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31190489

RESUMO

AIM: To compare the results of the MRI-ultrasound fusion targeted biopsy (MRF-TB) and systematic 12-core biopsy (SB) of the prostate and analyze the relationship between biopsy results and the prebiopsy multiparametric MRI. MATERIAL AND METHODS: The study included 380 men aged from 45 to 80 years with a total PSA level of 4 to 10 ng/ml (according to Hybritech calibration) and a negative result of digital rectal examination. All men underwent the multiparametric MRI of the prostate before biopsy. MRI results were assessed according to the PI-RADS Version 2 criterion. In all men (n=247) with PI-RADS category 2 or higher lesion were performed MRF-TB (4 targeted columns) and SB (12 standard points) of the prostate. RESULTS: There were no significant differences in the detection of all types of prostate cancer (PCa) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less low-risk PCa (Gleason 6) (p<0.001) and significantly more aggressive PCa (Gleason more or equal 7) (p<0.001) were detected in MRF-TB group in comparison with SB group. In addition, MRF-TB allowed to detect significantly more aggressive type of PCa (Gleason more or equal 4 + 3) compared to SB (p=0.025). CONCLUSION: MRF-TB allows to detect more significant PCa (Gleason more or equal 7) in comparison with SB, while limiting the detection of low-risk PCa (Gleason 6) in general population of men.


Assuntos
Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Neoplasias da Próstata , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Ultrassonografia de Intervenção
20.
Vasc Endovascular Surg ; 53(6): 507-511, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31216954

RESUMO

Inferior vena cava (IVC) thrombosis is a specific form of thromboembolism that occurs at a rate of 1.5% in all patients hospitalized with a deep vein thrombosis. Malignant IVC thrombosis may occur due to compression from a tumor mass or metastasis or may also occur through tumor invasion of the venous vasculature. Obstruction of the IVC can lead to IVC syndrome, marked by ascites, lower extremity edema, and even congestive hepatic failure. We present a case of extensive IVC thrombosis in a 69-year-old female with metastatic adrenal cell carcinoma, presenting with severe bilateral lower extremity edema and ascites. Computed tomography showed IVC compression by the caudate lobe due to a metastatic liver mass and extensive clot burden of the IVC extending from the renal veins to the right atrium (RA). She underwent percutaneous IVC stenting with 4 stents placed in tandem from the IVC to the RA. Her hospital course was complicated by gastrointestinal bleed requiring clipping, acute liver failure, and hypophysitis due to trial therapy. Although her IVC symptoms were partially relieved with percutaneous intervention, her acute liver failure worsened and she was ultimately transitioned to hospice care.


Assuntos
Neoplasias do Córtex Suprarrenal/complicações , Carcinoma Adrenocortical/complicações , Procedimentos Endovasculares , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/patologia , Carcinoma Adrenocortical/diagnóstico por imagem , Carcinoma Adrenocortical/secundário , Idoso , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Flebografia/métodos , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
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