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1.
Radiographics ; 42(5): 1358-1376, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35802501

RESUMO

Elder abuse may result in serious physical injuries and long-term psychological consequences and can be life threatening. Over the past decade, attention to elder abuse has increased owing to its high prevalence, with one in six people aged 60 years and older experiencing some form of abuse worldwide. Despite this, the detection and reporting rates remain relatively low. While diagnostic imaging is considered critical in detection of child abuse, it is relatively underused in elder abuse. The authors discuss barriers to use of imaging for investigation and diagnosis of elder abuse, including lack of training, comorbidities present in this vulnerable population, and lack of communication among the intra- and interdisciplinary care providers. Moreover, imaging features that should raise clinical concern for elder abuse are reviewed, including certain types of fractures (eg, posterior rib), characteristic soft-tissue and organ injuries (eg, shoulder dislocation), and cases in which the reported mechanism of injury is inconsistent with the imaging findings. As most findings suggesting elder abuse are initially discovered at radiography and CT, the authors focus mainly on use of those modalities. This review also compares and contrasts elder abuse with child abuse. Empowered with knowledge of elderly victims' risk factors, classic perpetrator characteristics, and correlative imaging findings, radiologists should be able to identify potential abuse in elderly patients presenting for medical attention. Future recommendations for research studies and clinical workflow to increase radiologists' awareness of and participation in elder abuse detection are also presented. An invited commentary by Jubanyik and Gettel is available online. Online supplemental material is available for this article. ©RSNA, 2022.


Assuntos
Abuso de Idosos , Idoso , Comunicação , Abuso de Idosos/diagnóstico , Humanos , Pessoa de Meia-Idade , Prevalência , Radiologistas , Fluxo de Trabalho
2.
J Stroke Cerebrovasc Dis ; 27(4): e59-e64, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29150242

RESUMO

We report imaging findings of 3 patients with anterior inferior cerebellar artery (AICA) infarcts who presented with atypical clinical findings of cerebellar strokes. AICA strokes are rare, and diagnosis can be difficult because of the high variability of the posterior circulation vascular anatomy. We describe the embryology and variant anatomy of AICA so that clinicians can understand and recognize the patterns of these infarcts.


Assuntos
Artérias/diagnóstico por imagem , Infarto Encefálico/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Cerebelo/irrigação sanguínea , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Idoso , Feminino , Humanos , Masculino , Valor Preditivo dos Testes
5.
Ophthalmic Plast Reconstr Surg ; 30(2): e45-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24614565

RESUMO

Lymphomas are the most common primary orbital malignancies in adults. The authors present a 62-year-old Hispanic woman with a 2-year history of slowly enlarging bilateral lower eyelid masses that the patient described as "bags." On palpation, firm, mobile, nontender masses with associated tear trough deformities were noted. Biopsy of the left lower eyelid mass was consistent with a mucosa-associated lymphoid tissue lymphoma. Herniated orbital fat is an extremely common finding in the aging population and is often associated with a prominent tear trough. The patient with orbital lymphoma appeared to have herniated orbital fat with associated tear trough deformities. Lymphoma resembling herniated orbital fat is uncommon but should be considered in all patients with prominence in the periorbital region.


Assuntos
Tecido Adiposo/patologia , Neoplasias Palpebrais/diagnóstico , Hérnia/diagnóstico , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Doenças Orbitárias/diagnóstico , Biópsia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia
6.
AJR Am J Roentgenol ; 199(3): 635-43, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22915405

RESUMO

OBJECTIVE: Medical physics instruction for diagnostic radiology residency at our institution has been redesigned with an interactive and image-based approach that encourages clinical application. The new medical physics curriculum spans the first 3 years of radiology residency and is integrated with the core didactic curriculum. CONCLUSION: Salient features include clinical medical physics conferences, fundamentals of medical physics lectures, practicums, online modules, journal club, and a final review before the American Board of Radiology core examination.


Assuntos
Biofísica/educação , Currículo , Física Médica/educação , Internato e Residência , Radiologia/educação , Humanos
7.
Orbit ; 31(5): 319-20, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22616643

RESUMO

Simple lipomas of the eyelid are rare. We present a case of a 61-year-old man, who presented with 6 months of a slowly worsening blepharoptosis. On examination, that patient was noted to have a palpable, soft mass in the medial left upper eyelid. Histopathological examination of the mass revealed mature adipose tissue most consistent with lipoma. Simple lipomas of the eyelid are very unusual but should be considered in the differential diagnosis of patients presenting with mechanical ptosis.


Assuntos
Neoplasias Palpebrais/diagnóstico , Neoplasias Palpebrais/cirurgia , Lipoma/diagnóstico , Lipoma/cirurgia , Diagnóstico Diferencial , Progressão da Doença , Neoplasias Palpebrais/patologia , Humanos , Lipoma/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
8.
Clin Imaging ; 45: 118-121, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28666242

RESUMO

Foreign bodies in the spine are most commonly traumatic and managed in an acute setting. A few case reports describe foreign bodies resulting in delayed neurologic dysfunction, most commonly iatrogenic or from penetrating injury. We present a 30-year old man with lower extremity weakness from an intradural extramedullary foreign body granuloma secondary to a thorn, which was initially thought to represent an aggressive malignant process with intra and extramedullary involvement on MR. Postoperatively, the patient endorsed a causative trauma several years prior. We also present a review of the few similar published cases as well as the described prototypical imaging features and pathologic process.


Assuntos
Dura-Máter/lesões , Corpos Estranhos/diagnóstico , Traumatismos da Coluna Vertebral/diagnóstico , Vértebras Torácicas/lesões , Ferimentos Penetrantes/diagnóstico , Dura-Máter/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
9.
Acad Radiol ; 23(3): 374-81, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26781203

RESUMO

RATIONALE AND OBJECTIVES: Learner assessment in medical education has undergone tremendous change over the past two decades. During this time frame, the concept of Entrustable Professional Activities (EPAs) was introduced to guide the faculty when making competency-based decisions on the level of supervision required by trainees. EPAs are gaining momentum in medical education as a basis for decisions related to transitioning from residency training to clinical practice. The purpose of this article is twofold: (1) define EPAs for radiology (EPA-R) and (2) illustrate radiology-specific examples of these EPAs. MATERIALS AND METHODS: A multi-institutional work group composed of members of the Alliance of Directors and Vice Chairs of Education in Radiology convened at the 2015 Association of University Radiologists annual meeting to discuss radiology EPAs. The EPAs initially developed by the Accreditation Council for Graduate Medical Education (ACGME) Radiology milestone work group and the resultant ACGME Radiology milestones formed the basis for this discussion. RESULTS: A total of 10 radiology EPAs and illustrative vignettes were developed to help radiology educators and trainees better understand milestone assessment and how this translates to the necessary skills and responsibilities of practicing radiologists. Examples of EPA mapping to the ACGME subcompetencies and methods of assessment were included. CONCLUSIONS: EPAs offer an opportunity to improve our approach to training by increasing our focus on how we provide appropriate supervision to our residents and assess their progress. In this work, through suggested lists and vignettes, we have attempted to establish the framework for further discussion and development of EPA-Rs.


Assuntos
Competência Clínica/normas , Educação Baseada em Competências/normas , Radiologia/educação , Acreditação , Comunicação , Educação de Pós-Graduação em Medicina/normas , Avaliação Educacional/métodos , Docentes de Medicina , Humanos , Consentimento Livre e Esclarecido , Internato e Residência/normas , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Relações Médico-Paciente , Estudantes de Medicina , Ensino/métodos
12.
Am J Trop Med Hyg ; 80(3): 373-8, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19270284

RESUMO

Neurocysticercosis (NCC) includes a wide spectrum of illnesses. Newer neurosurgical approaches are being applied to NCC. Although clinical trials are leading to a consensus on medical management, fewer data address neurosurgical approaches. We reviewed all neurocysticercosis patients evaluated by neurosurgery at Ben Taub General Hospital, Houston, Texas, between August 1997 and December 2005. From 31 patients that had a neurosurgical evaluation, 16 patients were treated with shunts (5 had shunt failure requiring revision), 13 by surgical resection of cysts (9 underwent craniotomy and 4 endoscopy), and 2 by medical therapy. A fifth endoscopy was performed in one patient with shunt failure. None of the endoscopic patients needed another intervention. Despite the availability of anti-parasitic and anti-inflammatory therapies, neurosurgery continues to play an important role in the management of selected cases of NCC. In contrast to the high rate of shunt failure, neuroendoscopy seems to be associated with higher success rate than any other neurosurgical approach.


Assuntos
Neurocisticercose/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Antiparasitários/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurocisticercose/tratamento farmacológico , Neurocisticercose/patologia , Estudos Retrospectivos , Adulto Jovem
13.
Curr Infect Dis Rep ; 7(1): 39-47, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15610670

RESUMO

Neurocysticercosis, caused by infection with the pork tapeworm Taenia solium, is increasingly recognized as a cause of neurologic disease worldwide. Because the clinical presentation is nonspecific, diagnosis has been difficult. Advances in imaging studies and serodiagnostic techniques are facilitating the diagnosis of neurocysticercosis and tapeworm carriers. Neurocysticercosis represents a spectrum of disease. Seizures are the main clinical manifestation in parenchymal neurocysticercosis. Recent studies emphasize that such seizures are the result of the host inflammatory response, even in patients who only have calcifications with no viable cysticerci. Controlled clinical trials have demonstrated that antiparasitic drugs can decrease the number of generalized seizures, although the benefit is small and confined to a subgroup of patients. Corticosteroids can also decrease seizure frequency. Case studies have demonstrated that endoscopic surgery appears to be the optimal approach to ventricular cysts. Recombinant vaccines are being developed and may prove important in disease control.

14.
J Neuropsychiatry Clin Neurosci ; 17(3): 350-6, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16179657

RESUMO

This study evaluated the prevalence and specificity of diagnostic criteria for postconcussional syndrome (PCS) in 178 adults with mild to moderate traumatic brain injury (TBI) and 104 with extracranial trauma. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases (ICD-10) criteria for PCS were evaluated 3 months after injury. The results showed that prevalence of PCS was higher using ICD-10 (64%) than DSM-IV criteria (11%). Specificity to TBI was limited because PCS criteria were often fulfilled by patients with extracranial trauma. The authors conclude that further refinement of the DSM-IV and ICD-10 criteria for PCS is needed before these criteria are routinely employed.


Assuntos
Lesões Encefálicas/complicações , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/etiologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Testes Neuropsicológicos/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/métodos , Síndrome Pós-Concussão/epidemiologia , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos
15.
Neurocrit Care ; 1(1): 69-83, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-16174900

RESUMO

BACKGROUND: It is controversial whether a low cerebral blood flow (CBF) simply reflects the severity of injury or whether ischemia contributes to the brain's injury. It is also not clear whether posttraumatic cerebral hypoperfusion results from intracranial hypertension or from pathologic changes of the cerebral vasculature. The answers to these questions have important implications for whether and how to treat a low CBF. METHODS: We performed a retrospective analysis of 77 patients with severe traumatic brain injury who had measurement of CBF within 12 hours of injury. CBF was measured using xenon-enhanced computed tomography (XeCT). Global CBF, physiological parameters at the time of XeCT, and outcome measures were analyzed. RESULTS: Average global CBF for the 77 patients was 36+/-16 mL/100 g/minutes. Nine patients had an average global CBF<18 (average 12+/-5). The remaining 68 patients had a global CBF of 39+/-15. The initial ICP was >20 mmHg in 90% and >30 mmHg in 80% of patients in the group with CBF<18, compared to 33% and 16%, respectively, in the patients with CBF>or=18. Mortality was 90% at 6 months postinjury in patients with CBF<18. Mortality in the patients with CBF>18 was 19% at 6 months after injury. CONCLUSION: In patients with CBF<18 mL/100 g/minutes, intracranial hypertension plays a major causative role in the reduction in CBF. Treatment would most likely be directed at controlling intracranial pressure, but the early, severe intracranial hypertension also probably indicates a severe brain injury. For levels of CBF between 18 and 40 mL/100 g/minutes, the presence of regional hypoperfusion was a more important factor in reducing the average CBF.


Assuntos
Lesões Encefálicas/fisiopatologia , Circulação Cerebrovascular/fisiologia , Adulto , Lesões Encefálicas/complicações , Lesões Encefálicas/terapia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
16.
J Neuropsychiatry Clin Neurosci ; 16(4): 493-9, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15616177

RESUMO

The objectives of this study were to compare diagnoses of postconcussional syndrome between the International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). The patient sample was comprised of 178 adults with mild-moderate traumatic brain injury (TBI). The study design was inception cohort, and the main outcome measure was a structured interview 3 months after injury. The results were that, despite concordance of DSM-IV and ICD-10 symptom criteria (kappa=0.73), agreement between overall DSM-IV and ICD-10 diagnoses was slight (kappa=0.13) because fewer patients met the DSM-IV cognitive deficit and clinical significance criteria. Agreement between DSM-IV postconcussional disorder and ICD-10 postconcussional syndrome appears limited by different prevalences and thresholds.


Assuntos
Síndrome Pós-Concussão/diagnóstico , Adulto , Concussão Encefálica/patologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Terminologia como Assunto
17.
Rev. colomb. radiol ; 16(3): 1779-1787, sept. 2005. ilus
Artigo em Espanhol | LILACS | ID: lil-521524

RESUMO

El síndrome de encefalopatía reversible posterior (PRES, por sus sigla en inglés, derivadas de posterior reversible encephalopathy syndrome) es un síndrome clínico compuesto por cefalea, alteraciones visuales y convulsiones, usualmente en pacientes con elevación súbita de la presión arterial. Los hallazgos imagenológicos son los de edema cerebral vasogénico reversible sin infarto. Su localizacion es predominantemente posterior; afecta la corteza y la sustancia blanca subcortical de los lóbulos occipitales, parietales y temporales posteriores. El tratamiento con antihipertensivos y la remoción de medicación inmunosupresora generalmente se asocia con recuperación neurológica completa, que también se refleja en las imágenes, las cuales vuelven a su condición basal. La hipertensión no tratada, por otro lado, resulta en falla progresiva del sistema de autorregulación cerebral del sistema nervioso central con hemorragia intracraneal, infarto cerebral irreversible, coma y muerte.


Assuntos
Humanos , Edema Encefálico , Diagnóstico por Imagem , Encefalopatia Hipertensiva , Imageamento por Ressonância Magnética
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