RESUMO
Inferior vena cava (IVC) filters are a controversial mechanical adjunct in the prevention of pulmonary embolism, the most serious result of venous thromboembolism. Despite modern IVC filters being in clinical use for more than 45 years, there is still uncertainty amongst many radiologists about the indications for IVC filter placement and their removal, particularly the more recent prophylactic use in patients without confirmed deep vein thrombosis (DVT) or pulmonary embolism (PE). Recently published guidelines on filter use from the National Institute of Health and Clinical Excellence (NICE) and other professional bodies are discussed. The vast majority of IVC filters in the UK are inserted by interventional radiologists, so radiologists may be the first point of contact for information requested by other clinicians. The increasing use of filters means that radiologists will encounter filters increasingly often during abdominal cross-sectional imaging. Awareness of common filter-related complications, such as tilting, thrombosis, and caval perforation, is useful to reassure or alert other clinicians. The potential role of filters in upper extremity DVT and requirement for concomitant anticoagulation is discussed.
Assuntos
Filtros de Veia Cava , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Cirurgia Bariátrica/instrumentação , Remoção de Dispositivo/métodos , Remoção de Dispositivo/normas , Feminino , Humanos , Neoplasias/terapia , Intervenção Coronária Percutânea/instrumentação , Guias de Prática Clínica como Assunto , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Desenho de Prótese , Implantação de Prótese/métodos , Embolia Pulmonar/prevenção & controle , Terminologia como Assunto , Filtros de Veia Cava/efeitos adversos , Tromboembolia Venosa/terapia , Ferimentos e Lesões/terapiaRESUMO
The current pathway for men suspected of having prostate cancer [transrectal biopsy, followed in some cases by magnetic resonance imaging (MRI) for staging] results in over-diagnosis of insignificant tumours, and systematically misses disease in the anterior prostate. Multiparametric MRI has the potential to change this pathway, and if performed before biopsy, might enable the exclusion of significant disease in some men without biopsy, targeted biopsy in others, and improvements in the performance of active surveillance. For the potential benefits to be realized, the setting of standards is vital. This article summarizes the outcome of a meeting of UK radiologists, at which a consensus was achieved on (1) the indications for MRI, (2) the conduct of the scan, (3) a method and template for reporting, and (4) minimum standards for radiologists.
Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico , Biópsia , Meios de Contraste , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias da Próstata/patologia , Reino UnidoRESUMO
Vascular malformations are a diffuse collection of abnormalities that are usually present at birth but may present any time during childhood or as an adult. Historically terminology has been complicated and used interchangeably causing confusion to patients and clinicians alike; however, a structured internationally agreed classification system exists. It is not uncommon for patients with vascular malformations to be referred to various specialties without obtaining a correct diagnosis and appropriate treatment. Vascular malformations can occur anywhere within the body and all patients will require imaging at some stage; therefore, it is important for all radiologists to be aware of the correct terminology and imaging characteristics. This review discusses classification and illustrates salient imaging findings and the modern approach to treatment of vascular malformations.
Assuntos
Angiografia por Ressonância Magnética , Ultrassonografia , Malformações Vasculares/diagnóstico , Humanos , Terminologia como Assunto , Malformações Vasculares/classificação , Malformações Vasculares/terapiaRESUMO
Transurethral resection of the prostate (TURP) is considered the gold-standard operation to treat lower urinary tract symptoms due to benign prostatic enlargement in men. Postoperative bleeding is a recognised complication and managing it is a core skill required by attending urologists. We report a rare case of postoperative bleeding caused by fistulating vessels to the prostate which developed after TURP. These fistulas arose from the right internal iliac vessels and communicated with pre-existing pelvic varices affecting the right paraprostaticand seminal vesicle tissues. The fistulating vessels were successfully embolised with liquid embolic agent. Surgeons should be aware that persisting haemorrhage can occur post-TURP from the rare presence of fistulating vessels communicating with pelvic varices. Early computed tomography angiographic assessment is warranted in cases where bleeding is prolonged and refractory to standard management in view of timely referral for percutaneous embolisation.
Assuntos
Embolização Terapêutica , Fístula/terapia , Hemorragia Pós-Operatória/terapia , Próstata/irrigação sanguínea , Ressecção Transuretral da Próstata/efeitos adversos , Varizes/terapia , Idoso , Fístula/complicações , Hematúria/etiologia , Hematúria/terapia , Humanos , Masculino , Hemorragia Pós-Operatória/etiologia , Prostatismo/cirurgia , Varizes/complicaçõesRESUMO
This case highlights the successful management of acute Type B dissection complicated by visceral malperfusion. Even though the procedure of hybrid supra-aortic translocation and endovascular stenting corrected the malperfusion, it is important for vigilant CT scan surveillance for the post operative complications which can occur with this procedure.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Isquemia/etiologia , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Isquemia/cirurgia , Rim/irrigação sanguínea , Fígado/irrigação sanguínea , Pessoa de Meia-Idade , Pericárdio/lesões , Ruptura , Stents , Tomografia Computadorizada por Raios X , Vísceras/irrigação sanguíneaRESUMO
T cell activation is commonly assayed in vitro by measuring the proliferative response of primed cells to an antigenic stimulus. We have modified the conventional form of this assay by dividing up the response into two stages. During the first stage, antigen drives the specific expression of IL-2 receptor expression. This phase is carried out in the presence of homologous mouse serum, in order to reduce non-specific responses to a minimum. During the second phase, proliferation of these activated T cells is driven by the addition of excess exogenous IL-2. This modified form of proliferation assay significantly increased the signal to noise ratio which can be attained, and is of particular value when looking at the T cell response to weak (e.g., cross-reactive) antigens, or low concentrations of antigen.
Assuntos
Interleucina-2/fisiologia , Ativação Linfocitária , Receptores de Antígenos de Linfócitos T/fisiologia , Linfócitos T/imunologia , Animais , Antígenos/imunologia , Células Cultivadas , Insulina/imunologia , Linfonodos/citologia , Camundongos , Receptores Imunológicos/fisiologia , Receptores de Interleucina-2RESUMO
Palliation of malignant gastrointestinal obstruction is a major aspect of oncology. We assessed the efficacy of stents in the palliation of gastric outlet, duodenal and colonic obstruction. We undertook a retrospective study of 35 consecutive patients who were referred for stent insertion with palliative intent from June, 1999 to March, 2003. Thirty-two stents were successfully placed in 30 patients. Technical success rate was 86% (30/35 patients). Of the patients who had successful insertion, 83% had complete relief of symptoms. In 1 patient the stent failed to expand. There was no procedure related mortality. Median survival was 1.6 months (range, 0-14.8). The conclusion was that self-expandable metal stents provide an effective method of palliation in malignant gastrointestinal obstruction, with high clinical and technical success rates and low complication rates.
Assuntos
Obstrução da Saída Gástrica/cirurgia , Cuidados Paliativos , Stents , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução da Saída Gástrica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/mortalidade , Análise de SobrevidaRESUMO
While there is general agreement that research in health education is valuable, there is considerable disagreement on the form it should take, and how it should be organised. After a review of the problems and opportunities from two perspectives, a number of points are suggested which should be taken into account by anyone considering basing research posts in service units.
Assuntos
Educação em Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Reino UnidoRESUMO
Liquid sclerotherapy, laser and surgery have been used in the treatment of head and neck vascular anomalies with variable success for many years. A multidisciplinary team consisting of plastic surgery, maxillofacial surgery and interventional radiology currently treats such lesions by converting liquid sclerosant into foam. Foam sclerotherapy is currently used successfully to treat varicosities of the lower limbs and in this study, we present four cases in which 3% sodium tetradecyl sulfate has been used to treat low-flow vascular malformations in the head and neck.
RESUMO
Clostridium difficile associated disease is an increasingly common cause of morbidity and mortality. Pseudomembranous colitis following hospital-administered antibiotic treatment is the most common symptomatic manifestation. Small bowel enteritis caused by C. difficile, however, is rarely described. Here, we present a series of four patients with hospital-acquired small bowel enteritis caused by C. difficile, discuss its CT and histopathological features, and review the current literature.
Assuntos
Clostridioides difficile , Enterocolite Pseudomembranosa/microbiologia , Intestino Delgado/microbiologia , Adulto , Idoso , Infecção Hospitalar/diagnóstico por imagem , Infecção Hospitalar/microbiologia , Infecção Hospitalar/patologia , Enterocolite Pseudomembranosa/diagnóstico por imagem , Enterocolite Pseudomembranosa/patologia , Evolução Fatal , Feminino , Humanos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Extracolonic findings are frequently recognized alongside colonic pathology at computed tomographic colonography (CTC). This study assessed the clinical impact of extracolonic findings in a symptomatic population at high risk of colorectal cancer. METHODS: CTC was performed in a consecutive cohort of patients assessed in a fast-track colorectal cancer clinic as being at high risk of colorectal cancer. A review of CTC findings and case notes was undertaken. Patients with extracolonic findings were followed up for at least 12 months. RESULTS: Thirty-one (13.8 per cent) of 225 patients investigated by CTC had colorectal cancer. Extracolonic findings were identified in 81 (53.3 per cent) of 152 patients with normal or non-neoplastic bowel findings, compared with 27 (37 per cent) of 73 patients with colorectal neoplasia (P = 0.025). Twenty-four patients (10.7 per cent) with extracolonic findings underwent further investigation or treatment. The median duration of investigation was 19.5 weeks. Seventy-five clinical events were recorded, including 14 surgical procedures. CONCLUSION: A prospective cost-benefit analysis of diagnostic CTC should be performed before it is established as a first-line investigation for colonic symptoms.
Assuntos
Colonografia Tomográfica Computadorizada , Neoplasias Colorretais/diagnóstico por imagem , Achados Incidentais , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colonografia Tomográfica Computadorizada/economia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/economia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Pseudoaneurysms secondary to bone tumours are rare and most of the reported cases are related to osteochondromas, either due to direct pressure or following surgery. Aneurysmal bone cysts are relatively common bony lesions usually treated by curettage. DISCUSSION: We describe an unusual case of pseudoaneurysm of the anterior tibial artery complicating curettage of an aneurysmal bone cyst which presented as a rapidly enlarging mass clinically thought to be rapid recurrence of the tumour. This was successfully treated by embolisation.
Assuntos
Falso Aneurisma/etiologia , Cistos Ósseos Aneurismáticos/cirurgia , Curetagem/efeitos adversos , Fíbula/cirurgia , Tíbia/irrigação sanguínea , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Angiografia , Criança , Embolização Terapêutica , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
AIM: To investigate interpretative accuracy and reporting time for radiologists performing computed tomography (CT) colonography in day-to-day non-academic clinical practice. MATERIALS AND METHODS: Thirteen radiologists from seven centres, who were reporting CT colonography in non-academic daily clinical practice, interpreted a dataset of 15 colonoscopically validated cases in a controlled environment. Ten cases had either a cancer or polyp >10mm; one case had a medium polyp and four were normal. Correct case categorization and interpretation times were compared using analysis of variance to aggregated results obtained from both experienced observers and observers recently trained using 50 cases, working in an academic environment. The effect of experience was determined using Spearman's rank correlation. RESULTS: Individual accuracy was highly variable, range 53% (95% CI 27-79%) to 93% (95% CI 68-100%). Mean accuracy overall was significantly inferior to experienced radiologists (mean 75 versus 88%, p=0.04) but not significantly different from recently trained radiologists (p=0.48). Interpretation time was not significantly different to experienced readers (mean 12.4 min versus 11.7, p=0.74), but shorter than recently trained radiologists (p=0.05). There was a significant, positive, linear correlation between prior experience and accuracy (p<0.001) with no plateau. CONCLUSION: Accuracy for sub-specialist radiologists working in a non-academic environment is, on average, equivalent to radiologists trained using 50 cases. However, there is wide variability in individual performance, which generally falls short of the average performance suggested by meta-analysis of published data. Experience improves accuracy, but alone is insufficient to determine competence.
Assuntos
Competência Clínica/normas , Colonografia Tomográfica Computadorizada/normas , Neoplasias do Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Variações Dependentes do Observador , Fatores de TempoRESUMO
We report a 47-year-old man with myelofibrosis who presented with bilateral nephromegaly secondary to extramedullary haematopoiesis. We discuss diagnosis and treatment of this rare case and review the literature.
Assuntos
Hematopoese Extramedular , Nefropatias/diagnóstico , Mielofibrose Primária/diagnóstico , Transformação Celular Neoplásica , Humanos , Hipertrofia/etiologia , Nefropatias/terapia , Leucemia Mieloide Aguda , Masculino , Pessoa de Meia-Idade , Mielofibrose Primária/terapiaRESUMO
A series of experiments have been carried out in-vitro in order to assess the possibility of using a collagen membrane in the repair of various sections of the urinary tract following operative surgery such as the removal of a stone from the ureter. The collagen film has been tested for its compatability with urine, its ability to prevent leakage of fluid in a simulated wound in-vitro and for its ability to withstand any degradative effect of liver and kidney homogenates. The material was not significantly degraded by either urine or by tissue homogenates and was able to prevent leakage of fluid under the experimental conditions employed. Although some slight build-up of calcium and some trace elements took place after incubation in urine over a six-day period this was not significant. On the basis of the results obtained it has been decided to proceed to in-vivo trials on rabbits using the collagen membrane. The possibility of using such a material in partial nephrectomy operations is discussed.