RESUMO
BACKGROUND: Air enema under fluoroscopy is a well-accepted procedure for the treatment of childhood intussusception. However, the reported radiation doses of pneumatic reduction with conventional fluoroscopy units have been high in decades past. OBJECTIVE: To compare current radiation doses at our institution to past doses reported by others for fluoroscopic-guided pneumatic reduction of ileo-colic intussusception in children. MATERIALS AND METHODS: Since 2007 radiologists and residents in our department who perform reduction of intussusceptions have received a radiation risk training. We retrospectively analyzed the data of 45 children (5 months-8 years) who underwent a total of 48 pneumatic reductions of ileo-colic intussusception between 2008 and 2012. We analyzed data for screening time and dose area product (DAP) and compared these data to those reported up to and including the year 2000. RESULTS: Our mean screening time measured by the DAP-meter was 53.8 s (range 1-320 s, median 33.0 s). The mean DAP was 11.4 cGy â cm(2) (range 1-145 cGy â cm(2), median 5.45 cGy â cm(2)). There was one bowel perforation, in a 1-year-old boy requiring surgical revision. Only three studies in the literature presented radiation exposure results on children who received pneumatic or hydrostatic reduction of intussusception under fluoroscopy. Screening times and dose area products in those studies, which were published in the 1990 s and in the year 2000, were substantially higher than those in our sample. CONCLUSION: Low-frequency pulsed fluoroscopy and other dose-saving keys as well as the radiation risk training might have helped to improve the quality of the procedure in terms of radiation exposure.
Assuntos
Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Doses de Radiação , Radiografia Intervencionista , Criança , Pré-Escolar , Feminino , Fluoroscopia , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Lactente , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVES: To compare the diagnostic performance of magnetic resonance imaging (MRI) in terms of sensitivity and specificity using a field strength of <1.0 T (T) versus ≥1.5 T for diagnosing or ruling out knee injuries or knee pathologies. METHODS: The systematic literature research revealed more than 10,000 references, of which 1598 abstracts were reviewed and 87 full-text articles were retrieved. The further selection process resulted in the inclusion of four systematic reviews and six primary studies. RESULTS: No differences could be identified in the diagnostic performance of low- versus high-field MRI for the detection or exclusion of meniscal or cruciate ligament tears. Regarding the detection or grading of cartilage defects and osteoarthritis of the knee, the existing evidence suggests that high-field MRI is tolerably specific but not very sensitive, while there is literally no evidence for low-field MRI because only a few studies with small sample sizes and equivocal findings have been performed. CONCLUSIONS: We can recommend the use of low-field strength MRI systems in suspected meniscal or cruciate ligament injuries. This does, however, not apply to the diagnosis and grading of knee cartilage defects and osteoarthritis because of insufficient evidence.
Assuntos
Traumatismos do Joelho/patologia , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética , Diagnóstico Diferencial , Humanos , Sensibilidade e EspecificidadeRESUMO
PRINCIPALS: Throughout the world, falls are a major public health problem and a socioeconomic burden. Nevertheless there is little knowledge about how the injury types may be related to the aetiology and setting of the fall, especially in the elderly. We have therefore analysed all patients presenting with a fall to our Emergency Department (ED) over the past five years. METHODS: Our retrospective data analysis comprised adult patients admitted to our Emergency Department between January 1, 2006, and December 31, 2010, in relation to a fall. RESULTS: Of a total of 6357 patients 78% (n = 4957) patients were younger than 75 years. The main setting for falls was patients home (n = 2239, 35.3%). In contrast to the younger patients, the older population was predominantly female (56.3% versus 38.6%; P < 0.0001). Older patients were more likely to fall at home and suffer from medical conditions (all P < 0.0001). Injuries to the head (P < 0.0001) and to the lower extremity (P < 0.019) occurred predominantly in the older population. Age was the sole predictor for recurrent falls (OR 1.2, P < 0.0001). CONCLUSION: Falls at home are the main class of falls for all age groups, particularly in the elderly. Fall prevention strategies must therefore target activities of daily living. Even though falls related to sports mostly take place in the younger cohort, a significant percentage of elderly patients present with falls related to sporting activity. Falls due to medical conditions were most likely to result in mild traumatic brain injury.
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Acidentes por Quedas/estatística & dados numéricos , Traumatismos Craniocerebrais/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Meio Ambiente , Traumatismos da Perna/epidemiologia , Traumatismo Múltiplo/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Distribuição por Sexo , Suíça/epidemiologia , Adulto JovemRESUMO
During the peak of the second wave of the coronavirus disease 2019 (COVID-19) pandemic in November 2020, the district of Rohrbach, Upper Austria, was reported to have had the highest 7day incidence of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) positive cases worldwide. In this study, we present the clinical characteristics of COVID-19 cases during the second wave of the pandemic in patients admitted to the only primary care hospital in the district of Rohrbach between October 2020 and February 2021. In total, 260 patients were hospitalized with a mean age of 72 years and a mortality rate of 14.6% and 13 patients (5%) were transferred to the intensive care unit (ICU). Critically ill patients (22.7%) were of older age and often lived in retirement and nursing facilities as compared to mild or moderately ill patients. Patients with a severe disease course showed significantly longer hospitalization, a worse peripheral oxygen saturation on admission and significantly higher levels of Creactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), troponin I and Ddimer as compared to mild or moderate COVID-19 cases. These laboratory parameters might help to identify COVID-19 patients with a severe disease course. In conclusion, we could show that older, frail individuals are the most vulnerable group affected by COVID-19. Whether this trend in hospitalized patients continues with the persistence of the pandemic, the emergence of novel virus mutations, and the availability of several different vaccines is presently unclear and remains to be determined.
Assuntos
COVID-19 , Idoso , Áustria , Hospitalização , Humanos , Unidades de Terapia Intensiva , Saturação de Oxigênio , Pandemias , Estudos Retrospectivos , SARS-CoV-2RESUMO
Congenital vascular malformations (CVM) are made of dysplastic vessels with no cellular proliferation. Low- or slow-flow malformations (LFM) consist predominantly of venous and/or lymphatic vessels. Correct terminology is necessary for differentiating vascular malformations from tumours such as haemangiomas, in order to prevent ineffective or even adverse therapy. The role of the radiologist in the management of patients is two-fold: making the diagnosis with the use of ultrasound and magnetic resonance imaging, and performing sclerotherapy, which is the treatment of choice. Prior to sclerotherapy, percutaneous phlebography is necessary to visualize the dynamic situation inside the lesion and the flow into the adjacent vascular system. The double-needle technique is a useful therapy option reducing the risk of embolisation of the sclerosing agent. Large lesions might need subsequent surgical treatment. A multidisciplinary approach is substantial for optimal patient management.
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Malformações Arteriovenosas/classificação , Radiologia Intervencionista , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/terapia , Criança , Humanos , Radiologia Intervencionista/métodos , Fluxo Sanguíneo Regional/fisiologia , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Terminologia como AssuntoRESUMO
BACKGROUND: The known biological activities of nitric oxide suggest a role in bone healing. We hypothesized that L-arginine, a source of nitric oxide, expedites the healing process of stabilized diaphyseal defects. TYPE OF STUDY: Prospective blinded animal study. METHODS: Using a guinea-pig model, a 7 mm diaphyseal and periosteal defect was produced in the right femur and splinted intramedullary with a 1.4 mm K-wire. The guinea pigs (n = 44) were treated orally in three parallel groups: two treatment groups received high doses of L-arginine (one group for 2 weeks and the other for 4 weeks) and a control group received vehicle only. After four weeks, all animals were killed and both femora explanted. Radiological, histological, histomorphometric and mechanical evaluation was performed blinded. RESULTS: Radiographs showed significantly more healing in the treatment groups (2 weeks, 10/15; 4 weeks, 11/15) than in the control group (3/14). The mechanical energy necessary for femur failure was significantly higher in the 4-week treatment group than in the control group (P < 0.05). Histology and histomorphometry showed significantly increased coverage of nonvascularized bone fragments with newly formed bone in the treatment groups (P < or = 0.05). The contralateral uninjured femora did not show significant differences between groups. CONCLUSIONS: Oral L-arginine expedites healing in stabilized diaphyseal defects in guinea pigs without detrimentally affecting uninjured counterparts.
Assuntos
Calcificação Fisiológica/efeitos dos fármacos , Fraturas do Fêmur/tratamento farmacológico , Fraturas do Fêmur/fisiopatologia , Consolidação da Fratura/fisiologia , Administração Oral , Animais , Relação Dose-Resposta a Droga , Elasticidade , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/patologia , Consolidação da Fratura/efeitos dos fármacos , Cobaias , Masculino , Estudos Prospectivos , Radiografia , Método Simples-Cego , Estresse Mecânico , Resultado do Tratamento , Suporte de CargaRESUMO
In this study, magnetic resonance imaging was compared with histology to evaluate the usefulness of magnetic resonance imaging to distinguish malignant from benign cardiac and paracardiac masses in 55 patients. Tumor location, tissue composition, and pericardial or pleural effusion all were identified as key predictors of lesion type. Observers were accurate in the prediction of lesion type (area under curve 0.88 and 0.92), and there was good interobserver variability (Cohen's kappa = 0.64).
Assuntos
Neoplasias Cardíacas/diagnóstico , Imageamento por Ressonância Magnética/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tumor Carcinoide/diagnóstico , Carcinoma Broncogênico/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Fibroma/diagnóstico , Neoplasias Cardíacas/classificação , Neoplasias Cardíacas/complicações , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Mixoma/diagnóstico , Razão de Chances , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico , Derrame Pleural Maligno/complicações , Derrame Pleural Maligno/diagnóstico , Análise de Regressão , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Single- and multi-slice computed tomography (CT) is regarded as the primary imaging tool in traumatology, both in adults and children. For complicated infectious disease and renal tumours, these techniques are recommended only as secondary diagnostic tools. Specifically, multi-slice CT (MSCT) provides excellent spatial resolution, which is a particular advantage for the evaluation of small structures as they are typical in children. However, MSCT offers more information than is required for diagnosis. Therefore, low-dose protocols are necessary for paediatric examinations. The CT dose-index (CTDI(vol)) should not exceed 2 mGy for newborns, 4 mGy for toddlers, 5 mGy for elementary school children, and 8 mGy for adolescents.
Assuntos
Nefropatias/diagnóstico por imagem , Rim/diagnóstico por imagem , Rim/lesões , Tomografia Computadorizada por Raios X/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Masculino , Doses de RadiaçãoRESUMO
Wegener's granulomatosis (WG) is an idiopathic inflammatory systemic disease that can occasionally cause an acute respiratory distress syndrome. We report on a 17-year-old girl with Wegener's granulomatosis and acute hemorrhagic respiratory failure successfully treated using bronchoalveolar lavage with diluted porcine surfactant (Curosurf; 4.8 mg/mL) followed by a low-dose bolus of surfactant. The cumulative dose of surfactant was 40 mg/kg BW. The lavage with diluted surfactant and the administration of the bolus were performed with a flexible bronchoscope. The patient was ventilated during the whole procedure, stayed hemodynamically stable and showed only a very short phase of desaturation. The PaO2/FiO2 ratio increased from 54.8 to 62.4 after one hour, to 106 after 17 hours and finally to 280 after four days. The patient was extubated five days after lavage treatment, and almost normal lung function was restored after eight weeks. Bronchoalveolar lavage with diluted surfactant by flexible bronchoscopy allows selective and direct drug administration and removes airway and alveolar debris. The technique reduces the amount of surfactant needed to overcome inhibition and thereby reduces therapy costs. We conclude that this early therapeutic intervention with surfactant might help to avoid an invasive rescue therapy such as extra corporeal membrane oxygenation, thus improving outcome in terms of faster recovery of lung function.
Assuntos
Produtos Biológicos/uso terapêutico , Granulomatose com Poliangiite/complicações , Fosfolipídeos/uso terapêutico , Surfactantes Pulmonares/uso terapêutico , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/etiologia , Doença Aguda , Adolescente , Produtos Biológicos/administração & dosagem , Líquido da Lavagem Broncoalveolar , Feminino , Seguimentos , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/diagnóstico por imagem , Hemorragia/complicações , Hemorragia/etiologia , Humanos , Pneumopatias/complicações , Pneumopatias/etiologia , Fosfolipídeos/administração & dosagem , Alvéolos Pulmonares , Surfactantes Pulmonares/administração & dosagem , Radiografia Torácica , Insuficiência Respiratória/diagnóstico por imagem , Fatores de Tempo , Resultado do TratamentoRESUMO
We report a case of a 33-year-old woman with emergency admission due to dyspnoea and fever. History included squamous cell carcinoma of the cervix in complete remission. Contrast-enhanced computed tomography (CT) scanning of the chest, which was indicated to rule out pneumonia, revealed an infiltrative cardiac mass. Further assessment of the tumour by echocardiography and cardiac magnetic resonance imaging (MRI) showed transmural infiltration of the apical interventricular septum with a mass extending into the left and right ventricle cavities. The mass was highly suspicious for a cardiac metastasis. Cardiac metastases from cervical cancer are extremely rare. Recurrence of cervical carcinoma involving the heart should be considered even after a curative therapy approach. Non-invasive imaging plays a paramount role in investigating cardiac masses. Echocardiography, CT and MRI are complementary imaging modalities for complete work-up of intracardiac lesions.
RESUMO
OBJECTIVES: Sexuality is an essential aspect of human function, well-being and quality of life. Many people have sex without complications. However, there are some people who need to seek emergency medical help for related health problems. The aim of this study was to present a first overview of patients who received a radiological examination related to sexual intercourse based emergency department admission. METHODS: Our centralized electronic patient record database was reviewed for patients who had been admitted to our emergency department with an emergency after sexual intercourse between 2000 and 2011. The database was scanned for the standardized key words 'sexual intercourse' or 'coitus' retrospectively. For all patients identified in the electronic patient record database the radiological examinations were searched for manually in our Radiology Information System, and reviewed by three independent radiologists. RESULTS: One hundred and twenty nine out of 445 (29,0%) patients received a radiological examination after immediate emergency department admission related to sexual intercourse. Fifty two out of 129 (40.3%) patients had positive radiological findings while 77 (59.7%) did not. Eighty point seven percent (nâ=â42) of the radiological findings were a sexual intercourse-associated pathology and 19.2% (nâ=â10) were considered to be incidental findings. Age and male sex positively correlated with radiological imaging workup (p<0.001, respectively p<0.037). The most common sexual intercourse-associated pathology was headache attributed to cerebrovascular insult (nâ=â21, 40.3%) followed by epididymitis (nâ=â7, 16.6%) and obstructive uropathy (nâ=â5, 11.6%). Of the patients with headache attributed to non-traumatic intracranial hemorrhage, subarachnoid hemorrhage (nâ=â14, 66.6%) was the most common, followed by intracerebral bleeding (nâ=â4, 19.0%) and one subdural hemorrhage. CONCLUSIONS: Pathological findings are manifold. Cerebral imaging is the most common type of radiological imaging performed. Further prospective and standardized studies should be performed to better evaluate the significance of radiological imaging in this patient collective with the aim to gain better knowledge on what patients profit from what type of radiological imaging when presenting with a sexual intercourse related emergency. ADVANCES IN KNOWLEDGE: The present study provides a first overview on radiological findings of sexual intercourse related emergency department admissions.
Assuntos
Emergências , Serviço Hospitalar de Emergência , Admissão do Paciente , Radiografia , Comportamento Sexual , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: D-dimer levels are often elevated in renal insufficiency. The diagnostic accuracy of D-dimer to rule out pulmonary embolism in patients with renal insufficiency is unclear. METHODS: We evaluated the data of patients presenting to our Emergency Department and receiving computed tomography angiography to rule out pulmonary embolism with measurement of D-dimer and creatinine. Glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. RESULTS: There were 1305 patients included; 1067 (82%) had an estimated glomerular filtration rate (eGFR) exceeding 60 mL/min, 209 (16%) 30-60 mL/min, and 29 (2%) <30 mL/min. One hundred fifty-two patients (12%) had D-dimer below 500 µg/L. eGFR (R = -0.1122) correlated significantly with D-dimer (P <.0001). One hundred sixty-nine patients (13%) were found to have pulmonary embolism. Sensitivity of D-dimer for patients with an eGFR >60 mL/min was 96% (confidence interval [CI], 0.93-0.99) and 100% (CI, 100-100) for those with 30-60 mL/min, while specificity decreased significantly with impaired renal function. Area under the curve of the receiver operating characteristic for D-dimer was 0.734 in patients with an eGFR of >60 mL/min, and 0.673 for 30-60 mL/min. CONCLUSIONS: D-dimer levels were elevated in patients with an eGFR <60 mL/min, but proved to be highly sensitive for the exclusion of pulmonary embolism. However, because almost all patients with impaired renal function had elevated D-dimer irrespective of the presence of pulmonary embolism, studies should be performed to determine renal function-adjusted D-dimer cutoffs.
Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Insuficiência Renal/complicações , Estudos RetrospectivosRESUMO
In a retrospective analysis with two readers blinded to the clinical information, coronal short tau inversion recovery (STIR) images were compared to contrast-enhanced fat-saturated T1-weighted imaging (T1 CEfs) in 51 cases of cervical lymphoma. Interrater reliability was good to excellent. Although sensitivity and subjective quality of the STIR sequence were higher than those of the T1 CEfs sequence (sensitivity 85%/72%, respectively), specificity (82%/95%) as well as positive likelihood ratio (4.65/15.93) was much lower. Therefore, contrast-enhanced sequences should be included in the primary staging of lymphoma.
Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Linfoma/patologia , Imageamento por Ressonância Magnética/métodos , Meios de Contraste , Feminino , Humanos , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
PURPOSE: To evaluate the effect of ultrasonography (US) on the rate of appendectomy after false-positive diagnosis of acute appendicitis (negative appendectomy). MATERIALS AND METHODS: Data were analyzed in 736 pediatric patients (mean age, 13.2 years) who had undergone appendectomy between 1995 and 2000. Histologic data were compared in patients who underwent US with those who did not undergo imaging prior to surgery. US was performed by a radiologist or a pediatric surgeon or both. RESULTS: A total of 643 (87.4%) of the 736 pediatric patients underwent preoperative US, and 93 (12.6%) of the 736 did not undergo preoperative US. Of the 736 patients, 97 (13.2%) underwent negative appendectomy. Thirty-four (36.6%) of the 93 patients who underwent appendectomy with no preoperative US and 63 (9.8%) of the 643 patients who underwent preoperative US underwent negative appendectomy. There was a significant association between US and positive appendectomy (P <.001). CONCLUSION: US in pediatric patients suspected of having appendicitis can significantly lower the negative appendectomy rate.
Assuntos
Apendicectomia , Apendicite/diagnóstico por imagem , Adolescente , Adulto , Apendicite/cirurgia , Criança , Pré-Escolar , Reações Falso-Positivas , Feminino , Humanos , Lactente , Masculino , UltrassonografiaRESUMO
The negative influence of obesity on the detection rate of the appendix for US in adults has been reported. It has been assumed that obesity is a limiting factor in the detection of the appendix with US in children as well, but this has not yet been proven. The aim of our study was to evaluate whether nutritional condition (defined by the body mass index-for-age percentiles: BMI-FAP) influences the detection of the appendix in children on US. One hundred twenty-six children (65 girls and 61 boys) with a mean age of 11.4 years with clinically suspected acute appendicitis underwent ultrasound on a commercially available high-end machine (HDI 5000, ATL, Bothell, Wash.). The BMI was calculated, and children were divided in three weight groups in accordance with the BMI-FAP, and were correlated with US findings. Evaluation of the three weight groups in accordance with the BMI-FAP demonstrated significant differences ( p=0.04) in the detection of the appendix. There was no statistical significance for the BMI, weight, height, and age solely for the detection of the appendix. In children there is a correlation between the nutritional condition as defined by the BMI-FAP and the detection of the appendix.
Assuntos
Apendicite/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Doença Aguda , Adulto , Fatores Etários , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Variações Dependentes do Observador , UltrassonografiaRESUMO
OBJECTIVE: The purpose of this work is to present a simple and descriptive classification system for venous malformations (VMs) that may serve as a basis for interventional therapy, and to test its usefulness in a sample of consecutively referred paediatric patients. MATERIALS AND METHODS: The classification system we developed includes four types: type I, isolated malformation without peripheral drainage; type II, malformation that drains into normal veins; type III, malformation that drains into dilated veins; and type IV, malformation that represents dysplastic venous ectasia. The system was prospectively tested using phlebography in a sample of 43 children and adolescents with VMs who were referred for treatment during a 10-month period. Our hypothesis was that the type of VM would determine whether low-risk sclerotherapy was indicated. RESULTS: Thirteen (30%) patients had a type-I VM, 16 (37%) had a type-II, 9 (21%) had a type-III, and 5 (12%) had a type-IV malformation. In more than 90% of patients with a type-I or type-II lesion, sclerotherapy could be performed without any problems. In one third of patients with a type-III VM, sclerotherapy had to be withheld and one of nine (11%) developed a severe complication after therapy. Of the five patients with type-IV lesions, three (60%) had to be excluded from sclerotherapy. CONCLUSIONS: Our initial results indicate that sclerotherapeutic intervention in patients with type-III and type-IV VMs must be carefully considered, while it can be safely performed in low-risk patients with type-I and type-II lesions.