ABSTRACT
Introdução: A trombose venosa cerebral constitui entidade clínica rara, respondendo por menos de 1% dos casos de AVC. Está associada a trombofilias hereditárias, infecções parameníngeas, traumatismos, além de vasculites, câncer e a própria quimioterapia. Relato do caso: Paciente de 59 anos com adenocarcinoma colônico sob quimioterapia com 5-Fluorouracil infusional (esquema de Gramont) associado a bevacizumabe apresentou quadro de tontura em desequilíbrio, déficit de força em membro inferior, cefaleia e convulsões, sendo constatada trombose venosa cerebral. Evoluiu com reversão total dos déficits neurológicos com anticoagulação. Conclusão: Enfatiza-se papel do câncer e da própria quimioterapia na etiopatogenia da trombose venosa cerebral em paciente sem aparente trombofilia hereditária e outros fatores tipicamente implicados na gênese desta rara condição.
ABSTRACT
Objective:The aim of this study was to evaluate the frequency and possible causes of anxiety in women undergoing mammography and verify the impact of prior information as a tool to reduce anxiety. Material and Methods: The sample consisted of female patients who underwent mammography at an oncology reference center in Brazil. Total sample was divided into two groups and only one group received an explanatory folder with information regarding the mammography and its follow-up. All patients received a questionnaire containing demographic and clinical data, questions about the mammographic exam and the State-Trait Anxiety Inventory (STAI). Results: Two hundred and seventy-four patients were included, aged between 21 and 89 years. Exam purpose was screening in 48.3%. Self-perception of anxiety was reported in 52.2% and most frequent causes of anxiety referred by patients were worry over results (35.3%) and fear of having pain or discomfort during the procedure (26.6%). The levels of anxiety according to the STAI were moderate or high on 52.6% on the state component, and 82.1% on the trait component. There was no statistically significant difference on anxiety levels according to any of the demographic or clinical variables, or between patients who received and did not receive the educational folder prior to the exam. Conclusion: Anxiety is a common feature of women undergoing mammography, mainly caused by fear of the results and lack of knowledge of the exam. According to the results of this and other studies, there was no impact on reducing levels of anxiety with information measures immediately before the exam.
Subject(s)
Humans , Female , Anxiety , Mammography , Breast Neoplasms/diagnosisABSTRACT
Biópsia percutânea dirigida por tomografia computadorizada tem sido amplamente utilizada como um procedimento efetivo e seguro para obtenção de diagnóstico histológico em muitas situações clínicas e em diversos órgãos. No pulmão, a biópsia percutânea tornou-se uma das principais escolhas para investigação de nódulos e massas. Sua versatilidade permite o acesso de lesões nas diversas localizações do pulmão, podendo ser utilizada para lesões periféricas e profundas mesmo de pequenas dimensões. Discutiremos as indicações, os aspectos técnicos do procedimento e os índices esperados de sucesso e complicação das biópsias percutâneas de nódulos e massas pulmonares.
Computed tomography-guided needle biopsy has been widely utilized as an effective and safe diagnostic procedure in many clinical settings. In the lungs, transthoracic needle biopsy has become one of the primary choices to investigate nodules and mass lesions. The procedure versatility allows access to either peripheral or central lesions at almost any site, even in cases of small nodules. In this article, indications, technical aspects of the procedure, expected success and complication rates of computed tomography-guided transthoracic needle biopsy of pulmonary nodules and masses are discussed.
Subject(s)
Humans , Biopsy, Needle/methods , Lung Neoplasms , Solitary Pulmonary Nodule/diagnosis , Lung/pathology , Solitary Pulmonary Nodule , Biopsy, Needle , Diagnostic Techniques and Procedures , Tomography, X-Ray ComputedABSTRACT
CONTEXT AND OBJECTIVE: Computed tomography (CT) guided biopsy is widely accepted as effective and safe for diagnosis in many settings. Accuracy depends on target organ and needle type. Cutting needles present advantages over fine needles. This study presents experience from CT guided biopsies performed at an oncology center. DESIGN AND SETTING: Retrospective study at Hospital do Câncer A. C. Camargo, São Paulo. METHODS: 1,300 consecutive CT guided biopsies performed between July 1994 and February 2000 were analyzed. Nodules or masses were suspected as primary malignancy in 845 cases (65 percent) or metastatic lesion in 455 (35 percent). 628 lesions were thoracic, 281 abdominal, 208 retroperitoneal, 134 musculoskeletal and 49 head/neck. All biopsies were performed by one radiologist or under his supervision: 765 (59 percent) with 22-gauge fine-needle/aspiration technique and 535 (41 percent) with automated 16 or 18-gauge cutting-needle biopsy. RESULTS: Adequate samples were obtained in 70-92 percent of fine-needle and 93-100 percent of cutting-needle biopsies. The specific diagnosis rates were 54-67 percent for fine-needle and 82-100 percent for cutting-needle biopsies, according to biopsy site. For any site, sample adequacy and specific diagnosis rate were always better for cutting-needle biopsy. Among 530 lung biopsies, there were 84 pneumothorax (16 percent) and two hemothorax (0.3 percent) cases, with thoracic drainage in 24 (4.9 percent). Among abdominal and retroperitoneal biopsies, there were two cases of major bleeding and one of peritonitis. CONCLUSION: Both types of needle showed satisfactory results, but cutting-needle biopsy should be used when specific diagnosis is desired without greater incidence of complications.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged, 80 and over , Biopsy, Fine-Needle/methods , Neoplasms/pathology , Tomography, X-Ray Computed , Needles , Retrospective Studies , Cancer Care Facilities/statistics & numerical data , Neoplasms , Radiography, Interventional/methodsABSTRACT
PURPOSE: To report the experience of a radiology department in the use of computed tomography - guided cutting needle biopsy of pulmonary nodules, by evaluating diagnostic yield and incidence of complications. METHODS: This is a retrospective analysis of 52 consecutive patients who underwent lung lesion biopsy guided by computed tomography, performed between May 1997 and May 2000. Thirty-five patients were male and 17 were female, with ages ranging from 5 to 85 years (median, 62 years). The size of the lesions ranged from 1.8 to 15 cm (median, 5.4 cm). RESULTS: In a total of 52 biopsies of lung lesions, 51 biopsies (98.1 percent) supplied appropriate material for histopathological diagnosis, with 9 diagnosed (17.3 percent) as benign and 42 (80.8 percent) as malignant lesions. Specific diagnosis was obtained in 44 (84.6 percent) biopsies: 4 benign (9.1 percent) and 40 (90.9 percent) malignant lesions. The sensitivity, specificity, and accuracy of the cutting needle biopsies for determining presence of malignancy were 96.8 percent, 100 percent, and 97.2 percent, respectively. Complications occurred in 9 cases (17.3 percent), including 6 cases (11.5 percent) of small pneumothorax, 1 (1.9 percent) of hemoptysis, 1 (1.9 percent) of pulmonary hematoma, and 1 (1.9 percent) of thoracic wall hematoma. All had spontaneous resolution. There were no complications requiring subsequent intervention. CONCLUSION: The high sensitivity and specificity of the method and the low rate of complications have established cutting needle biopsy as an efficient and safe tool for the diagnosis of lung lesions. In our hospital, cutting needle biopsy is considered a reliable procedure for the evaluation of indeterminate pulmonary nodules