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1.
Revista Digital de Postgrado ; 10(1): 262, abr. 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147578

ABSTRACT

El bloqueo del nervio peri prostático con lidocaína, proporciona un buen alivio del dolor en la realización de la biopsia prostática guiada por ultrasonido, pero el dolor post-procedimiento, puede llegar a ser significativo, la adición del supositorio de diclofenac, podría proporcionar alivio adicional. Se asignaron al azar pacientes en 2 grupos el grupo 1 bloqueo con lidocaína del plexo peri prostático + supositorio de diclofenac sódico y el grupo 2 bloqueo con lidocaína del plexo peri prostático + supositorio de placebo, realizando biopsia doble sextante, el dolor a varios intervalos después del procedimiento se registró en una escala visual análoga (EVA) de 0 a 10. Los 2 grupos fueron similares en cuanto a edad, volumen de próstata, antígeno prostático específico, diagnóstico histopatológico. Los pacientes que recibieron diclofenac tuvieron puntajes de dolor significativamente más bajos que los que recibieron placebo (2 frente a 3,35) p 0,02. La administración rectal de diclofenac antes de la realización de la biopsia de próstata es un procedimiento simple que alivia significativamente el dolor experimentado sin aumento en la morbilidad(AU)


The peri-prostatic nerve block with lidocaine, provides good pain relief in performing ultrasoundguided prostate biopsy, but the postprocedure pain can be significant, the addition of diclofenac suppository, could provide additional relief. Patients were randomly assigned in 2 groups to group 1 blockade with lidocaine of the prostatic peri plexus + suppository of diclofenac sodium and group 2 blockade with lidocaine of the prostatic peri plexus + placebo suppository, performing double sextant biopsy, pain at several intervals after the procedure was recorded on a visual analog scale (EVA) from 0 to 10. Thee 2 groups were similar in terms of age, prostate volume, prostate-specific antigen, histopathological diagnosis. Patients who received diclofenac had pain scores significantly lower than those who received placebo (2 vs. 3.35) p 0.02. Rectal administration of diclofenac before performing a prostate biopsy is a simple procedure that relieves significantly pain experienced without increased morbidity(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Prostate/pathology , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diclofenac/therapeutic use , Anesthetics, Local/therapeutic use , Lidocaine/therapeutic use , Nerve Block/methods , Placebos/therapeutic use , Prostate/diagnostic imaging , Administration, Rectal , Prospective Studies , Pain Management/methods , Image-Guided Biopsy , Anesthesia, Local
2.
Prensa méd. argent ; 107(2): 97-104, 20210000. fig, tab
Article in English | LILACS, BINACIS | ID: biblio-1361373

ABSTRACT

Objetivos: Evaluar la frecuencia y gravedad de la hemorragia parenquimatosa pulmonar tras la biopsia pulmonar con aguja transtorácica coaxial, según factores de procedimiento, aún no descritos en la literatura. El objetivo de este estudio fue determinar si la elección de la tecnología de biopsia coaxial, el posicionamiento del paciente y la dignidad de la lesión son tres nuevas variables que influyen en el riesgo de hemorragia parenquimatosa tras biopsias coaxiales de pulmón. Métodos: Se revisaron retrospectivamente los registros de 117 pacientes que se sometieron a biopsias con aguja transtorácica del pulmón entre enero de 2018 y abril de 2020. El resultado primario fue la hemorragia pulmonar. Se ha utilizado un sistema de clasificación para clasificar la hemorragia parenquimatosa pulmonar: Grado 0 - Grado 3. Se evaluaron tres variables novedosas relacionadas con el paciente, la técnica y la lesión como predictores de hemorragia pulmonar: tecnología de biopsia coaxial, posición del paciente y dignidad de la lesión. Resultados: De los 117 pacientes, 18 (15,4%) pacientes con tecnología de biopsia coaxial de corte, versus 29 (24,8%) pacientes con tecnología coaxial de núcleo completo mostraron hemorragia significativa en las exploraciones de control posteriores a la biopsia. (IC del 95% 0,06-0,33, p <0,0001). No hubo diferencias significativas en la hemorragia pulmonar entre el diagnóstico histológico benigno y maligno (IC 95% 0,84-4,44, p = 0,1199) y la posición del paciente en decúbito prono o supino (IC 95%: 0,57-2,57, p = 0,6232). Conclusiones: La incidencia y gravedad de la hemorragia pulmonar depende de la tecnología de biopsia coaxial utilizada; siendo mayor en pacientes sometidos a una biopsia con tecnología full-core y menor después del uso de tecnología de corte. En este estudio de pronóstico no se estableció una correlación significativa entre la hemorragia pulmonar parenquimatosa y la posición del paciente o la dignidad de la lesión


Objectives: To evaluate the frequency and severity of pulmonary parenchymal hemorrhage after coaxial transthoracic needle biopsy of the lung, according to procedural factors, not yet described in literature. The aim of this study was to determine whether the choice of the coaxial biopsy technology, patient positioning and the lesion dignity are three new variables influencing the risk of parenchymal hemorrhage after coaxial biopsies of the lung. Methods: Records from 117 patients who underwent transthoracic needle biopsies of the lung between January 2018 and April 2020 have been retrospectively reviewed. The primary outcome was pulmonary hemorrhage. A grading system has been used to classify pulmonary parenchymal hemorrhage: Grade 0 ­ Grade 3. Three novel patient, technique and lesion-related variables were evaluated as predictors of pulmonary hemorrhage: coaxial biopsy technology, patient positioning and lesion dignity. Results: Out of the 117 patients, 18 (15,4%) patients with cutting coaxial biopsy technology, versus 29 (24,8%) patients with full core coaxial technology showed significant hemorrhage on the post-biopsy control scans. (95% CI 0,06-0,33, p<0,0001). No significant difference in pulmonary hemorrhage between benign and malignant histological diagnosis (95% CI 0,84-4,44, p=0,1199) and prone or supine patient positioning (95% CI: 0,57-2,57, p= 0,6232) was found. Conclusions: The incidence and severity of pulmonary hemorrhage depends on the coaxial biopsy technology used; being higher in patients undergoing a biopsy with full-core technology and lower after the use of cutting technology. No significant correlation between parenchymal pulmonary hemorrhage and patient positioning or lesion dignity was established in this prognostic study.


Subject(s)
Humans , Prognosis , Tomography, X-Ray Computed , Retrospective Studies , Risk Factors , Lung Injury/therapy , Image-Guided Biopsy/methods , Hemorrhage/prevention & control , Supine Position
3.
Braz. j. med. biol. res ; 54(8): e11335, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285674

ABSTRACT

Stereotactic biopsies for lesions in the brainstem and deep brain are rare. This study aimed to summarize our 6-year experience in the accurate diagnosis of lesions in the brain stem and deep brain and to discuss the technical note and strategies. From December 2011 to January 2018, 72 cases of intracranial lesions in the brainstem or deep in the lobes undergoing stereotactic biopsy were retrospectively reviewed. An individualized puncture path was designed based on the lesion's location and the image characteristics. The most common biopsy targets were deep in the lobes (43 cases, 59.7%), including frontal lobe (33 cases, 45.8%), temporal lobe (4 cases, 5.6%), parietal lobe (3 cases, 4.2%), and occipital lobe (3 cases, 4.2 %). There were 12 cases (16.7%) of the brainstem, including 8 cases (11.1%) of midbrain, and 4 cases (5.6%) of pons or brachium pontis. Other targets included internal capsule (2 cases, 2.8%), thalamus (3 cases, 4.2%), and basal ganglion (12 cases, 16.7%). As for complications, one patient developed acute intracerebral hemorrhage in the biopsy area at 2 h post-operation, and one patient had delayed intracerebral hemorrhage at 7 days post-operation. The remaining patients recovered well after surgery. There was no surgery-related death. The CT-MRI-guided stereotactic biopsy of lesions in the brainstem or deep in the brain has the advantages of high safety, accurate diagnosis, and low incidence of complications. It plays a crucial role in the diagnosis of atypical, microscopic, diffuse, multiple, and refractory lesions.


Subject(s)
Humans , Brain/diagnostic imaging , Stereotaxic Techniques , Biopsy , Brain Stem/diagnostic imaging , Retrospective Studies , Image-Guided Biopsy
4.
Int. braz. j. urol ; 46(6): 993-1005, Nov.-Dec. 2020. tab
Article in English | LILACS | ID: biblio-1134264

ABSTRACT

ABSTRACT Purpose To investigate the course of anxiety and depression before and after transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and in the postoperative 1st month when the histopathological biopsy result was obtained. Methods In between June 2017- January 2019, 204 patients who underwent TRUS-Bx and completed the questionnaires assessing anxiety and depression were included in the study. Questionnaires were completed immediately before the biopsy, immediately after the biopsy and at the end of the first month when the histopathological biopsy results were given. State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS) and perceived stress scale (PSS) forms were used to assess anxiety and depression. After the histopathological examination patients were divided into two groups as patients without cancer (Group 1) and with cancer (Group 2). Data was compared between the groups. Results PSA level was negatively correlated with STAI TX-1 scores of the patients immediately after TRUS-Bx, whereas it was positively correlated with STAI TX-1 and TX-2 30 days after the TRUS-Bx. PSA level was positively correlated with HADS-A and HADS-D scores immediately before and 30 days after TRUS-Bx. Biopsy results showed a significant difference in 30 day post-biopsy related data. STAI TX-1, STAI TX-2, HADS-A, HADS-D and PSS scores were higher in Group 2 compared with Group 1. Conclusions Pre-biopsy anxiety disappeared after bx, but there was a significant increase in anxiety and depression in patients after the diagnosis of malignancy. Patients were seriously concerned about the diagnosis of prostate cancer.


Subject(s)
Humans , Male , Aged , Prostatic Neoplasms , Depression/etiology , Anxiety/etiology , Biopsy , Prospective Studies , Prostate-Specific Antigen , Ultrasonography, Interventional , Image-Guided Biopsy , Middle Aged
5.
Arq. bras. med. vet. zootec. (Online) ; 72(5): 1997-2001, Sept.-Oct. 2020. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1131557

ABSTRACT

A literatura atual discute múltiplas modalidades de imagem para acompanhar o processo de cicatrização da origem do ligamento suspensor do boleto (LSB) em equinos, mas nenhuma pode garantir que eles possuam fibras colágenas com calibre suficiente para suportar o retorno ao exercício. Já as técnicas morfológicas e bioquímicas, bem como a análise de birrefringência, podem ser mais apropriadas para caracterizar o processo de cicatrização e avaliar a eficiência do tratamento. O objetivo deste artigo é descrever procedimento simples que possibilita a coleta de amostras teciduais de boa qualidade e em sentido longitudinal, por biópsia em equinos em estação. Após antissepsia local, sedação e bloqueio do nervo palmar lateral no aspecto medial do osso acessório do carpo (OAC), o membro foi colocado em suspensão com o carpo flexionado em 90º; a agulha de biópsia guiada por ultrassom foi introduzida em sentido distoproximal, 11 a 13cm distal ao OAC, ângulo de 20º em relação ao LSB, até a região de sua origem. O equipamento foi disparado e coletou-se a amostra tecidual. Essa técnica possibilitou a coleta de fragmentos de boa qualidade para análise histológica e de birrefringência, sem reações adversas, podendo ser usada em modelos experimentais ou na prática clínica.(AU)


Subject(s)
Animals , Round Ligaments/diagnostic imaging , Horses , Image-Guided Biopsy/veterinary
6.
Int. braz. j. urol ; 46(2): 244-252, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090589

ABSTRACT

ABSTRACT Purpose To evaluate the usefulness of natural killer cell activity (NKA) in diagnosing prostate cancer (PC). Materials and Methods The medical records of patients who underwent transrectal prostate biopsy (TRBx) at Korea University Ansan Hospital between May 2017 and December 2017 were retrospectively reviewed. NKA levels were measured using NK Vue® Tubes (ATgen, Sungnam, Korea). All blood samples were obtained at 8 AM on the day of biopsy. Patients with other malignancies, chronic inflammatory conditions, high prostate-specific antigen (PSA) level (>20ng/mL), or history of taking 5-alpha-reductase inhibitor or testosterone replacement therapy were excluded. Results A total of 102 patients who underwent TRBx for PC diagnosis were enrolled. Among them, 50 were diagnosed with PC. Significant differences in age and NKA level were observed between the PC and no-PC groups. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off of NKA level for the prediction of PC was 500pg/dL, with a sensitivity of 68.0% and a specificity of 73.1%. In addition, NKA level (0.630) had the greatest area under the ROC curve compared to those for the ratio of total PSA to free PSA (0.597) and PSA density (0.578). Conclusions The results of this pilot study revealed that low NKA and high PSA levels were likely to be associated with a positive TRBx outcome. NKA detection was easy and improved the diagnostic accuracy of PC.


Subject(s)
Humans , Male , Aged , Prostatic Neoplasms/diagnosis , Killer Cells, Natural/metabolism , Prostate-Specific Antigen/blood , Prostatic Neoplasms , Prostatic Neoplasms/blood , Killer Cells, Natural/physiology , Biomarkers/metabolism , Biomarkers/blood , Pilot Projects , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Image-Guided Biopsy , Middle Aged
8.
Article in Chinese | WPRIM | ID: wpr-828176

ABSTRACT

This study aims to compare the prostate cancer detection rate between magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) cognitive fusion targeted biopsy and systematic biopsy. A total of 614 patients who underwent transrectal prostate biopsy during 2016-2018 with multiparametric magnetic resonance imaging (mpMRI) were included. All patients with a PI-RADS V2 score ≥ 3 accepted both targeted biopsy and systematic biopsy, and those with a PI-RADS V2 score ≤ 2 only accepted systematic biopsy. Overall prostate cancer detection rate between the two biopsies was compared. MRI-TRUS cognitive fusion targeted biopsy identified 342 cases (75.7%) of prostate cancer while systematic biopsy identified 358 cases (79.2%). There was no significant difference in the detection rate between the two groups ( = 1.621, = 0.203). Targeted biopsy had significant fewer biopsy cores compared with systematic biopsy, reducing (9.3 ± 0.11) cores ( < 0.001) in average. Targeted biopsy had about 10.8% ( < 0.001) more tumor tissues in positive cores compared with systematic biopsy. The results show that both MRI-TRUS cognitive fusion targeted biopsy and systematic biopsy have good detection rate on prostate cancer. Cognitive targeted biopsy may reduce biopsy cores and provide more tumor tissues in positive cores.


Subject(s)
Biopsy , Methods , Humans , Image-Guided Biopsy , Magnetic Resonance Imaging, Interventional , Male , Prospective Studies , Prostatic Neoplasms , Diagnostic Imaging , Ultrasonography, Interventional
9.
Article in English | WPRIM | ID: wpr-882125

ABSTRACT

@#OBJECTIVE: Transrectal ultrasound-guided prostate biopsy (TRUSPBx) is the recommended method for the histopathologic confirmation of prostate cancer. However, the overall cancer detection rate is low; hence, patients are potentially exposed to multiple biopsies and their attendant morbidity. Multiparametric MRI of the prostate followed by MRI-Ultrasound fusion-guided prostate biopsy (FBx) is an emerging diagnostic pathway that has been established and recommended in men with a persistently elevated PSA despite a previous negative biopsy. However, evidence regarding its value in the biopsy-naïve setting is scarce. The objective is to compare the diagnostic accuracy of MRI fusion-guided prostate biopsy against TRUSPBx in biopsy-naïve men. METHODS: This is a retrospective cohort study involving biopsy-naïve men with a PSA of 3 to 20 ng/ml. Primary outcomes of the study include overall cancer detection rate (CDR) and detection of clinically-significant prostate cancer (csPCa). Subgroup analyses were performed based on PSA level and prostate volume. Independent t-test, Mann Whitney U test and Chi square test were used in the statistical analysis. RESULTS: A total of 185 biopsy-naïve men with a PSA level of 3 – 20 ng/mL were included in the study. Median pre-biopsy PSA level was 7.07 ng/mL (5.06 – 11.0) and 9.02 ng/mL (5.8 – 13.8) in the FBx arm and TRUS-guided biopsy arm, respectively. Ninety-nine (n=99; 53%) underwent MP-MRI of the prostate followed by MRI fusion-guided prostate biopsy and eighty-six (n=86; 46%) underwent the standard TRUS-guided prostate biopsy. Compared to TRUSPBx, FBx significantly detected more prostate cancer (CDR: 68% vs 30%, p<0.0001) and csPCa (46% vs 22%, p=0.001). The diagnostic yield of FBx was distinctly superior in the subgroup of men with a PSA of 4 – 10 ng/mL (CDR: 64% vs 7%, p<0.0001; csPCa: 43% vs 2%, p<0.0001) and a prostate volume of <40grams (CDR: 82% vs 36%, p<0.0001; csPCa: 53% vs 21%, p=0.006). CONCLUSION: Compared to the current standard, the diagnostic yield of MRI fusion-guided prostate biopsy is significantly better in biopsy-naïve men. FBx detected more men with prostate cancer, with a higher proportion of men having clinically-significant disease. This advantage is strongly evident in men with a PSA level of 4 – 10 ng/mL and an average prostate volume of 40 grams. Hence, Multiparametric MRI of the prostate followed by MRI fusion-guided prostate biopsy is an effective first-line diagnostic modality for prostate cancer in men presenting with elevated PSA levels.


Subject(s)
Male , Image-Guided Biopsy , Prostatic Neoplasms
10.
Article in English | WPRIM | ID: wpr-810988

ABSTRACT

OBJECTIVE: To examine time trends in ultrasonography (US)-guided 14-gauge core needle biopsy (CNB) for breast lesions based on the lesion size, Breast Imaging-Reporting and Data System (BI-RADS) category, and pathologic findings.MATERIALS AND METHODS: We retrospectively reviewed consecutive US-guided 14-gauge CNBs performed from January 2005 to December 2016 at our institution. A total of 22,297 breast lesions were included. The total number of biopsies, tumor size (≤ 10 mm to > 40 mm), BI-RADS category (1 to 5), and pathologic findings (benign, high risk, ductal carcinoma in situ [DCIS], invasive cancer) were examined annually, and the malignancy rate was analyzed based on the BI-RADS category.RESULTS: Both the total number of US scans and US-guided CNBs increased while the proportion of US-guided CNBs to the total number of US scans decreased significantly. The number of biopsies classified based on the tumor size, BI-RADS category, and pathologic findings all increased over time, except for BI-RADS categories 1 or 2 and category 3 (odds ratio [OR] = 0.951 per year, 95% confidence interval [CI]: 0.902, 1.002 and odds ratio = 0.979, 95% CI: 0.970, 0.988, respectively). Both the unadjusted and adjusted total malignancy rates and the DCIS rate increased significantly over time. BI-RADS categories 4a, 4b, and 4c showed a significant increasing trend in the total malignancy rate and DCIS rate.CONCLUSION: The malignancy rate in the results of US-guided 14-gauge CNB for breast lesions increased as the total number of biopsies increased from 2005 to 2016. This trend persisted after adjusting for the BI-RADS category.


Subject(s)
Biopsy , Biopsy, Large-Core Needle , Breast Neoplasms , Breast , Carcinoma, Intraductal, Noninfiltrating , Image-Guided Biopsy , Information Systems , Odds Ratio , Retrospective Studies , Ultrasonography
11.
Einstein (Säo Paulo) ; 18: eAO4662, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056076

ABSTRACT

ABSTRACT Objective To assess accuracy of multiparametric magnetic resonance of the prostate to estimate gland volume, comparing the results with transrectal ultrasound and surgical specimen. Methods A retrospective study of 85 patients who underwent multiparametric magnetic resonance and transrectal ultrasound (for fusion image-guided biopsy) before radical prostatectomy. Prostate measurements were obtained from magnetic resonance axial and sagittal T2-weighted images and ultrasound; the prostate volume was determined using the ellipsoid formula. The results were compared with the surgical specimen weight. Maximum interval between multiparametric magnetic resonance imaging, transrectal ultrasound, and prostatectomy was 6 months. Results The prostate volume measured by multiparametric magnetic resonance imaging was 18-157cm3 (mean of 49.9cm3) and by transrectal ultrasound, 22-165cm3 (mean of 54.9cm3); the surgical specimen weight was 20-154g (mean of 48.6g), with no statistical differences. Based on the values obtained from imaging examinations, the prostate volume obtained was very close to the real prostatic weight, and the measures by multiparametric magnetic resonance were slightly more precise. Conclusion Prostate volume measured by multiparametric magnetic resonance imaging and transrectal ultrasound showed similar values, and excellent agreement with real prostate weight of the surgical specimens. Prostate volume measured by magnetic resonance has been increasingly used in the clinical practice, and its value enables appropriate therapeutic planning and control of patients.


RESUMO Objetivo Avaliar a acurácia da ressonância magnética multiparamétrica da próstata para estimativa do volume da glândula, comparando seus resultados com a ultrassonografia transretal e correlacionando com o volume obtido da peça cirúrgica. Métodos Estudo retrospectivo incluindo 85 pacientes submetidos à ressonância magnética e, posteriormente, à ultrassonografia transretal (para orientação de biópsia com fusão de imagens) e, a seguir, à prostatectomia radical. As dimensões prostáticas foram obtidas na ressonância a partir das imagens nos planos axial e sagital em sequências ponderadas em T2 e, assim como na ultrassonografia, o volume foi calculado a partir do método da elipsoide. Os valores foram comparados com o peso prostático pós-cirúrgico. O intervalo máximo entre a ressonância e ultrassonografia e prostatectomia foi de 6 meses. Resultados O volume prostático obtido por ressonância magnética foi de 18 a 157cm3(média de 49,9cm3); pela ultrassonografia transretal, foi de 22 a 165cm3(média de 54,9cm3); e o peso da peça cirúrgica foi de 20 a 154g (média de 48,6g), sem diferenças estatísticas. A partir do valor obtido por esses métodos de imagem, provou-se que o volume prostático obtido aproximou-se bastante do peso real da próstata, com discreta maior precisão das medidas obtidas por ressonância magnética multiparamétrica. Conclusão As medidas do volume prostático adquiridas pela ressonância magnética e pela ultrassonografia transretal são semelhantes entre si, com excelente concordância com os pesos reais das próstatas obtidos das peças cirúrgicas. A avaliação desse dado, a partir da ressonância, método cada vez mais utilizado na prática clínica, permite o adequado planejamento terapêutico e o controle dos pacientes.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Prostate/anatomy & histology , Prostatic Neoplasms/diagnostic imaging , Ultrasonography/methods , Multiparametric Magnetic Resonance Imaging/methods , Organ Size , Prostate/diagnostic imaging , Prostatectomy , Prostatic Neoplasms/pathology , Retrospective Studies , Image-Guided Biopsy/methods , Dimensional Measurement Accuracy , Middle Aged
12.
Rev. bras. anestesiol ; 69(6): 622-625, nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1057467

ABSTRACT

Abstract Background: Sepsis is a life-threatening organ dysfunction with non-specific clinical features that can mimic other clinical conditions with hyper metabolic state such as malignant hyperthermia. Perioperatively anesthesia providers come across such scenarios, which are extremely challenging with the need for urgent intervention. Objective: To illustrate the need for early intervention and consultation for added assistance to approach and rule out malignant hyperthermia and other possible causes during such a scenario. Case report: A 63-year-old male underwent an uneventful elective flexible cystoscopy and transrectal ultrasound-guided prostate biopsy. Postoperatively he developed symptoms raising suspicion for malignant hyperthermia. Immediately malignant hyperthermia protocol was initiated that included administration of dantrolene and consultation of malignant hyperthermia association hotline along with other diagnostic and interventional management aimed at patient optimization. While early administration of dantrolene helped in hemodynamically stabilizing the patient, the consultation with other providers and malignant hyperthermia association hotline along with repeated examinations and lab works helped in ruling out malignant hyperthermia as the possible diagnosis. The patient later recovered in the intensive care unit where he was treated for the bacteremia that grew in his blood cultures. Conclusions: Sepsis shares clinical symptoms that mimic malignant hyperthermia. While sepsis rapidly progresses to secondary injuries, malignant hyperthermia is life threatening. Providing ideal care requires good clinical judgment and a high level of suspicion where timely and appropriate care such as early administration of dantrolene and consultation of malignant hyperthermia association hotline for added assistance can influence positive outcomes.


Resumo Justificativa: A sepse é uma disfunção orgânica fatal com características clínicas inespecíficas que podem imitar outras condições clínicas com quadro hipermetabólico, como a hipertermia maligna. Os cenários são extremamente desafiadores para a anestesia perioperatória e requerem intervenção urgente. Objetivo: Ilustrar a necessidade de intervenção e consulta precoces para uma assistência adicional na abordagem e exclusão de hipertermia maligna e outras possíveis causas durante tal cenário. Relato de caso: Paciente do sexo masculino, 63 anos, submetido à cistoscopia eletiva com cistoscópio flexível e biópsia transretal da próstata guiada por ultrassom sem intercorrências. No pós-operatório, o paciente desenvolveu sintomas que levantaram a suspeita de hipertermia maligna. O protocolo de hipertermia maligna foi imediatamente iniciado, inclusive a administração de dantrolene e uma consulta pela linha direta da associação de hipertermia maligna, juntamente com outros diagnósticos e manejos intervencionistas com vistas ao aprimoramento do paciente. Enquanto a administração precoce de dantrolene ajudou na estabilização hemodinâmica do paciente, a consulta com outros anestesistas e com a Associação de Hipertermia Maligna, juntamente com repetidos exames físicos e laboratoriais, ajudou a excluir a hipertermia maligna como o possível diagnóstico. O paciente recuperou-se mais tarde na unidade de terapia intensiva, onde recebeu tratamento para a bacteremia detectada em suas hemoculturas. Conclusões: A sepse compartilha sintomas clínicos que mimetizam a hipertermia maligna. Enquanto a sepse progride rapidamente para lesões secundárias, a hipertermia maligna é uma ameaça à vida. Proporcionar o tratamento ideal requer um bom julgamento clínico e um alto nível de suspeita quanto aos cuidados oportunos e apropriados, como a administração precoce de dantrolene e a consulta pela linha direta da Associação de Hipertermia Maligna para assistência adicional, que podem resultar em desfechos positivos.


Subject(s)
Humans , Male , Postoperative Complications/diagnosis , Sepsis/diagnosis , Malignant Hyperthermia/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Time Factors , Acute Disease , Sepsis/physiopathology , Sepsis/therapy , Cystoscopy/methods , Dantrolene/administration & dosage , Image-Guided Biopsy/methods , Malignant Hyperthermia/physiopathology , Middle Aged
14.
Rev. méd. Chile ; 147(10): 1266-1272, oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058593

ABSTRACT

Background: CT-guided core biopsy is a widely used diagnostic technique for retroperitoneal lesions. Aim: To evaluate the diagnostic yield and safety of this procedure. Material and Methods: Review of medical records of 136 patients aged 57 ± 16 years (55% males) subjected to core biopsies performed between 2006 and 2016. Procedure images, biopsy reports and patients' medical charts were reviewed. Diagnostic yield was calculated in those patients whose final diagnosis was confirmed using strict criteria for malignancy. Results: A final diagnosis was confirmed in 122/136 patients. Of these, 110 had malignant lesions. The sensitivity and global accuracy of the procedure for malignancy were 93%. In only 4 of 13 benign lesions (31%), a specific diagnosis was obtained with the biopsy. Only minor complications were reported (6 small, self-contained hematomas). There were no major complications. Conclusions: CT-guided core biopsy of retroperitoneal lesions is a safe procedure, with an excellent diagnostic yield.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Retroperitoneal Neoplasms/pathology , Tomography, X-Ray Computed/methods , Image-Guided Biopsy/methods , Retroperitoneal Neoplasms/diagnosis , Retroperitoneal Space/pathology , Radiography, Interventional/methods , Chile , Cross-Sectional Studies , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Statistics, Nonparametric , Biopsy, Large-Core Needle/methods
15.
J. bras. nefrol ; 41(3): 423-426, July-Sept. 2019. graf
Article in English | LILACS | ID: biblio-1040256

ABSTRACT

ABSTRACT Introduction: Vascular access and renal biopsy are common procedures in nephrology. In this study, two artisanal simulators of very low cost and excelent image quality are (prented) presented to guide, by ultrasound, the venous access and renal biopsy. Methods: The simulators are constructed using chicken breast slices, Penrose drain, plastic milk shake straw and pig kidney. Results: Both simulators enable immediate identification of the anatomical structures of interest, vessels and kidney, and enable spatial orientation and hand-eye coordination, essential for the development of the necessary skills to safely carry out invasive procedures. Conclusion: The simulators described, were extremely useful for simulating venous access and renal biopsy guided by ultrasonography, enabling training to reduce the failure rate in punctures and the potential complications associated with the described procedures.


RESUMO Introdução: O acesso vascular e a biópsia renal são procedimentos comuns na prática nefrológica. Neste estudo, são apresentados dois simuladores artesanais de baixo custo e excelente qualidade de imagem para guiar, ultrassonograficamente, o acesso venoso e a biópsia renal. Métodos: Os simuladores são construídos utilizando fatias de peito de frango, dreno de Penrose, canudo plástico milk shake e rim de porco. Resultados: Ambos os simuladores permitem a identificação imediata das estruturas anatômicas de interesse, vasos e rim, e possibilitam a orientação espacial e coordenação olho-mão, essenciais para o desenvolvimento das habilidades necessárias para realizar seguramente procedimentos invasivos. Conclusão: Os simuladores descritos, extremamente úteis para as simulações do acesso venoso e a biópsia renal guiados por ultrassonografia, possibilitam o treinamento objetivando a redução do insucesso das punções e das complicações potenciais associadas aos procedimentos descritos.


Subject(s)
Animals , Ultrasonography/methods , Simulation Training/methods , Nephrologists/education , Kidney/pathology , Nephrology/education , Swine , Blood Vessels , Punctures , Chickens , Clinical Competence , Muscle, Skeletal , Image-Guided Biopsy
16.
Int. braz. j. urol ; 45(4): 724-731, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019880

ABSTRACT

ABSTRACT Objectives To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. Materials and Methods In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). Results Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. Conclusions Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.


Subject(s)
Humans , Male , Aged , Prostatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Prostatic Neoplasms/pathology , Reference Values , Brazil , Logistic Models , Observer Variation , Reproducibility of Results , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Prostate-Specific Antigen/blood , Statistics, Nonparametric , Risk Assessment , Neoplasm Grading , Image-Guided Biopsy/methods , Middle Aged
17.
Int. braz. j. urol ; 45(4): 713-723, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019891

ABSTRACT

ABSTRACT Purpose To determine if PSAD, PSADtz, and ADC values improve the accuracy of PI-RADS v2 and identify men whose concurrent systematic biopsy detects clinically significant cancer on areas without mpMRI visible lesions. Materials and methods Single reference-center, cross-sectional, retrospective study of consecutive men with suspected or known low to intermediate-risk prostate cancer who underwent 3T mpMRI and TRUS-MRI fusion biopsy from 07/15/2014 to 02/17/2018. Cluster-corrected logistic regression analyses were utilized to predict clinically significant prostate cancer (Gleason score ≥3+4) at targeted mpMRI lesions and on systematic biopsy. Results 538 men (median age=66 years, median PSA=7.0ng/mL) with 780mpMRI lesions were included. Clinically significant disease was diagnosed in 371 men. PI-RADS v2 scores of 3, 4, and 5 were clinically significant cancer in 8.0% (16/201), 22.8% (90/395), and 59.2% (109/184). ADC values, PSAD, and PI-RADS v2 scores were independent predictors of clinically significant cancer in targeted lesions (OR 2.25-8.78; P values <0.05; AUROC 0.84, 95% CI 0.81-0.87). Increases in PSAD were also associated with upgrade on systematic biopsy (OR 2.39-2.48; P values <0.05; AUROC 0.69, 95% CI 0.64-0.73). Conclusions ADC values and PSAD improve characterization of PI-RADS v2 score 4 or 5 lesions. Upgraded on systematic biopsy is slightly more likely with PSAD ≥0.15 and multiple small PI-RADS v2 score 3 or 4 lesions.


Subject(s)
Humans , Male , Aged , Prostatic Neoplasms/diagnosis , Prostate-Specific Antigen/blood , Prostatic Neoplasms/pathology , Prostatic Neoplasms/blood , Reference Values , Magnetic Resonance Imaging/methods , Logistic Models , Cross-Sectional Studies , Multivariate Analysis , Predictive Value of Tests , Retrospective Studies , ROC Curve , Neoplasm Grading , Image-Guided Biopsy , Middle Aged
19.
Int. braz. j. urol ; 45(3): 486-494, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012318

ABSTRACT

ABSTRACT Objectives: To identify the group of patients who could safely avoid prostate biopsy based on the findings of multiparametric prostate resonance imaging (MRmp), parameterized with PI-RADS v2, using prostate biopsy as reference test and to assess the sensitivity and specificity of mpMR in identifying clinically significant prostate cancer using prostate biopsy as a reference test. Patients and Methods: Three hundred and forty two patients with suspected prostate cancer were evaluated with mpMR and prostate biopsy. Agreement between imaging findings and histopathological findings was assessed using the Kappa index. The accuracy of mpMR in relation to biopsy was assessed by calculations of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 342 biopsies were performed. In 201 (61.4%), mpMR had a negative result for cancer, which was confirmed on biopsy in 182 (53%) of the cases, 17 (4.9%) presented non-clinically significant cancer and only 2 (0.5%) clinically significant cancer. 131 (38.3%) patients had a positive biopsy. Clinically significant cancer corresponded to 83 (34.2%), of which 81 (97.5%) had a positive result in mpMR. Considering only the clinically significant cancers the mpMR had a sensitivity of 97.6%, specificity of 76.8%, PPV 57.4% and VPN of 99%. Conclusions: mpMR is a useful tool to safely identify which patients at risk for prostate cancer need to undergo biopsy and has high sensitivity and specificity in identifying clinically significant prostate cancer.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Prostate/pathology , Prostate/diagnostic imaging , Prostatic Neoplasms/pathology , Prostatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Image-Guided Biopsy/methods , Reference Standards , Reproducibility of Results , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Neoplasm Grading , Middle Aged
20.
Chinese Journal of Surgery ; (12): 404-407, 2019.
Article in Chinese | WPRIM | ID: wpr-772324

ABSTRACT

With the advancement of clinical concepts and techniques in diagnosis and treatment of breast diseases, pathological evaluation of breast lesions and regional lymph nodes using tissue biopsy has been widely recognized in clinical practice. In order to standardize biopsy techniques of breast lesions and lymph nodes guided by ultrasound in application, Chinese Association of Breast Surgery organized domestic experts going into deep discussion, reiterating indications and contraindications in clinical operation and finally pointing out concrete suggestions on the operation guidelines.


Subject(s)
Axilla , Diagnostic Imaging , Pathology , Breast Neoplasms , Diagnostic Imaging , Pathology , General Surgery , Consensus , Female , Humans , Image-Guided Biopsy , Lymph Nodes , Diagnostic Imaging , Pathology , Lymphatic Metastasis , Practice Guidelines as Topic , Sensitivity and Specificity , Ultrasonography
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