ABSTRACT
INTRODUCTION: The pathological status of obesity can influence COVID-19 from its initial clinical presentation, therefore, the identification of clinical and laboratory parameters most affected in the presence of obesity can contribute to improving the treatment of the disease. OBJECTIVE: To identify the clinical, laboratory, and tomographic characteristics associated with obesity and BMI at t hospital admission in adult patients with COVID-19. METHODS: This is a cross-sectional observational study with a total of 315 participants with COVID-19 confirmed by rt-PCR. The participants were divided into non-Obese (n=203) and Obese (n=112). Physical examinations, laboratory tests, and computed tomography of the chest were performed during the first 2 days of hospitalization. RESULTS: Patients with obesity were younger, and they had higher systolic and diastolic blood pressure, higher frequency of alcoholism, fever, cough, and headache, higher ALT, LDH, and red blood cell count (RBC), hemoglobin, hematocrit, and percentage of lymphocytes. Also, they presented a lower value of leukocyte count and Neutrophil/Lymphocyte Ratio (RNL). The parameters positively correlated with BMI were alcoholism, systolic and diastolic blood pressure, fever, cough, sore throat, number of symptoms, ALT in men, LDH, magnesium, RBC, hemoglobin, hematocrit, and percentage of lymphocytes. The parameters negatively correlated with the BMI were: age and RNL. CONCLUSION: Several parameters were associated with obesity at hospital admission, revealing better than expected results. However, these results should be interpreted with great caution, as there may be some influence of a phenomenon called the Obesity Paradox that can distort the severity and prognosis of the patient.
Subject(s)
Humans , Male , Female , Adult , Patient Admission , Tomography , Biomarkers , Body Mass Index , Clinical Laboratory Techniques , COVID-19 , Obesity , Cross-Sectional StudiesABSTRACT
La tuberculose est une des maladies infectieuses les plus répandues dans le monde .Elle représente un problème de santé publique majeur dans les pays en voie de développe ment, y compris l'Algérie . À l'échelle mondiale et parmi tous les cas de tuberculose, l'OMS rapporte 14 % de tuberculose extra-pulmonaire (TEP) sans atteinte pulmonaire concomitante. Dans notre pays et durant ces dernières années, une recrudescence de la tuberculose extrapulmonaire a été observée. L'objectif de cet article était de présenter un cas atypique de tuberculose cérébrale dont le diagnostic a été tardif, posé par l'examen anatomopathologique avec une revue de la littérature. C'est le cas d'une jeune patiente hospitalisée dans le cadre de l'urgence pour un syn drome d'hypertension intracrânienne avec troubles neurologiques. La tomodensitomé trie cérébrale a objectivé de multiples localisations cérébrales avec une hydrocéphalie active. Le bilan d'extension était sans anomalie. La patiente avait bénéficié d'une inter vention chirurgicale, les suites opératoires ont été favorables. L'examen anatomo-pa thologique était en faveur d'une lésion inflammatoire spécifique granulomateuse faite de larges plages de nécrose caséeuse. La patiente a répondu au traitement antituber culeux. Le problème diagnosticque et les résultats seront discutés avec une revue de la littéra ture. La tuberculose cérébrale est une forme rare de la tuberculose extra-pulmonaire. Le tableau clinique ainsi que la neuro-imagerie (TDM, IRM) sont atypiques. Le diagnostic était postopératoire, reposant sur l'examen anatomopathologique. Le pronostic dépend de la précocité du diagnostic, du siège de la lésion et de la réponse au traitement antituberculeux.
Tuberculosis is one of the most widespread infectious diseases in the world. It constitutes a major public health problem, especially in developing countries, including Algeria. Globally and among all tuberculosis cases, WHO reports 14% extra-pulmonary tuberculosis (EPT) without concomitant pulmonary involvement. In our country and in recent years, an upsurge in extrapulmonary tuberculosis has been observed. The objective of this article was to present an atypical case of cerebral tuberculosis whose diagnosis was late, made by anatomopathological examination with a review of the literature. We report the case of a young patient hospitalized in emergency for an intracranial hypertension syndrome with neurological disorders. Cerebral computed tomography revealed multiple brain locations with active hydrocephalus. The extension assessment was without anomaly. The patient underwent a surgical intervention, the operative consequences were favorable. The pathological examination was in favor of a specific inflammatory granulomatous lesion made up of large areas of caseous necrosis. The patient was cured under anti-tuberculosis treatment. The diagnostic problem and the results will be discussed with a review of the literature. Cerebral tuberculosis is a rare form of extrapulmonary tuberculosis. The clinic as well as the neuroimaging (CT, MRI) are atypical. The diagnosis is postoperative, based on the pathological examination. The prognosis depends on the early diagnosis, the site of the lesion and the response to anti-tuberculosis treatment.
Subject(s)
Surgical Procedures, Operative , Tuberculosis , Tomography , Intracranial Hypertension , Tuberculosis, Central Nervous System , Neurologic Manifestations , Therapeutics , DiagnosisABSTRACT
The Canalis Sinuosus is a structure of the maxilla that allows the passage of the anterosuperior alveolar nerve and has a neurovascular activity. To visualize this structure, Conical Beam Computed Tomography (CBCT) is best recommended. This article aimed to report a case of facial pain after the insertion of a dental implant due to compression of the Canalis Sinuosus. Thus, the implant was removed, followed by the insertion of a bone graft. After that, the facial pain stopped. In conclusion, the identification of anatomical structures in preoperative examinations is essential in surgical dental procedures.
O Canalis Sinuosus é uma estrutura da maxila, que permite a passagem do nervo alveolar anterosuperior e tem uma atividade neurovascular. Para visualizar essa estrutura, a Tomografia Computadorizada de Feixe Cônico (TCFC) é melhor recomendada. Este artigo teve como objetivo relatar um caso de dor facial após a inserção de um implante dentário, devido à compressão do Canalis Sinuosus. Assim, o implante foi removido, seguido pela inserção de um enxerto ósseo. Depois disso, a dor facial foi interrompida. Em conclusão, a identificação de estruturas anatômicas em exames pré-operatórios é essencial em procedimentos odontológicos cirúrgicos.
Subject(s)
Dental Implants , Facial Pain , Tomography , Cone-Beam Computed Tomography , MaxillaABSTRACT
El sarcoma de ewing es un tumor maligno de rápido crecimiento, con prevalencia de 1-5 casos por cada 1.000.000 habitantes, su forma extraesquelética en la cavidad sinonasal o senos paranasales es inusual. Objetivo: describir la localización atípica de esta neoplasia y la importancia de lograr un diagnóstico oportuno. Paciente femenina, con una masa en la cavidad nasal derecha de dos meses de evolución, cefalea y epistaxis. Con asimetría en región orbitaria derecha y deformidad del tabique nasal, senos paranasales con sintomas de obstrucción. La tomografía reveló una masa que invade senos paranasales. La biopsia mostró un sarcoma de Ewing. Se confirmó con CD99. La paciente recibió quimioterapia y plan de resección quirúrgica, pero falleció. El diagnóstico y tratamiento oportuno del sarcoma de ewing en cavidad sinonasal debe apoyarse con examenes tomográficos, histopatológicos, inmunohistoquímicos y de ser posible citogenéticos para llegar al diagnóstico definitivo en etapas tempranas del tumor
Ewing's sarcoma is a rapidly growing malignant tumor, with a prevalence of 1-5 cases per 1,000,000 inhabitants, its extraskeletal shape in the sinonasal cavity or paranasal sinuses is unusual. Objective: to describe the atypical location of this neoplasm and the importance of achieving a timely diagnosis. Female patient, with a mass in the right nasal cavity of two months of evolution, headache and epistaxis. With asymmetry in the right orbital region and deformity of the nasal septum, paranasal sinuses with symptoms of obstruction. Tomography revealed a mass that invades the paranasal sinuses. The biopsy showed Ewing's sarcoma. It was confirmed with CD99. The patient received chemotherapy and a surgical resection plan, however she died. The timely diagnosis and treatment of Ewing's sarcoma in the sinonasal cavity should not be based solely on clinical evaluation, it requires a tomographic, histopathological, immunohistochemical and, if possible, cytogenetic examination to reach a definitive diagnosis in the early stages of the tumor.
Subject(s)
Female , Child , Epistaxis , Biopsy , Tomography , Drug TherapyABSTRACT
El nuevo virus del SARS-CoV-2 y su enfermedadCOVID-19 ha representado un desafío para los clínicos,afectando distintos órganos y sistemas. Aunque la gravedadde la infección viene determinada sobre todo por la apariciónde neumonía grave y dificultad respiratoria aguda, se handescrito otras afectaciones en distintos aparatos y sistemas,como la sintomatología gastrointestinal, pancreática y biliar. Elcompromiso pancreático está poco descrito, con escasos reportesen la literatura a nivel mundial, siendo registrado actualmenteen más de 20 países. En este documento, se presenta un casode pancreatitis aguda donde se destaca la nueva posibilidad deasociación al COVID-19. Se trata de paciente de 17 años, desexo femenino, con antecedente de un puerperio tardío, sinhaber tenido contacto con personas confirmadas o sospechosasde COVID-19, ni viajes al extranjero. En vista de la evolucióntórpida de la paciente, se realiza tomografía axial computarizadade abdomen y pelvis donde se reportan los siguientes hallazgos:liquido peri pancreática, vesícula distendida con liquido perivesicular, liquido libre en fondo de saco e interesas. Al realizarlaparotomía exploradora se evidencia necrosis pancreática conlicuefacción en toda su extensión con esteato necrosis en epiplónmayor. Posterior al tratamiento, la paciente evolucionó afebril,con mejoría de la tolerancia oral, sin dolor abdominal, consintomatología respiratoria leve, sin requerir oxígeno en ningúnmomento, completando un total de 21 días de antibioticoterapiaempírica biasociada(AU)
e new SARS-CoV-2 virus and its diseaseCOVID-19 have posed a challenge to clinicians, affectingdifferent organs and systems. Although the severity of theinfection is mainly determined by the occurrence of severepneumonia and acute respiratory distress, other involvementin different organs and systems has been described, suchas gastrointestinal, pancreatic and biliary symptomatology.Pancreatic involvement is poorly described, with few reportsin the literature worldwide, being currently registered in morethan 20 countries. In this paper, a case of acute pancreatitisis presented, highlighting the new possibility of associationto COVID-19. îe patient is 17 years old, female, with ahistory of a late puerperium, without having had contact withpeople confirmed or suspected of having COVID-19, or travel abroad. In view of the patient's torpid evolution, a computedaxial tomography of the abdomen and pelvis was performed,where the following findings were reported: peri pancreaticfluid, distended gallbladder with peri vesicular fluid, free fluid inthe cul-de-sac and interstitium. On performing an exploratorylaparotomy, pancreatic necrosis with liquefaction in all itsextension with steato necrosis in the greater omentum wasevidenced. Aîer treatment, the patient evolved afebrile, withimproved oral tolerance, without abdominal pain, with mildrespiratory symptoms, without requiring oxygen at any time,completing a total of 21 days of empirical antibiotic therapy(AU)
Subject(s)
Female , Adolescent , Pancreatitis , SARS-CoV-2 , COVID-19 , Tomography , Abdominal Pain , Gallbladder , Anti-Bacterial AgentsABSTRACT
Paciente femenina de 72 años. Mediante estudios de imagen (ultrasonido y tomografía), se le identificó lesión en parénquima hepático, anexo derecho, peritoneo y apéndice cecal, y mediante estudio histopatológico se determinó la presencia concomitante de carcinoma hepatocelular de células claras, tumor mucinoso limítrofe de bajo potencial maligno o borderline, pseudomixoma peritoneal y neoplasia mucinosa de bajo grado del apéndice cecal, respectivamente. Debido a que las neoplasias reportadas no guardan relación con el mismo órgano ni con el sistema, se considera que son neoplasias aparecidas al azar y de tipo sincrónico por ser diagnosticadas en el mismo espacio temporal. Se practicó laparotomía exploradora con exéresis de lesión anexial y de apéndice cecal. La lesión hepática recibió quimioembilización transarte rial por radiología intervencionista. Posterior a la intervención quirúrgica, la paciente presenta buen estado general. En seguimiento con resonancia magnética se cataloga con persistencia de lesión hepática ya tratada, por lo tanto, con enfermedad estable; se refiere a oncología clínica para valoración de quimioterapia en el manejo del pseudomixoma peritoneal. Dieciocho meses después de los diagnósticos iniciales, se documenta carcinoma basocelular y se cataloga como neoplasia metacrónica por la diferencia de tiempo entre los diagnósticos
A 72-year-old female patient with a one-year history of abdominal pain in the right upper quadrant, colicky, radiating to the back, accompanied by adynamia and weight loss. Abdominal distension and a painful mass on palpation in the right hypochondrium were evidenced. Imaging studies identified different lesions in the hepatic parenchyma, right adnexa, peritoneum and cecal appendix. The histopathological study described the presence of clear cell hepatocellular carcinoma, borderline mucinous tumor of low malignant potential or borderline, peritoneal pseudomyxoma and low-grade mucinous neoplasm of the cecal appendix respectively, as synchronous neoplasms. An exploratory laparotomy was performed with excision of the adnexal lesion and the cecal appendix. The hepatic lesion received transarterial chemoembilization by interventional radiology. Follow-up with conservative management by clinical oncology was indicated. The patient evolved with good general condition, in the follow-up with magnetic resonance imaging was classified with persistence of stable hepatic lesion. Eighteen months after the diagnosis of synchronous neoplasms, basal cell carcinoma was identified, due to the difference in the time of diagnosis this is considered a metachronous neoplasm
Subject(s)
Carcinoma, Basal Cell , Neoplasms, Second Primary , Neoplasms , Ultrasonics , Tomography , El Salvador , Medical OncologyABSTRACT
La celulitis orbitaria representa una causa frecuente de inflamación de la órbita, constituyendo una urgencia médica que requiere un manejo multidisciplinario. Se presenta caso de una recién nacida con clínica de aumento de volumen en región bipalpebral derecha y fiebre de 24 horas de evolución. Al examen físico se evidencia proptosis de ojo derecho, aumento de volumen bipalpebral que impide la apertura del globo ocular en su totalidad con signos de flogosis y secreción purulenta en borde palpebral. Los laboratorios reportan leucocitosis y trombocitosis reactiva; tomografía de orbita muestra tumefacción y edema periorbitario derecho, aumento difuso de densidad grasa post-septal extra e intraconal, hallazgos sugestivos de celulitis orbitaria derecha. Se indica antibioticoterapia con vancomicina y cefotaxime, ameritando además drenaje de absceso, obteniéndose secreción purulenta, en la que se aísla Estafilococo aureus meticilino resistente. Siendo una patología inusual en este grupo etario, se recomienda la publicación de este caso(AU)
Orbital cellulitis represents a frequent cause of inflammation of the orbit, constituting a medical emergency that requires multidisciplinary management. We present a case of a newborn with clinic of volume increase in right bipalpebral region and fever of 24 hours of evolution. Physical examination reveals proptosis of right eye, increase of bipalpebral volume that prevents the opening of the eyeball in its entirety with signs of flushing and purulent eyelid margin secretion. Laboratories report leukocytosis and reactive thrombosis; orbital tomography scan shows right periorbital swelling and edema, diffuse increase of extra and intraconal post-septal fat density, suggestive findings of right orbital cellulitis, covered with vancomycin and cefotaxime; subsequently requires abscess drainage where Staphylococcus aureus methycilin- resistant is isolated. Being an unusual pathology in this age group, the publication of this case is recommended(AU)
Subject(s)
Humans , Female , Infant, Newborn , Infant, Newborn , Emergencies , Orbital Cellulitis , Physical Examination , Signs and Symptoms , Tomography , Drainage , Abscess , LaboratoriesSubject(s)
Humans , Male , Child , Pain/etiology , Hip Joint/diagnostic imaging , Neuroblastoma/diagnosis , Neuroblastoma/therapy , Tomography , Diagnosis, DifferentialABSTRACT
Abstract Objectives Glenoid component failure is the main cause of total shoulder arthroplasty (TSA) revision, and component design seems to influence the failure rate. The aim of the present study was to clinically and radiographically (through X-rays and computed tomography scan) evaluate the results of TSA using a minimally cemented glenoid component. Methods Total should arthroplasties performed using the minimally cemented Anchor Peg (DuPuy Synthes, Warsaw, IN, USA) glenoid component between 2008 and 2013 were evaluated. University of California at Los Angeles (UCLA) scores were calculated, and standardized plain film and computed tomography images were obtained, at a minimum follow-up of 24 months. The presence of bone between the fins of the central component peg, which indicates its integration, was assessed on the images, as well the presence of radiolucent lines around the glenoid component. Results Nineteen shoulders in 17 patients were available for evaluation. According to the UCLA score, clinical results were satisfactory in 74% of cases and fair in 21% of cases. One patient had a poor result. Component integration was found in 58% of patients (total in 42% and partial in 16%). Radiolucent lines were observed in 52% of cases. No relationship was detected between component integration and clinical results. Conclusion Satisfactory clinical results were achieved in most patients undergoing TSA using a minimally cemented glenoid component. Radiolucent lines around the glenoid component are common, but do not interfere with the clinical results. Level of evidence IV; Case series; Treatment study.
Resumo Objetivos A falha do componente glenoidal é a principal causa de revisão da artroplastia total do ombro (ATO) e sua frequência parece ser influenciada pelo design do componente. O objetivo deste estudo foi a avaliação clínica e radiográfica (através de raios X e tomografia computadorizada) dos resultados da ATO com componente glenoidal minimamente cimentado. Métodos O presente trabalho analisou ATOs realizadas com componente glenoidal Anchor Peg (DuPuy Synthes, Warsaw, IN, EUA) minimamente cimentado entre 2008 e 2013. Por um período mínimo de acompanhamento de 24 meses, escores segundo critérios da University of California at Los Angeles (UCLA) e imagens padronizadas de radiografia simples e tomografia computadorizada foram analisadas. A presença de osso entre as aletas do pino do componente central, que é um indicador de sua integração, foi avaliada nas imagens, bem como a presença de linhas radiotransparentes ao redor do componente glenoidal. Resultados Dezenove ombros de 17 pacientes foram avaliados. De acordo com o escore da UCLA, os resultados clínicos foram satisfatórios em 74% dos casos e moderados em 21% dos casos. O resultado foi ruim em um paciente. A integração de componentes foi observada em 58% dos pacientes, sendo total em 42% e parcial em 16% dos casos. Linhas radiotransparentes foram observadas em 52% dos pacientes. Nenhuma relação entre a integração de componentes e os resultados clínicos foi detectada. Conclusão A maioria dos pacientes submetidos à ATO com componente glenoidal minimamente cimentado apresentou resultados clínicos satisfatórios. Linhas radiotransparentes ao redor do componente glenoidal são comuns, mas não interferem nos resultados clínicos Nível de evidência IV; Série de caso; Estudo terapêutico.
Subject(s)
Humans , Male , Female , Middle Aged , Shoulder , Prosthesis Failure , Tomography , Radiographic Image Enhancement , Arthroplasty, ReplacementABSTRACT
BACKGROUND: Computed Tomography plays a priceless role for diagnostic and therapeutic purpose; however,applying an optimized Computed Tomography Technique to produce qualified image while delivering minimum radiation dose to patients is the common challenge. The main objective of this study was to establish local diagnostic reference levels for adult patients who visited abdominopelvic Computed Tomography examination. METHODS: A total of 158 patients who had taken abdominopelvic Computed Tomography examination from three selectedAmhara region hospitals were investigated. Both prospective and retrospective techniques of data collection were used while collecting the data in the entire sample. Two GE - Optima Computed Tomography 540 (16 slices) and one Phillips Brilliance (64slices), were employed during data collections. Data for patient demographics scan protocols, Computed Tomography dose descriptors and machine specifications were collected and analyzed by using SPSS software version 26. RESULTS: The third quartile estimated computed tomography dose index volume and dose length product, which is the local Diagnostic Reference Levels, were 12 mGy and 1904 cm.mGy respectively. The investigated local Diagnostic Reference Levels of Computed Tomography Dose index volume (mGy) was comparable to other international Diagnostic Reference Levels. However, the third quartile value of dose length product (cm.mGy) was higher than other reported international Diagnostic Reference Levels. CONCLUSION: The values of local Diagnostic Reference Levels presented in this work can be used as a baseline upon which future dose measurements can be compared in Amhara region
Subject(s)
Humans , Patients , Four-Dimensional Computed Tomography , Tomography , Dosage , Patient Outcome AssessmentABSTRACT
Introducción: la revolución tecnológica que hemos vivido en los últimos años ha generado un extendido uso de la inteligencia artificial (IA) como tecnología de base para el desarrollo de diversos sistemas y soluciones en medicina. En el campo de la otorrinolaringología, estamos viendo hasta ahora los primeros esfuerzos para aprovechar este surgimiento. Objetivo: el presente proyecto busca describir el proceso de desarrollo de una app móvil creada gracias al trabajo colaborativo entre otorrinolaringólogos e ingenieros biomédicos, que tiene la intención de optimizar la evaluación preoperatoria de la tomografía de senos paranasales (TC de SPN). Métodos: el desarrollo de la app siguió el método de priorización para especificaciones de MoSCoW. Utilizamos la información recolectada de encuestas realizadas a 29 expertos en rinología de diferentes partes del mundo, quienes evaluaron variantes anatómicas en la tomografía y se utilizaron dos modelos de regresión para la predicción de dificultad y riesgo a partir de herramientas de aprendizaje estadístico. Conclusión: hemos desarrollado una herramienta y un modelo estadístico que es fácil de utilizar y que idealmente ayudará al cirujano en el proceso de evaluación preoperatoria de TC de SPN. Este es un ejercicio que permite demostrar la eficacia de un desarrollo colaborativo para lograr soluciones en nuestra especialidad y un acercamiento hacia la IA.
Introduction: The recent technology revolution that we have experienced has generated extensive interest in the use of artificial intelligence (AI) in the development of various systems and solutions in medicine. In the field of Otorhinolaryngology, we are seeing the first efforts to take advantage of this flourishing area. Objective: We sought to describe the development process of a mobile app created through a collaborative effort between ENT surgeons and biomedical engineers. This app has the intention to optimize the preoperative evaluation of paranasal sinus tomography (CT) to improve safety and outcomes in Endoscopic Sinus Surgery (ESS). Methods: The development of the app followed the prioritization method for MoSCoW specifications. We used the information collected from surveys of 29 Rhinology experts from different parts of the world, who evaluated anatomical variants on sinus CT scans. Two regression models were used to predict difficulty and risk using statistical learning. Conclusion: Via statistical modelling, we have developed a user-friendly tool that will ideally help surgeons assess the risk and difficulty of ESS based on the pre-operative CT scan of the sinuses. This is an exercise that demonstrates the efficacy of the collaborative efforts between surgeons and engineers to leverage AI tools and promote better solutions for our patients.
Subject(s)
Humans , Paranasal Sinuses , Software , Artificial Intelligence , TomographyABSTRACT
As neoplasias cardíacas primárias são raras, e o diagnóstico correto é essencial para planejar o tratamento mais adequado. O objetivo deste estudo foi demonstrar o papel da ressonância magnética cardíaca na avaliação, no diagnóstico e no acompanhamento de fibroma cardíaco. Paciente do sexo feminino, 21 anos, com massa miocárdica ao ecocardiograma. Realizou ressonância magnética com diagnóstico de fibroma cardíaco. Foi acompanhada durante 6 anos com estabilidade do quadro. Fibromas cardíacos correspondem à segunda neoplasia mais comum em crianças e jovens. À ressonância magnética, caracterizam-se por realce tardio intenso e homogêneo.(AU)
Subject(s)
Humans , Female , Adult , Young Adult , Fibroma/ultrastructure , Fibroma/diagnostic imaging , Heart Ventricles/abnormalities , Neoplasms/diagnosis , Time Factors , Magnetic Resonance Imaging , Echocardiography/methods , Magnetic Resonance Spectroscopy/methods , Tomography/methods , Follow-Up StudiesABSTRACT
Introducción Se pretende definir si la medición de los defectos glenoideos y de Hills-Sachs por resonancia magnética es equivalente a la medición a través de tomografía simple en pacientes con inestabilidad anterior de hombro. Materiales y métodos Estudio observacional descriptivo, tipo transversal de una cohorte de estudios de imagenología de pacientes con antecedente de luxación anterior de hombro, los cuales comprenden resonancia magnética y tomografías simples de hombro, realizadas en un hospital de cuarto nivel. Resultados La cohorte estuvo conformada por 20 casos; se encontró una alta correlación y estadísticamente significativa para la medición del diámetro y defecto glenoideo, con una p<0.05 entre la resonancia y la tomografía simple. Además, se encontró con significancia estadística la medición del intervalo del Hill-Sachs, pero el índice de correlación no fue alto, 60%. Para la concordancia intraobservador, se calculó un índice Kappa para la resonancia magnética de 0.8 comparado con la tomografía con valor de p <0.05 significativo para los defectos enganchantes y no enganchantes. Conclusión La resonancia magnética simple es un método de imagen confiable con alto índice de correlación para la medición del diámetro y los defectos glenoideos con buena concordancia para establecer si los defectos de Hill-Sachs son enganchantes o no.
Introduction The aim is to define whether the measurement of glenoid and HillSachs defects by magnetic resonance imaging is equivalent to the measurement by simple tomography in patients with anterior shoulder instability. Materials and methods Descriptive, observational, cross-sectional study of a cohort of imaging studies of patients with a history of anterior shoulder dislocation, comprising magnetic resonance and simple tomography of the shoulder, performed in a fourth level hospital. Results The cohort consisted of 20 cases; a high and statistically significant correlation was found for the measurement of the glenoid diameter and defect, with a p<0.05 between the MRI and simple tomography. In addition, the HillSachs interval measurement was found to be statistically significant, but the correlation index was not high, 60%. For intraobserver agreement, a Kappa index was calculated for MRI of 0.8 compared to CT with p-value <0.05 significant for engaging and non-engaging defects. Conclusion Simple MRI is a reliable imaging method with high correlation index for the measurement of diameter and glenoid defects with good agreement to establish whether HillSachs defects are engaging or not.
Subject(s)
Humans , Tomography , Shoulder Dislocation , Magnetic Resonance ImagingABSTRACT
The lungs have great importance in patients with paracoccidioidomycosis since they are the portal of entry for the infecting fungi, the site of quiescent foci, and one of the most frequently affected organs. Although they have been the subject of many studies with different approaches, the severity classification of the pulmonary involvement, using imaging procedures, has not been carried out yet. This study aimed to classify the active and the residual pulmonary damage using radiographic and tomographic evaluations, according to the area involved and types of lesions.
Subject(s)
Humans , Paracoccidioidomycosis/diagnostic imaging , Severity of Illness Index , Lung/microbiology , Lung Diseases/microbiology , Radiography, Thoracic , TomographyABSTRACT
Introducción: La Nefropatía Inducida por Contraste (NIC) es una complicación causada por la ad-ministración intravenosa de medios de contrastes para estudios imagenológicos, lo cual incrementa la morbi-mortalidad y costos hospitalarios. La incidencia oscila el 2% en personas sin factores de riesgo, pudiendo llegar hasta el 25 a 50% cuando se asocian factores predisponentes. El objetivo de este estudio fue evaluar el desarrollo de NIC en pacientes oncológicos y no oncológicos hospitaliza-dos, sus características clínicas, prevalencia, factores asociados y aplicación de una escala de riesgo pre exposición. Metodología: Se realizó un estudio de casos y controles en los Hospitales "Abel Gilbert Pontón" y el Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" - Guayaquil en el período Abril a Septiembre del 2020. La muestra fue no probabilística, de pacientes con y sin diagnóstico oncológico. En ambos grupos se requirió una tomografía contrastada. Se registró edad, sexo, tipo de cáncer, presencia de Diabetes Tipo 2 (DMT2), Hipertensión arterial, creatinina basal y a las 48 horas. Se usó una escala de preexposición para NIC. Se compara las prevalencias con Chi2, y las asociaciones con Odds Ratio. Resultados: Fueron 100 casos y 100 controles. La prevalencia de NIC fue 28% en no oncológicos y 22% en oncológicos (P=0.33), el factor de riesgo asociado fue la Diabetes Mellitus tipo 2 (OR 2.19 [IC95% 1.0007 4.808; P=0.0498). El valor de creatinina previa no tuvo efecto sobre el desenlace de nefropatía. La distribución de categorías pre exposición no mostró diferencias significativas entre los pacientes que desarrollaron NIC en relación con los que no desarrollaron (P=0.063). Conclusión: El desarrollo de NIC no se ve influenciado por edad, sexo, paciente e HTA, pero si se ve asociado a la presencia de DM2. La estratificación de riesgo pre exposición no fue de utilidad en este caso, su distribución fue similar en pacientes con o sin NIC
Introduction: Contrast Induced Nephropathy (CIN) is a complication caused by intravenous administration of contrast media for imaging studies, which increases morbidity and mortality and hospital costs. The incidence ranges from 2% in people without risk factors, and can reach up to 25 to 50% when predisposing factors are associated. The objective of this study was to evaluate the develop-ment of CIN in hospitalized cancer and non-cancer patients, their clinical characteristics, prevalence, associated factors, and the application of a pre-exposure risk scale. Methodology: A case-control study was carried out at the "Abel Gilbert Pontón" Hospitals and the "Dr. Juan Tanca Marengo "- Guayaquil in the period April to September 2020. The sample was non-probabilistic, of patients with and without oncological diagnosis. Contrast tomography was required in both groups. Age, sex, type of cancer, presence of Type 2 Diabetes (T2DM), arterial hypertension, creatinine at baseline and at 48 hours were recorded. A pre-exposure scale for CIN was used. The prevalences are compared with Chi2, and the associations with Odds Ratio. Results: There were 100 cases and 100 controls. The prevalence of CIN was 28% in non-cancer patients and 22% in oncological patients (P = 0.33). The associated risk factor was Type 2 Diabetes Mellitus (OR 2.19 [95% CI 1.0007 - 4.808; P = 0.0498). The previous creatinine value had no effect on the outcome of nephropathy. The distribution of pre-exposure categories did not show significant differences between the patients who developed CIN in relation to those who did not develop (P = 0.063). Conclusion: The development of CIN is not influenced by age, sex, patient and hypertension, but is associated with the presence of DM2. Pre-exposure risk stratification was not useful in this case, its distribution was similar in patients with or without CIN
Subject(s)
Humans , Adult , Middle Aged , Contrast Media , Kidney Diseases , Tomography , Risk Factors , CreatinineABSTRACT
Introducción: Quistes hepáticos son formaciones de contenido líquido-seroso rodeado de parénquima hepático normal y sin comunicación con la vía biliar intrahepática. Mayor incidencia en adultos mayores de 50 años, con una relación mujer / hombre de 1.5: 1. Son asintomáticos. Los síntomas se presentan debido a su tamaño o bien por la presencia de complicaciones como la hemorragia, la rotura, la infección intraquística, o la compresión de estructuras adyacentes. Objetivo: Caracterizar a una paciente que presenta quiste hepático gigante complicado por rotura traumática. Caso clínico: Paciente femenino de 81 años, acudió a emergencia luego de haber presentado caída impactándose sobre superficie dura a nivel de parrilla costal e hipocondrio derecho, presentó dolor abdominal intenso acompañado de nausea y vómito. Al examen físico mostró signos claros de irritación peritoneal. Se realizó tomografía axial computarizada que reporta rotura de la pared de quiste hepático y aproximadamente 600 ml de líquido libre en cavidad. Se efectúo tratamiento quirúrgico de emergencia al realizar destechamiento del quiste y lavado de la cavidad. Conclusiones: Los quistes hepáticos, debido a su tamaño o complicaciones pueden poner en peligro la vida de los pacientes. Es necesario que dentro del arsenal diagnóstico del cirujano esté presente el conocimiento de esta patología(AU)
Introduction: Hepatic cysts are formations with liquid-serous content surrounded by normal liver parenchyma and without communication with the intrahepatic bile duct. It is reported with higher incidence in adults over fifty years of age, with a women/men ratio of 1.5: 1. They are asymptomatic; symptoms appear due to either their size or the presence of complications such as hemorrhage, rupture, intracystic infection, or compression of adjacent structures. Objective: To characterize a patient with a giant hepatic cyst complicated by traumatic rupture. Clinical case: A 81-year-old female patient went to the emergency room after falling and subsequently impacting herself on a hard surface at the level of the rib cage and right hypochondrium; she presented intense abdominal pain accompanied by nausea and vomiting. The physical examination showed clear signs of peritoneal irritation. A computerized axial tomography was performed, reporting rupture of the hepatic cyst wall and approximately 600 mL of free fluid within the cavity. Emergency surgical treatment was performed after cyst unroofing and cavity washing. Conclusions: Hepatic cysts, due to their size or complications, can endanger the patients' lives. It is necessary for the surgeon to consider knowledge of this condition as part of his or her diagnostic resources(AU)
Subject(s)
Humans , Female , Aged, 80 and over , Abdominal Pain/etiology , Cysts/epidemiology , Liver/injuries , Tomography/methods , Emergency Service, HospitalABSTRACT
Resumen Los tumores del estroma gastrointestinal (GIST) son tumores infrecuentes del tracto digestivo. Sus localizaciones más frecuentes son el estómago, intestino delgado, colon y recto; su aparición en otros lugares fuera del trato gastrointestinal como el mesenterio, epiplón o retroperitoneo es infrecuente. La tomografía axial computarizada (TAC) y la resonancia magnética (RM) son los estudios de imágenes de primera elección. La recesión quirúrgica es el estándar de oro para los tumores localizados y en los tumores avanzados o metastásicos son tratados con imatinib. A continuación, se presenta el caso de un paciente masculino de 53 años de edad sin antecedentes de patologías previos con cuadro clínico de dolor abdominal generalizado, pérdida de peso de 20 kg aproximadamente, distención abdominal, melena, hematemesis y astenia; en el examen físico presentó abdomen distendido y en la palpación se encontró endurecimiento epigástrico y mesogástrico, y marco colónico izquierdo. En la tomografía de abdomen se observó una masa tumoral de aspecto infiltrativo de aparente origen gástrico, con crecimiento extragástrico e infiltración del bazo, páncreas, raíz mesentérica, epiplón mayor, colon transverso, asas intestinales delgadas e infiltración en el hilio hepático, y metástasis hepática. Además, el cuadro se asoció con enfermedad respiratoria por coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2; neumonía por coronavirus de 2019 [COVID-19]). Se realizó una biopsia percutánea ecodirigida en el hipocondrio izquierdo y la histología reportó un GIST. En este artículo se revisa la clínica, diagnóstico y tratamiento del GIST gigante extradigestivo.
Abstract Giant extraintestinal gastrointestinal stromal tumors (GIST) are rare tumors of the digestive tract. Its most frequent locations are the stomach, small intestine, colon, and rectum. Its appearance in other places outside the gastrointestinal tract such as the mesentery, omentum, or retroperitoneum is infrequent. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) are the imaging studies of the first choice. Surgical recession is the gold standard for localized tumors and advanced or metastatic tumors are treated with imatinib. This study presents the case of a male patient of 53 years with no history of previous pathologies. The patient was admitted with a clinical condition of generalized abdominal pain, weight loss of approximately 20 kg, abdominal distention, melena, hematemesis, and asthenia. Physical examination revealed a distended abdomen and palpation revealed epigastric and mesogastric hardening and left colonic frame. The abdominal tomography revealed a tumor mass with an infiltrative appearance of apparent gastric origin, with extragastric growth and infiltration of the spleen, pancreas, mesenteric root, greater omentum, transverse colon, thin intestinal loops, and infiltration in the hepatic hilum, and liver metastases. Moreover, the condition was related to the severe acute respiratory syndrome type 2 coronavirus (SARS-CoV-2). An ultrasound-guided percutaneous biopsy was performed in the left upper quadrant and histology reported a GIST. In this article medical condition, diagnosis, and treatment of the Giant extraintestinal gastrointestinal stromal, is reviewed.
Subject(s)
Humans , Male , Middle Aged , Gastrointestinal Tract , Gastrointestinal Stromal Tumors , SARS-CoV-2 , Neoplasms , Pathology , Rectum , Stomach , Tomography , Abdominal Pain , Colon , Diagnosis , AbdomenABSTRACT
Será o exame de tomografia computadorizada realmente de alto custo para o paciente, ou existe uma resistência por grande parte dos profissionais em indicá-lo? Paradigmas já foram quebrados com relação à dose de radiação. Ela é tão pequena que, em muitas universidades nos EUA, o paciente não utiliza avental de chumbo durante o exame. Isso se dá porque o exame usado para Endodontia tem algumas diferenças em relação à tomografia médica (AU).
Is the CT scan really a high cost for the patient, or is there a resistance on the part of most professionals to indicate it? Paradigms have already been broken with regard to the radiation dose. In many universities in the USA, the patient does not wear a lead apron during the exam because the dose is so small. The reason for this is that the exam used for Endodontics has some differences in relation to medical tomography (AU).
Subject(s)
Humans , Radiation Dosage , Tomography , Tomography, X-Ray Computed , Endodontics , Radiation , LeadABSTRACT
Introducción: Dentro de la atención al lesionado con trauma torácico se cuenta con varios medios diagnósticos, entre ellos la evaluación por ecografía focalizada en trauma extendido a tórax, el cual ha mostrado una alta sensibilidad, aun realizado por médicos no radiólogos como cirujanos generales, emergencistas e intensivistas. Objetivo: Determinar la utilidad de la ecografía torácica extendida realizada por cirujanos en lesionados con traumatismo torácico. Métodos: Se realizó un estudio observacional, descriptivo de evaluación de pruebas diagnósticas con un diseño transversal, en 1052 pacientes ingresados en la sala de emergencia. Se les realizó la evaluación por ecografía torácica extendida en el Hospital Universitario "General Calixto García", durante el período comprendido entre enero de 2020 y febrero de 2021. Resultados: Fueron realizados en un periodo de 1 año un total de 1052 ultrasonidos torácicos, 221 casos fueron positivos, de ellos 81 neumotórax (7,7 por ciento) y 62 hemoneumotórax (5,9 por ciento) todos confirmados por tomografía de tórax. La edad promedio fue de 45,27 (18-97), el sexo masculino prevaleció con 772 casos (73,4 por ciento). Los mecanismos productores de trauma más frecuentes fueron: caída de altura 273 casos (26 por ciento) y trauma contuso 181 casos (17,2 por ciento). La ecografía torácica extendida obtuvo una sensibilidad de un 95,24 por ciento y una especificidad de 99,88 por ciento en el diagnóstico lesiones torácicas. Conclusiones: La ecografía torácica extendida demostró que en manos de los cirujanos generales es una herramienta confiable, segura, no invasiva, poco costosa, repetible, que permite diagnosticar rápidamente lesiones torácicas y tratarlas(AU)
Introduction: Within care for the injured patient with thoracic trauma there are several diagnostic means. For example, extended focused assessment with sonography for thoracic trauma has shown high sensitivity, even when performed by non-radiologists such as general surgeons, emergency specialists and intensivists. Objective: To determine the usefulness of extended thoracic sonography performed by surgeons on injured patients with thoracic trauma. Methods: An observational, descriptive and cross-sectional study of diagnostic tests assessment was carried out in 1052 patients admitted to the emergency room. They were assessed by extended thoracic sonography at General Calixto García University Hospital, during the period between January 2020 and February 2021. Results: A total of 1052 thoracic ultrasounds were performed in a period of one year, of which 221 cases were positive. Of them, 81 were pneumothorax (7.7 percent) and 62 were hemopneumothorax (5.9 percent), all confirmed by chest tomography. The average age was 45.27 (18-97). The male sex prevailed, with 772 cases (73.4 percent). The most frequent trauma-producing mechanisms were altitude fall, accounting for 273 cases (26 percent), and blunt trauma, accounting for 181 cases (17.2 percent). Extended thoracic ultrasound showed a sensitivity of 95.24 percent and a specificity of 99.88 percent in the diagnosis of thoracic injuries. Conclusions: Extended thoracic ultrasound showed that, in the hands of general surgeons, it is a reliable, safe, noninvasive, inexpensive and repeatable tool that allows rapid diagnosis and treatment of thoracic injuries(AU)
Subject(s)
Humans , Thoracic Injuries/diagnostic imaging , Ultrasonography/methods , Emergency Service, Hospital , Focused Assessment with Sonography for Trauma/methods , Hemopneumothorax/diagnostic imaging , Tomography/adverse effects , Epidemiology, Descriptive , Diagnostic Tests, Routine/methods , Observational Studies as TopicABSTRACT
Resumen El adenocarcinoma de yeyuno es el tumor primario del intestino delgado más infrecuente y raro, y representa el 3 % de todos los cánceres gastrointestinales, con una incidencia anual estimada de 0,3 a 2 casos por cada 100 000 personas. En Estados Unidos y España representa el 0,4 % de los cánceres gastrointestinales y el 0,2 % de las muertes asociadas a malignidad, con síntomas inespecíficos como anemia de etiología inexplicable, dolor abdominal y pérdida de peso; la mayoría de ellos son diagnosticados en etapas avanzadas de la enfermedad. A continuación, se presenta el caso de una paciente femenina de 46 años con síntomas inespecíficos, pérdida de peso, dolor abdominal y vómito, cuya tomografía abdominal computarizada evidenció el sitio y extensión de la lesión neoplásica, mientras que la cápsula endoscopia y enteroscopia mostró una lesión neoplásica en el yeyuno proximal. La histopatología reportó un adenocarcinoma de yeyuno moderadamente diferenciado que presentó resultados favorables gracias a la resección quirúrgica curativa, lo cual mejoró el pronóstico de vida a 5 años y tuvo un seguimiento favorable hasta la actualidad.
Abstract Jejunal adenocarcinoma is the rarest primary small bowel tumor and represents 3% of all gastrointestinal cancers, with an estimated annual incidence of 0.3 to 2 cases per 100 000 people. This disease accounts for 0.4% of gastrointestinal cancers and 0.2% of deaths associated with malignancy in the United States and Spain, with nonspecific symptoms, such as anemia of unexplained etiology, abdominal pain, and weight loss; most cases are diagnosed in advanced stages of the disease. The following is the case of a 46-year-old female with non-specific symptoms, weight loss, abdominal pain and vomiting. A computerized tomography scan of the abdomen allowed determining the site and extension of the tumor, while a capsule endoscopy and an enteroscopy showed a neoplastic lesion in the proximal jejunum. A histopathology analysis reported moderately differentiated adenocarcinoma of jejunum with favorable results after a curative surgical resection that improved the prognosis of life at 5 years and with favorable follow-up until to date.