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1.
Cureus ; 15(12): e50549, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38222222

ABSTRACT

Urothelial carcinoma on a ureterocele is extremely rare in the literature, and few case reports have been reported. There are no guidelines for diagnosis and management, and current practice is extrapolated from bladder and upper urothelial tract carcinoma. We present a case from a 61-year-old man with urothelial carcinoma on a ureterocele treated with ureterocele resection, distal urethrectomy, and reimplantation on the bladder. We also review the literature concerning diagnostic approaches and management.

2.
Nefrologia (Engl Ed) ; 42(1): 1-7, 2022.
Article in English | MEDLINE | ID: mdl-36153888

ABSTRACT

Chronic kidney disease (CKD) is an emerging global burden with an increasing number of patient's requiring renal replacement therapy (RRT), with hemodialysis being the most prevalent dialysis modality. A functioning vascular access remains the main constrain for an adequate treatment. Clinical and, in some patients, ultrasound evaluation are fundamental for better access planning. Access planning is dependent not only on patient clinical characteristics and preference but also in vascular patrimony. As such, ultrasound evaluation aids in characterizing patient arterial and venous upper arm anatomy and provides information for which access would better suit each patient. Doctors dealing with CKD patients should be familiar with the role of ultrasound and Doppler use in access planning.


Subject(s)
Arteriovenous Shunt, Surgical , Renal Insufficiency, Chronic , Arteriovenous Shunt, Surgical/adverse effects , Humans , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Renal Replacement Therapy , Veins
3.
J Vasc Access ; : 11297298221113690, 2022 Jul 26.
Article in English | MEDLINE | ID: mdl-35891580

ABSTRACT

Unilateral vocal fold paralysis (UVFP) is a frequent finding in otorhinolaryngology practice, but its occurrence as a port complication was very rarely described in English Literature. The authors report a 55-year-old woman with a pancreatic adenocarcinoma who presented a left vocal fold paralysis that occurred concurrently with a venous thrombosis of the left subclavian vein, where a totally implantable venous-access had been previously placed. Although the patient's oncologic disease, that could mislead to a neoplastic cause of the UVFP, the authors came across with an unusual etiology and to their best knowledge, it is the first case of irreversible UVFP associated with onsite thrombosis of the vessel where a port was implanted. The objective of this article is to present and discuss this rare case of UVFP secondary to a port complication and to review the main mechanisms of iatrogenic vocal fold paralysis related to these devices.

4.
J Belg Soc Radiol ; 106(1): 2, 2022.
Article in English | MEDLINE | ID: mdl-35088028

ABSTRACT

Teaching Point: Gastric lipomas are very rare and generally asymptomatic benign tumors; however, they can manifest as life-threatening complications, readily diagnosed by CT.

5.
Nefrología (Madrid) ; 42(1): 1-7, Ene-Feb., 2022. ilus
Article in English | IBECS | ID: ibc-204262

ABSTRACT

Chronic kidney disease (CKD) is an emerging global burden with an increasing number of patient's requiring renal replacement therapy (RRT), with hemodialysis being the most prevalent dialysis modality. A functioning vascular access remains the main constrain for an adequate treatment. Clinical and, in some patients, ultrasound evaluation are fundamental for better access planning. Access planning is dependent not only on patient clinical characteristics and preference but also in vascular patrimony. As such, ultrasound evaluation aids in characterizing patient arterial and venous upper arm anatomy and provides information for which access would better suit each patient. Doctors dealing with CKD patients should be familiar with the role of ultrasound and Doppler use in access planning. (AU)


La enfermedad renal crónica (ERC) es una carga global emergente con un número creciente de pacientes que precisan tratamiento renal sustitutivo (TRS) y la hemodiálisis es la modalidad de diálisis más prevalente. Un acceso vascular funcional sigue siendo la principal limitación para un tratamiento adecuado. La evaluación clínica y, en algunos pacientes la ecográfica, son fundamentales para una mejor planificación del acceso. La planificación del acceso depende no solo de las características clínicas y las preferencias del paciente, sino también de la anatomía vascular. Por tanto, la evaluación ecográfica ayuda a caracterizar la anatomía arterial y venosa de la parte superior del brazo del paciente y ofrece información sobre qué acceso sería más adecuado para cada paciente. Los médicos que tratan a pacientes con ERC deben estar familiarizados con el papel de la ecografía y el uso del Doppler en la planificación del acceso. (AU)


Subject(s)
Humans , Nephrology , Vascular Access Devices , Ultrasonography , Ultrasonography, Doppler , Renal Dialysis , Arteriovenous Fistula
7.
Nefrologia (Engl Ed) ; 2021 Mar 08.
Article in English, Spanish | MEDLINE | ID: mdl-33707099

ABSTRACT

Chronic kidney disease (CKD) is an emerging global burden with an increasing number of patient's requiring renal replacement therapy (RRT), with hemodialysis being the most prevalent dialysis modality. A functioning vascular access remains the main constrain for an adequate treatment. Clinical and, in some patients, ultrasound evaluation are fundamental for better access planning. Access planning is dependent not only on patient clinical characteristics and preference but also in vascular patrimony. As such, ultrasound evaluation aids in characterizing patient arterial and venous upper arm anatomy and provides information for which access would better suit each patient. Doctors dealing with CKD patients should be familiar with the role of ultrasound and Doppler use in access planning.

8.
J Vasc Surg ; 73(3): 1022-1030, 2021 03.
Article in English | MEDLINE | ID: mdl-32707377

ABSTRACT

OBJECTIVE: Current scientific evidence is insufficient to determine the best vascular access for each patient. It is an unmet clinical need because vascular access dysfunction accounts for 20% to 30% of hospital admissions. Our aim was to evaluate preoperative color flow Doppler ultrasound (CDUS)-derived parameters (vein diameter and brachial artery flow and diameter) and their effect interaction with comorbidities as predictors of brachiocephalic (BC) and brachiobasilic (BB) arteriovenous fistula (AVF) maturation. METHODS: A prospective analysis was performed of patients who underwent BC and BB AVF as primary definitive vascular access between January 2016 and May 2017. Variables included patients' demographics, comorbidities, medication, preoperative blood pressure, and CDUS-derived parameters. Outcomes were patency 48 hours after surgery and fistula maturation at 6 and 12 weeks. Nonparametric descriptive and univariate statistics were used. Logistic regression models and receiver operating characteristic curve analyses were performed. RESULTS: There were 132 patients (91 with BC AVF and 41 with BB AVF) included. The 48-hour patency was 91.7%. AVF maturation at 6 weeks was observed in 71.3%, and AVF maturation at 12 weeks was observed in 66.3%. There were no associations in univariate and multivariate logistic regression analysis between AVF maturation and comorbidities. Systolic blood pressure was an independent predictor of 48-hour patency with an optimized cutoff of 154 mm Hg (area under the curve, 0.73; P = .013; Youden index, 0.40). Vein diameter with tourniquet was an independent predictor of AVF maturation at 6 and 12 weeks with an optimized cutoff of 3.9 mm (area under the curve, 0.74; P < .001; Youden index, 0.38). CONCLUSIONS: AVF maturation was independent of comorbidities. Systolic blood pressure ≥154 mm Hg and vein diameter with tourniquet ≥3.9 mm were the associated conditions that better predicted BC and BB AVF maturation. There were no effect interactions between CDUS-derived parameters and associated comorbidities.


Subject(s)
Arteries/surgery , Arteriovenous Shunt, Surgical , Renal Dialysis , Ultrasonography, Doppler, Color , Upper Extremity/blood supply , Veins/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Arteries/diagnostic imaging , Arteries/physiopathology , Arteriovenous Shunt, Surgical/adverse effects , Blood Pressure , Clinical Decision-Making , Comorbidity , Female , Humans , Longitudinal Studies , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Vascular Patency , Veins/diagnostic imaging , Veins/physiopathology , Young Adult
9.
Ultrasound ; 27(4): 225-232, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31762780

ABSTRACT

INTRODUCTION: Doppler ultrasound is recommended by international societies for preoperative vascular mapping in vascular access surgery. Literature is scarce regarding data on Doppler ultrasound-associated errors. OBJECTIVES: Our aim was to evaluate Doppler ultrasound precision for upper limb vascular mapping. METHODS: Fifty-two adult healthy volunteers were evaluated for superficial vein diameter, brachial artery flow and diameter in the lower third of non-dominant arm by a dedicated vascular access radiologist blinded for the identification of the participants. Each participant was scheduled for three evaluations one week apart. Friedman test and multivariate analysis of variance for repeated measures were used. RESULTS: There were no statistical differences within subjects across the three weeks except for brachial artery flow in participants who had basilic vein as the dominant vein. DISCUSSION: Repeated anatomical and haemodynamic parameters measured by Doppler ultrasound performed by an experienced medical sonographer, according to our protocol, did not show statistical differences within subjects, independently of age, gender and body mass index.

10.
Clin Imaging ; 58: 114-128, 2019.
Article in English | MEDLINE | ID: mdl-31323482

ABSTRACT

BACKGROUND: High-resolution ultrasound is considered the best imaging technique for evaluating the thyroid gland, as it is accessible, non-invasive, and highly sensitive concerning the detection and characterization of thyroid nodules. However, a background knowledge of the normal ultrasound anatomy of the thyroid gland, adjacent structures, and its anatomical variants is crucial to avoid misdiagnosis in daily practice. Through this pictorial review, we intend to.


Subject(s)
Thyroid Gland/diagnostic imaging , Ultrasonography/methods , Diagnostic Errors , Humans , Thyroid Nodule/diagnostic imaging
11.
J Surg Case Rep ; 2019(3): rjz073, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30906521

ABSTRACT

The incidence of internal hernias is rare (0.2-0.9%). The prevalence of intestinal obstruction for an internal hernia is low (0.5-5%), however if strangulation is present the overall mortality is higher than 50%. There are multiple places where an internal hernia may be localized, with transmesenteric: transmesocolic (8%) and transomental (1-4%) as the rarest. We report a series of two cases (men with 40 years-old and women with 92 years old) of volvulus of colon sigmoid in a strangulated transverse and descendent transmesocolic hernia, with one case associated also to a transomental hernia. Both patients were submitted to a Hartmann procedure and on follow-up remained free of complains. In conclusion, transmesenteric internal hernia should be included as diagnosis hypothesis for intestinal occlusion and if the diagnosis is made, the patient should be submitted to emergency surgery due to high rates of complications, high morbidity and mortality.

12.
Clin Case Rep ; 6(12): 2509-2510, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30564360

ABSTRACT

Killian-Jamieson diverticulum represents a rare form of esophageal diverticulum originating on the anterolateral wall of the cervical esophagus. Despite its rarity, it is crucial to recognize this entity, with such specific imaging findings, to avoid unnecessary invasive procedures such as fine-needle aspiration or even surgery.

13.
Clin Imaging ; 50: 289-293, 2018.
Article in English | MEDLINE | ID: mdl-29738997

ABSTRACT

BACKGROUND: A higher prevalence of thyroid nodules/carcinoma in females is well-known from the literature. The reasons for this difference are not fully explained. We intended to assess gender variation in the referral for ultrasound-guided fine needle aspiration (FNA) of thyroid nodules, to study reasons for gender referral differences, and to assess differences in nodules characteristics between genders. METHODS: Included were 272 consecutive patients, with 290 nodules submitted to FNA. Patients were questioned on the reason why ultrasound (US) examination was required. Electronic medical records were reviewed. Nodules' ultrasound/cytological characteristics were assessed. Variables studied: referral cause; referral pattern (hospital-specialist versus general-practitioner); number of nodules; age, thyroid function; nodule size, TIRADS classification, resistive index, Doppler pattern, Bethesda categorisation. Variables were compared between males and females referred for FNA. Significant variables were assessed with logistic regression. RESULTS: Of the 272 patients, 215(79%) were women with a female:male referral ratio for FNA of 3.8:1. Non-parametric statistically significant differences (p < 0.05) were found between genders in: thyroid function, nodule size, referral pattern and referral cause. Nodule size and thyroid function tests became non-significant in logistic regression. Cause and referral pattern remained significantly associated with gender. Referral by a general-practitioner was associated with a 2.6-fold increase in odds of referring a female. Causes unrelated to the thyroid were associated with a 3.2-fold increase in odds of female reference. CONCLUSIONS: A referral bias might be responsible for the higher rate of thyroid nodules in female patients, both due to referral by general practitioners and due to causes indirectly related to the thyroid gland.


Subject(s)
Thyroid Neoplasms/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Ultrasonography , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle , Female , General Practitioners , Humans , Male , Middle Aged , Practice Patterns, Physicians' , Prevalence , Prospective Studies , Referral and Consultation , Sex Factors , Thyroid Neoplasms/epidemiology , Thyroid Nodule/epidemiology , Young Adult
14.
Clin Case Rep ; 6(4): 766-767, 2018 04.
Article in English | MEDLINE | ID: mdl-29636960

ABSTRACT

Although mild pericardial effusion is a usual finding in patients with hypothyroidism, massive pericardial effusion or pericardial tamponade is rare and customarily related to severe hypothyroidism. The diagnosis of hypothyroidism should be considered in the differential of patients presenting with unexplained pericardial effusion, even when signs and symptoms of hypothyroidism are nonexistent.

15.
Case Rep Radiol ; 2018: 4935261, 2018.
Article in English | MEDLINE | ID: mdl-29682385

ABSTRACT

Urachal pathologies are rare and can mimic numerous abdominal and pelvic diseases. Differential diagnosis of urachal anomalies can be narrowed down by proper assessment of lesion location, morphology, imaging findings, patient demographics, and clinical history. We report a case of a 60-year-old male, with a history of unintentional weight loss without associated symptoms, who was diagnosed with locally invasive urachal adenocarcinoma. With this article, we pretend to emphasize urachal adenocarcinoma clinical features along with its key imaging findings with radiologic-pathologic correlation.

16.
Abdom Radiol (NY) ; 41(10): 1877-90, 2016 10.
Article in English | MEDLINE | ID: mdl-27315073

ABSTRACT

PURPOSE: Neoadjuvant chemotherapy in potentially resectable high-risk Stage II and Stage III colon cancer has demonstrated promising results in the PRODIGE 22-ECKINOXE Phase II trial. Identification of adverse morphologic features, namely T3 with >5 mm extramural extension/T4 stages and/or N2, is fundamental and requires accurate noninvasive imaging. Our aim was to assess the value of optimized preoperative MDCT to stratify potentially resectable colon cancer patients for neoadjuvant therapy. METHODS: this is an observational prospective cross-sectional radiologic-pathologic agreement study. All patients with colon cancer referred to our Institution's Radiology department for preoperative MDCT staging between 01-10-2013 and 11-02-2015 underwent independent reading based on axial and multiplanar reconstruction images by 3 radiologists with 3, 6, and 20 years of experience in gastrointestinal radiology. T stage, extramural extension if T3 (≤5 mm or >5 mm), and N stage were recorded. Surgical specimens subsequently obtained underwent micro-pathologic analysis by a gastrointestinal pathologist with 9 years of experience in gastrointestinal pathology. Main outcome measures were sensitivity, specificity, PPV, NPV, AUROC, diagnostic accuracy, and interobserver agreement of optimized MDCT, and pathologic analysis of the surgical specimen considered the reference standard. RESULTS: 74 patients [43 males; median age 73 (45-89)] were eligible. MDCT sensitivity, specificity, PPV, NPV, AUROC, and diagnostic accuracy ranged between 42.9-76.2, 75.5-90.6, 55.2-76.2, 80.0-90.6, 0.67-0.83 and 0.76-0.86%, respectively, for the identification of T3 > 5 mm/T4 disease, with moderate interobserver agreement (0.49); and 8.3-33.3, 93.5-98.4, 20-66.7, 84.1-88.2, 0.51-0.65 and 0.80-0.86%, respectively, for the identification of N2 disease, with absent interobserver agreement (0.10). CONCLUSIONS: Specificity of MDCT in the stratification of patients for neoadjuvant therapy may be high enough to prevent overtreatment. However, it may lead to undertreatment in a meaningful proportion of patients. Observer performance may benefit from targeted training programs, given the variability and observer dependence of the results. Limitations include 4-slice MDCT equipment, time to surgery and lack of long-term outcome information based on imaging parameters per se.


Subject(s)
Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Multidetector Computed Tomography/methods , Aged , Aged, 80 and over , Chemotherapy, Adjuvant , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Prospective Studies , Risk Factors , Sensitivity and Specificity , Treatment Outcome
17.
RBCF, Rev. bras. ciênc. farm. (Impr.) ; 44(4): 629-636, out.-dez. 2008. graf, tab
Article in Portuguese | LILACS | ID: lil-507913

ABSTRACT

Este trabalho teve como objetivo realizar um estudo sobre a utilização de plantas medicinais pela população atendida no Programa de Saúde da Família em Governador Valadares, Estado de Minas Gerais, a fim de resgatar, preservar e utilizar este conhecimento em trabalhos com a comunidade. Foi usada a metodologia de questionários pré-estabelecidos, que foram aplicados pelos Agentes de Saúde da Família. O estudo foi feito em 27 bairros da cidade, sendo aplicados 2454 questionários, resultando em 232 plantas citadas como medicinais pela população entrevistada. As principais indicações de uso das plantas medicinais foram como calmante (10%), contra gripe (18%) e infecções (9%). A maioria das plantas utilizadas são preparadas na forma de chá (78%) e obtidas em cultivo próprio (57%), sendoque, em geral, o conhecimento sobre o uso e modo de preparo da plantas medicinais foi obtido dos familiares (67%). A maioria das espécies citadas e utilizadas popularmente possui atividade farmacológica já comprovada na literatura necessitando, entretanto, de orientação correta sobre seu cultivo e emprego terapêutico.


This study was conducted to evaluate the use of medicinal plants by the population assisted by the ôPrograma de Saúde da Famíliaõ in Governador Valadares -MG, in order to rescue, preserve and use this knowledge in works carried out with the community. The preestablished questionnaire methodology was used. Those questionnaires were applied by the Family Health Agents. The study was accomplished in 27 residential quarters, as being applied 2454 questionnaires,and 232 plants were mentioned as medicinal ones by the interviewed population. The main indications for using the medicinal plants were: as sedative (10%), against influenza(18%) and infections (9%). Most plants under use are prepared as tea (78%) and are obtained in own cropping(57%). In general, the knowledge on the use and preparation of the medicinal plants proceeded from their relatives (67%). Most mentioned and popularly used species have pharmacological activity already proven in the literature. However, this population needs a correct orientation on their cropping and therapeutic use.


Subject(s)
Plants, Medicinal , National Health Strategies , Applied Research , Phytotherapy
18.
Acta Med Port ; 18(3): 227-30, 2005.
Article in Portuguese | MEDLINE | ID: mdl-16207459

ABSTRACT

Splenic Epidermoid Cyst is a rare entity and the imaging methods play a major role in the diagnosis, although this can only be accomplished by the histological features. The authors report a case of splenic epidermoid cyst in a child of eleven years old, which presented with one month history of post-traumatic abdominal pain. They illustrate the imaging features on ultrasound, CT and MR with pathologic correlation. A review of imaging aspects in the characterization and diagnosis of this clinical entity is made.


Subject(s)
Epidermal Cyst/diagnosis , Splenic Diseases/diagnosis , Child , Epidermal Cyst/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Splenic Diseases/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography
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