Liver Donations and Transplants in the State of Paraná, Brazil.

BACKGROUND: The increase in the waiting list for a liver and the high mortality rate of patients with terminal liver disease represent serious public health problems in Brazil. OBJECTIVE: To analyze donations and liver transplants in the State of Paraná, Brazil. METHOD: A cross-sectional study was carried out with data from 3931 reports of deaths due to brain death and 8146 solid organ transplants made available by the State Transplant System of Paraná between 2011 and 2016. The data related to donation and liver transplantation were analyzed using descriptive statistics and inference. RESULTS: A total of 751 (28.9%) liver donations were carried out. Of these, the greatest chance of effectiveness occurred in patients younger than 50 years OR: 1.94 (CI: 1.60-2.34; P < .01) and male OR: 1.27 (CI: 1.06-1.52; P < .01). A total of 720 (8.8%) liver transplants were performed, most of which were funded by the Unified Health System. There was a significant increase in donations and liver transplants over the years. CONCLUSION: Donor numbers and liver transplants increased in the State but did not meet the need for the waiting list within the analyzed period.

The Process of Kidney Donation in the Northern Macroregional Area of Paraná, Brazil.

INTRODUCTION: The high morbidity and mortality caused by chronic kidney disease, and consequently, the increase in the need for kidney transplants, makes the evaluation of the kidney donation process relevant to verifying the service's fragility with the goal of optimizing this process. OBJECTIVE: This study analyzed the process of kidney donation in the Northern Macroregional area of Paraná, Brazil. METHOD: This was a cross-sectional and retrospective evaluation study based on 586 reports of deaths provided by the Intra-Hospital Organ Donation and Transplant Tissue Commissions to the Organ Procurement Organization of the Northern Macroregional area of Paraná in Brazil between 2011 and 2015. Data were analyzed by descriptive statistics, prevalence ratio, and Poisson regression. RESULTS: The prevalence of kidney donation was higher among the deaths of individuals younger than 61 years of age (P = .018) due to traumatic brain injury and hemorrhagic cardiovascular accident (P < .001), assisted in private institutions (P = .037), and occurring in the second half of the year (P = .015). CONCLUSION: The process of kidney donation was mainly compromised due to the refusal of the family and was associated with clinical and organizational aspects.

Echinococcal cysts of the liver: a retrospective analysis of clinico-radiological findings and different therapeutic modalities.

The clinico-radiological findings and management of 61 patients with proven hepatic echinococcal cysts (HEC) examined over the past 5 years were retrospectively analyzed. The sonography and computed tomography (CT) scan findings were studied before and after therapy. The indications, healing, and complications rates for each therapeutic modality were recorded. There is a predominance of HEC in adult females (female to male ratio, 1.77:1). The majority of patients complained of abdominal pain (39/61; 64.4%), and the majority of cysts were solitary (43/61; 70.5%), localized in the right lobe (47/61; 77.0%), and superficial (57/61; 93.4%). Few cysts were complicated by rupture, intraperitoneal (2/61; 3.2%), or intrabiliary (5/61; 8.2%). Medical treatment consisted of antihelmintic chemotherapy alone in eight patients with an adequate response in seven patients (7/8; 87.5%). Thirty-two patients had open or laparoscopic surgery with a cure rate of 50%. The other 50% had major complications requiring a further adjuvant therapy for a complete cure. Nine patients underwent percutaneous catheter ablation combined with adjuvant chemotherapy; healing was observed in eight patients (8/9; 88.8%). HEC are best treated by nonsurgical minimally invasive techniques combined with adjuvant antihelmintic chemotherapy, while surgery should be reserved for complicated HEC by intraperitoneal rupture.

Unilocular hepatic echinococcal cysts: sonography and computed tomography findings.

AIM: In endemic regions, unilocular hepatic echinococcal cysts (HEC) may be difficult to differentiate radiologically from simple non-parasitic cysts, especially if serological tests were negative. The aim of this descriptive study is to elucidate distinctive imaging findings that allow a diagnosis of HEC. MATERIALS AND METHODS: The sonographic and computed tomography (CT) findings of 21 patients with proven unilocular HEC were retrospectively analysed. A total of 28 examinations were reviewed, including 14 sonograms (ultrasound; US) of the liver and 14 CT studies. RESULTS: Seven imaging features that help in the diagnosis of unilocular HEC were identified by US and/or CT in 14 patients (14/21; 66.6%). They are, by order of frequency: hydatid sand (29.2%), focal or segmental thickening of the cyst wall (29.2%), coexistent echinococcal cysts in the spleen or lungs (16.6%), pericystic biliary radicles dilatation (8.3%), atrophy of the right lobe with compensatory hypertrophy of the left hepatic lobe (8.3%), satellite cysts typical of HEC in the liver (4.2%) and pericyst calcification (4.2%). CONCLUSION: These ancillary signs should prompt us to consider HEC as the cause of a unilocular cyst in approximately two-thirds of patients.

Metastatic rhabdomyosarcoma to the breast.

Rhabdomyosarcoma is a common extramammary primary malignancy in childhood that rarely metastasises to the breast. We present a patient with primary sinonasal rhabdomyosarcoma who was in remission when she developed breast metastases. We describe particular imaging findings of this disease, using ultrasound and MR imaging. To our knowledge, MR findings have only been described in one previous case report in the literature.

The gamut of abdominal and pelvic cystic masses in children.

The gamut of abdominal and pelvic cystic masses in children is long with lesions affecting the urogenital tract and retroperitoneum, gastrointestinal tract and mesentery, hepatobiliary tract, and spleen. The goal of this pictorial review is to display the radiological manifestations of these disorders. The radiologist will learn, from this review of the differential diagnosis, how to reach a diagnosis after analyzing the characteristic findings using the appropriate imaging diagnostic studies among the various modalities available in his armamentarium, and the optimal management of these conditions.

Unenhanced spiral CT scan in the initial evaluation of renal colic: AUBMC experience.

BACKGROUND AND OBJECTIVE: Until recently, intravenous urography and ultrasonography have been the standard diagnostic modalities in the initial evaluation of acute flank pain. However, since 1995 the role of non-enhanced CT scan (NECT) has become more important in establishing the diagnosis of renal colic. In this retrospective descriptive study, we evaluated the usefulness of NECT in the diagnosis and management of patients with suspected urinary tract stones at the American University of Beirut-Medical Center (AUBMC). MATERIALS AND METHODS: We reviewed the records of 102 patients who presented to AUBMC over a period of two years for flank pain with or without hematuria. NECT were obtained in all patients. We studied the images for the presence of stones and frequency of associated urinary findings. Incidental abdominal and pelvic abnormalities were recorded. RESULTS: Fifty-four patients were found to have positive CT examinations for the presence of urinary tract stones on the ipsilateral side of the flank pain. Twenty-two stones were present in the kidneys, 23 in the ureters and 16 at the ureterovesical junction (UVJ). In these 54 patients with stone disease, 31 had associated pelvicalyceal dilatation (57%), and 16 had perinephric streaking (29.6%). In the 39 patients with ureteral and UVJ stones, 26 had ureteral dilatation (66.6%), and 17 had periureteral streaking (43.5%). In the 23 patients with only ureteral stones, 10 had a positive rim sign (43.4%). CONCLUSION: A diagnosis of urinary tract stone is not always readily apparent on the basis of physical exam and laboratory studies. NECT is now universally accepted as a preferred method for the evaluation of ureteral and kidney stones in patients with suspected renal colic.

Perirenal fluid in renal parenchymal medical disease ('floating kidney'): clinical significance and sonographic grading.

AIM: To study the clinical significance and radiologic features of perirenal fluid in patients with renal parenchymal disease. MATERIALS AND METHODS: During the previous 5 years, nine patients were found to have perirenal fluid on sonography associated with renal parenchymal medical disease. The clinical, radiological, histopathological and laboratory data were analysed. RESULTS: The perirenal fluid is a spontaneous subcapsular transudate in patients suffering from a nephropathy with a sodium retention state, with or without renal failure. Three sonographic patterns of perirenal fluid were observed: grade 1 is a thin layer of perirenal fluid; grade 2 is a moderate amount of perirenal fluid collection with indentations of the renal parenchyma and strands in the fluid, grade 3 is a large fluid collection surrounding the kidney. CONCLUSION: The perirenal fluid represents a sign of sodium retention state and oedema in patients with intrinsic renal parenchymal medical disease which may be caused by several nephropathies.

Adjuvant therapy in the treatment of complications following surgery for hepatic echinococcal cysts.

Thirty-two patients had surgery for hepatic echinococcal cysts (HEC). Serious complications were observed in 16 patients (50%): cyst recurrence (n = 4), infected residual cyst cavity (n = 7), infected residual cyst cavity with biliary and duodenal fistulae (n = 2), recurrent biliary obstruction following open surgery for a ruptured HEC into the biliary tree (n = 2), delayed rupture of an HEC into the biliary tree following laparoscopic surgery with secondary biliary obstruction (n = 1). These major complications were successfully managed by percutaneous methods in 8 of 16 patients while antihelmintic therapy was sufficient in two patients with a small recurrent cyst and ERCP was used in one patient to relieve biliary obstruction. Surgery was required in two patients only. With a success rate of 87.5%, the nonsurgical approach is the preferred method for treating a post-surgical complication.

Aberrant cervical thymus in an infant: an unusual cause of stridor.

We report an 8-month-old infant presenting with stridor caused by a nonpalpable neck mass discovered at imaging and surgery. The diagnosis of aberrant thymic tissue was confirmed at histopathology. The authors reviewed the literature and discuss the embryology, imaging findings and differential diagnosis of this rare disorder.

Percutaneous treatment of heterogenous predominantly solid echopattern echinococcal cysts of the liver.

PURPOSE: We report our technique for and results of percutaneous treatment of heterogenous, predominantly solid echopattern hepatic hydatid cysts (HHC), i.e., complex type IV cysts according to Gharbi's sonographic classification of HHC. METHODS: Eight patients with nine complex type IV HHC were treated by percutaneous aspiration followed by hypertonic saline ablation, using a 14 Fr van Sonnenberg sump drainage catheter under sonographic and fluoroscopic guidance. RESULTS: Successful drainage of cysts contents was achieved in all eight patients. No major complications, such as anaphylaxis, abdominal dissemination, cyst recurrence, or death, occurred. Minor complications including pain (n = 4), mild fever (n = 5), right reactive pleural effusion (n = 4), and transient hypernatremia (n = 2) were observed and managed conservatively. Follow-up imaging studies for an average period of 15 months (range 1-48 months) showed either complete healing (n = 3) or significant reduction in the size of the cyst with solidification (n = 6). CONCLUSION: Nine complex type IV HHC were effectively treated by suction of the membranes and hypertonic saline ablation using a 14 Fr sump drainage catheter, without major complications.

Primary epiploic appendagitis: a report of two cases.

Primary epiploic appendagitis (PEA) is a rare benign self-limiting inflammatory process of the colonic epiploic appendices. Patients present with acute abdominal pain, often misdiagnosed clinically as acute appendicitis or diverticulitis. Computed tomography (CT) scan findings of this condition are characteristic and can confidently suggest the diagnosis avoiding unnecessary barium enemas and colonoscopy, biopsy, or surgery.

Tibial and fibular developmental fields defects.

Malformations of the lower limbs are rare and heterogeneous anomalies. To explain the diversity and complexity of these abnormalities, authors introduced the concept of tibial and fibular developmental fields. Defects in these fields are responsible for different malformations, which have been described, to our knowledge, in only one report in the radiology literature. We present a case of a newborn with femoral bifurcation, absent fibulae and talar bones, ankle and foot malformations, and associated atrial septal defect. Our case is an example of defects in both fibular and tibial developmental fields.