Fracture and migration of a suprarenal inferior vena cava filter in a pregnant patient.

Placement of retrievable inferior vena cava (IVC) filters as prophylaxis for pulmonary embolism (PE) is an increasingly attractive option for patients who require temporary IVC filtration. However, experience thus far with retrievable filters in pregnant patients is limited. This report describes a suprarenally placed Recovery IVC filter in a pregnant woman with PE despite therapeutic anticoagulation. After failed induction of labor and uneventful cesarean section, the patient returned for filter retrieval 167 days after initial placement. Fracture and inferior migration of the filter was observed, and subsequent attempts at filter retrieval were unsuccessful.

Right lower quadrant pain: value of the nonvisualized appendix in patients at multidetector CT.

PURPOSE: To retrospectively determine the value of the nonvisualized appendix at multidetector computed tomography (CT) in patients with acute right lower quadrant pain in whom appendicitis was a consideration. MATERIALS AND METHODS: Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent. Records were retrospectively reviewed in patients who presented to the emergency department between April 29 and October 31, 2003, with right lower quadrant pain. Scanning was performed with the same eight-detector row CT scanner by using oral and (unless contraindicated) intravenous contrast agents, and transverse and coronal reformations were obtained. Two radiologists prospectively evaluated all scans at the time of the examination and rendered a consensus opinion. Clinical follow-up of at least 3 months' duration was performed retrospectively for patients whose appendix was not visualized to determine whether appendicitis had developed. Statistical analysis and calculation of percentages with confidence intervals (CIs) were performed. RESULTS: Of the 400 consecutive patients who underwent multidetector CT, 132 (33.0%) were male and 268 (67.0%) were female. Eighty patients (20.0%) had acute appendicitis and 79 (19.8%) had another cause for abdominal pain. A normal appendix with no other cause for pain was seen in 182 patients (45.5%). In 59 patients (14.8%), the appendix was not visualized. Of these 59 patients, 50 had adequate follow-up. Clinical follow-up was uneventful in 49 of these 50 patients. Thus, on otherwise normal multidetector CT scans in patients suspected of having acute appendicitis, nonvisualization of the appendix was negative for appendicitis in 98% (95% CI: 71%, 100%) of cases. Conversely, when the appendix was seen at multidetector CT and was abnormal, appendicitis was present in 95% (95% CI: 72%, 100%) of cases. CONCLUSION: In patients with right lower quadrant pain, a nonvisualized appendix at multidetector CT reliably excludes acute appendicitis.

Prevalência de adenocarcinoma do esôfago e da junçäo esofagogástrica durante 10 anos nun centro de referência para câncer no Sul do Brasil / Prevalence of adenocarcinoma of the esophagus and esophagogastric junction during a 10 year period in a cancer referral center in Southern Brazil

A incidência do adenocarcinoma do esôfago e junção esofagogástrica tem aumentado dramaticamente nos EUA e na Europa, mas dados epidemiológicos no Brasil são escassos. Objetivo e métodos - Foram revisados os casos de câncer envolvendo o esôfago e confirmados, histologicamente, num período de 10 anos (1987-1996) obtidos por biopsia durante endoscopia digestiva alta, para determinar a prevalência desse tumor em um centro médico de referência para câncer, no Sul do Brasil. Os casos de câncer foram classificados em três categorias: adenocarcinoma, carcinoma epidermóide e outros. Resultados - Entre 349 casos de câncer; encontrou-se adenocarcinoma em 53 (15,2 por cento), carcinoma epidermóide em 283 (81,1 por cento) e outras neoplasias em 13 (3,7 por cento). Conclusões - A prevalência encontrada de adenocarcinoma na população estudada foi de 15 por cento.