LI-RADS 4 or 5 categorization may not be clinically relevant for decision-making processes: A prospective cohort study.

INTRODUCTION AND OBJECTIVES: The liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center. MATERIALS AND METHODS: Prospective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1). RESULTS: Of 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18-90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59-98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64-87) had confirmed HCC, 17% with microvascular invasion. CONCLUSIONS: LI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.

Empiema del Muñón Ureteral: Secretos Para un Buen Diagnóstico / Empyema of the Ureteral Stump: Secrets for a Correct Diagnosis

El muñón ureteral es el segmento de uréter remanente posterior a una nefrectomía, que puede, ocasionalmente, dar origen a un cuadro sintomático infeccioso poco frecuente, conocido como empiema del muñón ureteral (EMU). El mismo suele atribuirse a otra patología por desconocimiento médico y no es reconocido hasta que el cuadro clínico avanza significativamente o se realiza la exploración quirúrgica. Los muñones ureterales que se encontraban sanos en la cirugía inicial no suelen desarrollar patología. Por el contrario, los uréteres obstruidos, crónicamente infectados o asociados a litiasis o reflujo distal, son los que se encuentran en riesgo de desarrollar complicaciones futuras. En esta revisión, se repasa la literatura y se presentan casos de pacientes con antecedentes de nefrectomía que por diferentes causas transcurrieron con empiema en el muñón ureteral, con el fin de analizar las posibles causas y factores predisponentes de la patología, describir los hallazgos radiológicos en los diferentes métodos diagnósticos y poder reconocer las posibles complicaciones para su correcto manejo terapéutico. Las infecciones urinarias a repetición son útiles para sospechar la presencia de EMU. Ellas se deben al reflujo urinario o disfunción en el vaciamiento del uréter remanente, con estasis e infección del mismo. Por lo tanto, en pacientes con antecedentes de nefrectomía que presentan dolor abdominal difuso, fiebre y antecedentes de infecciones urinarias a repetición, es necesario sospechar empiema del muñón ureteral para poder realizar un correcto análisis imagenológico y posterior tratamiento.

The ureteral stump is the segment of the ureter that remains after a nephrectomy, and it can occasionally give rise to a rare symptomatic infectious disorder known as an empyema of the ureteral stump. The syndrome is usually attributed to another disease due to the radiologist's or ED physician's unawareness, and diagnosis is delayed until there is significant clinical progression, complimentary images or exploratory surgery is performed. Ureteral stumps that were healthy at the initial surgery, usually do not pose further problems. On the other hand, ureters that are obstructed, chronically infected or associated with nephrolithiasis or distal reflux, are at risk for developing future complications. This review goes over the available literature on the subject and presents cases of patients who underwent a nephrectomy and, for different reasons, developed an empyema of the ureteral stump in order analyze the possible causes and predisposing factors, describing the main radiologic findings in each of the different imaging modalities, and recognize the possible complications and their according therapeutic management. Repeated urinary tract infections are useful for suspecting the presence of an empyema, and are due to vesicoureteral reflux or ureteral dysfunction, with consequent urinary stasis and infection. Thus, patients with a history of nephrectomy presenting with diffuse abdominal pain, fever and repeat urinary infections, should raise the suspicion of empyema of the ureteral stump, leading to a correct imaging analysis and posterior treatment.

Encefalomiopatía mitocondrial, acidosis láctica y episodios de accidente cerebrovascular, síndrome de MELAS. Reporte de un caso clínico / Mitochondrial encephalomyopathy lactic acidosis and stroke like episodes MELAS syndrome. Report of a clinical case

Las enfermedades mitocondriales producen una serie de desórdenes neurológicos que se heredan por parte materna, el síndrome de MELAS es considerado un raro desorden multisistémico neurodegenerativo de muy mal pronóstico, posee una incidencia de 16,3/100 000 casos, este síndrome se manifiesta antes de los 40 años, caracterizado por cuadros convulsivos, alteración del estado de conciencia, acidosis láctica, y accidentes cerebrovasculares, estas manifestaciones suelen ser evidentes en los estadíos avanzados, lo que dificulta su diagnóstico; siendo necesario un equipo multidisciplinario, donde los estudios de laboratorio y las técnicas imagenológicas juegan un papel fundamental. Les presentamos el caso de un paciente masculino de 29 años que acudió a emergencia del Hospital Central de Mendoza-Argentina con antecedentes de madre y hermana fallecidas. Tanto la tomografía como la resonancia magnética evidenciaron zonas infartadas de localización temporo-parieto-occipital, acompañado de calcificaciones en los núcleos basales, llegando al diagnóstico de síndrome de MELAS, para el cual no existe un tratamiento definitivo sólo paliativo

Mitochondrial diseases are neurological disorders that are inherited maternally, the MELAS syndrome is considered a rare multisystem neurodegenerative disorder with a poor prognosis, has an incidence of 16,3 / 100 000 cases, this syndrome is manifested before age 40 years, characterized by convulsive, altered state of consciousness, lactic acidosis, and stroke, these manifestations are usually evident in advanced stages, making it difficult to diagnosis; being necessary equipment multi-disciplinary where laboratory studies and imaging techniques play a fundamental role. We present the case of a male patient of 29 years, who attended in Emergency of Hospital Central Mendoza-Argentina with a history of mother and sister dead. Both Computed tomography and Magnetic resonance showed infarcted areas with localization temporo-parieto-occipital, accompanied by calcifications in the basal nuclei, reaching the diagnosis of MELAS. for this syndrome there is not definitive treatment, only palliative.

Transport and health: a look at three Latin American cities.

Transport is associated with environmental problems, economic losses, health and social inequalities. A number of European and US cities have implemented initiatives to promote multimodal modes of transport. In Latin America changes are occurring in public transport systems and a number of projects aimed at stimulating non-motorized modes of transport (walking and cycling) have already been implemented. Based on articles from peer-reviewed academic journals, this paper examines experiences in Bogotá (Colombia), Curitiba (Brazil), and Santiago (Chile), and identifies how changes to the transport system contribute to encourage active transportation. Bus rapid transit, ciclovias, bike paths/lanes, and car use restriction are initiatives that contribute to promoting active transportation in these cities. Few studies have been carried out on the relationship between transport and physical activity. Car ownership continues to increase. The public health sector needs to be a stronger activist in the transport policy decision-making process to incorporate health issues into the transport agenda in Latin America.

Transport and health: a look at three Latin American cities / Transporte y salud: una mirada a tres ciudades latinoamericanas / Transporte e saúde: um olhar sobre três cidades latino-americanas

Transport is associated with environmental problems, economic losses, health and social inequalities. A number of European and US cities have implemented initiatives to promote multimodal modes of transport. In Latin America changes are occurring in public transport systems and a number of projects aimed at stimulating non-motorized modes of transport (walking and cycling) have already been implemented. Based on articles from peer-reviewed academic journals, this paper examines experiences in Bogotá (Colombia), Curitiba (Brazil), and Santiago (Chile), and identifies how changes to the transport system contribute to encourage active transportation. Bus rapid transit, ciclovias, bike paths/lanes, and car use restriction are initiatives that contribute to promoting active transportation in these cities. Few studies have been carried out on the relationship between transport and physical activity. Car ownership continues to increase. The public health sector needs to be a stronger activist in the transport policy decision-making process to incorporate health issues into the transport agenda in Latin America.

El transporte está asociado con problemas ambientales, pérdidas económicas, salud poblacional e inequidades sociales. En ciudades de Europa y Estados Unidos hay iniciativas para promover el transporte multimodal. En Latinoamérica hay proyectos en curso para cambiar los sistemas de transporte y estimular el transporte no motorizado (caminar y montar bicicleta). Basada en una revisión de artículos publicados en revistas académicas, se identifica de qué forma los cambios en el transporte en Bogotá (Colombia), Curitiba (Brasil) y Santiago (Chile) han contribuido a promover el transporte activo. A pesar que en estas tres ciudades se están implementando iniciativas para promover el transporte activo (sistema de autobuses articulados, ciclovías, ciclorutas, y restricciones para el uso del coche particular), pocos estudios han sido desarrollados sobre la relación entre el transporte y la actividad física utilitaria. La tenencia del coche particular continúa incrementándose. El sector de salud necesita ser un agente fuerte para incorporar la salud pública en la agenda de transporte en América Latina.

O transporte está associado a problemas ambientais, perdas econômicas, de saúde da população e as desigualdades sociais. Em cidades da Europa e da América existem esforços para promover o transporte multimodal. Na América Latina, há projetos em andamento para mudar os sistemas de transporte e incentivar o transporte não motorizado (caminhar e andar de bicicleta). Com base em uma revisão de artigos publicados em revistas acadêmicas identificou-se como as mudanças no transporte contribuíram para promover o transporte ativo em Bogotá (Colômbia), Curitiba (Brasil) e Santiago (Chile). Apesar de que nestas três cidades se estejam implementando iniciativas para promover o transporte ativo (sistema de ônibus articulado, ciclovias, pistas de ciclismo e restrições ao uso do automóvel particular), poucos estudos têm sido desenvolvidos sobre a relação entre transporte e atividade física utilitária. O uso de carro particular continua aumentando. O setor da saúde tem de ser um ativista forte para incorporar a saúde pública na agenda de transportes na América Latina.