RESUMO
OBJECTIVES: The aim of the present study was to determine the long-term prognostic value provided by the exercise electrocardiographic (ECG) response to nuclear myocardial perfusion imaging (MPI) in the evaluation of patients with chest pain, focusing on patients with a discrepancy between the two tests. METHODS: A total of 1460 consecutive patients (777 female; 62.6 ± 11.4 years) undergoing exercise myocardial single-photon emission computed tomography (SPECT) were included. The endpoint was the occurrence of acute coronary syndrome, heart failure or cardiac death during follow-up. RESULTS: Ischemic ECG changes were observed during stress testing in 271 patients (18.5%) and 362 patients (24.7%) had positive (abnormal) exercise MPI results. There was a discrepancy between ECG and SPECT findings in 471 patients (32.2%). During the follow-up period (14.0-39.6 months), 224 patients (15.3%) presented cardiac events. The hazard ratios (HR) of ECG and MPI results to predict events were 1.506 (95% CI: 1.113-2.039) and 10.481 (95% CI: 7.799-14.080), respectively. In patients with negative MPI, the ECG response did not predict events (HR 1.214 [95% CI: 0.646-2.282]), the same as in patients with positive MPI (HR 1.203 [95% CI: 0.848-1.705]). Only in hypertensive patients with positive SPECT did the ECG show significant prognostic value (HR 1.937 [95% CI: 1.030-3.642]). In multivariate analysis, positive MPI proved an independent long-term prognostic factor (HR 10.536 [95% CI: 7.759-14.308]), but not ECG (HR 1.356 [95% CI: 0.994-1.850]). CONCLUSION: MPI results (normal vs. abnormal) had strong predictive value and discrepant ECG results had no significant additive prognostic value.
Assuntos
Dor no Peito/diagnóstico por imagem , Dor no Peito/etiologia , Eletrocardiografia , Teste de Esforço , Imagem de Perfusão do Miocárdio , Tomografia Computadorizada de Emissão de Fóton Único , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de TempoRESUMO
Poorly differentiated follicular thyroid carcinoma (PDFC) is a tumor of follicular cell origin with intermediate attributes between well-differentiated carcinomas and anaplastic carcinomas. The majority of patients presenting with distant metastases have locally advanced tumors, being lungs and bones the most common sites affected. We present a case of a patient with a painful bulky mass at the left thorax-abdominal wall as an uncommon distant metastasis of a PDFC. After thyroidectomy, a pre-ablative 131I whole-body scan showed distant metastases on the neck, both lungs, and lateral chest-abdominal wall, so the administration of I for thyroid remnant ablation stimulated with RH-TSH was decided.
Assuntos
Adenocarcinoma Folicular/patologia , Diferenciação Celular , Adenocarcinoma Folicular/cirurgia , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Feminino , Humanos , Metástase Neoplásica , Glândula Tireoide/patologia , Tireoidectomia , Imagem Corporal TotalAssuntos
Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Radiografia Abdominal , Radiografia Torácica , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Hepatomegalia/diagnóstico , Humanos , Imuno-Histoquímica , Fígado/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/diagnóstico , Masculino , Síndrome do Carcinoide Maligno/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/secundário , Palpação , Cintilografia , Somatostatina/análogos & derivadosRESUMO
No disponible
Assuntos
Adulto , Idoso , Pessoa de Meia-Idade , Humanos , Embolia Pulmonar/diagnóstico , Relação Ventilação-Perfusão/fisiologia , Tomografia Computadorizada por Raios X , Espectrometria gamaRESUMO
Tumours that produce metastases in the paranasal sinuses or sphenoidal sinus are rare; the carcinomas of kidney and lung being the most frequent with this type of metastasis. Distant metastases from differentiated thyroid carcinoma are rare and, moreover, when they metastasize, they do so into lung and bone. We report a patient who had a papillary thyroid carcinoma with metastases into the sphenoidal sinus.
Assuntos
Carcinoma Papilar/secundário , Neoplasias dos Seios Paranasais/secundário , Seio Esfenoidal/patologia , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/radioterapia , Carcinoma Papilar/cirurgia , Terapia Combinada , Irradiação Craniana , Diplopia/etiologia , Feminino , Cefaleia/etiologia , Humanos , Histerectomia , Radioisótopos do Iodo/uso terapêutico , Leiomioma/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Segunda Neoplasia Primária , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/radioterapia , Neoplasias dos Seios Paranasais/cirurgia , Cintilografia , Compostos Radiofarmacêuticos/uso terapêutico , Radioterapia Adjuvante , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Neoplasias Uterinas/cirurgiaRESUMO
Tumours that produce metastases in the paranasal sinuses or sphenoidal sinus are rare; the carcinomas of kidney and lung being the most frequent with this type of metastasis. Distant metastases from differentiated thyroid carcinoma are rare and, moreover, when they metastasize, they do so into lung and bone. We report a patient who had a papillary thyroid carcinoma with metastases into the sphenoidal sinus
