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1.
HPB (Oxford) ; 18(8): 684-90, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27485063

RESUMO

OBJECTIVE: To investigate the long-term oncological outcome of patients with resectable hepatocellular carcinoma (HCC) undergoing sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE). METHODS: Analysis of all Child A HCC patients who underwent TACE-PVE before major liver resection from 2006 to 2012 was performed according to whether or not they underwent surgical resection as planned. RESULTS: 54 patients (50 men, 93% median 69-years (range 44-87)) were included. Thirty-nine (72%) patients underwent resection, including 19/25, 16/23, and 4/6 of patients with BCLC A, B, and C (p = 0.839). Twenty-two (56%) had tumor recurrence (median delay 10 months) including 9/19, 11/16, and 2/4 of the patients with BCLC A, B, and C (p = 0.430). Survival was significantly better in resected patients as compared to those who were not resected (median overall survival (OS): 44 vs. 18 months; p < 0.001). Recurrence was associated with a poorer prognosis as compared to patients without recurrence (median OS 43 months vs. not reached; p < 0.001). BCLC stage did not influence survival (p = 0.13). CONCLUSION: In patients with large unilobar HCC, TACE-PVE leads to resection in most patients, with a good oncological outcome regardless of the tumor burden. When this strategy fails, patients can be managed with TACE despite prior PVE.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Embolização Terapêutica/métodos , Hepatectomia , Artéria Hepática , Neoplasias Hepáticas/terapia , Terapia Neoadjuvante/métodos , Veia Porta , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/secundário , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/mortalidade , Quimioterapia Adjuvante , Bases de Dados Factuais , Progressão da Doença , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/mortalidade , Feminino , Hepatectomia/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/mortalidade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
2.
J Ultrasound Med ; 34(8): 1445-52, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26206831

RESUMO

OBJECTIVES: The purpose of this article is to show the anatomic variations of extensor tendon synovial sheaths in the wrist. METHODS: Videos from 157 patients that were available in the electronic database were reviewed. Sonography showed involvement of 186 tendon sheaths. RESULTS: We describe our center's experience with most tendon variants described in the literature and show the sonographic appearance of the most frequent ones. CONCLUSIONS: Sonography is an accepted, safe, and efficient method for evaluating conditions characterized by effusion into the synovial sheaths of the wrist extensor tendons. Knowledge of anatomy and anatomic abnormalities of these sheaths is essential for diagnosis and for correct ultrasound-guided injection therapy or, less frequently, planning a surgical approach.


Assuntos
Membrana Sinovial/anormalidades , Membrana Sinovial/diagnóstico por imagem , Tendões/anormalidades , Tendões/diagnóstico por imagem , Ultrassonografia/métodos , Punho/anormalidades , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Punho/diagnóstico por imagem , Adulto Jovem
3.
Eur J Radiol ; 84(5): 816-22, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25703650

RESUMO

PURPOSE: To compare qualitative and quantitative magnetic resonance (MR) imaging characteristics of hepatic hemangiomas in patients with normal, fibrotic and cirrhotic livers. MATERIALS AND METHODS: Retrospective, institutional review board approved study (waiver of informed consent). Eighty-nine consecutive patients with 231 hepatic hemangiomas who underwent liver MR imaging for lesion characterization were included. Lesions were classified into three groups according to the patients' liver condition: no underlying liver disease (group 1), fibrosis (group 2) and cirrhosis (group 3). Qualitative and quantitative characteristics (number, size, signal intensities on T1-, T2-, and DW MR images, T2 shine-through effect, enhancement patterns (classical, rapidly filling, delayed filling), and ADC values) were compared. RESULTS: There were 160 (69%), 45 (20%), and 26 (11%) hemangiomas in groups 1, 2 and 3, respectively. Lesions were larger in patients with normal liver (group 1 vs. groups 2 and 3; P=.009). No difference was found between the groups on T2-weighted images (fat-suppressed fast spin-echo (P=.82) and single-shot (P=.25)) and in enhancement patterns (P=.56). Mean ADC values of hemangiomas were similar between groups 1, 2 and 3 (2.11±.52×10(-3) mm(2)/s, 2.1±.53×10(-3) mm(2)/s and 2.14±.44×10(-3) mm(2)/s, P=87, respectively). T2 shine-through effect was less frequently observed in cirrhosis (P=.02). CONCLUSION: MR imaging characteristics of hepatic hemangioma were similar in patients with normal compared to fibrotic and cirrhotic livers. Smaller lesion size was observed with liver disease and less T2 shine-through effect was seen in hemangiomas developed on cirrhosis, the latter being an important finding to highlight in these patients at risk of developing hepatocellular carcinoma.


Assuntos
Hemangioma/patologia , Cirrose Hepática/diagnóstico , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Eur Radiol ; 25(2): 346-58, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25231131

RESUMO

OBJECTIVES: To prospectively assess the stiffness of incidentally discovered focal liver lesions (FLL) with no history of chronic liver disease or extrahepatic cancer using shearwave elastography (SWE). METHODS: Between June 2011 and May 2012, all FLL fortuitously discovered on ultrasound examination were prospectively included. For each lesion, stiffness was measured (kPa). Characterization of the lesion relied on magnetic resonance imaging (MRI) and/or contrast-enhanced ultrasound, or biopsy. Tumour stiffness was analysed using ANOVA and non-parametric Mann-Whitney tests. RESULTS: 105 lesions were successfully evaluated in 73 patients (61 women, 84%) with a mean age of 44.8 (range: 20‒75). The mean stiffness was 33.3 ± 12.7 kPa for the 60 focal nodular hyperplasia (FNH), 19.7 ± 9.8 k Pa for the 17 hepatocellular adenomas (HCA), 17.1 ± 7 kPa for the 20 haemangiomas, 11.3 ± 4.3 kPa for the five focal fatty sparing, 34.1 ± 7.3 kPa for the two cholangiocarcinomas, and 19.6 kPa for one hepatocellular carcinoma (p < 0.0001). There was no difference between the benign and the malignant groups (p = 0.64). FNHs were significantly stiffer than HCAs (p < 0.0001). Telangiectatic/inflammatory HCAs were significantly stiffer than the steatotic HCAs (p = 0.014). The area under the ROC curve (AUROC) for differentiating FNH from other lesions was 0.86 ± 0.04. CONCLUSION: SWE may provide additional information for the characterization of FFL, and may help in differentiating FNH from HCAs, and in subtyping HCAs. KEY POINTS: • SWE might be helpful for the characterization of solid focal liver lesions • SWE cannot differentiate benign from malignant liver lesions • FNHs are significantly stiffer than other benign lesions • Telangiectatic/inflammatory HCA are significantly stiffer than steatotic ones.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Adenoma de Células Hepáticas/diagnóstico por imagem , Adulto , Idoso , Biópsia/métodos , Carcinoma Hepatocelular/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Métodos Epidemiológicos , Feminino , Hiperplasia Nodular Focal do Fígado/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Adulto Jovem
6.
J Clin Ultrasound ; 42(9): 560-1, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24865328

RESUMO

Pisiform bursitis is a disease often forgotten in both everyday practice and medical literature. The pisiform bursa is not constant; when present, it is located between the tendon of the flexor carpi ulnaris and pisiform bone. Bursitis causes pain in the medial side of the wrist and enters into the differential diagnosis of various diseases of this anatomic region, in particular, with enthesitis of the flexor carpi ulnaris and the ganglion of piso-pyramidal compartment. We present the sonographic appearance of pisiform bursitis in a symptomatic patient.


Assuntos
Bursite/diagnóstico por imagem , Pisciforme/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Adulto , Anti-Inflamatórios/uso terapêutico , Bursite/terapia , Diagnóstico Diferencial , Feminino , Humanos , Descanso , Ultrassonografia
7.
J Ultrasound ; 16(3): 119-21, 2013 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-24432161

RESUMO

PURPOSE: To demonstrate usefulness of ultrasonography evaluation of the nerves of the elbow and of the structures that more frequently might cause its compression. MATERIALS AND METHODS: Anatomic course of nerves, muscles, tendons, fibrous structures and bursae potentially associated with nerve compression syndromes were evaluated. Informed consent was obtained from each volunteer. RESULTS: Ulnar, median and radial nerves are always evaluable with ultrasonography as well as muscles and tendons potentially associated with nerve compression. The bursae cannot be sonographically explored unless distended by fluid. CONCLUSION: Ultrasonography is a reliable method for the evaluation of the nerves of the elbow and of the structures that might cause its compression.

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