RESUMO
OBJECTIVE: To evaluate the efficacy of densitometric analysis of cranial CT imaging in the measurement of areas with low cerebral blood flow and lack of hemodynamic reserve in patients undergoing carotid endarterectomy. PATIENTS AND METHODS: 40 consecutive patients undergoing carotid endarterectomy have been included in the study. All of them had preoperative cranial CT, pre and postoperative basal and acetazolamide SPECT. Cranial CT imaging after digitalization and computer processing were obtained with 4 densitometric patterns: 1). normal cerebral blood perfusion; 2). ischemic or low brain blood perfusion (patron I); 3). parenchyma without cerebral hemodynamic reserve (patron nR), and 4). brain infarction. RESULTS: 32 out of 40 (80 %) patients had abnormal densitometric patterns: 19 nR patterns (47.5 %), 11 I pattern (27.5 %) and 2 established brain infarction. The correlation between densitometric cranial TC imaging and SPECT was 92% when analyzing areas with hypoperfusion (S: 96.5 %; E: 82 %). Cranial CT detected 12/13 of patients who lacked cerebral hemodynamic reserve in the SPECT analysis (S: 74 %; E: 92 %; Vpp: 95 %). CONCLUSIONS: There is a good correlation between analysis of densitometric cranial TC imaging and SPECT in determining low cerebral blood flow areas and lack of cerebral hemodynamic reserve. This method could help to improve carotid surgery indications in patients with carotid stenosis.
Assuntos
Encéfalo , Endarterectomia das Carótidas/métodos , Tomografia Computadorizada por Raios X , Idoso , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/cirurgia , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada de Emissão de Fóton ÚnicoAssuntos
Fármacos Anti-HIV/farmacologia , Resistência Microbiana a Medicamentos , HIV/efeitos dos fármacos , Fármacos Anti-HIV/uso terapêutico , Resistência Microbiana a Medicamentos/genética , Feminino , Genes Virais , HIV/genética , HIV/fisiologia , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Espanha , Replicação Viral/efeitos dos fármacos , Replicação Viral/genéticaRESUMO
A case of spontaneous acute infrarenal aortic dissection, with extension to the right common iliac artery and proximally to just below the origin of the renal arteries is presented. This dissection did not involve the visceral vessels nor the iliac system. The diagnosis was made with ultrasonography and computed tomography, without the need for angiography, and confirmed during surgical intervention, in which, prosthetic replacement of the affected segment was carried out.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Dissecção Aórtica/cirurgia , Doença Aguda , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/patologia , Aorta Abdominal/patologia , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/patologia , Implante de Prótese Vascular , Diagnóstico por Imagem , Humanos , Artéria Ilíaca/patologia , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-IdadeAssuntos
Candidíase/diagnóstico , Dependência de Heroína/complicações , Vértebras Lombares/microbiologia , Osteomielite/microbiologia , Espondilite/microbiologia , Vértebras Torácicas/microbiologia , Adulto , Candida/isolamento & purificação , Candidíase/complicações , Heroína , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Osteomielite/complicações , Osteomielite/diagnóstico , Abscesso do Psoas/complicações , Abscesso do Psoas/microbiologia , Radiografia , Espondilite/complicações , Espondilite/diagnóstico , Vértebras Torácicas/diagnóstico por imagemRESUMO
We report a series of 37 patients with upper gastrointestinal fistulas, from a total of 90 postoperative fistulas, treated in our Department over a period of five years (1987-1991). 46% of these originated after peptic ulcer surgery. Most patients (54%) required surgical intervention mainly due to the presence of major intraabdominal sepsis, and only 12 (32.4%) had spontaneous fistula closure. Morbidity (59.4%) and mortality rates (32.4%) were high.
Assuntos
Duodenopatias/etiologia , Doenças do Esôfago/etiologia , Fístula/etiologia , Fístula Gástrica/etiologia , Fístula Intestinal/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Primary spleen angiosarcoma is a malignant neoplasia based on vascular tissue and it is a rare tumor (65 cases published). The clinical aspects are obscure and the specific diagnosis is made by laparotomy. The prognosis is very poor in any case and survival isn't more than two years, whenever the spleen undergoes spontaneous rupture in which case the survival should be less than six months. The splenectomy before rupture could increase survival. Patients with or without metastatic disease may be treated by chemotherapy but with poor results. Radiotherapy is used for relief the pain produced for bone metastasis.
Assuntos
Hemangiossarcoma , Neoplasias Esplênicas , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/cirurgiaRESUMO
The reactive hemophagocytic syndrome is a rare clinical-pathological entity which usually has a benign evolution and which is characterized by the systemic proliferation of mature histiocytes, with a great phagocytosis ability and which occurs in a secondary form in some infections and neoplasias and after the administration of certain drugs. We present a case of reactive hemophagocytic syndrome in a patient presenting a non-Hodgkin lymphoma, of crest malignancy, B immunoblastic and kappa monoclonal, with fatal evolution and in which the diagnosis was obtained after necropsy.
