CT-based pathological lung opacities volume as a predictor of critical illness and inflammatory response severity in patients with COVID-19.

Objective: The aim of the study was to assess the impact of CT-based lung pathological opacities volume on critical illness and inflammatory response severity of patients with COVID-19. Methods: A retrospective, single center, single arm study was performed over a 30-day period. In total, 138 patients (85.2%) met inclusion criteria. All patients were evaluated with non-contrast enhanced chest CT scan at hospital admission. CT-based lung segmentation was performed to calculate pathological lung opacities volume (LOV). At baseline, complete blood count (CBC) and inflammation response biomarkers were obtained. The primary endpoint of the study was the occurrence of critical illness, as defined as, the need of mechanical ventilation and/or ICU admission. Mann-Whitney U test was performed for univariate analysis. Logistic regression analysis was performed to determine independent predictors of critical illness. Spearman analysis was performed to assess the correlation between inflammatory response biomarkers serum concentrations and LOV. Results: Median LOV was 28.64% (interquartile range [IQR], 6.33-47.22%). Correlation analysis demonstrated that LOV was correlated with higher levels of D-dimer (r = 0.51, p < 0.01), procalcitonin (r = 0.47, p < 0.01) and IL6 (r = 0.48, p < 0.01). Critical illness occurred in 51 patients (37%). Univariate analysis demonstrated that inflammatory response biomarkers and LOV were associated with critical illness (p < 0.05). However, multivariate analysis demonstrated that only D-dimer and LOV were independent predictors of critical illness. Furthermore, a ROC analysis demonstrated that a LOV equal or greater than 60% had a sensitivity of 82.1% and specificity of 70.2% to determine critical illness with an odds ratio of 19.4 (95% CI, 4.2-88.9). Conclusion: Critical illness may occur in up to 37% of the patients with COVID-19. Among patients with critical illness, higher levels of inflammatory response biomarkers with larger LOVs were observed. Furthermore, multivariate analysis demonstrated that pathological lung opacities volume was an independent predictor of critical illness. In fact, patients with a pathological lung opacities volume equal or greater than 60% had 19.4-fold increased risk of critical illness.

Computed Tomography-based Lung Residual Volume and Mortality of Patients With Coronavirus Disease-19 (COVID-19).

RATIONALE AND OBJECTIVES: To assess the effect of computed tomography (CT)-based residual lung volume (RLV) on mortality of patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: A single-center, retrospective study of a prospectively maintained database was performed. In total, 138 patients with COVID-19 were enrolled. Baseline chest CT scan was performed in all patients. CT-based automated and semi-automated lung segmentation was performed using the Alma Medical workstation to calculate normal lung volume, lung opacities volume, total lung volume, and RLV. The primary end point of the study was mortality. Univariate and multivariate analyses were performed to determine independent predictors of mortality. RESULTS: Overall, 84 men (61%) and 54 women (39%) with a mean age of 47.3 years (±14.3 y) were included in the study. Overall mortality rate was 21% (29 patients) at a median time of 7 days (interquartile range, 4 to 11 d). Univariate analysis demonstrated that age, hypertension, and diabetes were associated with death (P<0.01). Similarly, patients who died had lower normal lung volume and RLV than patients who survived (P<0.01). Multivariate analysis demonstrated that low RLV was the only independent predictor of death (odds ratio, 1.042; 95% confidence interval, 10.2-10.65). Furthermore, receiver operating characteristic curve analysis demonstrated that a RLV ≤64% significantly increased the risk of death (odds ratio, 4.8; 95% confidence interval, 1.9-11.7). CONCLUSION: Overall mortality of patients with COVID-19 may reach 21%. Univariate and multivariate analyses demonstrated that reduced RLV was the principal independent predictor of death. Furthermore, RLV ≤64% is associated with a 4-fold increase on the risk of death.

Enlarged adipocytes from subcutaneous vs. visceral adipose tissue differentially contribute to metabolic dysfunction and atherogenic risk of patients with obesity.

Morphological characteristics and source of adipose tissue as well as adipokines may increase cardiometabolic risk. This study aimed to explore whether adipose tissue characteristics may impact metabolic and atherogenic risks. Subcutaneous Adipose Tissue (SAT), Visceral Adipose Tissue (VAT) and peripheral blood were obtained from obese patients submitted to bariatric surgery. Adipose tissue (morphometry), plasma adiponectin, TNF-α, resistin (multiplexing) and biochemical chemistry were analyzed; as well as endothelial dysfunction (Flow Mediated Dilation, FMD) and atherogenesis (Carotid Intima Media Thickness, CIMT). Subgroups divided by adipocyte size and source were compared; as well as correlation and multivariate analysis. Sixty patients 36.6% males, aged 44 years-old, BMI 46.7 kg/m2 were included. SAT's adipocytes showed a lower range of size expandability than VAT's adipocytes. Independent from their source, larger adipocytes were associated with higher glucose, lower adiponectin and higher CIMT. Particularly, larger adipocytes from SAT were associated with higher blood pressure, lower insulin and HDL-cholesterol; and showed positive correlation with glucose, HbA1c, systolic/diastolic values, and negatively correlated with insulin and adiponectin. VAT's larger adipocytes particularly associated with lower resistin and lower FMD values. Gender and Diabetes Mellitus significantly impacted the relation of adipocyte size/source with the metabolic and atherogenic risk. Multivariable analysis suggested hypertension-resistin-HbA1c interactions associated with SAT's larger adipocytes; whereas potential insulin-adiponectin associations were observed for VAT's larger adipocytes. Adipocyte morphology and source are differentially related with cardiometabolic and atherogenic risk in population with obesity, which are potentially affected by gender and Diabetes Mellitus.

CT-Based Hepatic Residual Volume and Predictors of Outcomes of Patients with Hepatocellular Carcinoma Unsuitable for Surgical Therapy Undergoing Transarterial Chemoembolization.

RATIONALE AND OBJECTIVES: To assess the association between baseline CT-based volumetric parameters and biochemical hepatic evaluations, such as, Child-Pugh, MELD score, and modified MELD-Na score, on the prediction of outcomes of patients with HCC undergoing transarterial chemoembolization (TACE). MATERIALS AND METHODS: A retrospective of a prospectively maintained database, single arm, and single center study was performed including 41 patients with diagnosis of hepatocellular carcinoma treated with TACE. Study endpoints included liver dysfunction (new events of ascites, encephalopathy, and/or death) and overall survival rate. Multi-phase CT-based volumetric analysis was performed to calculate total liver volume and tumor volume using portal and late arterial phases, respectively. Residual volume was calculated subtracting the tumor volume minus the total liver volume. Child-Pugh, MELD score, and MELD-Na score were measured during the baseline evaluation. RESULTS: At a median follow-up time of 8 months (IQR, 5-14), 16 patients (39%) were diagnosed with hepatic dysfunction. In patients with hepatic dysfunction, the median residual hepatic volume was 1002.1 cc (IQR, 633-1077.1 cc) compared to patients with normal liver function post-TACE with a median residual volume of 1233 cc (IQR, 1018.7-1437.6 cc) (p = 0.02). Survival analysis demonstrated an overall survival rate of 95%, 90%, 85% at 30 days, 12 months, and 24 months, respectively. The overall survival rate in patients with Child-Pugh A was 100%, 97%, and 97% at 6, 12, and 24 months, respectively; compared to patients with Child Pugh B with an overall survival of rate of 86%, 78%, and 78% at 6, 12, and 24 months, respectively (p = 0.07). Median baseline MELD-Na score was higher in patients that died during the study period compared to patients that survived (6.7 [IQR, 5-14.2] versus 4.1 [IQR, 2.14-6.85]) (p = 0.09). CONCLUSION: Low baseline CT-based residual volume is associated with the occurrence of hepatic dysfunction at a median time of 8 months. Baseline Child-Pugh A patients were found to have higher survival rate than Child-Pugh B. Interestingly, higher baseline MELD-Na score was associated with mortality.

Hepatocellular carcinoma: epidemiological profile from a cohort of federal employees in Mexico.

INTRODUCTION: Hepatocellular carcinoma (HCC) has become a frequent type of cancer in Mexico. At the present time it represents the 19th cause of death in the population. OBJECTIVE: To recognize the epidemiological profile and the treatment results in a cohort of federal employees with HCC. MATERIAL AND METHODS: We analyzed 47 consecutive cases with HCC diagnosis from January 2004 till December 2007. Twenty four demographic data, tumor staging, clinical, and biochemical variables were analyzed to identify parameters predicting survival by computing Kaplan-Mier and Mantel-Cox survival curves. RESULTS: Patient reference increased 5% each year. The mean age was 60.4 years, 63.8% female sex, and 72.3% had cirrhosis, 44.7% had Hepatitis C infection. Most patients presented with advanced disease: 55.3% were AJCC stage 3 and 21.3% stage 4, 51.1% were BCLC class D. Mean tumor size was 8.09 cm. Median survival time from diagnosis was 122 days. Patients that did not receive treatment had a median survival of 70 days; the longest survival of patients was of those that received transarterial chemoembolization with a median of 707 days, followed by surgery with 683 days. Univariate analysis showed survival was associated to MELD score, AJCC and BCLC staging, creatinine level and ascites. Multivariate analysis showed tumor differentiation, AJCC staging and the choice of treatment to be related to the risk of death. CONCLUSION: An increase in the referral of HCC was demonstrated. Most patients had cirrhosis and HCV infection. Due to advance disease staging, TACE was the treatment that offered longest survival.

Procesos hemorrágicos hepáticos no traumáticos. Utilidad de la tomografía axial computada / Non traumatic liver hemorrhagic process. CT evaluation

Se estudiaron 42 pacientes (17 hombres y 25 mujeres), dos de ellas embarazadas y una en puerperio, para valorar la utilidad de la TAC en la detección de procesos hemorrágicos no traumáticos (PHNT) en 42 hepatopatías locales y difusas asociadas a hepatomegalia y masas palpables subcostales. Dieciocho pacientes (43 por ciento) presentaron PHNT. En 12 casos, sospechados por clínica, laboratorio, rayos X y US (67 por ciento) y en otros 15 por TAC (83 por ciento). Dos requirieron arteriografías (11 por ciento) y uno RM (6 por ciento) ante tomografías dudosas. Tres PHNT se localizaron en segmento hepático IV, tres en IV y V, dos en el VI, once en ambos hemihígados y uno en hemihígado izquierdo. Los PHNT se comprobaron mediante biopsia, estudios postmorten, aspiración dirigida o laparotomía. El US proporcionó imagen diagnóstica de la hepatopatía en 86 por ciento de los casos (36/42) y la TAC en 93 por ciento (39/42). Se destaca la utilidad de la TAC para sospechar PHNT en adenoma hepatocelular (3/3), hematomas de embarazo y puerperio (3/3), quistes hepáticos (1/4), policistosis (2/2), y colangiocarcinoma (1/1), así como sus limitaciones en hemangiomas gigantes (2/7) y metástasis (2/10)

Diagnóstico del volvulus de la vesícula / Diagnosis of torsion gallblader

Se estudiaron seis pacientes en los que se estableció el diagnóstico preoperatorio de vólvulus de la vesícula biliar, que fueron operados oportunamente y que tuvieron evolución postoperatoria satisfactoria.Constituyeron el 1.96 por ciento de 306 colecistopatías agudas y el 0.18 por ciento de 3240 cirugías biliares.Clínicamente se sospechó el vólvulus por dolor cólico brusco,vómitos tempranos simultáneos con el dolor, masa palpable precoz en el hipocondrio derecho, ausencia de signos de toxicidad, edad avanzada y constitución delgada.Debido a que la información diagnóstica de los estudios radiológicos y de los métodos no invasivos es escasa o nula, el cirujano debe recurrir a la clínica,exámenes de laboratorio de rutina,así como a la radiografía simple de abdomen para llegar a la decisión quirúrgica de urgencia en el vólvulus de la vesícula biliar.

Cirugía del cáncer proximal de la vía biliar y de la confluencia de los hepáticos / Surgical treatment for carcinoma at the confluence of the mayor hepatic ducts

Se analizaron las técnicas quirurgicas, morbilidad, mortalidad y supervivencias en 34 casos de cancer proximal de la vía biliar y de la confluencia de los hepáticos. Se integro un Grupo 1 de ocho pacientes sin neoplasia vesicular y pocas repercuciones hepáticas y generales y un Grupo II, de 26,con tumoreción en área vesicular y mayores repercusiones en hígado,funcionales y metastásicas. En el primer grupo, con seis resecciones del tumor, dos segmentectomías IV y dos derivaciones biliodigestivas bilaterales, la mortalidad fue de 12.5 por ciento. En las resecciones la supervivencia promedio fue de 21 meses y no hubo morbilidad postoperatoria y en las derivaciones fue de 12 a 16 meses, también sin complicaciones. En el grupo II, en las derivaciones e intubaciones transtumorales. la mortalidad fue de 15.25 por ciento. Dos muertes en seis intubaciones transtumorales y tres comas postoperatorios en ocho derivaciones biliodigestivas modificadas de Longmire.En una técnica original de anastomosis hepáticoyeyunal sero-serosa no hubieron muertes ni complicaciones postoperatorias en 12 pacientes. La supervivencia promedio del Grupo II fue de 15.25 meses.

Pancreatitis aguda asociada a microcáculos biliares en el conducto de Wirsung / Acute pancreatitis associated to biliary microcalculi in the Wirsung duct

En 8 casos quirúrgicos y 2 de estudios post-mortem, se describe el perfil clínico patológico de una forma de pancreatitis aguda asociada a microcálculos bibliares en el conducto de Wirsung, demostrados por estudios radiológicos operatorios o directamente por la necropsia. Variaron de 1 a 4 mm.Se localizaron en la parte distal de Wirsung (1/10) y en toda su extensión (10/10) el cual presentó un diámetro promedio de 7 mm. Hubo estenosis de Oddi (10/10) y de la desembocadura del Wirsung (2/10), dilatación del colédoco (10/10), éstasis de bilis (10/10) y congestión hepática (4/10), esteatonecrosis pancreáticas 810/10), histológicamente: necrosis, pérdida del patrón celular, infiltración inflamatoria aguda y zonas hemorrágicas. La pancreatitis aguda, clínica y bioquímica fue más intensa que la observada en obstrucciones biliares sin microcálculos en el Wirsung. Se señalan las diferencias entre estas observaciones y las otras de pancreatitis asociada a litiasis del Wirsung que aparecen en la literatura y se comentan los factores etiopatogénicos involucrados.