RESUMO
BACKGROUND: Primary hyperparathyroidism is a commonly encountered illness that can usually be treated successfully with surgery. However, non-surgical ablation by either infusion of contrast media via angiography or percutaneous injection of ethanol has been reported from a few medical centers. METHODS: All patients undergoing non-surgical treatment of primary hyperthyroidism at the University of Oklahoma Health Sciences Center were identified and their records reviewed. RESULTS: We have used non-surgical techniques to treat three patients with primary hyperparathyroidism. The patients were considered poor surgical candidates or had persistent hypercalcemia after neck exploration. Hypercalcemia was improved or cured in each of the patients without recurrence. CONCLUSIONS: Our application of these techniques indicates that centers without extensive experience can successfully employ angiographic or ethanol ablation of parathyroid adenomas.
Assuntos
Etanol/uso terapêutico , Hiperparatireoidismo/terapia , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Feminino , Humanos , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/etiologia , Injeções , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/terapia , Estudos RetrospectivosRESUMO
BACKGROUND: Compression ultrasonography has a high negative predictive value for deep vein thrombosis in symptomatic outpatients. Limited data are available on factors influencing positive predictive value. The objective of this study was to evaluate the positive predictive value of compression ultrasonography according to the anatomic site of vein noncompressibility. METHODS: We performed a prospective cohort study of 756 consecutive outpatients with suspected first-episode deep vein thrombosis. Compression ultrasonography was performed at the initial visit: results were abnormal if a noncompressible segment was identified or normal if all segments were fully compressible. Venography was performed in patients with abnormal compression ultrasonography results. Positive predictive value was determined according to the site of noncompressibility: common femoral vein only, popliteal vein only, or both sites. Venography was the reference standard for the presence of deep vein thrombosis. RESULTS: Positive predictive value was 16.7% (95% confidence interval, 0.4%-64.1%) for noncompressibility isolated to the common femoral vein compared with 91.3% (95% confidence interval, 72.0%-98.9%) for the popliteal vein only and 94.4% (95% confidence interval, 72.7%-99.9%) for both sites (P<.001). Of 15 patients with isolated noncompressibility of the common femoral vein, 8 (53%) had pelvic neoplasm or abscess compared with 2 (5%) of 42 with noncompressibility of the popliteal vein only and 6 (13%) of 47 with noncompressibility of both sites (P<.001). CONCLUSIONS: The positive predictive value of noncompressibility isolated to the common femoral vein is too low to be used alone as the diagnostic end point for giving anticoagulant therapy. Noncompressibility isolated to the common femoral vein is a diagnostic marker for pelvic disease.
Assuntos
Veia Femoral/diagnóstico por imagem , Veia Poplítea/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Flebografia , Valor Preditivo dos Testes , Estudos Prospectivos , UltrassonografiaRESUMO
BACKGROUND: Ultrasonography using vein compression accurately detects proximal deep venous thrombosis in symptomatic outpatients. Repeated testing is required for patients with normal results at presentation, but the optimal management of such patients is uncertain. OBJECTIVE: To test the safety of withholding anticoagulation in outpatients suspected of having first-episode deep venous thrombosis who have normal results on simplified compression ultrasonography at presentation and on a single repeated test done 5 to 7 days later. DESIGN: Prospective cohort study. SETTING: Noninvasive vascular laboratories at a university teaching hospital and a Veterans Administration medical center. PATIENTS: 405 consecutive outpatients suspected of having first-episode deep venous thrombosis. INTERVENTION: Ultrasonography was performed at presentation. The common femoral and popliteal veins were assessed for compressibility. If the result was normal, anti-coagulation was withheld and testing was repeated 5 to 7 days later. Anticoagulation was withheld from all patients whose results remained normal according to compression ultrasonography, regardless of their symptoms. The safety of this approach was tested by follow-up lasting 3 months. MEASUREMENTS: Objective testing was done during follow-up in all patients with symptoms or signs of venous thromboembolism. The outcome measure was symptomatic venous thrombosis or pulmonary embolism during follow-up, confirmed by objective testing. RESULTS: Ultrasonography had normal results in 335 patients (83%) and abnormal results in 70 (17%). None of the patients with normal results died of pulmonary embolism. Venous thromboembolism occurred during follow-up in 2 patients with normal ultrasonographic results (0.6% [95% CI, 0.07% to 2.14%]) and in 4 patients with abnormal results (5.7% [CI, 1.58% to 13.99%]) (P = 0.009). CONCLUSIONS: It is safe to withhold anticoagulation in outpatients suspected of having first-episode deep venous thrombosis if results of simplified compression ultrasonography are normal at presentation and on a single repeated test done 5 to 7 days later.
Assuntos
Tromboflebite/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Protocolos Clínicos , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Tromboflebite/tratamento farmacológico , Ultrassonografia/métodosRESUMO
RATIONALE AND OBJECTIVES: A two-center, prospective, double-blind study was conducted to compare the performance parameters (efficacy, safety, and injection-associated discomfort) of iohexol with those of the new, isosmolar contrast medium iodixanol in extremity phlebography. METHODS: Ninety-nine patients from two centers, for whom venography was clinically indicated, were blindly randomized into two groups, iohexol at 300 mg I/ml (IOH 300) or iodixanol at 270 mg I/ml (IOD-270). Patient vital signs and reports of adverse events were recorded for a minimum of 1 hr and monitored until the outcome was known. Any discomfort associated with the injection was also recorded. Laboratory measures included urinalysis, creatinine levels in serum and blood urea nitrogen. RESULTS: Both contrast media provided good or excellent visualization in nearly all patients (100% of patients in the IOD-270 group and 96% in the IOH-300 group). The incidence of adverse reactions was low in both groups (8.5% in the IOD-270 group and 10% in the IOH-300 group). Injection associated discomfort lasting less than 4 min occurred in nine patients, four in the IOD-270 group and five in the IOH-300 group. Although clinically relevant changes in vital signs occurred in more than half the patients, most were judged to be anxiety related. Review of laboratory data revealed no evidence of toxicity for either agent. There was no statistically significant difference between the two agents with regard to any of these observed parameters. CONCLUSION: The data support the conclusion that both IOD-270 and IOH-300 are safe and effective agents when used for adult phlebography and are associated with little injection-site discomfort.
Assuntos
Meios de Contraste , Extremidades/irrigação sanguínea , Iohexol , Flebografia , Ácidos Tri-Iodobenzoicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/efeitos adversos , Método Duplo-Cego , Humanos , Iohexol/efeitos adversos , Pessoa de Meia-Idade , Estudos Prospectivos , Ácidos Tri-Iodobenzoicos/efeitos adversosRESUMO
PURPOSE: To evaluate the role of radiologic services in the assessment of injuries and identification of deceased victims of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City, Okla. MATERIALS AND METHODS: In cooperation with the Oklahoma University Health Sciences Center Disaster Studies Group, all victims of the Oklahoma City bombing who were treated in hospitals were evaluated. All radiologic studies performed in these patients during a 4-week period after the bombing were recorded. Major injuries incurred by the victims were noted but were not documented. In addition, assistance provided by radiologic services to the medical examiner's office for identification of deceased victims was assessed. RESULTS: On the day of the bombing, 99% (480 of 485) of the imaging studies performed were either plain radiography, primarily of the extremities and chest, or computed tomography (CT), half of which were of the head. Six deceased victims were identified solely by means of characteristics on radiographs. CONCLUSION: Almost all bombing-related radiologic studies were either plain radiography or CT. Other modalities had only limited roles. In deceased victims, plain radiography aided identification, and in many other victims it allowed localization of materials that were potential pieces of evidence.
Assuntos
Traumatismos por Explosões/diagnóstico por imagem , Explosões , Medicina Legal , Humanos , Oklahoma , Radiografia/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , ViolênciaRESUMO
We report the angiographic appearance of a posterior communicating artery aneurysm with a fistula to the cavernous sinus, which had been misinterpreted as a direct carotid-cavernous fistula, on which endovascular repair was unsuccessfully attempted.
Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Traumatismos por Explosões/terapia , Explosões , Radiografia Intervencionista , Adulto , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Oklahoma , ViolênciaAssuntos
Angioplastia com Balão/instrumentação , Artérias Carótidas , Corpos Estranhos/terapia , Microcirurgia/instrumentação , Radiografia Intervencionista/instrumentação , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral/instrumentação , Pré-Escolar , Embolização Terapêutica/instrumentação , Desenho de Equipamento , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Derivação Portossistêmica Cirúrgica/instrumentaçãoAssuntos
Angioplastia com Balão , Oclusão Vascular Mesentérica/tratamento farmacológico , Oclusão Vascular Mesentérica/terapia , Terapia Trombolítica , Trombose/tratamento farmacológico , Trombose/terapia , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Adulto , Dissecção Aórtica/etiologia , Angioplastia com Balão/efeitos adversos , Doença Crônica , Terapia Combinada , Feminino , Humanos , Injeções Intralesionais , Masculino , Artérias Mesentéricas , Pessoa de Meia-Idade , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagemRESUMO
Transjugular intrahepatic portosystemic shunts (TIPS) is a relatively new procedure for variceal decompression and alleviation of variceal bleeding. A central connection is made transjugularly between the right hepatic vein and portal vein confluence. The shunt is then buttressed with metallic stents. Between March and August 1992, nine patients with cirrhosis and recurrent variceal hemorrhage have undergone the TIPS procedure at Oklahoma Memorial Hospital. The procedure was successfully performed in all patients. The mean initial direct portosystemic gradient of 22.4 mm Hg was reduced to 9.7 mm Hg. All patients have survived to date with no evidence of recurrent variceal hemorrhage following discharge or transfer. Initial results from our institution and internationally suggest that the TIPS procedure will become an attractive alternative to operative portosystemic shunts.
Assuntos
Cateteres de Demora , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Derivação Portossistêmica Cirúrgica/instrumentação , Stents , Adulto , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Feminino , Seguimentos , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Endostoma of bone (bone island) is a rare lesion and has been described in the spinous process in only one previous publication. Although these lesions are benign, they have a potential for enlargement. Radiography cannot completely differentiate these lesions from more aggressive processes, and removal of the lesion should be considered.
Assuntos
Neoplasias Ósseas/patologia , Vértebras Lombares , Neoplasias da Coluna Vertebral/patologia , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/tratamento farmacológico , Miosite/complicações , Miosite/tratamento farmacológico , Osteoma Osteoide/diagnóstico , Esclerose , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgiaRESUMO
The characteristics of laser lithotripsy of biliary calculi are compared for a flashlamp pumped dye laser (lambda = 640 nm) and a Cr:Tm:Ho-YAG laser (lambda = 2.1 microns). Data on fragmentation efficiency with respect to laser power and pulse repetition rate are presented for different types of stones. It is shown that both lasers can produce effective stone fragmentation. The laser power required for efficient fragmentation characteristics is significantly less for the visible wavelength laser. However, the problems associated with damage to the fiber tips of the delivery system during operation were found to be less with the near infrared wavelength. The laser power for efficient fragmentation with the dye laser varies significantly for different types of stones while the power for efficient fragmentation with the holmium laser is the same for all stones.
Assuntos
Colelitíase/terapia , Terapia a Laser , Litotripsia a Laser , Litotripsia/métodos , Humanos , Técnicas In VitroRESUMO
The courses of 17 patients who underwent 20 separate attempts at thrombolysis for acute arterial thrombosis are reviewed to clarify the safety and efficacy of this therapy. Seventeen of 20 thrombolyses were angiographically successful. Patients who had correctable lesions identified and reconstructive procedures performed tended to do better than those who did not, and patients who had successful thrombolysis tended to have fewer and less radical amputations. Complications can be reduced by careful, close monitoring of patients undergoing therapy.
Assuntos
Estreptoquinase/uso terapêutico , Trombose/tratamento farmacológico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Doença Aguda , Amputação Cirúrgica , Artérias , Feminino , Seguimentos , Oclusão de Enxerto Vascular/tratamento farmacológico , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Estreptoquinase/efeitos adversos , Trombose/etiologia , Trombose/cirurgia , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversosRESUMO
Two illustrative cases of patients with skeletal fluorosis and classic radiographic changes are presented. One patient demonstrated a progressive paraparesis, while the other was diagnosed incidentally on routine radiographs. A review of the literature, treatment, and histologic findings are presented.
Assuntos
Doenças Ósseas/induzido quimicamente , Intoxicação por Flúor/diagnóstico por imagem , Idoso , Doenças Ósseas/diagnóstico por imagem , Osso e Ossos/patologia , Feminino , Intoxicação por Flúor/patologia , Humanos , Masculino , RadiografiaRESUMO
Renal imaging and biopsy are used in the management of patients with renal disease. The scintigraphic detection of an arteriovenous fistula, an infrequent but significant complication of renal biopsy, is the subject of this report.
Assuntos
Fístula Arteriovenosa/etiologia , Biópsia/efeitos adversos , Artéria Renal , Veias Renais , Humanos , Rim/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
In this retrospective study, the findings on abdominal sonograms in six patients newly diagnosed as having chronic disseminated histoplasmosis are reported. Five of six patients showed bilateral adrenal gland enlargement that was similar in degree from side to side. The most characteristic feature was the maintenance of a triangular shape in five glands and a cylindrical shape in two glands. Four glands had a nonspecific round or oval shape. All sonographic findings correlated well with the computed tomographic (CT) findings on each patient except that CT detected the one enlarged right adrenal gland not demonstrated sonographically. Abdominal sonography may provide the initial important clue to the diagnosis of chronic disseminated histoplasmosis.
Assuntos
Doenças das Glândulas Suprarrenais/patologia , Histoplasmose/patologia , Ultrassonografia , Glândulas Suprarrenais/patologia , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
We reviewed the initial chest roentgenograms of 182 consecutive adult patients with proven active tuberculosis. Less than 50% of all cases were known or suspected at the time of initial presentation. There is a low degree of correlation between radiologically discernible active pulmonary tuberculosis and extrapulmonary tuberculosis. A high percentage of cases represent uncommon pulmonary locations. We present the frequency of occurrence of four common pulmonary patterns.
Assuntos
Tuberculose Pulmonar/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Oklahoma , Peritonite Tuberculosa/diagnóstico por imagem , Peritonite Tuberculosa/epidemiologia , Radiografia , Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/epidemiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/epidemiologia , Tuberculose Urogenital/diagnóstico por imagem , Tuberculose Urogenital/epidemiologiaRESUMO
During a 36-month period, the serial chest x-ray films of 26 patients with the adult respiratory distress syndrome (ARDS) were evaluated for the patterns of onset, course, and follow-up appearance when possible. An exudative phase appearance can be recognized, which can clear. The exudative phase appearances are (1) a bilateral, homogeneous, white-out alveolar appearance; (2) an asymmetric consolidative appearance; and (3) a central perihilar ("bat-wing") consolidative appearance. This progresses to a proliferative phase manifested on chest x-ray film as an interstitial appearance that must not be confused with fibrosis, as the chest x-ray film may return to normal.
Assuntos
Síndrome do Desconforto Respiratório/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/diagnóstico , Pneumonia/complicações , Radiografia , Síndrome do Desconforto Respiratório/etiologia , Choque/complicaçõesRESUMO
A 12-year-old girl with abdominal pain and occasional dark vaginal discharge was found upon abdominal x-ray examination to have amorphous pelvic calcification. Calcification can occur in ovarian fibromas and should be considered as a cause of amorphous pelvic calcification in female patients. When bilateral, calcified, and nodular, the possibility of basal cell nevus syndrome is suggested.