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Valor predictivo de la puntuación SYNTAX en la lesión vascular culpable y no culpable. Respuesta
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Solid pseudopapillary neoplasm-Case report of a rare pancreatic tumor
Get PDFINTRODUCTION:
Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor. Most patients are female within the second or third decade of life with only a small minority concerning children. Frequently described as low malignant potential tumors, surgical resection remains the main treatment.
PRESENTATION OF CASE:
The authors present a case of a SPN diagnosed in a 17-year-old Caucasian girl with vomiting and abdominal pain localized to the right upper quadrant. CT scans and MRI scans showed the presence of a well-defined tumor arising from the pancreatic head with 14cm of greater diameter. Pylorus-preserving pancreatoduodenectomy was performed and histopathology confirmed a SPN with complete resection and no evidence of malignancy.
DISCUSSION:
SPN are usually found incidentally hence the importance of an accurate radiologic diagnosis. Symptoms may be present such as abdominal pain or vomiting due to compression, namely in large tumors. A surgical approach is usually indicated aiming complete resection, with tumor size not predicting resectability.
CONCLUSION:
Solid pseudopapillary tumors of the pancreas are extremely rare and usually have an excellent long-term prognosis after surgical resection.info:eu-repo/semantics/publishedVersio
NUT midline carcinoma of the larynx: an international series and review of the literature
Get PDFAIMS:
NUT midline carcinoma (NMC) is a rare undifferentiated and aggressive carcinoma that locates characteristically to the midline of the head and neck, and mediastinum. NMC is characterized by chromosomal rearrangements of the gene NUT, at 15q14. The BRD4 gene on 19q13 is the most common translocation partner forming a fusion oncogene, BRD4-NUT. By the end of 2014, the International NUT Midline Carcinoma Registry had 48 patients treated for NMC. Laryngeal NMC are exceedingly rare, and we report a case series of seven cases.
METHODS AND RESULTS:
We searched for cases in files of different hospitals as well as a thorough search of the English language literature. The diagnosis of NMC is made by demonstration of NUT rearrangement either by immunohistochemistry, fluorescence in-situ hybridization (FISH) or reverse transcription-polymerase chain reaction (RT-PCR). We found three previously published cases, and in this series add four cases of our own.
CONCLUSIONS:
NMC consists of monomorphic, often discohesive, cells with an epithelioid appearance and distinct nucleoli. The tumours typically show abrupt squamous differentiation. The mean age of the patients was 34 years, hence significantly lower than that for conventional laryngeal carcinoma. All tumours were located in the supraglottis and five patients died of the disease after 3, 7, 8, 9 and 11 months. Laryngeal NMC may be underdiagnosed, and an increased awareness among pathologists is warranted. NMC has characteristic morphological features, and positive immunostaining with the NUT antibody is diagnostic. Its aggressive behaviour demands a very intense treatment strategy and the need for its recognition is emphasized further by new promising treatment strategies.info:eu-repo/semantics/publishedVersio
Ureteroscopy-assisted Percutaneous Kidney Access Made Easy: First Clinical Experience with a Novel Navigation System Using Electromagnetic Guidance (IDEAL Stage 1)
Get PDFBACKGROUND:
Puncture of the renal collecting system represents a challenging step in percutaneous nephrolithotomy (PCNL). Limitations related to the use of standard fluoroscopic-based and ultrasound-based maneuvers have been recognized.
OBJECTIVES:
To describe the technique and early clinical outcomes of a novel navigation system for percutaneous kidney access.
DESIGN, SETTING, AND PARTICIPANTS:
This was a proof-of-concept study (IDEAL phase 1) conducted at a single academic center. Ten PCNL procedures were performed for patients with kidney stones.
SURGICAL PROCEDURE:
Flexible ureterorenoscopy was performed to determine the optimal renal calyx for access. An electromagnetic sensor was inserted through the working channel. Then the selected calyx was punctured with a needle with a sensor on the tip guided by real-time three-dimensional images observed on the monitor.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:
The primary endpoints were the accuracy and clinical applicability of the system in clinical use. Secondary endpoints were the time to successful puncture, the number of attempts for successful puncture, and complications.
RESULTS AND LIMITATIONS:
Ten patients were enrolled in the study. The median age was 47.1 yr (30-63), median body mass index was 22.85kg/m2 (19-28.3), and median stone size was 2.13cm (1.5-2.5cm). All stones were in the renal pelvis. The Guy's stone score was 1 in nine cases and 2 in one case. All 10 punctures of the collecting system were successfully completed at the first attempt without X-ray exposure. The median time to successful puncture starting from insertion of the needle was 20 s (range 15-35). No complications occurred.
CONCLUSIONS:
We describe the first clinical application of a novel navigation system using real-time electromagnetic sensors for percutaneous kidney access. This new technology overcomes the intrinsic limitations of traditional methods of kidney access, allowing safe, precise, fast, and effective puncture of the renal collecting system.
PATIENT SUMMARY:
We describe a new technology allowing safe and easy puncture of the kidney without radiation exposure. This could significantly facilitate one of the most challenging steps in percutaneous removal of kidney stones.info:eu-repo/semantics/publishedVersio
Bisalbuminémia: Uma Variante Rara da Albumina
Get PDFINTRODUCTION:
Bisalbuminemia is a qualitative disorder of albumin and it is defined by the coexistence in the same individual of two types of serum albumin with different electrophoretic mobility. There are two forms: hereditary and permanent, or acquired and transient.
CASE REPORT:
Girl, 17-years-old, referenced to the hospital consult after incidental finding of bisalbuminemia detected in plasma protein electrophoresis performed within the investigation of diminished muscular tone in the lower limbs. Physical examination was normal. Secondary causes of bisalbuminemia were excluded. Later, it was confirmed the same disorder in plasma protein electrophoresis performed to her 14-years-old brother and mother.
DISCUSSION:
We describe a rare case of hereditary bisalbuminemia in a portuguese family. In general, this condition shows no pathological significance, however it is of interest to the clinicians the knowledge of this analytic change for better orientation of their patients.info:eu-repo/semantics/publishedVersio
Assessment of forecasting models for patients arrival at Emergency Department
Get PDFThe unpredictability of arrivals to the Emergency Department (ED) of a hospital is a great concern of the management. The existence of more complex pathologies and the increase in life expectancy originate a higher rate of hospitalization. The hospitalization of patients via ED upsets previously programmed services and some cancellations may occur. The Hospital’s ability to predict turnout variations in the arrivals to the ED is fundamental to the management of the human resources and the required number of beds.
Braga Hospital, in Portugal, is the subject of this work. Data for ED arrivals in 2 years (2012–2013), the test period, was studied and forecasting models based on time series were built. The models were then tested against the real data from the evaluation period (2014). These models are of ARIMA (AutoRegressive-Integrated-Moving Average) type, used software was the Forecast Pro.info:eu-repo/semantics/publishedVersio
Androgenic alopecia: an entity to consider in adolescence
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Overall Survival Analysis and Characterization of an EGFR Mutated Non-Small Cell Lung Cancer (NSCLC) Population
Get PDFBACKGROUND:
Patients with activating somatic mutations in the Epidermal Growth Factor Receptor (EGFR) have better clinical outcomes when treated with Tyrosine Kinase Inhibitors (TKI) over chemotherapy. However, the impact of the use of TKIs on overall survival outside clinical trials is not well established.
OBJECTIVE:
To characterize and analyze the overall survival of a Caucasian population with NSCLC and EGFR mutations.
METHODS:
A retrospective cohort analysis of patients with NSCLC screened for EGFR mutations (exons 18-21) between October 2009 and July 2013 was conducted. Clinical and pathological characteristics, mutational EGFR status, treatment and overall survival were evaluated.
RESULTS:
From the 285 patients which performed screening for EGFR mutations, 54 (18.9%) had mutations, 25 (46.3%) of which in exon 19 and 20 of which (37.0%) in exon 21. The occurrence of mutations was associated with female sex and non-smoking habits (both, P<.001). The median survival of the global population was 12.0 months, with a better overall survival in mutated than non-mutated patients (20.0 vs 11.0 months, respectively; P=.007).
CONCLUSION:
These data contribute for a better knowledge of our lung cancer population concerning the mutational status and clinical outcomes, confirming a better overall survival for the patients with EGFR TKI sensible mutations.info:eu-repo/semantics/publishedVersio
Prevalence of secondhand smoke exposure in asthmatic children at home and in the car: A cross-sectional study
Get PDFObjective: To compare secondhand smoke exposure (SHSe) prevalence at home and inside the
car between asthmatic and non-asthmatic Portuguese children.
Materials and methods: This is a cross-sectional study that assessed children’s SHSe in a representative
sample of nine Portuguese cities. A validated self-reported questionnaire was
administered to a random sample of 4th grade students during the school year of 2010/2011.
The asthma prevalence was defined by the answers to three questions regarding asthma symptoms,
medication and inhaler use. We performed chi-square tests and analysed frequencies,
contingency tables, confidence intervals, and odd-ratios.
Results: The self-reported questionnaire was administered to 3187 students. Asthma prevalence
was 14.8% (472 students). Results showed that 32.3% of non-asthmatic children and 32.4%
of asthmatic children were exposed to secondhand smoke as at least one of their household
members smoked at home. The prevalence of parental smoking, smoking among fathers and
smoking among mothers at home was also similar in both groups (asthmatic and non-asthmatic
children). SHSe inside the car was 18.6% among non-asthmatic children and 17.9% among asthmatic
children.Conclusions: Asthmatic and non-asthmatic children were equally exposed to secondhand
smoke, because no significant differences were found between the two groups concerning the
prevalence of SHSe at home and inside the car. These findings highlight the need to include
SHSe brief advice in paediatric asthma management