RATIONALE AND OBJECTIVES: Pulmonary contour extraction from thoracic x-ray computed tomography images is a mandatory preprocessing step in many automated or semiautomated analysis tasks. This study was conducted to quantitatively assess the performance of a method for pulmonary contour extraction and region identification. MATERIALS AND METHODS: The automatically extracted contours were statistically compared with manually drawn pulmonary contours detected by six radiologists on a set of 30 images. Exploratory data analysis, nonparametric statistical tests, and multivariate analysis were used, on the data obtained using several figures of merit, to perform a study of the interobserver variability among the six radiologists and the contour extraction method. The intraobserver variability of two human observers was also studied. RESULTS: In addition to a strong consistency among all of the quality indexes used, a wider interobserver variability was found among the radiologists than the variability of the contour extraction method when compared with each radiologist. The extraction method exhibits a similar behavior (as a pulmonary contour detector), to the six radiologists, for the used image set. CONCLUSION: As an overall result of the application of this evaluation methodology...
The perioperative management of diabetic patients implies glicemic normalization before, during and after the procedure. Insulin therapy is always necessary when general anesthesia is considered, and in most cases of epidural analgesia. When ambulatory surgery is envisaged, the usual hypoglycemic treatment can be maintained, provided that a sufficiently good metabolic control is documented. The pathophysiological mechanisms for insulin-resistance in these situations are reviewed, as are the procedures for general clinical evaluation of the patient. The estimation of insulin needs, the problems related with the suspension of oral antidiabetic drugs and the description of the most usual schemes of intensive insulin therapy (namely those of continuous intravenous insulin infusion) are also detailed.
A 60-year-old male presented to the emergency room with a postprandial abdominal pain, vomiting, anorexia and weight loss. An epigastric mass could be felt on examination, and the laboratory test values confirmed that he had anaemia.
Wertheim-Meigs hysterectomy is used in the treatment of cervical cancer, but since 1988 we have also used it to stage and treat endometrial carcinoma. To evaluate the morbidity of Wertheim Meigs hysterectomy as well as node invasion incidence and its correlation with other prognostic factors, the authors made a retrospective study of 112 patients, from October 1986 to March 1996. Among the 112 cases evaluated, 52% had cervical carcinoma and 48% had endometrial carcinoma; mean ages were 45 +/- 10 and 60 +/- 8 years (p < 0.005). FIGO stage distribution was: I-94.8 and 33.3%; II-5.2 and 51.9%; III-0 and 13%; IV-0 and 1.8%, for cervical and endometrial carcinoma. Hemorrhagic and traumatic accidents happened in 24.3% and 1.7% respectively. We had 15.5% early post operative complications and 1.7% late post operative ones. The mean duration of surgery and hospitalization was 163 +/- 29 minutes and 10 +/- 5 days. Pelvic lymphadenectomy was performed in 70% of patients and para-aortic nodes were also excised in the other 30%. The mean number of lymphatic nodes excised were 17 +/- 9. Pelvic node invasion was found in 9% and in 3.7% of para-aortic ones. When we studied endometrial cancer, we found a positive correlation between external myometrium invasion and lymphovascular invasion and positive node (p < 0.05). From the data available we may conclude that the complication rate of Wertheim Meigs is quite important...
Haemangiomas are common focal liver lesions, generally detected in the work-up of asymptomatic patients. From the pathological point of view, they can be classified as small (capillary) or large, with cavernous vascular spaces that may show thrombosis, calcifications and hyalinisation. The polymorphic imaging appearance of haemangiomas depends on their histological features and flow pattern. The widespread use of cross-sectional imaging has allowed an increased detection rate and a better characterisation of this benign tumour. Recent developments of ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) providing high spatial and temporal resolution, together with the use of new contrast agents and/or pulse sequences has broadened the spectrum of imaging findings, contributing to diagnostic refinement in difficult cases. The scope of the present article is to provide an overview of the range of appearances of haemangiomas, explored with recent cross-sectional imaging modalities, emphasising its atypical findings as explored by temporally resolved contrast-enhanced imaging.
OBJECTIVE: Stroke is a major complication after coronary surgery, occurring in 1-4% of the patients. In this study, we evaluate the incidence and pre- and intraoperative risk factors for the development of a cerebrovascular accident (CVA) and the impact of such an event on perioperative mortality and on hospital length of stay.
METHODS: Data from 4567 patients submitted to isolated coronary artery bypass grafting (CABG) with hypothermic ventricular fibrillation between 1992 and 2001 were entered prospectively into a dedicated computerized database and analyzed retrospectively at this time. Univariate and multivariate analyses were performed where appropriate.
RESULTS: The incidence of postoperative CVA was 2.5% (116 patients). Multivariable logistic regression identified the following variables to be independent predictors of a postoperative CVA: cerebrovascular disease (P
An unusual myxoid and vascular appearing neoplasm of the vulva, termed an Aggressive Angiomyxoma, is described in two cases report. The clinical presentation and recurrence pattern were typical for previously described neoplasms of the same cellular pattern. The histopathology, difficulties in determining the surgical margins, and the treatment of this tumor are discussed.
Apresenta-se um caso de doença de Blount bilateral no estádio IV, numa criança obesa com 6 anos de idade. Na tíbia esquerda efectuou-se, inicialmente, uma osteotomia de valgização e desrotativa infra-tuberositária. Houve recidiva do varo com laxidão ligamentar, pelo que se realizou uma osteotomia de levantamento do prato tíbial interno com epifisiodése proximal externa da tíbia e do perónio. Houve novamente recidiva do varo, que foi corrigido num terceiro tempo cirúrgico, através da aplicação do método de Ilizarov. Na tíbia direita realizou-se, inicialmente, uma osteotomia de valgização e desrotativa e, posteriormente, uma epifisiodése proximal externa da tíbia e do perónio.
Obteve-se um bom resultado bilateralmente, sendo os joelhos indolores e estáveis, com desvio axial mínimo.
The increase in the prevalence of adverse reactions to foods and drugs represents a constant challenge to the development
of new methods of diagnosis. A meta-analysis on published studies concerning the clinical usefulness of the Basophil activation
test (BAT) in these reactions was performed. High sensibilities and specificities can be achieved if certain technical requirements
are observed. BAT results have a positive and high significant correlations with other routine diagnostic methods such as skin
tests, serum specific IgE and oral controlled challenge. Efficacy of diagnosis can be improved with the combined use of BAT and
other techniques. In order to achieve a well-conducted evaluation on the diagnosis of hypersensitivity reactions to foods and
drugs the best options should be
INTRODUCTION: Current European clinical guidelines do not restrict interventional cardiology at centers without on-site surgical backup, but disagreement still exists whether hospitals with cardiac catheterization laboratories, but without on-site cardiac surgery, should develop percutaneous coronary intervention (PCI) programs. Technical improvements in equipment and pharmacologic adjunctive therapy have increased the safety margins of diagnostic and therapeutic cardiac catheterization and more than half of the patients treated by PCI in Portugal are treated at hospitals without on-site cardiac surgery.
OBJECTIVES: We set out to compare clinical outcomes of elective and primary PCI for ST-segment elevation myocardial infarction at centers without on-site cardiac surgery with those at centers with on-site cardiac surgery.
METHODS: Based on the Portuguese Registry of Interventional Cardiology, we retrospectively reviewed a total of 13,235 PCI procedures performed from January 2002 to June 2006 and compared the results for 7,112 patients treated at hospitals without on-site cardiac surgery with 6,123 patients treated at hospitals with on-site cardiac surgery.
RESULTS: Demographic data were similar, with a mean age of 64 (55-72) vs. 63 (54-71) years...
Primary hyperparathyroidism is a rare occurrence in pregnancy with significant risks to the mother and the foetus, witch is related to the level of serum calcium. A 41-year-old women, gravida 2, para 1, presented at 22 weeks gestation with nausea, vomiting and mild cognitive dysfunction associated with hypercalcemic crisis. The hypercalcemia was observed to be related to parathyroid hyperplasia that was surgically removed. Complete resolution of her symptomatology and hypercalcemia occurred postoperatively. The pregnancy was complicated with transient hypertension. A small for gestational age healthy male infant was delivered at term with no neonatal complications related with this pathology.
Introdução: As doenças infecciosas são uma causa frequente de morbi-
-mortalidade no período neonatal. O conhecimento da epidemiologia de
cada unidade é um factor decisivo para o sucesso da antibioterapia empírica.
Objectivos: Caracterizar os episódios de sépsis neonatal (SNN) ocorridos
de Janeiro de 2004 a Dezembro de 2006 na Unidade de Cuidados
Intensivos Neonatais (UCIN) da Maternidade Bissaya Barreto.
Material e métodos: Estudo descritivo retrospectivo dos processos clínicos
dos recém-nascidos com o diagnóstico de SNN. Definiu-se sépsis
com confirmação laboratorial se dois ou mais critérios clínicos compatíveis,
associados a um dos seguintes critérios laboratoriais: a) identificação
de qualquer agente patogénico bacteriano na hemocultura ou no líquor
cefalo-raquídeo; b) identificação de Staphylococcus coagulase negativo
na presença de proteína C reactiva >2,0 mg/dl ou plaquetas 0,2. Definiu-se sépsis
clínica quando se verificou: instituição de terapêutica antibiótica durante
5 dias, hemocultura negativa ou não pedida, ausência de infecção noutro
local e dois ou mais critérios clínicos compatíveis. No caso de sépsis
clínica deveria haver pelo menos também um dos seguintes: proteína C
Although multiple reports show that defective genetic networks underlie the aetiology of autism, few have translated into pharmacotherapeutic opportunities. Since drugs compete with endogenous small molecules for protein binding, many successful drugs target large gene families with multiple drug binding sites. Here we search for defective gene family interaction networks (GFINs) in 6,742 patients with the ASDs relative to 12,544 neurologically normal controls, to find potentially druggable genetic targets. We find significant enrichment of structural defects (P ≤ 2.40E-09, 1.8-fold enrichment) in the metabotropic glutamate receptor (GRM) GFIN, previously observed to impact attention deficit hyperactivity disorder (ADHD) and schizophrenia. Also, the MXD-MYC-MAX network of genes, previously implicated in cancer, is significantly enriched (P ≤ 3.83E-23, 2.5-fold enrichment), as is the calmodulin 1 (CALM1) gene interaction network (P ≤ 4.16E-04, 14.4-fold enrichment), which regulates voltage-independent calcium-activated action potentials at the neuronal synapse. We find that multiple defective gene family interactions underlie autism, presenting new translational opportunities to explore for therapeutic interventions.