RESUMEN
Ninety-one patients affected with thyroid diseases (97 lesions) were examined with conventional B-mode and color-Doppler US. To verify if color-Doppler is able to provide additional elements in the US diagnosis, for each lesion were expressed two diagnosis: the first found on conventional US patterns and the second on color-Doppler patterns. US diagnosis was compared with histologic findings that identify 73 benign lesions and 24 malignant lesions. With conventional B-mode US the diagnosis was correctly expressed in 62/73 benign lesions (85%) and in 18/24 malignant lesions (75%) while it misdiagnosed as positives 11/73 case (15%) and as negatives 6/24 cases (25%). If we completed the conventional US diagnosis with color-Doppler patterns, the false negative reduced to 4% and false positive to 6.8%. On the whole, although any correlation between color-Doppler patterns and different histological types was found, the color-Doppler had a high predictive value of benignity in patterns I, II, and IV while pattern III is not peculiar because it includes either malignant or benign lesions.
Asunto(s)
Enfermedades de la Tiroides/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Tiroides/patología , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patologíaRESUMEN
BACKGROUND: The extensive use of orthopantomography contributed to the occasional discovery of the so called empty cysts (EC) also defined as traumatic or hemorrhagic, which are benign mainly asymptomatic lesions. There are different opinions on empty cysts (even on the proper term to define them) particularly regarding their epidemiology, etiopathology, and clinical and radiological aspect. The purpose of this study is to compare the literature and personal experience and to underline the peculiar aspects not only from a semantic point of view, but also from a more elaborate perspective. MATERIALS AND METHODS: Forty-five osteolytic lesions, which can be considered as empty cysts, taken out of a group of 30,000 patients in a period of 5 years have been examined retrospectively. Radiologic documentation included: orthopantomography, occlusal radiographs, intraoral periapical radiographs, intraoral tube panoramic radiographs and TC in 4 cases. Several parameters among which: trauma, symptoms, location, dimension and the radiological aspect of the lesion were taken into account. RESULTS: The authors concluded: trauma in 4 cases, location of 44 out of 45 empty cysts in the mandible, 67% of which distal to canines; displacement of adjacent teeth in four cases, without root resorbtion. The major axis of empty cysts varied from a minimum of 18 to a maximum of 80 mm. The morphology was oval or round, 37 cysts were monolocular, 8 were plurilocular. In 17 cases the authors noticed a reduction and a displacement of the corticals, but never discovered a pathological fracture. During the observed period an increase in growth of lesions was not found in the follow-up of 14 out of 44 patients. CONCLUSIONS: The personal data were compared to those of the literature where the authors found a larger incidence of patients with symptoms and a history of trauma and cementofibrousdysplasia. The authors suggested that the real incidence of empty cysts is higher than that of the literature. On the basis of personal experience empty cysts are very stable. Therefore, it is questionable if oral surgery should be avoided when radiological picture is certain.
Asunto(s)
Quistes Maxilomandibulares/diagnóstico por imagen , Osteólisis/patología , Adolescente , Adulto , Niño , Femenino , Displasia Fibrosa Ósea/complicaciones , Displasia Fibrosa Ósea/patología , Humanos , Quistes Maxilomandibulares/etiología , Quistes Maxilomandibulares/patología , Masculino , Radiografía Panorámica , Resorción Radicular/etiologíaRESUMEN
Several branches of competence are needed to evaluate malpractice in dentistry: first a complete case history, secondly careful clinical observation and finally a correct procedure of radiographic documentation. This latter is able to prove existence of the treatment and its evolution, moreover it shows the bone, the dental components underneath the surface and the treatment becomes appraisable by different observers. In restorative dentistry, radiological findings allow us to demonstrate overcontoured restorations in approximal sites and, if necessary, identify the biological width. In endodontics the insufficient filling or the overfilling of the root channel can be demonstrated along with the material used for the filling and the presence of fractured instruments inside the channel. In prosthodontics, on the other hand, the quality of the abutments, fractured roots and/or prosthesis, symptoms of inadequate charge on the bone and overcontours with the subsequent periodontal damage can be seen. In orthodontics one can assess the appearance of infrabone pockets, reabsorptions and horizontal recessions. In extractive surgery it is again possible to identify through radiographic documentation small root fragments in the maxillary sinus (possible sinusitis associated) and maxillary fractures as a consequence of extractions. In the field of implantology, damage to noble structures due to inadequate case planning can be highlighted.
Asunto(s)
Mala Praxis , Radiografía Dental , Implantación Dental , Endodoncia , Humanos , Italia , Ortodoncia , Prostodoncia , Extracción DentalRESUMEN
To assess if the effectiveness of biopsy sampling, whose usefulness is widely recognized, can be influenced by different cutting mechanisms, we compared four different types of needles (A, B, C, D) in 76 patients, each needle being of the same length (15 cm) and calibre (18 G) but with different tip shapes. Forty biopsy samples were obtained with each type of needle for a total of 160 samples in 76 patients; 61 samples were acquired under CT guidance and 99 under US guidance. The results were subdivided in 6 categories based on biopsy result: PI (diagnosis histotype in malignant lesions), PN (diagnosis of malignancy in neoplastic lesions), P (correct diagnosis in benign lesions), S (suspicion of neoplastic lesion), E (misdiagnosis), NI (insufficient material). The results, respectively, for each needle type are: 32.5%, 30%, 2.5%, 7.5%, 12.5% and 15% with needle A; 35%, 30%, 7.5%, 0%, 15% and 12.5% with needle B; 27.5%, 17.5%, 10%, 7.5%, 22.5% and 15% with needle C; 30%, 15%, 7.5%, 15%, 17.5% and 15% with needle D. The sensitivity and specificity for each needle type were, respectively, 84.4% and 85.29% for needle A; 86.66% and 88.57% for needle B; 70% and 73.52% for needle C; 77.41% and 79.41% for needle D. No statistically significant difference was found in the effectiveness of the four needles (chi 2); on the contrary, lesions's size can affect sampling quality.
Asunto(s)
Biopsia con Aguja/instrumentación , Agujas , Adulto , Anciano , Anciano de 80 o más Años , Anestesia Local , Biopsia con Aguja/métodos , Biopsia con Aguja/estadística & datos numéricos , Distribución de Chi-Cuadrado , Errores Diagnósticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agujas/estadística & datos numéricos , Neoplasias/diagnóstico por imagen , Neoplasias/patología , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/instrumentación , Ultrasonografía/instrumentaciónRESUMEN
Interventional radiology of the adrenal glands comprises angiographic and percutaneous procedures. Vascular maneuvers have never received widespread application. Venous retrograde adrenal gland ablation fell into disuse because it induced only temporary reduction of adrenal function, caused intense long lasting pain, and was considered unsafe. Chemoembolization of cortico-adrenal carcinoma has been shown to slow tumor growth and may be employed if the patient is inoperable. Percutaneous FNB, routinely performed in large hospital centers, has a high diagnostic yield and a low complication rate. The procedure is performed in the staging of oncological cases or in patients with incidentally found adrenal lesion with no evidence of adreno-cortical or adrenal medullary hypersecretion. Abscesses and adrenal cysts are rarely encountered in clinical practice. Percutaneous drainage of such lesions is readily accomplished under radiological guidance with little hazard for the patient. Furthermore treatment failure does not compromise surgical treatment. Percutaneous ethanol injection has been recently suggested for treatment of hormone producing adreno-cortical adenomas in patients at high surgical risk. Results are promising but further trials are required to ascertain the efficacy and the safety of the procedure.
Asunto(s)
Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/diagnóstico por imagen , Biopsia con Aguja/métodos , Drenaje/métodos , Absceso/cirugía , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Enfermedades de las Glándulas Suprarrenales/patología , Enfermedades de las Glándulas Suprarrenales/terapia , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/terapia , Glándulas Suprarrenales/patología , Glándulas Suprarrenales/cirugía , Anciano , Algoritmos , Angioplastia/métodos , Animales , Biopsia con Aguja/efectos adversos , Etanol/administración & dosificación , Etanol/uso terapéutico , Femenino , Haplorrinos , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Radiografía , Estudios RetrospectivosRESUMEN
Ureteral diversions may be complicated by strictures, hydronephrosis, pyelonephritis, lithiasis, fistulas, etc. In the last 10 years, 103 patients with 133 urological postoperative complications underwent percutaneous treatment. Most of the patients had been treated by percutaneous antegrade drainage; afterwards, stricture dilatation, ureteral stenting and stone extraction were performed. In one case a Strecker metallic stent was employed. We have successfully treated 101 of 133 complications (75.9%), with only 27 failures (20.3%). Five cases (3.8%) of lithiasis did not require percutaneous treatment. The good results obtained, the absence of major complications, the low cost and the little discomfort for the patients confirm the leading role of percutaneous treatment in complicated ureteral diversions.