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The gold standard for male to female genital reconstruction in the UK is vaginoplasty with penile and/or scrotal skin for neovagina formation. We present a rare case of a major haemorrhage in a 46-year-old patient, 26 days post-vaginoplasty. An urgent computed tomography scan identified a large retrovesical collection, with high-density contents in keeping with recent haemorrhage, containing a 6mm pseudoaneurysm within the right lateral wall. Following resuscitation, the patient was urgently treated with successful embolization of the feeding artery (branch of the prostatic artery), with pushable coils. We highlight the importance of expedient, life-saving management in a rare post-operative complication.
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The introduction of ultrasound contrast agents has rendered contrast-enhanced ultrasound (CEUS) a valuable complementary technique to address clinically significant problems. This pictorial review describes the use of CEUS guidance in abdominal intervention and illustrates such application for a range of clinical indications. Clinical application of CEUS discussed include commonly performed abdominal interventional procedures, such as biopsy, drainage, nephrostomy, biliary intervention, abdominal tumor ablation and its subsequent monitoring, and imaging of vascular complications following abdominal intervention. The purpose of this article is to further familiarize readers with the application of CEUS, particularly its specific strength over alternative imaging modalities, in abdominal intervention.
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Abdomen/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Ultrasonografía Intervencional/métodos , Abdomen/cirugía , Drenaje/métodos , Humanos , Biopsia Guiada por Imagen , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
OBJECTIVE: To explore the potential role of ultrasound (US) as a bedside tool in intensive care unit patients with presumed neurogenic heterotopic ossification (NHO). SETTING: Tertiary university teaching hospitals. PARTICIPANTS: Critical care patients with acquired brain injury. DESIGN: A multicenter prospective study of critical care patients with possible NHO. MAIN MEASURES: Following a screening clinical examination, the major joints were evaluated with US, serum laboratory work, and x-ray. RESULTS: A total of 310 patients had decreased range of motion by clinical screen and all received US interrogation. Sonographic signs of NHO were identified in 21 of the 310 patients (6.8%), of which 17/21 (81.0%) showed hyperemia; 9/21 (42.8%) showed the reverse zone phenomenon, and 4/21 patients (19.0%) showed the prezone phenomenon. All 21 patients progressed to the zone phenomenon within 15 weeks. Laboratory parameters were not significantly correlated with US (r = 0.11, r = 0.13; P > .05, respectively), whereas x-rays were associated with a mean diagnostic delay of 2 ± 0.5 weeks (P < .05) compared with US. All 21 sonographic NHO patients survived to intensive care unit discharge. Twelve months after admission, 3/21 had died; 6/21 still had abnormalities by x-ray, US, and clinical examination; and 12/21 had resolution by x-ray, US, and clinical examination. CONCLUSION: Our pilot study suggests potential benefits for bedside US in NHO, especially when compared with x-ray or laboratory investigations. These include the possibility of earlier diagnosis, consideration of therapy before ossification, and ease of follow-up. Our study also provides insights into the morphologic, sonographic, radiologic, and clinical course of NHO.
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Diagnóstico Precoz , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/diagnóstico , Pruebas en el Punto de Atención , Ultrasonografía Doppler/métodos , Adulto , Cuidados Críticos/métodos , Femenino , Hospitales Universitarios , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Centros de Atención Terciaria , Adulto JovenRESUMEN
Ultrasonography (US) is an established modality for intervention. The introduction of microbubble US contrast agents (UCAs) has the potential to further improve US imaging for intervention. According to licensing, UCAs are currently approved for clinical use in restricted situations, but many additional indications have become accepted as having clinical value. The use of UCAs has been shown to be safe, and there is no risk of renal toxic effects, unlike with iodinated or gadolinium contrast medium. Broadly speaking, UCAs can be injected into the bloodstream (intravascular use) or instilled into almost any accessible body cavity (endocavitary use), either in isolation or synchronously. In microvascular applications, contrast-enhanced US (CEUS) enhances delineation of necrotic areas and the vascularized target to improve real-time targeting. The ability of CEUS to allow true assessment of vascularity has also been used in follow-up of devascularizing intervention. In macrovascular applications, real-time angiographic images can be obtained with CEUS without nephrotoxic effects or radiation. In endocavitary applications, CEUS can achieve imaging similar to that of iodinated contrast medium-based fluoroscopy; follow-up to intervention (eg, tubography and nephrostography) can be performed at the bedside, which may be advantageous. The use of UCAs is a natural progression in US-guided intervention. The aim of this article is to describe the indications, contraindications, and techniques of using UCAs as an adjunctive tool for US-guided interventional procedures to facilitate effective treatment, improve complication management, and increase the overall success of interventional procedures. Online supplemental material is available for this article. ©RSNA, 2016.
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Medios de Contraste , Ultrasonografía Intervencional/métodos , Contraindicaciones , Medios de Contraste/administración & dosificación , Medios de Contraste/efectos adversos , Humanos , MicroburbujasAsunto(s)
Discitis/microbiología , Migración de Cuerpo Extraño/etiología , Implantación de Prótesis/instrumentación , Infecciones Relacionadas con Prótesis/microbiología , Absceso del Psoas/microbiología , Embolia Pulmonar/terapia , Infecciones Estafilocócicas/microbiología , Filtros de Vena Cava/efectos adversos , Vena Cava Inferior , Anciano , Antibacterianos/uso terapéutico , Discitis/diagnóstico por imagen , Discitis/terapia , Drenaje/métodos , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Humanos , Diseño de Prótesis , Falla de Prótesis , Implantación de Prótesis/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/terapia , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/terapia , Embolia Pulmonar/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/terapia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagenRESUMEN
We present a case of a biliary-arterial communication as a consequence of the placement of an internal-external biliary drainage catheter in a liver transplant patient diagnosed on contrast-enhanced ultrasound using a novel application by injecting microbubble contrast into the catheter tube. We postulate that this method may be sensitive in identifying occult communications between the biliary tree and the vascular compartment when a catheter drain is positioned, and there is hemobilia or unexplained sepsis.
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Fístula Biliar/diagnóstico por imagen , Medios de Contraste , Arteria Hepática/diagnóstico por imagen , Trasplante de Hígado , Microburbujas , Complicaciones Posoperatorias/diagnóstico por imagen , Fístula Vascular/diagnóstico por imagen , Fístula Biliar/etiología , Humanos , Masculino , Ultrasonografía , Fístula Vascular/etiología , Adulto JovenRESUMEN
Clinical signs and symptoms of non-infectious diseases are similar to those of infectious diseases during infancy. Therefore, rapid new methods for diagnosis of infections in infants are urgently needed. To examine the utility of measuring serum IL-1 beta for immediate diagnosis of sepsis in infants, in this cross-sectional epidemiological study blood samples were taken from 83 infants (41 female and 42 male) in whom infection was suspected and who were admitted to hospital. To perform serum interleukin (IL)-1 beta and quantitative C-reactive protein (CRP) tests, blood samples were placed in ice containers and delivered to the laboratory. The serum was removed from the samples at 4 degrees Celsius and stored in refrigerators at minus 30 degrees Celsius until the time of testing. The results were analysed by t tests. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of serum IL-1 beta were 27%, 71%, 25%, and 73%, respectively. Sensitivity, specificity, PPV and NPV of serum quantitative CRP were 76%, 60%, 40% and 88%, respectively. Hence quantitative serum CRP measurement for the diagnosis of infections is more efficient than measuring serum IL-1 beta levels. In general, quantitative serum CRP measurement as an alternative to other tests such as serum IL-1 beta assays might be an ideal test for diagnosing infections in infants.
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Bacteriemia/diagnóstico , Bacteriemia/epidemiología , Proteína C-Reactiva/metabolismo , Interleucina-1beta/sangre , Bacteriemia/sangre , Biomarcadores/sangre , Estudios Transversales , Diagnóstico Precoz , Femenino , Humanos , Recién Nacido , Irán/epidemiología , Masculino , Valor Predictivo de las Pruebas , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
t is known that ischemia reperfusion causes remote organ injury as well as local injury. The aim of this study was to investigate whether N-acetylcysteine has a protective effect against testicular injury after skeletal muscle ischemia reperfusion. Twenty male Wistar rats were allocated to two groups: ischemia reperfusion (control group) and ischemia reperfusion + N-acetylcysteine (treatment group). All animals underwent 2 h of ischemia by occlusion of the femoral artery and 24 h of reperfusion. Rats in treatment group received N-acetylcysteine (150 mg/kg IV) before the reperfusion period. After the reperfusion period, testes were removed for histopathological and biochemical studies. The blood samples were collected for evaluation of serum malondialdehyde (MDA) and nitric oxide (NO) production levels. The MDA levels in testes homogenates were found to be significantly decreased in treatment group (p < 0.05). Treatment of N-acetylcysteine significantly decreased serum MDA and NO levels compared to the control group (p < 0.05). In the control group, tissues showed histological changes. Histopathologically, there was a significant difference (p < 0.05) between two groups. According to histological and biochemical findings, we conclude that N-acetylcysteine has preventive effects in the testicular injury after skeletal muscle ischemia reperfusion.
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Acetilcisteína/farmacología , Antioxidantes/farmacología , Daño por Reperfusión/prevención & control , Testículo/patología , Animales , Masculino , Ratas , Ratas WistarRESUMEN
Background: There is a genuine interest in the development of probiotic milk and juice based beverages because they are a good-vehicle to deliver probiotic microorganisms to consumers. For this purpose, the viability and metabolism of four probiotic strains (Lactobacillus acidophilus LA5, Bifidobacterium lactis BB12, L. rhamnosus and L. plantarum) were studied in non-fermented milk and carrot juice mix drink. The drinks were evaluated in 5 days interval for viable cell count, pH, acidity, sedimentation and sensory quality during refrigerated storage at 4 ± 2ºC for up to 20 days. Results: The results showed that all strains had good viability in milk/carrot juice drink (88-98%), but L. acidophilus LA5 seemed more stable than three other strains. The levels of pH and acidity were ranged 5.33-6.6 and 0.13-0.31%, respectively. The drinks inoculated with L. rhamnosus and control (non-probiotic) showed more variation in pH and acidity. The most sedimentation was detected in drinks inoculated with L. rhamnosus, reaching 3.73 mL/10 mL sample. Sensory assessment indicated lowest acceptability in control and milk/carrot juice drink inoculated with L. rhamnosus, respectively. Conclusion: This study indicated that some probiotic bacteria can be applied by food producers to produce functional drinks with an increased shelf-life.
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Probióticos , Leche , Zumos , Bifidobacterium animalis/metabolismo , Lactobacillus/metabolismo , Gusto , Recuento de Colonia Microbiana , Sedimentación , Daucus carota , Viabilidad Microbiana , Alimentos Enfriados , Almacenamiento de Alimentos , Concentración de Iones de HidrógenoRESUMEN
OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of the quantitative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count in urinary tract infections (UTI) among hospitalised infants and children in Qazvin, Iran. METHODS: This cross-sectional study was conducted on 127 hospitalised children ranging in age from 2 months to 12 years old 31.79 months (SD 30.73) who were suspected of having a UTI and who did not receive antibiotics prior to being seen at a Qazvin teaching children's hospital between 2005 and 2006. A urine analysis (U/A) and urine culture (U/C) were performed. The blood was taken for CRP, ESR and WBC analyses. U/C has been considered the gold standard test for a UTI and dimercaptosuccinic acid renal scintigraphy (DMSA) as the gold standard for an upper UTI (pyelonephritis). These tests were used to determine the diagnostic accuracy, which is represented as the percent of correct results. RESULTS: Within the study population, 72 patients (56.7%) were younger than two years old 9.86 months (SD 4.56) and 55 (43.3%) were older than two years old 63.58 months (SD 30.96). One hundred and two patients (80.3%) were female. There were 100 cases that had a positive U/C. Of the patients with a positive U/C, 81 had pyuria (WBC more than 5/hpf), 71 had a peripheral WBC count of more than 10 000 /mL, 95 had a CRP of more than 10 mg/L and 82 had an ESR > 10 mm/h. The sensitivity and specificity as well as the positive and negative predictive values and the accuracy of CRP when using U/C as the gold standard were, respectively, 96%, 11.1%, 80.2%, 50%, and 78%; when using ESR as the gold standard were, respectively, 55%, 40%, 77.6%, 17.2%, and 52%; and when using WBC counts as the gold standard were, respectively, 69%, 52%, 86.6%, 35.6%, and 65%. The accuracy of CRP, ESR and WBC counts when considering the DMSA as the gold standard were 58.3%, 62.8%, and 64.5%, respectively. CONCLUSION: Although acute phase reactants can help in the diagnosis of a UTI, they are not pathognomonic. CRP, ESR and WBC were neither completely sensitive nor specific for detecting a UTI and its localisation site in Iranian children. Therefore, in a country where advanced clinical diagnostic tests are available, the advanced test should be used in conjunction with CRP, ESR and WBC analyses. Finally, a combination of laboratory tests along with history and exact clinical examination are needed for the diagnosis of a UTI and its localisation site.
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OBJECTIVE: To investigate the effects of extract of Urtica dioica, a perennial herb in Iran, on lipid profile in hypercholesterolemic rats. METHODS: The effects of Urtica dioica extract were tested by using it as a supplement in a high-cholesterol diet. Male rats were fed a high cholesterol diet (10 mL/kg) for 4 weeks with Urtica dioica extract (100 or 300 mg/kg) or 10 mg/kg lovastatin supplementation to study the hypocholesterolemic effects of Urtica dioica on plasma lipid levels, hepatic enzymes activities, and liver histopathological changes. RESULTS: Urtica dioica extract at 100 and 300 mg/kg significantly reduced the levels of total cholesterol (TC), and low-density lipoprotein-cholesterol (LDL-C) and also markedly decreased liver enzymes and weight in animals with a high cholesterol diet. Hematoxylin and eosin staining showed that in the 100 mg/kg extract of Urtica dioica group, the appearance of the liver cells was similar to the control group, and steatosis and inflammation were not found. In the 300 mg/kg extract of Urtica dioica group, mild steatosis was observed but mononuclear inflammatory infiltration was not found. CONCLUSION: The hepatic histopathological results reflect the correlation of Urtica dioica extract with both liver weight and the levels of plasma TC and LDL-C. These results indicate that Urtica dioica extract has hypocholesterolemic effects in the animal model.