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Interventions targeting patients with recent fragility fracture and their physician were most successful at initiating osteoporosis treatment during the first 12 months. This window of opportunity had already closed after 1 year. The reasons for declining or accepting the intensive intervention were explored in patients still untreated at 12 months. INTRODUCTION: A fragility fracture (FF) event identifies patients most likely to benefit from osteoporosis treatment. Nonetheless, most FF patients go untreated. Our objective was to determine how long an incident FF remains a strong incentive to initiate osteoporosis treatment. METHODS: A total of 1086 men and women over age 50 with a recent FF event were assigned to either standard care (SC), to minimal (MIN), or intensive (INT) interventions targeting patients and their family physician to initiate osteoporosis treatment. Inpatients with FF (mainly hip) evaluated by rheumatologists were also included in a specialized group (SPE; n = 324). At 1 year, untreated patients in both the SC and the MIN groups were offered an INT intervention. The cohort was followed through 48 months. A qualitative analysis of patient-centered decision-making associated with initiation of treatment was conducted. RESULTS: In MIN and INT groups, osteoporosis treatment was initiated in 41.0 and 54.3% of untreated patients by 12 months, respectively, compared to 68.4% in SPE and 18.9% in SC groups; initiation rates drastically dropped thereafter. Over 4863 patient-years of follow-up, the rates of new FF were 3.4 per 100 patient-years, without significant differences between patients with initial major or minor FF, nor between control or intervention groups. Failure by patients and physicians to recognize FF as a sign of underlying bone disease contributed the most to lack of treatment. CONCLUSION: While incident FFs are an ideal opportunity for starting osteoporosis treatment, 1 year later, the therapeutic window of opportunity has already closed.
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Conservadores de la Densidad Ósea/uso terapéutico , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Anciano , Canadá , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Dirigida al Paciente/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos , Medición de Riesgo/métodos , Factores de TiempoRESUMEN
UNLABELLED: This study determined the cost of treating fractures at osteoporotic sites (except spine fractures) for the year following fracture. While the average cost of treating a hip fracture was the highest of all fractures ($46,664 CAD per fracture), treating other fractures also accounted for significant expenditures ($5,253 to $10,410 CAD per fracture). INTRODUCTION: This study aims to determine the mean direct medical cost of treating fractures at peripheral osteoporotic sites in the year post-fracture (through 2 years post-hip fracture). METHODS: Health administrative databases from the province of Quebec, Canada were used to estimate the cost of treating peripheral fractures at osteoporotic sites for the year following fracture (through 2 years for hip fractures). Included in costs analyses were physician claims, emergency and outpatient clinic costs, hospitalization costs, and subsequent costs for treatment of complications. RESULTS: A total of 15,827 patients (mean age 72 years) who suffered one fracture at an osteoporotic site had data for analyses. Hip/femur fractures had the highest rate of hospital stays related to fracture (91%) and the highest rate of hospital stays associated with a post-fracture complication (8%). In the year following fracture, the mean (SD) costs (2009 Canadian dollars) of treating acute fractures and post-fracture complications were: hip/femur fracture $46,664 ($43,198), wrist fracture $5,253 ($18,982), and fractures at other peripheral sites $10,410 ($27,641). The average (SD) cost of treating post-fracture complications at the hip/femur in the second year post-fracture was $1,698 ($12,462). Hospitalizations associated with the fracture accounted for 88% of the total cost of fracture treatment. CONCLUSIONS: The treatment of hip fractures accounts for a significant proportion of the costs associated with the treatment of peripheral osteoporotic fractures. Interventions to reduce the incidence of fractures, particularly hip fractures, would result in significant cost savings to the health care system and would preserve quality of life in many patients.
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Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Osteoporosis Posmenopáusica/economía , Fracturas Osteoporóticas/economía , Anciano , Anciano de 80 o más Años , Costos y Análisis de Costo , Femenino , Fracturas de Cadera/economía , Fracturas de Cadera/terapia , Humanos , Persona de Mediana Edad , Fracturas Osteoporóticas/terapia , Posmenopausia , Complicaciones Posoperatorias/economía , Quebec , Traumatismos de la Muñeca/economía , Traumatismos de la Muñeca/terapiaRESUMEN
Background :This study examines the effect of exclusive versus non-exclusive breastfeeding on specific infant morbidities from birth to nine months; in Conakry (Guinea). Method: A cross-sectional study was conducted on 1;167 mother-infant pairs who visited one of 20 immunization centres in Conakry for vaccination between the 45th and 270th days of the child's life. Two data sources were used: the infant health book and an orally administered questionnaire completed with the mother. Data analyses included univariate cross-tabulations and multivariate logistic regression models to estimate the effect of breastfeeding on infant morbidity. Results : Exclusive breastfeeding decreased with the infant's age. At six months of age; the proportion of infants who were exclusively breastfed was only 15.5. After adjusting for the infant's age; and the interaction between the type of breastfeeding and the infant's age; exclusive breastfeeding significantly protected the infants against many of the studied morbidities (OR: 0.28; CI: 0.15-0.51) and specifically against diarrhoea (OR: 0.38; 95CI: 0.17 - 0.86); respiratory infections (OR: 0.27; 95CI: 0.14 - 0.50); and low growth rate (OR: 0.11; 95CI: 0.02 - 0.46); but not for otitis; urinary infection; or meningitis. This investigation confirmed the protective effects of exclusive breastfeeding on some specific infant's morbidities during the first nine months of life. The results of this study are of great importance for the development of an information program designed to encourage the exclusive breastfeeding among the mothers of Conakry; Guinea
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Alimentación con Biberón , Lactancia Materna , Lactante , MorbilidadRESUMEN
Background: The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care. Methods: Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC); a systemic approach; based on the PRECEDE PROCEED model of analysis; led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading; focused on the methodological process; should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere). The other reading; revolving around the specific theme and results; should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC). Results: The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects; i.e. sociological; educational; medical and public health. Conclusions: The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour; and to do it within the organization of local structures and institutions in the ministry of health in the DRC
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Sistemas de Salud , Fuerza Laboral en Salud/educación , Salud PúblicaAsunto(s)
Trastorno Bipolar/genética , Proteínas de Ciclo Celular/genética , Cromosomas Humanos Par 12 , Proteínas Serina-Treonina Quinasas/genética , Mapeo Cromosómico , Citoesqueleto/fisiología , Humanos , Péptidos y Proteínas de Señalización Intracelular , Proteínas del Tejido Nervioso/genética , Polimorfismo de Nucleótido Simple , Eliminación de Secuencia , Sinapsis/fisiologíaRESUMEN
INTRODUCTION: Genetic variants affecting adrenoceptors have been suggested to influence body fatness. A putative gain-of-function polymorphism in the beta(1)-adrenoceptor was recently discovered (Gly389Arg ADRB1). We examined the association between Gly389Arg ADRB1 and obesity status in a large cohort of well-characterized individuals. METHODS: First, a large cohort of 931 Caucasian women (55.0+/-12.2 y) were genotyped for Gly389Arg ADRBbeta1 and we examined the association of the Arg allele with body weight and BMI (Gly/Gly, n=54; Gly/Arg, n=360; Arg/Arg, n=517). To further examine phenotypes regulating energy balance and body fatness, we examined the contribution of the Arg allele to body composition (DEXA), fat distribution (CT scan), resting energy expenditure, energy and macronutrient intake, maximal oxygen capacity, and physical activity in a subsample of 214 women from the main cohort that had been carefully characterized (Gly/Gly, n=19; Gly/Arg, n=82; Arg/Arg, n=113). RESULTS: In the entire cohort (n=931), allele frequencies were 0.25 and 0.75 for the Gly and Arg alleles, respectively. In this cohort, we found that each Arg allele was associated with greater body weight of 2.91 kg (P=0.01) and BMI of 0.86 kg/m(2) (P=0.05). Accordingly, in the subsample of women, each Arg allele was associated with greater fat mass (3.71 kg; P=0.008). Other phenotypes were not significantly associated with the presence of the Arg allele. CONCLUSIONS: This is the first study to investigate the relationship between the Gly389Arg ADRB1 variant and obesity. We found that the Arg allele is associated with greater body weight and BMI in Caucasian women due to a greater fat mass.
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Arginina , Glicina , Obesidad/genética , Polimorfismo Genético , Receptores Adrenérgicos beta 1/genética , Adulto , Anciano , Anciano de 80 o más Años , Alelos , Índice de Masa Corporal , Peso Corporal , Ingestión de Energía , Metabolismo Energético , Ejercicio Físico , Femenino , Frecuencia de los Genes , Humanos , Persona de Mediana Edad , Consumo de Oxígeno , Fenotipo , Descanso , Población BlancaRESUMEN
The cytoplasmic domain of the insulin receptor (IR) beta-subunit contains cysteine (Cys) residues whose reactivity and function remain uncertain. In this study, we examined the ability of the bifunctional cross-linking reagent 1,6-bismaleimidohexane (BMH) to covalently link IR with interacting proteins that possess reactive thiols. Transfected Chinese hamster ovary cells expressing either the wild-type human IR, C-terminally truncated receptors, or mutant receptors with Cys --> Ala substitutions and mouse 3T3-L1 adipocytes were used to compare the BMH effect. The results showed the formation of a large complex between the wild-type human receptor beta-subunit and molecule X, a thiol-reactive membrane-associated protein, in both intact and semipermeabilized cells in response to BMH. Prior cell stimulation with insulin had only a modest effect in this process. Western blot analysis revealed that the receptor alpha-subunit was not present in the beta-X complex. The BMH cross-linking did not inhibit in vitro tyrosine phosphorylation of the receptor complexed with molecule X. Both the human IR Cys981Ala mutant and murine IR, that lacks the equivalent of human Cys(981), failed to react with BMH. Finally, no covalent association between IR beta-subunit and IRS-1, the protein tyrosine phosphatase LAR or SHP-2 was observed in BMH-treated cells expressing the wild-type human IR. These results demonstrate a striking difference in reactivity among the cytoplasmic IR beta-subunit thiols and clearly show that Cys(981) of human IR beta-subunit is in close proximity to a thiol-reactive membrane-associated protein under basal and insulin-stimulated conditions.
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Cisteína/metabolismo , Maleimidas/metabolismo , Receptor de Insulina/metabolismo , Receptores de Superficie Celular , Células 3T3 , Animales , Células CHO , Cricetinae , Cisteína/genética , Humanos , Péptidos y Proteínas de Señalización Intracelular , Proteínas de la Membrana/metabolismo , Ratones , Mutación , Fosforilación , Proteína Tirosina Fosfatasa no Receptora Tipo 11 , Proteína Tirosina Fosfatasa no Receptora Tipo 6 , Proteínas Tirosina Fosfatasas/metabolismo , Receptor de Insulina/genética , Proteínas Tirosina Fosfatasas Clase 4 Similares a Receptores , Compuestos de Sulfhidrilo/metabolismo , TransfecciónRESUMEN
The aim of this study was to describe the various MRI features, in correlation to surgical and pathological findings, in patients who presented with pituitary apoplexy (PA). Eleven patients presenting with PA, were evaluated with various MR protocols including spin-echo (SE) T1-weighted sequences in 9 of 11 patients, post gadolinium SE T1-weighted sequences in only 8 of 11 patients, and with T2-weighted SE sequences in 2 of 11 patients. All patients had transsphenoidal pituitary surgery after MR studies. The severity of presenting symptoms ranged from headaches to coma. Ten patients had pituitary macroadenoma; one had a non-hemorrhagic metastatic lesion into a non-adenomatous pituitary gland. Of the 11 patients, one was studied at the acute stage of PA (1 day after onset), 9 at the subacute period (3-15 days after onset), and one at the late stage (5 months after onset). Images compatible with intratumoral hemorrhage were found in all macroadenomas, whereas the metastatic pituitary lesion did not show evidence of bleeding. All gadolinium-enhanced studies showed partial tumoral enhancement. The SE T2-weighted studies demonstrated areas of low and high signal intensities in keeping with the presence of blood degradation contents. Pituitary apoplexy present with different MR features, including hemorrhagic and non-hemorrhagic characteristics on T1-weighted images. Gadolinium-enhanced images do not provide complementary diagnostic information when the presence of blood is assessed on plain images.
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Imagen por Resonancia Magnética , Apoplejia Hipofisaria/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemorragia/complicaciones , Hemorragia/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Apoplejia Hipofisaria/complicaciones , Apoplejia Hipofisaria/cirugía , Hipófisis/patología , Neoplasias Hipofisarias/complicacionesAsunto(s)
Adipocitos , Neoplasias Encefálicas/diagnóstico , Quiste Dermoide/cirugía , Glioma/diagnóstico , Complicaciones Posoperatorias , Neoplasias de la Médula Espinal/cirugía , Neoplasias Encefálicas/patología , Ventrículos Cerebrales/patología , Quiste Dermoide/complicaciones , Quiste Dermoide/diagnóstico , Glioma/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Rotura Espontánea , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/diagnóstico , Espacio Subaracnoideo/diagnóstico por imagen , Espacio Subaracnoideo/patología , Tomografía Computarizada por Rayos XRESUMEN
In this study, we used maleimidobutyrylbiocytin to examine possible alteration that may occur in the redox state of the insulin receptor (IR) sulfhydryl groups in response to reduced glutathione (GSH) or N-acetyl-L-cysteine (NAC). Short-term treatment of intact cells expressing large numbers of IR with GSH or NAC led to a rapid and reversible reduction of IR alpha-subunit disulfides, without affecting the receptor beta-subunit thiol reactivity. The overall integrity of the oligomeric structure of IR was maintained, indicating that neither class I nor class II disulfides were targeted by these agents. Similar findings were obtained in cells transfected with IR mutants lacking cysteine524, one of the class I disulfides that link the two IR alpha-subunits. Membrane-associated thiols did not participate in GSH- or NAC-mediated reduction of IR alpha-subunit disulfides. No difference in insulin binding was observed in GSH-treated cells; however, ligand-mediated increases in IR autophosphorylation, tyrosine phosphorylation of cellular substrates, and dual phosphorylation of the downstream target mitogen-activated protein kinase were inhibited at concentrations of GSH (10 mM or greater) that yielded a significant increase in IR alpha-subunit thiol reactivity. GSH did not affect IR signaling in the absence of insulin. Our results provide the first evidence that the IR alpha-subunit contains a select group of disulfides whose redox status can be rapidly altered by the reducing agents GSH and NAC.
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Receptor de Insulina/química , Receptor de Insulina/metabolismo , Compuestos de Sulfhidrilo/química , Compuestos de Sulfhidrilo/metabolismo , Acetilcisteína/farmacología , Animales , Células CHO , Carcinoma Hepatocelular , Cricetinae , Medios de Cultivo , Glutatión/metabolismo , Glutatión/farmacología , Humanos , Oxidación-Reducción , Unión Proteica/efectos de los fármacos , Ratas , Receptor de Insulina/fisiología , Factores de Tiempo , Células Tumorales CultivadasRESUMEN
Chinese hamster ovary (CHO) cells stably expressing the human insulin receptor and the rat glucagon-like peptide-1 (GLP-1) receptor (CHO/GLPR) were used to study the functional coupling of the GLP-1 receptor with G proteins and to examine the regulation of the mitogen-activated protein (MAP) kinase signaling pathway by GLP-1. We showed that ligand activation of GLP-1 receptor led to increased incorporation of GTP-azidoanilide into Gs alpha, Gq/11 alpha, and Gi1,2 alpha, but not Gi3 alpha. GLP-1 increased p38 MAP kinase activity 2.5- and 2.0-fold over the basal level in both CHO/GLPR cells and rat insulinoma cells (RIN 1046-38), respectively. Moreover, GLP-1 induced phosphorylation of the immediate upstream kinases of p38, MKK3/MKK6, in CHO/GLPR and RIN 1046-38 cells. Ligand-stimulated GLP-1 receptor produced 1.45- and 2.7-fold increases in tyrosine phosphorylation of 42-kDa extracellular signal-regulated kinase (ERK) in CHO/GLPR and RIN 1046-38 cells, respectively. In CHO/GLPR cells, these effects of GLP-1 on the ERK and p38 MAP kinase pathways were inhibited by pretreatment with cholera toxin (CTX), but not with pertussis toxin. The combination of insulin and GLP-1 resulted in an additive response (1.6-fold over insulin alone) that was attenuated by CTX. In contrast, the ability of insulin alone to activate these pathways was insensitive to either toxin. Our study indicates a direct coupling between the GLP-1 receptor and several G proteins, and that CTX-sensitive proteins are required for GLP-1-mediated activation of MAP kinases.
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Proteínas Quinasas Dependientes de Calcio-Calmodulina/metabolismo , Proteínas de Unión al GTP/metabolismo , Proteínas Quinasas Activadas por Mitógenos , Páncreas/metabolismo , Receptores de Glucagón/metabolismo , Animales , Células CHO , Clonación Molecular , Cricetinae , Activación Enzimática , Receptor del Péptido 1 Similar al Glucagón , Humanos , Ratas , Receptor de Insulina/metabolismo , Proteínas Quinasas p38 Activadas por MitógenosRESUMEN
OBJECTIVE: To compare bidimensional measurements with direct volumetry in the reporting of disease in patients with liver metastases who are receiving chemotherapy. PATIENTS AND METHODS: Ten patients (6 men and 4 women) receiving chemotherapy were included. A total of 37 contrast-enhanced abdominal computed tomographic (CT) scans, forming 26 pairs of studies, were evaluated retrospectively by 2 independent reviewers. One reviewer recorded bidimensional measurements from hard-copy films, and the other recorded volumetric measurements at the CT console. All measurements were analysed before and after application of a 5% variation interval. RESULTS: Reporting of disease was initially discordant in 5 (19%) of the 26 paired examinations. After application of a 5% variation interval, 9 cases (35%) were discordant. When borderline results (type of response modified by 5% variation) were excluded, 4 discordant cases (20%) remained. All but 1 case showed progressive disease with bidimensional measurements and no change at volumetry. The presence of a new lesion affected reporting in only 1 case. CONCLUSION: The 2 methods of reporting disease are not interchangeable. We believe that volumetric measurements are more representative of tumour burden than bidimensional measurements. However, acquisition of nonhelical data may be a pitfall in volumetric measurements. The increasing availability of helical CT technology should resolve this issue.
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Antineoplásicos/uso terapéutico , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Tomografía Computarizada por Rayos X , Medios de Contraste , Femenino , Neoplasias Gastrointestinales/patología , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Masculino , Estudios RetrospectivosRESUMEN
Glucagon-like peptide-1 is the main hormonal mediator of the enteroinsular axis. Recently, it has additionally received considerable attention as a possible new treatment for Type II (non-insulin-dependent) diabetes mellitus. Its major disadvantage is that its duration of action is too short to achieve good 24-h metabolic control. Exendin-4, which is produced in the salivary glands of Gila monster lizards, is structurally similar to glucagon-like peptide-1 and shares several useful biological properties with glucagon-like peptide-1. It binds the glucagon-like peptide-1 receptor, stimulates insulin release and increases the cAMP production in beta cells. We report that exendin-4 is a more potent insulinotropic agent when given intravenously to rats than is glucagon-like peptide-1 (ED50 0.19 nmol/kg for glucagon-like peptide-1 vs 0.0143 nmol/kg for exendin-4) and causes a greater elevation in cAMP concentrations in isolated islets. Of even greater interest we found that when given intraperitoneally only once daily to diabetic mice it had a prolonged effect of lowering blood glucose. After 1 week of treatment blood glucoses were 5.0+/-2.6 mmol/l compared to diabetic concentrations of 13.2+/-2.8 mmol/l. After 13 weeks of daily treatment HbA1c was 8.8+/-0.4% in non-treated diabetic animals compared with 4.7+/-0.25% in treated diabetic animals. Blood glucoses also were lower (p < 0.005) and insulin concentrations higher (p < 0.02) in the treated animals. Exendin-4 could therefore be preferable to glucagon-like peptide-1 as a long-term treatment of Type II diabetes.
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Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Glucagón/farmacología , Fragmentos de Péptidos/farmacología , Péptidos/farmacología , Precursores de Proteínas/farmacología , Receptores de Superficie Celular , Animales , Glucemia/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Proteínas Portadoras/genética , Cruzamientos Genéticos , AMP Cíclico/metabolismo , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Esquema de Medicación , Ingestión de Energía/efectos de los fármacos , Exenatida , Péptido 1 Similar al Glucagón , Hemoglobina Glucada/metabolismo , Insulina/sangre , Islotes Pancreáticos/efectos de los fármacos , Islotes Pancreáticos/metabolismo , Lagartos , Ratones , Ratones Endogámicos C57BL , Péptidos/administración & dosificación , Ratas , Ratas Wistar , Receptores de Leptina , Ponzoñas/administración & dosificación , Ponzoñas/farmacologíaAsunto(s)
Antiinflamatorios/efectos adversos , Artritis/diagnóstico por imagen , Enfermedad de Crohn/tratamiento farmacológico , Articulación de la Cadera , Osteonecrosis/diagnóstico por imagen , Articulación Sacroiliaca , Artritis/inducido químicamente , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Osteonecrosis/inducido químicamente , Radiografía , EsteroidesRESUMEN
BACKGROUND: To describe the appearance of renal masses during multiphase helical computed tomography (CT) acquisition and evaluate the impact of a cortical nephrographic phase on diagnosis. METHODS: The CT examinations of 33 patients with 37 lesions [18 renal cell carcinomas (RCC), nine solid tumors, 10 cystic lesions] were reviewed to characterize renal masses during four phases of CT scanning: plain, cortical nephrographic, tubular nephrographic, and pyelographic. Two reviewers analyzed all lesions on the complete data set, and a third reviewer analyzed three combinations of images separately: (1) plain and tubular nephrographic phases, (2) plain and cortical nephrographic phases, and (3) three phases combined. Receiver operating characteristics (ROC) curves were generated to determine the respective value of each combination in lesion characterization. RESULTS: During the cortical nephrographic phase, hyperdensity of solid renal masses was 100% specific and 22% sensitive for RCC, whereas combining hyperdense and isoattenuating heterogeneous masses was 91% specific and 56% sensitive. ROC curves demonstrated a sensitivity of 85%, 90%, 100% for the three combinations, respectively, with a constant specificity of 88% for diagnosing RCC. CONCLUSION: The cortical nephrographic phase is useful to characterize renal masses and should be included in the routine helical CT protocol.
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Enfermedades Renales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Absceso/diagnóstico por imagen , Absceso/patología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/secundario , Adenoma Oxifílico/diagnóstico por imagen , Adenoma Oxifílico/patología , Adulto , Anciano , Angiomiolipoma/diagnóstico por imagen , Angiomiolipoma/patología , Biopsia , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/patología , Carcinoma de Células Transicionales/diagnóstico por imagen , Carcinoma de Células Transicionales/patología , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Renales/patología , Enfermedades Renales Quísticas/diagnóstico por imagen , Enfermedades Renales Quísticas/patología , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Neoplasias Renales/secundario , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
We describe a duplication of the odontoid process in a 6-year-old patient that included a partially fused midline ossicle on the anterior arch of C-1, fusion of the anterior lip of the foramen magnum and the arch of C-1, and an incomplete bony posterior arch of C-1.
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Vértebras Cervicales/anomalías , Apófisis Odontoides/anomalías , Tomografía Computarizada por Rayos X , Vértebras Cervicales/diagnóstico por imagen , Niño , Femenino , Movimientos de la Cabeza/fisiología , Humanos , Apófisis Odontoides/diagnóstico por imagenRESUMEN
We present a case of aggressive fibromatosis of the scalene and longus colli muscles with surgically proved secondary involvement of the brachial plexus and carotid sheath in a 29-year-old woman in whom MR imaging failed to show involvement of the carotid sheath. The well-defined lesion was isointense on T1-weighted images and hyperintense on T2-weighted images relative to adjacent normal muscle and enhanced brightly.