RESUMEN
Adhesive capsulitis, commonly known as frozen shoulder, is a painful and restrictive condition that significantly impairs the quality of life for affected individuals. We present the successful endovascular treatment of adhesive capsulitis in the first-ever case performed in Portugal. A 6-month follow-up with objective results is presented, using the visual analog scale for pain and the Quick Dash questionnaire. Trans-arterial, musculoskeletal embolization, as a cutting-edge technique, offers a promising avenue for patients with adhesive capsulitis unresponsive to traditional management, opening new possibilities for improved outcomes and enhanced quality of life.
Asunto(s)
Bursitis , Embolización Terapéutica , Humanos , Bursitis/terapia , Embolización Terapéutica/métodos , Resultado del Tratamiento , Femenino , Procedimientos Endovasculares/métodos , Persona de Mediana Edad , Articulación del Hombro/diagnóstico por imagen , Calidad de Vida , Dimensión del Dolor , MasculinoRESUMEN
BACKGROUND: Hemorrhoidal disease most commonly manifests itself with chronic rectal bleeding and, in its most severe and refractory forms, may lead to chronic anaemia with the need for recurrent blood transfusions. The main pathogenetic mechanism involved seems to be arterial hyperflux in the terminal branches that supply the hemorrhoidal plexus. It is based on this principle, that embolization of the superior rectal artery (emborrhoid technique) has recently re-emerged, with very promising results that support its feasibility, treatment efficacy, and safety. CASE PRESENTATION: We report a case of a patient with both recurrent hemorrhoidal bleeding and portal hypertension with rectal varices, who underwent SRA embolization as a salvage therapy, with significant clinical improvement and no immediate or short-term complications. CONCLUSIONS: We believe that the positive results from our case raise the possibility that the emborrhoid technique could be effective and safe even in patients with portal hypertension, and that it would be clinically relevant to investigate this hypothesis on larger samples with a longer follow-up.
RESUMEN
OBJECTIVE: The present study was aimed at evaluating the contribution of transrectal prostate ultrasound in the screening for prostate neoplasias and in the guidance of prostate biopsies. MATERIALS AND METHODS: Prospective study developed over a one-year period. All the patients with indication for prostate biopsy were evaluated. Regardless of PSA values, the patients underwent ultrasound in order to identify suspicious nodules (confirmed by two observers). Sextant biopsy was subsequently performed. In cases of finding suspicious nodules, an additional puncture directed to such nodules was done. RESULTS: In a total of 155 cases the prevalence of malignancy was of 53%. Suspicious nodules were detected in 34 patients, and 25 where malignant (positive predictive value of 74%). The specificity and sensitivity for suspicious nodules were 88% and 31% respectively. Comparatively with the randomly obtained sextant specimens, the rate of findings of neoplasia was higher in the specimens obtained with puncture directed to the nodule (p = 0.032). No statistically significant difference was observed in the Gleason score for both types of specimens (p = 0.172). CONCLUSION: The high positive predictive value and the high rate of findings of neoplasia in specimens of suspicious nodules should be taken into consideration in the future. The authors suggest a biopsy technique similar to the one described in the present study (sextant biopsy plus puncture directed to the suspicious nodule).
OBJETIVO: O objetivo deste estudo é avaliar o papel da ecografia prostática transretal no rastreamento da neoplasia prostática e na orientação da biópsia prostática. MATERIAIS E MÉTODOS: Estudo prospectivo com a duração de um ano. Foram avaliados todos os doentes com indicação para biópsia. Ignorando o valor de PSA, realizamos ecografia para identificar nódulos suspeitos (confirmados por dois observadores). Efetuamos, depois, biópsia dirigida a todos os sextantes. Nos casos com nódulo suspeito, efetuamos ainda punção adicional dirigida ao nódulo. RESULTADOS: Num total de 155 casos, a prevalência de malignidade foi 53%. Detectamos nódulos suspeitos em 34 pacientes, 25 dos quais malignos (valor preditivo positivo de 74%). A especificidade e a sensibilidade dos nódulos suspeitos foram 88% e 31%, respectivamente. A porcentagem de tumor foi superior nas biópsias dirigidas ao nódulo, comparativamente à amostra com maior representação tumoral obtida aleatoriamente (p = 0,032). Não houve diferença estatisticamente significativa entre o escore de Gleason de ambas as amostras (p = 0,172). CONCLUSÃO: O elevado valor preditivo positivo e a elevada representação tumoral nos nódulos considerados suspeitos deverão ser levados em consideração no futuro. Sugerimos uma técnica de biópsia igual à utilizada neste estudo (biópsia sextante mais punção dirigida a nódulo suspeito).
RESUMEN
Objective: The present study was aimed at evaluating the contribution of transrectal prostate ultrasound in the screening for prostate neoplasias and in the guidance of prostate biopsies. Materials and Methods: Prospective study developed over a one-year period. All the patients with indication for prostate biopsy were evaluated. Regardless of PSA values, the patients underwent ultrasound in order to identify suspicious nodules (confirmed by two observers). Sextant biopsy was subsequently performed. In cases of finding suspicious nodules, an additional puncture directed to such nodules was done. Results: In a total of 155 cases the prevalence of malignancy was of 53%. Suspicious nodules were detected in 34 patients, and 25 where malignant (positive predictive value of 74%). The specificity and sensitivity for suspicious nodules were 88% and 31% respectively. Comparatively with the randomly obtained sextant specimens, the rate of findings of neoplasia was higher in the specimens obtained with puncture directed to the nodule (p = 0.032). No statistically significant difference was observed in the Gleason score for both types of specimens (p = 0.172). Conclusion: The high positive predictive value and the high rate of findings of neoplasia in specimens of suspicious nodules should be taken into consideration in the future. The authors suggest a biopsy technique similar to the one described in the present study (sextant biopsy plus puncture directed to the suspicious nodule). .
Objetivo: O objetivo deste estudo é avaliar o papel da ecografia prostática transretal no rastreamento da neoplasia prostática e na orientação da biópsia prostática. Materiais e Métodos: Estudo prospectivo com a duração de um ano. Foram avaliados todos os doentes com indicação para biópsia. Ignorando o valor de PSA, realizamos ecografia para identificar nódulos suspeitos (confirmados por dois observadores). Efetuamos, depois, biópsia dirigida a todos os sextantes. Nos casos com nódulo suspeito, efetuamos ainda punção adicional dirigida ao nódulo. Resultados: Num total de 155 casos, a prevalência de malignidade foi 53%. Detectamos nódulos suspeitos em 34 pacientes, 25 dos quais malignos (valor preditivo positivo de 74%). A especificidade e a sensibilidade dos nódulos suspeitos foram 88% e 31%, respectivamente. A porcentagem de tumor foi superior nas biópsias dirigidas ao nódulo, comparativamente à amostra com maior representação tumoral obtida aleatoriamente (p = 0,032). Não houve diferença estatisticamente significativa entre o escore de Gleason de ambas as amostras (p = 0,172). Conclusão: O elevado valor preditivo positivo e a elevada representação tumoral nos nódulos considerados suspeitos deverão ser levados em consideração no futuro. Sugerimos uma técnica de biópsia igual à utilizada neste estudo (biópsia sextante mais punção dirigida a nódulo suspeito). .