RESUMEN
We report a case of congenital absence of the cervical and petrous part of the left internal carotid artery, the middle and proximal part of the basilar artery, and the V4 segment of the left vertebral artery associated with a left persistent trigeminal artery and a coarctation of the aorta. The left cerebral vessels are supplied via the anterior communicating artery and the left persistent trigeminal artery. The coexisting coarctation of the aorta led to a subclavian steal phenomenon. The alteration of the cerebral hemodynamics has to be taken in consideration when performing cerebral angiography and surgical correction in such a case.
Asunto(s)
Coartación Aórtica/complicaciones , Arteria Basilar/anomalías , Arteria Carótida Interna/anomalías , Cerebelo/irrigación sanguínea , Malformaciones Arteriovenosas Intracraneales/complicaciones , Adulto , Arterias/anomalías , Angiografía Cerebral , Circulación Cerebrovascular , Circulación Colateral , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagenRESUMEN
PURPOSE: The object of this study was to evaluate the diagnostic accuracy of the stereotactic large core breast biopsy in the histological assessment of mammographically suspicious lesions. MATERIAL AND METHODS: In 106 patients with a mammographically suspicious lesion, 67 with a mass (55 non-palpable, 12 palpable and 39 with microcalcification stereotactic large core biopsies were performed. Samples were obtained in the prone position under local anesthesia with a 14-gauge needle and an automated high-speed gun. An average of 4.3 cores per lesion were acquired. In 68 patients (64%) an additional surgical biopsy was performed, 38 (36%) had clinical and mammographic follow-up. RESULTS: In 4 of the 106 stereotactic biopsies insufficient material for the histological examination was obtained. In the 68 core biopsies with surgical correlation there were no false-positive, but 2 false-negative results with regard to the malignancy of the lesion (sensitivity: 93.8%; specificity: 100%). The 2 false-negative results were obtained in lesions that were mammographically judged as malignant while histology of the stereotactic biopsy showed fibrosis. The stereotactic large core breast biopsy was well tolerated by all patients. No clinically significant complications occurred. CONCLUSION: The stereotactic large core breast biopsy of a mammographically suspicious lesion can be performed with a high diagnostic accuracy. A correlation of the mammographic and histological findings and a follow-up program are necessary in order to recognize false-negative results early and to avoid a delay in the diagnosis.
Asunto(s)
Biopsia con Aguja/métodos , Neoplasias de la Mama/patología , Mama/patología , Mamografía , Técnicas Estereotáxicas , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de la Mama/diagnóstico , Enfermedades de la Mama/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/diagnóstico por imagen , Carcinoma/diagnóstico , Carcinoma/patología , Diagnóstico Diferencial , Femenino , Fibroadenoma/diagnóstico , Fibroadenoma/patología , Enfermedad Fibroquística de la Mama/diagnóstico , Enfermedad Fibroquística de la Mama/patología , Fibrosis , Estudios de Seguimiento , Hemangioma/diagnóstico , Hemangioma/patología , Humanos , Hiperplasia , Persona de Mediana Edad , Palpación , Tumor Filoide/diagnóstico , Tumor Filoide/patología , Sensibilidad y Especificidad , Factores de TiempoAsunto(s)
Vértebras Cervicales/diagnóstico por imagen , Cabeza , Osteofitosis Vertebral/diagnóstico por imagen , Soporte de Peso/fisiología , Adulto , Fenómenos Biomecánicos , Vértebras Cervicales/fisiopatología , Femenino , Cabeza/diagnóstico por imagen , Cabeza/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Factores de Riesgo , Sierra LeonaRESUMEN
OBJECTIVE: To evaluate the relationship between load-carrying on the head and the development of degenerative change in the cervical spine. DESIGN AND SUBJECTS: A case-control study was performed with 35 individuals who had carried loads on their head (carriers) and 35 persons who never had carrier loads on their head (non-carriers). A scoring system was utilized for the assessment of the degenerative change in the cervical spine at the C3/C4, C4/C5, C5/C6 and C6/C7 levels on lateral cervical spine radiography. A total score was calculated by summing the scores for the single segments. RESULTS AND CONCLUSION: In 31 of the 35 (88.6%) carriers degenerative change was found in the cervical spine, but only in 8 of the 35 (22.9%) non-carriers (P < 0.01). The total score and the scores for segments C4/5, C5/C6 anc C6/C7 were significantly higher for the carriers than the non-carriers. It is concluded that the axial strain of load-carrying on the head exacerbates degenerative change in the cervical spine.
Asunto(s)
Vértebras Cervicales/diagnóstico por imagen , Enfermedades Profesionales/diagnóstico por imagen , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Sierra Leona , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/etiología , Estrés MecánicoRESUMEN
A 58-year-old woman presented with multiple gastroduodenal ulcera caused by a pancreatic polypeptidoma (PPoma) without hypergastrinemia or gastrin-producing tumor cells. After curative resection of the neoplasm, the clinical symptoms disappeared and the patient has now been disease-free for 6 years. We conclude that patients with non-gastrin-producing endocrine pancreatic tumors may demonstrate the clinical features of Zollinger-Ellison syndrome and should be included in the differential diagnosis of this syndrome.
Asunto(s)
Tumores Neuroendocrinos/cirugía , Neoplasias Pancreáticas/cirugía , Polipéptido Pancreático/metabolismo , Síndrome de Zollinger-Ellison/cirugía , Biomarcadores de Tumor/análisis , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Somatostatina/análisis , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/patologíaRESUMEN
PURPOSE: The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of sequential transarterial chemoembolization (TACE) for patients with unresectable advanced hepatocellular carcinoma (HCC). METHODS: Twenty-one consecutive patients with unresectable T3 and T4 HCC were treated by sequential TACE (median time interval between treatments 7 weeks) up to six times with an emulsion of lipiodol, epirubicin, and cisplatin. All TACE procedures were performed as unilobar or whole-liver chemoembolization. RESULTS: An average of 3.9 TACE procedures were performed per patient. One primary and two secondary technical failures occurred. No procedural death was observed. After exclusion of the patient with the primary technical failure and 3 patients with extrahepatic disease, the survival rates for the remaining 17 patients at 6, 12, 18, and 24 months were 70.6%, 52.9%, 44.1%, and 33.1%, respectively. CONCLUSION: Sequential TACE is a safe procedure in patients with unresectable advanced HCC and feasible in most cases. It seems to prolong the survival time compared with historical series of untreated patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Adulto , Anciano , Cisplatino/administración & dosificación , Epirrubicina/administración & dosificación , Estudios de Factibilidad , Femenino , Humanos , Aceite Yodado/administración & dosificación , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
Between January 1990 and January 1996, 39 consecutive patients with histologically improved pT3 or pT4 HCC tumors underwent curative resection (n = 19) or sequential transarterial chemoembolization (n = 20) with a median time interval of 7 weeks up to six times with an emulsion of Lipiodol, Epirubicin and Cisplatin. The 30-day mortality rate for all sessions of TA was 3.8% vs. 21.8% in the resection group (p < 0.05); the cumulative survival rate for the embolization group at 6, 12, 18 and 24 months was 72.3%, 50.1%, 41.2%, 35.4% vs. 42.1%, 31.6%, 31.6% and 14.2% following resection, which cannot be considered statistically significant. Patients with T3 and T4 HCC, treated with sequential embolization or resection, seem to have a comparable survival time.