RESUMEN

Introducción y objetivo: La morfología espermática se ha utilizado como factor pronóstico en fertilización in vitro; sin embargo, en inseminación intrauterina (IIU) su rol predictivo es controversial. El objetivo de este estudio fue determinar el impacto que tiene la morfología espermática como parámetro aislado del espermiograma en la probabilidad de embarazo de parejas que son tratadas con IIU. Material y métodos: Estudio retrospectivo de los ciclos de IIU realizados en la Unidad de Medicina Reproductiva de Clínica Las Condes entre enero del 2016 y diciembre del 2018. Regresión logística de las siguientes variables: morfología espermática agrupada en 0-1%, 2-3% y≥4%, recuento total de espermatozoides con motilidad progresiva inseminados, edad de la mujer y del hombre. Resultados: Se incluyeron 385 casos, diagnosticándose embarazo clínico en 85 de ellos. Al separar en grupos de morfología espermática<4% y≥4% la tasa de embarazo fue de 22% en ambos grupos. La edad de la mujer fue el único factor estadísticamente significativo en la regresión logística. El área bajo la curva de ROC de morfología espermática como predictor de embarazo fue de 0,53. Conclusiones: Nuestro estudio concluye que la morfología espermática no debe ser considerada como parámetro único a la hora de decidir si una pareja puede ser tratada o no con IIU, eliminando la teratozoospermia aislada como indicación directa de fertilización in vitro. No fue posible determinar un punto de corte de morfología espermática que sirva como predictor de embarazo. (AU)

Introduction and objective: Sperm morphology has been used as a prognostic factor in in vitro fertilization, however, in intrauterine insemination (IUI) its predictive role is controversial. The aim of this study was to determine the impact of sperm morphology as isolated parameter of the spermiogram has on the probability of pregnancy in couples that are treated with IUI. Material and methods: Retrospective study of IUI cycles performed in the Reproductive Medicine Unit of Clínica Las Condes between January 2016 and December 2018. Logistic regression of the following variables: sperm morphology grouped in 0-1%, 2-3% and≥4%, total progressively motile sperm count inseminated, age of the woman and the man. Results: A total of 385 cases were included and clinical pregnancy was diagnosed in 85 of them. When separating into groups of sperm morphology<4% and≥4%, the pregnancy rate was 22% in both groups. The age of the woman was the only statistically significant factor in the logistic regression. The area under the ROC curve of sperm morphology as a predictor of pregnancy was 0.53. Conclusions: Our study concludes that sperm morphology should not be considered as a single parameter when deciding whether or not a couple can be treated with IUI, eliminating isolated teratozoospermia as a direct indication for in vitro fertilization. It was not possible to determine a cut-off point for sperm morphology that serves as a predictor of pregnancy. (AU)

Asunto(s)

RESUMEN

INTRODUCTION AND OBJECTIVE: Sperm morphology has been used as a prognostic factor in in vitro fertilization, however, in intrauterine insemination (IUI) its predictive role is controversial. The aim of this study was to determine the impact of sperm morphology as isolated parameter of the spermiogram has on the probability of pregnancy in couples that are treated with IUI. MATERIAL AND METHODS: Retrospective study of IUI cycles performed in the Reproductive Medicine Unit of Clínica Las Condes between January 2016 and December 2018. Logistic regression of the following variables: sperm morphology grouped in 0-1%, 2-3% and≥4%, total progressively motile sperm count inseminated, age of the woman and the man. RESULTS: A total of 385 cases were included and clinical pregnancy was diagnosed in 85 of them. When separating into groups of sperm morphology<4% and≥4%, the pregnancy rate was 22% in both groups. The age of the woman was the only statistically significant factor in the logistic regression. The area under the ROC curve of sperm morphology as a predictor of pregnancy was 0.53. CONCLUSIONS: Our study concludes that sperm morphology should not be considered as a single parameter when deciding whether or not a couple can be treated with IUI, eliminating isolated teratozoospermia as a direct indication for in vitro fertilization. It was not possible to determine a cut-off point for sperm morphology that serves as a predictor of pregnancy.

Asunto(s)

RESUMEN

Patients with thick skin are a challenge in facial plastic surgery. Rhinoplasty is still the most frequently performed facial plastic procedure worldwide and it becomes very difficult to obtain optimal consistent results in these patients. A systematic presurgical skin evaluation is performed dividing skin into type I-III depending on the elasticity, oiliness, presence of skin alterations, size of skin pores, and laxity. Depending on the skin type, presurgical, surgical, and postsurgical management of the epidermis and dermis is defined. Preconditioning and treating thick skin can improve postsurgical results and reduce postsurgical unwanted results.

Asunto(s)

RESUMEN

Panic disorder (PD) is one of the most common psychiatric disorders. Web-based self-help treatments for PD have had promising results. These online treatments seem to have larger effect sizes (ESs) when professional support is added. However, the amount of support or how it should be administered is not yet clear. The aim of this trial was to study two ways of administering psychological support provided by phone as a part of Internet-based self-help treatment for PD based on cognitive behavioral therapy. Seventy-seven participants diagnosed with PD were randomly assigned to one of three experimental conditions: a waiting list control group; a treatment group with non-scheduled psychological support; or a treatment group with scheduled psychological support. PD symptoms of participants who received treatment improved significantly compared to the control group (mean ES d = 1.18, p < .05). In addition, there were statistically and clinically significant differences between treatment groups (Mean difference = -3.20, p = .005, 95% CI [-5.62, -.79]). The scheduled group showed a larger ES, a lower dropout rate, and better adherence to treatment than the non-scheduled group. Scheduled support seems to be indicated for patients who seek Web-based treatment for PD, and their symptoms of panic, anxiety, and depression improve at post-treatment and six-month follow-up. In contrast, when support depends on patient demand, they receive less support and so, the therapeutic effect is poorer.

Asunto(s)

RESUMEN

OBJECTIVE: To describe the enhancement pattern of hemangiomas with gadoxetate disodium and propose a new sign - the "extended washout sign" - to diagnose hemangiomas on hepatobiliary MR imaging. MATERIALS AND METHODS: In this retrospective IRB approved study, quantitative and qualitative image analysis of 45 hemangiomas and 37 metastases in 77 patients was performed. Gadoxetate disodium-enhanced MR imaging was obtained during arterial and portal venous phases as well as with delays of 3, 8, and 20min. Lesion signal intensity was measured at each phase. Quantitatively, extended washout was defined as a 10% or greater decrease in signal intensity from 8 to 20min on 3D gradient echo images. Statistical analysis was performed using unpaired Student's t-test. Qualitative analysis was also performed to assess observer confidence based on T2-weighted images, dynamic images, and combined early (8min) and late (20min) hepatobiliary phases. Extended washout was defined as a perceptible change in signal from 8 to 20min. RESULTS: On quantitative analysis, 84% of hemangiomas demonstrated a positive extended washout sign while only 18% of metastases did. Qualitatively, 78% of hemangiomas demonstrated a perceptible change in signal from 8 to 20min, while only 5.4% of metastases did. When extended washout was used in combination with T2 hyperintensity, specificity increased to 100%, with a sensitivity of 87% and area under the curve of 0.99. CONCLUSIONS: When combined with T2 signal intensity, the extended washout sign can be used to increase accuracy of differentiating hemangiomas from metastases on gadoxetate disodium-enhanced MRI.

Asunto(s)

RESUMEN

Assessing the severity of liver fibrosis has direct clinical implications for patient diagnosis and treatment. Liver biopsy, typically considered the gold standard, has limited clinical utility due to its invasiveness. Therefore, several imaging-based techniques for staging liver fibrosis have emerged, such as magnetic resonance elastography (MRE) and ultrasound elastography (USE), but they face challenges that include limited availability, high cost, poor patient compliance, low repeatability, and inaccuracy. Computed tomography (CT) can address many of these limitations, but is still hampered by inaccuracy in the presence of confounding factors, such as liver fat. Dual-energy CT (DECT), with its ability to discriminate between different tissue types, may offer a viable alternative to these methods. By combining the "multi-material decomposition" (MMD) algorithm with a biologically driven hypothesis we developed a method for assessing liver fibrosis from DECT images. On a twelve-patient cohort the method produced quantitative maps showing the spatial distribution of liver fibrosis, as well as a fibrosis score for each patient with statistically significant correlation with the severity of fibrosis across a wide range of disease severities. A preliminary comparison of the proposed algorithm against MRE showed good agreement between the two methods. Finally, the application of the algorithm to longitudinal DECT scans of the cohort produced highly repeatable results. We conclude that our algorithm can successfully stratify patients with liver fibrosis and can serve to supplement and augment current clinical practice and the role of DECT imaging in staging liver fibrosis.

Asunto(s)

RESUMEN

Computed tomographic (CT) angiography has become the standard of care, supplanting invasive angiography for comprehensive initial evaluation of acute and chronic conditions affecting the vascular system in the abdomen and elsewhere. Over the past decade, the capabilities of CT have improved substantially; simultaneously, the expectations of the referring physician and vascular surgeons have also evolved. Increasingly, CT angiography is used as an imaging biomarker for treatment selection and assessment of effectiveness. However, the growing use of CT angiography has also introduced some challenges, as potential radiation-associated and contrast media-induced risks need to be addressed. These concerns can be partly confronted by modifying scanning parameters (applying a low tube voltage) with or without using software-based solutions. Most recently, multienergy technology has endowed CT with new capabilities offering improved CT angiographic image quality and novel plaque characterization while decreasing radiation and iodine dose. In this article, we discuss current and new approaches using both conventional and multienergy CT for studying vascular disease in the abdomen. We propose various approaches to overcoming commonly encountered image quality challenges in CT angiography. In addition, we describe supplemental strategies for improving patient safety that leverage the available technology.

Asunto(s)

RESUMEN

OBJECTIVE: Inflammatory hepatocellular adenoma (HCA) is a recently categorized entity of hepatocellular neoplasms. We investigated whether gadoxetic acid-enhanced MRI can distinguish inflammatory HCA from focal nodular hyperplasia (FNH). MATERIALS AND METHODS: From January 1, 2009, through January 1, 2013, gadoxetic acid-enhanced MRI examinations from two institutions were reviewed for HCA, with specific histologic features of inflammatory HCA. Biopsy and resection slides were reviewed, and immunohistochemistry for glutamine synthetase was performed in a subset to confirm the initial diagnosis. RESULTS: A total of 10 possible cases of inflammatory HCA were identified in the pathology database. On the basis of glutamine synthetase staining performed for this study, three cases were rediagnosed as FNH and thus were excluded from the study. Therefore, a total of seven patients with inflammatory HCA were identified. On gadoxetic acid-enhanced MRI, four of these patients had classic features of FNH (group A, FNH mimics), and three had imaging features suggestive of HCA (group B, typical inflammatory HCA). Imaging features that were considered diagnostic of FNH included isointense or minimal T2 hyperintensity, arterial enhancement, and diffuse hyperintensity on hepatobiliary phase. Three of the four patients with FNH mimics had slides available for pathologic rereview, and the diagnosis of inflammatory HCA was supported by glutamine synthetase immunohistochemistry findings. The pathology reports of the remaining four cases were rereviewed and were also found to have features consistent with inflammatory HCA. CONCLUSION: Inflammatory HCA can mimic FNH on MRI, including hepatobiliary phase hyperintensity. Moreover, conventional pathology using histopathology alone may lead to misclassification of inflammatory HCA.

Asunto(s)

RESUMEN

With the increasing clinical use of cytostatic and novel biologic targeted agents, conventional morphologic tumor burden assessments, including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors, are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue. Therefore, the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired. In this review, we will discuss the conventional and new approaches to assess tumor burden. Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes, these functional tumor burden analyses are very promising. However, some of them have not gone thorough all steps for standardization and validation. Nevertheless, these new techniques and criteria will play an important role in the cancer management, and provide each patient more tailored therapy.

Asunto(s)

RESUMEN

OBJECTIVE: To study the impact of sinogram-affirmed iterative reconstruction (SAFIRE) and concurrent application of automated tube voltage selection (ATVS) on image quality (IQ) and radiation dose. METHODS: A phantom was scanned using various computed tomography (CT) parameters (kV, 80-120; mAs, 50-200). Abdomen contrast-enhanced CT (CECTs) in 170 adults were performed using dose-modified protocols: in 145 patients (group I), ATVS was applied (mAs, 111-649); in 25 (group II), the kV was fixed at 120 (reference mAs, 150). In 95 patients, standard-dose (SD) scan was available. Two readers evaluated the IQ of filtered back projection (FBP) and SAFIRE (levels 1, 3, and 5) images. RESULTS: In phantom, nonlinear drop in noise with increasing strengths of IR (levels S1-S5) was noted. The dose-modified IR scan was rated diagnostic in all 170 patients, with IQ score comparable to that of SD-FBP (P = 0.3). Lower kV (100/80) was prescribed by ATVS in 70% examinations in group I. In comparison with SD-FBP, the mean dose in CT dose index in group I (IR, 3.2 mGy; SD-FBP, 13.02 mGy; P < 0.0001) and in group II (IR, 4.8 mGy; SD-FBP, 11.8 mGy; P < 0.001) was 75.4% and 59.3% lower. CONCLUSIONS: Use of SAFIRE and ATVS provides diagnostic quality images at 59.3% to 75.4% reduced dose compared with SD-FBP scan.

Asunto(s)

RESUMEN

RATIONALE AND OBJECTIVES: To evaluate the performance of hybrid iterative reconstruction technique (h-IRT) on image quality (IQ) in abdominal dose-modified (DM) scans in phantom and in patients in comparison to filtered back projection (FBP). MATERIALS AND METHODS: An anthropomorphic phantom was scanned using various kVp (80-140) and mAs (25-100) settings. Images were reconstructed with FBP and h-IRT levels (1-6). In 69 adults (59.6 ± 13.54 years; 20 male, 49 female), DM computed tomography (CT) scans were performed using 120 kVp and 100-120 mAs. In 25/69, 5-mm FBP and h-IRT (levels 1-4 and 5) images were analyzed to validate IQ. The subsequent 44/69 had FBP and h-IRT (level 4) images reconstructed. Two readers evaluated 188 image series for IQ, noise, and artifacts. Objective and subjective data were analyzed using t-test and Wilcoxon signed-rank test, respectively. In 46/69 patients, prior dose CT was available for dose comparison. RESULTS: In the phantom, noise reduction ranged from 12% (h-IRT level 1) to 50% (level 6). In patients, h-IRT level 4 images were rated diagnostic in 69/69 exams but DM-FBP images were found nondiagnostic in 20/69 patients. The size-specific dose estimate (SSDE) was reduced by 55% in the dose-modified CT group, (SSDE:4.55 ± 1.15 mGy) over the prior dose protocol (SSDE:10.21 ± 3.5 mGy, P < .0001). CONCLUSION: h-IRT improved IQ in abdominal DM-CT scans in phantom and in patients. Dose improvements were greater in smaller patients than larger ones.

Asunto(s)

RESUMEN

INTRODUCTION: Computed tomography (CT) has become key for patient management due to its outstanding capabilities for detecting disease processes and assessing treatment response, which has led to expansion in CT imaging for diagnostic and image-guided therapeutic interventions. Despite these benefits, the growing use of CT has raised concerns as radiation risks associated with radiation exposure. AREAS COVERED: The purpose of this article is to familiarize the reader with fundamental concepts of dose metrics for assessing radiation exposure and weighting radiation-associated risks. The article also discusses general approaches for reducing radiation dose while preserving diagnostic quality. The authors provide additional insight for undertaking protocol optimization, customizing scanning techniques based on the patients' clinical scenario and demographics. Supplemental strategies are postulated using more advanced post-processing techniques for achieving further dose improvements. EXPERT OPINION: The technologic offerings of CT are integral to modern medicine and its role will continue to evolve. Although, the estimated risks from low levels of radiation of a single CT exam are uncertain, it is prudent to minimize the dose from CT by applying common sense solutions and using other simple strategies as well as exploiting technologic innovations. These efforts will enable us to take advantage of all the clinical benefits of CT while minimizing the likelihood of harm to patients.

Asunto(s)

RESUMEN

The case of a six-month-old child with pancreatoblastoma is presented. Pancreatoblastoma is a rare primary neoplasm of childhood, usually presenting in children ranging from 2 -8 years old. The radiologic findings vary from solid to complex masses. This case is unusual due to the young age of the patient.

RESUMEN

BACKGROUND: The best results in the surgical treatment of gastric cancer are those obtained by the Japanese surgical school that emphasizes D2 lymphadenectomy as a fundamental principle for obtaining better local control of the disease. However, this technique has not gained wide acceptance in the West, owing to the fact that the results of Japanese studies have not been reproduced frequently in Western countries. In recent years, a series of studies have recommended the centralization of gastric cancer treatment in specialized surgical units in order to obtain results similar to those achieved by Japanese centers. The objective of this study was to describe the specialization process and to show the short-term results obtained in the surgical treatment of gastric cancer in the Specialized Unit of the Rebagliati National Hospital, the largest general referral hospital in Lima, Peru. METHODS: In the year 2000 a specialized service was created for the surgical treatment of gastric cancer, initiating a process that included the establishment of surgical treatment guidelines, training in the Japanese surgical technique, and progress along the learning curve for D2 lymphadenectomy. Clinical, surgical, and pathological data were recorded prospectively in a fixed format, considering that strict documentation of cases was also an important step within this process. RESULTS: Between January 1, 2004, and December 31, 2005, 243 consecutive patients with a proven diagnosis of gastric adenocarcinoma were admitted to the operating theater for surgical treatment. During this study period, morbidity was 22.7% and hospital mortality, 2.8%. The numbers (mean +/- SD) of resected lymph nodes for distal gastrectomy and total gastrectomy were 37.3 +/- 12.4 and 45.3 +/- 14.5, respectively. Hospital stay was 13 days for distal gastrectomy as well as for total gastrectomy. CONCLUSION: According to our results, adequate training in the Japanese surgical technique, progress along the learning curve for D2 lymphadenectomy, and the establishment of specialized units are highly recommended for the surgical treatment of gastric cancer in Western referral hospitals.

Asunto(s)

RESUMEN

This report describes the case of a patient who underwent total gastrectomy, splenectomy and pancreatomy corporo-postero as a consequence of gastric and pancreatic metastasis from carcinoma to clear cells, five years after having undergone radical nephrectomy. Upper digestive bleeding was the first symptom, and pancreatic lesion was detected in previous CT scans. There are many documented cases of pancreatic metastasis, but only eight gastric metastasis in the last 15 years, although we did not find reports about surgical treatment for concomitant gastric and pancreatic injury. Surgical treatment which in some reports include highly complex surgeries such as gastrectomies with combined resections of invaded organs and pancreatoduodenectomy, are good options for select cases, because good survival rates have been reported.

Asunto(s)

RESUMEN

El presente reporte se describe el caso de una paciente sometida a gastrectomía total, esplenectomía y pancreatectomía corporo-caudal por presentar metástasis gástrica y pancreática de carcinoma renal a células claras, 5 años después de haber sido sometida a nefrectomía radical. El cuadro se presentó como una hemorragia digestiva alta, y la lesión pancreática se evidenció en los estudios tomográficos previos a los que fue sometida la paciente. Existen muchos casos reportados en la literatura de metástasis pancreática, pero solo 8 en relación a metástasis gástrica. Sin embargo no encontramos reportado el tratamiento quirúrgico por lesión gástrica y pancreática concomitante. El tratamiento quirúrgico que en algunos reportes incluye cirugías de alta complejidad como gastrectomías con resecciones combinadas de otros órganos y pancreatoduodenectomía, se ofrecen como una buena alternativa para casos seleccionados ya que se han reportado buenas sobrevidas.

This report describes the case of a patient who underwent total gastrectomy,splenectomy and pancreatomy corporo-postero as a consequence of gastric and pancreatic metastasis from carcinoma to clear cells, five years after having undergoneradical nephrectomy. Upper digestive bleeding was the first symptom, and pancreatic lesion was detected in previous CT scans. There are many documented cases of pancreatic metastasis, but only eight gastric metastasis in the last 15 years, althoughwe did not find reports about surgical treatment for concomitant gastric and pancreatic injury. Surgical treatment which in so me reports include highly complex surgeries such as gastrectomies with combined resections of invaded organs andpancreato duodenectomy, are good options for select cases, because good survivalrates have been reported.

Asunto(s)

RESUMEN

The results of the surgical treatment for gastric cancer within a specialized surgical service in this pathology are described in this work. This system for surgical treatment of gastric cancer is new in our country. The implementation process included prepare a team of surgeons and establish protocols and guides to surgical treatment, based on the recommendations of the Japanese Gastric Cancer Association. Additional training in the Japanese advanced surgical technique was required, as well as a strict documentation of the cases. During 2004, 139 surgical interventions were carried out on 137 patients with tumoral gastric pathology. Surgical mortality was 2.1% and morbidity was 21.8%. The average resected glands was 38.6.t 13.7 (range: 20-87) for distal gastrectomy and 46.6 +/- 16.2 (range: 24-87) for total gastrectomy. The stay in the hospital was 11.7 +/- 6.3 days (range: 5-37) for distal gastrectomy and 14.8 +/- 11.3 days (range: 7-56) for total gastrectomy. The hospital and surgeon volumes are underlined as important factors in determining the short and long term results. Implementation of specialized surgical units in general hospitals, for surgical treatment of gastric cancer, is recommended.

Asunto(s)

RESUMEN

En el presente trabajo se describen los resultados del tratamiento quirúrgico del cáncer gástrico dentro de un servicio de cirugía especializado en ésta patología. Este sistema de trabajo para el tratamiento quirúrgico del cáncer gástrico es una experiencia nueva en nuestro país y su proceso de implementación incluyó la conformación del equipo de cirujanos, el establecimiento de protocolos y guías de tratamiento quirúrgico basados en las recomendaciones de la Asociación Japonesa de Cáncer Gástrico; el entrenamiento y perfeccionamiento en técnica quirúrgica japonesa y la documentación rigurosa de los casos. Durante el año 2004 se realizaron 139 intervenciones quirúrgicas en 137 pacientes con patología gástrica tumoral. La mortalidad quirúrgica fue de 2.1 por ciento y la morbilidad de 21.8 por ciento. La media de ganglios resecados fue de 38.6 + 13.7 (rango: 20-87) para gastrectomía distal y 46.6 + 16.2 (rango 24-87) para gastrectomía total. La estancia hospitalaria fue de 11.7 + 6.3 días (rango 5-37) para gastrectomía distal y 14.8 + 11.3 días (rango 7-56) para gastrectomía total. Se resalta el volumen hospital y volumen cirujano como importantes factores determinantes de los resultados a corto y largo plazo, recomendándose la implementación de unidades quirúrgicas especializadas en hospitales generales para el tratamiento quirúrgico del cáncer gástrico.

Asunto(s)

RESUMEN

Se realizó un estudio descriptivo y retrospectivo durante el período de 1983 a 1993, en el Instituto de Salud del Niño (ISN). Encontrándose 101 casos con el diagnóstico de Divertículo de Meckel, el 75.25 por ciento de estos estuvieron complicados. La incidencia encontrada fue de 1.2 por ciento. El 89.5 por ciento de los casos complicados eran menores de 10 años y el 47.4 por ciento eran menores de 2 años. Los síntomas más comunes fueron: dolor abdominal (68.4 por ciento), vómitos (68.4 por ciento), fiebre (47.3 por ciento) y distensión abdominal (39.4 por ciento). Las anomalías congénitas que se presentaron en el 17.8 por ciento de los casos fueron: malrotación intestinal, bridas congénitas, hernia inguinal y onfalocele. Las complicaciones más frecuentes fueron: obstrucción intestinal (47.4 por ciento), diverticulitis (19.7 por ciento), hemorragia digestiva baja (15.8 por ciento) y perforación intestinal (14.5 por ciento). El tejido heterotópico estuvo presente en 20.7 por ciento de los casos. En nuestro instituto , el grupo de menores de 2 años, presentó un mayor porcentaje de casos complicados (p<0.01). La obstrucción intestinal fué el cuadro clínico más común de presentación del divertículo de Meckel (p<0.001). La hemorragia digestiva baja fue la segunda complicación en pacientes menores de 2 años (p<0.05). Se encontró una marcada asociación con otras anomalias congénitas

Asunto(s)