RESUMO
Background: Tissue sampling using endoscopic ultrasound-guided fine-needle aspiration is the gold standard for diagnosing malignant pancreatic tumors; however, its sensitivity and specificity are highly variable. Thus, fine-needle biopsy using cutting needles has been developed to overcome current limitations and improve diagnostic yield. Our study compared two fine-needle biopsy needles for tissue sampling for pancreatic solid lesions. Materials and Methods: Samples obtained from patients with pancreatic solid lesions using the 22-gauge fine-needle biopsy needles (Franseen needle or reverse bevel needle) were retrospectively analyzed. The primary outcomes were diagnostic yield and sample adequacy. The secondary outcome was diagnostic performance. The analysis was performed using 2 × 2 tables to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for each needle type. Proportions were compared using the Z test. For quantitative variables, a comparative analysis was performed using Student's t test. Qualitative and unpaired outcome variables were described using Fisher's exact test. Results: Sixty-three patients with pancreatic lesions were included in the analysis. The fine-needle biopsy Franseen and reverse bevel groups included 33 and 30 patients, respectively. An adequate sample was obtained in 97% of patients in the Franseen needle group versus 80% in the reverse bevel needle group; the diagnostic yields in these groups were 93.9 and 66.7%, respectively. Neither differences between needle passes nor complications were noted. The sensitivity and specificity were 93.5 and 100%, respectively, in the fine-needle biopsy Franseen group, versus 71 and 100%, respectively, in the reverse bevel needle group. Conclusions: The Franseen needle was more effective for sampling pancreatic tumors than the reverse bevel needle.
Introdução: A aquisição de tecido através de punção com agulha fina guiada por ecoendoscopia é o padrão para o diagnóstico de neoplasias pancreáticas malignas; contudo, a sua sensibilidade e especificidade é altamente variável. A biópsia por agulha fina (FNB) usando agulhas cortantes foi desenvolvida para ultrapassar as limitações atuais. Este estudo comparou duas agulhas de FNB na aquisição de tecido de lesões pancreáticas sólidas. Métodos: Amostras obtidas de doentes com lesões pancreáticas sólidas utilizando agulha de FND de 22 gauge (Franseen ou reverse bevel) foram avaliadas retrospetivamente. Os outcomes primárias foram a rentabilidade diagnóstica e a adequabilidade das amostras. O outcome secundário foi a performance diagnóstica. A análise estatística foi realizada através de tabelas de contingência 2 × 2 para cálculo da sensibilidade, especificidade, valor preditivo positivo e negativo e acuidade para cada tipo de agulha. As proporções foram calculadas utilizando o teste-Z. Para variáveis quantitativas foi realizada análise comparativa com teste t-Student. Variáveis qualitativas e não pareadas foram comparadas com teste exato de Fisher. Resultados: Foram incluídos 63 doentes com lesões pancreáticas (33 no grupo FNB Franseen e 30 no grupo reverse bevel). Foram obtidas amostras adequadas em 97% do grupo Franseen vs 80% no grupo reverse bevel, sendo a rentabilidade diagnóstica de 93.9 e 66.7%, respetivamente. Não houve diferenças no número de passagens nem nas complicações. A sensibilidade e especificidade foram, respetivamente, de 93.5 e 100% no grupo Franseen versus 71 e 100% no grupo reverse bevel. Conclusões: A agulha Franseen foi mais efetiva na aquisição de amostras de lesões pancreáticas do que a agulha reverse bevel.
RESUMO
La ultrasonografía es un método de evaluación rápido y eficaz en los departamentos de emergencias, siempre en manos entrenadas. La lesión vascular periférica es un cuadro que en lo que trauma se refiere, debe tener un veloz diagnóstico y tratamiento por los riesgos que significa: En lesiones abiertas, la hemorragia; y en lesiones cerradas se añade el síndrome compartimental. Lograr la evaluación de la indemnidad o no del árbol vascular en los miembros, se torna importante a la hora de prevenir eventos que requieran intervención quirúrgica (reparación y/o fasciotomía). El objetivo de este trabajo consiste en demostrar la utilidad del conocimiento del árbol vascular periférico y su evaluación mediante doppler para el manejo del trauma vascular periférico, mental (n=77) = 11 (14,78 %). Resolución: lesión vascular = 1 (1,3 %) síndrome compartimental= 1 (1,3 %) con resolución quirúrgica. La utilización de la ultrasonografía y del doppler para la evaluación vascular periférica es útil para el reconocimiento precoz del riesgo a desarrollar desde una lesión vascular simple hasta un síndrome compartimental. La utilización de listas de verificación durante la simulación para la generación del criterio, son útiles en la formación de residentes de cirugía
Report the recurrence rate ofnegative pressure subdural drainage (NPSD) versusto other kind of drains (OD). Design and Methods: Astudy was conducted cross-sectional and weretrospectively analyzed on the database of theneurosurgical service and we looked for all surgicalprocedures recorded from January 2006 to December2015. Procedures with preoperative diagnosis ofsubdural hematoma (SDH) were selected, with a to-tal of 364 interventions, were excluded patients withpostoperative diagnosis different from SDH andeliminated those who did not have complete data,recurrence was identified, a statistical analysis wasperformed describing frequency measurementspercentage and standard deviation, RM and chi-square was obtained by software EPIDAT 3.1. 277 surgeries were performed in 230 patients, Thepopulation was divided into two groups: the first thoseinterventions with negative pressure subduraldrainage versus a second group with other differentdrains, and finally we compared the recurrence ratein each group, 44 surgeries had recurrence of SDH.The proportion of recurrence was found 16 % of thesurgeries, 16 % (n=7) of these were performed withnegative pressure subdural drainage and theremaining 84 % (n=37) by other drainage. The reasonfor prevalence found was 0.36 (95 % CI , 0.15 to0.85), with statistically significant differences (p =0.0165). The chi-square was 5.75 for the SDH withNPSD. It was found that patients treated with NPSDhave a lower risk of recurrence compared with OD,which acts as a protective factor for patients treatedwith this type of drain, this is statistically significant.
Assuntos
Humanos , Hematoma Subdural Crônico/diagnóstico , Hematoma Subdural Crônico/terapia , Recidiva , Drenagem , Estudos TransversaisRESUMO
La neurocisticercosis (NCC) es la parasitosis más común del cerebro y presenta gran variedad de patrones pudiendo mimetizarse con numerosas patologías. Presentamos el caso de un paciente con aneurisma inflamatorio, del cual sólo encontramos 5 casos reportados en la literatura, y sólo uno cuenta con reporte histopatológico. El presente caso reporta un paciente con antecedente de diabetes mellitus e hipertensión arterial, que inició su padecimiento con crisis parciales simples secundariamente generalizadas.Al estudiar el paciente se le diagnosticó neurocisticercosis racemosa, se realizó resección de lesiones con ruptura transoperatoria de aneurisma inflamatorio secundario a NCC con clipaje exitoso. En la literatura se describen cambios inflamatorios en la pared del aneurisma y de la arteria dependiente, secundarios al proceso inmune con vasculitis asociada a un proceso inflamatorio crónico, estos cambios en la pared del aneurisma incrementa la posibilidad de rotura intraoperatoria. El reporte histopatológico fue concluyente con neurocisticercosis.
Neurocysticercosis (NCC) is themost common parasitic disease of the brain, has awide variety of patterns of presentation and can mimic many diseases. We report a patient with inflammatory aneurysm, and found only 5 cases reported in the literature, and only one has histopathological report.This is a case report of a patient with diabetes and arterial hypertension condition which started with simple secondary generalized partial seizures. The study reported the patient was diagnosed with neurocysticercosis racemosa, resection of lesions was performed with secondary inflammatory rupture intraoperative aneurysm clipping successful NCC,inflammatory changes in the literature described in the aneurysm wall and the dependent artery,secondary to immune process with vasculitis associated with a chronic inflammatory process, these changes in the aneurysm wall increase the possibility of intraoperative rupture. Histopathological report was conclusive with neurocysticercosis.