Search

The burden of coronavirus disease 2019 (COVID-19) airspace opacities is time consuming and challenging to quantify on computed tomography. The purpose of this study was to evaluate the ability of a deep convolutional neural network (dCNN) to predict inpatient outcomes associated with COVID-19 pneumonia.A previously trained dCNN was tested on an external validation cohort of 241 patients who presented to the emergency department and received a chest computed tomography scan, 93 with COVID-19 and 168 without. Airspace opacity scoring systems were defined by the extent of airspace opacity in each lobe, totaled across the entire lungs. Expert and dCNN scores were concurrently evaluated for interobserver agreement, while both dCNN identified airspace opacity scoring and raw opacity values were used in the prediction of COVID-19 diagnosis and inpatient outcomes.Interobserver agreement for airspace opacity scoring was 0.892 (95% CI 0.834-0.930). Probability of each outcome behaved as a logistic function of the opacity scoring (25% intensive care unit admission at score of 13/25, 25% intubation at 17/25, and 25% mortality at 20/25). Length of hospitalization, intensive care unit stay, and intubation were associated with larger airspace opacity score (p = 0.032, 0.039, 0.036, respectively).The tested dCNN was highly predictive of inpatient outcomes, performs at a near expert level, and provides added value for clinicians in terms of prognostication and disease severity. more...

PURPOSE Recent studies have evaluated the presence of correlations between the magnetic resonance imaging (MRI) characteristics of Pituitary Adenomas (PAs) and their intraoperative tumor consistency. In this sense, predicting the consistency of preoperative PAs can help in selecting the most appropriate surgical approach for patients. However, the current literature lacks valid conclusions, and few articles that addressed the topic showed conflicting results. This study aimed to determine whether there is a correlation between the consistency of PAs and conventional MRI sequences, such as ADC, DWI, and FIESTA, in addition to a histopathological study of collagen and reticulin in these lesions, using Masson’s trichrome, reticulin, and fractal dimension (FD). METHODS Preoperative assessment was performed using MRI sequences, surgeons' perception of intraoperative consistency, and histopathological features using conventional methods (Masson's Trichomium and Reticulin) and FD. RESULTS The correlation between the MRI sequences and intraoperative consistency of the tumors did not show statistical relevance, and it was not possible to establish a specific signal intensity (SI) value for hard, intermediate, or soft tumors. No statistically significant correlation between the consistency of the tumor and quantification of collagen fibers, in both FD and conventional analyses. CONCLUSION The analysis of traditional MRI sequences plus ADC and FIESTA was not able to predict the consistency of the PAs. Moreover, it was found that collagen fibers identified through Masson’s trichrome, reticulin, and FD methods were not statistically associated with tumor consistency. more...

Introducao/Objetivos : O Colangiocarcinoma e o segundo tumor hepatico maligno mais prevalente, apresentando prognostico reservado quando nao e passivel de resseccao, ja que esta e sua unica possibilidade de cura. Visando melhores resultados na terapeutica cirurgica, alem de criterios adequados de ressecabilidade, e impreterivel a tecnica cirurgica mais segura e eficaz. Atualmente, observa-se que o uso da Liver Hanging Maneuver (LHM), como componente da tecnica de abordagem anterior (AA) das grandes resseccoes hepaticas, tem conferido a essas, maior viabilidade, ja que permite: menor hemorragia; menor manipulacao e ruptura tumoral; maior estabilidade na manipulacao da Veia Cava Inferior (VCI); reduzido dano isquemico ao figado remanescente e melhor sobrevivencia aos pacientes com tumor hepatico. Relato de Caso: Paciente do sexo feminino, 58 anos submetida a uma trisetorectomia com abordagem anterior e uso da Liver Hanging Maneuver devido a um colangiocarcinoma intrahepatico. Resultados: Boa evolucao pos-operatoria e atualmente esta com dois anos de seguimento ambulatorial. Apresentamos os aspectos tecnicos da “Liver Hanging Maneuver”. Conclusao: Tecnica segura que aumenta a viabilidade das grandes resseccoes hepaticas, principalmente nos casos de tumores intra-hepaticos grandes, como no caso discutido nesse relato. Descritores: Neoplasias hepaticas, Colangiocarcinoma, Carcinoma hepatocelular, Ductos biliares intra-hepaticos; Hepatectomia/metodos Abstract Introduction/Purpose: Cholangiocarcinoma is the second most prevalent hepatic tumor presenting a reserved prognosis when is not amenable to resection, because this treatment is the only possibility of cure. Seeking for better surgical outcomes, beyond of adequate resectability criteria, the safety and most effective surgical technique is fundamental. Nowadays, it is observed that the use of Liver Hanging Maneuver as a component of the anterior approach techinique of large liver resections has conferred to these greater viability, since it allows: less haemorrhage; less tumoral manipulation and rupture; better haemodynamic stability by avoiding any twisting of the inferior vena cava; reduced ischemic damage of the liver remnant, and better survival for patients with hepatic tumor. Case report: 58-year-old patient, female, did submit to a trisetorectomy due to intrahepatic cholangiocarcioma with the use of the Liver Hanging maneuver. Results: Good postoperative evolution and currently has two years follow-up. We introduce the technical aspects of Liver Hanging Maneuver. Conclusion: A safe technique that increases the viability of large hepatic resections, especially in cases of large intrahepatic tumors, as in the case discussed in this report. Keywords: Liver neoplasms; Cholangiocarcinoma; Carcinoma, hepatocellular; Bile ducts, intrahepatic; Hepatectomy/methods more...

Objective: To report a case septic arthritis with a rare pathogen in a immunosuppressed child. Case description: Male patient, 6 years old, had liver transplant five and half years ago due to biliary atresia. Patient was using tacrolimus 1mg q.12h. This patient started to have pain in left foot and ankle and had one episode of fever 3 days before hospital admission. Physical examination showed weight 17kg, height 109cm, temperature 36.4°C, with pain, swelling and heat in the left ankle, without other clinical signs. Initial tests: hemoglobin 11.7g/dL hematocrit 36.4%, leukocyte count 17,600µL-1 (7% banded neutrophils, 70% segmented neutrophils, 2% eosinophils, basophils 1%, 13% lymphocytes, 7% monocytes) C-reactive protein 170.88mg/L. Joint ultrasound showed moderate effusion in the site. Patient was submitted to surgical procedure and Sphingobacterium multivorum was isolated from the effusion. The germ was susceptible to broad spectrum cephalosporins (ceftriaxone and cefepime) and fluoroquinolones (ciprofloxacin and levofloxacin), and it was resistant to carbapenemic antibiotics and aminoglycosides. He was treated intravenously with oxacillin for 15 days and ceftriaxone for 13 days, and orally with ciprofloxacin for 15 days, with good outcome. Comments: The S. multivorum is a gram negative bacillus that belongs to Flavobacteriaceae family and it is considered non-pathogenic. It has rarely been described as a cause of infections in humans, especially in hospital environment and in immunosuppressed patients. This case report is relevant for its unusual etiology and for the site affected, which may be the first case of septic arthritis described. more...

O objetivo do trabalho foi avaliar as condições sanitárias de frango e diversos tipos de lingüiças comercializados na cidade de Botucatu,São Paulo, pela determinação do número mais provável de coliformes a 45ºC/g além da pesquisa de Salmonella pela metodologia tradicional e pela PCR. Foram coletadas 50 amostras de carcaça de frango e 75 de lingüiças frescais, procedentes de nove estabelecimentos diferentes da cidade, no período de abril a novembro de 2006. Das 50 amostras de frango, 35 (70%) estavam fora dos parâmetros microbiológicos, segundo a RDC nº12 da Anvisa (>;10(4) coliformes a 45ºC/g). Embora nessa Resolução, a pesquisa de Salmonella não seja exigida, 4 amostras (8%) apresentaram o patógeno pela metodologia tradicional. Essa presença foi confirmada pela PCR, que também foi positiva para mais 23 amostras, num total de 27 positivas (54%). Dentre as 75 amostras de lingüiças, 30 (40%) estavam fora dos limites permitidos, com 7 amostras positivas para Salmonella, pela metodologia tradicional. Entretanto, se considerar-se a pesquisa pela PCR, o número de amostras positivas aumenta para 42 (56%). Somando-se a taxa de freqüência de Salmonella aos limites microbiológicos para coliformes a 45ºC, 86,7% das lingüiças analisadas estavam impróprias para o consumo. In the present investigation were evaluated the sanitary conditions of poultry and several types of sausages retailed in Botucatu, São Paulo, Brazil for the determination of the most probable number of coliforms at 45ºC/g besides the research of Salmonella using traditional methodology and PCR. In order to do so, 50 samples of poultry and 75 of sausages were collected from nine different establishments in the city, in the period of April to November of 2006. Of the 50 samples of chicken meat, 35 (70%) were out of the microbiologic parameters, according to Brazilian Sanitary Resolution RDC nº12 of Anvisa (>;10(4) coliforms at 45ºC/g). In this Resolution, the research of Salmonella is not demanded, but 4 samples (8%) presented the pathogen using the traditional methodology. That presence was confirmed by PCR, which was also positive in another 23, in a total of 27 positive samples (54%). Among 75 samples of sausages, 30 (40%) were out of the allowed limits, with 7 positive samples for Salmonella, using traditional methodology. However, if we consider PCR test, the number of positive samples increases to 42 (56%). Adding this number to coliforms microbiological limits, 86.7% of the analyzed sausages were inappropriate for the consumption. more...