Faculty Opinions recommendation of Short article: Negative small-bowel cross-sectional imaging does not exclude capsule retention in high-risk patients.

2016 ◽  
Author(s):  
Marco Pennazio ◽  
Anastasios Koulaouzidis
Keyword(s):  
High Risk ◽  
Small Bowel ◽  
Short Article ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Capsule Retention

The role of pre-biopsy mpMRI in lymph node staging for prostate cancer

2021 ◽  
pp. 039156032110168
Author(s):  
Nassib Abou Heidar ◽  
Robert El-Doueihi ◽  
Ali Merhe ◽  
Paul Ramia ◽  
Gerges Bustros ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Gleason Score ◽  
Gold Standard ◽  
Cross Sectional ◽  
Significant Difference ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Kappa Agreement

Introduction: Prostate cancer (PCa) staging is an integral part in the management of prostate cancer. The gold standard for diagnosing lymph node invasion is a surgical lymphadenectomy, with no superior imaging modality available at the clinician’s disposal. Our aim in this study is to identify if a pre-biopsy multiparametric MRI (mpMRI) can provide enough information about pelvic lymph nodes in intermediate and high risk PCa patients, and whether it can substitute further cross sectional imaging (CSI) modalities of the abdomen and pelvis in these risk categories. Methods: Patients with intermediate and high risk prostate cancer were collected between January 2015 and June 2019, while excluding patients who did not undergo a pre-biopsy mpMRI or a CSI. Date regarding biopsy result, PSA, MRI results, CSI imaging results were collected. Using Statistical Package for the Social Sciences (SPSS) version 24.0, statistical analysis was conducted using the Cohen’s Kappa agreement for comparison of mpMRI with CSI. McNemar’s test and receiver operator curve (ROC) curve were used for comparison of sensitivity of both tests when comparing to the gold standard of lymphadenectomy. Results: A total of 143 patients fit the inclusion criteria. We further stratified our patients into according to PSA level and Gleason score. Overall, agreement between mpMRI and all CSI was 0.857. When stratifying patients based on Gleason score and PSA, the higher the grade or PSA, the higher agreement between mpMRI and CSI. The sensitivity of mpMRI (73.7%) is similar to CSI (68.4%). When comparing CSI sensitivity to that of mpMRI, no significant difference was present by utilizing the McNemar test and very similar receiver operating characteristic curve. Conclusion: A pre-biopsy mpMRI can potentially substitute further cross sectional imaging in our cohort of patients. However, larger prospective studies are needed to confirm our findings.

Cross-Sectional Imaging of Small Bowel Malignancies

2012 ◽  
Vol 63 (3) ◽  
pp. 215-221 ◽  
Author(s):  
Dellano D. Fernandes ◽  
Ram Prakash Galwa ◽  
Najla Fasih ◽  
Margaret Fraser-Hill
Keyword(s):  
Small Bowel ◽  
Accurate Diagnosis ◽  
Imaging Features ◽  
Cross Sectional ◽  
Conventional Endoscopy ◽  
Cross Sectional Imaging ◽  
Pretreatment Staging ◽  
Sectional Imaging ◽  
Histologic Subtypes

Small bowel malignancies are rare neoplasms, usually inaccessible to conventional endoscopy but detectable in many cases by cross-sectional imaging. Modern multidetector computed tomographies permit accurate diagnosis, complete pretreatment staging, and follow-up of these lesions. In this review, we describe the cross-sectional imaging features of the most frequent histologic subtypes of the small bowel malignancies.

scholarly journals Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice

2019 ◽  
Author(s):  
Suzanne J Faber ◽  
Nynke Scherpbier ◽  
Hans Peters ◽  
Annemarie Uijen
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Fluid Loss ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
Raas Inhibitors

Abstract Background Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. Methods We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1-6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥70 years, CKD, or heart failure. From this population, we selected patients with a ‘dehydration-risk’ episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in three months after the ‘dehydration-risk’ episode. Results We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 ‘dehydration-risk’ episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. Conclusions Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during ‘dehydration-risk’ episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

Case 9.28

2014 ◽  
pp. 476-477
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Small Bowel ◽  
Cross Sectional ◽  
New Era ◽  
True Incidence ◽  
Live Births ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
The Right ◽  
Left Abdomen

11-year-old boy with suspected IBD Coronal SSFSE images (Figure 9.28.1) demonstrate abnormal orientation of large and small bowel, with small bowel in the right abdomen and colon in the left abdomen. Malrotation Classic thinking regarding malrotation holds that most cases are detected within the first few months of life. However, in the new era of cross-sectional imaging for everyone, more and more adults with asymptomatic malrotations are noted and the true incidence is not entirely certain. Estimates in the literature range from 1 in 6,000 to 1 in 200 live births. Autopsy studies suggest that some form of malrotation exists in 0.5% to 1% of the population....

scholarly journals Diabetic foot and its serial treatment in high-risk patients: focusing on the individual

2020 ◽  
Vol 66 (11) ◽  
pp. 1542-1547
Author(s):  
Eli Ávila Souza Júnior ◽  
Raul Silva Simões de Camargo ◽  
Tiago Soares Baumfeld ◽  
Daniel Soares Baumfeld ◽  
Benjamin Dutra Macedo
Keyword(s):  
High Risk ◽  
Diabetic Foot ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
High Risk Group ◽  
Foot Care ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Individual

SUMMARY Objectives: To assess knowledge about diabetic foot, care measures, and the importance attached to serial treatment in a group of high-risk diabetic foot patients. METHODS: This is a cross-sectional study, carried out in a tertiary hospital, with 25 patients undergoing serial treatment for diabetic foot. The tabulation of the data occurred through the use of three methodological figures: core idea, key expressions, and the collective subject discourse. RESULTS: It became evident that even among high-risk patients with diabetic foot, there is no complete knowledge about the definition of the disease. Despite this, all participants reported practicing daily care measures, including frequent inspection of the feet, food care, and attention to footwear. Regarding the importance of serial treatment, there was unanimous recognition of the relevance of this practice, which improves self-care discipline, optimizes the understanding of the disease, and helps to prevent progression. CONCLUSIONS: Authentic speeches in the context of a pathology of considerable prevalence manifested, in an unprecedented way, with conceptions about its definition, care measures, and importance of serial treatment in a high-risk group.

The value of lymph node ultrasound and whole body PET/CT in stage IIB/C patients prior to SLNB.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22079-e22079
Author(s):  
Emma H.A. Stahlie ◽  
Bernies Van Der Hiel ◽  
Annemarie Bruining ◽  
Michel W.J.M. Wouters ◽  
Yvonne Schrage ◽  
...  
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Whole Body ◽  
Preoperative Imaging ◽  
Cross Sectional ◽  
Primary Tumors ◽  
Pet Ct ◽  
Cross Sectional Imaging ◽  
Melanoma Patients ◽  
Sectional Imaging

e22079 Background: Stage IIB/IIC (pT3b-T4N0) patients are known to have high-risk primary tumors, even higher risk than some stage IIIA/B melanomas (AJCC Staging System 8th edition), however they follow the same routine to sentinel lymph node biopsy (SLNB) as more low-risk tumors. A priori the risk of finding SLNB or other metastases is much higher for these thick and/or ulcerated primary melanomas compared to the thinner ones. Guidelines are not conclusive regarding the use of preoperative imaging in these cases. Recently, a trend to more frequently use cross-sectional imaging has been noticed. However, others have previously shown that preoperative ultrasound was the most sensitive. The aim of this pilot study was to assess the value of ultrasound (US) and Positron Emission Tomography/Computerized Tomography (PET/CT) prior to SLNB for stage IIB/C (pT3b-T4N0) melanoma patients. Methods: Starting 2019-04, all patients with a pT3b melanoma or higher (8th AJCC) were included. All patients underwent US and PET/CT before their planned lymphoscintigraphy and routine SLNB. Suspected metastases were confirmed with cytologic puncture. Results: A total of 20 patients were screened. Seven patients (35%) had metastases detected by imaging: one by PET/CT, three by US and three by both imaging modalities. Three of these metastases were detected by US as well as PET/CT. All metastases were nodal. For all seven patients treatment was altered to lymph node dissection with adjuvant therapy. Of the 13 patients in whom no metastases were identified by imaging, six (46%) still had a positive sentinel node (SN). Conclusions: This study showed that this select group of patients had a high risk of metastases prior to SLNB and that all recurrences except one, were detected by ultrasound. This suggests that nodal staging with US is sufficient and can replace the need for SLNB when metastases is proven with cytology. Despite negative imaging, SLNB cannot be foregone for pT3b-pT4N0 melanoma patients, as many still have an involved SN. Cross-sectional imaging can be reserved for patients after positive cytology or SN to confirm the absence of distant visceral metastases.

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