This study compared different acquisition protocols performance to detect small liver metastases (<2 cm). Thirty consecutive patients with histologically proven hepatic metastases were explored by MDCT at the liver equilibrium phase by four successive acquisitions. We compared the following protocols (1-4): 5/30/1.5 (section thickness/table speed/pitch); 5/15/0.75; 5/11.25/0.75; and 2.5/15/1.5 with the same X-ray dose. The gold standard was based on patient radiological follow-up. Evolutive lesions were considered as true positive (TP). The described lesions, not found on the follow-up exams despite tumoral progression, were considered as false positive (FP). Stable lesions could not be considered as metastasis and were eliminated. One hundred and seventy-six lesions were detected: 61 TP and 91 FP. Twenty-four lesions were eliminated.The mean kappa values for protocols 1, 2, 3 and 4 were, respectively, 0.43, 0.68, 0.73 and 0.51 (0.61-0.80: substantial agreement) and the mean areas under the ROC curve were, respectively, 0.76, 0.87, 0.86 and 0.80. The results of protocols 2 and 3 were significantly superior to those of protocols 1 and 4. MDCT protocols using thin sections or an increased table speed are less efficient in detecting small metastases.
Acute appendicitis is the most common acute surgical infection during pregnancy. Although usually pyogenic in origin, parasitic infections account for a small percentage of cases. Despite the relatively high prevalence of acute appendicitis in our environment, it is not commonly associated with schistosomiasis. We report here the association of pregnancy and appendicitis caused by Schistosoma haematobium. Schistosomiasis is very common complication of pregnancy in hyperendemic areas. Schistosome egg masses can lodge throughout the body and cause acute inflammation of the appendix, liver and spleen. Congestion of pelvic vessels during pregnancy facilitates passage of eggs into the villi and intervillous spaces, causing an inflammatory reaction. Tourism and immigration make this disease a potential challenge for practitioners everywhere.
All manner of foreign bodies have been extracted from the bladder. Introduction into the bladder may be through self-insertion, iatrogenic means or migration from adjacent organs. Extraction should be tailored according to the nature of the foreign body and should minimise bladder and urethral trauma. We report a case of a bullet injury to the bladder, which finally presented as a gross hematuria after remaining asymptomatic for four years. We present here an alternative to suprapubic cystostomy with a large bladder foreign body treated via a combined transurethral unroofing followed by removal using a grasper passed through a suprapubic laparoscopic port.
A 42-year-old Portuguese woman had a several months history of abdominal bloating and recent occasional pain in the right upper abdomen. In Portugal, she had lived in a rural area; she had left Portugal several years ago but returned every summer. Her medical history was relevant for 10 years of corticoid therapy for lupus erythematosus.Physical examination showed upper abdominal tenderness and a palpable mass in the right upper abdomen. Laboratory data showed normal glutamic oxaloacetic transaminase and glutamic pyruvic transaminase activities and slightly elevated alkaline phosphatase levels. Tests for tumor markers were negative. A parasitologic serologic test (enzyme-linked immunosorbent assay) was positive for Echinococcus granulosus (level, 60 U/mL; normal level, Ͻ0.9 U/mL).A right-sided hepatic mass was seen at ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. US revealed a multilocular anechoic cystic lesion made up of cysts that ranged from 0.2 to 12 mm in diameter. The mass involved a major part of the hepatic parenchyma. Biliary and vascular structures were displaced but not involved.Abdominal CT performed before and after intravenous administration of contrast material demonstrated a multilocular hypoattenuating mass (16 ϫ 9 ϫ 12 cm) in segments IV, VII, and VIII (Fig 1). Before injection, CT demonstrated thin eggshell calcifications within septa. Segment II and III bile ducts were dilated. After injection, the mass showed slight enhancement of the septa.
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