Background: A variety of neurological manifestations have been attributed to COVID-19. Objective: To investigate the occurrence of neurological symptoms and neuroimaging findings in patients hospitalized in two Brazilian reference centers. Methods: We performed a retrospective cohort study of patients who had laboratory-confirmed COVID-19 presenting in two hospitals in Brazil between March 4 and July 7, 2020, who underwent brain imaging. Results: We recorded 1,359 patients with laboratory-confirmed COVID-19. Brain imaging was performed in 250 (18.4%) patients with neurological symptoms, and nine of them (3.6%) had acute or subacute ischemic stroke neuroimaging findings. Six of the nine patients initially presented with respiratory symptoms while the other three patients presented to the emergency room with acute stroke signs. Conclusions: We described the neuroimaging findings of patients infected with COVID-19 who presented with neurological symptoms in two major hospitals in Brazil. We reinforce the importance of being aware of cerebrovascular complications, both in severe hospitalized patients and in patients who present to the emergency room with acute neurological symptoms, even in the elderly.
as well as in patients with various disease states such as septic shock and cardiovascular disease.Aim of this study was to evaluate the effect of RDW value measured upon admission to hospital on prediction of prognosis of acute pancreatitis (AP) in comparison with Ranson's scoring system (RS). Methods: This is a retrospective study enrolling 202 patients admitted to our hospital with diagnosis of AP. Data collected was demographic data, co-morbidities, length of hospital stay, laboratory values at admission and after 48 hours. Patients were divided into two groups as severe pancreatitis and mild pancreatitis according to RS. Admission RDW of patients were compared with admission RS and 48th hour RS to identify any possible relationship between these values in prediction of prognosis.Results: There were 111 female and 91 male patients. There was not a statistically significant correlation (p > 0.05) between initial RDW and RS at admission. The 48th hour RS had statistically significant (p < 0.05) correlation with initial RDW. Median RDW of patients in mild pancreatitis group was 13.60 while it was 14.25 in those with severe pancreatitis (p < 0.05). Conclusion: Initial RDW at admission might be used as a simple, easily measured, single marker to predict prognosis in AP, instead of waiting 48 hours to assess RS.
Background: The development of internal fistulas, the obstruction of the upper gastrointestinal tract and bile ducts, pseudoaneurisms and symptomatic pseudocysts are considered rare complications of chronic pancreatitis. The aim of the study was to review the 8-year experience in the treatment of this category of patients. Methods: Retrospective analysis of the treatment results of patients with chronic pancreatitis who were treated in our institution during the period between January 2008 and June 2015. Results: Out of 135 patients, 40 were females (29.6%) and 95 e males (70.4%). Alcohol was an etiologic factor in 50 cases (37.0%). Of all patients, 52 (38.5%) suffered gastroduodenal/biliary obstruction; internal pancreatic fistulae developed in 36 (26.7%). Pseudoaneurisms of the splenic/gastroduodenal artery developed in 22 (16.3%), while symptomatic and/or infected pseudocysts e in 23 patients (17.0%). 92 patients (68.1%) underwent surgical intervention. The Frey and Beger procedure was performed in 34, cystogastro/duodenostomy in 48, external drainage and other procedures in 11, distal pancreatectomy with splenectomy in 2 patients. Conservative treatment was successful in 33 (24.5%) cases. ICU treatment was necessary for 64 patients (47.4%), a mean of 4.1 days (range 1e 19). The overall average hospital stay was 17.8 days (range 4e56), the mortality rate for the whole group was 1.5%. Conclusion: Surgical intervention is the most common treatment of rare complications of chronic pancreatitis in our institution. The Frey and Beger procedure and internal drainage are associated with low complication and mortality rate; however, minimally invasive treatment should be used more often in the future.
Introduction: The clinical-radiological differentiation between neoplastic and pseudotumoral lesions has an important role in therapeutic approach, with repercussions on the conduct to be taken. When facing an expansive lesion, in addition to neoplasms, a list of differential diagnoses must be considered, including inflammatory, infectious, hemorrhagic lesions, among others. In this context, the role of imaging methods is highlighted in order to anticipate surgical management in the presumption of an aggressive neoplasm or, on the other hand, avoid an unnecessary invasive procedure. Objectives: To identify the warning signs of pseudotumor lesions in imaging studies. Methodology: Retrospective pictorial review of the archives of Diagnostic Imaging service of Santa Casa de São Paulo, between 2010 and 2020. Results: The warning signs that indicate a probable pseudotumoral lesion include spontaneous hypersignal in T1, marked hyposignal in T2, absence of significant expansive effect, cavitated lesion with high signal in diffusion, incomplete ring impregnation, restricted peripheral ring diffusion and spectral relations (choline / creatine) lower than 2. Each of these distinguishing features is discussed and exemplified. Conclusions: Although the distinction between expansive neoplastic and pseudotumoral lesions is not always direct, the systematic use of the exposed criteria allows greater assertiveness in the differential diagnosis. If the diagnostic doubt persists, therapeutic proof tests have a fundamental role in this context and, unfortunately, in some cases the final diagnosis will only be possible with biopsy.
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