The term gossypiboma denotes a cotton foreign body retained inside the patient during surgery, a rare surgical complication. The symptoms following this entity are non-specific, such as pain, palpable mass and fever, which make clinical diagnosis difficult. The computerized tomography (CT) scan is the most useful method for diagnosis; however, sometimes the preoperative diagnosis remains uncertain even after the imaging exam. In that case, laparoscopy arises as a valuable diagnostic tool, as well as a prompt treatment option. However, when diagnosis is made years after the original surgery, the laparoscopic approach becomes harder. Our patient presented without clear symptoms, remaining asymptomatic for 34 years. The CT scan presumptive diagnosis was a gastrointestinal stromal tumour, and laparoscopy was performed providing an accurate diagnosis and treatment in the same surgical time.
PURPOSE Diffusion-weighted imaging (DWI) is a MRI technique that, although relatively recent, has shown promise for the evaluation of focal hepatic lesions, providing information both on qualitative and quantitative parameters. The present study was designed to analyze the role of DWI, particularly the ADC (apparent diffusion coefficient), in differentiating benign solid liver lesions from malignant ones in a sample of noncirrhotic patients. METHODS We conducted a retrospective analysis of MRI scans performed at a tertiary hospital in Porto Alegre, Rio Grande do Sul, Brazil, from 2015 to 2018. The distribution of lesions into benign vs. malignant groups was determined by imaging criteria and/or histological analysis. ADC were obtained for each lesion.RESULTS Overall, 118 focal liver lesions were evaluated, with 78 benign and 40 malignant. The mean ADC value was 1.420×10−3 mm2/s for benign lesions versus 1.130×10−3 mm2/s for malignant lesions (p<0.001). ROC curve analysis showed an area under the curve of 0.79, optimal cutoff point of 1.19×10−3 mm2/s for discriminating between malignant and benign lesions, sensitivity and specificity of 75% and 73.1%.CONCLUSIONS We demonstrate the appropriateness of ADC for characterization of benign solid lesions of the liver and to distinguish these masses from malignant metastatic lesions.
IntroductionSubstance misuse increases the risk of developing psychosis in vulnerable people. However, patients with substance use disorders’ attributes and their effect on first-episode psychosis (FEP) are still unclear.ObjectivesTo describe and compare inpatient admissions for FEP with substance misuse and its impact on clinical outcomes.MethodsWe conducted an observational and retrospective study, analyzing sociodemographic determinants and clinical data regarding the patients hospitalized for FEP, between January 2019 and June 2022, in the psychiatric unit at our hospital in Bragança, Portugal. We used logistic regression to estimate the effect of social determinants and other clinical data regarding the patients hospitalized for FEP with substance abuse.ResultsWe included 78 patients in this study. Of these patients, 30% (n=23) reported substance (drugs or alcohol) misuse prior to hospital admission. Regarding only the patients with substance misuse, 96% were male and the median age was 31 years. Cannabis was the most often reported substance of abuse (83%). Most of these patients were unmarried (OR:10.794; 95%CI:2.855-40.805;P=0.001), lived in a rural setting (OR:0.263; 95%CI:0.094-0.731;P=0.009) and had no previous psychiatric history (OR:1.022; 95%CI:0.386-2.709;P=0.964).Regarding hospital admission, 70% were involuntary admitted (OR:4;95%CI:1.408-11.366;P=0.007) and the median time of hospitalization was 17 days. At the time of discharge, 48% of these set of patients still didn’t have insight into their mental illness (OR:1.737;95%CI:0.646-4.679;P=0.272). During the evaluation period of this study, 13% of the patients were readmitted to the hospital (OR:1.029;95%CI:0.241-4.383;P=0.970) and 35% missed outpatient appointments (OR:3.133;95%CI:1.003-9.791;P=0.044). The diagnoses at the time of discharge were: substance-induced psychosis (52%), schizophrenia (22%), affective psychosis (17%), and acute and transient psychotic disorder (9%).ConclusionsThis analysis indicates substance misuse predates and is prevalent in FEP. Many of these patients fail to recognize and accept that they are suffering from a mental illness and drop out of outpatient psychiatric care. Further, substance-induced psychoses are associated with a significant risk for transition to schizophrenia particularly following cannabis-induced psychosis. Thus, it is crucial to optimize adherence to the therapeutic regimen and outpatient follow-up.Disclosure of InterestNone Declared
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