A case of a symptomatic free-floating thrombus of the internal carotid artery is described. A 51-year-old woman presented with a transient ischemic attack and was placed on anticoagulation after diagnosis with angiography. After medical therapy failed, she underwent suction embolectomy using reversal of flow with the Parodi Anti-Embolism System. Balloon angioplasty was performed, and a stent was placed. The patient tolerated the procedure well. A follow-up carotid ultrasound scan showed resolution of the thrombus.
In the analyzed series, fewer patients than expected underwent surgical resection, and only 67.2% undergo regular follow-up, but no more than 2.4% developed malignancy.
HighlightsHepatoblastoma in the adult is a very rare tumor with a bad prognosis.The diagnosis is always post surgery or post mortem (biopsy is not recomended).Surgery is the only curative treatment.Skills in vascular and thoracic surgery are useful for the treatment of this tumor.
Purpose
The aim of this prospective study was to compare and correlate clinical, MRI, and arthroscopic findings in cases of suspected meniscal tears. Using arthroscopic findings as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of clinical investigation and MRI were evaluated to determine if is possible, after a careful examination, to bypass MRI and perform directly arthroscopy in suspected cases.
Methods
A total of 80 patients with a history of knee trauma, preoperative RX, and MRI underwent arthroscopy over an 8-month period at our department. All patients had a clinical examination performed by an experienced knee surgeon. These examiners evaluated and recorded the results of three tests: medial and lateral joint line tenderness test, McMurray's test, and Apley's test. The injury was classified as a meniscal tear if there were at least two positive tests. Finally, using the arthroscopic findings as the gold standard, sensibility, specificity, accuracy, positive and negative predictive values of clinical examination, and MRI were evaluated and compared.
Results
Clinical examination performed by an experienced knee surgeon reported better sensitivity (91 vs. 85%), specificity (87 vs. 75%), accuracy (90 vs. 82%), positive predictive value (94 vs. 88%), and negative predictive value (81 vs. 71%) than MRI for medial meniscal tears. These parameters showed minimal differences for lateral meniscal tears.
Conclusion
Clinical examination performed by an experienced knee surgeon provided equal or better results to diagnose meniscal injuries in comparison to MRI. MRI is not necessary to confirm these lesions and should not be used as the primary diagnostic tool.
Level of Evidence
Level II, prospective study.
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