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Papers by marcela pecora cohen
Journal of vascular and interventional radiology : JVIR, 2020
Dermatology Practical & Conceptual, 2015
Background: In vivo confocal microscopy is an imaging technique that has been applied to the stud... more Background: In vivo confocal microscopy is an imaging technique that has been applied to the study of the ocular surface. However, confocal microscopes dedicated to eye examination are routinely adopted only in ophthalmology reference centres and do not allow an examination of periocular tissue, nor a fluorescence examination. Methods: We applied for the first time the two in vivo confocal microscopes commonly used in dermatology (VivaScope ® 1500 and 3000, CALIBER, distributed in Europe by Mavig GmbH, Munich, Germany) to observe the cornea, the bulbar and tarsal conjunctiva, the eyelid margin, the lacrimal punctum and the palpebral skin of healthy volunteers. Tumoral, inflammatory and infectious diseases of the ocular mucosa and periocular skin from more than 200 patients were observed under the same microscopes. Both microscopes have a reflectance mode. VivaScope ® 1500 allows an additional fluorescent examination and its placement on the ocular surface was made possible by the creation of a special interface between the microscope and the ocular apparatus. Results: Thanks to its compact and flexible configuration, the handheld camera VivaScope ® 3000 allowed to access more easily to the ocular and periocular tissues. Diagnosis of benign and malignant tumors (melanoma, squamous cell carcinoma and basal cell carcinoma), as well as infectious and genetic disease (storage diseases), could be evocated. The detection of parasites (Demodex folliculorum) on eyelids was possible. Confocal images correlated well with conventional histopathology. The fluorescence examination of corneal squamous cell carcinoma by VivaScope 1500 was characterized by extravasation of fluorescein after intravenous injection. Conclusions: Confocal microscopes dedicated to the skin offer new perspectives for the diagnosis, optimization of treatments, and follow-up of the ocular diseases. They will allow dermatologists to examine conjunctival and eyelid tumors, as it is for skin or genital mucosa. In addition, thanks to some adaptations of the dermatological device VivaScope ® 1500, it is possible for the first time to perform a fluorsecnte examination of the ocular and peri-ocular tissue, opening a new era in the clinical imaging of the ocular surface. A new semiology remains to be learned.
Radiologia Brasileira, 2018
Historically, radiology has developed in a way that has increasingly distanced the radiologist fr... more Historically, radiology has developed in a way that has increasingly distanced the radiologist from the patient. Currently, diagnostic imaging results are predominantly communicated through written reports. Written communication is not considered sufficient, verbal communication being essential for the performance of the modern radiologist to be considered satisfactory. However, a lack of preparation on the part of the radiologist when communicating the diagnosis, especially when it is not favorable (as is often the case in a cancer hospital), makes that conversation quite challenging. Studies conducted in other countries have demonstrated that there are a variety of opinions on the part of requesting physicians and patients regarding radiologist-patient communication, which can be explained by cultural differences. Although there is no rule regarding the best way to accomplish such communication, there are definitely incorrect ways. To bridge the gap between radiologists and patien...
Journal of the American College of Radiology : JACR, Jan 2, 2018
The aim of this study was to evaluate radiologists' experiences with patient interactions in ... more The aim of this study was to evaluate radiologists' experiences with patient interactions in the era of open access of patients to radiology reports. This prospective, nonrandom survey of staff and trainee radiologists (n = 128) at a single large academic institution was performed with approval from the institutional review board with a waiver of the requirement to obtain informed consent. A multiple-choice questionnaire with optional free-text comments was constructed with an online secure platform (REDCap) and distributed via departmental e-mail between June 1 and July 31, 2016. Participation in the survey was voluntary and anonymous, and responses were collected and aggregated via REDCap. Statistical analysis of categorical responses was performed with the χ test, with statistical significance defined as P < .05. Almost three-quarters of surveys (73.4% [94 of 128]) were completed. Staff radiologists represented 54.3% of survey respondents (51 of 94) and trainees 45.7% (43 ...
Abdominal radiology (New York), Jan 23, 2017
To validate the use of a split-bolus pancreas CTA protocol for local staging of pancreatic cancer... more To validate the use of a split-bolus pancreas CTA protocol for local staging of pancreatic cancer and to evaluate its ability to detect and characterize liver lesions. Consecutive patients with pancreatic cancer who underwent split-bolus pancreas CTA between 12/2015 and 12/2016 were included in this IRB-approved HIPAA-compliant retrospective study. Objective evaluation of the abdominal vessels, the pancreas, the liver, and lesions, if present, was performed with attenuation measurements and tumor conspicuity and contrast-to-noise ratio (CNR) calculations. An abdominal radiologist with 20 years of experience performed subjective evaluation of image quality and blindly detected and characterized liver lesions. Any inconclusive findings or grading scores were evaluated in consensus with another abdominal radiologist with 7 years of experience. Liver findings were validated using a composite reference standard to assess accuracy. There were 82 pancreatic cancer patients with a total of ...
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, Jan 27, 2016
Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in... more Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in patients with indeterminate lesions on ultrasound. Methods This prospective, descriptive study included patients with indeterminate breast lesions in the ultrasound and with indication for percutaneous or surgical biopsy. The elastography was evaluated by qualitative analysis and by two methods for the semi quantitative analysis. Results We evaluated 125 female patients with 159 lesions, with a mean age of 47 years, and a range of 20-85 years. Ultrasound has shown to be a method with good sensitivity (98.1%), but with a lower specificity (40.6%). On the elastography qualitative analysis, the specificity and accuracy were of 80.2% and 81.8% respectively. The mean size of the lesions showed no difference in classification by elastography. For the semiquantitative elastography, the mean values of the malignant lesions were statistically higher when compared with the subcutaneous tissue o...
Surgical Cosmetic Dermatology, 2013
Tomografia de coerência óptica no diagnóstico do carcinoma basocelular Optical coherence tomograp... more Tomografia de coerência óptica no diagnóstico do carcinoma basocelular Optical coherence tomography in the diagnosis of basal cell carcinoma
Arquivos De Gastroenterologia, 2005
OMICS Journal of Radiology, 2015
Objective: To evaluate the diagnostic accuracy of early postoperative Doppler ultrasound (DUS) fo... more Objective: To evaluate the diagnostic accuracy of early postoperative Doppler ultrasound (DUS) for vascular thrombosis after liver transplantation and to evaluate its impact on clinical outcome. Materials and Methods: This retrospective study examined 219 patients who underwent liver transplantation at a single reference institution. The results of early postoperative DUS were compared with angiographic, clinical and surgical data through a medical records review. The sensitivity and specificity of DUS for diagnosing vascular complications in the hepatic arteries and portal vein were calculated. Results: DUS diagnosed vascular complications in 23 out of 210 included patients (10.9%). For the diagnosis of arterial and portal vein complications (stenosis/thrombosis), DUS showed respectively sensitivity of 75% and 90.9% and specificities of 96% and 100%. Overall mortality rate was 10.5% and patients who presented vascular alterations at early postoperative DUS presented a higher mortality (21.7%) rate than those with normal DUS (9.0%), although with no statistically significant difference (p=0.074). Conclusion: DUS is a valuable tool for early vascular complication diagnosis, with high specificity rates for portal and arterial stenosis/thrombosis. Sensitivity rate in this series was lower for arterial complications.
Journal of the American Academy of Dermatology, 2015
REFERENCES 1. Sellheyer K, Nelson P, Bergfeld WF. Nonspecific histopathological diagnoses: the im... more REFERENCES 1. Sellheyer K, Nelson P, Bergfeld WF. Nonspecific histopathological diagnoses: the impact of partial biopsy and the need for a consensus guideline. JAMA Dermatol. 2014;150(1): 11-12. 2. Phelps RG, Lebwohl MG. Biopsy techniques: shave, punch, or excision? JAMA Dermatol. 2014;150(1):12-13. 3. Fernandez EM, Helm T, Ioffreda MD, Helm KF. The vanishing biopsy: the trend toward smaller specimens. Cutis. 2005;76: 335-339. 4. Carag HR, Prieto VG, Yballe LS, Shea CR. Utility of step sections: demonstration of additional pathological findings in biopsy samples initially diagnosed as actinic keratosis. Arch Dermatol. 2000;136:471-475. 5. Ya-Xian Z, Suetake T, Tagami H. Number of cell layers of the stratum corneum in normal skinerelationship to the anatomical location on the body, age, sex, and physical parameters. Arch Dermatol Res. 1999;291:555-559.
Revista da Associação Médica Brasileira (1992)
To evaluate Doppler Ultrasound (DUS) in oncology patients suspected of having Deep Venous Thrombo... more To evaluate Doppler Ultrasound (DUS) in oncology patients suspected of having Deep Venous Thrombosis (DVT) and correlate findings with their clinical characteristics and outcome. A study was made with 96 consecutive oncology patients submitted to DUS suspected to have DVT between May 2001 and April 2002. The same radiologist examined 73 women and 23 men, with a median age of 58 years, using DUS equipment, with high frequency linear and convex probes (logic500--GE and HDI5000--Philips). In 42 (43.8%) patients the DUS was considered normal, in 33 (34.4%) DVT was diagnosed and 21 of them had superficial or previous deep venous thrombosis or non conclusive studies. Considering clinical evaluation (and death by PE as caused by DVT) as the gold standard, DUS sensitivity was of 95.9%. There was a statistically significant correlation between DVT and tumor stage at the time of initial diagnosis and patient's survival rate (p<0.05). There was no correlation between DVT and gender, age...
Revista da Associação Médica Brasileira, 2006
RESUMO OBJETIVO. Avaliar as características clínicas e evolução dos pacientes com câncer e suspei... more RESUMO OBJETIVO. Avaliar as características clínicas e evolução dos pacientes com câncer e suspeita de TVP submetidos à USD e a sua sensibilidade. MÉTODOS. Estudamos 96 pacientes. A mediana da idade foi de 58 anos, sendo que 73 eram do sexo feminino. A USD foi realizada pelo mesmo radiologista em equipamentos digitais (logiq-500-GE e HDI5000-Phillips), com transdutores lineares de alta freqüência e, quando indicado, convexo de 3,5 mHz, utilizando-se modo B e Doppler. RESULTADOS. Sessenta e sete pacientes (69,8%) evoluíram a óbito, sendo que apenas quatro (4,1%) tiveram exame negativo para TVP e a causa do óbito relacionado a TEP. Quarenta e dois pacientes (43,8%) não apresentavam TVP à USD, enquanto 33 (34,4%) apresentaram-na, sendo que os demais (21,8%) tinham TVP antiga ou trombose superficial. Considerando-se a evolução como padrão ouro e qualquer diagnóstico de TEP desses pacientes causado por TVP, a sensibilidade da USD foi de 95,9%. Encontramos correlação estatisticamente significativa entre a presença de TVP e o estadiamento da neoplasia ao diagnóstico (p<0,05) e com a sobrevida dos pacientes (p<0,05). Não encontramos correlações significativas com as demais variáveis estudadas. CONCLUSÃO. A USD tem alta sensibilidade para diagnóstico de TVP em pacientes com câncer. A presença de TVP nessa população de pacientes se correlaciona com uma menor sobrevida e não há características clínicas que nos permitam isolar um subgrupo de pacientes com maior chance de TVP por USD. UNITERMOS: Trombose de veias profundas. Ultra-sonografia, diagnóstico e etiologia. Neoplasias-complicações. Fatores de risco-uso diagnóstico.
World Journal of Surgical Oncology, 2013
Background: Because of its safety, relative low cost and widespread availability, conventional ul... more Background: Because of its safety, relative low cost and widespread availability, conventional ultrasound (US) is the modality of choice for initial evaluation of the liver. Following US, in patients eligible for surgery, further computed tomography and/or magnetic resonance imaging is usually recommended for surgical planning. There are no recent published series focusing on conventional abdominal US exclusively employed for the evaluation of liver nodules before surgery. The objective of this study is to evaluate the efficacy of focused conventional preoperative US in detecting liver lesions, and the impact of US findings on surgical management. Methods: Sixty-seven noncirrhotic patients underwent surgical resection, after being previously submitted to focused liver US evaluation. US results were compared with intraoperative US (IOUS) and histology (gold standard). The IOUS was performed by the same radiologist who performed the preoperative US. Patient-by-patient and lesion-by-lesion analyses were performed. Results: A total of 241 lesions were depicted in 67 patients. The mean number of lesions detected per patient by US and IOUS was 2.37 and 3.37, respectively (P = 0.001). In 52.2% of patients, US and IOUS depicted the same number of liver lesions. Surgery with curative intent was conducted in 61 (91.0%) patients. Histological evaluation was obtained in 196 lesions; 155 were considered malignant. The overall lesions detection rate by US was 65.6%. For lesions <15 mm and lesions ≥15 mm, US showed a sensitivity rate of 55.3% and 75.5%, respectively. Conclusions: The relatively high sensitivity rates achieved by US focused on liver evaluation, with the aim of lowering costs but not efficiency, places the method in focus again for use in the routine preoperative staging of candidates for liver resection. We suggest for preoperative evaluation that US could be associated with one section imaging method (computed tomography or magnetic resonance imaging) as routine.
The Breast Journal, 2011
A 46-year-old woman was submitted to ultrasound (US)-guided vacuum-assisted biopsy of a solid nod... more A 46-year-old woman was submitted to ultrasound (US)-guided vacuum-assisted biopsy of a solid nodule in the left breast. During the procedure there was important bleeding controlled with local compression. At that time, the presence of a hematoma of about 40 • 30 mm was found using US (Fig. 1). The patient received discharge with compressive bandaging and was advised to return the following day. On return, ultrasonographic evaluation showed the presence of stable collection in relation to postprocedure exam, however, with small pulsating component, in which color-flow Doppler sonography showed turbulent flow with to-and-fro pattern with communication with a peripheral arterial vessel, characterizing a partially thrombosed pseudoaneurysm (Fig. 2). US-guided compression of the pseudoaneurysm was performed for about 60 minutes, obtaining incomplete thrombosis of the lesion. It was decided to maintain the patient with continuing compressive bandaging.
Journal of Clinical Ultrasound, 2011
The purpose of this randomized, prospective study was to evaluate the effect of three preparation... more The purpose of this randomized, prospective study was to evaluate the effect of three preparation types on the abdominal sonographic examination quality and on patient acceptance. Examinations were performed on 611 patients in the imaging department of a referral oncology center. Patients were divided into three groups: preparation with fasting, water, laxatives, and antiflatulents (Group I), preparation with fasting, water, and antiflatulents alone (Group II), or preparation with fasting and water alone (Group III). The examination quality was evaluated both objectively through grades and subjectively through impressions. Statistical significance was set at the p ≤ 0.05 level. No difference in examination quality was seen among patients with or without medication. Improved visualization of the retroperitoneum in the mid abdomen was observed among Group I patients. Patients in Groups II and III displayed fewer side effects. Other variables, such as obesity and increased abdominal wall thickness, also impacted the image quality. Visualization of the abdominal organs was satisfactory even in patients who had only fasted and received water. The use of laxative and antiflatulent preparations is not required before routine abdominal ultrasound examinations.
Arquivos de Neuro-Psiquiatria, 2008
CONTEXT: Low-grade astrocytomas are intracerebral lesions of relatively high frequency in the und... more CONTEXT: Low-grade astrocytomas are intracerebral lesions of relatively high frequency in the under-18 pediatric population. They often present indolent behaviour, and complete surgical resection is the choice treatment. In cases where the surgery is not possible, chemotherapy and radiotherapy may be used. Medical reports do not recommend examination of the spinal cord at diagnosis or during treatment, since the risk of dissemination of the lesion to the spine is minimal according to medical experience. We describe here four cases of children with low-grade astrocytoma with aggressive dissemination to the neuroaxis.
Arquivos de Gastroenterologia, 2005
RACIONAL: Vinte e cinco a 50% dos pacientes com metástases hepáticas são potenciais candidatos à ... more RACIONAL: Vinte e cinco a 50% dos pacientes com metástases hepáticas são potenciais candidatos à cirurgia curativa. A ultra-sonografia intra-operatória tem sido usada com grande acurácia para orientar a ressecção das lesões hepáticas. OBJETIVO: Avaliar em nosso meio a importância desse método nas cirurgias hepáticas e comparar seus achados com os dos métodos de imagem pré-operatórios. PACIENTES E MÉTODOS: Estudou-se prospectivamente 35 pacientes com metástases hepáticas e indicação cirúrgica, com os seguintes tumores primários: cólon (24), tumor neuroendócrino (3), carcinoma de células renais e melanoma (2) e outros (4). A idade mediana foi de 56 anos, sendo 20 pacientes do sexo feminino. Os pacientes foram submetidos a pelo menos um exame entre tomografia computadorizada (30), ultra-sonografia (14) e ressonância magnética (8). RESULTADOS: A ultra-sonografia intra-operatória foi útil em 23 (65,6%) das 35 cirurgias, e mudou o plano cirúrgico em 9 (25,7%) pacientes. Houve correlação e...
Journal of vascular and interventional radiology : JVIR, 2020
Dermatology Practical & Conceptual, 2015
Background: In vivo confocal microscopy is an imaging technique that has been applied to the stud... more Background: In vivo confocal microscopy is an imaging technique that has been applied to the study of the ocular surface. However, confocal microscopes dedicated to eye examination are routinely adopted only in ophthalmology reference centres and do not allow an examination of periocular tissue, nor a fluorescence examination. Methods: We applied for the first time the two in vivo confocal microscopes commonly used in dermatology (VivaScope ® 1500 and 3000, CALIBER, distributed in Europe by Mavig GmbH, Munich, Germany) to observe the cornea, the bulbar and tarsal conjunctiva, the eyelid margin, the lacrimal punctum and the palpebral skin of healthy volunteers. Tumoral, inflammatory and infectious diseases of the ocular mucosa and periocular skin from more than 200 patients were observed under the same microscopes. Both microscopes have a reflectance mode. VivaScope ® 1500 allows an additional fluorescent examination and its placement on the ocular surface was made possible by the creation of a special interface between the microscope and the ocular apparatus. Results: Thanks to its compact and flexible configuration, the handheld camera VivaScope ® 3000 allowed to access more easily to the ocular and periocular tissues. Diagnosis of benign and malignant tumors (melanoma, squamous cell carcinoma and basal cell carcinoma), as well as infectious and genetic disease (storage diseases), could be evocated. The detection of parasites (Demodex folliculorum) on eyelids was possible. Confocal images correlated well with conventional histopathology. The fluorescence examination of corneal squamous cell carcinoma by VivaScope 1500 was characterized by extravasation of fluorescein after intravenous injection. Conclusions: Confocal microscopes dedicated to the skin offer new perspectives for the diagnosis, optimization of treatments, and follow-up of the ocular diseases. They will allow dermatologists to examine conjunctival and eyelid tumors, as it is for skin or genital mucosa. In addition, thanks to some adaptations of the dermatological device VivaScope ® 1500, it is possible for the first time to perform a fluorsecnte examination of the ocular and peri-ocular tissue, opening a new era in the clinical imaging of the ocular surface. A new semiology remains to be learned.
Radiologia Brasileira, 2018
Historically, radiology has developed in a way that has increasingly distanced the radiologist fr... more Historically, radiology has developed in a way that has increasingly distanced the radiologist from the patient. Currently, diagnostic imaging results are predominantly communicated through written reports. Written communication is not considered sufficient, verbal communication being essential for the performance of the modern radiologist to be considered satisfactory. However, a lack of preparation on the part of the radiologist when communicating the diagnosis, especially when it is not favorable (as is often the case in a cancer hospital), makes that conversation quite challenging. Studies conducted in other countries have demonstrated that there are a variety of opinions on the part of requesting physicians and patients regarding radiologist-patient communication, which can be explained by cultural differences. Although there is no rule regarding the best way to accomplish such communication, there are definitely incorrect ways. To bridge the gap between radiologists and patien...
Journal of the American College of Radiology : JACR, Jan 2, 2018
The aim of this study was to evaluate radiologists' experiences with patient interactions in ... more The aim of this study was to evaluate radiologists' experiences with patient interactions in the era of open access of patients to radiology reports. This prospective, nonrandom survey of staff and trainee radiologists (n = 128) at a single large academic institution was performed with approval from the institutional review board with a waiver of the requirement to obtain informed consent. A multiple-choice questionnaire with optional free-text comments was constructed with an online secure platform (REDCap) and distributed via departmental e-mail between June 1 and July 31, 2016. Participation in the survey was voluntary and anonymous, and responses were collected and aggregated via REDCap. Statistical analysis of categorical responses was performed with the χ test, with statistical significance defined as P < .05. Almost three-quarters of surveys (73.4% [94 of 128]) were completed. Staff radiologists represented 54.3% of survey respondents (51 of 94) and trainees 45.7% (43 ...
Abdominal radiology (New York), Jan 23, 2017
To validate the use of a split-bolus pancreas CTA protocol for local staging of pancreatic cancer... more To validate the use of a split-bolus pancreas CTA protocol for local staging of pancreatic cancer and to evaluate its ability to detect and characterize liver lesions. Consecutive patients with pancreatic cancer who underwent split-bolus pancreas CTA between 12/2015 and 12/2016 were included in this IRB-approved HIPAA-compliant retrospective study. Objective evaluation of the abdominal vessels, the pancreas, the liver, and lesions, if present, was performed with attenuation measurements and tumor conspicuity and contrast-to-noise ratio (CNR) calculations. An abdominal radiologist with 20 years of experience performed subjective evaluation of image quality and blindly detected and characterized liver lesions. Any inconclusive findings or grading scores were evaluated in consensus with another abdominal radiologist with 7 years of experience. Liver findings were validated using a composite reference standard to assess accuracy. There were 82 pancreatic cancer patients with a total of ...
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, Jan 27, 2016
Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in... more Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in patients with indeterminate lesions on ultrasound. Methods This prospective, descriptive study included patients with indeterminate breast lesions in the ultrasound and with indication for percutaneous or surgical biopsy. The elastography was evaluated by qualitative analysis and by two methods for the semi quantitative analysis. Results We evaluated 125 female patients with 159 lesions, with a mean age of 47 years, and a range of 20-85 years. Ultrasound has shown to be a method with good sensitivity (98.1%), but with a lower specificity (40.6%). On the elastography qualitative analysis, the specificity and accuracy were of 80.2% and 81.8% respectively. The mean size of the lesions showed no difference in classification by elastography. For the semiquantitative elastography, the mean values of the malignant lesions were statistically higher when compared with the subcutaneous tissue o...
Surgical Cosmetic Dermatology, 2013
Tomografia de coerência óptica no diagnóstico do carcinoma basocelular Optical coherence tomograp... more Tomografia de coerência óptica no diagnóstico do carcinoma basocelular Optical coherence tomography in the diagnosis of basal cell carcinoma
Arquivos De Gastroenterologia, 2005
OMICS Journal of Radiology, 2015
Objective: To evaluate the diagnostic accuracy of early postoperative Doppler ultrasound (DUS) fo... more Objective: To evaluate the diagnostic accuracy of early postoperative Doppler ultrasound (DUS) for vascular thrombosis after liver transplantation and to evaluate its impact on clinical outcome. Materials and Methods: This retrospective study examined 219 patients who underwent liver transplantation at a single reference institution. The results of early postoperative DUS were compared with angiographic, clinical and surgical data through a medical records review. The sensitivity and specificity of DUS for diagnosing vascular complications in the hepatic arteries and portal vein were calculated. Results: DUS diagnosed vascular complications in 23 out of 210 included patients (10.9%). For the diagnosis of arterial and portal vein complications (stenosis/thrombosis), DUS showed respectively sensitivity of 75% and 90.9% and specificities of 96% and 100%. Overall mortality rate was 10.5% and patients who presented vascular alterations at early postoperative DUS presented a higher mortality (21.7%) rate than those with normal DUS (9.0%), although with no statistically significant difference (p=0.074). Conclusion: DUS is a valuable tool for early vascular complication diagnosis, with high specificity rates for portal and arterial stenosis/thrombosis. Sensitivity rate in this series was lower for arterial complications.
Journal of the American Academy of Dermatology, 2015
REFERENCES 1. Sellheyer K, Nelson P, Bergfeld WF. Nonspecific histopathological diagnoses: the im... more REFERENCES 1. Sellheyer K, Nelson P, Bergfeld WF. Nonspecific histopathological diagnoses: the impact of partial biopsy and the need for a consensus guideline. JAMA Dermatol. 2014;150(1): 11-12. 2. Phelps RG, Lebwohl MG. Biopsy techniques: shave, punch, or excision? JAMA Dermatol. 2014;150(1):12-13. 3. Fernandez EM, Helm T, Ioffreda MD, Helm KF. The vanishing biopsy: the trend toward smaller specimens. Cutis. 2005;76: 335-339. 4. Carag HR, Prieto VG, Yballe LS, Shea CR. Utility of step sections: demonstration of additional pathological findings in biopsy samples initially diagnosed as actinic keratosis. Arch Dermatol. 2000;136:471-475. 5. Ya-Xian Z, Suetake T, Tagami H. Number of cell layers of the stratum corneum in normal skinerelationship to the anatomical location on the body, age, sex, and physical parameters. Arch Dermatol Res. 1999;291:555-559.
Revista da Associação Médica Brasileira (1992)
To evaluate Doppler Ultrasound (DUS) in oncology patients suspected of having Deep Venous Thrombo... more To evaluate Doppler Ultrasound (DUS) in oncology patients suspected of having Deep Venous Thrombosis (DVT) and correlate findings with their clinical characteristics and outcome. A study was made with 96 consecutive oncology patients submitted to DUS suspected to have DVT between May 2001 and April 2002. The same radiologist examined 73 women and 23 men, with a median age of 58 years, using DUS equipment, with high frequency linear and convex probes (logic500--GE and HDI5000--Philips). In 42 (43.8%) patients the DUS was considered normal, in 33 (34.4%) DVT was diagnosed and 21 of them had superficial or previous deep venous thrombosis or non conclusive studies. Considering clinical evaluation (and death by PE as caused by DVT) as the gold standard, DUS sensitivity was of 95.9%. There was a statistically significant correlation between DVT and tumor stage at the time of initial diagnosis and patient's survival rate (p<0.05). There was no correlation between DVT and gender, age...
Revista da Associação Médica Brasileira, 2006
RESUMO OBJETIVO. Avaliar as características clínicas e evolução dos pacientes com câncer e suspei... more RESUMO OBJETIVO. Avaliar as características clínicas e evolução dos pacientes com câncer e suspeita de TVP submetidos à USD e a sua sensibilidade. MÉTODOS. Estudamos 96 pacientes. A mediana da idade foi de 58 anos, sendo que 73 eram do sexo feminino. A USD foi realizada pelo mesmo radiologista em equipamentos digitais (logiq-500-GE e HDI5000-Phillips), com transdutores lineares de alta freqüência e, quando indicado, convexo de 3,5 mHz, utilizando-se modo B e Doppler. RESULTADOS. Sessenta e sete pacientes (69,8%) evoluíram a óbito, sendo que apenas quatro (4,1%) tiveram exame negativo para TVP e a causa do óbito relacionado a TEP. Quarenta e dois pacientes (43,8%) não apresentavam TVP à USD, enquanto 33 (34,4%) apresentaram-na, sendo que os demais (21,8%) tinham TVP antiga ou trombose superficial. Considerando-se a evolução como padrão ouro e qualquer diagnóstico de TEP desses pacientes causado por TVP, a sensibilidade da USD foi de 95,9%. Encontramos correlação estatisticamente significativa entre a presença de TVP e o estadiamento da neoplasia ao diagnóstico (p<0,05) e com a sobrevida dos pacientes (p<0,05). Não encontramos correlações significativas com as demais variáveis estudadas. CONCLUSÃO. A USD tem alta sensibilidade para diagnóstico de TVP em pacientes com câncer. A presença de TVP nessa população de pacientes se correlaciona com uma menor sobrevida e não há características clínicas que nos permitam isolar um subgrupo de pacientes com maior chance de TVP por USD. UNITERMOS: Trombose de veias profundas. Ultra-sonografia, diagnóstico e etiologia. Neoplasias-complicações. Fatores de risco-uso diagnóstico.
World Journal of Surgical Oncology, 2013
Background: Because of its safety, relative low cost and widespread availability, conventional ul... more Background: Because of its safety, relative low cost and widespread availability, conventional ultrasound (US) is the modality of choice for initial evaluation of the liver. Following US, in patients eligible for surgery, further computed tomography and/or magnetic resonance imaging is usually recommended for surgical planning. There are no recent published series focusing on conventional abdominal US exclusively employed for the evaluation of liver nodules before surgery. The objective of this study is to evaluate the efficacy of focused conventional preoperative US in detecting liver lesions, and the impact of US findings on surgical management. Methods: Sixty-seven noncirrhotic patients underwent surgical resection, after being previously submitted to focused liver US evaluation. US results were compared with intraoperative US (IOUS) and histology (gold standard). The IOUS was performed by the same radiologist who performed the preoperative US. Patient-by-patient and lesion-by-lesion analyses were performed. Results: A total of 241 lesions were depicted in 67 patients. The mean number of lesions detected per patient by US and IOUS was 2.37 and 3.37, respectively (P = 0.001). In 52.2% of patients, US and IOUS depicted the same number of liver lesions. Surgery with curative intent was conducted in 61 (91.0%) patients. Histological evaluation was obtained in 196 lesions; 155 were considered malignant. The overall lesions detection rate by US was 65.6%. For lesions <15 mm and lesions ≥15 mm, US showed a sensitivity rate of 55.3% and 75.5%, respectively. Conclusions: The relatively high sensitivity rates achieved by US focused on liver evaluation, with the aim of lowering costs but not efficiency, places the method in focus again for use in the routine preoperative staging of candidates for liver resection. We suggest for preoperative evaluation that US could be associated with one section imaging method (computed tomography or magnetic resonance imaging) as routine.
The Breast Journal, 2011
A 46-year-old woman was submitted to ultrasound (US)-guided vacuum-assisted biopsy of a solid nod... more A 46-year-old woman was submitted to ultrasound (US)-guided vacuum-assisted biopsy of a solid nodule in the left breast. During the procedure there was important bleeding controlled with local compression. At that time, the presence of a hematoma of about 40 • 30 mm was found using US (Fig. 1). The patient received discharge with compressive bandaging and was advised to return the following day. On return, ultrasonographic evaluation showed the presence of stable collection in relation to postprocedure exam, however, with small pulsating component, in which color-flow Doppler sonography showed turbulent flow with to-and-fro pattern with communication with a peripheral arterial vessel, characterizing a partially thrombosed pseudoaneurysm (Fig. 2). US-guided compression of the pseudoaneurysm was performed for about 60 minutes, obtaining incomplete thrombosis of the lesion. It was decided to maintain the patient with continuing compressive bandaging.
Journal of Clinical Ultrasound, 2011
The purpose of this randomized, prospective study was to evaluate the effect of three preparation... more The purpose of this randomized, prospective study was to evaluate the effect of three preparation types on the abdominal sonographic examination quality and on patient acceptance. Examinations were performed on 611 patients in the imaging department of a referral oncology center. Patients were divided into three groups: preparation with fasting, water, laxatives, and antiflatulents (Group I), preparation with fasting, water, and antiflatulents alone (Group II), or preparation with fasting and water alone (Group III). The examination quality was evaluated both objectively through grades and subjectively through impressions. Statistical significance was set at the p ≤ 0.05 level. No difference in examination quality was seen among patients with or without medication. Improved visualization of the retroperitoneum in the mid abdomen was observed among Group I patients. Patients in Groups II and III displayed fewer side effects. Other variables, such as obesity and increased abdominal wall thickness, also impacted the image quality. Visualization of the abdominal organs was satisfactory even in patients who had only fasted and received water. The use of laxative and antiflatulent preparations is not required before routine abdominal ultrasound examinations.
Arquivos de Neuro-Psiquiatria, 2008
CONTEXT: Low-grade astrocytomas are intracerebral lesions of relatively high frequency in the und... more CONTEXT: Low-grade astrocytomas are intracerebral lesions of relatively high frequency in the under-18 pediatric population. They often present indolent behaviour, and complete surgical resection is the choice treatment. In cases where the surgery is not possible, chemotherapy and radiotherapy may be used. Medical reports do not recommend examination of the spinal cord at diagnosis or during treatment, since the risk of dissemination of the lesion to the spine is minimal according to medical experience. We describe here four cases of children with low-grade astrocytoma with aggressive dissemination to the neuroaxis.
Arquivos de Gastroenterologia, 2005
RACIONAL: Vinte e cinco a 50% dos pacientes com metástases hepáticas são potenciais candidatos à ... more RACIONAL: Vinte e cinco a 50% dos pacientes com metástases hepáticas são potenciais candidatos à cirurgia curativa. A ultra-sonografia intra-operatória tem sido usada com grande acurácia para orientar a ressecção das lesões hepáticas. OBJETIVO: Avaliar em nosso meio a importância desse método nas cirurgias hepáticas e comparar seus achados com os dos métodos de imagem pré-operatórios. PACIENTES E MÉTODOS: Estudou-se prospectivamente 35 pacientes com metástases hepáticas e indicação cirúrgica, com os seguintes tumores primários: cólon (24), tumor neuroendócrino (3), carcinoma de células renais e melanoma (2) e outros (4). A idade mediana foi de 56 anos, sendo 20 pacientes do sexo feminino. Os pacientes foram submetidos a pelo menos um exame entre tomografia computadorizada (30), ultra-sonografia (14) e ressonância magnética (8). RESULTADOS: A ultra-sonografia intra-operatória foi útil em 23 (65,6%) das 35 cirurgias, e mudou o plano cirúrgico em 9 (25,7%) pacientes. Houve correlação e...