Navegando por Palavras-chave "Differential diagnosis"
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- ItemSomente MetadadadosDiffusion-weighted magnetic resonance imaging indicates the severity of acute pancreatitis(Springer, 2015-02-01) Tertulino, Franklin de Freitas [UNIFESP]; Schraibman, Vladimir [UNIFESP]; Ardengh, Jose Celso [UNIFESP]; Espirito-Santo, Danilo Cerqueira do [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Apodaca Torrez, Franz Robert [UNIFESP]; Lobo, Edson Jose [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Goldman, Suzan Menasce [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Purpose: To test the use of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between different degrees of severity of acute pancreatitis (AP).Method: Thirty-six patients who underwent DW-MRI and magnetic resonance cholangiopancreatography were divided into patients with mild AP (mAP, n = 15), patients with necrotizing AP (nAP, n = 8), and patients with a normal pancreas (nP, n = 15; controls). the pancreas was divided into head, body, and tail, and each segment was classified according to image features: pattern 1, normal; pattern 2, mild inflammation; and pattern 3, necrosis. Apparent diffusion coefficients (ADCs) were measured in each segment and correlated with clinical diagnoses.Results: A total of 108 segments was assessed (three segments per patient). Segments classified as pattern 1 in the nP and mAP groups showed similar ADC values (P = 0.29). ADC values calculated for the pancreatic segments grouped according to the different image patterns (1-3) were significantly different (P < 0.001). Comparisons revealed significant differences in signal intensity between all three patterns (P < 0.05).Conclusions: DW-MRI was a compatible and safe image option to differentiate tissue image patterns in patients with mAP, nAP, and nP, mainly in those with contrain-dications to contrast-enhanced MRI (which is classically required for determining the presence of necrosis) or computed tomography. ADC measures allowed precise differentiation between patterns 1, 2, and 3.
- ItemAcesso aberto (Open Access)Estudo comparativo da flarefotometria em pacientes com melanoma maligno e nevo de coróide(Conselho Brasileiro de Oftalmologia, 2002-01-01) Ballalai, Priscilla Luppi [UNIFESP]; Erwenne, Clélia Maria [UNIFESP]; Chojniak, Martha Motono; Universidade Federal de São Paulo (UNIFESP); Hospital A C Camargo Departamento de Tumores OcularesIntroduction: Malignant intraocular tumors are associated with an increase in the aqueous flare, caused by alterations of the blood-ocular barriers through various mechanisms. Several studies have demonstrated an ocular flare increase using flare photometry in eyes with benign and malignant tumors. Purpose: To evaluate flare photometry as an adjunct method in the differential diagnosis of choroidal malignant melanoma and choroidal nevus comparing to normal control eyes. Methods: Eyes with melanoma and nevus were diagnosed by indirect binocular ophthalmoscopy and/or ultrasound were evaluated. The fellow normal eyes were used as a control. In all subject and control eyes flare photometry was performed using the Laser Flare Meter (FC 500, Kowa), under mydriasis. Statistical analysis was done using the Wilcoxon, Mann-Whitney, and Spearman tests. Results: Thirty-one eyes with malignant melanoma and 18 eyes with nevus were evaluated. The flare photometry average in the eyes with malignant melanoma was 17.1 ph/ms and in the control fellow eyes it was 4.06 ph/ms. In eyes with choroidal nevus the flare photometry average was 6.12 ph/ms and in the control fellow eyes it was 4.47 ph/ms. The flare photometry was higher in eyes with malignant melanoma and nevus than in the fellow normal eyes (p<0.001 and p<0.01). Comparing the eyes with malignant melanoma and nevus, flare photometry was significantly higher in eyes with malignant melanoma (p<0.001). There was a positive correlation between the tumor thickness and flare photometry (r=0.47). Conclusion: Flare photometry is a helpful tool in the differential diagnosis of malignant melanoma and choroidal nevus.
- ItemSomente MetadadadosFuzzy cognitive map in differential diagnosis of alterations in urinary elimination: A nursing approach(Elsevier B.V., 2013-03-01) Baena de Moraes Lopes, Maria Helena; Siqueira Ortega, Neli Regina; Panse Silveira, Paulo Sergio; Massad, Eduardo; Higa, Rosangela; Marin, Heimar de Fatima [UNIFESP]; Universidade Estadual de Campinas (UNICAMP); Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Purpose: To develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I).Methods: A fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. the model was implemented in Microsoft Visual C++(R) Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). the sensitivity and specificity of the model were calculated considering the expert's opinion as a gold standard. in order to compute the Kappa's values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different.Results: the overestimation of the accordance showed an excellent agreement (kappa = 0.92, p < 0.0001); and the underestimation provided a moderate agreement (kappa = 0.42, p < 0.0001). in general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42).Conclusions: the decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view.Limitations: in spite of the good results, the FCM should be improved to identify the diagnoses of urge urinary incontinence and total urinary incontinence. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
- ItemSomente MetadadadosHigh-Resolution Computed Tomography in the Diagnosis of Diffuse Parenchymal Lung Diseases: Is it Possible to Improve Radiologist's Performance?(Lippincott Williams & Wilkins, 2016) Verrastro, Carlos Gustavo Yuji [UNIFESP]; Antunes, Viviane Baptista [UNIFESP]; Jasinowodolinski, Dany; D'Ippolito, Giuseppe [UNIFESP]; Meirelles, Gustavo de Souza Portes [UNIFESP]Objective The aims of this study were to assess the concordance between high-resolution computed tomography (HRCT) diagnostic hypotheses (DH) and final diagnosis in patients with diffuse lung disease and to evaluate whether clinical data or the radiologist's degree of certainty influence concordance. Methods Concordances between first and any one of radiologists' DH and final diagnosis were assessed before and after access to clinical data, with study of importance of degree of certainty in the DH formulated. Results Concordances of HRCT DH and final diagnosis were 48% and 76%, respectively, considering first or any of the DH without access to clinical data. Accessing clinical data improved concordance especially for hypersensitivity pneumonitis. Diagnostic hypotheses formulated with high degree of confidence were correct in 69% of cases. Conclusions First HRCT DH was concordant with final diagnosis in approximately half of cases, increasing to approximately 75% when considering any 1 of the 3 DH. Radiologists' knowledge of clinical data or increased degree of certainty improved concordance of HRCT DH and the final diagnosis.
- ItemSomente MetadadadosHuman Schistosoma mansoni-associated glomerulopathy in Brazil(Oxford Univ Press, 2002-01-01) Nussenzveig, Israel; Brito, Thales de; Carneiro, Celia Regina Whitaker [UNIFESP]; Silva, Ana Maria G; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
- ItemAcesso aberto (Open Access)Internal carotid artery aneurysm mimicking normal-tension glaucoma(Consel Brasil Oftalmologia, 2018) Pincelli Netto, Mario [UNIFESP]; Ferrari, Pedro Vanalle [UNIFESP]; Herrerias, Bruno Torres [UNIFESP]; Hirai, Flavio Eduardo [UNIFESP]; Gracitelli, Carolina Pelegrini Barbosa [UNIFESP]Differentiating glaucomatous from nonglaucomatous optic disc cupping remains challenging. We present a case of a 48-year-old woman with an internal carotid aneurysm of approximately 3.5 mm x 6.5 mm that mimicked normal-tension glaucoma. The patient had a 2-year history of low vision acuity in her left eye and frontal oppressive headache. Owing to the carotid aneurysm, she developed an asymmetric vertical cup-to-disc ratio above 0.2, and marked inferotemporal neuronal rim loss and pallor of the residual rim were noted in the left disc. She also developed a visual field defect with an arcuate scotoma in the left eye. The patient was referred to a neurosurgeon and underwent endovascular aneurysm occlusion. This case highlights the diagnostic importance of recognizing that many neurological defects remain underdiagnosed.
- ItemAcesso aberto (Open Access)Pesquisa da doença de alfa manosidose como diagnóstico diferencial para mucopolissaridoses dos tipos I, II e VI na população brasileira(Universidade Federal de São Paulo (UNIFESP), 2017-09-28) Marins, Maryana Mara [UNIFESP]; Pesquero, João Bosco [UNIFESP]; Gomes, Caio Perez [UNIFESP]; http://lattes.cnpq.br/8433460346998230; http://lattes.cnpq.br/0856630824759511; http://lattes.cnpq.br/1626371860783907; Universidade Federal de São Paulo (UNIFESP)Objetivo: Pesquisar a doença de alfa manosidose em indivíduos com suspeita clínica de mucopolissacaridose (MPS) dos tipos I, " e VI sem diagnóstico confirmado. Métodos: Foram selecionadas 50 amostras de indivíduos brasileiros com suspeita clínica de MPS I, " e/ou VI cujo os resultados bioquímicos e/ou moleculares não determinaram diagnóstico para MPS. Essas amostras foram submetidas à analise molecular através de sequenciamento do gene MAN2B1, pela técnica de Sanger e análise bioquímica por meio de dosagem de atividade enzimática da alfa manosidase por ensaio fluorimétrico. Resultados: Foram padronizadas as análises molecular e bioquímica para doença de Alfa Manosidose. Foi realizado o sequenciamento de 50 amostras. Foram identificadas 35 variantes no total, sendo: 22 em regiões não codificantes e 13 variantes exônicas. Todas essas variantes foram analisadas in si/ico, sendo consideradas: 1 potencialmente patogênica, 23 provavelmente neutras e 10 de efeito desconhecido. Um indivíduo apresentou a mutação p.S899* em homozigose que gera um "stop codon" prematuro resultando em uma proteína truncada. A dosagem de atividade enzimática em indivíduos saudáveis foi em média 19,89 nmol/mLlh (desvio padrão de 8,63nmol/mLlh), já no grupo casoríeste trabalho a dosagem da atividade enzimática apresentou resultados inconsistentes (dados não mostrados), provavelmente devido ao tempo de estocagem. Conclusão: O presente trabalho traz informações importantes para caracterização genética e bioquímica da doença de Alfa Manosidose na população brasileira. É possível concluir que a doença de Alfa Manosidose possa ser subdiagnosticada no Brasil, não só pela presença de um indivíduo afetado em nosso estudo, mas também pela falta de conhecimento da doença, devido a poucos estudos descritos na literatura e da ausência de trabalhos relacionados a essa doença na população brasileira. Os resultados mostraram que a realização da pesquisa da doença de Alfa Manosidose pode ser um diagnóstico diferencial para MPS e que poderia ser implementado nos ambulatórios e centros de referência do território nacional.
- ItemAcesso aberto (Open Access)Pseudohypopyon immediately after intravitreal injection of triamcinolone acetonide: case reports(Conselho Brasileiro de Oftalmologia, 2005-04-01) Campos, Vânia Ewert de [UNIFESP]; Maia, André [UNIFESP]; Muccioli, Cristina [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Report on the development of pseudohypopyon immediately after intravitreal injection of triamcinolone acetonide (TAAC). Two phakic patients presenting with a transient pseudohypopyon after having been treated with intravitreal triamcinolone. One had a clinically significant macular edema with cystoid component (CSME with CMS) and the other, active Vogt-Koyanagi-Harada (VKH) with serous retinal detachment of the macula. One eye from each patient developed a pseudohypopyon with crystal deposits adherent to the corneal endothelium. In one case it appeared right after the injection and disappeared spontaneously in 24 hours. In the other patient it appeared on day 3 and disappeared also spontaneously within 2 days. The pseudohypopyon is an important sign that can be observed after intravitreal injection of TAAC, in phakic patients, with spontaneous resolution and without complication. The pseudohypopyon caused by the deposition of TAAC in the anterior chamber immediately after its injection into the vitreous should be differentiated from other forms of hypopyon associated with this type of treatment.