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Objectives Anaplastic thyroid carcinoma (ATC) has a poor survival. The combination of Dabrafenib plus Trametinib (DT) had a significant impact in survival of BRAF p.V600E patients. However, durable responses may be compromised by resistance. We aim to present our experience with DT in BRAF positive ATC patients and compare the outcomes with usual therapy, and to study tumor molecular alterations in the DT group. Methods Patients treated between May 2018 and April 2022 in a tertiary referral center, assessed for BRAF status were included. Patients were divided in three groups: BRAF p.V600E treated with DT, BRAF wild type (WT) under multimodal therapy (MT), and BRAF WT under compassionate care (CC). Response was assessed monthly in the first 6 months and every 3 months afterwards, by RECIST 1.1. Overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Results Twenty-seven ATC patients were included (DT = 9, MT = 8, and CC = 10). Median OS was 475 days for DT, 156 days for MT, and 39 days for CC (P < .001). At 12 months, only patients in the DT group were alive (71%). Median PFS was 270 days, in the DT group, compared with less than 32 days in BRAF WT (P < .001). No severe adverse events were reported. Molecular profiling showed that in one of the four clinical progressions, a pathogenic NRAS mutation was found. Conclusions Our results show a significant real-world efficacy of Dabrafenib plus Trametinib in both survival and recurrence compared with standard treatment, with a good safety profile.

Mucoceles of the appendix are rare and can have quite variable imaging and clinical presentations, sometimes mimicking an adnexal mass. The underlying cause can be neoplastic or non-neoplastic. The typical imaging appearance of a mucocele of the appendix is that of a cystic structure with a tubular morphology. This structure is defined by having a blind-ending and being contiguous with the cecum. Radiologists should be familiar with key anatomical landmarks and with the various imaging features of mucoceles of the appendix, in order to provide a meaningful differential diagnosis of a lesion in the right lower abdominal quadrant. In addition, a neoplastic mucocele can rupture, resulting in pseudomyxoma peritonei, which will change the prognosis dramatically. Therefore, prompt diagnostic imaging is crucial. Resumo Mucoceles do apêndice são raras e podem ter uma apresentação clínica e imagiológica bastante variável, por vezes mimetizando patologia anexial. As causas subjacentes podem ser neoplásicas ou não neoplásicas. O aspecto de imagem típico de mucoceles do apêndice é o de uma estrutura de natureza cística com morfologia tubular. Esta estrutura deverá terminar “em fundo cego” e ser contígua com o ceco. Os radiologistas devem estar familiarizados com os pontos anatômicos de referência e com as diferentes características imagiológicas de mucoceles do apêndice, de modo a fornecer um adequado diagnóstico diferencial de uma lesão localizada no quadrante abdominal inferior direito. Para além disso, uma mucocele neoplásica pode sofrer ruptura, resultando em pseudomixoma peritoneal, o que altera drasticamente o prognóstico. Assim, o diagnóstico por imagem em tempo útil é crucial.

Although US is one of the most used modalities for head and neck imaging, its use in the diagnosis of laryngeal abnormalities is much less widespread. The standard assessment of laryngeal abnormalities currently involves direct laryngoscopy and cross-sectional imaging (either CT or MRI) but rarely US. US is readily available, noninvasive, and radiation free, and it allows real-time imaging (with video for dynamic assessment), higher resolution than that of cross-sectional imaging, and the performance of targeted fine needle aspiration cytology or biopsy. This modality, particularly with the advent of high-resolution US, has been found to be at least comparable to CT or MRI for diagnosis of malignant lesions and benign abnormalities such as vocal nodules, polyps, cysts, and Reinke edema. Furthermore, it has been found to be more sensitive for diagnosis of abnormalities such as small glottic tumors, and its dynamic capability can be used to identify functional abnormalities such as vocal cord palsy. The authors outline the technique of laryngeal US, which includes strategies to avoid calcified laryngeal cartilage by imaging through the thyrohyoid and cricothyroid membranes with a five-sweep strategy supplemented by cine film of the technique. They also provide US images of common laryngeal abnormalities such as tumors with and without extralaryngeal extension; vallecular, thyroglossal, and vocal cord cysts; laryngeal mucoceles; and vocal cord palsy.

Simple Summary This work aims to evaluate the utility of fusing T2-weighted images with diffusion-weighted images to determinate the depth of myometrial invasion and the stage of endometrial cancer. By showing its superior diagnostic performance, we aim to encourage its use in endometrial cancer staging, and, in the future, obviate the need for intravenous contrast medium administration. Abstract Endometrial cancer is the eighth most common cancer worldwide, and its prognosis depends on various factors, with myometrial invasion having a major impact on prognosis. Optimizing MRI protocols is essential, and it would be useful to improve the diagnostic accuracy without the need for other sequences. We conducted a retrospective, single-center study, which included a total of 87 patients with surgically confirmed primary endometrial cancer, and who had undergone a pre-operative pelvic MRI. All exams were read by an experienced radiologist dedicated to urogenital radiology, and the depth of myometrial invasion was evaluated using T2-Weighted Images (T2WI) and fused T2WI with Diffusion-Weighted Images (DWI). Both results were compared to histopathological evaluations. When comparing both sets of imaging (T2WI and fused T2WI-DWI images) in diagnosing myometrial invasion, the fused images had better accuracy, and this difference was statistically significant (p < 0.001). T2WI analysis correctly diagnosed 82.1% (70.6–88.7) of cases, compared to 92.1% correctly diagnosed cases with fused images (79.5–97.2). The addition of fused images to a standard MRI protocol improves the diagnostic accuracy of myometrial invasion depth, encouraging its use, since it does not require more acquisition time.

Introdução: O vi?rus varicela-zo?ster (VZV), ou herpesvi?rus tipo 3, causa duas síndromes virais distintas: varicela (catapora) e herpes-zo?ster. O principal fator desencadeante do herpes zo?ster e? a idade avançada, seguida por imunossupressão, trauma e irradiac?a?o. O herpes-zo?ster ofta?lmico (HZO) se inicia com o pro?dromo de febre, cefaleia e fadiga, e, posteriormente, evolui com manifestações cutâneas localizadas no derma?tomo inervado pelo ramo acometido. O exantema inicia-se como erupc?a?o maculopapular, evoluindo para vesículas de conteúdo claro que tornam-se pu?stulas flavas e, posteriormente, crostas. Alguns sinais são característicos do acometimento do ramo trigêmio, como o sinal de Hutchinson (vesi?culas e pústulas na ponta do nariz). O tratamento da fase aguda do HZO e? sistêmico, com o uso de antivirais orais no paciente imunocompetente e tópicos quando há ceratite. Relato de caso: Paciente de 82 anos, proveniente de Onça de Pitangui, MG. Apresentou-se em abril/2018 à UBS queixando-se de hiperemia, dor conjuntival e secreção ocular flava, além de lesão pruriginosa em região frontal. É firmado o diagnóstico de conjuntivite bacteriana e iniciado tratamento com Cilodex®. Após 3 dias, paciente evolui com aparecimento de pústulas em região frontal e dorso nasal. Encaminhado ao hospital em Belo Horizonte, foi efetuado diagnóstico de ceratite herpética por VZV. Discussão: O paciente avaliado apresenta fatores desencadeantes, como exposição solar e idade que corroboram com o desenvolvimento de HZO. Sintomas prodrômicos não foram encontrados no caso, apesar de serem frequentes nessa patologia. O sinal de Hutchinson, indicativo de acometimento do ramo nasociliar do nervo oftálmico, foi o direcionador para a possibilidade diagnostica de HZO e para posterior investigação especifica de ceratite herpética. O tratamento deve ser introduzido precocemente para evitar complicações e sequelas. Conclusão: A ceratite herpética por VZV é, portanto, um quadro desafiador no aspecto de identificação e tratamento. Faz-se assim importante o relato do caso, para que possa-se ter maior conhecimento sobre a lesão e menos complicações, como danos oculares irreversíveis. O tratamento é simples e, quando adequado, evita perda visual permanente.

The marsh deer (Blastocerus dichotomus) is the largest deer in the South American continent and is listed in the red list of endangered animals according to IBAMA and IUCN. It has a very small population in captivity, estimated at 100 individuals. Among the main problems of this species “ex situ” we have puliciosis. This infestation can cause significant anemia, weariness and even death. The control of these parasites is carried out in several ways, with flea combat in the hosts and in the environment, and joint control is the most effective method. However, the control of fleas in animals is quite restricted, both by the behavior of the animal, and by the nonexistence of an effective and long-acting anti parasitic product. This work tested a collar impregnated with imidacloprid and flumethrin, recommended for use in domestic dogs, because it is of single application and long duration. The collar showed to be very efficient for eighteen months, in the elimination of fleas, associated with spraying of deltamethrin in the enclosure; without occurrence of adverse effects.

To establish MRI features that help differentiate atypical leiomyomas and leiomyomas with degeneration that show hyperintensity on T2WI from leiomyosarcomas. This retrospective study evaluated 41 women who performed MRI before undergoing hysterectomy and had histologically proven atypical leiomyomas, leiomyomas with degeneration or leiomyosarcomas (21 leiomyomas; 20 leiomyosarcomas); only patients with T2 hyperintense myometrial tumors were included. The association between MRI features (contours; free pelvic fluid; intra-tumoral hemorrhagic areas, T2 heterogeneity; T2 dark areas; flow voids; restriction on diffusion-weighted images; signal intensity and heterogeneity after contrast administration; unenhanced areas, localization of unenhanced areas; necrosis; cystic areas) and the histology (leiomyoma vs. leiomyosarcoma) were calculated using Fisher’s exact test. For those features that showed a significant association, a univariate linear regression was performed. Five MRI features demonstrated a significant correlation with malignant histology: irregular borders (p = 0.03); “T2 dark” areas (p = 0.02); presence of central necrosis (p = 0.01); presence of high signal on b1000 DWI (p

Objetivo: Verificar, por meio de uma revisão narrativa de literatura, a influência do DM2 no prognóstico da infecção por COVID-19, assim como o impacto do controle glicêmico nos desfechos apresentados por esses pacientes. Revisão bibliográfica: A DM2 relaciona-se com a infecção e a gravidade da SARS-CoV-2. Os sintomas apresentados pelos pacientes diabéticos infectados por SARS-CoV-2 foram muito amplo, entretanto, percebeu-se maior comorbidade nas análises laboratoriais e de imagem, além de maior mortalidade entre os pacientes diabéticos infectados pelos novo coronavírus. A literatura divergiu ao comparar o quadro clínico do pacientes diabéticos e não diabéticos infectados por COVID-19, mas convergiu ao relatar aumento da morbimortalidade. Considerações finais: A adaptação metabólica promovida pelo indivíduo diabético se mostra prejudicial no contexto do COVID-19, predispondo o paciente à infecção e ao surgimento de outras complicações, além de determinar um pior controle glicêmico e prognóstico. Tais achados destacam a necessidade de uma abordagem multidisciplinar para o gerenciamento dessa população de pacientes visando à prevenção de complicações e de formas graves da infecção.

To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI. The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as “RECOMMENDED” versus “NOT RECOMMENDED” (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts). Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended. These consensus recommendations should be used as a guide for endometrial cancer staging with MRI. • MRI is recommended for initial staging of endometrial cancer. • MR imaging protocol should be tailored based on the risk of lymph node metastases. • Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging. • The mnemonic “Clinical and MRI Critical TEAM” summarizes key elements of the standardized report.

Objective The aim of the Female Pelvic Imaging Working Group of the European Society of Urogenital Radiology (ESUR) was to develop imaging guidelines for MR work-up in patients with known or suspected uterine leiomyomas. Methods Guidelines for imaging uterine leiomyomas were defined based on a survey distributed to all members of the working group, an expert consensus meeting at European Congress of Radiology (ECR) 2017 and a critical review of the literature. Results The 25 returned questionnaires as well as the expert consensus meeting have shown reasonable homogeneity of practice among institutions. Expert consensus and literature review lead to an optimized MRI protocol to image uterine leiomyomas. Recommendations include indications for imaging, patient preparation, MR protocols and reporting criteria. The incremental value of functional imaging (DWI, DCE) is highlighted and the role of MR angiography discussed. Conclusions MRI offers an outstanding and reproducible map of the size, site and distribution of leiomyomas. A standardised imaging protocol and method of reporting ensures that the salient features are recognised. These imaging guidelines are based on the current practice among expert radiologists in the field of female pelvic imaging and also incorporate essentials of the current published MR literature of uterine leiomyomas. Key Points • MRI allows comprehensive mapping of size and distribution of leiomyomas. • Basic MRI comprise T2W and T1W sequences centered to the uterus. • Standardized reporting ensures pivotal information on leiomyomas, the uterus and differential diagnosis. • MRI aids in differentiation of leiomyomas from other benign and malignant entities, including leiomyosarcoma. Electronic supplementary material The online version of this article (10.1007/s00330-017-5157-5) contains supplementary material, which is available to authorized users.

Vulvar carcinoma is an uncommon tumor that predominantly affects postmenopausal women. Currently, there is no screening procedure for vulvar carcinoma; in most cases, it is diagnosed only when symptoms appear. The most widely used staging system is that developed by the International Federation of Gynecology and Obstetrics. Lymph node status is the most important prognostic factor. We searched the PubMed/Medline database to identify relevant English-language articles on vulvar cancer, with a special focus on its imaging evaluation. Magnetic resonance imaging is useful for local and nodal staging, as well as facilitating the planning of surgical interventions and radiotherapy. Computed tomography or positron-emission tomography/computed tomography can play an important role in nodal and distant disease assessment, whereas ultrasound is often used for image-guided biopsies. Imaging is pivotal for staging and treatment planning in vulvar carcinoma. Resumo O carcinoma da vulva é um tumor incomum que afeta predominantemente mulheres em menopausa. Atualmente, não existe um teste de rastreio para o carcinoma da vulva, e a maioria dos casos é diagnosticada com o aparecimento de sintomas. O sistema de estadiamento mais frequentemente utilizado é o da International Federation of Gynecology and Obstetrics. O fator prognóstico mais importante é o estadiamento ganglionar. Neste trabalho foram efetuadas pesquisas na base de dados PubMed/Medline, considerando-se textos pertinentes em língua inglesa sobre carcinoma da vulva, com especial ênfase na avaliação radiológica. A ressonância magnética é útil para a avaliação local e ganglionar e pode ajudar no planejamento cirúrgico e/ou de radioterapia; a tomografia computadorizada ou a tomografia com emissão de pósitrons/tomografia computadorizada pode ser importante na apreciação ganglionar e na doença a distância; e a ultrassonografia é, por vezes, utilizada para orientar procedimentos de intervenção, como a biópsia. A radiologia é fundamental no estadiamento e planejamento do tratamento do carcinoma da vulva.

Objective: To evaluate the added value of diffusion-weighted imaging (DWI) in the preoperative assessment of myometrial invasion in endometrial cancer, in comparison with T2-weighted imaging (T2WI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Materials and Methods: This was a retrospective study involving 44 women with endometrial cancer who underwent preoperative 1.5 T MRI. Two radiologists, both of whom were blinded to the histopathology reports, performed a consensus interpretation of the depth of myometrial invasion and of the stage of the cancer, considering three sets of sequences: T2WI, DCE-MRI+T2WI, and DWI+T2WI. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each set. The accuracy was compared with p-value adjustment by the Benjamini-Hochberg procedure. Results: Among the 44 patients evaluated, DWI+T2WI demonstrated better diagnostic performance in assessing deep myometrial invasion and correctly staged more patients (n = 41) than did DCE-MRI+T2WI (n = 34) and T2WI (n = 22). The superior diagnostic accuracy of DWI+T2WI was statistically significant in comparison with T2WI (p < 0.05) but not in comparison with DCE-MRI+T2WI (p > 0.05). Conclusion: The addition of DWI apparently improves the diagnostic accuracy of MRI in the preoperative assessment of the depth of myometrial invasion in endometrial cancer, which may be particularly helpful in patients for whom contrast agents are contraindicated. Resumo Objetivo: Determinar o valor adicional da difusão (DWI) em ressonância magnética (RM) na avaliação pré-operatória da invasão miometrial do câncer do endométrio, em comparação com sequências T2 e com o estudo dinâmico após contraste paramagnético (dynamic contrast-enhanced - DCE). Materiais e Métodos: Estudo retrospectivo incluindo 44 mulheres com câncer do endométrio que realizaram RM 1,5 T pré-operatória. Dois radiologistas desconhecendo a histopatologia final realizaram interpretação consensual sobre a profundidade de invasão miometrial e o estádio da doença considerando três conjuntos de sequências: T2, DCE+T2 e DWI+T2. Para cada conjunto foram calculadas acuidade, sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo. A acuidade diagnóstica foi comparada com ajuste do valor de p utilizando o procedimento Benjamini-Hochberg. Resultados: DWI+T2 apresentou melhor performance diagnóstica na avaliação da invasão miometrial e permitiu estadiar corretamente mais pacientes (41/44) do que DCE+T2 (34/44) e T2 (22/44). A superior acuidade diagnóstica da DWI+T2 foi estatisticamente significativa quando comparada com T2 (p < 0,05), mas não quando comparada com DCE+T2 (p > 0,05). Conclusão: A interpretação da DWI+T2 melhorou a acuidade diagnóstica da RM na avaliação pré-operatória da invasão miometrial do câncer de endométrio, o que poderá ser particularmente útil em pacientes com contraindicação para contraste paramagnético.

Developments in magnetic resonance imaging have expanded its role in the assessment of the female pelvis, including the diagnosis of ovarian lesions. In this setting, diffusion-weighted imaging has proven its diagnostic value, which is particularly important in differentiating between benign and malignant ovarian tumors. In general, the latter show restricted diffusion, whereas the former do not. Exceptions include teratomas, endometriomas, hemorrhagic cysts, ovarian abscesses, ovarian infarction, and some benign stromal tumors. The aim of this review is to draw attention to benign ovarian lesions with restricted diffusion, with a special focus on diffusion-weighted imaging pearls and pitfalls. Resumo Os recentes desenvolvimentos nas técnicas de ressonância magnética aumentaram o seu papel na avaliação da pelve em mulheres, incluindo o diagnóstico de lesões ovarianas. A imagem ponderada em difusão comprovou ter um valor diagnóstico indiscutível, fato particularmente importante na diferenciação entre tumores ovarianos benignos e malignos. Em geral, os últimos têm restrição na difusão, enquanto os primeiros não. As exceções incluem teratomas, endometriomas, cistos hemorrágicos, abcessos ovarianos, enfarte ovariano e alguns tumores benignos do estroma ovariano. Esta revisão tem como objetivo expor lesões ovarianas benignas com restrição na difusão, com especial enfoque nas pérolas e armadilhas da imagem ponderada em difusão.

Primary vaginal malignancies constitute a rare entity. The aim of this study was to review all primary vaginal malignancies diagnosed in an oncologic referral centre over 11 years. A total of 35 cases were retrospectively analysed, including clinical and MRI features. Squamous cell carcinoma (SCC) was the most frequent histologic subtype (77.1%), followed by adenocarcinoma (14.3%). There was no statistically significant difference for the mean age at diagnosis or for the mean largest diameter of the tumour. Most SCCs (95%) were homogeneous on T2-weighted imaging, while all adenocarcinomas were heterogeneous (p = .0001). Concerning location, both SCCs (59.3%) and adenocarcinomas (80%) occurred more often on the upper third. However, regarding the wall of origin, all adenocarcinomas originated on the anterior vaginal wall (p = .0002), while SCCs (62.5%) had a predisposition for the posterior wall (p = .017). Regarding the history of previous hysterectomy, in the SCC group, 73.3% of patients with previous hysterectomies had cervical dysplasia (p = .018). Impact statement What is already known on this subject? MRI plays an important role in the initial approach of primary vaginal malignancies. In previous studies, it is said that SCCs usually appear homogeneous on T2WI, with the intermediate-high signal, while adenocarcinomas are often homogeneously hyperintense. Regarding location, it is known that SCCs usually arise from the posterior wall of the upper third, while adenocarcinomas often originate on the anterior wall of the proximal third. What do the results of this study add? In this study, we found that all of our cases of adenocarcinomas were heterogeneous on T2WI, with high-signal intensity areas, while SCCs were predominantly homogeneous, and this association was statistically significant. We could also confirm the data in the literature regarding the most common location of these tumours. This study also showed an association between vaginal SCC and a previous hysterectomy with cervical dysplasia. What are the implications of these findings for clinical practice and/or further research? The histologic type of vaginal malignancy has clinical and management impact. Although MRI is usually performed after histologic characterisation, this is not always the case. We think that this study can constitute a starting point to better understand the MRI features of these rare tumours. Although this technique will obviously never preclude histologic characterisation, it may provide some initial hint on the type of tumour and its aggressiveness. info:eu-repo/semantics/publishedVersion

Endometrial cancer is the most common gynecological malignancy in developed countries with a rising incidence mainly related to obesity. Magnetic resonance imaging (MRI) has been recognized to be the gold standard imaging modality to accurately assess tumor staging and help stratify patient treatment. In this review, we will discuss the advantages and challenges of MRI staging of endometrial cancer with a particular focus on the MRI acquisition protocol and the role of diffusion-weighted imaging (DWI).

Purpose of Review The purpose of this review is to highlight potential magnetic resonance (MR) imaging pitfalls that may mask and simulate ovarian cancer. Recent Findings MR imaging is the standard method for evaluating female pelvic masses of indeterminate origin, especially sonographically indeterminate adnexal masses. To define the correct origin and nature of a pelvic mass has an enormous clinical impact, namely in females of child-bearing age. This is particularly true in adnexal lesions. Ovarian cancer usually requires a cytoreductive surgery in a specialized oncological centre. In contrast, a benign ovarian lesion may be treated by simple resection in a general hospital. To help preventing diagnostic errors and in order to guide appropriate therapeutic management, radiologists should be aware of potential MR pitfalls that may mask and simulate ovarian cancer. Summary The first section of this article will describe the MR imaging protocol that authors perform in their oncological centre, highlighting how imaging techniques can be optimized in order to reduce pitfalls in the characterization of an indeterminate pelvic mass. In the next section, authors will revise the main anatomic and organ-specific signs that may allow the radiologist to determine the ovarian origin of a pelvic mass. Finally, benign gynaecological masses that may simulate ovarian cancer in a non-emergency setting will be discussed, with emphasis on features that may provide important clues to their diagnosis. info:eu-repo/semantics/publishedVersion

Clinical and pathological aspects of endometrial cancers that develop after radiation therapy for cervical carcinoma have been studied for years but their imaging features have not yet been described. To determine these features, we performed a retrospective study that included all patients of our institution that were diagnosed with an endometrial cancer after being submitted to radiation therapy for cervical cancer and that performed computed tomography (CT) or magnetic resonance (MR) imaging at the time of the diagnosis, in a period of 11 years. We found 13 patients meeting these inclusion criteria. A wide range of morphologies were observed: single solid tumors (46%); single mixed tumors (15%); large heterogeneous multifocal tumors (15%) and multifocal small polypoid tumors (15%). Large tumors were frequent at presentation, with 65% of the lesions measuring more than 5 cm (mean, 7.4 cm; range, 1.2-14.9 cm). Hematometra was a striking feature that was present in 85% of the cases, with a mean volume of 318 mL and was associated in 91% of the cases with cervical stenosis, a known complication of pelvic radiotherapy that could justify a delay in symptoms presentation. Post-radiotherapy changes and hematometra limited the utility of MR imaging in local staging. Distant metastases could be promptly diagnosed with CT or MR imaging and were observed in 42% of the patients. These rare heterogeneous tumors should be considered after radiotherapy for cervical carcinoma, especially when hematometra is observed. Aggressive histological presentations and delayed symptoms due to cervical stenosis are responsible for an unfavorable prognosis.

Community resilience (CR)—ability to withstand and recover from a disaster—is a national policy expectation that challenges health departments to merge disaster preparedness and community health promotion and to build stronger partnerships with organizations outside government, yet guidance is limited. A baseline survey documented community resilience–building barriers and facilitators for health department and community-based organization (CBO) staff. Questions focused on CBO engagement, government–CBO partnerships, and community education. Most health department staff and CBO members devoted minimal time to community disaster preparedness though many serve populations that would benefit. Respondents observed limited CR activities to activate in a disaster. The findings highlighted opportunities for engaging communities in disaster preparedness and informed the development of a community action plan and toolkit.

Endometrial cancer is the most common gynecological malignancy in well-developed countries. Biologically and clinicopathologically, endometrial carcinomas are divided into two types: type 1 or estrogen-dependent carcinomas and type 2 or estrogen-independent carcinomas. Type 1 cancers correspond mainly to endometrioid carcinomas and account for approximately 90 % of endometrial cancers, whereas type 2 cancers correspond to the majority of the other histopathological subtypes. The vast majority of endometrial cancers present as abnormal vaginal bleedings in postmenopausal women. Therefore, 75 % of cancers are diagnosed at an early stage, which makes the overall prognosis favorable. The first diagnostic step to evaluate women with an abnormal vaginal bleeding is the measurement of the endometrial thickness with transvaginal ultrasound. If endometrial thickening or heterogeneity is confirmed, a biopsy should be performed to establish a definite histopathological diagnosis. Magnetic resonance imaging is not considered in the International Federation of Gynaecology and Obstetrics staging system. Nonetheless it plays a relevant role in the preoperative staging of endometrial carcinoma, helping to define the best therapeutic management. Moreover, it is important in the diagnosis of treatment complications, in the surveillance of therapy response, and in the assessment of recurrent disease. info:eu-repo/semantics/publishedVersion

INTRODUCTION Adolescent smoking studies find evidence of active peer influence and selection processes. However, studies have shown that these processes operate differently depending on context. This study uses SIENA to model coevolutionary processes between smoking and changes in friendship ties, comparing two high schools in which data were collected in identical fashion to explore influence and selection mechanisms with respect to current smoking, and smoking levels. METHODS This is a longitudinal survey with 2 waves of data. In-home surveys were conducted with students from 2 large high schools in the United States: a West Coast school, and a Midwestern school. Participants were consented students in 10th and 11th grades at the first wave of data collection. The primary measures were self-reported smoking behavior and friendship nominations. RESULTS There is evidence of influence and selection in both schools for adolescents' smoking status (1 = any smoking) and for level of smoking. CONCLUSIONS These models reflect great similarities in influence and selection processes across schools for different smoking behaviors. However, smoking prevalence may impact the exact mechanisms by which influence and selection operate. Researchers should consider smoking interventions with independent modules addressing different selection and influence processes, implemented based on contextual factors such as the prevalence of smoking.

An 81-year-old female patient noticed a left-side cervical lump with no associated symptoms 6 months before admission on our institute. Days before presenting to the Endocrinology Department, there was a sudden rapid growth of the neck mass, causing dysphagia for liquids and dysphonia, but no dyspnoea. The patient denied family history of thyroid pathology. Clinical examination revealed a massive mass extending from the mandible angle to the supraclavicular region, occupying the anterior and both lateral cervical compartments, especially on the left side. The mass was fixed and of hard consistency, with associated bilateral cervical lymphadenopathies difficult to distinguish from the mass. Laboratory work-up identified hypokalaemia and hypernatraemia. The definite diagnosis of anaplastic thyroid carcinoma (ATC) was obtained by fine needle aspiration cytology. Contrast-enhanced CT (figure 1) was performed for tumour staging and showed a heterogeneous and infiltrative mass, with origin on the left lobe of the thyroid gland, measuring …

We describe a case of a 73-year-old man with a chondrosarcoma of the hyoid bone. The patient presented with a painless palpable lump in the upper anterior cervical region that had been growing for over 10 months. Fine-needle aspiration cytology suggested pleomorphic adenoma but further imaging investigation with CT revealed an exophytic tumour originating from the body of the hyoid bone with prominent chondroid-like calcifications typical of a chondrosarcoma. Histopathology of the surgical specimen confirmed the diagnosis of a moderately differentiated chondrosarcoma. Chondrosarcomas account for 11% of all bone cancers, of which up to 12% are in the head and neck. Primary sites of the head and the neck include the skull base, the nasal cavity, the maxilla, the mandible and the larynx. Chondrosarcomas of the hyoid bone are exceptionally rare, with only 20 such cases previously reported in the English literature.

Ovarian carcinoma is the most common cause of death from a gynecologic malignancy with more than 2/3 of patients having peritoneal involvement at the time of diagnosis. Treatment is principally dependent on stage and extent of disease and center expertise. Patients with advanced disease are treated either by primary cytoreductive surgery (debulking) followed by adjuvant chemotherapy, or neoadjuvant chemotherapy prior to debulking surgery. Imaging at the time of initial presentation has become critical in the selection of patients who may benefit from neoadjuvant chemotherapy instead of primary debulking surgery. Moreover, with the development of neoadjuvant treatment and molecularly targeted drug, evaluation of treatment response has becoming both critical and challenging. Indeed, evaluating early tumor changes, for example, relies more on functional (assessment of tumor vascularity, necrosis, etc.) rather than macroscopic changes in tumor size. This highlights a need for novel non-invasive biomarkers to allow implementation of personalized treatment. Thus, in this review, we focus on the advances of imaging in the diagnosis and management of ovarian cancer including functional imaging and radiogenomics.

The inclusion of community partners in participatory leadership roles around statistical design issues like sampling and randomization has raised concerns about scientific integrity. This article presents a case study of a community-partnered, participatory research (CPPR) cluster-randomized, comparative effectiveness trial to examine implications for study validity and community relevance. Using study administrative data, we describe a CPPR-based design and implementation process for agency/program sampling, recruitment, and randomization for depression interventions. We calculated participation rates and used cross-tabulation to examine balance by intervention status on service sector, location, and program size and assessed differences in potential populations served. We achieved 51.5% agency and 89.6% program participation rates. Programs in different intervention arms were not significantly different on service sector, location, or program size. Participating programs were not significantly different from eligible, nonparticipating programs on community characteristics. We reject claims that including community members in research design decisions compromises scientific integrity. This case study suggests that a CPPR process can improve implementation of a community-grounded, rigorous randomized comparative effectiveness trial.

We describe a case of a 35-year-old woman with a pedunculated uterine leiomyoma with diffuse hydropic degeneration presenting as a giant abdominal mass. The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. Magnetic resonance imaging (MRI) was performed to further characterise and revealed a myometrial pedunculated tumour. Despite its marked T2-signal heterogeneity and volume, there were no other suspicious findings to suggest a malignant nature; therefore, fertility-sparing myomectomy was performed. Leiomyomas frequently undergo degenerative changes altering their imaging appearances. Leiomyomas with uncommon degenerative changes may be difficult to differentiate from malignant myometrial tumours, based solely on imaging. To the best of our knowledge, a diffuse hydropic degeneration imaging appearance has only been described twice in the literature. We describe the imaging appearance of this rare form of leiomyoma drawing attention to its differential diagnosis.

Mestrado em Engenharia do Ambiente - Instituto Superior de Agronomia Submitted by Margarida Galamba (galamba@isa.utl.pt) on 2015-03-20T10:40:49Z No. of bitstreams: 1 Avaliação de pesticidas em ecossistema orizícola - Parametrização e calibração do modelo RICEWQ.pdf: 3411302 bytes, checksum: 80ca6758b40e117900bade24d1c934bf (MD5) Made available in DSpace on 2015-03-20T10:40:49Z (GMT). No. of bitstreams: 1 Avaliação de pesticidas em ecossistema orizícola - Parametrização e calibração do modelo RICEWQ.pdf: 3411302 bytes, checksum: 80ca6758b40e117900bade24d1c934bf (MD5) Previous issue date: 2014