RESUMEN
PURPOSE: Confocal laser endomicroscopy (CLE) is a fluorescence-based fiber-optic imaging technique with the potential for intraoperative grading of upper tract urothelial carcinoma (UTUC). This study aims to (1) investigate the prevalence of the previously proposed CLE criteria for bladder cancer in papillary UTUC, (2) estimate the diagnostic value of CLE for UTUC grading and (3) propose a scoring system for a more quantifiable approach of CLE-based grading of UTUC. MATERIALS AND METHODS: Ureteroscopic CLE was performed in patients with UTUC. Following CLE imaging, co-localized biopsies were taken for histopathologic comparison. Postoperatively, two blinded raters assessed the CLE images. RESULTS: Fifty-three papillary UTUCs (34 low grade and 19 high grade) were imaged with CLE in 36 patients. All the previously described CLE criteria were identifiable in varying proportions. After excluding 10 non-diagnostic recordings (5 low grade and 5 high grade) due to insufficient image quality, the histopathologic grade was correctly identified with CLE in 26 low-grade UTUCs (90%) and in 12 high-grade UTUCs (86%). The most prevalent CLE criteria with the highest diagnostic potential were cellular organization, morphology and cohesiveness of cells. A scoring system was proposed with these criteria, which yielded similar diagnostic accuracies. CONCLUSIONS: Based on the previously proposed criteria, CLE enables accurate grading of papillary UTUC at a non-diagnostic rate of 19%. The most prevalent CLE criteria with the highest diagnostic potential for grading of papillary UTUC are cellular organization, morphology and cohesiveness of cells. The proposed scoring system may simplify the assessment of CLE images for UTUC grading but external validation is required.
Asunto(s)
Carcinoma de Células Transicionales/patología , Neoplasias Renales/patología , Microscopía Confocal , Neoplasias Ureterales/patología , Anciano , Femenino , Humanos , Masculino , Clasificación del Tumor , Estudios ProspectivosRESUMEN
BACKGROUND: Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure, which appears in previously healthy women towards the end of pregnancy or within five months following delivery. Although the ECG is widely used in clinical practice, its prognostic value has not been established in PPCM. METHODS: We analysed 12-lead ECGs of patients with PPCM, taken at index presentation and follow-up visits at 6 and 12â¯months. Poor outcome was determined by the composite endpoint of death, readmission, NYHA functional class III/IV or left ventricular ejection fraction (LVEF) of ≤35% at follow-up. RESULTS: This cohort of 66 patients had a median age of 28.59 (IQR 25.43-32.19). The median LVEF at presentation (33%, IQR 25-40) improved significantly at follow-up (LVEF 49%, IQR 38-55, Pâ¯<â¯0.001 at 6â¯months; 52% IQR 38-57, Pâ¯=â¯0.001 at 12â¯months). Poor outcome occurred in 27.91% at 6â¯months and 41.18% at 1â¯year. Whereas sinus tachycardia at baseline was an independent predictor of poor outcome at 12â¯months (OR 6.56, 95% CI 1.17-20.41, Pâ¯=â¯0.030), sinus arrhythmia was associated with event free survival (log rank Pâ¯=â¯0.013). T wave inversion was associated with an LVEF ≤35% at presentation (Pâ¯=â¯0.038), but did not predict poor outcome. A prolonged QTc interval at presentation (found in almost half of the cohort) was an independent predictor of poor outcome at 6â¯months (OR 6.34, 95% CI 1.06-37.80, Pâ¯=â¯0.043). CONCLUSION(S): A prolonged QTc and sinus tachycardia at baseline were independent predictors of poor outcome in PPCM at 6â¯months and 1â¯year respectively.
Asunto(s)
Cardiomiopatías/fisiopatología , Electrocardiografía/métodos , Periodo Periparto/fisiología , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Adulto , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico por imagen , Complicaciones Cardiovasculares del Embarazo/epidemiología , Pronóstico , Método Simple Ciego , Sudáfrica/epidemiologíaRESUMEN
OBJECTIVE: To document maternal and foetal morbidity and mortality in anticoagulated, pregnant patients with mechanical heart valves until 42 days postpartum. METHODS: In a tertiary single-centre, prospective cohort, 178 consecutive patients at the cardiac-obstetric clinic were screened for warfarin use between 1 July 2010 and 31 December 2015. Of 33 pregnancies identified, 29 were included. Patients received intravenous unfractionated heparin from six to 12 weeks' gestation and peripartum, and warfarin from 12 to 36 weeks. Maternal outcomes including death, major haemorrhage and thrombosis, and foetal outcomes were documented. RESULTS: There were two maternal deaths, five returns to theatre post-delivery, eight patients transfused, six major haemorrhages, one case of infective endocarditis and three ischaemic strokes. Ten pregnancies had poor foetal outcomes (six miscarriages, three terminations, one early neonatal death). Twenty patients required more than 30 days' hospitalisation, and 15 required three or more admissions. HIV positivity was associated with surgical delivery (p = 0.0017). CONCLUSION: Complication rates were high despite centralised care.
Asunto(s)
Anticoagulantes/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas , Heparina/efectos adversos , Hemorragia Posparto/inducido químicamente , Complicaciones Cardiovasculares del Embarazo/inducido químicamente , Warfarina/efectos adversos , Aborto Espontáneo/inducido químicamente , Adulto , Anticoagulantes/administración & dosificación , Femenino , Mortalidad Fetal , Edad Gestacional , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Heparina/administración & dosificación , Humanos , Nacimiento Vivo , Mortalidad Materna , Hemorragia Posparto/diagnóstico , Hemorragia Posparto/mortalidad , Hemorragia Posparto/terapia , Periodo Posparto , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/mortalidad , Complicaciones Cardiovasculares del Embarazo/terapia , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/mortalidad , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Sudáfrica , Factores de Tiempo , Warfarina/administración & dosificación , Adulto JovenRESUMEN
The last confirmed case of poliomyelitis in Namibia had been reported in 1988. However, between Nov 8, 1993, and Jan 7, 1994, 27 cases of paralytic poliomyelitis were confirmed in the country. The outbreak was limited to the south health region; at least 80% of infants in this region have received four doses of oral poliovaccine (OPV) by the age of 1 year. Acute flaccid paralysis (AFP) was the predominant clinical presentation during the outbreak. The patients' ages ranged from 13 months to 12 years; 24 were younger than 5 years. Of the 26 patients whose vaccine status was known, 14 had received four doses of OPV, 6 had one or two doses, and 6 no vaccine. Genotypic analysis showed 86% homology of outbreak isolates with a 1982 Namibian isolate and west African isolates. Factors that may have had a role in the outbreak include establishment of a pool of susceptible people, rapid urbanisation, inadequate sanitation, poor water supply, and possible endemicity of poliovirus in neighbouring areas. Epidemics can occur in areas of high vaccine coverage. Our findings emphasise the need to improve AFP surveillance activities and the estimation of vaccine coverage to identify areas of potential susceptibility for outbreaks.