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PURPOSE OF THE REVIEW: To summarize currently available data on the topic of mitral valve prolapse (MVP) and its correlation to the occurrence of atrial and ventricular arrhythmias. To assess the prognostic value of several diagnostic methods such as transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance, cardiac computed tomography, electrocardiography, and electrophysiology concerning arrhythmic episodes. To explore intra and extracellular biochemistry of the cardiovascular system and its biomarkers as diagnostic tools to predict rhythm disturbances in the MVP population. RECENT FINDINGS: MVP is a common and mainly benign valvular disorder. It affects 2-3% of the general population. MVP is a heterogeneous and highly variable phenomenon with three structural phenotypes: myxomatous degeneration, fibroelastic deficiency, and forme fruste. Exercise intolerance, supraventricular tachycardia, and chest discomfort are the symptoms that are often paired with psychosomatic components. Though MVP is thought to be benign, the association between isolated MVP without mitral regurgitation (MR) or left ventricle dysfunction, with ventricular arrhythmia (VA) and sudden cardiac death (SCD) has been observed. The incidence of SCD in the MVP population is around 0.6% per year, which is 6 times higher than the occurrence of SCD in the general population. Often asymptomatic MVP population poses a challenge to screen for VA and prevent SCD. Therefore, it is crucial to carefully assess the risk of VA and SCD in patients with MVP with the use of various tools such as diagnostic imaging and biochemical and genetic screening.
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Biomarcadores , Muerte Súbita Cardíaca , Prolapso de la Válvula Mitral , Humanos , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/fisiopatología , Muerte Súbita Cardíaca/epidemiología , Biomarcadores/sangre , Arritmias Cardíacas/fisiopatología , Electrocardiografía , Pronóstico , Ecocardiografía , Factores de RiesgoRESUMEN
OBJECTIVE: To determine cost-effectiveness of preoperative lymphoscintigraphy (LSG) for detection of inguinofemoral sentinel lymph nodes (SLN). METHOD: We compared the use of preoperative LSG prior to SLN excision versus omission of preoperative LSG. The two outcomes were death or survival. Costs associated with the procedure were determined by CPT code and published estimates. Cost analysis was performed using Treeage software, and incremental cost-effectiveness ratios (ICERs) were calculated. The measure of effectiveness was incremental survival benefit. ICER thresholds for considering LSG to be cost-effective were based on the value of a statistical life (VSL). RESULTS: Using a baseline probability of 0.93 for finding SLN with LSG, our model estimated LSG costs were $2783.84 with 84.7% survival. Our model then estimated the cost and survival without LSG by varying the SLN detection rate. Survival was equivalent when probability of SLN detection without LSG was 0.93. If detection without LSG was >0.93, not performing LSG was the dominant strategy. Costs were equal when probability of finding SLN without LSG was 0.6. For any SLN detection without LSG below 0.6, performing LSG was the dominant strategy. Formal cost-effectiveness analysis was performed using ICERs for probabilities from 0.60 to 0.93. In this range, costs were higher with LSG, but survival was improved. As long as the incremental detection with LSG was at least 1.05% to 1.47% higher, LSG was cost-effective with ICERs below the VSL. CONCLUSION: In our model, LSG is cost-effective as long as it increases detection of SLN by at least 1.05-1.47%.
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Metástasis Linfática/diagnóstico , Linfocintigrafia/economía , Biopsia del Ganglio Linfático Centinela/métodos , Neoplasias de la Vulva/diagnóstico , Anciano , Análisis Costo-Beneficio , Árboles de Decisión , Femenino , Humanos , Persona de Mediana Edad , Neoplasias de la Vulva/mortalidadRESUMEN
We present a case of aggressive angiomyxoma of the vulva. The patient presented with a persistent, enlarging vulvar mass, initially misdiagnosed as a Bartholin gland cyst. The patient underwent wide local excision, which resulted in total resection of the mass. Final pathology was consistent with aggressive angiomyxoma, a rare soft tissue tumor with a predilection for the female pelvis. Though rare, it is important to consider in the differential diagnosis of a pelvic mass, given the locally aggressive nature of this tumor and propensity for recurrence.
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Basing on clinical experience of 212 surgically treated spinal tumours the authors present the principal problems in surgical treatment of neoplasmatic disease of the spine. The essential aim of surgical treatment is the tendency to the radical removal of the tumour and, in the same time, to achieve a good stabilization of the spine. The best method of stabilization of the spine is internal stabilization, transpedicular and interbody. The removed parts of the vertebral column should be replaced with bone grafts. The surgical treatment should be combined with oncological and rehabilitation.
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Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Linfoma/patología , Linfoma/cirugía , Plasmacitoma/patología , Plasmacitoma/cirugía , Sacro/patología , Sacro/cirugía , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/cirugía , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Invasividad Neoplásica , Implantación de Prótesis , Costillas/trasplanteRESUMEN
To examine the clinical significance of neutrophil gelatinase in rheumatic diseases, plasma and synovial fluid (SF) gelatinase levels were determined in 62 patients with rheumatoid arthritis (RA), 12 patients with ankylosing spondylitis (AS), 18 patients with osteoarthritis (OA) and 17 healthy controls. The gelatinase level was measured by enzyme-linked immunoassay (ELISA). The assay had a sensitivity of 1 ng/ml and a working range of 5-25 ng/ml. Gelatinase levels were significantly higher in the plasma of patients with RA and of patients with RA complicated by amyloidosis or vasculitis as compared to those of healthy controls. Moreover, the mean value of gelatinase in the plasma of patients with RA complicated by vasculitis was found to be significantly higher than that of RA patients without vasculitis. A significant increase in gelatinase concentration was also observed in the plasma of AS patients but not in the plasma of patients with OA. The concentration of gelatinase in the RA SF samples was much higher (18-fold) than the level of the enzyme in the plasma of RA patients. There was also a higher concentration of gelatinase (four-fold) in OA SF compared with OA plasma. The results suggested that circulating gelatinase may reflect some degree of neutrophil activation in patients with inflammatory arthritis, especially in those with RA complicated by vasculitis. However, the results did not allow a differentiation between chronic and acute inflammation.
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Colagenasas/metabolismo , Neutrófilos/enzimología , Enfermedades Reumáticas/enzimología , Líquido Sinovial/enzimología , Adulto , Anciano , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Metaloproteinasa 9 de la Matriz , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The authors have made a detailed study of 202 cases recognized as early RA. All of them were referred to the Institute for thorough examination and were afterwards followed up for two to six years. The observation of the course of the disease revealed four groups: 1. Cases where development of bone erosions proved the diagnosis of RA, 2. Cases in whom all previous symptoms and signs disappeared, 3. Cases in whom diagnosis could not be established after follow-up, 4. Cases in whom other diseases were manifest. The first two groups were analysed retrospectively to find the characteristic features in the early stages of RA.