RESUMEN
BACKGROUND: The population of women of childbearing age palliated with a Fontan repair is increasing. The aim of this study was to describe the progress of pregnancy and its outcome in a cohort of patients with a Fontan circulation in the UK. METHODS: A retrospective study of women with a Fontan circulation delivering between January 2005 and November 2016 in 10 specialist adult congenital heart disease centres in the UK. RESULTS: 50 women had 124 pregnancies, resulting in 68 (54.8%) miscarriages, 2 terminations of pregnancy, 1 intrauterine death (at 30 weeks), 53 (42.7%) live births and 4 neonatal deaths. Cardiac complications in pregnancies with a live birth included heart failure (n=7, 13.5%), arrhythmia (n=6, 11.3%) and pulmonary embolism (n=1, 1.9%). Very low baseline maternal oxygen saturations at first obstetric review were associated with miscarriage. All eight women with saturations of less than 85% miscarried, compared with 60 of 116 (51.7%) who had baseline saturations of ≥85% (p=0.008). Obstetric and neonatal complications were common: preterm delivery (n=39, 72.2%), small for gestational age (<10th percentile, n=30, 55.6%; <5th centile, n=19, 35.2%) and postpartum haemorrhage (n=23, 42.6%). There were no maternal deaths in the study period. CONCLUSION: Women with a Fontan circulation have a high rate of miscarriage and, even if pregnancy progresses to a viable gestational age, a high rate of obstetric and neonatal complications.
Asunto(s)
Procedimiento de Fontan , Cardiopatías Congénitas/cirugía , Hemodinámica , Complicaciones del Embarazo/etiología , Resultado del Embarazo , Aborto Inducido , Aborto Espontáneo/etiología , Adulto , Femenino , Muerte Fetal/etiología , Procedimiento de Fontan/efectos adversos , Cardiopatías Congénitas/sangre , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/fisiopatología , Humanos , Recién Nacido , Nacimiento Vivo , Oxígeno/sangre , Muerte Perinatal , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Reino Unido , Adulto JovenRESUMEN
A rare case of phyllodes tumour of the prostate of which less than 100 cases have been reported in the literature. It has an unclear clinical course and uncertain management options. In an inoperable case such as this, the authors discuss the difficulties faced with its management and the limited, possibly palliative role, of hormonal treatment using luteinising hormone-releasing hormone analogue in managing it over a medium term.
Asunto(s)
Tumor Filoide/diagnóstico , Neoplasias de la Próstata/diagnóstico , Anciano , Biomarcadores de Tumor/sangre , Biopsia con Aguja , Diagnóstico Diferencial , Progresión de la Enfermedad , Endosonografía , Humanos , Masculino , Cuidados Paliativos , Tumor Filoide/patología , Próstata/patología , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Carga Tumoral/fisiología , Ultrasonografía Intervencional , Retención Urinaria/etiologíaRESUMEN
Takayasu arteritis (TA) is a rare, sporadic and chronic inflammatory arteritis, which predominantly affects the aorta and its branches. Diagnosis can be difficult and there are limitations to the current diagnostic work-up. By detecting areas of active glucose metabolism present in active vasculitis, imaging with fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) could potentially have a role in the management of TA. Our aim was to assess this role by reviewing 28 (18)F-FDG PET scans performed on 18 patients suspected of having TA. All patients had full clinical and laboratory assessment, cross-sectional imaging and angiography, and 16/18 satisfied the American College of Rheumatologists' criteria for TA. (18)F-FDG PET achieved a sensitivity of 92%, a specificity of 100%, and negative and positive predictive values of 85% and 100% respectively in the initial assessment of active vasculitis in TA. We conclude that (18)F-FDG PET can be used to diagnose early disease, to detect active disease (even within chronic changes) and to monitor the effectiveness of treatment.