Spontaneous prematurity in fetuses with congenital diaphragmatic hernia: a retrospective cohort study about prenatal predictive factors.

BACKGROUND: To evaluate possible predictive factors of spontaneous prematurity in fetuses with congenital diaphragmatic hernia (CDH). METHODS: A retrospective cohort study was performed. Inclusion criteria were presence of CDH; absence of fetoscopy; absence of karyotype abnormality; maximum of one major malformation associated with diaphragmatic hernia; ultrasound monitoring at the Obstetrics Clinic of Clinicas Hospital at the University of São Paulo School of Medicine, from January 2001 to October 2014. The data were obtained through the electronic records and ultrasound system of our fetal medicine service. The following variables were analyzed: maternal age, primiparity, associated maternal diseases, smoking, previous spontaneous preterm birth, fetal malformation associated with hernia, polyhydramnios, fetal growth restriction, presence of intrathoracic liver, invasive procedures performed, side of hernia and observed-to- expected lung to head ratio (o/e LHR). On individual analysis, variables were assessed using the Chi-square test and the Mann-Whitney test. A multiple logistic regression model was applied to select variables independently influencing the prediction of preterm delivery. A ROC curve was constructed with the significant variable, identifying the values with best sensitivity and specificity to be suggested for use in clinical practice. RESULTS: Eighty fetuses were evaluated, of which, 21 (26.25%) were premature. O/e LHR was the only factor associated with prematurity (p = 0.020). The ROC curve showed 93% sensitivity with 48.4% specificity for the cutoff of 40%. CONCLUSION: O/e LHR was the only predictor of prematurity in this sample.

Tratamento coadjuvante da arterite de Takayasu através de angioplastia transluminal percutânea com stents: relato de caso e revisão de literatura / Coadjuvant treatment of Takayasu Arteritis by percutaneous transluminal angioplasty with stents: case report and literature review

Os autores fazem uma breve revisão de literatura sobre o uso coad-juvante de stents na arterite de Takayasu e apresentam um relato de caso de uma mulher jovem, 27 anos de idade, com quadro de cefaléia holocraniana acompanhada de náuseas, síncopes e tonturas. Concomitantemente apresentou turvação visual e claudicação de membros superiores. Entre as várias possibilidades, aventou-se a hipótese diagnóstica de arterite de Takayasu, confirmada posteriormente, sendo então realizado tratamento coadjuvante através de angioplastia transluminal percutânea com stents.

The authors present a brief literature review about coadjuvant treatment with stents in Takayasu Arteritis and report a case of a 27 year old woman showing a holocranial cephalalgia, associated with nausea, fainting and dizziness. Simultaneously she suffered blurred sight and claudication of the upper limbs. Among the different diagnostic possibilities, the hypothesis of Takayasu Arteritis was first considered and later confirmed. Coadjuvant treatment by a percutaneous transluminal angioplasty with stents was performed.