ABSTRACT
ABSTRACT Introduction. To identify the impact of portal vein thrombosis (PVT) and associated medical and surgical factors on outcomes post liver transplant (LT). Material and methods. Two analyses were performed. Analysis One: cohort study of 505 consecutive patients who underwent LT (Alberta) between 01/2002-12/2012. PVT was identified in 61 (14%) patients. Analysis Two: cohort study of 144 consecutive PVT patients from two sites (Alberta and London) during the same period. Cox multivariable survival analysis was used to identify independent associations with post-LT mortality. Results. In Analysis One (Alberta), PVT was not associated with post-LT mortality (log rank p = 0.99). On adjusted analysis, complete/occlusive PVT was associated with increased mortality (Hazard Ratio (HR) 8.4, p < 0.001). In Analysis Two (Alberta and London), complete/occlusive PVT was associated with increased mortality only on unadjusted analysis (HR 3.7, p = 0.02). On adjusted analysis, Hepatitis C (HR 2.1, p = 0.03) and post-LT portal vein re-occlusion (HR 3.2, p = 0.01) were independently associated with increased mortality. Conclusion: Well-selected LT patients who had PVT prior to LT had similar post-LT outcomes to non-PVT LT recipients. Subgroups of PVT patients who did worse post-LT (complete/occlusive thrombosis pre-LT, Hepatitis C or post-LT portal vein re-occlusion) warrant closer evaluation in listing and management post-LT.
Subject(s)
Portal Vein , Liver Transplantation , Venous Thrombosis/complications , End Stage Liver Disease/surgery , Liver Cirrhosis/surgery , Portal Vein/diagnostic imaging , Time Factors , Chi-Square Distribution , Proportional Hazards Models , Multivariate Analysis , Retrospective Studies , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Treatment Outcome , Hepatitis C/complications , Venous Thrombosis/surgery , Venous Thrombosis/mortality , Venous Thrombosis/diagnostic imaging , Kaplan-Meier Estimate , End Stage Liver Disease/diagnosis , End Stage Liver Disease/mortality , End Stage Liver Disease/virology , Liver Cirrhosis/diagnosis , Liver Cirrhosis/mortality , Liver Cirrhosis/virologyABSTRACT
INTRODUCTION: To identify the impact of portal vein thrombosis (PVT) and associated medical and surgical factors on outcomes post liver transplant (LT). MATERIAL AND METHODS: Two analyses were performed. Analysis One: cohort study of 505 consecutive patients who underwent LT (Alberta) between 01/2002-12/2012. PVT was identified in 61 (14%) patients. Analysis Two: cohort study of 144 consecutive PVT patients from two sites (Alberta and London) during the same period. Cox multivariable survival analysis was used to identify independent associations with post-LT mortality. RESULTS: In Analysis One (Alberta), PVT was not associated with post-LT mortality (log rank p = 0.99). On adjusted analysis, complete/occlusive PVT was associated with increased mortality (Hazard Ratio (HR) 8.4, p < 0.001). In Analysis Two (Alberta and London), complete/occlusive PVT was associated with increased mortality only on unadjusted analysis (HR 3.7, p = 0.02). On adjusted analysis, Hepatitis C (HR 2.1, p = 0.03) and post-LT portal vein re-occlusion (HR 3.2, p = 0.01) were independently associated with increased mortality. CONCLUSION: Well-selected LT patients who had PVT prior to LT had similar post-LT outcomes to non-PVT LT recipients. Subgroups of PVT patients who did worse post-LT (complete/occlusive thrombosis pre-LT, Hepatitis C or post-LT portal vein re-occlusion) warrant closer evaluation in listing and management post-LT.
Subject(s)
End Stage Liver Disease/surgery , Liver Cirrhosis/surgery , Liver Transplantation , Portal Vein , Venous Thrombosis/complications , Canada , Chi-Square Distribution , End Stage Liver Disease/diagnosis , End Stage Liver Disease/mortality , End Stage Liver Disease/virology , Female , Hepatitis C/complications , Humans , Kaplan-Meier Estimate , Liver Cirrhosis/diagnosis , Liver Cirrhosis/mortality , Liver Cirrhosis/virology , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Male , Middle Aged , Multivariate Analysis , Portal Vein/diagnostic imaging , Proportional Hazards Models , Retrospective Studies , Time Factors , Treatment Outcome , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/mortality , Venous Thrombosis/surgerySubject(s)
Adenocarcinoma, Follicular/diagnostic imaging , Adenocarcinoma, Follicular/surgery , Surgery, Computer-Assisted/standards , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/surgery , Thyroidectomy/standards , Ultrasonography, Interventional/standards , Adenocarcinoma, Follicular/chemistry , Adenocarcinoma, Follicular/secondary , Biomarkers, Tumor/analysis , Biopsy, Fine-Needle/methods , Contraindications , Diagnosis, Differential , High-Intensity Focused Ultrasound Ablation/methods , High-Intensity Focused Ultrasound Ablation/standards , Humans , Lymphatic Metastasis , Medical Records/standards , Neck Dissection/methods , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/epidemiology , Prognosis , Risk , Surgery, Computer-Assisted/methods , Thyroglobulin/analysis , Thyroid Diseases/diagnosis , Thyroid Neoplasms/chemistry , Thyroid Neoplasms/pathology , Thyroidectomy/methods , Ultrasonography, Interventional/methodsABSTRACT
Good practice guide for cervical ultrasound scan and echo-guided techniques in treating differentiated thyroid cancer of vesicular origin. American, European and French Recommendations for the treatment of differentiated vesicular thyroid cancer were recently published. Cervical ultrasound scanning is now considered a key examination in the follow-up of these cancers. This examination is noninvasive, easy to perform and to obtain, is not costly, but remains operator-dependent. To date, there are no recommendations published that assemble all the technical aspects, results, indications and the limits of this examination in the initial medical report and the follow-up of these cancers. In order to standardise the procedure and validate the quality of the examination, a workgroup made up of a panel of experts particularly involved in carrying out ultrasound scans was set up. The aim was to draw up a good practice guide for performing cervical ultrasound scans and echo-guided techniques in treating patients with differentiated thyroid cancer of vesicular origin. The main objectives are to: (a) standardise the procedure and reports, (b) define the criteria for establishing whether lesions identified during a cervical ultrasound scan are malignant or benign, (c) standardise the indications for carrying out cytological tests and an in situ assay of markers, (d) help doctors to select the patients who ought to receive a cervical ultrasound scan and or cytological tests, (e) discuss how frequently the examinations should be carried out depending on the risk of recurrence.
Subject(s)
Adenoma/diagnostic imaging , Carcinoma/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Ultrasonography/standards , Adenoma/mortality , Adenoma/surgery , Carcinoma/mortality , Carcinoma/surgery , Female , Humans , Iodine Radioisotopes , Male , Thyroid Neoplasms/mortality , Thyroid Neoplasms/surgery , Thyroidectomy , Ultrasonography/methodsABSTRACT
OBJECTIVE: To assess endometrial volume as a predictor of endometrial malignancy in women with postmenopausal bleeding. METHODS: Endometrial volume was measured by virtual organ computer-aided analysis in 170 women with postmenopausal bleeding, and histopathologic results of endometrial biopsies were obtained for all. A group of 100 women without postmenopausal bleeding was used for control. RESULTS: There were 90 cases of benign disease, 53 cases of atypia, and 27 cases of endometrial cancers in the study group. Whereas endometrial thickness was 9.61+/-5.12 mm (range, 5-20 mm) and endometrial volume was 3+/-1.1 mL (range, 1.8-5.4 mL) in women with atypia or cancer, they were 4.87+/-3.43 mm (range, 2-8 mm) and 1.52+/-0.82 (range, 0.6-2.2 mL), respectively, in women with benign disease. In the control group, endometrial volume was 1.15+/-0.14 mL (range, 0.6-1.3 mL). Volume was more sensitive than thickness for predicting malignancy, and a cutoff value of 1.35 mL was found to provide the best sensitivity. CONCLUSION: An endometrial volume of 1.35 mL or greater may predict malignancy in women with postmenopausal bleeding.
Subject(s)
Endometrial Neoplasms/diagnostic imaging , Endometritis/diagnostic imaging , Endometrium/diagnostic imaging , Image Processing, Computer-Assisted/methods , Metrorrhagia/diagnostic imaging , Ultrasonography, Doppler/methods , Aged , Aged, 80 and over , Body Weights and Measures/methods , Case-Control Studies , Endometrial Neoplasms/complications , Endometrial Neoplasms/pathology , Endometritis/pathology , Endometrium/pathology , Female , Humans , Metrorrhagia/etiology , Middle Aged , Postmenopause , ROC CurveABSTRACT
OBJECTIVE: To discuss about management of facial paralysis reccurence and to highlight the ENT's important role in the diagnosis of systemic diseases. MATERIAL AND METHODS: This article presents a case report about a controlateral facial palsy recurrence, two months later in a fifty-two year's old woman. This cranial nerves involvement was due to non-Hodgkin lymphoma with neuro-meningeal spreading. The first palsy had completely recovered with steroids. The early recurrence of the palsy and the lymph nodes areas exam lead to the diagnosis. The patient was treated by chemotherapy with good neuromeningeal diffusion. The facial score rapidly improved, according to facial electromyography results. DISCUSSION: Specific biological and radiological explorations are usually carried out in recurrent facial palsy. Complete clinical examination and cerebrospinal fluid study are useful in this case. Moreover it should be preferable to do these explorations before steroid therapy. A diffuse meningeal enhancement on the MRI can complete sometimes clinical and biological data. CONCLUSION: Cranial nerves involvement is sometimes one of the first symptoms of neuro-meningeal lymphoma. Facial palsy reccurence has to conduce ENT pratician to do more specific explorations, of which CSF analysis is required.
Subject(s)
Brain Neoplasms/complications , Brain Neoplasms/pathology , Facial Paralysis/etiology , Lymphoma/complications , Lymphoma/pathology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brain Neoplasms/drug therapy , Electromyography , Facial Paralysis/diagnosis , Female , Humans , Lymphoma/drug therapy , Magnetic Resonance Imaging , Middle Aged , RecurrenceABSTRACT
OBJECTIVE: To determine preoperative method that predicts nature of ovarian tumors. METHODS: Fifty patients with complex pelvic masses assessed preoperatively with two-dimensional ultrasound (2DUS), two-dimensional power Doppler (2DPD), three-dimensional ultrasound (3DUS), three-dimensional power Doppler (3DPD), color Doppler. RESULTS: All patients underwent exploration, 19 (38%) had benign tumors, 31 (62%) had ovarian cancer. 2DUS identified 29 cases suspicious for malignancy giving sensitivity, specificity, PPV and accuracy of 80%, 78%, 86%, and 80%. 2DUS with 2DPD identified 28 suspicious cases giving sensitivity, specificity, PPV and accuracy of 80%, 84%, 89%, and 82%. 3DUS identified 31 suspicious cases including 28 cancers giving sensitivity, specificity, PPV and accuracy of 90%, 84%, 90%, and 88%. 3DUS with 3DPD, identified 34 suspicious cases including all 31 cancers giving sensitivity, specificity, PPV and accuracy of 100%, 84%, 91%, and 94%. Color Doppler RI of 0.48 identified 28 cases of 31 cancers giving sensitivity of 90%. CONCLUSION: Evaluation by 3DUS with 3DPD improves diagnostic accuracy of ovarian tumors.
Subject(s)
Ovarian Neoplasms/diagnostic imaging , Ultrasonography, Doppler, Color/methods , Female , Humans , Imaging, Three-Dimensional/methods , Ovarian Neoplasms/pathology , Prospective Studies , Sensitivity and SpecificityABSTRACT
PURPOSE: To evaluate the role of ultrasound and Doppler velocimetry in the diagnosis of breast cancer. METHODS: Thirty breast cancer patients, diagnosed by clinical examination, mammography and fine needle aspiration, or trucut biopsy were assessed by breast ultrasound including Doppler velocimetry to evaluate blood flow in the axillary and lateral thoracic arteries. Postoperative histopathological examination proved malignancy in all cases. This cohort was compared to another group of 30 patients with proven benign breast disease and a cross-matched control group of 30 asymptomatic women with no breast disease. RESULTS: In the 30 cancer patients, the size of masses ranged from 1-4 cm (2.51 +/- 1.13), the mean axillary artery resistance index (RI) ranged from 0.8-0.88 (0.84 +/- 0.03), and the lateral thoracic artery RI ranged from 0.45-0.59 (0.55 +/- 0.106). However, power Doppler did not detect any increased perfusion. In the benign group, the lateral thoracic artery RI ranged from 0.78-0.86 (0.85 +/- 0.8) and the axillary artery RI ranged from 0.81-0.89 (0.81 +/- 0.05), while in the control group, the mean lateral thoracic artery RI ranged from 0.85 to 0.89 (0.87 +/- 0.082), and the axillary artery RI ranged from 0.84-0.9 (0.88 +/- 0.16). Statistical analysis revealed only a high statistical significance (p < 0.01) for the lateral thoracic artery indices between the malignant group as compared to the benign and normal groups. There was no statistical significant difference in the axillary artery RI between the three groups. CONCLUSION: It is suggested that a marked decrease in the lateral thoracic artery RI with a cut-off value less than 0.6 is highly suggestive of malignancy. Taking the pilot nature of the results, further studies with much larger numbers are needed to corroborate such findings.
Subject(s)
Breast Neoplasms/blood supply , Breast Neoplasms/diagnostic imaging , Breast/blood supply , Thoracic Arteries/diagnostic imaging , Adult , Axilla/diagnostic imaging , Blood Flow Velocity , Female , Humans , Lymph Nodes/diagnostic imaging , Middle Aged , Pulsatile Flow , Ultrasonography, DopplerABSTRACT
OBJECTIVE: To evaluate our clinical practice for Group B streptococcus (GBS) screening during pregnancy and antibiotic therapy during delivery. MATERIAL AND METHODS: We performed a retrospective evaluation of our SBS screening protocol, by vaginal swab, for a period of two years, including 1,674 asymptotic patients. Intra partum antibiotic prophylaxis was administrated for GBS-positive women. RESULTS: The rate of GBS carriage was 6.9%. Antibiotics were administrated for 79.3% patients with GBS-positive culture. Of these women only 39% had an interval greater than four hours between antibiotic injection and delivery. In the group of patients with positive GBS culture, no newborn was infected and only 5% were colonised. In the GBS-negative group with 1.3% of the newborns were GBS positive. CONCLUSION: We were surprised by our low rate of GBS carriage and the non optimal application of antibiotics during labor. We reviewed our results with all our team and a prospective evaluation has been initiated.
Subject(s)
Streptococcus agalactiae/isolation & purification , Adult , Anti-Bacterial Agents/administration & dosage , Delivery, Obstetric , Female , Humans , Infant, Newborn , Pregnancy , Retrospective Studies , Streptococcal Infections/prevention & control , Vagina/microbiologyABSTRACT
BACKGROUND: Trophoblastic diseases correspond to a very heterogeneous group of rare pathology in young women which fertility should be preserved. PATIENT AND METHODS: We conducted a retrospective study from 1997 to 2003, including all patients with molar pregnancy or trophoblatic tumor in our department of Obstetrics and Gynecology. RESULTS: Fifteen patients were identified with 9 molar pregnancies, 5 trophoblastic tumors and 1 placental tumor of implantation site. The outcome was favorable for 14, and one patient died from her metastatic disease. For 4 patients we asked our university colleague for the optimal approach. DISCUSSION: Management of molar pregnancies is well established. Persistent gestational disease is more rare and problematic with potential metastatic dissemination. Multidisciplinary care is often needed. CONCLUSION: Persistent gestational disease should be managed in a highly specialized centre, as developed in the Lyon University Hospital.
Subject(s)
Gestational Trophoblastic Disease , Adolescent , Adult , Female , Gestational Trophoblastic Disease/diagnosis , Gestational Trophoblastic Disease/epidemiology , Gestational Trophoblastic Disease/therapy , Humans , Middle Aged , Pregnancy , Retrospective StudiesABSTRACT
AIM: The aim of our study was to define the usefulness of fine needle aspiration cytology (FNAC) in the assessment of loco-regional recurrence of differentiated thyroid carcinoma (DTC). METHODS: Among 1182 consecutive patients treated and followed for DTC from 1992 to 2001, we retrospectively analysed 65 FNAC results of patients presenting a suspicion of loco-regional recurrence. Recurrences were proved at histology in 35 cases and by cervical radioiodine uptake on post-therapeutic WBS (whole body scan) in nine cases. RESULTS: Among the 44 recurrences, FNAC results were malignant, benign and unsatisfactory in 33, two and nine cases, respectively. For the diagnosis of malignancy, FNAC sensitivity was 94%, specificity 100%, positive predictive value 100% and negative predictive value 87%. In the 35 cases where divergent results between diagnostic WBS (37-111MBq (131)I) and Tg level were observed, FNAC assessed the final status in 22 cases (malignant and benign in 17 and five cases, respectively). Of the 12 non-functioning and non-secreting lesions, FNAC diagnosed malignancy in four of the five malignant cases and ruled out malignancy in all seven benign lesions. CONCLUSION: These results outline the interest of FNAC in the assessment of loco-regional recurrences of DTC, especially when classical follow-up tools such as WBS and/or Tg level are unable to detect the recurrences.
Subject(s)
Biopsy, Fine-Needle , Carcinoma/diagnosis , Carcinoma/secondary , Neoplasm Recurrence, Local/diagnosis , Thyroid Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Predictive Value of Tests , Retrospective Studies , Sensitivity and SpecificityABSTRACT
This study was designed to identify the distribution of type IV collagen, laminin, and fibronectin with an avidin-biotin method in sections of equine endometrial samples, fixed in Bouin's solution and embedded in paraffin wax. Thirty endometrial biopsies were collected at three different stages of the oestrous cycle. The basement membrane of luminal epithelium reacted positively with antibody against type IV collagen. Both type IV collagen and laminin were found in the basement membranes of endometrial glands, and fibronectin occurred diffusely in the interstitial tissue. Blood vessels expressed all of the extracellular matrix components studied. No differences in the distribution of extracellular matrix components were found at the different stages of sampling.
Subject(s)
Endometrium/metabolism , Estrous Cycle/metabolism , Extracellular Matrix/metabolism , Horses/physiology , Animals , Collagen Type IV/metabolism , Female , Fibronectins/metabolism , Immunohistochemistry , Laminin/metabolismSubject(s)
Breast Neoplasms/diagnosis , Carcinoma, Small Cell/diagnosis , Neuroendocrine Tumors/diagnosis , Aged , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/surgery , Female , Humans , Immunohistochemistry , Mitotic Index , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/surgeryABSTRACT
OBJECTIVE: To determine the safety and cost-effectiveness of replacing the intravenous (IV) tubing sets in hospitalized patients at 4- to 7-day intervals instead of every 72 hours. DESIGN: Prospective, randomized study of infusion-related contamination associated with changing IV tubing sets within 3 days versus within 4 to 7 days of placement. SETTING: A tertiary university cancer center. PATIENTS AND METHODS: Cancer patients requiring IV infusion therapy were randomized to have the IV tubing sets replaced within 3 days (280 patients) or within 4 to 7 days of placement (232 patients). Demographic, microbiological, and infusion-related data were collected for all participants. The main outcome measures were infusion- or catheter-related contamination or colonization of IV tubing, determined by quantitative cultures of the infusate, and infusion- or catheter-related bloodstream infection (BSI), determined by quantitative culture of the infusate in association with blood cultures in febrile patients. RESULTS: The two groups were comparable in terms of patient and catheter characteristics and the agents given through the IV tubing. Intent-to-treat analysis demonstrated a higher level of tubing colonization in the 4- to 7-day group versus the 3-day group (median, 145 vs 50 colony-forming units; P=.02). In addition, there were three episodes of possible infusion-related BSIs, all of which occurred in the 4- to 7-day group (P=.09). However, when the 84 patients who received total parenteral nutrition, blood transfusions, or interleukin-2 through the IV tubing were excluded, the two groups had a comparable rate of colonization (0.4% vs 0.5%), with no catheter- or infusion-related BSIs in either group. CONCLUSION: In patients at low risk for infection from infusion- or catheter-related infection who are not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying the replacement of IV tubing up to 7 days may be safe, as well as cost-effective
Subject(s)
Antineoplastic Agents/administration & dosage , Cross Infection/etiology , Infusions, Intravenous/adverse effects , Neoplasms/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Equipment Contamination , Female , Humans , Infusions, Intravenous/economics , Male , Middle Aged , Parenteral Nutrition, Total , Time FactorsABSTRACT
We report a very rare case of ovarian gastrinoma in the context of multiple endocrine neoplasia type I, including primary hyperparathyroidism and Zollinger-Ellison syndrome. Somatostatin receptor scintigraphy revealed the ovarian involvement at an early stage. Oophorectomy led to the final diagnosis and complete healing.
Subject(s)
Gastrinoma/diagnosis , Multiple Endocrine Neoplasia Type 1/diagnosis , Ovarian Neoplasms/diagnosis , Adult , Female , Gastrinoma/complications , Gastrinoma/surgery , Humans , Hyperparathyroidism/complications , Multiple Endocrine Neoplasia Type 1/complications , Ovarian Neoplasms/complications , Ovarian Neoplasms/surgery , Ovariectomy , Pregnancy , Radionuclide Imaging , Receptors, Somatostatin/analysis , Ultrasonography , Zollinger-Ellison Syndrome/complicationsABSTRACT
Female genital mutilation (FGM) is considered as the most dangerous custom still ritually practiced and 2 million girls undergo the ordeal each year. This practice is anchored and fixed firmly in numerous African people's culture and Western countries are confronted to it through African immigrants. In order to understand the justifications and the consequences of FGM we interviewed 14 genitally mutilated African women living in France. Unfortunately and despite the conscious knowledge of consequences and absurd side of such practice, yet it seems to be perpetuated over the descendants. Educational approach is the best solution to fight female genital mutilation fixed firmly in numerous African people's culture.
Subject(s)
Circumcision, Female/adverse effects , Culture , Adolescent , Africa/ethnology , Attitude to Health , Female , France , Humans , Patient Education as Topic , SexualityABSTRACT
We report two cases of moderate maternal poisoning during the third trimester. They underwent hyperbaric oxygen therapy at 2.5 atmospheres for 90 minutes and were delivered at term. In one case the newborn presented an antenatal ischemic cerebral lesion probably due to monoxide poisoning. Pathophysiology and treatment of such accidents are discussed.