RESUMO
OBJECTIVE: This prospective study of pregnant patients, Surveillance To Prevent AV Block Likely to Occur Quickly (STOP BLOQ), addresses the impact of anti-SSA/Ro titers and utility of ambulatory monitoring in the detection of fetal second-degree atrioventricular block (AVB). METHODS: Women with anti-SSA/Ro autoantibodies by commercial testing were stratified into high and low anti-52-kD and/or 60-kD SSA/Ro titers applying at-risk thresholds defined by previous evaluation of AVB pregnancies. The high-titer group performed fetal heart rate and rhythm monitoring (FHRM) thrice daily and weekly/biweekly echocardiography from 17-26 weeks. Abnormal FHRM prompted urgent echocardiography to identify AVB. RESULTS: Anti-52-kD and/or 60-kD SSA/Ro met thresholds for monitoring in 261 of 413 participants (63%); for those, AVB frequency was 3.8%. No cases occurred with low titers. The incidence of AVB increased with higher levels, reaching 7.7% for those in the top quartile for anti-60-kD SSA/Ro, which increased to 27.3% in those with a previous child who had AVB. Based on levels from 15 participants with paired samples from both an AVB and a non-AVB pregnancy, healthy pregnancies were not explained by decreased titers. FHRM was considered abnormal in 45 of 30,920 recordings, 10 confirmed AVB by urgent echocardiogram, 7 being second-degree AVB, all <12 hours from normal FHRM and within another 0.75 to 4 hours to echocardiogram. The one participant with second/third-degree and two participants with third-degree AVB were diagnosed by urgent echocardiogram >17 to 72 hours from an FHRM. Surveillance echocardiograms detected no AVB when the preceding interval FHRM recordings were normal. CONCLUSION: High-titer antibodies are associated with an increased incidence of AVB. Anti-SSA/Ro titers remain stable over time and do not explain the discordant recurrence rates, suggesting that other factors are required. Fetal heart rate and rhythm (FHRM) with results confirmed by a pediatric cardiologist reliably detects conduction abnormalities, which may reduce the need for serial echocardiograms.
Assuntos
Bloqueio Atrioventricular , Complicações na Gravidez , Criança , Gravidez , Humanos , Feminino , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/epidemiologia , Autoanticorpos , Estudos Prospectivos , Anticorpos Antinucleares , Ecocardiografia/métodosAssuntos
Moléculas de Adesão Celular Neuronais/genética , Deleção Cromossômica , Cromossomos Humanos Par 2/genética , Deficiências do Desenvolvimento/genética , Deleção de Genes , Hérnias Diafragmáticas Congênitas , Proteínas do Tecido Nervoso/genética , Anormalidades Múltiplas/genética , Estatura/genética , Proteínas de Ligação ao Cálcio , Criança , Hibridização Genômica Comparativa , Feminino , Hérnia Diafragmática/genética , Humanos , Moléculas de Adesão de Célula NervosaRESUMO
Se trató de paciente masculino de 57 años de edad sin antecedentes de patología sistemática de base ni antecedente quirúrgico, hospitalizado en nuestro centro con diagnóstico clínico y radiológico de Obstrucción Intestinal. Fué intervenido quirúrgicamente, evidenciándose tumoración adherida al ileón distal. Los hallazgos anatomopatológicos evidenciaron una lesión benigna formada por tejido conectivo, vasos y células inflamatorias (eosinófilos y algunos linfocitos). El diagnóstico final fue un POLIPO FIBROIDE INFLAMATORIO. Una enfermedad inusual en este sitio específico del tracto gastrointestinal
