Hepatic granulomas: a 10 year single centre experience

BACKGROUND: Epithelioid granulomas have been reported in 2-15% of unselected liver biopsies, with numerous underlying aetiologies described. However, all UK series were reported before identification of hepatitis C virus (HCV). AIM: To evaluate the current aetiologies of hepatic granulomas and to assess the prognosis for the "idiopathic" group, in which all investigations for a recognised cause were negative or normal. METHODS: A retrospective review of patient case notes between 1991 and 2001; all patients who had a liver biopsy at Glasgow Royal Infirmary revealing epithelioid granulomas had their case notes and liver biopsies reviewed and a standard proforma completed. RESULTS: Over the study period, 1662 liver biopsies were performed. Hepatic granulomas were found in 63. Of those identified, 47 were female, with a mean age of 42 years (range, 17-81). Underlying aetiologies were as follows: primary biliary cirrhosis (PBC; 23.8%), sarcoidosis (11.1%), idiopathic (11.1%), drug induced (9.5%), HCV (9.5%), PBC/autoimmune hepatitis (AIH) overlap (6.3%), Hodgkin lymphoma (6.3%), AIH (4.8%), tuberculosis (4.8%), resolving biliary obstruction (3.2%), and other single miscellaneous causes (9.5%). Of the seven patients with idiopathic hepatic granulomas, one was lost to follow up, one died of stroke, and the remaining five were well with no liver related morbidity at a mean follow up of 6.2 years. CONCLUSIONS: The aetiology of hepatic granulomas is broad ranging, with HCV an important cause in this population. Despite extensive investigations, a 10-15% of patients still had "idiopathic" hepatic granulomas. However, the prognosis for this last group appears to be excellent.     

Bronchiectasis in children: 10-year experience at a single institution

Purpose

Bronchiectasis in children is still one of the most common causes of childhood mortality in developing countries. The aim of this study was to investigate the epidemiological characteristics, clinical features, underlying etiologic factors, and distinct change in the management of patients with bronchiectasis at Asan Medical Center Children''s Hospital of Seoul.

Methods

A retrospective study of children diagnosed with bronchiectasis was conducted between January 1999 and December 2008. All patients underwent a comprehensive examination to identify etiologic factors. Data analysis in terms of age at onset, initial presenting symptoms, underlying etiology, distinct change in treatment, distribution of pulmonary involvement on computed tomography (CT), and causative microbiological flora triggering secondary infections was performed.

Results

The median age at the time of the diagnosis of bronchiectasis was 7.6 years (range, 2 months to 18 years). Persistent coughing was the most common symptom. The underlying etiologies identified in 79 patients (85.8%) included bronchiolitis obliterans (32.6%), childhood respiratory infection (20.6%), interstitial lung disease (17.3%), immunodeficiency (8.6%), and primary ciliary dyskinesia (4.3%). In 53 children (67%), the identified cause led to a distinct and individualized change in management. The distribution of CT abnormalities had no correlation with the underlying cause of bronchiectasis.

Conclusions

Selected Korean children with bronchiectasis were reviewed to identify diverse underlying etiologies. All children with bronchiectasis should be comprehensively investigated because identifying underlying causes may have a major impact on their management and prognosis.     

Long-terme outcome of peritoneal dialysis treatment--27 years of single centre experience

By the end of 2007 we had 160 patients on CAPD treatment in our centre (44% male, 56% female) aged between 29-78 years. Till 1994 13% of our patients were diabetics. In the last 10 years (1997-2007) the percentage of diabetics increased to 36%. During the 27 years period 44% of our patients died, 35% switched to haemodialysis and 3% have undergone renal transplantation. The survival rate after three years of treatment was 75%, after five years 63% and after 10 years 44%. Technique survival was 77%, 65% and 48% respectively. There were 309 episodes of peritonitis as the main complication of treatment (one episode on every 9, 4 months of treatment till 1994 and one episode on every 25, 8 months in the last ten years), out of which 58% was caused by Gram positive bacteria, 18% by Gram negative, 4% were fungal infections while the remaining 20% were culture negative. Regarding other complications we had 42 exit-site infections and 8 episodes of sclerosing peritonitis with 4 deaths. We found peritonitis to be the main reason of switching to haemodialysis (71%) and the main reason of death (39%) among the patients on CAPD. In the last 10 years (1997-2007) we analyzed the diabetics group separately and we found that the rate of CAPD dropout was not significantly different between diabetics and non-diabetics group. However, when analysing the causes of CAPD dropout, we found significant difference in mortality ate (50% among diabetics versus 26% among non-diabetics) and the rate of switching to haemodialysis (37% versus 55% respectively). In addition we established that the rate of CAPD survival was better after 1994 and we speculate that the main reason is the diminished peritonitis rate.     

Patient attitudes towards twin pregnancies and single embryo transfer - a questionnaire study

BACKGROUND: The present trend towards selective single embryo transfer (SET) calls for evaluation of patient attitudes towards twins and how the patients balance advantages and disadvantages of one or two embryos in IVF/ICSI treatment. METHODS: The study was conducted in a Danish public fertility clinic, where the common practice was double embryo transfer (DET), and the number of reimbursed treatments was limited to three. Referred patients were given oral and written information about the IVF/ICSI treatment including twin probability following DET and the risk of preterm delivery and neonatal complications associated with twins. In order to evaluate patients and partners attitudes towards twins and SET, an anonymous survey was conducted, and 588 couples were invited to participate. RESULTS: Four hundred and fourteen women (70.4%) and 404 men (68.7%) answered the questionnaire adequately for analysis. About 58.7% preferred having twins to having one child at a time (37.9%). Primary reasons for preferring twins were desire for siblings (23.3%), a positive attitude towards twins (22.5%), and a wish to minimize physical and psychological stress through having as few IVF treatments as possible (19.3%). Economic considerations were not important. CONCLUSIONS: Obligatory single embryo policy would be in conflict with patient interests and wishes. More carefully prepared information seems to be needed. The challenge consists in balancing clinical considerations with unbiased information on twin pregnancy, respecting patient autonomy and enabling informed decision-making.     

Clinical usefulness of fine needle aspiration cytology in patients less than 20 years old: a 10-year experience at a single institution

The purpose of this study was to identify the spectrum of cytological diagnoses and evaluate the diagnostic effectiveness of fine needle aspiration cytology (FNA) in patients less than 20 years old. The subjects were selected by retrospectively reviewing records from 1999 to 2009. Selected patients less than 20 years old underwent FNA. Cytological and histological slides of samples from the subjects were reviewed. Our study included a total of 909 subjects with a mean age of 14.6 years. The majority of the FNA samples were taken from lymph nodes (n = 448, 49.3%), with the remaining aspirates obtained from the thyroid gland (n = 247, 27.2%), soft tissues of head and neck masses (n = 106, 11.7%), salivary glands (n = 75, 8.3%), breasts (n = 18, 1.9%), skins (n = 9, 1.0%) and soft tissues of extremity (n = 6, 0.7%). The majority (87.6%, n = 796) of the FNA samples were categorized as ‘benign’, with the remaining designated as ‘atypical lesion’ (n = 18, 2.0%), ‘malignant’ (n = 24, 2.6%), or ‘inadequate specimen’ (n = 71, 7.8%). FNA accuracy was 92% for diagnosing cancer. Specificity and sensitivity were 99% and 63%, respectively. Our study first revealed that FNA has a high specificity for diagnosing cancer in various anatomical locations in young patients and can be confidently used as an effective tool for diagnosing malignancies in young individuals with a clinically suspicious lesion.     

Change in bacterial aetiology of peritoneal dialysis-related peritonitis over 10 years: experience from a centre in south-east Asia

This study reviewed 1787 episodes of peritoneal dialysis (PD)-related peritonitis in 544 patients between 1994 and 2003. The overall rate of peritonitis was 0.68 episodes/year of PD, but decreased from 1.10 to 0.46 episodes/year between 1994 and 2003. The incidence of peritonitis caused by coagulase-negative staphylococci declined between 1994 and 1998 from 0.21 to 0.06 episodes/year of PD, coinciding with a reduction in the use of spike PD sets. There was a 60.1% response rate to antibiotics throughout the period, but the percentage of cases that required modification of the initial empirical antibiotic regimen rose from 13.6% to 58.7%, indicating that treatment should be individualised.     

Evaluation of infections associated with implantable cardiac electronic devices: 10 years of experience in a single center

PurposeCardiac implantable electronic device (CIED) is used increasingly in recent years. In this study, it is aimed to evaluate the frequency of CIED-associated infections in the cardiology clinic of our hospital in the last 10 years, the causative microorganisms by determining their risk factors and clinical characteristics.Materials and methods225 patients who underwent CIED implantation in our hospital's cardiology clinic between March 2009 and December 2019 were retrospectively identified. The patients were grouped as with and without CIED-associated infection.ResultsIn a period of approximately 10 years, the rate of CIED infection was determined as 4.8%. 9 of the patients (81.8%) had CIED infection after the first implantation, and 2 of the patients (18.2%) after replacement. When the groups with and without CIED infection were compared; there was no significant difference in the group with CIED infection compared to the control group in terms of age, gender, type of the device inserted and the way of placing the device (implantation/replacement). Comparing risk factors between CIED infection and control group, there is no significant difference in terms of diabetes mellitus (DM), congestive heart failure, renal failure, hypertension, dyslipidemia, malignancy, immunosuppression. The use of anticoagulation was found statistically significant.ConclusionsCIED infections occur clinically with increased morbidity and mortality due to factors related to the patient and/or the type of device implanted. Knowing the patient's comorbid conditions well and taking precautions before CIED implantation can contribute to the reduction of the CIED infections.     

Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre

BACKGROUND: Our aim was to supplement the mostly individual case reports on the rarely occurring and life-threatening condition of ectopic pregnancy developing in a Caesarean section scar. METHODS AND RESULTS: Eight of all the patients treated in our department between 1995 and 2002 had been diagnosed for ectopic pregnancy that developed in a Caesarean section scar. They comprised this case series group. Four of them underwent methotrexate treatment; one had expectant management, one transcervical aspiration of the gestational sac and two by open surgery. All the non-surgically treated women had an uneventful outcome. One underwent a term Caesarean hysterectomy and the other first trimester hysterotomy and excision of the pregnancy located in the scarred uterus. Analysis of all these women's obstetric history revealed that five of them (63%) had been previously operated because of breech presentation, one had a cervical pregnancy and one had placenta previa. Four of them (50%) had multiple (> or = 2) Caesarean sections. CONCLUSIONS: The women at risk for pregnancy in a Caesarean section scar appear to be those with a history of placental pathology, ectopic pregnancy, multiple Caesarean sections and Caesarean breech delivery. Heightened awareness of this possibility and early diagnosis by means of transvaginal sonography can improve outcome and minimize the need for emergency extended surgery.     

First trimester fetal reduction: its role in the management of twin and higher order multiple pregnancies

Multiple pregnancy may be the result of stimulated or non-stimulated,and of assisted or natural conception. As observed in the pastdecade, assisted conception technologies have significantlyincreased the prevalence of multiple pregnancy. The increasehas been much more marked for triplets and higher order births.Rates of perinatal mortality and fetal and maternal complicationsare higher in twins than in singletons, and the adverse outcomerises with increasing number of multiples. Unplanned multiplepregnancy may be felt to be emotionally and physically so stressfulan experience as to drive patients to refusal of pregnancy itself,or to want to reduce the number of fetuses to an acceptablestandard. Fetal reduction techniques have emerged as a veryeffective medical approach to improve pregnancy outcome anda key option of patients trying to carry a pregnancy to term.Multiple fetuses are most frequently heterozygotes; thereforethe risk of each of them being affected by a Mendelian diseaseor sporadic chromosomal aberration is an independent probability.Thus, the incidence of genetic defects in at least one fetusis increased and directly related to the order of multiples,and this makes it worthwhile to offer karyotyping of the fetus(es)to be spared, before the reduction procedure takes place. Whena multiple pregnancy is established, one may conclude selectivereduction is the most effective therapeutic approach for reducingrisks.     

Frequencies of fetal chromosomal abnormalities at prenatal diagnosis: 10 years experiences in a single institution.

We present frequencies of fetal chromosomal abnormalities in 4,907 prenatal cytogenetic examinations at Samsung Cheil Hospital from 1988 to 1997 for 10 yr duration. Prenatal karyotypes were undertaken in 3,913 amniotic fluid samples, 800 chorionic villi samples, and 194 percutaneous umbilical blood samples. The frequency of fetal abnormal karyotypes was 3.1% (150 cases). Numerical chromosome abnormalities were 87 cases (1.8%) and structural aberrations of chromosomes were 63 cases (1.3%). In the numerical chromosomal abnormalities, the frequency of trisomy 21 was by far the highest (36 cases), followed by trisomy 18 in 22 cases and sex chromosome aneuploidies in 19 cases. In the structural chromosomal aberrations, 5 cases had the inversions in chromosome 2, 7, 17, and Y. Chromosomal deletions in 6 cases and additions in 4 cases were analysed. Of the remaining 47 translocation in abnormal fetuses, reciprocal translocation was in 26 cases and Robertsonian translocation in 21 cases. Among them, 41 cases were balanced translocation and 6 were unbalanced. Thirty five cases of translocation were inherited from one of the parents. Four had de novo chromosome rearrangements, and 8 cases were unknown.     

单中心9年不完全川崎病回顾性分析

目的探讨不完全川崎病（KD）的临床特征,以提高临床诊治水平。方法回顾性分析2002年1月至2010年12月KD住院患儿的临床资料,比较不完全KD与典型KD在发病年龄、性别、临床表现、实验室检查、治疗及冠状动脉损害等方面的差异。结果 1484例KD患儿进入分析,其中不完全KD262例（17.6%）,典型KD1222例;〈1岁患儿中不完全KD占24.9%。不完全KD和典型KD患儿的平均发热时间分别为（7.8±5.0）和（6.7±3.6）d,差异有统计学意义。不完全KD四肢改变、多形皮疹、眼结膜充血、口唇改变、颈部淋巴结肿大和肛周改变的发生率显著高于典型KD;卡疤改变、扁桃体肿大、阴囊或外阴改变、呕吐和腹泻的发生率与典型KD差异无统计学意义。两组CRP、ESR、Hb、WBC、PLT、ALT、AST、CK-MB和LDH等实验室指标差异无统计学意义。不完全KD与典型KD患儿对IVIG无反应的发生率差异无统计学意义（14.1%vs17.5%）;不完全KD患儿冠状动脉扩张、冠状动脉瘤和巨大冠状动脉瘤的发生率分别为57.5%、14.1%和1.9%,典型KD患儿分别为31.5%、5.9%和0.6%,两组差异有统计学意义。结论不完全KD较典型KD发热时间长,且冠状动脉损害发生率高,但实验室指标差别不大。     

Patient attitudes towards twin pregnancies and SET: a questionnaire study

Sir, We read with great interest the article by Hojgaard et al.,‘Patient attitudes towards twin pregnancies and singleembryo transfer—a questionnaire study’, in Hum Reprod2007;22:2673–2678. The authors showed that most patientstreated for infertility preferred to have twins (58%) ratherthan one child at a time (37.9%). The most frequent reasonsgiven were ‘a desire for siblings, a positive attitudetowards twins and a wish to have as few IVF treatments as possible’.They concluded that ‘an obligatory single embryo policywould     

One hundred twin pregnancies in a prenatal diagnosis program

One hundred pairs of twins were encountered in 8,500 pregnancies having genetic amniocentesis. Only 5 of 27 (18.5%) pairs were recognized before the institution of routine ultrasonic examination, while 69 of 73 (94%) twin pairs were found after ultrasound use. Amniotic fluid was obtained from both sacs in 71 of the 73 (97%) identified twin gestations in which both twins were living at the time of amniocentesis.     

Radiofrequency ablation of lung cancer at Okayama University Hospital: a review of 10 years of experience

The application of radiofrequency ablation for the treatment of lung cancer by our group at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences began in June 2001, and in the present report, we review our 10-year experience with this treatment modality at Okayama University Hospital. The local efficacy of radiofrequency ablation for the treatment of lung cancer depends on tumor size and the type of electrode used, but not on tumor type. An important factor for the prevention of local failure may be the acquisition of an adequate ablative margin. The combination of embolization and radiation therapy enhances the local efficacy. Local failure may be salvaged by repeating the radiofrequency ablation, particularly in small tumors. Survival rates after radiofrequency ablation are quite promising for patients with clinical stage I non-small cell lung cancer and pulmonary metastasis from colorectal cancer, hepatocellular carcinoma, and renal cell carcinoma. The complications caused by radiofrequency ablation can be treated conservatively in the majority of cases. However, attention should be paid to rare but serious complications. This review shows that radiofrequency ablation is a promising treatment for patients with lung cancer.     

Reply: Patient attitudes towards twin pregnancies and SET: a questionnaire study

Sir, We are grateful to Garel et al. (2008) for their interest inour article (Højgaard et al., 2007). It is true thatself-administered questionnaires may mask more complex opinions. In order to address this, we therefore conducted a qualitativestudy prior to the questionnaire