Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus

OBJECTIVE: The purpose of this study was to describe the outcomes of a 10-year cohort of pregnancies in patients with systemic lupus erythematosus and to evaluate clinical and laboratory markers for adverse outcomes. STUDY DESIGN: We reviewed all pregnancies in patients with systemic lupus erythematosus who were seen at Stanford University from 1991 to 2001. Univariate analyses were performed to identify potential risk factors for adverse outcomes. RESULTS: Sixty-three pregnancies in 48 women were identified. Approximately 35% of the pregnancies occurred in women with previous renal disease and 10% in women with previous central nervous system disease. Flares occurred in 68% of the pregnancies, the majority of which were mild to moderate. Preeclampsia complicated 12 pregnancies. Factors that were associated with premature delivery included prednisone use at conception (relative risk, 1.8), the use of antihypertensive medications (relative risk, 1.8), and a severe flare during pregnancy (relative risk, 2.0). Thrombocytopenia was associated with an increased risk of preeclampsia (relative risk, 3.2). CONCLUSION: Flares, most of which were mild to moderate, occurred most of the pregnancies in our cohort of patients with systemic lupus erythematosus. Thrombocytopenia, hypertension, and prednisone use may be predictive factors for particular adverse outcomes.     

Tumor recurrence and survival in patients treated for thymomas and thymic squamous cell carcinomas: a retrospective analysis.

PURPOSE: Thymic epithelial tumors (TET) are rare epithelial neoplasms of the thymus with considerable histologic heterogeneity. This retrospective study focused on the correlation of WHO-defined TET histotypes with survival and tumor recurrence in a large cohort of patients receiving different modes of treatment. PATIENTS AND METHODS: Two hundred twenty-eight patients were followed for up to 21 years (median, 60 months; range, 1 to 252 months) after primary surgery. Forty-two patients received adjuvant radiotherapy (mean dose, 53 Gy), and 33 patients received adjuvant chemotherapy. RESULTS: Seventy-six (88%) of 86 patients with WHO type A, AB, and B1 thymomas were treated by surgery alone, with three tumor relapses after 3 to 10 years (median, 3.4 years). Twelve of 67 patients with WHO type B2 and B3 thymomas in Masaoka stages I and II were treated by adjuvant radiotherapy without evidence of tumor recurrence after 1 to 12 years (median, 4 years). Among 75 patients with B2 and B3 thymomas with incomplete resection or a tumor stage III or higher, the recurrence rate was 34% (n = 23) after 0.5 to 17 years (median, 5 years) in patients receiving adjuvant radiochemotherapy, compared to 78% (seven of nine patients) in patients without adjuvant radiochemotherapy. Incomplete tumor resection was associated with a high recurrence rate (65%) and a poor prognosis (P <.01). CONCLUSION: The long-term outcome of TET patients is related to tumor stage, WHO histotype, completeness of surgical removal, and type of treatment. Prospective trials are warranted to formally address the efficacy of adjuvant therapy in the treatment of localized and advanced malignant TETs.     

Hornhauttrübung nach Keratoplastik bei Keratokonus infolge Einnahme von Isotretinoin (Ciscutan®)

Zusammenfassung  Wir beschreiben den Krankheitsverlauf eines Patienten mit Keratokonus, der nach einer perforierenden Keratoplastik infolge der Einnahme von Isotretinoin (Ciscutan^?) Trübungen im Transplantat entwickelte. Isotretinoin ist ein synthetisch hergestelltes Vitamin A Derivat und wird zur Behandlung von schwerer Akne eingesetzt. Zahlreiche okul?re Nebenwirkungen wie auch Ver?nderungen der Hornhaut sind bekannt. Diese Trübungen wurden als reversibel und irreversibel beschrieben. Bei unserem Patienten waren sie nach Absetzen von Isotretionin bleibend, sodass eine Re-Keratoplastik notwendig wurde. Die Histologie und Ultrastruktur des getrübten L?ppchens zeigten blasige Ver?nderungen der basalen Schichten des Epithels sowie granul?re Einlagerungen mit vakuoligen Spalten. Isotretinoin sollte bei frischem Zustand nach Keratoplastik wegen der noch der aktiven Wundheilungsvorg?nge, in die auch das Vitamin A Derivat eingreift, nicht eingenommen werden.