Left ventricular concentric geometry as a risk factor in gestational hypertension

In the past, an adverse prognostic significance of an altered left ventricular geometry in essential hypertension has been demonstrated. There are no data on the prognostic significance of an altered cardiac structure during pregnancy. The present study was designed to evaluate the prognostic impact on the outcome of pregnancy of an altered geometry of the left ventricle in mild gestational hypertension. One hundred forty-eight consecutive, pregnant, mild gestational hypertensive women (systolic and diastolic blood pressure, 140 to 150 mm Hg and 90 to 99 mm Hg, respectively) were included in the study. Patients were monitored until term to detect subsequent fetal and/or maternal adverse outcomes (preeclampsia, preterm delivery, abruptio placentae, other maternal medical problems, fetal distress, neonatal low birth weight, admittance to neonatal intensive care unit). One hundred one gestational hypertensive patients (68.2%) had an uneventful pregnancy; 47 patients (31.8%) showed a subsequent development of maternal and/or fetal complications. Concentric geometry was prevalent among patients with the subsequent development of complicated gestational hypertension (37 out of 47 patients) compared with the uneventful gestational hypertensive patients (31 out of 101 patients; 78.7% versus 30.1%; P=0.0001). The multivariate analysis showed concentric geometry as an independent predictor of adverse outcomes (odds ratio, 3.65; 95% confidence interval, 1.30 to 10.27; P=0.014). In patients with gestational hypertension, blood pressure values alone appear to be insufficient to identify the effective risk of adverse events. Ventricular geometry gives additional prognostic information, possibly improving our clinical ability to follow and eventually treat these patients.     

Imaging features of common and uncommon bladder neoplasms

In this article, the authors discuss imaging features of common and less-common epithelial and nonepithelial bladder neoplasms. Epithelial tumors include entities, such as urothelial cell carcinoma, squamous cell carcinoma, and adenocarcinoma, along with less-common entities, such as small cell and carcinoid tumors. Nonepithelial or mesenchymal tumors are also less commonly encountered and include benign entities, such as leiomyoma and neurofibroma, and malignant entities, including leiomyosarcoma and lymphoma. Their imaging features with an emphasis on computed tomography and magnetic resonance imaging are described.     

Intravitreal bevacizumab for a subfoveal myopic choroidal neovascularization in the first trimester of pregnancy

Abstract Purpose: To report the clinical course of a highly myopic woman treated by a single intravitreal injection of bevacizumab during the first trimester of pregnancy. Methods: Observational case report. A 35-year-old woman affected by pathologic myopia complained of blurred vision in her left eye in the fourth week of pregnancy. A subfoveal myopic choroidal neovascularization (CNV) was diagnosed on the basis of slit-lamp fundus biomicroscopy and fluorescein angiography. After discussing the treatment-related risks, she was administered an intravitreal injection of bevacizumab in her seventh gestational week. During pregnancy, fetal ultrasound and ophthalmic examination were performed monthly. After delivery, the mother and infant were followed quarterly for 12 months. Results: The patient had an uneventful prenatal course and delivered a healthy full-term infant. Significant visual improvement with no documented adverse events related to treatment was obtained. Conclusions: In our experience, a single intravitreal bevacizumab injection administered during the first trimester of pregnancy did not provoke any complications, and was effective in myopic CNV treatment. Further studies are warranted to provide more detailed information about this treatment and the related risks in pregnant women.     

Spectral-domain OCT in anti-VEGF treatment of myopic choroidal neovascularization

Purpose

To evaluate changes in macular morphology due to myopic choroidal neovascularization (CNV), using spectral-domain optical coherence tomography (SD-OCT).

Methods

In all, 22 eyes with recent-onset untreated CNV underwent 1 intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), followed by a pro-re-nata regimen. SD-OCT was performed at baseline (before first administration of anti-VEGF treatment) and month 1, and 2; macular morphologic changes and outer retina characteristics (SD-OCT findings) associated with CNV activity were evaluated. Sensitivity and specificity were calculated for SD-OCT findings using fluorescein angiography (FA) as standard reference.

Results

Mean central retinal thickness (CRT) showed no significant reduction from baseline (284±98 μm) to month 1 (257±74 μm) and month 2 (263±72 μm). A hyper-reflective lesion with fuzzy borders (fuzzy area), and ‘absent or altered'' IS/OS junction were the only SD-OCT findings associated with CNV activity (P<0.0001). Both these SD-OCT findings showed good sensitivity and specificity (95.1 and 96.0% (95% CI: 0.87–0.89), respectively, for the fuzzy area; 87.9 and 66.7% (95% CI: 0.65–0.87), respectively, for ‘absent or altered'' IS/OS junction) when compared with FA leakage (standard reference).

Conclusions

Outer retina characteristics (ie, hyper-reflective lesion with fuzzy borders, and ‘absent or altered'' IS/OS junction) appear more meaningful than CRT in the evaluation of myopic CNV activity. These SD-OCT findings show overall good sensitivity and specificity when compared with FA leakage (standard reference), and could be considered as an alternative diagnostic tool to FA for myopic CNV monitoring.     

地理信息系统应用于血吸虫病的监测 Ⅰ.应用预测模型的可能性

目的：建立血吸虫病地理信息系统，利用气象参数建立模型来探讨预测血吸虫病的流行区的可能性。方法：以世界粮农组织出版的FAOCLIM数据库中的数据为基础，以血吸虫发育扩散关系密切的温度和潜在蒸发指数（地面水平衡系统）为基础的改良Malone公式计算血吸虫传播指数，结合AVHRR卫星图片资料，获得校正植被指数（NDVI）和第4频道地面温度指数、高程分布图，在ArcView3．0a和ERDAS软件支持下，进行GIS数据空间分析和地图重叠分析，以某一类别值显示出流行区的地理分布图。结果：血吸虫传播指数（指数值大于900）的分布基本上与中国南部地区的血吸虫病流行区相吻合。多层重叠分布图显示了红色区域的高危地区与长江流域的血吸虫病高发地区基本一致。结论：血吸虫病的流行范围与温度、高程、雨量等因素密切相关。利用气象资料模型和卫星遥感资料对预测血吸虫病的潜在流行区具有可能。准确、快速地利用AVHRR遥感资料来预测、预报血吸虫病流行范围和强度具有应用前景，值得作进一步探讨。     

Anti-HIV chemoprophylaxis for blood-exposure accidents

Chemoprophylaxis against HIV after accidental blood exposures represents a new indication for antiretroviral drugs. Efficacy has been suggested by the results of a case-control study in health care workers and the reduction of mother to infant transmission of HIV with zidovudine. The post-exposure treatment should be given as soon as possible, and in the latest at 48 hours. National guidelines recommend a triple therapy with or without protease inhibitor, adapted to the source patient. The evaluation of efficacy needs a standardized follow-up.     

Asymmetric spermatic cord vessel enhancement on CT: a sign of epididymitis or testicular neoplasm

Purpose

To determine whether asymmetric spermatic cord vessel enhancement (ASE) on contrast-enhanced computed tomography (CECT) indicates scrotal pathology.

Methods

Sixty-one male patients with scrotal symptoms who underwent both scrotal ultrasound (US) and CECT within 24 h were identified through a radiology information system. Twenty-eight emergency department patients who underwent CECT only for unrelated symptoms were included for comparison. Two blinded radiologists independently reviewed each CECT scan for qualitative ASE. These data were compared with US diagnoses, when present. A third blinded radiologist reviewed each CECT scan for quantitative ASE by measuring Hounsfield unit (HU) density ratios. McNemar, Kappa, Student’s t test, and ANOVA were used for analysis.

Results

Eighty-nine total patients included 28 with CECT only and 61 with CECT and US, of which 41 had abnormal US: 15 acute epididymitis and/or orchitis, 7 testicular neoplasms, 11 varicoceles, and 8 with other pathologies. Twenty patients with normal US and 28 patients with CECT only served as control groups. Identification of ASE agreed with US diagnosis of epididymitis (and/or orchitis) or testicular neoplasm (reader 1: κ = 0.79, reader 2: κ = 0.75) with average 95.5% sensitivity and 88.8% specificity, and no significant difference between readers (p = 0.58). For epididymitis (and/or orchitis) or testicular neoplasm patients, the average ratio of spermatic cord HU density (ipsilateral:contralateral) was significantly different from other patients (4.01 vs. 1.26, p = 0.0025).

Conclusion

ASE on CECT shows stronger correlation with epididymitis (and/or orchitis) and testicular neoplasm compared with other scrotal pathologies. If discovered on CECT, this should prompt further clinical and/or imaging workup.