Search

Aims: To assess whether the combination of transthoracic echocardiography (TTE) and multidetector computed tomography (MDCT) data affects the grading of aortic stenosis (AS) severity under consideration of the energy loss index (ELI) in patients undergoing transcatheter aortic valve replacement (TAVR)., Methods and Results: Multimodality imaging was performed in 197 patients with symptomatic severe AS undergoing TAVR at the University Hospital Zurich, Switzerland. Fusion aortic valve area index (fusion AVAi) assessed by integrating MDCT derived planimetric left ventricular outflow tract area into the continuity equation was significantly larger as compared to conventional AVAi (0.41 ± 0.1 vs. 0.51 ± 0.1 cm2/m2; P < 0.01). A total of 62 patients (31.4%) were reclassified from severe to moderate AS with fusion AVAi being >0.6 cm2/m2. ELI was obtained for conventional AVAi and fusion AVAi based on sinotubular junction area determined by TTE (ELILTL 0.47 ± 0.1 cm2/m2; fusion ELILTL 0.60 ± 0.1 cm2/m2) and MDCT (ELIMDCT 0.48 ± 0.1 cm2/m2; fusion ELIMDCT 0.61 ± 0.05 cm2/m2). When ELI was calculated with fusion AVAi the effective orifice area was >0.6 cm2/m2 in 85 patients (43.1%). Survival rate 3 years after TAVR was higher in patients reclassified to moderate AS according to multimodality imaging derived ELI (78.8% vs. 67%; P = 0.01)., Conclusion: Multimodality imaging derived ELI reclassifies AS severity in 43% undergoing TAVR and predicts mid-term outcome., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Brief reference to surgical techniques applied to carcinomas of the cervix, corpus, and ovaries is followed by a comprehensive report in greater detail on carcinoma patients treated between 1969 and 1978. Mention is made first of carcinoma of the cervix, with particular reference being made to its preliminary phases, including basal hyperplasia, dysplasia, carcinoma in situ, and microcarcinoma. No patients in preliminary phases at all had been admitted to hospital in 1969, but almost 100 patients per annum were hospitalised more recently, in the wake of extended routine testing, including colposcopy, Papanicolaou's diagnosis, and checks by reflected light. The total number of patients admitted over the ten years under review has been 476, with carcinomas being detected in most of them by conisation. Wertheim's radical surgery with lymph node exstirpation was applied to 221 cases of invasive carcinoma of the cervix. Hysterectomy, with both adnexa involved, and lymph node exstirpation were applied to 154 cases of corpus carcinoma. The uterus only, but usually together with the adnexa, was removed in 19 cases. Surgery was applied to 109 cases of ovarian carcinoma, with adnexa being removed, in some cases with hysterectomy and omentumectomy. Also admitted were 17 patients with different types of carcinomas and eleven cases of uterus sarcoma. Surgical treatment was given to 984 of 1,130 genital carcinomas, bringing the overall operability rate to 87 per cent. Primary therapeutic irradiation was decided for most of the other patients. Ther overall mortality was 1.6 per cent (16 cases).

A 19-year-old nullipara developed uremia due to acute pyelonephritis in the 30th week of pregnancy, necessitating hemodialysis within one week of onset of clinical infective symptoms. Almost daily prophylactic hemodialyses (7 in all) were performed. BUN and serum creatinine levels were maintained below 75 mg/100 ml and 12 ml/100 ml respectively, and the patient's weight was kept constant until delivery in the 32nd week of pregnancy. A live healthy child of 1.7 kg was born with a length of 39 cm and a normal neurologic examination. After 10 hemodialyses, polyuria set in and the maternal BUN and serum creatinine levels were within normal ranges 3 weeks after delivery. The importance of close cooperation between gynecologist and internist is stressed.