Urine albumin concentration and albumin-to-creatinine ratio at 11(+0) to 13(+6) weeks in the prediction of pre-eclampsia.

OBJECTIVE: To determine the performance of screening for pre-eclampsia by maternal characteristics, urine albumin concentration and albumin-to-creatinine ratio (ACR) at 11(+0) to 13(+6) weeks. DESIGN: Prospective cross-sectional observational study. SETTING: Routine antenatal visit. POPULATION: A total of 2679 pregnant women at 11(+0) to 13(+6) weeks of gestation. METHODS: Maternal variables, urine albumin concentrations and ACR of 51 women who developed pre-eclampsia were compared with 2364 women who were unaffected by hypertensive disorders. Regression analysis was used first to determine which of the factors among the maternal characteristics were significant predictors of urine albumin concentration and ACR in the unaffected group and second to determine the contribution of urine albumin concentration and ACR in the prediction of pre-eclampsia. MAIN OUTCOME MEASURES: Development of pre-eclampsia. RESULTS: In the unaffected group, log urine albumin concentration and log ACR were influenced by ethnic origin, age, body mass index (BMI), parity and smoking. In the prediction of pre-eclampsia, significant contributions were provided by log urine albumin concentration, log ACR, ethnic origin, BMI, age, family and history of pre-eclampsia. The median urine albumin concentration and the median ACR in the pre-eclampsia group were significantly higher than those in the unaffected group. However, in screening for pre-eclampsia, the area under the receiver operating characteristic curve was not significantly improved by the combined models than with maternal variables alone. The value of urine albumin concentration was not improved by correcting for the creatinine concentration. CONCLUSION: In the prediction of pre-eclampsia, urine albumin concentration at 11(+0) to 13(+6) weeks does not provide additional value to maternal variables.

Uterine artery Doppler at 11 + 0 to 13 + 6 weeks in the prediction of pre-eclampsia.

OBJECTIVE: To determine the performance of screening for pre-eclampsia (PET) by maternal characteristics and uterine artery pulsatility index (PI) at 11 + 0 to 13 + 6 weeks' gestation. METHODS: In women with singleton pregnancies attending for routine care at 11 + 0 to 13 + 6 weeks' gestation we recorded maternal variables and measured the uterine artery PI. We identified 107 cases that subsequently developed PET and 5041 that were unaffected by PET, gestational hypertension or delivery of newborns with birth weight below the 10(th) centile. A multivariate Gaussian model was fitted to the distribution of log multiples of the median (MoM) PI in the PET and unaffected groups. Likelihood ratios for log MoM PI were computed and used together with maternal variables to produce patient-specific risks for each case. Predicted detection rates (DR) and false-positive rates (FPR) were calculated by taking the proportions with risks above a given risk threshold. RESULTS: In the unaffected group log MoM PI was influenced by maternal ethnic origin, body mass index, previous history of PET and fetal crown-rump length. In the prediction of PET significant contributions were provided by log MoM PI, ethnic origin, body mass index and previous and family history of PET. For an FPR of 10% the DRs of all PET and PET leading to delivery before 34 weeks' gestation by log MoM PI and maternal variables were 61.7% and 81.8%, respectively. CONCLUSION: Maternal variables together with uterine artery PI at 11 + 0 to 13 + 6 weeks' gestation provide sensitive prediction of the development of PET, especially of severe early-onset PET.

Adenocarcinoma de cérvix diagnosticado por histeroscopia / Hysteroscopically-diagnosed cervical adenocarcinoma

Paciente menopáusica de 48 años que ingresa por sospecha de enfermedad inflamatoria pélvica. En la ecografía se observó endometrio engrosado. La citología fue negativa y la biopsia endometrial estableció el diagnóstico de endometritis sin signos de malignidad, con cultivo positivo para Streptococcus pneumoniae. Al mes se realizó una nueva citología que presentó células glandulares de probable origen endometrial, pero sin atipias, y una biopsia endometrial compatible con hiperplasia endometrial compleja. En la histeroscopia se observó una mucosa irregular con vascularización aumentada en el orificio cervical interno. La biopsia fue informada como adenocarcinoma de tipo endocervical, por lo que se realizó intervención de Schauta-Amreich y linfadenectomía pélvica. En la histeroscopia deben biopsiarse o extirparse todas las alteraciones que encontremos

We present the case of a 48-year-old woman who was admitted to hospital with suspected pelvic inflammatory disease. Ultrasound showed a thick endometrium. The results of Pap smear were negative and endometrial biopsy established a diagnosis of endometritis without malignant signs and positive Streptococcus pneumoniae culture. One month later, a further Pap smear revealed glandular cells of probable endometrial origin, but without any atypia, while endometrial biopsy showed findings compatible with complex endometrial hyperplasia. Hysteroscopy revealed an irregular surface with increased vascularization in the internal cervical orifice. Biopsy showed endocervical adenocarcinoma, and a Schauta-Amreich intervention with pelvic lymphadenectomy was performed. All alterations found on hysteroscopy should undergo biopsy or be removed

[The use of Josamycin in dental pathology]. / Impiego della josamicina in patologia odontostomatologica.

Authors evaluated the clinical results of the use of Josamycin in odontostomatology. The clinical trial has been carried out on 42 patients with acute bacterial infections. Josamycin appeared a very safe and effective antibiotic.

Clinical multicentre trial with josamycin propionate in paediatric patients.

Josamycin propionate, a tasteless josamycin derivative suitable for the preparation of paediatric oral suspension, was employed in a large, multicentre clinical study aimed at evaluating the effectiveness and safety of the drug. Two hundred paediatric practitioners participated in the study, and 1908 children (mean age 5.27 years) were treated. Respiratory and pararespiratory infections were the most common diagnosis. The mean daily dose of josamycin was 53.5 mg/kg and the drug was administered for an average of 7.31 days. Josamycin proved to be a highly effective antimicrobial agent for the treatment of infections occurring in paediatric practice, with a success rate of 97.1%. The drug also showed a high degree of acceptance by the young patients and was very well tolerated: only 98 children (5.14%) developed side-effects during the treatment. However, the side-effects observed were reliably attributable to josamycin in only 10 out of 300 subjects who were not receiving other drugs; among these the frequency rate was 3.33%.