RESUMO
OBJECTIVE: To assess the value of the prenasal thickness to nasal bone length ratio (PT/NBL) for detecting trisomy 21 (T21) after the first trimester. METHOD: Two examiners blinded to fetal T21 status retrospectively measured prenasal thickness (PT) and nasal bone length (NBL) of T21 and control fetuses at 15-36 weeks' gestational age on two-dimensional images from all T21-screening ultrasounds from November 2010 to April 2013. ROC curve analysis and its diagnostic values determined the best cut-off value for the ratio. Interobserver reproducibility was assessed. RESULTS: Good quality ultrasound profile images were available for 26 fetuses with T21 compared to 91 normal fetuses. The median PT/NBL ratio was 1.28 for T21 and 0.73 for control fetuses (p<0.0001). The PT/NBL ratio performed significantly better (AUC 0.99; 95%CI 0.97-1) than either PT (0.82; 0.73-0.91) or NBL (0.91; 0.85-0.98). The optimal PT/NBL ratio cut-off was 0.98, with a sensitivity of 88.5% [76.2-100%] and a specificity of 100%. Interobserver variability was low. CONCLUSION: The PT/NBL ratio is a strong marker for detecting T21 in the second and third trimesters, significantly more effective than either indicator alone.
Assuntos
Desenvolvimento Ósseo , Síndrome de Down/diagnóstico por imagem , Osso Nasal/diagnóstico por imagem , Cartilagens Nasais/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Algoritmos , Biomarcadores , Síndrome de Down/embriologia , Síndrome de Down/epidemiologia , Feminino , França/epidemiologia , Humanos , Osso Nasal/embriologia , Cartilagens Nasais/embriologia , Variações Dependentes do Observador , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Método Simples-Cego , Adulto JovemRESUMO
PURPOSE: To report 4 cases of Pseudomonas aeruginosa endophthalmitis caused by internal contamination of the internal pathways of a phacoemulsifier. SETTING: Ophthalmology Center, Perpignan, France. METHODS: Four clinical cases of postoperative endophthalmitis occurred after phacoemulsification. An investigation was necessary to prove the cause of the bacteriological contamination. RESULTS: Serotyping and ribotyping of the Pseudomonas aeruginosa strains obtained from the vitreous samples and from the phacoemulsifier showed that all these strains were identical and that the initial site of the contamination was the phacoemulsifier. CONCLUSIONS: The profession should be cognizant of this cause of endophthalmitis, although its occurrence is rare. Cataract surgeons should test samples from the collection bags of their phacoemulsifiers to ensure there is no bacteriological contamination.
