Role of ultrasound in detection of lymph-node metastasis in gynecological cancer: systematic review and meta-analysis.

OBJECTIVE: To assess the diagnostic performance of transvaginal sonography (TVS) for the preoperative evaluation of lymph-node metastasis in gynecological cancer. METHODS: This was a systematic review and meta-analysis of studies published between January 1990 and May 2023 evaluating the role of ultrasound in detecting pelvic lymph-node metastasis (index test) in gynecological cancer, using histopathological analysis as the reference standard. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity and diagnostic odds ratio were estimated. RESULTS: The literature search identified 2638 citations. Eight studies reporting on a total of 967 women were included. The mean prevalence of pelvic lymph-node metastasis was 24.2% (range, 14.0-65.6%). The risk of bias was low for most domains assessed. Pooled sensitivity, specificity and diagnostic odds ratio of TVS were 41% (95% CI, 26-58%), 98% (95% CI, 93-99%) and 32 (95% CI, 14-72), respectively. High heterogeneity was found between studies for both sensitivity and specificity. CONCLUSION: TVS showed a high pooled specificity for the detection of pelvic lymph-node metastasis in gynecological cancer, but pooled sensitivity was low. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Atrial fibrillation after vardenafil therapy.

Vardenafil is a new oral phosphodiesterase inhibitor used for erectile dysfunction. We report a case admitted with a first-detected, symptomatic paroxysmal atrial fibrillation in a healthy patient after self-medication with vardenafil.

Efficacy and safety of sotalol versus quinidine for the maintenance of sinus rhythm after conversion of atrial fibrillation. SOCESP Investigators. The Cardiology Society of São Paulo.

To compare the efficacy and safety of sotalol and quinidine after conversion of atrial fibrillation (AF) of <6 months, a prospective multicenter trial enrolled 121 patients who were randomized to receive dl-sotalol (160 to 320 mg/day, 58 patients) or quinidine sulfate (600 to 800 mg/day, 63 patients). Patients with left ventricular ejection fraction of <0.40 or left atrial diameter >5.2 cm were excluded. After 6 months of follow-up, using the Kaplan-Meier method, the probabilities of success were comparable between sotalol (74%) and quinidine (68%), but recurrences occurred later with sotalol than with quinidine (69 vs 10 days, p <0.05). Four patients developed proarrhythmic events, 3 (5%) with sotalol and 1 (2%) with quinidine, which were all associated with diuretic therapy. In patients converted from recent-onset AF (< or = 72 hours), sotalol was more effective than quinidine (93% vs 64%, p = 0.01), whereas in chronic AF (> 72 hours), quinidine was more effective than sotalol (68% vs 33%, p <0.05). During recurrences, the ventricular rate was significantly reduced in patients taking sotalol (98 to 82 beats/min, p <0.05). Independent predictors of therapeutic success were recent-onset AF in the sotalol group (p <0.001) and absence of hypertension in the quinidine group (p <0.05). In conclusion, sotalol and quinidine have comparable efficacy and safety for the maintenance of sinus rhythm in the overall group. In recent-onset AF, sotalol was more effective, whereas in chronic AF, quinidine had a better result. Recurrences occurred later with sotalol when compared with quinidine. Because of proarrhythmia, these drugs should be used judiciously in patients on diuretic therapy.

[Analysis of atrial fibrillation recurrence during therapy with sotalol or quinidine. Researchers of +SOCESP]. / Análise da recorrência de fibrilação atrial durante terapia com sotalol ou quinidina. Investigadores da SOCESP.

PURPOSE: To analyze the recurrences of atrial fibrillation in patients treated with sotalol or quinidine. METHODS: After conversion to sinus rhythm, 121 patients with paroxysmal atrial fibrillation were randomized to sotalol (58 patients) or quinidine (63 patients) and followed-up during 6 months. Symptoms and ventricular rates on the 12 lead electrocardiogram of the arrhythmic events were compared between the two groups. Clinical and echocardiographic characteristics were analyzed as predictors of atrial fibrillation recurrence. RESULTS: Seventeen (14%) patients relapsed into atrial fibrillation; 7 (12%) were treated with sotalol and 10 (16%) with quinidine. Recurrence occurred later in the sotalol group (median 69 days) in comparison with the quinidine group (median 10 days) (p = 0.04). Symptoms were present in 14 (82%) patients during the initial crisis and in 10 (47%) during recurrence. Recurrence was less symptomatic during antiarrhythmic therapy (p < 0.04), with no statistical differences between the two groups. Only patients treated with sotalol had ventricular rates during the recurrences lower than during initial crisis (p < 0.02). All variables failed to predict recurrence of atrial fibrillation. CONCLUSIONS: It was not possible demonstrate differences between sotalol and quinidine for the prevention of atrial fibrillation. Recurrence was less symptomatic during antiarrhythmic therapy. Patients treated with sotalol relapsed to atrial fibrillation later and had ventricular rates during recurrences significantly lower than during the initial crisis.

Os grandes ensaios terapêuticos em arritmias ventriculares e sua repercussäo na terapêutica farmacológica antiarrítmica / Great trials with antiarrhytmic drugs on treatment of ventricular arrythmias and their impact on modern pharmacology therapy

As arritmias ventriculares têm sido objeto de numerosos estudos multicêntricos nos últimos vinte anos. Os resultados desses estudos modificaram näo só as opçöes terapêuticas atuais, como também motivaram a elaboraçäo de novos ensaios terapêuticos. A populaçäo de coronarianos após o infarto do miocárdio tem sido a mais amplamente estudada. As drogas da classe II foram as únicas que realmente preveniram a mortalidade total em infartados sem taquiarritmias ventriculares sustentadas prévias. Já as drogas da classe I, apesar de serem potentes supressoras de ectopias ventriculares, näo demonstraram reduçäo da mortalidade. No CAST, em um acompanhamento médio de 10 meses, a mortalidade foo maior no grupo tratado (7,7 por cento) que o placebo (3 por cento). Metanálises realizadas com drogas dessa classe mostraram mortalidade maior no grupo tratado (5,6 por cento) que no placebo (4,9 por cento). Quando comparada com o placebi, a amiodarona promoveu uma reduçäo de 33 'por cento' no risco de morte por arritmia no CAMIAT, que acompanhou por 2 anos pacientes infartados com arritmia ventricular complexa. Entretanto a reduçäo da mortalidade total de 18 'por cento' näo foi considerada estatisticamente significante. No EMIAT, comparada com o placebo, a amiodarona tampouco reduziu a mortalidade total em infartados portadores de disfunçäo ventriuclar esquerda. Durante 2 anos de acompanhamento em portadores de miocardiopatia, o GESICA revelou menor mortalidade total em uma populaçäo com apenas 39 'por cento' de coronarianos, 1,2 grupo tratado com a amiodarona. A reduçäo de risco foi de 28 'por cento', quando comparada com o grupo controle. O STAT-CHF näo demostrou reduçäo da mortalidade total em miocardiopatas (71 por cento de coronarianos) comparando o placebo (42 por cento) com a amiodarona (39 por cento) durante um acompanhamento de 2 anos. No grupo de pacientes que sobreviveram à fibrilaçäo ventricular, o CASCADE demonstrou menor mortalidade no grupo tratado impiricamente com a amiodarona quando comparado a drogas da classe I guiadas pelo Holter ou pelo estudo eletrofisiológico. Comparando o D,L sotalol com drogas classe I, o ESVEM demonstrou menor incidência de recorrência da taquicardia ventricular sustentada e menor mortalidade quando comparado com seis drogas da classe I em três anos de acompanhamento. O sucesso da amiodarona e do sotalol no controle das taquicardias sustentadas foi atribuído à combinaçäo da açÝo classe III com a ß - bloqueadora presente nas duas

Ablaçäo por radiofreqüência - flutter atrial / Ablation of atrial flutter - case report

Os autores relatam o caso de uma paciente de 63 anos, portadora de flutter atrial crônico refratário ao tratamento clínico com amiodarona e sotalol. A mesma foi submentida à ablaçäo por radiofreqüência com sucesso. Preditores eletrofisiológicos de sucesso clínicos säo descritos, bem como a importância de um mapeamento detalhado da regiäo inferior do átrio direito (por meio de um catéter duodecapolar), possibilitando a definiçäo exata da linha e dos tipos de bloqueios.