Cystic appearance of low-grade endometrial stromal sarcoma in the right atrium: case report

A 71-year-old woman presented with a right adnexal solid mass invading the right gonadal vein and inferior vena cava up to the hepatic veins revealed by CT and confirmed by MRI. A thin-walled cyst and a solid mass were unexpectedly found in the right atrium by transesophageal echocardiography (TEE) in the operating room. Using color Doppler and air bubbles as contrast material a circumscribed cyst was confirmed and localized close to the IVC. The cyst was connected to the mass in the inferior vena cava. The tumor, including the cyst, was removed without using cardiopulmonary bypass and described as a low-grade endometrial stromal sarcoma, a rare slowly growing tumor. This is the first TEE description of endometrial stromal sarcoma manifesting as a right atrial cyst

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

A review of observed and projected changes in climate for the islands in the Caribbean

Observed and projected changes in climate have serious socio-economic implications for the Caribbean islands. This article attempts to present basic climate change information-based on previous studies, available observations and climate model simulations-at spatial scales relevant for islands in the Caribbean. We use the General Circulation Model (GCM) data included in the Coupled Model Intercomparison Project phase 3 (CMIP3) and the UK Hadley Centre regional climate model (RCM) data to provide both present-day and scenario-based future information on precipitation and temperature for individual island states. Gridded station observations and satellite data are used to study 20th century climate and to assess the performance of climate models. With main focus on precipitation, we also discuss factors such as sea surface temperature, sea level pressure and winds that affect seasonal variations in precipitation. The CMIP3 ensemble mean and the RCM successfully capture the large-scale atmospheric circulation features in the region, but show difficulty in capturing the characteristic bimodal seasonal cycle of precipitation. Future drying during the wet season in this region under climate change scenarios has been noted in previous studies, but the magnitude of change is highly uncertain in both GCM and RCM simulations. The projected decrease is more prominent in the early wet season erasing the mid-summer drought feature in the western Caribbean. The RCM simulations show improvements over the GCM mainly due to better representation of landmass, but its performance is critically dependent on the driving GCM. This study highlights the need for high-resolution observations and ensemble of climate model simulations to fully understand climate change and its impacts on small islands in the Caribbean

BAYLEY-III score to evaluate neurodevelopment after pediatric cardiac surgery

Actas del congreso publicadas en: Cirugía Cardiovascular. Órgano Oficial de la Sociedad Española de Cirugía Cardiovascular y Endovascular ISSN: 1134-0096Introduction: Neurodevelopment in children with congenital heart disease is a major concern. Bayley scales are a standardized instru ment used to assess this. Objectives: Our goal was to evaluate Bayley-III scores among infants undergoing cardiac surgery in our institution. Methods: We evaluated the neurodevelopment of infants under 4years who underwent cardiac surgery with extracorporeal circula- tion during 2016-2019 at our institution. We excluded preterm ba- bies, children with chromosomal abnormalities, hearing loss, cerebral palsy, or ECMO before surgery. Results: Sixty infants with a mean age of 2.95 ± 3.28 months at the time of the surgery were assessed at 26.46 ± 8.47 months after sur- gery. Main diagnostic groups were septal defects(n = 18), right sided heart diseases(n = 12), anomalies of thoracic arteries and/or veins(n = 10), transposition of the great arteries(n = 9), left sided heart diseases(n = 5), single ventricle(n = 3) and other(n = 3). Complete repair was achieved in 93% of cases, 4 children were palliated. Mean Bayley-III scores were highest in left sided heart diseases (98.73 ± 4.02) and transposition of great arteries (93.93 ± 12.61). Scores were significantly lower in children with single ventricle physiology (78.89 ± 15.49; p = 0.04) and palliative procedures (73.41 ± 16.73; p = 0.02) when compared to the rest of the cohort. We did not find statistically significant association between Bayley-III scores and pump times beyond 90 min, low weight at surgery (2.5 Kg), surgery during neonatal period (30 days), selective cerebral perfusion, intu- bation time nor PICU/NICU length of stay. Conclusions: Single ventricle physiology and palliative procedures have a detrimental outcome on neurodevelopment in children. Although other variables studied did not yield statistically significant results, it is mandatory to continue following the neurodevelopment of these infants in order to apply appropriate therapies and edu- cation.Depto. de Estudios EducativosFac. de EducaciónTRUEsubmitte