Ultrasound characteristics of endometrial cancer as defined by the International Endometrial Tumor Analysis (IETA) consensus nomenclature - A prospective multicenter study

OBJECTIVES: To describe the sonographic features of endometrial cancer in relation to stage, grade, and histological type using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: Prospective multicenter study on 1714 women with endometrial cancer undergoing a standardized transvaginal grayscale and Doppler ultrasound examination by an experienced ultrasound examiner using a high-end ultrasound system. Clinical and sonographic data were entered into a web-based protocol. We assessed how strongly sonographic characteristics, according to IETA, were associated to outcome at hysterectomy, i.e. tumor stage, grade, and histological type. RESULTS: After excluding 176 women (no or delayed hysterectomy, final diagnosis other than endometrial cancer, or incomplete data), 1538 women were included in our statistical analysis. Median age was 65 years (range 27-98), and median BMI 28.4 (range 16-67), 1378 (89.7%) women were postmenopausal, and 1296 (84.2%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage. High-risk tumors (stage 1A, grade 3 or non-endometrioid or ≥ stage 1B) were less likely to have regular endometrial myometrial border (difference of -23%, 95% CI -27 to -18%), whilst they were larger (mean endometrial thickness; difference of +9 mm, 95% CI +8 to +11 mm), more frequently had non-uniform echogenicity (difference of +10%, 95% CI +5 to +15%), a multiple, multifocal vessel pattern (difference of +21%, 95% CI +16 to +26%), and a moderate or high color score (difference of +22%, 95% CI +18 to +27%), than low-risk tumors. CONCLUSION: Grayscale and color Doppler ultrasound features are associated with grade and stage, and differ between high and low risk endometrial cancer

Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

Analyse du risque lié à l'adoption de systèmes intensifs de production : le cas des « camellones chontales »

A Social-Economic Study of Camellones Agro-Piscicultural Systems ; Tabasco, Mexico. The recently implanted Camellones agro-piscicultural system in a swampy zone in T abasco S tate, in southeastern Mexico, has been placed at the disposal of Chontales peasants. It theoretically has high potentialities to enable peasants to improve their standard of living. The purpose of this study is to compare the traditional farming methods employed historically by the Chontales with other more intensive farming methods proposed by institutions that do not belong to the peasant world. The second part of the study attempts to estimate the risks associated with intensive farming. These two approaches point out the constraints that weigh upon the transformation of traditional production systems and the resistance of peasants confronted with such changes.La construction de billons ou «camellones» dans une zone marécageuse du sud-est du Mexique offre théoriquement des potentialités élevées qui devraientpermettre aux habitants, les Indiens Chontales, d'améliorer sensiblement leur niveau de vie. Dans une première partie, le mode d'exploitation développé spontanément par les Chontales est comparé à d'autres modes d'exploitation plus intensifs proposés par des institutions extérieures au monde paysan. On tente ensuite d'évaluer le risque associé à l'adoption des innovations proposées. Ces deux approches mettent en évidence les contraintes qui pèsent sur la transformation des systèmes de production traditionnels et la résistance des paysans face à ces transformations.Pierard O., Vandercam F., Degand J., Installe M. Analyse du risque lié à l'adoption de systèmes intensifs de production : le cas des « camellones chontales ». In: Cahiers d'outre-mer. N° 182 - 46e année, Avril-juin 1993. pp. 195-208

Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study

ObjectivesTo describe the sonographic features of endometrial cancer in relation to stage, grade, and histological type using the International Endometrial Tumor Analysis (IETA) terminology. MethodsProspective multicenter study on 1714 women with endometrial cancer undergoing a standardized transvaginal grayscale and Doppler ultrasound examination by an experienced ultrasound examiner using a high-end ultrasound system. Clinical and sonographic data were entered into a web-based protocol. We assessed how strongly sonographic characteristics, according to IETA, were associated to outcome at hysterectomy, i.e. tumor stage, grade, and histological type. ResultsAfter excluding 176 women (no or delayed hysterectomy, final diagnosis other than endometrial cancer, or incomplete data), 1538 women were included in our statistical analysis. Median age was 65 years (range 27–98), and median BMI 28.4 (range 16–67), 1378 (89.7%) women were postmenopausal, and 1296 (84.2%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage. High-risk tumors (stage 1A, grade 3 or non-endometrioid or ≥ stage 1B) were less likely to have regular endometrial myometrial border (difference of −23%, 95% CI −27 to −18%), whilst they were larger (mean endometrial thickness; difference of +9 mm, 95% CI +8 to +11 mm), more frequently had non-uniform echogenicity (difference of +10%, 95% CI +5 to +15%), a multiple, multifocal vessel pattern (difference of +21%, 95% CI +16 to +26%), and a moderate or high color score (difference of +22%, 95% CI +18 to +27%), than low-risk tumors. ConclusionGrayscale and color Doppler ultrasound features are associated with grade and stage, and differ between high and low risk endometrial cancer.</p