53 research outputs found
Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic
BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.
METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation.
FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile.
INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction
Development of Hepatocellular Carcinoma in a Patient with Chronic Hepatitis C 21 Years after Achieving a Sustained Virological Response to Interferon Therapy
A 77-year-old man with chronic hepatitis C (CH-C) infection, who achieved a sustained virological response (SVR) to interferon (IFN) therapy, was followed up regularly. Before IFN therapy, he did not have metabolic diseases, and the histological diagnosis of his chronic hepatitis was stage-3 fibrosis. After achieving SVR, the fibrosis-4 (FIB-4) index level dropped once but gradually increased. 21 years after SVR, hepatocellular carcinoma (HCC) was diagnosed by dynamic computed tomography. The HCC was 12 mm in diameter. The HCC was treated with radiofrequency ablation. CH-C patients with advanced fibrosis require long-term follow-up, even after achieving SVR
Sarcomatoid acquired cystic disease-associated renal cell carcinoma
In this article, we report a rare case of
hitherto undescribed acquired cystic disease (ACD)-
associated renal cell carcinoma (RCC) with sarcomatoid
change. A 78-year-old woman had been receiving
hemodialysis for fourteen years at the time when a renal
tumor was encountered on the follow-up examination of
the kidney. Microscopically, oncocytic cuboidal cells
proliferated with tubular, cribriform or papillary growth
patterns, and atypical columnar cells with abundant
cytoplasm proliferated with papillary configuration.
Oxalate crystal deposition was observed in the stroma
and the tumor focally resembled translocation type
(TFE3) RCC. Sarcomatous neoplastic cells were also
seen. The cytoplasm of oncocytic and sarcomatous
neoplastic cells was diffusely positive for antimitochondrial
antibody and the ultrastructural
examination detected many mitochondria in the
cytoplasm of oncocytic carcinoma cells and sarcomatous
neoplastic cells. The loss of chromosomes 1p, 2q11-22,
9 and 14 was observed using comparative genomic
hybridization analysis. We thus report here a case of
hitherto undescribed ACD-associated RCC intermingled with oncocytic cells, translocation type RCC-like area
and sarcomatoid change. This is the sixth case of
sarcomatoid RCC arising in end-stage kidney disease
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