A rare case of Takayasu’s arteritis in pregnancy

Takayasu’s arteritis (TA) is an uncommon, chronic inflammatory vascular disease of unknown etiology that primarily involves aorta and its branches and pulmonary arteries. Though it is present worldwide, it is more prevalent in Asian countries. It usually presents during reproductive age group with non-specific symptoms. The symptoms of the disease are varied and patients can present asymptomatically with impalpable pulses. There are no specific laboratory tests to diagnose TA. Angiographic imaging is considered to be the gold standard investigation in diagnosing TA. Steroids with subsequent tapering doses are the mainstay of medical treatment. Reconstructive vascular surgery is limited to the severe and irreversible stenotic lesions. Though the disease process theoretically is not aggravated by the pregnancy, development of preeclampsia and fetal growth restriction may occur during pregnancy. Preconception counseling and careful monitoring of pregnant mother by a multidisciplinary team, improves the pregnancy outcome. Here we present a bad obstetric case with TA who subsequently developed severe preeclampsia and fetal growth restriction. The pregnancy outcome could be made favourable by strict monitoring and multidisciplinary team approach

Single blind randomized Phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial

Background: The treatment results of external beam radiotherapy for intermediate and high risk prostate cancer patients are insufficient with five-year biochemical relapse rates of approximately 35%. Several randomized trials have shown that dose escalation to the entire prostate improves biochemical disease free survival. However, further dose escalation to the whole gland is limited due to an unacceptable high risk of acute and late toxicity. Moreover, local recurrences often originate at the location of the macroscopic tumor, so boosting the radiation dose at the macroscopic tumor within the prostate might increase local control. A reduction of distant metastases and improved survival can be expected by reducing local failure. The aim of this study is to investigate the benefit of an ablative microboost to the macroscopic tumor within the prostate in patients treated with external beam radiotherapy for prostate cancer.Methods/Design: The FLAME-trial (Focal Lesion Ablative Microboost in prostatE cancer) is a single blind randomized controlled phase III trial. We aim to include 566 patients (283 per treatment arm) with intermediate or high risk adenocarcinoma of the prostate who are scheduled for external beam radiotherapy using fiducial markers for position verification. With this number of patients, the expected increase in five-year freedom from biochemical failure rate of 10% can be detected with a power of 80%. Patients allocated to the standard arm receive a dose of 77 Gy in 35 fractions to the entire prostate and patients in the experimental arm receive 77 Gy to the entire prostate and an additional integrated microboost to the macroscopic tumor of 95 Gy in 35 fractions. The secondary outcome measures include treatment-related toxicity, quality of life and disease-specific survival. Furthermore, by localizing the recurrent tumors within the prostate during follow-up and correlating this with the delivered dose, we can obtain accurate dose-effect information for both the macroscopic tumor and subclinical disease in prostate cancer. The rationale, study design and the first 50 patients included are described.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

A rare case of Takayasu's arteritis in pregnancy

Takayasu’s arteritis (TA) is an uncommon, chronic inflammatory vascular disease of unknown etiology that primarily involves aorta and its branches and pulmonary arteries. Though it is present worldwide, it is more prevalent in Asian countries. It usually presents during reproductive age group with non-specific symptoms. The symptoms of the disease are varied and patients can present asymptomatically with impalpable pulses. There are no specific laboratory tests to diagnose TA. Angiographic imaging is considered to be the gold standard investigation in diagnosing TA. Steroids with subsequent tapering doses are the mainstay of medical treatment. Reconstructive vascular surgery is limited to the severe and irreversible stenotic lesions. Though the disease process theoretically is not aggravated by the pregnancy, development of preeclampsia and fetal growth restriction may occur during pregnancy. Preconception counseling and careful monitoring of pregnant mother by a multidisciplinary team, improves the pregnancy outcome. Here we present a bad obstetric case with TA who subsequently developed severe preeclampsia and fetal growth restriction. The pregnancy outcome could be made favourable by strict monitoring and multidisciplinary team approach

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak