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PubMed1997

Screening for colorectal cancer with the fecal occult blood test: a background paper. American College of Physicians.

PURPOSE: Screening for colorectal cancer with fecal occult blood tests or sigmoidoscopy can reduce mortality rates. If occult blood testing is done, clinicians must decide how to interpret the results and plan further management. If the results are positive, a decision must be made about evaluating the colon. This report provides information that can be used to perform fecal occult blood tests, interpret the results of those tests, and plan patient management. DATA SOURCES: The MEDLINE database was searched for data relevant to optimizing the technique of fecal occult blood testing. Studies were also identified from the bibliographies of published articles about test performance and the interpretation of test results, particularly sensitivity, specificity, and the probability of colorectal cancer after a positive test result. STUDY SELECTION AND DATA EXTRACTION: Studies were selected and data were extracted on the basis of the authors' combined judgment. DATA SYNTHESIS: When used for screening, fecal occult blood tests have positive results about 1% to 16% of the time, depending on such factors as the age of the person being tested, whether the sample is rehydrated, and whether the test is used for initial screening or for rescreening. When the colons of persons who have positive test results are evaluated, the rate of finding any colorectal cancer is about 2% to 17% and the rate for early colorectal cancer (Dukes stage A or B) is about 2% to 14%. CONCLUSIONS: These results suggest that, in general, persons who have positive results on a fecal occult blood test should have a full colonic examination. More research is needed to understand and improve the sensitivity and specificity of the fecal occult blood test.

Colorectal Neoplasms↗
PubMed1999

Limitations of the faecal occult blood test in screening for colorectal cancer.

BACKGROUND: A screening test should be acceptable, safe, simple, accurate, reliable, effective, and inexpensive. Screening for colorectal cancer with the faecal occult blood test is done to reduce the incidence and mortality from colorectal cancer. How does this test measure up to these requirements? METHODS: The characteristics of faecal occult blood test are described by means of clinical epidemiology, analysing its compliance, sensitivity, specificity, positive predictive value, and its test performance in Bernoulli trials. A decision tree and a Markov model are used to compare the cost-effectiveness of screening strategies involving faecal occult blood test and colonoscopy. RESULTS: After 5-10 years, patient compliance in a faecal occult blood test screening programme falls below 50%. Over 80% of the patients are likely to leave the programme before its completion. Although the test itself may seem safe and simple, the high rate of false-positive outcomes exposes many subjects to the potential complications of colonoscopy. The high rate of false-negative tests gives patients with colorectal cancer a false sense of security and delays their proper diagnostic work-up. In populations with low prevalence rates of colorectal cancer, faecal occult blood test becomes very inaccurate in diagnosing colorectal cancer, as its positive predictive value falls below 5%. Its long-term test performance is unreliable in that it comes to depend on the frequency, with which the test is repeated. Any negative or positive test result can be achieved by varying the frequency of test repetition. Screening by colonoscopy every five or ten years is more cost-effective than screening by annual faecal occult blood test in preventing the occurrence of colorectal cancer and its associated mortality. CONCLUSIONS: Screening strategies for colorectal cancer involving faecal occult blood test should be abandoned.

Colonoscopy↗
PubMed1997

Incidence of visible and occult blood on laryngoscope blades and handles.

Anesthesia providers must take appropriate precautions to reduce the potential for transmission of infectious agents to the patients under their care. The devastating spread of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) over the past decade has resulted in the development of specific guidelines for the cleaning, disinfection, sterilization, and handling of medical equipment and instruments. Contamination of laryngoscope blades and handles with visible and occult blood frequently occurs during routine airway management. Several studies suggest procedures for cleaning, disinfection, sterilization, or handling of laryngoscope blades and handles are ineffective, or there may be poor compliance with the established protocols. The purpose of this study was to determine the incidence of visible and occult blood on laryngoscope blades and handles that were identified as ready for patient use. Sixty-five laryngoscope blades and handles identified as ready for patient use were observed for visible blood and tested for occult blood. A modified version of the three-stage phenolphthalein blood indicator test was employed to determine the presence of occult blood. None of the blades or handles observed had visible blood. Of the 65 blades tested for occult blood, 13 (20%) tested positive. Of the 65 handles tested for occult blood, 26 (40%) tested positive. More afternoon blades and handles tested positive for occult blood than morning blades and handles (P < 0.01). The extent to which contaminated anesthesia equipment plays in nosocomial infection is difficult to determine. The presence of blood is an indicator of potential cross-infection, since biological fluids, such as blood and saliva, are known to transmit infectious diseases. This study confirms that more rigorous decontamination protocols must be instituted to ensure complete removal of blood prior to sterilization, since laryngoscope blades and handles have irregular surfaces with repositories for infectious material.

Anesthesia↗
PubMed2003

Distribution of hepatitis B virus in the liver of chronic hepatitis C patients with occult hepatitis B virus infection.

Although occult hepatitis B virus (HBV) infection (HBV-DNA in serum in the absence of hepatitis B surface antigen [HBsAg]) is common in chronic hepatitis C, its characteristics are not well known. In this work, the presence of HBV-DNA (by polymerase chain reaction; PCR) and its distribution (by in situ hybridization) in liver biopsies and peripheral blood mononuclear cells (PBMCs) from 32 patients with chronic hepatitis C and occult HBV infection and in 20 HBsAg chronic carriers were determined. The results showed that serum HBV-DNA levels were statistically lower (P = 0.001) in patients with occult HBV infection than in HBsAg chronic carriers. The HBV infection pattern in liver cells was identical between patients with occult HBV infection and those with chronic hepatitis B. However, the mean percentage of HBV-infected hepatocytes was significantly lower (P = 0.001) in patients with occult HBV infection (5 +/- 4.44%) than in HBsAg chronic carriers (17.99 +/- 11.58%). All patients with chronic hepatitis B have HBV-DNA in their PBMCs while this occurred in 50% of the cases with occult HBV infection. In conclusion, patients with occult HBV infection have a low number of HBV-infected hepatocytes and this fact could explain the lack of HBsAg detection and low viremia levels found in these cases.

Adult↗
PubMed2006

Incidence and management of occult hemothoraces.

BACKGROUND: Little is known about the incidence of and associated management outcomes of occult hemothorax in blunt trauma patients. The increased use of computed thoracic tomography for the evaluation of the multiply injured blunt trauma patient has led to an increase in the identification of these hemothoraces and management dilemmas. METHODS: A retrospective review of blunt trauma patients with occult hemothoraces was performed. Patients were divided into 2 groups: chest tube versus no chest tube. Outcomes and complications for the 2 groups were defined. Data included demographics, Injury Severity Score, length of stay, need for mechanical ventilation and thoracic consult, pneumonia, and empyema. The size of the occult hemothorax was measured on the computed thoracic tomography. RESULTS: Eighty-eight patients (21.4%) had a total of 107 occult hemothoraces. Patients in the chest tube group were more likely to have a higher Injury Severity Score and an associated occult pneumothorax and to have smaller hemothoraces. CONCLUSIONS: Occult pneumothoraces occur in a significant proportion of the multiply injured blunt trauma population. Small, isolated, occult hemothoraces can be managed safely in the stable patient.

Adult↗
PubMed1999

Occult bacteremia in young febrile children.

The evaluation of nontoxic-appearing, young, febrile children has been a subject of considerable debate. Of young, nontoxic-appearing children aged 3 to 36 months with temperatures of 39 degrees C or more and no clear source, approximately 2% to 3% have occult bacteremia. Of these bacteremias, approximately 90% are caused by S. pneumoniae, 5% by nontyphoidal Salmonella sp., and 1% by N. meningitidis. Most children with occult pneumococcal bacteremia improve spontaneously, but approximately 25% of untreated patients have persistent bacteremia or develop new focal infections, including 3% to 6% who develop meningitis. Occult meningococcal bacteremia, although rare, has frequent complications, including meningitis in approximately 40% and death in approximately 4%. Less is known about the natural history of untreated occult nontyphoidal Salmonella bacteremia. Empiric antibiotic treatment of children with occult bacteremia decreases the rate of complications, including meningitis. Few disagree that febrile, young children at risk for occult bacteremia require a careful clinical evaluation and close follow-up. The benefits of laboratory screening and selective empiric antibiotic treatment of febrile children at risk for occult bacteremia have to be weighed against the costs of screening tests and blood cultures, inconvenience, temporary discomfort to patients, risk for side effects of antibiotics, and the role of antibiotics in the development of bacterial resistance. Although great debate exists concerning the role of empiric antibiotics, a strategy for obtaining blood cultures and empirically administering antibiotics on the basis of an increased ANC, in addition to close clinical follow-up, may be effective in reducing the frequency and severity of uncommon but adverse sequelae. A highly effective S. pneumoniae bacterial conjugate vaccine will soon be available, which will benefit all children, and will alter the ways that clinicians evaluate fully immunized young, febrile children.

Anti-Bacterial Agents↗
PubMed1998

Digital subtraction indocyanine green angiography of occult choroidal neovascularization.

OBJECTIVE: This study aimed to use a new technique for ocular imaging, digital subtraction indocyanine green angiography (DS-ICGA), to evaluate patients with occult choroidal neovascularization (CNV). DESIGN: The design was a cross-sectional study of patients with occult CNV. PARTICIPANTS: A total of 31 eyes of 31 patients were studied. INTERVENTION: Digital subtraction of sequentially acquired indocyanine green angiographic frames was used to image the progression of the dye front in eyes with occult CNV. A method of pseudocolor imaging of the choroid was developed that allows differentiation and identification of underlying choroidal arteries and veins. RESULTS: The DS-ICGA of occult CNV showed consistent findings. Occult CNV was imaged with greater detail and in a shorter period of time than with conventional indocyanine green angiography. The fundus landmarks were retained with DS-ICGA much better than with conventional indocyanine green angiography. CONCLUSIONS: The DS-ICGA uses time to dissect the choroidal circulation. With DS-ICGA, occult CNV could be imaged more quickly and in greater detail than with conventional imaging techniques. The DS-ICGA may improve the authors ability to image, and subsequently treat, occult CNV.

Angiography, Digital Subtraction↗
PubMed1996

Using tomography to diagnose occult ankle fractures.

STUDY OBJECTIVES: To determine the incidence of occult ankle fractures and to determine whether an ankle effusion identified radiographically correlated with the presence of an occult fracture. METHODS: Attending physicians in the emergency department of a university hospital prospectively identified patients with acute ankle injuries that produced ecchymosis or edema over two or more major ligaments of the ankle. Plain radiographs of these patients demonstrated ankle effusions without fractures. A consecutive sample of patients with acute ankle injuries was selected. Thirty-six of 1,151 patients were eligible to enter the study; 2 of these patients subsequently were excluded from the data analysis. All eligible patients underwent plain ankle tomography at 3-mm intervals in the coronal and sagittal planes. The types and frequencies of occult ankle fractures identified on plain film tomography were noted. The distention of the ankle joint capsule of enrolled patients was measured to determine if the degree of effusion correlated with the presence of an occult fracture. RESULTS: The minimum incidence of occult fractures in the general population with ankle injuries was 1%. Twelve of 34 patients (35%) with acute, severe injuries had occult fractures. Depending on the size, an effusion was correlated with the presence of an occult fracture in 35% to 85% of the study population. CONCLUSION: Plain film tomography should be used when evaluating ankle injuries if both edema or ecchymosis over two or more stabilizing ligaments and radiographic evidence of an effusion are present simultaneously.

Acute Disease↗
PubMed1996

The fate of bypass grafts to angiographically occult runoff vessels detected by magnetic resonance angiography.

PURPOSE: Magnetic resonance angiography (MRA) is a noninvasive vascular imaging technique that is more sensitive than contrast arteriography (CA) for the detection of patent distal runoff vessels. This technique has facilitated performance of MRA-directed bypass procedures for patients who were believed not to be bypass candidates because of the absence of a suitable target vessel on the preoperative CA. The fate of bypasses to these angiographically occult runoff vessels is unknown, however, and it has been proposed that patients with angiographically occult runoff may have aggressive occlusive disease, rendering bypass procedures ultimately futile. METHODS: Between April 1992 and February 1995, 212 autogenous vein infrageniculate bypasses were performed for limb-salvage indications, 22 (12%) to angiographically occult runoff vessels. Results of bypasses performed to angiographically occult vessels were compared with those of bypasses to CA-detected runoff vessels. Life-table analysis of graft-patency and limb-salvage rates was performed. RESULTS: The accuracy of the MRA-predicted patency of angiographically occult vessels was confirmed in every case by the operative findings. Life-table analysis revealed no significant difference in primary graft patency (p > 0.05) or limb-salvage (p > 0.05) rates between patients with bypasses to runoff vessels seen by MRA alone. At 35 months after surgery, the primary graft patency rate was 68% for bypasses to CA-detected vessel bypass and 67% for MRA-detected vessels. The limb salvage rate was 83% for CA-detected vessel bypass patients and 78% for patients with angiographically occult runoff. CONCLUSIONS: MRA can accurately identify patent runoff vessels not visualized by CA. Results of bypasses performed to angiographically occult runoff vessels are similar to those of bypasses performed to vessels detected by CA. MRA should be performed in patients in whom CA fails to reveal runoff vessels suitable for use in a limb-salvage procedure. The greater sensitivity of MRA may facilitate successful bypass surgery and improve the overall limb-salvage rate.

Aged↗
PubMedDate not supplied

Videourodynamic diagnosis of occult genuine stress incontinence in patients with anterior vaginal wall relaxation.

OBJECTIVE: To (1) utilize videourodynamics, the gold standard, to assess the prevalence of occult genuine stress incontinence (GSI) among preoperative patients with symptomatic anterior vaginal wall relaxation and (2) identify urodynamic discriminators that might help predict occult GSI. METHODS: In this prospective study, videourodynamic evaluation was performed on 48 consecutive patients presenting for preoperative urodynamic evaluation of anterior vaginal wall prolapse. Patients with occult GSI were identified by urodynamic testing with and without Gehrung pessary support of the bladder base during stress maneuvers. Variables from the history, physical examination, and videourodynamics were then analyzed. RESULTS: The overall incidence of occult GSI was 25% (22.7% in the pelvic organ prolapse [POP] group and 26.9% in the POP-UI group). Patients with occult GSI were not identifiable on history but did have a higher incidence of late first sensation, open bladder neck at rest, and hypermobility on imaging with videourodynamics. CONCLUSION: This study suggests that one quarter of women presenting with anterior wall relaxation with or without incontinence symptoms have occult GSI. Given this high prevalence, preoperative evaluation with urodynamics, possibly videourodynamics, utilizing bladder base support is justified if the data are substantiated in a larger, definitive study. Patients with a late first sensation, open bladder neck, and hypermobility may have a higher incidence of occult GSI.

Aged↗
PubMed2005

Clinical impact of occult HBV infections.

HBV infection in the absence of HBsAg has been a matter of debate for years, but its existence and clinical relevance are now supported by many publications, editorials and reviews. HBV DNA without HBs antigenemia was detected in the following clinical situations: (1) Chronic, presumably viral, hepatitis unrelated to HCV, atypical alcoholic hepatitis and hepatocellular carcinoma (HCC); (2) viral reactivation following immunosuppression; (3) Transmission through transplantation, transfusion or experimental transmission to chimpanzees. Occult HBV infections are not restricted to areas of high HBV endemicity. Indeed, such cases have been described in Western countries including France. It is now established that occult HBV infection among non-HCV patients suffering from chronic hepatitis varies from 20% to 30% in Europe, and in the context of HCV infection it varies from 20% in France up to 80% in Japan. The percentage of occult HBV infections among non A-E cases depends on several parameters: (1) The method of detection, including PCR primer selection; (2) patient recruitment; (3) patients from countries highly endemic for HBV are more likely to develop occult HBV infections; (4) prevalence may also vary depending on the nature of biological material tested, with a higher proportion for liver compared to serum specimen. The mechanisms leading to HCC in occult HBV infection seem similar to those overt cases, patients with low-grade but diagnosable HBV replication that retains its pro-oncogenic properties. During the course of HCV infection, occult HBV infection may worsen liver damage induced by HCV and reduce the response to HCV antiviral treatment. Occult HBV infection is a frequent phenomenon and HBV DNA testing with highly sensitive PCR in the clinical setting is therefore becoming of paramount importance.

Carcinoma, Hepatocellular↗
PubMed2000

The immunohistochemical assessment of occult regional lymph node metastases in patients with T3pN0M0 prostate cancer before definitive radiotherapy.

OBJECTIVE: To detect occult regional lymph node metastases in patients with T3pN0M0 prostate cancer not recognized by routine haematoxylin and eosin staining, and to evaluate the clinical relevance of this finding. PATIENTS AND METHODS: Formalin-fixed and paraffin-embedded pelvic lymph nodes (1118) from 92 patients were evaluated by immunohistochemistry using antibodies for prostate specific antigen (PSA) and pancytokeratin (AE1/AE3). Of the tumours, 14% were well, 69% moderately and 17% poorly differentiated. The extent of tumour was categorized as T3pN0M0 in all patients, who were referred for definitive radiotherapy after pelvic staging lymphadenectomy. The median (range) serum PSA value before treatment was 18.5 (0.4-342) microg/L. After radiotherapy, the patients were followed by assessing biochemical progression, pelvic recurrence and/or development of distant metastases. The median (range) observation time for all patients was 61 (16-136) months. RESULTS: Occult lymph node metastases were detected in four (4.4%) of the 92 patients. Patients with or without occult metastases had similar serum PSA levels and histological grades. None of the four patients with occult metastases progressed, compared with 37 of the 88 (42%) with no such metastases. CONCLUSION: Using immunohistochemistry the detection rate of occult lymph node metastases in patients with T3pN0M0 prostate cancer is low. The occurrence of such metastases is probably unrelated to the serum PSA value before treatment. The short-term outcome of patients subsequently treated with definitive radiotherapy does not seem to be associated with the finding of occult lymph node metastases, but long-term follow-up is needed. So far, the results do not justify the search for occult lymph node metastases as a routine procedure in these patients

Aged↗
PubMed1999

Mammographically Occult Breast Cancers.

A small percentage of breast cancers are not visible on mammography. Since mammographically occult malignancies may be more difficult to diagnose, we hypothesized that the lack of visualization would cause a delay in detection, more aggressive surgical and adjuvant therapy, and poorer outcome. Patients with mammographically occult malignancies were compared to patients with cancers visible on mammogram. The significance of mammographic visibility for treatment and local and distant recurrence rates were evaluated. Ninety-one of the 813 (11%) cancers were mammographically occult. Patients with mammographically occult malignancies were significantly younger, of lower body weight, and had fewer pregnancies than patients with cancers visible on mammography: age, body weight, and parity were statistically significant (p < 0.001) in stepwise logistic regression. Ductal carcinoma in situ was significantly more frequently diagnosed in patients with mammographically visible malignancies (14% versus 4%, p = 0.0163) and nodal involvement was significantly more frequent in patients with mammographically occult malignancies (35% versus 24%, p = 0.0391). Diagnostic delays exceeding 3 months were experienced by 24% of patients with mammographically occult malignancies compared to 13% of patients with tumor visible on mammography (p < 0.0001). Adjuvant chemotherapy was given to 63% of patients with occult malignancies compared to 41% of patients with mammographically visible cancers (p = 0.0027). The use of breast-conserving therapy and adjuvant radiation and tamoxifen were comparable. Survival free of local recurrence and distant metastases for the 403 patients followed for 5 years or more was not related to mammographic visibility.

Journal Article↗
PubMed2002

Occult lymph node metastases as a predictor of tumor relapse in patients with node-negative esophageal carcinoma.

BACKGROUND & AIMS: Esophageal carcinoma is an aggressive disease with a very poor prognosis. Early tumor relapse after surgical resection in patients with node-negative esophageal carcinoma suggests that occult metastases may have been missed at the original pathologic examination. The aim of this study was to determine the prevalence of immunohistochemically detected occult lymph node microscopic metastases in patients with pathologic N0 esophageal carcinoma and the impact of these occult metastases on relapse-free survival. METHODS: All patients (n = 124) with pathologic N0 esophageal carcinoma undergoing resection at our institution between January, 1994, and October, 1998, constituted the study population. Esophagectomy specimens were reevaluated by immunohistochemistry (monoclonal antibody against cytokeratin AE1/AE3). Clinical and pathologic features were summarized, and patient relapse-free survival was estimated. RESULTS: Among the total of 124 patients, occult lymph node microscopic metastases were identified by immunohistochemistry in 14 patients (11%) (T1 mucosa, 4%; T1 submucosa, 6%; T2, 22%; and T3, 14%). Patients were followed for a median of 3.2 years. Relapse-free survival was not significantly associated with the presence of occult lymph node microscopic metastases as detected by immunohistochemistry (P = 0.12). Advanced T stage (T3; P < 0.001) and lymphovascular invasion (P < 0.001) were found to be associated with tumor relapse. CONCLUSIONS: In the present study, occult lymph node microscopic metastases in pathologic N0 esophageal carcinoma patients were less frequent than previously reported. T stage and lymphovascular invasion were significantly associated with relapse-free survival, although a significant association with occult lymph node metastases was not detected.

Blood Vessels↗
PubMed2001

Occult lymph node metastases in supraglottic cancers of the larynx.

Occult cervical lymph node metastases may often be associated with cancers of the supraglottic larynx. The aims of this investigation were: (1) to determine the incidence of occult lymph node metastases in patients with cancer of the larynx; (2) to assess whether the presence of such metastases was related to the extent of the primary tumor (T) and its grading (G); and (3) to discuss which therapeutic approach should be followed in treating clinically occult lymph node metastases. Our investigation included 97 patients who underwent supraglottic horizontal laryngectomy and elective cervical lymph node dissection. The incidence of occult lymph node metastases in the series considered was 27%. Based on the preoperative staging of the tumor, 14% of the cases had metastatically involved lymph nodes in the T1 tumors, 21% in the T2 tumors, 35% in the T3, and 75% in the T4. In the statistical analysis, a significant difference was shown to exist when T1 + T2 and T3 + T4 (P = 0.04) were compared. In terms of grading, occult metastases were found in 16% of the G1 tumors, 27% of the G2, and 42% of the G3. The statistical analysis demonstrated a significant difference between G1 and G3. In brief, the incidence of occult metastases was higher for the less differentiated tumors and for the ones with a higher T value; the effects of both factors are combined thereby increasing the rate of occult metastases (P = 0.05).

Adult↗
PubMed2003

Occult central nervous system involvement in patients with metastatic breast cancer: prevalence, predictive factors and impact on overall survival.

BACKGROUND: As screening central nervous system (CNS) imaging is not routinely performed, the incidence and clinical relevance of occult CNS metastases in advanced breast cancer is unknown. PATIENTS AND METHODS: All patients screened for participation in one of four clinical trials were included; each of the trials excluded patients with known CNS involvement and required screening CNS imaging. A cohort of breast cancer patients with symptomatic CNS metastases was identified from the IU Cancer Center Tumor Registry for comparison. RESULTS: From November 1998 to August 2001, 155 screening imaging studies were performed. Twenty-three patients (14.8%) had occult CNS metastases. HER-2 overexpression (P = 0.02) and number of metastatic sites (P = 0.03) were predictive of CNS involvement by multivariate analysis. Median survival from time of metastasis (1.78 versus 2.76 years; P <0.0001) and from screening (4.67 versus 10.4 months; P = 0.0013) was shorter in patients with than without occult CNS metastasis. Survival among patients with occult CNS metastasis was similar to patients with symptomatic CNS disease. CONCLUSIONS: Patients with CNS involvement, whether occult or symptomatic, have an impaired survival. Occult CNS metastasis is relatively common, but impact on survival of treating occult CNS disease in patients with progressive systemic metastases is questionable.

Adult↗
PubMed2005

Reevaluating occult incontinence.

PURPOSE OF REVIEW: Occult incontinence is a controversial subject without significant exposure in the literature. Conventionally, it has been assumed to be a marker for increased risk of postoperative stress urinary incontinence (POSUI) after repair of pelvic organ prolapse. The controversy surrounds the performance of prophylactic incontinence procedures based on this assumption. Until 2004 no article in the English language had been published demonstrating an association between occult incontinence and increased risk of stress urinary incontinence after repair of severe pelvic organ prolapse in previously continent women. We will explore the evidence regarding occult incontinence, review the data on intervention trials, and address questions that remain. RECENT FINDINGS: The limited evidence suggests 11-22% of continent patients with severe pelvic organ prolapse will develop POSUI. New evidence suggests that patients with occult incontinence are at substantially more risk. Since anti-incontinence procedures in patients with occult incontinence reduces the incidence of POSUI (to 0-15%), there appears to be some benefit from screening and intervention. Most studies on the subject are small and limited by their design. Results differ regarding whether a negative stress test can be used to rule out the risk of POSUI. SUMMARY: Minimal existing evidence in the English language suggests that patients with occult incontinence are at increased risk of POSUI. Outcomes in occult incontinence patients undergoing repair of pelvic organ prolapse need systematic study. Until there is adequate solid evidence on the predictive values of our screening test, we cannot counsel patients regarding our ability to prevent POSUI or protect them from unnecessary procedures.

Female↗
PubMed2005

Natural course of occult choroidal neovascularization in age-related macular degeneration: development of classic lesions in fluorescein angiography.

PURPOSE: To analyse the frequency of conversion from occult with no classic choroidal neovascularization (CNV) and occult with minimally classic CNV into predominantly classic CNV secondary to age-related macular degeneration. METHODS: Retrospective evaluation of baseline and repeat angiograms of 54 eyes with a follow-up of 6-12 months. RESULTS: In the group with initially occult with no classic CNV, nine of 40 eyes (23%) progressed to a predominantly classic lesion, whereas in the group of occult with a minimally classic CNV, 10 of 14 eyes (71%) eyes developed a predominantly classic CNV. CONCLUSIONS: The proportion of eyes that develop predominantly classic CNV is much higher in eyes with initially occult and minimally classic CNV, compared with eyes with initially occult and no classic CNV. Our data suggest that the natural course of CNV secondary to AMD begins as occult and progresses to classic CNV.

Aged↗