Acute fatty liver with pancreatitis in pregnancy after in vitro fertilization - literature review and case report.

BACKGROUND: Acute fatty liver disease in pregnancy (AFLP) is a low-incidence condition that usually affects women in the third trimester of pregnancy or the early postpartum period. This article reviews recent advances in the diagnosis and treatment of AFLP with pancreatitis in pregnancy induced by in vitro fertilization (IVF). CASE REPORT: A rare case of AFLP and pancreatitis occurred in a pregnant woman with an IVF-induced twin pregnancy delivered by cesarean section. Diagnosis of this condition is difficult, and delay in accurate diagnosis and timely and appropriate treatment can lead to serious complications such as acute pancreatitis or extensive damage to multiple organs and systems, which can have significant consequences. The main therapeutic approach was the rapid administration of drugs accompanied by therapeutic measures to support liver function and pancreatic complications. CONCLUSIONS: We would like to reemphasize the importance of multidisciplinary management and rapid intervention in AFLP with acute pancreatitis after IVF.

Results of in vitro fertilization after diagnosis and treatment of chronic endometritis.

OBJECTIVE: A significant cause of infertility is the inability of the embryo to implant. Endometritis is one of the major causes affecting embryo implantation. The present study addressed the diagnosis and effects of chronic endometritis (CE) treatment on pregnancy rates after in vitro fertilization (IVF). PATIENTS AND METHODS: We conducted this retrospective study on 578 infertile couples treated with IVF. In 446 couples, we performed a control hysteroscopy with biopsy before IVF. In addition, we examined the visual aspects of the hysteroscopy and the results of the endometrial biopsies, followed by antibiotic therapy if necessary. Finally, the results of IVF were compared. RESULTS: Of the 446 cases studied, we diagnosed 192 (43%) with chronic endometritis, either by direct observation or based on the histopathological result. In addition, the cases diagnosed with CE we treated with a combination of antibiotics. The group diagnosed at CE and subsequently treated with antibiotic therapy had a significantly higher pregnancy rate after IVF (43.2%) than the group without treatment (27.3%). CONCLUSIONS: Hysteroscopic examination of the uterine cavity was particularly important for the success of IVF. The initial CE diagnosis and treatment were an advantage for the cases in which we performed the IVF procedures.

Importance of Follow-Up and Early Detailed Evaluation in Early Onset Growth Restricted Fetuses.

Early onset fetal growth restriction (EO-FGR) is associated with significant feto-maternal complications, therefore efforts should be made to identify the causes and the potential outcome of the pregnancy. Some of the pitfalls in first-trimester imaging of the fetal anomalies are related to the inadequacy of the examination, because of the fetal position and limited clarity in relation to the size of the structures being examined. In this paper we present a case where careful ultrasound scan follow-up and the use of both approaches transabdominal and transvaginal were useful to complete a detailed structural evaluation as part of the diagnosis, management and prognosis of a fetuses diagnosed with EO-FGR in the first trimester and a triploidy with atypical ultrasound features.

Ultrasound Evaluation of Fetal Biometry and Doppler Parameters in the Third Trimester of Pregnancy Suspected of Intrauterine Growth Restriction.

PURPOSE: The purpose of this study was to investigate fetal biometry and Doppler parameters in the third trimester of pregnancy with suspected restriction of fetal growth as potential predictors of unfavorable neonatal status. MATERIAL/METHODS: The uterine artery, umbilical and middle cerebral artery, cerebroplacental ratio (CPR), and estimated fetal weight (EFW) were evaluated in a cohort of 126 pregnancies that resulted in the birth of a fetus <10 percentiles (SGA). RESULTS: The demographic data of the studied cases did not show a significant difference between the parameters studied in the two study groups: Late SGA fetuses and Early SGA fetuses. Analyzing fetal biometry we found a significant difference for some parameters in relation to the two study groups. Our study showed that the Early SGA fetuses group had a lower birth weight, a lower gestational age at birth, an increase in the incidence of premature birth with an increase in Doppler abnormal incidence. CONCLUSIONS: Ultrasound examination and Doppler monitoring provide a non-invasive repetitive method for supervising fetuses with growth restriction in order to apply an adequate management.

The Importance of the Correlation between the Ultrasonographic Evaluation of Endometrium and Histopathological Findings in Patients with Endometrial Hyperplasia and Carcinoma.

PURPOSE: The aim of this study was to estimate how ultrasonographic evaluation of endometrium and histopathological findings are correlated in a group of premenopausal and postmenopausal women. MATERIAL AND METHODS: I have studied 106 premenopausal and postmenopausal women who underwent endometrial biopsy based on results of transvaginal ultrasonography. RESULTS: Mean age of patients was 52.29±8.14 years. Postmenopausal status <10 years was common in 20 patients (18.86%), postmenopausal status >10 years was common in 21 patients (19.81%), and premenopausal status in 65 patients (61.32%). Transvaginal sonography reported EH in 97 cases (91.50%) and EH was confirmed by pathology in 88 cases (83.01%). CONCLUSION: Endometrial thickness was correlated with histopathological diagnosis much better in postmenopausal women.

Utility of Cerebroplacental Ratio in IUGR Fetuses from Pregnancy with Preeclampsia in Prediction the Risk for Perinatal Complications.

PURPOSE: The aim of this study was to show that is the incidence of intrauterine growth restriction (IUGR) in women with preeclampsia (PE), assessment of cerebroplacental ratio (CPR) to establish the diagnostic value of CPR in fetuses with preeclampsia with/without IUGR. MATERIAL AND METHODS: We performed an analysis of 49 cases with gestational hypertension and PE and 16 cases with normal pregnancy for control lot, study in Obstetrics and Gynecology Clinic of the Municipal Hospital Filantropia, Craiova, between October 2013 and October 2015. It was performed clinical and laboratory evaluation and management of each case. CPR ratio was measured in the third trimester in all cases, being studied according to the normal and abnormal values obtained, following the evolution of the newborn. RESULTS: Mild PE cases were predominant with 21 cases (19.27%), severe PE accounted for 16 cases (14.68%) and gestational hypertension was found in 16 cases in our study. Distribution of IUGR cases presented interesting and contradictory data, because we met cases of IUGR in pregnancies without PE, at a rate of only 1.54%. The incidence of IUGR was significantly higher in cases with severe early-onset PE (10.20%). Cases of severe PE, but with late-onset, had IUGR in only 2.04% of cases. We found a significant statistical significance (p <0.005) on the incidence of IUGR in cases with severe early-onset PE. CPR identified adverse perinatal outcomes in 18.46% of cases with CPR <1.08. CONCLUSIONS: This study shows that early onset severe PE and concomitantly IUGR affects a significant proportion of pregnancies. CPR can be used to identify fetuses with an increased risk of intrauterine compromise.

Polytrauma and Multiple Severity Scores.

The initial assessment and management of seriously injured patients is a challenging task and requires a rapid and systematic approach. Injuries causing this mortality occur in predictable patterns and recognition of these patterns led to the development of advanced trauma life support (ATLS) by the American College of Surgeons, and standardized protocol for trauma patient evaluation has been developed. Different systems of trauma scoring have been developed. This study was conducted out of the need for unified scale to assess polytrauma patients from the moment patient are admitted in, till when discharged from Intensive Care Unit (ICU), so we compared the accuracy of few scoring systems in predicting mortality rate in polytrauma patients, and then assessed the cost-effectiveness applying these methods, and how much are these applicable. Here we chose 3 scoring systems: Glasgow Coma scale (GCS), Revised Trauma score (RTS) and Acute Physiology and Chronic Health Evaluation II scales (APACHE II). APACHE II system proved to be helpful in giving primary impression about case prognosis, and overall it reflects the quality level provided in the facility which is providing the health care for the polytraumatized patients, and it can be used as unified scale to compare the healthcare results and outcomes in different hospitals. APACHE II can be considered to be a largely accurate and applicable system for the polytraumatized patients but the association between three of scores offers better results about predicting prognosis of these patients.

The Predictive Value of Scores Used in Intensive Care Unit for Burn Patients Prognostic.

PURPOSE: Statistical evaluation of the prognosis of burned patients based on the analysis of prognostic scores as quickly and easily obtainable that track the evolution of burned patient in ICU. Material / Methods: The prospective study included 92 patients were performed with severe burns on 35-67% body surface large area, aiming to establish a cut-off score for each studied and statistically significant prognostic parameter for assessing the risk of mortality. The control group was represented by 20 patients with burns on the body surface of <10%. RESULTS: The death rate was not statistically significant on burned (p> 0.05) sex (male / female), but we had p <0.001 when we referred to the total body surface area, and p <0.05 when we took into account the degree burns, acute respiratory distress syndrome and age. For each index / prognostic score studied by making ROC curve when they take different values, we set a cut-off. Quantification of variables by calculating the area under the ROC curve (AUC), sensitivity and sensitivity, positive predictive value (PPV) and negative predictive value (NPV), allowed a better appreciation of these prognostic scores. CONCLUSIONS: These systems applicable to the burned patient scores, making a cut-off of each index / mortality probability score, he can manifest usefulness in medical decision making process and strategy to reduce the risk of death in patients with severe burns.

[Alternatives to allogenous blood transfusion]. / Metode alternative la transfuzia de sânge alogen.

Blood transfusion is usually meant to lower morbidity and mortality rates. Allogenous blood transfusion implies certain risks that can be avoided by autologous blood transfusions techniques including: preoperatory autologous blood donation, acute normovolemic hemodilution, intraoperatory and postoperatory blood salvage. Preoperatory blood donation and acute normovolemic hemodilution are used for planned interventions with an estimated blood loss higher than 20% of blood volume. These methods imply Erythropoietin and iron treatment. Intraoperatory and postoperatory blood salvage is performed by personnel trained in blood donation, handling and storage. Autologous blood transfusions are used for certain surgical procedures that commonly require transfusions: orthopedic surgery, radical prostatectomy, cardiovascular surgery, organ transplantation. An alternative to allogenous blood transfusion is the use of artificial oxygen transporters: human or animal hemoglobin solutions or pefluorocarbonate solutions. These solutions do not require cross reactions, do not carry diseases and are generally well tolerated and easily stored in the operating room, ambulance and other transport means. They have however a slight degree of toxicity.

Bilateral struma ovarii: a case mimicking an ovarian neoplasm.

We present a case of bilateral struma ovarii which developed postoperatively and was histopathologically diagnosed after the patient was hospitalized for investigation and treatment of tumoral anexal bilateral formations. There was no evidence of clinical malignancy or metastases. Data from the literature, together with histopathologic, diagnostic and therapeutic aspects of the disease were checked again taking into account the scarcity of this lesion, especially bilaterally.