Using IOTA terminology to evaluate fetal ovarian cysts: analysis of 51 cysts over 10-year period.

OBJECTIVES: To describe ultrasound features of fetal ovarian cysts as reported by the original ultrasound examiner, to apply International Ovarian Tumor Analysis (IOTA) terminology after retrospective analysis of the images and to describe patient management and evolution of fetal cysts during pregnancy and after delivery. METHODS: This retrospective observational study included pregnant women diagnosed on ultrasound examination with a fetal ovarian cyst at the Prenatal Diagnosis Division of the Bambino Gesù Children's Hospital, in Rome, between March 2011 and May 2020. Cysts were classified by the original ultrasound examiner as 'simple' (unilocular anechoic cyst) or 'complex' (cyst with other morphology). In addition, three ultrasound examiners, experienced in gynecologic ultrasound, classified retrospectively the fetal ovarian cysts according to IOTA terminology, by reviewing stored ultrasound images. The evolution of these fetal ovarian cysts during pregnancy and after birth was recorded. RESULTS: Included were 51 ovarian cysts in 48 fetuses. Of the 51 cysts, 29 (56.9%) had been classified by the original ultrasound examiner as 'simple', and 22 (43.1%) as 'complex'. Of the simple cysts, the majority (20/29 (69.0%)) resolved spontaneously after delivery, 2/29 (6.9%) resolved following intrauterine aspiration, 2/29 (6.9%) resolved after postnatal aspiration and 5/29 (17.2%) underwent surgery due to persistence after delivery; in all five, normal ovarian parenchyma without signs of necrosis was observed at histology. Of the complex cysts, 7/22 (31.8%) resolved spontaneously. The other 15/22 (68.2%) were removed surgically and, at histology, necrosis was observed in most (12/15 (80.0%)), while a benign epithelial cyst with normal ovarian parenchyma was observed in 3/15 (20%). After reviewing the ultrasound images and applying IOTA terminology, all 51 (100%) fetal cysts were described as unilocular; 29/51 (56.9%) cysts showed anechoic content (described as simple cysts by the original ultrasound examiner), and 10/51 (19.6%) had low-level, 1/51 (2.0%) had ground-glass, 9/51 (17.6%) had hemorrhagic, 1/51 (2.0%) had mixed and 1/51 (2.0%) had undefined content (all described as complex by the original ultrasound examiner). Among the 29 anechoic ovarian cysts, resolution was observed in most (24/29, 82.8%) cases. Similarly, resolution was observed in 7/10 (70.0%) cysts with low-level content. Resolution was not observed in any of the other 12 cysts and all of these cases underwent surgery, with evidence of necrosis being observed in 11 (91.7%). CONCLUSIONS: Applying IOTA terminology provided a more detailed and accurate description of fetal ovarian cysts compared with the original classification into 'simple' and 'complex' categories. Anechoic cysts (described as simple cysts by the original ultrasound examiner) and cysts with low-level content (described as complex by the original ultrasound examiner) frequently resolved spontaneously. Cysts with ground-glass, hemorrhagic, mixed or undefined content were frequently associated with necrosis at histology following surgery. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

[Nutrition, bone disease and alcoholic cirrhosis]. / Nutrición, enfermedad ósea y cirrosis alcohólica.

OBJECTIVES: To know the prevalence of osteopenia and osteoporosis in alcoholic cirrhotic males from 45 to 65 years old. To prove if the nutritional state is involved in the loss of bone mass in the hepatic disease. STUDY POPULATION: 52 alcoholic cirrhotic males from 45 to 65 years old, with normal kidney function, non-sedentary and with no treatment that could alterate the study. Design and variables: transversal descriptive study finished in 2 years. The nutritional state was evaluated by means of classic anthropometric parameters (weight, height, perimeter of the arm and skin folds) and total body densitometry (DPX plus LUNAR-DEXA with dual energy X-ray absorptiometry. STATISTICAL ANALYSIS: Mc Intosh computer (Filemaker PRO program). T Student was used to compare groups and p was significant if alpha alpha < or = 0.05. Clinical severity of cirrhosis: Child-Turcotte classification. RESULTS: Osteopenia was diagnosed if bone mineral density (BMD) was higher than 1 standard deviation (SD) but lower than 3 SD below T score (mean values for adult women) and osteoporosis (OP) if BMD was higher than 3 SD or vertebral compression fractures appeared in simple radiographies. The prevalence of bone disease was 58%. The percentages of fat obtained by means of anthropometric and densitometric measures were higher in non-osteopenic patients. DISCUSSION: The prevalence of bone disease was higher than another studies. The total body densitometry is a more exact method to measure the percentage of body fat. The percentages of fat obtained with both methods were not related to the loss of bone mass. The nutritional state as an isolated factor does not lead to bone disease in these patients.

[Bone metabolism and bone mass loss in eating disorders]. / Metabolismo óseo y pérdida de masa ósea en los trastornos de la alimentación.

Eating disorders (anorexia and bulimia nervosa) are present in 1-3% of young female women. A later beginning, prolonged amenorrhea and low body mass index are risk factors of osteopenia in bulimic patients. Bone demineralization in anorexia nervosa is due to a greater resorption than bone formation leading to osteopenia, secondary osteoporosis and increased risk of pathologic fractures. Pathophysiology of bone disease includes factors as long duration of amenorrhea, deficient absorption of calcium, extreme physical exercise, 1.25 vitamin D deficiency, low creatinine clearance, increased blood and urinary cortisol and high levels of GH. Proposed treatments are nutritional improvement and weight gain (the most important), calcium supplementation, moderate exercise, estrogens, antidepressive drugs, fluoride in selected cases, byphosphonates and recombinant human IGF-1. An adequate questionnaire is essential in women with slightly decreased weight and menstrual disorders.

[Multiple genetic typing (vitamin D receptors and estrogens) in the assessment of the risk of fractures]. / Papel de la tipificación genética múltiple (receptores de vitamina D y estrógenos) en la determinación del riesgo de fractura.

BACKGROUND: Several studies suggested that some vitamin D receptor (VDR) and estrogen receptor (ER) polymorphisms influence bone mass. However, others did not confirm these results. This study was undertaken to determine if the genotypes revealed by the combined analysis of VDR and ER polymorphisms are associated with clinically significant differences in peak bone mass and the risk of osteoporotic fractures. PATIENTS AND METHODS: Restriction fragment length polymorphisms of VDR were determined with the enzymes Bsml, Apal, Taql, and Fokl. Enzymes Xbal and Pvull were used as polymorphic markers of the ER. The study group comprised 149 young control women (18-34 years), 66 postmenopausal controls, 99 women with hip fracture and 76 women with osteoporotic vertebral fractures. Bone mineral density (BMD) was measured by DEXA. RESULTS: We did not find significant differences in lumbar spine or hip BMD among young women with different genotypes (determined with either single or multiple polymorphic markers). Likewise, there were no differences in the frequency distributions of VDR or ER alleles between control and fractured women. The study had a 77% power to detect a fracture odds ratio of 2 in case of genotypes present in at least 15% of the population. CONCLUSIONS: These results suggest that the polymorphic markers used in this study do not have enough discriminant power to be clinically useful in the assessment of fracture risk.

[Pulmonary epidermoid carcinoma in a 22-year-old patient with multiple cutaneous metastasis]. / Carcinoma epidermoide pulmonar en paciente de 22 años con metástasis cutáneas múltiples.

The authors present one clinical case of lung epidermoid carcinoma with several concurrent features which are uncommon in relation to this type of neoplasia. Consequently, the age of the patient (22), the lack of known risk factors, the histologic type (little differentiated squamous) and an aggressive biologic behaviour of the tumour, preceded of multiple cutaneous metastasis, are circumstances that make this clinical case exceptional. The more significative aspects present at lung carcinoma included in this age group respect to others are analyzed.

[Peritoneal pseudomyxoma secondary to mucinous cystadenoma of the ovary]. / Pseudomixoma peritoneal secundario a cistoadenoma mucinoso de ovario.

We present a new case of pseudomyxoma peritonei secondary to a mucinous cystadenoma of the ovary, whose presenting symptoms were abdominal distension and bilateral hernias. This is an uncommon entity and diagnosis tends to be casual. Each day, ultrasonography and computed tomography are more useful in suspicion. Aggressive surgical debulking followed by intraperitoneal chemotherapy seem to be the better treatment, even though controversies persist.

[Relapsing polychondritis with atypical presentation]. / Policondritis recidivante de presentación atípica.

Relapsing polychondritis is an episodic systemic disorder, characterized by recurrent inflammation that affects cartilaginous structures, the cardiovascular system, eyes and ears. Although the etiology is unknown, experimental evidence strongly suggest that immunologically mediated mechanisms are implicated. Auricular, articular and nasal manifestations are the most frequent disturbances. In about 30% of cases, relapsing polychondritis is associated with other connective tissue diseases and vasculitis. Actually, the diagnosis is based on the criteria proposed by McAdam, and modified by Damiani. We present a case, whose first manifestations of relapsing polychondritis were an intermittent fever and transient arthralgias. Eight months later, auricular chondritis appeared, and gave us the key to diagnosis.

[Varicella pneumonia in the adult]. / Neumonía por varicela en el adulto.

In the adult, the primary infection by the varicella-zoster virus acquires an unusual severity due to several complications, the most frequent of them being pneumonia. The authors analyze the clinical, epidemiological, serological and radiological data of the only two cases of varicellous pneumonia in the adult at a general hospital during the past 5 years. They highlight as the main characteristics: easiness of diagnosis, dissociation between clinical and radiological signs and the excellent therapeutical response to the early administration of intravenous Aciclovir. They comment as well the risk factors of this complication and the criteria for hospitalization.

[Hemodynamic impact of tension ascites and evacuatory paracentesis]. / Repercusiones hemodinámicas de la ascitis a tensión y de la paracentesis evacuadora.

Cardiac function is studied with regular hemodynamic determinations and 2D-doppler echocardiography, in 22 patients with massive ascites. Patients were divided in two groups: 1. Hepatic cirrhosis (n = 12) and 2. Peritoneal carcinomatosis (n = 10). Patients with carcinomatosis showed lowered heart-beat volume, cardiac output, ventricular work and ejection fraction in comparison with cirrhotic patients. In cirrhotic patients the hemodynamic study was done before and after an evacuatory paracentesis, following which an improvement in cardiac function was shown, with significant increments in heart-beat volume, cardiac output, ventricular work, and ejection fraction. 42% of the cirrhotic patients showed an hyperdynamic circulatory status in the baseline study, but after paracentesis this hyperkinetic status was present in 100% of the patients. It is suggested that tension ascites influences negatively in cardiac function because it difficult the venous return. This depression in the ventricular function is more obvious in patients with carcinomas that in cirrhotic patients due to the fact that the former do not have a previous circulatory status.

[Acute suppurative thyroiditis and Klebsiella pneumoniae sepsis. A case report and review of the literature]. / Tiroiditis aguda supurada y sepsis por Klebsiella pneumoniae. Presentación de un caso y revisión de la literatura.

The acute suppurative thyroiditis is a rare infection. It affects specially patients with preexisting thyroid gland pathology and its frequency is higher in women. In childhood it's linked to local anatomic defects. The infection used to be located in left thyroid lobe and it's much less usual in right lobe, in both or in isthmus. The most important causal microorganisms are staphylococci (Staphylococcus aureus overcoat) and streptococci (usually Streptococcus pyogenes and Streptococcus pneumoniae), with frequent isolation of mixed flora and anaerobes in the last reported cases. We present the case of a male patient, without previous thyroid disease, who suffered an acute suppurative thyroiditis and Sepsis due to Klebsiella pneumoniae, with right lobe abscess and secondary septic focus formation (kidneys, spleen, lungs), with fatal course despite of medical treatment, favoured or precipitated by the development of serious alcoholic abstinence.

[Yersiniosis in a general hospital in the Basque country (1984-1989). Clinical and epidemiological aspects]. / Yersiniosis en un hospital general del País Vasco (1984-1989). Aspectos clínico-epidemiológicos.

BACKGROUND: The features of the diseases caused by Yersinia have not been properly evaluated in the Basque Country. The present study was performed to assess the incidence and consequences of this infection. METHODS: 51 cases of Yersinia infection in a general hospital during the period 1984-1989 were reviewed. Clinical, epidemiological, microbiological, and therapeutic data and the hospital stay were evaluated. RESULTS: 62% of patients were males with a mean age of 16 +/- 19.4 years. Most came from urban areas. 40% of cases developed in winter and 32% in summer. The presenting features were: acute gastroenteritis (66%), pseudoappendicitis (10%), sepsis (4%), lymphadenopathy (2%) and others (18%). 40% of the patients had significant underlying diseases, and 16% had complications attributable to the infection. The microbiological diagnosis was made by stool culture in 88%. 96% corresponded to Yersinia enterocolitica (biotype 4), serogroup 0: 3 (93%). Yersinia pseudotuberculosis was isolated from the culture of a cervical lymph node in one patient. In the Yersinia enterocolitica strains the most common antibiotic resistances were to ampicillin (87%), cephalotin (81%), ticarcillin (75%), mezlocillin (43%) and piperacillin (43%). The mean hospital stay was 6.1 +/- 12.2 days and it was significantly shorter in children (3.3 +/- 6.1%) than in the adult population (10.9 +/- 17.4) (p less than 0.05). It was longer in patients with underlying diseases (13.3 +/- 17.8 vs 3.3 +/- 5.6) (p less than 0.005). CONCLUSIONS: Our patient population had male and urban predominance. Most infections were caused by Yersinia enterocolitica and presented as acute gastroenteritis, without differences between winter and summer. We point out to the relationship between Yersinia infection, abnormalities in iron metabolism and immunosuppression. There were few complications of the infection. The mean hospital stay was directly correlated with age and underlying diseases.

[Somatostatin and ventricular function in liver cirrhosis]. / Somatostatina y función ventricular en cirrosis hepática.

Left ventricular function is studied in cirrhotic patients and in patients with alcoholic hepatitis by means of isotopic ventriculography (Tc99m) both in basal conditions and after the i.v. injection of a somatostatin bolus (250 mcg). The results obtained are compared to those of conventional hemodynamics. Basal ventricular function is normal in both groups and somatostatin induces a significant decrease (p less than 0.001) in heart rate (74 + 12 vs 67 + 11 bpm), ejection fraction (60 + 6 vs 57 + 65) and maximal ejection rate (-3.3 + 0.4 vs -2.0 + 0.3) in patients and normal controls respectively. The hormone induces a significant increase (p less than 0.01) in telediastolic pressure of the left ventricle (8.1 + 4 vs 21 + 7 mmHg) with no change in systemic resistance. The results suggest that somatostatin has a negative inotropic effect on the heart as well as causing bradycardia.