Cystic dilatation of umbilical cord associated with patent urachus.

An urachus is a remnant of allantois in embryo development constituting a connection between the dome of the bladder and umbilicus. It develops on day 16 after conception and closes during the pregnancy to form the median umbilical ligament. Patent urachus results from a failure in closing its lumen in 10-12 gestational weeks. This anomaly occurs in 1-2 babies in 100,000 births. We present the case of patent urachus. In 20 gestational weeks, a dilatation of the umbilical cord with an anechoic mass with a transverse dimension of 19 x 12 mm starting from the fetal insertion and length of 30 cm was seen on ultrasound without any other fetal and placental disorders. Histology showed cystic edema. Prenatal diagnosis of patent urachus can be difficult because this pathology may be mistaken with other, more dangerous causes of cord cysts; thus, the occurrence of cord cysts should be closely monitored.

Women with inflammatory bowel diseases have a suboptimal cervical cancer screening rate and are not aware of the recommended human papilloma virus vaccine.

The aim of the study was to assess the self-reported cervical cancer screening rate among patients with inflammatory bowel diseases (IBD) and patient attitude towards human papilloma virus (HPV) vaccination. A self-designed survey was conducted in hospitalized IBD patients. The survey comprised demographic data, questions regarding cervical smear test frequency and vaccinations recommended for an IBD patient. Randomly, patients completed the survey with a physician present to determine question comprehension. In order to provide test-retest reliability a group of 10 patients completed it twice. Survey data from 150 IBD patients (mean age: 36 years, SD ± 13; mean IBD duration: 10 years, SD ± 6.5) were analyzed. Fifteen percent of the patients reported irregular cervical testing and 15% do not remember when having had a previous cervical testing performed. Only 69% of the patients undergo testing regularly; 30% annually, 32% every 2-3 years; 7% every 5 years. The mean age of patients tested regularly was 22 years, vs. 32 years tested irregularly (p < .001). Only 10% of women claimed that HPV vaccine is recommended for an IBD patient. There is a low adherence to the recommendations regarding cervical cancer screening and prophylaxis. Better multi-disciplinary cooperation between patients and physicians is required to improve patient education and outcomes.

Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assessment in pregnant women - preliminary report.

OBJECTIVES: The study aimed at determining whether there exists a correlation between the cervical cohesion parameters assessed in the elastography and the length of the cervix. MATERIAL AND METHODS: Assessment of cervical cohesion parameters with the use of real-time sonoelastography was performed on 59 patients between 28 and 39 weeks of gestation. RESULTS: The analysis showed that there exists a statistically significant (p=0.033) correlation between the cervical length and the elasticity of the front cervical labium (strain ratio A). Correlation coefficient (r) stood at (-) 0.28. CONCLUSIONS: 1. There exists a negative correlation between the condition on the front cervical labium in elastographic imaging and the length of the cervical canal in USG imaging. 2. Elastography of the uterine cervix may be helpful in assessing the risk of premature labour or cervical insufficiency. 3. There is a need to perform a study on a larger group of patients in order to determine whether elastography may find its place among routine obstetric diagnostic methods.

Nonimmune hydrops fetalis.

BACKGROUND: Nonimmune hydrops fetalis (NHF) is an abnormal accumulation of fluid - especially serous - in visceral cavities and soft tissues. This condition may be caused by: cardiovascular diseases, chromosomal disorders, infections, lung, stomach, intestinal, kidneys, urinary tract and blood diseases, metabolic disorders and tumors. NHF may by diagnosed by an ultrasound scan. THE AIM of the study was to present diagnostic and therapeutic difficulties as well as management with reference to NHF. CASE STUDY: An abnormal accumulation of fluid in visceral cavities and subcutaneous tissue of two fetuses was diagnosed by an ultrasound scan. Despite a detailed and specific diagnostic proceeding which included: infections, congenital malformations, chromosomal abnormalities etc. it was impossible to establish the cause of NHF. The symptomatic therapy was performed: periodic cordocentesis with an injection of human albumin solutions. In case of the first fetus therapeutic thoracocentesis was performed. The fetuses were delivered in 32nd and 31st week of pregnancy. Both neonates survived but even after the delivery it was impossible to establish the cause of NHF. CONCLUSIONS: Multidirectional diagnostic approach is essential for the implementation of causal treatment of NHF. In case of idiopathic NHF the only management is symptomatic therapy, fetal monitoring and preterm delivery.

[Prenatal diagnosis of triploidy]. / Diagnostyka prenatalna triploidii.

Triploidy is one of the most common chromosomal numerical aberrations, resulting usually from one out off two main mechanisms: aberrant segregation of chromosomes during meiosis or from the fertilization of one egg by two sperms. Triploidy usually causes prenatal death. In present paper the methods of non-invasive and invasive prenatal diagnosis of triploidy are described. We also report the case of triploid fetus, diagnosed by ultrasound visualisation followed by amniocenthesis and cytogenetic analysis.

[Prenatal diagnosis of triploidy]. / Diagnostyka prenatalna triploidii.

Triploidy is one of the most common chromosomal numerical aberrations, resulting usually from one out off two main mechanisms: aberrant segregation of chromosomes during meiosis or from the fertilization of one egg by two sperms. In present paper the methods of non-invasive and invasive prenatal diagnosis of triploidy in I and II trimester are described. We also report the case of triploid fetus, diagnosed by ultrasound visualisation followed by amniocenthesis and cytogenetic analysis.

[Leukemic reaction in the course of uterine myoma and urinary tract infection in pregnancy]. / Odczyn bialaczkowy u ciezarnej w przebiegu stanu zapalnego misniaka macicy i zakazenia ukladu moczowego.

A leukaemic reaction is an increase of leukocytes count in peripheral blood between 20-50 G/l with significant percentage of immature white blood cells: metamyeloblasts, myelocytes and even myeloblasts in blood smear. The leukaemic reactions during cancers and many infections diseases, especially in the pregnancy, by their clinical symptoms and laboratory changes can imitate acute and chronic leukaemias. In this article we introduce a pregnant woman with the leukaemic reaction with leucocyte count 51 G/l and a presence of immature white blood cells with myeloblasts in peripheral blood smear. This leukaemic reaction was caused by inflammatory process in the myoma uteri and the urinary tract.

[Uterine myomas in pregnancy]. / Miesniaki macicy w ciazy.

In this paper different views regarding the diagnosis and management of uterine myomas during pregnancy, delivery and puerperium are presented. A review was done of the complications which may develop during pregnancy depending on the sizes of the myomas and their localization in relation to the placenta. Indications for operative management of uterine myomas, given by various authors are presented. Controversies connected with enucleation of uterine myomas in pregnancy are described. Indications, contraindications as well as possible complications regarding enucleation of uterine myomas in pregnancy which appear in the bibliography are presented. An analysis was done of the possible dangers which threaten women with uterine myomas during puerperium. On the basis of our own experience, the authors are of the opinion that only abiding by the indications for enucleation of uterine myomas in pregnancy and during caesarean sections, can bring about good results. Management of women who have uterine myomas must be cautious and devoid of routine.

[Stromal sarcoma in pregnancy--a case report]. / Miesak podscieliska w ciazy--opis przypadku.

In this paper a case of a young pregnant woman with a uterine tumour of 9 cm in size, which was diagnosed as leiomyoma is presented. The patient was delivered at 33 weeks through caesarean section, during which abdominal viscera were found to be normal. Due to the size of the tumour, as well as its localisation--in the uterine wall in the vicinity of the big uterine vessels--an operation to excise it was postponed until after the puerperium period was over. After a few weeks the patient developed intensive abdominal pains. A computer tomography scan was done in which apart from swelling of the retroperitoneal lymph nodes, metastatic type changes in the lungs were also observed. Suspicion of a malignant uterine tumour was confirmed during operation, however due to the extensive progress of the disease a radical operation was not possible. In the histopathological examination stromal sarcoma was revealed. In spite of attempts at using chemotherapy and hormonotherapy no positive effect was achieved. Rapid development of the sarcoma led to the death of the patient after 4 months.