In-utero aspiration vs expectant management of anechoic fetal ovarian cysts: open randomized controlled trial.

OBJECTIVE: To assess the efficacy and safety of in-utero aspiration (IUA) of anechoic fetal ovarian cysts. METHODS: This multicenter, prospective, randomized open trial in two parallel groups included women from nine outpatient fetal medicine departments with singleton pregnancy ≥ 28 weeks of gestation and a female fetus with an ultrasound-diagnosed simple ovarian cyst, defined as a single fully anechoic cystic structure measuring ≥ 30 mm. They were allocated randomly to IUA under ultrasound guidance or expectant management. All procedures were performed by trained senior obstetricians. Primary outcome was need for neonatal intervention, by laparoscopy, laparotomy or transabdominal aspiration. Secondary outcomes were in-utero involution of the cyst and oophorectomy at birth. Analyses were conducted according to the intention-to-treat principle. RESULTS: Of 61 participants, 34 were allocated to IUA and 27 to expectant management. Three IUA procedures (9%) could not be performed (one due to fetal position and two due to aspirations being dry). The remaining 31 IUA procedures were uneventful. The incidence of neonatal intervention did not differ significantly between the IUA and the expectant management groups (20.6% vs 37.0%; relative risk (RR), 0.55; 95% CI, 0.24-1.27). Nonetheless, IUA was associated with increased incidence of in-utero involution of the cyst (47.1% vs 18.5%; RR, 2.54; 95% CI, 1.07-6.05) and reduced rate of oophorectomy (3.0% vs 22.0%; RR, 0.13; 95% CI, 0.02-1.03) compared with expectant management. CONCLUSION: IUA of anechoic fetal ovarian cysts, compared with expectant management, was not associated with a reduction in overall neonatal interventions but was associated with a reduced oophorectomy rate. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Pregnancy and primary Sjögren's syndrome: management and outcomes in a multicentre retrospective study of 54 pregnancies.

OBJECTIVES: Primary Sjögren's syndrome (pSS) is one of the most common autoimmune diseases, mainly affecting women during the fourth decade of life. During pregnancy, the presence of anti-Ro/SSa and anti-La/SSb antibodies increases the risk of congenital heart block (CHB). Foetal and pregnancy outcomes in pregnant women with pSS compared with the general population are difficult to evaluate because of confounding factors including age and body mass index (BMI). METHOD: The aim of this case-control study was to analyse the impact of pSS in pregnant women on foetal and pregnancy outcomes. RESULTS: We enrolled 19 women with pSS (54 pregnancies) matched by age and BMI to 216 controls. Patients with pSS delivered significantly earlier (38 weeks + 3 days vs. 39 weeks + 2 days) and experienced more spontaneous abortions [< 22 weeks of gestation (WG)] than the controls [n = 16/54 (30.0%) vs. n = 1/216 (0.4%); p < 0.00001]. Preterm delivery (≤ 37+6 WG) was significantly higher in the pSS group than in the control group (29% vs. 12%, p = 0.04). pSS activity significantly affected the birthweight percentile, which was lower in pregnancies occurring after the diagnosis of pSS than in those occurring before (32.43 ± 21.57 vs. 60.46 ± 27.37; p = 0.008). No case of CHB was observed. CONCLUSIONS: pSS is responsible for an increased risk of spontaneous abortion. The duration of pregnancy is lower in patients with than without pSS, with more premature deliveries. Pregnancies that occur after the onset of the disease result in lower birthweight percentile children than when pSS is not clinically overt.

Photocatalytic degradation of an azo-dye on TiO2/activated carbon composite material.

A sequential adsorption/photocatalytic regeneration process to remove tartrazine, an azo-dye in aqueous solution, has been investigated. The aim ofthis work was to compare the effectiveness of an adsorbent/photocatalyst composite-TiO2 deposited onto activated carbon (AC) - and a simple mixture of powders of TiO2 and AC in same proportion. The composite was an innovative material as the photocatalyst, TiO2, was deposited on the porous surface ofa microporous-AC using metal-organic chemical vapour deposition in fluidized bed. The sequential process was composed of two-batch step cycles: every cycle alternated a step of adsorption and a step of photocatalytic oxidation under ultra-violet (365 nm), at 25 degreeC and atmospheric pressure. Both steps, adsorption and photocatalytic oxidation, have been investigated during four cycles. For both materials, the cumulated amounts adsorbed during four cycles corresponded to nearly twice the maximum adsorption capacities qmax proving the photocatalytic oxidation to regenerate the adsorbent. Concerning photocatalytic oxidation, the degree of mineralization was higher with the TiO2/AC composite: for each cycle, the value of the total organic carbon removal was 25% higher than that obtained with the mixture powder. These better photocatalytic performances involved better regeneration than higher adsorbed amounts for cycles 2, 3 and 4. Better performances with this promising material - TiO2 deposited onto AC - compared with TiO2 powder could be explained by the vicinity of photocatalytic and AC adsorption sites.

Fetal obstructive uropathy complicated by urinary ascites: outcome and prognostic value of fetal serum ß-2-microglobulin.

OBJECTIVES: To determine whether the prognostic value of fetal serum ß-2-microglobulin is altered and whether the occurrence of fetal urinary ascites prevents kidney damage in cases of fetal obstructive uropathy with urinary ascites. METHODS: This was a retrospective study of cases of fetal bilateral obstructive uropathy that occurred between 2006 and 2010, for which both fetal serum and ascites samples were sent to our laboratory for analysis. ß-2-microglobulin was assayed in both fetal serum and the corresponding ascites. Renal outcome was analyzed. Histological features of the kidney in cases of termination of pregnancy and renal function of liveborn infants were recorded. RESULTS: Fourteen cases with analysis of fetal serum and fetal ascites in a context of urinary obstruction were included. Renal outcome was unfavorable in eight cases (57%) and favorable in six (43%). When fetal serum ß-2-microglobulin was < 5 mg/L, renal outcome was favorable in all cases (4/4). When fetal serum ß-2-microglobulin was ≥ 5 mg/L, 8/10 cases (80%) had an unfavorable renal outcome (sensitivity, 100%; specificity, 66%). CONCLUSION: Fetal serum ß-2-microglobulin reliably predicts postnatal renal outcome in obstructive uropathy complicated by urinary ascites. Moreover, urine extravasation does not seem to protect fetal renal function.

Prenatal diagnosis of lobar bronchial atresia.

We report three cases of fetal lobar bronchial atresia referred to our Fetal Medicine Center during the mid-trimester of pregnancy over the last 15 years. Lobar bronchial atresia can mimic a main stem bronchial atresia on mid-trimester ultrasound examination as it induces extensive lobar enlargement, major mediastinal shift and eversion of the diaphragm. It was associated with severe pulmonary hypoplasia in all three cases, even though polyhydramnios and ascites were absent in two. Termination of pregnancy was performed at parental request after extensive counseling in each of the cases and necropsy confirmed one or two enlarged lung lobes leading to major compression of the remaining lobe(s) of the ipsilateral lung, the contralateral lung and the heart. No other anomalies were observed and the karyotype was normal in all cases.

Competitive adsorption of phenolic compounds from aqueous solution using sludge-based activated carbon.

Preparation of activated carbon from sewage sludge is a promising approach to produce cheap and efficient adsorbent for pollutants removal as well as to dispose of sewage sludge. The first objective of this study was to investigate the physical and chemical properties (BET surface area, ash and elemental content, surface functional groups by Boehm titration and weight loss by thermogravimetric analysis) of the sludge-based activated carbon (SBAC) so as to give a basic understanding of its structure and to compare to those of two commercial activated carbons, PICA S23 and F22. The second and main objective was to evaluate the performance of SBAC for single and competitive adsorption of four substituted phenols (p-nitrophenol, p-chlorophenol, p-hydroxy benzoic acid and phenol) from their aqueous solutions. The results indicated that, despite moderate micropore and mesopore surface areas, SBAC had remarkable adsorption capacity for phenols, though less than PICA carbons. Uptake of the phenolic compound was found to be dependent on both the porosity and surface chemistry of the carbons. Furthermore, the electronegativity and the hydrophobicity of the adsorbate have significant influence on the adsorption capacity. The Langmuir and Freundlich models were used for the mathematical description of the adsorption equilibrium for single-solute isotherms. Moreover, the Langmuir-Freundlich model gave satisfactory results for describing multicomponent system isotherms. The capacity of the studied activated carbons to adsorb phenols from a multi-solute system was in the following order: p-nitrophenol > p-chlorophenol > PHBA > phenol.

Prenatal diagnosis of thrombosis of the dural sinuses: report of six cases, review of the literature and suggested management.

OBJECTIVES: To describe and assess the sonographic findings, evolution and clinical implications of thrombosis of the fetal dural sinuses. METHODS: We compiled a multicenter report of the outcomes of five cases with a prenatal diagnosis of thrombosis of the dural sinuses, and one case in which thrombosis of the dural sinus was diagnosed at necroscopy after termination of pregnancy. Prognostic factors are discussed, and suggestions made for prenatal and postnatal management. RESULTS: The mean (range) gestational age at diagnosis of thrombosis of the dural sinuses in the five cases in which it was made prenatally was 25.2 (22-31) weeks. In these five cases, diagnosis was made by sonography and confirmed by magnetic resonance imaging (MRI), which showed a blood clot in the region of the torcular herophili. Three of the six cases delivered vaginally with favorable sonographic findings, and normal clinical neurological development. Two pregnancies were terminated at the request of the parents. In one of these cases the prognosis was poor, with signs of fetal decompensation or cardiac failure; the pregnancy was terminated and necropsy revealed thrombosis of the occipital dural sinuses associated with a hemangioma. One infant, in whom the thrombosis developed in conjunction with a dural sinus malformation, died at 4 months of age. CONCLUSIONS: Thrombosis of the cerebral venous circulation can occur antenatally and is detectable by fetal real-time and color Doppler ultrasound examination. A review of the literature supports targeted evaluation of the fetus by serial ultrasound imaging and MRI to help guide the diagnosis, and to improve the counseling and management of such cases. Partial or total regression, isolated abnormality, absence of fetal decompensation or signs of cardiac failure and favorable clinical evolution are suggestive of favorable prognosis. In such cases, non-interventional neonatal management is recommended.

Ultrasound in gas-liquid systems: effects on solubility and mass transfer.

The effect of ultrasound on the pseudo-solubility of nitrogen in water and on gas-liquid mass transfer kinetics has been investigated in an autoclave reactor equipped with a gas induced impeller. In order to use organic liquids and to investigate the effect of pressure, gas-liquid mass transfer coefficient was calculated from the evolution of autoclave pressure during gas absorption to avoid any side-effects of ultrasound on the concentrations measurements. Ultrasound effect on the apparent solubility is very low (below 12%). Conversely ultrasound greatly improves gas-liquid mass transfer, especially below gas induction speed, this improvement being boosted by pressure. In typical conditions of organic synthesis: 323 K, 1100 rpm, 10 bar, k(L).a is multiplied by 11 with ultrasound (20 kHz/62.6 W). The impact of sonication is much higher on gassing out than on gassing in. In the same conditions, this enhancement is at least five times higher for degassing.

[Congenital lobar emphysema: a rare etiology of hyperechoic lung]. / Une étiologie rare de poumon hyperéchogène: l'emphysème lobaire géant congénital.

Lobar congenital emphysema is a rare pulmonary malformation corresponding to progressive overinflation of a pulmonary lobe secondary to partial bronchial obstruction. Prenatal diagnosis is mainly based on lung hyperechoic area. Sonographic features are not specific highlighting the interest of fetal MRI or postnatal tomodensitometry. This case report describes prenatal detection including pitfalls and postnatal management.

[Breech presentation and vaginal delivery: evolution of acceptability by obstetricians and patients]. / Accouchement du siège par voie vaginale: évolution de l'acceptabilité par les obstétriciens et les patientes.

OBJECTIVE: To investigate the influence of obstetrician and patient respectively on mode of delivery in case of breech presentation at term. PATIENTS AND METHODS: This retrospective study included all women with a singleton pregnancy in a breech presentation delivered at term in a tertiary care maternity unit from January 1998 to December 2004. Mode of delivery was suggested by a score based on maternal age, parity, obstetrical past history, radiopelvimetry and cephalopelvic confrontation. The obstetrician was free to follow or not the score indication and patient's informed consent was required concerning the mode of delivery. Our main outcome measurements were mode of delivery and neonatal parameters. RESULTS: Two hundred cases were identified. Elective cesarean section increased progressively (from 52% in 1998 to 80% in 2004 [P=0,002]). Neonatal status and proportion of score in favour of vaginal birth remained stable during the study period. The rise in cesarean section rate was mainly due to patient's request (P=0,001) whereas the trend of obstetrician in favour of cesarean did not reach significance (P=0,3). DISCUSSION AND CONCLUSION: The rise of elective cesarean section for term breech delivery in a maternity unit using a predefinite score is mainly induced by patient's request. This evolution has no effect on neonatal status.

[Congenital mucocele of the ventral face of the tongue]. / Mucocèle congénitale de la face ventrale de la langue.

BACKGROUND: Congenital cystic lesions of the oral cavity are an extremely rare occurrence. Their prenatal diagnosis is essential since they can impede respiratory and swallowing functions. We describe a case that was detected prenatally and discuss its management. CASE REPORT: A 21-year-old primigravida patient who was 23 weeks pregnant was referred to our obstetrics and gynecology center after fetal ultrasonography showed a cystic lesion of the oral cavity. She had no family history of any congenital anomalies. Ultrasonography showed a male fetus with an anechoic mass measuring 21×11 mm encompassing the entire oral cavity, evoking either a mucocele or a cystic hygroma. Magnetic resonance imaging (MRI) showed a fetus with a wide-open mouth, due to a well-demarcated protruding cystic mass with no solid component, suggestive of a mucocele. A prenatal sonographically guided percutaneous needle aspiration of mucous fluid was performed at 33 gestational weeks. Although the mucocele decreased significantly in size, it nevertheless continued to expand progressively. After an uncomplicated pregnancy, the patient had spontaneous onset of labor at 39 weeks of gestation. An iterative aspiration was performed in the same manner in utero, resulting in a complete collapse of the mucocele. If needed, intubation could be considered. A 3030-g male was born by vaginal delivery, without respiratory distress. Clinical examination showed the extremely opened mouth and confirmed the presence of a large cystic mass approximately 4 cm in diameter, of sublingual origin and encompassing the entire oral cavity. The continuous protrusion of the tongue was responsible for the infant's inability to close the mouth and be breastfed. After insertion of a feeding tube, the newborn had maxillofacial surgery consisting in marsupialization of the cyst at 2 days of age. The mucocele decreased in size and the postoperative course was uneventful. No recurrence was observed at 6 months' follow-up. DISCUSSION AND CONCLUSION: Congenital mucoceles of the tongue are very rare benign lesions of the oral cavity, resulting from extravasation or retention of mucus from minor salivary glands. Their prevalence is unknown and, to our knowledge, less than ten cases of prenatal diagnosis have been previously reported. Such cystic lesions can cause respiratory distress and swallowing disorders in newborns. They are usually suspected on ultrasonography. MRI highlights the nature of the lesion and its locoregional connections with muscles and blood vessels. It provides a good analysis of the soft tissues and can distinguish between the muscles of the tongue and the pathologic mass. However, the use of CT has been reported when the diagnosis was made after childbirth or in adulthood. Given the risks of interference of the lesion with respiratory and swallowing functions, intrauterine decompression of the mucocele can be an option to prevent respiratory distress at birth and the need for neonatal intubation. Mucoceles provide somewhat confusing and disturbing ultrasonographic appearances, which can be stressful for the medical team and parents. Prenatal diagnosis and early surgical intervention (marsupialization, complete excision of the cyst or the salivary gland) can prevent risks of breathing distress and breastfeeding problems. Therefore, this strategy is essential to offer fast and satisfactory management of this rare but anxiety-producing congenital situation.

Influence of ultrasound on mixing on the molecular scale for water and viscous liquids.

Micromixing has a decisive action on the yield of fast reactions such as combustions, polymerizations, neutralizations and precipitations. The aim of this study was to test the possible effect of ultrasound on micromixing, through the phenomenon of acoustic cavitation. To evaluate the local state of micromixing, we used a system of parallel competing reactions involving the Dushman reaction between iodide and iodate, coupled with a neutralization. At first, we studied the effects of the acoustic frequency on micromixing (20-540-1000 kHz). It was found that micromixing through acoustic cavitation and acoustic streaming was more important at 20 kHz than at 540 kHz or 1 MHz. At high and low frequency, it was shown that the injection must be located near the ultrasonic emitter. The influence of the acoustic intensity proved to be predominant mostly for low intensities; for an acoustic intensity of 10 W cm(-2), a characteristic micromixing time of about 0.015 s has been obtained. Viscous media have been studied and experiments showed that micromixing is more difficult to achieve than in aqueous media, but that ultrasound may be as effective as classic stirring.

Modelling of free radicals production in a collapsing gas-vapour bubble.

This paper deals with a model linking bubble dynamics under an acoustic pressure field and production of free radicals in the resulting collapses of this bubble. The bubble dynamics model includes interdiffusion of gas and vapour in the bubble as well as evaporation or condensation at the interface, and it assumes uniformity of the internal pressure and perfect gas law for the gas vapour mixture. At the maximum compression of the bubble, all the reactions of dissociation which can occur are assumed at thermodynamic equilibrium. The local composition (especially in free radicals) in the bubble is then calculated by an algorithm based on free energy minimization using the information concerning the maximum compression provided by the bubble dynamics model resolution. Using this model a comparison of free radicals production has been made for two different driving frequencies (20 kHz and 500 kHz), and at given bubble radius and acoustic pressure, an optimum of liquid bulk temperature has been derived for the production of free radicals very similar to the experimental one concerning oxidation reactions in aqueous phase.

Growth rate of potash alum crystals: comparison of silent and ultrasonic conditions.

The influence of power ultrasound on the growth rate of potash alum was investigated. The experiments on growth of potash alum crystals were carried out in a stirred double jacket tank in silent conditions as well as in the presence of power ultrasound (20 kHz) at 32 degrees C, with different initial crystal sizes. It was observed that the mass growth rate of potash alum was faster under ultrasound compared to that under silent conditions. The shape was not modified by ultrasound but the size of crystals, which are grown under ultrasound, are smaller and with higher density compared to those grown under silent conditions.

A comparative study of local sensors of power ultrasound effects: electrochemical, thermoelectrical and chemical probes.

In order to propose standard methods for the local measurement of the effects of power ultrasound inside a reactor, we compare three methods: a chemical dosimeter (Weissler reaction), a thermal sensor (embedded thermocouple) and an electrochemical probe (developed in our laboratory). The same emission device, i.e. the resonant tube (Sonitube-Sodeva), was used for all these methods. Similar trends were observed using various measurements: ultrasound effects vary significantly along the tube axis (due to standing waves in the resonant tubular emitter), but only slightly from the tube axis to the wall. More reliable and reproducible results were obtained with the thermal and electrochemical probes than with the chemical dosimeter.

Comparison of ultrasound effects in different reactors at 20 kHz.

To compare the performances of three power ultrasonic devices at 20 kHz: a horn, a cup horn and a tube, the local intensity distributions of local effects of cavitation have been investigated. The sensor is an electrochemical probe, measuring the solid-liquid mass transfer rate, related to the cavitation intensity. The axial and radial profiles of mass transfer coefficients have been investigated in three devices, at various power inputs. In all these equipments very strong heterogeneities have been characterized, whether a standing wave appears or not.

Crystallization of potash alum: effect of power ultrasound.

The influence of power ultrasound on the crystallization of potash alum was investigated. Experiments have been carried out in a batch stirred vessel. It was found that ultrasonic waves decrease the supersaturation limits and modify the morphology of the crystals produced. The average crystal size decreases with an increase of ultrasonic power. To investigate also the action of ultrasound on already existing crystals, crystals produced in silent conditions were suspended in saturated potash alum solution at various ultrasonic powers. The results show that ultrasound has also an abrasive effect on potash alum crystals for high power inputs.

Ultrasound in organic electrosynthesis.

Mechanical effects induced by ultrasonication can be very helpful for the activation of electrochemical reactions. The continuous cleaning of the electrodes by ultrasound irradiation of the electrochemical cell or the enhancement of mass transfer at the electrodes are examples of such activation. Finally, ultrasonication can play an important part for the orientation of reactions whose selectivities are very sensitive to stirring. Two very different examples have been chosen to illustrate these phenomena: the indirect electrooxidation of di-ketone-L-sorbose into the corresponding ketogulonic acid and the direct electroreduction of acetophenone into pinacol.