Hyperbaric oxygen therapy for cesarean section wound in diabetes mellitus gravida.

We report the use of hyperbaric oxygen (HBO) therapy to treat the complication of necrotizing fasciitis following Cesarean section in a postpartum gravida with diabetes mellitus. Our patient was a 25-year-old, gravida 1, para 1, woman with a history of type 1 diabetes mellitus since the age of 18. The patient experienced preterm labor at 31+1 gestational weeks and was treated with magnesium sulfate for tocolytic therapy. The patient then went into labor at 39+6 gestational weeks. She received Cesarean section due to prolonged labor associated with non-reassuring fetal status of both smooth baseline and fetal tachycardia. An ultrasound scan of the lower abdomen on the 4th postoperative day revealed fluid collection measuring 4 mm over the rectus fascia and edematous change of the surrounding soft tissues under the Cesarean section incision site. The patient eventually received HBO for a total of 7 days. Following HBO, the condition of the surgical wound improved dramatically. The results of this case showed that HBO has the potential to be a cost-effective way to enhance the healing of necrotizing fasciitis in diabetes mellitus gravida.

Prenatal diagnosis of dextrotransposition of the great arteries.

Dextrotransposition of the great arteries (DTGA) is a common cardiac cause of cyanosis in newborn infants that can cause acidosis and death within a short period of time unless there is a large atrial-level shunt or a patent ductus arteriosus. Here, we report a case of prenatal diagnosis of DTGA at 24+1 gestational weeks. In a tilted 4-chamber view, the pulmonary trunk branched to the left and the right pulmonary, with its root connected to the left ventricle outflow tract. In the short-axis view, the pulmonary trunk was shown to be parallel with the ascending aortic root. Cesarean section was performed due to the nonreassuring fetal status at 38+5 gestational weeks. The male neonate appeared to have mild cyanotic symptoms and weighed 3,108 g. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Neonatal echocardiography was performed immediately after birth and the findings confirmed DTGA associated with atrial septal defect secundum. Postnatally, angiography confirmed the echocardiographic diagnosis of DTGA with a large atrial septal defect secundum and a large patent ductus arteriosus. Jatene arterial switch operation and atrial septal defect closure with Gore-Tex patch were performed. The neonate withstood the operation well and was discharged 27 days after birth weighing 2,950 g and in a stable condition. Prenatal diagnosis of DTGA can greatly aid to prepare the patient's family and the surgeon and significantly improve the outcome of complex heart disease in the neonatal period.

Ultrasound and magnetic resonance images of endodermal sinus tumor.

Endodermal sinus tumor, also known as yolk sac tumor, is a rare malignant ovarian tumor that usually occurs in the second decade of life. Here, we report a case of endodermal sinus tumor which occurred in a 14-year-old girl. She presented with lower abdominal pain for about 4 months. Initial ultrasound findings revealed a large ovarian multilocular solid tumor. Doppler study revealed multiple arteriole vessels running in the solid section of the tumor from which the lowest resistance index of 0.30 was recorded. The lactate dehydrogenase level was 261 U/L, and alpha-fetoprotein marker was 131,630 ng/mL. Axial contrast-enhanced T1-weighted magnetic resonance imaging showed a large cystic mass with solid components in the peripheral portions of the mass. The peripheral solid portions showed strong enhancement, indicating their hypervascularity. She received staging operation for malignant ovarian tumor, and the pathology reports revealed ovarian malignance of endodermal sinus tumor with omental invasion, stage IIIc. This case report suggests that in an adolescent female with elevated alpha-fetoprotein, low resistance index in the tumor mass and hypervascularity on contrast-enhanced T1-weighted magnetic resonance image, the probability of an endodermal sinus tumor should be highly suspected preoperatively.

Fetal nasal bone length and Down syndrome during the second trimester in a Chinese population.

OBJECTIVE: The purpose of the present study was to build a database of reference ranges of fetal nasal bone length (NBL) in a Chinese population. The accuracy rate of detecting Down syndrome was also analyzed using fetal NBL as a marker. METHODS: The control group of fetuses included 342 normal singleton pregnancies with no chromosomal or congenital anomalies. The present study was a cross-section study and the control group was used to construct percentile values of NBL from 13 to 29 gestational weeks of age. Two-dimensional ultrasonography was used for the nasal bone studies. Measurements of NBL were collected and each fetus contributed a single value to the reference sample. During the study period, 14 fetuses with Down syndrome were examined. Measurement of fetal NBL was made during amniocentesis, with gestational age ranging from 13 to 19 weeks. RESULTS: From 342 normal fetuses with gestational age ranging from 13 to 29 weeks, reference ranges of NBL were constructed. The reference ranges were constructed from the 100(1 - p)% reference range: Y +/- Zp x square root sigma 2, where Y = 25 - exp(3.58 - 0.044 x t + 0.0006 x t2), with Y being the fitted mean of regression model and t being gestational age (weeks). Using fetal NBL, the regression model was Pr(Down syndrome) = exp(W)/ [1 + exp(W)], where W = 0.62-4.80 x NBL (multiples of the median) in predicting Down syndrome. Fetal NBL was found to have a sensitivity and specificity of 0.78 and 0.78, respectively, in predicting Down syndrome in the second trimester of pregnancy. CONCLUSIONS: Fetal NBL measurement can provide a simple and useful algorithm to predict Down syndrome during the second trimester of pregnancy.

Combination of fetal Doppler velocimetric resistance values predict acidemic growth-restricted neonates.

OBJECTIVE: This study was undertaken to determine the efficacy of combination Doppler velocimetric resistance values of the umbilical artery and ductus venosus in predicting growth-restricted neonates with acidemia. METHODS: This retrospective case-control study included 61 gravidas complicated by intrauterine growth restriction with acidemia and 65 control pregnancies. The Doppler velocimetric resistance values obtained from the growth-restricted and control fetuses were in turn compared with the median values derived from another 192 normal pregnancies to adjust the biometric bias due to gestational age. RESULTS: Based on the pulsatility index of the umbilical artery and pulsatility index for the vein of the ductus venosus, the areas under the receiver operating characteristic curves were 0.7992 and 0.6749, respectively, for predicting growth-restricted neonates with acidemia. With a combination of the pulsatility indices of the umbilical artery and the pulsatility indices for the vein of the ductus venosus, the predictive accuracy of the growth-restricted neonates with acidemia increased, with sensitivity of 0.79 and specificity of 0.79 and an area under the receiver operating characteristic curve of 0.8441. CONCLUSIONS: Compared with single-vessel assessment, combining the pulsatility indices of the umbilical artery and the pulsatility indices for the vein of the ductus venosus provides the greatest accuracy in predicting growth-restricted neonates with acidemia.

Lessons from border cell migration in the Drosophila ovary: A role for myosin VI in dissemination of human ovarian cancer.

Dissemination of ovarian cancer is a major clinical challenge and is poorly understood at the molecular level due to a lack of suitable experimental models. During normal development of the Drosophila ovary, a dynamic process called border cell migration occurs that resembles the migratory behavior of human ovarian cancer cells. In this study, we found that myosin VI, a motor protein that regulates border cell migration, is abundantly expressed in high-grade ovarian carcinomas but not in normal ovary and ovarian cancers that behave indolently. Inhibiting myosin VI expression in high-grade ovarian carcinoma cells impeded cell spreading and migration in vitro. Optical imaging and histopathologic studies revealed that inhibiting myosin VI expression reduces tumor dissemination in nude mice. Therefore, using genetic analysis of border cell migration in Drosophila is a powerful approach to identify novel molecules that promote ovarian cancer dissemination and represent potential therapeutic targets.