The relationship between brachial artery flow-mediated dilatation, high sensitivity C-reactive protein, and uterine artery doppler velocimetry in women with pre-eclampsia.

PURPOSE: To investigate serum high sensitivity C-reactive protein (hs-CRP) levels and endothelial function in pregnancies complicated by pre-eclampsia and to clarify their relationship with uterine artery Doppler velocimetry. METHODS: A cross-sectional study was carried out in 70 pregnant women (35 patients with pre-eclampsia and 35 age-matched normotensive healthy pregnant women) during the third trimester of pregnancy. The maternal levels of serum hs-CRP were determined in all cases by immunonephelometry. Uterine artery Doppler velocimetry was performed. Flow-mediated dilatation was measured by sonography of the brachial artery for the assessment of endothelial function. RESULTS: Serum hs-CRP levels were higher in the pre-eclamptic group than in the normotensive group. hs-CRP levels were positively correlated with mean arterial pressure. Eleven patients with pre-eclampsia had abnormal uterine artery Doppler velocimetry. hs-CRP levels were significantly higher in pre-eclamptic patients with than without abnormal uterine artery Doppler velocimetry. Endothelial function was inversely correlated with hs-CRP levels and mean arterial pressure. CONCLUSIONS: These findings suggest that maternal serum hs-CRP levels increase with the severity of pre-eclampsia, reflecting endothelial dysfunction and constituting a potential marker of pathological utero-placental perfusion, with a high risk for fetal growth restriction.

Isolated impairment of posterior pituitary function secondary to severe postpartum haemorrhage due to uterine rupture.

Cranial diabetes insipidus (DI) due to postpartum haemorrhage is an extremely rare clinical event. We describe herein isolated posterior pituitary insufficiency in a 26-year-old woman who had undergone subtotal hysterectomy for severe postpartum haemorrhage because of uterine rupture. The patient experienced polyuria within 6 h postoperatively. DI was suggested by the elevated urine volumes and low urine specific gravity. The diagnosis of DI was confirmed by water deprivation test and vasopressin stimulation test. The anterior pituitary function was within normal limits. A high clinical suspicion is certainly required for the diagnosis of DI in the immediate postpartum period. To rapidly initiate appropriate therapy, the possibility of DI should always be kept in mind while evaluating patients who have polyuria and polydipsia after severe postpartum bleeding. Delay or failure to treat this condition might result in hypovolemic shock.

Virtual and fiber-optic bronchoscopy in patients with indication for tracheobronchial evaluation.

OBJECTIVE: The aim of this study was to compare the results of virtual bronchoscopy (VB) images in defining tracheobronchial pathologies with those of fiber-optic bronchoscopy (FOB) in patients with clinical indication for bronchoscopy. METHODS: Twenty-two patients with bronchoscopy indication were evaluated with FOB and VB. The VB results were evaluated blindly, independent of the FOB results. RESULTS: In 19 of the 22 patients, tracheobronchial abnormalities were present on FOB, whereas 3 patients had normal findings on FOB. In 17 of 19 patients, VB demonstrated the FOB diagnosis of tracheobronchial abnormality. While FOB detected 11 endoluminal lesions, VB detected 6. While FOB detected 20 obstructive lesions, VB detected 26. In evaluating external compression, FOB detected 2 lesions and VB detected 15. CONCLUSIONS: VB is a non-invasive, uncomplicated, and reproducible examination method in patients with an indication for thorax examination. Virtual bronchoscopy could find a clinically broader field of application in the future.

Primary abdominal ectopic pregnancy: a case report.

INTRODUCTION: We present a case of a 13-week abdominal pregnancy evaluated with ultrasound and magnetic resonance imaging. CASE PRESENTATION: A 34-year-old woman, (gravida 2, para 1) suffering from lower abdominal pain and slight vaginal bleeding was transferred to our hospital. A transabdominal ultrasound and magnetic resonance imaging were performed. The diagnosis of primary abdominal pregnancy was confirmed according to Studdiford's criteria. A laparatomy was carried out. The placenta was attached to the mesentery of sigmoid colon and to the left abdominal sidewall. The placenta was dissected away completely and safely. No postoperative complications were observed. CONCLUSION: Ultrasound examination is the usual diagnostic procedure of choice. In addition magnetic resonance imaging can be useful to show the localization of the placenta preoperatively.

Doppler analysis of uterine perfusion and ovarian stromal blood flow in polycystic ovary syndrome.

OBJECTIVE: To investigate blood flow velocity in the ovarian stromal artery and uterine artery in women with polycystic ovary syndrome (PCOS) and to correlate these velocities with clinical and biochemical parameters. METHODS: A prospective study was carried out in 55 patients with PCOS and 42 age-matched women who did not have PCOS. Clinical, biochemical, and hormonal characteristics, and utero-ovarian Doppler ultrasound blood flow parameters were determined, and correlations between the parameters were evaluated. RESULTS: Ovarian stromal blood flow was higher (P<0.01) and uterine perfusion was lower (P<0.01) in women with PCOS compared with women who did not have PCOS. Ovarian stromal artery pulsatility index (PI) was inversely correlated with levels of dehydroepiandrosterone sulfate (DHEAS) and insulin-like growth factor-1, and with the luteinizing hormone/follicle-stimulating hormone ratio. There was a positive correlation between uterine artery PI and DHEAS level. CONCLUSION: Doppler analysis of the uterine and intraovarian arteries may provide additional information about the etiopathogenesis of PCOS and partly explain the clinical implications of the condition.

Ovarian Hyperstimulation Syndrome with pleural effusion: a case report.

BACKGROUND: To report a case of severe ovarian hyperstimulation syndrome (OHSS) with right pleural effusion following controlled ovarian hyperstimulation. CASE PRESENTATION: A 24-year-old woman had severe OHSS as a complication of gonadotropin stimulation. The clinical picture showed enlarged ovaries, massive ascites, pleural effusion, abdominal pain, and dyspnea. Beside the medical treatment, abdominal paracentesis for the drainage of the massive ascites and tube thoracostomy were performed, resulting in expansion of the lung. CONCLUSION: Physicians can reduce the risk of OHSS by monitoring gonadotropin therapy and by withholding human chorionic gonadotropin medication. In in vitro fertilization protocols it can be advantageous to postpone the embryo transfer by freezing the embryos. Placement of a chest tube is a safe and efficient method for the treatment of pleural effusion.