Neurodevelopmental outcome at 2 years of corrected age in fetuses with increased nuchal translucency thickness and normal karyotype compared with matched controls.

OBJECTIVES: Increased nuchal translucency (NT) thickness is an antenatal marker of aneuploidy or malformation that can lead to termination of pregnancy. This study assessed the long-term neurodevelopmental prognosis of infants who had isolated increased NT in utero. METHODS: This was a prospective cohort study of infants with a NT thickness > 95th percentile in the first trimester, but with a normal karyotype and no major anomalies, and controls with normal NT matched for birth weight, Apgar score, place of birth, parity and gestational age at birth. At 2 years of corrected age, all infants underwent the psychometric Brunet-Lézine test to evaluate their developmental quotient (DQ), overall (global) and specifically for the areas of posture, language, coordination and sociability. RESULTS: A total of 203 chromosomally normal infants were included in the increased-NT group and 208 in the control group. The mean global DQ was significantly lower in the increased-NT group than in the control group (108.6 ± 9.7 vs 112.8 ± 8.3; P < 0.0001), but it was within the normal range expected for that age in both groups. Similarly, the mean DQs for coordination, sociability and language, but not for posture, were significantly lower in infants with increased NT than in controls. Only one case with increased NT had a DQ < 70 (defined as severe neurodevelopmental impairment), compared with none in the control group. The difference between the two groups remained significant for a NT threshold ≥ 99th percentile and when the data were adjusted for NT thickness, the infant's sex and the mother's educational level. In the increased-NT group, NT thickness was < 3.5 mm in over half (56%) of the infants, between 3.5 mm and 5 mm in 33% and > 5 mm in 11%, with a mean global DQ of 108.4, 110.1 and 109.7, respectively. CONCLUSIONS: Infants who had isolated increased fetal NT in the first trimester had a significantly lower, but normal, DQ at a corrected age of 2 years, when compared with controls. The findings were independent of the infant's sex, fetal NT thickness and the mother's educational level. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Review concludes that specific recommendations are needed to harmonise the provision of fresh mother's milk to their preterm infants.

AIM: There are no specific recommendations for using a mother's fresh milk for her preterm infant. We reviewed the available evidence on its collection, storage and administration. METHODS: The working group of the French Neonatal Society on fresh human milk use in preterm infants searched the MEDLINE database and Cochrane Library up to June 2017 for papers published in English or French. They specifically analysed 282 papers providing information on prospective, retrospective and clinical studies and examined guidelines from various countries. RESULTS: The review concluded that fresh mother's own milk should be favoured in accordance with the latest recommendations. However, it must be carried out under stringent conditions so that the expected benefits are not offset by risks related to different practices. The working group has summarised the best conditions for feeding preterm infants with human milk, balancing high nutritional and immunological quality with adequate virological and bacteriological safety. Professionals must provide parents with the necessary conditions to establish breastfeeding, together with specific and strong support. CONCLUSION: Based on their review, the working group has made specific recommendations for using fresh mother's own milk under careful conditions, so that the expected benefits are not offset by risks related to practices.

Assessment of human milk composition using mid-infrared analyzers requires calibration adjustment.

OBJECTIVE: Nutrient composition of human milk (HM) is highly variable. Targeted HM fortification has been proposed to address these variations and reduce the cumulative nutritional deficit in preterm infants. Near-infrared analysis is used to measure the protein and fat content in HM; however, the reliability of this technique has not been evaluated. The objective of this study is to evaluate the reproducibility and accuracy of two generations of HM analyzers (HMA1 and HMA2) in estimating protein and lipid contents. STUDY DESIGN: Reproducibility was assessed by analyzing in duplicate 146 and 128 HM samples with HMA1 and HMA2 (Miris), respectively. To evaluate the accuracy, lipid and protein concentrations were assessed in 31 and 39 samples using HMA1 or HMA2, respectively. Values were compared with measurements obtained using reference methods and correction equations were calculated. After applying the correction equations on 12 HM samples, the performance of the two devices were compared and the equation was validated according to the reference methods. RESULTS: The coefficients of variation for protein and lipid assessments were below 3% for both HMA1 and HMA2. Protein concentrations were significantly underestimated by HMA2 (-0.53±0.23 g dl-1). Lipid content was significantly overestimated by both devices, but the error was greater with HMA1 (0.76±0.48 g dl-1) than with HMA2 (0.36±0.33 g dl-1). Correction equations were specific for each generation of HMA. Finally, after correction, both instruments provided similar and accurate results. CONCLUSION: HMAs require calibration adjustment before their use in clinical practice, to avoid inappropriate HM fortification.

Fetal thrombotic vasculopathy is associated with thromboembolic events and adverse perinatal outcome but not with neurologic complications: a retrospective cohort study of 54 cases with a 3-year follow-up of children.

OBJECTIVE: to test the hypothesis that placental fetal thrombotic vasculopathy (FTV) is associated with obstetric complications and predisposes the child to unfavorable outcomes. METHODS: 54 placentas with FTV lesions and 100 placentas without FTV lesions were collected over a 5-year period at the Croix-Rousse Pathology Department. Clinical findings including maternal, fetal, neonatal condition and pediatric outcome up to three years were collected for each case and control observation. The statistical analyses were assessed with Wald's chi-square derived from conditional logistic regression modeling. RESULTS: FTV was associated with a significantly higher frequency of obstetric complications: (pregnancy-induced hypertension (OR 3.620, CI 1.563-8.385), preeclampsia (OR 3.674, CI 1.500-8.998), emergency delivery procedures (OR 3.727, CI 1.477-9.403), cesarean sections (OR 2.684, CI 1.016-7.088)), poor fetal condition (intrauterine growth restriction (IUGR) (OR 5.440, CI 2.007-14.748), nonreassuring fetal heart tracing (OR 6.062, CI 2.280-16.115), difficulties in immediate ex utero adaptation (OR 3.416, CI 1.087-10.732)) and perinatal or early childhood demise (OR 3.043, CI 1.327-6.978). On pathological examination, FTV was associated with marginal cord insertion (OR 3.492, CI 1.350-9.035), cord stricture and hypercoiled cord (OR 3.936, CI 1.209-12.813). Thromboembolic events were significantly more frequent in cases with FTV (OR 2.154, CI 1.032-5.622). Neurological complications within the first 3 years of life were also more frequent in the FTV group compared to the control group, but this association was not statistically significant. CONCLUSIONS: FTV is associated with maternal complications, pathological findings in the placenta, especially gross cord abnormalities, IUGR, and poor perinatal or early childhood outcome. It may also predispose children to somatic thromboembolic events.

[Neonatal outcome of fetal hyperechogenic bowel]. / Devenir néonatal des fœtus présentant un intestin hyperéchogène.

OBJECTIVE: Echogenic bowel (EB) represents 1 % of pregnancy and is a risk factor of fetal pathology (infection, cystic fibrosis, aneuploidy). The aim of our study was to determine the fetuses' outcomes with isolated EB. PATIENTS AND METHODS: This is a retrospective study of all patients who presented singleton gestations with a fetal isolated echogenic bowel between 2004 and 2011 in two prenatal diagnosis centers. Search of aneuploidy, infection and cystic fibrosis was systematically proposed as well as an ultrasound monitoring. RESULTS: On 109 fetus addressed for isolate echogenic bowel five had other signs associated and 74 had a real isolated echogenic bowel (without dilatation, calcification, intrauterine growth restriction). In 30 cases, the EB was not found. Eighty-five percent of the patients had in the first trimester a screening for trisomy 21. None fetus with isolated EB had trisomy, infection or cystic fibrosis. One fetus died in utero and one newborn died of a metabolic disease without digestive repercussions. DISCUSSION AND CONCLUSION: The risk of trisomy 21 and the risk to have a serious disease appear low for the fetus with EB. It does not seem necessary to propose a systematic amniocentesis in case of isolated echogenic bowel.

[Pseudomyxoma peritonei secondary to a teratoma of the omentum with a mucinous component of borderline malignancy]. / Pseudomyxome péritonéal secondaire à un tératome épiploïque à composante mucineuse de malignité frontière.

A mature cystic teratoma of the omentum occurred in a 37 years old woman who had an appendicectomy at the age of 8. This extragonadal teratoma contained a predominant mucinous glandular pattern of borderline malignancy, responsible for pseudomyxoma peritonei. Ovarian biopsies had only shown surface mucinous deposits at the time of the first laparotomy but two years later ovarian mucinous cystadenomas of borderline malignancy appeared. The patient developed intestinal obstruction, surround by mucinous retractile material and died four years and an half after initial diagnosis. This case is, to our knowledge, the first pseudomyxoma peritonei occurring from an extragonadal teratoma, the events chronology suggesting the secondary nature of the ovarian tumors.

[Uterine hemangiopericytomas. Two case reports]. / Hémangiopéricytomes utérins. A propos de deux observations.

The diagnosis of uterine haemangiopericytoma is still a matter of debate. The existence of haemangiopericytoma must be proven on the basis of classical histology, ultrastructure histology and immunohistochemical analyses. The diagnosis, even when apparently sure, must nevertheless be proven. We described two cases emphasizing the clinical and laboratory features of uterine haemangiopericytoma. Progress in nuclear magnetic resonance imaging, ultrastructural analysis and immunohistochemistry should help in confirming the diagnosis of haemangiopericytoma. Highly vascular leiomyoma or low malignity grade leiomyosarcoma have been mistakenly identified as haemangiopericytoma.

[Inflammatory pseudotumor of the urachus. A case]. / Pseudo-tumeur inflammatoire de l'ouraque. Une observation.

The occurrence in a 9-year old boy of a painful, prominent and solid mid-hypogastric tumour is reported. This clinically isolated muscular tumour was suggestive of sarcoma. En bloc resection of the tumour including the attached vesical cupula was performed. Histology showed that this large tumour was purely inflammatory and had developed from remnants of the urachus. This diagnosis must be considered whenever a suprapubic tumour is discovered. Since malignant transformation of urachus cysts is possible, surgical resection is advised.

[Volvulus of the sigmoid colon. Emergency resection and anastomosis]. / Volvulus du côlon sigmoïde. Résection anastomose en urgence.

Eleven cases of sigmoid volvulus in patients aged 76 years in average, without visible signs of necrosis on endoscopy, are reported. All patients were treated within 6 to 48 hours by colic resection and immediate restoration of continuity with a mechanical anastomosis. Morbidity was low, including one case of evisceration and one of pneumonia, and there was no mortality after three months. Early resection seems to prevent the risks of necrosis and recurrence, and to have a good prognosis for survival.

[Idiopathic calcinosis of the scrotum. Apropos of a case. Review of the literature]. / Calcinose idiopathique du scrotum. A propos d'un cas. Revue de la littérature.

The authors report the case of a 44 years old male patient, admitted for a left inguinal hernia. Multiple scrotal cysts were discovered and removed at surgery. Histological study showed an idiopathic calcinosis of the scrotum.

[Use of electrolyte solutions in surgery (author's transl)]. / Utilisation des solutions d'électrolytes en chirurgie.

The use of isotonic saline and Ringer's lactate in surgery has become widespread following the work of Shires on the sequestration of extra-cellular fluid in hemorrhagic shock. Their use both in military and civilian practice and during hemodilutions in cardiac surgery have shown their efficacy. During intensive care, the risk of pulmonary edema is insignificant when less than 4 liters are given daily. Apart from cases of severe renal failure, they increase diuresis and reduce post-operative renal failure. Their use in appropriate cases permits economies in blood transfusion.