Case Report of an exceptional spontaneous abdominal heterotopic pregnancy with superfetation: Diagnosis and treatment: Heterotopic pregnancy with superfetation (8+1 WG & 5+4 WG).

Heterotopic pregnancy is an extremely rare condition in which an intrauterine and an extrauterine pregnancy co-exist. In spontaneous conceptions, heterotopic pregnancy occurs in only 1/30 000 pregnancies. The treatment of heterotopic pregnancy must be as minimally invasive as possible to preserve the development of the intrauterine pregnancy. Superfetation, defined as the coexistence of 2 or more foetuses of different gestational ages, remains particularly exceptional and poorly explained (second ovulation? embryonic diapause?). Here, we present an extremely rare case of a spontaneous heterotopic evolutive pregnancy with superfetation, consisting of an embryo in the pouch of Douglas estimated at 8 + 1 weeks of gestation (WG) and a progressive intrauterine pregnancy estimated at 5 + 4 WG. We treated the extrauterine pregnancy with an intra-cardiac injection of potassium chloride echo-guided via the vaginal route, and the patient then underwent exploratory laparoscopy 9 days later and lavage and aspiration of the abdominal heterotopic pregnancy due to pain and biological inflammatory syndrome probably caused by pelvic mass syndrome and peritoneal irritation from the foetal necrosis. She has not yet given birth and is currently at 36 WG.

Impact of ultrasound speed choice on the quality of the second-trimester fetal ultrasound examination in obese women.

PURPOSE: The purpose of this study was to assess the impact of the free choice of ultrasound propagation velocity on ultrasound image construction to improve the completion rate and anatomical quality of fetal second-trimester ultrasound examination in obese women. MATERIALS AND METHODS: This repeated cross-sectional single-center study retrospectively collected second-trimester ultrasound images of 88 obese women. During the first period, ultrasound examinations were performed in 44 women (mean age, 31.4±5.9 [SD] years; range: 21.1 - 45.3 years) applying only the standard 1540m/s tissue ultrasound velocity (group 1). During the second period, ultrasound examinations were performed in other 44 women (mean age, 31.4±5.1 [SD] years; range: 20.6 - 41.6 years) with the operator free to choose among three available velocity settings (1420m/s, 1480m/s or 1540m/s) for the scanning planes for the morphological images (group 2). All women underwent mid-trimester ultrasound examination at 20 to 24 gestational weeks. Two observers assessed the examinations in both groups for completeness, quality, and duration of fetal ultrasound examinations. RESULTS: No differences in age (P>0.99), body mass index (P=0.67), prevalence of previous cesarean delivery (P=0.30) or gestational age at the second-trimester scan (P=0.20) were found between the two groups. The mean cumulative duration of these ultrasound examinations was longer in group 1 than in group 2 (for both the complete (P=0.04) and incomplete (P=0.03) examinations). The quality of the anatomic images according to Salomon's criteria was less often acceptable in group 1 (5/44, 11.4%) than in group 2 (15/44, 34.1%) (P=0.02). CONCLUSION: Free choice of ultrasound velocity improves the overall performance of fetal second-trimester ultrasound examinations in obese women.

Shear wave elastography safety in fetus: A quantitative health risk assessment.

PURPOSE: To identify the effects of shear wave elastography in the fetus for evaluation in widespread use. MATERIALS AND METHODS: The Health Risk Assessment method proposed by the National Research Council was used with literature to evaluate the safety of shear wave elastography for the fetus regarding its potential effects in human tissues. RESULTS: The experimental and epidemiologic data from 25 articles showed that shear wave elastography maintained the same thermal effect as pulsed Doppler ultrasound already authorized in obstetrics, and that cavitation effect on fetal tissue is improbable. Nonetheless, the vibratory character of shear waves could induce displacement of fetal tissue while potential effects of very short duration energy peaks of the radiation force focused wave front remain unknown. CONCLUSION: The actual knowledge does not provide enough information to assess the effects of shear wave elastography on fetal tissues, thus these points have to be explored by further experimental studies.

Improving image quality of mid-trimester fetal sonography in obese women: role of ultrasound propagation velocity.

OBJECTIVE: The quality of ultrasound images is impaired in obese patients. All ultrasound scanners are calibrated for an ultrasound propagation velocity of 1540 m/s, but the propagation in fatty tissue is slower (in the order of 1450 m/s). The main objective of this study was to evaluate the quality of images obtained with different ultrasound propagation velocity settings during the mid-trimester fetal ultrasound examination in obese patients. METHODS: This was a cross-sectional study using image sets of four recommended scanning planes collected from 32 obese pregnant women during their mid-trimester fetal scan. Each image set comprised three images obtained successively at three different propagation velocity settings (1540 m/s, 1480 m/s and 1420 m/s). A panel of 114 experts assessed the quality of 100 image sets, grading them from A (most acceptable) to C (least acceptable). Scanning-plane-specific indicators of adiposity (fatty layer thickness, probe-to-organ distance) were analyzed for each scanning plane. RESULTS: The experts had a mean of 18.1 ± 10.2 years of experience. The grade distribution (A, B, C) differed significantly (P < 0.0001) between the three propagation velocity settings tested; at the lower speed of 1480 m/s, images were most often graded A, while at the conventional speed of 1540 m/s, they were most often graded C. Regardless of the scanning plane, the thicker the fatty layer of the abdominal wall in a given plane, the lower the preferred speed (P < 0.0001). CONCLUSION: The construction of images taking into account ultrasound propagation velocities lower than 1540 m/s can improve significantly the quality of images obtained during mid-trimester fetal ultrasonography in obese women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Effect of corn particle size on site and extent of starch digestion in lactating dairy cows.

Two experiments were conducted to determine the effects of corn particle size (CPS) on site and extent of starch digestion in lactating dairy cows. Animals were fitted with ruminal, duodenal, and ileal cannulas. Dry corn grain accounted for 36% of dry matter intake. In experiment 1, 6 cows were used in a duplicate 3 x 3 Latin square design. Semiflint corn was used. Corn processing methods were grinding, medium rolling, and coarse rolling. The mean particle size of the processed corn was 730, 1807, and 3668 microm, respectively. Rumen digestibility of starch linearly decreased from 59% with ground corn to 36% with coarsely rolled corn. Similarly, small intestine digestibility linearly decreased with increased CPS, and consequently, the amount of starch digested in the small intestine was not affected by corn processing. In experiment 2, 4 cows were used in a 2 x 2 crossover design. Dent corn was used. Corn processing methods were grinding and coarse rolling. The mean particle size of the processed corn was 568 and 3458 microm, respectively. Rumen digestibility of starch decreased from 70% with ground corn to 54% with coarsely rolled corn. Small intestine digestibility of starch was not significantly affected by CPS, and the amount of starch digested in the small intestine tended to be greater for rolled than for ground corn. In both experiments, starch total tract digestibility decreased with increased CPS. In conclusion, CPS is an efficient tool to manipulate rumen degradability of cornstarch. In midlactation cows, the decrease in the amount of starch digested in the rumen between grinding and coarse rolling is partly compensated for by an increase in the amount of starch digested in the small intestine with dent genotype, but with semiflint genotype postruminal digestion is not increased and rumen escape starch is not utilized by the animal.

Effect of the methodology on peptide amino acid concentrations in blood and plasma of sheep.

Different methodologies for the measurement of peptide amino acid (PAA) in blood and plasma were compared in sheep. Preparation of blood and plasma samples consisted of a deproteinization, either chemical with sulfosalicylic acid (0.04 g for 1 ml of sample) or physical by ultrafiltration (10,000-MW cut-off filters), with or without a subsequent ultrafiltration through a 3,000-MW cut-off filter. Peptide concentrations were determined by quantification of amino acid concentrations before and after acid hydrolysis of samples. Free amino acid concentrations were similar by all the method used (about 2.5 and 2.7 mM, for blood and plasma respectively). Peptide concentrations were higher with chemical deproteinization (10.6 and 4.2 mM, for blood and plasma respectively) than with physical deproteinization (5.7 and 3.3 mM, for blood and plasma respectively). When the deproteinized samples were further treated to remove material of molecular weight above than 3 kDa, peptide concentrations were significantly reduced, which indicates inefficiencies in the ability of the deproteinizing procedures in removing all the proteinaceous materials. Concentration of small PAA (< 3 kDa) in blood was about 1.5-fold that in plasma, mainly due to peptide Gly and Glu derived from the hydrolysis of the erythrocyte glutathione. The choice of a methodology for quantifying circulating peptides is discussed.

Phagocyte functions in stressed rats: comparison of modulation by glutamine, arginine and ornithine 2-oxoglutarate.

The effects of diets supplemented with 6.8 mmol.day-1.kg-1 glutamine, arginine or ornithine 2-oxoglutarate [ornithine alpha-ketoglutarate (OKG), a precursor of both glutamine and arginine] on phagocyte functions [i.e. H2O2 production by leucocytes and secretion of tumour necrosis factor alpha (TNFalpha) by stimulated macrophages] of stressed rats were studied. The relationship between the immunological effects of these amino acids and their plasma and tissue (muscle and intestine) concentrations was also explored. The catabolic model used consisted of injections of dexamethasone (DEX; 1.5 mg.day-1.kg-1) for 5 days. As previously described, DEX suppressed TNFalpha secretion in stimulated macrophages. Supplementation with arginine or OKG, but not glutamine, was able to counteract the DEX effect on TNFalpha secretion. Glutamine, arginine and OKG supplementation increased H2O2 production by monocytes and polymorphonuclear neutrophils from DEX-treated rats. All DEX-treated rats showed plasma and muscle glutamine depletion and also a decrease in the concentration of arginine in the gastrocnemius. Supplementation with glutamine, arginine or OKG was not able to counteract these depletions. It was concluded that glutamine, arginine and OKG improve phagocyte responses during stress, and that glutamine depletion is not necessarily associated with dysimmunity, since no correlation between glutamine tissue pools and the immune state was observed.