Cerebroplacental ratio assessment in early labor in uncomplicated term pregnancy and prediction of adverse perinatal outcome: prospective multicenter study.

OBJECTIVE: It has been suggested that the use of Doppler ultrasound in term pregnancies with normal-sized fetuses is able to identify those at high risk of subclinical placental function impairment. The objective of this study was to evaluate the relationship between cerebroplacental ratio (CPR) measured in early labor and perinatal and delivery outcomes in a cohort of uncomplicated singleton term pregnancies. METHODS: This was a prospective multicenter observational study conducted at three tertiary centers between January 2016 and July 2017. Low-risk term pregnancies, defined by the absence of maternal morbidity or pregnancy complication, accompanied by normal ultrasound and clinical screening of fetal growth in the third trimester, with spontaneous onset of labor were included. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler was assessed on admission for early labor. All measurements were performed in between uterine contractions and according to international standards. CPR was computed by dividing MCA pulsatility index by UA pulsatility index and converted into multiples of the median (MoM) in order to adjust for gestational age. Doctors and midwives involved in the clinical management of the women were blinded to the results of the Doppler evaluation. Mode of delivery and perinatal outcome were compared between pregnancies with reduced CPR MoM, defined as CPR MoM within the lowest decile of the study population, and those with normal CPR MoM. Receiver-operating characteristics curve analysis was used to assess the predictive performance of CPR for obstetric intervention due to fetal distress and composite adverse perinatal outcome. RESULTS: Overall, 562 women were included. The rate of obstetric intervention for suspected fetal distress in labor was more than three times higher among cases with reduced CPR MoM compared to those with normal CPR MoM (9/54 (16.7%) vs 28/508 (5.5%); P = 0.004). Furthermore, a significantly higher rate of composite adverse perinatal outcome was found in fetuses with CPR MoM < 10th percentile compared to those with CPR MoM ≥ 10th percentile (6/54 (11.1%) vs 19/508 (3.7%); P = 0.012). CPR had low sensitivity and low positive predictive value for prediction of obstetric intervention due to fetal distress (24.3% and 18.0%, respectively) and composite adverse perinatal outcome (24.0% and 11.1%, respectively). CONCLUSIONS: Data on a wide cohort of low-risk term pregnancies in early labor showed that, while reduced CPR is associated with a higher risk of obstetric intervention due to fetal distress and composite adverse perinatal outcome, it is a poor predictor of adverse perinatal outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

RETINAL RACEMOSE HEMANGIOMA WITH FOCAL MACULAR INVOLVEMENT.

PURPOSE: To report a case of racemose hemangioma with macular involvement and treated with anti-vascular endothelial growth factor. METHODS: Observational case report. RESULTS: JFS, a 31-year-old woman, presented with a complaint of blurred vision in her right eye over the preceding 2 months, worsening during the previous month. An examination conducted in May 2013 showed visual acuity of 20/30 in her right eye and 20/20 in her left eye, deteriorating to 20/40 in the right eye 1 month later. Retinography of the right eye revealed a dilated tortuous retinal vessel in the lower temporal arcade, affecting the macular region. Because of progressive deterioration in the patient's visual acuity, she was treated with 3 intravitreal bevacizumab injections, with an interval of 1 month between them. At the end of the proposed treatment, the patient was followed up on an outpatient basis for 12 months, with visual acuity of 20/20 in both eyes and no signs of retinal exudation throughout the entire follow-up period. CONCLUSION: Racemose hemangioma with focal macular involvement may lead to a progressive reduction in visual acuity because of exudation. Further studies need to be conducted to confirm the efficacy of bevacizumab injections to treat vascular malformation; however, this form of management does seem promising.

[Preliminary study of p53 and FGFR3 gene mutations in the urine for bladder tumors]. / Étude préliminaire des mutations des gènes p53 et FGFR3 sur le culot urinaire des tumeurs de la vessie.

INTRODUCTION: Two major pathways are described in bladder carcinogenesis: one for invasive or high grade tumors characterized by alteration of the p53 tumor suppressor gene and the other for non-invasive tumors or low grade involving mutations FGFR3. The objective of our study was to validate the research in the urine of mutations in these two genes in patients with a bladder tumor. PATIENTS AND METHODS: In our preliminary study, we investigated 36 patients the FGFR3 and p53 mutations in tumors and urine collected during endoscopic resection. The p53 mutations were sought in FASAY, which allows a functional analysis of the protein P53. The FGFR3 mutations were sought in SNaPshot that searches the eight most frequent mutation points of this gene. RESULTS: For 24 patients (66% of cases), we found at least one of the two mutations in the tumor. This mutation was present in the urine in 15 patients (sensitivity=62.5%). In only one patient, we found a mutation in the urinary sediment that did not exist in the tumor (specificity=91.7%). CONCLUSION: The search for mutations of p53 and FGFR3 in the urine was a simple and non-invasive assay, which seems superior to urinary cytology for the detection of bladder tumors, raising hopes of an interest in this bio-assay for surveillance of bladder tumors and screening risk populations.

Pulmonary edema at recovery after colic operation with in-situ nasogastric tube in a horse.

After an uneventful general anesthesia, in a horse negative pressure pulmonary edema developed due to acute upper airway obstruction during the anesthetic recovery phase after colic surgery. No pathologic alteration of respiration was observed until the horse stood up and began suffocating. The horse had recovered with the nasogastric tube in situ. This, together with the postmortem diagnosis of laryngeal hemiplegia resulted in impairment of airflow through the larynx and development of pulmonary edema. Our objective is to alert clinicians about the possible hazard of recovery with an in-situ nasogastric tube.

An attenuated Salmonella enterica serovar Typhimurium strain lacking the ZnuABC transporter induces protection in a mouse intestinal model of Salmonella infection.

Salmonella enterica serovar Typhimurium has long been recognised as a zoonotic pathogen of economic significance in animals and humans. Attempts to protect humans and livestock may be based on immunization with vaccines aimed to induce a protective response. We recently demonstrated that the oral administration of a Salmonella enterica serovar Typhimurium strain unable to synthesize the zinc transporter ZnuABC is able to protect mice against systemic salmonellosis induced by a virulent homologous challenge. This finding suggested that this mutant strain could represent an interesting candidate vaccine for mucosal delivery. In this study, the protective effect of this Salmonella strain was tested in a streptomycin-pretreated mouse model of salmonellosis that is distinguished by the capability of evoking typhlitis and colitis. The here reported results demonstrate that mice immunized with Salmonella enterica serovar Typhimurium (S. Typhimurium) SA186 survive to the intestinal challenge and, compared to control mice, show a reduced number of virulent bacteria in the gut, with milder signs of inflammation. This study demonstrates that the oral administration a of S. Typhimurium strain lacking ZnuABC is able to elicit an effective immune response which protects mice against intestinal S. Typhimurium infection. These results, collectively, suggest that the streptomycin-pretreated mouse model of S. typhimurium infection can represent a valuable tool to screen S. typhimurium attenuated mutant strains and potentially help to assess their protective efficacy as potential live vaccines.

Giant cell glioblastoma in the cerebrum of a Pembroke Welsh corgi.

A 6-year-old, neutered female Pembroke Welsh corgi was presented with a 1-month history of ataxia and panting. The clinical signs progressed until the dog became anorexic, obtunded and exhibited circling to the left. At necropsy examination, a mass was detected in the left forebrain, impinging on the cribriform plate. Microscopically, the mass was composed of sheets of round to pleomorphic neoplastic cells with vacuolated cytoplasm. Nuclear atypia, anisocytosis and anisokaryosis were common. Numerous bizarre, multinucleated giant cells containing 60 or more nuclei and giant mononuclear cells were present. The matrix contained abundant reticulin. Immunohistochemistry revealed the neoplastic cells uniformly to express vimentin, and a small number of neoplastic cells expressed glial fibrillary acid protein. A diagnosis of giant cell glioblastoma was made. Although well recognized in man, this tumour has been documented rarely in the veterinary literature.

[Intestinal obstruction caused by ischemic colitis: description of 3 surgically treated cases]. / Occlusione intestinale da colite ischemica: descrizione di 3 casi trattati chirurgicamente.

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction who required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

[Postoperative esophageal-visceral fistulae: their prevention and treatment]. / Fistole esofago-viscerali postoperatorie: prevenzione e trattamento.

A series of 12 cases of esophageal anastomotic leakage following esophageal surgery observed from 1969 to 1989 is retrospectively analyzed. In the period 1969-1975 6 patients were treated in emergency and the mortality rate was 66.6%, while the remaining 6 patients observed from 1975 to 1989 were treated conservatively with total parenteral nutrition (sometimes associating adequate surgical drainage): the mortality rate was 16.6%. In conclusion, not only in the treatment of anastomotic leakage, but also in its prevention, artificial nutrition has a crucial role. The outcome of thoracic and abdominal fistulas depends mainly on adequate drainage, not necessarily surgical. Cervical fistulas heal in 2-4 weeks, but strictures arise frequently and respond to endoscopic dilatation.

[The role of blood transfusion on the postoperative morbidity of tumors of the colon and rectum]. / Il ruolo delle emotrasfusioni sulla morbilità p.o. nei tumori del colon-retto.

UNLABELLED: Previous studies have demonstrated that perioperative blood transfusions in patients with colo-rectal cancer may be related to a poor p.o. prognosis. Blood transfusions have been reported to exert an immunosuppressive action thus representing a risk factor of p.o. septic complication. MATERIAL AND METHOD: 100 patients were investigated retrospectively (60 M. and 40 F., mean age 61.7 yrs, range 18-86). Location of the tumour was rectum in 49 cases, sigmoid in 33, descending colon in 9 and ascending colon in 9. Dukes' staging of the tumour was A in 16 cases, B in 34, C in 30, D in 20. 61% of the patients received blood transfusions, before the operation in 10, during the operation in 13, after the operation in 16. 22 patients received blood transfusions before, during and after the operation. P.o. septic complications were then correlated to number and timing of blood transfusions, sex and age of the patients, location of neoplasm, Dukes' staging, surgical technique, severe anemia and malnutrition. RESULTS: P.o. septic complications were observed in 25 patients, without significative correlation with patients sex and age, site and staging of the tumour, surgical technique, preoperative anemia and/or malnutrition. A statistically significative increase in the incidence of septic complications was observed only in transfused patients compared to non transfused (34% vs. 10.3% - X2 = 5.62, p less than 0.01). This was noted regardless the presence of advanced disease, location of the tumour, surgical technique employed. The increased incidence of septic p.o. complications was observed even comparing transfused to non-transfused grouped accordingly to the different factors considered in the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic and therapeutic problems of non perianal fistulas and abscesses in Crohn's disease.

Problems related to the appearance of non perianal fistulas and abscesses are examined in a series of 204 patients operated on for Crohn's disease. Incidence of these complications was 34.3% (70 cases); one or more fistulas were present in 54 patients, associated with abscesses in 13, while abscesses alone were present in 3. The highest incidence was observed in the male sex, in patients over 50 years, and in the presence of stenosing Crohn's lesions (P less than 0.001). On the contrary, the primary site of Crohn's disease does not seem to affect significantly their appearance. The clinical suspect of fistulas or abscesses should be supported with radiographic, endoscopic, echographic and scintiscan findings, even though about 7.2% of fistulas are diagnosed only intraoperatively. Surgical treatment is the most suitable therapeutic management; however enteroenteric and mesenteric fistulas are only relative indications for surgery. TPN is suitable for postoperative enteric fistulas (5 cases). Postoperative morbidity is not different in patients with or without such complications at surgery. Long-term prognosis of non perianal fistulas and abscesses is related only to recurrences of Crohn's disease and their anatomopathologic evolution.

[Effects of ceruletide in the treatment of postoperative paralytic ileus]. / Effetti del ceruletide nel trattamento dell'ileo paralitico postoperatorio.

After a short analysis of the pathogenetic causes which can lead to paralytic ileus and the drugs at present available for treatment of this serious morbid form, the paper reports results obtained with Ceruletide, a decapeptide which has proved active on intestinal peristalsis in experimental and clinical trials. The results of this study, carried out on 20 patients subjected to surgical operation on the abdomen, treated with Ceruletide by intramuscular route 24-48 hours after the operation, showed that this drug is capable of leading to a quick recovery of intestinal motor activity without causing the patient unpleasant effects for the patient. The practical utility of Ceruletide is evident since by leading to earlier canalisation of the intestine it also allows the venous hydro-electric delivery to be reduced, nasogastric aspiration to be eliminated early and hence the postoperative course to be made more acceptable to the patient.