Combination of cable ties and barbed sutures for fasciotomy closure - two case reports.

While fasciotomy is the only urgent treatment option for compartment syndrome, the resulting open wound leaves room for complications. Closure of the wound can be done by different techniques, including split-thickness skin grafts, negative pressure therapy, an absorbable barbed suture system and a cable ties system. The aim of this paper is to demonstrate how a combined application of these methods can reduce their respective individual disadvantages. Our combined method was tried in two patients, one with an open tibial fracture and the other who underwent ulnar nerve reparation. Both patients started exhibiting signs of compartment syndrome within 3 hrs after surgery. Firstly, absorbable barbed suture systems were positioned with the running intradermal technique. Following this the cable ties were inserted and the limb in question was placed in an elevated position. Complete closure of the patient's wounds was achieved within 2 weeks without complications. This result is a testament to the added benefit of a combination of these methods in comparison with the results they produce individually.

First trimester diagnosis of cystic hygromata using transvaginal ultrasound and cytogenetic evaluation.

We studied the outcome of fetuses in whom cystic hygroma was diagnosed in the first and early second-trimester of pregnancy using transvaginal ultrasonography. The purpose of this study was to evaluate the association between fetal cystic hygroma and fetal cytogenetic abnormalities, and the long-term prognosis. Thirty-five consecutive fetuses between 9.1 and 13.4 weeks of gestation diagnosed as having a nuchal hygroma were evaluated ultrasonographically and karyotyped. Those with a normal chromosome complement were ultrasonographically monitored throughout the remainder of the pregnancy to document the resolution of the hygroma. Eighteen of thirty-five fetuses were found to have a normal karyotype and five of these were aborted electively. The hygromas resolved in ten of these karyotypically normal fetuses within four weeks of initial diagnosis and they were phenotypically normal at birth. Seventeen fetuses were karyotypically abnormal with trisomy twenty-one being the most common abnormality. Prenatal cytogenetic analysis should be offered to women with fetal cystic hygroma diagnosed in the first trimester. A normal outcome is likely in those without chromosome abnormalities.

Preoperative diagnosis of primary fallopian tube carcinoma by transvaginal ultrasound, cytological finding and CA-125.

Primary Fallopian tube carcinoma is rarely diagnosed preoperatively. We present the case of a 69-year-old woman with primary tubal carcinoma, which was diagnosed preoperatively on the basis of the cytological finding, characteristic features on transvaginal sonography, transvaginal color flow imaging and elevated CA-125. Transvaginal color Doppler imaging demonstrated the tumor revealed areas of neovascularization with characteristic low impedance (resistance index, 0.34 and pulsatility index, 0.62). Pathohistologic confirmation of the clearcell carcinoma has been done.

First-trimester diagnosis of cystic hygromata by transvaginal sonography.

This paper reports two cases of fetal nuchal cystic hygromata diagnosed in the first trimester of pregnancy by transvaginal sonography. In the first case, at 10 weeks' gestation, in addition to the hygromata, the fetus had an exomphalos. In the second case, at 13 weeks' gestation, the fetus had hydrocephalus and pleural effusion. Transabdominal chorion villus sampling was carried out and the fetal karyotypes were trisomy 18 and trisomy 21, respectively.

Transabdominal placental biopsy in the second and third trimester of pregnancy.

Transabdominal placental biopsy under ultrasound guidance was carried out in 260 cases in the second trimester and 50 cases in the third trimester of pregnancy. Placental tissue was aspirated using an 18 or 20 gauge needle. In a total of 310 placental biopsies in the second and third trimester, 100 were performed because of suspicious ultrasonographic findings. Placental biopsy is simple in the presence of severe oligohydramnios where fetal blood sampling is usually more difficult. Oligohydramnios and polyhydramnios were the ultrasonographic findings in 50% of cases and were found to be associated with 30% of abnormal chromosomal findings. There was one (0.3%) abortion within two weeks following placental biopsy. Placental biopsy did not affect the outcome of the pregnancy.

Ultrasonography in the detection of cervical incompetency.

In 80 pregnancies with clinical and ultrasonic signs of cervical incompetency, the length of the cervix and the thickness of the anterior wall of a lower uterine segment have been evaluated ultrasonically. We have also measured the width of the endocervical canal and studied the prolapse of fetal membranes (with fetal parts) into the endocervical canal. We evaluated these same parameters in 80 healthy pregnancies. The length of the cervix, the thickness of the anterior wall of a lower uterine segment, and the width of the endocervical canal were followed longitudinally in the patients from the 10th to the 36th gestation week. No statistically significant differences between age groups were found. In four age groups at risk for cervical incompetency, cervical lengths and wall thickness were significantly different (p less than 0.001) from those in comparable controls. Forty-five percent of the patients in the at-risk group, with cervical cerclage, delivered at 37.3 (range: 32 to 41) weeks and 6.25% of pregnancies ended in abortion when the amniotic membrane herniated into the cervical canal, with or without some part of the fetus.

[Use of ultrasound in the diagnosis of genital endometriosis]. / Primjena ultrazvuka u dijagnostici genitalne endometrioze.

A comparison was made between ultrasound and clinical findings in 45 patients with patients with adenomyosis. In patients with ovarian endometriosis ultrasound showed a cystic ovarian endometriosis ultrasound showed a cystic ovarian tumour in 27 patients, a mixed ovarian tumour in 5 patients, and a solid ovarian tumour in 3 patients, then polycystic ovaries in 5 patients, while in 4 patients the ultrasound finding was negative. In patients with adenomyosis, ultrasound suggested an uterus metriticus 9 times, a myoma 5 times, while cystic islets in the myometrium were found in two cases. The findings described are not specific to endometriosis.

[Ultrasound grading of placental maturity and fetal lung maturity]. / Ultrazvucno stupnjevanje zrelosti posteljice i fetalna plucna zrelost.

In 126 pregnant women of the gestational age from the 28th to the 44th gestational week, the biparietal diameter, the abdomen diameter, and the placental maturity after Granum et al. were determined. Amniocentesis was performed for obstetric indication. Also the L/S ratio and the cytological estimation of the gestational age were recorded. The first degree of the placental maturity was found in 37, the second degree in 3, and the third degree in 36 pregnant women. In the first group, BPP was 8.38 +/- 0.75, the abdomen diameter 8.30 +/- 0.63, and pulmonary maturity in 73% of women according to the L/S ratio and in 91.9% according to cytological estimation. In the second group, BPP was 9.15 +/- 0.65, the abdomen diameter 9.03 +/- 0.83, and in 77.9% of women the L/S ratio was higher than 2 but in 56.6% of women, according to cytological estimation, there was a good pulmonary maturity. At the third degree of placental maturity, BPP was 9.49 +/- 0.60, the abdomen diameter 9.63 +/- 0.92, and a good pulmonary maturity in 94.4% of women. The RDS was not observed in 5.6% of newborns with the L/S ratio below 2. According to cytological estimation, BPP below 9.15 was found in pre-term labour and higher than 9.15 in at-term births when in 94% of women the L/S ratio was higher than 2.

[Simultaneous ultrasound and vaginal or rectal examination]. / Simultani ultrazvucni i vaginalni ili rektalni pregled.

The advances of simultaneous ultrasonic and vaginal or rectal examinations are described with regard to a better evaluation of the size, localization, and consistency of the process in the pelvis.

[Evacuation of a hydatidiform mole with ultrasonic guidance]. / Evakuacija hidatidne mole uz ultrazvucni nadzor.

In addition to being the best method for the diagnosis of the hydatidiform mole, ultrasound is also used in the surgical treatment of the mole. The procedure of the evacuation of the complete hydatidiform mole by vacuum suction and continuous ultrasonic monitoring is described. The method is illustrated by three cases.

[Pregnancy outcome in cervical cerclage with repositioning of prolapsed fetal membranes]. / Ishod trudnoca u kojih je ucinjena serklaza cerviksa s repozicijom prolabiranog vodenjaka.

In the past five years cerclage was performed at the Department in 265 pregnant women (1.87% of all births). The outcome of pregnancy is presented in fifteen pregnant women in whom cerclage was performed with the reposition of the prolapsed fetal membranes. In five patients pregnancy was terminated on time, while four of them gave birth to premature infants, and the infants are alive. The total survival rate is 60%. In three of the women pregnancy was effected between the 29th and the 31st weeks, and their newborns died, whereas the remaining three women aborted before the 28th gestation week. The results justify the operation even in such unfavorable cases, as an attempt to maintain pregnancy.

Ultrasonic planimetry of the gestation sac as a biometric method in early pregnancy.

A new method for determining the area of the gestation sac by thread planimetry is described. Mean weekly values with two standard deviations were determined on a series of 237 measurements of gestation sac area, age five to 11 weeks, in normal pregnancies. The gestation sac area grows curvilinearly from 1.85 cm2 at five weeks to 15 cm2 at 11 weeks. The mean diameter was calculated from the gestation sac area by using an adequate approximation of the irregular gestation sac shape to a circle of the same area. The dependence of the mean gestation sac diameter on gestation age is defined by the regression equation y = 0.46x - 0.95 and the correlation factor r = 0.92. Practical applications of gestation sac planimetry include the determination of gestation age in early pregnancy, and the follow-up of growth or determination of delayed growth in disturbed or failed early pregnancy.

Ultrasonic calculation of chorion cavity volume.

A method for calculating chorion cavity volume in the first trimester of pregnancy from the ultrasonic projection of the gestation sac is described. The area of the longitudinal and transverse sections were measured, and the volume was calculated from the mean value of the two measurements. The chorion cavity volume increased curvilinearly and approximately exponentially from 2.14 cc at five weeks to 44.38 cc at 11 weeks of gestation. The method was checked by comparing the computed volume and the real volume obtained surgically and by experimenting with an "artificial gestation sac" picture. A good correlation was obtained. The results match data reported in the literature.

[Dynamics of changes in fetal presentation and position in late pregnancy]. / Dinamika promjene polozaja i namjestaja ploda u kasnoj trudnoci.

The frequency of various presentations and positions of the fetus in individual gestational weeks in the third trimester was examined in 1137 pregnant women based on 1785 ultrasonic findings. Cephalic presentation at 28 weeks was observed in 62% cases and at the end of pregnancy in 95%. Breech presentation decreased from 29% to 4% before delivery, and transverse presentation was 10 times less frequent at delivery than at the beginning of the third trimester. The first and second fetal positions occurred almost equally in both of the main longitudinal presentations. Dynamics of changes regarding position and presentation was examined in 32 patients regularly each week. In 10 of them there was no presentation change and in 22, changes occurred once or several times, tending to attain a physiologic cephalic presentation before delivery. This presentation, once attained, did not change after the 33rd week. With regard to breech presentation, changes are possible even up to the 36th week. The optimal time for ultrasonic examination with the purpose of determining fetal presentation and position is 33-37 full gestational weeks.

[Malignant tumor (sarcoma) on a fetal neck, diagnosed during pregnancy by means of ultrasonics]. / Bösartiger Tumor (Sarkom) am Hals eines Fetus, durch Ultraschall während der Gravidität festgestellt

Authors present a case of congenital sarcoma discovered by ultrasound at 30 weeks of pregnancy. The tumour was shown projecting from the anterior neck, well limited and measured 12 X 12 X 8 cm associated with maternal hydramnios. Pregnancy was terminated. Patho-histological finding was a spindle cell sarcoma of the neck and mandibular region. Discussion is about clinical, ultrasound-diagnostic and morphological aspect of this rare entity.