First Trimester Neurosonogram-Our Experience.

Central nervous system (CNS) malformations represent 1% of all births. For this reason, efforts are being made to increase detection of such anomalies prenatally. Consequently, a detailed assessment of the fetal nervous system in the first trimester of pregnancy is no longer a utopia as this kind of evaluation can detect severe malformation such as acrania, neural tube defects, holoprosencephaly or can draw attention regarding to anomalies currently detected in the second trimester due to certain markers of diagnosis. MATERIAL AND METHODS: The study included 1376 pregnant women with gestational ages between 11 and 14 weeks, who were referred to our unit for sonographic evaluation. We analyzed in all patients the fetal brain in axial and mid-sagittal views, assessing markers like intracranial translucency, brainstem/brainstem-occipital bone (BS/BSOB) ratio, choroid plexus (CP/HA) ratio, the octopus sign in order to detect as many anomalies in the first trimester of pregnancy. RESULTS: We detected 6 CNS anomalies during our search. All markers assessed were abnormal in all pathological cases. CONCLUSION: A detailed assessment of the fetal brain is recommended at 11-14 weeks because the earlier the diagnosis is confirmed, the lower the chances of obstetrical, psychological complications to supervene.

Giant Rhinosinusal Inverted Papilloma.

Sinonasal papilloma is a benign tumor, derived from Schneiderian sinonasal epithelium. There have been described three histological subtypes: inverted, oncocytic and exophytic. The case presented here is A 66-year-old male patient, which was hospitalized in our Otolaryngology Department for a giant tumor, that was exteriorized from the left nostril, repeated epistaxis, nasal obstruction and anosmia. The computed tomography scan revealed an iodophilic and non-homogeneous tumor, with areas of necrosis, which included the entire left nasal cavity, with extension to the rhinopharynx and the left maxillary sinus. We completely removed the tumor by an endoscopic medial maxillectomy, with the subsequent histopathological examination revealing an inverted papilloma, with areas of low grade dysplasia and also areas with oncocytic Schneiderian papilloma. At the six-months postoperative control, there was no tumor recurrence. Major issues of this type of tumor is fast invasion capacity and numerous local recurrence. More recent studies have shown that these relapses are often overdue tumors.

Implications of the First Trimester 2d and 3d Ultrasound in Pregnancy Outcome.

BACKGROUND: In this study we researched for the first trimester pregnancy measurements by transabdominal and transvaginal ultrasound: gestational sac volume (GSV), embryo volume (EV), placenta volume (PV), yolk sac volume (YSV) and crown rump lengh (CRL) in predicting pregnancy outcome. Our goals was to demonstrate the ability of the first trimester ultrasound in identifying patients at high risk for abortion, intrauterine growth restriction (IUGR) and low birth weight. METHODS: Prospective observational clinical study that investigated the role of the first trimester 2D and volumetric (3D) measurements in predicting pregnancy outcome. The study was carried out in the Obstetrics and Gynecology Department of the Emergency County Hospital in Craiova during a study period of 3 years (between 2016 and 2018). The study included a number of 87 pregnancies. Patients included in the study were offered an early 2D and 3D transabdominal and transvaginal ultrasound and afterwards they were followed up until delivery. The statistical analyses (standard deviation, coefficient of variety, Cohen K correlation coefficient) determined a correlation between the two ultrasound methods, between the values of these parameters and pregnancy prognosis, the correlation being more relevant for the 3D ultrasound. The GSV, EV, YSV, PV, CRL and pregnancy outcome was established. RESULTS: Our study showed that the concordance degree between the two methods was 89.7%. 3D ultrasound had a diagnostic impact in 96.6% of the cases, while 2D ultrasound had a diagnostic impact in 89.6% of the cases. The incidence of the patients at high risk for complications was recorded in pregnancies with abnormal early ultrasound markers. CONCLUSIONS: First trimester ultrasound is a capable method for identifying a higher percentage of patients at risk of pregnancy complications, counseling and monitoring compared to 2D ultrasound. Also, because there is no radiation exposure, the risks are non-existent.

A Severe Case of Aneurysmal Malformation of the Vein of Galen, Cardiac Failure and Intrauterine Fetal Death.

Aneurism of the vein of Galen is a rare congenital anomaly, where complex arteriovenous malformation are identified between multiple choroidal arteries and the median prosencephalic vein of Markowski, which is a precursor of the vein of Galen, with subsequent aneurysmal enlargement of the respective arteriovenous system. The congenital malformation develops during week 6 to 11 of fetal development. Infants often die from high-output congestive heart failure. We present a case of a 40 years old patient, presented the first time at hospital at 28 weeks of gestation for lower perception of fetal movements. The patient was referred to our Prenatal Diagnosis Unit for a suspected cardiac malformation. We diagnosed cardiomegaly along vein of Galen aneurysmal malformation (VGAM) with severe cardiac failure, ascites, and critical fetal distress. Fetal demise was noted 24 hours later, during the corticosteroid procedures for fetal maturation. A stillborn weighting 2000g with a severe hydropic aspect was born after labor induction. Autopsy was performed following injection of colored gelatin in carotid vessels. The aneurysmal defect was evident in the vein of Galen and straight sinus. We also found the transverse, sagittal and the occipital sinus seriously dilated. We could not highlight the communication with the middle cerebral artery, because of the degradation of the cerebral tissue, despite an optimal preparation.