Acardiac twin pregnancy: successful intrauterine ablative treatment with alcohol at 14 weeks of gestation.

Twin reversed arterial perfusion (TRAP) sequence is a serious condition of monochorionic twin pregnancy, occurring in approximately one in 35,000 cases. First trimester treatment of TRAP sequence is controversial with higher incidence of procedure related complications. Present case demonstrates a TRAP sequence that was managed by intrauterine treatment with one-ml 100% pure alcohol injection into the abdominal part of the umbilical artery and obliteration of the acardiac twin at 14 weeks of gestation. Antenatal follow-up was uneventful and elective cesarean section was performed at 39 weeks' gestation. Postnatal outcome of the pump twin was excellent at 30 months after birth. Early second trimester elective ablation by alcohol injection can be an inexpensive, alternative, and reasonable minimal invasive treatment option to prevent fetal loss of pump twin before mid and late second trimester in perinatology centers where intrafetal cord occlusive methods are not available.

Single umbilical artery and congenital heart disease in selected and unselected populations.

OBJECTIVE: A variable association between single umbilical artery (SUA) and congenital heart disease (CHD) has been reported previously. Discrepancies in the results may be related to the populations studied. In this study we assessed the relationship between SUA and CHD in two well-defined selected and unselected populations. METHODS: This was a retrospective review of all cases of SUA detected antenatally in a tertiary referral center between 1997 and 2003. Umbilical arteries were routinely identified around the fetal bladder by color-flow Doppler ultrasonography. The unselected population included pregnancies from a well-defined geographical area, delivering in the same hospital. The selected group was referred from other hospitals because of suspected abnormalities or other risk factors. Major CHD was defined as CHD needing postnatal treatment or long-term follow-up. RESULTS: There were 10 fetuses with major CHD in the selected group: four cases among 25 with extracardiac defects (16%; 95% CI, 4.5-36.1%) and six cases out of 22 with no other abnormalities (27%; 95% CI, 10.7-50.2%; P = 0.35). In the unselected group there were two cases of major CHD, both among the 13 fetuses with extracardiac abnormalities (15%; 95% CI, 2-45%), while there were no major cardiac defects in the 85 fetuses with SUA and no extracardiac abnormalities (0%; 95% CI, 0-4%; P = 0.03). CONCLUSIONS: The association between SUA and CHD varies dramatically with population selection criteria. The risk for CHD after the detection of SUA in an otherwise apparently normal fetus from an unselected population seems small and may not warrant specialist fetal echocardiography.

Prenatal diagnosis of a case probably with Oral-Facial-Digital Syndrome--Gabrielli type.

We report here a case with microcephaly, preauricular pits, cleft lip-palate, hypertelorism, multiple frenula and preaxial polydactyly. The clinical picture overlaps with many syndromes, but it is mostly consistent with oral-facial-digital syndrome, Gabrielli type. There are no previously reported cases of this syndrome presenting also with microcephaly. On the other hand, it is hard to differentiate this clinical picture from Goldenhar syndrome (Oculo-auriculo-vertebral spectrum), and oculo-auriculo-fronto-nasal syndrome because of many overlapping features.

A prenatally diagnosed case of sirenomelia with polydactyly and vestigial tail.

We are presenting a prenatally diagnosed case with sirenomelia, vestigial tail and polydactyly. A 30-year-old woman at 16 weeks of gestation with dichorionic twins was admitted to the hospital. Prenatal ultrasound demonstrated fusion of the lower limbs in one member and normal femurs, tibias and fibulas, and normal vertebras in the second twin, suggesting the diagnosis of sirenomelia. The twins were delivered vaginally at 35 weeks after spontaneous onset of labor. The affected newborn died after 24 hours and postnatal examination revealed unseparated lower limbs with extreme retroversion, bilateral pes equinus, unilateral postaxial polydactyly, a vestigial tail on the sacral region, a large and wide penis and anal atresia. There is only one previous report of sirenomelia with vestigial tail in the literature. However, a large, wide penis and polydactyly have not been reported before in association with this anomaly.

Elevated second trimester serum homocysteine levels in women with gestational diabetes mellitus.

OBJECTIVE: Our aim was to investigate the association between total serum homocysteine, vitamin B12 and folate levels in pregnant women with gestational diabetes mellitus (GDM), glucose intolerance and compare them with those of glucose tolerant pregnant women. MATERIALS AND METHODS: Serum homocysteine, vitamin B12 and serum folate levels were prospectively measured in a total of 223 pregnant women who were grouped according to their status of glucose tolerance as gestational diabetes (abnormal 1-h and 3-h glucose tolerance test; n = 30), glucose intolerant (abnormal 1-h, but normal 3-h glucose tolerance test; n = 46) or normal controls (normal 1-h glucose test; n = 147). RESULTS: Mean serum homocysteine concentration of women in gestational diabetes, glucose intolerants and normal controls at 24-28 weeks of gestation was 9.0 +/- 3.1, 8.1 +/- 2.5 and 7.4 +/- 1.6 micromol/l, respectively. The only statistically difference in homocysteine levels was observed between women with gestational diabetes and normal controls (P < 0.01). However, no difference was observed for vitamin B12 and folate levels. CONCLUSION: Second trimester serum homocysteine concentrations are higher among women with GDM, as compared to normal controls.

Benign cystic mesothelioma presenting as a huge pelvic mass--a case report.

Benign cystic mesothelioma is an extremely rare peritoneal tumor. It is reported in women of childbearing [corrected] age but also in males and needs a careful [corrected] differential diagnosis between benign and malign neoplasia to choose the most [corrected] adeguate therapy. A 25-year-old female [corrected] was treated in our clinic for a gigantic cystic mass (25 x 22 x 3 cm in diameter) containing [corrected] many to [corrected] cysts of different sizes. All tumoral markers were within normal range. Surgical [corrected] treatment consisted of radical excision of the mass and the prognosis was good [corrected].

Hydrosonography in screening for intracavitary pathology in infertile women.

OBJECTIVES: We evaluated the value of hydrosonography in screening for intracavitary pathologies in infertile patients. METHODS: A total of 93 infertile women with suspected intracavitary lesions on transvaginal ultrasonography (TVS) underwent hydrosonography. Specimens obtained either by dilatation and curettage or hysteroscopic resection were compared with findings on TVS and hydrosonography. RESULTS: Pathology confirmed the presence of sonographically diagnosed intracavitary lesions in 40 out of 66 (60%) women. The sensitivity, specificity, positive predictive value, and negative predictive value of TVS for the detection of endometrial cavity lesions were 78%, 38%, 61%, and 59%, respectively. Forty-six out of 71 (65%) women who were found to have intracavitary lesions on hydrosonography were pathologically confirmed. The sensitivity, specificity, positive and negative predictive value of hydrosonography in the detection of endometrial cavity lesions were 90%, 40%, 65%, and 77%, respectively. CONCLUSIONS: Hydrosonography is a useful procedure in screening for intracavitary pathologies and allows differentiation of intracavitary, endometrial, and submucosal abnormalities.

Postmenopausal endometrial cancer screening: is there a correlation between transvaginal sonographic measurement of endometrial thickness and body mass index?

OBJECTIVE: The aim of this study was to correlate the body mass index with transvaginal sonographic measurement of endometrial thickness in a cohort of postmenopausal women who were admitted for endometrial cancer surveillance. MATERIAL AND METHODS: Transvaginal sonographic measurement of endometrial thickness was performed in 97 postmenopausal women who attended the gynecology clinic for endometrial cancer screening with no history of hormone replacement therapy and correlated with body mass index. Baseline characteristics including age, years since menopause and body mass index were recorded for each subject. The relationship between transvaginal sonographic endometrial thickness and baseline characteristics was assessed in each. RESULTS: Body mass index was significantly correlated with years since menopause (r = 0.292, p = 0.004) and age (r = 0.243, p = 0.01) but not with endometrial thickness (r = -0.07, p = 0.454). Endometrial thickness versus time since menopause correlation was found to be significant (r = 0.274, p = 0.03) in patients with a body mass index lower than 30. CONCLUSION: The present findings indicate that endometrial thickness does not differ with body mass index in the screening of postmenopausal women for endometrial cancer.

Comparison of hydrosonography and transvaginal ultrasonography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.

BACKGROUND: The aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding. STUDY DESIGN: Prospective, randomized, and unblinded study. MATERIAL AND METHODS: A total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 +/- 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure. RESULTS: The surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results. CONCLUSION: Hydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.

Primary pleural lymphoma: an unusual presentation of childhood non-Hodgkin lymphoma.

A case of primary pleural non-Hodgkin lymphoma in a 2.5-year-old girl is reported. The patient had pleural involvement as the initial and only manifestation of the disease. Histopathologic examination showed lymphoblastic lymphoma of T-cell origin. The child received the modified LSA2-L2 protocol. During the maintenance treatment, she had an isolated central nervous system relapse and died of neutropenic sepsis. To the authors' knowledge this represents the first case report of primary pleural lymphoma in the childhood period.