Maternal-fetal prognosis in HELLP syndrome in a level 3 maternal-fetal care centre.

PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate the maternal and perinatal outcome and prognosis in pregnant women with HELLP syndrome. MATERIALS AND METHODS: Medical records of eligible pregnant women with HELLP syndrome were reviewed retrospectively. Patients were evaluated in terms of maternal complication, as well as the types of delivery. Perinatal outcome were evaluated in terms ofApgar score, birth weight, respiratory distress syndrome, and neonatal intensive care unit admission. RESULTS: The leading maternal complications associated with HELLP syndrome were the following: severe preeclampsia, eclampsia, placental abruption, acute pulmonary edema, acute kidney failure, disseminated intravascular coagulation syndrome, and immediate maternal death. The most prominent neonatal outcomes associated with HELLP syndrome were: antenatal fetal death, intrauterine growth restriction, prematurity. CONCLUSION: The management and delivery of the patients with HELLP syndrome must take place in a tertiary referral maternal and fetal care centre.

Postpartum splenic rupture: a possible iatrogenic event, but finalized with successful conservation of the spleen.

The authors present the case of a postpartum splenic rupture induced probably by iatrogenic injury (recent vaginal delivery with a prolonged expulsion with uterine fundus compression) including the left hypochondria region costal grid. The case was solved with splenic preservation and achieving hemostasis only by local plugging and Gelaspon. The case raised also other problems regarding the etiology of splenic rupture, in establishing a causal relationship between a intrapartum splenic injury, and the three episodes of inferior genital tract hemorrhaging, in establishing the cause of the infectious syndrome from the 24h postpartum day, (parietal infection or splenic abscess requiring splenectomy).

An unusual enhanced Doppler vascular profile of a rare uterine tumor: PEComa.

PEComas represent a rare class of mesenchymal tumors, with different primary locations. There are less than 100 cases of uterine PEComas published in English literature until now and information considering imaging features of these PEComas is very limited, focusing on CT and MRI and not as much on ultrasounds (US). The authors present here a case of rapidly growing uterine PEComa, with local invasive potential and recurrence, and the review of literature on US characteristics of PEComas. Harboring a hyperechogeneous heterogeneous aspect with no clear separation from the adjacent uterus on the whole boundary, with an extremely rich central vascular network, with low impedance and a rapidly growing profile, this tumor does not show the classic US appearance of malignant PEComas, which are generally easily confused with leiomyomas. However, even if this pattern did not allow the authors to anticipate the histopathological result, it offered clear clues about its invasiveness potential.

Pelvic endometriosis and uretero-hydronephrosis: clinical, imagistic and surgical implications--case report.

UNLABELLED: Endometriosis represent the presence and proliferation of functional endometrial-like tissue outside the uterine cavity, and is a chronic, recurrent, debilitating desease, in which kidney implications are rare, but complex. OBJECTIVE: Evaluation of clinical, imagistic and surgical implications of uretero-hydronephrosis secondary to recurrent pelvic endometriosis. MATERIAL AND METHODS: 30 year old patient diagnosed with primary infertility and left ovarian endometriosis (treated with classically conservative surgical procedure), presented acute onset of obstructive urinary symptoms, requiring internal drainage of the upper urinary straight path (Cook probe) for uretero-hydronephrosis grade III. CT and MRI examination reveals the presence of a imprecise pelvic mass incorporating right distal ureter and uretero-bladder ostium. RESULTS: In this clinical and laboratory context, classic surgery is practicing with right anexectomy and direct right uretero-vesical reimplantation, also with psoas bladder-hitch. Histopathological examination confirmed the presence of recurrent ovarian endometriosis with right distal ureteral invasion. CONCLUSION: Recurent endometriosis, although considered a benign condition, often present invasive characters, determining considerable anatomical destructions and severe symptoms.

Benign breast disease and the risk of breast cancer in the next 15 years.

AIM: Fibrocystic mastosis (FCM) is defined by the totality of dystrophic changes of the mammary tissue, the grouping in the form of fibrosis of epithelial, cystic, metaplastic and hyperplastic alterations. A very good estimation of the cancer risk is related specifically to the microscopic aspect. Other factors, the family history as well as the presence of an inherited gene determining the increase in the risk of breast cancer are also considered. But, if a woman known with fibrocystic mastosis has not undergone any biopsy, then it is impossible to calculate the specific individual risk of developing cancer. MATERIAL AND METHODS: The data collected as a study material and considered refer to: the total num- ber of cases investigated and diagnosed with fibrocystic mastosis, the annual distribution of this disease cases, the distribution of the cases according to age groups, admission reasons, clinical examination, personal pathologic history clinically significant for the basic disease (the main diagnosis), the family medical history significant for the basic disease, the anatomopathological diagnosis. RESULTS: Between 2004 and 2006, at "Cuza Voda" Obstetrics and Gynecology Hospital of Iasi, a maximum number of cases is noticed in 2006, when there were 147 cases, and the lowest number of cases was in 2005. There was high frequency of the anatomopathological examinations that highlighted the presence of fibrocystic lesions (both proliferative and non-proliferative), and the second most often diagnosis is fibroadenoma. Though fibrocystic mastosis is not clearly defined, it is still admitted that in order to support this diagnosis it is first compulsory to exclude malignant tumours. CONCLUSIONS: Only in 5% of the women with fibrocystic mastosis cellular changes can be revealed in the form of atypical hyperplasia, which are a risk factor for cancer. The lesion that delimits cancer from non-cancer is ductal carcinoma in situ. An incidence of over 20% is present in the countries that use mammographic screening programmes, mammographic surveillance programmes and programmes for the guided localization of nonpalpable lesions of the mammary gland.

Heterologous type of malignant mixed Müllerian tumor of the uterus presenting as a vulvar mass.

Carcinosarcoma is a rare, extremely aggressive tumor of the uterus with a poor prognosis. The authors describe a case of a 78-year-old woman who presented with a giant mass protruding through the cervix, vagina, and vulva. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histopathological examination of the surgical specimen revealed a malignant mixed Müllerian tumor. The clinical and pathological features, molecular data, and prognosis of this aggressive neoplasm are discussed. Although uterine carcinosarcomas are extremely rare, when a postmenopausal woman with a vulvar mass is admitted to the gynecology clinic, the physician should consider that the mass may be a carcinosarcoma.

The role of EEG brain mapping in quantification of brain damage in hypertensive disease associated with pregnancy.

UNLABELLED: The existence of a high blood pressure during the pregnancy represents a real danger for the mother and child, responsible for damage of the kidney, brain, liver, and placenta, cardiovascular and hormonal system. Nervous system changes can include blurred vision, seeing spots, severe headaches, convulsions, brain hemorrhage, and even occasionally blindness. AIM: To evaluate the spatial distribution of electroneuro-pathological aspects of brain activity at pregnant women with hypertensive disease by BEAM (Brain Electrical Activity Mapping). MATERIAL AND METHODS: Twenty pregnant women (week 20 to 39) with hypertensive disease were recruited. Healthy pregnant women were also recruited control group. Maternal monitoring included spectral multichannel EEG analysis (brain mapping), repeated clinical examinations and laboratory investigations. RESULTS: The major EEG changes observed were focal slowing of the background activity (14 patients)--occipital lobes especially, and intermittent spike and sharp wave transients (5 patients). CONCLUSIONS: Our finding's indicate that EEG brain mapping are probably sensitive in detecting the extent of the pathology in the brain in women with in hypertensive disease associated with pregnancy.