Prenatal sonographic features of embryonal rhabdomyosarcoma.

We describe a case of fetal rhabdomyosarcoma detected during the third trimester of pregnancy by prenatal sonography. At 33 weeks' gestation, sonography performed because of suspected polyhydramnios showed a solid mass of 120 x 54 mm arising from the anterior wall of the fetal thoracic cage. Another mass within the left maxillary area which originated from the left orbital floor was also detected. In the abdomen, there were multiple round masses in and around the liver. As the previous scan at 28 weeks had appeared normal, the multiple masses which became visible and enlarged rapidly in different locations led us to believe that there was fetal cancer. The most likely diagnosis was rhabdomyosarcoma (which was later confirmed), because it is the most prevalent soft-tissue tumor in children and may develop within or outside muscle anywhere in the body and at any age. Two other reported cases which were detected by prenatal ultrasound examination are also discussed.

Elevated second trimester human chorionic gonadotropin level associated with adverse pregnancy outcome.

OBJECTIVE: Our purpose was to determine whether unexplained elevations in maternal serum human chorionic gonadotropin in the second trimester may be associated with adverse pregnancy outcome. METHOD: Between April 1992 and April 1995, 610 pregnant women undergoing second trimester triple marker screening for Down syndrome who delivered at our institution were evaluated. Eighty-one women with a hCG level greater than 2.0 multiples of the median (MoM) were included in the study group while 481 women with hCG levels < 2.0 MoM served as controls. Pregnancies with fetal chromosomal and structural anomalies and maternal serum alpha-fetoprotein levels greater than 2.0 MoM were excluded from the study. Pregnancy outcomes were obtained from hospital delivery records. Statistical analysis were performed by Student's t-test; odds ratios and 95% confidence intervals were also calculated. RESULTS: Women with elevated human chorionic gonadotropin levels showed an increased risk for preeclampsia (odds ratio (OR): 5.93, 95% confidence interval (CI): 1.97-15.88), intrauterine growth retardation (OR: 5.34, 95% CI: 2.14-13.34), preterm delivery (OR: 5.66, 95% CI: 3.22-9.98), and preterm premature rupture of membranes (OR: 3.15, 95% CI: 1.23-8.07). CONCLUSION: Unexplained elevation of human chorionic gonadotropin in the second trimester appears to be associated with adverse pregnancy outcome.

Digital examination and transperineal ultrasonographic measurement of cervical length to assess risk of preterm delivery.

OBJECTIVE: To compare the diagnostic performance of cervical length measurement determined with transperineal ultrasonography and digital assessment of the cervix for the prediction of preterm delivery in patients with preterm labor. METHOD: 90 patients admitted to the hospital with the diagnosis of preterm labor and intact membrane underwent cervical length measurement by transperineal ultrasonography along with digital examination for cervical dilatation and effacement. The main outcome measure was delivery before 37 weeks' gestation. RESULTS: 32 patients (35.5%) delivered preterm. Receiver operative characteristic curve analysis revealed that cervical canal length < or = 28 mm measured by transperineal sonography had the highest diagnostic performance with a sensitivity of 78.1% and specificity of 82.7%. The sensitivity and specificity of digital examination were found to be 65.5%, 72.4% and 62.5%, 68.9% for the cervical dilatation > 2 cm and effacement > or = 40%, respectively. CONCLUSION: Transperineal ultrasonographic examination for cervical length is more accurate than digital examination for prediction of preterm delivery in patients presenting with preterm labor. Transperineal ultrasonographic examination of cervix is invaluable in the prediction of preterm delivery where transvaginal transducers are lacking or skilled staff are unavailable.

The configuration of prepubertal hymen in Turkish population and its clinical aspect.

The importance of the hymenal configuration lies in the fact that it is accepted as an important sign of the virginity in many countries and also it needs a clearcut definition for the forensic evaluation of child abuse and rape. To improve understanding of configuration of the normal hymen we studied 100 prepubertal hymens. In addition to the most commonly seen types we found the fimbriated hymen at a high rate especially in adolescents. There was another configuration the appearance of which differed on each half of the vaginal orifice; one half had a labium while the other had fimbriae. The tagged type hymen was also encountered.

The validation of a computerized system for the interpretation of the antepartum fetal heart rate tracings (version 89/2.34).

We have developed a knowledge-based system for the interpretation of the antepartum fetal heart rate tracings. This study consists of four groups of patient: (1) 49 normal pregnancies with a normal perinatal outcome; (2) 13 normal pregnancies with abnormal perinatal outcome; (3) 33 high-risk pregnancies with abnormal perinatal outcome; and (4) 16 high-risk pregnancies with normal perinatal outcome. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of our expert system (version 89/2.34) were estimated to be 60.0, 85.7, 75.0 and 75.0%, respectively. When the normal pregnancies with abnormal outcome and the high-risk pregnancies with normal outcome were excluded from the population, sensitivity, specificity, PPV and NPV were calculated to be 57.7, 82.9, 68.2 and 75.6%, respectively (corrected values). The prevalance of abnormal outcome for this study was 41.7%.

Serum and parotid saliva testosterone, calcium, magnesium, and zinc levels in males, with and without periodontitis.

Fourteen male patients with periodontitis and 10 patients free of periodontitis were included in the study. The concentrations of testosterone (T), calcium (Ca), magnesium (Mg), and zinc (Zn) were measured in serum and parotid saliva. Patients with periodontitis had increased Ca and decreased Zn serum levels, and they had decreased Ca and increased T levels in parotid saliva. Furthermore, there was a low correlation between parotid saliva T and Mg levels in the patients with periodontitis (r = 0.61, n = 14, t = 2.663, p less than 0.005), and there is an inverse relationship between serum and parotid saliva Mg levels (r = - 0.58, n = 14, t = 2.468, p less than 0.05).