Fetal hydrometrocolpos, uterus didelphys with low vaginal and anal atresia: difficulties in differentiation from a complex cloacal malformation: a case report.

Hydrometrocolpos, occurring in approximately 1/6000 newborn girls, can be caused by a stenotic urogenital sinus, a severe cloacal malformation, but also by other conditions such as an imperforate hymen, a midline vaginal septum and vaginal atresia. The prenatal differential diagnosis of this wide spectrum of conditions is not easy and requires a multidisciplinary approach with follow-up scans and MRI to access the severity of the condition. A non-consanguineous couple was referred in the first pregnancy at 30 weeks. The father, 30 years of age, of Kaukasian origin, and the mother of Asian origin, 26 years of age. Ultrasound at 30 weeks revealed ambiguous genitalia (with suspicion of clitoral hypertrophy), a septated structure located behind the bladder compatible with hydrometrocolpos with a uterine malformation (uterus didelphys), a single umbilical artery, mild ascites and growth on the tenth centile. The differential diagnosis included a vaginal atresia, a urogenital sinus and a more severe cloacal malformation. After serial scans, MRI and counselling by an experienced surgeon the preferential diagnosis of a cloacal malformation was made and a late pregnancy termination was performed. Pathological examination revealed: low vaginal atresia with uterus didelphys, anal atresia with rectovaginal fistula and a normal urinary tractus. The differential diagnosis between hydrometrocolpos due to vaginal atresia or due to a more severe cloacal malformation is not straightforward. Care should be taken in decision making and counselling patients with these complex prenatal malformations.

Perfusion of the uterine junctional zone in nulliparous and primiparous women assessed by DCE-MRI, as a function of menstrual cycle and hormonal contraception.

PURPOSE: To evaluate the perfusion parameters of inner and outer myometrium in healthy nulliparous and primiparous women who are and who are not currently using hormonal contraceptives by means of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIAL AND METHODS: We performed pelvic 1.5T DCE-MRI on 98 women: 18 nulliparous non-users, 30 nulliparous users, 12 primiparous non-users and 38 primiparous users of hormonal contraception (mean age respectively 26.4, 25.8, 30.23 and 28.18years). The nulliparous non-users underwent DCE-MRI investigations during their follicular, ovulatory and luteal phase. Perfusion parameters (iAUC/volume, Ktrans, Kep and Ve) were assessed in the anterior and posterior junctional zone (JZ), outer myometrium and cervix. RESULTS: In nulliparous non-users, the mean Ktrans and iAUC/volume showed a decrease from follicular to luteal phase (0.82 vs 0.55min-1 for Ktrans, p=0/027 and 1.28 vs 0.68 for iAUC/volume, p<0.001). The anterior JZ demonstrated lower Ktrans (p=0.050) and higher Kep (p=0.012), in nulliparous non-users, lower Ktrans in nulliparous users (p<0.001) and lower Ve in primiparous users (p=0.012) than the anterior outer myometrium. Ktrans at the anterior and posterior JZ wall in nulliparous users was lower than in non-users (p=0.001 and p=0.013) and Ve at the anterior JZ wall in primiparous users was lower than in non-users (p=0.044). CONCLUSION: This study provides data on normal perfusion parameters of inner and outer myometrium, which may be potentially useful in assisted reproductive therapy.

Hypertensive brain stem encephalopathy in a patient with chronic renal failure.

Hypertensive brain stem encephalopathy is a rare disorder that can be seen in severe hypertensive encephalopathy. Patients with chronic renal failure are more prone to develop this disorder because a mild elevation of the blood pressure can already induce brain changes. It is important to diagnose this entity as soon as possible because the symptoms and brain stem lesions are reversible following treatment and because it is important to exclude brain stem ischemia in the diagnostic work-up. Brain MRI and particularly diffusion weighted images are crucial for this purpose.

Sulfite oxidase deficiency in a newborn.

Isolated sulfite oxidase deficiency is a rare, autosomal recessive disease with a very poor prognosis. This condition usually presents in the neonatal period and is mainly characterized by neurological abnormalities, including refractory seizures, abnormal muscle tone, abnormal movements, and marked developmental delay. The differentiation from hypoxic-ischemic encephalopathy is difficult based on clinical findings alone. We present a neonatal case

Validation of 3D power Doppler and VOCAL software in the sonographic assessment of hepatic venous flow.

UNLABELLED:  AIM: To evaluate the reproducibility of three-dimensional power Doppler ultrasonography (3D-PDU) and the repeatability of Virtual Organ Computer-aided AnaLysis (VOCAL) software in the assessment of hepatic venous flow in ten healthy non-pregnant individuals. METHODS: Visualization of hepatic veins was performed using both intra- and subhepatic approaches; These examinations were repeated twice. Vascular indices were obtained for each examination in a reference point using both small and large volume samples (3 times per type of volume sample). Intraclass Correlation Coefficients and Pearson's Product-Moment Correlation Coefficient were calculated to assess reproducibility and repeatability, respectively. RESULTS: Intraclass Correlation Coefficients were more than 0.60 in small volumes, but variable in large volumes for both approaches. However, re-identification of the reference point failed in 30% using the subhepatic approach. Repeatability was high for all VOCAL analyses (Pearson's Product-Moment Correlation Coefficient > 0.98). CONCLUSIONS: These results indicate reliable use of intrahepatic small volume samples in clinical application and invite to explore the role of this technology in the assessment of hepatic venous hemodynamics.

Colonoscopy-assisted reposition of the incarcerated uterus in mid-pregnancy: a report of four cases and a literature review.

The treatment of mid-gestational uterine incarceration remains a challenge. The success rate of manual reduction decreases with gestational age, and an operative procedure may carry important fetal, next to possible maternal morbidities. We will present four cases of uterine incarceration between the 15th and 25th week of pregnancy of which three colonoscopy-assisted manual repositions proved successful. It illustrates that conservative treatment of uterine incarceration is feasible, even during the late second trimester. That is why a review of the conservative approach of this rare condition is also presented.

Hypoplasia of L5 and wedging and pseudospondylolisthesis in patients with spondylolysis: study with MR imaging.

BACKGROUND AND PURPOSE: The association between L5 hypoplasia and bilateral spondylolysis was described earlier on conventional radiographs of the lumbar spine. The purpose of this study was to describe the findings on MR imaging in patients with hypoplasia of L5 and to correlate these findings with the presence of bilateral spondylolysis of L5. MATERIAL AND METHODS: We studied the MR images of 22 patients with hypoplasia and posterior wedging of L5 and with bilateral spondylolysis at L5. The anteroposterior diameter of L4, L5, and S1 were measured and compared. The degree of posterior wedging of L5 was calculated. The degree of anterolisthesis was determined. The intervertebral disks of L4-L5 and L5-S1 were studied. RESULTS: The mean difference between the anteroposterior diameter of L4 and L5 was 3.0 mm, or 8.8% shortening of L5 compared with L4. The mean difference between the anteroposterior diameter of L5 and S1 was 4.4 mm, or 12.3% shortening of L5 compared with S1. The mean percentage posterior wedging was 24.7%. In 13 patients, there was no anterior vertebral slipping. True anterolisthesis grade I was seen in 5 patients and anterolisthesis grade II in 4 patients. Diskarthrosis with disk dehydration of L4-L5 was seen in 20 of the 22 patients. CONCLUSIONS: It is confirmed that hypoplasia of L5 can simulate anterolisthesis. Hypoplasia of the vertebral body of L5 can predict the presence of bilateral spondylolysis.

Additional value of integrated PET-CT in the detection and characterization of lung metastases: correlation with CT alone and PET alone.

The purpose was evaluating retrospectively the additional value of integrated positron emission tomography (PET) and computed tomography (CT) in the detection of pulmonary metastases in comparison with CT and PET alone. Fifty-six lung nodules, divided into three groups according their size, detected in 24 consecutive patients with a known primary tumor were retrospectively evaluated with integrated PET-CT, CT and PET. The nature of these nodules was determined by either histopathology or a follow-up of at least 6 months. The CT and PET images of the integrated PET-CT were evaluated separately by a radiologist and a nuclear medicine physician, the integrated PET-CT images were evaluated by a chest radiologist and nuclear medicine physician in consensus. The investigators were asked to search lung nodules and to determine whether these nodules were metastases or not. Sensitivity and accuracy for CT, PET and integrated PET-CT for characterization of all pulmonary nodules were, respectively: 100%, 90%, 100% and 57%, 55%, 55%. There was no significant difference in the characterization of pulmonary nodules between integrated PET-CT and CT alone (P=1.000) and PET alone (P=0.1306). An accurate evaluation is only possible for lesions larger than 1 cm.