Tumour necrosis factor-alpha in patients with severe preeclampsia with and without HELLP syndrome

Tumor necrosis factor-a [TNF- alpha], acytokine produced mainly by macro-phages, is involved in immunoregulation, the modulation of cell growth and differentiation, as well as in the induction of oxygen radicals. This study was designed to investigate whether tumor necrosis factor- alpha [TNF- alpha] is present in maternal plasma in pregnancies associated with severe preeclampsia with and without HELLP syndrome and its concentrations. Fifty patients with severe preeclampsia composed the study group. This group is further subdivided into severe preeclamptic without HELLP syndrome, [n = 37] and severe preeclampsia with HELLP syndrome [n = 13]. A control group composed of 25 pregnant women, some of them were in early labor [n = 11] and the rest [n - 14] were in late pregnancy. Maternal plasma samples for TNF- alpha were taken for all groups. Also, serum creatinine spartate aminotransferase [AST], alanine aminotransferase [ALT] and platelets count to diagnose the presence of HELLP syndrome. TNF-alpha was detected in 80% of the studied group with severe preeclampsia [n = 50], while it was detected only in 13 patients [21%] only in the control groups. Also, the maternal plasma concentration in the severe preeclamptic group was [61 +/- 17] ng/ml and [146 +/- 37] ng/ml in the severe preeclampsic group with HELLP syndrome [n = 13] respectively which were statistically highly significant when compared to maternal plasma levels in the control group [7 +/- 3] ng/ml. There were no positive or negative correlation between TNF- alpha plasma concentrations in both groups and maternal age, gestational age and parity. Also, in the severe preeclamptic group there were no positive or negative correlation between the diastolic blood pressure, the amount of protein urine, the liver enzymes or platelets count and TNF- alpha maternal serum levels. So, we can concluded that tumor necrosis factor-alpha is increased in the plasma of patients with severe pre-eclampsia especially those developing HELLP syndrome. These data are suggestive of a role for abnormal immune activation in the pathophysiologic mechanisms of severe pre-eclampsia with or without HELLP syndrome

Adnexal masses: clinical issues and magnetic resonance imaging appearance

Magnetic resonance images [MRI] of the pelvis in 33 women suspected of having an adnexal mass on physical examination or ultrasound study were done to determine accuracy of MRI in characterization of adnexal masses prior to surgery with correlation to histopathology. Masses were classified according to MRI diagnosis into three groups [benign [neoplastic and non neoplastic] and malignant groups]. They were analysed for size, location, morphologic characteristics and signal behaviour. In every case an attempt was made to generate a specific diagnosis according to previously reported characteristics MR appearance. Surgical follow up was obtained within 19 days of MRI examination for 30 patients. Surgical interference was avoided in 3 non neoplastic cases which diagnosed by MRI as theca lutein cysts, where follow up by clinical, examination, MRI and serial serum titre of B-subunit of hCG showed regression of masses by medical treatment. Of the total 30 operative adnexal masses, MRI, was 85.7% sensitive and 95% specific in prosectively diagnosing ovarian malignancy. MRI is highly accurate in identifying common benign and non neoplastic pelvic masses. In conclusion, when physical examination or ultrasound examination are inconclusive, pelvic MRI can aid in the evaluation of women with suspected pelvic masses