Hypervascular retained products of conception: dilemma of diagnosis and management

Retained products of conception (RPOC) are a partial retention of placental tissue after dilation and curettage (D&C) procedures or vaginal deliveries. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception. This raises the possibility of serious intra‐operative haemorrhage because of the possibility of arterio‐venous malformation. The aim of this article is to discuss the diagnosis and management options of retained products of conception (RPOC) with increased vascularity where simple dilatation and curettage may lead to life threatening haemorrhage and endanger the life of the patient and to enlighten the importance of evaluation of vascularity in all cases of RPOC prior to dilatation and curettage in order to avoid the dreaded complication of massive haemorrhage.

Ureterovaginal Fistula: Aetiological Factors and Treatment Outcome

Ureterovaginal fistula commonly occurs as a result of complication of pelvic surgeries with gynaecologic surgeries accounting for approximately two thirds. It is one of the most feared complications of pelvic surgery. Objectives: This study aims to determine the aetiological factors, role of ultrasound in the confirmation of dignosis and outcome of surgical repair of ureterovaginal fistula at the National Obstetric Fistula Centre, Katsina (NOFIC). Methods: This was a two-year retrospective review of all cases that underwent surgical repair for ureterovaginal fistula at the National Obstetric Fistula Centre Babbar Ruga, Katsina from 1st Jan, 2016 to 31st Dec, 2017. Result: A total of 27 patients had surgery for ureterovaginal fistula during the study period. However only 25 case notes were eligible for data entry and analysis. The mean age of the patients was 29.88 ± 8.53 with a modal parity of one. Eighty-eight percent presented with history of leakage of urine per vagina following emergency caesarean section, caesarean hysterectomy in 8%, prolonged obstructed labour in 8% and gynaecological hysterectomy in 4%. The onset of leakage varied from 2 to 10 days with a mean duration of onset of 5.64 ± 1.70. In addition to the ureterovaginal fistula, 3 had vesicouterine (VUF) fistula and 1 had vesicocervicovaginal (VCVF) fistula. The fistula was bilateral in 2 of the patients. The fistulae involved the left ureter in 13 patients and the right ureter in 10. Abdominal ultrasound was the main means of confirmation of diagnosis. Abdominal reimplantation of the ureter was the most common (88%) treatment approach. Majority 88% (22/25) were healed and continent at discharge. Conclusion: Emergency caesarean section was found to be commonest aetiological factor and the use of abdominopelvic ultrasound was found to be effective in the confirmation of diagnosis and identifying the affected ureter.

The value of nuchal translucency thickness in the fetal chromosome abnormality screening / 实用医学杂志

Objective To evaluate the value of nuchal translucency (NT) thickness in the fetal chromosome abnormality screening. Methods 11 086 pregnant women received NT measurement in 11 ~ 13+6 weeks at Hainan general hospital from January 2010 to December 2014 were selected in the study. The NT thickness was measured according to guidelines from Fetal Medicine Foundation. 122 fetuses (NT≥2.5 mm) were recruited to accept karyotype analysis. Results 11 086 pregnant women received NT measurement in 11 ~13+6 weeks, in which 122 cases′ NT are more than or equal to 2.5 mm, with a positive rate of 1.10%. 122 cases of fetal NT thickening are between 2.5 to 12.0 mm, with the average degree at (4.5 ± 2.1)mm. 122 invasive prenatal diagnostic specimens chromosome karyotype analysis results showed chromosomal abnormalities in 21 cases (abnormal rate of 17.2%), the abnormal chromosome number in 17 cases and abnormal structure in 4 cases. The top 3 are trisomy 21 (12 cases, 57.1%), chromosome pericentric inversion (3 cases, 14.3%), and trisomy 18 (2 cases, 9.5%). Fetal chromosomal abnormalities resulting from different childbirth age, the sex of the fetus, NT thickness showed significant statistical difference (P < 0.05). The concrete manifestation is that fetal chromosomal anomaly detection rate in childbirth by women more than 35 years old age are higher than other age. Female fetal chromosomal anomaly detection rate is higher than the male , and NT thickness of 5mm of fetal chromosomal abnormality rate is significantly higher than the thickness of NT group at 2.5mm~ and 3.5mm~. Fetal NT thickening of NT measurements was in significant positive correlation with fetal chromosome abnormal rate (χ2=15.533, P < 0.001). Logistic regression analysis found that with a higher NT thickness , risk of fetal chromosomal abnormalities would be significantly higher , and thickening of NT could be an independent predictor of fetal chromosome abnormalities. Conclusion In early pregnancy, ultrasound examination of fetal ultrasound screening of NT thickness can be used as an important index of fetal chromosomal abnormality , and interventional diagnosis of prenatal NT thickness increase could pose increased risk of fetal chromosomal abnormalities.

Lithopaedion.

A lithopaedion or lithopedion is ancient Greek word meaning a stone baby. It is a rare phenomenon which occurs most commonly when a fetus dies during an ectopic pregnancy or during an abdominal pregnancy. The chance of abdominal pregnancy is one in 11,000 pregnancies. If the dead fetus is too large to be re-absorbed by the mother’s body it becomes a foreign body to the mother’s immune system. To protect from possible infection, the mother’s body will encase the fetus in a calciferous substance. The fetus is gradually mummified becoming a stone baby. Lithopedion may occur from 14 weeks’ gestation to full term. It is not unusual for a stone baby to remain undiagnosed for decades and found incidentally when taking plain x-rays films for various other investigations. This paper describes the known case of this phenomenon. The present case was about a 70 year old post-menopausal woman attended the Gynecology OPD with the complaints of mass per vaginum since 5 years. X-ray and Ultrasound scan of abdomen and pelvis revealed a lithopaedion.

Usefulness of Preoperative Computed Tomography in Children with Clinically Suspected Appendicitis

The entity of negative appendectomies still poses a dilemma in chlidren. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. However, the impact of CT scans on the diagnosis in children is unknown exactly. The purpose of this study was to critically evaluate CT scans for the evaluation of acute appendicitis in children, to review utilization of this diagnostic test in our appendicitis population and to determine if diagnostic accuracy has improved. A retrospective analysis of efficacy of CT scan for diagnosis of appendicitis in children was conducted. Children undergoing appendectomy for acute appendicitis were reviewed from 2007 to 2012. Perforation and negative appendectomy (removal of a normal appendix) rates were determined by the final pathologic report. Statistical comparison were made using the chi2 test and significance was assigned at p < 0.05. Five hundred four appendectomies were performed. Mean age was 10.1 +/- 3.21 years, and 62.7% were boys. Overall, 308 children (61.1%) underwent CT scanning, 100 (19.8%) had US performed, and 97 (19.2%) had no radiographic study. A pathologically normal appendix was removed in 8.7% (27 of 308) of CT patients, 9.0% (9 of 100) of US patients, and 11.3% (11 of 97) of patients without a study. The frequency of CT scanning increased from 29.7% (27 of 91) of all children in 2007 to 75.6% (59 of 78) in 2012, whereas utilization of US decreased from 30.8% (28 of 91) to 11.5% (9 of 78). During this time period the difference in the negative appendectomy rate did change significantly from 14% to 6%. Liberal use of CT scans in diagnosing appendicitis in children has resulted in a decreased negative appendectomy rate.

Anomalias e prognóstico fetal associados à translucência nucal aumentada e cariótipo anormal / Fetal abnormalities and prognosis associated with increased nuchal translucency and abnormal karyotype

OBJETIVO: Descrever a frequência de anomalias cromossômicas em fetos com translucência nucal (TN) aumentada, e a frequência de malformações estruturais, a evolução e o resultado da gestação nos fetos com TN aumentada e cariótipo anormal. MÉTODOS: Estudo retrospectivo envolvendo 246 casos com medida da TN acima do percentil 95º para a idade gestacional, com cariótipo fetal conhecido ou avaliação clínica das crianças no período pós-natal. Os casos foram acompanhados no setor de Medicina Fetal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTADOS: O resultado do cariótipo fetal esteve alterado em 14,2 por cento dos casos. O acompanhamento dessas gestações revelou anormalidade estruturais em 80,8 por cento dos fetos, sendo as anormalidades cardíacas as mais comuns (61,5 por cento). Resultados gestacionais adversos, como abortamento, óbitos intraútero e neonatal ocorreram em 76,5 por cento dos fetos. CONCLUSÃO: Translucência nucal aumentada, entre 11 - 13 semanas e 6 dias, é importante marcador de anomalias cromossômicas fetais e malformações estruturais fetais, principalmente cardíacas. Diante deste achado, há aumento do risco de abortamento, óbito intrauterino e neonatal para estas gestações.

OBJECTIVES: This study aimed to evaluate the incidence of chromosomal abnormalities in fetuses with increased nuchal translucency (NT) measurement. Incidence of structural abnormalities and pregnancy outcome was also described in fetuses with increased NT and abnormal karyotype. METHODS: This was a retrospective study involving 246 fetuses with increased NT and known karyotype followed at the Fetal Medicine Unit, Hospital das Clínicas, São Paulo University Medical School. RESULTS: Fetal karyotype was abnormal in 14.2 percent of the cases. Ultrasound anomaly scan and specialized echocardiographic studies in these cases showed fetal structural abnormalities in 80.8 percent and cardiac defects were found in 61.5 percent of the fetuses. Pregnancy outcome was abnormal in 76.5 percent of these women. CONCLUSION: Increased NT measurement at 11 to 13 weeks and 6 days is an important marker for fetal chromosomal and structural abnormalities, mainly fetal cardiac defects. This finding also indicates increased risk of spontaneous fetal and neonatal death.

Complicaciones postoperatorias en colecistectomía abierta, hospital Teodoro Maldonado Carbo, enero a junio de 2003 / Postoperative complications in open cholecystectomy, hospital Teodoro Maldonado Carbo January to June/2003

Los procedimientos y técnicas quirúrgicas de las vías biliares se realizan para producir la mejoría y/o curación de los diferentes síndromes que las involucran. Sin embargo, siguen existiendo situaciones en las que el propio tratamiento quirúrgico es responsable directo de cuadros de morbilidad y mortalidad. Tipo de estudio: Descriptivo, retrospectivo, transversal, Objetivos: Conocer las complicaciones de la colecistectomía abierta; distribuir la incidencia y secuelas de las complicaciones posquirúrgicas en cada grupo etáreo. Metodología: Se realizó el estudio durante 6 meses con 223 pacientes a los que se les realizó colecistectomía abierta. Resultados: de éstos, sólo 16 pacientes se mostraron con complicaciones (7). Según el género, los pacientes masculinos fueron 10 (62) y las pacientes femeninas 6 (38). Las edades con mayor complicación fueron de 40 a 49 años (5 pacientes). Con respecto a las complicaciones, la hemorragia fue la mayor causa, con 5 pacientes. En conclusión, si bien existe una alta incidencia de pacientes, el número de casos complicados no es grande. Afortunadamente la morbilidad supera a la mortalidad y estas complicaciones pudieron ser diagnosticadas y tratadas. Conclusión: Aunque los métodos realizados en el acto quirúrgico y el cuidado postoperatorio que se lleva a cabo siguen siendo efectivos para la gran mayoría de pacientes, hay que considerar siempre la existencia de complicaciones.

Surgical procedures and techniques in bile ducts are carried out to obtain improvement and/or healing of syndromes involving bile ducts. Nevertheless, there are still situations in which the surgical treatment itself is the direct responsible of morbidity and mortality profiles. Type of study: Descriptive, retrospective, transverse. Objectives: To know the complications of open cholecystectomy, arrange the impact and after-effects of postoperative complications in each age group. Methodology: the study was made for 6 months with 223 patients to whom an open cholecystectomy was carried out. Results: only 16 patients had complications (7). Male patients: 10 (62). Female: 6 (38). Ages with greatest complications: 40 to 49 (5 patients). Among complications, Haemorrhage was the greatest cause: 5 patients. In conclusion, although there is a high incidence of patients, the amount of complicated cases is not big. Fortunately morbidity exceeds mortality and these complications were diagnosed and treated. Conclusion: Although methods used in surgery and postoperative care are still effective for most of patients, we must always regard the possibility of complications.

A Study on the Prediction of Neurodevelopmental Outcome by Cranial Ultrasound in Preterm and Low Birth Weight Infants

PURPOSE: Recent progress in neonatal medicine increased the survival of preterm low birth weight infants. However, neurodevelopmental sequelae are ever increasing. We carried out this study to determine whether serial cranial ultrasonographic findings could predict neurodevelopmental outcome. METHODS: Four hundred and forty-one preterm low birth weight infants, who were admitted to the Neonatal Intensive Care Unit of Chonnam University Hospital from Jan. 1996 to Dec. 1998, were enrolled in this study. Infants were allocated to one of four groups, according to their ultrasonographic findings. Cases were included in group I when they showed normal ultrasound scans or their periventricular echogenicity was equal to choroid plexus(n=232); in group II, subependymal hemorrhage, intraventricular hemorrhage without ventricular dilatation(n=146); in Group III, intraventricular hemorrhage with ventricular dilatation or perivemtricular echogenicity-3 (n=48); in Group IV, bilateral cystic Periventricular leukomalacia(PVL)(n=15). In these four groups, correlation among the incidence of cerebral palsy and neurodevelopmental abnormalities, cranial ultrasonographic findings, and other perinatal parameters were evaluated by ANOVA test, chi- square test, and logistic regression analysis. RESULTS: The incidence of cerebral palsy was remarkably high in group IV(86.6%) and half of them showed a combination of other developmental abnormalities. The significant predictors of cerebral palsy were cystic PVL and duration of oxygen therapy. CONCLUSION: Cranial ultrasonographic findings could predict the development of cerebral palsy and other neurodevelopmental outcome in preterm low birth weight infants.

Bladder Volume Measurement Using Portable Ultrasound Instrument in Spinal Cord Injury Patients

A noninvasive measurement of residual urine or bladder volume would reduce number of unnecessary catheterizations and be useful for an intermittent catheterization program in the management of neurogenic bladder. The purpose of this study is to evaluate a portable ultrasound instrument for the measurement of bladder volume and to assess the effect of several factors such as trabeculation or soft tissue thickness on the accuracy of the measurements. Nine patients with neurogenic bladder dysfunction underwent 480 bladder volume measurements using a portable ultrasonographic device(BVI-2500 BladderScan) before 60 intermittent catheterizations. Ultrasonographic measurements of urine volume were compared with catheterized urine volumes. The mean difference was 46.42+/-39.15 cc and the mean percentage error was 23.32+/-19.31%. Mean differences of each bladder capacity were not affected by bladder capacity, and mean percentage errors tend to decrease as the bladder capacity increase. Bladder trabeculation and soft tissue thickness had no effect on the accuracy of the measurements. The ultrasonographic measurements detected the presence of residual urine volumes of > or =100 cc with a sensitivity of 81% and a specificity of 93%. The repeatability(Mean/SD) was 23%. The accuracy had no correlation with the frequency of scanning. We conclude that BVI-2500 bladder scan portable ultrasonographic device is a useful tool for the management of neurogenic bladder dysfunction in spinal cord injured people. Trabeculation and soft tissue thickness has no effect on the accuracy of the measurements.