Prenatal management, pregnancy and pediatric outcomes in fetuses with septated cystic hygroma

It has been reported that, compared with simple increased nuchal translucency, fetal cases with septated cystic hygroma (CH) are more likely to face perinatal handicaps. However, pediatric outcomes and proper prenatal counseling for this anomaly have not yet been truly defined. We performed this study to determine pregnancy and pediatric outcomes of fetuses with septated CH. We searched records for cases with septated CH and collected data for structural abnormalities, karyotype analysis, and pregnancy outcomes. Fetuses born with septated CH were also evaluated for their pediatric outcomes. Sixty-nine fetuses with septated CH were enrolled in the study. Results showed that chromosomal abnormalities were present in 28 fetuses (40.6%), and the most common aneuploidy was Turner syndrome (n=14, 20.3%); 16 (23.2%) of the remaining cases, in which aneuploidy was not found, had coexistent structural malformations; 25 (36.2%) cases had normal karyotype and morphology. The total number of live births and infants with unfavorable neurologic follow-up were 13 (18.8%) and 2 (2.9%), respectively. Septated CH is associated with poor perinatal outcomes; therefore, karyotype analysis and ultrasonographic anomaly screening should be performed as initial steps, and expectant management should be offered to couples with euploid fetuses that have normal morphology.

Effects of Hysteroscopic Septotomy on Pregnancy in Patients with History of Infertility or Recurrent Spontaneous Abortion / 대한불임학회지

OBJECTIVE: The aim of this study was to evaluate the influences of uterine septum and their elimination on the reproductive outcomes in women who have history of recurrent spontaneous abortion (RSA) and/or infertility. METHODS: The medical records of reproductive outcomes in patients who have had history of RSA and infertility who were diagnosed with uterine septum only by hysterosalpingogram (HSG) between January 2008 and December 2009 were retrospectively analyzed. The subjects who have had severe male factor, tubal factors, other uterine factors, endocrine abnormalities, peritoneal factors, and abnormal karyotyping among both partners were excluded. In 27 patients, confirmation of diagnosis by laparoscopy and elimination of uterine septum by trans-vaginal hysteroscopy was done. Seventeen patients were strongly suspected to uterine septum on HSG but tried to get pregnancy without any other procedure for evaluation and management of uterine anomaly. Age matched 42 patients who have history of RSA and/or infertility and diagnosed to normal HSG finding at same period were randomly selected as control. The medical records of reproductive outcomes were analyzed and compared between groups. RESULTS: The mean time of observation after diagnosis was 21.8 months (10 to 32). 55.6% (15/27) of patients in patients who received trans-vaginal hysteroscopic uterine septotomy were success to get pregnancies and was significantly higher than that of 17 patients who did not receive proper management (23.5%, 4/17, p<0.05). In control population, 40.5% (17/42) were success to pregnancies and the differences were not statistically significant compared to both two study groups. The live birth rate which was excluded pregnancy loss by abnormal fetal karyotyping and congenital anomaly were 75% (9/12) in treated septated uterus group and 84.6% (11/13) in control group each which have no statistically significant different. In patients with septated uterus who did not receive proper management showed lower delivery rate (50%, 2/4) than that of other groups but was not statistically significant. CONCLUSION: According to present data, women with a uterine septum have an increased chance of successful pregnancy with improved obstetric outcome after proper management of the uterine cavity. And these results were showed in patients with no regard to their reproductive history. But, in case of failed to receive proper management, uterine septum can affect not only pregnancy ongoing but successful pregnancy too.

Clinical Features of Congenital Cytomegalovirus Infection in Neonates / 대한주산의학회잡지

OBJECTIVE: Cytomegalovirus(CMV) is the most common cause of congenital infection with diverse clinical features according to the age of hosts. This study was done to evaluate clinical manifestations and complications in congenital CMV infection. METHODS: Between October 2000 and September 2001, 10 cases of congenital CMV infection were diagnosed by urine culture within 2 weeks after birth. Demographic data, clinical and laboratory findings were collected from maternal and newborn hospital records. RESULTS: There were 7 males and 3 females. Average gestational age was 38+0 weeks(34+2-41+1), average birth weight was 2462+/-598.2g(1670-3360) and 5 cases were small for gestational age. Average head circumference was 31.9+/-1.8cm(29-34.3). There were 4 cases of microcephaly, 6 cases of petechiae, 3 cases of leukocytopenia, 6 cases of thrombocytopenia. There was no case showing hepatomegaly, hepatic dysfunction, or pathologic jaundice. 4 cases showed physiologic jaundice. IgM level was elevated in 5 out of 9 cases. Polymerase chain reaction(PCR) was positive in 7 cases. All cases showed germinal matrix hemorrhage and septated cysts on cranial ultrasonography. 1 case showed cerebral calcification. 1 case showed bilateral sensorineural hearing loss on brainstem auditory evoked potentials(BAEP). There was no case showing chorioretinitis on fundoscopy. CONCLUSION: There were diverse clinical manifestations in CMV infection in neonates. All cases showed germinal matrix hemorrhage and septated cysts. When we find these findings, we should consider the possibility of CMV infection. One patient developed bilateral sensorineural hearing loss, so its early detection and follow-up might be necessary.

Endoscopic treatment of septated chronic subdural hematoma With a report of 45 cases / 中国微创外科杂志

Objective To evaluate the therapeutic results of neuroendoscopy for the treatmentof of patients with septated Chronic Subdural Hematoma(SCHS). Methods 45 patients with SCSH were operated on under endoscope through a burrhole approach.neomembranes were resected by small microscissors.A closed drainage system was applied temporarily to ensure the efflux of the remaining hematoma. Results Forty-five cases were treated successfully.All patients had a sufficient or complete hematoma evacuation whithout recurrence of subdural hematoma.There was no subdural infection,bleeding,brainedema and cranial aerocele. Conclusions Neuroendoscopy is minimally invasive technique and have the advantages ot simple,effective,safe,less complication,less expensive and shorter hospitalization in the treatment of SCSH.

Encapsulated Choroid Plexus Papilloma with Surrounding Large Cyst

The case of a 6-month-old male infant with a choroid plexus papilloma showing unusual features is presented. This case is very unusual because the tumor did not have any connection with the choroid plexus but was attached to the normal brain parenchyme, encapsulated with thick hyalinized membrane and surrounded with large multi-septated cyst. At the surgery, it was confirmed that the tumor was in fact located at the right temporal lobe without having any connection to the normal choroid plexus and surrounding cyst was not lateral ventricle. Histopathological examination revealed a choroid plexus papilloma. We present this unusual case of choroid plexus papilloma with review of literature. Also, the pathogenesis of the tumor capsule and surrounding cyst is discussed.

A Case of Mucopyocele of the Septated Maxillary Sinus

A 48-year-old man has felt discomfort and fullness of left eye for 4 months. He noticed left infraorbital mass 2 months ago and visited our clinic. The corrected visual acuity was 1.0 in both eyes. Exophthalmometry showed 12mm in the right eye and 14mm in the left eye (bar:100mm). A hard, non tender, immobile mass was palpable in the infraorbital area of the left eye. Computed axial tomography showed low density cystic mass with rim enhancement which extended from the anterior wall of the maxillary sinus to the infraocular area. At operation, the cystic mass had yellowish mucopurulent material and eroded the anterior wall of maxillary sinus and the orbital floor. The mass was not connected with the maxillary sinus. On the light microscopic examination, the cystic mass was lined with pseudostratified ciliated columnar epithelium and diagnosed as mucopyocele. Occasionally the sinus is congenitally divided by bony septa into two more or less separate cavities. In this case, the mucopyocele was thought to be originated from congenitally septated maxillary sinus presenting as infraorbital mass.