Monochorionic vs Dichorionic Twins: Kanet Test vs Postnatal Neurodevelopment.

The twin pregnancy is a risk pregnancy, being associated with a series of fetal and neonatal complications when compared to singleton pregnancies. Ultrasound assessment of the fetal brain is mandatory in the prenatal screening for fetal, congenital and acquired anomalies. Fetal neurosonography is useful in the prenatal diagnosis of cerebral anomalies, combining ultrasonography with fetal ultrasound. In this study, we assessed the Kanet score in two populations of pregnant women with dichorionic twin pregnancies (DC twin) (n=67) and monochorionic twin pregnancies (MC twin) (n=24). In the two groups we included pregnancies with normal fetal growth and pregnancies with discordant fetal growth (DC twin) and selective intrauterine reatriction (MC twin). For both groups, we assessed the antenatal Kanet score during three visits and compared the results with the neurodevelopment immediately after birth up to the two-year-old children. The calculation of the average values of the Kanet score for dichorionic pregnancies revealed normal, maximal average values at all three visits, for all fetuses, no matter if they had normal growth or discordant growth. At the first and third visit, we observed statistically significant differences between the average Kanet scores in DC twins with discordant growth vs. DC twins with normal growth. The analysis of average values of the Kanet score in the group of MC twin pregnancies revealed statistically significant differences between monochorionic twins with discordant growth vs. twins with normal growth at all three visits (p=0.0001), with average values between 17.30 and 19.62 being deemed normal. Amiel-Tison score was used as a standard tool for the neurological assessment both immediately after birth and for children up to two years of age.

The experience of our Clinic in laparoscopy for adnexal masses and the correlation between ultrasound findings and pathological results.

INTRODUCTION: An adnexal mass (mass of the ovary, Fallopian tube, or surrounding connective tissues) is a common gynecological problem. Ovarian pathology can occur at any time from fetal life to menopause. Sonography is a clinically important imaging modality for assessing whether an adnexal mass is likely benign or possibly malignant. Most ovarian surgeries are for benign disease and can be performed laparoscopically. PATIENTS, MATERIALS AND METHODS: We retrospectively evaluated all the patients from our Clinic who underwent laparoscopy for adnexal tumors in the last three year. We were studying the correlation of the preoperative ultrasound examination and the pathological result for each case. RESULTS: In this study, there were included 71 patients who underwent a laparoscopic intervention for adnexal tumors. The average age was 33 years old (range 18 and 60 years old). The ultrasound findings were ovarian endometriosis in 23.9% of cases, left ovarian cysts (22.5%) and right ovarian tumors (18.3%), and the lowest percentage was of left ovarian tumors (8.5%). Regarding the histopathological examination, we found the following results: ovarian endometriosis (32.4%), ovarian functional cysts (15.5%), serous ovarian cysts (15.5%), salpingitis (12.7%), ovarian myoma (7%), papillary serous ovarian cysts (4.2%), ovarian teratoma cysts (9.9%), one case (1.4%) of ovarian carcinoma and one case (1.4%) of borderline serous tumor. In this study, we observed that it was a strong correlation between the ultrasound finding and the pathological result for adnexal tumors (p<0.001). CONCLUSIONS: The laparoscopy was performed in our Clinic for adnexal masses with benign characters in ultrasound examination. The histopathological examination confirmed the diagnosis, being only one case of ovarian carcinoma in this study.

Diagnosis and complications of renovascular hypertension in children: literature data and clinical observations.

INTRODUCTION: Renovascular hypertension in children is a very rare illness. It occurs as a result of the imbalance between hypotensive and hypertensive systems. Renal ischaemia (95% of the cases) and the shortening of hipotensive factors (5% of the cases) are responsible for the production mechanism of renovascular hypertension in children. In order to make an early diagnosis regarding the renovascular hypertension in all children suffering from renovascular illnesses, blood pressure must be taken correctly and repeatedly. MATERIALS AND METHODS: This paper is a case study on 19 children with renovascular hypertension, aged between 2 and 15 years old. Most cases were divided into two groups: subjects aged 4-7 years old and subjects aged 8-12 years old. Each group represents 34.2% of all cases. The diagnosis of renovascular hypertension in those 19 children was established after correctly taking the blood pressure and comparing it with the normal values for each age. Hypertension was diagnosed before knowing its cause in 8 neglected cases. The blood pressure was repeatedly taken in the other 11 children suffering from renovascular illnesses and the diagnosis of hypertension was early established when blood pressure values increased. Previously, blood pressure was normal in these 11 cases. RESULTS: The etiopathogenical diagnosis showed parenchymal diseases in 12 cases--63.1%. Seven patients suffered from renovascular lesions--36.9%. Laboratory exams, radiology, imagistic exams, arteriography and scintigraphy were steps taken in order to establish the etiopathogenical diagnosis. These exams showed the next direct causes of renovascular hypertension: bilateral chronic pyelonephritis in 4 cases--21.4%, hydronephrosis in 3 cases--16.2%, congenital renal hypoplasia in 2 cases--10.4% and doubled kidney in 2 cases--10.4%. The other 8 cases presented acute glomerulonephritis, unilateral renal agenesis, horseshoe kidney, unilateral pyelonephritis, renal artery agenesis, renal trauma, renal abcess and Wilms tumor, one case of each illness--5.2%. The major complications were: retinopathy, chronic renal failure and stroke. CONCLUSIONS: Laboratory data are just a hint in diagnosing renovascular hypertension. However, radiology, imagistic exams, arteriography and scintigraphy are compulsory in the renourinary status and etiopathogenical diagnosis.

Reno-ureteral diseases inducing hypertension in children.

UNLABELLED: Revealing the cause of renal hypertension is a major objective in medical practice. A series of investigations are required in order to elucidate the primary disease and then the treatment surgical and/or medical. The transitory hypertension of adolescent is not discussed in this paper. Measuring the blood pressure in children is often neglected and the evaluation of the hypertension is performed after the diagnosis of the renovascular disease. AIMS: The classification of renovascular hypertension in children and the statistical evaluation of its etiology in order to reveal the most frequent renovascular disease are a topical work of several authors. A guide of the most frequent causes of hypertension in children edited after the studies of several authors may lead to a complete classification and describe a complexed concept regarding diagnosis, evaluation and treatment of the patients. MATERIALS AND METHODS: This paper displays an analytic study on 19 patients, aged between 2 and 15 years, diagnosed with hypertension and presenting signs and symptoms of hypertension. Four of the 19 patients needed medical treatment, 12, surgical treatment, and for three patients the treatment was mixed. RESULTS: The renal hypertension was determined by aberrant renal arteries in four cases, by pyelonephritis in four cases, by reno-pyeloureteral duplication with congenital megaureter in two cases and by transversal renal rupture, renal agenesis, horse shoe kidney, glomerulonephritis and Wilms tumor, in one case each. In our study, the parenchymal diseases predominated (12 cases of 19-63.1%) over the 7 cases with renovascular lesions--36.9%. Among the parenchymal diseases seven are unilateral, six reno-ureteral malformations and a pyelonephritis, and five are bilateral, four pyelonephritis and a glomerulonephritis.Those seven cases of renovascular lesions include six indirect lesions (three hydronephrosis, one Wilms tumor, one renal abscess, one renal trauma) and one case of congenital vascular anomaly without stenosis (renal agenesis). CONCLUSIONS: All reno-ureteral diseases included in Ursea-Ionescu-Târgoviste classification can induce hypertension but renovascular hypertension does not appear in all cases. The diagnosis of the reno-ureteral diseases inducing hypertension in children permits the treatment of hypertension and reno-ureteral illness. The analytic study of diagnostic and treatment methods of different diseases and authors may select the most efficient methods and orientate towards a new therapeutical concept and/or evaluation system. The treatment of the reno-ureteral diseases inducing hypertension avoids the development of some serious complications: the retinopathy, the chronic renal failure, the cerebrovascular accidents.