Intrauterine growth restriction and fetal body composition.

OBJECTIVE: To assess the differences in fetal body compartments between fetuses with normal growth and those with reduced intrauterine growth, during the third trimester, through ultrasonographic determination of subcutaneous tissue thickness (SCTT). METHODS: Twenty-eight patients were enrolled into this case control study carried out at 30-31 weeks' gestation. Two study groups were matched for maternal age and pregestational body mass index: controls (n = 14) and intrauterine growth-restricted (IUGR) fetuses (n = 14). Routine ultrasound-derived biometric parameters (head circumference, abdominal circumference, femur length and humerus length) were measured. Additionally, the mid-arm fat mass and lean mass (MAFM and MALM), the mid-thigh fat mass and lean mass (MTFM and MTLM), the abdominal fat mass (AFM) and the subscapular fat mass (SSFM) were measured. The Mann-Whitney U-test and Student's t-test were used to compare the two groups. RESULTS: The abdominal circumference and the humerus were significantly smaller in IUGR fetuses than in controls. Most of the SCTT values were different in the two groups. The SSFM (3.6 +/- 1.1 vs. 2.6 +/- 0.7 mm; P = 0.011), the AFM (5.1 +/- 0.7 vs. 4 +/- 1 mm; P = 0.01), the MAFM (3.5 +/- 0.9 vs. 2.2 +/- 0.8 cm2; P < 0.01) and MALM (2.1 +/- 0.4 vs. 1.7 +/- 0.5 cm2; P = 0.029) were all significantly greater in fetuses with normal development compared to those with growth restriction. CONCLUSIONS: During the third trimester, SCTT (with the exception of MTFM and MTLM) is reduced in fetuses with IUGR. Furthermore, MALM is lower in growth-restricted fetuses, confirming that the parameters measured in this study are affected in IUGR fetuses. Our findings indicate that specific changes in fetal body compartments occur as a result of chronic metabolic impairment.

Emergency pelvic packing to control intraoperative bleeding after a Piver type-3 procedure. An unusual way to control gynaecological hemorrhage.

We report a case of gynaecologic haemorrhage after a Piver type-3 procedure treated by a packing technique. The postoperative course was uneventful and the packs were removed after six days. Intra-abdominal packing should be familiar to both obstetricians and gynecologists because when any other attempt to provide hemostasis fails, it can be the last successful way to control a life-threatening haemorrhage.

Laparoscopic Lymphadenectomy and Vaginal Radical Hysterectomy for the Treatment of Cervical Cancer

The choice of treatment (surgery, radiotherapy) for cervical carcinoma depends on surgical staging. The noninvasive approach for node evaluation is not very accurate; therefore lymph node metastasis has to be determined surgically. Seventeen women with cervical cancer underwent bilateral laparoscopic lymphadenectomy with dissection of the common iliac, hypogastric, and external iliac vessels and the obturator nerve. The average number of lymph nodes sampled was 14 (range 12-24 nodes). The mean duration of lymphadenectomy was 60 minutes (range 50-90 min). Based on preoperative evaluation and on the pathology report, a radical vaginal hysterectomy (Schauta-Amreich) was performed in all women at the end of laparoscopy. All laparoscopies and radical hysterectomies were uneventful. Based on this preliminary experience, laparoscopic lymphadenectomy may play an important role in reviving radical vaginal hysterectomy in women with cervical cancer. Followed by vaginal radical hysterectomy, it may be the treatment of choice in early disease, avoiding an abdominal incision.

Efficacy and tolerability of brodimoprim at two different dosage schedules in the treatment of acute uncomplicated bacterial cystitis: comparative study vs. pefloxacin.

In an open study, 172 male and female adult patients with acute uncomplicated bacterial cystitis were randomly allocated to three treatment groups. Two groups received brodimoprim 200 mg tablets as follows: a single dose of two 200 mg tablets on day 1, followed by one tablet per day on days 2 and 3 (58 patients); or a single daily dose of two tablets, for 2 days (63 patients). The third group received a single dose of pefloxacin, as two 400 mg tablets, for 1 day (51 patients). Complete urinalysis, sediment and urine culture examinations were carried out before treatment and 10 days after the last dose. Evaluation also comprised, at the time of enrolment and 48 h after the last dose, measurement of corporal temperature and assessment of symptoms (dysuria, pollakiuria, strangury, suprapubic pain, burning sensation during urination and urgency) on a 4-point scale. The eradication rate for the pathogen concerned was 98.3% and 96.7% in the groups receiving brodimoprim for 3 and 2 days, respectively, and 92.8% in the pefloxacin group (between-group comparison n.s.). There was significant regression of symptoms (P < 0.001) in the three groups (between-groups comparison n.s.). Mainly gastrointestinal adverse events occurred in 3 patients receiving brodimoprim for 2 days and in 4 patients from each of the other two groups.

Endometrial carcinoma. Clinical and pathological correlations with survival and surgical treatment.

From 1978 to 1985 a total of 151 patients were treated for endometrial carcinoma. Of these, 25 patients underwent extrafascial abdominal hysterectomy and pelvic lymphadenectomy, 25 were treated according to Wertheim procedure and pelvic lymphadenectomy and 32 underwent intrafascial abdominal hysterectomy; 62 women underwent vaginal surgery, 7 of whom according to Shauta. A correlation between the degree of myometrial invasion, histological grading, hystological type and stage of the tumor showed no statistically significant difference. The 5-year actuarial survival rate was found to be 76.5%. A comparison between survival and age of patients showed a significant difference in the survival (p less than .01) of the group less than 55 years as compared to the older age group. As far as the surgical treatment instituted is concerned, no statistical difference in survival was found between patients operated vaginally and those operated abdominally (p greater than .05). The site of recurrences were then analyzed in 22 patients, 50% were local recurrences, and the remaining distant metastases. Of these only one patient was cured and is still free of disease 5 years after recurrence. The criteria used to select patients for vaginal surgery are also indicated.