Impact of tissue harmonic imaging on measurement of nuchal translucency thickness.

OBJECTIVES: To evaluate the effect of tissue harmonic imaging (THI) on the measurement of fetal nuchal translucency thickness (NT). METHODS: One-hundred and three pregnant women underwent first-trimester NT measurement according to The Fetal Medicine Foundation criteria. NT was evaluated using conventional ultrasonography (CUS) and THI without modifying any other ultrasound parameter (e.g. gain). For each patient three images with CUS and three images with THI were stored and then measured independently on the ultrasound system by two different operators. The maximum measurements using CUS and THI were compared. Differences between the values of CUS and THI NT measurements were tested using the Wilcoxon signed-rank test. Bland-Altman plots were constructed, and intraobserver and interobserver variabilities were assessed by calculation of the intraclass correlation coefficient. Probability values of < 0.05 were considered significant. RESULTS: Mean maternal age was 32.8 (range, 20-42) years, mean gestational age at examination was 12 + 1 (11 + 0 to 13 + 6) weeks and mean crown-rump length (CRL) was 55.8 (SD, 7.2) mm. Median fetal NT was 1.4 (0.8-3.5) mm using CUS and 1.2 (0.6-3.3) mm using THI (P < 0.001) for the first operator. A second operator remeasured the first 51 cases: median fetal NT was 1.4 (0.8-3.8) mm using CUS and 1.1 (0.6-3.1) mm using THI (P < 0.001). Fetal NT measurements were above the expected median value according to CRL in 49 cases (47.6%) using CUS and in only 24 cases (23.3%) using THI. CONCLUSIONS: THI leads to a small, but significant, reduction of the NT measurement and this could reduce the sensitivity of screening for Down syndrome.

Incision-to-delivery interval and neonatal wellbeing during cesarean section.

AIM: The aim of this study was to investigate the effect of variation of the incision-to-delivery interval on neonatal wellbeing during cesarean delivery. METHODS: In this prospective study, 71 women, hemodynamically stable and without severe comorbidities, undergone an antepartum cesarean delivery; acid-base status, umbilical arterial oxygen content and Apgar score were used as indicators of neonatal wellbeing. Umbilical cord blood gas, the Apgar score of each neonate, the interval between skin incision and delivery and the interval between hysterotomy and fetal extraction of 71 cesarean deliveries were assessed in our level III University Hospital. RESULTS: Neither variation of skin incision-to-delivery interval nor variation of the interval between hysterotomy and delivery of the fetus is associated with a variation of indicators of neonatal wellbeing. CONCLUSION: A longer skin incision-to-delivery interval in cesarean birth does not compromise neonatal acid-base balance. Similarly, a longer interval between hysterotomy and delivery of the fetus is not associated with a variation of indicators of neonatal wellbeing. Awareness of this fact could give the surgeon more tranquility and help to prevent part of the iatrogenic complications associated with cesarean delivery.

Fertility after non-surgical management of the symptomatic first-trimester spontaneous abortion.

AIM: The aim of this study was to assess clinical outcome after a non-surgical management of the symptomatic spontaneous abortion in the first-trimester of pregnancy in a level III maternity hospital and to assess the subsequent fertility of the study population. METHODS: A prospective study in which 70 women with a symptomatic early pregnancy loss undergone an expectant management of miscarriage was performed. If resolution was not obtained after 4 days, medical treatment with misoprostol was administered. The patients were followed-up after the first menstrual cycle with a medical examination and an ultrasound scan. After 12 months, the patients were interviewed by phone to investigate on possible complications of abortion and on the occurrence of new pregnancies. RESULTS: The non-surgical management of miscarriage was successful in 68 out of 70 women (97%). Surgical intervention was necessary in 2 of 70 women (3%). Bleeding and pain were described as slightly more than a normal menstrual cycle. Among the 60 patients that answered at the 12-month follow-up (85.7%), none reported gynecological troubles and the subsequent pregnancy rate of the women was 81%. CONCLUSION: Expectant management of selected cases of spontaneous abortion, associated to medical treatment in indicated cases, could offer a valid alternative to dilatation and curettage.

Updated perspectives on emerging vibrios associated with human infections.

This review describes the ecological, clinical and epidemiological features of emerging vibrios and discusses what laboratory methods are being used for the detection of pathogenic vibrios in clinical, environmental and food samples. After selecting articles illustrative of the current scientific research on pathogenic vibrios, the review focuses on the need for better insight into the risk factors of emerging infections to establish adequate prevention procedures.

Detection of Bacillus species in selected meals from an apulian catering service.

The authors have started a microbiological survey of the meals given in a factory canteen in the town of Bari with the evaluation of food contamination from the bacteria of the genus Bacillus. In the examined meals, all the detected Bacillus species have the potential to cause food-borne illnesses, even if the relatively low bacterial counts are not dangerous for healthy consumers. The study underlines the need of guidelines to enstablish which levels of food contamination are significant potential risks to all community catering service users.

Flutamide in the treatment of hirsutism: long-term clinical effects, endocrine changes, and androgen receptor behavior.

OBJECTIVE: To investigate the long-term effects of treatment with low doses of flutamide on clinical and hormonal parameters, as well as on the androgen receptor status, in hirsute women. DESIGN: Eighteen hirsute patients with regular menses were studied basally and during treatment with 125 mg flutamide, three times per day for 12 months. Barrier or intrauterine contraception was used during the study in sexually active women. Safety parameters were assessed throughout the study. Hirsutism, graded by the modified Ferriman-Gallwey score, and hormonal parameters were evaluated basally and at 4-month intervals during treatment. Gonadotropin-releasing hormone and ACTH stimulation tests were performed before and after 3 to 4 months of therapy. In addition, the concentration of androgen receptors in mononuclear leukocytes was measured, in both the follicular and luteal phases of the menstrual cycle, basally and after 4 months of flutamide treatment. RESULTS: Flutamide was well tolerated in all women, with the noticeable exception of one patient who presented increased serum transaminase after 8 months of therapy. Hirsutism markedly improved in all women during the treatment (Ferriman-Gallwey score after 1 year: 4.1 +/- 0.5 versus 14.1 +/- 0.9). A reduction of serum androgens was found, whereas no change was observed in either basal or GnRH-stimulated gonadotropins or in the cortisol and 17 alpha-hydroxyprogesterone response to ACTH. Cycles remained ovulatory. Before treatment, the number of androgen receptors was higher in the luteal than in the follicular phase. This rhythmic differentiation disappeared after the patients had been given the antiandrogen drug. CONCLUSIONS: Flutamide is effective in the treatment of hirsutism but requires constant surveillance of liver function. Androgen receptor blockade might be potentiated by a reduction of serum androgens. Flutamide affects androgen receptor behavior during the menstrual cycle. The meaning of this finding remains to be elucidated.

Endometrial carcinoma in tamoxifen-treated breast cancer patients.

Tamoxifen is an important agent for the treatment of breast cancer. Occasionally the drug, which is an antiestrogen, has agonistic estrogenic activity. The authors describe three new cases of endometrial carcinoma developing in breast cancer patients taking tamoxifen and stress the necessity of carefully monitoring the uterine cavity under tamoxifen treatment.

Failure of ultrasonographic parameters to predict the severity of fetal anemia in rhesus isoimmunization.

Ultrasonographic measurements of placental thickness, extrahepatic and intrahepatic umbilical vein diameters, abdominal circumference, head circumference, head/abdominal circumference ratio, and intraperitoneal volume were made in 50 rhesus-isoimmunized pregnancies at 18 to 26 weeks' gestation. The severity of fetal anemia was assessed by fetal blood sampling. Results in the isoimmunized group were compared with a control population of 410 normal pregnancies at 17 to 32 weeks' gestation. In the absence of fetal hydrops, none of the parameters studied could reliably distinguish mild from severe fetal hemolytic disease.