The prognostic value of antenatal ultrasound in cases complicated by fetal ovarian cysts.

OBJECTIVE: Ovarian cysts are relatively common prenatal findings in female fetuses. The aim of this study is to evaluate the ability of antenatal ultrasound in predicting spontaneous regression or a need for surgery. DESIGN: All cases of fetal ovarian cysts treated in our Department between 2007 and 2016 were included. Patients underwent a sonographic monitoring in utero and after birth until spontaneous or surgical resolution. Subjects were divided into two groups according to their postnatal management. Receiver-operating characteristics (ROC) curves were used to test the predictive ability for postnatal surgery of the cyst's mean and maximum diameters; their optimal cut off points were also determined. RESULTS: 38 cases of antenatally-detected fetal ovarian cysts were included. 12/38 cases underwent surgery (Group A). 26/38 cases were resolved spontaneously (Group B). Cyst size of those which were surgically excised significantly differed from those that regressed spontaneously. ROC curve pointed to 45 mm and 47 mm as optimal cut off points for the mean and the maximum cystic diameters, respectively. CONCLUSIONS: Cyst size and echo-structure seemed good predictors for prognosis after birth. The optimal cut off points of the cysts mean and maximum diameters in predicting postnatal surgery have been identified as 45 mm and 47 mm, respectively.

The effect of the medico-legal evaluation on asylum seekers in the Metropolitan City of Milan, Italy: a pilot study.

In the present-day situation, the clinical forensic documentation of an asylum seeker's narrative and his or her examination, together with the physical and psychological findings, may have very important effects on the outcome of the request for political asylum. Since 2012, the Municipality of Milan, the University Institute of Legal Medicine, and other institutions have assembled a team with the task of examining vulnerable asylum seekers and preparing a medical report for the Territorial Commission for International Protection (Prefecture, Ministry of Interiors), who will assess the application. We compared medico-legal reports and outcomes of 57 cases which were evaluated by the Commission after having undergone a medico-legal evaluation through the Istanbul Protocol criteria and examined, in particular, which medico-legal variables seem associated to the outcome. The results show that forensic assessment seems to have a significant and interesting correlation with the final assessment given by the Commission. For example, the higher the level of consistency, according to the Istanbul Protocol, the more frequently protection is granted. These data show how important clinical forensic medicine can be in such scenarios and how the presence of clinical forensic experts should be encouraged in such evaluations, as has been recently enshrined in Italy in the guidelines of a Ministerial Decree of April 3rd, 2017 for the assistance and the rehabilitation as well as the treatment of psychiatric disorders in refugees and asylum seekers who have undergone torture, rape, and other severe forms of psychological, physical, or sexual violence.