ABSTRACT
Miscarriage is one of the most frequent problems in human pregnancy. The most widely accepted definition is that proposed by the World Health Organization (WHO) in 1977. The incidence among clinical pregnancies is about 12-15% but including early pregnancy losses it is 17-22%. The only two etiologic factors recognized by all authors are uterine malformations and parental balanced chromosomal rearrangements. There have been many other suggested risk factors. In this revision we discuss these.
Subject(s)
Abortion, Spontaneous/etiology , Abortion, Spontaneous/epidemiology , Autoantibodies , Chromosome Aberrations , Female , Humans , Isoantibodies , Pregnancy , Risk Factors , Uterus/abnormalitiesABSTRACT
OBJECTIVE: To determine the usefulness of diagnostic tests performed before a second look laparotomy in patients with epithelial ovarian cancer. STUDY DESIGN: Thirty-three patients with epithelial ovarian cancer attended at Fundación Jiménez Díaz from 1984 to 1995 were studied. All patients initially underwent cyto-reducing surgery, followed by at least six platinum-based chemotherapy cycles. Prior to second look laparotomy all patients were evaluated by computerized tomography (CT) of the pelvis and abdomen, CA-125, pelvic-abdominal echography and gynecologic examination. To evaluate sensitivity, specificity, positive predictive value and negative predictive value for each test contingency tables were used. RESULTS: Eleven out of the 33 second look patients (33%) had histologic or cytologic evidence of disease. Six out of the eleven positive second look had a positive CT prior to second look (sensitivity of 55%). CT showed lack of disease in 21 out of the 22 negative second look cases (specificity 95%). Positive and negative predictive values of the test were 86% and 81%, respectively. Nine cases out of the 28 who had a CA-125 obtained had a positive second look. Four out of these nine patients had an increased CA-125 value (sensitivity 44%, specificity 95%, positive predictive value 80% and negative predictive value 78%). Sensitivity, specificity, positive predictive value and negative predictive value of physical examination and echography were 36%, 100%, 100%, 76% and 27%, 95%, 75%, 72%, respectively. On the other hand, sensitivity, specificity, positive predictive value and negative predictive value of all tests taken together were 64%, 91%, 78% and 83%, with a rate of false-negative results of 17% and a rate of false-positive results of 22%. CONCLUSION: Pelvic-abdominal computerized tomography, CA-125, pelvic-abdominal echography and gynecologic examination can be an alternative to second look laparotomy for the diagnosis of persistence or recurrence of the disease in patients with epithelial ovarian cancer.
Subject(s)
Neoplasm Recurrence, Local/diagnosis , Ovarian Neoplasms/diagnosis , Adult , Aged , CA-125 Antigen/blood , Female , Humans , Laparoscopy , Middle Aged , Ovarian Neoplasms/therapy , Reoperation , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: We describe the ultrasonographic pattern of a pelvic echinococcus cyst, visualized using a vaginal probe and color Doppler. CASE: A 27-year-old woman presented with an asymptomatic right adnexal mass. Vaginal ultrasonography revealed a cyst in the posterior cul-de-sac, adjacent to the right ovary, with internal septae resembling a maze or an onion slice structure. Color Doppler revealed peripheral vascularization with a low resistance pattern (resistance index 0.6; pulsatility index 0.93). Benign cysts usually have a simple echogenic pattern. In contrast, ovarian carcinomas have a complex internal structure. CONCLUSION: Ovarian echinococcus cysts may have a peculiar ultrasonographic pattern at high-frequency (7.5-MHz) vaginal ultrasonography. Such high-frequency ultrasonography can be a useful tool in the diagnosis of the disease.
Subject(s)
Echinococcosis/diagnostic imaging , Ovarian Cysts/diagnostic imaging , Adult , Female , Humans , UltrasonographyABSTRACT
Intrahepatic cholestasis of pregnancy is a relatively common disease. It has an unknown etiology and may have a recurrent pattern. It commonly occurs in the 2nd-3rd trimester and characteristically presents with pruritus, jaundice and abnormal liver function tests. There is also an increased risk of preterm delivery and of cesarean section. Both maternal and neonatal prognosis is generally good. We describe a case of intrahepatic cholestasis of pregnancy with an atypical presentation and outcome. Our patient presented with acute renal and hepatic failure with hepatic encephalopathy, DIC and hypertension which was the cause of the fetal death in the third trimester of the pregnancy.
