The transverse four-chamber view for the assessment of atrial tissue deformation in the fetus.

AIMS: To determine if atrial tissue deformation (peak strain, PS) and time to peak strain (TTPS) can be assessed in the fetus, with identification of best echocardiographic plane. MATERIALS AND METHODS: Pulsed-wave tissue Doppler study of a longitudinal and a transverse four-chamber view (FCV) in each of 20 healthy fetuses. Determination of PS and TTPS in regions of interest (ROI), viz., lateral walls of the right and left atria (RA, LA); comparison of values depending on section plane, with results-based discussion of the physiology of fetal atrial deformation and of possible clinical uses. RESULTS: PS and TTPS could be determined on transverse FCV in 91% of subjects and in 61% on longitudinal FCV. Transverse PS and TTPS were significantly higher than longitudinal (p = 0.0001). Transverse PS was significantly higher in RA than in LA (26.9% vs. 17.3%, p = 0.034), and transverse TTPS was significantly shorter in RA than in LA (p = 0.034). CONCLUSION: Atrial radial PS and TTPS determinations are possible in the fetus. The transverse FCV is best suited for these. The highest PS values and shortest TTPS values are found in ROI representing the RA. Our findings may contribute to detailed intrauterine assessment of atrial and ventricular myocardial function.

Evaluation of placental syndecan-1 expression in early pregnancy as a predictive fetal factor for pregnancy outcome.

OBJECTIVE: Early expression of syndecan-1, a regulator of growth factor and chemokine function, in animal and human abortuses or placenta at delivery suggests a potential role during embryonic development. The aim of this study was to examine the correlation between early placental syndecan expression and fetal outcome in ongoing pregnancies. METHODS: Prospective immunohistochemical analysis of 203 chorionic villus sampling specimens obtained during a 4-year period (2001-2004). The chorionic villi were processed for paraffin-embedded immunohistochemistry. Scores of intensity of syndecan-1 expression in chorionic villi were correlated with maternal cofactors and pregnancy outcome. RESULTS: Syndecan-1 immunostaining was significantly related to villus size, maternal tobacco use, and fetal biometry at ultrasonography. After correcting the above confounders, scores of syndecan-1 expression correlated with preterm birth and low birth weight. CONCLUSIONS: Placental syndecan-1 expression is associated with premature birth and fetal growth.

Endosalpingiosis-an underestimated cause of chronic pelvic pain or an accidental finding? A retrospective study of 16 cases.

OBJECTIVE: The relevance of endosalpingiosis as a cause of chronic pelvic pain is controversial. To examine the clinical presentation of endosalpingiosis, the files of the Institute of Pathology at the University of Münster for the years 1994-1999 were screened by keyword search for the diagnosis of endosalpingiosis and the patient files were reviewed. PATIENTS: Thirteen patients with the diagnosis endosalpingiosis treated at our institution were identified within the past 6 years. Five patients (38%) presented with pelvic pain, five (38%) with hyper- or dysmenorrhea, five (38%) patients had no complaints at all, one of these had primary and one had secondary infertility, three had persistent ovarian cysts. The diagnosis of endosalpingiosis was confirmed by a second pathologist for all patients included in this study. RESULTS: Mean age at diagnosis was 43 (range 24-82), of the five patients presenting with pelvic pain, the localization of endosalpingiosis was consistent with the localization of pain in only four (30%) patients. Localization and macroscopic appearance of endosalpingiosis and endometriosis seems to be the same in our cases. Five (38%) patients suffered from myomatous uterus, five (38%) had additional endometriosis, five (15%) patients had hydrosalpinx (postinflammatory tubal disease), and seven (53%) had pelvic adhesions. Nine patients had previously been admitted for surgery, only two (15%) patients had tubal surgery, two (15%) had cesarian section and five (38%) had a history of more than two abdominal operations. Eleven (85%) cases of endosalpingiosis were diagnosed by the same pathologist. CONCLUSIONS: Endosalpingiosis seems to be an accidental finding, associated with additional pelvic pathology, rather than being a frequent cause of pelvic pain.