Correlations of Placental Histopathology, Neonatal Outcome, and Cardiotocogram Baseline Variability and Acceleration Patterns in the Growth Restricted Preterm Population.

OBJECTIVE: To evaluate the possible connections of cardiotocography (CTG) signs with neonatal outcome and placental histopathology between growth restricted preterms. MATERIALS AND METHODS: Placental slides, baseline variability, and acceleration patterns of cardiotocograms, and neonatal parameters were studied retrospectively. Placental histopathological changes were diagnosed according to the Amsterdam criteria; percentage of intact terminal villi and capillarization of villi were also studied. 50 cases were analyzed: 24 were early-onset fetal growth restriction (FGR), 26 were late-onset FGR. RESULTS: Reduced baseline variability was related to poor neonatal outcome; lack of accelerations similarly had associations with poor outcomes. Maternal vascular malperfusion, avascular villi, VUE, and chorangiosis were more common in the background of reduced baseline variability and absence of accelerations. Lower percentage of intact terminal villi was significantly associated with lower umbilical artery pH, higher lactate levels, and reduced baseline variability on CTG; absence of accelerations was correlated with decreased capillarization of terminal villi. CONCLUSIONS: Baseline variability and absence of accelerations seem to be useful and reliable markers in predicting poor neonatal outcome. Maternal and fetal vascular malperfusion signs, decreased capillarization, and lower percentage of intact villi in placenta could contribute to pathologic CTG signs and poor prognosis.

Placental Pathology and Its Associations With Clinical Signs in Different Subtypes of Fetal Growth Restriction.

OBJECTIVE: We evaluated placental alterations in different subtypes of fetal growth restriction (FGR) to determine any clinical associations. METHODS: FGR placentas classified according to the Amsterdam criteria were correlated with clinical findings. Percentage of intact terminal villi and villous capillarization ratio were calculated in each specimen. Correlations of placental histopathology and perinatal outcomes were studied. 61 FGR cases were studied. RESULTS: Early-onset-FGR was more often associated with preeclampsia and recurrence than late-onset-FGR; placentas from early-onset-FGR often had diffuse maternal (or fetal) vascular malperfusion and villitis of unknown etiology. Decreased percentage of intact terminal villi was associated with pathologic CTG. Decreased villous capillarization was associated with early-onset-FGR and birth weight below the second percentile. Avascular villi and infarction were more common when femoral length/abdominal circumference ratio was >0.26, and perinatal outcome was poor in this group. CONCLUSION: In early-onset-FGR and preeclamptic FGR, altered vascularization of villi may have a key role in pathogenesis, and recurrent FGR is associated with villitis of unknown etiology. There is an association between femoral length/abdominal circumference ratio >0.26 and histopathological alterations of placenta in FGR pregnancies. There are no significant differences in the percentage of intact terminal villi between different FGR subtypes by onset or recurrency.

Placental pathology of preeclampsia from a clinical point of view: Correlation between placental histopathology, clinical signs of preeclampsia and neonatal outcome.

AIM: To evaluate the associations between placental histopathology (signs of maternal and fetal vascular malperfusion, delayed villous maturation, villitis of unknown etiology) and subtypes of preeclampsia by onset, clinical aspects of the disease and neonatal outcome. METHODS: Placental slides from preeclamptic pregnancies were retrospectively reviewed according to a uniform scheme. Information regarding obstetrical anamnesis, clinical data and perinatal outcome was collected from charts, and statistical analysis was performed in order to demonstrate associations between microscopic placental alterations and different aspects of preeclampsia. RESULTS: A total of 49 cases were studied. Diffuse signs of maternal vascular malperfusion and avascular villi were more common in early-onset-preeclampsia associated with worse prognosis. Preeclampsia with fetal growth restriction had more often diffuse signs of maternal and fetal vascular malperfusion and villitis of unknown etiology. Recurring preeclampsia was associated with more common perivasculitis. Umbilical and uterine artery Doppler indices were associated with medial hypertrophy and/or acute atherosis of maternal decidual vessels. Large foci of avascular villi correlated with extent of maternal 24-h-proteinuria which itself correlated with outcome of preeclampsia. Rate of capillarisation of villi was significantly lower in case of hypertension requiring a three-drug combination of antihypertensive medications versus hypertension treated with one or two drugs, preeclampsia with growth restriction, and stillbirth versus live birth. CONCLUSIONS: Early- versus late-onset-preeclampsia showed a markedly different profile of histopathological features and perinatal outcome, reflecting their distinguished pathogenesis and prognosis; preeclampsia complicated with fetal growth restriction also had distinctive features. Qualitative and quantitative changes define placental pathology of preeclampsia.

[Examination of maternal extended spectrum beta-lactamase bacterial colonization and follow-up of newborns requiring Neonatal Intensive Care Unit admission]. / Neonatális Intenzív Centrumban ellátást igénylo betegeink anyai széles spektrumú béta-laktamáz-termelo baktériummal történt kolonizációjának vizsgálata és követése.

INTRODUCTION: The extended beta-lactamase producing Enterobacteriaceae may cause asymptomatic carriage if present in the colon of premature infants or pregnant women. AIM: To assess the incidence of colonization among mothers whose infants were admitted to Neonatal Intensive Center on the day of their delivery for this pathogen. METHOD: From October 1, 2013 until October 31, 2015 the authors screened mothers on the day of their delivery for this pathogen. Nineteen of the 751 anorectal swabs or stool samples were found to be positive. Mothers having positive samples were given personal education for hand hygiene, then they actively participated in the care of their babies. From some premature infants ear swab and stomach washing were taken and sent for culture on the day of their admission. In the course of their hospital stay, anorectal swabs were taken and screened for this bacteria colonization at least once. RESULTS: None of the premature infants of the 19 extended beta-lactamase producing Enterobacteriaceae-positive mothers became positive in the studied period. CONCLUSION: If the mother is colonized, the spreading of pathogen to newborns can be prevented by observing the hygienic rules. Orv. Hetil., 2016. 157(34), 1353-1356.

Wavefront-guided photorefractive keratectomy for myopia and myopic astigmatism.

PURPOSE: To evaluate the results of wavefront-supported customized ablation (WASCA) in eyes treated with photorefractive keratectomy (PRK) to correct spherical myopia and myopic astigmatism. METHODS: One-hundred fifty eyes of 104 patients (mean age 33.4 +/- 4.4 years) were included in the study. An Asclepion Shack-Hartmann wavefront aberrometer was used to assess lower and higher order refractive aberrations of eyes, and customized PRK treatments were carried out using the Asclepion-Meditec MEL 70 G-Scan excimer laser. Follow-up time was 6 months. RESULTS: The mean preoperative spherical equivalent refraction was -4.02 +/- -1.04 D, and mean uncorrected visual acuity (UCVA) was 0.06 +/- 0.02. Postoperatively, mean UCVA was 1.04 (better than 20/20), mean best spectacle-corrected visual acuity was 1.22 (20/16), and average spherical equivalent refraction was -0.12 D; 98.6% (148 of 150 eyes) were within +/-0.50 D of intended refraction, and 100% were within +/-1.00 D. Concerning safety, in 71.1% of eyes (107 of 150) BSCVA was the same as preoperatively, and in 8.2% (11 of 150) it increased by two or more Snellen lines. None of the eyes lost two or more lines of BSCVA. The root mean square value for higher order aberrations increased 1.4 times following PRK. CONCLUSIONS: WASCA-guided PRK was efficacious, safe and predictable; BSCVA may be improved by the WASCA method compared to results achievable with a traditional PRK technique, in spite of an increase in the root mean square value for higher-order aberrations.

First results with wavefront-guided photorefractive keratectomy for hyperopia.

PURPOSE: To compare the results of traditional laser photoablation and wavefront-supported customized ablation (WASCA) in hyperopic photorefractive keratectomy (H-PRK). METHODS: This was a prospective study, comparing two treatment groups, each comprising 40 eyes of 20 patients. Wavefront aberrations were examined using a Shack-Hartmann aberrometer. Preoperative refraction was similar in the two groups; in the traditional H-PRK group (Group 1) it was +3.10 +/- 0.85 D, and in the WASCA-guided group (Group 2) it was +2.90 +/- 0.80 D. H-PRK was performed with the Asclepion-Meditec MEL 70 flying-spot excimer laser. The follow-up time was 6 months. RESULTS: In Group 1, mean postoperative refraction was +0.14 +/- 0.24 D, and in Group 2, -0.10 +/- 0.25 D; mean uncorrected visual acuity was 0.92 +/- 0.16 in Group 1 and 0.95 +/- 0.18 in Group 2. Mean best spectacle-corrected visual acuity was 0.96 +/- 0.04 in Group 1 and 1.06 +/- 0.13 in Group 2. In Group 1, 67.5% (27 of 40 eyes), and in Group 2, 85% (34 of 40 eyes) were within +/-0.50 D of target refraction. Regarding change of spectacle-corrected visual acuity in Group 1, 5% (2 of 40 eyes), and in Group 2, 20% (8 of 40 eyes) gained one Snellen line compared to the preoperative; in Group 1, 10% (4 of 40 eyes), and in Group 2, 12.5% (5 of 40 eyes) lost two Snellen lines. In Group 2, the root mean square value for the higher order aberration increased from the initial 0.134 to 0.257 microm at 6 months after surgery. CONCLUSIONS: WASCA-guided hyperopic-PRK treatment was found to be safe and predictable. The results were better than those achieved with traditional PRK performed using the same flying-spot type excimer laser.

[Experience with laser in situ keratomileusis]. / A lézer in situ keratomileusis mútétek során szerzett tapasztalataink.

AIM OF THE STUDY: To evaluate the results of laser in situ keratomileusis (LASIK) in groups with different refractive errors. PATIENTS AND METHODS: 68 LASIK procedure have been performed in the following patient groups: Group 1 (-3.0 D to -6.0 D) n = 14; Group 2 (-6.25 D to -9.0 D) n = 29; Group 3 (-9.25 D to -14.0 D) n = 13; Group 4 (eyes with hyperopic refractive error between +1.75 D and +7.5 D) n = 12. A Moria CB manual mikrokeratom was used, flap thickness was 130 microns. Excimer laser treatment was carried out with Asclepion-Meditec MEL 70 G-Scan flying spot excimer laser. Follow-up time is 6 months. RESULTS: The preoperative correction decreased in Group 1. from -4.45 D +/- 0.93 D (SE = spherical equivalent) to -0.04 D +/- 0.13 D, in Group 2. from -7.81 D +/- 0.98 D (SE) to -0.56 D +/- 0.9 D, in Group 3. from -11.33 D +/- 1.97 D (SE) to -1.88 D +/- 1.64 D, and in Group 4. from +4.67 D +/- 1.67 D (SE) to +0.24 D +/- 0.50 D 6 months following LASIK. The best spectacle corrected visual acuity (BSCVA) decreased by 2 or more Snellen lines in 4 eyes in Group 2, in 2 eyes in Group 3, and there was no change in Group 1 and Group 4. BSCVA improved by 2 or more Snellen lines in one eye in Group 2, in 2 eyes in Group 3 and there was no change in Group 1 and in Group 4. CONCLUSIONS: The preoperative correction decreased significantly following LASIK procedure in each patient group. The method was found to be effective, safe and durable during the 6 months follow-up. Application is recommended especially in eyes with a refractive error higher than -6.0 D due to possible intra- and early postoperative complications.