First Trimester Ultrasound Diagnosis of Right Aortic Arch (RAA).

OBJECTIVES: In the present research we proposed to evaluate the cases diagnosed in the first trimester of pregnancy by ultrasound with RAA, knowing the fact that although, in most cases the disease is isolated and asymptomatic, in some cases the presence of RAA can be associated with other fetal structural abnormalities that must be detected and monitored during pregnancy. We established correlations between the postnatal or anatomopathological examination (in cases ended by therapeutic abortion) and the presence of RAA detected in the first trimester. MATERIAL AND METHOD: We conducted a retrospective analytical study that investigated the role of the RAA early detection (isolated or associated with other cardiac abnormalities) for a correct pregnancy monitoring and postpartum management. Between 2012 and 2018, patients admitted in the first Obstetrics and Gynecology Clinic-the Prenatal Diagnostic Unit-of the Emergency County Hospital from Craiova, were evaluated in the first trimester of pregnancy for genetic abnormalities and early morphology. The study material was represented by the patient's medical records (observation sheets, surgical protocol records, anatomopathological diagnostic records). The obtained information was stored in Microsoft Excel files and statistically processed. RESULTS: During the study period, 14 cases with right aortic arch were diagnosed in the first and second trimester of pregnancy. 4 cases were detected in the first trimester: 2 cases (50%) presented left ductus arteriosus (DA)-RAA type 2 ("U" sign) and 2 cases (50%) presented right DA-RAA type 1 (mirror image-"V" sign). RAA type 1 associated Tetralogy of Fallot in one case (25%) and in another one case (25%) the anomaly was isolated. RAA type 2 associated atrio-ventricular septal defect (AVSD) in one case (25%) and in another one case (25%) the anomaly was isolated. There were no fetal extracardiac structural abnormalities associated with the RAA diagnosis in the first trimester. CONCLUSIONS: Over a seven years study period (2012-2018), 14 cases with RAA in the first and second trimester of pregnancy were detected. In the low-risk pregnancies group, the first trimester incidence of the RAA was 0.11% and the association of congenital heart abnormalities was 50%.

Comparative efficacy of oral contraceptive versus local treatment versus intense pulsed light combined with vacuum in endocrine acne in women.

Acne is the most common affection of adolescents, although it can be also found in adult women. Our study was aimed at the comparative assessment of three different therapies over a three-month period, applied to women with moderate comedogenic and papulo-pustular endocrine acne. In the study 116 female patients with endocrine localized face acne were included and divided into three groups: group I with 42 patients was treated with a combination of contraceptive pill + local treatment + pulsed-vacuum light; group II with 38 patients was treated with contraceptives and pulsed-vacuum light and group III with 36 patients was treated only with local treatment. The acne evaluation was made using the Global Acne Grading System (GAGS). Statistical data processing was carried out using the STATA software. For the comedogenic form of acne, the good and very good results were superior in group I vs group II and III (83.33% vs 31.58% vs 5.56%) at the end of the three months of treatment. For the papulo-pustulous form of acne, good and very good results were similar in groups I and II (92.86% vs 73.68%) both after the first month of treatment and at the end of the study, well above the local treatment group (13.99%). Our study highlighted the superiority of laser treatment combined with hormonal treatment, compared to hormonal and local treatment in the comedogenic form of acne, and the superiority of hormonal treatment combined (or not) with laser treatment in the papulo-pustular form compared to local treatment.

A Severe Case of Aneurysmal Malformation of the Vein of Galen, Cardiac Failure and Intrauterine Fetal Death.

Aneurism of the vein of Galen is a rare congenital anomaly, where complex arteriovenous malformation are identified between multiple choroidal arteries and the median prosencephalic vein of Markowski, which is a precursor of the vein of Galen, with subsequent aneurysmal enlargement of the respective arteriovenous system. The congenital malformation develops during week 6 to 11 of fetal development. Infants often die from high-output congestive heart failure. We present a case of a 40 years old patient, presented the first time at hospital at 28 weeks of gestation for lower perception of fetal movements. The patient was referred to our Prenatal Diagnosis Unit for a suspected cardiac malformation. We diagnosed cardiomegaly along vein of Galen aneurysmal malformation (VGAM) with severe cardiac failure, ascites, and critical fetal distress. Fetal demise was noted 24 hours later, during the corticosteroid procedures for fetal maturation. A stillborn weighting 2000g with a severe hydropic aspect was born after labor induction. Autopsy was performed following injection of colored gelatin in carotid vessels. The aneurysmal defect was evident in the vein of Galen and straight sinus. We also found the transverse, sagittal and the occipital sinus seriously dilated. We could not highlight the communication with the middle cerebral artery, because of the degradation of the cerebral tissue, despite an optimal preparation.

Postpartum Spontaneous Subcapsular Hepatic Hematoma (SSHH)- Conservative Management. Case Report and Review of Literature.

Spontaneous subcapsular hematoma of the liver, with no history of preeclampsia and HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count.), represents an exceptionally rare clinical condition in pregnancy and postpartum. The complications can be devastating in terms of fetal and maternal mortality. We hereby present a case of a 33-year-old female that underwent an emergency Cesarean section (C-section) at term with the extraction of a live foetus. Few hours after delivery, she complained of intense epigastric and abdominal pain. The diagnostic work-up suggested a SSHH. The condition was managed conservatively in a multidisciplinary team.

EGFR, HER2÷neu and Ki67 immunoexpression in serous ovarian tumors.

In this study, we analyzed EGFR, HER2/neu and Ki67 immunoexpression for 26 benign, borderline and malignant serous ovarian tumors. EGFR and HER2/neu immunoreactions were present in some benign/borderline tumors with high/low intensity of immunostain. In poorly differentiated adenocarcinomas, the EGFR/HER2/neu reaction was intense compared to well-differentiated ones. The Ki67 medium proliferation index was 2.1% for benign tumors, 6% in the borderline and 47.7% in malignant tumors. EGFR, HER2/neu and Ki67 can be used to identify benign/borderline tumors with progression potential and the malignant aggressive tumors.

The study of p53 and p16 immunoexpression in serous borderline and malignant ovarian tumors.

The study assessed p53 and p16 immunoexpression in 20 cases of ovarian serous carcinomas and four cases of serous borderline tumors, the results being statistically analyzed in relation to clinicopathological data of the cases. The p53 immunoreaction was observed in 85% of cases, the medium percentage of positivity being 15% for borderline tumors, 45% for low-grade carcinomas and 60% for high-grade carcinomas. The p16 immunoreaction was observed in 75% of cases, the medium percentage of positivity being 30% for borderline tumors, 25% for low-grade carcinomas and 62% for high-grade carcinomas. The p53 and p16 reaction was also identified at the tubal epithelium in cases of invasive carcinomas. Statistical analysis indicated significant differences in p53 expression depending on tumor type and for p53 and p16 expression compared to the degree of tumor differentiation. The study indicated a diffuse immunostain for p53 and p16 in high-grade serous ovarian carcinomas. The presence of "p53 signature" and areas with variable tumor differentiation and reactivity, in the case of high-grade carcinomas, supporting the existence of multiple mechanisms of their occurrence and progression.