Ovarian steroid cell tumor and a contralateral ovarian thecoma in a postmenopausal woman with severe hyperandrogenism.

A 49-year-old woman presented with rapidly progressing hirsutism, receding hairline, male-pattern baldness and deepening of voice, which had developed over the past 2 years. Hormonal evaluation showed a markedly elevated serum testosterone level (418 ng/dl) and no evidence of increased production of cortisol, dehydroepiandrosterone, dehydroepiadrosterone-sulfate, androstenedione, or 17-hydroxyprogesterone. Transvaginal ultrasound examination suggested the presence of a small mass within the left ovary, but all other radiological studies, including adrenal and ovarian computed tomography, magnetic resonance imaging, radio-labelled cholesterol scintigraphy and positron emission tomography, were negative. Subsequently, bilateral selective venous sampling showed a marked testosterone gradient in the right ovarian vein. Bilateral salpingo-oophorectomy was performed (the patient had had a previous vaginal hysterectomy), and histopathological examination revealed a 10-mm steroid cell tumor within the right ovary and a 15-mm thecal cell tumor within the left ovary. The postoperative serum testosterone level returned to normal and the patient showed a slow regression of clinical symptoms. The simultaneous occurrence of a virilizing ovarian steroid cell tumor and an apparently non-functioning thecoma within the contralateral ovary emphasizes the potential pitfalls that may exist in the preoperative evaluation of patients with markedly increased testosterone production.

Pulmonary stenosis and reactive right ventricular hypertrophy in the recipient fetus as a consequence of twin-to-twin transfusion.

The present study describes an association between adverse outcome in the twin-to-twin transfusion syndrome (TTTS) and pulmonary stenosis or reactive right ventricular hypertrophy. Six discordant monozygotic twin pregnancies with TTTS are described. Ventricular hypertrophy and atrioventricular valvular regurgitation occurred in all the recipient twins with pulmonary valvular stenosis in three cases and infundibular stenosis in one case. The recipient twin in one pair and both twins in another pregnancy died as a consequence of immaturity but the remaining twins all survived. Surgical intervention was required in one baby for valvular pulmonary stenosis. Our observations suggest that elevated blood pressure in the transfusion recipient may play an important role in pathogenesis. We hypothesise that both pulmonary stenosis and right chamber hypertrophy are secondary to hemodynamic changes. Although we have found valvular pulmonary stenosis in three recipients and infundibular stenosis in only one, this (obstruction to outflow) could be due to right chamber hypertrophy.

[Practice of fetal pathological examination]. / A fetopathologiai feldolgozás gyakorlata.

Authors report on the practice and most important genetic questions of fetopathological examinations. A so called genetic-morphologic approach is suggested. The observer needs special knowledge to recognize major and minor signs of defects in fetuses in the second, or sometimes even in the first trimester. Spontaneous abortions in the first trimester are caused mainly by chromosome aberrations. In the second trimester the main causes of spontaneous abortions are maternal in origin or secondary to intrauterine infection. Medical legal aspects are also reviewed. For proper documentation a photo or X-ray must be taken. Cytogenetic and molecular genetic methods are also very important tools, therefore examination must be performed before fixation. For the first time in Hungary fetal biometric data are presented with correlation between gestational age and different organ weights. Our aim is to promote better understand of fetal malformations and disorders.

[Acardius (TRAP-sequence) (Twin Reversed Arterial Perfusion)]. / Acardia (TRAP-sequentia).

Two cases of acardius were observed by the authors among nearly twenty thousand deliveries in the seven year period of the 1st Department of Obstetrics and Gynecology, between 1990 and 1. July 1997. The incidence of acardia which was found in this material is more than three times higher than the incidence generally given in the literature. Presenting the cases, the contemporary possibilities of prenatal diagnosis of this highly pathologic form of monozygotic twin pregnancy are discussed in details, further a survey is given of the new, so far experimental, but promising, less and less invasive interventions directed towards in utero terapy by closing the connecting vessels, including also laser occlusion of chorioangiopagus.

Very-low-birthweight breech infants: short-term outcome by method of delivery.

The purpose of this study was to determine the incidence of mortality and morbidity of the very-low-birthweight infant (< 1,500 g) in breech presentation based on mode of delivery and birthweight. A retrospective chart review of 1,009 infants who were in breech presentation at the time of delivery between January 1, 1990 and December 31, 1995 at the First Department of Obstetrics and Gynecology of Semmelweis Medical School in Budapest, Hungary. Data collected included birthweight, mode of delivery, pregnancy complications and neonatal mortality and morbidity. Comparison of groups was made based on mode of delivery, and data were analyzed using Fisher's exact test and chi-square analysis. For those infants weighing less than 1,500 g at birth, vaginal delivery was associated with higher mortality than for those delivered abdominally (73.8% vs. 37.7%, P < 0.001). There was no significant difference in survival for those infants weighing 1,500 g or more. Regarding morbidity, in those infants weighing less than 1,500 g, vaginal delivery was associated with a higher incidence of 1 min Apgar below 4 (21.7% vs. 5.2%, P < 0.001), a higher incidence of 5-min Apgar scores below 4 (11.6% vs. 1.2%, P < 0.001), a higher incidence of grade III or grade IV IVH (18.8% vs. 3.5%, P < 0.001) and a higher incidence of necrotizing enterocolitis (5.8% vs. 0.6%, P < 0.05). There is an increased incidence of mortality and morbidity for the VLBW breech infant delivered vaginally. Cesarean delivery may improve outcome for these infants.

[Successful twin delivery following reduction of quadruplet pregnancy]. / Négyesiker-terhesség redukciója után kiviselt kettósiker-terhesség.

The authors report first time in the Hungarian literature on multifetal pregnancy reduction: a quadruplet pregnancy was reduced to twins on transabdominal way in the 16th week of gestation on request of the parents. The quadruplets resulted from a forcefully induced ovulation. First weeks of gestation were complicated by a severe but effectively treated ovarian hyperstimulation syndrome. Following the successful and uncomplicated intervention the course of pregnancy was undisturbed, two living healthy babies were delivered in the 35th gestation week. Placentae of the liveborn as well as of the stillborn fetuses were pathologically examined. On occasion of the case report theoretical and practical questions of multifetal pregnancy reduction are discussed in details from indications through technical implementation to a review of legal, ethical and also psychological relations of that intervention. A standpoint for the national practice is also framed by the authors.

Factors influencing nonstress test results in multiple gestations.

The nonstress test remains the most widely used method of antepartum fetal health assessment in multiple gestations. However, few data are available on factors influencing its results in those cases. Our observation on 530 such tests has shown results similar to those in singleton gestations. Prematurity was associated with a higher rate of nonreactive tests; however, order and mode of presentation had no impact.

[Supplementation of antenatal cardiotocography (nonstress test) by nipple self stimulation]. / Ergänzung der antenatalen Kardiotokographie ohne Belastung (Non-Stress-Test) mittels Autostimulation der mütterlichen Brustwarze.

Self-stimulations of nipples were performed in 155 late pregnant women in connection with antenatal cardiotocography (nonstress test). Cardiotocographs were interpreted using an own score. Uterine contractions could be produced by nipple stimulation in 111 women (71.6 per cent). In 13 cases with score 6 to 8 these contraction contributed to explantation of fetal condition. In additional 11 cases with score 9 to 10 the attention was focussed to the reduced fetal or placental capacity by the suspect cardiotocogram. In this group frequency of caesarean section was increased significantly. In cases with successful nipple stimulation the rate of labour induction with effect was higher. Oxytocin liberation by nipple stimulation may be regarded as endogenous oxytocin stress test. This simple procedure which can be done quickly and without danger is supposed to be a good supplement to nonstress test. Its reliability can be improved and the success of induction of labour estimated.

[Comparative studies of placentar diffusion of propanidid (Sombrevin) and barbiturate in premature pregnancies and cesarean sections]. / Vergleichende Untersuchungen der plazentaren Diffusion von Propanidid (Sombrevin) und Barbiturat bei Frühgeburten und Kaiserschnitt

The placental diffusion and fetal elimination of propanidid (Sombrevin) and hexobarbituralnatrium adhibited for the introduction of narcosis in cases of prematures requiring caesarean section is studied by virtue of maternal, umbilical cord, and new-born blood samples. On the basis of the results we come to the conclusion that for the introduction of narcosis in prematures requiring caesarean section, Sombrevin seems to be more suitable than hexobarbituralnatrium, owing to the quicker propanidid elimination.