HDLive ultrasound images of ovarian dermoid cysts: diagnostic accuracy.

OBJECTIVE: To demonstrate that the use of 3D/4D HDLive increases the image quality in the diagnosis of benign cystic ovarian teratomas. MATERIALS AND METHODS: 3D/HDLive ultrasound (US) was used in 31 cases of suspected ovarian cystic teratoma using vaginal 2D US. The following pathognomonic images of mature cystic teratomas were considered for diagnosis: 1) a cystic, unilocular lesion with a densely echogenic tubercle (Rokitansky nodule); 2) a diffuse or partially echogenic mass usually demonstrating sound attenuation; 3) fluid-fluid/fat-fluid levels; 4) dermoid mesh with hyperechogenic calcifications indicating the presence of bone, teeth, or other ectodermally-derived structure; 5) multiple mobile spherical structures (fat globules). RESULTS: Dermoids present a wide spectrum of images depending on the predominant tissue type. In the vast majority of cases there are dense echogenic structures that correspond to complex masses of fatty tissue, sebum, hair, epithelial remnants, along with cartilage or bone. If we catalogue all the images together, the pathognomonic of dermoid are: 1) cystic or solid cystic lesions with a Rokitansky nodule, with bone, teeth or cartilage (six cases, 22.2%); 2) a solid mass with or without attenuation that corresponds with pure sebum (five cases, 18.5%); 3) a diffuse mass with fine bands that correspond with hair inside sebum (four cases, 12.9%) and that may form meshes or plugs corresponding with a mixture of fat, sebum, and hair (three cases, 11.5%). CONCLUSIONS: HDLive U.S. provides some images of exceptional quality that enhance the definition of the structures of these tumors (fat, hair, cartilage, bone, etc.) compared to 2D/3D/4D.

Morphological and proteomic characterization of midgut of the malaria vector Anopheles albimanus at early time after a blood feeding.

The midgut of anopheline mosquito is the entry of Plasmodium, the causative agent of malaria.When the mosquito feeds on parasite infected host, Plasmodium parasites reach the midgut and must confront digestive enzymes, the innate immune response and go across the peritrophic matrix (PM), a thick extracellular sheath secreted by the mosquito midgut epithelial cells. Then, to continue its development, the parasite must reach the salivary glands to achieve transmission to a vertebrate host. We report here the morphological and biochemical descriptions of the midgut changes after a blood meal in Anopheles albimanus. Before blood feeding, midgut epithelial cells contained numerous electrondense vesicles distributed in the central to apical side. These vesicles were secreted to the luminal side of the midgut after a blood meal. At early times after blood ingest, the PM is formed near microvilli as a granulous amorphous material and after it consolidates forming a highly organized fibrillar structure, constituted by layers of electrondense and electronlucent regions. Proteomic comparative analysis of sugar and blood fed midguts showed several molecules that modify their abundance after blood intake; these include innate immunity, cytoskeletal, stress response, signaling, and digestive, detoxifying and metabolism enzymes. Biological significance In the midgut of mosquitoes during bloodfeeding, many simultaneous processes occur, including digestion, innate immune activities, cytoskeleton modifications, construction of a peritrophic matrix and hormone production, between others. Mechanical forces are very intense during bloodfeeding and epithelial and muscular cells must resist the stress, modifying the actin cytoskeleton and coordinating intracellular responses by signaling. Microorganisms present in midgut contents reproduce and interact with epithelial cells triggering innate immune response. When infectious agents are present in the blood meal they must traverse the peritrophic matrix, an envelope formed from secretion products of epithelial cells, and evade the immune system in order to reach the epithelium and continue their journey towards salivary glands, in preparation for the transmission to the new hosts. During all these processes, proteins of mosquitoes are modified in order to deal with mechanical and biological challenges, and the aim of this work is to study these changes.

Semi-automatic Sono T measurement of nuchal translucency.

A prospective study of 63 singleton pregnancies between 11 + 0 and 13 + 6 weeks gestation underwent semi-automatic nuchal translucency (NT) measurement and were compared with two-dimensional ultrasonography (2D US). Inter-observer variation and the repeatability were evaluated. Sono T automatically achieves mid-sagittal plane views and measures the maximum NT thickness. Measurements have less inter-observer variation (CI = -0.13, -0.04) when compared with 2D measurements (CI = -0.45, 0.28). It is reproducible and comparable to conventional 2D US technique for NT measurement. However, incorporating Sono T into routine practice requires further program refinements in order to reduce erroneous NT measurements.

High doses of GnRH antagonists are efficient in the management of severe ovarian hyperstimulation syndrome.

OBJECTIVE: To determine whether treatment of severe ovarian hyperstimulation syndrome (OHSS) with high-dose gonadotropin-releasing hormone (GnRH) antagonist, due to its luteolytic effect, is an effective method of management. METHODS: Six infertile patients who had been scheduled for embryo transfer and developed early-onset severe OHSS with ascites and hemoconcentration were chosen for treatment with 3.0 mg of a GnRH antagonist (Cetrotide; Cetrorelix, Serono, Madrid, Spain). The response of these patients was compared with five patients with severe early-onset OHSS who received support therapy alone. All patients were evaluated clinically, echographically, and hematologically. RESULTS: Estradiol (E2) levels dropped significantly a few days after treatment. Peritoneal fluid regression measured by ultrasound was faster on the study group compared with controls. Hematocrit remained comparable in both groups during follow-up. In two cases a second bolus of GnRH-antagonist was used due to clinical and biochemical findings during the four days of observation following the initial dose. None of the patients treated with GnRH antagonists required paracentesis. CONCLUSIONS: Treatment with high doses of GnRH antagonists seems to be effective in the management of severe OHSS.

Nuevas aplicaciones en el diagnóstico ecográfico en 3D-4D en malformaciones fetales / New applications of 3D-4D ultrasonographic diagnosis of fetal malformations

Durante los tres últimos años han aparecido numerosas revisiones y nuevas modalidades ecográficas, tales como la tomografía con ultrasonidos, el VOCAL, el STIC, el modo inverso, el reverso, etc., que han revolucionado nuevamente las posibilidades de mejorar o completar el diagnóstico de las malformaciones fetales. El empleo de la tecnología 3D-4D puede aplicarse en la gran mayoría de las malformaciones y, combinado con la visión de la cinética fetal, ha mostrado que permite reducir el tiempo de exploración precisado para una completa visualización y mejor definición de las malformaciones

In the last 3 years, numerous revisions and new ultrasound modalities have emerged, such as ultrasound tomography, VOCAL, STIC, inverse mode, reverse mode, etc. These state of the art technologies have improved and/or completed the diagnosis of fetal malformations. These 3D-4D techniques can be applied to most malformations. In combination with fetal kinetics, this technology reduces the time spent in examination and improves visualization of malformations

Gestación ectópica: evolución diagnóstica y terapéutica en la última década / Ectopic pregnancy: changes in diagnosis and treatment in the last

El embarazo ectópico representa la implantación de una gestación fuera de la cavidad uterina. Esta situación patológica se conoce desde el siglo xvii, y presenta una incidencia aproximada de 11-18 casos por cada 1.000 partos. Sin lugar a dudas, esta implantación gestacional patológica representa una de las complicaciones más graves del embarazo, y su incidencia se ha visto incrementada notoriamente en los últimos 20 años. En el presente artículo revisamos la evolución en nuestro centro de esta enfermedad (AU)

Ectopic pregnancy consists of implantation of an embryo outside the uterine cavity. This abnormality has been known since the seventeenth century and the incidence is approximately 11-18 cases per 1,000 deliveries. Ectopic pregnancy is undoubtedly one of the most dangerous complications in pregnancy, and its incidence has risen markedly in the last 20 years. The present study reviews changes in the incidence, etiologic factors, diagnosis and treatment of this complication in our center (AU)

GP35 ANOAL, an abundant acidic glycoprotein of female Anopheles albimanus saliva.

Salivary glands of female mosquitoes produce proteins, not completely described yet, that participate in carbohydrate and blood feeding. Here, we report an acidic glycoprotein of 35 kDa (GP35 ANOAL) secreted in the saliva of the malaria vector mosquito Anopheles albimanus. GP35 ANOAL is produced exclusively in the distal lateral lobes of adult female salivary glands, it has a pI of 4.45 and is negatively stained by regular silver stain. An 888 bp cDNA clone encoding a predicted product of 240 amino acids has a signal peptide, potential post-translational modification sites, and a disintegrin signature RGD. The GP35 ANOAL sequence depicts high similarities with the 30 kDa saliva allergen of Aedes aegypti, 30 kDa allergen-like hypothetical proteins, and GE-rich proteins present in several Anopheles species, as well as in Ae. albopictus and Culex pipiens quinquefasciatus. The function of this protein family is still unknown.

Prenatally detected double trisomy: Klinefelter and Down syndrome.

Double trisomies are a rare occurrence. We report the first case of a Down and Klinefelter's syndrome (48,XXY,+21) in a fetus that was prenatally diagnosed during the 15th week of pregnancy. Even though the nasal bone was present, and the color-Doppler study of the ductus venosus and the nuchal thickness were normal, the maternal serum test results indicated an increased risk of Down syndrome and consequentially a genetic amniocentesis was performed. A 48,XXY,+21 karyotype was observed and the patient decided to terminate the pregnancy. In this case, we did not find the typical ultrasound (US) signs that would have led us to the chromosomopathy; furthermore, we emphasize the advantages of using biochemical screening which, in our case, were crucial in arriving at the correct diagnosis.

Empleo prenatal de esteroides: riesgos y beneficios / Prenatal steroid use: risks and benefits

El empleo de corticoides ante la posibilidad de un parto prematuro ha disminuido la incidencia de distrés respiratorio, hemorragia intraventricular y muerte neonatal. En aquellas mujeres en que el parto se pospone más allá de una semana, el empleo de nuevas dosis semanales ha sido empleado en la práctica obstétrica pese a que hay poca evidencia de su eficacia. Nuevos estudios sugieren en estas pautas repetidas pocos beneficios y riesgos potenciales, por lo que sugieren las dosis únicas (AU)

A single course of corticosteroids given to women before an anticipated preterm birth reduces the incidence of respiratory distress syndrome, intraventricular hemorrhage, and neonatal death. For women who do not deliver within 1 week, administration of repeat courses of corticosteroids has become common obstetric practice, despite little evidence of efficacy. Emerging data suggest that this practice produces little benefit and may potentially be harmful. Therefore, the use of corticosteroids to improve perinatal outcomes should be restricted to a single course (AU)

Tumor de Krukenberg secundario a adenocarcinoide apendicular / Krukenberg tumor secondary to appendiceal adenocarcinoid

Las metástasis ováricas de tumores apendiculares son excepcionales. Presentamos el caso de una mujer de 38 años con una tumoración ovárica bilateral sometida a histerectomía total con salpingo-ooforectomía bilateral, apendicectomía y omentectomía. El estudio anatomopatológico reveló la presencia de un tumor de Krukenberg secundario a un adenocarcinoide oculto de apéndice. Asimismo, se realiza una actualización de estos casos

Ovarian metastasis from appendiceal neoplasms are rare. We present the case of a 38-year-old woman with bilateral ovarian tumors who underwent bilateral salpingo-oophorectomy, total hysterectomy, appendectomy and omentectomy. Pathological diagnosis was Krukenberg tumor from an occult appendiceal adenocarcinoid. We also review the literature on this topic

Útero septo con duplicación cervical: una anomalía mülleriana infrecuente / Septate uterus with cervical duplication: an infrequent Müllerian abnormality

En el presente caso hemos descrito una variante mülleriana infrecuente (útero septo y cérvix doble), que resulta inconsistente con la embriología clásica. Asimismo, hemos realizado un diagnóstico correcto mediante el empleo de ecografía tridimensional, que representa el primer caso de la bibliografía mundial descrito mediante esta técnica ecográfica. Por último, hemos repasado las opciones terapéuticas y discutido su inclusión futura en la clasificación de las malformaciones uterinas. (AU)

Artrogriposis múltiple congénita (contracturas congénitas múltiples): revisión / Arthrogryposis multiplex congenita (multiple congenital contractures): a review

La artrogriposis o contracturas múltiples es la aparición de contracciones articulares de etiología variable en el período prenatal. La artrogriposis puede ser el resultado de un déficit neurológico, de alteraciones neuromusculares, de anomalías del tejido conectivo, de bridas amnióticas o de anomalías posicionales fetales. La artrogriposis puede ser el resultado de causas sin aparente relación hereditaria (neuropáticas) o proceder de factores hereditarios (la forma miopática, por ejemplo). El diagnóstico ecográfico depende de la observación de la ausencia o la escasa motilidad de los miembros y de anomalías de posición de las contracturas articulares. El pronóstico depende de la etiología específica de las contracturas. Se describe la incidencia de anomalías contracturales y otras malformaciones acompañantes sobre la base de 8 casos observados con ecografía tridimensional. (AU)

Prenatal diagnosis of sacrococcygeal teratomas by two- and three-dimensional ultrasound.

We suspected two fetuses of having sacrococcygeal teratomas following initial two-dimensional ultrasound scanning at 18 and 22 weeks' gestation. The fetuses were then scanned with three-dimensional multiplanar surface and three-dimensional orthogonal planar ultrasound to establish a definitive diagnosis. Although we made a presumptive diagnosis in both cases after initial two-dimensional scanning, with three-dimensional ultrasound we were better able to define the degree of involvement of the sacrum and other pelvic structures of prognostic importance.

Diagnóstico precoz de fetos triploides / Early diagnosis of triploid foetus

Las gestaciones triploides en las cuales el feto evoluciona favorablemente más allá del primer trimestre suponen una rareza. El diagnóstico precoz de dichas gestaciones triploides representa un desafio para los profesionales dedicados al diagnóstico prenatal. El presente caso, diagnosticado correctamente en una fase precoz, nos permite llevar a cabo una valoración de las diferentes técnicas diagnósticas de las que disponemos en la actualidad, haciendo especial énfasis en el empleo de la ecografía tridimensional (AU)

Fetus acardius: two- and three-dimensional ultrasonographic diagnoses.

OBJECTIVE: To determine whether ultrasonographic detection of acardiac fetuses and diagnostic accuracy of related malformations improve with complementary use of two-dimensional ultrasonography, three-dimensional ultrasonography, and Doppler scanning. METHODS: Three pregnant women with multifetal gestations who were found to have discordant fetuses on initial two-dimensional ultrasonographic scanning were subsequently scanned with three-dimensional ultrasonography and color Doppler ultrasonography. RESULTS: Although the possibility of acardiac fetuses was entertained in all cases after two-dimensional ultrasonographic scanning, the diagnosis was confirmed, and the accuracy and extent of fetal malformations were established with three-dimensional ultrasonography and color Doppler scanning. Two of the women had twin gestations, and the third woman had a triplet gestation. Among the women with twin gestations, 1 donor twin had no abnormalities, and the other donor twin had a diagnosis of arthrogryposis and gastroschisis. The woman with triplets had 1 acardiac fetus; the donor fetus was anencephalic; and the third fetus had alobar holoprosencephaly. CONCLUSIONS: Complementary use of two-dimensional ultrasonography, three-dimensional ultrasonography, and color Doppler scanning improves diagnostic accuracy and the ability to evaluate the extent and severity of organ compromise in pregnancies complicated by acardiac fetuses.