Left ventricular function evaluation of the fetal heart: reference intervals and inter-observer variability of 2D speckle-tracking echocardiography measurements.

AIMS: Measurement of myocardial strain using 2D speckle-tracking echocardiography can successfully quantify ventricular function, being considered superior to conventional echocardiography. This study aimed to establish reference intervals, interobserver agreements and reliability of two fetal echocardiographic parameters which reflect left ventricular myocardial function, left ventricular apical 4 chamber endo peak strain (AP4pLS) and ejection fraction (EF). MATERIAL AND METHODS: We conducted a prospective study on 103 healthy fetuses. In each case, cardiac ultrasound images obtained were stored and afterwards were subject to offline 2D speckle-tracking echocardiographic analyses. In 15 randomly chosen subjects a second examiner also carried out an offline analysis of the 4-chamber view and the archived images, in order to assess inter-observer reproducibility and agreement level. Our study group was sub-divided into four different gestational age groups. RESULTS: Reference ranges were established for the two measured parameters, AP4pLS and EF, which did not differ significantly between four different gestational age groups (p=0.98 and p=0.64) and neither correlated with gestational age progression (p=0.37 and p=0.08). An excellent level of agreement between the two examiners was found for the echocardiographic measurements, expressed through an intra-class correlation coefficient (ICC) value of 0.85 (0.62-0.94 for 95%CI) for AP4pLS and 0.78 (0.47- 0.92 for 95% CI) for EF. CONCLUSIONS: Speckle tracking AP4pLS and EF parameters are useful for assessment of ventricular myocardial function in healthy fetuses and can be reliably reproduced by two different skilled examiners. Further studies conducted on larger populations are required to standardize reference values of fetal speckle-tracking measurements.

Transvaginal Ultrasound Combined with Strain-Ratio Elastography for the Concomitant Diagnosis of Uterine Fibroids and Adenomyosis: A Pilot Study.

Uterine fibroids (UFs) and adenomyosis (AM) represent two benign uterine conditions that can affect fertility and are most frequently commonly responsible for abnormal uterine bleeding and chronic pelvic pain. Their differential diagnosis still represents a challenge, and several authors advise the addition of elastography to transvaginal ultrasound (TVUS) for a more accurate imagistic recognition. Through this study, we aimed to assess the diagnostic accuracy of TVUS combined with strain-ratio elastography (SRE) in concomitant AM and UFs. We conducted a study on 17 patients diagnosed with concomitant UFs and AM undergoing hysterectomy and 46 healthy patients. TVUS combined with SRE was conducted in each patient, focusing on identifying rigidity patterns of the lesions. Significantly higher mean SR and maximum SR values were identified among both AM and UF lesions as opposed to controls (p < 0.01), with the highest tissue stiffness being encountered among AM lesions, which allows for the differentiation of UF (p < 0.01) and concomitant identification of both lesions. These results are reflected by higher cut-off values obtained for AM, both for mean SR (5.42 vs. 2.85) and maximum SR (5.80 vs. 3.30). TVUS combined with SRE showed good diagnostic performance in identifying coexisting UFs and AM within the same uterine specimen. Future studies on wider populations are required to validate our findings.

Ibuprofen, a Potential Cause of Acute Hemorrhagic Gastritis in Children - A Case Report.

INTRODUCTION: Upper gastrointestinal bleeding is an uncommon but possible life-threatening entity in children, frequently caused by erosive gastritis. Non-steroidal anti-inflammatory drugs are one of the most common class of drugs which can cause gastrointestinal complications, including hemorrhagic gastritis. CASE REPORT: The case of a 6-year-old male, admitted for hematemesis, abdominal pain and loss of appetite. It was ascertained at the time of admission, that ibuprofen had been prescribed as the patient had a fever. This was inappropriately administered as the mother did not respect the intervals between the doses.Initial laboratory tests revealed neutrophilia, leukopenia, high levels of lactate dehydrogenase and urea. An upper digestive endoscopy revealed an increased friability of the mucosa, digested blood in the gastric corpus and fornix. No active bleeding site was detected. The histopathological examination described a reactive modification of the corporeal gastric mucosa. Intravenous treatment with proton pump inhibitors and fluid replacement were initiated, with favorable results. CONCLUSION: Ibuprofen can lead to upper digestive hemorrhage independently of the administered dose. Parents should avoid administering Ibuprofen for fever suppression without consulting their pediatrician.