A debate about ultrasound and anatomic aspects of the cervix in spontaneous preterm birth.

Preterm birth is the legal first global cause of neonatal death. The cervix has two roles: it has to stay closed to allow the fetus to undergo a normal development during gestation, and at term, the cervix has to dilate under the pressure of uterine contractions to allow the delivery. The purpose of this article is to establish if the ultrasound measured length of the cervix and its appearance are predictive for the spontaneous preterm birth. Cervical insufficiency can be described by painless cervical dilatation leading to pregnancy losses/ births, with no other risk factors present. During gestation, the physiological softening of the cervix is determined by the extracellular matrix components, particular decorin, and thrombospondin 2. The direction of the collagen fibers remains the same - circumferential direction, but the collagen solubility increases. Therefore, during pregnancy, the cervical tissue is more hydrated and has higher collagen extractability than non-pregnant tissue. Women with cervical incompetence have increased levels of smooth muscle cells than normal pregnant women, the number of elastic fibers is low, and also the concentration of hydroxyproline is decreased. Transvaginal ultrasound is the suitable gold standard exam that can offer essential information about the cervical length and state of the internal os in early asymptomatic stage of cervical insufficiency for predicting and preventing preterm birth. In our experience, a transvaginal ultrasound screening for the measurement of the cervix is required. We consider that the proper gestational age for the prediction of a preterm birth is at 18-22 weeks of gestation for the general population and earlier for patients with a history of preterm birth. Just from an observational point of view, we concluded with the fact that the cerclage of the cervix is unnecessary if the cervical length is above 2 cm and if the internal cervical os is closed. In the absence of funneling, the probability of cervical incompetence is low and the best prophylactic option is progesterone administration.

Velamentous insertion of umbilical cord with vasa praevia: case series and literature review.

A velamentous umbilical cord is characterized by membranous umbilical vessels at the placental insertion site that are prone to compression and rupture, especially when they are located in the membranes covering the cervical os (vasa praevia). The velamentous insertion of the umbilical cord, with a reported incidence of 1% in singleton pregnancies and 15% in monochorionic twin gestations, has been associated with obstetric complications: fetal growth restriction, prematurity, congenital anomalies, low Apgar scores, fetal bleeding with acute fetal distress and placental retention. The pathogenesis is unknown, but the trophotropism theory is the most common and supported by the association of velamentous cord insertion and placenta praevia. The prevalence of vasa praevia is of approximately 1/ 2500 deliveries; the risk factors include the use of assisted reproductive technologies, low-lying placenta or placenta praevia, bilobed or succenturiate lobe placenta and multiple gestation. The diagnosis is rarely established before delivery and consequently the fetal mortality is extremely high. We report two cases of velamentous marginal umbilical cord insertion associated with vasa praevia (type 1 vasa praevia) and placenta praevia diagnosed during a routine mid-trimester fetal 2D ultrasound scan, color and power Doppler transvaginal ultrasound cervical assessment. The ultrasound examination revealed one umbilical vessel crossing the internal os of the cervix entering the placental margin and connecting to the subchorionic vasculature, remaining immobile when the uterus was shaken, the color Doppler imaging enhancing the identification of the vessel. The patients were admitted to the hospital in the third trimester and deliveries were planed and successfully performed at 38 weeks gestation, being confirmed by a macroscopic examination ultrasound diagnostic.

[Cystic congenital dilatation of main biliary duct]. / Dilatatie congenitala chistica a caii biliare principale.

A case of cystic congenital dilatation of hepatocholedoch, in a patient aged 27, is presented. The malformation affects the entire biliary duct, being classified as Todani Ic type. The diagnosis was intraoperatively established and the surgical solution was the quasitotal extirpation of the hepatocholedoch followed by the reconstruction of the biliary transit through hepaticojejunostomy on Y loop Roux. The postoperative evolution was favourable and the result is still good after 13 years.

Study on the energy and protein metabolism in horses.

The present study focused on energy and protein metabolism in pregnant and lactating mares, including the suckling and weaned growing horses, in order to determine feed availability, as also the energy and protein requirements. The authors found that the feeding diets, consisting of alfalfa hay, oats and compounds, had different availability values in terms of energy and protein, according to animal physiological conditions and age. Thus, the pregnant mares utilized the metabolizable energy (ME) and digestible crude protein (DCP) intake in average proportions of 64.5 +/- 3.2%, 54.6 +/- 3.0%, respectively, while in the lactating mares the values were 60.1 +/- 2.8%, respectively, 50.1 +/- 4.0%. However the amount of energy and protein required for maintenance was similar in these two animal physiological conditions: 531 kJ, ME/kg0.75, 529 KJ, ME/kg0.75 and 3 g DCP/kg0.75, respectively. The suckling colts had a daily average gain between 1405 and 891 g and the young horses after weaning up to 2 years of age between 773 and 447 g. The net efficiency of ME and of DCP for growth in the suckling colts was of 40.6 +/- 2.1% and 46.1 +/- 3.2%, respectively and in young horses after weaning had similar values of 40.3 +/- 4.0%, respectively 44.4 +/- 2.2%, but the maintenance requirement of energy and protein differed from 506 kJ, ME/kg0.75 and 4.51 g DCP/kg0.75 respectively to 587 kJ, ME/kg0.75 and 3.51 g DCP/kg0.75, respectively.

Study on the energy and protein requirements in goats.

The present study focussed on the energy and protein metabolism in pregnant and lactating goats, including young female goats up to 8 months of age, in order to determine feed availability, as also the energy and protein requirements. It was found that the diets consisting of alfalfa hay, oats hay, maize, wheat bran and mixed feeds (fed to suckling females) had different availabilities in terms of energy and protein, according to animal physiological condition and age. Thus, in pregnant goats, 21% of the metabolizable energy (ME) was used as net energy for pregnancy (foetus plus foetal membranes); the amount of energy required for maintenance was 0.400 MJ/kg 0.75. The availability of digestible protein in the intestines (PDI) for pregnancy was 41.2 +/- 3.1%, while the amount of protein required for maintenance was 2.32 g PDI/kg 0.75. In lactating goats 60.7% of the ME of the diets is used as milk net energy, and 58.9 of the PDI as milk protein. Young female goats had a daily net gain ranging between 173 g and 60 g; the amount of protein in the gain varied between 23 g (month 2) and 12 g (month 8); and that of fat, between 8 g (month 1) and 24 g (month 6). The energy and protein requirements for maintenance were found to be 0.450 MJ ME/kg 0.75 and 2.43 g PDI/kg 0.75, respectively. The net efficiency of ME for growth was of 46.2 +/- 3% and of PDI for protein retention, of 50.1 +/- 2%.

Clear cell sarcoma of tendons and aponeuroses (malignant melanoma of soft tissue). A case report.

A case of a 55 year old patient with a tumour in the inguino-scrotal region infiltrating into the depth of the thigh was reported. The most tumoral cells appeared clear, rich in glycogen and in melanic pigment, with positive reaction for S-100 protein; between tumoral cells fine vasculo-conjunctival axes were observed. Excluding a Grawitz tumour metastasis one made the differential diagnosis with synovial sarcoma, epitheloid form of malignant schwanomas, spindle cell melanomas, liposarcoma, fibrosarcoma, the tumour was included in the distinct oncologic entity described by Enzinger, with neuroectodermal origin. This case is the first published in Romania.

[The diagnostic and therapeutic considerations in hepatic hydatid cyst]. / Cîteva consideratii diagnostice si terapeutice în chistul hidatic hepatic.

The paper is based on 213 surgical interventions for hepatic hydatid cyst. The importance of monography in the early diagnosis, detection of multiple sites and postoperative follow-up of the cases suspected of recurrence is underlined.