Anencephaly: pitfalls in pregnancy outcome and relevance of the prenatal exam.

Anencephaly is an embryological malformation of the central nervous system, invariable lethal, characterized by the absence of the brain and cranial vault and by other defects of the cranial structures. It has no cure but it can be detected during the pregnancy with ultrasonography. We present a rare case of a 15-year-old primipara, with no prenatal care, who delivered at 37 weeks an anencephalous female newborn. Ultrasonography avoided the confusion with a breach presentation, which, in conjunction with the prematurity, premature rupture of membranes and the young maternal age would have favored the cesarean section. The rarity of the case is increased by the singularity of the malformation. The importance of the prenatal care and genetic workup are stressed out in this embryologic pathology.

[Urachal cyst in an adult woman]. / Chist voluminos de uraca la o femeie adulta.

Urachal abnormalities represent a rare pathology and, in case of presence, they are more frequent in children and, among adults, in men. We report a case of urachal cyst in an adult woman in whom it was difficult to determine preoperatively the origin of the abdominal tumor. Positive diagnosis and treatment implied surgical exploration and resection. Even rare, this pathology should be considered in the differential diagnosis of an abdominal cyst. While the diagnosis may be established by clinical examination and imaging methods, surgical exploration is justified and, besides, offers the therapeutic opportunity.

[Experimental study of the use of piritramide as intrathecal analgesic]. / Cercetari experimentale privind utilizarea piritramidei ca analgezic intratecal.

Opioids proved their advantages as general and intrathecal (i.t.) analgesics. Piritramide (P), a largely used analgesic opioid today, has not been studied in i.t. administration. Our experimental research aimed in determining the efficiency, security and optimal dose of i.t. P. In 9 adult mongrel dogs equally randomized in 3 groups we injected i.t. P 1.3 mg x kg-l (group 1), P 0.8 mg x kg-l (group 2) and sodium chloride 0,9% (group 3) and we registered the motility, the pain reaction to electrical and mechanical nociceptive stimuli, the respiratory rate and amplitude, electrocardiogram, heart rate, mean arterial blood pressure electroencephalogram and, for 2 subjects from group 1, electromyogram. The P-induced analgesia was strong, dose-dependent, and segmental, with a time of onset of 5-8 min, duration of 1h 45 min-2h 30 min, and prolonged residual analgesic level for 5-6 h. The dogs from the 1st group presented moderate side effects: bradypnea, tachycardia and arterial hypotension at 5 min, reduction in the posterior limbs motility, sleep. We could conclude that i.t. piritramide 0.8 mg x kg-l provides a solid, segmental, long-lasting analgesia, without marked adverse effects.

[Ovarian cyst and pregnancy. Conservative management and consecutive emergency cystectomy. Case report]. / Chist ovarian asociat cu sarcina. Conduita conservativa si chistectomie intempestiva ulterioara. Caz clinic.

The association of an ovarian cyst with pregnancy is relatively rare; it may result in serious maternal and fetal complications and its treatment is still controversial. We present a case in which the rarity is given by the association of an 11cm--serous right ovarian cyst (with signs of torsion) with a monofetal 6 gestation week--pregnancy, by the initial conservative management and by the subsequent laparotomy and cystectomy at 16 gestational weeks, required by the acute abdominal pain caused by the torted cyst. The approach was initially conservative followed by laparotomy and cystectomy at 16 gestation weeks, required by the acute abdominal pain caused by the torsive cyst. Pregnancy was, afterwards, uneventful and the patient delivered vaginally, at term, a 3200 g healthy girl. Management options of such a case are discussed.

Asymptomatic abdominal wall endometrioma 15 years after cesarean section.

Abdominal wall endometriosis is rare and its diagnosis is difficult. However, the consequences may be serious, like recurrences or even malignant transformation. We report a rarer case of asymptomatic abdominal wall endometrioma, accidentally found during a surgical procedure for a second cesarean section, in a 39-years old patient, without any relevant history of endometriosis. The tumor was subcutaneous, 3/3 cm in size, located in the left angle of the incision from the 15 years previously performed cesarean section and freely mobile in relation with the skin and the fascia. It was excised, with clear margins (to prevent recurrences), during the procedure. The patient was discharged after five days. The postoperative period and the follow-up at one and three months were uneventful. The pathological examination clarified the diagnosis by revealing an endometrioma with decidual reaction. Such a condition may be, therefore, evoked before an abdominal wall tumor, even without specific symptoms, even in a 39-years old woman and longtime after the possible causal surgery. Pathological examination remains the ultimate diagnostic tool. Relevant prophylactic attitude at the end of the cesarean section may be considered.

[The value of transvaginal ultrasonography in the follow-up of postmenopausal women's endometrium]. / Valoarea ecografiei transvaginale în monitorizarea endometrului pacientelor în postmenopauza.

Endometrial cancer remains, today, a serious problem, especially for postmenopausal women. The aim of our study was to evaluate the utility of the transvaginal ultrasound examination in the management of the endometrial abnormalities in postmenopausal women. We included, in a prospective cohort, 49 successive postmenopausal women: 34 with metrorrhagia (group I) and 15 with no symptoms (group II) and we compared the results obtained by ultrasound examination, Pap smear and endometrial biopsy. Patients in group I had a higher frequency of risk factors and thick and abnormal endometrium. Unlike Pap smear, ultrasound examination and biopsy had comparable values. We could conclude that transvaginal sonography is a reliable technique for the endometrium evaluation in the postmenopausal women. Ultrasound exam could select the cases (without any symptoms) for endometrial biopsy and detect associated gynecological pathology.