Nonimmune Hydrops Fetalis: Factors Which Predict Outcome.

AIMS AND OBJECTIVE: To evaluate the cause of NIHF cases referred to a tertiary referral center and to analyze the outcome. MATERIALS AND METHODS: A total of 130 cases of fetal hydrops registered during eight-year study period were reviewed. Antenatal ultrasound, blood investigations and postnatal fetal examination were done, and outcome was noted. RESULTS: Out of 130 cases of NIHF, antenatal ultrasound showed the presence of structural malformations in 94/130 (72.3%), cardiac abnormality was the most common (34/130, 26.1%) and cystic hygroma was seen in 15/130 (11.5%). Chromosomal abnormality was observed in 15(11.5%) cases, and Doppler US showed anemia in 4/130 (3.1%) cases only. Live born were 25 (12.9%), and rest all were stillborn or abortion. Later mean gestational age of presentation (p = 0.0001), presence of gastrointestinal malformation (p = 0.0001) and absence of structural malformations (p = 0.0441) were factors significantly associated with live birth; the presence of cystic hygroma (p = 0.0431) or structural heart defect (p = 0.007) was significantly associated with poor outcome. CONCLUSION: Fetal anemia was not a common cause of NIHF in the study population. The early onset of hydrops and presence of structural malformation carry a graver prognosis; type of structural defect also has bearing on outcome.

Premature Ovarian Failure: An Association with Autoimmune Diseases.

INTRODUCTION: Premature Ovarian Failure (POF) is the cessation of ovarian function before the age of 40 years. POF is reported to be associated with autoimmune diseases in 20-30% of cases. AIM: Patients presenting with idiopathic POF were screened for the presence of autoimmune disorders. MATERIALS AND METHODS: Twenty patients with idiopathic POF were included in the study. Baseline investigation in all subjects included fasting serum FSH, LH, E2, progesterone, free T3, free T4, Thyroid-Stimulating Hormone (TSH) and Anti-Thyroperoxidase (anti-TPO) antibodies, testosterone and Dehydroepiandrosterone (DHEAS) levels. Fasting and post-glucose (2 hours after 75g of oral glucose) serum calcium and phosphate were estimated using appropriate assays in biochemistry laboratory. RESULTS: Seven patients (35%), who presented with secondary amenorrhea, had thyroid disorders and were already on thyroxine replacement therapy. One patient also had vitiligo. There was no history of adrenal disorder. Anti-TPO levels were elevated in two (10%) patients of secondary amenorrhea group. The levels of serum testosterone were low in three patients. Serum DHEAS levels were low in 13 patients. Blood sugar levels (fasting and 2 hour post 75g glucose load) and fasting insulin levels were normal. Serum calcium and phosphate levels were normal in all the patients. CONCLUSION: Thyroid autoimmunity is the most common autoimmune disease associated with POF. The finding of low DHEAS in a large percentage of patients (65%), suggests possibility of adrenal dysfunction. This requires further testing for adrenal reserve and adrenal autoantibodies.

A multivessel umbilical cord with a single umbilical artery.

Umbilical cord abnormalities are known to be associated with congenital anomalies, chromosomal abnormalities and potential complications during pregnancy. We are reporting a case of a multivessel umbilical cord which comprised two umbilical veins alongwith a single umbilical artery.

Role of Combination OF Mifepristone and Misoprostol Verses Misoprostol alone in Induction of Labour in Late Intrauterin Fetal Death: A Prospective Study.

OBJECTIVE: To compare efficacy, safety and tolerance of combination of mifepristone and misoprostol versus misoprostol-only in induction of late intrauterine fetal death (IUFD). MATERIALS AND METHODS: This prospective study included a consecutive series of 52 women gravid up to fourth with IUFD after 28 weeks of gestation between January 2008 and June 2011. Women were divided into two groups. First group of women received a single oral dose of 200mg mifepristone, and after 24 hours, 100ug of intravaginal misoprostol was administered, followed by intravaginal 100µg misoprostol at four hourly intervals if required. Second group of women received 100 µg misoprostol at four hourly interval per vaginally (maximum 600µg in 24 hours). Oxytocin was given for augmentation if needed. RESULTS: The induction-to-delivery time was shorter with the combination regimen (p < 0.001) group. The total dose of misoprostol needed was lower in the group pre-treated with mifepristone (p < 0.001). Oxytocin was required only in misoprostol group. The two groups did not differ as regards complications experienced during labor and delivery significantly. CONCLUSION: Both regimens, misoprostol-only and the combination of mifepristone and misoprostol are safe in induction of labor after intrauterine fetal death (IUFD). Pre-treatment with mifepristone is more effective in terms of reducing of induction delivery interval, requirement of lesser dose of misoprostol and no need of augmentation with oxytocin.

High dose chemotherapy with autologous stem cell transplantation in diffuse large B-cell lymphoma.

BACKGROUND: High-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) plays an important role in the treatment of aggressive non-Hodgkin's lymphoma (NHL). We report on a retrospective analysis of all patients with diffuse large B-cell lymphoma who were consecutively treated with HDT followed by ASCT at the University Hospital of Bonn, Germany, between 1996 and 2004. METHODS: A total of 25 patients were transplanted for biopsy-proven diffuse large B-cell lymphoma (DLBCL). Eight patients received up-front HDT as first-line therapy, four patients received HDT due to incomplete response to conventional induction chemotherapy, and six patients were treated for primary refractory disease. Seven patients had recurrent lymphoma. RESULTS: A complete remission (CR) was achieved in 14 of 25 patients (56%). Estimated 3-year survival for patients treated with upfront HDT, chemosensitive patients with incomplete response to first line therapy, and patients with chemosensitive relapsed disease was 87.5%, 50.0% and 60.0%, respectively. In contrast, no patient with primary refractory disease or relapsed disease lacking chemosensitivity lived longer than 8 months. Chemosensitivity was the only significant prognostic factor for overall survival (OS) in multivariate analysis. CONCLUSIONS: Our results confirm that HDT and ASCT is a highly effective therapy in patients with DLBCL leading to long-term survival in a substantial proportion of patients. Patients treated upfront for high-risk disease, incomplete response to conventional first-line therapy, or for chemosensitive relapse have a good prognosis. In contrast, patients with primary chemorefractory disease and patients with relapsed disease lacking chemosensitivity do not benefit from HDT with ASCT.