Prenatal diagnosis of a variant of the azygos venous system.

BACKGROUND: The azygos venous system consists of the azygos vein on the right side and the hemiazygos and accessory hemiazygos on the left side. The azygos vein runs through the abdominal cavity along the right side of the vertebral bodies, in a cranial direction, passes through the diaphragm and reaches the mediastinum, where it forms the arch of the azygos which flows into the superior vena cava. Along its course, the azygos vein communicates with the intercostal veins on the right, the hemiazygos vein that collects blood from the left lower intercostal veins, and accessory hemiazygos vein that drains into the left upper intercostal veins. The last two, at the level of the seventh thoracic vertebra, unite and end in the azygos vein. The accessory hemiazygos vein is normally included in the length between T4 and T8. The embryological origin of the accessory hemiazygos vein is the result of an expansion in the direction of the cranial hemiazygos vein, which comes from the left upper sovracardinale vein (Dudiak et al. in Semin Roentgenol 24(1):47-55, 1989; Radiographics 11(2):233-246, 1991; Webb et al. in Am J Roentgenol 139(1):157-161, 1982). FINDINGS: This case report describes a rare variant of azygos vein system identified in prenatal diagnosis and confirmed by postnatal ultrasonography. CONCLUSIONS: The observation of the patient has excluded hemodynamic alterations associated with vascular anomaly.

Monoprosthesis for simultaneous correction of stress urinary incontinence and cystocele: a 3-year follow-up.

BACKGROUND: Stress Urinary Incontinence (SUI) and cystocele can occur simultaneously because they have identical predisposing factors. This procedure reinforces pubourethral ligaments and the vesicovaginal fascia, solving SUI and Cystocele. METHODS: 57 patients with grade III or higher cystocele were enrolled in this trial; SUI was present in 20% of patients (mean age: 57 years). NAZCA TC was used as monoprosthesis. Prolapse was evaluated using the POP-Q System, sexuality using the FSFI questionnaire, and LUTS using the OAB-SF questionnaire. RESULTS: After surgery, there were positive changes, sustained during the follow-up: SUI was cured in 80% patients; there was only one patient with de novo SUI and a single case of prolapse recurrence. CONCLUSIONS: These results suggest that NAZCA TC is safe and effective, adding the advantage of correcting SUI at the same time.