101
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Gajewska K, Herinckx A, Holoye A, D'Haene N, Massez A, Cassart M, Van Rysselberge M, Donner C. Antenatal embolization of a large chorioangioma by percutaneous Glubran 2 injection. Ultrasound Obstet Gynecol 2010; 36:773-775. [PMID: 20737457 DOI: 10.1002/uog.8806] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/06/2010] [Indexed: 05/29/2023]
Abstract
We describe a case of a large chorioangioma diagnosed at 18 weeks' gestation. Because of advanced fetal heart failure at 23 weeks' gestation, embolization of the chorioangioma's vessels was performed by percutaneous injection of Glubran 2 surgical glue. There was no immediate secondary effect of treatment. Devascularization was complete and durable. Signs of fetal cardiac failure normalized after 1 month and a healthy infant was delivered at 38 weeks. To our knowledge this is the first reported case of perinatal survival after successful embolization of a chorioangioma using tissue glue.
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Affiliation(s)
- K Gajewska
- Department of Obstetrics and Gynecology, University Hospital Erasme, Brussels, Belgium
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102
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Abstract
OBJECTIVE The purpose of this presentation is to review the role of sonography in evaluation of acute abdomen during pregnancy. METHODS Illustrative cases were collected from gravid patients who presented with signs and symptoms suspicious for acute abdomen and subsequently underwent sonography. RESULTS This presentation shows sonographic findings of various maternal complications that can present with acute abdominal pain in pregnant patients. CONCLUSIONS Sonography remains the first line of imaging in pregnant patients presenting with acute abdomen. Patient triage or additional imaging may be obtained on the basis of the sonographic findings.
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Affiliation(s)
- Phyllis Glanc
- Department of Medical Imaging, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
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103
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Laughlin SK, Herring AH, Savitz DA, Olshan AF, Fielding JR, Hartmann KE, Baird DD. Pregnancy-related fibroid reduction. Fertil Steril 2010; 94:2421-3. [PMID: 20451187 DOI: 10.1016/j.fertnstert.2010.03.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 01/04/2010] [Accepted: 03/10/2010] [Indexed: 11/19/2022]
Abstract
We tested the hypothesis that the protective effect of parity on fibroids is due to direct pregnancy-related effects by following women from early pregnancy to postpartum period with ultrasound. Of 171 women with one initial fibroid, 36% had no identifiable fibroid at the time of postpartum ultrasound, and 79% of the remaining fibroids decreased in size.
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Affiliation(s)
- Shannon K Laughlin
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA.
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104
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Zanardini C, Papageorghiou A, Bhide A, Thilaganathan B. Giant placental chorioangioma: natural history and pregnancy outcome. Ultrasound Obstet Gynecol 2010; 35:332-336. [PMID: 19859897 DOI: 10.1002/uog.7451] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Giant placental chorioangiomas are associated with a high prevalence of pregnancy complications and a poor perinatal outcome. The aim of the study was to evaluate the natural history, intrauterine treatment and outcome of pregnancies complicated by giant placental chorioangioma. METHODS This was a retrospective study of 19 cases of giant placental chorioangioma, in which the natural history, intrauterine treatment and outcome of pregnancy were evaluated. RESULTS Eighteen of the 19 cases were associated with a wide variety of fetal complications, including polyhydramnios, growth restriction, hyperdynamic circulation, cardiomegaly, anemia and non-immune hydrops. Two-thirds of the cases developed complications that required either elective delivery for fetal growth restriction (n = 6) or intervention for cardiovascular effects (n = 7). Fetal therapy, when required, was tailored to the particular complication and resulted in a successful pregnancy in all cases. CONCLUSIONS The presence of large placental chorioangioma is associated with the development of fetal growth restriction and hyperdynamic state in a significant number of cases. This series elucidates some of the putative underlying mechanisms for these complications, and reports on a safe and effective treatment modality, percutaneous ultrasound-guided interstitial laser therapy.
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Affiliation(s)
- C Zanardini
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
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105
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Kowalczyk N, Carr Z. Undifferentiated embryonal sarcoma: a case report. Radiol Technol 2010; 81:329-334. [PMID: 20207789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Undifferentiated embryonal sarcoma (UES) is the fourth most common hepatic malignancy diagnosed in children, but is extremely rare in older patients. Classification of the tumor is difficult because of its unknown etiology. PURPOSE The purpose of this study is to describe a case of UES in a 19-year-old pregnant woman with UES who delivered a stillborn fetus and passed away because of UES, and how medical imaging can be used to help differentially diagnose UES. CONCLUSION A multiphase liver computed tomography protocol best demonstrates all forms of liver cancers and lesions; therefore, it is the scan of choice when a liver abnormality is suspected but the type of lesion is unknown.
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Affiliation(s)
- Nina Kowalczyk
- School of Allied Health Professions, The Ohio State University, Columbus, Ohio, USA
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106
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Arteaga-Gómez AC, Aranda-Flores C, Márquez-Acosta G, Colín-Valenzuela A. [Adnexal tumor and pregnancy: diagnosis and treatment]. Ginecol Obstet Mex 2010; 78:160-167. [PMID: 20939220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The finding of adnexal masses during pregnancy is an exceptional event. Its reported incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses. OBJECTIVE Describe a case series of patients with adnexal mass and pregnancy. MATERIAL AND METHODS We retrospectively reviewed the medical records of patients who had diagnosis of pregnancy and adnexal over a period of five years. RESULTS The incidence was 0.22%. The mean age was 26 +/- 7.3 years, mean gestational age was 17 +/- 6.6 weeks. The diagnosis was established by ultrasound (USG) in 95% of cases, 48% had cystic characteristics, the mean diameter of the tumor was 99 +/- 42 mm. Cistectomy was performed during pregnancy or trans-cesarean section in 30% and 58% of patients respectably. The mean tumor size was 118 mm (range 2 a 40 mm), weight 1,370 g (range 10 a 5,800 g). The most frequent histological diagnosis were serous cyst (40%), mature teratoma (28%), mucinous (6%), malignancy (4%). There were not complications related to the surgical procedure. CONCLUSIONS The USG constitute a safe method for the diagnosis, but the image method with the highest positive predictive value is the MRI. Tumor markers (CA-125, AFP, GCH-B,DHL, ACE), are not useful during pregnancy. If the tumor doesn't achieve surgical criteria the recommended follow up is clinical observation and USG. If surgery is decided, it should be performed between 16 a 23 weeks of pregnancy, and it's recommended to send the tumor to histological diagnosis, in case of malignancy the surgery will continue according to the tumor stage. The time and delivery route will be decided by the obstetrician.
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Affiliation(s)
- Ana Cristina Arteaga-Gómez
- Servicio de Ginecología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Secretaría de Salud, México, DF
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107
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O'Gara PT, Shepard JAO, Yared K, Sohani AR. Case records of the Massachusetts General Hospital: Case 39-2009--a 28-year-old pregnant woman with acute cardiac failure. N Engl J Med 2009; 361:2462-73. [PMID: 20018968 DOI: 10.1056/nejmcpc0907803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Acute Disease
- Adult
- Brain/pathology
- Central Nervous System Neoplasms/diagnosis
- Diagnosis, Differential
- Fatal Outcome
- Female
- Heart Failure/etiology
- Humans
- Lymphoma/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/pathology
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/pathology
- Pleural Effusion/diagnostic imaging
- Pregnancy
- Pregnancy Complications, Cardiovascular/etiology
- Pregnancy Complications, Neoplastic/diagnosis
- Pregnancy Complications, Neoplastic/diagnostic imaging
- Pregnancy Complications, Neoplastic/pathology
- Pregnancy Trimester, Third
- Radiography
- Ultrasonography
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Affiliation(s)
- Patrick T O'Gara
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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108
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Bińkowska M, Debska M, Debski R. [Large uterine leiomyoma in pregnancy--case report]. Ginekol Pol 2009; 80:946-948. [PMID: 20120942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
This is a case report of a successful pregnancy outcome in a 36-year-old primigravida with an enormous leiomyoma. Potential pregnancy complications and pain treatment during pregnancy are discussed in the following work.
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Affiliation(s)
- Małgorzata Bińkowska
- II Klinika Połoznictwa i Ginekologii, Centrum Medycznego Ksztatcenia Podyplomowego w Warszawie.
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109
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Boersma AA, Meyboom-de Jong B. Medical abortion in primary care: pitfalls and benefits. W INDIAN MED J 2009; 58:610-613. [PMID: 20583695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We describe five pitfalls of medical abortion: ectopic pregnancy not terminated after misoprostol, but without negative side-effects; long-term vaginal blood loss with suspicious retained products which disappeared spontaneously; a patient with uterus myomatatosus with severe pain and retained products in the uterus; repetition of misoprostol because of retained products in the uterus after two weeks and an allergic reaction to methotrexate. Despite these pitfalls, there are enough benefits to consider medical abortion with methotrexate and misoprostol as a safe method with a high success rate of more than 91% and a good alternative for surgical abortion. An invasive procedure is not necessary, there are no long-term complications and it can be performed at an earlier stage, which makes it more acceptable in society. In Curaçao, where abortion is legally restricted, medical abortion is performed with methotrexate and misoprostol. In countries where abortion is legal, mifepristone and misoprostol are the first choice.
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110
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Affiliation(s)
- S J O'Connor
- Mayday University Hospital, Croydon, Surrey CR7 7YE.
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111
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Sherer DM, Dalloul M, Salame G, Sokolovski M, Bender L, Alasio T, Abulafia O. Color Doppler sonographic features of a Brenner tumor in pregnancy. J Ultrasound Med 2009; 28:1405-1408. [PMID: 19778892 DOI: 10.7863/jum.2009.28.10.1405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
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112
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Andreani M, Vergani P, Ghidini A, Locatelli A, Ornaghi S, Pezzullo JC. Are ultrasonographic myoma characteristics associated with blood loss at delivery? Ultrasound Obstet Gynecol 2009; 34:322-325. [PMID: 19670350 DOI: 10.1002/uog.7319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The presence of myomas in pregnancy is associated with greater blood loss at delivery. The aim of this study was to evaluate whether the sonographic characteristics of myomas can predict blood loss at delivery in women with large myomas. METHODS Among women who underwent second-trimester ultrasound screening at our department between January 1996 and December 2004, 251 had at least one myoma with a mean diameter > or = 5 cm. Number of myomas (single vs. multiple), maximum diameter of the largest myoma, sum of the maximum diameter of each myoma, change in size of myomas between first and last scan, and location in relation to the placenta and to the presenting part of the fetus (above or below) were analyzed in relation to blood loss at delivery and severe postpartum hemorrhage (> or = 1000 mL). RESULTS Multivariate analysis showed that the presence of multiple myomas was the only parameter independently associated with amount of blood loss at delivery (P = 0.003). The association between the presence of multiple myomas and severe postpartum hemorrhage was of borderline significance for the statistical power of this study (P = 0.08). CONCLUSIONS In women with large myomas, the presence of multiple tumors is independently associated with heavier blood loss at delivery but not with postpartum hemorrhage of > or = 1000 mL.
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Affiliation(s)
- M Andreani
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.
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113
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Vázquez Camacho EE, Alfán Guzmán F, Carbajal Ocampo D. [Ovarian cystadenoma and ectopic pregnancy. A case report]. Ginecol Obstet Mex 2009; 77:387-392. [PMID: 19902630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 40-year-old woman without symptoms, with a three-week amenorrhea, and with no previous pregnancy history. Three months before she followed treatment with clomifeno and no other risk factors. A measure of beta fraction is performed, finding a probable pregnancy of 3-4 weeks. A new measure of beta fraction is made three weeks later with an ultrasound, finding an important increment in measure, but without evidence of intrauterine pregnancy in the ultrasound. A new ultrasound is made seven weeks after her last period, finding a mass in the left ovary, but without increment in beta fraction. At week ten, she presents an uterine bleeding during a trip, which is diagnosed as a probable mole without any further medical treatment and from the 12th week, there is a considerable decrement in the beta fraction measure, without any other symptom, but the persistent adnexal mass at the left ovary, with irregular septum images at ultrasound. A laparotomy is performed finding an ectopic pregnancy surrounded by a serum cystadenoma.
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114
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115
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Affiliation(s)
- Karsten Müssig
- Division of Endocrinology, Metabolism and Pathobiochemistry, Department of Internal Medicine, University Hospital Tübingen, Germany
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116
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Abstract
OBJECTIVE Krukenberg tumors in pregnancy are extremely rare. Only three cases have been reported, two of which were diagnosed postpartum. CASE REPORT A 20-year-old, primigravida with bilateral malignant ovarian tumors, who received no prior antenatal care, was presented with intestinal obstruction at 5 months' gestation. Pregnancy was preserved, and bilateral oophorectomy, omentectomy with resection of sigmoid colon growth, and colostomy were performed. The patient aborted spontaneously and postoperatively, and was treated with adjuvant chemotherapy. CONCLUSION Because platinum-based chemotherapy can be safely given during pregnancy, hysterectomy can be avoided in cases of bilateral malignant ovarian tumors if the uterus is not grossly involved, so allowing preservation of an existing pregnancy.
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Affiliation(s)
- Savita Rani Singhal
- Department of Obstetrics and Gynaecology, Pandit Bhagwat Dayal Sharma Postgraduate Institute, Medical Sciences, Rohtak, Haryana, India.
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117
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Bińkowska M, Debska M, Mazurek M, Słapa R, Debski R. Embolization of renal angiomyolipoma in pregnancy: case report. Ginekol Pol 2009; 80:449-452. [PMID: 19642603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Renal angiomyolipoma is a rare benign tumour composed of adipose tissue, blood vessels and smooth muscles. However it can locally grow to a great size and its numerous blood vessels may cause major bleeding requiring immediate intervention. CASE At 20th week of pregnancy a previously healthy 26-year old pregnant woman with an episode of sudden and severe pain in the left flank followed by fainting was diagnosed with a bleeding tumour of the left kidney. The diagnosis was based on ultrasonography and magnetic resonance imaging (MRI). Diagnostic angiography was followed by selective embolization of the tumour blood vessels. At 38th week of pregnancy elective caesarean section was performed and after the puerperium the tumour was resected. CONCLUSION Embolization of renal angiomyolipoma bleeding vessels during pregnancy can be an effective therapeutic approach protecting against further bleeding and haemorrhagic shock thereby obviating the need to perform urgent surgery and allowing the woman to carry her pregnancy to term safely in outpatient setting.
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Affiliation(s)
- Małgorzata Bińkowska
- II Klinika Połoznictwa i Ginekologii, Centrum Medyczne Kształcenia Podyplomowego, Warszawa.
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118
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Testa AC, Licameli A, Di Legge A, Mascilini F, Petruzziello L, Pelagalli M, Scambia G, Ferrandina G. Color Doppler sonographic features of a Krukenberg tumor in pregnancy. J Ultrasound Med 2009; 28:695-698. [PMID: 19389911 DOI: 10.7863/jum.2009.28.5.695] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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119
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Guida M, Paladini D, Greco E, Di Spiezio Sardo A, Coppola C, Nappi C. Pregnancy-induced symptomatic pelvic and extra-pelvic cavernous hemangiomatosis. CLIN EXP OBSTET GYN 2009; 36:55-57. [PMID: 19400421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Pregnancy-induced pelvic and extra-pelvic cavernous hemangiomatosis is a serious condition, associated with considerable maternal and fetal risks. This report describes the ultrasound (US) features and the clinical management of such rare condition in a young caucasian woman. CASE A 20-year-old woman was referred to our department following the occurrence of swelling in her inguinal and vulvar area together with lipotimic episodes. Diffuse cavernous hemangiomatosis of the pregnant uterus associated with vaginal, inguinal and vulvar varicosities was diagnosed clinically and by 2D and 3D US. The patient underwent expectant management of the gestation, under close US monitoring of both superficial and inner varicosities, careful surveillance of the maternal and fetal condition and prophylaxis for thrombotic complications with medical therapy. A cesarean section was performed at 37 weeks of gestation because of the worsening of her lipotimic episodes and her unfavorable Bishop's score. CONCLUSION This is the first report in which pregnancy-induced varicose disease involved contemporarily uterine, vaginal, inguinal, and vulvar veins totally sparing the lower extremities. This case suggests that, under close monitoring, a conservative approach can be adopted in such conditions. Vaginal delivery is to be preferred, but if cesarean section is required, the surgery should be performed under general anesthesia and packed red cells and plasma units should always be available.
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Affiliation(s)
- M Guida
- Department of Obstetrics and Gynecology, University of Naples Federico II, Naples, Italy
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120
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Chandacham A, Kietpeerakool C, Khunamornpong S, Suprasert P, Srisomboon J, Charoenkwan K, Phongnarisorn C, Cheewakraingkrai C, Siriaree S, Tantipalakorn C. Successfully conservative treatment of large cervical choriocarcinoma with profuse vaginal bleeding. J Med Assoc Thai 2009; 92:120-123. [PMID: 19260253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Primary choriocarcinoma of the uterine cervix is a rare disease. The accurate diagnosis of such a disease is difficult to achieve because of its rarity. Furthermore, the majority of cases presented with abnormal vaginal bleeding that could be caused by other more common conditions including, threatened abortion, cervical polyp, cervical pregnancy, or cervical cancer. In the present report, the authors present a case of large cervical choriocarcinoma with life-threatening vaginal bleeding, which was initially misdiagnosed as a cervical cancer The active cervical bleeding was successfully controlled with selective uterine arterial embolization. Remission of cervical choriocarcinoma was accomplished with combination chemotherapy without the need of hysterectomy.
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Affiliation(s)
- Anchalee Chandacham
- Department of Obstetrics and Gynecology, Nakornping Hospital, Chiang Mai 50180, Thailand.
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121
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David C, Lupaşcu I, Socolov D, Vişan V. [Large ovarian cyst associated with pregnancy. Case report]. Rev Med Chir Soc Med Nat Iasi 2008; 112:1007-1011. [PMID: 20209778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The incidence of adnexal masses in pregnancy is rather low. The diagnosis has become more common with the routine use of ultrasonography in prenatal care. The management of adnexal masses during pregnancy remains controversial. Ultrasonography can characterise correctly the adnexal mass and avoid antepartum surgery. We present the case of a 32 years old gravida, IV gesta, I para, with an ovarian cystic tumour that enlarged during pregnancy from 7 cm to 20 cm. The tumour was correctly characterised by ultrasound exam (Sassone 3) and surgery was not indicated. The pregnancy evoluated well and the patient delivered at term by c. section and ovariectomy was also performed. The postpartum evolution was good.
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Affiliation(s)
- Cristina David
- Facultatea de Medicină, Clinica a III Obstetrică-Ginecologie, Universitatea de Medicina Si Farmacie "Gr.T. Popa" Iaşi
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122
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Hoopmann M, Rahimi G, Hartlapp I, Eifinger F, Garnier Y, Bald R. [Chemotherapy-induced fetal anemia in maternal acute myelocytic leukemia]. Ultraschall Med 2008; 29:424-7. [PMID: 17717788 DOI: 10.1055/s-2007-963219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This article discusses the management of a pregnancy of a 32-year-old primigravida with acute myelocytic leukemia treated with induction chemotherapy starting in the 20 + 5 week of gestation. Sonographic monitoring showed evidence of fetal ascites and anemia that could be treated with an intrauterine fetal transfusion. After maternal recovery, a caesarean section was performed in the 27 + 5 week of gestation. We delivered a vivid eutrophic female prematurely. The infant showed persisting signs of myelosuppression. Two further transfusions had to be performed. The present report describes the interdisciplinary therapeutic management when polychemotherapy during pregnancy is necessary for the mother. Cases of acute leukemia in pregnancy are complicated by severe prenatal risks caused by the hematologic illness and by the immediate beginning of chemotherapy. In the third trimester premature delivery is preferable to intrauterine exposition to cytostatic agents. In the second trimester the pregnancy has to be monitored for the typical risks and complications of chemotherapy. Fetal cytotoxic myelosuppression is detectable by prenatal observation so that interventional strategies are feasible.
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MESH Headings
- Adult
- Anemia, Neonatal/chemically induced
- Anemia, Neonatal/diagnostic imaging
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/toxicity
- Bone Marrow/drug effects
- Cesarean Section
- Cooperative Behavior
- Female
- Follow-Up Studies
- Humans
- Infant, Newborn
- Jaundice, Neonatal/chemically induced
- Jaundice, Neonatal/diagnostic imaging
- Leukemia, Myeloid, Acute/diagnostic imaging
- Leukemia, Myeloid, Acute/drug therapy
- Patient Care Team
- Pregnancy
- Pregnancy Complications, Neoplastic/diagnostic imaging
- Pregnancy Complications, Neoplastic/drug therapy
- Pregnancy Trimester, Second
- Ultrasonography, Prenatal
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Affiliation(s)
- M Hoopmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Köln.
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123
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Netters FJS, van Oven MW, van Loon AJ, Hoogenberg K. [Struma ovarii during pregnancy]. Ned Tijdschr Geneeskd 2008; 152:1335-1338. [PMID: 18661861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 41-year-old pregnant woman, gravida 10, para 7, with gestational diabetes, was diagnosed with subclinical hyperthyroidism. At 16-weeks gestation a left-sided unilateral ovarian cyst was discovered. At 37 weeks of pregnancy an elective caesarean section was carried out, due to the transverse presentation caused by the cyst, followed by an adnexectomy. Histological examination showed a struma ovarii, a rare mature ovarian teratoma mainly consisting of thyroid tissue. There was no evidence of malignancy.
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124
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Abstract
We report a case of a large fetal oropharyngeal teratoma in a 19-week fetus evaluated with 3-dimensional (3D) sonography. The 3D sonographic surface and maximum mode rendering of the tumor allowed detailed visualization of the mass lesion and thus enabled active patient participation in the management of the pregnancy.
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Affiliation(s)
- Chander Lulla
- The Ria Clinic, B44 Gita, Pandita Ramabai Road, Gamdevi, Mumbai, Maharashtra, India 400007
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125
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Gilboa Y, Fridman E, Ofir K, Achiron R. Carcinoid tumor of the appendix: ultrasound findings in early pregnancy. Ultrasound Obstet Gynecol 2008; 31:576-578. [PMID: 18393270 DOI: 10.1002/uog.5313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Ultrasound examination of a woman in early pregnancy with right lower quadrant abdominal pain demonstrated an edematous appendix with amorphous fluid surrounding the appendix. At laparotomy, these findings were confirmed. On pathological evaluation following surgical removal of the appendix a rare case of carcinoid tumor of the appendix was diagnosed. This is the first description of the transvaginal ultrasound features of a carcinoid tumor of the appendix.
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Affiliation(s)
- Y Gilboa
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel.
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126
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Abstract
Chorioangioma is a benign vascular tumor of the placenta arising from primitive chorionic mesenchyme. Large (>4 cm) chorioangiomas are much rarer and are often associated with maternal and/or fetal complications. We describe the sonographic features of a large placental chorioangioma with normal outcome.
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Affiliation(s)
- Kishor Taori
- Department of Radiodiagnosis, Government Medical College and Hospital, Nagpur 440003, India
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127
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Poujade O, Pujade-Lauraine E, Levardon M, Luton D. Ovarian malignant immature teratoma associated with pregnancy--a case report. EUR J GYNAECOL ONCOL 2008; 29:649-650. [PMID: 19115697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report the case of a malignant immature teratoma diagnosed at 21 weeks of amenorrhea in a 36-year-old healthy woman. Ultrasound examination showed a multilocular cystic mass of 175 mm in diameter, situated on the left side of the uterus. A left ovariectomy was performed by laparotomy at 22 weeks of amenorrhea. Histologic examination revealed a malignant grade 2 immature teratoma, and the patient underwent three courses of chemotherapy with a good pregnancy outcome. A cesarean section was carried out at 39 weeks of amenorrhea, associated with a left salpingectomy on which the pathologist examination did not find any malignant cells. The newborn had a normal aspect, and the mother was considered to be in remission after two more courses of chemotherapy..
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Affiliation(s)
- O Poujade
- Service de Chirurgie Gynécologie Obstétrique, Hôpital Beaujon AP-HP, Clichy, France.
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128
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Dukovski A, Apostolova M. [Hemodynamic assessment of early pregnancy. Part three--complications]. Akush Ginekol (Sofiia) 2008; 47:13-15. [PMID: 18642568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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129
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Abstract
Virilization in pregnancy due to borderline mucinous ovarian tumors is very rare. A case of a 28-year-old patient who was noted at 28 weeks' gestation to have marked virilization with raised serum androgens, ascites and a large complex right adnexal mass is presented. Delivery was carried out by cesarean section and at surgery a large tumor was noted in the right ovary. Histology revealed a borderline mucinous ovarian tumor with stromal luteinization, but there was no evidence of stromal invasion. Serum androgens returned to normal levels following surgery and the maternal virilization had resolved at the 6-week postnatal visit. Stromal changes in borderline mucinous ovarian tumors may result in virilization due to androgen production; surgical removal is associated with an excellent clinical outcome.
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Affiliation(s)
- Selvan Pather
- Sydney Gynecologic Oncology Group, Sydney Cancer Center, Royal Prince Alfred Hospital, The University of Sydney, New South Wales, Australia.
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130
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Degani S, Tamir A, Leibovitz Z, Shapiro I, Gonen R, Ohel G. Three-dimensional power Doppler in the evaluation of painful leiomyomas and focal uterine thickening in pregnancy. Int J Gynaecol Obstet 2007; 99:122-6. [PMID: 17888922 DOI: 10.1016/j.ijgo.2007.04.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 04/26/2007] [Accepted: 04/27/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the usefulness of 3-dimensional (3D) power Doppler ultrasound in distinguishing painful leiomyomas from focal myometrial contractions or nonpainful leiomyomas in pregnancy. METHODS A 2D section of the area of interest in the uterine wall was first obtained in 29 patients to determine whether the pain originated from a myoma or a uterine contraction. Then, volume acquisition was activated and Doppler indices (vascularization index, flow index, and vascularization-flow index) were calculated for thickened and normal uterine wall. RESULTS Of 15 patients found to have uterine myomas, 11 had multiple tumors and 4 had single tumors. In the remaining 14 patients the painful uterine thickening proved to be a focal contraction. Painful segments of uterine thickening were associated with lower Doppler indices. Painful myomas were found to have significantly lower indices than normal uterine wall (P=0.008, 0.03, and 0.01 for VI, FI, and VFI, respectively, vs. 0.001, 0.003, and 0.01). However, the differences in indices between nonpainful myomas and uterine wall on the one hand, and nonpainful myomas and focal uterine contractions on the other, were not statistically significant. CONCLUSION Three-dimensional power Doppler ultrasound may be a sensitive and reliable tool for distinguishing painful uterine myomas from focal myometrial contractions and nonpainful myomas.
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Affiliation(s)
- S Degani
- Ultrasound Unit, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Ruth and Baruch Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
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131
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Hauth E, Umutlu L, Forsting M. [Contrast-enhanced MR-mammography in a pregnant woman with breast carcinoma]. ROFO-FORTSCHR RONTG 2007; 179:1083-4. [PMID: 17879180 DOI: 10.1055/s-2007-963400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
MESH Headings
- Adult
- Biopsy
- Breast/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Chemotherapy, Adjuvant
- Contrast Media
- Female
- Gadolinium DTPA
- Humans
- Magnetic Resonance Imaging/methods
- Mammography
- Neoplasm Staging
- Pregnancy
- Pregnancy Complications, Neoplastic/diagnosis
- Pregnancy Complications, Neoplastic/diagnostic imaging
- Pregnancy Complications, Neoplastic/drug therapy
- Pregnancy Complications, Neoplastic/pathology
- Ultrasonography, Mammary
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132
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Affiliation(s)
- J Mechery
- Royal Berkshire Hospital, Reading, UK.
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133
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Abstract
Neuroblastoma is a tumor of the sympathetic ganglia and adrenal medulla that rarely metastasizes to the placenta. A 21-year-old gravida 3, para 1 at 28 weeks' gestation had an incidental finding of a 3.8-cm fetal renal mass on prenatal ultrasound. Within 1 week, the fetus developed hydrops and was delivered for nonreassuring fetal assessment. The mother developed mirror syndrome as manifested by hypertension, oliguria, and edema. The hydropic infant developed pulmonary hypertension, sepsis, and renal failure. On day of life 4, life support was discontinued. Pathological examination of the placenta revealed disseminated small round blue cells consistent with neuroblastoma. Metastasis of congenital neuroblastoma to the placenta is exceedingly rare, and cases discovered prenatally have resulted in significant maternal morbidity and 100% neonatal mortality.
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Affiliation(s)
- Andrew T Allen
- Department of Obstetrics and Gynecology, Keesler Medical Center, Keesler AFB, Mississippi 39534, USA.
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134
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Affiliation(s)
- Aaron D Kirkpatrick
- Department of Radiology, Wilford Hall Medical Center, 2200 Bergquist Dr, Lackland AFB, TX 78236-9908, USA.
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135
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Teo KY, Shah S, Spencer CP. Questioning the accuracy of radiological investigations, methodology and cost-effectiveness of study titled 'Adenomyosis and risk of preterm delivery' by Juang et al. BJOG 2007; 114:907; author reply 908. [PMID: 17567424 DOI: 10.1111/j.1471-0528.2007.01358.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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136
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Yazbek J, Salim R, Woelfer B, Aslam N, Lee CT, Jurkovic D. The value of ultrasound visualization of the ovaries during the routine 11–14 weeks nuchal translucency scan. Eur J Obstet Gynecol Reprod Biol 2007; 132:154-8. [PMID: 16914254 DOI: 10.1016/j.ejogrb.2006.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Revised: 05/24/2006] [Accepted: 07/05/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the feasibility and possible value of routine screening for ovarian pathology in asymptomatic pregnant women at 11-14 weeks' gestation. STUDY DESIGN A policy of routine ovarian visualization was implemented in 2925 pregnant women attending for a nuchal translucency scan at 11-14 weeks' gestation. In all cases, an attempt was made to visualize the ovaries on transabdominal ultrasound scan. Simple cysts were defined as unilocular cysts with regular internal walls and no solid components, which contained clear anechoic fluid. All other cysts were classified as complex. Simple cysts<5 cm in diameter were all managed expectantly with no further follow-up. All women with large simple cysts>or=5 cm in diameter or complex cysts had further detailed follow-up scans. Surgical intervention during pregnancy was offered to women with clinical symptoms suggestive of cyst complications or those with ultrasound features suggestive of malignancy. All other women were managed expectantly until after delivery. RESULTS Adnexal cysts were found in 728/2925 (24.9%) pregnant women. 400/728 (55%) women had simple cysts<5 cm in diameter, whilst 328/728 (45%) women had large simple or complex cysts requiring follow-up. On subsequent scans, cysts resolved spontaneously in 278/328 (84.8%) women. A total of 33/728 (4.5%) women with ultrasound evidence of adnexal cyst underwent surgery. In one woman the intervention was required because of pain, one woman had suspected cancer on ultrasound scan and the remaining 31/33 (94%) of operations were performed at patients' requests. All the cysts were found to be benign on histological examination. The overall intervention rate was 1.1/100 screened pregnant women or 4.5/100 cysts detected on ultrasound scan. CONCLUSION Asymptomatic adnexal cysts detected in the first trimester of pregnancy are unlikely to be malignant or to cause clinical symptoms antenatally. The policy of routine ultrasound visualization of the ovaries in pregnancy cannot be justified.
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Affiliation(s)
- Joseph Yazbek
- Early Pregnancy and Gynaecology Assessment Unit, Kings' College Hospital, London, United Kingdom.
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137
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Abstract
OBJECTIVES To evaluate cases of partial hydatidiform mole coexisting with a live fetus, including an observation of our own, and to discuss the proper antenatal management of women wishing to continue with a partial molar pregnancy. METHOD A PubMed search was then undertaken, extending over the time period from 1975 to 2006, using the keywords 'partial hydratidiform mole', 'hydatidiform mole' and 'coexisting fetus'. RESULTS At 16 weeks of gestation, an ultrasonographic examination revealed a normal fetus with an extremely large, multicystic placenta. The woman was informed of future risks but wished to continue with the pregnancy. The pregnancy progressed until 28 weeks without any complication but ended spontaneously with a vaginal delivery; the fetus had died in utero. Pathologic examination of the placenta revealed areas of hydropic degeneration and necrosis. Including our own observation, 17 cases of partial hydatidiform mole associated with a fetus of normal karyotype have been documented. CONCLUSION Although the rate of adverse perinatal outcome is high, we still believe that if amniocentesis or fetal blood sampling reveals a normal karyotype, then continuing the affected pregnancy with close follow-up in tertiary centers is a feasible choice.
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138
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Abstract
OBJECTIVE We present a case of a 38-year-old postpartum woman who had antepartal undiagnosed sarcoma with multiple metastasis. Although the patient underwent aggressive treatment with surgery and chemotherapy, she died 3 months after the vaginal delivery of a healthy female infant weighing 2,090 g at 35 weeks of gestation. CASE REPORT The patient had right shoulder pain and mild chest discomfort during the last trimester of the pregnancy. Six days after delivery, she came to our emergency room because her pain had become more severe. A humeral neck tumor with bone destruction was found in the right shoulder on X-ray. After detailed evaluation, right humeral surgery, cardiac surgery, and liver biopsy were performed. All the removed specimens were sent for pathologic examination, and the results showed a sarcoma favoring malignant fibrous histiocytoma with its primary origin in the left atrium. CONCLUSION Obstetricians should be aware that any non-specific complaint may be due to severe disease. It is better to evaluate all symptoms and signs that persist. In this case, early intervention such as radiologic imaging of the bone or echocardiography could have been performed during pregnancy to prevent tumor spread, maternal morbidity, and even death.
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MESH Headings
- Adult
- Bone Neoplasms/diagnostic imaging
- Bone Neoplasms/drug therapy
- Bone Neoplasms/secondary
- Bone Neoplasms/surgery
- Chemotherapy, Adjuvant
- Fatal Outcome
- Female
- Heart Atria
- Heart Neoplasms/diagnostic imaging
- Heart Neoplasms/pathology
- Heart Neoplasms/surgery
- Histiocytoma, Malignant Fibrous/diagnostic imaging
- Histiocytoma, Malignant Fibrous/pathology
- Histiocytoma, Malignant Fibrous/secondary
- Histiocytoma, Malignant Fibrous/surgery
- Humans
- Humerus/surgery
- Infant, Newborn
- Postpartum Period
- Pregnancy
- Pregnancy Complications, Neoplastic/diagnostic imaging
- Pregnancy Complications, Neoplastic/pathology
- Pregnancy Complications, Neoplastic/surgery
- Pregnancy Trimester, Third
- Shoulder Joint
- Tomography, X-Ray Computed
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Affiliation(s)
- Hung-Wen Su
- Department of Obstetrics and Gynecology, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
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139
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Abstract
OBJECTIVE To study the causes of the observed association between presence of leiomyomata in pregnancy and increase in risk of cesarean delivery. METHODS We accessed the obstetric database of women who underwent second-trimester ultrasound screening between January 1996 and December 2004 and who delivered at more than 22 weeks of gestation. Ultrasonographic characteristics of the leiomyomata, including number, maximum diameter, change in size during pregnancy, and location were recorded. Pregnancy outcome was compared between the cohort with large uterine leiomyomata (5 cm or more) (n=251) and those without leiomyomata (n=24,546) using chi(2), Fisher exact test, Student t test, and linear and logistic regression analysis, with an odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity considered significant. RESULTS Women with large leiomyomata had higher rates of cesarean delivery before onset of labor (OR 3.1, 95% CI 2.2-4.2) but not during labor (OR 1.0, 95% CI 0.6-1.6). The association between leiomyomata and cesarean delivery before labor remained significant after controlling for maternal age, nulliparity, fetal malpresentation, and placenta previa (OR 2.1, 95% CI 1.4-3.1). The only ultrasonographic leiomyoma characteristic independently associated with cesarean delivery before labor after controlling for confounders was maximum diameter of the largest leiomyoma (OR 1.3, 95% CI 1.1-1.4, P=.001). CONCLUSION Uterine leiomyomata 5 cm or larger are independently associated with cesarean delivery performed before labor, and the risk increases with the size of the leiomyoma. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Patrizia Vergani
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy
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140
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Ramírez Arreola L, Nieto Galicia LA, Gómez García E, Cerda López JA. [Giant chorioangioma and its perinatal complications. A report of a case]. Ginecol Obstet Mex 2007; 75:104-10. [PMID: 17542259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
It is presented a clinical case of a pregnant patient, who attended to the hospital's emergency service because of the presence of transvaginal liquid. A polyhidramnios was diagnosed, due to a placental chorioangioma (of approximately 7 cm), which was confirmed by hystopatological examination, reporting placental chorioangioma with its three histological types: cellular, angioblastic and degenerative. The case and its complications, such as polyhidramnios, membranes rupture and preterm labor, are analized. Existing literature is reviewed.
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141
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Hammoud AO, Asaad R, Berman J, Treadwell MC, Blackwell S, Diamond MP. Volume change of uterine myomas during pregnancy: do myomas really grow? J Minim Invasive Gynecol 2007; 13:386-90. [PMID: 16962519 DOI: 10.1016/j.jmig.2006.04.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 03/27/2006] [Accepted: 04/13/2006] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To estimate changes in uterine myoma volume during pregnancy. DESIGN Review of departmental electronic perinatal database and medical records. Canadian Task Force Classification II-3. SETTING Obstetrical ultrasound unit in an academic tertiary care center. PATIENTS One hundred-seven patients diagnosed with uterine myomas during pregnancy and who had two or more obstetrical ultrasounds in different periods of pregnancy. INTERVENTIONS We analyzed the change in volume of uterine myomas between the first half of pregnancy (up until 19 weeks), third quarter (20-30 weeks), and last quarter (31 weeks to term). The volume of largest uterine myoma was calculated using the formula Volume (mm3)=Pi/6x(length mm)x(width mm)x(height mm). MEASUREMENTS AND MAIN RESULTS The mean age of the population was 31+/-6 years. Between the first and the second study periods, the percentage of uterine myomas that decreased in size was 55.1% (95% CI: 43-66), with a mean decrease in volume of 35%+/-4%; while the percentage of uterine myomas that enlarged was 44.9% (95% CI: 34-56), with a mean increase in volume of 69%+/-11%. Between the second and the third study periods, 75% (95% CI: 56-87) became smaller, with a mean decrease in volume of 30%+/-3%; while 25% (95% CI: 13-43) enlarged, with a mean increase in volume of 102%+/-62%. CONCLUSION Contrary to common belief, we found that uterine myomas commonly decrease in volume over the course of pregnancy.
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Affiliation(s)
- Ahmad O Hammoud
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah 84132, USA.
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142
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Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Histomorphometric features of hydatidiform moles in early pregnancy: relationship to detectability by ultrasound examination. Ultrasound Obstet Gynecol 2007; 29:76-80. [PMID: 17171630 DOI: 10.1002/uog.3880] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The majority of partial (PHM) and complete (CHM) hydatidiform moles are diagnosed in early pregnancy. About half are identified as molar on ultrasonographic examination prior to evacuation. It is uncertain whether unsuspected cases represent an intrinsically different molar phenotype or are simply dependant on sonographer expertise. We measured a microscopic parameter, average villus diameter, of evacuated PHMs and CHMs to ascertain the cause of non-detection on ultrasound. METHODS Fifty-four molar pregnancies were examined from the files of the Trophoblastic Disease Unit, in which results of an ultrasound examination prior to evacuation were known. In each, the average cross-sectional diameter of the largest 10 villi was recorded. Maximum villus diameters were compared between gestational age groups (<14 weeks and >or=14 weeks), and ultrasound detection groups (detected (d) and not detected (nd)). RESULTS The average maximum villus diameter of the largest hydropic villi was significantly less in the first trimester for both PHMs and CHMs that were undetected by ultrasound examination compared to those identified as molar sonographically (P<0.001 and P<0.001, respectively). There was no significant difference in the maximum villus diameter between PHMs and CHMs that were not detected sonographically in the first trimester (P=0.44). Beyond 14 weeks of gestation, there was no significant difference between PHMs detected and undetected sonographically (P=0.88). CONCLUSION The average diameter of the largest, most hydropic villi, is significantly greater in cases of PHMs and CHMs detected by ultrasound examination in the first trimester compared to that of those not detected sonographically, but beyond 14 weeks such differences are minimal. These findings suggest that, although sonographer expertise could potentially increase ultrasound detection rates somewhat for PHMs and CHMs, a significant proportion of cases demonstrate minimal hydropic change in the first trimester and are therefore likely to remain unidentifiable by ultrasound examination prior to evacuation, even with improved sonographer expertise.
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Affiliation(s)
- D J Fowler
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - I Lindsay
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - M J Seckl
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - N J Sebire
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
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143
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Bosev D, Dimitrov A. [Changes in uterine myoma dimentions during pregnancy]. Akush Ginekol (Sofiia) 2007; 46:3-6. [PMID: 17974174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The purpose of this study is to follow up the changes in the myoma dimentions during pregnancy (1st, 2nd and 3rd trimester). The study is prospective and includes 90 pregnant women with myoma during the period 2002-2006. If more than one myoma was diagnosed, the largest one was considered to be representative. Our data show that the combination of myoma and pregnancy is more frequent with women over the age of 30 and it is more frequent with nullipares (63.2%). Single myomas were more frequent with 58%, 48% of the myomas were intramural and 62% were located in the uterine corpus. Our study shows that during the first trimester there is no change in the myomas dimentions in 35%-43% of the cases and during the second trimester there is no change of the myona dimentions in 50% of the cases. During the third trimester there are only 5% of the myomas that change their dimentions. We conclude, that the myomas, that enlarge during the first trimester, usually enlarge during the second trimester as well. We found no decrease of the myoma dimentions during the third trimester.
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144
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Bermúdez C, Luengas O, Pérez-Wulff J, Genatios U, García V, Guevara-Zuloaga F, Quintero RA. Management of a placental chorioangioma with endoscopic devascularization and intrauterine transfusions. Ultrasound Obstet Gynecol 2007; 29:97-98. [PMID: 17201009 DOI: 10.1002/uog.3903] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- C Bermúdez
- Unidad de Perinatología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - O Luengas
- Unidad de Perinatología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - J Pérez-Wulff
- Unidad de Perinatología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - U Genatios
- Unidad de Perinatología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - V García
- Unidad de Perinatología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - F Guevara-Zuloaga
- Unidad de Perinatología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - R A Quintero
- University of South Florida, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tampa, FL, USA
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145
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Kirk E, Papageorghiou AT, Condous G, Bottomley C, Bourne T. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Ultrasound Obstet Gynecol 2007; 29:70-75. [PMID: 17201012 DOI: 10.1002/uog.3875] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Previous studies have examined ultrasound findings in histopathologically confirmed cases of hydatidiform mole. The aim of this study was to assess the first-trimester ultrasonographic findings in all women suspected of having hydatidiform mole on ultrasound and those subsequently diagnosed with hydatidiform mole after histological examination of removed products of conception after surgical evacuation of the uterus. The aim was to obtain a true sensitivity and positive predictive value for ultrasound in the diagnosis of hydatidiform mole. METHODS A retrospective analysis was performed of all cases of sonographically suspected hydatidiform mole and histologically proven hydatidiform mole presenting to the Early Pregnancy Unit of an inner city hospital over a 4-year period. The sensitivity and positive predictive value (PPV) of ultrasound in the detection of histologically proven hydatidiform mole was calculated. RESULTS The study group consisted of 90 women; 56 were suspected of having hydatidiform mole on ultrasound, and of these 27 (48%) had hydatidiform mole confirmed after histopathological examination of the products of conception, while no changes suggestive of hydatidiform mole were present in the other 29 cases. Overall, 61 women had hydatidiform mole confirmed on histology-41 (67%) partial hydatidiform moles (PHM) and 20 (33%) complete hydatidiform moles (CHM). The ultrasound findings in the 34 cases not suspected of hydatidiform mole were an empty sac in 8/34 (24%) women and a delayed miscarriage in the other 26/34 (76%). The overall sensitivity and positive predictive value for the ultrasound diagnosis of hydatidiform mole was 44% and 48%, respectively. For PHMs the respective values were 20% and 22% and for CHMs they were 95% and 40%. CONCLUSION Ultrasonography is more reliable for diagnosing CHMs than for PHMs. Overall, the sensitivity of ultrasound for accurately predicting hydatidiform mole is 44%, and one in two women with an abnormal scan will have the disease confirmed on histology.
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Affiliation(s)
- E Kirk
- Early Pregnancy Unit, St George's, University of London, London, UK
| | | | - G Condous
- Early Pregnancy Unit, St George's, University of London, London, UK
| | - C Bottomley
- Early Pregnancy Unit, St George's, University of London, London, UK
| | - T Bourne
- Early Pregnancy Unit, St George's, University of London, London, UK
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146
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Abstract
OBJECTIVE Angiomyxoma is a rare tumor of the umbilical cord and is associated with increased perinatal morbidity and mortality. However, the management of these pregnancies in the third trimester is not clearly defined. We present a case of an angiomyxoma of the umbilical cord diagnosed in the second trimester, and highlight the contribution of color Doppler imaging to the early diagnosis of cord anomalies. CASE REPORT A 29-year-old, gravida 3, para 1, woman had elevated maternal serum alpha-fetoprotein at 17 weeks of gestation. Ultrasonography at 19 weeks showed a placental mass measuring 2 x 1.5 cm over the insertion site of the umbilical cord. The mass slowly enlarged in size, from 2.72 x 1.09 cm at 21 weeks to 3.9 x 3.9 cm at 33 weeks. Beyond the cord lesion, the development of the fetus was unremarkable. At 38 weeks, a normal female infant was delivered by cesarean section due to previous history of cesarean section. A mass measuring 3.2 cm was found near the insertion site of the umbilical cord to the placenta. Pathologic examination showed proliferation of thin-walled vessels embedded in a myxoid stroma, and the endothelial cells were positive for factor VIII-related antigen. CONCLUSION Angiomyxoma is a rare tumor of the umbilical cord and should be considered when using prenatal ultrasound for detection of cystic lesion. Color Doppler imaging can easily and instantly detect perfusion through the umbilical vessels and assess cardiac function. In our case, application of color Doppler imaging for monitoring the relationship between the tumor and the adjacent vessels allowed the fetus to be delivered at term with a favorable outcome.
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Affiliation(s)
- Hung-Pin Cheng
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
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147
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Machet L, Ossant F, Bleuzen A, Grégoire JM, Machet MC, Vaillant L. L’échographie cutanée haute résolution : utilité pour le diagnostic, le traitement et la surveillance des maladies dermatologiques. ACTA ACUST UNITED AC 2006; 87:1946-61. [PMID: 17211309 DOI: 10.1016/s0221-0363(06)74180-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although less precise than histological examination, high-resolution skin imaging is a noninvasive technique that provides complementary information to the clinical examination: the lesion's US structure as well as its lateral and depth extension. Ultrasonography helps in diagnosis and initial management by measuring melanoma thickness (so as to remove this lesion with safety margins) before destructive treatment (cryosurgery or radiotherapy), by showing tumor limits, or by detecting subclinical recurrence during the follow-up. In this paper, ultrasound images will be correlated with clinical and histological data in various clinical situations such as tumors, edema, cutaneous infiltration, sclerous tissues, hyperlaxity, and cutaneous aging.
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MESH Headings
- Adolescent
- Adult
- Aged
- Carcinoma, Basal Cell/diagnostic imaging
- Carcinoma, Basal Cell/pathology
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/pathology
- Ehlers-Danlos Syndrome/diagnostic imaging
- Ehlers-Danlos Syndrome/pathology
- Female
- Follow-Up Studies
- Hemangioma/diagnostic imaging
- Humans
- Keratosis/diagnostic imaging
- Keratosis/pathology
- Lip Neoplasms/diagnostic imaging
- Lip Neoplasms/pathology
- Male
- Melanoma/diagnostic imaging
- Melanoma/pathology
- Middle Aged
- Monitoring, Physiologic
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/pathology
- Pregnancy
- Pregnancy Complications, Neoplastic/diagnostic imaging
- Pregnancy Complications, Neoplastic/pathology
- Psoriasis/diagnostic imaging
- Psoriasis/pathology
- Scleroderma, Localized/diagnostic imaging
- Scleroderma, Localized/pathology
- Scleroderma, Systemic/diagnostic imaging
- Scleroderma, Systemic/pathology
- Skin/diagnostic imaging
- Skin/pathology
- Skin Aging
- Skin Diseases/diagnostic imaging
- Skin Diseases/pathology
- Skin Diseases/therapy
- Skin Neoplasms/diagnostic imaging
- Skin Neoplasms/pathology
- Time Factors
- Ultrasonography
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Affiliation(s)
- L Machet
- Service de Dermatologie, CHRU, Université François Rabelais, 37032 Tours.
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148
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Leszczyńska K, Makowska B, Preis K, Królikowska B, Boćkowski M, Ciach K. [The case of spleen's tumor and trombocytopenia in pregnant women]. Ginekol Pol 2006; 77:876-80. [PMID: 17378128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
The women with spleen's tumor and trombocytopenia was diagnosed and observed during pregnancy, labour and puerperium. The lowest level of thrombocytes (50 K/microl) was detected in 32nd week of pregnancy. Termination of the pregnancy by cesarean section was performed because of a big risk for the mother and child (tumor's crack, haemorrhage, infection). The same time the splenectomy was conducted. The results were successful.
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149
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Neiger R, Sonek JD, Croom CS, Ventolini G. Pregnancy-related changes in the size of uterine leiomyomas. J Reprod Med 2006; 51:671-4. [PMID: 17039693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To describe the effects of pregnancy on the growth of leiomyomas using sonographic measurements of leiomyomas taken longitudinally during pregnancy. STUDY DESIGN The study population included asymptomatic gravidas with singleton pregnancies in whom we identified uterine leiomyomas. We included all women whose leiomyomas were measured at least twice during the pregnancy. In a subgroup of women we also compared the size of leiomyomas before and after the index pregnancy. Using real-time sonography, we measured each leiomyoma in 3 axes and averaged the measurements. During subsequent studies we calculated the percent change in the size of each tumor. We assessed complications related to the presence of these tumors. RESULTS We evaluated 137 leiomyomas in 72 women (average, 2.3 +/- 1.8 per woman). Each underwent an average of 3.7 +/- 2.1 scans. The average gestational age at the time of first assessment was 14.4 +/- 5.4 weeks. The average diameter of the leiomyomas at the first study was 34.2 +/- 23 mm. On average, there was no significant change in the size of leiomyomas during pregnancy. We found that the size, location and our ability to visualize leiomyomas varied significantly during pregnancy. Four of the 72 women had obstetric complications related to the presence of leiomyomas. CONCLUSION The findings of our longitudinal sonographic assessment of 137 uterine leiomyomas suggest that despite the commonly held belief that they tend to enlarge during the course of pregnancy, this phenomenon is in fact quite rare.
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Affiliation(s)
- Ran Neiger
- Department of Obstetrics and Gynecology, Wright State University, Dayton, Ohio, USA.
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150
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Harris B, Bailey D, Roach P, Marshman D, McElduff A, King G. Use of Fusion Imaging to Localize an Ectopic Thoracic Parathyroid Adenoma. Ann Thorac Surg 2006; 82:719-21. [PMID: 16863795 DOI: 10.1016/j.athoracsur.2005.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 12/05/2005] [Accepted: 12/07/2005] [Indexed: 10/24/2022]
Abstract
We report the use of fused computed tomography and single photon emission computed tomography parathyroid (99m technetium)-sestamibi images to localize an ectopic parathyroid adenoma.
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Affiliation(s)
- Benjamin Harris
- Department of Thoracic Medicine, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
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