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[New aspects in diagnosis and therapy of placental insufficiency. Placental perfusion measurements; placental perfusion test (PPT) and betamimetic long term treatment (clinical and experimental data (authors transl)].

The rate of utero-placental blood flow depends on functional components (perfusion pressure and flow resistance within the area of the vascular bed of the placenta), as well as on morphological factors (regressive changes in the placenta). Different primary maternal conditions and diseases may lower the rate of placental flow, leading to placental insufficiency; the highest percentage, by far, of placental dysfunction is found in patients suffering from gestosis. Hypocirculation initially present in cases of EPH gestosis and caused by arteriolar spasms triggers off a vicious circle involving placental infarction and severe reduction in the utero-placental perfusion rate. This in turn leads to fetal hypotrophy, a high rate of premature births and perinatal mortality. Verification of HPL, HCG, alpha-Fetoprotein or E3 in maternal serum and amniotic fluid or urine greatly improved the recording of partial placental functions. Along with ultrasonic biometry, cardiotocography and amnioscopy, these hormonal parameters allow only indirect assessment of the placental function. On the other hand, measurements of the utero-placental flow offers a direct approach. In order to evaluate the placental flow measurements it is imperative to obtain a curve indicating the course over the last third of the pregnancy-in addition to establishing a general normal range. In case of placental insufficiency, it is necessary to determine whether this is due to functional disorders alone, or to more extenisve morphological changes. A placental perfusion test (PPT) was developed in order to make this distinction. Beta2-mimetic treatment is indicated if functional factors predominate, whereby it appears essential to obtain the requisite experimental data for precise quantification of beta-mimetic action.

Adrenergic beta-Agonists↗

Management of a displaced angle-supported anterior chamber intraocular lens.

A 49-year-old patient had a displacement of an anterior chamber intraocular lens (IOL) producing a cyclodialysis cleft and persistent hypotony with maculopathy. The patient underwent intraocular lens extraction, repair of the cyclodialysis cleft, and iris-fixation of an acrylic posterior chamber IOL with resolution of the hypotony and improvement of the maculopathy and best-corrected visual acuity. Many surgeons consider the implantation of an anterior chamber IOL as their first choice in the treatment of inadequate capsule support associated with cataract surgery, probably because it is a relatively easy procedure to perform. However, insufficient preoperative knowledge of the anterior segment biometry can lead to inadequate lens size and postoperative complications.

Anterior Chamber↗

[Chronic urticaria: clinical characteristics of a group of patients of Veracruz, Mexico].

BACKGROUND: Chronic urticaria and angioedema have a high incidence in the general population. Both diseases constitute a challenge in the identification of their causes, which in most of the cases are unknown. OBJECTIVE: To investigate some causes of chronic urticaria and angioedema, as well as its evolution in a group of patients. PATIENTS AND METHODS: 32 patients with chronic urticaria and angioedema, with poor response to the previous treatment, were included. A clinical history was made to all of them and they were asked for a complete hematic biometry, general urine exam, pharyngeal exudate, and coproparasitoscopic examinations. Some cases required other laboratory exams. RESULTS: There was a predominance of the female gender 22/32 (69%). It was observed that 75% of the patients had more than 20 years old. Evolution time has a mode between three and six months, with variations of three months to six years. We observed several types of intestinal parasites in 16 cases; each of them received specific treatment, but only five had an improvement of urticaria. Almost half of the patients presented wheals every day. We found seven cases with streptococcus beta-hemolitic group A, from which three had improvement of urticaria with the antimicrobial treatment; there were four cases of leukorrhea/vulvovaginitis, with improvement after the treatment for candidiasis identified by laboratory. CONCLUSIONS: There was a predominance of adults with infectious and parasitic disease. It was identified in most of the cases and had good clinical response to the specific treatment.

Adolescent↗

[Accuracy of the SRK II, SRK/T, Holladay and Hoffer Q IOL power calculation formulas in hyperopic patients after phacoemulsification].

PURPOSE: Comparison of the SRK II, SRK/T, Holladay and Hoffer Q formulas accuracy, in calculating IOL power in hyperopic patients. MATERIAL AND METHODS: 34 eyes of 22 hyperopic patients, 15 women and 7 men, at the age from 19 to 85 years old, after phacoemulsification with PCIOL implantation, operated between 1998 and 2004 were analysed retrospectively. The power of IOL was calculated using the SRK/T formula and ranged from 28.5 to 35.0 D. The axial length ranged from 19.6 mm to 21.99 mm. The obtained refraction was measured with autorefractometer from 9 days to 37 month after operation, mean 6 month. In addition, the theoretical target refraction for the implanted IOL was calculated using the SRK II, Holladay and Hoffer Q formulas and the differences between the target and obtained refraction for all the formulas were compared. RESULTS: The best accuracy of IOL power calculation was obtained with the Hoffer Q formula. The Holladay, SRK/T and SRK II formulas gave worse results respectively. CONCLUSIONS: For the purpose of IOL power calculation in hyperopic patients the Hoffer Q or Holladay formula should be chosen from those mentioned above. Nevertheless, miscalculation exceeding 3D also happens in case of using them. The use of SRK II and SRK/T is not recommended. To improve the results other formulas utilising precise measurements of the anterior segment should be applied. If it is impossible then attention should be paid to improving traditional biometry measurements.

Adult↗

Nasal bone hypoplasia in trisomy 21 at 15 to 24 weeks' gestation in A high risk Thai population.

OBJECTIVE: To assess the utility of nasal bone hypoplasia in the detection of fetuses with trisomy 21 in the second trimester in a high risk Thai population. MATERIAL AND METHOD: A prospective study involving pregnant women undergoing amniocentesis due to increased risk of aneuploidy from January 2005 to December 2005. Fetal biometry and nasal bone measurements were obtained at the time of amniocentesis. Linear regression model and diagnostic tests were analyzed using the SPSS computer program. RESULTS: A total of 407 fetuses were evaluated. In euploid fetuses, the Nasal Bone Length (NBL) increased linearly with advancing gestational age. Fetuses with Down syndrome had a significantly higher proportion of NBL below the 5th centile when compared with normal fetuses (p < 0.05). The optimal nasal bone threshold associated with trisomy 21 is a BiParietal Diameter/Nasal Bone Length (BPD/NBL) ratio of 10 or greater, yielded a sensitivity of 80%, specificity of 86% for detection of trisomy 21. CONCLUSION: Nasal bone hypoplasia is associated with an increased risk of Down syndrome in the presented population.

Adult↗

[Role of ST-analysis of fetal ECG in intrapartal fetus monitoring with presumed growth retardation].

OBJECTIVE: Evaluation of the role of ST analysis of fetus ECG for early detection of developing acute hypoxia in the course of delivery of fetuses with presumed growth retardation. A comparison with present way of intrapartal fetus monitoring. Impact on the number of surgical births for indications of threatening fetus hypoxia. Influence of the method on perinatal results and postnatal adaptation of the newborns. TYPE OF STUDY: A prospective study. SETTING: Gynecology-Obstetrics Clinic, Masaryk University and Teaching Hospital Brno. METHOD: Forty seven women with a growth retardation of the fetus diagnosed before delivery who gave birth in the Teaching Hospital in Brno during 2003-2005 and intrapartal ST analysis of fetus ECG was subsequently used, were enrolled into this prospective study (group A). The control group consisted of 87 deliveries taking place in the same period of time and concerning women with fetuses suffering from growth retardation and monitored by standard methods (group B). The standard methods included cardiotocography (CTG), supplemented with pulse oximetry (IFPO) if needed. The diagnosis of intrauterine fetus growth retardation was established on the basis of the results of repeated prepartal ultrasound fetus biometry with estimation of the mass, which corresponded to a group below 10 percentile for the given gestational age. The numbers of vaginal deliveries and surgically treated delivery due to threatening fetus hypoxia (Cesarean section, forceps delivery) were recorded. The authors evaluated postpartal pH from umbilical artery, independently for the group of values of pH < 7.00, the group of pH 7.00-0.10 and pH 7.10 or more. The values of Apgar score were evaluated for the first, fifth and tenth minute, respectively. The neonatologist followed the duration of stay of the newborn at the Newborn Intensive Care Unit, the Intermediate Care Unit, total duration of hospitalization, the occurrence of sepsis in the early newbotn period, the occurrence of hyperbilirubinemia, and the conclusion of neurological examination. All the results were evaluated statistically by the chi2 test, Kruskal-Wallis test or the Anova method. RESULTS: There was no statistically significantly difference in the number of delivery ended by surgery for threatening fetus hypoxia (p = 0.856) or the detection rate of intrapartal hypoxia according to pH values of umbilical blood divided into the three groups (p = 0.657, p = 0.958, p = 0.730, respectively). The values of Apgar score differed in favor of the group A significantly only in the first minute at the level of 5% opf significance (p = 0.018). The values of Apgar score in the fifth and tenth minute did not show any significant difference (P = 0301 and p = 0313, respectively). There was no statistically significant difference in neonatological results between the group A and B. CONCLUSION: The use of ST analysis of fetal ECG in the course of delivery of fetuses with presumed intrauterine growth retardation did not show any significant difference from the presently used methods (CTG supplemented with IFPO if needed). In using the method there was not any effect on the number of surgically treated deliveries for indications of threatening acute fetus hypoxia or perinatal results and postnatal adaptation of the newborns.

Cardiotocography↗

[Heterotopic pregnancy].

The heterotopic pregnancy is a combination of an intra-uterine and extra-uterine pregnancy, at the same time. The spontaneous heterotopic pregnancy is a rare illness with an estimated frequency below one per 20,000 and one per 30,000. The first case was reported in France by Duverney in 1708 during an autopsy. The frequency of this pregnancy has increased with the implementation of assisted reproduction techniques. This paper is the report of a case of spontaneous heterotopic pregnancy seen at the Angeles Mexico Hospital. A 32 year old woman, gravida 1; dilatation and curettage was performed on 13th February because of a blighted ovum, a lot of products of conception were obtained. The patient was discharged the next day only with analgesics. She returns to the emergency room on February 16th with hypovolemic shock and acute abdomen. A normocitic normocromic anemia was found on the hematic biometry, the transvaginal ultrasound reported amount of blood in the cul-de-sac, echogenic adnexal mass, suggesting a gestational sac with embryo. An emergency laparotomy was used to perform a left cornual resection; the findings were 600 cc of hemoperitoneum and a left ruptured ectopic pregnancy. She had an uneventful postoperative course, and was discharged 72 hours later without complications. Heterotopic pregnancy is a rare illness and must always be considered for the increase in pregnancy related with assisted reproduction techniques, although, it should be considered in a spontaneous pregnancy too.

Adult↗

[Vision quality of intraocular refraction surgery].

Intraocular refractive surgery is one of challenges since it is undertaken mostly for high myopia patient with healthy transparent crystalline lens. The improved vision quality is the premise for conducting this kind of surgery. Vision quality is one of comprehensive factors which are connected to the surgery techniques, ocular optics, ocular physical biometry, intraocular lens power calculation and psycho-physical perception of patient.

Humans↗

[Ectopic pregnancy--still a live clinical issue --a case report].

We report a case of a 23-year old patient with extrauterine (tubal) pregnancy at 14 weeks gestational age. The patient was admitted to the Clinic with growing abdominal pain lasting few hours, with worsening general condition with no previous symptoms. In ultrasound examination a normal size uterus was described. On the right and behind the uterus the structures of an alive fetus, 13 weeks gestational age according to biometry (BPD, FL) and a large amount of blood clots were seen. Laparotomy was performed and 1500 ml of blood with clots were evacuated from the peritoneal cavity. The right fallopian tube, bulged in isthmal region (close to its intramural part) was ruptured about 2 cm from the uterine corn. The 10 cm long fetus and afterbirth were born into the peritoneal cavity. Right salpingectomy was performed with no complications in the postoperative period.

Adult↗

[System of decision support in obstetrics. The computerization of prenatal consultations].

The aim of this study was to realize a prototype of a computer-aided decision support for prenatal visits. He has been developped on a microcomputer. We used procedural programming to represent the medical knowledge. This prototype has several interfaced units: a computerized prenatal record, the computing of quantitative variables (term, fetal biometry, uterine height) and the two computer-aided units (preterm births and modelization of weight gain during pregnancy). The next step will be the medical evaluation of this computer-aided decision support in obstetrics.

Anthropometry↗

[The interrelations between the pigment cells of the uveal tract and the cell population of the retina in ontogeny].

The authors suggest themselves to follow in dynamic the cellular retinal population in different ontogenetic phases and also the progress of pigmentagenesis in the uveal tract and in the enteral stratum of the retina. For this purpose there have been used eyes from embryos and fetuses from the interrupted pregnancies. The obtained material was processed in the classical hystological technique and for the objectiveness of the phenomena there have been used methods of biometry. The authors, reached the conclusion that the pigmenting of the uveal stratum is made simultaneously with the loading with pigment of the enteral stratum of the retina, under the influence of different factors, especially the humoral ones and the evolution of the cellular retinal population varies, depending on ontogenetic phases and ages till birth.

Gestational Age↗

[Development of an electronic calculator for gestational age in prenatal care].

The development of a portable electronic gestation calculator enables the obstetrician for the first time to recall all relevant data for his daily routine work from an electronic memory. This is useful not only for the calculation of the duration of pregnancies or the determination of delivery data, but also includes all relevant information from ultrasound biometry of the fetus. This paper presents the experience with this new electronic device, 'Babycomp', and comments on its design, technical features, functions and performance. The device has been thoroughly tested especially with respect to its suitability for practical purposes. Compared with the widely used disk for pregnancy calculations, the 'Babycomp' has a wide range of advantages for all users working in the field of obstetrics and reproductive medicine.

Computers↗

[Means of lowering the perinatal mortality in pregnant women with diabetes mellitus].

The paper gives some current approaches to the management of pregnant women with diabetes mellitus, in terms of perinatal medicine. These are based on a comprehensive detailed clinical examination of 104 patients, which involves the hormonal fetoplacental complex function, hypophyseo-thyroidal system, hemocoagulation system by using ultrasonic tools (fetal biometry and echocardiography, Doppler echometric studies of the fetoplacental blood flow in the umbilical vein, umbilical artery, and fetal aorta). A differential approach was proposed to the management of pregnancy and delivery of patients with diabetes mellitus, which allows perinatal mortality to be reduced.

Female↗

[Doppler and reduction of perinatal mortality].

The authors think that perinatal mortality can be substantially reduced by accurate evaluation of chronic fetal distress by means of ultrasonic biometry routinely applied to pregnant women at each consultation and a Doppler examination carried out whenever retardation is detected or in any abnormal situations which could lead to such retardation. The authors present their experience in 353 women followed-up in their Service.

Apgar Score↗

[Eyeball shape in children with emmetropia and myopia].

In order to determine the eyeball shape, the authors have carried out ultrasonic biometry of its three major parameters, the anteroposterior axis (APA), horizontal diameter (HD), and vertical diameter (VD), and estimated the ratios of these values (APA/HD and APA/VD) in children with emmetropia (234 eyes) and those with slight and medium-grave myopia (660 eyes), aged 7 to 14. The findings evidence a compressed ellipsoidal shape of the eyeball, presenting as a vertical oval, in all subjects with emmetropic refraction, whatever their age. In myopia the eyeball shape transforms, and all the eyeball sizes are increased, but the APA size is growing more rapidly than the rest sizes, and the eyeball acquires the ball shape with a trend to an elongated ellipsoidal shape. The mean APA length in 7-14-year-old children with emmetropia was up to 23 +/- 0.15 mm, whereas in those with the ball shape of the eyeball it was distended.

Adolescent↗

[An atypical echographic aspect of endometriotic cysts. Description of a case].

The paper reports an atypical ecographic pattern of endometriosic cysts. The large biometry and the presence of a septum which was more than 1 cm thick prevented the diagnosis of this ovarian pathology. The Authors agree that in similar cases it is important to limit the report to a mere description since it is impossible to identify the histological character of the ovarian mass.

Adult↗

[Diagnosis of placental insufficiency in patients with acquired heart defects].

The feto-placental unit has been evaluated in 102 patients with acquired heart disease presenting as different circulatory states (Grade 0 insufficiency in 43, Grade I in 34 and Grade II A-B in 25 women). Placental scintigraphy was performed in 102, cardiotocography in 77, ultrasonographic fetal and placental biometry in 102 and placental pathological examination in 15 women. The neonatal study included 104 infants, with 2 twin pairs. Scintigraphy revealed utero-placental blood flow (UPBF) impairment in 72 (70.6%) pregnancies; cardiotocography showed chronic fetal hypoxia in 51 (66.1%) and ultrasonography showed intrauterine growth retardation in 44 (43.1%) pregnancies. Disorders of UPBF coexisted with chronic fetal hypoxia and intrauterine growth retardation in 33 (42.8%) pregnancies, with chronic fetal hypoxia in 18 (23.4%) pregnancies. Impairment of UPBF alone was seen in 13 (16.9%) pregnancies. The digoxin test was done concomitantly with placental scintigraphy in 28 patients; it improved diagnostic precision and provided a measure of compensation of impaired UPBF.

Female↗

[Hepatectomy with total vascular exclusion. Anatomical principles based on 64 dissections].

Intra-operative hemorrhage is the main surgical risk during liver resections. Nowadays hepatectomies for large or posterior liver tumors close to the hepatocaval junction can benefit from total hepatic vascular exclusion (HVE) involving portal triad exclusion and clamping of the inferior vena cava (IVC) below and above the liver. Anatomical aspects of HVE have been studied in 64 subjects by segmental occlusive phlebographies of the IVC, injection of corrosive substances into the hepatocaval network, biometry of the retrohepatic IVC and serial sections of injected livers. A total HVE should exclude the right suprarenal and phrenic veins. Clamping of the suprahepatic IVC depends on the termination of the left inferior phrenic vein. Clamping of the subhepatic IVC must be retrohepatic: the right lobe of the liver has to be mobilized to free the right border of the retrohepatic IVC into which flows the right suprarenal vein 40 +/- 20 mm above the right renal vein and under the superior right hepatic vein. Both suprahepatic and retrohepatic clamps excluding the retrohepatic portion of the IVC (46.6 +/- 13 mm) and the hepatocaval junction should come in contact behind the IVC without overlapping.

Constriction↗