Fetal abnormalities leading to termination of twin pregnancies: the 17-year experience of a single medical center

Objective: To assess fetal abnormalities leading to termination of pregnancy (TOP) performed in twin pregnancies.

Method: The current study consisted of all women with dichorionic twin pregnancies (study group) who underwent TOP due to fetal abnormalities in our institute from 1999 to 2015. The data were compared to our registry of all parturient women with a singleton pregnancy (control group) that underwent TOP due to fetal anomalies at the same period.

Results: There were 2495 cases of TOP because of fetal indications during the study period. Of them, 86 (3.4%) and 2409 (96.6%) were from the study and control group, respectively. Structural anomalies were the leading indication for TOP in twins compared with singleton pregnancies (81.4% versus 50.9%, respectively, p?p?p?Conclusions: We found a different distribution for fetal anomalies leading to TOP in twins versus singleton pregnancies. The main indication for TOP in the study group was structural malformations, with a predominance of CNS abnormalities.     

Characteristics of maternal mortality in the university hospital of Pleven for the period of 1977-2001 years

The authors report retrospective investigation of causes for maternal mortality in the Department of Obstetric and Gynecology in Hospital in Pleven for the period 1977-2001 and comparison between indexes for a different period of time. Objects of investigation were patient histories necropsy report and forensic expertise. Vital births were 73922 for a period of 25 years in Pleven. Dead pregnant and materinity were 45 and the rate of maternal mortality was 60,07/per 100 000 vital births. Causes of maternal mortality were divided in immediate 40 cases (88,88%) and indirect - 5 cases (11,11%). The hemorrhage was the most common cause of maternal mortality - 18 cases (45%). The authors mention that the absolute number of maternal losses is comparatively constant but the rate of maternal mortality in creases because of tendency of decrease of birthrate and concentration of pathology in Department of Obstertic and Gynecology in Pleven.     

Characteristics of primary osteomyelitis among children in a medical center in Taipei, 1984-2002.

BACKGROUND AND PURPOSE: The presentation and sequelae of osteomyelitis are variable. This study evaluated the clinical manifestations and outcome of osteomyelitis in children in different age groups, and in different periods before and after the implementation of National Health Insurance (NHI). METHODS: The records of pediatric patients with osteomyelitis treated at a medical center in Taipei from 1984 to 2002 were reviewed. Clinical features, pathogens, laboratory and imaging findings, treatment, and outcome were analyzed. The patients were stratified into 3 groups based on age: infants (< or = 3 months of age), young children (between 4 months and 5 years), and older children and adolescents (> 5 years). Based on the date of implementation of the NHI program, the study period was divided into 2 stages: prior to implementation, from January 1984 to February 1995; and after implementation, from March 1995 to December 2002. RESULTS: The records of 209 patients were reviewed, including 45 infants, 77 young children, and 87 older children. The most common presenting findings were local tenderness (79%), local swelling (72%), and fever (57%). The lower limbs were the most commonly involved sites (65%). Staphylococcus aureus (34%), Mycobacterium tuberculosis (10%), Salmonella species (7%), and Pseudomonas aeruginosa (6%) were the most frequently isolated pathogens. At the time of diagnosis, abnormalities were found on radiographs in 83% of patients and on radionuclide bone scans in 86%. Surgical intervention with local debridement and curettage was performed in 102 patients (49%). Sixty five patients (31%) developed complications, including specific bony sequelae in 26 (12%). Sepsis and septic arthritis were more common in infants (p < 0.01). A history of trauma, protracted course of osteomyelitis, and surgical intervention were more common in older children and adolescents (p < 0.01). After the implementation of NHI, a larger proportion of patients had negative cultures (p < 0.01), and the mean duration of antibiotic therapy was shorter (p = 0.01). CONCLUSIONS: The clinical characteristics of osteomyelitis associated with sepsis or septic arthritis, chronic changes, and the need for surgery may differ depending on the age of the child. S. aureus, M. tuberculosis, and salmonellae were the most common pathogens in this Taiwanese series. Implementation of NHI in the more recent decade of the study period was associated with a shorter duration of intravenous antibiotic administration.     

Contraception for the transitional years of women older than 40 years of age.

Many women older than 40 years of age require both contraceptive protection and hormonal replacement therapy for climacteric symptoms. Combination therapy is advisable but progestins should be added to estrogen to prevent endometrial hyperplasia, decrease the risk of breast cancer, and prevent bone loss. Since the mid-1970s oral contraceptives (OCs) have been limited to women under 35 years of age because of risks of myocardial infarction and thromboembolic disease. The new low-dose OCs used in the 1980s and 1990s have minimized these risks, however, older women who smoke are advised against using estrogen-containing OCs. Natural estrogens are often preferred to the synthetic estrogenic hormones in hormone-replacement products including conjugated equine estrogens, 17 beta estradiol, estradiol valerate, estrone sulfate, and combinations. New progestational agents, 19-nortestosterone derivatives, include norgestimate, gestodene, and desogestrel. RU-486 has potential applications in abortion, once-a-north treatment to induce menses, postcoital therapy, and in breast cancer. Reversible nonhormonal methods such as rhythm, abstinence and withdrawal are used frequently. Barrier methods (diaphragms, cervical caps, and condoms) and spermicides alone or with barrier methods (e.g., vaginal sponges) are increasingly used by older women. IUDs have enjoyed wide acceptance. Sterilization is a nonreversible method but clips (e.g., Filshie clip) have provided reversibility. Progestin-only contraceptives are supplied as oral tablets, injectable solution, silastic implants, medicated IUDs and vaginal rings. Combination estrogen and progestin contraceptives are available as oral tablets and as vaginal rings. A variety of doses and alternate products are necessary for older women.     

Complex endometrial hyperplasia and carcinoma in adolescents and young women 15 to 20 years of age. A report of 10 cases

The clinical and histologic findings in 10 patients, 15-20 years of age, with complex hyperplasia or well-differentiated adenocarcinoma of the endometrium are presented. The morphologic distinction between the two lesions is discussed, and the frequency of misdiagnosis of this form of hyperplasia as carcinoma in this age group is emphasized. No difference was found in the behavior of the two lesions in this series of cases whether or not a hysterectomy was performed.     

Reversible contraception for the woman over 35 years of age.

Methods of reversible contraception, oral contraceptives, intrauterine devices, and Norplant (systemic progestin-only contraceptive; Wyeth-Ayerst, Radnor, PA), can be used for women over 35 years of age. Oral contraceptive formulations are safe and effective for healthy women up to the age of menopause. Oral contraceptives in women who do not smoke cigarettes do not result in a significant increased risk for cardiovascular disease. The incidence of breast cancer is not increased in women who have used oral contraceptives. A slight increase was found in younger women who had been on oral contraceptives based on a reanalysis of the contraceptive and steroid hormone study of the Centers for Disease Control. A reduction in the incidence of ovarian epithelial neoplasia by 40% was found in three European case-control studies. Two intrauterine devices are currently available on the US market: Paragard (GynoPharma, Somerville, NJ) and Progestasert (Alza Corp., Palo Alto, CA). Both of these provide highly effective contraception. A World Health Organization prospective randomized study found that there was an increase in pelvic inflammatory disease rates in the first 20 days after intrauterine device insertion. The intrauterine device itself did not increase the pelvic inflammatory disease incidence rates. The Norplant system exerts its contraceptive action through ovulation inhibition and alteration of cervical mucus. The major consumer complaint is irregular or prolonged uterine bleeding, which can be controlled by oral estrogen.     

3~14岁哮喘和变应性鼻炎患儿吸入性致敏原分布特征比较

目的比较3~14岁哮喘和变应性鼻炎患儿吸入性致敏原分布特征的异同。 方法2004 10—2005 10，北京儿童医院对527例哮喘和620例变应性鼻炎患儿进行吸入性致敏原皮肤点刺试验(skin prick test,SPT)，分析比较检出阳性的致敏原在两组病例中的分布特征。 结果哮喘和变应性鼻炎患儿SPT阳性检出率分别为77.8%和78.9%(χ2=0.823，P>0.05)。户尘螨、粉尘螨、交链孢霉、猫上皮、艾蒿是两种疾病主要致敏原。哮喘患儿户尘螨、粉尘螨、混合霉菌的阳性率分别为64.6%、59.8%、8.8%，均高于变应性鼻炎患儿(49.5%、47.9%、3.9%，均P<0.05)。变应性鼻炎患儿杂草花粉和艾蒿的阳性率分别为25.6%、26.0%，均高于哮喘患儿(19.3%、19.3%，均P<0.05)。40.2%的哮喘和46.2%的变应性鼻炎为单致敏原阳性。尘螨霉菌混合致敏及尘螨宠物混合致敏在哮喘和变应性鼻炎中最为常见。 结论尘螨、霉菌、夏秋季花粉和宠物是3~14岁哮喘和变应性鼻炎患儿主要吸入性致敏原，两病具有相似的致敏原分布特征，但尘螨及霉菌过敏多见于哮喘，夏秋季花粉过敏多见于变应性鼻炎。     

Clinicopathologic characteristics of Rosai-Dorfman disease in a medical center in northern taiwan.

BACKGROUND/PURPOSE: Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder that usually presents as cervical lymphadenopathy. Extranodal involvement occurs in up to 40% of patients. The disease is most prevalent in blacks and rare in Asians. This study analyzed the characteristics of RDD in patients from Taiwan. METHODS: Fourteen patients with a diagnosis of RDD were identified by review of records from 1995 to 2004 at National Taiwan University Hospital. Tissue sections from each patient were reviewed and immunohistochemical staining was performed. Data on clinical presentations, associated diseases, treatment and outcome were analyzed. In situ hybridization for Epstein-Barr virus (EBV)-encoded small RNAs (EBER-1) was also performed. Sets of primers specific for the conservative region of bacterial 16S-rDNA, IS6110 of Mycobacterium tuberculosis complex and consensus region of human herpes virus (HHV) DNA polymerase genome were used to detect the presence of these infectious agents in the specimens. RESULTS: There were six men and eight women with a mean age of onset of 44 years. Nine patients presented with skin lesions, four with lymph node involvement and one with nasal tumor. All lesions followed a chronic and indolent course. Most of the lesions regressed spontaneously, and no patients died as a result of this disease during follow-up. Three patients had associated immune-mediated disease, i.e. hemolytic anemia, ankylosing spondylitis and asthma. Two patients had a history of tuberculosis. Histologically, all lesions were characterized by a mixed infiltrate of large pale histiocytes, abundant plasma cells and lymphocytes regardless of the site of involvement. The strong immunoreactivities of these histiocytes to S-100 protein, CD68 and CD14 with occasional lymphophagocytosis were helpful in confirming the diagnosis, polymerase chain reaction analysis of 16S-rDNA, IS6110 and HHV gene and in situ hybridization for EBV were all negative. CONCLUSION: RDD in Taiwan is characterized by older age of onset compared to Western countries (44 years vs. 20 years) and more frequent extranodal involvement. The skin was the most common site of extranodal involvement, with about two-thirds of patients presenting with cutaneous lesions. There was no evidence of bacterial, mycobacterial or HHV infection in this series.     

Endometrial cancer in patients under 30 years of age. A report of two cases

Two unusual cases of a 22- and a 28-year-old woman, respectively, who were found to have endometrial adenocarcinoma, are presented. The patients experienced abnormal vaginal bleeding and the diagnosis was made by dilatation and curettage. They declined treatment with progestagens, therefore, a total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy were performed in both cases. We emphasize the need of endometrial evaluation in young females with abnormal bleeding before starting any medical treatment. Specific problems of endometrial cancer at young age include delay in diagnosis, difficulty in pathologic interpretation of the curettings and the motivation of most patients to preserve their fertility.