Prevalence of gallbladder disease in diabetes mellitus

A study was undertaken to compare the prevalence of gallstone disease (gallstones observed on ultrasound or history of cholecystectomy) in 308 diabetics and 318 controls. There was a higher prevalence of gallstone disease (GSD) in diabetics (32.7%) compared to controls (20.8%;P<0.001 chi-squared test). However, when gender was taken into account, the difference was only significant in females (diabetics 41.8% versus controls 23.1%;P<0.001). Analysis by type of diabetes revealed that subjects with non-insulin-dependent diabetes mellitus (NIDDM) had a higher prevalence of GSD than controls for both genders: males—controls 18.1%, NIDDM 33.3% (P<0.05), IDDM 15.6% ns; females—controls 23.1%, NIDDM 48.6% (P<0.001), IDDM 36.3% (P<0.05). On univariate analysis the following risk factors were associated with gallstones (P<0.1): increased age, body mass index (BMI), triglycerides, LDL cholesterol, decreased HDL cholesterol, alcohol intake, family history of GSD, and female parity >3. Using stepwise multiple logistic regression, the following variables were identified as independently predictive of gallstones for each gender/diabetic combination: Males—NIDDM (N=54), increased age, and decreased HDL; IDDM (N=90), age and family history; Females—NIDDM (N=74), increased age, diabetes, increased BMI, and decreased alcohol; IDDM (N=91), increased BMI, age, decreased alcohol and family history. The proportion of subjects who underwent cholecystectomy was higher in females (46.7%) compared to males (21.7%;P<0.01) but there were no differences between diabetics and controls in either sex. In conclusion, there was a higher prevalence of GSD in diabetics compared to controls. However, GSD is multifactorial and only in NIDDM females was diabetes an independent risk factor. The proportion of diabetics and controls with GSD who underwent cholecystectomy was equivalent.     

Sonographic Appearances of the Endometrium After Termination of Pregnancy in Asymptomatic Versus Symptomatic Women

Objective. The purpose of this study was to describe normal sonographic appearances of the endometrium in asymptomatic women after elective termination of pregnancy (TOP) and to determine whether sonographic findings are discriminatory in symptomatic women after TOP. Methods. Sonographic parameters were compared in prospectively recruited women after elective TOP. The first 38 were asymptomatic. In a later group, 105 had symptoms suggestive of retained products of conception (RPOC). Endometrial thickness, cavity irregularity, echogenicity of cavity contents, color Doppler flow, and resistive indices (RIs) were assessed. In the symptomatic group, sonographic findings were correlated with symptoms and histologic results. Results. There was a marked overlap in sonographic appearances between the groups. The endometrial cavity is commonly irregular and thickened and may show prominent color Doppler flow in women with an uneventful course as well as in women with histologically proven RPOC. Differences between asymptomatic and symptomatic women were only seen for: endometrial thickness (10.8 mm [range, 1–29 mm] versus 15.3 mm [range, 1.8–34 mm]; P = .0005), and cavity irregularity was greater in symptomatic women (P = .001). Color Doppler flow mean RIs were similar. Symptoms were similar in women proceeding to curettage versus no curettage; no significant relationship was found between individual symptoms and sonographic parameters. Chorionic villi were seen in 47 of 56 women (84%) with positive histologic results. Conclusions. Sonographic appearances and symptoms correlate poorly with each other and with histologic results. Sonography has limited benefits in triaging women with suspected RPOC after TOP in the first trimester. Our findings support a more conservative approach to suspected RPOC after TOP.     

Doppler Flow Velocity Waveform Analysis in Postdate Pregnancies

This study examines the efficiency of Doppler flow velocity waveform analysis in the evaluation of the postdate pregnancy. Seventy women whose pregnancies were at or beyond 41 weeks' gestation were assessed by calculating the systolic/diastolic ratios from umbilical and uteroplacental arteries. Waveform ratios from pregnancies associated with fetal compromise and abnormal neonatal outcome were similar to those from pregnancies in which the outcome was normal. These findings indicate that the pathophysiology of placental insufficiency in postdate pregnancies differs from that observed in cases of fetal growth retardation at earlier gestational ages. Doppler flow velocity waveform analysis is unlikely to be of benefit in the routine assessment of the postdate pregnancy.     

A Case of Multiple (5) Ectopic Pregnancies, Ultimately Resulting in a Twin Pregnancy After in Vitro Fertilization and Embryo Transfer

The history of a woman with anovulation, tubal disease and 5 ectopic pregnancies is presented. She finally succeeded in having a family by conceiving twins in her eighth attempt at in vitro fertilization.     

Echocardiographic features and outcome of truncus arteriosus diagnosed during fetal life

There are few data on the outcome of truncus arteriosus when this diagnosis is made during fetal life. Such prognostic information is important to assist parental counseling during pregnancy. This study aimed to analyze, retrospectively, the echocardiographic features and outcome of fetuses with truncus arteriosus. A database of those presenting to a tertiary center for fetal cardiology between 1990 and 1999 was reviewed. Cases in which truncus arteriosus was identified as a firm or differential diagnosis were selected. Outcome data were derived from clinical records, and fetal echocardiograms were reviewed retrospectively. At presentation, truncus arteriosus was firmly diagnosed in 16 patients and was a differential diagnosis in 12. Fourteen of 16 (87%) of the firm diagnoses were correct. There were 17 confirmed cases of truncus arteriosus. Pregnancy was terminated in 4 patients (24%) and there were 13 live births. One child was not actively treated, 4 (31%) died preoperatively, and 8 (61%) underwent surgery. Thirty-day surgical mortality was 2 of 8 (25%). There was 1 late death after cardiac catheterization, and overall survival on an intention-to-treat basis was 5 of 12 (42%). Five of 6 patients with a prenatal truncal valve Doppler velocity above the normal aortic range were found to have postnatal truncal valve stenosis. Two fetuses with stenotic valves died preoperatively with sudden cardiovascular collapse. Counseling of parents for fetuses with truncus arteriosus should include the relatively high nonsurgical mortality as well as surgical results. Elevated prenatal truncal valve Doppler velocity predicts postnatal truncal valve stenosis. Fetuses with truncal valve stenosis may be at risk of early sudden death.