Antihypertensive drugs during pregnancy. Effects on the fetus]

After reviewing the literature on this topic, the paper examines fetal effects during maternal anti-hypertensive treatment, assessing both possible teratogenic results and fetal outcome. All anti-hypertensive agents cross the placental barrier and are present in varying concentrations in the fetal circulation, thus provoking varying effects on the cardiocirculatory apparatus and fetal metabolism. Some agents, such as alpha-metildopa, may be considered reliable, whereas others, like ACE-inhibitors, are still used with considerable caution, an attitude which will only change following extensive clinical trials and through post-natal checks.     

Wegener granulomatosis of the eustachian tube and skull base mimicking a malignant tumor.

Wegener granulomatosis is a well-studied yet sometimes difficult-to-diagnose systemic vasculitis. Early treatment with immunosuppressants is the therapy of choice and usually controls the disease. Two cases of Wegener granulomatosis are presented, both with symptoms and imaging findings suggestive of a malignant tumor of the nasopharynx or skull base. The focus of upper respiratory involvement in each case was the eustachian tube.     

Transvaginal ultrasound evaluation of myometrial invasion in endometrial carcinoma

In 20 cases of histologically proved endometrial cancer the depth of myometrial invasion was ascertained by means of transvaginal ultrasound, using a high-frequency endocavitary probe. The sonographic findings were confirmed by histologic examination in 18 of the 20 patients evaluated (90.0%). Transvaginal ultrasound provides a fuller preoperative clinical picture and supplies additional diagnostic information which is invaluable in the choice of therapeutic approach.     

Oral condyloma lesions in patients with extensive genital human papillomavirus infection.

OBJECTIVES: The incidence, location, and morphologic appearances of human papillomavirus oral lesions in patients with genital condylomatosis were investigated with clinical, colposcopic, and histologic examination as diagnostic procedures. The human papillomavirus types were also evaluated with filter in situ hybridization. STUDY DESIGN: One hundred one patients, 66 female and 35 male, with genital condyloma underwent an oral cavity examination. Ninety-nine (99%) practiced orogenital sex, and all were asymptomatic for oral lesions. RESULTS: Ninety-one underwent biopsy; histologic studies gave a diagnosis of condyloma in 48% of 101 specimens collected. In 8 of 91 (9%) oral lesions were suspected by naked-eye examination; they were confirmed histologically in all eight. Of 83 patients suspected of having oral condyloma on colposcopic examination, 38 (46%) were confirmed histologically. Thus 38 of 46 patients (83%) had oral condyloma not visible to the naked eye. Colposcopically, oral lesions appeared filiform (50%), moruloid (26%), and mixed (24%). Twenty cytologic oral samples were also collected for deoxyribonucleic filter in situ hybridization analysis. Human papillomavirus deoxyribonucleic genital types were observed in 45% (9/20) of all oral scrapings collected, and all were histologically confirmed. CONCLUSION: Our data indicate that genital human papillomavirus types are capable of establishing a local infection in the oral cavity and demonstrate a high incidence of human papillomavirus oral lesions in patients with genital condyloma.     

Doppler assessment of fetal blood flow velocity waveforms during acute maternal oxygen administration as predictor of fetal outcome in post-term pregnancy

The changes in fetal blood flow velocity waveforms during maternal administration of 60% humidified oxygen were assessed by Doppler ultrasonography in 45 post-term fetuses. During oxygen treatment, nine fetuses exhibited temporary increases (24.3 +/- 2.0% [1 standard deviation] above pretreatment values) in the pulsatility index at the level of internal carotid artery. Although no significant changes (2.9 +/- 5.1%) were found in the remaining 36 fetuses. In this former group a higher incidence of emergency cesarean delivery due to fetal distress and more neonatal complications were observed. Also, meconium staining of the amniotic fluid and low 1- and 5-minute Apgar scores occurred more frequently in the group of fetuses who responded to maternal oxygen administration. An increase of at least 20% in the pulsatility index of internal carotid artery during maternal hyperoxygenation may be a useful marker of adverse outcome in post-term fetuses.     

Does conventional tomography still have a place in glottic cancer evaluation?

Computed tomography (CT) can detect laryngeal cancer invading the pre-epiglottic, paraglottic spaces, laryngeal cartilages, and soft tissues, but in T1 and limited T2 tumours its main value is in evaluating subglottic extent. Conventional tomography in the coronal plane has been used with reasonable success to detect both subglottic and ventricular invasion and is less expensive than CT. Twenty-nine cases of glottic carcinoma of all stages were examined clinically, endoscopically and radiographically by both coronal conventional tomography and CT. The results of these imaging studies are compared in this investigation, stressing their relationship to clinical findings (and stage), especially vocal and cord mobility. Coronal conventional tomography was found to be as accurate as CT for sublottic spread in nine cases of T1 and T2A cancer with normal vocal cord mobility. Conventional tomography had a slight tendency to overestimate ventricular and false cord involvement (two out of seven patients) with T1 glottic cancer. When mobility was impaired (four cases) or absent (15 cases), CT added data which changed staging and/or treatment plan in six cases. In seven others it was suggestive of a more advanced stage.     

Explained and Unexplained Medical Symptoms in Generalized Anxiety and Panic Disorder: Relationship to the Somatoform Disorders

We have examined the numbers and types of symptoms in a sample of 90 patients with generalized anxiety disorder (GAD) and 77 patients with panic disorder (PD) collected from six different sites during the conduct of a multicenter clinical trial. This information was obtained utilizing the Health Questionnaire, a 47-item self-report list of medical symptoms, patterned after the Somatization Disorder section of the Diagnostic Interview Schedule. Although the patients in this sample had a wide variety of medically explained and unexplained physical symptoms, none of them qualified for a diagnosis of somatization disorder by DSM-III-R criteria. GAD and PD patients reported remarkably similar numbers of explained and unexplained medical symptoms. The panoply of somatic symptoms presented by these patients presents a formidable diagnostic challenge for clinicians. These findings suggest that the pattern of overutilization of medical services that is well documented for PD patients may also be found for GAD patients.     

Evaluation of circulating immune complexes (C.I.C.) in endometrial cancer

We evaluated the presence of CIC in 32 patients with histological proven cancer of endometrium: 23 stage IA or IB (i.e. localized disease), 9 in stage II or III (i.e. advanced disease). The determination of CIC was done at the time of the diagnosis before the patients underwent any surgical or medical therapy. The presence of CIC was demonstrated in 17% (4/23) of the patients with localized disease and in 56% (9/9) of the patients with more advanced disease. Our findings indicate that the presence of CIC is higher in patients with advanced endometrial carcinoma (stage II, III), than in those suffering of a more limited disease (stage IA, IB) and this seems could be consistent with a possible role in modulating the immune response against tumour itself.