Transvaginal sonographic appearance of peritoneal pseudocysts.

OBJECTIVE: To describe the sonographic features of peritoneal pseudocysts (PPCs) in order to determine the particular aspects that distinguish them from true ovarian cysts. METHODS: Thirty-one women with PPCs were investigated using transvaginal sonography immediately before surgery. The diameters of the cysts were measured, and the shape, margins, content, location, presence of septa and echogenic portions were analyzed. RESULTS: The PPCs were monolateral in 20 (65%) and bilateral in 11 (35%) women. A well-defined cystic structure was found in only six (19%) women, while in the other 25 (81%) women the PPCs showed blurred, undefined margins and a bizarre morphology, giving them a star-like tubular or lumpy shape. The ipsilateral ovary was identified in 26 (84%) cases either external to the cyst or entrapped within it like a 'spider in a web'. Septa were present in 25 (81%) cases and were often mobile, resembling a 'flapping sail' when touched by the endovaginal probe. CONCLUSION: Despite having a gross morphology resembling that of a true ovarian cyst, PPCs present some characteristic sonographic findings that allow a correct differential diagnosis in the vast majority of cases.     

Prenatal diagnosis of a complete mole coexisting with a dichorionic twin pregnancy: case report

A complete mole coexisting with dichorionic twins was diagnosed by the combined use of sonography and chorionic villus sampling at 10 weeks gestation. The pregnancy resulted in the death of one fetus at 31 weeks from presumed feto-maternal haemorrhage, while the other fetus survived in good condition. A summary of the available literature, combined with this report, reveals a total of seven pregnancies with twins and a coexistent complete mole. Only two out of 14 fetuses survived. Maternal complications included one case of pre-eclampsia and one persistent trophoblastic tumour. Accurate diagnosis of complete mole is possible by genetic analysis of chorionic villi obtained with standard transabdominal sampling. Twins with a coexistent complete mole will usually undergo miscarriage. However, fetal survival is possible and the maternal risks seem limited. A concomitance between gestational trophoblastic disease and the occurrence of feto-maternal haemorrhage is observed.     

Frequent loss of expression of the cyclin-dependent kinase inhibitor p27(Kip1) in estrogen-related Endometrial adenocarcinomas.

PURPOSE: p27(Kip1) is a member of the Cip1/Kip1 family of cyclin-dependent kinase inhibitors and is a potential tumor suppressor gene. Low levels of p27 are associated with poor prognosis in a variety of gynecological tumors, including breast, ovarian, and cervical carcinomas. The role of p27 in endometrial cancer remains controversial. EXPERIMENTAL DESIGN: In the present study, p27 protein expression was investigated by immunohistochemistry in a series of 217 endometrial adenocarcinomas and, where present, in synchronous normal endometrium, simple and complex hyperplasia (with or without atypia), and cystic atrophy. The relationship between p27 expression and clinical outcome was also evaluated. RESULTS: Immunohistochemical analysis revealed a significant loss of p27 expression from normal (33%) through hyperplastic endometrium (50%) to endometrial adenocarcinomas (71%; P 相似文献   

Prenatal diagnosis and obstetrical management of multicystic dysplastic kidney disease

Multicystic dysplastic kidney disease (MDKD) is one of the most common congenital renal anomalies. We report 16 consecutive cases of MDKD recognized in the antenatal period by sonography. Diagnosis is usually easy as MDKD has in the vast majority of cases a striking ultrasound appearance including enlargement of the kidney and multiple renal cysts. However, differentiation from obstructive uropathy may be difficult, and we made a total of five erroneous diagnoses. Unilateral MDKD has almost invariably a good prognosis. However, severe life-threatening associated anomalies were found in six cases. Therefore, a detailed survey of fetal anatomy and determination of karyotype are strongly recommended.     

Correlation among amniotic fluid index (AFI), cesarean section rate, and labor length in inducted pregnancies beyond 41 weeks' gestation with unfavorable cervix

This paper evaluated how the pregnancy after 41 completed weeks' gestation with amniotic fluid index (AFI) > 6 has a slower response to the prostaglandin E2 (PGE2) induction. Eighty-one post-term pregnancies (41 completed gestations' weeks) with unfavorable cervix were considered in this follow-up. Induction was performed by means of intracervical PGE2 gel (Dinoprostone 0.5 mg). After 12 hours, if the cervix was still unfavorable, then another gel administration followed. Cases that had oxytocin administration were excluded from the study. The median time of spontaneous delivery in the overall series was 25 hours, 14 minutes. We had 18 cases of cesarean section (22.2%). In the group of pregnancies with AFI > 6 (60 cases) and in the group with AFI < or =6 (21 cases), the median time of spontaneous delivery was 29 hours, 25 minutes and 23 hours, 39 minutes, respectively (p-value = 0.02). The rate of cesarean sections was 26.67 and 9.52, respectively in the two groups (p-value >0.05). Two out of four cases of cesarean sections for fetal distress belonged to the group of AFI > 6. All the 14 cases of cesarean section for dystocia belonged to the group with AFI > 6. Considering just patients who did not deliver within 12 hours (57 cases), median time of spontaneous delivery was 33 hours and 24 hours 40 minutes for group AFI > 6 (42 cases) and AFI < or =6 (15 cases), respectively (p-value = 0.0009). Thirty-one cases out of 57 had another PGE2 gel administration. Adjusted odds ratio was 0.33 (0.16-0.65, 95% C.I.) for AFI < or =6 versus AFI > 6.     

Ultrasound of the fetal central nervous system

Current ultrasound equipment allows the antenatal identification of many central nervous system anomalies from early gestation. In selected cases, special techniques (transvaginal sonography, three-dimensional ultrasound, colour Doppler) may enhance the diagnostic potential. Diagnostic accuracy, however, remains heavily dependent upon the expertise of the sonologist. Fetal ultrasound is effective in identifying neural tube defects, although alpha-fetoprotein screening seems to yield a greater sensitivity. The sensitivity in the diagnosis of central nervous system malformations other than neural tube defects remains unclear because of the ascertainment biases of the few large prospective studies that have been carried out so far. Magnetic resonance imaging may play a major role in the evaluation of cases with suboptimal ultrasound visualization, or when specific anomalies are suspected, such as intracranial haemorrhage or migrational disorders.     

Factors associated with cone margin involvement in CIN patients undergoing conization-equivalent electrosurgical procedure

BACKGROUND: Most studies of cervical conization have considered the frequency of complications and the outcome of follow-up. The determinants of cone margin positivity have been inadequately described. In a series of CIN patients undergoing conization-equivalent electrosurgical procedure, we evaluated the factors associated with (i) any cone margin involvement, and (ii) endocervical margin involvement (with or without other locations) as contrasted with all other conditions. METHODS: Study population included 718 patients. Potential determinants of margin involvement were or were treated as categorical. Univariate analysis was based on the chi-square test. Multivariate associations were estimated by multiple logistic regression models. RESULTS: Cone margin involvement was observed in a total of 195 patients (27%). In univariate analysis, the frequency was positively related to histologic grade, time period, lesion size, and cone width and depth. In multivariate analysis, histology diagnosis and time period retained a strong association. The effect of lesion size was of borderline significance. The endocervical location emerged as a multivariate determinant of margin positivity. The effect of cone width and depth was not confirmed. Endocervical margin involvement was observed in 98 cases (14%). In univariate analysis, the frequency was positively associated with histologic grade, time period, and age, and inversely related to the visibility of the squamous-columnar junction. Multivariate analysis confirmed the strong effect of histology diagnosis and time period. The association with age and visibility of the squamous-columnar junction was weaker. CONCLUSIONS: Histology diagnosis and time period were the strongest determinants of cone margin involvement. Endocervical margin positivity was also related to patient age and visibility of the squamous-columnar junction. Cone width and depth had no protective effect.