Assessment of postoperative postvoid residual bladder volume using three-dimensional ultrasound volumetry

The aim of our prospective study was to assess the concordance between postvoid residual volumes (PVR) of the urinary bladder obtained by two different three-dimensional (3-D) ultrasound (US) volumetric methods (VOCAL and XI VOCAL) and with measurement by the catheter in postoperative patients who have undergone radical hysterectomy. The 3-D sonographic volume-determination of PVR with both methods correlated significantly with the actual amount of PVR by the catheter. The accuracy of both 3-D US volumetric methods was significantly higher under 300 mL of PVR. Bland-Altman plots were generated to examine limits of agreement. Both noninvasive 3-D sonographic methods are appropriate for the correct volume-determination of PVR following radical hysterectomy. Thus, we may avoid routine, albeit often unnecessary, catheterization to measure postoperative residual bladder volumes and subsequently the incidence of lower urinary tract infection may be reduced and better postoperative comfort for patients may be permitted.

Assessment of three-dimensional sonographic features of polycystic ovaries after laparoscopic ovarian electrocautery

BACKGROUND

Treatment of polycystic ovary syndrome-related infertility includes laparoscopic ovarian electrocautery. Three-dimensional (3-D) sonographic characterization of polycystic ovaries has been performed recently, including the study of the effect of laparoscopic ovarian drilling on ovarian volume. The impact of laparoscopic treatment on ovarian volume and vascular flow-patterns assessed by 3-D color power angiography (CPA), however, has not yet been elucidated.

OBJECTIVE

To measure ovarian volume, to evaluate and quantify intraovarian blood flow with 3-D CPA histogram analysis before and after laparoscopic ovarian electrocautery, and to compare the hormonal effects of surgery with 3-D sonographic findings.

SETTING

University hospital.

PATIENT(S)

Ten patients, aged 18-34 years, with polycystic ovary syndrome.

INTERVENTION(S)

Evaluation of serum and urinary hormone profiles as well as transvaginal 3-D ultrasonography were performed before and after laparoscopic ovarian surgery.

RESULT(S)

Ovarian volume decreased, and 3-D CPA showed increased intraovarian flow intensity after laparoscopic electrocautery. Serum LH and T levels, ratios of urinary steroids reflecting 5 alpha-reductase enzyme activity, and androgen to cortisol metabolites decreased; serum FSH levels increased 1 week after laparoscopy and correlated well with changes of 3-D sonographic features. Seven patients ovulated regularly after surgery, and five pregnancies were conceived within 1 year.

CONCLUSION(S)

Three-dimensional ultrasonography may be a useful adjunct and noninvasive method for correlating clinical parameters with the blood flow alterations in polycystic ovary syndrome patients.

Hydrops foetus universalis – a retrospective study

A szerzők a hydrops foetus előfordulási gyakoriságát, létrejöttének okait vizsgálták. Öt év alatt 555 foetalis és neonatális autopsziás vizsgálatot végeztek. Hydropsot igazoltak 28 magzatnál. Három esetben Rh-izoimmunizáció állt a háttérben, 25 foetusnál nem immun hydrops került megállapításra. Huszonöt esetben sikerült a hydrops kiváltó okát tisztázni, az ok 3 esetben felderítetlen maradt. Tizenkét esetben középidős spontán vetélés, illetve in utero elhalás történt, míg 12 foetusnál orvosi indok alapján történt a terhesség terminálása. Emellett 4 újszülöttkorban meghalt beteget is vizsgáltak. Az orvosi indok alapján történő terhességmegszakításnál a foetusok átlagos kora a 16. és a 20. gesztációs hét között volt, míg a középidős spontán vetélés és in utero elhalás esetén ez a 24. terhességi hetet jelentette. A patológiai vizsgálat valamennyi esetben a terhességi korhoz képest várható testsúlynövekedését, periferiás oedemát, ascitest, illetve hydrothoraxot igazolt. Az esetek felében hydropericardium is látható volt. Hepatosplenomegália, cardiomegália, pulmonális hypoplasia, fokozott extramedulláris hemopoezis, placenta oedema valamennyi esetben megfigyelhető volt. A nem immun hydrops hátterében a következő rendellenességeket találták: 4 esetben cardiális malformatiót, 1 esetben szkeletális rendellenességet, 3 foetusnál kromoszómarendellenességet, 2 foetusnál cysticus hygromát, 3 esetben iker-iker transzfúzióval járó monochorialis diamnialis ikerterhességet, 7 esetben infekciót, 1 foetusnál sacrococcygeális teratomát. Két esetben a kiváltó ok anyai betegséget jelentett. A klinikai és patológiai diagnózisokat összehasonlítva megállapították, hogy a nem immun hydrops kórokával kapcsolatban csupán 3 esetben volt teljes egyezés a klinikai véleménnyel. A patológiai vizsgálat által feltárt kórokot az öröklődés, terápiás lehetőségek mérlegelése szempontjából 10 esetben szignifikánsnak véleményezték. A szerzők kiemelik nem immun hydrops esetén a részletes patológiai vizsgálat szükségességét, a klinikai vizsgálatokkal való korreláció meghatározásának fontosságát, a szerológiai vizsgálatok jelentőségét és a társszakmákkal való együttműködés szükségességet a hydropsos magzatokkal kapcsolatos további teendők meghatározása érdekében.

Transvaginal extraction of the laparoscopically removed spleen

Laparoscopic removal of normal and moderately enlarged spleens has become the gold standard operation in recent years because its short operative time, technical safety, and quick patient recovery time. The best method for extraction of the removed spleen, however, has not yet been determined. The authors present a new method for the extraction of the laparoscopically removed spleen. Using a transvaginal approach, the organ is removed through an incision on the posterior vaginal wall and exteriorized in a laparobag. The procedure is similar to a routine vaginal hysterectomy, but is technically much simpler to perform.

Correlation of prenatal clinical findings with those observed in fetal autopsies: pathological approach

Our objective was to present a comprehensive description of the clinicopathological findings of 173 abortions, including 121 therapeutic and 52 spontaneous ones in the period between 1992 and 1998. In all of these fetuses pathological examination was carried out. It was complemented when indicated by immunohistochemistry, in situ hybridization, flow cytometry, and X-ray examination. In the 121 therapeutic abortions the distribution of malformations was: 45 central nervous system anomalies (37%), 12 genitourinary anomalies (10%), 25 gastrointestinal anomalies (21%), two respiratory system anomalies (1.65%), eight cardiac anomalies (6.6%) and 28 other anomalies (17.2%) as revealed by autopsy. From the clinically selected 52 spontaneous abortions, major malformations were seen in 15/52 cases. With the comparison of the pathological and clinical findings in 121 therapeutic abortions, the percentage of cases with correct clinical designation and no missed anomalies amounted for 49%. However in 51% additional or different lethal, severe, or major malformations were revealed or excluded by fetopathological examinations. In 4% the clinical observation and diagnosis were modified, but without implications for the therapeutic termination of pregnancy. The clinical indication could not be supported in another 3% of the cases.

[Parvovirus B19 infection in hydrops fetalis]

In a retrospective study from 210 foetal autopsies carried out in a period between 1992 and 1999 fifteen hydropic foetuses were found. The cause of the hydrops was shown to be Rh incompatibility in one case only. The cause of hydrops was not discernible in one case. In the others pathological examination clarified the cause and pathomechanism of non-immune hydrops. One isolated cystic hygroma, one monochorionic twin pregnancy with twin to twin transfusion, one case of sacrococcygeal teratoma and 4 cases of congenital heart diseases were reported. Postmortem interphase cytogenetic examination showed X0 monosomy in 2 cases. In further 4 foetuses pathognomic viral inclusions in the proerythroblasts raised the probability of parvovirus B19 infection what was confirmed by immunohistochemistry and electronmicroscopic examination. The occurrence of the parvovirus B19 associated cases of foetal hydrops was shown to be higher (4/15) in this series than in the literature. The accumulation of cases in 1998 is suggestive of an outbreak. The prenatal diagnostic implications and the attempts on further management are also discussed.

Twin pregnancy following in vitro fertilisation coinciding with laryngeal cancer

The authors report the case of a 33-year-old female patient who was admitted to their Department with supraglottic laryngeal cancer detected in the 1st trimester of her twin pregnancy following in vitro fertilisation after a 10-year nulliparous period of her married life. Since a horizontal supraglottic laryngectomy performed during pregnancy the patient has been free of recurrences, and the twins delivered 3 years ago are in good health. According to the authors, of all available therapeutic possibilities (surgery, cytostatic drugs, telecobalt irradiation) in pregnancy coinciding with laryngeal cancer, optimal therapeutic effects can be achieved by surgery.

[Dopamine, noradrenaline and serotonin levels in amniotic fluid during the second trimester in normal and pathologic pregnancy]

Authors measured the dopamine (DA), noradrenaline (NA) and serotonin (5-HT) contents of amniotic fluid between 19 and 21 weeks with fluorimetric method. The amniotic fluid samples were obtained by transabdominal amniocenteses performed due to elevated maternal serum-alphafetoprotein levels and suspect ultrasound findings. They considered as normal values the average of 30 amniotic fluid samples obtained from pregnant women who gave birth to healthy babies at term. The mean values (mean+SE) of normal cases were 136.6 + 20.2 nmol/l for DA, 29.5 + 9.4 nmol/l for NA and 72.6 + 4.9 nmol/l for 5-HT. Against these values, in cases of open spina bifida the level of NA showed no significant difference, the DA level was higher (p < 0.05) and the 5-HT level was also higher (p < 0.001). The DA level was found higher (p < 0.05) in cases of intrauterine retardation as well, however there was no difference in the NA and 5-HT levels in these cases. In cases of preterm deliveries, none of the above parameters showed differences. Authors suggest that in cases of spina bifida the measurement of 5-HT in the amniotic fluid can be a complementary diagnostic method. They also state that no prognosis about the outcome of pregnancies can be expected from such examinations.

[Exclusion of Sandhoff disease (Tay-Sachs 0 variant) by chorion biopsy]

Transcervical chorionic villus sampling with ultrasound guidance at the 11-th week of pregnancy was made at a woman with the history of one lethal case of Sandhoff disease. The total hexosaminidase and the hexosaminidase A were determined. At the 16-th week amniocentesis was performed and the characteristic enzymes were determined from the amniotic cell culture. The results of the examinations made possible to advise the patient to carry out the pregnancy. The examinations after delivery confirmed the newborn to be a carrier.

[Treatment of cervical cancer using the Wertheim-Latzko radical operation at the Gynecology Clinic of Pécs]

The authors performed 119 Wertheim--Latzko operations from July 1, 1975 to December 31, 1988. 108 patients are still alive. The 5 years survival rate of patients operated on before 1984 was 89.8%. Radical hysterectomy involving careful removal of regional lymphnodes was carried out after lymphography and preoperative irradiation. Postoperative irradiation was made on radiologist's indication. Significance of combined surgical and radiotherapy is emphasised in the management of cervical cancer in stages IB and IIA. Surgery is especially important in adenocarcinomas that are less sensitive to irradiation, in cases of large and necrotic tumors with the barrel formation of endocervical cavity and in cases not showing appropriate regression after radiotherapy. Surgical tumor removal appears to be of much value in young patients, in cases of anaplastic tumors in suspicious lymphographic findings, and in those patients, whose recovery may be expected only from operation and supplementary radiotherapy. Very important condition for obtaining good recovery results and low rate of surgical complications are the team of experienced surgeons and organized regional centres for radical hysterectomies.

Levels of placenta-specific tissue protein 12 (PP12) in serum during normal pregnancy and in patients with trophoblastic tumour

A sensitive radioimmunoassay method has been developed to measure soluble placental protein 12. Using this method trace amounts of PP12 have also been detected in the sera of healthy non-pregnant subjects (24.0 +/- 6.15 micrograms/l). During normal pregnancy serum PP12 levels rose rapidly reaching a peak value of 139.90 +/- 40.26 micrograms/l at 18 weeks. Serial determinations of PP12 have been made in 31 patients with trophoblastic tumours (16 hydatidiform moles, 10 invasive moles and five choriocarcinomas). It has been found that in patients with hydatidiform and invasive moles its initial values are extremely high (342.9 +/- 257.9 micrograms/l and 279.3 +/- 103.1 micrograms/l, respectively), much exceeding the non-pregnant and normal pregnant values. After evacuation of hydatidiform moles serum-PP12 rapidly fell to the upper limit of normal at 21-28 days, and to normal values at 8-12 weeks after operation. In patients with invasive mole requiring chemotherapy the rate of fall of PP12 level was slower. In patients with choriocarcinoma serum-PP12 levels were moderately raised (59-132 micrograms/l) and followed the clinical course of the disease. Serum-PP12 levels would seem to be of less value in monitoring patients with trophoblastic tumours than other tumour-markers (hCG, and SP1).