[Second trimester cerclage of short cervixes: which technique to use? A retrospective study of 25 cases]

OBJECTIVE

To evaluate pregnancy outcome after therapeutic or emergency cerclage performed on the basis of clinical or/and ultrasound cervical modifications noted before 26 weeks of gestation and to precise which surgical procedure (Shirodkar or McDonald) is the most appropriate in these indications.

PATIENTS AND METHODS

Retrospective study between January 1(st) 1996 and December 31(st) 2001 on 25 clinical charts of patients with suspected cervical incompetence who had second trimester cervical cerclage on the basis of clinical or ultrasound cervical length shortening. Patients with first trimester prophylactic cervical cerclage were excluded from analysis. The choice between the two surgical procedures (Shirodkar or McDonald) depended on surgeon preference but the two groups were identical for previous obstetrical history, time of cerclage and cervical modifications. Statistical analysis was performed using Chi 2 test or t-test according to the type of variables.

RESULTS

In our series, 9 patients had cervical cerclage performed with Shirodkar (S) procedure and 16 had McDonald cerclage (MD). Mean operating time (S: 52 +/- 18 minutes; MD: 39 +/- 3 minutes; p=0.1) and mean hospital stay (S: 5.2 +/- 1.3 days; MD: 5.3 +/- 1.5 days; p=0.9) were not significantly different between the two procedures. The difference in mean gestational age at delivery, (S: 35.7 +/- 3.2 Wks; MD: 33.2 +/- 2.9 Wks; p=0.5) and in the number of premature deliveries before 32 completed weeks (S: 22.2%; MD: 43.7%; p=0.4) better in Shirodkar group didn't reach statistical signification. No statistical difference was noted in the number of admission in neonatal intensive care unit (S: 22.2%; MD: 31.2%; p=0.9) and in neonatal survival (S: 1 neonatal death; MD: 1 neonatal death) between the two groups.

CONCLUSION

No conclusion regarding the most appropriate cervical cerclage procedure can be drawn from our study. However, Shirodkar procedure seems preferable to us due to tendency in a higher mean gestational age at delivery and because it didn't appeared to be longer or more difficult procedure. Multicentric studies may probably give better knowledge in this topic.

Prenatal diagnosis and postnatal outcome of congenital megalourethra. Report of two cases

We present 2 cases of congenital megalourethra diagnosed by prenatal ultrasound scan during the second trimester of pregnancy. The first one was associated with features suggesting prune belly syndrome (PBS) in contrast to the other one. Fetal urine biochemistry and fetal serum beta2-microglobulin was used to rule out severe renal impairment that would have led to postnatal renal failure soon after birth. In both cases, after extensive counselling, the parents opted against termination of pregnancy and in both cases vaginal delivery of a live neonate occurred. Postnatal follow-up demonstrated that the two infants were found to have mildly altered renal function without any physical or mental development delay. Association with features of PBS didn't seem to influence the severity of renal function impairment however, but PBS may influence parents' decision regarding termination because of additional corrective surgery and further infertility.

[Idiopathic granulomatous mastitis. Review of the literature illustrated by 4 cases]

INTRODUCTION

Idiopathic granulomatous mastitis (IGM) was described as a specific entity in 1972 by Kessler and Wolloch. Despite the 120 cases reported in the international literature, this pathology remains quite unknown.

MATERIAL AND METHODS

Four cases of idiopathic granulomatous mastitis are reported in this article in order to outline the main clinical features of this affection. Data in the literature were used to discuss diagnostic and therapeutic particularities.

DISCUSSION

The histologic findings of a non-caseating granulomatous inflammation, centered on breast lobules, composed of epithelioid cells and multinucleated giant cells, allow establishing the diagnosis of granulomatous mastitis (GM). The main presenting symptom of GM is a single inflammatory mass of the breast; the diagnosis is thus often mistaken for breast carcinoma (more than 50% of the reported cases). Radiologic and cytologic findings alone do not enable reaching certain diagnosis because they cannot resolve the differential diagnosis of inflammatory process and malignancy. The diagnosis of IGM can be established after the etiological work up remains negative. A course of oral corticosteroid therapy, non-steroidian anti-inflammatory drugs, or colchicine can be used in order to shrink the breast mass, allowing more conservative surgery. Local excision is of limited benefit as there is a strong tendency for recurrence.

CONCLUSION

Different therapeutic options of IGM are explained by its clinical variability. A more pragmatic therapeutic approach would be enabled by a new classification based on course and severity.

Prenatal ultrasonographic diagnosis of the cerebro-costo-mandibular syndrome: case report and review of the literature

We present an antenatal ultrasonographic diagnosis of the cerebro-costo-mandibular syndrome. This rare dysmorphic disorder (only 51 cases have been reported to date) mainly associates defective costal development with features of the Pierre-Robin syndrome. The diagnosis is very often made at birth and the prognosis is very poor. Antenatal ultrasound examination may show a combination of orofacial and chest maldevelopment. In our case the diagnosis was made at 20 weeks' gestation during a routine ultrasound examination and the patient chose to terminate the pregnancy at 24 weeks.