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Vlădăreanu R, Maier C, Tocariu R, Șerban M, Brătilă E. Perinatal Diagnosis and Management of a Case with Interrupted Aortic Arch, Pulmonary Valve Dysplasia and 22q11.2 Deletion: A Case Report. Medicina (Kaunas) 2023; 59:1838. [PMID: 37893556 PMCID: PMC10608239 DOI: 10.3390/medicina59101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion disorder caused by hemizygous microdeletion of the long arm of chromosome 22. It is now known to have a heterogenous presentation that includes multiple additional congenital anomalies and later-onset conditions, such as gastrointestinal and renal abnormalities, autoimmune disease, variable cognitive delays, behavioral phenotypes and psychiatric illness. The purpose of our paper is to present the case of a fetus diagnosed with a complex association of cardiac anomalies: interrupted aortic arch type B, large malalignment-type ventricular septal defect, pulmonary valve dysplasia, and aberrant right subclavian artery for whom the result of genetic testing revealed 22q11.2 deletion. The pregnancy was regularly followed until delivery which took place in Germany so that neonatal cardiac surgery could be performed in an experienced center for cardiac malformations. The distinctivness of our report resides in the fact that it offers a complete image of a case of 22q11.2 deletion syndrome starting from the prenatal diagnosis (and emphasizing on the most relevant sonographic features) and, with parents not opting for termination of pregnancy, ending with the newborn surviving major cardiac surgery, offering thus the possibility to bring into focus postnatal outcome and future expectations in similar cases.
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Affiliation(s)
- Radu Vlădăreanu
- Department of Obstetrics And Gynecology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
| | - Călina Maier
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Raluca Tocariu
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Marcela Șerban
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
| | - Elvira Brătilă
- Department of Obstetrics And Gynecology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Department of Obstetrics And Gynecology, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. Panait Sîrbu”, 060251 Bucharest, Romania; (R.T.); (M.Ș.)
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Neștianu EG, Brădeanu CG, Alexandru DO, Vlădăreanu R. The Necessity of Magnetic Resonance Imaging in Congenital Diaphragmatic Hernia. Diagnostics (Basel) 2022; 12:diagnostics12071733. [PMID: 35885637 PMCID: PMC9320675 DOI: 10.3390/diagnostics12071733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
This is a retrospective study investigating the relationship between ultrasound and magnetic resonance imaging (MRI) examinations in congenital diaphragmatic hernia (CDH). CDH is a rare cause of pulmonary hypoplasia that increases the mortality and morbidity of patients. Inclusion criteria were: patients diagnosed with CDH who underwent MRI examination after the second-trimester morphology ultrasound confirmed the presence of CDH. The patients came from three university hospitals in Bucharest, Romania. A total of 22 patients were included in the study after applying the exclusion criteria. By analyzing the total lung volume (TLV) using MRI, and the lung to head ratio (LHR) calculated using MRI and ultrasound, we observed that LHR can severely underestimate the severity of the pulmonary hypoplasia, even showing values close to normal in some cases. This also proves to be statistically relevant if we eliminate certain extreme values. We found significant correlations between the LHR percentage and herniated organs, such as the left and right liver lobes and gallbladder. MRI also provided additional insights, indicating the presence of pericarditis or pleurisy. We wish to underline the necessity of MRI follow-up in all cases of CDH, as the accurate measurement of the TLV is important for future treatment and therapeutic strategy.
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Affiliation(s)
- Erick George Neștianu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Correspondence: or ; Tel.: +40-722400261
| | | | - Dragoș Ovidiu Alexandru
- Department of Medical Informatics and Bio-Statistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Radu Vlădăreanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 011461 Bucharest, Romania
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Varlas VN, Borș RG, Pop AL, Năsui BA, Bacalbasa N, Bohîlțea R, Vlădăreanu R, Manolea C. Oncofertility and COVID-19: At the Crossroads between Two Time-Sensitive Fields. J Clin Med 2022; 11:jcm11051221. [PMID: 35268312 PMCID: PMC8911324 DOI: 10.3390/jcm11051221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background: COVID-19 infection has dominated our lives and left its mark on it. The impact on fertility is major, and the long-term consequences may be disastrous. When we talk about oncofertility, we are talking about those patients worried about the delay in receiving medical services (possible cancelation of surgery, decreased availability of medical services, reorientation of medical resources) due to COVID-19. Finally, patients’ worsening biological and reproductive statuses, associated with high levels of anxiety and depression, are closely related to social restrictions, economic impact, reorientation of medical resources, health policies, and fears of SARS-CoV-2 infection. Aim: We reviewed the current literature on fertility during the COVID-19 pandemic and its effect on cancer patients. Specifically, how cancer treatment can affect fertility, the options to maintain fertility potential, and the recovery options available after treatment are increasingly common concerns among cancer patients. Methods: A systematic literature search was conducted using two main central databases (PubMed®/MEDLINE, and Web of Science) to identify relevant studies using keywords SARS-CoV-2, COVID-19, oncofertility, young cancer patient, cryopreservation, assisted reproductive techniques (ART), psychosocial, telemedicine. Results: In the present study, 45 papers were included, centered on the six main topics related to COVID-19. Conclusions: Fertility preservation (FP) should not be discontinued, but instead practiced with adjustments to prevent SARS-CoV-2 transmission. The increased risk of SARS-CoV-2 infection in cancer patients requires screening for COVID-19 before FP procedures, among both patients and medical staff in FP clinics, to prevent infection that would rapidly worsen the condition and lead to severe complications.
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Affiliation(s)
- Valentin Nicolae Varlas
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Roxana Georgiana Borș
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Correspondence: (R.G.B.); (R.B.)
| | - Anca Lucia Pop
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Clinical Laboratory, Food Safety, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania
| | - Bogdana Adriana Năsui
- Department of Community Health, Iuliu Hațieganu University of Medicine and Pharmacy, 6 Louis Pasteur Street, 400349 Cluj-Napoca, Romania;
| | - Nicolae Bacalbasa
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Obstetrics and Gynaecology, Cantacuzino Clinical Hospital, 030167 Bucharest, Romania
| | - Roxana Bohîlțea
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Correspondence: (R.G.B.); (R.B.)
| | - Radu Vlădăreanu
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Department of Obstetrics and Gynecology, Elias Clinical Hospital, 17 Mărăști Blvd., 011461 Bucharest, Romania
| | - Corina Manolea
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (V.N.V.); (A.L.P.); (N.B.); (R.V.); (C.M.)
- Assisted Reproduction Department, Columna Medical Center, 021522 Bucharest, Romania
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Bohîlțea RE, Dima V, Ducu I, Iordache AM, Mihai BM, Munteanu O, Grigoriu C, Veduță A, Pelinescu-Onciul D, Vlădăreanu R. Clinically Relevant Prenatal Ultrasound Diagnosis of Umbilical Cord Pathology. Diagnostics (Basel) 2022; 12:diagnostics12020236. [PMID: 35204327 PMCID: PMC8871173 DOI: 10.3390/diagnostics12020236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 12/10/2022] Open
Abstract
Umbilical cord abnormalities are not rare, and are often associated with structural or chromosomal abnormalities, fetal intrauterine growth restriction, and poor pregnancy outcomes; the latter can be a result of prematurity, placentation deficiency or, implicitly, an increased index of cesarean delivery due to the presence of fetal distress, higher admission to neonatal intensive care, and increased prenatal mortality rates. Even if the incidence of velamentous insertion, vasa praevia and umbilical knots is low, these pathologies increase the fetal morbidity and mortality prenatally and intrapartum. There is a vast heterogeneity among societies’ guidelines regarding the umbilical cord examination. We consider the mandatory introduction of placental cord insertion examination in the first and second trimester to practice guidelines for fetal ultrasound scans. Moreover, during the mid-trimester scan, we recommend a transvaginal ultrasound and color Doppler assessment of the internal cervical os for low-lying placentas, marginal or velamentous cord insertion, and the evaluation of umbilical cord entanglement between the insertion sites whenever it is incidentally found. Based on the pathological description and the neonatal outcome reported for each entity, we conclude our descriptive review by establishing a new, clinically relevant classification of these umbilical cord anomalies.
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Affiliation(s)
- Roxana Elena Bohîlțea
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (D.P.-O.); (R.V.)
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11–13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania; (B.M.M.); (A.V.)
- Correspondence: (R.E.B.); (V.D.); (A.M.I.); (C.G.)
| | - Vlad Dima
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11–13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania; (B.M.M.); (A.V.)
- Correspondence: (R.E.B.); (V.D.); (A.M.I.); (C.G.)
| | - Ioniță Ducu
- Department of Obstetrics and Gynecology, University Emergency Hospital, 169 Splaiul Independentei Bld., Sector 5, 050098 Bucharest, Romania;
| | - Ana Maria Iordache
- Optospintronics Department, National Institute for Research and Development in Optoelectronics-INOE 2000, 409 Atomistilor, 077125 Magurele, Romania
- Correspondence: (R.E.B.); (V.D.); (A.M.I.); (C.G.)
| | - Bianca Margareta Mihai
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11–13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania; (B.M.M.); (A.V.)
| | - Octavian Munteanu
- Department of Anatomy, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania;
| | - Corina Grigoriu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (D.P.-O.); (R.V.)
- Department of Obstetrics and Gynecology, University Emergency Hospital, 169 Splaiul Independentei Bld., Sector 5, 050098 Bucharest, Romania;
- Correspondence: (R.E.B.); (V.D.); (A.M.I.); (C.G.)
| | - Alina Veduță
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11–13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania; (B.M.M.); (A.V.)
| | - Dimitrie Pelinescu-Onciul
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (D.P.-O.); (R.V.)
| | - Radu Vlădăreanu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (D.P.-O.); (R.V.)
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Bohîlțea RE, Margareta Mihai B, Munteanu O, Ducu I, Adrian Dumitru V, Gheorghe CM, Augustin Georgescu T, Varlas V, Vlădăreanu R. Early prenatal diagnosis of an atypical phenotype of sacral spina bifida. J Med Life 2022; 14:716-721. [PMID: 35027976 PMCID: PMC8742886 DOI: 10.25122/jml-2021-0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022] Open
Abstract
Neural tube defects (NTDs) occur during embryogenesis, specifically during the fifth or sixth week of gestation, and are described as aberrant neural tube closing. The defect may alter the normal development of the vertebrae, spinal cord, cranium, or brain. The present study describes the case of a 41-year-old pregnant woman with fetal sacral meningocele, no associated pathologies, no family history of neural tube defects, a pregnancy under folate supplementation with the aim of highlighting the importance of ultrasound in diagnosing neural tube defects. The ultrasonographic diagnosis was not clear from the beginning. In our case, the differential diagnosis of meningocele was made with the cystic compound of a sacrococcygeal teratoma, which represents one of the most common congenital tumors in newborns. The particularity of this case was that a neural tube defect occurred despite the prophylactic administration of folic acid during pregnancy, which represents a well-documented protection against neural tube defects in fetuses.
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Affiliation(s)
- Roxana Elena Bohîlțea
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Bianca Margareta Mihai
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Octavian Munteanu
- Department of Obstetrics and Gynecology, University Emergency Hospital, Bucharest, Bucharest, Romania
| | - Ioniță Ducu
- Department of Obstetrics and Gynecology, University Emergency Hospital, Bucharest, Bucharest, Romania
| | - Vasile Adrian Dumitru
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Consuela-Mădălina Gheorghe
- Department of Marketing and Medical Technology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Valentin Varlas
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Radu Vlădăreanu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Elias University Emergency Hospital, Bucharest, Romania
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Bohîlțea RE, Dumitru A, Vlădăreanu R, Pleș L, Georgescu TA, Petrescu IA, Munteanu O. Ultrasound Pitfalls in a Complex Fetal Cardiac Malformation—Case Report of a New Arteriovenous Central Communication. Diagnostics (Basel) 2021; 11:diagnostics11122398. [PMID: 34943634 PMCID: PMC8699901 DOI: 10.3390/diagnostics11122398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 12/18/2021] [Indexed: 11/22/2022] Open
Abstract
Cardiac and cardiovascular malformations are of real interest in terms of definition, epidemiology, and means of early diagnosis by imaging. Although ultrasound examination reaches exceptional performance nowadays, unusual pathologies are still exposed to the risk of either incorrect acquired image or misinterpretation by the specialist in a routine scan. Herein, we present a case of a 20-week-old fetus (from an apparently low-risk pregnancy) with complex cardiac and vascular abnormalities, including an arteriovenous malformation along with ventricular septal defect, ductal coarctation of the aorta, aneurysm of a brachiocephalic vein, and dilation of the entire neck and upper mediastinum venous system, and the limitations that were encountered in the process of diagnosis and management of the case.
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Affiliation(s)
- Roxana Elena Bohîlțea
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
- Correspondence: (R.E.B.); (L.P.); (I.-A.P.)
| | - Adrian Dumitru
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.D.); (T.A.G.)
| | - Radu Vlădăreanu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Liana Pleș
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, Sf Ioan Hospital-Bucur Maternity, 040294 Bucharest, Romania
- Correspondence: (R.E.B.); (L.P.); (I.-A.P.)
| | - Tiberiu Augustin Georgescu
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.D.); (T.A.G.)
| | - Ioan-Andrei Petrescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence: (R.E.B.); (L.P.); (I.-A.P.)
| | - Octavian Munteanu
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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Maier C, Potecă A, Olincă M, Vlădăreanu R, Brătilă E. Placental mesenchymal dysplasia and maternal factor V Leiden: Accountable for severe early-onset intrauterine growth restriction? Eur J Obstet Gynecol Reprod Biol 2021; 266:42-44. [PMID: 34592647 DOI: 10.1016/j.ejogrb.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Călina Maier
- Clinical Hospital of Obstetrics and Gynecology "Professor Doctor Panait Sîrbu", Department of Obstetrics and Gynecology 13, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Anca Potecă
- Clinical Hospital of Obstetrics and Gynecology "Professor Doctor Panait Sîrbu", Department of Pathology, Bucharest, Romania
| | - Maria Olincă
- Clinical Hospital of Obstetrics and Gynecology "Professor Doctor Panait Sîrbu", Department of Pathology, Bucharest, Romania
| | - Radu Vlădăreanu
- Elias University Emergency Hospital, Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Elvira Brătilă
- Clinical Hospital of Obstetrics and Gynecology "Professor Doctor Panait Sîrbu", Department of Obstetrics and Gynecology 13, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Berceanu C, Gheonea IA, Vlădăreanu S, Cîrstoiu MM, Vlădăreanu R, Mehedinţu C, Berceanu S, Ciortea R, Brătilă E. Ultrasound and MRI comprehensive approach in prenatal diagnosis of fetal osteochondrodysplasias. Cases series. Med Ultrason 2017; 19:66-72. [PMID: 28180199 DOI: 10.11152/mu-922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To present the systematic ultrasonographic assessment in fetal osteochondrodysplasias and to evaluate the fetal MRI intake, as a complementary exploration to US, in the prenatal diagnosis and perinatal prognosis of fetal nonlethal osteochondrodysplasias. Material and methods: In this tertiary multicentre study were included 37 cases diagnosed prenatally with various entities in the category of nonlethal fetal osteochondrodysplasias. The initial diagnosis was carried out by the routine or detailed ultrasound examination. Fetal MRI was accomplished for selected cases. RESULTS Nonlethal skeletal dysplasia was suspected and then diagnosed after 17 gestational weeks. The suspicion of osteochondrodysplasia as a reference diagnosis element has required systematic and thorough ultrasound examination. Fetal MRI is a valuable exploration, complementary to prenatal ultrasound bringing in very useful details for the diagnosis of osteochondrodysplasias. The global diagnosis of skeletal dysplasia depends to a great extent on the genetic or biochemical abnormality that causes them. CONCLUSIONS US is always the fundamental screening exploration for fetal assessment in nonlethal osteochondrodysplasias. The details brought by the fetal MRI are useful, and the exploration is harmless for the fetus and the mother. Certain diagnosis cannot be accurate and complete without the contribution of genetics, maternal and fetal medicine, obstetrics or radiology.
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Affiliation(s)
- Costin Berceanu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, University Emergency Hospital of Craiova, Romania
| | - Ioana Andreea Gheonea
- Department of Radiology and Medical Imaging, The University of Medicine and Pharmacy of Craiova, Romania
| | - Simona Vlădăreanu
- Department of Neonatology, University of Medicine and Pharmacy Carol Davila, Elias University Emergency Hospital, Bucharest, Romania.
| | - Monica Mihaela Cîrstoiu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy Carol Davila, University Emergency Hospital, Bucharest, Romania
| | - Radu Vlădăreanu
- Department of Obstetrics and Gynecology, The University of Medicine and Pharmacy Carol Davila, Elias University Emergency Hospital, Bucharest, Romania
| | - Claudia Mehedinţu
- Department of Obstetrics and Gynecology, The University of Medicine and Pharmacy Carol Davila, Nicolae Malaxa Hospital, Bucharest, Romania
| | - Sabina Berceanu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, University Emergency Hospital of Craiova, Romania
| | - Răzvan Ciortea
- Department of Obstetrics and Gynaecology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elvira Brătilă
- Department of Obstetrics and Gynecology, The University of Medicine and Pharmacy Carol Davila, St. Pantelimon Emergency Hospital, Bucharest, Romania
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Mircea O, Bartha E, Gheorghe M, Irimia T, Vlădăreanu R, Puşcaşiu L. Ovarian Damage after Laparoscopic Cystectomy for Endometrioma. Chirurgia (Bucur) 2016; 111:54-57. [PMID: 26988540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Despite extensive research endometriosis is an area with important controversies. The European Society of Human Reproduction and Embriology issued in 2014 the last Guideline for endometriosis management including the statement that among 83 recommendations in 32 cases the best available evidence was only based on good clinical practice, further research being necessary to solve the lack of evidence in this pathology. The prevalence of endometriosis is unknown in Romania but in the medical literature estimates range from 2 to 10% of women of reproductive age, to 50% of infertile women, worldwide. Ovarian endometrioma prevalence goes up to 44%. A Cochrane review published in 2008 by Hart et al. concluded that excisional surgery of ovarian endometriosis results in a more favorable outcome compared to drainage and ablation with regard to recurrence, pain symptoms and subsequent spontaneous pregnancy in subfertilewomen- so the gold standard was set. But several authors revealed that ovarian tissue was inadvertently excised together with the cyst wall and endometrioma cystectomy is associated with a significant decrease in residual ovarian volume that may result in diminished ovarian reserve and function. The aim of our retrospective study was to evaluate whether or not ovarian parenchyma is inadvertently removed during laparoscopic surgery for endometrioma in a Romanian academic center. MATERIAL AND METHOD We performed a retrospective study including women having undergone endometrioma excision, between January 2009 to June 2014 in the Department of Gynecology and Obstetrics of Targu-Mures University Hospital. Histological specimens of excised endometriomas were reviewed by different pathologists, who carried out serial microscopic sections according to pathology protocol for diagnosis of ovarian mass but not specific for the ovarian parenchyma removed with the cyst. RESULTS Among 202 endometriomas, drainage and ablation was done in 60 cases and excisional surgery in the remaining 152 cases. Ovarian parenchyma was found in 40% of cases of endometrioma cystectomy. DISCUSSION We observed that endometrioma cystectomy leads to ovarian tissue removal in an important number of cases. Furthermore, at the time of surgery the amount of ovarian parenchyma loss may increases proportionally with increases in cyst diameter and patient age. Considering that most of the woman in our series were infertile and because of data from series using plasma energy, a shift in the endometrioma treatment paradigm is likely to occur.
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Onisâi M, Vlădăreanu AM, Delcea C, Ciorăscu M, Bumbea H, Nicolescu A, Voican I, Filipescu A, Rotaru O, Vlădăreanu R. Perinatal outcome for pregnancies complicated with thrombocytopenia. J Matern Fetal Neonatal Med 2012; 25:1622-6. [DOI: 10.3109/14767058.2011.648245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vlădăreanu R. Progress in obstetrics or the road to the promised land. J Med Life 2008; 1:55-9. [PMID: 20108480 PMCID: PMC3018962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The exceptional progress in obstetrics, especially in the second half of the 20th century, creates a series of dilemmas, without having yet the answer to old, basic questions, such as premature delivery and prevention of preeclampsia. Sexual liberty and the delay of the first pregnancy are responsible for the drop in natality rate and the increasing demand for assisted reproductive technologies. Their success is marked, though, by a drastic increase in the multiple birth rate and its complications. The advancing maternal age brings along a number of cardiovascular pathologies that endanger not only the present pregnancy, but also the long distance health prognosis. Plus, there is a marked risk for foetal chromosomal anomalies, which explains the need and the importance of prenatal diagnosis. Probably the newest branch in materno-foetal medicine, it offers many answers and solutions, but there are still a lot of question marks. In conclusion, the progress is necessary, is expected, but it should always be filtered by time and experience.
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Affiliation(s)
- Radu Vlădăreanu
- University of Medicine and Pharmacy Carol Davila, Departament of Obstetrics and Gynecology, University Emergency Hospital Elias, Bucharest, Romania
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Vlădăreanu R, Andrei C. Modern screening in cervical cancer. Perspectives of HPV prophylactic vaccines. Rev Med Chir Soc Med Nat Iasi 2007; 111:144-54. [PMID: 17595860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Despite the tremendous progress made along several different lines of research, cervical cancer has not has been overcome. The presence or the absence of the HR-HPV infection defines new possible approaches to screen and prevent cervical cancer. The aim of this review is to summarize the mechanisms that contribute to HPV-mediated cervical carcinogenesis, to present the modern screening in cervical cancer (liquid-based cytology, liquid-based hybridization, PCR-based assays) and also the beginning of the HPV vaccine era.
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Affiliation(s)
- R Vlădăreanu
- Obstetrics and Gynecology Department, Elias Univesitary Emergency Hospital, Bucucureşti
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Vlădăreanu R, Onofriescu M, Mihăilescu D, Zvăncă M. Magnetic resonance imaging in obstetrics. Rev Med Chir Soc Med Nat Iasi 2006; 110:567-74. [PMID: 17571547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
UNLABELLED Ultrasonography is the primary screening modality for obstetrics imaging. When additional information is needed to care for pregnant patients, computed tomography and magnetic resonance imaging (MRI) can be used. Because MRI provides superior contrast resolution compared with CT, uses no ionizing radiation, and permits imaging in more than one plane, it has been used in feto-maternal imaging. This article presents principles, practical aspects and indications of MRI in obstetrics: diagnosis of fetal anomalies, prenatal counseling and management, placental position and placenta praevia, pregnant patient with associated pathology (e.g. acute abdomen, hydronephrosis, adnexal masses) and pelvimetry. The article presents, also, fetal central nervous system malformations (one of the most frequent indication of MRI in obstetrics) and other fetal anomalies like diaphragmatic hernia or gastroschisis. CONCLUSIONS Ultrasound continues to be the screening modality of choice in the evaluation of the fetus. Proper use and interpretation of ultrasound limits the cases in which magnetic resonance is necessitated. However, there are many cases in which MRI alternative imaging is useful, complementary to ultrasounds.
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