Spinal anesthesia for cesarean section in a woman with Kartagener’s syndrome and a twin pregnancy

Kartagener's syndrome is an inherited disease characterized by a triad of symptoms: bronchiectasis, situs inversus and sinusitis resulting from defective cilial motility. There are few reports in the literature regarding the optimum anesthetic technique in patients with Kartagener's syndrome. The main anesthetic considerations are related to the respiratory system and increased risk of infection. We report the case of a woman with Kartagener's syndrome and a twin pregnancy conceived by in-vitro fertilization-embryo transfer, who underwent cesarean section under spinal anesthesia. Despite recurrent pulmonary problems, the twin pregnancy resulted in a successful outcome. This was facilitated by a close working relationship between the obstetrician, anesthesiologist and patient.

Congenital heart diseases in twin pregnancies

OBJECTIVE

To find connection between the type of congenital heart malformations and twin pregnancies.

METHOD

Retrospective analysis of data of fetal cardiology database between 1 January 1996 and 30 November 2003.

RESULTS

In single pregnancies 455 and in twin pregnancies 31 severe congenital heart malformations were diagnosed prenatally. In monozygotic twin pregnancies 36% of heart malformations were pulmonary stenosis and 45% endocardial fibroelastosis, which is significantly higher than in single pregnancies. In dizygotic twin pregnancies Ebstein malformation was significantly more frequent than in single pregnancies. With the exception of Ebstein malformation in dichorionic and dizygotic twin pregnancies the cardiac malformations were similar to the ones in single pregnancies.

CONCLUSIONS

The twin pregnancy alone can be considered as indication for fetal echocardiography. The type of congenital heart malformations detected in monochorial twin pregnancies was different from those found in single, dizygotic or dichorionic twin pregnancies. Chorionicity seems to be more important than zygosity.

Pulmonary stenosis and reactive right ventricular hypertrophy in the recipient fetus as a consequence of twin-to-twin transfusion

The present study describes an association between adverse outcome in the twin-to-twin transfusion syndrome (TTTS) and pulmonary stenosis or reactive right ventricular hypertrophy. Six discordant monozygotic twin pregnancies with TTTS are described. Ventricular hypertrophy and atrioventricular valvular regurgitation occurred in all the recipient twins with pulmonary valvular stenosis in three cases and infundibular stenosis in one case. The recipient twin in one pair and both twins in another pregnancy died as a consequence of immaturity but the remaining twins all survived. Surgical intervention was required in one baby for valvular pulmonary stenosis. Our observations suggest that elevated blood pressure in the transfusion recipient may play an important role in pathogenesis. We hypothesise that both pulmonary stenosis and right chamber hypertrophy are secondary to hemodynamic changes. Although we have found valvular pulmonary stenosis in three recipients and infundibular stenosis in only one, this (obstruction to outflow) could be due to right chamber hypertrophy.

Calcification of the fetal heart--four case reports and a literature review

Calcification of the heart and vessels in fetuses is a rare condition. It may be dystrophic or metastatic. An extremely rare form of vascular calcification has been termed 'idiopathic arterial calcification of infancy', which is inherited in an autosomal recessive pattern. We report four cases of myocardial calcifications of different origin diagnosed in utero. The correct diagnosis is very important in regard to genetic counselling.

[Acardius (TRAP-sequence) (Twin Reversed Arterial Perfusion)]

Two cases of acardius were observed by the authors among nearly twenty thousand deliveries in the seven year period of the 1st Department of Obstetrics and Gynecology, between 1990 and 1. July 1997. The incidence of acardia which was found in this material is more than three times higher than the incidence generally given in the literature. Presenting the cases, the contemporary possibilities of prenatal diagnosis of this highly pathologic form of monozygotic twin pregnancy are discussed in details, further a survey is given of the new, so far experimental, but promising, less and less invasive interventions directed towards in utero terapy by closing the connecting vessels, including also laser occlusion of chorioangiopagus.

[Fetal myocardial calcification (report of 4 cases and review of the literature]

(Report of four cases and review of the literature) Calcification of the myocardium is a rare condition. The cause may be dystrophic or metastatic. An autosomal recessive inherited idiopathic arterial calcification of infancy is more rare abnormality. A dystrophic calcification is the more common of the three and may occur in areas of necrosis, hemorrhage, or fibrosis of the myocardium. Metastatic calcification is associated with hyperparathyroidism, D hypervitaminosis or renal failure, usually accompanied by the deposit of calcium in other organs, particularly the lungs, stomach, kidneys, spleen and liver. Authors report four cases of myocardial calcification diagnosed in intrauterine life. They give a review of literature of fetal and neonatal myocardial calcification.

[Successful twin delivery following reduction of quadruplet pregnancy]

The authors report first time in the Hungarian literature on multifetal pregnancy reduction: a quadruplet pregnancy was reduced to twins on transabdominal way in the 16th week of gestation on request of the parents. The quadruplets resulted from a forcefully induced ovulation. First weeks of gestation were complicated by a severe but effectively treated ovarian hyperstimulation syndrome. Following the successful and uncomplicated intervention the course of pregnancy was undisturbed, two living healthy babies were delivered in the 35th gestation week. Placentae of the liveborn as well as of the stillborn fetuses were pathologically examined. On occasion of the case report theoretical and practical questions of multifetal pregnancy reduction are discussed in details from indications through technical implementation to a review of legal, ethical and also psychological relations of that intervention. A standpoint for the national practice is also framed by the authors.

Skin penetration by 2,4-diaminoanisole in the rat

The absorption of 14C-labelled 2,4-diaminoanisole together with its reaction products was investigated after application to the skin of rats. 2,4-Diamino[14C]anisole was applied as an ingredient of three different hair-dyeing formulations using procedures approximating to realistic conditions of use. Percutaneous absorption of the compound ranged from 0.26 to 1.1% of the administered dose, according to the formulation used. Elimination occurred mainly in the urine, with a smaller proportion in the faeces. Very small amounts were detected in the expired air. Complementary investigations involving subcutaneous or oral application of a solution of 2,4-diamino[14C]anisole.2HCl showed that radioactivity was rapidly eliminated in the urine and faeces. Biliary excretion was demonstrated after oral administration.