Christine Tita Kaihura

Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy

BACKGROUND The aim of this study was to verify the efficacy of sodium-2-mercaptoethanesulfonate (mesna) in the chemical separation of tissues in abdominal myomectomies when used with the traditional mechanical separation techniques. STUDY DESIGN In a prospective, randomized study, 58 women underwent abdominal myomectomy. In 29 of these, we used mesna for highlighting and separating tissues, and in the other 29 we used saline solution for the same purposes. The variables evaluated included the number of myomas removed, the volume of the biggest myoma, and the total volume of the myomas removed in every intervention. We also recorded operating time, the length of hospital stay, the degree of procedure difficulty, perioperative blood loss, operative complications, and cost. RESULTS The operation was significantly shorter in the mesna group (p < 0.05) even though the volume and the number of myomas were larger. The degree of difficulty evaluated by the surgeon at the end of every operation was not significantly different in the two groups. The reduction in hemoglobin 24 hours after operation was significantly less in the patients treated with mesna (p = 0.006), but this difference was probably altered by the increase in hematocrit levels. CONCLUSIONS Because of its ability as a chemical dissector, mesna may be a useful aid in this type of benign gynecologic operation. Larger studies to confirm this are needed.

Chemically Assisted Dissection of Tissues in Laparoscopic Excision of Endometriotic Cysts

STUDY OBJECTIVE To evaluate the capacity of chemical dissection of tissues using a mucolytic substance, Mesna, in improving laparoscopic excision of endometriotic cysts. DESIGN Randomized, double-blind, controlled trial (Canadian Task Force classification I). SETTING University-affiliated training hospital. PATIENTS Forty-four women with symptomatic ovarian endometriotic cysts. Intervention. Laparoscopic excision of endometriotic cysts in 22 women with the aid of Mesna solution and in 22 with the aid of saline solution. MEASUREMENTS AND MAIN RESULTS In comparison with saline solution, Mesna as a chemical dissector resulted in significant reductions in operating time, in difficulty encountered by the surgeon to enucleate the cysts, and in less bleeding. No differences were found in length of hospital stay, costs of surgeries, analgesic requirement, and fever. Postoperatively, patients treated with Mesna achieved more pregnancies than those treated with saline. CONCLUSION Chemical dissection of tissues with Mesna proved to be a safe and suitable support in laparoscopic surgery for ovarian endometriotic cysts.

Is the short axis view of the fetal heart useful in improving the diagnostic accuracy of outlet ventricular septal defects

Outlet ventricular septal defects (VSDs) are usually suspected on the five‐chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic assessment of the short axis view may improve the prediction of prenatally detected outlet VSDs.

Quantitative analysis of fetal facial morphology using 3D ultrasound and statistical shape modeling: a feasibility study

BACKGROUND: The antenatal detection of facial dysmorphism using 3‐dimensional ultrasound may raise the suspicion of an underlying genetic condition but infrequently leads to a definitive antenatal diagnosis. Despite advances in array and noninvasive prenatal testing, not all genetic conditions can be ascertained from such testing. OBJECTIVES: The aim of this study was to investigate the feasibility of quantitative assessment of fetal face features using prenatal 3‐dimensional ultrasound volumes and statistical shape modeling. STUDY DESIGN: Thirteen normal and 7 abnormal stored 3‐dimensional ultrasound fetal face volumes were analyzed, at a median gestation of 29+4 weeks (25+0 to 36+1). The 20 3‐dimensional surface meshes generated were aligned and served as input for a statistical shape model, which computed the mean 3‐dimensional face shape and 3‐dimensional shape variations using principal component analysis. RESULTS: Ten shape modes explained more than 90% of the total shape variability in the population. While the first mode accounted for overall size differences, the second highlighted shape feature changes from an overall proportionate toward a more asymmetric face shape with a wide prominent forehead and an undersized, posteriorly positioned chin. Analysis of the Mahalanobis distance in principal component analysis shape space suggested differences between normal and abnormal fetuses (median and interquartile range distance values, 7.31 ± 5.54 for the normal group vs 13.27 ± 9.82 for the abnormal group) (P = .056). CONCLUSION: This feasibility study demonstrates that objective characterization and quantification of fetal facial morphology is possible from 3‐dimensional ultrasound. This technique has the potential to assist in utero diagnosis, particularly of rare conditions in which facial dysmorphology is a feature.

Three‐dimensional assessment of umbilical vein deviation angle for prediction of liver herniation in left‐sided congenital diaphragmatic hernia

To introduce a new sonographic marker of intrathoracic liver herniation in fetuses with left‐sided congenital diaphragmatic hernia (CDH).

OP04.03: Manual versus automated segmentation for the computed assessment of the fetal face from ultrasound scans: preliminary results from a pilot study: Short oral presentation abstracts

Objectives: The objective of this research was to evaluate the effectiveness of teaching, explore experiences of clinicians and examine the impact of POCUS in clinical practice using KEF. Methods: Two intensive 2-day ultrasound training small group workshops incorporating lectures and hands-on sessions involving high fidelity simulators and live pregnant models, endorsed by ASUM and ISUOG were conducted for 12 GPs and 13 midwives. Participants maintained a record of frequency of use, ultrasound applications, change in clinical practice, changes in behaviour of clinical management and in antenatal patients such as modifications in lifestyle as a result of the POCUS scan. The KEF Levels 1 to 4 were used to appraise the efficacy of POCUS training, which included assessment of immediate reactions after training (Level 1), learning after training (Level 2), behavioural changes after training (Level 3) and results and impact on clinical practice after training (Level 4) using specifically designed surveys. Results: KEF Level 1 surveys demonstrated that the participants found the training very useful. Details and data for KEF Levels 2, 3 and 4 surveys will be presented. Advantages, limitations, barriers and challenges of POCUS implementation in clinical practice will be presented. Concrete tips for use of KEF in evaluating efficacy of ultrasound training programs will be discussed. Conclusions: Provision of antenatal POCUS training appears to benefit clinical practice in remote resource-poor settings in remote South Australia. KEF appears to be useful in evaluation of POCUS training.

Prenatal diagnosis of fetal multiple hemivertebrae: the importance of 3D ultrasound assessment

Abstract We herein present a case of fetal multiple hemivertebrae detected at antenatal sonography. The use of the 3 D technology supported by a new contrast enhancement rendering algorithm (Crystal Vue) has allowed the accurate prenatal classification of the defect, confirmed at follow up, that would have been difficult to define by 2 D only.

How often an isolated cardiac disproportion predicts a coarctation of the aorta? Single center experience and systematic review of the literature

Abstract Background: Cardiac disproportion is considered as an indirect sign of coarctation of the aorta (CoA). In this review, we have reassessed the positive predictive value (PPV) of such finding for a postnatal confirmation of CoA. Data sources: All cases of isolated cardiac disproportion diagnosed in the four-chamber and/or three-vessel/three-vessel and trachea views (right/left sections >1.5) were included. Postnatal cardiac findings were recorded. Additionally, a systematic literature search (PubMed, EMBASE, Cochrane library, and the reference lists of identified articles) regarding the association between antenatally detected cardiac disproportion and postnatal confirmation of CoA was performed. Data from our center were pooled with those derived from the literature. Results: Ten fetuses with isolated cardiac disproportion were selected from our center and 259 from the literature review. CoA was postnatally confirmed in 101/269 (PPV 38%). PPV of antenatal cardiac findings was significantly higher in earlier gestation (23/27, 85% <26+0 weeks versus 11/39, 28%≥26+0 weeks, p < .001). No significant difference was noticed comparing ventricular disproportion with combined ventricular and great vessels disproportion (86/230 versus 15/39, p  .89). Discussion: Isolated cardiac disproportion has an overall chance of one in three of heralding a CoA in the neonate. The specificity of these findings is significantly higher in the second trimester.

Self-Amputation of the Extra Digit in a Fetus with Polydactyly: First Ultrasound Demonstration

We herein report the first ultrasound evidence of the self-amputation of an extra digit in case of fetal polydactyly. The prenatal evidence of fetal polydactyly is not always followed by postnatal confirmation. This is not always due to ultrasound misdiagnosis, but often to an in utero self-amputation phenomenon. We demonstrate that there is the detachment of part of the digit, leading to the evidence of a neonatal bump on the site of the prenatal extra digit. This demonstration has been possible by the direct visualization of the remnant by ultrasound.