Eleftherios Anastasakis

Dual testing with QF-PCR and karyotype analysis for prenatal diagnosis of chromosomal abnormalities. Evaluation of 13,500 cases with consideration of using QF-PCR as a stand-alone test according to referral indications.

Evaluate the results obtained from Quantitative Fluorescent (QF)‐PCR and conventional karyotype analysis to determine the advantages and disadvantages of dual testing in prenatal diagnosis.

Selective reduction in twins and multiple pregnancies

Abstract The number of multiple pregnancies has increased, mainly due to the uncontrolled use of the assisted conception techniques. Multifetal pregnancy reduction (MFPR) has been used to reduce the risks associated with these high-risk pregnancies. It is performed in the first trimester of pregnancy by transabdominal injection of potassium chloride into the fetal heart. The risk of miscarriage seems to be associated with the final number of fetuses. A review of the literature suggests that MFPR results in better pregnancy outcome, regardless of the initial number of fetuses. The reduction to a lower number of fetuses reduces fetal losses, prematurity, infant mortality and morbidity.

Uterine tumor resembling ovarian sex cord tumors treated by hysteroscopy.

Uterine tumors resembling ovarian sex cord tumors (UTROSCT) were first described in 1976 [1]. All reported cases were treated by abdominal hysterectomy. We present a case of UTROSCT managed by hysteroscopy and conservation of the uterus resulting in successful child bearing. A 28-year-old woman (gravida 0, para 0) presented with intermenstrual bleeding. Ultrasound revealed an endometrial polyp arising from the posterior uterine muscular layer. The polyp was removed at hysteroscopy. The histopathologic examination reported that the endometrium was normal. In the stroma there was focal periglandular condensation together with expanded areas demonstrating prominent ovarian sex cord-like architecture. Scattered mitotic figures were seen (up to 2 per 10 high power fields). The sex cord-like areas were positive for vimentin, the epithelial marker cytokeratin CAM 5.2, estrogen receptor (ER), and progesterone receptor (PR). Patchy positivity for inhibin and calretinin confirmed their sex cord stromal differentiation. The stroma between the sex cord-like areas was positive for actin and focally for desmin, but CD10 was only positive in the more normal areas of the endometrial stroma (Fig. 1).

Anaphylactic reaction to ceftriaxone in labour. An emerging complication

Malone PR, Westone-Underwood J, Aron PM, et al. 1986. The use of transabdominal ultrasound in the detection of early bladder tumours. British Journal of Urology 58:520–522. Spahn M, Bader P, Westermann D, et al. 2005. Bladder carcinoma during pregnancy. Urologia Internationalis 74:153–159. Steinburg GD. 2005. Bladder cancer. Available at: http://www. emedicine.com/MED/topic2344.htm (Accessed 7 May 2007). Wax JR, Ross J, Marotto L, et al. 2002. Nonbilharzial bladder carcinoma complicating pregnancy – treatment with bacille Calmette-Guerine. American Journal of Obstetrics and Gynecology 187:239–240.

Assessment of nuchal translucency thickness and the fetal anatomy in the first trimester of pregnancy by two-and three-dimensional ultrasonography: a pilot study

Abstract Aim: To evaluate the use of three-dimensional ultrasonography (3D) as an alternative for examining fetal anatomy and nuchal translucency (NT) in the 1st trimester of pregnancy. Method: Prospective study of 199 low risk pregnant women undergoing 1st trimester ultrasound scan for fetal anomalies. The NT and fetal anatomy were evaluated by three-dimensional (3D) ultrasonography after the standard two-dimensional (2D) examination. The gold standard in this study was the 2D ultrasonography. Results: In some of the evaluated parameters the 3D method approaches the conventional 2D results. These parameters are the crown-rump length (CRL), the skull – brain anatomy (93.5%), the spine (85.4%), the upper (88.4%) and lower limbs (87.9%) and the examination of the fetal abdomen (98.5%). Some of the anatomic parameters under evaluation revealed a statistically significant difference in favor of the 2D examination. During the 3D examination the nasal bone was identified in 62.1% of the cases, the stomach in 85.9%, and the urinary bladder in 57.3% of the cases. The NT was assessed accurately in half of the cases compared to 2D examination. Conclusion: The 3D ultrasound is insufficient for the detailed fetal anatomy examination during the 1st trimester of pregnancy. Nevertheless, the method might be improved in order to be considered as a screening method.

First trimester diagnosis of conjoint (pygopagus) twins: A case report of successful prenatal and postnatal management.

Bennich G, Langhoff-Roos J. 2005. Placenta percreta treated using a new surgical technique. European Journal of Obstetrics, Gynecology and Reproductive Biology 122:122–125. Chou MM, Ho ES, Lee YH. 2000. Prenatal diagnosis of placenta previa and accrete by transabdominal color Doppler ultrasound. Ultrasound in Obstetrics and Gynecology 15:28–35. Gilliam M, Rosenberg D, Davis F. 2002. The likelihood of placenta previa with greater number of caesarean deliveries and higher parity. Journal of Obstetrics and Gynecology 99:976– 980. Morkon NH, Henriksen H. 2001. Placenta percreta – two cases and review of the literature. European Journal of Obstetrics and Gynecology 100:112–115. Morrison JE. 1978. Placenta accreta. A clinicopathologic review of 67 cases. Journal of Obstetrics and Gynecology 7:107–123. Wong HS, Parker S. 2005. Ultrasound findings in conservatively treated placenta percreta. Ultrasound in Obstetrics and Gynecology 26:580–582.

Ultrasound of Congenital Fetal Anomalies. Differential Diagnosis and Prognostic Indicators

mention of open laparoscopy. There are occasions where the text would benefit from a comprehensive evaluation of the available evidence. Within the endometriosis section it is stated that ‘the risk of adhesions is not zero with laser vapourisation, but is much lower than after large excision’ but no data are used in order to support this statement. Nevertheless in other parts of the text the authors do explain why their views differ from the published evidence. This is of course almost inevitable in a field that is changing rapidly and in which all trials have their limitations. I have no doubt that every gynaecological surgery unit throughout the country would benefit from having this textbook made available to all the gynaecological surgeons.

Problem-based Obstetric Ultrasound

There is a large amount of on-going research in the area of reproductive medicine, for the management of infertility, not only in the primary and secondary care setting but also in regard to assisted reproductive treatment options. The development of new and effective treatment modalities has led to new challenging issues on the legal and moral aspects of new techniques which have been adequately addressed in this book. The authors have incorporated up-to-date information, encompassing the pathophysiology of infertility to treatment modalities and they are all well supported by useful data and illustrations. This book essentially reflects the active management practice of infertility in the USA, which is not always in line with our British practice. For example, it has been recommended that: ‘It is justified to perform an infertility evaluation and initial treatment if a couple have not achieved a pregnancy after 6 months of trying or sooner if there is an obvious or unknown cause of infertility’. This is not in line with NICE guidelines. I note that our US colleagues still recommend using a basal body temperature chart, which has been long abandoned in British practice. There is another interesting observation which relates to assessment of endocrine profile on day 3 of menstrual cycle for assessment of ovarian reserve. That involves measuring FSH and oestradiol on day 3; thereafter it is recommended that clomiphene citrate challenge test be used, especially if FSH is 410 m/l. However, it has to be recognised that FSH levels do fluctuate from cycle to cycle. Nevertheless, this book provides a lengthy chapter on preconception care and expands well on the social aspects such as occupational hazards, effects of excessive smoking and drinking, use of recreational drugs and risks related to high BMI. The book provides useful algorithms for management of various causes of infertility. The flow charts are clearly drawn regarding patient care and course of management. Other chapters provide explicit accounts of factors affecting success rate of various infertility treatments, use of clomiphene citrate, progesterone and even medical management of an ectopic pregnancy using methotrexate. I believe this book has an important contribution to the literature of infertility. It is useful for all practitioners with an interest in the management of infertile couples.