Luis Ortiz-Quintana

Fetal thymus size in uncomplicated twin and singleton pregnancies

The main objective of this study was to determine whether fetal thymic measurements could be obtained in twins, with a secondary goal to determine whether thymic measurements from uncomplicated singleton and twin pregnancies are comparable.

Second-trimester fetal aberrant right subclavian artery: original study, systematic review and meta-analysis of performance in detection of Down syndrome

First, to estimate the prevalence of fetal aberrant right subclavian artery (ARSA) in our population and its association with Down syndrome. Second, to determine the feasibility of ultrasound to visualize ARSA in the three planes. Finally, to carry out a systematic review of the literature on the performance of second‐trimester ARSA to identify fetuses with Down syndrome.

Sonographic thymic measurements in Down syndrome fetuses.

Children with Down syndrome (DS) can have hypoplastic thymuses with an impaired capacity to liberate newly generated T cells. We sought to determine if the size of the thymus in DS fetuses is different from control fetuses.

Comparison of measurements of the transverse diameter and perimeter of the fetal thymus obtained by magnetic resonance and ultrasound imaging

To compare measurements of the fetal thymus obtained by magnetic resonance imaging (MRI) and ultrasound (US).

Coronal view as a complementary ultrasound approach for prenatal diagnosis of aberrant right subclavian artery

Aberrant right subclavian artery (ARSA) is associated with chromosomal abnormalities, mainly Down syndrome, and congenital heart disease1–5. ARSA is caused by abnormal regression of the primitive right aortic arch between the right subclavian artery and the right common carotid artery. As a result, the aortic arch branches into four arteries instead of three, and the ARSA originates distal to the left subclavian artery at the level of the aortic isthmus. ARSA follows an oblique course behind the trachea and esophagus to reach the right arm. In 2005, Chaoui et al.2 described the methodology for assessment of fetal ARSA in the transverse three vessels and trachea view, in which the anomalous origin of ARSA, close to the ductus arteriosus, and its retrotracheal course can be visualized (Figures 1a and c). This group subsequently showed how to visualize fetal ARSA in a longitudinal view6, in which the artery arises as a fourth and distal vessel from the aortic arch; however, in this view the retrotracheal course is not identifiable. As Quarello and Carvalho7 remarked, although several anatomical variations can manifest as an aortic arch with four vessels in the longitudinal view, in cases in which ARSA originates anteriorly from the aortic arch, visualization of four supra-aortic vessels is not possible. We illustrate how this vessel can be visualized in the coronal plane. In order to assess ARSA, we obtain a coronal view of the fetal thorax, posterior to the trachea and anterior to the spine, until we are able to see the thoracic descending aorta. Highly sensitive color Doppler with a low velocity range (10–15 cm/s) shows ARSA as a vessel arising from the descending aorta at the level of the aortic isthmus and following an S-shaped course towards the right clavicle and shoulder (Figures 1b and c). This view has the advantage of providing visualization of the origin and course of the anomalous artery in the same plane. This view can also facilitate evaluation in cases in which the origin of ARSA is not in its most common position, such as ARSA originating anteriorly from the aortic arch or very distal to the left subclavian artery. It is important not to confuse ARSA with the azygos vein and its anastomosis with the superior vena cava. In the coronal view, the azygos vein courses parallel to the right side of the aorta, while ARSA arises from the aorta and follows an oblique course to reach the right arm. Pulsed Doppler interrogation is recommended to distinguish ARSA from the azygos vein in this region. In summary, fetal ARSA can be viewed in the coronal plane using ultrasonography. This approach shows both the anomalous origin of the artery and its S-shaped course to the right shoulder. Although the detection of ARSA is possible in a coronal view, it should be confirmed in the three vessels and trachea view.

Cardiovascular System Sonographic Evaluation Algorithm A New Sonographic Algorithm for Evaluation of the Fetal Cardiovascular System in the Second Trimester

To evaluate the reproducibility and feasibility of the new cardiovascular system sonographic evaluation algorithm for studying the extended fetal cardiovascular system, including the portal, thymic, and supra‐aortic areas, in the second trimester of pregnancy (19–22 weeks).

The impact of debulking surgery in patients with node-positive epithelial ovarian cancer: Analysis of prognostic factors related to overall survival and progression-free survival after an extended long-term follow-up period.

OBJECTIVE to estimate the prognostic factors associated with survival and progression free survival (PFS) in patients with node-positive epithelial ovarian cancer (EOC) after an extended long-term follow-up period. METHODS Data was provided by the Tumor Registry of the Mayo Clinic, Scottsdale, Arizona on 116 node-positive EOC patients who underwent primary cytoreductive surgery observed over the period 1996-2014. RESULTS At censoring date, 21 patients were alive (18%), 95 dead (82%), 18 without evidence of disease (NED) (15 alive, 3 dead) and 76 with evidence of disease (ED) (2 alive, 74 dead). Twenty-nine ED patients (38.2%) experienced a recurrence within 2 years, 53 patients (69.7%) before 5 years. No recurrences were recorded after 10 years. The median follow-up in alive patients was 169.8 months (1.20-207.9 months), 34.9 months (0.30-196.2 months) in dead patients, 128.4 months for NED patients (72.8-202.5 months) and 34.6 months (0.1-106.9 months) in ED patients. Multivariate analysis showed an increased risk of dead in patients with age ≥ 60 years (HR: 3.20; p < 0.002), stage IVA/B (compared with stage IIIA1/2, HR: 4.31; p < 0.001 and stage IIIB/C, HR: 5.31; p < 0.010) and incomplete surgery (compared with complete surgery, HR: 3.10; 95% CI, 1.41-6.77; p < 0.003) and a decreased PFS in stage IVA/B (compared with stages IIIB/C; p = 0.003 and stage IIIA; p = 0.000) and residual volume after surgery >0.6 cm (compared with residual disease <0.5 cm; p < 0.023). CONCLUSIONS prognostic factors for an extended long-term PFS are similar as those for survival, because after 17-year follow-up period, the majority of alive patients are NED patients.

Second trimester amniotic fluid adiponectin level is affected by maternal tobacco exposure, insulin, and PAPP-A level

OBJECTIVES Adiponectin is an adipocyte-derived plasma protein with insulin-sensitizing and antiatherosclerotic properties. The objectives of the present study were to determine the amniotic fluid (AF) concentration of adiponectin during the second trimester of pregnancy and to demonstrate its association with maternal and fetal variables and AF concentrations of insulin, leptin, and pregnancy-associated-plasma-protein A (PAPP-A). STUDY DESIGN We performed a cross-sectional study of 222 pregnant women who underwent amniocentesis at 15-18 weeks for genetic reasons. No malformation or chromosomal disorder was found in the newborn after birth. AF adiponectin, leptin, PAPP-A, and insulin concentrations were measured using commercially available assays. All maternal, fetal, and biochemical variables were studied using univariate and multivariate linear regression analysis to determine their association with the AF concentration of adiponectin. RESULTS Adiponectin concentration was negatively correlated with maternal smoking status (β=-5.208; p<0.001) and positively correlated with levels of insulin (β=0.621; p=0.002) and PAPP-A (β=40.150; p<0.001). Non-significant correlations were found between adiponectin concentration and maternal age, maternal body mass index, gestational age at amniocentesis, fetal gender, and AF level of leptin. CONCLUSION These findings suggest that the fetus and its membrane adipocytokines, in relationship with maternal and other fetal variables, play a dynamic role in the regulation of energy and oxidative stress homeostasis due to its insulin-sensitizing and antiatherosclerotic effects. The association of these molecules with maternal tobacco consumption during pregnancy could have perinatal implications.

Methotrexate-treated ectopic pregnancy: beta human chorionic gonadotropin serum changes as a success predictor using a mathematical model validation.

BACKGROUND Surgical rescue of methotrexate-treated ectopic pregnancy is necessary when tubal rupture or medical therapy failure is detected during post-therapeutic monitoring. It is known that an increased beta human chorionic gonadotropin (β-hCG) concentration is the most important factor associated with treatment failure. Therefore, we suggested that relative changes in serum β-hCG could predict a successful result of medical treatment, leading to facilitation of the decision to forgo the prospect of possible surgical rescue. METHODS A retrospective observational study of 115 patients with an ectopic pregnancy who were treated with a single dosage protocol of 50mg/m2 of methotrexate injected intramuscularly was performed at Puerta de Hierro University Hospital and Gregorio Marañón University General Hospital. Standard statistical tests were applied in order to evaluate the relative changes in β-hCG concentration between the 1st and the 4th days following methotrexate injection. RESULTS Methotrexate treatment has a 95% probability to be successful if the relative change of β-hCG from the 1st to the 4th day of monitoring is within the following interval: [-1.02; 0.15]. Moreover, if the values of β-hCG-relative change from 1st to 4th day of monitoring are within [0.54; 1.2], it assures a negative result of treatment with 95% probability. Therefore, the value 0.15 (15%) of β-hCG relative change can be considered a cut-off value for a positive result to treatment. CONCLUSIONS Our data support that negative β-hCG relative changes on the 4th day of treatment likely predict a successful result of methotrexate therapy, with a cut-off point of 0.15. Expectant management should be carried out in these cases if no clinical indications of surgery are presented.

Reference ranges for the pulsatility index of the fetal aortic isthmus in singleton and twin pregnancies.

The purpose of this study was to estimate reference ranges for the pulsatility index (PI) of the fetal aortic isthmus in uncomplicated singleton and twin pregnancies during the second half of pregnancy.