Raul A. Cortes

Prognostic role of tumor-head volume ratio in fetal sacrococcygeal teratoma

Objective: To evaluate the ability of a tumor-head volume ratio to predict outcome and incidence of hydrops in fetuses with sacrococcygeal teratoma. Methods: Seventy-one sonograms were reviewed retrospectively from 28 fetuses with sacrococcygeal teratoma managed in our institution. Head volume (HV) and total tumor volume were calculated from sonograms. Amount of cystic tumor was estimated to determine solid tumor volume (STV) for the STV/HV ratio. Results: Twenty percent of sonograms with STV/HV <1 and 97.3% with STV/HV >1 were associated with 1 or more abnormal sonographic signs (p = 0.000). Overall mortality was 11/27 (41%). There was no mortality in fetuses with a ratio of <1, while 11/18 (61%) of fetuses with ratio >1 died (p = 0.003). Conclusion: The STV/HV ratio may be used to identify fetuses with a high risk of a poor outcome due to high-output cardiac failure and hydrops, and may help guide management.

Intermediate Interstitial Deletion of Chromosome 7q Detected by First-Trimester Down’s Syndrome Screening

We report a case of prenatally diagnosed chromosome 7q intermediate interstitial deletion with the aid of first-trimester Down’s syndrome (DS) screening. After detection of a significantly diminished maternal serum pregnancy-associated plasma protein A and correspondingly high DS risk, the pregnant woman underwent amniocentesis for fetal chromosomal analysis. Amniocytes revealed a 46,XY,del(7) (q21.2q31.1) karyotype and 21 weeks’ sonography revealed fetal growth restriction, elevated nuchal fold thickness and cardiomegaly. After therapeutic induction at 22 weeks of gestation, a 310-gram male fetus was born with multiple gross abnormalities including hypertelorism, wide nasal bridge, low-set ears, cleft palate, prominent cheeks, prominent nuchal skin, simian crease and postaxial polydactyly. We review the associated prenatal screening findings, the sonographic profile and phenotypical features associated with chromosome 7q intermediate interstitial deletion.

Biomaterials and the Evolution of Hernia Repair I: The History of Biomaterials and the Permanent Meshes

Increasingly, bioprosthetic materials are being used for a variety of surgical applications. In general surgery, for example, surgical techniques for hernia repair have been influenced directly by the development of different prosthetic meshes. As the field of biomaterial science advances, new insight into the physiological response to materials guides the development of newer classes of biomaterials including synthetic, partially synthetic, and natural tissue derivatives. This chapter, the first of three parts on materials for hernia repair, outlines historical aspects of bioprosthetic materials, details experimental (often animal) and clinical evidence for use of current materials, and establishes a framework for understanding the principles used for development of new prostheses. Although hernias serve as the model disease, the fundamentals of bio-prostheses interactions are applicable to many different genres in medicine.

Biomaterials and the Evolution of Hernia Repair II: Composite Meshes

The term composite is used in a number of different ways in the literature and, depending on the background of the author, the definition is interpreted differently. In its broadest and simplest meaning, it refers to a structure composed of two or more different materials, independent of the manufacturing method. Methods used to combine materials vary from simple techniques such as sutured or glued meshes to more complex processing such as thermopressing and vapor deposition. Central to all these techniques is a desire to obtain favorable properties and minimize negative characteristics of respective components.

Failed termination of pregnancy due to uterus bicornis unicollis with bilateral pregnancy.

A case of pregnancy in each horn of a uterus with a double corpus and 1 cervix and vagina (uterus bicornis unicollis) is reported. The patient had earlier undergone a suction curettage for termination of pregnancy. Histologic evidence of retained products of conception was subsequently confirmed. Hysterosalpingography confirmed the presence of 2 independent uterine horns. The right uterine horn was entered and a suction currettage was performed. The patient requested permanent sterilization and laparoscopic cauterization of the tubes was performed. This case illustrates the importance of acquiring histologic confirmation of the complete evacuation of the products of conception.

Biomaterials and the Evolution of Hernia Repair III: Biologically Derived Prosthetic Meshes

The concept of using biologically based tissues as constructs is not new. For example, tissue-based heart valves have been used in cardiac surgery for more than three decades with excellent clinical success. Using protein fixation techniques, long-term host recognition of cadaveric or porcine antigens have been successfully repressed.