Renato Bauman

Modification of conservative treatment of heterotopic cervical pregnancy by Foley catheter balloon fixation with cerclage sutures at the level of the external cervical os: a case report.

IntroductionConservative treatment of a heterotopic cervical pregnancy was performed with a modification of the fixation of a Foley catheter at the level of the external cervical os, followed by the ligature of the descending cervical branches of the uterine arteries and systemic methotrexate application.Case presentationA 34-year-old Caucasian woman was diagnosed with double gestation after 6 weeks of in vitro fertilization treatment. A gynecological examination and color Doppler ultrasound scan revealed intra-uterine and cervical gestational sacs both containing live fetuses. A Foley catheter balloon was inserted into the cervical canal, inflated and fixed by a cerclage suture at the level of the external cervical os, followed by ligation of the descending cervical branches of the uterine arteries. Systemic methotrexate was applied. Three days after removal of the Foley catheter, an evacuation of the intra-uterine gestational sac was performed. Hemorrhage from the implantation site was controlled immediately and a pregnancy termination was successfully performed. The procedure was uneventful and our patient was discharged with a preserved uterus.ConclusionsConservative treatment of cervical pregnancy using a Foley catheter balloon is more efficacious if the Foley catheter balloon is attached in the correct position with a cerclage suture at the level of the external os, followed by ligation of the descending cervical branches of the uterine arteries, thereby exerting maximal pressure on the bleeding vessels.

In vitro fertilization in spontaneous cycles—our experience

OBJECTIVE To study the efficacy of a simple protocol of natural cycle in vitro fertilization. METHOD A retrospective study of 59 natural treatment cycles in 37 infertile couples with previous unsuccessful attempts of conventional in vitro fertilization. RESULTS In 24% of cycles, the aspiration was cancelled because of inadequate visualization of follicles or because of preterm ovulation. Aspiration was performed in 45 cycles with oocyte retrieval of 82% per aspiration. Embryo transfer was performed in 30 cycles, pregnancy rate per pick-up was 15%. CONCLUSION In vitro fertilization in a natural cycle is a simple, relatively cheap and comfortable procedure with reasonable results and can be offered to patients scheduled not only for in vitro fertilization because of tubal factor but also to patients with endometriosis or unexplained infertility.

Ruptured ovarian metastatic malignant melanoma caused acute abdomen

Ovarian metastatic malignant melanoma is a rare form of disseminated malignant melanoma. We present a rare case of acute abdomen due to rupture of ovarian metastatic malignant melanoma seven years after removal of a primary cutaneous malignant melanoma lesion, followed by reexcision of the cicatrix and axillary dissection (Clark III, Breslow IV), one year after osteoplastic parietal craniotomy for removal of recidiv metastatic lesions, and excision of the cutaneous malignant melanoma lesion on the upper leg were performed. During laparotomy because of acute abdomen, 4 L of free liquid (blood and ascites) were evacuated. The right adnexal mass was loose tumor, size 110x75 mm, with rupture on the posterior wall and hemorrhage. Unilateral adnexectomy was performed. Pathohystologic evaluation revealed tumor cells with eosinophilic, clear cytoplasm, intracytoplasmatic melanotic pigment and a great number of mitosis.Immunohistochemical results supported positivity for protein S-100, whereas results for cytoceratin 7, cytoceratin 20, pancytoceratin, epithelial membrane antigen and HMB-45 were negative. Three months after the surgery the patient died due to disseminated cerebral melanoma. An adnexal mass and the history of previous MM should be suspected to be ovarian metastatic malignant melanoma and the patient should be seen by gynecologist at least for active treatment.

Refractory shoulder dystocia in term macrosomic newborn with verified complete meningoencephalomyelocele

The authors presented the birth course, in a primiparous woman with complicated, refractory, high shoulder dystocia, of a macrosomic term-born malformed child (4400/54) with complete occipital meningoencephalomyelocele and microcephaly. After head delivery, high shoulder dystocia occurred that could not be resolved with neither the McRoberts or Resnik maneuver nor with the Woods and Barnum maneuvers, despite recurred tries. Only on third attempt with the Barnum maneuver was the posterior arm released with hand traction, followed by the whole body of the macrosomic baby. The child was transferred to the Neurosurgery department where operative correction was performed, and after the intervention the child died because of respiratory insufficiency. Due to the strict parental decision on pregnancy continuation and prohibition of any obstetric interventions during delivery, unborn child and parturient, as well as the obstetric team, were put into high professional, forensic and ethical risk.

Follicular fluid vascular endothelial growth factor is associated with type of infertility and interferon alpha correlates with endometrial thickness in natural cycle in vitro fertilization

The aim of this study was to analyse the presence of vascular endothelial growth factor (VEGF) and interferon alpha (IFN-α) in the follicular fluid (FF) and their possible influence, as pro-angiogenic or anti-angiogenic factors, on in vitro fertilization outcome. The concentrations of VEGF and IFN-α were correlated with oocyte and embryo quality, concentrations of hormones in the serum, perifollicular blood flow and endometrial thickness. VEGF was detected in all FF samples (median 706.6 pg/ml, range 182.9-6638 pg/ml). IFN-α was detected in 60% of the samples (median 6.5 pg/ml, range 0-79.4 pg/ml), while in 40% of the samples its levels were below the test detection limit. VEGF and IFN-α concentrations did not correlate with the cause of infertility, concentrations of FSH, LH, E2 and prolactin, oocyte or embryo quality. Significantly higher concentrations of VEGF have been found in women with primary compared with secondary infertility (p = 0.011, Mann Whitney test). The concentrations of VEGF and IFN-α did not correlate with the resistance index (RI) on days of hCG administration, follicular aspiration and embryo transfer. However, the concentrations of IFN-α correlated with endometrial thickness on the day of embryo transfer (Spearman correlation coefficient ρ = 0.4107; P < 0.05) but not on days of hCG administration and follicular aspiration. The mechanism of VEGF association with the previous ability of having a child needs to be clarified in future studies. The results of this study indicate a possible role of IFN-α in pathways of endometrial remodelling.