S. Gruessner

Management of stage I cervical sarcoma botryoides in childhood and adolescence

Rhabdomyosarcomas are the most common soft tissue sarcomas in childhood. The botryoid variant arises in infancy from the vagina or urinary bladder and extremely rarely from the uterine cervix. Treatment regimes range from local excision of the tumour to radical hysterectomy with adjuvant multidrug therapy and/or radiotherapy. In cases of minimal cervical invasion, the less invasive local excision in combination with adjuvant chemotherapy has resulted in excellent survival rates with complete functional preservation of the bladder, rectum, vagina, and ovaries. We present here a 30-year literature review and a case report of a cervical sarcoma botryoides in a 5-year-old girl. Conclusion:based on the literature review and our own observation, we recommend minor surgical approaches in combination with chemotherapy as the treatment of choice for early stage I cervical rhabdomyosarcoma.

Intravenous immunoglobulin (IVIG): modes of action in the clinical management of recurrent pregnancy loss (RPL) and selected autoimmune disorders

Abstract Recurrent pregnancy loss has been associated with autoimmune responses to membrane phospholipids and alloimmune reactions against paternally derived molecules on the trophoblast. The problem is psychologically and economically stressful as it undermines the capacity of some couples to reproduce and participate effectively in the day-to-day economic activities. This article reviews the adoption of intravenous immunoglobulin as a form of therapy for the clinical management of recurrent pregnancy loss and of selected autoimmune disorders. Side effects, contraindications and safety of use are discussed.

Early pregnancy loss and neonatal deaths associated with Klebsiella pneumonia infection: a mini review of possible occupational health risk

Recurrent pregnancy loss is a disease of grave psychological and economic concern. The etiology in the vast majority of the cases is unknown or at best poorly understood. Although Klebsiella pneumonia infections have been reported in humans and animals during pregnancy, there is hardly any information to indicate whether or not these infections may be responsible for early pregnancy loss. We present a review of literature and report for the first time in humans, Klebsiella pneumonia infection in placenta of a 38-year-old secondary recurrent aborter (parity 2+3).

Intestinal graft versus native liver cytokine expression in a rat model of intestinal transplantation with and without donor-specific cell augmentation

BACKGROUND Immunomodulatory strategies such as donor-specific bone marrow or blood transfusions have been used to promote engraftment after intestinal transplants. We previously showed that delivery of donor antigen via the portal vein can effectively reduce the rate of intestinal graft rejection. The purpose of our current study was to investigate the impact of donor-specific cell augmentation (blood versus bone marrow) via the portal vein on cytokine expression in intestinal grafts versus native livers. MATERIAL AND METHODS We performed heterotopic small intestinal transplants between male Brown-Norway (donor) and female Lewis (recipient) rats. We studied 10 groups according to the type of donor-specific cell augmentation and the use and dose of immunosuppressive therapy. For cell augmentation, donor-specific blood or bone marrow was transfused via the donor portal vein immediately before graft implantation. For immunosuppression, tacrolimus was used post-transplant at a high or low dose. Control rats received neither immunosuppression nor cell augmentation. Tissue samples for histological assessment were obtained at designated time points. RNA was extracted from intestinal graft and native liver biopsies for cytokine measurements (IL-1 alpha, IL-1 beta, IL-2, IL-4, IL-5, IL-6, IFN-gamma, TNF-alpha, and TNF-beta). Chimerism levels were determined using Q-PCR analysis. RESULTS Without concurrent immunosuppression, neither portal donor-specific blood nor bone marrow transfusion reduced the rate of rejection. With immunosuppression, outcome was significantly better after portal donor-specific blood (versus bone marrow) transfusion. Irrespective of the type of donor-specific cell augmentation, severe rejection caused strong cytokine expression in the grafts of IL-1 alpha, IL-1 beta, IFN-gamma, and TNF-alpha; in the native livers, mainly of TNF-alpha (with IFN-gamma showing hardly any increase). In general, rejection caused stronger cytokine expression in the grafts than in the native livers. Mild rejection correlated well with strong intragraft expression of IL-6, TNF-alpha, and TNF-beta (early rejection markers); severe rejection with IL-1 alpha, IL-1 beta, IFN-gamma, and TNF-alpha (late rejection markers). In addition to cell augmentation per se, the type of cell augmentation also had an impact on cytokine expression in both grafts and native livers. Cell-augmented (versus tacrolimus-treated) rats showed hardly any differences in intragraft cytokine expression, but the expression of almost all cytokines was significantly stronger in the native livers. With immunosuppression, bone marrow infusion increased intragraft cytokine expression of IL-1 alpha, IL-1 beta, IFN-gamma, and TNF alpha, as well as liver cytokine expression of IL-1 beta, compared to blood transfusion. This finding reflected the more advanced rejection stages in the bone marrow infused group; different types of donor-specific cell augmentation had similar effects on liver cytokine expression. In the absence of myoablative therapy, chimerism levels were low, in both cell-augmented and non-cell-augmented groups. CONCLUSIONS Rejection and donor-specific cell augmentation independently causes differences in intragraft versus native liver cytokine expression after intestinal transplants. Portal donor-specific blood transfusion, as compared with donor-specific bone marrow infusion, lowered the incidence of rejection and diminished intragraft cytokine up-regulation.

Radiofrequency endometrial ablation for the treatment of heavy menstrual bleeding among women at high surgical risk

To evaluate quality of life (QoL) after radiofrequency endometrial ablation (RFEA) for heavy menstrual bleeding among women at high surgical risk.

Doppler measurements in fetal descending aorta and umbilical artery can predict borderline oxygenation in pre-eclampsia and HELLP syndrome

Objective: To determine diagnostic utility of Doppler measurements in fetal descending aorta and umbilical arteries in predicting intrauterine growth retarded (IUGR) fetuses at risk in pregnancies complicated by preeclampsia and/or HELLP syndrome. Methods: Doppler measurements were taken in fetal descending aorta and umbilical arteries of 53 patients with pre-eclampsia, 10 of whom had HELLP syndrome using fetometry (ACUSON 128XP/10, 3.5 MHz probe). These values were compared with those of 44 appropriate-for-gestational age singleton pregnancies (AGA). Doppler Indices (Resistance Index (RI), Systolic/Diastolic (S/D) ratio) and end-diastolic flows were related to fetal heart rate (FHR) during contraction stress test, to cord blood parameters (pH, Base Excess) and to Apgar Scores. Results: In contrast to AGA fetuses, IUGR fetuses had decreased end-diastolic flow and an increase of Doppler Indices significantly earlier in the descending aorta (p < 0.05), compared to umbilical artery. Increased RI’s, S/D ratios and a decrease of end-diastolic flow in fetal aorta were significantly correlated to frequency of FHR decelerations during contraction stress tests, pH, Base Excess (p < 0.01) and Apgar Scores in IUGR fetuses. Conclusion: A decrease in end-diastolic flow paralleled with an increase in Doppler indices in fetal descending aorta reflect oxygen deprivation in IUGR fetuses during pre-eclamptic pregnancies with or without HELLP syndrome. While ductus venosus and umbilical artery are more frequently used nowadays to determine fetal oxygen deprivation, Doppler measurements in fetal descending aorta provide additional information for early detection of fetuses at risk for IUGR in pregnancies complicated with pre-eclampsia and/or HELLP syndrome

OC22.06: Quantitative carotid volume blood flow measurements using PW‐Doppler vs. transit‐time perivascular flowmetry in ovine twin fetuses

VOCAL tool within 4D View (GE Medical Systems) was used to outline the placenta. The power Doppler signal within this volume was counted in a three-dimensional manner adapting the random but systematic techniques used in stereology. Results: The mean (SD) placental FrVolBV was higher in the non-diabetic than in the diabetic group at each gestation; 0.144 (0.05) versus 0.104 (0.03) at 20 weeks, 0.145 (0.05) versus 0.128 (0.03) at 24 weeks, 0.159 (0.05) versus 0.133 (0.02) at 28 weeks and 0.154 (0.03) versus 0.123 (0.04) at 32 weeks. There was a significant difference in FrVolBV between normal and diabetic subjects [F(1.31) = 5.396, P = 0.027] and across gestation [F(3.93) = 3.633, P = 0.016]. Conclusions: Placental FrVolBV is reduced in women with diabetes from 20 weeks gestation using this novel stereological technique. This contrasts with the known increase in volume of the villous vasculature determined histologically. Structural changes in the large and apparently vascular placenta are therefore accompanied by altered function, with reduced perfusion demonstrable in-vivo.

P30.06: Prenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and MR imaging: two case reports

coloboma). It may be complete (when all ocular tissues are involved: optic nerve head, retina, choroid, iris, and lens) or incomplete. ONC represents an important cause of childhood visual impairment and blindness; moreover, it can be associated with several Mendelian and non-Mendelian syndromes (i.e. CHARGE, PHACE, etc.). Because of ultrasound limitation in depicting the posterior aspect of the fetal eye globe, ONC has not been reported so far during prenatal life. Patients and methods: Among about 250 fetal MR imaging cranial examinations performed during 2006 and 2007, we found three fetuses carrying ONC. The gestational age ranged between 20 and 32 weeks. Examinations were performed with a 1.5 T scanner, using 3–4-mm thick single-shot T2-wighted spin-echo sections. Results: In 2/3 cases ONC was associated with other cranial and extracranial malformations: CHARGE syndrome, and microcephaly respectively. In the other case only unilateral microphtalmos was associated. In two cases the ONC was bilateral. The ONC was depicted on coronal and sagittal sections as a cleft of the posterior aspect of the globe with small cystic bulging of the globe. Conclusions: Although the sensitivity of fetal MR imaging in detecting ONC remains to be determined, the prenatal diagnosis of ONC may have significant implications for counseling and it may prompt further investigations to rule out possible associated syndromic conditions.

OP03.04: Fetal malformations: comparison of MR imaging and ultrasonography for diagnosis

Methods: Sixty-six fetuses with isolated CDH were included. Contralateral fetal lung area was measured by 2D ultrasound (longest axis method). Ipsilateral, contralateral and total FLV were measured using multiplanar axial T2-WI MRI. Regression analysis was used to determine the significance of the association between contralateral lung area and total FLV and subsequently the predicted total FLV was calculated using a regression equation. Univariate regression analysis was used to investigate the effect on the proportionate difference between the predicted and the observed total FLV of gestational age (GA), proportionate volume of ipsilateral vs. total FLV, side of CDH, intrathoracic herniation of the liver and intra-tracheal presence of the balloon. Results: Sixty-six fetuses underwent a total of 191 paired 2D ultrasound and MRI examinations at a median GA of 30 (range, 18–38) weeks. It was possible to visualize and measure the contralateral lung area by 2D ultrasound as well as both the ipsilateral and contralateral lung volumes by MRI in all instances. There was a significant association between contralateral lung area and total FLV (r = 0.84; P < 0.001). Univariate regression analysis showed that the proportionate difference between the predicted and the observed total FLV was significantly associated with the proportionate volume of ipsilateral vs. total FLV but not with GA, side of CDH, intrathoracic herniation of the liver or intra-tracheal presence of the balloon. Conclusions: In CDH, contralateral lung area measurement by 2D ultrasound correlates well with total FLV by MRI irrespective of GA, liver herniation or side of herniation. Inconsistencies between both measurements are attributable to the contribution of the ipsilateral lung to the total FLV.

P10.40: Cerebro- and cardiovascular responses and oxygen consumption during prolonged hypoxia in fetal sheep

was 28% and 78% for the first trimester scan and 42% and 84% for the second trimester scan, while the values for predicting FGR was 22% and 84%, and 33% and 88% respectively. Conclusion: The performance of both first and second trimester RI values were better for pregnancy hypertension than fetal growth restriction. While there was good correlation between first and second trimester values, the performance appear to be better for second trimester values. A larger database would be needed to evaluate a combined first/second trimester index.