T. Singer

Rare case of ovarian cystic lymphangioma.

Lymphangiomas are rare, generally benign tumors of the lymphatic system comprised of multiple cystic spaces lined with endothelium. Lymphangiomas may arise in any part of the body. Lymphangioma of the ovary is rare; we have identified only 13 reports in a 50-year literature survey (PubMed 1959-2009). Typically, lymphangiomas are slow-growing tumors that remain asymptomatic for a long time. They are most often found incidentally in abdominal or pelvic imaging studies or at surgery or autopsy. Wide excision of the lesion with microscopically clear margins is the best approach when feasible. A postmenopausal woman had a symptomatic pelvic mass. Imaging studies demonstrated a complex left ovarian cyst. Complete removal of a cystic lymphangioma was successfully performed at laparoscopy. Cystic lymphangiomas should be included in the differential diagnosis of an ovarian cystic mass, and laparoscopic excision may be the method of treatment.

Restrictive dermopathy: two‐ and three‐dimensional sonographic features

when irreversible disease is suspected. This presumably occurs when AV-node disruption to conduction is primarily due to inflammation rather than tissue fibrosis. Similarly, resolution of myocardial echogenicity may in part have been due to suppression of local inflammation. Since the fetal risks of Sjögren’s syndrome are generally unpredictable, a proactive approach to identifying early AV-node disease has been advocated. Fetuses with a prolonged PR interval at 16 weeks’ gestation may benefit from transplacental dexamethasone therapy5. With second-degree heart block prenatal antiinflammatory agents can improve AV conduction3,4,6. Some consider dexamethasone at detection of AV-node disease essential for the prevention of hydrops7,8. In the absence of contraindications, maternal dexamethasone appears reasonable for recent-onset AV block, myocardial echogenicity, or altered myocardial function with or without hydrops. The earlier use of dexamethasone is unnecessary as significant fetal disease is rare prior to 16 weeks. In patients unresponsive to steroids, intravenous immunoglobulin or terbutaline are considerations for the stabilization of cardiac function5,7. We illustrate a possible role of transplacental dexamethasone therapy even when seemingly irreversible fetal manifestations of maternal Sjögren’s syndrome are present. Cautious consideration of side-effects and verification of a therapeutic effect are essential for the continuation of such therapy.

Laparoscopic resection of endometriosis in a patient with a ventriculoperitoneal shunt using the LapDisc.

The surgical approach in a patient with a ventriculoperitoneal shunt in need of abdominal surgery remains controversial. The risk of increased intracranial pressure with pneumoperitoneum in laparoscopy is still unresolved. We used the LapDisc (Ethicon, Inc., Somerville, New Jersey) to access the shunt and temporarily seal it, which enabled us to perform laparoscopic resection of endometriosis without subjecting the shunt to high intraabdominal pressure. The benefits of this approach are the ability to perform laparoscopy, less skin-to-shunt contact minimizing infection, and elimination of possible increased intracranial pressure secondary to pneumoperitoneum. With the progress made in the management of hydrocephalus, patients with ventriculoperitoneal (VP) shunts enjoy a longer lifespan. Therefore, the gynecologic laparoscopic surgeon can expect to treat a patient with a VP shunt in place.

AMH Serum Level as a Predictor of In Vitro Fertilization (IVF) Parameters [3B]

INTRODUCTION:Anti-mullerian hormone (AMH) serum level is a component of the infertility workup to evaluate ovarian reserve. Diminished ovarian reserve is one of the major causes of female infertility. Our study examines the relationship between AMH serum level and IVF success.METHODS:We performed a

Reduction in the number of CGG repeats on the FMR1 gene in carriers of genetic disorders versus noncarriers

Objective CGG repeat expansion on the fragile X mental retardation 1 (FMR1) gene is used to diagnose fragile X syndrome. Previous studies have discussed the correlation between the number of CGG repeats and its associated phenotypic components. The objective of this study is to determine whether the number of CGG repeats differ between carriers of genetic disorders versus noncarriers. Methods We performed a retrospective chart review of 2867 patients who received genetic screening at our fertility clinic between June 2013 and July 2015. The number of CGG repeats on allele 1 and allele 2 on the FMR1 gene was collected and it was specified whether the patient was a carrier or a noncarrier of a specific mutation. Patients with CGG repeats greater than or equal to 45 were excluded from the study. Results Carriers (n=759) had a reduced number of repeats compared to noncarriers (n=2024) on allele 1 (p=.03), allele 2 (p=.02) and the average of both alleles (p=.01). Additionally, the number of CGG repeats from the ten most carried diseases from the cohort were used and tested individually for clinical significance against the number of repeats in the noncarriers. A reduction in repeats was shown in several mutations and a few were outliers. Conclusion Our results demonstrate that there is a significant reduction in the number of CGG repeats in carriers of genetic mutations. A larger scale study of disease carrying patients would be beneficial.

P39.13: An early pregnancy failure followed by a tubal pregnancy and 2 full-term deliveries in different uterine cavities in a patient with uterine didelphys

counselled regarding the outcome for the baby. Amniocentesis was deferred in view of the gestational age and polyhydraminos. Mode of delivery was discussed and vaginal birth planned with consideration for caesarean section for obstetric indications. At 37 weeks gestation she delivered vaginally a female child weighing 2.25 kg. The baby was transferred immediately to the Paediatric cardiology unit and despite all measures died after two weeks of birth. Later debriefing and counselling was performed regarding future recurrence risk and prenatal diagnosis. In this case an important maternal and fetal diagnosis of chromosomal abnormality was made due to attendance in a dedicated specialist clinic and specific ultrasound features.

OP09.06: Ultrasound screening for major fetal congenital anomalies at the time of Nuchal Translucency Screening

after the onset of the last menstrual period were eligible for further analysis. For each gestational age (GA) we calculated mean CRL and standard deviation. For the purpose of the comparison with results obtained by Robinson and Fleming a non-linear regression analysis was performed in order to obtain the curve of best-fit together with two standard deviations. Original measurements were further analyse to determine dating curve for GA relative to CRL. Actual GA data were then compared with predicted GAs at corresponding CRL values of Robinson and Fleming, resp. Drumm dating curves. Results: The best-fit curve for relation of CRL to GA was achieved by a quadratic function y = −0.0232x2 + 5,1802x − 214,5414 (SD = 6.81, R2 = 0.2994). Dating curve for GAs relative to CRL was determined GA (days) = −0.0005CRL2 + 0,6264CRL − 69.9803 (SD = 3.34, R2 = 0.2949). Comparing actual GAs for our CRL values with predicted GAs from Robinson and Fleming at corresponding CRLs, mean diferrence were −1.32 ± 3.91 days. Similar comparison with the data of Drumm revealed mean difference 0.67 ± 4.17 days. Robinson CRL curve, resp. Drumm CRL curve underestimated GA by 7.6, resp. 6.9 days for CRL of 40 mm, and overestimated by 4.8, resp. 8.2 days for CRL of 90 mm. Conclusions: Dating curve based on 6221 CRL measurements was more gradual than those of Robinson and Drumm. For CRL of 40 mm Robinson CRL curve, resp. Drumm CRL curve underestimated the GA by 7.6, resp. 6.9 days, and for CRL of 90 mm overestimated by 4.8, resp. 8.2 days. The difference is on the verge of significancy.