Zoran Belics

Risk of chromosome abnormalities in the presence of bilateral or unilateral choroid plexus cysts

Objectives: To evaluate the rate of chromosome abnormalities in cases of uni- and bilateral choroid plexus cysts (CPCs). Methods: A total of 10,875 ultrasound (US) examinations were performed in the second trimester, and 435 cases with CPC (4%) were found. After genetic counseling, 45 patients decided not to undergo karyotyping. The authors performed a chromosome analysis in 390 cases of CPCs. Results: The total risk of chromosome abnormalities was 3.59% (n = 14) and risk of trisomies was 2.05% (n = 8). Trisomy 18 was found in 6 cases (1.54%), trisomy 21 in 1 case (0.26%), and trisomy 9 in 1 case (0.26%). The risk of 45,X karyotype was 0.77% (n = 3). One case of 47,XXY karyotype and 2 cases with other chromosome abnormalities were found. In 212 unilateral cases there were 7 with chromosome abnormalities (3.3%). In 178 bilateral cases there were 7 with abnormal karyotypes (3.93%). The CPC was associated with additional fetal US anomalies (with or without polyhydramnios/oligohydramnios) in 112 cases; chromosome abnormalities were detected in 4 cases (3.57%). 66 cases were associated with polyhydramnios/oligohydramnios but not with other fetal US anomalies; 3 cases of abnormal karyotypes were found (4.55%). The CPC was isolated in 212 cases and 7 cases were associated with chromosome disorders (3.3%). Conclusions: US plays an important role in prenatal diagnostics. Further genetic counseling is recommended in cases with CPCs.

Assessment of uterine circulation in ectopic pregnancy by transvaginal color Doppler

OBJECTIVE The aim of our study was to determine the effect of abnormal implantation on uterine circulation and to evaluate whether the assessment of uterinal blood flow can provide additional information for the diagnosis of tubal pregnancies. METHODS Forty-nine patients with ectopic pregnancy were examined by transvaginal color Doppler immediately before surgery. Resistance and pulsatility indices of blood flow in the uterine and tubal arteries were measured. RESULTS The blood flow parameters of the uterine and tubal arteries did not change with gestational age. There was a significant increase in blood flow on the side with the tubal gestation. Differences between sides were higher in the tubal arteries than in the main uterine arteries and showed no dependence on gestational age. CONCLUSION The abnormal implantation and tubal trophoblast invasion in ectopic pregnancy (EP) can cause more marked blood flow changes in the adjacent supplying vessels than in the main uterine arteries.

Sonographic measurement of the fetal iliac angle in trisomy 21, 18 and 13

Objective: To determine whether iliac wing angle measurement in second trimester fetuses is a useful sonographic marker for the detection of trisomy 21, 18 and 13. Methods: During the period between September 1998 and September 2001, 406 fetal iliac angle measurements were performed in women in the second trimester of their pregnancies. The iliac angle measurements in fetuses with trisomy 21 (n = 25), trisomy 18 (n = 10) and trisomy 13 (n = 5) were compared with iliac angle measurement in fetuses with normal karyotypes (n = 333). Results: The mean iliac wing angle in the fetuses with trisomy 21 was 92.67 and 79.35° and 74° in fetuses with trisomy 18 and 13 (the mean iliac wing angle in the healthy fetuses was 70.09°). Conclusion: The proven larger iliac wing angle in neonates with Down’s syndrome can be demonstrated sonographically during the pregnancy, especially during the second trimester, and may be useful in prenatal screening of trisomy 21. The sonographic measurement of the fetal iliac angle cannot be used as a marker for trisomy 18 and 13. We have shown that fetuses with trisomy 18 and 13, on average, have iliac angles only a few degrees larger than healthy fetuses.

Prenatal ultrasonographic measurement of the fetal iliac angle during the first and second trimester of pregnancy

The aim of this study was to present our results of the sonographic measurement of the fetal iliac angle during the first and second trimesters of pregnancy.

MR imaging follow up after MR-guided focused ultrasound surgery for uterine leiomyomas - Early and mid term results

Abstract Rationale and Objectives: MR-guided Focused Ultrasound Surgery (MRgFUS) is an evolving thermoablative technique for treatment of benign and malignant soft tissue tumors. The feasibility and effectiveness of this non-invasive method has been tested by several investigators by treating uterine fibroid. The aim of the present study was to evaluate early and mid-term efficacy of MRgFUS treatment using MR imaging follow-ups. Materials and Methods: 38 patients with uterine fibroids were enrolled and treated by MRgFUS in a single center. MRI follow-up exams were performed 3 and 6 months after the procedure. Total fibroid volumes (FV) and non-perfused volumes (NPV) were compared and evaluated over time. Results: There was a significant reduction of FV at 3- and 6-month follow-ups (10±19%, p=0.022 and 19±29%, p<0.001, respectively). In the subgroup of fibroids smaller than 5.4 cm in diameter a 35±18% volume reduction was found after 6 months. There was also a positive correlation found between the early N...

Prenatally diagnosed fetal brain injuries with known antenatal etiologies.

Periventricular leukomalacia of pre- or postnatal onset is responsible for severe neurological and intellectual impairment and cerebral palsy later in life. The etiology is multifactorial, involving hypoxic-ischemic insults of various origin. The disorder is characterized by multiple necrotic foci of the white matter found most frequently adjacent to the lateral ventricles. In the past, intrapartum factors were thought to be the major cause of neonatal brain damage, but recent investigations highlighted the role of antenatal risk factors. We present 4 cases of antenatally diagnosed brain injury with known and unusual etiology.

P14.51: Case of exomphalos complicated with umbilical cord teratoma

Congenital teratomas of the umbilical cord are extremely rare. Only eleven case are known in the literature and two of those were associated with exomphalos. A 23-year old mother was performed a routine ultrasound examination in the 17 week of gestation. The ultrasonographic examination revealed a 49 × 25 mm midline sac adjacent to the anterior abdominal wall containing a solid and cystic mass. The parents asked for termination of pregnancy. The fetus weighed 131 g without the tumor. From 4 mm of the fetal end the cord contained a sac, measuring 5.5 × 6 × 6 cm, covered by transparent membranes. Fetal organs, small and large bowels with appendix, and the spleen were herniated into the exomphalos, as well as a solid and cystic tumor mass of 3 × 3.5 × 4 cm. Examination of the did not revealed any further malformation, histology of parenchymal organs showed normal development. The placenta was of normal size and shape but an unusual membranous sac was attached to the fetal surface, marginally. It was connected with the umbilical cord with an amniotic band. Microscopical examination of the tumor revealed complex structure consisting of various tissues from the three germinal layers. Mature tissue types were represented by well differentiated respiratory and intestinal glands, skin with dermal appendages, islets of cartilage, renal glomeruli, smooth muscle fibers, and ganglion cells, scattered in mesenchymal tissue. Large amount of immature neural tissue was present. Malignant component was not detected. The tumor was diagnosed as a benign immature umbilical cord teratoma. In the course of ultrasonographic scanning umbilical cord teratoma might be suspected when a solid and cystic, rapidly growing lesion is seen, attached to the cord in midline location. When the tumor is surrounded by membranous structures and hiding in an omphalocele the narrowing of the cord between the tumor and the abdominal wall could be a useful sign.

P066: Prenatal sonographic measurement of the fetal iliac angle in trisomy 21, 18 and 13

OBJECTIVE To determine whether iliac wing angle measurement in second trimester fetuses is a useful sonographic marker for the detection of trisomy 21, 18 and 13. METHODS During the period between September 1998 and September 2001, 406 fetal iliac angle measurements were performed in women in the second trimester of their pregnancies. The iliac angle measurements in fetuses with trisomy 21 (n = 25), trisomy 18 (n = 10) and trisomy 13 (n = 5) were compared with iliac angle measurement in fetuses with normal karyotypes (n = 333). RESULTS The mean iliac wing angle in the fetuses with trisomy 21 was 92.67 and 79.35 degrees and 74 degrees in fetuses with trisomy 18 and 13 (the mean iliac wing angle in the healthy fetuses was 70.09 degrees ). CONCLUSION The proven larger iliac wing angle in neonates with Downs syndrome can be demonstrated sonographically during the pregnancy, especially during the second trimester, and may be useful in prenatal screening of trisomy 21. The sonographic measurement of the fetal iliac angle cannot be used as a marker for trisomy 18 and 13. We have shown that fetuses with trisomy 18 and 13, on average, have iliac angles only a few degrees larger than healthy fetuses.