Showing papers by "Elisenda Eixarch published in 2011"

Incidence and clinical implications of early inadvertent septostomy after laser therapy for twin-twin transfusion syndrome.

Abstract: Objective To evaluate the incidence and clinical outcome of inadvertent septostomy after fetoscopic laser therapy for twin–twin transfusion syndrome (TTTS) and, particularly, to explore its association with the risk of developing pseudoamniotic band syndrome (PABS). Methods In a cohort of 414 consecutive monochorionic twin pregnancies with confirmed TTTS treated with laser, the incidence of postoperative septostomy within 1 week of the procedure was recorded prospectively. Rates of preterm delivery, preterm premature rupture of membranes (PPROM), intrauterine fetal demise (IUFD) and PABS were compared among cases with and without septostomy. Results The mean gestational age at laser therapy was 20.4 (range, 15.3–27.6) weeks. Postoperative septostomy occurred in 30 (7.2%) cases. Pregnancies complicated with septostomy had a significantly higher proportion of preterm delivery before 32 weeks (76.7% vs. 30.2%, P < 0.001), PPROM before 32 weeks (46.7% vs. 19.0%, P < 0.001), IUFD (43.3% vs. 25.8%, P < 0.05) and PABS (13.3% vs. 1.0%, P < 0.001), compared with pregnancies without septostomy. Conclusions Inadvertent septostomy occurred in 7% of cases after fetoscopic laser therapy and was associated with a substantially increased risk of adverse perinatal outcome and PABS. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Outcome prediction in monochorionic diamniotic twin pregnancies with moderately discordant amniotic fluid.

Abstract: Objective The aim of this study was to identify predictors of twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR) in monochorionic diamniotic (MCDA) twin pregnancies with moderate amniotic fluid discordance (mAFD). Methods Monochorionic twins with mAFD (n = 45; gestational age, 15–29 weeks) were assessed for extent of fluid discordance, fetal growth discordance and fetal cardiac dysfunction, and were followed longitudinally. A prediction algorithm was constructed for TTTS and sIUGR and validated in an unrelated cohort (n = 52). Results Cardiac dysfunction could not predict TTTS or sIUGR. Twins below 20 weeks of gestation with a fluid discordance of ≥ 3.1 cm had a risk of TTTS of 85.7%. Sensitivity for TTTS was nevertheless only 55%. An intertwin weight discordance of ≥ 25% had 63% sensitivity and 76% specificity for sIUGR without TTTS. Conclusion The outcome of MCDA twins with mAFD remains unpredictable, yet high-risk and low-risk subgroups for TTTS can be identified based on severity of fluid discordance and gestational age. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Cord occlusion followed by laser cord transection in monochorionic monoamniotic discordant twins

Abstract: Objective To compare the outcomes of a consecutive case series of monochorionic (MC) monoamniotic (MA) discordant twins treated with umbilical cord occlusion and transection, with those of a cohort of MC diamniotic (DA) twins treated with conventional cord occlusion. Methods This study included 17 MCMA twins (12 true MA and five iatrogenic) treated with cord occlusion and transection and a control group of 72 MCDA discordant twins treated during the same period with cord occlusion in a single center. Duration of surgery, rates of preterm delivery (PTD) or preterm premature rupture of membranes (PPROM) < 32 weeks and intrauterine fetal demise (IUFD), perinatal outcome and neonatal survival were prospectively recorded in both groups. Results Median durations of surgery were 28.5 (range, 14.0–74.0) min and 24.0 (3.0–60.0) min in the cord transection and control groups, respectively (P = 0.24). There were no significant differences between cord transection and control groups in the rates of PPROM (35.3% vs. 20.8%, P = 0.22), PTD (41.2% vs. 28.2%, P = 0.29), IUFD (0% vs. 2.8%, P = 1.0) and neonatal survival (76.5% vs. 80.6%, P = 1.0). Gestational age at delivery (median 35.0 (24.5–39.0) vs. 37.1 (26.2–41.0) weeks, P = 0.21) and fetal birth weight (2215 (800–3200) g vs. 2605 (588–3830) g, P = 0.51) were similar between study groups. Conclusion Cord occlusion and transection in MCMA discordant twins resulted in similar perinatal outcomes to those of MCDA discordant twins treated with cord occlusion. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Automated morphometric characterization of cardiac fibers by second harmonic microscopy imaging

Abstract: Cardiovascular diseases are one of the main causes of mortality in the world. For this reason it is important to develop techniques that allow for better understanding of cardiac remodelling prior to heart failure. In this line, Second Harmonic Imaging (SHI) provides a label-free microscopy approach to image cardiac fibers. In this work, we automated means for measuring average sarcomere length, intrasarcomeric A-band distance and sarcomere fiber density as such features have been repeatedly correlated with major cardiomyopathies in the literature (previously measured by manual means). We tested our approach on healthy cardiac tissue of rabbits and human samples and compared such results with manual measurements on the same images to validate our methods. We also measured morphometric differences in cardiac fibers from our animal model which undergoes an irregular heart development. We then conclude that our automated measurements enable reliable characterization of cardiac fiber tissues.

OP14.02: Neurodevelopmental outcome of posterior fossa anomalies with uncertain prognosis

Abstract: Local glandular cystitis of the urinary bladder is a rare benign disease. In its minor form, it has the same clinical features as simple cystitis, but its major pseudoneoplastic form may be mistaken for bladder tumor, even pelvic tumor. This case presented the rare ultrasonographic characteristics of local extravesical glandular cystitis mimicking pelvic neoplasm using transvaginal sonography. A 36-year-old woman patient presented with a 3-week history of gross haematuria and intermittent suprapubic discomfort. Physical examination, urinary cytology and culture including AFB were unremarkable. She was examined by transvaginal sonography within 1–3 days, 14 days and 90 days after hospitalization. Ultrasound demonstrated a 28*19*16 mm solid mass lesion between the posterior bladder wall and anterior wall of cervix like a pelvic neoplasm. The echographic features on TRUS are hypoechoic and isoechoic mixed, poorly defined mass lesion with indistinct margins. Chronic sinus tract formation was contiguous with cervix and the mass was attached to the bladder wall. CT demonstrated invasion of the adjacent structures. Eventually, the patient underwent a transvaginal biopsy of the ‘‘tumor’’. The histology demonstrated glandular cystitis with mild chronic inflammation of the lamina and no evidence of malignancy. Histological analysis of the specimen confirmed diffuse muscle infiltrating areas of glandular cystitis. The patient made an uneventful recovery and was completely asymptomatic at 3-month follow up. Glandular cystitis is a benign proliferative disorder of the von Brunn’s nests within the mucosa and the submucosa of the urinary bladder epithelium. According to its extension we can distinguish localized from widespread intestinal metaplasia of glandular cystitis. The condition masquerading as a pelvic tumor is rare. We demonstrate a rare case which may assist diagnosis especially in young patients presented with haematuria and intermittent suprapubic discomfort.