An early suspicion of intestinal volvulus allows the clinician to refer the patient to a tertiary center so to confirm the diagnosis and perform an appropriate follow-up in order to identify the proper time of delivery. The prognosis of the babies with prenatal intestinal volvulus depends on the length of the segment involved, on the level of intestinal obstruction, on the presence of meconium peritonitis and on the gestational age at birth. Our experience, according with the literature, suggests that ascites and absence of abdominal peristalsis are ultrasonographic signs that, in the third trimester of pregnancy, correctly lead to an immediate delivery intervention.

Arterial hypertension is associated with an increased risk of atrial fibrillation (AF), and leads to a pronounced increase in morbidity and mortality. Left atrial volume (LAV) is an important prognostic marker in the older populations. The aim of our study was to identify the clinical and echocardiographic determinants of LAV in middle-aged (o70 years old) essential hypertensive patients.We evaluated cardiac structure and function in 458 patients, 394 treated and untreated mild to moderate essential hypertensives patients (mean±s.d. age 48.4±11.1 years) with no associated clinical condition and 64 normotensive control participants (age 45.7 ± 12.8 years; P ¼ 0.12). A multivariate analysis was performed to calculate the relative weight of each of the variables considered able to predict LAV. The LAV index (LAVi) was significantly increased in the essential hypertensive group vs the control group and was significantly dependent on blood pressure levels (SBP and DBP, Po0.05 for both) and body mass index (BMI) (Po0.0001). Considering the left ventricular (LV) variables, the LV mass index (LVMI) (R 2 ¼ 0.19, Po0.001) and LAV were increased in essential hypertensive patients with left ventricular hypertrophy (LVH), and patients with enlarged LAV showed lower systolic and diastolic function and an increased LVMI. The LAVi is dependent on blood pressure levels and anthropometric variables (age and BMI). Further structural (LVMI) and functional (systolic and diastolic) variables are related to the LAVi; LVMI is the most important variable associated with LAV in mild to moderate essential hypertensive adult patients. These findings highlight the importance of left atrium evaluation in adult, relatively young, essential hypertensive patients.

Introduction. Menopause is associated with a dramatic increase in incident hypertension and cardiovascular risk. It has been suggested that an impairment of baroreflex sensitivity BRS) may play a role in this process. Aim. To evaluate the relationship between BRS and global cardiovascular risk in healthy (NT) and hypertensive (EH) postmenopausal women. Methods. We evaluated, in 38 EH (mean age 55.2±4.6 years) and 23 NT (55.3±4.2 years) postmenopausal women, BRS, a complete Echocardiogram, office blood pressure and the abdominal circumference (AC). Women who presented AC > 88 were defined affected by central obesity (COb). Spontaneous BRS was assessed using Portapres device. Structure and function of their heart was studied by M-Mode, B-Mode and Doppler echocardiography (ATL 5000, probe 2-4 MHz). Results. EH shown higher blood pressure levels than NT and a bigger interventricular septum (9.4±1.9 vs 8.3±1.5 mm p<0.03) and mass (39.6±10 vs 34.5±7.2 g/m2.7 p<0.03). BRS was inversely associated with interventricular septum (r= -0.30, p<0.01), ventricular mass and posterior wall (r=-0.29, p 0.02). Patients with geometric remodelling had a significant reduction of BRS in comparison to normal subjects (p<0.03). We observed an inverse association between BRS and degree of diastolic dysfunction (p<0.01). AC was significantly higher in the EH (89.3±8.3 vs. 80.7±10.6 cm), significantly associated to blood pressure values (r=0.36 p<0.03), interventricular septum (r=0.35 p<0.01), posterior wall (r=0.36, p<0.01) and negatively associated with TDI E'/A ' (r=-0.43 p 0.004) and BRS (r=-34 p=0.02). Dividing women according to their fat distribution we observed a significant reduction of BRS in women who presented Cob (Cob: 13.4± 5.7 vs. non COb 10.1±3.2; p<0.05). We didn't observed any significant association between BRS and blood pressure levels. Conclusions. In post-menopausal women, the presence of central obesity is associated, independently to the blood pressure levels, with a reduced BRS and with the presence of cardiac organ damage. These findings suggest that an increased central fat distribution, determining an imbalance of the autonomic nervous system, may explain part of the increased cardiovascular risk in postmenopausal women.