OC014: Left atrial dynamics in fetuses of diabetic mothers

Abstract

Objectives: Abnormal uterine bleeding needs careful evaluation to exclude uterine pathology, particularly endometrial cancer. The combination of Saline Infusion Sonography (SIS) and endometrial aspiration is a reliable tool for this purpose. The objective of this study was to evaluate the effect of SIS on the quality of the endometrial aspiration specimen in women with abnormal uterine bleeding by performing both examinations in one session. Methods: In this single-blind randomised controlled trial, 113 women with abnormal uterine bleeding who visited the outpatient clinic were randomly allocated either to SIS and subsequent endometrial aspiration, or to the reverse order. Both examinations were performed in one session with the same catheter. All aspiration specimens were sent to the same pathologist, who evaluated the quality of the samples.Results: The quality of the endometrial aspiration specimen was significantly better in the group of women who had aspiration before SIS, compared with women who were allocated to the reverse order (P = 0.03). Blood and mucus staining and the presence of endometrial epithelium were found to have a significant influence on the sample quality. The difference between both groups was most pronounced in women below 50 years (P = 0.02). Conclusions: This study demonstrated that the proportion of adequate specimens is higher when endometrial aspiration is performed first and subsequently SIS. Objectives: Assess differences in contrast enhancement in morphologically abnormal small ovarian masses. Method: Retrospective assessment of contrasted transvaginal sonography in women with morphologically abnormal small ovarian masses who underwent surgical removal and subsequent histologic assessment. Standard color Doppler and harmonic pulse inversion transvaginal sonography was performed using a Philips iU22 scanner with a curved 8-4 MHz transvaginal probe. Before contrast was given, power Doppler sonography was performed for detection of relatively vascular areas within tumor. After consent was obtained, patients received intravenously 0.1 µg/kg of Definity followed by 10 cc saline bolus. A three-minute segment was recorded for later analysis offline using Q-lab software. Results: As of February 2008, 17 patients with a total of 23 tumors were studied. Nine adnexal masses were primary epithelial malignant ovarian tumors, including 3 adenocarcinomas, 2 serous adenocarcinomas 2 endometroid adenocarcinomas and 2 breast cancer metastases. 14 tumors were benign, including 9 endometriomas, 2 hemorrhagic corpora lutea, 2 mucinous cystadenoma, 1 paraovarian cyst, 1 fibroma and 1 cystadenofibroma. When contrast enhancement dynamics was assessed, malignant lesions demonstrated similar time to peak (26.1 ± 6.3 sec vs 24.9 ± 7.6 sec, P = 0.7), but greater peak enhancement (23.3 ± 2.8 dB vs 12.3 ± 3.9 dB, P < 0.01), longer half wash-out time (139.9 ± 43.6 sec vs 46.3 ± 19.7 sec (P < 0.01) and greater vascular volume (2012.9 ± 532.9 sec −1 vs 523.8 ± 318 sec −1 , P < 0.01) when compared to benign les...

Paediatric and congenital heart disease in South America: an overview

“…However, large cardiology centres usually have well-structured programmes of fetal cardiology with advanced techniques for the diagnosis and even treatment of some CHD in utero. Interesting clinical research has been performed on several cardiac fetal topics, including screening of CHD in selected pregnant women, abnormalities of the septum primum, cardiovascular abnormalities in fetuses of diabetic mothers, diastolic dysfunction, restriction of flow across the foramen ovale, treatment of fetal arrythmias and fetal interventions for aortic stenosis and hypoplastic left heart syndrome 545100101102103104105106107108109110111112113…”

Influence of fetal respiratory movements on left atrial functional status

“…Zielinsky et al . () and Miyague et al . () have already studied the influence of fetal breathing on the mobility of the septum primum and atrioventricular valve flows.…”

“…This can be demonstrated by the analysis of mitral and tricuspid valve flows, which shows an E/A ratio < 1 throughout gestation, with increasing values towards term (Harada et al , ). Left atrial shortening fraction has been shown to be lower in fetuses of diabetic mothers than in normoglicemic mothers as a result of myocardial hypertrophy (Zielinsky et al , ). In the normal fetus, however, the physiological behavior of the left atrial shortening fraction has not been fully studied yet.…”

Behavior of Pulmonary Venous Flow during Fetal Respiratory Movements

“…Several parameters and Doppler indexes have been used to assess diastolic function 7 in order to improve diagnosis, obtain a clear prognosis, and follow up the effect of therapeutic interventions. Alternative methods to transmitral flow Doppler have been studied to assess fetal diastolic function 7,9,11,[18][19][20] because the peculiar characteristics of fetal circulation have rendered traditional methods insufficient.…”