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The article discusses the study that determined collagen type IV presence and localization in prenasal tissue of fetuses with and without Down syndrome (DS). Topics discussed include no statistically significant differences found in presence and localization of antibodies for collagen IV in blood vessels and stroma for both groups, higher type IV collagen presence and localization in basement membrane (BM) of prenasal skin in DS specimens, and increased prenasal thickness (PT) in DS fetuses.

Objectives: To define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with PSMs. The outcome and proper management of patients with positive PSMs during nephron sparing surgery (NSS) are questionable. In this study we define the clinical outcomes of PSMs at NSS and suggest management. Methods: Clinical records of 114 renal units who underwent open NSS for a renal mass between May 1995 and September 2005 were reviewed. Results: PSMs were suspected on frozen section in 17 of 114 renal units (15%). Tumors with suspected PSMs at frozen section were smaller (2.9 ± 1.6) in comparison to those with negative surgical margins (3.4 ± 1.8 cm) (P = .001). Nine of 17 (53%) cases underwent total nephrectomy (5 immediately, 4 delayed). In 4 (24%), immediate re-excision of the renal crater was performed. A total of 4 (24%) that were followed up clinically were with no evidence of disease. Therefore, in 13 of 17 (77%) cases, the presence of tumor cells at the remaining side of the kidney could be evaluated histologically. In 2 cases from the immediate response group, tumor cells were found in the side opposite to the resection. There was no residual tumor in any case subjected to delayed nephrectomy. At median follow-up of 71 months, 15 of 17 patients are alive and with no evidence of disease. Two patients died because of unrelated causes. The overall 5-year survival rate is 98.2% and there is no cancer-specific mortality. Conclusions: The true PSM rate is in the range of 1.75%-5.26%. No disease progression or deaths attributable to renal cell carcinoma were associated with PSMs. Total nephrectomy should be avoided as a response to PSMs. [Copyright &y& Elsevier]

Objective: To supplement existing cases of cesarean scar pregnancy presenting as acute conditions. All of the study women had been treated by a conservative surgical approach. Design: Retrospective study. Setting: Department of obstetrics/gynecology of a tertiary referral center. Patient(s): We identified six pregnant women at 7-15 weeks' gestation who underwent emergency laparotomy and uterine-preserving surgery. Four of them were initially treated by uterine curettage because of misdiagnosed intrauterine pregnancies. The other two experienced failed methotrexate treatment. Intervention(s): All patients underwent a similar surgical technique while actively bleeding. This included laparotomy and ligation of bilateral uterine arteries, followed by wedge resection of the entire pregnancy in scar. The uterus was sutured in two layers. Main Outcome Measure(s): All the reported women in our series had been cured and their uteruses have been preserved. Result(s): There was an inadvertent injury to the bladder in one case, which was immediately repaired, and blood transfusion was required in two other cases. The postoperative course was uneventful for all the patients. One of the patients has already spontaneously conceived and she had an ongoing normal pregnancy at the time of writing. Conclusion(s): This small case series emphasizes that uterine-preserving surgery is an optional management for cesarean scar pregnancies presenting as acute conditions, cases resistant to medical treatment, or for women at advanced gestation. [ABSTRACT FROM AUTHOR]

Pelvic splenosis is a post-traumatic spleen autotransplantation, which can mimic various gynaecological diseases. A case of a 39-year-old woman, who underwent partial splenectomy because of a road accident in her childhood, currently presenting with abdominal pain and suspected corpus luteus torsion. Diagnostic laparoscopy was conducted which ruled out twisted ovary. This confirmed disseminated pelvic splenosis as a coincidental finding. Following this procedure, the abdominal pain ceased. The current report aims to raise the awareness of splenosis so that it may be appropriately recognized and differentiated from other pelvic findings. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To address the consequences of surgical curettage following failed medical abortion. Methods: A retrospective case–control study was performed in a tertiary gynecologic department. The case group comprised 104 women who underwent surgical curettage following failed medical abortion; the control group included 104 women who underwent early surgically induced abortion. Clinical characteristics and surgical findings were examined. The extent of inflammation was quantified following immunohistochemical staining for cell-surface markers characteristic of T lymphocytes, B lymphocytes, and macrophages. The extent of necrosis was evaluated morphologically. Results: Abnormal findings during surgical curettage were significantly more prevalent among women in the case group than in the control group (10.6% versus 1.9%; P =0.019). The most frequent abnormality in the case group was the presence of intimately adherent products of conception, necessitating sharp curettage. The extent of inflammation (represented by increased numbers of T and B lymphocytes) was greater in the case group than in the control group (P =0.046 and P =0.001, respectively), as was the extent of necrosis (P <0.05). Conclusion: Curettage following failed medical abortion harbors particular difficulties, which may be attributed to an inflammatory response. The long-term consequences of curettage following failed medical abortion warrant further investigation. [Copyright &y& Elsevier]

Objectives: To define the preoperative independent predictors indicating that renal mass has benign histologic features. Methods: A total of 1664 patients with Stage T1-T2N0M0 with a unilateral renal mass underwent nephrectomy. The endpoint at multivariate analysis was benign versus malignant histologic features. Results: The surgical approach (odds ratio [OR] 2.9, P = .0001), sex (OR 1.97, P = .0001), and age (OR 1.01, P = .007) were independent predictors for the malignant-benign distinction. Malignant tumors were more likely to occur in men (878 of 1009, 87%) versus women (515 of 651, 79%; P <.001). A weak relationship was found between an increasing tumor size and malignancy risk in men only. High-grade renal cell carcinoma was more prevalent in men (31% versus 21%, P = .001). The histologic tumor types were distributed differently between the 2 sexes: 8% papillary renal cell carcinoma in women versus 16% in men, 86% and 78% clear cell renal cell carcinoma, 33% and 57% oncocytoma, and 40% versus 12% angiomyolipoma, respectively. The physician''s preoperative judgment regarding tumor amenability for nephron-sparing surgery resulted in patient selection: 10% benign tumors for radical nephrectomy versus 25% for partial nephrectomy (P = .001) and 31% versus 20% high-grade tumors, respectively (P = .0001). Conclusions: Renal tumors were consistently benign in 20% of women, regardless of size. In contrast, in men, the malignancy risk increased slightly with tumor size. The surgeons'' preoperative decision regarding nephron-sparing surgery caused a selection bias in favor of benign lesions, regardless of sex. Our findings support the possibility of basing treatment decisions on the preoperative biopsy findings. Such changes could alter current practice and limit treatment of histologically proven benign lesions to surveillance or ablation only. [Copyright &y& Elsevier]

Objective: To present four cases of twin tubal pregnancies and discuss possible etiologies. Twin tubal pregnancies are a rare event, with incidence rates estimated as 1 out of 725–1,580 of tubal pregnancies. Design: Case series. Setting: Department of obstetrics and gynecology at a tertiary health care facility. Patient(s): All women with twin tubal pregnancy diagnosed and treated in the department during the years 2007–2009, according to electronic files and histologic reports. Intervention(s): None. Main Outcome Measure(s): Artificial reproductive technique preceding twin tubal pregnancies Result(s): We diagnosed four twin pregnancies of 163 tubal pregnancies, an incidence of 2.4%. Of the four cases, two conceived after gonadotropin stimulation and intrauterine insemination. The third conceived following in vitro fertilization and intracytoplasmic sperm injection. The fourth was a spontaneous conception diagnosed as monochorial monoamniotic twin tubal pregnancy. Conclusion(s): Twin tubal pregnancies may not be as rare as previously thought. Three of the four cases indentified during a 2-year period followed artificial reproductive technique. We hope that this report will promote the study of the epidemiology of this event, improve diagnosis, and encourage the development of treatment modalities. [ABSTRACT FROM AUTHOR]