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Aim. The aim of our study was to assess the accuracy of a combination of digital mammography and breast ultrasonography in the prediction of response to neoadjuvant systemic treatment in breast cancer patients with different tumor subtypes. Methods. The study was designed as a retrospective diagnostic accuracy study. Stage I-III female breast cancer patients who received any type of neoadjuvant systemic treatment with radiological response assessment by both mammography and breast ultrasound and followed by surgical treatment in the breast and axilla were included in the study. The primary outcome was the diagnostic accuracy of combined modalities of mammography and breast ultrasonography for predicting the pathological complete response. On mammography and breast ultrasonography, the radiological response was categorized into complete response and non-complete response. Pathological complete response on surgical specimens was described based on current guidelines. True and false positive cases as well as true and false negative cases were counted and compared among patients with 4 different molecular subtypes. The diagnostic accuracy of combined imaging modalities was analyzed for positive and negative predictive values, sensitivity, and specificity rates. All rates were calculated according to the previously described formulas. Results. Eighty-one breast cancer cases were included in the study. Positive predictive values of imaging were 100%, 75%, 100%, and 83%, whereas negative predictive values were 67%, 75%, 100%, and 100% in patients with HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2- tumors, respectively. Sensitivity rates were found to be 98%, 90%, 100%, and 100%, whereas specificity rates were 100%, 50%, 100%, and 67% in patients with HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2- tumors, respectively. Conclusion. Digital mammography and breast ultrasonography as a combined modality seem to show the pathological complete response after neoadjuvant systemic treatment in HR+/HER2- breast cancer patients with a very high specificity rate. Therefore, these conventional tools may help surgeons to select patients who might benefit from loco-regional treatment de-escalation with higher accuracy.

Background and Objectives: We investigated the effect of optimal maternal glycemic control on neonatal outcomes among infants born to mothers with diabetes. Materials and Methods: In this prospective study, we assessed 88 eligible mothers admitted to the obstetrics department for pregnancy evaluation. Our analysis included 46 infants born to diabetic mothers (IDMs) and 138 infants born to unaffected mothers, all admitted to the Level II Neonatal Intensive Care Unit (NICU). Results: Mothers affected by diabetes were generally older and exhibited a higher body mass index (BMI) and a greater number of gestations, although parity did not differ significantly. Cesarean section emerged as the most frequently chosen mode of delivery. A significantly higher proportion of infants in the affected group presented with respiratory disease (3% vs. 19.5%), which required NICU admission (4.3% vs. 23.9%), phototherapy (18.1% vs. 43.5%), and had congenital heart defects or myocardial hypertrophy (15.2% and 26% vs. 3% and 4.3%) compared to matched controls (p < 0.05). Conclusions: This study underscores the persistence of adverse neonatal outcomes in IDMs, even when maternal glycemic control is optimized. It calls for further investigation into potential interventions and strategies aimed at enhancing neonatal outcomes in this population.

Excessive gestational weight gain is a predictive factor for maternal obesity, with implications on newborn’s weight and potential short- and long-term complications. Gestational weight gain depends on ethnic and social factors, as well as on parity. Excepting the aforementioned factors, we must also recall the major impact of the genetic suscep-tibility being pointed out that three essential periods influence fetal evolution, i.e. periconceptional, intrauterine and postnatal. The intrauterine environment owns an essential role in the optimal development of fetus with an effect on the offspring’s organ structure and functions, being currently assumed that adulthood pathologies originate in the perinatal period. Thus, the relationship between excessive gestational weight gain and child’s obesity or metabolic disorders is well documented. Moreover, recent information from the literature suggests that child’s allergies, wheezing or asthma might also be related to maternal nutritional status. To sum up, excessive gestational weight gain owns a decisive role in the development of child’s obesity and meta-bolic disorders imposing the major importance of a balanced diet during pregnancy in order to favor an optimal weight gain with a positive effect on fetal wellbeing that will further prevent the offspring’s metabolic risk.

Background: The relationship between non-reassuring fetal heart rate (FHR) pattern, acidemia at birth and neonatal morbidity remains unclear. Our aim was to compare low versus high pH cord blood infants of women detected with a Category II FHR pattern for which the impact is unclear. Methods: A prospective study of 185 low-risk pregnant women in labor at > 370/7 weeks of gestation with a singleton fetus was conducted at a single center. Category II trace was defined by the presence of tachycardia or bradycardia, variable and late decelerations, marked variability at least 30 minutes in the 120 minutes prior to delivery. The primary outcome included the need for resuscitation and Neonatal Intensive Care Unit (NICU) admission. The cohort was also stratified into three categories according to admission to NICU and pH threshold ([i] umbilical artery blood pH < 7.15 and admitted; [ii] pH > 7.15 and admitted; [iii] not admitted). Results: 23% (43/185) of infants of women detected with Category II FHR pattern needed NICU admission. Category II FHR pattern was associated with low pH at birth, and the need for resuscitation was more frequent among infants in the lower pH group (73% vs. 10%, p < 0.05). Indices of right (tricuspid annular plane systolic excursion [TAPSE]: 7.3 ± 0.9 mm) and left ventricular performance (fractional shortening: 31% ± 8.9%, transmitral E’/A’ 0.9 ± 0.3) were low compared to normative data for healthy infants. CK, CK-MB, and left-to-right/bidirectional shunts at PFO and PDA were higher overall at 72 hours of age. Conclusions: Category II FHR is associated with resuscitation at birth, NICU admission, and length of hospitalization.

Potter syndrome represents an association between a specific phenotype and pulmonary hypoplasia as a result of oligohydramnios that can appear in different pathological conditions. Thus, Potter syndrome type 1 or autosomal recessive polycystic renal disease is a relatively rare pathology and with poor prognosis when it is diagnosed during the intrauterine life. We present the case of a 24-year-old female with an evolving pregnancy, 22/23 gestational weeks, in which the fetal ultrasound revealed oligohydramnios, polycystic renal dysplasia and pulmonary hypoplasia. The personal pathological history revealed the fact that 2 years before this pregnancy, the patient presented a therapeutic abortion at 16 gestational weeks for the same reasons. The maternal ultrasound showed unilateral maternal renal agenesis. Due to the fact that the identified fetal malformation was incompatible with life, we decided to induce the therapeutic abortion. The particularity of the case consists in diagnosing Potter syndrome in two successive pregnancies in a 24-year-old female, without any significant family history, but who is diagnosed with unilateral renal agenesis.

Hemihypertrophy or hemihyperplasia is a rare congenital condition, whose incidence is difficult to estimate, due to the fact that asymmetry is very mild, therefore remaining undiagnosed. Hemihyperplasia can be isolated or associated to certain genetic syndromes. We present the case of a 6-months-old female infant, in whom, during the neonatal period, was raised the suspicion of a congenital hemihypertrophy. She was admitted in our clinic due to the presence of a facial asymmetry. The clinical exam revealed also, besides the hemihyperplasia of the right hemiface more obvious at the level of the forehead, a hypertrophy of the right superior and inferior limbs. The laboratory tests identified a mild anemia, increased levels of transaminases and alfa-fetoprotein. The abdominal ultrasound revealed a mild hepatomegaly and the transfontanellar one discrete ventriculomegaly and frontal atrophy. The genetic test was negative, therefore the final diagnosis was of isolated hemihypertrophy. The further re-evaluations showed a decreasing level of alfa-fetoprotein, without other additional pathological elements. The particularity of the case consists in diagnosing an isolated hemohypertrophy in a 6-month-old female infant, with negative genetic test, in whom it was observed at the moment of birth a mild facial asymmetry, with afterwards favorable evolution, with progressive decrease of the alfa-fetoprotein level and normal abdominal ultrasound.

Ventriculomegaly represents the dilation of the cerebral ventricles above 10 mm, being classified as it follows: mild or “borderline” (10-12 mm), moderate (13-15 mm) and severe (over 15 mm). The incidence varies very much depending on the used technique and the gestational age. The level of choice in order to obtain the most exact measurement of the ventricular diameter is at the level of choroid plexus glomus. The MRI is another method to assess the fetal brain that allows also the evaluation of the cerebral surface. Unilateral ventriculomegaly is caused by the morphologic, physical or functional obstruction of foramen Monro. “Borderline” ventriculomegaly can be associated with chromosomal anomalies, congenital infections, cerebral vascular accidents or hemorrhage, but also other extra-cerebral anomalies. The factors that influence the prognosis of children diagnosed with mild ventriculomegaly are: gender, gestational age, ventricular size, uni- or bilateral impairment, symmetrical or asymmentrical bilateral ventriculomegaly, progression of ventriculomegaly – probably the most important factor of prognosis, regression of ventriculomegaly. The parents must be informed about the fact that there are certain ultrasonographic limitations regarding the differentiation of an isolated “borderline” ventriculomegaly of a ventriculomegaly associated to other occult anomalies that can not be identified initially, in order to take an adequate decision. The control fetal ultrasound is preferable to be performed after approximately 1-2 weeks from the moment of initial diagnosis of “ventriculomegaly”.

The diagnosis of fetal cerebral hemorrhage (HCF) is less reported (0,9/1000 births) in comparison to the postpartum one. We presented 2 cases of fetal intraventricular hemorrhages diagnosed. Case 1: HCF diagnosed by ultrasound at the gestational age of 28 weeks and confirmed after birth by the presence of erythrocytes (significant number, pathological aspect) in the spinal fluid and by the modifications signaled by the transfontanellar ultrasound (severe internal hydrocephaly, minimum cerebral tissue). The death occurred after 24 hours postpartum (pathological exam: intraventricular cerebral hemorrhage). We mention the apparent lack of maternal risk factors, negative TORCH tests. Case 2: internal hydrocephaly at the age of 37 gestational weeks and confirmed in newborn (after cesarean section) by the clinical characteristic modifications, severe neurological impairment with modification at the transfontanellar ultrasound and the hemorrhagic and hypertensive aspect of the spinal fluid. We did not encounter maternal risk factors. Also, apparently, there were not any fetal risks: weight 2,820 grams at 37 gestational weeks, negative TORCH tests, negative cultures and CRP. The hydrocephaly had a progressive evolution imposing ventriculotomies and cysternotomies; the placement of a ventriculoperitoneal shunt during the third neurosurgical intervention improved the vital prognosis. Conclusions. The presence of hydrocephaly was a faithful ultrasound sign for the diagnosis of HCF. The evolution and the prognosis are influenced by the severity of hemorrhage and the gestational age. The survivors benefit from neurosurgical treatment. The multifactorial etiology, of the HCF incompletely elucidated leads to difficulties in establishing a target group of screening, in order to identify this lesion.

Acute respiratory syndrome-related coronavirus 2, or SARS-CoV-2, mainly affects the vulnerable population, especially those with comorbidities, such as pregnant women. SARS-CoV-2 has been found to cause multiple manifestations, one of which is preeclampsia. In preeclampsia, uric acid is excessively produced in the ischemic placenta and is released into circulation by placental reperfusion. Another effect of uric acid is oxidative stress with the production of oxygen free radicals associated with severe preeclampsia and fetal hypoxia. In our case report, we present the situation of a 38-year-old pregnant woman who developed preeclampsia after infection with SARS-CoV-2 with rapid evolution and an increased level of uric acid. We discuss the option of Allopurinol treatment in the third trimester of pregnancy instead of premature birth, with excellent benefits for both the mother and newborn. Additional clinical correlations between antioxidant treatment with Allopurinol and placental findings are needed.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of

ObjectivesTo study changes in heart function and hemodynamics during the transitional period in small for gestational (SGA) infants and appropriate (AGA) healthier counterparts.DesignA hospital based prospective observational study was performed at a perinatal center. Echocardiograms were performed on the first postnatal day and again at 48 h age. Term SGA infants were compared with those AGA newborns matched for the GA and mode of delivery.ResultsEighteen SGA infants were compared with 18 AGA infants [gestation 38 ± 1.5 vs. 38 ± 1.2 weeks, p > 0.05 and birthweight 2331 ± 345 vs. 3332 ± 405 grams, p

Regarding the hypertensive disorders of pregnancy, pre-eclampsia (PE) remains one of the leading causes of severe and life-threatening maternal and fetal complications. Screening of early-onset PE ( 38 showed 66.2% sensitivity and 83.1% specificity in predicting the occurrence of PE within 4 weeks. Furthermore, 2018 ISUOG Practice Guidelines stated that a second-trimester mean uterine artery PI ≥ 1.44 increases the risk of later PE development. The implementation of a standard screening procedure based on the sFlt-1/PlGF ratio and uterine Doppler velocimetry may improve early detection of pre-eclampsia and other placenta-related disorders.

Pregnancy represents a psychologically and emotionally vulnerable period, and research indicates that pregnant women have a higher prevalence of symptoms of anxiety and depression, debunking the myth that hormonal changes associated with pregnancy protect the mother. In recent years, several researchers have focused on the study of prenatal anxiety/depression—emotional disorders manifested by mood lability and low interest in activities—with a high prevalence. The main objective of this research was to conduct an antenatal screening in a cohort of pregnant women hospitalized for delivery in order to assess the prevalence of anxiety and depression. The secondary objective was to identify the risk factors associated with depression and anxiety in women in the third trimester of pregnancy. We carried out a prospective study in which we evaluated 215 pregnant women in the third trimester of pregnancy hospitalized for childbirth at the Obstetrics and Gynecology Clinic of the Târgu-Mureș County Clinical Hospital. The research was carried out between December 2019 and December 2021. The results showed that age and the environment of origin are the strongest predictors of mental health during pregnancy (OR = 0.904, 95%CI: 0.826–0.991; p = 0.029). For women from urban areas, there is an increased probability of falling at a higher level on the dependent variable (moderate depression) (OR = 2.454, 95%CI: 1.086–5.545; p = 0.032). In terms of health behaviors, none of the variables were statistically significant predictors of the outcome variable. The study highlights the importance of monitoring mental health during pregnancy and identifying relevant risk factors to provide appropriate care to pregnant women and the need for interventions to support the mental health of pregnant women. Especially in Romania, where there is no antenatal or postnatal screening for depression or other mental health conditions, these results could be used to encourage the implementation of such screening programs and appropriate interventions.

Cȃştigul ponderal excesiv al femeii gravide este un factor predictiv pentru obezitatea maternă, cu implicații asupra greutății nou-născuților și posibile complicații pe termen scurt și lung. Cȃştigul ponderal ȋn sarcină depinde de factori etnici, sociali şi de paritate. Exceptând factorii menționați anterior, nu este de neglijat nici impactul major al susceptibilității genetice, punându-se în evidență că există trei perioade principale ce influenţează evoluţia fetală, și anume periconcepţională, intrauterină şi postnatală. Mediul intrauterin deține un rol esenţial în dezvoltarea optimă a fătului, având efect asupra structurilor şi funcţiilor organelor produsului de concepţie, considerându-se în acest moment că bolile adultului îşi au originea în copilărie. Astfel, este bine cunoscută legătura dintre câștigul ponderal gestațional excesiv și obezitatea sau bolile metabolice la copil. Mai mult, unele dintre cele mai noi informații din literatură sugerează că alergiile, wheezing-ul sau astmul copilului ar putea avea, la rândul lor, legătură cu statusul nutrițional matern. În concluzie, excesul ponderal gestațional deține un rol decisiv în apariţia obezităţii şi bolilor metabolice la copil, de aici rezultând importanţa majoră a unei diete echilibrate pe perioada sarcinii pentru a favoriza un câștig ponderal optim, cu efect pozitiv asupra bunăstării fetale, care să prevină riscul metabolic al produsului de concepţie.

Objective: This review aims to provide insights into the current non-invasive imaging methods used in the diagnosis of adenomyosis, as well as to highlight their diagnostic accuracy, advantages, disadvantages and limitations in the detection of this benign uterine condition. At the same time, this paper emphasizes the importance of using consensus-based terminology in the imaging description of these lesions. Mechanism: A search of PUBMED database was conducted for articles published between January 1998 and August 2022 and studies which compared non-invasive imaging methods with postoperative histology examination of uterine specimens were primarily selected. Transvaginal two-dimensional ultrasound was for a long time the main non-invasive imagistic method used for assessment of adenomyosis lesions. The introduction of Morphological Uterus Sonographic Assessment (MUSA) group criteria yielded a significantly better diagnostic outcome of adenomyosis in case of conventional ultrasonography, but the distinction of concomitant benign uterine conditions still remained challenging. Findings in Brief: The addition of three-dimensional ultrasound or elastosonography to conventional two-dimensional transvaginal ultrasound yielded higher diagnostic sensitivity. Qualitative elastography particularly proved useful in the diagnosis of adenomyosis due to its capacity to achieve differential diagnosis of benign uterine pathologies based on lesion stiffness. Magnetic resonance imaging (MRI) examination presents higher diagnostic specificity and sensitivity, can assess the endometrial and myometrial layers in detail, but its use has been shadowed by costs and significantly longer examination time. Conclusions: The imaging terminology established by consensus by the MUSA group in recent years has facilitated the description of adenomyosis-specific lesions. Two-dimensional transvaginal ultrasound in combination with three-dimensional ultrasound or combined with qualitative elastography offers similar diagnostic sensitivity and specificity to MRI. Despite some limitations, MRI remains a reliable diagnostic method for adenomyosis.

Ovarian malignant germ cell tumors (OMGCTs) represent a rare type of malignant tumors composed of primitive germ cells that often originate from dysgenetic gonads and are frequently associated with hermaphroditism. Such tumors occur more frequently in adolescents or young adults, and their etiopathogenic mechanism is not well established. We report the case of a 20-year-old female with ovarian dysgenesis and female phenotype. A laparoscopic surgery was performed, and ovotestis was discovered. To achieve a histopathological examination, right oophorectomy was performed, which confirmed the diagnosis of dysgerminoma. In the case of hermaphroditism, mixed germ cell tumors can develop, leading to a more aggressive evolution with bilateral malignancy of the gonads, which requires the removal of both ovotestis. The patient was recalled. A histopathological examination revealed a seminoma, so laparoscopic left oophorectomy was performed. The management of this type of diagnosis primarily involves surgery, minimally invasive interventions being preferred. Not all pathologic conditions are readily identifiable by means of exploratory laparoscopy, as in our patient’s case. We consider that the optimal solution for these patients would be the preservation of fertility via egg donation and embryo transfer; the survival rate of such patients being 97–100%, if the tumor is diagnosed at an early age.

Primary neuroendocrine tumors (NETs) of the breast are considered a rare and undervalued subtype of breast carcinoma that occur mainly in postmenopausal women and are graded as G1 or G2 NETs or an invasive neuroendocrine carcinoma (NEC) (small cell or large cell). To establish a final diagnosis of breast carcinoma with neuroendocrine differentiation, it is essential to perform an immunohistochemical profile of the tumor, using antibodies against synaptophysin or chromogranin, as well as the MIB-1 proliferation index, one of the most controversial markers in breast pathology regarding its methodology in current clinical practice. A standardization error between institutions and pathologists regarding the evaluation of the MIB-1 proliferation index is present. Another challenge refers to the counting process of MIB-1′s expressiveness, which is known as a time-consuming process. The involvement of AI (artificial intelligence) automated systems could be a solution for diagnosing early stages, as well. We present the case of a post-menopausal 79-year-old woman diagnosed with primary neuroendocrine carcinoma of the breast (NECB). The purpose of this paper is to expose the interpretation of MIB-1 expression in our patient’ s case of breast neuroendocrine carcinoma, assisted by artificial intelligence (AI) software (HALO—IndicaLabs), and to analyze the associations between MIB-1 and common histopathological parameters.

Background and Objectives: Cortisol, the stress hormone, is an important factor in initiating and maintaining lactation. Maternal suffering during pregnancy is predictive for the initiation and shorter duration of breastfeeding and can also lead to its termination. The aim of this study is to evaluate the relationship between the level of salivary cortisol in the third trimester of pregnancy and the initiation of breastfeeding in the postpartum period in a cohort of young pregnant women who wanted to exclusively breastfeed their newborns during hospitalization. Materials and Methods: For the study, full-term pregnant women were recruited between January and May 2022 in the Obstetrics and Gynecology Clinic of the Mureș County Clinical Hospital. Socio-demographic, clinical obstetric and neonatal variables were collected. Breastfeeding efficiency was assessed using the LATCH Breastfeeding Assessment Tool at 24 and 48 h after birth. The mean value of the LATCH score assessed at 24 and 48 h of age was higher among mothers who had a higher mean value of salivary cortisol measured in the third trimester of pregnancy (p < 0.05). A multivariate logistic regression model was used to detect risk factors for the success of early breastfeeding initiation. Results: A quarter of pregnant women had a salivary cortisol level above normal limits during the third trimester of pregnancy. There is a statistically significant association between maternal smoking, alcohol consumption during pregnancy and the level of anxiety or depression. Conclusions: The most important finding of this study was that increased salivary cortisol in the last trimester of pregnancy was not associated with delayed initiation/absence of breastfeeding.

Dysgerminoma represents a rare malignant tumor composed of germ cells, originally from the embryonic gonads. Regarding its incidence, we do not have precise data due to its rarity. Dysgerminoma occurs at a fertile age. The preferred treatment is the surgical removal of the tumor succeeded by the preservation of fertility. Even if a multidisciplinary team, founded in 2009 by a gynecologist, an oncologist, a pediatric oncologist and a pediatric surgeon, under the guidance of the Malignant Germ Cell International Consortium (MaGIC), studies this type of tumor, issues still remain related to the lack of a randomized study and to both the management and understanding of the concept of OMGCTs (ovarian malignant germ cell tumors). The aim of this review is to present from the literature the various approaches for this type of tumor, and, regarding innovative therapies or possible prevention, which can be applied in clinical practice. Multidisciplinarity and treatment in reference centers have proven their usefulness as well.

Introduction: The aim of this study was to assess the role of TNF-α 308 G>A gene polymorphism in children's overweight risk so as to correlate this polymorphism with anthropometric and biochemical variables. Materials and method: A cross-sectional study was carried out on 188 Romanian children ages 5–18 years, who were classified into controls (Group 1; n = 109) and overweight children (Group 2; n = 79). Results: Higher values of MUAC and TST (p A polymorphism and weight status in the studied population (p = 0.009). There was also a positive association between the variant genotypes (GA or AA) of TNF-α 308G>A gene polymorphism and weight status, which was more frequently found among normal weight than overweight children (74.5% versus 25.5%, respectively). The final logistic multivariable included five independent variables (TNF-α genotype, gender, cholesterol, ASAT, and ALAT), which were statistically significant predictors with negative/positive effects on children's overweight risk; this model explained 30% of the variance in the outcome variable. Conclusion: The variant genotype of TNF-α 308G>A gene polymorphism was more frequent among normal weight children. In the presence of other covariates, such as age, gender, cholesterol, LDL cholesterol, ALAT, and glycemia, the TNF-α 308 G>A gene polymorphism remained an independent protective factor for children's overweight status. Key Words: children, overweight risk, TNF-α 308 G>A polymorphism

Intrauterine devices (IUDs) are very common as a method of birth control. By adding progesterone (levonorgestrel), a decrease in the risk of complications has been documented, including the risk of perforation. Even though only a few complications have been described, adjacent organs may be involved in the case of migration—a life-threatening situation. A 45-year-old G4P2 woman was seen in our clinic for LNg-IUD removal, according to the medical instructions. Her main complaints were abdominal discomfort, low back pain, and recurrent menorrhagia. A “lost” IUD was initially suspected; the patient confirmed the detection and removal of the control strings, and a subsequent discussion related to delayed transmural migration of the IUD being followed. The ultrasonography revealed the migration of the IUD to the uterine cervix and size-decreased uterine fibroids, confirming the effectiveness of the LNg-IUD. The MRI and ultrasonography being useless, a subsequent X-ray and CT scan were requested, both confirming a myometrium-positioned IUD, adjacent to the serosa and lumbosacral plexus. Even though the IUD is considered a safe device with reversible effect, it can be associated with severe morbidity, with an ultrasound follow-up being required. For more precise detection of the IUD, we strongly recommend an X-ray or CT scan examination, followed by safe removal.

Objective This study aimed to compare energy and macronutrient intake, birth weight, and anthropometric parameters (mid-upper arm circumference or tricipital skin-fold thickness) between women who had adequate and excessive gestational weight gain (GWG) during pregnancy. Methods We studied 115 pregnant women and divided them according to GWG into two groups: adequate GWG (n = 49) and excessive GWG (n = 66). We assessed the medical history, clinical examinations, and dietary habits through a detailed 7-day dietary recall using myfitnesspal software. Results Weight, body mass index, mid-upper arm circumference, and tricipital skin-fold thickness were significantly higher at the time of delivery in women with excessive GWG compared with those with adequate GWG. A lipid-based diet was a risk factor for excessive GWG (relative risk: 1.488, 95% confidence interval: 1.112–1.991), whereas a protein-based diet was a protective factor (relative risk: 0.6723, 95% confidence interval: 0.4431–1.020). We found no significant relationship between a carbohydrate-based diet and GWG. The total energy intake was significantly higher in the excessive GWG group than in the adequate GWG group. Conclusions Mainly a lipid-based diet in pregnant women might represent a risk factor for excessive GWG. However, a protein-based diet is a protective factor for excessive GWG.

Sindromul Potter reprezintă o asociere dintre un fenotip specific şi hipoplazie pulmonară ca rezultat al oligohidramniosului, care poate surveni în anumite condiţii patologice. Astfel, sindromul Potter de tip I sau boala renală polichistică autozomal recesivă este o patologie cu incidenţă relativ rară şi prognostic infaust atunci când este diagnosticată în timpul vieţii intrauterine. Prezentăm cazul unei femei în vârstă de 24 de ani, internată în clinica noastră prezentând o sarcină în evoluţie, 22/23 săptămâni gestaţionale, la care ecografia fetală de rutină a evidenţiat oligohidramnios, displazie renală polichistică şi hipoplazie pulmonară. Antecedentele personale patologice au relevat faptul că, în urmă cu 2 ani, pacienta a suferit un avort terapeutic la vârsta de 16 săptămâni gestaţionale pentru aceleaşi motive. Ecografia maternă a arătat agenezie renală maternă unilaterală. Din cauza faptului că malformaţia evidenţiată era incompatibilă cu viaţa, s-a indus avortul terapeutic. Particularitatea cazului constă în diagnosticarea sindromului Potter la două sarcini consecutive la o femeie în vârstă de 24 de ani, fără antecedente heredocolaterale cunoscute, însă care este diagnosticată cu agenezie renală unilaterală.

Ventriculomegalia reprezintă dilatarea ventriculilor cerebrali peste 10 mm, fiind clasificată în uşoară sau „borderline“ (10-12 mm), moderată (13-15 mm) şi severă (peste 15 mm). Incidenţa variază foarte mult în funcţie de tehnica utilizată şi de vârsta gestaţională. Locul de elecţie pentru măsurarea cea mai exactă a diametrului ventricular este la nivelul glomusului plexului coroid. RMN-ul este o altă metodă de evaluare a creierului fetal care permite, de asemenea, vizualizarea suprafeţei cerebrale. Ventriculomegalia unilaterală este cauzată de obstrucţia morfologică, fizică sau funcţională a orificiului Monro. Ventriculomegalia „borderline“ poate fi asociată cu anomalii cromozomiale, infecţii congenitale, accidente vasculare cerebrale sau hemoragie, precum şi cu alte anomalii extracerebrale. Factori care influenţează prognosticul copiilor diagnosticaţi cu ventriculomegalie uşoară sunt: sexul, vârsta gestaţională, dimensiunea ventriculilor, afectarea uni- sau bilaterală, ventriculomegalie bilaterală simetrică sau asimetrică, progresia ventriculomegaliei – probabil cel mai important factor al prognosticului, regresia ventriculomegaliei. Părinţii trebuie informaţi despre faptul că există limitări ultrasonografice în diferenţierea unei ventriculomegalii „borderline“ izolate şi ventriculomegalie asociată unor altor anomalii oculte, care nu pot fi identificate iniţial în vederea luării unei decizii adecvate. Ecografia fetală de control este de preferat a se efectuat după aproximativ 1-2 săptămâni de la diagnosticul iniţial de „ventriculomegalie“.

Introduction: Childhood obesity is occurring at alarming rates in both developed and developing countries. “Obesogenic” environmental factors must be associated with variants of different risk alleles to determine polygenic or common obesity, and their impact depends on different developmental stages.The interaction between obesogenic environment and genetic susceptibility results in the so-called polygenic forms of obesity. In contrast, monogenic and syndromic obesity are not influenced by environmental events. Therefore, this review aimed to underline the roles of some of the most studied genes in the development of monogenic and polygenic obesity in children.Results: Among the most common obesity related genes, we chose the fat mass and obesity-associated (FTO) gene, leptin gene and its receptor, tumor necrosis factor alpha (TNF-α), the melanocortin 4 receptor gene (MC4R), Ectoenzyme nucleotide pyrophosphate phosphodiesterase 1 (ENPP1), and others, such as peroxisome proliferator-activated receptor gamma (PPARG), angiotensin-converting enzyme (ACE), glutathione S-transferase (GST), and interleukin-6 (IL-6) genes. The roles of these genes are complex and interdependent, being linked to different cornerstones in obesity development, such as appetite behavior, control of food intake and energy balance, insulin signaling, lipid and glucose metabolism, metabolic disorders, adipocyte differentiation, and so on.Conclusions: Genetic predisposition is mandatory, but not enough to trigger obesity.Dietary interventions and proper lifestyle changes can prevent obesity development in genetically predisposed children. Further studies are needed to identify the precise role of both genetic and obesogenic factors in the development of childhood obesity in order to design effective preventive methods.

Cantrell syndrome (CS) or pentalogy of Cantrell is defined as a rare condition involving a midline anterior abdominal wall defect, a distal sternal cleft, a defect of the anterior diaphragm, and a defect of the apical pericardium with pericardio-peritoneal communication, as well as intracardiac anomalies. We report the case of a male newborn with type 2 CS diagnosed during intrauterine life based on ultrasonographic evaluation. Clinical examination at birth revealed an abdominal wall defect with extrathoracic displacement of the heart and a diastasis of the sagittal suture. Postnatal echocardiography revealed tricuspid atresia, partial extrathoracic and extra-abdominal displacement of the heart and liver, a large ventricular septal defect, severe subpulmonary stenosis, hypoplasia of the pulmonary artery, and a large hourglass-shaped left ventricle secondary to narrowing of the heart at the level of its extrathoracic displacement. Computed tomography showed additional abnormalities including increased left ventricular volume with extrathoracic apical aneurysmal dilatation below the xiphoid process at the level of anterior abdominal wall, a hypoplastic right ventricle, partial transparietal herniation of the left hepatic lobe adjacent to a left ventricular diverticulum, and an adrenal hematoma. The newborn received intensive medical management during his first week of life; however, surgical management had to be postponed owing to his unstable condition. Eventually, it was performed on the 14th day of life, but unfortunately, the newborn died shortly after the procedure.

Hemihipertrofia sau hemihiperplazia este o boală congenitală rară, a cărei incidenţă este dificil de estimat din cauza faptului că asimetria este foarte uşoară în multe cazuri, rămânând astfel nediagnosticate. Hemihiperplazia poate fi izolată sau asociată unor sindroame genetice. Prezentăm cazul unui sugar, de sex feminin, în vârstă de 6 luni, la care în perioada perinatală s-a ridicat suspiciunea unei hemihipertrofii congenitale, internându-se în clinica noastră din cauza prezenţei unei asimetrii faciale. Examenul obiectiv a scos în evidenţă, de asemenea, pe lângă hemihiperplasia hemifeţei drept, mai evidentă la nivelul frunţii, o hipertrofie a membrului superior şi inferior drepte. Analizele de laborator au identificat o uşoară anemie, nivele crescute ale transaminazelor, precum şi al alfa-fetoproteinei. Ecografia abdominală a decelat uşoară hepatomegalie, iar cea transfontanelară discretă ventriculomegalie şi atrofie frontală. Testul genetic a fost negativ, astfel că diagnosticul final a fost de hemihipertrofie izolată. Reevaluările ulterioare au arătat un nivel al alfa-fetoproteinei în scăderea, fără alte elemente patologice adiţionale. Particularitatea cazului constă în diagnosticarea unei hemihipertrofii izolate la un sugar de 6 luni, cu test genetic negativ, la care s-a observat o uşoară asimetrie facială în momentul naşterii, cu evoluţie ulterioară favorabilă, cu scădere progresivă a nivelului alfa-proteinei şi ecografie abdominală normală.

Diagnosticul antepartum al hemoragiei cerebrale fetale (HCF) este mai puţin raportat (0,9/1.000 naşteri) comparativ cu cel postpartum. Sunt prezentate două cazuri de hemoragie intraventriculară fetală, diagnosticate ecografic antepartum. Cazul 1: HCF diagnosticată ecografic la vârsta gestaţională de 28 de săptamâni de gestaţie şi confirmată postnatal prin prezenţa în LCR a hematiilor (număr semnificativ, ratatinate) şi a modificărilor semnalate de ecografia transfontanelară (hidrocefalie internă severă, ţesut cerebral minim). Decesul a survenit la 24 de ore postpartum (ex. histopatologic: hemoragie cerebrală intraventriculară). Menţionăm absenţa aparentă a factorilor de risc materni, negativitatea testelor TORCH. Cazul 2: hidrocefalie internă la vârsta de 37 de săptămâni de gestaţie şi confirmată la nou-născut (după cezariană) de modificările clinice caracteristice, suferinţa neurologică severă asociată cu modificări la ecografia transfontanelară şi aspectul hemoragic şi hipertensiv al LCR. Nu au fost depistaţi factori de risc materni. De asemenea, aparent nu au existat riscuri fetale: greutatea 2.820 g la 37 de săptămâni de gestaţie, teste TORCH negative, culturi şi CRP negative. Hidrocefalia a avut o evoluţie progresivă impunând ventriculotomii şi cisternotomii; plasarea unui şunt ventriculo-peritoneal în timpul celei de-a treia intervenţii neurochirurgicale a ameliorat prognosticul vital. Concluzii. Prezenţa hidrocefaliei a fost un semn ecografic fidel pentru diagnosticul HCF. Evoluţia şi prognosticul sunt influenţate de severitatea hemoragiei şi de vârsta gestaţională. Supravieţuitorii beneficiază de tratamentul neurochirurgical. Etiopatogenia plurifactorială, incomplet descifrată a HCF conduce la dificultăţi în stabilirea unui grup ţintă de screening, în scopul identificării acestei leziuni.

Prezentăm cazul unui băiat de 9 ani cu epilepsie refractară la tratamentul anterior, diagnosticat cu sindrom Stevens Johnson apărut după introducerea în tratament a Lamictalului. Băiatul a prezentat febră, exantem polimorf maculo-papulo-eritematos, cu elemente veziculo buloase generalizate şi denudare tegumentară, conjunctivită, leziuni bucale. Pneumonia asociata am interpretat-o ca afectare a mucoasei tractului respirator inferior din cadrul sindromului Stevens Johnson. Evoluţia bolii a fost favorabilă după doze mari de imunoglobuline intravenos. În concluzie, deşi incidenţa sindromului Steven Johnson este mică la copil, pediatrii trebuie să fi e conştienţi de posibilitatea apariţiei ei (chiar după antiepileptice – Lamictal), iar utilizarea imunoglobulinelor IV, deşi con troversată, administrată în doze mari pare că duce la vindecarea bolii.

Elastografi a este o nouă metodă imagistică bazată pe ultrasunete, care permite evaluarea structurii ţesuturilor în ceea ce priveşte rigiditatea lor, fi ind utilă în explorarea diferitelor organe şi sisteme şi cu tot mai multe aplicaţii clinice. Dezvoltarea substanţelor de contrast de generaţia a doua a dus la amplifi carea semnalului ecografi c cu ajutorul microbulelor, care nu pot străbate peretele vascular şi care se elimină prin exhalare în 15 minute. Material şi metode. Prezentăm rezultatele unui studiu prospectiv derulat în clinica noastră, evaluând performanţele metodei ARFI (impulsul de difuzie a forţei acustice) în evaluarea elasticităţii fi catului la copii; prezentăm şi câteva cazuri pediatrice în care ecografi a cu contrast a adus reale benefi cii, uşurând diagnosticul şi facilitând luarea deciziilor terapeutice optime.

Aim: In the rare cases, the success of therapy is determined by early diagnosis. The aim of this paper is to illustrate the importance of judicious management of these cases by the family doctor. Methods: We present the case of a 12 year-old girl, with class II obesity, presenting with abdominal pain.The symptoms, according to the mother, started 2-3 days ago. But, by discussing directly to the child, we discovered that these symptoms began about 1 month ago. The clinical exam was unremarkable. We decided to perform an abdominal ultrasound at once, supplemented by laboratory tests afterwards. Results: On the ultrasound exam we detected a relatively rounded transonic, abdomino-pelvic mass, the outline without a Doppler signal, about 13 cm in diameter. In order to clarify the diagnosis, we have directed the patient for specialist consultation. The CT exam confirmed the giant cystic tumor. The treatment was surgical: laparoscopic right para-ovarian cystectomy; histopathology was serous cystadenoma. Evolution was favorable, early detection and rapid treatment thus prevented a series of complications. The particularity of this case was the camouflage of a rare diagnosis in children by nonspecific, banal symptoms. Conclusions: The management of anamnestic and clinical data, the possibility of performing early extensive work-up in the general practitioner's office, attests to the important role of the family doctor in resolving the case early, before complications occur. Direct communication at the level of understanding of the young patient should be a desideratum of each consultation. [ABSTRACT FROM AUTHOR]