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Struma ovarii is a rare ovarian neoplasm. This tumor is generally benign, although malignant transformation has been reported. The preoperative diagnosis is generally difficult. Thyroid hormones may be produced and in a few cases asymptomatic women may develop definitive clinical hypothyroidism after resection of struma ovarii. We report a case of a 39-year-old woman who underwent laparoscopic resection of an asymptomatic right ovarian mass. The pathologic diagnosis was struma ovarii. The postoperative period was uneventful and her thyroid function remained normal.

To describe antenatal corticosteroids (ANCs) policies in European obstetric units and to determine factors that influence the use of multiple courses.641 obstetricians from obstetric departments covering a geographical area in 14 European countries responded to a questionnaire on ANCs policies. Logistic regression was used to identify factors that were related to the use of multiple ANCs courses.The survey response rate was 76% (inter-country range 33-94%): 11% (0-50%) of the respondents started ANCs from 23 to 24 wk gestation, 82% from 24 to 28 wk (50-100%) and 7% from 28 to 36 wk (0-32%). Eighty-five percent of the units (63-100%) used multiple ANCs courses. After adjustment for country, number of infants delivered at 24-32 wk annually in the unit, NICU and maternal hypertension, maternal hypertension tended to be an explicative factor (OR 1.97; 95% CI: 0.75-5.17).The high proportion of departments that initiated ANCs between 24 and 28 wk of gestation is consistent with the high incidence of neonatal morbidity and mortality in that age range. Multiple courses are overwhelmingly prescribed in Europe, although their risk/benefit ratio compared with a single dose is not yet known. The likelihood of using repeated courses of ANCs may be related to the presence of maternal hypertension, and this highlights the importance of closely monitoring women at risk of premature delivery.

Uterine anomalies implicated in female subfertility, implantation failure and miscarriages can often be detected often by two-dimensional transvaginal (2D TV) ultrasound scanning. When used as a screening test TV ultrasound has provided sensitivity rates of up to 100% about uterine anomalies. Improved depiction has been achieved with the development of hysterosalpingosonography (HSSG). The anechoic interface provided by the saline solution allows the examiner to determine whether an abnormality is intracavitary, endometrial, or submucosal. The aim of this study was to evaluate the role of 2D TV contrast sonography and 3D TV ultrasound in the diagnosis of congenital uterine anomalies in comparison with their appearance of hysterosalpingosonography findings.

A case of a 24-week-old fetus of non consanguineous parents with an ultrasonographic diagnosis of a short right femur, ipsilateral agenesia of the fibula and a twisted right foot is described. Cordocentesis revealed a normal 46XY karyotype. The parents were informed on treatment options and after psychological counselling they decided to undergo an abortion. Post mortem examination confirmed the diagnosis of a severe right limb malformation.

Important factors which may affect the fetal circulation are the fetal breathing movements (FBMs) and other movements adn the features of fetal circulation. Recent studies have demonstrated that FBMs are a normal phenomenon of intrauterine development and that there are two patterns of FBMs: (1) A predominant pattern of rapid, irregular (in rate and amplitude) episodic movements, with interspersed episodes of apnea that is present more than 50 percent of the time and accounts for more than 90 percent of the breathing activity. Interestingly, periodic sighs are often seen during these FBMs; (2) There is also a less frequent pattern of sporadic, slow (1 to 4 movements/min), deep inspiratory movements, like sighs or gasps, or espiratory efforts which resemble grunting, coughing, or panting. The first pattern, which represents normal fetal respiratory activity, only occurs during rapid eye movements (REM) sleep, and it is unrelated to changes in blood gases and pH values and to afferent impulses from aortic and carotid bodies; FBMs may produce intrathoracic pressure swings of 35 Torr or more and are independent of Hering-Breuer reflexes. This pattern is usually accompanied by increased FHR beat-to-beat variability and increased systolic and diastolic blood pressure and flow (BF). Therefore, they may influence the velocimetry of B.F. in humans, e.g., RED and ARED in the umbilical artery blood flow (UABF), which do not necessarily indicate impending fetal demise. The second pattern is unrelated to the fetal behavioral state and blood gas tensions. Concerning the effects of drugs on FBMs, we have analysed the effects aminophylline (A)(bolus of 240 mg followed by 0.2 mg/kg/min) given to women not in labor; A caused a prompt and sustained FBMs that started as vorteces and then as regular inspiratory and expiratory movements, which increased in frequency (up to 88/min) and depth. Hexoprenaline given to pregnant women with threatened preterm labor were able to elicit FBMs and NFFV; the infusion of 0.3 microg/min increased UABF. Conjugated estrogens administered to the mother as a 10 mg bolus enhanced FBMs, as documented by TM and nasal flow velocity waveforms (NFFV); this was associated with an increased UABF; betamethasone (4 mg bolus to the mother) was shown to induce FBMs and an increased UABF. In a twin pregnancy betamethasone (0.5 mg/kg) was administered IV into the umbilical vein in one fetus and IM to the other; in both cases bradycardia and increase in UABF occurred, immediately after IV infusion, and after 30 min following IM injection FBMs were induced or enhanced in frequency and depth. The flow in MCA was unchanged. In conclusion, the fetal circulation is influenced by fetal behavioural states, particularly by FBMs that affect the fetal cardiovascular function, including blood pressure and FHR thereby conditioning the velocimetric response of its major vessels, i.e., UA and MCA BF, whose alterations do not necessarily reflect impending fetal demise.

The purpose of this study was to investigate the beneficial effects of low doses of ethinyl-estradiol on the lipid profile in postmenopausal women. One hundred and five patients (mean age [+/-S D] 42.9 +/- 5.0 years) who underwent a hysterectomy and bilateral salpingo-oophorectomy were included in the study. For the present study serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B (apoB), and lipoprotein(a) [Lp(a)] were investigated. When all patients were considered together (Table 1), EE2 therapy significantly increased serum levels of total cholesterol, HDL cholesterol and LDL cholesterol. The ratio of HDL to LDL cholesterol, Lp(a) and triglyceride concentrations did not change significantly from the baseline value. Although our study was not randomized or controlled with a placebo, the beneficial metabolic effects of ethinyl-estradiol on lipid patterns should be considered in patients needing hormonal replacement therapy in postmenopause.

To evaluate the vascular changes in ovaries affected by endometriomas 28 women with ovarian endometriosis underwent transvaginal ultrasound with color flow imaging and blood flow analysis of the ovarian artery before and after laparoscopic conservative treatment of the ovarian cyst. Mean pulsatility index (P.I.) and resistance index (R.I.) of the ovarian artery on the side affected by endometrioma were compared using Student's t-test. Mean P.I. after laparoscopy (1.59) was significantly lower (p = 0.001) than before surgical intervention (2.17). Analogously the mean R.I. was significantly different (p = 0.001) when compared before (0.81) and after (0.73) laparoscopy. Color Doppler velocimetry may add greater understanding of the ovarian hemodynamic changes that occur after conservative surgery on the ovary.

Adenomyosis is an underestimated pathology frequently responsible of unknown origin pelvic pain and uterine enlargement. It is hyperestrinic condition with poor specific symptomatology and preoperative diagnostic tools are very few. The most important of them, ultrasound, has improved its diagnostic capacity with the introduction of transvaginal way of examination. However, for the ultrasound resemblance, the common etiopathogenetic origin and the symptomatologic likeness between adenomyosis and uterine leiomyomatosis, a problem still open is the differential diagnosis between these two pathologies especially when both are present in the same subject. In our study where the preoperative ultrasound was followed by surgical finding, we try to give some ultrasonographical guidelines to discern among these two pathologic conditions.