No abstract

The incidence of insulin-dependent diabetes mellitus is about 0.8%, and gestational diabetes is 3-5%. Both are evidence of the metabolic disturbances of carbohydrates during pregnancy 1 . The incidence of congenital malformation is 3 to 4 times greater in children from diabetic mothers than in the general population 2 . Among those malformations, 50% are congenital cardiac diseases 3 . Maternal diabetes is a risk factor for congenital heart disease and an indication for fetal echocardiography [4][5][6][7][8][9][10][11][12] .Maternal hyperglycemia and the excess of glucose transferred to the fetus encourage fetal pancreatic islets to increase the production of insulin, leading to hyperinsulinism, which is responsible for fetal complications. Fetal myocardial hypertrophy is the most frequent abnormality found in newborns from diabetic mothers, and it may be found in up to 35% of these newborns 13 . The interventricular septum is particularly rich in insulin receptors 14 , which would justify increased hypertrophy in this segment, secondary to myocardial cell hyperplasia and hypertrophy due to the increased synthesis of fat and proteins.Fetal Doppler echocardiography has increased our knowledge about the cardiocirculatory changes in the prenatal period. Recent studies have shown significant changes in the cardiovascular flow of fetuses from diabetic mothers, especially in pregnancies with inadequate glycemic control 15 .With the introduction of echocardiography, several clinical studies have demonstrated normal patterns of pulmonary venous flow in children and adults through transesophageal and transthoracic echocardiography 16,17 . The use of the pulmonary vein pulsatility index as a parameter for diastolic function evaluation during fetal life has not yet been reported. Thus, we have tested the hypothesis that the pulmonary vein pulsatility index in fetuses from diabetic mothers is greater than that in fetuses from nondiabetic mothers, based on the idea that a less complacent left ventricle would increase presystolic flow impedance in the pulmonary vein, corresponding to the atrial contraction phases. Consequently, it would increase the pulsatility index in this vessel. Objective -To verify the hypothesis that the pulmonary vein pulsatility index is higher in fetuses of diabetic mothers than it is in normal fetuses of nondiabetic mothers. Methods -

Background-The usual positioning of the Doppler sample volume to assess fetal pulmonary vein flow is in the distal portion of the vein, where the vessel diameter is maximal. This study was performed to test the association of the pulmonary vein pulsatility index (PVPI) with the vessel diameter. Methods and Results-Twenty-three normal fetuses (mean gestational age, 28.6Ϯ5.3 weeks) were studied by Doppler echocardiography. Pulmonary right upper vein flow was assessed adjacent to the venoatrial junction ("distal" position) and in the middle of the vein ("proximal" position). The vessel diameter was measured by 2D echocardiography with power Doppler, and the PVPI was obtained by the ratio (maximal velocity [systolic or diastolic peak]Ϫminimal velocity [presystolic peak])/mean velocity. The statistical analysis used t test and exponential correlation studies. Mean distal diameter was 0.33Ϯ0.10 cm (0.11 to 0.57 cm), and mean proximal diameter was 0.16Ϯ0.08 cm (0.11 to 0.25 cm) (PϽ0.0001). Mean distal PVPI was 0.84Ϯ0.21 (0.59 to 1.38), and mean proximal PVPI was 2.09Ϯ0.59 (1.23 to 3.11) (PϽ0.0001). Exponential inverse correlation between pulmonary vein diameter and pulsatility index was highly significant (PϽ0.0001), with a determination coefficient of 0.439. Conclusions-In the normal fetus, the pulmonary venous flow pulsatility decreases from the lung to the heart, and this parameter is inversely correlated to the diameter of the pulmonary vein, which increases from its proximal to its distal portion. This study emphasizes the importance of the correct positioning of the Doppler sample volume, adjacent to the venoatrial junction, to assess pulmonary venous flow dynamics.

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...

ObjectiveTo test the hypothesis that left atrial shortening fraction is lower in fetuses of diabetic mothers than in fetuses of mothers with no systemic disease. Methods Forty-two fetuses of mothers with previous diabetes or gestational diabetes and 39 healthy fetuses of mothers with no Key words fetal echocardiography, fetal diastolic function, global left atrial shortening fractionAlterations in left ventricular relaxation, filling, and compliance are common in fetuses of diabetic mothers. Some studies have suggested that the unidimensional echocardiographic profile of the left atrium may be used as an indicator of abnormalities in left ventricular diastolic function, and that left atrial shortening fraction is proportional to compliance and inversely proportional to left ventricular stiffness constant. The usefulness of atrial shortening as a parameter for assessing fetal diastolic function has not yet been demonstrated.Gestational diabetes has an incidence of 3.5%, accounting for high morbidity and mortality both for the fetus and mother. Major congenital anomalies affect 4 to 12% of newborn infants of women with clinical diabetes, representing an incidence of malformations approximately 5 times higher than that in the general population. The fetal heart is one of the most affected organs, and 40 to 50% of the congenital defects are located in the cardiovascular system 1,2 . Becerra et al 3 have reported an absolute risk for major cardiac malformations of 8.5 per 100 live-born infants of diabetic mothers.The increased tendency towards the appearance of disproportional myocardial hypertrophy, especially of the interventricular septum, has already been demonstrated in children of diabetic mothers 4 . The appearance of fetal echocardiography has provided the opportunity to study the disease in the prenatal period, when it is called fetal myocardial hypertrophy 5,6 . Several case series studied have reported an approximate 30% prevalence of that anatomical change in children of diabetic mothers. Septal hypertrophy has been reported as early as 21 weeks of gestational age, but the prevalence is greater in the third trimester 7,8 . Thus, fetal echocardiography should be performed in all pregnancies complicated with diabetes mellitus, because fetal myocardial hypertrophy is frequent, easily detected on examination, and is a potential cause for nonimmune hydrops. Fetal myocardial hypertrophy is characterized by interventricular septum dimensions at the end of diastole greater than 2 standard deviations according to gestational age or greater than 5mm, as this value is greater than 2 standard deviations until the end of pregnancy 6 . Myocardial hypertrophy involving the right ventricle and left ventricular posterior wall may occur, but septal hypertrophy is usually more marked. The presence of a gradient in the left ventricular outflow tract reveals the obstructive forms of the disease. The changes in myocardial compliance and relaxation cause an altered pattern of diastolic filling, with an elevation in intraventri...

No abstract

Left atrial shortening fraction is higher during respiratory movements as a result of increased left ventricular compliance and consequent optimization of left atrial functional status.