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Background Multiple endocrine neoplasia (MEN) type 2a is an autosomal dominant syndrome caused by specific proto-oncogene mutations characterized by medullary carcinoma of the thyroid, pheochromocytoma, and, occasionally, multiglandular parathyroid hyperplasia, which rarely complicates pregnancy. Secondary diabetes rarely has been reported in association with principal endocrinopathies complicating pregnancy. Case A 34-year-old primiparous woman with recently diagnosed gestational diabetes had repeated episodes of dizziness at 30 weeks of gestation, initially attributed to glyburide. Continued episodes of dizziness and later-appearing bouts of severe headache, palpitations, diaphoresis, severe hypertension, and marked tachycardia led to diagnosis and management of MEN type 2a complicating pregnancy. Conclusion Patients with MEN type 2a complicating pregnancy may present with gestational diabetes.

Objective: To present current data pertaining to angiogenesis of the endometrium throughout the normal menstrual cycle and in benign and neoplastic diseases of the endometrium. Sources: We conducted a computerized search of MEDLINE, Current Contents, and Index Medicus for relevant studies in the English literature published between January 1966 and October 1998. Study selection: We reviewed all studies that included human and animal models of angiogenesis of normal cyclic endometrium and benign and neoplastic endometrial diseases. Tabulation, Integration, and Results: Angiogenesis is important to cyclic, regenerating endometria and disease processes including dysfunctional uterine bleeding, response to exogenous hormonal treatment, bleeding associated with intrauterine contraceptive devices, uterine leiomyomata, endometriosis, complex endometrial hyperplasia, and endometrial carcinoma. Conclusion: In the future, knowledge of specific angiogenic patterns of various disease processes might improve application of antiangiogenic medications in therapies for benign and neoplastic diseases of the endometrium.

To assess the advantage of applying uterine fundal pressure to assist transvaginal sonographic imaging of early second-trimester fetal anatomy.One hundred consecutive patients with singleton fetuses underwent routine transvaginal sonographic assessment of fetal anatomy between 13 and 17 weeks' gestation. If the entire fetal anatomy including cardiac outflow tracts was not depicted, uterine fundal pressure was applied with the operator's nonscanning hand in a bimanual fashion, to facilitate transvaginal imaging. Transabdominal sonography was performed when visualization of the entire fetal anatomy was not obtainable with transvaginal or uterine fundal pressure-assisted transvaginal sonography. Observed fetal structures with and without fundal pressure were compared. Factors assessed that may have modified the value of fundal pressure included patient weight, gestational age, fetal presentation, previous abdominal surgery, and the presence of uterine fibroids. Statistical analysis included McNemar test, chi 2, Fisher exact test, and t test, with P.05 considered significant.Visualization of lower limbs, head (including intracranial structures), upper limbs, kidneys, spine, gender, feet, hands (digits), face, four-chamber view, and cardiac outflow tracts was significantly enhanced by uterine fundal pressure-assisted versus nonassisted transvaginal sonography. Uterine fundal pressure improved transvaginal sonographic imaging in 91% of subjects, and in 51% of all subjects, a complete examination was thus obtained. In 20% of all subjects, transabdominal sonography was required to complete the examination. Complete fetal anatomic scanning was unobtainable despite uterine fundal pressure supplemented by transabdominal sonography in 29% of cases. Completion of the transvaginal sonographic fetal anatomic survey with uterine fundal pressure was related to gestational age (P.02) and maternal weight (P.05) yet not related to fetal presentation (P = .13), previous abdominal surgery (P = .06), or uterine fibroids (P = .26).Uterine fundal pressure applied during early second-trimester transvaginal sonographic evaluation of fetal anatomy significantly improves visualization of fetal structures otherwise located beyond the effective range of the transvaginal transducer.

Objective To evaluate if interleukin-10 levels in either early second-trimester amniotic fluid (AF) or maternal serum can be utilized as a predictor of the subsequent occurrence of small for gestational age (SGA) infants after controlling for gestational age at delivery. Methods We identified patients who underwent genetic amniocentesis for standard genetic indications or maternal blood sampling for maternal serum alpha-fetoprotein (MSAFP)/triple screen between January 1992 and February 1995 with available follow-up delivery data. Small for gestational age was defined as birth weight less than the tenth percentile for gestational age. Control patients were matched for gestational age at delivery, maternal age, race, and parity with at least two controls for each study patient. We excluded patients with maternal immune disease, chronic hypertension, diabetes, asthma, congenital heart disease, multiple gestation, and fetuses with structural or chromosomal anomalies. Second-trimester AF and serum samples were assayed for interleukin-10. Potential confounding variables considered were MSAFP level, smoking history, pregnancy-induced hypertension, and neonatal gender. The interleukin-10 levels were normalized using natural log transformation for statistical analysis. Statistical analysis included χ 2 . Fisher exact test, and analysis of variance, with P Results From the AF data base, 18 patients (6%) delivered SGA neonates and were matched with 46 controls. From the maternal serum data base, 13 patients (7%) delivered SGA neonates and were matched with 45 controls. Neither AF nor maternal serum interleukin-10 levels were significantly different in patients subsequently delivering SGA neonates compared with controls (AF: median 21.0 pg/mL [range 13.8–27.6] versus 17.5 pg/mL [range 8.9–362.12], P = .18; serum: median 15.7 pg/mL [range 9.9–73.5] versus 18.7 pg/mL [range 9.7–71.7], P = .60, respectively). No significant differences were identified in gestational age at sampling, maternal smoking history, pregnancy-induced hypertension, or elevated MSAFP in patients delivering SGA neonates compared with controls ( P > .05 for each). As expected, birth weight was significantly lower in patients delivering SGA neonates compared with controls ( P Conclusion Second-trimester AF or maternal serum interleukin-10 levels are not predictive of subsequent delivery of SGA infants.

Objective To review current data pertaining to prenatal ultrasonography of the ductus arteriosus. Data Sources We reviewed manuscripts published in the English language regarding prenatal ultrasonography and the fetal ductus arteriosus obtained from a MEDLINE search for 1966 onward. Additional sources were identified through cross-referencing. Methods of Study Selection Data regarding morphology, physiology, pathophysiology of fetal disease, and hemodynamic changes after administration of various maternal medications and structural congenital anomalies of the ductus arteriosus were selected. Data Extraction and Synthesis Knowledge of the function of the ductus arteriosus in both normal and abnormal fetal conditions is enhanced by prenatal ultrasonographic findings. Detailed analyses of ductus arteriosus hemodynamics are indicated in well-defined medical conditions, including maternal medication and established structural or functional fetal cardiac disease. Conclusion The fetal ductus arteriosus is a vascular structure of major functional importance. Knowledge of physiologic hemodynamic changes of blood flow in this vessel obtained by prenatal ultrasonography in conjunction with increasing gestational age, maternal medication, fetal growth restriction, as well as the detection of structural anomalies, may assist in clinical management of complicated pregnancies.

Objective: To evaluate angiogenesis in endometrial hyperplasia and stage I endometrial carcinoma, and to investigate the relationship between angiogenesis and tumor grade and depth of invasion. Methods: Three groups of patients were analyzed: control patients who underwent hysterectomy for benign conditions ( n = 19), patients with endometrial hyperplasia ( n = 24), and patients with stage I endometrial carcinoma ( n = 34). All hysterectomy specimens were stained immunohistochemically for factor VIII-related antigen as a sensitive and specific marker for vascular endothelium. Areas close to the deepest myometrial invasion or those with the highest grade of endometrial hyperplasia and the highest angiogenic intensity were selected. Three fields (× 400) were selected for each slide, and the mean microvessel count was calculated. Statistical analysis included Mann-Whitney U test ir Kruskal-Wallis analysis of variance and Dunn post hoc procedure. P Results: A significant difference was found between the microvessel count of controls versus the group with complex endometrial hyperplasia (median 21, range 16–80, versus median 38, range 20–130; P P P P = .5). In cases of stage I endometrial carcinoma, a higher number of microvessels was noted in specimens with myometrial invasion than in those without myometrial invasion (median 44, range 19–119, versus median 83, range 19–189; P P Conclusion: Complex endometrial hyperplasia and endometrial carcinoma are angiogenic. Furthermore, in stage I endometrial carcinoma, greater depth of invasion and higher tumor grade are directly correlated with angiogenic intensity.

BACKGROUND: Alimentary tract duplications are rare congenital lesions that may arise at any location throughout the gastrointestinal tract. The most common site of enteric duplications is the ileum, with only 13% of cases occurring in the colon. CASE: Prenatal sonography at 39 weeks' gestation showed a cystic structure with thick walls exhibiting clear peristaltic movements in the right lower fetal abdomen. Inner walls of the cystic structure had small folds suggestive of colonic haustra. The sonographic findings and location of the finding were consistent with duplication of the colon and, possibly, the cecum. Congenital duplication of the cecum was proven at neonatal laparotomy. Ileocecal resection with ileocolonic anatomosis was performed and congenital duplication of the cecum confirmed by pathology examination of the resected specimen. CONCLUSION: Unusual sites of alimentary tract duplications detected by prenatal ultrasound include the cecum.

BACKGROUND: Coarctation of the aorta is an uncommon condition complicating pregnancy. It is often associated with hypertension and usually involves the aortic isthmus. CASE: Coarctation of the descending thoracic aorta was found at 21 weeks’ gestation after physical findings of hypertension, a holosystolic murmur over the entire left hemithorax, and diminished lower extremity pulses. The diagnosis led to thoracotomy and placement of a graft bypass after an otherwise uneventful pregnancy. CONCLUSION: Unusual sites of coarctation of the aorta complicating pregnancy include the descending thoracic aorta.