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Background Identification of peri-operative variables predicting postoperative morbidity may improve postoperative patients' care. We aimed to identify patients' characteristics and operative factors predictive of early (≤30-day) and late (≤6-month) morbidity in cervical cancer patients undergoing surgery plus external beam radiotherapy (EBRT). Methods We studied 45 propensity-matched patient pairs (90 patients) undergoing laparoscopic radical hysterectomy (LRH) plus EBRT vs. abdominal radical hysterectomy (RAH) plus EBRT. Basic descriptive, multivariable and artificial neuronal network analyses (ANN) were used to design predicting models influencing outcomes. Results Baseline characteristics of the study populations were similar. Patients undergoing LRH experienced lower blood loss (200 (range, 10–700) vs. 400 (range, 100–2000) ml; P

Fetal cell-free DNA (cf-DNA) represents only a small fraction of the total cf-DNA in maternal plasma. This feature has rendered it difficult to reliably distinguish fetal alleles which are not very disparate from maternal ones, such as those involving point mutations, by conventional polymerase chain reaction (PCR)-based approaches. It has recently been shown that cell-free fetal DNA molecules have a smaller size than comparable cf-DNA molecules of maternal origin, and that this feature can be exploited for the selective enrichment of fetal DNA sequences, thereby permitting the detection of otherwise masked fetal genetic traits. By the use of this approach, we have shown that it is possible to detect fetal genetic loci for microsatellite markers, as well as point mutations involved in disorders such as achondroplasia and beta-thalassemia.

According to some reports in the literature, the hormonal fluctuations which occur during the menstrual cycle may affect the clinical expression of contact allergy to a greater or lesser degree. In clinical practice, too, patient history often shows exacerbation of the contact dermatitis during the days immediately preceding menstruation. On the contrary, the follicular phase of the cycle seems to have a temporary protective role in inhibiting the eliciting phase of allergic contact dermatitis. One possible explanation for this phenomenon is of immunological type: it has been demonstrated that oestradiol induces inhibition of delayed hypersensitivity type reactions, probably by acting indirectly on cells having a regulatory function in cell-mediated immunity. To investigate any inhibitory effect of the ovulatory phase of the menstrual cycle on contact sensitization, 30 selected fertile women, allergic to nickel sulfate and with a regular menstrual cycle lasting between 25 and 32 days, were enrolled. Patch tests were performed with a series of 10 serial aqueous dilutions of nickel sulfate, from 5% to 0.0013%. The 30 women were tested at 2 different times, in the ovulatory phase (demonstrated by transvaginal ultrasound) and the progestinic phase; they were subdivided into 2 groups of 15 women: in one group, the tests were made first in the ovulatory phase, and in the other, first in the progestinic phase of the menstrual cycle. There was a minimum interval of 5 weeks between the 2 test phases. The study shows that during ovulation the patch tests elicited significantly less intense responses than in the progestinic phase. These data therefore suggest that the ovulatory phase of the cycle has a significant inhibitory role on delayed hypersensitivity type reactions. For this reason, negative responses to patch tests executed in this phase could likely be false-negatives, and after careful evaluation of the phenomenon and of the clinical condition and patient history, it may be considered advisable to repeat the tests during the progestinic phase of the menstrual cycle.

Objective Monochorionic twins with twin–twin transfusion syndrome (TTTS) provide an ideal model in which to evaluate the influence of differing hemodynamic stress on umbilical cord (UC) morphology. The purpose of this study was to investigate the UC morphometry and UC coiling pattern at ultrasound in monochorionic twin pregnancies with TTTS. Methods A targeted sonographic evaluation of the UC was performed in 21 consecutive twin pregnancies with untreated TTTS. The cross-sectional area of the UC and of its vessels was measured. The Wharton's jelly area was computed by subtracting the vessels area from the area of the UC. The umbilical coiling index (UCI) was calculated as the reciprocal of the sonographic length of one complete vascular coil. The UCs were classified as uncoiled, normally coiled, hypocoiled, hypercoiled and atypically coiled (UCI not valuable). Results The UCs of recipient twins were invariably larger than those of donors, and this difference was mainly attributable to both a larger amount of Wharton's jelly and a larger umbilical vein diameter. The proportion of lean UCs was higher in the donor than in the recipient fetuses (18/21 vs 1/21, p < 0.0001), while large UCs were significantly more frequent in the recipient than in the donor twins (13/21 vs 1/21, p = 0.0002). In all twin pairs, a discordant umbilical coiling pattern was observed between the donor and the recipient twin. The prevalence of uncoiled and hypocoiled cords was higher in the donor group, while hypercoiling and atypical coiling were more frequently detected in the recipient group. Conclusions A discordant UC morphometry represents an additional phenotypic feature of twins with TTTS. The discordant intertwin coiling pattern in TTTS argues against an exclusively genetic origin of UC twists, and further supports a key role of hemodynamic forces in coiling development. Copyright © 2005 John Wiley & Sons, Ltd.

Acta Obstet Gynecol Scand 2002; 81: 1040-1046. © Acta Obstet Gynecol Scand 2002 Objective. To evaluate whether the technique to open the abdomen might influence the operative time and the maternal and neonatal outcome. Methods. All consecutive women who underwent a cesarean section at a gestational age greater than or equal to 32 weeks were randomly allocated to have either the Joel-Cohen or the Pfannenstiel incision. Exclusion criteria were two or more previous cesarean sections and previous longitudinal abdominal incision. During the study period 366 patients underwent a cesarean delivery. Of these patients, 56 did not meet the inclusion criteria. The remaining patients were allocated to the Joel-Cohen ( n = 152) group and to the Pfannenstiel ( n = 158) group. Extraction time was defined as the time interval from skin incision to the clamping of the umbilical cord. Results. The total operative time was similar in both groups [Joel-Cohen 32 min (12-60) vs. Pfannenstiel 33 min (18-70)]. The extraction tim...

Acta Obstet Gynecol Scand 2002; 81: 527-533. © Acta Obstet Gynecol Scand 2002 Objective. To explore whether the umbilical vein blood flow of growth-retarded fetuses with normal Doppler parameters changes over time differently to that of normally grown fetuses. Methods. Fifteen consecutive women whose fetus was diagnosed to be growth restricted were compared with 30 women whose fetus was normally grown. Two ultrasonographic evaluations were conducted at 2-weekly intervals (± 2 days) in all cases. At each sonographic evaluation, umbilical vein blood flow parameters were obtained by digital color Doppler velocity profile integration. To allow comparisons among fetuses, the umbilical vein blood flow per minute was normalized for abdominal circumference. Results. The absolute vein blood flow was lower in growth-retarded than in normally grown fetuses (209 ml/min ± 73 vs. 313 ml/min ± 72, p < 0.01). The median (range) umbilical vein blood flow normalized for abdominal circumference was significantly lower in gr...