Search

Introduction In chronic kidney disease (CKD) patients, the case fatality rate caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is higher than in the general population [1]. In patients hospitalised with COVID 19, right heart dysfunction is present in 20% of the cases, associated with an increased risk of all-cause death [2]. Purpose CARDIO-SCARS in CKD is a currently ongoing multi-center observational match controlled trial that aims to assess the cardiovascular (CV) risk in a CKD (stages 3 to 5), dialysis and kidney transplant population, following SARS-CoV-2 infection, by using clinical evaluation, various techniques and novel biomarkers (ClinicalTrials.gov Identifier NCT05125913). We hereby report the main baseline echocardiographic parameters that assess the right ventricular (RV) function. Methods We conducted a cross-sectional study that included 263 patients with CKD (dialysis, transplantation or eGFR Results Our study included 263 patients with CKD, divided in two groups: 168 patients post COVID-19 (94 in dialysis, 38 post kidney transplantation and 36 with CKD) and 95 patients in the control group (57 in dialysis, 30 post kidney transplantation and 8 with CKD).The mean age was 57.3±15.4 years (median 60 years old), 55.2% of the patients were males, 24% were diabetic and 9.5% were smokers. The mean duration of dialysis in the COVID-19 group was 63.8 months vs. 62.6 months in the control group. In the COVID group, the echocardiography was performed at a mean distance of 2.2±2.1 months after testing positive for SARS-CoV-2.All the parameters of RV function were better in the control group (FAC (%): 43.6±11 vs. 41.3±11; TAPSE (mm): 23.2±6.9 vs. 21.4±4.9; S tric (cm/s): 13.4±3.4 vs. 13±3.1; Tei index: 0.5±0.2 vs. 0.6±0.2; RVFWLS (%): −20.1±3.8 vs. −18.6±5.1. After performing a two-sample t-Test, statistical significance was reached only for TAPSE, Tei index and RVFWLS (0.008, 0.0001 and 0.006, respectively). Conclusions Our study is the first to describe echocardiographic alterations post-COVID in a CKD population. All CKD patients had lower values of RV parameters than those reported in the general population. Still, the CKD COVID group had lower values than CKD control group, with the same magnitude as the changes reported in the general population [3,4]. The evolution of these parameters and their prognostic significance is of interest, regarding long-term CV sequelae of COVID-19. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Ministry of Research and Innovation, CNCS-UEFISCDI

Endometrial cancer (EC) in postmenopausal women is usually associated with abnormal vaginal bleeding. However, asymptomatic cases of EC have been reported. The incidence of EC has been estimated to 1.3-3.05 per 1,000 screened postmenopausal asymptomatic women, the most significant ultra-sonographic feature being the thickened endometrium. We reviewed the literature on the accuracy of endometrial thickness measurement by transvaginal sonography (TVS) in predicting EC in asymptomatic postmenopausal women. The use of endometrial thickness as a sole screening test was found not to be of high predictive value and it should be combined with the evaluation of EC risk factors and followed by hysteroscopy and biopsy in suspicious cases. The lack of a universal cut-off value for endometrial thickness that could be correlated to EC is pointed out.

Pre-eclampsia is a severe multisystemic syndrome that represents a major cause of maternal, foetal and neonatal mortality and morbidity. In the study we conducted it stood out the. significant modifications of angiogenic markers in pregnant women suffering from pre-eclampsia and the existence of a correlation between C-reactive protein (CRP) and SBP, DBP and average BP.The group included in the study consisted of 138 pregnant women hospitalized at the "Cuza-Voda" Clinical Hospital of Obstetrics and Gynaecology of Iasi, between 2012-2014, with over 20 weeks gestational age and which gave their free consent to take part in the study.It is confirmed the importance of determining the markers for diagnosing and monitoring hypertensive pregnant women and at the same time it was pointed out that the sFlt-1/PlGF ratio represents a good pre-eclampsia predictor.The results of our study confirm the importance of determining sFlt-l and PlGF as markers for diagnosing and monitoring pregnant women with HBP as well as the sFlt-l/ PlGF ratio which represents a good pre-eclampsia predictor.

The study deals with the preoperative ultrasound diagnosis of ovarian endometriosis, postoperative ultrasound reassessment, laparoscopic surgical resolution of ovarian endometriosis, estimation of recurrence risk 12 months after surgery by ultrasound, reappearance of clinical symptoms (such as pain) or second-look laparoscopy, and pregnancy rate 2 years after surgery.140 patients with en- dometriosis and infertility admitted to the Iasi "Cuza-Vodă" Clinical Hospital of Obstetrics and Gynecology between the years 2009-2011 were included in the study. The patients were divided into 2 groups: group 1-59 cases that refused in vitro fertilization procedures, did not afford in vitro fertilization (IVF) or had minimal endometriosis and young ages and thus a possibility of delaying treatment, and group 2--62 cases which underwent IVF procedures immediately after surgery.No significant differences in the chance of becoming pregnant were found between the two groups (χ2 = 2.06, p = 0.0891, 95% CI); in group 1, 11.86% pregnancies were obtained while in group 2 the pregnancy rate was 11.29%. Based on the nonparametric method of analysis of contingency tables we could estimate the odds of becoming pregnant in the study groups, obtaining an odds ratio (OR = 1.16, CI: 1.04-2.23, 95% CI). This result indicated that in group 1 the odds of becoming pregnant was not significantly higher, and the estimation was made for a confidence interval of 95%. The study had in view the assessment of pregnancies obtained in the study groups and the time interval (number of weeks) from the time of intervention until the occurrence of pregnancy. The Kaplan-Meier analysis enabled the assessment of the mean value and the median value of the number of weeks until becoming pregnant, and these values did not show significant differences (χ2 = 1.55, p = 0.212, 95% CI).For endometriosis associated with infertility, hormonal suppression does not improve fertility, and therefore surgery followed by controlled ovarian hyperstimulation and intrauterine insemi- nation (IUI), provided the anatomy of the pelvis is preserved in early cases or in vitro fertilization in severe cases is preferred.

Prenatal diagnosis (PD) by FISH or cell culture is today an important tool for the prevention of chromosomal anomalies. A difficult issue is prenatal detection of gonosomal anomalies. Most gonosomal anomalies neither affect life expectancy nor cause psychomotor retardation, but sexualization disorders and the lack of reproductive potential are a constant finding.This study aimed at identifying the medical problems the specialists and the parental couple are faced with at the time of the diagnosis of fetal gonosomal anomalies.This retrospective study (2004-2012) was conducted in the Prenatal Genetic Diagnosis Department of "CuzaVoda" Maternity by FISH technique in 1685 pregnancies. The AneuVysion probes were used for identifying and enumerating chromosomes 13, 18, 21, X, and Y via fluorescence in situ hybridization (FISH) in interphase nuclei obtained from amniotic fluid.Fifteen fetuses were selected in which we were faced with difficulties interpreting the number of gonosomes: monosomy X (5 cases), pseudomosaicism XX/XY (3), trisomy XXY (3 cases), trisomy XYY (1 case), 45,X/46.XX mosaicism (1 case) and triploidy XXX (2 cases). Later, by repeating the analysis, 2 cases with pseudomosaicism XX/XY were excluded. A case highlighting the limitations of the FISH test was that of a fetus in which the FISH test revealed trisomy XXY, while postnatal karyotyping showed a six cell line mosaicism (marker and ring X chromosomes).All parental couples received nondirective genetic counseling, respecting the individuals' dignity and rights of self-determination. Parents received information on the natural course of the disease, treatment options, and psychological support and were involved in their child's recovery.

Borderline ovarian tumors are an intermediate stage between benign cystadenomas and adenocarcinomas.The paper evaluates the management of borderline ovarian tumors (BOTs) in the patients admitted and treated in our clinic in the interval January 2003 - June 2011.The observation sheets and pathology results of 264 patients with malignant ovarian tumors were analyzed.Of the 264 malignant ovarian tumors 74 (28.03%) were low malignant potential. Patients with BOT were aged 18-72 years (mean 46 +/- 6.2 years) and those with invasive tumors 14-83 years (mean 53 +/- 9.8 years). 92.18% were in stage 1. Sixty tumors were graded G1. 53.52 % of the tumors were over 10 cm (maximum 30 cm) in size. The histological types were: serous - 35 cases, mucinous - 19 cases, mixed (serous and mucinous) - 8 cases, and endometrioid - 2 cases. Fifteen patients presented intraepithelial carcinoma and 11 noninvasive implants into the peritoneal cavity. Five women had recurrences.Ovarian borderline tumors with histological characteristics of carcinoma, but with good behavior are now with better defined histological features. The biggest challenge in the management of women with these tumors is to identify the subset that will behave in a malignant fashion and to develop effective treatment for them.

PAX8 and WT1 are transcription factors, each of them with distinct roles in organogenesis, morphogenesis, cell growth, and differentiation. Recently, their expression was also confirmed in a variety of malignancies, being included in the antibodies panel recommended for the female genital tract pathology. The aim of our study was to evaluate PAX8 and WT1 in different types of ovarian cancer (OC) with focus on (i) the completion of evidences of the Müllerian origin and (ii) the establishment of primary ovarian tumor status vs. metastasis. The study group consisted of 86 cases, with histopathological diagnosis covering the main subtypes of OC (low- and high-grade serous, low- and high-grade endometrioid, clear cell, mucinous, malignant Brenner tumor, malignant mixed Müllerian tumor, undifferentiated, and borderline). The investigation was based on immunohistochemical examination, performed by using specific antibodies applied on blocks obtained through Tissue MicroArray technique, and interpreted by scores assessing the nuclear positivity of tumoral cells. One case was not valuable due to technical difficulties. PAX8 expression was positive in 70 (81.39%) cases, the remaining 15 (17.44%) negative cases suggesting a non-Müllerian origin. WT1 expression was positive in 61 (71%) cases, mainly expressed in serous carcinoma, regardless of their differentiation degree, and negative in 24 (27%) cases. Our study provide supplementary evidences to support the association of PAX8 and WT1 immunostaining in the investigation of the complex biology of OC, PAX8 confirming the ovarian primary and WT1 allowing the refinement of the diagnosis in phenotype overlapping cases.

The aim of the present study was to compare the GnRH agonist long protocol with the flexible GnRH antagonist protocol in infertile PCOS women undergoing COS in terms of clinical pregnancy rate (CPR), with special reference to the incidence of OHSS. Materials and Methods. The study was conducted at the Hospital Obstetrics and Gynecology Cuza Vodă Iaşi and Fertility Reproductive Medical Center Omini Clinic Iaşi from June 1, 2010, to September 31, 2012. PCOS as defined by the Rotterdam 2003 consensus, i.e. presence of two of the following three features: presence of oligo- and/ or anovulation, clinical and/or biochemical signs of hyperandrogenism, polycystic ovaries and exclusion of other endocrinopathies. Results. No differences were observed in clinical pregnancy rate (CPR) in the agonist and antagonist protocols, respectively. Incidence of OHSS was lower in the antagonist compared with agonist group (4% versus 28%). Duration of stimulation (13,80 + 1,4 vs 11,85 + 2,4 p < 0,001) and total gonadotrophin required (2435,5 + 884,5 versus 2005, 5 + 545,5 IU p < 0.003) were also lower in the antagonist compared with agonist protocol. Conclusions. The current study suggests that the flexible GnRH antagonist protocol is associated with a similar ongoing pregnancy rate, lower incidence of OHSS grade II, lower gonadotrophin requirement and shorter duration of stimulation, compared with GnRH agonist. The GnRH antagonist might be the treatment choice for patients with PCOS undergoing IVF

In the last 10 years, several studies have been carried out on additional ultrasound markers in the first trimester of pregnancy in order to improve detection rate of fetal numerical chromosome abnormalities (aneuploidy) and to reduce the rate of false-positive diagnosis. The purpose of this study was to evaluate the performance of various recommendations for which amniocentesis was performed followed by FISH testing in the diagnosis of aneuploidy. These evaluations were conducted in order to determine whether ultrasound aspects are associated with fetal aneuploidy and to estimate the risk level of individual markers using probability estimation analysis.The study has been carried out at the Clinical Hospital of Obstetrics and Gynecology "CuzaVodă" Iaşi, at the Laboratory of cytogenetic--prenatal diagnosis, during January 2004-December 2011, on a target group of 1406 pregnant women. As part of this study, 1411 amniocentesis were performed.increased efficiency of screening for fetal aneuploidy in the first trimester of pregnancy is obtained through combined method (maternal age over 35 years, increased nuchal translucency and the presence of double test risk) which has 100% detection rate and a rate false-positive result of 0%. The efficiency of this method is provided also by the relatively high risk (RR = 17.2) and its specificity (Sp = 100%). Making the assessment following the study false positive rate, it appears that a good method of risk assessment for aneuploidy is the combined evaluation of increased nuchal translucency (NT) with maternal age over 35 years (specificity 99.5%, a detection rate of 40% false positive rate of 0.45% and a relative risk of 7.09 for the presence of aneuploidy).The achievement of a correct prenatal diagnosis and the increase of the method efficiency, requires a correct selection of cases with aneuploidy risk assessment, based on the results of ultrasound and biochemical (double test risk) investigations correlated with advanced maternal age or previous presence of aneuploidy of children (Down syndrome, Edwards syndrome, Patau syndrome, Klinefelter syndrome and triplo X).

To update the data on the incidence of congenital malformations in our area and emphasize the importance of prenatal diagnosis.The study was conducted over a period of ten years and included 2211 cases with congenital malformations. Such parameters as the incidence of malformations over these years, gestational age at the moment of diagnosis, and mortality from congenital malformations were followed. Statistical and graphical data were processed with the help of SPSS 16.0 and MS Excel software.The total prevalence of malformations was 3.52%, comparable with the data in the literature. Over this period a number of 262 cases (11.8%) ended in spontaneous miscarriage or termination of pregnancy for fetal abnormalities. A significant percentage of these pregnant women gave birth to their child, many of them dying shortafter.Congenital malformations remain the leading cause of mortality in neonates. In Romania, the advanced techniques of prenatal diagnosis being used only in specialized centers, and a large number of cases may escape early diagnosis. This study underlines the importance of a correct assessment of fetuses so that the discovery of fetal abnormalities at birth not to be a surprise.

The correct estimation on dry weight is very important in providing effective and safe hemodialysis to end stage renal disease patients. Optimal fluid removal with minimal adverse reactions from the treatment is one goal of hemodialysis treatment. The aim of this article is to discuss different methods of assessing dry weight and to determine their role in the complex fluid management of end-stage renal disease patient. Recent literature describes various methods of determining optimal hydration state, including clinical or paraclinical methods. Each of these methods has their benefits and limitations. Despite the large number of studies conducted on new technologies for determining dry weight, there is a lack of larger, randomized controlled trials to support these methods. Although the successful use of different methods of dry weight assessment is not supported yet by large clinical trials, some evidence is starting to link the use of some methods to improved outcomes (morbidity, mortality) in this population.

Echocardiography is the key diagnostic method in the diagnostics of structural heart pathologies.To underline some possible situations that may cause errors in ultrasound examination of the fetal heart.We examined a number of 39,370 fetuses along a period of six years. The ultrasound scan was performed according with international standards of basic and extended cardiac scan.442 of them (1.12%) were diagnosed with cardiac malformations.Ultrasound examination errors can cause false positive, false negative or incomplete diagnosis. Limitations in fetal echocardiography are related to the examiner experience to do an accurate diagnosis. The difficulty of assessing complex congenital heart lesion is increased. The unsatisfactory study should be repeated and sometimes the exact diagnosis requires sequential procedures. The aim is to define fetal heart anatomy and adise the family, in collaboration with neonatologist. The final results ia an optimal behavior for the fetus and newborn.

Reproductive Disorders (RD), manifested by the biological inability to conceive (primary sterility) or inability to carry a pregnancy to full-term (infertility), affect 10-15% of reproductive-aged couples. The genetic etiology of RD is represented, in the majority of cases, by the chromosomal abnormalities.To retrospectively analyze the karyotype results in a selected group of couples with RD.The present study was performed in 266 couples with RD: 80 (30.07%) with primary sterility (ST), 149 (56.01%) with Recurrent Spontaneous Abortions (RSA) and 37 (13.90%) with Stillborn Children (SC). A GTG-banded karyotype was performed on both partners of each couple.We identified a chromosomal abnormality in 43 individuals (16.16%): 20 cases (7.51%) with ST, 13 cases (4.88%) with RSA and 10 cases (3.75%) with SC. The affected partner was female in 23 cases (8.64%) and male in 20 cases (7.51%). A X chromosome (numerical or structural) abnormality was detected in 18 cases (6.76%), most frequent X chromosome monosomy mosaicism in female and trisomy XXY in male; a balanced structural chromosomal abnormality (BSC) was detected in 23 couples (8.64%); in other two males with ST, the karyotype result was 46,XX.The results of our study are similar to other reported studies and underline the major etiologic role of chromosomal abnormalities in RD and the importance of chromosomal analysis for the etiologic diagnosis and genetic counseling of these patients.

To present the clinical and ultrasound features in patients with endometrial cancer in whom the endometrial thickness was less that 5 mm.Retrospective study on 263 patients with endometrial carcinoma in whom the ultrasound evaluation of the endometrium was performed. The features noticed in the patients with endometrial thickness below 5 mm are presented.In 249 (94.68%) of our patients with endometrial carcinoma the mean endometrial thickness was 15 mm. In 14 patients (5.32%), in whom biopsy was performed prior to ultrasound examination, endometrial thickness was less than 5 mm.A thin and regular endometrium (below 5 mm) rules out an endometrial carcinoma provided that no biopsy has been performed within 3 months before ultrasound examination.

The paper presents the motivations for the implementation of a computerized system operating in the field of medical decision, aimed at the reduction of the medical errors and the improvement of health status of the pregnant women and newborn babies. The proposed system is going to be available as an Internet accessible platform that will monitor the health status of the pregnant women during the perinatal period. The system will record and analyze the medical data and the key risk factors (such as social, infectious, genetic and environmental) which can occur during the this stage of the pregnancy and can severely affect the child's and/or the pregnant woman's health. The system will be able to alert the attending physician about potential risk situations for the child's or for the pregnant woman's health, as well as indicate an appropriate course of treatment. Besides the medical decision-making support system, the platform will also provide a statistical tool for various perinatal and pregnancy indicators which will be useful for both doctors and health authorities.

Our objective was to assess the association between fetal heart rate (FHR) and the amplitude of baseline T/QRS rise events during labour in normal and acidotic fetuses.Into a retrospective case-control setting, we analyzed STAN traces from acidotic (pH7.05, n = 39) and normal fetuses (n = 33) at birth, with baseline T/QRS rise type ST-event in fetal electrocardiogram. Mean FHR was computed over a 2-minute period associated with baseline T/QRS rise event. We described a control FHR segment, 10 minutes before first occurrence of baseline T/QRS rise event. We compared the mean FHR from ST-events, with data from control segment, in relation to the amplitude of T/QRS rise, for acidotic and normal fetuses.We found that, during the increase in the baseline of T/QRS, the mean frequency gradually and significantly decreased. This was quick and deep in normal fetuses and small, followed by a plateau, till high T/QRS values for acidotic group. However, for high T/QRS values, both groups had similar decreased values.We conclude that changes of FHR related to increase of T/QRS baseline are less pronounced in fetuses dealing with acidosis, probably due to activation of sympathetic system. This should enable us to intervene in the appropriate manner when the fetal defenses have been activated but before there is an increased risk of long-term squeals.

Ovarian cancer is unique among solid tumors in its propensity to remain localized in the peritoneal cavity for much of its natural history. There is now a growing body of clinical data demonstrating a survival advantage for patients with advanced stages of ovarian cancer treated by intraperitoneal (i.p.) chemotherapy compared with standard intravenous (i.v.) treatment route. Cytotoxic agents administered directly into the peritoneal cavity, however, have limited potential for penetrating bulky tumor masses. On the basis of the results of three randomized, phase III clinical trials, i.p. chemotherapy has now been shown to be superior to standard i.v. chemotherapy in the primary setting of chemotherapeutic management of advanced epithelial ovarian cancer, with small residual volume after surgery. Despite the fact that i.p. chemotherapy has been shown to determine an improvement in survival, many investigators feel that the formidable toxicity, complexity, and quality of life alterations associated with i.p. therapy make it mandatory that it should be compared prospectively to a less toxic and more convenient regimen of i.v. carboplatin/paclitaxel. The barriers to implementing this treatment into clinical practice appear to be toxicity concerns, and a lack of technical expertise with the peritoneal infusion devices. It is critically important to state that a large body of exiting data revels this is a management approach that can be administered safely, but not in routine oncology practice, outside the setting of a clinical trial or tertiary medical center.

Premature birth is a social problem due to its implications in the natal mortality and morbidity. This is the reason why it is necessary to establish new methods which could identify pregnant women with high risk of premature birth. Besides the measurable biochemical factors such as fetal fibronectin and salivary estriol, I1-6 sonography is a simple method highly efficient and of reasonable financial costs among all the sonographic means of observing the cervix uteri. The transvaginal sonography is the "golden standard", permitting the most faithful assessment of the pursued parameters--the length of the cervix, the aspect of the internal os (funneling), the cervix index. The experience gathered up to now shows that all of these investigations have a predictive value which is more negative than positive, but when used together they could lead to an improved result.

Chromosomal disorders are severe and affect 0.9% of the newborns. In these conditions, prenatal diagnosis should be compulsory in every public medical system.Our study is a retrospective analysis of pregnant women investigated by amniocentesis and FISH technique.We analyzed 233 samples collected between 2004 and 2007 at Iaşi "Cuza-Vodă" Obstetrics and Gynecology Hospital. The majority of cases were investigated between 16 and 24 weeks of pregnancy. Thirty-eight abnormal cases (16.30%) were identified: 17 cases with 21 trisomy, 16 cases with 18 trisomy, 3 cases with X monosomy, and 2 cases with 13 trisomy. The main reasons for amniocentesis were: advanced maternal age (12.5% abnormal cases) ultrasound abnormalities (26.15% abnormal cases), and biochemical abnormalities (7.14% abnormal cases).Our data are in agreement with other studies, and support our results.

Marfan syndrome is an uncommon condition in pregnancy. We present the case of 37 years old gravida 1, para 1 with Marfan syndrome. She delivered at term by cesarean section, a healthy male infant weighing 3500 grams with Apgar's of 9. During the postoperative period she developed aortic dissection and was referred to the Cardiovascular Surgery Department. We described such a case and the difficult decisions that we faced.

Ultrasonography is the primary screening modality for obstetrics imaging. When additional information is needed to care for pregnant patients, computed tomography and magnetic resonance imaging (MRI) can be used. Because MRI provides superior contrast resolution compared with CT, uses no ionizing radiation, and permits imaging in more than one plane, it has been used in feto-maternal imaging. This article presents principles, practical aspects and indications of MRI in obstetrics: diagnosis of fetal anomalies, prenatal counseling and management, placental position and placenta praevia, pregnant patient with associated pathology (e.g. acute abdomen, hydronephrosis, adnexal masses) and pelvimetry. The article presents, also, fetal central nervous system malformations (one of the most frequent indication of MRI in obstetrics) and other fetal anomalies like diaphragmatic hernia or gastroschisis.Ultrasound continues to be the screening modality of choice in the evaluation of the fetus. Proper use and interpretation of ultrasound limits the cases in which magnetic resonance is necessitated. However, there are many cases in which MRI alternative imaging is useful, complementary to ultrasounds.

Endometrial resection is a well-examined alternative therapy to hysterectomy in the treatment of abnormal uterine bleeding not associated with malignancy, that preserves the uterus at long term in at least 70% of patients. The new devices have been designed over the last decade, in response to demands from patients and practitioners. This review demonstrated that the second generation endometrial ablation techniques provide efficient and apparently safe endometrial ablation, are quicker to perform, and some may be more suitable for office treatment without the need for anesthesia, are simple to use and less skill dependent, and can, in properly selected cases, provide good results. Preprocedure counseling of patients, including the expected postoperative course and the known procedural risks, is important for adequate informed consent.

Scintigraphy was evaluated in comparison to clinical and paraclinical methods used in diagnosis of breast tumors. 32 patients with palpable breast tumors were investigated by clinical examination, ultrasound, mammography and scintigraphy. Different radiopharmaceuticals marked with 99mTc were used, having different affinity for the tumoral tissue. A Siemens Diacam gamma camera was used. Patients were submitted to dynamic study of early blood-pool and tissular phase, followed by late static incidences. Regions of interest were compared with similar areas of the contralateral breast. Conclusions were compared to histopathological diagnosis. We have calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each of the investigation methods. The sensitivity was 80% for clinical examination, 100% for ultrasonography, 66% for mammography and 100% for scintigraphy. The specificity was 77% for clinical examination, 50% for ultrasonography, 90% for mammography and 80% for scintigraphy. PPV was 75% for clinical examination, 60% for ultrasonography, 80% for mammography and 82% for mammography. NPV was 82% for clinical examination, 100% for ultrasonography, 71% for mammography and 100% for scintigraphy. Good correlation was found between scintigraphy and histopathology. Ultrasound and mammography also confirmed, in most cases, the clinically suspected diagnosis. Including scintigraphy in the investigation protocol for breast tumors will allow a better assessment of the therapy.

The authors report a case of cervical pregnancy in a nulliparous woman (after treatment for secondary infertility) treated systemically and locally with methotrexate. Related to the case, they make some considerations concerning early diagnosis and conservative treatment of ectopic cervical pregnancies, in order to maintain the patients' fertility. The woman presented in this case report is now 5-weeks intrauterine pregnant.

Diabetes mellitus complicates 2 to 3 per cent of all pregnancies and 90 per cent of these women have gestational diabetes mellitus (GDM)--the most common complication seen in obstetrical practice today. It occurs in the second half of pregnancy and is usually asymptomatic. It is recommended that all pregnant women to be screened by administering a 50 g oral glucose load followed by a glucose determination 1 hour later. The test may be performed at 24 to 28 weeks' gestation in the fasting stage. A 1-hour test value of 140 mg/dl (7.8 mmol/l) or more indicates the need for a 3-hour 100 g glucose tolerance test (GTT). The patient must have a normal fasting value and two abnormal GTT glucose determinations to be designated as GDM. Early detection and management are important to prevent complications to mother and fetus. Patients with GDM represent a group at significant risk for developing glucose intolerance later in life.