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Treatment of ovarian cysts with alcohol sclerosis
THURSDAY,
SEPTEMBER
7
P4.18.11 SUCCESSFUL INTRAUTERINE TREATMENT OF A HYDROPIC FETUS WITH MACROCSYTIC CCAM WITH SERIAL THORACOCENTESES AND THORACOAMNIOTIC SHUNT PLACEMENT A.M. Dept. OB/Gyn, StPdtische Kliniken Fran~urtiMain-H~chst,
P.J. Czygan, Dept. OB/Gyn, StPdtische Kliniken Frankfurt/MainHGchst, F. Bahlmann, Dept. Prenat. Diagnosis OB/Gyn, UniversitPtsklinik Mainz, Germany Objectives: A severily compromised 24+6 weeks fetus affected with unilateral macro-cystic CCAM with signs of fetal distress was treated sucessfully with serial fetal thoracocenteses and thoracoamniotic shunt placement). The pregnancy was carried near term and the newborn was operated successfully. Study Subject: A 34 -year gravida 2, para 1, presented at 24+6 weeks’ gestation The ultrasound scan showed a hydropic fetus with a large cystic mass in the right lung with displacement and rotation of the fetal heart. CTG was ominous, an absent end-diastolic bloodflow in the umbilical artery was present. After counseling the couple both opted for treatment despite of the outcome. Results: Four thoracocenteses were performed (24+6,26+3, 28+5,29+4) with 50-70 ml of fluid removed each time. Immediatly after the first procedure the doppler studies showed a marked improvement in the enddiastolic bloodflow. The anasarca disappeard within one week. The fetal condition was good despite a gradual increase of ascites and amniotic fluid. At 30+5 weeks‘ a thoraco-amniotic shunt placement was performed. The ascites dis-appeared, the amniotic fluid stayed within normal range. At 37+2 weeks’ a cesarion section was performed due to an abnormal CTG pattern and a FBS of ph 7,20. (male infant 3215 g, Apgar scores 61818 , pha 7,23). Assisted ventilation was necessary shortly after birth. Surgery was done on the third day of life. The child made a full recovery and left the hospital three weeks later. Conclusion: The thoracocenteses where sucessful in resolving the life threatening situation for the fetus. The shunt with continuous decompression of the chest organs resulted in a normal range of amniotic fluid volume and absorption of the ascites. In contrast to fetal surgery with the implications for the ongoing and any further pregnancy the inconvenience for the mother was minor.
P4.18.12 THREE DIMENSIONAL VOLUMETRY - A CLINCALLY CONTROLLABLE AND ACCURATE MEASURING METHOD AND ITS PRATICAL BENEFIT A. G. Vajda, A. Babinszki, L. Thurzo, Dept. OBIGYN, University
of Szeged, Szeged, Hungary Objectives: The authors intended to create a simple and easily reproducable method for evaluating the volumes of bio targets in 3 dimension and compare them with those in viva, and tested its practical usefulness. Study Methods: The authors examined 35 women, age between the 38. 53, before hysterectomy using COMBISON 530, and three-dimensional ultrasound equipment. In each case, the volume of the uterus was measured by three-dimensional volumetric methods. The calculated volumes were subsequent compared with the exact uterine volumes after hysterectomy which were determined by the water-displacement. On the basis of volumetric measurements, 20 ovarian tumors were measured before, during and after the cytostatic treatments. Results: The statistical comparison of the measured and calculated volumes didn’t show significant differences, and the efficacy of infusion treatment was well detectable in cases ovarian tumors. Conclusions: The change in the volume of an object could be an important sign of the progression of regression of a process, e.g. a malignant tumor. On the basis of this study, it seems that the threedimensional ultrasound technique has got the advantage of providing an easily and satisfactory reproducible method for the evaluation of quantitative values and exact volumetric measurements of several organs. This technique can be a sensitive marker of the tumor treatment urocedure.
1.51
P4.18.13 TREATMENT OF OVARIAN CYSTS WITH ALCOHOL SCLEROSIS V. S. Ciglar, Z. Duic, G. Zovko, Dept. OBIGYN, Merkur
University Hospital, Zagreb, Croatia. Objectives: The purpose of this study is a technique of punction and conservative treatment of cystic ovarian tumors. Study Methods: For this procedure the cyst must be unilocular, son¢, with smooth inner wall of the capsule, without septa and without neovascularisation on transvaginal color Doppler. Serum CA125 levels were lower than 35 U/ml. This offers the possibility of more conservative management of ovarian cysts that have a low risk of malignancy. Cysts capsule was punctured by 18 gauge needle under the control of 5 MHz transvaginal probe. If the cytologic findings were negative, after complete evacuation of cyst we injected sterile 96% alcohol in the 50% of the evacuated liquor amount. Alcohol remains in situ for 5 minutes and then it was completely evacuated. Results: During the period of 12 years we punctured 140 patients with ovarian cyst volume between 40 and 140 ml in the age from 20 to 60. For the local anestheisa we injected 2% Xylocain into posterior vaginal fornix. Five of the patients had very intensive pelvic pain but we treated them conservatively with analgetics. Relapse after three months appeared in 7 patients (5.00%) where the volume of cysts were bigger than 100ml. No menstrual disturbance was noticed in any patient. Conclusions: Technique of punction is simple and easy performed. Method of treating by 96% alcohol showed good results. Cyst volume bigger than 100 ml is better to treat surgically, by laparoscopy or laparotomy.
P4.18.14 ULTRASONIC FETAL AND PLACENTAL TISSUE CHARACTERISATION AND THE ROLE OF DOPPLER ULTRASOUND IN LUNG MATURITY
M. Podnaiski, M. Podobnik, S. Ciglar, B. Gebauer, Dept. OBIGYN, University Hospital Merkur, Zagreb, Croatia Objectives: The aim of this study is to known the relationship between the gestational age and quantitative assessment of ultrasonic signs of placental tissue, fetal lungs and liver tissue and to correlate Doppler parameters from main stems of the pulmonary arteries for determining fetal lung maturity in normal pregnancy and pregnancy with preeclampsia and diabetes. Study Methods: The placenta, fetal lungs and fetal liver in 300 normal pregnancies, 100 preeclamptic pregnancies and 100 diabetic pregnancy were examined by ultrasound at 30-41 weeks of gestation. The coefficients of variation (the standard deviation divided by the mean value) were used to characterise the tissue in different groups during pregnancy. Doppler velocimetry was performed in the main stems of pulmonary arteries in normal pregnancies and pregnancies with preeclampsia and diabetes. Results: The coefficients of variation in mature foetuses were greater than 29% for placentas in-viva, greater than 34% for placentas in-vitro, greater than 28% for liver tissue and greater than 30% for lung tissue. Placental, lung and liver tissue of diabetic pregnancy tended to have lower coefficients of variation throughout their pregnancies. We found in mature foetuses mean peak systolic velocity higher than 40 cm/set. and PI lower than 3,00. In mature foetuses with preeclampsia we found higher mean peak systolic velocity in comparing with normotensive patients. Conclusions: The coefficient of variation values for placentas in-viva and in-vitro, and fetal lungs and liver increase during pregnancy in normal and preeclamptic patients with increasing gestational age and decrease in diabetic patients.
SEPTEMBER
7
P4.18.11 SUCCESSFUL INTRAUTERINE TREATMENT OF A HYDROPIC FETUS WITH MACROCSYTIC CCAM WITH SERIAL THORACOCENTESES AND THORACOAMNIOTIC SHUNT PLACEMENT A.M. Dept. OB/Gyn, StPdtische Kliniken Fran~urtiMain-H~chst,
P.J. Czygan, Dept. OB/Gyn, StPdtische Kliniken Frankfurt/MainHGchst, F. Bahlmann, Dept. Prenat. Diagnosis OB/Gyn, UniversitPtsklinik Mainz, Germany Objectives: A severily compromised 24+6 weeks fetus affected with unilateral macro-cystic CCAM with signs of fetal distress was treated sucessfully with serial fetal thoracocenteses and thoracoamniotic shunt placement). The pregnancy was carried near term and the newborn was operated successfully. Study Subject: A 34 -year gravida 2, para 1, presented at 24+6 weeks’ gestation The ultrasound scan showed a hydropic fetus with a large cystic mass in the right lung with displacement and rotation of the fetal heart. CTG was ominous, an absent end-diastolic bloodflow in the umbilical artery was present. After counseling the couple both opted for treatment despite of the outcome. Results: Four thoracocenteses were performed (24+6,26+3, 28+5,29+4) with 50-70 ml of fluid removed each time. Immediatly after the first procedure the doppler studies showed a marked improvement in the enddiastolic bloodflow. The anasarca disappeard within one week. The fetal condition was good despite a gradual increase of ascites and amniotic fluid. At 30+5 weeks‘ a thoraco-amniotic shunt placement was performed. The ascites dis-appeared, the amniotic fluid stayed within normal range. At 37+2 weeks’ a cesarion section was performed due to an abnormal CTG pattern and a FBS of ph 7,20. (male infant 3215 g, Apgar scores 61818 , pha 7,23). Assisted ventilation was necessary shortly after birth. Surgery was done on the third day of life. The child made a full recovery and left the hospital three weeks later. Conclusion: The thoracocenteses where sucessful in resolving the life threatening situation for the fetus. The shunt with continuous decompression of the chest organs resulted in a normal range of amniotic fluid volume and absorption of the ascites. In contrast to fetal surgery with the implications for the ongoing and any further pregnancy the inconvenience for the mother was minor.
P4.18.12 THREE DIMENSIONAL VOLUMETRY - A CLINCALLY CONTROLLABLE AND ACCURATE MEASURING METHOD AND ITS PRATICAL BENEFIT A. G. Vajda, A. Babinszki, L. Thurzo, Dept. OBIGYN, University
of Szeged, Szeged, Hungary Objectives: The authors intended to create a simple and easily reproducable method for evaluating the volumes of bio targets in 3 dimension and compare them with those in viva, and tested its practical usefulness. Study Methods: The authors examined 35 women, age between the 38. 53, before hysterectomy using COMBISON 530, and three-dimensional ultrasound equipment. In each case, the volume of the uterus was measured by three-dimensional volumetric methods. The calculated volumes were subsequent compared with the exact uterine volumes after hysterectomy which were determined by the water-displacement. On the basis of volumetric measurements, 20 ovarian tumors were measured before, during and after the cytostatic treatments. Results: The statistical comparison of the measured and calculated volumes didn’t show significant differences, and the efficacy of infusion treatment was well detectable in cases ovarian tumors. Conclusions: The change in the volume of an object could be an important sign of the progression of regression of a process, e.g. a malignant tumor. On the basis of this study, it seems that the threedimensional ultrasound technique has got the advantage of providing an easily and satisfactory reproducible method for the evaluation of quantitative values and exact volumetric measurements of several organs. This technique can be a sensitive marker of the tumor treatment urocedure.
1.51
P4.18.13 TREATMENT OF OVARIAN CYSTS WITH ALCOHOL SCLEROSIS V. S. Ciglar, Z. Duic, G. Zovko, Dept. OBIGYN, Merkur
University Hospital, Zagreb, Croatia. Objectives: The purpose of this study is a technique of punction and conservative treatment of cystic ovarian tumors. Study Methods: For this procedure the cyst must be unilocular, son¢, with smooth inner wall of the capsule, without septa and without neovascularisation on transvaginal color Doppler. Serum CA125 levels were lower than 35 U/ml. This offers the possibility of more conservative management of ovarian cysts that have a low risk of malignancy. Cysts capsule was punctured by 18 gauge needle under the control of 5 MHz transvaginal probe. If the cytologic findings were negative, after complete evacuation of cyst we injected sterile 96% alcohol in the 50% of the evacuated liquor amount. Alcohol remains in situ for 5 minutes and then it was completely evacuated. Results: During the period of 12 years we punctured 140 patients with ovarian cyst volume between 40 and 140 ml in the age from 20 to 60. For the local anestheisa we injected 2% Xylocain into posterior vaginal fornix. Five of the patients had very intensive pelvic pain but we treated them conservatively with analgetics. Relapse after three months appeared in 7 patients (5.00%) where the volume of cysts were bigger than 100ml. No menstrual disturbance was noticed in any patient. Conclusions: Technique of punction is simple and easy performed. Method of treating by 96% alcohol showed good results. Cyst volume bigger than 100 ml is better to treat surgically, by laparoscopy or laparotomy.
P4.18.14 ULTRASONIC FETAL AND PLACENTAL TISSUE CHARACTERISATION AND THE ROLE OF DOPPLER ULTRASOUND IN LUNG MATURITY
M. Podnaiski, M. Podobnik, S. Ciglar, B. Gebauer, Dept. OBIGYN, University Hospital Merkur, Zagreb, Croatia Objectives: The aim of this study is to known the relationship between the gestational age and quantitative assessment of ultrasonic signs of placental tissue, fetal lungs and liver tissue and to correlate Doppler parameters from main stems of the pulmonary arteries for determining fetal lung maturity in normal pregnancy and pregnancy with preeclampsia and diabetes. Study Methods: The placenta, fetal lungs and fetal liver in 300 normal pregnancies, 100 preeclamptic pregnancies and 100 diabetic pregnancy were examined by ultrasound at 30-41 weeks of gestation. The coefficients of variation (the standard deviation divided by the mean value) were used to characterise the tissue in different groups during pregnancy. Doppler velocimetry was performed in the main stems of pulmonary arteries in normal pregnancies and pregnancies with preeclampsia and diabetes. Results: The coefficients of variation in mature foetuses were greater than 29% for placentas in-viva, greater than 34% for placentas in-vitro, greater than 28% for liver tissue and greater than 30% for lung tissue. Placental, lung and liver tissue of diabetic pregnancy tended to have lower coefficients of variation throughout their pregnancies. We found in mature foetuses mean peak systolic velocity higher than 40 cm/set. and PI lower than 3,00. In mature foetuses with preeclampsia we found higher mean peak systolic velocity in comparing with normotensive patients. Conclusions: The coefficient of variation values for placentas in-viva and in-vitro, and fetal lungs and liver increase during pregnancy in normal and preeclamptic patients with increasing gestational age and decrease in diabetic patients.