Correlation of doppler studies at 34 weeks of gestation with perinatal outcome in high risk pregnancies

Background: Antepartum detection of the fetus at risk of death or compromise in utero remains a major challenge in modern obstetrics. The waveform analysis of the feto- maternal circulation by Doppler ultrasound has therefore become a quick and a simple way of screening and identifying fetal compromise. The main objective of the study is to evaluate Doppler flow indices as an index for assessing fetal well being in high risk pregnancies and to determine the predictive value of various Doppler parameters with perinatal outcome.Methods: The study was a prospective cohort study were forty pregnant women with a high risk factor (intrauterine growth restriction, pre eclampsia and gestational diabetes mellitus) and forty pregnant women with no high risk(controls) were selected at 34 weeks of gestation. Both the groups underwent an obstetrical ultrasound with color Doppler examination of bilateral uterine arteries, umbilical artery and middle cerebral artery. Abnormality was serially monitored and pregnancy terminated in the presence of absent, reversal of end diastolic flow in umbilical artery or non-reassuring tests of fetal wellbeing.Results: Uterine artery S/D abnormality was seen in 32.5% of high risk cases were as abnormal umbilical artery S/D was seen in 25% and abnormal Pulsatility Index (PI) in 15% cases. Middle cerebral artery flow was abnormal in only 17.5% cases. Abnormality in the uterine artery flow correlated well with the incidence of preterm delivery (69.2%), need for cesarean section (53.8%) and length of Neonatal intensive care unit(NICU) stay >48 hours (69.23%). Abnormal umbilical artery flow was associated with a significant increase in the incidence of preterm delivery(75%), small for gestational age babies(93.75%) and length of NICU stay >48 hours (93.75%). There was no significant correlation seen with isolated abnormal middle cerebral artery flow.Conclusions: Both uterine and umbilical artery Doppler velocities correlate well with the perinatal outcome but abnormal uterine artery Doppler predicts adverse neonatal outcome better than the fetal vessels as it discriminates fetuses at risk because of abnormal placental vascularisation from those who are at risk due to other causes

Mucormycosis causing pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is an uncommon entity and is usually congenital in origin or secondary to pulmonary arterial hypertension. Infections causing PAA are few, tuberculosis and bacterial infections being the common causative organisms. There have been few cases reported previously, in which the organism causing PAA was found to be a rare fungus called mucor. Pulmonary mucormycosis causing PAA is an infrequent and almost fatal complication as most of the diagnosis was made post mortem. This report brings out a case of pulmonary mucormycosis causing ruptured PAA in a patient with diabetes. This patient was cured by a timely treatment of a combination of surgery and medical therapy

Thoracic myelopathy secondary to ossified ligamentum flavum and dural ossification – A series of 19 cases and review of literature

Objective: Thoracic myelopathy has gradually risen to be a prominent diagnosis in patients with persistent upper back pain, bladder symptoms and spastic paraparesis. Often encountered, these conditions pose a serious dilemma to neurosurgeons with respect to surgical planning, timing of surgery, prognosis and possible complications and outcome assessment. In view of these queries and to clarify the indications of when to intervene the following study has been undertaken.To analyze the clinical presentation, radiological features, clinical implications and surgical nuances and outcomes in patients with single and multiple level dorsal canal ossified ligamentum flavum (D-OLF) and associated dural ossification (DO). Patients and methods: Nineteen patients with the diagnosis of thoracic myelopathy (TM) were identified between January 2012 and March 2017. All patients were treated surgically, with decompressive laminectomies, in a single tertiary care center in Southern India. mJOA was calculated preoperatively and assessed postoperatively and a mean mJOA was calculated to assess the significance in neurological improvement. The data was collected from the medical records department and various factors were analyzed, using SPSS software, for correlation. Results: Mean age of our group was 50.84 years with a range of 29 to 71 years. It comprised of 11 males and 8 females. All patients had features of myelopathy. Surgery did have a positive effect on neurological improvement (p = 0.001) in all patients except one. Dural ossification had correlation with pre op and post op urinary disturbances with p value of 0.02. (Mann Whitney Test for 2 independent variables used). A total of ten patients had urinary symptoms pre operatively, out of which six patients showed postoperative improvement at the end of one year. Four of these patients continued to have symptoms, two patients were on Clean Intermittent Catheterisation (CIC), and one patient had features of hesitancy and frequency. Preoperative bladder dysfunction was a strong predictor for continued bladder dysfunction at the end of 1 year (p < 0.004). Conclusions: All patients with D-OLF and or DO presented with myelopathic features. MRI with concurrent CT spine helps to delineate dural ossification from D-OLF and helped to rule out other differentials. The classical “tram track” and “comma sign” is well noted in CT spine and helps to plan surgical approach and anticipate probable complications.Patients with concurrent D-OLF and DO and long segment pathology had increased risk of intraoperative dural tears and postoperative CSF leaks. These subset of patients had a peaked incidence of bladder involvement or non-improvement of existing bladder dysfunction, postoperatively. Patients with D-OLF and DO seemed to do better after surgical decompression. Surgery should be offered once diagnosis is confirmed on imaging, as all patients in out study, except one, showed postoperative neurological improvement.Our study concluded that patients with prolonged preoperative symptoms persisted to have them even after surgery. Patients with concurrent D-OLF and DO showed more significant improvement, postoperatively, in terms of mJOA – postop with a p = 0.002 as compared to patients with D-OLF alone.We recommend that each case be treated individually and treatment should be planned appropriately, based on the radiology and levels involved, keeping in mind the preoperative symptoms and their duration. Keywords: Ossified ligamentum flavum, Dural ossification, Postoperative complications, Decompression, Thoracic myelopathy, Urinary symptom