DVODIMENZIONALNI (2D) I ČETVERODIMENZIONALNI (4D) ULTRAZVUK SA SPACIOTEMPORALNOM SLIKOVNOM KORELACIJOM (STIC) U DIJAGNOZI ABNORMALNOSTI DESNOGA SRCA

Four cases of right heart anomalies are presented, where it was used 4D and STIC for improving detection and complete evaluation of anomaly. Prenatal diagnosis being associated with better obstetric management. Fetal echocardiography was performed with a 4D ultrasound system (Voluson E8, GE Healthcare, Kretztechnik, Zipf, Austria) equipped with a 4–8 MHz transabdominal transducer and STIC. All pregnant women underwent comprehensive evaluations with STIC, these views were stored and were shared for expert review, interdisciplinary consultation and parental counseling.Prikazana su četiri slučaja s anomalijom desnog srca u kojih su rabljeni 3D ultrazvuk i STIC, koji poboljšavaju otkrivanje i točno vrednovanje anomalije. Prenatalna dijagnoza je potrebna za bolji opstetrički postupak. Fetalna ehokardiografija je obavljena 4D ultrazvučnim sustavom (Voluson E8, GE Healthcare, Kretztechnik, Zipf, Austrija), koji sadrži 4–8 MHz transabdominalnu sondu i STIC. Sve su trudnice bile podvrgnute opsežnom istraživanju pomoću STIK-a, a dobivene slike su bile spremljene i za konzultaciju i mišljenje eksperata

PRENATALNA DIJAGNOZA TRIPLOIDIJE I TURNEROVA SINDROMA ULTRAZVUKOM

Triploidy means that there is a complete extra set of chromosomes in every cell of affected fetus. Instead of having 46 chromosomes, one set of 23 chromosomes from each parent, an individual with triploidy has 69 chromosomes. Triploidy can be detected prenatally by cytogenetic analysis of fetal cells obtained by chorionic villous sampling (CVS) or by amniocentesis. Postnatal diagnosis is based on phenotype of the proband with cytogenetic confirmation by karyotyping. Triploidy is lethal, most fetuses are miscarried, while some die within a few hours or days after birth. Turner syndrome is a form of primary ovarian insufficiency, called also gonadal disgenesis. Both, triploidy and Turner syndrome should be taken into consideration if sonography reveals minor or major abnormalities of the fetus in the first or in the second trimester of pregnancy. Active screening of these conditions is not justified in the general population. In rare occasions, both conditions can be diagnosed prenatally by ultrasound. The aim of this paper is to underline the importance of accurate prenatal ultrasonic diagnosis in everyday professional work, even though the conditions which are searched for are rare and exotic.Triploidija označava postojanje još jednog kompleta kromosoma u svakoj stanici oboljeloga ploda. Umjesto 46 kromosoma odnosno jednog kompleta po 23 kromosoma od svakog roditelja, jedinka s triploidijom ima 69 kromosoma. Triploidija se može otkriti prenatalno citogenetskom analizom stanica ploda dobivenih biopsijom korionskih resica ili amniocentezom. Postnatalna dijagnoza se zasniva na fenotipu probanda uz citogenetsku potvrdu određivanjem kariotipa. Triploidija je letalna, većina se plodova spontano pobaci, dok ostali umiru tijekom prvih nekoliko sati ili dana po rođenju. Turnerov sindrom je oblik primarne insuficijencije jajnika koji se naziva i gonadalna disgeneza. Na postojanje bilo triploidije bilo Turnerova sindroma valja posumnjati ako se ultrazvukom u ploda otkriju male ili velike malformacije tijekom prvoga ili drugog tromjesečja trudnoće. Aktivni probir ovih stanja nije opravdan u općoj populaciji. Rijetko se i jedna i druga bolest mogu dijagnosticirati prenatalno ultrazvukom. Cilj ovoga članka je ukazati na važnost pravilne ¬prenatalne ultrazvučne dijagnoze u svakodnevnom radu čak i u slučajevima kad su bolesti za kojima se traga rijetke i egzotične

Open Fetal Surgery and Fetoscopic Repair in Spina Bifida and Myelomeningocele in Romania

Spina bifida and myelomeningocele, although frequent, present difficulties when it comes to diagnosis and clinical management. The recent developments in ultrasound and MRI technologies and software, allow for an easier and more precise diagnosis. As such, in the first part of our chapter we will present general information, such as etiology, pathophysiology and methods of diagnosis. Fetal surgery, open or fetoscopic, represents a cure in most cases of spina bifida and in other cases reduces the chances of major developmental issues in babies born with this affliction. In the second part of our chapter, we will present the surgical protocols for both procedures, the indications, and the statistics that we have acquired in the cases we have diagnosed and operated on in the Regina Maria Maternity Hospital, Bucharest, the only center in Romania where these procedures are available

LEUKEMIJA I TRUDNOĆA. NIJE DALJE ŠTETNA POVEZANOST?

Purpose. Even though there are no solid data regarding chemotherapy treated leukemia during pregnancy, the results based on short series reports show that the management of such condition can be safely achieved during the second and third trimester. We present three personal cases of pregnant women treated with cytostatic agents, two of them accidentally receiving complete chemotherapy during the entire pregnancy without malformative consequences. First case. A 19 yrs old woman diagnosed with chronic myeloid leukemia who conceived spontaneously and mistook the pregnancy signs for a relapse of the disease. During the pregnancy she continued the treatment, receiving until the fifth month an association of Hydroxyurea and alfa-interferon and afterwards switched to Imatinib until term. She presented at 38–39 weeks and delivered by cesarean section a little girl of 3510 g in a perfect state of health. The blood count of both mother and child were normal. Second case. A similar situation in a young woman with lymphoblastic acute leukemia under treatment with Vincristin, Methotrexat, Purinethol. She presented in advanced spontaneous labour at 33–34 weeks and delivered a little girl of 1700 g without malformative signs and normal blood count. Third case. A 17 years old girl who was diagnosed with acute myeloid leukemia at 29 weeks pregnancy. She received induction chemotherapy with Ara-C, due to the significant bone marrow infiltrate and disease induced disseminated intravascular coagulopathy. She presented premature uterine contractions at 32 weeks and delivered by cesarean section a premature boy of 1750g with Apgar score 8. The infant did not present any malformation (by clinical and ultrasound examination) and the blood count was normal. The studies have shown so far that in the case of chronic myeloid leukemia, the treatment with Imatinib was associated with 50% apparently normal live infants and that chemotherapy for acute leukemia during the second or third trimester may not require termination of pregnancy, because both remission and delivery of a normal infant are likely to be obtained.SAŽETAK. Cilj. Uopće nema čvrstih podataka o kemoterapijom liječenim leukemijama tijekom trudnoće. Rezultati na temelju kratkih izvješća pokazuju da liječenje tijekom drugog i trećeg tromjesečja može biti uspješno obavljeno. Prikazujemo tri trudnice liječene citostaticima, dvije od njih su bez posljedičnih malformacija primale kompletnu kemoterapiju tijekom cijele trudnoće. Prvi slučaj. Žena od 19 godina koja je spontano zanijela i krivo shvatila znakove trudnoće kao recidiv bolesti. Tijekom trudnoće je nastavila liječenjem, primivši do petog mjeseca smjesu hidroksiureje i -interferona i zatim do termina imatinib. Javila se s 38–39 tjedana trudnoće te je carskim rezom rodila savršeno zdravu malu djevojčicu težine 3510 grama. Krvna slika majke i djeteta je bila potpuno normalna. Drugi slučaj. Sličan slučaj mlade žene s limfoblastičnom akutnom leukemijom, liječenom vinkristinom, metotreksatom, purinetolom. Javila se u uznapredovalom porodu s 33–34 tjedana te je rodila djevojčicu tešku 1700 grama, bez malformacija i s normalnom krvnom slikom. Treći slučaj. Djevojka od 17 godina kojoj je s 29 tjedana trudnoće dijagnosticirana akutna mijeloična leukemija. Primila je indukcijsku kemoterapiju Ara-C-om, zbog značajne infiltracije koštane srži te bolešću uzrokovane diseminirane intravaskularne koagulopatije. S 32 tjedna počeli su trudovi te je carskim rezom rodila nedonošena dječačića težine 1750 grama s Apgar zbrojem 8. Dijete nije imalo malformacija ni klinički niti ultrazvučnim pregledom. Krvna slika je bila normalna. Do sada su studije pokazale da kronična mijeloična leukemija, liječena imatinibom, u 50% slučajeva rezultira rađanjem zdrava djeteta te da kemoterapija akutne leukemije tijekom drugog i trećeg tromjesečja trudnoće na zahtijeva prekid trudnoće, jer se može postići remisija bolesti i rađanje normalna djeteta

KONGENITALNA CISTIČNA ADENOMATOIDNA MALFORMACIJA

Cystic adenomatoid lung malformation (CCAM) is a rare disease, with a prevalence 1/25 000 to 1/35 000 pregnancies, a developmental abnormality arising from an overgrowth of the terminal respiratory bronchioles. Prenatal diagnosis is based on the ultrasonographic demonstration of a hyperechogenic pulmonary tumor, which is microcystic or macrocystic. The disease may be associated with a mediastinal shift, hydrops fetalis or polyhydramnios. The outcome is bad in bilateral cases, in those with pulmonary hypoplasia and with fetal hydrops. In unilateral and isolated cases the prognosis may be good. Spontaneous resolution occurs prenatally only in the third trimester of pregnancy. Three cases of CCAM are presented. The case of type I was diagnosed at 28 weeks and regression occured in the third trimester, at 36 weeks of gestation. The prenatal and postnatal pictures of a case of the lung type II and of a case of CCAM type III with echogenic appearance of a uniformly solid mass, are presented too.Cistična adenomatoidna malformacija pluća (CACM) je rijetka bolest s pojavnošću od 1/25 000 do 1/35 000 trudnoća, razvojna pogrješka koja nastaje preraštanjem terminalnih respiratornih mjehurića. Prenatalna dijagnoza se zasniva na ultrazvučnom prikazu hiperehogenog tumora pluća, koji može biti mikrocističan i makrocističan. Pri bolesti može nastati pomak medijastinuma, fetalni hidrops ili polihidramnios. Ishod je loš u bilateralnim slučajevima, u onima s hipolazijom pluća i fetalnim hidropsom. U jednostranim i izoliranim slučajevima prognoza može biti dobra. Spontani nestanak se zbiva u trećem tromjesečju trudnoće. Prikazana su tri ploda s CCAM. Tip 1 bolesti je bio dijagnosticiran u fetusa s 28 tjedana i regresija je nastupila s 36 tjedana. Prikazane su prenatalne i postnatalne slike slučaja s ultrazvučnim nalazom jednakomjerno solidne mase s tipom II i s tipom III bolesti

PRENATALNA DIJAGNOZA TRIPLOIDIJE I TURNEROVA SINDROMA ULTRAZVUKOM

Triploidy means that there is a complete extra set of chromosomes in every cell of affected fetus. Instead of having 46 chromosomes, one set of 23 chromosomes from each parent, an individual with triploidy has 69 chromosomes. Triploidy can be detected prenatally by cytogenetic analysis of fetal cells obtained by chorionic villous sampling (CVS) or by amniocentesis. Postnatal diagnosis is based on phenotype of the proband with cytogenetic confirmation by karyotyping. Triploidy is lethal, most fetuses are miscarried, while some die within a few hours or days after birth. Turner syndrome is a form of primary ovarian insufficiency, called also gonadal disgenesis. Both, triploidy and Turner syndrome should be taken into consideration if sonography reveals minor or major abnormalities of the fetus in the first or in the second trimester of pregnancy. Active screening of these conditions is not justified in the general population. In rare occasions, both conditions can be diagnosed prenatally by ultrasound. The aim of this paper is to underline the importance of accurate prenatal ultrasonic diagnosis in everyday professional work, even though the conditions which are searched for are rare and exotic.Triploidija označava postojanje još jednog kompleta kromosoma u svakoj stanici oboljeloga ploda. Umjesto 46 kromosoma odnosno jednog kompleta po 23 kromosoma od svakog roditelja, jedinka s triploidijom ima 69 kromosoma. Triploidija se može otkriti prenatalno citogenetskom analizom stanica ploda dobivenih biopsijom korionskih resica ili amniocentezom. Postnatalna dijagnoza se zasniva na fenotipu probanda uz citogenetsku potvrdu određivanjem kariotipa. Triploidija je letalna, većina se plodova spontano pobaci, dok ostali umiru tijekom prvih nekoliko sati ili dana po rođenju. Turnerov sindrom je oblik primarne insuficijencije jajnika koji se naziva i gonadalna disgeneza. Na postojanje bilo triploidije bilo Turnerova sindroma valja posumnjati ako se ultrazvukom u ploda otkriju male ili velike malformacije tijekom prvoga ili drugog tromjesečja trudnoće. Aktivni probir ovih stanja nije opravdan u općoj populaciji. Rijetko se i jedna i druga bolest mogu dijagnosticirati prenatalno ultrazvukom. Cilj ovoga članka je ukazati na važnost pravilne ¬prenatalne ultrazvučne dijagnoze u svakodnevnom radu čak i u slučajevima kad su bolesti za kojima se traga rijetke i egzotične

Adaptive neural network fuzzy inference system for HFC processes

The paper presents the design and implementation of a fuzzy inference system (FIS) trained with adaptive neural networks for the generation of specification references in high frequency current (HFC) hardening processes. The specification references are then further used for the control of the process in obtaining the desired outcomes in terms of material hardening and resistance. The FIS is trained using data obtained from experimentation on an industrial HFC device. The trained FIS is then compared to a manually tuned FIS, resulting from expert and operator designs. The results led to the development of intelligent control interfaces in real time through the ANFIS method

LEUKEMIJA I TRUDNOĆA. NIJE DALJE ŠTETNA POVEZANOST?

Purpose. Even though there are no solid data regarding chemotherapy treated leukemia during pregnancy, the results based on short series reports show that the management of such condition can be safely achieved during the second and third trimester. We present three personal cases of pregnant women treated with cytostatic agents, two of them accidentally receiving complete chemotherapy during the entire pregnancy without malformative consequences. First case. A 19 yrs old woman diagnosed with chronic myeloid leukemia who conceived spontaneously and mistook the pregnancy signs for a relapse of the disease. During the pregnancy she continued the treatment, receiving until the fifth month an association of Hydroxyurea and alfa-interferon and afterwards switched to Imatinib until term. She presented at 38–39 weeks and delivered by cesarean section a little girl of 3510 g in a perfect state of health. The blood count of both mother and child were normal. Second case. A similar situation in a young woman with lymphoblastic acute leukemia under treatment with Vincristin, Methotrexat, Purinethol. She presented in advanced spontaneous labour at 33–34 weeks and delivered a little girl of 1700 g without malformative signs and normal blood count. Third case. A 17 years old girl who was diagnosed with acute myeloid leukemia at 29 weeks pregnancy. She received induction chemotherapy with Ara-C, due to the significant bone marrow infiltrate and disease induced disseminated intravascular coagulopathy. She presented premature uterine contractions at 32 weeks and delivered by cesarean section a premature boy of 1750g with Apgar score 8. The infant did not present any malformation (by clinical and ultrasound examination) and the blood count was normal. The studies have shown so far that in the case of chronic myeloid leukemia, the treatment with Imatinib was associated with 50% apparently normal live infants and that chemotherapy for acute leukemia during the second or third trimester may not require termination of pregnancy, because both remission and delivery of a normal infant are likely to be obtained.SAŽETAK. Cilj. Uopće nema čvrstih podataka o kemoterapijom liječenim leukemijama tijekom trudnoće. Rezultati na temelju kratkih izvješća pokazuju da liječenje tijekom drugog i trećeg tromjesečja može biti uspješno obavljeno. Prikazujemo tri trudnice liječene citostaticima, dvije od njih su bez posljedičnih malformacija primale kompletnu kemoterapiju tijekom cijele trudnoće. Prvi slučaj. Žena od 19 godina koja je spontano zanijela i krivo shvatila znakove trudnoće kao recidiv bolesti. Tijekom trudnoće je nastavila liječenjem, primivši do petog mjeseca smjesu hidroksiureje i -interferona i zatim do termina imatinib. Javila se s 38–39 tjedana trudnoće te je carskim rezom rodila savršeno zdravu malu djevojčicu težine 3510 grama. Krvna slika majke i djeteta je bila potpuno normalna. Drugi slučaj. Sličan slučaj mlade žene s limfoblastičnom akutnom leukemijom, liječenom vinkristinom, metotreksatom, purinetolom. Javila se u uznapredovalom porodu s 33–34 tjedana te je rodila djevojčicu tešku 1700 grama, bez malformacija i s normalnom krvnom slikom. Treći slučaj. Djevojka od 17 godina kojoj je s 29 tjedana trudnoće dijagnosticirana akutna mijeloična leukemija. Primila je indukcijsku kemoterapiju Ara-C-om, zbog značajne infiltracije koštane srži te bolešću uzrokovane diseminirane intravaskularne koagulopatije. S 32 tjedna počeli su trudovi te je carskim rezom rodila nedonošena dječačića težine 1750 grama s Apgar zbrojem 8. Dijete nije imalo malformacija ni klinički niti ultrazvučnim pregledom. Krvna slika je bila normalna. Do sada su studije pokazale da kronična mijeloična leukemija, liječena imatinibom, u 50% slučajeva rezultira rađanjem zdrava djeteta te da kemoterapija akutne leukemije tijekom drugog i trećeg tromjesečja trudnoće na zahtijeva prekid trudnoće, jer se može postići remisija bolesti i rađanje normalna djeteta

Modelling and simulation of a remote controlled mechatronic device

The paper introduces the design, modelling and simulation of an electromechanical actuator device able to produce periodical translation movement. The parameters characterizing this movement (stroke length, force, speed profile) are considered to be remotely programmable via a wireless interface