Retrognathia is a common feature of many fetal anomalies that may be diagnosed during ultrasound examination. The most common method used for the diagnosis of this condition is the inferior facial angle (IFA). The existing reference ranges for IFA have been established for the fetuses at 18- 28 weeks gestation and may be not applicable in the first trimester. The aim of the study was to document changes of IFA from 11+0 to 13+6 weeks gestation, to verify the reproducibility of IFA calculations obtained by the same examiner and to investigate the possible association between IFA values at the first and second trimester scans.
Material and methods: A prospective study was performed in 512 singleton pregnancies during the first trimester ultrasound exam. IFA was calculated by measuring the angle made by the cross-section of a line orthogonal to the forehead at the level of nasofrontal suture and the line from the tip of the mentum to the anterior border of the more protrusive lip. In 100 cases, stored images were used to calculate IFA twice by the same examiner. In a second trimester scan, IFA was measured again in 215 fetuses.
Results: The median IFA value at the time of the first trimester (IFA-1) was 880 (IQR: 8.0) and decreased with crown-rump length (CRL) and biparietal diameter (BPD). A moderate negative correlation was shown between IFA-1 and CRL (r= 0.3; p<0.001) as well as between IFA-1 and BPD-1 (r= 0.176; p=0.010). An intraclass correlation coefficient (ICC) of 0.87 (95% CI: 0.81 – 0.91) confirmed strong intraobserver agreement between two IFA measurements. In 215 fetuses that underwent a second trimester screening, the median IFA-2 was significantly lower compared to IFA-1(215) (750; IQR: 10.0 vs.870; IQR: 8.0; p<0.001), and there was no correlation between IFA1215 and IFA-2 (r= -0.024; p=0.731).
Conclusions: In the first trimester, IFA decreases with CRL and BPD. When performed by the same operator, measurement of IFA is reproducible. There is no correlation between the IFA values in the first and second trimesters.
Small cerebral vessel disease is a relatively new group of angiopathies diagnosed more frequently thanks to common availability of neuroimaging. The most frequent and the most known disease which belongs to this group is CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). Despite the name, it is a generalized small vessel disease, in which symptoms of brain damage dominate. The disease manifests as recurrent ischemic strokes, progressing dementia, migraine and mental disorders – symptoms which usually appear in 4-5 decade of life in patients without typical risk factors for vascular disease. In neuroimaging hyperintense changes and small ischemic foci disseminated in the cerebral white matter are seen. CADASIL is caused by mutations in the NOTCH 3 gene, which lead to the degeneration and loss of smooth muscle cells in small arteries. The disease is diagnosed on the basis of the result of the genetic test and microscopic examination of blood vessels in the material derived from a skin or skinmuscle biopsy. Since more and more frequently new techniques of neuroimaging reveal changes in the cerebral white matter - often asymptomatic or/ and mistakenly diagnosed as demyelinating lesions - only knowledge about CADASIL and other microangiopathies allows to avoid diagnostic errors.
Instruction: To answer the question if minimally invasive aortic valve replacement surgery through a right anterior minithoracotomy (RT-AVR) may result in increased incidence of postoperative pulmonary complications compared to conventional aortic valve replacement through a median sternotomy (AVR).
Material and methods: It was retrospective analysis of 212 patients scheduled for RT-AVR and 212 for AVR between January 2011 and December 2014 selected with propensity score matching. Respiratory system complications are analysed.
Results: Postoperative blood drainage was 353±249 and 524±325 ml in RT-AVR and AVR groups respectively (p<0.001). Hospital stay was 5.7±1.6 and 8.5±4.3 days (p<0.001), ICU stay was 1.3±1.2 and 2.6±2.8 days (p<0.001) in RT-AVR and AVR patients respectively. Respiratory system complications occurred in 13.7% of RT-AVR patients and 17.0% of AVR patients (p=0.364). Pneumonia was diagnosed in 2.4% and 0.5% of patients (p=0.129), pneumothorax in 2.0% and 1.3% of patients (p=0.515), pleural effusion in 8.5% and 7.5% of patients (p =0.732) and thoracentesis was performed in 7.1% and 7.5% of patients from RT-AVR and AVR groups respectively. Mediastinitis was diagnosed in 0.0% of RT-AVR and 2.8% of AVR patients (p=0.020). Phrenic nerve dysfunction was present in 3.8% of RT-AVR and in 0.0% of AVR patients (p=0.006). COPD (OR=5.5; p<0.001) and increased postoperative blood loss (OR=3.5; p<0.001) were risk factors of postoperative pulmonary complications.
Conclusion: Minimally invasive RT-AVR surgery did not result in increased rate of postoperative pulmonary complications compared to conventional AVR surgery through a median sternotomy.
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