Antenatal diagnosis of twin-twin transfusion syndrome by Doppler ultrasound

Article Abstract:

Twin-twin transfusion syndrome is a serious abnormality that affects some pregnancies involving identical (monozygotic) twins. The abnormality involves unequal or abnormal blood flow to and between the twin fetuses. Premature labor and death of either or both twins often results. This study examined the use of Doppler ultrasound (US) for early detection (primarily second trimester) of twin-twin transfusion syndrome. Doppler US uses high frequency sound waves to measure blood flow in vessels. For this study, it was used to measure blood flow in the umbilical artery (velocimetry). Thirty-one pairs of twins between the gestational ages of 21 and 31 weeks were examined with US and Doppler US. Doppler US measured the pulsatility index (PI) in the umbilical artery. PI was also determined for 320 normal singleton pregnancies. The results were compared with pregnancy outcomes. Discordant twin births were diagnosed if there was a 20 percent or greater difference in birth weight between the twins. Twin-twin transfusion syndrome was diagnosed on the basis of placental histologic evaluation. Twin-twin transfusion syndrome was diagnosed in six cases using US. Doppler US was performed every two weeks following diagnosis until birth to measure (PI) in the umbilical artery. PI values for the twin-twin transfusion cases did not differ from those of other twins or the control cases. Inter-twin PI differences were significantly higher for the twin-twin transfusion cases than for the other twin cases. Of 7 sets of twins with inter-twin PI differences greater than 0.5, 6 sets involved twin-twin transfusion syndrome. A PI difference of 0.5 or greater had a sensitivity of 75 percent and a specificity of 96 percent for detecting twin-twin transfusion, that is, a PI difference of 0.5 or more indicated transfusion syndrome in 75 percent of positive cases and 96 percent of the time correctly identified this problem. For the twin-twin transfusion cases, there was a positive correlation between inter-twin PI differences and differences in estimated fetal weight. These results indicate that Doppler US measurement of inter-twin PI differences may be useful for the early detection of twin-twin transfusion syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fetus, Fetal growth retardation, Fetofetal transfusion, Doppler ultrasonography

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CA 125 levels in menopausal women

Article Abstract:

Elevated blood levels of the antigen (protein) CA 125 are associated with ovarian cancer, and patients who have been treated for ovarian cancer are routinely tested to detect recurrence as early as possible. Since survival rates after late detection of ovarian cancer are low, screening tests that enable diagnosis earlier in the course of the disease are highly desirable. Establishing a cut-off point that would accurately distinguish suspiciously high CA 125 levels from normal levels is not easy, though, since the cancer can be present with only moderate CA 125 elevations. To better understand the normal, disease-free fluctuations in this antigen, 258 women with no history of breast cancer, and no cancer of other types during the previous five years, were studied; all subjects were going through menopause or were past menopause. Blood was sampled on two separate occasions for CA 125 levels, and 238 of the subjects underwent pelvic examination and transvaginal sonography (an imaging technique) to determine the size of their ovaries. Results showed that the average CA 125 level was 5.6 units per milliliter. The correlation between the two samples from women with CA 125 levels less than 35 units per milliliter (often used as a threshold value for diagnosing cancer) was very high, indicating that the results were quite reproducible. CA 125 levels were higher among the 52 women who had undergone hysterectomy (removal of the uterus) previously, especially if one or both ovaries had also been removed. Women with two or more children also had higher levels than those with one child or with none. No enlarged ovaries were detected, nor was any association between ovarian volume and CA 125 levels found. Characteristics such as age, race, height, weight, smoking, and medication use were not correlated with levels of the antigen. Thus, evaluation of a patient's CA 125 levels should take into account the number of children, as well as the number of ovaries, she has. Whether the conventional assay used to measure CA 125 is accurate at low concentrations requires further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Simultaneous measurement of CA 125, CA 19-9, tissue polypeptide antigen, and immunosuppressive acidic protein to predict recurrence of ovarian cancer

Article Abstract:

After patients with ovarian cancer have been treated, testing to detect cancer recurrence quickly is essential for improved survival rates. One substance that is a marker for ovarian tumors is CA 125; its levels increase in association with tumor progression. However, many cases have been documented in which CA 125 levels declined, even though patients had verified recurrences. It is possible that additional markers could improve the precision of this predictive marker. To evaluate this possibility, levels of three antigens (CA 125, CA 19-9, and tissue polypeptide antigen) were evaluated in 35 patients who experienced relapse after initial successful treatment of ovarian cancer. Results showed that before surgery, 34 patients had elevations of CA 125 to a level of at least 35 units per milliliter (U/mL); the one remaining patient had a level of 29 U/mL. For 21 cases, CA 125 elevation was noted at the time recurrence was detected, but for another 13 cases, the CA 125 level was lower than 35 U/mL when recurrence was diagnosed. When the sensitivities (percent correctly positive at the time of recurrence) and specificities (percent correctly negative) of the other markers were evaluated, it was found that the combination of tests provided a sensitivity of 66 percent three months before clinical recurrence, while each marker alone had a sensitivity of, at most, 33 percent. At the time of recurrence, the tests and their sensitivities were: CA 125, 64 percent; CA 19-9, 28 percent; and tissue polypeptide antigen, 60 percent. In summary, the combination of markers provided the most sensitive measure of recurrence; however, the specificity of the combination was only 77 percent. Given the present level of ambiguity in diagnosing a recurrence of ovarian cancer, the patient is advised to employ all available strategies, including examination, imaging, and tumor marker evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression

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