bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Women with Intellectual Disabilities Who Have Been Involved with the Criminal Justice System for Reasons of Aggression
Authors: Allen Ronald , Lindsay William R. , MacLeod Fiona , Smith Anne H. W.
Published: March 2003

While there has been an increase in research into offenders with intellectual disabilities (IDs), most of this work has been in relation to men who offend. The present paper investigates some of these issues with regard to five women with IDs. All the subjects had been referred to the service for assessment and treatment for reasons of aggression. All were treated using anger management training. All of the women responded to treatment and data is available for periods between 2.5 and 8 years following the initial referral. The results are discussed in terms of general issues on offending (e.g. re‐offending rates), specific issues of treatment (e.g. the relative effectiveness of relaxation and cognitive aspects of anger management training) and specific issues for the women (e.g. abuse).
A Group Treatment for Men with Intellectual Disabilities who Sexually Offend or Abuse
Authors: Rose John , Jenkins Rosemary , O'Connor Christopher , Jones Catherine , Felce David
Published: March 2003

Background  This report describes a group intervention for men with an intellectual disability who have sexually offended or abused others. The group was in response to referrals to a psychology department. The majority of these individuals had not been subject to legal proceedings.

Methods  A number of assessments were conducted prior to the group, immediately after the group and at 3‐ and 6‐month follow‐up.

Results  Attitudes consistent with offending reduced after participation for most participants, however, these tended to revert to pre‐group levels over time. Locus of control became more external after the group treatment, this was contrary to expectations and results obtained with interventions for individuals without an intellectual disability. Knowledge tended to increase after the group, however, problems with the questionnaire used made interpretation of the results difficult. No further incidents of sexual abuse have been recorded by any of the five group members who completed the group, since the start of the group (a period of 1 year to date).

Conclusions  This group should be seen as a pilot project. However, further therapeutic work is indicated as is theoretical and questionnaire development.
The Effect of Group Intervention on the Relationships of Parents with Intellectual Disabilities
Authors: McGaw S. , Ball K. , Clark A.
Published: March 2003

Background  Parents with intellectual disabilities frequently feel socially excluded and often become dependent on statutory agencies for support. This study aimed to tackle these difficulties by means of a group intervention.

Methods  Group intervention was provided to 12 parents with borderline or mild intellectual disabilities over 14 weeks. The effects of intervention were evaluated by comparing the intervention group with a borderline or mild intellectual disabilities control parent group (n = 10). Both experimental parent group (EPG) and control parent group (CPG) received home‐based teaching programmes during this period. Parents' self‐concept and perception of the quality of relationship with their children, partners, family members and professionals were assessed (Judson Rating Scale and Behaviour Problem Index) during baseline, post‐intervention and at 27‐week follow‐up.

Results  The results indicate that self‐concept improved significantly for the EPG with no observable gains made by the CPG. However, the ‘feel good factor’ which came from improvements in parents' self‐concept did not immediately benefit their children. In addition, the quality of relationship between EPG parents and their children, as well as parents' expectations of their children's capabilities did not improve as a result of group intervention. Nonetheless, follow‐up data revealed that group training did result in (i) all of the EPG parents making new friends and (ii) other positive social and practical changes taking place within their families. Single parent status and the accumulative effect of multiple group attendance were identified as important factors affecting parents' perception of themselves and the quality of their relationships.

Conclusions  The immediate and long‐term benefits of group attendance for parents with intellectual disabilities and secondary benefits for their children are discussed.
Transitions: Placing a Son or Daughter with Intellectual Disability and Challenging Behaviour in Alternative Residential Provision
Authors: Alborz Alison
Published: March 2003

Introduction  The timing of moves to alternative care has implications for the effective support of people with intellectual disabilities and their families. Essex et al. (1997) proposed three transition profiles: ‘normative’, ‘stress process’ and ‘postponed’. The applicability of these profiles to people with intellectual disabilities and challenging behaviour was tested.

Methods  Qualitative analysis of interviews with families of 13 males and five females aged between 11 and 35 years, who had left home, was undertaken.

Results  Few people moved due to ‘normative’ family life cycle changes. The majority left because of family difficulties (‘stress process’). This model was elaborated and three transition routes described: ‘forensic’– involving police contact (actual/potential), ‘family’– reflecting problems in the family and ‘service’– deficits leading to placement out of district.

Conclusions  This research suggests that people (particularly young men) with intellectual disabilities and challenging behaviour enter statutory care earlier than their counterparts, and people with different levels of intellectual and physical disabilities follow different transition routes.
Conservative management of pelvic abscess in recurrent pelvic inflammatory disease
Authors: Picker R. H. , McLennan A. C. , Robertson R. D. , Porter R. N.
Published: March 2003

The recent incidence of acute‐on‐chronic pelvic inflammatory disease, with associated abscess formation, has dramatically increased. Recurrent abscess formation in chronic pelvic inflammatory disease that fails to respond to maximal antibiotic treatment has been traditionally treated by open surgical drainage, frequently accompanied by pelvic clearance.

With the development of techniques associated with in vitro fertilization, treatment can now be effected allowing conservation of fertility. This paper describes 12 cases of ultrasound‐directed transvaginal fine‐needle aspiration of pelvic abscess. A positive outcome occurred in all patients, thus avoiding major surgery. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Screening for fetal anomalies during the first trimester of pregnancy: transvaginal versus transabdominal sonography
Authors: Achiron R. , Tadmor O.
Published: March 2003

Ultrasound is a sensitive tool for the diagnosis of fetal anomalies during the prenatal period. Most knowledge about the ultrasound images of such anomalies is based on abdominal scanning during the second trimester of pregnancy. The value of transvaginal sonography for evaluating fetal anomalies and a comparison with transabdominal sonography in the first trimester has, to our knowledge, so far not been studied.

During a 12‐month period, 800 pregnant women between 9 and 13 weeks of gestation, underwent first a transabdominal scan followed by a transvaginal examination, in order to compare the value of the two techniques. Eight cases of fetal abnormality, including anencephaly, exencephaly, cervical myelomeningocele, cystic hygroma, omphalocele, posterior fossa cyst and syndactyly, were diagnosed by using the transvaginal sonographic approach. The standard abdominal technique failed to detect four of these anomalies, while in the other four only vague and non‐specific fetal abnormalities could be demonstrated. All women with normal abdominal and vaginal sonograms in the first trimester were rescreened transabdominally at mid‐gestation. Five patients with a variety of fetal anomalies, including hydrocephalus, agenesis of corpus callosum, bilateral ureteropelvic junction obstruction, right heart hypoplasia and tetralogy of Fallot, were identified in the rescreening procedure. One case of ventricular septal defect and coarctation of the aorta was not detected at either of the first or second screening procedures. Our findings show that transvaginal sonography is more sensitive than transabdominal sonography in the detection of first‐trimester anomalies. However, since not all fetal anomalies are manifest so early in pregnancy, standard abdominal sonography in the second trimester is still recommended. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Changes in tubal blood flow in evaluating ectopic pregnancy
Authors: Kirchler H. Ch. , Kölle D. , Schwegel P.
Published: March 2003

Ectopic pregnancy is not recognized in 5523% of all cases using state‐of‐the‐art diagnostic procedures. In this study, blood flow in tubal arteries was measured using a transvaginal duplex Doppler ultrasonography system. A 3.5 MHz Doppler transducer coupled to a 5 MHz imaging transvaginal sector probe was used to depict flow characteristics in the tubal branch of the uterine artery. This was performed in 102 patients. There was a significant increase in the blood flow on the tubal gestation side (p < 0.0001; z = −4.08). This between‐side difference was determined using qualitative frequency shift analysis. The mean reduction in the resistance index on the side with the ectopic pregnancy as compared to the contralateral side was 15.6%. These changes appear to be due to trophoblast invasion. Between‐side differences showed no dependence on gestational age (between gestational weeks 4 and 12 postmenstruation). We compared these data with those from three control groups (‘early viable intrauterine pregnancy’, ‘early intrauterine pregnancy failure’, ‘non‐gravid state’). In all these control groups, the impedance to flow, expressed as ‘resistance index’, showed no significant between‐side difference. All control groups had significantly higher mean resistance index values than the ectopic pregnancy side, but did not differ from the contralateral side of the ectopic pregnancy group. The advantages of this new method in diagnosing ectopic pregnancy are early detection, non‐invasivity, and immediate results. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Doppler assessment of the normal early fetal circulation
Authors: Huisman T. W. A. , Stewart P. A. , Wladimiroff J. W.
Published: March 2003

Combined transvaginal and transabdominal Doppler ultrasound allows recording of fetal intra‐ and extracardiac flow velocity waveforms in late first‐ and early second‐ trimester pregnancies. At 10–12 weeks, end‐diastolic flow velocities were always absent in the fetal descending aorta and umbilical artery, but were present in over half of the intracerebral artery waveforms. The pulsatility index in the three vessels decreased significantly with advancing gestational age, suggesting a reduction in fetal and umbilical placental vascular resistance. Peak velocities during atria1 contraction (A‐wave) were nearly twice as high as those during early diastolic filling (E‐wave), reflecting low ventricular compliance. Continuous forward flow in the umbilical vein was associated with a pulsatile systolic and diastolic forward flow in the ductus venosus. Retrograde flow was only present in the inferior vena cava. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Echocontrast agent enhanced color flow imaging of the breast
Authors: Duda V. F. , Rode G. , Schlief R.
Published: March 2003

An ultrasound contrast agent which survives transit through the pulmonary circulation after injection into a peripheral vein can also be used for the demonstration of flow characteristics in the peripheral organs. Such a substance (SH U 508 A, Schering AG, Berlin) was tested in the Gynecological Department of the University of Marburg for its suitability for enhancing color‐coded Doppler signals in mammary diagnosis in a group of ten women with breast tumors. The observations made are compared with the histologically confirmed diagnoses. The very distinct enhancement of the color‐coded Doppler signals allows reliable demonstration of the vascularization characteristics, not only of the malignant, but also of all benign solid tumors examined. Color signals were even recorded from normal mammary tissue, which means that the demonstration of perfusion can no longer be used on its own as a diagnostic criterion. Observation of the characteristics of the blood supply to a tumor might, on the other hand, be an advantage, not only in respect of tumor typing, but also as regards the prognosis of a tumor. In this connection, the registration of the arrival, retention and wash‐out phases specific to a contrast agent appears to furnish particularly interesting information about the growth dynamics of a tumor. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Abnormal membranes in obstetrical ultrasound: incidence and significance of amniotic sheets and circumvallate placenta
Authors: Sistrom C. L. , Ferguson J. E.
Published: March 2003

Amniotic sheets were identified in ten of 1784 patients having routine obstetric ultrasound scans, giving an incidence of 0.6%. In the same population, findings suggesting circumvallate placenta were seen in three patients, giving an incidence of 0.2%. The overall frequency of finding abnormal membranes projecting into the gestational sac was 0.8% which is an order of magnitude greater than the incidence of amniotic bands, which are only present in up to 0.08% of pregnancies. It is important to distinguish amniotic sheets and circumvallate placenta from amniotic bands, since they are much more likely to be found during the ultrasound examination and need to be properly identified so as to avoid needlessly alarming pregnant patients or inappropriately considering termination of pregnancy for relatively benign entities. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Ductus venosus index: a method for evaluating right ventricular preload in the second‐trimester fetus
Authors: DeVore G. R. , Horenstein J.
Published: March 2003

This study was designed to examine ventricular preload by measuring the ductus venosus index during the second trimester of pregnancy. A total of 137 women were entered into the study. Each fetus was examined with real‐time, color and pulsed Doppler ultrasound. The color Doppler maximal velocity setting was adjusted so that the umbilical vein was homogeneous in color, did not demonstrate aliasing, and filled the venous lumen. The pulsed Doppler gate was placed within the ductus venosus in all subjects. Color Doppler identified a turbulent flow velocity within the ductus venosus which was not present in the umbilical vein, hepatic vein or inferior vena cava. The ductus venosus pulsed Doppler waveform demonstrated flow velocity from the umbilical vein to the heart during ventricular systole, the rapid filling phase of ventricular diastole, and atrial systole. However, flow velocity was decreased during atrial systole compared to ventricular systole and the rapid filling phase of diastole. The ductus venosus index was computed from the Doppler waveform of the ductus venosus at points consistent with ventricular and atrial systole ((ventricular systole ‐ atrial systole)/ventricular systole). Regression analysis demonstrated a significant (p = 0.001) relationship between the ductus venosus index and gestational age (ductus venosus index = 75.5757 − 7.25484 × weeks gestation), standard error of the estimate = 7.21959; R = −0.451. One fetus with a hypoplastic left atrium and ventricle demonstrated a normal ductus venosus index. Two fetuses, one with pulmonary atresia and the second with severe cardiovascular dysfunction, demonstrated an abnormal ductus venosus index associated with absent flow velocity during atrial systole. This was associated with notching in the umbilical vein. The ductus venosus index is an angle‐independent measurement from which right ventricular preload may be evaluated. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal color Doppler in the detection of external iliac vein thrombosis in pregnancy
Authors: Vine S. J. , Pugh N. D. , Pearson J. F.
Published: March 2003

A case is described where transvaginal color Doppler was used to demonstrate upward external iliac vein extension of thrombus at 26 weeks' gestation. Normally, transabdominal color Doppler can visualize the iliac vessels, but in advanced pregnancy the uterus obstructs the view. This technique is useful in determining of there is a ‘high’ deep vein thrombosis in pregnancy, and may also prove useful in the obese patient. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Doppler in non‐immune hydrops fetalis
Authors: Tulzer G. , Gudmundsson S. , Wood D. C. , Cohen A. W. , Weiner S. , Huhta J. C.
Published: March 2003

Fetal ultrasound studies were performed on 24 fetuses with non‐immune hydrops to evaluate echocardiographic and cardiovascular Doppler parameters that may be useful in assessing hemodynamics and in predicting outcome. Of all cardiovascular parameters analyzed, only the presence of abnormal pulsations in the umbilical vein (p < 0.001) was found to be significantly different between the 11 survivors and 13 non‐survivors. In a smaller subset of 12 fetuses, in whom inferior vena caval waveforms were recorded, survivors (n = 6) had a significantly lower percentage of retrograde flow in the inferior vena cava (p < 0.001) and higher inferior vena caval E/V velocity ratio (p < 0.001) than non‐survivors (n = 6). Sixteen of the 24 cases examined had abnormal umbilical venous pulsations; 12 of the 16 (75%) died including all fetuses with hydrops due to twin‐ to‐ twin transfusion or congenital heart disease. When fetuses with pulsatile flow in the umbilical vein were compared with fetuses with normal umbilical venous flow, the following significant differences were found: lower right and left ventricular output velocities, larger inferior vena caval diameter, decreased shortening fractions of the right and left ventricles, and lower peak velocities at the aortic and pulmonary valves and in the ductus arteriosus.
Strawberry‐shaped skull in fetal thanatophoric dysplasia
Authors: Seymour R. , Jones A.
Published: March 2003

The sonographic finding of a strawberry‐shaped skull is a marker of serious fetal malformation, most commonly associated with trisomy 18. We report a novel association of this sign with thanatophoric dysplasia. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Development of a training model for ultrasound‐guided invasive procedures in fetal medicine
Authors: Ville Y. , Cooper M. , Revel A. , Frydman R. , Nicolaides K. H.
Published: March 2003

Training in ultrasound‐guided procedures in fetal medicine is currently available in a few major fetal medicine units. Unlike elective surgical procedures, cordocentesis is usually performed without sedation as an outpatient procedure and active supervision of the trainee intensifies the anxiety already felt by the patient. In addition, the complication rate is higher in the initial few procedures or when the procedure is not regularly practiced. We have developed a comprehensive method of training for transabdominal invasive procedures using a medical model that simulates the in vivo situation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Changes mimicking endometrial neoplasia in postmenopausal, tamoxifen‐treated women with breast cancer: a transvaginal Doppler study
Authors: Achiron R. , Lipitz S. , Sivan E. , Goldenberg M. , Horovitz A. , Frenkel Y. , Mashiach S.
Published: March 2003

In menopausal patients with breast cancer who receive tamoxifen therapy, transvaginal sonography may show an abnormal endometrium. Our objective was to evaluate the effects of prolonged tamoxifen therapy on endometrial blood flow in postmenopausal patients with breast cancer, and to correlate blood flow characteristics with the sonographic appearance of the endometrium and its pathology. Transvaginal color Doppler ultrasound examinations were performed on 45 postmenopausal women (age range 54–70 years) with breast cancer, who had been treated with tamoxifen for 1–3 years. Twenty women (Group 1) had a thick, irregular, cystic endometrium of ≥ 5 mm, and 25 (Group 2) showed a thin endometrium of < 5 mm. The blood flow response was assessed by visualization of arterial waveforms in the endometrial and subendometrial regions with a transvaginal color flow imaging system. Resistance indexes (RI) were calculated for analysis and correlated with endometrial appearance and histology. The mean RI in Group 1 was 0.39 ± 0.10 (range 0.32–0.54), while the mean RI in Group 2 was 0.79 ± 0.10 (range 0.54–0.90; p < 0.001). On histology, 12 patients in Group 1 showed atrophic endometria confirmed by hysteroscopy, while in the remaining eight, endometrial polyps were found. In Group 2, all patients had scanty, atrophic endometria. Six of the eight patients with endometrial polyps had an RI of < 0.4 and none had malignant changes. These data suggest that tamoxifen therapy in women with postmenopausal breast cancer induces endometrial, morphological and blood flow changes, mimicking endometrial neoplasia. If low RI (0.4) and an abnormal appearance of the endometrium had been relied on as criteria that indicate malignancy, six of our patients (30%) with thick endometria would have been misdiagnosed as having carcinoma. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Anxiety levels of pregnant women during ultrasound examination: coping styles, amount of feedback and learned resourcefulness
Authors: Zlotogorski Z. , Tadmor O. , Duniec E. , Rabinowitz R. , Diaman Y.
Published: March 2003

Anxiety levels were measured before and after ultrasound examination in 183 women who underwent the procedure as part of their routine prenatal care. Women were classified according to their preferred mode of information gathering, their amount of available cognitive resources and predetermined feedback conditions. The results indicated significant reductions in state or situational anxiety levels for all subjects while trait anxiety was unaffected. In addition, the results suggested a correspondence between learned resourcefulness and informational coping styles. Women who had higher levels of cognitive resources and actively sought out information showed significantly greater decreases in state anxiety levels. This finding was also true for women who had lower levels of cognitive resources and tended to block out information. The impact of the scan was more profoundly affected by personality repertoires and informational coping styles than by either of the feedback conditions. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Blood flow changes in the intraovarian arteries during the periovulatory period: relationship to the time of day
Authors: Zaidi J. , Collins W. , Campbell S. , Pittrof R. , Tan S. L.
Published: March 2003

Intraovarian blood flow was assessed by transvaginal color and pulsed Doppler ultrasound prospectively in six women during the periovulatory period. All patients had regular ovulatory menstrual cycles and a mid‐luteal serum progesterone level consistent with spontaneous ovulation in the preceding cycle. Each patient underwent serial transvaginal ultrasound examination and Doppler assessment of blood flow in the ovarian stroma and in the wall of the dominant follicle or corpus luteum. When the mean follicular diameter was > 16 mm or day −2 from the estimated day of ovulation was reached, patients were scanned at 6‐h intervals at 06.00, 12.00, 18.00 and 24.00 until follicular rupture, to investigate the presence of circadian rhythms. The pulsatility index (PI) and the maximum peak systolic blood flow velocity (Vmax) were calculated as Doppler indices of impedance to blood flow and velocity, respectively. A venous blood sample was taken at each visit for subsequent hormonal analysis. There was no significant circadian fluctuation in either mean follicular Vmax or mean follicular PI before or after the luteinizing hormone (LH) surge. Similarly, mean Vmax and mean PI in the non‐dominant ovarian stroma did not show any significant fluctuation over the same periods. The mean PI in the dominant ovarian stroma showed daily fluctuations with the highest values occurring most commonly at 06.00 and the nadir in the afternoon and late evening. This fluctuation was the reverse of the circadian variation previously demonstrated in the uterine artery. However, in contrast to the uterine artery, comparison between the mean PI values in the dominant ovarian stroma at 06.00 and 18.00 only approached significance after the LH surge. The dominant ovarian stromal Vmax tended to rise during the day, although the differences between 06.00 and 18.00 were also not significant. Although there are fluctuations in Doppler blood flow indices in the dominant ovarian stroma, further studies are necessary to demonstrate whether this represents a significant circadian rhythm. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of bilateral proximal femoral hypoplasia
Authors: Gonçalves L. F. , De Luca G. R. , Vitorello D. A. , Parente L. M. M. , Philippi H. , Saab Neto J. A. , Pereira E. T.
Published: March 2003

Proximal femoral focal deficiency is a rare skeletal disorder, with an estimated incidence of 0.11 to 0.2/10 000 births. The bilateral form is uncommon, occurring in 10 to 15% of cases. We report a case of bilateral proximal femoral focal deficiency diagnosed by ultrasound at 30 weeks' gestation. Differential diagnosis, prognosis and management are discussed. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Growth of the fetal nose width and nostril distance in normal pregnancies
Authors: Goldstein I. , Tamir A. , Itskovitz‐Eldor J. , Zimmer E. Z.
Published: March 2003

The study was planned to obtain the dimensions of the fetal nose width and nostril distance during normal pregnancy as a basis for further studies and, for identification of deviations in growth. The study group included 302 healthy pregnant women at 14–40 weeks' gestation. Routine biometric measurements were obtained from all the participants, including biparietal diameter, bead and abdominal circumferences, measurements of the long bones and dimensions of the fetal nose width and nostril distance. The nose width and nostril distance were also calculated for each gestational age. A linear growth relationship was observed between nose width and gestational age (r = 0.88; p < 0.0001; y = 0.27 + 0.57 × gestational age), biparietal diameter (r = 0.92; p < 0.0001; y = 0.41 + 0.23 × biparietal diameter), bead circumference (r = 0.91; p < 0.00001; y = 0.85 + 0.63 × head circumference), femoral length (r = 0.91; p < 0.0001; y = 3.18 + 0.26 × femoral length) and humeral length (r = 0.73; p < 0.0001; y = 1.94 + 0.11 humeral length). A linear growth function was also observed between nostril distance and gestational age (r = 0.54; p < 0.00001; y = 2.77 + 0.15 × gestational age), biparietal diameter (r =: 0.71; p < 0.00001; y = 1.83 + 0.08 × biparietal diameter), head circumference (r = 0.70; p < 0.00001; y = 1.99 + 0.2 × head circumference), femoral length (r = 0.75; p < 0.00001; y = 2.49 + 0.09 × femoral length) and humeral length (r = 0.91; p < 0.00001; y = 1.89 + 0.32 × humeral length). A linear growth relationship was found between nose width and nostril distance (r = 0.71; p < 0.00001; y = 1.81 + 0.31 × nose width). These results provide normative data of the fetal nose width and nostril distance in various dimensions and across gestational age. In addition, the data offer the potential for prenatal diagnosis of nose and nostril abnormalities. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Intraobserver variation in transvaginal Doppler blood flow measurements in benign ovarian tumors
Authors: Tekay A. , Jouppila P.
Published: March 2003

Intraobserver variation in transvaginal color Doppler ultrasound measurements in ovarian tumors was evaluated in 20 women selected from a group of patients undergoing surgical exploration for an ovarian lesion. Only those cases who were suspected of having a benign ovarian tumor other than a unilocular simple cyst were recruited.

Pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV) and time‐averaged maximum velocity (TAMXV) were measured from intratumoral arteries in two repeat ultrasound sessions by the same observer. In each session, only two vessels with optimum Doppler signals were investigated. The repeatability of the measurements was studied by calculation of the within‐subjects standard deviation (SD), the value below which the difference between the repeat measurements will lie with a probability of 0.95, the coefficient of variation (CV) and the intraclass correlation coefficient (intra‐CC).

The CV was 15% for thee PI, 13% for the RI, 17% for the PSV and 23% for the TMXV when the average value from two vessels was used. The corresponding intra‐CC values were 0.86, 0.83, 0.96 and 0.90, respectively. In contrast, when a lowest (PI or Rl) or a highest (PSV or TAMXV) value was preferred, the CV increased to 25% for the PI, to 18% for the RI, to 28% for the PSV and to 33% for the TAMXV. Similarly, the intra‐CC values decreased.

All in all, the averaged PI and RI measurements in intratumoral arteries were considered to be reliable. Averaged PSV and TAMXV measurements had high CV figures, raising some doubt as to the consistency of these variables. Averaged index values were more consistent than the extreme (lowest or highest) values. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Round ligament varices in pregnancy mimicking inguinal hernia: an ultrasound diagnosis
Authors: Cheng D. , Lam H. , Lam C.
Published: March 2003

A case of uncomplicated round ligament varices mimicking an irreducible inguinal hernia in the third trimester of pregnancy is presented. The clinical and ultrasound features, pathophysiology and the role of conservative management are discussed. Non‐surgical treatment led to spontaneous regression after delivery. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Unusual fate of vesicoallantoic cyst with non‐visualization of fetal urinary bladder in a case of patent urachus
Authors: Yoo S.‐J. , Lee Y.‐H. , Ryu H. M. , Joo M. S. , Cheon C. K. , Park K. W.
Published: March 2003

We present the sonographic findings of a fetus with a vesicoallantoic cyst. The cyst was first identified at 17 weeks of gestation; it was associated with an omphalocele, and disappeared spontaneously at 29 weeks. The fetal urinary bladder was not visualized thereafter. An omphalocele and exstrophia of the urachus were found at birth and repaired. Non‐visualization of the fetal urinary bladder suggested rupture of the covering membrane of the omphalocele and allantois during fetal life. A defect in the wall of the omphalocele supported our hypothesis. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Fetal pyelectasis in consecutive pregnancies: a possible genetic predisposition
Authors: Degani S. , Leibovitz Z. , Shapiro I. , Gonen R. , Ohel G.
Published: March 2003

Mild fetal pyelectasis is a relatively common finding. The objective of this study was to assess its recurrence rate in subsequent pregnancies. The study comprised 420 women with two consecutive normal uncomplicated pregnancies screened at 15–24 weeks' gestation by ultrasound. Pyelectasis was defined as a fetal pelvis of 4 mm or more in its anterior‐posterior dimensions. Of 64 fetuses with pyelectasis, 43 (67%) had a recurrence of this finding in their subsequent pregnancy. Compared with normal fetuses, those with pyelectasis had a relative risk of 6.1 to have a recurrence of this finding in their next pregnancy (95% confidence interval, 4.3–7.5, p < 0.001).

These results suggest a predisposition for pyelectasis that may be influenced by genetic and/or environmental factors. More data are needed before an accurate adjustment based on previous results can be made. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Mature teratoma arising from an intra‐abdominal undescended testis presenting as a fetal abdominal mass
Authors: Shih H.‐H. , Teng R.‐J. , Tsou Yau K.‐I. , Lin H.‐H. , Hsieh F.‐J. , Chen C.‐C.
Published: March 2003

Teratoma of the intra‐abdominal testis is a rare finding in infants. We describe the case of a full‐term newborn treated for a calcified abdominal mass which was observed unexpectedly on prenatal sonography. An undescended right testis was also noted. During laparotomy, a twisted retroperitoneal tumor was found just above the right deep inguinal ring. Histological analysis revealed a mature teratoma of the intra‐abdominal right testis. The tumor was removed and there was no recurrence at follow‐up 1 year later. A teratoma should be considered in cases of fetal abdominal mass, especially when the testes cannot be detected in the scrotum by the 8thg month. Prenatal sonographic diagnosis might be possible. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester screening for fetal aneuploidy: biochemistry and nuchal translucency
Authors: Orlandi F. , Damiani G. , Hallaban T. W. , Krantz D. A. , Macri J. N.
Published: March 2003

Maternal dried whole‐blood specimens were collected prospectively from 2010 singleton pregnancies between 9 + 0 and 13 + 4 weeks that included 18 chromosomally abnormal pregnancies (11 Down's syndrome, four trisomy 18, two trisomy 13 and one triploidy). A subset of 744 pregnancies underwent ultrasound nuchal translucency measurement and included seven Down's syndrome, four trisomy 18, two trisomy 13 and one triploidy. Patients were evaluated for risk of Down's syndrome and trisomy 18 based on biochemistry (free β‐human chorionic gonadotropin and pregnancy‐associated plasma protein A), nuchal translucency and the combination of both. In prospective biochemical screening, false‐positive rates for Down's syndrome and trisomy 18 were 5.1% (66/1297) and 1.9% (25/1297) in women < 35 years of age and 14.2% (99/695) and 1.6% (1l/695) in women ≥ 35 years of age, respectively. The detection efficiency of aneuploidy was 6/6 (100%) in women < 35 years and 11/12 (92%) in women ≥ 35 years. Nuchal translucency measurement alone elected 57% (8/14) of cases of aneuploidy at a 5.8% (42/730) false‐positive rate. Modelling with the age distribution of live births, a 5% false‐positive rate resulted in Down's syndrome detection efficiency of 61% by biochemistry, 73% by nuchal translucency and 87% by combining both methods. The data in this study demonstrate that combined biochemical and ultrasound evaluation for Down's syndrome, and other chromosomal abnormalities in the first trimester of pregnancy yield a detection capability that may exceed that of current second‐trimester prenatal screening protocols. The potential for enhanced detection coupled to an earlier alert of fetal complications could represent a substantial advantage to both clinician and patient. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of trisomy 18 at the 10–14‐week ultrasound scan
Authors: Sherod C. , Sebire N. J. , Soares W. , Snijders R. J. M. , Nicolaides K. H.
Published: March 2003

A beneficial consequence of screening for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness (NT) at 1O–l4 weeks is the early diagnosis of trisomy 18. In a multicenter study of 91 091 singleton pregnancies there were 106 fetuses with trisomy 18 and (83% were identified by NT screening. Trisomy 18 was also associated with early onset intrauterine growth retardation, decreased fetal heart rate and the presence of exomphalos. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Presence of the ‘lemon’ sign in fetuses with spina bifida at the 10–14‐week scan
Authors: Sebire N. J. , Noble P. L. , Thorpe‐Beeston J. G. , Snijders R. J. M. , Nicolaides K. H.
Published: March 2003

In three cases of lumbosacral spina bifida diagnosed at 12, 13 and 14 weeks of gestation there was an associated lemon sign, or scalloping of the frontal bones, and in one case the fetal nuchal translucency was increased. In a multi‐center ultrasound screening study at 10–14 weeks there were 61 972 singleton pregnancies including 29 cases of spina bifida, none of which was diagnosed at the routine first‐trimester scan, but 28 of the 29 cases were detected by ultrasonography at 16–22 weeks; in one case the diagnosis was missed at the 20‐week scan and the defect was identified at 32 weeks during a scan for localization of the placenta. The fetal nuchal translucency was above the 95th centile in only one of the cases (3.4%). It is possible that the majority of fetuses with spina bifida have a lemon sign in the first trimester, but the sensitivity of the 10–l4‐week scan in the diagnosis of spina bifida and the prevalence of the lemon sign at this gestation will only be established by further studies incorporating early systematic examination of the head and spine. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Fetal weight gain in a serially scanned high‐risk population
Authors: de Jong C.L.D. , Gardosi J. , Baldwin C. , Francis A. , Dekker G.A. , van Geijn H.P.
Published: March 2003

Physiological as well as pathological variables influence fetal growth. This study was undertaken to assess the influence of physiological variables on fetal weight gain in a high‐risk population with normal outcome. A total of 121 pregnancies had 3–13 (median 8) ultrasound scans in the third trimester. Estimated fetal weight was calculated according to standard formulae. The estimated fetal weight at 30, 34 and 38 weeks and growth per day in the last 2 weeks prior to delivery were calculated and compared between subgroups defined on physiological characteristics, such as maternal height, maternal weight, parity and fetal sex.

There were differences in growth curves for each of the physiological parameters studied. Maternal height and weight were significantly related to the estimated fetal weight throughout the third trimester but there were no significant differences in growth per day in the last 2 weeks before birth. In contrast, subgroups defined by parity and fetal sex did not show significant fetal weight differences in the third trimester, but the daily growth rate prior to birth was significantly higher for multiparae and male fetuses.

Physiological factors affect fetal weight gain and need to be taken into account when fetal growth is monitored in high‐risk pregnancies. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Outcome and early childhood follow‐up of chromosomally normal fetuses with increased nuchal translucency at 10–14 weeks' gestation
Authors: Van Vugt J. M. G. , Tinnemans B. W. S. , Van Zalen‐Sprock R. M.
Published: March 2003

The aim of this study was to evaluate pregnancy outcome and early childhood of chromosomally normal fetuses with increased nuchal translucency at 10–14 weeks' gestation. A total of 63 chromosomally normal fetuses with a first‐trimester nuchal translucency thickness of 3 mm or more were evaluated. In ongoing pregnancies, follow‐up scans were performed to detect or exclude additional structural anomalies in the fetus. Follow‐up of the live‐born children was by questionnaires sent to parents or reviews of medical records. In 11 fetuses, additional structural anomalies were diagnosed at follow‐up scans; in this group there were five terminations of pregnancy, two intrauterine deaths, two neonatal deaths and two survivors. In addition, there were two unexplained intrauterine deaths. The remaining 50 pregnancies resulted in live births and the parents were sent questionnaires on the follow‐up of their children. Responses were received on 34 children at 7–75 months of age. Twenty‐nine children are healthy and five showed various minor health problems not related to the presence of increased nuchal translucency. These findings suggest that chromosomally normal fetuses with first‐trimester increased nuchal translucency and normal follow‐up scans have a good prognosis for a normal early childhood. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonography of the ureter during laparoscopic, abdominal and radical hysterectomy
Authors: Helin H.‐L. , Kirkinen P. , Purhonen S. , Penttinen J.
Published: March 2003

Objective

To examine, by perioperative ultrasonography, ureteral anatomy and function during laparoscopic, abdominal and radical hysterectomy

Subjects

The study group consisted of 36 patients scheduled for laparoscopic, abdominal or radical hysterectomy; there were 12 patients in each group.

Methods

The ureteral rest‐phase diameter, maximal diameter during peristaltic waves and frequency of peristaltic waves were recorded immediately before and after hysterectomy under standard anesthetic conditions with the use of a 7.5‐MHz linear laparoscopic ultrasound probe.

Results

Ureteral peristaltic activity was decreased and the rest‐phase diameter was increased after hysterectomy. The findings were most evident after radical hysterectomy with pelvic lymphadenectomy. Retrograde (cranial) flow was recorded in a majority of the patients. The individual variation was great, particularly after radical surgery. Short‐and long‐term clinical outcome was normal in all cases.

Conclusions

Uncomplicated hysterectomy is followed by changes in ureteral function. Although these changes apparently have no clinical significance, they must be recognized if laparoscopic ultrasonography is applied as a perioperative method to diagnose or exclude surgical ureteral lesions. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound evaluation of fetal tooth germs
Authors: Ulm M. R. , Kratochwil A. , Ulm B. , Solar P. , Aro G. , Bernaschek G.
Published: March 2003

Objective

A total of 126 genetic syndromes are associated with oligodontia or anodontia. The most frequent of these are ectodermal dysplasias, all types of facial cleft and Down's syndrome. With the advent of three‐dimensional ultrasonography, accurate assessment of many fetal abnormalities has become possible. The objective of this study was to determine the effectiveness of three‐dimensional ultrasonography in the visualization of fetal tooth germs.

Design

We examined 45 women with singleton pregnancies between 16 and 36 gestational weeks who were undergoing routine ultrasound check‐ups for fetal tooth germs with conventional two‐dimensional ultrasonography, followed by three‐dimensional ultrasonography using multiplanar reconstruction.

Results

In the 45 fetuses studied, fetal tooth germs were visualized at the first attempt in 36 cases (80%). In the group of fetuses aged between 19 and 36 weeks of gestation, the overall detection rate in both jaws was at least 86% for three‐dimensional ultrasonography, compared to at least 56% for two‐dimensional ultrasonography.

Conclusions

Three‐dimensional ultrasonography was clearly superior to conventional ultrasonography in the visualization and evaluation of fetal tooth germs. Three‐dimensional ultrasonography therefore has a potential for enhanced visualization of fetal tooth germs and may aid in the antenatal detection of syndromes associated with oligodontia or anodontia. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
The role of color Doppler imaging of the uterine arteries at 20 weeks' gestation in stratifying antenatal care
Authors: Kurdi W. , Campbell S. , Aquilina J. , England P. , Harrington K.
Published: March 2003

Objective

To determine the value of one‐stop color Doppler imaging of the uterine arteries at the time of the 20‐week anomaly scan, to select women at risk of developing pre‐eclampsia and intrauterine growth restriction (IUGR).

Patients and methods

A total of 1022 unselected women had color Doppler imaging of both uterine arteries at the time of their dating/anomaly scan (19–21 weeks' gestation). The presence or absence of notching of the flow velocity waveform (FVW) was noted, and the resistance index (RI) was measured. The main outcome measures were pre‐eclampsia, birth weight, placental abruption and stillbirth.

Results

The outcome in 946 women (92.6%) was available for analysis. Of these, 216 (23%) had abnormal uterine artery Doppler studies, 117 (12.4%) with bilateral (right and left FVW) notches; 21 (2.2%) women developed pre‐eclampsia, and 57 (6.0%) neonates were small for gestational age (SGA; < 5th centile), at birth. For women with bilateral notches the odds ratio (OR) for developing pre‐eclampsia was 12.8 (95% confidence interval (CI) 5.3–30.8), and 52.6 (95% CI 6.4–430.1) for pre‐eclampsia requiring delivery before 37 weeks' gestation. If the uterine artery Doppler studies were normal, the odds ratio for eveloping pre‐eclampsia was 0.11 (95% CI 0.04–0.28), and 0.3 (95% CI 0.17–0.51) for the delivery of an SGA baby less than the 5th centile. In women with bilateral notches with mean RI greater than 0.55, the positive pre‐dictive value for the main outcome measures was 46%.

Conclusion

Women with normal uterine artery color/pulsed Doppler studies at 20 weeks' gestation constitute a group that have a low risk of developing obstetric complications related to uteroplacental insufficiency. Women with high resistance in both uterine arteries (bilateral notches) have an increased risk of the subsequent development of such complications, in particular those requiring delivery before term. The addition of color Doppler imaging of the uterine arteries at the time of the routine 20‐week dating/anomaly scan may be of use in determining the type and level of antenatal care that is offered to women. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler study of the venous circulation in the fetal brain and hemodynamic study of the cerebral transverse sinus
Authors: Laurichesse‐Delmas H. , Grimaud O. , Moscoso G. , Ville Y.
Published: March 2003

Objectives

To describe the venous circulation in the fetal brain; to describe the normal blood flow velocity waveform in the transverse sinus and to establish normal reference ranges for the second half of gestation.

Population

A total of 126 pregnant women with uncomplicated pregnancies at 20–42 weeks of gestation.

Methods

A combination of color‐coded Doppler and two‐dimensional real‐time ultrasound was used to identify the main venous systems in the fetal brain. Blood flow velocity waveforms of the transverse sinus were obtained from a transverse plane of the head at the level of the cerebellum.

Results

A waveform could be obtained in the cerebral transverse sinus in 98% of the cases. The waveform obtained was triphasic with a forward systolic component, a forward early diastolic component and a lower forward component in late diastole. Reverse flow during atrial contraction was seen before 28 weeks and the diastolic flow increased with gestation thereafter. Pulsatility and resistance indices decreased and flow velocities increased in the transverse sinus throughout gestation.

Conclusion

The venous circulation of the fetal brain can be identified by color Doppler. The gestational age‐related decrease in resistance and increase in flow velocities suggest that hemodynamic studies of the cerebral transverse sinus might have clinical implications in studying compromised fetuses. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology