bluuebunny/crossref_metadata_2025 huggingface dataset:
INHERITED DEFECTSOF PLATELET FUNCTION
Authors: Nurden Alan T. , Nurden Paquita
Published: March 2003

Inherited platelet defects bleeding syndromes underlie of varying severity. The Bernard–Soulier syndrome and Glanzmann thrombasthenia are disorders of membrane glycoproteins. In the former, a deficiency of the GPIb‐IX‐V complex leads to defective platelet adhesion, while in thrombasthenia, platelet aggregation does not occur in the absence of the integrin ´IIbβ3. Defects of primary receptors for stimuli are increasingly being described, and include a defect of a newly cloned Gi‐protein‐linked, seven transmembrane domain, ADP receptor. These lead to agonist‐specific deficiencies in the platelet function response, as do abnormalities in the many intracellular signaling pathways of platelets. Defects affecting secretion from dense bodies and α‐granules, of ATP production and generation of procoagulant activity, are also encountered. Some disorders are exclusive to megakaryocytes and platelets, while in others, such as the Chediak–Higashi, Hermansky–Pudlak and Wiskott–Aldrich syndromes; the molecular lesion extends to other cell types. Disorders affecting platelet morphology, the so‐called ‘giant platelet’ syndromes should also be considered. In familial thrombocytopenias, platelets are produced in insufficient quantities to assure hemostasis. Platelet disorders are examples of rare diseases; nevertheless they have provided essential information in the elucidation of the molecular basis of platelet function.
Low body weight and type of protease inhibitor predict discontinuation and treatment‐limiting adverse drug reactions among HIV‐infected patients starting a protease inhibitor regimen: consistent results from a randomized trial and an observational cohort
Authors: Kirk O , Gerstoft J , Pedersen C , Nielsen H , Obel N , Katzenstein Tl , Mathiesen L , Lundgren Jd
Published: March 2003

Departments of Infectious Diseases,

1

Hvidovre Hospital, University of Copenhagen, Hvidovre,

2

Rigshospitalet, University of Copenhagen, Copenhagen,

3

Odense University Hospital, Odense,

4

Aalborg Hospital, Aalborg and

5

Marselisborg University Hospital, Aarhus, Denmark

Objectives  To assess predictors for discontinuation and treatment‐limiting adverse drug reactions (TLADR) among patients starting their first protease inhibitor (PI).

Methods  Data on patients starting a PI regimen (indinavir, ritonavir, ritonavir/saquinavir and saquinavir hard gel) in a randomized trial (RAS, n = 318) and an observational cohort (OBC, n = 505) were used to document reasons for discontinuation and TLADR. Risk factors for discontinuation of the initial

PI/developing TLADR were assessed in Cox models.

Results  A total of 43 (RAS) and 48% (OBC) discontinued the initial PI therapy within less than 2 years. In both populations TLADR were the most common reason for discontinuation. The incidence of TLADR in RAS was: 8.5 (indinavir), 66.0 (ritonavir), 15.6 (saquinavir hard gel) per 100 person‐years of follow‐up (P < 0.001). Body weight and type of PI initiated were independent risk factors for treatment discontinuation and TLADR in both groups. In OBC, the risk of developing TLADR increased by 12% per 5 kg lower body weight when starting the PI regimen [the relative hazard (RH) was 1.12 (95% confidence interval: 1.05–1.19) per 5 kg lighter], and starting ritonavir was associated with a three‐ to sixfold higher risk of TLADR relative to other PI regimens. Very similar results were documented in RAS [RH for body weight was 1.18 (1.07–1.29)].

Conclusions  Nearly half of the patients stopped treatment with the initial PI, most commonly as a result of adverse drug reactions. Low body weight and initiation of ritonavir relative to other PIs were associated with an increased risk of TLADRs. Very consistent results were found in a randomized trial and an observational cohort.
Current issues in the biology of AIDS‐related lymphoma
Authors: Bower M , Fife K
Published: March 2003

Three important issues have been the focus of much recent attention in the biology of AIDS‐related lymphomas. The altered epidemiology in the era of highly active antiretroviral therapy, the role of herpesviruses including human herpesvirus 8 and the molecular genetics of HIV‐associated T‐cell lymphomas. These topics are covered in this article and their potential application to the clinical management of AIDS‐related lymphomas are discussed.
Successful treatment of angiosarcoma of the scalp by intralesional cytokine therapy and surface irradiation*
Authors: Ulrich Jens , Krause Markus , Brachmann Adna , Franke Ingolf , Gollnick Harald
Published: March 2003

An 88‐year‐old woman presented to us with angiosarcoma of the scalp that had developed over a 6‐month period following previous trauma. Despite explicit information concerning the extremely malignant potential of the tumour the patient refused any surgical intervention. However, she agreed to receive local, intralesional interferon α‐2b and interleukin‐2 therapy. After partial remission of the tumour, the intralesional cytokine injections were combined with surface radiotherapy. This combination therapy led to a 2‐year remission of both the tumour and sonographically suspicious cervical lymph nodes. Apart from the typical, moderate side‐effects of interferon α‐2b and interleukin‐2 the therapy was well tolerated. In conclusion, in our limited experience intralesional cytokine therapy – alone as well as in combination with surface irradiation – seems to be an alternative therapeutic option for patients who is not a candidate for surgery.
Granulomatous folliculitis as a manifestation of post‐herpetic isotopic response
Authors: Schena D , Barba A , Chieregato C
Published: March 2003

We report a case of postherpetic granulomatous folliculitis in a 52‐year‐old female. The several cutaneous granulomatous eruptions following herpes zoster reported in the literature include annular, sarcoid and tuberculoid granuloma, granulomatous vasculitis and granulomatous folliculitis. The mechanism of granuloma formation is probably triggered by a delayed hypersensitivity response to the virus.
Pityriasis versicolor
Authors: Gupta AK , Bluhm R , Summerbell R
Published: March 2003

Pityriasis versicolor is a common superficial fungal infection of the skin. It is caused by Malassezia spp., which are normal human saprophytes. Under certain conditions, both exogenous and endogenous, the fungus can convert from a yeast to a pathogenic mycelial form. This alteration results in mild inflammation of the skin, and in characteristic clinical and histological changes. The taxonomy of Malassezia spp. has recently been modified to include six obligatorily lipophilic species, all of which can be found on human skin, plus one non‐obligatorily lipophilic species, which only rarely colonizes human hosts.

Learning objectives At the conclusion of this learning activity, participants should be aware of the role of Malassezia in the development of pityriasis versicolor, the clinical and histological changes arising from this dermatosis, and the diagnosis and treatment of this disorder.
Granulomatous folliculitis at sites of herpes zoster scars: Wolf's isotopic response
Authors: Fernández‐Redondo V , Amrouni B , Varela E , Toribio J
Published: March 2003

Cutaneous eruptions described on herpes zoster scars are variable. We present a case of granulomatous folliculitis occurring 4 weeks after an episode of herpes zoster infection in a woman with cutaneous T‐cell lymphoma. The pathogenesis of the lesions remains unclear. The viral genome was detected only in early lesions.
Fetal echocardiography in multiple gestations
Authors: Copel J. A. , Inati M. , Green J. J. , Hobbins J. C. , Keinman C. S.
Published: March 2003

We reviewed fetal echocardiograms from 36 multiple gestations from 20 weeks gestation to term. Seven sets of twins plus one set of triplets were referred because of a suspect cardiac anomaly in one fetus; heart disease was confirmed in one fetus of six sets of twins and in one triplet. Six sets were referred because of extracardiac malformations and heart disease was confirmed in two sets (including both twins in one set). The remaining case was detected in a patient sent for evaluation of karyotypic abnormality. Thus 11 fetal cardiac defects were detected in ten pregnancies. Chromosomes were abnormal in three of the anomalous fetuses. Two sets discordant for heart disease were monochorionic. Intervention, including a change in the planned location of delivery, or maternal digitalization for fetal congestive failure, occurred in six. We conclude that fetal echocardiography is feasible and useful in appropriate multiple gestations. Although often ethically complex, the information gained can be applied to patient management. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Fetal aortic diameter pulse wave response to changes in maternal position after membrane rupture
Authors: Stale H. , Gennser G.
Published: March 2003

An ultrasonic phase‐locked echo‐tracking system was used in order to study human fetal hemodynamics in relation to maternal postural changes after membrane rupture. Diameter pulse waves were recorded in the descending aorta of 17 fetuses presenting by the vertex in normal singleton pregnancies, with the mother in three different positions. The first measurements were made with the mother in the slightly left lateral recumbent (horizontal), then upon transition to the upright (70°), and finally upon return to the horizontal. Change from the horizontal to the upright position produced a moderate but significant increase (p < 0.05) in maternal heart rate, while the systolic and diastolic blood pressures remained unchanged. No significant changes were seen in the fetal pulse wave variables (i.e. end‐diastolic diameter, relative pulse amplitude, maximum incremental velocity, late decremental velocity, pulse duration, relative crest time and pulse wave velocity). The absence of fetal hemodynamic changes possibly reflects the presence of a protective effect against I gravitational stress to the fetal cardiovascular system provided by the remaining volume of amniotic fluid and the abundant fetal extracellular water. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Myocardial contractility in the anemic human fetus
Authors: Lingman G. , Legarth J. , Rahman F. , Stangenberg M.
Published: March 2003

Severely anemic fetuses in Rh‐isoimmunized pregnancies are often found to have hydrops and the etiology is debated. Fifteen fetal blood samplings were performed in nine fetuses for determination of the degree of anemia and of the acid‐base balance. Waveform analysis was performed on the maximum blood velocity curve in the umbilical arteries and the ascending fetal aorta, obtained by means of a pulsed Doppler technique. The blood acceleration in the ascending aorta increased down to a hematocrit of 0.18 and a hemoglobin concentration of 65 g/l, which might constitute a cardiac response to the anemia aimed at maintaining the peripheral blood circulation. Below these levels there was a decrease in blood acceleration, which could be caused by impaired cardiac oxygenation. This relationship could be described as a six‐power function (r = 0.87; p = 0.032). A second‐power relationship was found between the umbilical artery pulsatility index and the blood acceleration in the fetal ascending aorta (r = 0.64; p = 0.0418), which suggests that the cardiac pump function can alter the blood velocity waveform in the umbilical arteries. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound measurements of fetal limb bones
Authors: Exacoustos C. , Rosati P. , Rizzo G. , Arduini D.
Published: March 2003

In order to establish the growth patterns of fetal limbs, measurements of femur, humerus, tibia, fibula, radius and ulna were made by ultrasound and related to gestational age. To this end, 2317 normal singleton pregnant women were studied cross‐sectionally at 13–40 weeks of gestation. Patients were selected on the basis of a certain last menstrual period, history of regular cycles and at least one ultrasound scan before 16 weeks confirming gestational age. Linear growth of all limb measurements was observed between 13 and 28 weeks of gestation. From this gestational age onwards, a flattening of the growth curve was seen. A second‐degree polynomial equation turned out to be the best model to describe this phenomenon. The measurements of all six fetal long bones showed a high correlation with menstrual age (r ≥ 0.99). The femur displayed the largest mean weekly increments (2.8 mm per week from 13 to 28 weeks and 1.7 mm per week from 29 to 40 weeks of gestation) and the radius had the smallest (2.08 mm per week from 13 to 28 weeks and 1.25 mm per week from 29 to 40 weeks' gestation). Considering inter and intraoperator variations and the weekly increment of fetal long bone length, a correct evaluation of limb growth is possible for the femur every week before 28 weeks and every 2 weeks after 28 weeks. For the remaining limb bones, a correct evaluation is possible every 2 weeks at all gestational ages. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Fetal renal artery blood velocimetry in multicystic kidney disease
Authors: Kaminopetros P. , Dykes E. H. , Nicolaides K. H.
Published: March 2003

Color flow mapping and Doppler velocimetry were used to measure impedance to flow in both renal arteries of 11 fetuses with unilateral multicystic kidney disease at 19–34 (mean = 26) weeks' gestation. In all cases, the pulsatility index in the renal artery of the multicystic kidney was higher than that of the contralateral normal kidney; the mean pulsatility index in the arteries of the affected kidneys was significantly higher than the normal mean for gestation. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Erythroblastosis in birth asphyxia
Authors: Thilaganathan B. , Nicolaides K. H.
Published: March 2003

The pH and erythroblast count in umbilical venous blood were measured in 27 term neonates with normal birth weights. In seven cases, infants were admitted to the neonatal intensive care unit because of birth asphyxia, and the findings in these cases were compared to the values of the 20 non‐asphyxiated neonates that were delivered either vaginally (n = 10) or by elective Cesarean section (n = 10). The umbilical venous blood pH in the asphyxiated group was significantly lower than that in the control group of infants that were delivered by Cesarean section, but not significantly different from the controls that were delivered vaginally. In contrast, the erythroblast count in the asphyxiated group was significantly higher than that in the controls, irrespective of the mode of delivery. These findings suggest that cord blood erythroblast count at delivery may provide a better measure of fetal tissue hypoxia than umbilical venous pH. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of an intra‐abdominal ectasia of the umbilical vein with color Doppler ultrasonography
Authors: Rizzo G. , Arduini D.
Published: March 2003

A cystic lesion in the anterior upper part of the abdomen was detected in utero by ultrasonography. Color and pulsed Doppler studies performed over the mass revealed a marked turbulent flow through the cystic lesion in connection with the umbilical vein, suggesting the existence of an intra‐abdominal ectasia of the umbilical vein. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Accuracy of transvaginal ultrasound and serum hCG in the diagnosis of ectopic pregnancy
Authors: Gabrielli S. , Romero R. , Pilu G. , Pavani A. , Capelli M. , Milano V. , Bevini M. , Bovicelli L.
Published: March 2003

Transvaginal ultrasound was performed upon admission of 127 patients with a clinical suspicion of ectopic pregnancy in association with human chorionic gonadotropin (hCG) determination. Failure to visualize with sonography an intrauterine gestational sac with an hCG level superior to 1000 mIU/ml identified 25/42 tubal pregnancies with a positive predictive value of 86% and a specificity of 93%. Abnormal adnexal findings occurred in 95% of the ectopic pregnancies. Extrauterine gestational sacs with or without embryos could be confidently detected in 19 ectopic pregnancies (45%). A complex adnexal mass was seen in 19 cases and yielded a positive predictive value of 90% (19/21). Adnexal gestational sacs and complex masses were seen more frequently in those ectopic pregnancies with an hCG level above 1000 mIU/ml but the difference was not significant (100% versus 78%). Simple adnexal cysts were found more frequently in intrauterine pregnancies, and fluid in the cul‐de‐sac was also not indicative of ectopic pregnancy (positive predictive value, 29%). Transvaginal ultrasound has a primary role in the diagnosis of ectopic pregnancy. The combined use of uterine and adnexal sonography associated with elevated hCG levels allows a definitive diagnosis in the vast majority of cases at a very early stage, when the chances for a successful conservative treatment are greater. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
The role of ultrasound in gynecological emergencies
Authors: Mould T. A. J. , Byrne D. L. , Morton K. E.
Published: March 2003

The expanding use of ultrasonography in gynecology puts increasing strain on the resources of ultrasound departments; any mechanism to increase the diagnostic efficiency of the scan and reduce unwarranted investigation would, therefore, be welcome.

This prospective study examines the use of abdominal ultrasound examination in gynecological emergencies over a 6‐month period in a London teaching hospital. The examination changed the clinical management in 33% of cases where the pregnancy test was positive, but in only 14% where it was negative. In the former group, the confirmation of viable intrauterine pregnancy reassured both patient and clinician in 84% of the cases, making the test a useful investigation in 89% of the total cases where the pregnancy test was positive. When the pregnancy test was negative, the ultrasound scan was more likely to be useful if requested by doctors with gynecological experience. In cases of incomplete spontaneous abortion, ultrasound was not found to be a useful investigation.

Access to ultrasound equipment by, and basic ultrasound training of admitting junior doctors with gynecological experience would reduce referrals to the ultrasound department and reduce admissions to hospital, whilst improving appreciation of the role of ultrasound in gynecological emergencies. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Fetal atrioventricular and outflow tract flow velocity waveforms during conducted and blocked supraventricular extrasystoles
Authors: van der Mooren K. , Wladimiroff J. W. , Stijnen Th.
Published: March 2003

Maximum flow velocity waveforms at atrioventricular and outflow tract level were studied cross‐sectionally in 19 human fetuses with conducted and/or blocked supraventricular extrasystoles ranging from 25 to 38 weeks of gestation. At outflow tract level, peak systolic velocity and acceleration time for extrasystolic and post‐extrasystolic beats were compared with those for the immediately preceding normal beat. Regression lines were calculated for peak systolic velocities with filling time. At atrioventricular level, peak‐E wave and peak‐A wave velocities and E/A ratio for the extrasystolic and post‐extrasystolic beats were compared with those for the normal beat. At all levels, time‐averaged velocities were compared with reference charts standardized for gestational age.

Peak systolic velocity and acceleration time during the post‐extrasystolic beat were higher than during the normal beat; the Frank‐Starling mechanism, post‐extrasystolic potentiation as well as reduced ventricular afterload may all play a role in this. At all measuring levels, time‐averaged velocity during the extrasystolic beat was strikingly lower than the reference velocities. It is postulated that the increased blood volume and contraction force during the post‐extrasystolic beat cause the valve area to become larger, resulting in a relative decrease in velocities measured by Doppler ultrasound. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Cephalocele and cystic hygroma: diagnosis and differentiation in the first trimester of pregnancy with transvaginal sonography. Report of two cases
Authors: van Zalen‐Sprock M. M. , van Vugt J. M. G. , van der Harten H. J. , van Geijn H. P.
Published: March 2003

Two case reports are presented of fetuses with malformations in the neck region, detected in the first trimester of pregnancy by transvaginal ultrasonography. In one fetus a septated cystic hygroma was visualized. Trisomy 18 was found. The other fetus presented with a cephalocele. The ultrasound diagnosis was confirmed at autopsy in both cases. Sonographic criteria to distinguish between cystic hygroma and occipital cephalocele in the first trimester of pregnancy are discussed. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
The clinical significance of resolving polyhydramnios
Authors: Rochelson B. , Wagner J. , Shmoys S.
Published: March 2003

Polyhydramnios is associated with multiple maternal and fetal abnormalities. Although the risks of persistent polyhydramnios are well described, the clinical implications of polyhydramnios that resolves prior to delivery are not. Thirty‐four non‐diabetic patients with resolving polyhydramnios were studied. An amniotic acid index of ≥ 20 was used to define polyhydramnios. Antepartum and postpartum outcomes were compared with those patients with persistent polyhydramnios, and a control group of 102 singleton term deliveries. Patients with resolving polyhydramnios did not have a significant increase in congenital anomalies. An 8% incidence of congenital anomalies was noted in patients with persistent polyhydramnios; this was significant compared with controls (p < 0.05). Idiopathic resolving polyhydramnios was associated with a higher mean birth weight (p < 0.05) than controls, with significantly more babies weighing more than 4200 g. An increase in placental thrombus formation was noted in patients with idiopathic resolving and persistent polyhydramnios compared to the control group (p < 0.01). The etiology of this is unclear. Obstetricians should be aware of the risk of macrosomia and the possibility of placental disease in these fetuses. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Ovarian cysts during pregnancy: the role of ultrasonically guided transvaginal aspiration
Authors: Aboulghar M. , Mansour R. , Serour G.
Published: March 2003

Three cases of ovarian cysts, with a mean diameter measuring more than 6 cm during the second trimester of pregnancy, were aspirated transvaginally, guided by ultrasound. All cysts were unilocular, thin‐walled with no internal echoes. Cytological examination of the aspirated fluid revealed benign luteinized granulosa cells. No complications occurred and the pregnancies continued to full term. It is believed that needle aspiration of simple ovarian cysts of 6 cm diameter or more during pregnancy is a safe and effective treatment that is capable of reducing the risk of torsion, hemorrhage or rupture and avoiding unnecessary laparotomy. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
The acardiac twin: a case report using color Doppler ultrasonography
Authors: Crade M. , Nageotte M. P. , MacKenzie M. L.
Published: March 2003

The use of color Doppler sonography has expanded our understanding of the normal and abnormal pregnancy. A case is presented here in which color Doppler imaging was utilized to confirm a long‐held theory concerning the strikingly abnormal dynamics of arterial flow to an acardiac twin and observations are also presented concerning the possible route of venous return contrary to presumed theories established within the literature. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal color Doppler study of middle cerebral artery blood flow in early normal and abnormal pregnancy
Authors: Kurjak A. , Predanic M. , Kupesic‐Urek S. , Funduk‐Kurjak B. , Demarin V. , Salihagic A.
Published: March 2003

Transvaginal color and pulsed Doppler sonography was performed on 106 singleton pregnant women; 75 had clinically normal pregnancies, and the remaining 31 patients had complicated pregnancies with vaginal bleeding. The gestational ages ranged from the 7th to 18th menstrual weeks. The aim of the study was to establish the earliest gestational age at which intracranial blood flow could be detected, in particular in the middle cerebral artery. The intracranial circulation becomes visible at the 8th week of gestation (7 weeks and 3 days). The end‐diastolic component of blood flow is inconstantly present from the 11th to the 13th gestational week, and is always detected thereafter. A significant decrease in the pulsatility index (p < 0.05) and peripheral flow impedance index (p < 0.001) was observed during the early weeks of pregnancy in both the normal and complicated pregnancies. There was no significant difference between the groups (p > 0.05). Results suggest that Doppler studies of middle cerebral arteries in early pregnancy are unlikely to be of value in identifying fetal hemodynamic disorders in the early stages of spontaneous abortion. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Preoperative ultrasonic assessment of women undergoing gamete intrafallopian transfer: a prospective study of 350 cases
Authors: Guirgis R. R. , Alshawaf T. , Craft I. L.
Published: March 2003

A total of 350 women due to undergo gamete intrafallopian transfer were scanned vaginally on the operation day and the findings were compared with those recorded 2 days previously when human chorionic gonadotropin was administered. The aim was to assess the clinical value of ultrasound assessment on the operation day, especially from a prognostic point of view. Seven women (2%) were found to have already ovulated and evidence of imminent ovulation was detected in another 27 cases (7.7%). There were more frequent and more marked increases in the number of follicles with a diameter of > 14 mm, in the diameter of the leading follicle and in the endometrial thickness in the women who subsequently conceived. The endometrial reflectivity was brighter than the myometrium (grade A) in 77.3% of the women who conceived, compared with only 37.5% of those who did not conceive. These differences were statistically significant. It was concluded that follicular and endometrial changes recorded on the day of gamete intrafallopian transfer may have a prognostic value, as the pregnancy rate was higher in women who had the favorable ultrasonographic features outlined in the study. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography of the uterine cavity with hysteroscopic correlation in the investigation of infertility
Authors: Narayan R. , Goswamy R. K.
Published: March 2003

This report describes the correlation of hysteroscopic findings with preoperative transvaginal sonography in 200 patients being investigated for infertility. Real‐time ultrasound examination was performed on days 7, 14 and 21 in spontaneous ovulatory cycles. Diagnostic hysteroscopy was performed in the subsequent cycle. The abnormalities detected using transvaginal sonography were intrauterine adhesions, submucous fibroids, endometrial polyps, endometritis and a non‐specific irregular endometrium. A total of 182 patients were diagnosed correctly to have an abnormality by transvaginal sonography giving a false‐positive rate of 5.5%. The sensitivity of transvaginal sonography in detecting endometrial pathology was 98.9% with a positive predictive value of 94.3%. The positive predictive values for specific abnormalities were 98.5% for intrauterine adhesions, 91.7% for submucous fibroids, 91.4% for endometrial polyps, 85.7% for endometritis and 85.7% for irregular endometrium. These data show a strong correlation between findings from transvaginal sonography and hysteroscopy. Transvaginal sonography may be used to detect intrauterine pathology and identify patients in whom hysteroscopy and hysteroscopic surgery are indicated. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Intraobserver reliability of amniotic fluid volume estimation by two techniques: amniotic fluid index vs. maximum vertical pocket
Authors: Williams K. , Wittmann B. , Dansereau J.
Published: March 2003

We evaluated the intraobserver agreement of two techniques of amniotic fluid assessment: amniotic fluid index and maximum vertical pocket. The intraobserver variation of the two forms of amniotic fluid assessment was obtained by evaluating amniotic fluid prior to fetal biometry (post‐biometry value) and after fetal biometry (pre‐biometry value). Between January and June 1990, this amniotic fluid assessment was by the maximum vertical pocket technique, and between July and December 1990, by the amniotic fluid index technique.

In the Grace Maternity Hospital, Vancouver, 352 subjects were evaluated by the maximum vertical pocket technique, and 184 subjects by the amniotic fluid index technique.

Amniotic fluid volumes were categorized into normal, oligohydramnios, and polyhydramnios, and the pre‐biometry and post‐biometry categories of amniotic fluid index and maximum vertical pocket techniques were compared by kappa statistics. The maximum vertical pocket technique showed poor intraobserver agreement (κ = 0.33), but the amniotic fluid index technique showed good agreement (κ = 0.72). With the poor reproducibility of the maximum vertical pocket technique in assessing extremes of amniotic fluid volume, it is difficult to support its use as a component of fetal assessment. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Transverse cerebellar diameter in small‐for‐gestational‐age fetuses: pregnancy dating is possible only when growth retardation is secondary to uteroplacental insufficiency
Authors: Capponi A. , Rizzo G. , Pietropolli A. , Rinaldo D. , Arduini D. , Romanini C.
Published: March 2003

The objective of this study was to establish whether measurement of the transverse cerebellar diameter to determine gestational age differs in small‐for‐gestational‐age fetuses with normal or abnormal Doppler velocity waveforms. Our secondary objective was to compare the efficacy of measurement of transverse cerebellar diameter with that of femur length in pregnancy dating among small‐for‐gestational‐age fetuses. A total of 107 small‐for‐gestational‐age fetuses with established dates and free from structural and chromosomal abnormalities were considered for this study. According to the Doppler results, fetuses were divided into two groups: group A (n = 64), with normal Doppler values as expressed by a ratio of pulsatility indices between the umbilical artery and middle cerebral artery of ≤ 95th centile of our reference limits for gestation; and group B (n = 43), with ratio of > 95th centile. Measurements of transverse cerebellar diameter and femur length were compared to previously established 95th centile prediction intervals.

In both groups of small‐for‐gestational‐age fetuses, the values for transverse cerebellar diameter were lower than in normally grown fetuses after normalization for gestational age. The difference was more evident in group A (p ≤ 0.001) than in group B (p ≤ 0.05). Only 68.7% of transverse cerebellar diameter values of group A fetuses fell within the normal limits for gestation, while this occurred in 90.6% of group B fetuses.

When compared to the femur length, the transverse cerebellar diameter measurement appeared to be better for predicting gestational age in both groups of small‐for‐gestational‐age fetuses (p ≤ 0.001). However, this measurement may be used to estimate gestational age only in small‐for‐gestational‐age fetuses with abnormal Doppler findings. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasound‐guided ovarian endoscopy: a novel approach to the assessment of ovarian tumors
Authors: Granberg S. , Wikland M. , Bourne T. H. , Hamberger L.
Published: March 2003

The investigation of ovulatory dysfunction and the characterization of ovarian cystic tumors remain two major problems in gynecology. One of our limitations is the resolution of imaging techniques currently available. We describe the use of a fiberoptic endoscope to inspect the internal appearance of five different ovarian cystic lesions under the guidance of transvaginal ultrasound. The images obtained allow the operator to visualize structures of less than 1.0 mm in diameter, and so introduce the possibility of identifying both the cumulus oophorus in younger women, and very small papillary projections within potentially malignant ovarian cysts. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
In utero detection of ventriculomegaly during the second and third trimesters by transvaginal sonography
Authors: Monteagudo A. , Timor‐Tritsch I. E. , Moomjy M.
Published: March 2003

The purpose of this study was two‐fold. The first was to extend the previously developed and published nomograms of the fetal lateral ventricles from 18 weeks back to 14 weeks of gestation using transvaginal sonography, and, second, to test the performance of the nomograms by plotting the measurements of 36 fetuses whose transabdominal and/or qualitative transvaginal scans were suspicious for ventriculomegaly. In all the cases in which postnatal confirmation of the diagnosis was possible, prenatal ultrasound correctly identified the lesion. Although a total of nine nomograms was created, the clinically meaningful measurements were: the height of the occipital horn on the parasagittal plane, and the two ratios derived from the measurements performed on the parasagittal plane. In conclusion, the transvaginally generated nomograms were useful for the correct identification of fetuses with ventriculomegaly. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Teratogen exposure: lack of morphological abnormalities by detailed fetal sonography
Authors: Levine D. , Filly R. A. , Goldberg J. D.
Published: March 2003

Teratogen exposures cause 1–2% of congenital abnormalities. Our anecdotal experience was that detailed fetal sonograms conducted for the indication of teratogen exposure failed to demonstrate significant morphological abnormalities. We reviewed our experience to see how often such examinations yielded positive results. Records from 11 September 1989 to 13 September 1993 were reviewed. All women referred for detailed fetal sonography for the sole indication of exposure to drugs, toxins, or infectious agents and with a sonographic age of 16–24 menstrual weeks were included. All exposures were included in the study, even those without known teratogenic potential. Patients previously diagnosed with a morphological abnormality or with an abnormal level of maternal serum α‐fetoprotein were excluded.

A total of 125 women with 126 singleton pregnancies comprised the study population. Ten women had multiple exposures. Including the multiple exposures, there was a total of 138 exposures, 104 to drugs and other toxins (45 of which were not known human teratogens), and 34 to infections.

The only significant morphological abnormality found was a duplicated kidney in a woman with parvovirus exposure. While parvovirus is a cause of anemia and hydrops, it is not a known human teratogen. We therefore assume that this was a coincidental association. We conclude that teratogen exposure is a low‐yield indication for detailed fetal sonography. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Volume scanning in the evaluation of fetal malformations: a new dimension in prenatal diagnosis
Authors: Merz E. , Bahlmann F. , Weber G.
Published: March 2003

Three‐dimensional ultrasound examination was performed in 204 patients with a fetal malformation detected by conventional ultrasound. The patients were examined between 13 and 40 weeks of gestation. The ultrasound equipment used was a Combison 330 and a Combison 530 (Kretztechnik, Austria) with an abdominal Voluson sector transducer (3.5/5 MHz) (Kretztechnik, Austria). This ultrasound system can provide a high‐quality three‐dimensional surface or translucency image of fetal structures similar to that of a photograph or an X‐ray image within seconds without an additional expensive work‐station.

Of the 204 patients examined with three‐dimensional ultrasound, this technique proved advantageous in demonstrating fetal defects in 62% (127/204). In 36% (73/204), the three‐dimensional technique gave the same information and in four fetuses with a cardiac malformation (2%), the three‐dimensional technique was disadvantageous, due to movement artefacts during data acquisition. The technical advantages and problems of this three‐dimensional technique are demonstrated. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two‐dimensional sonography
Authors: Jurkovic D. , Geipel A. , Gruboeck K. , Jauniaux E. , Natucci M. , Campbell S.
Published: March 2003

The purpose of this study was to investigate the potential value of three‐dimensional ultrasound for the assessment of normal uterine anatomy and the diagnosis of congenital uterine anomalies. A total of 61 patients with a history of recurrent miscarriage or infertility and who had previously been investigated by hysterosalpingography were recruited into the study. They first underwent a conventional two‐dimensional transvaginal ultrasound scan. At the end of the examination, three‐dimensional ultrasound volumes were recorded and stored in the machine computer memory. The examination of planar reformatted sections was than used for the assessment of uterine morphology and the diagnosis of congenital anomalies. On three‐dimensional scanning, the most useful plane was a transverse section through the whole length of the uterus from the fundus to the cervix. Hysterosalpingography showed a normal uterus in 44 (72.1%) patients, an arcuate uterus in nine (14.8%) and a major fusion defect in three cases (4.9%). Five patients (8.2%) had large fibroids which were distorting the uterine cavity. Good‐quality two‐dimensional ultrasound images were obtained in 60 (98.3%) and three‐dimensional images in 58 (95.1%) cases. All poor images were caused by large uterine fibroids. Comparison between hysterosalpingography and ultrasound showed that five false‐positive diagnoses of arcuate uterus and three of major uterine anomalies were made on two‐dimensional scans. Three‐dimensional ultrasound agreed with hysterosalpingography in all cases of arcuate uterus and major congenital anomalies. The ability to visualize both the uterine cavity and the myometrium on a three‐dimensional scan facilitated the diagnosis of uterine anomalies and enabled easy differentiation between subseptate and bicornuate uteri. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Early uterine artery Doppler velocimetry and the outcome of pregnancy in women aged 35 years and older
Authors: van den Elzen H. J. , Cohen‐Overbeek T. E. , Grobbee D. E. , Quartero R. W. P. , Wladimiroff J. W.
Published: March 2003

The objective of this paper was to determine whether first‐and second‐trimester uterine artery Doppler velocimetry are associated with pregnancy complications in women of advanced maternal age. A prospective cohort study of 352 women aged 35 years and older was studied. The pulsatility index (PI) values at 12–13 weeks of gestation were significantly associated with development of hypertensive disorders, a small‐for‐gestational‐age infant and gestational diabetes, with a relative risk exceeding 4, 2 and 8, respectively for women with PI values in the highest quartile (> 1.67) of the PI distribution when compared with the lowest quartile of the PI distribution (< 1.24). At 23–27 weeks' gestation, uterine artery PI values were found to be associated with preterm delivery with a gestational age‐adjusted risk of 10.6 for women with PI values in the highest quartile of PI (> 1.24) when compared with PI values in the lowest quartile of the PI distribution (< 1.09). No associations existed between uterine artery PI, antepartum hemorrhage and Cesarean section rate.

The risk estimates for any of the outcome parameters were not affected by maternal age.

Results indicate that hemodynamic changes detectable in the uterine artery as early as the first trimester of pregnancy are associated with an increased risk of hypertensive disorders, a small‐for‐gestational‐age infant and gestational diabetes. A similar association exists in the late second trimester of pregnancy, with an increased risk of preterm delivery. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal pelvic kidney: a challenge in prenatal diagnosis?
Authors: Meizner I. , Yitzhak M. , Levi A. , Barki Y. , Barnhard Y. , Glezerman M.
Published: March 2003

The objective of this study was to establish ultrasonographic guidelines for the prenatal diagnosis of fetal pelvic kidneys and assess the relationship to clinical outcome. The records of all ultrasonographic diagnoses of a fetal pelvic kidney between 1 January 1991 and 31 December 1993 were reviewed. After review of the sonographic evaluation, the prenatal records were obtained, to assess demographic data as well as the obstetric course and neonatal outcome. If a fetal pelvic kidney was suspected on prenatal ultrasound examination, its precise location and size were recorded and compared with neonatal sonograms.

Twenty‐six cases of fetal ectopic kidney were diagnosed of which 13 were on the right side and 13 on the left (24/26 cases were diagnosed in the late second trimester). The size of the ectopic kidney did not differ from that of the normal kidney. Except for one case of hydronephrosis, there were no associated structural anomalies. All prenatal diagnoses were confirmed by postnatal sonograms and all neonates had normal renal function.

Our conclusions are that prenatal sonographic detection of fetal pelvic kidney is feasible, although in most cases the diagnosis is made beyond 24 weeks' gestation. The importance of prenatal diagnosis is that the parents can be reassured that normal renal function is highly probable and that early neonatal intervention is usually unnecessary. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal pressure gradient estimations across the ductus venosus in early pregnancy using Doppler ultrasonography
Authors: van Splunder I. P. , Stijnen T. , Wladimiroff J. W.
Published: March 2003

Doppler ultrasonography was used to estimate the pressure gradient across the ductus venosus at 8–20 weeks of gestation. According to a cross‐sectional study design, flow velocity waveform recordings were obtained from the umbilical vein and ductus venosus in 147 uncomplicated singleton pregnancies. Pressure gradients were calculated using the Bernoulli equation.

The pressure gradient was estimated at 0.1–1.9 mmHg during ventricular systole and at 0–0.5 mmHg during atria1 contraction. Time‐averaged pressure gradients ranged between 0.1 and 1.3 mmHg. No statistically significant correlation could be established between the absence or presence of umbilical venous pulsations and estimated pressure gradient.

Crude estimates of the pressure gradient across the ductus venosus can be established in the late first and early second trimester of pregnancy. The large scatter of data suggests limited accuracy of venous pressure gradient calculation in early gestation. However, it may also indicate that, in early gestation, venous hemodynamics function at very low pressures. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Reversed end‐diastolic umbilical artery velocity in two cases of trisomy 18 at 10 weeks' gestation
Authors: Martinez Crespo J. M. , Comas C. , Borrell A. , Puerto B. , Antolin E. , Ojuel J. , Fortuny A.
Published: March 2003

Doppler velocimetry of the umbilical artery was carried out during routine ultrasound examinations performed immediately before either chorionic villus sampling (n = 383) or genetic amniocentesis (n = 649) in 1032 women referred for prenatal diagnosis at our institution, between 10 and 18 weeks of gestation. Reversed end‐diastolic flow was detected in only two cases (0.19%), both of which were affected by trisomy 18. The diagnosis was made at 10 weeks' gestation and, to our knowledge, these are the earliest records of this pathological Doppler pattern. Although a possible relationship with early abnormal placentation remains to be established, the finding of reversed end‐diastolic velocities in the umbilical artery in the first trimester of pregnancy may be an early sign of karyotype abnormality. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Unusual appearances of echogenic foci within the fetal heart: are they benign?
Authors: Petrikovsky B. , Challenger M. , Gross B.
Published: March 2003

Nine fetuses with unusually appearing echogenic foci were selected from a series of 65 fetuses with intracardiac echogenie foci studied at the Fetal Diagnosis and Treatment Unit from January 1994 until February 1996. An echogenic focus or foci were defined as a structure or structures within the fetal heart with echogenicity similar to or greater than that of the surrounding bone. Unusually appearing foci were defined as lesions of unusual size, shape, structure or location. Three fetuses had unusually large echogenic, foci, and four had multiple foci in both ventricles. In one, fetus, two echogenic foci were very close to each other, creating an impression of a ‘double’ focus within the left ventricle. In another fetus, three echogenic foci were detected. Follow‐up protocol for fetuses with echogenic foci included comprehensive ultrasound, amniocentesis and fetal echocardiography. All studied fetuses had normal karyotype. A fetal echocardiogram failed to reveal congenital heart defects. The neonatal outcome was uneventful in seven out of nine cases; one patient decided to terminate her pregnancy for reasons unrelated to the ultrasound findings, and one delivered prematurely at 34 weeks of pregnancy. In conclusion, we failed to find any correlation between unusually appearing echogenic foci and adverse perinatal outcome. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology