bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute effects of a transdermal nitric oxide donor on perifollicular and intrauterine blood flow
Authors: Zackrisson U. , Brännström M. , Granberg S. , Janson P. O. , Collins W. P. , Bourne T. H.
Published: March 2003

Background

Nitric oxide is a potent vasodilator and is involved in several physiological events during the female reproductive cycle.

Objective

The aim of this study was to determine the acute effects of a nitric oxide donor on ultrasound‐derived indices of blood flow in the intact human uterus and ovaries during the follicular phase of the normal menstrual cycle.

Study design

The plan was to perform an observational study of six healthy volunteers, recruited during days 9–12 from day 1 of the last menstruation. Subjects were scanned transvaginally, with B‐mode and color Doppler imaging around 12.00, and 2 h after the application of a transdermal glyceryl trinitrate (GTN) patch 10 mg/24 h. The patch was then removed and the subjects were rescanned 2 h later.

End‐points

The main outcome measures were the peak systolic velocity (PSV), time‐averaged maximum velocity (TAMV) and the pulsatility index (PI) derived from flow velocity waveforms, in the left and right main uterine arteries, a radial artery and subendometrial vessels, and from vessels at the rim of the dominant ovarian follicle.

Results

One woman was scanned on day 9, two on day 10 and three on day 12 of the cycle. The median pretreatment values for endometrial thickness and follicular volumes were 7.2 mm (range 6.0–10.0 mm) and 3.1 ml (range 0.3–6.8 ml), respectively. GTN induced a significant (p < 0.05) increase in the PSV and TAMV in the subendometrial vessels in all subjects. There was a corresponding decrease in the PI in four cases. Changes in blood flow were reversible (50% of the changes in PSV, TAMV and PI were essentially reversed 2 h after the patch had been removed). In the uterine arteries, PSV and TAMV were significantly (p < 0.01) and progressively decreased with a concomitant significant (p < 0.01) increase in PI. There was also a tendency for the mean PI to decrease progressively in the vessels at the rim of the dominant follicle with decreased post‐treatment values in four out of six subjects.

Conclusions

GTN induces a reversible increase in subendometrial blood flow velocity during days 9–12 of the menstrual cycle. The expected circadian decrease in uterine artery blood flow seemed to be partly interrupted by GTN treatment.

Implications

These data justify the implementation of randomized controlled studies to determine the potential beneficial effects of transdermal GTN on ovarian and uterine blood flow and function. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasonographic assessment of fetal hands and feet
Authors: Hata T. , Aoki S. , Akiyama M. , Yanagihara T. , Miyazaki K.
Published: March 2003

Objective

The aim of this study was to describe fetal hands and feet using three‐dimensional ultrasonography.

Design

This was a randomized prospective study.

Methods

Ninety‐seven fetuses from 12 to 40 weeks' gestation were studied with a specially developed transabdominal three‐dimensional transducer (3.5 MHz). The imaging system used in this study can provide conventional two‐dimensional ultrasound images and can also generate, within seconds, high‐quality three‐dimensional images in the surface and transparent modes with no need for an external workstation. The rate of visualization of the hands/fingers and feet/toes at each gestational‐age interval was calculated using two‐dimensional and three‐dimensional ultrasonography.

Results

The ability to visualize fetal hands/fingers and feet/toes was better with three‐dimensional than with two‐dimensional ultrasonography in the late first trimester (detection rates were 65% and 41% by three‐dimensional ultrasonography for hands and feet, respectively, and 41% and 12%, respectively, by two‐dimensional ultrasonography). For the early second trimester, detection rates were 82% for hands and 72% for feet by three‐dimensional ultrasonography, and 54% for hands and 45% for feet by two‐dimensional ultrasonography. Optimal visualization of the fetal fingers using three‐dimensional ultrasonography was achieved between 28 and 35 weeks of gestation, although at this stage there were no significant differences in detection rates for hands and feet between two‐ and three‐dimensional imaging. During this period it was possible with three‐dimensional ultrasonography adequately to depict at least one hand in 93% of the fetuses at 28–31 weeks and in 88% at 32–35 weeks. The percentage of visualization of at least one fetal foot between 16 and 35 weeks using three‐dimensional ultrasonography ranged from 50 to 85%. Before 15 weeks or after 36 weeks, the respective percentages decreased.

Conclusions

Three‐dimensional ultrasonography provides a novel means of visualizing fetal fingers and toes. Our observations suggest that three‐dimensional ultrasonography may enhance the diagnostic potential of two‐dimensional ultrasonography and might be useful in identifying fetal malformations and anatomical markers of chromosomal abnormalities prenatally in high‐risk pregnancies. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Functional pulmonary valve regurgitation in the fetus
Authors: Smrcek J. M. , Germer U. , Gembruch U.
Published: March 2003

Objective

The purpose of this study was to determine the prevalence and the characteristics of functional pulmonary valve regurgitation in normally grown fetuses.

Design

A prospective cross‐sectional study.

Subjects

A total of 1115 singleton fetuses between 18 and 41 weeks of gestation and who had normal heart anatomy, normal estimated weight for gestational age and normal flow velocity waveforms in the umbilical and middle cerebral arteries and umbilical vein were examined. Cases with agenesis, constriction or other abnormalities of the ductus arteriosus were excluded.

Methods

Examination of the pulmonary valve was performed by color Doppler echocardiography, pulsed wave Doppler and, if necessary, continuous wave Doppler in the short‐axis view at the level of the origin of the great arteries and/or in a subcostal view of the right ventricular outflow tract and pulmonary trunk. If pulmonary valve regurgitation was detected by color Doppler flow imaging and confirmed by pulsed wave Doppler echocardiography, the maximum velocity of the regurgitant jets as well as their maximum lengths were measured.

Results

The prevalence of functional pulmonary valve regurgitation was 0.54% (n = 6). Pulmonary valve regurgitation was part diastolic in four cases and holodiastolic in two cases, with maximum velocity of ≤ 2.05 m/s and maximum length of 3–8 mm. Prenatal re‐examination of five of the six fetuses with pulmonary valve regurgitation showed that pulmonary valve regurgitation was a transient phenomenon in four cases. The fetal outcome in the presence of transient pulmonary valve regurgitation was normal; pediatric echocardiographic examination in these six fetuses with transient pulmonary valve regurgitation showed no regurgitations or other cardiac anomalies.

Conclusions

Pulmonary valve regurgitation was functional in all six fetuses. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Clinical interpretation of ultrasound biometry for dating and for assessment of fetal growth using a wheel and chart: is it sufficiently accurate?
Authors: Hutchon D. J. R. , Kearney C.
Published: March 2003

Objectives

To investigate how accurately practicing obstetricians (experts) can apply dating rules and compare the interpretation of gestation‐sensitive ultrasound data with those of a computer system.

Subjects

Seventeen practicing obstetricians, Members of the Royal College of Obstetricians and Gynaecologists, from 14 different units throughout the UK.

Design

Six cases with menstrual and ultrasound data together with identical ultrasound charts and obstetric wheels.

Main outcome measures Concordance between the calculated estimated date of delivery (EDD) and growth assessment provided by the experts and the computer system.

Results

The calculation of the EDD by the experts was imprecise (59% within 3 days overall). Concordance with the computer calculation was poorest when the ultrasound measurements lay close to the upper or lower centile lines (average 7% within 3 days of the computer). Interpretation of growth showed good concordance with the computer when gestation was not critical to the interpretation (94%), but very poor when gestation was critical (7%).

Conclusions

Calculation of EDD by means of an obstetric wheel and charts is not precise. Compared with the computer system, these errors have a significant effect on the subsequent interpretation of growth scans when the data are borderline. A computer system provides the more accurate method for interpreting gestation‐sensitive ultrasound biometry. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
The development of the fetal sternum: a cross‐sectional sonographic study
Authors: Zalel Y. , Lipitz S. , Soriano D. , Achiron R.
Published: March 2003

Objective

To assess the relationship between gestational age and sonographic appearance of the various sternal components and establish growth during human gestation.

Design

A prospective cross‐sectional study.

Methods

The study was performed on 252 consecutive normal singleton pregnancies from 19 weeks of gestation until term, using transabdominal high‐resolution ultra‐sound techniques. The sternal length, as well as the number of ossification centers at each gestational age, were recorded.

Results

The first occasion at which a fetal human sternum could be visualized with two to three ossification centers was at 19 weeks' gestational age. The fifth ossification center was first visualized at 29 weeks' gestation. The mean ± SE of sternal length varied from 15 ± 0.98 mm (95% confidence interval (CI) 12.79–17.21) at 19–20 weeks, to 36.50 ± 0.29 mm (95% CI 35.58–37.42) at 37–38 weeks' gestation. Sternal length as a function of gestational age was expressed by the regression equation: sternal length (mm) = −11.06 + 1.39 × gestational age (weeks). The correlation coefficient, r = 0.924 for sternal length, was found to be highly statistically significant (p < 0.0001).

Conclusions

The presented data offer normative measurements of the fetal sternum which may be helpful in the prenatal diagnosis of congenital syndromes that include, among other manifestations, abnormalities of sternal development. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Cardiac changes in fetuses secondary to immune hemolytic anemia and their relation to hemoglobin and catecholamine concentrations in fetal blood
Authors: Oberhoffer R. , Grab D. , Keckstein J. , Högel J. , Terinde R. , Lang D.
Published: March 2003

Objectives

Immune hemolytic anemia in the fetus may cause cardiac decompensation and intrauterine death. Postnatally, norepinephrine (noradrenaline) is released in chronic heart failure, and may lead to myocardial hypertrophy. The aim of this study was to determine fetal cardiac changes associated with immune hemolytic anemia by means of echocardiography, and to relate them to fetal hemoglobin and norepinephrine levels.

Design

Thirty anemic fetuses underwent a total of 76 umbilical venous transfusions. Before the procedure, fetal echocardiography was performed, and end‐diastolic myocardial wall thicknesses and ventricular dimensions together with Doppler flow patterns at the atrioventricular and semilunar valves were measured. Fetal hemoglobin, epinephrine and norepinephrine concentrations were determined before the transfusion. Statistical analysis of this prospective study comprised descriptive statistics including linear regression and correlation analyses. Two samples of measurements were compared by the Mann–Whitney U test.

Results

The mean hemoglobin concentration before the first tranfusion was 6.9 g% at a mean gestational age of 26.8 weeks. Norepinephrine values were elevated in comparison to a reference range, and were higher than epinephrine values. The most striking echocardiographic finding was myocardial hypertrophy of all ventricular walls. Mean blood flow velocities were increased; at the left ventricle, they were negatively related to the hemoglobin concentrations, and positively to the norepinephrine values.

Conclusions

Fetal myocardial hypertrophy in anemia may be the result of an augmented cardiac workload, indicated by the increased left ventricular mean velocities. This reaction reflects the redistribution of blood flow that may depend on hemoglobin and norepinephrine concentrations. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Nitric oxide donors in pregnancy: fetomaternal hemodynamic effects induced in mild pre‐eclampsia and threatened preterm labor
Authors: Luzi G. , Caserta G. , Iammarino G. , Clerici G. , Di Renzo G. C.
Published: March 2003

Objective

The present study was performed to determine whether there are significant differences in the effects of the nitric oxide donor, glyceryl trinitrate, administration in pregnancies complicated by mild pre‐eclampsia compared to the effects in pregnancies which are uncomplicated by this pathology. Glyceryl trinitrate is able to release nitric oxide (NO); deficiency of NO has been hypothesized in the pathogenesis of pre‐eclamptic disorders.

Methods

In this prospective study, ten patients with threatened preterm labor and ten patients with mild pre‐eclampsia were studied at around 30 weeks of pregnancy. The maternal blood pressure, maternal heart rate, fetal heart rate and flow velocity waveforms of the placental uterine artery, umbilical artery and fetal middle cerebral artery, evaluated by means of color Doppler and pulsed Doppler, were recorded before and 10, 20 and 30 min after the sublingual administration of 0.3 mg of glyceryl trinitrate or placebo. The pulsatility index (PI) was calculated. The percentage change from the control period (Δ%) was calculated for each parameter at 10, 20 and 30 min. Ten normal pregnant women at the same gestational age were used as controls and were administered a placebo.

Results

The maternal blood pressure recorded as systolic and diastolic values, demonstrated a significant decrease in the pre‐eclampsia group after glyceryl trinitrate administration; the Δ% at any time considered was significantly higher in the pre‐eclampsia group than in the threatened preterm labor group. The PI of the placental uterine artery showed a significant decrease in both groups after 20 and 30 min from drug administration; the Δ at 20 and 30 min was significantly higher in the pre‐eclampsia group than in the threatened preterm labor group. The PI of the umbilical artery showed a significant decrease after 30 min from the glyceryl trinitrate administration. The fetal heart rate showed no significant variations during the study in either group. The PI of the fetal middle cerebral artery showed no significant variations during the study in either group. No parameter was changed in the control group.

Conclusion

Glyceryl trinitrate administration was followed by a greater reduction of the resistance to blood flow in the fetoplacental circulation of the pregnancies affected by mild pre‐eclampsia compared to pregnancies uncomplicated by this pathology. This effect can be attributed to the NO released by the drug which offsets the decreased production of NO, postulated to contribute to the pathogenesis of pre‐eclampsia. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Early fetal megacystis between 11 and 15 weeks of gestation
Authors: Favre R. , Kohler M. , Gasser B. , Muller F. , Nisand I.
Published: March 2003

Objective

The purpose of this study was to evaluate the prognostic criteria of early fetal megacystis. Design A prospective, transvaginal ultrasound, cross‐sectional study at 11–15 weeks of gestation at a tertiary referral fetal medicine unit. Subjects and methods Sixteen pregnancies out of a total of 5240 were identified with early fetal megacystis. Fetal biometry, morphology, amniotic fluid, bladder size and volume were also evaluated. The karyotype was available in 15 cases. Vesicocentesis was performed in six fetuses and three had concomitant cystoscopies.

Results

In six fetuses, the megacystis was isolated. In the remaining ten, we detected associated hygroma (n = 5), nuchal translucency (n = 3), omphalocele (n = 1), mild pyelectasis (n = 1) and bilateral talipes (n = 1). In three cases the fetuses demonstrated renal hyperechogenicity with cysts, and in two cases oligohydramnios was found; four cases (25%) had chromosomal abnormalities; 47,XY + 13 (two cases), 47,XY + 18 and 47,XY + 21. Only one fetus from this study survived. In the remaining 13 cases, termination was proposed after counselling of the patients on the poor prognosis. The mean gestational age at termination was 15.5 ± 2.4 weeks (range 12–20). Three fetal trans‐abdominal cystoscopies did not allow us to view the valves; one urethral atresia was suspected, and confirmed postnatally.

Conclusions

We found a high rate of associated malformations, especially intestinal malformations. The systematic evaluation of the intestinal enzymes in the amniotic fluid and urine samples might be an important aid in the diagnosis of multiple malformations, such as cloacal dysgenesis. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
A prospective management study of slow‐release aspirin in the palliation of uteroplacental insufficiency predicted by uterine artery Doppler at 20 weeks
Authors: Harrington K. , Kurdi W. , Aquilina J. , England P. , Campbell S.
Published: March 2003

Objective
 To investigate the effect of low‐dose, slow‐release aspirin in reducing the incidence and/or severity of pregnancy complications in women identified as high risk of developing problems associated with uteroplacental insufficiency, namely pre‐eclampsia or delivering a small‐for‐gestational age (SGA) baby.

Design
 A prospective, randomized management study. One thousand and twenty‐two women of mixed parity underwent color flow/pulsed Doppler (CFPD) imaging of the uterine arteries at the time of the 17–23 week (mean 19.9) anomaly scan. Women who were screen positive were randomized to a control or treatment group. The treatment group was given 100‐mg slow‐release aspirin (Disprin CV) daily and followed up at regular intervals. Women in the routine group received routine antenatal care. Main outcome measures were pre‐eclampsia and SGA < 3rd centile. Secondary outcome measures were: SGA < 10th centile, pre‐eclampsia requiring delivery before 34 weeks, placental abruption, an Apgar score < 7 at 5 min, admission to neonatal intensive care unit or a pregnancy that resulted in a stillbirth or neonatal death. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for severe and any complications.

Results
 Two hundred and sixteen women were screen positive according to the defined criteria. One hundred and three women were assigned to the treatment group and 113 to the control group. The difference in the incidence of pre‐eclampsia and SGA < 3rd centile between the control and treatment groups did not reach statistical significance. There was a statistically significant reduction in any (OR 0.41 (CI 0.35–0.45), P < 0.01) and severe pregnancy complications (OR 0.43 (CI 0.21–0.84), P < 0.05) in the treatment group compared with the controls.

Conclusions
 The administration of slow‐release aspirin to women identified as high risk, using color Doppler imaging of the uterine arteries at 20 weeks’ gestation, did not significantly alter the incidence of pre‐eclampsia or delivery of a SGA baby. It did, however, improve the outcome by reducing the overall incidence of complications associated with uteroplacental insufficiency.
Fetal weight estimation by three‐dimensional ultrasound
Authors: Schild R. L. , Fimmers R. , Hansmann M.
Published: March 2003

Objective

To assess the value of three‐dimensional volume scanning in predicting fetal weight at birth.

Study design

Prospective cross‐sectional study within 7 days of delivery. A total of 190 patients were considered for final analysis (formula‐finding group: n = 125, formula evaluation group: n = 65). Inclusion criteria were a singleton pregnancy and absence of chromosomal or significant structural anomalies. Three‐dimensional (3D) volumetric measurements of the fetal thigh, upper arm and abdomen were performed together with conventional two‐dimensional (2D) biometry.

Results

All measurements were completed successfully in each patient. Polynomial regression analysis with standard biometric parameters and volumes of the upper arm, the thigh and the abdomen was employed to yield the best‐fit formula for prediction of fetal weight at birth. The new 3D formula (estimated fetal weight (EFW) = −1478.557 + 7.242 × thigh volume + 13.309 × upper arm volume + 852.998 × log10 abdominal volume + 0.526 × BPD3) proved to be superior to established 2D equations with the lowest mean error (25.8 ± 194.4 g), the lowest mean absolute error (155.2 ± 118.2 g) and the lowest mean absolute percentage error (6.1 ± 5.0%) when studied prospectively in the evaluation group.

Conclusion

3D sonography allows superior fetal weight estimation by including soft tissue volume. Further studies at the extremes of fetal weight are needed to confirm the value of our formula in these subsets. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Tissue Doppler imaging of the fetal heart
Authors: Paladini D. , Lamberti A. , Teodoro A. , Arienzo M. , Tartaglione A. , Martinelli P.
Published: March 2003

Objectives

The objectives of this study were: (i) to assess the feasibility of a tissue Doppler imaging (TDI) evaluation in the fetus, (ii) to identify color‐TDI patterns consistent with the various phases of the cardiac cycle; and (iii) to assess myocardial velocities and the myocardial velocity gradient.

Methods

Eighty‐nine normal fetuses between the 17th and the 37th week of gestation were studied. Color‒TDI was superimposed on an apical four‐chamber view of the fetal heart and three cardiac cycles captured in cine‒loop format. By reviewing the cine‐loop strip, color patterns consistent with the various phases of the cardiac cycle were identified. The procedure was then repeated with a transverse four‐chamber view. On each frame corresponding to mid‐systole, early and late diastole, myocardial velocities were calculated at the subepicardial and subendocardial layer and regressed against gestational age. Statistics included correlation and regression analysis, calculation of the 95% confidence intervals and of the Cronbach's alpha reliability coefficient for repeated observations.

Results

TDI examination is acceptably reproducible in the fetus. We were able to identify color‐TDI patterns depicting the systolic contraction wave, ventricular relaxation and atrial contraction. Statistical evaluation demonstrated that: all variables (systolic right and left subendocardial and subepicardial velocities, early diastolic right and left subendocardial and subepicardial velocities, end diastolic right and left subendocardial velocities, right subepicardial velocities) except end‐diastolic right and left subepicardial velocities, showed a positive correlation with advancing gestational age; subendocardial velocities were higher than subepicardial ones throughout the cardiac cycle in both ventricles; systolic myocardial velocities were higher in the left ventricle whereas early diastolic velocities were higher in the right ventricle; and the ratio between early and late diastolic subendocardial velocities (EM/AM) was constantly <1 and did not change with advancing gestational age.

Conclusions

TDI evaluation of the fetal heart is feasible and reproducible. Color‐TDI is able to identify the various phases of the cardiac cycle. Quantitative evaluation of myocardial velocities has shown also in the fetus the existence of the myocardial velocity gradient found in postnatal life. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
In utero diagnosis of obstructed supracardiac total anomalous pulmonary venous connection in a patient with right atrial isomerism and asplenia
Authors: Patel C. R. , Lane J. R. , Muise K. L.
Published: March 2003

We describe a rare case of right atrial isomerism, levocardia, right‐side stomach, obstructed supracardiac total anomalous pulmonary venous connection, double outlet right ventricle with complete atrioventricular septal defect and absent spleen. From the pulmonary venous confluence behind the atrium an ascending as well as a descending vertical vein communicated with the systemic venous system in the supracardiac as well as the infracardiac position. The pulsed and color Doppler examination of the individual pulmonary veins as well as of the vertical vein helped in making the diagnosis of obstructed total anomalous pulmonary venous connection. The diagnosis was made by fetal echocardiographic examination at 22 weeks of gestation and confirmed on postnatal echocardiography, cardiac catheterization, and at surgery. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal color Doppler assessment of venous flow in adnexal masses
Authors: Alcázar J. L. , López‐García G.
Published: March 2003

Objective

To analyze the usefulness of transvaginal color Doppler assessment of venous flow in the differential diagnosis of adnexal masses.

Material and Methods

Ninety‐one consecutive patients (mean age: 46.6 years, range: 16–81 years) diagnosed as having an adnexal mass were evaluated by transvaginal color Doppler sonography prior to surgery. Color Doppler was used to detect and analyze the flow velocity waveform from arterial and venous blood flow within the tumor. For arterial signals the resistance index and peak systolic velocity, and for veins the maximum venous flow velocity, were calculated. Receiver operator characteristic curves were plotted to determine the best venous flow velocity cut‐off. According to our previous study using arterial Doppler, a tumor was considered as malignant when flow was detected and the lowest resistance index was ≤ 0.45. Using venous Doppler a mass was considered as malignant when flow was detected and the venous flow velocity was ≥ the best cut‐off found on the receiver operator characteristic curve. Definitive histopathological diagnosis was obtained in all cases. Sensitivity, specificity, positive predictive value and negative predictive value for B‐mode morphology (evaluation performed according to Sassone's scoring system), arterial Doppler, venous Doppler, and a combination of both arterial and venous Doppler were calculated.

Results

Twenty‐five masses (27.5%) were malignant and 66 (72.5%) benign. Arterial and venous flow was found more frequently in malignant than in benign masses (92% vs. 41% (P < 0.001) and 72% vs. 21% (P < 0.001), respectively). The resistance index was significantly lower in malignant tumors (0.42 vs. 0.60, P = 0.0003). No differences were found in peak systolic velocity. Venous flow velocity was significantly higher in malignant masses (18.1 cm/s vs. 8.9 cm/s, P = 0.0006). The best cut‐off of venous flow velocity was 10 cm/s. Sensitivity, specificity, positive predictive value and negative predictive value for morphology, arterial Doppler, venous Doppler, and the combination of both arterial and venous Doppler were 92%, 71%, 45%, 96%; 76%, 95%, 87%, 91%; 68%, 94%, 81%, 89%; and 88%, 91%, 79%, 95%, respectively.

Conclusions

Our results indicate that preoperative evaluation by venous flow assessment of adnexal masses may be useful to discriminate between malignant and benign tumors. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Fetal axillary hemangiolymphangioma with secondary intralesional bleeding: serial ultrasound findings
Authors: Tseng J. J. , Chou M. M. , Ho E. S. C.
Published: March 2003

A case of fetal axillary hemangiolymphangioma coexisting with intralesional hemorrhage is presented. At 27 weeks' gestation, the fetus was found to have a 52 × 43‐mm left axillary multilocular cystic mass which showed no signals on color Doppler. The mass was composed mostly of sonolucent spaces. At 29 weeks' gestation, an arterial flow signal (15 cm/s) was detected within the mass. In addition, two low‐density echogenic cystic spaces with bidirectional flow waveforms were found, which raised the suspicion of intratumoral bleeding. Two weeks later, a fine‐needle aspiration of the mass revealed both straw‐colored and chocolate‐colored fluid. The tumor size increased from 52 × 43 mm at 27 weeks to 100 × 79 mm at 37 weeks. Blood clots developed gradually in the hemorrhagic spaces. The pregnancy proceeded smoothly to term and at 38 weeks an elective Cesarean section was performed. After a surgical excision of the mass at the age of 4 days, a mixed cavernous hemangioma and cystic lymphangioma with secondary intralesional hemorrhage was confirmed histopathologically. Copyright © 2002 ISUOG
First‐trimester placental volume as a marker for chromosomal anomalies: preliminary results from an unselected population
Authors: Metzenbauer M. , Hafner E. , Schuchter K. , Philipp K.
Published: March 2003

Objective

To compare first‐trimester placental volume in chromosomally abnormal and normal pregnancies.

Methods

Placental volumes were routinely recorded at the time of nuchal translucency thickness measurement at 10–13 weeks of gestation. This was done using customized three‐dimensional ultrasound equipment and measurements were then converted to the placental quotient (placental volume/fetal crown–rump length). The possible difference in placental quotient between chromosomally normal and abnormal pregnancies was examined.

Results

A total of 2863 pregnancies was evaluated, including 17 with major chromosomal defects (nine cases of trisomy 21, four of trisomy 18, two of trisomy 13, and one each of Turner syndrome and 48,XXY + 21). The median placental quotient in the chromosomally abnormal group (0.67) was significantly lower than that in the normal fetuses (0.98). In nine of the 17 affected pregnancies the quotient was below the 10th centile of the normal range.

Conclusions

Assessment of placental volume may prove to be useful in first‐trimester risk assessment for chromosomal anomalies. Copyright © 2002 ISUOG
Marked splenomegaly in fetal cytomegalovirus infection: detection supported by three‐dimensional power Doppler ultrasound
Authors: Chaoui R. , Zodan‐Marin T. , Wisser J.
Published: March 2003

An enlarged fetal spleen can be associated with fetal infection, anemia and different syndromes but its prenatal diagnosis is rare. We report on a diagnosis of splenomegaly at 32 weeks' gestation in a fetus which was found to be affected by cytomegalovirus infection. An enlarged spleen was suspected when the stomach was found to be displaced anteriorly and medially and the diagnosis was supported on visualization of the splenic vessels by color and three‐dimensional power Doppler ultrasound. The patient had been referred because of fetal growth restriction and intracerebral anomalies and the additional finding of splenomegaly was highly suspicious for cytomegalovirus infection. This was confirmed by positive maternal serology and by neonatal virus excretion in urine. Retrospectively, examination of stored blood samples from 9 and 23 weeks' gestation revealed an early cytomegalovirus infection. Antenatal and neonatal magnetic resonance imaging examinations showed microcephaly, lissencephaly and the presence of microcalcifications. At the age of 9 months, the child suffers from severe neurological impairment and blindness due to severe optical atrophy. This case emphasizes that color Doppler and three‐dimensional power Doppler ultrasound can facilitate the antenatal diagnosis of splenomegaly and can help to delineate the spleen from the similar‐looking neighboring liver. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Changes in fetoplacental vessel flow velocity waveforms following maternal administration of betamethasone
Authors: Edwards A. , Baker L. S. , Wallace E. M.
Published: March 2003

Objective

To determine the timing of the onset of the umbilical artery flow velocity waveform changes following maternal administration of betamethasone in pregnancies complicated by umbilical artery absent end‐diastolic flow, and to explore whether these changes are associated with flow velocity waveform changes in other fetoplacental vessels.

Subjects and methods

This was a prospective study of 12 women with pregnancies complicated by umbilical artery absent end‐diastolic flow. Flow velocity waveforms were recorded from the umbilical artery, fetal middle cerebral artery, renal artery, aorta and ductus venosus, before and after maternal betamethasone administration, using real‐time pulsed wave Doppler.

Results

In all 12 pregnancies, the administration of maternal betamethasone was followed by the return of end‐diastolic flow within 24 h. End‐diastolic flow was first observed at 4 h and was present in all women studied at 8 h. In addition, there was a statistically significant decrease in the pulsatility index in the fetal aorta at 8 h and the middle cerebral artery at 24 h. No change was observed in the ductus venosus or the renal artery flow velocity waveforms.

Conclusion

The findings suggest that, in pregnancies complicated by absent end‐diastolic flow in the umbilical artery, maternally administered betamethasone induces a return in umbilical artery end‐diastolic flow as early as 4 h, along with widespread vasodilatation throughout the fetoplacental vasculature. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of ovarian cyst formation in women using the levonorgestrel‐releasing intrauterine system vs. hysterectomy
Authors: Inki P. , Hurskainen R. , Palo P. , Ekholm E. , Grenman S. , Kivelä A. , Kujansuu E. , Teperi J. , Yliskoski M. , Paavonen J.
Published: March 2003

Objective

To analyze the effect of the levonorgestrel‐releasing intrauterine system (LNG‐IUS) on ovarian cyst formation, endometrial thickness and the size of uterus and uterine fibroids by ultrasonography.

Subjects and methods

This was a prospective, randomized trial comparing the LNG‐IUS and hysterectomy in 236 women (age range 35–49 years) referred for menorrhagia. Transvaginal ultrasound examination was used to study the presence of ovarian cysts, uterine size, endometrial thickness, and the size of the uterus and uterine fibroids during a 12‐month follow‐up period.

Results

At baseline examination, 12 ovarian cysts were detected, eight in the LNG‐IUS group and four in the hysterectomy group. During the follow‐up period, 14 new cysts had emerged at 6 months and 14 new cysts had emerged at 12 months in the LNG‐IUS group, whereas the corresponding figures in the hysterectomy group were three and eight, respectively. All but one of the 14 new cysts (94.1%) detected at 6 months in the LNG‐IUS group resolved spontaneously, whereas two out of the eight cysts detected at the baseline examination persisted for 12 months. Three cysts were removed at operation. The relative risk of the occurrence of ovarian cysts was significantly higher in women with LNG‐IUS, compared with women who underwent hysterectomy. LNG‐IUS did not affect the size of the uterus or uterine fibroids, but it was associated with a decrease in endometrial thickness. The occurrence of cysts did not correlate with age or follicle stimulating hormone levels, but a weak positive correlation between the occurrence of cysts and the presence of irregular bleeding was observed.

Conclusions

LNG‐IUS use in the treatment of menorrhagia was associated with the development of ovarian cysts, but these were symptomless and showed a high rate of spontaneous resolution. LNG‐IUS did not affect the size of the uterus or the size of uterine fibroids, but decreased the thickness of the endometrium. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic features of the endometrium and the ovaries in women on etonogestrel implant
Authors: Van Den Bosch T. , Donders G. G. G. , Riphagen I. , Debois P. , Ameye L. , De Brabanter J. , Van Huffel S. , Van Schoubroeck D. , Timmerman D.
Published: March 2003

Objective

To evaluate the ultrasound features of the endometrium and ovaries in women on etonogestrel implant, and to correlate these features with the bleeding pattern.

Methods

Observational study including 188 consecutive women presenting for follow‐up transvaginal ultrasound examination after insertion of an etonogestrel implant contraceptive device. Thirty women had more than one follow‐up examination. The bleeding pattern was considered abnormal if, in the last 3 months, there were more than five episodes of vaginal bleeding, or there was prolonged bleeding exceeding 14 consecutive days.

Results

At first follow‐up examination, the mean age was 29.7 years and 47% of women had an abnormal bleeding pattern. Most bleeding episodes were of less intensity than menses. The mean endometrial thickness (ET) on ultrasound was 2.9 mm (standard deviation, 2.0). Ovarian follicle growth exceeding 5 mm was observed in 60% of the cases. Ovulation was demonstrated in one woman. Univariate analysis showed a positive association (P < 0.01) between ET, bleeding pattern, and bleeding intensity. Follicle growth was positively associated (P < 0.01) with ET, bleeding pattern, and interval between insertion and examination. Multivariate analysis showed that the ET was on average 1.25 mm greater in women with abnormal bleeding (P = 0.0001). The odds of finding follicle growth were 2.8 times higher (95% confidence interval, 1.2–6.2) in women presenting with a three‐layer type of endometrial morphology. There was no association between the other patients' characteristics and the bleeding pattern.

Conclusions

Abnormal uterine bleeding in women on etonogestrel implant was associated with follicle growth and a thicker, three‐layer type of endometrium, suggesting incomplete ovarian inhibition and estrogen stimulation of the endometrium. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Adaptation in the vertebral column: a comparative study of patterns of metameric variation in mice and men
Authors: O'HIGGINS P. , MILNE N. , JOHNSON D. R. , RUNNION C. K. , OXNARD C. E.
Published: March 2003

In this paper we examine metamerism in the vertebral column of certain mammals from the perspectives of development and adaptation. To this end we examine the patterns of metameric variation of dimensions of the neural (vertebral) canal, vertebral body and spinous process in man and inbred strains of mice. The data from inbred strains of mice indicate that variability in dimensions within a strain reflects the temporal ordering and nature of developmental influences on vertebral morphogenesis. Differences between strains parallel the within‐strain findings. These findings are attributed to somatic and neural influences on morphogenesis. Comparisons between mice and man indicate that these same influences can be invoked to explain and interpret the mosaic nature of vertebral column evolution. These findings lead us to conclude that different vertebral elements and levels are subject to different interactions of evolutionary and morphogenetic influences. The study of these influences and their interactions should prove fruitful in developing an understanding of the relationship between adaptation, development, growth and function in the skeleton generally.
Projections of chemically identified myenteric neurons of the small and large intestine of the mouse
Authors: SANG Q. , WILLIAMSON S. , YOUNG H. M.
Published: March 2003

The projections of different subpopulations of myenteric neurons in the mouse small and large intestine were examined by combining immunohistological techniques with myotomy and myectomy operations. The myotomies were used to examine the polarity of neurons projecting within the myenteric plexus and showed that neurons containing immunoreactivity for nitric oxide synthase (NOS), vasoactive intestinal peptide (VIP), calbindin and 5‐HT projected anally, while neurons with substance P (SP)‐immunoreactivity projected orally, in both the small and large intestine. Neurons containing neuropeptide Y (NPY)‐ and calretinin‐immunoreactivity projected locally. In the large intestine, GABA‐immunoreactive neurons projected both orally and anally, with more axons tending to project anally. Myectomy operations revealed that circular muscle motor neurons containing NOS/VIP/±NPY and calretinin neurons projected anally both in the small and large intestine, while SP‐immunoreactive circular muscle motor neurons projected orally. In the large intestine, GABA‐IR circular muscle motor neurons projected both orally and anally. This study showed that although some neurons, such as the NOS/VP inhibitory motor neurons and interneurons, SP excitatory motor neurons and 5‐HT interneurons had similar projections to those in other species, the projections of other chemical classes of neurons in the mouse intestine differed from those reported in other species.
An improved low‐formaldehyde embalming fluid to preserve cadavers for anatomy teaching
Authors: COLEMAN RAYMOND , KOGAN IGOR
Published: March 2003

The desired properties required for successful embalming of cadavers for gross anatomy teaching include: (1) good long‐term structural preservation of organs and tissues with minimal shrinkage or distortion; (2) prevention of over‐hardening, while maintaining flexibility and suppleness of internal organs; (3) prevention of desiccation; (4) prevention of fungal or bacterial growth and spread within a specific cadaver and to other cadavers in the dissection room; (5) reduction of potential biohazards (spread of infection to dissection personnel and students); (6) reduction of environmental chemical hazards (especially from formaldehyde and phenol) in order to comply with increasingly severe health and safety regulations and a new awareness of possible dangers of these chemicals in the workplace; and (7) retention of colour of tissues and organs while minimising oxidation effects that result in ‘browning’.
The morphological basis of increased stiffness of rabbit tibialis anterior muscles during surgical limb‐lengthening
Authors: WILLIAMS PAMELA , KYBERD PETER , SIMPSON HAMISH , KENWRIGHT JOHN , GOLDSPINK GEOFFREY
Published: March 2003

When the tibialis anterior muscle of the rabbit is progressively stretched during surgical limb distraction, the muscle fibres lengthen by addition of new serial sarcomeres, provided that stretch is carried out at an appropriate rate. However, in spite of the apparent adaptation to the new functional length, range of joint movement is greatly decreased. In this study we have first, made measurements of the passive tension developed by distracted muscles over the range of joint movement and secondly made quantitative measurements of endomysial and perimysial connective tissue content. It was found that at all ankle joint angles greater than 90°, the passive tension developed by the distracted muscles was greater than both contralateral and sham‐operated controls. Image analysis showed that the ratio of collagen to contractile material was increased in distracted muscles compared with muscles from sham‐operated controls, due to increased deposition of collagen type III. Scanning electron microscopy showed the presence of a dense perimysial weave surrounding the distracted muscle fibres. These quantitative and qualitative changes in the connective tissue component could account for the increased stiffness demonstrated by the physiological measurements. It would seem that in distracted muscle the connective tissue element adapts less readily than the contractile component, with prolonged stretch leading to damage to the perimysial and endomysial network, with subsequent fibrosis and loss of muscle compliance. Such changes could help explain the loss of range of movement noted in the distracted limbs of patients undergoing surgical limb‐lengthening and in other conditions that result in muscle contractures.
The innervation of rainbow trout (Oncorhynchus mykiss) liver: protein gene product 9.5 and neuronal nitric oxide synthase immunoreactivities
Authors: ESTEBAN F. J. , JIMÉNEZ A. , BARROSO J. B. , PEDROSA J. A. , DEL MORAL M. L. , RODRIGO J. , PEINADO M. A.
Published: March 2003

We have explored the innervation of the rainbow trout (O. mykiss) liver using immunohistochemical procedures and light microscopy to detect in situ protein gene product 9.5 and neuronal nitric oxide synthase immunoreactivities (PGP‐IR and NOS‐IR). The results showed PGP‐IR nerve fibres running with the extralobular biliary duct (EBD), hepatic artery (EHA) and portal vein (EPV) that form the hepatic hilum, as well as following the spatial distribution of the intrahepatic blood vessel and biliary channels. These nerve fibres appear as single varicose processes, thin bundles, or thick bundles depending on their diameter and location in the wall of the blood vessel or biliary duct. No PGP‐IR fibres were detected in the liver parenchyma. NOS‐IR nerve fibres were located only in the vessels and ducts that form the hepatic hilum (EBD, EHA, EPV); in addition, NOS‐IR nerve cell bodies were found isolated or forming ganglionated plexuses in the peribiliary fibromuscular tissue of the EBD. No PGP‐IR ganglionated plexuses were detected in the EBD. The location of the general (PGP‐IR) and nitrergic (nNOS‐IR) intrinsic nerves of the trout liver suggest a conserved evolutionary role of the nervous control of hepatic blood flow and hepatobiliary activity.
Diffusion tensor imaging in biomechanical studies of skeletal muscle function
Authors: VAN DONKELAAR C. C. , KRETZERS L. J. G. , BOVENDEERD P. H. M. , LATASTER L. M. A. , NICOLAY K. , JANSSEN J. D. , DROST M. R.
Published: March 2003

In numerical simulations of skeletal muscle contractions, geometric information is of major importance. The aim of the present study was to determine whether the diffusion tensor imaging (DTI) technique is suitable to obtain valid input with regard to skeletal muscle fibre direction. The accuracy of the DTI method was therefore studied by comparison of DTI fibre directions in the rat tibialis anterior muscle with fascicle striation patterns visible on high‐resolution magnetic resonance imaging (MRI) and with fibre directions in an actual longitudinal section (ALS) through the same muscle. The results showed an excellent qualitative agreement between high‐resolution MRI and DTI. Despite less accurate quantitative comparison with ALS, it was concluded that DTI does indeed measure skeletal muscle fibre direction. After the experiment, it was possible to determine an appropriate voxel size (0.9 mm3) that provided enough resolution and acceptable accuracy (5°) to use DTI fibre directions in biomechanical analyses. Muscle deformation during contraction, resulting from a finite element simulation with a mesh that was directly generated from the experimental data, has been presented.