bluuebunny/crossref_metadata_2025 huggingface dataset:
Basal cell carcinoma on the dorsum of the hand: report of 11 cases
Authors: Van Zuuren Ej , Bastiaens Mt , Posma An , Bavinck Jn Bouwes
Published: March 2003

Background

Basal cell carcinoma (BCC) is the most common cutaneous malignancy, although the appearance on the dorsum of the hand appears to be rare.

Objectives

The purpose of this study was to identify and describe patients with BCC of the dorsum of the hand in a large cohort of BCC patients and to provide a review of the literature.

Methods

Eleven patients with a BCC on the dorsum of the hand were identified. Information on age at diagnosis, sex, treatment and follow up, presence of additional malignancies, etc., was gathered from medical records.

Results

Between January 1985 and December 1995, 2990 BCCs were registered, of which 11 were located on the dorsal aspect of the hand (0.37%). Nine patients were male and most patients had a history of multiple skin malignancies. Most of the BCCs were nodular or had a nodular component. Solar elastosis was frequently seen. The percentage of 0.37% compares well with BCC located on the dorsum of the hand in other studies, but also with other parts of the body per skin surface area (except the face and neck area).

Conclusions

The density of BCC on the dorsum of the hand is much lower than in the face and neck area but compares well with other parts of the body.
Clearance of ichthyosis linearis circumflexa with balneophototherapy
Authors: Gambichler Thilo , Senger Erik , Altmeyer Peter , Hoffmann Klaus
Published: March 2003

We report a 13‐year‐old boy suffering from severe ichthyosis linearis circumflexa. Evidence of hair shaft abnormalities and impaired immunity could not be found. The patient was treated with salt water baths and artificial UVB radiation (balneophototherapy) 3–5 times weekly. After 40 treatments with balneophototherapy the skin lesions were almost completely cleared and maintenance UVB monotherapy was performed twice weekly for 2 months. After 4 months, however, the disease relapsed. Balneophototherapy presents a potentially effective and well tolerated phototherapeutic option for ichthyosis linearis circumflexa. As only short periods of remission may be expected, intermittent balneophototherapy would be probably necessary to control the disease.
Treatment of Miescher’s cheilitis granulomatosa in Melkersson–Rosenthal syndrome
Authors: Camacho F , García‐Bravo B , Carrizosa A
Published: March 2003

Cheilitis granulomatosa is the most frequent dermatological sign in the Melkersson–Rosenthal syndrome. We reviewed 27 cases of this syndrome diagnosed and treated in the last 20 years. All the patients were surgically treated and received intralesional corticosteroids during surgery and tetracycline hydrochloride (500 mg, twice daily) after the operation to prevent recurrence.
Verrucous form of chilblain lupus erythematosus
Authors: Pock L , Petrovská P , Becvár R , Mandys V , Hercogová J
Published: March 2003

A 45‐year‐old woman had symmetrical livid plaques with yellowish hyperkeratoses for 5 years, which progressed on to the fingers and toes and on the soles of the feet. Two years later creamy, whitish areas and maceration appeared on the buccal mucosa and the lips. A skin biopsy revealed massive collagen hyaline degeneration in the perivascular area, hyperkeratosis and hypergranulosis, small lymphocyte infiltrates with several melanophages and extravasates of erythrocytes in the upper corium in perivascular areas and hydropic degeneration of basal keratinocytes. The findings using direct immunofluorescence were compatible with lupus erythematosus (LE). Laboratory investigation showed a slight leucopenia and thrombopenia, a slightly elevated erythrocyte sedimentation rate, hypocomplementaemia C3 and C4, a high titre of rheumatoid factor and antinuclear antibodies positivity of extractable nuclear antigen. The results reflected probably the development of a systemic form of the disease. The patient was successfully managed by methylprednisolone and hydroxychloroquine. After 1 year of therapy, a new skin biopsy revealed a substantial reduction of hyperkeratosis and hyaline degeneration of collagen tissue in the perivascular areas. The combination of the extensive hyperkeratosis and hyalinization thus seems to be features of the long‐lasting, untreated lesions in chilblain LE.
Nd:YAG 1064 nm laser in the treatment of facial and leg telangiectasias
Authors: Major A , Brazzini B , Campolmi P , Bonan P , Mavilia L , Ghersetich I , Hercogova J , Lotti T
Published: March 2003

Background Facial and leg telangiectasias are a frequent cosmetic concern for both females and males with various skin types and ages. To date the different treatments for these problems, in particular leg telangiectasias, have frequently failed or led to negative side‐effects.

Objective This study examines the clinical effects and safety of applications with a 1064‐nm Nd:YAG laser system (SmartEpil II, DEKA M.e.l.a., Florence, Italy) to treat vessels on the face and legs.

Materials and methods Twenty‐five subjects with facial telangiectasias underwent one treatment at 100 J/cm2, 10 ms and 2 Hz repetition rate. Thirty‐two subjects with leg telangiectasias, measuring 0.1–3 mm in diameter, were treated at 125–200 J/cm2, 10–30 ms and 2 Hz repetition rate. Subjects in this group underwent one to five treatment sessions at 8 week intervals.

Results All subjects showed visible improvement, with 95–100% clearing of the face telangiectasias after only one treatment, and 50–100% clearing of the lower extremity vessels after three to five treatments. Transitory hypopigmentation was seen in two cases subjected to leg vessel treatment.

Conclusions Treatment of facial and leg telangectasias using a true long pulse 1064 nm Nd:YAG laser is an effective and safe method. The relative lack of discomfort combined with a high degree of individual satisfaction should play a part in the fairly high level of acceptance of this new form of therapy for the treatment of leg and face telangiectasias.
Rheumatoid neutrophilic dermatitis: an initial dermatological manifestation of seronegative rheumatoid arthritis
Authors: Lazarov A , Mor A , Cordoba M , Mekori YA
Published: March 2003

Rheumatoid neutrophilic dermatitis (RND) is an uncommon, but distinctive manifestation of rheumatoid arthritis (RA). We describe the case of a 35‐year‐old female who developed RND as an early stage of seronegative RA. Clinically, the lesions were presented by erythematous, slightly tender, papules, 5–10 mm in diameter, on the extensor surface of the left arm. The histopathological findings revealed a dense, dermal, mainly neutrophilic infiltrate, with prominent leucocytoclasia, but without any features of vasculitis. There was fibrinoid degeneration of collagen, resembling the collagen changes present in rheumatoid nodules in a miniaturized form. RND can be a reliable, early clinical sign of RA, as seen in our patient. Furthermore, this case demonstrates that RND may be associated not only with seropositive RA, as described in the literature, but also with seronegative RA, never before reported. The histological findings in our case are remarkable because of the fibrinoid collagen degeneration, which is described here for the first time in RND. Thus, RND may, in fact, be the initial phase of a spectrum that begins with a neutrophilic reaction and mild fibrinoid collagen degeneration, and evolves into rheumatoid nodules at the final stage.
Inpatient dermatology: characteristics of patients and admissions in a Spanish hospital1
Authors: García‐Doval I , Feal C , Rosón E , De La Torre C , Abalde MT , Flórez A , Cruces MJ
Published: March 2003

Background Inpatient dermatology has not been properly described in many countries. National differences might be important in the evaluation of its usefulness and the applicability of politics of health expenditure restrictions.

Objective To describe inpatient activity and readmission rates in a dermatology department in Spain.

Study design Cross‐sectional prospective study in a single hospital.

Setting Secondary care hospital of the National Health Service in Pontevedra (Spain).

Methods From May 1997 to December 2000, all discharge sheets (1048) were included in the study, codified and described.

Results Surgery was the reason for admission in 37% of the inpatients. The most frequent diagnosis were: neoplasm (36%), infection (15%), psoriasis (10%), other (10%), dermatitis (6%) and drug reaction (5%). Readmission rates were 1.8% within 30 days, and 12.5% within 1 year.

Conclusions Inpatient dermatology is different in different countries. Compared with what has been described in the USA or UK, our data suggest an important surgical content of inpatient dermatology in Spain, not reported in those countries. Medical diagnoses also differ, consisting of more infections, and less psoriasis and dermatitis in our setting. Readmission rates are low when compared with previously published ones, a finding that supports a long‐term benefit of hospitalization.
Lichen sclerosus – a keratotic variant
Authors: Criado PR , Lima FHSD , Miguel DS , Valente NYS , Vasconcellos C , Sittart JAS
Published: March 2003

We describe an unusual case of keratotic lichen sclerosus with extragenital and genital lesions in a 34‐year‐old Brazilian man. The disease was characterized by several erythematous and brownish keratotic papules on the man's back, trunk and extensor areas of the limbs; histologic findings were typical of lichen sclerosus. Others atypical extragenital forms of lichen sclerosus are discussed.
Serum levels of interleukin‐18 and s‐ICAM‐1 in patients affected by psoriasis: preliminary considerations
Authors: Gangemi S , Merendino RA , Guarneri F , Minciullo PL , DiLorenzo G , Pacor M , Cannavò SP
Published: March 2003

Objective To find new aspects of the systemic involvement of the Immune System in psoriasis, we determined serum levels of interleukin‐18 (IL‐18) (Th1‐inducing factor cytokine), CD30 (Th2 marker) and sICAM‐1 (adhesion molecule). In addition we evaluated the correlation between these molecules and psoriasis area and severity index (PASI).

Background Psoriasis is associated to an overexpression of Th1 cytokines and a relative underexpression of Th2 cytokines.

IL‐18 plays an important role in inducing Th1 response because it is a potent inductor of synthesis of IFN‐γ, TNF and other mediators. The two major sources of IL‐18 are monocytes and macrophages but also human keratinocytes constitutively synthesized IL‐18.

Subjects and methods We selected two groups of subjects: 16 healthy donors (HD) and 16 patients affected by psoriasis, matched for sex and age.

Serum IL‐18, CD30 and sICAM‐1 levels were assayed by immunoenzymatic method with commercial kits.

Results IL‐18 and sICAM‐1 levels in the patients were significantly higher than in the HDs (385.94 ± 193.89 vs. 227.38 ± 92.76 pg/mL, P = 0.005 and 445.00 ± 152.67 vs. 317.88 ± 107.20 ng/mL, P = 0.02, respectively).

On the contrary, no significant difference was found between serum sCD30 levels of patients in respect to those of HDs.

A significant correlation was found between serum IL‐18 and PASI (Rho = 0.695, P = 0.0071), serum IL‐18 and sICAM‐1 (Rho = 0.543, P = 0.0356) and between sICAM‐1 and PASI (Rho = 0.659, P = 0.0107).
Turner's syndrome associated with psoriasis and alopecia areata
Authors: Rosina P , Segalla G , Magnanini M , Chieregato C , Barba A
Published: March 2003

Turner's syndrome is a sex chromosomal abnormality characterized by gonadal failure, short stature, skeletal and medical anomalies due to structural defects or monosomy of the X chromosome. The association between this syndrome and autoimmune diseases has been reported in the literature. This case report highlights the finding of two immunological skin diseases, alopecia areata and psoriasis, in an 18‐year‐old girl with Turner's syndrome. By the time of her referral to the Department of Dermatology, Verona University (Italy) the girl had suffered from psoriasis on the scalp for 5 years and alopecia for 6 months; the diagnoses were confirmed by histological evaluation. Topical therapy was useful for the treatment of the psoriatic lesions but not for the alopecia areata. Alopecia areata and psoriasis occurring together in Turner's syndrome may indicate some genetic relationship and could support the concept that these patients have the tendency to develop autoimmune or immunological diseases. Anxiety, depression and unsatisfactory relationships could have been important trigger factors in our patient. Multidisciplinary management, including psychological, educational and behavioural techniques, in addition to other therapies, could be useful in treating these conditions.
Nitric oxide levels in Behçet's disease
Authors: Sancak B , Önder M , Öztas MO , Bukan N , Gürer MA
Published: March 2003

Behçet's disease(BD) is a chronic multisystemic disorder which is characterized by a relapsing systemic inflammatory process. In certain inflammatory conditions such as rheumatoid arthritis, over production of nitric oxide (NO) could damage host cells and tissues, either directly and/or following reaction with other free radicals, such as superoxide anion to form species including peroxynitrite or hydroxyl radicals. Excessive superoxide radical production and impaired antioxidant mechanism in both the neutrophils and plasma of patients with BD have been reported. Our study was designed to investigate the role of NO in BD. NO is an extremely unstable molecule and rapidly converted in vivo and in vitro to nitrate () and nitrite (). For this reason serum and have been used as an index of NO generation. We measured serum nitrate + nitrite levels, by using an enzymatic one‐step methodology based on the reduction of nitrate to nitrite by nitrate reductase from Aspergillus species, in the presence of β‐NADPH. When compared to healthy controls, serum nitrate + nitrite levels were found to be higher in active periods of BD patients (P < 0.01). It was concluded that increased NO production in patients with BD might have critical biological activities relevant to vasculitic events in the active period of disease.
Quality of Life Measurement and People with Intellectual Disabilities: a Reply to Cummins
Authors: Hatton Chris , Ager Alastair
Published: March 2003

This paper continues an exchange concerning quality of life measurement and people with intellectual disabilities. It addresses the continuing debate concerning three major issues: the utility of measuring subjective well‐being in assessing service quality; the validity of quality of life as a construct; and the wider context within which quality of life assessment takes place. Evidence is presented to argue that subjective well‐being should not be used to assess service quality, as it is a largely dispositional trait and measures of subjective well‐being can only be reliably completed by a minority of people with intellectual disabilities. Some concerns are raised concerning the validity of current measures of quality of life, in terms of combining objective and subjective aspects of quality of life, summing quality of life domains, and the lack of investigation of the ‘psychological reality’ of quality of life as a construct. Finally, arguments concerning the potentially unfortunate consequences of adopting a quality of life approach within services are outlined. Such potentially unfortunate consequences are argued not to be caused by malignant motivations on the part of professionals, but to be the result of broader historical and professional processes.
The differential diagnosis of enlarged hyperechogenic kidneys with normal or increased liquor volume: report of five cases and review of the literature
Authors: Chitty L. S. , Griffin D. R. , Johnson P. , Neales K.
Published: March 2003

We report five cases of enlarged, hyperechogenic kidneys detected prenatally where the liquor volume was normal or increased. The etiology was different in all cases and included infantile and adult polycystic kidney disease, Perlman syndrome, trisomy 13 and cystic dysplasia. The differential diagnosis of such findings is discussed and other cases reported in the literature are reviewed. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Is the ultrasound definition of fluid collections in non‐immune hydrops fetalis helpful in defining the underlying cause or predicting outcome?
Authors: Skoll M. A. , Sharland G. K. , Allan L. D.
Published: March 2003

The ultrasound findings in 132 patients with non‐immune hydrops referred for echocardiographic assessment were retrospectively reviewed. Structural assessment was combined with evaluation of pleural and pericardial effusions, ascites and skin edema. Patients were divided into groups based on the underlying etiology of hydrops. Seventy patients were found to have cardiac abnormalities, including 45 with structural heart disease. Other causes included. chromosomal anomalies, infection, extra‐cardiac anomalies, genetic syndromes and, in 40 patients, unknown cause. Analysis of patterns of fluid accumulation revealed a significantly decreased incidence of pleural effusions and ascites in fetuses with an underlying cardiac abnormality. Cardiomegaly based on the cardio‐thoracic ratio was significantly more frequent in the cardiac group. When patients were grouped by outcome, no pattern of fluid distribution was found to be characteristic for survival or death. We conclude that ultrasound definition of fluid collections in non‐immune hydrops may be helpful in predicting the underlying cause of the hydrops, although there are no specific patterns predictive of outcome. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Doppler studies of the uteroplacental circulation in pregnancies complicated by diabetes
Authors: Bracero L. A. , Schulman H.
Published: March 2003

The aim of this study was to evaluate the uteroplacental side of the circulation in pregnancies complicated by diabetes. A total of 54 women with pregnancies complicated by diabetes underwent uterine and umbilical artery Doppler studies. Uterine Doppler velocity waveforms were not obtained in two women. The prevalence of abnormal uterine artery velocity waveforms was much higher than in a non‐diabetic population (15.4% vs. 2%, p < 0.001). Those eight women with abnormal uterine Doppler studies had a statistically higher incidence of poor glycemic control, chronic hypertension, polyhydramnios, vasculopathy, pre‐eclampsia, Cesarean births for fetal distress and newborns with respiratory distress syndrome. In this group of patients, the umbilical circulation was not considered to be a contributing factor in the development of problems. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Predictive value of transvaginal uterine Doppler assessment in an in vitro fertilization program
Authors: Favre R. , Bettahar K. , Grange G. , Ohl J. , Arbogast E. , Moreau L. , Dellenbach P.
Published: March 2003

This study evaluates the prognostic value of uterine Doppler performed on the day of embryo transfer in an in vitro fertilization program. Patients were divided into two groups according to the type of ovarian stimulation. The Doppler investigation was carried out using vaginal sonography. The pulsatility index was used to evaluate the uterine blood flow pattern. The hormonal profile (estradiol, luteinizing hormone (LH) and progesterone) was correlated to Doppler results and to the pregnancy rate. The comparison between patients treated with analogs and those who were not shows a significant difference in their hormonal profile. In the first group, we found a higher estradiol and progesterone serum concentration. The LH level and the pulsatility index were statistically lower. The endometrium was thicker in patients treated with gonadotropin releasing hormone agonists. In the group of patients treated with analogs, the statistical analysis showed no significant difference in the mean pulsatility index value in women who achieved a pregnancy and in those who failed. In the group of patients who received no agonists, only one variable was significantly different: the mean age was lower in women who became pregnant. We observed no ongoing pregnancy in women who had a pulsatility index value higher than two standard deviations (pulsatility index = 3.55). We therefore suggest the use of this value as a threshold. Thus, if a patient has a high uterine artery impedance, cryopreservation should be used and embryo transfer should be postponed to a subsequent cycle, or embryo transfer delayed for a few days using co‐culture. This study clearly shows the impact of hormonal response on the Doppler value and on the pregnancy rate. However, the use of a threshold value for uterine artery pulsatility index might have a clinical impact in the future management of patients attending an in vitro fertilization program. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasound diagnosis of a rare occurrence of lethal multiple pterygium syndrome in two siblings
Authors: Meizner I. , Hershkovitz R. , Carmi R. , Katz M.
Published: March 2003

We report two cases of prenatal ultrasound diagnosis of the lethal form of multiple pterygium syndrome in successive pregnancies in the same woman. This extremely rare entity is characterized by multiple pterygia, flexion contractures, facial anomalies and hypoplasia of heart and lungs. The appearance of the congenital cataract is unique and this finding was present in both abortuses. Prenatal detection of this syndrome is feasible, and an ultrasound survey should be offered during genetic counselling to previously affected couples. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Endoscopic laser coagulation of umbilical cord vessels in twin reversed arterial perfusion sequence
Authors: Ville Y. , Hyett J. A. , Vandenbussche F. P. H. A. , Nicolaides K. H.
Published: March 2003

In monozygotic twin pregnancies with reversed urterial perfusion (TRAP) sequence, the donor twin is ut high risk of perinatal death. This paper describes the use of endoscopic surgery in the management of this condition. In four cases of TRAP sequence presenting at 17, 20, 26 and 28 weeks' gestation, respectively, an endoscope was introduced into the uterus under local anesthesia and a Nd‐YAG laser was used to coagulate the umbilical cord vessels of the acardiac twin. Laser coagulation was successful in arresting blood flow to the acardiac fetus in the cases treated at 17 and 20 weeks, and healthy infants were delivered at term. In the pregnancies treated at 26 and 28 weeks, the umbilical cords were very edematous and laser coagulation failed to arrest blood flow; healthy infants were delivered after spontaneous labor at 29 weeks. These findings suggest that, during mid‐gestation, endoscopic laser coagulation of the umbilical cord vessels of the acardiac twin is an effective method of treating TRAP sequence. In later pregnancy, alternative methods of treatment are needed. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Prevalence in a volunteer population of pelvic cancer detected with transvaginal ultrasound and color flow Doppler
Authors: Schulman H. , Conway C. , Zalud I. , Farmakides G. , Haley J. , Cassata M.
Published: March 2003

Our objective was to find the prevalence of non‐symptomatic endometrial and ovarian neoplasms in a volunteer population of women, aged 40 and over. We offered a free volunteer screening program to asymptomatic women for a study using transvaginal ultrasound and color flow Doppler for the detection of pelvic cancer. In the first 2 years, 2117 women were examined, 51.3% post‐menopausal. An ovarian cyst was defined as having a maximum diameter of more than 2.4 cm. Color flow was used to identify blood vessels feeding pelvic organs and adnexal enlargements. An abnormal Doppler flow velocity for the ovary was defined as a resistance index of less than 0.41. Ovarian cysts of less than 5 cm with normal Doppler indices were followed up in 6 months to 1 year. An adnexal morphology score was created to quantify the usefulness of this parameter, particularly in postmenopausal women. Indications for surgery were pre‐defined as a persistent ovarian cyst of more than 5 cm, a persistent suspicious Doppler and a total endometrial thickness of greater than 0.59 cm in postmenopausal women not taking hormones.

A total of 202 women (9.5%) had ovarian cysts. Fourteen women were operated upon because of size criteria, one because of family history and three for persistent abnormal flow. By Doppler study, 15 cysts were predicted to be benign and histology was confirmatory. There were two false positives and one true positive, a stage Ib ovarian cancer. There were no false negatives, although a stage I endometrioid cancer of the ovary was detected 8 months after a negative scan. In those cases in which follow‐up data were available, 56% of the cysts regressed in premenopausal women. In postmenopausal women, 28% regressed. Twenty of 1086 postmenopausal women had endometrial biopsies. Three had endometrial cancer, two stage I and one stage IIA. Five had atypical or adenomatous hyperplasia, and seven had benign polyps.

So many women have small asymptomatic cysts of the ovary that a major reorientation of physicians' attitudes towards the ovary will have to be introduced to adapt to this new information. In this population, the prevalence of benign epithelial ovarian neoplasms was 7/1000, and of malignancy was 05/1000. In postmenopausal women, the prevalence rate for endometrial cancer was 5/1000, with 5/1000 hyperplasias and 7/1000 benign polyps. When endometrial and ovarian cancer screening are combined, the yield is comparable to that seen in breast and cervical cancer screening. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Fetal suprarenal masses: sonographic appearance and differential diagnosis
Authors: Rubenstein S. C. , Benacerraf B. R. , Retik A. B. , Mandell J.
Published: March 2003

We present eight cases of suprarenal masses detected sonographically in fetuses of 20–41 weeks. The appearances of the masses included hyperechoic (n = 2, both pulmonary sequestrations), solid isoechoic (n = 1, a neuroblastoma), purely cystic (n = 3, two neuroblastomas, one enteric cyst) and mixed or complex (n = 2, one neuroblastoma and one renal cyst). Three of the fetuses with neuroblastoma had normal scans in the second trimester, and in all four the neuroblastomas were detected after 36 weeks.

This study demonstrates the differential diagnosis of suprarenal masses in fetuses. Neuroblastomas can have a solid, purely cystic or complex sonographic appearance. Although not all suprarenal masses are neuroblastomas, the newborn with a prenatally detected suprarenal mass should be evaluated for the possibility of a neuroblastoma, since early diagnosis of this malignancy can be curative. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Toward fetal therapy using needle embryofetoscopy
Authors: Reece E. A. , Homko C. , Goldstein I. , Wiznitzer A.
Published: March 2003

Our objective was to explore the feasibility of using both transvaginal endoscopy and transabdominal needle embryofetoscopy for early prenatal diagnosis. Our experience with both terminating and continuing pregnancies is presented in this report. Following the granting of informed consent, patients undergoing first‐trimester terminations were invited to participate in this program. Initially, a transvaginal endoscope was used in these studies: a rigid fiberoptic endoscope 30 cm in length with a diameter of 1.5 mm. Subsequently, a specially designed 16‐gauge, double‐barrel needle sheath, equipped with a 0.8‐mm fiberoptic endoscope and a customized 27‐gauge heparinized needle were used. In either case, the endoscope was passed under ultrasound guidance in to the exocelomic space, from which the anatomy of the embryo/fetus was scrutinized. For continuing pregnancies, patients were selected when at high risk for various dysmorphology syndromes. To date, we have successfully performed more than 300 transvaginal procedures, successfully visualized the fetus in 95% of cases, and verified sonographically suspected anomalies in all of the five cases studied. We have also performed 20 transabdominal procedures, 15 in terminating pregnancies and five in continuing pregnancies, without adverse effects. Our experience establishes the feasibility of first‐trimester diagnostic endoscopy. This new development is expected to serve as a prelude for further studies that attempt to diagnose and treat congenital diseases in early pregnancy. Potential applications include gene and stem‐cell therapy at a time when the embryo is immunologically naive. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Postpartum surveillance of urinary retention by ultrasonography: the effect of epidural analgesia
Authors: Weissman A. , Grisaru D. , Shenhav M. , Peyser R. M. , Jaffa A. J.
Published: March 2003

Our objective was to investigate by ultrasonography whether the risk for postpartum urinary retention is increased following administration of epidural analgesia during labor and delivery. In a prospective study, 106 healthy women who had undergone vaginal delivery were evaluated. Sixty‐eight of the women had received epidural analgesia during labor and delivery. All subjects had an ultrasound examination at a mean of 42 h after delivery, and residual urine volume was estimated immediately after voiding. Correlations among obstetric parameters, epidural analgesia and residual urine volumes were evaluated. The mean accuracy rate of ultrasonography for estimation of bladder volumes was ± 10.2%. No cases of clinically evident urinary retention were diagnosed in the total puerperal population. There were no significant differences between the groups in the average amounts of residual urine as measured by ultrasonography. With modern obstetric practice, epidural analgesia for labor is not associated with an increased risk for postpartum urinary retention. The non‐invasive nature of ultrasound renders it especially attractive and useful for measuring residual urine volume in postpartum patients. The safety, simplicity and relative comfort of this method over‐ride the slightly imperfect calculations that it currently yields, and makes it preferable to catheterization or cystometry for evaluation of residual urine volume. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Endometrial thickness, morphology, vascular penetration and velocimetry in predicting implantation in an in vitro fertilization program
Authors: Zaidi J. , Campbell S. , Pittrof R. , Tan S. L.
Published: March 2003

A total of 96 women undergoing in vitro fertilization (IVF) treatment were studied on the day of human chorionic gonadotropin (hCG) administration by transvaginal ultrasonography with color and pulsed Doppler ultrasound. We assessed endometrial thickness, endometrial morphology, presence or absence of subendometrial or intraendometrial color flow, intraendometrial vascular penetration and subendometrial blood flow velocimetry on the day of hCG administration and related the results to pregnancy rates. The overall pregnancy rate was 32.3% (31/96) and there was no significant difference between the pregnant and non‐pregnant groups with regard to endometrial thickness, subendometrial peak systolic bloodflow velocity (Vmax) or subendometrial pulsatility index (PI). The pregnancy rates based on endometrial morphology were not significantly different, being 17.6% (3/17), 33.3% (2/6) and 35.6% (26/73) for types A (hyperechoic), B (isoechoic) and C (triple‐line) endometria, respectively. In eight (8.3%) patients, subendometrial color flow and intraendometrial vascularization were not detected. This absence of blood flow was associated with failure of implantation (p < 0.05). The pregnancy rates related to the zones of vascular penetration into the subendometrial and endometrial regions were: 26.7% (4/15) for Zone 1 (subendometrial zone), 36.4% (16/44) for Zone 2 (outer hyperechogenic zone) and 37.9% (11/29) for Zone 3 (inner hypoechogenic zone), and were not significantly different. Of cycles with type A endometrium, 23.50% (4/17) had absent subendometrial color, which was greater than the frequency of absent color in the type C endometrium (4.1 (S, p = 0.03). In conclusion, absent subendometrial and intraendometrial vascularization on the day of hCG administration appears to be a useful predictor of failure of implantation in IVF cycles, irrespective of morphological appearance of the endometrium. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic follow‐up of a placenta left in situ after delivery of the fetus in an abdominal pregnancy
Authors: Bajo J. M. , Garcia‐Frutos A. , Huertas M. A.
Published: March 2003

A case of abdominal pregnancy was followed until 34 weeks' gestation, when rupture of the amniotic sac was noted. A live and anatomically normal female weighing 1400 g was delivered by laparotomy and the placenta was left in place.

Color Doppler imaging and measurement of serum β‐human chorionic gonadotropin (β‐hCG) were successfully used to follow the placental involution after delivery. A progressive increase in the resistance index in the utero‐ovarian and subplacental vessels was observed while β‐hCG disappeared 45 days after laparotomy. The mother and baby left hospital 20 days after delivery and are both doing well. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound: accuracy of distance and volume measurements
Authors: Riccabona M. , Nelson T. R. , Pretorius D. H.
Published: March 2003

The aim of this study was to evaluate the accuracy of three‐dimensional ultrasound distance and volume measurements using a commercially available three‐dimensional ultrasound scanner. Sixty‐two distance measurements were performed twice on an ultrasound tissue‐mimicking phantom located in a water bath. Three‐dimensional ultrasound distance measurements were compared to the actual distance. Volume measurements were made in a water bath with 21 balloons of various shapes ranging in volume from 20 ml to 490 ml. Three‐dimensional ultrasound volume measurements were compared to actual balloon volumes and to conventional two‐dimensional ultrasound volume calculations.

The mean absolute error in three‐dimensional ultra‐sound distance measurements was 1.0 ± 0.8% (range, −2.3 to 4.9%) in the plane of acquisition and 1.0 ± 0.6% (range, −2.0 to −0.2%) for planes with other orientations. Three‐dimensional ultrasound volume measurements showed a mean absolute error of 6.4 ± 4.4% (range, −6.0% to +15.5%), which was considerably better than two‐dimensional ultrasound volume estimates having a mean absolute error of 12.6 ± 8.7% (range, −27.5% to +39.2 %). Volume measurements using two‐dimensional ultrasound methods were much less accurate than three‐dimensional ultrasound methods, for irregularly shaped objects.

In conclusion, our data show (that three‐dimensional ultrasound measurements of distance and volume are sufficiently accurate to use clinically. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal findings in chondrodysplasia punctata, tibia—metacarpal type
Authors: Mayden Argo K. , Toriello H. V. , Jelsema R. D. , Zuidema L. J.
Published: March 2003

Chondrodysplasia punctata, a skeletal dysplasia with craniofacial dysmorphism and joint contractures can occur with rhizomelia, mesomelia or both. The rhizomelic form is generally lethal, whereas one form of mesomelic chondrodysplasia punctata has been described that is associated with a presumably normal lifespan and intelligence. We describe a case of a fetus suspected prenatally of having rhizomelic chondrodysplasia punctata, who was subsequently diagnosed at 1.5 years of age to have the tibia–metacarpal form of chondrodysplasia punctata. The prenatal sonographic findings of second‐trimester micromelic bone shortening and third‐trimester proximal femoral stippling may be present in the rhizomelic form but are not specific to this condition. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Fetal hemoglobin changes in the twin oligohydramnios‐polyhydramnios sequence
Authors: Carroll S. G. , McLennan A. , Maxwell D. J.
Published: March 2003

Fetal hemoglobin concentration was measured in each twin from five monochorionic pregnancies complicated by twin‐to‐twin transfusion, diagnosed by growth discordance and coexistent oligohydramnios‐polyhydramnios. In three cases the hemoglobin concentration of the smaller twin with oligohydramnios was lower than the normal mean for gestation, and the hemoglobin difference was more than 5 g/dl in two of these cases. In the other two cases, the hemoglobin concentration of the four fetuses with coexistent oligohydramnios‐polyhydramnios was within the normal range. This suggests that twin‐to‐twin transfusion may occur without hemoglobin changes, or that alternatively coexistent oligohydramnios‐polyhydramnios occurs in the absence of twin‐to‐twin transfusion. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Echogenic material in the fetal gallbladder and fetal disease
Authors: Kiserud T. , Gjelland K. , Bognø H. , Waardal M. , Reigstad H. , Rosendahl K.
Published: March 2003

The presence of echogenic material within the gallbladder is probably a rare finding in the fetus, and the list of predisposing factors known for postnatal life seems not to be applicable to prenatal diagnosis. In the present study 1656 obstetric scans were performed on referrals to the Unit of Fetal Medicine. No echogenic gallbladder contents were found before 28 weeks. In the subgroup of 523 fetuses who were examined during gestational weeks 28–42, six fetuses were found to have echogenic material in the gallbladder. The echogenicities were found in patients who had the following: extra‐amniotic hematoma with intrauterine growth retardation and oligohydramnios, tetralogy of Fallot, trisomy 21 with atrioventricular septal defect and transient ascites, early abnormally distended fetal gallbladder, chromosomal aberration (translocation 10; 11) with bilateral clubfoot, and gastroschisis. Echogenic densities had disappeared at ultrasound scans performed during early postnatal life in four cases, were absent at five weeks in one case, and still present as calculi 8 months after birth in one case. Although no causative conclusions can be drawn from the report, these conditions are suggested as possible predisposing factors for the presence of echogenic material in the fetal gallbladder. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Two‐dimensional echocardiographic evaluation of ventricular systolic function in human fetuses with ductal constriction
Authors: Harada K. , Rice M. J. , Shiota T. , McDonald R. W. , Reller M. D. , Sahn D. J.
Published: March 2003

Ventricular systolic function was assessed in fetuses, 18 with and 18 without constriction of the ductus arteriosus by serial two‐dimensional and Doppler echocardiographic studies. Ductal constriction was defined as maximum systolic velocity of > 140 cm/s and diastolic flow velocity of > 30 cm/s. Ventricular end‐diastolic and end‐systolic areas were measured from a four‐chamber view and area shortening fraction (SF) was calculated: area SF = (area in end‐diastole ‐ area in end‐systole)/area in end‐diastole. In fetuses with ductal constriction, right ventricular end‐diastolic and end‐systolic areas were significantly increased and right ventricular area SF decreased significantly compared with those values in fetuses without ductal constriction (186 ± 48 vs. 150 ± 38 mm2, 112 ± 34 vs. 81 ± 19 mm2 and 0.40 ± 0.05 vs. 0.47 ± 0.03, respectively, p c 0.01) without any significant changes in left ventricular area SF. Serial studies were available in eight ductal constriction fetuses before and during indomethacin administration, and after withdrawal of the drug for a mean of 24 h. Both systolic and diastolic ductal flow velocities in all fetuses returned to normal range after discontinuation of the drug. During ductal constriction during indomethacin therapy, right ventricular end‐diastolic and end‐systolic cavity areas were significantly larger and area SF was significantly less than those values before and after the therapy (179 ± .38 vs. 157 ± 30 and 154 ± 27 mm2, 108 ± 33 vs. 82 ± 15 and 83 ± 15 mm2 and 0.40 ± 0.07 vs. 0.48 ± 0.03 and 0.46 ± 0.03, respectively, p < 0.01). This study suggests that ductal constriction influences right ventricular systolic performance. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Betamethasone treatment and fetal lung perfusion evaluated with color Doppler energy imaging
Authors: Dubiel M. , Gudmundsson S. , Pirhonen J. , Breborowicz G. H. , Marsal K.
Published: March 2003

The aim of this study was semiquantitative evaluation of tissue blood flow in the fetal lung before and after administration of betamethasone. This was carried out by means of computer analysis of ultrasound Doppler signals obtained by the color Doppler energy (CDE) technique. CDE signals were recorded in 20 singleton pregnancies with appropriate growth and imminent preterm delivery between 26 and 33 weeks of gestation. The CDE signal recordings were made before and after intramuscular administration of betamethasone 8 mg/day for 3 days. Fixed preset CDE system control settings for the fetal right lung were used during the examinations. Images from CDE scans were recorded on S‐VHS videotape and transmitted for computer analysis of 8‐bit images at 2.56 gray‐scale levels. The mean flow signal intensity was recorded for the fatal lung before and after betamethasone administration. Additionally, blood velocity waveforms were measured in the intrapulmonary arteries and veins in the peripheral part of the lung.

CDE signals from the fetal lung indicated increased energy values after corticosteroid treatment in 16 cases. In three cases there was no change in CDE signal values, and in one case a fall of the signal value was noted. Blood velocity waveforms from the intrapulmonary arteries showed decreased resistance to flow in 1.5 cases, increased resistance to flow in four cases and no change in one case. No significant differences in venous blood flow velocities were found.

In conclusion, the results suggest that there is an increase in fetal lung blood perfusion after maternal corticosteroid administration. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Umbilical artery Doppler velocimetry waveform abnormality in fetal gastroschisis
Authors: Robinson J. N. , Abuhamad A. Z. , Evans A. T.
Published: March 2003

Two cases of notching in the umbilical artery Doppler waveform in a pregnancy with gastroschisis are reported. The etiology of the abnormal Doppler pattern in relation to the displacement of the fetal stomach in this congenital abnormality is discussed. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
A case of partial mole associated with trisomy 13
Authors: Jauniaux E. , Halder A. , Partington C.
Published: March 2003

The majority of second‐trimester partial moles are found in association with triploidy. Rarely are they associated with tetraploidy or other aneuploidies and, to our knowledge, this is the first reported case of the prenatal diagnosis of partial mole in a pregnancy presenting with trisomy. The patient was referred at 21 weeks of gestation after a routine ultrasound examination had shown fetal and placental features suggesting a partial mole triploidy. Owing to the severe structural malformations and poor prognosis, the parents requested termination. Prenatal and postnatal cytogenetic investigations demonstrated an additional chromosome 13. Histopathological examination of the placenta showed focal areas of villous edema but no evidence of trophoblastic dysplasia. The maternal serum human chorionic gonadotropin level was within the normal range at all times. This case shows that trisomy can resemble a triploid partial mole in utero without the potential long‐term risk to the mother of persisting trophoblastic disease, as villous molar changes can obviously develop without trophoblastic dysplasia. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Prospective non‐invasive monitoring of pregnancies complicated by red cell alloimmunization
Authors: Iskaros J. , Kingdom J. , Morrison J. J. , Rodeck C.
Published: March 2003

Our purpose was to evaluate the impact of non‐invasive assessment of fetal anemia and anti‐D antibody quantification on the timing and frequency of invasive procedures in pregnancies complicated by rhesus alloimmunization. Nineteen consecutive non‐hydropic pregnancies referred to the fetal medicine center were assigned a prior risk category (none/mild, moderate or severe) and monitored by: (1) serial fetal measurements of umbilical vein maximal flow velocity (UVVmax), liver length and spleen perimeter measurements; and (2) serial anti‐D antibody concentration. Invasive tests for fetal anemia (amniocentesis or fetal blood sampling) were deferred in the absence of abnormal ultra‐sound findings and/or rising antibody levels. In six cases serial non‐invasive tests were normal with stable antibody levels, and no invasive tests were performed; four infants were mildly affected, one was unaffected and one required postnatal exchange transfusion. In the remaining 13 affected cases, amniocentesis was performed in nine cases for: elevated UVVmax alone (n = 3), elevated UVVmax and an increased antibody level (n = 2), or normal UVVmax with an increased antibody level (>15 IU/ml) and severe prior risk category (n = 4). Six fetuses underwent fetal blood sampling (initial hematocrit 9–29%), and five of these had an elevated UVVmax. Liver length and spleen perimeter measurements were increased in only one anemic fetus (hematocrit 13%). Of 17 infants born alive, an elevated UVVmax prior to delivery was predictive of the need for exchange transfusion (six of seven cases with an elevated UVVmax vs. one of ten with a normal UVVmax; χ2 = 5.73, p = 0.017 with Yates' correction).

These preliminary data suggest that pregnancies with a mild or no history of fetal anemia may be monitored by a combination of serial antibody quantification and Doppler monitoring of UVVmax. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Trisomy 10: first‐trimester features on ultrasound, fetoscopy and postmortem of a case associated with increased nuchal translucency
Authors: Schwärzler P. , Moscoso G. , Bernard J. P. , Hill L. , Senat M.‐V. , Ville Y.
Published: March 2003

We report a case of the prenatal diagnosis of trisomy 10 in a fetus presenting with an increased nuchal translucency thickness (5 mm) on a routine first‐trimester anomaly scan at 12 weeks' gestation. Multiple abnormalities were diagnosed by ultrasound and fetoscopy. Karyotyping on chorionic villus sampling led to the diagnosis of homogeneous trisomy 10 which was confirmed by in situ hybridization on fetal tissue samples. Postmortem examination confirmed major anatomical malformations, including facial cleft, arthrogryposis of the upper and lower limbs and bilateral diaphragmatic hernia, and also revealed hypoplastic lungs, right renal agenesis and a complex cardiac malformation.

Trisomy 10 is an uncommon chromosomal abnormality that is likely to be associated with increased fetal nuchal translucency. This case also emphasizes the value of a detailed anomaly scan in high‐risk patients in the first trimester of pregnancy. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology