bluuebunny/crossref_metadata_2025 huggingface dataset:
Photodynamic therapy with violet light and topical δ‐aminolaevulinic acid in the treatment of actinic keratosis, Bowen’s disease and basal cell carcinoma
Authors: Dijkstra AT , Majoie IML , Van Dongen JWF , Van Weelden H , Van Vloten WA
Published: March 2003

Background Most clinical studies using photodynamic therapy (PDT) with topical application of δ‐aminolaevulinic acid (δ‐ALA) use red light because it allows greater depth of penetration. However, given the porphyrin‐like spectrum of δ‐ALA‐induced photosensitivity, violet light provides a maximal overlap with the excitation spectrum of protoporphyrin IX, meaning that PDT with violet light uses less light energy to induce the phototoxic reaction.

Aim To study the efficacy of violet light in combination with topical δ‐ALA PDT in the treatment of premalignant and malignant skin lesions.

Methods Eight hours after 20%δ‐ALA was applied topically, photoirradiation was performed with an incoherent light source (Philips HPM‐10, 400 W) emitting predominantly violet light (400–450 nm). Lesions received 10–20 J/cm2 during an exposure time of 30 min. The 38 subjects treated included three with basal cell naevus syndrome with multiple (> 30) superficial and nodular basal cell carcinomas (BCCs), one subject had multiple lesions of Bowen’s disease, involving 50% of the scalp, and the remaining 34 subjects presented a total of 35 superficial BCCs, 10 nodular BCCs, four large solar keratoses and five solitary lesions of Bowen’s disease.

Results Complete remission both clinically and histologically was seen after a single treatment in 82% of the superficial BCCs (100% after a second treatment), 50% of the nodular BCCs, one of the four solar keratosis lesions (partial remission in the other three) and 90–100% of the solitary lesions of Bowen’s disease.

Conclusions δ‐ALA PDT using violet light appears to be a well tolerated and effective alternative treatment for premalignant and malignant skin lesions, especially when there are multiple lesions or large patches comprising a large area of skin.
An epidemiological study of acne in female adults: results of a survey conducted in France
Authors: Poli F , Dreno B , Verschoore M
Published: March 2003

Background Acne is usually perceived as a disease of teenagers, and most epidemiological studies have focused on adolescents.

Objective The primary objective was to investigate the prevalence of acne in a representative sample of French females. Information about skin type, life‐style factors influencing acne and quality of life were also recorded.

Methods A self‐administered questionnaire was sent to 4000 adult women aged 25–40 years, after a validation test by three dermatologists. A definition of acne severity, according to questionnaire answers, was established before the questionnaire was sent out.

Results A total of 3394 women completed the questionnaire of which 3305 were useable. The data showed a prevalence of acne in 17% of the population, and physiological acne in 24%. Thus, the total acne prevalence was 41%. Forty‐nine per cent of the acne patients had acne sequelae (scars and/or pigmented macules). Forty‐one per cent of adult acne patients had not experienced acne during their adolescence. A premenstrual flare and stress was recorded as causing acne in 78% and 50%, respectively. Twenty‐two per cent of acne subjects were currently receiving therapy. For most patients, acne did not severely impair their quality of life.

Conclusion This study shows a prevalence of acne in 41% of women in the general population. A high proportion of these acne cases are late onset acne.
Comparison of mastocytosis with onset in children and adults
Authors: Middelkamp Hup MA , Heide R , Tank B , Mulder PGH , Oranje AP
Published: March 2003

Objective To compare the incidence, symptomatology and course of mastocytosis with onset in childhood and in adults.

Design Retrospective study of 101 patients with mastocytosis who were referred from 1980 to 1998.

Patients Medical records of 65 cases of mastocytosis with onset in childhood and 36 in adulthood were analysed. The clinical course was assessed in a subgroup consisting of 33 subjects with childhood onset who were followed up until at least adolescence and 12 subjects with adult onset who were followed up for at least 10 years.

Results The onset of the disease occurred before the age of 2 years in 50% and between the ages of 2 and 15 years in 14% of cases (childhood onset). In 36% of patients onset occurred at the age of 16 years and older (adult onset). An incidence peak of 60% was noted in the first year of life. Mast cell‐mediated symptoms were not experienced by 21 of 36 adult onset mastocytosis patients nor by 27 of 65 childhood onset mastocytosis patients. Complete resolution was observed in five of 33 children. The majority of childhood onset cases (21 of 33) showed some improvement. Complete resolution was achieved in three of 12 adults. The majority of the remaining adults (eight of 12) showed no improvement.

Conclusions We confirm the incidence of onset of mastocytosis previously reported in the literature. We conclude that childhood onset mastocytosis is much less transitory than generally is assumed, although improvement occurs in the majority of cases. Symptomatology and clinical course of adult onset mastocytosis is less severe than suggested in the literature.
Facial and periorbital cellulitis with orbital involvement
Authors: Reis M Duarte , Freitas JP , Sousa Coutinho V , Guerra Rodrigo F
Published: March 2003

Orbital cellulitis is a rare, serious and potentially fatal condition, usually associated with trauma to the eyelids, external ocular infection, upper respiratory tract infection and, especially, sinusitis. It is distinct from the more common periorbital cellulitis because it involves all contents of the orbit and may threaten both the vision and the life of the patient. It occurs with greater frequency in children. We report the case of a 34‐year‐old woman with severe facial and right periorbital cellulitis who rapidly developed orbital involvement, as shown by computed tomography. Apart from a bilateral retroauricular dermatitis, present for several years, the woman had been always healthy. Systemic antibiotics were started without delay and she recovered very well, with no ocular sequelae. This case illustrates that a subset of bacterial skin infections is becoming more aggressive and should be recognized and treated early.
Cerebriform intradermal naevus (a rare form of secondary cutis verticis gyrata)
Authors: Geest AJ van , Berretty PJM , Klinkhamer PJJM , Neumann HAM
Published: March 2003

Background Acquired cerebriform intradermal naevus (CIN) is a rare form of pseudo cutis verticis gyrata.

Case report A case of acquired CIN of the scalp in a 46‐year‐old male patient is presented. The clinical and histopathological presentations of CIN are described and the therapeutic possibilities are discussed.

Conclusions In each individual case the physician must decide whether to do surgery or follow a wait‐and‐see policy. There is little risk of malignant change of CIN, and surgical excision of such lesions often involves evident mutilation.
Mycosis fungoides presenting with extensive pyoderma gangrenosum‐like ulcers
Authors: Carbia SG , Hochman A , Chaín M , Dei‐Cas I , Lagodín C , Devés A , Woscoff A
Published: March 2003

Mycosis fungoides (MF) may present with atypical clinical manifestations. Usually it mimics various chronic dermatoses, with the appearance of ulcers during the tumour stage. Infrequently, cutaneous ulcers are the main or initial sign of lymphoma. We report the case of a man who presented multiple skin lesions that clinically appeared to be pyoderma gangrenosum (PG). However, histological and immunohistochemical examination revealed MF. This case illustrates that PG‐like ulcers may be atypical cutaneous manifestations of MF and exceptionally the presenting sign of this disease.
Botulinum toxin A in anal fissures: a modified technique
Authors: Wollina U , Konrad H
Published: March 2003

Background Anal fissures are common and painful. Botulinum toxin A (BTXA) is considered to be the most potent non‐surgical treatment; however, no attention has been paid to associated hyperhidrosis.

Aim To compare traditional BTXA treatment of muscular spasticity in anal fissures with combined treatment of spasticity and focal hyperhidrosis of the anal fold and perianal skin.

Setting Outpatient department of a dermatological hospital.

Patients and methods Ten patients with chronic anal fissures (of more than 6 months duration who failed to respond to conservative treatment and who had refused surgery) associated with focal hyperhidrosis as assessed by Minor's sweat test were investigated in an open, two‐armed trial. Intramuscular injections of 20–25 U BTXA (Botox®) were performed in group A (n = 5). In group B (n = 5) those injections were combined with intracutaneous injection of 30–50 U BTXA to treat focal hyperhidrosis. Mean follow‐up was 5 months.

Results Five of five patients in group B but only two of five patients in group A experienced a complete remission despite the fact that relief of pain was evident in eight of 10 patients within 2 weeks. Patient satisfaction with treatment was high but slightly better in group B.

Conclusions This open trial suggests that combined therapy of both muscular spasticity and focal hyperhidrosis may provide better results than intramuscular injections alone in anal fissure therapy with BTXA.
Eosinophilic pustular folliculitis
Authors: Majamaa H , Vaalasti A , Vaajalahti P , Reunala T
Published: March 2003

Eosinophilic pustular folliculitis is a rase dermatosis and the treatment is difficult because the underlying pathogenic mechanism is unknown. The authors report a case of eosinophilic pustular folliculitis (Ofuji's disease) in a 50‐year‐old man who died 9 years after onset of the disease.
Recurrent lentigo maligna as amelanotic lentigo maligna melanoma
Authors: Ara M , Maillo C , Martín R , Grasa MP , Carapeto FJ
Published: March 2003

Amelanotic lentigo maligna and lentigo maligna melanoma are extremely rare tumours. Even rarer is a recurrent amelanotic lentigo maligna or amelanotic lentigo maligna melanoma at the site of a previously removed pigmented lentigo maligna. We describe two cases of recurrent amelanotic lentigo maligna melanoma manifesting as erythematous plaques evolved from previously excised pigmented lentigo maligna.
Lipomatous melanocytic nevomatosis
Authors: Cabrera H , Gómez Ml , García S
Published: March 2003

Giant congenital melanocytic nevi (GCMN) are rare and occur in about one out of every 200 000–500 000 births. Their importance resides in the aesthetic alteration they produce and in the possibility of malignant transformation or in their association with nevi in the central nervous system as a distinctive syndrome: neurocutaneous melanoblastosis or nevomatosis, due to the fact that nervous system lesions are produced by infiltration of nevus cells. We present here a patient with a combination of GCMN with an outstanding lipomatosis located on the same area.
Three cases of androgen‐dependent disease associated with myotonic dystrophy
Authors: Cooper SM , Dawber RPR , Hilton‐Jones D
Published: March 2003

Three cases of androgen‐dependent disease in females with myotonic dystrophy are described. Serum androgens in individuals affected by myotonic dystrophy are known to be lower on average than in normal controls. Despite this these three females developed diseases that are androgen dependent, including acne, hidradenitis suppurativa, androgenetic alopecia and keratosis pilaris. These cases support the hypothesis that the peripheral response to androgens rather than absolute circulating levels of androgens is important in androgen‐dependent conditions.
Measurement of Community Participation and Use of Leisure by Service Users with Intellectual Disabilities: the Guernsey Community Participation and Leisure Assessment (GCPLA)
Authors: Baker Peter A.
Published: March 2003

Community integration is now an important principle guiding service provision for people with intellectual disabilities. However, it has been argued that research has contributed little in the way of guidance and that this is mainly because of the lack of appropriate measures. The Guernsey Community Participation and Leisure Assessment (GCPLA) is described in the present paper. The GCPLA is a comprehensive assessment of community participation and the use of leisure that produces both quantitative and qualitative data. Data are presented which suggest that the instrument is potentially both valid and reliable. A study comparing use of their community by service users and a staff control group showed that the service users had a smaller range of activities, were less busy (i.e. took part in fewer frequent activities), and were more likely to access their communities in the presence of staff or carers, rather than alone or with friends. Suggestions for the use of the GCPLA are discussed including individual planning, service evaluation and training.
Outcome Evaluation of Bereavement Groups for Adults with Intellectual Disabilities
Authors: Stoddart Kevin P. , Burke Lillian , Temple Valerie
Published: March 2003

Background  Individuals with intellectual disabilities respond to loss in similar ways to other individuals. Bereavement interventions, whether provided individually or in a group, need to be planned according to the person's understanding, presenting symptoms, psychological functioning and support system. Measuring the effectiveness of such interventions is critical in order to increase our knowledge of useful interventions for this population. The present authors discuss individual and group bereavement therapy, and outline the goals and approaches used in their bereavement groups for adults with intellectual disabilities.

Methods  Individuals referred for bereavement group therapy were interviewed and assessed prior to their participation in the group. Measures of depression, anxiety, and knowledge of death and bereavement issues were administered before and after group participation.

Results  Scores for depression were significantly lower following group participation. However, scores for anxiety were mild and not significantly reduced. The participants' understanding and knowledge of the bereavement process did not improve significantly. When those with single and dual diagnosis were considered separately, those with a dual diagnosis experienced a significant decrease in depression, while those with a single diagnosis did not. Furthermore, depression scores for those with a dual diagnosis were generally higher.

Conclusions  The present preliminary investigation of therapeutic outcomes for bereavement group intervention suggests little change in anxiety and knowledge of death/bereavement issues, but significant improvement in symptoms of depression for participants, particularly those with a dual diagnosis. The weaknesses of the present study are discussed along with possible improvements for future studies.
Integration of Recent Reviews on Offenders with Intellectual Disabilities
Authors: Lindsay William R.
Published: March 2003

Background  Over the last 20 years, the interest in and amount of research relating to offenders with intellectual disability has increased.

Methods  Using a series of databases and less formal library searches, 11 articles that review across aspects of offenders and offending were considered. Reviews that considered only single aspects of offending or single offender groups were not included in this paper.

Results  The reviews highlight the following issues: epidemiology of offending and offenders; vulnerability; remedial and preventative intervention; and assessment of the offence. Issues of the importance of families and carers, female offenders, recidivism/outcome and research were also mentioned.
Staff Activity in Supported Housing Services
Authors: Felce David , Lowe Kathy , Jones Edwin
Published: March 2003

Background  Variation in staff performance between small community housing services indicates the need for research on the factors which predict high‐quality care.

Methods  The associations between service sector, staffing levels, staff characteristics, internal organization or working practices, non‐institutional milieu, and staff activity and the nature and extent of staff attention to residents were explored in a study of 10 statutory, 10 voluntary and nine private sector community housing schemes.

Results  There were few significant differences between sectors after differences in resident abilities were taken into account. Higher staff to resident ratios predicted greater resident receipt of attention and assistance but also a lower proportion of time during which each member of staff was directly concerned with residents. A greater range in resident ability predicted lower resident receipt of attention and assistance. A higher proportion of qualified staff was not shown to be a positive attribute but greater prior experience was associated with staff spending more time directly concerned with residents, less time doing ‘other’ activity and residents receiving more assistance. Measures of the internal organization and non‐institutional milieu of the settings were not strongly related to staff activity.

Conclusions  The findings are consistent with previous research that there are diminishing marginal returns associated with increasing staff. Size of residence was unimportant. Links between service organization and staff performance require further research but retaining experienced staff appears to be important. As resident receipt of attention and assistance was unrelated to their adaptive behaviour level, there is a need to find ways to ensure that staff support matches the needs of residents better.
Interpretation of pulsatility index in feeder arteries to low‐impedance vascular beds
Authors: Gosling R. G. , Lo P. T. S. , Taylor M. G.
Published: March 2003

A simple electrical circuit is proposed as a model for peripheral vascular beds of low impedance. The model consists of a flow and pressure source, i.e. the ‘feeder’ artery, with the vascular bed represented by a Zener diode Z giving rise to a ‘back pressure’ Pz and a pure resistance R. By applying Ohm's law to the definition of pulsatility index PIflow of flow in the feeder artery, it is shown that PIflow is dependent only on the mean blood pressure (input), the pulse pressure and Pz, and is independent of R.

For those vascular beds where the impedance is largely resistive, e.g. the brain, the kidney and the uterine‐placental complex, it is suggested that Pz may be a more useful characterizing parameter than the value of PIflow as at present used by some workers. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
The value of ultrasonic examination to detect and diagnose breast carcinomas. Analysis of the results obtained in 125 tumors using radiographic and ultrasound mammography
Authors: Rotten D. , Levaillant J. M.
Published: March 2003

A series of 125 breast carcinomas studied by both radiological and ultrasound mammography, and which were observed in 102 patients, is presented. Of the lesions, 76.5% were less than 20 mm in diameter, and 16.8% had a diameter 10 mm or less. Sixteen lesions were in situ or microinvasive. Analysis of the results shows a 40.8% rate of false‐negative results with radiological mammography, when only ‘highly suspicious’ and ‘suspicious’ images are considered. This figure is reduced to 28% when ‘benign‐appearing’ masses are included in the computation. Using similar diagnostic categories, the false‐negative rates obtained with ultrasound mammography were 14.4% and 12.8%, respectively. Combining radiological and ultrasound mammography resulted in a dramatic decrease in the false‐negative rate to 4% The number of false‐negative results observed with either radiological or ultrasound mammography was in the higher range of reported values when compared to selected studies. However, they may, in fact, closely reflect the real performance of these investigations, as they are available to patients in everyday clinical practice.

Analysis of the data shows that radiological mammography is less efficient in younger patients. The mean age of the patients in the radiological mammography positive group was 54.3 ± 1.2 years, as opposed to 47.5 ± 2.1 (p = 0.004) in the radiological mammography negative group. In contrast, the efficiency of ultrasound mammography is independent of the patient's age, and con sequently of breast density. In this series, no obvious size effect was apparent on tumor visibility using either imaging modality.

The present study shows that the false‐negative rate of radiological as well as ultrasound mammography is higher than usually perceived. Given the complementarity of radiological and ultrasound mammography, their combination proves highly sensitive and highly specific. However, this conclusion will only apply when both breasts are examined completely, but not when ultrasound examination of the breasts is restricted to the imaging of an anomaly detected with radiological mammography. The time needed to perform a complete breast examination reduces its potential use in a screening program. On the other hand, its use appears of major relevance in patients with breasts where the performance of radiological mammography is questionable, such as younger women, or women with dense breasts. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Fetal echocardiography and color Doppler flow imaging: the Rotterdam experience
Authors: Stewart P. A. , Wladimiroff J. W.
Published: March 2003

The adjunctive role of Doppler color flow mapping in the evaluation of cardiac structures and function was studied in 440 normal fetuses between 17 and 22 weeks of gestation (median, 20 weeks) and in 73 fetuses with suspected congenital heart disease between 16 and 38 weeks of gestation (median, 28 weeks). Flow through atrioventricular and arterial valves was generally easy to identify and identification was successful in approximately 90% of the normal fetuses. Flow in the pulmonary veins and through the foramen ovale was visualized in approximately 60% of normal cases. In the group with suspected congenital heart disease, Doppler color flow imaging provided additional information on both cardiac structure and function in 34 fetuses, on function alone in 13 fetuses and on structure alone in 20 fetuses. No additional information was collected in six fetuses. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Blood flow velocity in the uterine and ovarian arteries during the normal menstrual cycle
Authors: Sladkevicius P. , Valentin L. , Maršál K.
Published: March 2003

Twelve healthy women with regular menstrual cycles were examined with a combination of two‐dimensional real‐time ultrasound and color and spectral Doppler techniques on cycle days 4 and 8 and daily from cycle day 12 until follicular rupture, then days + 1, +2, +5, +7 and +12 after follicular rupture. The uterine and subendometrial arteries, arteries in the ovarian stroma and hilum, in the wall of the largest follicle of each ovary, and in the wall of the corpus luteum were examined. The pulsatility index and the time‐averaged maximum velocity were calculated. In the uterine arteries the pulsatility index was highest on day + 2, after which it decreased successively to its lowest value, whereas the time‐averaged maximum velocity reached its highest value on day + 12. Similar changes were observed in the subendometrial arteries. In the non‐dominant ovary, neither the pulsatility index nor the time‐averaged maximum velocity manifested any consistent changes during the cycle. In the dominant ovary, the time‐averaged maximum velocity increased and the pulsatility index decreased after follicular rupture, being significantly higher and lower, respectively, in the luteal than in the follicular phase. These changes were seen in the ovarian hilum, stroma and follicular wall, but were most obvious in the wall of the dominant follicle and of the corpus luteum. We conclude that the blood circulation in the uterus and in the dominant ovary changes considerably during the menstrual cycle, whereas that in the non‐dominant ovary shows no unequivocal changes. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Biometric measurements in fetuses of different race and gender
Authors: Bromley B. , Frigoletto F. D. , Harlow B. L. , Evans J. K. , Benacerraf B. R.
Published: March 2003

Sonographic fetal biometric measurements on 6082 low‐risk patients were compared in the second and third trimesters of pregnancy with respect to fetal race and gender. Ultrasonic measurements were obtained from fetuses of women participating in the Routine Antenatal Diagnostic Imaging with Ultrasound Study (RADIUS), who underwent both an early sonographic evaluation between 15 and 22 weeks' gestation and a later scan between 31 and 35 weeks' gestation. In the 16–21‐week scans, male fetuses had significantly larger biparietal diameter measurements compared to female fetuses (estimated difference 0.852 mm, 95% CI 0.737–0.967). There was only minimal difference in biparietal diameter between Black and White fetuses. Femur length was similar in both female and male fetuses, but longer in Black compared to White fetuses (estimated difference 0.808 mm, 95% CI 0.539–1.078).

During the 31–35‐week scans, male fetuses continued to have larger biparietal diameter measurements compared to female fetuses (estimated difference 1.22 mm, 95% CI 1.04–1.40), and femur lengths were persistently longer in Black compared to White fetuses (estimated difference 0.563 mm, 95% CI 0.234–0.893).

Further investigation is necessary to evaluate the effect of these slight differences in morphometric fetal measurements between races and genders, so that we can determine how best to use them for optimizing prenatal care. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis and fetal outcome of cystic adenomatoid malformation of the lung: case report and historical survey
Authors: Roelofsen J. , Oostendorp R. , Volovics A. , Hoogland H.
Published: March 2003

Diagnostic ultrasound allows prenatal diagnosis of cystic adenomatoid malformation of the lung from the second trimester onwards throughout pregnancy. If the diagnosis is made before the 24th week of pregnancy, counselling often results in termination of pregnancy. Whether or not this attitude is in agreement with good medical practice is discussed on the basis of our own experience and a review of the literature. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Expectant management of interstitial pregnancy
Authors: Zalel Y. , Caspi B. , Insler V.
Published: March 2003

A case of interstitial pregnancy is described. Transvaginal ultrasound examination, performed at 8 weeks' gestation, revealed an empty endometrial cavity with an eccentric gestational sac in the left uterine corner, with a clear separation between the uterine cavity (endometrium) and the gestational sac. Expectant management, consisting of repeated sonographic examinations and assessment of serum β‐human chorionic gonadotropin, resulted in a favorable outcome. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Blood flow velocity in the uterine and ovarian arteries during menstruation
Authors: Sladkevicius P. , Valentin L. , Maršál K.
Published: March 2003

Eleven healthy women with regular menstrual cycles were examined with a combination of two‐dimensional real‐time ultrasound and color and spectral Doppler techniques on the 7th day after follicular rupture, and on the 1st, 2nd, 3rd and 4th days of menstrual bleeding. Both uterine arteries, arteries in the stroma and hila of both ovaries, in the wall of the largest follicle of the non‐dominant ovary and in the wall of the corpus luteum were examined with the Doppler technique. The pulsatility index (PI) and the time‐averaged maximum velocity were calculated. In the uterine arteries, the PI was highest on the first day of menstrual bleeding (median PI 3.2 for the dominant and 3.0 for the non‐dominant uterine artery), after which it decreased to its lowest values on the second day (median PI 2.1 and 1.8, respectively) and third day (median PI 2.2 and 2.1, respectively). The time‐averaged maximum velocity reached its highest value on the second and third days of menstruation. The corpus luteum was still visible on the first day of menstrual bleeding in all women, and on the second day in five. It was indistinguishable on the third and fourth days of menstruation in all women. In the dominant ovary, the time‐averaged maximum velocity of flow in the arteries in the ovarian hilum decreased during menstrual bleeding and was lower during menstruation than in the preceding luteal phase. In the non‐dominant ovary, neither the PI nor the time‐averaged maximum velocity manifested any consistent changes during the period studied. We conclude that substantial changes in PI and time‐averaged maximum velocity occur in the uterine arteries and in the arteries of the dominant ovary during menstruation. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Differential diagnosis of breast lesions by color Doppler
Authors: Madjar H. , Prömpeler H. J. , Sauerbrei W. , Mundinger A. , Pfleiderer A.
Published: March 2003

Color Doppler allows flow detection in small tumor vessels. Due to the vascularity associated with the growth of malignancies, this method can be used to differentiate between benign and malignant breast lesions. In order to study the typical flow characteristics, we investigated multiple Doppler flow parameters. A UM9 HDI (ATL) was used with a linear transducer L 10‐5. The number of tumor vessels and the mean, maximum and total flow velocity were measured in 325 benign and 133 malignant lesions and showed highly significant differences (p < 0.0001). Flow profiles (resistance index and systolic/diastolic frequency ratio) showed a large overlap and did not allow accurate tumor differentiation when mean and minimum values were analyzed. Surprisingly, the maximum resistance index and systolic/diastolic frequency ratio were significantly higher in carcinomas than in benign lesions, but the overlap of the values was wider than the flow velocity measurements. Using the vessel number and the total tumor vascularity, 90% of all lesions could be differentiated. A difficulty that we encountered was that a few cancers have very low flow values and some of the proliferative benign lesions can have increased flow. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The prenatal sonographic appearance of enteric duplication cysts
Authors: Richards D. S. , Langham M. R. , Anderson C. D.
Published: March 2003

Enteric duplication cysts are rare lesions, and relatively few cases have been diagnosed prenatally. We report two cases with a distinctive presentation. One, a duplication of the antrum of the stomach, was adjacent to an extralobar pulmonary sequestration. The other, a duodenal duplication, appeared as a thick‐walled right lower quadrant cyst. We observed distinct peristalsis in this cyst, a finding that helped us make a firm diagnosis of enteric duplication. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Spontaneous resolution of non‐immune hydrops fetalis secondary to transplacental parvovirus B19 infection
Authors: Bhal P. S. , Davies N. J. , Westmoreland D. , Jones A.
Published: March 2003

We report a case of hydrops fetalis secondary to transplacental parvovirus B19 infection, in which spontaneous resolution of the hydrops occurred 4 weeks after the initial presentation. This case emphasizes the role of conservative management based one ultrasound evidence of continued resolution of the hydrops and intrauterine growth retardation. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography of the endometrium in a representative sample of postmenopausal women
Authors: Gull B. , Karlsson B. , Milsom I. , Wikland M. , Granberg S.
Published: March 2003

The aim of this study was to assess endometrial thickness using transvaginal sonography in a representative sample of postmenopausal women and to evaluate whether the technique can be used for screening of endometrial cancer. A random sample (n = 1000) of the total population of women aged 45–80 years resident in the city of Göteborg in 1993 was invited to attend for transvaginal sonography. The only exclusion criterion was hysterectomy. Transvaginal sonography was performed in 827 women. An endometrium of ≤ 4 mm was not investigated further. Women with an endometrium of 5–7 mm and non‐measurable cases were re‐assessed 1 year later, and women with an endometrial thickness of ≥ 8 mm were investigated directly with hysteroscopy and/or dilatation and curettage. A total of 559 women were postmenopausal and 183 were taking some form of hormonal substitution (33%). One case of endometrial cancer (endometrial thickness 19 mm), 23 cases of polyps without atypia (endometrial thickness 8–18 mm) and no cases of endometrial hyperplasia were diagnosed. Endometrial thicknesses were as follows (mean ± SEM; respectively grouped as ≤ 4 mm, 5–7 mm and ≥ 8 mm): total population of postmenopausal women (3.4 ± 0.1 mm, 82%, 13% and 6%); postmenopausal women without estrogens (3.0 ± 0.1 mm, 90%, 7% and 3%); postmenopausal women on medium‐potency estrogens + gestagen (5.1 ± 0.3 mm, 49%, 40% and 11%) and women with low‐potency estrogens only (3.6 ± 0.3 mm, 85%, 6% and 9%). The prevalence of endometrial cancer was 0.2% and for benign polyps 3.2% in this representative sample of postmenopausal women. Our results do not support generalized endometrial screening with transvaginal sonography. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Multiple intracardiac tumors: spontaneous prenatal recovery of fetal bradyarrhythmia
Authors: Cha'ban F. K. , Cohen‐Overbeek T. E. , Frohn‐Mulder I. M. , Wladimiroff J. W.
Published: March 2003

Although prenatally detected intracardiac tumors are reported to have a poor prognosis, tumor regression and even tumor disappearance have been observed during childhood. A case of prenatal cessation of fetal cardiac tumor growth and return of cardiac arrhythmia to normal sinus rhythm is presented. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Abnormal fetal aortic velocity waveform and intellectual function at 7 years of age
Authors: Ley D. , Tideman E. , Laurin J. , Bjerre I. , Marsal K.
Published: March 2003

Measurements of fetal aortic blood flow velocity and fetal growth were performed in 178 pregnancies. In 87 cases, the estimated fetal weight was > 2 SD below the gestational age‐related mean of the population. Three fetuses died in utero. In 148 children (84%) an assessment of overall intellectual ability was performed at 6.5 years of age.

Verbal and global IQ was lower in the group with an abnormal fetal aortic blood flow velocity waveform (mean ± SD 96.0 ± 17.7 and 95.9 ± 15.7, respectively; n = 41) compared to the group with a normal waveform (102.1 ± 12.2 and 102.9 ± 13.2, respectively; n = 105; p < 0.05). Logistic regression analysis revealed that abnormal fetal aortic velocity waveform, both independently and in combination with other factors, was a significant predictor of impaired intellectual outcome.

The association found between abnormal fetal aortic velocity waveform and impaired intellectual outcome suggests that hemodynamic evaluation of the fetus has a predictive value regarding postnatal intellectual development. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Isolated fetal pyelectasis: assessment of risk for postnatal uropathy and Down syndrome
Authors: Wickstrom E. , Maizels M. , Sabbagha R. E. , Tamura R. K. , Cohen L. C. , Pergament E.
Published: March 2003

Eighty‐two consecutive fetuses with ultrasound evidence of isolated pyelectasis (defined as dilatation in the anteroposterior renal pelvic dimension of ≥ 4 mm) were prospectively followed to determine the risk for postnatal uropathy and Down syndrome. In 98 (60%) kidneys, isolated pyelectasis was shown to be the first manifestation of a pathophysiological process that evolved into a gamut of postnatal uropathies (defined as urological conditions requiring remedial surgery or extended medical surveillance). Data quantifying the risk for postnatal uropathy in fetuses with varying degrees of isolated pyelectasis, at different gestational ages, are presented in figure format to facilitate prenatal counselling. Bivariate analysis showed that the evolution of isolated pyelectasis to uropathy was statistically significant when in utero progression was noted or in conjunction with other findings including contralateral pyelectasis (p < 0.01), male gender (p < 0.01) and increased kidney length (p < 0.001). Importantly, 55% of the infants requiring corrective surgery demonstrated in utero progression of pyelectasis (p < 0.002). Serial ultrasound examinations were necessary to evaluate progression or regression in the extent of pyelectasis. Finally, isolated pyelectasis was associated with an increased risk for Down syndrome, beginning at maternal age of 31 years, in the interval of 16–20 weeks' gestation. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Doppler assessment of flow velocity in the uterine artery during pubertal maturation
Authors: Laursen E. Mosfeldt , Holm K. , Brocks V. , Jarden M. , Müller J.
Published: March 2003

The aim of this study was to investigate the possible changes in uterine artery flow velocity during puberty and young adulthood.

In a cross‐sectional study, 133 healthy volunteers aged 6.7 to 25.4 years were investigated. Pubertal development according to the Tanner classification was recorded in each subject. Uterine arteries were visualized by transabominal color‐coded ultrasound. Maximum, minimum and time averaged maximum flow velocities were measured and the pulsatility index (PI) was calculated electronically.

When flow velocity was compared between patients at different rates of pubertal development, we found that the average velocity increased from Tanner breast stages I and II to V, followed by a slight decrease in adults (p < 0.0001). The PI varied significantly from stage I to adult (p < 0.0001). The PI was similar in breast stage I, stage II and in adults, with median 4.7 (range 2.7–8.5), 6.1 (range 3.0–7.8) and 4.3 (range 1.9–8.1), respectively. The PI decreased in stages III and IV to 2.6 (1.8–8.4) and 2.8 (1.2–7.9), respectively, whereas stage V was intermediate, at 3.7 (1.1–6.3). The variance of PI was independent of age.

In summary, we demonstrated a significant increase in the uterine artery flow velocity during puberty. Furthermore, a significant decline in vascular resistance expressed by the PI was observed in the mid‐pubertal period, reflecting increasing blood flow to the rapidly growing uterus. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The reproductibility of the results of transvaginal sonography of the uterus in patients with abnormal uterine bleeding
Authors: Emanuel M. H. , Ankum W. M. , Verdel M. J. C. , Hart A. A. M.
Published: March 2003

Our objectives were to determine the reproducibility, or interobserver agreement, of transvaginal sonographic imaging of the uterus in patients with abnormal uterine bleeding and to identify the effect of observer experience.

Transvaginal ultrasound findings of 235 patients with abnormal uterine bleeding were recorded systematically on videotape. Recordings were reviewed by three observers who had different levels of experience, and who were asked to judge the endometrium/uterine cavity and myometrium separately as being normal, abnormal or inconclusive, according to predefined criteria. Reproducibility was expressed by the observed rates of interobserver agreement and by kappa statistics. The differences in agreement between observer pairs were analyzed by means of McNemar's χ2 test.

The observed rates of agreement for the judgement of the endometrium/uterine cavity varied from 0.85 to 0.89, with a kappa value ranging from 0.70 to 0.78 between observers. The judgement of the myometrium resulted in agreement rates of 0.86–0.91 and kappa values of 0.67–0.80. Although the effect of experience was evident, the differences in agreement between observers were not significant (p > 0.01).

The reproducibility of the results of transvaginal sonography of the uterus in patients with abnormal uterine bleeding was good. Observations of the endometrium/uterine cavity with a normal appearance were the most highly reproducible, with the smallest effect of observer experience. This may reduce the need for invasive diagnostic procedures in patients with abnormal uterine bleeding. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Successful transvaginal ultrasound‐guided puncture and injection of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy and a history of a previous cervical pregnancy
Authors: Monteagudo A. , Tarricone N. J. , Timor‐Tritsch I. E. , Lerner J. P.
Published: March 2003

Cervical pregnancy is a rare type of ectopic pregnancy. A recurrent cervical pregnancy in conjunction with a viable intrauterine pregnancy is an even rarer event. We present a case in which a recurrent cervical pregnancy was treated by selective reduction using an injection of potassium chloride guided by transvaginal sonography. The intrauterine gestation was delivered at a gestation of 34 weeks and 4 days by Cesarean section. Subsequently, the patient was treated with intramuscular methotrexate with a prolonged, but complete, resolution of the cervical pregnancy. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal power Doppler angiography of the fetal brain
Authors: Pooh R. K. , Aono T.
Published: March 2003

Using transvaginal B‐mode sonography combined with power Doppler flow mapping on a total of 6.5 fetuses between 12 and 30 weeks of gestation, fetal intracerebral arteries and veins and blood flow were demonstrated in the coronal and sagittal planes. Clear images of the fetal brain and intracerebral vascular flow were obtained in 36 of the 65 cases. Bilateral vertebral arteries, the basilar artery and posterior cerebral arteries were imaged in the coronal plane at 12 weeks of gestation. Bilateral carotid and middle cerebral arteries were also depicted in the coronal plane at 13 weeks of gestation. The middle cerebral arteries and their branches were depicted via the anterior fontanelle in the coronal plane at 20 weeks of gestation. The anterior cerebral artery and its branches were demonstrated in the sagittal plane at 26 weeks of gestation. The fetal cerebral venous systems of the superior sagittal sinus, internal cerebral vein, vein of Galen and straight sinus were clearly imaged in the mid‐sagittal plane. Although we encountered several problems with this new technology of transvaginal power Doppler sonography, we were able to demonstrate its potential to assess fetal intracranial blood flow during pregnancy. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Early ultrasound diagnosis and follow‐up of molar pregnancies
Authors: Jauniaux E. , Nicolaides K. H.
Published: March 2003

The objective of this study was to investigate the role of ultrasound in the differential diagnosis and management of early pregnancies presenting with placental molar changes. Placental features were recorded over a 10‐month period in women undergoing ultrasound examination at 10–14 weeks of gestation. In cases of a molar pregnancy, the fetal karyotype was obtained in utero and, if tbe pregnancy continued, the maternal concentration of human chorionic gonadotropin (hCG) and uterine artery resistance to flow were measured serially. A histopathological examination of the placenta was performed in all cases after delivery. During the study period, 9425 women had an early scan and 11 molar pregnancies were identified including one classical mole, four hydatidiform moles coexisting with a normal pregnancy, three partial triploid moles and three partial moles associated in one case with a fetus presenting congenital anomalies diagnostic of Beckwith– Wiedemann syndrome. The hCG levels were high in all cases except one case of triploidy and remained high during the rest of the pregnancy in cases of hydatidiform moles coexisting with a fetus. In these cases, the uterine artery resistance was normal. The present data indicate that placental ultrasound examination can correctly identify molar changes in early pregnancy and together with hCG level and uterine Doppler measurements can establish the differential diagnosis in utero of the various forms of placental molar transformations. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Fetal heart volume assessment by three‐dimensional ultrasound
Authors: Chang F.‐M. , Hsu K.‐F. , Ko H.‐C. , Yao B.‐L. , Chang C.‐H. , Yu C.‐H. , Liang R.‐I. , Chen H.‐Y.
Published: March 2003

Heart volume may provide important information on the status of fetal hemodynamics. However, traditionally fetal heart volume has been assessed with the erroneous assumption that the fetal heart is spherical or elliptical. With the advent of three‐dimensional ultrasound, accurate assessment of organ volume has become feasible. The objectives of this study were to compare the reproducibility of two‐dimensional ultrasound and three‐dimensional ultrasound in the assessment of heart volume, and to test whether heart volume assessed by the traditional method of two‐dimensional ultrasound equates to that assessed by three‐dimensional ultrasound. If it proved to be significantly different, we aimed to find a new constant which, if incorporated into the traditional formula used to determine heart volume, would enable us to achieve more accurate volumes with two‐dimensional ultrasound. In total, 50 normal singleton fetuses ranging from 20 to 30 weeks' gestation were included in the study. Both the traditional two‐dimensional and the new three‐dimensional volume measurements were compared. The results showed that three‐dimensional ultrasound has a better reproducibility than two‐dimensional ultrasound in heart volume assessment and that heart volume assessed by the traditional formula of two‐dimensional ultrasound is significantly larger than that measured by three‐dimensional ultrasound (p < 0.001). We therefore propose that, if the traditional two‐dimensional equation is to be used, the constant for heart volume could be modified to 0.4563 (SE = 0.0153, n = 50) to achieve more accurate results. With this new constant, the heart volume derived by two‐dimensional ultrasound was not found to differ from that measured by three‐dimensional ultrasound. From our series, we conclude that three‐dimensional ultrasound is theoretically the best method for the assessment of heart volume. However, because of the limitations of three‐dimensional ultrasound (i.e. it is not routinely available, it is more expensive and more time‐consuming) two‐dimensional ultrasound in practical terms should be the method of choice. Although we were able to improve the accuracy of the heart volume measurements using a new constant in the traditional two‐dimensional formula, the new constant will not improve variability, which can only be reduced by three‐dimensional ultrasound. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology