bluuebunny/crossref_metadata_2025 huggingface dataset:
The Merkel cell carcinoma: survival and oncogene markers
Authors: Jemec B , Chana J , Grover R , Grobbelaar Ao
Published: March 2003

Background Merkel cell carcinoma (MCC) is a rare and malignant tumour. Survival data and prognostic factors are scarce.

Aim To investigate the usefulness of biological markers to predict the prognosis for these aggressive tumours.

Methods C‐myc oncoprotein and proliferation was analysed in specimens from 13 patients with MCC, treated between 1983 and 1997. The average age at presentation was 68.3 years. Overall follow‐up ranged from 14 to 158 months, with a mean of 68.2 months. Specimens were analysed by immunohistochemistry for proliferation (mib‐1) and flow cytometry for oncogene activity (c‐myc).

Results The median positivity was 52% for the c‐myc oncogene and 50% for proliferation, but these did not correlate to survival as analysed by the Kaplan–Meier method. Other parameters such as median age at presentation, sex, site of tumour and adjuvant radiotherapy were also analysed, but none were found to be significant.

Conclusions This study showed that neither c‐myc oncogene activity or mitotic index in MCC can be related to patient survival.
Familial erythromelanosis follicularis and chromosomal instability
Authors: Tüzün Y , Wolf R , Tüzün B , Özdemir M , Demirkesen C , Deviren A , Kotogyan A
Published: March 2003

We report a 17‐year‐old male patient with erythromelanosis follicularis faciei et colli (EFFC), oral leucokeratosis and diabetes mellitus without islet cell antibody. His sister also had minimal findings of EFFC and minimal follicular papules on her shoulders and extensor surfaces of the arms. The father had only fine follicular papules, but no erythromelanosis. Skin and mucous membrane lesions of the proband were investigated histopathologically. Interestingly, in peripheral lymphocyte cultures of the family members, chromosomal breakage was not observed spontaneously, but it was seen with nitrogen mustard, although this disease may be of autosomal recessive inheritance. Thus, we suggest that EFFC may be a polyaetiological disorder (i.e. familial and environmental) and might be considered one of the chromosomal instability syndromes.
Personality dimensions of sexually transmitted disease repeaters assessed with the Millon Clinical Multiaxial Inventory
Authors: Bjekíc M , Lecic‐Toševski D , Vlajinac H , Marinkovíc J
Published: March 2003

Objective To assess the personality characteristics of patients with repeated sexually transmitted diseases (STD).

Method A case–control study comparing 101 STD repeaters (subjects with a lifetime history of three or more STDs) with 182 controls who had no history of STD. All subjects attended the City Department for Skin and Venereal Diseases in Belgrade (Yugoslavia) from June 1997 to April 1998. Personality characteristics was assessed by the Millon Clinical Multiaxial Inventory (MCMI).

Results The analysis of MCMI test showed that STD repeaters had higher scores on narcissistic, antisocial and paranoid scales. The difference between STD repeaters and the controls was significant on antisocial, psychotic thinking and psychotic delusion scales, although scores on clinical syndromes were low for both cases and controls. Discriminant analysis showed that antisocial personality was predictive for STD repeaters.

Conclusions This study support the hypothesis that STD repeaters are different from controls in terms of their psychological characteristics. The behaviour of STD repeaters is ego–syntonic, which makes the treatment of their personality difficult and emphasizes the importance of work on primary and secondary prevention of STD.
The importance of accurate dosage of topical agents: a method of estimating involved area and application to calcipotriol treatment failures
Authors: Osborne JE , Hutchinson PE
Published: March 2003

Little attention is given to accurate dosage of topical medication which is a potential source of side‐effects and treatment failure. There are studies on the dosage for ‘sparing’ application relevant to topical steroids but not for ‘liberal’ application. Though calcipotriol is a first line topical treatment for psoriasis, approximately one‐third of patients do not respond adequately. The aims of the present study were to define liberal dosage, to develop a method of calculation of area of involved skin and to evaluate the efficacy of calcipotriol in optimized liberal dosages, based on preliminary studies, in calcipotriol treatment failures. Weight/unit area of ointment and cream base, constituting liberal application, was determined in six normal volunteers. The area of psoriatic involvement in 24 calcipotriol non‐responders was estimated by a ‘fill‐up’ method and a modified ‘hand’ method. The results of the two methods were similar (Pearson correlation coefficient 0.68, P < 0.0001) but the ‘hand’ method proved easier in use and was the preferred method for the rest of the study. The patients applied calcipotriol at their accustomed rates for at least 2 weeks and then at the calculated liberal rates, using cream in the morning and ointment at night, for 4 weeks. The efficacy measures were Psoriasis Area and Severity Index (PASI) (primary measure), a four‐point efficacy score and a visual analogue scale. As a result of the preliminary study and the actual amounts used by the patients in the psoriasis treatment study reported below, liberal application has been defined as 50 g/m2 per application for ointment base and 40 g/m2 per application for cream. At this dosage, an average individual would use ≈ 100 g of medication/week to treat 10% of the body surface. During the 4‐week treatment study, the psoriasis patients used an average of 39 g (SD 17 g)/m2 per application of cream and 52 g (SD 13 g)/m2 per application of ointment. All efficacy measures showed marked improvement (P < 0.0001). The frequency distribution of the PASI reduction defined responsive (70% of patients) and poorly responsive groups (30%), with mean PASI reduction of 60% and 17%, respectively.
Pre‐operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images
Authors: Carli P , De Giorgi V , Argenziano G , Palli D , Giannotti B
Published: March 2003

Background Epiluminescence microscopy (ELM) (dermoscopy, dermatoscopy) is a technique for non‐invasive diagnosis of pigmented skin lesions that improves the diagnostic performance of dermatologists. Little is known about the possible influence of associated clinical features on the reliability of dermoscopic diagnosis during in vivo examination.

Objective To compare diagnostic performance of in vivo dermoscopy (combined clinical and dermoscopic examination) with that of dermoscopy performed on photographic slides (pure dermoscopy).

Design This case series comprised 256 pigmented skin lesions consecutively identified as suspicious or equivocal during examination in a general dermatological clinic. Clinical examination and in vivo dermoscopy were performed before excision by two trained dermatologists. The same observers carried out dermoscopy on photographic slides at a later time, and these three diagnostic classifications were reviewed together with the histological findings for the individual lesions. This was carried out in a university hospital.

Results In vivo
dermoscopy performed better than dermoscopy on photographic slides for classification of pigmented skin lesions compared with histological diagnosis, and both performed better than general clinical diagnosis.
In vivo
dermoscopic diagnosis of melanoma showed 98.1% sensitivity, 95.5% specificity and 96.1% diagnostic accuracy while dermoscopic diagnosis of melanoma on photographic slides was less reliable with 81.5% sensitivity, 86.7% specificity and 85.2% diagnostic accuracy. In particular, diagnosis of melanoma based on photographic slides led to nine false negative cases (three
in situ , six invasive; thickness ranges 0.2–1.5 mm).

Conclusions In vivo
dermoscopy, i.e. combined clinical and dermoscopic examination, is more reliable than dermoscopy on photographic slides. In clinical practice, therefore,
in vivo dermoscopy cannot be considered independent from associated clinical characteristics of the lesions, which help the trained observer to reach a more precise classification. This may have implications on the reliability of ELM diagnosis made by an observer not fully trained in the clinical diagnosis of pigmented skin lesions or by a remote observer during digital ELM teleconsultation.
The link between Helicobacter pylori infection and rosacea
Authors: Szlachcic A
Published: March 2003

Background Rosacea is a common condition of unknown aetiology that is usually accompanied by gastrointestinal symptoms and responds favourably to treatment with antibiotics.

Aims/methods This study was designed to examine the prevalence of gastric Helicobacter pylori (Hp) infection verified by 13C‐UBT, CLO‐test, Hp culture and serology (IgG and IgA) and the presence of Hp in the oral cavity evidenced by CLO‐test, Hp culture and saliva anti‐Hp antibodies (IgG and IgA). During gastroduodenoscopy antral and fundic biopsy samples were taken for histological evaluation (the Sydney system). This study was performed on 60 subjects 30–70 years old with visible cutaneous rosacea symptoms and 60 age‐ and gender‐matched controls without skin diseases but with dyspeptic symptoms similar to those of rosacea and without endoscopic changes in gastroduodenal mucosa (non‐ulcer dyspepsia – NUD).

Results The Hp prevalence in rosacea patients was about 88%, compared to 65% in the NUD controls. A noticeable number of rosacea patients showed chronic active gastritis predominantly in antrum but also in the corpus while those with NUD showed only mild gastritis confined to the antrum only. Following the initial examination, a typical 1 week systemic anti‐Hp therapy, including omeprazole (2 × 30 mg), clarithromycin (2 × 500 mg) and metronidazole (2 × 500 mg), plus gargling and application of metronidazole paste in the case of Hp oral cavity infection. After the application of the systemic and local therapy in the oral cavity, Hp was eradicated from the stomach in 97% and from the oral cavity in 73% of treated patients. Within 2–4 weeks, the symptoms of rosacea disappeared or decreased markedly in 51 subjects.

Summary We conclude that: (1) rosacea is a disorder with various gastrointestinal symptoms closely related to gastritis, especially involving the antrum mucosa; (2) the eradication of Hp leads to improvement of symptoms of rosacea and reduction in related gastrointestinal symptoms; (3) the lack of improvement of cutaneous symptoms in rosacea after eradication of Hp from the gastric mucosa could depend on bacteria in the oral cavity; and (4) rosacea could be considered as one of the extragastric symptoms of Hp infection probably mediated by Hp‐related cytotoxins and cytokines.
Pemphigus vulgaris: a review of treatment over a 19‐year period
Authors: Ljubojević S , Lipozenčić J , Brenner S , Budimčić D
Published: March 2003

Background Pemphigus vulgaris is an autoimmune blistering disease of the skin and mucous membranes with a high mortality if left untreated.

Objective We present a retrospective analysis of 159 patients with pemphigus vulgaris and pemphigus vegetans who were admitted to the Department of Dermatology and Venereology, Zagreb University Hospital Center (Zagreb, Croatia) from 1980 to 1998.

Results Female to male ratio was approximately 2 : 1. The mean age was 53 years. During the war years in Croatia (1991–95) we noticed a low incidence of pemphigus vulgaris, and from 1996 to 1998 the incidence almost doubled. Diagnosis was based on histopathology [showing typical pemphigus vulgaris changes in 156 (98%) patients], indirect immunofluorescence [positive in 122 (77%) patients], direct immunofluorescence [positive in 141 (89%) patients], and blister smear cytology (Tzanck test) [positive in 115 (72%) patients]. High dosages of prednisone (100–150 mg) were given to 129 patients, which was combined with azathioprine. Patients with refractory pemphigus vulgaris were treated with intramuscular gold (14 patients) and plasmapheresis (five patients). All patients were treated with local ointments. The prolonged use of high doses of corticosteroids and immunosuppressants caused several complications, in particular, steroid diabetes (37 patients), skin infections (26 patients), arterial hypertension (23 patients), cardiorespiratory diseases (22 patients), sepsis (nine patients), etc. During the hospital treatment, 14 patients died, 10 during 1980–89 and only four during the 1990–98 period. The main causes of death were cardiorespiratory failure (six patients) and sepsis (five patients).

Conclusions Although pemphigus vulgaris is still a life‐threatening disease, today it can be successfully treated with a combination of immunosuppressive agents. Early diagnosis and treatment of pemphigus vulgaris allow a better prognosis with lower mortality rates.
Pretibial myxoedema associated with Hashimoto's thyroiditis
Authors: Cannavò SP , Borgia F , Vaccaro M , Guarneri F , Magliolo E , Guarneri B
Published: March 2003

Pretibial myxoedema is a cutaneous mucinosis typically associated with Graves’ disease, although it may also develop in subjects with non‐thyrotoxic thyroid pathologies. This report presents a rare case of pretibial myxoedema occurring in a 58‐year‐old woman with biopsy‐proven Hashimoto's thyroiditis. The hypothetical pathogenetic link between the two disorders is discussed with particular attention to the role of thyroid stimulating hormone receptor antibodies.
Onychomycosis: strategies to improve efficacy and reduce recurrence
Authors: Gupta Ak , Baran R , Summerbell R
Published: March 2003

Fungal infections may be difficult to treat for several reasons. It is important to obtain the correct diagnosis, and select the appropriate antifungal agent and route. General considerations that may be associated with recurrent infections are, a genetic predisposition and suboptimal bioavailability of drug, resulting in insufficient concentration at the target site. The aetiologic organism, the severity of disease, other coexisting diseases, concomitant drug intake, and the presence of fungal infection at other sites are some factors that determine the choice of antifungal therapy and its route of administration, oral vs. topical lacquer. Local factors such as the thickness of the nail, presence of lateral onychomycosis, longitudinal spike, dermatophytoma and severe onycholysis are some factors that may determine the choice of secondary measures such as mechanical or topical treatment. Booster or supplemental therapy may be of benefit when the response to initial treatment is poorer than expected and unlikely to result in complete response. Steps should be taken to reduce the possibility of recurrence once cure has been achieved.
Bullous eosinophilic cellulitis (Wells’ syndrome) associated with Churg–Strauss syndrome
Authors: Schuttelaar M‐LA , Jonkman MF
Published: March 2003

We report a patient with Churg–Strauss syndrome (CSS) with asthma, eosinophilia, nasal polyposis and ANCA‐associated multisystem vasculitis, who's skin eruption started with erythematous urticarial‐plaques followed by haemorrhagic bullae. Histology of the plaques revealed ‘flame figures’ in the dermis with no granulomatous or vasculitic process, consistent with the diagnosis of eosinophilic cellulitis or Wells’ syndrome. The association of CSS and Wells’ syndrome observed in this patient may have a common pathogenesis. CSS may induce Wells’ syndrome by an unknown factor.
Family Control: The Views of Families Who have a Child with an Intellectual Disability
Authors: Knox Marie
Published: March 2003

This paper, reporting on part of a wider study, explores the views held by 68 families, who have a child with a disability, of their perceptions of lifestyle control or empowerment. In particular, the paper seeks to examine whether these families perceive their interactions with service providers to be consistent with family‐empowerment principles. Individual open‐ended interviews were conducted with these family members, yielding information on their perceptions of their control over their family lives, and on their views as to how their interactions with service providers might be conducted in such a way as to recognize and enhance such control. The implications for professionals working with families in a manner that recognizes family members as truly equal partners and that promotes and enhances genuine family empowerment are discussed.
Annual Primary Health Care Contacts by People with Intellectual Disabilities: a Comparison of Three Matched Groups
Authors: Halstead Simon M. , Bradley Frances , Milne Steven , Wright Elaine C. , Hollins Sheila C.
Published: March 2003

The use of primary care services by three matched groups of people with intellectual disabilities was compared over a period of one year. Differences in the patterns of provision were detected between hospital intellectual disability specialists and general practitioners. The degree of behavioural disturbance and disability of the subjects were found to be the most important predictors of primary care contact.
Cognitive–Behavioural Treatment of Anger Intensity among Offenders with Intellectual Disabilities
Authors: Taylor John L. , Novaco Raymond W. , Gillmer Bruce , Thorne Ian
Published: March 2003

Background  Aggressive behaviour has been identified as a significant problem amongst people with intellectual disabilities living in institutional settings. Anger is a key activator of aggressive behaviour, as well as being an important element of clinical distress related to adverse life experiences. There is some evidence for the value of cognitive–behavioural treatments for anger problems with people having intellectual disabilities. No controlled studies of anger treatment involving intellectually disabled offenders living in secure settings have been conducted to date. A pilot study of an elaborated anger treatment protocol for this client population was undertaken, comparing the specialised anger treatment with routine care.

Methods  Detained men with intellectual disabilities and histories of offending were allocated to specially modified cognitive–behavioural anger treatment (n = 9) or to routine care waiting‐list control (n = 10) conditions. Eighteen sessions of individual treatment were delivered over a period of 12 weeks. Treatment outcome was evaluated by participants' self‐report of anger intensity to an inventory of provocations and by staff‐ratings of the anger attributes of participants' ward behaviour.

Results  Participants' reported anger intensity was significantly lower following the anger treatment, compared to the routine care wait‐list condition. There were largely no treatment condition effects in staff‐rated anger. Limited evidence for the effectiveness of anger treatment was provided by the staff ratings of participant behaviour post‐treatment.

Conclusions  Detained offenders with intellectual disabilities can benefit from intensive individual cognitive–behavioural anger treatment. Further research is required to examine the mechanisms for change and their sustainability.
A Randomized Controlled Trial of the Efficacy of a Cognitive‐Behavioural Anger Management Group for Clients with Learning Disabilities
Authors: Willner Paul , Jones Jessica , Tams Rachel , Green Gill
Published: March 2003

Background  Fourteen clients with learning disabilities referred for anger management were randomly assigned to a treatment group and a waiting‐list control group.

Methods  Treatment consisted of nine 2‐h group sessions, using brainstorming, role‐play and homework. Topics addressed included: the triggers that evoke anger; physiological and behavioural components of anger; behavioural and cognitive strategies to avoid the build‐up of anger and for coping with anger‐provoking situations; and acceptable ways of displaying anger (assertiveness). The intervention was evaluated using two inventories of anger‐provoking situations, which were completed independently by both clients and carers.

Results  Clients in the treated group improved, on both self‐ and carer‐ratings, relative to their own pre‐treatment scores, and to the control group post‐treatment. The within‐group improvement corresponds to a ‘moderate’ (0.68 SD) effect size, whereas the between‐group improvement corresponds to a ‘large’ (1.76 SD) effect size. The degree of improvement during treatment was strongly correlated with Verbal IQ. Clients in the treated group showed further improvement relative to their own pre‐treatment scores at 3‐month follow‐up.

Conclusions  The treatment was effective in decreasing anger, in this randomized controlled trial of routine clinical practice.
Braxton‐Hicks contractions can alter uteroplacental perfusion
Authors: Bower S. , Campbell S. , Vyas S. , McGirr C.
Published: March 2003

Color flow imaging was used to study the effect of spontaneous low‐amplitude uterine contractions (Braxton‐Hicks) on flow velocity waveforms obtained from the main uterine artery in 13 women between 26 and 34 weeks' gestation. Eight women had abnormal waveforms, as defined by the presence of an early diastolic notch, and five women had normal waveforms. In the former group, three women with chronic hypertension were started on the calcium antagonist nifedipine during this study. Contractions, which were monitored by external tocography, occurred more frequently in the group with abnormal waveforms and were temporally associated with an increase in impedance to blood flow. This effect occurred to the same degree in both normal and abnormal groups, but in the abnormal group the already impaired blood flow to the intervillous space was further diminished, resulting in absence of forward flow in diastole. Such acute reductions of flow in response to frequent, impalpable uterine contractions may cause a prolonged and silent insult to uteroplacental perfusion, which could hasten fetal compromise. This effect appeared to be abolished in patients on nifedipine, suggesting a possible therapeutic role for this drug in uteroplacental insufficiency. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic depiction of postmenopausal endometrium with transabdominal and transvaginal scanning
Authors: Nasri M. N. , Shepherd J. H. , Setchell M. E. , Lowe D. G. , Chard T.
Published: March 2003

The thickness of the endometrium was measured in postmenopausal women by both the transvaginal and transabdominal ultrasound approaches in two separate groups of patients. The first group consisted of 90 women who received a transabdominal scan of the endometrium before dilatation and curettage or hysterectomy for either postmenopausal bleeding or uterine prolapse. The second group consisted of 111 women who underwent a transvaginal scan of the endometrium for similar postmenopausal conditions.

Both methods suggested that an endometrial thickness of 5 mm may be used as a cut‐off level in the conservative management of patients with postmenopausal bleeding or in a screening program for endometrial carcinoma.

Patient acceptance and image quality were better in the group examined transvaginally. The proximity of the transvaginal probe to the endometrium, in the absence of a full bladder compressing the endometrium, revealed a unique group of patients with atrophic endometrium but thick endometrial cavity caused by intracavity fluid. In the presence of uterine fibroids distorting the uterine cavity, transvaginal scanning was better than transabdominal scanning for visualizing the endometrium. The transabdominal full‐bladder technique can be of value in detecting asymptomatic bladder pathology. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Relationship between fetal acidemia at cordocentesis and subsequent neurodevelopment
Authors: Soothill P. W. , Ajayi R. A. , Campbell S. , Ross E. M. , Candy D. C. A. , Snijders R. M. , Nicolaides K. H.
Published: March 2003

To determine whether there is a relationship between chronic fetal acidemia and subsequent neurodevelopment, a follow‐up study was undertaken of 36 children with normal karyotype and morphology, who had prenatal cordocentesis for severe growth retardation. The main outcome measure was the Griffiths neurodevelopmental quotient. The children who had acidemia as fetuses (n = 13) had a significantly lower developmental quotient (mean = 91.8, SD = 6.3) than those with normal (n = 23) fetal blood pH (mean = 100.3, SD = 10.3; t = −2.68, p = 0.011). There was also a significant correlation between developmental quotient and the degree of fetal acidemia (r = 0.41, n = 36, p = 0.012). The pregnancies with acidemic fetuses had similar epidemiological characteristics to those with fetuses with a normal pH, except for a higher incidence of smoking. There was no significant correlation between the degree of growth retardation (birth weight expressed as multiples of SD from the mean for gestational age and sex) and fetal acidemia (r = −0.23, n = 36, NS) or subsequent Griffiths developmental quotient (r = −0.005, n = 36, NS).

The results show an association between chronic fetal acidemia and subsequent impaired neurodevelopment. This observation suggests that future preventative interventions may be possible. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Ectopic pregnancy: transvaginal sonographic findings of 152 cases
Authors: Ekici E. , Yapar E. G. , Gökmen O. , Danişman N. , Özmen S.
Published: March 2003

In a retrospective study performed on 152 cases of verified ectopic pregnancy, the features at transvaginal sonography were evaluated. A total of 146 (96%) of the patients had at least one abnormal sonographic feature and pelvic/cul‐de‐sac fluid was the most common finding, detected in all of the 146 patients. Pelvic/cul‐de‐sac fluid was particulate in 103 patients and simple in 43. Pelvic/cul‐de‐sac fluid together with extrauterine findings were found to be present in 93.8% (137/146) of the patients, suggesting the fact that if pelvic/cul‐de‐sac fluid was detected, every effort should be made to image the tube. The extrauterine transvaginal sonographic features included 102 (63.0%) patients with a mass, 60 (41.1%) with a gestational sac (with or without yolk sac or embryo), and eight (5.3%) with a living embryo. Comparison of the sonographic findings according to the status of the ectopic pregnancy revealed that particulate fluid (98.9%), and an extra‐uterine mass (88.2%) were the features that aided in the diagnosis of ruptured and aborted ectopic pregnancies, whereas an extrauterine gestational sac (72.9%), and a living embryo (11.9%) were associated with intact ectopic pregnancies. Our findings support the practice of using transvaginal sonography, and ß‐human chorionic gonadotropin measurements in the diagnosis and prediction of the status of ectopic pregnancy. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Routine ultrasonography in utero and speech development
Authors: Salvesen K. Å. , Vatten L. J. , Bakketeig L. S. , Eik‐Nes S. H.
Published: March 2003

The purpose of this paper is to examine a possible association between prenatal ultrasonography and delayed speech among children. A follow‐up study was carried out on primary school children born to women who took part in two randomized controlled trials of routine ultrasonography during pregnancy. Of 2428 eligible singletons, 2161 (89%) were followed up with a parental questionnaire and with information from maternal and child health centers. Parents assessed the development of speech during the childhood years and reported their observations in a questionnaire. Maternal and child health center records provided data on the children's development of speech and any referrals of children to a speech therapist. No significant differences between ultrasound‐screened children and their controls were found in the parental assessment of speech development. According to health center records, screened children were less likely to be referred to a speech therapist (odds ratio, 0.51; 95% confidence interval 0.31, 0.85), but there were no other significant differences in speech development as reported in the health center records. We conclude that routine ultrasonography in utero is not associated with delayed speech in children. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Characteristics of follicular evacuation during human ovulation
Authors: Hanna M. D. , Chizen D. R. , Pierson R. A.
Published: March 2003

Our objectives were to determine the rate and extent of follicular evacuation during human ovulation. Female volunteers were given 5000 or 10 000 IU human chorionic gonadotropin to induce ovulation when a follicle reached 18–20 mm. Ovulations were observed via transvaginal ultrasonography and recorded. Images were digitized for computer‐assisted analysis. Areas of the follicles, taken to reflect follicular volume, were measured at specific time intervals from the moment of the first leakage of fluid until complete follicular evacuation. Twenty‐five ovulations were visualized. In 23 cases (92%) all of the follicular fluid was expelled, but in two cases the follicle failed to empty completely. In all complete ovulations the initial fluid loss was rapid. The time to reach 70% evacuation was 0.9 ± 0.3 min (± SEM). The remaining fluid leaked out more slowly; the mean time to complete follicular evacuation was 6.1 ± 1.1 min. There was considerable variability in the rates of ovulation (range 6 s to 18.5 min). An association was observed between the type of stigma formed prior to ovulation and the initial rate of fluid loss. The data provide evidence of variability during follicular evacuation, which may in turn influence the successful expulsion of the oocyte from the follicle. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
The head‐to‐abdomen circumference ratio: a reappraisal
Authors: David C. , Gabrielli S. , Pilu G. , Bovicelli L.
Published: March 2003

Our objective was to assess the clinical significance of the sonographically derived head‐to‐abdomen circumference ratio in small‐for‐gestational‐age (SGA) fetuses. The head‐to‐abdomen ratio was determined in 134 singleton SGA fetuses without ultrasound evidence of malformations at 26–40 weeks' gestation. Data were collected regarding antenatal surveillance, umbilical artery Doppler velocimetry and neonatal outcome.

In SGA fetuses, the head‐to‐abdomen ratio, adjusted for gestational age, had a normal frequency distribution, positively skewed with regard to fetuses with normal birth weight. An elevated head‐to‐abdomen ratio was found in 56 SGA fetuses (42%), and was associated with increased perinatal mortality (odds ratio 3.27; 95% confidence internal 1.04–9.34), lower birth weight (1533 ± 635 g vs. 2022 ± 655 g, p < 0.0001) and lower gestational age at delivery (34 ± 3.6 weeks vs. 36.3 ± 3.6 weeks, p < 0.005). However, logistic regression revealed that the most powerful antenatal determinants of pregnancy outcome were Doppler velocimetry of the umbilical artery, followed by biophysical profile, while no independent correlation was found with the head‐to‐abdomen ratio.

The existence of two distinct categories of SGA fetuses, ‘symmetric’ and ‘asymmetric’, remains uncertain. An elevated head‐to‐abdomen ratio is an adverse risk factor for pregnancy outcome. However, this parameter has no clear‐cut clinical value when umbilical artery Doppler velocimetry and biophysical antenatal testing are available. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Biometry of the fetal cisterna magna: estimates of the ability to detect trisomy 18
Authors: Steiger R. M. , Porto M. , Lagrew D. C. , Randall R.
Published: March 2003

Measurements of the fetal cisterna magna were obtained from a prospective sample of patients undergoing diagnostic obstetric ultrasound examinations. These normal measurements were then compared to a retrospective sample of ultrasound scans from fetuses with the diagnosis of trisomy 18 by amniocentesis. The fetal cisterna magna increases in size throughout pregnancy. The sample from fetuses with trisomy 18 was different and had a higher rate of small and large cisterna magnas. After the two samples were mixed, it was determined that a cut‐off of 2.5 standard deviations for the fetal cisterna magna would give a sensitivity of 26.3%, specificity of 99.1%, positive predictive value of 50.0% and negative predictive value of 97.6% for trisomy 18. The probability that a fetal cisterna magna of abnormal size will predict trisomy 18 in an early second‐trimester ultrasound examination with the 2.5 standard deviation cut‐off was estimated at 0.019. A fetal cisterna magna that is of abnormal size appears to be of diagnostic value in identifying the fetus with trisomy 18, but its sensitivity is low. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Isolated pericardial effusion: an indication for fetal karyotyping?
Authors: Sharland G. , Lockhart S.
Published: March 2003

The outcome and associations of 35 consecutive cases of isolated pericardial effusion detected in the fetus are presented. In all cases included in the study, there was no evidence of a structural abnormality or a rhythm disturbance detectable antenatally. Karyotyping revealed that 26% of cases had trisomy 21 and 31% of the total had some form of chromosomal anomaly. Our study shows that the outlook for isolated pericardial effusion is good. However, there is a high incidence of associated karyotypic anomalies, in particular trisomy 21. Fetal karyotyping is therefore recommended in these cases. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prognostic value of transvaginal sonography in asymptomatic endometrial cancers
Authors: Osmers R. G. W. , Osmers M. , Kuhn W.
Published: March 2003

In the period between 1985 and 1991, 83 postmenopausal women with endometrial cancer were examined by transvaginal sonography. None of them were on hormone replacement therapy and all had amenorrhea of more than 2 years. Twenty‐two were asymptomatic and had an endometrial cancer detected by transvaginal sonography and 61 showed atypical bleeding as their only clinical symptom.

Women with asymptomatic endometrial cancers detected by transvaginal sonography exhibited significantly less mean myometrial tumor infiltration and more well‐differentiated tumors than those with atypical bleeding (4 mm and 45% compared with 10 mm and 18%, respectively). In 75% of the cases the estimation by transvaginal sonography of tumor stage completely agreed with the histological staging.

These preliminary data show that asymptomatic endometrial cancers screened by transvaginal sonography are likely to have a better prognosis than symptomatic cancers. Furthermore, transvaginal sonography can be used as a reliable tool for tumor staging prior to surgery or radiotherapy. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The length of human pregnancy as calculated by ultrasonographic measurement of the fetal biparietal diameter
Authors: Kieler H. , Axelsson O. , Nilsson S. , Waldenströ U.
Published: March 2003

Pregnancy length was calculated from ultrasonic measurement of the fetal biparietal diameter (BPD) in the second trimester and compared with the corresponding length calculated from the last menstrual period (LMP) in 86.5 women with exactly 28‐day cycles and spontaneous onset of labor. The effects of maternal age, parity, smoking and sex of the child on BPD‐based pregnancy length were evaluated in 1998 women with spontaneous onset of labor. The mean pregnancy length was 280.6 days when based on BPD and 283.4 days when based on LIMP. The corresponding median values were 281 days and 284 days, respectively. Probably because of more preterm deliveries, women below 20 years of age had a significantly shorter pregnancy length than women 20–34 years of age. Women carrying girls had a significantly shorter pregnancy length than women carrying boys. There was a tendency to shorter pregnancy lengths among multiparae and among smokers. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography in suspected pelvic inflammatory disease
Authors: Taipale P. , Tarjanne H. , Ylöstalo P
Published: March 2003

Transvaginal sonography was used in the evaluation of clinically suspected pelvic inflammatory disease (PID). A total of 86 patients with PID were examined by transvaginal sonography within l‐3 days, 14 days and 90 days after hospitalization. The diagnosis of PID was confirmed in 37% of patients by laparoscopy, laparotomy or positive cervical culture of Chlamydia trachomatis or Neisseria gonorrhoea. In the remainder, the diagnosis was based on tenderness of the uterus, fever and lower abdominal pain that responded rapidly to antibiotics. At the time of admission, 31% of patients had a thick‐walled (≥ 5 mm) echogenic tube raising the suspicion of pyosalpinx or pyo‐ovary. During the following 3 months, 52% of patients developed tubes that were thin‐walled (< 5 mm) and poorly echogenic, and hydrosalpinx was suspected. At the first transvaginal sonographic examination, 64% showed no adnexal mass, but 16% of these developed suspected hydrosalpinx during the following 3 months. Of the total of 86 patients, 6% exhibited a hydrosalpinx for the first time after 3 months. C‐reactive protein concentrations and sedimentation rate values correlated positively with the ultrasonically determined volumes of pyosalpinx/pyoovaries, cul‐de‐sac fluid and ovaries. Transvaginal sonography appears to be very useful in the diagnosis of suspected PID and is recommended at least 3 months after symptoms have subsided for those patients with an adnexal mass at the time of the acute episode and for infertile patients. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal inguinoscrotal hernia: prenatal diagnosis and pathogenetic evaluation
Authors: Paladini D. , Palmieri S. , Morelli P. M. , Forleo F. , Morra T. , Salviati M. , Zampella C. , D'Angelo A. , Martinelli P.
Published: March 2003

Congenital inguinal hernias, relatively common among infants, have rarely been reported in utero. In this brief report, the prenatal diagnosis of this condition based on movement of the intestinal content within the ileal loops is described. The differential diagnosis with other masses protruding from the abdominal wall (omphalocele) or the perineal region (sacrococcygeal teratoma, hydrocele) is discussed. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Penetration of the bladder by a perforating intrauterine contraceptive device: a sonographic diagnosis
Authors: Caspi B. , Rabinerson D. , Appelman Z. , Kaplan B.
Published: March 2003

We describe a case of penetration of the urinary bladder by an intrauterine contraceptive device with perforation of the uterine wall. This finding was discovered incidentally during an ultrasound examination for an earlier non‐specific mild abdominal pain of short duration. No abnormality had been noted on pelvic examination, during which the device's strings were found to protrude through the patient's cervix; a short laboratory workup including urinalysis, urine culture, blood count and blood sedimentation rate was also negative. The sonographic diagnosis was confirmed by cystoscopy. The device was retrieved transcervically. No complications were observed on follow‐up.

Bladder perforation by an intrauterine contraceptive device is very rare, and only a handful of such cases have been described. In all previous cases, the diagnosis followed a rather prominent clinical presentation, whereas, in this case, the patient complained of intermittent low abdominal pain of short duration. We therefore suggest that pelvic ultrasound examination be performed in every patient with unexplained low abdominal pain who is known to carry an intrauterine contraceptive device. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Patterns of perinasal fluid flow and contractions of the diaphragm in the human fetus
Authors: Badalian S. S. , Fox H. E. , Zimmer E. Z. , Fifer W. P. , Stark R. I.
Published: March 2003

Our aim was to identify patterns of fetal perinasal fluid flow, and to determine the relationship of pattern of flow to the diaphragmatic component of fetal breathing movements. Twenty‐four fetuses were studied with the use of two ultrasound systems simultaneously. Continuous video‐tape records of the color and spectral Doppler imaging of fluid flow velocity in the nose and of the movements of the fetal diaphragm were made on two video recorders during 30‐min study sessions. Two different patterns of fetal perinasal flow were recognized. One type had a rapid rate and low amplitude, and was independent of ultrasonographically observed movements of the fetal diaphragm. The other type had a lower rate and higher amplitude, and was uniformly related to diaphragmatic contractions. The breath‐to‐breath interval, time of inspiration, time of expiration and peak inspiratory and expiratory velocities were determined for each type of perinasal flow. Two ratios were used to quantify the change of peak flow velocity. There were significant differences in the values of all timing parameters between diaphragm‐related perinasal flow velocities and those not related to the diaphragm, at both 30–36 and 37–41 weeks of gestation. The rate of perinasal flow related to diaphragmatic contraction cycles was one‐third that of the flow cycles not related to diaphragmatic contraction (approximately 50 vs. 148 cycles/min). For both patterns of perinasal flow velocity, the expiratory peak velocity ratio was about 1.6 times higher than the inspiratory peak velocity ratio.

We conclude that, in uncomplicated pregnancy, one pattern of fetal perinasal fluid flow reflects activity of the diaphragm. We speculate that the contractions of the fetal airway smooth muscle or oropharyngeal‐laryngeal muscle groups are the origin of the second pattern of perinasal flow. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Abnormal fetal aortic velocity waveform and minor neurological dysfunction at 7 years of age
Authors: Ley D. , 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 149 children (85%), a neurological examination was performed at 7 years of age with special emphasis on minor neurological dysfunction. The frequency of the more severe form of minor neurological dysfunction, MND‐2, was higher in the group with blood flow class (BFC) III (absent or reversed end‐diastolic flow velocity (8/21) than in the group with BFC 0 (normal velocity waveform) (14/105). Logistic regression analysis revealed that abnormal blood flow class, both independently and in combination with other factors, was the most significant predictor of MND‐2.

The association found between abnormal fetal aortic velocity waveforms and adverse outcome in terms of minor neurological dysfunction suggests that hemodynamic evaluation of the fetus has a predictive value regarding postnatal neurological development. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Evaluation of three‐dimensional ultrasonography and magnetic resonance imaging in assessment of congenital heart anomalies in fetal cardiac specimens
Authors: Meyer‐Wittkopf M. , Cook A. , McLennan A. , Summers P. , Sharland G. K. , Maxwell D. J.
Published: March 2003

In this observational study, multiplanar three‐dimensional ultrasound images were reconstructed from tomographic views obtained by scanning seven cadavaric fetal hearts with various congenital heart defects. Comparisons were made with multiplanar three‐dimensional magnetic resonance imaging (MRI) of the hearts. Good‐quality echocardiographic images were obtained in all but one of the fetal hearts. Multiplanar as well as three‐dimensional reconstructions were possible and allowed accurate assessment of complex cardiac defects. Overall, the MRI projections had better image quality and revealed more structural details than the sonographic views, although both imaging modes showed the same cardiac anatomical abnormalities. Our initial results demonstrate that simultaneous multiplanar display of cross‐sectional echocardiographic views can be performed to provide three‐dimensional images of the fetal heart, demonstrating structural cardiac malformation. However, the clinical application of three‐dimensional fetal echocardiography is at present limited by the time required for image data acquisition and the need for accurate temporal and positional gating in the living fetus. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The value of transvaginal sonography with and without saline instillation in the diagnosis of uterine pathology in pre‐ and postmenopausal women with abnormal bleeding or suspect sonographic findings
Authors: Bronz L. , Suter T. , Rusca T.
Published: March 2003

In this prospective study, 139 patients., 83 premenopausal patients with abnormal uterine bleeding and 56 postmenopausal patients either with metrorrhagia (33) or a suspect sonographic finding (23), were examined preoperatively with transvaginal sonography (TVS) and saline contrast hysterosonography (SCHS). The histological results, obtained by bysteroscopy, were compared with the pre‐operative findings. Uterine pathology (benign polyps, submucous fibroids, endometrial byperplasia and carcinoma) was found in 74.7% and 76.8% of the pre‐ and postmenopausal patients, respectively. TVS and SCHS are very sensitive at diagnosing uterine pathology, the latter being more specific and enabling better surgical management and a reduction in unnecessary interventions. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Perception of information, expectations and experiences among women and their partners attending a second‐trimester routine ultrasound scan
Authors: Eurenius K. , Axelsson O. , Gällstedt‐Fransson I. , Sjöden P.‐O.
Published: March 2003

The aim of this study was to evaluate pre‐scan counselling and the provision of information to parents‐to‐be, and their expectations before and experiences of a second trimester routine ultrasound scan. In the study, 303 pregnant women and their partners were asked to complete questionnaires before and after the scan. The main purposes of the examination were: dating, ascertaining fetal viability, and detection of multiple gestations. Although scanning for fetal malformations was not the purpose of the examination, 89% of the women and 84% of the men were concerned about this aspect. Even though it has been postulated that more women would not attend the examination if they knew it was for prenatal diagnostic purposes, the results of this study did not support this assumption. Only 57% of the women had received information at their antenatal care centers. A total of 138% of the women and 85% of the men said that they obtained sufficient information at the scan. Anxiety was low before the scan, both among women and men, with the exception of those women who had experienced problems at earlier scans. Positive feelings dominated during the scan and these feelings remained when experiences of the scan were reported by the parents‐to‐be after they had gone home. It is concluded that a routine second‐trimester scan is a positive event for the majority of the participating women and men. In spite of this, we believe that certain measures should be taken to improve pre‐scan counselling and the provision of adequate information. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology