bluuebunny/crossref_metadata_2025 huggingface dataset:
Adjuvant botulinum toxin A in dyshidrotic hand eczema: a controlled prospective pilot study with left–right comparison
Authors: Wollina U , Karamfilov T
Published: March 2003

Objective Dyshidrotic hand eczema is a therapeutic challenge. A prospective pilot study was performed with left–right comparison in order to investigate whether chemical de‐innervation of sudoriferic nerves would be superior to standard therapy with topical corticosteroids.

Background Botulinum toxin A (BTXA) is a potent inhibitor of acetylcholine release, that induces eccrine sweat production and release. Inhibition of sweating by other measures such as tap water iontophoresis has been shown to be beneficial in dyshidrotic hand eczema.

Methods Eight adult patients suffering from dyshidrotic hand eczema (atopic type) were included in a prospective, side‐by‐side controlled clinical pilot study using topical corticosteroids on both hands in combination with intracutaneous injections of 100 units of BTXA (Botox®) on the more severely affected hand on day 1. The dyshidrotic hand eczema was classified using the DASI (Dyshidrotic Eczema Area and Severity Index) before treatment (0), after 1 week, 4 weeks and 8 weeks.

Results Six patients completed the study, two dropped out because of social and personal reasons. The mean DASI score changed from 28 to17 with topical therapy alone and from 36 to 3 with adjuvant BTXA (P < 0.01). Itching and vesiculation were inhibited earlier when using the combination of corticosteroids and BTXA. There was one relapse in the corticosteroid group. Relapses have not been seen in the BTXA group.

Conclusions Interruption of sweating by BTXA improves the outcome and reduces relapses in patients with dyshidrotic hand eczema. BTXA is antipruritic as well suggesting that it does not only interact with acetylcholine release but substance P.
Acute generalized exanthematous pustulosis induced by ingestion of bamifylline
Authors: Galvão C , Criado Rfj , Criado Pr , Valente Nys , De Mello Jf , Fernandes Mfm
Published: March 2003

We report a case of acute generalized exanthematous pustulosis (AGEP) in a 64‐year‐old woman, associated with the use of bamifylline. To the best of our knowledge there have been no previous reports of AGEP induced by the ingestion of bamifylline in the medical literature. We, therefore, add this drug to the list of causes for AGEP.
Phakomatosis pigmentovascularis and Lisch nodules. Relationship between Von Recklinghausen and phakomatosis pigmentovascularis?
Authors: Ruiz Villaverde R , Viera Ramirez A , Linares Solano J , Naranjo Sintes R , Gutierrez Salmerón MT
Published: March 2003

In 1947, Ota described a malformative syndrome associating a vascular component (nevus flammeus) with melanocytic or epidermic nevi, which he named phakomatosis pigmentovascularis (PPV). We will discuss the case of a 10‐year‐old boy presenting giant nevus flammeus, nevus spillus, asymmetry in the development of both lower limbs, characteristic of PPV, together with interventricular communication and Lisch nodules, representative of Von Recklinghausen's disease. We believe that this case can be classified as PPV type IIb, associated with Lisch nodules and rarely described in Caucasian individuals.
The role of oxidants and antioxidants in psoriasis
Authors: Yildirim M , Inaloz HS , Baysal V , Delibas N
Published: March 2003

Background Psoriasis vulgaris is a chronic inflammatory skin disease characterized by well‐demarcated erythema and scaly plaques. The pathogenesis of psoriasis still remains unclear. An increased reactive oxygen species (ROS) and insufficient antioxidant activity have been determined in psoriatic lesions.

Aim of the study To evaluate and compare superoxide dismutase (SOD) and glutathione peroxidase (GP) activity in erythrocytes, catalase (CAT) activity and malondialdehyde (MDA) levels in serum of subjects with psoriasis and controls as well as MDA levels in skin biopsies from both groups.

Study population Twenty‐two psoriatic patients (12 women and ten men) and 22 (12 women and ten men) healthy controls were involved in this study.

Findings Statistically significant decreased levels of erythrocyte SOD and GP activities were noted in psoriatic subjects. Furthermore, a statistically significant increased serum CAT activity was found in the psoriasis group. No statistically significant difference was found in the serum MDA levels in the two groups, however, statistically significant increased tissue levels of MDA were noted in the psoriasis group.

Conclusions Our results support the hypothesis of an imbalance in the oxidant–antioxidant system in psoriasis.
The Cost‐Effectiveness of Supported Employment for People with Severe Intellectual Disabilities and High Support Needs: a Pilot Study
Authors: Shearn Julia , Beyer Stephen , Felce David
Published: March 2003

The costs and outcomes of supporting seven people with severe intellectual disabilities and high support needs in part‐time employment were compared with those of a Special Needs Unit (SNU) of a day centre, both within‐subject and against an equal‐sized comparison group. The income of those employed was described. Direct observation of the employment activities and representative SNU activities were undertaken to assess participant engagement in activity and receipt of assistance, social contact in general and social contact from people other than paid staff. Costs of providing service support were calculated taking account of staff : service user ratios, staff identities and wage rates and service‐administrative and management overheads. Employment was associated with greater receipt of assistance, higher task‐related engagement in activity and more social contact from people other than paid staff. SNU activities were associated with greater receipt of social contact. Supporting people in employment was more expensive than in the SNU. Cost‐effectiveness ratios of producing assistance and engagement in activities were equivalent across the comparative contexts. The SNU was more cost‐effective in producing social involvement; employment in producing social contact from people other than paid staff.
Forensic Risk Assessment in Intellectual Disabilities: The Evidence Base and Current Practice in One English Region
Authors: Turner Stephen
Published: March 2003

The growing interest in forensic risk assessment in intellectual disability services reflects the perception that deinstitutionalization has exposed more people to a greater risk of offending. However, ‘risk’ and the related idea of ‘dangerousness’ are problematic concepts because of connotations of dichotomous definition, stability and predictability. Assessment instruments in mainstream forensic psychiatry often combine actuarial and clinical data, and increasingly stress the dynamic nature of risk as well as the importance of situational and accidental triggers. Despite this increasing sophistication of research in mainstream forensic psychiatry, the ability to predict future offending behaviour remains very limited. Furthermore, actuarial predictors developed in studies of psychiatric or prison populations may not be valid for individuals with intellectual disabilities. Offending behaviour among people with intellectual disabilities is also hard to circumscribe because it often does not invoke full legal process or even reporting to the police. In order to discover how such problems were reflected in practice, a survey of providers in the North‐west Region of England was undertaken. Seventy out of 106 providers identified as possibly relevant to this inquiry responded to a short postal questionnaire. Twenty‐nine (42%) respondents – mainly in the statutory sector – reported operating a risk assessment policy relating to offending. The number of risk assessments completed in the previous year varied from none to ‘several hundred’. Providers reported three main kinds of problems: (1) resources or service configuration; (2) interagency or interdisciplinary cooperation or coordination; and (3) issues relating to the effectiveness, design and content of assessment.
Healthy Ageing – Adults with Intellectual Disabilities: Physical Health Issues
Authors: Evenhuis H. , Henderson C. M. , Beange H. , Lennox N. , Chicoine B.
Published: March 2003

This report has been prepared by the Ageing Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities (IASSID) in collaboration with the Department of Mental Health and Substance Dependence and the Programme on Ageing and Health, World Health Organization (WHO), Geneva, Switzerland, and all rights are reserved by the above mentioned organization. The document may, however, be freely reviewed, abstracted, reproduced or translated in part, but not for sale or use in conjunction with commercial purposes. It may also be reproduced in full by non‐commercial entities for information or for educational purposes with prior permission from WHO/IASSID. The document is likely to be available in other languages also. For more information on this document, please visit the following websites: , http://www.who.int/mental_health> and .
Mortality and Life Expectancy in Dutch Residential Centres for Individuals with Intellectual Disability, 1991–1995
Authors: Maaskant Marian A. , Gevers Jan P. M. , Wierda Henk
Published: March 2003

Background Several studies showed that the individuals with intellectual disability have a shorter life expectancy than their intellectually average peers. To gain insight in the present life expectancy of people with intellectual disability, a study with recent data was performed.

Methods We used data of the National Case Register (LRZ) with data of almost all residents of residential centres in the Netherlands for the period 1991–1995 (N = 29 290). Approximately 40% of all people with intellectual disability in the Netherlands reside in such centres.

Results Results showed that 5‐year‐old people with intellectual disability in Dutch residential centres have a life expectancy of 41 years. The life expectancy of their peers with Down's syndrome in the centres is 46. At the age of 30 years, the respective figures are 36 and 26 years. No statistically significant differences in mortality were found between women and men and between levels of intellectual disability.

Conclusions Due to prolonged longevity, the client population in residential centres will continue to age and thus the numbers of older individuals will increase. This ageing process has implications for the care for elderly individuals, because they need other care than before due to physical, psychological and social changes and spiritual challenges.
The physical and psychomotor development of children conceived by IVF and exposed to high‐frequency vaginal ultrasonography (6.5 MHz) in the first trimester of pregnancy
Authors: Gershoni‐Baruch R. , Scher A. , Itskovitz J. , Thaler I. , Brandes J. M.
Published: March 2003

We examined the physical and psychomotor development of 33 infants conceived by in vitro fertilization (IVF) who were exposed to high‐frequency transvaginal ultrasonography (HFTVS) (6.5 MHz) in the first trimester of pregnancy. The study group was composed of 21 singletons and six sets of twins. Thirty‐three non‐IVF controls were matched for birth weight, gestational age, sex, birth order, order in multiple delivery, mode of delivery, age at examination and parental age and education. Forty‐five IVF infants who were not exposed to HFTVS and their matched controls also served as comparison groups. The Bayley scales were used to assess the psychosocial development of the infants studied.

Increases in preterm delivery, low birth weight and Cesarean section rates were within the acceptable range for IVF babies. Mean birth weight, gestational age and birth weight percentiles of exposed IVF infants were lower than the expected mean for a normal population, but did not differ from that of non‐exposed IVF infants. Mean percentiles of weight and length at examination were also low but not different from those of non‐exposed IVF and matched control groups. However, percentiles of head circumference were normal at birth and at examination both in study and control groups. Overall, Bayley scores of exposed IVF infants were within the normal range and did not differ significantly from those of their matched controls and non‐exposed peers. These scores were significantly correlated to birth weight, percentiles of birth weight and head circumference at birth and at examination, and to the mother's education. Twins had lower physical and mental indices than singletons, but did not differ from their controls. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Ectopic pregnancy treatment using pelviscopic or vaginosonographically‐guided intrachorionic injection of methotrexate and POR 8®
Authors: Popp L. W. , Mettler L. , Weisner D. , Mecke H. , Freys I. , Semm K.
Published: March 2003

It is believed by some that the basis of modern first‐trimester pregnancy care should involve screening for ectopic pregnancy using vaginal ultrasonography. This has led to this condition being diagnosed in most cases at an earlier stage than has previously been possible. This advance in diagnostic ability has introduced the concept of conservative management for this condition.

The authors describe the conservative management of nine cases of ectopic pregnancy using intrachorionic injection of either methotrexate alone or in combination with POR 8®. In all cases less than 9 weeks had passed since the last menstrual period, and the ectopic pregnancies treated under ultrasound control were all thought to be viable. Five cases were treated using pelviscopy, whilst in another four the needle was guided using vaginal ultrasonography. There were no procedure‐related complications.

Following therapy, the women were followed up using serial levels of serum β‐hCG. In seven cases there was a gradual reduction to normal levels. There were two treatment ‘failures’. In both these cases methotrexate alone, rather than in combination with POR 8®, was used for injection. Although formal tests of tubal patency have not been performed in all cases, one woman in the series has since conceived and has a normal intrauterine pregnancy.

It is concluded that vaginal instillation of methotrexate is an alternative treatment for early ectopic pregnancy. It should be limited to viable ectopic pregnancies whose chorionic cavities are less than 2.0 cm in diameter. A plan for the management of ectopic pregnancy is presented, involving selection for both ultrasound‐guided injection and pelviscopic surgery. Laparotomy is not considered to be a treatment option in the majority of cases. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
In utero appearance of idiopathic infantile arterial calcification: ultrasound study of a 28‐week fetus
Authors: Crade M. , Lewis D. F. , Nageotte M. P.
Published: March 2003

An ultrasound study of a 28‐week gestation demonstrated changes of poor cardiac function associated with calcifications of the wall of major arteries. Sudden in utero deterioration into hydrops prompted the delivery of a female infant who was diagnosed at autopsy of having a rare disease entity, idiopathic infantile arterial calcification.

When a hydropic fetus is defined by ultrasound, this rare diagnosis should be included in the diagnostic considerations. Recent reports suggest successful therapy regimens for an otherwise fatal disease, making accurate diagnosis especially important. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
The pathophysiology of acute syphilitic funisitis
Authors: Schulman H. , Miller J. N. , Dolisi F.
Published: March 2003

There is an increase in the number of cases of syphilis in pregnancy in the United States. Fetal death may occur in syphilis from acute or chronic infections. A case is presented in which an acute fetal infection occurred. The patient presented at 31 weeks' gestation, with a decrease in fetal movements and non‐reactive cardiotocography. Ultrasound and Doppler analysis of the fetal heart, cerebral and umbilical arteries, aorta and umbilical vein led to the suspicion of acute cardiac failure. An amniocentesis yielded a white cell count of 1122 white blood cells, with 91% polymorphs, but the Gram stain was negative. The fetus developed a persistent bradycardia and was delivered. The diagnosis of acute severe syphilitic funisitis was suspected from histological sections of the cord. Diagnosis was established from maternal and fetal blood. Modern ultrasound techniques, including imaging, Doppler and cardiotocography, can lead to the analysis of the pathophysiology of disease states. An acute syphilitic infection should be suspected when this constellation of findings is found. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Cord vessel compression by an expanding allantoic cyst: case report
Authors: Battaglia C. , Artini P. G. , D'Ambrogio G. , Genazzani A. R.
Published: March 2003

The umbilical cord has been inadequately studied by ultrasound. Umbilical cord masses are rare and often misdiagnosed.

A case of a 4.3 × 3.2 cm anechoic floating cystic umbilical mass is reported. Doppler examination of the cord proximal to the cyst revealed a high resistance index of 0.84. Twelve hours later the cyst was larger (5.0 × 4.5 cm) and appeared tense; Doppler velocimetry worsened and absence of end‐diastolic flow in the umbilical artery was found. Cardiotocography a few hours later showed a bradycardiac non‐reactive trace with late decelerations. A live male weighing 1980 g was delivered by Cesarean section. At birth the cord position was normal. Pathological examination showed the lesion to be consistent with an allantoic cyst.

This is the first case in which antenatal evidence of cord compression by an expanding allantoic cyst has been demonstrated. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasound diagnosis of fetal candida infection: a complication of a retained intrauterine contraceptive device
Authors: Silver D. A. T. , Ashworth M. T. , Andrews H. S.
Published: March 2003

A 32‐year‐old woman was referred complaining of abdominal pain and bleeding at 18 weeks' gestation. The striking finding on ultrasound examination was of symmetrically enlarged echogenic fetal lungs. In addition, mediastinal compression, increased echogenicity of the kidneys and bowel, an enlarged liver of decreased echogenicity, and hydrops fetalis, as evidenced by ascites and skin edema, were all present. The differential diagnosis included upper respiratory tract obstruction and cystic kidney disease. The presence of fetal hydrops together with the other findings suggested a poor outcome, and on these grounds therapeutic abortion was recommended and performed. Subsequent postmortem findings explained all the ultrasound abnormalities on the basis of extensive fetal candida infection. The presence of a retained intrauterine contraceptive device was considered to be the likely cause and the implications of this, together with the ultrasound abnormalities and differential diagnoses, are discussed. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Real‐time quasi‐three‐dimensional viewing in sonography, with conventional, gray‐scale volume imaging
Authors: Kossoff G. , Griffiths K. A. , Warren P. S.
Published: March 2003

Real‐time three‐dimensional views of the fetus can be obtained with minor modification to conventional scanners. The modification consists of placing a divergent lens in the out‐of‐scan plane of the transducer to generate a beam fan‐beam in the insonated volume. All of the echoes from which insonates a volume rather than a slice of tissue. Scanning is performed using oblique angles of incidence to provide total reflection conditions. Echoes are then received only from anterior surfaces, automatically generating the three‐dimensional views. Intriguing portrayal of fetal detail can be obtained with this form of imaging which is likely to expand the clinical utility of sonographic examinations. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Doppler flow velocimetry of the umbilical artery, uteroplacental arteries and fetal middle cerebral artery in prolonged pregnancy
Authors: Zimmermann P. , Albäck T. , Koskinen J. , Vaalamo P. , Tuimala R. , Ranta T.
Published: March 2003

A total of 153 pregnant women, of at least 287 days' menstrual age, were studied in a prospectively designed cross‐sectional trial. In addition to the non‐stress test, contraction stress test, sonographic estimate of amniotic fluid and grade of placental maturation, Doppler measurements of the resistance index (RI) were taken in the umbilical artery, the uteroplacental arteries in the region of placental implantation and the fetal middle cerebral artery. Data were analyzed with regard to asphyxia and otherwise complicated fetal outcome. Furthermore, a possible relationship between grade of placental maturation, Doppler flow velocity waveforms and fetal outcome was investigated.

Doppler resistance indices in the umbilical artery, uteroplacental arteries in the region of placental implantation and fetal middle cerebral artery did not change significantly with increasing gestation from 41 to 43 weeks. The grade of placental maturation on ultrasound examination was not related to fetal outcome or Doppler indices in the first two vessels. In all vessels examined in this study, the majority of Doppler measurements in pregnancies with subsequent asphyxia or otherwise complicated fetal outcome were within the 95% prediction interval for patients with normal fetal outcome. None of the patients showed absent diastolic flow in the umbilical artery. With the use of a cut‐off value of RI = 0.62 in the umbilical artery, asphyxia could be predicted with 37% sensitivity and 75% specificity. Oligohydramnios and antepartum cardiotocography predicted asphyxia with 16% and 8% sensitivity and 95% and 96% specificity, respectively. Sensitivity for prediction of otherwise complicated fetal outcome by umbilical artery Doppler was only 7%.

We conclude that vascular resistance in the umbilical artery, uteroplacental arteries in the region of placental implantation and the middle cerebral artery does not change abruptly, when gestation exceeds 287 days. Ultrasonographic grading of placental maturation has no use in post‐term pregnancies. Doppler investigations of the umbilical artery had somewhat better sensitivity in the prediction of asphyxia when compared to ultrasound diagnosis of oligohydramnios or antepartum cardiotocography. However, Doppler showed only modest specificity compared to the other methods and probably has few advantages compared to the traditional methods of fetal surveillance. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Longitudinal study of fetal growth in subgroups of a low‐risk population
Authors: Mongelli M. , Gardosi J.
Published: March 2003

We investigated fetal weight gain in relation to maternal characteristics within a normal, heterogeneous population in Nottingham, UK. A total of 226 low‐risk pregnancies with normal neonatal outcome were examined longitudinally by serial ultrasound examination. Gestation was calculated from early measurements of biparietal diameter. A modified Hadlock's formula for fetal weight was employed, using the biparietal diameter, abdominal circumference and femur length, which was not associated with any significant systematic error. Individual curves were obtained by fitting serial fetal weight estimates and birth weight in a weighted log‐polynomial model for fetal growth. The overall growth formula showed an almost linear relationship between gestational age and fetal weight at term. Maternal height and weight at the first hospital visit were positively correlated with fetal weight in the third trimester. The fetuses of parous women were also heavier in late pregnancy, as were those of European compared to Indo‐Pakistani mothers. Intrauterine weight gain in the third trimester shows variation with pregnancy characteristics which need to be considered when fetal growth is assessed. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Resolving polyhydramnios: clinical significance and subsequent neonatal outcome
Authors: Hill L. M. , Lazebnik N. , Many A. , Martin J. G.
Published: March 2003

The objective of this study was to determine the clinical significance and neonatal outcome of patients with polyhydramnios that subsequently resolved prior to delivery. A retrospective review of 275 cases of polyhydramnios, defined as an amniotic fluid index of ≥ 25.0 cm, identified 41 cases in which the amniotic fluid volume returned to normal prior to delivery.

A total of 40 out of 41 patients with resolving polyhydramnios had a mild to moderate excess of amniotic fluid. There was a significant difference in the distribution of neonatal delivery weights between the study group and a matched control group. Twelve of 41 (29.3%) neonates from the study vs. none of the neonates in the control group were large for gestational age (p < 0.001). A total of 21 of 41 patients (51.2%) in the study group vs. three of 41 (7.3%) patients in the control group had at least minimal glucose intolerance (p < 0.01).

We conclude that patients with resolving polyhydramnios have a significantly higher prevalence of glucose intolerance and fetal macrosomia than patients with normal pregnancies. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of ectrodactyly: the ‘lobster claw’ anomaly
Authors: Leung K. Y. , MacLachlan N. A. , Sepulveda W.
Published: March 2003

Ectrodactyly is a rare condition characterized by absence of digits, ranging from single absence of a finger to the split hand/foot deformity. This anomaly has been reported as sporadic and in association with a number of genetic and non‐genetic syndromes, such as the autosomal dominant ectrodactyly and the ectrodactyly‐ectodermal dysplasia‐cleft palate (EEC) syndromes. In this report we present two cases of ectrodactyly prenatally diagnosed by ultrasonography during the second trimester of pregnancy. Routine examination of fetal hands and feet during secnd‐trimester ultrasonography should make the detection of hand and foot malformations more frequent. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasonographic diagnosis of fetal hepatic hyperechogenicities: clinical significance and implications for management
Authors: Achiron R. , Seidman D. S. , Afek A. , Malinger G. , Lipitz S. , Mashiach S. , Goldman B. , Yagel S.
Published: March 2003

The clinical significance of sonographically detected fetal hepatic hyperechogenicities has not been fully established. The aim of this study was to assess various aspects of fetal hepatic hyperechogenicities detected in utero, including natural history, prenatal investigation and pregnancy outcome.

In a retrospective survey of pregnant women presenting to the ultrasonographic unit, five fetuses with a mean gestational age of 20 weeks (range 14–24 weeks) were antenatally diagnosed as having hepatic hyperechogenicities. All cases underwent extensive investigation to establish the etiology and to determine the spectrum of ultrasonographic presentation. In three fetuses, only parenchymal lesions were found, while two had combined lesions: parenchymal and peritoneal. The earliest prenatal ultrasonographic diagnosis was made at 14 weeks' gestation in a fetus with combined hyperechogenic lesions, which, at 12 weeks' gestation, demonstrated unexplained fetal ascites. Associated abnormalities were found in only one fetus in which a solitary parenchymal lesion was associated with direct communication of the intra hepatic portion of the umbilical vein with the right atrium, and high output cardiac failure. In this case, termination of pregnancy confirmed ischemic hepatic necrosis. In the other four cases, no direct etiology could be determined, and all four pregnancies continued to term with normal neonatal follow up until 12 months of age. The present data suggest that in cases of fetal hepatic hyperechogenicities, where apparent intrauterine infection or neoplasia can be ruled out, a vascular disruption phenomenon is a putative etiology. If there are no associated morphological abnormalities or abnormal karyotypes, the prognosis may be favorable. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler analysis in lean and obese women with polycystic ovary syndrome
Authors: Battaglia C. , Artini P. G. , Genazzani A. D. , Sgherzi M. R. , Salvatori M. , Giulini S. , Volpe A.
Published: March 2003

The objective of this study was to determine whether obese patients with polycystic ovary syndrome (PCOS) show different ovarian and uterine blood flow patterns in comparison with lean patients.

Sixteen obese (body mass index: BMI = 31.4 ± 3.4 kg/m²) and 22 lean (BMI = 21.1 ± 1.3 kg/m²) PCOS patients underwent, in the early follicular phase if oligomenorrheic or randomly if amenorrheic, ultrasonographic evaluation of ovarian volume, echodensity and follicle number; transvaginal color Doppler evaluation of uterine and intraovarian blood flow; and radioimmunological assay of luteinizing hormone, follicle stimulating hormone, growth hormone, estradiol, progesterone, testosterone, androstenedione, insulin, insulin‐like growth factor I, and other hormonal parameters. Hematocrit, plasma glucose, total cholesterol, high density lipoprotein and triglycerides were also evaluated.

Insulin levels were significantly higher in the obese group, whereas levels of growth hormone were significantly lower. Moreover, a more adverse lipid profile was observed in overweight patients. This was associated with higher hematocrit values. At Doppler analysis, a significantly higher mean uterine artery pulsatility index (PI) was observed in the obese group. Furthermore, the PI was inversely correlated with high density lipoprotein values (r = −0.4820; p <0.05). In both groups, androstenedione was correlated with the uterine PI.

The above findings may, in part, explain the increased risk in women with PCOS of developing cardiovascular diseases, and emphasize that obesity may further increase the risk. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Tamoxifen and the uterus: an old drug tested by new modalities
Authors: Achiron R. , Grisaru D. , Golan‐Porat N. , Lipitz S.
Published: March 2003

Tamoxifen has been widely used in the treatment of breast cancer. The effects on the uterus include epithelial metaplasia, hyperplasia and even carcinoma. Transvaginal sonography has been used for visualization of endometrial changes during tamoxifen treatment. However, its use has disclosed that the drug may cause cystic changes in the subendometrial zone without epithelial pathology. Therefore, other sonographic techniques have been suggested for the evaluation of the patient receiving tamoxifen treatment, among them saline contrast hysterosonography and endometrial blood flow studies. These new modalities provide us with tools to evaluate the effect of tamoxifen on the endometrium, prior to the decision to perform invasive procedures. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Esophageal and duodenal atresia in a fetus with Down's syndrome: prenatal sonographic features
Authors: Chitty L. S. , Goodman J. , Seller M. J. , Maxwell D.
Published: March 2003

Ultrasound examination of a 22‐week fetus demonstrated a grossly distended stomach and proximal duodenum, with a large cystic area in the chest. There was associated poly‐hydramnios. A presumptive diagnosis of duodenal atresia with a congenital diaphragmatic hernia was made. Analysis of a fetal blood sample showed that the fetus had Down's syndrome. Histological examination after termination of the pregnancy revealed the unusual combination of duodenal and esophageal atresia, with an intact diaphragm. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The onset of inter‐human contacts: longitudinal ultrasound observations in early twin pregnancies
Authors: Arabin B. , Bos R. , Rijlaarsdam R. , Mohnhaupt A. , van Eyck J.
Published: March 2003

Twin pregnancies provide us with the opportunity to observe first reactions towards touch in utero, and this study illustrates the onset and development of these contacts. Forty women with twin pregnancies volunteered to take part in this study, 25 of whom (five monochorionic, 20 dichorionic pairs) fulfilled the inclusion criteria. Between 8 and 12 weeks' gestation, ultrasound examinations were performed transvaginally, and from 13 weeks onwards transabdominally, at weekly intervals. Ultrasound findings were recorded on videotapes and were analyzed retrospectively. The first contacts producing reactions in the co‐twin were defined as primary contacts, which could be slow or fast arm/leg/bead/body contacts. Primary contacts followed an action‐reaction model, and usually lasted < 3 s. These contacts were initially slow and then became fast. The first reactions of the co‐twin towards touch were observed at 65 postmenstrual days. Contacts of longer duration between both bodies including extremities, or contacts initiated by sucking movements towards the co‐twin were defined as complex contacts and were observed from 85 and 92 postmenstrual days, respectively. Nearly all contacts occurred significantly earlier in monochorionic compared to dichorionic twins. Female/female pairs seemed to develop complex body contacts earlier than male/male pairs, but for the onset of other contacts we have not yet found significant differences between gender combinations. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Triphasic umbilical venous blood flow with prolonged survival in severe intrauterine growth retardation: a case report
Authors: Baschat A. A. , Gembruch U.
Published: March 2003

We report a case of a singleton pregnancy with severe intrauterine growth retardation diagnosed at 24 + 0 weeks' gestation. Pulsed wave Doppler sonography revealed unilateral elevation of the pulsatility index with a diastolic notch in one uterine artery in association with reversed end‐diastolic flow in the umbilical artery. From 24 + 3 weeks onwards there were pathological indices in the descending aorta, inferior vena cava and ductus venosus, with biphasic pulsatile flow in the umbilical vein, while indices in the middle cerebral artery were normal. Coronary blood flow was demonstrated in both coronary arteries with the use of color‐coded and pulsed wave Doppler sonography. The clinical course was marked by minimal growth and persistence of pathological venous indices. At 29 + 3 weeks' gestation the venous flow pattern in the umbilical vein was noted to be triphasic pulsatile. At this time there was cardiac dilatation with tricuspid and mitral insufficiency. The parents did not want active management and intrauterine fetal death was diagnosed at 30 + 4 weeks' gestation. This case illustrates the fact that prolonged intrauterine survival, despite highly pathological Doppler indices in the venous and arterial circulation, is possible, indicating the extreme adaptability of some fetuses with early onset intrauterine growth retardation. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Fetal diaphragmatic hernia presented with transient unilateral pleural effusion
Authors: Lau T. K. , Fung H. Y. M. , Fung T. Y.
Published: March 2003

Isolated fetal pleural effusion is rare. A good outcome of 100% survival rate can be expected in cases of spontaneous resolution of the anomaly in utero. If resolved, they are usually not associated with any structural abnormality. We report a case of diaphragmatic hernia presenting as isolated unilateral pleural effusion which resolved spontaneously. This has important implications for the management of isolated fetal pleural effusion. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Measurement of the pregnant cervix by transvaginal sonography: an interobserver study and new standards to improve the interobserver variability
Authors: Burger M. , Weber‐Rössler T. , Willmann M.
Published: March 2003

Transvaginal sonography has become an important tool for assessing the gravid cervix uteri, especially in patients at risk for cervical incompetence and preterm delivery. The purpose of our prospective study was to evaluate interobserver variability in measurements of the cervical length and, as a second step, improve the reproducibility and interobserver discrepancy by the introduction of quality control standards when producing and measuring the image of the cervix. Before the introduction of these standards we obtained 46 measurements and observed a mean cervical length (internal to external os) of 33.7 mm (range 26–52 mm) and an interobserver average discrepancy of 3.04 mm (range 0–6 mm). Later, measurements were obtained only when the following conditions were assured and visualized on the screen: (1) the internal os is either flat or is an isosceles triangle; (2) the whole length of the cervical canal can be observed; (3) a symmetric image of the external os can be obtained; and (4) the distance from the surface of the posterior lip to the cervical canal is equal to the distance from the anterior lip to the cervical canal. After the implementation of these quality control standards, 70 measurements were performed obtaining a mean length of 35.3 mm (range 27–51) and an average interobserver discrepancy of 1.24 mm (range 0–4). Thus the measurement error was significantly lower following introduction of quality control standards. Furthermore, the coefficient of variation dropped from 7.1% to 3.3% after the introduction of the guidelines. We believe that these guidelines could be helpful by making the measurements of the cervical length more accurate, reducing the interobserver variability, improving the reproducibility and promoting the role of transvaginal sonography in monitoring the incompetent cervix. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Interfetal heart rate and size variation in first‐trimester multifetal pregnancies and heart rate of surviving fetuses after fetal reduction
Authors: Zimmer E. Z. , Chao C. R. , Sharma S. , Timor‐Tritsch I. E.
Published: March 2003

The objective of this study was to determine the variation in first‐trimester fetal size and fetal heart rates in multifetal pregnancies, and to study the effect of fetal reduction on the surviving fetal heart rate. Fetal crown‐rump length and fetal heart rates were measured in 44 patients with multifetal pregnancies who underwent fetal reduction. The heart rates of the surviving fetuses were also measured immediately after, and 1 h following the procedure. A total of 143 fetuses were evaluated prior to reduction and 75 fetuses following the procedure. There was no significant difference in crown‐rump length between fetuses of the same gestation. The interfetal fetal heart rate variation between fetuses of the same gestation, expressed as a standard deviation, was 4.78 ± 0.51 beats/min (mean standard deviation ± standard error of the mean) before reduction; this was a significantly greater variation than could be attributed to error in the measurement of heart rate. In the surviving fetuses, the mean heart rate did not change. However, immediately after the reduction, interfetal heart rate variation was abolished, but was observed again 1 h after the reduction. We conclude that in first‐trimester multifetal pregnancies (1) there is no significant difference in fetal crown‐rump length; (2) there is interfetal variation in heart rates; and (3) fetal reduction has only a limited effect on the heart rates of surviving fetuses. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Hemodynamic changes across the human ductus venosus: a comparison between clinical findings and mathematical calculations
Authors: Pennati G. , Bellotti M. , Ferrazzi E. , Rigano S. , Garberi A.
Published: March 2003

We investigated the hemodynamics of the ductus venosus in the human fetus by means of a combined approach based on Doppler and computational techniques. The aim of our study was to assess the blood velocity changes across the ductus venosus. Color Doppler equipment was used to investigate 29 normal fetuses between 20 and 39 weeks of gestation.

Velocities at the systolic peak (S), diastolic peak (D) and atrial contraction (A) were measured at the isthmus and at the outlet of the ductus venosus, and the corresponding angle‐independent indices (S/A, (S ‐ A)/S, (S ‐ A)/D) were calculated. A parametric computational model was developed in order to investigate the influence of anatomical features of the ductus venosus on the hemodynamics of the vessel. In all the fetuses the S, D and A velocities at the outlet portion were significantly lower than those at the isthmic part of the ductus venosus (p < 0.0001). The mean percentages of velocity reduction were 2:3.1%, 26.5% and 33.6%, respectively.

Computational simulations also showed a relevant decrease of the velocity along the ductus venosus during the whole cardiac cycle. Velocity reduction along the ductus was mainly due to its conicity and this reduction generally caused velocity values at the outlet to be below the normal range. Conversely, angle‐independent indices measured both at the isthmus and at the outlet lay within the same range of the reported reference values and therefore were not influenced by sampling site. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Venous blood flow pattern suggesting tachycardia‐induced ‘cardiomyopathy’ in the fetus
Authors: Krapp M. , Gembruch U. , Baumann P.
Published: March 2003

Studies in the fetal lamb and human fetus demonstrated that, in the late stage of supraventricular tachycardia, myocardial dysfunction (tachycardia‐induced ‘cardiomyopathy’) may appear and even persist after drug‐induced conversion to sinus rhythm. The objective of this study was to verify whether these changes in cardiac function are reflected in the venous system.

In seven fetuses with supraventricular tachycardia (five with hydrops and four of these with atrioventricular valve incompetence during tachycardia) between 24 and 33 weeks of gestation, spectral Doppler analysis of flow velocity waveforms in the inferior vena cava and the ductus venosus was performed before and after drug‐induced cardioversion, and was compared with reference values known from the literature and our own indices obtained in 129 normal pregnancies.

After drug‐induced conversion from supraventricular tachycardia to sinus rhythm associated with a change from a pulsatile to a normal biphasic forward venous blood flow pattern, abnormal venous indices resulting from increased reverse blood flow during atrial contraction persisted for 2–42 days (median 12 days).

Severe functional tricuspid insufficiency can lead to a significant decrease in the systolic peak velocity with deterioration of the venous blood flow indices. In the first days after supraventricular tachycardia, rapid changes in these indices seem to depend predominantly on the decrease of tricuspid insufficiency and the increase of the systolic peak velocity.

In addition to the persistence of atrioventricular valve regurgitation, abnormal indices of venous blood flow during sinus rhythm indicate the existence of altered myocardial function, suggesting reversible tachycardia‐induced ‘cardiomyopathy’. Blood flow indices in the venous system seem to reflect changing myocardial function very sensitively and rapidly and, therefore, appear very useful in the surveillance of the fetus with tachyarrhythmia under drug therapy, especially with regard to the assessment of cardiac function at the time of cardioversion and in the period after supraventricular tachycardia. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Umbilical cord coagulation by operative microendoscopy at 16 weeks' gestation in an acardiac twin
Authors: Hecher K. , Hackeloer B. J. , Ville Y.
Published: March 2003

Twin reversed arterial perfusion (TRAP) sequence carries high mortality and morbidity in the normal twin due to a hemodynamic imbalance through the feto–fetal vascular anastomosis. This report describes the ultrasound features of TRAP in the first trimester and a new technique for selective fetocide in the early second trimester in monochorionic twin pregnancies complicated by the TRAP sequence. Laser coagulation of the umbilical cord of the acardiac twin was performed under sonoendoscopic control. The blood flow in the umbilical cord of the acardiac twin was successfully arrested and the survivor developed normally. TRAP sequence can be recognized in the first trimester and successfully arrested by microendoscopic surgery. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Isolated choroid plexus cysts and association with fetal aneuploidy in an unselected population
Authors: Geary M. , Patel S. , Lamont R.
Published: March 2003

We sought to determine the relationship between an isolated choroid plexus cyst diagnosed antenatally and fetal aneuploidy in an unselected population at a district general hospital. Over a 5‐year period all women attending for a detailed anomaly scan at 18–20 weeks' gestation were screened for evidence of a fetal choroid plexus cyst. All cases of choroid plexus cyst were recorded prospectively. The size, position and number of the cysts were noted and associated abnormalities seen on ultrasound were also recorded. Cases of choroid plexus cyst associated with fetal aneuploidy were noted. A total of 13 690 women were screened, and 84 cases of choroid plexus cyst were identified (0.6%). Of these, 41% underwent prenatal karyotyping by amniocentesis; 78 of 84 cases (93%) were isolated. Six had other markers for aneuploidy, and three of these fetuses had trisomy 18. All cases of isolated choroid plexus cyst resulted in chromosomally normal neonates. This was confirmed by either normal antenatal karyotype or postnatal examination by the pediatricians. The size, position and number of cysts did not appear to influence the risk of aneuploidy. We conclude that the risk of aneuploidy for a case of isolated choroid plexus cyst in an unselected population appears to be very low, and in this series was 0%. In this setting, we suggest detailed ultrasound examination is essential, rather than routine karyotyping. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler sonographic features of uterine arteriovenous malformations: report of two cases
Authors: Müngen E. , Yergök Y. Z. , Ertekin A. A. , Ergür A. R. , Uçmakli E. , Aytaçlar S.
Published: March 2003

We describe the color Doppler sonographic features of uterine arteriovenous malformatiom in two cases. In both cases color Doppler imaging demonstrated hypervascularity throughout the arteriovenous malformation. The dominance of pale shades during both systole and diastole represented low‐impedance, high‐velocity flow within the lesion and a colored mosaic pattern representing turbulent flow was noted. Spectral analysis of the vessels within the lesion confirmed high‐velocity flow during both systole and diastole, and a low resistance index. The spectral waveform trace also showed spectral broadening consistent with turbulence and the spectral envelope was irregular. These findings indicated the presence of numerous arteriovenous shunts and marked turbulence within the arteriovenous malformation. Spectral analysis of the venous flow revealed high flow velocities and systolic velocity peaks similar to an arterial pattern. The uterine artery velocity waveforms were characterized by high flow velocity and a low resistance index. The diagnosis of uterine arteriovenous malformation was confirmed by histological examination in both cases.

The findings of these two cases suggest that color Doppler sonography may play an important role in the diagnosis of uterine arteriovenous malformations. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology