bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutting Edge: Cytosolic Bacterial DNA Activates the Inflammasome via Aim2
Authors: Warren Sarah E. , Armstrong Abraham , Hamilton M. Kristina , Mao Dat P. , Leaf Irina A. , Miao Edward A. , Aderem Alan
Published: June 2010

Pathogens are detected by pattern recognition receptors that, upon activation, orchestrate an appropriate immune response. The TLRs and the nucleotide-binding oligomerization domain-like receptors (NLRs) are prototypic pattern recognition receptors that detect extracellular and cytosolic pathogens, respectively. Listeria monocytogenes has both extracellular and cytosolic phases and is detected in the cytosol by members of the NLR family. These include two NLR members, NLRC4 and NLRP3, that, upon detection of cytosolic L. monocytogenes, induce the assembly of the inflammasome. Inflammasomes serve as platforms for the activation of the protease caspase 1, which mediates the processing and secretion of pro–IL-1β and pro–IL-18. We previously provided evidence that L. monocytogenes is also detected by a third inflammasome. We now use biochemical and genetic approaches to demonstrate that the third detector senses bacterial DNA and identify it as Aim2, a receptor that has previously been shown to detect viral DNA.
Guanosine Quadruplexes in Solution: A Small‐Angle X‐Ray Scattering Analysis of Temperature Effects on Self‐Assembling of Deoxyguanosine Monophosphate
Authors: Mariani P. , Spinozzi F. , Federiconi F. , Ortore M. G. , Amenitsch H. , Spindler L. , Drevensek-Olenik I.
Published: June 2010

We investigated quadruplex formation in aqueous solutions of 2′‐deoxyriboguanosine 5′‐monophosphate, d(pG), which takes place in the absence of the covalent axial backbone. A series of in‐solution small angle X‐ray scattering experiments on d(pG) have been performed as a function of temperature in the absence
of excess salt, at a concentration just above the critical one at which self‐assembling occurs. A global fit
approach has been used to derive composition and size distribution of the scattering particles as a function
of temperature. The obtained results give thermodynamical justification for the observed phase‐behavior,
indicating that octamer formation is essential for quadruplex elongation. Our investigation shows that d(pG)
quadruplexes are very suitable to assess the potential of G‐quadruplex formation and to study the self‐assembling thermodynamics.
Homocysteine Is a Risk Factor in Predialysis Patients When Associated with Malnutrition and Inflammation
Authors: Vieira Ana de Lurdes Agostinho Cabrita , Baptista Alexandre , Malho Anabela , Pinho Ana , Silva Ana Paula , Bernardo Idalécio , Neves Pedro Leão
Published: June 2010

The increased level of plasma total homocysteine (tHcy) in chronic kidney disease patients has been reported as a new and independent risk factor for cardiovascular disease. However, after the description of reverse epidemiology in the renal population, the association of tHcy and nutrition became less clear. We evaluated the association between homocysteine, nutritional status, and inflammation, and their impact on mortality in 95 predialysis patients. High sensitivity C-Reactive Protein (hs-CRP), interleukin 6 (IL-6), Tumor Necrosis Factor (TNF-)], and tHcy were evaluated, as was the nutritional status by the modified Subjective Global Nutritional Assessment (mSGA). We divided our population in four groups according to their tHcy and mSGA values being above or below the mean level and found the lowest survival in the group with tHcy and mSGA above the mean level, as well as higher levels of IL-6 () and TNF- (). Higher levels of homocysteine can be associated with higher mortality in predialysis patients, as long as they are associated with malnutrition and inflammation.
Nonsinonasal Neuroendocrine Carcinoma of the Head and Neck: Case Series and Review of Literature
Authors: Hanby Duncan F , McWhorter Andrew , Wallace Eric , Woltering Eugene A , Harton Anthony , Santiago Kerri B , Nuss Daniel W , Walvekar Rohan R
Published: June 2010

Objective

To describe three patients with nonsinonasal neuroendocrine carcinoma (NSNEC) of the head and neck and present a systematic review of literature.

Study design

Retrospective chart review

Methods

Three patients with pathologically proven NSNEC of the head-neck who presented to our institution were identified. Relevant demographic, clinic-pathological, and radiological data was recorded. A web-based search was conducted to identify relevant scientific literature on “neuroendocrine carcinoma (NEC) of the head and neck” and a systematic review of literature is presented.

Results

Two female and one male patient aged 44 to 66 years presented to our service with NEC of the supraglottis (2/3), and of the thymus (1/3). Diagnosis was confirmed with immunohistochemical staining such as Ki-67, synaptophysin, chromogranin, and also with octreotide scanning. The first case, a T4bN0M0 large cell NEC of the thymus with tracheal invasion received conservative airway management and emergent radiotherapy. The second case, moderately differentiated NEC of the supraglottis was managed with a laser supraglottic laryngectomy followed by adjuvant treatment. The third case, a laryngeal NEC was treated with chemoradiotherapy.

Conclusions

NSNEC of the head and neck are extremely rare tumors with variability in clinical presentation that present challenges in diagnosis and treatment planning. Consideration of the histological subtype and staining characteristics of the individual tumor, accurate diagnosis, and classification of the tumor is vital in order to tailor therapeutic intervention.
Nonresolving Osteomyelitis of the Maxilla and Maxillary Sinus after Long-term Use of Oral Bisphosphonates
Authors: Kaplan Ilana , Nicolaou-Ioannou Zoe
Published: June 2010

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a complication of Bisphosphonate (BP), medications used for treatment of osteoporosis, multiple myeloma and cancer bone metastasis. Manifestations of BRONJ include bone necrosis, exposure to the oral cavity, inflammation suppuration and pain with nonspecific radiographic changes.

Case history

A 64-year-old woman had been treated with oral BP since 1991 for arthritic pain and osteoporosis. There were no other medical problems, no other medications used, she did not smoke nor drink alcohol.

In 2005, the left maxillary molars had been extracted. The extraction site failed to heal, but she continued to use BP. Eighteen months later she presented with swelling and pain, suppuration and an area of 2 x 1 cm of exposed necrotic bone in the left posterior maxilla and oroantral fistula (OAF).

Panoramic radiograph showed partial opacification of the maxillary sinus, unhealed extraction site, and sclerosis of adjacent maxillary alveolus. Histopathological analysis diagnosed osteomyelitis associated with actinomycosis, consistent with BRONJ.

Treatment

BP was discontinued, followed by 7 months of PO antibiotics and iodoform gauze packs. The wound seemed to be completely closed but within 2 months signs and symptoms and OAF recurred. Treatment continued with antibiotics daily rinses and weekly irrigation with Chlorhexidine 2%, and several repeated sequesterctomies, however, the patient still had pain. A course of 30 hyperbaric oxygen treatment was administered. Three years from onset symptoms improved, and sequstered bone is no longer visible. However, the OAF is still present, requiring irrigations, and the radiographs still present bony abnormality.

An unusually severe BRONJ of 3 years duration associated with 15 years oral BP use is presented.
Papillary Thyroid Carcinoma with Malignant Pleural Effusion: Dilemma of Etiology
Authors: Krishnamurthy Arvind , Siddappa KT
Published: June 2010

Papillary carcinomas of thyroid generally have an indolent course with metastatic disease in less than 5% of patients. Common sites of distant metastasis include lung and bone. A presentation with malignant pleural effusion is exceedingly rare with only a handful of cases reported in literature. We present a case and discuss the treatment of a patient presenting of papillary thyroid cancer with a relapse of the disease in the pleural cavity. There are no standard treatment recommendations in this setting in view of paucity of published data from literature.
Large Angioleiomyoma on the Face
Authors: Kulkarni Vikram , Athanikar Vidisha , Katti Trupti
Published: June 2010

Objective

To report a rare case of angioleiomyoma with regard to size, type (variant) and location.

Case report

45 years old male presented with painless swelling on the right side of the face since 2 years. On examination, the swelling was 4 cm × 3 cm in size, firm in consistency with well-defined margins. It was not adhering to overlying skin and underlying structures. The swelling was excised and sent for histopathological diagnosis. It was reported as solid variant of angioleiomyoma based on microscopic features.

Conclusion

According to the world literature, large angioleiomyoma on face is rare or not reported yet (usually less than 2 cm) and location (usually externar ear, tip of nose, lip). This case is presented for its uniqueness in size —large (4 cm x 3 cm); painlessness; variant; and location.
Can 3-dimensional Ultrasound Change Gynecological Ultrasonographic Examination?
Authors: Bau Santiago , Sabatel Rosa , Mercé Luis T , Alcázar Juan Luis , Barco María Jesús , Troyano Juan , Bajo José
Published: June 2010

Objective

To verify whether 3D transvaginal ultrasonography is as accurate as 2D conventional ultrasonography and whether it provides additional advantages in gynecologic diagnosis.

Material and methods

We performed a prospective study in 46 women who underwent 2D and 3D transvaginal scans successively. Three 3D volumes (uterus and each ovary) were acquired and evaluated 4 months later on a personal computer. We compared 2D and 3D scans in relation to sonographic diagnosis and biometry and the time spent.

Results

There was complete agreement between 2D and 3D techniques for sonographic diagnosis (31 normal exams, 16 adnexal cysts and seven myomas), except for the visualization and measurement of the uterine cervix. The mean time for 2D scans was 3.29 ± 1.32 minutes and was 2.96 ± 0.58 minutes for 3D examination (P = 0.076). The time required to acquire 3D volumes was only 1 hour, freeing 1 hour and 32 minutes for the performance of new scans.

Conclusions

Transvaginal 3D ultrasonography can be more efficient than conventional 2D ultrasonography in gynecologic diagnosis.
Primary Care in Obstetrics and Gynecology — A Place for Advanced Ultrasound?
Authors: Honemeyer Ulrich
Published: June 2010

The evaluation of adnexal masses based on transvaginal sonography (TVS) and when their size is too big- transabdominal US can be facilitated and refined by using color Doppler (CD), power Doppler (PD), and pulsed Doppler(PW), including three-dimensional ultrasound (3D US). With these modes, we obtain information about vascularity and flow indices, and their distribution within a mass. Considering the fact that neoangiogenesis is a main feature of malignancy, this is essential information. Thus, we are able to assume the benign or malignant character of an adnexal mass, make the right choice of additional imaging or biochemical tests, and then channel the treatment appropriately. This is subsequently demonstrated for simple cyst, hemorrhagic cysts, endometrioma, dermoid, serous papillary cystoma, ectopic pregnancy, and ovarian carcinoma.

Abnormal uterine bleeding (AUB) is a common problem in primary care. Compared to transabdominal approach, TVS improves the detection rate of underlying uterine pathology. In conditions like endometrial hyperplasia, polyps, submucous leiomyoma, and endometrial cancer, CD, PD, PW and contrast enhanced transvaginal ultrasound may optimize sonographic evaluation. Saline infusion sonohysterography (SISH) in out patient department (OPD) is an alternative to invasive diagnostic hysteroscopy in patients with AUB.

Care for maternal and fetal well-being during pregnancy is a main task in OPD. The assessment of fetal pathology is almost entirely based on Ultrasound. Several illustrations of fetal anomalies detected during 1st trimester and 2nd trimester screening, of abnormal findings in feto-maternal Doppler ultrasound, and fetal pathology demonstrated in 3D/4D ultrasound mode, conclude this review of advanced ultrasound in primary care.
Long-term Outcome of Pregnancies with Increased Nuchal Translucency and Normal Karyotype
Authors: Orosz L , Lukács J , Szabó M , Kovács T , Zsupán I , Orosz G , Tóth Z , Török O
Published: June 2010

Objectives

The aim of this study was to examine the prevalence of major and minor anomalies according to the increase of NT thickness.

Methods

This is a long-term retrospective study in which singleton gestations of euploid fetuses with increased NT were analyzed. NT measurement was performed in the first trimester examination according to the criteria of fetal medicine foundation (FMF) when the fetal crown-rump length (CRL) was 45 to 84 mm. The cases were followed up from 1 to 5 years postpartum to assess the presence of CHD and to point out other anomalies that could be associated with increased NT.

Results

The outcome of 133 cases could be analysed out of 198 pregnancies of which in 55 cases some congenital anomalies (minor or major) were revealed up to the 5 years of life (prevalence of 41.4%). The prevalence of CHDs, including the defects of the great vessels, stood out among the others. In the group with NT between 95th and 99th centiles four cases with minor heart problems were identified (11.1%, 4/36). The rate of major cardiac defects proved to be 13.3% (6/45) in the group with NT between 3.5-4.4 mm, and 17.3% (9/52) in the group with NT > 4.5 mm. Among the 35 healthy children with various minor health problems not related to the presence of increased nuchal translucency there were 7 cases with hydrocele. In 3 of them it was associated with unilateral inguinal hernia but in 3 it was isolated and one was part of a complex malformation (The rate of other organ-specific anomalies did not prove to be significant). In the whole study population only thirteen cases (9.8%) ended up in intrauterine death, or arteficial abortion.

Conclusion

The prevalence of major cardiac defects as well as other major anomalies increases with fetal nuchal thickness. Since the prevalence of CHD is 100 times higher in the population of fetuses with NT above 4.5 mm, specialist fetal echocardiography should be offered in the second trimester together with other follow-up investigations. Among the children without any major abnormalities, a high number of minor anomalies were revealed during the long-term follow-up. These anomalies do not have significant disadvantage to the quality of life, but some of them necessitates short or long-term medical treatment and this should also be leveled with the future parents. Despite the numerous investigations the exact etiology of increased NT remains unknown. The relatively high prevalence of hydrocele in the newborns in our material raises the question wheather it is related to the presence of NT in the fetal period because of abnormal lymphatic development or alterations in the extracellular matrix. Further long-term follow-up studies could probably contribute to find explanation on the etiology of increased NT in the first trimester. These data can be used when counseling parents of euploid fetuses with increased fetal NT.
What should Medical Students Know and Understand about Fetal Ultrasonography of the Nervous System?
Authors: Brower Richard D
Published: June 2010

Evaluation of the developing nervous system is a standard and relatively sensitive component of routine fetal ultrasonography. Medical school learning objectives should direct students to consolidate core concepts related to normal and abnormal fetal nervous system development through critical observation of this commonly performed clinical procedure.
The Use of Transvaginal Ultrasound by Emergency Physicians in Medical Student Education
Authors: Zafar Nadah B , Greer Veronica , Woolard Robert H
Published: June 2010

Paul L Foster School of Medicine at Texas Tech University Health Sciences Center in El Paso offers the students a faculty (both clinician and basic scientists) guided clinical presentation based curriculum. Emergency physicians have been an integral part of this curriculum. Bedside transvaginal ultrasound has become an adjunct to the history and physical examination for the evaluation in a timely manner of acute pelvic and lower abdominal pain and vaginal bleeding in the female of reproductive years. Discussion of the approach to diagnosis is divided into two broad categories; evaluation when there's a positive pregnancy test (first trimester) and a negative pregnancy test. The discussion also illustrates how the emergency physician can, using ultrasound, introduce, integrate, and review, the pertinent basic sciences (anatomy, embryology, pathology, physiology, microbiology and biochemistry) with the medical student.
Delivering Bad News: Aspects to Consider When Training Medical Students and Residents
Authors: Loaiza Jose Leonardo , Arroyave Ana Maria
Published: June 2010

Ultrasound advances have made a tremendous impact in the field of obstetrics and gynecology. The routinely use of this technology has allowed doctors to diagnose medical conditions in real time. When ultrasound reveals a serious diagnosis or a finding of concern (i.e. fetal demise, fetal malformation, a suspicious mass), communicating bad news to the patient and family represents a challenge that most doctors don't feel comfortable doing. In the following section we will present a clinical vignette, that involves a fetus with multiple structural malformations diagnosed by ultrasound, to show some general principles that can help physicians to break bad news. We also highlight the importance of incorporating formal training in medical school to help students become familiar and more comfortable delivering bad news.
Gynecologic Ultrasound as a Pharmacosurveillance Tool
Authors: Quest Dale
Published: June 2010

A traditional medical school curriculum does not formally prepare physicians to participate in evaluation of safety and effectiveness after medications enter the market. This article provides examples where ultrasound has unrealized potential as a noninvasive tool for longitudinal assessment of drug safety and effectiveness in the real-world. The examples are intended to sensitize medical schools and medical students to opportunities for physicians to advance therapeutic evaluation of drugs as they are used for approved and unapproved indications in actual practice.
Screening for Fetal Malformations
Authors: Theodora M , Antsaklis A , Daskalakis G
Published: June 2010

Even though the issue of routine sonography for low-risk pregnant women continues to be controversial mainly because randomized trials have failed to demonstrate clear benefit on pregnancy outcome, detection of different fetal malformations seems be one of the main indications for performing scans in pregnancy. Due to progress made in ultrasound technology and the experience of sonographers it is feasible to diagnose congenital anomalies as early as the end of the first trimester. Nevertheless most targeted studies are performed at 18 to 20 weeks of gestation. The highest rates of detection of congenital anomalies are seen in tertiary care settings such as a university medical center. In high-risk cases a consulting perinatologist is commonly the physician most likely to integrate the ultrasound findings.
Three-dimensional and Power Doppler Ultrasound of the Follicle and Endometrium on the Day of hCG Administration
Authors: Panchal Sonal , Nagori CB
Published: June 2010

The advances in ultrasound technology has changed the management of infertility. With the advent of color Doppler, pulse Doppler, 3D US and then 3D power Doppler the previously unexplained causes of failure of fertilization and implantation can now be explained. 3D and 3D power Doppler can now be used for the assessment of the maturity of the follicle and receptivity of the endometrium and can give better idea about the functional maturity of the follicle and the endometrium, to decide the timing of hCG administration for all assisted reproductive techniques for better pregnancy rates. The accuracy of diagnosis and monitoring of infertility treatments such as ovulation induction has greatly increased because of the availability of sophisticated ultrasound technology and equipment.1
Ultrasound Evaluation of Abnormal Early Pregnancy
Authors: Ahmed Badreldeen , Kupesic Sanja , Carrera Jose Maria
Published: June 2010

Ultrasound examination has become the “golden standard” in follow-up of the development and complications in early pregnancy. With introduction of transvaginal sonography a possibility for early morphological and biometrical ultrasound examinations has been significantly improved. The essential aim of an early pregnancy ultrasound is not only to diagnose a pregnancy, but also to differentiate between normal and abnormal pregnancy. Application of color Doppler ultrasound has enabled functional hemodynamic presentation and evaluation soon after implantation.
Diagnosis of Fetal Anomalies in Developing Country: Experiences in Indonesia
Authors: Salim Azen , Wiknjosastro Gulardi Hanifa , Surya I Gede Putu , Karsono Bambang , Karkata I Made Kornia , Wibowo Noroyono , Andonotopo Wiku , Sanjaya I Nyoman Hariyasa
Published: June 2010

Although three-dimensional ultrasound (3DUS) has been available for more than 10 years in Indonesia, there was no publishing article from our region which systematically evaluates our experiences in this most recent ultrasound technologies and its application to obstetric. 3DUS is revolving into a technology with various range of applications in numerous fields because it helps overcome some of the key limitations related to two-dimensional imaging. It is through this review that we attempt to develop a continuous line of understanding the current diagnostic benefits of 3D and 4DUS in diagnosis of fetal abnormalities and consider the utility and role of this type of imaging in the routine clinical practice.
Ultrasonic Assessment of Infertility
Authors: Honda Ikuko
Published: June 2010

Ultrasonographic changes of endometrium, ovaries and salpinges detected by realtime B-mode and 3D ultrasound indicate effective treatment of infertility not only in the Assisted Reproduction Technology (ART) but also in the conventional management where essential plan for the therapy is indicated. The articles concerning ultrasonographic assessments of fecundity and infertility are reviewed. Although the ART has become ordinary treatment of infertility, the pregnancy rate is yet unsatisfactory and it is important to select cycles where favorable conception is predicted in order to increase pregnancy rate in ART. Although antral follicle count (AFC) is the index for predicting ovarian response to human menopausal gonadotropin (hMG) stimulation, it is able to select stimulation options for a poor responder of low AFC value. Since three-dimensional (3D) ultrasonography with power Doppler angiography (PDA) indicates an organ blood flow as a whole, they are important tools for the evaluation of perfusion. The assessment of perifollicular blood flow in preovulatory follicles may be useful for predicting conception and cancelling in vitro fertilization (IVF) in poor vascularity cycle. Since rich endometrial vascularity assessed by 2D and 3D flow signs and the low impedance to flow suggests well perfused endometrium and the high receptivity in the embryo transfer (ET), and vice versa, it would be recommended to limit the number of embryos for the ET in the high receptivity, while to cryopreserve the embryo in case of bad flow signs and wait the cycle of favorable perfusion in order to successfully transfer the embryo.
The Role of Magnetic Resonance Imaging in the Diagnosis of Fetal Malformations
Authors: Lituania M , Fondelli MP , Passamonti U , Saitta L , Cerchiaro A , Arcuri T
Published: June 2010

Even if ultrasonography still remains the primary prenatal investigation technique for the assessment of fetal development, magnetic resonance imaging (MRI) plays an important role for the study of fetal morphology and pathology.

MRI has been shown to be particularly useful for the evaluation of the central nervous system (CNS), the latter being a common site of pathology such as cerebral and spinal malformations.

MRI is contributive in defining fetal neck, thoracic, abdominal, and pelvic masses. This can be especially helpful when differing opinions exists as to the etiology of a mass.

Ultrasonography, a non invasive, low cost, real time technique, still represents the investigation of choice in prenatal screening, not only regarding the CNS. Nevertheless several cases need a diagnostic complement by means of MRI, that increases the diagnostic potential of ultrasound .

The additional information from MRI is important in prenatal counseling, delivery planning and planning for pre- or postnatal intervention.
An Attempt to Discover Antenatal Etiological Factors for Cerebral Palsy: What does 3D and 4D Ultrasonography Add?
Authors: Azumendi Guillermo , Marton Ingrid , Kurjak Asim , Herman Mislav
Published: June 2010

Cerebral palsy (CP) is a nonprogressive condition affecting developing fetal or infant brain resulting in disorders of movement and posture which are sometimes accompanied by disturbances of cognition, sensation, perception, behavior and seizures. The incidence of CP being 2 to 2.5 per 1000 live births did not considerably change in the last decades. Improvement of perinatal care did not result in the decreasing prevalence of CP. Consensus Statement of International Cerebral Palsy Task Force and its modification presented the essential criteria to define an acute intrapartum event sufficient to cause CP. These criteria were not helpful in allocating the time of brain injury, proving that etiology of CP is difficult to investigate. Better markers of acute intrapartum injury should be defined, although much evidence exists that most causes of CP are prenatal. Advances in 3D and 4D ultrasound (US) give opportunities to investigate fetal morphology and behavior. By 4D US, head, body and limb movements can be visualized simultaneously. The earliest phase of development can be studied in detail, making 4D superior compared to 2D. Is applicable neurological test for fetus available? This question is complicated, because even postnatally several neurological methods of evaluation exist, while hardly accessible fetus has less mature brain. Inexistence of reliable neurobehavioral assessment method for the fetuses is discouraging. The scientific community should intensify efforts in finding out simple, clinically applicable, and reproducible fetal neurological test(s), with fair sensitivity and specificity.
Fetal Ventriculomegaly
Authors: Pooh KyongHon , Pooh Ritsuko K
Published: June 2010

The causes of fetal ventriculomegaly vary. Ventriculomegaly can be caused by not only obstruction of cerebrospinal flow tract but also brain maldevelopment or other reasons. Recent advanced imaging technology and approaching technique of transvaginal sonography have contributed to an accurate prenatal diagnosis and clearly revealed fetal intracranial condition. However, management of the condition and counseling of parents are still difficult, because the initial cause, absolute risk, and degree of resulting neurological deficit cannot be determined with confidence. Ventriculomegaly is evaluated according to atrial width > 10 mm and mild ventriculomegaly is defined as an atrial width of 10 to 15 mm. In ventriculomegaly cases, accurate detection of intracranial structure and additional abnormalities is required. Furthermore, ventriculomegaly may resolve spontaneously or progress during pregnancy. Therefore, detailed neuroscan by advanced imaging technology, detailed extra-CNS scan, longitudinal serial scan during pregnancy are mandatory for proper counseling and management. Longitudinal observation study of not only short-term but also long-term neurological prognosis will be required.
Ultrasound of the Placenta
Authors: Zalud Ivica , Holzman Jennifer , Bartholomew Marguerite Lisa
Published: June 2010

This review covers ultrasound evaluation of the normal and abnormal placenta with clinical correlation. Normal placental function is essential for a healthy pregnancy outcome as well as for maternal, fetal, childhood, and adult health. Abnormal placental function may result in a compromised pregnancy, creating pathology for the fetus and mother alike. Despite the fact that placental anatomy, function, and location has far-reaching effects for the parents and the developing offspring, ultrasound examination of the placenta is often considered secondary to the fetus by expectant parents and sonographers as well. Location, size, shape, and architecture are easily ascertained with two-dimensional techniques. Three-dimensional ultrasound and Doppler techniques have opened up the frontier of placental function and have set the stage to make placental evaluation as fascinating as that of the fetus.

Learning objectives

To assess normal placenta by ultrasound.

To discuss abnormal placenta and umbilical cord.

To understand placentation in multiple gestation.
Adnexal Masses in Pregnancy: Diagnosis and Management
Authors: Graham George M
Published: June 2010

The widespread use of ultrasound in obstetrics has led to an increase in the diagnosis of asymptomatic adnexal masses in pregnancy. Ultrasound is an accurate and safe method for diagnosing the etiology of an adnexal mass and distinguishing benign from malignant pathology. The management of an adnexal mass in pregnancy is controversial. Historically, it was recommended that any adnexal mass be removed electively in the second trimester to exclude malignancy and prevent complications such as torsion, rupture, and obstruction of labor. More recent recommendations have limited surgical intervention in pregnancy to symptomatic adnexal masses and those that are highly suggestive of malignancy. Surgery in pregnancy is associated with an increased risk of adverse pregnancy outcomes. However, laparoscopy appears to be a safe alternative to laparotomy for benign masses when performed by experienced surgeons.

Learning objectives

To list the differential diagnoses of adnexal masses in pregnancy

To interpret ultrasound images of adnexal masses and distinguish benign from malignant masses

To describe the management options for adnexal masses in pregnancy, including the indications and options for surgical intervention.
Postmenopausal Dilemmas: The Role of Ultrasound
Authors: Murphy R Bryan , Zalud Ivica
Published: June 2010

The postmenopausal patient presents unique challenges in ultrasound. With age being a major risk factor for most malignancies, the results of the examination can result in a clinician being more apt to conduct more invasive tests or elect for a surgical cure. This article is aimed to review the common gynecological pathology in post- menopausal patients and how ultrasound can aid the clinician in diagnosis and management. As noninvasive and nonradiation imaging modality, pelvic ultrasound allows valuable approach to assessment of anatomy and pathology of the uterus and adnexa in postmenopausal patients. Validity for the delineation of morphological characteristics of pelvic abnormalities is widely tested and already applied to routine clinical care. The early detection of pelvic carcinoma is still the most attractive for further studies.

Learning objectives

To discuss how ultrasound can help in management of postmenopausal bleeding

To present the role of ultrasound in diagnosing pelvic masses

To understand ultrasound contribution in screening for pelvic malignancies.
Evaluation of Fetal Arrhythmias
Authors: Graham George M
Published: June 2010

Fetal arrhythmias are not uncommon. The diagnosis of a fetal arrhythmia is challenging and normally requires referral for a detailed fetal echocardiogram. The first step in the ultrasound evaluation should be distinguishing whether the arrhythmia is an irregular rhythm, a bradycardia, or a tachycardia. This can be done by evaluating the arrhythmia using simultaneous atrial and ventricular M-mode or pulsed Doppler. Although the majority of fetal arrhythmias are self-limited and benign, some are potentially life-threatening for the fetus and for these cases a multidisciplinary approach to treatment may be required.

Learning Objectives

Know the different types of fetal arrhythmias

Understand how fetal arrhythmias are diagnosed

Know which fetal arrhythmias require treatment
Just Images: Obstetrics
Authors: Bartholomew Marguerite Lisa , Fujimoto Chrystie
Published: June 2010

Diagnostic ultrasound in the field of obstetrics is used to evaluate fetal anomalies and well-being. These images are used to develop a differential diagnosis that can later be correlated with postnatal outcomes. The following cases are a small sample of recent challenging fetal anomalies at our institution that were detected on prenatal ultrasound.

Objectives

Interpret ultrasound images of fetal anomalies

Assimilate the interpretation of images into a differential diagnosis

Correlate prenatal imaging with postnatal outcomes
Alar Batten Grafts for Non-iatrogenic Nasal Valve Area/Alar Collapse
Authors: Reddy C Ekambar E , Teemul Trevor , Hampal Sucha , Reddy Krishna TV
Published: June 2010

Objectives

We present our 3 years experience with alar batten grafts, using a modified technique, for non-iatrogenic nasal valve/alar collapse.

Methods

Retrospective (Oct. 2005 to Apr. 2008) and prospective study (Apr. 2008 to Dec. 2008) of 16 consecutive patients undergoing alar batten grafts for alar collapse causing nasal obstruction. The graft was inserted through a rim incision and placed across as well as superficial to the lower lateral cartilage. The main outcome measures were subjective improvement in nasal obstruction and absence of alar collapse at examination.

Results

Alar collapse was bilateral (n = 8), right sided (n = 4) and left sided (n = 4) giving 24 operated sides (s = 24). Deviated nasal septum (n = 9), synechiae (n = 1) and drooping tip (n = 1) were also present. Donor sites for the graft were septal cartilage (n = 10), conchal cartilage (n = 4) or both septal and conchal cartilages (n = 2). The median follow-up was 4 months (range 1 month to 3 years). Subjective nasal obstruction had worsened in 0%, was unchanged in 16.6% (s = 4), had improved in 16.6% (s = 4) and 66.6% (s = 16) were completely free of obstruction. Two of the improved cases worsened at 10 and 3 years giving overall failure in 25% (s = 6). Significant alar collapse was present in all failed cases and absence of collapse was documented in improved cases (s = 13). In failed cases the graft size width was 5 to 8 mm and in successful cases it was 10 to 15 mm. Lengths of the grafts in all cases was between 18 and 24 mm. One complication of graft extrusion through skin occurred.

Conclusion

Our technique of alar batten graft insertion appears to be as effective as other techniques described in the literature. We suggest a minimum graft size of 10 mm width and 18 mm length to improve success rate.
Coexistent Optic Neuritis and Isolated Acute Sphenoid Sinusitis
Authors: Kumar Mahesh , Rajiniganth MG , Kim Usha R
Published: June 2010

We report two cases of optic neuritis associated with isolated acute sphenoid sinusitis. This is the first report of isolated sphenoid sinusitis with dehiscent optic canal with exposed nerve presented with optic neuritis without any orbital inflammation. In both cases visual acuity deteriorated with steroid therapy, CT scan showed air fluid in the sphenoid sinus with dehiscent optic canal. Antibiotic, sphenoidotomy and later steroid course had a partial recovery in vision.
Endoscopic Management of Optic Nerve Sheath Meningocele
Authors: Meher Ravi , Vats Pankaj , Vats Deepti , Dadeya Subash
Published: June 2010

Optic nerve sheath dilatation forming a cyst containing cerebrospinal fliud (CSF) is a rare condition. It is actually an enlargement and dilation of primarily the optic nerve sheath. There is an expansion of the cerebrospinal fliud space around the optic nerve with no associated inflammation, orbital or cerebral neoplasm at the apex of the orbit. It is a very rare condition and only few cases have been reported in the literature. We describe a case of optic nerve meningocele which was successfully managed surgically through intranasal route. A brief review of the existing literature is also presented.
Laser Transcanalicular Endonasal DCR
Authors: Yadav Pravesh , Meher Ravi , Goyal Kavita , Kumar Virad , Chopra Aditi
Published: June 2010

Nasolacrimal duct obstruction is a common disorder which clinically manifests as epiphora. Many procedures have been described to bypass this obstruction, for example external dacryocystorhinostomy (DCR), endoscopic DCR with and without stents, Laser endoscopic DCR. Each of these procedures has its own success rates and complications. We did an analysis of all laser assisted endonasal DCR performed in our department from Feb 2006 to July 2009. In all we had operated 237 total cases out of which 203 were with normal endonasal DCR and 34 cases were Laser transcanalicular endonasal DCR (Laser DCR). Over all success rate was 92%(218 cases). In case of Laser assisted endonasal DCR the success rate was 70.3% (19 cases) with failure rate of 29.7% (8 cases) at three months follow-up. This preliminary study reveals that LASER DCR is associated with higher failure rates as compared to the normal endonasal DCR.
Atmospheric deposition of mercury and major ions to the Pensacola (Florida) watershed: spatial, seasonal, and inter-annual variability
Authors: Caffrey J. M. , Landing W. M. , Nolek S. D. , Gosnell K. J. , Bagui S. S. , Bagui S. C.
Published: June 2010

Abstract. Atmospheric deposition was measured at three sites in the Pensacola Bay watershed, Florida, between November 2004 and December 2007. Mercury deposition in the Pensacola Bay watershed was similar to that from nearby Mercury Deposition Network sites along the Northern Gulf of Mexico coast. Mercury deposition during the summer months is higher than other months due to higher concentrations in rainfall throughout the region. Deposition of constituents like H+, sulfate, nitrate, ammonium, chloride and sodium, were much higher in Pensacola Bay that at National Atmospheric Deposition Program (NADP) sites. Chloride and sodium deposition are higher because Pensacola Bay sites are closer to the Gulf of Mexico which is a source of sea salt aerosols. Acid rain constituents, H+, sulfate, nitrate and ammonium are most likely higher at Pensacola Bay sites because these sites are much closer to emission sources of these constituents than NADP sites, particularly two Florida NADP sites, FL14 and FL23, which are located in rural counties far from major industrial activities.
Saharan dust and ice nuclei over Central Europe
Authors: Klein H. , Nickovic S. , Haunold W. , Bundke U. , Nillius B. , Ebert M. , Weinbruch S. , Schuetz L. , Levin Z. , Barrie L. A. , Bingemer H.
Published: June 2010

Abstract. Surface measurements of aerosol and ice nuclei (IN) at a Central European mountain site during an episode of dust transport from the Sahara are presented. Transport is simulated by the Eulerian regional dust model DREAM. Ice nuclei and mineral dust are significantly correlated. The highest correlation is found between IN concentration and aerosol surface area. The ice nucleating characteristics of the aerosol with respect to temperature and supersaturation are similar during the dust episode than during the course of the year. This suggests that dust is always a dominant constituent of ice nucleating aerosols in Central Europe.
Aerosol exposure versus aerosol cooling of climate: what is the total health outcome?
Authors: Löndahl J. , Swietlicki E. , Lindgren E. , Loft S.
Published: June 2010

Abstract. Particles, climate change, and health have thought-provoking interactions. Emission of aerosol particles is one of the largest environmental problems concerning human health. On the other hand, aerosol particles can have a cooling effect on climate and a reduction of those emissions may result in an increased temperature, which in turn may have negative health effects. The objective of this work was to investigate the "total health" effects of aerosol emissions, which include both exposure to particles and consequences of climate change initiated by particles. As a case study the "total health" effect from ship emissions were estimated by adding the number of deaths from aerosol emission exposure to the calculated number of lives saved from the cooling effect of the particles. The analysis indicated an annual mortality from ship emissions of 26 000 (minimum uncertainty range −5000 to 52 000), with 60 000 deaths from direct aerosol exposure and 34 000 lives saved by the cooling effect of particles. This is the first attempt to calculate the combined effect of particle emissions on health. We conclude that measures to reduce particulate air pollution will in some cases (black carbon) have win-win effects on health and climate, but for most particulates cause a shift from exposure-related health effects towards an increasing risk of health consequences from climate change. Thus, measures to reduce aerosol emissions have to be coupled with climate change mitigation actions to achieve a full health benefit on a global level.
Chemical properties of rain events during the AMMA campaign: an evidence of dust and biogenic influence in the convective systems
Authors: Desboeufs K. , Journet E. , Rajot J.-L. , Chevaillier S. , Triquet S. , Formenti P. , Zakou A.
Published: June 2010

Abstract. This paper documents the chemical composition of 7 rain events associated with mesoscale convective systems sampled at the supersite of Banizoumbou, Niger, during the first special observation periods (June–July 2006) of the African Monsoon Multidisciplinary Analyses (AMMA) experiment. Time-resolved rain sampling was performed in order to discriminate the local dust scavenged at the beginning of rain event from the aerosol particles incorporated in the cloud at the end of the rain. The total elemental composition is dominated by Al, Si, Fe and Ca, indicating a high influence of dust and limited marine or anthropogenic contribution. After the aerosol wash-out, the elemental concentrations normalized to Al and the microscopic observations of diatoms, a tracer of the Bodélé depression, both indicate that the total elemental composition of rainwater is controlled by dust originating from North-Eastern Saharan sources and probably incorporated in the convective cloud from the Harmattan layer. The low variability of the rain composition over the measurement period indicates a regional and temporal homogeneity of dust composition in the Harmattan layer. In the dissolved phase, the dominant anions are nitrate (NO3−), sulphate (SO42−) and chloride (Cl−). However, between June and July we observe an increasing contribution of the organic anions (formate, acetate, oxalate) associated with biogenic emissions to the total ion composition. These results confirm the large influence of biogenic emissions on the rain composition over Sahel during the wet season. The paper concludes on the capacity of mesoscale convective systems to carry simultaneously dust and biogenic compounds originating from different locations and depose them jointly. It also discusses the potential biogeochemical impact of such a phenomenon.
Collocating satellite-based radar and radiometer measurements – methodology and usage examples
Authors: Holl G. , Buehler S. A. , Rydberg B. , Jiménez C.
Published: June 2010

Abstract. Collocations between two satellite sensors are occasions where both sensors observe the same place at roughly the same time. We study collocations between the Microwave Humidity Sounder (MHS) on-board NOAA-18 and the Cloud Profiling Radar (CPR) on-board CloudSat. First, a simple method is presented to obtain those collocations and this method is compared with a more complicated approach found in literature. We present the statistical properties of the collocations, with particular attention to the effects of the differences in footprint size. For 2007, we find approximately two and a half million MHS measurements with CPR pixels close to their centrepoints. Most of those collocations contain at least ten CloudSat pixels and image relatively homogeneous scenes. In the second part, we present three possible applications for the collocations. Firstly, we use the collocations to validate an operational Ice Water Path (IWP) product from MHS measurements, produced by the National Environment Satellite, Data and Information System (NESDIS) in the Microwave Surface and Precipitation Products System (MSPPS). IWP values from the CloudSat CPR are found to be significantly larger than those from the MSPPS. Secondly, we compare the relation between IWP and MHS channel 5 (190.311 GHz) brightness temperature for two datasets: the collocated dataset, and an artificial dataset. We find a larger variability in the collocated dataset. Finally, we use the collocations to train an Artificial Neural Network and describe how we can use it to develop a new MHS-based IWP product. We also study the effect of adding measurements from the High Resolution Infrared Radiation Sounder (HIRS), channels 8 (11.11 μm) and 11 (8.33 μm). This shows a small improvement in the retrieval quality. The collocations described in the article are available for public use.
Ion-acoustic solitary waves and spectrally uniform scattering cross section enhancements
Authors: Ekeberg J. , Wannberg G. , Eliasson L. , Stasiewicz K.
Published: June 2010

Abstract. Spectra measured by incoherent scatter radars are formed predominantly by scattering of the incident signal off ion-acoustic and Langmuir waves in the ionosphere. Occasionally, the upshifted and/or downshifted lines produced by the ion-acoustic waves are enhanced well above thermal levels and referred to as naturally enhanced ion-acoustic lines. In this paper, we study another kind of enhancement, which is spectrally uniform over the whole ion-line, i.e. the up- and downshifted shoulder and the spectral valley in between. Based on observations made with the EISCAT Svalbard radar (ESR) facility, we investigate the transient and spectrally uniform power enhancements, which can be explained by ion-acoustic solitary waves. We use a theory of nonlinear waves in a magnetized plasma to determine the properties of such waves and evaluate their effects on scattered signals measured by ESR. We suggest a new mechanism that can explain backscattered power enhancements by one order of magnitude above the thermal level and show that it is consistent with observations.