bluuebunny/crossref_metadata_2025 huggingface dataset:
Merkel cell carcinoma – a retrospective analysis of 17 cases
Authors: Hohaus K , Köstler E , Schönlebe J , Klemm E , Wollina U
Published: March 2003

Objective To report clinical experience with the rare neuroendocrine Merkel cell carcinoma of the skin.

Subjects and setting Seventeen patients with Merkel cell carcinoma of the skin treated at the Departments of Dermatology and ENT, Krankenhaus Dresden‐Friedrichstadt, Dresden, Germany, during the years 1984–2000 were evaluated.

Methods A retrospective analysis was performed. Age and sex distribution, clinical data and therapy were collected. Outcome measures including overall survival, tumour‐free survival and relapse‐free survival were determined.

Results Six male and 11 female patients with an age range of 68–90 years (mean age 73.3 years) were identified. The primary tumour localization was head and neck region (n = 8), upper limbs (8), lower limbs (1). Twelve patients presented in tumour stage I, three in stage II and one in stage III. First line therapy was complete surgical excision with wide margins in 16 patients followed by loco‐regional radiation in 12 of 16 cases. In 16 patients follow up data were available. After primary treatment complete response was achieved in 14 of 16 patients (87.5%), two patients had a partial response. The median of relapse‐free survival was 44 weeks [mean ± standard deviation: (44 ± 118) weeks]. The median of overall survival was 102 weeks [mean ± standard deviation: (137 ± 94) weeks]. Three patients with a PR after primary treatment had a median overall survival of only 48 weeks [mean ± standard deviation: (51 ± 20) weeks].

Conclusions Primary surgical treatment with wide excision combined with radiotherapy seems to be a reasonable first‐line treatment but prospective controlled multicentre trials are necessary for validation.
Age Recognition in Adults with Intellectual Disabilities: a Literature Review and an Exploratory Study
Authors: Bell Dorothy M. , Espie Colin A.
Published: March 2003

The ability of children to classify accurately their own ages and the ages of others has been the subject of very limited research. However, the literature is largely in agreement on there being progressive increases in skill with chronological age, although there is disagreement on the age at which this ability becomes well developed. The processes look similar in the field of intellectual disabilities, although this area is extremely under‐researched. Key factors may include age, the amount of time spent in institutions (e.g. long‐term hospitals for people with intellectual disabilities), developmental level and IQ. The present paper provides a review of the relevant literature and an exploratory study investigating the age recognition of self and colleagues in a group of 20 adults with intellectual disability, some from within what has been a major hospital for people with intellectual disabilities and some from the wider community. Measures of age recognition using photographs, as well as standardized measures of intellectual ability and social adaptive behaviour, were administered, and correlations were found between the ability to recognize age in others and developmental age, and also IQ. Success on the task of age discrimination appears to be more likely if the IQ of the individual is around 60–65 or above, and if the person shows social adaptive behaviour equivalent to 8 or 9 years of age and over. Also included in the study was a task in which only the discrimination of whether the photographs were of adults or children was required, and this proved to be a simpler process for the participants. The present study also demonstrates some of the discriminative stimuli used by adults with intellectual disabilities to ascertain the approximate age of a person.
Assessment and Intervention to Teach Age Recognition Skills: a Suggested Programme Using the Example of a Case Study to Illustrate
Authors: Bell Dorothy M. , Espie Colin A.
Published: March 2003

A 43‐year‐old man with mild intellectual disabilities was referred after several contacts with the law when he had been seen in the street talking to children who were unknown to him. Some staff members feared that he had a sexual interest in children. Other colleagues considered that the behaviour was innocent, reflecting his friendly nature, but that it was a behaviour which was misinterpreted by others. The present paper charts the assessment of this man's difficulties and abilities over a wide range of relevant areas, and a reassessment following an intensive period of one‐to‐one training on age‐recognition skills. Although the training was unsuccessful, the measures used assisted in making a detailed assessment and providing clear instructions to care staff, all of which was to the subject's long‐term benefit. The present paper also illustrates the way in which difficulties of this nature can be assessed and uses allied assessment measures which may be helpful in looking at the whole picture of any person with such problems. It also considers how these areas may then be addressed. Although, in this case, the subject was unable to learn to discriminate specific age groups despite intensive training, he was consequently able to be advised in a manner which should keep him from getting into trouble in the future and the now detailed knowledge of his abilities in all these areas is valuable for his long‐term support in the community.
Healthy Ageing – Adults with Intellectual Disabilities: Women's Health and Related Issues
Authors: Walsh P. N. , Heller T. , Schupf N. , Van Schrojenstein Lantman‐de Valk H.
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: ,  and .
Is Satisfaction a Valid Concept in the Assessment of Quality of Life of People with Intellectual Disabilities? A Review of the Literature
Authors: Hensel Elizabeth
Published: March 2003

The present review examines the definitions of quality of life (QoL) which have developed over the past 3 decades and which reflect the increased awareness of the need to take into account individuals' own perceptions of their life. The concept of satisfaction is frequently used as an important subjective variable in QoL studies, despite the evidence of stability of satisfaction over individuals and over time, which suggests that it should be a measure insensitive to change. This evidence is examined and the idea of such stability being an adaptive psychological mechanism is considered. The use of satisfaction as a measure of QoL in people with intellectual disabilities (IDs) is discussed. The methodological difficulties encountered in assessing the subjective experiences of people with IDs are also discussed. Finally, it is argued that there is a strong argument for the abandonment of measures of QoL in general, and subjective ones in particular, for people with IDs. An alternative approach is suggested.
Ultrasound findings in gestations destined for unanticipated fetal demise
Authors: Dombrowski M. P. , Bottoms S. F. , Zador I. , Wolfe H. M. , Sokol R. J.
Published: March 2003

There are few reports of ultrasound findings in the second and third trimesters preceding intrauterine fetal demise. To describe these findings, the ultrasound assessments of 36 structurally normal singleton fetuses with subsequent intrauterine fetal demise were compared to gestational age‐matched controls. Compared to controls, it was found that biparietal diameter, head circumference, femur length and estimated fetal weight were all decreased, abnormalities of amniotic fluid volume were more frequent, but the cephalic index was not different. Upon delivery, the group with subsequent intrauterine fetal demise was not found to have any major anomalies, but had a high incidence of abnormal umbilical cord position, abruptio placentae, chorioamnionitis and meconium aspiration. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal sonographic diagnosis and perinatal management of ectopia cordis
Authors: Achiron R. , Shimmel M. , Farber B. , Glaser J.
Published: March 2003

Ectopia cordis is a rare malformation presenting as an isolated lesion or as part of the Cantrell's pentology syndrome. Prenatal ultrasonographic diagnosis of ectopia cordis must be followed by a careful search for associated anomalies, since the prognosis may vary accordingly. A case of prenatal diagnosis of ectopia cordis in the early second trimester is presented. Routine sonographic examination at 18 weeks of gestation revealed protrusion of the heart into the amniotic fluid, ventricular septal defect and omphalocele. The perinatal evaluation and management are discussed. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Absence of fetal breathing and abnormal fetal behavior in prolonged preterm ruptured membranes: case report
Authors: Pillai M. , James D.
Published: March 2003

A case is described where prolonged serial observations were carried out on a fetus, between 26 and 3.5 weeks' gestation, the membranes having been ruptured from 23 weeks. No fetal breathing or cyclical activity was observed, and there was no evidence of development of linkage between the fetal behavioral state variables. This was not associated with respiratory morbidity in the neonatal period, but subsequently with severe developmental delay, microcephaly, myoclonic epilepsy and hearing impairment. Absence of fetal breathing may be a more important predictor of prenatal neurological abnormality than of respiratory morbidity following birth. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal cord in normal third‐trimester pregnancy: a color Doppler imaging study
Authors: Jauniaux E. , Mawissa C. , Peellaerts C. , Rodesch F.
Published: March 2003

A prospective study was performed in a normal, unselected, population of 180 pregnant women to assess the screening properties of color Doppler imaging in the detection of nuchal cord during the third trimester of pregnancy. A search was made for the umbilical cord position initially using conventional real‐time gray‐scale imaging and subsequently using color imaging. Umbilical artery resistance and pulsatility indices and maximum peak systolic velocity were measured in each case at the level of the placental cord insertion. Forty‐five (25%) cases examined using color imaging presented with a nuchal cord at both ultrasound examination and delivery. Color imaging correctly identified in utero 28 (72%) single and 17 (94%) multiple nuchal cords found at birth. The overall sensitivity of color imaging in detecting nuchal cord prenatally was greater than for gray‐scale imaging (79% compared with 33%). The sensitivity of color imaging was also higher after 36 weeks than before (93% compared with 67%). No difference was observed between the umbilical artery resistance and pulsatility indices. There was also no difference observed for the maximum peak systolic velocity between cases presenting with a nuchal cord (at both ultrasound examination and delivery) and controls matched for gestational age. We suggest that the clinical usefulness of systematic identification in utero of nuchal cord in pregnancies presenting with a normal fetus in the vertex position is limited, but might be of value in the management of breech and twin gestations, and also in the management of chronically growth‐retarded fetuses. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Doppler velocimetry of the uterine artery as a screening test for gestational hypertension
Authors: Valensise H. , Bezzeccheri V. , Rizzo G. , Tranquilli A.‐L. , Garzetti G. G. , Romanini C.
Published: March 2003

Doppler ultrasound was used to study the main uterine artery flow velocity waveforms in an unselected population of 272 primiparous women at 22 weeks' gestation. The incidences of subsequent complications were as follows: gestational hypertension alone, 4.4%; intrauterine fetal growth retardation alone, 4%; and gestational hypertension with intrauterine growth retardation, 3.6%. The flow velocity waveform was considered abnormal when the resistance index in the uterine artery was greater than 0.58. This identified 9.5% of the population as ‘at risk’ and predicted either of the above outcomes with an overall sensitivity of 74% (kappa index, 0.72). The sensitivity of prediction for gestational hypertension alone was 50% while for proteinuric gestational hypertension it was 88%. The best result was obtained for the prediction of pregnancies affected by both gestational hypertension and intrauterine growth retardation, where the sensitivity was 100%. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Fetal acidosis and Doppler velocimetry of the umbilical arteries in labor
Authors: Stuart I. P. , Lindow S. W. , van der Elst C. W.
Published: March 2003

The objective of the study was to determine whether Doppler velocimetry indices of the fetal umbilical arteries change with the development of acidosis during labor. Repeated Doppler velocimetry was performed in selected patients with high‐risk labors for the purpose of evaluating whether this might be a useful test of fetal well‐being in labor. The study sample comprised 36 women with singleton pregnancies, complicated either by gestational proteinuric hypertension or by intrauterine growth retardation (or both) with a normal cardiotocographic tracing at the onset of labor. The acid–base status of the fetus was assessed after delivery by analyzing the umbilical artery blood. A total of 27 fetuses were followed through labor. Six were born with an umbilical artery base deficit of more than 10 mmol/l. No change in mean Pourcelot ratio (resistance index) was noted in both normal and acidotic fetuses. None of the acidotic fetuses showed a change in Pourcelot ratio of more than 0.03. We conclude that Doppler velocimetry of the umbilical arteries, as measured by the Pourcelot ratio, does not contribute to the diagnosis of fetal acidosis in labor. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography in the diagnosis of pelvic malignant recurrence: integration of sonography and needle‐guided biopsy
Authors: Volpi E. , Zola P. , De Grandis T. , Rumore A. , Volpe T. , Sismondi P.
Published: March 2003

The aim of this study was to evaluate the efficiency of transvaginal sonography and sonography plus needle biopsy in detecting pelvic malignant recurrence.

We scanned 24 patients already treated for gynecological malignancy, 21 of whom underwent needle biopsy under sonographic guidance. Thirteen patients were affected by cervical cancer, ten by ovarian cancer, and one by endometrial‐ovarian carcinoma.

Sonography detected 16 solid or cystic‐solid masses (median size 52 mm, range 15–85 mm), one case of ascites, and one liquid mass (hematoma). All the patients in whom a suspicious mass was detected had recurrence. In the six patients in whom no mass was visible, two had recurrence. Needle biopsy was able to demonstrate recurrence in 17 patients (also in two false‐negative scans). In one, even though sonography detected a mass, the histological sample was negative, but recurrence was later diagnosed by laparotomy.

Accuracy, sensitivity and specificity of transvaginal sonography were respectively 91.6%, 89.4% and 100%. The positive predictive value was 100% and the negative predictive value was 71.4%. Transvaginal sonography was shown to be a useful means of detecting pelvic recurrence. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester uteroplacental and fetal blood flow velocity waveforms in normally developing fetuses: a longitudinal study
Authors: van Zalen‐Sprock M. M. , van Vugt J. M. G. , Colenbrander G. J. , van Geijn H. P.
Published: March 2003

Our objectives were to obtain a complete overview of uteroplacental and fetal hemodynamics early in pregnancy and to record flow velocity waveforms in the vitelline artery using color Doppler equipment. Flow velocity waveforms were recorded in 18 uneventful pregnancies between 6 and 16 weeks of gestation. Doppler recordings were made of the left and right uterine and spiral arteries from 6 weeks of gestation onwards. Recordings of c the umbilical artery, fetal aorta and fetal cerebral arteries started in weeks 7, 8 and 9, respectively. Where possible, the vitelline arteries were also recorded. The resistance and pulsatility indices and 95% confidence intervals for predictions were calculated.

For the uterine and spiral arteries, characteristics of the waveforms were assessed. The resistance index of both uterine and spiral arteries gradually decreased with advancing pregnancy. For the umbilical artery, aorta and cerebral artery, the earliest possible Doppler recordings and characteristics of the waveforms were established. The pulsatility index of the umbilical arteries and fetal aorta showed a sharp decrease towards the 16th week. The pulsatility index of the fetal cerebral artery showed only a mild decrease towards week 16. In a longitudinal analysis, there were significant changes of the resistance and pulsatility indices for each patient. In the vitelline artery, recordings were possible in eight out of 18 fetuses, and only in weeks 7 and 8 of gestation. The pulsatility index showed a wide range and was not dependent on menstrual age.

Knowledge of the normal flow velocity waveforms in the maternal uteroplacental and fetal circulations early in pregnancy may lead to a better understanding of physiological mechanisms.
Fetal cerebral blood flow velocity during labor and the early neonatal period
Authors: Maesel A. , Sladkevicius P. , Valentin L. , Maršál K.
Published: March 2003

This study was performed to elucidate circulatory changes in the fetal cerebral circulation during uncomplicated labor and in early neonatal life. Eighteen healthy term singleton fetuses were followed longitudinally during labor. Using the transabdominal approach, and the color Doppler technique, the middle cerebral artery was identified and Doppler flow velocity waveforms recorded between and during uterine contractions. Neonatal recordings were made by insonating the middle cerebral artery from the temporal region before and immediately after the cutting of the umbilical cord, and at 1 hour and 1 day after birth. The recorded Doppler signals were evaluated for pulsatility index, heart rate, peak systolic flow velocity, end‐diastolic flow velocity and time‐averaged maximum velocity. There was no change in the pulsatility index between and during contractions (1.39 ± 0.36 and 1.40 ± 0.39, respectively, mean ± SD). A significant decrease in the pulsatility index compared to fetal values was seen 4 min after birth (1.06 ± 0.30, p < 0.01). One hour after birth, the pulsatility index values increased significantly (1.52 ± 0.25, p < 0.001), to fall again between I hour and 1 day after birth (0.95 ± 0.26, p < 0.001). Mechanical compression of the skull, blood gas changes and a decrease in ductal shunting may all have contributed to these changes. The present study has shown physiological neonatal circulatory adaptation and onset of breathing to cause manifest changes in cerebral blood flow velocity. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Use of an endolaparoscopic probe in conservative management of Fallopian pregnancy
Authors: Giordano B. , Contino B. , Gippa R. , Armellino F. , Alovisi C. , Gargiulo T.
Published: March 2003

The incidence of extrauterine pregnancy has shown an increasing trend, exceeding one out of every 100 term pregnancies. This has resulted in the development of more and more conservative surgical treatments in order to retain the fertility of women. The use of operative laparoscopy has led to progress being made in this direction, due to reduced tissue trauma and a reduction in the number of peritoneal adhesions. Tubal isthmic pregnancies tend to cause an irregular increase in the size of the whole tube, which causes problems for pinpointing the exact site of the ectopic implantation. It is often necessary to make a longitudinal incision in the tubal wall to identify the chorionic tissue and remove it completely. In an attempt to avoid this unnecessarily extensive surgery, we used an echographic sector probe under laparoscopic control to locate the exact area of the ectopic implantation. We found it was possible to remove the villous tissue through a very short and precise cut in the tubal wall which facilitated the drainage of the lumen and reduced the bleeding normally associated with more extensive tubal surgery. Hysterosalpingographic follow‐up studies after 2 months showed good tubal recanalization. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound in diagnosing phocomelia
Authors: Lee A. , Kratochwil A. , Deutinger J. , Bernaschek G.
Published: March 2003

Deformations of the extremities with limb reduction are rare congenital defects which affect one in 1692 live babies. Three‐dimensional ultrasound can be of value in the prenatal diagnosis of such deformities. We present a case of upper phocomelia and congenital thrombocytopenia (TAR syndrome). Visualization of the upper extremities was achieved by three‐dimensional ultrasound after surface and volume rendering. This new technique allows imaging not only of surfaces like the fetal skin, but also of internal structures like the fetal skeleton. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The effects of fetal blood sampling on ductus venosus blood flow velocity waveforms
Authors: Capponi A. , Rizzo G. , Rinaldo D. , Arduini D. , Romanini C.
Published: March 2003

The objective of this study was to evaluate the effect of fetal blood sampling on ductus venosus hemodynamics. A secondary objective was to establish the relationship between the amplitude of these changes, if any, and different variables related either to the procedure of sampling or to fetal characteristics. The ratio was assessed between the systolic and atrial velocities from the ductus venosus that were measured immediately before and immediately after fetal blood sampling in 32 appropriately grown fetuses and in 12 growth‐retarded fetuses. The latter group was characterized by abnormal Doppler indices in the umbilical artery and the middle cerebral artery, suggestive of uteroplacental insufficiency as the causative factor of the impaired growth. The systolic/atrial ratio fell significantly after fetal blood sampling, but this decrease was less evident in growth‐retarded fetuses. Neither the site of needling (placental cord insertion or intrahepatic vein) nor transplacental puncture during the procedure affected this decline. Similarly, fetal smallness, the volume of fetal blood aspirated and baseline values in Doppler indices from the ductus venosus and middle cerebral artery were unrelated to the observed changes. Stepwise regression analysis indicated that the variables that most significantly and independently affect the decline of the Doppler index were gestational age at the time of the procedure and pO2 values in the umbilical vein. In conclusion, modifications in ductus hemodynamics are induced by fetal blood sampling. These changes are less evident in hypoxemic growth‐retarded fetuses and this reduced hemodynamic response may explain the higher rate of complications occurring in such fetuses after blood sampling. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The hyperechogenic lungs of laryngotracheal obstruction
Authors: de Hull J. A. , Kornman L. H. , Beekhuis J. R. , Nikkels P. G. J.
Published: March 2003

A case is reported in which enlarged, hyperechogenic lungs, ascites and polyhydramnios on prenatal ultrasound were indications of a partial tracheal agenesis and tracheo‐esophageal fistula.

A review of the literature is given to assist clinicians in effectively counselling women in whom this ultrasound abnormality is detected. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The influence of the site of Doppler recording on umbilical artery pulsatility index during the first trimester
Authors: Martinez J. M. , Comas C. , Ojuel J. , Borrell A. , Puerto B. , Sentis J. , Fortuny A.
Published: March 2003

The aim of our study was to determine the pulsatility index (PI) of the umbilical artery velocity waveform obtained from the fetal insertion, the placental insertion and a free floating loop of the umbilical cord. This was a prospective study involving 60 consecutive singleton pregnancies undergoing ultrasound examination between 10 and 13 weeks' gestation. Doppler measurements were obtained transvaginally from the placental and the fetal abdominal insertion, and from a free floating loop of umbilical cord. Chromosomal abnormalities and structural malformations detected by ultrasound were excluded. A multi‐way analysis of variance did not show significant differences between the measurements of umbilical PI at the different sites of the umbilical cord and Pearson's coefficient showed an excellent correlation between them. No significant intra‐ and interobserver differences were found. In conclusion, measurements of Doppler velocimetric indices of the umbilical artery during the first trimester are not influenced by the recording site and these recordings are reproducible at this stage of gestation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
End‐result of routine ultrasound screening for congenital anomalies: The Belgian Multicentric Study 1984–92
Authors: Levi S. , Schaap J. P. , De Hava P. , Coulon R. , Defoort P.
Published: March 2003

Five ultrasound laboratories from Obstetrics and Gynecology departments of Belgian university hospitals or affiliated institutions conducted a prospective study from 1984 to 1992 in which the results of prenatal ultrasound examinations were compared to examination reports of the neonates. The results of the period 1984–89 (PI) have been published previously, and those of the period 1990–92 (PII) are presented here. Some very minor congenital anomalies, as listed. and defined in the EUROCAT Register, were excluded. Of 26 147 pregnant women at normal risk for congenital anomalies, 25 046 had at least one ultrasound scan (96%). A total of 616 fetuses were structurally abnormal (prevalence 2.42%), and 685 abnormalities were recorded. The sensitivity of the ultrasound test was 40.4% in PI and 51.1% in PII for abnormal fetuses (p < 0.05) and 45% (PI) and 64% (PII) for abnormalities (p < 0.01). The specificity was 99.9%) and the positive and negative predictive values were 94.2% and 98.6%, respectively; these values did not differ significantly between the two periods. The sensitivity for the detection of anomalies before 23 weeks increased from 21% in PI to 41% in PII, indicating an improvement in the early detection of fetal abnormalities. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Korotkoff's sounds in pregnancy
Authors: Quinn M.
Published: March 2003

Korotkoff1 described the sequence of vascular sounds heard with a stethoscope over the brachial artery during deflation of a pneumatic cuff The initial sounds are produced by vibrations of the vessel wall, although the sequence of vascular sounds has frequently been ascribed to ‘turbulence’ of flow in the vessel. This study has been performed to determine the relationship between the vascular sounds (Korotkoff I–V) produced during blood pressure cuff deflation and specific changes in the brachial artery waveform.

Ten nulliparous women admitted to hospital in the third trimester of pregnancy have been studied by means of concurrent Doppler ultrasound and phonocardiography. Changes in the brachial artery waveform during blood pressure cuff deflation were recorded using Doppler ultrasound (7.5 MHz) with concurrent objective demonstration of phases I–V of the vascular sounds using a phonocardiography microphone. Characteristic features of the brachial artery waveform were associated with phases I–IV of the vascular sounds in all patients (10/10). No consistent features of the brachial artery waveform were associated with phase V of the vascular sounds.

Phases I–IV of the vascular sounds are associated with specific changes in the pattern and direction of flow within the brachial artery in normotensive primigravid women. The vascular sounds produced by vibration of the vessel wall are modulated by changes in blood flow to produce the characteristic sequence of vascular sounds detected with a stethoscope during blood pressure cuff deflation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Early development of the abdominal wall, stomach and heart from 7 to 12 weeks of gestation: a longitudinal ultrasound study
Authors: Blaas H.‐G. , Eik‐Nes S. H. , Kiserud T. , Hellevik L. R.
Published: March 2003

The purpose of this ultrasound study was to describe longitudinally the normal embryonic development in vivo. Twenty‐nine healthy pregnant women were examined five times each with transvaginal ultrasound between 7 and 12 weeks of gestation measured from the lust menstrual period. Structures such as the midgut herniation into the umbilical cord, the stomach and the heart were recognized and measured.

It was possible to identify the physiological midgut herniation during weeks 7–8. It was always present from 8.5 to 10.5 weeks. At 12 completed weeks, the gut was retracted into the abdominal cavity for all the fetuses. We visualized the stomach in nine embryos (31%) during week 8, in 22 embryos (76%) before 10 weeks, and in all fetuses before 11 weeks. The heart rate increased rapidly to a mean of 175 beats per minute (bpm) at the beginning of week 9. Thereafter it decreased slowly to a mean of 166 bpm out 12 weeks. The mean heart diameter was 22% of the crown‐rump length at 7 weeks, 17% at 9 weeks and only 13% at 12 weeks. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prevalence of fetal facial cleft at different stages of pregnancy
Authors: Snijders R. J. M. , Sebire N. J. , Psara N. , Souka A. , Nicolaides K. H.
Published: March 2003

During a 7‐year period (1988–94), we diagnosed 102 fetuses with trisomy 18, and 54 with trisomy 13; in 6.9% of the trisomy 18 and in 40.7% of the trisomy 13 fetuses, there was a facial cleft. On the basis of (1) these frequencies of facial cleft in trisomic fetuses; (2) the reported prevalence of facial cleft in mid‐ trimester fetuses; and (3) estimates of the prevalence of trisomies 18 and 13 at 20 weeks of gestation in a population with the maternal age distribution of all deliveries in England and Wales, it was calculated that 6.5% of fetuses with a facial cleft would have trisomy 18 or 13. This estimated frequency of trisomies was significantly lower than the 26% observed in 111 fetuses with a facial cleft that were referred to our unit for fetal karyotyping. These findings suggest that the patients with a facial cleft examined in a referral center are preselected in favor of those with multiple abnormalities, and therefore a higher frequency of associated chromosomal defects. In the future, with improving quality of ultrasound equipment and standards of scanning, it is likely that more cases of isolated facial cleft will be identified and, consequently, the observed frequency of chromosomal defects should decrease. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis and treatment of fetal goitrous hypothyroidism: case report and review of the literature
Authors: Abuhamad A. Z. , Fisher D. A. , Warsoff S. L. , Slotnick R. N. , Pyle P. G. , Wu S.‐Y. , Evans A. T.
Published: March 2003

The recognition and treatment of fetal hypothyroidism are believed to be important to optimize growth and intellectual development in affected fetuses. We present a case of fetal goiter diagnosed by ultrasonography in the second trimester of pregnancy. Cordocentesis performed at 28 weeks confirmed the presence of fetal hypothyroidism. Fetal therapy was performed with weekly intra‐amniotic injections of thyroxine from 29 to 36 weeks. A repeat cordocentesis at 35 weeks showed normalization of fetal thyroid function. The fetal goiter decreased rapidly in size following fetal treatment. Amniotic fluid levels of thyroid stimulating hormone (TSH) and free thyroxine were obtained with each amniocentesis. Sulfated iodothyronine concentrations in maternal blood were obtained before and after fetal thyroxine treatment. This report discusses the role of amniotic fluid levels of TSH and free thyroxine and maternal levels of sulfated iodothyronine in the diagnosis and management of fetal hypothyroidism. A review of the English literature is presented. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Fetal urine production estimated with ultrasound. The lower limit of normality is illustrated in a case with severe hypoplasia of the kidneys
Authors: Fäquist M. , Silléz U. , Odén A. , Hökegåd K.‐H. , Blomberg S. G.
Published: March 2003

Urine production and weight deviation in a growth retarded fetus with oligohydramnios was estimated by ultrasound on four occasions between weeks 27 and 33 of gestational age. The fetus demonstrated facial features typical of Potter's syndrome. Although this syndrome is associated with bilateral renal agenesis, the fetus in the present case presented with hypoplastic kidneys. Urine production was reduced when measured on three occasions but was surprisingly normal at week 31. In this report, we describe a way to assess urine production in a fetus. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
A comparison between ultrasound and a reliable last menstrual period as predictors of the day of delivery in 15 000 examinations
Authors: Tunón K. , Eik‐Nes S. H. , Grøttum P.
Published: March 2003

In a non‐selected population comprising 1.5 241 women, an evaluation was performed of the ultrasonic measurement of the biparietal diameter compared with a reliable last menstrual period as the basis for estimation of the day of delivery. In women with a reliable menstrual history and spontaneous onset of labor, the ultrasound estimate was the significantly better predictor of the day of delivery in 52% of cases, and the last menstrual period estimate was the better predictor in 46% of cases. The percentages of women who delivered within 7 days of the predicted day were 61 and 56% for the ultrasound and the last menstrual period estimations, respectively. There was a significantly narrower distribution of births according to the ultrasound estimate (p < 0.001). The proportion of estimated post‐term births was 4% using the ultrasound method and 10% using the last menstrual period method (p < 0.001). Even when the difference between the methods in predicting the day of delivery was less than 7 days, the ultrasound method was better than the last menstrual period method. It is concluded that ultrasonic measurement of the biparietal diameter between 15 and 22 weeks of pregnancy is the best method for the estimation of the day of delivery and should be used as a routine procedure. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Fetal sexing by ultrasound in the second trimester: maternal preference and professional ability
Authors: Harrington K. , Armstrong V. , Freeman J. , Aquilina J. , Campbell S.
Published: March 2003

The study was planned to determine the proportion of parents that wish to know the sex of their fetus at the 20‐week anomaly scan, and to investigate our ability to diagnose correctly the sex of the fetus when undertaken as part of a routine scan. A total of 472 patients gave their informed consent. An attempt was made to identify the genitalia as part of the routine scan. No extra time was allowed to determine the sex of the fetus. Altogether 353 (74.7%) women wanted to know the sex, of which four (0.9%) wanted to know but did not want their partners to know. In 50 (10.6%) cases, it was not possible to determine the fetal sex in the time allowed. When the sex was identified, it was correct in 408 (96.7%) cases, and incorrect in 14 (3.3%) cases. Where the parents wanted to know the sex of the fetus, 24 (6.8%) scans were inconclusive, 319 (97%) were correctly identified, and ten (3%) were incorrectly identified (six male, four female). There were no terminations of pregnancy. The majority of prospective parents wish to know the sex of their child, and, in most cases, it is possible to determine the fetal sex at the time of the routine anomaly scan. During the time allowed, the fetal sex was undetermined in one in ten cases, and 3% were sexed incorrectly. If parents wish to know the gender of their fetus, it would appear reasonable to provide this information, provided that the parents are aware of the failure and error rates of sex identification using ultrasound. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound screening for anencephaly at 10–14 weeks of gestation
Authors: Johnson S. P. , Sebire N. J. , Snijders R. J. M. , Tunkel S. , Nicolaides K. H.
Published: March 2003

In an ongoing study involving seven hospitals in London and surrounding areas, 55 237 fetuses were examined by ultrasound at 10–14 weeks of gestation. There were 47 fetuses (1 in 1175) with anencephaly which presented with acrania with varying degrees of cerebral degeneration. The first audit of results was performed in April 1995. During the first phase of the study 34 830 fetuses were examined and in eight of the 31 with anencephaly the diagnosis was not made at the 10–l4‐week scan. Following the audit, 20 407 fetuses were examined and in all 16 with anencephaly the diagnosis was made at the 10–14‐week scan (p = 0.03). These findings demonstrate that anencephaly can be reliably diagnosed at the routine 1O–l4‐week ultrasound scan, provided a specific search is made for the sonographic features for this condition. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Harmonic imaging of porcine intraovarian arteries using sonographic contrast medium: initial findings
Authors: Ragavendra N. , Chen H. , Powers J. E. , Nilawat C. , Robert J. M. , Carangi C. , Laifer‐Narin S. L.
Published: March 2003

The purpose of this study was to visualize, using harmonic gray‐scale imaging, blood flow in porcine intraovarian arteries after intravenous injections of a bubble‐based sonographic contrast medium. Five female pigs underwent laparotomy. Surgically isolated ovaries were scanned intraperitoneally by an ultrasound system reconfigured with software changes to accomplish harmonic imaging. The transmission and receiving frequencies were set at 3.75 and 7.5 MHz, respectively. After injection of the sonographic contrast medium (Aerosomes®) into a peripheral vein, the ovaries were imaged in the harmonic mode. Ten minutes later, another contrast injection was administered and conventional gray‐scale imaging of the ovary performed. In all five pigs, intraovarian arteries were clearly identified upon harmonic imaging as brightly echogenic moving columns. The arterial blood pool appeared brighter during systole than diastole. Upon ultrasound contrast‐assisted conventional gray‐scale imaging, intraovarian arteries were not visualized in four pigs and poorly visualized in one. We conclude that contrast‐assisted harmonic imaging can adequately visualize blood flow in intraovarian arteries of surgically exposed porcine ovaries. Clinically, harmonic imaging may facilitate early detection of tumor‐induced angiogenesis in the human ovary. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Doppler assessment of the uterine and uteroplacental circulation in the second trimester in pregnancies at high risk for pre‐eclampsia and/or intrauterine growth retardation: comparison and correlation between different Doppler parameters
Authors: Zimmermann P. , Eiriö V. , Koskinen J. , Kujansuu E. , Ranta T.
Published: March 2003

During a 20‐month period we studied 175 pregnant women at high risk for hypertensive disorders of pregnancy or intrauterine growth retardation, and 172 patients at low risk, in a prospectively designed cross‐sectional trial. Using duplex pulsed wave Doppler ultrasound, we recorded blood velocity waveforms from both main uterine arteries, the uteroplacental arteries in the region of placental implantation and the umbilical artery at 21–24 weeks of gestation. Persistent notches in the main stem uterine arteries and elevated resistance indices of > 0.68 in the uterine arteries and > 0.38 in the uteroplacental arteries were defined as abnormal waveforms. The incidence of proteinuric pregnancy‐induced hypertension (PPIH) and intrauterine growth retardation (IUGR) were recorded as main outcome measures.

Doppler proved to be more efficient at predicting a complicated pregnancy in those patients who were at high risk: a positive medical history alone was associated with a three‐fold greater risk of developing PPIH and/or IUGR. In the high‐risk group a single pathological Doppler sign accounted for an additional three‐ to four‐fold increased risk, and the combination of all three pathological signs, a seven‐fold additional risk for later disease. In this group PPIH and/or IUGR was found in 58.3%, compared to 8.3% if Doppler results were normal.

The criterion for the definition of pathological Doppler results, whether persistent notching, the resistance index (RI) of the main stem uterine artery, or the RI in the arteries of the uteroplacental bed, was of minor importance, as all Doppler parameters were strongly correlated. However, the combination of all parameters was superior to a single parameter, and a bilateral notch was superior to a unilateral notch in terms of minimizing false‐positive results.

However, Doppler was less powerful in the population at low risk. Here PPIH and/or IUGR was seen in 6.1–6.4% in the group with abnormal Doppler findings compared to 5.2% in pregnancies with normal findings. None of the patients showed bilateral notching.

In conclusion, pathological Doppler velocimetry of the uterine and uteroplacental circulation was a powerful predictor of PPIH and/or IUGR in high‐risk pregnancies, identifying a group in which 58.3% would suffer from disease later in pregnancy. A combination of several Doppler parameters was superior to a single parameter, although the parameters were strongly correlated with each other. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Mild pyelectasis ascertained with prenatal ultrasonography is pediatrically significant
Authors: Persutte W. H. , Koyle M. , Lenke R. R. , Klas J. , Ryan C. , Hobbins J. C.
Published: March 2003

Isolated ‘mild renal collecting system dilatation’ (mild pyelectasis) is a common prenatal sonographic finding. An association between mild pyelectasis and fetal aneuploidy has been established, but in the absence of a concomitant anomaly, mild pyelectasis is usually regarded as benign and of no clinical consequence, and, follow‐up is often not obtained after the initial ascertainment. To test this, we investigated the relationship between mild pyelectasis and (1) progression to hydronephrosis; (2) postnatal vesicoureteral reflux (VUR.); and (3) postnatal surgery.

Between 1 January 1992 and 1 January 1995, we performed 453 prenatal sonographic examinations of 306 patients with mild fetal pyelectasis and no other anomalies. During the course of a routine sonographic examination, we performed a detailed evaluation of the fetal genitourinary tract. Mild pyelectasis was defined as a pelvocalyceal fluid‐filled space with the smallest of two transverse perpendicular sonographic measurements of ≥ 4 mm and < 10 mm. Hydronephrosis was defined similarly, but with a measurement of ≥ 10 mm. Postnatal urological assessment was obtained with routine renal ultrasonography, and voiding cystourethrography (VCUG), measurement of 99mTc‐labelled diethylenetriamine pentaacetic acid (DPTA) mercaptacetyltriglycerine (MAG3), and intravenous pyelogram, as necessary.

After exclusion criteria were applied, 294 (96%) patients with isolated fetal pyelectasis were considered. A total of 251 (82%) of these were followed with ultrasonography prenatally and during the postnatal period. Two or more prenatal examinations were carried out in 129 patients (51%) and in 35 (27%) of these cases the biometry progressed to frank hydronephrosis (> 10 mm). In only six (5%) of the cases followed prenatally did the measurement diminish to < 4 mm. We found a greater variability in prenatal renal biometry throughout gestation in infants found to have VUR, when compared with those who had no VUR. On postnatal follow‐up, 84 patients had VCUG. Sixteen of these patients (6% of all patients [16/251] and 19% [16/84] of those who had the test) were found to have an abnormal finding.

Whereas the prenatal appearance of mild pyelectasis improved in only a small number of cases, we found that it progressed to hydronephrosis in 27% of cases. Postnatal evaluation found VUR to be common in apparent uncomplicated mild prenatal pyelectasis. Although postnatal surgery was necessary in only a small number of cases, surgical intervention was necessary in 33% (four of 12) of those with VUR. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology