bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate and Long-Term Results of Coronary Angioplasty in Patients Aged 80 Years and Older
Authors: Chen Bo , Zhang Dingguo , Zhu Tiebing , Wang Liansheng , Li Chunjian , Wang Hui , Zhang Fumin , Cao Kejiang , Ma Wenzhu , Yang Zhijian
Published: June 2010

Objectives. To observe the short- and long-term outcomes after percutaneous coronary intervention (PCI) in octogenarians (>80y.o.) at our institution.Method. All octogenarians who underwent PCI during the study period were retrospectively retrieved from our database and clinically followed. Major adverse cardiac (and cerebral) events (MAC(C)E) was considered as primary outcome.Results. From January 2003 to December 2007, 140 octogenarians (mean age: 85±3y.o., 79% of male) underwent PCI and were clinically followed 14±11months. Procedural success was obtained in 100 percent of patients with single vessel disease, in 96 percent of patients with double vessel disease, and in 75 percent of patients with triple vessel disease. In-hospital, 30 days, and one year MACE rates were 5%, 5%, and 10.7%, respectively. Impaired left ventricular (LV) ejection fraction (hazard ratio(HR)=0.909, 95% confidence interval(CI)=0.856to 0.964,P=.002), diabetes mellitus (HR=5.792, 95%  CI=1.785to 18.796,P=.003), and low GFR (HR=2.943, 95%  CI=1.161, to 7.464,P=.023) were independently associated with an increase risk of MACE at long-term followup.Conclusion. Coronary angiography can be successfully performed in elderly patients with single and double vessel disease. The results in triple vessel disease are encouraging. Low LV function, diabetes, and impaired renal function increase the risk of long-term major adverse cardiac events.
Sociodemographic Risk Factors of Diabetes and Hypertension Prevalence in Republic of Korea
Authors: Min Hosik , Chang JongWha , Balkrishnan Rajesh
Published: June 2010

This study examined the relationships between SES and diabetes and hypertension for Korean adults using the Korean National Health and Nutritional Examination Survey. To handle the four dummy dependent variables: Diabetes and Hypertension, Diabetes alone, Hypertension alone, and Diabetes or Hypertension, four different logistic models were conducted. The descriptive statistics showed a considerable amount of comorbidity between the combined dependent variable of diabetes and hypertension. To gauge more realistic measures of SES, education and income were combined together as four dummy categories. The SES factor indeed had significant impacts on diabetes and hypertension. Socioeconomically disadvantaged groups demonstrated to have increased likelihood of having these diseases. However, we could not find the strong compensating effect between education and income; the higher level of education but lower income variable was only significant in having both diseases, and the higher income but lower level of education variable was only significant in having hypertension alone and either one of the diseases. Only the highest SES one, the one with a higher level of education and a higher income, was significantly lowering the likelihood of having these diseases in all models. Therefore, public policy and intervention programs should focus on individuals matching these socioeconomic characteristics.
Vertebroplasty and Kyphoplasty Can Restore Normal Spine Mechanics following Osteoporotic Vertebral Fracture
Authors: Luo Jin , Adams Michael A. , Dolan Patricia
Published: June 2010

Osteoporotic vertebral fractures often lead to pain and disability. They can be successfully treated, and possibly prevented, by injecting cement into the vertebral body, a procedure known as vertebroplasty. Kyphoplasty is similar, except that an inflatable balloon is used to restore vertebral body height before cement is injected. These techniques are growing rapidly in popularity, and a great deal of recent research, reviewed in this paper, has examined their ability to restore normal mechanical function to fractured vertebrae. Fracture reduces the height and stiffness of a vertebral body, causing the spine to assume a kyphotic deformity, and transferring load bearing to the neural arch. Vertebroplasty and kyphoplasty are equally able to restore vertebral stiffness, and restore load sharing towards normal values, although kyphoplasty is better at restoring vertebral body height. Future research should optimise these techniques to individual patients in order to maximise their beneficial effects, while minimising the problems of cement leakage and adjacent level fracture.
Evaluation of Human Telomeric G‐Quadruplexes: The Influence of Overhanging Sequences on Quadruplex Stability and Folding
Authors: Viglasky Viktor , Bauer Lubos , Tluckova Katarina , Javorsky Peter
Published: June 2010

To date, various G‐quadruplex structures have been reported in human telomeric sequences. Human telomeric repeats can form many topological structures depending on conditions and on base modification; parallel, antiparallel, and hybrid forms. The effect of salts and some specific ligands on conformational switches between different conformers is known, but the influence of protruding sequences has rarely been discussed. In this paper, we analyze different quadruplex‐forming oligomers derived from human telomeric sequences which contain 3′‐ and 5′‐protruding nucleotides, not usually associated with the G‐quadruplex motif. The study was performed using electrophoresis, CD, and UV spectroscopies. The major findings are (i) protruding nucleotides destabilize the G‐quadruplex structure, and (ii) overhanging sequences influence the folding of the quadruplex.
Is Childhood Obesity Associated with Bone Density and Strength in Adulthood?
Authors: Uusi-Rasi Kirsti , Kannus Pekka , Pasanen Matti , Sievänen Harri
Published: June 2010

Associations between childhood obesity and adult bone traits were assessed among 62 obese premenopausal women, of which 12 had been obese since childhood (ObC), and 50 had gained excess weight in adulthood (ObA). Body composition and bone mineral content (BMC) of the total body, spine, and proximal femur were assessed with DXA. Total cross-sectional area and cortical (diaphyseal CoD) and trabecular (epiphyseal TrD) bone density of the radius and tibia were measured with pQCT. Compared to ObA-group, ObC-group was 5.2 cm taller having 2.5 and 3.5 kg more lean and fat mass, respectively. Depending on the statistical adjustment, ObC-group had 5–10% greater TrD both in tibia and in radius. The remaining bone traits did not significantly differ between the groups. Current preliminary observations bring up an interesting question whether childhood obesity can result in denser trabecular bone in adulthood. However, prudence must be exercised in the statistical adjustment.
Treatment Intensification in the ‘High-risk’ Individual
Authors: Pai Prathamesh S
Published: June 2010

The high-risk individual merits treatment intensification. However, there are concerns with CERT. More supportive care is necessary as toxicity is higher. Treatment related death is a reality. Hence before we set out to prescribe concurrent chemoradiation we would need to stratify them according to the risk factors, their performance status and bear in mind the costs involved in intensive support during treatment.

Apart from chemoradiation we need to explore emerging treatment strategies such as fractionated radiation therapy, and targeted therapies such as epidermal growth factor receptor blockade which might offer better if not similar results but with lesser toxicity.
Intraosseous Compound-type Dermoid Cyst of the Jaw
Authors: Allon Dror M , Calderon Shlomo , Kaplan Ilana
Published: June 2010

Dermoid cysts within the maxillofacial skeleton are extremely rare, with only 13 cases in the literature. The present report describes a new long-standing intraosseous DC and reviews the literature.

A 69-year-old female presented with an expansile mandibular lesion, presenting a large radiolucency with the second and third molars impacted and displaced to the inferior mandibular border. Microscopic examination showed an intraosseous DC, lined by stratified keratinizing epithelium, with multiple aggregates of sebaceous cells and well formed sebaceous glands. Impaction of both second and third molars is an indication of initial development before the physiologic eruption time at approximately age 12. Thus, this presents an extremely longstanding intraosseous DC of at least 45 years duration. Analysis of the literature indicates that in comparison with the more common odontogenic keratocyst, intraosseous DC seems to have a very slow growth rate, and an indolent behavior.
Glomus Tumor Nose in a 6 Years Old Girl: A Rare Presentation
Authors: Dhond PV , Mittal Mudit , Yadav Rajesh , Mhashal Shashikant , Mody Nirav , Markar Pratima
Published: June 2010

Glomus tumors are relatively rare tumors of head and neck region. These tumors occur in infants and in the elderly, but usually occurs in 5th and 6th decades.1 Here we are reporting a rare case of glomus tumor presenting on the dorsum of nose of a six years old girl which was surgically removed successfully.
Endoscopic Removal of Sharp Foreign Bodies in Neck Using Image Intensified Television
Authors: Sharma Arpit , Joseph Shawn T , Gupta Rahul C
Published: June 2010

Foreign body impaction in the neck poses life-threatening problems when it is deep and close to vital structures. We report two cases of sharp metallic foreign body impaction in the neck – one of them in the prevertebral space and the other in the intervertebral disk space. A neck exploration and surgical removal of these foreign bodies, as is usually practised in most centers, would have been life-threatening and associated with high morbidity. We removed these foreign bodies using rigid endoscope under image intensified television (IITV) guidance. The patients could be discharged the same day. We suggest that endoscopic removal under IITV fluoroscopy system should be the method of choice in the removal of foreign bodies located in these sites. We also propose a classification of neck into vertical segments which would be useful in the management decision of these cases.
Esophageal Metastasis from Carcinoma Thyroid
Authors: Krishnamurthy Arvind , Siddappa KT , Sundersingh Shirley , Srinivas Satish , Kumar Krishna
Published: June 2010

The incidence of hematogenous spread at the time of presentation of well-differentiated thyroid carcinoma is the range of 4 to 15%. Distant metastases in the most common cause of death from well-differentiated thyroid cancers. About 5% of papillary carcinoma and 25% of follicular carcinoma develop distant metastases. Distant metastases occur largely in the lungs and to a lesser extent in the bones, brain and soft tissues. We report and discuss the management of an elderly gentleman with papillary carcinoma thyroid metastatic to the esophagus on follow-up. Only one similar published report is described which was from a follicular carcinoma thyroid. Our case of a papillary carcinoma thyroid metastatic to the esophagus seems to be the first if its kind.
Hypocalcemia after Thyroidectomy: The Need for Improved Definitions
Authors: Jessie WU , Harrison Barney
Published: June 2010

Introduction

Hypocalcemia and permanent hypoparathyroidism are important outcome measures after total thyroidectomy. The aim of this article is to identify and highlight the wide variation in the adequacy/definition of these complications as reported in the surgical literature.

Methods

Nineteen journal articles (2008) on complications of thyroidectomy and 17 journal articles (2002) on ‘prediction’ of postthyroidectomy hypocalcemia derived from a PubMed search were reviewed.

Results

Only 21% of studies of describing outcome and complications of thyroidectomy defined hypocalcemia, temporary/permanent hypoparathyroidism. 47% of studies on the early prediction of hypocalcemia failed to quote their normal range of serum calcium. When stated, the biochemical definition of hypocalcemia varied from 1.8 to 2.12 mmol/l. There is no consistent definition of post-thyroidectomy hypoparathyroidism.

Conclusion

There is no consensus apparent on literature review as to what constitutes post-thyroidectomy hypocalcemia and hypoparathyroidism. The need to benchmark and define appropriate outcome measures of thyroid surgery demands that this deficit is addressed.
Which Parameters could be Useful for Predicting Malignancy in Solid Adnexal Masses?
Authors: Alcázar Juan Luis , Royo Pedro , Pineda Laura
Published: June 2010

To determine which clinical, biochemical and other sonographic parameters could be useful to predict malignancy in sonographically solid adnexal masses.

Methods

Clinical (age, menopausal status, complaints and physical examination), biochemical (serum CA-125 levels) and other sonographic features (tumor volume, ascites, bilaterality, blood flow location and velocimetric pattern) from 163 women diagnosed as having a solid adnexal mass on B-mode gray-scale ultrasound were reviewed for this retrospective study. All patients had undergone surgery and mass removal. Definitive histologic diagnosis was available in all cases. All parameters were compared to final histological diagnosis (benign or malignant) in univariate statistical analysis. Then a stepwise forward logistic regression analysis was performed to identify those features that independently predict malignancy.

Results

A total of 173 masses were analyzed. Patients mean age was 52.4 years (range: 15 to 84 years) 117 masses were malignant and 56 were benign. After univariate analysis all parameters showed statistical differences between benign and malignant tumors. After logistic regression analysis only central blood flow (odd ratio: 64.2, 95% CI: 17.07 to 242.03) and presence of ascites (odd ratio: 32.77, 95% CI: 5.38 to 199.72) were identified as independent predictors of malignancy. The presence of one of these two features correlated to malignancy in 98.6% of cases. The absence of both was found in 82.1% of benign tumors.

Conclusions

The presence or absence of ascites or central blood flow may be helpful for discriminating benign from malignant solid adnexal masses.
Ultrasound in the Diagnosis of Deep Endometriosis
Authors: Ajossa Silvia , Paoletti Anna Maria , Garau Nicoletta , Mais Valerio , Piras Bruno , Gerada Marta , Silvetti Enrico , Orrù Marisa , Floris Lucia , Melis Gian Benedetto
Published: June 2010

Deep pelvic endometriosis is defined as subperitoneal infiltration of endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina, or bladder. Although laparoscopy and biopsy remain the gold standard for diagnosis, transvaginal ultrasonography should be considered as the first-line procedure because of its high diffusion and relatively low cost and discomfort. We analyzed in the present review the diagnostic capability of transvaginal ultrasonography in the detection of presence of deep endometriosis in some specific pelvic localizations such as bowel, uterosacral ligaments, rectovaginal septum and/or vagina. We also analyzed the few studies performed in the evaluation of bladder endometriosis. Although some studies are controversial, transvaginal ultrasonography seems to be an accurate technique in the identifications of deep endometriosis in several pelvic locations but a specific training of the operators is suggested.
Three-dimensional Ultrasonography in the Diagnosis of Müllerian Duct Anomalies
Authors: Bermejo Carmina , Cantarero Rocío , Díaz Dolores , Labrador Eva , López Laura Ruiz
Published: June 2010

Aims

We studied the effectiveness of three-dimensional (3D) ultrasonography in the diagnosis of uterine malformations.

Methods

175 patients with clinical or ultrasonographic suspicion of uterine malformation were studied between November 2004 and June 2008. In all women we measured uterine volume for processing and later reconstruction of 3D images. Cases in which no anomaly was detected with the 3D technique were excluded from study. A thorough physical genital examination with speculum was done before or after ultrasonography, except in three women with an imperforate hymen. Uterine malformations were recorded in detail, and the findings were catalogued according to the American Fertility Society (AFS) classification. In 32 women magnetic resonance (MR) imaging was also used, and agreement between the two techniques was calculated with the kappa index.

Results

The 175 müllerian anomalies we analyzed were diagnosed as agenesis (1 case), unicornuate uterus (1 genuine, 1 communicating), didelphys uterus (4), bicornuate uterus (22), septate uterus (80, 8 with two cervices) and arcuate uterus (68). For 1 unicornuate, 3 bicornuate, 25 septate (4 with two cervices) and 3 arcuate uteri we performed MR imaging. Diagnostic correlation between 3D ultrasonography and MR imaging was obtained in all cases according to the AFS classification (kappa = 100%); concordance was also seen for descriptions of associated uterine malformations except for two cases: 1 bicornuate uterus with the additional presence of a cervical septum as detected by MR imaging, which was not found on hysteroscopy for resection, and 1 septate uterus that appeared to have two cervices on 3D ultrasonography in a patient in whom physical examination was not possible, and in whom MR imaging showed a complete septum with hypointense signals (kappa = 93.45%; 95% confidence interval 80.75- 100%).

Discussion

Owing to its ability to clearly render contours of anatomical structures, 3D ultrasonography provides detailed images of uterine malformations and yields very similar results to those obtained with MR imaging. For an accurate comparison of the two techniques, ultrasonography should be accompanied by gynecologic physical exploration, since the two methods yield equivalent results for the relation between the uterine cavity and the fundus. MR imaging is especially useful to evaluate the cervix and vagina.
Tissue Block Ultrasound and Ovarian Cancer— A Pictorial Presentation of Findings
Authors: Crade Michael
Published: June 2010

Malignancy has classically been described, as having vessels “seemingly deployed without purpose.” In other words, vascularity that does not have tree like in branching with orderly distal tapering is abnormal. 3D imaging can create a virtual cast of vessels, to be “cut into” and “manipulated” on a computer monitor. This can be thought of as a most valuable “Tissue Block” of data, unlike any other imaging test, and I believe, holds the key to a more accurate diagnosis of ovarian cancer.
Impact of Ductus Venosus Assessment in Screening Down Syndrome Protocols: An Improved Strategy in a Fetal Medicine Unit
Authors: Echevarria Mónica , Comas Carmen , Rodríguez M Angeles , Nicolau Joan , Serra Bernat , Bach Concha , Sabrià Josep
Published: June 2010

Objective

To estimate the improvement in screening efficiency when ductus venosus (DV) Doppler studies are added to existing Down syndrome (DS) screening protocols.

Methods

First-trimester combined screening for trisomy 21 was prospectively carried out, from October 2003 to March 2008, in 8842 consecutive singleton pregnancies attended in our tertiary reference center. The nuchal translucency (NT) and the pulsatility index for veins for DV were calculated. The maternal serum biochemistry was measured using the Kryptor analyzer, at the same time of the scan (one step strategy) or before it (two step strategy). The detection rate (DR) and false-positive rates for standard screening strategy (maternal age, NT and biochemistry) and the same strategy but including DV assessment were calculated.

Results

Successful DV assessment was possible in the 95.3% of cases, representing a total of 8426 cases. Down syndrome was identified in 34 pregnancies (prevalence of DS 1:250). For a fixed screen positive rate of 5%, the addition of the DV assessment improves the DR from 85 to 94% and, for a fixed DR of 85%, it reduces the number of unnecessary invasive tests from 3.7 to 3.2%.

Conclusion

Early evaluation of DV can be introduced to standard DS screening strategies in experienced centers as a first level test to reduce invasive test rate derived from the existing protocols.
Advances in Visualization of the Early Human Development
Authors: Azumendi Guillermo , Maeda Kazuo , Pooh Ritsuko K , Lausin Iva
Published: June 2010

The anatomy and physiology of placental and embryonic development is a field where medicine exerts its impact on early pregnancy and opens fascinating aspects of embryonic differentiation. The introduction of high frequency transvaginal transducers as well as three and four dimensional sonography has resulted in remarkable progress in ultrasonic visualization of early embryos and fetuses.

Ultrasound has been widely used in the field of early human development due to its safety, diagnostic accuracy and convenience. Normal fetal anatomy and development have been widely investigated using two-dimensional ultrasound and most of the knowledge regarding early human development were established through understanding of sectional images of fetal body and organs obtained by two-dimensional ultrasound. Usage of new techniques has produced more objective and accurate information of embryonal and early fetal development. For the first time parallel analyses of structural and functional parameters in the first 12 weeks of gestation become possible. This article deals with establishment of human life from ovum and sperm, though fertilization, detailed histological development and the establishment of the placenta, and early human development visualized by 2- and 3-dimensional ultrasonography.
Management of Multiple Pregnancy
Authors: Dudenhausen Joachim W
Published: June 2010

Background

Changing delivery age and successes in reproductive have medicine induced an increase in incidence of the multiples in the industrialized world.

Methods

Selective literature research was performed complemented by the autor's clinical experience and national and international guidelines

Results

The risks of prematurity, IUGR, and antenatal demise are raised. Maternal risks are pre-eclampsia, diabetes, and bleeding during delivery. Prenatal and genetic diagnostics including ultrasonography are the most important methods of supervision during pregnancy. These are significant for diagnosis of twin-to-twin transfusion syndrome and cygosity.

Consequences

Cooperation betweeen prenatal medicine, obstetrics and neonatology is important for the care of mothers with multiples.
Early Fetal Echocardiography at the Time of 11+0–13+6 Weeks Scan
Authors: Nocun Agnieszka , Wiechec Marcin , Beithon RT Jill
Published: June 2010

Early Fetal Echocardiography (EFE) is generally defined as a fetal cardiac scan performed until 16 weeks of gestation. Fetal indications for EFE in the first trimester are in strong connection with ultrasound findings during routine nuchal scan: early diagnosed extracardiac malformations, abnormal ductus venosus (DV) velocimetry, tricuspid valve regurgitation (TR), single umbilical artery and increased NT measurement as a major fetal factor. Essential components of EFE include: abdominal view (AbdV), four chamber view (4CV), three vessel view (3VV), origin and cross-over of the great arteries (GA), aortic arch (AoA), ductal arch (DA), superior and inferior venae cavae and at least 2 pulmonary veins.

EFE has some limitations, which determine delayed diagnosis of some CHDs. Early fetal echocardiography is feasible and reasonable. It gives parents the opportunity to exclude approximately 60% of cardiac abnormalities and to reassure them of normal heart anatomy as early as possible.
Fetal Aortic-cerebral Doppler Resistance Index Ratio: An Indicator of Physiologic Blood Flow Distribution
Authors: Tóth Zoltán , Aranyosi János , Deli Tamás , Bettembuk Péter , Kozma Bence , Kovács Tamás , Török Olga
Published: June 2010

Identical hemodynamic impedance and constant ratio of the fetal descending aorta and middle cerebral artery of uncomplicated pregnancies at term.

Fetal aortic-cerebral Doppler resistance index ratio: An indicator of physiologic blood flow distribution.

Objective

To interpret the physiologic fetal arterial blood flow distribution by relating the vascular impedance of the fetal descending aorta (DA) and middle cerebral artery (MCA) and to establish the reference ranges for the aortic-cerebral Doppler resistance index ratio (ACRI).

Study design

Ninety-six patients with uncomplicated pregnancies were recruited for the cross-sectional assessment of the Doppler resistance index (RI) in the fetal DA and MCA between the 38rd and 40th weeks of gestation. The normal ranges of the ACRI were calculated. A cut-off value was designed to facilitate the clinical application of the ACRI.

Results

Between the 38th and 40th weeks of gestation in normal pregnancies the ACRI of healthy fetuses is constant, the overall mean is: 1.062 (+/– 0.087). A single cut-off value of 1.2 is recommended to assist separating normal and pathologic arterial blood flow patterns.

Conclusion

The normal ACRI reflects the identical vascular resistance of the descending aorta and the cerebral vessels, which maintains the physiologic fetal central arterial blood flow. Additional clinical studies are necessary to assess the diagnostic efficacy of the abnormal ACRI (>1.2) as a potentially useful marker of the centralized arterial circulation indicating the early stage of fetal hypoxemic jeopardy.
Telemedicine and Ultrasound in Obstetrics and Gynecology
Authors: Eichbaum Quentin
Published: June 2010

Telemedicine refers to the use of telecommunication technologies for the purpose of transmitting medical information between physically separated clinical sites, in order to provide health care to patients at such remote locations. Additionally, telemedicine can be used to educate health care workers and students at distant locations. Telemedicine technologies can be categorized as either ‘store-andforward’ or ‘interactive’ (or ‘synchronous/asynchronous’) depending on the timing of the transmission of information. This review focuses on applications of telemedicine to the field of obstetric and gynecologic (Obs/Gyne) ultrasound. It also examines the utilization patterns of telemedicine, as well as its costs and benefits. Finally, this article examines the role of telemedicine in medical education, specifically also with reference to Obs/Gyne ultrasound.
Recognizing TORCH Group of Infections on Fetal Sonography
Authors: Patham Bhargavi , Subramanya Sandesh
Published: June 2010

Maternal infections with TORCH group of organisms during pregnancy pose a threat to the fetus in acquisition of congenital abnormalities. Detailed ultrasonographic screening and serological testing provide vital clues to the early diagnosis of these infections in the fetus. We summarize the clinical features associated with TORCH with special emphasis on the in utero ultrasound-guided diagnosis.
Integrative Diagnostics Approach— A Contemporary Learning Methodology at Medical Schools
Authors: Patham Bhargavi
Published: June 2010

Paul L Foster School of Medicine is adopting a clinical presentation based curriculum that encompasses an approach of teaching clinical knowledge, medical skills and diagnostic imaging to the first and second year medical students. This approach may help our students to better integrate knowledge they acquire during the first two years of their medical education into the years of clerkship, residency and beyond. We believe that early integration of different medical imaging modalities and basic science disciplines, in particular the anatomy and pathology, may lead to more efficient use of medical technology and cost beneficial medical practice in the future.
2D and 3D Power Doppler Ultrasound of Endometrium as Implantation Marker
Authors: Bau Santiago , Mercé Luis T , Barco María J
Published: June 2010

Transvaginal ultrasonography has an important role in assessing the endometrium. With 2DUS, a single measurement of endometrial thickness in the sagittal plane is widely used in assisted reproductive technology and in pregnancy prediction. Endometrial volume, measured with 3DUS, has been studied as a potentially more accurate parameter. The endometrial pattern was related to the likelihood of implantation. This pattern correlated in a positive fashion with subsequent implantation. 3D ultrasound and 3D power Doppler parameters have been applied to assisted reproductive techniques as outcome predictors, although studies are still scarce, they show very promising results.
Three-dimensional Power Doppler Ultrasonography for Discriminating Benign from Malignant Ovarian Tumors: Current Experience
Authors: Alcázar Juan Luis
Published: June 2010

The differential diagnosis of adnexal masses still constitutes a major clinical challenge. B-mode ultrasonography is the most used imaging technique and it is the base for this differential diagnosis with acceptable results in terms of sensitivity but a relatively high false positive rate for predicting ovarian cancer. The role of pulsed Doppler remains controversial and seems to be not reproducible in clinical practice. In the last years, a new technology such as 3D ultrasound—both morphology and 3D Angio power Doppler—has become available for discriminating between benign and malignant ovarian tumors. In this article I aim to review critically recent literature of this topic.
Three-dimensional Sonoembryology
Authors: Azumendi Guillermo
Published: June 2010

Three-dimensional ultrasound is advantageous in studying normal embryonic and fetal development, as well as providing information for families at risk for specific congenital anomalies by confirming normality. The introduction of highfrequency transvaginal transducers has resulted in remarkable progress in ultrasonographic visualization of early embryos and fetuses. Three-dimensional ultrasound imaging in vivo compliments pathologic and histologic evaluation of the developing embryo, giving rise to a new term: 3D sonoembryology.
Neuroscan of Normal and Abnormal Vertebrae and Spinal Cord
Authors: Pooh Ritsuko K
Published: June 2010

The vertebral body, neural arch and its processes develop from the sclerotome of the primitive mesodermal segments. After chondrification, separate ossification centres appear for the body and one for each of the neural arches. Vertebrae are composed of a body and a vertebral arch. The vertebral foramina, which consist of the vertebral arch and back of vertebral body, form the vertebral canal including and protecting the spinal cord. The vertebral arches are formed by two pedicles and two laminae which unite as a spinous process.

Relation between the vertebrae and spinal cord during pregnancy is interesting. In embryonal period, the CNS develops earlier than other part of embryonal structures and occupies approximately one third of the whole embryonal body. At the 3rd month of development the length of the spinal cord equals that of the vertebral column. The spinal nerves and the relationship of the spinal nerves to the vertebra are established. Therefore the spinal cord segment is at the same level as the corresponding vertebral level. In subsequent fetal period, however, fetal body structure including vertebral column develops faster than the neural tube. As the consequence of this different development of the column and nerves, caudal end of the spinal cord within the vertebral column relatively moves upward with advancing gestation and reaches to the level of the third lumber vertebra at birth.
Advances in Fetal Neurophysiology
Authors: Predojevic Maja , Kadic Aida Salihagic
Published: June 2010

The human brain function is certainly one of the most amazing phenomena known. All behavior is the result of the brain function. The 100 billion nerve cells are the home to our centers of feelings and senses, pleasure and satisfaction; it is where the centers for learning, memory and creative work are located; where laughing and crying areas and the centers of our mind are. Our cognitive functions, such as thinking, speaking or creating works of art and science, all reside within the cerebral cortex. One of the tasks of the neural science is to explain how the brain marshals its millions of individual nerve cells to produce behavior and how these cells are affected by the environment.1 The brain function still remains shrouded in a veil of mystery. But what is known is that over 99 percent of the human neocortex is produced during the fetal period.2 Owing to the employment of state-of-the-art methods and techniques in prenatal investigations, a growing pool of information on the development of the central nervous system (CNS) and behavioral patterns during intrauterine life has been made available. This review outlines these events, along with the development of the fetal sensory system and circadian rhythms, the senses of vision and hearing, fetal learning and memory, and long-term effects of fetal stress on behavior. In brief, this review offers a glimpse of the fascinating world of the intrauterine life.
Cerebral Hemodynamics and Fetal Behavioral States in IUGR Fetuses
Authors: Clerici Graziano , Renzo Gian Carlo Di
Published: June 2010

The aim of this study was to evaluate the hemodynamic patterns in the proximal (M1) and distal (M2) portions of the middle cerebral artery (MCA) during different fetal behavioral states (FBSs) in healthy and IUGR fetuses. After identification of the FBS in 20 normal (group A) and 8 IUGR (group B) singleton pregnancies (36- 40 weeks), flow velocity evaluation was performed on the M1 and M2 segment of the MCA during “quiescence” (FBS 1F) and “activity” (FBS 2F). In the group A, a statistically significant decrease of impedance to flow values was identified in both segments of the MCA during “activity”. In the group B not statistically significant differences were identified in the impedance to flow values during different FBSs. For each segments of MCA it was found significant lower impedance to flow values in the group B for all FBSs. The mean fetal heart rate during “quiescience” was significantly lower than during “activity” in both groups. The results of this study provide evidences of the influence of different FBSs on fetal cerebral hemodynamic patterns. These information should be considered in the evaluation of fetal cerebral hemodynamics.
Molecular Genetics and Fetal Brain
Authors: Stavljenic-Rukavina Ana
Published: June 2010

Molecular aspects of genetic diseases that affect the nervous system are in the focus of scientific interest investigators from many fields of medicine and the knowledge of genetic abnormalities as well as phenotypic heterogeneity is rapidly expanding. This review is aimed to provide clinician's practical insight into molecular aspects of certain brain abnormalities and disorders based on prenatal ultrasound assessment and clinical findings. Additionally some risk determinants are included in order to elucidate its contribution to molecular mechanism underlying the disease development. Making a specific diagnosis of a genetically determined neurological disorder or defects requires access to a laboratory that can assist in arranging for appropriate testing to be carried out. Therefore this review contains technological aspects of molecular genetic testing, international guidelines and policies related to genetic testing and recommendation for application in clinical medicine.
Fetal Cerebral Ventriculomegaly: Sonographic Diagnostic Workup
Authors: Pinto Vincenzo , Rossi Cristina A
Published: June 2010

Dilatation of the fetal cerebral ventricles (ventriculomegaly) is a generic sonographic sign, which is common to several pathological entities carrying different prognosis.

Ventriculomegaly is easily recognized by ultrasound by measuring the atrial width. This simple measure allows the recognition of even mild forms of ventricular dilatation and is used as a screening method for ventriculomegaly. However, although the diagnosis of ventriculomegaly is easy, the prenatal identification of the cause of ventricular dilatation is a more difficult task. The recognition of associated brain anomalies is a crucial point. The research of the cause of ventriculomegaly is clinically useful, since the prognosis mainly depends on the etiology and on the presence of associated abnormalities.

In this article the role of prenatal sonography in recognizing the cause of the ventriculomegaly is reviewed.
The Use of Three-dimensional Ultrasound in Gynecological Patients
Authors: Alcázar Juan Luis
Published: June 2010

Two-dimensional ultrasound is commonly used in gynecologic patients. It has been shown to be very useful for diagnosing pelvic pathology in both asymptomatic and symptomatic patients. Three-dimensional ultrasound is a new imaging modality, which is being introduced into clinical practice. Although this technique will not probably replace two-dimensional ultrasound, it is being increasingly used. It has been reported that 3DUS is a very high reproducible technique that may have applications in the field of gynecology. These applications include imaging of the uterus, uterine cavity, adnexa and pelvic floor, as well as very interesting applications using three-dimensional power-Doppler ultrasound. The aim of this paper is addressing some technical features of three-dimensional ultrasound and reviewing its current status in clinical practice.
Ultrasonographic Evaluation of Fetal Face by 3D/4D Sonography
Authors: Azumendi Guillermo , Lausin Iva , Pooh Ritsuko K , Grant Gaston
Published: June 2010

The evaluation of the fetal face is an important part of every ultrasound examination since detailed facial examination can provide many information alerting the examiner about possible associated anomalies. Face and the brain have the same embryonic origin. By using 2 and 3D ultrasound techniques, it is possible to obtain clear images of different fetal face defects. Incorporation of the 4D ultrasonography made it possible to examine fetal behavior including fetal face movements. In that way using the ultrasound in the examination of the fetal face provides many new information not just about the morphology but also about neurological development and function of the fetal face.
Premature Ovarian Failure
Authors: Raga Francisco , Bonilla-Musoles Fernando , Osborne Newton G , Machado Luiz E , Bonilla Francisco
Published: June 2010

Using autoradiography, transmission and raster electron microscopy, this review shows how oocytes disappear in human ovaries.

Clinical, hormonal and ultrasound (using 3D, vocal and inverse mode) parameters used in the diagnosis of early ovarian aging are described on the light of the most recent knowledge.
Three-dimensional Ultrasound in Infertility
Authors: Zvanca Mona
Published: June 2010

Moving forward from the first approach of three dimensional ultrasound, as a new gadget for technicians, the method makes proof of its use in an increasing number of medical fields.

Aim

The present paper, and its graphic back-up, are intended as a visual testimony of the fact that 3D ultrasound is much more than a simple generator of “nice”, commercial, images. Moreover, its use may be extended from obstetrics to gynecological pathology, especially in cases related to infertility.

Material and methods

we performed a review of the main local infertility causes and their perception by the three dimensional ultrasound, as compared to the conventional methods. General literature citations were completed with personal cases and images. In our research we used a Kretz – Voluson Expert 730 ultrasound machine with a full logistic equipment. Our database was completed over a period of 18 months and included various pathology, such as uterine anomalies, fibroids, polyps, ovarian cysts and many others.

Results

Three dimensional ultrasound represents the best tool in evaluating the uterine cavity, the endometrium, assessing its volume and vascularity pattern. It also offers a very good image of the uterine structure, the adnexal morphology and their relationship. It performs a thorough pelvic assessment by a single examination. Moreover, it may realize a histerosalpingography, which is as efficient as the radiological method, but easier and with less side effects.

Conclusions

Even though it is technically more difficult and time consuming, a good practice and a high quality ultrasound equipment offer a series of benefits over any other kind of investigation.
Ethical Challenges in the Management of Pregnancies Complicated by Fetal Anomalies
Authors: Chervenak Frank A , McCullough Laurence B , Skupski Daniel , Chasen Stephen T
Published: June 2010

Ethics is an essential dimension of the clinical management of pregnancies complicated by fetal anomalies. Appealing to the ethical principles of beneficence and respect for autonomy, this reviews explicates the ethical concept of the ‘fetus as a patient’. This concept provides the basis for a comprehensive approach to ethical challenges in the management of pregnancies complicated by fetal anomalies. Practice, ethically justified guidance is given for the physician's role in counseling pregnant women about aggressive management, termination of pregnancy, selective termination of multifetal pregnancies, non- aggressive management, and cephalocentesis.
Sonographic Indications for Molecular Genetic Testing
Authors: Ward Kenneth
Published: June 2010

There are many well-accepted indications for cytogenetic testing indicated by the detection of a fetal abnormality on prenatal ultrasound. Over the last decade, the molecular bases for thousands of single gene disorders have been elucidated, molecular cytogenetic tests have been created, and molecular assays for most infectious agents have been developed—potentially improving our ability to make accurate prenatal diagnoses. This review describes the role of molecular diagnostics in detecting chromosomal microdeletions and microduplications, single gene disorders, and infectious diseases. We show that molecular genetic testing is now frequently indicated in the evaluation of abnormal ultrasound findings. A significant educational effort will be necessary to incorporate new molecular knowledge into obstetric ultrasound practice.
Evaluation of Early Pregnancy Failure with Ultrasound
Authors: Burlingame Janet M
Published: June 2010

Ultrasound has developed into a powerful tool in the management of early pregnancy failure. However, there is no single finding or measurement that should be used in making a final diagnosis of early pregnancy failure. Instead a combination of clinical, hormonal and ultrasound findings should be used when deciding on the clinical management course.
Ectopic Pregnancy and Ultrasound: A Review
Authors: Busse Raydeen M
Published: June 2010

First trimester bleeding occurs in up to 30% of all diagnosed pregnancies. Important causes of first trimester bleeding include spontaneous abortion, missed or threatened abortion, ectopic pregnancy, and gestational trophoblastic disease. One of the greatest dilemmas for clinicians is to accurately diagnose the cause of pain or bleeding, and specifically to determine if an ectopic pregnancy exists due to its grave consequences. Ectopic pregnancy occurs in almost two percent of all reported pregnancies in the United States and is the leading cause of pregnancy-related death in first trimester. When an early pregnant patient is identified who has bleeding or pain, it is crucial step to determine where the pregnancy is located. Ultrasound as a first line diagnostic tool offers an excellent opportunity for pregnancy localization. The use of the beta subunit of human chorionic gonadotropin (beta-hCG) quantification is a valuable adjunct to help determine the course and possible outcome of an early pregnancy. The goal should be to preserve the health and future reproductive capabilities of our patients.
Disorders in Amniotic Fluid
Authors: Sauvage Lynnae K
Published: June 2010

Disorders in amniotic fluid production occur frequently in pregnancy, and are associated with increased perinatal mortality and morbidity. This article will discuss amniotic fluid physiology, and will summarize noninvasive methods of measuring amniotic fluid. The definitions, common causes and possible therapeutic interventions available to treat oligohydramnios and polyhydramnios will be discussed.

Learning objectives

To have an understanding of the mechanisms underlying the regulation of amniotic fluid volumes

To understand the limitations of current clinical measurements of amniotic fluid volumes

To know the definitions, causes and potential treatments of disorders in amniotic fluid.
CMV Infection in Pregnancy
Authors: Goh William , Sauvage Lynnae
Published: June 2010

Cytomegalovirus (CMV) is a common and serious congenital infection affecting between 1 to 4% of newborns. Congenital infections can occur after both primary and recurrent maternal infections and are the major cause of childhood deafness, visual impairment, mental retardation and motor spastic or convulsive syndromes. Ultrasound findings including IUGR, ventriculomegaly, brain and hepatic and bowel calcifications, polyhydramnios, hydrops fetalis and pleural effusions are helpful and can aid in the prenatal diagnosis and followup of congenital CMV infection. CMV hyperimmunoglobulin is safe, and may be an effective treatment to minimize the morbidity and mortality of fetal CMV disease. There is ongoing research into the development of an effective vaccine for the prevention of CMV infection during pregnancy.

Objectives

Understand why CMV is an important cause of congenital injections

Understand the role of ultrasound in the diagnosis of intrauterine CMV infections

Understand the possible treatment options for a fetus infected with CMV
Invasive Fungal Rhinosinusitis: Our Experience
Authors: Dua Kapil , Chopra H , Chopra Neha , Puri Sanjeev , Mittal Vikrant
Published: June 2010

Opportunistic fungal infections in immunocompromised patients are associated with a high mortality rate. Endemic mycoses are often asymptomatic, but in appropriate hosts, fungi can cause severe and even fatal infection. Facial pain in an immunocompromised patient may signify invasive fungal sinusitis. Treatment with antifungal agents needs to be individualized according to factors such as the type of fungus, presence of renal failure, or pregnancy. Combining antifungal agents or addition of other approaches, such as surgical debridement or steps to control intracranial pressure, may be needed for adequate treatment of certain types of fungal infections.
Nasomaxillary Swing - A Novel Approach for Bilateral Angiofibroma
Authors: Thakar Alok , Gupta Gaurav , Grover Mohnish
Published: June 2010

Juvenile nasopharyngeal angiofibroma (JNA) is a high-risk tumor of adolescent males. Choice of the approach should be based on the stage and site of the lesion. For complete removal of tumor, surgical exposure must be adequate. We here present a case of nasopharyngeal angiofibroma with intracranial and bilateral infratemporal fossa extension in which tumor was completely excised by nasomaxillary swing approach.