bluuebunny/crossref_metadata_2025 huggingface dataset:
Third trimester measurements
Authors: Westerway S. L. C. , Heard R. , Morris J.
Published: March 2003

Third trimester pregnancy ultrasound for assessment of fetal size/growth is an important examination, which should be undertaken with care. This project looked at inter and intra sonographer measurement reproducibility on women in the final 4 weeks of pregnancy. Measurements taken included the biparietal diameter, occipito‐frontal diameter, head and abdominal circumference, femur and humerus lengths, umbilical artery resistive index, amniotic fluid index and cervical length. Images were captured on an ATL 5000 and transferred to an MO disc. Copies of the disc were distributed to 20 MIA practices that had access to either ATL 5000 or 3000 systems. The disc images were downloaded and all sonographers, including students, measured the fetal parameters as prompted, and recorded the results. Statistical analysis was performed using SPSS analysis of variance model ICC 2.1, which enabled comparisons for inter/intra sonographer variations. Paired t‐test was used to calculate the mean differences seen in repeat measurements by the individual sonographers. The results reflected the degree of experience of the sonographers, particularly with images at difficult angles. The study highlights the importance of standardized measuring protocols and image planes, particularly for patients undergoing ultrasound examinations at different practices.
Does chorionic villus sampling (CVS) influence fetal growth?
Authors: Larsen T. , Nguyen T. H.
Published: March 2003

Purpose:  To examine the relationship between CVS and birth weight.

Methods:  A cohort of singleton pregnancies with CVS carried out in Denmark (n = 19737) was compared to the total population of singleton pregnancies without AC (amniocentesis) or CVS (n = 873254) for infants born in the years between 1980 and 1996. Exclusion criteria were multiple pregnancies, infants with malformations, chromosomal abnormalities, stillbirths, and death within the first living year. The pregnancies with CVS were grouped according to gestational age (8–12th week of gestation) at the time of CVS, and mean birth weight was calculated for each group. Maternal age, parity and previous abortions were taken into account when comparing mean birth weights. To exclude social status as a confounder, the overall mean birth weight (pregnancies without CVS or AC) was also compared to the mean birth weight of a subgroup of infants (also without CVS or AC) born to women who undergo CVS in some other pregnancy.

Results:  The mean birth weight of the CVS cohort was found to be significantly higher than that of the total population and inversely related to the gestational age at CVS.

Conclusion:  The invasive procedure seems to stimulate growth. No known potential cofounders can explain the higher birth weight after pregnancies with CVS.
Fetus with osteogenesis imperfecta presenting as increased nuchal translucency thickness in the first trimester: a case report
Authors: Hsieh T.‐C. , Yeh G.‐P.
Published: March 2003

Background:  Nuchal translucency (NT) has been used successfully in screening for chromosomal abnormalities at 11–14 weeks of gestation. Increased NT thickness is also associated with lots of fetal anomalies in chromosomally normal fetuses. We report a case of osteogenesis imperfecta (OI), type II, presenting with increased NT thickness. A 26‐year‐old Taiwanese woman, gravida 2, para 1, without medical or family history was scanned for confirmation of menstrual gestational age at 13 weeks of gestation. Crown‐rump length was compatible with menstrual age. Increased NT thickness was noted (3.6 mm). Follow up scan 2 weeks later revealed hypomineralization of skull, multiple fractures of long bones and ribs and severe micromelia. A presumptive diagnosis of OI type II was made based on sonographic findings. After counseling, the parents decided to terminate the pregnancy. A stillborn weighing 70 g was delivered after intravaginal misoprostol application. Postmortem radiograph and autopsy confirmed the diagnosis of OI.

Discussion:  NT screening for chromosomal and structural abnormalities at 11–14 weeks of gestation was proposed by Nicolaides in the 1990s. It has gained worldwide popularity due to early screening and high detection rate. Distorted and narrow thoracic cage due to rib fractures or altered composition of the extracelluar matrix has been thought to be the possible mechanisms of increased NT thickness in fetuses with OI. In our opinion, the characteristic of hypomineralization in OI enables clear visualization of intracranial structures which may resemble the sonographic features of increased NT thickness in some cases. This finding should prompt the sonographer to measure NT thickness and scan for possible anomalies.
Reduction of complications during first trimester abortion with the use of sonography
Authors: Malvasi A. , Losito A. , Baldini D. , Mudoni A. , Traina V.
Published: March 2003

Background:  In our reproductive medicine service, more than 3000 abortions have been practised every year, since 1978. The standard operation for legal abortion is executed, according to law 194/78 within 90 days. The technique in voluntary or spontaneous abortion provides D&C as well as hysterosuction with the patients in general anesthesia. In order to reduce the possible complications for this operation and the increasing legal cases, routine perioperative sonography has been used to evaluate sudden abortion complications.

Methods:  Besides ordinary preoperative sonography assessing gestational age, evolution of pregnancy, pelvic disease, etc. the use of intraoperative sonography has been shown to be necessary. A permanent team of four operators performs the operation under sonographic guide by using an R–T 36600 General Electric apparatus owned by our medicine service. In a lapse of time of five years, 16804 abortions under sonographic guide were practised and in a retrospective way there was a statistically significant reduction of complications according to literature. The 16118 cases in the previous 5 years and within the two homogeneous groups.

Results:  We registered 11 complete and 13 incomplete uterine perforations vs. 4 and 7 (P < 0.01), 18 cases of retention of ovule remainders vs. 6 (P < 0.05), which required hospital readmission for a further examination of uterine cavity. In addition, the group under sonographic guide has shown a lower rate of failures in operations, antibiotics administrations (P < 0.001), endovaginal prostaglandin use (P < 0.005), anesthetics use (P < 0.05) and hospital stay (P < 0.01). If for the 24 previous uterine perforations in 19 cases the operation was delayed (11 ± days later) 13, when intraoperative sonography was used, it occurred only in three cases, for the other patients under sonographic guide, the uterine cavity was completely cleared with no complications at all (P < 0.001).

Conclusions:  In our service, as well as according to literature, intraoperative sonography during abortions, led to a great reduction of complications with a better compliance for the patient and a significant reduction of costs. In particular, thanks to the use of sonography, complete and incomplete uterine perforations descreased, in 91% cases under sonographic guide the uterine cavity was emptied with no complications for the patients. Because of the favorable relationship between costs and benefits, the intervention can be performed under sonographic guide.
Transvaginal ultrasound and induced abortion
Authors: Balic A. N. , Balic D. B. , Balic B. , Zukic I.
Published: March 2003

Background:  The aim of this study was to audit prospectively the value of preabortion ultrasonography.

Methods:  All women who came to our center because of doubt unplanned pregnancy in first trimester from March 1994 to July 2001 underwent an exam by vaginal ultrasound before abortion. We analyzed these data and compared them with complications after legal induced abortion.

Results:  During 2 years a total of 334 women were surveyed. Fifty‐three women (8.04%) were not pregnant. In 65 cases (9.86%), the pregnancy was greater by 2 weeks than we expected on the basis of last menstrual period. Also we found: 41 (6.22%) myoma uteri, 10 (1.51%) ovarian cysts, 15 (2.27%) multiple pregnancy, 8 (1.21%) anomaly of the uterus, 4 (0.61%) missed abortions and 5 (0.76%) embrionic abnormality (anencephalus, abdominal cyst, nuchal translucency).

Conclusion:  Preabortion ultrasonography increases security of this intervention by eliminating some problems linked induced abortion. Since the examination is simple, fast and cheap, we recommended it for routine use. We hope that it is one way for decreasing late complications after abortion, like infertility.
A large pedunculated leiomyoma with unusual features – a case report
Authors: Lee S.‐L. , Tay S.‐K.
Published: March 2003

Introduction:  Leiomyoma, a benign tumour arising from smooth muscle, is a common finding on gynecological ultrasound examination. It usually presents as a heterogeneous, hypoechoic mass with ill‐defined borders. According to its location, it may be described as submucous, subserosal, and intraligamentous. With the new generation ultrasound units, its perfusion may be mapped with accuracy.

Case report:  The patient is a 39‐year‐old lady who was first seen in our department in October 1998. She just had a delivery by cesarean section in August 1998. Her pregnancy was looked after by a different hospital, where she was told to have a fibroid. No follow up was arranged for her after her delivery. When she came to our department, she was complaining of occasional lower abdominal pain. An ultrasound scan that was performed revealed some small intramural and subserous leiomyomata of 1–2.6 cm. A predominantly cystic, loculated mass with an irregular contour was seen in the POD. It had some echogenic components and its measurements were 10.7 cm × 7.5 cm × 11 cm. Power Doppler detected some intratumoral venous flow. Impression was that it was not of ovarian origin. The patient was scheduled for a myomectomy/frozen section for fibroid on 9 November 1998.

Histopathology report:  Leiomyomas with edema, hyalinization and infarction.

Discussion:  The ultrasonic features in this case are not typical of a leiomyoma. Although cystic degeneration are sometimes seen in myomata, it is usually not so predominant. Although the state‐of‐the‐art ultrasound units, with color and power Doppler facilities, are supposed to be capable of producing very accurate assessment of pelvic masses, it was found to be inadequate in this instance. Firstly, the classification according to its location was not possible as the stalk was not seen, probably as a result of tumor size. Secondly, the blood flow results were not helpful as this is a predominantly cystic mass. Hence, not much useful information could be derived for the planning of the surgery.
Correlation between the umbilical cord cross‐sectional area and fetal anthropometric parameters
Authors: Vasques F. A. P. , Moron A. F. , Murta C. G. V. , Cattini H. , Barbosa M. M. , Gonçalves T. R. , Hisaba W. J. , Carvalho F. H. C.
Published: March 2003

A prospective cross‐sectional study was developed to determine the correlation between the umbilical cord cross‐sectional (UCCSA) and fetal anthropometric parameters during normal pregnancies (patients with known dates of LMP and an ultrasound examination before the 20th week, without any pathologic condition). The measurements of the umbilical cord cross‐sectional area were obtained in a plane adjacent to the insertion of the cord in the abdomen, as proposed by Raio et al., 1999, and compared to the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) by the non‐parametric correlation of Spearman. The inclusion criteria were: (1) singleton pregnancy; (2) gestational week >20 weeks; (3) intact membranes; (4) normal umbilical Doppler flow velocimetry. The exclusion criteria, in the presence of any of those were: (1) congenital and/or chromosomal abnormalities; (2) pregnancy complications (any type); (3) inadequate size for gestational agent the time the ultrasound examination was performed, i.e. the weight below the 10th or above the 90th percentile; (4) abnormal AFI. The patients were examined and included only once. The statistical analysis was performed by the program called Statistical Package for Social Sciences (SPSS) and we used a Toshiba 140 with a transabdominal transducer of 3.5 MHz. Our results showed a strong correlation (Spearman rank = 0.610, significant at the level of P < 0.01) between the UCCSA and the estimated fetal weight by ultrasound examination and also with the fetal anthropometric parameters (UCCSA × BPD = 0.622; UCCSA × HC = 0.617; UCCSA × AC = 0.625; UCCSA × FL = 0.604, all of them significant at the level of P < 0.01). We concluded that the UCCSA is a parameter that can be included at the routine of obstetrical ultrasound examinations.
Does cigarette smoking causes periodic decreases in blood flow to the fetus of mothers with hypertensive disorders and/or impaired fetal growth?
Authors: Lawrie T. A. , Rosier‐van Dünne F. , Norman K. , Odendaal H. J.
Published: March 2003

Aim:  To evaluate the acute effect of maternal cigarette smoking on umbilical and middle cerebral artery blood flow in the fetus of women with and without pre‐eclampsia and/or intrauterine growth restriction.

Methods:  Pregnant women and ≥24 weeks gestation were recruited from the antenatal ward at Tygerberg Hospital, South Africa. Doppler studies of the umbilical and middle cerebral arteries were performed before and at 10, 20 and 30 min after the mother had smoked a cigarette. The same studies were performed in the non‐smoking controls.

Results:  There were 13 smoking mothers with hypertension and/or a fetus with growth restriction (group A), 15 non‐smoking mothers with hypertension and/or a growth restricted fetus (group C) and 24 normotensive smoking mothers and an appropriately grown fetus (group B). There was a significant difference in the mean umbilical artery RI and PI values in group A vs. group C (P = 0.03 and 0.004, respectively). There was a significant difference in the mean middle cerebral artery PI between group B and group C (P = 0.004).

Conclusions:  Smoking significantly reduces the feto‐placental perfusion in pregnancies compromised by hypertension and/or intrauterine growth restriction and should be actively discouraged in these patients.
Case report: bradycardia in a fetus with trisomy 21
Authors: Cha S. C. , Porto R.
Published: March 2003

Introduction:  Trisomy 21 is the most common chromosomal abnormality and the risk of delivering a child with this defect increases with maternal age. Diagnosis can only be done by invasive procedures for fetal karyotyping. For parents who choose to avoid such tests, ultrasound scans can help identify markers of aneuploidy such as increased nuchal translucency thickness. However, these screening methods cannot identify all abnormal cases.

Case report:  V.L.F.R., 38 years‐old, first pregnancy, had a 1.6‐mm nuchal translucency thickness measurement at 11 weeks and normal anomaly scan at 20 ± 4 weeks. On the basis of these findings, she decided to avoid fetal karyotyping. Scan at 28 weeks showed normal fetal biometry apart from short femur. Fetal sinusal bradycardia (heart rate = 116 bpm) was diagnosed at 33 weeks and repeat computerized fetal heart monitoring from 34 weeks onwards was always normal apart from previously noted fetal bradycardia. Estimated fetal weight was 2.080 g at 35 weeks (below the 10th centile for gestation) but amniotic fluid volume and fetal Doppler studies were normal. Elective cesarean section was carried out at 38 weeks and a male newborn weighing 2.700 g, Apgar score 7‐9‐10 was delivered. Down syndrome was clinically suspected and confirmed by cytogenetic analysis.

Discussion:  Some studies have demonstrated that a silent pattern during fetal heart monitoring, with fewer accelerations and more decelerations, is more often found in trisomic fetuses than in normal ones. In this case report, fetal bradycardia was the only abnormal finding. It raises the possibility of considering this as a marker for aneuploidy when fetal biophysical profile and Doppler studies are normal in the third trimester.
Prenatal diagnosis of congenital cardiac tumors: two cases reports
Authors: Rodrigues G. , Castela E.
Published: March 2003

Introduction:  Congenital cardiac tumors are rare. Among the pediatric population, more than 90% of cardiac neoplasms are histologically benign. However, they have the potential for serious consequences, if not detected in a timely manner, usually because of their conspicuous location. Rhabdomyomas are the most common tumors of both infancy and childhood, occurring in 62% of cases.

Case report:  Cardiac rhabdomyomas were diagnosed in two patients at 33 and 34 weeks with support of pediatric cardiology through tele‐medicine. The first patient had multiple tumors, in right atrium, atrial septum, ventricular septum and mitral valve, with variable size and without cardiac arrythmia or stigmata of the tuberous sclerosis. This patient had unilateral ventriculomegaly due to cerebral ischemy probably linked to tumor embolization. The second patient had a single tumor, localized in ventricular septum without other ultrasounds findings. The two patients had not obstructed valvular inflow or outflow.

Conclusion:  Prenatal diagnosis of congenital cardiac tumors is possible in the hands of an expert, although it is impossible to make a histological diagnosis in utero, several ultrasonographic criteria, including tumor number, size, location and echogenicity, may help narrow the differential diagnosis. Thrombosis of cerebral venous circulation can occur antenatally. Accurate diagnosis can be made using fetal real time and color Doppler ultrasound. At the date of preparation of this abstract, the pregnancies are in course and delivery is expected in short‐term in a center of pediatric cardiology.
Assessment of normal fetal upper arm volume by three‐dimensional ultrasound
Authors: Yu C.‐H. , Chang F.‐M. , Liao T.‐P.
Published: March 2003

Purpose:  Precise assessment of the fetal organ volumes by prenatal ultrasound (US) is very important in the evaluation of fetal well‐being and maturation. Limb volume may be a possible predictive factor of intrauterine growth retardation. However, using two‐dimensional (2D) US to accurately estimate the fetal upper arm volume is difficult. With the advent of three‐dimensional (3D) US, the obstacle of 2DUS can be overcome. In this study we attempt to construct a normal reference centiles of fetal upper arm volume during gestation for clinical application using 3DUS.

Materials and methods:  In total, 206 singleton fetuses ranged between 20 and 40 weeks of gestation and fit the criteria of normal pregnancies were enrolled in this study. Three‐dimensional US was applied to measure the fetal upper arm volume. Linear regression, correlation analysis and polynomial regression analysis were used as the statistical methods. A P‐value of less than 0.05 was considered statistically significant.

Results:  Our results showed that fetal upper arm volume is highly correlated with the fetal gestational age (GA). Using GA as the independent variable and upper arm volume as the dependent variable, the best‐fit regression equation is upper arm volume (mL) = 43.54579 − 4.53032 × GA + 0.13305 × GA2 (r = 0.91257, P < 0.0001). The normal growth centiles of upper arm volume is established based on this equation.

Conclusion:  In conclusion, we can use the data of fetal upper arm volume assessed by 3DUS as a reference in evaluating fetal growth.
Intrauterine death of one twin, with rescue of the other, in twin–twin transfusion syndrome
Authors: Ohkuchi A. , Minakami H. , Shiraishi H. , Suzuki I. , Ohki T. , Sato I.
Published: March 2003

Single intrauterine death may occur in twin–twin transfusion syndrome. We investigated why the outcome of the surviving twin is fairly good when the donor twin dies first compared with when the recipient twin dies first. A detailed hemodynamic study was performed using Doppler ultrasound in a twin pregnancy affected by twin–twin transfusion syndrome before and after a single intrauterine death that occurred in the donor twin at 26 weeks' gestation. The recipient twin was expected to die due to severe right cardiac failure with functional stenosis of the pulmonary artery 2 days before the cotwin's death. The donor twin's death caused a prompt resolution of cardiac failure and improvement in other indices, including flow velocity waveform patterns of the umbilical vein, the middle cerebral artery and the ductus venosus. A healthy, premature female neonate weighing 1630 g with a hemoglobin concentration of 17.8 g/dL was delivered by Cesarean section following rupture of the fetal membranes 28 days after the episode. Hemorrhaging from the surviving twin to the dead twin that occurred just before or after the cotwin's death may have contributed to the decrease in volume overload in the recipient twin, leading to a prompt amelioration of the critical hemodynamic indices. The early death of the donor twin may thus have played a significant role in improving the status of the recipient twin in this case of twin–twin transfusion syndrome. Copyright © 2002 ISUOG
Monozygotic twins discordant for body stalk anomaly
Authors: Daskalakis G. J. , Nicolaides K. H.
Published: March 2003

We report on two cases of monozygotic twins discordant for body stalk anomaly, diagnosed prenatally in a multicenter ultrasound screening study at 10–14 weeks of gestation. Ultrasound showed a large abdominal wall defect with most of the abdominal contents and almost half of the body in the celomic cavity, in association with severe kyphoscoliosis and a very short umbilical cord. Both pregnancies were managed expectantly and delivered by Cesarean section. The abnormal babies died soon after birth and autopsy confirmed the sonographic diagnosis. Body stalk anomaly in twins is extremely rare. These are, to our knowledge, the first cases reported on monozygotic twins discordant for this anomaly, indicating that the incomplete twinning theory cannot uniformly explain the pathogenesis of the body stalk in twins. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Expectant management of incomplete, spontaneous first‐trimester miscarriage: outcome according to initial ultrasound criteria and value of follow‐up visits
Authors: Luise C. , Jermy K. , Collins W. P. , Bourne T. H.
Published: March 2003

Objectives

To assess whether the presence of a gestational sac or the width of the endometrium, can be used to predict the outcome of expectant management for an incomplete, first‐trimester miscarriage, and to determine an appropriate schedule for follow‐up visits.

Subjects

Consecutive women with a spontaneous miscarriage, who were attending an early pregnancy assessment unit.

Methods

Transvaginal ultrasonography was used at the first visit to identify those women with an incomplete miscarriage—defined as the presence of heterogeneous products of conception within the uterus and distinguishable from a missed miscarriage or an anembryonic pregnancy. The sonographic end‐points were the presence of a gestational sac or the thickness of the endometrium. All subjects were offered the choice of surgical evacuation of the uterus under general anesthesia or expectant management with a follow‐up visit within a few days of the cessation of transvaginal bleeding, or weekly monitoring for 4–5 weeks. The main outcome measures were the number of women with a complete miscarriage (defined as the absence of transvaginal bleeding and an endometrial thickness of <15 mm without surgical intervention) and the proportion of women completing their miscarriage within each week of management.

Results

Of the 312 women who participated, 234 (75%) chose expectant management; of these 13 were lost to follow‐up leaving data from 221 for analysis. Two‐hundred and one (91%) completed their miscarriage without intervention; the mean time from diagnosis to completion was 9 (range, 1–32) days. By the end of week 2, 184 women (83%) had miscarried. There was no statistically significant relationship between the initial presence of a gestational sac or endometrial thickness, and the success rate of expectant management. The odds of a woman completing a miscarriage spontaneously were 1 : 1 for week 1, 2 : 1 for week 2, 1 : 2 for week 3, and 1 : 5 for week 4. Twenty women had surgical treatment (19 elective with no serious prior complications, one emergency who was admitted to the accident and emergency department on day 21 of management). There were eight elective operations during week 1, and 11 over the following 3 weeks.

Conclusions

Most women with an incomplete, spontaneous miscarriage chose expectant management and had a successful outcome. Neither the presence of a gestational sac, nor the endometrial thickness at diagnosis can be used to predict the likelihood of management failure. The current schedule of regular routine follow‐up visits could be safely reduced to one or two fortnightly visits as appropriate, provided that patients have ready access to clinical advice by telephone. Copyright © 2002 ISUOG
Initial experiences of tissue harmonic imaging in the diagnosis of fetal cardiac tumors
Authors: Hosono T. , Chiba Y. , Kanai H. , Kanagawa T.
Published: March 2003

The usefulness of tissue harmonic imaging in prenatal diagnosis is illustrated in two fetuses with a cardiac tumor. Tissue harmonic imaging provided more informative images than conventional B‐mode imaging, enabling the detection of the site of attachment of the cardiac tumor and estimation of intracardiac blood flow. The advantages of tissue harmonic imaging over conventional B‐mode imaging in prenatal diagnosis are discussed. Copyright © 2002 ISUOG
A new clue to the prenatal diagnosis of lobar holoprosencephaly: the abnormal pathway of the anterior cerebral artery crawling under the skull
Authors: Bernard J. P. , Drummond C. L. , Zaarour P. , Molho M. , Ville Y.
Published: March 2003

We report a case of a 24‐week‐old fetus with cerebral anomalies suggestive of lobar holoprosencephaly including an unusual course of the anterior cerebral artery on Doppler examination. This abnormal trajectory of the anterior cerebral artery in holoprosencephalic brains has been described by pathologists, neurosurgeons and radiologists but our case indicates that this finding may be a useful adjunct to confirm such a difficult diagnosis prenatally. Copyright © 2002 ISUOG
Mid‐trimester fetal subdural hemorrhage: prenatal diagnosis
Authors: Meagher S. E. , Walker S. P. , Choong S.
Published: March 2003

A routine antenatal ultrasound examination at 20 weeks' gestation revealed a space‐occupying lesion in the fetal right cerebral hemisphere. The borders of the mass were indistinct and there was no midline shift. A small collection of echogenic bowel was identified at the right iliac fossa. In an attempt to explain both findings a provisional diagnosis of a fetal blood dyscrasia was made. Fetal cranial magnetic resonance imaging 24 h later confirmed the diagnosis of a subdural hemorrhage. Subsequent fetal blood sampling confirmed severe fetal thrombocytopenia. To our knowledge this is the first report of the antenatal diagnosis of spontaneous mid‐trimester fetal subdural hemorrhage. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
The sonographic evaluation of tubal patency with stimulated acoustic emission imaging
Authors: Prefumo F. , Serafini G. , Martinoli C. , Gandolfo N. , Gandolfo N. G. , Derchi L. E.
Published: March 2003

Objectives

Experimental and clinical data suggest that insonation of echo‐enhancing contrast agents with high acoustic power produces disintegration of microbubbles, resulting in a phenomenon called stimulated acoustic emission (SAE). The purpose of this study was to investigate whether SAE might be detected by transvaginal sonography and whether this technique may be useful in the assessment of tubal patency by hysterosalpingo‐contrast sonography (SAE‐HyCoSy).

Methods

Patients booked for X‐ray hysterosalpingography (HSG) for infertility evaluation also received SAE‐HyCoSy. The order of the two procedures was established in each patient by randomization after placement of a transcervical balloon catheter. For SAE‐HyCoSy, the ultrasound contrast medium Levovist was injected, with the acoustic power set at the maximum level permitted on ultrasound machines employing dedicated algorithms. Conventional HSG was performed for comparison.

Results

Seventy‐seven Fallopian tubes were examined in 41 patients. In all cases it was possible to obtain the SAE phenomenon. In 10 tubes (13%) proximal filling was not observed by both SAE‐HyCoSy and HSG. In the remaining 67 tubes, free spill from the distal end of the lumen was demonstrated in 96% of cases (64/67) with SAE‐HyCoSy and in 97% of cases (65/67) with HSG. Disagreement between the two techniques was observed in five tubes only, with a Cohen's κ coefficient of 0.76 (95% confidence interval, 0.56–0.96).

Conclusion

SAE techniques were successfully applied to HyCoSy and allowed the visualization of the free spill of contrast agent into the peritoneal cavity in the majority of cases. SAE‐HyCoSy showed good agreement with HSG in this preliminary study. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Symposium on glial interfaces in the nervous system: development and repair
Authors: FRAHER JOHN
Published: March 2003

This Anatomical Society symposium, held at University College, Cork in September 1995 was the first of its kind. The objective was to stimulate and facilitate constructive interaction between experts on topics relating to the various types of glial barrier which form partitions within the nervous system. Some of these barriers are transient and are found only during development, for example, those which define the limits of developing nuclei or fibre bundles. Others are permanent, such as those at the transitional zones which separate the CNS and PNS milieux at nerve root attachments to the neuraxis. Still others, such as glial scars, are seen only following injury when they tend to inhibit neurite regeneration. In experimental circumstances, for example following irradiation or chemical damage, glial barriers may be broken down and even relocated. This may be associated with Schwann cell invasion of the CNS and, experimentally, with Schwann cell and glial cell transplantation into demyelinated areas. Such transplantation studies are in turn related to remyelination and CNS axon regeneration and the factors which facilitate these. Twelve review lectures were given on these topics. Five articles based on these communications are reproduced here. The underlying theme was the relationship between advances in the understanding of fundamental nervous tissue biology, especially as related to glial cells, and potential developments aimed at treating CNS demyelinating diseases and achieving CNS regeneration.
Nerve fibre regeneration across the peripheral–central transitional zone
Authors: CARLSTEDT THOMAS
Published: March 2003

Neurons cannot negotiate an elongation across the peripheral (PNS)–central nervous system (CNS) transitional zone and grow into or out of the spinal cord in the mature mammal. The astrocytic rich CNS part of the spinal nerve root is most effective in preventing regeneration even of nerve fibres from transplanted embryonic ganglion cells. Regeneration of severed nerve fibres into the spinal cord occurs when the transition zone is absent as in the immature animal. Before the establishment of a transition zone there is also new growth of neuronal processes from dorsal horn neurons distally to the injured dorsal root. Thus the experimental strategy to reestablish spinal cord to peripheral nerve connectivity has been to delete the transitional region and implant severed ventral or dorsal roots into the spinal cord. Dorsal root implantation resulted in reestablished afferent connectivity by new neuronal processes from secondary sensory neurons in the dorsal horn of the spinal cord extending into the PNS. The ability for plasticity in these cells allowed for a concurrent retention of their original rostral projection. Ventral root implantation into the spinal cord corrected deficit motor function. In a long series of experiments performed in different species, the functional restitution was demonstrated to depend on an initial regrowth of motor neuron axons through spinal cord tissue (CNS). These findings have led to the design of a new surgical strategy in cases of traumatic spinal nerve root injuries.
The hypogastric and thirteenth thoracic ganglia of the rat: effects of age on the neurons and their extracellular environment
Authors: WARBURTON ALISON L. , SANTER ROBERT M.
Published: March 2003

Morphometric analyses of the neurons and microvessels of perfusion‐fixed hypogastric (HG) and 13th thoracic (T13) ganglia have been performed in male Wistar rats aged 4, 24 and 30 mo. Estimations of HG volume employing the Cavalieri principle have also been performed and showed that the size of the aged HG is increased by 42%. Routine histological staining of the ganglia with Masson's trichrome indicated that this may be due to the increased amount of interstitial connective tissue which was apparent in the aged animals. The number of neurons per unit area progressively decreased by 38% between ages 4 and 24 mo and by 16% between ages 24 and 30 mo in the HG and by 25% (4 and 24 mo) and 2% (24 and 30 mo) in the T13 ganglion. The total number of neurons in the HG however, estimated by a physical disector analysis, was constant with age. The number of microvessels per unit area, microvessel diameter, neuronal and nuclear areas did not differ significantly between the 3 age groups studied. This observed increase in ganglionic volume and decrease in neuronal packing density may be associated with changes in the extracellular matrix, in particular in glycosaminoglycans whose presence was indicated by metachromasia of the ganglia with toluidine blue. The extracellular matrix was therefore characterised using a panel of monoclonal antibodies against glycosaminoglycans and laminin. Chondroitin‐6 sulphate and chondroitin‐4 sulphate were present in the interstitial connective tissue, and there was an increase in the expression of both these epitopes at 24 mo, noteably surrounding neuron cell bodies. The expression of chondroitin‐4 sulphate/dermatan sulphate was unchanged, thus implying a decreased expression of dermatan sulphate with age. Keratan sulphate and the native chondroitin sulphate epitopes were absent from the ganglia at both ages. Laminin expression was increased in the aged ganglia. It is therefore clear that the constituents of the extracellular matrix are not constant throughout the adult lifespan and that the extracellular matrix may influence neuronal survival in old age. This is the first report characterising age‐related changes in the extracellular matrix of autonomic ganglia.
Catecholaminergic innervation of interscapular brown adipose tissue in the naked mole‐rat (Heterocephalus glaber)
Authors: DALY T. JOSEPH M. , WILLIAMS LAURA A. , BUFFENSTEIN ROCHELLE
Published: March 2003

The thermogenic potential of the interscapular brown fat pad in the naked mole‐rat Heterocephalus glaber, that exhibits poikilothermic thermal responses to changing temperatures is reported. Histological and ultrastructural study of the brown fat pad showed that it consists of layers of skeletal muscle interposed between the layers of brown adipose tissue with both unilocular and multilocular adipocytes. Large numbers of mitochondria were present between and around the lipid droplets of these cells. Glyoxylic acid condensation, used to demonstrate catecholaminergic nerves, was evident in low concentrations in the connective tissue between the brown adipocytes. A 3‐dimensional computer‐aided reconstruction of the fat pad showed the extent and ramification of nerves and blood vessels between the adipocytes. These findings show that although the naked mole‐rat is regarded as an endothermic poikilotherm, it possesses anatomical features usually found in homeothermic mammals, which are essential for thermogenesis.
Ultrastructure of quick‐frozen and freeze‐substituted chick osteoclasts
Authors: AKISAKA TOSHITAKA , MIYAJI TAKIO , YOSHIDA HISAHO , INOUE MEGUMI
Published: March 2003

For comparison with chemically fixed osteoclasts, we prepared chick osteoclasts by quick freezing followed by freeze‐substitution. In spite of technical difficulties this demonstrated that osteoclasts can be satisfactorily frozen in situ by the metal contact method. Ultrastructural differences were revealed between conventional fixation and quick freezing. Compared with conventional fixation, the quick freezing method appeared to improve preservation: (1) a discrete trilaminar plasma membrane and other intracellular membranes showed a smooth profile without undulation or rupture; (2) cytoskeletal components appeared to be clearer, straighter, and more numerous; (3) the interior of the ruffled finger contained interconnected lattice structures whereas highly organised microfilaments were seen in the clear zone; (4) well developed tubulovesicular structures (TVSs) that branched or anastomosed with each other were revealed in the cytoplasm; (5) the contents of intracellular membrane systems including the nuclear envelope, endoplasmic reticulum, and Golgi complex were stained to a various extent; (6) vesicles and vacuoles were much smaller, round and well‐defined with electron‐dense contents; (7) crystalline structures were seen at the extracellular channels of the ruffled border, in the lumen of TVSs, and in vesicles; (8) in some instances mitochondrial granules were visible; (9) within the resorptive lacuna, osteoclasts adhered to the degraded bone matrix without any intervening empty space.
Addendum
Authors: CATERSON B.
Published: March 2003

I am writing to the Journal of Anatomy as a component of the response by Archer et al. to a letter to the Editor submitted by Professors Robin Stockwell and John Scott. Professor Archer has asked me to comment on their claims and some matters regarding antibodies used in the studies in question. My responses to these issues are indicated below.
Short Report. The study of early human embryos using interactive 3‐dimensional computer reconstructions
Authors: SCARBOROUGH JULIE , AITON JAMES F. , McLACHLAN JOHN C. , SMART STEVEN D. , WHITEN SUSAN C.
Published: March 2003

Tracings of serial histological sections from 4 human embryos at different Carnegie stages were used to create 3‐dimensional (3D) computer models of the developing heart. The models were constructed using commercially available software developed for graphic design and the production of computer generated virtual reality environments. They are available as interactive objects which can be downloaded via the World Wide Web. This simple method of 3D reconstruction offers significant advantages for understanding important events in morphological sciences.
Acute neuronal and vascular changes following unilateral cerebellar pedunculotomy in the neonatal rat
Authors: SHERRARD RACHEL M. , BOWER ADRIAN J.
Published: March 2003

During development of the central nervous system (CNS) both deafferentation and axotomy induce increased neuronal death and result in a smaller brain with diminished function at maturity. Unilateral cerebellar pedunculotomy has been used as a model to study the relative importance of these 2 types of lesion on the survival of developing CNS neurons. Within the cerebellum, unilateral pedunculotomy causes deafferentation of the hemicerebellum and axotomy in the efferent pathway from the ipsilateral deep cerebellar nuclei. This results in a smaller hemicerebellum with normal cortical laminae but no extracerebellar outflow. In order to identify the sequence of events which leads to this altered structure and therefore to understand the relative importance of afferent versus target‐derived trophic support, unilateral cerebellar pedunculotomy was performed on neonatal rat pups, aged between 1 and 3 days. The cerebella were analysed for histological and vascular changes after survival times of 0, 3, 6, 9, 12, 18, 21, 24 and 48 h. The results show that the effects of axotomy on the deep cerebellar nuclear neurons begin within 3 h of the lesion and apoptotic neuronal degeneration occurs within 48 h. However, the cerebellar cortical neurons continue to undergo normal histological development for at least 48 h after deafferentation. In addition, since ischaemia induces similar effects, a study of the vascular tree was made. The results indicate that the pedunculotomy does not alter the blood supply to the cerebellum, nor induce ischaemia of the cerebellar neurons. From this it may be hypothesised that target‐derived trophic support is more crucial for the survival of immature neurons than is the trophic effect of afferent input.
Studies of neurotrophin biology in the developing trigeminal system
Authors: DAVIES ALUN M.
Published: March 2003

The accessibility of the primary sensory neurons of the trigeminal system at stages throughout their development in avian and mammalian embryos and the ease with which these neurons can be studied in vivo has facilitated investigation of several fundamental aspects of neurotrophin biology. Studies of the timing and sequence of action of neurotrophins and the expression of neurotrophins and their receptors in this well characterised neuronal system have led to a detailed understanding of the functions of neurotrophins in neuronal development. The concepts of neurotrophin independent survival, neurotrophin switching and neurotrophin cooperativity have largely arisen from work on the trigeminal system. Moreover, in vitro studies of trigeminal neurons provided some of the first evidence that the neurotrophin requirements of sensory neurons are related to sensory modality. The developing trigeminal system has been studied most extensively in mice and chickens, each of which has particular advantages for understanding different aspects of neurotrophin biology. In this review, I will outline these advantages and describe some of the main findings that have arisen from this work.
The host environment determines strain‐specific differences in the timing of skeletal muscle regeneration: cross‐transplantation studies between SJL/J and BALB/c mice
Authors: ROBERTS PETER , McGEACHIE JOHN K. , GROUNDS MIRANDA D.
Published: March 2003

The difference in the timing of the regeneration process of skeletal muscle between SJL/J and BALB/c mice was investigated using grafts of whole skeletal muscle (both autografts and allografts). Histological, autoradiographic and immunohistochemical techniques were used in the investigation. Infiltration of leucocytes into autografts, numbers of desmin‐positive myogenic cells and myotube formation were all more advanced in the SJL/J compared with BALB/c mice. Furthermore, autoradiographic evidence showed that myoblasts in the SJL/J autografts were synthesising DNA 12 h earlier than myoblasts in BALB/c autografts. In allografts, where SJL/J host mice received BALB/c grafts, and vice versa, leucocyte infiltration and myotube formation occurred earlier in the BALB/c muscles grafted into SJL/J hosts, than in the reverse situation with BALB/c hosts. The results show that, at least for whole muscle grafts, it is the host environment which determines the speed and outcome of the regenerative process.
Intrastriatal grafts of rat colonic smooth muscle lacking myenteric ganglia stimulate axonal sprouting and regeneration
Authors: TEW ELIZABETH M. M. , ANDERSON PATRICK N. , SAFFREY M. JILL , BURNSTOCK GEOFFREY
Published: March 2003

Grafts of living or freeze‐killed freshly dissected colonic smooth muscle from young inbred Fischer rats were implanted into the corpus striatum of adult Fischer rats. Sections of brain were examined electron microscopically 3 and 6 wk after implantation. At both times, living grafts were vascularised and contained healthy differentiated smooth muscle cells, fibroblasts, interstitial cells of Cajal and some macrophages. Large bundles of small nonmyelinated axons, identified as CNS axonal sprouts, could be observed in the brain at and near the interface between the living smooth muscle and the CNS tissue. Bundles of regenerating CNS axons, often associated with astrocyte processes, had grown into the grafts. Some axons within the grafts had matured, enlarged and become myelinated by oligodendrocyte processes or Schwann cells. In some cases, smooth muscle cells were observed in close and intricate association with axons. In contrast to the living grafts, grafts of freeze‐killed smooth muscle, examined 3 and 6 wk after implantation, contained macrophages, fibroblasts, collagen and large amounts of cellular debris, but no living muscle cells, astrocytes or Schwann cells. The striatal neuropil around freeze‐killed grafts did not contain large bundles of CNS axonal sprouts and bundles of axons were not observed within the freeze‐killed graft. This study demonstrates that cells from the smooth muscle layers of the colon, in the absence of myenteric ganglia, can stimulate a vigorous regenerative response from CNS axons when implanted into the corpus striatum of adult rats.
Nucleation and capture of large cell surface‐associated microtubule arrays that are not located near centrosomes in certain cochlear epithelial cells
Authors: TUCKER JOHN B. , MOGENSEN METTE M. , HENDERSON CRAIG G. , DOXSEY STEPHEN J. , WRIGHT MICHEL , STEARNS TIM
Published: March 2003

This report deals with the as yet undetermined issue of whether cell‐surface associated microtubules in certain cochlear epithelial cells are centrosomally nucleated and subsequently migrate to microtubule‐capturing sites located at the surface regions in question. Alternatively, the cells may possess additional nucleating sites which are noncentrosomal and surface‐associated. These alternative possibilities have been investigated for highly polarised epithelial cells called supporting cells in the mouse and guinea pig organ of Corti using antibodies to pericentrin and γ‐tubulin. There is substantial evidence that both proteins are essential components of microtubule‐nucleating sites in cells generally. Each mature supporting cell possesses a large microtubule array that is remotely located with respect to its centrosome (more than 10 μm away). The antibodies bind to a cell's centrosome. No binding has been detected at 2 other microtubule‐organising centres that are associated with the ends of the centrosomally‐remote microtubule array while it is being constructed. Such arrays include thousands of microtubules in some of the cell types that have been examined. If all a cell's microtubules are nucleated by its centrosome then the findings reported above imply that microtubules escape from the centrosomal nucleating site and migrate to a new location. Furthermore, capture of the plus and minus ends of the errant microtubules is taking place because both ends of a centrosomally‐remote microtubule array are attached to sites that are precisely positioned at certain cell surface locations. Minus ends are locating targets with an exactitude comparable to that which has been demonstrated for plus ends in certain cell types. These cells apparently operate a single control centre strategy for microtubule nucleation that is complemented by precise positioning of plus and minus end‐capturing sites at the cell surface.
Postscript on possum cartilage and oxygen; what is keratan sulphate? A Corrigendum to the Addendum
Authors: SCOTT J. E. , CATERSON BRUCE
Published: March 2003

The recent exchange on cartilage ultrastructure, the localisation of keratan sulphate (KS) therein and the influence of oxygen tension on both (Stockwell & Scott, 1997; Archer et al. 1997; Caterson, 1997) raised important issues which need clarification and extension. We wish to correct certain statements and to examine more rigorously principles which will establish a foundation for future discussion.