bluuebunny/crossref_metadata_2025 huggingface dataset:
Errors in the measurement of endometrial depth using transvaginal sonography in postmenopausal women on tamoxifen: random error is reduced using saline instillation sonography
Authors: Ballard P. , Tetlow R. , Richmond I. , Killick S. , Purdie D.W.
Published: March 2003

Objective

The endometrium in women on tamoxifen is often made irregular by small cysts. The aim of this study was to assess the accuracy and precision of the measurement of endometrial depth by transvaginal sonography.

Methods

The endometrial depth from endometrial biopsies obtained with the resectoscope in 15 women receiving tamoxifen was compared to the endometrial depth measured by TVS. The inter‐observer variability was measured in 58 women.

Results

In those biopsies of sufficient quality to allow a measurement, the corresponding depth measurement obtained by ultrasound was up to 3 mm greater than the histological measurement. The interobserver variability for the measurement of endometrial depth using TVS was assessed in 58 postmenopausal women on tamoxifen. The interobserver variability deteriorated as the mean endometrial depth increased, probably because the increase in depth resulted from greater morphological changes within the endometrium such as cyst formation which resulted in an irregular endometrial/myometrial boundary. This may, however, be improved by performing saline instillation sonography. In a prospective study of 10 postmenopausal women, the interobserver variability was significantly greater during tamoxifen treatment compared to pretreatment.

Conclusions

On the basis of the above, if uterine surveillance using TVS were to be offered to postmenopausal women on tamoxifen, then the procedure should be augmented by saline instillation sonography if the endometrial depth is > 4 mm, as this will improve the measurement precision and also identify intrauterine pathology. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels
Authors: Laudy J. A. M. , De Ridder M. A. J. , Wladimiroff J. W.
Published: March 2003

Objectives

To establish the nature and gestational age dependency of flow velocity waveforms from fetal middle and distal arterial pulmonary branches in the second half of normal pregnancy and to determine repeatability and inter–relationship of flow velocity waveform recordings from proximal, middle and distal arterial pulmonary branches.

Design

Cross‐sectional study.

Subjects/methods

A total of 111 singleton normal pregnancies between 20 and 40 weeks of gestation were studied using a color‐coded Doppler ultrasound system. Pulmonary waveforms were obtained at the level of the fetal cardiac four‐chamber view. Repeatability was tested from two recordings at 15 min time‐intervals in 25 separate normal pregnancies.

Results

Acceptable repeatability of flow velocity waveforms from fetal arterial pulmonary branches was established with coefficients of variation below 15%. The nature of middle arterial pulmonary flow velocity waveforms was similar to that of proximal waveforms and showed a gestational age‐related change for diastolic velocity parameters, peak systolic/peak diastolic ratio and pulsatility index. The distal arterial pulmonary branch displayed a monophasic forward flow velocity profile throughout the cardiac cycle. All velocity parameters of the distal branch remained unchanged with advancing gestation, with the exception of the pulsatility index. Significant inter–pulmonary changes were found for all pulmonary arterial waveform parameters.

Conclusions

Alteration in pulmonary vascular resistance may play a role in gestational age‐related changes, whereas changes in vessel branching/diameter and in the distance between the heart and more distal arterial pulmonary vessels may cause inter–pulmonary differences. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
In‐utero diagnosis of mucopolysaccharidosis type VII in a fetus with an enlarged nuchal translucency
Authors: Den Hollander N. S. , Kleijer W. J. , Schoonderwaldt E. M. , Los F. J. , Wladimiroff J. W. , Niermeijer M. F.
Published: March 2003

Mucopolysaccharidosis type VII was diagnosed prenatally during the first pregnancy of a Turkish consanguineous couple, following diagnostic work‐up of an increased nuchal translucency detected by ultrasound at 13 weeks of gestation. Mucopolysaccharidosis type VII (MPS VII) or Sly syndrome is a rare autosomal recessive lysosomal storage disease, caused by the deficiency of the enzyme β‐glucuronidase. The most severe form of MPS VII manifests itself by non‐immune fetal hydrops. Tests for the diagnosis of metabolic disorders, especially lysosomal diseases, are essential when the major causes of hydrops fetalis have been excluded. The presence of a β‐glucosidase deficiency, Gaucher's disease, in the infant of the patient's sister emphasizes the importance of a complete family history in consanguineous couples and the risk for several recessive diseases in some families. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of congenital Wilms' tumor (nephroblastoma) presenting as fetal hydrops
Authors: Vadeyar S. , Ramsay M. , James D. , O'Neill D.
Published: March 2003

We describe a case of congenital nephroblastoma (Wilms' tumor) presenting at 28 weeks of gestation with fetal hydrops and polyhydramnios. Prenatal diagnosis was made by biopsy. An emergency Cesarean section was performed due to deterioration in the cardiotocograph. A post‐mortem examination confirmed the diagnosis of congenital nephroblastoma. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Thermocoagulation for selective reduction of conjoined twins at 12 weeks of gestation
Authors: Lam Y. H. , Lee C. P. , Tang M. H. Y. , Lau E.
Published: March 2003

Conjoined twins occur rarely. Most of the prenatally diagnosed cases are terminated either because of extensive organ sharing or because of the presence of major structural abnormalities. We present a case of omphalopagus conjoined twins diagnosed at 10 weeks of gestation with selective reduction performed at 12 weeks. The twins were conjoined at the umbilicus with vascular communication demonstrated at the conjunction. Twin A was normal but twin B was growth restricted and hydropic. Thermocoagulation of twin B was performed at 12 weeks by passing an insulated electric wire through a 18‐gauge needle placed close to the fetal heart. Reassessment at 15 weeks showed that twin A was growing normally with a small dead twin B attached at its umbilicus. Twin B was subsequently sloughed off from this attachment and could be seen lying free in the amniotic cavity at 17 weeks. Twin A was delivered at term and was healthy. A small scar could be seen just above the umbilical cord insertion. This case represents the first antenatal example of selective reduction of conjoined twins by thermocoagulation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Coronary artery blood flow visualization signifies hemodynamic deterioration in growth‐restricted fetuses
Authors: Baschat A. A. , Gembruch U. , Gortner L. , Reiss I. , Weiner C. P. , Harman C. R.
Published: March 2003

Objective

To determine the relationship between fetal coronary blood flow (CBF) visualization in intrauterine growth restriction (IUGR), longitudinal changes in arterial and venous flow velocity waveforms and perinatal outcome.

Methods

A total of 48 IUGR fetuses (abdominal circumference below the 5th percentile for gestational age) with absent or reversed umbilical artery (UA) end‐diastolic velocity (AREDV) were examined longitudinally by echocardiography attempting CBF visualization at each examination. Doppler evaluation of the middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV) and umbilical vein (UV) was performed at each examination. Doppler measurements were correct for gestational age by conversion into Z‐ (Δ‐). Doppler results and outcome from fetuses in which CBF was visualized (group 1, n = 20) and those in which CBF was never visualized (group 2, n = 28) were compared. Outcome parameters analyzed included Apgar scores, cord arterial blood gases, perinatal mortality, respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and postpartum circulatory failure requiring pressor support.

Results

There was no difference in Doppler indices between groups at study entry. CBF visualization coincides with a significant increase of UA‐, IVC‐ and DV Δ‐indices. The greatest rate of change was observed for indices in the ductus venosus which occurred in the 24 h preceding CBF visualization. Group 1 fetuses required earlier delivery (median 27 + 4, vs. median 30 + 0), had lower birthweight (682 ± 305 g vs. 936 ± 416 g), lower cord pH (7.21 ± 0.1 vs. 7.27 ± 0.06) and cord pO2 (13 ± 4.5 vs. 24.1 ± 13.5 mmHg) compared to group 2 (all values P < 0.05). Mortality was similar (group 1 = 6/20, 30% group 2 = 6/28, 21.4%).

Conclusions

In IUGR, fetuses with AREDV and centralization are at high risk for hypoxemia, acidemia and adverse outcome. CBF visualization coincides with deteriorating venous flows. Operator dependence of CBF visualization and the strong association with abnormal venous flow stresses the importance of venous Doppler surveillance in these fetuses. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Quantification of the diastolic notch in Doppler ultrasound screening of uterine arteries
Authors: Aardema M. W. , De Wolf B. T. H. M. , Saro M. C. S. , Oosterhof H. , Fidler V. , Aarnoudse J. G.
Published: March 2003

Objective

To investigate a new method of quantification of the diastolic notch of the flow velocity waveforms of uterine arteries in the prediction of hypertensive disorders of pregnancy.

Methods

Pulsed‐wave Doppler was used to obtain flow velocity waveforms (FVWs) from the uterine arteries at 21–22 weeks of gestation from 531 nulliparous women and 94 multiparous women at high risk. From the FVWs, both the pulsatility index (PI) and the notch index (NI) were calculated and the predictive values for both indices were compared using logistic regression analysis for mild and severe early onset hypertensive pregnancy complications.

Results

Both the PI and the NI were poor predictors for mild gestational hypertension and pre‐eclampsia; predictive values for severe early onset disease, however, were much better. Logistic regression analysis showed the NI has no additional value compared with the PI in the prediction of either mild or severe disease.

Conclusion

The NI offers the possibility to quantify the diastolic notch in uterine artery analysis. Compared to the PI, this does not lead to better predictive values for hypertensive disorders of pregnancy. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The development of the fetal penis—an in utero sonographic evaluation
Authors: Zalel Y. , Pinhas‐Hamiel O. , Lipitz S. , Mashiach S. , Achiron R.
Published: March 2003

Objective

To establish a nomogram for fetal penile length during gestation.

Design

A prospective, cross‐sectional study of normal singleton pregnancies.

Subjects

Four hundred and nineteen male fetuses between 14 and 38 weeks were studied.

Methods

Measurements of fetal penis length were performed by high resolution transvaginal ultrasonography between 14 and 17 weeks of gestation, and by transabdominal ultrasonography beyond 18 weeks of gestation.

Results

Adequate penile length measurements were obtained in all 419 fetuses. Penile length as a function of gestational age was expressed by the regression equation: (square root) penile length (mm) = 0.277 + 0.121 × gestational age (weeks). The correlation coefficient, r = 0.967 was found to be highly statistically significant (P < 0.0001). The normal mean and the 90% prediction limits were defined. During the study period, we identified three fetuses with abnormalities involving penile development. Using the above reference data range, it has been shown that their penile length was below the lower limit.

Conclusions

The present data provide a normal range of fetal penile length from early stages of gestation that may allow intrauterine assessment of the development of the male external genitalia. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Ductus venosus studies in fetuses at high risk for chromosomal or heart abnormalities: relationship with nuchal translucency measurement and fetal outcome
Authors: Bilardo C. M. , Müller M. A. , Zikulnig L. , Schipper M. , Hecher K.
Published: March 2003

Objective

To investigate, in a high‐risk group of fetuses, the role of ductus venosus Doppler velocimetry as a prognostic factor, in addition to nuchal translucency measurement, for predicting chromosomal anomalies and, where the karyotype was normal, for predicting fetal outcome.

Methods

Nuchal translucency was measured and ductus venosus pulsatility index and late diastolic flow (a‐wave) were recorded in 186 fetuses at a median gestational age of 12.6 weeks (range, 10–17). Fetal karyotype, the presence of structural anomalies, pregnancy outcome, neonatal examination at birth and postnatal follow up were the outcome values.

Results

Nuchal translucency measurement was increased in 112 fetuses. The outcome of pregnancy was normal in 130 fetuses. Fifty‐six fetuses had an adverse outcome (46 chromosomal anomalies, three intrauterine deaths, six structural anomalies and one developmental disorder). The sensitivity of an abnormal ductus venosus pulsatility index or of absent or reversed flow during the a‐wave was 65% for chromosomal anomalies and 68% for an adverse outcome. The specificity was 79%. There was a significant correlation between nuchal translucency and ductus venosus pulsatility index. In chromosomally normal fetuses with an enlarged nuchal translucency an abnormal ductus venosus flow was associated with a nearly nine‐fold increase in adverse outcome (odds ratio 11.7).

Conclusion

Ductus venosus Doppler velocimetry can be used in addition to nuchal translucency measurement as a predictor of chromosomal anomalies. However, as the ductus venosus blood flow pattern is correlated with nuchal translucency measurement it cannot be used as an independent variable to reduce the indication for fetal karyotyping. Ductus venosus Doppler velocimetry may have a role in the counseling of parents in the case of an enlarged nuchal translucency and normal karyotype by identifying those fetuses in need of an intensive follow up due to an increased risk of adverse outcome. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases
Authors: Catanzarite V. , Maida C. , Thomas W. , Mendoza A. , Stanco L. , Piacquadio K. M.
Published: March 2003

Objective

To assess the specificity of sonographic diagnosis of vasa previa and pregnancy outcome in sonographically diagnosed cases.

Methods

We prospectively collected cases of vasa previa diagnosed by color Doppler sonography. Delivery by elective Cesarean section after demonstration of fetal pulmonary maturity and prior to the onset of labor was recommended unless obstetric complications supervened. Data regarding maternal obstetric courses and newborn status were collected.

Results

Eleven cases of vasa previa without placenta previa were diagnosed among 33 208 women over an 8‐year period. Ten patients had confirmation of the diagnosis by the delivering obstetrician and/or placental examination, giving a specificity of diagnosis of 91%. Among the 10 patients with confirmed vasa previa, two were delivered at 31.5 and 35.5 weeks' gestation prior to demonstration of lung maturity, and the remainder were delivered at 34–37.5 weeks, after lung maturity. All infants had normal Apgar scores and survived. One baby had Scimitar syndrome, which was not suspected from sonography.

Conclusions

The specificity of sonographic diagnosis of vasa previa at our center was 91%. Antenatal diagnosis permitted us to prevent the catastrophic outcomes commonly associated with vasa previa. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Does acute hypoxia cause fetal arterial blood flow redistribution?
Authors: Krampl E. , Chalubinski K. , Schatten C. , Husslein P.
Published: March 2003

Chronic fetal hypoxia in fetal growth restriction due to impaired placentation is associated with centralization of blood flow to the vital organs, such as brain, heart and adrenal glands, in order to maintain oxygenation. There is a correlation between fetal hypoxemia and low impedance to blood flow in the middle cerebral artery. However, there is no association between abnormal flow velocity waveforms and fetal distress in an unselected population, and this reported case also suggests that Doppler ultrasound is of no value in identifying acute fetal distress. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Reproducibility of pulsed Doppler measurements of the maternal renal circulation in normal pregnancies and those with pregnancy‐induced hypertension
Authors: Nakai A. , Miyake H. , Oya A. , Asakura H. , Koshino T. , Araki T.
Published: March 2003

Objective

To assess the inter‐ and intraobserver reproducibilities of pulsed Doppler measurements of the maternal renal circulation in normal pregnancies and those affected by pregnancy‐induced hypertension.

Materials and methods

Color and pulsed Doppler ultrasound was used to measure acceleration time and resistance index in the renal segmental and interlobar arteries. For the investigation of interobserver reproducibility, two sonographers performed measurements blindly in six normal pregnant women and 14 women with pregnancy‐induced hypertension between 28 and 36 weeks' gestation. A second group of 10 patients between 30 and 35 weeks' gestation were examined by one sonographer to assess the level of intraobserver reproducibility of measurements. For each patient in this group, the flow waveform was measured three times in succession. Calculations of the intraclass correlation coefficient Ri were used to determine the level of reproducibility.

Results

The interobserver Ri and intraobserver Ri for acceleration time in the segmental artery were 0.95 and 0.96 and for the interlobar artery they were 0.97 and 0.98, respectively. For the resistance index, these values were 0.01 and 0.01 in the segmental artery and 0.52 and 0.29 in the interlobar artery.

Conclusion

Both the inter‐ and intraobserver reproducibility of acceleration time measurements in the renal segmental and interlobar arteries were clinically acceptable but the equivalent reproducibilities of resistance index measurements were poor. Copyright © 2002 ISUOG
Detection of central pelvic recurrent disease with transvaginal color Doppler ultrasound in women treated for gynecological malignancy
Authors: Testa A. C. , Ciampelli M. , Mastromarino C. , Lopez R. , Zannoni G. F. , Mancuso S. , Scambia G.
Published: March 2003

Objective

To evaluate color Doppler characteristics of small recurrent tumors detected within the central pelvis in follow‐up patients treated for gynecological malignancy.

Patients and methods

A prospective study was performed on 340 patients who were being monitored following treatment for gynecological malignancies. A selected group of 27 patients, with small pelvic masses located in the central region of the pelvis, underwent a color Doppler examination. A subjective assessment of the vascularization (vascular score), the lowest resistance index (RI), the highest peak velocity (PSV) and the highest time averaged maximum velocity (TAMXV) of the vessels detected within the lesion were analyzed.

Results

In 16 patients the pelvic mass was found to be benign while in 11 patients a malignant recurrence was diagnosed. Gray‐scale examination could not differentiate between benign and malignant lesions. The color score of tumor recurrences was significantly higher in comparison to that in benign lesions (color score 3 in 54% vs. 0%, P < 0.005). The malignant lesions showed significantly lower mean values of RI and significantly higher mean values of PSV and TAMXV when compared with benign lesions (0.39 ± 0.09 vs. 0.81 ± 0.22, P < 0.0001; 19.3 ± 4.7 vs. 10.5 ± 5.6 cm/s, P < 0.0001; 8.9 ± 3.7 vs. 4.3 ± 2.7 cm/s, P < 0.005).

Conclusions

Color Doppler analysis added to transvaginal gray‐scale ultrasonography seems to be a helpful tool in the diagnosis of recurrent tumors in the central region of the pelvis. Copyright © 2002 ISUOG
The natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination in postmenopausal women
Authors: Valentin L. , Akrawi D.
Published: March 2003

Objective

To determine the natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination and judged to be benign in postmenopausal women.

Methods

One hundred and thirty‐four postmenopausal women referred for ultrasound examination and found to have an adnexal cyst judged to be benign and not causing any symptoms were followed with transvaginal ultrasound at 3, 6 and 12 months, and then every 12 months. The referring physician treated the patient at his/her own discretion.

Results

One hundred and sixty cysts were found, 121 (76%) being unilocular and 39 more complicated. Seventy‐two cysts (45%) had a largest diameter of 3–19 mm and 88 (55%) had a largest diameter of 20–80 mm. Median follow‐up time was 3 (range, 0.3–8) years. In twelve women (9%) the cysts were removed during follow‐up, all their cysts (n = 14) being benign. The indication to operate was a change in cyst morphology or increased cyst size in five (4%) women. In 39 (29%) women, the cysts disappeared; in 18 (13%), new cysts developed; and, in 65 (49%), the number of cysts and their location remained unchanged. Regression of cysts was observed in 54% (33/61) of women < 60 years vs. in 8% (6/73) of those ≥ 60 years (P = 0.0001). Ultrasound findings remained unchanged in 34% (21/61) of women < 60 years vs. in 77% (56/73) of those ≥ 60 years (P = 0.0001).

Conclusions

The results support conservative management of adnexal cysts incidentally detected at transvaginal ultrasound examination and judged to be benign in postmenopausal women. Whether such cysts need to be followed‐up at all and, if they do, how often and for how long, remains an open question.
Lactacidosis in the neonate is minimized by prenatal detection of congenital heart disease
Authors: Verheijen P. M. , Lisowski L. A. , Stoutenbeek P. , Hitchcock J. F. , Bennink G. B. W. E. , Meijboom E. J.
Published: March 2003

Objectives

To investigate the impact of prenatal detection of congenital heart disease on preventing severe preoperative lactacidosis.

Design

Patients operated upon for congenital heart disease during the first 31 days of life (n = 209) were studied retrospectively, 21 were diagnosed prenatally and 188 patients had not been diagnosed prenatally. Preoperative lactate, pH and base excess were evaluated.

Results

Differences were noted in preoperative pH (7.28 ± 0.03 vs. 7.24 ± 0.01, P = 0.29), base excess (−5.83 ± 0.64 vs. −6.93 ± 0.46 mmol/L, P = 0.10) and lactate (3.05 ± 0.35 vs. 6.08 ± 0.45 mmol/L, P < 0.001), indicating a significant difference in blood lactate values in favor of the prenatally diagnosed group.

Conclusions

Prenatal diagnosis of congenital heart disease and the resulting immediate postnatal care prevent lactate increase in the preoperative period of these patients. This may decrease the risk of cerebral damage and result in the patient being in better condition at surgery. Copyright © 2002 ISUOG
Cardiac ventricular performance in the appropriate‐ for‐gestational age and small‐for‐gestational age fetus: relation to regional cardiac non‐uniformity and peripheral resistance
Authors: Tsyvian P. , Malkin K. , Artemieva O. , Blyakhman F. , Wladimiroff J. W.
Published: March 2003

Objective

To investigate the relationship between parameters of diastolic function, loading conditions and remodeling of the left ventricle in the appropriate‐for‐gestational age and small‐for‐gestational age fetus.

Methods

Two‐dimensional echocardiographic left ventricular images were digitized in 24 appropriate‐for‐gestational age and 14 small‐for‐gestational age fetuses. The maximal short axis and long axis were measured. The left ventricular contour was divided into 12 segments. The changes in whole left ventricular cavity area were calculated for ventricular global area change assessment. The coefficient of variation for segmental fractional area change was calculated for the evaluation of left ventricular regional wall motion non‐uniformity.

Results

Mean left ventricular long axis/short axis ratio in the small‐for‐gestational age fetus (1.11 ± 0.08) was smaller (P < 0.01) than in the appropriate‐for‐gestational age fetus (1.75 ± 0.26). Mean fractional area change in the small‐for‐gestational age fetus was larger (P < 0.01) than in the appropriate‐for‐gestational age fetus (37.8 ± 17.6% vs. 21.1 ± 9.9%). Mean left ventricular global area change in the small‐for‐gestational age fetus was smaller (P < 0.05) than in the appropriate‐for‐gestational age fetus (53.2 ± 7.4% vs. 61.5 ± 10.3%). Mean ventricular isovolumic relaxation time in the appropriate‐for‐gestational age fetus was shorter (P = 0.03) than in the small‐for‐gestational age fetus (37 ± 6 ms vs. 57 ± 9 ms). Mean transmitral E‐wave/A‐wave ratio in the small‐for‐gestational age fetus was smaller (P < 0.01) than in the appropriate‐for‐gestational age fetus (0.69 ± 0.08 vs. 0.80 ± 0.08). A negative correlation (P < 0.05) was demonstrated between: (i) fractional area change and global area change in both small‐for‐gestational age (r = −0.62) and appropriate‐for‐gestational age fetuses (r = −0.58); (ii) umbil‐ical artery systolic/diastolic ratio and transmitral E‐wave/A‐wave ratio in both appropriate‐for‐gestational age (r =−0.58) and small‐for‐gestational age (r = −0.60) fetuses. A positive correlation existed between fractional area change and isovolumic relaxation time in the small‐for‐gestational age fetus (r = +0.72;P < 0.01).

Conclusions

The changes in ventricular shape, wall motion, spatial non‐uniformity and diastolic function in the small‐for‐gestational age fetus could be considered as adaptive changes, known as ventricular remodeling. It is proposed that the leading cause of ventricular remodeling in the small‐for‐gestational age fetus is chronic pressure overload due to increased placental vascular resistance. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
A normal second‐trimester ultrasound does not exclude intracranial structural pathology
Authors: Malinger G. , Lerman‐Sagie T. , Watemberg N. , Rotmensch S. , Lev D. , Glezerman M.
Published: March 2003

Objective

To report the prenatal diagnosis and management of 34 fetuses with various intracranial structural pathologies diagnosed following a normal second‐trimester ultrasound examination.

Methods

We retrospectively reviewed the images of 203 abnormal central nervous system ultrasound examinations performed between 13 and 37 weeks of gestation at our prenatal diagnosis unit. In 34 (16.7%) of them at least one previous second‐trimester ultrasound examination had been performed and considered normal. These 34 fetuses represent the study group.

Results

The following intracranial pathologies were diagnosed: dysgenesis of the corpus callosum, ventriculomegaly, cerebral cysts or hemorrhage, migrational disorders, vermian dysgenesis, arachnoid cysts, macrocephaly, enlarged subarachnoid space, brain calcifications and microcephaly.

Conclusion

A normal second‐trimester ultrasound scan does not rule out significant intracranial anomalies. Parents and physicians should be informed about the limitations of second‐trimester sonography as far as brain diagnosis is concerned. A repeat third‐trimester scan may enable more accurate diagnosis and counseling. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Middle cerebral artery Doppler in fetuses with transposition of the great arteries
Authors: Jouannic J.‐M. , Benachi A. , Bonnet D. , Fermont L. , Le Bidois J. , Dumez Y. , Dommergues M.
Published: March 2003

Objective

A previous anthropometric study has shown that neonates with transposition of the great arteries have a smaller head circumference and intracranial volume, which may be related to a lower oxygen content of blood delivered to the head and upper extremities. The aim of this study was to compare Doppler blood flow velocity waveforms in fetuses with transposition of the great arteries with those in healthy fetuses.

Methods

Doppler blood flow velocimetry was performed in the middle cerebral artery, the umbilical artery, the aorta and the ductus venosus in a consecutive series of 23 fetuses with transposition of the great arteries between 36 and 38 weeks' gestation. The control group consisted of 40 healthy fetuses matched for gestational age.

Results

There was no significant difference in pulsatility indices in the umbilical artery, the aorta and the ductus venosus between fetuses with transposition of the great arteries and controls. The median middle cerebral artery pulsatility index in the group with transposition of the great arteries was 1.37 (range, 1.10–2.02) and was significantly lower than that in the control group (median, 1.68; range, 1.46–2.04) (P < 0.001, Mann–Whitney test).

Conclusions

The lower pulsatility indices observed in the middle cerebral artery of fetuses with transposition of the great arteries may reflect a trend towards cerebral vasodilation. This phenomenon could be an indicator of hypoxemia and/or hypercapnia restricted to areas perfused by the preisthmus aorta and be related to the characteristics of the circulation in fetuses with transposition of the great arteries. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Congenital periventricular pseudocysts: prenatal sonographic appearance and clinical implications
Authors: Malinger G. , Lev D. , Ben Sira L. , Kidron D. , Tamarkin M. , Lerman‐Sagie T.
Published: March 2003

Objective

Periventricular pseudocysts (PVPC) are diagnosed in approximately 1% of premature newborns that undergo brain sonography during the first 24 h of life. These pseudocysts are thought to develop antenatally due to germinal matrix hemorrhage, but have not been described until now in prenatal ultrasound studies. The aim of this study was to report the identification, differential diagnosis, and prognosis of PVPC detected by prenatal ultrasound examination.

Design

Between 1997 and 2001 we made an ultrasound diagnosis of PVPC in 11 fetuses. In nine fetuses the findings were characteristic of PVPC and these patients represent our study group. Fetal magnetic resonance imaging was performed in five patients. Termination of pregnancy was carried out in three patients, in one case intrauterine fetal death occurred at 31 weeks, and one infant died in the neonatal period. The surviving four newborns are being followed in the pediatric neurology clinic.

Results

PVPC were diagnosed by ultrasound scan in fetuses between 16 and 37 weeks of gestation (mean, 29.7 weeks). Magnetic resonance imaging confirmed the presence of PVPC in two cases. In eight cases the pseudocysts were unilateral and in one case bilateral. They were an isolated finding in five patients. Four of these fetuses were delivered at term and have normal neurological development at ages ranging from 6 to 25 months. All fetuses with additional pathologies (coarctation of the aorta, hemimegalencephaly, cytomegalovirus infection, hypoplasia of the vermis with dysmorphism) did not survive.

Conclusions

The prenatal diagnosis of PVPC warrants an extensive search for possible associated pathological findings. As an isolated finding, antenatal PVPC seem to carry a good prognosis. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Structural colocalisation of type VI collagen and fibronectin in agarose cultured chondrocytes and isolated chondrons extracted from adult canine tibial cartilage
Authors: CHANG JIANG , NAKAJIMA HIDETO , POOLE C. ANTHONY
Published: March 2003

Cell–matrix and matrix–matrix interactions are of critical importance in regulating the development, maintenance and repair of articular cartilage. In this study, we examined the structural colocalisation of type VI collagen and fibronectin in isolated chondrons and long‐term agarose cultured chondrocytes extracted from normal adult canine articular cartilage. Using double labelling immunohistochemistry in conjunction with dual channel confocal microscopy and digital image processing we demonstrate that type VI collagen and fibronectin are distributed in a similar staining pattern and are colocalised at the surface of cultured chondrocytes and isolated chondrons. The results suggest that type VI collagen and fibronectin may play a role in both cell–matrix adhesion and matrix–matrix cohesion in the pericellular microenvironment surrounding articular cartilage chondrocytes.
Morphological and histochemical changes in the epididymis of hamsters (Mesocricetus auratus) subjected to short photoperiod
Authors: CALVO ALFONSO , BUSTOS‐OBREGÓN EDUARDO , PASTOR LUIS M.
Published: March 2003

The morphological involution and histochemical changes of the Syrian hamster (Mesocricetus auratus) epididymis induced by a short light period were investigated. Under short‐day conditions, the epididymis showed marked morphological changes including a decrease in luminal diameter, disappearance of spermatozoa, increase of interductal tissue, increase of intraepithelial lipofuscin deposits, the presence of phagolysosomes in the principal cells and macrophage‐like cells, and a considerable modification of most clear cells. With lectin histochemistry changes were found in the glycoconjugates of principal cells of the regressed epididymis, either a decrease (PNA, WGA, HPA and DBA) or an increase (MAA) in the affinity of lectins to the Golgi area, or a decrease (HPA) or an increase (PNA) in lectin binding to stereocilia. Both morphological and histochemical results showed that, under this light condition, the cauda epididymidis presented the most prominent alterations, and that the epididymis showed increased absorptive activity and a decreased synthesis of glycoproteins. All these changes are probably due to the decrease in testosterone levels.
Correspondence. Case report: accessory head of the deep forearm flexors
Authors: JONES M. , ABRAHAMS P. H. , SAÑUDO J. R.
Published: March 2003

In 1813 Gantzer described 2 accessory muscles in the human forearm which bear his name (Wood, 1868; Macalister, 1875) and these have subsequently been reported with variable attachments (Wood, 1868; Macalister, 1875; Turner, 1879; Schäfer & Thane, 1894; Le Double, 1897; Dykes & Anson, 1944; Mangini, 1960; Malhotra et al. 1982; Kida, 1988; Tountas & Bergman, 1993). The accessory heads of the deep flexors of the forearm (Gantzer's muscles) have been described as 2 different small bellies which insert either into FPL or FDP. There are no previous reports which have mentioned the existence of an accessory muscle which inserts into both of the 2 deep flexors of the forearm as in the case presented here.
Target pioneering and early morphology of the murine chorda tympani
Authors: SCOTT LISA , ATKINSON MARTIN E.
Published: March 2003

Many studies demonstrate that differentiation of certain sensory receptors during development is induced by their nerve supply. Thus the navigational accuracy of pioneering fibres to their targets is crucial to this process. The special gustatory elements of the facial and glossopharyngeal nerves are used extensively as model systems in this field. We examined the chorda tympani, the gustatory component of the facial nerve, to determine the precise time course of its development in mice. The transganglionic fluorescent tracer DiI was injected into the anterior aspect of the mandibular arch of fixed embryos aged between 30 and 50 somites (E10–E12). It was allowed to diffuse retrogradely via the geniculate ganglion to the brainstem for 4 wk, before the distribution of DiI was determined using confocal laser scanning microscopy. Geniculate ganglion cells were first labelled at the 34 somite stage (E10). Pioneering chorda tympani fibres that arise from these cells passed peripherally and followed an oblique course as they grew towards the mandibular arch. At the 36 somite stage (E10.5), the peripheral component followed an intricate postspiracular course and passed anteriorly to arch over the primitive tympanic cavity, en route to the lingual epithelium. From the 36 to 50 somite stages (E10.5–E12), it consistently traced in the fashion of a ‘U’ bend. The central fascicle also traced at the 36 somite stage (E10.5) and just made contact with the brainstem. At the 40 somite stage (E11), the central fibres clearly chose a route of descent into the spinal trigeminal tract and branched into the solitary tract. Pioneering chorda tympani fibres contact the lingual epithelium when the target is primordial. The lingual epithelium may be a source of a neurotropic factor that attracts peripheral chorda tympani fibres to the sites of putative papillae. However, the chorda tympani is probably not a vital influence on the subsequent differentiation of gustatory papillae, since the papillae are elaborated 5 d later at E15 in murine embryos. The early morphology of the nerve is true to the amniote vertebrate phenotype.
Vascularisation in adipose depots surrounding immune‐stimulated lymph nodes
Authors: MACQUEEN HILARY A. , WAIGHTS VERINA , POND CAROLINE M.
Published: March 2003

We report a change in the vascularisation of the adipose depots surrounding the popliteal lymph node that has, and the contralateral node that has not, been exposed to a simulated immune challenge. The percentage of the depot that consists of vessels, as measured by image analysis, decreases over a period of 2 d after immune stimulus, then increases in a biphasic manner over the next 2–3 wk. By 1 mo after the stimulus, the vascularisation has returned to baseline values. The adipose tissue surrounding both the stimulated and the unstimulated lymph nodes shows a similar pattern, but the unstimulated depot lags by 3–6 d in reaching its maximum vascularisation. These data support the hypothesis that perinodal adipose tissue is involved in peripheral immune responses.
The porcine bronchial artery: surgical and angiographic anatomy
Authors: GADE JOHN , NORGAARD MARTIN A. , ANDERSEN CLAUS B. , PETTERSSON GÖSTA , SVENDSEN ULRIK G. , OLSEN PETER S.
Published: March 2003

The pig is often used in experimental studies on the significance of bronchial artery circulation, but the anatomy of this artery is only poorly described. The purpose of this study was to improve the anatomical basis for experimental studies on the porcine bronchial artery circulation. The origin of the artery from the aorta is described in 32 pigs. Heart–lung blocks were perfused with saline and removed in 16 pigs, and the broncho‐oesophageal orifice was identified and cannulated. In these 16 specimens the intrapulmonary ramification was studied by angiography, and the extrapulmonary distribution and supply area by injection of Evans Blue. The broncho‐oesophageal artery originated from the aorta as a single trunk in 91%. Angiography showed that each principal bronchus was accompanied by 2 bronchial artery branches far into the lung parenchyma. The central branching pattern of the artery between the aorta and the principal bronchi was divided into 3 subtypes. Evans Blue showed communication with the whole mediastinum. The anatomical relations are described. It is concluded that the broncho‐oesophageal artery divides to follow each bronchus with 2 bronchial branches. A nomenclature for these branches is suggested. The pig anatomy is suited for experimental investigations on the bronchial circulation.
Scoring of nonmetric cranial traits: a population study
Authors: BRASILI P. , ZACCAGNI L. , GUALDI‐RUSSO E.
Published: March 2003

The aims of the present study were: (1) to supply further knowledge about variations in nonmetric cranial traits in relation to sex, age and laterality and (2) to evaluate biological distance between samples from a recent population. The incidence of 18 nonmetric variants of the cranium were determined in 3 adult samples of 394 skulls of known sex from North Sardinia (Sassari, Alghero and Ozieri); for the Sassari sample (n = 200) age at death was also known. Some significant sex differences were observed. Age did not appear to influence the frequency of the discontinuous traits but did for legibility. Side differences may provide important information about environmental influences. The interpopulation analysis indicates a stronger relationship between samples that are geographically closer (Sassari and Alghero), in accordance with other studies, strengthening the hypothesis of the validity of the use of nonmetric traits in the study of the peopling of a territory.
Evaluation by solid vascular casts of arterial geometric optimisation and the influence of ageing
Authors: WILLEMS P. W. A. , HAN K. S. , HILLEN B.
Published: March 2003

In the theoretical analysis of arterial networks the existence of geometric optimisation has long been suggested, although observational studies have not yet fully corroborated these theories. Since this could be due to experimental flaws, the aim of this study was to establish the validity of arterial geometric optimisation using a new experimental design and to assess the influence of ageing. Solid vascular casts of arterial mesenteric branching systems of 8‐wk‐old and adult dogs (beagles) were used to examine vascular diameters and branching angles, the latter in a manner that allowed optimisation of the line of view, thus minimising distortion errors due to a line of view not normal to the branching plane. Internal and external vessel diameters were found to be in accordance with the theoretical principle of minimum work (8‐wk‐old internal: r = 0.994; adult internal: r = 0.971; adult external: r = 0.985). Although branching angles were found to be in agreement with basic qualitative principles of arterial branching geometry, the measurements still showed a large amount of scatter and were generally smaller than expected on theoretical grounds, despite the newly designed measuring technique. These branching angles demonstrated small age‐related differences. However, when biological cost was considered per bifurcation, surprisingly, guidance towards minimum lumen volume and pumping power with increase in age could clearly be demonstrated (P<0.001). It is concluded that our findings support the existence of a degree of arterial geometric optimisation in favour of minimum lumen volume and pumping power, increasing with age. Future investigations should focus on the biofeedback mechanisms involved.
Normal growth and development of the lips: a 3‐dimensional study from 6 years to adulthood using a geometric model
Authors: FERRARIO VIRGILIO F. , SFORZA CHIARELLA , SCHMITZ JOHANNES H. , CIUSA VERONICA , COLOMBO ANNA
Published: March 2003

A 3‐dimensional computerised system with landmark representation of the soft‐tissue facial surface allows noninvasive and fast quantitative study of facial growth. The aims of the present investigation were (1) to provide reference data for selected dimensions of lips (linear distances and ratios, vermilion area, volume); (2) to quantify the relevant growth changes; and (3) to evaluate sex differences in growth patterns. The 3‐dimensional coordinates of 6 soft‐tissue landmarks on the lips were obtained by an optoelectronic instrument in a mixed longitudinal and cross‐sectional study (2023 examinations in 1348 healthy subjects between 6 y of age and young adulthood). From the landmarks, several linear distances (mouth width, total vermilion height, total lip height, upper lip height), the vermilion height‐to‐mouth width ratio, some areas (vermilion of the upper lip, vermilion of the lower lip, total vermilion) and volumes (upper lip volume, lower lip volume, total lip volume) were calculated and averaged for age and sex. Male values were compared with female values by means of Student's t test. Within each age group all lip dimensions (distances, areas, volumes) were significantly larger in boys than in girls (P < 0.05), with some exceptions in the first age groups and coinciding with the earlier female growth spurt, whereas the vermilion height‐to‐mouth width ratio did not show a corresponding sexual dimorphism. Linear distances in girls had almost reached adult dimensions in the 13–14 y age group, while in boys a large increase was still to occur. The attainment of adult dimensions was faster in the upper than in the lower lip, especially in girls. The method used in the present investigation allowed the noninvasive evaluation of a large sample of nonpatient subjects, leading to the definition of 3‐dimensional normative data. Data collected in the present study could represent a data base for the quantitative description of human lip morphology from childhood to young adulthood.
Stereological estimation of volume‐weighted mean glomerular volume from arbitrary sections of the equine kidney
Authors: BEECH D. J. , ROCHE E. D. , SIBBONS P. D. , ROSSDALE P. D. , OUSEY J. C.
Published: March 2003

Mean glomerular volume has previously been estimated, using stereological techniques, specifically the point‐sampled intercept (PSI), either from isotropic or from vertical sections. As glomeruli are approximately spherical structures, the same stereological technique was carried out on vertical and arbitrary sections to determine whether section orientation had any effect on mean glomerular volume estimation. Equine kidneys from 10 individuals were analysed using the PSI method of estimating volume‐weighted mean glomerular volume (MGV); for each kidney, arbitrary and vertical sections were analysed. MGVs were not significantly different between arbitrary and vertical sections (P = 0.691) when analysing the data with the paired t test; when plotting MGV estimates from arbitrary sections against those from vertical sections the intercept was found not to be significantly different from zero (P > 0.8) and the slope of the regression line not to be significantly different from 1.0 (P > 0.4). For the estimation of MGV in equine kidneys using PSI, arbitrary sections may be used if it is not possible to use isotropic or vertical sections, but some caution must be exercised in the interpretation of results so gained.
Carpal bone movements in gripping action of the giant panda (Ailuropoda melanoleuca)
Authors: ENDO HIDEKI , SASAKI MOTOKI , HAYASHI YOSHIHIRO , KOIE HIROSHI , YAMAYA YOSHIKI , KIMURA JUNPEI
Published: March 2003

The movement of the carpal bones in gripping was clarified in the giant panda (Ailuropoda melanoleuca) by means of macroscopic anatomy, computed tomography (CT) and related 3‐dimensional (3‐D) volume rendering techniques. In the gripping action, 3‐D CT images demonstrated that the radial and 4th carpal bones largely rotate or flex to the radial and ulnar sides respectively. This indicates that these carpal bones on both sides enable the panda to flex the palm from the forearm and to grasp objects by the manipulation mechanism that includes the radial sesamoid. In the macroscopic observations, we found that the smooth articulation surfaces are enlarged between the radial carpal and the radius on the radial side, and between the 4th and ulnar carpals on the ulnar side. The panda skilfully grasps using a double pincer‐like apparatus with the huge radial sesamoid and accessory carpal.