bluuebunny/crossref_metadata_2025 huggingface dataset:
A preliminary study of sonographic grading of fetal intracardiac echogenic foci: feasibility, reliability and association with aneuploidy
Authors: Wax J. R. , Royer D. , Mather J. , Chen C. , Aponte‐García A. , Steinfeld J. D. , Ingardia C. J.
Published: March 2003

Objectives

To prospectively and quantitatively grade intracardiac echogenic focus/foci (ICEF) using sonographic gain reduction and to determine the association of ICEF by grade with fetal aneuploidy.

Methods

Women referred for raised maternal age (≥ 35 years), or > 18 years of age and with a Down syndrome risk ≥1/270, increased trisomy 18 risk by second trimester serum screen or a prior aneuploid offspring were included in this institutionally approved protocol. Only pregnancies of gestational age between 14 and 24 weeks were included. All women had a targeted ultrasound and were offered fetal chromosome analysis. The classification of ICEF was made from a four‐chamber view of the fetal heart. The echo amplitude of the ICEF was compared to that of the thoracic spine and categorized according to the comparative gain setting at which the image of the relevant structure disappeared: Grade O = no ICEF present, Grade 1 = ICEF image lost before thoracic spine when gain was reduced, Grade 2 = ICEF image lost at same gain setting as thoracic spine, Grade 3 = thoracic spine image lost before ICEF. The primary outcome was a prenatally or post‐natally detected chromosomal abnormality.

Results

A total of 885 eligible women were examined during the 21‐month study period. ICEF were seen in 29 (3.3%) fetuses: 24(83%) in the left ventricle and five (17%) in the right ventricle. A chromosome abnormality was identified in 13/671 (1.9%) fetuses without ICEF (Grade 0) and 0/21 (0%) fetuses with Grade 1 ICEF. In contrast, two of five (40%) fetuses with Grade 2 ICEF were aneuploid (P = 0.005). No Grade 3 ICEF were observed. Additional sonographic abnormalities were seen in both aneuploid fetuses with Grade 2 ICEF. Interobserver agreement on ICEF grading was noted in 50/50 (100%) examinations (kappa = 1.0).

Conclusions

Sonographic grading of ICEF is feasible and highly reliable. Grade 2 ICEF, especially when accompanied by additional sonographic markers of a chromosomal abnormality, are associated with aneuploidy significantly more frequently than Grade 1 ICEF. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonographic markers for chromosomal abnormalities in women with negative nuchal translucency and second trimester maternal serum biochemistry
Authors: Verdin S. M. , Whitlow B. J. , Lazanakis M. , Kadir R. A. , Chatzipapas I. , Economides D. L.
Published: March 2003

Objective

To analyze the value of second trimester ultrasound examination among those women whose fetuses were indicated to be at low risk of chromosomal anomalies on the basis of both first trimester nuchal translucency measurement and second trimester biochemical screening.

Methods

A retrospective study of 5500 pregnancies carried out at the fetal medicine unit, Royal Free Hospital. During a period of over 3 years 5500 pregnancies underwent a first trimester scan and nuchal translucency measurement which enabled the detection of 62% (20 of 32) of all chromosomal anomalies. From the remaining pregnancies that underwent second trimester biochemical screening, 3548 were considered negative (risk < 1: 250; using maternal serum free beta human chorionic gonadotrophin and alpha fetoprotein). The ultrasound markers that were examined were: shortened femur length, echogenic bowel, pyelectasis, choroid plexus cysts and echogenic intracardiac foci. The likelihood ratios for chromosomal aneuploides for each of these markers were calculated.

Results

Of the 3548 screen negative pregnancies, 3541 (99.8%) had a normal karyotype. Seven (0.2%) fetuses had an abnormal karyotype including four (0.11%) with trisomy 21, one with trisomy 18 and two with 47XXY. Second trimester ultrasound markers were found in two of the five (40%) with severe chromosomal anomalies compared to 184 of 3541 (5.2%) with normal karyotypes. Detection of one or more ultrasound markers in a screen negative pregnancy increased the possibility of chromosomal aneuploidy and a negative ultrasound decreased the risk by a likelihood ratio of 0.6 (95% confidence interval, 0.3–1.3). The risk was considerably increased when two or more markers were detected and we would recommend karyotyping under these circumstances.

Conclusion

This preliminary data indicates a possible role for abnormal ultrasound markers in assessing the risk of chromosomal abnormalities in patients considered to be at low risk by nuchal translucency and serum screening. However analysis of a much larger study group will have to be conducted to assess the significance of individual markers. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal therapy of non‐immunologic hydrops fetalis caused by severe aortic stenosis
Authors: Schmider A. , Henrich W. , Dähnert I. , Dudenhausen J. W.
Published: March 2003

Congenital aortic stenosis is a rare cause of congestive heart failure and hydrops fetalis. This report describes a case of prenatally diagnosed critical aortic stenosis and endocardial fibroelastosis leading to a severe hydrops fetalis at 27 weeks of gestation. Successful transplacental digitalization was performed and all signs of hydrops resolved within 2 weeks. The pregnancy continued with normal development of the fetus and birth was induced at 39 weeks of gestation. After an uneventful vaginal birth, the child was transferred for cardiac catheterization, and balloon dilation of the aortic valve was performed successfully. Follow up at the age of 2 years showed only mild left ventricular cardiac hypertrophy, a moderate elevated pressure gradient of 50 mmHg at the aortic valve and mild aortic and mitral regurgitation. No further interventions were necessary at this point. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Fetal echogenic bowel: parameters to be considered in differential diagnosis
Authors: Strocker A.M. , Snijders R.J. , Carlson D.E. , Greene N. , Gregory K.D. , Walla C.A. , Platt L.D.
Published: March 2003

Objectives

To evaluate the extent that associated findings aid in the differential diagnosis and/or prognosis of fetal echogenic bowel.

Methods

Medical history, obstetric records and outcome details were examined for 131 consecutive pregnancies with fetal hyperechogenic bowel.

Results

In 62 (47%) cases, there were no visible anomalies other than hyperechogenic bowel and no evidence of growth restriction. This group included four (7%) pregnancies with Down syndrome, 15 (24%) with infection or a recent episode of influenza and eight (13%) with blood staining of amniotic fluid. In the remaining 69 (53%) cases, hyperechogenic bowel was accompanied by hydrops or nuchal edema (n = 16, 12.2%), growth restriction (n = 9, 6.9%), other markers for chromosome anomalies (n = 33, 25.2%) or multiple structural anomalies (n = 11, 8.4%). In this group, the prevalence of Down syndrome was 12%, infection or influenza was reported in 14 (20%) cases and there was blood staining of amniotic fluid in seven (10%). Cystic fibrosis screening was performed in 65 (50%) pregnancies; the results were negative in all cases and clinical assessment did not indicate cystic fibrosis in any of the 91 infants who were born alive. Maternal serum screening was performed in 41 (31%) pregnancies. High alpha‒fetoprotein levels were associated with multiple abnormalities or severe growth restriction.

Conclusions

In many pregnancies with fetal hyperechogenic bowel, there are multiple factors that may explain these findings. Thus identification of one potential underlying cause should not preclude further testing. Once chromosome defects, cystic fibrosis, structural abnormalities, infection and growth restriction have been excluded, parents can be counseled that the prognosis is good, irrespective of the presence or absence of blood stained amniotic fluid. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
The effect of gestational age and placental location on the prediction of pre‐eclampsia by uterine artery Doppler velocimetry in low‐risk nulliparous women
Authors: Antsaklis A. , Daskalakis G. , Tzortzis E. , Michalas S.
Published: March 2003

Objective

To assess how placental position and gestational age can influence the value of a diastolic notch of the uterine arteries as a screening test for pre‐eclampsia, in a low‐risk population of healthy nulliparous women.

Methods

Color Doppler ultrasound was used to examine both uterine arteries in 654 healthy nulliparas at 4‐week intervals between 20 and 32 weeks. The only criterion for an abnormal result was the presence of an early diastolic notch. In each subject the placental position was also recorded. The major end points were pre‐eclampsia and pre‐eclampsia requiring delivery before the 34th week.

Results

Ninety‐eight women (15%) had abnormal flow velocity waveforms at their first visit. Twenty‐one out of 654 women developed pre‐eclampsia (3.2%). The sensitivity of the test became lower as gestational age advanced and ranged from 81% at 20 weeks, to 71.4% at 32 weeks. In contrast, the specificity and positive predictive value increased significantly. Eleven out of 12 women who delivered before 34 weeks had abnormal waveforms at the 24th week. In women with a full lateral placenta, the predictive value of the test was extremely low, especially in cases with unilateral notches.

Conclusion

Pre‐eclampsia can be more accurately predicted if, along with the presence of a notch, both gestational age and placental position are taken into account. At week 24 the test maintains a high sensitivity (76.1%), but also has an improved specificity (95.1%) and positive predictive value (34%), which allow the clinician to intervene with a potential preventive treatment. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
Twin reversed arterial perfusion sequence in twin‐to‐twin transfusion syndrome after the death of the donor co‐twin in the second trimester
Authors: Gembruch U. , Viski S. , Bagamery K. , Berg C. , Germer U.
Published: March 2003

A twin‐to‐twin transfusion syndrome was diagnosed in a monochorionic‐diamniotic pregnancy at 18 weeks' gestation without any malformation, especially heart defect. In spite of the aggressive treatment (serial amnioreduction, digoxin treatment) the donor twin died at 25 weeks and twin reversed arterial perfusion (TRAP) sequence developed and was documented by Doppler ultrasound. In the TRAP‐twin, the route of the reversed blood flow from the umbilical arteries was as follows: descending aorta, aortic arch, ascending aorta, aortic valve, left ventricle, mitral valve, left atrium, foramen ovale, right atrium, inferior vena cava, ductus venosus; and back to the placenta through the umbilical vein. After a 12‐h observation period the twin reversed arterial perfusion sequence disappeared. During this period ultrasound and fetal blood sampling revealed no sign of fetal anemia or disseminated intravascular coagulation in the surviving twin. Based on our observations, we propose, that the death of one of the twins in monochorionic pregnancy can result in twin reversed arterial perfusion sequence, which is an ultimately rare phenomenon in the second trimester. To our knowledge, this is the first reported case of twin reversed arterial perfusion sequence subsequent to the intrauterine demise of one twin in twin‐to‐twin transfusion syndrome in which the TRAP‐twin had no cardiac malformation. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Limitations of using first‐trimester nuchal translucency measurement in routine screening for major congenital heart defects
Authors: Mavrides E. , Cobian‐Sanchez F. , Tekay A. , Moscoso G. , Campbell S. , Thilaganathan B. , Carvalho J. S.
Published: March 2003

Objective

To evaluate the effectiveness of nuchal translucency (NT) measurement in screening for major congenital heart disease (CHD) in chromosomally normal fetuses.

Design

A population based cohort study of all women having fetal NT measurement at 10–14 weeks of gestation in an unselected population over a 3‐year period. The outcome measure was the identification of major CHD in chromosomally normal pregnancies either antenatally or postnatally.

Results

Major defects of the heart and great arteries were identified in 26 out of 7339 pregnancies (prevalence 3.5 per 1000 pregnancies). Out of 26 cases, only four (sensitivity 15.4%, 95% CI 4–35) were in the group of 258 pregnancies (3.5%) with increased NT of ≥ 2.5 mm. The prevalence of major CHD increased from 3.1 per 1000 for NT < 2.5 mm to 50 per 1000 for NT ≥ 3.5 mm (likelihood ratio of 14.1, 95% CI 4.2–47.9). The positive and negative predictive values for NT ≥ 2.5 mm were 1.6% and 99.7%, respectively.

Conclusions

The prevalence of major CHD in this study was 3.5 per 1000, suggesting that ascertainment of CHD in our study population was thorough. Fetuses with NT measurements ≥ 3.5 mm have a significantly increased risk of major CHD, and this identifies a subgroup of high‐risk patients in whom early fetal echocardiography would be advocated. The low sensitivity of NT for major CHD in the general population, however, indicates that NT cannot be relied on as the sole or major screening tool for this condition as previously reported. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Significance of chromosome 22q11 analysis after detection of an increased first‐trimester nuchal translucency
Authors: Hollis B. , Mavrides E. , Carvalho J. S. , Hill L. , Dickinson V. , Thilaganathan B.
Published: March 2003

Objective

To determine the value of performing routine fluorescent in situ hybridization (FISH) for microdeletions of chromosome 22q11 when karyotyping fetuses with increased nuchal translucency.

Design

This was a prospective observational study carried out over an 18‐month period. Fetal karyotyping by chorionic villus sampling was offered to 5429 women attending for a routine booking scan in the first trimester when their nuchal translucency adjusted risk for Down syndrome was ≥ 1 in 300. Cytogenetic samples were routinely tested for the 22q11 microdeletion when the nuchal translucency was ≥ 3 mm.

Results

The prevalence of increased nuchal translucency ≥ 2.5 mm was 180 (3.3%) and ≥ 3.5 mm was 42 (0.8%). None of 75 fetuses with an increased nuchal translucency and normal karyotype demonstrated a 22q11 microdeletion on FISH analysis. In the same cohort, 3 of 20 (15%) cases of major congenital heart defects in which nuchal translucency was measured, had a nuchal translucency measurement ≥ 2.5 mm.

Conclusions

Routine FISH analysis for chromosome 22q11 microdeletions at the time of chorionic villus sampling for increased first‐trimester nuchal translucency is of limited value. As a significant proportion of fetuses with increased nuchal translucency will be found to have congenital heart defects later in the pregnancy, FISH analysis for chromosome 22q11 microdeletions can be targeted to fetuses with specific congenital heart defects. Tissue from the chorionic villus sampling should therefore be stored for subsequent analysis, until after detailed echocardiography is performed. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Fetus in fetu: a rare cause of a neonatal mass
Authors: Nastanski F. , Downey E. C.
Published: March 2003

Fetus in fetu is an unusual digression from the normal twinning process which often presents as a mass in neonates. Approximately 80 reports have been documented in the literature to date. The increasing use of routine obstetric ultrasound has identified more cases during the antenatal period. This allows more time for both the neonatology team and the parents to develop a coordinated treatment plan for the anticipated child. We report a case of a fetus in fetu which was first seen as a complex cystic mass during antenatal ultrasound at 21 weeks and was confirmed by subsequent imaging and surgical treatment shortly after birth. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Transient hydropic signs in the donor fetus after fetoscopic laser coagulation in severe twin–twin transfusion syndrome: incidence and clinical relevance
Authors: Gratacós E. , Van Schoubroeck D. , Carreras E. , Devlieger R. , Roma E. , Cabero L. , Deprest J.
Published: March 2003

Objective

To evaluate the incidence, characteristics, and impact on perinatal outcome of the development of hydropic signs in the donor fetus after laser coagulation for severe twin–twin transfusion syndrome in the second trimester.

Methods

Forty cases of second‐trimester severe twin–twin transfusion underwent fetoscopic laser coagulation of placental anastomoses and were followed up with serial ultrasound up to 14 days after therapy. Ultrasound scans were performed just before, and on days 1, 3, 5 and 14 after therapy, and fetuses were monitored for the presence of hydropic signs (skin edema, pleural effusion, ascites and pericardial effusion). Response to therapy and perinatal outcome in terms of neonatal survival were recorded for all cases.

Results

Four recipients (10%) and three donors (7.5%) died over the first 72 h after therapy. During the study period, two recipients (5.5%) developed frank hydrops fetalis, and eventually died in utero. Ten donors (27.0%) developed one or more hydropic signs. In nine (90%), signs were mild or moderate and transient (mean, 3.2 days), while in one case hydrops worsened and the fetus eventually died. No donors with transient hydrops died in utero, and two died postnatally due to extreme prematurity. Gestational age at procedure and deepest amniotic fluid vertical pocket were similar between hydropic and non‐hydropic donors. Discrepancy in estimated fetal weight at procedure was significantly lower in donors developing hydrops (9.6 (SD, 6.4) vs. 17.8 (14.4)%,P = 0.018). In pregnancies with hydropic donors, gestational age at delivery (33.1 (3.4) vs. 29.7 (3.5) weeks,P = 0.015) and birth weight for recipient (2392 (423) vs. 1631 (576) g, P < 0.001) and donor (1908 (774) vs. 1281 (583) g, P = 0.021) were significantly higher. The development of transient hydrops had no influence on neonatal survival at 28 days nor on the rate of clinical resolution of intertwin transfusion.

Conclusions

Transient hydropic signs may develop in a proportion of donor fetuses after laser coagulation for severe twin–twin transfusion syndrome. This phenomenon is normally not associated with a poor prognosis, and possibly indicates an hemodynamic adaptation response following interruption of the transfusion process. Copyright © 2002 ISUOG
Intrapartum fetal head position II: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the second stage of labor
Authors: Sherer D. M. , Miodovnik M. , Bradley K. S. , Langer O.
Published: March 2003

Objective

To test the null hypothesis that no correlation exists between transvaginal digital examination compared with the gold standard technique of transabdominal suprapubic ultrasound assessment of fetal head position during the second stage of labor. A secondary objective was to compare the performance of attending physicians vs. senior residents in depicting fetal head position by transvaginal digital examination in comparison with ultrasound assessment.

Methods

Consecutive patients in the second‐stage of labor at term with normal singleton cephalic‐presenting fetuses and ruptured membranes were included. Transvaginal digital examinations were performed by either attending physicians or senior residents and were followed immediately by transverse suprapubic transabdominal sonographic assessments performed by a single sonographer. Examiners were blinded to each other's findings. Power analysis dictated sample size. Exact binomial confidence intervals around observed rates were compared with χ2 and Cohen's κ‐tests. Logistic regression was applied. P < 0.05 was considered significant throughout.

Results

One hundred and twelve patients were studied. The absolute error of transvaginal digital examinations was recorded in 65% of patients (95% confidence interval, 56–74%). Parity, pelvic station, combined spinal epidural anesthesia, length of first or second stages of labor, use of oxytocin augmentation, gestational age, mode of delivery, birth weight, and examiner experience did not significantly affect examination accuracy. Stratification, when the transvaginal digital examination was recorded as correct if occurring within ±45° of the ultrasound assessment, reduced the error of the transvaginal digital examinations to 39% (95% confidence interval, 30–49%). Independent variables again did not affect examination accuracy in this assessment modality. Rates of agreement between the two methods for attending physicians compared with residents were not significantly different. The overall degrees of agreement were 40% (95% confidence interval, 26–55%) and 68% (95% confidence interval, 53–80%) (κ = 0.25 and 0.30) for the absolute agreement and ±45° assessment modalities, respectively, for attending physicians, and 31% (95% confidence interval, 20–44%) and 55% (95% confidence interval, 42–68%) (κ = 0.14 and 0.12) for senior residents.

Conclusion

Using ultrasound assessment as the gold standard, our data demonstrate a high rate of error (65%) in transvaginal digital determination of fetal head position during the second stage of labor. The performance of senior residents in transvaginal digital examinations did not differ significantly from that of attending physicians. Intrapartum ultrasound increases the accuracy of fetal head position assessment during the second stage of labor. Copyright © 2002 ISUOG
Teaching invasive perinatal procedures: assessment of a high fidelity simulator‐based curriculum
Authors: Pittini R. , Oepkes D. , Macrury K. , Reznick R. , Beyene J. , Windrim R.
Published: March 2003

Objective

Learning curves pose a difficult problem in the teaching of technical skills: how do you teach procedural skills without compromising patients' health? A simulator‐based curriculum has been designed to minimize the risks to patients undergoing amniocentesis by shifting the learning curve away from patients and into the laboratory. This study evaluated the effectiveness of a high‐fidelity simulator‐based curriculum in improving the performance of amniocentesis by obstetric trainees.

Design

Thirty trainees received a course on the practice of amniocentesis. The curriculum consisted of a lecture, a syllabus, and a hands‐on training session with the simulator. Pre‐ and post‐training performance were evaluated with two rating scales. Training and performance evaluation were completed using the same simulator. The effectiveness of the simulator‐based workshop and the effect of year of training were assessed using a two‐way analysis of variance.

Results

Performance scores improved from a mean score of 55% to 94% using checklist scoring and from 57% to 88% using global ratings. The two‐way analysis of variance revealed a significant effect of training (F
1,60 = 43.57; P < 0.001) accounting for 45% of the variance in scores, and a significant effect of experience level (F
2,60 = 9.16; P < 0.001) accounting for 25% of the variance in scores.

Conclusions

A comprehensive curriculum based on a high‐fidelity simulator was effective at improving skills demonstrated on the simulator. The challenge remains to establish that skills acquired on a simulator are transferable to the clinical setting. Copyright © 2002 ISUOG
Is there a relationship between fetal weight and amniotic fluid index?
Authors: Owen P. , Osman I. , Farrell T.
Published: March 2003

Objective

To establish whether there is a relationship between the amniotic fluid index and estimated fetal weight in the third trimester. The presence of a relationship would require adjustment of amniotic fluid index to take account of estimated fetal weight with potential improvement in its prediction of adverse perinatal outcomes.

Methods

Paired measurements of amniotic fluid index and estimated fetal weight from 274 low‐risk pregnancies enrolled in a longitudinal study of fetal growth. Measurements were made at fortnightly intervals from 30 weeks' gestation until delivery. A relationship between amniotic fluid index and estimated fetal weight was sought at gestational age week intervals of 30–32, 33–35, 36–38 and 39–41.

Results

One thousand and three pairs of measurements of amniotic fluid index and estimated fetal weight were available for analysis. Mean amniotic fluid index decreased towards term as expected. There was no correlation between amniotic fluid index and estimated fetal weight. Furthermore, there was no correlation between amniotic fluid index and estimated fetal weight at any of the gestational age intervals.

Conclusions

There is no clinically relevant correlation between amniotic fluid index and estimated fetal weight. It should remain clinical practice to take account of gestational age when interpreting amniotic fluid index but it is not necessary to make adjustments for estimated fetal weight. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of feticide carried out by cordocentesis versus cardiac puncture
Authors: Bhide A. , Sairam S. , Hollis B. , Thilaganathan B.
Published: March 2003

Objective

Feticide may be achieved by the injection of strong potassium chloride (KCl) into the fetal circulation via the cardiac route, or less frequently, into the umbilical cord. Despite the relative frequency of this procedure, little published information is available on the subject.

Subjects and methods

This was a retrospective analysis of all feticide procedures carried out prior to legal pregnancy termination in mid trimester of pregnancy from January 1996 to July 2001, in a tertiary fetal medicine referral center. The effect of gestational age and the route of access to fetal the circulation on the dose of strong KCl required to achieve cardiac asystole was evaluated.

Results

A total of 106 women underwent the procedure of feticide during the study period. Gestational age had no effect on the dose of strong KCl. The median dose of KCl administered by cordocentesis (5 mL) was significantly less (P < 0.001) than the dose required when fetal cardiocentesis was performed for administration of the drug (10 mL).

Conclusion

This is the first comparative study of feticide by the administration of strong KCl by fetal cardiocentesis and cordocentesis. The study demonstrates that both cardiac and umbilical routes can be used to achieve feticide effectively, without compromising maternal safety. A finding of this study is that significantly smaller doses of KCl were required to achieve fetal cardiac asystole when using the umbilical compared to the cardiac route, although this may be explained by differences in technique. Strong 15% KCl can safely be used to achieve feticide in volumes up to 20 mL for cardiocentesis and 8 mL for cordocentesis. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
The influence of maternal hematocrit on placental development from the first to the second trimesters of pregnancy
Authors: Michailidis G. D. , Morris R. W. , Mamopoulos A. , Papageorgiou P. , Economides D. L.
Published: March 2003

Objectives

To study the influence of maternal hematocrit (Ht) and hemoglobin (Hb) levels on placental size and growth in the first and mid‐second trimesters of pregnancy.

Subjects/methods

This was a prospective study performed at the fetal medicine unit of a university hospital. One hundred and eighty‐one women with a singleton pregnancy were recruited at 11–14 weeks' gestation. For each case three scans of the placenta were performed, the first at recruitment and the following two at 3‐week intervals. The volume of the placenta was measured at each visit using a three‐dimensional ultrasound scanner. The maternal Hb and Ht were measured within 2 weeks of the first scan.

Results

The placental growth during the second trimester was inversely related to the Ht levels (r = −0.29, P= 0.001). It was also related to the Hb level (r = −0.20, P = 0.021). An increase of 0.1 units of Ht was associated with 38% less growth of the placenta (95% confidence interval: 18–54% less growth).

Discussion

This study demonstrates the effects of maternal environment on placental growth. Our data suggest that the levels of Ht appear to affect the placental growth during the second trimester. Further studies on the factors that regulate placental growth are needed to elucidate the pathophysiology of these interactions and their effect on pregnancy outcome. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
A case of partial mole and atypical type I triploidy associated with severe HELLP syndrome at 18 weeks' gestation
Authors: Stefos T. , Plachouras N. , Mari G. , Cosmi E. , Lolis D.
Published: March 2003

Partial mole is a rare complication of pregnancy and 90% of cases are associated with triploidy. HELLP syndrome is also a rare and life‐threatening condition that occurs after 20 weeks' gestation. We report a case presenting with a combination of severe HELLP syndrome, partial mole, triploidy type I and fetal growth restriction at 18 weeks' gestation. Partial mole and any type of triploidy must be considered in cases of hydrocephalus and severe growth restriction in the second trimester of pregnancy.

Our case highlights the fact that growth restriction can be associated with type I triploidy and that severe HELLP syndrome can develop in such cases even before 20 weeks' gestation. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional power Doppler in the diagnosis of ovarian torsion
Authors: Yaman C. , Ebner T. , Jesacher K.
Published: March 2003

Recent advances in ultrasound technology have enabled the diagnosis of overall tissue vascularization by three‐dimensional (3D) power Doppler. This case report describes 3D power Doppler characteristics of unilateral ovarian torsion 2 weeks after embryo transfer in a pregnant patient with bilateral hyperstimulated ovaries. Before laparoscopic treatment the twisted right ovary showed the following 3D power Doppler indices: mean grayness index, 15.66; vacularization index, 0.24; flow index, 21.99; vascularization flow index, 0.05. One hour after laparoscopic treatment 3D power Doppler indices of the untwisted ovary were as follows: mean grayness index, 25.61; vacularization index, 3.81; flow index, 42.800; vascularization flow index, 1.63. The resistance index of the ovarian vessels before and after laparoscopy showed no significant difference (5.1 vs. 5.2).

The diagnosis of ovarian torsion can be better made with 3D power Doppler sonography than with two‐dimensional Doppler sonography. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women
Authors: Epstein E. , Valentin L.
Published: March 2003

Objectives

To determine intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women.

Design

Forty‐eight postmenopausal women underwent transvaginal ultrasound examination by two examiners. Each observer took three replicate measurements of the endometrium in each woman. Intraobserver repeatability was expressed as the difference between the highest and lowest measurement values obtained by one observer, the repeatability coefficient, and the intraclass correlation coefficient. Interobserver reproducibility was expressed as the difference between the mean of the three measurements of each observer, limits of agreement, and interclass correlation coefficient. The repeatability coefficient and the limits of agreement define the range within which 95% of the differences between two measurements are likely to fall. Data were analyzed for all women, as well as separately for women with endometrium ≤ 6 mm and > 6 mm. The agreement between observers in classifying women as having endometrium ≤ 4.4 mm or ≥ 4.5 mm was determined by calculating Cohen's kappa.

Results

In women with endometrium ≤ 6 mm the intraclass correlation coefficient was 0.95 for Observer 1 and 0.88 for Observer 2, the median difference between the highest and lowest values being 0.4 mm (range, 0–1.4) for Observer 1 and 0.7 mm (range, 0.1–2.2) for Observer 2, and the repeatability coefficient was 0.8 mm and 1.4 mm, respectively. The corresponding figures for women with endometrium > 6 mm were 0.99 and 0.99, 0.7 mm (0–2.9) and 1.0 mm (0.2–3.4), and 1.7 mm and 1.9 mm. In women with endometrium ≤ 6 mm the interclass correlation coefficient was 0.77, and the mean interobserver difference was 0.2 mm ± 1.8 mm (2 standard deviations), when calculations were based on the mean of three measurements per observer (± 1.9 mm when calculations were based on only one measurement per observer). The corresponding figures for women with endometrium > 6 mm were 0.98, 0.2 mm ± 3.1 mm (± 3.2 mm). The agreement between observers in classifying women as having an endometrium ≤ 4.4 mm or ≥ 4.5 mm was very good (kappa 0.81).

Conclusions

The reproducibility of endometrial measurements seems to be clinically acceptable and to allow reliable discrimination between postmenopausal women with endometrium ≤ 4.4 mm and ≥ 4.5 mm. In clinical practice, it is enough to take one endometrial measurement when performing transvaginal ultrasound examination. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Schwann cell invasion of the central nervous system of the myelin mutants
Authors: DUNCAN I. D. , HOFFMAN R. L.
Published: March 2003

Schwann cells are excluded from the CNS during development by the glial limiting membrane, an area of astrocytic specialisation present at the nerve root transitional zone, and at blood vessels in the neuropil. This barrier, however, can be disrupted and, with the highly migratory nature of Schwann cells, can result in their invasion and myelination of the CNS in many pathological situations. In this paper we demonstrate that this occurs in a number of myelin mutants, including the myelin deficient (md) and taiep rats and the canine shaking (sh) pup. While it is still relatively uncommon in the rodent mutants, the sh pup shows extensive Schwann cell invasion along the neuraxis. This invasion involves the spinal cord, brain stem, and cerebellum and increases in amount and distribution with age. In situ hybridisation studies using a P0 riboprobe suggest that the likely origin of these cells in the sh pup is the nerve roots, primarily the dorsal roots. Paradoxically, Schwann cell myelination of the CNS increases with time in the sh pup despite a marked, progressive gliosis involving the glia limitans and neuropil. Thus the mechanism by which these cells migrate into the CNS through the gliosed nerve root transitional zone or from vasa nervorum remains unknown. Extensive Schwann cell CNS myelination may have therapeutic significance in human myelin disease.
Rare origin of the inferior epigastric artery from an anomalous medial circumflex femoral artery
Authors: SHANAHAN DONAL , JORDAN R. K.
Published: March 2003

Mathes & Bostwick (1977) surgically manipulated the rectus abdominis myocutaneous flap to repair defects in the anterior abdominal wall. Subsequently this flap was used in breast reconstruction (Robbins, 1981; Hartrampf et al. 1982) as a donor for free‐tissue transfer (Bunkis et al. 1983) and to repair defects in the groin (Logan & Mathes, 1984; Ramasastry et al. 1989). Disadvantages of this flap are that it can be too thick to use effectively and a direct abdominal hernia may occur through the inguinal triangle (Mathes & Bostwick, 1977; Pennington & Pelly, 1980; Ramasastry et al. 1989; Itoh & Arai, 1993). To overcome these disadvantages the rectus abdominis and the fascia covering the inguinal triangle must be intact. Surgeons therefore harvested the inferior epigastric skin flap for free‐tissue skin transfer; this flap contained little or no rectus abdominis muscle or transversalis fascia (Koshima & Soeda, 1989). Previous investigators determined the anatomical basis for the use of this skin flap and used it to repair defects following resection of ulcers and scar tissue on the head, neck and extremities (Itoh & Arai, 1993).
Two rare anomalies of the brachial plexus
Authors: NAKATANI TOSHIO , TANAKA SHIGENORI , MIZUKAMI SHIGEKI
Published: March 2003

Morphological variations of the brachial plexus and variants in the distribution of the anterior division of the middle trunk are relatively frequent. Two of the rarest anomalies occurred in the left brachial plexus of a 62‐y‐old Japanese male, 1 of 104 plexuses dissected between 1996 and 1997 at Kanazawa University Faculty of Medicine. The superior trunk of the brachial plexus was formed by the anterior primary division of C5 and C6 and a thin branch (0.5 mm in diameter) from C4, the middle trunk by the C7, and the inferior trunk by C8 and T1 (Fig.). We could not determine whether there was a branch derived from T2 to T1, since the subject had died of lung carcinoma. The entire anterior division of the middle trunk crossed the axillary artery and joined the medial root of the median nerve which was the continuation of the medial cord after the cord branched off the ulnar nerve. The lateral cord pierced coracobrachialis and divided into the musculocutaneous nerve and the lateral root of the median nerve just after emerging from the muscle, finally joining the medial root of the median nerve superficial to the brachial artery ∼115 mm distal to the lower border of latissimus dorsi to form the median nerve. The musculocutaneous nerve gave rise to the nerves to biceps brachii, brachialis, and the long head of biceps brachii and finally continued as the lateral cutaneous nerve of the forearm. The branch to coracobrachialis had already been cut and its course could not be traced.
An anomalous muscle in the region of the popliteal fossa: case report
Authors: SOMAYAJI S. N. , VINCENT R. , BAIRY K. L.
Published: March 2003

Variations in the hamstring muscles are not common. We describe here a rare anomalous muscle in the popliteal fossa and speculate on its functional significance.
Computer‐aided interactive three‐dimensional reconstruction of the embryonic human heart
Authors: WHITEN SUSAN , SMART STEVEN D. , McLACHLAN JOHN C. , AITON JAMES F.
Published: March 2003

Despite the fact that development of the human embryo heart is of considerable clinical importance, there is still disagreement over the process and the timing of events. It is likely that some of the conflicting accounts may have arisen from difficulties in describing and visualising 3‐dimensional structures from 2‐dimensional sections. To help overcome this problem and to improve our understanding of the development of the heart, we have devised techniques for the production of interactive 3D models reconstructed from serial histological sections of human embryos. Our method uses commercial software designed for the creation of 3D models and virtual reality environments. The ability to construct interactive visual images which both illustrate and communicate complex 3D information contributes to our understanding of the complex developmental changes occurring in embryogenesis.
Algorithms for radiological image registration and their clinical application
Authors: HAWKES D. J.
Published: March 2003

This paper reviews recent work in radiological image registration and provides a classification of image registration by type of transformation and by methods employed to compute the transformation. The former includes transformation of 2D images to 2D images of the same individual, transformation of 3D images to 3D images of the same individual, transformation of images to an atlas or model, transformation of images acquired from a number of individuals, transformations for image guided interventions including 2D to 3D registration and finally tissue deformation in image guided interventions. Recent work on computing transformations for registration using corresponding landmark based registration, surface based registration and voxel similarity measures, including entropy based measures, are reviewed and compared. Recently fully automated algorithms based on voxel similarity measures and, in particular, mutual information have been shown to be accurate and robust at registering images of the head when the rigid body assumption is valid. Two approaches to modelling soft tissue deformation for applications in image guided interventions are described. Validation of complex processing tasks such as image registration is vital if these algorithms are to be used in clinical practice. Three alternative validation strategies are presented. These methods are finding application outside the original domain of radiological imaging.
Developmental changes in mucosubstances revealed by immunostaining with antimucus monoclonal antibodies and lectin staining in the epithelium lining the segment from gizzard to duodenum of the chick embryo
Authors: MATSUSHITA SUSUMU , ISHII YASUO , YASUGI SADAO
Published: March 2003

The mucosubstances in the epithelium lining the segment from gizzard to duodenum during development of the chick embryo was studied histochemically using monoclonal antibodies against gizzard mucus and lectins, with attention to the regional differentiation of the epithelium in this segment. The anterior limit of epithelial CdxA mRNA expression detected by in situ hybridisation, which served as the position of the gizzard‐duodenal boundary, was clearly found from d 3. Granules positive for some antibodies or lectins were found in the region ranging from the posterior part of the gizzard to the duodenum at d 3, which was followed by an increase in the number of granules and a gradual enlargement of the granule‐positive area to the anterior part of the gizzard over 4–6 d. From d 4, the epithelia of the gizzard body and of the pyloric or duodenal region came to be differently stained with some antibodies or lectins. From d 10, each region showed a specific pattern of staining. The epithelia of the gizzard body and pyloric region contained abundant mucus granules with a different staining pattern. In the duodenum the number of stained granules was low except in occasional goblet cells. Thus the epithelia of the gizzard body, pyloric region and duodenum may produce different mucosubstances and the regional differentiation in these epithelia may start at rather early stages soon after the formation of digestive tube.
Relationship between accessory foramina and tumour spread in the lateral mandibular surface
Authors: FANIBUNDA K. , MATTHEWS J. N. S.
Published: March 2003

The spread of tumour cells to the mandible has been well recognised and invasion of the edentulous alveolar ridge by tumour through accessory foramina has been documented. Tumour infiltration can also occur through the lateral cortical plate, but the number and distribution of accessory foramina on this surface has not been reported. Lateral surfaces of 89 mandibles were examined and accessory foramina which showed a direct communication with the underlying cancellous bone were charted. It was found that the number of accessory foramina varied greatly from specimen to specimen. Only 70.8% of mandibles showed foramina in the coronoid, sigmoid and condylar sections; of these 93.7% exhibited foramina in the condylar section, 23.8% in the coronoid and only 19% in the sigmoid section. This finding confirms that the current practice of conserving part of the ascending ramus posterior to the coronoid process following surgery is sound. Similarly in the rest of the lateral surface, foramina were present in the upper third section in 97.8% of mandibles, 61.8% in the lower third and 58.4% in the middle third sections. This result justifies the principle of rim resection in appropriate cases and the recognition that the alveolar section is commonly invaded before the rest of the body. The number and distribution of foramina may be of greater significance following radiotherapy when the foramina could provide multiple direct channels for invasion of tumour cells from the lateral surface to the medulla.
Mechanism of change in the orientation of the articular process of the zygapophyseal joint at the thoracolumbar junction
Authors: PAL G. P. , ROUTAL R. V.
Published: March 2003

The orientation of the superior articular processes in thoracic and lumbar vertebrae differs. The present study was undertaken to investigate the possible mechanism for the change from a posterolaterally facing superior articular surface in the thoracic region to a posteromedially facing curved articular surface in the lumbar region. The material of the study consisted of dry macerated bones of 44 adult human vertebral columns. The orientation of the superior articular process and its relation to the mamillary tubercle (process) was examined between T9 and L5 vertebrae in each column. An abrupt change from the thoracic to lumbar type of articular process was observed in 3 columns (7%). Forty‐one (93%) columns showed a gradual change extending over either 2 or 3 successive vertebrae. The present study suggests that the change in the orientation of the superior articular process, from the coronal to the sagittal plane (sagittalisation), occurs due to the change in the direction of weight transmission through zygapophyseal joints at the thoracolumbar junction. It was observed that the gradual sagittalisation of the superior articular process in the transitional zone brought it close to the mamillary tubercle which eventually fused with it. Thus the study suggests that the characteristic posteromedially facing concave superior articular process of lumbar vertebrae may have formed because of the fusion of the articular process and the mamillary tubercle.
Morphological heterogeneity of the GABAergic network in the suprachiasmatic nucleus, the brain's circadian pacemaker
Authors: CASTEL MONA , MORRIS JOHN F.
Published: March 2003

GABA (gamma‐amino‐butyric acid) is the predominant neurotransmitter in the mammalian suprachiasmatic nucleus (SCN), with a central role in circadian time‐keeping. We therefore undertook an ultrastructural analysis of the GABA‐containing innervation in the SCN of mice and rats using immunoperoxidase and immunogold procedures. GABA‐immunoreactive (GABA‐ir) neurons were identified by use of anti‐GABA and anti‐GAD (glutamic acid decarboxylase) antisera. The relationship between GABA‐ir elements and the most prominent peptidergic neurons in the SCN, containing vasopressin‐neurophysin (VP‐NP) or vasoactive intestinal polypeptide (VIP), was also studied. Within any given field in the SCN, approximately 40–70% of the neuronal profiles were GABA‐ir. In GABA‐ir somata, immunogold particles were prominent over mitochondria, sparse over cytoplasm, and scattered as aggregates over nucleoplasm. In axonal boutons, gold particles were concentrated over electron‐lucent synaptic vesicles (diameter 40–60 nm) and mitochondria, and in some instances over dense‐cored vesicles (DCVs, diameter 90–110 nm). GABA‐ir boutons formed either symmetric or asymmetric synaptic contacts with somata, dendritic shafts and spines, and occasionally with other terminals (axo‐axonic). Homologous or autaptic connections (GABA on GABA, or GAD on GAD) were common. Although GABA appeared to predominate in most neuronal profiles, colocalisation of GABA within neurons that were predominantly neuropeptide‐containing was also evident. About 66% of the VIP‐containing boutons and 32% of the vasopressinergic boutons contained GABA. The dense and complex GABAergic network that pervades the SCN is therefore comprised of multiple neuronal phenotypes containing GABA, including a wide variety of axonal boutons that impinge on heterologous and homologous postsynaptic sites.