bluuebunny/crossref_metadata_2025 huggingface dataset:
Type A Niemann–Pick disease
Authors: Raddadi Ali A , Al Twaim Abdulaziz A
Published: March 2003

Niemann–Pick disease (NPD) represents a type of lysosomal storage diseases in which sphingomyelin accumulates in the histocytes and reticuloendothelial cells of the spleen, liver, lymph nodes, bone marrow and central nervous system. We report a child with massive hepatosplenomegaly, lymphadenopathy, mental retardation and widespread papulonodular lesions. His clinical features conform to the type A subgroup of NPD.
Morphoea in three siblings
Authors: Iranzo P , Lopez I , Palou J , Herrero C , Lecha M
Published: March 2003

Atrophoderma of Pasini and Pierini (APP) is an uncommon form of localized morphoea that occurs as superficial, hyperpigmented plaques distributed mainly on the trunk and proximal part of the limbs. There is little information about the influence of genetic and environmental factors on disease susceptibility and expression for localized scleroderma, although APP familial cases have been reported.1 We report three siblings without a family history of autoimmune disease presenting cutaneous lesions suggesting morphoea (APP variant).
Persistent erythema multiforme: a report of three cases
Authors: Pavlović MD , Karadaglić DM , Kandolf LO , Mijušković Z̆P
Published: March 2003

Three cases of persistent erythema multiforme, two of unknown aetiology and one precipitated by influenza are reported. Lesions were widespread, mostly atypical in appearance and regressed in response to immunosuppressants (systemic steroids and/or azathioprine) or, in one case, to dapsone. One patient developed erythroderma responding eventually to etretinate. Histology in all patients was consistent with the mixed, epidermodermal pattern of erythema multiforme. There were no significant laboratory abnormalities nor marked symptomatology apart from itching. The persistent form appears to belong to the spectrum of erythema multiforme being heterogeneous with respect to inducing stimuli, including viral antigens, neoplastic or inflammatory disease or unknown causes. Whenever it is possible, treatment should be adjusted depending on the causative agent.
The acetowhite test in genital human papillomavirus infection in men: what does it add?
Authors: Kumar B , Gupta S
Published: March 2003

Background

Many genital human papillomavirus (HPV) infections are clinically invisible epithelial lesions. They remain so for a considerable time before some develop into clinically apparent lesions. The inapparent and asymptomatic nature of these lesions poses a problem in the detection and management of genital HPV infection. Without reliable, and readily available diagnostic methods, no definite therapeutic approach can be recommended or followed. The acetowhite test has been recommended to help determine the extent of the affected area.

Objective

To evaluate the acetowhite test in detecting inapparent subclinical HPV involvement in male patients with clinically apparent warts.

Methods

Two hundred and two uncircumcised patients with genital warts were included. Patients with concomitant inflammatory lesions were excluded. The warts and adjacent normal skin/mucosa of normal appearance were wrapped in gauze soaked in 5% acetic acid for about 3–5 min. The area was subsequently examined with a hand lens (× 8).

Results

All of the 116 hyperplastic warts became acetowhite, as well as a narrow rim of surrounding skin. Few flat warts in dry areas only became dull white and none pure white. No whiteness was observed in the surrounding area. Only 15 of 26 flat warts in moist areas became acetowhite. One (eroded lesion) of 13 verruca vulgaris type lesions and none of the pigmented papules gave positive results to the acetowhite test.

Conclusions

The sensitivity of the acetowhite test for hyperplastic warts is very high, but for other types of warts is low. Detection of subclinical HPV‐infected areas is difficult; the acetowhite test did not assist in the identification of additional areas of infection in our patients.
Itraconazole pulse therapy for the treatment of Candida onychomycosis
Authors: Gupta AK , De Doncker P , Haneke E
Published: March 2003

In this open label, multicentre trial, 44 patients with clinical and mycological evidence of Candida onychomycosis were treated with itraconazole pulse therapy. Onychomycosis of the toes alone and concomitant disease involving the fingers and toes was treated with three pulses, and onychomycosis of the fingers alone with two pulses. Final evaluation for patients with finger and toe onychomycosis was at 6–9 months and 9–12 months, respectively. There were 29 patients with toe onychomycosis (C. albicans, 27; C. glabrata, one; Candida species, one), 12 patients with finger onychomycosis (C. albicans, two; C. glabrata, one) and three patients had combined toe and finger onychomycosis (C. albicans, two; C. guillermondii, one). In the patients with toe onychomycosis mycological cure was observed in 29 of 32 patients (90.6%). There was complete cure [mycological cure (negative culture and KOH at endpoint evaluation) with clinical cure] or marked improvement (mycological cure with 75% or greater decrease in area of involvement of target nail compared with pretherapy) in 24 of 32 patients (75.0%). All 12 patients with finger onychomycosis alone due to Candida species achieved a mycological cure (100%). In this group of patients complete cure or marked improvement was observed in 11 of 12 patients (91.7%). Itraconazole pulse therapy was well tolerated and no serious adverse events were reported in the patients treated with this triazole. In conclusion, itraconazole pulse therapy is an effective and safe treatment for both finger and toe onychomycosis associated with Candida.
Syringoid eccrine carcinoma
Authors: Gregurek‐Novak T , Talan‐Hranilović J , Troskot N , Vučić M , Krušlin B
Published: March 2003

A rare case of a syringoid eccrine carcinoma in a 52‐year‐old male patient is described. During the first hospitalization, syringoma was diagnosed, both clinically and histologically, keeping in mind the possibility of its malignant alteration. Difficulties in making a diagnosis with histological and immunohistochemical examinations are reported. The possibility of differential diagnosis of primary breast carcinoma and methods of its exclusion are also described. Treatment of the patient was surgical with good results.
Control of the differentiation state and function of human epidermal Langerhans cells by cytokines in vitro
Authors: Prignano F , Gerlini G , Fossombroni V , Pimpinelli N , Giannotti B , Nestle FO , Romagnoli P
Published: March 2003

Langerhans cells can originate in vitro from immature precursors stimulated with granulocyte macrophage‐colony‐stimulating factor (GM‐CSF), tumour necrosis factor (TNF)‐α and stem cell factor (SCF). We asked whether these cytokines also control the differentiation state of Langerhans cells within the epidermis and upon leaving this tissue. We harvested sheets of human epidermis by controlled dispase hydrolysis of keratomes, cultured them in RPMI and 10% fetal calf serum for 48 h and analysed the sheets and the cells migrated spontaneously into the medium, most of which were Langerhans cells containing Birbeck granules.1 By flow cytometry, the intensity of CD1a expression was reduced quite evenly among Langerhans cells migrated from sheets within 48 h. The cells in the sheets underwent loss of dendrites, with a significant reduction in the cell perimeter that was prevented by GM‐CSF and TNF‐α together. Either of these cytokines induced expression of CD18 by cells in the sheets and those in the medium. Moreover, TNF‐α induced expression of CD54 by cells in the medium, but not by those retained in the sheets, whereas human SCF induced, dose dependently, expression of CD54 by cells in the sheets, but not from those in the medium.2 The proliferation of allogeneic lymphocytes was much higher when stimulating Langerhans cells were harvested from cultures with any cytokine, rather than from cultures without cytokines. We conclude the following: (i) GM‐CSF and TNF‐α help to maintain full differentiation of Langerhans cells within the epidermis; (ii) cytokine influence on Langerhans cells adhesiveness is in part context dependent; and (iii) pretreatment with cytokines influences positively the number or accessory activity of Langerhans cells on lymphocytes during subsequent mixed leucocyte reaction.
Assessing psychological distress in patients with skin diseases: reliability, validity and factor structure of the GHQ‐12
Authors: Picardi A , Abeni D , Pasquini P
Published: March 2003

Objective

We studied reliability, validity and factor structure of the 12‐item General Health Questionnaire (GHQ‐12) in dermatological patients.

Methods

Subjects attending a dermatological outpatient clinic were administered the GHQ‐12 and the Skindex‐29. A random subsample was mailed another copy of the questionnaires to be completed within 1 week.

Results

A total of 2579 subjects completed the GHQ‐12. The internal consistency of the GHQ‐12 was high (Cronbach’s α = 0.88). Test–retest reliability on 137 subjects was also fairly satisfactory (intraclass correlation coefficient = 0.72), notwithstanding a re‐test artefact probably related to reassurance from the physician. Evidence of construct validity was provided by the pattern of correlation between scores on the GHQ‐12 and on the scales of Skindex‐29, which were as hypothesized. Also, GHQ‐12 scores of patients in different clinical groups varied as hypothesized, with patients affected by inflammatory skin diseases scoring significantly higher than patients with isolated skin lesions. We obtained both a two‐factor and a three‐factor solution: the latter seemed theoretically more appropriate, although the first may have practical advantages. A ‘social dysfunction’ factor emerged in both analyses, while the other items loaded on a ‘general dysphoria’ factor or on two separate factors interpreted as ‘anxiety’ and ‘loss of self‐esteem’.

Conclusions

The GHQ‐12 is a reliable and valid instrument with a factor structure that is quite stable across different samples as well as across diverse cultures. Its brevity and easiness of completion make it a useful tool to assess psychological distress in dermatological patients.
Lichen planus pigmentosus–inversus
Authors: Pock L , Jelínková L , Drlík L , Abrhámová S , Vojtechovská Š , Sezemská D , Borodácová I , Hercogová J
Published: March 2003

We examined seven patients with lichen planus pigmentosus (LPP) clinically and microscopically. Clinically, all patients had a striking predominance of lesions in an intertriginous location, with most of them in the axillae. Microscopically, two biopsies were of significance. Except for the regressive lichen planus, which is usual in LPP, the active inflammatory phase was also present. In these biopsies the very intensive hydropic degeneration of basal keratinocytes was combined with the absence of compensatory increased proliferation of keratinocytes, i.e. without acanthosis. The short duration of this process probably led to the quick transformation into a long noninflammatory regressive phase with incontinence of the pigment. These specific morphogenetic dynamics are possibly why most of the morphs of LPP present as brown, non‐pruritic, small inflammatory macules. Because of the highly characteristic inverse location of the lesions in our patients we propose the designation LPP–inversus for this variant of the disease.
Pemphigus vulgaris with oral involvement: evaluation of two different systemic corticosteroid therapeutic protocols
Authors: Femiano F , Gombos F , Scully C
Published: March 2003

Background Pemphigus vulgaris is a potentially life‐threatening disease characterized by cutaneous and mucosal blistering. Systemic corticosteroids remain the mainstay of therapy, transforming an invariably fatal disease into one with a mortality that is now less than 10%. Nevertheless, oral lesions are often recalcitrant and corticosteroid therapy can provoke adverse effects.

Objective To determine whether two different regimens of systemic corticosteroid therapy based on prednisone gave different benefits.

Method We examined two different regimens of systemic corticosteroid therapy based on prednisone in an open study. Ten patients (group A) were treated with systemic corticosteroids, in a therapeutic protocol made up of orally administered prednisone. Ten matched patients (group B) were treated with systemic corticosteroids alternating a pulse of intravenous betamethasone with orally administered prednisone.

Results and conclusions The pulse protocol appeared to have some advantages both in a shorter time to resolution of symptoms and oral lesions, and in terms of minor adverse effects.
Botryomycosis in an HIV‐positive subject
Authors: De Vries HJC , Van Noesel CJM , Hoekzema R , Hulsebosch HJ
Published: March 2003

A 28‐year‐old male AIDS patient with generalized painful skin ulcers, fever and malaise presented to us. The differential diagnosis included varicella zoster infection, herpes simplex infection, actinomycosis, sporotrichosis and botryomycosis. Histopathology revealed clusters of Gram‐positive coccoid bacteria in the deep dermis, surrounded by a mixed dense inflammatory infiltrate. A bacterial culture grew Staphylococcus aureus. Viral cultures remained negative. Based on these findings botryomycosis was diagnosed. Large lesions were excised surgically and with antimicrobial therapy all skin symptoms disappeared. We discuss this case with reference to a short review of the literature on botryomycosis in relation to HIV infection.
Comparison of total fetal activity measurement with the biophysical profile in predicting intra‐amniotic infection in preterm premature rupture of membranes
Authors: Roberts A. B. , Goldstein I. , Romero R. , Hobbins J. C.
Published: March 2003

A comparison was made between measurement of total fetal activity and biophysical profile as predictors of infection in preterm premature rupture of membranes. Sixty‐four patients with premature rupture of membranes, not in labor, between 24 and 34 weeks' gestation were studied. All patients had an amniocentesis and 25 patients were diagnosed as having intra‐amniotic infection.

The sensitivities of the tests were 96% and 92%, respectively, with specificities of 82% and 59%. Measurement of the total fetal activity had significantly better specificity. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Sensitivity and specificity of routine antenatal screening for congenital anomalies by ultrasound: The Belgian Multicentric Study
Authors: Levi S. , Hyjazi Y. , Schaapst J.‐P. , Defoort P. , Coulon R. , Buekens P.
Published: March 2003

United States and European consensus views differ on the place of routine ultrasound scans during pregnancy and the validity of such scans as screening tests for fetal malformations in the general population is still under debate. Four ultrasound laboratories from Obstetric and Gynecology departments of Belgian University hospitals and affiliated hospitals have conducted a prospective study from 1984 to 1989 to compare the anomalies discovered in ultrasonic screening of the fetus with the anomalies of the neonates.

Of 16 370 pregnant women at normal risk for congenital anomalies attending the an tenatal clinics of these hospitals, 16 072 have had at least one ultrasound screening for congenital anomalies (98.5%). Congenital anomalies, single or multiple and ‘minor’ or ‘major’, were clearly defined in order to allow comparisons. The excluded congenital anomalies were listed as defined in the Eurocat Register. A total of 381 fetuses (2.3%) were structurally abnormal. Of the 381, 154 were correctly detected by ultrasound (sensitivity 40.4%). Altogether 15 972 fetuses were true negatives (specificity 99.9%). Eight (0.05%) were false positive for congenital anomalies. The positive predictive value was 95.1% and the negative predictive value was 98.6%. Ultrasound diagnoses were correctly achieved before 23 weeks of gestation for 21% of the anomalies. The gestational age, operator and technical dependence of ultrasound screening for congenital anomalies is discussed. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Tracking of fetal breathing movements by pulsed Doppler ultrasound
Authors: Shinozuka N , Yamakoshi Y. , Okai T. , Mizuno M
Published: March 2003

Fetal breathing movements form a useful means of monitoring fetal conditions and functional development. Precise quantitative evaluation of fetal breathing movements requires the development of a continuous automated technique. A preliminary study of Doppler signals due to fetal breathing movements was carried out using a cardiotocograph in which the normal high‐pass ‘thump’ filter had been removed. A pulsed Doppler system was then modified to produce five simultaneous outputs representing movement at depths separated by 1.5‐cm intervals. These outputs represent the displacement inside tissue at the various depths. Signal processing was executed on a 32‐bit computer with an analog‐to‐digital converter. On‐line processing using a zero‐crossing method and an off‐line high‐accuracy displacement estimation technique using an arc‐tangent method were applied. Using computerized signal processing, it was possible to detect movements of a few hundred microns representing fetal breathing movements while rejecting gross movements due to maternal breathing, etc. Although further studies are required before clinical application, it appears that quantitative assessments of fetal breathing movements should be possible with this technique. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Randomized study of early amniocentesis versus chorionic villus sampling: a technical and cytogenetic comparison of 650 patients
Authors: Byrne D. , Marks K. , Azar G. , Nicolaides K.
Published: March 2003

In a prospective randomized trial of 650 patients at 10–13 weeks' gestation, early amniocentesis was compared to chorionic villus sampling (CVS) for successful sampling and cytogenetic results and the speed with which results can he obtained. The indications for fetal karyotyping were advanced maternal age, parental anxiety or a family history of chromosomal abnormality in the absence of a balanced parental translocation. At early amniocentesis, 10 ml of amniotic fluid were successfully obtained in all 324 cases, in 320 (98.8%) at the first attempt and in four cases (1.2%) after two needle insertions. CVS provided sufficient material for cytogenetic analysis in 314 of 326 (96.3%) cases at the first attempt and in nine (2.8%) after two needle insertions; in three cases only maternal tissue was obtained and subsequently early amniocentesis was performed. Cell culture and chromosomal analysis were successful in 318 of 324 (98.1%) cases of early amniocentesis and in 321 of the 323 (99.4%) cases of CVS where villi were obtained. The median interval between sampling and successful result from cell culture was 12 days for early amniocentesis and 11 days for CVS. Mosaicism was detected in five cases of CVS but in none of the early amniocenteses; three of these cases were confirmed as true fetal mosaics. This study illustrates that early amniocentesis is a viable alternative to CVS for first‐trimester fetal karyotyping. The results of the continuing prospective 1 trial will establish the safety and cytogenetic accuracy of the two techniques. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
First‐ and early second‐trimester oligohydramnios—a predictor of poor fetal outcome except in iatrogenic oligohydramnios post chorionic villus biopsy
Authors: Bronshtein M. , Blumenfeld Z.
Published: March 2003

Whereas a well‐known association exists between oligohydramnios and renal agenesis, renal dysplasia, urinary tract obstruction and intrauterine growth retardation in the second half of pregnancy, the causes and prognosis of early oligohydramnios are less known. Twelve cases of first‐ and early second‐trimester oligohydramnios were detected out of 5000 fetal screenings for malformation detection. Two out of these 12 cases occurred in patients who had undergone chorionic villus sampling, two were associated with premature rupture of membranes, six were associated with fetal cardiac malformations and two cases were idiopathic. Whereas ten out of 12 cases ended in intrauterine fetal death, spontaneous or therapeutic abortions, in the two cases which developed after chorionic villus sampling the oligohydramnios was self‐limiting and these two pregnancies ended in term deliveries of normal, healthy neonates. It may be concluded that oligohydramnios in the first half of gestation bears a poor fetal prognosis except in cases where it follows chorionic villus sampling. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Prognostic appraisal of success and failure in an in vitro fertilization program by transvaginal Doppler ultrasound at the time of ovulation induction
Authors: Strohmer H. , Herczeg C. , Plöckinger B. , Kemeter P. , Feichtinger W.
Published: March 2003

In 323 stimulated cycles of women participating in in vitro fertilization treatment, a transvaginal Doppler examination was performed on the day of ovulation induction to investigate the value of blood flow velocimetry of the uterine artery. The results showed a significantly lower pulsatility index in patients who conceived (n = 42) compared with those who did not become pregnant (n = 272). The differences were especially marked during the first cycles. These results suggest that studies of the uterine hemodynamic response are useful in appraising the likelihood of success of implantation after embryo transfer. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Diagnosis of fetal lung maturity by ultrasound: a new method and first results
Authors: Sohn Ch. , Stolz W. , Bastert G.
Published: March 2003

The first results are presented of a method to determine the maturity of fetal lung by sonography. By comparing the frequency characteristics of lung echoes to those from the fetal liver as a reference organ, we avoid the known pitfalls which previously made it impossible to standardize fetal lung changes with gestation.

We examined 222 patients between 27 and 39 completed weeks of gestation. In one ultrasound section we depicted fetal lung and liver simultaneously. Switching to A‐mode we registered the frequencies contained in the video envelope in both organs.

The registered frequencies were entered digitally in to a computer and checked for mean frequency, maximum frequency and minimum frequency. Afterwards, the ratio of the frequencies of the lung and liver were obtained. For all weeks of gestation, the mean value and standard deviation were calculated.

We found the liver to be an adequate reference organ, since there is no change of the reflection pattern between the different weeks of gestation, while significant changes were registered in the fetal lungs. A quotient of Qmean lower than 1.1 suggests lung maturity, while values over 1.1 point to immaturity.

This appeared to be confirmed in 13 patients who had agreement between amniotic fluid lecithin values and Qmean. Further comparisons with amniotic fluid results will have to validate these findings. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound assessment of amniotic fluid volume: a comparison of the single deepest pool and amniotic fluid index to predict perinatal morbidity
Authors: Ajayi R. A. , Soothill P. W.
Published: March 2003

The ability of the amniotic fluid index and the single deepest pool to predict perinatal morbidity was compared in 291 high‐risk singleton pregnancies without ruptured membranes or fetal renal abnormalities. A poor outcome was defined as a birth weight < −2 standard deviations, emergency Cesarean section for fetal heart rate abnormalities in labor, 5‐minute Apgar score < 7, umbilical venous pH at delivery < 7.15 and admission to the special care baby unit. At least one of these parameters occurred in 71 (24%) of the 291 pregnancies. Oligohydramnios (an amniotic fluid index ≤ 5 cm) occurred in 19 (6.5%) of the 291 pregnancies; this group was more likely to have a poor outcome than those with an amniotic fluid index > 5 cm (χ2 = 2.41, p = 0.02). There was a significant correlation between amniotic fluid index and single deepest pool measurements ( r = 0.83, n = 291, p < 0.0001). At the recommended cut‐off values, the single deepest pool and the amniotic fluid index had sensitivities of 7% and 13%, respectively and specificities of 96% and 95% for predicting perinatal morbidity. Receiver operating characteristic curve analysis showed that these poor results were not the result of the cut‐off values chosen and that the performances of the amniotic fluid index and single deepest pool were similar. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Relationship between umbilical and fetal cerebral blood flow velocity waveforms and umbilical venous blood gases
Authors: Bonnin Ph. , Guyot B. , Bailliart O. , Benard C. , Blot Ph. , Martineaud J. P.
Published: March 2003

Nineteen women (mean ± SD: 28 ± 5 years) with small fetuses relative to gestational age (mean ± SD: 32 ± 2.2 weeks of gestation) were referred to our unit for cordocentesis for the determination of fetal karyotyping. Four of these 19 patients had small‐for‐gestational‐age ultrasound‐derived measurements under the third centile for gestational age. Fetal blood gases were measured in the umbilical vein. Umbilical artery and fetal internal carotid artery Doppler examinations were performed 15 min before cordocentesis. The results showed a progressive and proportional increase in umbilical artery resistance index with hypoxia (p < 0.001), hypercapnia (p < 0.025) and acidosis (p < 0.005). Moreover, the results showed a progressive and proportional decrease in fetal internal carotid artery resistance index with hypoxia (p < 0.01), hypercapnia (p < 0.01) and acidosis (p < 0.025). Fetal blood gases are therefore related to umbilical circulatory function and cerebral vasodilatation, suggesting fetal vascular redistribution. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Trisomy 18: behavioral and structural abnormalities. An ultrasonographic case study
Authors: Hepper P. G. , Shahidullah S.
Published: March 2003

A behavioral and structural analysis using ultrasound of a fetus suffering from Edwards syndrome is described. A number of structural anomalies were observed: the classic hand deformity, extended legs, diamond‐shaped head, open mouth and a severe cardiac abnormality. A number of distinctive behavior patterns were observed: vertical eye movements, longitudinal rotation of the trunk, rotation of hands, tremor of extremities and pulsatile body movements, which are not usually seen in the normal fetus. The use of behavioral indicators in the diagnosis of abnormalities is discussed. We conclude that the analysis of behavior may make a significant contribution to the ultrasonographic diagnosis of handicap. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Retention of fetal bones 8 years following termination of pregnancy
Authors: Al‐Shawaf T. , Brown J. , Keegan C.
Published: March 2003

We report on an unusual case where bone had been retained in the endometrium for a period of 8 years following termination, causing no symptoms except subfertility. Routine ultrasonography diagnosed the foreign body and this was removed by hysteroscopy assisted by ultrasound scanning. Pregnancy resulted after 6 months. A review of the literature is presented. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal ultrasound semiography of anencephaly: sonographic—pathological correlations
Authors: Salamanca A. , Gonzalez‐Gomez F. , Padilla M. C. , Sabatel R. M. , Cámara M. , Cuadros J. L.
Published: March 2003

A better understanding of the ultrasound findings in each of the different types of fetal anencephaly can help to reduce the number of false‐negative diagnoses of this condition during the prenatal period.

Errors in the estimation of the remaining cerebral tissue (angiomatous stroma, area cerebrovasculosa) can cause false‐negative diagnoses or diagnostic confusion with cases of microcephaly or incomplete ossification of the cranial vault.

In a retrospective study, 30 fetuses with anencephaly (diagnosed at 13–38 weeks of gestation) were grouped, in terms of their ultrasound results, according to the Nanagas classification. The ultrasound diagnoses were then correlated with those found through autopsy, to identify any errors in the ultrasound classification. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Early prenatal diagnosis of type II cystic adenomatoid malformation of the lung: sonographic and histological findings
Authors: Catanzarite V. , Mendoza A. , Chapman T. , Muller W. , Maida C.
Published: March 2003

Cystic adenomatoid malformation is a rare abnormality of the fetal lung. Depending on the size and histology of the cyst, it is classified as type I, II or III. With improving ultrasound technology, prenatal diagnosis during the mid‐trimester is now possible; however, the earliest previous reports of type II cases have been at 23–24 weeks' gestation. We here report cases diagnosed at 19.5 and 20.5 weeks. In contrast to the appearance of multiple small cysts seen later in pregnancy, these cases showed a predominance of marked hyperechogenicity, usually associated with type III malformations, with small areas of lung involved by sonographically detectable cysts. Both families chose pregnancy termination. Sonographic findings, counselling, and histology are presented and discussed. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Sonography of fetal Dandy—Walker malformation: a reappraisal
Authors: Pilu G. , Goldstein I. , Reece E. A. , Perolo A. , Foschini M. P. , Hobbins J. C. , Bovicelli L.
Published: March 2003

Thirty‐four cases of fetal Dandy‐Walker malformation recognized in utero with ultrasound between 16 and 37 weeks' gestation are reported. In each case a qualitative examination of the posterior fossa structures was performed, including the cerebellar hemispheres, cerebellar vermis, fourth ventricle and cisterna magna. In each case, the transverse cerebellar diameter and the depth of the cisterna magna were measured in a standard transcerebellar view of the fetal brain. The atrial width of the lateral ventricles was also assessed. The transverse cerebellar diameter was abnormal in 15 cases, the cisterna magna depth was abnormal in 33, and the atrial width was abnormal in 30. It is concluded that measurement of the transverse cerebellar diameter is unreliable in predicting fetal Dandy‐Walker malformation. Measurements of the cisterna magna and atrium seem to be more valuable, although the real sensitivity remains unclear. In pregnancies at risk for fetal Dandy‐Walker malformation, the sonographic examination should not be limited to the cerebral ventricles and transcerebellar view but should include a detailed evaluation of all the different anatomical components of the posterior fossa, especially the fourth ventricle and inferior cerebellar vermis. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of the prognostic value of pulsed Doppler blood flow parameters to predict SGA and fetal distress
Authors: Arabin B. , Mohnhaupt A. , Becker R. , Weitzel H. K.
Published: March 2003

A total of 219 women with complicated pregnancies had Doppler assessment of uteroplacental arteries, the umbilical artery, the fetal common carotid artery and the descending thoracic aorta to determine the prognostic value of Doppler examinations to predict the birth of a small‐for‐gestational‐age (SGA) infant with or without fetal distress. Preliminary reproducibility studies showed that the resistance index, pulsatility index and intensity weighted flow velocity had the lowest coefficients of variation. Data on the systolic/diastolic ratio and mean blood flow volume were, therefore, not considered for further evaluation.

Measurements were classified according to the time interval of the examination to the delivery of the baby according to the following groupings: 0–14 days, 15–28 days and 29–42 days. For evaluation of the SGA fetus complicated by fetal distress, only measurements within 2 weeks of delivery were analyzed. Significant differences were calculated by considering the area below the receiver operator characteristic (ROC) curves.

Only Doppler studies of the uteroplacental arteries (mainly resistance index) were predictive of the later development of the SGA fetus. All fetal parameters showed an increasing improvement in the predictive capacity for an SGA infant, the closer the measurements were made to the time of delivery. This improvement was not observed for uteroplacental vessels.

The resistance index of the uteroplacental vessels was significantly higher in SGA pregnancies complicated by fetal distress compared to SGA pregnancies alone. However, ROC analysis revealed that fetal Doppler velocimetry was more strongly related to fetal distress than SGA only. The single best fetal parameter was the mean velocity in the fetal descending thoracic aorta but the velocity ratio of the fetal common carotid artery over the fetal descending thoracic aorta had the highest predictive capacity for the SGA pregnancy complicated by fetal distress. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Maternal hyperoxygenation: a fetal blood flow velocity prognosis test in small‐for‐gestational‐age fetuses?
Authors: de Rochambeau B. , Poix D. , Mellier G.
Published: March 2003

Maternal hyperoxygenation tests were performed in 20 small‐for‐gestational age fetuses using 8 l/min of 70% humidified oxygen given for 20 min through a face mask.

Assessments were made of the fetal blood flow velocity, and the placental resistance index, cerebral resistance index and cerebroplacental ratio were calculated in 78 normal pregnancies and in the 20 small‐for‐gestational‐age fetuses during the hyperoxygenation test. The test was positive when the velocity indices increased by more than 10%. The reference ranges for placental and cerebral resistance indices were derived from the data measured in the 78 normal pregnancies. Of the 20 small‐for‐gestational‐age fetuses, three had a normal placental resistance index with a negative oxygen test response and a good fetal outcome. Seven had a mild increase in placental resistance index (> +2SD) and a brain‐sparing effect was observed (cerebral resistance index < −2SD or cerebroplacental ratio < l). In these seven fetuses, the fetal outcome was not poor, whether the oxygen test response was negative or positive.

Ten of the 20 small‐for‐gestational‐age fetuses had no umbilical diastolic flow (placental resistance index = 1) and a brain‐sparing effect. Their outcome was strongly dependent on the oxygen test response: a positive response indicated a good prognosis, a negative one a poor fetal outcome. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Fallopian tube carcinoma: recent diagnostic approach by color Doppler imaging
Authors: Shalan H. , Sosic A. , Kurjak A.
Published: March 2003

A case of primary adenocarcinoma of the Fallopian tube is presented. The diagnosis was made preoperatively by transvaginal color Doppler imaging. The tumor revealed areas of neovascularization with characteristic low impedance (resistance index, 0.35) and high blood flow velocity (peak systolic velocity, 16.7 cm/s) Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Foramen ovale: an ultrasonographic study of its relation to the inferior vena cava, ductus venosus and hepatic veins
Authors: Kiserud T. , Eik‐Nes S. H. , Blaas H.‐G. , Hellevik L. R.
Published: March 2003

According to the literature, oxygenated blood from the ductus venosus and hepatic veins may either enter the right atrium before flowing through the foramen ovale to the left atrium, or flow directly from the ductus venosus and the hepatic veins to the foramen ovale, bypassing the right atrium. To address this problem, 103 normal fetuses were examined by two‐dimensional imaging, M‐mode and color Doppler at an average gestational age of 27 weeks (range, 15–40 weeks). The position of the ventricular septum and foramen ovale, and the angle and flow direction of the inferior vena cava, ductus venosus and hepatic veins were recorded. Two pathways for blood were described: a left ductus venosus‐foramen ovale pathway that delivers blood directly to the foramen ovale circumventing the right atrium, and a right inferior vena cava‐right atrium pathway that delivers blood into the right atrium through the right portion of the proximal inferior vena cava at an angle of 13° to the long axis of the spine. The left and medial hepatic veins enter the left ductus venosus‐foramen ovale pathway, and the right hepatic vein enters the right inferior vena cava‐right atrium pathway. This supports the hypothesis that oxygenated blood from the ductus venosus and left hepatic veins flows directly through the foramen ovale to the left atrium avoiding extensive mixture in the inferior vena cava and an intermediate entrance to the right atrium. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Normal Doppler flow velocity waveforms in the fetal ductus arteriosus in the first half of pregnancy
Authors: Brezinka C. , Huisman T. W. H. , Stijnen T. , Wladimiroff J. W.
Published: March 2003

Ductus arteriosus flow velocity patterns were studied in 298 women between 9 and 25 weeks of gestation using transvaginal or transabdominal Doppler ultrasound. Technically acceptable recordings were first obtained at 11 weeks resulting in 231 women for further analysis. Ductal waveforms show a significant change in shape from early pregnancy to mid‐pregnancy, in that end‐diastolic velocities are absent until 13 weeks, are present in 50% at 15 weeks and are present in all cases from 17 weeks. Regression analysis demonstrated a statistically significant linear increase with advancing gestational age for all flow velocity parameters except for the pulsatility index which remained stable during the entire study period. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Doppler ultrasound examination of fetal renal arteries
Authors: Zimmermann R. , Eichhorn K. H. , Huch A. , Huch R.
Published: March 2003

This study used color Doppler imaging to establish the normal values of the pulsatility index in the fetal renal arteries in a group of 304 uncomplicated singleton pregnancies. The measurements were taken between 26 and 42 weeks of gestation. The median was 2.79 (95% confidence interval: 2.72–2.86) for 26 weeks' gestation, and it then fell linearly to 1.96 (95% confidence interval: 1.92–2.00) at 40 weeks. Compared with values published so far in the literature, the range was clearly smaller. These normal values could be used as a basis for further investigations on these vessels. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Evaluation of biophysical fetal assessment in high‐risk pregnancy to assess ultrasound parameters suitable for screening in the low‐risk population
Authors: Sim D. , Beattie R. B. , Dornan J. C.
Published: March 2003

During a 1‐year period, 662 pregnant women at 24–43 weeks' gestation were referred to the Department of Obstetrics and Gynaecology, at the Queens University Belfast, for fetal assessment because they were clinically suspected to be at high risk of perinatal complications. The results of our investigations were made available to the referring obstetricians who undertook the further management of the pregnancies. Subsequently six pregnancies resulted in perinatal deaths and 97 (14.7%) in the delivery of small‐for‐gestational‐age infants. We restrospectively analyzed the data from ultrasonographic evaluation of the fetus and subjective and objective assessments of the amniotic fluid volume to determine their value in the prediction of adverse perinatal outcome. A fetal abdominal circumference < 10th centile for gestation or a subjectively reduced amniotic fluid volume identified 87 (90%) of small‐for‐gestational‐age infants and five of the six perinatal deaths. When comparing the abdominal circumference and subjective liquor volume, both were sensitive in predicting delivery of a small‐for‐gestational‐age fetus (sensitivity 86% vs. 53%, respectively) and perinatal death (sensitivity 50% vs. 83%, respectively). We suggest that, since assessments of these two factors are complementary in evaluating a high‐risk pregnancy and can be measured in under 5 min, they now warrant consideration for screening in a prospective randomized trial in an unselected low‐risk population. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic dating of pregnancies conceived after contraceptive pill therapy
Authors: Waldenström U. , Axelsson O. , Nilsson S.
Published: March 2003

A total of 358 women succeeded in conceiving in the first cycle after stopping oral contraception. The estimated day of delivery was calculated from both an ultrasonographically measured fetal biparietal diameter, in the second trimester, and from the date of the withdrawal bleed. According to the biparietal diameter measurement, the estimated day of delivery was postponed more than 1 week in 138 cases (38.5%). For 304 women who delivered after the spontaneous onset of labor, the biparietal diameter estimate gave the best prediction of the day of delivery in 175 cases (57.6%), the date of the withdrawal bleed gave the best estimate in 91 (29.9%) (p < 0.001) and they were equally good in 38 (12.5%). The estimated day of delivery using a biparietal diameter measurement was within ± 14 days of the day of delivery for 267 of these 304 women (87.8%). The corresponding figure for the withdrawal bleed date was 218 (71.7%) (p ≤ 0.001). According to the withdrawal bleed date estimate, 68 women (22.4%) delivered beyond the estimated 42 weeks, compared to only 2.6% according to the biparietal diameter estimate. The median length of a pregnancy from the first day of the withdrawal bleed was 286 days and from the biparietal diameter was 281 days. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
The use of the transvaginal automated spring‐loaded puncture device transabdominally
Authors: Timor‐Tritsch I. E. , Monteagudo A.
Published: March 2003

Transabdominal use of a software integrated, automated, spring‐loaded transvaginal puncture device is described. This device allows accurate, high‐velocity needle placement into sonographically targeted areas under continuous direct vision without the use of local anesthesia. Successful use of the device in seven cases is described. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Prenatally diagnosed testicular torsion
Authors: Gordon A. C. , Chamberlain P. F.
Published: March 2003

A case is reported of absent testis in a boy of 7 months who was noted to have a cystic intra‐abdominal mass at 18–19‐week prenatal ultrasound scan. This is the second report of prenatally detected testicular torsion, the previous case being noted much later in pregnancy. On both occasions, the diagnosis was only established after birth. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Measurement of limb circumferences with three‐dimensional ultrasound for fetal weight estimation
Authors: Favre R. , Nisand G. , Bettahar K. , Grange G. , Nisand I. , Romain F.
Published: March 2003

A large number of formulae have been published for fetal weight estimation. This study examines the possibility of using three‐dimensional ultrasound to measure the limb circumference. This technology provides us with the opportunity to visualize two simultaneous, orthogonal planes, allowing the exact determination of the transverse plane at the mid‐point of the limb. A total of 157 patients were scanned in the week prior to delivery. The following variables were measured in 154 fetuses: biparietal diameter, head circumference, transverse abdominal diameter, abdominal circumference, femur length, thigh circumference and arm circumference. The whole population was split into three subgroups according to the abdominal circumference centile (< 10th centile, 10–90th centile, and > 90th centile), because this single variable has the strongest correlation with neonatal weight (R = 0.901). With forward stepwise multiple regression analysis, four models were elaborated, one for the whole population and one for each subgroup. The small‐for‐dates fetuses need a targeted formula including only two variables, thigh circumference and femur length. Our data suggest that the thigh circumference measurement improves the estimation for growth‐retarded fetuses and that the arm circumference improves the weight prediction for the others. The measurement of the two variables, made possible with three‐dimensional ultrasound, has improved our results in fetal weight estimation. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
The sensitivity and specificity of subjective and a semi‐quantitative technique of amniotic fluid volume assessment in predicting intrapartum morbidity
Authors: Williams K. , Wittmann B. K.
Published: March 2003

The aim of this study was to evaluate the ability of two techniques of amniotic fluid volume assessment to predict intrapartum morbidity in a high‐risk population. A total of 213 pregnant women at the Grace Maternity Hospital, Vancouver, Canada were examined ultrasonically and the amniotic fluid volume was assessed subjectively and using the amniotic fluid index. Both techniques showed high specificity and negative predictive values for all outcome measures, but had an associated poor sensitivity and positive predictive value. Both techniques were similar in their ability to identify situations involving intrapartum morbidity. It is concluded that amniotic fluid assessment is a weak predictor of intrapartum morbidity but may be useful in certain conditions such as when the pregnancy is post‐dates. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasonography in the diagnosis of primary ovarian pregnancy: case report
Authors: Atzori E.
Published: March 2003

This case report describes the sonographic appearance of an ovarian pregnancy; at 7 weeks of gestation, transvaginal ultrasonography revealed an enlarged left ovary containing the gestational sac, yolk sac, and embryonic structures without heart activity. High‐frequency transvaginal ultra‐sound examination proved a useful diagnostic tool in this case of ovarian pregnancy. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology