bluuebunny/crossref_metadata_2025 huggingface dataset:
Methotrexate in psoriasis: 26 years’ experience with low‐dose long‐term treatment
Authors: Haustein U‐F. , Rytter M.
Published: March 2003

Objective To evaluate the efficacy, safety and side‐effects of methotrexate (MTX) in psoriasis.

Design A 26‐year retrospective study.

Setting Department of Dermatology, Leipzig University, Leipzig, Germany.

Patients One hundred and fifty‐seven patients with extensive plaque psoriasis, erythrodermic, pustular and arthropathic forms, were treated with low‐dose methotrexate (15–20 mg maximum weekly dosage [Weinstein schedule]), the majority for long‐term periods. The mean cumulative dose was 3394 mg, the mean duration 237 weeks.

Results The effect of MTX treatment was good in 76%, moderate in 18% and poor in 6% of subjects; 61% experienced side‐effects, most frequently due to liver function abnormalities, bone marrow suppression, nausea, gastric complaints and hair loss. In 20% of cases the subjects were forced to discontinue therapy; 9% refused therapy due to physical and psychological discomfort, 2% wanted to become pregnant, 16% were lost to follow‐up, 6% died from multimorbidity and old age. Three subjects (2%) developed cancer of the lung, breast or cervix uteri, possibly in relation to long‐term MTX treatment. Altogether there were no deaths or life‐threatening side‐effects attributable to MTX treatment, and no cases of progressive liver cirrhosis apart from two extensive skin necroses due to overdosage (misunderstanding, suicidal attempt) that were treated successfully with citrovorum factor.

Conclusion Low‐dose MTX (<15–20 mg/week) is an effective therapy for extensive and severe forms of psoriasis if patients are selected carefully and monitored regularly, particularly with respect to liver and bone marrow toxicity. This helps to reduce severe side‐effects even during long‐term treatment. Drug interactions must be avoided. MTX therapy according to the guidelines is relatively safe and still has a place in the systemic treatment of psoriasis with 40 years of experience and an acceptable safety record.
The epidemiology of onychomycosis: possible role of smoking and peripheral arterial disease
Authors: Gupta Aditya K. , Gupta Madhulika A. , Summerbell Richard C. , Cooper Elizabeth A. , Konnikov Nellie , Albreski Douglas , MacDonald Paul , Harris Kenneth A.
Published: March 2003

Background

Onychomycosis is a relatively common condition the aetiology of which appears to be multifactorial, with both genetic and acquired factors being responsible. In our clinical practice we have observed that smokers and individuals with peripheral arterial disease may have an increased prevalence of onychomycosis compared to normal individuals.

Patients and methods

Patients attending a vascular clinic in a hospital were asked about a history of smoking and peripheral arterial disease. The lower extremity was assessed for peripheral arterial disease. Material was obtained from toenails for mycological evaluation.

Results

Two hundred and fifty‐four patients (male 146, female 108; age, mean ± standard error, 66.6 ± 0.8 years) were enrolled. Abnormal‐appearing nails and onychomycosis were present in 49.2% and 22.4% of patients, respectively. Factors associated with onychomycosis included, increasing age (risk odds ratio [ROR] 1.05, P = 0.002), male gender (ROR 1.7, P = 0.09), smoking (packs per day) (ROR 1.9, P = 0.02) and peripheral arterial disease (ROR 4.8, P = 0.02).

Conclusions

The factors predisposing to the development of onychomycosis are multifactorial. Both smoking (number of packs of cigarettes consumed per day) and peripheral arterial disease are independent predictors of onychomycosis. Awareness of these factors may help in the prevention of onychomycosis and the optimal management of this disease.
Burn‐induced linear IgA dermatosis
Authors: Girão L , Fiadeiro T , Rodrigues Jc
Published: March 2003

There have been several reports of linear IgA dermatosis (LAD) associated with drug exposure and lymphoproliferative malignancy, but trauma and burns have been suggested only in patients with bullous pemphigoid. We present a case of burn‐induced LAD in a 48‐year‐old caucasian male presenting with a recent history of blistering eruption on the periphery of a cicatricial area caused by boiling methyl alcohol. Clinically, he presented a widespread bullous eruption. The direct immunofluorescence examination of a perilesional biopsy revealed an intense homogeneous linear pattern of IgA deposition consistent with the diagnosis of LAD. The patient responded to therapy with systemic steroids.
Dermatological symptoms and sexual abuse: a review and case reports
Authors: Harth W , Linse R
Published: March 2003

Dermatological symptoms in cases of sexual abuse can be very diverse. To establish a causal relationship between skin diseases and sexual abuse is particularly difficult. In dermatology, three main areas of presentation can be identified.

Acute consequences

Direct injuries found on the genitalia and body. Behaviour and psychological changes seen. Sexually transmitted diseases (STD) may be identified, after an appropriate incubation period.

Long‐term consequences

In the long term, even decades later, patients may manifest with a wide spectrum of psychosomatic manifestations of skin diseases, particularly factitious disorders.

Imitations

A group whose skin manifestations may mimic and be mistaken for sexual abuse. The initial suspicion of sexual abuse and the need for specific questioning and investigations can lead to a disturbance in the doctor–patient relationship.
Post‐apopletic trigeminal trophic syndrome
Authors: Ferrara G , Argenziano G , Cicarelli G , Cusano F , Delfino M
Published: March 2003

Trigeminal trophic syndrome is an uncommon clinical entity in which cutaneous trophic ulceration develops with continuous manipulation of trigeminal dermatomes. Patients spontaneously refer picking, rubbing and/or scratching at the affected areas because of hypo‐anaesthesia, paraesthesia and/or pain following damage of the sensory trigeminal fibres or nuclei. We herein describe a patient who developed the syndrome as a sequela of brain stem infarction. Diagnosis by scrape cytology in ruling‐out basal cell carcinoma and other ulcerative skin diseases is discussed and the importance of neurological examination in disclosing hemi‐anaesthesia of trigeminal dermatome(s) is emphasized.
Prevalence of psoriasis in Spain (Epiderma Project: phase I)
Authors: Ferrándiz C , Bordas  , García‐Patos  , Puig S , Pujol R , Smandía A
Published: March 2003

Background

Various national and international studies are under way to obtain reliable data on the epidemiological features of psoriasis.

Objectives

The purpose of this study was to determine the prevalence of psoriasis in the general population in Spain as well as its variations according to sex, age and distribution in different geographical areas.

Material and methods

A random sample (12 938 subjects from 4027 households), representative of the general population, was the basis for a cross‐sectional survey through telephone calls performed by trained non‐medical interviewers using a specific questionnaire.

Results

The prevalence of psoriasis, similar in both sexes, was estimated to be 1.17–1.43%. The highest prevalence rates were shown among 20–50‐year‐old subjects. Distribution of psoriatic patients was not homogeneous throughout the country and prevalence was shown to be higher in the central dry region of the country.

Conclusions

In a population of about 40 million inhabitants, 470 000–570 000 psoriatic subjects constitute an important target for health care issues and further epidemiological studies.
Allergic reactions to decorative skin paintings
Authors: Nikkels AF , Henry F , Piérard GE
Published: March 2003

Background

Dye mixtures containing henna, P‐phenylenediamine (PPD), and indigo are applied to the skin in various parts of the world for religious purposes, social recognition or fun.

Aim

To identify eventual allergens responsible for contact sensitization to skin decoration in three young children. Lesions remained strictly limited to the site painted during the summer holiday. None of the children had a previous history of contact dermatitis, but two of them suffered from severe seasonal allergic rhinoconjunctivitis.

Findings

Patch testing revealed severe contact hypersensitivity to PPD in all three patients, and one child presented a positive prick test to 1% henna in water. The eruptions resolved following spontaneous elimination of the dyes and topical applications of corticosteroids, but left residual depigmentation.

Conclusion

PPD is the main allergen identified in allergic reactions to decorative skin paintings.
Phagocytized apoptotic cells in subcutaneous panniculitis‐like T‐cell lymphoma
Authors: Ikeda E , Endo M , Uchigasaki S , Baba S , Suzuki H , Kinukawa N , Nemoto N
Published: March 2003

We reported on a case of subcutaneous panniculitis‐like T‐cell lymphoma (SPTCL) with multiple erythematous nodular lesions on the extremities, trunk and face. Histological examination of an excised lesion revealed a dense infiltrate of markedly atypical T‐lymphoid cells expressing the CD8+ phenotype located in the subcutaneous tissue with histiocyte‐phagocytizing apoptotic cells. The ‘bean‐bag’ histiocytic cells, the characteristic finding of SPTCL, are considered to be products of haemophagocytosis. In our case the ‘bean‐bag’ cells were produced by phagocytosis of apoptotic bodies, as confirmed by electron microscopy. It is suspected that ‘bean‐bag’ cells are related not to haemophagocytosis but to phagocytosis of apoptotic cells in the CD8+ T‐cell type of SPTCL.
Anetoderma associated with antiphospholipid antibodies: case report and review of the literature
Authors: Romaní J , Pérez F , Llobet M , Planagumá M , Pujol RM
Published: March 2003

The association of primary anetoderma (PA) with antiphospholipid antibodies (APAs; with or without criteria of primary antiphospholipid syndrome) has been observed repeatedly and a possible pathogenic significance of this asssociation has been hypothesized. We report the case of a 21‐year‐old‐woman who developed anetodermic lesions on her upper trunk and arms. The presence of APAs was demonstrated, but no diagnostic criteria of systemic lupus erythematosus were present. A review of the literature disclosed 20 previously reported patients presenting this peculiar association. Thrombotic phenomena, represented by spontaneous abortions or venous thrombosis, are a frequent complication in this setting. Taking these observations into account a systematic search for APAs in patients with PA seems advisable.
Increased density of Demodex folliculorum and evidence of delayed hypersensitivity reaction in subjects with papulopustular rosacea
Authors: Georgala S , Katoulis AC , Kylafis GD , Koumantaki‐Mathioudaki E , Georgala C , Aroni K
Published: March 2003

Background

Rosacea is a common chronic dermatosis that evolves in stages. The mite Demodex folliculorum has been implicated in its obscure aetiopathogenesis.

Aim

To evaluate the importance of D. folliculorum in the aetiology and course of rosacea.

Methods

We studied 92 consecutive cases of papulopustular rosacea and 92 age‐ and sex‐matched controls. Prevalence and density of D. folliculorum were estimated by microscopic examination of the expressed follicular content. Histological examination and immunohistochemical study of the inflammatory infiltrate were performed in 10 subjects (five with positive D. folliculorum finding and five with negative finding).

Results

D. folliculorum was detected in 83 (90.2%) of the 92 rosacea subjects but only 11 (11.9%) of the controls. The mean mite density was 2.03 mites/visual field in the rosacea group (range 0–5, SD = 1.2) and 0.16 mites/visual field (range 0–2, SD = 0.52) in the control group. The difference was statistically significant (P < 0.0001) for both mite prevalence and density. Hair follicle infestation was associated with intense perifollicular infiltrate of predominantly (90–95%) CD4 helper/inducer T cells. We observed an increased number of macrophages and Langerhans cells only in those subjects with a positive D. folliculorum finding.

Conclusions

Although Demodex mites do not seem to be the cause of rosacea, they may represent an important cofactor, especially in papulopustular rosacea. Immunohistochemical findings suggest that a delayed hypersensitivity reaction, possibly triggered by antigens of follicular origin, probably related to D. folliculorum, may occur, stimulating progression of the affection to the papulopustular stage.
Pityriasis lichenoides et varioliformis acuta during pregnancy
Authors: Brazzini B , Ghersetich I , Urso C , Cianferoni L , Lotti T
Published: March 2003

Pityriasis lichenoides et varioliformis acuta (PLEVA) is a disorder of unknown aetiology that occurs at any age and can be localized on the skin and on the mucosas. We report the case of a 24‐year‐old woman who presented PLEVA at her 20th week of gestation. This is, to our knowledge, the second case of PLEVA during pregnancy reported in literature. We report this case for the importance of the diagnosis of PLEVA during pregnancy because of the possible involvement of the mucosal membranes, and in particular of the vagina or cervical os of the uterus, where it may cause premature labour and/or premature rapture of the membranes.
Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis
Authors: Piskin S , Sayan C , Durukan N , Senol M
Published: March 2003

Background The exact aetiology of recurrent aphthous stomatitis (RAS) is still unknown, but different predisposing factors, including iron, vitamin B12 and folic acid deficiencies, have been proposed.

Material and methods Serum iron, ferritin, folic acid and vitamin B12 levels were investigated in 35 patients with RAS and in 26 healthy controls.

Results Vitamin B12 levels were found significantly lower in subjects with RAS than in controls. No significant differences were found in other parameters.

Conclusion We concluded that vitamin B12 deficiency may be an aetiological factor in recurrent aphthous stomatitis.
Epidermolysis bullosa acquisita: treatment with intravenous immunoglobulins
Authors: Gourgiotou K , Exadaktylou D , Aroni K , Rallis E , Nicolaidou E , Paraskevakou H , Katsambas AD
Published: March 2003

Epidermolysis bullosa acquisita (EBA) is a rare autoimmune bullous disorder that is often difficult to treat. Few cases have been reported and therapy consists mainly of combinations of systemic steroids, immunosuppressants and, recently, administration of intravenous human immunoglobulin (IVIg). We describe a case of EBA in which our therapeutic choices were limited due to the patient’s poor general condition, including extensive infection of the lesions and a history of pulmonary tuberculosis. The patient was treated with IVIg at a dose of 400 mg/kg per day for 5 consecutive days every 4 weeks. The treatment was well tolerated and the results were satisfactory. It seems that IVIg, due to its possible immunomodulatory mode of action, can be an efficacious therapeutic agent in this rare autoimmune disease.
Steroid dermatitis resembling rosacea: aetiopathogenesis and treatment
Authors: Ljubojeviæ S , Basta‐Juzbašiæ A , Lipozenèiæ J
Published: March 2003

Background Corticosteroids were first introduced for topical use in dermatology in 1951. Since then uncontrolled use (abuse) has caused many different reactions, often with manifestations resembling those of rosacea.

Objective The prolonged use of local corticosteroids (usually 2–6 months) may lead to a clinical picture of severe dermatitis with erythema, papules and pustules that are classified according their localization to three types. The treatment of choice is tetracycline in combination with local application of neutral ointments.

Conclusions Trivial skin dermatoses, especially on the face, should not be treated with local corticosteroids.
A case of pemphigus vulgaris possibly triggered by quinolones
Authors: Anadolu RY , Birol A , Bostanci S , Boyvat A
Published: March 2003

Pemphigus vulgaris is an autoimmune blistering disorder in which both genetic and environmental factors, mainly drugs, are thought to play a part in its aetiopathogenesis. Although some drugs that contain thiol groups, such as d‐penicillamine and captopril, and non‐thiol drugs, such as cephalosporin, have been reported to trigger or induce pemphigus, there are no previous reports regarding the influence of quinolones in triggering this disease. Here we present a case of pemphigus possibly triggered by quinolones.
Schnitzler's syndrome with monoclonal IgGκ gammopathy: good response to cyclosporin
Authors: Pascual‐López M , Hernández‐Núñez A , Sánchez‐Pérez J , Fernández‐Herrera J , García‐Díez A
Published: March 2003

Schnitzler's syndrome (SS) is a rare entity characterized by the association of chronic urticaria and monoclonal IgM gammopathy. Usually, intermittent fever, arthralgia and elevation of erythrocyte sedimentation rate also occur. We report a patient with the same symptoms, but with monoclonal IgG instead of IgM paraproteinaemia. Histological examination of the urticarial lesions showed signs of leucocytoclastic vasculitis. After 20 years of therapeutic failure, cyclosporin has achieved a total clearance of urticarial lesions in our patient. Two previous similar cases with clinical features of SS and monoclonal IgG immunoglobulin have been described. We suggest our case also represents a variant of SS with IgG gammopathy.
Watering can perineum – a forgotten complication of gonorrhoea
Authors: Pandhi D , Reddy Bsn
Published: March 2003

In the modern era of broad spectrum antibiotics, urethral fistulae (watering can perineum) is one of the forgotten sequelae of chronic gonococcal infection. We report a 20‐year‐old unmarried male with gonococcal urethritis and two sinuses in the scrotum (watering can perineum). The micturating and retrograde urethro‐gram revealed mucosal irregularity and extravasation of contrast medium at the junction of bulbous and membranous urethra. Recent worldwide emergence of multidrug resistant strains of gonococci give rise to alarm. In the present scenario of HIV pandemic, ineffective treatment of patient or partner with gonorrhoea may result in development of these complications.
Parents of Adults with Intellectual Disabilities: Quality of Life and Experiences of Caring
Authors: Walden Sarah , Pistrang Nancy , Joyce Theresa
Published: March 2003

This study examined a UK sample of parents caring for their adult offspring with intellectual disabilities, and the factors contributing to their quality of life and experiences of caregiving. Structured interviews were conducted with 62 parents of adults with intellectual disabilities. On several indices of quality of life, parents did not seem to be functioning as well as caregiving parents in the US, or as well as adults in the general US population.The offspring's level of challenging behaviour and physical dependency and the parent's satisfaction with informal support were associated with parental quality of life. The salience that parents placed on their post‐parental life style was also associated with quality of life, with ‘captive’ parents faring more poorly than ‘captivated’ parents.
More than one Wavelength: Identifying, Understanding and Resolving Conflicts of Interest between People with Intellectual Disabilities and their Family Carers
Authors: Williams V. , Robinson C.
Published: March 2003

The present paper describes conflicts of interest in families which include someone with intellectual disabilities. Data were taken from a study concerned with the 1995 Carers Act. The research examined the experiences and views of 51 families who had some kind of assessment by a social services department. Cases were analysed where it was found that carers, the people for whom they cared and the assessors did not agree about such conflicts. Assessors sometimes stereotyped families and spoke of conflicts of interest when the situation was more complex. In particular, the real conflict was often between the whole family and an inadequate service system that did not offer enough support or choices to the individual. Conflicts which had occurred were related to three major motives driving carers: (1) the need for a break from caring; (2) the need to speak for their disabled relative; and (3) their concern for standards of behaviour. The present authors report on how these situations were handled by assessors and conclude with some recommendations for good carer assessments which will help to resolve conflicts of interest. A greater degree of informed choice for individuals with intellectual disabilities will in itself resolve many potential conflicts of interest.
The fetal mandible measurement: an objective determination of fetal jaw size
Authors: Otto C. , Platt L. D.
Published: March 2003

The sonographic diagnosis of micrognathia has been limited by the lack of an objective measurement of the fetal mandible. A cross‐sectional study of 134 normal patients of known gestational age between 14 and 39 weeks' gestation was performed. Models to predict mandible length based on gestational age, biparietal diameter, head circumference or femur length were derived by least squares regression analysis. The 95% prediction limits were also derived. Utilization of these curves generated from a normal population should allow for a more sensitive and reproducible method to diagnose micrognathia in the fetus. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Normal fetal cardiac measurements derived by cross‐sectional echocardiography
Authors: Sharland G. K. , Allan L. D.
Published: March 2003

Cardiac structures have been measured in normal fetuses by cross‐sectional echocardiography to establish a range of normal values. Gestational ages varied from 16 weeks to term. The cardiac structures measured were left and right ventricular width (n = 337), aortic root diameter (n = 296), pulmonary artery diameter (n = 312), mitral valve orifice (n = 159), and tricuspid valve orifice (n = 161). The lengths of the left and right ventricles were measured in 100 fetuses. Normal ranges were constructed using real‐time ultrasound images which can be readily used in routine practice. Measurement of cardiac structures is an aid to the study of cardiac abnormalities and the availability of normal ranges of measurements of fetal cardiac structures may help to confirm and define suspected cardiac malformation during routine screening. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Ventricular ejection force in growth‐retarded fetuses
Authors: Rizzo G. , Capponi A. , Rinaldo D. , Arduini D. , Romanini C.
Published: March 2003

The objective of this study was to determine whether in growth‐retarded fetuses secondary to uteroplacental insufficiency the cardiac ventricles exert a force different from that of appropriately grown fetuses. Doppler echocardiographic studies were performed in 1.56 appropriately grown fetuses (gestational age 18–38 weeks) and in 72 growth‐retarded fetuses (gestational age 24–36 weeks) free from structural and chromosomal abnormalities and characterized by Doppler changes in the umbilical artery and middle cerebral artery suggesting uteroplacental insufficiency as the most likely etiology of the growth defect. Right and left ventricular ejection force values were calculated from velocity waveforms recorded at the level of aortic and pulmonary valves, according to Newton's second law of motion. In appropriately grown fetuses, left and right ventricular ejection force values significantly increased with advancing gestation and the two ventricles exerted similar force. In growth‐retarded fetuses, the ventricular ejection force was significantly and symmetrically decreased in both ventricles. Among growth‐retarded fetuses, a poorer perinatal outcome was observed in those fetuses in which the ejection force of both ventricles was below the 5th centile of the normal limits for gestation. In 12 growth‐retarded fetuses followed longitudinally during the last week preceding intrauterine death or Cesarean section due to antepartum heart‐rate late decelerations, a significant decrease of ejection force was found in both ventricles. Finally, a significant relationship was found between the severity of acidosis and right and left ventricular ejection force values in 22 fetuses in which Doppler recordings were performed immediately before cordocentesis. In conclusion, in growth‐retarded fetuses the force exerted by the ventricles was symmetrically reduced and the degree of impairment seemed to be related to the severity of fetal compromise. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Pubertal maturation of the internal genitalia: an ultrasound evaluation of 166 healthy girls
Authors: Holm K. , Mosfeldt Laursen E. , Brocks V. , Müller J.
Published: March 2003

Pelvic ultrasound is an important tool in the management of children with disturbances of pubertal development; interpretation requires an understanding of the normal relationship between maturation of internal genitalia and the appearance of secondary sex characteristics. We performed pelvic ultrasound examinations in 166 healthy females aged 6.4–25.4 years, and related uterine and ovarian volumes and size of follicles to age and pubertal stage. We demonstrated growth of the uterus and ovaries before the appearance of breast development and pubic hair growth. In prepubertal girls, uterine and ovarian growth was related to height (p = 0.008 and p = 0.010, respectively). From breast stages 1–5, median uterine and ovarian volumes increased from 1.6 ml to 43 ml, and from 1.2 ml to 7.3 ml, respectively (p < 0.0001). Uterine growth continued several years after menarche. Postmenarcheal uterine growth was related to the number of years after menarche (p < 0.001), but not to height, weight or age. Follicles were seen in 86% of prepubertal girls and in 99% of pubertal girls. Follicles up to 8 mm in diameter were observed in prepubertal girls. Maturation of the internal genitalia begins before the onset of clinical puberty, and extends well into the second decade. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic incidence of polycystic ovaries in a gynecological population
Authors: Botsis D. , Kassanos D. , Pyrgiotis E. , Zourlas P. A.
Published: March 2003

The prevalence of polycystic ovaries in a large population of 1078 women of reproductive age was determined by pelvic ultrasonography. The ovarian ultrasonic appearance of 183 (17%) women met the morphological criteria of polycystic ovaries. Of these women, 147 (80.3%) had irregular cycles (group A) and 36 (19.70%) had normal cycles (group B). The remaining women constituted the control group. Ovarian volume was calculated in all women in whom at least one ovary was visualized. Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone were measured in 124 women from group A, 25 from group B and 50 controls. Mean ovarian volume was statistically higher in both group A (13.4 ml) and group B (11.8 ml) than in the control group (6.2 ml). Mean LH/FSH ratio and mean testosterone values were statistically higher in group A only (2.1 and 1.1 ng/ml, respectively) compared with the mean values in the control group (0.7 and 0.7 ng/ml, respectively). Obesity and hirsutism were more common in group A than in group B and the controls.

Screening the ovaries in women of reproductive age and subsequent assessment of morphology in polycystic ovaries can aid in the diagnosis of this condition in patients who may have a varied clinical presentation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Cost‐effectiveness of one‐stage ultrasound screening in pregnancy: a report from the Helsinki ultrasound trial
Authors: Leivo T. , Tuominen R. , Saari‐Kemppainen A. , Ylöstalo P. , Karjalainen O. , Heinonen O. P.
Published: March 2003

The objective of this study was to evaluate, in a controlled clinical trial, the costs of standardized one‐stage ultrasound screening in pregnancy in relation to the reduction in perinatal mortality. A trial population of 9310 pregnant women was randomly allocated to ultrasound screening or a control group. Two obstetric hospitals and 64 recruiting antenatal health centers were involved. The costs included actually realized costs, i.e. positive costs, and gains, i.e. negative costs, resulting from lower health‐care use. Cost‐accounting data were obtained by a questionnaire to all attenders and measurements at the screening, and later complemented by a questionnaire to a random sample of 534 screened women. Internal accounting and other hospital data, national statistics and health‐market sources were also used. The actually realized cost of each avoided perinatal death was FIM 84 378 ($21 938), while the net over‐all estimate combining all positive and negative costs showed a cost saving of FIM 65 680 ($17 077). The total positive unit cost of ultrasound screening was FIM 393 ($102). Longer ultrasound examination time and more numerous advanced examinations were rewarded by clearly fewer perinatal deaths and a better cost‐effectiveness ratio. One‐stage second‐trimester ultrasound screening is cost‐effective when all significant costs and effects are taken into account. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasound‐guided transcervical resection of uterine septa: 7 years' experience
Authors: Ohl J. , Bettahar‐Lebugle K.
Published: March 2003

This study evaluates the performance in our center of Querleu's transcervical resection of uterine septa. The procedure uses cold scissors under ultrasonographic guidance. Ninety‐three patients were treated during a 7‐year period. Follow‐up examination in patients having an obstetric history prior to resection, excluding those suffering from infertility, showed a decrease in premature deliveries (9.4% vs. 13%) and miscarriages (24.5% vs. 78%), and a dramatic increase in term deliveries (62.3% vs. 5.7%). The anatomical and functional results, as well as the complication rate, were similar to those observed following hysteroscopic metroplasty. The advantages of an ultra‐sound‐guided approach are the easy estimation of fundus thickness, the potential of resection regardless of the stage of the menstrual cycle and avoidance of costly equipment. For these reasons we have adopted it as our standard procedure. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Management of non‐immune hydrops: 8 years' experience
Authors: Anandakumar C. , Biswas A. , Wong Y. C. , Chia D. , Annapoorna V. , Arulkumaran S. , Ratnam S.
Published: March 2003

During a period of 8 years (1985–92), 100 fetuses were diagnosed to have non‐immune hydrops on the basis of ultrasonographic findings and absence of rhesus isoimmunization. Both the mother and the fetus were thoroughly evaluated by a set protocol that included a detailed fetal abnormality scan with echocardiography and fetal blood sampling. A cause for non‐immune hydrops could be identified in 81% of the fetuses. Cardiovascular abnormalities (23%) and α1‐thalassemia (22%) were almost equally common etiological factors in the South‐East Asian population under investigation. A chromosomal abnormality was detected in 10% of the fetuses with non‐immune hydrops. Twenty‐six fetuses were found to be suitable for in utero therapy. In utero therapy included one or more of the following: (1) fetal intravascular blood transfusion; (2) direct fetal drug therapy; and (3) fetal pleuroamniotic shunting. Eighteen of the 26 babies (69.2%) were alive and well at 1 month after delivery. It is concluded that in well‐selected cases appropriate in utero fetal therapy can lead to significant improvement in fetal salvage. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Doppler velocimetry of intraplacental fetal vessels in the second trimester: improving the prediction of pregnancy complications in high‐risk patients
Authors: Jaffe R. , Woods J. R.
Published: March 2003

The purpose of our study was to assess the value of fetal intraplacental velocimetry in predicting adverse pregnancy outcome in high‐risk patients. Thirty‐two women with pregnancies of 22 to 25 weeks' gestation were evaluated. They had demonstrated abnormal first‐trimester Doppler characteristics, yet had normal second‐trimester umbilical artery velocimetry. Doppler waveforms were obtained and the ratio between intraplacental and umbilical artery resistance indices was calculated.

Abnormally high ratios of intraplacental to umbilical artery resistance indices were associated with a significantly higher incidence of pregnancy complications. Among women with abnormal ratios, 17 (80%) of 21 pregnancies had later complications, whereas among those with normal ratios, only two (18%) of 11 women experienced later complications.

This study demonstrates that analysis of the ratio between intraplacental and umbilical artery resistance indices in the second trimester improves the diagnostic value of Doppler velocimetry in pregnancies at risk for later obstetric complications. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasonography for all placentas that appear to be low‐lying or over the internal cervical os
Authors: Smith R. S. , Lauria M. R. , Comstock C. H. , Treadwell M. C. , Kirk J. S. , Lee W. , Bottoms S. F.
Published: March 2003

The purpose of this study was to determine in what percentage of cases the assessment of placental localization using transabdominal sonography (TAS) was changed after transvaginal sonography (TVS) was applied. TVS was prospectively performed on all pregnant women of at least 1.5 weeks' gestation, when the placental edge using TAS appeared to be over or within 2 cm (low‐lying) of the internal cervical OS. The time required for the TVS scan and the distance of the placental edge from the maternal cervical OS were recorded. Of the 168 patients entered into the study, 131 were analyzed. Landmarks were poorly seen in 5O% of the cases when using TAS. In 66 cases, the placenta appeared low or possibly over the internal cervical os using TAS, but a definitive diagnosis could not be made due to suboptimal visualization. In the remaining 6.5 cases, visualization of the internal os and placental edge was possible using both TAS and TVS. In this group, there was a change in the diagnosis in 26% of the cases after TVS was performed. Our results suggest that optimal visualization of the placental edge and internal cervical os is usually difficult with TAS when the placenta appears low‐lying or over the internal cervical os. The assessment of placental localization was changed in over one‐quarter of cases (26%) after transvaginal sonography was performed. The use of transvaginal ultrasound should be seriously considered when the placenta appears to be low or over the internal cervical os by transabdominal ultrasound. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Luteal phase defect: comparison between Doppler velocimetry, histological and hormonal markers
Authors: Kupešić S. , Kurjak A. , Vujisić S. , Petrović Z
Published: March 2003

The aim of this prospective study was to investigate the relationship between the ultrasonographic appearance of the endometrium, histological dating by biopsy, hormonal profile and impedance within the segmental uterine and ovarian circulation for assessment of luteal phase function. A total of 61 infertile patients undergoing endometrial biopsy were studied by transvaginal B‐mode and color and pulsed Doppler ultrasound. Uterine, radial, spiral, ovarian and intraovarian artery impedance throughout the natural ovarian cycle were related to histological and hormonal markers of uterine receptivity. Plasma levels of follicle stimulating hormone, luteinizing hormone (LH) and estradiol were measured on cycle days 5 and 10 and measurements were continued daily until the detection of the LH surge. Endometrial biopsy was performed 7 days after ultrasonically and hormonally detected ovulation. Progesterone levels were evaluated on the day of endometrial biopsy and 3 days later. After all the data were collected, the patients were divided into two groups, according to the histopathology: 15 patients with normal endometrial dating and 43 patients with a delayed endometrial pattern (i.e. luteal phase defect). One patient with an asynchronous endometrium and two anovulatory subjects were excluded from further evaluation.

A significant difference between patients with a luteal phase defect and the control group was obtained for impedance in the uterine (p < 0.05), radial (p < 0.05), spiral (p < 0.00l), ovarian (p < 0.05) and intraovarian arteries (p < 0.001) during the luteal phase. The endometrium showed secretory transformation when serum levels of progesterone were higher than 15 ng/ml.

Segmental uterine and ovarian artery perfusion demonstrates a significant correlation with histological and hormonal markers of uterine receptivity. Therefore, blood flow impedance in the corpus luteum and spiral arteries may aid in assessing luteal phase adequacy. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
The effect of nuchal translucency measurement on second‐trimester biochemical screening for Down's syndrome
Authors: Kadir R. A. , Economides D. L.
Published: March 2003

In this study we examined the effect of introducing first‐trimester nuchal translucency measurement on the second‐trimester maternal serum screening for trisomy 21. The detection rate, false‐positive rate, likelihood ratio and positive predictive value of the double marker test before and after introduction of nuchal translucency measurement were determined. The detection rate of nuchal translucency screening for trisomy 21 was 83% (5/6) with a 1.3% false‐positive rate, a 63.8 likelihood ratio and a positive predictive value of 22.7%. After the introduction of nuchal translucency measurement, the likelihood ratio for a positive result and positive predictive value of the biochemical screening decreased from 9.1 to 5 and 2.7% to 0.45%, respectively. Our results show that nuchal translucency measurement is not only an effective method of first‐trimester screening for Down's syndrome but also has implications for the likelihood ratio and positive predictive value of second‐trimester biochemical screening. Since the biochemical test is now applied to a population with a decreased risk of trisomy 21, a positive test will be less likely to indicate Down's syndrome than when nuchal translucency measurement was not applied. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Comparison of prenatal ultrasound and postmortem findings in fetuses and infants with central nervous system anomalies
Authors: Isaksen C. V. , Eik‐Nes S. H. , Blaas H.‐G. , Torp S. H.
Published: March 2003

Detection of fetal developmental abnormalities by ultrasound examination of pregnant women has become a specialized field of medicine. Quality control of this field requires detailed examination of aborted fetuses. In 408 fetuses and infants with developmental anomalies, the prenatal ultrasound findings were compared with the postmortem findings. This study focused on 140 central nervous system (CNS) anomalies. Criteria for inclusion were an ultrasound examination at the National Center for Fetal Medicine (NCFM) and an autopsy performed during the period 1985–94. Results of the ultrasound and autopsy examinations were systematized into six different categories.

Hydrocephaly and anencephaly were the most frequent abnormalities, together accounting for 50% of the CNS anomalies. In 20 cases (14%), the CNS anomalies were associated with other important anomalies or chromosomal aberrations. In 125 of the cases (89%), there was complete concordance between the ultrasound and autopsy diagnoses. Of the 15 CNS cases with discrepancies, seven had nearly complete concordance; if we include these, the correlation was 94%.

In conclusion, this study confirms that developmental anomalies in the central nervous system are frequent and that ultrasound diagnoses are in good concordance with the autopsy diagnoses. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Variation of embryonic/fetal heart rate at 6–13 weeks' gestation
Authors: Montenegro N. , Ramos C. , Matias A. , Barros H.
Published: March 2003

The aim of this study was to investigate changes in heart rate, namely the intraindividual variation, in normal embryos/fetuses between 6 and 13 weeks' gestation. A prospective study was performed of 41 singleton pregnancies undergoing routine ultrasound examination during the first trimester of pregnancy. For each case, the embryonic/fetal heart rate was measured on three consecutive occasions with a mean interval of 4 min.

The difference in heart rate values between the serial measurements varied from 0 to 18 beats/min and was significantly associated with gestational age (Spearman r = 0.26, p < 0.01). In the group of 15 fetuses (examined before 10 weeks' gestation), the difference between measurements (median = 0 beats/min, range 0–8 beats/min) was significantly lower (z = 2.48, p < 0.05) than in fetuses assessed after 10 weeks of gestation (median = 3, range 0–18 beats/min).

Reliable and reproducible information concerning embryonic/fetal heart rate may be obtained from a single measurement, especially when pregnancies are examined before 10 weeks of gestation. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Perinatal outcome and prognostic factors in prenatally diagnosed congenital diaphragmatic hernia
Authors: Geary M. P. , Chitty L. S. , Morrison J. J. , Wright V. , Pierro A. , Rodeck C. H.
Published: March 2003

Objective

The purpose of this study was to assess perinatal outcome in cases of prenatally diagnosed congenital diaphragmatic hernia and identify the prognostic value of various prenatal factors.

Design

Retrospective review of fetal medicine, obstetric and histopathology records in all 34 cases of congenital diaphragmatic hernia identified prenatally between 1992 and 1996 at a tertiary referral fetal medicine unit.

Results

Overall survival was 18%. None of those with bilateral (0/1) or right‐sided (0/5) congenital diaphragmatic hernia survived, whereas 21% (6/28) of those with left‐sided hernias survived. Prenatal karyotyping was performed in 71% (n = 24) and five chromosomal abnormalities were identified. The pregnancy was terminated in 15 cases (44%). In the 19 continuing pregnancies, the survival rate was 32% (6/19). In those with an isolated congenital diaphragmatic hernia, the survival rate was 38% (5/13), and in those in which the hernia was isolated and left‐sided, the survival rate was 56% (5/9). In ongoing pregnancies diagnosed after 24 weeks, the survival rate was 33% (2/6) compared with 31% (4/13) in pregnancies diagnosed at ≤ 24 weeks. Of those infants who had surgical repair, six out of seven (86%) survived.

Conclusions

These data clearly demonstrate an improved prognosis in fetuses with an isolated left‐sided congenital diaphragmatic hernia. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Neurological morbidity after fetal supraventricular tachyarrhythmia
Authors: Schade R. P. , Stoutenbeek P. , de Vries L. S. , Meijboom E. J.
Published: March 2003

Background

Fetal tachyarrhythmia is a well‐documented entity which, in the absence of pharmacological intervention, may lead to congestive heart failure, fetal hydrops and eventually fetal demise. The success rate of the implemented treatment is generally measured by survival and achievement of control of the arrhythmia. We report on the occurrence of associated cerebral damage in three patients with fetal tachycardia.

Methods

We describe three patients with a history of fetal supraventricular tachyarrhythmia who developed cerebral complications.

Results

Two patients had cerebral hypoxic‐ischemic lesions and one had hemorrhagic lesions present at birth. They had developed severe congestive heart failure and fetal hydrops secondary to fetal tachyarrhythmia, and there were no other obvious causes for the cerebral pathology. Two of these patients were referred to us antenatally. Therapy was instituted and resulted in control of the tachycardia and resolution of hydrops. The third patient was referred to our clinic shortly after birth because of severe circulatory problems secondary to fetal tachyarrhythmia.

Conclusion

From these observations, we believe that a fetus with tachyarrhythmia and subsequent hydrops is at increased risk for the development of cerebral complications, due to the circulatory disturbances and sudden changes in heart rate which may lead to fluctuations in cerebral perfusion. This would imply that it is of the utmost importance to aim at immediate and complete control of the heart rate in the treatment of fetal tachyarrhythmia. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Assessment of endometrial receptivity for gestation in patients undergoing in vitro fertilization, using endometrial thickness and the endometrium‐myometrium relative echogenicity coefficient
Authors: Leibovitz Z. , Grinin V. , Rabia R. , Degani S. , Shapiro I. , Tal J. , Eibschitz I. , Harari O. , Paltieli Y. , Aharoni A. , Zeevi J. , Ohel G.
Published: March 2003

Objective

To evaluate the outcome of fertilization(IVF) treatment in relation to the sonographic parameters of the endometrium.

Design and methods

Seventy‐five patients with no uterine pathology (age 31.1±5.4 years) treated in our IVF clinic for various indications were assessed during 75 cycles in which good‐quality (grades 1 and 2) embryos were transferred. Controlled ovarian stimulation was achieved by the long protocol (gonadotropin releasing hormone agonist and gonadotropins). The bilayered endometrial thickness (BET), estradiol, luteinizing hormone and progesterone serum levels were measured in 272 tests. A special computer program was used to measure endometrial echogenicity relative to myometrial echogenicity. The gray‐level data were analyzed on the basis of the midsagittal sonographic uterine image. Endometrium‐myometrium relative echogenicity coefficient (E/M REC) values were computed and displayed graphically along the anteroposterior axis of the endometrial layers in the upper part of the uterine cavity. The area under the E/M REC curve within the BET limits was defined as the relative echogenicity area (REA) and was used as a measure of endometrial echogenicity. Each cycle was sampled in six time segments representing desensitization, follicular and luteal phases. Assigning the day of ovum pick‐up as day 0, the time segments of each cycle were: first, day −20 to day −11; second, day −10 to day −6; third, day −5 to day −2; fourth, day 0; fifth, day +7 to day +14; sixth, day +15 to day +21.

Results

A total of 276 embryos were transferred (3.68 ±1.01 per cycle), of which 223 were of good quality (2.97 ±1.51 per cycle). An intrauterine pregnancy was diagnosed in 29 patients. All patients in this study had a BET of > 5 mm in the third and the fourth time segments. There was no significant difference in BET and REA between pregnant and non‐pregnant patients tested in the first to the fifth time segments of the IVF cycles. Both BET and REA measured in the sixth time segment were significantly higher in pregnant compared to non‐pregnant patients.

Conclusions

Our results suggest that the proposed sonographic assessment of the endometrium shows no benefit in characterization of uterine receptivity in IVF patients with a reactive endometrium. High BET and REA values can indicate pregnancy during the sixth time segment, when the decidualization of the endometrium is well established. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology