bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistent pigmented purpuric eruption associated with mycosis fungoides: a case report and review of the literature
Authors: Georgala S , Katoulis AC , Symeonidou S , Georgala C , Vayopoulos G
Published: March 2003

A purpuric eruption may be an unusual early manifestation of mycosis fungoides (MF). On the other hand, persistent pigmented purpuric dermatoses (PPPD) may, occasionally, evolve to cutaneous T‐cell lymphoma. Coexistence of these two conditions has been reported, but it is extremely rare. We present the case of an elderly woman with a long‐standing pruritic, pigmented purpuric eruption. On 1‐year follow‐up, histological features suggesting early MF were observed and molecular analysis of the rearrangement of T‐cell receptor genes revealed clonality. Our patient may represent a case of PPPD evolving to MF, a case of MF clinically featuring PPPD, or an intermediate condition in a nosological continuity extending from PPPD to MF. A persistent pigmented purpuric eruption may rarely be a harbinger of cutaneous T‐cell lymphoma. Therefore, vigilant long‐term follow‐up of PPPD is highly recommended.
Superficial granulomatous pyoderma: an idiopathic granulomatous cutaneous ulceration
Authors: Thami GP , Kaur S , Punia RS , Kanwar AJ
Published: March 2003

A 70‐year‐old male with a superficial granulomatous ulcer is reported. Histopathological findings were the same as those described for superficial granulomatous pyoderma, a recognized variant of classic pyoderma gangrenosum. The differences between pyoderma gangrenosum and its variant superficial granulomatous pyoderma are highlighted.
An unusual case of palmoplantar keratoderma
Authors: Devos SA , Delescluse J
Published: March 2003

A 55‐year‐old woman with palmoplantar keratoderma presented an associated hyperhidrosis with distinct odour and maceration. She had had the lesions for about 20 years and this seemed to be an isolated case in her family. This case appeared very unusual because there were no signs of acanthokeratolysis in the biopsies. Two months of treatment with acitretin (Neotigason®; 25 mg daily), produced a spectacular result: clearance of all the lesions on both hands and a strong diminution of the lesions on the soles. The Unna–Thost variant of palmoplantar keratoderma usually appears in the first few months of life, and it rarely appears in the third decade. The condition is inherited as an autosomal dominant with high penetrance and expressivity. Our subject appeared to be an exception to these two facts.
Neutrophilic pustulosis and ulcerative colitis
Authors: Vázquez J , Almagro M , Del Pozo J , Fonseca E
Published: March 2003

Neutrophilic pustulosis is currently considered as a part of the spectrum of Sweet's syndrome, and has been associated with inflammatory bowel disease and several other diseases.

We report the case of a 34‐year‐old male who had been suffering from ulcerative colitis (UC) for several years and who experienced the manifestation of a pustular eruption on both forearms and the abdominal wall during an exacerbation of his bowel disease. Both processes were controlled with steroids per os. The histological picture showed an inflammatory infiltrate composed mainly of neutrophils with scattered neutrophilic epidermal abscesses. Certain distinct clinical and histological characteristics have been described as diagnostic of the pustular eruption of UC. This picture should be included in the spectrum of the neutrophilic dermatosis, in our case associated with an ulcerative colitis.

This is a well documented clinical and histologic case report of a recognized association of inflammatory pustulosis in the course of ulcerative colitis.
Pigmented terminal hair cysts within an intradermal melanocytic naevus
Authors: Erkek E , Bozdogan Ö
Published: March 2003

The combination of melanocytic naevi and cysts of adnexal or epithelial origin has been described previously. Herein we describe a case of intradermal melanocytic naevus containing pigmented terminal hair cysts, a rare variant of epithelial cysts. Our observation suggests that pigmented follicular cysts and combined cystic‐melanocytic lesions may be attributed to follicular occlusion.
Transvaginal color Doppler sonography of ovarian masses with pathological correlation
Authors: Fleischer A. C. , Rogers W. H. , Rao B. K. , Kepple D. M. , Jones H. W.
Published: March 2003

This report describes the correlation of pathological findings with transvaginal color Doppler sonography performed preoperatively on 26 ovarian masses. The pulsatility indices of benign lesions (1.9 ± 0.7) were higher than those of malignant ones (0.7 ± 0.2) (p = 0.03). Low pulsatility indices (< 1.0) were found in three relatively vascular benign lesions (one immature teratoma, one cystadenoma containing a dermoid cyst, one endometrioma), causing an overlap between the pulsatility indices of some benign and malignant masses. There appears to be significant potential for discrimination between benign and malignant ovarian masses with transvaginal color Doppler sonography. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Intraovarian Doppler velocimetry in ovulatory, dysovulatory and anovulatory cycles
Authors: Mercé L. T. , Garcés D. , Barco M. J. , de la Fuente F.
Published: March 2003

We have evaluated 48 spontaneous ovarian cycles in 23 women by transabdominal Doppler ultrasound. A total of 1064 intraovarian flow velocity waveform recordings were obtained. The ultrasound assessment of follicular growth, and changes in the concentrations of urinary luteinizing hormone and serum progesterone were used to classify the cycles. After follicular rupture (and presumed ovulation) in 30 cycles, the intraovarian flow velocity waveform (dominant ovary) showed a turbulent flow during the luteal phase (‘luteal conversion’). The maximal resistance index was lower compared to values obtained during the follicular phase, and from the contralateral ovary. The intraovarian flow velocity waveform from 12 abnormal cycles showed similar quantitative and qualitative changes. When ovulation did not occur (three cases of the luteinized unruptured follicle syndrome, three anovulatory cycles), there was no evidence of ‘luteal conversion’ and the velocimetry values were similar throughout the study. Intraovarian Doppler velocimetry makes it possible to distinguish between ovulatory and anovulatory cycles, and provides a non‐invasive diagnosis of the luteinized unruptured follicle syndrome. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of cleft palate: contribution of color Doppler ultrasound
Authors: Aubry M.‐C. , Aubry J.‐P.
Published: March 2003

The antenatal diagnosis of cleft palate by ultrasound can sometimes be difficult by conventional B‐mode imaging, especially when the tongue is in its normal position.

We describe two cases which illustrate the value of color Doppler in the antenatal diagnosis of cleft palate. In the first case, at 32 weeks' gestation, there was a large defect with a massive passage of flow extending from the buccal cavity into one of the nasal fossae. In the second case, at 22 weeks' gestation, a parasagittal view demonstrated the fetal tongue to be in the normal position, but there was an abnormal trajectory off low from the buccal cavity into one of the nasal fossae followed by an exit at the level of the cleft. Although a cleft lip was demonstrated on B‐mode imaging, we would not have been able to make the diagnosis of cleft palate without color Doppler.

This is the first report describing the contribution of color Doppler to the antenatal diagnosis of cleft palate. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Lethal multiple pterygium syndrome. The importance of fetal posture in mid‐trimester diagnosis by ultrasound: discussion and case report
Authors: Anthony J. , Mascarenhas L. , O'Brien J. , Battachargee A. K. , Gould S.
Published: March 2003

Lethal multiple pterygium syndrome and its variants provide an opportunity for prenatal diagnosis using mid‐trimester ultrasound examination. The case presented here highlights the importance of postural deformity in reaching a diagnosis and illustrates the importance of full ultrasound examination of the fetus even when the well‐documented common features of a condition are absent. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Outcome of twin gestations following sonographic demonstration of two heart beats in the first trimester
Authors: Benson C. B. , Doubilet P. M. , Laks M. P.
Published: March 2003

We conducted a prospective study to assess pregnancy outcome following a first‐trimester ultrasound examination demonstrating intrauterine twins with heart beats. Our study population included 68 cases of twin gestations in which a first‐trimester scan demonstrated two heart beats. We correlated pregnancy outcome with placentation type, gestational age, maternal age, and method of conception. There were 59 dichorionic and nine monochorionic gestations. Twenty‐six of the dichorionic pregnancies resulted from treatment for infertility. Among all 68 cases, 54 (79%) delivered viable twins, eight (12%) delivered one infant, and six (9%) delivered none. The outcome in dichorionic gestations (83% delivered twins, 12% singletons, 5% none) was significantly better than in monochorionic gestations (56%, 11%, 33%, respectively) (p < 0.05). Among dichorionic twins, pregnancy outcome was worse in twins initially identified on a 6–7.9 week ultrasound examination (74% delivered twins, 21% singletons, 6% none) as compared to those identified at 8–13 weeks (96%, 0%, 4%, respectively) (p < 0.05). The outcome in dichorionic gestations was worse in women over 35 compared to those under 35 (p < 0.05), and those with treatment for infertility compared to those who conceived naturally (p = 0.05). These results provide prognostic information about outcome of twin pregnancies scanned in the first trimester as a function of chorionicity, gestational age, maternal age, and method of conception. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic visualization of the fetal upper airway
Authors: Richards D. S. , Farah L. A.
Published: March 2003

Laryngeal obstruction is a life‐threatening condition which can sometimes be diagnosed by prenatal ultrasound examination. Dilatation of the fetal trachea is an important finding in these cases. Sonographic studies to evaluate the fetal upper airway were performed in 120 consecutive patients. The diameters of the trachea and pharynx were measured and our ability to visualize the trachea and the larynx was evaluated. The diameter of the trachea increased from a mean of 2.4 mm at 18 weeks to 4.6 mm at 38 weeks. The mean diameter of the pharynx increased from 4.4 mm at 18 weeks to 8.8 mm at 38 weeks. The fetal larynx was adequately visualized in 67%) of the cases, while the entire trachea was seen in 47% of the cases. Our success in visualizing the larynx and trachea was best between 20 and 30 weeks' gestation. This study shows that it is possible to obtain excellent views of the fetal airway in a high percentage of cases and reports the range of normal values for tracheal diameter. Early visualization of a diluted trachea may allow better management of a fetus with laryngeal obstruction. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Sonohysterography for distinguishing endometrial thickening from endometrial polyps in postmenopausal bleeding
Authors: Cohen J. R. , Luxman D. , Sagi J. , Yovel I. , Wolman I. , David M. P.
Published: March 2003

Sonohysterography, or sonographic uterine cavity visualization by uterine cavity distension, may help to distinguish true endometrial thickening from other intracavitary pathological conditions, assuming the same sonographic appearance. We examined 1.5 women with a thickened endometrium (range 10–25 mm) in sonography performed for postmenopausal bleeding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage. Histological examination of the seven polypoid structures revealed benign endometrial polyps in six patients, and one pedunculated submucous fibroid. In the patients undergoing diagnostic curettage, histological examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenocarcinoma. Two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Diagnosis of early ectopic pregnancy by measurement of the maternal serum to cul‐de‐sac fluid β‐hCG ratio
Authors: Hinney B. , Bertagnoli C. , Tobler‐Sommer M. , Osmers R. , Wuttke W. , Kuhn W.
Published: March 2003

In patients suspected of having an ectopic pregnancy, because of a positive β‐human chorionic gonadotropin (β‐hCG) test and a sonographically undetectable gestational sac, even laparoscopy cannot always achieve a precise diagnosis, when the gestational age is very early. This means that the patient has to be followed by repeated β‐hCG measurements and repeated laparoscopy, which are expensive and inconvenient for the patient. This paper reports on a method that is simple to perform and that will provide the clinician with valuable information about the strong likelihood of a tubal pregnancy when ultrasound and β‐hCG measurements raise the suspicion but are not diagnostic. A prerequisite for this approach is the availability of a minimal volume (1–2 ml) of peritoneal fluid in the pouch of Douglas. A total of 131 patients who had a positive β‐hCG test and an undetectable gestational sac within the uterine cavity and who had a small volume of cul‐de‐sac fluid were studied. The fluid was obtained transvaginally by means of an ultrasound‐guided automatic puncture system. The β‐hCG level was determined in the cul‐de‐sac fluid and in the maternal serum, for comparison. In two cases with tubal pregnancy, concentrated viscous blood samples were aspirated and β‐hCG concentrations could not be measured for technical reasons. In 129 cases, the ratio of levels of β‐hCG between serum and cul‐de‐sac fluid could be measured. In 42 out of 44 patients with intrauterine pregnancy, the ratio was greater than unity; in 82 out of 85 patients with a tubal pregnancy, the ratio was less than unity. With this ratio used for detection of tubal pregnancy, the diagnostic sensitivity of the test was 95.4% and the specificity was 95.2%. The positive predictive value was 97.6% and the negative predictive value 91.3% We conclude from these findings that the measurement of the maternal serum to cul‐de‐sac fluid β‐hCG ratio facilitated the early diagnosis of an ectopic pregnancy in the Fallopian tube. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal sonography and serum hCG in monitoring of presumed ectopic pregnancies selected for expectant management
Authors: Cacciatore B. , Korhonen J. , Stenman U.‐H. , Ylöstalo P.
Published: March 2003

We studied sonographic findings and levels of human chorionic gonadotropin (hCG) in 71 patients with a presumed ectopic pregnancy, recruited for conservative management, to find out whether these parameters may be useful in monitoring treatment. Patients were selected on the basis of decreasing hCG levels, minimal symptoms and an adnexal mass, suggestive of ectopic pregnancy, of ≤ 5 cm at transvaginal sonography. In 49 (69%) patients the ectopic pregnancy resolved spontaneously: the adnexal mass resolved significantly more slowly than did hCG levels. In 22 (31%) of the cases laparoscopy was required after an average of 9 days, because of worsening clinical symptoms. The initial size of the ectopic pregnancy did not significantly differ between the two groups, but it increased constantly in the laparoscopy group. The number of patients with free pelvic fluid also increased significantly in the laparoscopy group, whereas blood flow patterns at admission and during follow‐up did not differ between the two groups. A decrease in ectopic pregnancy size at day 7 had a sensitivity of 84% and a specificity of 100% in predicting spontaneous resolution. Transvaginal sonography monitoring appears useful in recognizing the ectopic pregnancies most likely to resolve spontaneously without complications. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Interobserver agreement in the results of Doppler examinations of extrauterine pelvic tumors
Authors: Sladkevicius P. , Valentin L.
Published: March 2003

The aim of this study was to evaluate interobserver agreement in the results of Doppler measurements of peak systolic velocity (PSV), time‐averaged maximum velocity (TAMXV) and the color content of tumor scans in extrauterine pelvic tumors. The results of transvaginal color and spectral Doppler examinations of 66 extrauterine pelvic masses obtained by two observers experienced in ultrasonography were compared. Each observer aimed to obtain the highest possible Doppler shift from arteries in the wall, septa and solid parts of each tumor. Tumor vascularization was assessed in terms of the ‘tumor color score’, i.e. the color content of the Doppler scan as rated for the tumor as a whole by each observer on a visual analog scale. The tumors were classified according to arbitrarily chosen cut‐off limits for the tumor color score, the highest tumor TAMXV and the highest tumor PSV. Inter‐class correlation coefficient values for TA MXV and PSV were ≥ 0.75, whereas that for tumor color score was 0.89. Interobserver agreement was complete for the detection of color in tumors (Kappa value 1.0), excellent for the recording of arterial Doppler shift spectra from tumors (Kappa value 0.82)) and moderate or good for classifying tumors based on cut‐off limits for TAMXV, PSV (Kappa values ranging from 0.44 to 0.67) and tumor color score (Kappa values ranging from 0.59 to 0.66). Despite the fact that two observers did not obtain the same absolute values for TAMXV, PSV or tumor color score, the interobserver agreement in the classification of tumors based on cut‐off limits for these variables was good. Therefore, in terms of reproducibility, it should be possible to use Doppler measurements of TAMXV, PSV and tumor color score as clinical variables to characterize extrauterine pelvic masses. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Measuring the thickness—is that all we have to do for sonographic assessment of endometrium in postmenopausal women?
Authors: Weigel M. , Friese K. , Strittmatter H.‐J. , Melchert F.
Published: March 2003

For sonographic assessment of the endometrium in postmenopausal women, measurement of the maximum thickness is used in many cases as the sole criterion. The cut‐off values stated in the literature, however, vary considerably. This prospective study examined 200 female patients in order to ascertain the value of echomorphology in addition to endometrial biometry.

Up to an overall endometrial thickness of 3 mm, we observed only histologies without any pathological findings, whereas from an endometrial thickness of 10 mm upwards, only polyps, hyperplasias and carcinomas were found. In more than a third of our patients, the endometrial thickness was between 3 and 10 mm where the structure of the endometrium could reflect the possible histological finding. homogeneity, low echo and a sonographically depictable central echo between symmetrical endometrial leaves were an indication for absence of pathological findings, whereas heterogeneity and high echogenicity were pointers for pathological changes.

In contrast to the sole measurement of endometrial thickness in the postmenopause, the combined metric and morphological parameters improve not only the predictability of pathological findings but, above all, the selectivity of the vaginosonographic assessment of the endometrium in postmenopausal women. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
The effect of feedback on anxiety levels during ultrasound scanning for ovarian cancer
Authors: Tadmor O. P. , Zlotogorski Z. , Galron‐Duniec M. L , Rabinowitz R. , Neuman M. , Beller U. , Diamant Y. Z.
Published: March 2003

Women undergoing ultrasound scanning for the detection of ovarian cancer benefit psychologically from the examination, which has been shown to reduce levels of anxiety, depression, hostility and complaints about somatic symptoms. However, it is not completely clear what aspects of the ultrasound examination are responsible for these effects, and how these beneficial psychological effects vary under different circumstances. This study examined, in particular, the effect of various levels of feedback on patients' anxiety levels before and after ultrasound examination.

Two hundred and seven women were randomly assigned to two different experimental conditions: high feedback and low feedback. The subjects' levels of anxiety (both trait and state anxiety) were measured immediately before and after the ultrasound examination. The women's individual risk factors for ovarian cancer were also recorded.

This study showed a significant decrease in the level of trait anxiety following ultrasound scanning. The decrease in anxiety did not relate to the level of feedback provided to the patients, nor to the woman's degree of risk for ovarian cancer. The results are discussed in terms of possible implications for clinical care and the allocation of resources in the medical system. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Normal fetal pulmonary venous blood flow velocity
Authors: Laudy J. A. M. , Huisman T. W. A. , de Ridder M. A. J. , Wladimiroff J. W.
Published: March 2003

Our objectives were to describe the normal pulmonary venous blood flow velocity waveform and to establish reference ranges for the second half of pregnancy in healthy human fetuses. A total of 123 women with uncomplicated pregnancies of between 20 and 40 weeks were examined, using a combined color‐coded Doppler and two‐dimensional real‐time ultrasound system. Pulsed Doppler flow velocity waveforms of pulmonary venous drainage into the left atrium were obtained from a transverse cross section of the fetal chest at the level of the cardiac four‐chamber view. All waveforms were obtained during fetal apnea.

The success rate in obtaining the pulmonary venous waveform was 81%. The waveform displayed a biphasic forward flow profile with a systolic and diastolic component. Peak systolic, peak diastolic and time‐averaged velocities demonstrated a gestational age‐related rise, whereas the peak systolic/peak diastolic ratio showed a gestational age‐related reduction. The nature of the fetal pulmonary venous flow velocity waveform pattern suggests positive pressure towards the left atrium throughout the cardiac cycle. We speculate that an increase in volume flow and the pulmonary venous pressure gradient play a role in the gestational age‐related changes in pulmonary venous flow velocities. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Impact of prenatal mid‐trimester screening on the prevalence of fetal structural anomalies: a prospective epidemiological study
Authors: Papp Z. , Tóh‐Pál E. , Papp Cs. , Tóz Z. , Szabó M. , Veress L. , Tórók O.
Published: March 2003

The objective of this study was to evuluate the effectiveness of the measurement of maternal serum α‐fetoprotein (MSAFP) at 16 weeks and a subsequent routine ultrasound screening at 18–20 weeks' gestation and the impact on the birth prevalence of congenital structural anomalies in an unselected pregnant populution of Hungary in a prospective epidemiological study.

A total of 63 794 pregnant women (representing one‐sixth of the population of Hungary) were offered this screening program over 3 years (1988–90). Of the pregnant population, 75.7% (48 312) received MSAFP screening and in 81.0% (51675), at least one ultrasound scan was performed.

In the screened pregnancies, 496 craniospinal, thoracoabdominal, urogenital and other severe major anomalies occurred: 317 were detected at 18–20 weeks (sensitivity 63.1%; specificity 100.0%; positive predictive vulue 100.0%). The sensitivity of ultrasound scanning was significantly higher (p < 0.05) than that of the MSAFP screening. (At the time of ultrasound scanning the MSAFP value was known.)

In this study, the less serious anomalies such as hydrocele, hypospadius and undescended testicle were not systematically searched for, but the birth prevalences were calculated. The overall mid‐trimester prevalence of severe plus less severe major anomalies was 2.26%.

The birth prevalences of severe major anomalies were 0.57 (craniospinal), 4.36 (thoracoabdominal and urogenital) and 1.21 (other severe) per 1000. These values were lower than the mid‐trimester prevalences which were 2.94, 5.20 and 2.06 per 1000, respectively. The prevalence values at the age of 1 year were also calculated (0.36, 2.21, 0.54 per 1000, respectively).

We conclude that our screening program with availability of termination of, pregnancy could significantly (p < 0.05) reduce the prevalence of severe major abnormalities at birth. Training programs in cardiac scanning are required. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Assessment of myometrial infiltration and preoperative staging by transvaginal ultrasound in patients with endometrial carcinoma
Authors: Weber G. , Merz E. , Bahlmann F. , Mitze M. , Weikel W. , Knapstein P. G.
Published: March 2003

In recent years, the incidence of carcinoma of the endometrium has shown an upward trend, such that it is currently the most frequently encountered malignant tumor of the female genital tract. An accurate preoperative diagnosis of the extent and spread of such carcinomas is of crucial importance for the selection of a therapeutic approach appropriate to the stage and infiltration of each particular tumor.

In a prospective study of 80 patients with a carcinoma of the endometrium, performed at the Department of Obstetrics and Gynecology of the University of Mainz, we compared the preoperative findings of transvaginal sonography with the postoperative histological results with respect to the following parameters: endometrial thickness, demarcation of the boundary of the endometrium, myometrial infiltration depth and staging.

In all of these patients, sonography revealed a distinct increase in the thickness of the endometrium. In all cases, the structure of the endometrium was found to be heterogeneous, with an irregular and poorly delineated boundary. Assessments of the depth of tumor infiltration and the tumor staging obtained by transvaginal sonography were found to correlate with the histological findings in 85% and 87.5% of the cases, respectively. Thus, in cases of endometrial carcinoma, transvaginal sonography has an essential role to play in devising an individualized operative treatment program that takes into account the extent, spread and stage of the tumor. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Extrauterine twin‐twin transfusion syndrome after birth in conjoined twins
Authors: Shyu M.‐K. , Shih J.‐C. , Lee C.‐N. , Wu C.‐C. , Jou H.‐J. , Hsieh F.‐J. , Chang M.‐H. , Tsou Yau K.‐I. , Teng R.‐J. , Lin G.‐J. , Li Y.‐W.
Published: March 2003

Cross‐circulation of conjoined twins in utero has been demonstrated and the extent of its severity has varied. Significant ‘extrauterine’ twin‐twin transfusion syndrome after birth, however, caused by an unbalanced shunting within the circulation has not been reported. In a case of omphalopagus conjoined twins complicated by hypovolemia in one twin and hypervolemia in the other, we demonstrated by color Doppler imaging an aberrant vessel from the hepatic artery of one twin to the hepatic vein of the other. Unbalanced shunting through this aberrant vessel was suspected and urgent separation of the conjoined twins was undertaken. Circulatory changes after birth leading to ‘extrauterine twin‐twin transfusion syndrome’ are discussed. A possible explanation of the pathophysiology of intrauterine twin‐twin transfusion syndrome is also given. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of a chest wall hamartoma and sternal cleft
Authors: Rose N. C. , Coleman B. G. , Wallace D. , Gaupman K. , Ruchelli E.
Published: March 2003

We present the prenatal evaluation and diagnosis of a disorganized chest wall hamartoma (with underlying sternal cleft in a family with a prior offspring with the VATER association. The possibility that these conditions are linked to mesodermal defects with a common pathogenic etiology is suggested. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The significance of non‐visualization of the fetal bladder during an ultrasound examination to evaluate second‐trimester oligohydramnios
Authors: Brumfield C. G. , Guinn D. , Davis R. , Owen J. , Wenstrom K. , Mize P.
Published: March 2003

Our objective was to determine the pregnancy outcome after targeted sonography performed for the evaluation of second‐trimester oligohydramnios fails to visualize the fetal bladder. A retrospective review identified patients in 1990–94 who were referred for targeted sonography from 16 to 24 weeks to evaluate oligohydramnios. The ultrasound records and photographs from the initial examination were reviewed and compared to later pregnancy outcome data obtained by reviewing delivery and neonatal records, neonatal renal ultrasound reports or autopsy information.

Complete outcome data were available in 98 patients. The fetal bladder was not visualized in 29 patients (30%). Post‐delivery analysis of the fetal urinary tract was performed in 25 patients either by autopsy or by neonatal renal ultrasound scanning. A severe anatomic malformation of the urinary system was present and had been detected by targeted sonography in 23 of 25 cases (92%). The remaining two fetuses were found to have anatomically normal urinary tracts at autopsy, but other pathological findings suggested that a functional derangement of the urinary system had led to non‐visualization of the bladder at ultrasound examination.

Non‐visualization of the fetal bladder during targeted sonography to evaluate oligohydramnios indicates a severe anatomic or functional problem of the fetal urinary tract. In our study, this ultrasound finding was associated with universal fetal or neonatal death. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The effect of amniotic sheet orientation on subsequent maternal and fetal complications
Authors: Lazebnik N. , Hill L. M. , Many A. , Martin J. G.
Published: March 2003

The purpose of this investigation was two‐fold, first, to determine the incidence of amniotic sheets in our obstetric population; and, second, to elucidate the maternal and fetal complications associated with this particular finding.

In this retrospective study, we searched the computerized records of the ultrasound department for the presence of amniotic sheets, in singleton pregnancies from 1 March 1991 to 17 September 1993. Sonograpbic criteria for an amniotic sheet included the findings that (1) a reflective membrane attached to the placenta at one end or the other, with measurable thickness, was identified traversing the amniotic fluid; and (2) the fetus was not attached to the membrane, and fetal ability to move without restriction was ascertained.

An amniotic sheet was identified in 79 of 17 553 examinations (0.45%) performed between 12 and 28 weeks' gestation. Two subsets of amniotic sheets were identified: perpendicular and not perpendicular. The sheets in the first subset were orientated perpendicular to the placental surface and were more likely to be associated with an abnormal presentation at delivery (p < 0.001) and a history of pelvic inflammatory disease, but not with a history of prior Cesarean section, or previous dilatation and curettage. The second subset of amniotic sheets were non‐perpendicular, either oblique or parallel, in orientation to the placental surface and were associated with fewer maternal complications. Of the study group, 40.7% had a history of vaginal bleeding. The incidence of vaginal bleeding was not significantly different between those patients with perpendicular or those with non‐perpendicular amniotic sheets.

We conclude that perpendicular, in contrast to non‐perpendicular, amniotic sheets are more commonly associated with breech presentation art term and a past history of pelvic inflammatory disease. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Is the fetal brain‐sparing effect a risk factor for the development of intraventricular hemorrhage in the preterm infant?
Authors: Mari G. , Abuhamad A. Z. , Keller M. , Verpairojkit B. , Ment L. , Copel J. A.
Published: March 2003

The intrauterine identification of fetuses at risk of developing intraventricular hemorrhage would be helpful to the perinatologist, in light of the recent results which suggest that indomethacin given to the infant reduces the risk of developing intraventricular hemorrhage. We hypothesized that fetuses undergoing brain sparing, as identified by a lowered pulsatility index (PI) in the middle cerebral artery, and delivered prior to 34 weeks may differ in terms of being at risk for intraventricular hemorrhage from those fetuses without the brain‐sparing effect.

The middle cerebral artery PI was studied in 43 fetuses between 25 and 33.6 weeks' gestation. The pregnancies were complicated by pre‐eclampsia, intrauterine growth restriction (IUGR) and preterm labor. A cranial sonogram was performed during the first postnatal week in all the neonates.

Intraventricular hemorrhage was present in 6/22 infants with a normal middle cerebral artery PI (group A) and 0/21 with an abnormal middle cerebral artery PI (group B) (p < 0.05). The mothers of the six fetuses who developed intraventricular hemorrhage underwent preterm labor. IUGR fetuses and pre‐eclampsia were more common in group B. No difference was found between the two groups when the following variables were compared: (1) gestational age at the time of the Doppler study; (2) gestational age at delivery; (3) antenatal exposure to steroids; (4) antenatal exposure to magnesium; (5) Apgar score greater than 6 at 5 min; (6) respiratory distress syndrome in the newborn; (7) necrotizing enterocolitis; (8) Cesarean section; and (9) sepsis in the infant.

Although the mean birth weight was significantly lower in group B than group A, no fetus in this group developed intraventricular hemorrhage. The fetal brain‐sparing effect, pre‐eclampsia and IUGR were associated with a lower risk of neonatal intraventricular hemorrhage than was preterm labor. Preterm labor appears to be a key factor in the development of intraventicular hemorrhage and must be included when testing associations with intraventricular hemorrhage. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
The relationship between preoperative endometrial thickness, the anteroposterior diameter of the uterus and clinical outcome following transcervical resection of the endometrium
Authors: Istre O. , Forman A. , Bourne T. H.
Published: March 2003

The objective of this study was to identify whether the endometrial thickness, or the anteroposterior diameter of the uterus as assessed by transvaginal ultrasonography (TVS), could be used to predict the clinical outcome following transcervical resection of the endometrium (TCRE).

An open observational trial was carried out, involving 195 consecutive patients undergoing TCRE, 188 of whom completed follow‐up. The patients were examined by TVS preoperatively, and then 6 weeks, 6 months and 1 year following TCRE. In all examinations, endometrial thickness, the anteroposterior diameter and residual endometrium, uterine morphology and the clinical outcome as measured by pain reduction, bleeding index and amenorrhea were assessed.

Patients with a preoperative endometrial thickness of 8 mm or less had a higher rate of amenorrhea after 1 year than patients with an endometrial thickness exceeding 8 mm. Outcome did not relate to the histological phase of the endometrium obtained during resection. Neither the uterine anteroposterior diameter, or the presence of submucous fibroids, had any influence on the clinical outcome. Cavity fluid was observed in some cases but was not always associated with symptoms. Residual endometrium could be detected by TVS in 38% of the women after 1 year, but the vast majority of these patients reported a satisfactory outcome from the procedure.

We conclude that the size of the anteroposterior diameter does not affect the clinical outcome of TCRE, whilst the preoperative endometrial thickness does have a significant impact on the likelihood of achieving amenorrhea after 1 year. The data suggest that TCRE should preferably be performed when the endometrium is at its thinnest and that there may be a useful role for agents that produce endometrial atrophy prior to surgery. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal color Doppler sonography in predicting the response to chemotherapy in advanced cervical cancer
Authors: Greco P. , Cormio G. , Vimercati A. , Loverro G. , Selvaggi L.
Published: March 2003

The role of Doppler ultrasonography in the diagnosis of advanced cervical cancer continues to be controversial. This study was designed to assess the clinical value of the technique in terms of predicting the response to chemotherapy in patients with advanced cervical cancer.

Twenty‐three patients with cancer of the cervix (FIGO stages Ib bulky‐IIIb) and 20 healthy women underwent transvaginal color Doppler assessment of the uterine arteries (both ascending and descending branches) and the intracervical vessels. Statistical analysis was performed by Student's t test for paired and unpaired data.

The intracervical vessels were the only site to show significant differences both in the resistance and in velocity parameters. A subgroup of 14 patients, scheduled for neoadjuvant chemotherapy, were evaluated before and at the completion of treatment. A significant increase in resistance and pulsatility index values and a decrease in peak systolic velocity were observed in the ten patients who responded to chemotherapy.

Preliminary results of our study suggest that Doppler parameters can be clinically useful in the evaluation of the response to neoadjuvant chemotherapy. More patients, sampled in a prospective way in order to increase the number of non‐responders, would be necessary to assess the possible role of Doppler ultrasound in predicting which patients will respond to chemotherapy. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Premature contractions: possible influence of sonographic measurement of cervical length on clinical management
Authors: Rageth J. C. , Kernen B. , Saurenmann E. , Unger C.
Published: March 2003

In a retrospective case control study with historical controls, the influence of the introduction of vaginal sonographic cervical length measurement on the utilization of hospital services and pregnancy outcome of gravid women at risk of preterm delivery was examined.

Prior to the introduction of vaginal ultrasonography to measure cervical length, we registered 76 hospitalizations totalling 1827 hospitalization days due to premature cervical ripening and/or premature labor in 1991 and 1992. In 1994, and 1995, after vaginal ultrasonography was introduced and intravenous tocolysis was limited to cases with cervical shortening to less than 3 cm, there were 64 admissions resulting in just 869 hospitalization days. Long‐term hospitalizations (over 10 days) were reduced from 55 to 25 cases (p < 0.0001) and the median length of hospital stay decreased from 18 to 8 days (p < 0.0001). The number of preterm births ( ≤ 37 weeks) remained stable: 12 cases in 1991–1992 and 13 cases in 1994–1995.

In conclusion, vaginal sonographic measurement of cervical length provides an objective criterion for cervical shortening with premature labor. The method could therefore be a suitable means of reducing unnecessary therapeutic interventions in gravid women with premature contractions and/or cervical dilatation. A prospective randomized trial to confirm these findings is suggested. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Giant glioependymal cyst resembling holoprosencephaly on prenatal ultrasound: case report and review of the literature
Authors: Pelkey T. J. , Ferguson J. E. , Veille J.‐C. , Alston S. R.
Published: March 2003

We report the earliest in utero presentation of a ‘giant’ glioependymal cyst detected on routine prenatal ultrasound at 22 weeks estimated gestational age. The clinicopathologic features of these rare lesions are reviewed as well as previous reports of glioependymal cysts detected in utero. The effects of large intracranial cysts on neurodevelopment are discussed as well as the differential diagnosis of infantile intracranial cysts and therapeutic alternatives. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Early sonographic diagnosis of Jarcho‐Levin syndrome: a prospective screening program in one family
Authors: Eliyahu S. , Weiner E. , Lahav D. , Shalev E.
Published: March 2003

The purpose of this study was to evaluate the possibility of early diagnosis of Jarcho‐Levin syndrome by ultrasound examination of the fetus.

Over a period of 5 years, nine women from one Arab family, known to carry an autosomal recessive form of the disease, were prospectively and repeatedly examined using ultrasound. Out of eight pregnancies, four fetuses were diagnosed as being affected by the disease as early as 12 gestational weeks. Three elected to terminate the pregnancy before viability and one was born at term. There were no misdiagnoses.

We conclude that early prenatal ultrasonographic diagnosis of Jarcho‐Levin syndrome is feasible, although later sonographic confirmation is often warranted. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Ultrasonography of the ureter during laparoscopic gynecological surgery
Authors: Helin‐Martikainen H.‐L. , Kirkinen P.
Published: March 2003

The purpose of this study was to evaluate the ultrasonographic appearance and normal function of the ureter during gynecological surgery. The study group consisted of 14 gynecological patients scheduled for laparoscopy and 12 patients scheduled for laparotomy. Under standardized anesthesia conditions before pelvic surgery, the appearance, location, dimensions and peristaltic activity of the ureter were examined using a 7.5‐MHz flexible laparoscopic linear transducer probe. Imaging of the ureter was possible in all cases. The ureteral lumen, mucosa, sub‐epithelial connective tissue and muscular layer could be imaged as a tubular structure with low‐level echoes. The separate layers, however, could not be differentiated by ultrasonography. The ureteral diameters at resting phase did not differ between the open surgery and laparoscopy groups. During peristaltic activity the maximal diameter was smaller in the laparoscopy group. The mean number of peristaltic waves was 23 ± 7 waves per 5 min and this did not differ significantly between the open and laparoscopic surgery groups. Intermittent periods of retrograde flow were detected in 21 of the 26 patients. As seen in this study, ureteral location and function can be ultrasonographically evaluated during surgery and laparoscopic conditions do not have much influence on the ureter. The role of laparoscopic ultrasonography in lowering the incidence of ureteral complications in gynecological surgery needs further study. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Restrictive dermopathy and associated prenatal ultrasound findings: case report
Authors: van der Stege J. G. , van Straaten H. L. M. , van der Walt A. C. , van Eyck J.
Published: March 2003

Restrictive dermopathy is a lethal autosomal recessive skin disease. Prenatal diagnosis has not yet been reported. We present a case of restrictive dermopathy and describe the associated prenatal sonographic findings. A continuously open mouth was the most striking feature and this sonographic finding may be a marker of a skin disease. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasonographic characterization of ovarian masses: comparison of five scoring systems in a multicenter study
Authors: Ferrazzi E. , Zanetta G. , Dordoni D. , Berlanda N. , Mezzopane R. , Lissoni G.
Published: March 2003

The aim of this work was to test and compare the accuracy of five different morphological scoring systems to identify malignant ovarian masses in a prospective multicenter study. Four of the systems had previously been reported by Granberg, Sassone, De Priest and Lerner and the fifth is newly developed.

A total of 330 ovarian neoplasms were collected in three different centers, which adopted the same diagnostic procedures. Of these, 261 masses were benign (mean diameter 50 ± 26 mm) and 69 were malignant (mean diameter 69 ± 33 mm) (prevalence 21%). The area under the receiver operating characteristic (ROC) curve for the multicenter score was 0.84. This was significantly better than the areas of the other four scores which ranged from 0.72 to 0.75. The cut‐off levels derived from the five ROC curves achieved a sensitivity that ranged from 74% (Sassone score) to 88% (De Priest score ≥ 5), and a specificity from 40% (De Priest) to 67% (multicenter); the highest positive predictive value was 41% (multicenter). With a cut‐off level of 9, the accuracy of the multicenter score was significantly better than the scores of Granberg and De Priest (McNemar's test p < 0.0001). Similar results were obtained in 207 ovarian masses of ≤ 5 cm in mean diameter, and when 19 borderline and 11 stage 1 cancers only were considered. For the clinical purposes of a screening test we also checked a possible cut‐off level of ≥ 8, which increased the sensitivity to 93% with a drop of specificity to 56%. With the use of the same criteria for the scores of the different authors, the following values were obtained for sensitivity: 96%, 81%, 93% and 90%; and for specificity: 23%, 56%, 28% and 49%.

The multicenter score performed well at distinguishing malignant from benign lesions, and was better than the other four traditional scores, for both large and small masses. This was mainly due to the introduction of two criteria that allowed correction for typical dermoids and endohemorrhagic corpora lutea. A completely reliable differentiation of benign from malignant masses cannot be obtained by sonographic imaging alone. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology