bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of antenatal ultrasound diagnosis assessed by Gold Standard – postmortem
Authors: Amaraddio D. M. , Chan F. Y. , Stone M. , Cooper D. , Payton D.
Published: March 2003

Background:  Antenatal ultrasound is an accepted and widespread method for prenatal diagnosis. It has been shown that the performance of ultrasound in tertiary referral centers is better than in general units. Even so, some anomalies could still be missed in tertiary centers. Audits based on neonatal outcomes may not be completely accurate, as some anomalies may not be apparent yet. Postmortem is considered to be the Gold Standard for all identifiable fetal anomalies.

Objective:  To evaluate the accuracy of antenatal ultrasound diagnosis in a tertiary referral center, using postmortem findings as the Gold Standard.

Methods:  The departmental ultrasound database was searched from 1993 to 1996. All fetuses who had a fetal or perinatal death were identified. This was matched with the database in the department of pathology. Charts of fetuses who matched the entry criteria (antenatal ultrasound performed in the department, and postmortem available) were reviewed. The postmortem findings were compared to the ultrasound report.

Results:  One hundred and ninety‐two fetuses with perinatal death were identified from the ultrasound database. One hundred and four received a postmortem. In 64 cases (70.3%), there was full concordance between postmortem and ultrasound findings. In 23 cases (25.3%), the ultrasound findings were confirmed, but additional anomalies were detected at postmortem. In three cases (3.3%), there were minor variations between the ultrasound and postmortem findings. There was no false positive diagnosis, and the only major anomaly not detected antenatally was one case with placenta accreta. Of all organ systems classified, best performance was in neural tube defects, where full concordance was found in 95.6% of cases. Most of the variations between ultrasound and postmortem were in fetuses with multiple anomalies. None of these variations would have affected obstetric management.

Conclusion:  In 96.7% of the fetuses identified to have congenital anomalies in this series, the findings were confirmed in postmortem. Postmortem contributed further information in 28.6% of cases. While antenatal ultrasound in this tertiary setting is shown to be accurate, postmortem is still important for future counseling.
MRI and US imaging in fetal anomalies
Authors: Ximenes R. , Ximenes D. S. , Ximenes A. , Sjzenfeld J. , Ajzen S. , D'Hippolitto G. , Goldman S. M. , Carvalho A. C. S.
Published: March 2003

Purpose:  The use of MRI in diagnose fetal abnormalities and the correlation with ultrasound.

Methods:  Twenty‐five patents in which were diagnosed fetal abnormalities (CNS, thorax and renal) were submitted to MRI. The stage of pregnancy at the time of MR imaging ranged 16–34 weeks gestation. The half‐Fourier single shot rapid acquisition with relaxation enhancement (RARE) technique was used to obtain T2‐weighted images, this sequence has excellent contrast resolution of fetal tissues. It is a single selection acquisition technique limits the artifacts related to maternal and fetal motion.

Results:  Fetus with CNS, thorax and renal abnormalities were submitted to MRI study. The CNS anomalies were vein of Galen aneurysm, archnoid cyst, Dandy–Walker complex, megacysterna magna, espina bifida. Thorax anomalies were adenomatoid cystic malformation. The renal anomalies were obstructive urophaty, renal displasia. The images of the ultrasound scans and the MRI images were analyzed individually and after compared each other to understand the limits and benefits of each technique.

Conclusion:  Fast MR imaging techniques provide excellent resolution for imaging the fetal anatomies without the need for maternal or fetal sedation, and should be used as a complementary tool in the diagnosis of fetal anomalies.
Morphological and color Doppler velocimetry ultrasound evaluation of breast solid lumps – a malignancy S‐score proposition
Authors: Marussi E. F. , Cecatti J. G. , Alvarenga M. , Machado M. R. M. , Franzin C. M. M. O. , Martinez E. C.
Published: March 2003

The purpose was to evaluate the sensitivity, specificity and predictives values for each morphological or CDV ultrasound criteria, alone or associated, for the prediction of breast's solid lumps malignancy and to create a malignancy's score. We studied 430 women with 502 breast lumps (359 benign and 143 malignant). They were cared at CAISM‐UNICAMP from May 1998 to November 1999 when a US examination of the breast were performed and the results compared with the pathological diagnosis, the gold standard. They had been evaluated through US morphological criteria such as borders, posterior wall, ecotexture, ecogenic halo, Cooper ligaments, diameters, volume, skin, compressibility, ratio between width and depth and CDV criteria such venous flow, color index, maximum systolic velocity, resistance index, pulsatility index and A/B ratio intra‐ and peritumoral. For data analysis, the groups of benign and malignant tumors were compared regarding control variables adjusted by age via logistic regression. The best individual performance among the morphologic criteria, were borders, ecogenic halo, Cooper ligaments, ecotexture, width/depth ratio and biggest diameter and among the CDV criteria, they were the color index, maximum systolic velocity, pulsatility and resistance index inside tumor. In the logistic regression analysis, the criteria identified as statistically associated to the malignancy were the borders, ecogenic halo, the largest diameter and the woman's age. They compound the equation of the malignancy's score, whose performance was of 95.2%. No one CDV criteria improved the global performance of the score. Excluding subjective criteria, the logistic regression analysis selected, for compound another equation of malignancy's score, the woman's age, the lump's largest diameter, the measure of the Cooper ligament and the VSmx inside the lump. This second score had a slightly lower performance than the first one (92% against 95.2%).
Value of texture analysis in ultrasonographic examination of exised specimens of breast masses
Authors: Bader W. , Westhof G. , Hackmann J. , Dieterle S. , Hatzmann W. , Boehmer S.
Published: March 2003

Purpose:  Specimen sonography is necessary for successful surgical excision of non‐palpable breast masses, discovered only in breast ultrasound. But is there any difference in echogenicity and echostructure between native and in vitro sonography?

Methods:  The ultrasound images from 46 benign and malignant breast tumors were documented under standardized conditions pre‐ and postoperative, using a linear array machine (Shimadzu, US device SDU‐490) and 7.5 MHz transducer with a water path interposed between the transducer and skin or the plastic bag, containing the fresh specimens after surgical excision. Two images of each tumor were documented on a 3/4 in. Sony high‐band video device (U‐matic BVU‐800‐P), and the recordings were digitized with an 8‐bit resolution in 384 × 288 pixels (frame grabber band, Ing. Büro Fa. Fricke, Berlin). In each sonographic image, the maximum area of the region of interest of the tumor was marked and then subjected to consecutive texture analysis and correlation to the histological findings. For evaluation of tumor status eight parameters of first and second order texture statistics (grey level histogram, Fourier analysis, co‐occurrence matrix) were applied.

Results:  In all cases, the mass was clearly identified on sonograms obtained in the operating room. Fibroadenomas (n = 11), fibrocystic diseases (n = 5) and ductal carcinomas (n = 26) showed comparable results in texture analysis. On the other hand, lobular carcinomas (n = 4) were clearly different in all parameters, in especially mean of grey level, homogeneity and contrast (P < 0.001 on the basis of Wilcoxon and Student's t‐test).

Conclusions:  In vitro examination is a rapid and efficient method of localizing impalpable breast masses in excised specimens, but differences in echostructure and echogenicity are possible.
Uterine artery Doppler blood flow resistance indices in the second half of pregnancy: measures of central tendency, distribution, inter‐ratio dependency, and explanation of variation
Authors: Thompson M. O. , Vines K. S. , Aqualina J. , Harrington K. F.
Published: March 2003

Study objectives:  To evaluate the three commonly used indices of Doppler blood flow resistance in clinical practice for the uterine artery. By assessing the measures of central tendency, dispersion, and variation, to determine the most appropriate index for clinical use transabdominally in the second half of pregnancy.

Methods:  A prospective study of uterine artery Doppler measurement in singleton pregnancies between 18 and 32 weeks gestation. Using previously described methods, two independent measurements were obtained transabdominally from each side in all subjects. The systolic/diastolic ratio (SD ratio), pulsatility index (PI), and resistance index (RI) were recorded from both the right and left uterine artery in turn. All measurements were obtained by a single operator (MOT) using the same machine (Philips SD 800). The results were analyzed statistically for the measures of dispersion, distribution, and the variation explained.

Results:  There were 1796 observations from 449 subjects in total, with the SD ratio showing the widest dispersion. The PI measurements were intermediate with respect to both, while the RI showed the least dispersion. The RI distribution was the closest to a naturally distributed (Gaussian) pattern, followed by the PI. The SD ratio did not appear to conform to a normal distribution. The interquartile ranges (IRQ) for the SD ratio were 0.71, 0.73 (left‐ and right‐uterine artery, respectively); PI: 0.42, 0.41; and RI: 0.15, 0.17. The mean of three derived measurements of the RI was sufficient to account for over 99% of the observed variation.

Conclusions:  Differences reported between the different resistance and pulsatility Doppler indices could be due to either random or systematic error, or a combination of both. The observations from this study suggest that when the RI is used, these are kept to a minimum. These findings may be helpful in selecting the appropriate index for uterine artery Doppler screening and clinical applications in the second half of pregnancy.
Ultrasound during breast‐feeding in normal term infants
Authors: Jacobs L. A.
Published: March 2003

The primary objective of this pilot study of infant feeding mechanisms on ultrasound was to develop local ultrasound techniques to assess the infant oral cavity during breast‐feeding.

Study methods:  A convenience sample of 32 volunteers with term babies were invited for ultrasound during a breast‐feed in week 1 and 4 of life. Useable data was obtained in 22 participants but not all attended for both scans yielding 36/44. The whole breast‐feeding scan was videotaped for analysis later. Conventionally, accepted positioning and attachment criteria were used. The infant was weighed before and after feeding to satisfaction from one breast. A submental approach was used to obtain a median sagittal view of the nipple position, hard and soft palate, tongue movements and the relationship between these intraoral structures. Various designs and frequency of transducers were tested. The optimal transducer is an EC‐7 endocavity transducer with a 135° end‐firing 7 MHz small radius curved array on a long, thin handle that does not interfere with feeding positioning.

Conclusions:  The relationship of nipple to hard palate/soft palate junction is shown to be variable with distances from 3 to 11 mm. The participants had previous and present history of breast‐feeding success. They were not specifically directed to attach in a particular way since their current infants were recruited as thriving, contented examples of the appearances of ‘normal breast‐feeding’. It is unknown, whether the participants in the landmark study by Woolridge et al. (1986), were instructed in feeding attachment prior to ultrasound imaging thus influencing the nipple position. Further data analysis will detect any infant maturation or learning differences between weeks 1 and 4. This simple ultrasound technique can be applied to the assessment of infant feeding problems and preterm infant feeding behavior.
Comparison of power Doppler and velocimetry in predicting outcome of high‐risk pregnancy
Authors: Dubiel M. A. , Breborowicz G. H. , Marsal K. , Gudmundsson S.
Published: March 2003

Purpose:  To prospectively evaluate semiquantitative computer analysis of power Doppler (PD) signals in the placenta, fetal brain, lung, liver, kidney and spleen in high‐risk pregnancies in relationship to perinatal outcome and also to compare tissue blood flow in the fetal brain and placenta with Doppler velocimetry.

Methods:  PD signals were recorded in 180 high‐risk pregnancies between 27 and 41 weeks of gestation. Images from PD scans angiographics were transmitted for computer analysis of pixel intensity. Mean flow signal intensity was recorded for each organ. The PD brain/lung ratio was calculated. The PD results were plotted on reference values and related to perinatal outcome. Middle cerebral (MCA), umbilical (UA) and uterine artery (Ut. A) velocimetry was also performed.

Results:  High‐risk pregnancies displayed lower PD signal intensity from the placenta, fetal lung, liver and kidney as compared to normal. However, the brain and spleen signals showed higher intensities suggesting increased tissue perfusion. PD signals from the fetal brain, lung, placenta and PD brain/lung ratio were correlated with perinatal outcome. The PD signal intensity from the fetal liver, kidney and spleen showed poor correlation with perinatal outcome. Fetal brain tissue blood flow showed better correlation with the outcome than MCA velocimetry. Placental tissue blood flow results were similar in predicting outcome to those obtained by means of UA and Ut. A velocimetry.

Conclusions:  In comparison with conventional Doppler velocimetry, computer analysis of PD signals, give similar results in the prediction of adverse perinatal outcome.
The accuracy and indications of fetal echocardiography in high‐risk patients: a 4‐year clinical experience in an obstetric unit
Authors: Martínez J. M. , Gómez O. , Puerto B. , Borrell A. , Palacio M. , Cararach V.
Published: March 2003

Objective:  To evaluate the accuracy and assess the indications of fetal echocardiography to diagnose structural heart disease in our high‐risk population, by an obstetric team.

Methodology:  Over a 4‐year period, a transabdominal echocardiography was performed in 912 high‐risk pregnancies for congenital heart disease at 18–38 weeks of gestation. In the last 140 cases an early examination combining either the transvaginal or the transabdominal route at 13–16 weeks was also carried out. Follow up was obtained from neonatal examinations and autopsies. The main indications for referral were: pregestational diabetes mellitus, family risk, increased nuchal translucency, suspected cardiac anomaly at screening ultrasound, women at high risk of chromosomal abnormality reluctant to invasive test, suspected arrhythmia, single umbilical artery, exposure to teratogens, and pregnancies affected by a chromosomal abnormality.

Results:  There were 79 (8.6%) major congenital heart defects, and most of them were yielded in the group of screening by ultrasound. Seventy of them (88.6%) were diagnosed correctly as abnormal prenatally. Atrioventricular septal defects (21 cases) and hypoplastic left ventricle syndrome (12 cases) were the most prevalent heart anomalies in the fetus. Isolated septal defects and coarctation of the aorta were the most difficult lesions to detect, being the ones with false positive and negative diagnosis. Another four cases of insignificant (<3 mm, no surgery nor medical treatment required) ventricular septal defects were overlooked during gestation, but closed by the sixth month of life. Fifteen apparently normal cases were lost to follow up.

Conclusion:  Our obstetric team results, in accordance with others previously published, show a good effectiveness to diagnose congenital heart anomalies. Most major detectable cardiac anomalies occur in the group without previously known risk.
Intrapartum fetal head position I: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the active stage of labor
Authors: D. M. Sherer , M. Miodovnik , K. S. Bradley , O. Langer
Published: March 2003

Objective

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

Methods

Consecutive patients in active labor at term with normal singleton cephalic‐presenting fetuses were included. All participants had ruptured membranes, cervical dilation ≥4 cm and fetal head at ischial spine station –2 or lower. Transvaginal sterile digital examinations were performed by either senior residents or attending physicians and followed immediately by transverse suprapubic transabdominal ultrasound assessments. Examiners were blinded to each other's findings. Power‐analyses dictated number of subjects required. Statistical analyses included Chi‐square, Cohen's Kappa test and logistic regression analysis. P < 0.05 was considered statistically significant.

Results

One hundred and two patients were studied (n = 102). In only 24% of patients (n = 24), transvaginal digital examinations were consistent with ultrasound assessments (P = 0.002, 95% confidence interval, 16–33). Logistic regression revealed that cervical effacement (P = 0.03) and ischial spine station (P = 0.01) significantly affected the accuracy of transvaginal digital examination. Parity, gestational age, combined spinal epidural anesthesia, cervical dilation, birth weight and examiner experience did not significantly affect accuracy of the examination. The accuracy of the transvaginal digital exams was increased to 47% (n = 48) (95% confidence interval, 37–57) when fetal head position at transvaginal digital examination was recorded as correct if reported within ±45° of the ultrasound assessment. The rate of agreement between the two assessment methods for attending physicians vs. residents was 58% vs. 33%, respectively (P = 0.02) with the ±45° analysis.

Conclusions

Using ultrasound assessment as the gold standard, our data demonstrate an overall high rate of error (76%) in transvaginal digital determination of fetal head position during active labor, consistent with the null hypothesis. Attending physicians exhibited an almost two‐fold higher success rate in depicting correct fetal head position by physical examination vs. residents in the ±45° analysis. Intrapartum ultrasound increases the accuracy of fetal head position assessment during active labor and may serve as an educational tool for physicians in training. Copyright © 2002 ISUOG
Teaching ultrasound‐guided invasive procedures in fetal medicine: learning curves with and without an electronic guidance system
Authors: Nizard J. , Duyme M. , Ville Y.
Published: March 2003

Objective

To compare the learning curves of inexperienced junior obstetrics/gynecology registrars for ultrasound‐guided invasive procedures on a training model, with and without an electronic guidance system.

Study design

Four junior registrars performed their first 100 procedures on a training model with a new electronic guidance system, and four other junior registrars performed their first 100 procedures on the same training model without using the guidance system. All procedures were performed using a free‐hand technique. We evaluated the quality of the procedure, which we defined as the time spent with the entire needle clearly visualized on the screen over the total duration of the procedure. We constructed learning curves for the eight junior registrars for comparative analysis.

Results

Quality of the procedure increased over time for all trainees. The learning curves were significantly steeper for trainees using the electronic guidance system. Trainees using the electronic guidance system performed better in the middle of their learning curve (procedures 25–75). All trainees reached the same level of quality by the end of their 100 procedures.

Conclusions

The automated electronic guidance system helps faster learning but, after 100 procedures on a training model, both groups reached the same level of quality. Copyright © 2002 ISUOG
Normal values of fetal ductus venosus blood flow waveforms during the first stage of labor
Authors: Krapp M. , Denzel S. , Katalinic A. , Berg C. , Smrcek J. , Geipel A. , Huber G. , Germer U. , Gembruch U.
Published: March 2003

Objective

To present normal values of fetal ductus venosus blood flow waveforms during the first stage of labor during and between contractions.

Materials and methods

Seventy‐eight women between the 37th and 41st weeks of gestation were included in the study. At distinct stages of cervical dilation, blood flow velocity waveforms of the fetal ductus venosus during and between contractions were visualized in fetuses with a normal non‐stress test. The pulsatility index for veins, peak velocity index for veins and fetal heart rate were calculated off‐line. The means ± standard deviations (SD) during and between contractions were compared using the Wilcoxon test.

Results

Ductus venosus blood flow velocity waveforms were visualized during 331 contractions and 375 episodes of uterine quiescence in 74 of 78 fetuses (95%) during normal labor. The mean ± standard deviation values of pulsatility and peak velocity indices for veins during contractions were 1.66 ± 0.85 (median: 1.56, range: 0.29–4.69) and 1.46 ± 0.65 (median: 1.34, range: 0.26–3.13), respectively. Between contractions the values were 0.48 ± 0.19 (median: 0.46, range: 0.14–1.00) for the pulsatility index and 0.44 ± 0.18 (median: 0.42, range: 0.14–1.00) for the peak velocity index for veins. These differences during and between contractions were highly significant (P‐value < 0.0001), whereas the fetal heart rate showed no significant differences.

Conclusion

There are significant differences in fetal ductus venosus blood flow waveforms during and between labor contractions. Further studies should evaluate whether these normal values of the fetal ductus venosus are beneficial for risk evaluation in fetuses with an abnormal non‐stress test and/or intrauterine growth restriction. Copyright © 2002 ISUOG
Funneling to the stitch: an informative ultrasonographic finding after cervical cerclage
Authors: O'Brien J. M. , Hill A. L. , Barton J. R.
Published: March 2003

Objective

The purpose of this study was to evaluate the utility of ultrasound surveillance after cerclage placement and to propose a rationale for cervical sonography in this setting.

Subjects and methods

This was a retrospective analysis of 53 women undergoing cervical cerclage by a maternal‐fetal medicine specialist, regardless of indication, and delivering between January 1999 and April 2001. Transvaginal ultrasonographic assessment of cervical length and the degree of cervical funneling after cerclage were compared to preoperative values and to outcomes including gestational age at delivery. Funneling to the cerclage was defined as membranes prolapsing down the endocervical canal until they reached the plane of the cerclage.

Results

Cervical cerclage resulted in a significant increase in cervical length from 2.1 ± 1.2 cm to 2.9 ± 0.8 cm after the procedure, P < 0.001; however, this measure was not correlated with gestational age at delivery. Funneling to the level of the cerclage was associated with an earlier gestational age at delivery 31.3 ± 5.6 weeks vs. 36.8 ± 2.8 weeks for those cases without this finding, P < 0.001. A statistically significant association between funneling to the cerclage and preterm delivery was identified irrespective of the indication (prophylactic or emergency) for the procedure. When descent of the membranes to the level of the cerclage was noted, it occurred by 28 weeks' gestation in all patients studied. The incidence of premature rupture of the membranes was also significantly greater postcerclage in women with descent of the membranes to the cerclage (52%) compared to those without this finding (9%) P = 0.002.

Conclusions

Funneling to the cerclage is significantly associated with earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation is useful in identifying patients at higher risk for premature rupture of the membranes and preterm delivery. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Venous Doppler velocimetry in the surveillance of severely compromised fetuses
Authors: Hofstaetter C. , Gudmundsson S. , Hansmann M.
Published: March 2003

Objective

To investigate whether venous Doppler velocimetric signs of cardiac decompensation might predict fetal demise in severely compromised fetuses.

Material and methods

This was a prospective study involving 154 growth‐restricted fetuses, 37 of which were found to have reversed flow in the umbilical artery (BFC III). Doppler velocimetry of the right hepatic vein and ductus venosus were investigated serially and the presence of umbilical venous pulsations also registered. Only the final examination prior to birth or fetal demise was accepted for analysis and related to obstetric outcome defined as gestational age at birth, birth weight and perinatal mortality. In cases of BFC III the venous velocimetry of 15 nonsurviving fetuses was compared to that of the 22 survivors.

Results

There was a significant correlation between venous blood velocity and placental vascular resistance. In the right hepatic vein there was a significant decrease in peak systolic and end‐systolic velocities and an increase of maximum velocity during atrial contraction and pulsatility (P < 0.05). A decrease of all velocities and increase of pulsatility were noted in the ductus venosus (P < 0.05). A reversed flow in the ductus venosus was found in 9/37 fetuses and double umbilical venous pulsations in 16/37 fetuses. However, the hepatic vein seemed to be a better predictor of impending mortality than the ductus venosus. Changes in diastolic venous blood velocity and a double pulsation in the umbilical vein were closely related to perinatal mortality, although these parameters did not provide a useful threshold to optimize the timing of delivery.

Conclusion

Diastolic venous velocimetry changes significantly in severely compromised fetuses. These changes might be of great clinical value in deciding on the timing of delivery to minimize damage to the fetus and newborn. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Hypophosphatasia associated with increased nuchal translucency: a report of two affected pregnancies
Authors: Souka A. P. , Raymond F. L. , Mornet E. , Geerts L. , Nicolaides K. H.
Published: March 2003

Perinatal hypophosphatasia is a lethal autosomal recessive skeletal abnormality with a birth prevalence of about 1 per 100 000. It is characterized by deficiency of the tissue‐nonspecific isoenzyme of alkaline phosphatase causing abnormal bone mineralization. In the two affected fetuses from the same family ultrasound examination at 14 and 12 weeks, respectively, demonstrated increased nuchal translucency thickness, hypomineralization of the skull and spine, narrowing of the chest and shortening of the limbs. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Operative fetoscopy via telesurgery
Authors: Quintero R. A. , Muñoz H. , Pommer R. , Diaz C. , Bornick P. W. , Allen M. H.
Published: March 2003

We describe a case in which telesurgical consultation from Tampa, Florida, USA was used to accomplish operative fetoscopy in Santiago, Chile for the treatment of a twin pregnancy involving an acardiac twin. The procedure was successful and a healthy infant was delivered at 37.5 weeks. Operative fetoscopy, a surgical approach to correct birth defects in utero via combined ultrasound and endoscopy, is only available in a handful of centers worldwide. Telesurgery makes use of telecommunication to allow a surgeon at a primary operating site to consult with another experienced surgeon for complex surgical cases. This case illustrates the potential for ultrasound and telesurgery to expand the horizons of operative fetoscopy. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of interruption of the aortic arch and its association with deletion of chromosome 22q11
Authors: Volpe P. , Marasini M. , Caruso G. , Gentile M.
Published: March 2003

Objectives

Differentiation of interruption of the aortic arch (IAA) type A from type B by prenatal echocardiography is possible but difficult. We report nine consecutive cases of the prenatal detection of IAA and evaluate the feasibility of making a correct prenatal diagnosis with fetal echocardiography. The incidence of 22q11 microdeletion in our series, detected using fluorescent in situ hybridization (FISH) analysis, was determined.

Methods

Echocardiography and FISH for the DiGeorge critical region (22q11) were performed in all cases. The findings were confirmed by autopsy (three cases) or at postnatal surgery (six cases).

Results

On fetal echocardiography we identified six type B cases and three type A. FISH detected microdeletions in 22q11 in five of nine fetuses (four type B cases and an unusual association with type A in one case).

Conclusions

Our report confirms the feasibility of making a correct prenatal diagnosis of IAA and its different types, based on echocardiographic examination. Furthermore our data are consistent with previous reports indicating that type A and type B are distinct entities. In more than 50% of fetuses with IAA type B, 22q11 microdeletion and DiGeorge or velo–cardio–facial syndromes may be expected. IAA type A is not commonly associated with 22q11 hemizygosity. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Glial–glial and glial–neuronal interfaces in radiation‐induced, glia‐depleted spinal cord
Authors: GILMORE SHIRLEY ANN , SIMS TERRY J.
Published: March 2003

This review summarises some of the major findings derived from studies using the model of a glia‐depleted environment developed and characterised in this laboratory. Glial depletion is achieved by exposure of the immature rodent spinal cord to x‐radiation which markedly reduces both astrocyte and oligodendrocyte populations and severely impairs myelination. This glia‐depleted, hypomyelinated state presents a unique opportunity to examine aspects of spinal cord maturation in the absence of a normal glial population. An associated sequela within 2–3 wk following irradiation is the appearance of Schwann cells in the dorsal portion of the spinal cord. Characteristics of these intraspinal Schwann cells, their patterns of myelination or ensheathment, and their interrelations with the few remaining central glia have been examined. A later sequela is the development of Schwann cells in the ventral aspect of the spinal cord where they occur predominantly in the grey matter. Characteristics of these ventrally situated intraspinal Schwann cells are compared with those of Schwann cells located dorsally. Recently, injury responses have been defined in the glia‐depleted spinal cord subsequent to the lesioning of dorsal spinal nerve roots. In otherwise normal animals, dorsal nerve root injury induces an astrocytic reaction within the spinal segments with which the root(s) is/are associated. Lesioning of the 4th lumbar dorsal root on the right side in irradiated or nonirradiated animals results in markedly different glial responses with little astrocytic scarring in the irradiated animals. Tracing studies reveal that these lesioned dorsal root axons regrow rather robustly into the spinal cord in irradiated but not in nonirradiated animals. To examine role(s) of glial cells in preventing this axonal regrowth, glial cells are now being added back to this glia‐depleted environment through transplantation of cultured glia into the irradiated area. Transplanted astrocytes establish barrier‐like arrangements within the irradiated cords and prevent axonal regrowth into the cord. Studies using other types of glial cultures (oligodendrocyte or mixed) are ongoing.
Use of antibodies directed against blood group substances and lectins together with glycosidase digestion to study the composition and cellular distribution of glycoproteins in the large human airways
Authors: BALS ROBERT , WOECKEL WERNER , WELSCH ULRICH
Published: March 2003

Some 30 lectins in combination with glycosidase digestion and immunohistochemistry with 5 antibodies directed against antigens of the ABO and Lewis blood group systems were used to analyse the distribution and synthesis of glycoconjugates in the epithelium of the large airways in man. Both mucous gland cells and goblet cells were labelled by 12 of 30 lectins and by the antibodies, dependent on the ABO, Lewis, and secretor status. The corresponding binding patterns of the serous gland cells differed markedly from those of goblet and mucous gland cells and in general were not dependent on the ABO, Lewis, and secretor status. After digestion with neuraminidase and fucosidase, binding of soy bean agglutinin and peanut agglutinin to goblet and mucous gland cells was increased. Binding of peanut agglutinin to serous gland cells was stronger only after the digestion with neuraminidase. Digestion with O‐glycosidase after the use of neuraminidase or fucosidase resulted in a decrease of peanut agglutinin binding to goblet and mucous gland cells. The present results show that the secretory products of goblet and mucous gland cells on the one hand and those of serous cells on the other differ considerably with respect to their terminal glycosylation. The glycosyltransferases coded by genes of the ABO and Lewis blood group and secretor systems are active only in goblet and mucous gland cells, resulting in the presence of the corresponding antigens. Precursor substances of blood group antigens types 1, 2, and 3 are found only in these cell types. In serous gland cells, blood group systems do not influence the glycosylation of glycoproteins. The results of the digestion with O‐glycosidase indicates the presence of O‐glycosylation in mucous gland and goblet cells, but not in serous gland cells.
A double‐label immunohistochemical study of intramural ganglia from the human male urinary bladder neck
Authors: DIXON J. S. , JEN P. Y. P. , GOSLING J. A.
Published: March 2003

Double‐label immunocytochemistry was used to investigate the colocalisation of various neuropeptides and the enzymes nitric oxide synthase (NOS) and tyrosine hydroxylase (TH) in intramural ganglia of the human male urinary bladder neck and trigone. Postmortem specimens were obtained from 7 male infants and children ranging in age from 2 mo to 3 y who had died as a result of cot death or accidental trauma. On average 60% of the intramural neurons were non‐TH‐immunoreactive (‐IR) (i.e. presumptive cholinergic) and 40% were TH‐ and DbβH‐IR (i.e. noradrenergic). Within the non‐TH‐IR population, calcitonin gene‐related peptide (CGRP) was found in 65% of cells, neuropeptide Y (NPY) in 90%, nitric oxide synthase (NOS) in 45%, somatostatin (SOM) in 90%, and vasoactive intestinal polypeptide (VIP) in 40%. The corresponding values for the TH‐IR neurons were CGRP (54%), NPY (70%), NOS (58%), SOM (73%) and VIP (40%). All the observed bombesin (BOM)‐immunoreactivity was colocalised with TH while 90% of VIP and almost all the CGRP was colocalised with NPY. Less than 5% of neurons were immunoreactive for substance P (SP) or met‐enkephalin (m‐ENK) and some of these also contained TH. Varicose nerve fibres were seen in close proximity to some of the intramural neurons, the majority of such varicosities showing immunoreactivity to CGRP, VIP or TH. Less common were pericellular varicosities immunoreactive to NPY, SOM or SP. These results demonstrate the neurochemical heterogeneity of intramural neurons in the human bladder neck and provide indirect evidence for the complexity of the peripheral innervation of the human urinary bladder.
The glenoid notch and its relation to the shape of the glenoid cavity of the scapula
Authors: PRESCHER ANDREAS , KLÜMPEN THOMAS
Published: March 2003

The prevalence of a notch in the anterior margin of the glenoid cavity of 236 scapulae (118 female, 118 male) was investigated. The notch was found in 129 scapulae (55%) and gave rise to a pear‐shaped cavity. In 107 scapulae (45%) the notch was absent, the shape of the cavity being oval. No sex difference was found in the prevalence of the notch. If a distinct notch exists, the glenoid labrum is not attached to bone at the notch and is therefore liable to be sheared off (Bankart lesion).
The intramuscular arterial anatomy of the long head of biceps femoris muscle
Authors: SHANAHAN DONAL , JORDAN R. K. , COULTHARD A. , COOPER P. N. , VARMA J.
Published: March 2003

We have previously shown that the neurovascular anatomy and length of the long head of biceps femoris (LHBF) is suitable for its possible use in the creation of a dynamic perianal myoplasty to restore faecal continence. If intramuscular arterioarterial anastomoses exist between a muscle's vascular pedicles then the delay procedure, i.e. ligating the vascular pedicles to the transposed section of the muscle, 4–6 wk before transposition, can be used to improve blood flow to the distal part of the transposed muscle. The intramuscular arterial anatomy of 20 biceps femoris muscles was shown by dissection (14) or radiographically (6). The mean entry point of the upper major vascular pedicle to the LHBF was 12 cm (s.d. 3.3) and the mean length of the LHBF was 36.8 cm (s.d. 1.8). Therefore the ratio between upper major vascular pedicle entry point and muscle length in 95% of specimens was 0.33 (0.2). In the present study intramuscular arterioarterial anastomoses were found between the arterial pedicles to the non‐transposed and transposed sections of the LHBF and between the long and short heads of this muscle. Using the delay procedure would therefore theoretically allow the intramuscular arterioarterial anastomoses between the arterial pedicle to the nontransposed and transposed sections of the LHBF to open up enhancing blood flow to the distal part of the myoplasty.
Correspondence: Possums, articular cartilage and oxygen. A comment on the papers by Archer et al. (1996) and Morrison et al. (1996)
Authors: STOCKWELL ROBIN A. , SCOTT JOHN E.
Published: March 2003

In their paper on opossum cartilage, Archer et al. (1996) contend that their ‘data pose questions … to the idea that global patterns of matrix components exist in mammalian articular cartilages’. We believe that this statement is not supported by their data. The points at issue concern the distributions of chondroitin sulphate (CS) and keratan sulphate (KS) in adult cartilage. Earlier work showed that: (1) the highest concentrations of CS are in the midzone of the noncalcified layer of the cartilage (Stockwell & Scott, 1967; Maroudas et al. 1969; Lemperg et al. 1974), while the authors' opossum data apparently show that the intensity of staining with Safranin O (and various antibodies specific for CS) ‘is greatest in the upper third of the tissue depth’; (2) in the noncalcified cartilage, the concentration of KS increases with distance from the articular surface (Stockwell & Scott, 1967; Maroudas et al. 1969; Venn, 1978). By contrast in the opossum, the authors state that there was ‘intense labelling throughout the upper half of the articular cartilage depth’. They considered that this finding, in particular, questions ‘the notions which link KS substitution with conditions of low oxygen tension’, since articular cartilage generally obtains its nutrient and O2 through the articular surface and thence by diffusion through the tissue depth.
Demonstration of the intralobular lymphatics in the guinea pig pancreas by an enzyme‐histochemical method
Authors: JI R. C. , KATO S.
Published: March 2003

Intralobular lymphatics in the guinea pig pancreas were demonstrated enzyme‐histochemically showing the extent, distribution and fine structure by combined light and transmission electron microscopy. 5′‐nucleotidase(5′‐Nase)‐positive lymphatic vessels were present throughout the pancreas. Intralobular lymphatics among the acini were comparatively rare and generally independent of the blood capillaries, pancreatic ducts and acini. These lymphatics revealed the usual structural features, such as typical intercellular junctions and very tenuous vascular walls without continuous basal laminae. Fine precipitates of the cerium‐based reaction product for 5′‐Nase activity were found to be associated with cell membranes of the lymphatic endothelium and pinocytotic vesicles. Lymphatics were not closely related to the endocrine islets, although alkaline phosphatase(ALPase)‐positive blood capillaries were well developed. Collecting lymphatic vessels with valves with weaker 5′‐Nase activity were also detected in the interlobular connective tissue. ALPase activity, absent in the lymphatics, was positive in the blood capillaries, suggesting that it is also a useful way of demonstrating, histochemically, the blood capillaries in the guinea pig pancreas.
Computer analysis of corneal innervation density using a novel double stain in rat corneal whole mounts
Authors: JACOT JORGE L. , GLOVER JOEL P. , ROBISON W. GERALD
Published: March 2003

Computerised morphometry and a double stain technique were utilised to examine the corneal nerves in whole mounts. This novel stain combines the nonspecific acetylcholinesterase(NsAchE) and gold chloride(AuCl) procedures to enhance staining contrast and facilitate computerised detection of corneal nerves. Fresh rat corneas were dissected, and the Descemet's membrane‐endothelium complex was removed. Then the corneas were fixed in 4% paraformaldehyde with 50 mm Na‐K phosphate buffer (pH 7.2) and 8% sucrose for 30 min. They were rinsed and stained singly with NsAchE or AuCl, or were double stained using NsAchE followed by AuCl. Between NsAchE and AuCl staining the corneas were stored frozen in OCT compound at −70°C. Flat mounts of whole corneas were photographed before and after the second staining. Measurable stromal innervation density (mean±S.D.) in age‐matched corneas stained with AuCl(3.90±0.36 mm/mm2) was not significantly different from that of NsAchE stained corneas. However, double staining compared with NsAchE staining of the same corneas revealed a 48±27% increase in demonstrable innervation density of the subepithelial nerve plexus (7.95±0.86 mm/mm2 vs 5.52±1.31 mm/mm2, respectively). Improved visualisation of epithelial nerves and their fine ramifications (leashes) was also obtained by double staining. This novel combination of 2 procedures enhances the detection of corneal nerves for analysis by computerised morphometry and provides a more representative estimate of total corneal innervation density.
Reconstruction of three‐dimensional anatomical landmark coordinates using video‐based stereophotogrammetry
Authors: STEVENS WILLIAM P.
Published: March 2003

A method is described for reconstructing the 3‐dimensional coordinates of anatomical landmarks from multiple video images. This method consists of 2 stages: (1) separate reconstructions of landmark coordinates visible in dorsal and ventral orientations using Direct Linear Transformation (Abdel‐Aziz & Karara, 1972), and (2) least‐squares alignment of the partial reconstructions using landmarks present in both. The repeatability of the overall reconstructions and of individual landmarks were assessed by performing multiple independent reconstructions of landmark coordinates for 2 canid specimens. Results indicate that the repeatability of interlandmark distances based on stereophotogrammetric reconstructions from standard‐resolution video images is comparable to that of caliper measurement, and slightly superior to that of electronic 3‐dimensional digitisation. At least 4 images should be available per landmark for optimal repeatability, but additional images allow only a slight increase in repeatability.
Neurotensin‐like immunoreactivity in the brain of the chicken, Gallus domesticus
Authors: ESPOSITO VINCENZO , DE GIROLAMO PAOLO , GARGIULO GIULIANA
Published: March 2003

The distribution of neurons containing neurotensin in the central nervous system of the chicken was studied immunohistochemically. The majority of the neurotensin‐immunoreactive (‐ir) cell bodies were located in the hypothalamus. Extensive groups of labelled perikarya were found in the hypothalamic periventricular nucleus and in the magnocellular periventricular nucleus. In addition, ir‐perikarya were scattered throughout the lateral hypothalamic area and in the ventromedial hypothalamic nucleus. The only extrahypothalamic site of ir‐perikarya was in the region immediately under the lateral forebrain bundle. Immunoreactive fibres were detected in the hippocampus, the parahippocampal area, the hypothalamus, the region of the tractus corticohabenular and corticoseptal tracts, the median eminence, the region above the posterior commissure and in the intercollicular nucleus. The distribution pattern of the neurotensin‐ir neurons suggests that neurotensin‐like peptides are involved in the hypophysiotropic functions.
Pancreatic endocrine cells in Bufo bufo: immunocytochemistry and ultrastructure
Authors: ACCORDI F. , BRACCI M. A. , VENTOLA F.
Published: March 2003

The endocrine pancreas of the toad consists of rounded islets of various sizes embedded in the exocrine tissue. Isolated cells are also present. At least 4 types of endocrine cell are distinguishable by shape, size and electrondensity of the secretory granules as well as by their immunoreactivity with different antisera: insulin, somatostatin, pancreatic polypeptide, and glucagon cells. Insulin cells can be divided into 2 types according to their cytoplasmic electrondensity. Colocalisation of different hormones in the same cell is rarely observed. The close contact between endocrine and exocrine cells and the scarcity of nerve supply is indicative of a paracrine control of hormone secretion.
Segmental duplication of the fetal anterior cerebral artery
Authors: VUČETIĆ RADOMIR R.
Published: March 2003

Segmental duplications (also termed ‘fenestrations’) of the fetal anterior cerebral artery are a relatively rare anomaly. Their occurrence was studied in 200 fetuses at 20–40 wk gestational age. Duplications were found in 21 of the 200 fetuses, i.e. 10.5%. In 2 fetuses, i.e. 1%, the duplications were bilateral. In 1 case, i.e. 0.5%, 2 duplications were found on the left anterior cerebral artery. There were 15 segmental duplications on the left anterior cerebral artery, i.e. 62.5% of all duplications, and 9 on the right, i.e. 37.5%. The duplications were located in the distal part of the A1 segment in 45.7%, at the level of the anterior communicating artery (A1–A2) in 37.7%, and in the initial part of the A2 segment in 16.6%. The duplications had 4 different forms namely oviform, fissured, triangular and punctate.