bluuebunny/crossref_metadata_2025 huggingface dataset:
Pityriasis alba: a study of pathogenic factors
Authors: Blessmann Weber M , Sponchiado de Ávila LG , Albaneze R , Magalhães de Oliveira OL , Sudhaus BD , Ferreira Cestari T
Published: March 2003

Background The aetiology of pityriasis alba (PA), a common dermatosis in childhood, is still controversial. The objective of this study was to assess the possible aetiopathogenic factors of this disease in infants.

Methods Forty‐four patients with PA and 31 healthy children were examined and compared. Personal hygiene habits, sun exposure, presence of Staphylococcus aureus in nasal fossae and presence of major or minor signs of atopy were assessed during anamnesis and physical examination. Susceptibility to ultraviolet (UV) B radiation was measured by the onset of a contact hypersensitivity reaction to diphenylcyclopropenone in individuals sensitized in previously irradiated areas.

Results The prevalence of PA was higher in individuals with darker skin, in high phototype categories, as well as in males. The number of daily baths and sun exposure between 10.00 h and 15.00 h were significantly higher in the PA group when compared with controls (P = 0.03 and P = 0.0015, respectively). The presence of atopy signs was more common in pityriasis patients (P = 0.002). Susceptibility to UVB radiation was 29.6% in the PA group vs. 29.0% in the control group; nevertheless, important differences were found after stratification in order to control possible confounding factors. The presence of S. aureus in the nostrils was equal in both groups.

Conclusions Our results confirm that PA, in our population, is more prevalent in males and in individuals in higher phototype categories. In those with inadequate personal hygiene and sun exposure habits the disease is more accentuated, demonstrating that the xerosis presenting in individuals with atopic diathesis is an important element in the development of the disease. S. aureus is not an important aetiopathogenic factor in PA. Susceptibility to UVB becomes important when related to the patient's phototype.
Manifestation of cellulitis after saphenous venectomy for coronary bypass surgery
Authors: Karakaş M , Baba M , Aksungur VL , Memişoǧlu HR , Aksungur EH , Denli YG , Karakaş P
Published: March 2003

A few cases of onset of cellulitis after saphenous venectomy for coronary by‐pass surgery were first reported by Baddour and Bisno in 1982. We reviewed the clinical characteristics of 31 subjects followed up in our department following onset of manifestations of cellulitis after saphenous venectomy for coronary by‐pass surgery. In all the subjects the cellulitis originated at the scar of the saphenous venectomy, and most presented ill‐defined, mildly erythematous, slightly oedematous lesions. Mycologically confirmed tinea pedis was found in 25 subjects. All the patients responded well to penicillins or cephalosporins.

In this report we comment on the pathogenesis of this complication of saphenous venectomy based on the clinical features of the cases reviewed. We suggest that saphenous venectomy may destroy the lymphatics in the lower leg, that are located adjacent to the great saphenous vein, and thus microorganisms penetrating into the skin may easily cause cellulitis in areas with impaired lymphatic drainage.
Sodium‐Valproate‐Induced Pancreatitis in a Man with Profound Intellectual Disability: the Significance of Diagnostic Difficulties
Authors: Hinder Steve , Perry David
Published: March 2003

Pancreatitis is a common but under‐reported complication of treatment with sodium valproate, a drug frequently prescribed for people with intellectual disabilities. The present authors report a case of valproate‐induced pancreatitis in a man with profound intellectual disability and review the relevant literature. The wider implications of problems experienced with diagnosis are discussed, emphasizing difficulties in recognizing pain and physical illness in this client group.
Differentiated Coping Strategies in Families with Children or Adults with Intellectual Disabilities: the Relevance of Gender, Family Composition and the Life Span
Authors: Grant G. , Whittell B.
Published: March 2003

The present paper considers the coping strategies of families with children and adults with intellectual disabilities. It is argued that the literature on coping and resilience in families has often been overlooked in favour of deficit models of family functioning. The present study was designed to provide a further test of the transactional model of coping, but more especially, to explore which problem‐solving, cognitive and stress reduction coping strategies family members found useful. Based on the use of a coping inventory Carers Assessment of Managing Index (CAMI), coping is shown to be differentiated according to gender, life stage and family structure. Implications for continuing research into family care are considered and some questions are raised about family support.
The Validity and Utility of Subjective Quality of Life: a Reply to Hatton & Ager
Authors: Cummins Robert A
Published: March 2003

My reply to Hatton & Ager concentrates on two major themes. The first concerns the psychological reality and measurement of the quality of life (QOL) construct for people with an intellectual disability. I conclude that a substantial weight of evidence supports the psychological reality of the construct, and that reliable and valid measurement of subjective life quality can be achieved for the majority of people. The second theme concerns the usefulness of subjective life quality measurement for service delivery. Here, I argue that such measurement can have major benefits for both respondents and service providers provided that the psychometric character of the data is understood. To this end, I recommend that journal editors, academics dealing in applied research, and practitioners, have a duty of care concerning the dissemination, investigation, and application of contemporary understanding in this area.
Sampling success and risk by transabdominal chorionic villus sampling, transcervical chorionic villus sampling and amniocentesis: a randomized study
Authors: Smidt‐Jensen S. , Permin M. , Philip J.
Published: March 2003

A total of 3347 women were randomized to either transabdominal chorionic villus sampling, transcervical chorionic villus sampling or amniocentesis. Unless induced or spontaneous abortion had occurred, they had all completed up to 28 weeks of pregnancy at the time of analysis. No significant difference was seen between total fetal loss in the transabdominal chorionic villus sampling group and the amniocentesis group (6.2% and 6.6%, respectively, SE difference 0.92%, p = 0.01). The total fetal loss in the transcervical group was 10.1%. When the number of failed procedures and those cases which were evaluated as infeasible for the assigned method, are compared, the overall sampling efficacy is less good transcervically than transabdominally. After pooling our data with data from the Canadian randomized study and the American non‐randomized study, the difference in risk between transcervical chorionic villus sampling and amniocentesis was 2.1%, SE difference = 0.64%, p = 0.8. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Transvaginal ultrasonic assessment of the early fetal brain
Authors: Achiron R. , Achiron A.
Published: March 2003

The introduction of high resolution transvaginal transducers has expanded our knowledge of the first and early second‐trimester fetus. This article describes transvaginal assessment of normal brain development. The feasibility of early detection of various fetal central nervous anomalies, such as anencephalus, exencephalus, hydrocephalus, Dandy Walker syndrome and myelomeningocele is described. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Validity of pulsatility and resistance indices in classification of adnexal tumors with transvaginal color Doppler ultrasound
Authors: Tekay A. , Jouppila P.
Published: March 2003

Transvaginal pulsed color Doppler ultrasound was used to examine 72 patients with a pelvic mass preoperatively. Tumor morphology was assessed, prominent areas of vascularization within the tumor were observed and the pulsatility index and the resistance index of tumor and uterine arteries were measured. Flow velocity waveforms with low pulsatility are considered to reflect neovascularization. The ultrasound diagnoses were compared with histopathological or cytological diagnoses. There were 61 benign, eight malignant and three borderline cases. In 75% of the malignant and 23% of the benign tumors, an intratumoral flow with a low pulsatility was detectable. The mean pulsatility index of tumor blood vessels was 1.2 in benign, 0.7 in malignant and 0.6 in borderline neoplasms. The corresponding mean resistance index values were 0.6, 0.5 and 0.5. The differences were not significant and the overlap between the malignant and benign lesions was large. The pulsatility index and resistance index of uterine arteries were significantly decreased in malignant tumors. The results show that, using a cut‐off resistance index value of 0.6, the sensitivity and specificity of color Doppler in the detection of malignant and potentially malignant tumors were 82% and 72%, respectively. However, a practical cut‐off level for either pulsatility or resistance indices, that could assist in differentiating between malignant or benign lesions, does not seem to exist. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
The interpretation of uterine artery pulsatility index in normal and hypertensive pregnancy
Authors: Grunewald C. , Kublickas M. , Nisell H. , Nylund L. , Westgren M.
Published: March 2003

The Doppler flow velocity pulsatility index (PI) of the uteroplacental vascular bed is of debatable value for the interpretation of hemodynamic changes, when these are due both to pathological alterations in the vasculature, as in mild pre‐eclampsia, and to physiological adjustments to vasoactive substances. The aim of this study was to apply a mathematical model, which includes maternal pulse pressure and mean arterial pressure, to the PI and to investigate whether this formula would add information with respect to discrimination between normal women and those with mild or severe pre‐eclampsia. The subjects were patients with mild (n = 41) and severe (n = 34) pre‐eclampsia and, as a control group, healthy pregnant women (n = 46). The uterine artery PI was studied by spectral Doppler analyses and compared to a Pz
value, theoretically representing a ‘back pressure’ in the uteroplacental circulation. Additionally, Pz
values were computed from earlier data concerning the dynamic circulatory effects of dihydralazine and acute volume expansion. The basal PI was significantly higher in the severely pre‐eclamptic patients but not in the mildly pre‐eclamptic patients compared to the controls. However, the Pz
was significantly higher in patients with both mild (p < 0.001) and severe pre‐eclampsia (p < 0.0001) compared to the normal group. In the severely pre‐eclamptic patients receiving dihydralazine, the Pz
tended to decrease (p = 0.07), in contrast to the volume‐expansion group where Pz
was unaffected by the procedure. In conclusion, it seems that including measurement of the mean arterial pressure and pulse pressure with the PI adds valuable information about the circulatory status in this particular vasculature, regarding both ‘basal’ values and hemodynamic changes. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Chromosomal defects and outcome in 1015 fetuses with increased nuchal translucency
Authors: Pandya P. P. , Kondylios A. , Hilbert L. , Snijders R. J. M. , Nicolaides K. H.
Published: March 2003

In 1015 fetuses undergoing first‐trimester karyotyping because of increased nuchal translucency thickness, the incidence of chromosomal abnormalities increased with both maternal age and nuchal translucency thickness. The observed numbers of trisomies 21, 18 and 13 in fetuses with nuchal translucency thicknesses of 3 mm, 4 mm, 5 mm and ≥ 6 mm were approximately 3 times, 18 times, 28 times and 36 times higher than the respective numbers expected on the basis of maternal age. The incidences of Turner syndrome and triploidy were 9‐fold and 8‐fold higher but the incidence of other sex chromosome aneuploidies was similar to that of an unselected population of women undergoing first‐trimester fetal karyotyping for maternal age. In the chromosomally normal group, the incidence of structural defects, mainly cardiac, diaphragmatic, renal and abdominal wall, was approximately 4%, which is higher than would be expected in an unselected population. The rates of fetal loss in the groups with nuchal translucency thickness of 3 mm and 4 mm were 2% and 4%, respectively, which is similar to the 2.3% rate of fetal loss observed in a group of fetuses with normal nuchal translucency thickness undergoing chorion villus sampling. For fetal nuchal translucency thickness of ≥ 5 mm, the rate of fetal loss was 13%. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Early development of the hindbrain: a longitudinal ultrasound study from 7 to 12 weeks of gestation
Authors: Blaas H.‐G. , Eik‐Nes S. H. , Kiserud T. , Hellevik L. R.
Published: March 2003

Twenty‐nine healthy pregnant women were examined by transvaginal ultrasound to evaluate embryonic development in vivo between 7 and 12 weeks of gestation. The rhombencephalon with its fourth ventricle, the cerebellum and the choroid plexuses of the fourth ventricle were identified and measured. The cavity of the rhombencephalon, the future fourth ventricle, was always visible from 7 weeks, initially lying superiorly in the head of the embryo. The cerebellum and the choroid plexuses of the fourth ventricle became distinguishable during week 8. The volume of the rhombencephalic cavity was estimated. The shape and size of these rhombencephalic structures, their position in relation to each other and their relation to other brain structures changed specifically during the embryonic and early fetal period. This sonoembryological development corresponded to the descriptions in classical embryological literature. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology
Role of transvaginal ultrasound color flow imaging and Doppler waveform analysis in differentiating between benign and malignant ovarian tumors
Authors: Anandakumar C. , Chew S. , Wang Y. C. , Chia D. , Ratnam S. S.
Published: March 2003

This study was undertaken to assess the usefulness of ultrasound color flow imaging and Doppler waveform analysis in differentiating between benign and malignant ovarian tumors.

From 1991 to 1993, 146 patients with 1.56 ovarian tumors underwent transvaginal scanning with color flow imaging and Doppler waveform analysis prior to surgery. All the ovarian tumors were removed surgically and confirmed histologically.

The sensitivity and specificity of color flow imaging in identifying malignant ovarian tumors was 76.5% and 68%, respectively. Positive and negative predictive values were 40% and 91.2%, respectively. The addition of Doppler waveform analysis failed to produce statistically better results. Seven of the eight cases of ovarian cancer were missed by color Doppler. There were no solid areas present and malignancy was not suspected. Both modalities also failed to identify any case of ovarian cancer presenting as a simple cyst. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis of a late abdominal pregnancy using ultrasound and magnetic resonance imaging: a case report of successful outcome
Authors: Hall J. M. , Manning N. , Moore N. R. , Tingey W. R. , Chamberlain P.
Published: March 2003

A case of an advanced abdominal pregnancy diagnosed by ultrasound and magnetic resonance imaging (MRI) at 21 weeks' gestation is presented. The complementary roles of ultrasound and MRI in achieving accurate diagnosis and the role of ultrasound in ongoing pregnancy assessment are emphasized. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler sonography of tubal torsion
Authors: Baumgartel P. B. , Fleischer A. C. , Cullinan J. A. , Bluth R. F.
Published: March 2003

These case reports illustrate the clinical and color Doppler sonographic findings in two cases of isolated tubal torsion. This condition may be associated with prior tubal ligation. The presence of high impedance or absent flow in a tubular structure in a patient with a history of tubal ligation should make one suspect this condition. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Correlation between karyotype and ultrasound findings in patients with failed early pregnancy
Authors: Goldstein S. R. , Kerenyi T. , Scher J. , Papp C.
Published: March 2003

The aim of this retrospective study was to identify any consistent patterns between ultrasound findings in failed pregnancies and either normal or abnormal karyotypes. The study involved 102 women, in whom the diagnosis of early pregnancy failure was made sonographically. The criteria for a failed pregnancy were: a gestational sac with a mean diameter of > 12 mm without a yolk sac; a yolk sac of > 6 mm mean diameter with or without abnormal morphology that ultimately failed to develop an embryonic structure; and an embryo with a crown‐rump length (CRL) of > 5 mm without cardiac activity, or the loss of previously identified cardiac activity. All patients underwent elective dilatation and curettage (D & C) and products of conception were sent for karyotyping.

Forty‐four pregnancies (43%) had abnormal karyotypes. Of these, 33 (75%) were trisomies. The other 11 included four triploidies, one tetraploidy, two with monosomy X, and four others (unbalanced complement, isochromosome, terminal deletion and translocation). Fifty‐eight pregnancies (57%) had normal karyotypes, of which 52 were 46,XX and six were 46,XY. The furthest sonographic anatomic landmark achieved did not differ with respect to karyotypic findings. An abnormal yolk sac was found in 10/58 cases (17.2%) with normal karyotypes and 8/44 cases (18.2%) with abnormal karyotypes. There were eight cases of trisomy 16, of which only two manifested an embryonic structure, but neither of which had cardiac activity; the largest was 4 mm. There were four cases of trisomy 22, of which three developed embryos with a CRL of > 10 mm with cardiac activity (11, 11 and 18 mm, respectively). In three cases of mosaicism, embryos developed cardiac activity, and were 9, 19 and 16 mm. Two cases of monosomy X had embryos of 14 and 24 mm. Only one out of five cases with multiple trisomies developed to a point at which any embryonic structure was identifiable on ultrasound examination.

The ultrasound appearance of early pregnancy failure in terms of furthest anatomic landmark reached was not significantly different in cases with normal or abnormal karyotype. An abnormally enlarged yolk sac, presumably secondary to hydropic change, is a non‐specific finding of failed pregnancy, and did not correlate with karyotypic status. It appears from these preliminary data that pregnancies with certain types of karyotypic abnormality (trisomy 22, mosaics, monosomy X) seem (to develop further prior to embryonic demise than hose with certain others (trisomy 16, multiple trisomies and unusual other variants). Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Standards for the quantification of serial changes in the amniotic fluid index
Authors: Owen P. , Ogston S.
Published: March 2003

A total of 274 low‐risk pregnancies underwent predetermined scheduled serial ultrasound examinations and measurements of the amniotic fluid index (AFI). As expected from previous cross‐sectional studies, there is a gradual decline in the AFI from mid‐trimester until term. The longitudinal nature of this data set permits the construction of conditional Gentiles for AFI whereby the AFI of an individual fetus at a given gestational age can be extrapolated to give a range of expected values for AFI (expressed as centiles) at a later gestational age. Examples of conditional centiles based upon 4‐week measurement separations are presented. These conditional centiles permit the appropriate evaluation and quantification of time‐dependent changes in AFI to be made. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Comparison between two methods of standardization for gestational age differences in fetal nuchal translucency measurement in first‐trimester screening for trisomy 21
Authors: Biagiotti R. , Periti E. , Brizzi L. , Vanzi E. , Cariati E.
Published: March 2003

Our purpose was to compare two different methods of expressing nuchal translucency (NT) measurements in first‐trimester screening for trisomy 21: the difference in millimeters from the median of nuchal translucency (delta value: δNT) and the multiple of the expected median (MoM). Fetal nuchal translucency was measured in 32 fetuses with trisomy 21 and in 3180 normal fetuses at 9–13 weeks' gestation. For each fetus, the measured nuchal translucency was expressed both as a delta value and MoM. The effectiveness of the MoM‐Gaussian vs. the delta value method in modifying the age‐specific risk for trisomy 21 was compared by using both the maternal age distribution of our study population and the age distribution of a general obstetric population. The use of the MoM‐Gaussian approach led to a reduction in the false‐positive rate at a given detection rate, both in the study population (by 1.2–15.2%) and in the general population (by 0.4–2.4%). Our results suggest that the use of the MoM‐Gaussian method might confer a potential advantage on the screening performance of nuchal translucency in combination with maternal age by decreasing the false‐positive rate. Further studies in larger unselected populations will be needed to confirm the effectiveness of this approach. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Doppler velocimetry of the aortic isthmus in human fetuses with abnormal velocity waveforms in the umbilical artery
Authors: Sonesson S‐E. , Fouron J.‐C.
Published: March 2003

Experimental studies in animals using Doppler ultrasound suggest that hemodynamic disturbances during fetoplacental circulatory insufficiency will be detected at an earlier and less severe stage in the aortic isthmus compared to the umbilical artery. In cases in which more severe impairment of the placental circulation was achieved, reverse flow was recorded in the aortic isthmus before its appearance in the umbilical artery. The present study was undertaken to investigate whether the same findings could be demonstrated in the aortic isthmus of the human fetus. The video recordings of 100 fetuses with abnormal umbilical artery pulsatility index were reviewed. Qualitative abnormalities of the Doppler waveform, i.e. absence or reversal of end‐diastolic velocities, were more frequently found in the aortic isthmus (absent 28%, reversed 41%) compared to the fetal end of the umbilical artery (absent 20%, reversed 19%; p < 0.0001) and also more frequently found in the fetal end compared to the placental end (absent 13%, reversed 2%; p < 0.0001). This study confirms our previous observations of the aortic isthmus as a site for early detection of fetoplacental hemodynamic disturbances. Reverse diastolic flow in the isthmus could direct poorly oxygenated blood from the descending aorta towards the carotid arteries and the brain. Further prospective studies are needed to establish the clinical value of these findings in terms of perinatal morbidity and, more importantly, of long‐term neurological impairment. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
In utero lysis of amniotic bands
Authors: Quintero R. A. , Morales W. J. , Phillips J. , Kalter C. S. , Angel J. L.
Published: March 2003

Amniotic band syndrome is a sporadic condition that occurs in approximately 1 : 1200 to 1 : 15 000 live births and that may result in amputations, constrictions and other deformities of the fetus. Although some cases present with congenital anomalies that are beyond surgical repair, a selected group of fetuses may show isolated limb constriction. It has been speculated that, without treatment, amputation or severe dysfunction of the limb may occur. Despite these potential complications, surgical treatment for this selected group of fetuses has not been previously performed. We report two cases that were successfully treated using novel minimally invasive surgical techniques. The cases involved fetuses with amniotic band syndrome with associated limb constriction in which the amniotic band was surgically interrupted to avoid spontaneous amputation of the extremity. Adequate blood flow distal to the obstruction was preserved and significant functional improvement of the extremity occurred in both cases, preserving the limbs. These cases represent the first prenatal surgical intervention successfully used to treat constricting amniotic bands in humans. In addition, these cases represent the first time that a non‐lethal fetal entity has been surgically treated in utero. The results of this innovative therapy will encourage the efforts to continue developing minimally invasive techniques for the correction of birth defects. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
The effect of intravascular blood transfusion on the flow velocity waveform of the portal venous system of the anemic fetus
Authors: d'Ancona R. L. , Rahman F. , Ozcan T. , Copel J. A. , Mari G.
Published: March 2003

Our objective was to assess flow velocity waveforms of the portal venous system of the anemic fetus prior to and immediately following intravascular transfusion.

Color‐guided pulsed Doppler was used to obtain flow velocity waveforms from the fetal portal vein in 14 anemic fetuses that were transfused in utero for rhesus alloimmunization. The portal vein velocity pattern was defined as continuous when no change in velocity during the cardiac cycle was noted. It was defined as pulsatile when a deflection of the wave was present. The flow velocity waveforms were quantified by using the ratio between the peak (highest, H) and the nadir (lowest, L) velocities (H/L ratio).

Fourteen intravascular transfusions were performed. Gestational age ranged from 19.5 to 35 weeks (mean ± SD, 24.7 ± 5.3 weeks). The hematocrit ranged from 5.9 to 31.2% (mean ± SD, 20.3 ± 9%) prior to transfusion; after transfusion it was between 24.8 and 56.7% (mean ± SD, 42 ± 10.4%). In six cases (43%) the waveforms were pulsatile prior to transfusion; in the other eight (57%) they were continuous. The pulsatile pattern was present following transfusion in 23 cases (93%, p < 0.05). The mean of the H/L ratio was 1.3 ± 0.38 prior to transfusion and 2.0 ± 0.86 after transfusion (p < 0.0s).

Because the portal vein has continuous non‐pulsatile flow in the normal fetus, the presence of pulsatility in the waves of six anemic fetuses (43%) may suggest portal hypertension. Compared to normal fetuses, there was an increased number of cases with pulsation, and even more so after transfusion. The pattern corresponds to findings in children with portal hypertension. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Sirenomelia sequence versus renal agenesis: prenatal differentiation with power Doppler ultrasound
Authors: Sepulveda W. , Corral E. , Sanchez J. , Carstens E. , Schnapp C.
Published: March 2003

In order to assess the role of power Doppler ultrasound in the prenatal diagnosis of sirenomelia, prenatal findings in two fetuses with the sirenomelia sequence and in seven with bilateral renal agenesis were reviewed and compared. Both conditions were characterized by absence of renal vessels. However, the two common iliac arteries were always visualized in fetuses with renal agenesis, whereas absence of distal branching of the main abdominal vessel was a characteristic feature of sirenomelia. Power Doppler ultrasound allows expeditious identification of absent or non‐functional renal arteries in fetuses with severe oligo‐hydramnios. In addition, incorporation of power Doppler imaging to identify the aortic bifurcation could provide a diagnostic feature that could assist in the prenatal diagnosis of sirenomelia and in the differential diagnosis with other causes of bilateral renal agenesis. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Assessment of left ventricular filling in normally grown fetuses, growth‐restricted fetuses and fetuses of diabetic mothers
Authors: Tsyvian P. , Malkin K. , Artemieva O. , Wladimiroff J. W.
Published: March 2003

Objective

To determine fetal left ventricular diastolic function as expressed by normalized left ventricular filling rate integral as well as conventional indices of transmitral blood flow in appropriate‐for‐gestational‐age (AGA), small‐for‐gestational‐age (SGA) and IDDM (insulin‐dependent diabetes mellitus) fetuses during the third trimester of pregnancy.

Design

A cross‐sectional study of fetal left ventricular filling using conventional parameters of transmitral blood flow.

Subjects

Twenty‐five AGA fetuses (mean 32 weeks), 18 SGA fetuses (mean 32 weeks) and 15 fetuses associated with IDDM (mean 31 weeks).

Methods

Doppler measurements of mitral inflow velocity were converted to relative cumulative volume flow by integration at sequential time points along the velocity contour, producing a relative filling curve of the ventricle. The area under this curve was calculated to obtain the left ventricular filling rate integral.

Results

The left ventricular filling rate integral (I) for the complete diastole (E + A wave) was not significantly different between AGA and SGA fetuses but significantly lower in the IDDM fetus (p < 0.05) compared with the AGA fetus. Ie (E wave) was significantly lower and Ia (A wave) significantly higher in both SGA fetuses (p < 0.05) and IDDM fetuses (p < 0.01) compared with AGA fetuses.

Conclusions

There is a delay in left ventricular filling which may reflect changes in myocardial relaxation and possible reduction in passive ventricular filling as a result of chronic hypoxemia in the SGA fetus and altered in utero metabolic environment in the IDDM fetus. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Imaging of placental vasculature using three‐dimensional ultrasound and color power Doppler: a preliminary study
Authors: Pretorius D. H. , Nelson T. R. , Baergen R. N. , Pai E. , Cantrell C.
Published: March 2003

Objective

To assess placental vasculature using color power Doppler and three‐dimensional ultrasound techniques.

Design

A prospective study was performed in patients to correlate visualization of placental vessels in vivo with known anatomy.

Subjects

Fourteen normal patients and one patient with intrauterine growth restriction were recruited to the study.

Methods

Vessels were assessed with regard to, first, the number of vessels seen within the placenta, second, the branching pattern of the vessels within the placenta, third, the number of vessels seen along the surface of the placenta, and, last, the number of vessels seen in the maternal circulation.

Results

Our results show that the placental vessels seen with this technique correlate well with known anatomy. A progressive increase in the number of intraplacental vessels and the number of vascular branches observed was seen with increasing gestational age. Volume data review using three orthogonal planar images had two distinct advantages. First, they could be obtained from orientations not possible using two‐dimensional ultrasound alone, and, second, they could be viewed in conjunction with volume‐rendered images to allow for referencing and identification of specific vessels. Volume‐rendered images were valuable in allowing the observer to acquire an improved overall understanding of placental anatomy. They also assisted the observer in following the continuity of vessels as they wrapped around and twisted through three‐dimensional space. Stereo viewing was helpful in distinguishing overlapping vessels.

Conclusions

Our study showed that sonographic volume imaging combined with color power Doppler imaging methods allowed for individual vessels in the placenta to be identified, both in the fetal and maternal circulations. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Cervical length at 23 weeks of gestation: relation to demographic characteristics and previous obstetric history
Authors: Heath V. C. F. , Southall T. R. , Souka A. P. , Novakov A. , Nicolaides K. H.
Published: March 2003

Objectives

To examine the feasibility of introducing routine measurement of cervical length at 23 weeks of gestation, to establish the distribution of cervical lengths in a routine population of singleton pregnancies and to examine the relation between cervical length and demographic characteristics and previous obstetric history.

Methods

Cervical length was measured by transvaginal sonography at 23 weeks of gestation in women with singleton pregnancies attending for routine antenatal care. The distribution of cervical lengths was established and the significance of differences in median cervical length between subgroups according to maternal age, ethnic origin, maternal ponderal index, cigarette smoking, alcohol drinking, drug abuse and previous obstetric history was calculated. In addition, 100 women were asked to complete a questionnaire aimed to assess the degree of discomfort, pain or embarrassment caused by the scan. In 100 pregnancies, cervical length was measured in each patient by two of four operators to determine intraobserver and inter‐observer variabilities.

Results

During the study period, 2702 (80%) of the 3358 women attending for a 23‐week scan agreed to participate in the study and, in all cases, the cervical length was measured successfully. The median cervical length was 38 mm and in 1.6% of cases the length was 15 mm or less. More than 90% of the women reported that the procedure was associated with no or only mild discomfort and embarrassment, whilst 85% found the ultrasound scan to be equally or less uncomfortable than a speculum examination. Measurement of cervical length was highly reproducible and, on 95% of occasions, the difference between two measurements by the same observer and by two observers was ≤ 3.5 mm and ≤ 4.2 mm, respectively. Cervical length was significantly shorter in women of Afro‐Caribbean origin compared to Caucasians, those aged less than 20 years, those with a low ponderal index, those with a history of previous miscarriage or preterm delivery and in drug abusers.

Conclusions

Transvaginal sonographic measurement of cervical length is highly reproducible and it is associated with a minimal degree of discomfort to the patients. At 23 weeks, the median cervical length is 38 mm and, in 1.6% of the population, the length is 15 mm or less. There is an association between cervical length and demographic characteristics and previous obstetric history. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Nuchal translucency audit: a novel image‐scoring method
Authors: Herman A. , Maymon R. , Dreazen E. , Caspi E. , Bukovsky I. , Weinraub Z.
Published: March 2003

Objective

The aim of this study was to evaluate the feasibility and reproducibility of a novel image‐scoring method of first‐trimester nuchal translucency measurement as an objective tool of ongoing audit and training.

Design

This was an independent evaluation of nuchal translucency images by three separate reviewers unaware of the examiner.

Subjects

There were 105 consecutive singleton pregnancies undergoing first‐trimester screening.

Methods

Each image was scored according to the following criteria: section (oblique, 0; mid‐sagittal, 2), caliper placing (misplaced, 0; proper, 2), skin line (nuchal only, 0; nuchal and back, 2), image size (unsatisfactory, 0; satisfactory, 1), amnion (not visualized, 0; visualized, 1) and head position (flexion/hyperextension, 0; straight, 1). The final score was categorized into one of four quality groups: excellent (8–9), reasonable (4–7), intermediate (2–3), unacceptable (0–1).

Results

The distributions of the four quality groups were similar between the three reviewers: 11.4% were classified as excellent, 57.1% as reasonable, 25.7% as intermediate and 5.7% as unacceptable. Inter‐reviewer agreement showed identical classification, by each pair of reviewers, from 65.7% to 74.3%, and partial agreement to neighboring quality groups from 25.7% to 34.3% of the cases. In none of the cases did the reviewers differ in categorizing cases to remarkably different quality groups. Application of the auditing method to the examiners showed similar distribution to the various quality groups and similar mean final score of 4.69 (0.39, SE), 4.54 (0.15, SE) and 4.65 (0.15, SE).

Conclusions

The described image‐scoring method represents a new approach towards the evaluation of ultrasound performance as a whole and nuchal translucency measurement in particular. It may be employed by every center in an independent manner with minimal resources and regardless of the method of risk assessment. More studies will be needed to determine the standards required from the examiners and to elucidate the contribution of the proposed auditing method to the examination's quality and the process of training. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Fetal yawning activity in normal and high‐risk fetuses: a preliminary observation
Authors: Petrikovsky B. , Kaplan G. , Holsten N.
Published: March 2003

Objective

To study yawning activity in healthy fetuses and in fetuses at high risk.

Methods

Yawning activity was studied in 16 healthy and 22 high‐risk fetuses. Studies were performed in the postprandial state at 09.00 and 12.00 in a quiet room with the woman in the lateral recumbent position. All ultrasound examinations were performed using a 3.5‐MHz Acuson 128 PX curvilinear probe. Fetal lips, mouth, tongue, pharynx, larynx, trachea and esophagus were surveyed in serial coronal and sagittal planes. All fetal mouthing movements were analyzed by a review of the videotape in slow motion.

Results

In both normal and high‐risk fetuses, yawning was represented by isolated mouthing movements and consisted of slow opening of the mouth with simultaneous downward movements of the tongue. This phase occupied 50–75% of the yawning cycle. After reaching its maximum opening, the mouth remained wide open for 2–8 s and returned to its resting position within seconds. Growth‐restricted fetuses demonstrated yawning patterns consisting of isolated yawns similar to those seen in healthy fetuses. Unusual bursts of fetal yawning activity were recorded in anemic fetuses.

Conclusion

Yawning activity in anemic fetuses may represent a compensatory process to increase venous return to the heart. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal visualization of vascular anastomoses in monochorionic twins using color Doppler sonography: the protective function of these anastomoses and the phenomenon of interference beating
Authors: Joern H. , Klein B. , Schmid‐Schoenbein H. , Rath W.
Published: March 2003

This report concerns the antenatal visualization and velocimetry of an arterioarterial and a venovenous anastomosis in a monochorionic twin pregnancy using color Doppler sonography. The phenomenon of ‘interference beating’ occurs when two flow velocity waveforms are super‐imposed in one blood vessel. This characteristic image can be generated antenatally to confirm the existence of a vascular communication. We were able to reveal these anastomoses postnatally using the dye injection technique. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
P106Persistent right umbilical vein: incidence and significance in a low risk population
Authors: Wolman I. , Gull I. , Amster R. , Hartoov J. , Fait G. , Lessing J. B. , Jaffa A. J.
Published: March 2003

Objectives

Our purpose was to conduct the first prospective evaluation of the incidence and neonatal outcome of fetuses with persistent right umbilical vein (PRUV). This condition had traditionally been considered to be extremely rare and to forebode grave consequences for the babies, but later evidence raised some doubt upon the veracity of these contentions.

Methods

Between August 1995 and November 1998, 8950 low‐risk patients were prospectively evaluated at two medical centers. The ultrasonographic diagnosis of a persistent right umbilical vein was made in a transverse section of the fetal abdomen when the portal vein was curved toward the stomach and the fetal gallbladder was located medially to the umbilical vein.

Results

Seventeen cases of fetuses with PRUV were detected during the study period among the 8950 study participants. Four of them had additional malformations of which three had been detected antenatally.

Conclusions

We established that the incidence of PRUV in a low risk population is 1:526. We believe that the sonographic finding of this anomaly is an indication for conducting targeted fetal sonography and fetal echocardiography. When the PRUV is connected to the portal system and after other anomalies are ruled out, the prognosis can generally be expected to be favorable.
P115First trimester diagnosis of the Pentalogy of Cantrell
Authors: Yamasaki A. , Pedreira D. A. L. , Muller R. , Machado M. V. , Schultz R. , Cha S. C.
Published: March 2003

Case report

CATO, 31‐year‐old, 2G 0P 1 missed abortion (6 weeks). Ultrasound at 13 weeks gestation showed an opened fetal thoraco‐abdominal wall, with ectopia cordis and a large omphalocele, severe scoliosis was noticed, suggesting the diagnosis of Pentalogy of Cantrell. Nucal translucency measured 1.5 mm and Doppler velocimetry of the venous ductus showed a reverse A wave. At 15 weeks, a transabdominal echocardiography showed a complete ectopia cordis and a ventricular septal defect with mild dilatation of right atrial and ventricular cavities. Kariotype obtained by cvs at 14 weeks showed a normal male (46,XY). Spontaneous fetal death occurred at 18 weeks and after 4 days induced labor resulted in an uneventful vaginal delivery. The anatomopathologic study confirmed the diagnosis of Pentalogy of Cantrel: ectopia cordis, cardiac anomalies (IAC, IVC, truncus arteriosus), sternal agenesis, diaphragmatic defect and gastrosquisis.

Discussion

Ectopia cordis is present in the Pentalogy of Cantrell, which is one of the thoraco‐abdominal malformation syndromes. It is a rare disease with a relatively good prognosis in neonatal series. Nevertheless, during pregnancy, few cases have been reported making fetal counselling difficult. This anomaly seems to be a X‐linked dominant inheritance, suggesting that male fetus can have worse prognosis.
P119Usefulness fetal echocardiography in the prenatal diagnosis of Down Syndrome (analysis of the 40 cases)
Authors: Krasoń A. , Kaczmarek P. , Janiak K. , Piotrowicz M. , Nowicki G. , Respondek‐Liberska M.
Published: March 2003

Background

The aim of our study was retrospective analysis of 40 cases fetuses with down syndrome (T21) who had detailed sonography and echocardiography.

Method

Video tape analysis of 40 fetuses with T21 who had completed ultrasound and echocardiography examinations and completed neonatal follow‐up in the same center.

Results

In our study the majority of cases 26 (65%) were low risk pregnancies. High risk pregnancies were in 14 (35%) cases. Congenital heart defect (72%) (AV‐canal in 13/18 cases) was the most common anomaly diagnosed prenataly in fetuses with T21. Functional cardiac anomalies with normal heart anatomy were recorded also such as: dyspoportion and hypertrophy in 4/12 cases, tricuspid valve regurgitation, bright spot and pericardial effusion in 3/12 cases. Extracardiac malformations (25%) were diagnosed in fetuses with T21 such as: dudenal atresia, femur length shortening, pyelectasis bilateralis, face anomalies, sceletal malformations, hydrops fetalis.

Conclusions

1. Congenital heart defect (72%) (AV‐canal in 13/18 cases) was the most common anomaly diagnosed in fetuses with T21. 2. The most common extracardiac malformation was duodenal atresia 13/40 = 32.5% cases. 3. Fetal echocardiography can be usefull to identify in the group of low risk pregnancies, the potential patients for cytogenetic examinations of trisomy 21.
P147Preoperative evaluation of endometriosis with transvaginal ultrasound
Authors: Kopjar M. , Alvir I.
Published: March 2003

Objective

To show the use of transvaginal ultrasound in the diagnosis of endometriosis, and based on that in the decision on the choice of treatment.

Patients and methods

Ultrasound finding of round shaped adnexal mass with thick wall and homogeneous, low level echo pattern was considered suspected for endometriosis. From 1995 to 1999 in women with chronic pelvic pain and palpable mass, transvaginal ultrasound confirmed the endometriosis, according to the above criteria in IS patients. Eleven patients were treated preoperatively with GnRH agonists (goserelin depot 3.6 mg) for 6 months. After the treatment operative laparoscopy was performed. In 7 patients laparoscopy was performed immediately, and patients received medicated treatment after the operations, also GnRH agonists for 6 months.

Results

During the preoperative treatment with GnRH most patients reported a reduction of pain after 3 months of treatment, and with patients operated immediately reduction of pain was reported 2 weeks following operation. Operation was shorter in patients with preoperative treatment with GnRH.

Conclusion

Disadvantages of preoperative treatment of endometriosis include changes in appearance of endometriosis, price of the medication, side‐effects, dilate of accurate diagnosis, and dilate in eventual pregnancy. For some patients it can be useful to start the preoperative medicated treatment to suppress ovulatory activity, so functional cysts would not be misdiagnosed for endometriosis. Patients with chronic pelvic pain should be evaluated laparoscopically to diagnose mild endometriosis adequately.
P15Cervical cerclage: comparison of two techniques by transvaginal ultrasound
Authors: Rozenberg P. , Gillet A. , Ville Y.
Published: March 2003

Background

Cervical cerclage can be performed using either the MacDonald technique or following an anterior colpotomy (Shirodkar technique). A randomized study comparing the two techniques would be impossible to run since 1900 patients would have to be included in each arm.

Objective

To evaluate the benefit of performing a colpotomy prior to putting a cervical suture, by measuring the distance between the stitch and the external os.

Design and methods

Retrospective case‐control study (January 1997–January 1999). All patients having had cervical cerclage after anterior colpotomy and giving birth in our Institution were the study group. Each case was matched with the next patient giving birth in our Institution after having had a MacDonald cerclage. The indication was left to the surgeon's decision and each surgeon used only one technique. Obstetrical characteristics were recorded and ultrasound measurement of the cervix was performed within 8 days following the procedure.

Results

During the study period, there were 15 cases in each group. There was no significant difference between the two groups in the obstetrical outcome. Cervical length was 36.6 mm and 35.4 mm, and the distance between the stitch and the external os was 16.1 mm and 13.5 mm in the Shirodkar and the MacDonald groups, respectively.

Conclusion

Anterior colpotomy did increase the distance between the stitch and the external os by only 2.6 mm and does not seem to offer any clinical benefit.