bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond body mass index
Authors: Prentice A. M. , Jebb S. A.
Published: March 2003

Body mass index (BMI) is the cornerstone of the current classification system for obesity and its advantages are widely exploited across disciplines ranging from international surveillance to individual patient assessment. However, like all anthropometric measurements, it is only a surrogate measure of body fatness. Obesity is defined as an excess accumulation of body fat, and it is the amount of this excess fat that correlates with ill‐health. We propose therefore that much greater attention should be paid to the development of databases and standards based on the direct measurement of body fat in populations, rather than on surrogate measures. In support of this argument we illustrate a wide range of conditions in which surrogate anthropometric measures (especially BMI) provide misleading information about body fat content. These include: infancy and childhood; ageing; racial differences; athletes; military and civil forces personnel; weight loss with and without exercise; physical training; and special clinical circumstances. We argue that BMI continues to serve well for many purposes, but that the time is now right to initiate a gradual evolution beyond BMI towards standards based on actual measurements of body fat mass.
Obesity in Malaysia
Authors: Ismail M. N. , Chee S. S. , Nawawi H. , Yusoff K. , Lim T. O. , James W. P. T.
Published: March 2003

This study was undertaken to assess the recent data on Malaysian adult body weights and associations of ethnic differences in overweight and obesity with comorbid risk factors, and to examine measures of energy intake, energy expenditure, basal metabolic rate (BMR) and physical activity changes in urban and rural populations of normal weight. Three studies were included (1) a summary of a national health morbidity survey conducted in 1996 on nearly 29 000 adults ≥20 years of age; (2) a study comparing energy intake, BMR and physical activity levels (PALs) in 409 ethnically diverse, healthy adults drawn from a population of 1165 rural and urban subjects 18–60 years of age; and (3) an examination of the prevalence of obesity and comorbid risk factors that predict coronary heart disease and type 2 diabetes in 609 rural Malaysians aged 30–65 years. Overweight and obesity were calculated using body mass index (BMI) measures and World Health Organization (WHO) criteria. Energy intake was assessed using 3‐d food records, BMR and PALs were assessed with Douglas bags and activity diaries, while hypertension, hyperlipidaemia and glucose intolerance were specified using standard criteria. The National Health Morbidity Survey data revealed that in adults, 20.7% were overweight and 5.8% obese (0.3% of whom had BMI values of >40.0 kg m–2); the prevalence of obesity was clearly greater in women than in men. In women, obesity rates were higher in Indian and Malay women than in Chinese women, while in men the Chinese recorded the highest obesity prevalences followed by the Malay and Indians. Studies on normal healthy subjects indicated that the energy intake of Indians was significantly lower than that of other ethnic groups. In women, Malays recorded a significantly higher energy intake than the other groups. Urban male subjects consumed significantly more energy than their rural counterparts, but this was not the case in women. In both men and women, fat intakes (%) were significantly higher in Chinese and urban subjects. Men were moderately active with the exception of the Dayaks. Chinese women were considerably less active than Chinese men. Chinese and Dayak women were less active than Malay and Indian women. In both men and women, Indians recorded the highest PALs. Hence, current nutrition and health surveys reveal that Malaysians are already affected by western health problems. The escalation of obesity, once thought to be an urban phenomenon, has now spread to the rural population at an alarming rate. As Malaysia proceeds rapidly towards a developed economy status, the health of its population will probably continue to deteriorate. Therefore, a national strategy needs to be developed to tackle both dietary and activity contributors to the excess weight gain of the Malaysian population.
ACQUIRED HEMOPHILIA
Authors: Boggio Lisa N. , Green David
Published: March 2003

Acquired hemophilia is a serious coagulopathy usually affecting the elderly, persons with autoimmune disorders and, infrequently, women in the immediate postpartum period. It is due to autoantibodies directed against specific domains of the factor VIII molecule, leading to inhibition of factor VIII binding to von Willebrand factor, to activated factor IX or to negatively charged phospholipids. This results in bleeding into the skin, muscles, gastrointestinal and genitourinary tracts, and other sites. Mixing patient plasma with normal plasma prolongs the activated partial thromboplastin time of the normal plasma and the Bethesda assay provides a quantitative estimate of the strength of the inhibitor. The selection of therapeutic concentrates for the management of acute bleeding is related to the titer of the inhibitor; if less than 5 Bethesda Units, human factor VIII may be effective, but higher titer inhibitors usually respond only to porcine factor VIII, recombinant factor VIIa or activated prothrombin complex concentrates. Corticosteroid treatment leads to disappearance of the autoantibody in 50% of patients; cyclophosphamide and cyclosporine are effective in many who do not respond to steroids. Occasionally, high dose intravenous immunoglobulin or immunosorbent columns transiently decrease inhibitor titers and enable control of bleeding. Other autoantibodies have been described against factors V, VII, XI and, rarely, factor XIII and prothrombin. New approaches in the management of autoimmune disease and, especially, methods to establish tolerance are in development.
Management of HIV and pregnancy in England's North Thames Region 1999: a survey of practice in 21 hospitals
Authors: Brook Mg , Taylor Gp , Dale A , Lyall Egh , Tomlinson D
Published: March 2003

Objectives To ascertain current practices in the diagnosis and management of HIV and pregnancy in the North Thames Region.

Methods Postal survey using a self‐completed questionnaire sent to the head of all of the Region's 34 units involved in the care of HIV. The survey asked questions on current policy around HIV and pregnancy in the HIV units and associated antenatal clinics and was linked to a case‐note survey of pregnant, HIV‐positive women in the last 2 years.

Results Over 50% of the responding antenatal units recommended the HIV test by March 1999. Most HIV units were offering a range of antiretroviral regimens in pregnancy, although a minority (33%) did not offer triple therapy. Elective Caesarean section was the recommended mode of delivery for most women (90%) irrespective of drug therapy or viral load. Most infants were being tested for HIV infection by a combination of PCR, viral culture and antibody testing to 18 months of age. All the infants (19) followed to 6 months of age in the case‐note survey were PCR negative. Reporting rates to the National Survey of HIV in Pregnancy were high (87%) but poor for the Drug Exposure Register (33%).

Conclusions Management of HIV and pregnancy in the North Thames units showed a large amount of consistency with regard to testing policies and management. However, there were a few units that did not offer therapy appropriate for advanced disease despite the recommendations of national bodies and a few units still did not recommend HIV testing to all women.
Kaposi's sarcoma in HIV‐infected patients: treatment options
Authors: Hermans P
Published: March 2003

Summary Kaposi's sarcoma (KS) is the most prevalent AIDS‐associated tumour, occurring in 20–30% of HIV‐1‐infected individuals in the early 1980s. The introduction of highly active antiretroviral therapy (HAART) has dramatically reduced the incidence of the disease and might therefore support the concept of ‘opportunistic malignancies’ requiring immune impairments to occur. The relationship between the immune system and the epidemiology of this virus‐induced tumour is of importance in order to identify new therapeutic approaches for treating or preventing its occurrence. As a model of impaired angiogenesis, therapeutic options for treating AIDS patients with KS should therefore target cell division, anti‐angiogenic processes, immune modulators, cytokines and potentially antiviral drugs.
Oral carcinoma in a young man: a case of dyskeratosis congenita
Authors: Moretti S , Spallanzani A , Chiarugi A , Muscarella G , Battini Ml
Published: March 2003

We report a 28‐year‐old male with a voluminous growth of the tongue, present for 6 months. The histological examination revealed a squamous cell carcinoma. The patient was also affected by oral leukoplakia, nail dystrophy, reticulated poikiloderma of the neck and hyperkeratosis of palms and soles. On the basis of clinical features and histological findings, as well as findings from the family, the diagnosis of dyskeratosis congenita (DKC) was made.
Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer
Authors: Bottoni Ugo , Dianzani Caterina , Pranteda Gugliemo , Innocenzi Daniele , De Giacomo Piero , Balzani Alberto , Zampetti Maurizio , Pala Salvatore , Calvieri Stefano
Published: March 2003

This is the report of an 80‐year‐old patient with diffuse brownish hyperpigmentation and velvety thickening of the skin with onset 1 year before. Warty lesions on his limbs were present as well as papillomatous and verrucous lesions on his lips, mouth and eyelid conjunctivae with hyperkeratosis of the nipples. Biopsies, performed at different sites, showed histological pictures consistent with a diagnosis of acanthosis nigricans (AN) with florid cutaneous and mucosal papillomatosis. This type of AN is frequently associated with internal malignancy. In our patient serum levels of tissue polypeptide antigen, carcinoembryonic antigen, cytokeratin fragment and squamous cell carcinoma antigen were high and chest computed tomography scan indicated a large tumour infiltrating the right lung and extending to the mediastinum. Cytological examination of bronchial drainage revealed the presence of neoplastic cells, non‐small cell type carcinoma. The most frequent cancer associated with malignant AN is gastric adenocarcinoma. Lung tumour has rarely been reported with AN. Malignant AN is sometimes associated with other cutaneous and mucosal warty lesions, as in our patient. These various skin and mucosal lesions are the expression of a systemic epithelial disorder and may help clinicians to suspect a malignant form of AN.
Myxoid plexiform fibrohistiocytic tumour
Authors: Cho S , Chang S‐E , Choi J‐H , Sung K‐J , Moon K‐C , Koh J‐K
Published: March 2003

Plexiform fibrohistiocytic tumour is a low‐grade malignant mesenchymal neoplasm of myofibroblastic origin with the capacity for biphasic differentiation toward a fibroblastic or histiocyte‐like morphology. We report a case of this rare tumour presenting as a tender subcutaneous nodule on the scalp of a 58‐year‐old man. Histopathological examination revealed multinodular biphasic proliferation of fibroblast‐like and histiocyte‐like cells with a few osteoclast‐like giant cells. This case is notable for the rare myxoid changes, which may reflect a different behaviour of this tumour when occurring in older people.
Pretibial myxedema as the initial manifestation of Graves’ disease
Authors: Georgala S , Katoulis Ac , Georgala C , Katoulis Ec , Hatziolou E , Stavrianeas Ng
Published: March 2003

Pretibial myxedema (PM) is a localized thickening of the pretibial skin due to accumulation of acid mucopolysacharides (glycosaminoglycans). Its pathogenesis is still under investigation. Pretibial myxedema, exophthalmus and thyroid acropachy are the classic extrathyroidal manifestations of Graves’ disease. Almost invariably, PM follows the onset of ophthalmopathy, developing after the diagnosis and treatment of hyperthyroidism. Pretibial myxedema preceding Graves’ ophthalmopathy is rare.

We report the case of a 28‐year‐old Greek woman, who presented with multiple, asymptomatic nodules and plaques of the lower legs in the absence of other physical findings. Histopathologic examination revealed deposition of mucopolysacharides in the lower dermis. Laboratory investigation showed elevated serum T3 and T4 and depressed TSH levels. In our patient, pretibial myxedema was the earliest manifestation, leading to the diagnosis of Graves’ disease.
Bacillary angiomatosis of the scalp in a human immunodeficiency virus‐negative patient
Authors: Kayaselçuk F , Çeken I , Bircan S , Tuncer I
Published: March 2003

Bacillary angiomatosis (BA) is a recently recognized bacterial infectious disease that is mainly seen in patients with the acquired immunodeficiency syndrome. BA has rarely been reported in immunocompetent individuals. A case of BA of the scalp in an immunocompetent patient, who was human immunodeficiency virus seronegative, is reported. The importance of differential diagnosis of this lesion is emphasized.
Residential Facilities in the Community for People with Intellectual Disabilities: How Neighbours' Perceptions are Affected by the Interaction of Facility and Neighbour Variables
Authors: Schwartz C. , Rabinovitz S.
Published: March 2003

The present paper reports a study of neighbours' perceptions of community‐based residential facilities for people with intellectual disabilities (IDs). Whereas earlier studies have researched the effect of single variables, the present paper breaks new ground by taking a multidimensional perspective. It analyses neighbourhood acceptance as a variable explainable by interactions between facility variables and the nature of the neighbourhood population itself. Two hundred and eight neighbours of 36 urban community facilities for people with IDs were surveyed, plus the facility managers. The individual characteristics of the neighbours which were found to relate to facility impact included: having young children at home; having a disabled family member; knowing that the neighbourhood contained a facility; and visiting the facility. Pertinent facility variables were: size, degree of supervision, and the pre‐ and post‐entry strategies used by managers to gain local acceptance for the facility. Most importantly, the present study found that none of these variables can be considered or used in isolation. The direction of their effect can be positive or negative according to the variables which they interact with. Theoretical aspects of the findings are discussed and interventions are suggested which might improve the community integration of people with IDs.
Factors Related to Positive Perceptions in Mothers of Children with Intellectual Disabilities
Authors: Hastings Richard P. , Allen Rachel , McDermott Kellyanne , Still Danielle
Published: March 2003

Background  Existing theoretical and empirical work in the intellectual disability field has paid little attention to parents' positive perceptions of their child and the positive impact that the child may have on the family generally. The main aim of the present study was to explore the factors related to the mothers' positive perceptions of their child with intellectual disability.

Methods  The mothers of 41 children with intellectual disabilities completed a self‐report questionnaire that measured demographic factors, child demographic variables (including caregiving demand), social support, coping strategies and dimensions of positive perceptions.

Results  Mothers' perceptions of the child as a source of happiness/fulfilment and as a source of strength and family closeness were positively associated with reframing coping strategies. Mothers' perceptions of the child as a source of personal growth and maturity were also positively associated with reframing coping strategies, the helpfulness and usefulness of support from family and friends, and the caregiving demand.

Conclusions  The relationship between coping and parental positive perceptions requires more investigation both theoretically and empirically. This relationship may also have important implications for the support of families of children with intellectual disabilities.
Amniocentesis with increased cell yield, obtained by filtration and reinjection of the amniotic fluid
Authors: Sundberg K. , Smidt‐Jensen S. , Philip J.
Published: March 2003

In order to increase the cell numbers obtained by amniocentesis, a new amniocentesis technique has been developed and we report preliminary results.

The amniotic fluid is aspirated in the usual manner and reinjected immediately into the amniotic cavity after passage through a filter which retains the cells from the fluid. By this procedure, the cells from a relatively large volume of amniotic fluid are concentrated on the filter while only a small volume of amniotic fluid is finally removed.

The method has been tested on 30 pregnant women referred for prenatal diagnosis. The mean culture time was 8.3 days and no immediate side‐effects were observed. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
The impact of sonographic assessment of the endometrium and meticulous hormonal monitoring during natural cycles in patients with failed donor artificial insemination
Authors: Gonen Y. , Calderon I. , Dirnfeld M. , Abramovici H.
Published: March 2003

The present study was undertaken to determine whether the sonographic characteristics of the endometrium in the proliferative phase of the natural cycle combined with meticulous hormonal monitoring would have an impact on the prediction of conception. Fourteen women with regular ovulatory cycles were examined daily, from day 8 of the cycle, by transvaginal ultrasound through 16 unstimulated cycles. All patients had had at least four previous unsuccessful donor artificial insemination cycles scheduled by basal body temperature records. During the study, donor artificial insemination was meticulously timed by hormonal and sonographic monitoring. Four clinical pregnancies occurred with a success rate of 29% per patient, or 25% per cycle. The endometrial thickness at the mid‐proliferative phase (day 8) was significantly smaller in patients who conceived in comparison with patients who failed to conceive (0.33 ± 0.07 cm vs. 0.59 ± 0.03 cm; p < 0.01). The endometrial thickness on the day of the luteinizing hormone (LH) peak was not significantly different between the two groups. However, the amount of endometrial growth between day 8 of the cycle and the day of the LH peak was significantly greater in conception than non‐conception cycles (0.55 ± 0.05 cm and 0.24 ± 0.06 cm; p < 0.01). No difference in hormonal parameters was observed either on day 8 of the cycle or on the day of the LH peak between conception and non‐conception cycles. On the day of the LH peak, an endometrium with typical triple line appearance and thickness of 0.6 cm or more was seen significantly more often in conception than non‐conception cycles (p < 0.05). No pregnancy occurred with an endometrium < 0.6 cm at the time of ovulation. The presence of the favorable endometrial pattern in the periovulatory phase was associated with a positive predictive value for pregnancy of 50% (sensitivity of 100% and specificity of 67%), whereas the negative predictive value of the hyperechoic pattern at the time of ovulation was 100%. Our data show negative correlation between early growth of the endometrium and pregnancy in unstimulated cycles, suggesting that the amount of endometrial growth during the cycle up to ovulation may have an important role in implantation. The sonographic image of the endometrium in natural cycles provides useful information about the possible outcome of the treated cycle. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Ectopic pregnancy: sonographically‐guided transvaginal reduction
Authors: Shalev E. , Zalel Y. , Bustan M. , Weiner E.
Published: March 2003

The advanced modalities of vaginal ultrasonography and sensitive human chorionic gonadotropin assays have greatly facilitated the diagnosis of early ectopic pregnancy. The treatment spectrum for ectopic pregnancy ranges from a variety of conservative operative measures, including salpingectomy and operative laparoscopy, to various medical regimens or simply watchful observation alone. We report 12 cases in which the ectopic gestation was treated by transvaginal instillation of potassium chloride or methotrexate under sonographic guidance. Three of these, one of two patients receiving potassium chloride and two of six patients receiving methotrexate, later required a laparotomy. The level of β‐subunit of human chorionic gonadotropin was found to be unreliable in predicting the outcome in these patients. Ultrasound follow‐up is mandatory. A protocol for treatment is presented. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Amnifiltration in the first trimester: feasibility, technical aspects and cytological outcome
Authors: Byrne D. L. , Marks K. , Braude P. R. , Nicolaides K. H.
Published: March 2003

An amnifiltration system has been developed which allows collection of cells from the amniotic sac in the first trimester of pregnancy whilst only removing 1 ml of amniotic fluid in total. The cells can be cultured and harvested, using the same methods as early amniocentesis, to enable prenatal diagnosis of fetal karyotype. A range of filters constructed from different materials and of differing pore sizes were examined for their ability to trap and subsequently release a maximum number of amniotic fluid cells. The best filter membrane was found to be a cellulose acetate filter of 0.8 µm pore size. To achieve the same cytogenetic outcome as a 10 ml amniocentesis, a minimum of 20 ml amniotic fluid must be filtered and recirculated through the system. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional imaging of solid breast tumors with ultrasound: preliminary data and analysis of its possible contribution to the understanding of the standard two‐dimensional sonographic images
Authors: Rotten D. , Levaillant J. M. , Constancis E. , Collet Billon A. , Le Guerinel Y. , Rua P.
Published: March 2003

Reconstructed three‐dimensional sonographic images are presented from patients having different histological types of breast tumors. Scanning is manual and performed using two‐dimensional annular array, sector transducers fitted on a mechanical arm, to provide spatial location. The three‐dimensional data are displayed using two different modalities. Planar reformatted sections allow the visualization of planes reconstructed along any direction chosen by the operator. Of particular interest are the reconstructions obtained along equatorial planes of the tumors, i.e. planes parallel to the chest wall and, consequently, to the fibroglandular layer of the breast. Volume rendering is obtained using the shaded‐surface visualization technique.

Three‐dimensional imaging provides new information and allows a better interpretation of the standard two‐dimensional images. Planar reformatted sections confirm that ductal carcinomas present margin jagging on all views, including the equatorial section planes. Using the shaded‐surface visualization technique, these tumors appear with a spiked outer surface. Thus, the most specific sonographic finding associated with ductal carcinomas may be that margin jagging extends over the entire periphery of the mass. On planar reformatted sections, benign tumors are surrounded by a continuous hyperechogenic rim, i.e. the rim is present irrespective of the section plane orientation. Medullary carcinomas are also surrounded by a hyperechogenic rim. However, a clearly distinctive feature of these lesions is found on planar reformatted sections: the rim is discontinuous on certain section planes. A mass can be considered benign only if its rim is continuous, i.e. if it is present all around the tumor. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Fetal hydronephrosis and renal artery blood velocity
Authors: Gudmundsson S. , Neerhof M. , Weinert S. , Tulzer G. , Woods D. , Huhta J. C.
Published: March 2003

The renal artery blood velocity waveform was recorded by Doppler ultrasound in 17 fetuses with hydronephrosis in the third trimester of pregnancy. The waveform was analyzed for pulsatility index and related to the degree of dilatation of the renal pelvis. The pulsatility index was found to be above the renal reference range in only five out of the total of 31 kidneys examined. No relationship was found between the degree of dilatation and pulsatility index. A slight relationship was, however, found between abnormal pulsatility index and the need for operative intervention in the neonatal period. Doppler ultrasound is a valuable tool for evaluating renal circulation, but the results suggest limited clinical value in fetuses with hydronephrosis. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
The ultrasonic assessment of discordant growth in twin pregnancies
Authors: MacLean M. , Mathers A. , Walker J. J. , Cameron A. D. , Howat R.
Published: March 2003

Discordant fetal growth, as defined by an intertwin weight difference (calculated as a percentage of the weight of the larger twin) of 20% or more, is associated with an increased perinatal mortality and morbidity. In this study, the accuracy of ultrasound estimation of fetal weight by abdominal circumference and biparietal diameter measurements in 107 twin pregnancies was assessed. Discordant growth greater than 20% as measured by ultrasound was found to have a sensitivity of 5–25%, a specificity of 87–95%, a positive predictive value of 12–43% and a negative predictive value of 80–85% at gestations ranging from 28 weeks to term. ROC calculations showed that changes in the discordance level used did not improve the value of the test. These results indicate that ultrasound measurement of fetal weight alone cannot be used accurately to assess discordant growth in twin pregnancies. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
In utero early suspicion of superfetation by ultrasound examination: a case report
Authors: Soudre G. , Guettier X. , Marpeau L. , Larue L. , Jault T. , Barrat J.
Published: March 2003

We report the case of a dichorionic and diamniotic pregnancy with the unique feature of an early ultrasound diagnosis of a 4‐week size difference, which persisted throughout pregnancy. At birth, the twins had a 1‐month difference in physical and neurological maturity. We believe that only the phenomenon of a superfetation can explain this difference. We report the cases found in the literature. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of lobar holoprosencephaly
Authors: Pilu G. , Sandri F. , Perolo A. , Giangaspero F. , Cocchi G. , Salvioli G. P. , Bovicelli L.
Published: March 2003

Lobar holoprosencephaly was identified with sonography in 12 fetuses between 21 and 35 weeks' gestation. A confident diagnosis was made in each case by a mid‐coronal view of the brain demonstrating absence of the cavum septum pellucidum with fusion and squaring of the frontal horns. The only associated anomaly was Dandy–Walker malformation that occurred in three cases. All fetuses had mild to severe ventriculomegaly. Five pregnancies were terminated; there was one spontaneous abortion and six fetuses were delivered at term. A ventriculo‐peritoneal shunt was implanted in four. Follow‐up was available for five and revealed severe mental retardation in each case. Lobar holoprosencephaly is amenable to prenatal ultrasound diagnosis, although a differentiation with other cerebral malformations may be difficult at times. The outcome of affected infants remains uncertain, but neurological impairment occurs frequently. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
The impact of α‐adrenergic stimulation on umbilical blood flow
Authors: Baker E. R. , Slack D. S. , Miller S. A. , Hendricks S. K.
Published: March 2003

This study evaluated the effects of intranasal phenylephrine, an α‐adrenergic agonist used for respiratory congestion, on uteroplacental blood flow. Twelve subjects were recruited from the Women's Clinic. Inclusion criteria were age greater than 18 years, singleton gestation, absence of medical illness and gestational age of 22–38 weeks. Phenylephrine (0.2 ml of 1% aq. solution) was applied to each nostril. Maternal blood pressure and pulse, umbilical artery velocimetry, and fetal heart rate were recorded prior to drug administration and at 5, 15, 30, 45 and 60 min after administration. There were no significant changes in maternal pulse, blood pressure or fetal heart rate. All subjects had normal baseline umbilical artery Doppler systolic/diastolic ratios. Eleven of 12 subjects demonstrated an elevation of the systolic/diastolic ratio consistent with vasoconstriction following administration. This elevation reached statistical significance at 30 min. Significant individual variation existed with regards to timing of maximal excursion of the systolic/diastolic ratio. The mean maximal change of the systolic/diastolic ratio was 1.57 ± 1.25 (p < 0.001) ranging from −0.53 to 4.11. The use of over‐the‐counter α‐adrenergic agents may result in decreased umbilical artery flow velocities. In high‐risk pregnancies these medications may be contraindicated. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Early prenatal diagnosis of type III bilateral congenital cystic adenomatoid malformation of the lung
Authors: Chou M. M. , Ho E. S. C. , Lee H. S. , Lee Y. H. , Su M. C. , Shih T. P.
Published: March 2003

We present a case of type III fetal cystic adenomatoid malformation with bilateral total involvement of the lungs. The characteristic sonographic findings are echogenic homogeneous lung mass, fetal ascites and platen tomegaly. The early diagnosis at 16 weeks' gestation allows the elective termination of pregnancy because of the likely fatal prognosis. To our knowledge, this is the earliest reported case of congenital cystic adenomatoid malformation of the lung that has been detected prenatally. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Potential for diagnosing imminent risk to appropriate‐ and small‐for‐gestational‐age fetuses by Doppler sonographic examination of umbilical and cerebral arterial blood flow
Authors: Hecher K. , Spernol R. , Stettner H. , Szalay S.
Published: March 2003

In a prospective study, 215 pregnancies of known gestational age were investigated using Doppler sonography. Multiple pregnancies and pregnancies complicated by fetal malformations were excluded. A pulsed Doppler machine was used to record the flow velocity waveforms in the umbilical artery (UA) and middle cerebral artery (MCA). The pulsatility index (PI) of both vessels and the ratio of PI UA to PI MCA were calculated. A total of 127 pregnancies ended in the birth of appropriate‐for‐gestational age babies with no perinatal problems; these formed the normal group (Group A). Of the 88 pregnancies which made up the risk group, 17 were appropriate‐for‐gestational age babies with perinatal problems (Group B), 55 were small‐for‐gestational‐age babies with no perinatal problems (Group C), and 16 were small‐for‐gestational age babies with perinatal problems (Group D). Normal ranges were calculated based on the results for Group A; the measured values for the risk groups were then compared to these. There were highly significant differences between values obtained from the risk groups and those of Group A with the exception of the umbilical artery in Group B and the middle cerebral artery in Group C. The best results came from the values for MCA in Group B (sensitivity = 71%), UA in Group D (sensitivity = 75%), and the PI ratio UA : MCA in Group D (sensitivity = 81%). The sensitivity for the ratio in Group D increased to 93% if only the last measurement for each patient taken within 14 days of delivery was analyzed. A drop in the MCA PI in appropriate‐for‐gestational‐age fetuses was the best indicator of imminent risk of hypoxemia. The PI ratio of UA : MCA is valuable in monitoring small‐for‐gestational‐age fetuses, particularly those with high UA PI levels, as a rise in the ratio provides an early indication of fetal risk. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Early prediction of uteroplacental complications of pregnancy using Doppler ultrasound, placental function tests and combination testing
Authors: Bewley S. , Chard T. , Grudzinskas G. , Cooper D. , Campbell S.
Published: March 2003

In a prospective, blind study of 183 unselected women attending for routine booking scan with a singleton pregnancy at 16–24 weeks' gestation, uteroplacental resistance index, and peripheral levels of α‐fetoprotein, human chorionic gonadotropin, human placental lactogen, Schwangerswaft protein, pregnancy‐associated placental protein A and insulin‐like growth factor (IGF) binding protein 1 were measured. High levels of α‐fetoprotein and IGF 1 binding protein 1 (> 90th centile) were associated with small‐for‐gestational age babies (< 10th centile) (sensitivity 24% and 22%; specificity 90% and 91%). High levels of α‐fetoprotein, human chorionic gonadotropin and pregnancy‐associated placental protein A (> 90th centile) were associated with one or more of three severe complications of pregnancy: very small‐for‐gestational age (< 3rd centile), severe proteinuric hypertension or intrauterine death (sensitivity 20%, 20% and 57%; specificity 90%, 95% and 91%, respectively). A uteroplacental resistance index > 90th centile was also associated with small‐for‐gestational age and severe complications (sensitivity 24% and 50%, specificity 90% and 90%). A combination of resistance index and a placental function test improved the prediction for a group of patients that included any complications (sensitivity 31% and specificity 89%). Doppler ultrasound was a more efficient predictor than individual placental function tests but screening predictions can be improved by combining Doppler parameters and placental protein estimations. Combinations of placental function tests might provide equivalent, or complementary, information. This preliminary work demonstrates the potential value of combining biophysical and biochemical tests to predict complications of pregnancy. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Current status of vaginosonography: a world‐wide inquiry
Authors: Bernaschek G. , Deutinger J.
Published: March 2003

In the last 5 years, vaginosonography has become a routine procedure in obstetrics and gynecology. Many obstetricians, gynecologists, radiologists and ultrasonographers have recognized the advantages of this method. Nearly all manufacturers of ultrasound equipment offer several types of vaginal probes. The rapid spread of vaginosonography has also led to some disadvantages concerning the lack of standardized terminology and image display. In this study, we collected data about the current standards of vaginosonography. To obtain data, questionnaires were sent out to the 1107 Departments of Obstetrics and Gynecology in the FIG0 Registry 1985. In the accompanying letter, the chairman was asked to hand over the questionnaire to the appropriate specialist.

The questionnaire was designed to gather information about the personnel performing vaginosonography and the techniques, transducer frequency, position of the patient and image display used. A total of 369 responses were received. Vaginosonographic investigations were performed in 84% of the University Departments of Obstetrics and Gynecology. In 90% of these, vaginosonography was performed by the obstetrician or gynecologist, in 4% by the radiologist and in 6% by the technician. Most departments preferred end‐firing transducers. The numbers of electronic and mechanical probes were nearly identical (56% vs. 44%). The preferences for a scanner with a narrow (less than 120°) or wide angle (more than 120°) were very similar (53% vs. 47%). More than half of the responders (54%) used a transducer frequency of 5 MHz, while 46% preferred scanners with a frequency between 5.5 and 7.5 MHz. In 55%, the gynecological examination table was considered to be superior to a flat table. Of the responders, 52% projected the apex of the vaginal probe to the bottom of the ultrasound monitor. This was particularly the case in Europe (63%). Questioned about a preference for a particular orientation in the future, an additional 7% voted to change to this mode of image display world‐wide. When performing a sagittal section, if the probe was projected to the bottom of the screen, dorsally located to the structures were projected twice as often to the left of the screen as to the right. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Fetal laryngeal obstruction: sonographic detection
Authors: Choong K. K. L. , Trudinger B. , Chow C. , Osborn R. A.
Published: March 2003

A patient was referred at 21 weeks' gestation for unexplained fetal lung hyperechogenicity and ascites. Amniocentesis was normal. Fetal lung biopsy was consistent with the clinical diagnosis of cystic adenomatoid malformation of the lungs. However, autopsy of the stillborn infant demonstrated a cartilaginous bar, causing total laryngeal obstruction. The distinctive ultrasonographic appearance is presented. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Leiomyosarcoma of the bladder ‐ ultrasonographic features
Authors: Caspi B. , Weinberg D. , Weissman A. , Eisencraft S. , Dgani R.
Published: March 2003

We present a case in which the evaluation of a bladder mass revealed a leiomyosarcoma of the bladder. The ultrasonographic appearance of this tumor is described for the first time. Leiomyosarcoma of the bladder, although rare, should be considered in the differential diagnosis of pelvic masses. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
An investigation of fetal growth using serial ultrasound data
Authors: Gallivan S. , Robson S. C. , Chang T. C. , Vaughan J. , Spencer J. A. D.
Published: March 2003

Serial ultrasonic measurements were performed in 67 Caucasian fetuses from 20 weeks' gestation until term to derive reference standards for abdominal circumference (AC) and estimated fetal weight (EFW). The variances of both AC and EFW increased with gestational age. Four mathematical models (linear, quadratic, Gompertz and Rossavik) were fitted to the log10(AC) and log10(EFW) data from each fetus using least squares regression analysis. The standard deviations of the residual error were greatest for the linear model. The linear model also overestimated the final log10(AC) while the linear, Gompertz and Rossavik models all overestimated the final log10(EFW) when these data were omitted from the fitting process. The individual quadratic constants were, therefore, used to produce 67 individual growth curves. Values of log10(AC) and log10(EFW) for each fetus at exact gestational ages between 20 and 40 weeks were derived by interpolation; the mean and standard deviation values were then used to derive centile ranges for abdominal circumference and estimated fetal weight. These standards should prove useful in the assessment of fetal growth. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Single umbilical artery: a Doppler flow velocity study of four cases
Authors: Iaccarino M. , D'Ambrosio A. , Bellucci Sessa E. , Fortunato A.
Published: March 2003

We measured the pulsatility index of the umbilical artery in four fetuses identified as having a single umbilical artery. A pulsed color Doppler ultrasound machine was used and measurements were performed at 4‐week intervals following the first diagnosis of single umbilical artery (week 22–34). The pulsatility index was derived from the mean of five consecutive measurements at the umbilical insertion of the cord, taking care to obtain the Doppler signal with an incidence angle between +45° and −15°. All measurements were taken during periods of fetal inactivity.

The pulsatility index at 22, 26, 30, 34 and 38 weeks in these pregnancies did not differ significantly from the mean values registered in normal pregnancies. The four women gave birth to babies of normal weight: two were healthy, one suffered from bladder extrophy and hemispondyly, the other had bilateral dilatation of the renal pelves, megalocystis, megalourethra and an imperforate anus. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Early diagnosis of fetal congenital heart disease by transvaginal echocardiography
Authors: Gembruch U. , Knöpfle G. , Bald R. , Hansmann M.
Published: March 2003

Fetal echocardiography was performed using a high‐frequency vaginal ultrasound probe in 114 singleton pregnancies between 11 and 16 weeks of gestation. The four‐chamber view with both atria, atrioventricular valves and ventricles as well as the origin and double‐crossing of aorta and pulmonary trunk could always be demonstrated from the 13th week onwards. In 12 of 13 cases, cardiac malformations were diagnosed in the first trimester. Only in one case was transabdominal echocardiography necessary at 20 weeks to make the diagnosis. In several cases, however, additional malformations were overlooked, in particular anomalies of the great arteries, such as coarctation of the aorta. Therefore, the accuracy of second‐trimester transabdominal echocardiography is markedly higher.

Because of the lower diagnostic accuracy, the high costs of equipment and the high training demanded of the examiner, first‐trimester transvaginal echocardiography should be restricted to the high‐risk fetus, i.e.:

Cases with other fetal anomalies very often associated with cardiac defects, such as nuchal edema and hygroma, non‐immune hydrops, omphalocele, situs, inversus, or persisting arrythmia;

High‐risk families with one or more first‐degree relatives with cardiac defects are either inherited by Mendelian rules alone, or as part of a rare syndrome; and

In pregestational diabetes of the mother.

Thus, many severe cardiac defects can be detected or excluded in the first trimester, reducing maternal anxiety. In these high‐risk cases, second‐trimester echocardiography using the transabdominal route should always be performed because of its distinctly higher diagnostic accuracy. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Vaginal ultrasonography in patients with postmenopausal bleeding
Authors: Auslender R. , Bornstein J. , Dirnfeld M. , Kogan O. , Atad J. , Abramovici H.
Published: March 2003

Our objective was to define a subset of women with postmenopausal bleeding in whom the accepted practice of endometrial sampling could be safely omitted. Vaginal endosonographic measurements were compared to the histological findings of curettings following diagnostic dilatation and curettage in 129 women with post‐menopausal bleeding who were not receiving hormonal therapy. Atrophy was diagnosed in 49%, slight proliferation in 10%, endometrial polyps in 11%, hypoplasia in 12%, and adenocarcinoma in 12%. Endometrial atrophy was associated with a mean sonographic thickness of 2.6 mm of the double layer (range 0–6.5 mm). Of the women with a final histological diagnosis of atrophy, 92% had an endometrial thickness of 3 mm or less. Furthermore, all women with a sonographic endometrial thickness of 3 mm or less had atrophic endometrium (p < 0.0001). An endometrial thickness of 3 mm or less would have reduced the number of dilation and curettage procedures by 45% and no cases of endometrial pathologies would have been missed. In women presenting with postmenstrual bleeding, meticulous scanning of the endometrium can select a group where endometrial sampling can be omitted from the protocol. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Extracardiac anomalies, aneuploidy and growth retardation in 100 consecutive fetal congenital heart defects
Authors: Respondek M. L. , Binotto C. N. , Smith S. , Donnenfeld A. , Weil S. R. , Huhta J. C.
Published: March 2003

The importance of extracardiac anomalies in 100 consecutive fetuses with congenital heart disease was evaluated. The most common cardiac diagnoses were hypoplastic left heart syndrome in 35% and atrioventricular canal defect in 15%. Extracardiac anomalies were present in 42%, abnormal karyotype in 19% and intrauterine growth retardation in 20%. There were 45 survivors (35 required neonatal surgery, ten did not require early surgery) and 80% (36/45) of the survivors had isolated congenital heart disease. Extracardiac anomalies and abnormal karyotype were more frequently present in non‐survivors (p < 0.001). Also, intrauterine growth retardation was more frequent in non‐survivors (p < 0.05).
Color Doppler examination of the outflow tracts of the fetal heart: a technique for identification of cardiovascular malformations
Authors: DeVore G. R.
Published: March 2003

The objective was to describe a technique using color Doppler to identify the outflow tracts of the fetal heart by directing the ultrasound transversely through the fetal chest. One hundred second‐ and third‐trimester control fetuses were examined with real‐time and color Doppler ultrasound. The ultrasound beam was directed cephalad, in the same transverse plane used to image the four‐chamber view, and the outflow tracts were examined. Four fetuses with abnormal cardiovascular anatomy were examined using the above approach, to study the anatomical relationships of the outflow tracts identified with color Doppler ultrasound in normal fetuses.

When the ultrasound beam was directed immediately cephalad to the four‐chamber view, the aorta was identified as it exited the left ventricle. Further movement of the ultrasound beam cephalad identified the following vessels in a single plane: the main pulmonary artery perpendicular to the ascending aorta; the left pulmonary artery branching from the main pulmonary artery; the full length of the ductus arteriosus; and the transverse arch of the aorta. The ascending aorta, main pulmonary artery, ductus arteriosus and transverse aortic arch were identified in 100% of fetuses. Four fetuses with abnormalities of the outflow tracts (aortic stenosis, aortic regurgitation, pulmonary stenosis and premature constriction of the ductus arteriosus) were imaged using this approach in which pathology was readily identified.

This technique enables rapid identification of the outflow tracts in second‐ and third‐trimester fetuses using color Doppler and accurately identifies abnormalities of these vessels. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Maternal hyperoxygenation in the treatment of mild intrauterine growth retardation: a pilot study
Authors: Battaglia C. , Artini P. G. , D'Ambrogio G. , Bencini S. , Galli P. A. , Genazzani A. R.
Published: March 2003

The aim of this study was to determine the efficacy of long‐term maternal hyperoxygenation in comparison with bed rest in the management of mildly growth‐retarded fetuses (5–10th centile).

Thirty‐eight patients with intrauterine growth retardation were studied. The patients were divided into oxygen‐treated (n = 18) and untreated (n = 20) groups. Ultrasound assessment of amniotic fluid volume was performed on alternate days, and the fetal abdominal circumference was evaluated weekly. Doppler analysis of fetal/maternal circulation was performed upon the patient's arrival at hospital, after 12 h, and thereafter on alternate days until parturition. Fetal blood was sampled by cordocentesis for immediate blood gas analysis at the start of the study and on the day of delivery.

Although in the treated patients there was significant improvement in Doppler flow pat tern and blood gas indices, no significant differences in type of delivery and perinatal outcome were noted between the groups. Maternal hyperoxygenation in mild intrauterine growth retardation did not improve perinatal outcome. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology