bluuebunny/crossref_metadata_2025 huggingface dataset:
Obesity and cardiovascular risk factors in Hong Kong Chinese
Authors: Lee Z. S. K. , Critchley J. A. J. H. , Ko G. T. C. , Anderson P. J. , Thomas G. N. , Young R. P. , Chan T. Y. K. , Cockram C. S. , Tomlinson B. , Chan J. C. N.
Published: March 2003

The purpose of this cross‐sectional study was to examine the risk associations between obesity indexes body mass index (BMI) and waist circumference (WC)], cardiovascular risk factors plasma glucose and lipids, blood pressure and urinary albumin excretion (UAE)] and morbidity conditions (Type 2 diabetes mellitus, hypertension, dyslipidaemia and/or albuminuria) in Hong Kong Chinese. Seven‐hundred and two Hong Kong Chinese subjects (18–65 years of age, 59.4% of whom had at least one morbidity condition) were recruited from the Prince of Wales Hospital, Hong Kong SAR. The measurements taken of the subjects included: height; weight; waist and hip circumferences; blood pressure; fasting plasma glucose and lipids; and 24‐h UAE. The mean BMI was 22.4 and 25.7 kg m−2 in healthy subjects and patients, respectively. The mean WC measurements of healthy subjects and patients were 77.1 and 86.4 cm in males and 71.0 and 81.8 cm in females, respectively. There were increasing trends between obesity indexes and the severity of cardiovascular risk factors and the prevalence of morbidity conditions (all P‐values for trend <0.05). Using 19.0–20.9 kg m−2 and <70 cm as a referent, subjects with a BMI of ≥25.0 kg m−2 (in both sexes) and/or a WC of ≥85 cm in males and ≥75 cm in females had an age‐adjusted odds ratio between 3.2 and 4.4 for the occurrence of at least one morbidity condition. Patients with a greater number of comorbidities also had higher BMI and WC measurements (all P‐values for the trend were <0.05 with adjustment for age and gender). Hence, despite Hong Kong Chinese being less obese than Caucasians, the intimate relationships among obesity, cardiovascular risk factors and morbidity conditions remain. Our data support using lower BMI and WC levels to define obesity and its associated health risks rather than using the criteria established from Caucasians who generally have larger body frames.
The relationship between body mass index and the prevalence of obesity‐related diseases based on the 1995 National Health Interview Survey in Korea
Authors: Moon O. R. , Kim N. S. , Jang S. M. , Yoon T. H. , Kim S. O.
Published: March 2003

This study estimated the body mass index (BMI) distribution of Koreans and examined the relationship between BMI and obesity‐related diseases, in particular hypertension and diabetes mellitus. We also attempted to provide primary data to determine suitable BMI cut‐off points for obesity in Korea. The 1995 National Health Interview Study (NHIS) data were used to estimate BMI and the prevalence of hypertension and diabetes mellitus. A random sample of 5750 Koreans (15–69 years of age) were investigated. BMI was calculated by self‐reported weights and heights. The diagnoses of hypertension and diabetes mellitus were obtained from self‐reported conditions specified in response to consultations with physicians. The mean BMI was 22.6 ± 2.6 kg m−2 for males and 21.7 ± 4.8 kg m−2 for females. The prevalence of hypertension and diabetes mellitus increased with BMI. The odds ratios of the third quartile of BMI (21.9–23.8 kg m−2) for hypertension and diabetes mellitus compared with the first quartile were 6.04 and 3.22, respectively. The odds ratio of the fourth quartile (>23.8 kg m−2) of BMI was not significantly different from that of the third quartile. The risk of hypertension and diabetes mellitus increased at the third quartile of BMI (21.9–23.8 kg m−2), this quartile being much lower than both the current World Health Organization (WHO) BMI cut‐off point of overweight of 25.0 kg m−2, and the 90th percentile proposed in the Monica project, BMI 26.4 kg m−2. This finding was notable considering the fact that both hypertension and diabetes mellitus occur in Koreans with lower BMIs than whites. Further studies are necessary to identify the BMI cut‐off point for obesity in Korea.
Genetic Features of B‐Cell Chronic Lymphocytic Leukemia
Authors: Stilgenbauer Stephan , Lichter Peter , Döhner Hartmut
Published: March 2003

The genetic features of B‐cell chronic lymphocytic leukemia CLL) are currently being reassessed by molecular cytogenetic techniques such as fluorescence in situ hybridization FISH). Conventional cytogenetic studies by chromosome banding are difficult in CLL mainly because of the low in vitro mitotic activity of the tumor cells, which leads to poor quantity and quality of metaphase spreads. Molecular genetic analyses are limited because candidate genes are known for only a few chromosomal aberrations that are observed in CLL. FISH was found to be a powerful tool for the genetic analysis of CLL as it overcomes both the low mitotic activity of the CLL cells and the lack of suitable candidate genes for analysis. Using FISH, the detection of chromosomal aberrations can be performed at the single cell level in both dividing and non‐dividing cells, thus circumventing the need of metaphase preparations from tumor cells. Probes for the detection of trisomies, deletions and translocation breakpoints can be applied to the regions of interest with the growing number of clones available from genome‐wide libraries. Using the interphase cytogenetic FISH approach with a disease specific set of probes, chromosome aberrations can be found in more than 80% of CLL cases. The most frequently observed abnormalities are losses of chromosomal material, with deletions in band 13q14 being the most common, followed by deletions in 11q22‐q23, deletions in 17p13 and deletions in 6q21. The most common gains of chromosomal material are trisomies 12q, 8q and 3q. Translocation breakpoints, in particular involving the immunoglobulin heavy chain locus at 14q32, which are frequently observed in other types of non‐Hodgkin’s lymphoma, are rare events in CLL. Genes affected by common chromosome aberrations in CLL appear to be p53 in cases with 17p deletion and ataxia telangiectasia mutated ATM), which is mutated in a subset of cases with 11q22‐q23 aberrations. However, for the other frequently affected genomic regions, the search for candidate genes is ongoing. In parallel, the accurate evaluation of the incidence of chromosome aberrations in CLL by FISH allows the correlation of genetic abnormalities with clinical disease manifestations and outcome. In particular, 17p abnormalities and deletions in 11q22‐q23 have already been shown to be among the most important independent prognostic factors identifying subgroups of patients with rapid disease progression and short survival. In addition, deletion 17p has been associated with resistance to treatment with purine analogs. Therefore, genetic abnormalities may allow a risk assessment for individual patients at the time of diagnosis, thus giving the opportunity for a risk‐adapted management.
Conventional Management of Chronic Lymphocytic Leukemia
Authors: Keating Michael J. , O’Brien Susan
Published: March 2003

Major advances have been made in the treatment of chronic lymphocytic leukemia over the last 20 years. A fundamental change has been precipitated by the discovery of the activity of the purine analogs fludarabine, 2‐chlorodeoxyadenosine and pentostatin. These agents are now being compared in comparative studies with conventional regimens based on alkylating agents. An appreciation of the wide spectrum of prognosis and need for treatment has been clarified, and other important modalities, such as monoclonal antibodies and autologous and allogeneic transplantation, have entered the arena and will need to be woven into the new algorithms for the treatment of this disease.
Towards an integrated classification of adult acute lymphoblastic leukemia
Authors: Foa Robin , Vitale Antonella
Published: March 2003

Acute lymphoblastic leukemia (ALL) represents a biologically and clinically heterogeneous group of diseases characterized by the abnormal proliferation and accumulation of immature lymphoid cells within the bone marrow and lymphoid tissues. Following a diagnostic work‐up, prognostic data are routinely achieved through physical examination, serum biochemical profiles, peripheral blood count and bone marrow morphology. Over the years, information obtained through karyotype, molecular genetics, extensive immunophenotype, multidrug resistance and, more recently, genomic profiling is progressively contributing to a better understanding of the biology of this complex disease, to the identification of subgroups of patients with a different clinical outcome, to the more precise monitoring of minimal residual disease, to the use of different therapeutic protocols based on prognostic indicators and, recently, also to the design of innovative and specific treatment strategies. In the present review, we will discuss how an integrated approach is now mandatory for the optimal management of adult ALL.
Enteric viral infections as a cause of diarrhoea in the acquired immunodeficiency syndrome
Authors: Thomas PD. , Pollok RcG. , Gazzard BG.
Published: March 2003

Background and aims The role of non‐cytomegalovirus (CMV) enteric viral infection in causing diarrhoea in patients with human immunodeficiency virus (HIV) is poorly understood. We aimed to investigate the prevalence of these infections in acute and chronic diarrhoea.

Methods Stool specimens from 377 HIV‐infected patients presenting with diarrhoea were studied prospectively for evidence of non‐CMV enteric viral infection. Patients with diarrhoea underwent investigation for gastrointestinal pathogens, including electron microscopic examination of stool for enteric viruses. We collected data on patients in whom enteric virus was identified and examined the association of enteric virus infection with diarrhoeal symptomatology.

Results Eighty‐nine (10.3%) stool specimens from 60 (15.9%) HIV+ individuals were positive for coronavirus (n = 13, 22%), rotavirus (n = 11, 18%), adenovirus (n = 30, 50%) and small round structured viruses (n = 5, 8%) or dual infection (n = 2, 3%). Thirty‐four of 52 (65%) patients available for analysis had acute diarrhoea, and 18/52 (35%) had chronic diarrhoea. Twenty‐three of 52 (44%) patients had a concurrent gut pathogen. After exclusion of concurrent pathogens enteric viral infections were found to be significantly associated with acute as opposed to chronic diarrhoea (P = 0.004). The presence of adenovirus colitis was significantly more likely to be associated with chronic diarrhoea (15/21 cases) than adenovirus isolated from stool alone (9/23 cases) (P = 0.03). There was a trend towards an association between adenovirus colitis and colonic cytomegalovirus infection (P = 0.06).

Conclusion Enteric viral infection is strongly associated with acute diarrhoea in patients with HIV. Light microscopic examination of large bowel biopsies can identify adenovirus colitis which is significantly associated with chronic diarrhoea, and in addition may facilitate gastrointestinal co‐infection with CMV.
Management of protozoal diarrhoea in HIV disease
Authors: Miao YM , Gazzard BG
Published: March 2003

Summary Since the first reported case of HIV infection in 1981, many HIV‐seropositive patients have died as a result of diarrhoea induced by opportunistic protozoal infections: pathogens that would normally cause only a transient illness in immunocompetent individuals. The introduction of highly active antiretroviral therapy (HAART) in 1996 has been associated with a significant decline in incidence and mortality arising from infections such as cryptosporidia and microsporidia. Previously, there were no chemotherapeutic agents known to be effective in eradicating these parasites, but since the availability of HAART, the memory of the emaciated terminally ill patient with advanced AIDS suffering from refractory diarrhoea will hopefully be a thing of the past. Significant advances in the knowledge of the pathogenesis of HIV disease, earlier detection and thus treatment of the virus, and availability of improved diagnostic techniques and HAART have transformed the way HIV‐associated diarrhoea is managed. In this review, we look specifically at the management of protozoa‐induced diarrhoea.
PENTA guidelines for the use of antiretroviral therapy in paediatric HIV infection
Authors: Sharland M , Gattinara di Zub G Castelli , Tomas Ramos J , Blanche S , Gibb DM
Published: March 2003

Objective

To produce European Guidelines for the use of antiretroviral therapy (ART) in HIV‐infected children.

Design

Systematic literature review using Medline, the major antiretroviral conference reports, and IDSA recommendations on guideline production.

Setting

Pediatric European Network for Treatment of AIDS (PENTA) Steering Committee.

Outcome measure

Guidelines have been produced for the use of antiretroviral therapy in HIV‐infected children in Europe. Recommendations on when to start ART and which ART to start, with dosages and a summary of the relevant literature, have been produced.

Conclusions

These guidelines are aimed at assisting paediatricians in Europe with ART prescribing, and provide a more cautious approach to starting therapy than current paediatric USA guidelines.
Long‐term assessment of neuropsychiatric adverse reactions associated with efavirenz
Authors: Lochet P , Peyrière H , Lotthé A , Mauboussin JM , Delmas B , Reynes J
Published: March 2003

Objectives

The Sensio study objectives were to assess the outcome of neuropsychiatric adverse reactions (NPAR) that develop after initiation of efavirenz (EFV) therapy, to ascertain the late NPAR after a 3‐month treatment period, to evaluate the impact of NPAR on patients' quality of life (QoL) in a real‐life population.

Methods

During a 6‐month period, consecutive HIV‐infected adult outpatients receiving an ongoing EFV therapy for at least 3 months were asked to fill in a specifically designed self‐administered questionnaire addressing sleep disturbances, behavioural changes, mood disturbances, anxiety, cognitive disorders, hallucinations, dizziness and the general impact on patients' QoL.

Results

A total of 174 questionnaires were analyzed. The main late emergent NPAR were sleep disorders: abnormal dreams 24.7%, nocturnal waking 19.6%, trouble falling asleep 17.8%; cognitive disorders: memory disorders 23.0%, impaired concentration 18.9%; anxiety 15.5%; mood disorders: sadness 19.3%, suicidal ideations 9.2%. Global neuropsychic discomfort was moderate to severe in 23% of patients after a 3‐month treatment period.

Conclusion

NPAR occur mainly during the first month of EFV therapy but often persist thereafter. A significant percentage of patients reported suicidal ideations at the time of the study. Our results suggest the need for routine screening for NPAR among patients receiving EFV therapy and better management.
An open study of efficacy and safety of long‐term treatment with mometasone furoate fatty cream in the treatment of adult patients with atopic dermatitis
Authors: Faergemann Jan , Christensen Ole , Sjövall Peter , Johnsson Annika , Hersle Kjell , Nordin Peter , Edmar Birgitta , Svensson Åke
Published: March 2003

Background Atopic dermatitis is a severe chronic skin disease often deteriorated by the presence of microorganisms and often responds well to treatment with potent corticosteroids. However, the long‐term use of potent topical corticosteroids are accompanied by side‐effects such as skin atrophy.

Objective To study the effect and safety of prophylactic treatment with mometasone furoate fatty cream (contains hexylene glycol) for 6 months in patients with atopic dermatitis.

Results Sixty‐one of 68 (90%) patients were still free of their disease after 6 months of twice weekly treatment and only one showed possible treatment related signs of skin atrophy. The number of Staphylococcus aureus and Pityrosporum ovale were significantly reduced in cleared patients.

Conclusions Mometasone furoate fatty cream is effective and safe both for treatment and as a prophylaxis in patients with atopic dermatitis.
Oral pigmentation
Authors: Lenane P , Powell Fc
Published: March 2003

Oral pigmentation may be physiological or pathological in nature. It may represent a localized anomaly of limited significance or the presentation of potentially life‐threatening multisystem disease. Evaluation of a patient with oral pigmentation requires a systematic approach with resource to appropriate investigations in certain circumstances. A full history of evolution of the pigmentary changes, as well as inquiring into family history, drug ingestion and systemic symptoms of concurrent disease are clearly important in the assessment. The duration, pattern, hue and distribution of colour changes can provide useful diagnostic clues. Special attention is given to newly appearing lesions, or those that have changed significantly in appearance, and biopsy may be needed to validate the clinical impression.

This review should enable the reader to increase their familiarity with the assessment of oral pigmentation, the common causes of oral pigmentary change and the rarer disorders of pigmentation seen in this area. The systemic diseases that may give rise to oral pigmentation are detailed and the early signs of oral melanoma are highlighted, as well as the drugs which may cause pigmentary changes in this area and the different pattern of pigmentation they may induce.
Plasma cell mucositis
Authors: Kaur C , Thami GP , Sarkar R , Kanwar AJ
Published: March 2003

A case of plasma cell mucositis is described for its rarity. A probable aetiological correlation with periodontitis is discussed. The patient showed good response to intralesional and topical steroids.
Dapsone in rosacea fulminans
Authors: Bormann G , Gaber G , Fischer M , Marsch WC
Published: March 2003

Rosacea fulminans is a rare disease with female predominance characterized by abrupt onset of pustules, papules, and confluent nodules on the face. The conventional treatment consists of systemic glucocorticoids and isotretinoin. We present the case of a 56‐year‐old woman with a marked facial papulopustular eruption that had followed an initial period of severe seborrhoea. Conventional treatment produced no clear improvement. Dapsone treatment achieved complete healing in 5 weeks.
Sun awareness and sun protection practices in Malta
Authors: Scerri L , Aquilina S , Gauci A Amato , Dalmas M
Published: March 2003

Background Concern regarding the rising incidence of melanoma and non‐melanoma skin cancers in Malta has led to the organization of annual campaigns since the early 1990s. These aim to inform the public of the dangers of sun exposure and to promote sun protection.

Objective  To help guide future campaigns, a survey was carried out to evaluate current sun protection measures among the Maltese people and to assess their level of knowledge regarding harmful effects of the sun on the skin.

Study design  A total of 559 pedestrians were interviewed in the main street of the capital city of Malta in the summer of 1999.

Results  Self‐reported rates of regular sunscreen and hat use in adults exposed to the spring/summer sun between 10.00 h and 15.00 h were 51% and 32%, respectively, for leisure activities, and 25% and 37%, respectively, for outdoor work. Men reported using sunscreen less often than women during both leisure and work. The fairer‐skinned outdoor workers actually reported making less use of a sunscreen and/or hat than their darker counterparts, and rates of sunscreen and/or hat use during leisure and work were not found to increase with the amount of time spent in the sun. Almost 75% of sunscreen users were using a sun protection factor of at least 15. Parents reported much higher rates of regular sunscreen and hat use by their young children than by themselves, with 87% of children under 12 years of age reported to be using sunscreen and 78% reported to be wearing a hat. The great majority knew that injudicious sun exposure is associated with skin cancer and skin ageing, but 48% were still regarding a suntan achieved without skin burning as ‘healthy’. The mass media was by far considered to be the main source of information for the general public regarding effects of the sun on the skin.

Conclusions  The positive impact of past campaigns can be seen in the high reported rates of sun protection in children. However, much remains to be done with adults in order to change their attitude about a ‘healthy suntan’ and to convince them that it is worthwhile to protect themselves from the sun.
Repair of acetone‐ and sodium lauryl sulphate‐damaged human skin barrier function using topically applied emulsions containing barrier lipids
Authors: De Paepe K , Roseeuw D , Rogiers V
Published: March 2003

Background It is generally acknowledged that well‐formulated moisturizing skin care products can restore disturbed barrier function that can be assessed by transepidermal water loss (TEWL) measurements. When ceramides and/or other barrier lipids are incorporated, it is, however, not always clearly demonstrated which ingredients of the formulation exert the beneficial effects.

Objectives In this study the effects of topically applied ceramide‐containing mixtures on the barrier repair of sodium lauryl sulphate (SLS)‐ and acetone‐induced skin damage have been studied in human volunteers. TEWL and stratum corneum hydration measurements were carried out. The emulsions applied contained either a mixture of two types of ceramides, CerIII and CerIIIB (emulsion 1) or a complete mixture of ceramides III, IIIB and VI together with phytosphingosine, cholesterol and the free fatty acid linoleic acid (emulsion 2).

Results After SLS damage, it was observed that barrier recovery was significantly accelerated by topical application (14 days, 2 ×/d) of emulsion 2 compared with the results obtained with emulsion 1. Corneometrical results were not relevant due to the occurrence of scaly fissured skin, failing to provide a good skin/probe contact. Although no effect on TEWL could be observed, the improvement of skin hydration after acetone treatment and a single application of the emulsions, was significantly more positive for emulsion 2 than for emulsion 1.

Conclusions The investigative methods used in this study show that ceramides combined with other skin lipids can improve barrier repair after damage.
Calcinosis cutis universalis
Authors: Ogretmen Z , Akay A , Bicakci C , Bicakci HC
Published: March 2003

We report the case of a 49‐year‐old female who complained of hardening of the skin, with onset about 1.5 years before presentation. The laboratory data showed normal biochemistry profile. Routine haematochemical examinations showed slight anaemia, an increased erythrocyte sedimentation rate and negative rheumatological markers. Calcium excretion in a 24‐h urine sample was normal, but the phosphate excretion was slightly low. The clinical diagnosis was verified by soft tissue ultrasound examination showing subcutaneous calcifications. X‐ray examination of bones evidenced no abnormal calcification. Mammography revealed deep seated bilateral reticular calcifications, even in the axillary region. Histological examination showed calcinosis cutis. On these grounds, the diagnosis of idiopathic universal calcinosis cutis was made. The authors describe the clinical and histological picture and discuss the laboratory findings.
Leukoplakia and intraoral malignancies: female cases increase in Greece
Authors: Zavras AI , Laskaris C , Kittas C , Laskaris G
Published: March 2003

In the developed world, intraoral malignancies are more frequent in males than females. Recent observations from Greece suggest that the number of females is increasing.

Aim The present study investigates gender and age statistics among subjects with cancers of the mouth or leukoplakia.

Methods Five hundred and twelve subjects of Greek origin participated in this analysis. Chi‐square and logistic regression statistics were used to compare if there are differences in participants’ gender and age, stratified by histological type.

Results Epithelial cancers and leukoplakia exhibited equal distributions among men and women. Men were diagnosed at a much younger age than women. Our data also indicates a progression in the process of epithelial cancer development, as benign leukoplakia was diagnosed 2–4 years earlier than epithelial dysplasia and 8 years earlier than squamous cell carcinoma (SSC). The same age difference was observed in non‐Hodgkin's lymphoma, although the male to female ratio was 3 : 1. In regards to anatomy, 47% of SSC appeared in the tongue. The most prevalent site for the development of non‐Hodgkin's lymphoma was the gingival (50%), followed by the palate (40%).

Conclusion Although oral cancer occurs earlier in men than women, the risk of females tends to be similar to that of males.
A Pilot Study of the Use of Physical Intervention in the Crisis Management of People with Intellectual Disabilities who present Challenging Behaviour
Authors: Baker Peter A , Bissmire Dianne
Published: March 2003

The use of physical intervention in response to challenging behaviour in a nonspecialized intellectual disability service setting was found to be extremely high. In addition, staff confidence in their ability to prevent and respond to crisis situations involving challenging behaviour was extremely low. All staff within this setting received training in Strategies in Crisis Intervention and Prevention (SCIP). At three‐month follow‐up staff felt more confident in the management of crisis, and more supported by their organization. No significant effects on the number of incidents reported were found, although the data suggested an increased tendency to use a physical intervention relative to other methods following training. The implications of these findings for service design and further research are discussed.
Role of Music Therapy in Social Skills Development in Children with Moderate Intellectual Disability
Authors: Duffy Barbara , Fuller Ray
Published: March 2003

The present study investigated the effectiveness of a music therapy programme in the enhancement of the social skills of children with moderate intellectual disability. Thirty‐two children (age range = 5–10 years) from four intellectual disability centres participated. At each centre, four children were randomly selected to participate in the music therapy programme, while four children were assigned to a non‐music control group programme. One staff member was trained in each group procedure at each centre, and requested to run 30‐min group sessions twice weekly over an 8‐week intervention period. Five social skills were targeted for intervention: turn‐taking, imitation, vocalization, initiation and eye contact. Measures of effectiveness involved comparison of pre‐ and post‐intervention scores on five target skills using a brief social skills test specifically designed for the study. Evaluation forms completed by teachers also provided feedback on the effectiveness of the intervention. The results reflect significant improvements in the five target social skills across both conditions following the 8‐week intervention. However, this difference was found to be independent of the music/non‐music intervention.
Differences in Stress Levels between Managers and Direct Care Staff in Group Homes
Authors: Rose John , Jones Catherine , Elliott Julie
Published: March 2003

A survey examined the differences between managers and direct carers working in community homes for people with intellectual disabilities in terms of the nature and causes of stress. Fifty‐seven managers and 49 direct carers provided data relating to perceived levels of pressure and support from a variety of sources. The questionnaire administered consisted of the Powell questionnaire of sources of stress and support ratings, a stress measure, and information on the background characteristics of participants. Analysis of the data revealed that managers of group homes were reporting higher levels of anxiety and pressure than direct carers. This was associated with managers reporting higher ratings for sources of stress. The implications of these findings are discussed.
Assessing the Severity of Challenging Behaviour: Psychometric Properties of the Challenging Behaviour Interview
Authors: Oliver Chris , McClintock Karen , Hall Scott , Smith Melanie , Dagnan Dave , Stenfert‐Kroese Biza
Published: March 2003

Background  The Challenging Behaviour Interview (CBI) was developed as an assessment of the severity of challenging behaviour. The CBI is divided into two parts. Part I of the interview identifies the occurrence of five clearly operationalized forms of challenging behaviour that have occurred in the last month. Part II of the interview assesses the severity of the behaviours identified on 14 scales measuring the frequency and duration of episodes, effects on the individual and others and the management strategies used by carers. In this paper we report upon its psychometric properties and discuss potential clinical and research uses of the new scale.

Methods  The CBI was administered to 40 adults and 47 children. Test–retest and inter‐rater agreement was assessed for 22 participants in the adult sample. Concurrent validity was assessed by correlating total scores for the child sample with the subscale and total scores of the Aberrant Behavior Checklist (ABC). Content validity was assessed by comparing scores for each behaviour on specific items relating to relevant aspects of severity of impact that would be expected to differ based upon the topographies of the behaviour.

Results  Mean inter‐rater and test–retest reliability kappa indices for the behaviours in Part I of the interview were 0.67 (range: 0.50–0.80) and 0.86 (range: 0.70–0.91), respectively. Mean inter‐rater and test–retest reliability Pearson‘s correlation indices for the behaviours in Part II of the interview were 0.48 (range: 0.02–0.77) and 0.76 (range: 0.66–0.85), respectively. Correlations with the ABC varied between 0.19 and 0.68. The majority of content validity comparisons were in line with prediction.

Conclusions  The potential of the interview for clinical assessment, as an outcome measure for services and individual interventions and research purposes, is discussed.
The clinical significance of absent or reverse end‐diastolic flow in the fetal aorta and umbilical artery
Authors: Mandruzzato G. P. , Bogatti P. , Fischer L. , Gigli C.
Published: March 2003

The clinical utility of Doppler blood flow investigations of the fetal and fetoplacental vessels is still under debate as far as timing of the delivery is concerned. However, in cases of absent or reverse end‐diastolic flow, fetal compromise is usually very severe. As a consequence, we have investigated the possibility of using this information as a guide to obstetrical management. Altogether, 32 fetuses with absent or reverse end‐diastolic flow in the fetal descending aorta and/or umbilical artery were studied.

Reverse flow was observed in 11 cases and absence of end‐diastolic flow in 21 cases. The two groups are considered separately. No significant difference was found in the mean gestational age at delivery. However, a highly significant difference was found in the mean birth weight and perinatal mortality rate.

All the cases of perinatal mortality were encountered in the group presenting with reverse flow (mortality rate, 63.6%). All the live fetuses were delivered by Cesarean section and no neonatal mortality was observed in this group. Two cases of handicap were observed, one in each group. In our experience, reverse flow indicates the necessity for immediate delivery if no other clinical contraindications are present. Absence of end‐diastolic flow can be observed for longer periods without adverse outcome. Absence of end‐diastolic flow always precedes the appearance of fetal distress. Therefore, we believe that, after exclusion of conditions such as fetal abnormalities or extreme prematurity, a planned delivery should be considered. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Doppler ultrasound examination of the renal artery in healthy women, normotensive pregnant women and in pre‐eclampsia
Authors: Gudmundsson S. , Maršál K.
Published: March 2003

A combination of real‐time linear array ultrasound scanning and pulsed Doppler ultrasonography was used to record blood flow signals from the right renal artery in 17 healthy women, in 15 normotensive pregnant women and in I7 women with pre‐eclampsia. The maximum blood velocity waveforms were analyzed for pulsatility index and systolic/diastolic ratio (S/D ratio). As compared with the two healthy groups, in pre‐eclamptic women the pulsatility index was slightly lower (p < 0.05), and the systolic/diastolic ratio non‐significantly different. These variables were unrelated to mean arterial pressure or the degree of proteinuria. A theory of renal arteriovenous shunts in pre‐eclampsia is proposed. Doppler ultrasound examination of the renal artery would seem to be of limited value‐for the purpose of monitoring renal vascular pathology in pre‐eclampsia. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
The use of endovaginal ultrasound to diagnose invasion of endometrial carcinoma
Authors: Karlsson B. , Norström A. , Granberg S. , Wikland M.
Published: March 2003

Endovaginal ultrasound was used in 30 women to characterize endometrial carcinoma with respect to myometrial invasion according to FIGO recommendations for surgical staging of endometrial cancer. The ultrasound data were correlated to macroscopic findings of the uterine specimen and to histopathology.

Using endovaginal ultrasound, the sensitivity of detecting myometrial invasion of > 50% was 15/19 or 79%. However, the positive predictive value was 100%, in all cases when ultrasound suggested myometrial invasion of > 50%. This was confirmed on histopathological examination of the tumor specimen. Cervical tumor extension was correctly diagnosed in all six women in which it was present. Endovaginal ultrasound seems to be a reliable method of assessing tumor invasion and engagement of the cervix. This non‐invasive method could be included as an important tool in the establishment of individualized treatment programs in women with endometrial carcinoma. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Selective termination to a singleton pregnancy is ethically justified
Authors: Chervenak F. A. , McCullough L. B. , Wapner R. J.
Published: March 2003

Consensus presently opposes selective termination of a multifetal pregnancy to a singleton. We reject this consensus because the arguments made in defense of it are deficient. We show that these arguments rely on the indefensible assumption that the previable fetus possesses independent moral status. We conclude that, since selective termination of a multifetal pregnancy of any order to a singleton is ethically justifiable, a pregnant woman's request for selective termination to a singleton from twins or a higher‐order multiple gestation should be respected and implemented. Physicians who object to selective termination to a singleton in private conscience should not feel compelled to perform the procedure but are obligated to make an appropriate referral. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Three‐dimensional ultrasound of fetal surface features
Authors: Nelson T. R. , Pretorius D. H.
Published: March 2003

This paper presents preliminary results of techniques which permit acquisition and display of three‐dimensional fetal anatomy using ultrasound image data collected as two‐dimensional planar images with commercially available equipment. A precision translational stage was used which permitted the transducer position and orientation in the volume to be accurately determined. Ultrasound video image data were digitized into a personal computer together with transducer position and orientation information. All image and position data were subsequently transferred to a graphics workstation. Gray‐scale ultrasound data were three‐dimensionally filtered, thresholded and analyzed using maximum intensity, variable transparency and surface rendering techniques to evaluate the fetal surface. Images of arbitrary orientation were displayed interactively on a graphics workstation. Our results demonstrate the potential of three‐dimensional ultrasound as a technique for visualization of fetal surfaces, extremities and internal anatomy. Three‐dimensional ultrasound offers potential advantages over existing diagnostic methods since it is non‐invasive and offers interactive review and viewing optimization after fetal scanning. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
First‐trimester diagnosis of nuchal anomalies: significance and fetal outcome
Authors: Ville Y. , Lalondrelle C. , Doumerc S. , Daffos F. , Frydman R. , Oury J. F. , Dumez Y.
Published: March 2003

High‐resolution real‐time ultrasonography now permits the differentiation between nuchal translucencies and cystic hygromata of the neck in the first trimester. A series of 85 nuchal anomalies are presented that were diagnosed by ultrasonography at 9–14 weeks' gestation; their association with chromosomal defects and fetal outcome are also presented. Chromosomal anomalies were found in 8/29 nuchal translucencies and in 16/56 cystic hygromata of the neck. However, in fetuses with normal karyotype, additional defects were diagnosed in l0/40 fetuses with cystic hygromata and in none with nuchal translucency. These data may be important for the management of these conditions and for counselling the patients toward further pregnancy. Copyright © 1992 International Society of Ultrasound in Obstetrics and Gynecology
Preoperative staging of breast cancer by palpation, mammography and high‐resolution ultrasound
Authors: Madjar H. , Ladner H. A. , Sauerbrei W. , Oberstein A. , Prömpeler H. , Pfleiderer A.
Published: March 2003

In breast cancer preoperative determination of the tumor size is important for planning breast‐conserving operations. In 100 patients with breast cancer, the preoperative tumor size was measured using clinical, mammographic and sonographic examinations and correlated with the results of a subsequent histological examination. Using a high‐resolution real‐time system, 98 tumors were visible. It was possible to detect not only early tumors under 1 cm in diameter, but also intraductal tumor components. This contributed greatly to the accuracy of the diagnosis. The sonographic measurement of tumor size demonstrated a correlation coefficient of 0.91 and was thus superior to mammography (0.79) and palpation (0.77). Measurement of the total tumor spread, including 39 multicentric lesions, showed an overestimation of 5% for the mammographic measurements and an overestimation of 4% for the sonographic measurements. Tumor extension was underestimated in 33% of the mammograms but in only 3% using ultrasound examination. The results, along with those of other studies, highlight the role of sonography in the diagnosis of breast cancer. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology
Ductus venosus blood velocity and the umbilical circulation in the seriously growth‐retarded fetus
Authors: Kiserud T. , Eik‐Nes S. H. , Blaas H.‐G. , Hellevik L. R. , Simensen B.
Published: March 2003

Based on the assumption that the ductus venosus is regulator of oxygenated blood in the fetus, the present study investigated the blood flow velocity of the ductus venosus in relation to the umbilical circulation in the that seriously growth‐retarded fetus. The study group of 38 fetuses (gestational week 17–39) had no chromosomal aberrations or structural malformations and had an ultrasonographic biometry of < 2.5th centile and birth weight of ≤ 2.5th centile. Of the 38 fetuses seven died in utero and four died postnatally. The ultrasonographic examination included pulsed Doppler measurement of the umbilical artery pulsatility index (PI), the umbilical vein dimension and blood flow velocity, and the peak and maximum blood flow velocities of the ductus venosus. The majority of fetuses had a raised PI in the umbilical artery (26/38) and reduced blood flow in the umbilical vein (25/33). Despite such changes in the umbilical circulation, a normal peak velocity in the ductus venosus was maintained in all fetuses. During the atrial contraction, however, 13 fetuses had reduced or reversed blood velocity in the ductus venosus. Reduced ductus venosus velocity during atrial contraction seemed to be a serious finding linked to raised PI and absent or reversed end‐diastolic flow in the umbilical artery, and umbilical vein pulsation. The results support the assumption that the blood flow of the ductus venosus is a preferential bloodstream in the human fetus that is maintained within normal ranges as long as possible during placental hemodynamic compromise. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler identification of a pericardial effusion in the fetus
Authors: DeVore G. R. , Horenstein J.
Published: March 2003

The aim of the study was to determine whether color Doppler identifies abnormal fluid within the pericardial space of the fetal were referred for heart. Second‐ and third‐trimester fetuses diagnostic ultrasound. The four‐chamber view of the fetal heart was imaged with real‐time ultrasonography and examined for the presence or absence of separation of the pericardium from the epicardium, which extended from the atrioventricular junction toward the apex of the ventricle. To examine the pericardial space, the color Doppler maximal velocity was set at low Nyquist limits (0.08–0.24 m/s). In each fetus the transducer was angled so that the axis of the interventricular septum was parallel or tangential to the ultrasound beam to optimize the color Doppler recording. The control group consisted of 50 fetuses (16–38 weeks of gestation) who did not demonstrate evidence of pericardial effusion when examined with real‐time ultrasound. Second‐ and third‐trimester fetuses were selected from our database who demonstrated a pericardial effusion identified with real‐time ultrasound.

Color Doppler signals were not identified within the pericardial space in the 50 control fetuses. Fetuses with a pericardial effusion identified with real‐time ultrasound demonstrated color Doppler within the pericardial space which was opposite to the direction of blood entering and exiting the ventricles. Color Doppler enhanced the detection of a pericardial effusion in the second‐trimester fetus when the axis of the heart was and third‐parallel or tangential to the ultrasound beam, which is suboptimal for real‐time imaging.

Color Doppler provides a new method to identify a pericardial effusion in the fetus during the second and third trimesters of pregnancy and complements the real‐time examination. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of umbilical cord pseudocyst
Authors: Sepulveda W. , Pryde P. G. , Greb A. E. , Romero R. , Evans M. I.
Published: March 2003

The association between umbilical cord anomalies and chromosomal abnormalities has received little attention in the literature. In this report, we present two cases of umbilical cord pseudocyst incidentally detected by ultrasound prior to genetic amniocentesis performed for the indication of advanced maternal age. In the first case it was only the initial abnormal finding in a 21‐week fetus ultimately found to have a trisomy 18. In the second case, detected at 26 weeks, the karyotype was normal and a healthy normal neonate was delivered at term. The finding of a umbilical cord cystic mass during prenatal sonographic examination should alert the clinician to the increased risk of aneuploidy. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of placental chorioangioma: contribution of color Doppler ultrasound
Authors: Chou M. M. , Ho E. S. C. , Hwang S. F. , Lee Y. H. , Chan L. P. , Wen M. C.
Published: March 2003

A case of placental chorioangioma was diagnosed at 35 weeks' gestation using color Doppler ultrasound. Color flow imaging showed an intraplacental hypoechoic mass fed directly by the anomalous chorionic tumor vessels arising from the insertion of the umbilical cord. Hypervascularization was present in some areas of the tumor. The diagnosis of typical ‘angiomatous’ type was confirmed by histopathological examination following delivery.
Reference ranges for fetal venous and atrioventricular blood flow parameters
Authors: Hecher K. , Campbell S. , Snijders R. , Nicolaides K.
Published: March 2003

This cross‐sectional study establishes reference ranges with gestation for Doppler parameters of fetal venous and atrioventriculur blood flow. Color flow Doppler was used to examine 143 normal singleton pregnancies at 20–40 weeks' gestation. Flow velocity waveforms were recorded from the ductus venosus, right hepatic vein and inferior vena cava. The waveforms are triphasic, reflecting ventricular systole, early diastole and atrial contraction. Peak velocities for these parameters were measured with pulsed Doppler and a new index, the peak velocity index for veins (PVIV), was calculated. Similarly, time‐averaged maximum velocities for the whole cardiac cycle were measured and the pulsatility index for veins (PIV) was calculated. Flow velocity waveforms were also recorded at the level of the atrioventricular valves and the ratios of peak velocities at early diastolic filling (E) and atrial contraction (A) were calculated. Regression analysis was used to define the association of each measured and calculated Doppler parameter with gestational age. Blood flow velocities in the fetal veins and velocities and E/A ratios across the atrioventricular valves increased significantly with gestation, whereas PVIV and PIV decreased. Blood flow velocities were highest in the ductus venosus and lowest in the right hepatic vein, and PVIV and PIV were highest in the hepatic vein and lowest in the ductus venosus. In the ductus venosus, there was always forward flow throughout the heart cycle, whereas in the inferior vena cava and hepatic vein during atrial contraction, flow was away from or towards the heart or there was no flow. Pulsatility of flow velocity waveforms in the venous system is the consequence of changes in pressure difference between the venous system and the heart during the heart cycle. The finding that PVIV and PIV decrease with gestation is consistent with decreasing cardiac afterload and maturation of diastolic ventricular function. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology
Estimation of gestational age by transvaginal sonographic measurement of greatest embryonic length in dated human embryos
Authors: Wisser J. , Dirschedl P. , Krone S.
Published: March 2003

A prospective descriptive study was carried out to establish reference values for gestational age assessment in the first trimester by measuring embryonic length in dated human embryos, by using transvaginal ultrasound. In 160 pregnant women who had undergone assisted reproductive procedures, 139 singleton embryos and 46 embryos from 21 multiple pregnancies were studied between the 35th and 98th day after the last menstrual period. Transvaginal ultrasound examination, including inspection of embryonic structures and measurement of greatest embryonic length (L), was performed in these women. Estimation of gestational age (t) by measurement of L in singletons is best described by the equation t = 35.72 + 1.082L¹/² + 1.472L − 0.09749L³/². Mean 95% confidence interval and 95% prediction interval were 4.3 and 9.3 days, respectively. There was no significant change in the estimation curve when multiple measurements in singletons were taken nor when embryos from multiple pregnancies were measured. Accuracy of embryonic age estimation from a single measurement of greatest embryonic length was evaluated. Copyright © 1994 International Society of Ultrasound in Obstetrics and Gynecology