bluuebunny/crossref_metadata_2025 huggingface dataset:
First‐trimester features of Fowler syndrome (hydrocephaly–hydranencephaly proliferative vasculopathy)
Authors: Laurichesse‐Delmas H. , Beaufrère A. M. , Martin A. , Kaemmerlen A. G. , Déchelotte P. , Lémery D.
Published: May 2003

We describe the features of Fowler syndrome (proliferative vasculopathy and hydrocephaly–hydranencephaly) diagnosed in the first trimester. The pregnancy with no significant family history was referred for karyotyping and ultrasound examination after a cystic hygroma was seen at 12 weeks. At 13 weeks, ultrasound examination revealed hydrocephaly–hydranencephaly, fetal akinesia, and arthrogryposis associated with increased nuchal translucency. The parents opted for termination of pregnancy and the diagnosis of Fowler syndrome was confirmed by pathological examination of the fetus. Calcified necrotic lesions and proliferative vasculopathy were observed in the entire central nervous system including the brainstem and spinal cord.

Cases previously reported in siblings suggest an autosomal recessive transmission but specific genetic antenatal diagnosis is not yet available. The diagnosis of proliferative vasculopathy and hydrocephaly–hydranencephaly (Fowler syndrome) should be considered whenever hydrocephaly–hydranencephaly associated with a fetal akinetic sequence are encountered at the end of the first trimester. Genetic counseling is recommended. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Umbilical vein blood volume flow rate and umbilical artery pulsatility as ‘venous–arterial index’ in the prediction of neonatal compromise
Authors: Tchirikov M. , Rybakowski C. , Hüneke B. , Schoder V. , Schröder H. J.
Published: May 2003

Objective

To assess the diagnostic power of the umbilical venous–arterial index (VAI) for the prediction of poor fetal outcome.

Subjects and methods

This was a retrospective, cross‐sectional clinical study in which normalized umbilical vein blood volume flow rate (nUV) (mL/min/kg estimated body weight), umbilical artery pulsatility index (UAPI), the newly developed VAI (nUV/UAPI), and the uterine artery resistance index (UTRI) were determined in 85 fetuses once (17–41 gestational weeks) during pregnancy using standard ultrasound Doppler equipment. A risk score based on umbilical blood pH, 1‐min Apgar score, birth weight, duration of gestation, type of respiratory support, and referral to the pediatric department was constructed, and fetuses were assigned to a control or a pathological group accordingly. Logistic regression and analysis of fitted receiver–operating characteristics curves were performed to evaluate the diagnostic power of nUV, UAPI, UTRI, and VAI.

Results

The incidence of compromised neonates was 17.6%. The area under the receiver–operating characteristics curve was larger for VAI than for UTRI or for UAPI (P < 0.002). At a cut‐off value of 100 mL/min/kg, the sensitivity of VAI to predict poor neonatal outcome was 85% with a 15% false‐positive rate.

Conclusion

Determination of the VAI has a greater diagnostic power to predict poor fetal outcome than the pulsatility index in the umbilical artery or the resistance index in the uterine artery. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Fetal transabdominal biometry at 11–14 weeks of gestation
Authors: Von Kaisenberg C. S. , Fritzer E. , Kühling H. , Jonat W.
Published: May 2003

Objective

To establish comprehensive transabdominal ultrasonographic reference ranges for viable normal singleton human fetuses at 11–14 weeks' gestation.

Methods

Single transabdominal ultrasound measurements were taken once per pregnancy at a gestational age of between 11 + 0 and 14 + 0 weeks (crown–rump length, 45–84 mm), in viable singleton fetuses with nuchal translucency ≤ 3 mm and without detectable structural anomalies, using four standard planes: (i) biparietal diameter (BPD) and fronto‐occipital diameter (FOD) resulting in head circumference (HC), anterior horn (Va), posterior horn (Vp), and hemisphere (HEM); (ii) transcerebellar diameter (TCD) and cisterna magna (CM); (iii) abdominal anteroposterior (AAP) and abdominal transverse diameter (ATD) resulting in abdominal circumference (AC); and (iv) femur length (FL). The respective ratios Va/HEM, Vp/HEM, HC/AC, BPD/FL, BPD/FOD, FL/CRL, FL/BPD and FL/AC and the estimated weight were derived. Reference ranges were constructed and the mean and 5th and 95th centiles were plotted against gestation.

Results

There was a general increase in biometric parameters with gestation. The ratios for the ventricles vs. hemisphere and BPD/FL ratio decreased while the BPD/FOD and HC/AC ratios remained constant. Analysis of the reference range for BPD/FL was performed in both 167 and 664 fetuses and the results showed almost the identical type of equation, indicating a high degree of accuracy for the growth charts.

Conclusions

We have established comprehensive reference ranges for first‐trimester fetal biometry by transabdominal sonography. These charts may have a role in the diagnosis of early onset symmetrical or asymmetrical growth restriction and in the interpretation of measurements in chromosomally abnormal fetuses, and they may help in the detection of skeletal dysplasias or acrania/anencephaly. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Anomalies of the fetal aortic arch: a novel sonographic approach to in‐utero diagnosis
Authors: Achiron R. , Rotstein Z. , Heggesh J. , Bronshtein M. , Zimand S. , Lipitz S. , Yagel S.
Published: May 2003

Objective

To describe a novel, sonographic approach for in‐utero evaluation of normal and abnormal aortic arch.

Methods

Aortic arch was evaluated by imaging of the axial view of the upper fetal mediastinum. The normal left aortic arch was defined by the V‐shaped appearance of the junction between the ductus arteriosus and aortic arch, with the trachea situated posteriorly. Right and double aortic arches were diagnosed when the great vessels appeared U‐shaped, with intermediate location of the trachea.

Results

Between 1997 and 1999, 18 347 women were scanned in three prenatal centers, and pathological findings were prospectively recorded. In a retrospective analysis of the records, we identified 19 fetuses (0.1%) with atypical, U‐shaped appearance, and no other structural abnormalities present. With the exception of one fetus with a ventricular septal defect, no congenital cardiac defects were present. Right aortic arch was found in 18 cases, while color Doppler made it possible to diagnose one case with double aortic arch, and one fetus was demonstrated as having Kommerell's diverticulum. In all 18 cases, a left descending aorta and left ductus arteriosus were present, the latter coursing to the left of the trachea, forming a loose partial vascular ring. All were asymptomatic at birth and early infancy. The fetus with double aortic arch that had a true vascular ring underwent early infantile correction.

Conclusions

It is possible to diagnose right and double fetal aortic arch using prenatal ultrasound. The use of color Doppler facilitated in‐utero evaluation of possible complications, such as true vascular ring. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler and gray‐scale ultrasound evaluation of the postpartum uterus
Authors: Van Den Bosch T. , Van Schoubroeck D. , Lu C. , De Brabanter J. , Van Huffel S. , Timmerman D.
Published: May 2003

Objectives

To evaluate the color Doppler and gray‐scale sonographic appearance of the uterus after pregnancy, with special attention to the occurrence of areas of enhanced vascularity and placental remnants.

Patients and methods

Cross‐sectional observational study involving 385 consecutive women presenting at their first visit after pregnancy. The uterus was evaluated using ultrasound with color Doppler. In the presence of placental remnants, blood was sampled for measurement of beta human chorionic gonadotropin (βhCG), hemoglobin (Hb) and infectious parameters. If indicated, a dilatation and curettage was performed.

Results

In 8.3% of women, areas of enhanced vascularity were detected with color Doppler examination. Most cases (68.9%) were focal areas of one or more vessels. In 2.6% of patients abnormal vascularity extended over a large area of the whole myometrium. In 6.75% of cases, placental remnants were detected. In 46% of these, blood sampling revealed βhCG levels below 30 mIU/mL; serological infection parameters and Hb concentration were within the normal range.

Conclusions

Areas of enhanced vascularity of the uterus, ranging from a focal vascular pedicle to a larger area of the myometrium, are relatively common after pregnancy. They are predominantly seen in the presence of placental remnants, in the early postpartum period and after instrumental or manual delivery of the placenta. There are no clear risk factors for retained placental tissue, besides the history of blood transfusion in the early postpartum, and perhaps multigravidity. Serology is of little help in the diagnosis of retained gestational products. The knowledge of the ultrasound and color Doppler features of the uterus after pregnancy may prove of practical value for the management of abnormal uterine bleeding in the postpartum period. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Limitations of transvaginal sonography for the diagnosis of adenomyosis, with histopathological correlation
Authors: Bazot M. , Daraï E. , Rouger J. , Detchev R. , Cortez A. , Uzan S.
Published: May 2003

Objectives

To evaluate the accuracy of transabdominal sonography (TAS) and transvaginal sonography (TVS) for the diagnosis of adenomyosis, and to determine the diagnostic relevance of various sonographic criteria.

Subjects and methods

A total of 129 women scheduled for hysterectomy were enrolled into this prospective study. Group 1 (n = 23) consisted of patients with menometrorrhagia who were free of myoma and endometrial disorders on TAS. Group 2 consisted of all the other patients (n = 106). TAS and TVS findings were compared to histopathological results.

Results

The prevalence of adenomyosis in Groups 1 and 2 was 91.3% and 24.5%, respectively. TAS had limited value for the diagnosis of adenomyosis in both groups. The sensitivity, specificity, and positive and negative predictive values of TVS in Groups 1 and 2 were 80.9% and 38.4%, 100% and 97.5%, 100% and 83.3%, and 40% and 82.9%, respectively. The accuracy of combined TAS and TVS in Groups 1 and 2 was 91.3% and 83%, respectively. The presence of myometrial cysts was the most specific ultrasound diagnostic criterion for adenomyosis. Hypoechoic linear myometrial striations related to the presence of myometrial hypertrophy correlated to hormonal status with a sensitivity of 66.6% and a specificity of 100% in Group 1.

Conclusions

Our results show that TAS has a limited diagnostic capacity for adenomyosis but also that TVS alone was poor in patients with an enlarged uterus. In these cases a combination of TVS and TAS should be used. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Color Doppler energy prediction of malignancy in adnexal masses using logistic regression models
Authors: Marret H. , Ecochard R. , Giraudeau B. , Golfier F. , Raudrant D. , Lansac J.
Published: May 2003

Objective

The aim of this study was to assess the usefulness of color Doppler energy in the preoperative diagnosis of ovarian malignancy using multivariate logistic regression analysis.

Methods

One hundred and thirty adnexal masses were studied with transvaginal B‐mode, color energy, and pulsed Doppler ultrasonography before surgery in order to develop a model that could be used to determine malignancy. Each ultrasonographic variable (tumor size, wall thickness, septal structure, echogenicity, papillary projection, density (solid or not)) was included individually or combined together as part of the Sassone ultrasound score. Intratumoral blood flow velocity waveforms were obtained to determine pulsatility index and resistance index and a more subjective parameter, location of tumor vascularity, was also assessed. Menopausal status and serum CA 125 levels were also entered as categorical variables. Sonographic parameters were entered alone, then associated with menopausal status and CA 125 serum levels, and finally with Doppler energy measurements. Our model was then validated in a group of 68 adnexal masses and compared to the model of Alcazar.

Results

Eighteen adnexal masses (13.8%) were malignant or of low malignant potential. Multivariate analysis showed that papillary projection of the tumor wall, cyst with solid parts, resistance index with a cut‐off value of 0.53, CA 125, and central blood flow location, were the only factors to be independent predictors of malignancy. Menopausal status was not an independent factor. For the final model including the Doppler energy parameter the best sensitivity and specificity were 83% and 93%, respectively, at a cut‐off value of 10% probability of malignancy compared to 83% and 87% for the morphological variables alone. Validation of the model showed its diagnostic performance to be as good as that reported in the original population and better than the model of Alcazar.

Conclusion

Sonographic analysis of adnexal masses including color Doppler energy shows the best predictive properties according to histological diagnosis, and improves preoperative diagnosis of malignancy. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Measuring cervical length with ultrasound: evaluation of the procedures and duration of a learning method
Authors: Vayssière C. , Morinière C. , Camus E. , Le Strat Y. , Poty L. , Fermanian J. , Ville Y.
Published: May 2003

Objective

To evaluate the learning curve and principal learning steps for a novice ultrasound operator to master the technique for measuring cervical length by transvaginal ultrasound.

Subjects and methods

The study involved asymptomatic patients with a singleton pregnancy between 21 and 38 weeks attending for a routine ultrasound scan. Two operators new to cervical ultrasound including one with experience in transvaginal gynecological ultrasound were assessed during their training. After an initial lecture session on the technique of cervical measurement, the trainees had one or two supervised practice sessions, validated by two interobserver agreement studies with 30 patients at a time; these compared the level of agreement between trainer and trainee throughout. Five examinations were performed in the first practice session; a second session was planned if the trainee could not perform all five examinations alone satisfactorily, in agreement with four quality criteria predefined for good cervical measurements. The second session lasted until five consecutive examinations could be performed adequately without the trainer's aid. Agreement between the two operators was assessed by intraclass correlation coefficient (ICC). The ICCs were compared with Fisher's Z transformation.

Results

Of the 150 patients included, 2.7% gave birth before term. The trainee with no experience in transvaginal ultrasound required two practice sessions; none of the five ultrasound scans performed in the first session was correct. In the second session, 18 consecutive ultrasound examinations were necessary to obtain five consecutive adequate results. During interobserver studies with the trainer, the ICC progressed from 0.43 in the first study to 0.64 in the second and 0.77 in the third (P = 0.049 between the first and third studies). The trainee with experience in transvaginal ultrasound required only one practice session. The ICC increased from 0.73 to 0.85 in the two interobserver studies with the trainer.

Conclusions

Measurement of cervical length by transvaginal ultrasound examination is a technique that can be learnt rapidly. While roughly 23 supervised ultrasound scans appear necessary for an operator with no experience in transvaginal ultrasound, substantially fewer are required for an operator already familiar with this approach for other indications. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Mid‐trimester ultrasound prediction of gestational age: advantages and systematic errors
Authors: Källén K.
Published: May 2003

Objective

To detect possible sources of bias in ultrasound prediction of gestational age.

Subjects and methods

Using the Swedish Medical Birth Registry, 571 617 women were identified who were delivered between 1990 and 1997 and who had obtainable information on last menstrual period and expected date of delivery according to ultrasound.

Results

Male fetuses were more likely than females to be judged older than the last menstrual period date suggested at early fetometry. The estimated magnitude of the systematic error by infant gender corresponded to 1.5 days. Similarly, the fetuses of young women, multiparous women, smokers and women with low educational level were at increased risk of being smaller than expected at ultrasound examination in early pregnancy. A strong association was seen between adjustments of expected date of delivery −7 days or more and small‐for‐gestational age according to ultrasound at birth. Compared to singleton pregnancies, twin pregnancies were more likely to be judged more progressed at ultrasound fetometry than the last menstrual period date suggested.

Conclusions

Compared to last menstrual period estimates, routine ultrasound measurements to predict date of delivery are comparatively reliable but systematic errors are inherent in the method. The erroneous adjusted dates may be due to incorrect measurements or systematic bias (e.g. gender), but they are also likely to reflect early growth restriction (e.g. in the case of maternal smoking and small‐for‐gestational age). Further studies are needed to investigate whether the systematic errors in ultrasound prediction of gestational age could lead to suboptimal obstetric management in adjusted pregnancies. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Utility of color Doppler indices of dominant follicular blood flow for prediction of clinical factors in in vitro fertilization‐embryo transfer cycles
Authors: Ozaki T. , Hata K. , Xie H. , Takahashi K. , Miyazaki K.
Published: May 2003

Objective

To investigate the relationship between color Doppler indices of dominant follicular blood flow and clinical factors in in vitro fertilization‐embryo transfer cycles.

Subjects and methods

This was a prospective study involving 26 patients completing a total of 33 in vitro fertilization cycles. Dominant follicular blood flow indices, peak systolic velocities, the resistance index and the pulsatility index were evaluated using transvaginal color Doppler. The indices were compared to the clinical outcomes of in vitro fertilization‐embryo transfer.

Results

There was a significant correlation between dominant follicular peak systolic velocities and the number of oocytes retrieved, as well as the number of mature oocytes obtained. There was no significant correlation between dominant follicular resistance index or pulsatility index and the number of follicles > 10 mm in diameter, the number of oocytes retrieved or the number of mature oocytes. There were no significant differences between dominant follicular peak systolic velocities, resistance index or pulsatility index, and fertilization rate or the ratio of good quality embryos. However, significant differences were found between the number of oocytes retrieved, as well as the number of mature oocytes for those patients in which the peak systolic velocity was below 25 cm/s.

Conclusions

Doppler assessment of dominant follicle blood flow alone is useful for predicting the number of retrievable oocytes. However, morphological quality of the embryo produced or the pregnancy rate cannot be predicted by this method. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Antenatal diagnosis and management of a vallecular cyst
Authors: Cuillier F. , Samperiz S. , Testud R. , Fossati P.
Published: May 2003

Vallecular cysts are rare. It is important to be aware of their presence as they can cause upper airway obstruction. We describe a case of congenital vallecular cyst diagnosed at 28 weeks of gestation. This early diagnosis enabled us to plan careful perinatal management. We believe that, in cases of suspected oropharyngeal tumors, elective delivery should be carried out in a tertiary referral center in which emergency ventilation and tracheostomy are possible. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis
Authors: Moore J. , Copley S. , Morris J. , Lindsell D. , Golding S. , Kennedy S.
Published: May 2003

Objective

To evaluate transvaginal and transabdominal ultrasound scanning, with or without Doppler, as a diagnostic test for the accurate diagnosis of pelvic endometriosis.

Methods

The MEDLINE (1966–2001) and EMBASE (1980–2001) databases were searched for relevant studies, published in English. Only studies fulfilling predefined criteria were selected. An assessment of quality was made for each study, and data were then reanalyzed using likelihood ratios to determine the usefulness of the test.

Results

In total, 67 papers were identified using the search strategy, of which 17 described relevant studies. Of these, seven fulfilled the inclusion criteria. All seven related to the use of transvaginal gray‐scale imaging in the diagnosis of ovarian endometriomata specifically, rather than endometriosis. The positive likelihood ratios ranged from 7.6 to 29.8, and the negative likelihood ratios ranged from 0.1 to 0.4. Confidence intervals were wide. One paper addressed the use of conventional color Doppler with ultrasound: the positive likelihood ratio was 1.2, with a negative likelihood ratio of 0.4. One paper assessed the use of color Doppler energy imaging, and showed a positive likelihood ratio of 33.5 and a negative likelihood ratio of 0.1.

Conclusions

Transvaginal ultrasound appears to be a useful test both to make and to exclude the diagnosis of an ovarian endometrioma. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Absent or hypoplastic thymus on ultrasound: a marker for deletion 22q11.2 in fetal cardiac defects
Authors: Chaoui R. , Kalache K. D. , Heling K. S. , Tennstedt C. , Bommer C. , Körner H.
Published: May 2003

Objective

Congenital heart defects (CHD), particularly conotruncal anomalies, may be associated with deletion of chromosome 22q11.2. Thymic aplasia or hypoplasia is known to be a typical feature in this condition. We aimed to establish (i) the prevalence of del22q11.2 in fetal CHD and (ii) whether ultrasound assessment of an absent or hypoplastic fetal thymus helps in preselection of a group who are at high risk for this deletion.

Study design

In fetuses (> 16 weeks) with CHD, karyotyping and fluorescence in situ hybridization for 22q11.2 were offered and the fetal thymus was evaluated sonographically.

Results

One hundred and forty‐nine fetuses with CHD and normal karyotype were analyzed. Seventy‐six fetuses had conotruncal anomalies. 22q11.2 deletion was present in 10 cases (6.7%), all of which had conotruncal anomalies (13.1%). Thymic hypoplasia or absence was suspected in 11 cases with conotruncal anomaly. Nine of these 11 had the deletion; two cases were false positive. One fetus with a normal‐sized thymus had deletion of 22q11.2 (sensitivity 90%, specificity 98.5%, positive predictive value 81.8%, and negative predictive value 99.2%). By subtype of cardiac anomaly, there was deletion in four of six fetuses with interruption of the aortic arch, two of four with absent pulmonary valve syndrome, three of nine with truncus arteriosus and one of 11 cases of tetralogy of Fallot. Pulmonary atresia with ventricular septal defect (n = 7), right‐sided aortic arch (n = 4), transposition of the great arteries (n = 14), double outlet right ventricle (n = 13) and other complex malpositions of the great vessels (n = 8) were not associated with the deletion.

Conclusion

Thymic hypoplasia or aplasia may reliably be diagnosed during fetal echocardiography. The technique allows identification of a group at high risk for 22q11.2 deletion and is more specific and sensitive than by subtype of cardiac anomaly alone. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Screening for pre‐eclampsia and fetal growth restriction in twin pregnancies at 23 weeks of gestation by transvaginal uterine artery Doppler
Authors: Yu C. K. H. , Papageorghiou A. T. , Boli A. , Cacho A. M. , Nicolaides K. H.
Published: May 2003

Objective

To assess the value of transvaginal uterine artery Doppler at 23 weeks of gestation in predicting the development of adverse perinatal outcomes in twin pregnancies.

Patients and methods

Women with twin pregnancies attending for routine ultrasound examination at 23 weeks in any one of seven hospitals underwent Doppler assessment of the uterine arteries. The right and left uterine arteries were identified using color flow mapping and velocity waveforms were obtained using pulsed Doppler. The mean pulsatility index (PI) of the two arteries was determined and the presence of uterine artery notching noted. Results were compared between monochorionic and dichorionic twins, and with our previously reported data from singleton pregnancies. Screening characteristics in the prediction of pre‐eclampsia, fetal growth restriction (FGR), placental abruption, fetal death and early preterm delivery were calculated.

Results

Uterine artery Doppler at 22–24 weeks of gestation was performed in 360 twin pregnancies, including 324 dichorionic and 36 monochorionic diamniotic twins. Complete outcome data were available in 351 (97.5%). The mean uterine artery PI did not change significantly with gestation and there was no significant difference in mean PI between the dichorionic and monochorionic groups. However, the mean PI was significantly lower in twin pregnancies than in singletons. The pregnancy was complicated by pre‐eclampsia in 6.0% of cases, FGR below the 5th centile of both twins in 8.8%, abruption in 0.9%, intrauterine fetal death in 1.7% and early preterm delivery at less than 32 completed weeks of gestation in 5.7% of cases. The respective sensitivities of uterine artery mean PI above the 95th centile for these complications were 33.3%, 9.7%, 66.6%, 33.3% and 18.6%.

Conclusions

In twin pregnancies PI in the uterine arteries is lower than that in singleton pregnancies, but there is no significant difference between dichorionic and monochorionic twins. Doppler assessment of the uterine arteries at 23 weeks identifies a large proportion of twin pregnancies destined to develop adverse outcomes related to uteroplacental insufficiency. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Doppler assessment of the uterine circulation in the second trimester in twin pregnancies: prediction of pre‐eclampsia, fetal growth restriction and birth weight discordance
Authors: Geipel A. , Berg C. , Germer U. , Katalinic A. , Krapp M. , Smrcek J. , Gembruch U.
Published: May 2003

Objective

To compare singleton nomograms of the uterine circulation with previously established twin nomograms in the prediction of pre‐eclampsia, fetal growth restriction (FGR), and birth weight discordance ≥ 20% in twin gestations.

Methods

This was a retrospective analysis of maternal and perinatal data obtained from 256 dichorionic twin pregnancies. The mean uterine artery resistance index was calculated from both sides and the presence and absence of notching was recorded. Cut‐off levels for abnormal flow parameters were the 95th centile of reference ranges of either singleton or twin nomograms.

Results

According to twin reference values, 14.0% of patients were screen positive, compared to only 3.1% when singleton reference values were used. The sensitivity of abnormal uterine artery Doppler results defined by twin nomograms vs. singleton normograms was 36.4% vs. 18.2% for pre‐eclampsia, 26.7% vs. 9.7% for FGR, 28.9% vs. 7.9% for birth weight discordance ≥ 20%, and 26.5% vs. 10.3% for any adverse outcome, respectively.

Conclusion

Despite using specially constructed twin normograms, uterine artery Doppler studies in twin gestations had an overall low sensitivity in predicting adverse obstetric outcome. Negative predictive values of uterine Doppler studies in twin gestations are lower compared to those reported in unselected singleton pregnancies, i.e. maternal and fetal complications occur more frequently despite normal uterine artery waveforms. This suggests that there is an additional pathomechanism, causing pre‐eclampsia and FGR in twin gestations, that is unrelated to uteroplacental insufficiency. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of congenital epulis:a case report
Authors: Nakata M. , Anno K. , Matsumori L. T. , Sumie M. , Sase M. , Nakano T. , HARA H. , Imate Y. , Nakamura Y. , Kato H.
Published: May 2003

Congenital epulis or congenital granular cell tumor, is a benign tumor that has rarely been diagnosed prenatally. We report a case of a large congenital epulis diagnosed at 26 weeks of gestation that increased in size during gestation. Color and power Doppler ultrasound examination showed marked blood flow in the tumor. The tumor could be resected completely following Cesarean section and histologically examined. We discuss the prenatal diagnosis and histogenesis of congenital epulis. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Clinically significant persistence and enlargement of an antenatally diagnosed isolated choroid plexus cyst
Authors: Becker S. , Niemann G. , Schöning M. , Wallwiener D. , Mielke G.
Published: May 2003

Isolated choroid plexus cysts are usually diagnosed at the time of screening ultrasonography during the second trimester. While they raise the question of underlying chromosomal abnormalities, their clinical course is almost invariably benign with complete resolution often by the third trimester.

We report the highly unusual case of a choroid plexus cyst diagnosed at 14 weeks of gestational age with subsequent further enlargement of the cyst,necessitating postpartum neurosurgical intervention. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Prenatal diagnosis of hypoplasia of the corpus callosum in association with non‐ketotic hyperglycinemia
Authors: Paupe A. , Bidat L. , Sonigo P. , Lenclen R. , Molho M. , Ville Y.
Published: May 2003

Abnormalities of the corpus callosum are often associated with a poor prognosis due to the anatomical defect itself and associated anomalies that include malformations and inherited metabolic disorders. We report a case of the prenatal diagnosis of hypoplasia of the corpus callosum that was associated with non‐ketotic hyperglycinemia. Metabolic disorders are a known association with corpus callosum abnormalities and carry a dismal prognosis. A diagnosis of non‐ketotic hyperglycinemia should be considered when a fetus presents with an abnormality of the corpus callosum. A literature search reviews other inherited diseases associated with hypoplasia of the corpus callosum. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology
Multiple risk factors in root survivorship: a 4‐year study in Concord grape
Authors: Anderson L. J. , Comas L. H. , Lakso A. N. , Eissenstat D. M.
Published: May 2003

• Minirhizotron techniques were used to examine root lifespan inVitis labruscana(Concord grape) for roots born in four different years that varied in rainfall.

• Experimental vines were given irrigation (irrigated or not) and canopy pruning treatments (minimal or balanced). Root survival was assessed from 1997 through 2000 and analysed using Cox proportional hazards regression. Model covariates included pruning, irrigation, vine yield, soil depth, root diameter, time of root birth, and numbers of neighboring roots.

• Soil depth, root diameter and time of birth consistently influenced root lifespan in all years (P < 0.05). Deeper and coarser roots had longer lifespans. Roots born near bloom were shorter‐lived than roots born later in the season. Pruning and irrigation influenced root lifespan in some years but their effects seemed to vary with growing‐season environmental conditions.

• These data underscore the value of long‐term studies in distinguishing factors that consistently affect root lifespan from those that change annually with environmental conditions, and emphasize the diversity in life histories of fine roots within a species.
Incorporating the views of obstetric clinicians in implementing evidence‐supported labour and delivery suite ward rounds: a case study
Authors: Deshpande Neelima , Publicover Mary , Gee Harry , Khan Khalid S.
Published: May 2003

Objectives: To implement evidence‐supported delivery suite ward rounds using strategies to overcome barriers.

Design: Qualitative case study to identify barriers and a quantitative assessment of outcomes on ward rounds.

Method: After an introduction to the proposed evidence‐supported delivery suite ward round reactions were elicited from 15 clinicians. Responses were categorized into barriers related to knowledge, skills, attitudes and behaviour. Using strategies to overcome these barriers, a weekly evidence‐supported ward round was established. During patient‐centred discussions, clinical questions were formulated. Following literature searches, evidence was acquired and appraised.

Results: Clinicians had limited awareness about the potential benefits of a clinical librarian's support during ward rounds. They were unsure of their skills in evidence‐based practice. There was scepticism, fear of loss of autonomy, poor motivation and resistance to change. Clinicians identified several factors that could impinge on their practice. Using appropriate strategies when evidence‐supported ward rounds were conducted, 67 questions were raised. However only seven articles were appraised in time to affect decisions on that ward round.

Conclusions: Knowledge of barriers was helpful in developing plans for implementation of evidence‐supported ward rounds. The pilot study indicates the feasibility of this approach.
Non use of health information kiosks examined in an information needs context
Authors: Williams Peter , Nicholas David , Huntington Paul
Published: May 2003

Whilst great emphasis has rightly been placed on the increased availability and use of health information, little research has been undertaken into the non use of such material, particularly with regard to electronic sources. Computer transactional log data from health information touch screen kiosks, collected as part of an ongoing Department of Health‐funded study being carried out by City University, showed that females in the 55–74 age group were particularly under‐represented as users. To explore reasons for this, in‐depth interviews were carried out with 13 non‐kiosk‐using, primary‐care out‐patients fitting this profile, at a surgery which had a kiosk that was being monitored. Subjects were interviewed at length about their information needs and information‐seeking behaviour, to determine reasons (if any) they might have had for non‐kiosk use. The study utilized an interview schedule and technique loosely based on the ‘Sense‐Making’ methodology of Brenda Dervin (Talk Presented at the International Communication Association Annual Meeting, May 1983, Dallas, Texas, USA. Available from: http://communicationsbsohio‐stateedu/sense‐making/art/artdervin83html.). Findings elicited many factors accounting for non use of the system. The first and major source of information remained the doctor, with written or other sources only being consulted where recommended or provided. There was evidence that patients wanted little more than the minimum information or instructions required to deal with their condition. Many appeared unaware of the presence of the kiosk and others assumed either that it was not for patient use or that it would not serve their needs. The methodology proved itself, with certain caveats, to be an appropriate vehicle for this kind of exploratory work.
Thermal Stress Analysis in Particulate Composite Components
Authors: Capela C. , Costa J. D. , Ferreira J. M. , Raimundo A. M.
Published: May 2003

Abstract: Thermal stresses resulting from flow of hot and cold water were obtained in sinks manufactured with acrylic casting dispersions by both experimental and numerical analysis. The experimental work was performed in two poly(methyl methacrylate) (PMMA)‐silica based particulate composites, compositions of which are different by the volume fraction of filler and the particle size. The thermal stresses in sinks were obtained using strain gauges. The alternate flow of cold and hot water using a mixed tap, results in the formation of thermal gradients, leading to the occurrence of thermal stresses. The experimental results were compared with the numerical results obtained with a commercial finite element software. For this analysis, some thermal parameters such as the convective heat transfer coefficient, the density, the thermal conductivity and the specific heat were experimentally obtained. In general, a good agreement between experimental and numerical results was observed. The results of this study, together with the results of fatigue and fracture tests, will be used in a tolerance analysis of defects in the products manufactured with these composites.
Residual Stress Evolution in Repair Welds
Authors: Veiga C. , Loureiro A. , Dias A.
Published: May 2003

Abstract: The aim of this paper is to study the influence of the repair procedure on the evolution of residual stress distribution in butt welds. C‐Mn steel coupon plates of 11 mm thickness were prepared, subjected to stress relief heat treatment and welded with two beads, using the gas metal arc welding process. After the deposition of two weld beads, two successive repair welds were made on the middle length of the second bead. Longitudinal and transverse residual stresses were measured in the vicinity of the weld, after deposition of the two weld beads and after each repair weld. Residual stress evaluation was conducted using an X‐ray diffraction method. The repair welds caused a decrease in magnitude of the initial longitudinal residual welding stresses, and an increase of the transverse residual stress magnitude, in tension at points within the repair length, and in compression at points outside the repair length.
An Arctangent Unwrapping Technique of Photoelasticity Using Linearly Polarized Light at Three Wavelengths
Authors: Kihara T.
Published: May 2003

Abstract:  In the automatic measurements of the principal stress directions ψ and the total relative phase retardation ρtol, ψ and ρtol can be easily obtained by the phase unwrapping method using the arctangent function. However, only some published works exist on the measurements of ψ and ρtol by photoelastic techniques using a linearly polarised incident light source. This paper presents the technique of applying an unwrapping by means of the arctangent function to photoelasticity. The technique overcomes the error associated with the quarter‐wave plate by using an incident light of different wavelength and does not need an interpolation for the determination of ψ . The technique is validated by determining ψ and ρtol for the well‐known circular disk subjected to a diametral compressive load model.
The Use of a Second Harmonic Correlation to Detect Damage in Composite Structures Using Thermoelastic Stress Measurements
Authors: Paynter R. J. H. , Dutton A. G.
Published: May 2003

Abstract: A novel development of the thermoelastic stress measurement technique using the second harmonic of the load test frequency is presented. Clear identification of significant sub‐surface damage is demonstrated using the new technique, and test results are presented from a small scale wind turbine blade test which indicate that some quantitative assessment of damage criticality might be possible from a single full‐field measurement. A hypothesis is presented as to why the new technique is successful, based on complex movements of the surface caused by local buckling (itself a consequence of the sub‐surface damage). Strain gauge evidence is presented to support this hypothesis.
Study of the Different Types of Actuators and Mechanisms for Upper Limb Prostheses
Authors: Cura Vanderlei O. Del , Cunha Fransérgio L. , Aguiar Manoel L. , Cliquet Jr. Alberto
Published: May 2003

Abstract:Research in the area of actuators and mechanisms has shown steadily growing technological advances in externally activated upper limb prostheses. From among the actuators, advances include the use of piezoelectric materials, special metal alloys, polymers, and new motor applications, while the advances in mechanisms include mechanical designs based on the anatomy of the human hand and improvements in the way these components are combined. These efforts are aimed at meeting the need for anthropomorphic and functional prosthetic devices that enable patients to carry out basic daily tasks more easily and reduce the rejection rate of prostheses. This article technically discusses the several types of actuators and mechanisms, listing their main characteristics, applications, and advantages and disadvantages, and the current state of research in the area of rehabilitation of upper limb functions through the use of active prostheses. Comparisons of these devices are made with regard to the main criteria of construction and operation required to achieve optimal prosthetic performance.
Prediction of Single‐Pool Kt/V Based on Clinical and Hemodialysis Variables Using Multilinear Regression, Tree‐Based Modeling, and Artificial Neural Networks
Authors: Goldfarb‐Rumyantzev Alexander , Schwenk Michael H. , Liu Samuel , Charytan Chaim , Spinowitz Bruce S.
Published: May 2003

Abstract: The impact of clinical and other variables on single‐pool Kt/V (spKt/V) is unclear. The goal of this study was to identify clinical and hemodialysis treatment related predictors of spKt/V and use multilinear regression (LM), tree‐based modeling (TBM), and artificial neural networks (ANN) to predict actual spKt/V. When 602 hemodialysis records were analyzed, spKt/V correlated with urea reduction ratio (URR) (r=0.91) and weakly with other variables. When URR was excluded, both LM and TBM identified normalized protein equivalent of total nitrogen appearance (nPNA), prehemodialysis (HD) and post‐HD weights, blood flow rate, and dialyzer surface area as predictors of spKt/V. LM identified sex, height, dialyzer ultrafiltration coefficient (Kuf), and duration of dialysis, while TBM identified the dialysis nurse code. Prediction algorithms were developed from a “training” dataset, and validated on a separate (“testing”) dataset. Correlation coefficients of predicted spKt/V with measured spKt/V with and without nPNA respectively were 0.745 and 0.679 for LM, 0.6 and 0.512 for TBM, and 0.634 for ANN, which performed better without using nPNA.
In Vitro and In Vivo Study of Ion‐Implanted Collagen for the Substrate of Small Diameter Artificial Grafts
Authors: Kurotobi Kimi , Suzuki Yoshiaki , Kaibara Makoto , Iwaki Masaya , Nakajima Hiroshi , Suzuki Hidenori
Published: May 2003

Abstract: Ion implantation into the collagen‐coated inner surface of the grafts was performed and evaluated in vitro and in vivo to develop small diameter artificial vascular grafts. He+ ion implanted collagen‐coated grafts with a fluence of 1 × 1014 ions/cm2 inhibited platelet adhesion and demonstrated patency for 240 days in an animal study. The platelet adhesion test using platelet rich plasma (PRP) showed antithrombogenicity at the fluence of 1 × 1014 ions/cm2. Washed platelet adhesion test showed thrombus formation at the fluence of 1 × 1014 ions/cm2. The results suggested that plasma protein adsorption onto the ion‐implanted collagen significantly improved performance of these synthetic grafts.
Activated Leukocytes Adsorbed on the Surface of an Extracorporeal Circuit
Authors: Tabuchi Noriyuki , Shibamiya Aya , Koyama Takatoshi , Fukuda Tetsuya , Oeveren Willem van , Sunamori Makoto
Published: May 2003

Abstract: Biocompatibility of extracorporeal circuits has mostly been investigated by sampling blood in circulation. However, a proportion of activated leukocytes leave circulation by sticking to the circuits, and might affect the circuit biocompatibility. To reveal these characteristics, we eluted the adsorbed leukocytes from circuits used for 6 patients by washing with ethylenediaminetetraacetic acid (EDTA)‐HEPES buffer. 1.3 × 109 leukocytes, representing 5 to 10% of the circulating leukocytes, were collected. Most were neutrophils expressing CD11b antigens as high as those in circulation during cardiopulmonary bypass. Adsorbed monocytes expressed tissue factor higher than those in circulation (P < 0.05). An elution procedure by EDTA itself induced only a minimal activation of the leukocytes. These results indicate that extracorporeal circuits adsorb a large number of activated neutrophils and a small number of highly thrombogenic monocytes during their use. Although our data is limited, this elution procedure appears useful to investigate the biocompatibility of extracorporeal circuits.
Trileaflet Valve for VAD Use with Purged Sinus
Authors: Goubergrits L. , Leirner A. , Affeld K.
Published: May 2003

Abstract: Clinical applications of ventricle assist devices continue to be problematic due to thromboembolic complications. The problem originates mainly at the valves, which are usually made of an antithrombogenic material, such as cross‐linked bovine pericardium. However, wherever the blood flow is stagnant or forms a recirculation region, a thrombus is likely to form. A similar blood flow is found in the space between the housing of the valve and the leaflets, the so‐called valve sinus. Consequently, thrombi are often generated in this region. The novel valve design presented in this article avoids the formation of stagnant flow in the valve sinus during systole by a purge flow. This flow is taken from the main flow through the valve and is directed into each sinus region. The effect is achieved by perforation of the valve sinus with a small orifice at the bottom of the sinus. The purge flow effect is investigated with the computational fluid dynamics (CFD) method. The simulation shows that the purge flow effectively increases flow in the valve sinuses.