bluuebunny/crossref_metadata_2025_split huggingface dataset:
First‐trimester prenatal diagnosis of a familial subtelomeric translocation
Authors: Kilby M. D. , Brackley K. J. , Walters J. J. , Morton J. , Roberts E. , Davison E. V. 
Published: March 2003

AbstractA new fluorescent in situ hybridization (FISH) technique utilizes a complete set of telomeric probes to screen for deletions or rearrangements within the subtelomeric regions of all chromosomes on a single slide. Such cryptic chromosome rearrangements would otherwise remain undetected by standard cytogenetic analysis.In this case report, we describe the first‐trimester prenatal diagnosis of an unbalanced rearrangement in a family where such a cryptic subtelomeric rearrangement is segregating. Interestingly the fetus was also noted to have an increased nuchal translucency at the time first‐trimester chorionic villus sampling was performed and a FISH diagnosis made. The result was subsequently confirmed on fetal material obtained after elective termination of the pregnancy.We believe this to be the first report in the literature (as by Medline, December 1999) of a first‐trimester prenatal diagnosis using such subtelomeric probes where confirmation by conventional cytogenetic analysis was not possible. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Improved early prediction of pre‐eclampsia by combining second‐trimester maternal serum inhibin‐A and uterine artery Doppler
Authors: Aquilina J. , Thompson O. , Thilaganathan B. , Harrington K. 
Published: March 2003

AbstractObjectiveTo evaluate the screening efficacy of second‐trimester maternal serum inhibin‐A combined with uterine artery Doppler studies performed at 20 weeks' gestation for the prediction of pre‐eclampsia.MethodsSix hundred and eighty‐nine consecutive unselected women who had inhibin‐A levels measured between 15 and 19 weeks' gestation subsequently had color flow pulsed Doppler of both uterine arteries at the time of the anomaly scan (mean 20.5, range 18–22 weeks' gestation). The main outcome measures were pre‐eclampsia and pre‐eclampsia requiring delivery before 37 weeks' gestation. The presence or absence of notches in the flow velocity waveform was noted, and the resistance index measured. Receiver operator curves were created for inhibin‐A and uterine artery Dopplers alone and in combination. Sensitivities for each method were compared at false‐positive rates of 3% and 7%.ResultsThirty‐five women developed pre‐eclampsia, of whom 15 required delivery before 37 weeks' gestation. For a false‐positive rate of 7%, the sensitivity using bilateral notches/mean resistance index ≥ 0.65 was 60% with a positive likelihood ratio of 8.6 (confidence interval 5.7–12.6). For the same false‐positive rate, when bilateral notches/mean resistance index ≥ 0.55 and unilateral notches/mean resistance index ≥ 0.65 were combined with inhibin‐A ≥ 1.0 multiples of the median, the sensitivity improved to 71% and the positive likelihood ratio to 10.8 (confidence interval 7.4–15.4). For pre‐eclampsia requiring delivery before 37 weeks for a false‐positive rate of 3%, the sensitivity for bilateral notches improved from 27% to 60% and the positive likelihood ratio improved from 9.2 to 20.8 when uterine artery notch data was combined with inhibin‐A. The improvement in sensitivity for the combined method, compared to either inhibin‐A or uterine artery Dopplers alone, was statistically significant for both pre‐eclampsia (P < 0.05) and preterm pre‐eclampsia (P < 0.02).ConclusionCombination of second‐trimester serum inhibin‐A and uterine artery Doppler at 20 weeks improves the screening efficacy for the prediction of pre‐eclampsia especially when this necessitates early delivery. This combination might form the basis of an effective and practical early screening test for the condition. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
Selective photocoagulation of communicating vessels in monochorionic twins with selective growth retardation
Authors: Quintero R. A. , Bornick P. W. , Allen M. , Morales W. J. 
Published: March 2003

Objective:  The purpose of this study was to assess the outcome of monochorionic (MC) twins with selective intrauterine growth retardation (SIUGR) treated with selective laser photocoagulation of the communicating vessels (SLPCV).Study design:  Patients at less than 26 weeks with MC SIUGR pregnancies were eligible for the study. SIUGR was defined as <10th percentile for gestational age. Absent or reverse end‐diastolic velocity in the umbilical artery of the SIUGR twin was required for eligibility after January 2000.Results:  Thirty patients met criteria for the study: 17 were managed expectantly (group I), two underwent umbilical‐cord ligation of the SIUGR twin, and 11 underwent SLPCV (group II). Survival rates for at least one fetus were no different between groups I and II (14/17 or 82.3% vs. 8/11 or 72.3%, P = 0.4). However, concomitant demise of the co‐twin occurred in 4/7 patients and iatrogenic premature delivery for deterioration of the SIUGR twin was necessary in two patients in group, resulting in significant neonatal morbidity. Of the live‐born babies, neurological handicap was present in 3/22 (13.6%) vs. 0/12 in groups I and II, respectively (P < 0.0001).Conclusions:  SIUGR in MC twins can be effectively treated with SLPCV. By unlinking the circulations between the fetuses, the pregnancy is rendered ‘functionally’ dichorionic, improving pregnancy management and resulting in decreased neonatal morbidity. This approach constitutes a new valuable alternative in the management of MC twin pregnancies with SIUGR and an extension of the use of SLPCV from TTTS to MC SIUGR. A randomized clinical trial of expectant management vs. SLPCV for MC SIUGR can be considered.
Doppler velocimetry of uterine arteries between 12 and 16 weeks of gestation
Authors: Char Sang Choon , Yamasaki A. A. , Braia G. , Toma O. 
Published: March 2003

Introduction:  The aim of prenatal care is to identify high risk pregnant in order to adopt preventive and/or therapeutic treatments. The presence of an end diastolic ‘notch’ at uterine Doppler velocimetry has been considered a predictor to pre‐eclampsia and intrauterine reduced growth. It reflects an answer expressed by a wave of high amplitude representing vascular bed with high resistance (utero‐placental circulation).Objective:  To identify high risk patients by analysis of uterine Doppler velocimetry between 12 and 16 weeks of gestation when occurs the second wave of trophoblastic invasion.Patients and methods:  Between June 1999 and June 2001, we did a longitudinal study with 127 pregnant from 12 to 16 weeks. This study analyzed uterine Doppler velocimetry using two types of equipment: Aloka Model 1700 and Medison Model Voluson 530. We determined the incidence of end diastolic ‘notch’ between 12 and 16 weeks and its evaluation during pregnancy.Results:  The incidence of end diastolic ‘notch’ was 26% (33 patients). Among these patients only nine (7%) still had notch at 16–24 weeks. Among patients with normal uterine Doppler velocimetry at 12–16 weeks, none developed pre‐eclampsia or intrauterine reduced growth.Conclusion:  It is possible to identify low risk patients (74%) to pre‐eclampsia and intrauterine reduced growth at the end of first trimester of pregnancy by uterine Doppler velocimetry. At the end of first trimester, 26% of patients can be identified as high risk for pre‐eclampsia or intrauterine reduced growth. The advantage of this early screening method is the possibility to give aspirin (100 mg/day) at time of second wave of trophoblastic invasion as prophylactic treatment.
Impact of sonohysterography on the management of women with uterine myomas
Authors: Pretorius D. H. , Becker E. , Lev‐Toaff A. S. 
Published: March 2003

Purpose:  Assess the importance of sonohysterography findings in women with suspected/known myomas particularly with regard to location within/near the endometrial cavity and its impact on treatment.Methods:  Review of 240 sonohysterograms identified 109 women (age 24–76, mean 42.4; 84.4% pre‐menopausal, 15.6% post‐menopausal) with suspected/known myomas. Images, reports, pathology/surgery results, and clinical/imaging follow up were reviewed. Myoma location with respect to the cavity was described and feasibility of hysteroscopic resection assessed.Results:  Indications for sonohysterography abnormal bleeding (74.3%), infertility (8.3%), other (17.4%). Five groups were defined (1) normal cavity (19/109 patients, 17.4%); (2) normal but displaced cavity (7/109, 6.4%); (3) myoma with endoluminal component (50/109, 45.9%); (4) other endoluminal findings, mostly polyps (25/109, 22.9%); (5) myoma plus other (8/109, 7.3%). An intracavitary myoma(s) (ICM), a submucous myoma >50% within the cavity, was found in 45 patients; submucous – 20; mural – 71; and subserosal – 37 (57 patients had myomas in more than one location). SHG indicated that myomas were amenable to hysteroscopic resection (HR) in 45 women; in 39 others SHG revealed that myoma(s) were not amenable to HR. There was a significant difference in the use of hysteroscopic resection between these two groups; HR was performed in 21/45 (46.7%) of the former but only in 2/39 (5.1%) of the latter (P < 0.01). Other treatments were not significantly different between the two groups: hysterectomy in 7/45(15.6%) and 5/39(12.8%); abdominal myomectomy in 1/45 (2.2%) and 3/39 (7.7%); uterine artery embolization, curettage or endometrial ablation in 4/45 (8.9%) and 3/39 (7.7%), respectively. Sonohysterography findings were proved by pathology, hysteroscopy, laparoscopy or imaging in 64/109 (63.3%) patients; however, in the ICM group, 41/45 (91.1%) were proved.Conclusions:  SHG is useful for assessing the relationship of myomas to the cavity and for identifying or excluding concomitant endometrial abnormalities. Although other factors also influence treatment choices, SHG provides information that assists in determining therapeutic approach, particularly the appropriate use of hysteroscopic resection.
A prospective study to evaluate the effectiveness of ultrasound‐guided transvaginal aspiration in the treatment of recurrent endometrioma
Authors: Chan L. Y. , So W. W. K. , Lao T. T. 
Published: March 2003

Purpose:  Recurrent endometrioma is a difficult clinical problem. Repeated conservative surgical treatment carries increase risk of damage to adjacent organs. Medical treatment has not been found effective. Ultrasound‐guided aspiration is an attractive option because it can be performed under conscious sedation and is applicable even when surgical excision is technically difficult. We postulated that the endometriotic tissue in the epithelial lining had undergone pressure atrophy after a period of observation and resolution of the endometrioma can be achieved by aspiration of its content.Methods:  A prospective study was carried out in which patients with recurrent endometrioma that remain stationary in size for a period of at least 6‐month duration were included. Ultrasound‐guided aspiration of endometrioma was performed transvaginally under conscious sedation. Ultrasound scan examination was performed at 1, 3, 6 and 12 months after aspiration to detect recurrence.Results:  Eight endometriomas were aspirated in six patients. All aspiration procedures were successful. The mean diameter and volume of endometrioma at aspiration were 31.0 mm (18.0–46.3) and 21.9 mL (3.16–52), respectively. The mean duration of procedure was 34.5 min (15–50). There were no major complications. Cytological examination revealed hemosiderin‐laden macrophages; neither malignant cells nor endometrial cells were detected in all cases. Six ovarian cysts recurred in five women (83.3%), all recurrence were detected within 3 months after aspiration.Conclusions:  We concluded that although transvaginal ultrasound‐guided aspiration is a safe procedure. However, the recurrence rate after aspiration is unacceptably high, and hence cannot be recommended as a treatment option for recurrent endometrioma.
Use of sonohysterography in the diagnosis and management of abnormal uterine bleeding
Authors: Patil A. D. 
Published: March 2003

Objective:  To assess the effectiveness of saline contrast sonohysterography in the diagnosis and management of abnormal uterine bleeding.Materials and methods:  Fifty‐two patients (aged 28–56 years) with abnormal uterine bleeding were included in a prospective study. They underwent a transvaginal ultrasonography as well as saline contrast sonohysterography. Patients with findings of uterine cavity abnormalities (endometrial polyps or submucous myomas) were advised surgery (operative hysteroscopy or hysterectomy). Patients with normal cavity or thickened endometrium underwent diagnostic hysteroscopy and biopsy, following which they were advised medical therapy or thermal ablation of the endometrium.Results:  Saline contrast sonohystergraphy depicted endometrial polyps (n = 22), submucous fibroids (n = 18) and normal cavities (n = 12). Hysteroscopic surgery resolved the bleeding in 20 of the patients with polyps and in 12 of the patients with fibroids. The findings of the measurement and localization of the lesions on saline contrast sonohysterography displayed good reliability at the time of surgery. Of the 12 patients with normal uterine cavity, eight patients had a normal histopathological report on biopsy and were offered either medical therapy or endometrial thermal ablation. Three patients had endometrial hyperplasia without atypia and one patient had endometrial carcinoma and underwent definitive surgery. The procedure of saline contrast sonohysterography was well tolerated by all patients with very minimal side‐effects. Between transvaginal ultrasound and saline contrast sonohysterography, the latter was found to be more specific and sensitive and the likelihood ratio was improved significantly with the use of this modality.Conclusions:  Saline contrast sonohysterography enhances endovaginal ultrasound examination of the uterine cavity in patients with abnormal uterine bleeding. It is easy and safe to perform, and its use can optimize the therapeutic interventions.
Artificial neural networks in sonographic characterization of adnexal tumors: a preliminary study
Authors: Czekierdowski A. , Bednarek W. , Rogowska W. , Kotarski J. 
Published: March 2003

Objectives:  To apply computer generated artificial neural networks (ANNs) for the development of a statistical model, helpful in better preoperative discrimination between benign and malignant adnexal tumors.Materials and methods:  The retrospective study included data of 162 patients who were examined with gray scale and color Doppler sonography (B‐K Medical, 2002 ADI, Denmark and Voluson 530, and 730 Kretz, Austria) because of adnexal tumors. Following variables were analyzed with the use of ANN: patient's age, menopausal status, years since menopause, tumor size and volume, presence of solid parts, papillary projections >3 mm, localization of blood vessels (central or peripheral), resistive and pulsatility indices, peak systolic velocity and color Doppler score according to Timmerman et al. (1999). The output variable was classified as either benign or malignant. The ANNs were generated with the use of a statistical package (Statistical Neural Networks, Statsoft, USA) and included linear, radial basis function and multiple layer perceptron networks. The networks were trained on randomly selected 81 cases, verified (n = 40), and tested on the remaining 41 cases. Sensitivity and specificity of generated statistical models were compared with those calculated for all individual sonographic parameters.Results:  In 43 women, the cysts resolved spontaneously whereas 119 patients were subsequently operated. Removed tumors were classified histologically as either benign (n = 93) or malignant (n = 26), including four borderline; five stage I ovarian cancers. The best performance was found for the radial basis function network with six input neurons and one hidden neuron. The specificity and sensitivity at the best decision cut‐off point were 96.1% (25 of 26) and 94.8% (129 of 136), respectively. These percentages were significantly better than respective prognostic values derived from independent use of each tested variable (P < 0.05).Conclusion:  Evaluation of clinical and ultrasound derived data with the use of artificial neural networks may improve the accuracy of preoperative prediction of ovarian malignancy. Prospective analysis of a larger group of patients, especially with early stages of the disease is warranted.Acknowledgements:  Supported by the Polish Scientific Investigation's Committee grant no. KBN 4P05E120 17.
The anatomy and morphology of the ductus venosus in the human fetus: relevance to clinical practice
Authors: Mavrides E. , Moscoso G. , Carvalho J. , Campbell S. , Thilaganathan B. 
Published: March 2003

Background:  Doppler of the fetal ductus venosus (DV) is becoming increasingly commonplace in clinical practice. However, the true anatomical relationships of the DV are yet to be clearly defined. Furthermore, there is conflicting evidence regarding the structure of the DV, especially with regard to the presence of a DV inlet sphincter. The aim of the present study is to examine the anatomy and morphology of the DV.Design:  A prospective study on 24 fetuses obtained from medical terminations between 13 and 17 weeks' gestation. Following microdissection of the liver, specimens were prepared for study of the anatomical relations, scanning electron microscopy or histology.Results:  A venous confluence at the terminal end of the umbilical vein, termed the portal sinus, was identified connected to the right and left intrahepatic portal veins. The DV, a branchless hourglass shaped vessel, originated from the portal sinus ascended steeply in the direction of the diaphragm. The endothelial surface of the DV showed longitudinal corrugations and at the level of the inlet, there was ‘shelf’ separating the DV from the portal sinus. Histological studies revealed elastin fibers, six to seven cell layers thick at the DV inlet and a single layer of smooth muscle extending from the shelf to the DV outlet. A large number of nerve fibers were present in the adventia of the DV inlet.Conclusions:  This study clearly delineates the anatomical relations of the fetal ductus venosus. The morphological findings refute the presence of a DV sphincter, but provide an insight into the physiology of the human fetal DV. In clinical practice, the consistent use of the suggested appropriate terminology would allow collection of comparable data between units and enable operators to be confident of which vessels they are sampling by Doppler ultrasound.
Preliminary experiences using quantitative color velocity imaging (CVI): a simple means to measure fetal volume flow?
Authors: Tutschek B. , Zimmermann T. , Wagner K. , Reihs T. , Henrich W. 
Published: March 2003

Purpose:  Color velocity imaging (CVI) quantifies blood flow using time domain ultrasonography and M‐mode vessel diameter measurements. It has been validated in vitro and correlates well with Doppler based velocity measurements. The purpose of this study was to apply an easy to use CVI software algorithm in fetal studies.Methods:  A high resolution ultrasound system (ATL HDI 5000, 7–4 and 5–2 MHz curved probes) was used. Analysis of ultrasound data was performed using dedicated software (HDILab, version 1.91; CVI_Q plug‐in version 2.0). The content of the cineloop, usually with several cardiac cycles, is stored in digital format, concurrent with an ongoing exam. Volume flow, peak velocity and vessel diameter (derived from color M‐mode) were measured off‐line.Results:  Data acquisition is quick and simple. The proximal portion of the intrahepatic umbilical vein with its straight course offers good sampling conditions. The ductus venosus can also readily be measured. Off‐line analysis does not require specific hardware and takes less than 3 min per vessels. There is significant intraobserver variablity, but generally CVI volumes flow measurements agreed with published data derived from invasive or Doppler based methods.Conclusions:  CVI volume flow measurement using this system is rapid and easy. The software also delineates the functional lumen diameter (based on color flow information) and calculates blood flow velocities, enabling correlation with Doppler measurements. The calculations are based on the assumption of certain standard conditions (laminar flow and circular cross section, e.g. in adult carotid artery), but restrictions in fetal vessels (e.g. tortuous vessels of the free umbilical cord with regions of non‐laminar flow, fetal and maternal movements) apply.
Ultrasonographic evaluation of changes in placental location with the advance in gestation
Authors: Luria M. , Diamant Y. Z. 
Published: March 2003

Purpose:  To evaluate the change in location of the placenta during pregnancy and the actual increase in the distance between the internal oss and lower placental margins in relation to the advance in gestation.Methods:  A total of 37 pregnant women were scanned three times during pregnancy: the first time between 14 and 22 weeks' gestation, the second between 23 and 29 weeks' gestation and the last between 30 and 34 week's gestation. Examinations were performed by two qualified examiners. Placenta and cervix were allocated and distance between the lower placental margin and the interval oss was measured. Examinations were either transvaginal or transabdominal, depending on patients' cooperation.Results:  Gradual increase in the distance between the placental margin and the internal oss was found. Mean value of 50.8 mm at 14–22 weeks increased to 111.6 mm at 30–34 weeks. Significant statistical difference was found between first, second and third measurements. Effect of maternal age on these changes was evaluated too and was found not to affect this phenomenon. Borderline results were found regarding the effect of parity.Conclusions:  Low‐lying placenta in early pregnancy is a known phenomenon. Little is known about quantitative change in placental location with advance in gestation. In the present study, we tried to quantitate the change. We found gradual, consistent and significant increase in the distance between placental margin and internal oss along gestation. This change increased with increase in parity in spite of the fact that parity is a risk factor for placenta previa. The present quantitative evaluation of placental location can serve as a predictor of low‐lying placenta.