bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal diagnosis of dysmorphic syndromes by routine fetal ultrasound examination across Europe
Authors: Stoll C. , Clementi M. ,   The Euroscan Study Group
Published: June 2003

AbstractObjectivesUltrasound scan in the mid‐trimester of pregnancy is now a routine part of prenatal care in most European countries. The objective of this study was to evaluate the prenatal diagnosis of dysmorphic syndromes by fetal ultrasound examination.MethodsData from 20 registries of congenital malformations in 12 European countries were included in the study.ResultsThere were 2454 cases with congenital heart diseases, 479 of which were recognized syndromes, including 375 chromosomal anomalies and 104 syndromes without chromosomal anomalies. Fifty‐one of the 104 were detected prenatally (49.0%). One hundred and ninety‐two of 1130 cases with renal anomalies were recognized syndromes, including 128 chromosomal anomalies and 64 syndromes without chromosomal anomalies; 162 of them (84.4%) were diagnosed prenatally, including 109 chromosomal anomalies and 53 non‐chromosomal syndromes. Fifty‐four of the 250 cases with limb defects were recognized syndromes, including 16 chromosomal syndromes and 38 syndromes without chromosomal anomalies; 21 of these 54 syndromes were diagnosed prenatally (38.9%), including 9 chromosomal syndromes. There were 243 cases of abdominal wall defects including 57 recognizable syndromes, 48 with omphalocele and 9 with gastroschisis; 48 were diagnosed prenatally (84.2%). Twenty‐six of the 187 cases with diaphragmatic hernia had recognized syndromes, including 20 chromosomal aberrations and 6 syndromes without chromosomal anomalies. Twenty‐two of them (84.6%) were detected prenatally. Sixty‐four of 349 cases with intestinal anomalies were recognized syndromes; 24 were diagnosed prenatally (37.5%). There were 553 cases of cleft lip and palate (CL(P)) and 198 of cleft palate (CP) including 74 chromosomal anomalies and 73 recognized non‐chromosomal syndromes. Prenatal diagnosis was made in 51 cases of CL(P) (53.7%) and 7 of CP (13.7%). Twenty‐two of 188 anencephalic cases were syndromic and all were diagnosed prenatally. Of 290 cases with spina bifida, 18 were recognized syndromes, and of them 17 were diagnosed prenatally. All 11 syndromic encephaloceles were diagnosed prenatally.ConclusionsAround 50% of the recognized syndromes which are associated with major congenital anomalies (cardiac, renal, intestinal, limb defects, abdominal wall defects and oral clefts) can be detected prenatally by the anomaly scan. However the detection rate varies with the type of syndrome and with the different countries' policies of prenatal screening. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Reproducibility of three‐dimensional ultrasound diagnosis of congenital uterine anomalies
Authors: Salim R. , Woelfer B. , Backos M. , Regan L. , Jurkovic D. 
Published: June 2003

AbstractObjectiveTo examine the reproducibility of the diagnosis of congenital uterine anomalies and the repeatability of measurements of uterine cavity dimensions using three‐dimensional (3D) ultrasound.MethodsThe reproducibility of diagnosis of congenital uterine anomalies was examined by re‐slicing stored 3D ultrasound volumes. Each data set was evaluated by two independent observers. Assessment of uterine morphology was performed in a standardized plane, with the interstitial portions of the Fallopian tubes used as reference points. Additionally, in 35 cases of congenital uterine anomalies the width of the uterine cavity (W), fundal distortion (F) and the length of unaffected uterine cavity (C) were measured. Intraobserver and interobserver variabilities were evaluated by each observer performing all three measurements twice.ResultsEighty‐three 3D ultrasound volumes were examined. Both operators classified 27 uteri as normal, 33 as arcuate, 19 as subseptate and three as unicornuate. A single case of uterine anomaly was described as arcuate uterus by one operator and subseptate by another (kappa 0.97). The intraobserver variability for each of the three measurements (W, F and C) was satisfactory with limits of agreement ranging from ±1.43 to ±2.51 mm. The examination of the interobserver variability showed no significant differences between the two observers (F = 0.484, P > 0.05).Conclusion3D ultrasound is a reproducible method for the diagnosis of congenital uterine anomalies and for the measurement of uterine cavity dimensions. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound assessment of cervical length in threatened preterm labor
Authors: Tsoi E. , Akmal S. , Rane S. , Otigbah C. , Nicolaides K. H. 
Published: June 2003

AbstractObjectiveMore than 70% of women presenting with threatened preterm labor do not progress to active labor and delivery. The aim of this study was to investigate the hypothesis that in women with threatened preterm labor, sonographic measurement of cervical length helps distinguish between true and false labor.MethodsWe examined 216 women with singleton pregnancies presenting with regular and painful uterine contractions at 24–36 (mean, 32) weeks of gestation. Women in active labor, defined by the presence of cervical dilatation ≥ 3 cm, and those with ruptured membranes were excluded. On admission to the hospital a transvaginal scan was performed to measure the cervical length. The subsequent management was determined by the attending obstetrician. The primary outcome was delivery within 7 days of presentation.ResultsIn 173 cases the cervical length was ≥ 15 mm and only one of these women delivered within 7 days. In the 43 cases with cervical length < 15 mm delivery within 7 days of presentation occurred in 16 (37%) including 6/14 (42%) treated with tocolytics and 10/29 (35%) managed expectantly. Logistic regression analysis demonstrated that the only significant contributor in the prediction of delivery within 7 days was cervical length < 15 mm (odds ratio = 101, 95% CI 12–800, P < 0.0001) with no significant contribution from ethnic group, maternal age, gestational age, body mass index, parity, previous history of preterm delivery, cigarette smoking, contraction frequency or use of tocolytics.ConclusionsIn women with threatened preterm labor, sonographic measurement of cervical length helps distinguish between true and false labor. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Abnormal cardiac function in fetuses with increased nuchal translucency
Authors: Rizzo G. , Muscatello A. , Angelini E. , Capponi A. 
Published: June 2003

AbstractObjectiveTo evaluate cardiac function in structurally and chromosomally normal fetuses with increased nuchal translucency (NT).MethodsForty‐two structurally and chromosomally normal fetuses with increased NT at 11–14 weeks of gestation underwent fetal echocardiographic examination at 20–23 weeks. Fifty fetuses with normal NT values were considered as controls. Pulmonary and aortic peak velocity and time to peak velocities were measured as indices of ventricular systolic function. The ratios between the E‐wave and A‐wave (E/A) and the ratios between the E‐wave and time velocity integral (E/TVI) at the level of both atrioventricular valves were evaluated as indices of ventricular diastolic function.ResultsIn fetuses with increased NT the E/A ratios were significantly decreased when compared to control fetuses at the level of both the mitral (0.52 ± 0.09 vs. 0.60 ± 0.10, P = 0.0002) and tricuspid (0.51 ± 0.09 vs. 0.61 ± 0.09, P < 0.0001) valves. Similar results were found for the E/TVI ratios (mitral valve 4.79 ± 1.03 vs. 5.63 ± 1.23, P = 0.0007 and tricuspid valve 4.40 ± 0.88 vs. 5.19 ± 0.82, P < 0.0001). No significant relationship was found between the degree of NT and the abnormalities in Doppler indices. There were no significant differences in Doppler systolic indices.ConclusionStructurally and chromosomally normal fetuses with increased NT have low E/A and E/TVI ratios at 20–23 weeks of gestation. These findings might indicate cardiac diastolic dysfunction. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
First‐trimester diagnosis of micrognathia as a presentation of Pierre Robin syndrome
Authors: Teoh M. , Meagher S. 
Published: June 2003

AbstractWe describe a case of first‐trimester diagnosis of micrognathia. A transvaginal ultrasound scan performed at 13 weeks' gestation revealed an abnormal fetal facial profile consisting of a small mandible and a receding chin. A subsequent amniocentesis at 15 weeks' gestation revealed a normal karyotype. A morphology scan and subsequent postmortem examination at 19 weeks confirmed the first‐trimester findings and revealed, in addition to the facial pathology, a complex cardiac abnormality and unilateral talipes equinovarus. These findings are consistent with the diagnosis of Pierre Robin syndrome. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium
Authors: Alcázar J. L. , Castillo G. , Mínguez J. Á. , Galán M. J. 
Published: June 2003

AbstractObjectiveTo evaluate the role of transvaginal power Doppler sonography to discriminate between benign and malignant endometrial conditions in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography.MethodsNinety‐one postmenopausal women (median age, 58 years; range, 47–83 years) presenting with uterine bleeding and a thickened endometrium (≥ 5‐mm double‐layer endometrial thickness) on transvaginal sonography were included in this prospective study. Endometrial blood flow distribution was assessed in all patients by power Doppler immediately after B‐mode transvaginal sonography. Three different vascular patterns were defined: Pattern A: multiple‐vessel pattern, Pattern B: single‐vessel pattern and Pattern C: scattered‐vessel pattern. Histological diagnoses were obtained in all cases. No patient taking tamoxifen citrate or receiving hormone replacement therapy was included.ResultsHistological diagnoses were as follows: endometrial cancer: 33 (36%), endometrial polyp: 37 (41%), endometrial hyperplasia: 14 (15%), endometrial cystic atrophy: 7 (8%). Blood flow was found in 97%, 92%, 79% and 85% of cases of carcinoma, polyp, hyperplasia and endometrial cystic atrophy, respectively. A total of 81.3% of vascularized endometrial cancers showed Pattern A, 97.1% of vascularized polyps exhibited Pattern B and 72.7% of vascularized hyperplasias showed Pattern C. Sensitivity and specificity for endometrial cancer were 78.8% and 100%. For endometrial polyp these respective values were 89.2% and 87% and for hyperplasia they were 57.1% and 88.3%.ConclusionsTransvaginal power Doppler blood flow mapping is useful to differentiate benign from malignant endometrial pathology in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound diagnosis of uterine arteriovenous fistula associated with placental site trophoblastic tumor
Authors: Ichikawa Y. , Nakauchi T. , Sato T. , Oki A. , Tsunoda H. , Yoshikawa H. 
Published: June 2003

AbstractWe report a case of a woman with abnormal vaginal bleeding who had a placental site trophoblastic tumor (PSTT) detected following hysterectomy. Surgery was performed because of a large uterine arteriovenous fistula detected by transvaginal color and pulsed Doppler sonography. Color Doppler sonography revealed a lacunar‐type lesion with a marked increase in uterine vascularity, and pulsed Doppler sonography demonstrated a low resistance index. This vascular pattern indicated the formation of blood lacunae and arteriovenous shunts caused by PSTT within the uterine myometrium. This is the first report to describe the ultrasound findings in a case of PSTT complicated by a uterine arteriovenous fistula. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Short‐term outcome of isolated and associated congenital heart defects in relation to antenatal ultrasound screening
Authors: Levi S. , Zhang W. H. , Alexander S. , Viart P. , Grandjean H. ,   The Eurofetus study group
Published: June 2003

AbstractObjectiveTo investigate the outcome of fetuses affected by congenital heart defects (CHD), either detected or undetected at ultrasound screening, according to their complexity and severity.DesignThe study group comprised 3633 malformed fetuses entered into the Eurofetus database of which 798 had CHD. We compared the short‐term outcome in cases where a CHD was detected by ultrasound screening with that in cases where a CHD was not detected. Isolated and associated CHD (ICHD and ACHD) and the degree of severity of defects were considered separately. Outcome data included termination of pregnancy (TOP), intrauterine fetal death, neonatal death (< 6 days after birth), gestational age at diagnosis and at delivery, mode of delivery and birth weight.ResultsOf the 798 fetuses with CHD, 595 had ICHD and 203 had ACHD. The diagnosis of an anomaly was made significantly earlier in ACHD cases. TOP was chosen in 28% of cases with a prenatal diagnosis of CHD, 20% for ICHD and 37% for ACHD (P < 0.001). The survival rate of antenatally diagnosed fetuses was lower in those with ACHD than in those with ICHD (P < 0.001) and lower for fetuses with antenatal diagnosis than with postnatal diagnosis (P < 0.001); this was due to significant differences in the complexity and severity of the defect. Premature delivery (< 32 weeks) was more frequent in fetuses in which an antenatal diagnosis of CHD had been made. Severe CHD were diagnosed earlier and were associated with a higher rate of TOP and spontaneous loss.ConclusionsThe severity of CHD has a positive influence on the sensitivity of screening but a negative influence on the outcome. CHD that are not diagnosed antenatally include a high proportion of benign malformations. This explains the apparent paradox of a poorer outcome in fetuses in which a CHD was detected prenatally compared to those fetuses in which the defect was undetected prenatally. However, prenatal diagnosis provides parents with the option of TOP or of preventive care in specialized centers. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Cervical changes in twin pregnancies observed by transvaginal ultrasound during the latter half of pregnancy: a longitudinal, observational study
Authors: Bergelin I. , Valentin L. 
Published: June 2003

AbstractObjectiveTo determine what constitutes normal cervical changes in twin gestations during the latter half of pregnancy, and whether there are differences in the pattern of cervical change between women expecting twins giving birth at term (≥ 36 completed gestational weeks, GW) and preterm.MethodsTwenty women (12 nulliparous, eight parous) expecting twins were examined with transvaginal ultrasound every week from 24 GW until delivery. Cervical length and width were measured, the inner cervical os was assessed as being closed or open, and any dynamic cervical changes were noted. Examination results were unavailable to the staff involved in the care of the women.ResultsEight women (40%) delivered preterm spontaneously at 32–35 GW. Cervical length remained unchanged (∼ 10 mm) in one woman, who delivered preterm. It decreased in the remaining 19 women. The median shortening rate for women manifesting a continuous shortening of the cervix was 2.9 (0.8–5.2) mm/week in women giving birth preterm vs. 1.8 (0.8–2.4) mm/week in those who gave birth at term (P = 0.08). Median cervical length at the first examination was similar in women who delivered preterm and at term (39 vs. 41 mm), but at 32 GW the cervix was shorter in women who delivered preterm (median, 18 vs. 31 mm, P = 0.02). Cervical width remained unchanged in 63% (5/8) of the women who delivered preterm vs. 8% (1/12) of those who gave birth at term (P = 0.02). The cervix became wider in the remaining women. Median cervical width at the first examination was similar in women who delivered preterm and at term (38 vs. 38 mm), but in women who delivered preterm the cervix was thinner at 0–6 days before spontaneous start of labor (median, 40 vs. 48 mm, P = 0.07). An opening of the inner cervical os was seen ≤ 27 GW in 88% (7/8) of the women who delivered preterm vs. 17% (2/12) of those who delivered at term (P = 0.006), the corresponding figures for dynamic changes being 63% (5/8) vs. 17% (2/12) (P = 0.06). Dynamic changes were seen in a greater proportion of the examinations in women who delivered preterm (median, 25% vs. 4%, P = 0.07).ConclusionsThe pattern of cervical changes from 24 GW to delivery differs between twin pregnancies delivering preterm (at 32–35 GW) and at term (≥ 36 GW). In twin pregnancies delivered preterm cervical shortening is more rapid, the cervix does not broaden to the same extent as in twins delivered at term, an open inner cervical os and dynamic cervical changes are seen earlier in gestation, and dynamic cervical changes are seen more often. Cervical changes in women with twins who give birth as early as at 24–31 GW may be different. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations
Authors: Timmerman D. , Wauters J. , Van Calenbergh S. , Van Schoubroeck D. , Maleux G. , Van Den Bosch T. , Spitz B. 
Published: June 2003

AbstractObjectiveThe aim of this study was to assess the spontaneous outcome of uterine vascular malformations detected with ultrasonography and color Doppler, and to investigate the predictive value of color Doppler imaging as to which patients require invasive treatment.MethodsThis was a prospective observational study conducted between January 1999 and February 2001 comprising all consecutive patients diagnosed with a uterine vascular malformation by ultrasonography and color Doppler imaging. Spectral analysis included measurement of flow velocities, pulsatility index (PI) and resistance index (RI). Close follow‐up was arranged in all cases and the outcomes were recorded.ResultsA total of 30 consecutive patients with uterine vascular malformations were included in the study. Spectral analysis of the vessels in the vascular malformations within the myometrium and endometrium revealed the presence of a low‐impedance and high‐velocity flow. The average values for PI, RI, peak systolic velocity (PSV) and time‐averaged maximum velocity (TAMXV) were 0.50, 0.38, 0.63 m/s and 0.46 m/s, respectively. Eight patients (27%) eventually required embolization of the uterine arteries and three of them had true arteriovenous malformations confirmed at angiography. PSV values of ≥ 0.83 m/s were associated with higher probabilities of further treatment, such as an embolization, whereas no vascular malformation with a PSV value < 0.39 m/s required embolization.ConclusionConservative management is possible in more than two‐thirds of patients presenting with uterine vascular malformations diagnosed by color Doppler sonography. Despite considerable overlap, PSV values appear to be useful in distinguishing between low‐ and high‐risk patients. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Applications and advances in polycapillary optics
Authors: MacDonald C. A. , Gibson W. M. 
Published: June 2003

AbstractPolycapillary optics can be designed for a wide variety of x‐ray applications. They have been used as focusing collectors for x‐ray astronomy, to produce large‐area collimated beams for wafer analysis and to provide small focused beams for protein crystallography with low‐power x‐ray sources. They are also being developed for a number of medical applications, including the removal of Compton scattering with the resultant improvement in contrast and resolution in mammography, the production of monochromatic parallel beams for high‐contrast imaging in a clinical setting and the detection and localization of radioactive tracers in prostate cancer. Other exciting applications are extensions of measurements normally performed at synchrotrons into laboratory or clinical settings because of the increased efficiency of source utilization. The realization of these applications has been advanced by the recent marked improvement in available optic quality and reproducibility. Manufacturing progress has been assisted by the development of simulation analyses which allow for increasingly accurate assessment of optics defects. Optics performance over the whole range of energy from 10 to 80 keV can often be matched with one or two fitting parameters. This software development is ongoing, as is development of crystallographic analysis software designed to be used with highly focused beams. Continuing optics manufacturing challenges include the advance of applications at energies above 40 keV and the production of optics for imaging which are of adequate clinical size. Copyright © 2003 John Wiley & Sons, Ltd.
CRITICAL NOTICE
Authors: MACK ERIC 
Published: June 2003

Natural Goodness, PHILIPPA FOOT. Clarendon Press, 2002, 125 pages.Philippa Foot begins her short but intriguingly rewarding book on Natural Goodness
by recounting a story about Wittgenstein.Wittgenstein interrupted a speaker who
had realized that he was about to say something that, although it seemed
compelling, was clearly ridiculous, and was trying (as we all do in such
circumstances) to say something sensible instead. “No,” said Wittgenstein.
“Say what you want to say. Be crude and then we shall get on.” (p. 1)So it is no surprise that Natural Goodness itself is full of bold sayings which, although elegantly cast, will shock many readers' philosophical sensibilities. In this discussion of Foot's book I will complete compliance with Wittgenstein's advice by way of a crude attempt to interpret Foot's bold sayings.
Theoretical perspectives and new practices in audio-graphic conferencing for language learning
Authors: HAMPEL REGINE 
Published: June 2003

This article will start with the situation at the Open University, where
languages are taught at a distance. Online tuition using an audio-graphic Internet-based conferencing
system called Lyceum is one of the ways used to develop students’ communicative skills.Following Garrett’s call for an integration of research and practice at EUROCALL 1997
(Garrett, 1998) – a call which is still valid today – the present article proposes a
conceptual framework which can support the use of conferencing systems such as Lyceum in
language learning and teaching. In the first part of the article, I examine several pedagogical
theories supporting language learning, that is, second language acquisition and sociocultural
theories, and multimodality, and apply them to the practice of audio-graphic computer-mediated
communication (CMC) as used at the Open University. I also build on previous research, which,
however, is still dominated by written CMC. What Erben stated in 1999 is still true: that
audio-graphic technology “remains under-researched and under-theorised.” (Erben, 1999:230).
Firstly, I therefore examine studies on written CMC and secondly those that have been conducted on
audio-graphic CMC in order to identify the benefits and challenges of these media.Both the pedagogical theory and previous studies of CMC have informed the design and implementation
of online tuition at the Open University. Thus the second part of the article reports on a research
project on Lyceum, which took place in 2002. The goal of the project was to evaluate the use of
audio-graphic conferencing in practice, and this in turn has instigated both improvements in the
software used and in student support as well as further changes to the task design. I present some
findings and discuss both the challenges of audio-graphic conferencing that were encountered and
the benefits that were identified.