bluuebunny/crossref_metadata_2025_split huggingface dataset:
Working with an adult male with Down's syndrome, autism and challenging behaviour: evaluation of a programme of staff support and organizational change
Authors: Newman David W. , Summerhill Lisa , Mosley Ellis , Tooth Claire 
Published: May 2003

SummaryThe dual diagnosis of Down's syndrome and autism is a relatively rare clinical phenomenon. The identification of multiple diagnostic presentations in individual cases can bring acomplex clarityto what is an initially confusing picture. This paper examines the case of a male who has Down's syndrome and has been referred to a Clinical Psychology Service because he is presenting with ‘severe challenging behaviour’. The paper provides: (i) a case history and rationale for the assessment of autism, (ii) a description of methodology incorporating a single case design and (iii) an intervention aimed at increasing staff awareness of autism, improving staff communication and implementing an integrated care plan across environments. It was hypothesized that an intervention incorporating these important organizational changes would support staff in meeting the client's needs. The success of the intervention was measured in terms of the frequency of (i) positive behaviours and (ii) challenging behaviours displayed by the client. Frequencies are charted and statistical analysis applied. Results illustrate a positive change in the day centre environment but no significant change in the home environment. These results are discussed in relation to methodological considerations and issues for future service provision.
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

AbstractWe 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

AbstractObjectiveTo assess the diagnostic power of the umbilical venous–arterial index (VAI) for the prediction of poor fetal outcome.Subjects and methodsThis 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.ResultsThe 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.ConclusionDetermination 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

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

AbstractObjectiveTo describe a novel, sonographic approach for in‐utero evaluation of normal and abnormal aortic arch.MethodsAortic 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.ResultsBetween 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.ConclusionsIt 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

AbstractObjectivesTo 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 methodsCross‐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.ResultsIn 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.ConclusionsAreas 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

AbstractObjectivesTo 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 methodsA 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.ResultsThe 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.ConclusionsOur 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

AbstractObjectiveThe 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.MethodsOne 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.ResultsEighteen 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.ConclusionSonographic 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

AbstractObjectiveTo 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 methodsThe 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.ResultsOf 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.ConclusionsMeasurement 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

AbstractObjectiveTo detect possible sources of bias in ultrasound prediction of gestational age.Subjects and methodsUsing 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.ResultsMale 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.ConclusionsCompared 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

AbstractObjectiveTo investigate the relationship between color Doppler indices of dominant follicular blood flow and clinical factors in in vitro fertilization‐embryo transfer cycles.Subjects and methodsThis 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.ResultsThere 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.ConclusionsDoppler 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

AbstractVallecular 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

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