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Biomedical subjects

D H Pretorius

Publications and source records attributed to D H Pretorius.

At least 109 records · Page 6Linked to original sources
PubMed1987

Tracheoesophageal fistula in utero. Twenty-two cases.

A retrospective review of 22 infants born with tracheoesophageal fistula (TEF) with in utero sonograms was performed and the literature was reviewed. TEF or esophageal atresia should be considered when there is polyhydramnios and an absent fluid-filled stomach; these findings were seen in 32% of our cases. Amniotic fluid flows freely through some TEFs, resulting in a normal amount of amniotic fluid and a fluid filled stomach (six of 22 patients), while in other cases, the fluid does not traverse the fistula easily and polyhydramnios results. Polyhydramnios was present in 62% of our cases and was the most common sonographic finding. The earliest age at which polyhydramnios was diagnosed was 24 weeks. Sonography will detect approximately one third of fetuses with TEF; an improved outcome is expected in these fetuses.

Female↗
PubMed1986

Diagnosis of brain neuropathology in utero.

The fetal brain can be evaluated very effectively with high-resolution real-time ultrasound equipment. This paper reviews normal fetal brain anatomy with specific emphasis on artifacts of ultrasound scanning of the brain. A review of the developmental abnormalities seen in utero include ventriculomegaly, anencephaly, encephalocele, meningomyelocele, Dandy-Walker syndrome, holoprosencephaly, craniosynostosis, microcephaly, and agenesis of the corpus callosum. The destructive lesions reviewed include hydranencephaly, infection, intracranial hemorrhage, and mass lesion. Identification of these abnormalities can be extremely helpful in providing the patients with management options and providing the obstetrician with information which can help in obstetric and neonatal therapy.

Brain↗
PubMed1986

The fetal spine.

Ultrasonography has made it possible to evaluate the fetal spine in utero. Vertebral ossifications are demonstrable by ultrasonography in the early second trimester. Most spinal defects are apparent by 20-22 weeks menstrual age. Early detection of spinal anomalies allows for parental counseling and appropriate obstetrical management. Real-time equipment allows the fetal spine to be examined in parasagittal, transverse and coronal planes. The transverse plane provides the best view of the three ossification centers that form each fetal vertebra. Evaluation of the neural arch ossifications in the transverse view is crucial in detecting spina bifida defects. Ultrasonography of the fetal spine complements the use of alpha-fetoprotein levels in screening for neural tube defects. Examination of the fetal spine is also important in detecting vertebral ossification defects, particularly in cases of short-limbed dwarfs and infants of diabetic mothers.

Female↗
PubMed1986

Specific skeletal dysplasias in utero: sonographic diagnosis.

A retrospective study was performed of 13 short-limbed fetuses with lethal skeletal dysplasias that were evaluated with ultrasound (US) from 1981 to 1984. The specific diagnoses were thanatophoric dwarfism, achondrogenesis, osteogenesis imperfecta, and campomelic dwarfism. Death occurred in utero or within 2 weeks after delivery in all cases. US examination showed other associated abnormalities, including polyhydramnios, hydrops, shortened femurs, and CNS abnormalities. Radiographs confirmed these findings and provided more information regarding the shape of the limbs and thorax and the appearance of the spine. The probable diagnosis of lethal short-limbed dwarfism was made antenatally using US in eleven of the fetuses. Spinal appearance, thoracic shape, and associated hydrops and polyhydramnios were most helpful in determining the specific type of dysplasia present. Lethal short-limbed skeletal dysplasia may be diagnosed confidently in utero using US examination; however, obstetric plain film radiography may be required to determine the definitive type of dysplasia. In certain cases, US may be sufficient to make a definitive diagnosis.

Bone Diseases, Developmental↗
PubMed1986

Fetal omphalocele and gastroschisis: a review of 24 cases.

Fetal omphalocele and gastroschisis are congenital defects of the abdominal wall that require prompt surgical management at the time of delivery. To evaluate the role of prenatal sonography in identifying factors that influence prognosis, 24 cases of abdominal-wall defect (16 omphalocele, eight gastroschisis) were reviewed. Sonograms were evaluated for location of umbilical cord insertion, contents of the ventral defect, presence or absence of a covering membrane, fetal ascites, bowel-wall thickening, and coexisting anomalies. Sonographic differentiation between omphalocele and gastroschisis was possible in 18 (75%) of 24 cases. Eighteen patients had congenital defects in addition to the abdominal-wall defect. Associated abnormalities were present in 14 (88%) of 16 fetuses with omphalocele and four (50%) of eight with gastroschisis. Overall survival rate was 50%, excluding six terminated pregnancies. Survival rate was 33% for neonates with omphalocele and 83% for those with gastroschisis. The better prognosis for neonates with gastroschisis appears to reflect the lower frequency of associated congenital anomalies.

Abdominal Muscles↗
PubMed1986

Fetal lateral ventricular ratio determination during the second trimester.

Ventriculomegaly may be diagnosed sonographically by identifying abnormal ventricular size. The lateral ventricular ratio (LVR) is a useful index in differentiating normal-sized ventricles from ventriculomegaly. The purpose of this study was to validate previously reported data establishing the normal range for LVR during the second trimester. Prior to 24 weeks, the diagnosis of ventriculomegaly may be difficult since the LVR normal range is quite large. The LVRs for 122 normal fetal ultrasound examinations were calculated based on measurements obtained by three observers. Data were obtained for fetuses during each week of gestation from 15 to 25 weeks. Lateral ventricular ratios varied from 56 +/- 18 per cent (mean +/- 2 standard deviations) at 15 weeks to 33 +/- 4 per cent at 25 weeks. The lateral ventricular width (LVW) range for normal fetuses was 0.7 to 1.1 cm as compared with a LVW range of 1.1 to 2.7 cm for 16 fetuses with hydrocephalus diagnosed during the second trimester. In conclusion, the LVR is extremely useful in differentiating ventriculomegaly from normal ventricular size. Serial ultrasound examinations are often mandatory in the second trimester in order to definitely identify ventriculomegaly. In addition, normal ventricular size may be verified with a LVW of less than 1.1 cm.

Cerebral Ventricles↗
PubMed1985

Ultrasound diagnosis of hematotrachelos: a case report.

Hematotrachelos, the engorgement of the cervix uteri with retained blood, is discussed with reference to clinical presentation, ultrasonographic findings, and etiologies. Other disease processes related to hematotrachelos such as hematometra, hematocolpos, and hydrocolpos are also reviewed.

Blood↗
PubMed1985

Partial splenic embolization in children with hypersplenism.

Partial splenic embolization (PSE) was successfully accomplished in 10 of 11 children, aged 2-9, who had portal hypertension or variceal bleeding. Nine of the 11 children had undergone portoenterostomy (Kasai operation) for biliary atresia, and two had portal vein thrombosis. After embolization these children had a longer period of fever (mean = 23.7 days) and elevated white blood cell (WBC) count (above 10,000, mean = 13.6 days) than adults who have undergone the same procedure. The leukopenia and thrombocytopenia of hypersplenism were corrected by PSE in seven of eight children, and the condition of the eighth child improved. Among ten patients who had experienced episodes of variceal hemorrhage, the frequency of bleeding episodes was reduced from an average of 2.87 per year before PSE to 0.67 per year after PSE. There were no splenic abscesses and no other significant complications of the treatment. Ultrasound (US) evaluation after embolization demonstrated hypoechogenicity of the infarcted areas and tiny, linear echoes scattered throughout the spleen typical of postinfarction intravascular gas. All nine children who underwent follow-up Tc-99m sulfur colloid scanning showed evidence of splenic regeneration, though none has had recurrence of clinical symptoms. Splenic regeneration following PSE may occur more frequently in children than in adults.

Child↗
PubMed1985

Normal fetal sacrum simulating spina bifida: "pseudodysraphism".

An erroneous diagnosis of spina bifida may be made using obstetric ultrasound (US) if the examiner is unfamiliar with normal fetal sacral anatomy or the ways in which artifacts can affect the appearance of the normal lumbosacral posterior elements. Two normal neonates who appeared to have sacral dysraphism in utero are described and compared with US and CT studies of an anatomically normal 34-week cadaver specimen. In the event of transducer angulation, lumbosacral spina bifida must be diagnosed with the utmost caution if an associated sac or mass is not present.

Adult↗
PubMed1985

Fetal intracranial teratoma: US diagnosis of three cases and a review of the literature.

We describe three cases of fetal intracranial teratoma diagnosed by ultrasound and review the literature. Sonographic features include cranial enlargement, gross distortion of normal cerebral architecture by a hyperechoic, multicystic mass, and polyhydramnios. Despite early diagnosis, the cesarean section rate is high and the overall prognosis is dismal.

Adult↗
PubMed1985

Clinical course of fetal hydrocephalus: 40 cases.

The clinical course and outcome of hydrocephalus diagnosed in utero is not well understood. To approach this problem 40 cases were reviewed of intrauterine fetal hydrocephalus diagnosed with sonography, and follow-up information was obtained regarding them. Sonograms were evaluated for cerebral dimensions, biparietal diameter, brain mantle size, ventricular ratio, amount of amniotic fluid, and associated abnormalities. Neonatal brain sonograms and computed tomographic (CT) scans were reviewed also. Clinical charts were reviewed for maternal age and parity, referral source, family history, fetal age at diagnosis and delivery, mode of delivery, physical examination and/or autopsy findings, karyotype, amniotic alpha 1 fetoprotein level, cause of death, shunt placement after birth, and status of live infants. The observations indicate that the prognosis for fetal hydrocephalus is poor. Only six infants (15%) were alive after an average follow-up of 13 months. Three children were normal and the other three had neurologic abnormalities ranging from severe (paralysis and incontinence) to minimal (2-3 months delayed motor development). Thirty-four fetuses or neonates died. Nine families elected to terminate pregnancy. Ten opted for decompression at delivery for progressive hydrocephalus. Neural tube defects were present in 12 of 23 infants at delivery. Fourteen other infants had additional significant congenital abnormalities. Other abnormal sonographic findings included polyhydramnios (13 of 38), oligohydramnios or decreased fluid (nine of 38), neural tube defect (nine of 40), and other congenital abnormalities (nine of 40). These findings indicate that hydrocephalus diagnosed in utero by sonography is caused by a heterogeneous group of disorders. In general, the prognosis for normal development is poor. Individual prognoses, however, depend on the specific malformations and the interventions used.

Female↗
PubMed1985

The clinical significance of increased echogenicity in the fetal abdomen.

Seven cases of increased echogenicity in the fetal abdomen detected on prenatal sonography were reviewed for findings and causes. In four cases, the findings corresponded to calcification secondary to meconium peritonitis, infection, or unknown cause. One infant with meconium ileus had inspissated but noncalcified meconium corresponding to the increased echoes. In two cases, follow-up prenatal sonography was normal, and the neonate was also normal. Eight cases from the literature with increased echogenicity in the fetal abdomen were also reviewed: Two cases were secondary to meconium ileus, and six were caused by meconium peritonitis. Increased abdominal echogenicity on prenatal sonography may result from various processes that may affect obstetric and neonatal management.

Abdomen↗
PubMed1985

Artifacts seen commonly on ultrasonography of the fetal cranium.

Common artifacts seen during ultrasound examination of the fetal cranium and that may simulate pathology include hypoechoic parenchyma, noise in the near field, focal sonolucent areas, reverberation echoes and shadowing from portions of the skull base. Specific techniques can help one recognize, decrease or eliminate them.

Brain↗