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Biomedical subjects

D M Sherer

Publications and source records attributed to D M Sherer.

At least 163 records · Page 9Linked to original sources
PubMed1993

Ultrasonographic measurement of cheek-to-cheek diameter in fetal growth disturbances.

OBJECTIVE: Our purpose was to assess the value of the cheek-to-cheek diameter and the cheek-to-cheek diameter/biparietal diameter ratio in the ultrasonographic detection of abnormal fetal growth. STUDY DESIGN: The cheek-to-cheek diameter and cheek-to-cheek diameter/biparietal diameter ratio were examined in 21 small-for-gestational-age (< 10th percentile for estimated weight) and 87 large-for-gestational-age (> 90th percentile) fetuses. Statistical analysis consisted of Student's t test comparison between means and analysis of covariance for comparison of regression lines slope between these 108 fetuses and previously published nomograms of appropriate-for-gestational-age fetuses. RESULTS: The mean cheek-to-cheek diameters in small-for-gestational-age fetuses were significantly smaller than in appropriate-for-gestational-age fetuses (p < 0.0001). In large-for-gestational-age fetuses the mean cheek-to-cheek diameters were significantly larger (p < 0.005). Although large-for-gestational-age fetuses of diabetic mothers exhibited higher cheek-to-cheek diameter/biparietal diameter ratios than did appropriate-for-gestational-age fetuses (p < 0.0001), in fetuses of nondiabetic mothers this ratio was only minimally larger (p < 0.05). CONCLUSION: The cheek-to-cheek diameter and cheek-to-cheek diameter/biparietal diameter ratio are innovative ultrasonographic parameters for detecting abnormal fetal growth. Furthermore, the cheek-to-cheek diameter/biparietal diameter ratio permits insight into the possible underlying pathophysiologic mechanisms of fetal macrosomia.

Cephalometry↗
PubMed1993

Twin-twin transfusion with abrupt onset of microcephaly in the surviving recipient following spontaneous death of the donor twin.

We describe a case in which twin-twin transfusion with fetal death of the donor at 23 weeks was complicated by suspected intracranial embolic insult of the surviving recipient twin. Dynamic transient intracranial ultrasonographic findings were noted with complete resolution by 28 weeks. Subsequent severe microcephaly of the survivor with no further growth of any of the cranial parameters beyond 25 weeks was thought to be a result of this very unusual pathophysiologic mechanism.

Adult↗
PubMed1993

Physiology of isolated long-term variability of the fetal heart rate.

Ten singleton third trimester fetuses exhibiting isolated long-term variability of the fetal heart rate were studied with a single Doppler transducer actocardiograph in conjunction with real-time ultrasonography. Each of these studies revealed repetitive clustered bursts of fetal breathing movements during the acceleratory phases and apneic episodes during the deceleratory phases of this fetal heart rate pattern, respectively, in the absence of other fetal movements. This observation may explain the physiology of isolated long-term variability of the fetal heart rate.

Adult↗
PubMed1993

Twin-twin transfusion syndrome: rapid development of severe hydrops of the donor following selective feticide of the hydropic recipient.

Twin-twin transfusion syndrome is a serious complication of monozygotic twin pregnancies and is associated with high rates of perinatal morbidity and mortality. Unfortunately, therapies to disrupt the arteriovenous anastomoses are limited, and the success rate of these therapeutic modalities are poor. We present a case of severe twin-twin transfusion syndrome at 23 weeks' gestation in which selective feticide of the recipient hydropic twin by intracardiac injection of potassium chloride was followed by rapid development of hydrops in the donor twin.

Abortion, Induced↗
PubMed1993

Presence of cytomegalovirus inclusion bodies in a recurrent ulcerative vaginal lesion.

Cytomegalovirus is present in the female lower genital tract with an incidence of 4% to 12%. Intracellular inclusion bodies, which constitute evidence of the presence of this organism, are noted on Papanicolaou smears or at direct biopsy. All previous reports regarding tissue diagnosis have involved the uterine cervix. We report an unusual case of a postmenopausal woman who was found to have recurrent symptomatic vaginal lesions; repeated biopsies of the lesion disclosed the presence of cytomegalovirus inclusion bodies.

Aged↗
PubMed1993

Ultrasonographically guided subclavian vein catheterization in critical care obstetrics and gynecologic oncology.

Invasive hemodynamic monitoring has become an integral part of intensive care management. Whereas the pulmonary artery catheter is the mainstay for determination of the hemodynamic profile and differentiation between cardiogenic and noncardiogenic forms of pulmonary edema, immediate central venous access in itself is of importance in rapid volume replacement in cases complicated by severe hypovolemia. Central venous catheters are also the preferred route of administration of total parenteral nutrition to patients with cancer. We present our experience with real-time ultrasonographic guidance during subclavian vein catheterization in critical care obstetrics and gynecologic oncology.

Catheterization, Central Venous↗
PubMed1993

Massive hydronephrosis mimicking theca lutein cysts in association with partial hydatidiform mole.

We present an unusual case of partial hydatidiform mole in which extensive, multiple cystic structures encompassing the entire right abdomen and pelvis, initially thought to represent theca lutein cysts, were subsequently shown to consist of massive unilateral right hydronephrosis. Percutaneous nephrostomy decompression bypassing the ureteropelvic obstruction revealed functional renal parenchyma.

Adolescent↗
PubMed1993

Fetal sacral length in the ultrasonographic assessment of gestational age.

OBJECTIVE: Our purpose was to establish a nomogram of fetal sacral length throughout gestation and to assess its value in cases of abnormal fetal growth. STUDY DESIGN: A prospective cross-sectional study of 506 singleton fetuses with normal growth between 15 and 41 weeks' gestation was performed. Regression analyses were performed on sacral length, gestational age, biparietal diameter, head circumference, and femur length. The sacral length in 80 singleton gestations with abnormal growth (40 > 90th percentile and 40 < 10th percentile for gestational age) were compared with the nomogram. RESULTS: Linear relationships between gestational age and sacral length, biparietal diameter, head circumference, and femur length were demonstrated. Sacral length (centimeters) as a function of gestational age (weeks) was expressed by the regression equation: Sacral length = -0.108 + 0.102 Gestational age, with a Pearson correlation coefficient of R2 = 0.959. The sacral length of all 80 fetuses with abnormal growth demonstrated the same relationship to gestational age as did the 506 normal controls. CONCLUSION: This study defines the normal limits of sacral length; demonstrates a high correlation between sacral length, gestational age, and other standard measurements of fetal growth; and indicates that sacral length can predict gestational age, irrespective of fetal nutritional status.

Cross-Sectional Studies↗
PubMed1993

Prenatal ultrasonographic diagnosis of intracranial teratoma and massive craniomegaly with associated high-output cardiac failure.

Congenital intracranial teratomas are rare and usually fatal. We present prenatal diagnosis of such a case associated with scalp, facial, and body skin edema, hepatomegaly, extramedullary hematopoiesis, polyhydramnios, and a hydropic placenta. These manifestations of high-output cardiac failure were thought to be the result of the large cardiac output required by massive intracranial tumor arteriovenous shunting.

Adult↗
PubMed1993

Extensive fetal intrathoracic injuries sustained in a motor vehicle accident.

Motor vehicle accidents are the primary nonobstetric cause of maternal and subsequent fetal mortality. We present a case in which blunt abdominal trauma sustained by a pregnant woman in a motor vehicle accident caused extensive intrathoracic fetal injuries consisting of bilateral hemothorax, severe bilateral interstitial pulmonary hemorrhages, hemopericardium, and subepicardial hemorrhages, in addition to fetal cranial injuries. To the best of our knowledge, this is the first report of fetal intrathoracic injuries sustained with blunt maternal trauma. The underlying mechanism of intrathoracic trauma was thought to be similar to that of blast injury with transmission of excessive hydrostatic forces throughout the amniotic fluid with severe impact on the elastic fetal chest. This case supports the concept of in utero blast injury to the fetus as a possible cause for fetal soft tissue trauma associated with blunt trauma to the maternal abdomen.

Accidents, Traffic↗
PubMed1993

The ferning and nitrazine tests of amniotic fluid between 12 and 41 weeks gestation.

Most studies investigating the usefulness of ferning and nitrazine methods for detecting the presence of amniotic fluid following ruptured amniotic membranes have employed samples from vaginal pooling. Reported accuracies are 84 to 100% for the ferning test and 87 to 97% for the nitrazine test. Our study was designed to determine if these tests are applicable throughout gestation. Samples were obtained from amniocenteses between 14 and 42 weeks. Part I: Of 112 samples allowed to dry on a slide for 3 minutes only, 86.6% were ferning positive and 100% were nitrazine positive. Flame-drying increased the presence of ferning to 96.4%. Part II: 363 samples were allowed to dry completely for up to 10 minutes. All samples were ferning and nitrazine positive. Part III: 17 samples were tested for ferning and nitrazine at 1 hour, and again at 1 week. Sixty-six samples were tested within 1 week and again at 2 weeks. All samples remained ferning and nitrazine positive. Therefore optimal analysis of suspected amniotic fluid occurs when specimens are air-dried for 10 minutes. These tests may be reliably performed at gestations of 12 to 41 weeks.

Amniotic Fluid↗
PubMed1993

Prenatal sonographic diagnosis of isolated distal amelia of an upper extremity.

We report a case of fetal amelia (limb deficiency). The causes of this anomaly include amniocentesis, amniotic band syndrome, teratogen exposure, or a vascular accident. Recently, chorionic villus sampling has also been implicated in the amputation of an extremity. Although chorionic villus sampling (CVS) was not performed in our case, this possible association suggests subsequent sonographic scanning following CVS should include precise delineation of all fetal limbs.

Adult↗
PubMed1993

Maternal and neonatal outcome associated with prolonged premature rupture of membranes below 26 weeks' gestation.

The outcomes of 41 patients with prolonged, premature rupture of membranes in the midtrimester (19.5 to 26 weeks) managed conservatively were retrospectively analyzed. The maternal obstetric history was notable for a high incidence of second trimester bleeding and a prior history of preterm delivery. The mean duration of ruptured membranes before delivery was 10.6 days and was unrelated to gestational age. Delivery occurred within 2 weeks in 75% of the cases. The major indication for delivery was chorioamnionitis in 71% of patients. The only major maternal morbidity was chorioamnionitis. The overall perinatal survival was 47%, but in infants exceeding 24 weeks' gestation or 500 gm weight, the survival increased to 75%. No significant limb abnormalities, facial anomalies, growth retardation, or pulmonary hypoplasia occurred in the study population. Long-term follow-up demonstrated that 28% of infants exhibited major neurologic or developmental deficits.

Adolescent↗