Biomedical subjects
Publications and source records attributed to D Maxwell.
Pallister-Killian syndrome (tetrasomy 12p) is an uncommon aneuploidy, which may present in the prenatal period with an ultrasonographically detected fetal abnormality or following karyotyping for maternal age. We report a case that presented with increased nuchal translucency and hydrops at a first trimester screening scan for trisomy 21.
OBJECTIVE: To construct a reference range for fetal penile length. METHODS: The length of the penis was measured during ultrasound assessment of 95 structurally normal male fetuses of gestational ages 16-38 weeks. Two fetuses with bladder outflow obstruction were also examined. RESULTS: Fetal penile length increases significantly with gestational age, from a mean value of 6.0 mm at 16 weeks to 26.4 mm at 38 weeks. One fetus with urethral agenesis had a penile length on the 0.3rd centile. CONCLUSIONS: Measurement of the fetal penis is easy and not time-consuming. In cases of bladder outflow obstruction, assessment of penile length assists in the differentiation between urethral agenesis and posterior urethral valves.
In the 'chronically vulnerable areas' (CVAs) of East Africa a smooth linear transition away from emergency programming towards rehabilitation and long-term development is difficult, if not impossible. This makes uncritical application of the 'relief-to-development' continuum to programming unhelpful at best, and perhaps counter-productive. This paper is the result of CARE's efforts to review its own programmes--and those of some of its sister agencies--in chronically vulnerable areas in the East Africa region, to derive important lessons learned and to identify areas where improvements are needed. The paper focuses on strategic considerations and decision-making in relation to entry, programme design and strategies for transition and exit.
Perlman syndrome is a rare overgrowth syndrome, thought to be inherited in the autosomal recessive fashion. We describe the sonographic features in two cases, and review the literature.
Ultrasound examination of a 22-week fetus demonstrated a grossly distended stomach and proximal duodenum, with a large cystic area in the chest. There was associated polyhydramnios. A presumptive diagnosis of duodenal atresia with a congenital diaphragmatic hernia was made. Analysis of a fetal blood sample showed that the fetus had Down's syndrome. Histological examination after termination of the pregnancy revealed the unusual combination of duodenal and esophageal atresia, with an intact diaphragm.
OBJECTIVE: To measure fetal lung volume using a computer based, enhanced, 3-dimensional ultrasound imaging system. DESIGN: An observational study. SETTING: The Fetal Medicine Unit at Guys Hospital, London. PARTICIPANTS: Twenty healthy women with a singleton pregnancy between 24 and 36 weeks of gestation were scanned on one occasion during pregnancy using an ultrasound based 3-dimensional imaging system. All delivered at term with weights above the 10th centile for gestation. RESULTS: Total lung volume increased exponentially with gestational age. Right lung volume measured consistently greater than left lung volume. CONCLUSIONS: The use of this new enhanced 3-dimensional imaging system allows for estimations of fetal lung volume. Preliminary data confirm that fetal lung volume, measured by a computerised 3-dimensional ultrasound imaging system increased exponentially with gestational age. The use of this system has obvious application in the further study of lung growth in utero and possible clinical application in disease states where fetal lung growth may be impaired.
A fetus diagnosed by sonography at 20 weeks' gestation had multiple skeletal abnormalities. The main features were absent ossification of the skull and cervical and upper thoracic vertebral bodies; short, angulated femora, tibiae, radii and ulnae but normal humeri; platyspondyly; trident-shaped acetabular roofs; sclerotic bands on the iliac wings and scapulae; clavicular hooks; and overall, mixed bone density. We suggest that this is a new chondrodysplasia which, since the parents are first cousins, could follow autosomal recessive inheritance.
The exogenous application of abscisic acid (ABA) to barely seedlings resulted in partial protection of the PSII photochemistry against photoinhibition at low temperature, the effect being most pronounced at 10(-5) M ABA. This was accompanied by higher photochemical quenching (qP) in ABA-treated leaves. A considerable increase (122%) in the amount of total carotenoids and xanthophylls (antheraxanthin, violaxanthin and zeaxanthin) was also found in the seedlings subjected to ABA. The activity of the xanthophyll cycle measured by the epoxidation state of xanthophylls under high-light treatment was higher in ABA-treated plants compared with the control. This corresponds to a higher value (0.411) of non-photochemical quenching (qNP) observed in ABA-treated than in control (0.306) leaves.
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Posterior approaches to the petroclival area requiring extensive drilling of the posterior pyramidal wall have been described in the last 10 years. If hearing is to be preserved, damage to the inner-ear structures must be avoided; however, the fine points of this pyramidal drilling technique have never been reported in detail. A microneurosurgical anatomical study was undertaken in 15 cadavers to determine the relationships between bone landmarks and labyrinthine structures that could be used to give some practical drilling guidelines. Drilling of the posterior pyramidal wall is facilitated on identification of the intersection of the petrous ridge with the most anterior portion of the bone ledge covering the sigmoid sinus (petrosigmoid intersection), the bony operculum of the endolymphatic sac, and the petrous ridge. Drilling may proceed rather safely at a minimum depth of 2.5 mm in an area 0.9 cm anterior and 1 cm inferior to the petrosigmoid intersection and petrous ridge, respectively. From there, identification of the vestibular aqueduct, genu, and horizontal portion is necessary to safely open the posterior wall of the internal auditory canal. The vestibular aqueduct represents the lateral and superior limits of drilling. The bone between these areas may then be safely drilled to a depth of at least 2.5 mm. A microneurosurgical dissection of the posterior pyramidal wall conducted in cadaveric material according to these guidelines did not violate any inner-ear structures.
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The main objective of preoperative imaging studies is to define as accurately as possible the number, size, location, and relationship of tumor masses in the liver to pertinent portal and hepatic venous vasculature. Computerized tomographic portography images hepatic veins and segmental portal vein branches and identifies the anatomical location of tumor nodules with excellent sensitivity and a low false-positive rate. The intraoperative correlation of computerized tomographic portography on 30 patients in the last 20 months at this institution shows a sensitivity of 88 per cent with a low rate of false-positivity. The ability to detect metastatic lesions in the liver by computerized tomographic portography diminishes when the lesions are noted to be less than 1 cm. The authors conclude that the preoperative interpretation of the computerized tomographic portogram provides valuable information not previously available to the surgeon operating on the liver.
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