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Biomedical subjects

D R Cyr

Publications and source records attributed to D R Cyr.

At least 37 records · Page 2Linked to original sources
PubMed1988

Exencephaly--clinical and ultrasonic correlation to anencephaly.

The antenatal sonographic diagnosis of exencephaly in four gestations is reported. Exencephaly is an uncommon malformation of the cranium that characteristically involves a large, disorganized mass of cerebral tissue. The flat bones of the calvaria are absent, leaving the brain mass uncovered. Secondarily, anencephaly may develop as a result of prolonged exposure of the developing encephalon to amniotic fluid and trauma in utero. As in anencephaly, facial structures and the bony base of the calvarium are often preserved in exencephaly. Sonographically, the outstanding feature of exencephaly is the cerebral mass, with convolutions or "pseudo" sulcal patterns present. These findings correlate well with the pathologic examination and define a clinical entity that is incompatible with human life.

Anencephaly↗
PubMed1988

Fetal rhombencephalon: normal US findings.

Using ultrasound (US), the authors examined 25 embryos that were 8-10 menstrual weeks old for gestational age and the presence of a small cystic structure (3-4 mm) in the posterior aspect of the cranium. This structure was seen in all embryos. The US images of an in vitro embryo at 8 weeks menstrual age were also evaluated for anatomic correlation. Analysis of these US images determined that the cystic structure was the open rhombencephalon or hindbrain. Follow-up US studies or postpartum clinical examinations of the 25 in utero embryos demonstrated no abnormal posterior cranial cystic structures or neurologic deficits. This first-trimester structure should be considered a normal finding, since it develops into the normally proportioned fourth ventricle after the 11th menstrual week.

Female↗
PubMed1988

The Dandy-Walker malformation prenatal sonographic diagnosis and its clinical significance.

To determine the usual sonographic findings and clinical significance of the Dandy-Walker malformation (DWM) identified in utero, we reviewed seven proven cases diagnosed by prenatal ultrasound during a 6-year period. All patients demonstrated complete or partial absence of the cerebellar vermis and a posterior fossa cyst. Other central nervous system (CNS) findings included hydrocephalus (five cases) and agenesis of the corpus callosum (one case). Extra-CNS abnormalities were prospectively identified in 3 of 4 fetuses with multiple anomalies. Chromosomal analysis was performed on all four fetuses with multiple extra-CNS anomalies, yielding 2 abnormal karyotypes (trisomy 18 and mosaic trisomy 13). Fetal mortality was directly dependent on the presence of extra-CNS anomalies. Five fetuses ultimately died, including all four with multiple extra-CNS anomalies. The remaining two patients are alive at 1.5 and 6 years of age. We conclude that DWM has a distinctive sonographic appearance that can be identified by prenatal ultrasound and that identification of DWM should initiate a careful search for concurrent anomalies as well as consideration of chromosomal analysis.

Abnormalities, Multiple↗
PubMed1988

Prenatal diagnosis of agenesis of the corpus callosum.

The prenatal sonographic findings in seven cases of agenesis of the corpus callosum (AGCC) are reported. Findings that suggest AGCC on standard transverse views of the fetal cranium are emphasized. All seven cases demonstrated ventricular abnormalities including four fetuses (57%) who demonstrated laterally displaced lateral ventricles and/or disproportionate enlargement of the occipital horns. Two additional fetuses demonstrated a large midline fluid collection, representing a dilated third ventricle. The remaining case demonstrated atypical findings of a septated periventricular cystic mass. Following birth, additional malformations were found in 5 of the 7 fetuses (71%), including one fetus with trisomy 8. We conclude that AGCC can be suggested on the basis of prenatal sonographic findings and that awareness of typical findings should permit more frequent detection of this anomaly in utero. Due to the frequency of concurrent anomalies, identification of AGCC should initiate a careful search for additional malformations.

Agenesis of Corpus Callosum↗
PubMed1988

Intraperitoneal fetal transfusion under direct ultrasound guidance.

The outcomes of 77 fetal intraperitoneal transfusions in 35 pregnancies managed with direct ultrasound guidance and intensive perinatal management were reviewed. Patients were monitored with amniocentesis, and standard indications were used for timing of transfusions. The mean gestational age at first transfusion was 27.3 weeks (range 22-33). The overall mortality rate was 14% (five of 35). No immediate transfusion-related deaths occurred; all fetuses who were not hydropic at first transfusion survived (26 of 26). The mean gestational age at delivery was 33.6 weeks (range 25-36). One infant developed respiratory distress syndrome (RDS). Transfusion-related complications occurred in five cases (fetal colon infusions in two, fetal retroperitoneal infusion in two, and fetal abdominal wall hematoma in one). None of these infants required urgent delivery or suffered long-term sequelae. In nonhydropic fetuses, intraperitoneal transfusions under direct ultrasound guidance had a low incidence of morbidity and no mortality. These results should provide baseline data against which to compare new techniques, such as direct cord transfusion. With neonatal mortality rates of 10% and significant morbidity rates of 10-20% in infants delivered at 32 weeks who develop RDS, intraperitoneal transfusion should be considered in the 32- to 33-week fetus with marked pulmonary immaturity.

Amniocentesis↗
PubMed1988

Perinatal management of gastroschisis.

Fetal anterior abdominal wall defects will be recognized with increasing frequency with the widespread use of maternal serum alpha-fetoprotein screening. A clear distinction must be made between omphalocele and gastroschisis, and counseling and obstetric management must be specific for each. Sixteen cases of gastroschisis were identified antepartum and followed through delivery between 1980-1986. There was one antepartum fetal death before institution of a protocol to deliver all such affected fetuses at 36 weeks. One patient was lost to follow-up. There were no antenatal or neonatal deaths among the 14 infants seen subsequently, all of whom were delivered by cesarean section. Only one infant had an additional nongastrointestinal defect (mild hearing loss), and all 14 were of appropriate weight for gestational age. Twelve infants had a single operative procedure for repair of the defect, with a mean hospital stay of 19.6 days. Scheduled cesarean delivery at 36 weeks, after confirmation of fetal lung maturity, presents the infant to the pediatric surgeon under controlled conditions and shortens neonatal hospital stay.

Cesarean Section↗
PubMed1987

Efficacy of thromboresistant umbilical artery catheters in reducing aortic thrombosis and related complications.

Previous in vitro and in vivo reports suggest that catheters constructed of polyurethane with heparin bonded to the surface (HB-PU) are less thrombogenic than catheters made of polyvinyl chloride (PVC). A randomized trial sufficiently large (power 80%) to detect a reduction in the incidence of umbilical artery (UA) catheter complications, including aortic thrombus formation, from 45% to 20% was conducted in 125 infants. The infants were monitored for complications possibly related to the use of a UA catheter, such as systemic hypertension and abnormalities of lower extremity perfusion. The presence of aortic thrombi was assessed by ultrasound study 3.5 +/- 1.2 (SD) days and 11.1 +/- 2.3 days after insertion of the catheter. The use of HB-PU umbilical catheters did not lead to a significant reduction in the incidence of complications and aortic thrombi compared with the use of PVC catheters. The lack of reduction may have been related to the prolonged duration of catheter use in both groups. A much larger study would have been required to detect a smaller, but perhaps clinically significant, reduction in catheter-associated complications.

Aorta↗
PubMed1987

Placental abruption and placental hemorrhage: correlation of sonographic findings with fetal outcome.

Sixty-nine cases of placental abruption and placental hemorrhage detected with ultrasonography (US) were reviewed retrospectively to determine whether US findings correlate with fetal outcome. Four patients were lost to follow-up, and in the remaining 65 patients fetal outcome included demise in 12 cases (18%), termination of pregnancy in six (9%), premature delivery of a living infant in 15 (23%), term delivery of an infant who was small for gestational age in four (6%), and normal term delivery in 28 (43%). Fetal mortality correlated best with the estimated percentage of placental detachment, but was also significantly (P less than .01) associated with the location (retroplacental) and size (greater than 60 ml) of hemorrhage. Premature labor was associated (P less than .001) only with gestational age at the time of clinical presentation. No sonographic finding was identified as a risk factor for small-for-gestational-age infants. Sonographic findings of placental abruption correlate with fetal outcome, and this information may be useful for guiding obstetric management.

Abruptio Placentae↗
PubMed1987

Sonographic spectrum of placental abruption.

Fifty-seven cases of placental abruption detected by sonography were retrospectively reviewed. The location of hemorrhage was subchorionic in 46 cases (81%), retroplacental in nine cases (16%), and preplacental in two cases (4%). Subchorionic hematomas were more frequently shown in the 33 patients presenting before 20 menstrual weeks (91%) than in the 24 patients presenting after 20 weeks (67%). The echogenicity of hemorrhage depended on the time the sonogram was performed relative to the onset of symptoms: Acute hemorrhage was hyperechoic to isoechoic compared with the placenta, while resolving hematomas became hypoechoic within 1 week and sonolucent within 2 weeks. Acute hemorrhage was occasionally difficult to distinguish from the adjacent placenta. This occurred in five retroplacental hematomas that showed only an abnormally thick and heterogeneous placenta. Nine cases of placental abruption were initially confused with other mass lesions. Placental abruption causes a wide spectrum of sonographic findings that may be overlooked or misdiagnosed.

Abruptio Placentae↗
PubMed1987

Fetal bowel. Normal sonographic findings.

The normal sonographic appearance of fetal colon and small bowel is reported in a prospective study of 130 fetuses. The colon, which appeared as a continuous tubular structure located around the perimeter of the abdominal cavity, was seen in some fetuses as early as 22 menstrual weeks and in all fetuses examined after 28 weeks. Colon diameter demonstrated a linear relation (r = 0.82) with menstrual age, reaching a maximum of 18 mm at term. In comparison, small bowel was located centrally and individual segments never exceeded 7 mm in diameter or 15 mm in length. Small bowel loops were seen in only 30% of fetuses examined after 34 weeks. Peristalsis was routinely demonstrated of the small bowel, but was not observed in the colon.

Colon↗
PubMed1987

Anhydramnios.

Explore the source record for details and available documents.

Amniotic Fluid↗
PubMed1986

Intraoperative US as an aid to intraoperative electron beam radiation therapy.

Intraoperative electron-beam radiation therapy (IRT) is being used to treat certain abdominal malignancies. Accurate determination of tumor size, depth, and extent is necessary to select a treatment cone of appropriate size and appropriate electron beam energy for the treatment portal. Fourteen patients undergoing evaluation for this treatment were examined with intraoperative ultrasonography (IUS) to aid therapy planning. IUS study required little additional time and readily delineated tumor size, depth, and relationship to adjacent structures. In two patients, the US and operative findings provided information that precluded use of IRT. The traditional method of tumor evaluation by intraoperative palpation and inspection was consistently enhanced by the use of IUS findings. IUS is a valuable adjunct that improves the accuracy of therapy planning for IRT.

Abdominal Neoplasms↗
PubMed1986

Bowel migration in the normal fetus: US detection.

Ten fetuses underwent ultrasound scanning at 7-10 weeks gestational (postmenstrual) age. In all cases, an echogenic mass measuring 0.5-1.0 cm was demonstrated within the base of the umbilical cord at its insertion into the fetal abdomen. No area with echogenicity characteristic of the small bowel was identified within the lower part of the fetal abdomen. All fetuses were reexamined 4-12 weeks later, at which time the mass in the umbilical cord was no longer seen, and normal fetal bowel was visualized in the lower abdominal cavity of the fetus. This sequence of findings appears to represent the sonographic demonstration of normal fetal bowel migration early in gestation and should not be confused with defects of the abdominal wall such as omphalocele or gastroschisis.

Abdominal Muscles↗
PubMed1986

A systematic approach to fetal echocardiography using real-time/two-dimensional sonography.

Improvements in the resolution of real-time scanners have facilitated examination of the fetal heart and the performance of fetal echocardiograms. The techniques for systematic examination have rarely been described in detail. Six echocardiographic views, described in this report, allow complete examination of the four cardiac chambers, as well as the valvular structures. Interatrial and interventricular septa may be visualized, as well as the great vessels.

Blood Vessels↗
PubMed1986

Severe nonimmune fetal hydrops with fetal survival. A case report.

A case of severe idiopathic nonimmune fetal hydrops spontaneously resolved after delivery with only basic supportive therapy. This case emphasizes that natural occurrences occasionally are responsible for successes attributed to invasive intrauterine treatments.

Adult↗