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Biomedical subjects

E A Reece

Publications and source records attributed to E A Reece.

At least 127 records · Page 7Linked to original sources
PubMed1989

A comparison of transvaginal and abdominal ultrasound in visualizing the first trimester conceptus.

Ultrasound visualization of the first trimester embryo was compared using abdominal and transvaginal sonography. The parameters evaluated included the ability to obtain biometry, the ability to visualize detailed internal anatomy, and a subjective assessment of the overall image clarity. In 120 patients studied, transvaginal sonography was superior to abdominal sonography in obtaining biometric measurements in 51 cases (43%) and for visualizing internal anatomy in 45 cases (38%); also the image clarity of transvaginal sonography was subjectively better in 75 cases (63%). Vaginal sonography was superior to abdominal sonography in gestations less than or equal to 10 weeks, in obese patients, and in patients with retroverted uteri. The major difficulty encountered with transvaginal sonography was the limited maneuverability of the probe to generate specific views. Vaginal sonography can be a valuable tool in imaging the first trimester fetus, complementing, not replacing, abdominal sonography.

Abdomen↗
PubMed1989

Ultrasonography versus amniotic fluid spectral analysis: are they sensitive enough to predict neonatal complications associated with isoimmunization?

The modern management of pregnancy complicated by erythroblastosis fetalis is based on serial amniocenteses followed by either intrauterine transfusions or early delivery of affected infants, depending on the gestational age. A retrospective study was undertaken involving 92 isoimmunized pregnancies in which ultrasonography and amniotic fluid analyses were used to assess the relative predictive values for neonatal complications. Our data demonstrated that ultrasonography and optical density analyses were comparable in the evaluation of the isoimmunized pregnancy. The combined information from both these modalities did not increase the predictive value over that observed with either one alone. Both instruments were found to have high negative predictive values. However, neither method, used singly or in combination, was highly predictive of neonatal complications. In light of the low positive predictive values, caution should be exercised in using the results of amniotic fluid spectral analyses and/or ultrasound examinations for predicting perinatal complications.

Amniotic Fluid↗
PubMed1989

Sonographic evaluation of the normal developmental anatomy of the fetal cerebral ventricles: II. The atria.

A prospective ultrasound study was conducted on 171 normal pregnancies ranging in gestational age from 15 weeks to term to evaluate the developmental anatomy of the atria of the lateral ventricles. The atrial width showed no significant modifications throughout gestation, remaining fairly constant. Significant linear relationships were found between the cerebroatrial distance and gestational age (R2 = 0.88; P less than .0001) and between the cerebroatrial distance and the biparietal diameter (R2 = 0.936; P less than .0001), with a first- and second-order regression equation being the best fit, respectively. From these data, growth of the atria was characterized both biologically and mathematically, providing a comprehensive evaluation of the atrioventricular system throughout pregnancy. Such data offer the potential for early prenatal diagnosis of various types of developmental abnormalities of the fetal ventricular system.

Cerebral Ventricles↗
PubMed1989

Yolk sac failure in embryopathy due to hyperglycemia: horseradish peroxidase uptake in the assessment of yolk sac function.

We described previously the morphologic alterations of the visceral endodermal yolk sac cells of rat conceptuses cultured under hyperglycemic conditions which occurred concomitantly with major embryonic malformations. To determine whether the transport function of the yolk sac was impaired simultaneously as a result of these hyperglycemic conditions, horseradish peroxidase was used as a tracer protein to assess the transport function of the visceral endodermal yolk sac cells of conceptuses cultured in both control and hyperglycemic media. Cellular uptake of peroxidase, which was added to the culture medium for 3 or 24 hours, was observed in controls. This differed from the marked diminution in peroxidase uptake seen in conceptuses cultured in hyperglycemic medium. These results demonstrate that during hyperglycemia-induced embryopathy, there is concomitant yolk sac failure evidenced by morphologic alterations and impaired endocytosis. These findings therefore strengthen our hypothesis that diabetes-related malformations, as demonstrated experimentally in rat conceptuses, are associated with impairment in the structure and functions of the visceral yolk sac cells during a critical period of organogenesis.

Animals↗
PubMed1988

Subnormal cerebellum in fetuses with spina bifida.

The results of a prospective ultrasound study of the posterior fossa structures in 19 fetuses with spina bifida are reported. The transverse cerebellar diameter is below the normal limits and the cisterna magna is obliterated in all cases. Decreased cerebellar size and failure to visualize the cerebellum appear to be specific findings for spina bifida since they are not present in a group of 17 fetuses with isolated hydrocephalus. The results of this study indicate that ultrasound investigation of the posterior fossa may prove useful in the prenatal diagnosis of spina bifida.

Arnold-Chiari Malformation↗
PubMed1988

Diagnostic fetal umbilical blood sampling in the management of isoimmunization.

Current management of isoimmunization in pregnancy is predicted on the assumption that all sensitized women carry antigen-positive fetuses. In addition, management is based on indirect predictors of the magnitude of the fetal hemolytic disease. We present a preliminary report using a new approach of direct fetal blood sampling for the diagnosis and treatment of these patients. This form of evaluation provides specific information about fetal red blood cell antigen status and the degree of fetal anemia at an earlier gestational age than that validated by the Liley curves and eliminates empiricism from both the diagnosis and treatment of the isoimmunized pregnancy. The use of such a management protocol reduces the need for multiple invasive procedures in fetuses at little risk for disease and provides specific information about the status of those fetuses truly at risk.

Blood Group Incompatibility↗
PubMed1988

Prognostic significance of the human yolk sac assessed by ultrasonography.

Ultrasonographic examinations were conducted between 6 and 12 weeks' gestation in 77 first-trimester pregnancies with normal fetal outcome. Each examination consisted of measurements of the secondary yolk sac diameter and the fetal crown-rump length. The yolk sac was seen in all cases, and whereas its measurements demonstrated wide biologic variability, it correlated weakly (R2 = 0.39) with gestational age as confirmed by crown-rump length measurements. Growth of the yolk sac diameter, although slight, assumed a curvilinear relationship with gestational age. Such a growth profile is best described by a second-degree polynomial regression equation. The yolk sac performs important functions for embryonic development during organogenesis and the remnant of the secondary yolk sac seen on ultrasonography is often considered to be a potential predictor of fetal outcome. Our findings indicate that the size of this remnant in pregnancies with normal karyotypes and normal fetal outcomes is extremely variable. Additionally, the yolk sac size in patients with karyotypic abnormalities and spontaneous abortion were equally variable and almost all were within the normal range. In light of these findings, the secondary yolk sac size does not appear to be a sensitive predictor of embryonic integrity and pregnancy outcome.

Female↗
PubMed1988

Diabetic nephropathy: pregnancy performance and fetomaternal outcome.

A study of 31 continuing pregnancies complicated by diabetic nephropathy was conducted to determine the effects of diabetes-associated renal disease on maternal health and fetal outcome. Throughout pregnancy there was a significant increase in maternal blood pressure (p less than 0.001) and proteinuria (p less than 0.0001), with nephrotic syndrome (greater than 3.0 gm protein/day) developing in 71% of pregnancies. After birth, however, proteinuria reverted to levels not significantly different from values in early pregnancy. There was no apparent adverse effect of pregnancy on the natural course of the underlying renal disease. Stillbirths occurred in two patients (6%), and the remaining 29 pregnancies resulted in live-births at a mean gestational age of 36 weeks. Seventy percent of these infants were appropriate for gestational age, whereas 16% were small and 13% were large for gestational age. Birth weight was best correlated with gestational age and creatinine clearance (p less than 0.0001). Neonatal complications included respiratory distress syndrome (19%), hyperbilirubinemia (26), and congenital malformations (10%). The uncorrected perinatal survival rate was 94%. These data suggest that with contemporary methods of maternal evaluation and treatment, fetal surveillance, and neonatal care, the risks to patients with diabetic nephropathy during pregnancy are not excessive. The likelihood of a successful fetal and neonatal outcome is comparable to that in other patients with insulin-dependent diabetes.

Adolescent↗
PubMed1988

Sonographic assessment of the distal femoral and proximal tibial ossification centers in the prediction of pulmonic maturity in normal women and women with diabetes.

A noninvasive method for the assessment of fetal pulmonic maturity via the sonographic characterization of fetal distal femoral and proximal tibial epiphyseal ossification centers was evaluated. The study population included 82 patients in the third trimester of pregnancy, 47 of whom had uncomplicated gestations, while 35 had insulin-dependent diabetes. In uncomplicated pregnancies a distal femoral epiphysis measuring greater than or equal to 3 mm in the axial plane or the sonographic identification of a proximal tibial epiphysis of any dimension correlated with pulmonic maturity. The combination of a distal femoral epiphysis greater than or equal to 3 mm and the presence of a proximal tibial epiphysis was highly correlated with a lecithin/sphingomyelin ratio greater than or equal to 2:1 (sensitivity 100%, specificity 63%, negative predictive value 100%, and false-negative rate 0%). The Kappa value (K) for testing the agreement between ultrasound results and amniocentesis results was 0.39 (p less than 0.002). In diabetic pregnancies neither a distal femoral epiphysis greater than or equal to 3 mm nor a proximal tibial epiphysis of any dimension correlated precisely with the presence of phosphatidyl glycerol in the amniotic fluid. However, the combination of a distal femoral epiphysis greater than or equal to 3 mm and a proximal tibial epiphysis greater than or equal to 2 mm improved the prediction of phosphatidyl glycerol (sensitivity 83%, specificity 79%, negative predictive value 96%, false-negative rate 17%). The K value in this instance was 0.36 (p greater than or equal to 0.19). It is concluded that the sonographic assessment of the distal femoral and proximal tibial epiphyses and their dimensions in the axial plane may be useful as markers for pulmonic maturity in uncomplicated pregnancies.

Epiphyses↗
PubMed1988

Fatty acid content of yolk sac and embryo in hyperglycemia-induced embryopathy and effect of arachidonic acid supplementation.

Using the postimplantation rat conceptus model, we analyzed with gas-liquid chromatography, the fatty acid composition in major lipid groups (phospholipids, triglycerides, nonesterified fatty acids, and cholesterol esters) of yolk sacs and embryos cultured for 48 hours under control, hyperglycemic, and arachidonic acid-supplemented hyperglycemic conditions. In all experimental conditions the yolk sacs had greater fatty acid content than the embryos in all lipid groups except in nonesterified fatty acids. The fatty acid level in embryonic nonesterified fatty acids was significantly higher (p less than 0.05) in hyperglycemia-exposed embryos than found with arachidonic acid supplementation. Total yolk sac triglycerides were greater with added glucose (p less than 0.05) than with the addition of arachidonic acid to the same medium. Oleic acid, a fatty acid associated with essential fatty acid deficiency, was increased in the embryonic phospholipids and nonesterified fatty acids of conceptuses exposed to excess glucose, as well as in the culture media of this group, compared with the control or arachidonic acid-supplemented, hyperglycemic group (p less than 0.05). The results of this study demonstrate that diabetes-related embryopathy is associated with quantitative and qualitative abnormalities in major lipid groups. Furthermore, the elevation in embryonic oleic acid level suggests that the teratogenic mechanism could be related to a deficiency in essential fatty acids. The pattern of essential fatty acid deficiency and embryopathy was preventable with arachidonic acid supplementation in this experimental model.

Animals↗
PubMed1988

A reassessment of maternal serum alpha-fetoprotein in diabetic pregnancy.

We assessed maternal serum alpha-fetoprotein (AFP) concentrations in 227 diabetic women who belonged to different groups of White's classification but found no difference either between the insulin-dependent and the normative population or between the former and diabetics who were not insulin-dependent. By contrast, we found in maternal blood a marked, statistically significant inverse correlation between maternal serum AFP and the concentration of glycosylated hemoglobin in maternal blood assayed within 6 weeks of each other in mid-gestation (r = -0.4, p less than 0.05), but not when glycosylated hemoglobin was determined in the first two months of pregnancy (r = 0.05). These data indicate that the decrease in maternal serum AFP found in pregnant diabetic women is related to the efficacy of diabetic control but not to the diabetic status. A correction in maternal serum AFP should therefore be applied only to values obtained for women with poor glycemic control. Decreased maternal serum AFP in poorly controlled diabetics may indicate reduced synthesis of other fetal proteins which, in turn, may correlate with fetal growth retardation and the occurrence of malformation.

Adult↗
PubMed1988

Sonographic appearance of the fetal heel ossification centers and foot length measurements provide independent markers for gestational age estimation.

The sonographic measurement of fetal foot length and the assessment of fetal heel ossification centers were conducted as an additional method for the estimation of gestational age. Such an approach is particularly desirable in cases where measurements of other biometric parameters are precluded, for example, in diseases such as anencephaly, hydrocephalus, and short limb dysplasia. A significant correlation was found between fetal foot length and gestational age (r = 0.9, p less than 0.0001) and between fetal foot length and femur length (r = 0.9, p less than 0.0001). Ossification centers of the calcaneus and talus were all present by the twenty-second week of gestation. However, their measurements discriminated between gestational ages of 18 to 22 weeks. The utilization of fetal foot length and heel ossification centers will serve as a useful adjunct in the estimation of gestational age and possibly in the diagnosis of diseases affecting the fetal foot.

Calcaneus↗
PubMed1988

Reassessment of the utility of fetal umbilical vein diameter in the management of isoimmunization.

High-resolution ultrasound has been recently introduced in the management of many conditions in which the fetus is at risk. In the detection of severe erythroblastosis fetalis, sonographic evaluation of fetal anatomic changes is being used in association with amniotic fluid spectral analysis to assess the degree of the hemolytic process. In 1981 it was reported that sonographically detected umbilical vein dilatation, resulting from hepatic congestion, could be used as a sign of impending fetal compromise. We analyzed data obtained from 47 patients in a total of 76 examinations, including sonographic measurement of umbilical vein diameter, associated ultrasound findings, results of amniotic fluid spectral analyses, and neonatal outcome. The collected data, divided in two groups according to the results of amniotic fluid spectral analyses (less than high zone II and greater than or equal to high zone II), showed that the sonographic measurement of umbilical vein diameter does not differ significantly between the two groups (p greater than 0.05). Therefore, the present and relatively large series demonstrates that dimensions of the umbilical vein cannot be used as a reliable predictor of worsening fetal disease.

Erythroblastosis, Fetal↗
PubMed1988

Sonographic evaluation of the normal developmental anatomy of fetal cerebral ventricles: I. The frontal horn.

A prospective ultrasound study was conducted in 179 normal pregnant women with gestational ages ranging from 15-40 weeks. Several biometric measurements were obtained throughout pregnancy, including the cerebrofrontal horn distance of the lateral ventricle, the frontal hemispheric width, and the calculated ratio of cerebrofrontal horn distance/hemispheric width. Curvilinear relationships were found between cerebrofrontal horn distance and gestational age (R2 = 0.597; P less than .0001) and between cerebrofrontal horn distance and the biparietal diameter (R2 = 0.618; P less than .0001). In addition, a curvilinear relationship existed between cerebrofrontal horn distance/hemispheric width ratio and gestational age (R2 = 0.492; P less than .0001) and biparietal diameter (R2 = 0.930; P less than .0001). These data represent a comprehensive characterization of normal growth of the fetal frontal horns. They provide a method by which variations from the norm can be assessed and early prenatal diagnosis of developmental anomalies of the fetal ventricular system can be made.

Cerebral Ventricles↗
PubMed1988

The prevention of diabetes-associated birth defects.

Birth defects among infants of diabetic mothers convey a major financial and sociologic burden to society notwithstanding the psychologic impact to the patients and families. Epidemiologic, clinical, and experimental studies indicate that these malformations occur in early pregnancy, are influenced by the abnormal maternal metabolic milieu, and seem to result from a combination of more than one factor. Clinical and experimental studies, however, have demonstrated that optimal metabolic control achieved in the periconceptual period and maintained throughout the first trimester of pregnancy results in a significant reduction in the malformation rate among offspring of diabetic mothers. In this light, diabetic women contemplating pregnancy should be encouraged to delay conception until satisfactory metabolic control is achieved so that embryogenesis may occur in an optimal metabolic milieu. The experimental use of arachidonic acid in the prevention of diabetes-related embryopathy is a new and potentially valuable tool. It extends the spectrum of available methods for prevention and deserves further study as a potential agent for pharmacologic prophylaxis.

Abnormalities, Multiple↗
PubMed1988

Lactation outcome in insulin-dependent diabetic women.

To document the incidence and management of breast feeding among women with insulin-dependent diabetes mellitus (IDDM), 30 IDDM mothers and 30 controls were followed from birth of their infants to 6 weeks postpartum. The researchers interviewed the mothers in the hospital and by telephone at 1, 2, and 6 weeks postpartum. Fifty-three percent of the IDDM women and 57% of the general hospital population intended to breast feed. Because of the need for neonatal observation for hypoglycemia, most IDDM mothers were separated from their infants for the first 2 days. After 1 week, as many IDDM mothers as controls nursed. Initially, no differences in breast-feeding problems were found between the groups, but between 2 and 6 weeks postpartum, two IDDM nursing mothers but none of the controls experienced clinically diagnosed mastitis. A daily diet prescription of 31 kcal per kilogram of maternal body weight was associated with IDDM mothers' ability to sustain lactation, in contrast with 25 kcal per kilogram of maternal weight for IDDM mothers who stopped nursing. Six-week postpartum fasting plasma glucose levels of IDDM mothers who exclusively breast fed were significantly lower (4.6 +/- 2.2 mmol/L [82 +/- 40 mg/dl]) than the glucose levels of the women who stopped nursing (8.1 +/- 2.1 mmol/L [145 +/- 37 mg/dl]) or the glucose levels of the IDDM mothers who chose to bottle feed (6.7 +/- 1.7 mmol/L [120 +/- 30 mg/dl]). It appears that adequate maternal calories, blood sugar control, early breast stimulation, and mastitis monitoring are necessary for optimal lactation outcome in insulin-dependent diabetic women.

Blood Glucose↗
PubMed1988

Sonographic assessment of the fetal frontal lobe: a potential tool for prenatal diagnosis of microcephaly.

A prospective ultrasound evaluation of 150 normal pregnant women was conducted between 15 and 40 weeks' gestation. A variety of biometric measurements were obtained that included measurements of the frontal lobe distance (the anterior edge of the frontal horns of the lateral ventricles to the frontal bone) and the thalamic frontal lobe distance (measured from the posterior edge of the thalami to the frontal bone). Analysis of these data revealed a high degree of correlation between the gestational age and the frontal lobe distance (R2 = 0.89, p less than 0.0001), and between the gestational age and thalamic frontal lobe distance (R2 = 0.93, p less than 0.0001). Similarly, a high degree of correlation was also found between the biparietal diameter and the frontal lobe distance (R2 = 0.95; p less than 0.0001), between the biparietal diameter and the thalamic frontal lobe distance (R2 = 0.90, p less than 0.0001), and between the frontal lobe distance and the thalamic frontal lobe distance (R2 = 0.92, p less than 0.0001). The relationships between femur length and frontal lobe distance (R2 = 0.89, p less than 0.0001) and between the femur length and the thalamic frontal lobe distance (R2 = 0.945, p less than 0.0001) were also evaluated. Nomograms for the relationships between gestational age and frontal lobe distance and thalamic frontal lobe distance were generated and included the mean +/- SD and the percentile distributions. Growth of the frontal lobe was best described by a first-degree linear equation. The results of this study demonstrate the pattern of growth of the frontal lobe and the high rate of correlation between growth of the frontal lobe and the gestational age and the biparietal diameter. These findings offer a potential method by which the decreasing size of the frontal lobe, as shown in three cases described herein, can be evaluated prenatally and thus serve as a useful tool in the prenatal diagnosis of microcephaly.

Female↗