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Biomedical subjects

I Shapiro

Publications and source records attributed to I Shapiro.

At least 19 recordsLinked to original sources
PubMed1992

Neu-Laxova syndrome: prenatal ultrasonographic diagnosis, clinical and pathological studies, and new manifestations.

A diagnosis of the Neu-Laxova syndrome (NLS) was made by ultrasonography at 32 wks of gestation. Ultrasonographic examination showed intrauterine growth retardation (IUGR), Dandy-Walker anomaly, choroid plexus cysts, receding forehead and microcephaly, bilateral cataract without prominent eyes, scalp edema with no generalized edema, retrognathia, curved penis, and flexion deformities of limbs. The findings in this case are consistent with NLS; however, they did not fit any of Curry's [1982] groups. Massive swelling of hands and feet were among the main manifestations in classic NLS cases. In the case presented herein, edema was noted only in the scalp. This might shed further light on the question of variability vs. heterogeneity in the NLS. This case shows the existing possibility of an early diagnosis of NLS and adds Dandy-Walker anomaly and choroid plexus cysts as new findings to this syndrome.

Abnormalities, Multiple↗
PubMed1992

Doppler flow velocity waveforms in fetal surveillance of twins: a prospective longitudinal study.

In 37 consecutive twin pregnancies, monthly Doppler sonographic measurements were made of blood flow velocity waveforms of the internal carotid and umbilical artery of each fetus. A total of 197 Doppler studies were performed. Of the 74 infants, 23 were small for gestational age (SGA). Thirty-five of the SGA Doppler studies were abnormal, giving an overall sensitivity for predicting SGA fetus of 58% and a positive predictive value of 71%. These data are not as sensitive and specific as our earlier data; however, Doppler criteria preceded sonographic diagnosis of SGA by a mean interval of 3.7 weeks and demonstrated better sensitivity and specificity. A combination of these parameters improves sensitivity to 84%. We conclude that Doppler velocimetry complements real-time ultrasonography for the early diagnosis of abnormal growth in twin pregnancies.

Blood Flow Velocity↗
PubMed1991

[Fetal echocardiography].

Fetal echocardiography is an ultrasonic technique for the diagnosis of cardiac defects and fetal arrhythmias. During 1981-1990 we examined 1800 women referred for elective examinations from all over the country. Most, at high risk for fetal cardiac anomalies, were examined in the 22nd week of gestation. Others were examined whenever a fetal arrhythmia or a cardiac defect was suspected. In 251 fetuses (13.9%) pathological cardiac conditions were found, and structural heart defects in 51 (2.8%). When a cardiac defect with poor prognosis was diagnosed during the 2nd trimester, termination of pregnancy was suggested. In 35% of these cases termination of pregnancy was accepted. In 12% of the women examined spontaneous intra-uterine fetal death had occurred, while in 52% live babies were born, but half died within 6 months. In 215 fetuses (11.9%) a cardiac arrhythmia was found, which in 73% consisted of supraventricular premature beats. In 15.8% the fetus was endangered by the arrhythmia, mainly supraventricular tachycardia, atrial fibrillation or atrial flutter. Treatment was by drugs administered to the mother. In 1 case of complete A-V block echocardiographic follow-up demonstrated rapid deterioration of heart function. Delivery was induced and a pacemaker was implanted in the newborn.

Arrhythmias, Cardiac↗
PubMed1991

Delirium: phenomenologic and etiologic subtypes.

While all delirious patients have clouding of consciousness (alteration of attention) and cognitive dysfunction, the level of alertness of different patients may range from stuporous to hyperalert. We, therefore, developed an analog scale to rate the alertness of delirious patients, and a separate scale to rate the severity of their clouding of consciousness. Based on these scales, patients were categorized overall as relatively "activated" (relatively alert despite clouding of consciousness), or "somnolent" (relatively stuporous along with clouding of consciousness). Cognitive function was estimated using the Mini-Mental Status Exam. Separate ratings were made of hallucinations, delusions, illusions, and agitated behavior. Activated and somnolent patients had similar ages, overall severity of delirium, and Mini-Mental Status Exam scores. Activated patients, however, were more likely to have hallucinations, delusions, and illusions than somnolent patients, and were more likely to have agitated behavior. Patients with hepatic encephalopathy were more likely to have somnolent delirium, while patients with alcohol withdrawal appeared more likely to have activated delirium. These data indicate that phenomenologic subtypes of delirium can be defined on the basis of level of alertness. These subtypes are validated in part by their differing associations with symptoms unrelated to alertness. These subtypes may have different pathophysiology, and thus, potentially different treatments.

Aged↗
PubMed1990

Fetal blood flow velocity waveforms in pregnancies complicated by intrauterine growth retardation.

Fifty-three pregnancies suspected for a small-for-gestational age fetus (SGA) by ultrasonographic weight estimation (below the 10th percentile of Brenner nomograms) were studied using pulsed Doppler (Duplex) for recording fetal blood flow velocity waveforms from the umbilical artery and fetal internal carotid artery. The pulsatility index (PI) for each artery was calculated as an index of vascular resistance. The gestational age ranged from 29 to 40 weeks. In 42 cases an SGA newborn was delivered (according to Brenner tables corrected for maternal parity and fetal sex), 34 newborns were SGA according to Usher and McLean (2 SD below the mean). Fetal structural and/or chromosomal defects were found in four cases, all of which showed symmetric intrauterine growth retardation and normal PI values in the fetal internal carotid artery. After excluding the infants with congenital abnormalities and using nomograms constructed for our own population, the ratio between the PI of the umbilical artery and the internal carotid artery was found to be the best predictor of SGA (sensitivity 84.2%, specificity 90.9%, positive predictive value 97.0%, negative predictive value 62.5%). Using the more demanding criteria for SGA according to Usher and McLean, sensitivity improved to 100%, specificity was 80.0%, positive predictive value 87.9%, and negative predictive value 100%.

Blood Flow Velocity↗
PubMed1989

Ultrasound assessment of the bladder volume after anterior colporrhaphy.

In 40 gynecological patients 44 different determinations of the bladder volume were made using ultrasonic methods. The product of bladder depth, height, and width, as determined from transverse and sagittal scans, showed the best correlation with the bladder volume measured by urethral catheter (r = 0.981). For 73% of the measurements the error was under 20% when the true bladder volume was greater than 100 cm3. This method gives a reasonable assessment of the bladder residual volume. It is quick, safe, and repeatable and, therefore, useful in postoperative clinical practice.

Adult↗
PubMed1989

Maternal echocardiography in hypertensive pregnancies.

Echocardiographic hemodynamic and left ventricular parameters were determined in 14 normotensive and 18 hypertensive women during the last trimester of pregnancy. The hypertensive patients had significantly higher mean values of total peripheral resistance (p less than 0.001), maximum velocity of posterior wall motion (p less than 0.05), mean velocity of circumferential fiber shortening (p less than 0.01) and percent fiber shortening of left ventricular diameter (p less than 0.05). The mean values for heart rate, stroke volume, cardiac output, cardiac index, left ventricular posterior wall thickness and septal thickness did not differ significantly in both groups. These results reflect increased cardiac contractility related to elevated peripheral vascular resistance in subjects with pregnancy-induced hypertension.

Adult↗
PubMed1988

Decrease in pulsatile flow in the internal carotid artery in fetal hydrocephalus.

The effect of ventriculomegaly on pulsatile flow in the internal carotid arteries has been studied by Doppler ultrasound in four hydrocephalic fetuses. The pulsatility index showed progressive elevation proportional to the developing ventriculomegaly and thus may be a valuable index for the study of the mechanism of brain injury and for the determination of optimal timing of intervention.

Carotid Artery, Internal↗
PubMed1988

Fetal internal carotid artery flow velocity time waveforms in twin pregnancies.

The fetal internal carotid artery and umbilical artery flow velocity time waveforms were studied in 17 consecutive twin pregnancies. The pulsatility index was calculated for each fetus in each artery as an index of vascular resistance. All studies were done within 14 days before delivery. In 8 pregnancies both fetuses were of birthweight appropriate for gestational age; whereas, in 9 patients one or both of the infants were small for gestational age (SGA). From ultrasound criteria and Doppler studies of the umbilical and fetal internal carotid arteries, decreased fetal internal carotid artery pulsatility index (cut off value less than or equal to 1.2) was found to be the best predictor of SGA (sensitivity 83%, specificity 95%, positive predictive value 91%, negative predictive value 91%).

Birth Weight↗
PubMed1988

Fetal arrhythmia associated with sinus node dysfunction--a case report.

Real time and M-mode echocardiography were used for evaluation of fetal bradycardia. Sinus bradycardia was revealed without structural abnormalities. An abdominal wall derived fetal electrocardiogram and the failure of the sinus rate to increase in response to maternal exercise or I.V. atropine suggested sinus node dysfunction. Postnatal evaluation revealed sinus bradycardia with blunted response to I.V. atropine and an abnormal sinus node recovery time. A gradual increase in heart rate was demonstrated in the neonatal period, possibly due to decrease in vagal tone.

Adult↗
PubMed1987

Magnetic resonance imaging of gynecologic masses.

The pelvis of 21 women with various gynecological masses were imaged with magnetic resonance (MR) imagers at 2.0 and 0.5 T. Fifteen normal individuals were used for studying the normal appearance of the female genitalia using spin echo pulse sequences with various pulse repetition (TR) and spin echo (TE) time values. Images were compared with those of the ultrasonic images, intraoperative findings, and the histopathologic examinations. The masses included simple ovarian cyst, cystadenoma, serous cystadenocarcinoma, ovarian teratoma, dysgerminoma, and uterine myoma. MR imaging was useful in demonstrating the anatomy and pathology of the cases examined in this study. It detected the internal structure of some tumors which were sonographically homogeneous. The potential of MR in staging of malignancies was demonstrated.

Adolescent↗
PubMed1987

Familial combined sinus node and atrioventricular conduction dysfunctions.

Eighteen members of a family were investigated for cardiac conduction abnormalities following the discovery of a second-degree atrioventricular block in a fetus at 35 weeks of gestation. The conduction disturbance was diagnosed by ultrasonography. Seven of the family members were diagnosed as suffering from sinus node dysfunction and/or various degrees of atrioventricular block. Three of them were children aged 9 months to 6 years and all were asymptomatic. The symptomatic family members were two adults. One of them had a pacemaker inserted for a complete atrioventricular block and Adam-Stokes attacks while the other had had several fainting attacks. The clinical, electrocardiographic and ultrasonographic findings of the family members are presented. Previous reports in literature have documented the dominant transmission of familial sinus node dysfunctions or of familial cardiac conduction disturbances. The coexistence of both dysfunctions in the same family has not been emphasized in previous reports. A review of these previously reported families, as well as our patients, suggests the need of investigation and follow-up of the families in which one member of any age is diagnosed as suffering from an "idiopathic" disturbance of the cardiac conduction system.

Adult↗