Biomedical subjects
Publications and source records attributed to J M Pearce.
Prenatal diagnosis of cystic hygromata by means of ultrasound examination is possible and highly accurate. Although this is usually associated with Turner's syndrome especially if there is co-existent hydrops fetalis we report three cases in which cystic hygromata were associated with trisomies; two cases of trisomy 21 and one of trisomy 18.
The prenatal diagnosis by ultrasound examination of Joubert's syndrome of familial agenesis of the cerebellar vermis is described allowing termination of pregnancy at 26 weeks gestation. The diagnosis was made by a comparison of the prenatal ultrasound examination with computerized axial tomography obtained from the siblings with the same condition.
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A brief discussion of the normal anatomy and physiology relevant to the understanding of blood flow is presented. After a review of previous attempts to measure blood flow in the utero-placental and feto-placental circulation, a description is given of the methods of obtaining Doppler signals from both maternal and fetal vessels. Some of the problems are presented. Flow velocity waveform (FVW) analysis is then presented in normal and in complicated pregnancies. FVW in pregnancies complicated by proteinuric hypertension have arcuate FVWs that demonstrate increased pulsatility and decreased velocities in diastole. These changes are also observed in most pregnancies complicated by intrauterine growth retardation and precede changes in the fetal circulation by several weeks. Impaired fetal circulation is demonstrated by low or decreased diastolic velocities in both the descending thoracic aorta and the umbilical artery. An attempt is made to give a pathophysiological understanding for these changes.
The Quebec Task Force (QTF) on Whiplash Associated Disorders (WAD)--1995--sent a clear message that we need to re-evaluate the basis for our treatment strategies, and in particular place more emphasis on research to better define these strategies. Judging by many of the clinical strategies currently in use, the Task Force recommendations seem to have been largely ignored three years later. A further compelling reason to re-evaluate our current practices at this time is the finding of much more rapid recovery rates in some cultures, even with little or no therapy. This commentary is a frank consideration of the therapeutic community's responsibility to not only help solve the dilemma of whiplash, but also avoid contributing to the problem. We thus explore a new biopsychosocial model of whiplash, considering the effects of symptom expectation, amplification, and attribution in chronic pain reporting. Based on that model we propose a treatment strategy, and conclude that such strategies provide the only viable approach to this medicolegal and social dilemma.
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