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Biomedical subjects

J Wisser

Publications and source records attributed to J Wisser.

At least 19 recordsLinked to original sources
PubMed2005

Outcome of fetal renal pelvic dilatation diagnosed during the third trimester.

OBJECTIVES: The aim of this study was to evaluate renal function and the need for postnatal treatment--antibiotic therapy and/or surgery--in relation to the grade of fetal renal pelvic dilatation (RPD) found on third-trimester ultrasound examination. METHODS: The retrospective study included 78 children, born between 1995 and 2000, with 115 dilated fetal renal pelvic units. The children were allocated to three groups based on pelvic anteroposterior diameter (APD) detected on third-trimester ultrasound: APDs of 7-9.9 mm, 10-14.9 mm and > or = 15 mm were classified as mild dilatation, moderate hydronephrosis and severe hydronephrosis, respectively. Renal function was assessed by scintigraphy. RESULTS: None of the 20 children with mild dilatation experienced a urinary tract infection (UTI) or underwent surgery; two had associated renal or urinary tract abnormalities. In contrast, five out of 22 (23%) children with moderate hydronephrosis and 23 out of 36 (64%) with severe hydronephrosis had either a UTI or required surgery (P < 0.001); associated abnormalities were also more common (6 out of 22 and 15 out of 36, respectively). There was no significant correlation between the grade of antenatal RPD and postnatal ipsilateral renal function. CONCLUSIONS: The need for postnatal treatment increased significantly with the grade of antenatal RPD. Children with antenatal mild dilatation were discharged early from follow-up whereas those with moderate and severe fetal hydronephrosis needed close follow-up by a multidisciplinary team.

Anti-Bacterial Agents↗
PubMed2002

Diagnosis of skeletal dysplasia by multidisciplinary assessment: a report of two cases of thanatophoric dysplasia.

Skeletal dysplasias, a heterogeneous group of bone growth disorders, can be detected by routine prenatal ultrasound examination. As it is difficult to make a specific diagnosis, prediction of prognosis is of importance for obstetric management. In order to specify diagnosis, radiological, pathological and molecular genetic examination are often required. Our report describes two cases of thanatophoric dysplasia with different fetal sonographic findings. The classical classification of type I and II seems to be ambiguous as, in both cases, the same mutation in the fibroblast growth factor receptor 3 gene was found. The importance of comprehensive multidisciplinary assessment is emphasized.

Adult↗
PubMed2002

Marked splenomegaly in fetal cytomegalovirus infection: detection supported by three-dimensional power Doppler ultrasound.

An enlarged fetal spleen can be associated with fetal infection, anemia and different syndromes but its prenatal diagnosis is rare. We report on a diagnosis of splenomegaly at 32 weeks' gestation in a fetus which was found to be affected by cytomegalovirus infection. An enlarged spleen was suspected when the stomach was found to be displaced anteriorly and medially and the diagnosis was supported on visualization of the splenic vessels by color and three-dimensional power Doppler ultrasound. The patient had been referred because of fetal growth restriction and intracerebral anomalies and the additional finding of splenomegaly was highly suspicious for cytomegalovirus infection. This was confirmed by positive maternal serology and by neonatal virus excretion in urine. Retrospectively, examination of stored blood samples from 9 and 23 weeks' gestation revealed an early cytomegalovirus infection. Antenatal and neonatal magnetic resonance imaging examinations showed microcephaly, lissencephaly and the presence of microcalcifications. At the age of 9 months, the child suffers from severe neurological impairment and blindness due to severe optical atrophy. This case emphasizes that color Doppler and three-dimensional power Doppler ultrasound can facilitate the antenatal diagnosis of splenomegaly and can help to delineate the spleen from the similar-looking neighboring liver.

Adult↗
PubMed2002

Prenatal ultrasound findings in a fetus with congenital contractural arachnodactyly.

Congenital contractural arachnodactyly (CCA) or Beals-Hecht syndrome is an autosomal dominant disorder caused by mutations in the fibrillin-2 (FBN2) gene. The principal features of CCA are a marfanoid habitus, multiple congenital contractures, camptodactyly, arachnodactyly, kyphoscoliosis, muscular hypoplasia, and external ear malformations. Our case is the first that shows typical sonographic signs in a fetus at 25 weeks' gestation with molecular genetically verified CCA in a large family with many members affected over four generations. This demonstrates that CCA can be detected prenatally by non-invasive ultrasonography. The importance of confirmation of CCA by means of DNA sequence analysis of the FBN2 gene is stressed.

Adult↗
PubMed2001

Reference values of fetal peak systolic blood flow velocity in the middle cerebral artery at 19-40 weeks of gestation.

OBJECTIVES: The objectives of this prospective study were (i) to establish new reference values of peak systolic blood flow velocity measurement in the fetal middle cerebral artery (MCA-PSV) following validated methodological guidelines and (ii) to develop a method to calculate Z-scores of MCA-PSV. PATIENTS AND METHODS: Cross-sectional data were obtained from 331 pregnant women between 19 and 40 weeks' gestation. Reference ranges for MCA-PSV were constructed and for each measurement linear regression models were fitted separately to the mean and standard deviations (SD) as a function of gestational age. An application to calculate Z-scores was developed. A comparison was made between the reference ranges produced in our study and those of a previous one. RESULTS: A new chart, table of centiles and regression equations of MCA-PSV are presented. Comparison of our reference ranges with ones produced in a previous study showed similar 5th centile values. However, the values for the 50th and 95th centiles between 19 and 28 gestational weeks were lower in our study. CONCLUSIONS: We have constructed reference ranges for MCA-PSV which, because they are derived from a larger number of examinations in the 15-20-week period and because the methodological flaws of the previously published study have been eliminated, we consider to be more accurate and therefore more useful for clinical practice.

Blood Flow Velocity↗
PubMed2001

[Methods and consequences of pre-natal diagnostics].

Prenatal medicine is a young subdiscipline of modern obstetrics. It applies diagnostic methods like amniocentesis, chorionic villus sampling and foetal blood sampling. The latter is not only a diagnostic procedure but opens access to the foetal circulation and therefore to foetal therapy. Aim of prenatal diagnostic procedures is the most exact diagnosis of the foetal condition as basis for rational obstetrical decisions. If a foetal disease is diagnosed, decisions are in principal similar to the postnatal situation, but therapeutic options are reduced. Decision making in prenatal medicine always has to take maternal and foetal interests into account. We have to consider that not the methods but the intention and actions of the persons involved may cause an ethical dilemma. It must be our aim to use the methods of prenatal medicine with the utmost responsibility.

Amniocentesis↗
PubMed2001

Chronic tubulointerstitial nephropathy in six okapis (Okapia johnstoni).

Renal tubular atrophy with conical and medullary interstitial fibrosis with severe thickening of the basement membranes of atrophic tubules was found in six okapis (Okapia johnstoni). Focal glomerular atrophy, probably secondary to ischemic collapse of the glomerular capillary tuft, was also observed. Although the etiologies and pathogeneses of these nephropathies are unclear, primary damage of the tubular epithelium appears to be the most likely cause, and toxicity from ingested plant material, possibly willow (Salix sp.), is a possibility.

Animals↗
PubMed2001

Volume sonography of the pelvic floor in nulliparous women and after elective cesarean section.

OBJECTIVE: To describe the sonographic appearance of the pelvic floor which has not been stressed by forces of labor or vaginal delivery in pregnant women and after childbirth. SUBJECTS AND METHODS: In a prospective observational study 14 nulliparous women during first trimester pregnancy and 26 primiparous women after elective cesarean were examined within the first week postpartum. The integrity of the internal anal sphincter expressed as the ratio between the anterior and the posterior internal anal sphincter muscle thickness (a/p-ratio), asymmetry of the levator ani muscle and the paraurethral fixation of the lateral vaginal edges at the arcus tendineus were assessed using volume sonography. RESULTS: The a/p-ratio in nulliparous women was significantly higher (p<0.01) than after elective cesarean section. Asymmetry of the levator ani muscle did not differ between both groups but was more frequently in the nulliparous patients with an odds-ratio of 1.16 (CI 0.74-1.82). In both groups of women the paraurethral fixation of the lateral vaginal edges were above the suburethral level of the vagina. CONCLUSIONS: This study gives sonographic features of the pelvic floor in nulliparous women and in primigravidae after elective cesarean section. Data from the post-cesarean group can serve as reference values for further studies evaluating pelvic floor damage after various modi of vaginal delivery.

Adult↗
PubMed2000

Prenatal diagnosis of mosaicism for a del(22)(q13).

A case of prenatally detected mosaicism for a del(22)(q13) is reported. CVS was performed because of abnormal fetal ultrasound findings: cystic 'tumour' in the fetal neck and the upper thoracic aperture. Karyotypes from chorionic villi were suspicious of an aberration concerning the long arm of one chromosome 22. FISH analysis demonstrated mosaicism for a distal 22q deletion in fetal fibroblasts. The deletion was postnatally confirmed by FISH with a chromosome-specific 22q probe. The 'tumour' on autopsy turned out to be cystic thymic tissue. Apart from this, no other obvious fetal anomalies were found.

Adult↗
PubMed2000

Dandy-walker malformation: prenatal diagnosis and outcome.

Prenatal ultrasound identified Dandy-Walker malformation (DWM) in ten singleton pregnancies with concurrent central nervous system (CNS) anomalies and extra-CNS anomalies in eight cases. DWM was confirmed by postnatal magnetic resonance imaging (MRI) or pathological examination in nine cases. Karyotypes were normal in the seven infants tested. Postnatal neurological and developmental testing in the five survivors showed a spectrum of clinical outcome from minor defects to severe handicap. Postnatal investigation also disclosed additional CNS and extra-CNS findings not detected on ultrasound, as did autopsy in the other five infants. However, ultrasound diagnosis of DWM is accurate and is an indication for exhaustive screening for concurrent anomalies both within and outside the CNS and in chromosome structure and number, as the prognosis is heavily dependent on associated malformations and karyotype.

Adult↗
PubMed2000

Ultrafast MR imaging of the fetus.

OBJECTIVE: We examined the capability of ultrafast single-shot fast spin-echo imaging to assess different fetal organ systems compared with prenatal sonography, using autopsy or postpartum imaging as a standard of reference. SUBJECTS AND METHODS: Thirty women with complicated pregnancies (mean age of gestation, 190 +/- 54 days) underwent T2-weighted ultrafast MR imaging. MR images were analyzed with regard to diagnostic confidence in assessing abnormalities of fetal organ systems, and data were correlated with postpartum findings or necropsy. Results were compared with those of prenatal sonography. RESULTS: Using receiver operating characteristic curve analysis, diagnostic confidence of MR imaging was best for assessing the brain (area under the curve [Az] = 0.96) and spinal canal (Az = 1.0), uteroplacental unit (Az = 0.93), and lungs (Az = 0.91). Results for the heart (Az = 0.63) and extremities (Az = 0.77) were significantly lower than that of other organs (p < 0.001). Diagnostic accuracy increased with gestational age. No statistically significant difference between sonography and MR imaging was found for the detection of abnormality in any organ system. In three fetuses, MR imaging was superior to sonography in characterizing cerebral abnormalities. MR imaging was inferior to sonography in characterizing abnormalities of the heart and extremities. CONCLUSION: Our results indicate that ultrafast MR imaging can be used for in vivo fetal imaging, especially in assessing cerebral abnormalities. However, MR imaging should be restricted to situations in which sonographic findings are ambiguous or impaired.

Congenital Abnormalities↗
PubMed1999

Use of 3D ultrasound as a new approach to assess obstetrical trauma to the pelvic floor.

OBJECTIVE: To determine whether 3D ultrasound examination of pelvic floor anatomy after vaginal delivery allows detection of childbirth trauma. STUDY DESIGN: Pelvic floor anatomy was examined in 16 women during the puerperium with a 3D transrectal ultrasound probe. Images were acquired via the vaginal route for the assessment of anal morphology and the transrectal route to determine paravaginal fixation. Images of the anterior pelvic floor were calculated from the information stored in the volume block. Paravaginal defect is defined as a descent of the lateral vaginal wall below the suburethral vagina, whereas sphincter defects are characterised as thinning, or as gap formation of the anterior part of the internal anal sphincter. RESULTS: This new approach allowed the examination of a horizontal plane through the urethra and the periurethral tissue which is inaccessible with 2D ultrasound techniques. Morphology of the normal and traumatised anal sphincter could be demonstrated using reference planes perpendicular to the anal canal. CONCLUSIONS: Whereas in the past, defects of the vaginal attachment to the pelvic side wall could not be examined sonographically, 3D ultrasound can now be used to examine pelvic floor anatomy and to detect changes associated with trauma to the pelvic floor following vaginal delivery.

Fecal Incontinence↗
PubMed1999

Fetal ultrasound biometry: 1. Head reference values.

OBJECTIVE: To create reliable reference ranges and calculate Z scores for fetal head ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy. DESIGN: A prospective, cross-sectional study. SETTING: Obstetric clinics (outpatient and delivery units) at the University Hospital of Zurich. SAMPLE: The study data were obtained from 6557 pregnant women. METHODS: Only the first ultrasound examination between 12 and 42 weeks of each fetus with exactly established gestational age was used for analysis. No exclusions were made on the grounds of small-for-date birthweight, prematurity or other events several weeks after the examination. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each parameter. RESULTS: A total of 6217 fetal head biparietal diameters and 5510 occipito-frontal diameters were measured. Both head circumference and cephalic index were derived in 5462 cases where both biparietal diameter and occipito-frontal diameter could be measured on the same fetus. The centile charts, tables and regression formulae for biparietal and occipito-frontal diameters, head circumference and cephalic index are presented. An application to calculate Z scores was developed using Excel (Microsoft Corporation, USA) and macros are presented in detail in the Figure 8 footnote. The comparison of our charts with those of the two most recent studies revealed almost no differences in biparietal diameter centiles. In one publication, occipito-frontal diameter charts, and in another, head circumference charts were different from the current study. CONCLUSIONS: We have presented centile charts, tables and regression formulae for fetal head ultrasound biometry derived from a large and minimally selected sample size in a carefully designed cross-sectional study. Complete tables and regression formulae to calculate reference ranges and Z scores are presented for use in computer-aided evaluation of fetal ultrasound biometry.

Adult↗
PubMed1999

Fetal ultrasound biometry: 2. Abdomen and femur length reference values.

OBJECTIVE: To create reliable reference ranges and calculate Z scores for fetal abdomen and femur ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy. DESIGN: A prospective, cross-sectional study. SETTING: Obstetric clinics (outpatient and delivery units) at the University Hospital of Zurich. SAMPLE: The study data were obtained from 6557 pregnant women. METHODS: Only the first ultrasound examination between 12 and 42 weeks of each fetus with certainly established gestational age was used for analysis. No exclusions were made on the grounds of small-for-date birthweight, prematurity or other events several weeks after the examination. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each parameter. RESULTS: A total of 5807 mean abdominal diameters and abdominal circumferences were derived from fetal transverse and anterio-posterior fetal abdominal diameter measurements. Fetal femur length was measured in 5860 instances. The charts, tables and regression formulae of the biometrical measurements are presented. A comparison of our charts with others showed no significant difference. Only Merz's centiles for abdominal biometry were lower and for femur length higher than ours. An application to calculate Z scores was developed using Excel (Microsoft Corporation, USA); the macros are presented in detail in the Figure 6 footnote. CONCLUSIONS: We have presented centile charts, tables and formulae for fetal abdominal diameter and circumference and femur length derived from a large and minimally selected sample size in a carefully designed cross-sectional study. Complete tables and regression formulae to calculate reference ranges and Z scores are presented to use in computer-aided evaluation of fetal ultrasound biometry.

Abdomen↗