Biomedical subjects
Publications and source records attributed to M E Furness.
The extreme distress which possible fetal abnormality induces in expectant parents makes it potentially dangerous to report artefacts seen on antenatal scans, even to dismiss them. A selection of spurious abnormalities is presented, for ultrasound trainees.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Although plain and contrast radiology have become a well established part of the perinatal and fetal necropsy, the role of ultrasound has been less comprehensively explored. We have found a variety of ultrasonographic approaches to be of value in diagnosis, quality control, and teaching. Ultrasound is of particular help where consent for formal necropsy has been declined.
Dorsal enteric cysts have been recognized in association with a wide variety of developmental anomalies of the back, the spine, the central nervous system, the mediastinum and the gut. These lesions can be lethal and they caused the deaths of three of the eight patients in this study: two from meningitis and one from erosion into the aorta. Two of these deaths might have been prevented if they had been fully investigated earlier and the life-threatening components of these complex lesions removed. In the most recent case, however, the lesion was detected antenatally, expediting postnatal investigation and surgery. Three of the five survivors have neurological sequelae attributable to their intraspinal pathology.
Two cases of fetal renal vein thrombosis, diagnosed via maternal ultrasound scan are presented. One was associated with severe placental dysfunction and demonstrated haematuria and renal failure which resolved on day 10. The other followed an antepartum haemorrhage and resolved before the baby was born. The ultrasound showed, as transient findings, unilateral renal enlargement, thrombus protruding into the inferior vena cava, and mild fetal ascites. We suggest that fetal renal vein thrombosis may be more common than previously suspected, and warrants close monitoring of fetal well-being. Delivery should be considered if there is other evidence of fetal compromise, if the amount of peritoneal fluid suggests substantial haemorrhage, or if there is propagating thrombus in the inferior vena cava.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Unequivocal narrowing of the anterior cranium, with an apparent constriction in the approximate region of the coronal sutures, in the absence of oligohydramnios is presented as a warning sign of spina bifida in the second trimester fetus. It makes detailed assessment of the spine, cerebellum, and other ultrasonographic features imperative and may justify amniocentesis.
Explore the source record for details and available documents.
The echographic appearances seen in 47 children with dilatation of the pelvi-calyceal system but not ureter, in whom the diagnosis of pelvi-ureteric junction obstruction was strong enough to lead to surgical correction, were classed into two categories. Those children in whom the antero-posterior diameter of the pelvi-calyceal system exceeded 10 mm were classed as being 'suspicious' (of pelvi-ureteric junction obstruction). When dilatation of the pelvis was accompanied by dilatation of the calyces this appearance was classed as 'definite'. There was a high false positive rate but a very low false negative rate. A simple water load stress test performed in 17 children helped to decrease the false positives from 16 to 10 but the high false positive rate in the 'definite' group stresses the need for subsequent functional studies. Ultrasound is concluded to be a worthwhile screening test to select children requiring functional studies.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: To determine the influence of antenatal ultrasound on the management of exomphalos. METHODS: Retrospective case note review of 23 fetuses and infants referred to our institution with either a pre- or postnatal diagnosis of exomphalos over a 7-year period. RESULTS: There were 21 cases of exomphalos of which 18 were correctly diagnosed on antenatal ultrasound by 18 weeks' gestation. There were 2 false-positives and 3 false-negatives, including 1 case of amniotic band syndrome with an abdominal wall defect and 1 morphologically normal fetus. Associated anomalies were correctly identified in 12 but incorrectly reported in 8. Maternal serum alpha-fetoprotein levels were abnormal in 61% of cases of abdominal wall defects in this series. Amniocentesis was performed in 12 and cordocentesis in 1. There were 13 terminations, including 2 trisomy 18s and 1 trisomy 13. Two fetal deaths followed amniocentesis. Of the 10 live births, 9 had their exomphalos repaired with a 1-year survival rate of 89%. Prenatal diagnosis did not appear to influence outcome. CONCLUSIONS: Antenatal ultrasound diagnosed 86% of cases of exomphalos and correctly reported 67% of associated anomalies. Amniocentesis may have led to the death of 1 morphologically normal fetus.
Prenatal ultrasound diagnosis of clubfoot is increasing. Of 103 patients with clubfoot diagnosed at birth, 26 (25.2%) positive prenatal scans were identified with the earliest diagnosis being made at 15 weeks. A questionnaire assessment indicated that 17 (65.4%) deemed that the explanation of the baby's condition was clear. With an increasing incidence of antenatal detection, it is suggested that parents require adequate antenatal counseling by a specialist in the area of clubfoot to improve the understanding of the natural history and treatment of this condition.