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Biomedical subjects

R A Filly

Publications and source records attributed to R A Filly.

At least 181 records · Page 10Linked to original sources
PubMed1985

Nonpalpable breast lesion localization: limited efficacy of sonography.

We attempted to use hand-held, high-resolution breast sonography to localize for biopsy 11 solid, nonpalpable lesions detected by mammography. Using sonography, we identified and localized only one of four lesions presenting as poorly defined masses and only one of seven lesions presenting as clusters of tiny calcifications. This 18% rate of success is too low to justify the use of sonography for all patients undergoing needle localization. Mammography remains the procedure of choice for localizing solid, nonpalpable breast masses and clustered calcifications.

Adult↗
PubMed1985

Curvature of the fetal femur: a normal sonographic finding.

Perception of the fetal femur in the far field as curved is common in sonographic studies. The mild concavity of the medial aspect of the femoral diaphysis accounts for this apparent curvature, which should not be mistaken for fetal abnormality.

Diagnosis, Differential↗
PubMed1985

Fetal urethral obstruction: US evaluation.

To further elucidate antenatal sonographic features of fetal urethral obstruction and attempt to determine which features might predict subsequent outcome, 40 in utero cases were reviewed. All fetuses had dilated urinary bladders and/or thickened bladder walls; in 47.5% of fetuses a dilated posterior urethra was seen. Only 15 fetuses (37.5%) survived the neonatal period. Survivors tended to present later in gestation than nonsurvivors. Poor prognostic indicators included oligohydramnios (20 of 21 subsequently died), absence of caliectasis (20 of 24 died), a large amount of urine ascites (five of six died), and dystrophic bladder wall or peritoneal calcification (five of five subsequently died). Conversely, 14 of 19 (74%) fetuses without definite oligohydramnios survived the neonatal period.

Female↗
PubMed1985

Relationship of pleural effusions to pulmonary hemodynamics in patients with congestive heart failure.

On the basis of both experimental and clinical studies it is not clear whether left, right, or biventricular heart failure are necessary for the formation of pleural effusions. In order to study the relationship of pulmonary hemodynamics and the presence of pleural effusions in patients with congestive heart failure, we prospectively evaluated 37 patients admitted to the coronary care unit with congestive heart failure secondary to ischemic heart disease or a cardiomyopathy. We used real-time ultrasonography to document the presence of pleural effusions. We found that 19 of the 37 patients with heart failure had pleural effusions. Mean pulmonary artery wedge pressure was 24.1 +/- 1.3 mmHg (SE) in the 19 patients with pleural effusions versus 17.2 +/- 1.5 mmHg (SE) (p less than 0.001) in the 18 patients without pleural effusions. Pulmonary artery pressure was also higher in patients with pleural effusions with a mean value of 38.0 +/- 1.5 mmHg (SE) versus 30.7 +/- 2.1 mmHg (SE) (p less than 0.05) in the patients without pleural effusions. In contrast, mean right atrial pressure was not different between patients with pleural effusions (12.6 +/- 1.5 mmHg) (SE) versus those without pleural effusions (9.8 +/- 1.0 mmHg) (SE) (p = NS). In addition, there was no difference in cardiac output, pulmonary vascular resistance, or total protein concentrations between patients with and without pleural effusions. We conclude that, in patients with congestive heart failure, an elevated left atrial pressure is closely correlated with the presence of pleural effusions, while concurrent elevation of right atrial pressure is not associated with the presence of pleural effusions.

Blood Pressure↗
PubMed1985

Pelvimetry by magnetic resonance imaging.

Sagittal and transverse multisection magnetic resonance imaging (MRI) in 10 patients was used to obtain dimensions of the maternal pelvis, determine fetal position, and examine maternal and fetal soft tissues. Dimensions were measured with less than 1% instrument error, and bony landmarks were readily identified. MR pelvimetry is an accurate technique for obtaining traditional pelvimetric measurements without exposure to ionizing radiation. These techniques can be further used to investigate soft-tissue dystocia and obstructed labor.

Dystocia↗
PubMed1985

Early gestation: correlation of HCG levels and sonographic identification.

Previous reports have indicated that an intrauterine gestational sac is not usually detected when the maternal serum human chorionic gonadotropin (HCG) is less than 6000 mIU/ml. In order to evaluate this observation, maternal serum HCG concentrations were correlated with sonographic uterine findings in 49 patients with normal early intrauterine pregnancies. Of 37 patients in whom a gestational sac was seen, simultaneous HCG levels were 1800 mIU/ml or more in 36 cases and 357 mlU/ml in one case. In 12 cases in which a gestational sac was not detected, the serum HCG levels were 1400 mIU/ml or less. Thirteen patients had HCG levels of less than 6000 mlU/ml. A linear relation was found between gestational sac size and the exponential rise of HCG levels in early pregnancy (p less than 0.001). Of the 13 patients in whom HCG levels were less than 6000 mIU/ml, the gestational sac measured 10 mm or less in each case. Currently, a gestational sac is always seen when the HCG level is greater than 1800 mIU/ml. Comparison of serum HCG levels with sonographic detection of the gestational sac seems to be a useful method of evaluating early pregnancy.

Amnion↗
PubMed1985

Magnetic resonance imaging of fetal anomalies in utero: early experience.

Five cases of fetal dysmorphology were examined with high-resolution sonography and magnetic resonance imaging (MRI). Postpartum confirmation was available in all cases. The high contrast resolution of MRI resulted in clear depiction of the abnormalities, particularly dilated fluid-filled structures, whereas the real-time capability and spatial resolution of sonography permitted better appreciation of anatomic detail. While sonography will remain the primary imaging method for pregnancy, MRI appears to be a promising complementary technique in difficult cases.

Female↗
PubMed1985

Minimal fetal renal pyelectasis.

To assess the possible relationship between the degree of maternal hydration and the sonographic identification of minimal fetal renal pyelectasis, a prospective study was performed in which fetuses demonstrating mild dilation of the renal pelvis (maximum diameter ranging from 3 to 11 mm) were reexamined after the mothers refrained from oral intake for 12 hours. Complete or almost complete resolution of the pyelectasis occurred in only four of 17 kidneys (23.5 per cent) while the remaining fetal kidneys demonstrated little or no change in the degree of pyelectasis following maternal dehydration. This observation, as well as previous experimental research, suggests that the state of maternal oral hydration is not a major cause of minimal fetal pyelectasis. Additionally, the observation of fetal pyelectasis measuring at least 3 mm in greatest dimension is common, occurring in approximately 18 per cent of fetuses older than 24 menstrual weeks.

Dehydration↗
PubMed1985

Sonographic evaluation of ectopic pregnancy.

To assess sonographic findings in the evaluation for ectopic pregnancy, all women referred over a two-year period were prospectively evaluated. The incidence of intrauterine as well as adnexal findings was assessed in an attempt to optimize sonographic evaluation. Visualization of a double decidual sac sign (DDSS) within the uterus provided an accurate means of confirming an intrauterine pregnancy (IUP) prior to embryo visualization. Forty-two of 130 women with IUP were diagnosable only by the DDSS. As a screening test for ectopic pregnancy, sonographic documentation of an IUP provided the only convincing evidence for the absence of an ectopic gestation. Any woman clinically at risk for ectopic pregnancy whose sonogram did not confirm the presence of an intrauterine pregnancy was at relatively high risk (43 per cent) for having an ectopic gestation. Characterization of adnexal findings increased the level of risk for ectopic pregnancy in these women to 70-100 per cent. However, 20 per cent of women with a surgically confirmed ectopic pregnancy had normal adnexal findings.

Female↗
PubMed1985

Umbilical vein thrombosis: sonographic detection in utero.

Umbilical vein thrombosis is associated with a high perinatal mortality and is seen most often with compression, torsion, stricture, or hematoma of the umbilical cord. Three cases of umbilical vein thrombosis detected on obstetrical ultrasound scans performed for suspected fetal demise are presented.

Adult↗
PubMed1985

Sonography, a complementary examination to alpha-fetoprotein testing for fetal neural tube defects.

Neural tube defects (NTDs) are among the most common congenital anomalies in the United States, with an estimated prevalence of 16 per 10,000 births. The measurement of amniotic fluid alpha-fetoprotein (AF-AFP) concentration has been used to detect NTDs since the early 1970s. When the AF-AFP concentration is elevated, ultrasonography is commonly used to confirm the presence of a NTD. In this study, patient charts, amniocentesis records, and ultrasound reports from a three-year period were reviewed. The 97 fetuses identified as being at high risk for NTDs were divided into four groups: those with high AF-AFP concentrations (Groups 1 and 2, with from 3 to 5 standard deviations (SD) above the mean and with more than 5 SD above the mean, respectively): those referred from other institutions because of suspicious sonographic results (Group 3); and those at risk because of a previous sibling with a NTD (Group 4). Ultrasonography was 100 per cent sensitive and 100 per cent specific in diagnosing NTDs. Thus, in pregnancies with an elevated AF-AFP concentration, ultrasonography can reliably identify normal fetuses as well as differentiate between those with NTDs and those with other congenital anomalies. Also, since AF-AFP concentrations decline after 20 weeks' gestation, ultrasonography may be a better test than a repeat amniocentesis in equivocal cases of AF-AFP elevation.

Adult↗
PubMed1985

Placental thickness.

The sonograms of 200 randomly selected singleton pregnancies were reviewed. Placental thickness was measured and correlated with menstrual age. The placenta was demonstrated to increase in thickness with advancing menstrual age. At no stage of pregnancy was the normal placenta greater than 4 cm in thickness. Potential pitfalls in measuring placental thickness are addressed, as well as potential causes of aberrations in placental thickness.

Anthropometry↗
PubMed1984

Investigation of nonimmune hydrops fetalis.

Fifty pregnancies complicated by fetal ascites and generalized edema are reviewed and their prenatal findings, obstetric management, and fetal outcome are discussed. From the myriad of maternal, fetal, and placental problems which are known to cause nonimmune hydrops fetalis, many different causes of the disorder could be identified in 84% of all patients studied by extensive prenatal and postnatal workup. Therefore, in only 16% of the cases was the nonimmune hydrops fetalis labeled "idiopathic." The most common demonstrable causes of the disorder in this series were cardiac anomalies, followed by chromosomal disorders, congenital malformations, alpha-thalassemia, and the twin-twin transfusion syndrome. A systematic approach to the prenatal diagnostic workup of nonimmune hydrops fetalis is outlined, starting with the least invasive techniques (ultrasound, echocardiography, complete blood count, Kleihauer-Betke analysis, TORCH testing, and so forth) followed by more invasive techniques (amniocentesis and fetoscopy). Although the detection and prognostic evaluation of nonimmune hydrops fetalis are greatly improved by applying these techniques, the overall prognosis for most fetuses with nonimmune hydrops fetalis is still very poor, and only a few conditions causing the disorder, such as prenatally detected cardiac arrhythmias or selected cases of urinary tract obstruction, are amenable to treatment in utero.

Ascites↗
PubMed1984

Ultrasonographic determination of qualitative amniotic fluid volume in intrauterine growth retardation: reassessment of the 1 cm rule.

To assess the relative diagnostic efficacy of the "1 cm sign" for qualitative amniotic fluid volume determination in the prenatal evaluation of intrauterine growth retardation, 125 pregnancies resulting in small-for-gestational age infants were studied in a retrospective fashion. Qualitative amniotic fluid volume was designated as normal if at least one pocket of amniotic fluid measuring 1 cm in broadest diameter was identified. Of the 125 pregnancies with delivery of small-for-gestational age infants, only five would have been correctly predicted prenatally with qualitative amniotic fluid volume used as the sole criterion for intrauterine growth retardation. When this criterion was applied to a defined subset of 52 of these patients with last scans 0 to 15 days prior to delivery, only four cases would have been accurately predicted as having intrauterine growth retardation.

Amniotic Fluid↗
PubMed1984

Management of the fetus with an abdominal wall defect.

Eleven fetuses with omphalocele and two with gastroschisis were diagnosed by prenatal ultrasonographic examination. Intact omphalocele was accurately distinguished from gastroschisis by detection of a membranous sac covering the herniated viscera, by liver protruding from the abdomen, and by the frequent association of major structural anomalies. Gastroschisis was characterized by the absence of these findings and the presence of bowel loops floating freely in the amniotic fluid. Nine of eleven fetuses with omphaloceles had other major malformations and did not survive. Two small omphaloceles and two gastroschises were correctly diagnosed as isolated defects, free from associated anomalies. All four underwent maternal transport and were successfully managed with good outcome. Prenatal ultrasonography allows rational decisions about perinatal management by distinguishing between omphalocele and gastroschisis and by screening for associated anatomic defects. Karyotype analysis should be a part of the prenatal workup. Most isolated defects can be followed and delivered normally near term. Accurate prenatal diagnosis allows maternal transport and in a few cases may alter the timing or mode of delivery.

Adolescent↗
PubMed1984

Management of ventriculomegaly in the fetus.

We studied 24 human fetuses with cerebral ventriculomegaly by serial obstetric ultrasound to define the natural history of fetal ventricular enlargement and to develop a management strategy. In 10 fetuses, ventriculomegaly was associated with other severe anomalies; nine of these families chose to terminate the pregnancy. In three other severely affected fetuses in whom ventriculomegaly was detected serendipitously late in gestation, routine obstetrical management was performed; none survived. Eleven fetuses had ventriculomegaly without associated severe anomalies. Ventriculomegaly remained stable or of moderate severity throughout gestation in nine, resolved gradually in one, and progressed in one who did not have signs of increased intracranial pressure at birth. All of these fetuses were viable; three patients required shunting in the neonatal period, and two others by 5 months of age. Although obstetric ultrasound usually can detect anomalies associated with fetal ventriculomegaly, three fetuses with isolated ventriculomegaly had midline brain malformations that could not be distinguished in utero from hydrocephalus, even in retrospect. Prenatal diagnosis improves perinatal management by allowing counseling, and selective pregnancy termination, or selection of the timing, mode, and place of delivery to optimize outcome. Most fetuses with ventriculomegaly do not require intervention before birth.

Abnormalities, Multiple↗