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Biomedical subjects

R A Filly

Publications and source records attributed to R A Filly.

At least 235 records · Page 13Linked to original sources
PubMed1982

Management of the fetus with congenital hydronephrosis.

Twenty-six fetuses with dilated urinary tracts were studied with serial sonograms. Eight fetuses with unilateral hydronephrosis were followed without intervention; all are well after postnatal surgical correction. Three cases of bilateral hydronephrosis resolved spontaneously before birth. Eight fetuses with bilateral hydronephrosis had evidence of poor function: Three were not treated and died shortly after birth with small lungs and dysplastic kidneys; three others had diagnostic intervention that demonstrated irreversible disease and allowed termination of the pregnancy; two had obstruction successfully corrected in utero, but renal damage proved irreversible and precluded survival at birth. Seven fetuses with bilateral hydronephrosis and equivocal function underwent early decompression. Four were delivered early and corrected ex utero; 1 has renal failure and the other 3 are well. Three had obstruction relieved in utero by a catheter shunt placed percutaneously; 1 had multiple anomalies and died; the other 2 are well. Serial sonographic observation improves perinatal management of the fetus with a dilated urinary tract. The need for diagnostic or therapeutic intervention depends on the type and severity of obstruction and the time in gestation when it is discovered. Most fetuses do not require treatment before birth; a few may benefit from early decompression in or ex utero.

Drainage↗
PubMed1982

Displaced retroperitoneal fat: sonographic guide to right upper quadrant mass localization.

While it is often easy to detect masses in the right upper quadrant that originate from the liver, adrenal gland, or kidney, it may be difficult to determine the anatomic origin of large masses in the posterior aspect of the right upper quadrant. In this paper it is reported that the reflection produced by right upper quadrant retroperitoneal fat is displaced in a characteristic manner by masses originating in this area. This greatly assists in the localization of these masses. Hepatic and subhepatic masses posteriorly displace this echo, while renal and adrenal lesions anteriorly displace it.

Abdominal Neoplasms↗
PubMed1982

The double sac sign of early intrauterine pregnancy: use in exclusion of ectopic pregnancy.

Pelvic sonograms from 61 consecutive patients with suspected ectopic pregnancy and an additional 17 proved ectopic pregnancy cases were reviewed retrospectively. Special attention was given to the appearance of the uterus and intrauterine fluid collections in the absence of a fetal pole. Criteria for the exclusion of an ectopic pregnancy were established, based on a specific morphologic appearance of the decidua seen in early normal intrauterine pregnancy. A "double sac" appearance of two concentric echogenic rims was consistently identified early in normal intrauterine pregnancies before the appearance of a fetal pole, and served as a good morphologic discriminator for the decidual cast of ectopic pregnancy. We think the double sac appearance is a helpful indicator for differentiating an ectopic pregnancy from an early normal intrauterine pregnancy.

Diagnosis, Differential↗
PubMed1982

The varied sonographic appearance of the urinary tract in the fetus and newborn with urethral obstruction.

The urinary tract in the fetus responds to chronic obstruction differently than in adults. This difference leads to sonographic findings which are unique and occasionally misleading when urinary tract obstruction occurs in utero. These findings include development of macroscopic cysts and relative lack of dilatation of the intrarenal collecting system. Seven cases are presented to illustrate the spectrum of findings in fetal urinary tract obstruction at the urethral level, and criteria for distinguishing atypical renal obstructive disease with cysts from other forms of renal cystic disease in the newborn are offered.

Diagnosis, Differential↗
PubMed1982

Pseudo-sludge.

The authors differentiate between the sonographic appearance to spurious echoes in the gallbladder (pseudo-sludge) and the similar appearance of echogenic bile.

Bile↗
PubMed1982

Lesser sac fluid in predicting the etiology of ascites: CT findings.

The CT scan of 100 patients with ascites were reviewed to assess the relative distribution of fluid in the greater and lesser peritoneal sacs. Discordant fluid accumulations were found in most cases. Patients with benign, transudative ascites (e.g., peritoneal dialysis, cirrhosis, congestive heart failure) had large greater sac collections with little fluid in the lesser sac. Those patients with diseases of organs bordering the lesser sac (e.g., pancreatitis, posteriorly penetrating gastric ulcer) had larger lesser sac fluid collections with little in the greater sac. Cytologically positive carcinomatosis of the abdomen was associated with concordant fluid volumes in these two spaces. These findings suggest that fluid within the lesser sac is not a typical manifestation of generalized peritoneal ascites and that its presence should direct a search for pathology in neighboring organs and for peritoneal malignancy.

Abdominal Neoplasms↗
PubMed1982

Ultrasound appearance of fetal greater omentum.

Fetal ascites results in the ultrasonographic demonstration of normal structures within the fetal abdomen that are otherwise not seen. One such structure is a membrane that, when surrounded by intraperitoneal fluid, may simulate a loculated area of fluid or a fluid-filled viscus. On the basis of its configuration and site of insertion observed during real-time and static ultrasonography, we believe that this membrane is the greater omentum. Recognition of the typical appearance of greater omentum floating in fetal ascites will prevent the erroneous diagnosis of an abnormal intra-abdominal fluid collection.

Adult↗
PubMed1982

Disproportionate left hepatic lobe size in the fetus: ultrasonic demonstration.

The lateral segment of the left lobe of the liver is a useful window for abdominal sonography. An autopsy series suggested relative enlargement of the left lobe in infants and fetuses. The authors evaluated the relative size of the lateral segment of the fetal left lobe (L) compared with the remainder of the liver (R) in 89 obstetric ultrasonograms; the mean ratio L:R was 1.04. The same ratio was determined for 50 adults undergoing abdominal computed tomography, and the mean L:R was 0.76, which differs significantly from that in the fetus (P < 0.001). Normal values for L:R in fetuses and in adults may be useful in detecting a variety of hepatic diseases and possibly intrauterine growth retardation.

Adult↗
PubMed1982

A standardized plane for biparietal diameter measurement.

Biparietal diameter measurement is the most widely accepted means of determining gestational age. However, a standard anatomic plane for performing this measurement has not been established. Three hundred forty-four measurements on 256 patients who gave birth to normal infants were obtained and compared at various cranial levels based on brain anatomy. The results document that use of a standardized plane increases measurement reliability but does not significantly alter variability. We postulate that variability is based predominantly on biologic variation in fetal growth rates rather than on technical errors.

Cephalometry↗
PubMed1982

Inability of relative fetal hepatic lobar size to diagnose intrauterine growth retardation.

It has been demonstrated by autopsy and by ultrasonography that the fetal left hepatic lobe is proportionately larger than that in the adult, probably because of increased supply of oxygenated blood from the umbilical vein. Intrauterine growth retardation (IUGR) is associated with impairment of the fetal blood supply, and might affect the left lobe disproportionately. The authors evaluated the relative size of the lateral segment of the fetal left lobe (L) compared with the remainder of the liver (R) in 88 obstetrical sonograms from 53 patients with IUGR. There was no statistically significant difference in the mean ratio of L/R between normal and IUGR fetuses. There was also no evidence of decreasing L/R in IUGR fetuses with serial examinations. The L/R ratio does not discriminate between normal fetuses and those with IUGR.

Adult↗