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Biomedical subjects

R A Filly

Publications and source records attributed to R A Filly.

At least 109 records · Page 6Linked to original sources
PubMed1990

Combined Doppler and morphologic sonographic evaluation of renal transplant rejection.

We sought to evaluate whether results of Doppler ultrasound alone or in combination with morphologic sonographic evaluation could predict acute renal transplant rejection accurately enough to avoid biopsy. Seventy-one patients were evaluated at time of biopsy. A resistive index greater than 0.90 was 100% predictive of acute rejection, but sensitivity was only 26%. Resistive indices in acute and chronic rejection were often similar. When all morphologic features were abnormal (11%), acute rejection was uniformly present. Regression analysis selected resistive index over morphologic features for ability to predict acute rejection. When resistive index is greater than 0.90 or all morphologic features are abnormal, acute rejection can be predicted with high accuracy, but biopsy remains necessary in many cases.

Adolescent↗
PubMed1989

Gastrointestinal tract obstruction in the fetus.

Surgical advice is often sought when a prenatal diagnosis of gastrointestinal tract obstruction is made. We reviewed our experience with 17 such cases during a 4-year period. Eight fetuses had complete proximal obstruction. Seven of the 8 did well after maternal transport to a perinatal center and prompt neonatal surgery. Six fetuses had distal obstruction with dilated bowel and increased peristalsis. Two died after birth (1 with severe associated anomalies and 1 with short-bowel syndrome), and the other 4 did well. Three fetuses had a false-positive diagnosis of in utero meconium peritonitis. Two died and the other had no postnatal evidence of obstruction. Our data suggest (1) polyhydramnios may not be present early in gestation or with distal obstruction; (2) other anomalies, including a family history of cystic fibrosis, should be sought; (3) dilated bowel with increased peristalsis is diagnostic of fetal gastrointestinal tract obstruction, whereas intra-abdominal calcification and ascites are nonspecific findings; (4) late development of ascites in a fetus with documented obstruction may be an indication for early delivery; and (5) prenatal diagnosis permits appropriate counseling, planned delivery, and prompt postnatal resuscitation and surgery with a good prognosis in most cases.

Abnormalities, Multiple↗
PubMed1989

Noncystic "increased" periventricular echogenicity and other mild cranial sonographic abnormalities: predictors of outcome in low birth weight infants.

The sonograms of 71 low birth weight infants were retrospectively reviewed and compared with results of neuromotor examinations at 24 months of age to determine whether mild abnormalities commonly detected on cranial sonograms (including milder grades of hemorrhage, ventricular dilation, and noncystic increases in periventricular echogenicity) were correlated with future neurologic handicaps. Of the 71 infants studied, increased periventricular echoes were noted in 20 (28%), Grade 1 or 2 intracranial hemorrhage in 31 (43%), and mild-moderate ventriculomegaly in 28 (39%). Neuromotor handicaps were detected in 15 (21%). No significant correlation was found between the above sonographic abnormalities and the incidence of future neuromotor handicaps. When those neonates with asymmetric mild-moderate ventriculomegaly were separately analyzed, this group was found to have more neuromotor handicaps (p less than 0.05) than those with normal ventricular size, and this finding warrants future study. Importantly, early cranial sonograms were completely normal in 12% of those infants with neuromotor handicaps. We conclude that the presence of mild cranial sonographic abnormalities (including mildly increased periventricular echogenicity) in these infants is not well correlated with neuromotor handicaps detected at 24 months of age.

Brain↗
PubMed1989

Fetal hydrops and death from sacrococcygeal teratoma: rationale for fetal surgery.

Most sacrococcygeal teratomas diagnosed before birth can be managed by planned delivery and postnatal surgery. However, large tumors early in gestation may result in placentomegaly, hydrops, and fetal death and a preeclampsia-like syndrome in the mother. This chain of events may result from high output cardiac failure in the fetus caused by arteriovenous shunting through the tumor. We recently encountered this situation in a fetus at 21 weeks' gestation and performed fetal surgery in an attempt to reverse the process. Excision of the teratoma resulted in reversal of hydrops, diminution of descending aortic flow on Doppler echocardiography, and decrease in placental thickness. Despite these changes, uterine irritability after hysterotomy resulted in labor and delivery of a nonviable premature infant. This case demonstrates that when fetal sacrococcygeal teratoma becomes very large early in gestation, high output cardiac failure can endanger both fetus and mother. In the future, use of Doppler echocardiography may allow appropriate selection of high-risk fetuses. Intervention to prevent arteriovenous shunting through the tumor may offer these fetuses an improved chance for survival.

Adult↗
PubMed1989

Detection of fetal central nervous system anomalies: a practical level of effort for a routine sonogram.

To evaluate the efficacy of examining the lateral ventricular atrium, cisterna magna, and cavum septi pellucidi as a means of ascertaining that the development of the fetal central nervous system (CNS) is normal, a retrospective evaluation of the sonograms of 112 fetuses (15-39 weeks gestational age) with sonographically diagnosed CNS anomalies was performed. Malformations included in the study were diverse. The lateral ventricular atrium was enlarged (greater than 10 mm) in 99 (88%) fetuses. Of the remaining 13 fetuses, seven had an abnormal-sized cisterna magna (less than 2 mm or greater than 11 mm). These two measurements alone could be used to identify the presence of a CNS abnormality in 95%. Three of the six remaining fetuses exhibited gross abnormalities easily seen on the standard axial images obtained for biparietal diameter measurement. Although the cavum septi pellucidi was absent in a number of cases, its absence did not enhance sensitivity in the cohort examined. Prospective examination of 130 consecutive normal fetuses (15-40 weeks gestational age) was also performed. When specifically sought, the ventricular atrium was identifiable and measurable 99% of the time; the cisterna magna, 90% of the time; and the cavum septi pellucidi, 95% of the time. Because major CNS anomalies are uncommon and these measurements afford high sensitivity, an extremely low probability (0.005%) of abnormal brain or spinal cord development can be predicted if a normal-sized lateral ventricular atrium and cisterna magna are present. These results should not be construed as a license to underexamine fetuses for malformations. Rather, these measurements should serve as simple positive steps to assist in a difficult task.

Central Nervous System↗
PubMed1989

Effacement of the fetal cisterna magna in association with myelomeningocele.

The cisterna magna is effaced in association with myelomeningocele. The authors retrospectively investigated the size of the fetal cisterna magna as a predictor of fetal myelomeningocele in 67 pregnant women (17-38 menstrual weeks) referred for prenatal sonography because of an elevated serum alpha-fetoprotein level (n = 61) or a suspicion of fetal ventriculomegaly on previously obtained sonograms (n = 6). Twenty fetuses had myelomeningocele, 14 had isolated ventriculomegaly, and 33 were normal. A normal-sized cisterna magna (range, 4-9 mm in depth) was present in all normal fetuses. In 19 of 20 fetuses with myelomeningocele, the views of the posterior fossa were adequate, and in each of these the cisterna magna was effaced (n = 18) or very small (n = 1). The cisterna magna was effaced in five of 13 (38%) fetuses with isolated ventriculomegaly in whom the posterior fossa was adequately imaged. Although effacement of the cisterna magna is a nonspecific finding, the high negative predictive value of this sign is useful during routine screening of the fetal neural axis.

Cisterna Magna↗
PubMed1989

Twin embolization syndrome: prenatal sonographic detection and significance.

Twin embolization syndrome (TES) is a complication of monozygotic twinning following in utero demise of the co-twin. Passage of thromboplastic material into the circulation of the surviving twin results in ischemic structural defects of the central nervous system, gastrointestinal tract, and genitourinary system. In six cases of this rare abnormality, sonographically normal fetuses subsequently demonstrated ventriculomegaly, porencephaly, cerebral atrophy, or microcephaly following demise of the co-twin. Extracranial abnormalities included small bowel atresia (two cases) and renal cortical necrosis (one case). Surviving twins all had neurodevelopmental delay at follow-up. Two fetuses were aborted because of sonographically apparent, progressively severe brain abnormality. The lone survivor of a dizygotic triplet gestation was normal, despite sonographic findings of TES in the co-triplets. Because of poor outcome, prenatal sonographic diagnosis of TES may influence antenatal or neonatal management of the surviving monozygous twin. Recognition of TES may permit accurate postnatal counseling of prognosis and recurrence risks.

Adult↗
PubMed1989

Fetal femur length to detect trisomy 21. A reappraisal.

An association between short femur length (FL) relative to the biparietal diameter (BPD) measured in the second trimester and the Down syndrome recently has been reported by Benacerraf et al (1987). Fetuses meeting an easily calculated criterion were stated to have a high probability for trisomy 21. We compared the biometric data from a selected group of 229 normal second trimester fetuses with 30 fetuses of similar gestational age with karyotype-proven trisomy 21. We found a substantial difference in femur lengths of normal fetuses in our population compared to that reported by Benacerraf et al. The reason for the difference is unclear. Further, we were unable to demonstrate a statistically discernible deviation of measured versus predicted femur lengths in the Down syndrome cohort employing either the formula recommended by Benacerraf et al or a formula calculated from our normal cohort.

Biometry↗
PubMed1989

Fetal tissue sampling. The San Francisco experience with 190 pregnancies.

Prenatal diagnosis of genetic defects was done using fetal blood sampling in 167 at-risk pregnancies, by fetal skin biopsy in 15 pregnancies, and by fetal liver biopsy in 8 pregnancies. Fetal blood sampling was done by fetoscopy through January 1985 and by sonographically directed percutaneous umbilical blood sampling since then. In our series, cytogenetics has become the major indication for fetal blood sampling, increasing from 6% of the cases with fetoscopy to 48% with umbilical blood sampling. Fetoscopy provided pure fetal blood in 61% of cases while umbilical blood sampling provided pure fetal blood 97% of the time. The corrected risk of fetal demise after percutaneous umbilical fetal blood sampling was 2% and after fetoscopy was 4%.

Biopsy↗
PubMed1988

Early experience with open fetal surgery for congenital hydronephrosis.

The fetus with severe bilateral hydronephrosis and associated oligohydramnios in the second trimester is doomed at birth by ongoing pulmonary and renal damage. Since decompression with percutaneously placed catheters anesthetic, surgical, and tocolytic techniques for open fetal anesthetic, surgical, and tocolytic techniques for open fetal urinary tract decompression in animals, and have now applied those techniques to a small group of five patients. One had bilateral ureterostomies and the subsequent four had marsupialization of the bladder. All pregnancies proceeded to cesarean delivery at 32 to 35 weeks' gestation. There was no long-term maternal morbidity, and two mothers have since experienced normal pregnancies. Three fetuses had return of normal amniotic fluid dynamics, and all three had adequate pulmonary function at birth, suggesting that fatal pulmonary hypoplasia associated with early severe oligohydramnios had been reversed. Two neonates died at birth with pulmonary hypoplasia. One had no amniotic fluid even after decompression, and the other had some amniotic fluid after decompression but a tiny chest cavity due to the long period of severe oligohydramnios before decompression. Of the three surviving infants, one had normal renal function when she died of unrelated causes at 9 months of age. One has normal renal function at 23 months and the third had failing renal function at 2 1/2 years and has grown and developed normally, but will require renal transplantation. We have now developed selection criteria that would exclude from treatment the two fetuses who died of pulmonary hypoplasia and the one who developed renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Severity of intestinal damage in gastroschisis: correlation with prenatal sonographic findings.

From 1982 to 1986, 26 abdominal wall defects were detected prenatally. Seventeen pregnancies culminated in live births with ultrasound correctly distinguishing between omphalocele and gastroschisis in all cases. In the 11 cases of gastroschisis diagnosed before birth, we attempted to correlate the clinical outcome with the size of the abdominal wall defect, sonographic appearance of the eviscerated bowel, and known time of exposure to amniotic fluid (gestational age at birth to gestational age at diagnosis). Neither the time of exposure to amniotic fluid (median duration of 14 weeks) nor the defect size could be correlated with eventual clinical outcome. The presence of small bowel dilatation and mural thickening on prenatal sonography (four patients) had a high correlation with severe intestinal damage and poor clinical outcome. The absence of these two sonographic findings (seven patients) was associated with mild intestinal changes and benign clinical course with no morbidity or mortality. We conclude that obstetric ultrasound cannot only accurately detect the presence and type of abdominal wall defect, but it also gives an indication of the severity of intestinal damage and subsequent clinical course in prenatally diagnosed cases of gastroschisis. Early delivery of the fetus with prenatally diagnosed gastroschisis should no longer be performed to limit exposure to amniotic fluid. Now that reliable sonographic criteria of severe intestinal damage have been defined, the decision to deliver early can be restricted to those fetuses with bowel dilatation and mural thickening.

Abdominal Muscles↗
PubMed1988

Amniotic sheets.

Seventeen cases of an aberrant sheet of tissue in the amniotic cavity are described to expand and clarify previous observations of this entity. The sheet of tissue demonstrates a thickened base and a free edge that undulates. The fetus moves freely about the sheet of tissue. There are no associated fetal deformities, and infants have no manifestations of the amniotic-band syndrome. Evidence suggests that these sheets may originate from "wrapping" of the amniochorionic membrane over a uterine synechia. These benign sheets of tissue should not be confused with the amniotic-band syndrome.

Adult↗