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Biomedical subjects

R A Filly

Publications and source records attributed to R A Filly.

At least 145 records · Page 8Linked to original sources
PubMed1987

Sonographic analysis of the fetus with ureteropelvic junction obstruction.

Twenty-five fetuses with ureteropelvic junction obstruction were evaluated to determine the likelihood of progression of hydronephrosis in utero, and the outcome for the neonate. Such information may alter prenatal as well as perinatal management. These observations showed that the degree of dilatation in utero is likely to be greater than that observed postnatally; the degree of dilatation does not necessarily correlate with renal functional impairment measured postnatally; significant progression of dilatation in utero is relatively uncommon, especially in unilateral cases; and uretero-pelvic junction obstruction, even when bilateral, is unlikely to be fatal. Of 21 live newborn infants with follow-up, 14 required surgery and seven were placed under observation.

Female↗
PubMed1987

Relative growth of the higher fetal brain structures.

In a retrospective review of 90 normal obstetric ultrasonographic examinations obtained between 15 and 35 menstrual weeks, measurements were made of the transverse dimensions of the thalamus, basal ganglia/insula, atrium of the lateral ventricle, and temporal operculum in the standard biparietal diameter plane. At 15 menstrual weeks the echogenic choroid plexus, filling the lateral ventricle, dominates the appearance of the cranium. During later gestation, the cerebral hemispheres and basal ganglia (telencephalic structures) show marked growth, while the diencephalon and lateral ventricles increase much less rapidly in size. This observation is made using a method of measurement that least favors the demonstration of cerebral cortical growth. Of note is that the width of the lateral ventricle remains relatively stable throughout the second and third trimesters.

Brain↗
PubMed1987

Fetal spine morphology and maturation during the second trimester. Sonographic evaluation.

We reviewed high-resolution real-time sonographic images (especially selected for a lack of technical artifacts) of the fetal spine of 46 normal fetuses between 18-27 menstrual weeks of development. The degree of visible posterior neural arch ossification was graded and compared with the gestational age. Recognizable early ossification of the laminae was seen in the cervical region of all fetuses studied. Similar ossification followed sequentially in the thoracic, lumbar, and sacral regions; however, sonographically recognizable ossification of the laminae in the lumbar spine was delayed until 22-24 weeks and in the sacral spine until 25 weeks or more. Awareness of these features will help to prevent false-positive diagnoses of dysraphism and, conversely, hopefully augment our ability to detect such lesions.

Female↗
PubMed1987

Objective method of diagnosing oligohydramnios in postterm pregnancies.

Oligohydramnios is an important factor influencing the management of postterm pregnancies. However, sonographic assessment of oligohydramnios has been based largely on the subjective judgement of the sonologist. From January 1982 to December 1984, 54 patients had articulated-arm B-scan ultrasound examinations and were identified as postterm. Of these patients, 25 were subjectively diagnosed as having oligohydramnios. Five patients were considered to have low normal amounts of amniotic fluid. The remainder were considered to have normal or greater than normal quantities of amniotic fluid. From this population, an amniotic fluid index was determined for each patient by finding the product of the length, width, and depth of the largest amniotic fluid pocket. Patients with a fluid index less than 60 showed a strong association with the postmaturity syndrome. Indeed, all but one postmature infant was born of a pregnancy with a fluid index less than 60. No other fetal or perinatal complications were statistically correlated with oligohydramnios in this small patient series.

Amniotic Fluid↗
PubMed1987

Ectopic pregnancy. Diagnosis by sonography correlated with quantitative HCG levels.

Pelvic sonograms were correlated with simultaneous human chorionic gonadotropin (HCG) determinations in 150 women with early intrauterine pregnancy (N = 76) and ectopic pregnancy (N = 74). Of the 76 patients with intrauterine pregnancy (IUP), 55 had HCG levels exceeding 1,800 mIU/ml (Second International Standard), and in each case a gestational sac was identified. In comparison, 35 of 74 (47%) patients with ectopic pregnancy had HCG levels of 1,800 mIU/ml or more, and no case demonstrated a gestational sac. Although six patients (8%) with ectopic pregnancy demonstrated a "pseudogestational sac," no case was confused with a true gestational sac. We conclude that, when the HCG level exceeds 1,800 mIU/ml, an intrauterine gestational sac is normally detected and its absence is evidence for an ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1987

Pitfalls in femur length measurements.

The following study was performed to determine the precise anatomic correlate for the end points of sonographic measurement of the fetal femur. A cadaveric fetal thigh was dissected in layers and correlated with sonographic images. The margins of the osseous portion of the femur were determined on sonograms. Potential for underestimating femur length (oblique images) and overestimating femur length (including nonosseous portions of the femur in measurement) can be eliminated by requiring a view of the femur which includes the epiphyseal cartilages. In this way, the margins of the osseous portion may be accurately estimated, and there is assurance that the entire shaft has been visualized. Images of the dissected specimen indicate that the "distal femur point," which may cause confusion in measurement, is not a part of the osseous femur, but probably represents a specular reflection from the lateral surface of the distal epiphysis.

Age Determination by Skeleton↗
PubMed1987

Evaluation of fetal femur length for prediction of gestational age in a racially mixed obstetric population.

In a retrospective study, a group of 314 patients between 19 and 32 completed weeks' gestation were evaluated for differences in sonographic measurement of femur length vs. gestational age between the following racial categories: Hispanic, black, Oriental, and Caucasian. Selection criteria included known last menstrual period, singleton gestation, and a historic absence of maternal diabetes, hypertension, or renal disease or fetal anomalies. The gestational age against which the femur length was judged was determined from the last normal menstrual period, provided that this date differed by less than 2 weeks from age determined by fetal biparietal diameter and evaluation of the newborn. No statistically significant difference in femur length vs. gestational age was noted between the various racial categories.

Asian People↗
PubMed1987

Absorption of fetal intraperitoneal blood after intrauterine transfusion.

We reviewed the sonograms and medical records of all patients who underwent intrauterine transfusions between December 1981 and December 1984 in order to determine the time course for disappearance of the intraperitoneal blood. Seventy-two sonographic examinations were performed on 22 patients who underwent 51 intrauterine transfusions. Nonhydropic fetuses who received less than or equal to 50 cc of intraperitoneal blood exhibited no ultrasonic evidence of intraperitoneal fluid after 8 days. Nonhydropic fetuses receiving greater than 50 cc of intraperitoneal blood showed resolution of intraperitoneal fluid after 12 days. Hydropic fetuses, after intraperitoneal transfusion, all demonstrated persistence of intraperitoneal fluid. Intraperitoneal fluid was seen as long as 24 days after transfusion in hydropic fetuses.

Absorption↗
PubMed1986

Ultrasound evaluation of polyhydramnios and twin pregnancy.

We analyzed the ultrasound examinations and medical records of 75 pairs of twins who were delivered between January, 1983, and December, 1984, to study the relationship between increased amniotic fluid volume, fetal abnormalities, and preterm labor. Ten of these 75 twin pregnancies demonstrated elevated amniotic fluid volume that persisted throughout pregnancy. Total intrauterine volumes were elevated in these cases, and nine of the ten pregnancies were abnormal. In addition, it was noted that elevation of the amniotic fluid volume alone did not explain the high rate of preterm labor and delivery in twin gestations.

Congenital Abnormalities↗
PubMed1986

Cholecystitis: detection with MR imaging.

The role of magnetic resonance (MR) imaging in the detection of gallbladder disease was evaluated in 39 individuals (16 healthy, five with asymptomatic gallstones, and 18 with clinical symptoms of gallbladder disease). MR imaging was performed after they fasted for 12 hours. Imaging sequences included a combination of repetition times (TR) of 0.5 and 1.5 sec and echo times (TE) of 28 and 56 msec. On the images obtained at TR = 0.5 sec and TE = 56 msec, gallbladder bile was hyperintense compared with the liver in all healthy and asymptomatic subjects and was hypointense (n = 9), isointense (n = 4), or hyperintense (n = 5) in symptomatic patients, eight of whom had surgical confirmation of cholecystitis. Comparison of normal versus pathologically proved cases for the presence of gallbladder disease yielded a specificity of 100%, sensitivity of 75%, and a significant difference of P less than .01. Thus, with a pulse sequence of TR = 0.5 sec and TE = 56 msec, MR was sensitive in detecting gallbladder disease. However, the role of MR in the radiologic workup of gallbladder disease will be determined by more experience with this modality.

Adipose Tissue↗
PubMed1986

Abnormal pregnancy: early diagnosis by US and serum chorionic gonadotropin levels.

Simultaneous sonography and quantitative serum human chorionic gonadotropin (HCG) levels from 126 women with threatened abortion were compared. Of 56 women with normal outcome, 39 (70%) had a gestation sac greater than or equal to 5 mm in mean sac diameter, and in each case the HCG level was 1,800 milli-international units (mIU/ml) or greater. The serum HCG levels strongly correlated with the gestation sac sizes to a mean sac diameter of 25 mm. Of 70 abnormal pregnancies, 31 demonstrated a gestation sac. Of these, 20 women (65%) had disproportionately low HCG levels relative to sac size, including 12 in whom the HCG level was less than 1,800 mIU/ml. One woman with an early molar pregnancy had a disproportionately elevated HCG level. Correlation of sonograms with a simultaneous measurement of serum HCG level is a useful method for evaluating threatened spontaneous abortion. A disproportionately low HCG level relative to gestation sac size is evidence for an abnormal pregnancy.

Abortion, Spontaneous↗
PubMed1986

Threatened abortion: sonographic distinction of normal and abnormal gestation sacs.

In an attempt to determine whether sonographic evaluation alone can distinguish normal from abnormal gestation sacs, a retrospective analysis was performed of ultrasound (US) scans from 168 women with threatened abortion. Gestation sacs were judged to be abnormal on the basis of specific sonographic criteria including large size (greater than or equal to 25 mm mean sac diameter) without an embryo; distorted shape; thin (less than or equal to 2 mm), weakly echogenic, or irregular choriodecidual reaction; absence of a double decidual sac; and low position. Two criteria - large sac and distorted shape - had 100% specificity and were called major criteria. The remaining criteria were individually less specific, although 100% specificity was achieved when three or more of these minor criteria were demonstrated. When one major or three minor criteria were present, 53% of abnormal gestations were correctly identified without any false-positive diagnoses. The authors conclude that experienced sonographers can reliably identify many abnormal gestation sacs on a single examination.

Abortion, Threatened↗
PubMed1986

Multicystic dysplastic kidney in utero: changing appearance on US.

Serial ultrasound (US) examinations of six cases of fetal multicystic dysplastic kidney were reviewed. In all cases the diagnosis was confirmed by pathologic or neonatal radiologic examination. The in utero appearance on US scans of multicystic dysplastic kidneys sometimes changed dramatically. Furthermore, all of the multicystic dysplastic kidneys changed in size: four enlarged, one shrank, and one initially enlarged and later shrank. Radiologic and laboratory data suggest that multicystic dysplastic kidneys may have the capacity for glomerular filtration. The change in size and appearance of fetal multicystic dysplastic kidneys may result from this residual renal function.

Female↗
PubMed1986

Multicystic dysplastic kidney: observations of contralateral disease in the fetal population.

To evaluate multicystic dysplastic kidney (MDK) and associated contralateral renal abnormalities in the fetal population, 27 cases detected and followed in utero were reviewed retrospectively. The sonographic assessment included estimation of amniotic fluid volume and interval growth, evaluation for non-genitourinary anomalies, and postnatal follow-up study. Contralateral renal anomalies were detected in 41% of the fetuses and included obstruction of the ureteropelvic junction, renal agenesis, renal hypoplasia, and bilateral MDK. The incidences of these malformations were compared with results of earlier studies of MDK in the pediatric and adult populations. Lethal anomalies, such as bilateral MDK and MDK associated with contralateral agenesis, are common (19% and 11%, respectively) in the fetal population; obstruction of the contralateral ureteropelvic junction, a nonlethal anomaly, was seen less commonly (7%). Perinatal death from lethal abnormalities may spuriously raise the incidence of nonlethal contralateral abnormalities in the pediatric and adult populations. Contralateral mild fetal pyelectasis, found in 15% of fetuses with MDK, was not clinically significant.

Cysts↗
PubMed1986

Renal allograft rejection: US evaluation.

Real-time ultrasonography (US) was performed on the allografts of 100 consecutive renal transplant recipients at the time of allograft biopsy. Evaluation of the sonograms included the grading of parameters previously demonstrated to be indicative of allograft rejection. The appearance of the renal sinus fat, allograft size, corticomedullary ratio, sharpness of the corticomedullary junction, medullary conspicuity, presence of focal parenchymal abnormalities, and thickening of the pelvic or infundibular wall were individually evaluated. The authors correlated the US and the histopathologic findings. While the accuracy of a positive prediction of rejection was relatively high (83%-90%), this result is influenced by the relatively high prevalence of rejection in the biopsy group (83%). Accuracy of a negative prediction was uniformly low (17%-30%). Mild rejection was difficult to differentiate ultrasonographically from no rejection, although severe rejection could usually be differentiated from mild or no rejection, particularly in patients with the interstitial type of rejection.

Graft Rejection↗
PubMed1986

Septal veins: a normal finding on neonatal cranial sonography.

The appearance of normal septal veins on cranial sonography is described. Septal veins are part of the deep cerebral (galenic) venous system. Improved technology allows these structures to be identified as they course in the walls of the cavity of the septum pellucidum (cavum septi pellucidi). These veins are normal structures that should not be misinterpreted as pathologic ventricular septations, calcifications, or evidence of prior intracranial hemorrhage.

Cerebral Veins↗