Abdominal sonogram may prevent complications from liver biopsy.
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Abdomen↗
Biomedical subjects
R B Goldstein
Publications and source records attributed to R B Goldstein.
Prevalence of ventriculomegaly in association with myelomeningocele: correlation with gestational age and severity of posterior fossa deformity.
PURPOSE: To investigate the relationship of ventriculomegaly (VM) with gestational age (GA) and the severity of the associated Chiari II malformation. MATERIALS AND METHODS: The sonograms of 51 fetuses with myelomeningoceles were retrospectively reviewed. VM was judged to be present when the transverse ventricular atrial diameter was greater than 10 mm. The severity of the posterior fossa (PF) deformity was subjectively graded as mild, moderate, or severe. Thirty-four fetuses were scanned at < or = 24 weeks GA, and 17 were scanned at > 24 weeks GA. RESULTS: The prevalence of VM was 61%. However, only 44% of fetuses < or = 24 weeks GA had VM, whereas 94% of fetuses > 24 weeks GA had VM. When compared with fetuses with mild PF deformities, fetuses with moderate or severe deformities had a higher prevalence of VM and the largest ventricles. CONCLUSION: The prevalence of VM in fetuses with myelomeningoceles varies with both GA and the severity of the associated PF deformity. These observations may provide additional prognostic information once a myelomeningocele is detected at sonography.
Arnold-Chiari Malformation↗
Isolated mild fetal cerebral ventriculomegaly: clinical course and outcome.
PURPOSE: To assess the outcome of fetuses with isolated mild ventriculomegaly (IMVM). MATERIALS AND METHODS: The clinical course of 44 fetuses with IMVM was investigated. Cognitive and motor development was classified as normal or delayed. RESULTS: Clinical data were available for 37 subjects. Three (8%) neonates died. Of the 34 living children, follow-up was limited (< 9 months) in six and the clinical course beyond the 1st year of life was established in 28. Twenty-two (79%) of the 28 children are developing normally, whereas six (21%) are developmentally delayed. More than 90% of fetuses with ventricular atrial diameter of 10-11 mm are normal. Seventy-five percent of fetuses with IMVM were male. With exclusion of the six children with limited follow-up, 78% of boys older than 1 year are developmentally normal compared with only 50% of girls. CONCLUSION: The majority of living children with prenatally detected IMVM are developmentally normal, especially those with borderline ventriculomegaly. Gender differences in prevalence and outcome deserve further investigation.
Cerebral Ventricles↗
The fetal ventricular atrium: fourth down and 10 mm to go.
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Cerebral Ventricles↗
Sonographic detection of inferior vermian agenesis in Dandy-Walker malformations: prognostic implications.
PURPOSE: To compare the prognoses for fetuses with sonographically detected inferior vermian agenesis (IVA) or complete vermian agenesis (CVA). MATERIALS AND METHODS: The sonograms of 65 fetuses with Dandy-Walker malformations were retrospectively reviewed. Fetuses were divided into two groups--those with IVA and those with CVA. RESULTS: Of the 65 fetuses, 37 had IVA; 28, CVA. Thirteen (20%) of the 65-nine (24%) of the 37 with IVA and four (14%) of the 28 with CVA--lived for longer than 1 year. Chromosomal abnormalities were found in 23 (45%) of the 51 fetuses tested for karyotypic abnormalities or clinically thought to have Down syndrome. Seventeen (53%) of the 32 with IVA and six (32%) of the 19 with CVA that were tested for karyotypic abnormalities or clinically thought to have Down syndrome had chromosomal abnormalities (P = .07). Associated morphologic abnormalities were prenatally detected in 49 (75%) of the 65-in 28 (76%) of the 37 with IVA and in 21 (75%) of the 28 with CVA. CONCLUSION: The overall guarded prognosis is similar for fetuses with Dandy-Walker malformations for whom IVA or CVA has been sonographically diagnosed. Fetuses with IVA have a higher prevalence of karyotypic abnormalities.
Abnormalities, Multiple↗
The demography, phenomenology, and family history of 22 persons with compulsive hair pulling.
This study reports on the demographics, phenomenology, and family history of 22 compulsive hair pullers. Subjects were recruited through a psychiatric outpatient clinic as well as newspaper advertisements. Subjects completed a semistructured interview focused on hair-pulling behavior and demographics, the Diagnostic Interview Schedule to assess major (Axis I) mental disorders, and the Structured Interview for DSM-III-R Personality Disorders to assess Axis II disorders. The typical subject was a 33-year-old woman who had completed 1 or more years of college and had been pulling her hair for 19 years. Nearly two-thirds met the criteria for a major mental disorder (particularly anxiety and mood disorders), and more than one-half met the criteria for a personality disorder. Nearly three-quarters of first-degree relatives were reported to have a psychiatric disorder, and about 5% were reported to be hair pullers.
Adolescent↗
The normal location of the fetal conus medullaris.
In vivo studies of the location of the normal conus medullaris in infancy and childhood have been extended to the fetus utilizing sonography. This prospective study of 33 fetuses showed that the fetal conus medullaris can be visualized in the prone fetus as early as 19 menstrual weeks. By the time the conus medullaris was observed sonographically, its location was within the normal adult range, thus refuting the commonly held notion that the conus medullaris ascends to adult levels sometime in childhood. Our results suggest that a fetal spinal cord termination level of L2-L3 or higher should be considered within normal limits. A termination level of L3 is indeterminate and requires neonatal evaluation. A termination level of L3-L4 or lower is abnormal and should instigate a careful sonographic search for associated abnormalities.
Adult↗
Gastroschisis: can sonography of the fetal bowel accurately predict postnatal outcome?
To determine whether prenatal sonographic features of the small bowel can accurately predict postnatal outcome in fetuses with gastroschisis, the sonograms of 24 fetuses with prenatally detected gastroschisis were retrospectively reviewed for fetal bowel features including small bowel dilatation and bowel wall thickening. To identify a relationship between the sonographic features and neonatal outcome, each feature was analyzed against eight adverse clinical outcome measures including bowel obstruction or atresia, necrosis, and need for bowel resection, using chi-square analysis and Kendall's taub correlation. When a relationship was identified, the sensitivity and specificity of the sonographic feature for predicting adverse outcome were determined. Only maximum small bowel diameter was related to postnatal bowel complications. Significantly more fetuses with a maximum small bowel diameter of greater than 11 mm (7/12) had bowel complications than did fetuses with MBD 11 mm or less (2/12) P < 0.05). Using a cutoff point of greater than 11 mm for maximum small bowel diameter, the sensitivity was 78%, specificity 66%, and positive predictive value 71% for predicting postnatal bowel complications. However, in only seven of 24 cases did the two observers make the same maximum small bowel diameter measurement, and in 14 of 24 cases their measurements differed by 2 mm or more. The observers varied sufficiently in their measurements to shift three fetuses (13%) between categories (< or = 11 mm or > 11 mm). Although a maximum small bowel diameter of 11 mm stratified our fetuses, this measurement may not be clinically meaningful.
Abdominal Muscles↗
Disappearing fetal lung lesions.
Cystic adenomatoid malformations and sequestrations of the lung are uncommon but potentially devastating problems of the fetus and neonate. We have followed over 50 cases of fetal lung masses from the time of prenatal diagnosis. Serial prenatal ultrasonography demonstrated that 9 large pulmonary lesions dramatically decreased in size or disappeared completely. We conclude that the natural history of prenatally diagnosed fetal lung masses is highly variable. A huge mass associated with fetal hydrops has a dismal outcome. If hydrops is not present, then the initial impression concerning prognosis may not accurately predict outcome, because there may be marked improvement during fetal life.
Adult↗
Correction of congenital diaphragmatic hernia in utero: VI. Hard-earned lessons.
Extensive experimental work suggests that repair of congenital diaphragmatic hernia (CDH) in utero may salvage severely affected fetuses who otherwise have a high expected mortality despite optimal postnatal care including extracorporeal membrane oxygenation (ECMO). We have reported that repair of CDH in utero is physiologically sound and safe for the mother, but technically difficult especially when the liver is herniated into the fetal chest. In the 3 years since our last report (1989 to 1991), 61 additional patients were referred for consideration of in utero repair. Fetal repair was attempted in 14 with severe isolated left CDH diagnosed before 24 weeks gestation. Five fetuses died intraoperatively, from technical problems related to reduction of incarcerated liver and uterine contractions--problems which have subsequently been surmounted. Nine patients were successfully repaired. Four babies survived, two delivered prematurely and died, and three died in utero within 48 hours of repair. Intraoperative technical problems have been overcome; the factors limiting successful outcome are postoperative physiologic management of the maternal-fetal unit and effective tocolysis to control preterm labor.
Fetal Death↗
Alpha-fetoprotein screening programs: what every obstetric sonologist should know.
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Amniocentesis↗
Elevated levels of amniotic fluid alpha-fetoprotein: sonographic evaluation.
From 1978 to 1990, 263 fetuses with an elevated level of amniotic fluid alpha-fetoprotein (AF-AFP) (> 2.0 multiples of the median) were examined with targeted fetal sonography. All cases of AF-AFP elevation among 22,355 genetic amniocenteses were represented. Sonography correctly showed 32 open neural-tube defects, including 20 myelomeningoceles, and depicted 94% (63 of 67) of the anomalous fetuses. Two of five anomalous fetuses with normal sonograms, however, had extremely high AF-AFP levels leading to prospectively correct diagnoses of congenital nephrosis. Therefore, programmatically, 97% (65 of 67) of the anomalous fetuses were recognized. The three programmatic misdiagnoses were all detected in the neonatal period and surgically corrected; subsequent development was normal. The combination of an elevated AF-AFP level and a detailed sonogram allowed distinction between a normal and an anomalous fetus in 99% of cases. When elevated levels are noted, AF-AFP analysis followed by detailed sonography is highly successful for the detection and characterization of anomalous fetuses and the recognition of normal fetuses with physiologic increases of this protein in the amniotic fluid.
Acetylcholinesterase↗
Contrast sensitivity to patch stimuli: effects of spatial bandwidth and temporal presentation.
Models of the spatial response of human vision are important for applied work, but the available contrast sensitivity function (CSF) data vary widely due to the diverse spatiotemporal stimuli used over the years. To assist selection, this paper: (1) reports measurements of the effects on the CSF of varying the spatial and temporal windows of grating patches; (2) demonstrates that the widely discrepant CSFs from previous studies can be accounted for by using these results; and (3) discusses simple criteria for choosing CSFs for practical applications. CSFs were measured for several combinations of spatial and temporal waveforms, using the same subjects under otherwise identical conditions. The CSF was measured over the range of 0.5-10 c/deg using Gabor-type patches of 1.0-, 0.5-, 0.25-, and 0.125-octave spatial bandwidths using both abrupt and gradual temporal presentations. The results were compared with the CSF obtained with a fixed aperture (4 deg x 4 deg) grating pattern. Increasing the number of cycles resulted in increased sensitivity at intermediate frequencies, changing the CSF to a narrower bandpass shape. For each patch bandwidth, the gradual presentation CSF had a narrower spatial pass band than with the abrupt presentation. The relevance of the large differences in the CSFs obtained with different stimuli to our understanding of visual performance is discussed.
Contrast Sensitivity↗
Personality disorder in obsessive-compulsive volunteers, well comparison subjects, and their first-degree relatives.
OBJECTIVE: The authors sought to determine the frequency of DSM-III personality disorders in subjects with obsessive-compulsive disorder, well comparison subjects, and their first-degree relatives. METHOD: Thirty-two subjects with obsessive-compulsive disorder and 33 age-(within 5 years) and gender-matched well comparison subjects were assessed with the Structured Interview for DSM-III Personality Disorder and several self-report instruments. Their first-degree relatives were assessed in a blind manner with the same instruments. RESULTS: Subjects with obsessive-compulsive disorder were more likely than well comparison subjects to have a personality disorder, but compulsive personality was not the most frequent. No significant differences were found in the prevalence of personality disorders among first-degree relatives, including compulsive personality, or in obsessional, hysterical, or oral character traits. CONCLUSIONS: Personality disorders are highly prevalent among patients with obsessive-compulsive disorder, but the data do not support a relationship between obsessive-compulsive disorder and compulsive personality.
Adult↗
Frequency of fetal anomalies in sonographically detected polyhydramnios.
One hundred and five patients who met the criterion of having an amniotic fluid pocket depth greater than 8.0 cm were categorized as polyhydramniotic. Of these cases, 82% were singleton pregnancies and 18% were twin pregnancies. The degree of polyhydramnios correlated directly with the probability that an anomaly would be detected. For the lowest rank group (pocket depth of 8 to 9.5 cm), 50% of fetuses manifested an anomaly, whereas the highest rank (16.0 cm or greater pocket depth) carried an 88% risk for an anomaly. Overall, 63% of pregnancies with polyhydramnios revealed anomalies. Sonography found all to be anomalous. There were three false diagnoses of potential anomalies. Monochorionic anomalies of twinning (twin transfusion syndrome and acardiac twin) and gastrointestinal anomalies among singletons were the most commonly seen abnormalities. However, a broad spectrum of anomalies was represented in the study group. Only five diabetic mothers were seen in our study cohort, and in each of them the pregnancy was further complicated by an associated fetal anomaly.
Brain↗
Growth retardation in prenatally diagnosed cases of gastroschisis.
Gastroschisis is a rare congenital anomaly characterized by the herniation of fetal intestines directly through an abdominal wall defect. It is associated infrequently with chromosomal or other nonbowel defects and can be treated surgically after delivery, with survival rates reported to be between 87 and 100%. We reviewed 21 cases of prenatally diagnosed gastroschisis to ascertain the effect of fetal growth retardation on perinatal outcome. Ten of the 21 fetuses (48%) were identified prenatally as growth retarded, although only seven of these ten truly had birth weights less than the 10th percentile. Three additional fetuses that had not been identified prenatally as growth retarded did, in fact, have birth weights less than the 10th percentile, for a total frequency of growth retardation at birth of 48% (10/21 fetuses). When compared to non-growth-retarded fetuses with gastroschisis, fetuses who were growth retarded, although more likely to have been delivered by emergency cesarean section, had shorter hospitalization times, were more likely to have undergone primary closure on the first day of life, and had fewer major complications. We conclude that growth retardation is common in fetuses with gastroschisis and the postnatal outcome in gastroschisis is not poorer for fetuses who are growth retarded.
Abdominal Muscles↗
The lemon sign: not a specific indicator of meningomyelocele.
The association of the "lemon sign" with myelomeningocele has been well documented. This study was performed to determine if this sign is exclusive to myelomeningocele. The study population included all abnormal fetuses in our data base with this sonographically observed finding, from 1988 to 1991 (total of 23 cases). Twelve fetuses were found to have a myelomeningocele and six an encephalocele. Five fetuses with the lemon sign demonstrated a variety of structural anomalies not involving the neural tube. This sonographic finding appears not to be limited to cases of myelomeningocele.
Female↗
The AIUM/ACR antepartum obstetrical sonographic guidelines: expectations for detection of anomalies.
A survey was sent to 52 physicians considered experts in obstetrical sonography asking them to comment on the probability of observing various fetal abnormalities when the AIUM/ACR guidelines for a level one obstetrical sonogram were followed. Although definite trends were noted in several areas, there was much diversity in opinion concerning what should or should not be seen when the guidelines were followed. Given the fairly specific nature of the AIUM/ACR guidelines, we were uncertain why the responses were not in more uniform agreement.
Congenital Abnormalities↗