Monochorionic twinning: sonographic assessment.
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Chorion↗
Biomedical subjects
R B Goldstein
Publications and source records attributed to R B Goldstein.
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↗
Lymphoma presenting as allograft hematoma in a renal transplant recipient.
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Adolescent↗
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↗
A method to measure the degree of control per se in the oral glucose tolerance test.
Using the glucose and insulin values from a 5-hr oral glucose tolerance test, nine quantitative measures have been developed to separate normal, "flat-curve," and non-insulin-dependent diabetic (NIDD) patients. The purpose of these measures is to quantify per se the degree of control operating in glucose homeostasis. A control index which is based upon Swan's minimizing principle and uses only the glucose values was successful in assessing the degree of control operating in glucose homeostasis.
Adult↗
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↗
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↗
Gallstone formation during weight-reduction dieting.
We investigated the development of gallstones over an 8-week period from the onset of dieting in 51 obese men and women and 26 nondieting control subjects. Gallbladder examinations were performed by abdominal real-time ultrasonography for the detection of gallstones. Initial sonography was performed prior to dieting and only those subjects in whom initial sonograms showed no gallstones or sludge were included in the study. Repeated sonography was performed at 4-week intervals for 8 weeks while they remained on a 2100-kJ/d diet. Initial weight of subjects prior to dieting averaged 105.9 +/- 3.8 kg (162% of ideal body weight) and decreased to 89.4 +/- 3.2 kg (137.3% of ideal body weight) after 8 weeks of dieting. Sonography performed after 4 weeks of dieting revealed new-onset gallbladder sludge in 1 subject and gallstones in 4 subjects. After 8 weeks of dieting sludge was detected in 3 subjects and gallstones in 13 (25.5%). In contrast, none of the nondieting subjects developed any detectable gallbladder abnormalities. During the dieting period, 1 of 51 subjects developed symptoms of biliary colic, necessitating cholecystectomy. On cessation of dieting with reinstitution of normal feeding, 2 additional subjects with stones developed symptoms severe enough to require cholecystectomy. In all 3 cases, cholesterol gallstones were recovered at the time of surgery. Eleven of the 13 patients with gallstones were followed up for 6 months after discontinuation of the diet. Besides the 3 undergoing cholecystectomy, 4 subjects had gallstones on follow-up ultrasound examination, while sonographically detectable gallstones had disappeared in 4 subjects. We conclude that this form of weight-reduction dieting predisposes to the development of gallstones and that gallstone formation is a risk of this type of prolonged calorie restriction. Dissolution or evacuation of gallstones may occur with resumption of a normal diet.
Adult↗
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↗
Exclusion of fetal ventriculomegaly with a single measurement: the width of the lateral ventricular atrium.
The ventricular atria in 100 healthy fetuses with gestational ages ranging from 14 to 38 menstrual weeks were evaluated and compared with those of 38 fetuses in whom ventriculomegaly had been diagnosed in utero. Axial sonograms of the brain through the atrium of the lateral ventricle demonstrated that the normal atrial diameter remained relatively constant throughout the gestational age range observed. The atrium had a mean diameter of 7.6 +/- 0.6 mm (standard deviation [SD]). Measurement of this structure can be quickly performed, is reproducible with low intra- and interobserver variation, and permits ventriculomegaly to be excluded. Atrial diameters exceeding 10 mm (above 4 SDs) suggest ventriculomegaly, with a low false-positive rate.
Brain↗
Prenatal diagnosis of anencephaly: spectrum of sonographic appearances and distinction from the amniotic band syndrome.
To document the characteristic sonographic abnormalities of anencephaly and to identify potentially confusing sonographic features, we reviewed 20 cases of anencephaly. All of these cases were diagnosed prenatally with sonography after 14 menstrual weeks in patients who were seen at our institution between 1984 and 1988. In all cases, the correct diagnosis was made on the prenatal sonograms and was confirmed pathologically. The sonographic diagnosis was primarily based on the absence of brain and calvarium superior to the orbits on coronal views of the fetal head. This typical appearance was altered by the presence of echogenic tissue superior to the orbits in nine (45%) of 20 cases. Pathologically, the tissue corresponded to angiomatous stroma (area cerebrovasculosa) and appeared quite sizable on sonograms in four fetuses (20%). It may appear solid or mixed solid and cystic. In one fetus, it appeared brainlike. Despite this appearance, the sonologist should not be dissuaded from the diagnosis of classic anencephaly. Hydramnios occurred in seven (35%) of 20 patients, and oligohydramnios occurred in none of the patients. Anencephaly may be distinguished from the cranial defects associated with the amniotic band syndrome (amputation defects that occur as the sequelae of amniotic disruption) on the basis of the symmetry of the cranial defects (100% of anencephalic fetuses in this series) and the absence of limb, body wall, and spinal abnormalities that typically accompany the amniotic band syndrome. Although there may be minor variations in the sonographic appearance of the cranial defect of anencephalic fetuses (i.e., much or little angiomatous stroma), we conclude that this anomaly can be accurately detected and diagnosed on fetal sonograms obtained after 14 weeks menstrual age and distinguished from the amniotic band syndrome.
Amniotic Band Syndrome↗
Sonographic estimation of amniotic fluid volume. Subjective assessment versus pocket measurements.
Amniotic fluid volume (AFV) estimation is an important part of routine obstetric sonography. Despite the clinical importance placed upon excessive or diminished AFV in pregnancy, there is little uniformity in the way it is estimated sonographically. We compared AFV estimations obtained using two commonly employed sonographic methods "subjective" visual assessment and amniotic fluid pocket measurements. Estimates obtained using both methods correlated closely. In addition, there was excellent intraobserver and interobserver agreement among estimates obtained using subjective criteria. This supports the belief that experienced observers tend to agree on the sonographic appearance of normal, excessive or decreased AFV. Methods for AFV estimation and potential pitfalls are discussed.
Amniotic Fluid↗
Sonographic identification of autosomal recessive polycystic kidney disease associated with increased maternal serum/amniotic fluid alpha-fetoprotein.
A patient with no family history of renal disease was referred for obstetric sonography because of elevated maternal serum and amniotic fluid alpha-fetoprotein (AFP), and was proved to be carrying a fetus with autosomal recessive polycystic kidney disease. Review of records of previous cases with a sonographic diagnosis of this disease revealed one other case with elevated and one case with normal amniotic fluid AFP. Sonographers should be aware of the potential diagnosis of this condition in patients with elevated AFP, even in gestations not known to be at risk. Because the sonographic diagnosis of this disease can be difficult in gestations known to be at risk, AFP determination may prove to be a useful diagnostic adjunct in these pregnancies as well.
Adult↗
Myopic cracks, angioid streaks, and traumatic tears in Bruch's membrane.
We studied the pattern of break formation in 60 eyes with myopic lacquer cracks, angioid streaks, or traumatic tears in Bruch's membrane, using a graphics composition technique and computer analysis of digitized images. Lacquer cracks were found in a reticular distribution within a posterior staphyloma; angioid streaks occurred in a spider-web configuration centered on the optic nerve; traumatic tears were characteristically curved, perineural, and eccentric temporally. The specific break patterns imply the operation of biomechanical forces.
Adolescent↗
Sonographic diagnosis of meconium ileus in utero.
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Adult↗
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↗
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↗
A multivariate statistical method for the establishment of maximum allowable exposure to toxic materials in the workplace.
A model has been developed for setting standard limiting concentrations for toxic substances in the body fluid or tissues of industrial workers. The method is very flexible, and allows the use of either univariate or multivariate data, and of classification schemes which are either supervised, unsupervised, or partially supervised. An index of subclinical biological damage is derived which is used to determine an optimal limiting exposure level. The model is applied to the particular case of selecting a maximum allowable concentration of blood lead in workers in industrial settings where lead toxicity is a danger.
Analysis of Variance↗