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Biomedical subjects

R L Berkowitz

Publications and source records attributed to R L Berkowitz.

At least 109 records · Page 6Linked to original sources
PubMed1988

Choroid plexus cysts in the fetus: a benign anatomic variant or pathologic entity? Report of 41 cases and review of the literature.

During a 22-month period, 6288 women undergoing prenatal sonographic studies in the second and third trimesters were evaluated prospectively to determine the incidence of choroid plexus cysts in the fetus, to follow the natural course of these cysts in intrauterine life, and to determine the association of chromosomal and anatomic anomalies in these fetuses. We diagnosed choroid plexus cysts in 41 fetuses, an incidence of 0.65%. Unilateral and bilateral cysts were equally frequent, and in most cases diagnosed by 21 weeks' gestation. On follow-up scans, the cysts had completely disappeared by 23-24 weeks in 80% of the cases, and by 28 weeks in another 10%. Once resolved, the cysts did not recur, and a normal sonogram in the late second trimester predicted normal scans in late pregnancy and in the neonate. One fetus had a chromosomal abnormality (trisomy 18). Associated anatomic anomalies were detected in three fetuses, including the one with trisomy 18. We believe that in the great majority of cases, fetal choroid plexus cysts are benign transient variants of normal intracranial anatomy. It is, however, important to conduct a careful sonographic search for associated anomalies. Chromosomal studies are strongly recommended whenever associated anatomic abnormalities are detected and when the choroid plexus cysts are large, bilateral, and persistent beyond 20-22 weeks' gestation.

Adult↗
PubMed1987

Prenatal sonographic assessment of the fetal thorax: normal values.

Fetal thoracic circumference and thoracic length measurements were obtained by ultrasonographic examination on 576 women between 16 and 40 weeks gestation. Nomograms for thoracic circumference and thoracic length with respect to gestational age were developed. Growth of both thoracic parameters was observed to be linear throughout gestation. In normal pregnancy the ratios of thoracic circumference to abdominal circumference and thoracic length to humerus length remained virtually constant at 0.89 and 0.93, respectively.

Adolescent↗
PubMed1987

The nonpredictive value of fetal urinary electrolytes: preliminary report of outcomes and correlations with pathologic diagnosis.

Fetal urine was sampled 12 times in nine fetuses with sonographically diagnosed urinary tract obstruction to assess renal function. By previously proposed criteria, four fetuses were predicted to have poor renal function. Two of these fetuses were found to have renal dysplasia on autopsy after elective termination. The other two died in the neonatal period but only one of these had histologic evidence of renal dysplasia. Five fetuses were predicted to have good renal function. Three of these developed renal failure after birth, one was found to have renal dysplasia on autopsy after elective termination, and one is alive and well. We conclude that fetal urine electrolytes are not necessarily an accurate predictor of neonatal renal function.

Chlorides↗
PubMed1987

Technical aspects of intravascular intrauterine transfusions: lessons learned from thirty-three procedures.

Our technique for performing intravascular transfusions is described and four failed attempts are presented. The appropriate choice of needle, insertion site, and premedication are discussed. A rationale for intravenous fetal muscle blockade in selected cases is presented and a transfusion setup designed to minimize movement of the needle hub is described. Finally, the judicious use of intraperitoneal transfusions in some cases is suggested.

Blood Transfusion, Intrauterine↗
PubMed1987

Fetal giant hemangiolymphangioma: report of a case.

A hemangiolymphangioma is a malformation of both lymphatic and blood vessels. A case of giant hemangiolymphangioma with extensive fetal involvement is presented and considerations in the antenatal diagnosis of this anomaly are discussed.

Female↗
PubMed1987

Prenatal prediction of osteogenesis imperfecta (OI type IV): exclusion of inheritance using a collagen gene probe.

Autosomal dominant osteogenesis imperfecta is caused by mutations in the COL1A2 and COL1A1 genes of type I collagen. In a family with OI type IV genetically linked to the COL1A2 gene, we attempted prenatal diagnosis in a pregnancy at risk by genotyping the DNA of the fetus for a COL1A2 gene associated RFLP. Our results showed that the fetus inherited the normal COL1A2 allele from her affected parent. Linkage analysis can thus be used in the prenatal diagnosis of dominantly inherited osteogenesis imperfecta.

Adult↗
PubMed1987

Prenatal diagnosis of fetal brain tumors.

Two cases of congenital brain tumors were detected during routine antepartum sonography at the Mount Sinai Medical Center Perinatal Ultrasound Unit. In both cases, diagnosis was made during the third trimester at 31 and 33 weeks, respectively. In one of these patients, no intracranial abnormalities were noted on a sonogram performed in conjunction with genetic amniocentesis at 18 weeks gestation. The histologic diagnosis of both tumors was glioblastoma multiforme grade III. Previous reports describing the prenatal sonographic diagnosis of intracranial tumors have been in cases with fetal intracranial teratomas.

Adult↗
PubMed1986

Intrauterine intravascular transfusions for severe red blood cell isoimmunization: ultrasound-guided percutaneous approach.

Eight pregnancies with severe red blood cell isoimmunization were managed with use of an intravascular approach for intrauterine transfusions. Fetoscopy was not employed, and the procedures were performed percutaneously under direct ultrasound visualization. A total of 16 of 18 attempted transfusions were successfully performed, with four fetuses requiring more than one transfusion. Technical aspects of the procedure as well as its indications, advantages, and drawbacks are discussed.

Adult↗
PubMed1986

Gestational diabetes: impact of home glucose monitoring on neonatal birth weight.

Two groups of 58 gestational diabetic women matched for age, prepregnancy weight, height, and parity were studied. The home glucose monitoring study group performed fasting and 1-hour postprandial capillary blood glucose testing after every meal. The control group was followed by conventional treatment. The incidence of macrosomia (birth weight of greater than or equal to 4000 gm) and large (greater than or equal to 90%) for gestational age infants was significantly reduced in the home glucose monitoring group. The mean birth weight of the study group was 3231 +/- 561 gm, while that of the control group was 3597 +/- 721 gm (p less than 0.002). Significantly more patients in the home glucose monitoring group were receiving insulin therapy (50% versus 21%). We believe that intensive home glucose monitoring will allow for the early identification of those gestational diabetic patients needing insulin and thus reduce the incidence of macrosomia and large for gestational age infants.

Adult↗
PubMed1986

Intravascular transfusion in utero: the percutaneous approach.

A severely Rh-isoimmunized pregnancy is described in which an intrauterine transfusion of blood was given by the intravascular route directly into an umbilical vessel. Fetoscopy was not used, and the procedure was performed percutaneously under direct ultrasound visualization.

Adult↗
PubMed1986

Prenatal shunting of fetal ascites in nonimmune hydrops fetalis.

A case of severe nonimmune hydrops fetalis presenting at 24 weeks gestation is presented. Ultrasound, echocardiographic, and fetal ascitic fluid studies were nondiagnostic. Because of massive fetal ascites an indwelling peritoneal amniotic cavity shunt was placed. Despite functioning of the shunt, a fetal death in utero occurred.

Adult↗
PubMed1986

Long-term use of magnesium sulfate as a tocolytic agent.

Two patients in premature labor were treated continuously for six and 13 weeks with intravenous magnesium sulfate (MgSO4) for tocolysis. In each case, conventional therapy with intravenous and oral ritodrine failed to abate uterine contractions, and attempts to taper the MgSO4 were unsuccessful. Both pregnancies proceeded uneventfully otherwise, with normal fetal growth. Long-term MgSO4 may be a safe and efficacious alternative for occasional patients not responding to other modes of therapy for the treatment of premature labor.

Adult↗
PubMed1986

Antenatal diagnosis of recessive dystrophic epidermolysis bullosa: collagenase expression in cultured fibroblasts as a biochemical marker.

We performed fetoscopy and skin biopsy on a 19-week fetus at risk for recessive dystrophic epidermolysis bullosa (RDEB). Ultrastructural analysis of the tissue revealed dermolytic blister formation in the skin characteristic of the disease. To develop a biochemical test for use in antenatal diagnosis of RDEB, we established skin fibroblast cultures from the 20-week aborted fetus. The collagenase production by fetal RDEB fibroblast cultures was greater than seen in normal fetal fibroblast cultures. The concentration in culture medium from fetal RDEB cultures was 5.42 +/- 0.74 micrograms/ml (mean +/- SE) compared with 2.24 +/- 1.11 micrograms/ml in normal adult control cultures and 2.05 +/- 0.61 micrograms/ml in cultures from patients with other genetic forms of epidermolysis bullosa (p less than 0.025). In contrast, the concentration of collagenase in the fetal RDEB culture medium was not different from that seen in cell cultures from known patients with RDEB (5.34 +/- 1.12 micrograms/ml). Collagenase activity of the fetal RDEB medium was also increased approximately 3.5-fold. These data indicate that enhanced expression of collagenase by fetal RDEB skin fibroblasts can serve as a biochemical adjunct, and possibly an alternative, to morphologic examination of tissue for antenatal diagnosis.

Biopsy↗
PubMed1986

Combined pregnancy: the Mount Sinai experience.

Nine recent cases of coexisting intra- and extrauterine pregnancy at The Mount Sinai Medical Center are presented. The myriad of clinical presentations is exemplified in the postabortal, endometriosis, posttreatment; ovulation induction, and routine "rule-out ectopic" situations. A brief review of the literature follows detailing historical reports of diagnostic inaccuracy and delayed diagnosis. Several studies are cited supporting the difficulty of correctly diagnosing heterotopic pregnancy as well as factors which may predispose to it. The advantages and pitfalls of ultrasonography are mentioned as well as recommendations for early laparoscopic intervention when clinical history and ultrasound are suggestive. Caution is advised in those infertility patients who may undergo "routine" curettage at laparoscopy for ectopic pregnancy and thus, be at risk for inadvertent termination of an otherwise salvageable intrauterine pregnancy. This report further supports several other reviews in noting that the incidence of combined pregnancy may be much greater than formerly appreciated.

Adult↗
PubMed1985

A comparison of sonographic estimation of fetal weight and obstetrically determined gestational age in the prediction of neonatal outcome for the very low-birth weight fetus.

A comparison of sonographic estimation of fetal weight and obstetrically determined gestational age in the prediction of neonatal outcome for the very low-birth weight fetus was conducted in a study population of 122 fetuses. With stepwise logistic regression, obstetric gestational age was found to be the best predictor of neonatal death, while sonographic estimated fetal weight did not add significantly to this prediction. However, both variables were important in the prediction of adverse neonatal outcome (neonatal death together with major neonatal complications of prematurity.

Female↗
PubMed1985

The management of fetal hydrocephalus.

The management of 53 consecutive documented cases of fetal hydrocephalus is presented. Hydrocephalus was isolated in nine cases (17%) and associated with other abnormalities in 44 (83%). Our success in diagnosing abnormalities associated with hydrocephalus improved from the time period 1977 through 1981 to that of 1982 through 1983. In this series, management consisted of termination of pregnancy, 14 (26%); ventriculoamniotic shunt placement and cesarean section, two (4%); cephalocentesis and cesarean section, two (4%); cesarean section without cephalocentesis or ventriculoamniotic shunt placement, 18 (34%); cephalocentesis and vaginal delivery, nine (17%); and vaginal delivery without cephalocentesis, eight (15%). The outcomes were spontaneous abortion, 14 (26%); intrapartum death, eight (15%); postnatal death, 16 (30%); currently alive, 15 (28%). Current approaches to the management of fetal hydrocephalus are discussed, and areas of therapeutic uncertainty are delineated.

Abnormalities, Multiple↗