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Biomedical subjects

Roy A Filly

Publications and source records attributed to Roy A Filly.

24 records · Page 2Linked to original sources
PubMed2002

Sonographic evaluation of liver nodularity: Inspection of deep versus superficial surfaces of the liver.

PURPOSE: We determined the diagnostic performance of assessing the nodularity of deep versus superficial surfaces of the liver as a predictor of cirrhosis. METHODS: One sonologist retrospectively reviewed the sonograms of 100 patients at risk for cirrhosis based on clinical data and laboratory tests. A second sonologist reviewed the sonograms of a subset of 25 patients to assess for inter-reader variability, while the first sonologist re-reviewed the sonograms of a different subset of 25 patients for intrareader variability. Sonograms of all patients were obtained with standard sector- or curved-array transducers. Biopsy confirmation of cirrhosis was used as the standard for diagnostic accuracy. RESULTS: Fifty of the 100 patients had a pathologic diagnosis of cirrhosis. The sensitivity of inspection of the deep surface versus the superficial surface was 86% versus 53% (p = 0.0003), respectively. Sensitivity was not dependent on pathologic type. Intrareader agreement was better for deep than for superficial surface observations. The overall inter-reader agreement was fair and comparable for both deep and superficial surface methods. CONCLUSIONS: The sensitivity for detecting cirrhosis based on surface nodularity is greater for deep than for superficial surface observations. As the prevalence of disease increases, the accuracy of assessment of the deep surface in predicting cirrhosis increases.

Adolescent↗
PubMed2002

US evaluation of fetal growth: prediction of neonatal outcomes.

PURPOSE: To determine whether fetal growth measured at serial ultrasonographic (US) examinations can predict neonatal morbidity, independent of whether gestational age is known. MATERIALS AND METHODS: Women (n = 321) who had singleton pregnancies and underwent two or more second- or third-trimester obstetric US examinations were included in a retrospective cohort analysis. Inadequate fetal growth was defined as growth at or below the 10th percentile. The relative risk of each poor outcome was calculated for fetuses with inadequate growth, compared with the risk for fetuses with normal growth. RESULTS: Inadequate fetal growth was associated with 3.9 times the risk of a birth weight less than 2,500 g, 17.7 times the risk of a birth weight less than the 3rd percentile for gestational age, 2.3 times the risk of preterm birth, 2.6 times the risk of a long newborn hospital stay, and 3.6 times the risk of neonatal intensive care unit admission. After adjusting for confounding variables, including fetal weight, fetal growth remained a significant predictor of small birth size and poor outcomes. Inadequate growth predicted the risk of poor outcomes, even when gestational age was unknown. When inadequate growth was used to identify fetuses at risk, 21%-67% of neonates who were small at birth or had poor outcomes were identified at false-positive rates of only 5%-9%. For all outcomes, inadequate growth enabled identification of more fetuses with poor birth outcomes than low estimated fetal weight. CONCLUSION: Morbidity is significantly increased among fetuses who demonstrate less than expected growth. Growth between two US examinations can be used to estimate the risk of neonatal morbidity, even when gestational age is unknown.

Adult↗
PubMed2002

Sonographic detection of gallbladder duplication: two cases discovered in utero.

OBJECTIVE: To report the in utero diagnosis of a duplicated gallbladder. METHODS: Obstetric sonography was performed at 2 separate referral centers. A comprehensive level 11 examination was performed at each center. RESULTS: In both cases, a duplicated gallbladder was detected in utero without the presence of other anatomic abnormalities. CONCLUSIONS: Gallbladder duplication, although uncommon, should be considered when an additional cystic structure is seen in the right upper quadrant. Recognition of the presence of a duplicated gallbladder, a relatively benign condition, prevents invoking a more serious diagnosis, such as a choledochal or duodenal duplication cyst.

Adult↗
PubMedDate not supplied

Chorioamniotic membrane separation following fetal surgery.

OBJECTIVE: As the volume of fetal surgery cases has steadily increased, an increasing incidence of chorioamniotic membrane separation (CMS) has been noted. Due to the potential adverse consequences from this abnormality, we reviewed the last decade of experience with fetal intervention at our institution and examined the incidence and outcomes of fetuses given this diagnosis. STUDY DESIGN: A retrospective chart review of 75 fetal surgery cases at our institution was performed. Variables analyzed included preoperative, operative, and outcome data. Postoperative ultrasounds were evaluated for the presence of CMS. RESULTS: Excluding operative deaths, the incidence of CMS was 47%. There were significant differences (p<0.05) in time to delivery (7 vs 5 weeks), cases using a perfusion pump (80% vs 60%), and number of trocars (2.13 vs 1.54) in cases of CMS versus those without. Ultrasounds showed normal to high levels of amniotic fluid in 97% of cases. There was an increased incidence of premature rupture of membranes (63% vs 45%), preterm labor (57% vs 38%), and chorioamnionitis (29% vs 15%) with CMS, but no difference in mortality rate. CONCLUSION: CMS is a frequent finding following fetal surgery. It is associated with significant morbidity but is manageable with close follow-up in a hospital setting. Following fetal surgery, the finding of CMS can be a life-threatening complication that warrants further study to understand its etiology and prevention.

Amnion↗