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Biomedical subjects

J Fitzsimmons

Publications and source records attributed to J Fitzsimmons.

36 records · Page 2Linked to original sources
PubMed1989

Sonography of placental abnormalities and oligohydramnios in women with elevated alpha-fetoprotein levels: comparison with control subjects.

To evaluate the relationship of placental and amniotic fluid findings to elevated maternal serum alpha-fetoprotein (MS-AFP) levels, we compared sonograms made between 18 and 24 weeks gestational age in 76 women with elevated MS-AFP levels with sonograms of a control group. Patients with fetal malformations, incorrect dates, twins, or lack of follow-up were excluded. Overall, 27 (36%) of 76 patients with elevated MS-AFP levels had placental or amniotic fluid abnormalities compared with only three (3%) of 87 control subjects. Significant differences (p less than .01) were noted in the frequency of periplacental hemorrhage (9% vs 0%), intraplacental sonolucencies greater than or equal to 1.5 cm in diameter (18% vs 3%) and moderate or severe oligohydramnios (17% vs 0%). More patients with elevated MS-AFP levels had placenta previa (4%) or placental thickness greater than or equal to 3.5 cm (12%) than did those in the control group (1% and 5%, respectively), although these differences did not reach statistical significance. Seven (26%) of the 27 patients had more than one abnormality. We conclude that placental and/or amniotic fluid abnormalities are frequently shown on sonograms in women who are examined because of elevated MS-AFP levels.

Amniotic Fluid↗
PubMed1989

Chromosomal abnormalities in fetuses with omphalocele. Significance of omphalocele contents.

Twenty-six consecutive fetuses with a sonographically detectable omphalocele and known karyotype were reviewed to identify risk factors that might be associated with chromosomal abnormalities. Risk factors that were analyzed included contents of the omphalocele sac, maternal age, fetal sex, sonographically detectable concurrent anomalies, and any major concurrent anomaly. Chromosomal abnormalities were found in 10 cases (38%) from trisomy 18 (n = 4), trisomy 13 (n = 4), trisomy 21 (n = 1), or 45, X (n = 1). The absence of liver from the omphalocele sac (intracorporeal liver) was strongly associated with an abnormal karyotype; chromosomal abnormalities were present in all 8 fetuses with an intracorporeal liver compared to 2 of 18 fetuses with an extracorporeal liver (p less than .0001, two-tailed Fisher exact test). Other risk factors that were statistically associated with chromosomal abnormalities included advanced maternal age (greater than or equal to 33 years, p = .03) and sonographically detectable concurrent malformations (p = .05). We conclude that sonographic findings can help determine the relative risk of chromosomal abnormalities in fetuses with omphalocele; abnormal karyotypes were significantly associated with the absence of liver from the omphalocele sac and sonographically detectable concurrent malformations in this series. Sonographers should also be aware that omphaloceles that contain bowel alone tend to be small and can be missed or mistaken for other abdominal wall defects (gastroschisis or umbilical hernia).

Adolescent↗
PubMed1989

Choroid plexus cysts in fetuses with trisomy 18.

An association between fetal choroid plexus cysts and trisomy 18 has been suggested. However, the prevalence of such cysts in aneuploid fetuses is unknown. To determine this frequency, we studied 14 fetuses with trisomy 18 examined at the Central Laboratory for Human Embryology. Five fetuses were found to have choroid plexus cysts on postmortem ultrasound examination. All those with cysts were earlier than 26 weeks in gestation, and the prevalence among second-trimester fetuses was 71.4%. In contrast, such cysts are reported in less than 1% of the general population of second-trimester fetuses. Thus, choroid plexus cysts are common in trisomy 18, and the finding of such cysts on a second-trimester ultrasound examination should suggest further evaluation, including chromosome analysis.

Choroid Plexus↗
PubMed1989

Mechanism of graft failure in HLA-matched and HLA-mismatched bone marrow transplant recipients.

This report characterizes the mechanism of graft failure in five patients who received allogeneic marrow depleted of T cells in vitro using anti-T12 (CD6) monoclonal antibody and rabbit complement. This group of five patients represents all patients who experienced early graft failure in a larger group of 59 consecutive patients given T12 depleted marrow over a 5-year period. Although all patients received ablative pre-transplant conditioning including total body irradiation (12-14 Gy) graft failure was more frequent in patients without genetically HLA-identical donors (four of 11 patients) than in patients with HLA identical sibling donors (one of 48 patients). In patients without genotypically identical donors, graft failure was observed with variable degrees of genetic disparity including two patients with HLA haplotype-mismatched sibling donors, one patient with a phenotypically HLA-matched parental donor, and one patient with an HLA-matched unrelated donor. In patients with both HLA identical and non-identical donors, results of immunophenotypic analysis demonstrated that early graft failure was associated with peripheral lymphocytosis with T cells expressing CD2, CD3, CD5, CD6, CD8 and Ia antigens. Direct cytotoxicity studies demonstrated specific lysis of donor cells by circulating lymphocytes and further analysis indicated that effector cells were derived from the recipients and not donors. Taken together, these results suggest that these allogeneic grafts did not 'fail', but rather that residual host cytotoxic T cells were responsible for active rejection of donor marrow.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The Dandy-Walker malformation prenatal sonographic diagnosis and its clinical significance.

To determine the usual sonographic findings and clinical significance of the Dandy-Walker malformation (DWM) identified in utero, we reviewed seven proven cases diagnosed by prenatal ultrasound during a 6-year period. All patients demonstrated complete or partial absence of the cerebellar vermis and a posterior fossa cyst. Other central nervous system (CNS) findings included hydrocephalus (five cases) and agenesis of the corpus callosum (one case). Extra-CNS abnormalities were prospectively identified in 3 of 4 fetuses with multiple anomalies. Chromosomal analysis was performed on all four fetuses with multiple extra-CNS anomalies, yielding 2 abnormal karyotypes (trisomy 18 and mosaic trisomy 13). Fetal mortality was directly dependent on the presence of extra-CNS anomalies. Five fetuses ultimately died, including all four with multiple extra-CNS anomalies. The remaining two patients are alive at 1.5 and 6 years of age. We conclude that DWM has a distinctive sonographic appearance that can be identified by prenatal ultrasound and that identification of DWM should initiate a careful search for concurrent anomalies as well as consideration of chromosomal analysis.

Abnormalities, Multiple↗
PubMed1988

Significance of a single umbilical artery in fetuses with central nervous system malformations.

To determine whether the presence of a single umbilical artery (SUA) is useful information for evaluating fetuses with known central nervous system (CNS) malformations, the present study reviewed 107 consecutive cases of fetal CNS malformations (hydrocephalus, meningomyelocele, Dandy-Walker malformation, and holoprosencephaly) identified by prenatal sonography. Of the 107 fetuses studied, 20 (18%) had a SUA noted at the time of delivery or autopsy and 87 (81.3%) had two umbilical arteries. Of the 20 fetuses with a SUA, six were prospectively recognized on sonography, six were identified retrospectively, and eight could not be evaluated due to oligohydramnios or technical factors. All 20 fetuses with a SUA had extra-CNS anomalies and 8 of 15 (53%) fetuses tested had chromosomal abnormalities. These rates were significantly higher (P less than .05) than observed in 87 fetuses with two umbilical arteries who had extra-CNS anomalies in 35 cases (39%) and chromosomal abnormalities in 11 of 45 (24%) cases tested. We conclude that identification of a SUA in combination with a CNS anomaly should suggest the presence of additional extra-CNS anomalies and is an indication for chromosomal analysis.

Abnormalities, Multiple↗
PubMed1988

Perinatal management of gastroschisis.

Fetal anterior abdominal wall defects will be recognized with increasing frequency with the widespread use of maternal serum alpha-fetoprotein screening. A clear distinction must be made between omphalocele and gastroschisis, and counseling and obstetric management must be specific for each. Sixteen cases of gastroschisis were identified antepartum and followed through delivery between 1980-1986. There was one antepartum fetal death before institution of a protocol to deliver all such affected fetuses at 36 weeks. One patient was lost to follow-up. There were no antenatal or neonatal deaths among the 14 infants seen subsequently, all of whom were delivered by cesarean section. Only one infant had an additional nongastrointestinal defect (mild hearing loss), and all 14 were of appropriate weight for gestational age. Twelve infants had a single operative procedure for repair of the defect, with a mean hospital stay of 19.6 days. Scheduled cesarean delivery at 36 weeks, after confirmation of fetal lung maturity, presents the infant to the pediatric surgeon under controlled conditions and shortens neonatal hospital stay.

Cesarean Section↗
PubMed1986

Value of magnetic resonance imaging in assessing bone destruction in head and neck lesions.

We utilized low-field magnetic resonance imaging (MRI) to evaluate 12 patients with head and neck lesions and suspected skull base or facial bone destruction. All except one had high resolution computed tomography (CT). MRI was performed on a 0.15 tesla (low-field) resistive unit, with routinely good resolution due mainly to the use of specially designed rf receiver coils (surface coils). T1 and T2 weighted spin echo images were performed in all cases. In three instances axial, coronal, and sagittal images were done. All CTs were done with high resolution techniques on state-of-the-art equipment. Comparison of the CT and MR images (at low-field strength) showed that MRI's main strength lies in its freedom to perform images in any plane and to visualize intracranial lesions with early brain involvement. Otherwise, the two modalities are comparable. Bone destruction seen on CT was always detectable on MRI, although CT is clearly superior in resolving bone detail. MRI is recommended when direct coronal CT scans are not obtainable to evaluate superiad tumor extension. The improved visualization of nasopharyngeal soft tissue and cavernous sinus region is likely to make MRI the examination of first choice in evaluating lesions of the nasopharynx, skull base, and cavernous sinus.

Adult↗
PubMed1986

Pregnancy in a drug-abusing population.

Substance abuse in pregnancy places both mother and infant at extremely high risk. There is little information, however, about the impact of changing patterns of drug use and improvements in medical technology on pregnancy outcome. The Family Center Program utilizes a team approach to provide counseling, support, and education as well as complete medical care for substance-abusing pregnant women. We reviewed the records of women seen in the Family Center Program from 1981 to 1983 to evaluate the effect of intervention on pregnancy outcome. Complications, including prematurity, growth retardation, intrauterine fetal demise, and neonatal abstinence, were common, although early prenatal care and frequent visits appear to reduce the risk of low birth weight infants. Uncorrected perinatal mortality was 11/163 (67/1,000). Compared to earlier experience in this program, few women delivered with no prenatal care. Thus a program designed specifically for the needs of these women is successful in increasing the number seeking prenatal care and appears to improve pregnancy outcome. Despite this, serious problems are common and further improvement seems unlikely unless such women can be maintained in a stable, drug-free environment during their pregnancies.

Adult↗
PubMed1985

Comparison of bursting strength between suture- and laser-anastomosed vessels.

The bursting strength of suture- and laser-assisted vascular anastomosis (LAVA) was assessed using a standard rat femoral artery model. Vessels were studied from 1 hour to 3 weeks. LAVA arteries consistently demonstrated lower bursting strengths than those of suture controls, with significant differences at 1 day, 3 days (P less than 0.001), and 1 weeks (P less than 0.01). Return of strength occurred in a pattern reminiscent of wound-healing models. Relatively low bursting strengths at 1 and 3 days in the LAVA cohort may explain the high aneurysm rate reported to complicate this procedure.

Animals↗
PubMed1982

Parental consanguinity and the Majewski syndrome.

We report a female infant with the Majewski syndrome, one of a group of conditions characterised by short ribs, polydactyly, dwarfism, and early neonatal death. This syndrome seems to be extremely rare, with only five well documented cases reported and, including this case, nine recorded in all. The Majewski syndrome is considered to be recessively inherited, and this report adds further support to this hypothesis, as the infant was born to consanguineous parents.

Abnormalities, Multiple↗
PubMedDate not supplied

MR imaging of uterine leiomyomas and their complications.

Magnetic resonance (MR) imaging in eight patients with uterine leiomyomas and in eight normal female volunteers clearly depicted the size, shape, and position of the corpus uteri and demonstrated adjacent anatomic structures to good advantage in transaxial, coronal, and sagittal planes. Spin echo (SE) with short repetition time (TR) and short echo time (TE) values was judged best for overall delineation of anatomic structures. Longer TR and TE times were used to differentiate myometrium from endometrium. Detection and characterization of complications of uterine myomas were facilitated by the use of multislice/multiecho SE techniques, but in general TE values greater than 60 ms were not needed to differentiate endometrium from myometrium and in most cases did not improve the MR depiction of abnormalities. Calculated T1 and T2 relaxation times from this preliminary study do not demonstrate a clear advantage in further characterizing uterine abnormalities.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging of the extremities. I. Technique for depiction of normal anatomy.

In 3 adult volunteers, the appropriate technique for depicting the normal anatomy with magnetic resonance imaging was tested. At 0.15 T, the images obtained in different anatomic planes with different pulse sequences and radiofrequency coils were compared. Spin echo technique with a repetition time of 500 ms and an echo time of 30 ms appeared as a good compromise, giving excellent depiction of both soft tissues and joints, especially if a surface coil was used. The optimum anatomic plane varied with the structures examined.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging of the extremities. II. T1 and T2 relaxation times of muscle and fat. Normal values, reproducibility and dependence on physiologic variations.

In a resistive magnetic resonance imaging system, the T1 and T2 values of muscle and fat were calculated in 2 volunteers, at rest and during venous and arterial stasis, postischemic hyperemia and dehydration. The values found at rest were reproducible from one occasion to another and there were no significant differences between values in the arms and legs. Dehydration induced a slight increase in the T2, otherwise there was no change during stasis, hyperemia or dehydration.

Adipose Tissue↗