Biomedical subjects
Publications and source records attributed to L Bovicelli.
The management options available for fetuses with hydrocephalus are reviewed. These options include termination of pregnancy, judicious use of destructive procedures, early delivery by cesarean section and postnatal shunting, and placement of ventriculoamniotic shunts. The frequency of associated anomalies and the need for further clinical trials are stressed.
The intracranial anatomy of 351 normal fetuses, ranging from 15 to 42 weeks' gestational age, was investigated sonographically in an attempt to define the normal sonographic anatomy of the subarachnoid spaces during intrauterine development. The triangular velum, vein of Galen, ambient, interpeduncular, chiasmatic, Sylvian, and supracerebellar cisterns and the cisterna magna were easily recognized in the vast majority of cases as fluid-filled spaces following the contour of the brain. A large fluid layer, overlying the cerebral convexities, was seen in early gestation and subsequently disappeared. Evaluation of the subarachnoid cisterns in a fetus with ventriculomegaly allowed the prenatal diagnosis of communicating hydrocephalus. Knowledge of the normal sonographic anatomy of the subarachnoid spaces is useful both in avoiding misinterpretation of the normal sonogram and in the differential diagnosis of congenital hydrocephalus.
Real-time ultrasound equipment has the potential for investigating the fetal neural axis and allows the diagnosis of many anomalies arising from this area. Five cases of Dandy-Walker syndrome, one of the major causes of congenital hydrocephalus, were diagnosed antenatally. In all cases ultrasound allowed specific recognition of the defect in the cerebellar vermis. This defect connected the fourth ventricle to a posterior fossa cyst in four cases and to an occipital meningocele in one case. In three cases the diagnosis was made prior to viability, and the parents elected termination of pregnancy. In two cases recognized in the third trimester, neurosurgical care was provided soon after delivery.
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Doppler ultrasound investigation of cerebral blood flow velocity was performed in hydrocephalic infants through the anterior fontanelle. Systolic (S) and end-diastolic (D) frequency values recorded on the anterior cerebral artery were used to define the pulsatility index (PI) calculated from the equation PI=S-D/S. Comparison between systolic, end-diastolic and pulsatility index values of 50 normal infants and 10 hydrocephalic infants showed a statistically significant difference (P less than 0.05) for systolic and pulsatility index values. However, no significant difference was found for end-diastolic values. The authors believe that the phenomenon could be explained as an increase of the cerebrovascular compliance which counteracts the increase of the perivascular pressure in an attempt to maintain a normal cerebral blood flow. Therefore, the transfontanelle Doppler ultrasound technique may provide a useful and early tool in diagnosing cerebral blood-flow changes in hydrocephalic infants.
Women with the polycystic ovary syndrome were treated cyclically for two years with an oral oestrogen/progestogen combination of 50 mg of cyproterone acetate and 0.05 mg of ethinyloestradiol. Ovarian volume, ovarian texture and uterine size were monitored by ultrasound before, during and after treatment. Menstrual rhythm, ovulation and the degree of hirsutism were also studied clinically. A significant decrease in the ovarian volume and in the number of cystic areas was observed during treatment. Hirsutism was also markedly improved. Some of these beneficial effects persisted after treatment was stopped. The number of subjects who had regular, ovulatory cycles increased after stopping treatment. Growth of uterine muscle occurred during treatment.
The uterus and ovaries of 50 patients with polycystic ovarian disease (PCOD) and 30 eumenorrheic women were studied with a real-time ultrasound mechanical sector scanner. Uterine and ovarian volumes (UV and OV) and the OV/UV ratio were calculated, and ovarian morphology was classified as prevalently solid and cystic. Both ovaries were displayed in 44 of the PCOD and in 25 of the normal patients and appeared bilaterally solid, cystic, or with different morphology, respectively, in 43.2%, 47.7%, and 9.1% of cases in the former group and in 76%, 20%, and 4% in the latter group. Statistically significant differences between normal and PCOD patients were found in OV, UV, and OV/UV ratio. Bilaterally enlarged ovaries with multiple tiny cysts, the classic ultrasonographic picture of the polycystic ovary, were found in only 16 (36.3%) of the PCOD cases, while 34 (77.3%) had an OV/UV ratio greater than 1 standard deviation above the mean. Four ultrasonographic ovarian patterns were observed in the PCOD patients: enlarged cystic; enlarged solid; normal-sized cystic; and normal-sized solid. These findings emphasize the need for a reconsideration of the ultrasonographic criteria of PCOD.
Real time ultrasonography of the pelvic organs was performed on 114 normal premenarcheal girls aged between 2 years and 13 years 11 months. Values were obtained for total uterine length, anteroposterior diameters of the corpus and cervix, corpus/cervix ratio, and uterine and ovarian volumes and the resultant data were grouped according to age. It was concluded that there is no change in uterine size until approximately 7 years of age. Then the uterus begins to enlarge, both in prepubertal girls, in whom this is an age related function, and in pubertal girls, whose uterine growth is influenced not only by age but also by size and, independently of these two factors, by oestradiol concentrations. The onset of a modification in uterine morphology with a greater enlargement of the corpus than the cervix is also seen at age 7 years. Ovarian maturation begins in the very first years of life and, even in pubertal girls, seems to be influenced by age only and not by hormonal stimuli.
Age-related changes in uterine and ovarian morphology and size were studied in 114 normal premenarcheal girls using a real-time mechanical sector scanner. Reference growth values were obtained for total uterine length, anteroposterior diameters of the corpus and cervix, corpus/cervix ratio, and uterine and ovarian volumes. Up to 7 years of age uterine size was not influenced by age and there was a relative predominance of the cervix over the corpus. Thereafter the uterus underwent a regular increase in size and the corpus gradually became larger than the cervix. Ovarian volume was relatively stable up to 5 years, when regular age-related growth started, associated with an increase in cystic functional changes in the ovary. As uterine and ovarian morphology and size are reliable indicators of the degree of sex-hormone stimulation, real-time ultrasound offers a rapid method of studying normal and abnormal pubertal development in girls.
40 women who underwent amniocentesis were administered the Symptom Questionnaire to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms and hostility significantly decreased after the results of the procedure were communicated to the patient, replicating the findings in a previous study. Psychological distress, however, returned to the initial levels in the third trimester of pregnancy. Women whose only indication for amniocentesis was an age of 35 years or older displayed significantly higher hostility and somatic symptoms and less contentment before the procedure than the other women. Subsequently these differences lost their significance and the two groups showed similar patterns of psychological distress throughout the pregnancy.
Follicular growth was monitored in 19 patients during 20 spontaneous and induced cycles by different examiners in a blind trial using a real-time linear array, a mechanical sector scanner, and a gray scale compound scanner. This was done to compare the efficacy of different ultrasound equipment in the study of ovarian cycle. The mean maximum follicular diameter was calculated with each equipment and the quality of follicular images was classified as poor, sufficient, and good as defined in the study. The overall best results in ovary and follicle visualization were achieved with the real-time sector scanner. Measurements of the same dominant follicle using realtime and compound scanners were highly correlated (linear array/compound scanner: r = 0.894, p less than 0.001; sector/compound scanner: r = 0.928, p less than 0.001). Following ovulation, some unexpected differences in the distribution of the postovulatory patterns were noted with each instrument. Except in difficult patients, real-time examination, preferably performed using a sector scanner, appears to be the optimal first ultrasonic approach for monitoring follicular growth.
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Fifty women undergoing amniocentesis and a matched control group of pregnant women were administered the Symptom Questionnaire to evaluate changes in psychologic distress. They were divided into subgroups according to previous experiences of pregnancy (no previous pregnancy, previous live births and no terminated pregnancy, previous terminated pregnancy). The amniocentesis subgroups did not show changes in anxiety, depression and somatic symptoms significantly different from those of the corresponding control subgroups. Only hostility was characteristic of amniocentesis, and its patterns varied according to the previous history of pregnancy.
Fifty women who underwent amniocentesis and a matched control group of pregnant women were administered the Symptom Questionnaire to evaluate changes in distress. Anxiety, depression, and somatic symptoms had significantly decreased after the results of amniocentesis were communicated to the patient, but the decrease was similar in the normal control women. Hostility was higher in the amniocentesis group and decreased to normal levels after amniocentesis was performed, even before the results were communicated to the patient.
A new case of pregnancy in a 29-year-old woman with trisomy 21 is described. She gave birth to a male infant, chromosomally and phenotypically normal, who died the day after delivery due to prematurity. Thirty pregnancies of 26 affected mothers, including the present woman, resulted in 10 children with Down syndrome, 18 children (1 set of twins) without Down syndrome, and 3 spontaneous abortions. Although rare, pregnancies in women with Down syndrome could become more frequent, increasing the importance of genetic, reproductive, and obstetric problems. These problems are reviewed with special reference to the occurrence of nonspecific abnormalities in chromosomally normal children, difficulties in labor and delivery, and frequency of prematurity and low birth weight.
A series of 237 patients in the first trimester of pregnancy were examined to derive normal growth curves for fetal crown-rump length (CRL) and biparietal diameter (BPD) using sector scanner real-time ultrasound equipment. Conventional B-scan CRL measurements were obtained from 50 of these patients: In 41 (82%), the values fell within a range +/- 5 mm of those of real-time. Another group of 97 patients between 7 and 13 wk of gestation was then examined in a blind trial to confirm the accuracy of real-time measurements in estimating gestational age. An estimate was made in 95% of cases to within 4.6 days with CRL and to within 5 days with BPD. A similar comparison was made with both of these dimensions using a comparative nomogram, giving a prediction within 3.9 days in 95% of cases. This method is now used routinely.
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