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Biomedical subjects

M Bronshtein

Publications and source records attributed to M Bronshtein.

At least 37 records · Page 2Linked to original sources
PubMed1998

Prenatal sonographic diagnosis of nasal malformations.

The aim of this study was to describe the prenatal detection of fetal nasal abnormalities by ultrasound. Transvaginal and transabdominal sonography was used for the detection of fetal malformations in 25, 114 cases. The fetal nose was visualized in all the fetuses in an oblique section and in the lateral profile of the face. Fifteen cases of fetal nasal malformations were detected between the 12th and 27th week of gestation. All but two, who had dilatation and curettage, were confirmed by postabortal or postnatal examination. Dyskaryosis (trisomies 18 and 21, triploidy, and tetrasomy 12 p) was diagnosed in six cases (40 per cent). The nasal malformations were isolated in four cases, one of them being associated with tetrasomy 12 p. The fetal nose should also be a target in the prenatal sonographic screening for malformations in the early mid-trimester. The incidence of fetal nasal anomalies is 1:1674 fetuses (15:25, 114). The fetal nose should be visualized by ultrasound in both an oblique plane and a lateral profile to identify its abnormalities.

Adult↗
PubMed1998

Transvaginal sonographic measurement of fetal lingual width in early pregnancy.

Our objective was to construct a nomogram of the fetal lingual size early pregnancy and to assess the size of the tongue in abnormal fetuses. The lingual width was measured by using transvaginal ultrasonography in 80 normal fetuses at 13 and 18 weeks' gestation. In addition the tongue was measured in 22 fetuses at these gestational ages who had an abnormal karyotype or oro-facial malformations. A linear relationship was found between the lingual width and gestational age in normal fetuses. The lingual size was within the normal range in cases of trisomy 13, trisomy 21 and Turner syndrome. A small tongue was observed in fetuses with micrognathia. Correlation between lingual width and gestational age was observed in early pregnancy. The relationship between the size of the tongue and oro-facial malformation needs further evaluation.

Chromosome Aberrations↗
PubMed1998

Isolated large fourth ventricle in early pregnancy--a possible benign transient phenomenon.

Twenty-one fetuses with an enlarged fourth ventricle were detected by ultrasound at 14-16 weeks' gestation. No other central nervous system anomalies were observed and a normal size fourth ventricle was noted in all cases on follow-up scans at 22-23 weeks' gestation. Five fetuses had associated structural anomalies: a single umbilical artery in two cases, non-septated cystic hygroma in two cases and ventricular septal defect in one fetus. All fetuses had a normal brain sonogram after delivery. Nineteen newborns who were followed up to the age of one year had no developmental problems. It is concluded that an isolated enlarged fourth ventricle might be a physiological variant in early fetal life.

Cerebellum↗
PubMed1997

Single umbilical artery--right or left? does it matter?

Ultrasonographic prenatal diagnosis of single umbilical artery (UA) is well documented, but the exact siding of the single UA and its correlation with the occurrence of other congenital malformations and the outcome of the baby remain unclear. We report our experience with 46 cases of prenatally diagnosed single UA. This is the first prospective study of a large number of consecutive pregnancies in which the side of the existing artery was identified in fetuses with a single UA. Most of the cases were identified by transvaginal sonography at 14-16 weeks' gestation. A right artery was detected in 25 fetuses (54.3 per cent), and a left artery in 21 cases (45.7 per cent). Six fetuses (13 per cent) had associated anomalies, five of them in the urinary system. No correlation was found between the type or severity of the malformations and the side of the missing (or existing) UA. In our experience, the exact location of the single UA can be reliably determined by ultrasonography from the beginning of the second trimester of pregnancy. The selection process of the missing (or existing) vessel is likely to be random, even though a right single artery was seen slightly more often.

Abdomen↗
PubMed1997

Early sonographic diagnosis of fetal small left heart ventricle with a normal proximal outlet tract: a medical dilemma.

A small left heart ventricle with a normal outflow tract was detected by transvaginal ultrasound in 16 fetuses at 14-16 weeks' gestation. A high incidence of associated anomalies was found in these fetuses, namely coarctation of the aorta (5), abnormal karyotype (4), cystic hygroma (4), and ventricular septal defect (3). The incidence of extracardiac anomalies was probably even higher, since post-mortem and karyotype examinations were not performed in all cases of termination of pregnancy. In patients who decided to continue the pregnancy (7), a normal left ventricle was observed in four cases on follow-up scans. Three of these neonates were normal after delivery and one had several cardiovascular anomalies. Out of three fetuses with asymmetric ventricles on follow-up scan, one infant had a normal outcome. The high incidence of associated fetal anomalies in cases of a small left ventricle raises a medical dilemma in counselling the parents.

Female↗
PubMed1997

The influence of prenatal ultrasound on the prevalence of congenital anomalies at birth.

The objectives of the study were (1) to assess whether prenatal ultrasound examinations affected the prevalence of congenital anomalies at birth and the incidence of terminations of pregnancy for fetal anomalies and (2) to examine the detection rate of the main fetal anomalies. We studied all births and stillbirths with congenital defects, and all terminations of pregnancy for fetal anomalies in the Rambam Medical Center during a 5-year period (1989-1993) and correlated them to ultrasound findings. There were 23439 births during the study period. The incidence of newborns with anomalies decreased from 1.95 to 1.34 per cent (P < 0.01). The incidence of termination of pregnancy because of fetal anomalies increased from 0.35 to 0.83 per cent (P < 0.003) and the detection rate of malformations increased from 53.94 to 79.60 per cent (P < 0.001). It is concluded that terminations of pregnancy after ultrasound detection of fetal anomalies had an impact on the prevalence of anomalies in newborns. There was also continuing significant improvement in the detection rate of ultrasound examinations.

Abortion, Therapeutic↗
PubMed1997

Prenatal sonographic diagnosis of vermal agenesis.

Agenesis of the vermis as detected during gestation by ultrasonography may indicate the existence of various malformation arrays or syndromes. We report on our observations of five cases of complete vermal agenesis that were detected at 22-31 weeks of gestation. All had a vertex presentation and transvaginal sonography established the diagnosis of vermal agenesis. Two of the vermal agenesis cases had no associated anomalies outside the central nervous system (CNS). In one, the cerebellar cleft was the only abnormality present and the other also had lobar holoprosencephaly. The three remaining fetuses had trisomy 13 and featured various additional extra-CNS anomalies. The association of complete vermal agenesis and trisomy 13 has not been previously reported. Our experience with this series suggests that supplementation with vaginal fetal sonography is a valuable tool for obtaining a more accurate view of the posterior fossa whenever a cyst or a cyst-like abnormality is detected by transabdominal sonography. A finding of isolated vermal agenesis appears to mandate a careful search for additional anomalies and the performance of karyotype analysis.

Cerebellar Diseases↗
PubMed1997

Prenatal sonographic findings in 187 fetuses with Down syndrome.

We determined the type and frequency of abnormal sonographic findings in 187 Down syndrome fetuses. Examinations were performed transvaginally or transabdominally between 9 and 28 weeks' gestation. Consecutive scans performed prior to knowledge of the fetal karyotype (n = 144) were analysed separately for one of the participating centres. In 93 fetuses (49.7 per cent), a total of 138 abnormalities were observed. The most commonly detected anomalies were cystic hygroma and increased nuchal fold thickness (30.5 per cent), hydrops (9.6 per cent), cardiac defects (7.5 per cent), pyelectasis or hydronephrosis (5.9 per cent), echogenic bowel (4.8 per cent), and a large variety of internal organ abnormalities (16.0 per cent) which are not typically associated with Down syndrome. Two anomalies or three anomalies in the same fetus were observed in 21 and 5 fetuses, respectively. No patterns of concurrent malformations were apparent among these fetuses. Sensitivity for Down syndrome detection by ultrasound scans performed without knowledge of the fetal karyotype was 24.1 and 42.6 per cent before 13 weeks and between 14 and 23 weeks, respectively. We conclude that structural abnormalities are frequently observed in Down syndrome fetuses, but many sonographic findings are not typically associated with this syndrome.

Abdomen↗
PubMed1997

Ultrasound imaging of fetal neck anomalies: implications for the risk of aneuploidy and structural anomalies.

This study summarizes 24,000 transvaginal ultrasound examinations which were performed in a predominantly low-risk population at 14-16 weeks' gestation. 1254 (5.2 per cent) fetuses had a nuchal fold or a non-septated cystic hygroma. Of these fetuses, 140 (11.1 per cent) had additional structural anomalies. Cardiovascular anomalies were the most commonly detected structural malformations. Forty-three (3.4 per cent) fetuses were aneuploid. Trisomy 21 was the most common chromosomal anomaly (n = 27). Aneuploidy was significantly more common in fetuses who had a nuchal finding and an associated structural anomaly. The prevalence of nuchal fold and non-septated cystic hygroma, as well as the incidence of their associated structural anomalies, was similar. Based on these data, it is concluded that a complete ultrasonic survey of the fetus and karyotyping are advocated in fetuses with a nuchal abnormality, irrespective of maternal age or triple serum screening results.

Adolescent↗
PubMed1997

Caution: prenatal clubfoot can be both a transient and a late-onset phenomenon.

Clubfoot (talipes equinovarus) is a common orthopaedic malformation that can be accurately diagnosed prenatally. The study was conducted to investigate possible in utero visualization of transient and late-onset clubfoot. Early (13-16 weeks' gestation) prenatal transvaginal sonographic diagnosis of clubfoot deformity was made in 36 cases during the study period. Only those cases where follow-up examination revealed different sonographic findings were considered. The results showed that seven cases of transient (as well as relapsing) clubfoot were identified. In 4 of 7 cases, the clubfoot resolved (all after more than 10 min of observation) during the same examination. In the fifth and sixth cases, it initially resolved, later reappearing in follow-up examinations (20 and 22 weeks' gestation). In the seventh case, the clubfoot persisted for two consecutive examinations (2 weeks apart each) and later disappeared. In addition, six late-onset (22-24 weeks' gestation) clubfoot cases were identified during the study period. Although infrequent, in utero clubfoot can be both a transient and a late-onset phenomenon. Over- and under-diagnosis are potential hazards in these situations.

Clubfoot↗
PubMed1997

Ultrasonography of fetal heart failure in early gestation.

Cardiac dysfunction was observed with transvaginal ultrasound in 12 fetuses at 13-17 weeks' gestation. Impaired contractility of the heart and significant reduction of the left ventricular fractional shortening were noted in these fetuses. Three of the fetuses also had supraventricular tachycardia. Many of the fetuses had cardiomegaly, oligohydramnios, a thick placenta, or associated cardiac and structural anomalies.

Cardiomegaly↗
PubMed1996

Early sonographic diagnosis of fetal midline disruption syndromes.

This is a study of different severe fetal body wall defects and other abnormalities which were observed by transvaginal ultrasonography in six fetuses at 11 4/7 to 15 weeks' gestation. The main abnormalities were acrania, kyphoscoliosis, neural tube defect, ectopia cordis, diaphragmatic hernia, and ventral wall defect with exstrophy of the intestine, liver, and kidneys. A normal amniotic sac was noted in three cases. In one case, the amniotic sac could not be defined and in the other two cases, some of the abdominal contents were located outside the amniotic sac. The possible aetiology of these fetal malformations is discussed.

Abdominal Muscles↗
PubMed1996

Multiple fetal intracardiac echogenic foci: not always a benign sonographic finding.

Isolated left-sided echogenic foci in the fetal heart are considered as a benign condition, probably representing a normal variant of the development of papillary muscles. The objective of the present study was to evaluate the incidence and significance of multiple or diffuse echogenic foci in the fetal heart. We analysed retrospectively 25 725 ultrasound examinations conducted for fetal malformations between 12 and 24 weeks' gestation. In the study group, echogenic intracardiac foci were observed in 44 cases (0.17 per cent). In 35 fetuses, these foci were confined to the region of the papillary muscles/chordae tendinae as an isolated finding in the left side of the heart. All these fetuses had an uneventful neonatal follow-up. However, in nine of these cases, diffuse echogenic foci were demonstrated in various regions of the fetal heart, five of them with involvement of the right ventricle. In five of the nine cases, other major pathologies were found. In one case, a missed abortion occurred and in one case of early termination of pregnancy, calcifications were demonstrated in the endocardium on histological examination. Only in two of the nine fetuses was the outcome uneventful. Our findings suggest that diffuse echogenicity in the fetal heart, especially when the right ventricle is also involved, may signal a poor prognosis and deserves a further search for associated pathologies. This is in contrast to the benign character of an isolated left-sided echogenic focus.

Adult↗
PubMed1996

Early sonographic detection of fetal intestinal obstruction and possible diagnostic pitfalls.

We present five fetuses at 15-17 weeks' gestation with a sonographic diagnosis of intestinal obstruction. Dilation of the intestine was the presenting sonographic finding in fetuses with a volvulus and/or anal atresia. Two of the fetuses also had other abnormalities. Intestinal peristalsis may be observed in early pregnancy as transient dilation of intestinal segments. Sonographers are cautioned about a false-positive diagnosis of intestinal obstruction in such cases.

False Positive Reactions↗
PubMed1996

Early sonographic findings suggestive of the human fetal tail.

The prenatal diagnosis of a human tail was suggested in six fetuses with ultrasound findings of an echogenic protrusion in the lumbo-sacral region. All fetuses were at 14-16 weeks' gestation. The ultrasound findings disappeared in all cases at 22-23 weeks. Dermal abnormalities such as pilonidal sinus, deep dimples, and scarred tissue were found in all six newborns. It is possible that the late regression of the embryonic human tail was the cause of these dermal findings.

Animals↗
PubMed1996

Early diagnosis of duodenal atresia and possible sonographic pitfalls.

The sonographic diagnosis of duodenal atresia and associated anomalies was made in a fetus at 15 weeks' gestation. A transient double-bubble sign was observed in three other normal fetuses. Sonographers are cautioned that normal intestinal peristalsis may cause a false image of duodenal atresia.

Down Syndrome↗