Biomedical subjects

Milan Stanojevic

Publications and source records attributed to Milan Stanojevic.

6 recordsLinked to original sources

PubMed2026

Respiratory-onset peripartum cardiomyopathy: a systematic review of diagnostic pitfalls and clinical outcomes.

INTRODUCTION: Peripartum cardiomyopathy (PPCM) may initially present with prominent respiratory symptoms that resemble primary pulmonary disease, particularly in late pregnancy and the early postpartum period. In clinical practice, this presentation often triggers alternative diagnostic pathways, introducing delay at a time when rapid cardiac assessment is critical. Although respiratory-dominant presentations are repeatedly described across case-based and observational reports, they have not been systematically examined as a distinct diagnostic pathway within the PPCM literature. CONTENT: This PRISMA-guided systematic review synthesized evidence relating to respiratory-onset presentations of PPCM. Major databases and registers were searched comprehensively. Following screening of 589 records and full-text assessment of 145 reports, 49 studies met inclusion criteria. Twenty studies were qualitatively prioritized for narrative synthesis using ROBIS-informed methodological appraisal. Evidence was examined across diagnostic misclassification patterns, cardiopulmonary mechanisms, differential diagnoses, investigative strategies, and acute and longitudinal management considerations. SUMMARY: Respiratory-led presentations were commonly misattributed to asthma, pneumonia, pulmonary embolism, or perioperative causes, with diagnostic delay frequently reported. Across heterogeneous study designs, cardiogenic pulmonary edema with left-ventricular systolic dysfunction emerged as a recurring unifying mechanism. Early use of echocardiography, natriuretic peptides, and targeted imaging consistently aided differentiation from primary respiratory pathology. Severe clinical deterioration was often described in the context of delayed recognition. OUTLOOK: Respiratory-onset PPCM represents a high-risk diagnostic pathway rather than a discrete disease entity. Prospective registries, standardized diagnostic algorithms, and closer integration of obstetric and cardiopulmonary care are needed to refine early recognition and improve maternal outcomes.

Humans↗

PubMed2006

Normal standards for fetal neurobehavioral developments--longitudinal quantification by four-dimensional sonography.

AIM: To construct normal standards for fetal neurobehavioral development using longitudinal observations through all trimesters by four-dimensional sonography. SUBJECT AND METHODS: A group of 100 healthy normal singleton pregnancies were recruited for longitudinal 4D US examinations to evaluate fetal neurodevelopmental parameters between 7 to 40 weeks' gestation. Variables of maternal and fetal characteristics including gestational age, eight fetal movements patterns in the first trimester and 14 parameters of fetal movement and fetal facial expression patterns recorded thereafter for the construction of fetal neurological charts. RESULTS: Measurement of 7 parameters in the first trimester and 11 parameters in the second and third trimesters correlated with gestational age (P<0.05). Those parameters have been followed longitudinally through all trimesters and showed increasing frequency of fetal movements during the first trimester. A tendency towards decreased frequency of facial expressions and movement patterns with increasing gestational age from second to third trimesters has been noticed. CONCLUSION: With 4D sonography, it is possible to quantitatively assess normal neurobehavioral development. There is urgent need for further multicentric studies until a sufficient degree of normative data is available and the predictive validity of the specific relationship between fetal neurobehavior and child developmental outcome is better established.

Brain↗

PubMed2005

The potential of four-dimensional (4D) ultrasonography in the assessment of fetal awareness.

AIM: The aim of the study was to observe different expressions and movements of a fetal face during investigation of fetal behavior in the second and the third trimester of normal pregnancies, as a probable manifestation of fetal awareness. SUBJECTS AND METHODS: Over a 6-month period a study was conducted in three centers in Zagreb, Croatia and in Barcelona and Malaga, Spain. Women with singleton pregnancies (16-33 weeks) who were referred for ultrasound check-up for determination of gestational age, suspicious fetal malformations, polyhydramnios, and/or the assessment of biophysical profile or other possible pathology, were assigned to the study. After regular two-dimensional (2D) ultrasound assessment at an antenatal clinic, pregnant women were offered the possibility of undergoing 4D ultrasound examination if the fetus and the mother were considered "normal", i.e., if ultrasound and clinical assessment were uneventful. If the newborn delivered at term had 1- and 5-min Apgar scores of 7 and 10, respectively, and if the newborn was considered "term and normal" (normal spontaneous activity, normal posture and tone, and presence of some primitive reflexes) at the first and subsequent regular check-ups, the inclusion criteria were deemed to have been met. Out of 119 patients, 99 fulfilled the inclusion criteria, 40 of whom were in the second, and 59 in the third trimester of pregnancy. A Voluson 730 Expert system with a transabdominal 5-MHz transducer was used for 4D ultrasonography. After regular 2D scanning, the 4D mode was switched on, and a live 3D image was reconstructed by selecting ideal 2D mid-sagittal images of the face (the region of interest). The volume was automatically scanned every 2 s while the surface-rendered mode was switched on, and 4D images were displayed on the screen and recorded on videotape during a 30-min observation period. Movements of the following fetal face structures were analyzed: forehead, brows, nasal soft tissue and nasolabial folds, upper lip, oral cavity and tongue, lower lip and chin, eyelids and eyes, mouth and mouth angles, and facial expression. 4D ultrasonography allowed in utero observations of fetal facial expressions such as smiling, yawning, and swallowing. RESULTS: The quality of 4D depiction of fetal facial expressions increased with gestational age. The frequency of fetal facial expressions such as yawning ranged from 1 and 6 with a median of 1.5 per 30-min observation period; smiling ranged from 2 and 8 with the median of 2; tongue expulsion ranged from 2 to 6, median 3; mouth and eye squeezing ranged from 5 to 10, median 6; scowling ranged from 1 to 3, median 0.5; and isolated eye blinking ranged from 4 to 12 with a median of 5. CONCLUSIONS: Our study shows the ability of 4D sonography to depict different facial expressions and movements, which might represent fetal awareness. Nevertheless, long, precise and thorough observation of fetal faces by 4D sonography was hampered as the images were only near real-time. Thus, we were only able to study the quality and not the quantity of facial movement patterns.

Croatia↗

PubMed2005

Fetal behavior assessed in all three trimesters of normal pregnancy by four-dimensional ultrasonography.

AIM: To assess fetal behavior in all three trimesters of normal pregnancy and to investigate the continuation of behavior from fetal to neonatal period. METHODS: One hundred out of 130 pregnant women in all trimesters with singleton pregnancy were assigned for the investigation. All recordings were performed in the morning, after two hours of fasting. Video recordings of newborns were made while the newborns were in bed, separated from other infants in the nursery, dressed, and lying on their backs in a supine position with unrestrained hands. Recording was not performed during prolonged episodes of fussing and crying, during drowsiness, and episodes of hiccupping. All observed facial expressions and movement patterns were presented collectively with maximum, minimum, and median frequencies during 30-minute observation period. RESULTS: We noted a tendency towards decreased frequency of facial expressions and movement patterns with increasing gestational age. In the first trimester, we observed the highest incidence of general movements ranging between 5 and 147, and with a median value of 47. In the second trimester, the number of head and hand movements decreased gradually, compared with the first trimester. The highest range was registered for head retroflexion pattern, ranging from 15 to 42 with a median of 25. The most frequent facial pattern in the second trimester was sucking (3 and 30 movements per infant with a median value of 9). Wilcoxon rank-sum test showed statistically significant differences between the fetuses in the third trimester and the newborns (P<0.05) in hand to head, hand to mouth, hand to eye, hand to ear movement), tongue expulsion, and smiling, whereas the differences between the rest of the movements were not statistically significant. Spearman rank order correlation reached statistical significance (P<0.05) in isolated eye blinking, smiling, grimacing, hand to head, hand to mouth, hand to eye, hand to face, and in hand to ear movement, whereas the differences between the rest of the facial expressions were not statistically significant. CONCLUSION: Fetal behavioral patterns directly reflect the developmental and maturational processes of the central nervous system. 4D observation of fetal and early neonatal period may add to better understanding of the neurological development of the fetus.

Echocardiography, Four-Dimensional↗

PubMed2004

Behavioral pattern continuity from prenatal to postnatal life--a study by four-dimensional (4D) ultrasonography.

AIM: To investigate whether the same behavioral patterns were present pre- and postnatally, and whether there were any differences in the frequency of movements observed in fetal and in early neonatal life. SUBJECTS AND METHODS: Ten out of 37 pregnant women in the third trimester of pregnancy (median gestational age 34 weeks, range 33 to 35 weeks) in the two-month period (from November 1st to December 31st, 2003) were enrolled in the investigation. Ten term, appropriate for gestational age newborns (seven born vaginally, three by elective SC, six girls, six first-born) and were enrolled in the study. All 4D examinations were performed on Voluson 730 (Kretztechnik, Zipt, Austria) and Acuvix (Medison, Korea) with transabdominal 5 MHz transducer. After standard assessment in 2D B-mode ultrasound, a 4D mode was switched on and live 3D image was reconstructed by selecting the ideal representative 2D image placed in the region of interest (ROI). The recordings of neonatal behavior were made on the Sony P-612 OHMPL videotape by video camera (Sony Camcoder CC DTRV 318 Hv8) and reviewed on the videocassette recorder (Sony VHS SLV-N 900). The median of newborns' age at the moment of recording was 49 hours (range 4 to 112). During the examination, newborns were lying in the bed, separated from other infants in the nursery, dressed, and lying on their backs in a supine position with unrestrained hands. The temperature in the room was 22 to 24 degrees C. The video recording was performed mainly while the children were actively awake or during alert inactivity. RESULTS: There were no movements observed in fetal life that were not present in neonatal life, while the Moro reflex was present only in neonates. The most frequent fetal and neonatal movements were scowling, eye and mouth opening, and hand to face, hand to eye and hand to head movements. Isolated blinking, mouth to eyelid movement, yawning, tongue expulsion and scowling were more frequent in neonates than in fetuses, although the difference was not statistically significant. Hand to mouth movements were more frequent in neonatal than in fetal life while all other hand movements were less frequent in neonates than in fetuses, although the differences did not reach statistical significance. Spearman rank order correlation reached statistical significance in smiling (R=0.71; t=2.91; P=0.02) and in hand to ear movement (R = 0.80; t= 3.86; P = 0.005), and was almost statistically significant in isolated eye blinking (R=0.61; t=2.17; P =0.06), while the correlations between the rest of the movements were not statistically significant. CONCLUSIONS: 4D ultrasonography is a powerful tool in the assessment of fetal behavior, and our study showed that there is a continuity from fetal to neonatal behavior, especially in terms of isolated eye blinking movements, mouth and eyelid opening, yawning, tongue expulsion, smiling, scowling and hand movements directed to other parts of the face.

Facial Expression↗

PubMed2002

Three-dimensional (3D) ultrasound--a useful imaging technique in the assessment of neonatal brain.

Clinical application of ultrasound began about fifty years ago. From one-dimensional A-mode, through two-dimensional real time and Doppler examinations, a new era in clinical ultrasonography then began in the late eighties. Development of computer technology enabled introduction of 3D ultrasonography into clinical practice. In obstetrics ultrasound revolutionized fetal follow-up, but it was as important for the detection of intracranial pathology during the neonatal period and infancy. Two-dimensional real time ultrasonography was [table: see text] an exciting method that changed our understanding of the prevalence and pathophysiology of brain pathology in premature and term infants. Will application of 3D ultrasonography bring any substantial improvement to neuroimaging diagnostics in the newborn period? This article attempts to find the answer to this question, despite the limitations set by the short period of application of 3D neurosonography in neonates. The advantages of 3D brain ultrasonography application in neonates are: quicker and observer independent data acquisition, the possibility of off-line data analysis, projection of 3D data on a 2D plane with volumetric, color and power Doppler studies. Unavailability of equipment is the main reason why 3D ultrasonography was performed in only half of the newborns in whom it was indicated. Cost of equipment prevents introduction of 3D as a standard diagnostic procedure in neonates, although its diagnostic value is indisputable.

Brain↗