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Biomedical subjects

P W Callen

Publications and source records attributed to P W Callen.

At least 55 records · Page 3Linked to original sources
PubMed1988

Early experience with open fetal surgery for congenital hydronephrosis.

The fetus with severe bilateral hydronephrosis and associated oligohydramnios in the second trimester is doomed at birth by ongoing pulmonary and renal damage. Since decompression with percutaneously placed catheters anesthetic, surgical, and tocolytic techniques for open fetal anesthetic, surgical, and tocolytic techniques for open fetal urinary tract decompression in animals, and have now applied those techniques to a small group of five patients. One had bilateral ureterostomies and the subsequent four had marsupialization of the bladder. All pregnancies proceeded to cesarean delivery at 32 to 35 weeks' gestation. There was no long-term maternal morbidity, and two mothers have since experienced normal pregnancies. Three fetuses had return of normal amniotic fluid dynamics, and all three had adequate pulmonary function at birth, suggesting that fatal pulmonary hypoplasia associated with early severe oligohydramnios had been reversed. Two neonates died at birth with pulmonary hypoplasia. One had no amniotic fluid even after decompression, and the other had some amniotic fluid after decompression but a tiny chest cavity due to the long period of severe oligohydramnios before decompression. Of the three surviving infants, one had normal renal function when she died of unrelated causes at 9 months of age. One has normal renal function at 23 months and the third had failing renal function at 2 1/2 years and has grown and developed normally, but will require renal transplantation. We have now developed selection criteria that would exclude from treatment the two fetuses who died of pulmonary hypoplasia and the one who developed renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Severity of intestinal damage in gastroschisis: correlation with prenatal sonographic findings.

From 1982 to 1986, 26 abdominal wall defects were detected prenatally. Seventeen pregnancies culminated in live births with ultrasound correctly distinguishing between omphalocele and gastroschisis in all cases. In the 11 cases of gastroschisis diagnosed before birth, we attempted to correlate the clinical outcome with the size of the abdominal wall defect, sonographic appearance of the eviscerated bowel, and known time of exposure to amniotic fluid (gestational age at birth to gestational age at diagnosis). Neither the time of exposure to amniotic fluid (median duration of 14 weeks) nor the defect size could be correlated with eventual clinical outcome. The presence of small bowel dilatation and mural thickening on prenatal sonography (four patients) had a high correlation with severe intestinal damage and poor clinical outcome. The absence of these two sonographic findings (seven patients) was associated with mild intestinal changes and benign clinical course with no morbidity or mortality. We conclude that obstetric ultrasound cannot only accurately detect the presence and type of abdominal wall defect, but it also gives an indication of the severity of intestinal damage and subsequent clinical course in prenatally diagnosed cases of gastroschisis. Early delivery of the fetus with prenatally diagnosed gastroschisis should no longer be performed to limit exposure to amniotic fluid. Now that reliable sonographic criteria of severe intestinal damage have been defined, the decision to deliver early can be restricted to those fetuses with bowel dilatation and mural thickening.

Abdominal Muscles↗
PubMed1988

Amniotic sheets.

Seventeen cases of an aberrant sheet of tissue in the amniotic cavity are described to expand and clarify previous observations of this entity. The sheet of tissue demonstrates a thickened base and a free edge that undulates. The fetus moves freely about the sheet of tissue. There are no associated fetal deformities, and infants have no manifestations of the amniotic-band syndrome. Evidence suggests that these sheets may originate from "wrapping" of the amniochorionic membrane over a uterine synechia. These benign sheets of tissue should not be confused with the amniotic-band syndrome.

Adult↗
PubMed1988

Factors affecting prenatal sonographic estimation of weight in extremely low birthweight infants.

Because critical management decisions are based on sonographic estimation of fetal weight in fetuses less than 1000 g, we sought to evaluate the accuracy of birthweight prediction in this range and to identify factors affecting this accuracy. Fetal weight was estimated using several published methods in 53 fetuses with birthweights less than 1000 g. Standard deviations greater than 12.3% indicate more random error in the sonographic weight prediction than has been reported in higher weight groups. No statistically significant differences were found between patient groups with decreased, normal, or increased amniotic fluid volume or portable examination. There was a trend toward lower mean deviation (2.9 vs 6.0%) and standard deviation (8.9 vs. 15.0%) in studies with scan quality judged "good" compared with "poor" based on ability to visualize anatomic landmarks.

Amniotic Fluid↗
PubMed1988

Sonographic identification of autosomal recessive polycystic kidney disease associated with increased maternal serum/amniotic fluid alpha-fetoprotein.

A patient with no family history of renal disease was referred for obstetric sonography because of elevated maternal serum and amniotic fluid alpha-fetoprotein (AFP), and was proved to be carrying a fetus with autosomal recessive polycystic kidney disease. Review of records of previous cases with a sonographic diagnosis of this disease revealed one other case with elevated and one case with normal amniotic fluid AFP. Sonographers should be aware of the potential diagnosis of this condition in patients with elevated AFP, even in gestations not known to be at risk. Because the sonographic diagnosis of this disease can be difficult in gestations known to be at risk, AFP determination may prove to be a useful diagnostic adjunct in these pregnancies as well.

Adult↗
PubMed1988

Natural history of fetal ventriculomegaly.

The natural history of in utero ventriculomegaly was defined by a retrospective review of the outcome of 47 fetuses evaluated during a 5-year period by the Fetal Treatment Program at the University of California. In 20 fetuses, a diagnosis of ventriculomegaly associated with other severe abnormalities was made early in pregnancy. Termination of pregnancy was elected in 19 of 20 cases, and no fetus survived. In five fetuses, the diagnosis was made late in pregnancy and was associated with severe abnormalities. Fetuses were handled in a routine obstetric fashion and none survived. Of the other 22 fetuses 19 had stable and two had progressive ventriculomegaly; in one case, ventriculomegaly resolved in utero. Nineteen of these fetuses have survived, 13 with normal intellectual development and six with moderately to severely delayed development. Associated abnormalities were detected with ultrasonography in 74% of fetuses; there was a 20% false-negative rate of detection. Ventriculomegaly was isolated and progressive in two fetuses. In both cases, fetuses were delivered at term, and postnatally a shunting procedure was performed. Both children are neurologically normal. From our results and a review of the literature, which supports our findings, we were unable to define a group of fetuses with in utero ventriculomegaly that would benefit from in utero shunting.

Abortion, Therapeutic↗
PubMed1987

Perinatal management of the fetus with an abdominal wall defect.

The antenatal diagnosis of abdominal wall defects has allowed improved perinatal management. For fetuses with associated anomalies, the options of elective termination or minimal intervention can be offered. Our ability to predict the extent of bowel damage in gastroschisis based on the ultrasound findings enables us to offer early delivery to those fetuses who are at high risk. The data are not clear at the present time whether cesarean section offers any advantage. These fetuses should, however, be delivered at a center which is capable of providing high level medical and surgical care to these potentially ill infants. Initial resuscitation of these neonates requires early insertion of an intravenous line and a nasogastric tube, the administration of antibiotics, sterile coverage of the eviscerated bowel, and careful attention to temperature instability. Neonates with gastroschisis should be operated on as soon as they are stable, whereas infants with omphalocele can be investigated for associated anomalies prior to surgery. Primary fascial closure is performed whenever possible. Where this is not possible, a staged repair using a silastic chimney achieves closure within 3-6 days. Skin coverage alone or nonoperative management is reserved for the few cases with giant omphalocele, associated anomalies, or poor operative risk. Decisions about primary versus delayed closure, while usually dictated by clinical judgement, can be aided by indirect measurement of intraabdominal pressure. Postoperative ventilation, and consideration of long-term nutritional needs, are also important parts of the perioperative management.

Abdominal Muscles↗
PubMed1987

Sonographic analysis of the fetus with ureteropelvic junction obstruction.

Twenty-five fetuses with ureteropelvic junction obstruction were evaluated to determine the likelihood of progression of hydronephrosis in utero, and the outcome for the neonate. Such information may alter prenatal as well as perinatal management. These observations showed that the degree of dilatation in utero is likely to be greater than that observed postnatally; the degree of dilatation does not necessarily correlate with renal functional impairment measured postnatally; significant progression of dilatation in utero is relatively uncommon, especially in unilateral cases; and uretero-pelvic junction obstruction, even when bilateral, is unlikely to be fatal. Of 21 live newborn infants with follow-up, 14 required surgery and seven were placed under observation.

Female↗
PubMed1987

Objective method of diagnosing oligohydramnios in postterm pregnancies.

Oligohydramnios is an important factor influencing the management of postterm pregnancies. However, sonographic assessment of oligohydramnios has been based largely on the subjective judgement of the sonologist. From January 1982 to December 1984, 54 patients had articulated-arm B-scan ultrasound examinations and were identified as postterm. Of these patients, 25 were subjectively diagnosed as having oligohydramnios. Five patients were considered to have low normal amounts of amniotic fluid. The remainder were considered to have normal or greater than normal quantities of amniotic fluid. From this population, an amniotic fluid index was determined for each patient by finding the product of the length, width, and depth of the largest amniotic fluid pocket. Patients with a fluid index less than 60 showed a strong association with the postmaturity syndrome. Indeed, all but one postmature infant was born of a pregnancy with a fluid index less than 60. No other fetal or perinatal complications were statistically correlated with oligohydramnios in this small patient series.

Amniotic Fluid↗
PubMed1987

Evaluation of fetal femur length for prediction of gestational age in a racially mixed obstetric population.

In a retrospective study, a group of 314 patients between 19 and 32 completed weeks' gestation were evaluated for differences in sonographic measurement of femur length vs. gestational age between the following racial categories: Hispanic, black, Oriental, and Caucasian. Selection criteria included known last menstrual period, singleton gestation, and a historic absence of maternal diabetes, hypertension, or renal disease or fetal anomalies. The gestational age against which the femur length was judged was determined from the last normal menstrual period, provided that this date differed by less than 2 weeks from age determined by fetal biparietal diameter and evaluation of the newborn. No statistically significant difference in femur length vs. gestational age was noted between the various racial categories.

Asian People↗
PubMed1987

Absorption of fetal intraperitoneal blood after intrauterine transfusion.

We reviewed the sonograms and medical records of all patients who underwent intrauterine transfusions between December 1981 and December 1984 in order to determine the time course for disappearance of the intraperitoneal blood. Seventy-two sonographic examinations were performed on 22 patients who underwent 51 intrauterine transfusions. Nonhydropic fetuses who received less than or equal to 50 cc of intraperitoneal blood exhibited no ultrasonic evidence of intraperitoneal fluid after 8 days. Nonhydropic fetuses receiving greater than 50 cc of intraperitoneal blood showed resolution of intraperitoneal fluid after 12 days. Hydropic fetuses, after intraperitoneal transfusion, all demonstrated persistence of intraperitoneal fluid. Intraperitoneal fluid was seen as long as 24 days after transfusion in hydropic fetuses.

Absorption↗
PubMed1986

Ultrasound evaluation of polyhydramnios and twin pregnancy.

We analyzed the ultrasound examinations and medical records of 75 pairs of twins who were delivered between January, 1983, and December, 1984, to study the relationship between increased amniotic fluid volume, fetal abnormalities, and preterm labor. Ten of these 75 twin pregnancies demonstrated elevated amniotic fluid volume that persisted throughout pregnancy. Total intrauterine volumes were elevated in these cases, and nine of the ten pregnancies were abnormal. In addition, it was noted that elevation of the amniotic fluid volume alone did not explain the high rate of preterm labor and delivery in twin gestations.

Congenital Abnormalities↗
PubMed1986

Multicystic dysplastic kidney in utero: changing appearance on US.

Serial ultrasound (US) examinations of six cases of fetal multicystic dysplastic kidney were reviewed. In all cases the diagnosis was confirmed by pathologic or neonatal radiologic examination. The in utero appearance on US scans of multicystic dysplastic kidneys sometimes changed dramatically. Furthermore, all of the multicystic dysplastic kidneys changed in size: four enlarged, one shrank, and one initially enlarged and later shrank. Radiologic and laboratory data suggest that multicystic dysplastic kidneys may have the capacity for glomerular filtration. The change in size and appearance of fetal multicystic dysplastic kidneys may result from this residual renal function.

Female↗
PubMed1986

Multicystic dysplastic kidney: observations of contralateral disease in the fetal population.

To evaluate multicystic dysplastic kidney (MDK) and associated contralateral renal abnormalities in the fetal population, 27 cases detected and followed in utero were reviewed retrospectively. The sonographic assessment included estimation of amniotic fluid volume and interval growth, evaluation for non-genitourinary anomalies, and postnatal follow-up study. Contralateral renal anomalies were detected in 41% of the fetuses and included obstruction of the ureteropelvic junction, renal agenesis, renal hypoplasia, and bilateral MDK. The incidences of these malformations were compared with results of earlier studies of MDK in the pediatric and adult populations. Lethal anomalies, such as bilateral MDK and MDK associated with contralateral agenesis, are common (19% and 11%, respectively) in the fetal population; obstruction of the contralateral ureteropelvic junction, a nonlethal anomaly, was seen less commonly (7%). Perinatal death from lethal abnormalities may spuriously raise the incidence of nonlethal contralateral abnormalities in the pediatric and adult populations. Contralateral mild fetal pyelectasis, found in 15% of fetuses with MDK, was not clinically significant.

Cysts↗
PubMed1986

Renal allograft rejection: US evaluation.

Real-time ultrasonography (US) was performed on the allografts of 100 consecutive renal transplant recipients at the time of allograft biopsy. Evaluation of the sonograms included the grading of parameters previously demonstrated to be indicative of allograft rejection. The appearance of the renal sinus fat, allograft size, corticomedullary ratio, sharpness of the corticomedullary junction, medullary conspicuity, presence of focal parenchymal abnormalities, and thickening of the pelvic or infundibular wall were individually evaluated. The authors correlated the US and the histopathologic findings. While the accuracy of a positive prediction of rejection was relatively high (83%-90%), this result is influenced by the relatively high prevalence of rejection in the biopsy group (83%). Accuracy of a negative prediction was uniformly low (17%-30%). Mild rejection was difficult to differentiate ultrasonographically from no rejection, although severe rejection could usually be differentiated from mild or no rejection, particularly in patients with the interstitial type of rejection.

Graft Rejection↗
PubMed1986

The prognostic value of loculations in parapneumonic pleural effusions.

Forty-eight patients with pleural effusions who had sonographically directed thoracocentesis were evaluated retrospectively for radiologic findings, pleural fluid chemistries, and outcome. Loculation was found to be a radiologic marker of diagnostic and prognostic significance. The presence of loculations correlated with exudative pleural fluid chemistries, but no radiologic finding was specific for empyema. "Extreme" pleural fluid chemistries were associated with loculation, but not with empyema. Patients with loculated effusions had larger effusions, longer hospitalizations, and more frequent tube thoracostomy procedures than patients with nonloculated effusions. Light's criteria for tube thoracostomy were found to be unreliable in patients with loculated parapneumonic effusions or in patients treated with prolonged antibiotic therapy prior to thoracocentesis.

Biopsy, Needle↗
PubMed1986

The effect of ventricular dilatation upon biometry of the fetal head.

The ultrasonograms of 15 patients with moderate to marked fetal hydrocephalus were evaluated retrospectively in an attempt to determine the effect of ventricular dilatation upon biometry of the fetal head in the latter half of pregnancy. In 13 of the 15 cases the age based upon biometry of the fetal head was within one week of the clinical estimate of gestational age based upon the last menstrual period. As accurate head measurements may be useful even in cases of hydrocephalus, these measurements should not be dismissed as being invalid particularly when commensurate with a clinical estimate of gestational age.

Cephalometry↗