Biomedical subjects

R Chaoui

Publications and source records attributed to R Chaoui.

At least 91 records · Page 5Linked to original sources

PubMed1998

Fetal hepatosplenomegaly: an isolated sonographic sign of trisomy 21 in a case of myeloproliferative disorder.

Enlargement of the fetal liver and spleen as well as oligohydramnios were the only pathological sonographic signs detected in a pregnant woman presenting because of decreased fetal movements at 31 weeks' gestation. Doppler examination of fetal vessels revealed pathological values (absent or reversed flow in the umbilical artery, centralization of fetal circulation). No hydrops development or any further malformations were seen. The association of pathological Doppler findings with hepatosplenomegaly roused the suspicion of fetal infection. The infant had to be delivered because of deterioration of fetal heart rate patterns 2 days later. The newborn had Down's syndrome and the confirmed hepatosplenomegaly was found to be due to a transient myeloproliferative disorder with severe leukocytosis and predominance of immature blast forms. Hematological parameters normalized without specific therapy within 3 weeks. Although transient leukemic reactions have been diagnosed prenatally in cases of Down's syndrome associated with non-immune hydrops, to our knowledge this is the first reported case of isolated hepatosplenomegaly visualized by prenatal ultrasound as a sign of trisomy 21. The presence of fetal hepatosplenomegaly has to be taken into consideration as a possible marker for trisomy 21 and not only for infectious or metabolic diseases.

Adult↗

PubMed1998

Doppler assessment of tracheal fluid flow during fetal breathing movements in cases of congenital diaphragmatic hernia.

OBJECTIVE: The purpose of this investigation was to examine the characteristics of breathing-related fluid flow in the trachea of human fetuses with congenital diaphragmatic hernia in the hopes of developing a standard for the prenatal diagnosis of the degree of severity of the resulting pulmonary hypoplasia. Our ultimate goal is the prediction of postnatal mortality in fetuses with congenital diaphragmatic hernia. SUBJECTS AND METHODS: The study comprised six cases of isolated congenital diaphragmatic hernia (one on the right side; five on the left) varying in gestational age from 26 to 36 weeks. Four of the patients survived after surgical repair and two died during the neonatal period owing to lung hypoplasia. Color Doppler was used to visualize the fluid displacement in the trachea generated by fetal breathing movements. Spectral Doppler was then used to analyze the fluid flow velocity waveforms. More than 40 continuous breathing cycles (inspiration + expiration) were recorded for each case. We distinguished between regular and irregular patterns. RESULTS: Only the regular breathing phases, defined as five or more consecutive cycles of symmetric appearance, were considered for analysis. The inspiration and expiration times, the peak velocity of inspired and expired fluid and the volume obtained by integration of the tracheal fluid flow displaced during fetal breathing were compared with those of five healthy fetuses for each gestational age. Only the tracheal volume flow was helpful in predicting outcome. In normal pregnancies this parameter increased from 0.21 +/- 0.10 ml/breath (mean +/- SD) at 26 weeks to 1.37 +/- 0.48 ml/breath at 36 weeks of gestation. A significantly low (p < 0.05) volume flow was found only in the fetuses with congenital diaphragmatic hernia with a lethal postnatal outcome, whereas this parameter was normal in all survivors. CONCLUSIONS: Our preliminary observations suggest that the tracheal volume flow during fetal breathing activity is related to lung growth. In fetuses with severe lung hypoplasia one would expect a significant reduction in this parameter as an expression of deficient fetal lung growth. The displaced fluid volume per breath in the trachea of human fetuses as assessed by Doppler ultrasound may be a useful predictor of outcome in cases of isolated congenital diaphragmatic hernia.

Female↗

PubMed1997

[Modern fetal autopsy oriented to clinical demands using technical information methods].

Modern ultrasonic diagnostic instruments with high resolution and color Doppler sonography allow the obstetrician to describe pathological findings very precisely and at an early stage of pregnancy. The use of high-resolution ultrasound makes it possible to detect heart malformations already between the 8th and 10th week of gestation. This development has essentially changed the clinical requirements on fetal autopsy which in its traditional way no longer meets the increased demands. Unless the pathologists faces this challenge the importance of fetal autopsy will diminish. Modern image databases and communication techniques allow the pathologist to have direct access to text and images of pre-findings by other clinics. Great importance, however, must be attached to the interdisciplinary cooperation with obstetricians and geneticists. We report on routine fetal autopsy by using an interdisciplinary database an the Charité.

Autopsy↗

PubMed1997

Prenatal diagnosis of ventriculo-coronary communications in a second-trimester fetus using transvaginal and transabdominal color Doppler sonography.

We report on the prenatal diagnosis of ventriculo-coronary communication associated with pulmonary atresia and an intact interventricular septum. The diagnosis was made by transvaginal color Doppler sonography at 17 weeks' gestation and confirmed by transabdominal sonography at 19 weeks. Color Doppler demonstrated the communication between the distal hypoplastic right ventricle and the right coronary artery, with the course of this vessel situated along the outer heart wall. Spectral Doppler assessment showed bidirectional arterial flow in this vessel. Extracardiac skeletal anomalies (cleft hands and feet) were also detected and classified as an ectrodactyly-ectodermal dysplasia clefting (EEC) syndrome. This led the parents to opt for termination of pregnancy. All findings were confirmed on autopsy. Using stereomicroscopy the malformations of the coronary system and main connections to the lumen of the right ventricle were additionally demonstrated. To our knowledge this is the first report on the identification of coronary artery malformations in a midtrimester fetus using transvaginal color Doppler. The early appearance enabled us to investigate the pathophysiological sequence of the combined defect. Further investigation might elucidate whether ventriculo-coronary communications arise secondary to pulmonary atresia and intact inter-ventricular septum, due to increased ventricular pressure, or are the primary defect leading to intrauterine pulmonary atresia or, indeed, whether both defects appear simultaneously.

Adult↗

PubMed1997

Doppler assessment of tracheal and nasal fluid flow during fetal breathing movements: preliminary observations.

Our aim was to determine if it was technically possible to assess fetal tracheal fluid flow during fetal breathing movements, and to compare the data obtained with those recorded in the fetal nasopharynx. Tracheal and nasal fluid flow was analyzed in ten uncomplicated pregnancies, the gestational age ranging between 28 and 38 weeks. Color Doppler was used to detect the fluid displacement in the trachea generated by fetal breathing movements. Spectral Doppler was then used to analyze the fluid flow velocity waveforms. During the same breathing episode, nasal fluid flow was assessed by the same technique. The inspiration and expiration times were variable and not statistically comparable for both nasal and tracheal flow. Peak velocities of inspired and expired fluid were higher in the trachea than in the nose (p < 0.05). We found that the peak velocity of tracheal flow waveforms was significantly higher for inspiration than expiration (p < 0.05). No significant differences were found in the time velocity integral between inspiration and expiration (p = 0.79). The calculated intratracheal flow volume displaced during one breathing cycle increased from 1.3 to 5.0 ml with advancing gestation. Assessment of nasal and tracheal flow, using color and spectral Doppler, is feasible in the human fetus. Intratracheal flow measurements may provide an insight into the effect of fetal breathing movements on lung fluid in the human fetus.

Female↗

PubMed1997

[Doppler examination of the fetal left and right pulmonary artery. Relation to fetal position and gestational age: a methodological study].

UNLABELLED: A Methodical Study: AIM OF THE STUDY: To analyse the feasibility of colour and spectral Doppler assessment of blood flow in the fetal right (RPA) and left (LPA) main pulmonary arteries in relation to fetal position and to gestational age. STUDY DESIGN: The fetal position was a priori divided into 3 types, depending on whether the fetal heart was visualised apically (Type 1), from the right side (Type 2) or from the left side (Type 3). Three groups A (19-25 weeks gestation), B (26-32) and C (33-39) including 33 consecutive pregnancies each, were examined to document the fetal position as well as the rate of the successful Doppler examinations of the RPA and/or LPA. RESULTS: The fetal position Type 2 was most common throughout gestation (in group A = 42%, B = 36%, C = 51%) followed by the type 3 and then type 1. The rate of successful Doppler records from the RPA and LPA depended on the fetal position: In Type 2 RPA in 98%; in Type 3, LPA in 100%; but the apical approach was not effective (< 40%). Depending on gestational age, the success rates for a Doppler examination of at least one vessel were high (> 85%), whereas successful examination of both vessels was unlikely (12%). CONCLUSIONS: In the second half of pregnancy, independent of fetal position, Doppler examination of at least one pulmonary artery is successful in most cases, whereas the assessment of both vessels is rather difficult.

Female↗

PubMed1997

[Normal value curves for intrauterine fetal blood gas and acid-base parameters in the 2nd and 3rd trimester].

OBJECTIVE: The aim of the study was to establish reference ranges for fetal blood gases and acid-base balance for the second half of the gestation. METHODS: 155 appropriate-for-gestational-age fetuses between 18 and 39 weeks of gestation underwent a diagnostic cordocentesis. From a specimen obtained from umbilical venous blood the acid-base balance and blood gases were evaluated using an AVL 995 blood gas analyzer. In detail, pH, oxygen partial pressure, and carbon dioxide partial pressure were measured and oxygen saturation, bicarbonate concentration and base excess calculated. Thereafter, a linear regression for gestational age was calculated and the 95% confidence interval established. RESULTS: pH, oxygen partial pressure, and oxygen saturation showed a significant decrease with advancing gestational age, whereas the carbon dioxide partial pressure increased. The ranges of bicarbonate and base excess did not differ significantly. CONCLUSION: The results give information about blood gases in the fetus under physiological conditions, and the reference ranges can be used for comparison in fetuses at high risk of hypoxia or acidemia.

Acid-Base Equilibrium↗

PubMed1997

Surgical management of complicated colonic diverticulitis.

BACKGROUND: Improvements in surgical techniques, advances in intensive care medicine and progress in the management of peritoneal sepsis have recently favoured colonic resection with primary anastomosis in the treatment of complicated diverticulitis. METHODS: Some 224 patients with complicated diverticulitis who had undergone surgery in the preceding 22 years were reviewed. Complications present on admission included acute phlegmon without pus formation (92 patients), paracolic abscess and/or localized peritonitis (99), diffuse purulent peritonitis (33), complete obstruction of the sigmoid colon (eight) and paracolic abscess complicated by fistula (27). RESULTS: The overall mortality rate was two (1 per cent) of 183 for resection with primary anastomosis, seven of 31 for Hartmann's operation and four of ten for the delayed three-stage procedure. The anastomosis was made by instruments employing the double-stapled technique in 130 patients and hand-sutured in 94. Reversal of Hartmann's operation was undertaken in only 31 per cent compared with 89 per cent for closure of the protective colostomy in patients with primary anastomosis. CONCLUSION: The Hartmann operation may be the most popular at present, but resection with primary anastomosis is the safest procedure for all stages of complicated diverticulitis, and reduces costs. There is no longer any clinical indication for the three-stage operation.

Adult↗

PubMed1997

Prenatal diagnosis of laryngeal atresia in two cases of congenital high airway obstruction syndrome (CHAOS).

Complete occlusion of the upper airways is known to cause secondary morphological changes, including bilaterally enlarged hyperechogenic lungs, dilated trachea, and hydrops. Prenatal diagnosis of upper airway obstruction has been described in several cases. In these reports, the diagnosis was primarily attributed to indirect signs, and the authors were in doubt as to whether the location of the obstructed area (larynx, glottis or trachea) could be precisely visualized by ultrasound. In this paper two cases are reported presenting the features of congenital high airway obstruction syndrome (CHAOS) diagnosed at the 22nd week of gestation. In both cases, the upper neck was perfectly visualized in a coronal plane. At the onset of fetal breathing movements, the stenotic larynx remained in a closed position. By positioning a colour signal on the fluid-filled dilated trachea, we noticed absence of flow throughout the onset of breathing activity. We conclude that the atretic area must be situated at the level of the larynx. Because of the poor prognosis of laryngeal stenosis and the presence of associated anomalies, both pregnancies were terminated in the 23rd week. This report shows that the application of colour and spectral Doppler may be helpful in the differential diagnosis of fetuses with CHAOS.

Adult↗

PubMed1997

[Ultrasound biometry of the fetal lung--measurement planes and reference values].

The aim of the study is to present biometrical data of the fetal lung measured in real-time sonography in mid-pregnancy. In 313 healthy fetuses of singleton pregnancies between the 15th and 30th week of gestation the fetal lung was measured in the horizontal, sagittal and frontal cross-sectional planes. In each plane the lung was measured in the following levels: clavicula, heart at the atrioventricular level (four chamber view) and diaphragm, as well as the lung length. During observation time all parameters showed a significant linear increase (r2 > 0.9; p < 0.001). Furthermore we found a high correlation between the same lung measurements collected in the different planes. The intraobserver variability was 3-8%. Such references of different planes could be helpful for differentiation of a small (hypoplasia) or a large lung (malformation).

Female↗

PubMed1996

The fetal 'heart-sparing effect' detected by the assessment of coronary blood flow: a further ominous sign of fetal compromise.

Fifteen years after its introduction in obstetrics, Doppler sonography can now be considered to be more than a useful tool in differentiating fetuses at low or high risk for adverse perinatal outcome. In compromised fetuses, it allows very reliable assessment of the actual condition of the fetus in the cascade of deterioration, enabling an optimized perinatal management. The visualization of coronary flow, as presented in this issue of the Journal, is an important part of the cascade of abnormal hemodynamic events detectable by Doppler in such compromised fetuses.

Coronary Circulation↗

PubMed1996

Blood flow velocity waveforms from peripheral pulmonary arteries in normally grown and growth-retarded fetuses.

The objective of this study was to describe blood flow velocity waveforms of fetal peripheral pulmonary arteries in normally grown and growth-retarded fetuses. Doppler studies were performed in 182 normally grown fetuses (gestational age 18-40 weeks) and in 61 growth-retarded fetuses (gestational age 24-36 weeks) that were free from structural and chromosomal abnormalities and whose umbilical and middle cerebral artery Doppler findings suggested uteroplacental insufficiency as the most likely etiology of the growth defect. The pulsatility index was used to quantify the velocity waveforms. Successful recordings were obtained in 90.1% of the normally grown and 93.4% of the growth-retarded fetuses. In normally grown fetuses the pulsatility index values significantly decreased with advancing gestation. In growth-retarded fetuses the pulsatility index values were significantly elevated compared to those of normal fetuses. A significant relationship was observed between the severity of hypoxia and pulsatility index values from the peripheral pulmonary arteries in 29 fetuses in which Doppler recordings were obtained immediately before cordocentesis. In conclusion, these data show that in normal fetuses the Doppler-measured impedance to flow in the peripheral pulmonary circulation decreases with advancing gestation. Impedance to flow in the lungs is elevated in the presence of growth retardation and this increase is related to the severity of fetal hypoxia.

Acid-Base Equilibrium↗

PubMed1996

Prenatal diagnosis of a choledochal cyst: a case report and review of the literature.

There are 16 reported cases of prenatally diagnosed choledochal cyst in the literature. We present a new case diagnosed at 29 weeks' gestation by routine ultrasound scanning. At 40 weeks' gestation, a male infant was born by spontaneous delivery. At 16 weeks of age, the patient underwent a laparotomy, which confirmed the diagnosis of a choledochal cyst. The cyst and the gallbladder were removed en bloc and reconstruction of the biliary tree was performed by formation of a retrocolic Roux-en-Y-hapatojejunostomy with an antireflux valve. Histological examination of the cyst showed a thickened fibrous tissue wall with necrotising areas and without epithelial lining. The patient's postoperative course was uneventful. Review of the literature shows that it is possible to make a presumptive prenatal diagnosis of this anomaly as early as 15 weeks' gestation. The differential diagnosis of a sonolucent lesion in the fetus should also include the rare choledochal cyst. Treatment of choice is the radical excision of the cyst with construction of a Roux-en-Y hepaticoenterostomy. Long-term results with this method are very good. Surgery may be instituted at the earliest possible opportunity before severe complications such as cholangitis, liver abscesses, cirrhosis, and malignant degeneration can occur.

Adult↗

PubMed1995

Significantly increased maternal and fetal IgG autoantibody levels to 52 kD Ro (SS-A) and La(SS-B) in complete congenital heart block.

Antibodies to Ro(SS-A) are an important laboratory parameter of congenital heart block (CHB), but the maternal presence of anti-Ro(SS-A) antibodies does not always lead to this fetal acquired autoimmune disease. The current study investigated quantitative and qualitative differences of anti-52, -60 kD Ro(SS-A), 0La(SS-B) and -U1RNP(-C, -A, -68 kD) autoantibodies (either IgG or IgM) in sera derived from 16 infants with CHB and their mothers compared to eight healthy anti-Ro(SS-A) positive infants (controls) born to SLE mothers. No serum sample contained IgM auto-antibodies of the specificities investigated. Anti-60, 52 kD Ro(SS-A) and La(SS-B) IgG antibodies coincided in 9/16 CHB cases, exclusively (P < 0.05). Associated anti-52 kD Ro(SS-A) and -La(SS-B) IgG antibodies were detected in 14/16 CHB and in 3/8 control cases (P < 0.05). Anti-U1RNP 68 kD antibodies occurred in 1/16 CHB infants and in 4/8 controls. In general, newborn and maternal antibody patterns and reactivities were similar in all cases investigated. The fetal CHB sera contained significantly higher IgG levels of anti-52 kD Ro(SS-A) (P < 0.005) and -La(S-B) (P < 0.015) compared to control samples. Sera from mothers with CHB children had significantly higher levels of anti-52 kD Ro(SS-A) (P < 0.015) and -La(SS-B) (P < 0.015) IgG antibodies than those of the control group. Thus, the coincidence of anti-52 kD, -60 kD Ro(SS-A) and -La(SS-B) IgG antibodies as well as significantly increased levels of antibodies to 52 kD Ro(SS-A) and La(SS-B) are associated with evidence of complete congenital heart block. The data suggest that the known associated humoral autoimmune findings are exclusively of maternal origin.

Autoantibodies↗

PubMed1995

[Torsion of the myoma pedicle as a rare cause of ileus in puerperium].

Myoma of the uterus could not only complicate pregnancy and delivery but also puerperium. The paper reports on an unusual, but severe complication due to myoma. A 35-year old woman with myoma of the uterus was admitted with an acute abdomen and ileus on the 16th day after delivery. Pregnancy, delivery and early puerperium were uneventful. During laparotomy a twisting of a pedicle of a myoma and compression of the bowel were found. The myoma was resected and the postoperative course was normal.

Abdomen, Acute↗

PubMed1995

[Differential breast tumor diagnosis by comparing blood circulation of the tumor with the contralateral breast using color coded, pulsed Doppler ultrasound].

74 breast tumor patients were preoperatively examined by means of colour and pulsed-wave Doppler sonography using the ultrasonic instrument ALT Ultramark 9 HDI with a broad-band linear scanner, 5-10 MHz. The Doppler flow velocity waveforms, from the vessels of the mammary lesion (affected breast) and the corresponding quadrant of the contralateral breast (non-affected breast), respectively, were compared in respect of the four parameters maximal systolic velocity, minimal diastolic velocity, pulsatility index (PI) and resistance index (RI). In 48 cases we succeeded in representing arterial vessels both inside the affected and the contralateral breast. The aim of the study was to examine whether these parameters show a significantly different degree of deviation in correlation with the tumours being either benign or malign. In cases with benign lesions (n = 24) we did not find any significant differences in all the parameters that we examined. In cases with cancer, however (n = 18), a significantly higher systolic velocity was found in the affected breast compared to the contralateral breast, but there were no differences in the other parameters. Although the quantitative Doppler measurements are angle-dependent parameters, the study showed that the maximal velocity in the affected breast compared to the contralateral breast is the most useful parameter in differential diagnosis of breast tumours.

Blood Flow Velocity↗

PubMed1995

[Indirect transplacental therapy of the fetus].

UNLABELLED: The paper is a review on the actual possibilities and indications of the transplacentar therapy of the fetus. At first some principles of the pharmacodynamics of the materno-placento-fetal unit are explained in order to enable an effective drug administration and reach therapeutic levels in the fetus. Common and less common diseases of the fetus and their therapy are exposed, such as the acceleration of lung maturation with corticosteroids, the cardioversion of tachycardias with digoxin and other antiarrhythmic drugs, the therapy of toxoplasmosis with pyrimethamine, the treatment of polyhydramnios using indomethacin, the therapy of very rare inborn errors of metabolism, the therapy of thrombocytopenia and the prevention of neural tube defects by folic acid supplementation. For these diseases the pathophysiologic background, the therapy rationale and possible side effects of therapy were exposed. Prior to an intrauterine therapy the perinatologist has to ask himself the 5 "W"- QUESTIONS: Which fetus to treat? Why to treat? When to treat? Who will treat? Way of treatment?

Congenital Abnormalities↗

PubMed1995

[Doppler echocardiographic analysis of blood flow through the fetal aorta and pulmonary valve in the second half of pregnancy].

Pulsed Doppler velocimetry of the fetal aortic and pulmonary valves derived in the five-chamber-view and short-axis view were performed in 88 uncomplicated pregnancies between the 20th and 40th week of gestation. The maximal and mean velocities were assessed for both semilunar valves. Considering the valve diameters and heart rate the stroke volume and cardiac output for both ventricles were calculated. Furthermore, the common stroke volume, common cardiac output and the ratio of right to left cardiac output were calculated. Normal ranges for all these parameters were constructed and correlated with gestational age. The maximal velocities were higher in the aorta than in the pulmonary trunk, but no differences were found in the mean velocities. The stroke volume and cardiac output of the right ventricle were in higher ratio 1.3:1 than that of the left ventricle as an expression of the right ventricular dominance in the fetus. Intracardiac Doppler flow velocimetry gives an insight into the physiology of fetal circulation and is a basis for the analysis of blood flow under pathological conditions.

Aorta↗