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Biomedical subjects

R J Carpenter

Publications and source records attributed to R J Carpenter.

At least 91 records · Page 5Linked to original sources
PubMed1986

Fetal ventricular pacing for hydrops secondary to complete atrioventricular block.

The advent of ultrasound recording has expanded the capabilities for treatment of the fetus in utero. The diagnosis of specific disease processes has allowed for prenatal intervention by new techniques designed to improve fetal survival. The application of ventricular pacing in a hydropic fetus with complete atrioventricular (AV) block is reported. Complete AV block resulted from maternal collagen vascular disease. The application of ventricular pacing was to allow for further in utero development and for reversal of hydrops fetalis after improvement in cardiac output. Despite fetal death 4 hours after placement of the ventricular pacing lead, this procedure when applied earlier in the development of hydrops may allow for fetal survival. Ventricular pacing was accomplished without apparent trauma to mother or fetus and no evidence of fetal injury was seen at necropsy. Therefore, in the fetus who would otherwise die in utero before the point of viability ex utero, fetal ventricular pacing may be a rational alternative to current observation.

Adult↗
PubMed1985

Prenatal diagnosis of haemophilia A by factor VIII gene analysis.

Cloned factor VIII deoxyribose nucleic acid (DNA) sequences were used as probes in the prenatal diagnosis of haemophilia A. Fetal DNA from cultured amniotic fluid cells was examined for a DNA polymorphism within the factor VIII gene which marked the haemophilia A gene in the pregnant obligate carrier. The fetus was predicted to be an affected male, and the diagnosis of haemophilia A was confirmed both in utero and after termination of the pregnancy.

Adult↗
PubMed1985

Pulsed Doppler fetal echocardiography.

Pulsed Doppler echocardiography (PDE) has proven value in the examination of the infant or child with known or suspected congenital heart disease. In order to assess how PDE might be useful in the evaluation of the infant in utero, we reviewed our experience with this technique used in combination with both cross-sectional and M-mode echocardiography. Where previous examinations had suggested some abnormality or where there was a risk factor for congenital heart disease, we performed PDE examinations on the cardiovascular system of 36 infants in utero ranging in gestational age from 20-39 weeks (mean 32 weeks). PDE of the fetal heart was found to be valuable in three areas: (1) quantitation of hemodynamics, (2) characterization of cardiac rhythm, and (3) identification of certain congenital cardiovascular structural anomalies.

Echocardiography↗
PubMed1985

HLA and beta 2-microglobulin expression in basal and squamous cell carcinomas of the skin.

Histologic sections of seven squamous cell carcinomas (SCC), 13 basal cell carcinomas (BCC), and a Bowenoid actinic keratoses were examined for expression of HLA class 1 antigens (HLA-ABC) using a monoclonal antibody and an immunoperoxidase technique. Expression of beta 2-microglobulin was examined with a polyclonal antibody method. Neither cell marker was detected within the Bowenoid actinic keratoses. Squamous cell carcinomas and basal cell carcinomas exhibited decreased expression of both HLA-ABC and beta 2-microglobulin and often did not express these antigens at all. HLA-ABC was present in only two of 13 basal cell carcinomas and four of seven squamous cell carcinomas. beta 2-microglobulin was present in one of 13 basal cell carcinomas and two of seven squamous cell carcinomas. When present, these antigens often were present in a few areas of the tumor, but absent in others. In both SCC and BCC, both antigens were usually lost simultaneously. In all tumors with beta 2-microglobulin, HLA-ABC also was retained. There was no apparent relationship of anatomic site or type of tumor with retention of surface antigens. Since some tumors or portions of tumors retained HLA-ABC and beta 2-microglobulin on their surfaces, the absence of these antigens is not an absolute marker for malignancy.

Basal Cell Carcinoma↗
PubMed1985

Fetal femur length: a critical reevaluation of the relationship to menstrual age.

This investigation has reexamined the measurement of the femur length and the use of this measurement as a growth and dating parameter. Straight-line measurements of shaft length were found to be smaller than measurements made along the bone curvature. However, the maximum difference did not exceed 2 mm. Thus, because of its simplicity, use of straight-line measurements appears justified. The optimal (R2 = 96.1%) growth curve model was a linear-quadratic function, with variability around the regression line increasing with menstrual age. The optimal (R2 = 96.8%) dating curve model was a linear-quadratic function in which loge menstrual age is a function of femur length. The variability associated with age estimates increased with femur length. These data were used to construct new standard curves for growth assessment and dating of fetuses using femur length measurements.

Cephalometry↗
PubMed1984

Legal liability in the use of ultrasound by office-based obstetricians.

Ultrasound has proved to be a valuable diagnostic tool in the practice of obstetrics. Its rapidly increasing use by the office-based obstetrician, however, has opened a potential new area of legal vulnerability. The malpractice liability that may arise from its use is reviewed and practical ways to avoid it are considered.

Female↗
PubMed1984

Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements.

Sonographic estimation of fetal weight in utero was performed in 167 live-born fetuses examined within one week of delivery. Regression models were based on measurements of abdominal circumference, head circumference, biparietal diameter, and femur length, both alone and in combination. The best results (1 S.D. = 7.5% of actual weight) were obtained by combining measurements of the fetal head, abdomen, and femur, most likely due to the strong linear relationship between femur length and crown-heel length.

Abdomen↗
PubMed1983

Cystic hygroma and hydrops fetalis in a fetus with trisomy 13.

We report a case of trisomy 13 with cystic hygroma and generalized hydrops fetalis diagnosed prenatally by routine ultrasound prior to genetic amniocentesis in a 34-year-old woman. Although fetal cystic hygroma is usually associated with a 45,X karyotype, this and other previous reports suggest that it may be seen in association with other chromosomal and nonchromosomal abnormalities as well. Thus, a diagnosis of Turner Syndrome should not be made on the basis of a cystic hygroma observed by prenatal sonography alone.

Adult↗
PubMed1983

Midtrimester genetic amniocentesis. Use of ultrasound direction vs. blind needle insertion.

A prospective comparison of ultrasound-directed second-trimester genetic amniocentesis to blind amniocentesis showed a significant reduction in the incidence of both bloody taps and failed amniocentesis. The incidence of other parameters, such as fetal outcome, failed culture of amniotic fluid fibroblasts and spontaneous abortion, was similar. These data support the use of amniocentesis under ultrasound control as a routine component of prenatal genetic diagnosis.

Abortion, Spontaneous↗
PubMed1983

Ultrasonic demonstration of ectopic ureterocele.

The gray scale ultrasound findings in two children with ectopic ureterocele are presented and correlated with traditional radiographic findings. In one case, the diagnosis was made in utero, utilizing ultrasound. The examination is noninvasive and performed quickly, and it may be able to replace the intravenous pyelogram in the initial evaluation of patients suspected of having such congenital anomalies. Retrograde cystography will still be necessary to detect vesicoureteral reflux.

Adult↗
PubMed1982

Fetal head and abdominal circumferences: I. Evaluation of measurement errors.

Several sources of error associated with the measurement of fetal head and abdominal circumferences (HC, AC) were examined using dynamic image ultrasound. Statistically significant systematic intraobserver errors were not seen unless technical differences in the images were present (HC only) and the range for random errors was 4-5% (2 SD) for both measurements. Although differences in the procedures used to acquire images for measurement had some effect on accuracy (HC only), the primary source of variations in measurements made by different investigators was the measurement methods. Different measuring devices gave different results and different investigators used the same devices differently. Under optimal measuring conditions, the interobserver error for experienced investigators was 1.2 (+/-4.3 SD)% for HC and 2.4 (+/-1.6 SD)% for AC. Comparison of prenatal and postnatal measurements indicated that there were no systematic differences for HC but for AC, the prenatal measurements were 6% greater. Random differences were +/-6% (2 SD) for HC and +/-13% (2 SD) for AC.

Abdomen↗
PubMed1982

Fetal head and abdominal circumferences: II. A critical re-evaluation of the relationship to menstrual age.

Dynamic image ultrasound was utilized to re-examine the changes in head and abdominal circumferences (HC, AC) with gestational age in normal fetuses. Data collected in a cross-sectional study of fetal growth were evaluated using mathematical modeling techniques. The results of this analysis indicated that a linear-cubic function optimally fits the HC data (R2 = 97.3%) while the AC data was fitted optimally by a linear function (R2 = 95.5%). The predicted values calculated from these functions were in very close agreement [mean deviation (absolute value): 1.97% (HC), 1.38% (AC)] with those calculated from average functions for HC and AC obtained in a previous longitudinal growth study. Variability was not constant throughout pregnancy for either HC or AC. With HC the normal range changed from +/-1.5 cm to +/-2.5 cm at 28 wk (menstrual age). The AC variability increased progressively with increasing menstrual age and was shown to be related to the predicted AC value. The normal range was found to be 13% of the predicted AC value throughout pregnancy. Based on these results, a new set of normal HC and AC values for the 12-40 wk (menstrual age) period is presented.

Abdomen↗
PubMed1982

Obliterative cholangitis due to cytomegalovirus: a possible precursor of paucity of intrahepatic bile ducts.

A fetus at 24 weeks' gestation was found to have ascites and abdominal calcifications by ultrasonography. Pathologic examination after prostaglandin termination of pregnancy two weeks later revealed disseminated cytomegalovirus infection with inclusions in the lung, pancreas, kidney, and liver. A mononuclear inflammatory reaction was present in the portal areas of the liver and in the kidney, and gliosis was diffuse in the brain. The liver lesions were of greatest interest because most portal areas had no bile ducts. In other portal areas there was a combination of inclusions in epithelial cells of the few remaining interlobular ducts and intense duct-oriented inflammation. Thus, in fetuses surviving intrauterine cytomegalovirus infection, inflammatory destruction of intrahepatic bile ducts could manifest as chronic cholestasis and paucity of bile ducts later in infancy.

Bile Ducts, Intrahepatic↗