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Fetal ocular biometry has been previously established and reported. The purpose of this communication is to report an equation to predict fetal age from the binocular distance. The error of the estimation is also reported. The potential value of this measurement is illustrated in a case of thanatophoric dysplasia.
Ultrasound visualization of the first trimester embryo was compared using abdominal and transvaginal sonography. The parameters evaluated included the ability to obtain biometry, the ability to visualize detailed internal anatomy, and a subjective assessment of the overall image clarity. In 120 patients studied, transvaginal sonography was superior to abdominal sonography in obtaining biometric measurements in 51 cases (43%) and for visualizing internal anatomy in 45 cases (38%); also the image clarity of transvaginal sonography was subjectively better in 75 cases (63%). Vaginal sonography was superior to abdominal sonography in gestations less than or equal to 10 weeks, in obese patients, and in patients with retroverted uteri. The major difficulty encountered with transvaginal sonography was the limited maneuverability of the probe to generate specific views. Vaginal sonography can be a valuable tool in imaging the first trimester fetus, complementing, not replacing, abdominal sonography.
Ultrasound fetal biometry is widely used for detection of intrauterine growth retardation (IUGR). Since fetal growth is a dynamic process, studies estimating validity of ultrasound near term may not be applicable earlier in pregnancy. This study applied receiver operating characteristic (ROC) curve analysis to ultrasound biometric data obtained at 26-34 weeks gestation to predict fetuses destined to be IUGR at birth. In this method, the area under the curve (theta) is the index of performance. Sixty-nine (9%) of the 768 singleton infants studied were IUGR at birth. Ultrasound estimated fetal weight (theta = .793) and abdominal circumference (theta = .785) had equivalent performance, significantly better than head circumference (theta = .724) or femur length/abdominal circumference ratio (theta = .619). Performance was not as good as suggested by studies conducted within 2 weeks of delivery.
OBJECTIVE: To evaluate a screening protocol using advanced maternal age, triple-marker screening, and genetic sonography. METHODS: We compared adverse chromosomal outcomes of pregnancy in 1556 women referred for increased risk of aneuploidy because of either advanced maternal age or triple-marker test results. Patients were counseled about the results of the triple-marker test and subsequent sonography, which led to a patient decision of whether to pursue amniocentesis. Fetal measurements and structural abnormalities were compared with chromosomal findings. When patients elected amniocentesis, karyotypes were obtained. RESULTS: Genetic sonography reduced the rate of amniocentesis by 61% overall and by 40% when compared with an alpha-fetoprotein profile alone. The sensitivity of sonography combined with the triple-marker screen for the detection of trisomy 21 was 87% compared with 91% for the triple-marker screen alone. CONCLUSIONS: This study confirmed that sonographic findings in a targeted population, in combination with other risk markers (advanced maternal age and triple-marker screening), can be used to assess the risk of aneuploidy. Biometry provides additional information for assessing the risk of aneuploidy. Combining advanced maternal age, serum triple-marker screening, and sonographic screening may provide better risk prediction for use in clinical counseling.
OBJECTIVE: To assess the usefulness of transverse cerebellar diameter (TCD) as an independent parameter for gestational age assessment in third trimester of pregnancy. DESIGN: An observational study. PLACE AND DURATION OF STUDY: Diagnostic Radiology Department, PNS Shifa, Karachi between April 2002 to July 2004. PATIENTS AND METHODS: This study was performed on patients between 26-38 weeks of gestation with normal pregnancy. Grey scale antenatal ultrasonography was done with 3.5 MHz probe to measure fetal transverse cerebellar diameter and was correlated with gestational age in weeks. These cases were followed progressively at different periods of gestation throughout the pregnancy. Collected data was converted into variables which were analyzed by SPSS version 10, descriptive statistics included mean +/- standard deviation which were computed for TCD and other fetal biometry parameters. RESULTS: Transverse cerebellar diameter varied in a linear fashion in third trimester, while transverse cerebellar diameter/abdominal circumference (TCD/AC) ratio remained constant in second half of pregnancy. All the parameters were expressed by regression equations and correlation coefficients were found to be statistically significant (r=0.99 for TCD, r=0.98 for TCD/AC all p<0.0001). CONCLUSION: This study signifies that transverse cerebellar diameter and TCD/AC ratio on serial sonography give an accurate idea of gestational age. Cases with intrauterine growth restriction can be diagnosed if local, nomogram can be prepared for different ethnic groups.
In the field of measuring patient satisfaction (in other words, the quality perceived subjectively by hospital patients) there is still a great need for more knowledge. Therefore, the Institute of Medical Computer Science and Biometry of the University of Rostock carried out a questioning of 497 patients at the Hospital for Internal Medicine of the University Rostock to measure the patient satisfaction with the hospital. In addition, an employee questioning was performed in order to gain further information. In addition to univariate and bivariate analyses a special focus was set on the analysis of the hospitals' competitive situation, to take into account the importance of patient satisfaction as strategic success factor within the competitive situation. A competition analysis and a Key-Issue Analysis were performed. Finally, focus is on the problems of external hospital comparison and a comparison of trends of patient satisfaction at hospitals in Hamburg and Rostock was made.
The Rehabilitation Research Network of Ulm on "Bausteine der Reha" consists of several departments of the University of Ulm, and various rehabilitation hospitals and cooperates with a pension insurance institute (LVA Wuerttemberg). The aim of this interdisciplinary approach is to evaluate process and outcome of rehabilitation measures considering specific clinical and rehabilitative questions with main emphasis on epidemiological and economic aspects. The Rehabilitation Research Nétwork of Ulm is subdivided into clinical projects and cross-sectional subjects. The clinical studies deal with cardiovascular and neurological rehabilitation and rehabilitation in disorders of the musculoskeletal system. The cross-sectional topics contain special fields such as biometry, health economics, epidemiology and occupational rehabilitation. All participating institutions have access to a central database with uniform structure of the data.
The patients with a chromosome 22q11 deletion have a variable phenotype which includes DiGeorge (DG) and Velocardiofacial (VCF) syndromes. The aim of the present study is to characterize the phenotype of DG and VCF using facial biometry in 12 portuguese patients. We found 4/12 patients with the DG phenotype: 3/4 had telecanthus, small mouth and retrognathia; 1/4 had telecanthus, short nose with bulbous tip and a normal mouth. These patients had major cardiac defects associated with hypoplastic or absent thymus and monosomy 22q11. We did not find velopharyngeal insufficiency in patients with the so called DG phenotype 8/12 patients had the VCF phenotype: typical facies with variable features. Four of these had velopharyngeal insufficiency and learning disabilities. Four patients had cardiac defects and 5/8 had monosomy 22q11. Probably this clinical variability is due to mutations in critical genes involved in embryonic development.
Inappropriate hospital care has become a recurring theme since the publication of the results of the model project on the appropriateness of hospital care (Section 275 a SGB V) by the medical service of the National Associations of Health Insurers (MDS) in Spring 1997. Nationwide, an increased number of appropriateness assessments have since been conducted by the medical service of the health insurers (MDK). The basis for an objective assessment of the appropriateness of hospital care is a diligent, comprehensive, and methodologically valid examination of the actual situation. At first, it was unknown to what extent current methods in Germany conformed to international scientific standards in Epidemiology, Biometry, and Health Services Research. Following a thorough scientific examination of several typical methodologies, it became clear that current methods are insufficient, and hence do not allow valid conclusions regarding inappropriate hospital admissions or hospital days. This statement does not deny that inappropriate hospital use is very likely, but our current assessment tools do not permit further conclusions to be drawn. The purpose of this article is to identify typical mistakes in the fundamental aspects of a valid assessment based on selected examples. Proposals are made regarding methodology and the presentation of results that follow from this critical examination.
BACKGROUND: Hyperopia is the most common refractive error of children. Children with mild (or even moderate) levels of hyperopia usually do not experience visual problems resulting from this hyperopia. However, children with moderate-to-high degrees of hyperopia are at significantly increased risk for the development of amblyopia and strabismus. It is this association with these visually threatening disorders that makes hyperopia in children an important public health problem. In addition, even lesser degrees of hyperopia may affect the child's ability to perform well in near-related tasks, such as reading. The effect hyperopia has on an individual child is dependent on a variety of factors, including the magnitude of hyperopia, the age of the individual, the status of the accommodative and convergence system, and the demands placed on the visual system. Early detection and treatment of hyperopia may help prevention of potential complications from adversely impacting the child's vision. Although much is known about childhood hyperopia and its effects on vision, there is also much that is not known. The natural history, ocular biometry, relationship to accommodative function, the indications for treatment, and the most effective treatment modalities are among the underlying issues and clinical considerations awaiting more complete understanding.
PURPOSE: Knapp's Law, which states that anisometropias due to varying abnormal axial lengths between eyes would not result in inequality in relative retinal image size, provided the correcting spectacle lens was placed at the far point of the eye, has been shown to fall short in clinical practice in several studies using "direct comparison eikonometry". To test these findings using space eikonometry and to further elucidate this Law's clinical applicability, the following study was conducted. METHODS: Thirteen patients with suspected axial anisometropia of at least 4 Diopters were identified, selected and examined. Cycloplegic refraction, A-scan ultrasonic ocular biometry and Essilor Projection Space Eikonometry were performed. RESULTS: Ten of the thirteen patients had their anisometropia due primarily to ocular axial length differences. Of these ten, seven (70%) had detectable levels of aniseikonia and 3 (30%) demonstrated no aniseikonia. The other three patients whose aniso-metropia was due to combined axial and refractive components, all had aniseikonia. CONCLUSION: As a geometric optics theory, Knapp's Law stands on its own merits. However, in clinical practice, reduction in retinal element density in high myopia limits its applicability. Such patients often do have significant aniseikonia which can produce ocular referable complaints and/or interfere with binocular vision.
INTRODUCTION: Ultrasound has a number of valuable functions in obstetrics including dating, confirming viability, counting the number of fetuses and the exclusion of gross fetal anomalies. During two routine obstetric ultrasound scans, between 11 and 14 gestational weeks and around 20 weeks, the fetus should be carefully examined after which the existence of anomalies can be confirmed or, with a limited certainty that ultrasound enables, excluded. In order to obtain high standards of ultrasound screening, a uniformed protocol is needed, which would enable standardized examination. In this paper the Novi Sad University Department of Obstetrics and Gynaecology presents a new protocol for ultrasound examination which would ensure standardized ultrasound scanning and adequate record keeping. MATERIAL AND METHODS: The protocol is based on contemporary recommendations of the Royal College of Obstetricians and Gynaecologists of Great Britain, the Royal College of Radiologists of Great Britain, the American College of Obstetricians and Gynaecologists, as well as protocols used in routine ultrasound examinations of low-risk population (1,2,3,4,5,6). RESULTS: There are two protocols: one for scanning in the first and the other in the second/third trimester. All the findings are recorded in adequate forms. In the first trimester number, viability, gestational age and expected date of delivery are established (4,6). At the end of the first trimester an anomaly scan can be performed as well (8,9,10,11,12). It includes measuring of crown-rump length, nuchal translucency and fetal heart rate, and examination of placenta, skull, brain, spine, abdomen, stomach, bladder and upper and lower extremities. An adjusted risk of chromosomal abnormality is given, based on maternal age and nuchal translucency measurement. In the second and third trimester the usual fetal biometry is performed as well as a detailed scan of anatomy, which includes searching for ultrasound markers of chromosomal abnormality. At 23 weeks the transvaginal evaluation of cervical length is performed, in an attempt to screen for women at risk of preterm delivery. A new, adjusted risk of chromosomal risk can be given, based on maternal age, nuchal translucency measurement in the first trimester and presence/absence of ultrasound markers of chromosomal abnormality. DISCUSSION: Ultrasound in obstetrics has a major role. All scans in pregnancy must have clear aims, which in early pregnancy are (2): establishing fetal viability; establishing gestational age; identification of multiple pregnancies and their horionicity; exclusion of major fetal anomalies; psychological support and in second trimester are (4,13): (1) establishing normal ultrasound appearances of the fetus, which does not mean that the fetus is normal. The expression 'normal' should be avoided because of possible medico-legal implications. (2) identification of: anomalies incompatible with life; anomalies linked with high morbidity and long-term handicap; fetal conditions than that can be treated during intrauterine life; fetal conditions that will need postnatal tests and therapy. CONCLUSION: New protocol and forms will enable an easier systematic obstetric ultrasound examination.
The aim of this prospective study is to asses the possibilities of translabial (transperineal) sonography for observation the cervix uteri and to compare it with the transabdominal sonography. The material consists of 58 pregnant women in third trimester of pregnancy. We use abdominal transducer (3.5 Mhz) of Kranzbuhler ultrasound for abdominal and transperineal scanning. The ultrasound examination of the cervix includes: endocervical length, cervical weight, weight of the cervical canal and in case of tunneling its parameters. The satisfying image for ultrasound biometry of the cervix we achieved in 92% of the cases with transabdominal scanning and in 97% with translabial scanning. The mean values of the ultrasound examined parameters of the cervix are not significantly different with transabdominal and translabial measurement. The translabial ultrasound method is feasible and well accepted by the pregnant women.
AIM: To propose optimal policy of pregnancy and labor management in females with solitary kidney. MATERIAL AND METHODS: The study included 102 pregnant women who had contracted or transplanted donor kidney, renal aplasia (17, 3 and 28 females, respectively) or had undergone nephrectomy for different diseases (n = 54). Filtration, concentration, nitrogen-eliminating renal functions, renal hemodynamics, bacteriological picture of the urine were examined. Also, ultrasonography of the kidneys, cardiotocographic monitoring, ultrasonic fetal biometry, dopplerometry of placental blood flow were made. RESULTS: Most of the pregnant women showed declined function of the solitary kidney, but renal insufficiency was a rare finding. Pyelonephritis of the solitary kidney, on the contrary, occurred rather frequently (77.8%) causing intrauterine infection in 46% of the fetuses. Obstetric complications arose more frequently than in women with two kidneys: gestosis--28%, threatened abortion--18%, premature delivery--25%. Hypotrophy was registered in 23% of the newborns. Adequate management of pregnancy reduced stillbirth rate to only 5%. 78% of the neonates were born mature and had normal body mass. CONCLUSION: Solitary kidney is not contraindication to pregnancy while pyelonephritis exacerbation--to abortion. Pregnancy is contraindicated in chronic renal failure.
We carried out a prospective study at Ouagadougou, from March 1 1997 to April 30 1998, in which we plotted curves of fetal weight gain, estimated by ultrasound biometry, with the aim of comparing our results to those of other authors and establishing a local chart. We established a growth curve from 936 fetal weights estimated during the follow up of 126 pregnant women. The mean age of the women included was 26 +/- 0,8 years and 52.4% were of the mean socioeconomic level. We identified significant differences between our weight gain curve and those of other authors. The factors involved in this difference are unclear but may be nutritive, ecological and ethnic in nature. Further work is required to produce local charts, to optimize the estimation of fetal weight.
When studying the morphology of the adrenals sufficiently exact criteria for their evaluation are necessary. Some of them may be obtained from complex macro- and microscopical investigations with the use of biometry and mathematical statistics. The work analyzes macroscopical (weight, volume, specific gravity) and microscopical (qualitative -- plethora, content of lipids, foci of cytolysis, mosaity etc. and quantitative -- absolute and relative dimensions of zones, cyto- and karyometry, interrelationship of zones, their relationship with KNP as a whole) data. On their grounds the estimation of the functional state of the adrenal cortex is made depending on the mechanism and causes of death as well as on duration of the disease.
AIM: The aim of this study was to assess the eventual impact of degenerative changes of seminiferous tubules on Doppler flow parameters in testicular vessels. MATERIAL AND METHODS: There were 12 men with degenerative changes of seminiferous tubules (diagnosed by testicular biopsy) in study group and 24 healthy men with normal semen parameters in control group. Patients' age in both groups was respectively 32.22 +/- 5.31 and 29.64 +/- 3.17 (ns). Sonographic biometry of testes volume was performed and the values of qualitative flow indices in terminal section of testicular artery were evaluated. The both groups results were compared with themselves by T-test. Also the values of qualitative flow parameters in testis after biopsy and contralateral one were compared. Additionally the correlation between vascular flow parameters and selected hormone levels (FSH, LH, T, E2 and Prl) was determined. RESULTS: The mean testes volume in the study group was 10.81 +/- 3.77 cm3 and in the control one 14.42 +/- 5.42 cm3 (ns). The values of particular flow indices in both study and control group were respectively: S:D 3.20 +/- 0.95 and 2.92 +/- 0.96 (ns), PI 1.46 +/- 0.46 and 1.23 +/- 0.41 (ns), RI 0.69 +/- 0.09 and 0.66 +/- 0.08 (ns). There were no differences between flow parameters in testis after biopsy and contralateral one. Testosterone was the only hormone correlating with analyzed flow indices (S:D, PI, RI) and the correlation coefficient value was respectively 0.51, 0.49 and 0.52 (p < 0.05). CONCLUSIONS: The significant influence of degenerative changes of seminiferous tubules on vascular flow in testicular artery was not observed. There were no differences between flow parameters in testis after biopsy and contralateral one. The testosterone was the only hormone significantly correlating with analyzed flow indices.
BACKGROUND: The aim of this study was to determine the efficacy of different mathematical formulae described in the literature and to propose new mathematical formulae to estimate fetal long bones biometry in early pregnancy. METHODS: In 1481 singleton euploid fetuses a transvaginal ultrasound examination was performed between 9 and 16 week's gestation. To determine the relationship between the biparietal diameter and long bone lengths, a sample group of 100 randomly chosen normal fetuses was evaluated by regression equations. The equations derived were then tested in the remaining 1381 control fetuses and the mean absolute percentage error and the mean systematic error with their standard deviations were compared with previously reported mathematical formulae by other authors. RESULTS: All previous formulae described in literature when applied to our population revealed an overestimation of expected long bones measurements. Using our mathematical formulae, the mean absolute percentage error and the mean systematic error were 11.5% and 1% in estimating femur and 10.9% and 0.8% in estimating humerus length, respectively. CONCLUSIONS: These newly derived ultrasound morphometric formulae could be proposed as reliable models in estimating fetal long bone lengths in early pregnancy.