Validation of in vivo noninvasive high-frequency ultrasonography of the arterial wall layers.

To validate estimates of the arterial wall thickness and its separate layers, 19 superficial (7 femoral and 12 cutaneous) arteries were transcutaneously sonographed in 13 anaesthetized pigs with a high-resolution equipment fitted with a 25 MHz frequency probe. Means of ultrasonographic estimates of each wall layer were compared with those obtained from microscopy of the respective arterial specimens taken after the pigs were sacrificed. For all vessels combined, Spearman-rank correlation tests between ultrasonography and histology estimates were significant for total arterial wall thickness (r(s) = 0.78; p =.0001) but not for the separate layers. For the cutaneous arteries, a significant correlation was found for total arterial wall thickness (r(s) = 0.69; p =.01) and media layer (r(s) = 0.76; p =.004). The method seems to give valid estimates of both total arterial wall and media thickness in superficial arteries, but to be less accurate for estimate the adventitia and intima layers.

Follow up of precocious pseudopuberty associated with isolated ovarian follicular cysts.

The clinical outcomes of seven girls presenting with pseudosexual precocity caused by isolated autonomous ovarian follicular cysts are presented. Six of the seven girls, aged 11 months to 6.9 years, had a unilateral ovarian cyst detected by ultrasound at the first acute episode. Plasma oestradiol was raised in only five of the cases, but all had a low response to luteinising hormone releasing hormone stimulation. Follow up lasted for up to eight years with recurrent episodes of variable frequency and severity in all seven patients. Evidence of McCune-Albright syndrome appeared later in only three patients. It could not be predicted from the initial symptoms or the clinical course. Mutations of the G(s)alpha protein leading to activation were investigated in the lymphocytes and ovarian and bone tissues of four patients. Only one patient showed a mutation in bone tissue. Close follow up with repeated searches for skeletal lesions remains necessary since the distribution of somatic mutations cannot be assessed by molecular studies. Most patients with recurrent ovarian cysts require a conservative approach.

Catamenial epilepsy: gynecological and hormonal implications. Five case reports.

The aim of this study was to analyze the gynecological and hormonal condition of five patients with catamenial epilepsy and to establish a relationship with the presence of convulsive crises. The clinical profiles of five patients were obtained and their serum levels of anticonvulsants and sex steroids were determined. Four patients showed obvious signs of premenstrual tension syndrome (PMTS), with retention of fluid and reduction of the serum levels of anticonvulsants, which were restored to therapeutic levels after treatment of the PMTS. The fifth patient presented with chronic anovulation, which was treated by administration of progesterone during the second phase of the menstrual cycle, resulting in an improvement in the frequency of convulsions. In the cases studied, the low levels of progesterone and their rapid fall in PMTS, as well as the raised levels of circulatory estrogens in the anovulatory menstrual cycle, appear to be implicated in the convulsive disorder of catamenial epilepsy.

A comparison of three tests for determining fetal pulmonary maturity.

OBJECTIVE: The aim of the study was to determine the sensitivity, specificity and predictive value of two simple and cheap diagnostic tests of fetal pulmonary maturity (FPM) and compare them with the more complex and expensive phospholipid profile (PP), which includes the determination of phosphatidyl glycerol (PG) and the lecithin/sphingomyelin (L/S) ratio. METHODS: Samples of amniotic fluid were obtained from 70 patients between the 26th and 38th weeks of pregnancy. The PP, shake test and tap test at 2, 5 and 10 min were determined. All patients gave birth within 12 h following these tests and none received corticoids during this period. The neonates were observed for 72 h. The results of the tests were compared with the incidence of neonatal respiratory distress syndrome. RESULTS: The sensitivity of the shake test was 92% for FPM, as was the sensitivity of PP, while for the tap test at 2, 5 and 10 min it was between 96 and 100%. In terms of specificity, the 5- and 10-min tap test diagnoses were 100% correct for immaturity while all other tests were 60-78% correct. The predictive value for maturity was 100% for the tap test (5 and 10 min), 67% for the 2-min tap test, 64% for PG, 60% for L/S and 56% for the shake test. CONCLUSION: The tap test is a good alternative to other diagnostic methods of FPM. Its use at the bedside, its rapidity and low cost enhance its value.