Excursion index of the septum primum as a parameter for diastolic function assessment of Thai fetuses: at 32 to 35 weeks' gestation.

OBJECTIVE: To establish the normal value of fetal diastolic function by the measurement of the excursion index of the septum primum (EISP) from 32 to 35 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Fetuses of normal Thai pregnant women were recruited for 2-dimensional echocardiographic measurements of the EISP (the ratio between the linear displacement of the flap valve and the left atrial diameter) from 32 to 35 weeks' gestation. All had a confirmed gestational age, normal structural scanning, and negative diabetic screening at 24 to 28 weeks' gestation. The 5th, 50th and 95th percentile of the EISP were demonstrated The relationship between the EISP and gestational age were determined RESULTS: Three hundred twenty-seven measurements were obtained The normal values of the EISP according to gestational age were presented as 5th, 50th, and 95th percentile ranks. The correlation coefficients (r) between the EISP and gestational age were 0.03. The EISP were not statistically different with advancing gestation. The 5th, 50th, and 95th of the EISP were 0.32, 0.45, and 0.59 respectively. The intra-observer variability was 5.5%. CONCLUSION: The normal values of fetal EISP in the Thai population from 32 to 35 weeks' gestation were established This could serve as a baseline data in detection of the alteration of left ventricular diastolic function during fetal life.

Persistence of Cloquet's canal in normal healthy eyes.

PURPOSE: Optic nerve head (ONH) structural imaging with state-of-the-art, high-speed, ultra-high-resolution optical coherence tomography (hsUHR-OCT). DESIGN: Observational cohort study. METHODS: ONH centered 3-dimensional (94,371,840 voxel measurements in a 6- x 6- x 1.4-mm tissue volume) hsUHR-OCT data were obtained in one eye from each of six males and nine females normal healthy volunteers (40 +/- 9 years of age). The presence of structures projecting anteriorly from the disk into the vitreous was noted. RESULTS: Structures were noted in 14 of 15 (93%) examined eyes, emanating from the rim of the ONH at the nasal inferior sector, presenting as thin tissue meandering into the vitreous. CONCLUSIONS: Previous technologies provided limited visualization of ONH structures. The ability to scan the entire disk using 3-dimensional OCT (3D-OCT) in a high-density raster pattern reveals a high frequency of persistence of Cloquet's canal in the normal healthy eye.

[Velocimetry of the ductus venosus in the first stage of labor]. / Cirkulácia v ductus venosus pocas prvej doby pôrodnej.

OBJECTIVE: To assess feasibility and physiological variation of fetal ductus venosus Doppler velocimetry during the first stage of labor between uterine contractions. STUDY DESIGN: A prospective cross-sectional study including 23 healthy women with low-risk pregnancies. Maximum velocities during ventricular systole (S) and atrial contraction (A) were recorded in the ductus venosus between contractions. Pulsatility index for veins (DV PIV) and the ductus venosus index (DVI) were also calculated. SETTING: Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University, Martin. RESULTS: Acceptable ductus venosus waveforms were acquired in 19 fetuses (83%). The mean +/- SD values of the ductus venosus index and the pulsatility index were 0.46 +/- 0.07 (95% CI: 0.42-0.49) and 0.57 +/- 0.12 (95% CI: 0.51-0.63), respectively. The mean +/- SD values of maximum velocities during ventricular systole (S) and atrial contraction (A) were 65 +/- 8 cm/s and 35 +/- 5 cm/s, respectively. CONCLUSION: Ductus venosus blood flow velocities can be assessed during labor. This calls for an extension of the detection possibilities of intrauterine fetal status and gives an idea to establish reference ranges for these circulation parameters during labor in the future.

Real-time ultrasound measure of the fetal eye (vitreous body) for prediction of parturition date in small ponies.

Ultrasonographic fetal eye measures have been used to estimate gestational age of the fetus in light horse mares. However, fetal eye measures have not been published for smaller pony breeds. This study was conducted to develop reference ranges for ultrasonographic measures of fetal eyes in small ponies for the purpose of predicting days before parturition (DBP) when breeding or ovulation dates are unknown. Twenty-three Shetland-type pony mares were studied across one (n = 10) or two (n = 13) gestations in 2004 (18 pregnancies) and 2005 (18 pregnancies). Measurements of fetal eyes were obtained during transrectal ultrasound examination. Examinations were conducted once monthly in a field situation beginning in December (2003) or August (2004) until mares foaled (March through July). The length (from sclera to sclera) and width (from retina to cornea) of the vitreous body were measured. For the 273 examinations in which gestation age was greater than 2 months, eye measures were obtainable in 248 (91%). Mixed-effects linear regression modeling was used to account for serial growth measures within pregnancy, repeated measurements across mares, and unbalanced study design. Independent variables evaluated included vitreous body length, vitreous body width, the ratio of length to width, parity, and mare height at the withers at parturition. Eye length was the best single predictor of days before parturition, with almost no additional predictive value of the other variables considered. Our resulting regression equation is: days before parturition=265.16-0.21*(vitreous body length in mm)(2). This study suggests that measure of the fetal eye is a practical on-farm procedure for estimating days before parturition in small ponies.

First-trimester screening for trisomy-21 using a simplified method to assess the presence or absence of the fetal nasal bone.

OBJECTIVE: To determine the benefit of including nasal bone assessment in addition to standard first-trimester markers (nuchal translucency, free beta human chorionic gonadotropin and pregnancy-associated plasma protein A) as a screening test for Down syndrome, using a strict criterion for classification of nasal bone absence. STUDY DESIGN: Nasal bone assessment was conducted in 2411 patients with crown-rump length between 45 and 84 mm, including 15 patients with Down syndrome. A patient was considered to have an absent nasal bone only if there was no evidence of present nasal bone. Unlike other studies, nasal bone was classified as present when there was evidence of a thin echogenic line under the skin. Simulation studies were conducted to assess the detection rate and false-positive rate of a combined first-trimester screening protocol including nasal bone assessment. RESULTS: There were 9 of 2396 (0.4%) unaffected cases with absent nasal bone (95% confidence interval 0.2%, 0.7%) and 8 of 15 (53.3%) Down syndrome cases (95% confidence interval 26.6%, 78.7%). Using a 1 in 250 risk cut-off, the detection rate of standard first-trimester screening was 87%, with a false-positive rate of 4.3%. Incorporating nasal bone measurement improved the detection rate of Down syndrome to 90% and reduced the false-positive rate to 2.5%. CONCLUSION: The use of a strict criterion to determine nasal bone absence leads to fewer cases classified as absent and may simplify the implementation of nasal bone as a marker for first-trimester screening, resulting in lower false-positives and higher detection, compared with other current screening protocols.

Trigeminal neuralgia associated with a primitive trigeminal artery variant: case report.

OBJECTIVE AND IMPORTANCE: A variant type of the primitive trigeminal artery (PTA) is a rare anomalous vessel that originates from the internal carotid artery and directly supplies the territory of the anteroinferior cerebellar artery and/or the superior cerebellar artery. We report a case of trigeminal neuralgia associated with this PTA variant, and we discuss the characteristics of this vessel. CLINICAL PRESENTATION: A 51-year-old woman presented with a 10-year history of left paroxysmal facial pain. Magnetic resonance angiography and cerebral angiography demonstrated that an aberrant vessel originating from the left internal carotid artery directly supplied the cerebellum, without a basilar artery anastomosis. INTERVENTION: Surgical exploration was performed via a left retrosigmoid approach. A loop of the aberrant vessel, which entered the posterior fossa through the isolated dural foramen, was compressing the trigeminal nerve. This aberrant vessel was displaced medially from the nerve with a prosthesis, with care to avoid kinking and avulsion of the perforating arteries. The patient's neuralgia resolved postoperatively. CONCLUSION: Although the PTA variant is frequently associated with intracranial aneurysms, it is extremely rare for the variant to lead to trigeminal neuralgia. During microvascular decompression surgery, surgeons should be careful to prevent injury of the perforating arteries arising from the PTA variant.

Prenatal diagnosis of fetal tail and postabortum anatomical description.

Fetal ultrasound examination at 13 weeks of gestation demonstrated a homogeneously echogenic protrusion, or tail, 7 mm in length, in the sacral region. At 15 weeks, the ultrasound appearance was consistent with a regression of the tail and by 21 weeks it had completely disappeared. Severe intrauterine growth restriction with reduced uterine blood flow was diagnosed at 21 weeks and intrauterine death occurred at 24 weeks of gestation. Postmortem examination revealed a 4-mm caudal appendage which contained no vertebrae on radiography. The appendage was located under and behind the last sacral vertebra suggesting a true vestigial tail with a delayed process of regression.

Early sonographic detection of a 'human tail': a case report.

We report on a newborn in whom an echogenic protrusion arising in the caudal region was detected at 12 weeks' gestation. Subsequent ultrasound examinations at weeks 15 and 22 failed to demonstrate this finding. After birth, the infant was found to have a pilonidal sinus. The pilonidal sinus may represent a remnant of the embryonic appendage ('human tail') that usually disappears by the end of the 8th week of gestation. This case might support the theory of congenital pilonidal sinus origin.

Determination of gestational age in medium and small size bitches using ultrasonographic fetal measurements.

A study was undertaken to estimate gestational age, in terms of days from parturition, in medium and small size dogs by ultrasonographic examination. Serial ultrasonographic examinations were performed in four medium size pregnant bitches throughout two consecutive pregnancies and three small size pregnant bitches throughout one pregnancy, in order to determine the range of variation in the size of selected fetal structures throughout gestation. Formulae were derived to estimate the expected delivery date for both groups of bitches by measuring anatomical fetal structures, so that this method could be applied to a large number of different breeds. The determination of gestational age could be achieved with reasonable precision by selecting fetal structures. Prediction of parturition date was accurate to within one day by ultrasonographic measurement of the diameter of the gestational sac in early pregnancy and the biparietal diameter in late pregnancy in both small size breeds and medium size breeds.