Echocardiography in Early Pregnancy Haak, Monique C.; van Vugt, John M. G.
Journal of ultrasound in medicine,
March 2003, Letnik:
22, Številka:
3
Journal Article
Recenzirano
Objective. First‐trimester transvaginal sonography is a widely used technique to examine the fetus early in pregnancy. The aim of this review was to explore the possibilities of examining the fetal ...heart at this early stage of pregnancy. Methods. With the use of a computerized database (PubMed, US National Library of Medicine, Bethesda, MD), articles on first‐trimester echocardiography were retrieved. Furthermore, the cited references of the studied articles were used to find additional articles. Results. In the analyzed articles, an increase in visualization rates of the 4‐chamber view and the outflow tracts was shown in the last decade, with visualization rates of greater than 90% at 13 weeks' gestation. The different cardiac defects that are shown in first‐trimester fetuses are mainly defects involving the 4‐chamber view, indicating that defects solely affecting the outflow tracts are difficult to diagnose in the first trimester of pregnancy. The sonographic assessment of the fetal heart between 14 and 18 weeks' gestation has been described. The literature, however, has not shown clear advantages of performing fetal echocardiography during this period compared with transvaginal sonography at 13 weeks' gestation. Conclusions. First‐trimester echocardiography is a promising technique, which can be of considerable value for patients at risk of having offspring with cardiac defects. This technique is, however, currently limited to a few specialized centers.
Popvirus Aerts, Monique; Van den Haak, Marcel
2009., 2009
eBook
Er waart een popvirus door het land. Steeds meer sferen in de samenleving lijken gepopulariseerd te worden. Religie vindt een nieuwe weg op de videowebsite GodTube.com; debatten over islam en ...integratie worden voor een breed en jong publiek gebracht in televisieseries als Dunya en Desie; HEMA-posters en videoclips rukken op in kunstmusea. Soms gebeurt deze popularisering van bovenaf, door museumdirecteuren of televisiemakers; soms ook komt het van onderaf, als internetgebruikers bijvoorbeeld zelf op een politieke discussie reageren op YouTube.
BACKGROUND: Measurement of nuchal translucency (NT) is a widely used method of screening for chromosomal abnormalities. Increased NT is seen in a diversity of fetal malformations. The mechanism ...explaining the abnormal fluid accumulation and the transient nature of NT remains unexplained. METHODS: The nuchal regions of normal and trisomy 16 mouse embryos were examined for (lympho)vascular abnormalities using immunohistochemical markers against lymphatic vessels (LYVE-1) and smooth muscle (1A4) and endothelial (CD34) cells. Additionally, an ultrasonographic study was carried out on 17 human fetuses with an increased NT. Two of these fetuses were examined morphologically. RESULTS: In both abnormal human and mouse specimens, we found a mesenchyme lined cavity within the posterior nuchal region as well as bilaterally enlarged jugular LYVE-1 positive lymphatic sacs. The persistence of jugular lymphatic sacs was also confirmed by ultrasound in 14 human fetuses with increased NT. CONCLUSION: Our findings identify the cause of increased NT as mesenchymal oedema in the presence of distended jugular lymphatic sacs, detected by the hyaluronan receptor LYVE-1. The delayed organization and connection of these lymphatic sacs to the venous circulation might explain the transient nature of NT. Disturbance in timing of endothelial differentiation might be a common denominator in the origin of NT, linking cardiovascular and haemodynamic abnormalities.
Nuchal edema (NE) is a clinical indicator for aneuploidy, cardiovascular anomalies, and several genetic syndromes. Its etiology, however, is unknown. In the nuchal area, the endothelium of the ...jugular lymphatic sacs (JLS) develops by budding from the blood vascular endothelium of the cardinal veins. Abnormal distension of the jugular sacs is associated with NE. We hypothesize that a disturbed lymphatic endothelial differentiation and sac formation causes NE. We investigated endothelial differentiation of the jugular lymphatic system in human and mouse species with NE.
Aneuploid human fetuses (trisomy 21; trisomy 18) were compared with euploid controls (gestational age 12 to 18 weeks). Trisomy 16 mouse embryos were compared with wild type controls (embryonic day 10 to 18). Trisomy 16 mice are considered an animal model for human trisomy 21. Endothelial differentiation was investigated by immunohistochemistry using lymphatic markers (prox-1, podoplanin, lymphatic vessel endothelial hyaluronan receptor LYVE-1) and en blood vessel markers (neuropilin NP-1 and ligand vascular endothelial growth factor VEGF-A). Smooth muscle actin (SMA) was included as a smooth muscle cell marker.
We report a disturbed venous-lymphatic phenotype in aneuploid human fetuses and mouse embryos with enlarged jugular sacs and NE. Our results show absent or diminished expression of the lymphatic markers Prox-1 and podoplanin in the enlarged jugular sac, while LYVE-1 expression was normal. Additionally, the enlarged JLS showed blood vessel characteristics, including increased NP-1 and VEGF-A expression. The lumen contained blood cells and smooth muscle cells lined the wall.
A loss of lymphatic identity seems to be the underlying cause for clinical NE. Also, abnormal endothelial differentiation provides a link to the cardiovascular anomalies associated with NE.
Aim
The aim of this study was to assess the clinical and oncological outcome of a selected group of stage IV rectal cancer patients managed by the watch‐and‐wait approach following a (near‐)complete ...response of the primary rectal tumour after radiotherapy.
Method
Patients registered in the Dutch watch‐and‐wait registry since 2004 were selected when diagnosed with synchronous stage IV rectal cancer. Data on patient characteristics, treatment details, follow‐up and survival were collected. The 2‐year local regrowth rate, organ‐preservation rate, colostomy‐free rate, metastatic progression‐free rate and 2‐ and 5‐year overall survival were analysed.
Results
After a median follow‐up period of 35 months, local regrowth was observed in 17 patients (40.5%). Nine patients underwent subsequent total mesorectal excision, resulting in a permanent colostomy in four patients. The 2‐year local regrowth rate was 39.9%, the 2‐year organ‐preservation rate was 77.1%, the 2‐year colostomy‐free rate was 88.1%, and the 2‐year metastatic progression‐free rate was 46.7%. The 2‐ and 5‐year overall survival rates were 92.0% and 67.5%.
Conclusion
The watch‐and‐wait approach can be considered as an alternative to total mesorectal excision in a selected group of stage IV rectal cancer patients with a (near‐)complete response following pelvic radiotherapy. Despite a relatively high regrowth rate, total mesorectal excision and a permanent colostomy can be avoided in the majority of these patients.
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