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Clinical improvement and shrinkage of uterine fibroids after thermal ablation by magnetic resonance‐guided focused ultrasound surgery
Rabinovici, J.; Inbar, Y.; Revel, A. ...
Ultrasound in obstetrics & gynecology,
October 2007, Volume:
30, Issue:
5
Journal Article
Peer reviewed
Open access
Objective
Hysterectomy or myomectomy are the accepted treatments for symptomatic uterine fibroids. Heat ablation of uterine fibroids has been shown to be an effective alternative treatment. The aim ...
of this study was to determine the clinical efficacy of non‐invasive thermal ablation by transcutaneous magnetic resonance‐guided high‐intensity focused ultrasound (MRgFUS) for the treatment of symptomatic uterine fibroids.
Methods
In this prospective study, MRgFUS ablation of uterine fibroids was performed in 35 symptomatic women scheduled for hysterectomy. Clinical symptoms, patient satisfaction and uterine size were determined at 1 month and 6 months after the procedure.
Results
This outpatient procedure was very well tolerated by all women. Sixty‐nine percent (24/35) of the treated patients reported either significant or partial improvement in symptoms. Treated fibroids decreased in volume by 12% and 15% at 1 and 6 months, respectively. Minor transient side‐effects were observed in two women. Six women underwent hysterectomy during the follow‐up period.
Conclusion
This study demonstrates the clinical efficacy of MRgFUS ablation of uterine fibroids. This novel, non‐invasive surgical approach may offer an alternative therapy for women with uterine fibroids. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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Fetal aberrant right subclavian artery in normal and Down syndrome fetuses
Zalel, Y.; Achiron, R.; Yagel, S. ...
Ultrasound in obstetrics & gynecology,
January 2008, 2008, 2008-Jan, 2008-01-00, 20080101, Volume:
31, Issue:
1
Journal Article
Peer reviewed
Objectives
To evaluate the prevalence of fetal aberrant right subclavian artery (ARSA) in a low‐risk population and compare it with that among Down syndrome fetuses, in order to estimate its ...
potential as a marker in Down syndrome screening.
Methods
Women undergoing routine fetal sonographic examination between 13 and 26 weeks of gestation were evaluated once for the presence of ARSA using either a transvaginal multifrequency 5–9‐MHz probe or a transabdominal 4–8‐MHz probe as appropriate. Early pregnancy outcome was obtained in all cases.
Results
Nine hundred and twenty‐four fetuses were recruited. An ARSA was detected in 13 fetuses (1.4%) with normal karyotype. During the study period, eight fetuses with Down syndrome referred either with known karyotype or with signs suspicious for Down syndrome were evaluated by the same protocol. Three of eight fetuses (37.5%) were found to have an ARSA. In none of these cases was ARSA an isolated finding. The odds ratio for ARSA in Down syndrome compared with normal fetuses was 42.04 (95% CI, 9.08–194.6).
Conclusions
An ARSA was found in 1.4% of the normal population. In the small group of Down syndrome fetuses we observed a trend towards a higher rate of ARSA than in normal fetuses. In none of the Down syndrome fetuses was ARSA an isolated finding. Larger prospective studies are needed to examine the significance of ARSA as an isolated finding and the potential of ARSA as a marker in Down syndrome screening. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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Fetal thymus size as a predictor of chorioamnionitis in women with preterm premature rupture of membranes
Yinon, Y.; Zalel, Y.; Weisz, B. ...
Ultrasound in obstetrics & gynecology,
June 2007, Volume:
29, Issue:
6
Journal Article
Peer reviewed
Objective
Emerging evidence indicates that chorioamnionitis is associated with a significant decrease in thymic size at birth in very low birth weight (VLBW) preterm infants. The aim of this study ...
was to determine whether decreased fetal thymus size is associated with histological or clinical chorioamnionitis in patients with preterm premature rupture of membranes (PROM).
Methods
Twenty‐one patients between 24 and 35 weeks of gestation with preterm PROM were included. Serial ultrasound examinations were performed during the latency period, and measurements of the fetal thymus size were obtained. Small thymus was defined as a thymus perimeter ≤ 5th percentile according to a fetal thymus nomogram, which was based on measurements of 403 fetuses. Diagnosis of chorioamnionitis was made using neonatal clinical parameters and histological examinations of the placentas.
Results
In our study 13 patients presented with thymus size below the 5th percentile. Among the 13 patients with small thymus, nine (69%) had clinical or histological findings consistent with the diagnosis of chorioamnionitis. All eight women with a normal‐sized thymus had no evidence of clinical or histological chorioamnionitis. Fetal thymus perimeter ≤ 5th percentile yielded a sensitivity of 100%, specificity of 66.7%, a positive predictive value of 69% and a negative predictive value of 100% for identifying chorioamnionitis in patients with preterm PROM.
Conclusions
Fetal thymus size is decreased in women with preterm PROM and chorioamnionitis. Measurement of the fetal thymus might allow an early diagnosis of chorioamnionitis in cases of preterm PROM. Normal thymus size might be used to rule out latent intrauterine infection. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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Secondary cytomegalovirus infection can cause severe fetal sequelae despite maternal preconceptional immunity
Zalel, Y.; Gilboa, Y.; Berkenshtat, M. ...
Ultrasound in obstetrics & gynecology,
April 2008, Volume:
31, Issue:
4
Journal Article
Peer reviewed
Open access
Objectives
To describe our experience in cases with sonographic signs of fetal infection and with maternal serological ‘immunity’ to cytomegalovirus (CMV) infection.
Methods
This was a bicenter study ...
of six pregnant women referred for evaluation of suspected fetal infection. All cases had confirmed maternal serology for past exposure to CMV but no evidence of recent secondary CMV infection. All underwent sonographic evaluation as well as complete investigation for CMV infection.
Results
The mean age of the women was 29 (range, 23–35) years and the mean gestational age at diagnosis was 23.5 weeks (range, 20–31) weeks. Sonographic findings included microcephaly, ventriculomegaly, periventricular calcifications and cystic lesions, echogenic bowel, hydrops and hepatosplenomegaly. Amniocentesis was performed in all cases for fetal karyotyping and viral assessment, and all were found by polymerase chain reaction to be positive for CMV infection. Four pregnancies were terminated following the parents' request. One pregnancy continued until intrauterine fetal death occurred 2 weeks after diagnosis. Postmortem was denied in all cases but one. One infant was delivered with evidence of severe cerebral palsy.
Conclusion
In the presence of sonographic findings suggestive of fetal CMV infection, prompt investigation of amniotic fluid should follow even if maternal serology does not support recent maternal seroconversion. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
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Three‐ and four‐dimensional ultrasound: new methods for evaluating fetal thoracic anomalies
Achiron, R.; Gindes, L.; Zalel, Y. ...
Ultrasound in obstetrics & gynecology,
July 2008, Volume:
32, Issue:
1
Journal Article
Peer reviewed
Open access
Objective
To study three‐ (3D) and four‐dimensional (4D) ultrasound applications for the evaluation of fetal thoracic anomalies.
Methods
Volume datasets of 23 fetuses with thoracic anomalies were ...
acquired with static 3D and cine 4D ultrasound, i.e. spatiotemporal image correlation (STIC) mode. The volumes were analyzed and displayed by multiplanar and tomographic ultrasound imaging (TUI) modes and static volume contrast imaging (VCI). Color Doppler was added to the volumes acquired, and various rendering modes were used to display the volume datasets.
Results
The mean gestational age at evaluation was 22 (range, 14–34) weeks. The anomalies were identified as: diaphragmatic hernia (n = 5), lung dysplasia (n = 11), skeletal dysplasia with small thorax/thanatophoric dysplasia (n = 2), abnormal situs (n = 2), hydrothorax (n = 2) and esophageal atresia (n = 1). The TUI mode achieved optimal display of the thorax, thereby aiding the diagnosis of diaphragmatic hernia and lung dysplasia. In right diaphragmatic hernias, the VCI mode proved invaluable as it distinguished liver from lung tissue. High‐definition color Doppler with glass‐body rendering significantly contributed to the detection of abnormal vascularization in lung dysplasia. Maximal transparent mode with a transvaginal transducer provided accurate diagnosis of skeletal dysplasia in the first trimester. Situs abnormalities were best viewed with a minimal transparent mode, in which abnormal organs and positions of vessels were clearly identified. Pleuroamniotic shunt localization was monitored precisely by 3D in a fetus with hydrothorax, and inversion mode added important information regarding the size of an esophageal pouch in a fetus with esophageal atresia.
Conclusion
The 3D‐4D technique is a novel, useful sonographic tool for evaluating the fetal thorax. It enhances precise diagnosis and provides better spatial visualization of the anomalies involved. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
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Prenatal ultrasonographic diagnosis of persistent hyperplastic primary vitreous
Katorza, E.; Rosner, M.; Zalel, Y. ...
Ultrasound in obstetrics & gynecology,
August 2008, Volume:
32, Issue:
2
Journal Article
Peer reviewed
Open access
Persistent hyperplastic primary vitreous (PHPV) is a rare developmental malformation of the eye characterized by the presence of a vascular membrane located behind the lens. We report, for the first ...
time in the literature, the identification on ultrasound examination of bilateral cataract and thickened hyaloid artery–lens junction, leading to a diagnosis of bilateral PHPV, in a fetus at 23 weeks' gestation. Histological examination at postmortem confirmed the prenatal diagnosis of bilateral PHPV and cataract. A thorough ultrasound examination of the fetal eye in cases with cataract is recommended. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
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Tailored management of twin reversed arterial perfusion (TRAP) sequence
Weisz, B.; Peltz, R.; Chayen, B. ...
Ultrasound in obstetrics & gynecology,
20/May , Volume:
23, Issue:
5
Journal Article
Peer reviewed
Open access
Objective
To describe our management of pregnancies complicated by twin reversed arterial perfusion (TRAP) sequence.
Methods
This was a retrospective study involving all cases of TRAP sequence ...
referred to our fetal medicine unit in a 3‐year period (2000–2002). Patients were routinely managed by repeat sonographic surveillance with sonographic anatomical evaluation and detailed echocardiography. Cases with signs of impending cardiac failure were treated by in‐utero YAG‐laser coagulation of the umbilical vessels of the acardiac twin.
Results
Six cases were studied. Three patients in whom there were no signs of deterioration in the status of the pump twin, and in whom the acardiac twin was smaller than the pump twin, were managed conservatively. However, one of these with monoamniotic twins ended in intrauterine fetal death of the pump twin. The other two cases presented with spontaneous cessation of blood flow in the umbilical artery of the acardiac twin. Both delivered at term normal neonates whose follow‐up revealed no signs of neurological sequelae. One case of quadruplet pregnancy (with TRAP sequence and two dichorionic twins) was treated by selective termination of the monochorionic twins. Two cases with signs of impending cardiac failure were treated by in‐utero YAG‐laser occlusion of the vessels in the acardiac mass. Both interventions had a favorable outcome.
Conclusions
Conservative treatment is suitable for milder cases of TRAP sequence in which the pump twin is the larger one. Cases in which the acardiac twin is larger have a poorer prognosis and should be treated by invasive intervention and cord occlusion. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
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