The Obstetric Medicine Listserv: review of controversies surrounding thrombophilia testing.

A woman with no significant personal or family history of thrombosis asked her internist to obtain a thrombophilia work-up prior to starting the combined oral contraceptive for dysmenorrhoea, after another physician advised her to have the test. The case was sent to an international email discussion group where the consensus was that testing should not be done. The responses of the group and review of this controversial topic are presented.

Breast cancer survivors and vitamin D: a review.

Recent evidence has suggested a role for vitamin D in breast cancer prevention and survival. Studies have reported an inverse relation between vitamin D intake and the risk of breast cancer, improvements in survival after a diagnosis of breast cancer in women with higher levels of vitamin D, and vitamin D insufficiency in up to 75% of women with breast cancer. Preclinical data have indicated that vitamin D affects up to 200 genes that influence cellular proliferation, apoptosis, angiogenesis, terminal differentiation of normal and cancer cells, and macrophage function.

[Quantitative and qualitative analysis of the blood flow in breast tumors using power Doppler ultrasound].

Purpose: Our study was performed to obtain additional information regarding the present diagnostic approaches in breast tumor diagnosis by investigating tumor vessels. We present a new method that helps to capture the morphologic features from power Doppler ultrasound images using a computer-aided system facilitating pixel relation analysis techniques in the region of interest (ROI).

Materials And Methods: 45 solid breast tumors, including 18 benign and 27 malignant histologically proven cases, were studied using quantitative and qualitative parameters with extracted three-dimensional (3D) diagrams.

A practical approach to guide clinicians in the evaluation of male patients with breast masses.

Breast cancer must be considered in the evaluation of breast masses in men, although various benign causes are more common, including gynecomastia and conditions of the skin and subcutaneous tissue. A patient's history may identify key features suspicious for malignancy or reassuring for benign disease. Physical examination has been documented to be as effective as mammography in distinguishing benign from malignant lesions, and both have been reported as highly accurate for the identification of malignancy.

Advances in the care of patients with intracerebral hemorrhage.

Intracerebral hemorrhage (ICH), which comprises 15 percent to 30 percent of all strokes, has an estimated incidence of 37,000 cases per year. One third of patients are actively bleeding when they present to the emergency department, and hematoma growth during the first hours after ICH onset is thought to be a prime determinant of clinical deterioration. Inflammation, as opposed to ischemia, also negatively affects patient condition.

[Grey-scale texture analysis of the cervix in pregnancy].

Aim: The measurement of the length of the cervix is just a method of routine, but the analysis of the grey-scale texture of the cervix represents a method poorly evaluated to date which may have the scope of improving the prediction of premature birth. Before it can be used for clinical purposes, the method must be standardised.

Methods: 66 patients were examined endosonographically.

Adhesion prevention comparing liquid and solid barriers in the rabbit uterine horn model.

Objective: The purpose of this study was to assess the ability of four different either solid or fluid barriers to reduce adhesions in an established model of gynecological surgery.

Study Design: 50 Chinchilla rabbits underwent bilateral deperitonealization and devascularization of the uterine horns (DUH). Afterwards solid membranes of either hyaluronic acid-carboxymethylcellulose (HA-CMC) or lactide-caprolactone-copolymer (LCC) were placed around the injured uterine horns or fluids (icodextrin (ID) or phospholipids (PL)) were intraperitonealy administered.

[Analysis of Foetal Heart Rate Data using Complex Software: Comparison of Recurrence Plot of Foetal Heart Rate with the Course of Pregnancy -].

Background: Is it useful to further analyse foetal heart rate to improve the prediction of pregnancy complications? The analysis of the foetal heart rate is usually based on the variability of the heart rate, i. e. the more variable the heart rate presents - except a decrease - the better the condition of the foetus is.

Importance of ductus venosus Doppler assessment for fetal outcome in cases of intrauterine growth restriction.

Objective: The measurement and evaluation of ductus venosus (DV) blood flow velocity waveform in high-risk pregnancies has been studied intensively in recent years in order to find a more intermediate signal of fetal compromise. Our objective was to study the fetal outcome of pregnancies with intrauterine growth retardation (IUGR) and normal pulsatility of DV compared to an IUGR group with increased DV pulsatility.

Methods: The outcome of 42 fetuses before 32 weeks of gestational age without chromosomal or structural aberrations was analyzed.

[Prenatal diagnosis of hepatic hemangioendothelioma and peripartual management].

Infantile hepatic hemangioendothelioma is a benign hepatic tumor that can be associated with life-threatening perinatal complications. A 38-year-old gravida 3 para 2 was referred to our hospital with preterm labor at 33.6 gestational weeks.

Phospholipids reduce adhesion formation in the rabbit uterine horn model.

Objective: To access the ability of intraperitoneal phospholipids to reduce adhesions in a standardized model for gynecologic operations.

Design: A randomized, experimental, blinded study using the double uterine horn model.

Setting: Academic animal research laboratory.

[Dopplersonography of the ductus venosus: assessment, evaluation and actual clinical importance].

The ductus venosus (DV) connects the intra-abdominal umbilical vein with the infundibulum of the IVC and develops during pregnancy to a trumpet-shaped structure with a narrow isthmus that accelerates the blood jet crossing the IVC directly to the left atrium via the foramen ovale avoiding mixing with deoxygenated blood from the right chamber. In animal studies, blood flow and doppler sonographically analyzed blood flow velocity waveforms mainly is controlled by heart rate and central venous pressure. The velocity waveform of the DV contains two peak components: the first indicates systolic velocity of the ventricle, the second peak diastolic velocity.

[Preoperative determination of the structure of pelvic tumors with color-coded Doppler ultrasound and conventional transvaginal ultrasound diagnosis].

In 265 adnexal masses results of conventional transvaginal sonography and coloured doppler sonography were compared with histopathological results. Statistical evaluation was based on lowest PI and RI as well as highest peak systolic velocity from signals derived of all detectable tumour vessels. Cut-off values from actual literature and cut-off values established in Aachen (PI < 0.

[Notching of the bilateral uterine artery flow velocity wave-forms in the third trimester and perinatal complications].

Pulsatile color duplex Doppler ultrasonography system was used to study blood flow velocity waveforms in the uterine arteries of 492 pregnant women in the third trimester. In 38 (7.7%) patients unilateral and in 42 (8.

[Blood circulation in retarded and normal offspring of hypertonic pregnant women].

Doppler velocimetry was carried out on 62 women with hypertensive disorders in pregnancy. From this group, 19 infants with intrauterine growth retardation (IUGR, defined as gestational age related birth weight of < 10.percentile) were born.

[Maternal-fetal circulation in premature labor].

Color and pulsed wave Doppler ultrasonographic studies were performed of the maternal uterine, umbilical, and fetal middle cerebral and renal arteries in 70 singleton preterm pregnancies, within 24 hours of delivery. There were 29 fetuses that had a small weight for gestational age (SGA) at the time of delivery. From these 25 fetuses were small as a result of placental insufficiency.

[Fetal blood circulation in multiple pregnancy].

Blood flow velocity waveforms in maternal uterine and fetal umbilical, middle cerebral and renal arteries were studied utilizing color coded pulsed Doppler ultrasound in 31 twin and 3 triplet gestations during the last trimester. Thirty-one (45.6%) out of 68 neonates were born with appropriate body weight for gestational age.

[Transvaginal Doppler ultrasound in early pregnancy--normal values and comparison with a risk sample with threatened abortion].

In the study introduced here, norm values for embryo-feto-placental circulation are illustrated. The values were gained by examining 75 singleton pregnancies of uncomplicated course and ending with non-problematic birth of an eutrophic child. In addition to qualitative parameters such as A/B-ratio and Pulsatility Index, the maximum systolic frequency shift was measured by transvaginal Doppler sonography between the fifth and 24th week of gestation (post menstruation), to obtain another quantitative parameter.

[Doppler color ultrasonography of maternal-fetal circulation in HELLP syndrome].

The authors investigated the blood flow velocity waveforms of the mothers uterine arteries and fetal middle cerebral, renal and umbilical arteries in cases of HELLP syndrome by color Doppler ultrasonography. The elevated velocimetry indices in the uterine and umbilical arteries were the result of utero-placental and fetoplacental vascular lesions with resultant decrease in blood flow. These laid to the centralization of fetal circulation with increased blood flow in cerebral and decreased in renal arteries.

[Doppler ultrasound studies of venous retrograde flow in precardiac veins of the fetus in normal and abnormal pregnancies].

Precardiac venous blood flow, umbilical artery and aortal blood flow of 120 unselected patients has been investigated by means of Doppler ultrasound. Measuring a hepatic vein directly before entering the inferior vena cava we found a characteristic blood flow pattern with a moderate foreward flow during systole and a small foreward flow during early diastole and a very small reverse flow because of atrial contraction during late diastole. We found changes in this flow pattern with reduction of the mean velocity in cases of high risk pregnancies with intrauterine growth retardation.

[The importance of measuring both umbilical arteries for accuracy in Doppler ultrasound studies].

In a quarter of our Doppler investigations differences between the S/D-ratios of the arteries of one umbilical cord were more than 20%. In these cases one Doppler value was decided to be normal and the other to be pathological. In cases with two pathological values most caesarean sections because of fetal distress had to be performed and most SGA babies were born.

[Doppler color sonography in the study of fetal cerebral circulation in oligohydramnios].

Blood flow velocity waveforms in the fetal middle cerebral arteries and umbilical arteries were studied with color flow imaging in 21 pregnancies complicated by oligohydramnios. According to the authors results 3 groups of fetuses may divided: 1. the blood flow in both vessels are normal; 2.

[The value of Doppler ultrasound studies in threatened premature labor].

95 patients were investigated using Doppler ultrasound to evaluate its usefulness during the clinical management of patients with preterm labor, preterm rupture of membranes and incompetent cervix. Cases with additional pregnancy complications as preeclampsia or intrauterine growth retardation or infection of the amnion or the birth canal were excluded from our study. We examined the umbilical artery and the uterine arteries.