Three-dimensional sonographic assessment of fetal behavior in the early second trimester of pregnancy.

OBJECTIVE: To evaluate the fetal behavior pattern in the early second trimester of pregnancy by use of specially developed abdominal dynamic three-dimensional sonography. METHODS: Dynamic three-dimensional sonographic examinations were performed on 11 healthy pregnant women at 14 to 18 weeks of gestation. This imaging system provided continuous three-dimensional sonographic images every 1 to 2 seconds. Fetal movements were recorded continuously for 60 minutes in each fetus. The rate of occurrence of head, mouth, arm, trunk, and leg movements was evaluated. All fetal behavioral patterns were observed during the period studied. RESULTS: The active phase (time with fetal movements) was 59.4%, and the resting phase was 40.6%. The most active fetal behavior pattern was an arm movement, whereas the least was a mouth movement. Moreover, each fetal movement was synchronized and harmonized with other fetal movements (a few movement patterns were found to be generated simultaneously). CONCLUSIONS: Dynamic three-dimensional sonography provides a novel means for evaluation of fetal behavior in the early second trimester of pregnancy. These results suggest that dynamic three-dimensional sonography may be an important modality in future early fetal behavior research and in evaluation of early fetal well-being.

Difference spatial distribution function analysis of aqueous solutions. IV. Hydration structure changes of ethylene glycol solutions throughout conformational change process from gGg' to tGg' conformers.

Monte Carlo (MC) simulations were carried out for an infinitely dilute aqueous solution of two stable conformers (gGg' and tGg') and of three conformations between gGg' and tGg' conformers of ethylene glycol (EG) at 298K. Based on the spatial distribution function (SDF) goo(x,y,z), obtained from the MC simulation in the above conformations in liquid water, the high distribution of hydration water molecules could be divided into hydrogen acceptor (HA), hydrogen donor (HD), MIX (overlapped distribution of HA and HD), and hydrophobic hydration (HH) regions. The spatial orientations of hydrogen-bonded water molecules were found to be of a linear type with a triple-layer structure in the HA region and HA part (in the MIX region), and double-layer structures in the HD region and HD part (in the MIX region). In addition, it was apparent that the spatial orientations of these water molecules were of the linear type throughout the conformational change process from gGg' to tGg' conformers in liquid water. From the difference SDF (DSDF), deltagoo(x,y, z), between the SDFs of two conformations, we concluded that the distribution of hydration water molecules in the HA and HD parts of the MIX region are governed by the competition of internal hydrogen bonds between the hydrogen atom and two lone-pair electrons on the oxygen atom of an EG molecule.

Difference spatial distribution function analysis of aqueous solutions. III. Hydration structures of alcohol and ether solutions having straight chain and branched alkyl groups.

Spatial distribution functions (SDFs), gOO(x,y,z) and gOH(x,y,z), obtained from Monte Carlo simulations at 298 K were applied to characterize the anisotropic structure of infinitely dilute aqueous solutions of alcohols and ethers having straight chain and branched alkyl groups. In spite of the different size and shape of the hydrophobic groups, the spatial orientation of the hydrogen-bonded water molecules was found to be of linear type with a triple layer structure in the hydrogen acceptor (HA) region and a double layer structure in the hydrogen donor (HD) region. The volumes and the coordination number (CN) in the HA region were essentially identical for all alcohol and ether solutions, but the volumes for the isopropyl alcohol (IPA) and isopropyl methyl ether (IPE) solutions were greater than those for the other solutions. In the hydrophobic hydration (HH) region, these values increased with increasing size and shape of hydrophobic groups, except in the case of IPA and IPE solutions. These results indicated that the hydration structures around the isopropyl group in alcohol and ether solutions differed from those in other solutions. From the results of the difference SDF (DSDF), AgOO(x,y,z), between SDFs gOO(x,y,z) for the two states, it was apparent that the distribution of hydration water molecules in the HA region for ether solution was characterized by the increase of the distribution in the direction of lone pair electrons on the oxygen atom of the solute molecule with increasing hydrophobicity.

Difference spatial distribution function analysis of aqueous solutions. II. Hydration structures of dimethyl ether, 180 degrees ethyl methyl ether and 0 degree ethyl methyl ether solutions.

Monte Carlo simulations are systematically presented to demonstrate the influence of the hydrophobic group's steric bulk on hydration structure. We have simulated a dimethyl ether (DME), two conformations for ethyl methyl ether (0 degree EME and 180 degrees EME), and 0 degree ethanol solutions. Spatial distribution function (SDF), goo(x,y,z) and difference SDF (DSDF), delta goo(x,y,z), obtained from MC simulation in an infinitely dilute aqueous solution of ether show the three-dimensional probability of an atom-atom pair distribution between solute and solvent atoms. Based on the results of SDF in an infinitely dilute aqueous solution of ether, the distribution of hydration water molecules can be divided into hydrogen acceptor (HA) and hydrophobic hydration (HH), regions, and the spatial orientation of the hydrogen-bonded water in the HA region is found to form a triple-layer structure, as it does in alcohol solutions. From the results of an analysis of the DSDF delta goo(x,y,z) between the SDFs of EME and DME, it is apparent that the distribution changes of hydration water molecules in ether solutions are essentially similar to those in the alcohol solutions. Further, we show that the hydration water molecules are distributed mainly in the stable area in the binding energy's (BE) contour maps for each region.

Saline infusion contrast intrauterine sonographic assessment of the endometrium with high-frequency, real-time miniature transducer in normal menstrual cycle: a preliminary report.

Normal endometrial texture was visualized using saline infusion contrast intrauterine sonography with a specially developed 20 MHz flexible catheter-based high-resolution, real-time miniature (2.4 mm outer diameter) ultrasound transducer in primary infertile women (n = 15) with a normal menstrual cycle. All the women had <2 years infertility duration and were studied in proliferative, and early or mid-secretory phases. Before intrauterine sonography, transvaginal sonographic assessment of the endometrium was conducted. The overall image clarity was subjectively compared between intrauterine and transvaginal sonography. Most endometrial textures in both proliferative and secretory phases were viewed more easily with intrauterine rather than transvaginal sonography, and this was especially true with an intrauterine saline infusion technique. Moreover, it was possible to obtain finer image quality of very small endometrial interfacial and internal textures with intrauterine sonography. However, the depth of penetration of the ultrasound beam is only approximately 2 cm, therefore examination of larger pathological endometrial lesions is markedly limited because of the shallow scanning range of the high-frequency transducer. Intrauterine sonography may be a valuable tool in imaging endometrial texture in normal menstrual cycle, and possibly in infertility practice, complementing and not replacing transvaginal sonography.

Laparoscopy-assisted intrapelvic sonography with a high-frequency, real-time miniature transducer for assessment of the Fallopian tube: a preliminary report.

Our purpose was to visualize normal and abnormal Fallopian tubes using laparoscopy-assisted intrapelvic sonography with a specially developed 20 MHz flexible catheter-based high-resolution, real-time miniature (2.4 mm outer diameter) ultrasound transducer in infertile women. A total of 21 women (20 infertile, one with unilateral hydrosalpinx, and one tubal pregnancy) were studied with pelvic saline effusion under laparoscopy. Fimbriae were clearly depicted with a cockscomb-like form in 95% of patients. All ampullae were visualized, and mucosal layers were clearly distinguished from muscle layers in 70% of patients. Scanty intratubal effusion was noted in 50% of patients, and tubal spastic findings were found in 10% of patients. In all, 60% of isthmuses were detected, and mucosal layers were distinguished from muscle layers in 30%. In the subject with hydrosalpinx, the tubal wall was thinner, and it was not possible to distinguish between muscle and mucosal layers. In the subject with a tubal pregnancy, the amniotic membrane and decidua were depicted more clearly than by transvaginal sonography. In conclusion, laparoscopy-assisted intrapelvic sonography with a high-frequency, real-time miniature transducer may be useful in the assessment of tubal texture and function in tubal disorders, possibly in infertility practice.

Detection of small-for-gestational-age infants with poor perinatal outcomes using individualized growth assessment.

OBJECTIVE: Our objective was to evaluate individualized growth assessment using the Rossavik growth model for detection of small-for-gestational-age (SGA) infants with a poor perinatal outcome. METHODS: Rossavik growth models derived from second-trimester ultrasound measurements were used to predict birth characteristics of 47 singleton SGA infants. Individual fetal growth curve standards for head and abdominal circumference, and weight were determined from the data of two scans obtained before 25 weeks' menstrual age and separated by an interval of at least 5 weeks. Comparisons between actual and predicted birth characteristics were expressed by the Growth Potential Realization Index (GPRI) and Neonatal Growth Assessment Score (NGAS). The proportions of perinatal outcomes [mechanical delivery, low Apgar score, abnormal fetal heart rate (FHR) patterns, neonatal acidosis, meconium staining of amniotic fluid, neonatal intensive care unit (NICU) admission and maternal complications] were compared between SGA infants with normal NGAS and those with abnormal NGAS. RESULTS: Of the 47 fetuses studied, 27 had normal growth outcomes at birth and 20 showed evidence of intrauterine growth restriction, based on NGAS. There were significant increases in mechanical deliveries, abnormal FHR patterns and meconium staining of amniotic fluid in cases of growth-restricted neonates, determined using the NGAS classification, when compared with events related to normally grown infants. However, there were no significant differences in low Apgar score, neonatal acidosis, NICU admission and maternal complications between the 2 groups. CONCLUSION: Individualized growth assessment should be useful for detection of SGA infants with poor perinatal outcomes.

Three-dimensional ultrasonographic assessment of fetal hands and feet.

OBJECTIVE: The aim of this study was to describe fetal hands and feet using three-dimensional ultrasonography. DESIGN: This was a randomized prospective study. METHODS: Ninety-seven fetuses from 12 to 40 weeks' gestation were studied with a specially developed trans-abdominal three-dimensional transducer (3.5 MHz). The imaging system used in this study can provide conventional two-dimensional ultrasound images and can also generate, within seconds, high-quality three-dimensional images in the surface and transparent modes with no need for an external workstation. The rate of visualization of the hands/fingers and feet/toes at each gestational-age interval was calculated using two-dimensional and three-dimensional ultrasonography. RESULTS: The ability to visualize fetal hands/fingers and feet/toes was better with three-dimensional than with two-dimensional ultrasonography in the late first trimester (detection rates were 65% and 41% by three-dimensional ultrasonography for hands and feet, respectively, and 41% and 12%, respectively, by two-dimensional ultrasonography). For the early second trimester, detection rates were 82% for hands and 72% for feet by three-dimensional ultrasonography, and 54% for hands and 45% for feet by two-dimensional ultrasonography. Optimal visualization of the fetal fingers using three-dimensional ultrasonography was achieved between 28 and 35 weeks of gestation, although at this stage there were no significant differences in detection rates for hands and feet between two- and three-dimensional imaging. During this period it was possible with three-dimensional ultrasonography adequately to depict at least one hand in 93% of the fetuses at 28-31 weeks and in 88% at 32-35 weeks. The percentage of visualization of at least one fetal foot between 16 and 35 weeks using three-dimensional ultrasonography ranged from 50 to 85%. Before 15 weeks or after 36 weeks, the respective percentages decreased. CONCLUSIONS: Three-dimensional ultrasonography provides a novel means of visualizing fetal fingers and toes. Our observations suggest that three-dimensional ultrasonography may enhance the diagnostic potential of two-dimensional ultrasonography and might be useful in identifying fetal malformations and anatomical markers of chromosomal abnormalities prenatally in high-risk pregnancies.

Three-dimensional ultrasonographic assessment of the umbilical cord during the 2nd and 3rd trimesters of pregnancy.

OBJECTIVE: To evaluate the umbilical cord and its abnormalities by use of three-dimensional ultrasonography with a specially developed abdominal three-dimensional transducer. PATIENTS AND METHODS: Ninety-five pregnancies (92 normal, 2 with hydrops fetalis, and 1 with omphalocele) from 14 to 40 weeks of gestation were studied with a specially developed abdominal three-dimensional transducer (3.5 MHz). This system can provide conventional two-dimensional ultrasonography images and can also generate within seconds high-quality three-dimensional images in the surface and transparent mode with no need for an external workstation. A proportion of the umbilical cords (coiled or noncoiled free loop, abdominal insertion, and placental insertion) visualized at each gestational age interval is presented. RESULTS: The proportion of the umbilical cords visualized during pregnancy except for between 24 and 27 weeks of gestation was about 70% (range 64-83%). Optimal visualization of the umbilical cord was achieved between 24 and 27 weeks of gestation. During this period it was possible to adequately depict the umbilical cord in 93% of the cases. The proportions of the noncoiled umbilical cord depicted during pregnancy ranged from 8 to 45%. The detection rate of abdominal insertion of the umbilical cord visualized at 14-19 weeks was 44%; the detection rate decreased thereafter. Placental insertion of the umbilical cord could not be identified after 28 weeks of gestation. In 2 cases with hydrops fetalis, edematous umbilical cord was evident. In 1 fetus, omphalocele was clearly depicted. CONCLUSIONS: The new three-dimensional ultrasound technology generates within seconds high-quality three-dimensional images of the umbilical cord, although limitation of viewing direction exists. These results suggest that the new three-dimensional ultrasonography has the potential to be a supplement to two-dimensional ultrasonography and might be useful in identifying abnormal umbilical cords in utero.

Assessment of embryonic anatomy at 6-8 weeks of gestation by intrauterine and transvaginal sonography.

Our purpose was to compare the ultrasound visualization of the early first-trimester embryo using transvaginal and intrauterine sonography. In all, 32 women about to undergo therapeutic abortion at 6-8.9 weeks gestation were studied using a specially developed catheter-based, high-resolution, real-time miniature (2.4 mm outer diameter) ultrasonography transducer (20 MHz). Before the intrauterine sonographic procedure was performed, transvaginal sonographic assessment of the embryo was conducted. The parameters evaluated included the ability to visualize anatomical structures and a subjective assessment of the overall image clarity. The ability to view most organs was better with intrauterine sonography compared to transvaginal sonography, and this was especially true for the brain, spine, heart, liver, midgut herniation, extremities, and sacral tail. Moreover, it was possible to obtain finer image quality of very small embryonic structures with intrauterine sonography than with transvaginal sonography. Stomach, spleen, kidney, and bladder could not be depicted with both techniques. One cystic hygroma was diagnosed at 7 weeks 6 days using intrauterine sonography, but not with transvaginal sonography. Intrauterine sonography may provide additional information on the visualization of anatomical structures of the embryo in the early first trimester of pregnancy. In this limited series, one case of cystic hygroma was demonstrated and, thus, there is a potential for its use in the early detection of embryonic malformation. These results suggest that intrauterine sonography may be a valuable tool in imaging the early first-trimester embryo, complementing and not replacing transvaginal sonography in high-risk pregnancies.

Assessment of cardiac sympathetic function with iodine-123-MIBG imaging in obstructive sleep apnea syndrome.

UNLABELLED: Iodine-123-MIBG imaging has been used to evaluate myocardial sympathetic function in various cardiac diseases. In patients with obstructive sleep apnea syndrome (OSAS), increased sympathetic activity has been widely recognized, as assessed by measuring the plasma concentration and urinary excretion of catecholamines and by measuring muscle sympathetic nerve activity. However, these measurements are not specific indices of cardiac sympathetic function. Therefore, this study was undertaken to assess cardiac sympathetic function in patients with OSAS using MIBG cardiac scintigraphy. METHODS: This study consisted of 11 patients (10 men, 1 woman; mean age 43 +/- 16 yr) with a diagnosis of OSAS established by polysomnography, and 8 age-matched normal control subjects (7 men, 1 woman; mean age 45 +/- 18 yr). Early (15 min) and delayed (3 hr) planar images were taken after the injection of 111 MBq of [123I]MIBG. The mean counts of the whole heart and the mediastinum were obtained to calculate heart-to-mediastinum count ratios from the early images (H/Me) and from the delayed images (H/Md) and the myocardial washout rate (WR). Eight patients were restudied after 1 mo of nasal continuous positive airway pressure treatment. RESULTS: The H/Me and H/Md ratios were significantly lower in the patients than in the control subjects (H/Me, 2.49 +/- 0.32 versus 2.84 +/- 0.34, p = 0.0207; and H/Md, 2.33 +/- 0.30 versus 3.02 +/- 0.36, p = 0.0013). The WR was higher in the patients than in the control subjects (36.2 +/- 9.0% versus 23.6 +/- 4.9%, p = 0.0022). The H/Me and H/Md ratios in the patients were significantly correlated with the apnea-hypopnea index and the degree of hypoxemia during sleep. After treatment, H/Me and H/Md remained unchanged, but WR significantly recovered (from 34.9 +/- 10.4% to 26.3 +/- 7.7%, p = 0.0357). CONCLUSION: Cardiac sympathetic function and integrity are impaired in subjects with OSAS when compared with age-matched control subjects. MIBG cardiac imaging can be helpful in evaluating cardiac involvement and efficacy of therapy in OSAS.

Noninvasive assessment of myocardial viability by positron emission tomography with 11C acetate in patients with old myocardial infarction. Usefulness of low-dose dobutamine infusion.

BACKGROUND: When patients with severely depressed left ventricular function are treated, it is crucial to know in advance how much functional recovery is expected from coronary revascularization. METHODS AND RESULTS: We compared the results of 11C acetate positron emission tomography (PET) with dobutamine infusion with changes in regional wall motion evaluated by left ventriculography in 28 patients with old Q-wave anterior myocardial infarctions. Dysfunctional but viable myocardium (group A, n = 13) was separated from nonviable myocardium (group B, n = 15) by echocardiographic assessments of regional wall motion before and after successful coronary revascularization. 11C acetate PET was performed to characterize normalized myocardial blood flow and oxidative metabolism (the clearance rate constant, k mono). While the baseline k monos of the infarct areas of the two groups were different with overlap, the responses to dobutamine infusion were directionally different. In addition, relative perfusion by 11C acetate PET could predict recovery of left ventricular function as well as or better than dobutamine 11C acetate kinetics. The extent of the increase in k monos of the infarct area with dobutamine infusion correlated well (P < .01) with the degree of the increase in the percentage of systolic segment shortening in the infarct area (left ventriculography) after coronary revascularization. CONCLUSIONS: 11C acetate PET with dobutamine infusion can predict not only the reversibility of dysfunctioning myocardium after coronary revascularization but also the extent of improvement of regional wall motion in patients with old Q-wave infarction.

Evaluation of perinatal outcome using individualized growth assessment: comparison with conventional methods.

OBJECTIVE: To evaluate individualized growth assessment using the Rossavik growth model for detection of growth-retarded neonates with poor perinatal outcomes. METHODS: Rossavik growth models derived from second-trimester ultrasound measurements were used to predict birth characteristics of 154 singleton neonates. Individual fetal growth curve standards for head and abdominal circumference and weight were determined from the data of two scans obtained before 25 weeks' menstrual age and separated by an interval of at least 5 weeks. Comparisons between actual and predicted birth characteristics were expressed by the Growth Potential Realization Index and the Neonatal Growth Assessment Score (NGAS). The proportions of perinatal outcomes (mechanical delivery, low Apgar score, abnormal fetal heart rate [FHR] patterns, neonatal acidosis, meconium staining of amniotic fluid, neonatal intensive care unit admission, and maternal complications), using NGAS, were compared with those by the traditional birth weight-for-gestational age method and the ponderal index, respectively. RESULTS: Of the 154 fetuses studied, 120 had normal growth outcomes at birth; 18 showed evidence of intrauterine growth retardation; and 16 had macrosomia, based on NGAS. According to birth weight-for-gestational age classification, 32 fetuses were small for gestational age; 118 were appropriate for gestational age; and only 4 were large for gestational age. According to the ponderal index, 55 fetuses had growth retardation, 99 showed appropriate growth and there was no macrosomia. There was a significant increase in mechanical deliveries in cases of growth-retarded neonates, determined using the NGAS classification, when compared with events related to normally grown or macrosomic neonates. However, there were no significant differences in mechanical deliveries among the groups by birth weight classification or ponderal index. Both birth weight classification and NGAS classification showed a significant increase in the low Apgar score, abnormal FHR patterns, and neonatal acidosis in infants classified as growth retarded when compared with appropriately grown or macrosomic infants. However, there were no significant differences in the low Apgar score, abnormal FHR patterns, and neonatal acidosis between growth-retarded and appropriately grown infants when they had been so classified by ponderal index. Three growth category classification methods failed to reveal significant differences in meconium staining of amniotic fluid, neonatal intensive care unit admission, and maternal complications among the groups. CONCLUSION: We do cast doubt on the usefulness of the ponderal index for detection of growth-retarded neonates with poor perinatal outcomes, and individualized growth assessment seems to perform at least as well as the traditional birth weight-for-gestational age method.

Longitudinal Doppler ultrasonographic assessment of alterations in regional vascular resistance of arteries in normal and growth-retarded fetuses.

The objective of this longitudinal study was to evaluate alterations in regional vascular resistance of arteries with advancing gestation in normal and growth-retarded fetuses. Color Doppler flow imaging and pulsed Doppler ultrasonographic assessments were performed on 13 normal and 7 growth-retarded fetuses, ranging from 15 to 40 weeks menstrual age. The pulsatility index was calculated for middle cerebral artery, descending aorta, splenic artery, renal artery, femoral artery and umbilical artery, respectively. Optimal models for these pulsatility index values were determined by regression analysis. A normal range of the pulsatility index for each artery generated in the normal fetuses. In the middle cerebral artery, the models showed a parabolic pattern during pregnancy in the two groups and the predicted pulsatility index values in growth-retarded fetuses were always lower than those in the normal fetuses, especially late in pregnancy. In the renal artery, the predicted pulsatility index values in growth-retarded fetuses were higher than those in normal fetuses near term. In other arteries, the predicted pulsatility index values showed their own specific patterns and there were no significant differences in predicted pulsatility index values in the two groups. In conclusion, alterations in regional vascular resistance of arteries with advancing menstrual age occur evidenced in both normal and growth-retarded fetuses.

Prediction of neonatal crown-heel length in normal singletons, twins, and triplets using individualized growth assessment.

In groups of normally growing singletons (20), twins (20), and triplets (13), predicted femur diaphysis length (FDL) values at birth were obtained using Rossavik growth models specified from second-trimester ultrasound studies of fetal growth. Six previously published functions were utilized to obtain predicted crown-heel length (CHL) values from predicted FDL values. These values were compared to the actual CHL values and the percent differences calculated. Based on their systematic (mean percent difference) and random (standard deviation of percent difference) prediction errors, the functions of Vintzileos (singletons), Hadlock (twins), and Brown (triplets) were found to give optimal results (no systematic error; random error: +/- 6%). Using predicted CHL values obtained with these optimal functions, growth potential realization index values for CHL (GPRICHL) were determined for singletons, twins, and triplets. In all three groups, the mean GPRICHL value was 100% with a range of approximately 95% to 105%. These results indicate that the CHL can be predicted from second-trimester growth patterns and evaluated using individualized growth assessment methods.

Evaluation of triplet growth status at birth using individualized growth assessment: comparison with conventional methods and development of a new classification system.

A new growth classification system for triplets based on individual growth curve standards provides new information on the growth status of triplets at birth. OBJECTIVES. The objectives of this study were to characterize growth outcome at birth in triplet pregnancies using Individualized Growth Assessment methods, and to compare these results to conventional methods of growth outcome evaluation. STUDY DESIGN. Rossavik growth models derived from second-trimester ultrasound measurements were used to predict the birth characteristics of 21 triplet neonates. Actual measurements of weight, head, abdominal, and thigh circumferences at birth were compared to population standards and to predicted values, the latter by calculation of Growth Potential Realization Index (GPRI) values. GPRI values were calculated using singleton (measurement procedure correction) and triplet (measurement procedure correction+decreased soft tissue deposition) correction factors (SCF, TCF). Neonatal Growth Assessment Scores (NGAS) were calculated using both sets of GPRI values. RESULTS. Three types of triplet neonates were identified. Group I (33.3%) were normal with both types of NGAS values, had very few abnormal GPRI values or anatomic measurements, and were all appropriate for gestational age. Group III (14.3%) were abnormal with both types of NGAS values, most GPRI values were abnormal, and all were small for gestational age. Group II (52.4%) had abnormal NGAS values when calculated from GPRI values determined with SCF and normal NGAS values when calculated from GPRI values determined with TCF. All but one was AGA. Almost all GPRIWT and GPRIThC values were abnormal using SCF and normal using TCF. CONCLUSION. Although growth outcome in triplet neonates can be normal (Group I) or intrauterine growth retarded (Group III), the majority are in an intermediate group (Group II) characterized by a decrease in soft tissue mass, which may or may not be pathological.

Echocardiographic assessment of systolic time intervals in vaginal and cesarean delivered neonates.

Echocardiographic assessments of fetal and neonatal systolic time intervals were made to determine differences in circulatory changes in 40 neonates delivered vaginally and 30 delivered by elective cesarean section. Left preejection period (LPEP), left ventricular ejection time (LVET), LPEP/LVET, right preejection period (RPEP), right ventricular ejection time (RVET), RPEP/RVET, and heart rate were determined at various time points from antenatal to 120 hours after delivery. There were no significant changes in left systolic time intervals between the two groups at any various time points. However, RPEP and RPEP/RVET values were significantly higher in the cesarean section group than in those in normal vaginal delivery group within 12 hours after delivery. These results suggest that the transient pulmonary hypertension after delivery is prolonged in babies delivered by elective cesarean section.

Transvaginal Doppler ultrasound assessment of intratumoral hemodynamic change before and during hypertensive intra-arterial chemotherapy for uterine cancer.

OBJECTIVE: To evaluate blood flow in malignant uterine tumors during hypertensive intra-arterial chemotherapy. METHODS: Hypertensive intra-arterial chemotherapy (angiotensin II, cisplatin 100 mg, doxorubicin 40 mg) was given to two women with cervical cancer (stage IVA) and seven with endometrial cancer (three stage IA, one stage IB, two stage II, and one stage III). The intratumoral blood flow velocity waveforms were imaged by transvaginal Doppler ultrasound before and during the chemotherapy in six patients. RESULTS: The mean peak systolic velocity during hypertensive intra-arterial chemotherapy (58.9 +/- 29.3 cm/second) was significantly higher than that before chemotherapy (16.0 +/- 6.3 cm/second) (P < .05). There was a significant difference between the end-diastolic velocity before (5.2 +/- 1.8 cm/second) and during chemotherapy (21.2 +/- 6.8 cm/second) (P < .05). The resistance index value during hypertensive intra-arterial chemotherapy (0.607 +/- 0.094) fell significantly from that before therapy (0.644 +/- 0.119) (P < .05). Blood flow velocity waveforms in normal myometrial tissue could be recorded in three cases; in all, the diastolic flow noted before hypertensive intra-arterial chemotherapy disappeared during chemotherapy. CONCLUSION: These results suggest that hypertensive intra-arterial chemotherapy induces a selective marked increase of blood flow in uterine cancer.

Ultrasonographic assessment of fetal and neonatal spleen.

To assess the growth and function of the fetal spleen, ultrasonographic examinations were performed on 229 normal fetuses, ranging from 20 to 41 weeks, menstrual age. Curvilinear relationships were found between the menstrual age and splenic length (R2 = 92.7%), circumference (R2 = 93.9%), and area (R2 = 95.2%). A normal range of splenic length, circumference, and area measurements for estimating the growth of the fetal spleen during normal pregnancy was generated. Splenic parameter values just after delivery were significantly lower than those measured within 7 days before delivery, and returned to former sizes 24 hours later, in both vaginal delivery and cesarean section groups. Splenic parameter values in the vaginal delivery group were also significantly lower than those in the cesarean section group, just after delivery. Moreover, neonatal splenic length showed negative correlations with lactate dehydrogenase (p < 0.001) and glutamic oxaloacetic transaminase (p < 0.05) in the umbilical venous blood, respectively. These results provide a foundation for the evaluation of fetal splenic growth and function during pregnancy and the early neonatal period.

Transvaginal color Doppler imaging for hemodynamic assessment of reproductive tract tumors.

Transvaginal color Doppler flow imaging was carried out on 68 Japanese women (normal, 10; uterine myoma, 21; cervical carcinoma, 7; endometrial carcinoma, 10; benign ovarian tumor, 12; ovarian carcinoma, 8). Blood flow velocity waveforms were evaluated by calculation of the resistance index (RI). In 6 patients with cervical carcinoma neovascularization was evident within the cervix. In all patients with endometrial carcinoma such signs were present adjacent to and/or within the endometrium. These findings were absent in normal women and in those with myomata. There was a significant difference between the RI (0.510 +/- 0.097) in patients with cervical carcinoma and in normal women (0.881 +/- 0.048) in the ascending branch. In endometrial carcinoma the RI (0.535 +/- 0.158) was significantly lower in the arcuate artery compared to the normal uterus (0.768 +/- 0.075) and patients with uterine myoma (0.679 +/- 0.131), respectively. There was no area of neovascularization in the normal ovaries. Neovascularization was confirmed in four patients with a benign ovarian tumor and in all patients with an ovarian carcinoma. A significantly lower RI was obtained in cases of ovarian carcinoma (0.503 +/- 0.122) than in patients with benign ovarian tumors (0.888 +/- 0.216). Transvaginal color Doppler imaging and pulsed Doppler analysis may be useful diagnostic tools to differentiate benign and malignant tumors.