Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound.

OBJECTIVE: We investigated the correlation between the angle of progression measured by transperineal ultrasound and fetal head station measured by open magnetic resonance imaging (MRI), the gold standard, in pregnant women at full term. METHODS: Thirty-one pregnant women at full term with a fetus in the occipitoanterior position were enrolled. First, the distance between the leading part of the skull and the interspinal plane was obtained using an open MRI system with the patient in a supine position. Immediately after MRI, the angle of progression was obtained by transperineal ultrasound without changing the woman's posture. RESULTS: There was a significant correlation between the angle of progression determined by transperineal sonography and the distance between the presenting fetal part and the level of the maternal ischial spines (y = - 0.51x + 60.8, r(2) = 0.38, P < 0.001). None of the fetal heads was engaged at the time of MRI and ultrasound examinations. CONCLUSIONS: The present study demonstrated a predictable relationship between the angle of progression obtained by transperineal ultrasound and the traditional scale used to quantify fetal head descent. Based on our results, station 0 would correspond to a 120° angle of progression. However, this correlation is based on statistical assumptions only and has to be proven in future studies.

The UICC Telepathology Consultation Center. International Union Against Cancer. A global approach to improving consultation for pathologists in cancer diagnosis.

BACKGROUND: The morphologic diagnosis of tumor specimens with precise tumor typing, staging, and grading remains the basis of almost all cancer treatments. Thus, in each tumor case, a histologic diagnosis of the highest quality should be the physician's priority. In approximately 10-20% of tumor cases, diagnostic uncertainty remains to some degree, requiring a second opinion in determining the biologic behavior, the histogenesis, the grade of dedifferentiation, or any other parameter. Facilitating the communication between pathologists and the exchange of cases, telepathology gains more and more importance. To benefit from this technical development, the International Union Against Cancer (UICC) has decided to establish a Telepathology Consultation Center (UICC-TPCC) for interested pathologists around the world. METHODS: The communication and exchange of histologic images works via the Internet. To ensure constant documentation, a case-based data base and image archive is used. Special TPCC software handles all requests to the TPCC and controls the interaction among requesting pathologists, TPCC, and UICC experts (transferring, reading, answering, logging, storing, etc.). All necessary data for controlling the telepathology service are stored in a customized SQL data base. The necessary equipment for the requesting pathologist is a personal computer; a digital or television camera/frame grabber, which is attached to a microscope; and access to the Internet. The requesting party contacts the TPCC's World Wide Web server and uploads the images and the clinical data of their case. To ensure uninterrupted functioning, the hardware will be part of a high-level communication center, which is connected via ATM (asynchronous transfer mode, 155 megabits per second) to the Internet. RESULTS: The UICC has decided to establish the TPCC at the Institute of Pathology at the Charité, Humboldt-University, Berlin, Germany. The TPCC will not make the diagnoses itself but will involve an affiliated specialized expert pathologist. He or she will be on the panel of UICC experts who will constitute the "diagnostic backbone" of the TPCC. The center will function as follows: If a pathologist anywhere on the globe is confronted with the diagnosis of a difficult tumor case, he takes digitized histologic images (5-40 in number) and sends them along with sufficient clinical data to the server of the UICC-TPCC, asking for a second opinion. The center checks the case and transfers it to one of the UICC experts. This expert makes his or her diagnostic suggestion, which is then transferred back to the requesting pathologist via the UICC-TPCC. CONCLUSIONS: The UICC-TPCC will be able to provide rapid and inexpensive diagnostic aid to pathologists all over the world, offering the possibility of a second opinion in accordance with the UICC-TNM and World Health Organization (WHO) standards. During the first and second year, the UICC-TPCC will be financed by sponsors. Telepathology makes the distribution of new developments of diagnostic standards, e.g., of the TNM system, WHO terminology, new tumor classifications, and updated information on actual technologies, globally accessible in a direct and rapid way. It also enables a high quality of education and teaching.

Differentiation between human fetal breathing patterns by investigation of breathing-related tracheal fluid flow velocity using Doppler sonography.

We report our results from the analysis of Doppler measurements of breathing-related fluid flow velocity waveforms in the trachea in human fetuses. Our aim was to determine whether, using the proposed method, reproducible patterns can be recognized over the latter half of gestation. Breathing-related tracheal fluid flow velocity of 47 normal fetuses at 20-39 weeks' gestation were analysed. Colour Doppler was used to document 'streaming' of fluid in the trachea, followed by spectral Doppler to record flow velocity waveforms. More than 40 (median 94; range 42-725) continuous breathing cycles (inspiration+expiration) were obtained in each case. Although breathing-related fetal tracheal fluid flow waveforms were found to be highly variable, we were able to distinguish by visual analysis between a regular and an irregular pattern. Among the regular patterns, we further differentiate between a regular symmetric (sinusoidal type) and a regular asymmetric (deep inspiration with expiratory flow retardation) pattern. The regular pattern occurred consistently in all age groups studied and there were no significant (p<0.05) differences in the occurrence rate of the regular symmetric and asymmetric pattern. The incidence of the regular pattern increased significantly (p<0.05) from 11.74+/-3.38% (mean +/- SEM) at 24-27 weeks to 20.72+/-1.75% at 28-31 weeks of gestation and remained constant thereafter. This study shows that the proposed method can provide detailed information on breathing-related tracheal fluid flow velocity as early as 20 weeks of gestation. The information that a regular symmetric pattern was observed throughout the second half of gestation is important. Hence, a higher standardization of on-going fetal breathing movements studies may be achieved by measuring breathing-related tracheal fluid flow velocity waveform parameters only during this pattern.

[Gynecological ultrasound network: new concepts]. / Vernetzte gynäkologische Sonographie: Konzepte und Möglichkeiten.

Digital data processing and storage are advancing in many medical settings. Some ultrasound machines process, store and provide images digitally. For many obstetrical and gynecological ultrasound units electronic filing and reporting are essential parts of their documentation. However, patient data are often entered redundantly into the different systems (admission and billing, encoding of diagnoses, medical reports etc.). Bi-directional exchange of textual data is the first step towards successful integration. Additionally, affordable central digital video storage from different sources within a department or hospital will soon become available.

[Modern fetal autopsy oriented to clinical demands using technical information methods]. / Moderne, an klinischen Anforderungen orientierte Fetalautopsie unter Nutzung von informationstechnischen Methoden.

Modern ultrasonic diagnostic instruments with high resolution and color Doppler sonography allow the obstetrician to describe pathological findings very precisely and at an early stage of pregnancy. The use of high-resolution ultrasound makes it possible to detect heart malformations already between the 8th and 10th week of gestation. This development has essentially changed the clinical requirements on fetal autopsy which in its traditional way no longer meets the increased demands. Unless the pathologists faces this challenge the importance of fetal autopsy will diminish. Modern image databases and communication techniques allow the pathologist to have direct access to text and images of pre-findings by other clinics. Great importance, however, must be attached to the interdisciplinary cooperation with obstetricians and geneticists. We report on routine fetal autopsy by using an interdisciplinary database an the Charité.