Search

OBJECTIVES The objective of our study was to determine the impact of laser therapy for twin-to-twin transfusion syndrome (TTTs) on subsequent pregnancies. METHODS This was a monocentric retrospective observational study. Women treated by laser fetoscopy for TTTs were asked to answer a postal questionnaire about subsequent pregnancies. The primary outcome was fecundity (number of pregnancies and time to pregnancy). We also assessed pregnancy complications, birth weight, and gestational age at delivery. Pregnancy complications included the following: threatened preterm labor, preeclampsia, placenta accreta, postpartum hemorrhage, and psychological disorders. Our study population was compared with an external control group made up of mothers of monochorionic twins without TTTs. RESULTS We included 122 cases managed at the Necker Hospital between 2008 and 2012 and 39 controls. The median conception time was longer in the TTTs group (6.4 ± 11.1 versus 2 ± 1.6 months, P = .03). The numbers of live childbirths at the end of those pregnancies were equivalent (77.6% versus 66.7%, P = .56). Birth weight (3317 ± 726 versus 3240 ± 382 g, P = .81) and gestational age at delivery (38.2 ± 6.8 WG versus 39.5 ± 1.2 WG, P = .64) were similar, with no increase of obstetrical complications compared with the control group. DISCUSSION Twin-to-twin transfusion syndrome and its treatment do not seem to impact subsequent pregnancies.

Background Fetal cerebral ventricular dilatation (CVD) is a common abnormal prenatal finding that often predicts a poor prognosis. The etiology involves both genetic and nongenetic factors with diverse pathogenic mechanisms. We describe the neuropathological features of CVD in a large cohort of fetuses. The goals are to determine the physiopathological mechanisms and etiologies. Methods We retrospectively analyzed a series of 130 fetuses examined at the Necker University Hospital following termination of pregnancy between January 2000 and December 2014. Chiari II and Dandy-Walker malformations were excluded from our study population. Karyotype and/or array comparative genomic hybridization were performed in all cases. Targeted Sanger sequencing or next generation sequencing were carried out in 34 and 5 cases, respectively. Results We distinguished four groups of pathological entities: (1) midbrain/hindbrain patterning defects (54 cases, 42%), mainly related to aqueduct of Sylvius anomalies (atresia or stenosis); (2) cerebral cytoarchitectonic disorders (16 cases, 12%), essentially resulting from arachnoidal neuroglial ectopia; (3) hemorrhagic and perfusion failure (42 cases, 32%); and (4) nonspecific CVD (18 cases, 14%), without apparent obstruction, cortical malformation, or clastic injury. Although the pathogenic mechanisms of CVD were identified in 86% of cases, the causes, both acquired and genetic, were recognized in 21% of cases only. Conclusion The neuropathological analysis is a powerful tool in the diagnosis of the fetal CVD pathogenic mechanisms and to identify homogeneous groups. The paucity of molecular diagnosis, notably in the major groups of midbrain/hindbrain patterning defects and hemorrhagic and perfusion failure, highlights the needs of future research to improve our current knowledge on CVD causes. Birth Defects Research, 2017. © 2017 Wiley Periodicals, Inc.

The sonographic features of endometriomas and their natural history during pregnancy remain poorly known. The objective of our study was to report our experience concerning the diagnosis, spontaneous progression and management of endometriomas during pregnancy.A retrospective observational study in 46 patients (53 cysts) presenting with an ovarian endometrioma diagnosed during ultrasound examination at the first trimester of pregnancy. Sonographic findings (according to the criteria of the International Ovarian Tumor Analysis (IOTA) group and how they changed for each cyst during pregnancy and postpartum were reviewed, together with cyst management. The median follow-up was 4 years [IQR: 3-6]. Median age at diagnosis was 31 years [IQR: 27-35].Among the 53 cysts identified as "endometriomas" on the first-trimester ultrasound examination, 49 (92%) were described like "cyst fluid with ground-glass echogenicity". Fifty-two cysts (98%) had a maximum diameter100mm, only one cyst (2%) presented papillary projection and 5 cysts (9%) were multiloculated. During the second-trimester ultrasound monitoring of these cysts, of the 33 cysts that we monitored, 8 (24%) increased in size, 11 (34%) decreased in size, 5 (15%) disappeared and 9 (27%) did not change. During the third-trimester ultrasound monitoring of these cysts, of the 13 cysts that we monitored, 5 (39%) increased in size, 5 (39%) decreased in size, 2 (15%) disappeared and 1 (7%) did not change. All children (48 newborns) were born alive at a median gestational age of 39 weeks [IQR=39-40]. Only 10 cysts (19%) required surgical treatment. In all cases, surgery consisted of cystectomy. Two cysts were operated on during pregnancy (between 14 and 17 weeks of gestation) because of symptoms of adnexal torsion, 3 during cesarean section, and 5 postpartum. Four of the 10 (40%) cysts operated on were histopathologically "endometriomas", and one of them was decidualized. Four cysts were mucinous cystadenomas, one was a serous cystadenoma and one cyst was a dermoid cyst.This study underscores the difficulty of diagnosing endometriomas during pregnancy and the absolute necessity of surgical removal when ultrasonographic findings are doubtful.

Resume But Etudier les issues des grossesses triples (GGG) compliquees d’un syndrome transfuseur-transfuse (STT). Methodes Etude retrospective des interventions, des issues et du suivi perinatal (28 jours de vie) des GGG prises en charge pour un STT. Resultats Entre 2002 et 2013, 25 GGG compliquees par un STT ont ete vues dans notre centre, dont 20 bichoriales et 5 monochoriales. L’âge gestationnel (AG) au diagnostic du STT etait de 19,7 SA (±2,4) avec 2, 4, 16 et 1 grossesses presentant un STT stade I, II, III et V, respectivement. Elles ont eu une fœtoscopie a un AG moyen de 19,9 SA (16,7–24,4 SA). Il y a eu 3 (13,0 %) fausses couches tardives. L’AG moyen a l’accouchement etait de 29,6 SA (19,6–37,1 SA) globalement (26,3 SA et 31,1 SA dans les grossesses monochoriales et bichoriales, respectivement). Le taux global de survie fœtale est de 57,97 % (40 % et 66,7 % dans les groupe des grossesses monochoriales et bichoriales, respectivement). Neanmoins, la mortalite neonatale ( Conclusion Les GGG operees par fœtoscopie pour un STT ont un taux de survie des 3, d’au moins 2 et d’au moins 1 fœtus autour de 21,7 %, 69,6 % et 82,6 %, respectivement. Le taux global de survie fœtale est de 59,9 %. Il existe une tendance a une meilleure survie pour les GGG bichoriales que les GGG monochoriales ( p = 0,079).

Resume Objectif Evaluer les resultats du depistage de la trisomie 21 par le risque combine du 1er trimestre (tel qu’il a ete defini par l’arrete du 23 juin 2009) dans la structure Prima facie. Methodes Etude monocentrique portant sur l’ensemble des patientes ayant consulte a Prima facie avec une grossesse monofœtale evolutive, non issue de don d’embryon, entre le 1er janvier 2009 et le 31 decembre 2014. Resultats Dix-huit mille deux cent cinquante-et-une patientes ont ete incluses, parmi lesquelles 17 267 ont effectue le depistage de la trisomie 21 par le risque combine. Mille quarante-six de ces patientes (6,1 %) ont eu un risque superieur a 1/250. Soixante-quinze fœtus etaient porteurs d’une trisomie 21, dont 65 dans le groupe a risque accru. La sensibilite et la specificite du depistage sont de 86,7 et 94,4 %. La mediane de la clarte nucale etait de 0,98 MoM. Conclusions Le depistage de la trisomie 21 par le calcul du risque combine du 1er trimestre a permis de depister 86,7 % des trisomies 21 avec un taux de faux-positifs de 5,6 %.

Cytogenetic microarray analysis is now the first-tier genetic test used in a postnatal clinical setting to explore genomic imbalances in individuals with developmental disability and/or birth defects. However, in a prenatal setting, this technique is not widely implemented, largely because the clinical impact of some copy number variants (CNVs) remains difficult to assess. This limitation is especially true in France where termination of pregnancy for medical reasons may be performed at any stage of gestation. During a period of 15 months, we investigated 382 fetuses presenting with ultrasound anomalies, using a customized microarray designed to avoid the detection of CNVs raising challenges for genetic counseling. After excluding common aneuploidies, 20/374 (5.3%) fetuses had a pathogenic CNV, among which 12/374 (3.2%) could have been detected by karyotyping, whereas 8/374 (2.1%) were cryptic. Within these 374 cases, 300 were ongoing pregnancies at the time of array comparative genomic hybridization (aCGH) testing. For these pregnancies, we detected 18/300 (6%) pathogenic CNVs, among which 6/300 (2%) were cryptic. Using this approach, only 2/300 (0.6%) of the detected CNVs raised difficulties for genetic counseling. This study confirms the added value of this strategy in a prenatal clinical setting to minimize ethical issues for genetic counseling while enhancing the detection of genomic imbalances.

Resume Objectif Determiner l’incidence des anomalies chromosomiques, des associations syndromiques et des malformations fœtales en cas de retard de croissance intra-uterin (RCIU) dans un centre de reference en diagnostic prenatal. Patientes et methodes Il s’agit d’une revue retrospective de tous les cas vus entre 14 et 27 SA avec un perimetre abdominal (PA) Resultats Un total de 8626 fœtus a beneficie d’un examen echographique entre 14 et 27 SA. Deux cent trente-neuf fœtus (2,8 %) presentaient un RCIU defini par un PA Discussion et conclusion Cette etude decrit les anomalies et issues associees au diagnostic de RCIU au 2e trimestre dans une large population de patientes. Nos resultats suggerent que l’absence de malformation associee, le degre de retard de croissance, l’âge maternel et la quantite de liquide amniotique peuvent orienter le diagnostic et le conseil antenatal de cette population a haut risque.

Objective To compare the performance of traditional growth charts for estimated fetal weight (EFW) and a validated pragmatic probabilistic approach using biometry at 31–34 weeks' gestation to screen for late pregnancy small-for-gestational age (SGA) fetuses in a low-risk population. Methods Records of ultrasound biometry at 31–34 weeks were reviewed in 7755 consecutive low-risk women between 2002 and 2011. Fetal malformations, Doppler anomalies and preterm delivery before 37 weeks were excluded. SGA was defined by various percentile cut-offs of birth weight. The probability of SGA was modeled as a function of Z-scores of femur length, abdominal circumference and head circumference. The model was validated on a second independent dataset of 1725 pregnancies from a different screening unit. The screening performance of this probabilistic approach was compared with those of traditional EFW growth charts. The additional value of factoring in maternal characteristics was also ascertained. Results Using national birth-weight charts, the proportions of newborns at 37–42 weeks with birth weight

The aim of this study was to evaluate the nature and incidence of long-term maxillary sinus adverse events related to endosseous implant placement with protrusion into the maxillary sinus.Retrospective cohort study.All patients who underwent placement of endosseous dental implants with clinical evidence of implant penetration into the maxillary sinus with membrane perforation were included in this study. Only patients with a minimum follow-up of 5 years after implant placement were included in this study. Maxillary sinus assessment was both clinical and radiological.Eighty-three implants with sinus membrane perforation in 70 patients met the study's inclusion criteria. Mean age was 65.96 years ± 14.23. Twelve patients had more than one implant penetrating the maxillary sinus, and seven of them had bilateral sinus perforation. Estimated implant penetration was ≤ 3 mm in all cases. The average clinical and radiological follow-up was 9.98 years ± 3.74 (range 60-243 months). At the follow-up appointments, there were no clinical or radiological signs of sinusitis in any patient.This long-term study, spreading over a period of up to 20 years, indicates that no sinus complication was observed following implant penetration into the maxillary sinus. Furthermore, absence of occurrence of such complications is related to the maintenance of successful osseointegration. A contrario, and in the presence of an acute or chronic maxillary sinusitis, the differential diagnosis must always consider other potential odontogenic and nonodontogenic etiologies.

Discordant chromosomal anomalies in monozygotic twins may be caused by various timing issues of erroneous mitosis and twinning events. Here, we report a prenatal diagnosis of heterokaryotypic monozygotic twins discordant for phenotype. In a 28-year-old woman, ultrasound examination performed at 26 weeks of gestation, detected intrauterine growth restriction and unilateral cleft lip and palate in twin B, whereas twin A had normal fluid, growth and anatomy. Molecular karyotyping in twin B identified a 18q21.2qter deletion, further confirmed by FISH analysis on amniocytes. Interestingly, in twin A, cytogenetic studies (FISH analysis and karyotype) on amniocytes were normal. Genotyping with microsatellite markers confirmed the monozygosity of the twins. At 32 weeks of gestation, selective termination of twin B was performed by umbilical cord coagulation and fetal blood samples were taken from the umbilical cord in both twins. FISH analyses detected mosaicism in both twins with 75% of cells being normal and 25% harboring the 18qter deletion. After genetic counseling, the parents elected to terminate the second twin at 36 weeks of gestation. In postmortem studies, FISH analyses revealed mosaicism on several tissues in both twins. Taking into account this observation, we discuss the difficulties of genetic counseling and management concerning heterokaryotypic monozygotic twins.

Fetal takings still concern about 6 to 7% of the pregnancies. If, in the majority of the cases, the taking does not present difficulty for a trained operator, particular circumstances related to maternal context (anticoagulating treatment, vaginal bleeding, fever…) may make the taking become more difficult. From a questionnaire sent to the French multidisciplinary centers for prenatal diagnosis and a review of the literature, we establish guidelines for fetal taking in these circumstances.

Objective To investigate the prognostic value of a hernia sac in isolated congenital diaphragmatic hernia (CDH). Methods Our database was searched to identify all consecutive cases of CDH referred to our fetal medicine unit between January 2004 and August 2011. Presence or absence of a hernia sac was assessed in liveborn cases using surgery or postnatal autopsy reports. We studied the correlation between the presence of a hernia sac and prenatal findings and perinatal morbidity and mortality. Results Over the study period, there were 70 cases with isolated CDH born alive in which either a surgery or autopsy report was available. Neonatal death, either preoperative or postoperative, occurred in 1/18 (5.6%) infants with a hernia sac and in 17/52 (32.7%) cases without a hernia sac (P = 0.03). Patients with a hernia sac had a significantly higher observed to expected pulmonary volume on prenatal magnetic resonance imaging (51.9 vs 39.3%, P = 0.01). Neonatal morbidity in surviving infants was lower in the group with a hernia sac, although not significantly. Conclusion The presence of a hernia sac is associated with a higher pulmonary volume and a better overall prognosis for CDH. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

To evaluate the long-term survival rate of rough-surfaced implants placed in maxillary sinuses augmented with deproteinized bovine bone (Bio-Oss; Geistlich Pharma AG, Wolhusen, Switzerland).Thirteen maxillary sinuses were augmented in 10 patients with Bio-Oss. After an average healing period of 13.8 months, 24 implants were placed. In 4 cases, biopsies were performed and submitted to histological analysis. Clinical and radiographic evaluation was performed 9 years after implant placement and minimum 8 years after functional loading.At the 9-year control, all the 24 implants were still functional. Thus, the implant survival rate was 100%.Bio-Oss is an acceptable substitute to the autogenous bone, and it can be used as a unique material for sinus floor elevation. Rough-surfaced implants placed in 100% Bio-Oss grafts showed a high survival rate (100%) on the long term. Larger clinical trials are necessary to confirm our results.

Objective We examined the outcomes of pregnancies in which the fetal head circumference (HC) was below the 5th centile at the routine second-trimester scan. Materials and Methods We retrospectively analysed outcomes of 18 377 women according to HC Z scores at second-trimester ultrasound examination between 2001 and 2008. We collected all major malformations, intrauterine deaths and other abnormal outcomes. Results Six hundred seventy-four fetuses (3.7%) had an HC below the 5th centile. Twenty-one major malformations were noted, consisting mainly of neurological abnormalities (3.1%). There were seven intra uterine fetal death (1.3%). Of all the fetuses, 26% were lost to follow-up. Outcome and neurological development was normal in 467 cases, based on neonatal examination and/or parent or general practitioner reports. Major abnormalities were noted in respectively 26.2%, 3.0% and 1.1% of fetuses with Z scores

Aims: The aim of this study was to assess the diagnostic performance of 3-D contrast-enhanced power Doppler ultrasonography (3-D CEPDUS) for differentiating benign and malignant adnexal masses. Material and Methods: Consecutive patients with adnexal masses were included prospectively and underwent 2-D ultrasonography and 3-D CEPDUS in a tertiary centre in Paris, France. The main outcome measure was the diagnostic accuracy of 3-D CEPDUS to diagnose malignant and borderline adnexal masses. The reference standard was the final histological examination. Two-dimensional ultrasonography and 3-D CEPDUS were compared using semiquantitative scores. Three-dimensional CEPDUS assessed vessel density, vessel pattern, and three vascular indexes in a 5-mL region of interest (vascularization index [VI], flow index [FI], and vascularization flow index [VFI]). The 2-D and 3-D examinations were done by different sonographers who were blinded to the other test. The pathologist was blinded to ultrasonography findings. Results: Of 99 patients, 88 had benign tumors and were compared to the 11 patients with borderline (n = 5) or malignant (n = 6) tumors. The sensitivity of the subjective 2-D score was 55% (95% confidence interval [CI], 25–84) and specificity 94% (95%CI, 89–99). The sensitivity of the subjective 3-D score was 82% (95%CI, 58–100) and specificity 90% (95%CI, 83–96). Improvement of detection of malignant or borderline tumors by subjective 3-D score was 150%. Vessel density and patterns were not more efficient than the subjective 3-D score. The mean vascular index values were significantly different between benign and borderline/malignant groups: VI, 7.2 versus 35.5 (P

Standardization of the gynecological emergency ultrasound examination could allow more accurate evaluation in gynecologic or general emergency unit. A systematic set of images, "Standardized Acute Female Echography" (SAFE), was defined. In practice, four pictures are realized whatever presenting complaint (set "A"). These pictures describe the normal anatomy and allow verifying the quality of ultrasonography realization. The picture A1 is obtained by abdominal probe and investigates the Morison's pouch. The pictures A2, A3 and A4 are obtained by transvaginal probe and correspond respectively to the mid-sagittal uterus view, the right ovary and the left ovary. For each of these pictures, some quality criteria were defined allowing a control of ultrasound examination. When abnormality is detected, others pictures (set "B)" are required to describe it. These pictures are called B1 in case of intra-uterine abnormality and B2 in case of adnexal abnormality. This standardization of pelvic ultrasonography could allow a quality control and a delegation of the ultrasound examination by training physicians or diagnostic medical sonographers without repetition of the examination. SAFE could be a reference in the field of gynecological emergencies imaging picture by improving diagnostic and therapeutic management.

Objective To develop a quantitative quality control process of nuchal translucency (NT) measurement at 11–14 weeks of gestation based on the mixture model, characterized by analysis of the corresponding distribution of the likelihood ratio (LR). Methods Based on the published mixture model for NT measurement in the first trimester, we simulated the expected distribution of NT and the corresponding LR. This approach was then tested for the quality control of 15 048 NT measurements performed by four operators trained and certified by The Fetal Medicine Foundation. The new quality control approach based on LR was compared with existing processes based on NT plots, multiples of the median (MoMs) and analysis of the 95th centile. Results Each operator contributed 2176–4730 examinations. Median, 5th and 95th centile of NT values ranged from 1.4 to 1.6, 1.0 to 1.0 and 2.2 to 2.6 mm, respectively. Median of NT-MoM values ranged from 0.83 to 0.95. Analysis of the distribution of NT measurements confirmed departure from the assumptions of the delta-NT and NT-MoM models. Analysis of LR distributions demonstrated a significant difference between observed and expected distributions for all operators (P < 10−4). Conclusion An LR-based quality control process is feasible at 11–14 weeks of gestation. Because it is more sensitive to measurement bias around the critical area of the 95th centile, its use should be encouraged. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Panoramic radiographs allow evaluation of the available bone height for implant treatment planning while imparting a low radiation dose. As panoramic radiography produces image distortion, reference objects are required to determine the exact magnification. This study aims to estimate a panoramic unit's vertical magnification factor (MF) by measuring the length of dental implants used as radiopaque reference objects on postoperative panoramic radiographs. We compared our findings to the vertical MF listed by the panoramic unit manufacturer, and studied the reproducibility and accuracy of our measuring method by analyzing the inter- and intraobserver agreements.

Nedir R, Nurdin N, Vazquez L, Szmukler-Moncler S, Bischof M, Bernard J-P. Osteotome sinus floor elevation technique without grafting: a 5-year prospective study. J Clin Peridontol 2010; 37: 1023–1028. doi: 10.1111/j.1600-051X.2010.01610.x. Abstract Aim: To evaluate the long-term stability of peri-implant bone formation following implant placement without grafting into resorbed posterior maxillae. Materials and Methods: Twenty-five implants of 10 mm were placed in 17 patients to rehabilitate atrophic maxillae by means of an osteotome sinus floor elevation (OSFE) procedure without grafting. Mean residual bone height was 5.4±2.3 mm. Bone levels were evaluated at 1, 3 and 5 years using periapical radiographs. Results: All implants fulfilled survival criteria and gained peri-implant bone (mean increase 3.2±1.3 mm). Implant protrusion into the sinus decreased from 4.9±1.9 mm after surgery to 1.5±0.9 mm after 5 years. Mean crestal bone loss amounting to 0.8±0.8 mm stabilized over the 5-year observation interval. Twenty implants showed additional peri-implant bone gain following the 1-year control. Conclusions: Implant rehabilitation of atrophic maxillae may be greatly simplified using implants 10 mm and the OSFE technique without grafting. Grafting material is not needed to gain at least 3 mm of bone in the atrophic maxilla. The procedure appears predictable with favourable long-term results.

Resume Les grossesses monochoriales biamniotiques representent environ 20% des grossesses gemellaires mais sont responsables d’une part importante de leur mortalite et de leur morbidite. Il n’existe aucune etude randomisee comparant differents protocoles de prise en charge. Les experts recommandent une surveillance par un praticien travaillant en etroite collaboration avec une structure de soin experimentee dans la prise en charge des grossesses monochoriales et de leurs principales complications. La prise en charge doit comporter une evaluation echographique bimensuelle.

Summary. Differential diagnosis and treatment modalities of giant cell granulomas have been a controversial matter since Jaffe first distinguished true giant cell tumours (TGCG) from central giant cell granulomas (CGCG). CGCG is a slowly growing and painless tumour usually treated by simple curettage but denotes a strong tendency to recurrence. A case report is presented to describe conservative therapy of CGCG in the maxilla of a young child: surgical enucleation of the tumour at the age of 11 years, though successful, was followed by progressive impaction of the maxillary right permanent canine. Orthodontic treatment aligned the maxillary teeth to accommodate autotransplantation of the impacted tooth. Clinical and radiographic evaluation of the patient 5 years after the initial surgical treatment showed good bony and periodontal healing around the transplanted canine and no recurrence of the CGCG. As the literature shows that distinction of the two tumours is difficult even by histological means, various clinico-pathologic factors involved in prognostic evaluation are discussed. Resume. Traitement conservateur chirurgical et orthodontique d'un granulome a cellules geantes chez l'enfant Le diagnostic differentiel et les differentes modalites therapeutiques du granulome a cellules geantes sont l'objet de discussions depuis la distinction, etablie par Jaffe en 1953, entre granulome central a cellules geantes et tumeur vraie a cellules geantes. Le granulome central a cellules geantes est une tumeur d'evolution lente et asymptomatique, generalement traitee par simple curetage bien que manifestant une forte tendance a recidiver. Un cas de traitement conservateur de GCCG chez un jeune enfant est presente. A la suite de l'exerese chirurgicale de la tumeur a l'âge de 11 ans, la canine superieure droite s'est progressivement incluse. Un traitement orthodontique a permis l'alignement des dents de l'arcade superieure en laissant la place necessaire pour l'autotransplantation de la canine incluse. l'examen clinique et radiologique, cinq ans apres le curetage chirurgical initial, montre la parfaite incorporation tant osseuse que parodontale du transplant sans recidive du GCCG. De nombreaux auteurs jugent neanmoins tres difficile de poser un diagnostic differentiel precis entre ces deux pathologies, meme a l'aide d'un examen histologique. Cette incertitude pouvant amener a un traitement chirurgical par exerese complete souvant invalidant, les differents elements pronostiques lies a cette pathologie sont discutes. Zusammenfassung. Konservative, chirurgische und orthodontische Behandlung eines Falles mit Riesenzellgranuloma Die Differentialdiagnose und die Behandlungsmoglichkeiten von Riesenzellgranuloma sind kontrovers, seit Jaffe als erster zwischen einem echten Riesenzelltumor (TGCG) und einem zentralem Riesenzelltumor (CGCG) unterschied. Der Letzte ist ein langsam schmerzlos wachsender Tumor, welcher in der Regel mittels einfache Kurretage entfernt wird, aber eine erhohte Tendenz von Rezidiven aufweist. Ein Fall wird beschrieben von einem 11 jahrigem Kind bei welchem ein CGCG in der maxilla konservativ ausgeschalt wurde. Obwohl der Eingriff sichtlich erfolgreich war wurde eine Retention des oberen rechten bleibenden Eckzahnes festgestellt. Eine orthodontische Behandlung der oberen Zahne ermoglichte die Einreihung des autotransplantierten retinierten Zahnes. Klinische und rontgologische Beurteilung des Patienten 5 jahre nach dem primaren Eingiff zeigten gut knochernde und peridontale Heilung des transplantierten Eckzahnes, und keine Rezidiv des Tumors. In der Literatur wird darauf hingewiesen dass das Unterscheiden zwischen den beiden Tumoren, sogar mit histologischen Mitteln, sehr schwierig ist. Verschiedne klinische pathologische Faktoren in Bezug der prognostischen Beurteilung werden diskutiert. Resumen. Tratamiento quirurgico y ortodontico conservador de un nino con granuloma de celas gigantes El diagnostico diferencial y modalidades de tratamiento de los granulomas de celulas gigantes han sido controversiales desde que Jaffe distinguio por primera vez los verdaderos tumores de celulas gigantes (VTCG) de los granulomas centrales de celulas gigantes (GCCG). El (GCCG es un tumor de crecimento lento e indoloro usualmente tratado con un simple curetage, pero tiene una gran predileccion a recurrir. Se reporta el caso de un tratamiento conservador para el GCCG en el maxilar superior de un nino joven Aun cuando la enucleacion quirurgica del tumor a los 11 anos de edad tuvo exito, una progresiva impactacion del canino superior derecho fue evidente. El tratamiento ortodontico alieno los dientes superiores para acomodar al canino que fue autotransplantado. El examen clinico y radiografico 5 anos despues transplante mostro una buena cicatrizacion osea y alveolar alrededor del canino transplantado sin recurrencia del GCCG. Como la literatura muestra que la diferenciacion entre los dos tumores es dificil incluso por medios histologicos, varios factores clinico-patologicos involucrados en la evaluacion del pronostico se presentan en el reporte.

Objective Short cervical length is an important risk factor for preterm delivery. However, because cervical length changes throughout pregnancy, adequate risk estimation needs to take into account the gestational age (GA) at which the measurement is taken. We aimed to model cervical changes throughout pregnancy in order to be able to use Z-scores, avoiding the confounding effect of GA. Methods Cervical length was prospectively measured in singleton pregnancies, as part of routine antenatal care over a 3-year period. Measurements were taken at GA ranging from 16 to 36 weeks and only one measurement per pregnancy was used in the analysis. Because cervical length measurements are not normally distributed, we used a non-parametric approach (LMS method) to best describe the distribution of the measurements with gestation. Results We included 6614 cervical length measurements. The LMS method identified changes in cervical length measurement across GA. We computed new reference charts and provide L, M and S values that allow the calculation of Z-score at any GA from any cervical length measurement ‘Y’ using the formula: Z-score = ((Y/M)L − 1)/(L × S). Conclusion Cervical length measurements do not have a normal distribution at a given GA and so require a statistical model that takes this into account. The model that we developed allows easy Z-score calculation, therefore avoiding the confounding effect of GA and allowing straightforward monitoring of cervical length. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Objectives: The quality of ultrasound (US) examination in the setting of a gynaecological emergency consultation is variable. Our aims were to develop and evaluate the feasibility of an image-based scoring method for the evaluation of standardised gynaecological images in this context. Study design: Ultrasound images of the uterus (2 planes), ovaries (1 plane of each side) and Morrison’s pouch were obtained by specialist registrars as part of their assessment of gynaecological emergencies during a three-month period. Twenty images of each of these 5 planes were randomly selected and anonymised. These 100 images were analysed by two reviewers. Each image was scored according to 23 criteria yielding a maximum score of 23 points for the entire ultrasound examination. Training was then offered with special emphasis on quality criteria. Following training, another set of 100 images obtained by the same specialist registrars was scored. Scores before and after training were compared. Inter- and intra-reviewer reproducibility were analysed using intra-class correlation, adjusted Kappa and Bland– Altman plot. Results: The mean ( SD) scores were 10.22(2.75) and 16.1(3.35) before and after theoretical training respectively (p < 10 4 ). The intra-class correlation coefficient and the mean difference in score were 0.973 [0.957;0.990] and 0.02 [1.98;1.94], and 0.952 [0.894;1] and 0.1 [2.44;2.24] for inter- and intra-reviewer reproducibility respectively. Kappa values were above 0.8 for all but 3 criteria. Conclusion: A quality control policy for gynaecological emergencies based on image scoring is feasible and allows for good inter- and intra-reviewer reproducibility. A policy of this nature is likely to improve the quality of emergency gynaecological ultrasound examination.

Objective To evaluate the impact of emergency cerclage on perinatal outcome in cases presenting with cervical length less than fifth centile at the time of laser surgery. Population and Methods Observational study of severe twin-to-twin transfusion syndrome (TTTS) cases diagnosed before 26 weeks of gestation and treated by fetoscopic selective laser coagulation (FSLC). Transvaginal sonographic measurement of cervical length prior to treatment identified cases with cervical length less than fifth centile (15 mm). Expectant management was followed in these cases prior to 2004, and a McDonald suture was performed immediately after laser surgery from 2004 onwards. Outcome was compared in patients with and without cerclage. Results Cervical length was a strong predictor for gestational age (GA) at delivery (p = 0.005). Mean GA at laser therapy was comparable [22.4 ( ± 2.1) and 22.1 ( ± 2) in patients with (n = 9) and without cerclage (n = 5), respectively, (p = 0.8)], whereas mean (SD) GA at delivery was 30.5 ( ± 4.3) and 23.1 ( ± 2.6) weeks in patients with and without cerclage, respectively, (p = 0.004). There were 16 (89%) and 4 (40%) surviving twins in cases with and without cerclage, respectively (p = 0.01). Conclusions In TTTS treated by laser, cervical length before treatment is significantly associated with GA at delivery. In cases with cervix < 15 mm, emergency cerclage may prolong the pregnancy and allow for better outcome. Copyright © 2008 John Wiley & Sons, Ltd.

Objective To evaluate the outcome of severely anaemic monochorionic (MC) twins surviving the death of their co-twin following early intrauterine rescue transfusion in cases of feto-fetal transfusion syndrome (FFTS). Study design We reviewed all MC pregnancies complicated with FFTS following primary management, in which a single intrauterine fetal death (IUFD) was diagnosed with certainty within 24 hours between January 1999 and December 2006. We included MC survivors who presented ultrasound or Doppler features of fetal anaemia following the death of their co-twin. Intrauterine transfusion (IUT) was given to all survivors who were anaemic. Results Nineteen MC twin pregnancies presented a single intrauterine death (IUD) associated with an anaemic co-twin. Median gestational age at IUD was 23 [20–28] weeks. The median interval between IUD and IUT was 12 [8–24] hours. There were 58% (11/19) healthy survivors. Perinatal death rate was 26% (5/19) including 16% (3/19) intrauterine and 10% (2/19) neonatal deaths. Abnormal prenatal cerebral findings developed in 21% (4/19) cases, always within 1 month after the death of the co-twin. Considering occlusive techniques and other management separately, there were 64% (7/11) and 50% (4/8) healthy survivors, respectively, and perinatal death occurred in 36% (4/11) and 12.5% (1/8) of fetuses, respectively. Prenatal fetal cerebral lesions developed in 9% (1/11) of cases following occlusive techniques and in 37.5% (3/8) of fetuses when managed differently. The median gestational age at delivery in the survivors was 31 [25–38] weeks. Conclusion In cases of FFTS with single anaemic survivors, early IUT could be offered following extensive counselling and close follow up.

Objectives: To evaluate the long-term fixture success rate, crestal bone loss and peri-implant soft tissue parameters around ITI dental implants placed in the posterior region of partially edentulous patients. Material and methods: A total of 192 ITI dental implants were consecutively placed in premolars and molars of 83 partially edentulous patients admitted for treatment at Geneva Dental School. All implants were restored by means of ceramic-to-metal fused fixed partial dentures and single crowns. Patients were followed as part of a prospective longitudinal study focusing on implant success. Surgical, radiographic and clinical variables were collected at the 1-year recall after implant placement and at the most recent clinical evaluation. Results: The mean observation time was 6 years (range 5–10 years). Four implants failed, yielding a 10-year cumulative survival rate of 97.9%. The mean annual crestal bone loss was −0.04±0.2 mm. Hollow-cylinder implants displayed more crestal bone loss (−0.13±0.24 mm) than hollow-screw implants (−0.02±0.19 mm; P=0.032). Clinical parameters such as age, gender, implant length and bone quality did not affect crestal bone levels. Increase in recession depth (P=0.025) and attachment level (P=0.011) were significantly associated with crestal bone loss. Conclusions: ITI dental implants placed in the posterior jaw demonstrate excellent long-term clinical success. Hollow-cylinder implants seem to display a higher risk for crestal bone loss. Recession depth and attachment levels appear to be good clinical indicators of peri-implant bone loss.

Objective: To evaluate the influence of the crown-to-implant ratio (C/I) ratio and different implant prosthetic treatment modalities on crestal bone loss around dental implants placed in the posterior region. Material and methods: A total of 192 ITI dental implants were consecutively placed in premolars and molars of 83 partially edentulous patients. All implants were restored by means of ceramic-to-metal fused fixed partial dentures or a single crown. Patients were followed as part of a prospective longitudinal study focusing on implant success. Surgical, radiographic and clinical variables were collected at the 1-year recall after implant placement and at the most recent clinical evaluation. Radiographic parameters were evaluated on periapical radiographs taken with a standardized long-cone paralleling technique. Implant restorations were divided into three groups according to their respective clinical C/I ratios: (a) 0–0.99, (b) 1–1.99 and (c) ≥2. Results: The mean clinical C/I ratio was 1.77±0.56 mm. A total of 51 implants (26.5%) showed a clinical C/I ratio equal to or greater than 2. In this group, three implants failed, giving a cumulative survival rate of 94.1%. Crestal bone loss was −0.34±0.27 mm in group a, −0.03±0.15 mm in group b and −0.02±0.26 mm in group c. Differences among groups were statistically significant (P=0.009). Mode of retention, splinting or presence of cantilever extensions did not have an effect on crestal bone loss around ITI dental implants. Conclusions: Implant restorations with C/I ratios between 2 and 3 may be successfully used in the posterior areas of the jaw.

Purpose To test the value of serum CA-125 measurements alone or as part of a multimodal strategy to distinguish between malignant and benign ovarian tumors before surgery based on a large prospective multicenter study (International Ovarian Tumor Analysis). Patients and Methods Patients with at least one persistent ovarian mass preoperatively underwent transvaginal ultrasonography using gray scale imaging to assess tumor morphology and color Doppler imaging to obtain indices of blood flow. Results Data from 809 patients recruited from nine centers were included in the analysis; 567 patients (70%) had benign tumors and 242 (30%) had malignant tumors—of these 152 were primary invasive (62.8%), 52 were borderline malignant (21.5%), and 38 were metastatic (15.7%). A logistic regression model including CA-125 (M2) resulted in an area under the receiver operating characteristic curve (AUC) of 0.934 and did not outperform a published (M1) without serum CA-125 information (AUC, 0.936). Specifically designed new models including CA-125 for premenopausal women (M3) and for postmenopausal women (M4) did not perform significantly better than the model without CA-125 (M1; AUC, 0.891 v AUC, 0.911 and AUC, 0.975 v AUC, 0.949, respectively). In postmenopausal patients, serum CA-125 alone (AUC, 0.920) and the risk of malignancy index (AUC, 0.924) performed very well. Results were very similar when the models were prospectively tested on a group of 345 new patients with adnexal masses of whom 126 had malignant tumors (37%). Conclusion Adding information on CA-125 to clinical information and ultrasound information does not improve discrimination of mathematical models between benign and malignant adnexal masses.

Resume Contexte Des etudes recentes ont montre l'efficacite du depistage de la trisomie 21 par le test combine du premier trimestre reposant sur l'âge maternel, les marqueurs seriques (β-HCG libre, PAPP-A) et la mesure echographique de la clarte nucale. Cependant, ces etudes n'incorporaient pas les performances de l'echographie de routine de 20–22 semaines d'amenorrhee (SA), largement realisee. Methodes Nous avons realise une etude interventionelle, multicentrique, en population generale dans le departement des Yvelines dont le but etait d'evaluer la performance du test combine du premier trimestre, suivi par l'echographie du second trimestre et/ou le dosage des marqueurs seriques maternels (β-HCG libre et alpha-fœtoproteine ou HCG totale, alpha-fœtoproteine et œstriol non conjugue) quand ce depistage serique etait prescrit incidemment. Les taux de detection et de tests positifs ont ete estimes en utilisant une methode de correction pour les issues non verifiees. Une analyse des couts a ete egalement effectuee. Resultats Pendant la periode d'etude, 14 934 femmes ont ete incluses. Cinquante et un cas de trisomie 21 ont ete observes, donnant une prevalence de 3,4 pour 1000 grossesses. Parmi ceux-ci, 46 cas ont ete diagnostiques, dont 41 au premier trimestre et cinq au second trimestre. Parmi les cinq cas de trisomie 21 non depistes, tous ont ete diagnostiques en postnatal apres une grossesse non compliquee. Les taux de detection et de tests positifs du depistage combine du premier trimestre ont ete de 79,6 et 2,7 %, respectivement. Ces taux ont atteint 89,7 et 4,2 %, respectivement quand le test combine a ete complete par l'echographie du second trimestre. Le cout moyen de la procedure complete du depistage a ete de 108 € par femme et le cout par grossesse affectee de trisomie 21 diagnostiquee a ete de 7,118 €. Conclusion Nos resultats suggerent qu'une approche interventionelle pragmatique en deux etapes utilisant le test combine du premier trimestre suivi par l'echographie du second trimestre est une option souhaitable et acceptable pour le depistage de la trisomie 21 au cours de la grossesse.

Objectives Normal ranges for fetal cerebral ventricular width are usually based on parametric methods, which define cut-off values based on means and standard deviations. We aimed to construct reference charts based on a large sample and using a method that better fits with skewed measurements. Methods In November 2001–December 2005, a single operator, who was unaware of the subsequent analysis, performed prospectively and routinely fetal cerebral ventricular width measurements. We used the LMS method (which summarizes the changing distribution of a variable of interest according to a covariate (gestational age) using three curves representing the median (M), the coefficient of variation (S) and skewness (L)) to describe the distribution of measurements with gestational age. The LMS method provides a general method for fitting smooth centile curves to reference data. It utilizes the power transformation family of Box and Cox to allow the skewness of the measurement distribution, as well as the median and variability, to vary with age. The theoretical proportion of fetal ventricular widths ≥ 10 mm based on the LMS method and on methods based on the assumption of normality were compared with the actual proportion using binomial tests. The influence on ventricular size of gestational age and fetal gender and presentation was assessed using robust regression methods. Results Included in the study were 4769 ventricular measurements, 42 (0.88%) of which were ≥ 10 mm. The LMS method allowed us to fit the skewness of the measurements and identified slight changes throughout gestation. The actual proportion of measurements ≥ 10 mm was not different from that expected according to the LMS method (0.88% vs. 1%, P = 0.25), whereas it was significantly different from that based on the classical normal approximation (0.88% vs. 0.4%, P < 0.0001). There was a significant difference with gender (males: + 0.29 ± 0.042 mm as compared to females, P < 0.0001), but there was no difference with fetal presentation (P = 0.4). Conclusion We present new reference values for fetal ventricular width based on the LMS method. A fixed cut-off value of 10 mm identifies around 1% of the population throughout gestation, which is more than that calculated in previous studies. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

Objectives To formulate reference charts and equations for estimated fetal weight (EFW) from a large sample of fetuses and to compare these charts and equations with those obtained for birth weight during the same study period and in the same single health authority. Methods Biometric data were obtained at 20–36 weeks' gestation from routine screening examinations spanning 4 years. Exclusion criteria were a known abnormal karyotype or congenital malformation and multiple pregnancy. No data were excluded on the basis of abnormal biometry. EFW was calculated based on Hadlock's formula. We used a polynomial regression approach (mean and SD model) to compute a new reference chart for EFW. This chart was compared with that of birth weight at 25–36 weeks' gestation during the same study period and in the same health authority. Results 18 959 fetuses were included in the study. New charts and equations for Z-score calculations at 20–36 weeks' gestation are reported. Comparison with the birth-weight chart showed that the EFW was noticeably larger at 25–36 weeks' gestation. At 28–32 weeks' gestation, the 50th centile for birth weight compared approximately with the 10th centile for EFW. Conclusion We present new reference charts and equations for EFW. EFW is computed throughout gestation based on measurements in healthy fetuses. However, before full term, birth-weight charts reflect a significant proportion of growth-restricted fetuses that deliver prematurely. We provide additional evidence that comparing EFW with birth-weight charts is misleading. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

Because of an increasing demand for limited health care resources as well as an increasing impact of legal aspects in ultrasound practice, it has become necessary to ensure that screening procedures are cost-effective and clinically effective and to develop systems that could help sonographists in certifying their practice. Based on the literature, various approaches for quality control are reviewed. Special emphasis is put on the use of fetal biometry and statistical tools to develop quality control systems based on both qualitative and quantitative approach. Besides their potentials for audit and quality control, such tools could also be useful during the process of training.

Objective This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery. Study design A total of 151 consecutive TTTS cases were treated by selective fetoscopic laser therapy. Cases in which both twins were alive 1 week after surgery were followed up with ultrasound and Doppler examination, including middle-cerebral artery peak systolic velocity measurement (MCA-PSV). Results In the 151 cases treated with laser, both twins were still alive 7 days after the procedure in 101 cases. Intrauterine death of 1 and both twins occurred in 7 and 1 cases, respectively. Recurrence of TTTS with the polyhydramnios-oligohydramnios sequence occurred in 14 (14%) cases. In another 13 (13%) cases, amniotic fluid remained normal in both sacs, but MCA-PSV increased above 1.5 MoM in 1 twin and decreased concomitantly below 0.8 MoM in the co-twin. This was related to anemia and polycythemia, respectively, and resulted from unidirectional feto-fetal blood transfusion, mainly from former recipients into former donors. Late complications were managed accordingly by repeat laser, amnioreduction, cord coagulation, intrauterine blood transfusion, or elective delivery. Conclusion MCA-PSV Doppler measurements are useful in the follow-up of double survivors to detect and manage late complications after selective laser therapy.

Prenatal ultrasound and magnetic resonance imaging (MRI) demonstrated a large oropharyngeal tumor, and cardiac and cranial abnormalities consistent with neurofibromatosis type 1 (NF1) in a third-trimester fetus, which were confirmed on postmortem examination. Sonographic features of NF1 are generally nonspecific; MR examination provided significant additional information, facilitating prenatal diagnosis.

Objectives The need for training programs and certification processes in fetal ultrasound has become obvious. The purpose of this study was to evaluate the feasibility of a score-based quality control system for fetal biometry in the second trimester. Methods Standard measurements of biparietal diameter and head circumference, abdominal circumference, and femur length at 20–24 weeks had been made by four operators using the same ultrasound machine. Twenty-five of each of the cephalic, abdominal and femoral images with the calipers in place were selected arbitrarily from each operator's ultrasound database and anonymized. These 300 images were analyzed by three experienced reviewers blinded to the operator's identity. Each image was first evaluated subjectively and then scored according to six criteria for abdominal and cephalic measurements and four criteria for femur length making a six-point score for abdominal and cephalic biometry and a four-point score for femur length. For subjective evaluation, inter-reviewer differences were analyzed using percentage agreement and adjusted kappa. For objective evaluation, a difference in scoring of one point or less among reviewers was considered good agreement. Intrareviewer variability was assessed using 40 images of each type of examination selected arbitrarily. Results The distribution of scores was similar between reviewers. One operator obtained significantly lower scores whereas the other three had good and comparable results. There was no statistical difference in the mean score attributed by each reviewer and agreement was good in 84–90% of the cases. Intrareviewer agreement was good in 90–100% of the cases, with similar scores for each reviewer. Conclusion A quality control policy based on image scoring is feasible and allows for fair to good inter- and intrareviewer reproducibility. The potential contribution of this approach to assess the quality of routine ultrasound examinations should be tested on a larger scale. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.

Objectives To develop and evaluate the feasibility of Z-score distribution-based quality assessment for fetal biometry at 20–24 gestational weeks. Methods Four sonographers measured fetal biparietal diameter, head circumference, abdominal circumference and femur length in unselected pregnancies undergoing routine sonography at 20–24 weeks in our center between June 2001 and January 2004. All measurements were transformed into Z-scores. Distributions of Z-scores were compared with the expected standard normal distribution based on mean, SD and the Kolmogorov–Smirnov test. Modelling was performed to assess the sensitivity, specificity and Youden's index (sensitivity + specificity − 1) of each sonographer, reflecting their ability to detect fetuses with abnormal biometry in our population. Results A total of 5241 ultrasound examinations were included. None of the Z-score distributions could be considered similar to the standard normal distribution: means of Z-scores ranged from −0.604 to 0.73 and the SD ranged from 0.726 to 0.896. Sensitivity and specificity ranged from 25.31% to 68.67% and 93.44% to 100%, respectively; Youden's index ranged from 0.25 to 0.69. Conclusion Analysis of Z-score distribution can be used to assess the quality of fetal measurements. Several indices can be extracted from this analysis in order to improve quality assessment of fetal biometry measured by ultrasound. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.

Objective The prevalence and significance of intertwin growth discrepancy in the first trimester of pregnancy are controversial. The aim of this study was to refine the incidence and outcome of this discrepancy in relation to dating of the pregnancy and other biometric parameters. Methods This prospective study of twin pregnancies initially evaluated at 11–14 weeks' gestation was conducted between 2001 and 2004. Differences in crown–rump length (CRL) and estimated gestational age (GA) were calculated for each twin pair and their distribution was analyzed according to chorionicity and mode of conception (spontaneous or following assisted reproductive technologies). CRL-based GA and actual GA were compared. Other biometric parameters were also compared for each twin pair. The distribution of discrepancies was analyzed according to pregnancy outcome. Results A total of 182 twin pregnancies was included. The mean ± SD discrepancy in CRL was 3.4 ± 3.18 mm or 5.1 ± 4.69% and the 95th centile was 9.8 mm or 14.3%. There was no influence of chorionicity (P = 0.44), mode of conception (P = 0.18) and no relation with outcome (P = 0.54). In conceptions resulting from assisted technology, the measured CRL of the smaller twin was closer to the actual GA. Cephalic and abdominal biometric measurements were significantly greater in the twin with the smaller CRL (P 15 mm were affected by trisomy 18 and triploidy, respectively. Conclusions CRL discrepancy in twin pregnancies in the first trimester is a frequent finding. Discrepancy >95th centile indicates major growth delay of one twin, which could indicate the presence of aneuploidy. For milder degrees of discordance the CRL of the smaller fetus is a more accurate estimate of the actual GA. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.

Objectives The assessment of fetal biometry is usually based on the comparison of measured values with predicted values derived from reference charts or equations in a normal population. This study was undertaken to assess the impact of the choice of reference charts and to develop a Z-score-based tool that could help sonographers to choose the reference charts that best fit their practice. Methods Fetal biparietal diameter, head circumference, abdominal circumference and femur diaphysis length measurements were made at 20–24 and 30–34 weeks' gestation by four experienced sonographers. All measurements were transformed into Z-scores calculated according to three prediction equations (Snijders and Nicolaides, 1994; Chitty et al., 1994 and Kurmanavicius et al., 1999). Distributions of Z-scores were compared to the expected standard normal distribution based on mean, SD and Kolmogorov–Smirnov test. Simulations were made to assess sensitivity (Se), specificity (Sp) and Youden's index (Se + Sp − 1) of each reference equation, reflecting their ability to identify fetuses with abnormal biometry in our population. The reference that best fitted our practice was determined based on these results. Results The Z-scores of all biometric parameters were significantly different (P < 0.001) when using any of the three reference equations, and none of the Z-score distributions could be considered similar to the standard normal distribution. The number of measurements that would be considered as abnormal according to these references ranged from 2.6% to 23.6%. Se and Sp ranged from 39.59% to 67.12% and 90.14% to 99.69%, respectively. Conclusion Assessment of fetal biometry is largely dependent on the choice of reference charts. We suggest that the choice of reference charts for fetal biometry could be controlled using Z-scores in each institution and that this could be the first step towards any quality assessment policy. The method we describe for the choice of the most appropriate fetal biometry reference chart might be used for all size charts. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 6 - p. 604-606

The purpose of the present clinical study was (1) to evaluate the Osstell as a diagnostic tool capable of differentiating between stable and mobile ITI implants, (2) to evaluate a cut-off threshold implant stability quotient (ISQ) value obtained at implant placement (ISQitv) that might be predictive of osseointegration, (3) to compare the predictive ISQitv of immediately loaded (IL) implants and implants loaded after 3 months (DL). Two patient groups were enrolled, 18 patients received 63 IL implants and 18 patients were treated with 43 DL implants. The ISQ was recorded at implant placement, after 1, 2, 4, 6, 8, 10 and 12 weeks. All implants passed the 1-year loading control. Two implants failed, one DL implant with ISQ at placement (ISQi) of 48 and one IL implant with ISQi of 53. The resonance-frequency analysis (RFA) method was not a reliable diagnostic tool to identify mobile implants. However, implant stability could be reliably determined for implants displaying an ISQ> or =47. After 1 year of loading, all DL implants with an ISQi> or =49 and all IL implants with an ISQi> or =54 achieved and maintained osseointegration. By the end of 3 months, implants with ISQi 69 had their stability decrease during the first 4 weeks before remaining stable. Although preliminary, these data might orient the practitioner to choose among various loading protocols and to selectively monitor implants during the healing phase.

The purpose of the present study was (1) to measure the primary stability of ITI implants placed in both jaws and determine the factors that affect the implant stability quotient (ISQ) determined by the resonance frequency method and (2) to monitor implant stability during the first 3 months of healing and evaluate any difference between immediately loaded (IL) implants and standard delayed loaded (DL) implants. The IL and DL groups consisted of 18 patients/63 implants and 18 patients/43 implants. IL implants were loaded after 2 days; DL implants were left to heal according to the one-stage procedure. The ISQ was recorded with an Osstell apparatus (Integration Diagnostics AB, Gothenburg, Sweden) at implant placement, after 1, 2, 4, 6, 8, 10 and 12 weeks. Primary stability was affected by the jaw and the bone type. The ISQ was higher in the mandible (59.8+/-6.7) than the maxilla (55.0+/-6.8). The ISQ was significantly higher in type I bone (62.8+/-7.2) than in type III bone (56.0+/-7.8). The implant position, implant length, implant diameter and implant deepening (esthetic plus implants) did not affect primary stability. After 3 months, the gain in stability was higher in the mandible than in the maxilla. The influence of bone type was leveled off and bone quality did not affect implant stability. The resonance-frequency analysis method did not reveal any difference in implant stability between the IL and DL implants over the healing period. Implant stability remained constant or increased slightly during the first 4-6 weeks and then increased more markedly. One DL and IL implant failed; both were 8 mm long placed in type III bone. At the 1-year control, the survival rate of the IL and the DL implants was 98.4% and 97.7%, respectively. This study showed no difference in implant stability between the IL and DL procedures over the first 3 months. IL short-span bridges placed in the posterior region and full arch rehabilitation of the maxilla with ITI sandblasted-and-etched implants were highly predictable.

Small clinical trials are trials in which the number of patients does not enable the objective of the study to be appropriately met with the usual methodological rules. This situation is common in the case of rare diseases, in paediatrics, in certain cancer pathologies or when the number of patients exposed to the treatment needs to be limited. The principal methodological problems are initially identified, and the classical methods (controlled, randomised, double-blind trial using parallel groups, crossover trial, factorial design, trial performed with several measures repeated over time, add-on design, randomised withdrawal design or early-escape design) and more uncommon methods (sequential approaches, meta-analyses, the ‘N of 1’ method and other methods that facilitate decision making or modelling) are then discussed. Subsequently, recommendations are made to ensure that the results obtained are not a matter of chance, and to increase the level of proof.

This paper reports on a 7-year life table analysis on ITI titanium plasma-sprayed (TPS) and sandblasted and etched (SLA) implants placed in a private practice and loaded for at least 1 year. In 236 patients, 528 (264 TPS and 264 SLA) implants were placed, 351 (66.5%) implants rehabilitated the posterior region and 71.1% implants were < or =11 mm. In the posterior mandible and maxilla, the mean implant length was 9.90 and 9.74 mm respectively. Implant length was determined through standard radiographs only. Increase of the number of implants or reduction of the width or length of the rehabilitations was no specifically sought for the shorter implants. One hundred and twenty-two SLA implants were loaded within 63 days. All early loaded SLA implants resisted the applied 35 N cm without rotation or pain. Three implants failed, one early and two late failures, all were SLA implants placed in the mandible. Shorter implants did not fail more than longer ones. The cumulative success rate was 99.40%. The predictable use of short implants supporting single crowns and small fixed partial dentures of 2-4 units supported by two to three implants permitted (1) restricting the need for sophisticated and expensive presurgical procedures aimed to determine precisely the available bone height by computerized radiographic methods, (2) the placement of prosthetically driven restoration instead os surgically driven ones, (3) reducing the indications span for complex invasive procedures like sinus lift and bon grafting procedures, (4) facilitating the surgery, without attempting to place the longest implant and (5) avoiding the occurrence of sensation disturbance. The safe use of short implants in a private practice should make implant therapy simpler and accessible to a higher number of patients and practitioners.

Objectives To report a rare case of congenital hiatal hernia illustrating the importance of its prenatal diagnosis as well as to discuss the prenatal sonographic criteria. Case Report A case of congenital hiatal hernia was diagnosed by ultrasound at 33 weeks of gestation. After a normal second-trimester morphologic ultrasound examination, a hypoechogenic mass was detected in the posterior mediastinum juxtaposed to the vertebral body and seemed to be in continuity with the intra-abdominal stomach bubble. Congenital hiatal hernia was suspected mainly because of the dynamic position of the stomach during the examination, without mediastinal shift, and normal appearance of the diaphragm on parasagittal sections of the thorax. Postnatal management was planned with no urgency and surgery was successfully performed, confirming the diagnosis. Conclusion This rare case illustrates the importance of prenatal diagnosis of congenital hiatal hernia for prenatal counseling and postnatal management. The ultrasound criterion for prenatal diagnosis is the presence of a herniated stomach in the posterior mediastinum, sometimes having a dynamic position during examination, with no mediastinal shift associated with normal diaphragm appearance on parasagittal sections of the thorax. Copyright © 2003 John Wiley & Sons, Ltd.

Objective: To assess the feasibility, tolerance and diagnostic accuracy of endometrial biopsy (EB) during sonohysterography (SH) compared to EB after hysteroscopy (HSC) in endometrial disorders. Methods: 105 consecutive patients with irregular uterine bleeding were included prospectively in the calendar year 2001. SH and flexible HSC were performed in an office setting, subsequently and in a random order, by two different practitioners blind to the former experiment. SH-EB was performed using a 3.1-mm ultrasound-guided Bernard catheter in the uterine cavity still partly distended and with a gentle 20-ml syringe vacuum aspiration. The biopsy was directed on focal lesions or else randomly when no targets had previously been found. A Cornier Pipelle® was used to perform EB after HSC. We investigated all patients by biopsy, independent of the endometrial thickness. HSC-EB was the gold standard. Results: For both methods, cervical catheterism was impossible in 20 patients, 75 of them successfully underwent both exams. Duration and tolerance were similar. SH was effective in the distinction between normal and pathologic cavities, as well as in the diagnosis of polyps. Endometrium appeared significantly thinner with HSC (1.8 mm) when compared to SH (2.9 mm, p < 0.05). Histological endometrial assessment failed in 30 cases of SH-EB and in 22 cases in HSC-EB (NS). There was a poor correlation of the histological results of both techniques. Hyperplasia has never been diagnosed by SH-EB, whereas 3 EB issued from HSC-EB brought up this diagnosis. Conclusion: SH-EB with our technique did not improve the diagnostic potential of SH and severe diagnosis was missed. Histological assessment should fail less when we exclude endometrial atrophy. The diameter of the catheter and the aspiration technique must be revised and the learning curve must be considered. Our technique cannot replace EB by HSC.

The anchorage of machined Branemark and ITI TPS-coated implants of various lengths was investigated in an animal model. Branemark fixtures 7 and 10 mm long and ITI implants 6 and 10 mm long were inserted in the mandible of dogs and were reverse-torqued after 3 months of healing. The failing mode was different for the two implant systems. For the ITI implants, loosening coincided with the peak reverse-torque values. For the Branemark fixtures, two reverse-torque values were identified and recorded, a ‘start to rotate’ and a peak value. The ‘start to rotate’ values for the 7 and 10 mm Branemark fixtures were 36.67 and 38.57 Ncm, respectively, the peak values were 61.88 and 69.13 Ncm. The increase in implant length from 7 to 10 mm did not significantly improve the anchorage. The mean reverse-torque values for the 6- and 10-mm ITI implants were 104.66 and 192.25 Ncm, respectively; the difference was statistically significant. The mean removal torque of the 6-mm ITI implant was higher than the 7- and 10-mm Branemark implants. It is suggested that the distinct anchorage magnitude and the distinct loosening patterns registered for both implant systems might be related to the various surface states. The latter might account for the different failure tendencies mentioned in the literature for short Branemark and ITI implants.