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The article reports on the registration of Atlas bmr-12 forage sorghum developed jointly by the United States Department of Agriculture, Agricultural Research Division, Institute of Agriculture and Natural Resources of the University of Nebraska. Atlas was developed by crossing the Atlas to the brown midrib source F220 that was facilitated by the use of the nuclear male-sterility gene. Fertility in A1 cytoplasmic male-sterile lines under greenhouse condition did not restore in Atlas bmr-12. Through Atlas bmr-12 the digestibility-enhancing brown midrib gene bmr-12 makes available in a current utilized self-pollinated forage sorghum cultivar with its adaptation and performance.

Background: GLP-1 (glucagon-like peptide-1) and GLP-2 (glucagon-like peptide-2) are released in equimolar amounts in response to meal ingestion. GLP-1 inhibits gastric emptying and reduces postprandial gastric and exocrine pancreatic secretion and may play a physiological regulatory role in controlling appetite and energy intake in humans. The role of GLP-2 is more uncertain. Based on the results of animal studies, it has been suggested that GLP-2 may induce intestinal epithelial growth and inhibit gastric motility. The aim of this study was to determine to what extent GLP-2 alone or together with GLP-1 inhibits gastric emptying and the sensation of hunger in man. Methods: Eight healthy volunteers were tested in a double-blind, placebo-controlled fashion. Antral emptying of a liquid meal and hunger ratings were determined using ultrasound technology and visual analogue scales scoring during infusions of saline, GLP-2 (0.5, and 1.0 pmol kg body wt -1 min -1 ), GLP-1 (0.5 pmol kg body wt -1 min -1 ) or GLP-1 and GLP-2 (0.5 pmol kg body wt -1 min -1 ). Results: The GLP-2 infusions resulted in a dose-dependent increase in antral emptying time (35%; ns and 75%; P = 0.049) compared to saline, but GLP-2 was less potent than GLP-1, which increased the antral emptying time by 192% ( P < 0.001). Addition of GLP-2 to the GLP-1 infusion did not alter the antral emptying time compared with GLP-1 alone. The GLP-1 infusion decreased the sensation of hunger compared with saline ( P = 0.023), whereas the two GLP-2 infusions had no significant effect. Addition of GLP-2 to the GLP-1 infusion did not decrease the sensation of hunger further. Conclusions: Both GLP-1 and GLP-2 inhibit antral emptying in man, but GLP-1 is more potent. [ABSTRACT FROM AUTHOR]

Total mixed rations containing conventional forage sorghum, brown midrib (bmr)-6 forage sorghum, bmr-18 forage sorghum, or corn silage were fed to Holstein dairy cows to determine the effect on lactation, ruminal fermentation, and total tract nutrient digestion. Sixteen multiparous cows (4 ruminally fistulated; 124 d in milk) were assigned to 1 of 4 diets in a replicated Latin square design with 4-wk periods (21-d adaptation and 7 d of collection). Diets consisted of 40% test silage, 10% alfalfa silage, and 50% concentrate mix (dry basis). Acid detergent lignin concentration was reduced by 21 and 13%, respectively, for the bmr-6 and bmr-18 sorghum silages when compared with the conventional sorghum. Dry matter intake was not affected by diet. Production of 4% fat-corrected milk was greatest for cows fed bmr-6 (33.7 kg/d) and corn silage (33.3 kg/d), was least for cows fed the conventional sorghum (29.1 kg/d), and was intermediate for cows fed the bmr-18 sorghum (31.2 kg/ d), which did not differ from any other diet. Total tract neutral detergent fiber (NDF) digestibility was greatest for the bmr-6 sorghum (54.4%) and corn silage (54.1%) diets and was lower for the conventional (40.8%) and bmr-18 sorghum (47.9%) diets. In situ extent of NDF digestion was greatest for the bmr-6 sorghum (76.4%) and corn silage (79.0%) diets, least for the conventional sorghum diet (70.4%), and intermediate for the bmr-18 sorghum silage diet (73.1%), which was not different from the other diets. Results of this study indicate that the bmr-6 sorghum hybrid outperformed the conventional sorghum hybrid; the bmr-18 sorghum was intermediate between conventional and bmr-6 in most cases. Additionally, the bmr-6 hybrid resulted in lactational performance equivalent to the corn hybrid used in this study. There are important compositional differences among bmr forage sorghum hybrids that need to be characterized to predict animal response accurately. [ABSTRACT FROM AUTHOR]

Four near-isogenic Wheatland × Tx430 grain sorghum [Sorghum bicolor (L.) Moench] hybrids differing in allelic status at the Waxy locus were grown in yield trials to determine their potential to expand existing sources of low-amylose starch. The hypothesis tested was that agronomic performance and grain yield do not differ among hybrid genotypes. Hybrids were generated in a two-by-two factorial design using wxb and wild-type (WT) Wheatland as female parents with wxa and WT Tx430 as male parents. Yield trials were conducted at two Nebraska locations in 2009 and 2010. No differences were observed for field emergence, but grain yield of the interallelic waxy (wxb × wxa) hybrid was 330 kg ha×1 greater than the WT × WT hybrid (P = 0.0482). The wxb × Wx hybrid had the highest grain yield, 633 kg ha×1 greater than the WT (P = 0.0003). Amylose starch content was lowest for wxb × wxa (7.66 g kg1), intermediate for wxb × Wx and Wx × wxa (25.06 and 27.20 g kg1, respectively); and highest for WT × WT (34.80 g kg1) (n = 4, P < 0.0001). The waxy and heterowaxy hybrids evaluated in this study are promising options for commercial production of starches with reduced amylose contents in a drought-tolerant crop. [ABSTRACT FROM AUTHOR]

Although heterosis is well established in grain and forage sorghum [Sorghum b/color (L.) Moench], reports of heterosis in sweet sorghum are limited to results from grain sorghum x sweet sorghum hybrids. Recent development of cytoplasmic male-sterile sweet sorghum lines allows creation of sweet sorghum hybrids for research and industry. Male sterility may also affect allocation of photosynthate to plant parts, creating the potential to increase sugar content in stems by eliminating seed as a sink. The objectives of this study were to compare performance of A3 cytoplasmic male-sterile lines and A3 cytoplasmic male-sterile hybrids to fertile B3 counterparts and to each other. A3 cytoplasmic male-sterile 'Dale', 'Wray', 'Sugar Drip', and N100 were crossed in all combinations to their male-fertile counterparts, resulting in 20 genotypes including the male-fertile lines. The 20 genotypes were grown in a randomized complete block in 2004 and 2005 at Lexington, KY. Male-sterile hybrids and lines had higher brix than male-fertile lines. Hybrids produced greater stalk yield due to taller plants with greater stem diameter. Juice fraction and juice composition remained relatively unchanged. Only six hybrids showed positive heterosis for brix. The greater juice yield and higher sugar content of selected hybrids such as A3 Ni 00 x Dale could produce more total syrup or ethanol than current pureline sweet sorghum varieties. [ABSTRACT FROM AUTHOR]

Aim: Ultrasound has a well-established role in the diagnostic assessment of acute abdominal pain where some ultrasonically easily-accessible organs account for several diagnostic possibilities. The objective of the present study was to evaluate whether surgeons without ultrasound experience could perform valid abdominal ultrasound examinations of patients referred with acute abdominal pain., Methods: Patients referred with acute abdominal pain had an ultrasound examination by a surgeon in training as well as by an experienced consultant radiologist whose results served as the gold standard. All participating surgeons were without any pre-existing ultrasound experience and received one hour of introduction to abdominal ultrasound., Results: Thirty patients underwent 40 surgeon performed and 30 radiologist performed ultrasound examinations. Regarding gallstone and cholecholecystitis the sensitivity, specificity and kappa-agreement of the surgeon performed ultrasound examination was 1.00 (0.77-1.00), 0.96 (0.79-0.99), 0.94 (0.3-1.00) and 0.40 (0.12-0.77), 0.97 (0.83-0.99), 0.44 (0.00-0.96); respectively. Visualization of the common bile duct was poor having 73% non-diagnostic surgeon-performed ultrasound examinations., Conclusion: Surgeons in training without pre-existing ultrasound experience and only a minimum of formal ultrasound education can perform valid and reliable ultrasound examinations of the gallbladder in patients admitted with acute abdominal pain.

Purpose: To study the hepatic transit time of an ultrasound contrast agent in patients with liver disease, and to evaluate the mechanism(s) of the well-established shorter cubital vein to hepatic vein transit time in cirrhosis., Material and Methods: Thirty-four patients scheduled for Menghini liver biopsy were studied by ultrasound after injection of 2.5 g Levovist (Schering, Berlin, Germany) into an arm vein. The time from injection until the first appearance of contrast echoes in the hepatic artery and hepatic veins was registered. Hepatic transit time was the difference between the two., Results: Biopsy showed cirrhosis in 9 patients, other diffuse hepatic pathology in 23 patients, and normal liver in 2 patients. Mean hepatic vein arrival time was earlier in cirrhosis than in other liver disease (19.4 s versus 26.0 s; P = 0.013), and hepatic transit time was shorter (6.6 s versus 11.6 s; P = 0.024). A hepatic transit time <10 s was found in all patients with cirrhosis, but also in 10 of 23 patients with other liver pathology., Conclusion: Hepatic transit time measurement could not be used to distinguish between cirrhosis and other hepatic pathology, but a transit time = 10 s excluded cirrhosis. The earlier hepatic vein arrival time in cirrhosis is apparently mainly caused by intrahepatic shunting rather than by early arrival of contrast to the liver.

Purpose: To examine the emptying times of broth and water, and explore the possibility of a cephalic influence on gastric emptying., Material and Methods: On different days each of twelve healthy volunteers had meals of either 350 ml water or 350 ml broth. Subsequently ten volunteers had meals of water alone and of water followed by sham feeding with broth. The antral area was determined at sonography five times before the meal as a baseline, and every 1-4 minutes after the meal. The time until the antral area had decreased to 150% of baseline (T150) was determined and used as surrogate expression of gastric emptying time., Results: The mean T150 was for water 20.3 min (range 12-40), and was for broth significantly shorter 12.6 min (5-21), P = 0.0020. In the subsequent series the mean T150 was 28.5 min (18-49) for water, and significantly shorter for water followed by sham feeding, 22.8 (14-40), P = 0.0078., Conclusion: Broth empties faster from the stomach than plain water, probably because of a "cephalic phase" stimulation of gastric motility via the vagus nerve.

Purpose: Ultrasound scanning is replacing scintigraphy in studies of gastric emptying of liquid, but both have considerable day-to-day variability. This study describes a modified ultrasound technique for assessing gastric emptying of liquid, and evaluates the inter- and intraindividual variation in emptying time., Material and Methods: On different days, each of 12 healthy volunteers had meals of 350 ml broth. The antral area was measured at sonography 5 times before the meal as a baseline, and every 1-4 min after the meal. The time until the antral area had decreased to 150% of baseline (T150) was determined and used as surrogate expression of gastric emptying time., Results: The mean T150 for a broth meal was 12.6 min (range 5-21) and 13.5 min (6-23) (first and second meal, respectively). The standard deviation of the differences between the 12 pairs of repeated measurements was 3.1 min and the coefficient of variation was 24%., Conclusion: Ultrasound monitoring of antral size after a liquid meal is a well suited method for assessing gastric emptying of liquid.

Increased muscle tenderness is the most prominent finding in patients with tension-type headache, and it has recently been shown that muscle blood flow is diminished in response to static exercise in tender points in these patients. Although tenderness has been ascribed to local inflammation and release of inflammatory mediators, the interstitial concentration of inflammatory mediators has not previously been studied in tender muscles of patients with tension-type headache. The aim of the present study was to investigate in vivo concentrations of prostaglandin E2 (PGE2), adenosine 5'-triphosphate (ATP), glutamate, bradykinin and other metabolites in a tender point of patients with chronic tension-type headache, in the resting state as well as in response to static exercise, and to compare findings with measurements in a matched non-tender point of healthy controls. We recruited 16 patients with chronic tension-type headache and 17 healthy control subjects. Two microdialysis catheters were inserted into the trapezius muscle and dialysates were collected at rest, 15 and 30 min after start of static exercise (10% of maximal force) and 15 and 30 min after end of exercise. All samples were coded and analysed blindly. There was no difference in resting concentration of any inflammatory mediators or metabolites between tender patients and non-tender controls (P > 0.05). We also found no difference in change in interstitial concentration of ATP, PGE2, glutamate, glucose, pyruvate and urea from baseline to exercise and post-exercise periods between patients and controls (P > 0.05). The present study provides in vivo evidence of normal interstitial levels of inflammatory mediators and metabolites in tender trapezius muscle in patients with chronic tension-type headache during both rest and static exercise. Thus, our data suggest that tender points in these patients are not sites of ongoing inflammation.

Purpose: Video glasses form a virtual image in front of the user. We investigated the utility of video glasses at US-guided interventions., Material and Methods: The video glasses were tested at 75 consecutive US-guided interventions. The operator sees the US image in front of him, and below the glasses, simply by moving his eyes, he can see the patient and the field of intervention., Results: The video glasses could be used at all 75 US-guided interventions. The image quality was below that of the US monitor, but adequate. The working posture was improved, it was easy to get accustomed to using the system, there was no increased time consumption, and the patients felt comfortable with the set-up., Conclusion: Use of video glasses facilitates US-guided interventions.

Painful impulses from tender pericranial muscles may play a major role in the pathophysiology of chronic tension-type headache. Firm evidence for peripheral muscle pathology as a cause of muscle pain and chronic headache is still lacking. Using a microdialysis technique, we aimed to estimate in vivo blood flow and interstitial lactate concentrations in the trapezius muscle at rest and during static exercise in patients with chronic tension-type headache and in healthy subjects. We recruited 16 patients with chronic tension-type headache and 17 healthy control subjects. Two microdialysis catheters were inserted into the trapezius muscle (on the non-dominant side) of subjects, and dialysates were collected at rest, 15 and 30 min after the start of static exercise (10% of maximal force) and 15 and 30 min after the exercise was completed. All samples were coded and analysed blind. The primary endpoints were to detect a difference between patients and controls in changes of muscle blood flow and the interstitial lactate concentration from baseline to exercise and post-exercise periods. The increase in muscle blood flow from baseline to exercise and post-exercise periods was significantly lower in patients than controls (P = 0.03). There was no difference in resting blood flow between patients and controls (P = 0.43). Resting interstitial concentration of lactate did not differ between patients (2.51 +/- 0.18 mM; mean +/- standard error of the mean) and controls (2.35 +/- 0.23 mM, P = 0.57). There was no difference in change in interstitial lactate from baseline to exercise and post-exercise periods between patients and controls (P = 0.38). The present study provides in vivo evidence of decreased blood flow in response to static exercise in a tender muscle in patients with chronic tension-type headache. We suggest that, because of increased excitability of neurones in the CNS, the central interpretation and response to normal sensory input are altered in patients with chronic tension-type headache. This may lead to enhanced sympathetically mediated vasoconstriction and thereby a decreased blood flow in response to static exercise.

The purpose of this study was to investigate the occurrence of gallstones and the severity of acute pancreatitis in a Danish population, and in severe cases, the relation between pancreatic necrosis and gallstones. We used Ranson's prognostic scoring system to measure the severity of acute pancreatitis, ultrasonography for detecting biliary stones, and computed tomography or laparotomy for detecting pancreatic necrosis. During a two year period, we registered 101 patients. Approximately 70% were mild cases, and we found 18 patients with and 53 patients without gallstones. Among patients with severe cases, we observed 14 with and 16 without gallstones. There was a significantly higher proportion of gallstones in severe cases. Eight of 30 patients with severe pancreatitis had pancreatic necrosis, but we found no relation between the occurrence of necrosis and gallstones. We conclude that patients with gallstone related pancreatitis have more severe disease than patients without stones, but the complication of pancreatic necrosis is not related to gallstones.

Objective: To study maternal serum levels of human placental lactogen (hPL), pregnancy-associated plasma protein A (PAPP-A) and endometrial secretory protein PP14 (PP14) in first trimester of diabetic pregnancy., Methods: Seventy-nine insulin-dependent diabetic women and 93 normal pregnant women had a venous blood sample drawn in weeks 8-14, ultrasound age. Serum levels were measured by radioimmunoassays and expressed in multiples of the median serum value in normal pregnancy at that ultrasound age., Results: Levels of hPL were significantly lower in diabetic mothers than in controls, z'= -5.502, p<0.00001. Levels of PAPP-A were also significantly lower, z' =2.263, p=0.024, but were significantly less depressed than those of hPL, z'=2.41, p=0.015. The PP14 levels did not deviate from normal., Conclusion: In first trimester of diabetic pregnancy there appears to be both a more general depression of trophoblast function, and also a specific depression of the hPL release.

Objective: The purpose of this study was to describe and evaluate a method for assessing the sound propagation velocity in breast tumors relative to the velocity in adjacent tissue., Subjects and Methods: Sixty-six patients with palpable breast tumors were studied. The scanning plane was aligned so that it transected the tumor and depicted the front of a rib or the pleura-lung interface behind the tumor. This contour was evaluated for distortion, and the height of the distortion and the height of the tumor were used to calculate the relative sound propagation velocity., Results: A posterior reference line was revealed behind 62 of 66 tumors. Of these 62 tumors, an elevation was seen behind 49 tumors, and no distortion was seen behind 13 tumors. A depression was never observed. The median relative sound propagation velocity of 1.07 that was calculated in 42 carcinomas (range, 1.00-1.14) was insignificantly higher (p = .079) than the median relative sound propagation velocity of 1.04 obtained in 20 fibroadenomas (range, 1.00-1.15)., Conclusion: Although assessment of relative sound propagation velocity in breast tumors was successful, the relative velocities differed only insignificantly between benign and malignant lesions.

Objective: To test the hypothesis that there is an association between simple renal cysts and arterial blood pressure (BP)., Patients and Methods: The study comprised a review of the case-notes of 115 patients (mean age 67.7 years, range 31-91) in whom renal cyst(s) was an incidental ultrasonographic finding, and 115 age- and sex-matched control patients. The notes were reviewed without knowledge of the origin or treatment., Results: The systolic and diastolic BP were significantly higher in patients with a cyst(s) than in control patients (P = 0.031 and P = 0.0034; mean difference 6.9 mmHg and 5.0 mmHg, respectively). In those aged 30-70 years, the presence of one or more simple renal cysts increased the risk of having a diastolic BP > or = 95 mmHg from seven in 58 to 17 in 58 patients (P = 0.038)., Conclusion: The association between simple renal cysts and higher arterial BP probably arises from underlying renal disease causing both. Occasionally it is possible that renal ischaemia caused by cyst expansion, and therefore increased renin release, generates the elevation in BP. If so, methods to identify such cysts should be developed.

Diagnosis of pleural effusion (PE) on supine chest X-ray (SCXR) is considered difficult. This study aimed at evaluating the accuracy of the diagnosis of PE on SCXR and was performed in two phases. At phase 1, a formula for the sonographic estimation of the volume of PE was established by correlating 24 measurements (in 7 patients in whom complete drainage was achieved) with the drained volumes. At phase two, 112 consecutive SCXRs were supplemented by sonography of the chest. The films were evaluated for the presence of PE and for the presence of different radiologic signs of PE. Sonography showed PE in 41 right and 30 left hemithoraces. The overall accuracy of the diagnosis of PE on SCXR was 82 %. Only one of the undiagnosed PEs had a volume of > 300 ml. The most accurate signs were increased density of the hemithorax, blunted costophrenic angle, and loss of the hemidiaphragm silhouette.

Purpose: The aim of this study was to evaluate the use of rectal endosonography for preoperative staging of tumour extension and lymph node involvement in rectal tumours., Material and Methods: Over a 4-year period 100 patients with rectal tumours were studied with sonography using 7 MHz endoprobes. Tumour spread was assessed according to the TNM classification, and the number and maximum size of perirectal lymph nodes were registered. The sonographic findings were compared with the surgical and histological findings., Results: The overall accuracy of endosonography in assessing local tumour extension was 85% (76-91%; 95 percent confidence limits). T4 tumours with a large contact surface to an adjacent organ tended to be nonresectable. Lymph node assessment could be made in 81 patients who underwent radical resection: sonography showed lymph nodes in 49 patients, 30 of whom had nodal metastases; the histological examination showed lymph nodes in the remaining 32 patients, 8 of whom had nodal metastases. The number of lymph nodes at the histological examination was markedly higher than the number depicted by preoperative ultrasound., Conclusion: This study confirmed the use of endoluminal ultrasound in the preoperative evaluation of local tumour spread. However, endosonographic assessment of perirectal nodal involvement seems to be too unreliable to be used for the preoperative selection of patients.

Purpose: To describe the changes in the endosonographic appearance of the anal sphincter muscles with age., Material and Methods: Fifty subjects (age range 22-85 years) with no history of anorectal disease or surgery were studied with anal endosonography. The thickness of the internal and external anal sphincter was registered and correlated to age. For the internal sphincter, which is often asymmetric, the maximum and minimum thicknesses were measured at any part of the circumference (except anteriorly for anatomic reasons) and also in the lateral positions., Results: A significant positive correlation with age was found for all maximum, minimum, and average internal sphincter thicknesses. Moreover, the echogenicity of the internal sphincter changed with age as the sphincter muscle became more echogenic. There was no significant correlation between external sphincter thickness and age., Conclusion: Knowledge of the normal variation of the internal sphincter thickness with age is important since endosonography may be used to identify patients with hypertrophy of the internal sphincter. Currently, we consider maximal thicknesses above 4 mm to be abnormal in patients under 50 years of age, whereas in patients aged at least 50 years thicknesses of 5 mm or more are considered abnormal.

The present study presents data from a population study of 659 randomly selected adult volunteers. All participants had a renal sonographic examination and at the same time had their urine tested for hematuria by dipstick. Thirty participants (5%) had dipstick hematuria. Similar rats of abnormal renal findings were obtained in the hematuria-positive and hematuria-negative groups, 10% and 8%, respectively. Our results suggest that dipstick investigation for hematuria in mass-screening programs is not effective for the detection of structural renal abnormalities.

A new method of measuring the size of the thymus in infants less than 1 year of age is presented. The width of the thymus was measured in a transverse image while the area of the largest lobe was assessed in a longitudinal image. The thymic index was then defined as the product of these two values. Intra- and interobserver variation analysis were performed in 23 infants. Each infant was scanned alternately by both of two radiologists, and later the same day the measurements were repeated. The mean differences between the first and second measurements (intraobserver variation) were -0.25 (2 SD 7.56) and -1.13 (2 SD 10.80), respectively, for the two observers. The mean difference between the first measurements of the two observers (interobserver variation) was 1.47 (2 SD 9.39). In a postmortem study of 12 infants the thymic index measured by sonography showed an acceptable correlation to the actual volume (c = 0.80) and weight (c = 0.87) of the thymus. In conclusion, our sonographic estimate of the volume of the thymus, the thymic index, in infants under 8 months of age seems to be easy, reliable and reproducible.

Brown midrib sorghum silage was compared with alfalfa, corn, and normal sorghum silages for its effect on performance, ruminal metabolism, and digestive kinetics of Holstein dairy cows in midlactation. Twelve cows averaging 90 +/- 5 DIM were assigned to one of four diets in replicated 4 x 4 Latin squares with 4-wk periods. Additionally, 3 ruminally fistulated cows (95 +/- 20 DIM) were assigned to the same diets in a 3 x 4 Youden square for measurement of ruminal characteristics. Diets were fed as isonitrogenous TMR that contained 65% silage (DM basis). The DMI was greater for the corn and brown midrib sorghum (4% of BW/d) than for the alfalfa and normal sorghum diets (3.4% of BW/d). The brown midrib sorghum supported FCM production that was similar to that of cows on corn and alfalfa diets (25.8 kg/d), but cows fed normal sorghum produced less milk and fewer milk components. Source of silage had no effect on eating time, but rumination was least for the alfalfa diet. Ruminal pH and ammonia concentrations were similar for all diets. Total VFA concentrations were greatest for the corn and brown midrib sorghum diets. The brown midrib sorghum had greater in situ extent of ruminal NDF digestion than did the normal sorghum, which agreed with in vitro data. The brown midrib sorghum used in this experiment supported FCM production similar to the corn and alfalfa silages commonly fed to dairy cows in midlactation.

Objective: To study in an optimized design the possible relation between serum levels in weeks 8-14 of human placental lactogen and pregnancy-associated plasma protein A and fetal size at delivery., Methods: Analysis of data from 93 normal singleton pregnancies. Gestational age was assessed from a sonographic crown-rump length measurement. Serum levels of human placental lactogen and pregnancy-associated plasma protein A were determined by radioimmunoassay, and were expressed in multiples of mean. The relative birth weight was used as an index of fetal growth., Results: Serum levels of human placental lactogen and pregnancy-associated plasma protein A showed a negative correlation to gestational age at delivery (p < 0.01 and p < 0.05, respectively), and there was a positive correlation between the serum level of pregnancy-associated plasma protein A and relative birth weight (p < 0.02)., Conclusions: Higher levels of human placental lactogen and pregnancy-associated plasma protein A predicted earlier delivery, maybe because of better fetal growth, and higher levels of pregnancy-associated plasma protein A predicted better fetal growth.

Objective: To investigate possible endocrine changes in patients with early pregnancy bleeding and subchorionic hemorrhage., Design: Prospective study in first trimester of pregnancy comparing circulating levels of human placental lactogen (hPL), pregnancy-associated plasma protein A (PAPP-A) and endometrial secretory protein PP14 (PP14) in women with and without subchorionic hemorrhage., Subjects: Sixty-nine women with early pregnancy bleeding, who in week 7-14 had a blood sample and an ultrasound study with both determination of fetal crown-rump length and a search for subchorionic hemorrhage., Results: There was no difference between serum levels of hPL, PAPP-A and PP14 in 29 women with and 40 women without subchorionic hemorrhage, and no correlation between serum levels and the size of the hematoma., Conclusion: Judged from the serum levels of the studied substances there were no indications of an impaired function of the trophoblast or the decidua that could explain the development of subchorionic hemorrhage.

Background: It has previously been shown that serum levels of pregnancy-associated plasma protein A (PAPP-A) are depressed in patients with early pregnancy bleeding and a live gestation. We examined whether human placental lactogen (hPL) levels show a similar pattern., Method: Prospective study in the 8th-14th gestational week comparing serum levels in 69 women with early pregnancy bleeding with those in 93 control pregnancies., Results: Serum levels of hPL were significantly depressed in women with early pregnancy bleeding (p < 0.0001)., Conclusions: The findings suggest a primary affection of the placenta in early pregnancy bleeding.

The aim of this study was to compare the number of lymph nodes detected by sonography with the actual number and nature of the lymph nodes found on histopathological examination. Twenty colorectal specimens with carcinoma were studied. Sonography was performed with the bowel submerged in water and pericolonic lymph nodes were marked on a drawing of the specimen. After fixation, pericolonic lymph nodes were identified by palpation and their location and size were noted on a similar drawing. By comparing the sonographic and histological findings it was possible to determine which nodes had been identified by sonography. Histological examination detected 205 lymph nodes in the 20 specimens. Sixty-four of them (31%) were found by in vitro sonography (25% of the benign nodes, 56% of the malignant nodes). Preoperative endosonographic assessment (performed in 10 of the patients) generally showed fewer lymph nodes than what was subsequently found by in vitro sonography. The inability of sonography to detect more than 56% of the metastatic lymph nodes makes preoperative endosonographic assessment less valuable than hitherto believed.

Purpose: Patients with anal incontinence attributable to trauma are usually treated by sphincter reconstruction. Failures because of incomplete reconstruction may possibly be detected by anal endosonography which gives detailed information on the anal sphincter muscles. The aim of this study was to describe the endosonographic findings in patients after sphincter reconstruction., Materials and Methods: Ten female patients who had undergone surgical sphincter reconstruction using an overlapping technique because of anal incontinence were studied with anal endosonography a median of six months after surgery. Five patients were fully continent, three were incontinent for flatus, and two patients were still incontinent for solid stool at the time of this study. Eight patients had also been studied with endosonography before surgery, and, in these patients, we compared the initial sonograms with the follow-up sonograms. The angular extent of the endosonographic defects in the external sphincter before and after reconstruction was measured in degrees and compared with the outcome of surgery., Results: After reconstruction, continuity of the external anal sphincter was completely restored at all levels in four patients, one of whom still had anal incontinence. Continuity was partially restored in three patients: two were fully continent, while one patient, previously incontinent for stool, was incontinent for flatus. In three patients the continuity was restored at one level but a persisting defect was found at a different level. In two of these patients the grade of incontinence was unchanged. Three patients also had defects in the internal anal sphincter., Conclusion: After surgical sphincter reconstruction for anal incontinence, we found sphincteric defects in six patients, including four of five patients who still had some degree of incontinence. Thus, endosonography may be used for postoperative assessment and may explain the unsatisfactory results of surgery in some patients. We recommend that endosonography be also performed preoperatively, whereby the effect of the operation on the size of the sphincteric defect can be assessed.

Purpose: The aim of our study was to investigate internal anal sphincter electromyographic signals., Methods: Electromyography of the internal anal sphincter was performed with platinum wire electrodes in six healthy volunteers (three males and three females), inserted under endosonographic guidance. Platinum wire electrodes were also inserted into the external anal sphincter. Activity of both the internal and external and sphincter in a 40-second period was measured., Results: Internal anal sphincter median activity was 22.1 (range, 5.5-67.6) microV. Slow-wave activity was 47 cycles/minute (range, 34-55 cycles/minute). After inflation of a rectal balloon with air until a constant relaxation of the anal canal was obtained, a decrease in internal and sphincter activity to 15.9 (1.2-31.3) microV as well as a decrease in slow-wave activity to 34 cycles/minute (range, 27-40 cycles/minute) was found. The original internal anal sphincter EMG was resumed after deflation of the rectal balloon. External anal sphincter median activity was 3.1 (range, 0.77-18.6) microV. During inflation of the rectal balloon, a reflex increase in external sphincter EMG activity was found. With the rectal balloon fully inflated a part of this increase was still present, 11.0 (1.9-24.6) microV. In some of the subjects, this increased activity was superimposed on the internal anal sphincter recordings as well. During a voluntary squeeze it was not possible to identify internal anal sphincter activity due to activity of the external anal sphincter totally overriding the internal anal sphincter signal., Conclusion: Precise EMG recordings from the internal anal sphincter is possible with endosonographic guidance of the electrodes, except during voluntary squeezing of the external and sphincter.

Endosonography gives detailed information on the internal and external anal sphincters. The goals of this study were to evaluate findings on anal endosonography in patients with anal incontinence and to study the value of endosonography for selecting the most effective surgical treatment. Forty-eight patients with incontinence for either gas (17 patients) or faeces (31 patients) were studied. Nineteen patients had idiopathic incontinence, 29 were incontinent due to previous obstetrical or surgical trauma. Endosonography and measurement of anal canal pressures were performed in all patients, 40 had needle electromyography. The endosonograms were evaluated without knowledge of the clinical findings and correlated with the results of needle electromyography, with the anal pressures, and to the type of surgery subsequently performed. In 30 patients surgery was subsequently planned on the basis of the results of endosonography and the anophysiologic examinations. Endosonograms showed defects in 27 external sphincters, 12 of whom had internal sphincter defects also. One patient had an abnormal thinning of the external sphincter. Eight patients had defects of the internal sphincter as the only finding. Twenty-two of the patients with sonographically detected defects or thinning of the external sphincter had an EMG performed, this showed defects of the external sphincter in 18, four defects in the middle and upper anal canal had not been found. There was no correlation between the sphincteric defects found by endosonography and the anal canal pressures. Sphincter reconstruction was offered to most patients with damage to the external sphincter; patients with isolated defects in the internal sphincter or intact internal and external sphincters were offered a number of other surgical procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: To determine a reference level for alpha-fetoprotein (AFP) in the amniotic fluid (AF) in pregnant women with insulin-dependent diabetes mellitus in order to suggest an explanation for the observed decrease in maternal serum AFP., Methods: Alpha-fetoprotein was measured in AF, maternal serum, or both in the second trimester in 287 pregnant women with insulin-dependent diabetes mellitus. Retrospectively, these AFP values were correlated with glycosylated hemoglobin (HbA1C) levels, early fetal growth delay, and congenital malformations., Results: The median concentration of AFAFP was 0.89 multiples of the normative median (MoM) (n = 280; 95% confidence interval [CI] 0.88-0.93 MoM); the maternal serum AFP (MSAFP) value was 0.78 MoM (n = 155; 95% CI 0.77-0.84 MoM). A statistically significant but weak positive correlation was found between HbA1C and MSAFP (r2 = 0.033, P = .03), but the correlation with AFAFP was not statistically significant. The levels of AFP did not correlate with early fetal growth delay. One neural tube defect, but none of the 11 other major malformations, was detected by AFP screening., Conclusions: A physiologic basis for the decreased AFAFP and MSAFP levels is still obscure. Screening for congenital malformations in diabetic pregnancies should include both a mid-gestation ultrasound scan and MSAFP measurement. However, routine amniocentesis does not seem to be indicated. Concentrations of AFAFP may be corrected for the observed decrease.

Follow-up was performed two to six years after anal dilatation for fissure-in-ano in 32 consecutive patients who had not undergone additional anal surgery. All patients were interviewed and asked specifically about impairment of flatus or fecal control and its possible relation to the anal dilatation. Anal dilatation was followed by minor anal incontinence in 12.5 percent of the patients. Anal endosonographic follow-up was accepted by 20 patients, and sphincteric defects were found in 13 (65 percent) of those. Two patients with anal incontinence had internal sphincter defects. Sphincteric defects were also found in 11 of the 18 continent patients who underwent sonography: internal sphincter defects in nine, external sphincter defect in one, and combined defects of both sphincter muscles in one. In conclusion, anal dilatation results in sphincter damage in more than half of patients, but few of them develop anal incontinence.

Objective: Rectal endosonography is useful for the preoperative detection of perirectal lymph nodes in patients with rectal carcinoma, but some lymph nodes may be overlooked. The aim of this study was to compare the number of lymph nodes detected at sonography with the actual number and the pathology of the nodes found on examination of surgical specimens., Materials and Methods: Colorectal specimens from 20 patients who had undergone resection of the colon (six patients) or rectum (14 patients) for carcinoma were selected for study. Sonography with 7-MHz endoprobes was performed with the bowel opened and submerged in water. The location and size of all lymph nodes that could be visualized in the pericolonic fat were marked on a drawing of the specimen. Distinction between malignant and benign nodes was not attempted. After fixation, pericolonic lymph nodes were identified by careful palpation, and their location and size were noted on a similar line drawing of the specimen. This was performed "blindly" without knowledge of the sonographic findings. By comparing the sonographic localization and size of the nodes with the histologic findings, it was possible to determine which nodes had been identified and which had been overlooked on sonograms. Preoperative endosonography had also been performed in 10 patients with rectal carcinoma, and the number of lymph nodes detected with this examination was compared with the results of the in vitro sonographic and histopathologic examinations., Results: Histologic examination detected 205 lymph nodes in the 20 specimens. Sixty-four (31%) of them were seen on in vitro sonograms (25% of the benign nodes and 56% of the malignant nodes). The overall detection rates were 16% for nodes less than 5 mm in diameter, 56% for nodes between 6 and 10 mm, and 82% for lymph nodes larger than 10 mm. Preoperative rectal endosonography generally showed fewer lymph nodes (average, 1.2 nodes) than what was subsequently found with in vitro sonography (average, 2.7 nodes)., Conclusion: Our study suggests that only approximately half of the malignant nodes in patients with colorectal carcinoma are visualized with endosonography of the surgical specimen. Even fewer nodes are visualized on preoperative in vivo examinations. The inability to detect more than 56% of metastatic lymph nodes makes preoperative endosonographic assessment less valuable than hitherto believed. This should be considered if sonographically guided biopsy of lymph nodes is considered as part of preoperative staging.

Objective: Endosonography using an anal probe gives detailed information about the internal and external anal sphincters. The goals of this study were to evaluate findings at anal endosonography in patients with anal incontinence and to study whether endosonography might replace needle electromyographic mapping in providing information on the external anal sphincter. Furthermore, we compared the type of sphincter damage found by endosonography with the anal canal pressures and studied the value of endosonography for selecting the most effective surgical treatment., Subjects and Methods: Forty-eight patients with incontinence for either gas (17 patients) or feces (31 patients) were studied. Nineteen patients had idiopathic incontinence, 29 were incontinent as a result of previous obstetrical or surgical trauma. Endosonography and measurement of anal canal pressures were performed in all patients; 40 had needle electromyography. The endosonograms were evaluated without knowledge of the clinical findings, and the endosonographic findings were correlated with the results of needle electromyography, with the anal pressures, and with the type of surgery subsequently performed. In 30 patients, surgery was subsequently planned on the basis of the results of endosonography and the anophysiologic examinations., Results: Endosonograms showed defects of the external sphincters in 27 patients, 12 of whom had internal sphincter defects also. One patient had an abnormal thinning of the external sphincter. Eight patients had defects of the internal sphincter as the only finding. Twenty-two of the patients with sonographically detected defects or thinning of the external sphincter had electromyography, which showed defects of the external sphincter in 18; four defects in the middle and upper anal canal were not found. The sphincteric defects found by endosonography did not correlate with the anal canal pressures. Sphincter reconstruction was offered to most patients who had damage to the external sphincter; patients with isolated defects in the internal sphincter or intact internal and external sphincters were offered a number of other surgical procedures., Conclusion: Endosonography can be used in place of the invasive electromyographic mapping for detecting defects of the external sphincter, and endosonography also gives additional information on the internal sphincter, which cannot be obtained by other means. No correlation between the anal pressures and the type of sphincter damage found by endosonography can be demonstrated. The main reason for performing endosonography is to detect defects in the external sphincter, for which surgical reconstruction is most likely to be done, whereas visualization of internal sphincter defects seems to have no influence on surgical management and does not lead to any specific treatment.

Preoperative evaluation of stenotic rectal tumors is important since they often involve adjacent organs and thus may require additional therapy. Previous reports on endosonographic staging have excluded stenotic tumors because they could not be fully visualized with the available equipment. In this study, we have evaluated the role of endosonography in staging stenotic rectal tumors, with special attention to the use of forward-looking endoprobes. Preoperative staging was performed in 28 patients with stenotic rectal tumors. Tumor extension was evaluated according to the TNM classification, and the results were compared with surgical and histopathologic findings. Endosonography accurately assessed tumor extension in two T2 tumors, 14 T3 tumors, and seven T4 tumors. Three T2 tumors were overstaged, and two T4 tumors were staged as T3. The accuracy was 82 percent. Twenty-two tumors were subject to histopathologic evaluation of lymph nodes. Lymph nodes larger than 1 cm had been seen by endosonography in eight patients, five of whom had nodal metastases. Lymph nodes smaller than 1 cm or no lymph nodes were found in 14 patients, four of whom had nodal metastases. In conclusion, full sonographic visualization of stenotic rectal tumors and thus evaluation of tumor extension can be achieved by using forward-looking endoprobes.

Objective: The purpose of this study was to investigate the normal sonographic measurements of the kidney in adult volunteers., Subjects and Methods: Length, width, and thickness of the kidney and its central echogenic area and the parenchymal thickness of the upper pole were measured in an age- and sex-stratified random sample of 665 volunteers 30, 40, 50, 60, and 70 years old. Measurements were made with the volunteers prone. Volumes of the kidney, the central echogenic area, and the renal parenchyma were calculated. Renal dimensions and renal and parenchymal volume were correlated with age, height, weight, body mass index, and total body area. In 94 subjects, renal length was measured with the volunteers supine also., Results: Median renal lengths were 11.2 cm on the left side and 10.9 cm on the right side. Median renal volumes were 146 cm3 in the left kidney and 134 cm3 in the right kidney. Renal size decreased with age, almost entirely because of parenchymal reduction. Renal volume correlated best with total body area. Renal length correlated best with body height. Measurements of renal length obtained with the subjects supine were not significantly different from those obtained with the subjects prone., Conclusion: The most exact measurement of renal size is renal volume, which showed the strongest correlation with height, weight, and total body area. Clinically, measurement of renal length is most practical and can be done with the subject prone or supine.

Objective: To investigate whether fetal weight estimation by ultrasound in diabetic pregnancy might be based upon fetal abdominal circumference (AC) alone., Design: A retrospective study., Setting: Diabetes Center, Rigshospitalet and Ultrasound Laboratory, Glostrup Hospital, Copenhagen., Subjects: Eighty-six diabetic pregnant women who had an ultrasound study within 2 days before delivery., Results: We assessed in 73 fetuses various formulas based upon biparietal diameter and AC against formulas based upon AC alone, and these were only marginally less effective than the more complex ones. In 86 fetuses an AC was available. These fetuses were divided into a study population and a test population. The linear model was customized for the study population. Evaluation on the test population showed that the relative error (error as a percentage of birthweight) in predicting birthweight had a standard deviation of 7.8%. The efficacy of AC in detecting fetuses greater than 4000 g was examined in the test population: If AC greater than 36.0 cm was chosen as criterion for macrosomia the positive and negative predictive values were 80% (8/10) and 91% (30/33), respectively., Conclusion: Formulas for estimating fetal weight in diabetic pregnancy based on AC alone are almost as effective as more complex ones. We recommend a simple linear formula of fetal weight as a function of AC.