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Resume Objectif Evaluer les caracteristiques du diagnostic antenatal et les issues de grossesses de fœtus presentant une crosse aortique droite (CAD) isolee. Methodes Etude retrospective de fœtus presentant une CAD isolee, realisee entre janvier 2010 et fevrier 2018. Les cas ont ete extraits des donnees d’un centre de cardiopediatres referents. Tous les fœtus ont beneficie de l’expertise d’un echographiste referent afin d’eliminer une anomalie morphologique. Une analyse de la litterature a ete effectuee afin d’etablir les caracteristiques du diagnostic antenatal et des issues de grossesses des fœtus susmentionnes. Resultats Une CAD isolee a ete diagnostiquee chez 56 fœtus et un double arc aortique (DAA) isole chez un fœtus. L’âge gestationnel moyen au diagnostic etait de 24 semaines d’amenorrhees (SA). Le sexe-ratio (garcon/fille) etait de 0,89. Aucune anomalie significative n’a ete mise en evidence sur les prelevements invasifs (caryotype et FISH ou GCH array). Un nouveau-ne a ete symptomatique (stridor) ; seul cas pour lequel le diagnostic de CAD isolee a ete redresse en DAA. Quatre etudes comprenant 115 cas de CAD isolee ont ete revues. Une anomalie chromosomique significative a ete depistee : une deletion 22q11, chez un nouveau-ne porteur d’une fente du palais mou. Une complication obstetricale majeure est notee : une mort fœtale in utero a 41 SA. Conclusion Le diagnostic de CAD isolee peut etre difficile, mais n’implique pas de modifier la surveillance obstetricale. La realisation d’un prelevement invasif est a discuter. Une echocardiographie est a effectuer systematiquement dans le premier mois de vie.

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 %.

L'industrie du transport frigorifique cherche activement des solutions innovantes pour remplacer ou ameliorer les systemes conventionnels de production de froid, notamment par compression mecanique de vapeur, avec entrainement par moteur diesel.Les developpements industriels recents des unites cryogeniques offrent des alternatives performantes, sures, fiables et durables.Cet article passe en revue toutes les solutions cryogeniques developpees recemment. Il les positionne par rapport aux usages, aux attentes du marche et les compare aux solutions conventionnelles, tant sur le plan energetique qu’environnemental, et ce pour chaque segment du marche du colis a la semi-remorque.

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.

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.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.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.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 109:1586-1595, 2017. © 2017 Wiley Periodicals, Inc.

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 feasibility and impact of using a software-supported protocol for routine second-trimester ultrasound scanning.We conducted a comparative observational study of 2 sets of 25 randomly selected normal routine second-trimester examinations performed by the same expert sonographer before and 1 year after the introduction of a software-supported protocol. The scanning protocol was identical during both periods and conformed to International Society of Ultrasound in Obstetrics and Gynecology guidelines. Two independent expert sonographers reviewed the temporal sequences of fetal anatomic visualization. The examination duration, number of images, time per stored image, and number of recorded anatomic features according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines were compared between the periods.The mean examination duration and the number of images stored ± SD were both significantly higher during the period with the software-supported protocol than during the previous period (18.9 ± 5.3 versus 15.3 ± 2.8 minutes, respectively; P = .005; and 52.0 ± 2.4 versus 35.2 ± 3.4; P .001). The mean time per image was also shorter with the software-supported protocol (19 ± 7 versus 26 ± 4 seconds; P .001). Recording of the placental location, amniotic fluid quantification, cavum septi pellucidi, thoracic shape, both kidneys, both arms, and genitalia was significantly more consistent with the software-supported protocol (P .001; P = .001; P = .022; P = .050; P = .022; P .001; and P = .048).This pilot study suggests that a software-supported protocol standardizing image acquisition may improve operator efficiency during second-trimester ultrasound scans.

Project management in the Oil and Gas Industry (OGI) of the United Arab Emirates (UAE) is vibrant in nature due to various factors. Delivering a successful project is the ultimate goal of every project manager. However, failures are common and frequent in delivering projects within in the stipulated time schedules, within budget, without reports of HSE (Health, security and Environment) incidents and with ultimate satisfaction of the client/end user. The pace of project implementation and delivery depend upon factors, some of which are beyond the control of project managers and could put the project success at stake. Therefore, it is required that project key performance indicators (KPI) are identified which have the most relevance in OGI. The main objective of the study presented in this paper was to determine the key performance indicators for OGI. Based on the qualitative data and information collected through this study, a confirmation of the role that KPIs played in cost, time and quality was recorded. Additionally, Health, Safety and Environment (HSE) were found to be criteria for other KPIs when assessing a project’s success. Users’ satisfaction level is an additional parameter that contributed to a project’s success.

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.

L’endocardite infectieuse (EI) est une maladie grave, potentiellement mortelle, en relation etroite avec la medecine bucco-dentaire. La prescription d’une antibioprophylaxie avant tout geste responsable d’une bacteriemie transitoire est recommandee depuis plusieurs decennies, mais l’incidence de l’EI est restee stable. Depuis 1997, les recommandations americaines et celles des pays industrialises vont dans le sens d’une limitation toujours plus nette des indications de l’antibioprophylaxie et l’une d’entre elles propose meme l’abandon total de l’antibioprophylaxie. Les arguments avances sont principalement statistiques et ne reposent pas sur des etudes cliniques controlees. En raison de l’incidence faible de l’EI, les probables consequences negatives de ces nouvelles recommandations ne seront perceptibles que dans plusieurs annees.

Resume Objectifs Construire de nouvelles courbes et equations francaises de reference pour l’epaisseur de la clarte nucale (CN) a 11–14 SA a partir d’un large echantillon. Comparer ces nouvelles references avec des courbes deja publiees. Materiel et methodes Les mesures ont ete obtenues a partir d’un seul centre de depistage sur sept ans. Seules les mesures realisees pour des longueurs craniocaudale (LCC) comprises entre 45 et 84 mm par des operateurs entraines et certifies par la FMF ont ete utilisees. Les grossesses multiples, les anomalies du caryotype, les hygromas kystiques ainsi que les mesures faites par un echographiste ayant realise moins de 500 mesures sur la periode etaient exclues. Pour chaque LCC, les percentiles bruts de CN ont ete calcules, puis ajustes par une regression par methode des moindres carres avec un polynome d’ordre eleve. Les resultats ont ete compares a des courbes et references existantes. L’impact d’une deviation des valeurs medianes a ete evalue. Resultats Parmi les mesures de clarte nucale, 19 198 ont pu etre incluses. Les nouvelles courbes et equations sont presentees. Les medianes de CN etaient comparables a celles rapportees dans la litterature. La variation de valeur mediane de nuque n’entrainait pas de modification sur les performances du depistage. Conclusion Nous presentons de nouvelles courbes et equations de reference pour la clarte nucale au premier trimestre en France. Celles-ci peuvent servir pour des programmes d’assurance qualite. Bien qu’ayant ete realisees sur un large echantillon de fœtus, nos courbes ne mettent pas en evidence de difference significative par rapport aux courbes existantes. Ces resultats ne justifient pas l’utilisation ou le developpement d’algorithme « nationaux » pour le depistage du premier trimestre.

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.

Resume La question de l’asepsie des sondes d’echographie est hautement d’actualite. Le probleme est d’evaluer le risque de contamination et la necessite d’une procedure specifique de traitement des sondes lorsqu’elles sont munies de gaine de protection a usage unique. Puisqu’il n’existe pas de referentiel pour les criteres de qualite des gaines de protection, il faut verifier qu’elles sont marquees CE par leur fabricant. L’usage d’un preservatif pour les sondes vaginales n’est pas recommande bien qu’ils soient moins sujets aux dechirures que les gaines protectrices commercialisees. Bien que le taux global de perforation des gaines varie selon les publications de 1 a 9 %, aucun cas d’infection liee a une echographie abdominale ou vaginale n’a ete rapporte. Cependant, tout patient doit etre considere comme une source potentielle d’infection. Les recommandations francaises classent les sondes d’echographie endovaginale dans la categorie semi-critique et conseillent la desinfection de niveau intermediaire. Les recommandations americaines, canadiennes et australiennes exigent toujours une desinfection de haut niveau en raison du risque de rupture de la gaine. Tout echographiste devrait des lors respecter des regles de conduite raisonnables afin de pouvoir totalement rassurer les patientes sur les risques de contamination individuelle lies a une echographie diagnostique pratiquee en suivant les regles d’hygiene.

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.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 1 - p. 50-56

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.

Objectives.The purpose of this panoramic radiography study was to assess the impact of image magnification on the accuracy of vertical measurements in the posterior mandible.Methods.Six dental implants, inserted in the posterior segments of a resin model, were used as reference objects. Two observers performed implant length measurements using a proprietary viewer with two preset image magnifications: the low (1.9 : 1) and the medium (3.4 : 1) image magnifications. They also measured the implant lengths in two Digital Imaging Communications in Medicine viewers set at low (1.9 : 1), medium (3.4 : 1), and high (10 : 1) image magnifications.Results.The error between the measured length and the real implant length was close to zero for all three viewers and image magnifications. The percentage of measurements equal to the real implant length was the highest (83.3%) for the high image magnification and below 30% for all viewers with the low image magnification.Conclusions.The high and medium image magnifications used in this study allowed accurate vertical measurements, with all three imaging programs, in the posterior segments of a mandibular model. This study suggests that a low image magnification should not be used for vertical measurements on digital panoramic radiographs when planning an implant in the posterior mandible.

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.