Fetal weight estimation by 2D and 3D ultrasound: comparison of six formulas

PURPOSE

To evaluate and compare the accuracy of different formulas to estimate fetal weight using 2D and 3D ultrasound.

MATERIALS AND METHODS

We performed a prospective study on unselected singleton pregnancies. All scanned fetuses delivered within 7 days in absence of structural and chromosomal abnormalities were included. The fetal weight was calculated using the 3D Schild, Chang, Liang and 2D Hansmann, Merz and Hadlock formulas. Absolute and mean deviations of estimated fetal weight were calculated.

RESULTS

Of 249 scanned fetuses 200 that fulfilled the criteria were included. Birth weights ranged between 535 and 5020 g. The highest correlation between estimated fetal and birth weight was achieved by applying Schild's equation, and the absolute percentage error was 5.6%. The corresponding values for 2D Hansmann, Merz and four-parametric Hadlock formulas were 7.5%, 7.9%, and 9.2%, respectively, while these were 13.1% and 30.7% for Liang's and Chang's 3D equations. Using the Schild formula, a deviation from birth weight below 10 % was achieved in 80 % of fetuses, with Hansmann's in 73.5% and with Merz in 72.5%, while this parameter was much lower in the remaining equations.

CONCLUSION

The best option with the highest accuracy for sonographic fetal weight estimation was the 3D Schild equation followed by the 2D Hansmann and Merz formulas. Published data of the accuracy could be reproduced with the exception of the "Asian" 3D equations in our European population. The limited improvement in weight agreement using the 3D technique compared to the 2D technique may be outweighed by the time consumption.

Pituitary function tests: comparison of ACTH and 11-deoxy-cortisol responses in the metyrapone test and with the insulin hypoglycemia test

PURPOSE

To compare the sensitivity of ACTH and 11-deoxy-cortisol (comp. S) responses in the short metyrapone test and the latter with the insulin hypoglycemia test.

METHODS

Retrospective evaluation of 115 short metyrapone tests and comparison of 18 pairs of metyrapone and insulin tests. 20 healthy controls and 95 patients with confirmed pituitary disease were studied. All hormones were measured by sensitive radioimmunoassays.

RESULTS

In patients with pituitary disease not requiring hydrocortisone substitution (n = 70), the ACTH response in the metyrapone test was subnormal in 47 cases (< 33 pmol/L), the comp. S response (< 200 nmol/L) in 21 cases only. Comparison of the relationship between ACTH and comp. S with an ACTH-cortisol dose-response curve obtained in normal subjects shows that subnormal ACTH responses after metyrapone in the range between 13 and 33 pmol/L still generate normal comp. S responses. The results of the metyrapone test correlated significantly with those of the insulin test.

CONCLUSIONS

Measuring plasma ACTH in the scope of the metyrapone test makes the test more sensitive to detect secondary adrenal insufficiency than with steroid measurements alone. Results of the metyrapone test correlate significantly with the cortisol response to insulin hypoglycemia.

Effects of sorafenib on proliferation of hormone-sensitive and hormone-insensitive prostate cancer cells

e16092

Background: Sorafenib is a multi-targeted kinase inhibitor approved for treatment of renal and hepatocellular cancer. In patients with castration therapy-resistant prostate cancer sorafenib treatment is associated with discordant prostate-specific antigen (PSA) and clinical responses, possibly due to an effect on PSA expression. The mechanisms of its action in advanced prostate tumors are not investigated so far. The aim of the present study was to evaluate the effects of sorafenib in androgen-sensitive (LNCaP) and -insensitive (PC 3) prostate cancer cell lines. Methods: Proliferation was evaluated by measurement of cell number and protein. Expression of cell cycle and apoptosis regulatory proteins of the Bcl-2 family was determined by Western blot. Results: Treatment of those cells by sorafenib for 48 hours resulted in a concentration-dependent inhibition of proliferation. Maximal inhibition was achieved with 25 μM of the compound. Cell number was reduced by 50% in both cell lines. We observed inhibition of expression of cyclin-dependent kinase 2 in LNCaP and PC3 cells. In addition, Mcl-1 protein, that is frequently overexpressed in prostate cancer, was down-regulated by sorafenib in both cellular models. Conclusions: Sorafenib caused inhibition of growth of prostate cancer cells regardless of their androgen sensitivity. Its inhibitory effects on cyclin- dependent kinase 2 and Mcl-1 imply that sorafenib regulates cell cycle progression and apoptosis in prostate cancer. On the basis of these results experiments with chemotherapy-resistant prostate cells are being performed.

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Olanzapine plasma concentration in a newborn

Little is known about the use of antipsychotics in pregnancy and the corresponding plasma levels in the newborn child. We report on a woman with schizophrenia treated with olanzapine during pregnancy. Plasma levels of olanzapine were assessed both from the mother and from umbilical cord. The plasma level of the newborn (11 ng/mL) was about one third compared to the mother (range 25-34 ng/mL).The development of the fetus, delivery and the development of the child during the first six months were normal.

The impact of risk factors and more stringent diagnostic criteria of gestational diabetes on outcomes in central European women

OBJECTIVES

In the face of the ongoing discussion on the criteria for the diagnosis of gestational diabetes (GDM), we aimed to examine whether the criteria of the Fourth International Workshop Conference of GDM (WC) select women and children at risk better than the World Health Organization (WHO) criteria.

DESIGN AND SETTING

This was a prospective longitudinal open study in five tertiary care centers in Austria.

PATIENTS AND OUTCOME MEASURES

The impact of risk factors, different thresholds (WC vs. WHO), and numbers of abnormal glucose values (WC) during the 2-h, 75-g oral glucose tolerance test on fetal/neonatal complications and maternal postpartum glucose tolerance was studied in 1466 pregnant women. Women were treated if at least one value according to the WC (GDM-WC1) was met or exceeded.

RESULTS

Forty-six percent of all women had GDM-WC1, whereas 29% had GDM-WHO, and 21% of all women had two or three abnormal values according to WC criteria (GDM-WC2). Eighty-five percent of the GDM-WHO were also identified by GDM-WC1. Previous GDM [odds ratio (OR) 2.9], glucosuria (OR 2.4), preconceptual overweight/obesity (OR 2.3), age 30 yr or older (OR 1.9), and large-for-gestational age (LGA) fetus (OR 1.8) were the best independent predictors of the occurrence of GDM. Previous GDM (OR 4.4) and overweight/obesity (OR 4.0) also independently predicted diabetes postpartum. GDM-WC1 had a higher rate of obstetrical complications (LGA neonates, neonatal hypoglycemia, cesarean sections; P < 0.001) and impaired postpartum glucose tolerance (P < 0.0001) than GDM-WHO.

CONCLUSION

These results suggest the use of more stringent WC criteria for the diagnosis of GDM with the initiation of therapy in case of one fasting or stimulated abnormal glucose value because these criteria detected more LGA neonates with hypoglycemia and mothers with impaired postpartum glucose metabolism than the WHO criteria.

Ex-Utero Intrapartum Treatment (EXIT) in a giant case of Congenital Cystic Adenomatoid Malformation (CCAM) of the lung

Congenital Cystic Adenomatoid Malformations (CCAM) of the lung are a relatively rare anomaly. The majority of cases do not require any antenatal or perinatal interventions. However, selected cases need special and intensified management. This article discusses a case of a CCAM of the left pulmonary lobe covering 2/3 to 3/4 of the thoracic volume, causing mediastinal shift and hydrops. The enormous size required the planning of an EXIT (Ex Utero-Intrapartum Treatment) procedure, which was performed when the trial of intraoperative ventilation of the lungs was unsuccessful. A thoracotomy and resection of the left upper lobe were performed with the fetus on feto-placental circulation. After resection and closure of the thoracotomy, improvement of lung ventilation allowed the delivery of the child. The child and mother were discharged in a healthy condition. We conclude that the EXIT procedure is a feasible and potentially life-saving method for select cases of prenatally detected CCAM.

[Feasibility of fetal echocardiography at 11-14 weeks scan]

PURPOSE

Sonographic diagnostics are increasingly brought forward into the first trimenon. Lately, more and more expert studies have been published on echocardiography in the context of the Nuchal Translucency (NT) screening (gestational age 11-14 weeks). The aim of this study has been to evaluate the feasibility of early echocardiography on the occasion of first trimenon screening in the context of routine operation.

MATERIALS AND METHODS

From February 2003 to March 2004, an echocardiography was prospectively sought in 130 assigned, unselected pregnant women during the first trimenon screening. Three doctors with different OGUM/DEGUM (Austrian and German societies for ultrasound in medicine) qualifications at our ward tried to represent the four-chamber view (4CV) and the outflow tracts (OFT), each via B-mode and color Doppler. The study conditions were "routine", in particular they were temporally limited. In case no sufficient visual representation was achievable with the transabdominal examination, transvaginal sonography was also used.

RESULTS

Via B-mode, 4CV was indicated as successful in 86/130, and OFTs in 37/130. Via color Doppler, on the other hand, it was possible to sufficiently represent 4CV in 75/130 and OFTs in 87/130.

CONCLUSION

In routine screening, early heart examination is a big challenge and in many cases even with good equipment no complete diagnostic echocardiography can be achieved. The utilisation of the color Doppler is helpful particularly for the representation of the outflow tracts.

The antiapoptotic effect of IL-6 autocrine loop in a cellular model of advanced prostate cancer is mediated by Mcl-1

Levels of the proinflammatory cytokine interleukin-6 (IL-6) are increased in therapy-resistant prostate cancer. IL-6 has been considered a positive growth factor in late-stage prostate cancer cells and a potential target for therapeutic interference. Effects of inhibition of IL-6 on cell survival were studied in LNCaP-IL6+ cells, a model system for advanced prostate cancer, which produce IL-6. We show that the autocrine IL-6 loop is responsible for resistance to apoptosis and increased cellular levels of myeloid cell leukemia-1 (Mcl-1) protein, an antiapoptotic member of the Bcl-2 family. Treatment of cells with a chimeric anti-IL-6 antibody (CNTO 328) led to the induction of apoptosis and downregulation of Mcl-1 protein levels. Specific knockdown of Mcl-1 gene expression by small interfering RNA also yielded an increase in apoptosis of LNCaP-IL-6+ cells. Vice versa, inactivation of IL-6 autocrine loop had no influence on apoptosis levels in the absence of Mcl-1, thus suggesting this molecule as a mediator of the survival action of IL-6. Mcl-1 protein regulation by the endogenous cytokine directly involved the extracellular signal-regulated kinase 1/2 mitogen-activated protein kinase pathway. Our data support the concept of anti-IL-6 targeted therapy in therapy-resistant prostate cancer.

Early maturation as a risk factor for aggression and delinquency in adolescent girls: A review

Early physical maturation has long been considered a risk factor for the development of delinquent girls. The basis of this relationship has not been fully explored or understood. This review summarises the current literature and research on early physical maturation in adolescent females and places it within a developmental perspective. The process of early physical maturation is also placed within a biopsychosocial model so that risk and protective factors arising from the biological, social, family, education and peer environments can be ascertained. A complex model of maturation and environmental-social interaction is constructed and currently supported by research, but it is clear that a great deal of further work is necessary to fully understand this process.