Expression of TP and TIE2 genes in normal ovary with corpus luteum and in ovarian cancer: correlation with ultrasound-derived peak systolic velocity.
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Transvaginal colour and pulsed Doppler ultrasonography analyses of blood flow velocity have indicated that intra-tumoral peak systolic velocity (PSV) is a good indicator of ovarian malignancy. Therefore, we examined whether there was an association between the expression of angiogenic genes, e.g. thymidine phosphorylase (TP) and TIE2 and the PSV of blood flow in normal and cancerous ovaries. Initially, 40 patients were examined by transvaginal ultrasonography and 23 ovaries were surgically removed; 14 were normal with corpora lutea (CL) and nine showed ovarian cancer. The ovarian tissue was dissected according to areas of high blood velocity and gene expression was examined using the reverse transcriptase-polymerase chain reaction (RT-PCR). No significant differences were found between PSV in the normal ovary with CL and ovarian cancer (P = 0.95). TP gene expression was significantly higher in ovarian cancer than in normal ovary with CL (P = 0.02), while TIE2 gene expression was not significantly different (P = 0.186). There was a significant correlation between TIE2 gene expression and PSV in the normal ovary with CL (r = 0.633, P = 0.015), while TP expression was significantly correlated with the PSV in ovarian cancer (r = 0.757, P = 0.018). These results indicate that there is a biological difference between physiological and pathological angiogenesis, TIE2 having a physiological role and TP being involved in pathological angiogenesis. (+info)
Blood flow velocity waveforms from fetal peripheral pulmonary arteries in pregnancies with preterm premature rupture of the membranes: relationship with pulmonary hypoplasia.
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OBJECTIVES: To measure fetal peripheral pulmonary artery velocity waveforms by Doppler ultrasonography in pregnancies complicated by premature rupture of membranes under 24 weeks' gestation and to relate the Doppler indices to the development of fetal pulmonary hypoplasia. DESIGN: A prospective longitudinal study of fetal peripheral pulmonary artery velocity waveforms from premature rupture of membranes to delivery. SUBJECTS: Twenty pregnancies complicated by premature rupture of membranes before 24 weeks of gestation and delivering after 26 weeks. METHODS: Peripheral pulmonary artery velocity waveforms were recorded by Doppler technique at weekly intervals until delivery and Pulsatility Index (PI) calculated. Pregnancies were managed conservatively according to an institutional management protocol. Pulmonary hypoplasia was defined at autopsy by lung/body weight ratios and radial alveolar counts. Pulsatility Indices of fetuses developing pulmonary hypoplasia were compared with those with a normal lung development. RESULTS: After premature rupture of membranes PI values were higher than normal reference limits for gestation, but no differences were found between the six fetuses which developed pulmonary hypoplasia and the remaining 14 fetuses with normal lung development. In this latter group PI values progressively decreased with advancing gestation (ANOVA for repeated measurements F = 11.61; P < or = 0.001), while they increased in fetuses developing pulmonary hypoplasia (F = 8.44; P < or = 0.001). As a consequence of these opposite trends significant differences in PI values were present between the two groups of fetuses from 2 weeks after the premature rupture of membranes. Two weeks after the premature rupture of membranes a PI value from the peripheral pulmonary arteries above the 95th centile had a sensitivity of 62.5%, specificity of 94.6%, positive predictive value of 83.3%, negative predictive value of 78.5% and relative risk of 3.88 (95th confidence interval 1.34-11.28) for the prediction of pulmonary hypoplasia. CONCLUSION: The measurement of peripheral pulmonary velocity waveforms may help to establish the risk of developing pulmonary hypoplasia in pregnancies complicated by premature rupture of membranes. (+info)
A prospective management study of slow-release aspirin in the palliation of uteroplacental insufficiency predicted by uterine artery Doppler at 20 weeks.
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OBJECTIVE: To investigate the effect of low-dose, slow-release aspirin in reducing the incidence and/or severity of pregnancy complications in women identified as high risk of developing problems associated with uteroplacental insufficiency, namely pre-eclampsia or delivering a small-for-gestational age (SGA) baby. DESIGN: A prospective, randomized management study. One thousand and twenty-two women of mixed parity underwent color flow/pulsed Doppler (CFPD) imaging of the uterine arteries at the time of the 17-23 week (mean 19.9) anomaly scan. Women who were screen positive were randomized to a control or treatment group. The treatment group was given 100-mg slow-release aspirin (Disprin CV) daily and followed up at regular intervals. Women in the routine group received routine antenatal care. Main outcome measures were pre-eclampsia and SGA < 3rd centile. Secondary outcome measures were: SGA < 10th centile, pre-eclampsia requiring delivery before 34 weeks, placental abruption, an Apgar score < 7 at 5 min, admission to neonatal intensive care unit or a pregnancy that resulted in a stillbirth or neonatal death. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for severe and any complications. RESULTS: Two hundred and sixteen women were screen positive according to the defined criteria. One hundred and three women were assigned to the treatment group and 113 to the control group. The difference in the incidence of pre-eclampsia and SGA < 3rd centile between the control and treatment groups did not reach statistical significance. There was a statistically significant reduction in any (OR 0.41 (CI 0.35-0.45), P < 0.01) and severe pregnancy complications (OR 0.43 (CI 0.21-0.84), P < 0.05) in the treatment group compared with the controls. CONCLUSIONS: The administration of slow-release aspirin to women identified as high risk, using color Doppler imaging of the uterine arteries at 20 weeks' gestation, did not significantly alter the incidence of pre-eclampsia or delivery of a SGA baby. It did, however, improve the outcome by reducing the overall incidence of complications associated with uteroplacental insufficiency. (+info)
Fetal arterial and venous Doppler parameters in the interpretation of oligohydramnios in postterm pregnancies.
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OBJECTIVE: The objective of the current study was to evaluate fetal arterial and venous Doppler parameters in postterm pregnancies with oligohydramnios and those with normal amniotic fluid. STUDY DESIGN: A cross-sectional study was performed in 38 pregnancies beyond 41 weeks' gestation. Pulsed Doppler imaging was used to determine the pulsatility index (PI) for the fetal middle cerebral artery (MCA), renal artery, umbilical artery, inferior vena cava (IVC) and ductus venosus. The amniotic fluid index (AFI) was used for semiquantitive assessment of amniotic fluid volume. Oligohydramnios was defined as an AFI < 5 cm. RESULTS: Oligohydramnios was detected in 10 cases, and a normal AFI was present in 28 cases. In the presence of oligohydramnios the PI of the MCA was decreased, while the renal artery PI and the MCA PI/UA PI ratio were found to be elevated. In cases of oligohydramnios the PI in the IVC was increased but was unchanged in the ductus venosus. CONCLUSION: Oligohydramnios in post-term pregnancies is associated with arterial redistribution of fetal blood flow typifying the brain sparing effect and with decreased resistance in the MCA and increased resistance in the fetal IVC. (+info)
Prenatal diagnosis of intrahepatic arteriovenous shunts.
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A case of mixed intrahepatic arteriovenous shunts in a fetus diagnosed at 35 weeks' gestation is presented. Color Doppler ultrasonography in the fetal liver demonstrated complicated vascular connections fed by the hepatic arterial branches and drained into the portal and middle hepatic veins. Pulsed Doppler ultrasonography identified a high cardiac output state by the detection of increased flow velocities of the great vessels. The contribution of Doppler ultrasonography to hemodynamic changes is highlighted. The management is briefly discussed. (+info)
Venous emptying mediates a transient vasodilation in the human forearm.
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We tested the hypothesis that venous emptying serves as a stimulus for vasodilation in the human forearm. We compared the forearm blood flow (FBF; pulsed Doppler mean blood velocity and echo Doppler brachial artery diameter) response to temporary elevation of a resting forearm from below to above heart level when venous volume was allowed to drain versus when venous drainage was prevented by inflation of an upper arm cuff to approximately 30 mmHg. Arm elevation resulted in a rapid reduction in venous volume and pressure. Cuff inflation just before elevation effectively prevented these changes. FBF was briefly reduced by approximately 16% following arm elevation. A transient (86%) increase in blood flow began by approximately 5 s of arm elevation and peaked by 8 s, indicating a vasodilation. This response was completely abolished by preventing venous emptying. Arterial inflow below heart level was markedly elevated by 343% following brief (4 s) forearm elevation. This hyperemia was minor when venous emptying during forearm elevation had been prevented. We conclude that venous emptying serves as a stimulus for a transient (within 10 s) vasodilation in vivo. This vasodilation can substantially elevate arterial inflow. (+info)
Role of ductus venosus in distribution of umbilical blood flow in human fetuses during second half of pregnancy.
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Color Doppler sonography was used to study umbilical and ductus venosus (DV) flow in 137 normal fetuses between 20 and 38 wk of gestation. Hepatic flows were also evaluated. In all parts of the venous circulation examined, blood flow increased significantly with advancing gestational age. The weight-specific amniotic umbilical flow did not change significantly during gestation (120 +/- 44 ml. min(-1). kg(-1)), whereas DV flow decreased significantly (from 60 to 17 ml. min(-1). kg(-1)). The percentage of umbilical blood flow shunted through the DV decreased significantly (from 40% to 15%); consequently, the percentage of flow to the liver increased. The right lobe flow changed from 20 to 45%, whereas the left lobe flow was approximately constant (40%). These changes are related to different patterns of growth of the umbilical veins and DV diameters. The present data support the hypothesis that the DV plays a less important role in shunting well-oxygenated blood to the brain and myocardium in late normal pregnancy than in early gestation, which leads to increased fetal liver perfusion. (+info)
Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function.
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AIMS: Rapid, accurate, and widely available non-invasive evaluation of right ventricular function still presents a problem. The purpose of the study was to determine whether the parameters derived from Doppler tissue imaging of tricuspid annular motion could be used as indexes of right ventricular function in patients with heart failure. METHODS: Standard and pulsed Doppler tissue echocardiography were obtained in 44 patients with heart failure (mean left ventricular ejection fraction 24 +/- 7%) and in 30 age- and sex-matched healthy volunteers. The tricuspid annular systolic and diastolic velocities were acquired in apical four-chamber views at the junction of the right ventricular free wall and the anterior leaflet of the tricuspid valve using Doppler tissue imaging. Within 2 h of Doppler tissue imaging, the first-pass radionuclide ventriculogram, determining right ventricular ejection fraction and equilibrium gated radionuclide ventriculography single photon emission computed tomography, were performed in all patients. RESULTS: In patients with heart failure, the peak systolic annular velocity was significantly lower and the time from the onset of the electrocardiographic QRS complex to the peak of systolic annular velocity was significantly greater than the corresponding values in healthy subjects (10.3 +/- 2.6 cm. s(-1) vs 15.5 +/- 2.6 cm.s(-1), P < 0.001, and 198 +/- 34ms vs 171 +/- 29 ms, P < 0.01, respectively). There was a good correlation between systolic annular velocity and right ventricular ejection fraction (r = 0.648, P <0.001). A systolic annular velocity < 11.5 cm.s(-1)predicted right ventricular dysfunction (ejection fraction < 45%) with a sensitivity of 90% and a specificity of 85%. CONCLUSION: We conclude that the evaluation of peak systolic tricuspid annular velocity using Doppler tissue imaging provides a simple, rapid, and non-invasive tool for assessing right ventricular systolic function in patients with heart failure. (+info)