Re: Fw: Fw:
From: art fougner, md (evsono@pipeline.com)
Fri Apr 22 11:24:02 2005
Thanks Professor Zalel ...
i had the Filly article but not the others.
art
At Fri, 22 Apr 2005, Prof. Yaron Zalel wrote:
>
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>>>----- Original Message -----
>From: Prof. Yaron Zalel To: ultrasound@obgyn.net ; Multiple recipients of list ULTRASOUND
>Cc: novakov@EUnet.yu
>Sent: Friday, April 22, 2005 10:04 AM
>Subject: Re: Fw:
>
> Dear Alexandra!
>
> I'm attaching to you some slides (part of a presentation called "Diagnostic accuracy of fetal anomalies") in which you'll be able to find first of all the accuracy of detecting fetal anomalies as a whole and of skeletal malformations in particular.
>
> You have to remember some facts!
>
> First of all it depends whether the examination was targeted or screening, low rish or high risk!.
> Secondly, it depends on the local regulations.
>
> In low risk populations, the sensitivity of ultrasound ranges between 14-85%, with specificity of 93-99%.
> This suggests, that in low risk patients, ultrasound may be helpful at ruling out anomalies, but it is not particularly
> reliable in terms of detection.
> In high-risk patients, targeted ultrasound is more accurate in anomaly detection, with sensitivities of 27-99% and specificities
> that range between 91-100%.
>
> .Faber (2001) - accuracy of 56% with 11% false positive and 28% false negative.
> .Magriples (1998) - The sensitivity, specificity, and negative and positive predictive values of the screening ultrasonography were 71.4%, 99.4%, 99.1%, and 80%, respectively.
> .Ogunyemi (2000)- Prenatal diagnosis was possible in 62%and in 5.5% late prenatal diagnosis was possible.
>
> Accuracy of detection of cong. Anomalies
> Goncalves, Jeanty, Piper
>
> 26 (all), 16 (club feet) Musculo-skeletal
>
> The AIUM/ACR antepartum obstetrical sonographic guidelines:
> Expectations for detection of anomalies
> R. Filly, R. FilG
> Filly, Goldstein & Callen
> oldstein, P. Callen
>
> Observable in the majority of cases
>
> .Anencephaly (100%), Hydranencephaly (100%), Hydrocephalus (97%), Alobar holoprocencephaly (95%), Large posterior fossa cyst (85%), open SB (88%).
> .Severe (>20 mm) unilateral & bilateral (98%) hydronephrosis, Bilateral renal agenesis (93%).
> .Large amount of ascites (100%), Omphalocele (100%), gastroschisis (95%), Limb-body wall complex (88%), prox small bowel obstruction with hydramnios (95%), Diaph. Hernia (88%).
> .Ectopia cordis (58%), HLH (74%), HRH (66%).
> .Hydrothorax & mediastinal shift (95%).
> .OI (88%), achondroplasia (81%), amputation (55%).
>
> SKELETAL DYSPLASIAS
>
> .Parilla (2003) - Diagnostic accuracy of 65%. There were 2 false-positive - both had mild long-bone shortening (3-4 weeks discrepancy at 30 weeks' gestation).
>
> Holder-Espinasse et al (2004) - Limb abnormalities:
> .107 cases - Limb anomalies were detected in 45% of cases.
> .Can be isolated, syndromic or associated with multiple malformations.
> ."These limb malformations are Developmental anomalies!"
>
> Hope this will help
>
>Prof. Yaron Zalel
>
>>> ----- Original Message -----
> From: Aleksandra Novakov Mikic
> To: Multiple recipients of list ULTRASOUND
> Sent: Thursday, April 21, 2005 11:52 PM
> Subject: Fw:
>
>>> ----- Original Message -----
> From: Aleksandra Novakov Mikic
> To: ultrasound@dns.obgyn.net
> Sent: Thursday, April 21, 2005 11:49 PM
>
> Dear friends,
> a colleague of mine has missed a shorter leg with a rudiment of a foot and the family is now going to court. Is anybody aware of a paper(s) where the issue of false positives and false negatives of ultrasound diagnosis is discussed and any kind of data base where one can see what is the detection rate of skeletal dysplasias of all kinds.
> Thanks a lot...Friend in need is a friend indeed, let us remember...
> ALeksandra
>
>--Boundary_(ID_NQi7o6R/p1KeED0klH9XRA)
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>>>----- Original Message -----
>From: <A
>title=zalel_y@netvision.net.il href="mailto:zalel_y@netvision.net.il">Prof.
>Yaron Zalel
>To: <A title=ultrasound@obgyn.net
>href="mailto:ultrasound@obgyn.net">ultrasound@obgyn.net ; <A
>title=ultrasound@dns.obgyn.net href="mailto:ultrasound@dns.obgyn.net">Multiple
>recipients of list ULTRASOUND
>Cc: <A title=novakov@EUnet.yu
>href="mailto:novakov@EUnet.yu">novakov@EUnet.yu
>Sent: Friday, April 22, 2005 10:04 AM
>Subject: Re: Fw:
>
> Dear
> Alexandra!
> <FONT face=Arial
> size=4>
> I'm attaching to you
> some slides (part of a presentation called "Diagnostic accuracy of fetal
> anomalies") in which you'll be able to find first of all the accuracy of
> detecting fetal anomalies as a whole and of skeletal malformations in
> particular.
> <FONT face=Arial
> size=4>
> You have to remember
> some facts!
> <FONT face=Arial
> size=4>
> First of all it
> depends whether the examination was targeted or screening, low rish or high
> risk!.
> Secondly, it depends
> on the local regulations.
> <FONT face=Arial
> size=4>
> <FONT face=Arial
> size=4>
> <FONT face=Arial
> size=4>
> <FONT face=Arial
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1" align=left
> v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">In
> low risk populations, the sensitivity of <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">ultrasound
> ranges between 14-85%, with specificity <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">of
> 93-99%.
> <DIV class=O dir=ltr
> style="DIRECTION: rtl; mso-char-wrap: 1; mso-kinsoku-overflow: 1" align=left
> v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US dir=ltr
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">This
> suggests, that in low risk patients, ultrasound <SPAN lang=EN-US
> dir=ltr
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">may
> be helpful at ruling out
> anomalies, but it is not <SPAN lang=EN-US dir=ltr
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">particularly
>
> <DIV class=O dir=ltr
> style="DIRECTION: rtl; mso-char-wrap: 1; mso-kinsoku-overflow: 1" align=left
> v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US dir=ltr
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">reliable
> in terms of detection. <SPAN
> style="FONT-SIZE: 28pt; COLOR: yellow; FONT-FAMILY: Arial; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
> <DIV class=O dir=ltr
> style="DIRECTION: rtl; mso-char-wrap: 1; mso-kinsoku-overflow: 1" align=left
> v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US dir=ltr
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">In
> high-risk patients, targeted ultrasound is more <SPAN lang=EN-US
> dir=ltr
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">accurate
> in anomaly detection, with sensitivities of <SPAN lang=EN-US dir=ltr
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">27-99%
> and specificities
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1" align=left
> v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><SPAN
> style="mso-spacerun: yes"> that range between 91-100%<SPAN
> dir=rtl
> style="FONT-SIZE: 28pt; COLOR: yellow; FONT-FAMILY: Arial; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">.<SPAN
> lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
>
> <DIV class=O dir=ltr style="DIRECTION: ltr; mso-line-spacing: '100 50 0'"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4> <SPAN
> style="FONT-SIZE: 156%; COLOR: white; mso-color-index: 0">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.5%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: white; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0">Faber
> (2001) <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
> <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">accuracy
> of 56% with 11% false <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">positive
> and 28% false negative. <SPAN
> style="FONT-SIZE: 156%; COLOR: white; mso-color-index: 0">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.28%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: white; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0">Magriples
> (1998) -<SPAN lang=EN-US
> style="FONT-SIZE: 28pt; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
> <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">The
> sensitivity, specificity, and <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">negative
> and positive predictive values of the <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">screening
> ultrasonography were 71.4%, 99.4%, <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">99.1%,
> and 80%, respectively. <SPAN
> style="FONT-SIZE: 156%; COLOR: white; mso-color-index: 0">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.9%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: white; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0">Ogunyemi
> (2000)-<SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
> Prenatal diagnosis was <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">possible
> in 62%and in 5.5% late prenatal <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">diagnosis
> was possible.
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><FONT
> face=Arial size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><FONT
> face=Arial size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><FONT
> face=Arial size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Accuracy
> of detection of cong.
> Anomalies<SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><SPAN
> style="mso-spacerun: yes"> & bsp;
> <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Goncalves,
> Jeanty, Piper<SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: white; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0"><SPAN
> style="mso-spacerun: yes">
>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: white; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0"><SPAN
> style="mso-spacerun: yes"><FONT face=Arial color=#000000
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026">
>
> <TD
> style="BORDER-RIGHT: black 1px solid; BORDER-TOP: black 1px solid; VERTICAL-ALIGN: top; BORDER-LEFT: black 2px solid; BORDER-BOTTOM: black 1px solid"
> width'0 height2>
> <DIV dir=ltr
> style="DIRECTION: rtl; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'"
> align=left><SPAN lang=EN-US dir=ltr
> style="FONT-SIZE: 24pt; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><FONT
> face=Arial size=4>26 (all), 16 (club
> feet)
> <TD
> style="BORDER-RIGHT: black 2px solid; BORDER-TOP: black 1px solid; VERTICAL-ALIGN: top; BORDER-LEFT: black 1px solid; BORDER-BOTTOM: black 1px solid"
> width'0 height2>
> <DIV dir=ltr
> style="DIRECTION: rtl; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'"
> align=left><SPAN lang=EN-US dir=ltr
> style="FONT-SIZE: 28pt; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><FONT
> face=Arial
> size=4>Musculo-skeletal /TBODY>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> face=Arial color=#000000
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> face=Arial color=#000000
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> face=Arial color=#000000 size=4>
> <DIV class=O dir=ltr style="DIRECTION: ltr"
> v:shape="_x0000_s1026">The AIUM/ACR antepartum obstetrical
> sonographic guidelines:Expectations for detection of
> anomalies<SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: white; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0">R.
> Filly, R. FilG
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026">Filly,
> Goldstein & Callen oldstein, P.
> Callen<SPAN lang=EN-US
> style="FONT-SIZE: 36pt; COLOR: black; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 3">
>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> face=Arial color=#000000
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 36pt; COLOR: black; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 3"><FONT
> face=Arial size=4>Observable in the majority of
> cases
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 36pt; COLOR: black; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 3"><FONT
> face=Arial size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> lang=EN-US
> style="FONT-SIZE: 36pt; COLOR: black; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 3"><FONT
> face=Arial color=#000000
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 36pt; COLOR: black; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 3"><FONT
> face=Arial size=4> <SPAN
> style="FONT-SIZE: 133%; COLOR: yellow">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '90 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -4.13%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Anencephaly
> (100%), Hydranencephaly (100%), <SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Hydrocephalus
> (97%), Alobar holoprocencephaly (95%), <SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Large
> posterior fossa cyst (85%), open SB (88%).
> <SPAN
> style="FONT-SIZE: 133%; COLOR: yellow">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '90 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -4.13%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Severe
> (>20 mm) unilateral & bilateral (98%) <SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">hydronephrosis,
> Bilateral renal agenesis (93%).
> <SPAN
> style="FONT-SIZE: 133%; COLOR: yellow">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '90 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.69%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Large
> amount of ascites (100%), Omphalocele (100%), <SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">gastroschisis
> (95%), Limb-body wall complex (88%), prox <SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">small
> bowel obstruction with hydramnios (95%), Diaph. <SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Hernia
> (88%). <SPAN
> style="FONT-SIZE: 133%; COLOR: yellow">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '90 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -4.13%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><FONT
> face=Arial color=#000000 size=4>Ectopia cordis (58%), HLH (74%), HRH (66%).
>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '90 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -4.13%; POSITION: absolute; mso-special-format: bullet">
> <SPAN
> lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><FONT
> face=Arial color=#000000 size=4>Hydrothorax & mediastinal shift (95%).
>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '90 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.93%; POSITION: absolute; mso-special-format: bullet">
> <SPAN
> lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><FONT
> face=Arial color=#000000 size=4>OI (88%), achondroplasia (81%),
> amputation (55%).
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '90 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '90 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '90 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 44pt; COLOR: black; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 3"><FONT
> face=Arial size=4>SKELETAL DYSPLASIAS
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '90 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 44pt; COLOR: black; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 3"><FONT
> face=Arial size=4> <SPAN
> style="FONT-SIZE: 133%; COLOR: white; mso-color-index: 0">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '80 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.55%; POSITION: absolute; TOP: 0.15em; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 24pt; COLOR: white; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0">Parilla
> (2003) <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Diagnostic
> accuracy of 65%. There <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">were
> 2 false-positive both had mild long-bone <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">shortening
> (3-4 weeks discrepancy at 30 weeks <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">gestation).
>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '80 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '80 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: white; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0">Holder-Espinasse
> et al (2004)<SPAN lang=EN-US
> style="FONT-SIZE: 32pt; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
> <SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: white; FONT-FAMILY: Arial; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 0"><SPAN
> lang=EN-US
> style="FONT-SIZE: 32pt; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
> <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Limb
> abnormalities: <SPAN
> style="FONT-SIZE: 156%; COLOR: yellow">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.38%; POSITION: absolute; TOP: 0.13em; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">107
> cases<SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial"><SPAN
> style="mso-spacerun: yes"> - <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Limb
> anomalies were detected in 45% <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">of
> cases. <SPAN
> style="FONT-SIZE: 156%; COLOR: yellow">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.78%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> color=#000000><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Can
> be isolated, syndromic or associated with <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">multiple
> malformations. <SPAN
> style="FONT-SIZE: 156%; COLOR: yellow">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN
> style="LEFT: -3.76%; POSITION: absolute; mso-special-format: bullet">
> <FONT face=Arial color=#000000
> size=4><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; FONT-FAMILY: Arial; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">These
> limb malformations are <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Developmental
> <SPAN lang=EN-US
> style="FONT-SIZE: 28pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">anomalies!<SPAN
> lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Hope
> this will help
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT
> size=4><SPAN lang=EN-US
> style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">
><DIV class=O dir=ltr
>style="DIRECTION: ltr; mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 216"
>align=left v:shape="_x0000_s1026"><FONT face=Arial
>color=#000000 size=2><SPAN lang=EN-US
>style="FONT-SIZE: 32pt; COLOR: yellow; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial">Prof.
>Yaron Zalel
>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '100 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '90 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><SPAN lang=EN-US
> style="FONT-SIZE: 44pt; COLOR: black; mso-bidi-font-family: Arial; mso-hansi-font-family: Arial; mso-color-index: 3"><FONT
> face=Arial size=4>
> <DIV class=O dir=ltr
> style="DIRECTION: ltr; mso-line-spacing: '90 50 0'; mso-margin-left-alt: 216"
> align=left v:shape="_x0000_s1026"><FONT face=Arial
> size=4> </SPAN> -----
> Original Message -----
> <DIV dir=ltr style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"
> align=left>From: <A
> title=novakov@EUnet.yu href="mailto:novakov@EUnet.yu"><FONT color=#000000
> size=4>Aleksandra Novakov Mikic<FONT
> size=4>
> To:
> <A title=ultrasound@dns.obgyn.net
> href="mailto:ultrasound@dns.obgyn.net"><FONT color=#000000
> size=4>Multiple recipients of list ULTRASOUND<FONT
> size=4>
> Sent:
> Thursday, April 21, 2005 11:52 PM
> Subject:
> Fw:
> <FONT
> size=4>
> <FONT face=Arial
> size=4>
> -----
> Original Message -----
> <DIV dir=ltr style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"
> align=left>From: <A
> title=novakov@eunet.yu href="mailto:novakov@eunet.yu"><FONT color=#000000
> size=4>Aleksandra Novakov Mikic<FONT
> size=4>
> To:
> <A title=ultrasound@dns.obgyn.net
> href="mailto:ultrasound@dns.obgyn.net"><FONT color=#000000
> size=4>ultrasound@dns.obgyn.net<FONT
> size=4>
> Sent:
> Thursday, April 21, 2005 11:49 PM
> <FONT
> size=4>
> Dear
> friends,
> a colleague of mine
> has missed a shorter leg with a rudiment of a foot and the family is now going
> to court. Is anybody aware of a paper(s) where the issue of false positives
> and false negatives of ultrasound diagnosis is discussed and any kind of data
> base where one can see what is the detection rate of skeletal dysplasias of
> all kinds.
> Thanks a lot...Friend
> in need is a friend indeed, let us remember...
> <FONT face=Arial
> size=4>ALeksandra
>
>--Boundary_(ID_NQi7o6R/p1KeED0klH9XRA)--
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
