Re: Calculation of Risk for Down
From: udaya kumar (udaya@md2.vsnl.net.in)
Sun Feb 25 18:48:14 2001
And..........Inhibin A. Why is'nt anybody mentioning it.
..Udayakumar
"art fougner, md" wrote:
> David -
>
> in your opinion then, you would favor combining serum risks, age risks,
> and sonar risks? or would one trump the other, eg age 42 would be enough
> to warrant karyotype?
>
> thanks
>
> art
>
> At Fri, 23 Feb 2001, D. Nyberg wrote:
> >
> >There is reasonable evidence to indicate that ultrasound and
> >biochemical markers are largely independent. We can review what data is
> >available, but I'm sure you'll also see more on this in the future.
> >Recall that ultrasound and biochemical markers also are independent in
> >the first trimester so this should not be surprising. Although it would
> >be preferable to offer a combined ultrasound-biochemical risk (as
> >Bahado-Singh has does, and as we will present at the AIUM in a few
> >weeks), a simple method is to base the apriori risk on the triple screen
> >result (biochemistry plus age). We will need further studies to see how
> >accurate that approach is, but for now it seems like a reasonable
> >approach to use in practice.
> >
> >David Nyberg
> >
> >On Fri, 23 Feb 2001, Ph Coquel wrote:
> >
> >> Doc Gyneco said::
> >>
> >> > To alter her triple-screen risk you must be sure about statistical
> >> > independance between the serum markers and the hyperechoic bowel marker.
> >> >
> >> > In my opinion, there is no study in this issue.
> >> >
> >> > So, you can't modified the triple screen risk.
> >> >
> >> > And the likelihood ratio could be apply to her age related risk.
> >>
> >> Yes, but in UOG 2000;16:402-406, Verdin and all analyse the value of the
> >> second trimester ultrasound examination among the women whose fetuses were
> >> indicated to be at low risk for chromosomal anomalies on the basis of both
> >> first trimester nuchal translucency measurement and second trimester
> >> biochemical screening
> >>
> >> LLR for echogenic bowel is 283 (71 -1133) 95% IC with 2 abnormal karyotype
> >> for five fetuses at low risk
> >>
> >> But the study numbers are relatively small (5500 pregnacies) and 3548
> >> considered negative after bichemical screening (7 abnormal karyotype in this
> >> group)
> >> ¨
> >> Ph Coquel,MD
> >>
> >> Annecy, France
> >>
> >--------------------------------------------------------------------
> >David A. Nyberg, M.D !!!!
> >--------------------------------------------------------------------
> >--------------------------------------------------------------------
> >--------------------------------------------------------------------
> > !US!
> >
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> >
>
> --
> art fougner, md
>
> A series of 1000 cases begins with but a single anecdote.
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