Re: nasal Bones in T1
From: Terry J DuBose (tjdubose@juno.com)
Thu Nov 22 21:29:01 2001
Dr. Coquel, Thanks for the good discussion... and short comings of the
papers. I understand the problems of publishing in a journal that is not
in the medline database...
I agree, the nasal bones are interesting, and appear to be a relatively
important soft marker for some trisomies.
thanks again, Terry J DuBose, M.S., RDMS, APS
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On Thu, 22 Nov 2001 10:58:32 -0600 "Philippe Coquel"
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<philippe.coquel@wanadoo.fr> writes:
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> In fact, there are two problems
>
> The paper by F Guy et all speaks about the length of the nasal bone
> after 14
> wa and not before as in the paper of Cicero et al. This is a good
> but only
> a biometry paper
>
> The second problem is more complex
>
> First, the paper, in French,
>
> ( [Trisomy 21. 209 cases from the French College of Fetal
> Ultrasonography.
> Pertinence of ultrasonographic signs].
> Contracept Fertil Sex. 1997 Dec;25(12):VII-XIV. French. No abstract
> available.
> PMID: 9497609 [PubMed - indexed for MEDLINE]
>
> has been published in a scientific journal without abstract
> available in
> Medline. The great majority of sonologists and sonographers in the
> world
> don't know this paper because it is in French and because key words
> research
> is difficult without abstract.
>
> Second and more important: The idea and the collect of cases are
> good but
> this is only a series of cases without control group. It is not
> possible to
> calculate specificity and LR. More ever, the description of nasal
> bone
> abnormalities is some confuse in this paper mixing absence of
> visualisation
> of the nasal bone synchondrosis and short nasal bones. In the
> anomalies of
> the face, same signs are used twofold and then, calculations are
> wrong.
>
> Because of these major mistakes of methodology, the results of the
> paper
> cannot be used in conjunction with the others markers of the trisomy
> 21
> during the second trimester.
>
> Now, we use in practice ( for almost of us) only nasal bones
> visualisation
> or not, without short nasal bone sign in addition of soft markers
>
> It is for this reason that I make some comments last year to try to
> have a
> study about the problem with a control group and to know the real
> sensitivity and specificity of this sign.
>
> We don't have great data bases in France
>
> It's a big problem to do studies with correct statistic basis.
>
> I don't know if members of Nicolaides staff have read the comments
> but the
> main thing is the realisation of their study between January and
> October
> 2001 (five months later after the discussion here)
>
> Their great idea is to have used the 11-14 we exam and not like in
> France
> the 22wa exam. Then , main signs of trisomy 21 can be seen during
> the exam
> of 11-14 wa
>
> The second thing is the very nice and correct statistical analysis.
> It is
> fundamental before use a diagnostic test in routine
>
> The third is the quality of their conclusions and the comments of H
> Cuckle .
>
> Now, we are waiting for confirmation by others studies but I think
> that this
> paper is a giant leap
>
> Ph Coquel, MD
>
> Dr. Coquel, I agree this is both interesting and exciting; but how
> is
> this different from your report here:
> http://www.obgyn.net/us/us.asp?page=/us/present/0009/nasal_bones
>
> or how different from the comments you made in this forum in August
> 2000? See:
> http://forums.obgyn.net/ultrasound/ULTRASOUND.0008/0053.html
>
> and: http://forums.obgyn.net/ultrasound/ULTRASOUND.0008/0051.html
>
> http://forums.obgyn.net/ultrasound/ULTRASOUND.0008/0049.html
>
> I also notice that the current article did not reference Le Duff,
> which
> you did reference here in August, 2000: "Le Duff, 1997 Trisomy 21.
> 209
> cases from the french college of fetal ultrasonography. Pertience of
> ultrasound Contracept Fertil Sex 1997 25 12 VII,XIV TRISOMIE 21 237
> Cas
> colligés par le Collège Français"
>
> The Cicero, et al article has very nice statistical analysis, but it
> does seem that they would at least give the prior publications on the
> nasal bone observation a reference. At any rate, thanks for the
> heads
> up on this article.
>
> Peace, Terry J DuBose, M.S., RDMS, APS
> University of Arkansas for Medical Sciences
>
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