Re: mail server problem
From: art fougner, md (evsono@pipeline.com)
Tue Nov 26 06:50:30 2002
it appears the nasal bone will eventually be incorporated into the
nuchal scan - absent nasal bone significantly increases the DS LR.
art
At Mon, 25 Nov 2002, Terry J DuBose wrote:
>
>This message is in MIME format. Since your mail reader does not understand
>this format, some or all of this message may not be legible.
>
>----__JNP_000_6b46.75a9.51bf
>Content-Type: text/plain; charset=iso-8859-1
>Content-Transfer-Encoding: 8bit
>
>On Mon, 25 Nov 2002 22:18:19 +0100 "Philippe Coquel"
><philippe.coquel@wanadoo.fr> writes:
>I have a problem with the mail server
>
>could you help me and send the message (at the end of this message)
>thanks
>Philippe
>
>Title:
>Nasal bone: a new sign?
>
>This seems an interesting paper
>
>I am surprised that the sign is a « new » sign because it is used in
>France since twelve years.
>
>Two years ago, we spoke about it in this forum (with images) and with Ph
>Jeanty
>
>But B Benacerraf and B Bromley show a statistically significant
>difference between the groups (Down syndrome and normal euploid fetuses.
>And calculate the likelihood ratio
>
>The limit is the significance of the nasal bone as an isolated finding,
>in a low-risk population,
>
>Ph Coquel,MD
>
>New sonographic marker detects Down syndrome
>11/19/02
>By: Tracie L. Thompson
>
>A short or absent nasal bone as noted on second-trimester ultrasound may
>indicate a fetus with Down syndrome, according to a new study.
>
>Dr. Beryl Benacerraf, clinical professor of radiology and obstetrics and
>gynecology at Harvard Medical School, presented initial findings from her
>group's research at the 2002 Society of Radiologists in Ultrasound
>meeting
>in San Francisco. The study will be published in the December issue of
>the
>Journal of Ultrasound in Medicine; the first co-author is Dr. Bryann
>Bromley, an associate clinical professor of obstetrics, gynecology and
>reproductive biology, also at Harvard Medical School in Boston.
>
>A number of obstetrical ultrasound findings have been previously
>identified
>in the medical literature as frequent but nondefinitive markers of Down
>syndrome in the second trimester. These include nuchal translucency
>indicating redundant skin at the back of the neck, hyperechoic bowel,
>short
>femur and humerus bones, and others.
>
>Researchers have only recently focused on nasal bone length as a possible
>sonographic marker, even though Dr. J. Langdon Down in 1866 described a
>characteristically small nose as part of the syndrome. In 2001, British
>researchers looking at first-trimester sonograms reported that a short or
>missing nasal bone identified 73% of Down syndrome fetuses with a 1%
>false-positive rate (The Lancet, November 17, 2001, Vol.358:9294, pp.
>1665-1667).
>
>More recently, researchers from Argentina found that the absence of nasal
>bone on first-trimester ultrasound was significantly associated with Down
>syndrome. Their study was published in Prenatal Diagnosis (October 2002,
>Vol. 22:10, pp.930-932).
>
>"Having seen that we wanted to evaluate nasal bone length as a
>sonographic
>marker in the second trimester," Benacerraf said, "because, at least in
>Boston, we see most of our patients coming in for their obstetrical
>ultrasound mostly in the second trimester."
>
>"If you get a very good sagittal image, you will be able to identify the
>ossification of the nasal bone quite nicely as a finite measurement you
>can
>make," Benacerraf said. The researchers used electronic calipers to
>measure
>from the base of the nasal bone closest to the frontal bone to the distal
>extent of the ossification.
>
>The prospective study evaluated 239 consecutive fetuses between 15 and 20
>weeks gestation. The fetuses were already scheduled for an ultrasound and
>subsequent amniocentesis because of high-risk factors such as advanced
>maternal age and serum biochemical screening results.
>
>Of the 239 fetuses examined, 16 were confirmed at amniocentesis as having
>Down syndrome. The 16 fetuses had a mean gestational age of 17 weeks and
>mothers a mean age of 37 years -- nearly identical demographics to those
>of
>the 223 normal euploid fetuses.
>
>However, there was a statistically significant difference between the
>groups
>in their mean nasal bone length as measured at the second-trimester
>ultrasound. Among the fetuses with Down syndrome, the mean NBL was 3.5
>mm,
>compared to 4.6 mm for those without Down syndrome, Benacerraf said.
>
>To account for growth of the nasal bone with advancing gestational age,
>the
>researchers also calculated the ratio of NBL to biparietal diameter. That
>ratio ended up as a mean of 11.3 for the Down syndrome fetuses versus 8.1
>for the euploid fetuses.
>
>"This ratio among normal fetuses is pretty much constant throughout the
>gestational age window that we use, which is actually very helpful,"
>Benacerraf said. "It therefore suggests that a single cutoff can be used
>to
>define abnormal regardless of this gestational age."
>
>Using an NBL/BPD ratio of 10, the researchers were able to identify 81%
>of
>the fetuses with Down syndrome with an 11% false-positive rate. Using a
>lower ratio of 9 would have identified all of the Down syndrome fetuses
>but
>generated too many false positives, Benacerraf said.
>
>Interestingly, 6 of the 16 Down syndrome fetuses, or 37%, had no visible
>nasal bone ossification at all, while that was the case for only one, or
>0.5%, of the 223 euploid fetuses. Based on these findings, an absent
>nasal
>bone would therefore have a likelihood ratio of 83 -- making it a more
>accurate reported predictor of Down syndrome than any other sonographic
>marker in the second trimester, Benacerraf said.
>
>A majority of the Down syndrome fetuses -- 13 of the 16 -- also exhibited
>other sonographic markers of aneuploidy. Of the three fetuses with no
>additional markers, two had absent nasal bones, she said.
>
>"The presence of a nasal bone is an important new marker in the detection
>of
>fetuses with Down syndrome, which has the potential of being as accurate
>or
>as helpful as the nuchal fold," Benacerraf concluded.
>
>The marker could help high-risk women avoid amniocentesis or identify
>possible aneuploid fetuses in low-risk women. However, Benacerraf added,
>"the significance of the nasal bone as an isolated finding, particularly
>in
>a low-risk population, has not yet been established."
>
>By Tracie L. Thompson
>AuntMinnie.com contributing writer
>November 19, 2002
>----__JNP_000_6b46.75a9.51bf
>Content-Type: text/html; charset=iso-8859-1
>Content-Transfer-Encoding: quoted-printable
>
><!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
>
>On Mon, 25 Nov 2002 22:18:19 +0100 "Philippe Coquel" <<A
>href="mailto:philippe.coquel@wanadoo.fr">philippe.coquel@wanadoo.fr gt;
>writes:
><BLOCKQUOTE dir=ltr
>style="PADDING-LEFT: 10px; MARGIN-LEFT: 10px; BORDER-LEFT: #000000 2px solid">
> I have a problem with the mail
>server
>
> could you help me and send the message (at
> the end of this message)
> thanks
> Philippe
>
> Title:
> Nasal bone: a new sign?
>
> This seems an interesting paperI am surprised that the sign is a
> « new » sign because it is used in France since twelve years.<BR Two years
> ago, we spoke about it in this forum (with images) and with Ph
> JeantyBut B Benacerraf and B Bromley show a statistically significant
> difference between the groups (Down syndrome and normal euploid fetuses. And
> calculate the likelihood ratioThe limit is the significance of the
> nasal bone as an isolated finding, in a low-risk population,Ph
> Coquel,MDNew sonographic marker detects Down
> syndrome11/19/02By: Tracie L. ThompsonA short or absent nasal
> bone as noted on second-trimester ultrasound mayindicate a fetus wit Down
> syndrome, according to a new study.Dr. Beryl Benacerraf, clinica
> professor of radiology and obstetrics andgynecology at Harvard Medical
> School, presented initial findings from hergroup's research at the 2002
> Society of Radiologists in Ultrasound meetingin San Francisco. The study
> will be published in the December issue of theJournal of Ultrasound in
> Medicine; the first co-author is Dr. BryannBromley, an associate clinical
> professor of obstetrics, gynecology andreproductive biology, also a
> Harvard Medical School in Boston.A number of obstetrical ultrasound
> findings have been previously identifiedin the medical literature a
> frequent but nondefinitive markers of Downsyndrome in the second
> trimester. These include nuchal translucencyindicating redundant ski at
> the back of the neck, hyperechoic bowel, shortfemur and humerus bone , and
> others.Researchers have only recently focused on nasal bone length as
> a possiblesonographic marker, even though Dr. J. Langdon Down in 186
> described acharacteristically small nose as part of the syndrome. In 2001,
> Britishresearchers looking at first-trimester sonograms reported tha a
> short ormissing nasal bone identified 73% of Down syndrome fetuses with a
> 1%false-positive rate (The Lancet, November 17, 2001, Vol.358:9294,
> pp.1665-1667).More recently, researchers from Argentina foun that
> the absence of nasalbone on first-trimester ultrasound was significantly
> associated with Downsyndrome. Their study was published in Prenatal
> Diagnosis (October 2002,Vol. 22:10, pp.930-932)."Having seen that
> we wanted to evaluate nasal bone length as a sonographicmarker in th
> second trimester," Benacerraf said, "because, at least inBoston, we see
> most of our patients coming in for their obstetricalultrasound mostl in
> the second trimester.""If you get a very good sagittal image, yo will
> be able to identify theossification of the nasal bone quite nicely a a
> finite measurement you canmake," Benacerraf said. The researchers used
> electronic calipers to measurefrom the base of the nasal bone closes to
> the frontal bone to the distalextent of the ossification.Th
> prospective study evaluated 239 consecutive fetuses between 15 and 20<BR weeks
> gestation. The fetuses were already scheduled for an ultrasound
> andsubsequent amniocentesis because of high-risk factors such as
> advancedmaternal age and serum biochemical screening results.<BR Of
> the 239 fetuses examined, 16 were confirmed at amniocentesis as havingDown
> syndrome. The 16 fetuses had a mean gestational age of 17 weeks and<BR mothers
> a mean age of 37 years -- nearly identical demographics to those of<BR the 223
> normal euploid fetuses.However, there was a statistically significant
> difference between the groupsin their mean nasal bone length as measured
> at the second-trimesterultrasound. Among the fetuses with Down syndrome,
> the mean NBL was 3.5 mm,compared to 4.6 mm for those without Down
> syndrome, Benacerraf said.To account for growth of the nasal bon with
> advancing gestational age, theresearchers also calculated the ratio of NBL
> to biparietal diameter. Thatratio ended up as a mean of 11.3 for the Down
> syndrome fetuses versus 8.1for the euploid fetuses."This ratio
> among normal fetuses is pretty much constant throughout the<BR gestational age
> window that we use, which is actually very helpful,"Benacerraf said. "It
> therefore suggests that a single cutoff can be used todefine abnorma
> regardless of this gestational age."Using an NBL/BPD ratio of 10 the
> researchers were able to identify 81% ofthe fetuses with Down syndrome
> with an 11% false-positive rate. Using alower ratio of 9 would have
> identified all of the Down syndrome fetuses butgenerated too many false
> positives, Benacerraf said.Interestingly, 6 of the 16 Down syndrome
> fetuses, or 37%, had no visiblenasal bone ossification at all, while that
> was the case for only one, or0.5%, of the 223 euploid fetuses. Based on
> these findings, an absent nasalbone would therefore have a likelihoo
> ratio of 83 -- making it a moreaccurate reported predictor of Down
> syndrome than any other sonographicmarker in the second trimester,
> Benacerraf said.A majority of the Down syndrome fetuses -- 13 of the
> 16 -- also exhibitedother sonographic markers of aneuploidy. Of the three
> fetuses with noadditional markers, two had absent nasal bones, she
> said."The presence of a nasal bone is an important new marker in the
> detection offetuses with Down syndrome, which has the potential of being
> as accurate oras helpful as the nuchal fold," Benacerraf
> concluded.The marker could help high-risk women avoid amniocentesis or
> identifypossible aneuploid fetuses in low-risk women. However, Benacerraf
> added,"the significance of the nasal bone as an isolated finding,
> particularly ina low-risk population, has not yet been
> established."By Tracie L. ThompsonAuntMinnie.com contributin
> writerNovember 19, 2002
>
>
>----__JNP_000_6b46.75a9.51bf--
>
--
art fougner, md
ich bin ein New Yorker
|
|
