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Re: Yolk sacFrom: DuBose, Terry (DuboseTerryJ@exchange.uams.edu)Fri Jan 29 13:53:49 1999
Think it would be a great project, and no doubt successful if Drs. Worrall, Corda, and perhaps Dr. Lyons, would agree to collaborate and lead us through this. I agree that there may be criticism concerning bias due to the nature of the study. But, a large enough "n" from a world wide study, just might produce something useful, if only confirming of what has been done before. Would you, Worrall & Corda (and Lyons?) be willing to propose a protocol for data collection? I also think it should be resolved to take measurements in a consistent manner. We could use a factor to account for inner and outer measurements but it would not be the best. Unless we were able to collect enough both ways in order to look at variability of the two methods. Perhaps you should request both inner and outer diameters for each case. The MYSD does seem to be a pain, and less useful. However, if it was decided to go with a single diameter, would you think the largest would be best? Might be best to discuss a protocol a bit more before launching the project. Not only how to take measurements, but how to send the data and to whom? Should we register each lab that will be included, or just accept measurements from anyone? Do we want to put up an example of how the measurements should be taken, once we have a decision? The most valuable lesson might be to learn how to gather global data on the Web in a manner that will be acceptable to the scientific community. I am sure there will be some false starts. We are going where none have gone before... sort of. Not discounting all the large center studies before this. But I am very curious as to how to best conduct research using this new medium. We have already shown that we can accumulate some very rare images fairly quickly and also gather comments from a very large number of folks. This is great! Onward, through the fog! Peace, Terry J. DuBose, M.S., RDMS, FAIUM University of Arkansas for Medical Sciences, USA Director, Diagnostic Sonography Program http://www.uams.edu/chrp/dmshome.htm <http://www.uams.edu/chrp/dmshome.htm> VOICE: 501-686-6510 FAX: 501-686-6513 Chair, http://www.obgyn.net/us/us.htm <http://www.obgyn.net/us/us.htm> http://www.io.com/~dubose/ <http://www.io.com/~dubose/> Now is the time for all good folks to come to the aid of the Earth. ---- -----Original Message----- From: Joseph A Worrall MD RDMS [SMTP:jworrall@alaska.net] Sent: Friday, January 29, 1999 2:08 PM To: Multiple recipients of list Subject: Re: Yolk sac 1- Who should keep records?: Andrea, how about you being the record keeper? 2- How to measure? For the non-spherical yolk sacs, Mean Sac Diameter would be best, and that would be the mean of length, height, and width. So that we eliminate bias as to what constitutes a "non-spherical" yolk sac, it would be best if all yolk sacs were measured in three planes, and reported as MSDY (Mean Sac Diameter Yolk - to distinguish from the MSD of the gestational sac). HOWEVER - many would find having to take three measurements of the yolk sac a PITB (pain in the butt) and probably would not do it, so most likely we would be wise to just ask for an inner to inner measurement, and not worry about the data errors when the yolk sac is not spherical (You can tell already that I am not a trained scientist). Andrea, if you are serious about this, you will have to establish a YOLK SAC REGISTRY, and tell people what gestational age we should confine our measurements to, how to use email or OBGYN.NET to report the results, and most difficult, how to get follow-up on the pregnancy outcome. This would be a multicenter data collection, and the follow-up would be the most problematic. Regarding a post earlier today - I doubt that the yolk sac would ever have the specificity, sensitivity, and positive predictive value, that it could be used as a definitive indicator of aneuploidy. But maybe - that is why a huge study would be helpful. Is it possible to conduct such a study on the internet, internationally, and without Government grants of thousands of dollars or lira or whatever? I do not know, but I would be a willing participant. My guess is that there are enough dedicated sonographers that it might be possible. Probably the resulting study would have enough design faults and statistical problems, and biases, that it would not be considered a serious study, but it might indicate a trend to confirm studies that have already been done, such as Dr. Lyons' study. Joseph A Worrall MD RDMS
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