Ariel J. Jaffa

Neurodevelopmental outcome of children with intrauterine growth retardation: a longitudinal, 10-year prospective study.

One hundred twenty-three children with intrauterine growth retardation were prospectively followed from birth to 9 to 10 years of age in order to characterize their specific neurodevelopmental and cognitive difficulties and to identify clinical predictors of such difficulties. Perinatal biometric data and risk factors were collected. Outcome was evaluated at age 9 to 10 by neurodevelopmental, cognitive, and school achievement assessments. Sixty-three children served as controls who were appropriate for gestational age. Significant differences in growth (P < .001), neurodevelopmental scores (P < .001), intelligence quotient (IQ) (P < .0001), and school achievements measured by the Kaufmann Assessment Battery for Children (P < .001) were found between the children with intrauterine growth retardation and controls. Children with intrauterine growth retardation demonstrated a specific profile of neurocognitive difficulties at school age, accounting for lower school achievements. The best perinatal parameter predictive of neurodevelopment and IQ was the Cephalization Index (P < .001). Somatic catch-up growth at age 2 and at age 9 to 10 correlated with favorable outcome at 9 to 10 years of age.

Vascular endothelial growth factor is increased in patients with preeclampsia.

PROBLEM: This study was conducted to determine whether altered levels of vascular endothelial growth factor (VEGF) may play a role in the pathogenesis of preeclampsia.

Neurodevelopmental Outcome in Children With Intrauterine Growth Retardation: A 3-Year Follow-Up

The study was designed to detect early clinical predictors of developmental outcome in children with intrauterine growth retardation. Eighty-five children with intrauterine growth retardation were followed up prospectively to 3 years of age, using biometric parameters, perinatal risk questionnaires, and neurodevelopmental evaluations. Forty-two children served as controls. A significant difference in neurodevelopmental score at 3 years of age was noted between the intrauterine growth retardation and control groups (P < .001). In the intrauterine growth retardation group, the clinical parameters that most significantly correlated with outcome were cephalization index (head circumference:birthweight ratio), neonatal risk score, and birthweight. The best predictor of 3-year outcome was the cephalization index (P < .01). The children with intrauterine growth retardation with neonatal complications had significantly lower IQ scores (P < .05) and a poorer neurodevelopmental outcome (P < .01) than those without complications. Children with intrauterine growth retardation are at higher risk for developmental disabilities than are controls, especially in the presence of neonatal complications and a high cephalization index. (J Child Neurol 1999;14:724-727).

Prevalence and characteristics of voiding difficulties in women: are subjective symptoms substantiated by objective urodynamic data?

OBJECTIVES To examine the prevalence and characteristics of voiding difficulties in women. METHODS Two hundred six consecutive female patients who attended a urogynecology clinic were recruited. Patients were interviewed regarding the presence and severity of symptoms that would suggest voiding difficulties (ie, hesitancy, straining to void, weak or prolonged stream, intermittent stream, double voiding, incomplete emptying, reduction, and positional changes to start or complete voiding). Urodynamic evidence of voiding difficulty was considered as a peak flow rate less than 12 mL/s (voided volume greater than 100 mL), or residual urine volume greater than 150 mL, on two or more readings. Residual urinary volume, flow patterns, and pressure-flow parameters were analyzed and compared between symptomatic and asymptomatic patients who had urodynamic parameters of voiding difficulties. RESULTS One hundred twenty-seven (61.7%) women reported having voiding difficulty symptoms; 79 others (38.3%) were free of such symptoms. Urodynamic diagnosis of voiding difficulty was made in 40 women (19.4% of the study population): 27 in the symptomatic group and 13 in the asymptomatic group (21.2% and 16.5%, respectively). Only 1 patient had voiding difficulty due to bladder outlet obstruction. All other cases of low flow rate were due to impaired detrusor contractility. CONCLUSIONS Objective evidence of voiding difficulty may be found in both symptomatic and asymptomatic patients and is usually due to impaired detrusor contractility. The clinical significance of the abnormal flow parameters in asymptomatic patients is unclear.

Six-Year Follow-Up of Children With Intrauterine Growth Retardation: Long-Term, Prospective Study

This prospective study was designed to characterize the neurodevelopmental and cognitive difficulties specific to children with intrauterine growth retardation and to detect early clinical predictors of these difficulties. Eighty-one children with intrauterine growth retardation were monitored up to 6 to 7 years of age using biometric parameters, perinatal risk questionnaires, and detailed neurodevelopmental and cognitive assessments. Forty-one children served as age-matched, appropriate for gestational age controls. A significant difference in growth parameters (P < .001), neurodevelopmental score (P < .05), and IQ (P < .05) was found between the children with intrauterine growth retardation and controls. A specific profile of difficulties in coordination, lateralization, spatial and graphomotor skills, and abundance of associated movements is typical of the children with intrauterine growth retardation and hints at possible later learning disabilities. The clinical parameters best predicting neurodevelopmental outcome were the neonatal risk score (P < .05) and the weight and height at 6 years of age (P < .05). The children with intrauterine growth retardation with neonatal complications had lower neurodevelopmental scores than the controls but no difference in IQ. Intrauterine growth retardation children diagnosed prenatally had the same neurodevelopmental and IQ scores as those diagnosed at birth, probably due to the careful perinatal and obstetric care provided. Children with intrauterine growth retardation demonstrate a specific profile of neurodevelopmental disabilities at preschool age. Early diagnosis and intervention could probably reduce these difficulties to a minimum. (J Child Neurol 2000;15:781-786).

Peristaltic flow in a tapered channel: application to embryo transport within the uterine cavity

Cyclic uterine peristalsis plays a central role in assisting the transport of sperm to the fallopian tube and later in the conception process in transporting the embryo to a fundal site for implantation. Fulfillment of these essential events within the time limits of fertilization and implantation depends on concomitant intrauterine fluid motion induced by uterine wall motility. A model of wall-induced fluid flow within a finite tapered two-dimensional channel was developed to simulate intrauterine fluid flow pattern and transport phenomena due to symmetric and asymmetric wall displacements. The analysis showed that the transport phenomena are strongly dependent on the phase shift of wall displacement and the angle between the walls. The velocities, flow rates, pressure and the axial transport of massless particles are reduced to zero when contractions are completely out of phase. Cases of reflux and trapping in a tapered channel are discussed for the first time. The reflux phenomenon is most likely to occur when wall motility is asymmetric, especially when the angle between the walls increases, while trapping is enhanced as the asymmetric motility and the angle between the channel walls decrease. The relevance of the results to intrauterine fluid transport phenomena, embryo transfer and hydrosalpinx was explored.

Plasma interleukin-12 is elevated in patients with preeclampsia.

PROBLEM: Abnormal immune activation has been suggested as a contributor to the development of preeclampsia. We hypothesized that intact interleukin (IL)‐12 directly, or through its main mediator, interferon (IFN)‐γ, contributes to the altered immune response observed in preeclampsia.

Dynamics of the intrauterine fluid-wall interface

AbstractIntrauterine fluid movements, which are responsible for embryo transport to a successful implantation site at the fundus, may be induced by myometrial contractions. Myometrial contractions in nonpregnant uteri were studied from in vivo measurements of intrauterine pressures with fluid-filled catheters and by visual observations of high-speed replaying of ultrasound images of the uterus. Transvaginal ultrasound (TVUS) images of sagittal cross sections of the nonpregnant uterus were scanned with an intravaginal ultrasound probe. Images at consecutive times (2 s apart) were digitized and processed by employing modern techniques of image processing. The sets of images were compared to evaluate time variation of the fluid–wall interface with respect to amplitude, frequencies, and wavelength of myometrial contractions. Analysis of TVUS images from 11 volunteers during the proliferative phase revealed that myometrial contractions are fairly symmetric and are propagated from the cervix towards the fundus at a frequency of about 0.01-0.09 Hz. The wavelength, amplitude, and velocity of the fluid–wall interface during a typical contractile wave were found to be 10-30 mm, 0.05-0.2 mm, and 0.5-1.9 mm/s, respectively. Additional data acquisition from a large number of normal subjects is needed to build a data base to predict normal characteristics of myometrial contractions in a nonpregnant uterus, in order to better understand their role in the preimplantation process.

Cryptorchidism: incidence and sperm quality in infertile men.

Summary. In a population of 8500 men attending the andrology outpatient clinic, 200 men (2.35%) were recorded as having some disturbances with the descent of the testes into the scrotum. Medical history of the patients revealed that 51 underwent unilateral orchidopexy; 40 bilateral orchidopexy; and 24 were treated with human chorionic gonadotropin in order to induce descent of their testes. In addition, 6 patients reported spontaneous descent of the testes, and 13 others were found to be unilaterally cryptorchid upon physical examination. Results of semen analysis, hormonal profile, testes position, and testicular volume were compared to those of 105 proven fertile men. The major finding of this study shows that post‐partum undescended testes suffer from primary Sertoli cell malfunction as reflected by elevated serum follicle stimulating hormone levels. Serum luteinizing hormone and testosterone levels were within the normal range. Surgical descent of the testes did not improve sperm production, proved by low sperm quality of all the study groups, compared to the cryptorchid group. Among the patients who were operated on, no correlation was found between age at operation and semen variables. All groups showed poor sperm quality which can be defined as oligoteratoasthenozoospermia. The degree of spermatogenic damage was in the following order of diagnosis or treatment: bilateral orchidopexy > cryptorchid testes > hormonal treatment > unilateral orchidopexy > late spontaneous descent of the testes. Thus, it is advisable to postpone surgical treatment of cryptorchidism and apply this only after a waiting period, and if the hormonal approach has failed to descend the testis.

Uterine rupture at 33 weeks' gestation subsequent to hysteroscopic uterine perforation****

A 40-year-old woman underwent operative hysteroscopy for suspected submucosal myoma, during which the uterine fundus was perforated. At laparotomy the perforation site was sutured. In a subsequent pregnancy she had a sudden onset of abdominal pain. Laparotomy revealed a uterine rupture with a partially protruding placenta. A healthy newborn was delivered by a low-segment cesarean section.