C. Bottomley
St George's Hospital
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Featured researches published by C. Bottomley.
Ultrasound in Obstetrics & Gynecology | 2007
S. A. Bora; E. Kirk; C. Bottomley; F. Mukri; L. Tan; T. Bourne
Objectives: The differential diagnosis of fetal renal or suprarenal pathology includes severe or life-threatening conditions such as infantile renal polycystosis or bilateral renal agenesis as well as potentially malignant forms such as a Wilms’ tumor, suprarenal neuroblastomas or lymphangiomas. The nature and exact location of these lesions are important for diagnosis and optimal perinatal management and cannot always be made conclusively on ultrasound. This report evaluated the added value of fetal Magnetic Resonance Imaging (fMRI) in the differential diagnosis of fetuses with renal or suprarenal pathology. Methods: All fetuses with suspected but inconclusive ultrasound diagnosis of (supra)renal lesions underwent fMRI during the study period (2001–2006). The fMRI scanning protocol consisted of T1, T2 and diffusion weighed images (DWI) in the three orthogonal axes. Results: During the study period 547 fMRI examinations were performed. There were 28 cases (5.1%) with (supra)renal pathology suspected on ultrasound examination. Antenatal MRI was performed at a median gestational age of 24 (range 17–39) weeks. The tentative sonographic diagnosis was confirmed by fMRI and postnatal imaging studies in 22 cases (78.5%). In 5 cases (17.8%) MRI added relevant information. In one case (3.8%) the MRI was of no value due to the poor image quality. Conclusions: MRI can have an additive value in the perinatal workup of renal and suprarenal pathology of unclear origin on prenatal ultrasound. It is especially helpful to differentiate renal from adrenal origin of the lesions and offers good image quality in the presence of oligoor anhydramnios.
Ultrasound in Obstetrics & Gynecology | 2008
S. A. Bora; L. Tan; F. Mukri; C. Bottomley; E. Kirk; D. Timmerman; T. Bourne
ectopic pregnancy (EP) or persisting PUL. According to the old protocol all PULs with an hCG ratio < 0.87 were discharged at 48 h (failing PULs). PULs with an hCG ratio 0.87–1.66 are at increased risk of being ectopic, therefore all PULs with an hCG ratio > 0.87 had a second scan in 1 week to confirm location and a third scan in 2 weeks to confirm viability. In this review we evaluate if the introduction of a new protocol will change the management of PULs. This model incorporates hCG ratio cut-offs for the prediction not only of pregnancy location but also pregnancy viability. In the case a PUL has an hCG ratio > 2.00, after confirmation of location with the second scan, the third viability scan can be avoided and the woman is booked directly for the Nuchal scan. Results: If we apply the new protocol to the old database of PULs we will diagnose correctly, without unnecessary scans and without increasing the risk of missing EPs, the 89.3% of failing PULs, 77.2% of viable IUPs, 67.3% of non-viable IUPs. Comparing to the old protocol, we will save 213 scans in the viable IUPs group, approximately 1 scan every 4 PULs. We will unnecessarily book NT scans in 32.8% of PULs who are likely to end up as non-viable IUPs. Conclusions: If applied top our population of PULs, the new protocol allows a reduction of the number of follow-up scans without compromising patient safety.
Ultrasound in Obstetrics & Gynecology | 2008
A. Pexsters; Anneleen Daemen; C. Bottomley; D. Van Schoubroeck; L. De Catte; D. Timmerman; T. Bourne
C. Bottomley1, A. Daemen2, F. Mukri1, A. T. Papageorghiou3, E. Kirk1, A. Pexsters4, B. De Moor2, D. Timmerman4, T. Bourne5 1Early Pregnancy and Gynaecology Ultrasound Unit, St George’s University of London, London, United Kingdom, 2Department of Electrical Engineering (ESAT), University Hospital Gasthuisberg, Leuven, Belgium, 3Fetal Medicine Unit, St George’s Hospital, London, United Kingdom, 4Department of Obstetrics and Gynaecology, University Hospitals, Leuven, Belgium, 5OB/Gyn, University Hospitals, Leuven, Belgium, Early Pregnancy and Gynaecology Ultrasound Unit, St George’s University of London, London, United Kingdom
Ultrasound in Obstetrics & Gynecology | 2008
A. Pexsters; Anneleen Daemen; J. P. Frijns; C. Bottomley; D. Van Schoubroeck; L. De Catte; D. Timmerman; T. Bourne
Background: Controversy exists regarding whether myocardium compresses during contraction. Some studies have shown that during systole the muscle compresses when fluid and blood exit from the muscle during contraction. This theory has not been tested in the fetal heart. Objectives: To examine whether fetal myocardium during systole is of lesser or equal volume to that of diastole, and to compare these measures in newborn myocardium, employing 4D-STIC and inversion mode. Methods: STIC volumes were acquired and analyzed with VOCAL and inversion mode. Right and left heart end-diastolic and endsystolic myocardial (MV) and ventricular volumes were determined. Proportional change between end-diastolic and end-systolic MV was calculated, as were stroke volume (SV) and ejection fraction (EF) for the right and left ventricles. For comparison, echocardiography was performed on 10 normal term newborns and children using 4D-STIC, but limiting acquisition and analysis to the left ventricle. Results: 30 fetuses at GA 20–37 wks were examined. The Total Volume Change (ventricle+myocardium) between end-diastole and end-systole ranged from 0.5–5.38 cm3 in the left ventricle and 0.25–4.89 cm3 in the right, while the SV ranged from 0.13–2.64 cm3 in left ventricle and 0.15–2.16 cm3 in the right at these GAs. SV values therefore are smaller than the total volume change in systole, i.e. SV does not account for all volume change following cardiac contraction. This difference is the compression of the myocardium. MV compressed between end-diastole and endsystole by 8–19% in the right ventricle and 5–25% in the left. In newborns and children left heart MV compression between enddiastole and end-systole was 0–8%. EF was relatively constant at ∼60%. Conclusions: Fetal myocardial volume in the second half of gestation compresses by approximately 20% during systole. To the best of our knowledge this is the first study to demonstrate the compressibility of fetal myocardium.
Ultrasound in Obstetrics & Gynecology | 2007
F. Mukri; C. Bottomley; A.T. Papageorghiou; L. Tan; S. A. Bora; T. Bourne
Objectives: Of 1000 women attending an early pregnancy unit over 3 months who had at least two ultrasound examinations confirming singleton viability, two classes of pregnancies are considered: ongoing pregnancies and early pregnancy losses. Our objective was to discriminate between these two classes to predict early pregnancy loss. We considered the rate of growth of the crown–rump length (CRL), the mean sac diameter (MSD) and the difference between MSD and CRL as a function of the gestational age (GA). Methods: Classical linear discriminant analysis (LDA) classifies data by maximizing the ratio of the between-class variation to the within-class variation. FLDA is an extension where the predictor variables are curves (e.g. a variable measured multiple times during pregnancy). Serial observations from each individual are modeled with a spline function (a curved line formed by two or more vertices), parameterized with a basis function multiplied by a 5-dimensional coefficient vector. A training set was used to estimate the mean coefficient vector for each class. New patients can then be classified by determining the class with the closest mean coefficient vector. Results: 270 patients had at least two measurements for CRL and GA. Nine of these subsequently resulted in early pregnancy loss. It was not possible to discriminate between classes with FLDA using CRL alone. Using MSD we could include 99 patients and mean growth curves of MSD as function of GA for ongoing pregnancies and pregnancy losses did not overlap (P < 0.0001). The MSD for early pregnancy loss was smaller at all gestational ages. Moreover, the difference between MSD and CRL could be used to discriminate between ongoing pregnancies and pregnancies destined to fail (P < 0.0001). Conclusions: Using FLDA it is possible to predict early pregnancy loss on the basis of MSD or difference between MSD and CRL for patients in whom MSD and CRL have been measured on at least two occasions.
Ultrasound in Obstetrics & Gynecology | 2006
A.T. Papageorghiou; E. Kirk; G. Condous; C. Bottomley; T. Bourne
tenaculum. This enables continuous monitoring during cervical dilatation and uterine curettage for surgical treatment of miscarriage. The purpose of this study was to establish the feasibility of evacuation of retained products of conception using this new device to monitor the procedure. Methods: Women diagnosed with miscarriage or retained products of conception on TVS were invited to join the study. The procedure was timed from application until removal of the tenaculum. Views obtained were rated as satisfactory or poor. Success of the procedure was gauged by absence of products of conception, assessed by TVS and transabdominal ultrasound scan (TAS) at the end of the procedure. Operative complications were recorded. Women were followed-up by telephone questionnaire. Results: 43 women were recruited to the study. The procedure was successful in 42/43 (98%) cases. The mean operating time was 7 minutes (range 2 to 23 minutes). There were two minor operative complications. In one case the condom broke, which may have increased the risk of infection, and in a further case the tenaculum caused trauma to the cervix, necessitating hemostatic suture. On follow-up questionnaire the mean duration of bleeding was 4 days (range 1–7 days). There were no cases of post-operative complications necessitating readmission or repeat procedure. Conclusion: This study indicates that TVS-guided ERPC is a successful method for surgical evacuation of the uterus following miscarriage, with a low risk of complications.
Ultrasound in Obstetrics & Gynecology | 2006
C. Bottomley; E. Kirk; A.T. Papageorghiou; G. Condous; T. Bourne
increased availability of highly sensitive quantitative b-HCG testing and improvement in trans-vaginal USS technology. Objective: To determine whether laparoscopy is still the gold standard for the diagnosis of ectopic pregnancy. Materials and Method: A retrospective analysis of the adnexal findings, serum b-HCG and progesterone levels in 84 cases of surgically confirmed EP. Results: Mean age = 29.7 yrs, range = 17–41 yrs. Adnexal masses: A pelvic mass was ultimately found in all the patients. 75/84 (89.3%) had an adnexal mass on the initial scan, while 9/84 (10.7%) were managed as pregnancy of unknown location until a subsequent USS elucidated a pelvic mass in these patients. A live EP was found in 18/84 (21.4%) of cases while a further 8/84 (9.5%) had a gestational sac with a yolk sac or fetal pole. The side of the pelvic mass could not be determined in 8/84 (9.5%) of cases because of it’s central location. 9.5% of cases were cornual pregnancies. Serum b-HCG: 14/84 patients (16.7%) had b-HCG levels of < 1000 i.u., 26.2% had levels of 1,001–4000 i.u., 35.7% had levels of 4,001–10,000 i.u. 14.3% had levels > 25, 000 i.u. Serum progesterone: Five patients did not have serum progesterone results. Of the remaining 79, 38% had serum progesterone of 20 or less, 48.1% had a serum progesterone level of 21–60, while 13.9% had levels of 61–100. Conclusion: Since an adnexal mass was demonstrated virtually in all cases, it may be safe to conclude that in combination with quantitative b-HCG assays, laparoscopy now has very limited or no role in diagnosis, but rather for treatment of ectopic pregnancy.
Ultrasound in Obstetrics & Gynecology | 2006
C. Bottomley; Kamal Ojha; E. Kirk; T. Bourne
increased availability of highly sensitive quantitative b-HCG testing and improvement in trans-vaginal USS technology. Objective: To determine whether laparoscopy is still the gold standard for the diagnosis of ectopic pregnancy. Materials and Method: A retrospective analysis of the adnexal findings, serum b-HCG and progesterone levels in 84 cases of surgically confirmed EP. Results: Mean age = 29.7 yrs, range = 17–41 yrs. Adnexal masses: A pelvic mass was ultimately found in all the patients. 75/84 (89.3%) had an adnexal mass on the initial scan, while 9/84 (10.7%) were managed as pregnancy of unknown location until a subsequent USS elucidated a pelvic mass in these patients. A live EP was found in 18/84 (21.4%) of cases while a further 8/84 (9.5%) had a gestational sac with a yolk sac or fetal pole. The side of the pelvic mass could not be determined in 8/84 (9.5%) of cases because of it’s central location. 9.5% of cases were cornual pregnancies. Serum b-HCG: 14/84 patients (16.7%) had b-HCG levels of < 1000 i.u., 26.2% had levels of 1,001–4000 i.u., 35.7% had levels of 4,001–10,000 i.u. 14.3% had levels > 25, 000 i.u. Serum progesterone: Five patients did not have serum progesterone results. Of the remaining 79, 38% had serum progesterone of 20 or less, 48.1% had a serum progesterone level of 21–60, while 13.9% had levels of 61–100. Conclusion: Since an adnexal mass was demonstrated virtually in all cases, it may be safe to conclude that in combination with quantitative b-HCG assays, laparoscopy now has very limited or no role in diagnosis, but rather for treatment of ectopic pregnancy.
Ultrasound in Obstetrics & Gynecology | 2006
E. Kirk; G. Condous; C. Bottomley; B. Van Calster; S. Van Huffel; D. Timmerman; T. Bourne
E. Kirk1, G. S. Condous1, C. Bottomley1, B. Van Calster2, D. Timmerman3, S. Van Huffel2, T. Bourne1 1Early Pregnancy and Gynaecological Scanning Unit, St George’s Hospital, University of London, United Kingdom, 2Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Belgium, 3Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium
Ultrasound in Obstetrics & Gynecology | 2006
E. Kirk; G. Condous; C. Bottomley; B. Van Calster; S. Van Huffel; D. Timmerman; T. Bourne
E. Kirk1, G. S. Condous1, C. Bottomley1, B. Van Calster2, D. Timmerman3, S. Van Huffel2, T. Bourne1 1Early Pregnancy and Gynaecological Scanning Unit, St George’s Hospital, University of London, United Kingdom, 2Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Belgium, 3Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium