Title: Ultrasound in Obstetrics & Gynecology

Title: Ultrasound in Obstetrics & Gynecology

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? Morris, R.K., Ruano, R. and Kilby, M.D. (2011), Effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction: A systematic review. Ultrasound in Obstetrics & Gynecology, 37 (6), 629-637.

Abstract: Objective To determine the effectiveness of fetal cystoscopy in the prenatal diagnosis of and intervention for congenital lower urinary tract obstruction. Methods This study was a literature search using MEDLINE, EMBASE, Cochrane Library, MEDION, Web of Science reference lists and contact with experts. All studies reporting on fetal cystoscopy in lower urinary tract obstruction with data for a 2 x 2 table were selected for review. No language restrictions were applied. There was independent selection of studies, data extraction and quality assessment by two reviewers. Peto odds ratios were calculated as a summary measure of effect. Results A total of 2071 citations were identified and 66 papers selected for detailed evaluation, from which four papers with a total of 63 patients were selected for inclusion. Two papers had results for the use of cystoscopy in diagnosis, showing that fetal cystoscopy altered the ultrasound diagnosis of the underlying pathology in 36.4 and 25.0% of fetuses, respectively. Compared to no treatment, fetal cystoscopic intervention demonstrated an odds ratio for improved perinatal survival of 20.51 (95% CI, 3.87-108.69). However, comparing vesicoamniotic shunt (VAS) with fetal cystoscopy there appeared to be no significant improvement in the perinatal survival odds ratio of 1.49 (95% CI, 0.13-16.97). These results had wide CIs and for cystoscopy vs. VAS, all results crossed the line of no effect. Conclusion There is little published evidence for the effectiveness of therapeutic fetal cystoscopy as an intervention for congenital lower urinary tract obstruction and the quality of this evidence is poor. It should thus be considered to be an ‘experimental intervention’ and subjected to further investigation. Copyright (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Keywords: Amniotic Shunt Tube, Antenatal Intervention, Assessment, Citations, Cochrane, Copyright, Diagnosis, Effectiveness, Evaluation, Experience, Fetal Cystoscopy, Intervention, Literature, Lower Urinary Tract, Lower Urinary Tract Obstruction, Management, Medline, Methods, Papers, Pathology, Patients, Percutaneous Cystoscopy, Perinatal, Posterior Urethral Valves, Ratio, Review, Science, Stent, Survival, Systematic, Systematic Review, Tract, Treatment, Ultrasound, Uropathy, Vesicoamniotic Shunt, Vesicocentesis, Web of Science

? Chan, Y.Y., Jayaprakasan, K., Tan, A., Thornton, J.G., Coomarasamy, A. and Raine-Fenning, N.J. (2011), Reproductive outcomes in women with congenital uterine anomalies: A systematic review. Ultrasound in Obstetrics & Gynecology, 38 (4), 371-382.

Full Text: 2011\Ult Obs Gyn38, 371.pdf

Abstract: Objective Congenital uterine anomalies are common but their effect on reproductive outcome is unclear. We conducted a systematic review to evaluate the association between different types of congenital uterine anomaly and various reproductive outcomes. Methods Searches were performed using MEDLINE, EMBASE, the Cochrane Library and Web of Science. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Uterine defects were grouped into arcuate uteri, canalization defects (septate and subseptate uteri) and unification defects (unicornuate, bicornuate and didelphys uteri). Pooled risk ratios (RR) with 95% confidence intervals (CI) were computed using random effects models. Results We identified nine studies comprising 3805 women. Meta-analysis showed that arcuate uteri were associated with increased rates of second-trimester miscarriage (RR, 2.39; 95% CI, 1.33-4.27, P = 0.003) and fetal malpresentation at delivery (RR, 2.53; 95% CI, 1.54-4.18; P < 0.001). Canalization defects were associated with reduced clinical pregnancy rates (RR, 0.86; 95% CI, 0.77-0.96; P = 0.009) and increased rates of first-trimester miscarriage (RR, 2.89; 95% CI; 2.02-4.14; P < 0.001), preterm birth (RR, 2.14; 95% CI, 1.48-3.11; P < 0.001) and fetal malpresentation (RR, 6.24; 95% CI, 4.05-9.62; P < 0.001). Unification defects were associated with increased rates of preterm birth (RR, 2.97; 95% CI, 2.08-4.23; P < 0.001) and fetal malpresentation (RR, 3.87; 95% CI, 2.42-6.18; P < 0.001). Conclusions Canalization defects reduce fertility and increase rates of miscarriage and preterm delivery. None of the unification defects reduces fertility but some are associated with miscarriage and preterm delivery. Arcuate uteri are specifically associated with second-trimester miscarriage. All uterine anomalies increase the chance of fetal malpresentation at delivery. Copyright. (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Keywords: 3-Dimensional Ultrasound, Assessment, Author, Clinical Implications, Cochrane, Confidence Intervals, Congenital Uterine Anomalies, Copyright, Diagnosis, Embase, England, Fetal, Hysteroscopic Metroplasty, Infertile Women, Infertility, Malformations, Malpresentation, Medline, Meta Analysis, Meta-Analysis, Metaanalysis, Methods, Miscarriage, Mullerian Anomalies, Mullerian Duct Anomalies, Outcome, Outcomes, Pregnancy, Preterm Birth, Quality, Review, Risk, Scale, Science, Septate Uterus, Systematic, Systematic Review, Web of Science, Women

Title: The Umbrella Effect, Croatica Chemica Acta

Full Journal Title: The Umbrella Effect, Croatica Chemica Acta

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? Kovacevic, D., Kobal, I. and Kallay, N. (1998), Adsorption of organic acids on metal oxides. The Umbrella Effect, Croatica Chemica Acta, 71 (4), 1139-1153.

Abstract: Simultaneous interpretation of electrokinetic and adsorption data for organic ions at metal oxide surfaces is introduced. It is shown that, for the salicylic acid/hematite system, the singly charged salicylate ions react with surface-OH, groups releasing one water molecule. The salicylate ions, when bound to the surface, exhibit a pronounced >>Umbrella effect<<, i.e., each relatively large organic ion covers about four to six surface-OH, excluding them from the further adsorption process. Within the electrical interfacial layer, the salicylate ions are located in the plane near the onset of the diffuse layer. It is demonstrated that the interpretation of adsorption data solely may lead to erroneous conclusions regarding the mechanism of binding and the structure of the interfacial layer. Electrokinetic measurements provide useful information, enabling the solution of the above problem.

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