Mild pyelectasis: evaluating the relationship between gestational age and renal pelvic anterior-posterior diameter

OBJECTIVE: To determine the relationship between gestational age and renal pelvic anterior-posterior diameter and the feasibility of developing gestational age-specific thresholds for the diagnosis of mild pyelectasis. METHODS: Cross-sectional study of 420 singleton fetuses between 16 and 39 weeks' gestation. The mean renal AP diameter as a function of gestational age was determined using fractional polynomial regression models and centile plots were generated. Assessment of goodness of fit for each regression model was performed. RESULTS: There was a positive correlation between gestational age and renal pelvic AP diameter (Pearson's Correlation Coefficient 0.65). Using the derived mean and standard deviations of renal AP diameter, gestational-age specific 95% reference levels were generated. The sensitivity, specificity, positive, and negative predictive values of using the gestational age-specific cutoffs for predicting persistent postnatal renal anomaly were 80%; 99%; 29%; and 99% respectively. CONCLUSION: There is a positive correlation between gestational age and renal pelvic AP diameters. Reliable gestational age-specific renal AP thresholds for diagnosis of pyelectasis are provided.     

Diet-controlled gestational diabetes mellitus does not influence the success rates for vaginal birth after cesarean delivery

OBJECTIVE: We sought to determine whether women with diet-controlled gestational diabetes mellitus who attempt vaginal birth after cesarean delivery are at increased risk of failure, when compared with their non-diabetic counterparts. STUDY DESIGN: We identified 13,396 women who attempted vaginal birth after cesarean delivery among 25,079 pregnant women with a previous cesarean delivery who were delivered between 1995 and 1999 at 16 community and university hospitals. Analysis was limited to 9437 women without diabetes mellitus and 423 women with diet-controlled diabetes mellitus who attempted vaginal birth after cesarean delivery with a singleton gestation and 1 previous low-flap cesarean delivery. Data that were collected by trained abstractors, included demographics, medical history, and both pregnancy and neonatal outcomes. Multivariable logistic regression analysis was performed to determine an adjusted odds ratio for vaginal birth after cesarean delivery success among women with diet-controlled gestational diabetes compared with women with no diabetes mellitus. We controlled for birth weight, maternal age, race, tobacco, chronic hypertension, hospital settings, labor management, and obstetric history. RESULTS: Forty-nine percent of the women with gestational diabetes mellitus and 67% of the women with no diabetes mellitus attempted vaginal birth after cesarean delivery. The success rate for attempted vaginal birth after cesarean delivery among gestational diabetic women was 70%, compared with 74% for non-diabetic women. We found that gestational diabetes mellitus is not an independent risk factor for vaginal birth after cesarean delivery failure. The relative risk for vaginal birth after cesarean delivery success in women with gestational diabetes mellitus compared with women without gestational diabetes mellitus was 0.94 (95% CI, 0.87-1.00). After an adjustment was made for confounding, the odds ratio for success with gestational diabetes mellitus was 0.87 (95% CI, 0.68-1.10). CONCLUSION: Women with diet-controlled gestational diabetes mellitus who were carrying singleton fetuses who had no more than 1 previous low flap cesarean delivery should be counseled that their disease does not decrease their chances for a successful vaginal birth after cesarean delivery. Among diet-controlled diabetic women, the overall success rate for vaginal birth after cesarean delivery remains acceptable, and attempted vaginal birth after cesarean delivery should not be discouraged solely on the basis of gestational diabetes mellitus.     

Kinetics and growth modes of quasi-2d silver branched electrodeposits produced in the presence of a supporting electrolyte

Quasi-2d silver electrodeposits were grown electrochemically at constant potential from aqueous Ag⁺ ion-containing solutions in the presence of a supporting electrolyte, at room temperature, using a three-electrode quasi-2d circular electrochemical cell. Open branching and dense radial branching patterns were distinguished on the centimetre scale, and growth mode transitions could be observed during the process. Branching patterns exhibited a mass fractal behaviour with a mass fractal dimension increasing from that expected for a DLA-like pattern to that of a dense branching pattern as either the cathodic overpotential (η_c) or the Ag⁺ ion concentration in the solution (c) was increased. The electrodeposition current increased with time exhibiting different regimes depending on whether an open branching or a dense radial branching growth mode prevailed. When the electrodeposition time exceeded a certain critical value, the radial growth rate of electrodeposits (v_r) approached a v_rαη_cc relationship. The experimental morphologies and growth kinetics were reproduced by Monte Carlo simulations of a growth model in which depositing particles follow a biased random walk.     

Rectal balloon for CT of rectal cancer

The use of a balloon catheter to distend the rectum for pelvic CT in patients with rectal cancer is described. The 20-cm long balloon, inserted over a 12F catheter and inflated with 180-200 ml of water, is simple to use, well tolerated by patients and allows high-quality CT scans. Preliminary results of the presurgical staging of rectal cancer by CT with rectal balloon in a series of 15 patients show a high accuracy when comapred with the pathological findings: involvement of perirectal nodes and adjacent structures was correctly identified in all cases, while CT overestimated the invasion of perirectal fat in two cases, due to the impossibility of distinguishing neoplastic from inflammatorry tissue. The operability statement (site and dimensions of the tumour) allowed correct surgical planning in all cases. Correspondence to: M. Bellomi