Tamy Shohat, MD, MPH, Orly Ramono-Zelekha and the Israel Network for Ultrasound in Obstetrics and Gynecology
Background: Charts of fetal measurements are widely used in the follow-up of pregnant women, however no charts have been constructed for the Israeli population.
Objectives: To establish growth charts for fetal femur size and biparietal diameter.
Methods: A prospective cross-sectional study of 1,422 singleton pregnancies was conducted.
Results: A total of 1,143 pregnancies met the inclusion criteria. Femur length and biparietal diameter were measured. A linear cubic model was fitted to construct growth charts for the different centiles. The charts were compared with previously published data.
Conclusions: We have constructed new fetal measurement charts for femur length and biparietal diameter that are unique for the Israeli population. These charts have been found to be similar to those published for other Caucasian populations.
Talia Weinstein, MD, Ran Tur-Kaspa, MD, Avry Chagnac, MD, Asher Korzets, MD, Yacov Ori, MD, Dina Zevin, MD, Michal Herman, MD and Uzi Gafter, MD PhD
Background: Hepatitis C virus is the major cause of acute and chronic hepatitis in patients with end-stage renal disease receiving replacement therapy.
Objectives: To define the prevalence of HCV RNA in a population of patients on dialysis in Israel, to determine the relative risk of acquiring HCV infection while treated by hemodialysis or chronic ambulatory peritoneal dialysis, and to define the HCV genotypes in this population.
Methods: During 1995 we studied 162 dialysis patients. Information was obtained regarding the mode of dialysis, years of treatment, number of blood transfusions, and results of serological testing for HCV, hepatitis B virus, and human immunodeficiency virus. Anti-HCV antibodies were tested by a third-generation microparticle enzyme immunoassay. HCV RNA was determined by polymerase chain reaction. HCV genotyping was performed by a hybridization assay.
Results: HCV RNA was detected in 18% of the HD group and 7% of the CAPD group. The number of HCV RNA-positive patients was significantly higher in the HD than the CAPD group (P < 0.05). HCV RNA-positive HD patients were treated longer than the HCV RNA-negative patients (P < 0.02).
Conclusions: Third-generation immunoassay proved to be highly sensitive (94%) and specific (91%) in identifying HCV RNA positivity. Several HCV subtypes were detected, lb being the most frequent. Identification and isolation of infected HCV patients may minimize its spread in dialysis units and prevent cross-infection.
Imad R. Makhoul, MD DSc, Osnat Zmora, MD, Ada Tamir, DSc, Eli Shahar, MD and Polo Sujov, MD
Background: Congenital subependymal pseudocysts are incidental findings that are found in 05-5.2% of neonates during postmortem examination or head ultrasonography. In our institution we detected 10 neonates with CSEPC.
Objective: To investigate associated etiological factors, morphologic characteristics and outcome of CSEPC.
Methods: We performed a meta-analysis of the literature on CSEPC (1967-98), including our 10 cases.
Results: A total of 256 cases of CSEPC were analyzed. Ultrasound diagnosed 77.6% of CSEPC 48.8% were bilateral and 53.4% were located in the caudothalamic groove or head of caudate nucleus. Altogether, 93.5% resolved during 1-12 months of ultrasonographic follow-up. Compared to the general neonatal population, the following features were more prevalent in the CSEPC population: prematurity, maternal vaginal bleeding, preeclamptic toxemia, intrauterine growth restriction, asphyxia, fetal cytomegalovirus and rubella infections, congenital malformations, chromosomal aberrations, infant mortality, and neurodevelopmental handicap. The risk for neurodevelopmental handicap was significantly higher when CSEPC were associated with fetal infections, IUGR, malformations and chromosomal aberrations, or persistence of CSEPC during follow-up. CSEPC infants without any of these four conditions had a low risk for neurodevelopmental handicap.
Conclusions: CSEPC are morphologic features of various underlying conditions encountered in the fetus. Association of CSEPC with IUGR, fetal infections, malformations and chromosomal aberrations or persistence of CSEPC indicates a higher risk for future neurodevelopmental handicaps, probably because of the deleterious effects on the fetal brain that are inherent in these conditions. A favorable outcome is expected in the absence of these risk factors.
Michael Davidovitch, MD, Gabriela Holtzman, MD and Emanuel Tirosh, MD
Background: Autism is a pervasive developmental disorder. The incidence rate and other related epidemiological characteristics of the Israeli population are not available.
Objectives: To assess the incidence rate of autism in the Haifa area and to compare family characteristics with previous reports from other countries.
Methods: We approached facilities in the Haifa area that are involved with the diagnosis and treatment of autism. The study group comprised children born between 1989 and 1993. Records of the children were scrutinized and 69% of the mothers were interviewed. Live-birth cohorts of the same years were employed for incidence computation.
Results: An incidence rate of 1/1000 was derived. Male to female ratio was 4.2:1. Pregnancy and perinatal periods were mostly uneventful. A low prevalence of developmental and emotional morbidity was reported for family members.
Conclusions: The epidemiological characteristics found in the Haifa area are similar to those reported from non-Israeli communities. This finding supports an underlying biological mechanism for this disorder. These data can be used for future trend analyses in Israel.
Maurit Beeri, MD, Ziv Haramati, MD, JJT. Azaria Rein, MD and Amiram Nir, MD
Background: Parental knowledge of their child’s heart disease, while often overlooked, contributes to compliance and reduces anxiety. Prior studies have shown that 36% of parental diagnostic descriptions are incorrect.
Objectives: To assess parental knowledge and attitudes among outpatients at a hospital pediatric cardiology clinic.
Methods: Seventy-four families completed a questionnaire in which they described their child’s condition and stated their attitude towards dental hygiene and future prenatal diagnosis.
Results: Eighteen percent of the parents failed to describe their child’s malformation correctly. We found that parental understanding of the heart defect correlated with parental education. Future prenatal diagnosis was considered by 88% of families, and termination of pregnancy by 40%. Only 40% of children were aware of their heart problem. Children of parents who were ignorant about the condition tended to lack knowledge themselves. An additional finding was that 68% of Jewish families turn to non-medical personnel for medical advice - an interesting finding not hitherto addressed.
Conclusions: Ignorance of their child’s problem did not correlate with its severity or complexity but rather with parental background: the less educated the parent, the more likely was the problem perceived incorrectly.
Jonathan M. Lehmann, MB, Bchir, Ali Shnaker, MD, Daniel Silverberg, MD, Kati Dayan, MD and Misha Witz, MD
Eliad Karin, MD, Riad Haddad, MD and Hanoch Kashtan, MD