The Definition, Diagnosis, and Management of Growth-Discordant Twins: An International Census Survey

1991 ◽  
Vol 40 (3-4) ◽  
pp. 345-351 ◽  
Author(s):  
I. Blickstein
Keyword(s):  
Stress Testing ◽  
Expectant Management ◽  
Doppler Velocimetry ◽  
Diagnosis And Management ◽  
Clear Cut ◽  
Biophysical Profile ◽  
Per Se ◽  
Discordant Twins ◽  
Discordant Twin

AbstractIn order to establish a protocol considering the definition, diagnosis, and management of growth-discordant twin gestations, a questionnaire was sent to 96 authors of twin-related obstetric articles. The views of the 61 responders comprise this international census survey. The data suggest that a clear cut-off value for discordancy is still needed; however, the data indirectly supported a two-grade definition, namely, mild (> 15% and < 25% birth-weight disparity) and severe (> 25%) growth discordants. Expectant management was advocated by the majority of participants with out-patient follow-up for mild discordants, while severe discordants may preferably be hospitalized. Follow-up should be done by non-stress testing (daily - 2/wk), biophysical profile (1-2/wk), Doppler velocimetry (1/wk - bi-weekly) and sonographic biometry (bi-weekly). The opinions considering termination of pregnancy because of intertwin growth discordancy were divided; however, discordancy per se, was not considered an indication for cesarean delivery. An adapted management flowchart that summarizes the survey's data is presented and may be used as a standard for future investigations.

Discordant Twin Pregnancy with One Malformed Fetus – Color Doppler Follow Up for Expectant Management

2011 ◽  
Vol 3 (9) ◽  
pp. 469-472
Author(s):  
Ishan Kumar ◽  
◽  
Shivi Jain Shivi Jain ◽  
Ashish Verma ◽  
Madhu Jain Madhu Jain ◽  
...  
Keyword(s):  
Twin Pregnancy ◽  
Color Doppler ◽  
Expectant Management ◽  
Discordant Twin

scholarly journals Neonatal Screening for Congenital Hypothyroidism: What Can We Learn From Discordant Twins?

2019 ◽  
Vol 104 (12) ◽  
pp. 5765-5779 ◽  
Author(s):  
Emanuela Medda ◽  
Maria Cristina Vigone ◽  
Alessandra Cassio ◽  
Francesca Calaciura ◽  
Pietro Costa ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Congenital Hypothyroidism ◽  
Screening Program ◽  
Phenotypic Variance ◽  
Fetal Life ◽  
Long Term Follow Up ◽  
Discordant Twins ◽  
Discordant Twin

Abstract Context Newborn screening program for congenital hypothyroidism (CH) adopting rescreening in at-risk neonates. Objectives To estimate the concordance rate for CH in twin pairs discordant at the first screening; to verify whether long-term follow-up of healthy cotwins belonging to CH discordant pairs may be useful to diagnose thyroid hypofunction during development; to evaluate the importance of genetic and environmental influences on liability to permanent and transient CH. Design and Patients Forty-seven screening discordant twin pairs were investigated. Proband was defined as the twin in the pair with a positive test at the first screening and a confirmed diagnosis of CH. Results Seven screening discordant twin pairs became concordant for CH within the first month of life (pairwise concordance of 14.9%) because seven screening negative cotwins showed high TSH values when retested. During long-term follow-up (range, 3 to 21 years), hypothyroidism was diagnosed in two monozygotic screening negative cotwins at the age of 9 months and 12 years, respectively. Furthermore, the twin analysis showed that 95% of liability to transient CH was explained by genetic factors and 5% by environmental (unshared) factors, whereas 64% of phenotypic variance of permanent CH was explained by common environmental factors (shared during the fetal life) and 36% by unshared environmental factors. Conclusions This study showed that the introduction of rescreening permits the diagnosis of CH in a greater number of twins. It also showed the importance of long-term follow-up in both twins in the pair, and the role of nongenetic factors in the etiology of permanent CH.

scholarly journals P34 Characteristics, diagnosis and management of Cushing’s disease - A systematic review and meta-analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Chan Hee Koh ◽  
Danyal Z Khan ◽  
Ronneil Digpal ◽  
Hugo Layard Horsfall ◽  
Hani J Marcus ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cushing’S Disease ◽  
Meta Analysis ◽  
A Priori ◽  
Pituitary Surgery ◽  
Serum Cortisol ◽  
Cushing's Disease ◽  
Diagnosis And Management ◽  
Over Time

Abstract Introduction The clinical practice and research in the diagnosis and management of Cushing’s disease remains heterogeneous and challenging to this day. We sought to establish the characteristics of Cushing’s disease, and the trends in diagnosis, management and reporting in this field. Methods Searches of PubMed and Embase were conducted. Study protocol was registered a-priori. Random-effects analyses were conducted to establish numerical estimates. Results Our screening returned 159 papers. The average age of adult patients with Cushing’s disease was 39.3, and 13.6 for children. The male:female ratio was 1:3. 8% of patients had undergone previous transsphenoidal resection. The ratio of macroadenomas: microadenomas:imaging-undetectable adenomas was 18:53:29. The most commonly reported preoperative biochemical investigations were serum cortisol (average 26.4µg/dL) and ACTH (77.5pg/dL). Postoperative cortisol was most frequently used to define remission (74.8%), most commonly with threshold of 5µg/dL (44.8%). Average remission rates were 77.8% with recurrence rate of 13.9%. Median follow-up was 38 months. Majority of papers reported age (81.9%) and sex (79.4%). Only 56.6% reported whether their patients had previous pituitary surgery. 45.3% reported whether their adenomas were macroadenoma, microadenoma or undetectable. Only 24.1% reported preoperative cortisol, and this did not improve over time. 60.4% reported numerical thresholds for cortisol in defining remission, and this improved significantly over time (p = 0.004). Visual inspection of bubbleplots showed increasing preference for threshold of 5µg/dL. 70.4% reported the length of follow up. Conclusion We quantified the characteristics of Cushing’s disease, and analysed the trends in investigation and reporting. This review may help to inform future efforts in forming guidelines for research and clinical practice.

MR imaging of ventriculus terminalis of the conus medullaris: A report of two operated patients and review of the literature

2003 ◽  
Vol 44 (4) ◽  
pp. 444-446
Author(s):  
R. Dullerud ◽  
A. Server ◽  
J. Berg-Johnsen
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Signal Intensity ◽  
Incidental Finding ◽  
Conus Medullaris ◽  
Review Of The Literature ◽  
Per Se ◽  
Specific Symptoms ◽  
Work Up

We report on 2 patients in whom a cystic dilation of the conus medullaris was incidentally found at MR imaging carried out in the work-up for sciatica. The cysts were well circumscribed and had signal intensity identical to the CSF on both T1- and T2-weighted images. There was no evidence of contrast enhancement. None of the patients had specific symptoms related to the spinal cord. At surgery, no evidence of malignancy was seen in any of the patients. A benign cystic dilation, also called dilated ventriculus terminalis, occasionally can be seen in the conus medullaris as an incidental finding at thoracolumbar MR imaging. Unless the expansion per se indicates cyst drainage, these patients may be monitored by clinical and MR follow-up, avoiding surgery in a substantial number of cases.

scholarly journals Drinking and mortality: long-term follow-up of drinking-discordant twin pairs

Addiction ◽  
2015 ◽  
Vol 111 (2) ◽  
pp. 245-254 ◽  
Author(s):  
Pyry Sipilä ◽  
Richard J. Rose ◽  
Jaakko Kaprio
Keyword(s):  
Long Term Follow Up ◽  
Discordant Twin

Exacerbated mini-puberty of infancy in an ex-extreme preterm girl

2020 ◽  
Vol 13 (9) ◽  
pp. e235492
Author(s):  
Mafalda Casinhas Santos ◽  
Sara Limão ◽  
Patrícia Ferreira
Keyword(s):  
Ovarian Cyst ◽  
Luteinising Hormone ◽  
Vaginal Bleeding ◽  
Expectant Management ◽  
Central Precocious Puberty ◽  
Spontaneous Resolution ◽  
Breast Development ◽  
Long Term Follow Up

Vaginal bleeding can occur shortly after delivery in 3%–5% of newborns as a consequence of placental hormone withdrawal . Although usually benign, its differential diagnosis includes central precocious puberty, tumours and other pathological conditions. A girl born at 26 weeks of gestation presented with five episodes of vaginal bleeding, each lasting less than a week, initiated at 4 months of age. Luteinising hormone and oestradiol levels were in the pubertal range. Later, she exhibited breast development, with no other pubertal signs. An ultrasonography test revealed an impregnated endometrium and a right ovarian cyst with 43 mm of diameter. A cranioencephalic MRI was unremarkable. Clinicians adopted expectant management and there was clinical, hormonal and radiological resolution in 3 months. The spontaneous resolution suggested mini-puberty of infancy. This is usually an asymptomatic condition, but to date, four cases of an exacerbated form in extremepremature infants have been reported. Long-term follow-up data are missing.A girl born at 26 weeks of gestation presented with five episodes of vaginal bleeding, each lasting less than a week, initiated at 4 months of age. Luteinising hormone and oestradiol levels were in the pubertal range. Later, she exhibited breast development, with no other pubertal signs. An ultrasonography test revealed an impregnated endometrium and a right ovarian cyst with 43 mm of diameter. A cranioencephalic MRI was unremarkable. Clinicians adopted expectant management and there was clinical, hormonal and radiological resolution in 3 months. The spontaneous resolution suggested mini-puberty of infancy. This is usually an asymptomatic condition, but to date, four cases of an exacerbated form in extremepremature infants have been reported. Long-term follow-up data are missing.

scholarly journals Body mass variability is represented by distinct functional connectivity patterns

2018 ◽  
Author(s):  
Jennifer R Sadler ◽  
Grace Elisabeth Shearrer ◽  
Kyle Stanley Burger
Keyword(s):  
Functional Connectivity ◽  
Body Mass ◽  
Visual Processing ◽  
Weight Status ◽  
Design Sensitivity ◽  
Human Connectome Project ◽  
Connectivity Patterns ◽  
Discordant Twins ◽  
Project Data ◽  
Discordant Twin

Understanding weight-related differences in functional connectivity provides key insight into neurocognitive factors implicated in obesity. Here, we sampled three groups from human connectome project data: 1) 47 pairs of BMI-discordant twins (n=94; average BMI-discordancy 6.7 3.1 kg/m2), 2) 47 pairs of gender and BMI matched BMI-discordant, unrelated individuals, and 3) 47 pairs of BMI-similar twins to test for body mass dependent differences in between network functional connectivity. Across BMI discordant samples, three networks appeared to be highly sensitivity to weight status; specifically, a network compromised of gustatory processing regions, a visual processing network, and the default mode network (DMN). Further, individuals with a lower BMI relative to their twin had stronger connectivity between striatal/thalamic and prefrontal networks (pFWE = 0.04) in the BMI-discordant twin sample. Cortical-striatal-thalamic networks underlie regulation of hedonically motivated behaviors. Stronger connectivity may facilitate increased regulation of decision-making when presented with highly rewarding, energy-dense foods. We also observed that individuals with a higher BMI than their twin had stronger connectivity between cerebellar and insular networks (pFWE = 0.04). Increased cerebellar-insula connectivity is associated with caloric deprivation and, in high BMI individuals, is associated compromised satiation signaling, thereby increasing risk for postprandial food intake. Connectivity patterns observed in the BMI-discordant twin sample were not see in a BMI-similar sample, providing evidence that the results are specific to BMI discordance. Beyond the involvement of gustatory and visual networks and the DMN, little overlap in results were seen between the two BMI-discordant samples. This may be a function of the higher study design sensitivity in the BMI-discordant twin sample, relative to the more generalizable results in the unrelated sample. These findings demonstrate that distinct connectivity patterns can represent weight variability, adding to mounting evidence that implicates atypical brain functioning with the accumulation and/or maintenance of elevated weight.

scholarly journals The diagnosis and management of adult ADHD in HMP Elmley, a Category B remand prison

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S90-S90
Author(s):  
Kathleen McCurdy ◽  
Nosa Igbinomwanhia
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Physical Health ◽  
Attention Deficit ◽  
Prison Population ◽  
Waiting Times ◽  
Adhd Medication ◽  
Diagnosis And Management ◽  
Hyperactivity Disorder ◽  
Initial Appointment

AimsAttention deficit hyperactivity disorder (ADHD) is a highly prevalent disorder in young adult prisoners. This audit aimed to identify how many residents are prescribed medication treatment for ADHD in HMP Elmley and whether those seen by the prison psychiatrists have been managed in line with NICE guidelines. We also audited waiting times and time to follow-up appointments. This was done with the overall aim to identify potential areas for development.MethodWe performed a spot audit of all residents in HMP Elmley who were prescribed ADHD medication on 4th November 2019, using their electronic patient records. Appointments with the psychiatrists were then subdivided into initial assessments and follow-up appointments for the purpose of analysis. Performance was measured against NICE Guideline [NG87]: Attention deficit hyperactivity disorder: diagnosis and management. We also calculated the waiting times for initial appointment and follow-up appointment.ResultWe found that 33 of residents were on ADHD medication at the time of the audit, approximately 3% of the prison population. 64% of those had a pre-existing diagnosis and 36% had been given a new diagnosis at HMP Elmley. Of those newly diagnosed 100% had undergone a Diagnostic Interview for Adults in ADHD (DIVA) assessment for diagnosis.Baseline physical health checks had been performed in 68% of patients prior to starting medication and a cardiovascular examination had occurred in 9%. At follow-up 100% of patients had their physical observations and weight checked and their symptoms reviewed.91% of patients were started on methylphenidate or lisdexamfetamine as first line treatment, with the rest started on atomoxetine and the reason for this documented.100% patients were offered general psychological support.There was a mean 22 day wait for an initial appointment (range 0-65) and a mean 20 day wait from starting medication to a psychiatric follow-up appointment (range 8-37)ConclusionThe number of residents treated for ADHD in HMP Elmley is relatively low (3%) compared to the estimated prevalence in prison population.The key areas for improvement are in baseline cardiovascular examinations and physical health evaluations. The waiting time between initial psychiatric appointment and follow-up is another area where improvement is needed and this will form the basis of a quality improvement project.Future steps include setting up a specific ADHD clinic with an allocated nurse practitioner to support, producing a template for ADHD assessments and follow-ups, producing a local policy on ADHD and developing specific resources for ADHD psychoeducation.

Usefulness of Exercise Stress Testing for Prediction of Blood Pressure Trends

PEDIATRICS ◽  
1985 ◽  
Vol 75 (6) ◽  
pp. 1071-1075
Author(s):  
David E. Fixler ◽  
W. Pennock Laird ◽  
Kent Dana
Keyword(s):  
Blood Pressure ◽  
Stress Testing ◽  
Isometric Exercise ◽  
Systolic Pressure ◽  
Exercise Stress ◽  
Female Adolescents ◽  
Exercise Stress Testing ◽  
Stress Tests ◽  
Blood Pressures

The purpose of this study was to determine whether values of blood pressure during exercise help predict which adolescents are prone to maintain high blood pressure. Dynamic and isometric exercise stress tests were performed on 131 adolescents who had had systolic or diastolic pressures greater than the 95th percentile on three examinations the previous year. Follow-up blood pressures were measured 1 year after the stress testing, and outcomes were classified on the basis of the blood pressure status that year. Stepwise regression analysis was used to examine the association between earlier blood pressures and exercise pressures with outcome pressures. In both male and female adolescents, the average resting systolic pressure on the earlier survey was the best predictor of systolic pressure 2 years later. Blood pressures and heart rates during dynamic and isometric exercise did not significantly contribute to the models' prediction of future systolic or diastolic pressures. The data suggest that exercise stress testing is not a valid method for predicting youths whose blood pressures will remain elevated over the next 1 to 2 years.

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