Faculty Bibliography

OBJECTIVE: Macrosomia at term is associated with increased maternal and neonatal morbidity, including a higher rate of cesarean delivery and shoulder dystocia. Induction of labor has been suggested as a means to prevent further weight gain and improve outcome. The aim of this study was to determine whether or not induction of labor in these cases improves maternal and neonatal outcome. METHODS: Patients at term with an ultrasonic fetal weight estimation of 4000-4500 g were prospectively randomized into two groups: induction of labor (group D and expectant management (group II). Patients with diabetes, a previous cesarean delivery, or nonvertex presentation were excluded. Outcome variables included mode of delivery, arterial cord pH, presence of shoulder dystocia, brachial plexus injury, clavicular fracture, cephalohematoma, and intraventricular hemorrhage. RESULTS: Of 273 patients who were eligible for the study, 134 were randomized to group I and 139 to group II. Parity, gestational age, and fetal weight estimation were similar in the two groups. The neonates of group II patients were significantly heavier (4132.8 +/- 347.4 versus 4062.8 +/- 306.9 g; P = .024). The rate of cesarean delivery was 19.4% in group I and 21.6% in group II patients (not significant [NS]). Cord pH was similar in both groups. Shoulder dystocia was diagnosed in five group I and six group II patients (NS). None developed brachial plexus injury. There were two cases of mild, transient brachial plexus injury in group II patients without documented shoulder dystocia. Mild intraventricular hemorrhage was diagnosed in three of 44 group I and two of 31 group II neonates evaluated (NS). CONCLUSION: In this prospective, randomized study, induction of labor for suspected macrosomia at term did not decrease the rate of cesarean delivery or reduce neonatal morbidity. Ultrasonic estimation of fetal weight between 4000 and 4500 g should not be considered an indication for induction of labor

We report acquisition of 3D image-guided localized proton spectroscopy (1H-MRS) in the human brain on a standard clinical imager. 3D coverage is achieved with a hybrid of chemical shift imaging (CSI) and transverse Hadamard spectroscopic imaging (HSI). 16 x 16 x 4 arrays of 3.5 and 1 ml voxels were obtained in 27 min. The spatially selective HSI 90 degrees pulses incorporate naturally into a PRESS double spin-echo sequence to subdivide the VOI into four partitions along its short axis. 2D CSI (16 x 16) is performed along the other long axes. Because the hybrid excites the spins in the entire VOI, a square-root-N signal-to-noise-ratio (SNR) gain per given examination time is realized compared with sequentially interleaving N 2D slices. A two-fold gain in sensitivity is demonstrated in the brain for N = 4

Refocused insensitive nucleus enhancement by polarization transfer (RINEPT) from protons (1H) to a J-coupled phosphorus (31P) has been incorporated into three-dimensional (3D) chemical-shift-imaging (CSI) sequence on a clinical imager. The technique is demonstrated on a phantom and in in vivo human brain. The polarization-transfer efficiency (approximately 1.2) is lower than the theoretical maximum of gamma1H/gamma31P approximately 2.4 resulting from 1H-1H homonuclear J couplings of similar magnitude competing with the 1H --> 31P transfer. Nevertheless, compared with direct 31P Ernst-angle excitation, signal gains of up to x1.8 were obtained mainly as a result of T1 differences between 31P and the 1H. Spectral interpretation is simplified by editing out all non-proton-coupled 31P signals. The duration, approximately 50 min, and power deposition, approximately 1 W x kg(-1), make the application suitable for human studies

Simultaneous acquisition of 1H-decoupled 31P and 19F 3D CSI is demonstrated in the liver of a patient undergoing 5-fluorouracil chemotherapy. Both 31P and 19F shared the same voxel size (64 or 27 ml), bi-level 1H-decoupling and 0.35 s TR. The measurements were done in a 1.5 Tesla clinical imager with three radio-frequency (RF) channels and a triple-tuned surface-coil. The overall MRI and MRS examination time was under 90 min. Simultaneous acquisition of 31P and 19F permits localized study of the influence of hepatic metabolism on the uptake and catabolism of fluoropyrimidine drugs without extra measurement time or higher SAR

The mechanism of the contractile effect of domperidone on gallbladder smooth muscle has been investigated by using an in-vivo and an in-vitro model. In the in-vivo part of the study 14 healthy males were administered 20 mg domperidone or two placebo tablets orally and gallbladder emptying was measured by ultrasonography. The reduction in the gallbladder volume was significant compared to the placebo at 45 and 55 min. In the in-vitro part of the study, the gallbladder strips isolated from guinea pigs were field stimulated and 10(-6)-10(-4) M concentrations of dopamine were administered before electrical field stimulation (EFS) was repeated. Dopamine exerted no significant effect upon the contractions obtained by EFS. The effect of dopamine and domperidone under basal conditions were also explored. Under basal conditions, dopamine neither contracted nor relaxed the gallbladder muscle between 10(-6) and 10(-4) M concentrations when added directly to the organ bath. Besides, a significant contraction was observed with 10(-4) M concentration of domperidone whereas 10(-7), 10(-6) and 10(-5) M concentrations exerted no effect. This effect of domperidone was thought to be nonspecific but inhibited by 10(-6) M atropine, 10(-5) M pirenzepine and abolished by 10(-6) M tetrodotoxin. In summary, domperidone produces a modest contraction in human gallbladder. This effect does not seem to occur upon dopaminergic receptors in guinea pig models

Simultaneous multivoxel 31P and 19F 3D localized NMR spectroscopy is demonstrated on a phantom and in the liver of patients undergoing bolus-infusion 5-fluorouracil chemotherapy. The 19F and 31P spectra were localized with 8 x 8 x 8 3D chemical-shift imaging, with both nuclei sharing the same field of view and voxel size (27 and 64 ml in phantom and liver, respectively) using a 1.5-Tesla clinical imager with two RF channels and a dual-tuned surface coil. The repetition time (TR = 0.26 s) and Ernst nutation angles (theta E = 32 degrees for 19F, 28 degrees for 31P) were chosen to optimize the signal-to-noise ratio (SNR) per-unit time for the 0.5- to 2-s T1 range of the 19F and 31P metabolites of interest. The overall examination time, including tuning, imaging, shimming and dual-nuclear spectroscopy, was under 90 min. Simultaneous acquisition of 31P and 19F spectra will permit the study of the influence of hepatic and/or tumor metabolism on the uptake and catabolism of fluoropyrimidine drugs with no extra measurement time