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Article
Hyperprolactinaemia: when MRI is indicated?

Author: Wasan I. Majeed
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2009 Volume: 8 Issue: 1 Pages: 59-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Design This prospective study was carried out at the magnetic resonance imaging (MRI) unit at the department of diagnostic imaging of Al-Kadhmiya Teaching Hospital over a period of 26 months. Objective: To establish a strategy for the use of MRI of the pituitary region in patients with hyperprolactinaemia based on the possibility of finding a pathology in the pituitary region as a cause of hyperprolactinaemia with respect to serum prolactin (PRL) as well as the analysis of serum PRL in relation to the size of adenoma in the pre & post medical treatment evaluation to determine the need for MRI in the follow up in patients with pituitary adenoma. Subjects & Methods We selected 69 women recently found to have clinical & biochemical evidence of hyperprolactinaemia with serum PRL exceeding the double the upper normal level of the control. MRI of the pituitary region & serum PRL were assessed at the initial presentation for all patients & after the institution of bromocriptine (BRC) treatment for 28 patients who were shown to have either micro or macroadenomas at the initial MRI. The diameter of the adenoma served as a predictor for its size & was considered for correlation with serum PRL level at the follow up period of 3 , 6 & 12 months of treatment. Results At the initial MRI, 27 patients had microadenomas (39.1%), 12 patients had macroadenomas (17.4%), 9 patients had empty sella turcica (13.1%), and 21 patients (30.4%) had no obvious abnormality in the pituitary region The analysis of individual serum PRL level to establish a cut-off point of serum PRL above which all cases were positive for a pathology in the pituitary region on MR imaging, revealed a cut-off value = 84.6 ng/ml. A strong correlation has been found between the size of adenoma and serum PRL level at the initial presentation as well as at the follow up assessment that revealed a parallel reduction in adenoma diameter & serum PRL level. Conclusion MRI of the pituitary region is justifiable in women with hyper-prolactinaemia when serum PRL level is approximately two & a half folds of the upper normal level where its likely to reveal an abnormality , but it should not be used routinely for the follow up of patients on treatment as the assessment of serum PRL level will suffice as a predictor of tumor shrinkage unless there is no response to medical treatment or the patient developed new symptoms that suggest increase in the size of the adenoma or involvement of the surrounding structures.


Article
Hyperprolactinaemia: when MRI is indicated?

Authors: Wasan I. Majeed --- Mohammed Abd Kadhim
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2008 Volume: 7 Issue: 2 Pages: 59-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Design: This prospective study was carried out at the magnetic resonance imaging (MRI) unit at the department of diagnostic imaging of Al-Kadhmiya Teaching Hospital over a period of 26 months. Objective: To establish a strategy for the use of MRI of the pituitary region in patients with hyperprolactinaemia based on the possibility of finding a pathology in the pituitary region as a cause of hyperprolactinaemia with respect to serum prolactin (PRL) as well as the analysis of serum PRL in relation to the size of adenoma in the pre & post medical treatment evaluation to determine the need for MRI in the follow up in patients with pituitary adenoma. Subjects & Methods: We selected 69 women recently found to have clinical & biochemical evidence of hyperprolactinaemia with serum PRL exceeding the double the upper normal level of the control. MRI of the pituitary region & serum PRL were assessed at the initial presentation for all patients & after the institution of bromocriptine (BRC) treatment for 28 patients who were shown to have either micro or macroadenomas at the initial MRI. The diameter of the adenoma served as a predictor for its size & was considered for correlation with serum PRL level at the follow up period of 3 , 6 & 12 months of treatment. Results: At the initial MRI, 27 patients had microadenomas (39.1%), 12 patients had macroadenomas (17.4%), 9 patients had empty sella turcica (13.1%), and 21 patients (30.4%) had no obvious abnormality in the pituitary region The analysis of individual serum PRL level to establish a cut-off point of serum PRL above which all cases were positive for a pathology in the pituitary region on MR imaging, revealed a cut-off value = 84.6 ng/ml. A strong correlation has been found between the size of adenoma and serum PRL level at the initial presentation as well as at the follow up assessment that revealed a parallel reduction in adenoma diameter & serum PRL level. Conclusion: MRI of the pituitary region is justifiable in women with hyper-prolactinaemia when serum PRL level is approximately two & a half folds of the upper normal level where its likely to reveal an abnormality , but it should not be used routinely for the follow up of patients on treatment as the assessment of serum PRL level will suffice as a predictor of tumor shrinkage unless there is no response to medical treatment or the patient developed new symptoms that suggest increase in the size of the adenoma or involvement of the surrounding structures.


Article
THE RELATIONSHIP BETWEEN UMBILICAL VENOUS BLOOD FLOW & FETAL WEIGHT IN THE LAST TRIMESTER
العلاقة بين حجم جريان الدم في وريد الحبل السري ووزن الجنين في الفصل ألأخير من الحمل

Authors: Abir T. Makki عبير طالب مكي --- Wasan I. Majeed وسن إسماعيل مجيد --- Maha M. Al-Bayati مها محمد ألبياتي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2009 Volume: 7 Issue: 4 Pages: 4-10
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Doppler applications in pregnancy are expanding exponentially. Flow velocity waveforms provide important information from 12 weeks to term, from maternal vessels, placental circulation and fetal systemic vessels. An important application is the quantitative calculation of umbilical blood flow volume.Objective: to assess the relation between the umbilical blood flow at one hand & fetal body weight & placenta weight on the other hand in the last trimester in both term & preterm labor groups Study design: A prospective study Setting: department of Gynecology & Obstetrics & Department of Radiology at Al-Kadhimiya Teaching Hospital Patients & methods: This study included 50 pregnant women at first stage of labor. The patients were classified into two groups; group A: Infants born at < 37 weeks of gestation and group B: those infants born at 37 weeks of gestation .The diameter of the umbilical vein was determined by ultrasound & spectral Doppler was used to assess velocity of blood in the umbilical vein & the umbilical blood flow (UBF) per unit fetal body weight & placental weight estimated in both groups. Results : A statistically significant difference was found in the diameter of the umbilical vein (7.84 mm vs. 8.62 mm , p=0.0001) , the volume of umbilical blood flow (410.22 mL/min vs. 523.20 mL/min, p=0.0001), UBF/Fetal weight (230.68 mL/min/kg vs. 166.79 mL/min/kg , p=0.0001 ) & UBF/Placental weight(102.65 mL/min/100gm vs. 87.23 mL/min/100gm , p=0.01) of group A & group B respectively while the mean velocity of blood flow in the umbilical vein showed no statistically significant difference in both groups (14.11 cm/s vs. 14.93 cm/s , P=0.8).Conclusion: The increase in umbilical blood flow is exceeded by the fetal growth and to a lesser degree by placenta growth. A significant reduction in the umbilical blood flow per unit fetal weight & placental weight take place with increasing gestational age. Keywords: umbilical venous blood flow, fetal body weight, placental weight

خلفية الدراسة : بدأ فحص الدوبلر بالتطور بسرعه في مجال فحوصات ألحمل وظهر أن موجات جريان ألدم توفر معلومات مهمة ابتداء من الاسبوع الثاني عشر للحمل وحتى نهايته من ألأوعيه الدموية للأم واوعية المشيمه والجنين . ومن أهم ألتطبيقات هو مقدار كمية الدم الجارية في ألأوعية ألدموية في الحبل السري هدف ألدراسة: تحديد العلاقة بين حجم جريان الدم في وريد الحبل السري من جهة و بين وزن الجنين ووزن المشيمة من جهه أخرى في الفصل ألأخير من الحمل في حالات ألولادات المبكرة والولادات الكاملةتصميم ألدراسة: دراسه توقعية مكان إجراء الدراسة : قسم النسائية والتوليد وقسم ألأشعة ألتشخيصية في مستشفى الكاظمية التعليميالأشخاص وطرائق العمل : ضمت ألدراسة خمسون سيده حامل خلال المرحله ألأولى من ألولاده . تم تقسيم ألمرضى ألى مجموعتين , مجموعة " أ" :ألأطفال المولودين أقل من 37 أسبوع من ألحمل , ومجموع’ "ب": ألأطفال ألمولودين أكثر من 37 أسبوع من ألحمل . تم قياس قطر وريد ألحبل السري باستخدام فحس الموجات فوق الصوتية التقليدي وأجري فحص ألدوبلر ألموجي لقياس سرعة وحجم جريان ألدم في وريد ألحبل ألسري لكل وحده من وزن ألجنين ووزن ألمشيمة في مجموعتي ألدراسة .ألنتائـج: ظهر فرق احصائي مهم بين كل من : قطر وريد الحبل ألسري (7.84 ملم مقابل 8.62 ملم , قيمة p =0.0001 ) ,حجم جريان ألدم في وريد الحبل ألسري (410.22 مل/دقيقة مقابل 523.2 مل/دقيقة , قيمة p = 0.0001) , حجم جريان ألدم في وريد ألحبل ألسري لكل وحده من وزن الجنين (230.68 مل/دقيقة/كغم مقابل 166.79 مل/دقيقة/كغم , قيمة p = 0.0001) , حجم جريان ألدم في وريد ألحبل ألسري لكل وحدة من وزن ألمشيمة (102,65 مل/دقيقة/100 غم مقابل 87.23 مل/دقيقة/100 غم , قيمة p = 0.01) لمجموعة "أ" و "ب" على ألتوالي ,في حين أن سرعة جريان ألدم لم تظهر أي أهمية أحصائية بين ألمجموعتين (14.11 سم /ثانية مقابل 14.93 سم /ثانية , قيمة p = 0.8 )الإستنــتاج: نسبة زيادة حجم جريان الدم في وريد الحبل السري هي اقل من ألزيادة ألحاصلة في وزن الجنين و ألمشيمة . يتحقق أنخفاض مهم في حجم جريان ألدم بألتناسب مع وزن الجنين مع تقدم مدة الحمل مفتاح الكلمات: جريان الدم في وريد الحبل السري , وزن الجنين , وزن ألمشيمة

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