Careful Ultrasonography Research Articles

Strawberry gallbladder: a velvety carpet of surgical anguish

Cholesterolosis is an uncommon pathologic finding of the gallbladder. The etiopathogenesis is not yet clear but it is proposed that it occurs due to increased cholesterol uptake from supersaturated bile. One must try to make a preoperative diagnosis by careful ultrasonography. Laparoscopic cholecystectomy is the gold standard treatment in symptomatic cases whereas asymptomatic patients can be treated conservatively as a case of functional dyspepsia.

Whether to transfer mosaic embryos: a cytogenetic view of true mosaicism by amniocentesis

Research questionPreimplantation genetic testing for aneuploidies has increasingly been employed for embryo selection, resulting in a recent surge in mosaic embryos. According to the cytogenetic results, which types of mosaic embryo survive early pregnancy, progress to the second trimester and finally result in a live birth? DesignThis study evaluated 30,587 pregnant women undergoing amniocentesis from January 2004 to March 2020 at the cytogenic centre of Kaohsiung Chang Gung Memorial Hospital. Samples from amniocentesis were cultured using the in-situ method. The types and distribution of level III chromosomal mosaicism (two or more cells with the same abnormality in two or more colonies and both culture dishes, clinically referred to as ‘true mosaicism’) were retrospectively reviewed. ResultsAmong the 30,587 women, 78 cases (0.26%) of level III chromosomal mosaicism were identified. The types of chromosomal mosaicism were classified as sex chromosome mosaicism (SCM), autosomal chromosome mosaicism (ACM) and marker chromosome mosaicism (MCM), with SCM, ACM and MCM accounting for 58.97%, 32.05% and 8.97% of cases, respectively. The most common mosaic cell lines were monosomy X and trisomy 21. The most common mosaic cell line progressing to live birth was monosomy X. ConclusionsMosaic monosomy X and trisomy 21 are the most common cell lines of true mosaicism determined by amniocentesis. Monosomy X mosaicism is the most common cell line in live births. For women considering the transfer of these types of mosaic embryo in a circumstance where euploid embryos are unavailable, clinicians should provide careful prenatal counselling, detailed ultrasonography and amniocentesis.

Careful medical interview and ultrasonography enabled detection of acute kidney injury and hematoma after lumbar trigger point injection\u2014a case report

BackgroundTrigger point blocks are now widely practiced, especially in pain treatment. Among the complications of lumbar trigger point injection, reports of medically induced kidney injury are very rare, and diagnosis during emergency treatment is rare.Case presentationA 78-year-old woman on antiplatelet medication following a stroke was diagnosed with treatable type A aortic dissection at another hospital after undergoing lumbar trigger point injection. On arrival at our hospital, there were no signs of hemodynamic deterioration. Additional careful medical re-interview and ultrasonography by anesthesiologists enabled a definitive diagnosis of acute kidney damage and hematoma caused by lumbar trigger point injection, and aortic dissection surgery was abandoned.ConclusionThis clinical case demonstrates the importance of awareness of potential kidney injury and hematoma during lumbar trigger point injection.

MP54-16 FAVORABLE PROGNOSIS IN END-STAGE RENAL DISEASE PATIENTS WITH RENAL CELL CARCINOMA: A LONG-TERM FOLLOW-UP STUDY IN A SINGLE INSTITUTION

You have accessJournal of UrologyKidney Cancer: Localized III1 Apr 2014MP54-16 FAVORABLE PROGNOSIS IN END-STAGE RENAL DISEASE PATIENTS WITH RENAL CELL CARCINOMA: A LONG-TERM FOLLOW-UP STUDY IN A SINGLE INSTITUTION Yoshihiro Ikeda, Yoshio Terasawa, Shinichi Yamashita, Takashi Kudo, Masataka Aizawa, Hisanobu Adachi, Mareyuki Endo, Kensuke Joh, Naomasa Ioritani, and Seiichi Orikasa Yoshihiro IkedaYoshihiro Ikeda More articles by this author , Yoshio TerasawaYoshio Terasawa More articles by this author , Shinichi YamashitaShinichi Yamashita More articles by this author , Takashi KudoTakashi Kudo More articles by this author , Masataka AizawaMasataka Aizawa More articles by this author , Hisanobu AdachiHisanobu Adachi More articles by this author , Mareyuki EndoMareyuki Endo More articles by this author , Kensuke JohKensuke Joh More articles by this author , Naomasa IoritaniNaomasa Ioritani More articles by this author , and Seiichi OrikasaSeiichi Orikasa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1605AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Patients with end-stage renal disease (ESRD) show an increased risk of renal cell carcinoma (RCC). Some recent reports have revealed better prognosis for ESRD-RCC than for sporadic RCC. We have achieved successful long-term results for RCC patients with ESRD, and evaluated clinical characteristics and oncological outcomes of ESRD-RCC in this study. Methods From November 1985 to January 2013, 187 male and 33 female patients with ESRD-RCC underwent radical nephrectomy in our institute. All patients showed a dialysis status of chronic renal failure at the time of diagnosis. Information about age, sex, symptoms, duration of dialysis therapy, tumor staging and grading, histological subtype and outcome were recorded. Survival was assessed using Kaplan-Meier methods. Results Symptomatic RCC was only seen in 22 cases (10.0%), and gross hematuria was the most frequent complaint (13 cases). Incidental cases comprised 198 (90.0%), with 152 cases (88.2%) diagnosed on routine screening ultrasonography. Radical nephrectomy was performed in 270 cases, and mean age at operation was 55.0}11.0 years. Bilateral RCC was observed in 54 patients (24.5%). Mean duration of dialysis before surgery was 154.1}92.5 months, and mean follow-up period was 90.0}71.9 months. Pathological tumor stage was stage 1 in 265 kidneys (98.1%), and mean maximum tumor size was 2.2}1.3 cm. Eight patients showed advanced RCC, and 1 patient died from renal cancer. Twenty-two patients died from other causes. Estimated 5- and 10-year cancer-specific survival rates were both 99.6%. Five- and 10-year recurrence-free survival rates were 95.5% and 94.8%, respectively. Conclusions RCC arising in native kidneys of dialyzed patients seems to show favorable outcomes. In our institute, most ESRD patients were identified under routine screening ultrasonography and detected in the early stage with small diameter RCC. Careful and regular screening ultrasonography seems important for better survival of ESRD patients with RCC. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e578 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Yoshihiro Ikeda More articles by this author Yoshio Terasawa More articles by this author Shinichi Yamashita More articles by this author Takashi Kudo More articles by this author Masataka Aizawa More articles by this author Hisanobu Adachi More articles by this author Mareyuki Endo More articles by this author Kensuke Joh More articles by this author Naomasa Ioritani More articles by this author Seiichi Orikasa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Management of Postoperative Complications Following Splenectomy

Complications of post-splenectomy, especially intra-abdominal hemorrhage can be fatal, with delayed or inadequate treatment having a high mortality rate. The objective of this study was to investigate the cause, prompt diagnosis, and outcome of the fatal complications after splenectomy with a focus on early diagnosis and management of hemorrhage after splenectomy. The medical files of patients who underwent splenectomy between January 1990 and March 2011 were reviewed retrospectively. The cause, characteristics, management, and outcome in patients with post-splenectomy hemorrhage were analyzed. Fourteen of 604 patients (1.19%) undergoing splenectomy had intraperitoneal hemorrhage: reoperation was performed in 13 patients, and 3 patients died after reoperation, giving the hospital a mortality rate of 21.43%; whereas, 590 of 604 patients (98%) had no hemorrhage following splenectomy, and the mortality rate (0.34%) in this group was significantly lower (P < 0.001). The complications following splenectomy, including pneumonia pancreatitis, gastric fistula, gastric flatulence, and thrombocytosis, in patients with postoperative hemorrhage were significantly higher than those without hemorrhage (P < 0.001). According to the reasons for splenectomy, 14 patients with post-splenectomy hemorrhage were grouped into two groups: splenic trauma (n = 9, group I) and portal hypertension (n = 5, group II). The median interval between splenectomy and diagnosis of hemorrhage was 15.5 hours (range, 7.25-19.5 hours). No differences were found between groups I and II in terms of incidence of postoperative hemorrhage, time of hemorrhage after splenectomy, volume of hemorrhage, and mortality of hemorrhage, except transfusion. Intra-abdominal hemorrhage after splenectomy is associated with higher hospital mortality rate and complications. Early massive intraperitoneal hemorrhage is often preceded by earlier sentinel bleeding; careful clinical inquiry and ultrasonography are the mainstays of early diagnosis.

Pentalogy of Cantrell diagnosed in the first trimester of pregnancy

Introduction: Pentalogy of cantrell is a rare syndrome of unknown etiology characterized by multiple structural congenital anomalies. case report: We aimed to present an early diagnosed case of pentalogy of cantrell accompanied by craniorachischisis. conclusion: Pentalogy of cantrell can be diagnosed with a careful ultrasonography in the first trimester. Potential side effects of pregnancy termination to the mother can be reduced by the early diagnose of the disease.

Bilateral phacomorphic angle-closure glaucoma in a highly myopic patient secondary to isolated spherophakia

Background Angle closure most commonly occurs in older hyperopic patients as a result of primary relative pupil block. Less frequently, angle closure occurs in highly myopic patients with conditions other than primary relative pupil block. This report presents the diagnosis, pathophysiologic mechanism, and management of a patient with both high myopia and bilateral advanced phacomorphic angle-closure glaucoma caused by isolated spherophakia. Case A 40-year-old asymptomatic man with very high myopic astigmatism presented with chronic angle closure and an intraocular pressure of 42 mmHg in both eyes. Additionally there was a nonmyopic fundus and 24-mm axial length, with a clear crystalline lens protruding through the pupillary plane in each eye, confirmed by B-scan ultrasonography. Gonioscopy and A-scan and B-scan ultrasonography identified the pathogenesis of intraocular pressure elevation, angle closure, and high myopia to be lenticular in origin. Initial medical therapy and subsequent laser iridotomy relieved the pupil block angle closure and successfully lowered intraocular pressure. Conclusion Angle closure can occur in highly myopic eyes. Careful gonioscopy and ultrasonography can lead to the correct diagnosis and tailored management for these eyes. Phacomorphic angle-closure glaucoma from spherophakia is associated with Weill-Marchesani syndrome as well as a few other uncommon syndromes. Isolated pseudophakia is a rarely reported cause of phacomorphic angle closure.

Soft-Tissue Sarcomas in the Inguinal Region May Present as Deep Vein Thrombosis

Swelling, pain, and discoloration in the affected extremities are classic symptoms of deep vein thrombosis (DVT), although these symptoms are often unreliable for diagnosis, and wide differential diagnoses exist. Soft-tissue sarcomas arising in the inguinal region may encompass or be adjacent to femoral vessels and result in venous obstruction, mimicking symptoms of DVT. Wepresent two cases of soft-tissue sarcomas in the inguinal region that were initially misdiagnosed as spontaneous DVT and administered unnecessary long-term anticoagulation therapy. Inpatients diagnosed with unprovoked DVT, especially young patients aged <45 years, we recommend a careful physical examination and ultrasonography in the inguinal region to prevent overlooking possible underlying malignancy, as delays in diagnosis may affect prognosis.

Optimization of Minimally Invasive Radio-Guided Parathyroidectomy: The Importance of Neck Ultrasonography and Intraoperative Parathyroid Hormone Assay

To determine whether close collaboration between a neck ultrasound-certified endocrinologist and a skilled endocrine surgeon can optimize minimally invasive radio-guided parathyroidectomy (MIRP) surgical outcomes. Outcome data were collected on patients with primary hyperparathyroidism whom we intended to treat with MIRP at the induction of anesthesia between October 1, 2005, and December 31, 2007. Patients underwent preoperative gamma camera sestamibi scanning (GCSS), intraoperative gamma probe sestamibi scanning (IOSS), and preoperative neck ultrasonography. Intraoperative parathyroid hormone (PTH) monitoring was performed. Postoperative surgical success was defined as a serum calcium concentration between 8.0 and 10.4 mg/dL within 4 weeks of surgery. During the study period, MIRP was planned for 46 patients. Of the 46 patients, 39 had preoperative neck ultrasonography; 7 underwent evaluation by an endocrinologist or internist who was not ultrasound certified and they therefore did not undergo preoperative ultrasonography. IOSS correctly identified 1 adenomatous gland in 38 of 46 patients (83%), while GCSS correctly localized 1 adenomatous gland in 30 of 46 patients (65%). In 11 GCSS-negative patients, IOSS identified the abnormal gland in 7 (64%), while ultrasonography identified the abnormal gland in 8 (73%). The surgical approach was converted to traditional parathyroidectomy in 3 patients. Every patient exhibited at least a 51% drop in intraoperative PTH levels with resection of the final adenoma; average decrement for the entire group was 79 +/- 8% from the highest baseline level. Forty-five patients (98%) demonstrated sustained normalization of serum calcium within several days of surgery. A collaborative endocrinology and surgical endocrine oncology practice arrangement, emphasizing careful preoperative physician-supervised neck ultrasonography and the use of intraoperative PTH measurement, optimizes MIRP outcomes.

Orbital pseudotumor: Distinct diagnostic features and management

Purpose:To provide an overview of the spectrum of diseases known as ‘idiopathic orbital inflammatory syndrome’ also known as orbital pseudotumor, with emphasis on specific diagnostic challenges in the evaluation and management of patients with this disorder.Methods:Review of the relevant literature and summarize recent findings regarding the epidemiology, diagnosis, pathophysiology and treatment of orbital pseudotumor.Results:Orbital pseudotumor is a benign intraorbital process confined to the orbit but extra orbital involvement can occur. It is among the 3rd most common orbital diseases along with thyroid orbitopathy and lymphoproliferative disorder and accounts for 5-10% of orbital processes. Clinically, orbital pseudotumor has been categorized as myositis, dacryoadenitis, anterior, apical and diffuse process. Patients may present with diplopia, conjunctival chemosis, proptosis or abnormal computed tomography scan (CT-scan) findings. Patients may also have associated optic neuropathy. Diagnosis is based on careful history, ultrasonography (U/S), CT-scan and magnetic resonance imaging (MRI) studies which may also provide prognostic information. Treatment consists of systemic corticosteroids in the form of oral or intravenous administration. Confirmation is made by orbital biopsy. In addition to radiation, cytotoxic agents, immunosuppressant, IV immunoglobulin, biological therapy, TNF-alpha inhibitor monoclonal antibody and Mycophenolate Moftil have been found to be useful in the management of refractory orbital pseudotumor.Conclusion:Understanding of the clinical features of patients with orbital pseudotumor, differentiating it from other orbital processes by use of imaging techniques and timely implementation of available treatment strategies may help prevent visual loss and associated morbidity from this condition.

Prise en charge obstétricale après grossesse ectopique intracicatricielle: à propos d'un cas et revue de la littérature

We report the case of a patient who came out pregnancy twelve months after medical and surgical treatment of an ectopic pregnancy in a previous caesarean section scar. The preconceptional management consisted in a saline infusion sonohysterography and a pelvic magnetic resonance imaging. Judging the risks of abnormal placental insertion to be higher in this case compared to a simple caesarean section, a careful ultrasonography with color doppler imaging was carried out. The myometrium fragility caused by the ectopic pregnancy in the caesarean section brought us to recommend a prophylactic caesarean section around 37. The high risks of hemorrhage required a medical center with embolization possibilities. A review of literature in order to define the medical care adapted in this case was come out.

Micturating cystourethrograms are not necessary for all cases of antenatally diagnosed hydronephrosis

Objective Since 1995 we have, at our centre, adopted a selective approach to performing micturating cystourethrograms (MCUGs) on patients with antenatally diagnosed hydronephrosis. This study reviews the outcome of this policy. Methods We carry out MCUGs only if any of the following features are present on ultrasound: bilateral hydronephrosis, ureteric dilatation, renal scarring, bladder wall thickness greater than 5 mm, or presence of a duplex system or ureterocele. Patients with simple unilateral hydronephrosis are excluded, and are managed with 6 months’ trimethoprim prophylaxis and ultrasound surveillance with a minimum of 3 years’ follow up. Results Fifty-five patients were referred with an antenatal diagnosis of hydronephrosis between 1999 and 2002; 26 (47%) did not have an MCUG. Of these, five had increasing hydronephrosis and required surgery for pelvi-ureteric junction obstruction, and three had a multicystic dysplastic kidney on postnatal scanning. In the remaining 18 patients, the hydronephrosis resolved spontaneously, with no renal scars or asymmetry. During follow up, none of these patients had a urinary tract infection. Conclusion We believe that vesico-ureteric reflux in most antenatally diagnosed hydronephrotic kidneys is physiological rather than pathological, and resolves with time without causing long-term renal damage. This is a separate entity from, rather than a precursor of, the pathological symptomatic refluxing kidney in older, mainly female children. Taking a more conservative approach to the postnatal investigation of antenatally diagnosed hydronephrotic kidneys has not resulted in any missed damaged kidneys, but has reduced the number of invasive investigations performed. A careful protocol and detailed postnatal ultrasonography are important to prevent missed pathological cases.

Fetal mesenchymal hamartoma of the liver: Report of a case

The authors report a case of hepatic mesenchymal hamartoma diagnosed prenatally with ultrasound scan and magnetic resonance imaging (MRI) and confirmed histologically postdelivery. The fetus had a multicystic mass in the left upper abdomen, which showed a rapid enlargement accompanying maternal hypertension and preterm labor. The patient was delivered by cesarian section at 30 weeks and 5 days weighing 1,190 g, and, at birth, a large abdominal mass and severe anemia were noted. Surgical resection and neonatal management were successful, and the patient is alive in a good condition after 3 years follow-up. Although histologically benign, because this lesion frequently results in perinatal complications such as fetal hydrops, maternal toxemia, and preterm labor, early careful fetal ultrasonography should improve the prognosis of this lesion.

Cystic Thyroid Nodules: Diagnostic and Therapeutic Dilemmas

Cystic thyroid nodules are common, comprising as many as 40% of thyroid nodules encountered by the endocrinologist. Their differential diagnosis is relatively broad and includes lesions that may not fit a stereotypical presentation, such as intrathyroidal thyroglossal duct cysts, branchial cleft cysts that are close to the midline, and cystic lesions that are malignant. Benign cystic thyroid nodules not infrequently present with symptoms and signs that mimic an aggressive thyroid cancer, including pressure symptoms and rapid growth; however, a cystic papillary thyroid carcinoma may provide few clues of its malignant nature, including a soft consistency to palpation and little or no apparent growth over the course of several years. The physical and biochemical features of the aspirated fluid of a nodule provide little diagnostic information; both benign and malignant lesions may yield grossly bloody aspirates or translucent yellow fluid. Cystic thyroid nodules not only have a higher than usual likelihood of yielding cytology specimens that are inadequate for diagnosis but also have higher than usual rates of false-negative cytology specimens. However, using a careful clinical assessment, ultrasonography, Doppler studies and ultrasound-guided fine-needle aspiration biopsy, the malignant or benign nature of most cystic thyroid nodules can be identified. This article reviews the differential diagnosis, diagnostic approach, and treatment of cystic nodules.

A case of transverse testicular ectopia with Müllerian duct remnant

Transverse testicular ectopia (TTE) associated with persistent müllerian duct (PMD) is a rare genitourinary anomaly. The authors report a case with a review of the literature and stress the importance of careful physical examination and ultrasonography in making a correct preoperative diagnosis of TTE. One should be careful not to miss the tiny PMD structure at the operation. Transseptal orchidopexy is the surgical treatment of choice. J Pediatr Surg 36:1710-1712. Copyright © 2001 by W.B. Saunders Company.

Antenatal renal pelvic measurements: what do they mean?

To analyse data on cases with urological abnormalities recorded over a 15-year period (1984-98) by the Northern Region Congenital Abnormality Survey (NorCAS), with special reference to fetal renal pelvic measurements. Data on all urological cases recorded in the NorCAS database and in notification documents forwarded from hospitals in the Northern Region were extracted and incorporated in a separate unattributable database for analysis. Specific fields for filing recorded fetal renal pelvic measurements with their corresponding gestational ages were inserted; it was ensured as far as possible that these measurements were made in the anteroposterior plane. The total number of cases analysed was 2737; a measurement of the fetal renal pelvis was recorded in 813, and more than once in 468, giving 1301 measurement episodes with the corresponding gestational ages, pregnancy and postnatal outcome. The male/female (M/F) ratio was significantly higher in those cases which had a fetal renal pelvic measurement recorded than in those which had not. This was because there was a 12/1 M/F ratio in measured cases of vesico-ureteric reflux (VUR). Few cases of VUR had a fetal renal pelvic measurement recorded. The difference in the fetal renal pelvic measurements between those cases which were normal postnatally and those which had a structural abnormality, an obstructive lesion or VUR became significant at 7 mm and at 18 weeks of gestational age. Over the whole period the proportion of cases in which micturating cysto-urethrography was technically possible and might have contributed to the diagnosis was 28.5%; the highest was 44.1% in 1998. Antenatal renal dilatation occurs infrequently in the presence of VUR and when it does, the fetus will probably be male. Antenatal ultrasonography is unlikely to contribute to detecting VUR in females, the gender in whom early diagnosis is particularly desirable. Other means of suspecting VUR antenatally, e.g. the family history or genetic coding, may be more valuable. A measurement of the fetal renal pelvis of > or = 7 mm at a gestational age of 18 weeks should prompt subsequent careful ultrasonography during the pregnancy and early postnatal investigation of the urinary tract. The diagnosis of VUR should not be excluded because the fetal renal pelvis is only minimally dilated if the fetus is female.

SEVERE LIMB REDUCTION DEFECTS AFTER UTERINE LAVAGE AT 7–8 WEEKS' GESTATION

A 35-year-old multiparous Chinese woman underwent a uterine lavage procedure for prenatal sex determination at 7-8 weeks' gestation. The baby was delivered by elective Caesarean section because of breech presentation at 38 weeks' gestation. The child weighed 2425 g and had severe reduction defects of all four limbs. This case warrants advising prospective patients of a possible association and encouraging practitioners to mount a careful prenatal ultrasonography and postnatal follow-up of all pregnancies investigated by prenatal diagnostic uterine lavage.

The associated anomalies that determine prognosis in congenital omphaloceles

Congenital abdominal wall defects such as omphaloceles can be recognized by fetal ultrasonography. To determine whether associated anatomic features may be useful in determining fetal prognosis, a retrospective study was performed over a 5-year period. There were 28 cases of omphalocele; 16 were larger than 5 cm and classified as giant, and the remainder were considered small. Eleven of the 12 infants with small omphaloceles survived with minimal neonatal complications. Ten of the 16 infants with giant omphaloceles died because of associated congenital anomalies. These were congenital heart disease, central nervous system malformations, and diaphragmatic hernias. This review suggests that the prognosis is good when a prenatal diagnosis of giant omphalocele is made and careful fetal ultrasonography, including echocardiography, does not identify heart, central nervous system, or diaphragmatic malformations, even when there is liver herniation into the omphalocele. (Am J Obstet Gynecol 1990;163:1646-9.)

Posterior Nuchal Cystic Hygroma

When cystic hygroma is detected antenatally, the prognosis is usually poor, and intrauterine or neonatal death are common. This seems especially true for Turner syndrome (the largest etiologic group associated with cystic hygroma) and the lethal multiple pterygium syndromes. However, some fetuses with Turner syndrome, and also with certain other diagnoses, had a good outcome, and further study of these conditions is required before more definite prognostic indicators and risk figures will be available. Increasing numbers of syndromes are being reported in association with fetal cystic hygroma, and lymphedema may be a common element in their pathogenesis. Mild, short-lived, or otherwise uncomplicated jugular lymphatic obstruction may be a cause of the neck webbing seen in the Noonan, familial pterygium colli, and distichiasis-lymphedema syndromes. With earlier and more widespread fetal ultrasonography, and more sensitive techniques, a greater number of resolving fetal cases may be reported. This may clarify the natural history and provide prospective criteria for the conditions that have better prognoses. The associated conditions include autosomal dominant and recessive genetic traits. Careful ultrasound study for other malformations, polyhydramnios and fetal growth parameters, a fetal karyotype, and, if appropriate, pathologic examination are required to determine the etiology and recurrence risk. The parents should be asked about exposure to alcohol or other agents and should be examined for signs of pterygium colli or Noonan syndrome. If the decision is made to continue the pregnancy, and there is doubt about the natural history and prognosis, multi-disciplinary supervision should include social services, neonatology, pediatric surgery, cardiology, and genetics specialties when indicated.

Association of neural tube defects with omphalocele in chromosomally normal fetuses

Omphalocele is frequently associated with other congenital malformations or a chromosome abnormality. Previously published series of omphalocele have emphasized the association of congenital heart defects or chromosomal abnormalities. We present five cases of omphalocele with concurrent neural tube defect from among the 15 cases of omphalocele evaluated between 1981 and 1985. Fourteen of 15 were detected prenatally. A sixth case is presented in which both a neural tube defect and an omphalocele were suspected on a prenatal ultrasound, but only the latter was found on autopsy. We recommend that a systematic evaluation be performed on every fetus with an omphalocele to include amniotic fluid alpha fetoprotein, acetylcholinesterase levels, chromosome study, and careful ultrasonography looking for evidence of other abnormalities, especially neural tube defects, before counseling the parents.