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Papers by Gabriel Iliescu

Donald School Journal of Ultrasound in Obstetrics & Gynecology, 2015

Open spina bifida (OSB) is a non-lethal fetal anomaly, yet often leads to severe disability. Most... more Open spina bifida (OSB) is a non-lethal fetal anomaly, yet often leads to severe disability. Most cases of open spina bifida are detected at the second trimester fetal anomaly ultrasound scan. The 11 to 13 weeks of amenorrhea scan evolved over the last 20 years from essentially a dating scan, to a genetic scan, and recently to one which includes, in addition to the genetic markers, a basic checklist for examination of the whole fetal anatomy. The direct visualization of the spine at the first trimester (FT) scan remained difficult, despite the wider use of high-resolution ultrasound machines and the volumetric approach. Thus, indirect intracranial morphological markers for OSB were proposed to diagnose this neural tube defect. The present review aims to describe the specific anatomical feature of the spine and the posterior brain, both on parasagittal and on axial planes, recently proposed for the early detection of OSB. Specialists involved in the prenatal diagnosis will eventually...

Ultrasound in Obstetrics & Gynecology, 2014

Ultrasound in Obstetrics & Gynecology, 2014

Ultrasound in Obstetrics & Gynecology, 2012

Current health sciences journal, 2012

We describe a series of cases where modern ultrasound (US) techniques diagnosed major structural ... more We describe a series of cases where modern ultrasound (US) techniques diagnosed major structural abnormalities of the fetus in the first trimester (FT), unapparent when using the basic protocol of US investigation. In some cases, major structural abnormalities can be revealed in the FT scan solely to specialized personnel. Perhaps early screening should be confined in specialized centers, because congenital abnormalities detailed diagnostic has a huge impact in counseling the couple and also in prenatal advice of future pregnancies.

Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2011

Morphological investigation of the central nervous system (CNS) in fetuses with positive markers ... more Morphological investigation of the central nervous system (CNS) in fetuses with positive markers for open spina bifida (OSB) detection, visualized by ultrasound during the first trimester of pregnancy. Data from fetuses that underwent routine first trimester ultrasound scan in our center during September 2007-March 2011 and presented abnormal aspects of the fourth ventricle, also referred as intracranial translucency (IT), provided the morphological support to evaluate CNS features. A neuro-histological study of posterior cerebral fossa illustrated anatomical features of the structures involved in the sonographic first trimester detection of neural tube defects. Abnormal IT aspects were found in OSB cases examined in the first trimester, but also in other severe cerebral abnormalities. Brain stem antero-posterior diameter (BS) and brain stem to occipital bone (BSOB) ratio may be more specific for OSB detection. Correlations between histological aspects of posterior brain fossa and u...

Ultrasound in Obstetrics & Gynecology, 2014

Donald School Journal of Ultrasound in Obstetrics & Gynecology, 2012

ABSTRACT

Ultrasound in Obstetrics & Gynecology, 2011

Conclusions: Sonographic evaluation of the uterine scar six weeks after Cesarean section allows t... more Conclusions: Sonographic evaluation of the uterine scar six weeks after Cesarean section allows the measurement of thickness. The use of ''dehiscence risk coefficient'' allows more precise description of the scar defect. Risk factors for a thinner Cesarean section scar are uterine retroflexion, amniotic fluid leakage before Cesarean section, repeat, and emergency Cesarean section.

Ultrasound in Obstetrics & Gynecology, 2011

Oral poster abstracts mosaicisms/translocations/deletions/sexual CA; only 2/13 women opted for TO... more Oral poster abstracts mosaicisms/translocations/deletions/sexual CA; only 2/13 women opted for TOP whereas 11/13 fetuses with normal morphology were delivered at term after a reassuring genetic counseling. 47/1423 (3,3%) fetuses had AS but normal karyotype: in 8 cases, anomalies were confirmed (3 major CHD, 1 NTD, 1 CDH, 2 nefropathies, 1 anomalous CNS). 39/1423 (2,7%) fetuses were false positive cases. Conclusions: CHD and ECA US screening performed by trained obstetricians at the time of NT measurements could identify a high rate of all aneuploidies at a low rate of false positives.

Ultrasound in Obstetrics & Gynecology, 2013

To evaluate intra- and interobserver agreement for first-trimester fetal cardiac structural asses... more To evaluate intra- and interobserver agreement for first-trimester fetal cardiac structural assessment, using two-dimensional (2D) ultrasound (2D-US) and 4D-US (4D spatiotemporal image correlation (STIC) technology), to compare the methods and to assess the advantages of adding color Doppler to each technique. Digital videoclips (B-mode and color Doppler) and 4D-STIC volumes (gray-scale and color Doppler) from 632 pregnancies with normal fetal hearts were acquired and stored at the time of detailed first-trimester ultrasound examination. Later analysis on a randomized sample of 100 cases was performed, targeting 11 cardiac structures and features. We compared visualization of fetal heart parameters using 2D-US vs 4D-US and gray-scale vs color Doppler imaging. STIC volumes were considered satisfactory (adequate visualization of at least 8/11 parameters) in 78% of cases and 2D-US acquisitions in 89% of cases. The intra- and interobserver agreement was good for both 2D and 4D methods (kappa > 0.6), and the percentage overall agreement was very high using both methods (95%). 2D- and 4D-US identification of the fetal cardiac parameters did not differ significantly. The differences between gray-scale and color Doppler imaging were statistically significant in identifying similar key cardiac parameters, for both 2D- and 4D-US (P < 0.05). Both 2D and 4D methods for assessing first-trimester heart parameters are feasible and repeatable within and between observers. Color Doppler adds valuable information to both methods.

Ultrasound in Obstetrics and Gynecology, 2010

Objectives: Screening at 11-14 weeks is changing from a simple NT measurement to a comprehensive ... more Objectives: Screening at 11-14 weeks is changing from a simple NT measurement to a comprehensive first trimester anomaly scan. However, the detection of open neural tube defect (NTD) before 14 weeks is still a challenge, since lemon and banana signs, used in second trimester ultrasound, are rarely present. Aim of the study is to seek for simple first trimester signs to alert the examiner for the presence of NTD. Methods: The midsagittal view of the face used for NT and nasal bone measurements was analyzed in normal fetuses and fetuses with NTD. The region between the brain stem and occipital bone, includes the 4 th ventricle (intracranial translucency = IT), the choroid plexus of the 4 th ventricle and the future cisterna magna. Results: In normal fetuses between 11-14 weeks there is an increase in the anterior posterior diameters of posterior fossa structures. Fetuses with NTD detected prospectively and retrospectively showed however abnormal values due to the downward shifting of the brain stem. Conclusions: In the plane used for NT measurement the evaluation of the posterior part of the brain between the brain stem and the occipital bone appears to be the clue in suspecting NTD at the 11-14 weeks scan. Further prospective studies are needed to find the sensitivity of these observations during routine screening.

International Journal of Gynecology & Obstetrics, 2009

Objectives: As Romania is on the first place in Europe for mortality by cervical cancer, the aim ... more Objectives: As Romania is on the first place in Europe for mortality by cervical cancer, the aim of our study is to correlate the persistence of HPV DNA with viral load and E6/E7 viral mRNA presence in order to identify subjects at risk for cervical cancer development. Materials and Methods: HPV positive case patients with cytological interpretation of either NILM or ASCUS were selected from a cohort of 460 women enrolled in a study on HPV prevalence. Viral tests were determined in cervical-brush specimens at base line and at one year interval. HPV genotypes were determined by a hybridization assay (InnoLipa), E6/E7 viral mRNA presence was determined by a NASBA technique (PreTect HPV Proofer) and viral load was quantified in real-time PCR (PrimerDesign). Results: The persistent infections were confirmed by the presence of the same HPV DNA type in consecutive testing and by the presence of E6/E7 mRNA. Persistence was significantly greater by oncogenic HPV types 16, 18 and 31 alone or in association with low/medium risk types. From 108 patients (17-48 years) in 35 cases (32.41%) the same type of E6/E7 mRNA was detected in consecutive testing. We found E6/E7 mRNA higher levels in patients with HPV types 16 and 18 (prevalent types in Romania). The viral loads were higher in subjects with HPV 16 type (2.2×105-8.9×107) as compared with HPV18 type (338,000-3.3×105). Conclusions: Our results indicated that viral persistence is associated with higher viral loads and mRNA levels.

International Journal of Gynecology & Obstetrics, 2009

growth and fetal well being exams were normal. At 36 weeks, another episode of splenic sequestrat... more growth and fetal well being exams were normal. At 36 weeks, another episode of splenic sequestration occurred. The spleen was enlarged, palpable 8 cm below the costal margin and the Hb level was 6.0, Ht19%, and platelet count 112,000/mm3. Two units of packed red cells were transfused. The post transfusion exams were: Hb = 8.2 g/dL, Ht = 25%. The C-section was performed at 37 weeks. The newborn weighted 3,030 grams, Apgar's score 9/10/10. The patient received more two units of packed red cells after surgery. Both mother and baby were discharged at postpartum alive and well. Discussion: Immediate transfusion of red cells is the only effective treatment of acute splenic sequestration and should be performed carefully during pregnancy to avoid adverse maternal and fetal outcome.

Donald School Journal of Ultrasound in Obstetrics & Gynecology, 2015

Open spina bifida (OSB) is a non-lethal fetal anomaly, yet often leads to severe disability. Most... more Open spina bifida (OSB) is a non-lethal fetal anomaly, yet often leads to severe disability. Most cases of open spina bifida are detected at the second trimester fetal anomaly ultrasound scan. The 11 to 13 weeks of amenorrhea scan evolved over the last 20 years from essentially a dating scan, to a genetic scan, and recently to one which includes, in addition to the genetic markers, a basic checklist for examination of the whole fetal anatomy. The direct visualization of the spine at the first trimester (FT) scan remained difficult, despite the wider use of high-resolution ultrasound machines and the volumetric approach. Thus, indirect intracranial morphological markers for OSB were proposed to diagnose this neural tube defect. The present review aims to describe the specific anatomical feature of the spine and the posterior brain, both on parasagittal and on axial planes, recently proposed for the early detection of OSB. Specialists involved in the prenatal diagnosis will eventually...

Ultrasound in Obstetrics & Gynecology, 2014

Ultrasound in Obstetrics & Gynecology, 2014

Ultrasound in Obstetrics & Gynecology, 2012

Current health sciences journal, 2012

We describe a series of cases where modern ultrasound (US) techniques diagnosed major structural ... more We describe a series of cases where modern ultrasound (US) techniques diagnosed major structural abnormalities of the fetus in the first trimester (FT), unapparent when using the basic protocol of US investigation. In some cases, major structural abnormalities can be revealed in the FT scan solely to specialized personnel. Perhaps early screening should be confined in specialized centers, because congenital abnormalities detailed diagnostic has a huge impact in counseling the couple and also in prenatal advice of future pregnancies.

Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2011

Morphological investigation of the central nervous system (CNS) in fetuses with positive markers ... more Morphological investigation of the central nervous system (CNS) in fetuses with positive markers for open spina bifida (OSB) detection, visualized by ultrasound during the first trimester of pregnancy. Data from fetuses that underwent routine first trimester ultrasound scan in our center during September 2007-March 2011 and presented abnormal aspects of the fourth ventricle, also referred as intracranial translucency (IT), provided the morphological support to evaluate CNS features. A neuro-histological study of posterior cerebral fossa illustrated anatomical features of the structures involved in the sonographic first trimester detection of neural tube defects. Abnormal IT aspects were found in OSB cases examined in the first trimester, but also in other severe cerebral abnormalities. Brain stem antero-posterior diameter (BS) and brain stem to occipital bone (BSOB) ratio may be more specific for OSB detection. Correlations between histological aspects of posterior brain fossa and u...

Ultrasound in Obstetrics & Gynecology, 2014

Donald School Journal of Ultrasound in Obstetrics & Gynecology, 2012

ABSTRACT

Ultrasound in Obstetrics & Gynecology, 2011

Conclusions: Sonographic evaluation of the uterine scar six weeks after Cesarean section allows t... more Conclusions: Sonographic evaluation of the uterine scar six weeks after Cesarean section allows the measurement of thickness. The use of ''dehiscence risk coefficient'' allows more precise description of the scar defect. Risk factors for a thinner Cesarean section scar are uterine retroflexion, amniotic fluid leakage before Cesarean section, repeat, and emergency Cesarean section.

Ultrasound in Obstetrics & Gynecology, 2011

Oral poster abstracts mosaicisms/translocations/deletions/sexual CA; only 2/13 women opted for TO... more Oral poster abstracts mosaicisms/translocations/deletions/sexual CA; only 2/13 women opted for TOP whereas 11/13 fetuses with normal morphology were delivered at term after a reassuring genetic counseling. 47/1423 (3,3%) fetuses had AS but normal karyotype: in 8 cases, anomalies were confirmed (3 major CHD, 1 NTD, 1 CDH, 2 nefropathies, 1 anomalous CNS). 39/1423 (2,7%) fetuses were false positive cases. Conclusions: CHD and ECA US screening performed by trained obstetricians at the time of NT measurements could identify a high rate of all aneuploidies at a low rate of false positives.

Ultrasound in Obstetrics & Gynecology, 2013

To evaluate intra- and interobserver agreement for first-trimester fetal cardiac structural asses... more To evaluate intra- and interobserver agreement for first-trimester fetal cardiac structural assessment, using two-dimensional (2D) ultrasound (2D-US) and 4D-US (4D spatiotemporal image correlation (STIC) technology), to compare the methods and to assess the advantages of adding color Doppler to each technique. Digital videoclips (B-mode and color Doppler) and 4D-STIC volumes (gray-scale and color Doppler) from 632 pregnancies with normal fetal hearts were acquired and stored at the time of detailed first-trimester ultrasound examination. Later analysis on a randomized sample of 100 cases was performed, targeting 11 cardiac structures and features. We compared visualization of fetal heart parameters using 2D-US vs 4D-US and gray-scale vs color Doppler imaging. STIC volumes were considered satisfactory (adequate visualization of at least 8/11 parameters) in 78% of cases and 2D-US acquisitions in 89% of cases. The intra- and interobserver agreement was good for both 2D and 4D methods (kappa > 0.6), and the percentage overall agreement was very high using both methods (95%). 2D- and 4D-US identification of the fetal cardiac parameters did not differ significantly. The differences between gray-scale and color Doppler imaging were statistically significant in identifying similar key cardiac parameters, for both 2D- and 4D-US (P < 0.05). Both 2D and 4D methods for assessing first-trimester heart parameters are feasible and repeatable within and between observers. Color Doppler adds valuable information to both methods.

Ultrasound in Obstetrics and Gynecology, 2010

Objectives: Screening at 11-14 weeks is changing from a simple NT measurement to a comprehensive ... more Objectives: Screening at 11-14 weeks is changing from a simple NT measurement to a comprehensive first trimester anomaly scan. However, the detection of open neural tube defect (NTD) before 14 weeks is still a challenge, since lemon and banana signs, used in second trimester ultrasound, are rarely present. Aim of the study is to seek for simple first trimester signs to alert the examiner for the presence of NTD. Methods: The midsagittal view of the face used for NT and nasal bone measurements was analyzed in normal fetuses and fetuses with NTD. The region between the brain stem and occipital bone, includes the 4 th ventricle (intracranial translucency = IT), the choroid plexus of the 4 th ventricle and the future cisterna magna. Results: In normal fetuses between 11-14 weeks there is an increase in the anterior posterior diameters of posterior fossa structures. Fetuses with NTD detected prospectively and retrospectively showed however abnormal values due to the downward shifting of the brain stem. Conclusions: In the plane used for NT measurement the evaluation of the posterior part of the brain between the brain stem and the occipital bone appears to be the clue in suspecting NTD at the 11-14 weeks scan. Further prospective studies are needed to find the sensitivity of these observations during routine screening.

International Journal of Gynecology & Obstetrics, 2009

Objectives: As Romania is on the first place in Europe for mortality by cervical cancer, the aim ... more Objectives: As Romania is on the first place in Europe for mortality by cervical cancer, the aim of our study is to correlate the persistence of HPV DNA with viral load and E6/E7 viral mRNA presence in order to identify subjects at risk for cervical cancer development. Materials and Methods: HPV positive case patients with cytological interpretation of either NILM or ASCUS were selected from a cohort of 460 women enrolled in a study on HPV prevalence. Viral tests were determined in cervical-brush specimens at base line and at one year interval. HPV genotypes were determined by a hybridization assay (InnoLipa), E6/E7 viral mRNA presence was determined by a NASBA technique (PreTect HPV Proofer) and viral load was quantified in real-time PCR (PrimerDesign). Results: The persistent infections were confirmed by the presence of the same HPV DNA type in consecutive testing and by the presence of E6/E7 mRNA. Persistence was significantly greater by oncogenic HPV types 16, 18 and 31 alone or in association with low/medium risk types. From 108 patients (17-48 years) in 35 cases (32.41%) the same type of E6/E7 mRNA was detected in consecutive testing. We found E6/E7 mRNA higher levels in patients with HPV types 16 and 18 (prevalent types in Romania). The viral loads were higher in subjects with HPV 16 type (2.2×105-8.9×107) as compared with HPV18 type (338,000-3.3×105). Conclusions: Our results indicated that viral persistence is associated with higher viral loads and mRNA levels.

International Journal of Gynecology & Obstetrics, 2009

growth and fetal well being exams were normal. At 36 weeks, another episode of splenic sequestrat... more growth and fetal well being exams were normal. At 36 weeks, another episode of splenic sequestration occurred. The spleen was enlarged, palpable 8 cm below the costal margin and the Hb level was 6.0, Ht19%, and platelet count 112,000/mm3. Two units of packed red cells were transfused. The post transfusion exams were: Hb = 8.2 g/dL, Ht = 25%. The C-section was performed at 37 weeks. The newborn weighted 3,030 grams, Apgar's score 9/10/10. The patient received more two units of packed red cells after surgery. Both mother and baby were discharged at postpartum alive and well. Discussion: Immediate transfusion of red cells is the only effective treatment of acute splenic sequestration and should be performed carefully during pregnancy to avoid adverse maternal and fetal outcome.