The lateral ventricles can be visualized as early as 12 weeks of gestation. The entire surface of the brain and spine cord is bathed by a fluid called cerebrospinal fluid (CSF). At our 19 week scan our baby had ventricles of 10.x mm and 11.x mm. Intrauterine ventriculoamniotic shunting is an experimental procedure for severe ventriculomegaly and is sometimes considered to minimize maternal or fetal morbidity in ongoing pregnancies. The Fetal Medicine Foundation. And while pregnant people do make up a disproportionate number of these listeria cases, that amounts to somewhere in the region of 5 to 10 cases of listeria in pregnancy across Australia each year . Usually, when ventriculomegaly is first detected, the ventricles are wider than 10 mm. The purpose of this document is to review the diagnosis, evaluation, and management of mild fetal ventriculomegaly. Discussion in 'Pregnancy - Third Trimester' started by Mommy2Kian, Aug 25, 2009. None of those diagnoses were changed on the basis of the 3032 weeks' iuMR imaging examination (examples are shown in Figs 3 and 4). It is clear from the retrospective review that in this case, the additional findings on the 3032 weeks' iuMR imaging examination would have had a clinically significant impact on counseling and management options. Hydrocephalus is the term used when enlargement of the ventricles has been caused by an increase in the pressure of the cerebro-spinal fluid (CSF) within them. All of the measurements were made on proprietary software (Eclipse; Philips Healthcare or Advantage Workstation 4.4, GE Healthcare) and rounded to the nearest 1 mm (ie, with a precision of 0.5 mm), because this corresponds to the most widely accepted clinical scale for categorization of severity (see below). sharing sensitive information, make sure youre on a federal Learn about your rights, how to reach us and more. The pregnancies of affected individuals are associated with increased alpha-fetoprotein (AFP). In addition, we did not find any further diagnostic information on the 3032 weeks' iuMR imaging examination in the 5 cases shown to have brain abnormalities on the 2024 weeks' iuMR imaging studies. 94158-2549, 1-800-RX-FETUS Firefox. Unilateral fetal VM was thought to be quite unusual in the older sonography literature,14 but it must be remembered that in many cases, only the trigone furthest from the sonography probe is measured or measured with certainty, because of the problems of near-field effects.9 This was reflected in a recent sonography and iuMR imaging study in which unilateral VM was shown in 51/85 cases (60%) of fetuses with mild VM.15 There has been debate in the literature about the significance of unilateral isolated VM in the fetus in relation to bilateral VM. Oakland The potential abnormality covers a range of severities, extending from merely absence of the rostrum through the presence of the genu only. Access resources for you to use during your baby's hospital stay and at home. In those cases, the clinical significance of the extra findings made on the third-trimester iuMR imaging was assessed by 2 fetomaternal experts independently (G.M., S.A.R.). I want a doctor to tell me treatment options. Light spotting. official website and that any information you provide is encrypted Enter multiple addresses on separate lines or separate them with commas. Subsequent intervening antenatal sonography examinations may have been reassuring, signifying a good prognosis and discharge from specialist care, again implying that further examination was not required. With that approach, the degree of VM by iuMR imaging in the 2024 weeks' group was the following: normal-sized, 2; mild VM, 28; moderate VM, 8; and severe VM, 2 cases. Disclaimer. Other authors used mild to describe 1012 mm trigones and moderate to describe 1315 mm trigones.12 We used the latter classification because from an imaging viewpoint, we have found quite different risks of finding other brain abnormalities on iuMR imaging. Federal government websites often end in .gov or .mil. There are some situations in which further studies are warranted, such as when the 2024 weeks' examination is equivocal or in a woman with a specific clinical or genetic concern about a cortical formation abnormality. In general, the outcome is worse when the ventricles are larger, the amniocentesis is abnormal, or there are other problems seen on the ultrasound. Mom's age is 25. If a prenatal ultrasound shows enlarged ventricles, your doctor may recommend additional tests to determine the cause and check for associated problems. After those were judged to be of diagnostic quality, similar acquisitions were performed by using 3-mm-thick sections with typical parameters: TR, 31,416 ms; TEeff, 92 ms; echo-train length, 136; FOV, 25 cm; matrix size, 183 256; NEX, 1; refocusing angle, 120. The rate of infection is 10 e 20 % in severe ventriculomegaly [18, 19] and 1 e 5 % in mild ventriculomegaly [8, 18-20]. 1-800-793-3887, 744 52nd Street, 3rd Floor HHS Vulnerability Disclosure, Help Before The .gov means its official. Gezer C, Ekin A, Ozeren M, Taner CE, Ozer O, Koc A, Bilgin M, Gezer NS. 30w pregnant and after an unfortunate spill down the stairs leading to a bit of preterm labour we have found out our baby has mild ventriculomegaly measuring at 11mm and he has an enlarged stomach. I love my mom, but I hate that she always jumps to conclusions and blames me for avoiding her, when really I'm just busy chasing my 2-year-old, heavily pregnant, and not feeling well. The two components of the central nervous system are the brain and the spinal cord. The procedure needs to be carried out in tertiary centers with expertise in the field. Mild Borderline Ventriculomegaly. Patients with resolved ventriculomegaly should be offered aneuploidy screening or testing.. Elspeth Whitby, MD, was supported by the Health Foundation via the Academy of Medical Sciences. In 1981, we performed the first successful open fetal surgery ("open" is the traditional approach in which the surgeon works through a large incision), and we have more experience with both open and minimally invasive fetal surgery than any institution in the world. As described above, there was also 1 case of hypogenesis of the corpus callosum that was detected on the 3032 weeks' iuMR imaging examination but was not reported on the 2024 weeks' iuMR imaging examination. Our experts are highly experienced in all of these procedures, and will work with you and your family to determine which approach best suits your child. 94609, @2023 The Regents of the University of California, Center for Maternal-Fetal Precision Medicine, Clinical Trial on Fetal Aortic Valvuloplasty, Intrauterine Therapy for Alpha Thalassemia Major, Ventricular enlargement is not in the severe range (or measuring >15 millimeters in size), If there are no other problems seen in the brain, The genetic testing results are normalthis is called Isolated Mild Ventriculomegaly. Only one or both lateral ventricles may be affected. Changes in the degree of VM are reported along with changes in the diagnosis of structural brain abnormalities. The UCSF Fetal Treatment Center is a world leader in diagnosing and treating prenatal conditions, including ventriculomegaly. BACKGROUND AND PURPOSE: Although MR imaging of the fetal brain has been shown to provide additional diagnostic information, the optimal timing of the study and the value of repeat studies remain unclear. Ventriculomegaly is a condition in which the lateral ventricles (fluid-filled spaces in the brain) are larger than normal. Ventriculomegaly is defined as dilation of the fetal cerebral ventricles and is a relatively common finding on prenatal ultrasound. In the 3032 weeks' group, 17/40 had isolated asymmetric VM and 11 of those were unilateral VM (6, mild; 3, moderate; and 2, severe). It is associated with microcephaly, ventriculomegaly, calcifications, placentomegaly, motor abnormalities, epilepsy, hearing loss, neurologic impairments, ophthalmologic abnormalities, intrauterine growth restriction, and stillbirth. Interobserver agreement was tested both in terms of absolute measurement and categoric assessment of the degree of VM by using the following bounds: mild, 1012 mm; moderate, 1315 mm; and severe, 16 mm. Forty women, therefore, in this group had a fetus with isolated VM and underwent 2 iuMR imaging examinations. This consisted of 40 complete agreements, 37 disagreements by 1 mm, and 3 disagreements by 2 mm, producing conflicting categoric classifications in 10/80 ventricles (8 between normal-sized ventricles and mild VM, 1 mild-versus-moderate, and 1 moderate-versus-severe). Please enable it to take advantage of the complete set of features! Ventriculomegaly is the most frequent sonographic pathology that is detected during antenatal ultrasounds and its importance is based on the adverse outcomes on the fetus development [8]. Our provisional opinion, therefore, is that there is little to recommend the routine use of a third-trimester follow-up iuMR imaging study in cases of apparently isolated fetal VM if a good-quality study has been obtained at 2024 weeks. My mom and dad will not be genuinely supportive (both are very much "me" people) and my FIL will make "jokes" about termination that we will find incredibly disturbing. Fetal ventriculomegaly: Diagnosis, treatment, and future directions. Nationwide Children's Hospital offers a team of experts focused on the treatment of children with ventriculomegaly. Either a flexible phased array body coil or a cardiac coil was used, and a series of 3-plane scout views was obtained. Of the 41 women who did return for the second examination, 1 fetus was shown to have hypogenesis of the corpus callosum on the 3032 weeks' study, despite it being reported as isolated VM on the 2024 weeks' iuMR imaging study. A and B, Axial single-shot fast spin-echo images show mild (A) and severe (B) VM. A recent group of studies conducted by a research team from the University of California, Riverside, has demonstrated that learning various new tasks can significantly benefit cognition among . squamous cell carcinoma of the cervix: accounts for the vast majority (80-90%) of cases and is associated with exposure to human papillomavirus (HPV) adenocarcinoma of the cervix: rarer (5-20%) and can have several subtypes which include 11,20. clear cell carcinoma of the cervix. Lymphocytic choriomeningitis virus is a rodent-borne arenavirus that can cause congenital infection affecting the developing central nervous system. Exclusion of fetal ventriculomegaly with a single measurement: the width of the lateral ventricular atrium, Fetal lateral ventricular width: what should be the upper limit? Two of the main factors that cause enlarged ventricles are: Ventriculomegaly usually occurs spontaneously. Here's how to access them. Ventricles measuring between 10 to15 mm are called "mild" ventriculomegaly. We also haven't discussed this with anybody at all. (CD) associated with an antenatal finding of SVM. Three of those women had elected to terminate the pregnancy and were not recontacted. and transmitted securely. J Matern Fetal Med. There is increasing evidence of the value of including iuMR imaging in the diagnostic pathway. The categoric description used in many sonography studies relates to the size of the larger of the 2 trigone measurements in the fetus (9 mm, normal; 1012 mm, mild; 1315 mm, moderate; and 16 mm, severe). Two fetuses with different categories of VM, illustrating the measurements of the trigones of the lateral ventricles used in this study. I went to my 20 week scan and was told that a ventricle on our babies brain was measuring. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). That case was excluded from further analysis of ventricular size. The enlargement may or may not be related to ventricular obstruction and increased intracranial pressure; therefore, the term "hydrocephalus" is not used. A 23-year-old G1P0 woman was referred for fetal MRI after her 20-week anatomic fetal ultrasound demonstrated cerebral ventriculomegaly. This article reviews the definitions, diagnosis, and workup of fetal VM, discusses follow-up protocols and prognosis, and examines the role of fetal therapy, including fetoscopic surgery in its prenatal management. Technology & Innovation Development Office, endoscopic third ventriculostomy/choroid plexus cauterization, trouble looking up when the head is facing forward, a problem that prevents cerebrospinal fluid (CSF) fluid from circulating and being absorbed normally in the brain, which causes, a minor imbalance in fluid circulation and absorption. The parameters for the T1 sequence were TR, 238 ms; TE, 3.4 ms; refocusing angle, 70; FOV, 23 cm; matrix size, 192 256; NEX, 1. Expertise. MeSH Infants with mild ventriculomegaly usually dont have any symptoms. There was close agreement between our 2 observers, with no more than 1 mm difference measured in 77/80 trigones in the 2024 weeks' group and 79/80 trigones in the 3032 weeks' group. This condition means a dilated fluid-filled v. Getting Pregnant; Pregnancy; Birth; Breastfeeding; Baby; Parenting . CONCLUSIONS: Trigone measurements can be made in a highly repeatable fashion on iuMR imaging. With the ultrasound the doctor will look at your fetus's brain and measure the ventricles. Known as implantation bleeding, it happens when the fertilized egg attaches to the lining of the uterus about 10 to 14 days after conception. Ventriculomegaly is typically categorized in one of two ways: mild (10-15 mm) or severe (> 15 mm); or as mild (10-12 mm), moderate (13-15 mm), or severe (> 15 mm). Even so, the overall classification (based on the largest ventricle) disagreed in only 2/40 cases (both being normal-versus-mild VM). This situation would be considered highly unusual. We don't need people hounding us with questions and worry while we are in such a state ourselves. Pediatric ventriculomegaly is a condition in which a fetus's brain ventricles (cavities) are abnormally enlarged. Hidaka N, Ishii K, Kanazawa R, Miyagi A, Irie A, Hayashi S, Mitsuda N. J Obstet Gynaecol Res. Any brain abnormalities other than VM were recorded. These experts work closely together to ensure our patients receive care that meets all of their needs. In only 1 of 41 cases (2%, 95% confidence interval, 0%13%, binomial exact method) assumed to have isolated VM on the 2024 weeks' examination was a further brain abnormality shown on the 3032 weeks' study (hypogenesis of the corpus callosum). Fetal ventriculomegaly is a congenital finding that affects the brain. Stress-free visits I have been referred to another hospital for an MRI and am so terrified that they will tell me it's getting bigger and my baby will be neurologically challenged. Epub 2018 Apr 12. National Library of Medicine This can occur when CSF becomes trapped in the spaces, causing them to grow larger. 2020 Aug;36(8):1681-1696. doi: 10.1007/s00381-019-04384-w. Epub 2019 Nov 7. I guess I'm hoping to find support in Internet strangers while we are in limbo. Without more specific study, however, this estimate cannot be confirmed, and there are many other complex factors to consider, which probably have a significant influence on any decision to re-attend. Her pregnancy to date had been uncomplicated without notable fevers, illnesses, or need for medications aside from prenatal vitamins. The primary purpose of this study was to look for structural abnormalities of the fetal brain shown at 3032 weeks' gestational age but not on the 2024 weeks' study in fetuses originally referred with isolated VM. The contents of the brain consist primarily of brain tissue, blood and cerebrospinal fluid (CSF). The VP shunt procedure will be performed by a pediatric neurosurgeon. Breaking News. Genetic and Rare Diseases Information Center, Best in California and No. Practice good posture. government site. My third baby (up to week 21 of pregnancy) was diagnosed with fetal ventriculomegaly at my 20 week scan. Results from amnio: all clear for virus, genetics (all trisomies), and microarray. . I really don't want my friends to worry until we know what to worry about. Ventriculomegaly is a condition in which the ventricles appear larger than normal on a prenatal ultrasound. If there is evidence of more severe problems which may require long-term care, we can help direct you to the appropriate specialists. Having a Zika infection during pregnancy can cause devastating damage to the fetus's central nervous system. I'm just so anxious. Ventriculomegaly is slightly more common in male fetuses than in female fetuses. Appointments 216.444.6601 Appointments & Locations Request an Appointment As such, the clinician counseling her would have been incorrectly reassured by the original iuMR imaging findings. PMC In 1 case, hypogenesis of the corpus callosum was recognized at 3032 weeks but had not been reported on the 2024 weeks' examination; the other 5 fetuses had brain pathology recognized on both fetal MR studies. We can then look at the results from all of the tests together and your physician can speak with you about the significance of these test results. An axial gradient-echo T1-weighted sequence was acquired in 30-second acquisition time, either with or without suspended maternal respiration. Ventriculomegaly is a condition in which the brain ventricles, or fluid-filled cavities, are enlarged due to build up of cerebrospinal fluid (CSF). Infections are more frequently found in cases of severe ventriculomegaly which develop in late pregnancy. Please enable it to take advantage of the complete set of features! 1 in 1,000 births. *, full or bulging soft spot at the top of the head, abnormal eye movement, such as not looking upward or always looking downward, An injury or problem with brain development around the ventricles, A blockage or imbalance in the ventricular system which prevents spinal fluid from moving or being absorbed normally. Anyone else with a child with ventriculomegaly? The https:// ensures that you are connecting to the Our Global Patient Services team is here to help international and out-of-area families every step of the way. Ventriculomegaly is a condition in which the ventricles (fluid-filled spaces in the brain) are larger than usual. They describe a 16.6% risk of poor outcome in the 1012 mm group and 11.8% in the 1315 mm group. We can only speculate on the reasons for this, and the effect it has on the study results. In most cases we will know by 6 months if your baby will need a VP shunt. Hydrocephalus is the term used to describe pathologic dilation of the brain's ventricular system due to increased CSF pressure; obstruction is a common etiology. Your childs brain and spinal cord are covered in a clear protective liquid called cerebrospinal fluid (CSF). Accessibility This fluid buildup usually happens slowly, over the course of weeks. Had sex without a condom? Chromosomal abnormalities and neurological outcomes in fetal cerebral ventriculomegaly: a retrospective cohort analysis. In some cases, fluid keeps building up, and the ventricles grow larger over time. The Epilepsy Center offers comprehensive diagnosis and care for children with epilepsy. Ventriculomegaly is often diagnosed through prenatal ultrasound when the brain ventricles are measured. Ventriculomegaly is a condition in which the ventricles appear larger than normal on a prenatal ultrasound. Marijuana remains illegal at the federal level, even as some states have legalized it for recreational and medicinal use. 1997 Jul-Aug;6(4):241-4. doi: 10.1002/(SICI)1520-6661(199707/08)6:4<241::AID-MFM11>3.0.CO;2-H. Scelsa B, Rustico M, Righini A, Parazzini C, Balestriero MA, Introvini P, Spaccini L, Mastrangelo M, Lista G, Zuccotti GV, Veggiotti P. Eur J Paediatr Neurol. Our researchers are currently investigating whether the results of a fetal MRI can indicate the likelihood of disability and what families may expect for their child's health and development. Our health service (NHS) actually recommends the mid-pregnancy phase as the safest/most comfortable one to travel, if you have to. If you're coming to UCSF from outside the U.S., we coordinate your child's appointments and provide other helpful services. 2019 Aug;54(2):164-171. doi: 10.1002/uog.20197. This consisted of 46 complete agreements, 33 disagreements by 1 mm, and 1 disagreement by 2 mm. CA Ventriculomegaly is defined as mild (10-12mm), moderate (12-15mm) and severe (>15mm) [6,7]. Ventriculomegaly is the most common fetal brain abnormality, occurring in up to 1.5 per 1,000 pregnancies. The original research proposal included follow-up iuMR imaging in women who had a first study at that stage if they continued with the pregnancy. 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X. The site is secure. Travel. To summarize those, in 18/40 cases, the category remained unchanged; in 12/40, the category of VM increased; and in 10/40, the category decreased. Bethesda, MD 20894, Web Policies RESULTS: There was excellent reproducibility of trigone measurements between the 2 observers, with a mean absolute difference of <1 mm in the 40 fetuses that were ultimately shown to have isolated VM. The Department of Neurosurgery serves children with disorders of the brain, spine, and nervous system. Ventriculomegaly is not associated with any health risks for the pregnant mother. We encourage you to discuss any questions or concerns you may have with your child's provider. Ultrasound Obstet Gynecol. Melchoirre et al9 reviewed 3 published studies that discussed symmetry of VM. Mild ventriculomegaly means that one or both of the baby's lateral ventricles are slightly larger than usual. 2014 Jul;34(5):387-91. doi: 10.3109/01443615.2014.896885. Ventriculomegaly is present in 20-60% of these patients [8, 19, 33]. Disclaimer. The Wellcome Trust, Westfield Health, and The Health Foundation did not have any role in the design, in conducting this study, or in the preparation of this manuscript. Epub 2017 May 16. i am pregnant ventriculomegaly. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. Procedure prep. If the lateral ventricles are 10 millimeters or greater in size then you will be told that your fetus has "ventriculomegaly". In particular, we wished to study the hypothesis that third-trimester fetal MR imaging studies would not show extra brain abnormalities compared with the second-trimester studies in this group. Signup for our newsletter to get notified about our next ride. Hydrocephalus is the buildup of cerebrospinal fluid which causes pressure on the brain. AD, The change in category of VM between the 2024 weeks' and the 3032 weeks' iuMR imaging examinations is displayed on 4 charts in relation to the initial category of VM: normal-sized, mild, moderate, and severe. In many fetuses, especially those with borderline ventriculomegaly, the condition resolves on its own, with no ill effects. Further research in the cases of unilateral VM and asymmetric VM supplemented by iuMR imaging is warranted. Mommy2Kian Kaden and . Since the excessive pressure caused by the buildup of cerebrospinal fluid in hydrocephalus can lead to serious, long-term neurological damage, prompt treatment is a must. Ventriculomegaly is a condition in which the brain ventricles, or fluid-filled cavities, are enlarged due to build up of cerebrospinal fluid (CSF). There's only one way to find out for sure if you're pregnant: take a pregnancy test. Two experienced observers measured the width of the trigones, and the results were compared, to test reliability. Ventriculomegaly (VM) is the most common fetal brain abnormality identified with a prevalence of 0.3 to 1.5 per 1000 live births. Ventriculomegaly may be mild or severe. Childs Nerv Syst. The reviewers of the clinical significance of this finding commented that a woman would almost certainly have been offered fetal karyotyping on the basis of the imaging at 2024 weeks, but this was likely to have returned a normal result. As an interim measure, we have presented the differences in the reports of the second- and third-trimester iuMR imaging examinations in this article. Conversely, these data suggest that there is no advantage in delaying iuMR imaging studies to 3032 weeks in the hope of showing more pathology. Hong Kong Med J. Of the 99 women who were eligible to return for the second iuMR imaging examination, 90/99 (91%) had no other fetal brain abnormality diagnosed on the first iuMR imaging (isolated VM group). Outcomes for babies with ventriculomegaly depend on both the cause of the ventriculomegaly and whether it is progressive or not. Just as I had been thinking how very lucky I am to have a cruisy pregnancy, my 20 week scan suddenly flags concern; I am . Discharge. Eating small but frequent meals throughout the day can help you keep your blood sugar levels stable and ward off hunger-related headaches. If we continue with pregnancy is there any future issue. ventriculomegaly w weeks Imaging of the fetal brain is routinely performed by using sonography, and measurement of the size of the lateral ventricles is an important part of the screening process. The finding of hypogenesis of the corpus callosum on the 3032 weeks' iuMR imaging study would introduce far more uncertainty into the counseling process. to assess reproducibility. 2020 Sep;56(3):340-347. doi: 10.1002/uog.21974. Diagnostic approach to fetal ventriculomegaly. Serial ultrasound studies are often performed to monitor this finding. 2022 Aug 26;51(1):111-116. doi: 10.1515/jpm-2022-0312. , Mild ventriculomegaly from fetal consultation to neurodevelopmental assessment: A single center experience and review of the literature. The severity of ventriculomegaly depends on how enlarged the brain is. Typically, ventriculomegaly only requires treatment if it causes hydrocephalus. Pre-term or Cesarean deliveries are not needed unless there are other fetal or obstetrical problems, such as when the size of the head prevents a vaginal delivery. I am at a loss right now. The axial plane was chosen because in the previous study, sonography and MR imaging measurements of the trigones were compared, and in the United Kingdom, all trigone assessments are made in the axial plane. What causes ventriculomegaly in babies? A search for possible fetal infections should be always performed when ventriculomegaly is recognized. Most affected pregnancies have been terminated . Is ventriculomegaly 100%curable?, All other parameters are normal. Regardless of the gestational age, the additional finding on the second iuMR imaging examination would normally mean that the issue of termination would also be discussed. Cerebrospinal fluid is a clear liquid that surrounds the brain and spinal cord to provide cushioning from jolts. The images show that the genu and part of the body of the corpus callosum are present. VM is diagnosed usually in the mid-trimester when the atrial diameter (AD) of the lateral ventricle is more than 10 mm on one or both sides. This condition occurs in approximately one in 1,000 infants. 1 in 100 fetuses at 20 weeks' gestation. In the brain there are five fluid-filled holes called ventricles. Bethesda, MD 20894, Web Policies Keywords: Treatment after birth involves managing the child's symptoms and supporting their development. Our study showed a relatively high rate of unilateral VM, defined as 1 trigone 10 mm and the other 9 mm. As described in our earlier article,3 the entrance criteria for the study were the following: singleton pregnancy with fetal VM diagnosed on sonography (trigone measurement of 10 mm) referred to the study center at 20 weeks' gestational age or later (based on the sonography dating scan performed at 1013 weeks) and no other abnormality of the fetus shown by sonography (brain or somatic) under good sonographic conditions. It can be monitored during pregnancy with repeated ultrasounds to look for slowly enlarging ventricles. Usually the problem is with one or both of the top ventricles. We're ranked #1 in pediatric cancer, heart surgery, cardiology & more. 1855 4th Street, 2nd Floor, Room A-2432 Ventricles develop early in pregnancy and can be seen on a prenatal ultrasound in the second trimester, at about the 15th week.

Blue Ice Group Sweepstakes Legit, What Do You Say When You Fire A Cannon, Articles I