Transvaginal ultrasonographic diagnosis of bladder-wall invasion in patients with cervical cancer

OBJECTIVE: To evaluate the use of transvaginal ultrasonography for diagnosing invasion of the bladder by cervical cancer. METHODS: Twenty-one women with stages Ib-IIIb cervical cancer underwent radical hysterectomy or staging laparotomy. All had computed tomography (CT) scans and cystoscopic examinations, and five also underwent magnetic resonance imaging (MRI). During transvaginal ultrasonography, a transvaginal transducer was inserted into the anterior fornix of the vagina and the bladder wall was studied in the sagittal plane. The moveability of the bladder wall was assessed by the ability of the bladder to slide along the uterine cervix when the probe was pushed up against the bladder from the anterior fornix. Moveability was considered to indicate an intact bladder wall. RESULTS: The accuracy of transvaginal ultrasonography was superior to that of the other methods for detecting bladder-wall invasion by cervical cancer. The accuracy was 95% for transvaginal ultrasonography, 76% for CT, 86% for cystoscopy, and 80% for MRI. CONCLUSION: Transvaginal ultrasonographic examination is useful for detecting invasion of the bladder wall by cervical cancer.     

Transvaginal versus transperineal ultrasonography: a blinded comparison in the assessment of cervical length at midgestation

OBJECTIVE: The study's objective was to determine the correlation and agreement between transperineal ultrasonography and transvaginal ultrasonography in the assessment of cervical length in gravid patients. STUDY DESIGN: After a pilot, unblinded series of transperineal and transvaginal cervical length measurements in 200 gravid patients, 206 study patients between 14 and 34 weeks' gestation with intact membranes and cervical dilatation of < or = 2 cm underwent transperineal and transvaginal cervical length assessment under a blinded, 2-sonographer protocol. The Pearson correlation coefficient, Lin concordance coefficient, and Bland-Altman plot were used. Acceptable concordance was defined as > 0.82, with an acceptable correlation of > 0.9 and an acceptable difference between the means of < 3 mm. The power of the study to detect this degree of concordance was estimated to be 95% at this sample size. RESULTS: Paired ultrasonographic measurements were obtained for all 206 study patients. Transperineal mean cervical length was 35 +/- 8.6 mm. Transvaginal mean cervical length was 35.9 +/- 8.8 mm. The Pearson correlation coefficient was 0.959, and the Lin concordance coefficient was 0.955, with a 95% confidence lower bound of 0.949. Close agreement between transperineal and transvaginal measurements was observed across the full range of cervical lengths (1-5 cm). The estimated difference between the paired means was 1 mm. The 95% tolerance interval for any given paired observation (Transperineal length - Transvaginal length) was -5.7 to +4 mm. CONCLUSIONS: Cervical length measured by transperineal ultrasonography demonstrates close correlation and agreement with transvaginal measurements. With sonographer experience and optimal technique, approximately 95% of transperineal cervical length observations can be expected to be within 5 mm of a given paired transvaginal measurement. Transperineal ultrasonography may be a preferred method of cervical length assessment for situations in which vaginal placement of instruments should be minimized.     

Effect of cytochrome P450-dependent metabolites of arachidonic acid on the functional state of vessels]

We hoped to determine the number of pulses and energy needed to create acute ureteral perforations with four different lithotripters in a reproducible ex vivo model. A simple model was constructed to control variables in the testing such as wall thickness, intraluminal pressure, distance between the probe tip and ureter, and power delivered to tissue. Segments of domestic pig ureter were prepared and fixed in position in a normal saline (NS) bath at room temperature. We then attempted perforation with the holmium:YAG (HoL) laser, coumarin pulsed-dye laser (CdL), electrohydraulic lithotripter (EHL), and pneumatic impactor (PI) by placing the instrument probes at right angles to the ureteral wall. The ureter was filled with a methylene blue-stained solution of NS at 90 cm H2O pressure via a urodynamics catheter, and perforation was recorded on initial extravasation of dye. The endpoints measured were time to perforation and total energy required. At 0.5 mm of separation between the wall and probe, the HoL perforated the ureter in an average of 2 seconds and 0.01 kJ delivered at 5 W (10 Hz and 0.5 J/pulse). The EHL perforated at an average of 24.44 +/- 8.77 seconds and a total energy of 0.01 +/- 0 kJ. The CdL was able to perforate but at much longer intervals (257.51 +/- 99.08 seconds) and higher energy levels (12.88 +/- 4.95 kJ) on average than either the EHL or HoL. Lastly, the PI was unable to perforate the ureter in more than 6 continuous minutes of application. In addition, we found that at 2-mm separation between the HoL probe tip and the ureteral wall, acute perforation was not possible even at very high power settings. We conclude that although each endoscopic lithotripter has advantages as well as disadvantages, in this ex vivo model, it was clear that the HoL and EHL can easily perforate the ureter and must be used with vigilance. It was found that at 2 mm of separation between the probe and target, the HoL, was unable to perforate acutely. The CdL and PI were associated with a much higher safety index, and the PI was unable to produce ureteral perforation.     

Therapeutic antiradiation properties of leukinferon]

OBJECTIVE: Our purpose was to compare the screening effectiveness and acceptability of transvaginal ultrasonography (with sonohysterography if endometrial thickness was >4 mm) with office hysteroscopy. STUDY DESIGN: This randomized crossover study comprised 53 consecutive asymptomatic (without vaginal bleeding) postmenopausal patients with breast cancer who had taken tamoxifen (20 or 40 mg/day) for at least 6 months. RESULTS: Two patients had endometrial cancer (1 primary, 1 breast secondary), both detected only by transvaginal ultrasonography. Twenty-six patients had at least 1 polyp (total 47, all benign). The women who had polyps were not significantly different in their age, body mass, months of tamoxifen intake, or the cumulative dose. The sensitivity and specificity of transvaginal ultrasonography were 85% and 100%, respectively. The corresponding values for office hysteroscopy were 77% and 92%. It was significant that more patients preferred transvaginal ultrasonography to hysteroscopy (P < .001). CONCLUSION: Transvaginal ultrasonography (plus sonohysterography) may be more effective and acceptable than office hysteroscopy for detecting endometrial abnormalities in women taking tamoxifen.     

Transvaginal ultrasonography combined with CA-125 plasma levels in the diagnosis of endometrioma

OBJECTIVE: To assess the role of transvaginal ultrasonography combined with CA-125 plasma levels in the diagnosis of endometrioma. DESIGN: Prospective study with pathological confirmation of the diagnosis. SETTING: Department of Obstetrics and Gynecology of the University of Cagliari, Italy. PATIENTS: One hundred one consecutive premenopausal nonpregnant women submitted to laparoscopy or laparotomy, from November 1993 to October 1994, because of the presence of an adnexal mass. INTERVENTIONS: Within 2 days before surgery all patients underwent transvaginal ultrasonography and evaluation of CA-125 plasma levels. The ultrasonographic impression and the CA-125 value were then compared with the histopathological diagnosis. MAIN OUTCOME MEASURE: The overall agreement between the test result and the actual outcome was calculated using the kappa index for the transvaginal ultrasonography used alone and for the combination of transvaginal ultrasonography and CA-125 values, for each chosen cutoff and range. RESULTS: Transvaginal ultrasonography has a strong agreement between test and surgery (kappa value 0.76) whereas the combined use of the two methods is associated with a lower kappa index, ranging from 0.40 to 0.69. CONCLUSION: Transvaginal ultrasonography used alone has a better predictive capacity in differentiating endometrioma from other adnexal masses than combined methods.     

Depressive stupor--malignant neuroleptic syndrome--serotonin syndrome. A case contribution to a difficult differential diagnosis]

PURPOSE: Our goal was to assess, with a prospective study, the role of hysterosalpingo-contrast sonography (HyCoSy) with an echocontrast agent and transvaginal ultrasonography alone in the evaluation of tubal status. METHODS: Thirty patients were included in the study. These patients underwent an initial plain transvaginal ultrasound examination the day before the HyCoSy. The findings obtained from both examinations were compared with laparoscopic diagnosis, performed in the same menstrual cycle. RESULTS: The kappa values were 0.48 for patency evaluation and 0.67 for the diagnosis of the presence of at least one patent tube, suggesting a good agreement in both cases between HyCoSy and surgery. HyCoSy had a significantly lower sensitivity (50%), but not a significantly higher specificity (75%), than transvaginal ultrasonography alone in the diagnosis of tubal infertility-related abnormalities such as peritubal adhesions. CONCLUSIONS: The study demonstrates that the HyCoSy is a useful test when scheduling the most suitable treatment for infertile couples.     

Lung function changes among recycling workers exposed to organic dust

OBJECTIVE: To describe the feasibility of diagnosing fetal congenital heart defects by transvaginal ultrasonography during the first trimester of pregnancy. METHODS: Pregnant women presenting to the Ultrasonographic Unit at the Chaim Sheba Medical Center who had a diagnosis of fetal heart defects were reviewed retrospectively. Attention was paid to prenatal ultrasound studies, karyotype, and pathologic examinations. RESULTS: Using high-resolution transvaginal ultrasonography, we were able to detect fetal tachycardia (one case), ectopia cordis with ventricular septal defect (one case), atrioventricular septal defect (two cases), ventricular septal defect with persistent truncus arteriosus (one case), tetralogy of Fallot (two cases), and large right atrium with unguarded tricuspid valve (Uhl disease) (one case). Seven of these fetuses had normal karyotypes and all showed additional sonographic abnormalities, including septated cystic hygroma (three cases), hydrops (ascites and pericardial effusions) (two cases), omphalocele (one case), and bilateral agenesis of kidneys (one case). Only one fetus with an abnormal karyotype (45,XO) showed a combination of septated cystic hygroma with hydrops. CONCLUSIONS: High-resolution duplex Doppler transvaginal ultrasonography during the first trimester of pregnancy seems to be a useful diagnostic method for detecting some congenital heart diseases.     

Hepatitis C. Issues for women and their partners

OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal ultrasonography in detecting and measuring free pelvic fluid. STUDY DESIGN: Eighty-two patients undergoing diagnostic or therapeutic laparoscopy at a tertiary care center were prospectively assessed before surgery by transvaginal ultrasound. Free pelvic fluid was measured in two ultrasonographic planes. These measurements were compared to the volume of fluid aspirated during laparoscopy. RESULTS: The mean volumes reported for transvaginal ultrasound were significantly lower than those observed at laparoscopy (mean milliliters +/- SEM, 2.54 +/- 0.5 versus 9.42 +/- 1.3, P < .001). The smallest volume of free pelvic fluid that was consistently detected by ultrasound was 8 mL. Whenever no fluid or < 1 mL was detected by transvaginal ultrasound, a small volume of fluid was found at laparoscopy (mean milliliters +/- SEM, 1.6 +/- 0.47). The sensitivity of transvaginal ultrasound was 83% and specificity was 69%. CONCLUSION: Transvaginal ultrasound is a sensitive method of detecting the presence of > 8 mL of free pelvic fluid and therefore is an important diagnostic tool in the assessment of pelvic pathology associated with increased peritoneal fluid.     

Expression of ribonucleolytic toxin restrictocin in Escherichia coli: purification and characterization

OBJECTIVES: To define the incidence and severity of ovarian hyperstimulation syndrome (OHSS) occurring in oocyte donors. METHODS: Women (n = 149) aged 31.3 +/- 4.8 years (mean +/- S.D., range 21-41 years) participated as designated oocyte donors and underwent 400 consecutive cycles of controlled ovarian stimulation using human menopausal gonadotropin following pituitary downregulation with gonadotropin-releasing agonist. Patients were monitored by serial transvaginal ultrasound examinations and serum estradiol (E2) determinations. Oocytes (15.6 +/- 7.5 per aspiration; range 2-57) were harvested by ultrasound-directed transvaginal follicle aspiration 36 h following the intramuscular injection of human chorionic gonadotropin (hCG). Follow-up examination occurred 1 and 2 weeks post-aspiration. RESULTS: On the day of hCG injection E2 levels ranged from 512 to 13,502 pg/ml (mean 2902.7 +/- 1486.9 pg/ml). Over the next few weeks the degree of hyperstimulation in donors was staged: mild 65% (grade I, n = 98; grade II, n = 162); moderate 33.5% (grade III, n = 120; grade IV, n = 14); severe 1.5% (grade V, n = 6; grade VI, n = 0). Associated preaspiration E2 levels were: grade I, 1120 +/- 424 pg/ml; grade II, 2084 +/- 613 pg/ml; grade III, 3785 +/- 1713 pg/ml; grade IV, 5370 +/- 1264 pg/ml; grade V, 4286 +/- 1100 pg/ml. Worsening OHSS was associated with increasing levels of E2. There were no serious complications and hospitalization was not required. All symptoms resolved within 30 days of aspiration, disappearing by the time of the first menstrual flow in women of grade-III or lower stage. CONCLUSION: Although oocyte donors commonly experienced exaggerated levels of serum E2 they rarely (< 2%) developed severe OHSS. This may be attributable to their lack of embryo transfer which avoids exacerbating the illness.     

A retrospective descriptive study of pediatric trauma in a desert country

OBJECTIVE: To determine the optimal initial depth of tube placement in nasotracheal intubation (NTI) of adult patients, measured at the naris, prior to obtaining a chest radiograph (CXR). METHODS: Part 1: A prospective, observational study was performed to compare the initial depth of NTI, measured at the naris, with the observed height of the endotracheal tube (ETT) tip above the carina on the initial CXR. Optimal depths were predicted by gender. Part 2: Results from Part 1 were prospectively validated by measuring the frequency of adequate placement when ETTs were placed to this depth. ETT placement was considered adequate if the tip was at least 2 cm above the carnia and below the larnx on the CXR. RESULTS: Part 1: The mean depth measured at the naris was 27.5 +/- 1.5 cm in women (n = 50) and 27.8 +/- 1.0 cm in men (n = 74). The mean distance of the tip of the ETT to the carina was 3.9 +/- 2.7 cm in women and 6.4 +/- 2.2 cm in men. Initial tube position was adequate in 39 (78%) of the women and 72 (97%) of the men. It was determined that if a depth of 26 cm had been used in the women and 28 cm in the men, 45 (90%) of the women and 70 (95%) of the men would have had adequate tube placement, resulting in statistically significant improvement in the women (p < 0.05; McNemar chi 2). Part 2: These calculated depths (26 and 28 cm) were then prospectively applied in 26 women and 52 men. Twenty-five (96%) of 26 women and 51 (98%) of 52 men had adequate placement, with a mean height above the carina of 4.5 +/- 1.4 cm in women and 5.6 +/- 1.8 cm in men. CONCLUSION: Initial placement of NTI at 26 cm in women and 28 cm in men, measured at the naris, resulted in adequate initial placement for most adult patients.     

The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia

To verify the reliability of transvaginal ultrasonography in diagnosing intrauterine disease and in evaluating the operability of submucous myomas and to determine the feasibility, acceptability and validity of hysteroscopy for menorrhagia, we performed a prospective 5 year study on 793 women of mean age +/- SD of 41.5 +/- 7.8 years. All the patients referred for excessive menstrual bleeding with uterine volume <12 week pregnancy who underwent complete physical examination, transvaginal ultrasonography and outpatient hysteroscopy with endometrial biopsy were included in the study. Outpatient hysteroscopy was not completed due to intolerance or was unsatisfactory due to excessive bleeding in 23 cases (2.9%). Only 28 women (3.5%) declared they would have refused the procedure had they imagined the pain involved. One case of pelvic infection was observed. Compared with hysteroscopy, transvaginal ultrasonography had 96% sensitivity, 86% specificity, 91% positive predictive value and 94% negative predictive value in the diagnosis of intrauterine abnormality. The sensitivity, specificity, positive and negative predictive values of ultrasonography in identifying submucous myomas operable hysteroscopically (intramural extension <50%) were respectively 80, 69, 83 and 65% with a k index of agreement between ultrasonography and hysteroscopy of 0.48. Thus, considering the good specificity and high negative predictive value, transvaginal ultrasonography may be suggested as the initial investigation in menorrhagic patients, limiting hysteroscopy to cases with positive or doubtful sonographic findings.     

Examination gloves as barriers to hand contamination in clinical practice

OBJECTIVE: To test the effectiveness of vinyl and latex gloves as barriers to hand contamination with gram-negative organisms and enterococci during routine hospital procedures. DESIGN AND INTERVENTIONS: We studied 137 procedures during which a health care worker's gloved hand contacted a patient's mucous membrane and was thus potentially contaminated with gram-negative rods or enterococci. Quantitative hand cultures were obtained from each health care worker before and after the gloved contact using a modified glove juice method, and the exterior glove surface was also quantitatively cultured after patient contact. Used gloves were then tested for leaks using the American Society for Testing and Materials' watertight test. SETTING: Harborview Medical Center, a 330-bed city-county hospital and level I regional trauma and burn center, is both a teaching facility affiliated with the University of Washington and the major provider of care to indigent and uninsured persons in Seattle-King County, Washington. PATIENTS AND OTHER PARTICIPANTS: Respiratory therapists performing endotracheal tube care on intubated intensive care unit patients, registered nurses performing digital rectal stimulation for bowel training on patients with spinal cord injury in the rehabilitation ward, and dentists performing routine dental examinations and procedures on healthy outpatients in the dental clinic. MAIN OUTCOME MEASURE AND RESULTS: Eighty-six of the 135 gloves cultured had gram-negative rods or enterococci on the external surface after use and were thus sources of potential hand contamination. Microbial contamination of the health care worker's hands occurred in 11 (13%; 95% confidence interval, 6% to 20%) of these 86 events, and was more frequent with vinyl (10 of 42) than latex (one of 44) gloves (P < .01). After use, glove leaks were also more frequent in vinyl gloves (26 of 61) than with latex gloves (six of 70) (P < .001). Even when leaks were present, gloves prevented hand contamination in 77% of instances and quantitative counts of microorganisms contaminating hands were 2 to 4 logs less than counts on external glove surfaces. Health care workers reported awareness of the presence of glove leaks in only seven (22%) of the 32 events in which leaks were subsequently demonstrated. CONCLUSIONS: Under conditions of routine use, gloves effectively function as a protective barrier even when leaks are present. Latex gloves were less frequently associated with leaks and hand contamination. Since hand contamination occurred after 13% of exposures and cannot be readily identified by health care workers, routine hand washing should be done after each patient contact.     

Esophageal perforation: emphasis on management

BACKGROUND: Perforation of the esophagus is a deadly injury that requires expert management for survival. METHODS: We performed a retrospective clinical review of 66 patients treated at Emory University affiliated hospitals for esophageal perforation between 1973 and 1993. RESULTS: Iatrogenic perforations accounted for 48 injuries (73%), barogenic perforations occurred in 12 patients (17%), trauma was causative in 3 (5%), and 3 patients had esophageal infection and other causes. Lower-third injuries occurred in 43 cases (65%), middle third in 14 (21%), and upper third in 9 (14%). Early contained perforations were managed successfully by limiting oral intake and giving parenteral antibiotics in 12 patients. Cervical perforations were drained without attempt at closure of the leak. Perforations with mediastinal or pleural contamination recognized early were managed by primary closure and drainage in 28 patients. Reinforcement of the primary closure using stomach fundus, pleural, diaphragmatic, or pericardial flap was performed in 16 patients. Those perforations that escaped early recognition required thoughtful management, using generous debridement and drainage and sometimes esophageal resection. The esophageal T tube provided control of leaks in 3 of these patients and was a useful adjunct. Using these management principles, we achieved a 76% survival rate for all patients. Six patients with perforations complicating endoesophageal management of esophageal varices were a high-risk subset with an 83% mortality rate. CONCLUSIONS: Esophageal perforation remains an important thoracic emergency. Aggressive operative therapy remains the mainstay for treatment; however, conservative management may be preferred for contained perforations and the esophageal T tube may be used for late perforations.     

Clinical and instrumental evaluation after Burch's colposuspension in patients with stress urinary incontinence

The authors performed a retrospective study of 29 patients undergoing Burch's anterior colposuspension to treat stress incontinence. Patients were aged between 32 and 71 years old and before surgery presented a urodynamic picture with low mictional pressure, normal filling and Max P of lower closing at 40 mm. Follow-up monitoring ranged from a minimum of 6 months to a maximum of 5 years (mean length 33 months) and was carried out using a urodynamic examination and transvaginal scan to evaluate the distance of the bladder neck from the posterior face of the pubic symphysis. Seventeen women (65.5%) were fully cured after surgery, whereas 27% improved. In "dry" patients the urodynamic examination showed increased significantly of the functional length of the urethra and the transvaginal scan showed that mean values of the distance between bladder neck and pubic symphysis were lover than those in those patients who still presented symptoms. The authors also used ultrasonography to evaluate the efficacy of the latter in the study of urinary incontinence. As reported in other studies, they affirm that intracavitary ultrasonography using a linea probe is equivalent to radiography using cystography with metallic repere, making the examination less invasive and easily repeatable; in addition, it is also important for studying the dynamics of the pelvic floor to establish effective rehabilitative treatment.     

Angioplasty guidewire velocity: a new simple method to calculate absolute coronary blood velocity and flow

The Thrombolysis In Myocardial Infarction (TIMI) frame count is a relative index of coronary flow that measures time by counting the number of frames required for dye to travel from the ostium to a standardized coronary landmark in a cineangiogram filmed at a known speed (frames/s). We describe a new method to measure distance along arteries so that absolute velocity (length divided by time) and absolute flow (area x velocity) may be calculated in patients undergoing percutaneous transluminal coronary angiography (PTCA). After PTCA, the guidewire tip is placed at the coronary landmark and a Kelly clamp is placed on the guidewire where it exits the Y-adapter. The guidewire tip is then withdrawn to the catheter tip and a second Kelly clamp is placed on the wire where it exits the Y-adapter. The distance between the 2 Kelly clamps outside the body is the distance between the catheter tip and the anatomic landmark inside the body. Velocity (cm/s) may be calculated as this distance (cm) divided by TIMI frame count (frames) x film frame speed (frames/s). Flow (ml/s) may be calculated by multiplying this velocity (cm/s) and the mean cross-sectional lumen area (cm2) along the length of the artery to the TIMI landmark. In 30 patients, velocity increased from 13.9 +/- 8.5 cm/s before to 22.8 +/- 9.3 cm/s after PTCA (p <0.001). Despite TIMI grade 3 flow both before and after PTCA in 18 patients, velocity actually increased 38%, from 17.0 +/- 5.4 to 23.5 +/- 9.0 cm/s (p = 0.01). For all 30 patients, flow doubled from 0.6 +/- 0.4 ml/s before to 1.2 +/- 0.6 ml/s after PTCA (p <0.001). In the 18 patients with TIMI grade 3 flow both before and after PTCA, flow increased 86%, from 0.7 +/- 0.3 to 1.3 +/- 0.6 ml/s (p = 0.001). Distance along coronary arteries (length) can be simply measured using a PTCA guidewire. This length may be combined with the TIMI frame count to calculate measures of absolute velocity and flow that are sensitive to changes in perfusion. TIMI grade 3 flow is composed of a range of velocities and flows.     

Effect of chronic administration of cabergoline on uterine perfusion in women with polycystic ovary syndrome

OBJECTIVE: To confirm whether patients with polycystic ovary syndrome (PCOS) have a reduction in uterine perfusion and to verify whether chronic administration of cabergoline can decrease this high vascular resistance. DESIGN: Prospective randomized trial. SETTING: Endocrinological Centre of the Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy. PATIENT(S): Thirty patients were enrolled in the study: 20 affected by PCOS and 10 healthy controls. Patients with PCOS were randomly assigned to one of two treatments for 3 months: oral administration of cabergoline (0.5 mg) every week or oral administration of placebo every week. INTERVENTION(S): All patients underwent transvaginal ultrasonography associated with Doppler flow measurement of the uterine artery, and serum hormone concentrations were determined during the early follicular phase. In women with PCOS, Doppler flow measurement and hormonal assessment were repeated in the early follicular phase of the third month of treatment. MAIN OUTCOME MEASURE(S): Pulsatility index of the uterine artery before and during treatment. RESULT(S): The mean pulsatility index of the uterine artery in patients with PCOS was significantly higher than that of the control group (3.29+/-0.5 and 2.01+/-0.2, respectively). Patients with PCOS treated with cabergoline showed a significant increase in uterine perfusion, with a pulsatility index of 3.14+/-0.6 before and 2.39+/-0.5 during the treatment. No difference was found in patients with PCOS treated with placebo. CONCLUSION(S): Patients with PCOS have high resistance in the uterine arteries, but chronic administration of cabergoline can increase uterine perfusion.     

Assessment with transvaginal ultrasonography of endometrial thickness in women with postmenopausal bleeding

OBJECTIVE: The aim of this study was to assess the use of transvaginal ultrasonography in measuring endometrial thickness in postmenopausal women with bleeding, thus to determine the least invasive treatment. STUDY DESIGN: We evaluated 168 women with postmenopausal bleeding by transvaginal ultrasonography and histological study of the endometrium. RESULTS: No cancerous or precancerous lesions were found when endometrial thickness was under 10 mm. The mean endometrial thickness in women with cancerous and precancerous lesions was 10.75 +/- 1.63 mm, while in non-pathological lesions it was 1.36 +/- 1.18 mm. CONCLUSIONS: To diagnose endometrial pathology, an endometrial thickness over 6 mm yields a sensitivity of 88.6%, a specificity of 90.6%, a positive predictive value of 92%, with 4.6% of false-positives and 4.6% of false-negatives (six small polyps and one irregular maturation). Although we are waiting for other prospective and multicentric studies, our present experience leads us to believe that Dilatation and Curettage (D&C) can be avoided in postmenopausal bleeding with endometrial thickness under or equal to 6 mm.     

Transvaginal ultrasonography in the diagnosis of pelvic adhesions

We studied the role of transvaginal ultrasonography and clinical factors in the diagnosis of pelvic adhesions in a population of 139 consecutive pre-menopausal non-pregnant women submitted to diagnostic and/or operative laparoscopy between February 1995 and November 1996. All patients underwent transvaginal ultrasonography and were interviewed within 2 days of their laparoscopy. The ultrasonographic impressions were then compared with the laparoscopic diagnosis. Patients were classified as having tuboperitoneal abnormalities if evidence of fimbrial, peritubal and/or peri-ovarian adhesions was encountered during surgery. The overall agreement between the ultrasound test result and the surgical findings was calculated using the kappa index. The adhesion of the ovary to the uterus, as evaluated by transvaginal ultrasonography, is most accurate in diagnosing pelvic adhesions (kappa = 0.5) in comparison with the other ultrasonographic findings and clinical parameters. According to the logistic regression equation that was obtained, the probability of the presence of pelvic adhesions varied between a minimum of 12% for patients with no risk factors to a maximum of 93% for patients with three risk factors (previous pelvic surgery and transvaginal ultrasound findings of blurring of the margins of the ovary and adhesion of the ovary to the uterus).     

A monitoring, feedback, and triggering system for reproducible breath-hold MR imaging

OBJECTIVE: To evaluate the diagnostic accuracy and clinical usefulness of high-resolution transvaginal duplex Doppler ultrasound in postpartum and post-abortion patients with excessive hemorrhage who are suspected of having residual trophoblast. METHODS: Forty-eight women with excessive hemorrhage referred for possible residual trophoblastic tissue were evaluated by transvaginal duplex Doppler ultrasonography. Based on two-dimensional imaging, the patients were divided prospectively into groups: women who had an empty uterus with a normal uterine cavity, those with a pure endometrial fluid collection and no echogenic foci, those who had a mixed endometrial fluid collection with foci of echogenicity, and those with intracavitary heterogeneous material with mixed echo patterns of fluid and solid components. In each group, Doppler studies were performed and the resistance index (RI) was calculated. The two-dimensional patterns and Doppler results were correlated with clinical and pathologic follow-up. RESULTS: Twenty-eight subjects had a normal uterine cavity and seven had a pure endometrial fluid collection; all were treated conservatively and none showed later clinical evidence of residual trophoblastic tissue. In 13 women, residual trophoblast was strongly suggested from the images of two-dimensional ultrasonography: Five showed an endometrial fluid collection with some echogenic foci, and eight exhibited intracavitary mixed echogenic material. All underwent curettage, and residual trophoblastic tissue was found in ten of the 13. The mean (+/- standard deviation) RI to flow in the myometrial arteries was 0.54 +/- 0.15 in women without residual trophoblast and 0.35 +/- 0.1 in those with residual trophoblastic tissue (P < .01). CONCLUSION: Our experience suggests that transvaginal duplex Doppler ultrasonography is an effective noninvasive method for evaluating patients with excessive postpartum and post-abortion hemorrhage who are suspected of having residual trophoblastic tissue. Its use enhances the positive preoperative diagnosis of residual trophoblastic tissue and may reduce unnecessary curettage procedures.