Normal Ultrasound Examination Research Articles

How reassuring is a normal breast ultrasound in assessment of a screen-detected mammographic abnormality? A review of interval cancers after assessment that included ultrasound evaluation

To review factors resulting in a false-negative outcome or delayed cancer diagnosis in women recalled for further evaluation, including ultrasound, after an abnormal screening mammogram. Of 646,692 screening mammograms performed between 1January 1995 and 31 December 2004, 34,533 women were recalled for further assessment. Nine hundred and sixty-four interval cancers were reported in this period. Forty-six of these women had been recalled for further assessment, which specifically included ultrasound evaluation in the preceding 24 months, and therefore, met the inclusion criteria for this study. Screening mammograms, further mammographic views, ultrasound scans, clinical findings, and histopathology results were retrospectively reviewed by two consultant breast radiologists. The interval cancer developed in the contralateral breast (n=9), ipsilateral breast, but different site (n=6), and ipsilateral breast at the same site (n=31) as the abnormality for which they had recently been recalled. In the latter group, 10 were retrospectively classified as a false-negative outcome, nine had a delay in obtaining a biopsy, and 12 had a delay due to a non-diagnostic initial biopsy. Various factors relating to these outcomes are discussed. Out of 34,533 women who attended for an assessment visit and the 46 women who subsequently developed an interval breast cancer, 15 were true interval cancers, 10 had a false-negative assessment outcome, and 21 had a delay to cancer diagnosis on the basis of a number of factors. When there is discrepancy between the imaging and histopathology results, a repeat biopsy rather than early follow-up would have avoided a delay in some cases. A normal ultrasound examination should not deter the radiologist from proceeding to stereotactic biopsy, if the index mammographic lesion is suspicious of malignancy.

Development of a stiffness measurement accessory for ultrasound in breast cancer diagnosis

When ultrasound imaging is used for breast cancer diagnosis, the lesion's morphology is usually used to determine if the lesion is benign or malignant. Sometimes, the information provided by the procedure may not be adequate to make an accurate judgment. Additional information is needed, such as the stiffness of the lesion relative to its surrounding tissue. This paper presents an ultrasound accessory device designed to achieve this purpose. The device is easy to operate and is similar in use to a normal clinical breast ultrasound examination. A sonologist must only attach an ultrasound probe to the device and then slide it across the lesion maintaining a constant compression depth. The built-in inverse biomechanical model of the device will then calculate the predicted stiffness ratio of the lesion relative to its surrounding tissue based on the measured palpation data. Modelling and experiments have been performed on phantoms with embedded inclusions. The experimental results show that the stiffness ratio of the inclusion to its surrounding material can be accurately predicted by the handheld device. A preliminary clinical test was also performed to demonstrate the use of this device in vivo, to offer additional information to aid classification of the tumor as benign or malignant when complemented with ultrasound images.

Acoustic radiation force impulse elastography in distinguishing hepatic haemangiomata from metastases: preliminary observations

The increasing quality of diagnostic ultrasound has resulted in the detection of greater numbers of potentially benign hepatic lesions. Current radiological practice requires contrast enhanced ultrasound, CT or MRI to confirm the diagnosis. Acoustic radiation force impulse (ARFI) elastography is an imaging technique measuring the elasticity of biological tissues. Recent technical advances in ultrasound have made it possible to generate shear waves, whose velocity in the liver is proportional to the degree of hepatic elasticity. This shear wave velocity (SWV) may be used as a marker for both focal and diffuse liver pathology.We used this technique to examine patients with normal livers and those with haemangiomata and metastases. Patients with normal ultrasound examinations and normal liver enzymes, n = 99, had SWVs of 1.24 ± 0.23 m s(-1) (mean ± standard deviation) independent of site of measurement, age or gender. Results of SWV measurements in haemangiomata, n = 35, produced values of the same order, 1.35 ± 0.48 m s(-1). In contrast, patients with metastases, n = 10, had SWVs of 4.23 ± 0.59 m s(-1). With a cut-off value of 2.5 m s(-1), the sensitivity and specificity for haemangiomata were 97.1% and 100%, respectively, with an area under the curve of 0.999. ARFI elastography with SWV measurements is a promising new technique which could replace invasive investigations for benign hepatic lesions.

Childhood outcomes of neonates diagnosed with portal vein thrombosis

The study aims to determine childhood outcomes of neonates diagnosed with portal vein thrombosis (PVT). A retrospective chart review of neonates diagnosed with PVT who had documented follow up (physical examination, laboratory tests or ultrasonographic examination) at the age of 2 years or beyond was conducted. Data were available for 70 children (71% of eligible neonates) at a median age of 5 years (range 2-8 years). Physical examination was unremarkable in all who were examined (n= 68). Twenty-five children had liver functions assessed and only mild abnormalities were detected in nine children. Six of 25 patients tested for thrombophilia showed abnormalities. Thirty-seven children had ultrasonographic follow up. Left lobar atrophy (LLA) was noted in 20 children (16 had isolated LLA, two had LLA and splenomegaly, and two had LLA and portal hypertension). Five children who had normal ultrasound examinations at discharge had splenomegaly (two with additional finding of LLA) at follow up. Two children with portal hypertension diagnosed during neonatal period needed porta-caval shunting. Our results show that among patients, who had PVT as neonates, 28% still had asymptomatic LLA in childhood, 7% had slowly progressive splenomegaly and 3% required shunting because of progression of portal hypertension. Ultrasonographic follow up was the most sensitive method in detecting progression associated with neonatal PVT. Until more data are available, periodic long-term ultrasonographic follow up should be considered for neonates diagnosed with PVT.

Late dislocation of the hip following normal neonatal clinical and ultrasound examination

We present a case of late dislocation of the hip in a 30-month-old girl. Her hip was clinically stable at birth and an ultrasound scan at six weeks was normal. She had no additional risk factors for developmental dysplasia. She underwent anterior open reduction with a femoral osteotomy.

Prenatal transient alveolomaxillary defect in a case of mucolipidosis II (I‐cell disease)

Mucolipidosis II (ML II or I-cell disease) is a rare inherited lysosomal storage disease that causes multisystem deterioration and death in early childhood. Little is known about the fetal features of this condition, and therefore the diagnosis is usually established postnatally when core symptoms occur, including severe growth/developmental delay, coarse facial features, multiplex skeletal deformities and joint limitation1. We report a case of ML II which presented an uncommon fetal sign of transient alveolomaxillary defect (TAD) on prenatal ultrasound imaging before 28 weeks' gestation. A 23-year-old Taiwanese primigravida was referred to our clinic for evaluation of fetal cleft lip/palate suspected on ultrasound examination at 24 weeks' gestation. Detailed sonographic examination confirmed the presence of an alveolomaxillary defect, in which a hole in the maxilla was identified but the soft tissue of the upper lip appeared intact (Figure 1). No other associated structural abnormality was noted. Chromosome analysis revealed a normal male karyotype. The mother denied any drug or teratogen exposure and the personal and family histories of both parents were unremarkable. The pregnancy was then followed with normal serial ultrasound examinations. Unexpectedly, the alveolomaxillary defect was no longer present in the repeat scans performed at 28 weeks' gestation and thereafter. The etiology of the TAD thus remained unknown during the prenatal period. Prenatal ultrasound image at 24 weeks' gestation showing the alveolomaxillary defect presenting as a hole (arrow) while the upper lip seems intact. The infant was born with a weight of 2105 g (10th percentile) via vaginal delivery at 37 weeks' gestation. No facial clefting was noted after birth. Magnetic resonance imaging and computed tomography revealed the craniofacial/maxillary structure to be normal (Figure 2). Cranial sonography presented no findings except mild left ventriculomegaly. Other features of the neonate included a left paramedian caruncle in the upper lip, light hair color, lax skin with sparse subcutaneous fat, long digits and bilateral inguinal hernia. At 2 months of age the infant presented with coarse facial features and dysostosis multiplex (generalized osteopenia, atlas hypoplasia, short, thick clavicles, thick elevated scapula with poorly formed glenoid fossa, oar-shaped ribs and lumbosacral spine). Lysosomal enzyme evaluation and molecular analysis confirmed the diagnosis of ML II. There was markedly increased lysosomal enzyme activity in the plasma and the infant was found to be compound heterozygous with two truncated mutations, c.2422delC (p.L808fsX19) and c.3565C > T (p.R1189X), in the disease-causing gene GNPTAB. The infant died of respiratory failure at the age of 14 months. The family declined necropsy and biopsy of the baby, precluding histopathological investigation of the alveolomaxillary region. Postnatal images of the patient at 14 days (a–c) and at 2 months (d,e) of age. Photographs show the following clinical features: (a) a left paramedian caruncle in the upper lip (arrowhead), light hair color, lax skin with sparse subcutaneous fat, (b) long fingers and (c) long toes. Magnetic resonance imaging (d) and computed tomography (e) examinations showed the alveolomaxillary structure to be normal. TAD is an extremely rare condition in fetuses. To our knowledge, the association of the sign with fetal ML II has not previously been reported, but maxillofacial lesions have been occasionally found in children with ML II2, 3. Some of the lesions found in affected children are surrounded by impacted tissue, and it has been suggested that this involves a process in which the bony defect is replaced with abnormal connective tissue3. Indeed, recent studies have shown that ML II can lead to abnormalities in connective tissues with frequent skeletal involvement4-6. Maxillary deformation followed by tissue replacement associated with ML II may account for the TAD seen in our patient. The possible association of TAD and fetal ML II may provide useful information for prenatal diagnosis and counseling; that is, even a transient bony defect may imply an underlying inherited metabolic condition such as lysosomal storage disease. M. Chen* ** §§, Y.-Y. Ke* §, S.-P. Chang*, D.-J. Lee , C.-H. Chen¶, G.-C. Ma* ¶¶, * Department of Genomic Medicine, Erlin branch, Changhua, Taiwan, Department of Medical Research, Erlin branch, Changhua, Taiwan, Department of Obstetrics and Gynecology, Erlin branch, Changhua, Taiwan, § Department of Pediatrics, Changhua Christian Hospital, Erlin branch, Changhua, Taiwan, ¶ Department of Obstetrics and Gynecology, Changhua Christian Hospital, Erlin branch, Changhua, Taiwan, ** Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan, Department of Medical Genetics, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan, Department of Life Sciences, National Chung-Hsing University, Taiwan, §§ Department of Life Sciences, Tunghai University, Taiwan, ¶¶ Institute of Biochemistry and Biotechnology, Chung Shan Medical University, Taichung, Taiwan

Tiroiditis crónica de Hashimoto: Serie clínica

Chronic Hashimoto Thyroiditis (CHT) is the main cause of hypothyroidism. To report a series of patients with CHT. Retrospective analysis of a series of 27 men aged 38 +/- 14 years and 201 women aged 37 +/- 16 years, evaluated in the private offices of two of the authors. Fifty six percent of patients only had unspecific symptoms at the moment of consultation, 50% had a family history of thyroid diseases and only 21% of women had a previous history of goiter. Eighty one percent of patients had clinical or subclinical hypothyroidism, 62% had both antithyroglobulin and antithyroid peroxidase positive antibodies and 13% had both antibodies negative. Only 1.4% of patients had a normal thyroid ultrasound examination. Patients were treated with levothyroxine at a mean dosage of 75 microg/day and 53% achieved an adequate TSH level. Six often patients operated due to nodules had a papillary carcinoma. CHT should be sought in the general population, especially those with a family history of thyroid disease. Thyroid ultrasound is seldom normal in patients with CHT. Thyroid substitution should be monitored periodically to achieve adequate TSH levels.

How often does office hysteroscopy reveal pathology not previously noted on transvaginal ultrasound—a look at two typical reproductive endocrinology patient groups, including failed IVF–ET patients

Transvaginal ultrasound and office hysteroscopy are established diagnostic tools for the evaluation of infertility patients, with hysteroscopy often considered as the more precise method to evaluate the uterine cavity and ultrasound as the more readily available and less invasive method. We look at both methods in two typical infertility patient groups, including one group with a history of failed in vitro fertilization–embryo transfer (IVF–ET) cycles. Eighty patients were prospectively evaluated. Forty patients presented with a history of failed embryo transfer despite repeat normal transvaginal ultrasound examinations. Forty infertility patients with abnormal ultrasound testing served as a group for comparison. All patients underwent office hysteroscopy. In the subgroup with abnormal ultrasound findings, office hysteroscopy confirmed the diagnosis in 75% of cases but did not add new information. In patients with a history of failed embryo transfer and at least twice normal ultrasound examinations, only 1/40 patients (2.5%) was noted to have a minor abnormality on office hysteroscopy not previously diagnosed on ultrasound. In infertility patients, including those with a history of failed IVF–ET cycles, repeat normal transvaginal ultrasound appears to be an efficient method for the determination of significant intrauterine abnormalities.

Is ultrasound screening for DDH in babies born breech sufficient?

To review our incidence of developmental dysplasia of the hip (DDH) in breech infants referred for ultrasound screening and to determine if subsequent follow-up radiographs are necessary in these patients with normal clinical and ultrasound examinations. A review of the clinical data and imaging studies of all children with the risk factor of breech presentation that were referred for orthopedic evaluation over a 5-year period was conducted. All patients were examined by a fellowship-trained pediatric orthopedic surgeon and all ultrasounds were done at approximately 6weeks of age by an experienced ultrasonographer. Ultrasounds were evaluated using the dynamic method as described by Harcke. As per our protocol, all patients with normal screening ultrasounds were brought back for a final clinical examination and radiographic check at 4-6months. Acetabular dysplasia was indicated by radiographic parameters-if there was severe blunting of the sourcil, abnormal acetabular index for age, or if there was significant asymmetry of acetabular indices side-to-side-in the setting of clinical parameters-if there was greater than 10° difference in side-to-side abduction or symmetric abduction of less than 60°. Three hundred patients with the risk factor of breech presentation were included. Thirty-four patients had clinically unstable hips; 266 had clinically stable hips and were screened by ultrasound. Sixty-four percent were female and 36% were male. Twenty-seven percent of these breech patients had abnormal screening ultrasounds and were subsequently treated. Of the remaining 73% with normal ultrasounds, who were returned per protocol at a mean of 5months, 29% had evidence of dysplasia and underwent treatment. The diagnosis of dysplasia following a normal ultrasound was based on both radiographic and clinical parameters. Of the hips treated with a Pavlik harness, 62% had acetabular indices at least two standard deviations from the age-corrected average versus 26% of patients not treated. The average length of follow-up was 10months. Retrospectively, we found that, at approximately 6weeks of age, ultrasound screening of breech patients with clinically stable hips produces an incidence of DDH of 27%. In those patients with a normal ultrasound, 29%, at 4-6months radiographic follow-up, were found to have dysplasia requiring treatment. This data supports breech as the most important risk factor for hip dysplasia and we, therefore, recommend careful and longitudinal evaluation of these patients with: a careful newborn physical examination, an ultrasound at age 6weeks, and an anteroposterior (AP) pelvis and frog lateral radiograph at 6months, as the risk of subsequent dysplasia is too high to discharge patients after a normal ultrasound.

Increased nuchal translucency in euploid fetuses—what should we be telling the parents?

Nuchal translucency (NT) measurement between 11 and 14 weeks' gestation is an undisputed marker for aneuploidies. When conventional karyotyping is normal, enlarged NT is a strong marker for adverse pregnancy outcome, associated with miscarriage, intrauterine death, congenital heart defects, and numerous other structural defects and genetic syndromes. The risk of adverse outcome is proportional to the degree of NT enlargement. Although the majority of structural anomalies are amenable to ultrasound detection, unspecified genetic syndromes involving developmental delay may only emerge after birth. Concern over these prenatally undetectable conditions is a heavy burden for parents. However, following detection of enlarged NT the majority of babies with normal detailed ultrasound examination and echocardiography will have an uneventful outcome with no increased risk for developmental delay when compared to the general population. Counseling should emphasize this to help parents restore hope in normal pregnancy outcome and infant development.

A Caveat to the Performance of Pericardial Ultrasound in Patients With Penetrating Cardiac Wounds

The pericardial window in a focused assessment with sonography for trauma (FAST) examination is highly accurate for detecting hemopericardium and, therefore, associated cardiac injury. A series of patients with false-negative pericardial ultrasound examinations, who were subsequently diagnosed with cardiac lacerations after presenting with stab wounds, are described. All patients with a normal pericardial ultrasound examination, despite subsequent diagnosis of a cardiac injury, are described (2005-2008). Five patients with stab wounds to the precodium displayed initial and repeatedly normal pericardial windows on a FAST examination. Each patient was eventually diagnosed with a penetrating cardiac injury and concurrent laceration of their pericardial sac. This combination of injuries allowed decompression of blood from the cardiac injury into the thoracic cavity and, therefore, prevented accumulation of a hemopericardium. The pericardial component of the FAST examination is commonly used for patients who present with penetrating wounds to the precordium. In cases of concurrent lacerations of the pericardial sac, pericardial ultrasound may not detect a cardiac injury because of associated decompression into the thoracic cavity.

Effect of Maternal Obesity on the Ultrasound Detection of Anomalous Fetuses

To estimate the effect of maternal habitus on detection of fetuses with major structural anomalies during second-trimester standard and targeted ultrasound examinations. This was a retrospective cohort study of pregnancies 18 to 24 weeks that underwent ultrasonography over a 5-year period. An anomalous fetus was considered detected if a major abnormality of the relevant organ system was identified, regardless of the anticipated ultrasound detection. Anomalies were verified using a prospectively maintained database. Body mass index (BMI) was based on weight at first prenatal visit. There were 10,112 standard examinations in low-risk pregnancies and 1,098 targeted examinations in pregnancies with either high-risk indications or with an abnormality detected during standard ultrasonography. Detection of anomalous fetuses decreased with increasing BMI. For normal BMI, overweight, and class I, II, and III obesity, detection with standard ultrasonography was 66%, 49%, 48%, 42%, and 25%, respectively, and with targeted ultrasonography, 97%, 91%, 75%, 88%, and 75%, respectively, both P< or =.03. Residual anomaly risk after a normal ultrasound examination increased with increasing BMI, from 0.4% among women of normal BMI to 1.0% among obese women, P=.001. Anomaly detection was lower among women with pregestational diabetes than in those with other high-risk indications, 38% compared with 88% respectively, P<.001. With increasing maternal BMI, we found decreased detection of anomalous fetuses with either standard or targeted ultrasonography, a difference of at least 20% when women of normal BMI were compared with obese women. Anomaly detection was even less in pregnancies complicated by pregestational diabetes. Counseling may need to be modified to reflect the limitations of ultrasonography in obese women.

Assessment of fetal Sylvian fissure operculization between 22 and 32 weeks: a subjective approach

Sylvian fissure operculization (SFO) is a dynamic process throughout gestation and is a reliable feature of fetal cortex gyration that is amenable to prenatal ultrasound examination. This study aimed to define a subjective and reproducible method for SFO assessment. This was a cross-sectional study of the sonographic anatomy of SFO conducted over a 9-month period in 200 fetuses with normal anatomical ultrasound examination at 22-32 weeks of gestation. We used a standardized view in an axial cerebral plane. SFO was scored according to a pre-defined scoring sheet based on the degree of overriding of the insula by the temporal lobe across gestational age. Because of the nested nature of the dataset, linear mixed effects models were used for concurrent assessment of inter- and intraobserver agreement of this scoring method. Subject-specific variance of the score was derived for each week of gestation from the whole repeated-measures dataset and the 5(th) and 95(th) percentiles of the score (mean score(week) +/- 1.645 SD(subject, week)) were determined. The inter- and intraobserver agreement correlation coefficients were 0.91 (0.89-1.00) and 0.95 (0.93-1.00), respectively, with a standard error of measurement < 1 scoring unit, which corresponds to an accuracy of within 1 week. A reference chart was fitted, showing the increase of the SFO score between 22 and 32 weeks, along with age-specific 5(th) and 95(th) percentiles. A simple scoring evaluation of the SFO is a reliable method for its assessment at between 22 and 32 weeks of gestation.

Use of laparoscopic cholecystectomy for biliary dyskinesia in the child

Background Biliary dyskinesia (BD) is a consideration as a cause of chronic abdominal pain in the pediatric population. We sought to correlate the results of cholecystokinin–diisopropyl iminodiacetic acid (CCK-DISIDA) scanning, the basis for diagnosis of BD, with outcome after laparoscopic cholecystectomy. Methods A retrospective review was performed of all patients who underwent a laparoscopic cholecystectomy from May 2000 through March 2007. The diagnosis of BD was based on CCK-DISIDA scan demonstrating a gallbladder ejection fraction (GBEF) of less than 35% and/or reproduction of pain on CCK administration or no filling of the gall bladder with a normal ultrasound examination. Hospital, General Surgery office, and Gastroenterology Office charts were reviewed for demographic and management data points. We used χ 2 and Mann-Whitney tests for statistical analysis. Results For the period of review, 430 patients underwent a laparoscopic cholecystectomy including 75 patients with a preoperative diagnosis of BD. The mean age of the BD population was 14 (range, 9-19) years. Female to male ratio was 2.4:1. The mean body mass index was 24.4 kg/m 2. On average, patients had abdominal symptoms for 15.5 (range, 0.25-72) months. Each patient underwent nearly 2.5 studies (computed tomography, ultrasound, esophagogastroduodenoscopy, or upper gastrointestinal series) before diagnosis by CCK-DISIDA. The mean GBEF was 17.4%. When commented on (n = 41), pain on CCK administration was noted in 25 (61%) patients. Pathology revealed chronic cholecystitis in 44%. After laparoscopic cholecystectomy, 58 (77.33%) patients reported resolution of their abdominal pain (mean follow-up 4 months). Of the 17 patients without improvement, 7 were later diagnosed with other underlying pathology (Crohn's, hiatal hernia, cyclic vomiting). There was no difference in GBEF, age, histopathology, or sex between the two groups. There were no complications. Conclusion Laparoscopic cholecystectomy is a safe and effective treatment for the majority of children diagnosed with BD. Although CCK-DISIDA was used to identify biliary dysfunction, it did not correlate with outcome.

ULTRASONOGRAPHIC DETERMINATION OF RESISTIVE INDEX AND GRAFT SIZE FOR EVALUATING CLINICAL FELINE RENAL ALLOGRAFTS

Ultrasonographic examination is a commonly employed technique for postoperative renal allograft evaluation after transplantation. Allograft size and resistive index (RI) are two objective ultrasonographic measures that may help establish a diagnosis and direct postoperative management for grafts with suboptimal function but their diagnostic efficacy has not been evaluated in clinical veterinary patients. Results of 69 feline renal transplant ultrasonographic examinations and RI determinations were studied. Based on clinical parameters at the time of the ultrasonographic examination, patients were grouped into six clinical/functional categories including evaluations of clinically normal grafts, delayed graft function, ureteral obstruction, uroabdomen, graft thrombosis, and rejection. RI, graft size (length, cross-sectional area, and volume), cyclosporine A whole blood trough concentration, Doppler blood pressure, creatinine concentration, and days from transplantation were compared between these categories and associations with each other were examined. RI was of little value in differentiating among the clinical categories with the exception of graft thrombosis. Graft volume and time from transplantation were significantly greater in grafts with signs of rejection and ureteral obstruction compared to clinically normal ultrasound examinations. Graft volume, cross-sectional area and length were generally associated. Cyclosporine A blood concentrations was associated with RI in both the pooled data and in the delayed graft function category. These results indicate RI should be used only as part of a larger clinical picture and in light of other factors including cyclosporine A concentration and the timing of the study relative to the implantation surgery for the diagnosis of postoperative transplantation complications. Graft volume may provide a more sensitive, albeit, nonspecific, indicator of allograft dysfunction.

What follow-up is required for children with a family history of developmental dysplasia of the hip?

To determine what follow-up is needed for children with a family history of developmental dysplasia of the hip (DDH) but who have had a normal clinical and ultrasound examination at 6 weeks of age. A retrospective review of medical and imaging records of all children with a family history of DDH referred to the hip-screening clinic over a 5-year period. An absolute acetabular index value of greater than 30 degrees or gross asymmetry in acetabular index values was used as an indication of occult acetabular dysplasia. One hundred and eighty-one children were identified as having had a normal ultrasound scan with a positive family history of DDH. Two (1.1%) children had acetabular dysplasia on their radiograph performed at 9-12 months of age. The dysplasia, however, resolved in both cases with simple observation and both children have now been discharged from further follow-up. We do not feel that it is necessary for children with a positive family history of DDH to have a radiograph of their pelvis at 1 year of age if they have had a normal clinical and ultrasound examination at 6 weeks of age and such children can safely be discharged from further follow-up at that time.

P42.13: Ultrasonographic assessment of endometrial cavity in two times: ultrasound, sonohysterography with saline infusion

To assess the ability of screening endometrial diseases by transvaginal ultrasound and by sonohysterography (SIS) in proliferating phase. Outcomes have been verified by histology from hysteroscopy. In a prospective observational study, we enrolled 124 cases of suspected endometrial disease in fertile women. Inclusion criteria were: atypical bleeding (menomethrorragia, hypermenorrhea, spotting), clinical suspicion of endometrial lesion, an under-mucosal leiomyoma. In all cases, normal transvaginal ultrasound examination was performed previously with a high frequency probe alone, and then with saline infusion within 5 days from the end of last menstruation. We used a specific catheter (1.8 mm. Goldstein Catheter Cook) for instilling the pre-heated sterile saline solution, which results in good patient compliance and no complications. The test results were compared with hysteroscopy within 15 days. The first ultrasound test identified 71 suspected cases of endometrial disease such as polyps, under-mucosal leiomyomas and endometrial hyperplasia (thickness > 10 mm); 57 (80.2%) were confirmed by hysteroscopy data; on the other hand, out of the 53 patients with a negative ultrasound examination, 13 presented a positive hysteroscopy (sensibility 81%, specificity 74%). By the SIS in the proliferating phase we found 54 women positive out of 56, 64 negative out of 68 (sensibility 93%, specificity 97%). Moreover, the use of power Doppler associated with the contrast fluid allowed us to establish the type of lesion, identifying 31 polyps out of 36, 12 leiomyomas out of 12, nine cases of hyperplasia out of 10. SIS is a high sensibility and specificity test, with same characteristics of hysteroscopy, but with less risks and more comfortable. In a gynecology unit in which surgery hysteroscopy is not completely risk free, SIS represents a valid, rapid, sensitive and costless test.

Late presentation of developmental dysplasia of the hip following normal ultrasound examination

The use of ultrasound in screening for develop-mental dysplasia of the hip (DDH) is wellestablished. Most UK centres undertake selectiveexamination of neonates for those with risk factorsfor DDH or with abnormal or suspicious clinicalexamination, rather than screening of allneonates. Several studies comparing selectiveexamination with screening of all neonates havesuggested a lower incidence of late presentinghip dislocation (after 12 weeks) in screenedpopulations compared with those examinedselectively.

Maternal anxiety and ultrasound markers for aneuploidy in a multiethnic population

Discussion of isolated ultrasound (US) markers for fetal aneuploidy can provoke significant patient anxiety. The objective of this study is to quantify maternal anxiety associated with the detection of these markers. All patients undergoing routine second-trimester US examination for fetal anatomical survey over a one-year period were administered the State-Trait Anxiety Inventory (STAI) for Adults before and after the procedure. Women with isolated fetal markers for aneuploidy were notified of the findings but discouraged from pursuing amniocentesis. Rates of normal US examination, aneuploidy markers, anomalies, amniocentesis, and pregnancy outcomes were assessed across the ethnic groups. Pre- and post-ultrasound STAI surveys were scored and standardized with previously established norms. Student t-tests, Chi-square, and analysis of variance (ANOVA) were used where appropriate. Among the 798 patients tested, 57% were Hispanic, 30% were Asian, 6% were Black, and 7% were White. Maternal anxiety level was decreased in women after a normal US. The anxiety level increased with aneuploidy markers and was the highest with anomalies. Aneuploidy markers were more common among Hispanic and Asian fetuses, without any associated aneuploidy. Women with isolated aneuploidy markers underwent amniocentesis as often as women with advanced maternal age. The detection and communication of isolated aneuploidy markers is associated with increased maternal anxiety and unnecessary amniocentesis.

Is secondary radiological follow-up of infants with a family history of developmental dysplasia of the hip necessary?

The practice of regular radiological follow-up of infants with a positive family history of developmental dysplasia of the hip is based on the widespread belief that primary acetabular dysplasia is a genetic disorder which can occur in the absence of frank subluxation or dislocation. We reviewed all infants who were involved in our screening programme for developmental dysplasia of the hip, between November 2002 and January 2004, and who had a normal clinical and ultrasound examination of the hip at six to eight weeks of age, but who, because of a family history of developmental dysplasia of the hip, had undergone further radiography after an interval of 6 to 12 months. The radiographs of 89 infants were analysed for signs of late dysplasia of the hip and assessed independently by three observers to allow for variability of measurement. There were 11 infants (11%) lost to follow-up. All the patients had normal radiographs at the final follow-up and none required any intervention. We therefore question the need for routine radiological follow-up of infants with a positive family history of developmental dysplasia of the hip, but who are normal on clinical examination and assessment by ultrasound screening when six to eight weeks old.