Sonographic Observation Research Articles

Function of the Ovaries in Female Kidney Transplant Recipients

Objectives One of the effects of an improved general health state after successful kidney transplantation in women of reproductive age is recurrence of regular menstrual function. Materials and methods Sixty-three ovarian cycles in female kidney transplant recipient, aged from 18 to 44 years, at 1.5 to 15 years after transplantation, were compared with 50 cycles of healthy women. We monitored the menstrual cycle duration as well as follicle stimulation hormone (FSH), leutinizing hormone (LH), estradiol, progesterone, prolactin, creatinine, and testosterone serum concentrations as well as hematocrit and obtained sonographic observations of ovarian follicle growth and ovulation. Results Of the recipients, 68.1% had regular menstrual cycles. Ovulatory cycles were observed in 45% of patients. Estradiol concentration established in the first phase of the cycle was significantly higher among the transplanted group (mean value 226.86 ± 97.45 pg/mL vs 140.00 ± 61.00 in the controls). A significantly lower level of progesterone (15.05 ± 17.34 ng/mL vs 30.79 ± 18.48 ng/mL in the controls) and of testosterone were observed in kidney recipients. Other hormonal parameters did not differ significantly between the groups. Conclusions Similar serum FSH, LH, and prolactin concentrations as well as increased levels of estrogens were observed in kidney transplant recipients compared with healthy nonrecipients. The rate of ovulatory cycles in regularly menstruated kidney graft recipients was similar to that of healthy women. Stabilization of graft function resulted in restoration of normal ovarian hormone metabolism and ovulatory cycles in female kidney transplanted recipients.

Real‐time 3‐D sonographic observation of fetal facial expression

There have been a few reports about 3-D sonographic observation of fetal movements using dynamic 3-D sonography. However, dynamic 3-D sonography is not real-time, the frame rate being in the region of 4-6 frames per second depending on the size of the region of interest and the number of lines employed. Recently, a new faster 3-D sonography, which acquires up to 28 frames per second, has become available. Using this system, we studied a full range of fetal facial expressions during pregnancy. A total of 17 normal fetuses in 16 pregnancies (15 singletons and one twin) at 20-38 weeks' gestation was studied using a transabdominal real-time 3-D ultrasound machine. This 3-D ultrasound machine proved capable of providing continuous 3-D sonographic images every 0.05 and 0.035 s. The fetal face was monitored for 15 min for each subject. Fetal eyelid movement (fetal blinking) was observed in three of 17 fetuses (17.6%). Double blinking was identified in one fetus at 38 weeks. Various types of mouth movement (yawning, a little opening, chewing, and subtle lip movement) could be observed in nine of 17 fetuses (52.9%). In the course of yawn-like opening of the mouth, tongue movements such as tongue thrust and tongue click were clearly shown in three fetuses (17.6%). A lingula movement was also identified in the course of tongue movement. Real-time 3-D sonography provides a novel means for evaluation of fetal movement, particularly fetal facial expression, in the second and third trimesters. Real-time 3-D sonography might be an important modality in future fetal behavior research and in evaluation of fetal well-being.

The Likelihood Ratio of Sonographic Findings for the Diagnosis of Hemorrhagic Ovarian Cysts

The purpose of this study was to quantify the likelihood ratio (LR) of specific sonographic features and experienced sonologist assessment in diagnosing a hemorrhagic ovarian cyst and to better understand the diagnostic power of sonography in making this diagnosis. Two sonologists, blinded to the patient's clinical history, independently reviewed the sonograms of 252 adnexal masses. For each mass, each sonologist recorded features using a standardized checklist, which included observations regarding the presence of fibrin strands, a retracting clot, septations, and wall irregularity. Each reviewer independently chose 1 specific conclusion from a list of possibilities that included the diagnosis of a hemorrhagic ovarian cyst. Sonographic observations and sonologist predictions were compared with pathologic findings (n = 214) or follow-up sonography (n = 38). Of the 252 masses, there were 30 hemorrhagic cysts. One sonologist correctly identified 25 hemorrhagic cysts, with 1 false-positive, 2 false-negative, and 3 indeterminate calls (LR 185). The other sonologist correctly identified 24 hemorrhagic cysts, with 1 false-positive, 0 false-negative, and 6 indeterminate calls (LR 178). The 2 cases incorrectly diagnosed as hemorrhagic cysts were endometriomas at pathologic diagnosis. Specific sonographic observations and combinations of observations performed as follows: retracting clot (LR >67); fibrin strands (LR 40); fibrin strands and no septations (LR 100); and fibrin strands, no septations, and smooth wall (LR 200). Fibrin strands and a retracting clot are paramount observations in allowing high confidence in the diagnosis of hemorrhagic ovarian cysts. Approximately 90% of hemorrhagic ovarian cysts will exhibit at least 1 of these 2 features.

Prenatal ultrasonography and neonatal imaging of complete cleft sternum: a case report

The prenatal diagnosis of a complete cleft sternum was established in a fetus of a twin pregnancy at 22 weeks' gestation. We present the prenatal imaging and correlation with postnatal magnetic resonance imaging and high-resolution ultrasonography. Thinned and depressed midline anterior chest wall transmitting the cardiac pulsation was the clue to the diagnosis, and the defective sternum could be identified on close sonographic observation. Successful surgical correction was undertaken at 2 months of age. There were no major associated abnormalities such as ectopia cordis or midline abdominal wall defects.

204 ASSOCIATION BETWEEN SOME ULTRASONIC CHARACTERISTICS OF CORPUS LUTEUM ANDPROGESTERONE VALUES IN CASPIAN MINIATURE MARES

Reproductive characteristics of the Caspian miniature horse have some similarities to other equine breeds, but several differences such as follicular wave pattern, multiple ovulations, and the size of ovulatory follicle have been reported. Still there are some other characteristics to be determined. This study was carried out to investigate ultrasonic and hormonal changes of the Caspian mares during estrus cycle. Eleven clinically healthy and cycling Caspian mares, aged 3–17 years and weighing 159–236 kg L.W., were used from April to July. Using an ultrasound scanner equipped with a 5-MHz, B-mode, linear array rectal transducer, formation of the corpus luteum was observed from Day 0 (day of ovulation), and changes in plasma progesterone were investigated by daily blood collection and assay by means of an RIA method. Repeated measure ANOVA test was used for statistical analysis. The maximum size of the corpus luteum was seen at Day 3 postovulation (36.6 ± 1.91 mm), and remained up to 10 days after ovulation. At Days 10–11 a significant decrease in size was observed; thereafter gradual regression occurred and minimum size was reached by Days 16–17 (17.3 ± 1.46 and 16.9 ± 1.20 mm, respectively). The first significant increase in progesterone level was detected 24 h after ovulation and average high values of 8 ng/mL by Day 4 after ovulation. The average peak value of progesterone was detected on Days 7 to 10 of the cycle (11.6 ± 1.37 ng/mL) and remained so until Day 12. The lowest plasma progesterone concentration (less than 1 ng/mL) was observed from Day 14 till one day postovulation, coinciding with the CL regression found in sonographic observations. The results of this study revealed that the pattern of corpus luteum formation and Its changes in size and the plasma progesterone levels during the estrus cycle in this breed follow a pattern similar to that of other equine breeds. The authors wish to thank the University of Tehran for funding and Khojir stud farm for providing animals.

Laser-induced thermotherapy (LITT) for malignant liver tumours: the role of sonography in catheter placement and observation of the therapeutic procedure

Evaluation of sonography in the placement of catheters for laser-induced thermotherapy (LITT) as well as for the observation of the therapeutic procedure in cases of malignant liver tumours. Following the placement of 1-4 LITT applicators, 18 patients with malignant liver tumours (recurrence of hepatocellular carcinoma n = 5, metachronous liver metastases n = 13) were examined by ultrasound to determine the position of the applicators as well as the sonographic visualisation of the respective lesion. The laser treatment procedure was also observed sonographically. As standard reference method for the documentation of thermally induced necroses we used magnetic resonance tomography 24-48 hours after the procedure. The tip of the applicator could be localised in all cases, and the position of the applicator relative to the lesion could be directly visualised in 78% of cases. The hyperechogenic thermal effect during LITT had a median size of 4.5 cm, thus proving to be significantly larger than the actual necrosis induced (p < 0.01). The sonographic observation of the procedure identified 8/10 primarily incomplete ablations which were then treated again immediately after correction of the position of the applicators. Continuous sonographic observation of the procedure of LITT can yield important additional information.

Ultrasonographic findings and differentiation of benign and malignant focal splenic lesions

The purpose of this study was to analyse the sonographic findings of focal splenic lesions with an attempt to differentiate benign lesions from malignancies. The sonographic findings of 53 cases...

Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure: sonographic observations.

Focal narrowing of the upper intrahepatic inferior vena cava on computed tomography performed in patients with elevated intraabdominal pressure has been reported recently. The purpose of this study was to assess this phenomenon further with gray scale and duplex Doppler sonography. Seven patients with elevated intraabdominal pressure due to massive ascites in whom computed tomography showed narrowing of the intrahepatic inferior vena cava were studied. Sonography confirmed focal narrowing of the intrahepatic inferior vena cava that persisted throughout the respiratory and cardiac cycles. The narrowed inferior vena cava segment had a characteristic slitlike appearance on transverse images, slightly oblique to the sagittal plane. A focal flow jet typical of stenosis was observed in the three patients in whom Doppler sonography technically was feasible. In three of four patients who were able to sit or to turn into the left lateral decubitus position, the narrowing immediately resolved after the positional change but promptly recurred upon return to the supine position. In patients with elevated intraabdominal pressure, focal slitlike narrowing of the intrahepatic inferior vena cava is an anticipated finding that should not be misinterpreted as evidence of stenosis of the inferior vena cava or of a juxtacaval liver lesion.

Sonographic observations of the peripheral vasculature of the equine thoracic limb.

Investigations of the equine peripheral vascular system have been constrained by the lack of a non-invasive method of examining the arteries and veins of the limbs of the conscious horse. Precise correlations were established between the gross anatomical features of the peripheral vessels and their B-mode sonographic appearance in each thoracic limb of 35 horses. A sonographic imaging protocol was established. Additional Doppler sonographic recordings defined the arterial waveforms and demonstrated that blood flow to the foot could be evaluated in the lateral proper digital artery, distal to the level of the coronary band. Valves (with 2-4 cusps) were identified in the lumina of the medial and lateral palmar common digital veins and those of the medial and lateral palmar proper digital veins. Spontaneous echo contrast, a smoke-like haze of echoic blood, was seen in the lateral and medial palmar common digital veins, the distal deep palmar venous arch and communicating branches, and the palmar proper digital veins, and occasionally seen in the distal deep palmar arterial arch and distal proper palmar digital arteries. The value of duplex sonography (B-mode and Doppler) for anatomical and physiological studies of the peripheral vasculature of the horse was clearly established. Such data could be applied to the investigation of diseases affecting the peripheral circulation.

ULTRASOUND-ASSISTED LAPAROSCOPIC CREATION OF A NEOVAGINA BY MODIFICATION OF VECCHIETTIʼS OPERATION

In performing Vecchietti's operation laparoscopically, it is important to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease and speed of this operation. The pneumoperitoneum is emptied and the bladder filled with 200 mL of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorectal space, with ultrasound guidance, and its emergence into the pelvis is controlled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall. Seven patients with vaginal aplasia had this procedure. There were no complications, and the mean operative time was 43 minutes (range 35-55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual intercourse as very satisfying and two as moderately satisfying. This original technique was used for easy, safe, and rapid creation of neovaginas.

Sonographic observations of the gastroduodenal junction in neonatal piglets

Knowledge of the function of the gastroduodenal junction is important, as changes in its motility are associated with gastrointestinal disorders. Sonographic observations were made of the stomach and duodenum of 19 neonatal piglets, 2–6 d of age. Contractions of the stomach and duodenum were identified clearly; the overall rate of gastric contractions was about 4 min −1. The percentage of contractions in which there was a closure of the terminal pyloric antrum and pyloric canal varied, being 57.2% ± 4.6% in the first postprandial hour and 43.1% ± 3.0% in the third. Antegrade flow of digesta principally occurred preceding a closure of the pyloric antrum and canal. During contractions of the pyloric antrum, the torus pyloricus moved caudally to fill the lumen of the pyloric canal. Our sonographic method provided a noninvasive technique for studying the form and function of gastroduodenal motility in the neonate, suitable for investigating factors that alter gastric emptying.

Persistent right umbilical vein in trisomy 18: sonographic observation.

Journal of Ultrasound in MedicineVolume 17, Issue 12 p. 775-779 Article Persistent right umbilical vein in trisomy 18: sonographic observation. L De Catte, L De Catte Department of Feto-Maternal Medicine, University Hospital Brussels, Belgium.Search for more papers by this authorK Osmanagaoglu, K Osmanagaoglu Department of Feto-Maternal Medicine, University Hospital Brussels, Belgium.Search for more papers by this authorI De Schrijver, I De Schrijver Department of Feto-Maternal Medicine, University Hospital Brussels, Belgium.Search for more papers by this author L De Catte, L De Catte Department of Feto-Maternal Medicine, University Hospital Brussels, Belgium.Search for more papers by this authorK Osmanagaoglu, K Osmanagaoglu Department of Feto-Maternal Medicine, University Hospital Brussels, Belgium.Search for more papers by this authorI De Schrijver, I De Schrijver Department of Feto-Maternal Medicine, University Hospital Brussels, Belgium.Search for more papers by this author First published: 01 December 1998 https://doi.org/10.7863/jum.1998.17.12.775Citations: 12AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume17, Issue12Dec 1998Pages 775-779 RelatedInformation

Ultrasonographic features of intestinal adenocarcinoma in five cats.

Adenocarcinoma, followed by lymphosarcoma, are the most common feline intestinal neoplasms. Clinicopathological, survey radiographic, and ultrasonographic findings of five cats with intestinal adenocarcinoma are reported. An abdominal mass was palpable in all five cats, but the mass could be localized to bowel in only two cats. Radiographically an abdominal mass was detected in only one cat. Ultrasonographically there was a segmental intestinal mural mass in all five cats. The mass was characterized by circumferential bowel wall thickening with transmural loss of normal sonographic wall layers. In one cat, the circumferential symmetric hypoechoic bowel wall thickening was similar to that reported for segmental lymphoma. In the other four cats, the sonographic features of the thickened bowel wall were varied, being mixed echogenicity and asymmetric in 3 cats and mixed echogenicity and symmetric in one. The results of the present report suggest that sonographic observation of mixed echogenicity segmental intestinal wall thickening in the cat represents adenocarcinoma rather than lymphosarcoma, although other infiltrative diseases should be considered.

Fetal midgut herniation into the umbilical cord: improved definition of ventral abdominal anomaly with the use of transvaginal sonography.

The most common anomalies of the fetal ventral abdominal wall include omphalocele and gastroschisis. Umbilical cord hernia is another abdominal wall defect that is poorly defined and usually mistakenly considered as a small omphalocele. The present report describes the sonographic features and clinical significance of four cases of umbilical cord hernia identified transvaginally in the early second trimester of pregnancy. These cases seemed to present a different entity from that of simple omphalocele. The transvaginal sonographic approach provided a clear image of the midgut protruding into the umbilical cord, precise localization of cord insertion in the region of the umbilical ring. Doppler flow evaluation of the umbilical vessels and their relation to the protruding mass. Serial sonographic observations revealed a stable umbilical cord mass in three fetuses, and an enlarging mass in one. Normal karyotype was determined and no associated malformations were detected prenatally. However, in one case that underwent immediate correction of the hernia after delivery at term, the neonate was subsequently found to have pulmonic stenosis and severe neonatal seizures developed at 4 months of age. In two cases, pregnancy was terminated due to parental request. The fourth fetus was delivered vaginally at term and catastrophic division of the umbilical cord containing a loop of small intestine was avoided only by the diligent observation of the midwife. We suggest that umbilical cord hernia is a distinct anomaly originating at a different stage of embryogenesis, thereby having a unique clinical significance, unlike simple omphalocele. Umbilical cord hernia should therefore be defined and considered as a separate entity.

Association of sonographically detected subacromial/subdeltoid bursal effusion and intraarticular fluid with rotator cuff tear.

Although an association between sonographically detected joint fluid and rotator cuff disease has been reported, the significance of sonographically detected subacromial/subdeltoid bursal effusion has not been studied. We examined a group of patients who had shoulder sonography and surgery to determine the association between bursal and joint effusion and surgically proved tears of the rotator cuff. We retrospectively reviewed the preoperative shoulder sonography reports of 163 patients for the presence of fluid within the subacromial/subdeltoid bursa or glenohumeral joint. Surgical reports were obtained to determine the status of the rotator cuff. The sonographic reports of 232 asymptomatic shoulders were also reviewed to determine the prevalence of fluid within the subacromial/subdeltoid bursa or the glenohumeral joint. Sixty-seven (41%) of the 163 patients had a joint effusion, bursal fluid, or both. Joint effusion alone was seen in 35 patients. Fourteen of these had a normal rotator cuff at surgery, and 21 had a rotator cuff tear (sensitivity, 22%; specificity, 79%; positive predictive value, 60%). Bursal fluid alone was seen in 10 patients, seven of whom had a rotator cuff tear (sensitivity, 7%; specificity, 96%; positive predictive value, 70%). In 22 patients, fluid was seen in both the bursa and the joint; 21 had surgically proved rotator cuff tears (sensitivity, 22%; specificity, 99%; positive predictive value, 95%). Of the 232 asymptomatic shoulders, 16 (6.9%) had isolated joint effusions, eight (3.4%) had isolated bursal effusions, and four (1.7%) had both joint and bursal effusions. The sonographic finding of intraarticular fluid alone (without bursal fluid) has both a low sensitivity and a low specificity for the diagnosis of rotator cuff tears. However, the finding of fluid in the subacromial/subdeltoid bursa, especially when combined with a joint effusion, is highly specific and has a high positive predictive value for associated rotator cuff tears. Sonographically detected fluid in both the joint and the bursa is an uncommon finding in asymptomatic shoulders. The sonographic observation of fluid in the subacromial bursa, either isolated or combined with a joint effusion, should prompt a careful evaluation of the supraspinatus tendon for tear.

The antral nipple sign of pyloric mucosal prolapse: endoscopic correlation of a new sonographic observation in patients with pyloric stenosis.

This study describes the antral nipple sign of pyloric mucosal prolapse, a newly delineated sonographic observation in patients with pyloric stenosis, correlates the endoscopic findings, and examines its prevalence and significance in 31 consecutive patients with pyloric stenosis. Fifty patients who did not have pyloric stenosis served as the control population. The antral nipple sign consists of visualization of prolapsed, hypertrophied pyloric mucosa protruding into the gastric antrum. Using the Wilcoxon scores (rank sums), there was no significant difference among the patients in age, weight, or pyloric muscle dimensions. Although the diagnosis of pyloric stenosis is made on the basis of muscle thickness, we have documented that the pyloric mucosa becomes redundant in infants with pyloric stenosis, permitting a fuller understanding of the anatomic correlate underlying the sonographic images.

Sonography of the fetal neural axis: a practical approach

Among serious fetal anomalies currently detectable with ultrasound, defects of the central nervous system (CNS) are among the most common. These congenital anomalies are especially likely to burden not only affected children with severely limiting handicaps, but also their families with long-lasting anguish and financial responsibility. It is appropriate that interest in methods for improving prenatal detection of these abnormalities has intensified. Alphafetoprotein screening programmes are now widely available, and many papers have been written describing useful sonographic observations that enhance prenatal diagnosis. As a consequence, the majority of the most common serious neural axis defects including fetal hydrocephalus, anencephaly, myelomeningocele and encephalocele, previously detected almost exclusively at birth, today can be accurately detected prenatally. A few observations in the fetal brain and spine have proven to be especially useful in this task. This article presents a simplified and effective approach to the general sonographic survey of the neural axis in fetuses at average and increased risk for these anomalies. The aim is to improve not only accuracy of diagnosis of CNS malformations, but the efficiency and confidence of the examiner.

Frequency and treatment of ovarian cysts in adolescence.

Ultrasound examination of the ovaries was performed monthly in the follicular phase of 139 healthy adolescents for one year. In 17 girls (12.2%) ovarian cysts spontaneously disappeared within 3 months of first observation. In 6 subjects, treatment with the combined estrogen/progestogen pill was given. The treatment was effective in 4 girls after 2-6 months while 2 subjects required surgical intervention for a cystic teratoma and a simple follicular cyst respectively. A spell of serial sonographic observation of ovarian cysts would seem appropriate in adolescents.

Epignathus: clinical and sonographic observations of two cases.

The epignathus or mature pluritissued teratoma of the mid-line of the palate is a benign tumor for which the neonatal prognosis is related to the obstruction of the superior airway. This paper concerns observations of two cases, which developed in different ways. Echography enables diagnosis of this type of malformation which classically combines a heterogeneous polylobed mass, polyhydramnios and the absence of other morphological anomalies. It enables an accurate differential diagnosis to be made by eliminating the other masses of the cephalic region. Echographic diagnosis also allows a rational management decision to be made, i. e. termination of pregnancy if prognosis is poor, or continuation with multidisciplinary (neonatologist, obstetrician, surgeon) intervention at birth.

Hepatic vein flow reversal at duplex sonography: a sign of transjugular intrahepatic portosystemic shunt dysfunction.

Sonognaphy is an important diagnostic tool in the noninvasive evaluation of hepatic parenchymal disease and of hepatic vasculatune. With the use of duplex and color Doppier sonognaphy, functional hemodynamic information meganding vascular patency, flow direction, and flow patterns can be obtained [1 , 2]. Recently, these techniques have been used to assess transjugulan intrahepatic portosystemic shunts (TIPS), a relatively new, nonsurgical therapy for the management of uncontrollable vaniceal bleeding associated with portal hypertension. Preliminary observations indicate that Doppler sonography is accurate for detecting TIPS occlusion and may be useful for predicting alterations in shunt function on the basis of calculated flow velocities and changes in direction of portal venous flow [3, 4]. We report here a case of abnormal TIPS function revealed by the sonographic observation of reversal in the direction of flow within the right hepatic vein.