Transvaginal Probe Research Articles

Ultrasound-guided transrectal drainage of deep pelvic abscesses in children: a modified and simplified technique

Appendicitis is a common cause of acute surgical abdomen in children and often presents after perforation. Intra-abdominal abscesses can be drained percutaneously via transabdominal, transgluteal or, in the case of deep pelvis abscess, via transrectal approach. To describe a modification of previously described techniques for transrectal drainage procedures, which involves the use of a transvaginal probe and a modified enema tip as a guide for the one-step trocar technique. We also aimed to evaluate the safety and effectiveness of this modified technique for drainage of deep pelvic abscesses in children. A retrospective review of medical records was performed to identify all patients who underwent transrectal abscess drainage at our pediatric institution during a 5-year period. Surgical and radiologic procedure notes and imaging studies were evaluated. The data were analyzed to determine technical and clinical success rates, and to evaluate for any procedure-related complication. The study population consisted of 46 patients with a mean age of 10.9 years. Of the 46 children, 20 underwent transrectal abscess drainage solely using transrectal US for guidance; 2 also underwent minimal fluoroscopy at the time of transrectal drainage. Fifteen children required placement of one or more percutaneous transabdominal drains at the same time as transrectal catheter placement, and nine required addition percutaneous drainage catheters placed at another time. All transrectal drainage procedures were technically and clinically successful. There were no procedure-related complications. The described modified technique for US-guided transrectal drainage of deep pelvic abscesses resulting from perforated appendicitis in children is safe, effective and relatively easy to perform, with the added benefit of omitting radiation exposure in children.

P28.10: Vaginal gel 3D volumetry in women with suspect of deep infiltrating endometriosis: a pilot study

To determine vaginal volumetry and evaluate variations within subjects, by VOCAL. 26 patients with suspected Deep infiltrating endometriosis (DIE), who had bowel preparation and empty bladder were subject of vaginal sonography. Intravaginal GEL was used, and the whole vagina was evaluated with the transvaginal probe in the introitum. A 3D capture with 60% and 12 cm depth was performed. Vaginal length, width, posterior fornix length and vaginal volumen were measured for all. All cases were amenable for measurement. The procedure was not painful and always took less than 1 minute. Mean age was 33 (24-47) years, mean BMI was 24 (18-30). The population was highly selected as only 1 had a vaginal delivery and 2 had 1 Caesarean section. The other 23 women were nulliparous. Vaginal length was 8.2cm (4.77-5.9), maximal vaginal width was 5.7cm (4.3-6.92), posterior fornix length was 1.8cm (1.5-3.4), length to width ratio was 1.46 (0.98-1.89). There was no correlation between vaginal volume and women age (Pearson p = 0.96). The only positive correlation was found between BMI and vaginal volume with vocal (Pearson R = 0.398, p = 0.04). Despite this small population, and highly selected clinically, vaginal ultrasound may allow to measure the vagina. This will motivate others to conduct new trials that may explain prolapse, incontinence, sexual function or even, vaginal tears in delivery.

OP17.01: Disinfection of transvaginal ultrasound probes in a clinical setting; comparative performance of automated and manual reprocessing methods

<scp>OP</scp>17.01: Disinfection of transvaginal ultrasound probes in a clinical setting; comparative performance of automated and manual reprocessing methods

P30.19: Application of quantification elastography in patients suspected of endometrial hyperplasia

Endometrial pathologies are common ultrasound findings in group of peri and postmenopausal women and are an indication for further diagnostics including biopsy, curettage, hysteroscopy. This study assessed whether a new elastography application with quantification possibility can differentiate normal and abnormal endometrium and to be a helpful tool to establish further management. The study included a group of 47 patients with endometrial thickness more than 5 mm. Elastographic images of the uterus were achived in all patient, due to pressure applied by operator of transvaginal probe. Mid-saggital view of endometrium was delineated and assessed, according to EITA scale and with the use of elastography index (EI). Subsequently pathological analysis was performed. Correlation between elastography indices, presented in numbers and pathologic results was analyzed. Pathologies of endometrium (7 cases of carcinoma, 12 polyps, 5 hyperplasia) had higher elastography index - above 3. 22 out of 23 patients with normal and atrophic endometrium had EI less than 3. The values of EI for endometrial pathologies were in range from 3 to 8, the highest values were in hyperlasia and cancer. The corellation was significant, p < 0,0001. We did not find any changes in elastograms and EI, depending on the amount of pressure applied during examination. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Design of miniaturized illumination for transvaginal co-registered photoacoustic and ultrasound imaging.

A novel lens-array based illumination design for a compact co-registered photoacoustic/ultrasound transvaginal probe has been demonstrated. The lens array consists of four cylindrical lenses that couple the laser beams into four 1-mm-core multi-mode optical fibers with optical coupling efficiency of ~87%. The feasibility of our lens array was investigated by simulating the lenses and laser beam profiles using Zemax. The laser fluence on the tissue surface was experimentally measured and was below the American National Standards Institute (ANSI) safety limit. Spatial distribution of hemoglobin oxygen saturation (sO2) of a mouse tumor was obtained in vivo using photoacoustic measurements at multiple wavelengths. Furthermore, benign and malignant ovaries were imaged ex vivo and evaluated histologically. The co-registered images clearly showed different patterns of blood vasculature. These results highlight the clinical potential of our system for noninvasive photoacoustic and ultrasound imaging of ovarian tissue and cancer detection and diagnosis.

Interlaced photoacoustic and ultrasound imaging system with real-time coregistration for ovarian tissue characterization.

Coregistered ultrasound (US) and photoacoustic imaging are emerging techniques for mapping the echogenic anatomical structure of tissue and its corresponding optical absorption. We report a 128-channel imaging system with real-time coregistration of the two modalities, which provides up to 15 coregistered frames per second limited by the laser pulse repetition rate. In addition, the system integrates a compact transvaginal imaging probe with a custom-designed fiber optic assembly for in vivo detection and characterization of human ovarian tissue. We present the coregistered US and photoacoustic imaging system structure, the optimal design of the PC interfacing software, and the reconfigurable field programmable gate array operation and optimization. Phantom experiments of system lateral resolution and axial sensitivity evaluation, examples of the real-time scanning of a tumor-bearing mouse, and ex vivo human ovaries studies are demonstrated.

Persistence of Microbial Contamination on Transvaginal Ultrasound Probes despite Low-Level Disinfection Procedure

Aim of the StudyIn many countries, Low Level Disinfection (LLD) of covered transvaginal ultrasound probes is recommended between patients' examinations. The aim of this study was to evaluate the antimicrobial efficacy of LLD under routine conditions on a range of microorganisms.Materials and MethodsSamples were taken over a six month period in a private French Radiology Center. 300 specimens derived from endovaginal ultrasound probes were analyzed after disinfection of the probe with wipes impregnated with a quaternary ammonium compound and chlorhexidine. Human papillomavirus (HPV) was sought in the first set of s100 samples, Chlamydia trachomatis and mycoplasmas were searched in the second set of 100 samples, bacteria and fungi in the third 100 set samples. HPV, C. trachomatis and mycoplasmas were detected by PCR amplification. PCR positive samples were subjected to a nuclease treatment before an additional PCR assay to assess the likely viable microorganisms. Bacteria and fungi were investigated by conventional methods.ResultsA substantial persistence of microorganisms was observed on the disinfected probes: HPV DNA was found on 13% of the samples and 7% in nuclease-resistant form. C. trachomatis DNA was detected on 20% of the probes by primary PCR but only 2% after nuclease treatment, while mycoplasma DNA was amplified in 8% and 4%, respectively. Commensal and/or environmental bacterial flora was present on 86% of the probes, occasionally in mixed culture, and at various levels (10->3000 CFU/probe); Staphylococcus aureus was cultured from 4% of the probes (10-560 CFU/probe). No fungi were isolated.ConclusionOur findings raise concerns about the efficacy of impregnated towels as a sole mean for disinfection of ultrasound probes. Although the ultrasound probes are used with disposable covers, our results highlight the potential risk of cross contamination between patients during ultrasound examination and emphasize the need for reviewing the disinfection procedure.

Percutaneous Transabdominal Oocyte Retrieval Using Vaginal Ultrasound Probe: A Novel, Effective and Safe Method for Oocyte Retrieval in Patients with Vaginally Inaccessible Ovaries

Transvaginal oocyte retrieval using high frequency transvaginal ultrasound (US) has become the gold standard method in IVF. The use of the transvaginal probe is ubiquitous and offers a focused window of observations and high resolution images. Transabdominal percutaneous retrieval is useful in patients with distorted pelvic anatomy or anomalies which prevent vaginal access to the ovaries.

Valsalva test: a new method to evaluate postpartum anal sphincter function by perineal ultrasound

A 37-year-old woman (gravida 1, para 1) visited our hospital for flatus from the vagina. She was 6 months postpartum and her mode of delivery was vacuum extraction at another hospital. Anal sphincter defects were found on neither inspection nor palpation of the vagina. Three-dimensional (3D) transperineal ultrasonography (US) was performed using GE Healthcare Voluson i with a transvaginal probe (5–9 MHz). 3D-US volume data of the anal canal were obtained, tomographically sliced at 1-mm intervals at the coronal section. Both internal and external anal sphincters were thin in the direction of one o’clock (Fig. 1). Next, she was told to strain and her anal canal was observed by 2D-US. A rectovaginal fistula with both anal sphincter defects was clearly visualized in the direction of one o’clock (Fig. 2).

Ultrasound assessment of bladder wall thickness as a screening test for detrusor instability

The aim of the current study was to evaluate the diagnostic accuracy of transvaginal ultrasound measurement of bladder wall thickness (BWT) in diagnosis of over active bladder (OAB). The current prospective study was conducted at Ain Shams University Maternity Hospital over 2 years. Patients presented to the urogynecology outpatient clinic with symptoms of urinary frequency, urgency, nocturia and/or urge incontinence were included in this study. The allocated patients were divided into two groups; Group 1(study group): fifty (50) patients with urodynamic diagnosis of detrusor instability (OAB) were included. Group 2 (control): fifty (50) patients with urodynamic diagnosis of stress incontinence were included. Using a transvaginal probe, BWT was measured in three sites at the thickest part of (a) the dome of the bladder (b) the trigone, and (c) the anterior wall of the bladder. An average of the three measurements was considered as the mean bladder thickness. A total of 100 patients with lower urinary symptoms were finally analyzed. There were no statistical significant differences between both groups regarding age, parity and body mass index, while there was statistically longer disease duration in group 2. Excluding urgency, there was statistical significant difference (P < 0.001) regarding lower urinary tract symptoms namely frequency, urgency incontinence, coital incontinence and nocturia. Patients in group 1 were more positive to symptoms of frequency, urgency incontinence, and nocturia, while patients in group 2 were more positive regarding coital incontinence. The thickness of trigon, dome, anterior wall and mean BWT was significantly higher in group 1 when compared to group 2. Receiver operator characteristics curve was constructed for estimating the association between mean BWT and prediction of OAB in patients with lower urinary tract symptoms. Mean BWT at 4.78 mm was considered as best cut-off value for prediction of OAB with sensitivity of 90 % and specificity of 78 %. Mean BWT was significantly associated with OAB > 4.78 mm as denoted by the significantly large area under the curve [AUC], AUC was 0.905. In women with lower urinary tract symptom, transvaginal ultrasounds measured mean BWT seems to be an effective non invasive diagnostic tool for prediction of OAB.

Use of spatiotemporal image correlation at 11–14 weeks' gestation

To assess prospectively the use of four-dimensional (4D) spatiotemporal image correlation (STIC) in the evaluation of the fetal heart at 11-14 weeks' gestation. The study involved offline analysis of 4D-STIC volumes of the fetal heart acquired at 11-14 weeks' gestation in a population at high risk for congenital heart disease (CHD). Regression analysis was used to investigate the effect of gestational age, maternal body mass index, quality of the 4D-STIC volume, use of a transvaginal vs transabdominal probe and use of color Doppler ultrasonography on the ability to visualize separately different heart structures. The accuracy in diagnosing CHD based on early fetal echocardiography (EFE) using 4D-STIC vs conventional two-dimensional (2D) ultrasound was also evaluated. One hundred and thirty-nine fetuses with a total of 243 STIC volumes were included in this study. Regression analysis showed that the ability to visualize different heart structures was correlated with the quality of the acquired 4D-STIC volumes. Independently, the use of a transvaginal approach improved visualization of the four-chamber view, and the use of Doppler improved visualization of the outflow tracts, aortic arch and interventricular septum. Follow-up was available in 121 of the 139 fetuses, of which 27 had a confirmed CHD. A diagnosis based on EFE using 4D-STIC was possible in 130 (93.5%) of the 139 fetuses. Accuracy in diagnosing CHD using 4D-STIC was 88.7%, and the results of 45% of the cases were fully concordant with those of 2D ultrasound or the final follow-up diagnosis. EFE using 2D ultrasound was possible in all fetuses, and accuracy in diagnosing CHD was 94.2%. Five of the seven false-positive or false-negative cases were minor CHD. In fetuses at 11-14 weeks' gestation, the heart can be evaluated offline using 4D-STIC in a large number of cases, and this evaluation is more successful the higher the quality of the acquired volume. 2D ultrasound remains superior to 4D-STIC at 11-14 weeks, unless volumes of good to high quality can be obtained.

P05.14: Routine screening for fetal anomalies in the 12th week of pregnancy (1996–2012): advantages and limitations

Evaluation of the advantages and limitations of routine screening in early pregnancy by transvaginal sonography in an unselected population. Routine ultrasound examination was offered to every woman in the 12th week of her pregnancy using a transvaginal probe. The examination protocol was focused on surching for major structural anomalies. Routine transabdominal screening at 18 and 32 weeks was also performed. Anomalies were divided into three groups. Group 1: all cases were diagnosed; Group 2: only a certain percent of the cases were detected; Group 3: not detected. Diagnoses were confirmed by neonatological and pathological examinations In a seventeen-year period 22195 women were examined and 393 fetuses had malformations. Fetal anomalies were diagnosed in 130 cases at the 12th week (33,3%), 94 cases at 18 weeks (23,9%), 138 cases at 32 weeks (35,2%) and 29 cases later. All those malformations which cause severe defects and/or extensions of the body contour were detected (Group 1). Structural anomalies which can be diagnosed as a consequence of obstruction or stenosis and those causing small defects were recognised only in a certain percent of cases (Group 2). The explanation for the failure to detect the anomalies included in Groups 2 and 3 is discussed. Early transvaginal screening offers the possibility of early termination of pregnancies with severe structural anomalies in 33,3% of cases. However standard mid-second-trimester transabdominal scanning is still recommended since a significant number of malformations cannot be detected so early in pregnancy. (a) There are malformations which do not manifest so early in pregnancy; (b) we do not have enough experience of the early pathological changes of these anomalies; (c) the resolution of the transvaginal probe is still not enough to recognise them.

Reusable surgical instruments: a guide to two standards

Journal of Operating Department PractitionersVol. 1, No. 1 CommentReusable surgical instruments: a guide to two standardsAngela CobboldAngela CobboldSearch for more papers by this authorAngela CobboldPublished Online:18 Nov 2013https://doi.org/10.12968/jodp.2013.1.1.50AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesCentral Sterilising Club (2013) What's Happening-Documents, Guidelines and Standards. http://tinyurl.com/o3gusjx (accessed 8 October 2013) Google ScholarDepartment of Health (2004) The planning and design of sterile services departments. http://tinyurl.com/q9jhujw (accessed 8 October 2013) Google ScholarDepartment of Health (2009) Health Technical Memorandum 01-01 Decontamination of reusable medical devices Parts B, C and D. http://tinyurl.com/pz9mw2c (accessed 8 October 2013) Google ScholarDepartment of Health (2013a) Choice Framework for local Policy and Procedures 01-01 – Management and decontamination of surgical instruments (medical devices) used in acute care. Part A: The formulation of local policy and choices. http://tinyurl.com/nvms5g3 (accessed 27 September 2013) Google ScholarDepartment of Health (2013b) Choice Framework for local Policy and Procedures 01-06 –Decontamination of flexible endoscopes: Operational management. http://tinyurl.com/qy68jvt (accessed 27 September 2013) Google ScholarHospitals Worldwide (2013) UK Hospitals and Health Clinics. http://tinyurl.com/6xfol5p (accessed 27September 2013) Google ScholarJoint Advisory Group \9jag on GI and Endoscopy (2013) Frequently asked questions. http://tinyurl.com/nabzo8q (accessed 27September 2013) Google ScholarMedicines and Healthcare products Regulatory Agency (2012a) Medical Device Alert: Reusable transoesopha-geal echocardiography, transvaginal and transrectal ultrasound probes (transducers). http://tinyurl.com/nv5k2v8 (accessed 8 October 2013) Google ScholarMedicines and Healthcare products Regulatory Agency (2012b) Top ten tips on endoscope decontamination. http://tinyurl.com/3ysdvs8 (accessed 8 October 2013) Google ScholarNational Institute for Health and Care Excellence (2006) Patient safety and reduction of risk of transmission of Creutzfeldt-Jakob disease (CJD) via interventional procedures. www.nice.org.uk/ipg196 (accessed 27 September 2013) Google Scholar FiguresReferencesRelatedDetails 1 October 2013Volume 1Issue 1ISSN (print): 2053-3292ISSN (online): 2053-3306 Metrics History Published online 18 November 2013 Published in print 1 October 2013 Information© MA Healthcare LimitedPDF download

Ectopic Pregnancy in the Era of Medical Abortion: Are We Ready for It? Spectrum of Sonographic Findings and Our Experience in a Tertiary Care Service Hospital of India

The aim of this study was to share our experience of clinical presentation and ultrasonographic findings in cases of ectopic pregnancy especially in the context of usage of unsupervised medical abortifacients. This is prospective study conducted over a period of 1year extending from August 01, 2009 to July 31, 2010 in a tertiary care Armed Forces Hospital of India. Clinically and or sonologically suspected cases of ectopic pregnancy formed the study group. Detailed clinical, menstrual, and treatment history was obtained for each patient. Ultrasonography (USG) was done with multifrequency convex (2.5-6MHz) followed by transvaginal (6-10MHz) probes. Operative findings were noted and recorded in each case. In the study period, a total of 1958 pregnant patients were admitted and treated, which included 1690 deliveries and 268 abortions. Based on USG findings, 16 cases (0.8%) of ectopic pregnancy were diagnosed. While four patients were treated medically (with methotrexate), 12 cases underwent surgery. Out of 16 cases, 10 cases were suspected clinically as ectopic pregnancy. Features suggestive of menorrhagia, threatened abortion, and pelvic inflammatory disease were present in five, three, and three cases, respectively. History of intake of medical abortifacients (MA) (mifepristone followed by misoprostol) was present in 07 (43.75%) cases. On USG, commonest abnormality was a complex adnexal mass seen in 12 (75%) cases. Gestational sac with definite embryo within and surrounding echogenic rim was seen in five cases. Live ectopic pregnancy was diagnosed in two (12.5%) cases. Endometrial thickness was less than 10mm in all cases who had taken MA. Pseudo gestation sac was seen in 02 (12.5%) cases. Significant hemoperitoneum was present in 10 out of 12 cases operated. Organized hematoma in pelvis masking the presence of adnexal mass was noted in three cases. Over-the-counter availability, failure to strictly follow the guidelines, unsupervised usage of MA along with atypical clinical history have increased diagnostic dilemma in ectopic pregnancy. Sonographic findings are frequently atypical in such cases. Ectopic pregnancy may remain under-diagnosed with potentially serious consequences in patients who have taken MA without prior confirmation of intrauterine gestation.

Influence of ovarian manipulation on reproductive endocrinology in polycystic ovarian syndrome and regularly cycling women

Little is known about the function of the ovarian neuronal network in humans. In many species, copulation influences endocrinology through this network. As a first step, the possible influence of ovarian mechanical manipulation on pituitary and ovarian hormones was evaluated in polycystic ovarian syndrome (PCOS) and regularly cycling women. Prospective case-control study (2008-2010). Ten PCOS women (Rotterdam criteria) undergoing ovulation induction with recombinant-FSH and ten normal ovulatory controls were included in an academic fertility clinic. In the late follicular phase blood was drawn every 10 min for 6 h. After 3 h the ovaries were mechanically manipulated by moving a transvaginal ultrasound probe firmly over each ovary ten times. Main outcome measures were LH and FSH pulsatility and ovarian hormones before and after ovarian manipulation. All PCOS patients showed an LH decline after the ovarian manipulation (before 13.0 U/l and after 10.4 U/l, P<0.01), probably based on a combination of a longer LH pulse interval and smaller amplitude (P=0.07). The controls showed no LH change (before 9.6 U/l and after 9.3 U/l, P=0.67). None of the ovarian hormones (estradiol, progesterone, anti-Müllerian hormone, inhibin B, androstenedione and testosterone) changed in either group. Ovarian mechanical manipulation lowers LH secretion immediately and typically only in preovulatory PCOS patients. The immediate LH change after the ovarian manipulation without any accompanying ovarian hormonal changes point to nonhormonal communication from the ovaries to the pituitary. A neuronal pathway from the ovaries communicating to the hypothalamic-pituitary system is the most reasonable explanation.

Transvaginal sonographic sliding sign: accurate prediction of pouch of Douglas obliteration

Transvaginal sonographic sliding sign: accurate prediction of pouch of Douglas obliteration

Questionable value of absolute mean gray value for clinical practice

Questionable value of absolute mean gray value for clinical practice

Use of Gaseous Spring Water for Tubal Patency Test

Brief Description of the Purpose of the StudyThe purpose of this study was to try Gaseous Spring water as an alternate contrast agent in Tubal Patency test which would be easily available and to reduce the cost of the procedure.MethodsThis technique is common to all procedures, regardless of the contrast agent chosen. A balloon catheter is preferred as it is less likely to dislodge and creates a better seal at the internal cervical os. Following the insertion of the catheter, the speculum is removed and the transvaginal ultrasound probe reinserted. Under Ultrasound control about 5-10 CC of echo-enhancing agent ie gaseous spring water is inserted very slowly so that Micro Air bubbles are not destroyed. Tubal patency was assessed by direct imaging of micro air bubbles at the Cornual end and by seeing the bubble constantly moving at the Cornual ean of 5 to 10 seconds to made the diagnosis of patent tube.Main ResultsOut of 360 patients examined by gaseous spring water 288 patients i.e. 80% were found to have bilateral Patent Tubes.Importance of the ConclusionsThe Tubal Patency assessment with gaseous spring water was found to be cost effective, safe, easily available and less time consuming then HSG. It is recommended that spring water should be used to check tubal patency in sub fertile women. Brief Description of the Purpose of the StudyThe purpose of this study was to try Gaseous Spring water as an alternate contrast agent in Tubal Patency test which would be easily available and to reduce the cost of the procedure. The purpose of this study was to try Gaseous Spring water as an alternate contrast agent in Tubal Patency test which would be easily available and to reduce the cost of the procedure. MethodsThis technique is common to all procedures, regardless of the contrast agent chosen. A balloon catheter is preferred as it is less likely to dislodge and creates a better seal at the internal cervical os. Following the insertion of the catheter, the speculum is removed and the transvaginal ultrasound probe reinserted. Under Ultrasound control about 5-10 CC of echo-enhancing agent ie gaseous spring water is inserted very slowly so that Micro Air bubbles are not destroyed. Tubal patency was assessed by direct imaging of micro air bubbles at the Cornual end and by seeing the bubble constantly moving at the Cornual ean of 5 to 10 seconds to made the diagnosis of patent tube. This technique is common to all procedures, regardless of the contrast agent chosen. A balloon catheter is preferred as it is less likely to dislodge and creates a better seal at the internal cervical os. Following the insertion of the catheter, the speculum is removed and the transvaginal ultrasound probe reinserted. Under Ultrasound control about 5-10 CC of echo-enhancing agent ie gaseous spring water is inserted very slowly so that Micro Air bubbles are not destroyed. Tubal patency was assessed by direct imaging of micro air bubbles at the Cornual end and by seeing the bubble constantly moving at the Cornual ean of 5 to 10 seconds to made the diagnosis of patent tube. Main ResultsOut of 360 patients examined by gaseous spring water 288 patients i.e. 80% were found to have bilateral Patent Tubes. Out of 360 patients examined by gaseous spring water 288 patients i.e. 80% were found to have bilateral Patent Tubes. Importance of the ConclusionsThe Tubal Patency assessment with gaseous spring water was found to be cost effective, safe, easily available and less time consuming then HSG. It is recommended that spring water should be used to check tubal patency in sub fertile women. The Tubal Patency assessment with gaseous spring water was found to be cost effective, safe, easily available and less time consuming then HSG. It is recommended that spring water should be used to check tubal patency in sub fertile women.

Feasibility of high-intensity–focused ultrasound (HIFU) for treatment of polycystic ovarian syndrome: potential for noninvasive treatment

Purpose Polycystic ovarian syndrome (PCOS) affects 5-10 % of females in the child bearing period and is a common cause of infertility in this population. Surgical treatment is indicated for patients resistant to medical management. We investigate the feasibility of using HIFU as a non-invasive treatment of PCOS. Materials and Methods Ex-vivo canine ovaries fixed in gelatin were held in degassed water in front of an integrated 3.5 MHz dual mode ultrasound array (DMUA) system fenestrated to allow simultaneous use of a diagnostic transducer. DMUAs are transducers capable of imaging and treating with HIFU simultaneously using the same elements. Synthetic aperture (SA) and single transmit focus (STF) imaging were used to guide the treatment and HIFU shots (about 9-11 kW/cm 2 , 2 sec exposure time) were done at 6-7 mm depth. Ovaries were then sectioned and photographed to inspect the resultant damage. Results Echogenic changes were observed on imaging at the focal spot. Localized damage (~8×5 mm) was detected at the cortico-medullary interface; corresponding to the site of the echogenic changes. The ovarian surface was smooth and intact. SA imaging clearly showed the anatomical details of the ovaries. Conclusion We report the first use of DMUAs for potential treatment of PCOS by HIFU. Results demonstrate the feasibility of inducing thermal damage in ovaries without significant damage to the ovarian surface. This could potentially reduce the incidence of post-operative pelvic adhesions. Further, it should be possible to apply HIFU through a transvaginal probe, thus eliminating the risk associated with laparoscopy. SA imaging provided high resolution imaging that can guide the treatment. Further research is still needed to refine the exposure parameters and provide histological characterization of the HIFU induced damage.

Hygiene of transvaginal ultrasound probes in a developing country: case of Togo

The purpose of this study was to assess the knowledge and practices of hygiene rules for transvaginal ultrasound by sonographers practicing in Togo. Their knowledge of these rules is good. In practice, they mainly use condoms to protect the vaginal probe, which is sufficient to prevent horizontal transmission of infection. The shortcomings are at the level of hand hygiene; they do not routinely wash hands or wear gloves, nor do they follow guidelines for disinfection of the probes.