US Measurements Research Articles

Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation

The objective of the study was to compare the diagnostic reliability of 3D US with MR arthrography in diagnosing supraspinatus tendon tears, with arthroscopic findings used as the standard. In a prospective study 50 patients who later underwent arthroscopic surgery of the rotator cuff were examined pre-operatively by 3D US with MR arthrography. The presence or absence of a full- or partial-thickness supraspinatus tendon tear and the tear size as demonstrated by each imaging and arthroscopy was recorded. The tear size was divided into three grades: small (<1 cm), medium (1-3 cm), and large (>3 cm). The arthroscopic diagnosis was a full-thickness tear in 40 patients, partial-thickness tears in 5, and intact supraspinatus tendon in 5. 3D US correctly diagnosed 35 out of 40 full-thickness tears and MR arthrography 39 out of 40 full-thickness tears. Regarding partial-thickness tears, 3D US underestimated 2 cases as no tear and overestimated 1 case as a full-thickness tear. MR arthrography underestimated 1 case as a partial-thickness tear and overestimated 2 cases as full-thickness and partial-thickness tears respectively. 3D US and MR arthrography yield a sensitivity for full-thickness tears of 87.5% and 97.5% with specificity of 90.0% and 90.0%. Based on the grading system, 3D US measurements correctly predicted the tear size of 23 (65.7%) of the 35 full-thickness tears and MR arthrography 30 (75.0%) of the 39 full-thickness tears. Three-dimensional ultrasound seems to be a promising imaging modality comparable to MR arthrography for the assessment of the supraspinatus tendon tears.

Anti Dumping Laws and Practice in India

Until the early 1990’s, Anti Dumping measures were used by only western and developed countries. Since 1992, however, the situation has changed dramatically. As developing countries began to participate more actively in the world trading system, they were frequently confronted by increasing pressure from domestic industries to take action against allegedly dumped imports. More and more, developing countries responded by taking anti-dumping actions and since 1995 more than half of all known anti-dumping investigations have been opened by developing countries. There is no obligation on WTO members to provide for the possibility to take anti-dumping actions. However, it is important that Members be able, if they choose, to exercise their right to take such actions in a manner consistent with the complex multilaterally agreed rules set out in the WTO Agreement on Anti-Dumping. Therefore this article emphasizes on the Anti Dumping measures as enunciated in the AD Agreement and the comparative analysis of Anti Dumping measures in US, EU and India.

The experience of service users with regard to satisfaction with clinical services

Satisfaction questionnaires for service users remain in development. Whilst different from patient reported outcome measures, assessing and monitoring service user satisfaction is a recognised quality indicator of use for commissioning clinical services. Adaptation of a US measure into a UK clinical service was successful in identifying service user satisfaction with two specialist clinical services for sexual-, relationship- and gender-related problem areas. Seventy-eight percent of gender clinic service users and 84% of relationship and sexual clinic service users expressed being satisfied or very satisfied with the service. The potential value for clinical teams in reviewing returns of satisfaction questionnaires from service users is discussed.

The Commission's New Border Package: Does It Take Us One Step Closer to a 'Cyber-Fortress Europe'?

On 13 February 2008, the European Commission presented a new 'Border Package', setting out its vision of how to foster the further management of the EU's external border. In assessing the desirability and feasibility of the new system, CEPS JHA specialists find the Commission's proposal ill-considered and likely to have substantial counterproductive effects on the ground. They expect it to create the same sort of public relations problems as do similar US measures among a travelling public that finds itself increasingly the object of state suspicion, with no concrete reason or grounds.

The Development of the Herpes Symptom Checklist and the Herpes Outbreak Impact Questionnaire

Objective To develop measures of the day-to-day symptomatic and functional impact of recurrent genital herpes (RGH) outbreaks. The Herpes Outbreak Impact Questionnaire (HOIQ) and the Herpes Symptom Checklist (HSC) were designed to be acceptable to clinical professionals and to reflect patients' experience. Methods Scale content was derived via literature review and interviews with RGH patients and physicians. Questionnaires were assessed for face/content validity in the UK and the language checked for acceptability in the United States. The US measures were assessed for face/content validity with patients. Scaling/psychometric properties were determined via web survey. Participants completed the questionnaires twice during an outbreak, with 24 to 72 hours between administrations. Results Respondents found the questionnaires relevant and easy to understand and complete. Application of Rasch analysis resulted in the removal of two HOIQ items. Both scales were found to be unidimensional. Item stability testing for the HOIQ indicated that the measure is reproducible. Internal consistency was good (alpha: time 1 = 0.87, time 2 = 0.91). Discriminative validity was demonstrated by the measure's ability to distinguish between individuals who differed by self-reported severity of outbreak. The HOIQ and HSC were both responsive to change over time. Conclusions The HSC and the HOIQ can determine the impact of a herpes outbreak effectively. They are designed to be used daily during such outbreaks and to determine the effectiveness of RGH treatment.

Les principes du revenu de solidarité active au regard des expériences étrangères

The principles of «revenu de solidarité active » in light of other countries’ experience. The revenu de solidarité active (RSA or working solidarity income) is a major reform in French social protection. Firstly, it replaced the minimum welfare benefits paid to people of a working age, along with the associated bonus mechanisms and has been added to the calculation of the «prime pour l’emploi » . Secondly, it is a significant income supplement for poor workers, with the objective being both to ensure financial support and to prompt a return to work. Based on a comparison with US and UK measures (the EITC and WTC and CTC respectively) which have long been contingent on employment-related benefits, the authors attempt better to understand the expected effects from the RSA. Thanks to the MYRIADE microsimulation model developed by the Caisse nationale des allocations familiales, an ex-ante assessment of this measure and of several alternative scenarii is presented with emphasis on the role played by each component in the scale.

Quantitative bone US measurements in neonates and their mothers

Factors that affect quantitative ultrasound (QUS) bone measurements have not been clearly defined for all clinical populations. To determine some technical and clinical aspects that may affect QUS bone measurement in the neonate-maternal dyad. Speed of sound (SOS) was measured at the radius and tibia using a commercial multisite axial transmission QUS instrument and three manufacturer-provided probes (CS, CR and CM). The study included 183 singleton neonates and 159 mothers. The type of probe, weight and edema significantly affected SOS measurements. In infants, the CS and CR probes measured SOS consistently at the tibia but not the radius. Gestational age was predictive of SOS from the CS probe and remained significant when race, gender, and birth weight were included. None of these parameters predicted SOS when using the CR probe. Maternal SOS at the radius and tibia was correlated with the CM probe. Maternal SOS was predicted by age but not by gravid status, number of living children, or race. There was no consistent correlation between maternal-infant dyad SOS measurements. Axial transmission SOS of bone varies with probe and site and is affected by technical and clinical factors. Valid data depend on documentation of the probes used and the clinical population studied.

Neighbourhood design and physical activity

Health problems related to physical inactivity have become a global health challenge affecting people from the full spectrum of income, age, and ethnicity. This paper examines if neighbourhood environments are associated with physical activity, especially walking and cycling. It analyses 608 respondent survey data from Washington State in the US and Geographic Information System-derived measures of the neighbourhood environment. Respondents reported traffic volume to be the most significant barrier, and good lighting to be the most important facilitator of walking and cycling. Utilitarian destinations, such as grocery stores, restaurants, retail stores and convenience stores, were significant correlates of walking and moderate-intensity physical activities, while housing type, sports facility and transportation infrastructure were correlated with vigorous physical activities. Active people rated higher for their neighbourhood attributes including safety, visual quality, knowing neighbours, seeing many other people walking and cycling, and the availability of sports facilities, parks, and bike racks. Simple interventions such as street lighting, pavements/sidewalks, street trees, benches, bike lanes or trails, bike racks, and traffic-calming devices appeared to hold some promise in promoting physical activities in neighbourhoods. Long-term solutions should include strategies to enhance overall aesthetics, safety, accessibility, street connectivity, and social interactions among neighbours. Les questions de santé liées à l'inactivité physique sont devenues un défi mondial qui intéresse l'ensemble de la population quels que soient les revenus, l'âge et la race. Cet article examine si l'environnement du voisinage est associé à l'activité physique, notamment la marche et le cyclisme. Il analyse les données d'une enquête faite auprès de 608 personnes de l'État de Washington aux États-Unis ainsi que des mesures de l'environnement du voisinage dérivées de systèmes d'information géographique. Les personnes interrogées ont répondu que la circulation était l'obstacle le plus significatif et qu'un bon éclairage était l'atout le plus important pour la marche et le cyclisme. Les destinations utilitaires, comme les supermarchés, les restaurants, les boutiques de détail et de proximité, avaient un rapport significatif avec la marche et des activités physiques d'intensité moyenne, alors que le type de logement, les installations sportives et les infrastructures de transport étaient corrélés à des activités physiques intenses. La population active attache davantage d'importance à des caractéristiques du voisinage comme la sécurité, la qualité visuelle, la connaissance des voisins, l'observation de nombreuses autres personnes pratiquant la marche et le cyclisme ainsi qu'à la disponibilité d'installations sportives, de parcs et de porte-vélos. De simples éléments comme l'éclairage des rues, les chaussées, les arbres, les bancs, les pistes et les voies cyclables, les porte-vélos, les ralentisseurs semblent être quelque peu prometteurs dans la promotion des activités physiques de voisinage. Des solutions à long terme devraient inclure des stratégies visant à améliorer l'esthétisme global, la sécurité, l'accessibilité, la connectivité des rues et les interactions sociales entre voisins. Mots clés: vie active, environnement bâti, cyclisme, conception, santé, voisinage, activité physique, santé publique, configuration dans l'espace, concepts urbains, marche, bien-être

Comparison of Lens Thickness Measurements Using the Anterior Segment Optical Coherence Tomography and A-scan Ultrasonography

To assess lens thickness (LT) measurements with anterior segment optical coherence tomography (AS-OCT) in comparison with A-scan ultrasonography (A-scan US). Enrolled were 66 eyes of 48 phakic elderly volunteers aged > or = 50 years and 56 eyes of 56 young participants aged 18 to 40 years. LT was measured with the internal manual caliper tools in AS-OCT. The A-scan US measurements were based on an average of 10 consecutive automatic measurements. Reproducibility was assessed by three measurements each with AS-OCT and A-scan US independently obtained by two observers who were masked to one another's results. The failure rates of AS-OCT and A-scan US were 9.1% and 7.6%, respectively, in elderly subjects, but no failure was observed in young subjects. The LT values measured by AS-OCT were significantly greater than A-scan US; the paired difference was 0.135 mm in elderly and 0.101 mm in young subjects (P < 0.001). These differences did not correlate with the nuclear cataract grades (r = 0.078, P = 0.558). Intraobserver agreement on AS-OCT (95% limits of agreement [LoA]: -0.049 to +0.045 mm; ICC: 0.999) was better than A-scan US (95%LoA: -0.194 to +0.218 mm; ICC: 0.974). The 95% LoA of interobserver agreement using AS-OCT and A-scan were -0.084 to +0.073 and -0.278 to +0.239 mm, respectively, and the ICCs were 0.996 and 0.960, respectively. AS-OCT can be used to measure lens thickness in most eyes with clear or opacified lenses. It appears to be an alternative means of measuring lens thickness, particularly when a noncontact method is needed.

Characteristics of the bladder in infants with urinary tract infections: an ultrasound study

Patients with urinary tract infection (UTI) are known to have impaired bladder function as demonstrated by urodynamic (UD) studies. UD is rarely performed in infants. To evaluate bladder function in infants with UTI using a dynamic US protocol. Maximal bladder volume (MaxBV), residual volume (RV) and bladder wall thickness (BWT) were measured and compared with values from normal controls. A total of 57 consecutive infants (47 males, 10 females; mean age 0.48+/-0.30 years) with proven UTI, and 63 age-matched normal controls (37 males, 26 females; mean age 0.47+/-0.37 years) were recruited. MaxBV was determined just before voiding, and RV and BWT were measured after spontaneous voiding. Infants with UTI had smaller MaxBV (34.89 vs. 42.91 ml), larger RV (3.46 vs. 1.51 ml) and greater BWT (4.21 vs. 3.68 mm) than normal infants (P<0.05, Mann-Whitney test). Smaller bladder volume, larger residual volume and thicker bladder wall in infants with UTI can be explained by bladder instability, hypercontractility and infection-induced oedema of the bladder wall during UTI. The US measurement of bladder parameters might serve as an objective guide for clinical diagnosis and allow objective evaluation of bladder function during posttreatment follow-up.

OC129: Role of ultrasound in guiding of surgery radicality in cervical cancer management

Objectives: Standard treatment for early-stage cervical cancer (stage IA2-IB2) is radical hysterectomy (RH). This is accompanied by side effects that affect the quality of life. Moreover there are young patients who want to preserve fertility. If the disease is accurately graded (tumor volume, depth of invasion [DOI]), radicality of surgery could be adjusted and patients offered alternatives to the standard technique that include fertility-sparing surgery (FSS) using radical trachelectomy (RT), or nerve-sparing (NS) surgery that offers lower morbidity. This study aims to evaluate the role of US in guiding of surgery radicality and the importance of a novel marker distance measurement between tumor and pericervical fascia (DTF). Methods: 106 early stage cervical cancer patients treated between January 2005 and December 2007 were enrolled. All underwent US examination including the staging and topography of tumor, distance evaluation between tumor and pericervical fascia in all directions, and volumometry of tumor/cervix. US data were confirmed by histopathology. Results: Based on US topography and volumometry, 4 RT, 2 NS RT, 26 type II RH, 38 type II NS RH (8 site-differentiated surgeries) and 36 type III RH were performed. The correlation coefficient (R) for US volumometry (compared to histopathology) was 0.996, the accuracy of US tumor topography reached 93%. Based on US measurement of craniocaudal distance and tumor topography, 6 RT were performed (2 of them NS), one of them requiring completion of RH due to peroperationally determined endometrial extent of disease. Conclusion: Ultrasound is an invaluable tool in cervical cancer management. While radical hysterectomy type III is still needed in bulky tumors and insufficient DTF, many patients with tumors ≤40 mm and tumor-pericervical fascia distance ≥ 5 mm (determined by US) could undergo less radical nerve-sparing parametrial resection, or, based on the measurement of craniocaudal extent ≥10 mm, be offered FSS.

OC130: Intratumoral vascularization in endometrial cancer as assessed by transvaginal 3D Power‐Doppler sonography: correlation with histoprognostic factors

Objectives: Standard treatment for early-stage cervical cancer (stage IA2-IB2) is radical hysterectomy (RH). This is accompanied by side effects that affect the quality of life. Moreover there are young patients who want to preserve fertility. If the disease is accurately graded (tumor volume, depth of invasion [DOI]), radicality of surgery could be adjusted and patients offered alternatives to the standard technique that include fertility-sparing surgery (FSS) using radical trachelectomy (RT), or nerve-sparing (NS) surgery that offers lower morbidity. This study aims to evaluate the role of US in guiding of surgery radicality and the importance of a novel marker distance measurement between tumor and pericervical fascia (DTF). Methods: 106 early stage cervical cancer patients treated between January 2005 and December 2007 were enrolled. All underwent US examination including the staging and topography of tumor, distance evaluation between tumor and pericervical fascia in all directions, and volumometry of tumor/cervix. US data were confirmed by histopathology. Results: Based on US topography and volumometry, 4 RT, 2 NS RT, 26 type II RH, 38 type II NS RH (8 site-differentiated surgeries) and 36 type III RH were performed. The correlation coefficient (R) for US volumometry (compared to histopathology) was 0.996, the accuracy of US tumor topography reached 93%. Based on US measurement of craniocaudal distance and tumor topography, 6 RT were performed (2 of them NS), one of them requiring completion of RH due to peroperationally determined endometrial extent of disease. Conclusion: Ultrasound is an invaluable tool in cervical cancer management. While radical hysterectomy type III is still needed in bulky tumors and insufficient DTF, many patients with tumors ≤40 mm and tumor-pericervical fascia distance ≥ 5 mm (determined by US) could undergo less radical nerve-sparing parametrial resection, or, based on the measurement of craniocaudal extent ≥10 mm, be offered FSS.

Measurement matters for modelling US import prices

AbstractWe focus on capturing the increasingly important role that emerging economies play in determining US import prices. Emerging‐market producers differ from others in two respects: (1) their cost structure is well below that of developed‐market producers, and (2) their wide profit margins induce pricing policies that seek to exhaust production capacity. We argue that these features have dampened the short‐run responses of import prices to changes in the value of the dollar but that they have not altered the associated long‐run response. To capture these considerations, we develop a new method to measure foreign prices and adopt a formulation that differentiates between short‐ and long‐run responses. Our econometric work asks two questions: First, can one replicate the literature's dispersion of pass‐through estimates? Second, is there any evidence of a change in the dynamic response of import prices to changes in the exchange value of the dollar? To address the first question, we estimate the parameters of our models using several alternative measures of US and foreign prices, dynamic specifications, and sample periods. We find that these alternative inputs translate into a large range of parameter estimates, a finding that helps to rationalizing the existing dispersion of estimates. To address the second question, we compute the implied dynamic adjustment of import prices to a change in the value of the dollar using parameters estimated from two samples: 1974–2000 and 1974–2005. The long‐run response of import prices is similar regardless of which sample is used—roughly one‐half of the change in the exchange rate is passed through to import prices. However, the short—run response is quite sensitive to the sample period. Specifically, the short‐run response based on data through 2005 is smaller than the short‐run response based on data through 2000. We argue that one force behind the change in dynamics of the import‐price process is the greater presence of producers from emerging economies and that their effect on import prices can be captured with their measure of foreign prices. Published in 2008 by John Wiley &amp; Sons, Ltd.

The Correlation Between Visceral Fat Distance Measured by Ultrasonography and Visceral Fat Amount by Computed Tomography in Type 2 Diabetes

Background: Visceral adipose tissue accumulation highly correlates with metabolic abnormalities and cardiovascular disease. Computed tomography (CT) is considered to be the standard method for visceral fat evaluation, but it is not used as a routine procedure. Ultrason ography (US) is a safe method, fairly inexpensive and widely available modality for measuring abdominal fat thickness. The aim of this study was to investigate the correlation between the intra-abdominal fat distance by US measurement and the visceral fat amount by CT and cardiovascular risk factors and to evaluate whether the intra-abdominal fat distance is better correlate with visceral fat amount by CT than other anthropometric paramete rs and to assess the cut-off value of intra-abdominal fat distance for visceral obesity in type 2 diabetic patients. Methods: We obtained abdominal subcutaneous and intra-abdominal fat dis tance by using a high-resolution US (HDI 5000, ATL, Phillps, USA) at 1 cm above umbilical level in one hundred twenty-eight type 2 diabetic patients. CT scan (Light Speed plus, GE, USA) for the measurement of subcutaneous and intra-abdominal visceral fat area was also performed in the supine position at the L4-5 level. Lean body mass and % body fat were measured in a bioimpedance using DSM (Direct Segmental Measurement by 8-point electrode) method (InBody 3.0, Biospace, Seoul, Korea). We measured patient's height, weight, BMI (Body mass index), waist circumference, WHR(Waist-hip ratio) and blood pressure and also measured fasting blood glucose, HbA1c and lipid profiles. Results: Abdominal subcutaneous and visceral fat distance measured by US is 2.05 ± 0.52 cm, 4.43 ± 1.54 cm, respectively. In pearson's correlations, visceral fat distance were correlated with BMI (r = 0.681, P < 0.001), waist circumference (r = 0.661, P < 0.001), WHR (r = 0.571, P < 0.001), triglyceride (r = 0.316, P < 0.001), HDL-cholesterol (r = -0.207, P < 0.004). US-determined visceral fat distance was also correlated with visceral fat amount by CT (r = 0.674, P < 0.001) and BMI (r = 0.610, P < 0.001), waist circumference (r = 0.626, P < 0.001), WHR (r = 0.557, P < 0.001). When we used waist circumference (men: 90 cm, women: 85 cm) as parameters for visceral obesity, the cutoff value of visceral f at distance, obtained by the receiver operating

The usefulness of ultrasound examination of the bowel as a method of assessment of functional chronic constipation in children

Ultrasonographic assessment of stool retention in children with chronic constipation requires the diagnosis of megarectum. The aim of the study was to evaluate an atypical method of US assessment of megarectum, fecal impaction and enlarged colon in order to decide whether it can be used as an assessment method for children with functional chronic constipation. A total of 120 children with a positive diagnosis of chronic constipation were included in the study. All patients fulfilled the ROME II diagnostic criteria for defecation disorders. The control group comprised 105 patients with a normal defecation pattern. Children with a US diagnosis of megarectum, fecal impaction and enlarged colon were referred for proctoscopy and measurement of colonic transit time. The transverse diameter of the rectal ampulla increases with age and thus influenced the US measurements in both the patient and control groups. The numerical values of this parameter differed significantly between patients and controls in all age groups. The rectopelvic ratio is the ratio of the width of the rectal ampulla (as seen by US) to the distance between the anterior superior iliac spines (measured externally using a measuring tape). This allows the definition of megarectum. In the diagnosis of fecal impaction, US showed a sensitivity of 88.3% relative to proctoscopy. In children with fecal impaction the colonic transit time, average segmental transit time for the rectum and sigmoid colon, and average segmental transit time for the left colon were significantly longer. There was no statistically significant difference for the right side of the colon. US assessment of stool retention and overfilling of the colon in children with functional chronic constipation has a high correlation with proctoscopy findings and colonic transit time. The rectopelvic ratio can be used to diagnose megarectum in children with functional chronic constipation with a cut-off value of 0.189.

Age-dependent dynamic sonographic measurement of pediatric clubfoot

US shows promise in evaluating clubfeet. In order to assess responses to therapy, the measurements of normal feet and clubfeet must be known. To investigate the role of US measurement in quantitatively evaluating normal feet and clubfeet in children, and to assess changes in these feet with age. Patients <1 year old with unilateral or bilateral clubfoot deformity underwent US examination of the foot with specific attention to the medial malleolar to navicular (MMN) distance. Measurements were made in neutral and full adduction positions, and in the abduction position simulating the Ponseti maneuver. Children undergoing US for other reasons had the same imaging performed and served as controls. A total of 127 feet in 66 children were evaluated (20 children had bilateral clubfeet, 25 had unilateral clubfoot, and 21 had normal feet). Clubfeet had significantly (P < 0.001) lower MMN measurements at all three positions than control feet. These distances increased with patient age for both normal feet and clubfeet, but the rate of increase was less for clubfeet. Normal feet and clubfeet exhibit marked differences in MMN distances, as well as differences in rate of change over time. By understanding the age-dependent variability of normal feet and clubfeet, dynamic sonography can help assess clubfoot anatomy and could help to assess the effect of treatment interventions.

Concordance between thyroid nodule sizes measured by ultrasound and gross pathology examination: Effect on patient management

Ultrasound examination (US) is an essential tool in the evaluation of thyroid nodules. The size determined by US is used to distinguish between clinical vs. nonclinical thyroid nodules i.e. greater than or equal to or less than 1 cm. In this study, we evaluated the concordance between the sizes of thyroid nodules measured by US and by gross examination after thyroidectomy. This study included 664 nodules that underwent fine-needle aspiration (FNA) and subsequent excision in 621 patients; 580 had single and 41 patients had multiple (39 with 2, and 2 with 3 nodules) nodules. Both US and gross pathology measurements were taken in three dimensions. The nodule sizes as measured by US were stratified into five groups: A: <or=1.0 cm, B: 1.1-2.0 cm, C: 2.1-3.0 cm, D: 3.1-5.0 cm, and E: >or=5.1 cm. FNA diagnoses were categorized into: Benign (n = 59), Neoplastic / Indeterminate (n = 342), Suspicious (n = 123), Malignant (n = 106), and nondiagnostic (n = 34). Upon excision 278 (42%) nodules were classified as malignant and 386 (58%) as benign. In group A the concordance between US and excisional size was 78.5%, group B 56%, group C 34.5%, group D 40% and group E 52.5%. Only 14 (14/664 2%) nodules measured <or=1.0 cm by US, however, after thyroidectomy 105 (105/664 15.5%) measured <or=1.0 cm in size. Histological diagnoses of this group were benign 62 (58%), papillary microcarcinoma 39 (37%), medullary microcarcinoma 3 (3%) and follicular/Hurthle cell carcinoma 2 (2%) cases. In this study the concordance in benign or malignant nodules measured by US and surgical pathology examination is <or=50%, except in the <or=1.0 cm size range (78.5%). This may lead to an increase in the number of patients undergoing FNA and subsequent surgical excision.

Prostate-Specific Antigen Levels, Prostate-Specific Antigen Kinetics, and Prostate Cancer Prognosis: A Tocsin Calling for Prospective Studies

In 1985, a US man had an 8.7% lifetime risk of receiving a diagnosis of prostate cancer and a 2.5% risk in his life of death from the disease; these two risks today are 17% and 3%, respectively (1,2). Prostate-specific antigen (PSA) screening is largely responsible for this increase in diagnosis; its contribution to the 31% fall in mortality between 1990 and 2003 remains a subject of heated debate (2). Along with the substantial increase in detection of the disease has been a concomitant stage migration from tumors of high volume and grade to tumors of lower volume and grade — and presumably of lower biologic potential. Recognizing the substantial impact of all prostate cancer treatment options on a man’s quality of life, including sexual, urinary, and bowel function, interest in active surveillance as a management option for prostate cancer has increased substantially. Active surveillance is a management strategy that acknowledges that many tumors are slow growing and may not cause morbidity or mortality during a patient’s lifetime. Active surveillance commonly includes regular PSA tests and rectal examinations as well as periodic prostate biopsy to detect any increase in tumor volume and grade. The premise with this management is that should evidence of increased tumor volume or grade be detected, potentially curative treatment can be initiated to control the disease. This approach differs from that of Fall et al. (3), who followed patients expectantly, without attempting early intervention for cure. Although a strategy of active surveillance makes intuitive sense, in practice there are few data to guide physicians and their patients with the question of when to treat. Because we are a risk-averse society, most recommendations favor early treatment to avoid the potential loss of the “window of curability” of these tumors. Current strategies often focus on absolute PSA levels, PSA kinetics, and evidence of increase in tumor grade or volume (4). In practice, the most common reason for treatment is a “worrisome” PSA level or an increase in PSA velocity. In this context, Fall et al. show the challenges with using PSA measures to identify tumors that meet the ultimate defi nition of “biologic aggressiveness,” causing the death of the patient. It must be recognized, however, that the patients in this series were substantially different from the majority of patients with localized prostate cancer today in countries where PSA screening is highly prevalent (such as the United States): PSA levels were above 10 ng/mL in 48% of the patients in that population, and more than 60% of men had tumors that were palpable on rectal examination. At diagnosis, these were high-volume tumors, tumors more likely to exhibit stronger PSA kinetics driving more favorable PSA operating characteristics than would be expected from popula tions containing higher fractions of screen-detected cancers (5). As a result, we would expect less optimistic performance of these PSA measures in a typical US

Low endometrial volume may predict early pregnancy loss in women undergoing in vitro fertilization

To evaluate the role of 3-D US measurement of the endometrium during early IVF-pregnancy and before the appearance of gestational sac in the prediction of pregnancies outcome. 60 pregnant women following IVF treatment were included in the study. The women underwent transvaginal 3D US measurements of endometrial volume and thickness on day 15-17 post ET. Patients were followed and classified according to pregnancy outcome into 2 further groups. The group with early pregnancy loss and the group with ongoing pregnancy. While no differences were observed between those who miscarried and those who did not in gestational age, endometrial thickness or volume, spontaneous early pregnancy loss was significantly higher in patients with endometrial volume <2 mL as compared to those with endometrial volume >2 mL. 3-D US measurement of endometrial volume of less than 2 mL during early IVF pregnancy and prior to the appearance of gestational sac is a powerful predictor of pregnancy loss.

Contrast-enhanced ultrasonography in the follow-up of patients with hepatic metastases from breast carcinoma

Oncological treatment planning relies on the evaluation of treatment response, which is defined by the change in size of measurable lesions. The purpose of this study was to evaluate the use of contrast-enhanced ultrasound (CEUS) to obtain a precise measurement of hepatic metastases in breast cancer patients with fatty-liver disease. Twelve consecutive patients with 25 liver metastases from breast cancer and fatty liver disease, as defined by US criteria, were enrolled in this prospective study. All patients underwent conventional US, CEUS and multidetector computed tomography (MDCT), used as the gold standard for measuring the maximum diameter of lesions. Agreement between US, CEUS and MDCT measurements was analysed using Altman-Bland plots; 95% confidence limits were calculated for the difference among means. Mean diameter as measured by MDCT was 26.2 mm (range 11-83). US allowed measurement of 20/25 lesions. In 15 lesions, CEUS measurements were more accurate than those obtained by US. The difference among means was 1.1 mm with a 95% confidence interval (-9.2, 11.4) for US measurements and 0.6 mm with a 95% confidence interval (-2.0, 3.1) for CEUS. Our preliminary data show that CEUS can be used to obtain more accurate measurements than conventional US for the follow-up of patients with metastases in fatty liver.