Three-dimensional ultrasound diagnosis of ruptured subcapsular liver hematoma caused by HELLP syndrome

Early detection of embryonic malformations by transvaginal and color Doppler sonography.

A total of 834 women with uneventful pregnancies were followed prospectively until the 15th week of gestation by TVS to screen for early embryonic malformations. Twenty-eight embryonic anomalies were detected in this series (3.3%). The median gestational age at diagnosis was 11 (range, 8 to 15) weeks. Two neural tube defects were missed by early TVS screening. Two suspected abdominal wall defects were not confirmed by repeat mid-second trimester abdominal sonography representing 6.7% of all fetal malformations evident by 24 weeks of gestation. The sensitivity and specificity of TVS screening for fetal malformations in this series were 93.3 and 99.7%, respectively. In addition, the role of T…

Morphological assessment of the umbilical cord with three-dimensional ultrasonography

ABSTRACTThe long cylindrical cord covered by a layer of amnion that extends from the umbilicus of the fetus to the fetal surface of the placenta is known as the umbilical cord, or, in older medical textbooks, as funiculis umbilicalis. The two umbilical arteries extend as branches of the internal iliac arteries that emerge from the fetal body at the umbilicus, and run a helical course through the umbilical cord carrying venous blood to the placenta. In most normal placentas, the umbilical arteries anastomose within 2 cm of insertion into the placenta. The fetal umbilical vein emerges from the placenta and carries oxygenated blood to the fetus. The cord vessels are supported by a matrix of my…

Umbilical cord cysts: evaluation with different 3-dimensional sonographic modes.

Objective. The purpose of this series was to determine whether the use of different 3-dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. Methods. Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2-dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer-aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. Results. Three-dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of …

Gonadotropin-releasing hormone (GnRH)-I regulation of interleukin (IL)-1b and IL-1 receptor antagonist expression in cultured human endometrial stromal cells

Aim:  Human endometrium is an active site of cytokine production and action. Among these cytokines, the interleukin-1 (IL-1) system seems to be relevant to the embryonic implantation process. We have previously reported the production of GnRH-I by human blastocyst, as well as the presence of GnRH-I receptor in human endometrium. This suggests a close interaction between the immune and endocrine systems through these cytokine mediators in embryonic implantation. Methods:  To test the relevance of this interaction during embryonic implantation, we investigated GnRH-I regulation of IL-1b and IL-1ra mRNA and protein expression in human endometrial stromal cells using quantitative competitive po…

Control of intrauterine device insertion with three-dimensional ultrasound: is it the future?

A comparative study was designed to determine whether three-dimensional transvaginal sonography (3D-TVS) offered advantages over two-dimensional transvaginal sonography (2D-TVS) for the identification and location of IUDs in 66 asymptomatic women. Hysteroscopy was performed in cases in which there was a discrepancy between the information obtained by both methods (n = 14). In eight cases (12.2%) the IUD was misidentified with 2D-TVS. In six cases (9.1%) it was not possible to identify the device model with 2D-TVS. In two cases (3.0%) 2D-TVS failed to identify the position of the device. In contrast, all IUDs were identified and located accurately with 3D-TVS. © 1996 John Wiley & Sons, Inc.

First-trimester neck abnormalities: three-dimensional evaluation.

In order to study the first trimester ultrasonographic differences between nuchal translucency and hygroma colli, we rescanned 25 fetuses (13 with nuchal translucency and 12 with hygroma colli) using transvaginal and three-dimensional ultrasonography, after obtaining a fetal karyotype report. Our objective was to test the premise that the different physiopathologic mechanisms of both processes would be reflected in detectable sonographic differences. Our retrospective analysis showed that the most striking ultrasonographic difference was the presence of bullae as well as greater irregularity, extent, and amplitude of the membrane in cases of hygroma colli. Fetuses with simple nuchal translu…

Posters
Early pregnancy
P01First trimester normograms for a wide variety of ultrasound, hemodynamic and serum parameters

Background The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy. Method A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied. Results An increasing trend with advancing gestation was evident for the mean gestational sac (MSD) and amniotic sac (AS) diameters, trophoblastic rim, CRL and seru…

Is avoidance of surgery possible in patients with perimenopausal ovarian tumors using transvaginal ultrasound and duplex color Doppler sonography?

A total of 108 cases of small perimenopausal ovarian tumors (largest diameter, less than 7 cm) were evaluated by transvaginal sonography and duplex color Doppler sonography; 101 had criteria for benignity and 7 for malignancy. All cysts were punctured and aspirated to avoid unnecessary surgery (benign cases) and establish the cytologic diagnosis as well as to avoid the risk of leakage (malignant cases). Recurrence rate of benign punctured cysts was 25% within 1 year of follow up. No difference in recurrent rate was seen between pre- and postmenopausal patients (19 of 56 cases in the premenopausal group, and five of 28 cases in the postmenopausal group). The larger the cyst, the greater the …

Does transvaginal color Doppler sonography differentiate between developing and involuting ectopic pregnancies?

The objective of this study was to assess the addition of transvaginal color Doppler imaging to transvaginal ultrasonography and beta-human chorionic gonadotropin values to differentiate between developin and involuting ectopic pregnancies. Forty surgically confirmed ectopic pregnancies were classified into developing or involuting according to histopathologic findings. Results were compared retrospectively with the plasma beta-human chorionic gonadotropin values as well as the resistive index and pulsatility index obtained in corpora lutea and peritrophoblastic flow in serial examinations. Student's t-test was used for comparison of means. Logistic regression analysis was applied to predic…

Three-dimensional inversion mode rendering in molar pregnancy

Three-dimensional hysterosonography for the study of endometrial tumors: comparison with conventional transvaginal sonography, hysterosalpingography, and hysteroscopy.

We studied endometrial thickness and homogeneity in 36 patients with postmenopausal bleeding using three-dimensional ultrasound following distention of the uterine cavity with a sterile saline solution (3D-SHSG). Results with 3D-SHSG were compared with findings using transvaginal sonography, transvaginal sonohysterography, transvaginal color Doppler, and hysteroscopy. Sixteen patients (including three on tamoxifen) were undergoing hormone therapy at the time when they were studied. Visualization of the uterine cavity and of endometrial thickness was better with 3D-SHSG than with any of the other ultrasound techniques. The results with 3D-SHSG corresponded to the findings observed with hyste…

Immunohistochemical localization of filaggrin in benign, premalignant and malignant cervical tissue.

Epithelial distribution of filaggrin, a histidine-rich protein related to squamous terminal differentiation, was investigated in 87 cervical biopsies using an avidin-biotin-peroxidase technique with a monoclonal anti-human filaggrin antibody (AKH1). Normal squamous cervical epithelium exhibited a positive homogeneous immunoperoxidase stain in the upper parabasal, intermediate and superficial cell layers. Similar findings were obtained in cervical condylomas, although full-thickness staining was observed in 35.7% of the cases (P < 0.001). Filaggrin expression in CIN was inversely related to the severity of the lesion (P < 0.001). An irregular staining pattern was present in most high-grade C…

Útero septo con duplicación cervical: una anomalía mülleriana infrecuente

Resumen En el presente caso hemos descrito una variante mulleriana infrecuente (utero septo y cervix doble), que resulta inconsistente con la embriologia clasica. Asimismo, hemos realizado un diagnostico correcto mediante el empleo de ecografia tridimensional, que representa el primer caso de la bibliografia mundial descrito mediante esta tecnica ecografica. Por ultimo, hemos repasado las opciones terapeuticas y discutido su inclusion futura en la clasificacion de las malformaciones uterinas

Three-dimensional ultrasound evaluation of ovarian masses.

Seventy-six women with ovarian masses first detected with two-dimensional (2D) ultrasound were then evaluated with three-dimensional (3D) ultrasound. Two-dimensional ultrasound detected four of five ovarian malignancies. One additional ovarian carcinoma was diagnosed by 3D scanning. Observation of papillary projections, characteristics of cystic walls, and the extent of capsular infiltration of tumors was superior with 3D ultrasound as was the calculation of ovarian volume. Fifty-seven of the women studied underwent surgery within 7 days of 3D ultrasound evaluation. Histologic examination of surgical specimens confirmed the 3D sonographic diagnoses. There was one false positive and one fals…

Three-dimensional ultrasound radiance mode imaging of a uterine lipoleiomyoma.

In this case report the diagnosis of a uterine lipoleiomyoma is depicted by means of a three-dimensional radiance mode. The advent of radiance or silhouette mode as a new tool in ultrasound diagnosis is intended to assist by generating additional realistic image visualization and a better distinction among different tissues.

Endometrial receptivity: evaluation with ultrasound.

An adequate endometrial receptivity is a crucial factor for embryo implantation. We describe endometrial morphology (endometrial appearance or pattern, endometrial thickness, volume, and delimitation), based on the concepts and possibilities of the new ultrasound modalities (3-dimensional/4-dimensional ultrasound, automatic volume calculation, virtual organ computer-aided analysis, tomographic ultrasound image, inverse mode, and 3-dimensional Doppler angiography) as markers of endometrial receptivity.

Two-dimensional and three-dimensional sonography of conjoined twins.

Purpose The aim of this study was to evaluate and compare the diagnostic capabilities of 2-dimensional (2D) and 3-dimensional (3D) sonography for the study of conjoined twins. Methods Four pregnant women with an initial 2D sonographic diagnosis of conjoined twins were examined with color Doppler sonography, 3D multiplanar sonography, and orthogonal plane imaging and 3D surface rendering. Results All 4 cases of conjoined twins were initially diagnosed with either transvaginal or transabdominal 2D sonography. 3D sonography afforded more realistic views and demonstrated more clearly the linking areas and surface anomalies, but 2D and color Doppler sonography provided more definitive and specif…

Use of three-dimensional ultrasonography for the study of normal and pathologic morphology of the human embryo and fetus: preliminary report.

Our objective was to determine whether three-dimensional ultrasonography offers advantages over two-dimensional sonography for the evaluation of normal and pathologic morphology of human embryos and fetuses at various stages of pregnancy. Our studies suggest that small fetal and embryonic malformations are better defined with 3D sonography. Our experience indicates that 3D sonography allows more detailed visualization of fetal internal structures. We believe that with technical improvements 3D sonography will permit a more complete evaluation of fetuses earlier in gestation than is possible with current 2D sonographic instruments.

Assessment of endometrial volume by three-dimensional ultrasound prior to embryo transfer: clues to endometrial receptivity

The aim of the present prospective study was to obtain quantitative data on endometrial volume by three-dimensional (3D) ultrasound at the time of embryo transfer in an in-vitro fertilization programme and to assess its value in predicting endometrial receptivity. The cycles (n = 72) were classified according to endometrial volume: group A2 ml, group B 2-4 ml, and group C4 ml. Comparisons of the groups showed that pregnancy and implantation rates were significantly lower (P0.05) in the group of patients with an endometrial volume2 ml. Furthermore, no pregnancy was achieved with an endometrial volume1 ml. It is concluded that endometrial volume by 3D transvaginal ultrasound may become a new …

Expression of vascular endothelial growth factor receptors in the endometrium of septate uterus.

Objective To compare the messenger RNA (mRNA) expression of vascular endothelial growth factor (VEGF) receptors (KDR, Flt-1, and sflt) in the different endometrial locations of septate uterus and normal uterus. Design Prospective, observational study. Setting University teaching hospital. Patient(s) Twelve women with complete septate uterus undergoing hysteroscopic metroplasty and 12 women with normal uterus. Intervention(s) Endometrial tissue samples were obtained from the endometrium covering the septum and the endometrium lining the lateral wall of the uterus. Moreover, endometrial samples were obtained from patients with normal uterus. Main Outcome Measure(s) Differences in the mRNA exp…

Sonographische Diagnose eines Holoakardius

In the 28th week of gestation a normal foetus and a holoacardius were diagnosed via sonography in a biamnotic monochoriatic twin pregnancy. The growth of the foetuses was observed under continuous sonographic control up to the 40th week of pregnancy. The patient delivered a healthy twin by Caesarean section and the acardius was subjected to a postmortem. Macroscopic and histological findings in the foetus, the placenta and the umbilical cords are demonstrated. The pathogenesis of the holoacardius is discussed as being due to chromosomal aberrations and foeto-foetal transfusion syndrome.

Three-dimensional sonographic diagnosis of a large cystic neck lymphangioma.

Lymphangiomas are fairly well-circumscribed benign masses of lymphatic vessels or channels that vary in size, are usually greatly dilated, and are lined with normal endothelial cells. They may be classified into 3 groups: lymphangioma simplex, consisting of capillary-sized channels; cavernous lymphangiomas, consisting of dilated channels with a fibrous adventitial covering; and cystic lymphangiomas, or hygromas, composed of multiple cysts of varying sizes that are lined with endothelial cells. Mixed types may coexist within a given lesion. Although lymphangiomas can occur in any part of the body where lymphatic ducts are located, 95% of them are found in the neck, the head, or the axilla. 1…

3D sonographic prenatal diagnosis of lobar holoprosencephaly associated with cebocephaly. Assessment and diagnosis with multiplanar reconstruction

Multiple congenital contractures (Congenital multiple arthrogryposis)

Arthrogryposis, is the occurrence of joint contractures of variable etiology that start prenatally. Arthrogryposis may result from neurologic deficit, neuromuscular disorders, connective tissue abnormalities, amniotic bands, [figure: see text] or fetal crowding. Arthrogryposis may result from no apparent hereditary causes (neuropathic, for example) or may be the result of hereditary factors (myopathic form, for example). Ultrasound diagnosis depends on observation of scant or absent motion of fetal extremities. Prognosis depends on the specific etiology of the contractures.

Three-dimensional visualization of the human embryo: a potential revolution in prenatal diagnosis

Prenatal diagnosis of congenital cystic adenomatoid malformation using three-dimensional inversion rendering: A case report

We report a case of a congenital cystic adenomatoid malformation of the lung (CCAM). At 12 weeks of gestation, an echogenic lung associated to a hydrothorax was detected. Despite the results of the combined test that informed of a high risk of chromosomopathy, normal karyotype was confirmed after an amniocentesis. The three-dimensional ultrasound inversion mode depicted all the cysts within the fetal lungs as opaque areas that were seen concurrently together, which was compatible with CCAM. After parental counseling, the patient opted to terminate the pregnancy at 18 weeks. Pathological analysis of the lungs confirmed the diagnosis of a CCAM type II. The recent advent of the three-dimension…

Empleo prenatal de esteroides: riesgos y beneficios

Resumen El empleo de corticoides ante la posibilidad de un parto prematuro ha disminuido la incidencia de distress respiratorio, hemorragia intraventricular y muerte neonatal. En aquellas mujeres en que el parto se pospone mas alla de una semana, el empleo de nuevas dosis semanales ha sido empleado en la practica obstetrica pese a que hay poca evidencia de su eficacia. Nuevos estudios sugieren en estas pautas repetidas ocos beneficios y riesgos potenciales, por lo que sugieren las dosis unicas.

Ecografía tridimensional en uroginecología

Resumen La ecografia 3D permite observar, en tres planos y sistema volumetrico, el suelo pelvico, la uretra, el rabdoesfinter y el cuello vesical. Los estudios existentes muestran una excelente correlacion entre los hallazgos 3D de esta nueva tecnologia y los estudios de presiones. La ecografia 3D se convertira, con toda probabilidad, en una nueva y excelente ayuda para el estudio de la disfuncion pelvica y la incontinencia urinaria.

SonoAVC: a new tool in early diagnosis of patent urachus with bladder prolapse

Polycystic ovarian syndrome: assessment with color Doppler angiography and three-dimensional ultrasonography.

We conducted a three-dimensional ultrasonographic evaluation of the size and structure of the ovaries of women who had clinical and biochemical findings suggestive of polycystic ovary syndrome. We carried out a comparative color Doppler frequency and color Doppler amplitude study of the vascular patterns of these ovaries. This study involved 65 women of reproductive age with polycystic ovary syndrome and 25 eumenorrheic women who were not taking hormonal contraceptives and who had a body mass index below 25 kg/m2. Compared to controls, women with polycystic ovary syndrome had larger ovaries and thicker stroma, increased impedance in the uterine arteries, increased stromal vascularity with d…

Gestación ectópica: evolución diagnóstica y terapéutica en la última década

Resumen El embarazo ectopico representa la implantacion de una gestacion fuera de la cavidad uterina. Esta situacion patologica se conoce desde el siglo XVII, y presenta una incidencia aproximada de 11-18 casos por cada 1.000 partos. Sin lugar a dudas, esta implantacion gestacional patologica representa una de las complicaciones mas graves del embarazo, y su incidencia se ha visto incrementada notoriamente en los ultimos 20 anos. En el presente articulo revisamos la evolucion en nuestro centro de esta enfermedad.

Fetus acardius: two- and three-dimensional ultrasonographic diagnoses.

Objective. To determine whether ultrasonographic detection of acardiac fetuses and diagnostic accuracy of related malformations improve with complementary use of two-dimensional ultrasonography, three-dimensional ultrasonography, and Doppler scanning. Methods. Three pregnant women with multifetal gestations who were found to have discordant fetuses on initial two-dimensional ultrasonographic scanning were subsequently scanned with three-dimensional ultrasonography and color Doppler ultrasonography. Results. Although the possibility of acardiac fetuses was entertained in all cases after two-dimensional ultrasonographic scanning, the diagnosis was confirmed, and the accuracy and extent of fet…

Quilotórax antenatal en feto euploide con translucencia nucal aumentada en el primer trimestre

Resumen Gestacion en que el feto presento una translucencia nucal aumentada en el primer trimestre; el cariotipo normal fue tras la amniocentesis. A las 33 semanas se observo un derrame pleural derecho que desplazaba el mediastino, asociado a polihidramnios. Se produjo un parto prematuro a las 33,4 semanas; se obtuvo un recien nacido que presento distres respiratorio y requirio colocacion de un drenaje toracico. La presencia de linfocitos en el liquido pleural oriento el diagnostico hacia un quilotorax. Aunque es conocida la asociacion entre translucencia nucal aumentada con cariotipo normal y resultados perinatales desfavorables, la asociacion con quilotorax es infrecuente.

Congenital Müllerian anomalies: a review of currently available imaging modalities

Congenital uterine anomalies are associated with infertility and adverse obstetric outcomes. The sensitivity of transvaginal sonography in diagnosing these anomalies ranges from 42% to 87%. More re...

Neoplasia sincrónica de endometrio y ovario

Resumen Este es el caso de una paciente con neoplasia sincronica de endometrio y ovario. Se presento a una edad joven (45 anos) y con signos clinicos de hipermenorrea. Posteriormente, mediante pruebas de imagen, hallamos la tumoracion ovarica. Los tipos histologicos fueron endometrioides en ambas localizaciones y, como en la mayoria de este tipo de neoplasias sincronicas, de bajo grado y estadio. Todos estos factores son de buen pronostico. Dentro de las neoplasias sincronicas, esta asociacion de tumores es relativamente frecuente; se caracterizan por tener buen pronostico y ser de bajo grado. Hay estudios en la actualidad cuyo objetivo es establecer criterios claros para diferenciar 2 neop…

Multimodality 3-dimensional volumetric ultrasound in obstetrics and gynecology with an emphasis in HDlive technique.

HDlive (high-definition live or real-time US), a new ultrasound software, combines a movable virtual adjustable light source in a software that calculates the proportion of light reflecting through surface structures, depending on light direction. The light source can be manually positioned to illuminate the desired area of interest. The ultrasound technician can control light intensity to create shadows that enhance image quality. HDlive is an innovation that will render even more realistic images of fetal anatomy and of gynecologic lesions. The full potential of this new technology is yet to be determined and deserves scientific evaluation.

Human Oviductal Gonadotropin-Releasing Hormone: Possible Implications in Fertilization, Early Embryonic Development, and Implantation1

The oviduct is host to gametes and early embryos at a critical point in their lives. It is clear that the interactions of gametes/early embryo with the maternal oviduct in an autocrine and paracrine manner provide a microenvironment that enhances fertilization, early embryonic development, and implantation. Moreover, there is considerable evidence that an extrahypothalamic GnRH may play a substantial role as a molecular autocrine/paracrine regulator in these events. Gametes and preimplantation embryos express GnRH and GnRH receptor at both messenger ribonucleic acid (mRNA) and protein levels. However, whether GnRH is produced by the human oviduct has not yet been demonstrated. We used RT-PC…

Prenatally detected double trisomy: Klinefelter and Down syndrome

Double trisomies are a rare occurrence. We report the first case of a Down and Klinefelter's syndrome (48,XXY,+21) in a fetus that was prenatally diagnosed during the 15th week of pregnancy. Even though the nasal bone was present, and the color-Doppler study of the ductus venosus and the nuchal thickness were normal, the maternal serum test results indicated an increased risk of Down syndrome and consequentially a genetic amniocentesis was performed. A 48,XXY,+21 karyotype was observed and the patient decided to terminate the pregnancy. In this case, we did not find the typical ultrasound (US) signs that would have led us to the chromosomopathy; furthermore, we emphasize the advantages of u…

HDlive ultrasound images in assisted reproduction treatment.

Abstract The volume ultrasound technology software known as the HDlive technique represents an innovative tool, a step towards an even more realistic anatomical visualization of pelvic organ structures. HDlive can help improve physician–patient communication with the aid of life-like images and might prove useful in the field of assisted reproduction treatment. The clinical application of this novel ultrasound technology in assisted reproduction treatment deserves scientific evaluation.

Abdominal wall defects: two- versus three-dimensional ultrasonographic diagnosis.

We diagnosed 12 cases of abdominal wall defects. The cases diagnosed occurred in 6 fetuses with omphalocele, 3 with gastroschisis, 2 with prune-belly syndrome, and 1 with pentalogy of Cantrell. Except for 1 case of gastroschisis first diagnosed on the basis of three-dimensional ultrasonography at 14 weeks' gestation, all cases were first detected by two-dimensional transabdominal ultrasonography and then reevaluated with three-dimensional ultrasonography using multiplanar and orthogonal plane modes. Although the original diagnosis was accurate on the basis of two-dimensional ultrasonography in 11 of 12 cases, additional information was obtained by three-dimensional scanning in all cases. Ou…

Diagnosis of Endometrial Carcinoma: Predictive Value of Transvaginal Color Doppler

The objective of this study was to determine whether transvaginal ultrasound plus color Doppler flow improve the ability to diagnose endometrial carcinoma and allow better discrimination between benign and malignant endometrial lesions. One hundred thirty women with abnormal uterine bleeding were evaluated with transvaginal color Doppler before fractional dilatation and curettage (D&C). The endometrial line thickness and endometrial characteristics were evaluated by endosonography. The resistive and pulsatile indices of the uterine arteries and of the endometrium were evaluated with transvaginal color Doppler. Following D&C and tissue diagnosis, women were divided into two groups, 62 with a…

The role of gonadotropin-releasing hormone in murine preimplantation embryonic development.

Previous studies have established the presence of an extrahypothalamic GnRH in a variety of tissues. GnRH receptor is known to be present in the placenta, which produces and secretes the decapeptide from the very early stages of placentation. We hypothesized that GnRH may play a role in the preimplantation development of embryos. To examine this hypothesis, we assessed GnRH and GnRH receptor messenger RNA (mRNA; RT-PCR) and protein expression (Immunohistochemistry) in preimplantation murine embryos at various developmental stages. Furthermore, preimplantation murine embryos were cultured with GnRH agonist and antagonist in vitro to assess the influence of GnRH analogs on embryo development.…

Tumor de Krukenberg secundario a adenocarcinoide apendicular

Resumen Las metastasis ovaricas de tumores apendiculares son excepcionales. Presentamos el caso de una mujer de 38 anos con una tumoracion ovarica bilateral sometida a histerectomia total con salpingo-ooforectomia bilateral, apendicectomia y omentectomia. El estudio anatomopatologico revelo la presencia de un tumor de Krukenberg secundario a un adenocarcinoide oculto de apendice. Asimismo, se realiza una actualizacion de estos casos.