bluuebunny/crossref_metadata_2025_split huggingface dataset:
WS09‐02Ultrasound diagnosis of adnexal masses
Authors: Valentin L. 
Published: March 2003

The basis of ultrasound diagnosis of adnexal masses is the gray scale ultrasound image. In our prospective study of 173 patients scheduled for laparotomy because of an adnexal mass, an experienced examiner correctly discriminated between benign and malignant masses in 95% of cases on the basis of subjective evaluation of the gray scale ultrasound image (sensitivity 92%, i.e. 22/24, specificity 96%, i.e. 143/149). A correct specific diagnosis (e.g. dermoid cyst, endometrioma, etc.) was made in 72 of the 173 women, i.e. in 42%. Adding Doppler ultrasound examination to gray scale imaging did not change the diagnostic accuracy, but it increased the confidence (as rated on a visual analogue scale) with which a correct diagnosis was made in 14% of cases. Increased diagnostic confidence was observed most often in stage I ovarian malignancies (83%, i.e. 5/6). Doppler ultrasound examination was not helpfull in the diagnosis of borderline tumors. For less experienced ultrasound examiners the use of mathematical models to calculate an individual risk of malignancy might be an alternative to subjective evaluation of the the gray scale ultrasound image. In a study of 136 consecutive women scheduled for laparotomy because of an adnexal mass, two mathematical formulas were cross‐validated prospectively: that of Tailor et al. (Ultrasound in Obstetrics and Gynecology 1997; 10 : 41–7) and that of Timmermann et al. (Am J Obstet Gynecol 1999; 181: 157–65). Both models performed less well than in the studies where they were created, the sensitivity and specificity of the first model being 71% and 82%, respectively, and the sensitivity and specificity of the second model 72% and 68%, respectively.ConclusionSubjective evaluation of the gray scale ultrasound image is an excellent method for discrimination between benign and malignant adnexal masses. Mathematical models hold promise but must be fine tuned on the basis of information from a very large number of tumors.
WS09‐04Ultrasound diagnosis of adnexal masses: computer modelling
Authors: Alcázar J. L. 
Published: March 2003

The differential diagnosis of adnexal masses still represents a challenge. The main goal is to determine whether a given mass is malignant or benign, in order to establish the best therapautical approach. When a clinician face to a woman diagnosed as having an adnexal tumor several parameters may be used to determine the nature of the mass, such as patient's age, menopausal status, clinical complaints, physical examination, tumor's sonographic and Doppler features and serum tumor markers. When these data are collected may be difficult to interpret them all together and the clinician has to rely in one or two of them to predict the diagnosis and to decide the management strategy, guided many times by own experience or strict protocols.A possible solution to this question may be the use of computer modelling. This means the use of statistical or mathematical models developed, using computer aid, to predict adnexal malignancy.Currently, there are two methods that may be used: Multiple Logistic Regression Analysis (MLRA) and Artificial Neural Networks (ANN).Both techniques allow to calculate the probability of a particular event has occurred, in this case a mass to be malignant or benign.By computer modelling, actual independent predictors parameters are identified and may be used combined and simultaneously to predict malignancy. Each method has advantages and disadvantages, being MLRA the statistical technique of choice and ANN a potential newer alternative to MLRA.Several studies have been published using one or both technique to predict adnexal malignancy. The results of these studies are encouraging showing a high diagnostic performance. All studies comparing MLRA to ANN showed the latter seems to be superior. However, it should be taken into account that most of these models have not tested prospectively.
WS09‐06What does contrast media add to three dimensional power Doppler evaluation of adnexal masses?
Authors: Šparac V. , Kupešić S. , Kurjak A. 
Published: March 2003

AimTo investigate the potential usefulness of contrast enhanced three‐dimensional (3D) power Doppler sonography in the differentiation of benign and malignant adnexal lesions.MethodsA total of 31 patients with complex adnexal lesions of uncertain malignancy at transvaginal B mode and/or color Doppler sonography were prospectively evaluated with three‐dimensional power Doppler sonography before and after injection of the contrast agent. Presence of a penetrating pattern and a mixed penetrating and peripheral pattern suggested adnexal malignancy.The results were compared with histopathology.ResultsThere were 10 cases of ovarian malignancy and 21 benign adnexal lesions. Of the 10 ovarian cancers, 6 (60%) showed vascular distribution suggestive of malignancy at nonenhanced 3D power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or a mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy with two benign lesions (fibroma and cystadenofibroma) which were misdiagnosed as malignant. The use of a contrast agent with three‐dimensional power Doppler sonography showed diagnostic efficiency (96.7%) that was superior to nonenhanced 3D power Doppler sonography (93.5%).ConclusionContrast enhanced 3D power Doppler sonography provides better visualizatoin of tumor vascularity in complex adnexal masses. If used together with 3D morphological ultrasound assessment, enhanced 3D power Doppler imaging might precisely discriminate benign from malignant adnexal lesions.
WS09‐08Sonographic and clinical characteristics of struma ovarii
Authors: Zalel Y. , Seidman D. S. , Oren M. , Achiron R. , Gotleib W. , Mashiach S. , Goldenberg M. 
Published: March 2003

BackgroundTo evaluate the preoperative clinical, laboratory and sonographic characteristics of struma ovarii.MethodA retrospective review of gynecologic patients operated for mature cystic teratoma over a 10‐year period, identified 16 cases of struma ovarii. These cases were the subject of this study and were compared to 32 cases of ovarian dermoid cysts.ResultsThe incidence of struma ovarii among all cases of dermoid cysts was 4.8%. Most patients were menopausal, the mean lesion diameter was 57.3 mm, occurred more frequently (68.8%) in the right adnexa and presented with normal CA‐125 level. Blood flow signals were detected from the center of the lesions in all cases. Rare cases presented with elevated tumor marker and low‐resistance blood flow. In dermoid cycsts, blood flow had a higher resistive index. In addition, no blood flow could be detected from the center of the echogenic lesion in dermoid (P < 0.0001).ConclusionIt is difficult to distinguish between struma ovarii and dermoid cysts, based on their sonographic appearance. Nevertheless, Doppler flow may aid in the preoperative diagnosis of struma ovarii. Blood flow signals, detected from the center of the echogenic lesions and low resistance to flow may be more common in struma ovarii.
WS10: Chromosomopathies WS10‐01Pathophysiology of increased nuchal translucency‐abnormalities of the extracellular matrix
Authors: Von Kaisenberg C.S. , Jonat W. , Brand‐Saberi B. , Farzaneh F. , Nicolaides K.H. 
Published: March 2003

ObjectiveIn about 80% of fetuses with trisomies, Turner syndrome, and in fetuses with skeletal abnormalities, genetic syndromes, structural abnormalities and cardiac defects, there is increased collection of fluid in the neck region. This can be visualized sonographically at 11–14 weeks of gestation as increased nuchal translucency thickness. The pathophysiology of this common phenotypic expression of different chromosomal abnormalities is uncertain, but there is some evidence that the underlying mechanism may be altered composition of extracellular matrix components and/or cardiac failure.MethodsWe performed a number of studies investigating nuchal skin tissue for various extracellular matrix components and cardiac heart failure using molecular techniques. We used northern blotting, immunohistochemistry, electron‐microscopy and in situ hybridization.ResultsStudies investigating the heart found increased levels of mRNA for ANP and BNP, and reduced levels of Calcium ATPase, whereas transcript levels for GATA‐4 were unchanged. Studies investigating components of the extracellular matrix in nuchal skin of trisomic fetuses found overexpression of ecm genes in trisomies (collagen type VI, collagen type IV, laminin) or an altered ratio of genes between normals and abnormals (collagen type VI).ConclusionsThe present data provide some evidence, that chromosomally abnormal fetuses with increased nuchal translucency at 12–14 week may suffer from an altered extracellular matrix of the heart and skin or transient heart failure.
WS12‐07Fetal venous and arterial circulation in hypoxic IUGR. From adaptation to decompensation
Authors: Ville Y. 
Published: March 2003

ObjectiveTo evaluate the changes in flow velocity waveforms in the mid‐cerebral artery and in the transverse cerebral sinus in growth restricted fetuses and to correlate these changes between them and with (1) flow velocity waveforms in the ductus venosus and (2) changes in computerized analysis of fetal cardiotocogram.DesignFetuses between 22 and 37 weeks' gestation with an estimated fetal weight below the 5th centile were included in this prospective longitudinal study. Doppler measurements in the umbilical artery, descending aorta, middle cerebral artery, transverse cerebral sinus and ductus venosus were recorded. Fetal heart rate was analyzed by a computer system according to the Dawes‐Redman criteria.ResultsBlood flow within the midcerebral artery and that in the cerebral transverse sinus follow a mirror image distribution. Arterial redistribution is already present when alteration in the venous cerebral circulation develops.We measured a significant correlation between pulsatility index in the transverse cerebral sinus and in the ductus venosus over the study period and at delivery. There was a negative correlation between these indices and short and long‐term variability of the fetal heart rate. There was a parallel increase in pulsatility in the ductus venosus and the transverse cerebral sinus. These changes were inversely correlated with fetal heart rate variability and preceded fetal distress.ConclusionCerebral venous blood flow in IUGR fetuses may be a useful additional investigation to (1) understand better the mechanism of cerebral redistribution in hypoxemic IUGR and (2) to discriminate between fetal adaptation and fetal decompensation in chronic hypoxemia.
WS14‐03Fetal extremities – three‐dimentional approach
Authors: Kos M. 
Published: March 2003

BackgroundTo assess particular features of fetal extremities evaluation using three‐dimensional ultrasound.MethodsTotal of 276 patients were selected from our routine outpatient clinic or sent for supervision from other clinics because of a suspected fetal anomaly. Patients were examined during a three year period (Jan1997‐Dec1999). Pre‐selected patients were examined with standard 2‐D ultasonic devices, and their gestation age ranged between 12 and 40 weeks. 3‐D ultrasound devices were Combison 530D and Voluson 530D MT (Kretztechnik, Zipf, Austria) with a 3–5 MHz annular array transducer for three dimensional volume scanning.ResultsIn 28/276 patients the initial diagnosis was suspected by 2‐D sonography at entry in the study. In 18/28 suspected cases diagnosis was determined after examination by 3‐D sonography (15/28 clubfoot, 3/28 other limb anomalies). The diagnosis of clubfoot was confirmed In 17/28 cases after delivery or termination of pregnancy, meaning that 2/18 cases of clubfoot were not detected using ultrasonography. In all of 3 other cases the sonographic diagnoses of hand contractures and micromelia were confirmed after termination of pregnancy.Conclusion3‐D sonography accurately visualized angular and structural limb anomalies. In two cases of severe oligohydramnios we missed clubfoot by 3‐D sonography.
F12Diagnosis of ovarian cancer with ultrasound, serum CA125 and logistic regression
Authors: Lawrence A. C. , Aslam N. , Wolfer B. , Elson C. J. , Jurkovic D. 
Published: March 2003

BackgroundThe aim of this study was to compare the accuracy of a logistic regression model for the diagnosis of ovarian malignancy to subjective assessment made by experienced ultrasonographers at the time of the scan.MethodAll patients undergoing surgery for known adnexal masses were assessed preoperatively using transvaginal ultrasound and serum CA125 measurements. A number of demographic, morphological and Doppler parameters necessary for the regression analysis were recorded. The risk of malignancy was then calculated using a previously published multivariate regression model. Independently to these calculations, an attempt was made to establish the histological diagnosis based on subjective assessment of ultrasound findings by experienced operators.ResultsA total of 161 patients had surgery for adnexal masses between August 1997 and June 2000. Of these, 115 had benign masses, 9 borderline and 37 malignant. The multivariate logistical regression model diagnosed ovarian malignancy with a sensitivity of 68.9% and specificity of 79.7%. The subjective assessment of the malignancy gave a sensitivity of 92.7% with a specificity of 78.2%. The calculated likelihood ratios were 3.4 and 4.3, respectively.CommentMultivariate logistic regression model is less accurate than subjective assessment by experienced observers in the diagnosis of ovarian cancer.
F122Fetal cardiology considering fetal intervention, and animal model of fetal pacing and fetal cariopulmonary bypass
Authors: Chiba Y. , Kawamata K. , Bando K. , Kawahira Y. 
Published: March 2003

BackgroundTwo hundred two cases of structural heart diseases were diagnosed prenatally, and 23 cases of complete AV block were delivered. However, their mortality has not been decreased. We have to discuss the possibility of fetal interventions for heart diseases.MethodsThe mortality of fetal heart diseases diagnosed prenatally were discussed. Resent new findings of fetal cardiology considering fetal mortality and the possibility of fetal interventions were discussed. Animal experiments for fetal cardiac interventions were performed.ResultsThe total mortality of fetal structural heart diseases was 60.2%. The mortality of hydropic heart diseases was 92%. The mortality of hypoplastic left heart syndrome was 100%, that of Ebstein's anomaly was 88%, and that of pulmonary valve atresia or stenosis was 64%. The total mortality of complete AV block was 30.4%. That of hydropic complete AV block was 50%. Fifteen cases of complete AV block were performed implantation of pacemaker after birth. The youngest case was 32 weeks delivered, the birth weight of which was 1906g. The procedure of fetal intervention should be simple. They will be aortic valvotomy, pulmonary valvotomy, enlargement of foramen ovale, and fetal pacing. Considering fetal or neonatal interventions for pulmonary atresia or critical stenosis, the findings of sinusoidal communication is essential. According to the good resolution of ultrasonic equipment, details of sinusoidal communication can be diagnosed. We have started group study to select cases to be considered cardiac interventions for fetuses and to develop surgical technique by support of japanese ministry of health and Welfare. We performed the implantation of pacemaker to fetal ram and experiments of fetal cardiopulmonary bypass.
Ectopic pregnancy F16Natural course of ectopic pregnancy evaluated by transvaginal sonography
Authors: Okitsu O. , Nakasaka H. , Mimura T. 
Published: March 2003

BackgorundSome of the cases with ectopic pregnancy (EP) may have spontaneous resolution without any treatment. Our aim of this study was to survey natural course of EP with serial sonographic assessment.MethodAll patients with EP from 1995 to 2000 were recruited. Inclusion criteria were 1. Positive hCG test, 2. Adnexal mass, suggestive of EP depicted by transvaginal sonography, 3. No fetal activity, 4. Pelvic fluid less than 300 mL, 5. Minimal symptoms, 6. Conservative management might be profitable to the patients, and 7 Informed consent. Under Hospitalization, the patients underwent at least one sonographic examination per day. When the amount of intraperitoneal hemorrhage proved to be increasing during the follow‐up, surgical treatment was performed.ResultsOf 34 cases with ectopic pregnancy, 13 cases with tubal pregnancy had emergency laparotomy immediately after admission. One case with cervical pregnancy was treated with methotrexate. Other 20 cases were enrolled in this study. Of the cases, 10 had laparotomy because of increasing intraperitoneal hemorrhage and/or worsening symptoms. In other 10 cases, spontaneous regression of the mass and decline of hCG level were confirmed. They could be discharged without any surgical treatment.ConclusionExpectant management was successful in 10 (50.0%) of the patients, in which natural course of EP was followed by transvaginal sonography.
F21Recurrent non inmune hydrops fetalis in parents with shared HLA DR and DQ
Authors: Pérez Fernández R. , De León J. A. , Pintado P. , Orera M. , Carbone J. , Ortiz L. 
Published: March 2003

IntroductionNon immune hydrops fetalis (NIHF) is defined as the extra cellular accumulation of fluid in tissues and serous cavities, without evidence of circulating antibodies against red blood cell antigens. NIHF is the result of a heterogeneous group of conditions including cardiovascular, pulmonary, chromosomal, haematology, infectious disorders and deposit disease.A 34‐year‐old pregnant woman with obstetrical history of two prior perinatal deaths between 29th and 30th weeks of gestation, all associated with foetal hydrops. In the prior pregnancy we made a exhaustive study of the foetal blood, obtained by cordocentesis, and the parents' blood. This study included haematology, infectious serology, hormonal and immune disorders and it was detected a shared HLA DR and DQ. In the current pregnancy, the foetus has developed hydrops at the 20th week of gestation which has been diagnosticated by ultrasound. Once again the results of the research has been normal and we have tried to correct the hypoproteinemia with albumen infusion by cordocentesis. The following up has showed the increase of the hydrops concluding with cardiovascular failure and foetal death.DiscussionThe mortality rate of recurrent NIHF is over the 80% of the cases and depends on the ethiology. The epidemiological studies had demonstrated the association between abortions and parents who shared HLA DR and DQ but the association with recurrent NIHF is not a proved fact.The diagnosis of hydrop fetalis is by ultrasound on detection of skin thickness greater than 5 mm with fluid accumulation in at least one of the serous cavities. It is also necessary to obtain a detailed ultrasound scan for structural defects, echocardiography and Doppler blood flow studies of mayor foetal vessels. Ultrasound is an important tool used in the following up of NIHF and it makes possible the use of the cordocentesis therapy in some cases.
F27A correlation of the uterine and ovarian perfusion with parity of women having a history of recurrent spontaneous abortions
Authors: Jirous J. , Diejomaoh M. , Al‐Othman S. , Al‐Abdulhado F. , Al‐Xmarzouk N. , Sugathan T. 
Published: March 2003

BackgroundTo explore a relationship between the incidence of recurrent spontaneous abortions (RSA) and values of Doppler indices characterizing the uterine and ovarian perfusion in women with history of Primary and secondary RSA.MethodA prospective study was carried out in which color Doppler transvaginal ultrasonography was used to estimate the endometrial thickness (ETH), the uterine pulsatility index (UTAP) and the intraovarian arterial resistance index (IOARI) on the 21st day of a regular 28‐day menstrual cycle in a control group of 19 healthy fertile nonpregnant parous women and 81 cases of nonpregnant women having a history of RSA.ResultsA highly significant difference (P < 0.001) was observed between UTAPI and IOARI values of control group and women with primary RSA. The same results were obtained for secondary RSA women who had some more 3 abortions. No difference was found for ETH values in control and study groups.ConclusionOur study has demonstrated the presence of a significantly decreased uterine and ovarian perfusion in nonpregnant women with primary RSA and secondary RSA if more than 3 abortions occurred. The significance of this result in the management of RSA requires further study. There was no difference between UTAPI and IOARI values in the control group and secondary RSA women with only 3 abortion.
F33Application of early sonographic markers of Down syndrome to pregnancies achieved by assisted reproduction techniques
Authors: Lara C. , Bellver J. , Iberico G. , Remohí J. , Pellicer A. , Serra‐Serra V. 
Published: March 2003

BackgroundBiochemical markers need to be adjusted in pregnancies following assisted reproduction techniques (ART) for proper interpretation of second trimester Down syndrome screening results. However, little information is available on the application of first trimester sonographic markers of Down syndrome to ART pregnancies.MethodsThe crown‐rump length (CRL), nuchal translucency (NT), fetal heart rate (FHR), femur length (FL) and humerus length (HL) were measured transvaginally in 301 normal fetuses (159 singletons and 142 twins) between 10 and 14 weeks gestation. A control group of naturally conceived fetuses (n = 91) was compared to those obtained after intrauterine insemination (n = 35), in vitro fertilization (IVF) (n = 35), intracytoplasmic sperm injection (ICSI) (n = 47), combined IVF‐ICSI (n = 25) and ovum donation (n = 68). Adjustment for gestational age was performed by dividing the sonographic measurement by the CRL in each fetus.ResultsNaturally conceived fetuses showed similar NT/CRL, FHR/CRL, FL/CRL and HL/CRL ratios than ART fetuses (P = NS). No differences were observed either between the various ART pregnancies (P = NS).ConclusionOur preliminary results suggest that no adjustments are needed for the application of early sonographic markers of Down syndrome to pregnancies achieved by ART.
F42Doppler assessment of the intervillous blood flow before and after selective twin reduction in the reduced twin placenta
Authors: Antsaklis A. , Miliu‐Paulescu D. , Doublis D. , Daskalakis G. , Theodhosi G. 
Published: March 2003

BackgroundThe aim of this study was to compare the Doppler parameters (PI, RI) from the intervillous blood flow of the reduced twin placenta before and after the selective twin reduction.MethodWe studied 21 patients with triplets (trichorionic triamniotic) who underwent selective twin reduction (to twin pregnancy) at 10 weeks gestation from the last menstrual period. The intervillous blood flow of the reduced twin placenta was studied using pulsed color Doppler before and 10 days after the selective reduction. The arterial waveform signals were assessed by resistance index and pulsatility index.ResultsArterial blood flow signals isolated from the intervillous space before the selective reduction did not show significant difference in RI (0.35 ± 0.03) and PI (0.78 ± 0.04) comparing with the values obtained 10 days after the reduction (RI 0.36 ± 0.03 and PI 0.73 ± 0.02).ConclusionsThe impedance to flow did not show significant difference after a relatively short period from the embryos death.