Translabial ultrasonography and placenta previa: does measurement of the os-placenta distance predict outcome?

The aim of this study was to assess the value of the measurement of os-placenta distance by translabial ultrasonography in the evaluation of placenta previa. This method was used in 40 women with suspected placenta previa to measure the distance between the placenta and internal cervical os. Sonographic diagnoses were compared to placental location determined at delivery. Translabial ultrasonography proved superior to the transabdominal route in both diagnosis and exclusion of placenta previa. Measurement of the os-placenta distance can be used as an adjunct to clinical assessment to predict the likelihood of safe vaginal delivery in cases of suspected placenta previa.

Implications of unsuspected pulmonary embolism detected by computed tomography.

OBJECTIVE: To describe the computed tomography (CT) findings and clinical implications of pulmonary thromboembolism noted incidentally on CT. PATIENTS AND METHODS: The authors reviewed the CT studies and medical records for nine patients in whom CT had shown clinically unsuspected pulmonary thromboembolism. The study group consisted of seven men and two women ranging in age from 51 to 75 years, who were referred for CT over a 5-year period for a variety of indications. The location of the emboli and the presence and location of parenchymal and pleural abnormalities were determined. Subsequent changes in patient care were analysed. RESULTS: The locations of the thromboemboli were described according to pulmonary zone. One case involved zone 1 (main pulmonary artery to a lung), all involved zone 2 (first-order branches), and four involved extension into zone 3 (second-order branches). No emboli were distinguished in zone 4 (beyond the segmental arteries). Four patients had pleural-based opacities characteristic of infarcts, and three had pleural effusions. Eight patients underwent confirmatory testing. A vena cava filter was placed in three patients, one of whom also received anticoagulation therapy. The other six patients were treated by anticoagulation alone. All of the patients survived and were discharged. CONCLUSION: Radiologists should watch carefully for occult pulmonary thromboembolism when interpreting CT studies of the thorax. Establishing this diagnosis can result in immediate changes to treatment and possibly a reduction in the substantial morbidity and mortality associated with untreated pulmonary emboli.

Ultrasound of the abdomen.

In summary, ultrasonography and its recent advances appear ideally suited to a number of conditions common in the critically ill patient and the ICU setting. Depending on the clinical situation, and, providing appropriate technical expertise is available, ultrasonography can both gather diagnostic information and, where indicated, guide therapeutic intervention.

Human orthotopic small intestine transplantation: radiologic assessment.

The authors describe the postoperative anatomy and review the radiologic examinations of five patients who underwent orthotopic small intestine or combined orthotopic liver and small intestine transplantation. Mucosal thickening of the transplanted intestine was demonstrated on the first postoperative contrast material-enhanced images and was due to submucosal edema. This resolved within 2 weeks in the long-term survivors. Bowel peristalsis appeared normal as early as 31 days after transplantation. Contrast-enhanced examinations of the intestine were useful to exclude surgical complications such as anastomotic leaks or strictures, but were insensitive for biopsy-proved cytomegalovirus enteritis or rejection.

Substrate utilization for estrogen synthesis by human fetal membranes and decidua.

We have investigated the ability of tissue explants of human amnion, chorion, and decidua to produce estrone when incubated alone or in the presence of estrone sulfate, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, or testosterone. Amnion produced very little estrone from any substrate. Chorion utilized all substrates and decidua utilized estrone sulfate and dehydroepiandrosterone sulfate for estrone production. For both chorion and decidua, estrone sulfate was quantitatively the most important substrate. Chorionic tissues obtained after spontaneous labor produced greater levels of estrone than tissues obtained before labor (p less than 0.05). We could demonstrate no effect of cortisol, estriol, progesterone, prostaglandins, oxytocin, or dibutyryl cyclic adenosine monophosphate on estrogen production. We also measured endogenous concentrations of estrone and estradiol in fetal membranes. We found no significant difference in tissue concentrations between the two methods of delivery. There was no significant correlation between estrone and estradiol concentrations and distance from the placenta. We conclude that human chorion and decidua can produce estrogen, which may have some role in determining the timing of parturition.