Terbutaline in diagnosis of interstitial fallopian tube obstruction.

Effectiveness of terbutaline, a potent uterine muscle relaxant, for differentiation of temporary and anatomic interstitial fallopian tube obstruction (IFTO) at hysterosalpingography (HSG) was explored. In 43 IFTO evaluated, HSG after terbutaline showed patency in only one of 16 tubes in which IFTO was caused by spasm or other temporary cause. We conclude that terbutaline is not helpful in differentiating temporary from anatomic tubal obstruction during HSG.

Transcatheter tubal sterilization in rabbits. Technique and results.

RATIONALE AND OBJECTIVES: A potential method of nonsurgical tubal sterilization was tested in rabbits. METHODS: Metal coils were designed which could be placed into the uterotubal junction using transvaginal fluoroscopic fallopian tube catheterization. These metal coils were successfully placed unilaterally in the uterotubal junction of 32 rabbits. The contralateral fallopian tube and uterus were used as a control. The rabbits were bred, and the presence of pregnancies was confirmed by palpation. RESULTS: In 21 rabbits (66%), the coil stayed in place. Sixteen rabbits had multiple gestations on the side without the coil and no gestations on the side with the coil. Three rabbits had gestations on both sides, even though the coil was in place, and two rabbits never conceived. In 11 rabbits (34%) the coil was dislodged as early as 5 days and as late as 18 weeks after the procedure. Five of these 11 rabbits had bilateral embryos, 4 had embryos only on the side contralateral to where the coil had been, and 2 never conceived. CONCLUSIONS: The metal coil does prevent conception if it stays in place at the uterotubal junction. However, the coil failed to prevent pregnancy in 3 of 19 rabbits, and was dislodged in 11 rabbits, giving an overall failure rate for contraception of 44%.

Transvaginal fallopian tube catheterization in an animal model.

A rabbit model for testing the safety and effectiveness of diagnostic and interventional techniques of fallopian tube catheterization is presented. Hysterography with injection into the terminal portion of the uterine horn visualized the fallopian tube in only 6% of cases; however, this increased from 33% to 50% by pretreatment with progesterone, administration of glucagon or phentolamine, or increased pressure of injection with balloon obstruction of the uterine horn. Salpingography with a catheter introduced in the tubal ostium or directly inside the tube was most effective and resulted in a consistent (100%) visualization of the fallopian tube. The technique also allowed coaxial introduction of small diameter guidewires and catheters deep into the fallopian tube.

Gadolinium-DTPA transplacental transfer and distribution in fetal tissue in rabbits.

RATIONALE AND OBJECTIVES: The authors assessed to what extent the commonly used the magnetic resonance imaging contrast agent, gadopentetate dimeglumine, crosses the placenta. METHODS: Eight pregnant rabbits in the third trimester were injected with 0.1 mmol/kg of gadopentetate dimeglumine, and killed 5, 15, 30, or 60 minutes after injection. Placental and fetal tissues were analyzed for gadolinium content. RESULTS: Placental concentrations of gadolinium were initially high (16.6 +/- 3.4 micrograms/gram) and then declined with a biexponential pattern. Initial gadolinium levels in the fetal organs were low and remained so except for the fetal kidneys, which showed increased levels of gadolinium from 4.3 +/- 1.1 micrograms/gram at 5 minutes to 6.8 +/- 1.8 micrograms/gram at 60 minutes. CONCLUSIONS: The results indicate that gadolinium does cross the rabbit placenta, and that concentrations in the placenta and the fetal urinary tract are sufficient for imaging as well as possible fetal toxicity.

Salpingitis isthmica nodosa: results of transcervical fluoroscopic catheter recanalization.

OBJECTIVE: To investigate the role of transcervical tubal catheterization in diagnosis and treatment of proximal tubal obstruction associated with salpingitis isthmica nodosa. DESIGN: Retrospective case study. SETTING: University hospital and outpatient radiology practice. PATIENTS: Fifty-two women with proximal tubal obstruction associated with salpingitis isthmica nodosa. INTERVENTION: Selective salpingography and catheter recanalization using fluoroscopic guidance. MAIN OUTCOME MEASURES: The number of tubes visualized to the fimbria as a percentage of the tubes with proximal tubal obstruction on the initial hysterosalpingogram was determined as a measure of diagnostic efficacy. To evaluate the treatment potential of catheter recanalization, the patients were grouped according to tubal status at the conclusion of the procedure and subsequent pregnancies were evaluated. RESULTS: Forty-seven of 65 tubes (72%) with proximal tubal obstruction were recanalized successfully. Among the 19 women who were able to conceive only via a recanalized salpingitis isthmica nodosa tube, there were 6 live births (32%) and two tubal pregnancies (10%). CONCLUSION: Selective salpingography allows complete tubal diagnosis in almost three fourths of patients with proximal tubal obstruction and salpingitis isthmica nodosa. The radiographic diagnosis of salpingitis isthmica nodosa may be pressure dependent. Intrauterine pregnancies occur via recanalized salpingitis isthmica nodosa tubes, therefore catheter recanalization may be attempted before tubal microsurgery or IVF in patients with proximal tubal obstruction and associated salpingitis isthmica nodosa.

Diagnosis of cornual obstruction by transcervical fallopian tube cannulation.

Interstitial fallopian tube obstruction (IFTO) occurs in 15% of hysterosalpingograms (HSG) performed for infertility. Conventional HSG or laparoscopy may not differentiate cornual spasm or other temporary cause from true obstruction. We used transcervical cannulation of the proximal oviduct with a 3-F Teflon catheter and flexible guidewire 0.018 inch (0.043 cm) in diameter under hysteroscopic or fluoroscopic guidance to evaluate IFTO in 28 patients. Fluoroscopic catheterization techniques with selective salpingography demonstrated patency in 84% of obstructed tubes. Hysteroscopic cannulation with direct visualization by laparoscopy or laparotomy was successful in 92%. In one patient, perforation of the isthmus occurred without sequelae. Transcervical coaxial cannulation of the proximal oviduct is an effective method for evaluating cornual obstruction.

An improved method of needle localized biopsy of nonpalpable lesions of the breast.

We have created a modified technique of localization biopsy of the breast that more easily identifies the position of the wire tip after placement and before biopsy. After wire placement, metallic skin markers are placed on the nipple and wire entry site. The patient is then positioned on a roentgenography table in the same position to be used during biopsy. A supine roentgenogram of the breast is obtained. At the time of the biopsy, this roentgenogram is aligned with the corresponding markers on the skin of the patient and the position of the wire tip is noted. A curvilinear incision along Langer's lines can then be made at that site. This procedure was used in 53 consecutive biopsies of nonpalpable mammary lesions. In all instances, the biopsy incisions were independent of the wire insertion sites and in each instance, the lesion was excised in a single specimen. Compared with other techniques, our method is simple, inexpensive, requires no special equipment and results in only a minimal increase in radiation dose to the breast (50 millirad). The decrease in the amount of tissue dissection without decreasing accuracy afforded by our technique can improve compliance with the American Cancer Society's recommended surgical guidelines for breast preservation therapy.

Endoscopic transvaginal approach to the rabbit uterine cervix: improvement in the technique of selective tubal catheterization.

RATIONALE AND OBJECTIVES: The authors compared two methods of selective fallopian tube catheterization in female rabbits. METHODS: Technical success rates and procedure times in two groups of animals were compared. Group 1 consisted of 20 female rabbits catheterized with a fluoroscopic technique. Group 2 consisted of 55 rabbits catheterized with a combination of endoscopic and fluoroscopic guidance. RESULTS: The technique used in group 2 allowed a statistically significant reduction in the time required for cervical catheterization and the total procedural time (P < .01). There was a parallel statistically significant reduction in fluoroscopy time (P < .01). Technical success rates and adverse effects were similar for the two techniques. CONCLUSION: The combined endoscopic-fluoroscopic technique requires a shorter time than the established fluoroscopic technique and should be considered for future selective tubal catheterization experiments in rabbits.

Abdominal aortic aneurysm: incidence in a population at risk.

One hundred twenty patients aged fifty years and over underwent screening by ultrasound for abdominal aortic aneurysms as part of their routine follow-up visit to a cardiologist. The overall incidence of aneurysm greater than or equal to 4 centimeters in diameter was 5%. In the 84 men with aortas less than 4 centimeters, the average aorta size was 2.4 centimeters. In the 30 women with aortas less than 4 centimeters, the average aorta size was significantly smaller, 1.9 centimeters (p less than .001). It was discovered that men who smoke and have hypertension have a statistically significant increase in aorta size compared to those men without these risk factors (less than .05). The results indicate that the incidence of abdominal aortic aneurysm is probably high enough in this population to justify screening by ultrasound.

Selective salpingography and fallopian tube recanalization.

Obstruction of the uterine (proximal) end of the fallopian tube is noted on up to 20% of hysterosalpingograms and has a variety of underlying causes. Definitive diagnosis and treatment in the past have required laparoscopy or laparotomy with tubal resection. Selective salpingography and fallopian tube recanalization with fluoroscopically guided catheters has emerged as an improved method both for diagnosis and treatment in these patients. Technical success rates for overcoming the obstruction and visualizing distal tubal anatomy range from 76% to 95%. Pregnancy rates after the procedure vary depending on the patient populations studied; however, early results indicate a greater than 50% intrauterine pregnancy rate by 1 year. The rate of ectopic pregnancy is approximately 10% and that of early tubal reocclusion is less than 30%. Selective salpingography and fallopian tube recanalization is recommended as the first intervention in patients with obstruction of the proximal fallopian tube.

Women's imaging fellowships: development and future.

Fellowships, which consist of training in predominantly breast imaging and in gynecologic and obstetric sonography, have steadily increased in number since 1992. There are currently 10 such fellowships, and the majority of these are called "women's imaging fellowships." All 19 fellows (100%) trained between 1992 and 1996 have immediately gained employment upon completion of the training, compared with the 86% employment rate of radiology fellows in general. Indications are that women's imaging fellowships will continue to provide subspecialists in radiology oriented to the imaging requests of obstetrician-gynecologists and other physicians who take care of women.

Use of hydrophilic guide wires in the fallopian tubes: effect on sperm survival and mouse embryo development.

Hydrophilically coated guide wires from two different manufacturers were tested in vitro for potential use in the fallopian tubes. Incubation of the guide wires and scrapings from the guide wires with sperm and with mouse embryos did not show any deleterious effect on sperm survivability or embryo development. These "slippery" guide wires may prove useful for fallopian tube catheterization.

Nonsurgical fallopian tube recanalization for treatment of infertility.

Fluoroscopic transcervical fallopian tube recanalization was performed in 100 consecutive patients with infertility and proximal tubal obstruction documented with hysterosalpingography. In 86 patients, the procedure enabled at least one tube to be opened. Twenty-six intrauterine pregnancies resulted from the successful recanalization. A well-defined subset of 20 patients were evaluated to better define the treatment effect of fallopian tube recanalization. All 20 had bilateral proximal tubal obstruction without other tubal disease, and all had been recommended for tubal microsurgery or in vitro fertilization. Recanalization of one or both tubes was successful in 19 of these women (95%). Nine patients conceived (47%) without receiving any other therapy, and the average time from procedure to conception was 4 months. All pregnancies were intrauterine. Eight of the 10 patients who did not conceive underwent follow-up hysterosalpingography an average of 6 months following the procedure; four (50%) demonstrated reocclusion of both tubes. The authors conclude that nonsurgical fallopian tube recanalization is an effective treatment for infertility caused by proximal tubal obstruction.

Fallopian tubes: improved technique for catheterization.

Successful fallopian tube catheterization for diagnosis or treatment of infertility combines hysterosalpingographic and angiographic techniques. An improvement in the catheterization strategy was developed so that angled, tortuous, or more distally obstructed fallopian tubes could be catheterized. In 22 patients, 38 fallopian tubes were catheterized by using this strategy. In nine tubes (24%), forceful ostial injection alone of contrast material was able to open and/or depict the fallopian tube. In 13 tubes (34%), a discrete obstruction was recanalized by using the standard fallopian tube catheterization set. In 12 tubes (32%), successful recanalization required the use of a softer, tapered guide wire and catheter. In four tubes (10%), recanalization was unsuccessful.

Radiologic evaluation of the thymus in juvenile myasthenia gravis.

Clinical records and chest radiographs of nineteen patients with juvenile myasthenia gravis treated by thymectomy were reviewed retrospectively. Correlation of radiographic findings, clinical data, and pathologic observations were sought to determine the value of radiography in the pre-operative assessment of juvenile myasthenia gravis patients. Although the vast majority of patients had normal plain films and tomographic chest radiographs the thymuses in seventeen of the nineteen patients were pathologically abnormal. The pathologic abnormalities consisted of hyperplasia and/or the presence of germinal centers within the glands. Despite these histologic abnormalities, the weights of the surgically removed thymuses were generally in the range of normal for patients of this age. None of the nineteen patients had a thymoma. In our series, there was no apparent benefit from radiographic examination of the thymus gland in consideration of thymectomy for patients with juvenile myasthenia gravis.

Device for hysterosalpingography and fallopian tube catheterization.

A device was developed for hysterosalpingography and fallopian tube recanalization. It differs from the previously used vacuum-cup device in that the central shaft slides and has an acorn-shaped tip. Optimal results were obtained in all 14 women (100%) who underwent catheterization with the new device; optimal results were achieved in only five of eight women (62%) who underwent catheterization with the fixed-shaft device during the same time period.

Selective injection of contrast media: inflammatory effects on rabbit fallopian tubes.

The inflammatory effects of fallopian tube catheterization and selective injection of seven contrast agents (ethiodized oil, diatrizoate meglumine 52%, diatrizoate meglumine 66%, iothalamate meglumine 60%, iopamidol, ioxitol, and ioxaglate) were evaluated in 88 rabbits. The contrast agent used was randomly selected and selectively injected after unilateral catheterization; the contralateral side was used for control. Pathologic inspection of right and left uteri with attached fallopian tubes and ovaries was done without knowledge of side of catheterization or duration of time since catheterization. The degree and location of inflammation were noted. Inflammation disappeared by 4 days in five of seven contrast agents. Iothalamate meglumine 60% and iopamidol required 2 weeks for disappearance of inflammation. Essentially no inflammation was associated at any time with ioxaglate. These findings suggest that all of these contrast agents would be clinically acceptable for direct injection into the human fallopian tube.

Focal calcifications in otherwise ultrasonographically normal ovaries.

PURPOSE: To analyze the natural history, clinical importance, and need for follow-up in patients with discrete calcifications in otherwise ultrasonographically (US) normal ovaries. MATERIALS AND METHODS: US scans obtained in 28 women with ovarian calcifications but without masses or other structural abnormalities were retrospectively reviewed. Follow-up findings were available in 15 women (mean age, 38.0 years; range, 26-72 years). RESULTS: Two of the 15 women had trilateral calcifications. Thus, 17 ovaries had focal calcifications. Histopathologic confirmation was obtained in 10 cases; follow-up US findings, five cases; and follow-up laparoscopic findings, two cases. In 13 (76%) of the 17 ovaries, calcifications were not clinically important. In four (24%) of the 17, the calcification was the initial or only manifestation of a neoplasm. Lesions were benign in all four of these ovaries: There was one dermoid, one mucinous cystadenoma, and two adenofibromas. CONCLUSION: Until more data are available, findings of calcifications in ovaries with otherwise normal US findings warrant some form of follow-up.

First-trimester diagnosis of exencephaly.

First-trimester diagnosis of fetal exencephaly is reported. Vaginal ultrasonography showed a normal volume of fetal brain with abnormal internal anatomy. The diagnosis was confirmed by repeat ultrasonography at 14 weeks and at subsequent termination of pregnancy. This is the earliest reported diagnosis of exencephaly by prenatal ultrasonography.